21st June 2023

Cervical cancer

Cancers of the cervix may present with abnormal vaginal bleeding, dyspareunia, vaginal discharge, pelvic pain or asymptomatically through the national screening programme. NHS screening in England is currently offered every three years between the ages 25-49 and every 5 years between the ages 50-64 to everyone with a cervix. The programme differs across the UK and so questions on the frequency of screening are unlikely to feature in the exam. High-risk HPV infection is found in association with >99% of cervical cancers and therefore is the primary test on the screening sample. HPV negative samples are not further tested. Those found to have a mild dyskaryosis will be invited for a repeat smear as the majority of these changes regress spontaneously. Those with moderate-high grade dyskaryosis will be invited for a colposcopy for diagnosis +/- treatment.

The majority of cervical cancers are squamous cell carcinoma, with adenocarcinoma accounting for 10-15% of cases. Surgical options are the mainstay of treatment for small, organ-confined tumours (<4cm). For patients with very small tumours, fertility-sparing treatments can be offered in the form of a LLETZ (large loop excision of the transformation zone) or trachelectomy. For those tumours >4cm or those which have invaded beyond the cervix, radical treatment is pursued with radical chemoradiotherapy followed by brachytherapy. The management of metastatic disease includes chemotherapy, radiotherapy, and an emerging role for immunotherapy.