Cervical cancer is a malignancy that begins in the cells lining the cervix, the lower part of the uterus connecting to the vagina. This cancer develops slowly over many years, typically following persistent infection with certain high-risk types of the human papillomavirus (HPV). Diagnosis usually occurs through two routes: the routine discovery of pre-cancerous cell changes or the investigation of noticeable physical symptoms. Discovering the condition early, before it progresses to invasive cancer, significantly improves treatment success.
Pathways to Initial Suspicion
The most common way people learn about potential abnormalities is through routine screening, which detects cell changes before symptoms appear. Screening involves two tools: the Papanicolaou (Pap) test and the HPV test. The Pap test collects a sample of cervical cells to check for morphological changes under a microscope. The HPV test checks for the presence of high-risk strains of the virus responsible for almost all cervical cancers.
An abnormal Pap test result usually indicates pre-cancerous changes, not cancer itself. Low-grade Squamous Intraepithelial Lesion (LSIL) suggests mildly abnormal cell growth, often due to a recent HPV infection. High-grade Squamous Intraepithelial Lesion (HSIL) indicates more significant abnormalities and a higher likelihood of progression if untreated. These abnormal findings flag the need for further diagnostic work.
Recognizing Physical Indicators
For individuals without recent screening or whose condition has progressed quickly, discovery often begins with physical symptoms that prompt a medical visit. The most common sign is abnormal vaginal bleeding. This can manifest as bleeding between regular menstrual periods, after sexual intercourse, or any bleeding occurring after menopause.
Another frequent indicator is an unusual or persistent vaginal discharge, which may be watery, thick, or tinged with blood. The discharge can sometimes develop a foul odor, often a sign of tissue breakdown. Pelvic pain or pain experienced during sexual intercourse (dyspareunia) can also be a symptom. These complaints prompt a physician to perform a focused examination.
Confirming the Diagnosis
The next step in confirming a diagnosis, whether suspicion arose from screening or symptoms, is a colposcopy. During this outpatient procedure, a magnifying instrument called a colposcope is used to closely examine the surface of the cervix and vagina. The healthcare provider often applies a mild acetic acid solution, which causes abnormal areas to turn white, making them clearly visible for evaluation.
If any suspicious areas are identified, a small tissue sample is removed in a procedure called a punch biopsy. For lesions extending higher into the cervical canal, an endocervical curettage (ECC) may be performed to collect cells from that area. The tissue samples are then sent to a pathology laboratory for microscopic analysis. The pathologist’s report, which confirms the presence of invasive cancer cells, provides the definitive diagnosis.
In some cases, a larger sample may be needed for analysis or removal. This is accomplished through a Loop Electrosurgical Excision Procedure (LEEP) or a cone biopsy (conization). LEEP uses a thin, heated wire loop to slice away tissue, while a cone biopsy surgically removes a cone-shaped wedge of tissue. These procedures can serve as both a diagnostic step and a treatment for early-stage or pre-cancerous lesions.
Immediate Next Steps After Discovery
Following the confirmed diagnosis, the next phase involves determining the extent of the disease, a process called staging. Staging uses various imaging tests, such as CT scans, MRIs, and PET scans, to evaluate whether the cancer has spread beyond the cervix. The staging results directly influence the subsequent treatment strategy.
The patient is then referred to a specialist, typically a gynecologic oncologist, an expert in treating cancers of the female reproductive system. The specialist reviews the pathology and staging reports to develop a personalized treatment plan, discussing the type and stage of cancer and the available treatment options.