Cervical cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]


Cervical cancer must be differentiated from other diseases that cause abnormal vaginal bleeding, such as cervical polyp, cervical leiomyoma, invasion of the cervix from primary uterine malignancy, vaginal cancer, cervical lymphoma, metastases to cervix, and cervical ectopic pregnancy.

Cervical cancer differential diagnosis

  • Cervical cancer must be differentiated from a mass involving the cervix, and causing abnormal vaginal bleeding:[1][2][3]
Abnormal Uterine bleeidng differential diagnosis
Ob-Gyn neoplasm and diseases Clinical manifestations Para-clinical findings Gold standard
Symptoms Physical exam Lab Findings Imaging Histopathology

vaginal bleeding

Other Genitourinary/ Gastrointestinal symptoms Abdominal pain Pelvic


B symptoms Gynecological examinations Abdominal



Pap smear

STI panel

Other labs Ultrasound Other


Cervical cancer[4][5][6][7][8][9][10][11]
  • Postmenopausal
  • Intermenstrual
  • Postcoital
  • Bleeding after pelvic exam


+ +
  • Cervical mass on exam
+ ± HPV T2-weighted MRI :
  • Ovoid, heterogeneous tumor distending the cervical canal with stromal involvement. PET/CT scan:
Cervical intraepithelial neoplasia:
Cervical polyp[12]
  • Mass on exam
  • Hyper/hypoechogenic masses with or without cysts
  • Filling the endocervical or vaginal canal
Cervical leiomyoma[13][14][15][16][17][18][19][20][21]
  • Heavy/prolonged menstrual bleeding
  • Intermenstrual bleeding
+ + ±
  • Well circumscribed hyperechoic mass
T2-weighted MRI:
  • Hypointense masses
  • Homogeneous


  • Red degeneration
  • Clinical diagnosis/ and
Cervical lymphoma[22][23][24]
  • Difficulty urinating
  • Post-coital pain
+ + +
  • Irregularity
+ Pap smear: Immunohistochemistry markers:
  • Well-defined, solid, concentric, hypoechoic mass
  • Intramyometrial infiltrative nodules
  • Small tumor cells with large nuclei
  • High mitoses and proliferation
Cervical sarcoma[25][26][27][28] + + ±
  • Cervical mass
  • Lump protruding from vagina/vulva
+ Leiomyosarcoma markers: MRI:
  • Endometrial polypoid mass
  • Hypointense hypervascular solid components
Cervical erosion(Ectropion)[29][30][31][32][33]
  • Post-coital pain
  • Painful cramps
+ +
  • Red, glandular area around os of cervix
  • Intermenstrual bleeding
  • Postcoital
  • Pain during urination
+ +
  • May have fever only
STI panel:

May be detected as retention cysts in cervix.

  • Non-specific, lymphocytic infiltration may be seen in microscopic histology.
  • Koilocytic changes in case of HPV as cause of chronic cervicitis.
  • Heavy mentrual bleeding
  • Painful menstruation
  • Burning/painful urination
  • Painful bowel movement
  • Pain during or after sex
  • Infertility
  • Watery vaginal discharge
+ +

(limited value)

  • Ground glass echogenicity of the cyst fluid (Endometrioma)
  • Cysts are unilocular
Pelvic inflammatory diseases[46][47][48][49]
  • Bleeding after sex
  • Intermenstrual bleeding
  • Oral temperature >101F
  • Vaginal/vulvar tender lesion depending on microbial causes
STI panel:
  • WBC
  • Oral temperature >101F
  • Thickened, fluid-filled tubes with or without free pelvic or tubo-ovarian complex
MRI findings:
  • Inflammation in pelvic soft tissue
  • Clinical diagnosis is gold standard for diagnosing PID
  • Abnormal uterine bleeding
  • Painful menstruation
+ +
  • Subendometrial striations
  • Myometrial cysts
  • Asymetrical thickness in myometrium walls
  • Heterogenous echotexture of myometrium
  • Thickened junctional zone
  • Presence of ectopic endometrial glands into the myometrium.
Cervical ectopic pregnancy[56][57] +
  • Soft and disporportionally enlarged uterus.
± T2-weighted MRI:
  • Hypointense large mass

T1-weighted MRI:

  • Partially hyperintense mass
Vaginal cancer[58][59][60][61]
  • Postcoital bleeding
+ + ±
  • Ill-defined vaginal ulcer
  • In case of metastases to internal organs
Ultrasound: MRI:
  • Isointense on T1-weighted images
  • Soft-tissue mass with intermediate-to-high signal intensity on T2-weighted images
Biopsy findings:
Paget's disease of vulva to cervix[62][63][64][65][66]
  • Bleeding from lesion
  • Pain in vulva
  • Itching or burning sensation in vulva
  • Negative for S-100 and Melan-A
  • Hyperintense on diffusion weighted imaging
  • Thick vulvar skin
  • "Cake-icing effect", pathognomic for vulvar paget's disease
Nabothian cyst[67][68][69][70]
  • Postcoital bleeding
  • Majority of them are asymptomatic due to their small size( few milimeters)
  • Anechoic well defined cystic lesions
  • Intermediate or slightly high signal intensity T2-weighted
  • High signal intensity on T2-weighted images
  • Benign cystic lesion
  • Multiple benign cystic masses, usually few milimieters in diameter.
IUD use[71][72][73]
  • Heavy bleeidng
+ +
  • Normal
  • May have decreased RBC count
  • Linear echogenic intrauterine structures


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