If any of these tests or procedures show that you have cervical cancer, you may need further tests to find out whether the cancer has spread to other parts of your body. This is called staging. You may have one or more of the tests described below.
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Blood test
You may have a blood test to check your general health, and how well your kidneys and liver are working.
Imaging scans
Various imaging scans can create pictures of the inside of your body and provide different types of information. You may have one or more of the following imaging scans to find out if the cancer has spread to lymph nodes in the pelvis or abdomen, or to other organs in the body.
CT scan
A CT (computerised tomography) scan uses x-rays to take pictures of the inside of your body and then compiles them into a detailed, 3-dimensional picture.
When you make the appointment for the scan, you will be told if there are any special instructions to follow. Before the scan, you may be given a drink, or have an injection of a dye (called contrast) into one of your veins. The contrast may make you feel hot all over for a few minutes. You may also be asked to insert a tampon into your vagina. The dye and the tampon make the pictures clearer and easier to read.
During the scan, you will need to lie still on a treatment table that moves in and out of the CT scanner, which is large and round like a doughnut. The scan is painless and takes 5–10 minutes.
MRI scan
An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to create detailed cross-sectional pictures of the inside of your body. Let your medical team know if you have a pacemaker or any other metal implant, as some may affect how an MRI works.
Sometimes gel is placed in the vagina before the MRI scan to better show the cervix or vagina. During the scan, you will lie on a treatment table that slides into a large metal cylinder that is open at both ends.
The test is painless but the noisy, narrow machine can make some people feel anxious or claustrophobic. If you are concerned, talk to your medical team before the scan. You may be given medicine to help you relax, and you will usually be offered headphones or earplugs. Most MRI scans take between 30 and 90 minutes.
PET–CT scan
A PET (positron emission tomography) scan combined with a CT scan is a specialised imaging test. It provides more detailed information about the cancer than a CT scan on its own. Not all people need to have a PET–CT scan.
Before having the scan, you will be injected with a glucose (sugar) solution containing a small amount of radioactive material. Cancer cells show up brighter on the scan because they take up more glucose than normal cells do. The radioactive material will leave your body within a few hours.
You will be asked to lie still for 30–60 minutes while the solution spreads through your body, then you will have the scan. Let your doctor know if you are claustrophobic, as you need to be in a confined space for the scan. It may take a few hours to prepare for a PET–CT scan, but the scan itself usually takes about 30 minutes.
Before having scans, tell the doctor if you have any allergies or have had a reaction to contrast during previous scans. You should also let them know if you have diabetes or kidney disease, or are pregnant or breastfeeding.
Examination under anaesthetic
Another way to check whether the cancer has spread is for the doctor to examine your cervix, vagina, uterus, bladder and rectum. This is done in hospital under general anaesthetic.
If the doctor sees any abnormal areas of tissue during the procedure, they will usually take a biopsy.
The area examined will depend on where the cancer may have spread to and may include:
| Pelvic examination | The doctor will put a speculum into your vagina and spread the walls of the vagina apart so the doctor can check the cervix and vagina for cancer. |
| Uterus | The cervix will be dilated (gently opened) and some of the cells in the lining of the uterus (endometrium) will be removed and sent to a laboratory for examination. This is called a dilation and curettage (D&C). |
| Bladder | To examine the bladder, the doctor will insert a thin viewing instrument with a camera and light on the end (a cystoscope) into your urethra. The urethra is the tube that drains urine (wee) from the bladder. |
| Rectum | The doctor will wear gloves and use a finger to feel for any abnormal growths inside your rectum. To examine your rectum more closely, the doctor may insert an instrument called a sigmoidoscope, which is a tube with an attached camera. |
For people who will be having radiation therapy, the doctor may implant small markers into the cervix or vagina to show the size and position of the cancer. The markers (called fiducials) are made of gold and are about the size of a grain of rice. They can be seen on x-ray and CT scans and are used to guide radiation therapy treatment.
You can usually go home from hospital on the same day after an examination under anaesthetic. You may have some light bleeding and cramping for a few days afterwards. Your doctor will talk to you about any other side effects you may have.
→ READ MORE: Staging and prognosis for cervical cancer
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Prof Martin Oehler, Director of Gynaecological Oncology, Royal Adelaide Hospital, and Clinical Professor, University of Adelaide, SA; Dawn Bedwell, 13 11 20 Consultant, Cancer Council QLD; Gemma Busuttil, Radiation Therapist, Crown Princess Mary Cancer Centre, Westmead Hospital, NSW; Dr Antonia Jones, Gynaecological Oncologist, The Royal Women’s Hospital and Mercy Hospital for Women, VIC; Angela Keating, Senior Psychologist, Royal Hospital for Women, NSW; Anne Mellon, Clinical Nurse Consultant – Gynaecological Oncology, Hunter New England Centre for Gynaecological Cancer, NSW; Dr Inger Olesen, Medical Oncologist, Andrew Love Cancer Centre, Barwon Health, Geelong, VIC; Dr Serena Sia, Radiation Oncologist, Fiona Stanley Hospital and King Edward Memorial Hospital, WA; A/Prof Megan Smith, Co-lead, Cervical Cancer and HPV Stream, The Daffodil Centre, Cancer Council NSW and The University of Sydney, NSW; Emily Stevens, Gynaecology Oncology Nurse Coordinator, Southern Adelaide Local Health Network, Flinders Medical Centre, SA; Melissa Whalen, Consumer.
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