Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Major haemorrhage, sepsis or obstructive renal failure
Brisk vaginal bleeding with shock, infected necrotic tumour, fistula-related sepsis or bilateral ureteric obstruction with acute kidney injury requires immediate resuscitation and anatomical control.
Action: Use ABCDE care, obtain large-bore access, FBC, coagulation, renal profile and crossmatch, give blood and antibiotics when indicated and involve gynaecological oncology, interventional radiology, urology and radiation oncology urgently for packing, embolisation, haemostatic radiotherapy, ureteric stents, nephrostomy or surgery.
Synopsis
Recognise symptomatic cervical cancer despite screening history, obtain colposcopic histology, stage local and nodal disease accurately and coordinate fertility-preserving surgery, radical chemoradiation, brachytherapy and recurrent-disease care.
Persistent high-risk HPV causes most cervical cancer; HPV vaccination and screening prevent disease but a symptomatic cervix always enters a diagnostic, not screening, pathway.
Key symptoms are postcoital, intermenstrual or postmenopausal bleeding, watery or offensive discharge, pelvic pain and dyspareunia; advanced disease causes leg oedema, renal obstruction and fistula.
First-line assessment is speculum and bimanual examination followed by urgent colposcopy and directed biopsy of a suspicious cervix; do not rely on cytology alone to exclude invasion.
Key red flags
Persistent postcoital, intermenstrual or postmenopausal bleeding needs direct cervical examination even when the last screening test was negative.
Haemorrhage or sepsis
Brisk bleeding, shock, fever with necrotic discharge or obstructed infected uterus requires immediate resuscitation and specialist source control.
Investigation priorities
01
First-line speculum and bimanual examinationFirst stepFirst line
Identify a visible cervical lesion, bleeding source, vaginal extension, uterine and parametrial abnormality and infection.
02
Preferred MRI pelvisPreferred
Stage tumour size, stromal and parametrial invasion, vagina, bladder, rectum and pelvic nodes and plan surgery or brachytherapy.
Management branches
Abnormal bleedingExamine and biopsy the cervix
Postcoital, intermenstrual or postmenopausal bleeding or abnormal discharge persists.
Take pregnancy, contraception, screening, infection and bleeding history and perform speculum and bimanual examination, stabilising major haemorrhage first.
Refer a suspicious cervix directly for urgent colposcopy and biopsy rather than repeating screening cytology as the sole response.
Key medicines
Cisplatin radiosensitisationGive cisplatin 40 mg/m² intravenously once weekly during external-beam radiotherapy, commonly for five or six doses and often capped at 70 mg per dose, using the exact local hydration and eligibility protocol.
Pembrolizumab for eligible advanced diseaseGive pembrolizumab 200 mg intravenously every 3 weeks or 400 mg every 6 weeks, with protocol chemotherapy or alone only within the licensed PD-L1, line and current NICE-funded cervical-cancer indication.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.