Cervical cancer

Last reviewed: 4 Jun 2022
Last updated: 02 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • abnormal vaginal bleeding
  • postcoital bleeding
  • pelvic or back pain
  • dyspareunia
  • cervical mass
  • cervical bleeding
More key diagnostic factors

Other diagnostic factors

  • mucoid or purulent vaginal discharge
  • bladder, renal, or bowel obstruction
  • bone pain
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • vaginal or speculum examination
  • colposcopy
  • biopsy
  • human papillomavirus (HPV) testing
More 1st investigations to order

Investigations to consider

  • CBC
  • 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
More investigations to consider

Emerging tests

  • p16 and Ki67 biomarker expression

Treatment algorithm

ACUTE

nonpregnant stage IA1: microinvasive disease

nonpregnant stage IA2 or IB1: early stage disease

nonpregnant stage IB2-IIA: early stage disease

nonpregnant stage IIB-IVA: locally advanced disease

nonpregnant stage IVB: metastatic disease

nonpregnant: local or regional recurrent disease

pregnant: any stage

Contributors

Authors

Richard T. Penson, MD, MRCP
Richard T. Penson

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
Larissa J. Lee

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 tumor 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.

  • Cervical cancer images
  • Differentials

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

    • WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention, second edition: use of mRNA tests for human papillomavirus (‎HPV)‎
    • Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
    More Guidelines
  • Patient leaflets

    Cervical cancer

    HPV (human papillomavirus) vaccine

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer