Cervical cancer

Published by Bupa's Health Information Team, January 2011.

This factsheet is for women who have cervical cancer, or who would like information about it.

Cervical cancer develops if the cells of the cervix (the neck of the womb) become abnormal and grow out of control.

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About cervical cancer

Around 2,900 women in the UK are diagnosed with cervical cancer every year. However, cervical cancer is one of the most preventable cancers.

Deaths from cervical cancer in the UK have fallen over the last 25 years. This reduction is mainly because of the NHS cervical screening programme which detects changes in the cells of your cervix at a pre-cancerous stage. If abnormal cells are caught early, cancer can be prevented.

Types of cervical cancer

There are two main types of cervical cancer. Sometimes, cervical cancer can be a mixture of the two types. Squamous cell cancer (the most common) develops in the flat cells covering your cervix. Adenocarcinoma develops in the gland cells that produce mucus, found in the passageway from your cervix to your womb.
 

Types of cervical cancer

There are two main types of cervical cancer - squamous cell cancer (the most common) and adenocarcinoma, although they are often mixed. They are named after the types of cell that become cancerous. Squamous cells are flat cells covering your cervix; adenomatous cells are found in the passageway from your cervix to your womb. Other rarer cancers of the cervix include small cell cancer.

Symptoms of cervical cancer

If your smear detects abnormal cells on your cervix, they are usually at an early pre-cancer stage, and don't cause any symptoms. Treating the abnormal cells prevents cancer developing.

If abnormal cells do develop into cervical cancer, you may have the following symptoms:

• abnormal vaginal bleeding, for example between periods or after sex
• smelly vaginal discharge
• pain during sex
• vaginal bleeding after the menopause
• pain in your pelvis

These symptoms aren't always due to cervical cancer but if you have them, see your GP.

Causes of cervical cancer

The main cause of cervical cancer is the human papilloma virus (HPV). There are over a hundred different types, or strains, of HPV and each type has a specific number. Some types of HPV cause warts and verrucas, and others increase the risk of cervical cancers.

You may have caught this common virus through sex and be unaware that you have it as 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, having genital warts doesn’t make you more likely to develop cervical cancer. Cervical cancer is caused by a different type of HPV.

Risk factors of cervical cancer include:

• smoking
• having sex at an early age
• having other sexually transmitted infections such as chlamydia and herpes
• having many sexual partners, or have a partner who has had many partners
• taking the contraceptive pill long-term
• having a weakened immune system

Diagnosis of cervical cancer

If you have had an abnormal screening result, or have symptoms of cervical cancer, your doctor will refer you to a gynaecologist (a doctor who specialises in women’s reproductive health).

You may have a number of tests including the following.

• A colposcopy – your doctor uses a lighted magnifying instrument called a colposcope to examine your cervix and take a small sample of tissue (a biopsy) to be sent to a laboratory for testing to see if the abnormal cells have spread.
• A cone biopsy – your doctor will take a cone of your cervix tissue under general anaesthesia, The sample will be sent to a laboratory for testing.
• LLETZ (large-loop excision of the transformation zone) or loop diathermy – your doctor uses a heated loop of wire to remove the abnormal cells which are then sent to a laboratory for testing.
• A CT, MRI, PET or ultrasound scan – to check your health and show how far the cancer has spread (if at all).

If you’re pregnant, it’s safe for you to have a colposcopy. If any pre-cancerous cells are found, treatment is normally arranged for after your baby has been born. If your doctor suspects you have cancer, you may have a cone biopsy, although this can cause a miscarriage and affect future pregnancies. The results will show what stage your cervical cancer is and how far it has spread.

Treatment of cervical cancer

Your treatment will depend on the stage of your cervical cancer and your general health. You may have a combination of treatments. Your surgeon or oncologist will advise you which treatment is best for you.

Surgery

If you have very early stage cervical cancer, a cone biopsy may be all you need.

The most common surgical treatment for cervical cancer is a hysterectomy, including removal of the top few centimetres of your vagina and the lymph nodes in your pelvis.

If you have early stage cancer and still wish to have more children, a radical trachelectomy might be possible. Your surgeon will remove most of your cervix but leave the opening behind, so that you may still have a baby afterwards.

Radiotherapy

Radiotherapy is a treatment to destroy cancer cells with radiation. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. You may have only radiation, or you may have radiation following surgery.

You may have radiation combined with chemotherapy if the cancer is more advanced or has spread to other areas. This reduces the risk of the cancer coming back. Radiotherapy can be given either from outside the body (external beam radiotherapy) or internally (brachytherapy). These treatments are usually given in sequence.

Chemotherapy

Chemotherapy is a treatment to destroy cancer cells with medicines. It’s used with radiotherapy, or to help to shrink a tumour before radiotherapy or surgery. It can also control symptoms if cancer comes back after an initial treatment.

Prevention of cervical cancer

The following steps may help to reduce your risk of cervical cancer.

• Condoms – using these during sex gives you some protection.
• Regular smears – these are part of the NHS cervical screening programme and can detect pre-cancerous cells in your cervix. If you're aged between 25 and 49 and live in England, you will be invited for a smear every three years; the invitation will be every five years if you’re aged between 50 and 64. 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 which protects against the HPV strains most likely to cause cervical cancer. A three-year catch-up programme to vaccinate girls under 18 began in 2009.

Help and support

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.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.