Pap Smear Test
Cervical Cancer Diagnosis
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|How Is Cervical Cancer Diagnosed?
As symptoms of cervical cancer do not always occur or may be missed in the early stages, the first part of diagnosis usually starts with a routine Pap smear test. A Pap test will not only highlight cervical cancer but also any abnormal cell changes in the cervix known as cervical intraepitheilial neoplasia (CIN) or cervical dysplasia (a sort of pre-cancer change.). The Pap test result will be graded according to any cell abnormalities, ranging from normal and atypical to dysplasia (subdivided into another 3 grades) and cervical cancer stages. If cells are classified as atypical or above another Pap test is carried out in a few months. Many Pap tests return normal the second time around. The American College of Obstetrics and Gynecology recommends that a persistent abnormality of the cervix, or any result which comes back as a high grade dysplasia be further evaluated. More extensive diagnosis is a step by step process which usually includes colposcopy, punch biopsy and endocervical curettage (ECC).
A colposcopy is a procedure in which the cervix is examined with the aid of a special illuminated microscope called a colposcope. This procedure can be carried out in a doctor's office and causes about the same level of discomfort as a pelvic exam. The woman takes her clothes off below the waist and will lie on an examination table with the knees raised. The doctor will insert a speculum (smooth instrument) into the vagina to spread the vaginal walls. The colposcope is then inserted and magnifies the image of the cervix so that abnormalities not usually seen by the eye can be viewed more easily. A camera may also be attached to the colposcope to take pictures or videos. Before inserting the scope the doctor may rinse the cervix with a weak acetic acid (rather like vinegar) to remove any mucous and excess cells. The acetic can also help to highlight any differences between normal and abnormal cells. The most abnormal looking part is selected for biopsy (known as a cervical or punch biopsy). This procedure may cause brief cramping and some vaginal spotting for a day or two afterwards. Taking a pain killer such as Motrin or Advil 30 minutes before the exam may decrease cramping pain. The doctor will talk to you about the colposcopy at the time but lab results for the biopsy may take 2 -3 weeks.
Check out: The Causes of cervical cancer
How To Prepare For a Colposcopy
1. Schedule a colposcopy after a period has finished as bleeding will make it harder for the doctor to see things. The best time is 8 to 12 days after the first day of your last period.
Sometimes the transformation zone (a specific area of the cervix) cannot be seen by colposcopy and this is when an ECC is used. In fact some experts recommend that all women having a colposcopy should also have an ECC at the same time unless they are pregnant. Once again a speculum is inserted into the vagina to widen access to the cervical canal. The whole surface of the cervical canal is scraped with a knife like tool called a curette. This is done twice. Patients may feel mild cramping with some light spotting afterwards. The results are sent to a lab for testing.
If the results of a punch biopsy contradict the results of a Pap test, a cone biopsy may be carried out. A cone biopsy (also known as a cold knife biopsy or conization) can both diagnose and treat cell abnormalities. In a cone biopsy a cone-shaped wedge of tissue is removed from the lower cervix and the surrounding area is then stitched (sutured) or closed with heat (cauterized). Often the biopsy removes the affected cells which means it is a cure in itself (see cervical cancer treatment). A cone biopsy is performed in hospital on an out-patient basis under general anesthesia.
A common alternative to a cone biopsy is the loop electrosurgical excision procedure (LEEP). This procedure accomplishes the same ends a cone biopsy but is carried out under local anesthetic. With this method a thin wire loop is heated by an electrical current and acts as a knife to cut the tissue.
If a diagnosis of cancer is given, the next step is to find out how far the cancer has spread. Many of the tests below are used for staging cervical cancer, although not all will be necessary. The decision about which test to use will be depend on the results from a physical examination as well as biopsy results and blood tests.
Cystoscopy & Proctoscopy
These are examinations, which need to be carried out under local or general anesthesia, are more commonly carried out in women with large tumors. They are not usually necessary if the cancer is caught early enough. During a cystoscopy a slender lighted tube is inserted into the bladder through the urethra. A proctoscopy is a similar inspection of the rectum. These tests will help diagnose if the cancer has spread beyond the cervix.
If the doctor suspects cancer may have spread, imaging studies will be carried out to see how far it has spread. Imaging techniques include:
• Chest X-Ray
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