Table of contents

Cervical cancer



Cervical cancer refers to malignant disease arising from the cervical epithelium, and principally comprises SCCs.
Over 90% of cervical cancers are caused by infection of the cervical epithelium by a high-risk subtype of HPV, which leads to overexpression and integration of E6 and E7 viral oncogenes, resulting in transformation to CIN, squamous intraepithelial lesions, and invasive cervical carcinoma.
The incidence of cervical cancer in women is estimated at 7.4 cases per 100,000 person-years.
Disease course
Clinical manifestations of localized disease include abnormal vaginal bleeding, menorrhagia, and dyspareunia, while more advanced disease can lead to systemic symptoms.
Prognosis and risk of recurrence
The 5-year survival is estimated at 87% for patients with stage 1 node-negative and 73% for patients with stage 1, node-positive disease. In patients with more advanced disease (stages 2B-4A), 5-year survival with chemoradiation therapy is estimated at 70%.


Key sources

The following summarized guidelines for the evaluation and management of cervical cancer are prepared by our editorial team based on guidelines from the U.S. Preventive Services Task Force (USPSTF 2018), the European Society of Medical Oncology (ESMO 2017), and the Canadian Task Force on Preventive Health Care (CTFPHC 2013). ...
Show more

Screening and diagnosis

Indications for screening: as per USPSTF 2018 guidelines, screen for cervical cancer every 3 years with cervical cytology alone in women 21-29 years of age.
Show 4 more
Create free account

Classification and risk stratification

Risk stratification: as per ESMO 2017 guidelines, tumour risk assessment includes tumour size, stage, depth of tumour invasion, lymph node status, lymphovascular space invasion, and histological subtype. Lymph node status and the number of lymph nodes involved as the most important prognostic factors.

Medical management

Chemoradiation therapy: as per ESMO 2017 guidelines, administer chemoradiation therapy as the standard care for patients with bulky IB2-IVA disease, as it has demonstrated an improvement in both disease-free survival and overall survival over standard radiation therapy/hydroxyurea.

More topics in this section

  • Adjuvant chemoradiation therapy

  • Neoadjuvant chemotherapy

  • Palliative chemotherapy

Surgical interventions

Indications for surgery: as per ESMO 2017 guidelines, reserve surgery only in patients with earlier stages of cervical cancer up to FIGO IIA, without risk factors necessitating adjuvant therapy, which results in a multimodal therapy without improvement of survival but increased toxicity.

More topics in this section

  • First-line surgical treatment

  • Fertility-sparing treatment

Preventative measures

Primary prevention: as per ESMO 2017 guidelines, primary prevention of cervical cancer is now possible via immunisation with highly efficacious HPV vaccines.

More topics in this section

  • Secondary prevention

Follow-up and surveillance

Serial clinical assessment
As per ESMO 2017 guidelines:
Schedule follow-up visits during which a patient history and a complete physical examination (including a pelvic-rectal exam) should be obtained.
Return to annual population-based general physical and pelvic examinations after 5 years of recurrence-free follow-up.

More topics in this section

  • Serial imaging assessment