Cervical Cancer Diagnosis
From an abnormal result to a confirmed diagnosis
- An abnormal Pap test (Pap smear; in the UK, a smear test) or a positive HPV test does not mean cancer, and many of these changes go away on their own.
- Neither a "wound" on the cervix nor an ultrasound result can confirm or rule out cancer on its own.
- A confirmed diagnosis can only be made with a colposcopy and a biopsy.
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An “unclear” test result does not mean cancer has been confirmed. It means more checks are needed. While you wait for results, you can carry on with your normal daily life. If you notice a new or worrying symptom, contact your doctor for advice.
Does a "wound" or infection on the cervix mean cancer?
Any “wound” or infection on the cervix means cancer.
Some symptoms of a “wound” or an infection are similar to symptoms of cancer, and that can be worrying.
What people call a “wound” on the cervix is often inflammation or cervical ectropion (a benign condition in which cells from inside the cervical canal extend onto the outer surface of the cervix; once called “cervical erosion”). The cause is found through an exam and tests.
Treating an infection can ease the symptoms, but it does not replace follow-up of cell changes. Even after your symptoms improve, keep having the recommended tests on schedule.
Three main steps in checking the cervix
Screening
Pap test, HPV test or both
Confirming the diagnosis
Colposcopy + biopsy
Staging
Imaging to see how far the cancer has spread
Don't confuse uterine cancer with cervical cancer
Uterine cancer (endometrial cancer) starts in the lining of the body of the uterus (womb), called the endometrium. Cervical cancer starts in the cervix, the part of the uterus that opens into the vagina. They are two different diseases, with different symptoms, screening and diagnostic tests. A Pap test checks the cervix, not the body of the uterus.
What your result means and what happens next
ASC-US
Unclear cell changes
Unclear cell changes
Some cells do not look completely normal, but the cause of the changes is not clear. This result does not mean cancer.
Depending on your HPV result and previous tests, a repeat test or a colposcopy may be needed.
LSIL
Low-grade cell changes
Low-grade cell changes
Mild changes were seen in the cells of the cervix, usually linked to HPV.
Depending on your age, HPV result and previous tests, follow-up is done with a repeat test or a colposcopy.
ASC-H
Possible high-grade changes
Possible high-grade changes
Abnormal cells were seen, and high-grade changes are possible but not yet confirmed (a more serious finding than ASC-US).
Colposcopy
HSIL
High-grade cell changes
High-grade cell changes
High-grade cell changes. Precancerous changes such as CIN 2 or CIN 3 may be present. This result on its own is not a diagnosis of cancer.
Colposcopy and biopsy. In some situations, removing the abnormal area with a procedure such as LEEP (loop electrosurgical excision procedure; in the UK, LLETZ) is suggested.
AGC
Abnormal glandular cells
Abnormal glandular cells
Some glandular cells look abnormal and need a closer look (both the cervix and inside the cervical canal).
Colposcopy + a sample from inside the cervical canal (endocervical sampling). At age 35 and over, or if you have abnormal bleeding or obesity, or are not ovulating, a sample of the uterine lining (endometrial biopsy) is also taken.
CIN 1, CIN 2, CIN 3
Grade of cell changes on a biopsy
Grade of cell changes on a biopsy
They show how severe the cell changes are in a tissue sample. None of them means cancer.
CIN 1 often goes away on its own and needs follow-up. CIN 2 needs close follow-up or treatment, and CIN 3 usually needs treatment. Read the details on our precancerous cervical changes (CIN) page.
HPV positive
High-risk HPV was found
High-risk HPV was found
One of the high-risk types of HPV was found in the sample (a positive result). A positive result does not mean cancer, but it does need follow-up.
It depends on the HPV type, your Pap test result and previous tests. If HPV 16 or HPV 18 is found, a colposcopy is usually recommended even if the Pap test is normal.
Two common results that seem to contradict each other
- HPV test negative (no HPV was found), but the Pap test is abnormal: how is that possible?
Cell changes are not always caused by HPV. Also, the virus may not show up in the sample. - Pap test normal, but the biopsy showed changes: why?
A Pap test is a screening test and may not pick up every change. In a biopsy, tissue is examined under a microscope, which allows a more precise diagnosis.
Having HPV 18 does not mean you definitely have cancer. Most HPV infections go away on their own, but high-risk types need follow-up.
Confirming the diagnosis: colposcopy and biopsy
At this stage, the doctor looks at the cervix more closely and, if needed, takes a sample from any abnormal-looking area.
Colposcopy
A colposcopy is a close look at the cervix with a magnifying instrument (a colposcope). It is usually done as an outpatient procedure and takes about 15 to 20 minutes. How much discomfort or pain people feel varies. If a biopsy is needed, you may feel a pinch or cramping.
