Practice Guidelines

Management of cervical cancer: summary of SIGN guidelines

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39399.642894.AD (Published 03 January 2008) Cite this as: BMJ 2008;336:41
  1. R M James, programme manager1,
  2. M E Cruickshank, senior lecturer in obstetrics and gynaecology2,
  3. N Siddiqui, consultant gynaecological oncologist3
  4. on behalf of the Guideline Development Group
  1. 1Scottish Intercollegiate Guidelines Network (SIGN), 28 Thistle Street, Edinburgh EH2 1EN
  2. 2Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital AB25 7ZD
  3. 3Department of Gynaecology Oncology, Glasgow Royal Infirmary G4 0SF
  1. Correspondence to: R M James roberta.james{at}nhs.net

    Why read this?

    Despite a well organised cervical screening programme for preinvasive disease in the United Kingdom, there are still about 2800 new cases of and 1000 deaths from cervical cancer each year.1 Many patients still present to their general practitioner with symptoms associated with cervical cancer. The Joint Committee for Vaccination and Immunisation has announced the introduction of human papillomavirus vaccination for 12-13 year old girls next year, but it is predicted that it may take 40 to 60 years for an effect on the rates of cervical cancer to be seen.

    This article summarises the most recent guidance from the Scottish Intercollegiate Guidelines Network (SIGN) on the management of cervical cancer.2 The guideline aims to ensure that equitable standards of care are available to all women who develop cervical cancer and that the social and economic burden it places on women and their carers is minimised.

    Recommendations

    SIGN recommendations are based on systematic reviews of best available evidence, and the strength of the evidence is indicated as A, B, C, or D (fig 1). Recommended best practice (“good practice points”) based on the clinical experience of the guideline development group is also indicated (as GPP).

    Fig 1 Explanation of SIGN grades of recommendations

    Presentation

    Intermenstrual bleeding, post-coital bleeding, and post-menopausal bleeding are common and non-specific symptoms and may be associated with cervical cancer or with other conditions such as genital Chlamydia trachomatis infection. The probability that a woman aged 45-54 developing post-coital bleeding in the community has cervical cancer is 1 in 2400 (which decreases with younger age to 1 in 44 000 for women aged 20-24).

    • Test women with these symptoms for Chlamydia and treat if appropriate (D).

    • If malignancy is suspected on examination (for example, a visible ulcerating or fungating lesion), women should be referred urgently for further investigation …

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