When cervical cancer is suspected from an abnormal cervical smear, clinical
history or physical examination, further investigations are needed to
confirm the diagnosis. These may include:
- Punch biopsy or target biopsy
- Cone biopsy
Colposcopy is required when abnormality is detected by cervical smear.
Colposcopy is like a microscope put near the vagina to allow more detailed
examination of the cervix. It is usually done in a gynecological out-patient
clinic. The examination usually takes about 20-30 minutes. You need to
lie down on your back on a couch similar to that for cervical smear. A
speculum will be used to open the vagina. The cervix will be stained by
acetic acid. The extent and severity of the lesion are identified and
appropriate treatment will be provided. Under the guidance of colposcopy,
a piece of the lesion will be removed (called a biopsy) and sent to the
laboratory for detailed examination. When the biopsy result is available,
you will be offered treatment accordingly. Unlike cervical smear, colposcopy
(with biopsy) is a diagnostic test (rather than a screening test) to confirm
the diagnosis, which can help in choosing the appropriate treatment. Also,
colposcopy needs special equipment to perform and requires more expertise.
Abnormalities found in biopsy are categorized into several entities:
cervical intraepithelial neoplasia (CIN), carcinoma in situ and invasive
||CIN 1, or mild cell changes, means one third of the thickness of
the skin covering the cervix has abnormal cells. This is similar to
LSIL in cervical smear. Majority of CIN 1 will regress to normal on
its own, but sometimes treatment is needed if the lesion is extensive.
If treatment is not necessary, you probably need to repeat a cervical
smear in 3-6 months to see if the lesions have regressed. About 15%
of these cases will progress to more severe lesions and require treatment
||CIN 2 (moderate cell changes) or CIN 3 (severe cell changes) means
two thirds and full thickness of the cervix has abnormal cells, respectively.
These lesions correspond to HSIL in cervical smear. Treatment is usually
necessary as 5-12% of them will progress to cancer.
||Carcinoma in situ is well contained within the skin covering the
cervix. It will become cancer when it breaks through the bottom layer
of the skin covering the cervix into the underlying tissue.
||Invasive carcinoma means cancer which possesses the ability to invade
surrounding structures and spread to other organs.
(ii)Punch biopsy or target biopsy
Under the guidance of colposcopy, a small piece of tissue with lesion
is obtained (biopsy), which is then sent to the lab for examination. Local
anaesthetic will be injected into the cervix before biopsy is taken. After
the procedure, some pain, bleeding or discharge may occur, which could
usually be controlled using simple measures such as pain-killers.
(iii) Cone biopsy
If the area of the lesion is large or the doctor cannot see the abnormal
area clearly with colposcopy because the abnormal cells are high up in
the cervical canal, a ring of tissue will be removed and sent to the lab
for examination to make sure the whole cancer is removed. This is a minor
operation and usually done under general anaesthesia. You will probably
need to stay overnight in the hospital.
After the operation, some gauze may be packed inside your vagina to stop
the bleeding which may persist for a few days. You may experience some
menstruation-like pain which can be reduced by taking painkiller prescribed
by your doctor.
When you go home, you should rest for the first week, but you do not
have to stay in bed. Avoid doing heavy housework or carry heavy loads.
Avoid vigorous exercise or sexual activity for 4-6 weeks.