Human papillomavirus‐independent cervical cancer and its precursor lesions

Key content With the move towards ubiquitous human papillomavirus (HPV) primary screening and increasing coverage with HPV vaccination, the prevalence of HPV‐associated cervical cancers is predicted to decrease. Clinicians must be aware of HPV‐independent adenocarcinomas, which are likely to increase as a proportion of the total diagnosed cervical adenocarcinomas. Advances in histopathology, immunohistochemistry and molecular genetics have increased our understanding of the spectrum of gastric‐type and other rare HPV‐independent adenocarcinomas. Clinical outcome and prognosis of HPV‐independent adenocarcinoma is worse than the HPV‐associated adenocarcinoma. There is a paucity of evidence‐based guidelines tailored to management of HPV‐independent adenocarcinomas. Learning objectives To know the various types of HPV‐independent cervical cancers, as classified by the WHO 2020 classification of cervical adenocarcinomas. To appreciate current understanding of possible precursor lesions of HPV‐independent cervical cancers, especially gastric‐type adenocarcinoma. To be aware of the potential ‘red‐flag’ symptoms and findings on radiological investigations for early diagnosis, and the current evidence available for the management and clinical outcomes of HPV‐independent adenocarcinoma.