HPV is transmitted by skin-to-skin contact, including during oral sex, hand-to-genital contact, and sexual intercourse. Risk factors for HPV and cervical cancer include young age at sexual debut, multiple sexual partners, high parity, smoking, herpes simplex, HIV, coinfection with other genital infections, and prolonged use of oral contraceptive pills. HPVs are small icosahedral viruses, approximately 50 to 60 nm in diameter, non-enveloped, containing a circular double-stranded DNA genome (between 7000 and 8000 bp), infecting mucosal and skin epithelia in a specific manner and inducing cell proliferation (5). HPV DNA, the oncoproteins E6 and E7 interfere with the critical host cell cycle; specifically, E6 interferes with suppressive tumour protein p53, whereas E7 interferes with retinoblastoma protein (pRB) (6).

Patients with cervical cancer are maybe asymptomatic during the early stages. With the subsequent progression of the disease, symptoms like abnormal vaginal bleeding (especially between periods, after menopause or following sexual intercourse), vaginal discomfort, pain during intercourse, persistent pain in the back, legs, or pelvis, weight loss, fatigue and loss of appetite, swelling in the legs. malodorous vaginal discharge and dysuria become more prominent. In the late stages, urinary or faecal incontinence may occur in cases of a fistulous connection between the tumour and the bladder or between the tumour and the rectum.

A complete medical history must include a sexual history, including the patient's age at first sexual intercourse. Sexual history also contains questions about postcoital bleeding and pain during intercourse. Questions about previous STIs, including HPV and HIV, the number of lifetime sexual partners, tobacco use, and prior vaccination against HPV are all vitally important. Women should also be asked about menstrual patterns, abnormal bleeding, persistent vaginal discharges, irritations, and known cervical lesions (7).

The physical exam must include a complete evaluation of the external and internal genitalia. Positive exam findings in women with cervical cancer might include a friable cervix, visible cervical lesions, erosions, masses, bleeding with the examination, and fixed adnexa. An examination under anaesthesia can give a better insight into the stage of cervical cancer.

Differential diagnoses of cervical cancer include

1. Cervicitis
2. Cervical polyps
3. Cervical fibroids
4. Endometrial cancer
5. Vaginitis
6. Pelvic inflammatory disease

1.  Packed cell volume and complete blood count (evaluates the extent of blood loss from vaginal bleeding episodes) to detect anaemia.
2. Electrolyte, urea and creatinine (detects renal function impairment)
3. Abdominopelvic ultrasound scan (first-line imaging to detect the tumour)
4. Cystoscopy (visualizes tumour spread to bladder mucosa)
5. Proctoscopy (visualizes tumour spread to rectum)
6. Chest x-ray (detects metastasis to lungs)
7. Intravenous urography (detects ureteric occlusion in stage 3 disease)
8. Abdominopelvic CT scan/MRI/PET scan (excellent for detecting local tumour extension, and staging and can also be used for monitoring tumour response.

Stage I

The disease is strictly confined to the cervix, with the A/B designation indicating the depth of invasion (≤5 3 or >5 mm).

Stage II

The disease invades beyond the uterus but has not extended into the lower vagina or to the pelvic side wall

This stage also has an A/B designation based on the greatest dimension (with 4cm cut-off) and involvement of the parametria

Stage III

The disease has extended to the lower one-third of the vagina (11IA) or the pelvic side wall and/or hydronephrosis/non-functioning kidney (I11B), and/or pelvic/paraaortic lymphadenopathy (111C).

Stage IVA

The disease is locally aggressive, involving adjacent organs such as the bladder or rectum.

Stage IVB

The disease has spread to other solid distant organs; this stage can also be indicative of nonregional nodal disease (8).

The treatment of cervical cancer starts from prevention which could be primary (screening for detection and treatment of pre-neoplastic lesions); secondary (treatment of pre-neoplastic lesions, early cervical carcinoma and prevention of complications); tertiary (treatment of late or advanced cervical carcinoma and complications); palliative care (for advanced lesions and end of life care).

Diagnoses involves examination under anaesthesia to stage, obtain a biopsy for pathological diagnosis (confirmatory) and prognosticate as well as formulate treatment plan. The staging is aided by imaging studies.

Treatment of early-stage disease is usually surgical resection, ranging from a conization to a modified radical hysterectomy. Conization or trachelectomy may be an option for women with early-stage disease who desire future fertility. Advanced cases are usually managed initially with chemoradiation followed by (+/-) surgery. However, women with a high risk of residual tumour postresection or suboptimal surgery, may require adjuvant treatment with chemotherapy and radiation.

Prognostic factors for survival include disease stage, lymph node involvement, tumour volume, lympho-vascular space invasion, and histological type and grade of tumour. Routine follow-up visits are recommended every 3–4 months for the first 2–3 years, then every 6 months until 5 years,

and then annually for life. At each visit, history taking and clinical examination are carried out to detect treatment complications and psychosexual morbidity, as well as assess for recurrent disease. When diagnosed early, the 5-year relative survival rate for cervical cancer is approximately 92%. This value drops to 60% when diagnosis is made after spread to local or regional lymph nodes and 19% with distant metastasis at diagnosis.

The World Health Organization (WHO) has called for a global initiative for the elimination of cervical cancer as a public health problem by implementing the following 90%–70%–90% triple pillar intervention strategy before the year 2030:

1. 90% of girls to be fully vaccinated with two doses of HPV vaccine by the age of 15 years;
2. 70% of women screened using a high‐performance screening test at the age of 35 and 45 years; and
3. 90% of women to be detected with cervical lesions to receive treatment and care (9).