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How We Diagnose Cervical Cancer

  • Testing for cervical cancer

    The Susan F. Smith Center for Women's Cancers unites many of the world's leading experts in gynecologic cancer. Beginning with your first appointment at the Division of Women's and Perinatal Pathology at Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC), we select gynecologic cancer experts to personally care for you and manage your pre-cancer (dysplasia) or cervical cancer diagnosis.

    Christopher Crum, MDChristopher Crum, MD, director, Women's and Perinatal Pathology

    We are one of the few clinical services globally with a team of pathologists and clinicians who focus exclusively on diagnosing, evaluating, and managing gynecological cancers. Our Pathology Division is home to the largest team of gynecology specialists in the world; these highly specialized experts serve as the radar for your entire treatment team. Recently, our pathologists discovered the cells that give rise to cervical cancer, and we now use this information to better understand the origins of the disease.

    Our Pap smear experts are leaders in national research, continually investigating ways to improve early detection and treatment. We analyze thousands of Pap test results each month — including routine and complex cases — and we see more than 400 cervical cancer patients each year. Many women come to DF/BWCC after discovering they have had an abnormal Pap test that indicates cancerous changes or cells. If you are diagnosed with cervical cancer, have concerns, or would like a second opinion, you can schedule an appointment with one of our gynecology specialists.

  • We provide evaluation and diagnostic services for women who:

    • Receive an abnormal Pap test result with high-risk HPV
    • Are diagnosed with cervical dysplasia or cervical cancer
    • Require follow-up care due to past Pap test abnormalities
    • Require long-term survivorship care

    If you would like a second opinion...

    Our diagnostic team provides second opinions, including for challenging or difficult cases. We are happy to consult with you, your primary care physician, or other specialists.

    You may want to consider a second opinion:

    • To confirm your diagnosis
    • For an evaluation of an uncommon presentation
    • To have your original biopsies or other tissue diagnosis confirmed
    • For details on the type and stage of cancer
    • To better understand your treatment options
    • To learn if you are eligible for clinical trials

    Phone: 877-442-DFCI or 877-442-3324
    Online: Complete the Appointment Request Form
    If you cannot travel to Boston in person, you can take advantage of our Online Second Opinion service

    Tests to examine the cervix

    Pap test (smear)

    Unlike other gynecologic cancers, cervical cancer can be detected through various screening tests. The most common screening test to detect cervical cancer or precancerous cells (dysplasia) is the Pap test. During a Pap test, the doctor takes a sample of cells from the surface of the cervix inside the vagina, and then sends the sample to be reviewed by pathologists in a lab at DF/BWCC. If abnormal cells are found, follow-up tests will be performed. If cervical cancer is detected, you will be assigned a dedicated team to provide personalized treatment.

    Pap smearPap smear. A speculum is inserted into the vagina to widen it. Then, a brush is inserted into the vagina to collect cells from the cervix. The cells are checked under a microscope for signs of disease.

    DNA test

    In conjunction with your Pap test, a DNA test may be conducted to detect the presence of the human papillomavirus (HPV). The human papillomavirus is actually a group of viruses, and certain strains of the virus contribute directly to the development of cervical cancer. An HPV test may be done if your Pap smear shows abnormal cells. As with a Pap smear, cells will be collected from the cervix and examined for a cervical HPV infection. The HPV DNA test may be used to determine the frequency of Pap smear screening based upon national guidelines.

    It's important to understand that abnormal Pap test results are common, and that test abnormalities such as precancerous cells do not always indicate cervical cancer. Detecting cervical abnormalities or the HPV virus at an early stage is the best case scenario, as most early detection cases can be managed and minimally treated before cancer develops.

    Beyond the Pap test: diagnosing cervical cancer

    When precancerous or cancerous cells are found through a Pap test or pelvic examination, we may perform additional tests, or cervical biopsies, to determine the presence of cervical cancer. During a biopsy a small portion of cervical cells or tissues will be removed for examination by our pathology experts. For some patients, such pre-treatment surgical procedures can completely remove the abnormal tissue, making additional treatment unnecessary. For others, one or more tests may be required, and additional treatment may follow. Some of the diagnostic tests that may be needed include:

    • Colposcopy: A procedure that uses an instrument with magnifying lenses, called a colposcope, to examine the cervix for abnormalities. If abnormal tissue is found, a biopsy is usually performed (colposcopic biopsy) and small tissue samples will be removed for further examination. A biopsy or endocervical curettage (ECC), a procedure to gently scrape the lining of the endocervical canal (the area running the length of the cervix), may be completed along with the colposcopy procedure.
    • Loop electrosurgical excision procedure (LEEP): A procedure that uses a thin electric wire loop to obtain a slightly larger sample of cervical tissue so it can be examined under a microscope. This procedure is usually done in the office under local anesthesia.
    • Cone biopsy (conization): a procedure in which a laser, loop electrosurgical excision procedure (LEEP), or cold-knife is used to remove a cone-shaped piece of cervical tissue for further examination. This procedure may require the use of general anesthesia. The cone biopsy procedure may be used to diagnose cervical cancer, as well as to treat or remove precancerous or early cancerous areas. This is usually performed if a diagnosis cannot be found after a colposcopy.

    Determining the stage of cervical cancer

    If cervical cancer is found after a biopsy, further tests are conducted to determine if the cancer cells have spread within the cervix or to other parts of the body. The process used to find out if, and how far, the cancer has spread beyond the cervix is called staging. It is important to know the stage of the cancer — in other words, how far the cancer has progressed — in order to plan treatment. The following tests and procedures may be used in the staging process:

    • A PET/CT scan: A painless procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to trace and create computerized pictures of the solution inside your body. The procedure is painless and has no side effects.
    • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
    • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. The procedure is similar to having a CT scan, except the MRI does not deliver radiation.
    • A CT scan (also known as a CAT scan): A painless procedure that takes a series of detailed x-ray pictures inside the body from different angles. CT scans are performed very quickly and is a painless test that will examine your pelvis, abdomen, and chest. The results are typically read and reviewed by our radiology team the same day.
    • Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid, using a thin needle

    Stages of cervical cancer

    The staging of cervical cancer is the most important factor in determining your treatment plan. The stage of cervical cancer is carefully divided into categories based on the size and spread of cancer beyond the cervix and into other places in the body (metastasis), such as the lymph nodes, blood, or other organs. The stages of cervical cancer are as follows:

    • Stage 0 (carcinoma in situ or dysplasia) indicates that abnormal cells have been found in the innermost lining of the cervix, but are not invasive (have not spread to nearby tissue). These cells are not cancer, but precancerous, which means the cells may disappear naturally, or become cancer and spread into nearby normal tissue. Treating precancerous cells will prevent them from spreading and becoming cancer.
    • Stage I (stages IA and IB) is cancer in the cervix only.
    • Stage II (stages IIA and IIB) indicates that cancer has spread beyond the cervix to the tissue around the uterus or to portions of the vagina. In this stage the cancer has not spread to the pelvic wall (the tissues that line the part of the body between the hips).
    • Stage III (stages IIIA and IIIB) means the cancer has invaded most of the vagina and possibly the tissues between the hips (pelvic wall). Stage III may also indicate that cancer is interfering with proper kidney function.
    • Stage IV (stage IVA and IVB) is cancer that has spread beyond the cervix to the vulva or urethra, bladder, and rectum, as well as other parts of the body, such as the kidneys, lungs, liver, abdomen, or intestinal tract.