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This is a clinician-written, evidence-based summary aligned to the 2026 MLA Content Map. It is intended for medical students and junior doctors preparing for the UKMLA. Always cross-reference with NICE guidance, local protocols, and clinical judgement.
Key points
- Almost all (99.7%) cervical cancers caused by persistent high-risk HPV infection (types 16 and 18 account for ~70%)
- HPV vaccination (Gardasil 9): offered to all children aged 12–13 in the UK. Covers HPV 6, 11, 16, 18 + 5 others
- NHS Cervical Screening: HPV primary screening. Age 25–49 every 3 years, 50–64 every 5 years
- HPV-positive with abnormal cytology → colposcopy. CIN2/3 treated with LLETZ (large loop excision)
- Symptoms of invasive cancer: postcoital bleeding (PCB), IMB, PMB, offensive vaginal discharge, pelvic pain
- Treatment: early stage — surgery (radical hysterectomy ± lymphadenectomy). Advanced — concurrent chemoradiotherapy (cisplatin)
Overview
Cervical cancer is a malignancy arising from the cervix, most commonly squamous cell carcinoma (70–80%) or adenocarcinoma (20–25%). Virtually all cervical cancers are caused by persistent infection with high-risk HPV types, particularly HPV 16 and 18. The disease progresses through a precancerous stage (cervical intraepithelial neoplasia, CIN) over years to decades, making it highly amenable to prevention through vaccination and screening. The UK NHS Cervical Screening Programme has dramatically reduced cervical cancer incidence and mortality since its introduction.
Epidemiology
Cervical cancer is the 14th most common cancer in UK women, with approximately 3,200 new cases per year. Peak incidence is bimodal: 30–34 years and 80–84 years. Approximately 850 women die from cervical cancer annually in the UK. Risk factors include persistent high-risk HPV infection, smoking (doubles the risk), immunosuppression (HIV, transplant), early onset of sexual activity, multiple sexual partners, non-attendance for screening, and long-term COCP use (small increased risk). HPV vaccination has been shown to reduce cervical cancer rates by ~90% in vaccinated cohorts.
Clinical Features
Symptoms
Early-stage: often asymptomatic — detected by cervical screening
Postcoital bleeding (PCB) — the classic presenting symptom
Intermenstrual bleeding (IMB)
Postmenopausal bleeding (PMB)
Offensive or blood-stained vaginal discharge
Pelvic pain, lower back pain, or leg oedema (advanced disease — lymphatic/nerve involvement)
Haematuria or rectal bleeding (bladder/bowel invasion)
Signs
Visible cervical lesion on speculum: irregular, friable, bleeds on contact
Normal-appearing cervix (early/microinvasive disease)
Bulky cervix or parametrial thickening on bimanual or rectal examination (advanced disease)
Leg oedema (lymphatic obstruction)
Hydronephrosis on imaging (ureteric obstruction — advanced disease)
Investigations
First-line
NHS Cervical Screening (smear test)HPV primary screening using liquid-based cytology. If HPV-positive → cytology triage. If abnormal → colposcopy referral
ColposcopyDirect visualisation of cervix with acetic acid (turns abnormal areas white — acetowhite changes) and iodine (Schiller test). Allows targeted biopsy
Cervical biopsyPunch biopsy at colposcopy or excisional biopsy (LLETZ) — provides histological diagnosis and grading (CIN1, CIN2, CIN3, or invasive cancer)
Second-line
MRI pelvisStaging of confirmed cervical cancer — assess tumour size, parametrial invasion, lymph node involvement
CT chest/abdomen/pelvisStaging — distant metastases
PET-CTFor locally advanced disease — assess lymph node and distant metastatic disease
Specialist
EUA (Examination Under Anaesthesia)FIGO staging is clinical — EUA with cystoscopy and proctoscopy for advanced cases to assess bladder/rectal involvement
1
Prevention
- HPV vaccination (Gardasil 9): offered to all children aged 12–13 in the UK. Single dose schedule (changed from 2 doses in 2023)
- Covers HPV 6, 11, 16, 18, 31, 33, 45, 52, 58. Prevents ~90% of cervical cancers
- Cervical screening: age 25–49 every 3 years, age 50–64 every 5 years. HPV primary testing since 2019
2
CIN (precancerous changes)
- CIN1: usually regresses spontaneously — conservative management with surveillance
- CIN2/3: treat with LLETZ (large loop excision of the transformation zone) — excises abnormal tissue and provides histological specimen
- Alternatives to LLETZ: cold knife cone biopsy, cryotherapy, laser ablation
3
Early-stage invasive cancer (FIGO IA–IB)
- Stage IA1: cone biopsy or simple hysterectomy (fertility-sparing options available)
- Stage IA2–IB1: radical hysterectomy (Wertheim) with pelvic lymphadenectomy
- Fertility-sparing: radical trachelectomy (cervix removed, uterus preserved) for selected early-stage patients
4
Advanced-stage cancer (FIGO IB2+)
- Concurrent chemoradiotherapy: cisplatin-based chemotherapy given alongside external beam radiotherapy and brachytherapy
- Surgery generally NOT offered for stage IIB onwards
- Palliative care for metastatic disease
Complications
- Ureteric obstruction: Leading to hydronephrosis and renal failure (common in advanced disease)
- Fistulae: Vesicovaginal or rectovaginal (from tumour or radiation)
- Treatment effects: LLETZ — cervical stenosis, preterm labour risk. Radiotherapy — radiation cystitis, proctitis, vaginal stenosis, premature ovarian failure
- Recurrence: Pelvic or distant — prognosis poor if post-radiotherapy recurrence
- Lymphoedema: Post-surgery or radiotherapy to pelvic nodes
UKMLA Exam Tips
- 1HPV 16 and 18 cause ~70% of cervical cancers. HPV 6 and 11 cause genital warts (not cancer)
- 2Postcoital bleeding = cervical pathology until proven otherwise. Always perform speculum examination
- 3Cervical screening is HPV primary testing (not just cytology). HPV-positive + abnormal cytology → colposcopy
- 4CIN is NOT cancer — it is precancerous. CIN1 often regresses. CIN2/3 treated with LLETZ
- 5LLETZ slightly increases risk of preterm birth in future pregnancies — important to counsel
- 6Cervical cancer staging is CLINICAL (FIGO) — based on examination, not surgical findings
- 7Gardasil 9 now given as SINGLE dose at age 12–13 (UK schedule updated 2023)
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