Last reviewed: 25 Dec 2021
Last updated: 14 Oct 2021



History and exam

Key diagnostic 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

  • 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

Emerging tests

  • p16 and Ki67 biomarker expression

Treatment algorithm



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

Clinical Director

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
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. LJL received sponsored travel from AstraZeneca for an immunotherapy symposium and has an international patent filing for quantitative tumor 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.

Peer reviewers

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.

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