How is Cervical Cancer Diagnosed?

This is the sixth page in the Understanding Cervical Cancer Guide. This guide was developed by the HealthTree Education Team and was last updated and reviewed on June 16, 2026.

If your doctor suspects you may have cervical cancer, or if a screening test has found abnormal cells, there are several tests and procedures that can confirm a diagnosis. Some tests are used to confirm whether cancer is present. Others are used to learn more about the cancer, such as how far it has spread, and to help plan treatment. You may not need all of the tests listed here.

Physical examination and medical history

Your doctor will begin with a thorough medical history and a physical examination. This will include a pelvic exam, during which the doctor checks the cervix, uterus, vagina, and nearby organs for any abnormalities. A rectal exam may also be done to check for any spread to tissue near the rectum.

Pap test and HPV test

If abnormal cells have been found on a Pap test or HPV test, your doctor will likely recommend further testing. A Pap test alone cannot diagnose cervical cancer. It can only show that abnormal cells are present. A biopsy is needed to confirm a cancer diagnosis.

Colposcopy

A colposcopy is a procedure in which a doctor uses a special magnifying instrument called a colposcope to look closely at the cervix. Colposcopy is usually done when a Pap test or HPV test shows abnormal results. During colposcopy, the doctor may apply a solution to the cervix that makes abnormal cells easier to see. If any areas look suspicious, a small tissue sample called a biopsy will be taken for further testing.

Biopsy

A biopsy is the only way to confirm a diagnosis of cervical cancer. A small sample of tissue is removed from the cervix and examined under a microscope by a pathologist. There are several types of biopsies used for the cervix:

• Punch biopsy. A small, circular piece of tissue is removed from the abnormal area. This can usually be done in the office with little or no anesthesia.
• Endocervical curettage, sometimes called an ECC. A small instrument is used to scrape cells from the inside of the cervical canal.
• Cone biopsy, also called cold knife conization or conization. A cone-shaped piece of tissue is removed from the cervix. This is a more extensive biopsy done in an operating room under anesthesia. A cone biopsy can both diagnose and treat very early-stage cervical cancer.
• Loop electrosurgical excision procedure, known as LEEP. A thin wire loop that carries an electrical current is used to remove tissue from the cervix. This can also be both a diagnostic and treatment procedure for early abnormal cells.

Imaging tests

Once cervical cancer has been confirmed, imaging tests help determine how far the cancer has spread. Your doctor will recommend specific tests based on your situation.

• MRI scan. Magnetic resonance imaging uses magnetic fields and radio waves to create detailed pictures of the inside of the body. MRI is especially useful for seeing how deeply the cancer has grown into the cervix and nearby tissues, and whether it has spread to lymph nodes. It is often the most important imaging test for planning treatment.
• CT scan. A computed tomography scan uses X-rays to create detailed cross-sectional images of the body. CT scans are used to look for spread to lymph nodes and distant organs such as the lungs and liver.
• PET-CT scan. A positron emission tomography scan combined with a CT scan shows areas of the body where cells are using large amounts of energy, which can indicate cancer. PET-CT is helpful for detecting spread to lymph nodes and other parts of the body.
• Chest X-ray. A chest X-ray may be done to check whether cancer has spread to the lungs.
• Ultrasound. An ultrasound may be used to look at the kidneys and bladder to see whether a tumor is causing any blockage.

Additional procedures

• Cystoscopy. A thin, lighted tube is used to look inside the bladder to check whether cancer has spread there.
• Proctoscopy. A thin, lighted tube is used to look inside the rectum and lower colon to check for spread.

Biomarker and molecular testing

Tumor tissue may be tested for certain biomarkers that can help guide treatment decisions. These tests are especially important when considering immunotherapy or targeted therapies:

• PD-L1 testing. Measures a protein on tumor cells that can indicate whether a tumor is likely to respond to checkpoint inhibitor immunotherapy drugs such as pembrolizumab.
• Mismatch repair and microsatellite instability testing. Checks whether the cancer cells have defects in a DNA repair system. Cancers that are mismatch repair deficient or have high microsatellite instability tend to respond well to certain immunotherapy drugs.
• HPV typing. Confirms which type of HPV is associated with the cancer.