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Cervical cancer | Diagnosis | Symptoms | Treatment | NCCN Guidelines

Cervical cancer is epithelial cancer that forms in the uterine cervix. It is the fourth most common cancer in the world.

Cervical cancer can be prevented through human papillomavirus vaccination, screening, and treatment of precancerous lesions. The earliest symptoms are watery discharge from the vagina, post-coital bleeding, or intermittent spotting.

Stages of the disease

  • Stage I: Carcinoma is restricted to the cervix

  • Stage IA: Invasive carcinoma, maximum depth of invasion ≤5 mm

  • Stage IA1: Maximum depth of invasion ≤3 mm

  • Stage IA2: Maximum depth of invasion >3 and ≤5 mm

  • Stage IB: Maximum depth of invasion >5 mm

  • Stage IB1: Maximum depth of invasion >5 mm and ≤2 cm

  • Stage IB2: Maximum depth of invasion >2 cm and ≤4 cm

  • Stage IB3: Maximum depth of invasion >4 cm

  • Stage II cancer: Cancer has not extended onto the lower part of the vagina or pelvic wall

  • Stage IIA: Only the upper two-thirds of the vagina was involved

  • Stage IIB: Cancer spreads to the parametrial region but not the pelvic wall

  • Stage III: The lower third of the vagina and pelvic wall gets impacted

  • Stage IIIA: The lower third of the vagina was involved but not the pelvic wall

  • Stage IIIB: Extended to the pelvic wall

  • Stage IIIC: Pelvic region and para-aortic lymph nodes are involved

  • Stage IIIC1: Pelvic lymph node is only impacted

  • Stage IIIC2: Para-aortic lymph nodes are impacted

  • Stage IV: Other organs beyond the pelvis are impacted

  • Stage IVA: Cancer was spread to pelvic organs

  • Stage IVB: Cancer was spread to distant organs

Symptoms

  • Bleeding between or following periods

  • Excess bleeding than normal during menstruation

  • Pain after intercourse

  • Pelvic or back pain

  • Increased vaginal discharge

Diagnosis

Patients cannot diagnose the disease in the early stages.

Patients with symptoms should undergo a medical examination, which includes

  • History and physical

  • Complete blood count

  • Cervical biopsy

  • Liver function test

  • Renal function studies

  • Imaging