What are the typical symptoms of cervical cancer?

Typical Symptoms of Cervical Cancer

The most common symptoms of cervical cancer include abnormal vaginal bleeding (particularly postcoital bleeding), watery or blood-tinged vaginal discharge, and pelvic pain, though early-stage cervical cancer is often asymptomatic. 1

Primary Symptoms

Early cervical cancer is frequently asymptomatic, which is why screening programs are crucial for early detection. When symptoms do appear, they typically include:

• Abnormal vaginal bleeding:

  • Postcoital bleeding (occurs in approximately 5.7% of women with cervical abnormalities) 2
  • Intermenstrual bleeding (occurs in about 10% of women with cervical abnormalities) 2
  • Postmenopausal bleeding 1

• Abnormal vaginal discharge:

  • Often watery and may be blood-tinged 1
  • The most common presenting symptom (present in about 42.4% of women with cervical abnormalities) 2

• Pelvic pain:

  • May be persistent or occur during intercourse (dyspareunia) 1
  • Dyspareunia affects approximately 15.7% of women with cervical abnormalities 2
  • General pelvic pain occurs in about 28.6% of cases 2

Advanced Disease Symptoms

As cervical cancer progresses, additional symptoms may develop:

• Urinary symptoms:

  • Frequency, urgency, or hematuria (when the tumor invades the bladder) 1
  • Hydronephrosis or renal dysfunction (in stage IIIB disease) 3

• Rectal symptoms:

  • Tenesmus, rectal bleeding, or constipation (with rectal involvement) 1

• Other advanced symptoms:

  • Weight loss
  • Fatigue
  • Leg pain or swelling (due to lymphatic obstruction)
  • Back pain (from retroperitoneal lymph node involvement)

Lesion Characteristics

The physical appearance of cervical lesions can vary:

• Exophytic lesions: Grow outward from the cervical surface, appearing as cauliflower-like or papillary masses 1
• Endophytic lesions: Grow with stromal infiltration and minimal surface changes, making them potentially deceptive on examination 1

Clinical Significance

It's important to note that while these symptoms are concerning, they are not specific to cervical cancer:

• Postcoital bleeding carries a 0.6% risk of invasive cervical cancer in women with a normal-appearing cervix and normal cytology 4
• However, this risk is significantly higher than in the general population, warranting prompt investigation 4
• Cervical intraepithelial neoplasia (CIN) is found in approximately 17% of women presenting with postcoital bleeding 4

Warning Signs Requiring Urgent Referral

The following symptoms should prompt urgent referral for further investigation:

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

Diagnostic Approach

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
4. Refer to a multidisciplinary team if cancer is confirmed 1

Note that unscheduled cervical smears outside the regular screening program are not recommended for symptom investigation 1. Direct visualization and biopsy are more appropriate for symptomatic women.