Important examination methods for diagnosing cervical cancer include:
Anamnesis and clinical examination (palpation)
First, the doctor asks in detail about the presence of complaints and finds out possible risk factors (history of the disease). Finally, a clinical examination is carried out. At the same time, the doctor palpates the body of the uterus through the abdominal wall, through the vagina-cervix, uterine os and body of the uterus for possible changes. Additionally, tissues surrounding the uterus are felt through the rectum. In this way, the doctor can already obtain important information about the nature and extent of the disease. In addition, palpation of the cervical and inguinal lymph nodes is performed to detect pathological changes.
Cytology smear (Pap test)
A cytology smear taken from the uterine pharynx and cervix allows timely recognition of cancer cells or their precursors. With the help of a special instrument, the so-called speculum, the doctor opens the vagina. Thus, thanks to a small mirror, it is possible to directly examine the external uterine os. Subsequently, using a cotton swab, spatula or brush, the doctor takes cellular material from the uterine pharynx and cervical canal (smear). This procedure is completely painless. The resulting cells are applied to a small glass plate (glass slide) and examined in a special laboratory under a microscope for changes. If there are deviations from the normal cytological picture, depending on the results obtained, the doctor conducts further examinations.
Most sexually active women contract the human papillomavirus (HPV) at least once in their lives. The vast majority of these infections are cured without the appearance of clinical symptoms or the subsequent development of malignant tumors. In addition, most types of HPV are harmless, only a small part of them are related to the development of malignant tumors. For cervical cancer, these are mainly HPV 16 and 18. The tumor is almost always caused by HPV. Thus, in certain situations, it is advisable to perform an HPV test (for example, with an abnormal Pap smear). Human papillomavirus can be detected in the cells of the cervix using molecular biological research methods.
Studies have shown that a negative HPV test at the time of the study almost rules out overt precancerous changes or cervical cancer. However, a positive test result is not yet a cause for concern: a maximum of 2-3% percent of all HPV infections eventually lead to cervical cancer after many years. Therefore, a positive test result is insufficient to assess the actual risk of cancer. In any case, in order to determine whether there is a change in the cells of the cervix and the severity, an additional study of the tissue should be performed.
Colposcopy - Examination of the cervix and vagina with an optical device that magnifies the image
With the help of a special apparatus that functions like a magnifying glass, the doctor can examine the surface of the uterine os and vagina with ten to forty times magnification. Just like when taking smears, the doctor first opens the vagina with the help of mirrors. For a more accurate assessment of the state of the mucous membrane of the cervix and vagina, the image is transferred to the monitor. Under high magnification, the doctor can recognize even very small changes and classify them as either benign or malignant. A study at the cellular level (cytology) and an examination with an increase in the image (colposcopy) of the cervix allow in more than 90% of all cases to correctly identify changes in the mucosa.
Taking a sample of tissue from the uterus or cervix (biopsy)
If cancer is suspected based on Pap smear results, or if suspicious areas are seen on colposcopy, the diagnosis can be confirmed by taking a tissue sample (biopsy) (see Pap test, Pap test, and therapeutic recommendations above). To do this, a small piece of tissue is taken from the cervix with special biopsy forceps. This tissue sample is then examined under a microscope. If microscopic examination (histology) shows that suspicious areas can be removed within healthy tissue, then taking tissue from precancerous changes is most often also the only possible therapy.
Tapered excision of the cervix (conization)
It is not always possible to make an accurate diagnosis with a biopsy. In this case, the doctor can perform the so-called conization. In this case, using an electric loop or a laser beam, a cone-shaped piece of tissue is excised from the uterine pharynx and cervix. Subsequently, the tissue is examined under a microscope. This surgery is performed under anesthesia. Together with conization, curettage of the uterine mucosa (curettage) is also carried out in the area of the uterine os, in order to exclude the further spread of malignant changes to the uterine cavity. If microscopic examination reveals changes (cervical intraepithelial neoplasia CIN) or cervical cancer at an early stage, then surgical treatment is the only effective method of treatment. If it turns out that precancerous changes in the cervix during the operation were not removed within healthy tissues or have already penetrated into deeper layers of tissues, then the doctor should carry out further treatment taking into account personal data (for example, age, other general diseases).
