Clinical Review

Diagnosis and management of cervical cancer

BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39337.615197.80 (Published 11 October 2007) Cite this as: BMJ 2007;335:765
  1. Patrick Petignat, consultant gynaecological oncologist1,
  2. Michel Roy, professor and gynaecological oncologist2
  1. 1Senology and Gynaecological Oncology Unit, Geneva University Hospitals, 1211 Geneva 14, Switzerland
  2. 2Gynaecologic Oncology Service, CHUQ, Laval University, Quebec, Canada
  1. Correspondence to: P Petignat patrick.petignat{at}hcuge.ch

    Cervical cancer is the second most common cancer in women worldwide, with more than half a million new cases diagnosed in 2005.1 The disease disproportionately affects the poorest regions—more than 80% of cases are found in developing nations, mainly in Latin America, sub-Saharan Africa, and the Indian subcontinent.1 Cervical cancer is an important cause of early loss of life as it affects relatively young women. Important advances have taken place in the diagnosis and treatment of this cancer in recent years. Surgery or chemoradiotherapy can cure 80-95% of women with early stage disease (stages I and II) and 60% with stage III disease (table).2 3 4 5

    View this table:

    International Federation of Gynaecology and Obstetrics (FIGO) staging classification (FIGO 1995, Montreal): cervical carcinoma

    Summary points

    • Cervical cancer disproportionately affects women in developing countries, which have no effective screening systems

    • Cervical biopsy is the most important investigation in diagnosing cervical cancer

    • Cervical cancer is a clinically staged disease

    • Fertility sparing surgery (conisation or radical trachelectomy (excision of the cervix)) is an option for women with early stage disease

    • Chemoradiotherapy is the standard of care for locally advanced and early stage cancers with poor prognostic factors

    • Chemotherapy is palliative only in patients with recurrent or metastatic disease

    Sources and selection criteria

    We searched the literature to identify all relevant articles published from 1966 to March 2007 (PubMed and Cochrane database) using a combination of the terms “cervical cancer”, “diagnosis”, and “management”. Variables of interest were cervical cancer, surgery, chemotherapy, radiotherapy, chemoradiotherapy, complications of treatment, recurrence, and follow-up. Much of the clinical management discussed in this review was based on meta-analyses, systematic reviews, and phase III randomised controlled trials (RCTs).

    What causes cervical cancer?

    Infection with high risk types of human papillomavirus is the main cause of cervical cancer.6 This has obvious implications for primary prevention (vaccination) and secondary …

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