Diagnosing cervical cancer: from smear test to treatment decision

From abnormal smear to diagnosis: the steps of the pathway

A diagnosis can occur in two very different ways emotionally: during a routine screening, often as an unexpected announcement, or following symptoms that led to a consultation. In both cases, the diagnostic journey follows the same steps.

An abnormal smear or high-risk HPV (HR-HPV) test triggers a colposcopy : an examination of the cervix performed with a magnifying device, which allows for the visualization of abnormal areas and the performance of targeted biopsies. These samples are then analyzed by a pathologist, who determines the exact nature of the cells and specifies whether it is a precancerous lesion (CIN) or an invasive cancer.

In some cases, particularly when biopsies reveal a high-grade lesion, a conization is proposed. This procedure consists of removing a cone of cervical tissue: it is both diagnostic and, if the resection margins are clear, sometimes sufficient as treatment for precancerous lesions.

{{encart-bleu}}

Staging: why it determines treatment

Once cancer is confirmed by biopsy, a staging workup is performed to determine the extent of the disease. Two examinations form the basis of this process:

• Thepelvic MRI : evaluates the size of the tumor and its local spread to adjacent structures (vagina, parametrium, bladder, rectum)
• The PET-CT scan (positron emission tomography): checks for lymph node involvement and distant metastases

The results of these examinations directly determine the treatment strategy proposed during the multidisciplinary team meeting:

• Tumor limited to the cervix (stages I and IIA): surgery is generally the gold standard
• Spread beyond the cervix or lymph node involvement (stage IIB and beyond): concurrent chemoradiotherapy becomes the standard treatment

When the staging workup determines a decision as critical as the choice between surgery and chemoradiotherapy, a second opinion based on a review of the imaging and pathology reports can provide the necessary confirmation before proceeding.

{{cta14-large}}

The multidisciplinary team meeting: how treatment decisions are made

The multidisciplinary team meeting (MDT) is the stage where the relevant specialists review the case together and propose a treatment protocol. For cervical cancer, the MDT typically includes a gynecologist, a gynecologic surgeon, a radiation oncologist, a medical oncologist, a radiologist, and a pathologist.

The MDT produces a treatment proposal tailored to the stage and characteristics of the disease, based on current clinical guidelines. This proposal is then presented to the patient, who can ask questions and express her preferences, particularly regarding fertility preservation.

The window between the confirmation of the diagnosis and the MDT meeting is the most opportune time to initiate a second opinion: the case files are available, and the treatment decision has not yet been finalized. This second opinion does not challenge the MDT process; rather, it allows the patient to approach this stage with additional insight.