There are two main types of cervical cancer – squamous cell cancer (the most common) and adenocarcinoma, although they can also be mixed. They are named after the type of cell that becomes cancerous. Squamous cells are flat cells covering your cervix (the neck of your womb). Adenomatous cells are found in the passageway from your cervix to your womb. Other rarer cancers of the cervix include small cell cancer.
In the early stages of cervical cancer, you may not have any symptoms, so it’s important to go to your cervical screening appointments. Cervical screening (smear test) is offered to all women between the ages of 25 and 64 every three or five years depending on your age bracket. The test takes just a few minutes and involves a nurse or sometimes a doctor gently putting a speculum (a small instrument) into your vagina. This helps to hold your vagina open while a small brush wipes over the cervix to pick up some cells.
If your smear detects abnormal cells on your cervix (the neck of your womb), they’re usually at an early pre-cancer stage. Treating the abnormal cells prevents cancer developing. If abnormal cells do develop into cervical cancer, some of the symptoms you may have include:
- abnormal vaginal bleeding, for example between periods or after sex
- smelly vaginal discharge
- pain during sex
- vaginal bleeding after the menopause
- blood-stained vaginal discharge
- pain in your pelvis
The early stages of cervical cancer are usually picked up on a smear test. A smear test takes just a few minutes and involves a nurse or doctor gently putting a speculum (a small instrument) into your vagina. This helps to hold your vagina open while a small brush wipes over the cervix to pick up some cells. If your smear detects abnormal cells on your cervix (the neck of your womb), they’re usually at an early pre-cancer stage.
An abnormal screening result usually means that small changes have been found in the cells in your cervix. If you have an abnormal screening result, 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.
You may have a number of tests at a colposcopy clinic. Some of these tests can treat you at the same time so you may not need further treatment afterwards. The tests include the following.
- A colposcopy – your doctor uses a lighted magnifying instrument called a colposcope to examine your cervix. He or she may take a small sample of tissue (a biopsy). The sample will be sent to a laboratory for testing to see if the abnormal cells have spread.
- LLETZ (large-loop excision of the transformation zone) also known as loop diathermy – your doctor uses a loop of wire with an electrical current passing through it. This removes the abnormal cells which are then sent to a laboratory for testing.
- A cone biopsy – your doctor will take a cone-shaped portion of tissue from your cervix. The sample will be sent to a laboratory for testing.
- A CT, MRI, PET (positron emission tomography) or ultrasound scan – to check your health and show how far the cancer has spread (if at all).
Your treatment options will be based on the stage of your cancer and your general health. The main treatments are surgery, radiotherapy or a combination of radiotherapy and chemotherapy (chemoradiotherapy). You may be offered a combination of treatments and some of these may affect your fertility. Your surgeon or oncologist will advise you which treatment they feel is best for you. They can explain the different treatments in more detail and what they involve.
The standard surgical treatment for cervical cancer is a hysterectomy, which involves removing your womb and ovaries. This will include 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; this is called the lymphatic system. Your surgeon or oncologist may need to remove one or more of your lymph nodes as part of your treatment.
If you have early stage cancer and you want to have children, a procedure called radical trachelectomy might be possible. In this procedure, your surgeon removes most of your cervix but leaves the opening behind, so that you can still have a baby.
The main non-surgical treatment for cervical cancer is chemoradiotherapy or chemoradiation. This is a treatment where you have both chemotherapy and radiotherapy.
Chemotherapy is a treatment to destroy cancer cells with medicines. It works by stopping or slowing the growth of cancer cells.
Radiotherapy is a treatment to destroy cancer cells with radiation. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour.
Radiotherapy used to be the main treatment, but now chemoradiotherapy is often the best choice and has been shown to work better than just having radiotherapy on its own. You may have it as your sole treatment or you might have it after surgery. You might have radiotherapy separately as part of your treatment, before or after surgery. Doctors aren’t sure if having chemotherapy before surgery works and research is ongoing to find out.
Chemotherapy may be offered to you to help control your symptoms if your cancer comes back or has spread to other parts of your body. This is known as a palliative treatment. It can’t cure your cancer but aims to improve your quality of life.
