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Diagnosis

If you have symptoms or Pap test results that suggest precancerous cells or cancer of the cervix, your doctor will suggest other procedures to make a diagnosis. The first step is usually colposcopy, in which the doctor examines the cells of the cervix more closely. Another common test to more closely examine the cells is a biopsy, in which a sample of cervical cells is taken for examination.

Colposcopy

Colposcopy is a diagnostic test used to evaluate an area of abnormal tissue on the cervix, vagina, or vulva using an instrument called a colposcope. A colposcope looks like a pair of binoculars on a stand. It magnifies tissue so a healthcare practitioner can see abnormalities that cannot be seen with the naked eye.

Biopsy

In a biopsy, your doctor removes a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells. Most women have the biopsy in the doctor's office, and no anesthesia is needed.

Different types of cervical biopsies include:

Punch biopsy: The tissue sample is removed from the cervix using biopsy forceps, an instrument used to grasp tissue firmly and then remove it. This procedure is usually performed in your gynecologist's office and does not require anesthesia.

Endocervical curettage (ECC): A tissue sample is scraped from an area just past the opening of the cervix using a curette (small, spoon-shaped instrument) or a thin, soft brush. This can be done in your doctor's office and does not require anesthesia. LEEP (Loop Electro-Surgical Excision Procedure): The LEEP is performed using a small heated wire to remove tissue and precancerous cells from the cervix.

This procedure can be done in your doctor's office and requires local anesthesia. Cone biopsy (also called LEEP cone or cold knife cone biopsy): A cone-shaped sample of tissue is removed from the cervix so that the pathologist can see if abnormal cells are in the tissue beneath the surface of the cervix. This specimen is much bigger than the biopsy done in the office without anesthesia. A sample of tissue can be removed for a cone biopsy using a LEEP cone procedure, which can be done in the doctor's office under local anesthesia, or a knife cone procedure, done in an operating room under local or general anesthesia.

Cystoscopy and Proctoscopy

If advanced cancer is diagnosed and your doctor suspects the cancer may have spread beyond the cervix, a cytoscopy or proctoscopy may be done using a lighted tube to view the inside of the bladder (cystoscopy) or the anus, rectum and lower colon (proctoscopy).

Imaging

To learn more about the extent of disease and suggest a course of treatment, the doctor may order some of the following imaging tests: Chest X-ray: This is a picture of the chest that shows your heart, lungs, airway, blood vessels and lymph nodes. A chest X-ray can often show whether cancer has spread to the lungs.

Computed tomography (CT) scan: This diagnostic test uses an X-ray machine and a computer to create detailed pictures of the body, including 3-D images. It is used to detect disease outside the cervix or abnormal organ structure. CT scans also can be used to guide a needle into a mass if a biopsy is needed.

Magnetic resonance imaging (MRI): This diagnostic test uses magnetic fields and radio waves to create computerized pictures of the pelvis and abdomen. You may have to be placed in a tube, which can feel confining to people who have a fear of enclosed spaces.