HPV infection is the most important factor in developing cervical cancer; HPV is detected in 95% of cervical tumours.

There are around 80 types of HPV that are related to cervical cancer. The high-risk types - HPV 16 and 18 - involved in 70% of cervical cancer.

Other risk factors include:

• Heterosexual women.
• Women with multiple sexual partners
• Smoking.
• Lower social class.
• Immunosuppression - eg, HIV and post-transplant.

Many cases are detected by screening. Abnormal vaginal bleeding is the most common symptom of cervical cancer.

Other common symptoms of established cervical cancer are:

• Vaginal discharge: this varies greatly in amount and can be intermittent or continuous.
• Bleeding: this can be spontaneous but may occur after sex, micturition or defecation, in the early stages. Occasionally, severe vaginal bleeding may necessitate emergency hospital admission.
• Heavy bleeding during menstrual periods
• Pain during / after sexual intercourse
• Vaginal discomfort/urinary symptoms.

Late symptoms

• Painless haematuria.
• Chronic urinary frequency.
• Painless fresh rectal bleeding.
• Altered bowel habit.

Cervical cancer screening recommended for all sexually active women

Screening is done by a Pap smear as an outpatient procedure.

All Patients need to undergo per vaginal evaluation

• Patient may need Colposcopy - allows examination of the visible cervix and if needed biopsy
• Basic blood tests
• CT and/or MRI scanning of the pelvis and abdomen are often used to stage disease, along with relevant biopsies.
• Positron emission tomography (PET) is also being used increasingly for staging.
• A CT scan of the chest, abdomen and pelvis with contrast is usually preferred to chest X-ray to assess for metastatic disease.
• In advanced cases, Examination under anaesthesia is often undertaken with abdominal, vaginal and rectal examination, with or without colposcopy, hysteroscopy, cystoscopy and sigmoidoscopy. Biopsies are taken as necessary.

• Very early tumours are cured by local excision procedures like conization or trachelectomy or a fertility preserving hysterectomy
• Early stage tumours are treated with concurrent chemoradiation or with surgery (hysterectomy) with excellent prognosis
• A few patients in early stage with high risk factors may need a radical hysterectomy surgery and followed by adjuvant therapy with chemotherapy or radiation as necessary
• Patients with advanced disease may need radical hysterectomy or even pelvic exenteration(anterior/posterior/ total) and pelvic lymphadenectomy followed by adjuvant chemotherapy/ radiotherapy and also targeted therapy if necessary

All advanced surgeries for carcinoma cervix including

• Laparoscopic/open radical hysterectomy with bilateral salping0- oophorectomy + Pelvic Lymph node dissection
• Fertility preserving surgery for young women- Conization or Trachelectomy or Radiotherapy
• Laparoscopic/open pelvic exenteration in advanced cervical cancers
• Chemotherapy/ Chemoradiotherapy based on cancer stage
• Targeted therapy / molecular therapy for advanced cancer
• Specialised screening for Cervical cancers