Ultrasound examinations (sonography)
Abdominal ultrasound (abdominal ultrasound) gives an idea of the condition of internal organs such as the liver, kidneys, ureters, spleen and intestines. With this examination, the doctor can assess whether the tumor has already spread to one of these organs (the occurrence of metastases). An ultrasound examination of the internal genital organs is performed using a special ultrasound probe that is inserted into the vagina (transvaginal sonography). With this method, the doctor can determine whether the tumor has spread to the uterus (the body of the uterus) and whether the tumor is affected by the fallopian tubes and ovaries.
Examination of the bladder (cystoscopy) and intestines (rectoscopy)
These examinations are necessary in the progressive stages of the disease if there is a suspicion of damage to the tumor process of the bladder and rectum. In this case, the probe is inserted through the urethra into the bladder and through the anus into the rectum. In this way, the doctor can examine the walls of the bladder and rectum and take tissue samples from suspicious areas. Subsequently, a microscopic examination of tissue samples is carried out.
Curettage of the mucous membrane of the uterine cavity (curettage), possibly with an examination of the uterine cavity (hysteroscopy)
If during the progressive stages of the disease there is a suspicion that the tumor has already spread to the uterine cavity, then to clarify the diagnosis, the most reliable method is a microscopic examination of the uterine mucosa. To obtain a test material, a careful scraping of the uterine mucosa through the vagina is carried out. At the same time, fragments of the mucous membrane of the cervix and the body of the uterus are separately obtained and examined. In the future, under the action of sex hormones, the mucosa is restored. During the inspection of the uterus, a probe (hysteroscope) equipped with a small camera and a light source is advanced through the vagina into the uterine cavity. For better visualization of the mucosa, fluid is injected into the uterus through a hysteroscope. Tissue sampling is most often combined with hysteroscopy. This allows you to identify suspicious areas before scraping, from which samples can be taken in the future.
Blood tests provide information about the general condition of the patient, as well as the functions of individual organs, such as the kidneys and liver. The results of the studies are important in terms of future treatment. Additionally, tumor markers can also be determined. In this case, we are talking about substances that are intensively formed by tumor cells. Cervical carcinomas sometimes produce the tumor marker SCC (squamous cell carcinoma antigen), which can be detected in the blood. However, not all patients with cervical cancer have tumor markers. In addition, tumor markers can also be found in the blood of healthy people. Therefore, for the diagnosis, they are rather of secondary importance. When monitoring the further course of the disease, tumor markers are determined only in women whose tumor marker was elevated during the disease.
Computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)
With the help of CT, MRI and, if necessary, PET, the attending gynecologist receives information about the extent to which the operation will be performed to remove the malignant tumor. In addition, metastases and enlarged lymph nodes can be detected and measured using these two methods.
Positron emission tomography (PET), combined with computed tomography (PET-CT) if necessary, and single photon emission tomography (SPECT) are special examination methods that also produce layered images of the body. They make visible the distribution of a weakly radioactive labeled substance (RFP) in the body, which is previously injected through a vein in the arm. All these new methods are united by the fact that they give a functional image of metabolic processes. Morphological representation is not possible. Thus, these methods are only important for dealing with questions related to metabolism, for example, the search for metastases (they have increased metabolic activity) in a very common disease process.
Operative determination of the stage of the disease
With operative staging by laparoscopy, it is possible to determine the spread of the tumor in the pelvic area. In particular, the walls of the bladder and rectum, as well as the lymph nodes in the pelvic area and along the main artery (aorta), can be examined for tumor invasion. In patients with small tumors and the desire to maintain fertility, this method can avoid an incision in the abdominal cavity. This allows more accurate planning of radiation therapy in patients with advanced tumors and, thus, reduce or avoid side effects.
Examination of sentinel lymph nodes
Another method is to examine the "sentinel" or sentile lymph nodes (SLN). In this case, only those lymph nodes are removed, into which the outflow of lymph from the tumor is carried out in the first place. If they are not affected by tumor cells, then the tumor has not yet spread further in the body. For a more accurate conclusion, sentinel lymph nodes should be examined from both sides, i.e. in the pelvis on the left and right. Thanks to the blue dye and the radioactive label, the corresponding lymph nodes are visualized and can be clearly identified. Only the combination of these two methods provides reliable protection and has been effective in breast cancer for quite a long time. Examination of sentinel lymph nodes has so far proved to be appropriate only for small tumors (<2 cm).
Head of the clinic of mammology and gynecology
Head of the Clinic of Gynecology and Oncogynecology
Head of the Mammology Center
Head of the Center for Operative Gynecology
Head of the Regional Center for Pelvic Floor Surgery