Cervical cancer is a common malignant gynecological tumor that seriously threatens women’s reproductive health and lives, mainly caused by persistent infection with high-risk human papillomavirus (HPV). Similar to other malignant tumors, early detection, early diagnosis, and early treatment are the key to improving the cure rate and survival rate of cervical cancer. The 5-year survival rate of early cervical cancer can reach more than 95%, while that of advanced cervical cancer is less than 30%. Therefore, mastering the common examination methods for cervical cancer and carrying out regular screening and diagnosis are crucial for women of childbearing age and middle-aged and elderly women. The following details the common examination methods for cervical cancer, including screening examinations, diagnostic examinations, and auxiliary examinations, to help women understand and take the initiative to protect their cervical health.
Cervical Cancer Screening Examinations
Cervical cancer screening is the most effective way to find early cervical lesions and precancerous lesions, which is suitable for asymptomatic women of all age groups, especially women aged 21 to 65. The core purpose of screening is to detect high-risk HPV infection and abnormal cervical epithelial cells early, so as to intervene in time and prevent the development of precancerous lesions into invasive cervical cancer. Common screening methods include HPV detection and cervical cytology examination (TCT/LCT).
HPV detection is used to check whether the cervix is infected with high-risk HPV, which is the main cause of cervical cancer. High-risk HPV types mainly include HPV16, 18, 31, 33, etc., among which HPV16 and 18 are the most likely to cause cervical cancer, accounting for about 70% of all cervical cancer cases. Dr. Lisa Garcia, a gynecologic oncologist specializing in cervical cancer, points out that HPV infection is very common in women of childbearing age, but most infections can be cleared by the body’s immune system within 1-2 years; only persistent high-risk HPV infection for more than 2 years will increase the risk of cervical lesions.
Cervical cytology examination (TCT/LCT) is to collect cervical epithelial cells for microscopic examination to observe whether there are abnormal cells (such as atypical squamous cells, squamous cell carcinoma cells). This examination can directly find abnormal changes of cervical cells, which is complementary to HPV detection. At present, the most commonly used screening mode is the combination of HPV detection and cervical cytology examination, which can significantly improve the accuracy of early screening and reduce the missed diagnosis rate.
Screening frequency: For women aged 21-29, it is recommended to do cervical cytology examination every 3 years; for women aged 30-65, it is recommended to do HPV detection combined with cervical cytology examination every 5 years, or cervical cytology examination alone every 3 years; for women over 65 years old, if there is no abnormal screening result in the past 10 years, screening can be stopped.
Diagnostic Examinations for Cervical Cancer
If abnormal results are found in cervical cancer screening (such as positive high-risk HPV, abnormal cervical cytology), further diagnostic examinations are needed to confirm whether there are cervical precancerous lesions or cervical cancer, and clarify the pathological type and lesion degree. Common diagnostic examinations include colposcopy and cervical biopsy.
Colposcopy is a minimally invasive examination that uses a colposcope to magnify the cervix 10-40 times to observe the morphology of the cervical epithelium, blood vessels, and lesions. For suspicious lesion areas, special dyes (such as acetic acid and Lugol’s iodine) can be used to make the lesions more obvious, which is conducive to accurately locating the biopsy site and improving the positive rate of biopsy.
Cervical biopsy is the gold standard for the diagnosis of cervical cancer and precancerous lesions. Under the guidance of colposcopy, a small amount of tissue is taken from the suspicious lesion area of the cervix for pathological examination. Pathological examination can clearly determine whether the lesion is precancerous lesion (such as cervical intraepithelial neoplasia) or invasive cervical cancer, and clarify the pathological type (such as squamous cell carcinoma, adenocarcinoma) and grade, which provides a direct basis for the formulation of treatment plans. For patients with suspected deep lesions or unclear lesion scope, endocervical curettage can be performed to further clarify the lesion situation.
Auxiliary Examinations for Cervical Cancer
After the diagnosis of cervical cancer, auxiliary examinations are needed to clarify the stage of the tumor (whether there is lymph node metastasis and distant metastasis), so as to formulate a more targeted comprehensive treatment plan. Common auxiliary examinations include pelvic magnetic resonance imaging (MRI), chest CT, abdominal ultrasound, bone scan, and blood tumor marker detection.
Pelvic MRI is the preferred auxiliary examination for cervical cancer staging, which can clearly show the size, scope, and depth of cervical lesions, as well as whether there is invasion of surrounding tissues (such as vagina, parametrium) and pelvic lymph node metastasis. Chest CT is used to check whether there is lung metastasis, which is one of the common distant metastasis sites of cervical cancer. Abdominal ultrasound checks whether there is metastasis of liver, spleen, and other abdominal organs. Bone scan is used to detect bone metastasis, which can find early bone metastasis lesions that are not easy to be found by X-ray. Blood tumor marker detection mainly includes squamous cell carcinoma antigen (SCC) and CA125. The level of SCC is often increased in patients with cervical squamous cell carcinoma, which can be used for auxiliary diagnosis, treatment effect evaluation, and recurrence monitoring.
Special Examinations for High-Risk Groups
High-risk groups of cervical cancer include women with persistent high-risk HPV infection, women with a family history of cervical cancer, women with early sexual activity (before 18 years old), women with multiple sexual partners, women who have given birth multiple times, women with a history of sexually transmitted diseases, and women who smoke for a long time. For high-risk groups, the screening frequency should be appropriately increased, and more intensive examination methods can be used if necessary.
For women with persistent high-risk HPV infection (positive for more than 2 years), it is recommended to do colposcopy and cervical biopsy every 6-12 months to closely monitor the changes of cervical lesions. For women with a family history of cervical cancer (such as mothers, sisters, or daughters with cervical cancer), it is recommended to start screening 10 years earlier than the age of onset of their relatives, and use the combination of HPV detection and cervical cytology examination for screening to improve the early detection rate.