Cervical cancer: symptoms and diagnosis
Most women with abnormal cell changes feel well and have no symptoms. Having symptoms usually means a cancer is present. Some women may have irregular bleeding, discomfort or bleeding during or after sex or unusual vaginal discharge. Pelvic pain, excessive tiredness, swollen legs or backache can be signs of more advanced cancer.
These symptoms can also be due to other more common problems, but you should still have them checked by your doctor. You may need to be referred to a specialist for further diagnosis and treatment.
Doctors and other health professionals you may see
Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will examine you and may ask you to have more tests. If you have cancer, one or more specialists will advise you about treatment options.
You should expect to be cared for by a team of health professionals from the relevant major fields (see following list). Ideally, all your tests and treatment should be available at your hospital; however, this may not be possible.
Health professionals who care for women with cervical cancer include:
- gynaecological oncologists, surgeons who diagnose and treat women with cervical cancer
- radiation oncologists, who specialise in using radiotherapy to treat cancer
- medical oncologists, who specialise in chemotherapy and hormone therapy to treat cancer
- nurses and general practitioners, who will help you through all stages of your cancer
- dietitians, who will recommend the best diets to follow during and after treatment
- social workers, physiotherapists, psychologists and occupational therapists, who will advise you on support services and help you to get back to normal activities.
Tests to diagnose dysplasia and cervical cancer
Various tests are used to detect dysplasia and cervical cancer. The tests reveal more about the cell changes and allow the doctor to make decisions about further tests or treatment. When discussing these tests with your doctor, make sure you understand what is being discussed and what will happen.
The tests may not be very pleasant but are designed to be as quick and painless as possible. Some women feel uncomfortable about having them. It helps to understand exactly what the tests involve. Having a partner or friend with you can give you extra support at this time.
Colposcopy gives a magnified view of the cervix. It can often be done in the doctor's room. As with a Pap test, the doctor puts a speculum into your vagina to hold the walls slightly apart. The doctor looks at your cervix through the colposcope, which is like a microscope on a stand. The doctor may paint your cervix with a vinegar solution, which
causes healthy cells to turn pink and abnormal cells to turn white. Some colposcopes have a special TV screen so you can watch the procedure if you wish.
If you are pregnant a colposcopy is quite safe. However, you should always tell your doctor if you are or think you may be pregnant, as you may need different treatment.
Sometimes the doctor takes a biopsy at the same time.
Treatment for dysplasia
If you are diagnosed with dysplasia (abnormal cell changes that may become cancer but are not yet cancer), you may need treatment to remove the abnormal cells from the cervix.
In mild cases, all you may need is more frequent Pap tests, to watch that the cells return to normal.
In more severe cases, the abnormal cells may be removed using laser surgery, loop excision (sometimes called LEEP or LLETZ procedure) or cauterisation (burning). These destroy the abnormal cells without harming normal tissue. A cone biopsy may also remove all the abnormal cells.
These treatments can cause temporary cramping or other pain, bleeding or a watery discharge for several weeks.
Although it is not cervical cancer, the diagnosis and treatment of dysplasia may still be a shock and it may take you some time to recover emotionally. Talking with friends, partners or relatives may help.
In a cervical biopsy, a small piece of tissue is removed from the cervix. The doctor uses the colposcope to see the area that needs to be removed.
You may feel a little pain when the biopsy is taken: ask the doctor to tell you when this might happen.
The tissue is sent to a laboratory for examination. Usually, a definite diagnosis cannot be made until the results of the biopsy are received. This may take several days, or sometimes longer.
A biopsy can cause some bleeding or other discharge, but it usually heals quickly. Some women have pain afterwards, similar to menstrual cramping, which can be helped by pain relievers.
To allow your cervix to heal after a biopsy, your doctor will tell you for how long you should avoid sex and tampons.
Cone biopsy/loop excision
If the biopsy shows abnormal cells on the surface of the cervix, you may need to have a cone biopsy or loop excision. This removes a larger and deeper area of tissue from the cervix. Sometimes it removes all the abnormal cells and no further treatment is needed. In other cases, it shows that the cells have spread into the cervix, and further treatment is needed.
