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Cervical Cancer Clinical Presentation

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Cervical Cancer Clinical Presentation

Author: Cecelia H Boardman, MD; Chief Editor: Warner K Huh, MD more... Updated: Jul 1, 2013

History
Because many women are screened routinely, the most common finding is an abnormal Papanicolaou (Pap) test result. Typically, these patients are asymptomatic. Clinically, the first symptom of cervical cancer is abnormal vaginal bleeding, usually postcoital. Vaginal discomfort, malodorous discharge, and dysuria are not uncommon. The tumor grows by extending along the epithelial surfaces, both squamous and glandular, upward to the endometrial cavity, throughout the vaginal epithelium, and laterally to the pelvic wall. It can invade the bladder and rectum directly, leading to constipation, hematuria, fistula, and ureteral obstruction, with or without hydroureter or hydronephrosis. The triad of leg edema, pain, and hydronephrosis suggests pelvic wall involvement. The common sites for distant metastasis include extrapelvic lymph nodes, liver, lung, and bone.

Physical Examination
In patients with early-stage cervical cancer, physical examination findings can be relatively normal. As the disease progresses, the cervix may become abnormal in appearance, with gross erosion, ulcer, or mass. These abnormalities can extend to the vagina. Rectal examination may reveal an external mass or gross blood from tumor erosion. Bimanual pelvic examination findings often reveal pelvic or parametrial metastasis. If the disease involves the liver, hepatomegaly may develop. Pulmonary metastasis usually is difficult to detect on physical examination unless pleural effusion or bronchial obstruction becomes apparent. Leg edema suggests lymphatic or vascular obstruction caused by tumor.

Contributor Information and Disclosures

Author Cecelia H Boardman, MD The Dianne Harris Wright Professorship for Obstetrics and Gynecology Oncology Research, Virginia Commonwealth University Medical Center; Associate Professor (Collateral), Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Virginia Commonwealth University School of Medicine Cecelia H Boardman, MD is a member of the following medical societies: American College of Obstetricians
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and Gynecologists, American College of Surgeons, Minnesota Medical Association, and Society of Gynecologist Oncologists Disclosure: Merck Salary Speaking and teaching; Glaxo Salary Speaking and teaching; Depuy Salary Speaking and teaching Coauthor(s) Kirk J Matthews Jr, MD Resident Physician, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center Disclosure: Nothing to disclose. Chief Editor Warner K Huh, MD Professor, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Senior Scientist, Comprehensive Cancer Center, University of Alabama School of Medicine Warner K Huh, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American College of Surgeons, American Society of Clinical Oncology, Massachusetts Medical Society, and Society of Gynecologist Oncologists Disclosure: MERCK Consulting fee Consulting; ROCHE PHARMA/DIAGNOSTICS Consulting fee Consulting; INTUITIVE SURGICAL Proctor Fee Consulting; Qiagen Consulting fee Consulting Additional Contributors A David Barnes, MD, PhD, MPH, FACOG Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah) A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association Disclosure: Nothing to disclose. Anthony El-Khoueiry, MD Assistant Professor of Medicine, Clinical Instructor, Division of Medical Oncology, Keck School of Medicine, University of Southern California Disclosure: Nothing to disclose. Agustin A Garcia, MD Associate Professor of Medicine, Keck School of Medicine, University of Southern California Disclosure: Nothing to disclose. Omid Hamid, MD Associate Director of Melanoma Center, Medical Director of Neuro-oncology Clinic, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California Disclosure: Nothing to disclose. John J Kavanagh Jr MD, Chief, Professor, Department of Internal Medicine, Section of Gynecological and Medical Therapeutics, MD Anderson Cancer Center, University of Texas Medical School at Houston John J Kavanagh Jr is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association for the History of Medicine, American College of Physicians, American Federation for Medical Research, American Medical Association, Society of Gynecologist Oncologists, Southern Medical Association, and Texas Medical Association Disclosure: Nothing to disclose. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment

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