Staging/Detection
Staging and detection tests are only as good as the doctors who report and interpret them. That’s why our doctors-who work together as a patient’s care team-are the highest trained specialists in the state.
Once a cancer has been diagnosed, it is very important for doctors to find out where the cancer may have spread (the “stage” of the cancer) to determine the best possible treatment plan for you. To find out, doctors use staging tests, which include:
- Different types of scans
- Different ways to take tissue samples to look for tumor cells microscopically (biopsy tests)
Scans and other tests may also be used:
- In a “surveillance program” looking for any signs of relapse after treatment
- In a “screening program” to detect cancer early in individuals at high-risk
- To monitor responses to treatment
Tests
Diagnostic Tests
The following procedures may be used to find cervical cancer:
Pap smear (Pap test) – A brush or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to see if they are abnormal.
Colposcopy
– A procedure to look inside the vagina and cervix for abnormal areas. Allows for a magnified view of the vagina and cervix to inspect for precancerous or cancerous changes and to guide biopsies of the abnormal areas.
Biopsy – If abnormal cells are found, a sample of tissue is cut from the cervix and viewed under a microscope by a doctor called a pathologist to check for signs of cancer. A biopsy that removes only a small amount of tissue is usually done in the doctor’s office.
Pelvic exam:
- The doctor inserts one or two lubricated, gloved fingers of one hand into the vagina. The other hand is placed over the lower abdomen to feel the size, shape and position of the uterus and ovaries. After examining the vagina, a rectal exam done to check for spread of cancer.
- An instrument called a speculum is inserted into the vagina to check for signs of disease.
Endocervical curettage – A narrow instrument is used to collect a small amount of tissue from the cervical canal. This is another type of biopsy.
Staging Tests
After cervical cancer has been diagnosed, tests are done to find out the “stage” of the cancer (or how far the cancer has spread). Tests used to determine cancer’s stage are:
Chest X-ray – An X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
CT scan
(CAT scan) – A series of detailed pictures are taken of areas inside the body. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called:
- Computed tomography
- Computerized tomography
- Computerized axial tomography
Ultrasoundexam – High-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
MRI
(magnetic resonance imaging) – This is often used by the radiation oncologist to plan radiation treatment. A magnet, radio waves and a computer are used to make a series of detailed pictures of areas inside the body. This is also called nuclear magnetic resonance imaging (NMRI).
PET scan (positron emission tomography scan) – This complements a CT scan and is some times done at the same time. A small amount of safe radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells.
Pretreatment surgical staging – This is occasionally done to find out how far the cancer has spread. Knowing how far the cancer has spread assists with planning the proper treatment of cervical cancer.
Surgery
Operations and procedures to remove cervical cancer are done by doctors who have specialized training, called gynecologic oncologists. When caught at an early stage, cervical cancer can be removed using minimally invasive procedures.
Cryosurgery (cryotherapy) – An instrument is used to freeze and destroy abnormal tissue.
Laser surgery – A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.
Loop
electrosurgical excision procedure (LEEP) – A treatment that uses electrical current passed through a thin wire loop as a knife to remove abnormal tissue or cancer.
Conization (biopsy) – Removal of a cone-shaped piece of tissue from the cervix and cervical canal. A doctor called a pathologist views the tissue under a microscope to look for cancer cells.
Total hysterectomy – Removal of the uterus, including the cervix. The different types of this surgery are:
-
Vaginal hysterectomy – If the uterus and cervix are taken out through the vagina.
-
Total abdominal hysterectomy – If the uterus and cervix are taken out through a large incision (cut) in the abdomen.
-
Total laparoscopic hysterectomy – If the uterus and cervix are taken out through a small incision in the abdomen using an instrument called a laparoscope.
-
Radical hysterectomy – A surgical procedure to remove the uterus, cervix, upper part of the vagina and the tissue next to these organs. Nearby lymph nodes in the pelvis will also be removed to check for the spread of cancer.
Pelvic exenteration – Removal of the lower colon, rectum and bladder. The cervix, vagina, ovaries and nearby lymph nodes are also removed. Artificial openings (stoma) are made for urine and stool to flow from the body to a collection bag. Plastic surgery may be needed to make an artificial vagina after this operation.
Bilateral salpingo-oophorectomy – A surgical procedure to remove both ovaries and both fallopian tubes. This is usually done if women have been through menopause. But the ovaries don’t always have to be removed for women who have not gone through menopause.