3.1 Diagnostic workup

3.1 Diagnostic workup

After a thorough medical history and examination, the sequence of investigations depicted may be considered.

Sequence of investigations for cervical cancer

Investigations include:

  • gynaecological examination
  • colposcopic assessment prior to treatment by a practitioner certified in this field
  • cervical biopsy for confirmation of diagnosis
  • cone biopsy (conisation)/type 3 excision is recommended if the cervical biopsy is inadequate to define invasiveness or if accurate assessment of microinvasive disease is required) (NCCN 2017)
  • complete blood count (including platelets), and liver and renal function tests (NCCN 2017)
  • pelvic ultrasound (in cases where no lower genital tract abnormality is detected at colposcopy after referral with abnormal glandular cytology)
  • endocervical sampling for suspected glandular abnormalities and HPV 16/18 positivity
  • endometrial sampling to exclude an endometrial origin for atypical glandular cells (if required) (Cancer Council Australia 2016).

Timeframes for completing investigations should be informed by evidence-based guidelines (where they exist) while recognising that shorter timelines for appropriate consultations and treatment can reduce the woman’s distress.

The following recommended timeframes are based on expert advice from the Cervical Cancer Working Group:

  • For obvious abnormalities, a colposcopy within two weeks of referral.
  • Diagnostic investigations should be completed within two weeks of specialist review.