Early stage cervical cancer often has no obvious symptoms and signs, and the cervix may be smooth or difficult to distinguish from cervical columnar epithelial ectopic. Patients with cervical canal type are easily missed or misdiagnosed due to normal appearance of the cervix. With the development of lesions, the following manifestations may appear: 1) Symptoms 1) Vaginal discharge Most patients have vaginal discharge, which is white or bloody and may be thin like watery or rice slop, or have fishy odor. In advanced stage, due to necrosis of cancer tissue and infection, there may be a lot of rice-soup-like or purulent foul-smelling leucorrhea. (2) Vaginal bleeding is mostly contact bleeding in early stage; irregular vaginal bleeding in middle and late stage. The amount of bleeding varies according to the size of lesion and invasion of interstitial blood vessels, and may cause heavy bleeding if it invades large blood vessels. Younger patients may also present with prolonged periods and increased menstrual flow; older patients often have irregular vaginal bleeding after menopause. Generally, the exogenous type shows vaginal bleeding symptoms earlier and bleeds more; the endogenous type shows the symptoms later. (3) Late symptoms appear in different secondary symptoms according to the extent of cancer involvement. Such as frequent urination, urgent urination, constipation, swelling and pain of lower limbs, etc.; when the cancer compresses or involves ureter, it may cause ureteral obstruction, hydronephrosis and uremia; in late stage, there may be anemia, cachexia and other symptoms of systemic failure. 2.Signs Carcinoma in situ and micro-infiltrating carcinoma may have no obvious foci, and the cervical area may be smooth or only columnar epithelial ectopic. Different signs may appear with the development of the disease. Ectogenous cervical cancer can be seen as polyp-like or cauliflower-like superfluous organisms, often accompanied by infection, and the tumor is brittle and prone to bleeding; endogenous cervical cancer can be seen as cervical hypertrophy, hardness and cervical canal expansion; in advanced stage, the cancer tissue is necrotic and falls off, forming ulcers or cavities with bad odor. When the vaginal wall is involved, superfluous growth can be seen on the vaginal wall or the vaginal wall is hardened; when the parametrial tissue is involved, thickened, nodular, hard or frozen pelvic tissue can be found on double or triple examination. 3.Pathological types Three types of carcinoma are common: squamous carcinoma, adenocarcinoma and adenosquamous carcinoma. (1) Squamous carcinoma is classified into grade III according to histological differentiation. Grade I is highly differentiated squamous carcinoma, grade II is medium differentiated squamous carcinoma (non-keratinized large cell type), and grade III is low differentiated squamous carcinoma (small cell type), which is mostly undifferentiated small cells. (2) Adenosquamous carcinoma accounts for 3% to 5% of cervical cancer. It is formed by the differentiation of reserve cells to both glandular cells and squamous cells. The cancer tissue contains both adenocarcinoma and squamous carcinoma components. (3) Adenocarcinoma accounts for 15% to 20% of cervical cancer. There are 2 main histological types. (1) Mucinous adenocarcinoma: the most common type, which originates from columnar mucus cells in the cervical duct. Microscopically, we can see the glandular structure, the proliferation of glandular epithelial cells in multiple layers, obvious heterogeneous proliferation, and nuclear schizophrenia. It can be divided into high, medium and low differentiated adenocarcinoma. (2) Malignant adenoma: also known as slightly deviated adenocarcinoma, it is a highly differentiated mucosal adenocarcinoma of the cervical duct. There are many cancerous glands with different sizes and variable morphology, and they protrude into the deep interstitial layer of the human cervix in a punctiform manner, and the glandular epithelial cells are not heterogeneous. 4.Metastatic pathways are mainly direct spread and lymphatic metastasis, while hematogenous metastasis is less common. (1) Lymphatic metastasis: cancer invades lymphatic vessels after local infiltration to form tumor plugs, which enter local lymph nodes with lymphatic fluid drainage and spread in lymphatic vessels. The primary group of lymphatic metastasis includes parametrium, paracervical, foramen ovale, internal iliac, external iliac, common iliac and presacral lymph nodes; the secondary group includes deep and superficial inguinal lymph nodes and para-aortic lymph nodes. (2) Hematogenous metastasis is less common, and it can metastasize to lung, liver or bone in advanced stage. (3) Direct spread is the most common, with local infiltration of cancer tissue and spread to adjacent organs and tissues. The cancer often involves the vaginal wall downward and rarely involves the cervical canal upward to the official cavity; the cancer spreads to both sides and can involve the paracervical and paravaginal tissues to the pelvic wall; when the cancer compresses or invades the ureter, it can cause ureteral obstruction and hydronephrosis. In advanced stage, the cancer may spread to the bladder or rectum, forming vesico-vaginal fistula or recto-vaginal fistula.