Cervical Cancer Diagnosis
(Pap test, colposcopy, cervical conization, other tests)

If the Pap test is normal (formerly class I), it is repeated at the interval the doctor has determined to be appropriate for the woman. If the Pap test is atypical (former class II), the doctor likely will recommend to repeat the test in 3 or 6 months. There might have been an infection of the cervical canal or a vaginitis, which caused the cervical cells to look atypical, in which case the repeat test likely will be normal again.

However, if the atypical Pap test remains, or if the initial Pap test showed dysplasia, it is better to refer the woman to a gynecologist who is trained in colposcopy.    

What is colposcopy?

What is conization?

This is a procedure, which can be done on a day-care basis. The specialist removes a cone-shaped portion of cervical tissue in order to be able to send a block of tissue to the pathologist. This tissue sample includes the socalled "transformation zone", which is the line where the lining of the cervical canal meets the ouside surface lining. With the hormonal changes within the menstrual cycle over a lifetime this is the high risk area from which most cancers of the cervix arise. If there is cancer in this conical tissue sample, the pathologist can indicate exactly how deep the cancer went and whether or not any cancer was present "in the margins". In other words: the specialist did not get all the cancer, if the margin was not free of cancer; but it would be an early cancer, if the magin was free of cancer. There are situations where a cone biopsy should not be done: in the case of a cancer of the cervix that could be identified by colposcopy and where the biopsy confirmed that it is indeed invasive. In this case conization is not radical enough, as cancerous tissue would be left behind. After detailed staging appropriate cancer therapy is necessary!

What other tests?

For instance, a CT scan of the pelvis and possibly the region of the aorta should be done to rule out any metastases to pelvic or paraaortic lymph glands. A chest X-ray is done to rule out lung metastases. Cystoscopy and proctosigmoidoscopy check out the bladder and the rectum/sigmoid colon area for metastases. If there is evidence of ovarian involvement, an exploratory laparotomy may have to be undertaken. Blood tests involve liver function tests to rule out liver metastases, renal function tests to rule out kidney obstruction as well as general blood tests for tumor markers and bone marrow function. Occasionally special circumstances will require other tests in certain situations such as an MRI scan or a lymphangiogram to study the lymphatic flow from the legs into the paraaortic lymph glands. With metastases along the aorta there would be a blockage of the lymphatic drainage. This information is necessary for staging in cervical cancer that has spread.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on gynecological tumors.

2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on gynecological tumors.

3. WG Quint et al. J Pathol 2001 May;194(1):51-58.

4. A Duenas-Gonzalez et al. Am J Clin Oncol 2001 Apr;24(2):201-203.

5. BD Kavanagh et al. Am J Clin Oncol 2001 Apr;24(2):113-119.

6. K Nakanishi et al. Skeletal Radiol 2001 Mar;30(3):132-137.

7. M Follen et al. Cancer 2001 May 1;91(9):1758-1776.

Last Modified: Dec. 3, 2006