clinical features
Last reviewed 10/2020
A minority of patients are asymptomatic, diagnosis being established after a routine cervical smear.
The majority present with:
- postcoital, postmenopausal or intermenstrual bleeding - occurs in 80-90% of patients; initially, irregular but later becomes continuous
- blood stained vaginal discharge
Features of advanced disease include:
- heavy bleeding
- offensive vaginal discharge
- pain - indicating extension beyond the cervix:
- lower abdominal pain may signify a large pelvic mass
- sciatic pain may signify involvement of lymphatic nodes which have become adherent to the sacral plexus
- back pain may signify vertebral metastases
- urinary and/or faecal incontinence - from fistulae formation
- leg swelling
- uraemia - from ureteric obstruction or ascending pyelonephritis
Pelvic examination may reveal a cervix which is friable and bleeds easily. Early tumours may be seen as a small nodule or ulcer on the vaginal surface, or as a diffuse patch resembling an erosion. Advanced lesions may appear as a crater shaped ulcer with high everted edges or as a warty-looking mass. They may replace the entire cervix.
Rectal examination is essential to ascertain the extent of spread.