Cervical Cancer - Diagnosis

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Atypical Glandular Cells and Adenocarcinoma. Atypical glandular cells pose a higher risk for cancerous changes than atypical squamous cells or low-grade squamous intraepithelial lesions. Patients with atypical glandular cells need colposcopy and endocervical testing. Adenocarcinoma refers to glandular cells that are cancerous.

Colposcopy and Biopsy

The Pap smear shows only the presence of abnormal cells. It is useful simply as a screening test that identifies women who may have preinvasive or early cancerous changes. For a definitive diagnosis, the next step is usually colposcopy, during which the cervix is visualized under low power magnification. The surgeon takes samples of suspicious cells for biopsies. A biopsy will determine the stage of the precancerous growth or whether invasive cancer is present.

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The Procedure. Colposcopy can be performed in a doctor's office without anesthesia in 10 - 15 minutes. It causes about as much discomfort as mild menstrual cramps:

• First, using a speculum to keep the vagina open, the doctor aims a light at the cervix.
• The doctor then looks through the eyepiece of a special microscope, known as a colposcope, to view the cervix.
• A biopsy (a sampling of the tissue) is taken of suspicious areas, of the endocervical canal (the inner part of the cervix and uterus), and any abnormal-looking areas. This may cause cramping or pinching.

Click the icon to see an image of a colposcopy-directed biopsy.

After the colposcopy, the woman may have a brownish discharge from an iron solution called Monsel's solution, which the doctor applies to prevent bleeding. Doctors usually advise sexual abstinence for 1 - 2 weeks.

Biopsy Results

The precancerous changes from biopsy results of colposcopy are called cervical intraepithelial neoplasia. They are categorized according to severity: CIN I, CIN II, and CIN III.

• CIN I is classified as mild dysplasia. It is equivalent to a low-grade squamous intraepithelia lesion (LGSIL) identified by a Pap smear. CIN I may progress if untreated but often goes away without treatment.
• CIN II is classified as moderate dysplasia. It is equivalent to a high-grade squamous intraepithelial lesion (HGSIL) found in a Pap test.
• CIN III is classified as severe dysplasia. It is the most aggressive form of dysplasia. It is also equivalent to a high-grade squamous intraepithelial lesion.

CIN III is considered the same as carcinoma in situ (CIS) or Stage 0 cervical cancer. In both CIN III and CIS the precancerous cells still rest on the surface of the cervix and have not yet invaded deeper tissues. However, if not surgically removed, there is a high chance that CIN III or CIS can progress to invasive cancer.

Follow-Up Procedures. Women with evidence of cervical intraepithelial neoplasia (CIN) or cervical cancer need treatment. Women with biopsies that show low-grade abnormal cells, but whose cervix is otherwise normal, are generally given follow-up colposcopies.

If a biopsy detects invasive cancer, the patient will need additional tests to find out how far the cancer has spread. Tests to stage cancer may include a computed tomography (CT) scan (to check for the spread of the disease to lymph nodes and areas around the pelvic region), chest x-ray, ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, and other imaging tests.

Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).