Cervical Cancer - Diagnosis and Treatment

Diagnosis

Early Checks for Cervical Changes

Regular screening tests most often find cervical cancer. These tests look for both cancer and changes in cervical cells that can become cancer. Screening starts at the age of 21.

It usually happens every three to five years, depending on risk and results.

Main Types of Screening Tests

Test Name	Purpose	Who Should Get It
Pap Test	Finds abnormal or precancerous cells	All women from age 21
HPV DNA Test	Checks for high-risk HPV infection	With or after Pap tests

Pap tests gently scrape cells from the cervix. Lab staff check these cells for any changes or signs of cancer. If the cells look abnormal, doctors may order more tests.

HPV DNA testing looks for the human papillomavirus, which causes most cervical cancers. This test may be done at the same time as a Pap test. If high-risk HPV types are found, doctors recommend closer monitoring or more tests.

Regular screening catches abnormal cell changes early. Detecting these changes—also called cervical intraepithelial neoplasia (CIN)—lets doctors treat them before they turn into cancer.

Confirming a Cervical Cancer Diagnosis

If a screening test suggests possible problems, doctors perform more detailed checks. They usually start with a careful physical exam of the cervix using a colposcope. This magnifying device helps spot abnormal areas.

Types of Diagnostic Procedures

Colposcopy: The doctor looks closely at the cervix to find suspicious spots.
Biopsies: Doctors take tissue samples for lab tests. Types include:
- Punch Biopsy: Doctors use a special instrument to take a tiny piece of tissue.
- Endocervical Curettage: Doctors scrape cells from the cervical canal using a small spoon-shaped tool or a brush.
- LEEP (Loop Electrosurgical Excision Procedure): Doctors remove a thin layer of tissue with a wire loop carrying a mild electric current.
- Cone Biopsy (Conization): Doctors take a bigger, cone-shaped sample. This procedure goes deeper and is done in a hospital with anesthesia.

Each biopsy helps doctors check for both cancer and the degree of abnormal changes. If cancer is found, the doctor will explain the type—most cervical cancers are squamous cell carcinomas or adenocarcinomas.

Symptoms that could require testing:

Unusual vaginal bleeding
Pelvic pain
Bleeding after sex

If a woman has increased risk factors (such as a history of high-risk HPV, smoking, long-term oral contraceptive use, HIV infection, or past abnormal tests), the doctor may recommend more frequent or advanced diagnostic testing.

Determining How Far Cancer Has Spread

After doctors confirm cervical cancer, they determine how far it has spread to guide treatment choices.

Staging Methods

Doctors use several tests to figure out the cancer’s stage:

Imaging Scans: X-rays, MRI, CT, and PET scans show the tumor’s size, shape, and if it has moved to other parts of the body.
Other Exams: Sometimes doctors use scopes to look inside the bladder and rectum to check if cancer is there too.

The cancer is assigned a stage from 1 to 4 based on how far it has spread:

Stage	Description	Where It’s Found
1	Early, small	Only in cervix
2	Larger, local	Beyond cervix, not distant
3	Spread nearby	Into tissues next to cervix
4	Advanced	In nearby organs or far away

Doctors use staging to plan the best approach—such as surgery, medicine, or radiation. The stage also helps doctors talk to patients about likely outcomes and answer common questions, like the effects on fertility or long-term health.

Quick Facts Table:

Item	Details
Main cause of cervical cancer	High-risk human papillomavirus (HPV) infection
Key risk factors	Smoking, immune problems (like HIV), long-term oral contraceptive use, history of DES
Screening methods	Pap test, HPV test
Diagnostic procedures	Colposcopy, punch biopsy, endocervical curettage, LEEP, cone biopsy
Staging tests	Imaging (MRI, CT, PET), exams of bladder/rectum
Most common symptoms	Unusual vaginal bleeding, pain in pelvis, pain during intercourse, sometimes no symptoms
Cancer types	Squamous cell carcinoma, adenocarcinoma

Treatment

Operations to Remove Cancer

Surgeons often operate if the cervical cancer is small or has not spread. The type of surgery depends on the cancer’s size and stage, the patient’s wishes about future fertility, and overall health.

