If cervical cancer is suspected, consultation with a gynaecologist must be done so that the disease can be arrested as quickly as possible. The most frequent manner in which the disease is found to exist is an abnormal pap-smear test. We are elaborating the various tests that can be carried out to ascertain whether cervical cancer exists:
If there are symptoms of cancer indicated in pap-smear, the patient is referred to have a colposcopy. In this test the patient lies down on a table as if undergoing a pelvic exam. A speculum is inserted in the vagina and it stretches the vaginal walls so that the doctor can see the cervix. The colposcope is an instrument that has binocular like lenses and it helps the doctor to closely and clearly examine the surface of the cervix. The doctor may apply acetic acid (similar to vinegar) so that the cervix’s abnormal tissues can be seen. Colposcopy can be mildly painful and can be used to perform a biopsy of the cervix.
2 Cervical biopsies
These procedures are similar to colposcopy and require a small portion of tissue of the cervix to be extracted. The examples of these procedures are Colposcopy biopsy, Endocervical curettage & cone biopsy. Endocervicalcurettage is scraping off tissue from the cervix so that it can be examined under a microscope to ascertain the particular state of the cells. The test involves use of a curette, a thin instrument that is guided to the cervix to take samples. Cone biopsy is yet another method that involves extraction of tissues of the cervix for examination. The biopsy usually brings out the difference between the two zones in a transformation zone consisting of exocervix and endocervix. The former is the outer part of the cervix while the latter is from the inner portion. Cone biopsy is done in two methods:
- Loop Electrosurgical procedure (LEEP): This method involves the use of a thin wire loop that is heated by passing current through it. The heated loop acts as a scalpel and it cores out tissue from the cervix.
- Cold knife biopsy: This procedure utilizes a surgical scalpel or a laser to remove tissue from the cervix. The procedure can involve general anaesthesia or a form of anaesthesia that numbs the patient from waist down.
3 Cystoscopy, proctoscopy, and examination under anaesthesia
These procedures are done on women who have developed large tumours. Cystoscopy involves insertion of a thin slender tube with camera and light, in the urethra to reach the bladder. In this way, the doctor examines the urethra and the bladder for signs of spreading of the cancer from the cervix. In this procedure local anaesthetic is used but in some cases general anaesthesia can also be used. Proctoscopy is the visual inspection of the rectum with the aid of a lighting device to check for signs of cancer spreading from the cervix.
4 Imaging techniques:
There are several imaging techniques that help with the diagnosis of cervical cancer. CT-scan and MRI are the most commonly used imaging procedures. We are elaborating them as under:
- Computed Tomography: This imaging technique relies upon several images taken and then combined into one single slide. The multiple slices of a part of body are then studied in great detail with the help of the images obtained. CT scan helps to determine if the cancer has spread to the lymph nodes or liver, lungs and elsewhere. Before the test can be done, the patient is asked to drink 1 or 2 pints of fluid (oral contrast) so that the outline of internal organs can be seen clearly. There may be an IV contrast administered to the patient which helps to better outline internal organs. There is also the procedure to guide a biopsy needle with the help of CT scanning. In this procedure the needle is guided to the abnormal mass within the cervix so that a thin strip of tissue can be extracted. CT guided core needle biopsy involves extraction of a cylindrical shape tissue from the cervix.
- Magnetic Resonance Imaging: This imaging technique utilizes radio waves and strong magnets instead of x-rays. The radio waves are absorbed by the soft tissues and then transmitted again in a certain pattern that is read by the computer in the form of highly detailed images of the soft tissue structure. This technique is highly effective in detecting cancers of the cervix. MRI scans are done in cases where having a CT scan is not possible either due to the allergy to the contrast dye or other reasons.
- Intravenous Urography: This involves a special dye being injected in a vein so that it can get accumulated in the ureter and bladder, indicating ifthe cancer has spread to these portions of the abdomen from the cervix.
- Positron Emission Tomography: In this imaging technique, a radioactive sugar (known as fluorodeoxyglucose or FDG) is administered to the patient so that it can reach the cancer cells that absorb more of the sugar due to their rapid multiplication. In this test the radioactive sugar is administered and the patient asked to lie down on a table after approximately 30 minutes. A special camera takes images of areas where the sugar molecules have accumulated and this is used to ascertain where the cancer exists and if it has spread to other regions as well.