Last reviewed: January 2018
Last updated: November  2017



History and exam

Key diagnostic factors

  • presence of risk factors
  • abnormal vaginal bleeding
  • postcoital bleeding
  • pelvic pain, dyspareunia
  • cervical mass
  • cervical bleeding

Other diagnostic factors

  • mucoid or purulent vaginal discharge
  • bladder, renal, or bowel obstruction
  • bone pain

Risk factors

  • HPV infection
  • age group
  • human immunodeficiency virus (HIV)
  • early onset of sexual activity (younger than 18)
  • multiple sexual partners
  • cigarette smoking
  • immunosuppression
  • all other STDs
  • oral contraceptive use
  • high parity
  • uncircumcised male partner
  • micronutrient malnutrition
  • low serum folate
  • low vitamin C and E levels
  • alcohol abuse
  • low socioeconomic status

Diagnostic investigations

1st investigations to order

  • vaginal or speculum examination
  • colposcopy
  • biopsy
  • HPV testing
Full details

Investigations to consider

  • FBC
  • renal function testing
  • liver function tests (LFTs)
  • CXR
  • IVP
  • barium enema
  • proctoscopy
  • cystoscopy
  • MRI pelvis
  • PET whole body
  • PET/CT whole body
  • CT of chest/abdomen/pelvis with IV/oral contrast
Full details

Treatment algorithm


Authors VIEW ALL

Richard T. Penson

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital




RTP is a paid participant in scientific advisory boards for Genentech/Roche. RTP is the author of a number of references cited in this monograph.

Larissa J. Lee

Assistant Professor

Department of Radiation Oncology

Brigham and Women’s Hospital




LJL declares that she has no competing interests.

Dr Richard T. Penson and Dr Larissa J. Lee would like to gratefully acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, the previous contributors to this monograph. NSH and AHR declare that they have no competing interests.

Peer reviewers VIEW ALL


Minimally Invasive Gynecologic Surgery

Magee Women's Hospital

University of Pittsburgh Medical Center



LY declares that she has no competing interests.

Consultant in Obstetrics & Gynaecology

Lead Clinician in Colposcopy

Imperial College Healthcare NHS Trust




DL declares that she has no competing interests.

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