By Simiyu Nalianya: BSc Nutrition
The early stages of cervical cancer usually do not have any symptoms. This is why it is important to have screening Pap tests. As a tumor grows in size, it can produce a variety of symptoms including:
Many of these symptoms are non-specific and can represent a variety of different conditions.
If you have any of these symptoms, talk with your healthcare provider.
The most common reason for your provider to pursue the diagnosis of cervical cancer is if you have an abnormal Pap test. Pap tests exist to find pre-cancerous lesions in your cervix. A pre-cancerous lesion means that there are abnormal appearing cells, but they haven't invaded past a tissue barrier in your cervix; thus a pre-cancerous lesion cannot spread or harm you. However, if left untreated, a pre-cancerous lesion can evolve to an invasive cancer. Pap tests are reported as no abnormal cells, atypical (abnormal) cells of undetermined significance, low grade abnormal cells or high grade abnormal cells. Depending on your specific case, your provider will decide how to proceed. A report of no abnormal cells equates to a negative test, meaning you simply need to have the next screening per the screening guidelines. Atypical cells of undetermined significance can be handled in three different ways: Repeat Pap test in 4-6 months, they can get HPV testing. Colposcopy. Colposcopy is a procedure done during a pelvic exam with the aid of a colposcope, which is like a microscope. By using acetic acid on the cervix and examining it with a colposcope, your provider can look for abnormal areas of your cervix. Colposcopy is uncomfortable, but not painful, and can be done in your gynecologist's office. Biopsy is the only way to know for sure if you have cancer, because it allows your provider to get cells that can be examined under a microscope. Once the tissue is removed, a pathologist will examine the specimen. Biopsy can be completed in conjunction with colposcopy. Your provider will decide how to proceed with the workup of a Pap test showing abnormal cells of undetermined significance, depending on the details of your case. If repeat Pap tests are not normal, then you will be referred for colposcopy. If you test positive for HPV, you will be referred for colposcopy. Generally, most patients with low grade abnormal cells, or high grade abnormal cells will be immediately referred for colposcopy. If you are pregnant, an adolescent, HIV positive, or post-menopausal, your provider may have slightly different recommendations. In some cases, the Pap test will have cells that look abnormal, but could have come from higher in your uterus. There is a chance that if this happens, you will need to have your uterine lining sampled. Talk to your provider about your Pap test results, and next steps after an abnormal Pap. If you are having symptoms (bleeding/discharge) from a cervical cancer, then it can probably be seen during a pelvic exam. Any time your provider can see a cervical tumor on pelvic exam, it will be biopsied. When abnormal appearing tissue is noticed during a colposcopy, it will be biopsied as well. There are a few different ways to do a biopsy. Punch biopsy may be used to remove a small section of the cervix. LEEP (loop electrosurgical excision procedure) is another method to do a biopsy where a thin slice of the cervix is removed. Conization or cone biopsy may be performed. A cone biopsy removes a thicker section of the cervix, and allows the pathologist to see if cancerous cells have invaded through the cervix. The cone biopsy has the added value of sometimes being able to cure a pre-cancerous lesion that is localized to a small area. Other tests that may be performed as part of a diagnostic work-up include blood tests, liver function tests and HIV testing.