Managing patients with symptoms of cervical cancer

Patients who show symptoms that suggest cervical cancer need diagnostic testing rather than screening. Find out what the symptoms are and how you may need to investigate further.

Diagnostic testing

Patients who show symptoms that suggest cervical cancer need diagnostic testing rather than screening.

Diagnostic testing involves both a:

  • co-test
  • gynaecological assessment.

You may also need to refer the patient to a gynaecologist for specialist gynaecological assessment.

A co-test is where the laboratory tests for both human papillomavirus (HPV) and liquid-based cytology (LBC):

  • on the same sample
  • at the same time.

This means that the LBC test is done regardless of the HPV test result.

Abnormal vaginal bleeding

Abnormal vaginal bleeding is the most common symptom of cervical cancer.

For pre-menopausal patients with unexplained bleeding between periods:

  • request a co-test
  • perform a gynaecological assessment and consider a specialist gynaecologist referral.

For pre-menopausal patients who have had bleeding after sex:

  • request a co-test
  • perform a gynaecological assessment.

If the cervix is clinically normal and the co-test is negative, no further investigation is necessary after a single episode of post-coital bleeding. However, if bleeding after sex recurs or persists, refer them for a specialist gynaecological assessment and colposcopy.

For post-menopausal patients with any vaginal bleeding:

  • request a co-test
  • perform a gynaecological assessment
  • request a transvaginal ultrasound
  • refer them for a specialist gynaecological assessment, which should include endometrial sampling.

For more detail, read identification and investigation of abnormal bleeding in the National Cervical Screening Program Guidelines.

It is not necessary to request a co-test or refer for a colposcopy if a patient has:

  • breakthrough or irregular bleeding due to hormonal contraception
  • contact bleeding that occurs when collecting a cervical sample
  • heavy regular periods (menorrhagia)
  • irregular bleeding due to a sexually transmitted infection (STI) such as chlamydia.

Other symptoms you should investigate

In rare cases, the first signs of cervical cancer can include ongoing vaginal discharge, pain during sex (deep dyspareunia), or both.

Unusual vaginal discharge

If there is unexplained, persistent vaginal discharge (especially if smelly or bloodstained):

  • conduct a gynaecological and sexual health history
  • perform a gynaecological assessment and test for sexually transmitted infections
  • request a co-test – if the co-test is abnormal, refer the patient for a specialist gynaecological assessment and colposcopy.

Even if the co-test is negative (no HPV detected and LBC normal), consider referral for a specialist gynaecological assessment.

For more detail, read investigations of other symptoms in the National Cervical Screening Program Guidelines.

Pain during sex (deep dyspareunia)

If there is unexplained pain during sex but no bleeding or vaginal discharge:

  • conduct a cervical screening test (if due)
  • perform a gynaecological assessment and consider referral for a specialist gynaecological assessment.

For more detail, read investigations of other symptoms in the National Cervical Screening Program Guidelines.

Requesting a co-test

On the pathology request form:

  • write ‘Co-test, symptomatic’
  • clearly describe the symptoms.

For more on how to complete the form, including MBS item numbers, read our guide for pathology tests for cervical and vaginal tests.

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