Read about the steps and how pain is managed on our colposcopy guide page.
Types of biopsy
- Punch biopsy: removing a small piece of tissue from the abnormal-looking area.
- Endocervical curettage (ECC): taking a sample from inside the cervical canal.
- LEEP: removing tissue with a thin wire loop and an electric current, for diagnosis or treatment.
- Conization (cone biopsy): removing a cone-shaped piece of the cervix, including part of the cervical canal.
A biopsy, with the tissue examined under a microscope, is the way to confirm a diagnosis of cervical cancer.
Common myth: "Cervical cancer can be diagnosed with an ultrasound"
An ultrasound is enough to confirm cervical cancer.
Ultrasound is used to check many problems of the uterus and ovaries. Because it is used so widely, people may assume it can also diagnose cervical cancer.
An ultrasound on its own cannot confirm or rule out cervical cancer. The diagnosis is confirmed with a biopsy and examination of the tissue under a microscope. Imaging tests such as MRI, CT and PET-CT scans may be ordered to check how far the disease has spread.
After diagnosis: finding out how far the cancer has spread
Imaging tests
Once cancer has been confirmed, imaging helps the doctor work out the size of the tumor and how far the disease has spread. In specialist centers, an ultrasound done by someone with special training and experience can be used instead of an MRI to check whether the cancer has spread to nearby tissue.
Further tests (if needed)
In some cases, a cystoscopy (a look inside the bladder) or a sigmoidoscopy (a look inside the lower part of the large bowel) is done to check whether nearby organs are involved.
Cervical cancer is grouped into stages I to IV. In stage I, the cancer is only in the cervix. Stage IV can involve the inner lining of the bladder or rectum, or spread to distant organs. The physical exam, imaging and pathology results all help determine the stage.
Which symptoms should I see a doctor about?
Spotting after sex
This is common and often has a non-cancerous (benign) cause, such as inflammation or cervical ectropion. But because it is sometimes a sign of changes in the cervix, it is best to have it checked, especially if it keeps happening.
Abnormal bleeding
Bleeding between periods, and especially any bleeding after menopause, even just spotting, needs to be checked by a doctor.
Unusual discharge
Discharge that smells strong or unpleasant or contains blood, or an unusual change in vaginal discharge that does not go away, should be checked. These changes can be caused by an infection and often do not mean cancer.
These symptoms often have a benign cause and do not mean cancer on their own, but they should be checked by a doctor to find the cause.
Can I get pregnant after a cervical cancer diagnosis?
Conization (cone biopsy)
When the disease is very limited and at a very early stage, removing a cone-shaped piece of the cervix is sometimes enough, and the uterus is kept.
Radical trachelectomy
In this surgery, the cervix is removed and the body of the uterus is kept. It may be considered for some patients with early-stage cancer, usually with small tumors up to 2 cm.
Fertility counseling
Pregnancy is possible for some people, but it depends on the stage of the disease, the treatment and individual circumstances. Before treatment starts, talk to your doctor about preserving your fertility.
Talking with your doctor: what questions should I ask?
- What exactly is the grade of my result, and what does it mean in plain language?
- What is the next step, and which tests do I need?
- Do I need a colposcopy or a biopsy?
- Could treatment affect my fertility?
- When will the results of further tests be ready, and which symptoms should I take seriously until then?
You have the right to a second opinion
If you have been given different opinions, or you have doubts about the diagnosis or treatment plan, you can also ask another specialist for their opinion.
Frequently asked questions about cervical test results
My Pap smear result was abnormal. Does that mean I have cancer?
No. An abnormal Pap test result does not, on its own, mean cancer. Many changes are mild and may go away on their own, but the result does need follow-up as your doctor advises.
Can an ultrasound show cervical cancer?
No. An ultrasound on its own cannot confirm or rule out cervical cancer. The diagnosis is confirmed with a biopsy and examination of the tissue under a microscope.
I'm HPV positive / I have HPV 18. Does that mean I definitely have cancer?
No. Most HPV infections go away on their own. High-risk types such as HPV 18 need follow-up, but a positive result does not mean you definitely have cancer.
At what age, and how often, should I have a Pap smear or HPV test?
The starting age and how often you are tested depend on the type of test and your individual circumstances. Read the full details on our cervical cancer screening page.
Does a colposcopy hurt?
Everyone’s experience is different. The exam and the biopsy may cause some discomfort or pain. Read more about the steps and ways to reduce pain on our colposcopy page.
Is HPV contagious? Does my partner need to be examined too?
Yes. HPV spreads through sexual contact, including genital skin-to-skin contact. If your partner has symptoms such as warts or other changes in the genital area, it is best for them to see a doctor for an exam. An HPV test is not recommended for your partner just because your result was positive. Read more in our guide to HPV.
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