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The diagnosis of cervical cancer usually begins in the doctor's office, during a routine pelvic exam and Pap test. Cervical cancer rarely produces symptoms in its early stages, so having a regularly scheduled pelvic exam is important.
The diagnosis and prognosis of cervical cancer includes the following:
Because cervical cancer is intimately related to several risk factors, your doctor will ask you several personal questions. It is crucial that you give honest answers. It is very important that you be extremely candid with your doctor about your sexual history. Depending on what it involves, your risk for cervical cancer could be greatly increased. Your doctor will need to know if you are experiencing any symptoms, such as abnormal vaginal bleeding, discharge, or pain.
Tell your doctor if you smoke. Tobacco use increases your risk for just about every cancer, including cervical cancer. Your doctor may also ask if you know if your mother took DES while she was pregnant with you.
Your doctor will do a complete physical exam, focusing on the pelvic exam and Pap test. For a complete description of both, see cervical cancer screening .
If your Pap test shows abnormal changes or unhealthy cell growth in the cervix, your doctor will need to perform further testing to determine if you have cancer, an infection, or some other condition.
If your health care provider suspects that you have abnormal cell growth from the results of your pelvic exam and Pap tests, diagnostic tests will be ordered to determine the nature of the abnormal cell growth of the cervix. Diagnostic tests include the following:
A colposcopy is the use of a colposcope, an instrument that shines a light on the cervix and magnifies the view, to closely examine your genitals, vagina, and cervix. The doctor places the speculum into your vagina and opens it slightly to see the cervix. A vinegar solution is swabbed onto the cervix and vagina. This solution makes abnormal tissue turn white so the doctor can identify the areas that need to be evaluated. If abnormal cells are found during a colposcopy, the doctor may do a biopsy.
A biopsy is the removal of a sample of cervical tissue to tested for cancer cells. There are several procedures used to obtain biopsies, including the following:
If the area of abnormal cell growth is small, these biopsy procedures may be able to remove all of the affected area. The tissue removed during biopsy is sent to a laboratory to be analyzed.
Cytology is the study of cells. The cytology of cancer cells differs significantly from normal cells, and physicians use the unique cellular features seen on biopsy samples to determine the diagnosis and assess the prognosis of a cancer.
The criteria for diagnosing precancerous lesions of the cervix vary somewhat among doctors, but important characteristics include cellular immaturity, cellular disorganization, nuclear abnormalities, and increased mitotic activity. Some of the cellular abnormalities seen in cervical cancer include the following:
The Pap test is used to identify the presence of abnormal cell growth that could develop into—or already is—cancerous. Most laboratories in the United States now use the Bethesda System to report Pap test results. The Bethesda System uses descriptive terms rather than class numbers, which were used to report Pap test results in the past.
The Bethesda System divides cervical cell abnormalities into three major categories:
ASCUS and LSIL are considered mild abnormalities. HSIL is more severe and has a higher likelihood of progressing to invasive cancer.
The classes of the Pap System are as follows:
Staging is the process by which physicians determine the prognosis of a cancer that has already been diagnosed. Staging is essential for making treatment decisions (e.g., surgery vs. chemotherapy). Several features of the cancer are used to arrive at a staging classification, the most common being the size of the original tumor, extent of local invasion, and spread to distant sites (metastasis). Low staging classifications (0 – 1) imply a favorable prognosis, whereas high staging classifications (4 – 5) imply an unfavorable prognosis.
Because of the widespread prevalence of cervical cancer throughout the world, the international cancer community has determined that only certain tests are considered relevant and acceptable in the staging process. These tests include a physical examination (under anesthesia if necessary), an intravenous pyelography (IVP), blood work, and a chest x-ray. CT scans, MRI scans, or any other more modern technology is not considered in the staging of cervical cancer, because these technologies are not necessarily available throughout the world. Additional tests to determine staging in the United States may include the following:
The following staging system is used to classify cancer of the cervix:
The abnormal cells are found only in the first layer of cells lining the uterus.
The cancer is strictly confined to the cervix. This stage has six levels, depending upon the size of the cancer:
Cancer has spread to nearby areas but is still inside the pelvic area. This stage has two levels.
Cancer has spread throughout the pelvic area. The tumor involves the lower third of the vagina or the pelvic wall, and may be blocking the ureters, which are the tubes that carry urine from the kidney to the bladder. This stage has two levels.
Cancer has spread to other parts of the body. This is the most advanced stage of cervical cancer. This stage has two levels, depending on which organs the cancer has invaded:
Prognosis is a forecast of the probable course and/or outcome of a disease or condition. Prognosis is most often expressed as the percentage of patients who are expected to survive over five or ten years. Cancer prognosis is a notoriously inexact process. This is because the predictions are based on the experience of large groups of patients suffering from cancers at various stages. Using this information to predict the future of an individual patient is always imperfect and often flawed, but it is the only method available. Prognoses provided in this monograph and elsewhere should always be interpreted with this limitation in mind. They may or may not reflect your unique situation.
Five-year survival rates based on how far the cancer has spread are as follows:
Survival rates according to stage are as follow:
The following table shows trends in 5-year survival rates for cervical cancer by race and year of diagnosis in the US, from 1974 to 1997.
White | ||
---|---|---|
1974-76 | 1983-85 | 1992-97 |
70% | 71% | 72+% |
Black | ||
1974-76 | 1983-85 | 1992-97 |
64% | 60% | 58% |
All Races | ||
1974-76 | 1983-85 | 1992-97 |
69% | 69% | 70% |
Adapted from Cancer Facts & Figures by the American Cancer Society |
Sources:
American Academy of Family Physicians
The National Women’s Health Information Center
Cancer Facts & Figures. American Cancer Society Web site.
Available at:
http://www.cancer.org/
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Accessed November 19, 2002.
Cervical cancer. American Cancer Society Web Site.
Available at:
http://www.cancer.org/
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Accessed November 19, 2002.
Cervical cancer (PDQ): Treatment. National Cancer Institute Web site.
Available at:
http://www.cancer.gov/
Accessed November 19, 2002.
DeVita VT, Hellman S, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology , 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2001:1519-1549.
Otto SE. Oncology Nursing . 4th ed. St. Louis, MO: Mosby, Inc.; 2001:248-257.
Holtz DO, Dunton C. Traditional management of invasive cervical cancer. Obstetrics and Gynecology Clinics .2002;29.
Last reviewed February 2003 by Jondavid Pollock, MD, PhD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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