Clinical features

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.