You can have these treatments either as an inpatient (where you stay overnight) or as an outpatient (where you visit the hospital for your treatment but go home afterwards). This will depend on how well you are and what your doctor advises.
For more information about the side-effects of these treatments, see our topics on chemotherapy and radiotherapy.
The main cause of cervical cancer is the human papilloma virus (HPV). There are over 100 different types, or strains, of HPV and each type has a specific number. Some types cause warts and verrucas, others increase the risk of cervical and other types of cancer.
You may have caught this common virus through sex and be unaware that you have it because it usually causes no symptoms. Your immune system may get rid of the infection so you may never be aware of it. Only a very small proportion of women with HPV will develop cervical cancer.
Although HPV is from the same family as the virus that causes genital warts, there’s no need to worry. Having genital warts doesn’t make you more likely to develop cervical cancer. Cervical cancer is caused by a different type of HPV.
To reduce the number of women developing cervical cancer, vaccinations to protect against HPV have been developed. Since 2008 in the UK, there has been a national programme of vaccination for girls aged 12 to 13.
Risk factors for cervical cancer include:
- having sex at an early age
- having other sexually transmitted infections (STIs) such as chlamydia and herpes
- having many sexual partners, or a partner who has had many partners
- having a weakened immune system (you might have the HPV virus but it has been inactive until this point)
The following steps can help prevent cervical cancer.
- Regular smears – these are part of the NHS cervical screening programme and can detect pre-cancerous cells in your cervix (neck of the womb). If you're aged between 25 and 49 and live in England, you will be invited for a smear every three years. If you’re aged between 50 and 64, the invitation will be every five years. The exact age groups for screening vary between different UK counties.
- HPV vaccine – girls aged between 12 and 13 across the UK are now offered a vaccine. This protects against the HPV strains most likely to cause cervical cancer.
- Condoms – using these during sex gives you some protection.
Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to 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 to you in hospices or at home, and this is called palliative care. See the further information in our Resources section for links to further support and information.
Will treatment for cervical cancer affect my sex life?
It's usually safe to start having sex again within a few weeks of finishing radiotherapy or having surgery for cervical cancer. But, treatment for cervical cancer may cause an early menopause and radiotherapy can cause side-effects that can affect your sex life.
If you haven't yet had your menopause, radiotherapy or surgery to remove your womb and ovaries (hysterectomy) will cause an early menopause. The symptoms are the same as those of a natural menopause. These include:
- hot flushes and sweating
- a dry vagina
- low mood
- loss of interest in sex
You may want to use condoms if you’re having chemotherapy. This is because doctors don’t know whether or not these medicines can pass to your partner though your vaginal or cervical mucus, so a condom will help protect your partner.
Finally, treatment may make you feel anxious about having sex again. You might need a bit more time to come to terms with what’s happened to you. Talk to your partner to keep communicating. If this becomes a problem for you both, you may want to talk to a sex therapist. Your GP may be able to put you in touch with one.
Will I still need cervical screening tests if I have had the human papilloma virus vaccine?
Yes, if you’ve had the human papilloma virus (HPV) vaccine, you will still need regular cervical screening tests.
There are around 100 types of HPV. Some of them are associated with an increased risk of developing certain types of cancer. The HPV vaccine doesn't protect against all types of HPV that are associated with cervical changes and cancer. Therefore, the vaccines don't provide complete protection against the disease. It's thought that the vaccines will prevent at least seven out of 10 of the most common type of cervical cancer (squamous cell cancer). So it's important to attend routine cervical screening appointments even if you have had the HPV vaccine.
Does human papilloma virus cause cancer in men?
Yes, the human papilloma virus (HPV) is associated with cancer of the penis, anus, and head and neck. The head and neck area includes the tonsils, tongue, and the area at the back of the throat, known as the pharynx.
ExplanationHPV is a common virus that can be passed on through sex but it doesn't usually cause symptoms. There are around 100 types of HPV. Some of these can cause genital warts and some increase the risk of developing a particular cancer and are called 'high-risk' HPV. Your immune system usually removes the virus from your body. However, the virus can also remain in your body without causing any harm for a long time.
