If the following clinical and pathological features were in chronological order which would come fourth?

The answer is D. Early onset of sexual activity and promiscuous sexual activity (C) are associated with increased risk of cervical cancer; biopsy of the cervix (A) shows cervical intraepithelial neoplasia grade III. An excision or cone biopsy of the cervix is performed (B) which reveals invasive carcinoma; cervical cancer invades locally in the pelvis (D) and eventually causes uraemia by ureteric obstruction (E). Herpes virus type 2 and human papillomavirus have been implicated as possible carcinogenic agents.