How Is Cervical Cancer Diagnosed?

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Cervical cancer diagnosis usually begins with a routine Pap smear screening. Abnormal results are then followed by a biopsy, in which a small amount of tissue is studied in a laboratory to test for cervical cancer.

Other tests or procedures may be done when cervical cancer is diagnosed and staged, before treatment begins. That's especially true in more advanced stages of cervical cancer.

This article explains the tests and procedures used to diagnose cervical cancer. It also describes the first signs of cervical cancer, the stages that classify the extent of the cancer, and the importance of early detection.

cervical cancer diagnosis


First Signs of Cervical Cancer

Cervical cancer symptoms do not usually appear until cancer has progressed to a fairly advanced stage. HPV, the most common cause of cervical cancer, does not usually cause symptoms—which is why it's so important to have your regularly scheduled gynecological exams.

Nevertheless, there are a few things you can look for while noting these will not enable you to diagnose cervical cancer. Rather, they are simply signs you should see a healthcare provider.

These signs and symptoms include:

  • Abnormal uterine bleeding
  • Genital warts, which may be raised, painless, and skin-colored (although the strains of HPV responsible for genital warts are not linked to cervical cancer)
  • Increased urinary frequency
  • Pelvic pain, especially during intercourse
  • Vaginal discharge

How Is Cervical Cancer Detected in Its Early Stages?

The American Cancer Society recommends people between the ages of 25 and 65 should be screened with either an HPV test, or HPV test and Pap smear, every five years. A Pap smear alone is every three years. A healthcare provider can then follow up on any abnormal changes, in order to detect a cancer in its early stages. More frequent testing may be recommended for those at higher risk.

Cervical Cancer Screening

Abnormal changes in the cervix typically develop over several years. Since cervical cells go through a series of alterations before becoming cancer cells, it is possible to screen for evidence of HPV or for precancerous changes with diagnostic tests.

The two main ways to diagnose cervical cancer are the Pap smear and HPV test. These screenings are then followed with additional diagnostic tests.

Pap Smear

A Pap smear plays a vital role in diagnosing cervical cancer. It is how most people discover that they have cervical dysplasia or cervical cancer. It is a simple test that can reveal abnormalities of the cervix long before they progress into cancer.

A Pap smear is usually done in an exam room during a routine gynecological checkup. During a Pap smear, your healthcare provider removes a tiny amount of tissue from the cervix. This is done by gently swabbing the cervix with a small brush (like a mascara wand) or a cotton swab.

It only takes seconds to collect a Pap smear sample. Some people experience a mild cramping sensation similar to menstrual cramps after this, but usually there is no pain.

The cells are examined under a microscope and abnormal cells are referred to as cervical dysplasia

Cervical dysplasia is classified as follows:

  • ASCUS (atypical cells of undetermined significance) describes any changes that are mildly abnormal. The cause could be a result of anything from an infection to the development of precancerous cells. ASCUS is not an indication of cervical dysplasia until further confirmatory testing is performed.
  • AGUS (atypical glandular cells of undetermined significance) refers to an abnormality in the glandular cells that produce mucus. Although not technically classified as cervical dysplasia, AGUS can be an indication of an underlying serious condition. AGUS results are considered rare, found in less than 1% of all Pap results.
  • LGSIL (low-grade squamous intraepithelial lesion) means that the test has detected mild dysplasia. It is a common finding, with about 50% of cases returning to normal results.
  • HGSIL (high-grade squamous intraepithelial lesion) is a more serious classification that, if left untreated, could lead to the development of cervical cancer.

HPV Testing

HPV testing is another important test that may be done alone or at the same time as a Pap smear. If only a Pap smear has been done and it is abnormal, an HPV test can often be done on the same sample. The sample collected is sent to a lab to identify the virus. 

While there are over 100 strains of the virus, not all of these cause cancer. Around 70% of cervical cancers are caused by HPV 16 and HPV 18. Another 20% of cervical cancers are related to infection with six HPV strains (31, 33, 34, 45, 52, and 58). Additional HPV viruses have been linked to cancer with other HPV strains too.

