Last reviewed: 4 Feb 2021
Last updated: 15 Oct 2019



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


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, and Merck. RTP is an author of a number of references cited in this topic.

Larissa J. Lee

Assistant Professor

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.

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.

Peer reviewersVIEW 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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