How Does Your Doctor Know You Have Cervical Cancer?
If you're having symptoms that are like those of cervical cancer, your doctor will want to know why. Your doctor will ask a number of detailed questions. You'll probably talk about these issues:
Family history of cancer
How old you were when you first had sex
If you have had unprotected sex
Other risk factors, such as a history of genital warts, human papillomavirus (HPV) infection, or previous abnormal Pap smears
To learn more about your symptoms, your doctor will do a pelvic exam and tests.
Many women don't have symptoms of cervical cancer. Sometimes your doctor may first see signs of cancer during a pelvic exam or a Pap test.
What your doctor learns from a pelvic exam
Your doctor or health care provider does a pelvic exam in the office. This exam is recommended as a regular screening for women. To have the exam, you'll need to remove your clothes from the waist down and put on a medical gown. You lie on your back on an exam table, bend your knees, and then place your feet in supports called stirrups at the end of the table. This position allows the doctor to look at or feel your uterus, vagina, ovaries, fallopian tubes, bladder, and rectum. The doctor places a plastic or metal tool called a speculum inside your vagina, which allows the doctor to see the upper portion of your vagina and your cervix. After removing the speculum, the doctor inserts two or three gloved fingers into your vagina and uses his or her other hand to press on your abdomen. This is to feel for masses (lumps) or anything unusual.
You may also have a Pap test and HPV test during a pelvic exam.
Some cervical cancers may be found during a pelvic exam. While your doctor cannot see precancerous changes such as dysplasia, he or she may see some invasive cancers during an exam. If the doctor or nurse notices something suspicious during the pelvic exam, additional tests can help determine whether you have cervical cancer.
What your doctor learns from a Pap test
A Pap test is the standard way to see if there are any cell changes that cause concern. You should start seeing your doctor for regular screening Pap tests once you turn 21. After age 30, Pap tests can be done with or without HPV tests, but it is preferred that an HPV test be done at the same time. These tests can help find cervical cancer or even identify problems before they become cancer. You should not have these tests done during your period. The best time to have them is 10 to 20 days after the first day of your last period.
The Pap test, as well as the HPV test, is simple and relatively painless. You can have these tests done right in the doctor's office. The HPV and Pap tests may feel uncomfortable, but they should not hurt, and it takes just seconds to do them. The doctor uses a speculum to widen your vagina and examine the upper part of your vagina and cervix, which is the area that connects your vagina to your uterus. The doctor then uses a small, soft brush to collect cells from the cervix and vagina. A specialized doctor called a pathologist looks at the cells under a microscope to check for cancer and HPV infection.
There are 2 types of Pap tests. The difference between them has to do with how the cells are checked after they are taken from your cervix. There is not a difference in how the cells are removed from you:
With the regular method, the cell sample gets put on a slide and checked in a lab.
With the newer liquid-based test, the doctor mixes a special liquid with the cells. This helps to preserve the cells for testing so that they can be seen and checked more clearly in the lab.
Both tests can find precancerous cells. The newer method is usually more expensive, but it can be used to evaluate HPV from the same specimen taken for the Pap.
Avoid these things before your Pap and HPV tests:
Don't have sex for 2 days (48 hours).
Don't use a tampon for 2 days (48 hours).
Don't use any kind of vaginal products or medicines for 2 days (48 hours).
You should also avoid douching before Pap and HPV tests. In fact, doctors recommend avoiding douching altogether because it disrupts the natural balance of bacteria and acidity in the vagina. This can irritate the vagina and actually lead to an increased risk for certain infections.
Following the tests, ask when you can expect results and how you will receive them. For instance, will you receive results by telephone or in the mail? Knowing how long you will have to wait for results may help you feel less anxious.
Why your doctor does an HPV test
If you are under age 30 and your Pap test shows that abnormal cells may be present, your doctor may do a human papillomavirus (HPV) test. This test looks at the abnormal cells to see if HPV is present. Some types of HPV increase the risk of cervical dysplasia or cancer. The HPV test can be used along with the Pap test, and the 2 tests together are preferred for women 30 and older, the age group most likely to develop cervical cancer. This simply means that rather than doing the HPV as a follow-up test, your health care provider may do the Pap test and the HPV test at the same time.
How your doctor uses a colposcopy
If your doctor finds something suspicious during the pelvic exam or Pap test, he or she may decide to do a colposcopy. This test helps pinpoint abnormal areas in the cervix. This procedure can be done in a doctor's office. You lie in the same position as for a pelvic exam, on your back with your knees up and feet in stirrups. The doctor inserts a tool called a speculum to widen your vagina. The doctor or nurse puts a vinegar-like solution (3% to 5% acetic acid) on your cervix. This helps highlight abnormal areas. Next, the doctor places a special microscope called a colposcope at the opening of your vagina to magnify the surface of the cervix up to 40 times its normal size.
You may have a biopsy during a colposcopy. This involves removing tissue to be examined under a microscope. It may pinch some. It may also cause some bleeding or other discharge. The area usually heals quickly. Some women also feel some pain similar to menstrual cramps. Your doctor can suggest medicine that will help relieve your pain.