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Laboratory Evaluation

• Complete Blood Count - helps to determine the presence of infection (usually reflected in an elevated white blood cell count) or anemia (low red blood cell count)

• Chemistries - to evaluate kidney function and electrolyte balance (potassium, sodium, chloride)

• Urinalysis and Urine Culture - to evaluate for the presence of infection as well as to measure kidney function

Radiological Evaluation

• Computerized Tomography (CT Scan) - Commonly known as a "CAT scan", this procedure uses special x-ray equipment to obtain images from different angles around the body and then uses computer processing of the information to show a cross-section of body tissues and organs. It usually requires injection of intravenous contrast and drinking of oral contrast to enhance the images.

• Magnetic Resonance Imaging (MRI) - MRI uses radiofrequency waves and a strong magnetic field rather than x-rays to provide remarkably clear and detailed pictures of internal organs and tissues.

CT and MRI have similar efficacy in evaluating the status of the cervix and lymph nodes, excluding obstruction of the ureters and bladder ("obstructive uropathy"), and identifying metastatic disease.

• Positron Emission Tomography (PET Scan) - PET measures metabolic activity and is more sensitive in detecting involvement of the lymph nodes; It is useful as a follow-up tool to measure response to chemotherapy and radiation and identification of recurrent disease.

Biopsy

• Colposcopy - this requires the insertion of a scope into the vagina to allow visualization of the cervix under magnification (usually between 10x and 40x). An acetic acid solution is applied to the cervix with a cotton swab - areas that turn yellow or white are indicative of abnormal cells and will be removed (endocervical curretage "ECC") for biopsy. The procedure can be performed in the gynecologist's office and takes approximately 15 minutes.

• Loop Electrocautery Excision Procedure (LEEP) This is a more extensive method of diagnosing abnormal tissue and may also be used as a treatment for CIN and early invasive cervical cancer. The procedure entails the removal of suspicious cervical tissue with a sharp wire loop and the site is cauterized (burned) to eliminate any remaining abnormal tissue.

• Conization - In this procedure, a small scalpel or laser is used to remove a cone-shaped section of the cervix for biopsy. This procedure requires general anesthesia and usually is performed as outpatient surgery in the hospital. Most doctors suggest conization only when other diagnostic tests have revealed cancerous abnormalities.

Sentinel Node Evaluation

Tumors have three ways of spreading: 1) by local invasion of adjacent tissue; 2) via the bloodstream; and 3) via the lymphatic system. Lymphatic drainage is a system of vessels in the body that drains fluid from the body and returns it to a central location. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. Examination of the sentinel node is performed to learn whether malignant cells have spread to that node.

The sentinel node for a given tumor is located by injecting a tracer substance around the area of the tumor that will travel through the lymphatic system to the first draining (sentinel) node. The tracer substance may be a blue dye that can be visually tracked or a radioactive substance that can be followed radiologically. The sentinel lymph node is then biopsied to reveal whether there are malignant cells present - this helps to guide the treatment plan.