July 29, 2016
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Cervical Cancer (cont.)

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What are cervical cancer screening guidelines?

The US Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommend that all women between the ages of 21 and 65 receive screening every 3 years. A Pap smear obtained during a routine pelvic examination is the typical screening procedure, but when a Pap smear is combined with an HPV test, screening every 5 years is acceptable for women aged 30 and above.

Women who have had a total hysterectomy for a benign condition no longer have a cervix, and thus do not need to be screened for cervical cancer. However, women who have had a subtotal hysterectomy still have a cervix and should be screened according to guidelines.

Certain conditions and special situations may change the frequency of screening, such as a history of abnormal Pap smears.

What tests are used to diagnose cervical cancer?

As described above, Pap testing is done to screen for cervical cancer. If abnormal cells are detected on the Pap smear, a colposcopy procedure is then performed. Colposcopy uses a lighted microscope to examine the external surface of the cervix during a pelvic examination. If abnormal areas are noted, a small tissue sample (biopsy) is taken for examination by a pathologist to look for precancerous changes or cancer. Colposcopy requires no special anesthesia and is similar to having a Pap smear in terms of discomfort.

The transformation zone of the cervix (see above) cannot always be visualized well during colposcopy. In this case, a sample of cells may be taken from the interior canal of the cervix, known as an endocervical curettage or scraping. Another option is conization, or removal of a cone-shaped portion of the cervix around the cervical canal. This tissue can be removed with a thin loop of wire that is heated by an electrical current, known as loop electrosurgical excision procedure (LEEP), also called a large loop excision of the transformation zone (LLETZ). LEEP is performed in the doctor's office with a local anesthetic. Another possibility is to have the cone-shaped tissue fragment removed in an operating room under general or regional anesthesia, referred to as a cold knife conization.

After a conization or biopsy procedure, the pathologist studies the tissue to determine if precancerous changes (referred to as cervical intraepithelial neoplasia grades 1 to 3, depending on its extent) or cancer are present.

If cancer is present, depending on the size and extent of the tumor, other tests might be done to help determine the extent to which the tumor has spread. These additional tests can include chest x-rays, or CT or MRI imaging studies. Cystoscopy (examination of the interior of the urinary bladder using a thin, lighted scope) or proctoscopy (examination of the rectum) may be necessary. An examination under anesthesia allows the doctor to perform a manual pelvic examination without causing pain to help determine the degree of spread of the cancer within the pelvis.

Medically Reviewed by a Doctor on 2/4/2016

Source: MedicineNet.com

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