Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- abnormal vaginal bleeding
- postcoital bleeding
- pelvic or back pain
- dyspareunia
- cervical mass
- cervical bleeding
Other diagnostic factors
- mucoid or purulent vaginal discharge
- bladder, renal, or bowel obstruction
- bone pain
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 abuse
- low socioeconomic status
Diagnostic investigations
1st investigations to order
- vaginal or speculum examination
- colposcopy
- biopsy
- human papillomavirus (HPV) testing
Investigations to consider
- FBC
- renal function testing
- liver function tests
- chest x-ray
- intravenous pyelogram
- renal ultrasound
- barium enema
- proctoscopy
- cystoscopy
- MRI pelvis
- PET whole body
- PET/CT whole body
- CT of chest/abdomen/pelvis with intravenous/oral contrast
Treatment algorithm
Contributors
Authors
Clinical Director
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
Disclosures
RTP is a paid participant in scientific advisory boards for Genentech, Roche, and Merck. RTP is an author of a number of references cited in this topic.
Assistant Professor
Department of Radiation Oncology
Brigham and Women’s Hospital
Boston
MA
Disclosures
LJL receives research funding from the Koch Institute at the Massachusetts Institute of Technology and the Dana-Farber Cancer Institute. LJL is also the principal investigator of an immunotherapy and radiation trial sponsored by AstraZeneca.
Dr Richard T. Penson and Dr Larissa J. Lee would like to gratefully acknowledge Dr Neil S. Horowitz and Dr Anthony H. Russell, previous contributors to this topic.
Disclosures
NSH and AHR declare that they have no competing interests.
Peer reviewers
Fellow
Minimally Invasive Gynecologic Surgery
Magee Women's Hospital
University of Pittsburgh Medical Center
PA
Disclosures
LY declares that she has no competing interests.
Consultant in Obstetrics & Gynaecology
Lead Clinician in Colposcopy
Imperial College Healthcare NHS Trust
London
UK
Disclosures
DL declares that she has no competing interests.
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