Cervical cancer is a disease that can be diagnosed at its early stages unlike other oncologic pathologies if a woman has regular checks at a gynecologist. Cervical cancer does not arise from nothing. The oncologic process is preceded by precancerous conditions, which can be detected and cured in a timely manner. Sometimes, tens of years pass since the onset of precancerous changes in the epithelium of the cervix to appearance of the invasive cancer.
How is cervical cancer diagnosed?
Despite the fact that early diagnostics of cervical cancer have been developed, the mortality from this illness remains high. It rarely is detected on the early stage. However, years can pass before the onset of tumor’s invasion and precancerous conditions can be detected during that time if a woman has regular check-ups at a gynecologist.
Cervical cancer diagnostics includes if the illness is suspected:
- A swab for oncocytology for a screening detection of the pathological changes of epithelium
- Colposcopy, if there are changes detected in the swab
- Blood tests for oncologic markers
- Biopsy of suspicious neoplasm
Imaging methods are also important in cervical cancer diagnostics. These include ultrasound, x-ray, CT, MRI. However, they are used not for the primary tumor detection, but to identify the spread of the oncologic process and determine the stage of the cancer.
What is screening for cervical cancer?
Cervical cancer is the third most common oncologic disease among women. Therefore, its screening (mass) diagnostics has been widely introduced. The essence of this issue is that it does not begin after the onset of symptoms, but on the background of health state. That is, when the signs of the disease are not there yet. Any woman should have first a swab test for cervical cancer after 3 years since starting sexual activity. A year later the swab should be collected again, since it is not always possible to diagnose cervical cancer with it. The sensitivity of the test is on average 85-90%. This means that with pathological changes in the epithelium, the swab will show normal results in 10-15% of cases.
Main reasons are:
- Pathologically altered cells may not be included in a sample of clinical material;
- Doctor might not capture the affected area;
- If atypical cells are present on the spatula, they do not always transfer on to the slide;
- Evaluation of the cytological picture may be erroneous (due to human factor).
In the elderly age, screening diagnostics are usually stopped. This is possible if a woman is over 70 years old, and she has a minimum of 3 negative swabs on oncocytology within the last 10 years.
If laboratory test for cervical cancer is positive, then other confirmatory tests are required as long as the swab only gives approximate results. The next stage of screening for cervical cancer is colposcopy. This is an examination of the mucous membrane with a special optical device, increasing the image dozens of times. Thanks to colposcopy, a doctor can detect not only cancer, but also background and precancerous diseases.
Extended colposcopy carries the largest diagnostic importance. Its essence is that the cervix is processed by various substances. Mostly, these are acetic acid or iodine with glycerin, but there are also other samples. They all show what kind of reaction the tissues have to the substances. Then a biopsy is taken from the suspicious area since it’s the key method for cervical cancer detection.
For the diagnosis of the disease, clinical examination plays an important role. Often women ask if they can feel the cervical cancer with a finger. Yes, you can find it that way. However, in this case, we are not talking about early diagnosis. Only with a large size of the neoplasm it is possible to palpate.
Which oncologic marker shows cervical cancer?
Oncologic markers are chemical compounds that are detected in the blood for various types of cancers. The main cervical cancer oncologic marker is SCC Ag (squamous cell carcinoma antigen). It is not used for screening the disease, because it is inferior in sensitivity and specificity to cytological examination of the cervical swab. Therefore, cervical cancer oncologic marker is used only for preclinical diagnosis of relapse or to assess the effectiveness of the therapy.
SCC Ag increases in case of any squamous cell carcinoma, regardless of its location. Therefore, an increase in its level can point at cancer neoplasm of:
- The esophagus
- The lung
- Head and neck
- Rectum, etc.
Cervical cancer oncologic marker can also increase with non-tumor diseases. These include tuberculosis, dermatological pathologies (psoriasis, eczema, lichen planus and others), renal or hepatic insufficiency. Even positive result of a blood test for cervical cancer on the oncologic markers does not indicate a disease presence. As well as a negative one does not clearly indicate the absence of oncologic pathology.
Data obtained during the study are evaluated:
- In dynamics (a number of analyzes at regular intervals)
- In combination with other research methods
Therefore, a blood test for cervical cancer is indicative, not confirmatory. It is not used for early diagnosis of the disease. At stage 1 of cervical cancer, an examination of the antigen of squamous cell carcinoma will yield positive results only in 15% of cases. Only at the late stages of the illness there is a high sensitivity of the diagnostic test that can yield 90-95%.
What test should be passed for cervical cancer diagnostics?
A cytological examination of a stained swab taken from the cervical canal is the main test for cervical cancer. It has many advantages.
