Cervical cancer
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 use
- 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
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
Contributors
Authors
Richard T. Penson, MD, MRCP
Clinical Director
Medical Gynecologic Oncology
Division of Hematology Oncology
Massachusetts General Hospital
Boston
MA
Disclosures
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
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. LJL received sponsored travel from AstraZeneca for an immunotherapy symposium and has an international patent filing for quantitative tumour oxygen measurements in cervical cancer.
Acknowledgements
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
Linda Yang, MD
Fellow
Minimally Invasive Gynecologic Surgery
Magee Women's Hospital
University of Pittsburgh Medical Center
PA
Disclosures
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
London
UK
Disclosures
DL declares that she has no competing interests.
Differentials
- Human papillomavirus (HPV) infection
- Pelvic infection
- Nabothian cyst
More DifferentialsGuidelines
- Minimally invasive radical hysterectomy for early stage cervical cancer
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
More GuidelinesPatient leaflets
Cervical cancer
HPV (human papillomavirus) vaccine
More Patient leaflets
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