3. Diagnosis

​Updated May 2026​​

Investigation of abnormal cervical screening results

The primary method for cervical cancer screening in British Columbia is now high-risk HPV testing, which has replaced cytology (Pap testing) in most cases. HPV testing is more sensitive for detecting high-grade cervical lesions and has a higher negative predictive value. Cytology is still used in certain follow-up or triage situations (e.g., after a positive HPV test).

HPV-based screening is recommended every 5 years for individuals aged 25–69 who screen HPV-negative. Positive HPV tests are followed by reflex cytology and/or referral to colposcopy, depending on the result. Refer to section 2 above for detailed cervical screening guidelines and references.

HPV/Cytology Sample Collection

In British Columbia, eligible participants may choose to self-collect a vaginal sample using a mailed self-screening kit, which includes instructions and prepaid return packaging. Self-screening samples are tested for high-risk HPV only; participants with HPV types 16 and/or 18 detected are referred directly to colposcopy, while those with other high-risk types are referred to their provider for follow-up cervical cytology.

A provider-based liquid-based collection device is used to obtain a sample of cells from the cervical transformation zone. In BC, cervical samples are collected using a broom-type or brush/spatula combination device and placed into a liquid-based cytology vial. Sampling should ensure adequate cellular material from both ectocervix and endocervix, especially in individuals over 30 years of age or with glandular abnormalities. Participants may choose either sampling methods (provider collected or self-collected) as per their preference in most cases.

Indications for Colposcopy

Colposcopy is indicated for individuals with a high-risk (hr) HPV positive test and abnormal reflex cytology (e.g., ASC-H, HSIL, AGC), hrHPV 16/18 positive testing or persistent positive hrHPV other testing, or specific clinical findings such as visible cervical lesions. Referral practices should align with the BC Cancer Screening Program Guidelines. HPV-based triage algorithms now dictate most referrals.

For details please visit:  http://www.bccancer.bc.ca/screening/health-professionals/cervix/resources

Histologic Classification

According to the 2020 WHO Classification of Female Genital Tumours (5th edition), cervical neoplasia is categorized into squamous, glandular, and other rare tumour types1. These are now further classified by HPV association, which has important clinical and prognostic implications. HPV-independent tumours are associated with a poorer prognosis and are less likely to respond to standard chemoradiation. Accurate HPV status classification is important to inform treatment planning.

Squamous cell tumours and precursors

  • Squamous intraepithelial lesions of the uterine cervix
  • Squamous cell carcinoma, HPV-associated, of the uterine cervix
  • Squamous cell carcinoma, HPV-independent, of the uterine cervix
  • Squamous cell carcinoma NOS of the uterine cervix

Adenocarcinomas

  • Adenocarcinoma in situ, HPV-associated, of the uterine cervix
  • Adenocarcinoma, HPV-associated, of the uterine cervix
  • Adenocarcinoma in situ, HPV-independent, of the uterine cervix
  •  Adenocarcinoma, HPV-independent (includes gastric type adenocarcinoma, clear cell adenocarcinoma, mesonephric adenocarcinoma, endometrioid adenocarcinoma)

Other epithelial tumours

  • Carcinosarcoma
  • Adenosquamous and mucoepidermoid carcinomas
  • Adenoid basal carcinoma

Mixed epithelial and mesenchymal tumours

  • Adenomyoma
  • Adenosarcoma

Germ cell tumours

Neuroendocrine neoplasia

  • Neuroendocrine tumou​r
  • Neuroendocrine carcinoma (small cell and large cell)
  • Carcinoma admixed with neuroendocrine carcinoma

Other rare tumours

  • Sarcomas, lymphomas, melanoma

Microscopic description

Pathologic reports of invasive carcinoma should include:

  • Histologic type and grade
  • Tumour size (if able to determine)
  • HPV-associated or independent
  • Depth of stromal invasion
  • Presence of lympho​vascular space invasion (LVSI)
  • Margin status if excised
  • Tumour dimensions (especially diameter and depth of invasion)
  • Lymph node status (number and location of nodes involved, size of metastases)
  • Other tissue/organ involvement (including parametrial or vaginal involvement if surgically resected)

These features are critical for staging, prognosis, and treatment planning.

References

1.           Herrington CS. WHO Classification of Tumours Female Genital Tumours: International Agency for Research on Cancer, 2020.