Diagnosis & Staging
Many women come to Memorial Sloan Kettering after they have had an abnormal Pap smear that indicates cancerous changes in the cervix during a routine visit to the doctor. When you come to us, our doctors will likely examine the cervix, take a biopsy of cervical tissue, and perform other tests to assess the stage of the cancer.
We may perform one or more of the following tests and procedures:
A Pap smear is a test most commonly used to screen for and detect the possibility of cervical cancer or precancer, called dysplasia.
To perform a Pap smear, the doctor inserts a lubricated instrument called a speculum into the vagina to enlarge the opening, and takes a sample of mucus and cells by gently scraping the cervix. Though the procedure is generally not painful, some women experience a few seconds of minor discomfort.
The tissue samples are then sent to a lab at Memorial Sloan Kettering to be analyzed under a microscope by one of our expert pathologists. Collection, sampling, screening, and interpretation of Pap smears require considerable experience and skill to ensure an accurate diagnosis.
With a Pap smear, cells are applied to a slide and then stained and examined in the laboratory. With liquid-based cytology, the cells are obtained in the same manner as they are for a Pap smear, but instead of being stained they are placed in a liquid, processed in a machine, and then placed on a slide. This test provides higher-quality samples than a Pap smear.
If a Pap smear or liquid-based cytology test shows an abnormality, your doctor may perform a colposcopy, in which a lighted magnifying instrument attached to magnifying binoculars (a colposcope) is used to examine your cervix.
Your doctor may also perform a biopsy at the same time, removing a tiny section of the surface of the cervix to examine under the microscope. One of our specially trained pathologists will examine the sample to see whether it contains abnormal or cancerous cells.
If abnormal cells are found or if a diagnosis is not clear after a colposcopy, it may be necessary to have minor surgery to remove a slightly larger piece of tissue from the cervix. This procedure is called a cone biopsy, or conization. In addition to helping to confirm a diagnosis, a cone biopsy can serve as an initial treatment, to simultaneously remove any precancerous or cancerous cells.
Our doctors may order a chest x-ray, CT scan of the abdomen and pelvis, and/or an MRI scan if there is reason to believe that the cancer has spread, or metastasized, beyond the cervix to other parts of the body.
Regardless of whether you are treated at Memorial Sloan Kettering or at another institution, the stage of the cancer will largely determine the treatment approach that your doctor recommends.
Cervical cancer is classified into several stages:
Carcinoma In Situ/Precancers (Stage 0) — The first stage of cervical cancer is carcinoma in situ (also known as precancer or severe dysplasia), in which a group of abnormal cells has started to grow but has not yet spread to nearby tissues. Because stage 0 “precancers” are likely to eventually spread deeper into the tissue and become cancerous, they should be treated.
Early Cervical Cancer (Stages I–IIA) — Although more extensive than stage 0, these cancers are still limited to the cervix.
Advanced Cervical Cancer (Stages IIB–IVA) — Cervical cancer that has spread beyond the cervix and invaded the surrounding pelvic tissues in the vagina, rectum, or bladder is known as locally advanced cervical cancer.
Stage IVB and Recurrent Cervical Cancer — Cervical cancer that has spread beyond the pelvis (into the lungs or liver, for example), or has returned following initial therapy, is placed in this category.