Cervical cancer – how is it detected?

Agnieszka Konieczna: Cervical cancer is one of the most common malignant neoplasms in women.

It usually takes a long time to develop, and its appearance is preceded by precancerous conditions that can be detected during preventive examinations. The formation of this neoplasm is associated with, inter alia, chronic infection with the human papillomavirus (HPV). Infection with the virus is acquired sexually. Some types of HPV, such as 11 and 6, lead to the so-called genital warts, which are growths on the skin and mucous membranes. The presence of genital warts (condyloma acuminata) does not mean, however, that a woman is at risk of developing cervical cancer. Infection with oncogenic types of the virus, such as 16 and 18, heals itself in 80% of cases. In 20% of cases, however, the virus is not eliminated and the infection becomes chronic. Cervical cancer may develop in some women with chronic HPV infection after a few years. Cervical cancer in the initial stages of development does not give any symptoms, and their appearance indicates its advanced form. The symptoms of cancer advancement include: abnormal bleeding, which may not be related to the menstrual cycle, profuse vaginal discharge, difficulty urinating or passing stools, limb oedema, and lower abdominal pain.

Cervical cancer diagnosed early is completely curable, so it is worth undergoing preventive examinations.

Prophylactic examinations in the diagnosis of cervical cancer:

Pap smear – it is a basic preventive examination, completely painless and not burdensome for the patient. It consists in taking a cell swab from the surface and the cervical canal with a special brush. Then, after the use of appropriate chemical reagents, the cells are viewed under a microscope. In addition to conventional smear smears, the so-called liquid cytology, also known as thin-layer cytology. The material taken from the surface of the cervix and its canal is placed in a special substrate and only automatically distributed under laboratory conditions on the slide and examined. If the cytological result is abnormal, other tests can be performed on the already collected material, e.g. a test for the presence of HPV. Therefore, there is no need to collect another smear from the same patient. This is an undoubted advantage of thin-layer cytology.

When the Pap smear is abnormal:

In some cases, it is recommended to repeat the cytology after anti-inflammatory treatment or in perimenopausal women after topical treatment with oestrogens. It also happens that the smear should be repeated earlier than after 12 months. If there are abnormal cells that require further diagnosis, the doctor will refer the patient to additional tests, such as: human papillomavirus (HPV) test and colposcopy with possible cervical specimen collection.

HPV Test – sampling is performed in a similar way to taking a normal cervical smear. However, the human papillomavirus test cannot replace the pap smear test! There are more than 100 types of virus and the test examines the most common ones. A negative test result does not mean that there are no pathological changes in the cervix. A positive test result (i.e. evidence of the presence of a virus) means that in such a woman the control cytology should be performed more often, sometimes further diagnostics is also necessary.

Colposcopy consists in viewing under high magnification, using a device called a colposcope, with the use of special reagents, the so-called disc (surface) of the cervix. It is a painless, non-invasive test, only the use of reagents may, in rare cases, be associated with adverse effects: The use of Lugol’s solution in a patient allergic to iodine may cause an allergic reaction. Therefore, you should tell your doctor about an allergy to iodine before the examination. Only the acetic acid test will then be used, which may only result in a temporary burning sensation.

If the colposcopy result is abnormal, cervical specimens should be obtained for histopathological examination. Taking specimens from the ectocervix and biopsy of the cervical canal may be painful for the patient, therefore the procedure is performed under paracervical anaesthesia with 1% Lignocaine. Administration of Lignocaine may be associated with an allergic reaction, therefore it is necessary to inform the doctor if you are allergic to anaesthetics.  A possible complication of this procedure may be bleeding from the site of the sample taken, so sometimes it is necessary to put a suture on the neck to stop the bleeding. Usually, however, there is a slight degree of vaginal spotting, which may last up to a few days.

The collection of targeted specimens (under the control of a colposcope) is beneficial for the patient, as the chance of a false-negative result (i.e. the formation of abnormal cells despite the correct histopathological examination result) is small. If the cytology result is oncologically unsuspected and the colposcopy is correct, it is possible to refrain from taking cervical specimens, which is an invasive test.

All the above-mentioned diagnostic methods help in the early detection of cervical cancer. Early detection of this cancer gives a good chance of a complete cure, which is why regular check-ups by a gynaecologist are so important.