Diagnostic Procedures

If your Pap smear reveals cervical abnormalities, a colposcopy may be scheduled. A colposcopy is an in-office exam that allows the healthcare provider to view the cervix more closely with a colposcope, a lighted instrument that magnifies the cervix. Images may be projected onto a screen for a more detailed view and biopsy planning.

A healthcare provider may perform a biopsy during a colposcopy, or perhaps separate from it, so that a sample of cervical tissue can be examined by a pathologist.

Cervical Cancer Biopsies

Healthcare providers may perform a cervical biopsy during colposcopy or another procedure. This involves removing a small amount of cervical tissue to be examined under a microscope, with several procedures that are done to test for cervical cancer.

Types of biopsy include:

  • Punch biopsy, a fast and relatively pain-free procedure to collect one or several small tissue samples. Abnormal cells found during a colposcopy and biopsy may be described as cervical intraepithelial neoplasia (CIN).
  • Endocervical curettage (ECC), done with a small brush to remove tissue from the narrow cervix passage for biopsy
  • Cone biopsy, which may be done under general anesthesia if a large, cone-shaped tissue sample is needed for biopsy, or to remove precancerous tissue
  • A specific type of cone biopsy done under local anesthesia called loop electrosurgical excision procedure (LEEP). This procedure is done under local anesthesia to remove cervical tissue. It is typically used to treat high-grade dysplasia, rather than to diagnose cervical cancer.  

Be sure to discuss biopsy risks with your healthcare provider. Complications are rare but do occur, and may have lasting impacts, such as painful menstrual periods or changes in the cervix structure. Also tell them if you have pain, vaginal bleeding, and other symptoms that do not resolve within a few days after the procedure.

Cervical Cancer Staging

Once the biopsy results return, cervical cancer can either be ruled out or diagnosed. If a cervical cancer diagnosis is made, the next step is to determine the stage of cervical cancer. There are four stages of cervical cancer, each of which represents how far advanced cancer has spread.

What Is Stage 0 Cancer?

Stage 0 is not an official stage of cancer; it is used informally to describe carcinoma in situ, a noninvasive finding based on a biopsy. Any stage beyond stage 0 is considered invasive.

Stage I

Stage I tumors are generally only seen with a microscope, but in advanced stage I, cancer may be seen without a microscope. The cancerous cells have invaded the cervix and cells are no longer just at the surface. This stage is broken down into:

Stage IA: This is the earliest stage of invasive cervical cancer. The cancer cannot yet be visualized with the naked eye and can only be identified under the microscope. This stage is further broken down by size into:

  • Stage IA1: The invasion area is no more than 3 mm deep.
  • Stage IA2: The invasion area is greater than 3 mm but no more than 5 mm deep.

Stage IB: In stage IB, the invasion is greater than 5 mm deep, but still limited to the cervix.

  • Stage IB1: The cancer is deeper than 5 mm but not more than 2 cm in size.
  • Stage IB2: The cancer is at least 2 cm in size but not larger than 4 cm.
  • Stage IB3: The cancer is at least 4 cm in size and limited to the cervix.

Stage II

Stage II tumors have spread beyond the cervix. 

Stage IIA: These cancers have spread beyond the cervix to the upper two-thirds of the vagina, but have not spread around the uterus. This is further broken down by size into:

  • Stage IIA1: The tumor can be seen without a microscope but is no more than 4 cm in size.
  • Stage IIA2: The tumor can be seen without a microscope and is more than 4 cm in size.

Stage IIB: The cancer has spread to the tissues around the uterus and the upper two-thirds of the vagina, but not to the pelvic wall.

Stage III

In stage III, cervical cancer has spread beyond the uterus to the lower third of the vagina and/or extends to the pelvic wall. The cancer may be blocking the ureters (tubes that carry urine from the kidneys to the bladder) and may or may not involve nearby lymph nodes.

