Cervical cancer

Last reviewed: 28 Feb 2023
Last updated: 23 Feb 2023



History and exam

Key diagnostic factors

  • presence of risk factors
  • abnormal vaginal bleeding
  • postcoital bleeding
  • pelvic or back pain
  • dyspareunia
  • cervical mass
  • cervical bleeding
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • human papillomavirus (HPV) infection
  • age group
  • HIV infection
  • early onset of sexual activity (younger than 18)
  • multiple sexual partners
  • cigarette smoking
  • immunosuppression
  • history of STI
  • oral contraceptive pill use
  • high parity
  • uncircumcised male partner
  • micronutrient malnutrition
  • low serum folate
  • low vitamin C and E levels
  • alcohol use
  • low socioeconomic status
More risk factors

Diagnostic investigations

1st investigations to order

  • vaginal or speculum examination
  • colposcopy
  • biopsy
  • human papillomavirus (HPV) testing
More 1st investigations to order

Investigations to consider

  • FBC
  • renal function testing
  • liver function tests
  • chest x-ray
  • intravenous pyelogram
  • renal ultrasound
  • barium enema
  • sigmoidoscopy
  • cystoscopy
  • MRI pelvis
  • PET whole body
  • PET/CT whole body
  • CT of chest/abdomen/pelvis with intravenous/oral contrast
More investigations to consider

Emerging tests

  • p16 and Ki67 biomarker expression

Treatment algorithm


non-pregnant stage IA1: micro-invasive disease

non-pregnant stage IA2 or IB1: early stage disease

non-pregnant stage IB2-IIA: early stage disease

non-pregnant stage IIB-IVA: locally advanced disease

non-pregnant stage IVB: metastatic disease

non-pregnant: local or regional recurrent disease

pregnant: any stage



Richard T. Penson, MD, MRCP
Richard T. Penson

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital




RTP reports receiving personal fees from AbbVie, Clovis Oncology, Janssen Oncology (J&J), NewLink Genetics, Sutro Biopharma, Tesaro Inc., and Vascular Biogenics Ltd, research funding provided to the institution for clinical trials from Array BioPharma Inc., AstraZeneca., Genentech, Inc., Regeneron, and Sanofi-Aventis US LLC, and personal fees and research funding provided to the institution for clinical trials from AstraZeneca, Eisai Inc./Merck & Co., Tesaro Inc., Genentech/Roche, Inc., and Vascular Biogenics Ltd, during the conduct of the study. RTP is an author of a number of references cited in this topic.

Andrea L. Russo, MD


Gynecologic Radiation Oncology

Associate Clinical Director

Department of Radiation Oncology

Massachusetts General Hospital




ALR declares that she has no competing interests.


Dr Richard T. Penson and Dr Andrea L. Russo would like to gratefully acknowledge Dr Larissa J. Lee, their co-contributor who is sadly deceased, and to acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.


NSH and AHR declare that they have no competing interests.

Peer reviewers

Linda Yang, MD


Minimally Invasive Gynecologic Surgery

Magee Women's Hospital

University of Pittsburgh Medical Center



LY declares that she has no competing interests.

Deirdre Lyons, MB, BCh, BAO, MRCOG

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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