INVASIVE CERVICAL CANCER
A 43-year-old woman complains of intermenstrual postcoital bleeding for
the past six months between regular menstrual cycles that occur every 28
days. On pelvic examination a 3 cm exophytic mass is seen from the
anterior lip of the cervix. The rest of the pelvic examination, including a
rectovaginal examination, is normal.Invasive cervical cancer is cervical neoplasia that has penetrated through the
basement membrane. Patients can present with postcoital vaginal bleeding.
Other symptoms include irregular vaginal bleeding and, in advanced stages,
lower extremity pain and edema.
Cervical carcinoma is the third most common gynecologic malignancy; 45
is the mean age at diagnosis.
Diagnostic Tests/Findings
Cervical biopsy. The initial diagnostic test should be a cervical biopsy; the
most common diagnosis is squamous cell carcinoma.
Metastatic workup. Once a tissue diagnosis of invasive carcinoma is made, a
metastatic workup should be done that includes pelvic examination, chest x-
ray, intravenous pyelogram, cystoscopy, and sigmoidoscopy.
Imaging studies. Invasive cervical cancer is the only gynecologic cancer that
is staged clinically; an abdominal pelvic CT scan or MRI cannot be used for
clinical staging.