STEP 2: Presentation, initial investigations and referral

General/primary practitioner investigations: The five-yearly cervical screening test involves an oncogenic HPV test and reflex liquid-based cytology. Women with a positive oncogenic HPV (16/18) test result should be referred directly for colposcopic assessment, informed by the result of the reflex liquid-based cytology. Women with a positive oncogenic HPV (not 16/18) test result with a reflex liquid-based cytology result of possible high-grade lesion or high-grade lesion should be referred directly for colposcopic assessment.

A negative screening test should not preclude investigations of symptoms suggesting cervical cancer.

Signs and symptoms: A woman with symptoms at any age or vaccination status should be investigated. Early cervical cancer may be asymptomatic.

Symptoms may include:

  • postcoital bleeding
  • intermenstrual bleeding
  • postmenopausal bleeding
  • dyspareunia
  • unusual or bloodstained vaginal discharge.

Symptoms of advanced cervical cancer may include pelvic pain, extreme fatigue, kidney failure, leg pain/swelling and lower back pain.

A diagnosis of cervical cancer should be considered if:

  • abnormal cervical screening test
  • signs and symptoms
  • abnormal appearance of the cervix on clinical examination.

Referral: If the diagnosis is suspected or confirmed with initial tests, referral to a gynaecological oncologist who is a member of a multidisciplinary team is optimal.

Communication – lead clinician to:

  • provide information that clearly describes who they are being referred to and why, and the timeframe for appointments
  • support the woman while waiting for the specialist appointment.