You will usually have a general anaesthetic. You may be treated as a day patient or stay overnight in hospital.
Most women do not have any problems after a cone biopsy,although some women may have difficulty with their periods. You may have some bleeding or cramping for a short while after the cone biopsy. Avoid sex and tampons for three to four weeks. This allows time for your cervix to heal.
Your cervix may be weaker after a cone biopsy. You can still become pregnant but may be at more risk of having a mid-pregnancy miscarriage. Some supportive stitches can be put in early in the pregnancy; these stitches are not always required and are usually removed before the baby is due. If you want to become pregnant, you should discuss this and possible side effects with your doctor before you have a cone biopsy.
Further tests to diagnose cervical cancer
If you have been diagnosed with invasive cervical cancer, you will need further tests. These will tell your doctor how the cancer has spread.
When the test results come back, you and your doctor can discuss the best treatment plan for you.
The further tests may include some or all of the following.
Examination under anaesthetic (EUA), cystoscopy and proctosigmoidoscopy
These tests check whether the cancer has spread to other organs in your abdomen.
You will be admitted to hospital, usually as a day patient, for an extensive physical examination. While you are under anaesthetic, your gynaecological oncologist will examine your bladder, bowel, vagina and pelvic area very carefully.
Your doctor will use a cystoscope and a proctosigmoidoscope. A cystoscope is a thin, lighted instrument that is used to examine your bladder. A proctosigmoidoscope is a thin, lighted instrument that is used to examine the lower end of the bowel.
You may also have a biopsy of your cervix. Most women also have blood and urine tests.
Magnetic resonance imaging (MRI)
This test uses magnetism to build up pictures of the organs in your abdomen. It is very good at imaging the tissues of the pelvis where the cancer is.
MRI is painless, and the magnetism is harmless. You will be asked to lie down inside a large metal tube that is open at both ends. You will probably have an injection, to help show up blood vessels. The test may take up to an hour. The tube makes some people feel claustrophobic (afraid of being in a small space). You can usually take someone into
the room with you for company. The machine can be quite noisy.
Computed tomography (CT) scan
A CT scan is a type of x-ray that gives a cross-sectional picture of organs and other structures (including any tumours) in your body.
CT scans are usually done at a hospital or a radiology clinic. It takes about 30 to 40 minutes to complete this painless test.
You will be asked not to eat or drink before the scan, except you may have a liquid dye, in a drink and an injection. This dye makes your organs appear white on the scans that are taken, so anything unusual will show more clearly.
You may also be asked to put a tampon into your vagina before the scan; this also makes it easier to detect any problems.
You will lie on a table while the CT scanner, which is large and round like a doughnut, moves around you. Most people are able to go home as soon as their scan is over. There is a small possibility of the injected dye causing an allergic reaction. You should tell your doctor if you are allergic to iodine or to contrast dyes, or if you are diabetic or have abnormal kidney function.
If your doctor thinks you may have cancer that has spread, they will advise some further tests.
A positron emission tomography (PET) scan can check to see if cancer has spread to other parts of the body. You will have an injection of a glucose solution containing a very small amount of radioactive material.
The scanner moves around you, detecting the radioactive material in the glucose solution. Cancer cells show up as areas where glucose is being used by actively growing cells.
To show this accurately, you will need to not eat beforehand, and have a catheter in the bladder during the procedure.
If you have not had a CT or MRI scan, an intravenous pyelogram (IVP) will check your kidneys, bladder and ureters (the tubes that connect the kidneys to the bladder).
An IVP can be done in a hospital x-ray department or at a special clinic. You may be asked to go on a low-fibre diet and take something to help empty your bowels before you have the IVP.
Before the test, a dye that shows up on x-ray will be injected into a vein in your arm. This dye concentrates in your kidneys, ureters and bladder so that the x-rays can show any problems. An IVP should not cause any side effects.
Instead of an IVP, some specialists may advise you to have an ultrasound to check your kidneys.
For information or cancer support call 13 11 20.
For more information, see the Cancer Council of Victoria website (see the link below).