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CancerQuest > Introduction to Patient Information > Introduction to Cancer by Type > Cervical Cancer: Introduction > Cervical Cancer: Detection and Diagnosis

Cervical Cancer: Detection and Diagnosis

Detection:

Since early cervical cancer is asymptomatic, regular screening by a Pap smear is important in order to avoid the progression of precancerous lesions or noninvasive cancer. Current US guidelines recommend annual Pap smears for women over 21--or within three years after becoming sexually active. Screening should be continued until at least age 70. If you have had a history of normal Pap smears and a radical hysterectomy, in which the cervix has been removed due to non-cancerous reasons (i.e., fibroids), routine screening via Pap smear may not be necessary. ⁽¹⁾ However, women with prenatal exposure to diethylstilbestrol (DES), a prior history of cervical cancer or a disease/condition that weakens their immune system should continue screening past age 70. Although cancers of the ovaries, cervix, and uterus may be difficult to detect at an early stage, there are several detection options currently in use.

Important tests include:

• CA-125 for detecting ovarian cancer.
• Pap Smear for detecting cervical and vaginal cancer.
• Ultrasound for detecting ovarian and uterine cancer.

If the diagnostic tests indicate the presence of cancer, additional imaging (CT, MRI, etc.) may be performed to determine the location and extent of the disease. ^(2)(3)(4)

Specific tests for Human Papillomavirus (HPV) DNA may be administered annually to women over 30, which lessens the necessity of Pap smears to once every three years. ⁽¹⁾⁽⁵⁾ HPV screening involves a Polymerase Chain Reaction (PCR) based test that is able to detect DNA sequences common to all HPV strains. Because this sequence can be disrupted when the virus inserts itself into cellular DNA, other genes (E6 and E7) are often also identified. This allows the tests to reliably detect the presence of high-risk HPV strains. In a recent study, the addition of HPV DNA tests to traditional Pap smears reduced the incidence of grade 2/3 cervical intraepithelial neoplasia (CIN) by 40%. ⁽⁶⁾ Since HPV infections are frequently transient, it is possible that risk for cervical dysplasia or cancer may exist even with negative test results. ⁽⁷⁾

More on Viruses and Cancer
More on the Pap smear

Diagnosis:

If a Pap smear reveals abnormal cells, further diagnostic tests are performed to determine a diagnosis. Irregular cells could indicate:

• Human Papillomavirus Infection
• Cervical Intraepithelial Neoplasia (CIN): See the next page for details on this pre-cancerous condition.
• Cervical Cancer

Watch the full interview with cervical cancer advocates Lori and DeWayne Grice.

Further tests are necessary to make a diagnosis. Additional tests that may be performed include:

• Colposcopy
• Biopsy - removal of a small sample of tissue for examination by a pathologist. The procedure is typically done without anesthesia and is associated with minimal pain or bleeding. It is possible to perform the biopsy during a colposcopy.

More on General Detection Techniques.

References for this page:

1. NCCN Practice Guidelines in Oncology Cervical Cancer Screening v.1.2008 9/17/07 Accessed 12/04/07 [http://www.nccn.org/professionals/physician_gls/PDF/cervical_screening.pdf]
2. Petignat P, Roy M. "Diagnosis and management of cervical cancer." BMJ. 2007 Oct 13;335(7623):765-8 [PUBMED]
3. NCCN Practical Guidelines in Oncology v.1.2008 10/26/2007 Copyright National Comprehensive Cancer Network Website accessed 12/04/07 [http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf]
4. American Cancer Society Detailed Guide: Cervical Cancer. Accessed 08/03/2010 [http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=8]
5. American Cancer Society (accessed 9/5/07) [www.cancer.org]
6. Naucler P, Ryd W, Törnberg S, Strand A, Wadell G, Elfgren K, Rådberg T, Strander B, Forslund O, Hansson BG, Rylander E, Dillner J. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med. 2007 Oct 18;357(16):1589-97. [PUBMED]
7. Boulet G, Horvath C, Broeck DV, Sahebali S, Bogers J. Human papillomavirus: E6 and E7 oncogenes. Int J Biochem Cell Biol. 2007;39(11):2006-11. Epub 2007 Jul 19. [PUBMED]