What are the typical symptoms and treatment approaches for an adult female patient, likely of childbearing age or older with a possible history of Human Papillomavirus (HPV) infection, presenting with cervical cancer?

Top 3 Symptoms of Cervical Cancer

When a patient presents with cervical cancer, the three most common symptoms are: (1) abnormal vaginal bleeding (including post-coital, intermenstrual, or post-menopausal bleeding), (2) vaginal discharge, and (3) pelvic pain. 1, 2

Primary Symptom: Abnormal Vaginal Bleeding

• Abnormal vaginal bleeding is the hallmark presentation of cervical cancer and represents the most common symptomatic manifestation. 1, 2
• This includes post-coital bleeding (bleeding after intercourse), intermenstrual bleeding (bleeding between periods), and post-menopausal bleeding. 1, 2
• Intermittent spotting is frequently reported, particularly in women with early-stage disease. 2
• The National Comprehensive Cancer Network specifically recommends recognizing these bleeding patterns as the most common symptomatic presentation requiring investigation. 2

Second Most Common: Vaginal Discharge

• Vaginal discharge is a prominent symptom in cervical cancer, particularly with adenocarcinoma histology. 1
• Copious watery vaginal discharge can be the presenting symptom, especially in cervical adenocarcinoma cases. 3
• This symptom can be misleading, as it may be initially misdiagnosed as vaginitis or cervicitis, leading to delayed diagnosis. 4, 3

Third Most Common: Pelvic Pain

• Pelvic pain occurs in locally advanced disease and represents a later-stage symptom. 1
• Dyspareunia (painful intercourse) is specifically mentioned as an associated symptom. 1
• Pain typically indicates more extensive disease with parametrial or pelvic sidewall involvement. 1

Critical Clinical Caveat

• Many early cervical cancers are completely asymptomatic, which is precisely why screening programs exist. 1, 2
• The probability of cervical cancer in women presenting with post-coital bleeding varies dramatically by age: 1 in 44,000 for women aged 20-24 years versus 1 in 2,400 for women aged 45-54 years. 1, 2
• When symptoms do occur, various forms of abnormal vaginal bleeding predominate over all other presentations. 2

Common Diagnostic Pitfalls

• Cervical cancer can develop high in the endocervical canal, beyond the reach of standard examination or cone biopsy. 4
• Copious vaginal discharge from cervical adenocarcinoma may lead to false-negative Pap smears and misdiagnosis as infectious vaginitis. 4, 3
• Treatment of presumed cervicitis without visualization of the cervix can result in dangerous delays in diagnosis. 4
• If malignancy is suspected on examination (visible ulcerating or fungating lesion), urgent referral for further investigation is mandatory. 1