Diagnosing Cervical Cancer
Cervical cancer starts in the cervix, the cylinder of tissue that connects the uterus to the vagina. Most forms of cervical cancer are found in the cells that line the cervix and begin as precancerous cells that can be detected during routine screening.
NYU Langone doctors are experienced in managing the two types of cervical cancer. About 80 to 90 percent of cervical cancer develops in squamous cells, which are found on the surface of the cervix on the side closest to the vagina. The other 10 to 20 percent of cervical cancers are adenocarcinomas. This type of cancer develops in the gland cells that produce cervical mucus or fluid at the opening of the cervix, also known as the cervical canal.
Early cervical cancer is usually detected through screening tests and may not cause any symptoms, although abnormal bleeding can be an early sign. After cancer has spread into nearby tissue, symptoms may include unusual bleeding or other fluid discharge from the vagina—for example, between periods, after menopause has occurred, or after having sex.
If screening tests show that the cervix contains precancerous or cancerous cells, doctors at NYU Langone may conduct the following tests.
To perform a colposcopy, your doctor first inserts a speculum, which separates the walls of the vagina, and then examines the cervix and vagina through a colposcope. This device magnifies and lights the cervix to provide a more detailed view of the area. This procedure can be performed alone, allowing the doctor to look for abnormalities of the cervix and vagina, or in combination with a biopsy.
A biopsy is the removal of a small amount of tissue for examination under a microscope. For precancerous cervical growths, some forms of biopsy may serve as the treatment. A biopsy can be performed in several ways.
Guided Tissue Biopsy
For a guided tissue biopsy, your doctor uses an instrument with small surgical scissors at the end to remove or pinch off a small piece of the cervix. Doctors usually perform this type of biopsy in their office.
Sometimes, doctors need to perform a biopsy in the cervical canal. In endocervical curettage, a small spoon-shaped device called a curette is used to scrape cells from inside the cervical canal. This procedure is usually done in the doctor’s office.
Loop Electrosurgical Excision Procedure
Loop electrosurgical excision procedure, known as LEEP, is another biopsy option. The doctor uses a thin wire loop carrying a small electrical current to remove tissue from the surface of the cervix. The procedure is usually done in the doctor’s office with a local anesthetic.
A procedure called cone biopsy lets doctors reach areas higher up in the cervical canal. During this procedure, a doctor removes a cone-shaped piece of tissue using a scalpel or a laser. The base of the cone contains cells from the outer part of the cervix, where the squamous cells are located, and the upper point of the cone contains cells from the cervical canal, where the gland cells are located.
Doctors usually perform this type of biopsy in an outpatient surgical center, often with general anesthesia.
If a biopsy confirms the presence of cervical cancer, your doctor may use one or more imaging test to determine if it has spread to other areas of the body.
A CT scan is a type of X-ray that uses a computer to create cross-sectional, three-dimensional pictures, producing detailed views of tumors that may have spread from the cervix into other areas of the pelvis or abdomen, such as the lymph nodes. Lymph nodes are small glands located throughout the body that help to filter foreign matter, such as bacteria and viruses. Some types of cancer may spread to the lymph nodes first.
Before the CT scan, your doctor may give you two different contrast agents, one by mouth as a liquid and one through an injection into a vein. These chemicals are used to enhance the CT image.
An MRI scan uses magnetic fields and radio waves to create computerized, three-dimensional images of the body’s structures. MRI scans often create better images of soft tissue than CT scans. To enhance these images, your doctor may give you a contrast agent through an injection into a vein before the procedure.
Your doctor may also use a PET scan to find out whether cervical cancer has spread to other parts of the body. A PET scan requires an injection of a small amount of radioactive glucose, or sugar, into a vein. This radioactive glucose is drawn to tumor cells, which take in sugar more quickly than healthy cells, making cancer cells visible on a scan. The computer then creates three-dimensional images of areas where cancer is active in the body.
PET scans are also sometimes used to help determine how cancer responds to treatment.
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