🔑 Key Learning

  • Most cervical cancers are squamous cell carcinomas caused by high-risk HPV (types 16 and 18)
  • Most commonly affects sexually active women aged 30–45
  • Presents with abnormal vaginal bleeding (IMB, PCB), abnormal discharge, dyspareunia, and abnormal cervical appearance
  • UK cervical screening programme targets women aged 25–64
  • Symptomatic women should be referred via the 2WW pathway regardless of smear history
  • Pregnancy may delay smear, but it should be done 12 weeks post-delivery

🧬 Pathophysiology

  • Arises from ectocervical or endocervical mucosa
  • Around 80% are squamous cell carcinoma
  • Caused by persistent infection with high-risk HPV strains (especially types 16 and 18)
  • HPV induces cellular dysplasia, which may progress to carcinoma if not cleared

👀 Clinical Features

  • Affects sexually active women aged 30–45
  • Unexplained vaginal bleeding
    • Intermenstrual
    • Post-coital
    • Post-menopausal
  • Abnormal vaginal discharge (may be bloody and non-infective)
  • Dyspareunia
  • Pelvic pain
  • Cervix may appear inflamed or friable with contact bleeding or a visible lesion

🧪 Screening Programme

Inclusion criteria

  • Women aged 25–64

Frequency

  • Ages 25–49: every 3 years
  • Ages 50–64: every 5 years

Method – Step 1: HPV Primary Screening

  1. A cervical smear is taken and tested for high-risk HPV (hrHPV)
  2. If hrHPV negative → return to routine recall
  3. If hrHPV positive → sample undergoes cytology (cellular analysis)

Management based on cytology results:

  • hrHPV positive + cytology abnormal → refer to colposcopy
  • hrHPV positive + cytology negative → repeat hrHPV test at 12 months

At 12-month repeat:

  • hrHPV negative → return to routine recall
  • hrHPV positive → repeat hrHPV test again at 24 months

At 24-month repeat:

  • hrHPV negative → return to routine recall
  • hrHPV positive → refer to colposcopy
  • Any abnormal cytology at 12 or 24 months → refer to colposcopy

Notes

  • Unscheduled smears are not recommended if the woman is up to date with screening
  • Symptomatic women should be referred to gynaecology, not for screening
  • If delayed due to pregnancy, smear should be performed 12 weeks post-partum

📤 Referral

  • Refer any woman with clinical features suggestive of cervical cancer via the two-week wait pathway
    • Refer regardless of previous smear or screening results

📝 Exam Clues & Clinchers

  • Woman aged 30–45 with post-coital and intermenstrual bleeding → suspect cervical cancer
    • Bloody vaginal discharge → consider malignancy
    • Friable cervix on exam with contact bleeding → refer 2WW
  • HPV 16/18 associated with high risk of cervical dysplasia and cancer

🔗 Useful Links and References