Monday, February, 13, 2012

Cervical Cancer - Diagnosis

Table of Contents

Atypical Squamous Cells. Atypical squamous cells (ASC) are mildly abnormal cells on the surface of the cervix. They may simply represent inflammation. Over 80% of these cells become normal, but unfortunately, 5 - 17% of these women have a chance for having cervical intraepithelial neoplasia (CIN) II and III dysplasia, which indicates potentially invasive cells. Atypical squamous cells are further categorized as:

  • ASC-US. These atypical squamous cells of undetermined significance (ASC-US) are the lowest risk abnormal cells. Women with these cells should be tested for HPV. If results indicate they are infected with HPV, they should have a colposcopy to determine if the condition is actually at a more aggressive stage. If they do not have HPV they are simply monitored with repeat Pap smears.
  • ASC-H. This category refers to the presence of atypical squamous cells, but a doctor cannot exclude possible high-grade squamous intraepithelial lesions. Such women have a higher risk of having CIN II and III. All are referred for colposcopy.

Among those with atypical squamous cells, immunosuppressed women and those with high-risk human papillomavirus infections are at higher risk for cervical intraepithelial neoplasia II and III and should always be given colposcopy. Postmenopausal women with normal immune systems have a lower risk than younger women. In general, the actual risk for cervical cancer in women with atypical squamous cells is only 0.1 - 0.2%.

Squamous Intraepithelial Lesions (SILs). Squamous intraepithelial lesions (SILs) are classified as either low-grade (LGSIL) or high-grade (HGSIL). High-grade SILs are more serious than low-grade SILs, and need to be treated because they can develop into invasive cancer. Pap tests can identify the presence of SILs but not their grade. All patients with SILs should undergo colposcopy. A colposcopy can determine whether SILs are high-grade or low-grade and whether treatment is required.

Atypical Glandular Cells and Adenocarcinoma. Atypical glandular cells pose a higher risk for cancerous changes than atypical squamous cells or low-grade squamous intraepithelial lesions. Patients with atypical glandular cells need colposcopy and endocervical testing. Adenocarcinoma refers to glandular cells that are cancerous.

Colposcopy and Biopsy

The Pap smear shows only the presence of abnormal cells. It is useful simply as a screening test that identifies women who may have preinvasive or early cancerous changes. For a definitive diagnosis, the next step is usually colposcopy, during which the cervix is visualized under low power magnification. The surgeon takes samples of suspicious cells for biopsies. A biopsy will determine the stage of the precancerous growth or whether invasive cancer is present.

The Procedure. Colposcopy can be performed in a doctor's office without anesthesia in 10 - 15 minutes. It causes about as much discomfort as mild menstrual cramps:

  • First, using a speculum to keep the vagina open, the doctor aims a light at the cervix.
  • The doctor then looks through the eyepiece of a special microscope, known as a colposcope, to view the cervix.
  • A biopsy (a sampling of the tissue) is taken of suspicious areas, of the endocervical canal (the inner part of the cervix and uterus), and any abnormal-looking areas. This may cause cramping or pinching.
Click the icon to see an image of a colposcopy-directed biopsy.

Review Date: 10/21/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)