Cervical Cancer Exams and Tests continued...
The loop electrosurgical excision procedure (LEEP) technique uses an electrified loop of wire to take a sample of tissue from the cervix. This procedure can often be performed in your gynecologist's office.
A conization (removal of a portion of the cervix) is performed in the operating room while you are under anesthesia. It can performed with a LEEP, with a scalpel ( cold knife conization) or a laser. In this procedure, a small cone-shaped portion of your cervix is removed for examination.
LEEP or cold knife conization procedures result in tissue samples in which the types of cells and how much they have spread to underlying areas can be more fully determined. They can be used to diagnose problems or to treat known problems.
Over the years, different terms have been used to refer to abnormal changes in the cells on the surface of the cervix. These changes are now most often called squamous intraepithelial lesion (SIL). "Lesion" refers to an area of abnormal tissue; intraepithelial means that the abnormal cells are present only in the surface layer of cells. Changes in these cells can be divided into two categories:
- Low-grade SIL (LGSIL): Early, subtle changes in the size and shape of cells that form on the surface of the cervix are considered low grade. These lesions may go away on their own, but over time, they may become more abnormal, eventually becoming a high-grade lesion. LGSIL is also called mild dysplasia or cervical intraepithelial neoplasia 1 (CIN 1). These early changes in the cervix most often occur in women aged 25 to 35 years, but can appear in women of any age.
- High-grade SIL (HGSIL): A large number of precancerous cells, which look very different from normal cells, constitute a high-grade lesion. Like low-grade SIL, these precancerous changes involve only cells on the surface of the cervix. These lesions are also called moderate or severe dysplasia, CIN 2 or 3, or carcinoma in situ. They develop most often in women aged 30 to 40 years, but can occur at any age.
Precancerous cells, even high-grade lesions, usually do not become cancerous and invade deeper layers of the cervix for many months, perhaps years.
If abnormal cells spread deeper into the cervix or to other tissues or organs, the disease is then called cervical cancer, invasive cervical cancer, or metastatic cancer. Cervical cancer occurs most often in women aged 40 years or older.
If the biopsy results show invasive cancer, a series of tests will be performed, all designed to see whether the cancer has spread and, if so, how far. They include:
- A chest X-ray to see if the cancer has spread to the lungs.
- Blood tests can indicate whether the liver is involved. A CT scan may be necessary if results are not definitive.
- Special X-rays known as an IVP or a CT scan can be used to look at the urinary tract. The bladder and urethra are evaluated by cystoscopy.
- The vagina is examined by colposcopy. The rectum is evaluated by a procto signoidoscopy and barium enema.
- Lymph nodes are evaluated by CT scans, MRI scans, or PET scans. The MRI is superior to the CT scan and the PET scan is superior to both.
These tests are used to "stage" the cancer. By finding out how far it has spread, your health care providers can make a reasonable guess about your prognosis and the kind of treatment you will need.
- Cervical cancer is staged from stage 0 (least severe) to stage IV (metastatic disease, the most severe).
- Staging is based on size and depth of the cancerous lesion, as well as degree of spread.