Surgery Type	What Is Removed	Impact on Pregnancy	When Used
Cone Biopsy	Small part of cervix	Pregnancy possible	Tiny cancers
Radical Trachelectomy	Cervix and nearby tissue	Pregnancy can be possible	Small cancers
Radical Hysterectomy	Cervix, uterus, some vagina & lymph nodes	No longer possible	Larger/localized cancer
Minimally Invasive Method	Similar to above, with small incisions	Depends on type	Small, early cancers

Removing Only the Cancer Area: For very small cancers, surgeons may perform a cone biopsy. In this procedure, they remove a cone-shaped section of tissue from the cervix. The rest of the cervix stays in place, which means pregnancy might still be possible later.
Removing the Cervix (Radical Trachelectomy): Some patients need the whole cervix and a small area of surrounding tissue removed. Surgeons leave the uterus in place in this operation, so future pregnancy can be possible.
Removing Both Cervix and Uterus (Radical Hysterectomy): For more advanced or larger cancers, surgeons remove the cervix, uterus, part of the vagina, and some lymph nodes. This procedure, called a radical hysterectomy, can help cure the cancer and reduce its chance of returning. After this surgery, pregnancy is not possible, since the uterus is gone.
Less Invasive Hysterectomy: For very small cancers, surgeons may use a minimally invasive hysterectomy. This is done through small cuts in the abdomen using special tools. Patients usually heal faster and spend less time in the hospital. However, some research suggests that this approach might not always be as effective as the traditional method. It is important to talk with a surgeon about the benefits and risks.

Energy Beam Treatment

Doctors use radiation therapy, which relies on strong energy rays like X-rays or protons, to destroy cancer cells. They often combine radiation with chemotherapy, especially if the cancer has spread outside the cervix.

Sometimes, doctors give radiation after surgery if there is a higher chance the cancer will return.

Types of Radiation Delivery:

External Radiation: A machine outside the body aims beams directly at the affected area.
Internal Radiation (Brachytherapy): Doctors place a device with radioactive material inside the vagina for a short period.

Some patients may need both types. Radiation can cause menopause if a woman is still young. Doctors can discuss ways to try to protect eggs before starting radiation.

Medicines That Kill Cancer Cells

Doctors use chemotherapy drugs to damage or destroy cancer cells. They may use chemotherapy in several ways:

Combined with Radiation: Doctors may give lower doses of chemotherapy at the same time as radiation to make the radiation work better.
Higher Doses: For advanced cancer, doctors may use higher amounts of these drugs to help control symptoms or slow the spread.
Before Surgery: In some cases, doctors give chemotherapy first to shrink the cancer, making surgery less extensive and easier to perform.

Common side effects of chemotherapy include nausea, tiredness, hair loss, or a higher risk of infection. Doctors and nurses help patients manage these effects.

Treatments That Target Cancer’s Weaknesses

Doctors use targeted therapy medicines that block certain substances inside cancer cells that help them grow. By blocking these targets, the medicines can help destroy the cancer.

Combined With Other Treatments: Doctors often use targeted medicines together with chemotherapy for patients with advanced cervical cancer. This strategy may help slow down the cancer and give the immune system a better chance to work.

These medicines usually have different side effects than regular chemotherapy and may be easier to tolerate for some patients.

Helping the Body Defend Itself

Doctors use immunotherapy to help a person’s own immune system fight cancer more effectively. Normally, cancer cells can hide from the immune system. Immunotherapy helps immune system cells find and attack cancer.

When It Is Used:

Doctors may give immunotherapy when cervical cancer is advanced or when other treatments have not worked. These medicines do not cure all cancers but can help some people live longer or feel better for a longer period.

