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Cervical cancer

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 16 Apr 2025
Last updated: 14 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • abnormal vaginal bleeding
  • postcoital bleeding
  • pelvic or back pain
  • dyspareunia
  • cervical mass
  • cervical bleeding
Full details

Other diagnostic factors

  • mucoid or purulent vaginal discharge
  • bladder, renal, or bowel obstruction
  • bone pain
Full details

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
Full details

Diagnostic tests

1st tests to order

  • vaginal or speculum examination
  • colposcopy
  • biopsy
  • human papillomavirus (HPV) testing
Full details

Tests to consider

  • CBC
  • 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
  • molecular testing
Full details

Emerging tests

  • p16 and Ki67 biomarker expression

Treatment algorithm

ACUTE

nonpregnant stage IA1 without LVSI: desiring fertility

nonpregnant stage IA1 without LVSI: not desiring fertility

nonpregnant, stage IA1 with LVSI: desiring fertility

nonpregnant, stage IA1 with LVSI: not desiring fertility

nonpregnant stage IA2: desiring fertility

nonpregnant stage IA2: not desiring fertility

nonpregnant stage IB1: desiring fertility

nonpregnant stage IB1: not desiring fertility

nonpregnant stage IB2: desiring fertility

nonpregnant, stage IB2: not desiring fertility

nonpregnant stage IIA1

nonpregnant stage IB3 or IIA2

nonpregnant stage IIB to IVA

nonpregnant, stage IVB (metastatic disease)

nonpregnant local or regional recurrent disease

pregnant

Contributors

Authors

Richard T. Penson

Clinical Director

Medical Gynecologic Oncology

Division of Hematology Oncology

Massachusetts General Hospital

Boston

MA

Disclosures

RTP reports serving on scientific advisory boards for AstraZeneca, Eisai, GSK Inc., ImmunoGen Inc., Merck & Co., Mersana, Novocure, Roche Pharma, Sutro Biopharma, Vascular Biogenics Ltd; data and safety monitoring boards for AstraZeneca and Roche Pharma; institutional research funding (as Principal Investigator) for Array BioPharma Inc., AstraZeneca, Eisai Inc., Genentech Inc., Regeneron, Sanofi-Aventis US LLC, Tesaro Inc., Vascular Biogenics Ltd; and royalties from BMJ Publishing, UptoDate, Elsevier Ltd, Wolters Kluwer Health, and Wiley-Blackwell.

Director

Gynecologic Radiation Oncology

Associate Clinical Director

Department of Radiation Oncology

Massachusetts General Hospital

Boston

MA

Disclosures

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.

Disclosures

NSH and AHR declare that they have no competing interests.

Peer reviewers

Assistant Professor of Gynecologic Oncology

Dan L Duncan Comprehensive Cancer Center

Baylor College of Medicine Houston

Houston

TX

Disclosures

TH declares that she has no competing interests.

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.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Marth C, Landoni F, Mahner S, et al. Cervical cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Jul 1;28(suppl 4):iv72-83.Full text  Abstract

Fontham ETH, Wolf AMD, Church TR, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society CA Cancer J Clin. 2020 Sep;70(5):321-46.Full text  Abstract

Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri: 2021 update. Int J Gynaecol Obstet. 2021 Oct;155 Suppl 1(suppl 1):28-44.Full text  Abstract

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cervical cancer [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Cervical cancer images

  • Differentials

    • Human papillomavirus (HPV) infection
    • Pelvic infection
    • Nabothian cyst
    More Differentials

  • Guidelines

    • Screening for cervical cancer
    • Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
    More Guidelines

  • Patient information

    Cervical cancer

    HPV (human papillomavirus) vaccine

    More Patient information
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