Presentation

Patients with CIN and micro-invasive carcinoma have no symptoms. The diagnosis typically follows an abnormal cervical smear or colpo-scopic examination. Symptomatic patients should not be investigated by cervical smear alone. The earliest symptoms of invasive carcinoma are:

♦ Increased vaginal discharge

♦ Post-coital bleeding

♦ Inter-menstrual or post-menopausal bleeding

Increasing tumour bulk and pelvic infiltration leads to pressure on the bladder (frequency), rectum (altered bowel habit), or ureters (often asymptomatic until uraemia appears). Deep lateral pelvic pain can be due to direct extension of nodal disease. This can progress to lympho-edema, venous thrombosis of a lower limb, and even sciatic nerve palsy. Rarely in Western countries patients may present with a vesicovaginal or recto-vaginal fistula.

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