Diagnosing cervical cancer

Cervical screening test

The cervical screening test has replaced the Pap test. It finds cancer-causing types of HPV in cell samples taken from the cervix. For the self-collection method (see below), cells can be collected from the vagina.

The National Cervical Screening Program recommends that women and people with a cervix start cervical screening at age 25 and then have a test every 5 years until the age of 70–74. All women and people with a cervix need regular screening. There are 2 ways to collect cells for a cervical screening test. They are:

• health care provider collected – Your doctor or nurse will collect a sample of cells from your cervix
• self-collected – This method enables you to collect your own sample. A health care provider will give you a self-collection swab and explain how to collect your own cell sample. This method is only available to people who do not have any signs or symptoms of cancer. If HPV is detected in a self-collected sample, a follow-up test with your doctor may be required.

The test results are used to predict your level of risk for significant cervical changes. If the results show:

• higher risk – you will be referred for a colposcopy
• intermediate risk – you will be monitored with a follow-up cervical screening test in 12 months
• low risk (no HPV detected) – you will be due for your next cervical screening test in 5 years.

For more information, call Cancer Connect on 13 11 20, or see Cancer Council's guide to cervical screening.

Other tests

If your cervical screening results suggest that you have a higher risk of developing cervical cancer, you will usually have more tests. These tests are likely to include some of the following:

Colposcopy – This looks closely at the cervix and vagina to see if there are any abnormal or changed cells. An instrument called a colposcope (a microscope with a light) is placed near your genital area but does not enter your body. An instrument called a speculum will be inserted into the vagina to spread the walls apart so the vagina and cervix can be seen more clearly.

Biopsy – If your doctor sees abnormal or changed cells during a colposcopy, they will usually take a small tissue sample (biopsy) from the cervix. The tissue sample will be sent to a laboratory to be examined under a microscope by a doctor called a pathologist. This can show if there are cancerous or precancerous cells.

Cone biopsy – This is done when a larger area of tissue needs to be removed or when early-stage cancer is suspected. A cone biopsy is usually done as day surgery in hospital under general anaesthetic. A surgical knife (scalpel) is used to remove a cone-shaped piece of tissue from the cervix. As with a biopsy (see above), the sample will be sent to a laboratory for testing.

I had period-like pain for a few days after the cone biopsy but a hot water bottle and mild pain medicines helped a lot.

Julie

Imaging scans – These can create pictures of the inside of your body and provide different types of information. You may have one or more imaging scans to check if the cancer has spread to other parts of your body. These scans may include an MRI, PET–CT scan or chest x-ray. To find out more about these scans, call Cancer Connect on 13 11 20.

Examination under anaesthetic – To check whether the cancer has spread, the doctor may give you a general anaesthetic to examine your cervix, vagina, uterus, bladder and rectum. This is done in hospital and you can usually go home on the same day.

Staging

Staging describes the size of the cancer and how far it has spread. Knowing the stage helps doctors recommend the best treatment for you.

• Stage 1 (early or localised cancer) – Cancer is found only in the cervix.
• Stage 2 (locally advanced cancer) – Cancer has spread outside the cervix to the upper two-thirds of the vagina or other tissue next to the cervix.
• Stage 3 (locally advanced cancer) – Cancer has spread to the lower third of the vagina and/or the tissue on the side of the pelvis (pelvic wall). The cancer may also have spread to lymph nodes in the pelvis or abdomen, or caused a kidney to stop working.
• Stage 4 (metastatic or advanced cancer) – Cancer has spread to the bladder or rectum (stage 4A) or beyond the pelvis to the lungs, liver or bones (stage 4B).