What are the symptoms of cervical cancer?

Symptoms of Cervical Cancer

The earliest stages of cervical cancer are often asymptomatic, but when symptoms do appear, the most common presentations include abnormal vaginal bleeding (particularly postcoital bleeding and intermenstrual bleeding), watery vaginal discharge, and pelvic pain. 1

Common Symptoms

Vaginal Bleeding Patterns

• Postcoital bleeding - bleeding after sexual intercourse (occurs in approximately 0.5% of women) 2
• Intermenstrual bleeding - bleeding between regular menstrual periods (occurs in approximately 1.6% of women) 2
• Postmenopausal bleeding - any bleeding that occurs after menopause 1

Other Common Symptoms

• Abnormal vaginal discharge - often watery and may be blood-tinged 1
• Pelvic pain - may be persistent or during intercourse (dyspareunia) 1
• Urinary symptoms - in advanced cases with bladder involvement 1
• Rectal symptoms - in advanced cases with rectal involvement 1

Symptom Recognition Challenges

• Early cervical cancer symptoms are often subtle and may go unrecognized by patients 1
• The probability of cervical cancer in a woman aged 45-54 with postcoital bleeding is approximately 1 in 2,400 (lower in younger women) 1
• Adenocarcinoma symptoms may be more difficult to detect as they affect areas of the cervix that are harder to sample (endocervical canal) 1

Physical Examination Findings

• Exophytic lesions - grow outward from the cervical surface, appearing as cauliflower-like or papillary masses 1, 3
• Endophytic lesions - grow with stromal infiltration and minimal surface changes, making them potentially deceptive on examination 1, 3
• Advanced disease - may present with:
  • Parametrial invasion (felt as induration or nodularity on bimanual examination)
  • Extension to pelvic wall
  • Lower third vaginal involvement
  • Hydronephrosis
  • Invasion of adjacent organs 3

When to Suspect Cervical Cancer

Cervical cancer should be suspected in women with:

• Persistent abnormal vaginal bleeding, especially postcoital bleeding
• Visible ulcerating or fungating lesion on examination 1
• Abnormal cervical appearance with watery discharge and/or bleeding
• Unexplained pelvic pain, particularly during intercourse

Important Considerations

• Symptoms like abnormal bleeding are non-specific and may be associated with other conditions such as Chlamydia infection 1
• Unscheduled cervical smears outside the screening program are not recommended for symptom investigation 1
• If malignancy is suspected on examination, urgent referral for further investigation is necessary 1

Diagnostic Approach for Symptomatic Women

For women presenting with symptoms suggestive of cervical cancer:

1. Perform thorough pelvic examination to visualize the cervix
2. Obtain cervical biopsies of any visible lesions
3. Consider cone biopsy if cervical biopsy is inadequate to define invasiveness 1
4. Refer to a multidisciplinary team if cancer is confirmed 1
5. Appropriate imaging (MRI preferred for most stages) should be performed to determine extent of disease 1

Early recognition of symptoms and prompt investigation are critical for improving cervical cancer outcomes, as early-stage disease has significantly better survival rates than advanced disease.