Cervical Cancer: Tests After Diagnosis

When you learn that you have cervical cancer, you may be overwhelmed, scared, or angry. That's understandable and is completely normal. Acknowledge how you are feeling. Whatever emotions you have are okay.

Once you feel ready to move forward, the next step will likely be more tests. These tests will help you and your health care team find out everything you can about your cancer before deciding which treatment plan will work best for you.

The tests you may have include:

• Pelvic exam
• Cystoscopy
• Proctoscopy
• Imaging tests. These can include including chest X-ray, CT scan, MRI, IVP (intravenous pyelogram), PET or PET-CT scan, or ultrasound
• Blood tests

The main reason you would get one or more of these tests is to determine the stage of your cancer. The stage is one of the most important things to know when deciding how to treat cancer. This is because staging reflects:

• How large the cancer is
• If it has grown into nearby areas
• How far it has spread in your body

You may have a pelvic exam done while you are under general anesthesia. This is so your doctor can look more closely at your cervix and nearby organs. Your health care team will give you medicine to allow you to sleep comfortably and don't feel any pain during your exam. These two tests can also be done under general anesthesia. They may be done if you have a large cervical cancer tumor. If found early when the cancer is small and localized, you won't need them.

• Cystoscopy. During this test, your doctor uses a tool (cystoscope) to see if cancer has spread to your bladder or urethra. The urethra is the tube that lets urine flow from your bladder out of your body. The scope is long and thin with a tiny light and camera on the end. Your doctor guides the scope through your urethra and up into your bladder. They may take tissue samples to send to the lab for more testing.
• Proctoscopy. This may also be called a sigmoidoscopy. For this test, your doctor uses a tool (sigmoidoscope) to see if cancer has spread to your rectum or large intestine. The thin, tube-like scope has a tiny light and camera on the end. The scope goes into your anus, through your rectum, and up into the lower end of your large intestine. Your doctor can use the scope to take a sample of any abnormal tissue and send it to a lab for testing.

There are a variety of imaging tests. (They're listed below.) These tests will get images of your cervix and other parts of your body.

Just like when you get your photo taken, you need to stay still while an imaging machine snaps pictures. This helps important details show up more clearly. You may even be asked to hold your breath a few times during a test. This helps to create a more precise image.

Some imaging tests use a contrast agent or dye. This substance helps abnormal areas inside your body show up more easily on the scan. You may drink the contrast. Or it may be injected into your bloodstream. You may have a brief warm feeling rush through your body just after a contrast injection. The contrast will slowly move through your body and leave when you go to the bathroom, either when you have a bowel movement or urinate.

Before you get any tests done with a contrast agent, tell your health care team about any allergies or if you have ever had a reaction to it in the past, including:

• Itching
• Hives
• Trouble breathing
• Swelling
• Feeling nauseous or vomiting

If you have any allergic reactions, tell your doctor right away so you can be treated.

You may need one or more of these imaging tests:

• Chest X-ray. A chest X-ray uses a small amount of radiation to create an image of your organs and bones. It can show if there are signs of cancer in your lungs or nearby tissue. Any changes to normal tissue that appear on the X-ray (like enlarged lymph nodes) may mean that the cervical cancer has spread.
• CT scan. A CT scan uses radiation, a series of X-rays taken from different angles, and a computer to create detailed images of the inside of your body. During the test, you'll lie still on a narrow table. It slowly slides through the center of a ring-shaped scanner. The scanner rotates around you and directs beams of X-rays at your body. The computer combines the series of pictures taken to make a 3-D image of your body, including your bones, organs, tissues, and any possible tumors or abnormal areas. This test can help your health care team see where the cervical cancer is and if it has spread to other parts of your body.
• MRI scan. An MRI uses radio waves, powerful magnets, and a computer to create detailed images of the inside of your body. It's very helpful for looking at pelvic tumors and checking for cancer that has spread to your brain and spinal cord. An MRI may also be used if you need to avoid tests that use radiation. For this test, you'll lie still on a table. You'll pass through a long, tube-like scanner that directs a beam of radio waves at parts of your body. Tell your doctor if being in small spaces makes you uncomfortable or anxious. They may suggest picturing yourself in a peaceful place, like at the beach. You could also possibly get a sedative before the test. An MRI machine can become very loud with clicking and beeping noises. You may receive earplugs or headphones with music and a remote sensor to press if you need help during the test. It is important to let your doctor know if you have kidney disease before receiving the contrast gadolinium that is sometimes given with MRI scans.
• IVP. An IVP is an X-ray of your kidneys, bladder, and ureters (the tubes that carry urine from the kidneys to the bladder). During this test, an iodine-containing contrast agent is injected into your veins. A doctor will take X-rays of your kidneys, ureters, and bladder as the contrast flows through each of them.
• PET scan. For this test, you'll swallow a mildly radioactive sugar or get it as an injection. After about an hour or more you will be asked to lie still on a table. It'll slide through a ring-shaped scanner that rotates around your body. The PET machine scans your entire body and creates pictures that show where the sugar is being used the most. Cancer cells look brighter on the images because they are more active and divide more quickly. It's possible you may get a headache, feel nauseous, or vomit from the radioactive sugar. These are normal reactions. Some machines can do PET and CT scans at the same time. This means areas highlighted on your PET scan can be combined with images from your CT scan to create a more detailed picture. This is called a PET-CT scan. It can be especially helpful to show if cancer has spread to your lymph nodes.
• Ultrasound. Ultrasounds use high-frequency sound waves to create images of organs and tissue inside your body. Ultrasounds help find cancer because they can check blood flow around a tumor. A transvaginal ultrasound may be used if you cannot have an MRI of your pelvis area. An ultrasound probe is inserted into your vagina to more clearly see the cervix and nearby areas.

You may also have blood drawn for tests like a complete blood count (CBC) and blood chemistry studies. These tests can help your health care team understand how well your organs are working and detect signs of cancer spread.

Tell your doctor if you think you may be pregnant before you get any tests. Closely follow instructions to prepare before each test. Ask your health care team any questions and bring up any concerns before, during, or after diagnostic testing. If you're getting a second opinion, be sure your new doctor has access to all your test results.

Going through tests after receiving a cervical cancer diagnosis can be a lot. Know that you are not alone. Also remember that these tests are important. They will help your doctors create the best possible plan to treat your cancer.