If cervical cancer is suspected, you will be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system).
Referral will be recommended if the results of your cervical screening smear test suggest that there are abnormalities in the cells of your cervix. However, in most cases, the abnormalities do not mean that you have cervical cancer.
You may also be referred to a gynaecologist if you have abnormal vaginal bleeding or your GP noticed a growth inside your cervix during an examination.
The sexually transmitted infection (STI), chlamydia, is one of the most common reasons why women experience unusual vaginal bleeding. Your GP may recommend that you are tested for it first before being referred.
Testing for chlamydia involves taking a small tissue sample from your cervix or carrying out a urine test.
If you have had an abnormal cervical screening test result, or your symptoms suggest that you may have cervical cancer, your gynaecologist will usually carry out a colposcopy. A colposcopy is an internal vaginal examination to look for any abnormalities in your cervix.
During a colposcopy, a small microscope with a light source at the end (colposcope) is used. As well as examining your cervix, your gynaecologist may remove a small tissue sample (biopsy) so that it can be checked under a microscope for cancerous cells.
If your gynaecologist is unable to see your cervix properly using a colposcope, you may need to have a cone biopsy. This is a minor operation that's carried out in hospital, usually under a local anaesthetic.
During a cone biopsy, a small, cone-shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells. You may experience vaginal bleeding for up to four weeks after the procedure. You may also have period-like pains.
If the results of the biopsy suggest that you have cervical cancer, and there's a risk that the cancer may have spread, you'll probably need to have some further tests to assess how widespread the cancer is. These tests may include:
- a pelvic examination carried out under general anaesthetic – your womb, vagina, rectum and bladder will be checked for cancer
blood tests – which can be used to help assess the state of your liver, kidneys and bone marrow
computer tomography (CT) scan – scans are taken of the inside of your body and a computer is used to assemble them into a detailed, three-dimensional image; this is useful for showing up cancerous tumours and checking whether the cancerous cells have spread
magnetic resonance imaging (MRI) scan – this type of scan uses strong magnetic fields and radio waves to produce detailed pictures of the inside of your body; it can also be used to check whether cancer has spread
- chest X-ray – this will indicate whether cancer has spread to your lungs
positive emission tomography (PET) scan – this is similar to a MRI scan, except that it can also show how well different parts of the body are working; it can be used to see how well a person is responding to treatment
After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The lower the stage, the more likely a complete cure will be possible. The staging for cervical cancer is as follows:
stage zero (pre-cancer) – there are no cancerous cells in the cervix, but there are biological changes that could trigger the onset of cancer in the future; this is called cervical intraepithelial neoplasia (CIN) (see Cervical cancer - causes)
stage one – the cancer is still contained inside the cervix
stage two – the cancer has spread outside the cervix into the upper section of the vagina or in surrounding tissue
stage three – the cancer has spread into the lower section of the vagina and/or into the tissue of the pelvis
stage four – the cancer has spread into the bowel, bladder or, in very advanced cases, the lungs