High-risk HPV can increase the risk of penile or anal cancers. However, penile and anal cancer are rare in the UK. High-risk HPV may be a cause of cancer of the penis. Symptoms of penile cancer include:
- a change in the colour, or a thickening, of the skin of your penis
- discharge or bleeding from your penis
- growths or sores, especially under your foreskin High-risk HPV can cause changes in the cells around your anus.
- bleeding from your rectum (back passage)
- pain, discomfort, and itching around your anus
- small lumps around your anus • difficulty controlling your bowel movements (faecal incontinence)
- an ulcer that doesn't heal
- difficult or painful swallowing
- pain when you chew
- a constant sore throat
- a lump in your mouth
- numbness in your mouth or lips
- Cervical cancer statistics. Cancer Research UK. www.cancerresearchuk.org, reviewed 27 November 2014
- Gynaecology. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014 (online version)
- Cervical cancer. BMJ Best Practice. www.bestpractice.bmj.com, published July 2013
- Cervical screening: what your abnormal result means. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, published 2006
- Cervical cancer incidence and screening coverage. National Cancer Intelligence Network. www.ncin.org.uk, published February 2011
- Cervical carcinoma. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed May 2012
- What is cervical cancer? American Cancer Society. www.cancer.org, published September 2014
- Columbo N, Carenelli S, Colombo A, et al. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. European Society for Medical Oncology. Ann Oncol 2012; 23(7):27–32. doi:10.1093/annonc/mds268
- Suspected cervical dysplasia and cancer. Map of Medicine. Cervical dysplasia and cancer. International View. London: Map of Medicine; 2011 (Issue 3)
- Diagnostic tests for women with cervical cancer. American Cancer Society. www.cancer.org, published October 2014
- Management of cervical cancer. Scottish Intercollegiate Guidelines Network (SIGN), September 2013. www.sign.ac.uk
- Cervical cancer. The Merck Manuals. www.merckmanuals.com, published September 2013
- Cervical cancer. Women’s Health Concern. www.womens-health-concern.org, published September 2009
- Cervical screening. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2013
- Abnormal Pap smear. BMJ Best Practice. www.bestpractice.bmj.com, published August 2014
- Loop electrosurgical excision procedure (LEEP). Medscape. www.emedicine.medscape.com, published May 2014
- NHS Cervical Screening. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, published March 2013
- Cervical screening: the colposcopy examination. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, published January 2008
- Colposcopy and Programme Management Guidelines. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, published May 2010
- Human papillomavirus (HPV) vaccination. Patient Plus. www.patient.co.uk/patientplus.asp, reviewed October 2014
- Human papillomavirus and genital warts. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed July 2012
- Cervical cancer. Medscape. www.emedicine.medscape.com, published August 2014
- End of life care in adults – palliative care services. Map of Medicine. End of life care in adults. International View. London: Map of Medicine; 2014 (Issue 3)
- Your sex life and cervical cancer. Cancer Research UK. www.cancerresearchuk.org, reviewed June 2014
- Menopause and its management. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed October 2013
- Side effects of radiotherapy/brachytherapy. Jo’s Cervical Cancer Trust. www.jostrust.org.uk, published February 2014
- HPV vaccination. NHS Cancer Screening Programmes. www.cancerscreening.nhs.uk, published April 2013
- HPV and cancer. American Society of Clinical Oncology. www.cancer.net, published August 2013
- Penile cancer. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed June 2013
- Anal carcinoma. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed July 2012
- Anal cancer. BMJ Best Practice. www.bestpractice.bmj.com, published April 2014
- Diagnosis and management of head and neck cancer. Scottish Intercollegiate Guidelines Network (SIGN), November 2006. www.sign.ac.uk
- Cervical cancer statistics. Cancer Research UK. www.cancerresearchuk.org, reviewed 8 September 2014
- About cervical cancer radiotherapy. Cancer Research UK. www.cancerresearchuk.org, reviewed 20 August 2014
- Chemotherapy and you. National Cancer Institute. www.cancer.gov, published June 2011
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