Cervical cancer

About cervical cancer

In India, cervical cancer is 3 most common cancer. If abnormal cells are caught early, cancer can be prevented. Cervical screening picks up changes in the cells of your cervix at a pre-cancerous stage.

In UK, with the introduction of cervical screening programme by NHS, the number of women dying from cervical cancer has halved.

 The diagram shows the transformation zone. This is the area where cervical cancer usually starts, and from where cells are taken for to be examined. 

Types of cervical cancer

There are two main types of cervical cancer. They’re named after the type of cell that becomes cancerous:

• squamous cell cancer
• adenocarcinoma

Eight out of 10 cervical cancers are squamous cell cancer and fewer than two out of 10 are adenocarcinoma. Squamous cells are flat skin cells that cover your cervix (the neck of your womb). Adenocarcinoma is a cancer that starts in glandular cells like the ones found in the passageway from your cervix to your womb. You can also have a mix of the two types.

There are other types of cancer of the cervix including small cell cancer and lymphoma but these are very rare. 

Symptoms of cervical cancer

In the early stages of cervical cancer, you might not have any symptoms. This is why it’s important to have regular cervical screening. The cervical screening test is offered to all women aged between 25 and 64. You will be offered the test every three or five years, depending on your age.

If abnormal cells develop into cervical cancer, you might get symptoms. These may include:

• abnormal vaginal bleeding – for example, , bleeding between periods or after you have sex
• bleeding from your vagina after you’ve been through the menopause
• a vaginal discharge, which may smell unpleasant
• pain when you have sex
• blood-stains or mucus in your vaginal discharge
• pain in your pelvis or back

These symptoms aren't always caused by cervical cancer. Don’t be alarmed or panic if you have them, but do go and see your GP or practice nurse.

Diagnosis of cervical cancer

The earliest signs that cervical cancer may be developing are usually picked up by cervical screening (a smear test). If your smear test shows you have a human papillomavirus (HPV) infection, your cell sample will be tested for abnormal cells on your cervix (the neck of your womb). If you don’t have HPV, your cervical cells don’t need testing because HPV is by far the main cause of cervical cancer (see our section on causes of cervical cancer).

An abnormal smear test result means that you have an HPV infection. Sometimes, it also means that small changes have been found in the cells in your cervix. If you have HPV but no cell changes, you will be offered another smear in a year’s time to check that the infection has gone. If you have abnormal cells or have symptoms of cervical cancer, your doctor will refer you to a gynaecologist. This is a doctor who specialises in women’s reproductive health. Your doctor may also do a smear test when you are referred to a gynaecologist.

If you’re found to have abnormal cells or have symptoms of cervical cancer, you’ll be given an appointment at a colposcopy clinic. A colposcopy is a test using a magnifying instrument called a colposcope to examine your cervix. You may see a specially trained member of staff who may be a doctor or nurse who has training in colposcopy. They may take a small sample of tissue (a biopsy). The sample will be sent to a laboratory to be tested to see if the cells are abnormal and if so, how abnormal they are. Sometimes, your doctor might remove all of the abnormal cells straight away. 

If you’re pregnant, it’s safe for you to have a colposcopy. If your doctor finds any abnormal pre-cancerous cells, treatment can normally wait until after you have your baby.

To remove the abnormal cells, your doctor will use a loop of wire with an electrical current passing through it. This is called large-loop excision of the transformation zone (LLETZ); it is also known as loop diathermy. The removed cells will be sent to a laboratory for testing.

If your tests show that you do have cervical cancer, your doctor may ask you to have a CT scan, MRI scan or PET (positron emission tomography) scan. This is to see how far the cancer has grown into the tissues around your cervix and if it has spread further. 

Treatment of cervical cancer

Your treatment will depend on the stage of the cancer and your general health. The stage of a cancer means how far it has grown and whether it has spread to nearby lymph nodes or elsewhere in the body.

The main treatments are either surgery or a combination of radiotherapy and chemotherapy (chemoradiotherapy). Your treatment may affect your fertility. Do ask your specialist doctor (gynaecological oncologist) about this if you think you may want to have children in the future. They will explain the different treatments in more detail, what they involve and discuss which is best for you.

