Cervical Cancer: Diagnosis

Aprobado por la Junta Editorial de Cancer.Net, 09/2023

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How cervical cancer is diagnosed

There are different tests used for diagnosing cervical cancer. Not all tests described here will be used for every person. Some or all of these tests may be helpful for your doctor to plan the treatment of your cancer. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

The following tests may be used to diagnose cervical cancer:

  • Bimanual pelvic examination and sterile speculum examination. In this gynecologic examination, the doctor will check for any unusual changes in the cervix, uterus, vagina, ovaries, and other nearby organs. To start, the doctor will look for any changes to the vulva outside the body and then, using an instrument called a speculum to keep the vaginal walls open, the doctor will look inside the vagina to visualize the cervix. A Pap test is often done at the same time (see below). Some of the nearby organs are not visible during this exam, so the doctor will insert 2 fingers of 1 hand inside the vagina while the other hand gently presses on the lower abdomen to feel the uterus and ovaries. This exam typically takes a few minutes and is done in an examination room at the doctor’s office.

  • Pap test. During a Pap test, the doctor gently scrapes the outside and inside of the cervix, taking samples of cells for testing.

    Improved Pap test methods have made it easier for doctors to find cancerous cells. Traditional Pap tests can be hard to read because cells can be dried out, covered with mucus or blood, or may clump together on the slide.

    • The liquid-based cytology test, often referred to as ThinPrep or SurePath, transfers a thin layer of cells onto a slide after removing blood or mucus from the sample. The sample is preserved so other tests can be done at the same time, such as the human papillomavirus (HPV) test (see Screening).

    • Computer screening, often called AutoPap or FocalPoint, uses a computer to scan the sample for abnormal cells.

  • HPV typing test. An HPV test is similar to a Pap test. The test is done on a sample of cells from the cervix. The doctor may test for HPV at the same time as a Pap test or after Pap test results show abnormal changes to the cervix. Certain types or strains of HPV, such as HPV16 and HPV18, are called high-risk HPV. These strains are seen more often in people with cervical cancer and may help confirm a diagnosis. If the doctor says the HPV test is “positive,” this means the test found the presence of high-risk HPV, so long as you were tested for high-risk HPV. Many people have HPV but do not have cervical cancer, so HPV testing alone is not enough for a diagnosis of cervical cancer and other testing will be needed. If a person with a positive HPV test does not show signs of cervical cancer with further testing, the American Society of Clinical Oncology (ASCO) recommends that they receive a follow-up HPV test 1 year later.

  • Colposcopy. The doctor may do a colposcopy to check the cervix for abnormal areas. A colposcopy can also be used to help guide a biopsy of the cervix (see below). During a colposcopy, a special instrument called a colposcope is used. The colposcope magnifies the cells of the cervix and vagina, similar to a microscope. It gives the doctor a lighted, magnified view of the tissues of the vagina and the cervix. The colposcope is not inserted into the body, and the examination is similar to a speculum examination. It can be done in the doctor's office and has no side effects. This test can be done during pregnancy. ASCO recommends that people who receive an abnormal or positive result from cervical cancer screening tests receive a colposcopy.

  • Biopsy. A biopsy is the only way to make a definite diagnosis, even if other tests can suggest that cancer is present. During biopsy, a small amount of tissue is removed for examination under a microscope. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. If the lesion is small, the doctor may remove all of it during the biopsy.

    There are several types of biopsies. Most are usually done in the doctor's office, sometimes using a local anesthetic to numb the area. There may be some bleeding and other discharge after a biopsy. There may also be discomfort similar to menstrual cramps. One common biopsy method uses an instrument to pinch off small pieces of cervical tissue. Other types of biopsies include:

    • Endocervical curettage (ECC). If the doctor wants to check an area inside the opening of the cervix that cannot be seen during a colposcopy, they will use ECC. During this procedure, the doctor uses a small, spoon-shaped instrument called a curette to scrape a small amount of tissue from inside the cervical opening.

    • Loop electrosurgical excision procedure (LEEP). LEEP uses an electrical current passed through a thin wire hook. The hook removes tissue for examination in the laboratory. A LEEP may also be used to remove a precancer or an early-stage cancer.

    • Conization (cone biopsy). This type of biopsy removes a cone-shaped piece of tissue from the cervix. Conization may be done as treatment to remove a precancer or an early-stage cancer. It is done under a general or local anesthetic and may be done in the doctor's office or the hospital.

    If the biopsy shows that cervical cancer is present, the doctor will refer you to a gynecologic oncologist, which is a doctor who specializes in treating cancers of the female reproductive system. Your doctor may suggest additional tests to see if the cancer has spread beyond the cervix.

  • Pelvic examination under anesthesia. In cases where it is necessary for treatment planning, the specialist may re-examine the pelvic area while the patient is under anesthesia to see if the cancer has spread to any organs near the cervix, including the uterus, vagina, bladder, or rectum.

  • X-ray. An x-ray creates a picture of the structures inside of the body using a small amount of radiation. An intravenous urography is a type of x-ray that is used to view the kidneys and bladder.

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI produces detailed images of the inside of the body using magnetic fields, not x-rays. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

  • Positron emission tomography (PET) or PET-CT scan. A PET scan creates pictures of organs and tissues inside the body. A PET scan is usually combined with a CT scan (see above), called a PET-CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

  • Biomarker testing of the tumor. Your doctor may recommend running laboratory tests on a tumor to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options.

If there are signs or symptoms of bladder or rectal problems, these procedures may be recommended and may be performed at the same time as a pelvic examination:

  • Cystoscopy. A cystoscopy is a procedure that allows the doctor to view the inside of the bladder and urethra (the canal that carries urine from the bladder) with a thin, lighted tube called a cystoscope. The person may be sedated as the tube is inserted in the urethra. A cystoscopy is used to determine whether cancer has spread to the bladder.

  • Sigmoidoscopy (also called a proctoscopy). A sigmoidoscopy is a procedure that allows the doctor to see the colon and rectum with a thin, lighted, flexible tube called a sigmoidoscope. The person may be sedated as the tube is inserted in the rectum. A sigmoidoscopy is used to see if the cancer has spread to the rectum.

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cervical cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.