Invasive cervical cancer often appears as an irregular fleshy growth, often firm or hard, that tends to bleed easily. But even on pelvic examination by a doctor, pre-cancers and even early cancers of the cervix are often not visible to the naked eye. Special tests are necessary to diagnose cervical pre-cancers and cancers:

Cervical cancer diagnosis - procedures

• Pap smears screen for -- but do not diagnose -- cervical pre-cancers and cancers
• Pap smears that are collected or read by special methods (ThinPrep, AutoPap, PapNet) are now available that can be useful in certain situations or in laboratories for quality control
• Colposcopy is an examination of the cervix under magnification in order to locate an abnormality of the cervix
• Biopsy, colposcopy, or sometimes the use of LASER (a loop electrode) or other instrument allows a diagnosis to be made
• When cervical cancer is found, additional tests -- such as X-rays, using an instrument to look into the bladder (cystoscopy), and rectum and colon (colonoscopy) -- are used to determine how far the cancer has spread and what stage the disease is in

Further information about Cervical cancer diagnosis

A Pap smear is the best screening test used to detect cancer of the cervix. It is done as a part of a regular pelvic exam. A medical swab or brush is rubbed against the cervix. The tissue sample collected is smeared on a slide and sent to the laboratory for microscopic examination. This test detects cervical abnormalities more than 95% of the time. A negative test means that no abnormalities are present. If a Pap test is positive, an abnormality has been detected in the cell lining the cervix.

Because the Pap test is a screening test, rather than a diagnostic test, the doctor will order a biopsy. The purpose of the biopsy is to check if the abnormality is due to a pre-cancerous change or if cancer is present. During the biopsy, a piece of cervical tissue is removed and examined under a microscope. A cervical biopsy can be performed in several different ways. In a procedure known as colposcopy, the doctor uses a magnifying scope to view the surface of the cervix clearly. If any abnormal areas are seen, the doctor can use a pair of biopsy forceps to remove a small piece of the suspicious area for further testing. An additional procedure, known as endocervical curettage, uses a narrow instrument called curette to scrape off some tissue from the inside of the cervix. The tissue is then sent to the laboratory for examination.

A cone biopsy is sometimes used to remove a cone-shaped piece of tissue from the cervix for microscopic examination. In addition, it can be used to treat many of the pre-cancers and very early cancers. Two methods are most commonly used for performing the cone biopsy. In one method, known as loop electrosurgical excision procedure (LEEP), the tissue is removed by using a wire that is heated by electrical current. In the cold knife cone biopsy, a surgical scalpel is used to remove the tissue.

In addition to the Pap test and the biopsy results, several other tests may be used to determine the stage of the disease after a diagnosis of cervical cancer has been made. A cytoscopy may be ordered to check whether the cancer has spread to the urinary bladder and kidneys. Similarly, a proctoscopy will detect whether the cancer has spread to the rectum, and chest x rays may be ordered to check the lungs. Imaging tests such as computed tomography scans (CT) and magnetic resonance imaging (MRI) will help to identify the spread of the cancer to the nearby lymph nodes or other organs near the cervix.