  • Stage IIIA: The cancer may have spread to the lower third of the vagina but not the walls of the pelvis. It has not spread to nearby lymph nodes.
  • Stage IIIB: The cancer extends to the pelvic wall and/or causes kidney dysfunction that's not attributed to another known cause.
  • Stage IIIC: The cancer involves pelvic and/or para-aortic lymph nodes (those around the abdominal aorta), including micrometastases, irrespective of tumor size and extent.
  • Stage IIIC1: The cancer involves metastasis to the pelvic lymph nodes.
  • Stage IIIC2: The cancer involves para-aortic lymph node metastasis.

Stage IV

In stage IV, the cancer spreads beyond adjacent regions to other areas of the body. 

  • Stage IVA: These cancers have spread so that they have invaded either the bladder or rectum or both (spread to adjacent pelvic organs).
  • Stage IVB: These cancers have spread to distant regions of the body, for example, lymph nodes in a distant region of the body, the lungs, liver, or bones.
cervical cancer: stage at diagnosis



Cervical cancer that spreads is considered metastatic cancer. Imaging tests can help identify areas of metastasis.

In general, imaging tests are used for staging. So, if you have non-invasive cervical cancer removed, and no signs or symptoms of metastasis, these tests are likely not necessary.

If your healthcare provider suspects local spread or distant metastases (due to your symptoms or the appearance of the tumor on physical examination or under a microscope), then imaging tests will be used to assess the regions of the body that there is concern about.

Common Imaging Tests

  • Ultrasound: An ultrasound can look at the cervix, the bladder, and the whole pelvic region to determine the cause of symptoms. It can also be used to view other areas of the body if there is a concern about metastasis.  
  • X-ray: An X-ray, such as a chest X-ray, can identify metastatic cervical cancer that has spread to the lungs or the ribs, for example. Rarely, an abnormality seen on a routine X-ray could be the first sign of metastatic cervical cancer. 
  • MRI: An MRI scan can be used to visualize the area of the cervix and pelvis. An MRI is especially useful for evaluating the spine and the spinal cord, where late-stage cervical cancer may spread. 
  • CT scan: A CT scan, like an MRI, can visualize the area of the cervix and pelvis, as well as other regions of the body where cervical cancer could have metastasized. 
  • PET scan: A PET scan is a functional test that shows areas where there is active growth of a tumor. This is particularly helpful when it comes to evaluating lymph nodes, the lungs, and the liver.

Differential Diagnoses

There are a few other conditions that may initially appear similar to cervical cancer or HPV infection. Your healthcare provider may suspect them initially, but testing will quickly rule them in or out.

Common conditions include:

  • Endometrial cancer: Endometrial cancer is cancer of the uterus. The cervix is the passageway between the vagina and the uterus, so sometimes, the two diseases can appear similar if either one has spread to the other location. In general, a biopsy is a good method of distinguishing between the two. 
  • Vaginal cancer: Vaginal cancer is not common, but because the vagina is so closely attached to the cervix, the conditions can appear similar. However, as with endometrial cancer, a biopsy can differentiate between these types of cancer.

Other conditions that may mimic cervical cancer include:

Frequently Asked Questions

  • What causes cervical cancer?

    Cervical cancer is caused when healthy cells in the cervix develop mutations in their DNA. These mutations cause the cells to multiply out of control, resulting in a mass of abnormal cells called a tumor. The biggest risk factor is human papillomavirus (HPV) infection, and genetics and environmental factors are also thought to contribute.

  • Does cervical cancer show in blood tests?

    Pap smears and HPV testing are the routine screening tests for cervical cancer. Tissue biopsy and imaging can confirm a diagnosis. Genetic testing and biomarkers may inform treatment options. Blood tests are not used in diagnosing cervical cancer, but diagnostic blood tests are emerging as the science evolves.

  • Why might you need a hysterectomy after a cervical cancer diagnosis?

    Most early-stage cervical cancers are treated with a radical hysterectomy to remove the cervix, uterus, part of the vagina, and nearby lymph nodes. This increases the chances of a cure and prevents recurrence. Later-stage cervical cancer (stages 2B, 3, and 4) is typically treated with radiation, chemotherapy, and immunotherapies.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Lisa Fayed
Lisa Fayed is a freelance medical writer, cancer educator and patient advocate.