Test Your Knowledge

Diagnosis of all women’s reproductive cancers begins with a complete medical and family history, followed by a thorough pelvic examination. During a pelvic exam, the physician, often a gynecologist, will check the cervix, uterus, ovaries and surrounding organs for any potential problems.

The gynecologist may also perform a Pap smear. This routine screening test identifies changes in the cervix before cervical cancer develops. Although a positive Pap smear indicates the presence of abnormal cells, it does not necessarily mean cancer. A pathologist will determine the type of cells and level of abnormality. If a patient’s Pap smear result indicates abnormal changes, a repeat Pap smear may be recommended in six months.

Further tests or treatment may be ordered sooner depending on the extent and severity of the pathology report. Due to earlier detection, Pap smears have greatly decreased the death rate from cervical cancer over the past 40 years.

It is important to note that early screening tests are not used to detect all gynecologic cancers. For instance, tests for endometrial cancer are typically administered only after a patient reports symptoms of the disease to her physician. Other tests that may be used to diagnose reproductive cancers include:

• Colposcopy. A colposcopy is a procedure that enables the gynecologist to examine the abnormal cervical cells more closely. It may be performed if the results of a Pap smear reveal abnormal cells. During a colposcopy, the gynecologist coats the patient’s cervix with a vinegar solution that causes the irregular cells to turn white. The gynecologist then views these regions with a small microscope-like instrument called a colposcope.
  
  
• Biopsy. A biopsy is a procedure that is commonly used to diagnose women’s reproductive cancers. It involves removing a sample of tissue from a suspected area for examination under a microscope. Biopsies differ according to cancer type. A biopsy for suspected cervical cancer involves the removal of cervical tissue whereas a biopsy for suspected endometrial cancer involves the removal of endometrial tissue. A tissue biopsy is the only procedure that can definitively diagnose gynecological cancers.
  
  
• Hysteroscopy. This procedure often accompanies a biopsy. During a hysteroscopy, a lighted instrument called a hysteroscope is inserted into the uterus through the vagina and cervix. This allows the gynecologist to examine the inside of the patient’s uterus without making an abdominal incision. General anesthesia is typically administered prior to this procedure, which takes approximately 30 to 45 minutes.
  
  
• Ultrasound. This imaging test creates a video image using sound waves. During an ultrasound, a small probe is placed on the patient’s abdomen or inside her vagina (transvaginal ultrasound). The probe releases sound waves that echo as they enter bodily organs. This test is often useful in identifying tumors because healthy tissue and tumors reflect sound waves differently. Ultrasound is helpful in determining whether a tumor is solid or filled with fluid. However, ultrasound has its limits. For instance, transvaginal ultrasound cannot accurately detect if a mass in an ovary is malignant (cancerous) or benign (noncancerous).
  
  
• Cystoscopy and proctosigmoidoscopy. During a cystoscopy, the physician examines the patient’s bladder and urethra using a thin tube with a light and a lens. A proctosigmoidoscopy allows the physician to view the rectum through a lighted tube called a sigmoidoscope. Both of these procedures can help detect cancer that has spread (metastasized) to other sites.