Cervical Cancer - Diagnosis

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After a Hysterectomy. Women who have had a total hysterectomy (removal of uterus and cervix) for non-cancer reasons may choose to discontinue Pap testing. Women who have had a hysterectomy that preserves the cervix (called a supracervical hysterectomy) should continue with Pap screening.

Tests for Human Papillomavirus

A human papillomavirus (HPV) DNA test can identify the high-risk types of HPV that are known to cause cervical cancer. The presence of these types is a strong predictor of high-grade aggressive abnormalities or cancer itself. Testing for HPV does not replace the Pap smear, but when used in combination with the Pap test this screening combination may help to more accurately detect cervical cell abnormalities than either test alone.

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The HPV DNA test is recommended as a screening test for:

• Women over age 30. In sexually active women younger than age 30, an HPV infection is likely to go away on its own, so HPV DNA test results are not useful.
• Women of any age with slightly abnormal Pap test results. For these women, the HPV DNA test can help determine if more tests, or treatment, are needed.

Classifying Cervical Cells and Determining Further Testing

The cells viewed in a cervical smear sample are classified on a scale representing the spectrum of cell changes from normal to cancerous. The smear is first characterized as either normal or abnormal.

Once abnormal epithelial cells are identified, the doctor must decide whether the patient needs only repeat Pap smears, a test for the human papillomavirus (HPV) virus, or colposcopy (a procedure used to magnify the cervix and permit detection of lesions for biopsy). To help the doctor make the decision, the abnormal cells are divided into categories, depending on the degree of abnormality, and whether they are squamous or glandular (adenocarcinoma).

The two main types of cervical cell cancer are squamous cell and adenocarcinoma. Squamous cell carcinoma represents the large majority of all cervical cancers. The remaining cases are either a combination of squamous and glandular, or rarer types.