If cervical cancer is suspected, you'll be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system).
Referral will be recommended if the results of your cervical screening test suggest that there are abnormalities in the cells of your cervix. However, in most cases, the abnormalities don't mean you have cervical cancer.
You may also be referred to a gynaecologist if you have abnormal vaginal bleeding, or if your GP has noticed a growth inside your cervix during an examination.
The sexually transmitted infection (STI) chlamydia is one of the most common reasons why women experience unusual vaginal bleeding. Your GP may recommend that you're tested for it first before being referred. Testing for chlamydia involves taking a small tissue sample from your cervix, or carrying out a urine test.
If you've had an abnormal cervical screening test result, or your symptoms suggest that you may have cervical cancer, your gynaecologist will usually carry out a colposcopy. This is an examination to look for abnormalities in your cervix.
During a colposcopy, a small microscope with a light source at the end (colposcope) is used. As well as examining your cervix, your gynaecologist may remove a small tissue sample (biopsy) so that it can be checked under a microscope for cancerous cells.
In some cases, a minor operation called a cone biopsy may also be carried out. The operation is carried out in hospital, usually under a local anaesthetic.
During a cone biopsy, a small, cone-shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells. You may experience vaginal bleeding for up to four weeks after the procedure. You may also have period-like pains.
If the results of the biopsy suggest you have cervical cancer and there's a risk that the cancer may have spread, you'll probably need to have some further tests to assess how widespread the cancer is. These tests may include:
- a pelvic examination carried out under general anaesthetic – your womb, vagina, rectum and bladder will be checked for cancer
- blood tests – these can be used to help assess the state of your liver, kidneys and bone marrow
- computerised tomography (CT) scan – scans are taken of the inside of your body and a computer is used to assemble them into a detailed three-dimensional image; the CT scan can help to identify cancerous tumours and show whether cancerous cells have spread
- magnetic resonance imaging (MRI) scan – this type of scan uses strong magnetic fields and radio waves to produce detailed pictures of the inside of your body; it can also be used to check whether cancer has spread
- chest X-ray – this will indicate whether cancer has spread to your lungs
- positive emission tomography (PET) scan – a specialised scan, where a mildly radioactive substance is injected into your veins so the cancerous tissue shows up more clearly; it's often combined with a CT scan and is used to see if the cancer has spread, or to check how well a person is responding to treatment
After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows:
- stage 0 (pre-cancer) – there are no cancerous cells in the cervix, but there are biological changes that could trigger cancer in the future; this is called cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS)
- stage 1 – the cancer is still contained inside the cervix
- stage 2 – the cancer has spread outside of the cervix into the surrounding tissue, but hasn't reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina
- stage 3 – the cancer has spread into the lower section of the vagina and/or into the pelvic wall
- stage 4 – the cancer has spread into the bowel, bladder or other organs, such as the lungs