Usually, cervical cancer grows slowly. Precancerous changes may not become cancerous for months or years. Once they spread deeper into cervical tissue or to other tissues and organs, the cellular abnormalities are classified as cervical cancer, or invasive cervical cancer. Cervical cancer tends to occur in midlife; half of women diagnosed with cervical cancer are between the ages of 35 and 55, and it rarely occurs in women younger than 20.

A Pap test is a screening tool; other procedures are necessary to confirm Pap test abnormalities and diagnose conditions. All abnormal Pap tests should have some form of follow-up. This may include a "watch and wait" approach with retesting in several months. Or, depending on the degree of abnormality, your health care provider may order other tests, including:

• Colposcopy: The doctor uses a colposcope to magnify and focus light on the vagina and cervix to view these areas in greater detail. Depending on these findings, your health care professional may then use one or more of the following tests:

  • Biopsy: During this procedure, sample tissue is taken from the cervical surface. Often several areas are biopsied.

  • Endocervical curettage: Cells are scraped from inside the cervical canal using a spoon-shaped instrument called a curette to help make a more precise diagnosis. This procedure evaluates a portion of the cervix that cannot be seen.

  • Cone biopsy: When biopsy or endocervical curettage reveals a problem that requires further investigation, a cone biopsy may be performed. A "cone" of tissue is removed from around the opening of the cervical canal. In addition to diagnosing an abnormality, cone biopsy can be used as a treatment to remove the suspect tissue.

  • Loop Electrocautery Excision Procedure (LEEP): The suspicious area is removed with a loop device and the remaining tissue is electrocoagulated (vaporized with radio waves). LEEP is both a diagnostic test and a treatment. A pathologist examines tissue removed during LEEP.

If cancer of the cervix is diagnosed, more tests will be conducted to learn if cancer cells have spread to other parts of the body. These tests may include:

• Cystoscopy: This test is performed to see if the cancer has spread to the bladder. The doctor examines the inside of the bladder using a lighted tube.

• Proctoscopy: Similar to a cystoscopy, this test is performed to see if the cancer has spread to the rectum.

• Examination of the pelvis under anesthesia to check for further spread.