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Regular gynecological examinations can help prevent precancerous cells from developing into invasive cervical cancer. The diagnosis of cervical cancer begins with a pelvic examination, which will include a Pap smear. The Pap smear is the most commonly used screening test to detect cervical changes before cancer develops. Pap smears are usually conducted by a woman’s obstetrician-gynecologist as part of a regular gynecological examination. However, Pap smears may be conducted by other physicians, such as a family practitioner.

During a Pap smear, the patient lies on a table while the physician inserts an instrument called a speculum into her vagina. The speculum holds the vagina open while the physician cleans the patient’s cervix with a cotton swab and collects a sample of cells from the cervix using a tiny spatula, small brush or a cotton swab. The cell sample is then placed on a glass slide and sent to a laboratory for analysis.

If the Pap smear indicates the presence of irregularly shaped cells, known as dysplasia, or cancerous cells, the physician will need to conduct further testing. For example, another test used in cervical cancer screening is a test for the DNA of the human papillomavirus (HPV). The test uses a test sample similar to the Pap smear to identify some of the most common and high risk types of HPV. If HPV is identified, further DNA testing can indicate which strains are present. The HPV DNA test may be used as a next step after irregular Pap smear results. It may also be offered to women over age 30 as a screening test along with the Pap smear. The HPV DNA test is not routinely used in screening for younger women because HPV is more common in that age group and rarely causes cancer at that point.

Other diagnostic tests can include:

• Colposcopy. A test conducted by a gynecologist using a colposcope to further examine the cervical cells. The colposcope is an instrument with a magnifying lens that allows the physician to view the surface of the cervix with magnifying lenses.
  
  
• Colposcopic biopsy. During a colposcopy, the physician uses biopsy forceps to obtain a sample of cervical tissue for examination under a microscope.
  
  
• Endocervical curettage (endocervical scraping). Part of the tissue that lines the endocervical canal (the passage between the inner and outer part of the uterus) is removed by scraping using a narrow instrument called a curette, which scrapes the tissue. This procedure typically accompanies a colposcopy, and the tissue sample is sent to the laboratory for analysis.
  
  
• Cystoscopy and proctoscopy. During a cystoscopy, the physician checks the bladder and urethra using a thin tube with a light and a lens. If the patient has cervical cancer, the physician uses this procedure to help determine if the disease has spread into these areas. Additionally, the physician can remove small tissue samples for pathologic (microscopic) testing during this procedure. A cytoscopy and proctoscopy can be done with local or general anesthesia.
  
  During a proctoscopy, the physician views the rectum through a lighted tube to determine if cervical cancer has spread into this region. The physician will also do a thorough pelvic examination by viewing and feeling the patient’s reproductive organs while she is under anesthesia. This helps to determine whether the cancer has spread outside of the cervix.
  
  
• Imaging tests. If the physician determines that the patient has cervical cancer, certain imaging studies may be performed. These include:
  
  
• • CAT scan. During computerized axial tomography, the patient lies on a table while an x-ray scanner rotates around the body, capturing cross-sectional images. It may be performed with contrast material (dye) to help outline tissues and organs.
    
    
  • MRI. Magnetic resonance imaging uses strong magnets and radio waves to produce cross-sectional images of the body, much like a CAT scan. In addition, MRIs can also produce images that are parallel with the length of the body, which can be useful in identifying the spread of cancer to the spinal cord and brain. MRIs are particularly helpful in examining pelvic tumors.
    
    
  • PET scan. In positron emission tomography, a scanning machine takes images after the patient is injected with glucose (sugar) containing a radioactive atom. PET scans are useful for detecting whether cancer has invaded the lymph nodes and how far it has spread to other areas of the body.
    
    
  • Intravenous urography. Also called an intravenous pyelogram or IVP, this x-ray procedure helps detect urinary tract abnormalities that may be caused by cervical cancer. Before this procedure, a special dye is injected into the patient’s vein. The kidneys remove the dye from the bloodstream and pass it into the bladder. Patients who have already had an MRI or CAT scan may not require this test.