Cervical cancer is a human papillomavirus (HPV)-related malignancy, preventable by HPV vaccination, screening, and treatment of high-grade dysplasia.
Cervical cancer screening by cytology (Pap testing) alone, Pap and HPV co-testing, or primary HPV testing may detect pre-invasive disease.
Patients are commonly asymptomatic at presentation, and identified following screening. Patients with advanced disease may present with symptoms such as abnormal vaginal bleeding, postcoital bleeding, vaginal discharge, pelvic or back pain, dyspareunia, or obstructive uropathy.
Staging using International Federation of Gynecology and Obstetrics criteria is based on clinical assessment only. When available, advanced imaging modalities (magnetic resonance imaging, positron emission tomography [PET], PET/computed tomography [CT], CT) are used to evaluate the local extent of disease and to screen for metastases, which may guide treatment planning.
For microinvasive disease, treatment with conisation or simple (extra-fascial) hysterectomy is recommended.
For early stage invasive disease, surgery is recommended.
For locally advanced disease, chemoradiotherapy is significantly superior to radiotherapy alone.
Cervical cancer is a human papillomavirus-related malignancy of the uterine cervical mucosa.
History and exam
Key diagnostic factors
- presence of risk factors
- abnormal vaginal bleeding
- postcoital bleeding
- pelvic or back pain
- cervical mass
- cervical bleeding
Other diagnostic factors
- mucoid or purulent vaginal discharge
- bladder, renal, or bowel obstruction
- bone pain
- human papillomavirus (HPV) infection
- age group
- HIV infection
- early onset of sexual activity (younger than 18)
- multiple sexual partners
- cigarette smoking
- 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
1st investigations to order
- vaginal or speculum examination
- human papillomavirus (HPV) testing
Investigations to consider
- renal function testing
- liver function tests
- chest x-ray
- intravenous pyelogram
- renal ultrasound
- barium enema
- MRI pelvis
- PET whole body
- PET/CT whole body
- CT of chest/abdomen/pelvis with intravenous/oral contrast
- p16 and Ki67 biomarker expression
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
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.
Larissa J. Lee, MD
Department of Radiation Oncology
Brigham and Women’s Hospital
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. LJL received sponsored travel from AstraZeneca for an immunotherapy symposium and has an international patent filing for quantitative tumour oxygen measurements in cervical cancer.
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.
NSH and AHR declare that they have no competing interests.
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.
- Human papillomavirus (HPV) infection
- Pelvic infection
- Nabothian cyst
- Minimally invasive radical hysterectomy for early stage cervical cancer
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
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