Because symptoms are not always present in the pre-cancerous stage, an abnormal Pap smear is often the first indication of disease. Most symptoms appear as the cancer becomes invasive or metastasizes to other areas of the body. As most cervical cancer symptoms are not unique to the disease, consulting a physician is important.
Common cervical cancer symptoms include:
- unusual yellow vaginal discharge without odor
- bleeding and/or pain with intercourse, douching or pelvic exam
- painful urination
- lower back pain
- abnormal spotting or light bleeding between periods
- heavier bleeding during menstruation
- longer menstrual cycles.
Diagnostic Procedures Beyond the Abnormal Pap Smear
The gynecologist will collect a personal and family medical history and do a pelvic exam and a Pap smear. An abnormal Pap smear is the basis for further consultation. Most abnormal Pap smears are due to infection or inflammation, not cancer. If signs of infection are evident the infection will be treated, and a second Pap smear will be evaluated following treatment. If the abnormal results are not due to infection, the doctor may choose to more closely examine the cervix using colposcopy.
Colposcopy is the close examination of the cervix using a colposcope, an instrument that magnifies the tissue of the cervix. It is performed in the physician’s office and takes about fifteen minutes. As with a Pap smear, a speculum will be inserted into the vagina. The colposcope is positioned at the opening of the vagina. The gynecologist applies a vinegar solution to the cervix, which allows the abnormal tissue to be seen more easily. A bright light on the colposcope illuminates the cervix so the doctor can examine the cervix for abnormalities.
In March 2006 the Food and Drug Administration (FDA) approved the LUMA Cervical Imaging System, which is used in combination with colposcopy to produce a colored, patterned map of the cervix. The gynecologist uses this map and the results of colposcopy to determine which areas of the cervix should be biopsied. Use of the LUMA system will help doctors detect more cervical cancer precursor cells than colposcopy alone.
The gynecologist might also conduct a Schiller Test. A coat of iodine solution is applied to the cervix. The iodine changes the color of the cells: healthy cells will turn brown, while abnormal cells become white or yellow.
Biopsy of the Cervix: LEEP Procedure and ECC
The doctor may also choose to biopsy the abnormal tissue. A biopsy is a procedure that removes a small piece of tissue for examination under a microscope. In most cases a biopsy can be done in the doctor’s office with a local anesthetic (a medicine that numbs the tissue of the cervix). In a punch biopsy a small piece of tissue is pinched from the surface of the cervix.
If invasive cancer is suspected, the doctor will perform a cone biopsy and/or endocervical curettage to evaluate the extent of cancer, and to see if abnormal cells have spread to underlying tissues of the cervix.
A cone biopsy removes a cone-shaped piece of tissue from the cervix to look beneath the surface for abnormal cells. The tissue is removed with a scalpel, laser or LEEP procedure. LEEP, or loop electrosurgical excision procedure, uses an electrified wire loop to remove a thin layer of tissue from the cervix. Cone biopsy is sometimes used as treatment for localized cancer if evidence shows that the entire pre-cancerous lesion can be removed.
Endocervical curettage, or ECC, uses a spoon-shaped device called a curette to scrape cells from inside the cervical opening. The procedure causes some bleeding and cramping like the cramps associated with menstrual periods, but the scraped areas heal quickly.
Beers, M. H.,