A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing) of the skin, mucous membranes, abdominal wall, and inguinal region (groin area).
- Gynecological examination
- Inspection
- Vulva (external, primary female sexual organs).
- Vagina (vaginal) [staging T2a: tumor infiltration beyond uterus, vagina (upper 2/3); without infiltration of parametria]
- Cervix uteri (cervix), or portio (cervix; transition from cervix uteri to vagina (vagina)) [Fluor genitalis (discharge), often flesh-water colored; contact bleeding (bleeding, for example, after sexual intercourse); bleeding ex utero, usually metrorrhagia, i.e. bleeding outside the actual menstruation; this is usually prolonged and increased, a regular cycle is not recognizable], taking a Pap smear (for early detection of cervical cancer); in case of visible tumor taking a sample biopsy (tissue sample).
- Palpation (bimanual; palpation with both hands) of the internal genital organs.
- Cervix uteri (cervix) [if necessary, distended cervix due to tumor extension]:
- T1b: tumor macroscopically visible, limited to cervix uteri.
- T1b1: Tumor extension max. 4 cm.
- T1b2: tumor extension > 4 cm
- Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal size, no tenderness; T1: tumor confined to uterus]
- Adnexa (appendages of the uterus, i.e., the ovary and uterine tube). [Normal: free]
- Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free; tumor infiltration into the parametria, if any: T2b: tumor infiltration beyond uterus, vagina (upper 2/3), parametria]
- Pelvic walls [Normal: free; if applicable, T3b: tumor spread to pelvic wall or causes hydronephrosis/dumb kidney; if applicable, lymph node metastases in pelvic and/or para-aortic lymph nodes]
- Douglas space (pocket-like bulge of the peritoneum (abdominal wall) between the rectum (rectum) posteriorly and uterus (uterus) anteriorly) [Normal: free].
- Cervix uteri (cervix) [if necessary, distended cervix due to tumor extension]:
- Inspection
- Health check (as an additional follow-up measure).
Square brackets [ ] indicate possible pathological (pathological) physical findings.