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Cervical cancer


Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
Next review due December 2022

Cervical cancer is when the cells of your cervix (the neck of your womb) become abnormal and grow out of control. A virus called human papillomavirus (HPV) is the main cause of cervical cancer.

How cancer develops
Cancer is caused by cells in the body growing in an uncontrolled way.
How cancer develops
Cancer is caused by cells in the body growing in an uncontrolled way.

About cervical cancer

Around 3,200 women in the UK are diagnosed with cervical cancer every year. 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.

Since the NHS cervical screening programme was introduced, the number of women dying from cervical cancer has halved. Cervical screening saves around 4,500 lives every year in England alone.

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.


Image showing the cervix and transformation zone

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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, heavy periods, 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.

What should I do if I’m embarrassed to talk to my doctor?
Bupa GP, Naveen Puri, talks about what you should do if you’re having symptoms you’re worried to discuss with your doctor.
View transcript

Hello, I am Dr Naveen Puri, I am one of the GPs within Bupa Health Clinics.

Today I want to speak to you about embarrassing problems you might have and what we can do if you attend one of our clinics.

I want you to know that many people feel embarrassed or concerned about speaking about certain things with their doctors, but I'm here to reassure you these are the kinds of things we deal with every day.

For me, looking at someone's bottom or their breasts or their genitalia is no different to looking at their nose or elbow.

And that's true for all doctors as we train for many years in these parts of the body and are very used to having these conversations with people just like you.

So what I would encourage you to do if you have any concerns from your perspective, be it a change in your bowel habit, be it a lump, a rash, a swelling. Something on your genitalia or a part of your body you're not particularly familiar with or feel uncomfortable discussing.

Please be assured your doctor has done it all before.

Some of the ways we find patients find it easier to speak to a doctor is to either tell the doctor you feel embarrassed up front. That way a doctor can make extra effort to make sure you feel comfortable.

Or some patients come to us with pieces of paper and will write the problem down and hand it to us. That way we can help with whatever is going on for you as well.

You may also find it helpful to ask for a specific doctor, someone you're familiar with in your practice. Or you might want to ask for a doctor of a specific gender, or background to your liking as well.

I'd also say, doctors do this every day so don't be alarmed if we ask you certain questions around your symptoms. It is purely so we can help you get the best outcome for your enquiry.

And then finally, feel free to use language that suits you as well. We don't expect you to know the medical words for things, or a name for your diagnosis. That's our job to find out for you.

So, take your time, see a doctor, and hopefully we can help put your mind at ease.

 

 

What should I do if I’m embarrassed to talk to my doctor?
Bupa GP, Naveen Puri, talks about what you should do if you’re having symptoms you’re worried to discuss with your doctor.

Hello, I am Dr Naveen Puri, I am one of the GPs within Bupa Health Clinics.

Today I want to speak to you about embarrassing problems you might have and what we can do if you attend one of our clinics.

I want you to know that many people feel embarrassed or concerned about speaking about certain things with their doctors, but I'm here to reassure you these are the kinds of things we deal with every day.

For me, looking at someone's bottom or their breasts or their genitalia is no different to looking at their nose or elbow.

And that's true for all doctors as we train for many years in these parts of the body and are very used to having these conversations with people just like you.

So what I would encourage you to do if you have any concerns from your perspective, be it a change in your bowel habit, be it a lump, a rash, a swelling. Something on your genitalia or a part of your body you're not particularly familiar with or feel uncomfortable discussing.

Please be assured your doctor has done it all before.

Some of the ways we find patients find it easier to speak to a doctor is to either tell the doctor you feel embarrassed up front. That way a doctor can make extra effort to make sure you feel comfortable.

Or some patients come to us with pieces of paper and will write the problem down and hand it to us. That way we can help with whatever is going on for you as well.

You may also find it helpful to ask for a specific doctor, someone you're familiar with in your practice. Or you might want to ask for a doctor of a specific gender, or background to your liking as well.

I'd also say, doctors do this every day so don't be alarmed if we ask you certain questions around your symptoms. It is purely so we can help you get the best outcome for your enquiry.

And then finally, feel free to use language that suits you as well. We don't expect you to know the medical words for things, or a name for your diagnosis. That's our job to find out for you.

So, take your time, see a doctor, and hopefully we can help put your mind at ease.

 

 

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

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 HIV 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 screening 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).
    Cancer Awareness: Cervical Screening
    This Bupa animation will show some simple checks you can do at home and explains what cancer screening programmes are available in the UK.
    Cancer Awareness: Cervical Screening
    This Bupa animation will show some simple checks you can do at home and explains what cancer screening programmes are available in the UK.

    Help and support

    Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment includes 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. For links to further support and information, see the section: Other helpful websites.

    Frequently asked questions

    Expand all

    • Will treatment affect my sex life? Will treatment affect my sex life?

      Treatment for cervical cancer may cause an early menopause and radiotherapy can have side-effects that affect your sex life. But generally, it’s safe to start having sex again within a few weeks of having radiotherapy or surgery for cervical cancer.

