**5. Work up**

History and physical: Presentation may include postcoital bleeding, irregular or heavy vaginal bleeding, vaginal discharge, and lower back or pelvic pain. It may be asymptomatic and detected during the routine gynecologic examination.

Conduct complete pelvic examination, including bimanual examination and placement of fiducial markers at the caudal extent of vaginal disease. The patient should be positioned in a dorsal lithotomy during the examination. The rectovaginal exam gives information about parametrial extension and infiltration.

Labs: CBC, CMP, and LFTs. Consider HIV testing and pregnancy test.

Procedures/biopsy: Cervical biopsy and cone biopsy as indicated. For advanced stages (stage ≥IB2), consider examination under anesthesia, cystoscopy, and/or proctoscopy as indicated.

Pathology reports should always include information about a stromal invasion, lymph vascular space invasion (LVSI), sizes of the primary tumor, characteristics of margins and distance from the margins, parametrial invasion, number of dissected nodes, and number of positive nodes. The location of positive nodes is also essential, especially when an extranodal extension (ENE) is present.

Imaging: PET/CT. Pelvic MRI with intravaginal water-based gel. Chest imaging with a chest X-ray or CT chest.
