Cervical cancer
HPV 16 & 18 (squamous cell mostly)
Overview
Cervical malignancy driven by persistent high-risk HPV (16/18), commonly squamous cell. Largely preventable through HPV vaccination and screening; presents with post-coital, intermenstrual or postmenopausal bleeding.
Recognise
- Post-coital, intermenstrual or postmenopausal bleeding; offensive discharge
- Advanced: pelvic pain, hydronephrosis, leg oedema, fistula
- Irregular/friable cervix or visible lesion on speculum
Red flags
- Any abnormal bleeding with an abnormal-looking cervix → urgent colposcopy/referral, NOT wait for screening
Differentials & how to tell them apart
Investigations
Visible lesion → urgent referral for colposcopy and biopsy (do not rely on a smear). Staging: examination, MRI pelvis, CT.
Management
Stage-directed treatment (surgery for early; chemoradiation for advanced)
- 1Refer any suspicious cervix urgently for colposcopy + biopsy. Early disease: cone/trachelectomy (fertility-sparing) or hysterectomy.
- 2Locally advanced: chemoradiotherapy. Prevention: HPV vaccination + screening.
Key points
HPV vaccination (Gardasil 9) and HPV-primary screening have made this largely preventable. A visible lesion is referred directly — a normal smear does not exclude cancer.
Monitor & prognosis
Post-treatment surveillance; fertility implications.
Excellent if early; poorer once locally advanced.
Source: NICE NG12; cervical screening programme