      If you are pre-menopausal, 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. There are treatments that can help with symptoms that can affect your sex life, such as vaginal dryness or having less interest in sex (low libido).

      Radiotherapy may cause narrowing of your vagina and vaginal dryness, which can lead to pain when you have sex. Before you start radiotherapy, talk to your nurse or doctor about how to prevent and treat these after-effects.

      You should use condoms if you’re having sex within a few days of having any chemotherapy treatment. Doctors don’t know if these medicines can pass to your partner though your vaginal or cervical mucus – a condom will help protect your partner.

      An important aspect of cancer treatment is how it can make you feel. You or your partner may be anxious about having sex again and may need time to come to terms with what’s happened. Try to keep communicating. If you find it becomes a problem, you may want to talk to a therapist. Counselling may also be offered by the oncology team as part of your treatment.

    • Do I still need cervical screening after HPV vaccination? Do I still need cervical screening after HPV vaccination?

      Yes, it is best to still go for your screening appointments.

      In the UK, girls and boys are now vaccinated against high-risk types of HPV at the age of 11 to 14. This will dramatically reduce the incidence of abnormal cells and cervical cancer (and other cancers) in the future.

      We know the vaccine protects against the types of HPV that cause more than 75% (three-quarters) of all cases of cervical cancer. However, it may not give you 100% protection against all high-risk types of HPV.

    • Does human papilloma virus cause cancer in men? Does human papilloma virus cause cancer in men?

      Yes, the human papilloma virus (HPV) can cause several types of cancer in men, including:

      • anal cancers
      • cancer of the penis
      • cancers of the tonsils, tongue or throat (head and neck cancers)

      Symptoms can include:

      • lumps or growths that don’t go away
      • sores or ulcers that don’t heal
      • discharge or bleeding
      • pain, discomfort or numbness
      • difficulty swallowing or problems with your teeth

      If you notice any changes anywhere in your body that are abnormal for you, see your GP as soon as possible. The changes may not be caused by cancer. But the sooner cancers are diagnosed, the easier they are to treat. It doesn’t help to put off going to your doctor.



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    • Other helpful websites Other helpful websites

    • Sources Sources

      • Cervical cancer. BMJ Best Practice. bestpractice.bmj.com, last updated October 2019
      • Cervical cancer statistics. Cancer Research UK. cancerresearchuk.org, accessed November 2019
      • Cervical screening. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last updated August 2017
      • Abnormal Pap smear. BMJ Best Practice. bestpractice.bmj.com, last updated October 2019
      • Cervical cancer types and grades. Cancer Research UK. cancerresearchuk.org, last updated May 2017
      • Oxford Handbook of Oncology (4 ed.). Oxford Medicine Online. oxfordmedicine.com, last updated October 2018
      • Cervical screening. Patient. patient.info, last updated October 2014
      • Cervical cancer and HPV. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last updated April 2017
      • Cervical screening: programme overview. Public Health England. gov.uk, last updated November 2019
      • HPV Primary Screening GP Bulletin. NHS England. england.nhs.uk, published July 2019
      • Cervical screening: helping you decide. Public Health England. gov.uk, last updated September 2019
      • Cervical screening: implementation guide for primary HPV screening. Public Health England. gov.uk, last updated February 2019
      • Having a colposcopy. Public Health England. gov.uk, published June 2019
      • Atlas of Colposcopy: Principles and Practice. International Agency for Research on Cancer Screening Group. screening.iarc.fr, accessed November 2019
      • Stages of cancer. Cancer Research UK. cancerresearchuk.org, last updated December 2017
      • The lymphatic system and cancer. Cancer Research UK. cancerresearchuk.org, last updated December 2017
      • About Chemoradiotherapy. Cancer Research UK. cancerresearchuk.org, last updated August 2017
      • Cervical Cancer Treatment & Management. Medscape. emedicine.medscape.com, last updated February 2019
      • The Green Book. Public Health England. gov.uk, last updated July 2019
      • Palliative care – general issues. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last updated October 2016
      • Your sex life and cervical cancer. Cancer Research UK. cancerresearchuk.org, last updated October 2017
      • Side-effects of radiotherapy. Cancer Research UK. cancerresearchuk.org, last updated August 2017
      • Moscicki A-B, Palefsky JM. [title of article required here]. J Low Genit Tract Di 2011; 15(3):231–34 [doi would be useful here]
      • Key signs and symptoms of cancer. Cancer Research UK. cancerresearchuk.org, last updated November 2017
      • Symptoms of mouth cancer. Cancer Research UK. cancerresearchuk.org, last updated May 2018

    • Author information Author information

      Reviewed by Liz Woolf, Freelance Health Editor, and Marcella McEvoy, Specialist Health Editor, Bupa Health Content Team, December 2019
      Expert reviewer, Mr Robin Crawford, Consultant Gynaecological Oncologist
      Next review due December 2022

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