Surgery

The standard operation for cervical cancer is a hysterectomy, which involves removing your womb and ovaries. This operation includes removing the top few centimetres of your vagina and some of the lymph nodes in your pelvis. Lymph nodes (or glands) are part of your body’s natural defence system – the lymphatic system.

If you have early stage cancer and you want to have children, it might be possible to have a procedure that will preserve your fertility. This is called a radical trachelectomy. In this, your surgeon will remove most of your cervix but leave enough behind so that you can still have a baby. They will also remove the lymph nodes in your pelvis. 

Chemoradiotherapy

The main treatment for cervical cancer that doesn’t involve surgery is chemoradiotherapy or chemoradiation. This is where you have both chemotherapy and radiotherapy.

Chemotherapy is a treatment to destroy cancer cells with medicines. Radiotherapy uses radiation – a beam of radiation is targeted on the cancerous cells to shrink the tumour.

 You may have chemoradiotherapy as your sole treatment or you might have it after surgery. 

If your cancer is advanced

If your cervical cancer is stage 4b, this means it has spread to another part of your body. Your doctor may call this secondary or metastatic cancer. It may have already spread when you were diagnosed, or it may have come back some time after your treatment. There are treatments available. Unfortunately, they are unlikely to get rid of your cancer completely. But they may be able to control it for some time and improve your quality of life. 

Your doctor may suggest a combination of chemotherapy and a type of biological therapy that slows down the growth of cancer cells. You can find out more about biological therapies in our section on cancer terminology.

If the cancer has spread into only one part of your body, in some cases it may be possible to remove it with surgery. It may also be possible to have radiotherapy or chemotherapy afterwards. Or you may have radiotherapy with chemotherapy. 

The choice of treatment will depend on:

• where the cancer has spread
• the treatments you’ve had before
• your wishes and how well you are generally

Having treatment

All these treatments have different side-effects. Some are more difficult to get through than others. You will need to talk over the side-effects with your cancer specialist and make sure you know how the treatment is likely to help you.

Your cancer specialist is the best person to discuss your treatment with. Your cancer team have access to all your test and scan results. They are able to advise you on which types of treatment are possible and most likely to help.

For some treatments, you will need to come into hospital as an inpatient (where you stay overnight). For other treatments, you may be able to be an outpatient (where you visit the hospital for your treatment but go home afterwards). 

Causes of cervical cancer HPV

HPV

More than 99% of cervical cancers are caused by the human papilloma virus (HPV). There are many different types of HPV. Those that increase the risk of cancer are known as high-risk HPV. 

You catch this common virus through having sex. It doesn’t usually cause any symptoms and your immune system can fight it off, so you may never know you were infected. But for some women, the virus can stay in the body and cause the abnormal cells that can lead to cervical cancer. This may happen many years after the original infection. 

There is now a national programme of vaccination against HPV for boys and girls aged 11 to 14. In future, this will reduce the number of cervical and other cancers caused by HPV. 

Other causes

Not all high-risk HPV infections lead to cancer. This means there must be other factors that increase your risk. Statistically, you are at an increased risk of cervical cancer if you:

• start to have sex at an early age
• have sex with lots of different people or have had a partner who has many other partners

In these circumstances, the risk is likely to be increased because of the increased chance of picking up HPV. 

If you do contract HPV, there are some other factors which will increase your risk of developing cancer. These include:

• smoking
• having a weakened immune system – for example, because of[LW1] or immunosuppressant medication
• having other sexually transmitted infections (STIs) such as chlamydia and herpes

Prevention of cervical cancer

There are things you can do to help prevent cervical cancer.

• Have regular cervical screeing to pick up and treat any pre-cancerous cells in your cervix (neck of the womb). If you’re between 25 and 64, you’ll be invited for a smear test every three or five years.
• Have the HPV vaccine – this is now offered free to all young people between 11 and 14 across the UK.
• Use condoms. These offer some protection against HPV and other sexually transmitted infections (STIs). 

Help and support

Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment the support to help deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available in hospices, hospital or at home; this is called palliative care.