Immunotherapy can cause side effects, such as tiredness, skin rashes, diarrhea, or problems with organs like the lungs or liver. Health care teams watch closely for these effects.

Supportive and Comforting Care

Palliative care aims to improve comfort and overall well-being for people facing serious illness like cervical cancer, whether or not they are getting treatments to fight the disease.

Main Goals of Palliative Care:

Reduce pain and discomfort.
Control symptoms such as nausea, tiredness, or trouble breathing.
Support emotional and mental health.

A team including doctors, nurses, and counselors provides palliative care. It can be provided at the same time as other cancer treatments, such as surgery, chemotherapy, or radiation.

Palliative Care Team Roles Table:

Team Member	What They Do
Doctor	Medical care, symptom relief
Nurse	Monitors daily health
Counselor	Provides emotional support
Social Worker	Helps with planning & advice

Support Strategies and Ways to Manage

Dealing with cervical cancer brings many emotions and challenges. Building a support network can make a real difference during this difficult time. Here are some ways to help manage stress and keep up with daily life:

Get Informed: Learning about cervical cancer, treatment options, and prevention methods like the HPV vaccine can help with decision-making. Writing questions before doctor visits and bringing someone along can help you remember information.
Reach Out for Support: Some people talk to close friends, while others join support groups to share feelings and stories. Family members might also find support through caregiver groups.
Accept Help: Treatment may cause tiredness. Asking others for help with daily tasks can relieve some stress and give more time to rest.
Set Realistic Goals: Focusing on simple, reachable goals can provide a sense of purpose. For example, taking walks, eating nutritious meals, and following up on HPV vaccination can be part of a healthy routine.
Take Care of Yourself: Rest, balanced meals, and relaxation play a big role in recovery, especially for those with weakened immune systems or who are taking steroids. Self-care supports the mind and body after treatment.

Helpful Tips	Examples
Build a support network.	Friends, family, support groups
Focus on prevention.	HPV vaccine, cancer screening, healthy habits
Prioritize self-care.	Sleep well, nutritious food, relaxation

Getting Ready for Your Visit

Steps to Take Before Your Appointment

Check for any special instructions. Some appointments may require you to avoid eating or follow other directions the clinic gives you.
Record your symptoms. Write down all the details, even if they seem unrelated.
List your medical history. Include any past conditions and key health details.
Write down personal risks. Note things that could raise your risk of infections, such as starting sexual activity young, having multiple partners, or not using protection.
Bring a list of your medications. Include any prescription drugs, over-the-counter medicines, vitamins, and supplements.
Ask someone to go with you. A friend or family member can help you remember important details.
Prepare your questions. Write down any topics you want to talk about during your visit.

Sample Table: What to Bring

Item	Purpose
Symptom notes	Helps discuss problems clearly.
Medical history	Informs doctor about your risks.
Medication list	Checks for drug side effects.
Written questions	Makes sure all topics are covered.
Support person	Extra help remembering details.

Useful Topics to Discuss With the Health Team

Bring a list and ask about:

The possible causes of your symptoms
What tests you might need
Available treatments and their side effects
What the long-term outlook is
How often you should come back for checkups

If other questions come up, feel free to share those too.

Example Questions Table

Topic	Example Question
Symptoms	What could be causing my symptoms?
Testing	What kinds of tests will I need?
Treatment	What are my treatment options and side effects?
Outlook	What is my expected outcome?
Follow-up	How often should I have visits in the future?

How the Doctor Will Likely Respond

Be ready to answer questions about your health, such as:

When your symptoms began and if they have changed
Your history with Pap tests and any abnormal results
If you have ever received treatment for cervical conditions
Whether you have had any sexually transmitted infections
If you have used medicines that weaken the immune system
Your smoking history
Your plans about having children later on

Cervical Cancer – Diagnosis and Treatment