To make a diagnosis of cervical cancer, the practitioner relies on information from several sources.
Pelvic Physical Examination and Colposcopy
During a routine pelvic examination, the examiner may actually be able to feel rough patches of cancerous tissue by sweeping a gloved finger over the cervix. Before or after this manual examination, the doctor may perform a colposcopy. This examination is performed by inserting a metal instrument called a speculum into the vagina to open the vaginal canal. This allows the practitioner to view the cervix with an instrument called a colposcope, which helps the doctor visualize any areas in question as well as less obvious areas of cell abnormality.
Acetic acid or vinegar helps identify smaller lesions by turning them white when the solution is swabbed onto the genital mucous membranes. During the colposcopy, the doctor will take a cell sample for a Pap test. If the results of the physical examination or the Pap test indicate the presence or possible presence of cell abnormalities, you will schedule a follow-up colposcopy during which a tissue biopsy sample is taken for analysis.
The Pap test, developed in the 1950s, has dramatically reduced the incidence and rate of death from cervical cancer in the United States and other countries in which the test is widely available. Sometimes called a Pap smear, this test is usually part of your routine pelvic exam. The doctor uses a small spatula to scrape a few cells from the cervix and a brush that resembles a mascara wand to take a cell sample from inside the cervical canal.
The cells are affixed to a slide or placed into a small bottle of preserving solution for later examination under a microscope. A laboratory examination allows abnormal cells to be identified. The presence of abnormal cells may mean that you have an infection, or the cells may show precancerous changes or evidence of cervical cancer.
Preparing for a Pap
Before the test, avoid douching, intercourse, tampon use, insertion of contraceptive cream, jelly, or foam, and use of any cream or ointment to treat a yeast infection or other condition. A Pap test should be done when you are not menstruating.
The test can be a little uncomfortable. You may feel a sudden cramping or pain. The provider can supply a sanitary pad in case some slight bleeding occurs after the test.
Pap Test Guidelines
Women who are not yet sexually active, who have gone through menopause, or who are no longer sexually active may still need to have Pap tests. The American Cancer Society and American College of Obstetricians and Gynecologists offer the following guidelines:
- You should have your first Pap test within three years of becoming sexually active or by age 21.
- The test should be repeated every two years unless your Pap test results or risk factors indicate that you should be screened more often.
- If you are over age 30 and have had three consecutive negative Pap tests (meaning that no abnormalities were found), you may have the test every three years thereafter unless you or your partner have sex with a new partner or other risk factors develop.
- If you've reached age 65, have had three negative Pap tests during the past 10 years, and have no new sexual partners, you may discontinue having Pap tests.
- If you have had a hysterectomy for a reason other than having cancer or precancerous changes, you may be advised by your healthcare practitioner to discontinue having Pap tests.
- A woman should receive Pap tests regardless of her sexual orientation.
Results of the Pap test are generally returned within one to two weeks. The cell sample is determined to be either negative (no cell abnormalities detected) or positive (abnormal cells seen in the sample).
Liquid-based cytology was developed as an alternative to the Pap test. From the patient's perspective, it's identical in that the cells are collected the same way. The cell sample, however, is prepared differently in the lab. Early evidence indicated that this new way of analyzing the sample was more accurate than the Pap test. Subsequent studies have proved, however, that cytology is no more accurate than the Pap test, results in a higher rate of false positives (inaccurate indication of cell abnormality), and is less cost effective than Pap smears.
If a Pap test is positive, the nature of the lesion will determine the course of action by the physician. There are a range of possibilities; the cells may simply be atypical, which is likely to resolve on its own, or the cells may indicate a cancer that must be addressed immediately.
If the Pap smear is positive for cancer, a sample will be sent to a pathologist for laboratory analysis. Abnormal cells are assigned a stage. Learn more about the classification system used to stage cervical cancer.