This study is:
- Quickly performed, doctor takes a swab for an analysis for cervical cancer, the results can be obtained on the same or next day
- Painless, does not require either general or local anesthesia
- Does not harm health, and therefore can be conducted at any frequency
- Has a high sensitivity and specificity as the screening method
Tests for cervical cancer must be done regularly. If they are all negative, then it’s enough to pass tests once in 3 years starting from the age of 21. However, if the background and precancerous conditions are detected, more frequent observation is needed. The test has to be done annually. But, it’s not a problem for the majority of women. Taking into consideration, how much does the test for cervical cancer cost, screening won’t be a burden financially.
The importance of a swab for oncologic cytology is difficult to overestimate. In developed countries, this analysis identifies cervical cancer at stages 0 or 1 in 70-80% of cases. That is, only 20-30% of women have a disease at stage 2 and above. In this case, the pathology prognosis is much worse. The probability of a complete cure is not high.
Often women ask what blood test shows cervical cancer. There are several studies that help in diagnostics. For early detection of pathology, a blood test using PCR for oncogenic types of papilloma virus is used. In the case of virus detection, woman is monitored, as she is at risk for cervical cancer.
For patients who already are being treated for cancer, it is possible to take an analysis for cervical cancer to determine cancer markers in the blood. An increase in their concentration indicates ineffectiveness of treatment or relapse of the neoplasm. Reducing the amount of antigen of squamous cell carcinoma indicates the success of therapy or the ongoing remission of cancer.
Is it possible to detect cervical cancer with the ultrasound?
Ultrasound is one of the most often used methods of diagnostics in gynecology. All internal genital organs can be visualized with the help of ultrasound. Therefore, often patients ask if cervical cancer can be seen on ultrasound. Yes, theoretically it is possible. But in practice, ultrasound is not used for primary diagnostics of cervical cancer. Location of the tumor allows seeing it without using imaging techniques. After all, the cervix is not hidden by other tissues.
Is it possible to detect cervical cancer by ultrasound? No you cannot. Theoretically, if you perform ultrasound, the doctor will only see a tumor-like formation. But what is it - cancer or not - can be learned only with the help of a biopsy.
If you suspect a cervical cancer, a woman undergoes a simple and advanced colposcopy. Then a sample of tissue is taken from the detected suspicious region of the mucosa, which is sent for histological examination.
How cervical cancer is identified?
Cytological examination of the swab is what helps to indentify cervical cancer in the process of primary diagnostics. However, this test is not confirmatory. It differs from the cytological that it doesn’t sturdy separate cells from the sample, but a tissue fragment.
Cervical cancer can be detected with the help of the following biopsy types:
- Colposcopic biopsy using special forceps doctor removes 2-3 mm of tissue in a suspicious area.
- Endocervical curettage (scraping) used if the suspect zone is not located in the endocervical zone. This area is not available for the colposcope. In this case, curettage is performed using a curette, and the resulting material is sent for histological examination.
- Cone-shaped biopsy is a surgical procedure, during which the cervical region of the cone-shaped form is removed. This is both a treatment and a diagnosis. The method preserves the fertility.
All these methods allow us to . Thanks to them, a primary diagnosis is established. Then, studies are needed to assess the prevalence of the oncologic process.
There are many kinds of tests that can be applied to identify the stage of the disease. These are ultrasound, CT, MRI, radiography, endoscopic studies. For instance, one can find cervical cancer on ultrasound if it has spread beyond the peritoneum. Besides, ultrasound is used to assess the patency of the ureters and the state of the kidneys (kidney failure is the main cause of death in cervical cancer).
The most informative are the research methods that allow you to evaluate the stage and find out which organs the tumor has grown or has metastasized into:
- Endoscopic methods of investigation - cystoscopy (introduction of a video camera into the bladder) or proctoscopy (examination of the rectum with video endoscopic equipment)
- Laparoscopy allows inspecting the cavity of the small pelvis
- Chest X-ray detects metastases in the lungs
- Computed tomography or MRI - allows detection of metastases of any site of a few millimeters in size
- Intravenous (excretory) urography is an X-ray examination of kidneys with contrast to assess their function and urodynamics (urine flow through the urinary tract)
- Positron emission tomography is the introduction of radioactive substances that accumulate in tumor cells, followed by their visualization
The experienced doctor knows exactly what cervical cancer looks like on ultrasound, CT or MRI. The accurate definition of the illness stage helps to choose proper treatment strategy.
Arrangement of treatment in Germany
In Germany, modern methods of treating cervical cancer are used. Booking Health can arrange treatment for you in this country. We have concluded direct contracts with all major German clinics.
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Author: Dr. Nadezhda Ivanisova