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Cervical cancer

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
Cells begin to grow in an uncontrolled way

The diagram shows the transformation zone – this is the area where cervical cancer usually starts.


Image showing the cervix and transformation zone 

About cervical cancer

Around 3,000 women in the UK are diagnosed with cervical cancer every year. If abnormal cells are caught early, cancer can be prevented. Far fewer women now get or die from cervical cancer than in the past – there has been a reduction of almost three-quarters since the 1970s. This is mainly because of the NHS cervical screening programme, which detects changes in the cells of your cervix at a pre-cancerous stage. You can read more about cervical screening in our separate topic: Smear test (cervical screening).

Types of cervical cancer

There are two main types of cervical cancer:

  • squamous cell cancer (the most common)
  • adenocarcinoma

You can have a mix of the two types. They’re named after the type of cell that becomes cancerous. Squamous cells are flat cells that cover 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.

Symptoms of cervical cancer

In the early stages of cervical cancer, you might not have any symptoms, so it’s important to have regular smear tests. The smear test is offered to all women aged between 25 and 64, every three or five years depending on your age bracket. You can read all about what happens in the screening test in our separate topic: Smear test (cervical screening).

If abnormal cells develop into cervical cancer, you might get symptoms, which 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 smelly vaginal discharge
  • 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, so 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 early stages of cervical cancer are usually picked up on a smear test. See our topic on smear tests to learn more. If your smear test shows abnormal cells on your cervix (the neck of your womb), the sample will be tested for human papillomavirus (HPV). This is because HPV is a common cause of cervical cancer (see Causes of cervical cancer).

An abnormal smear test result usually means that small changes have been found in the cells in your cervix. If you have an abnormal 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.

If you’re found to have HPV or have symptoms of cervical cancer, you’ll have some tests at a colposcopy clinic. Some of these can treat you at the same time so you might not need to have any further treatment afterwards. These include the following.

  • A colposcopy – your doctor will use a magnifying instrument called a colposcope to examine your cervix. They may take a small sample of tissue, which is called a biopsy. They’ll send the sample to a laboratory to be tested to see if the cells are abnormal and if they’ve spread. Sometimes, your doctor might remove all of the abnormal cells straight away.
  • Large-loop excision of the transformation zone (LLETZ) also known as loop diathermy – your doctor will use a loop of wire with an electrical current passing through it. They’ll use this to remove the abnormal cells, which they’ll send 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).

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.

Treatment of cervical cancer

Your treatment options will depend on the stage of your cancer, and your general health. The main treatments are surgery 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 specialist doctor (gynaecological oncologist) will talk you through which treatment is best for you. They’ll explain the different treatments in more detail and what they involve.

Surgery

The standard operation for cervical cancer is a hysterectomy, which involves removing your womb and ovaries. You can read about the operation in our separate topic on hysterectomy. 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 may 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. You might have chemotherapy separately as part of your treatment, before or after surgery.

Palliative treatment

You may be offered chemotherapy or radiotherapy 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 treatment 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 thinks is best.

Causes of cervical cancer

HPV

The main cause of cervical cancer is the human papilloma virus (HPV). There are over 130 different types (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 and are known as high-risk HPV.

You might catch this common virus through having sex and be unaware that you have it because it doesn’t usually cause any symptoms. Your immune system may fight off the infection so you may never be aware of it. Yet for some women, the virus can lie dormant for many years and then cause abnormal cells, especially if something causes a dip in your immune system. But only a very small proportion of women with HPV will develop cervical cancer.

Vaccinations to protect against HPV have been developed to reduce the number of women developing cervical cancer. Since 2008 in the UK, there’s been a national programme of vaccination for girls aged 11 to 14.

Other causes

Other things that can increase your risk of getting cervical cancer include:

  • smoking
  • starting to have sex at an early age
  • having other sexually transmitted infections (STIs) such as chlamydia and herpes
  • having sex with lots of different people or having a partner who has many other partners
  • having a weakened immune system – for example, because of HIV or immunosuppressant medication
  • your family history – if your mother or sister has had cervical cancer, it may increase your risk but doctors are unsure whether this is something you can inherit or is because of other things you have in common

Prevention of cervical cancer

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

  • Have regular smear tests. 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 64, you’ll be invited for a smear test every three or five years depending on your age bracket. You can read all about what happens in the screening test in our separate topic: Smear test (cervical screening).
  • Have the HPV vaccine. Girls between 11 and 14 across the UK are offered a vaccine. This protects against the HPV strains most likely to cause cervical cancer.
  • Use condoms. These offer some protection against the HPV virus and other sexually transmitted infections (STIs).

Help and support

If you’re diagnosed with cancer, it 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 links to further support and information, see: Other helpful websites.

FAQ: Will treatment 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 sometimes 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 gone through the menopause yet, 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, which you can read about in our separate topic on menopause. This topic also discusses some treatments that can help.

Radiotherapy may cause narrowing of your vagina, a dry vagina and pain when you have sex. Talk to your healthcare team – your nurse or doctor – about how to manage these symptoms.

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.

An important aspect of cancer treatment to consider is how it can make you feel. It might 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 and keep communicating. If you find it becomes a problem for you both, you may want to talk to a sex therapist. Ask your GP if they can put you in touch with one.

FAQ: Do I still need smear tests?

Yes, if you’ve had the human papilloma virus (HPV) vaccine, you’ll still need to have regular smear tests.

There are over 130 types of HPV, and only some of them are associated with an increased risk of developing certain types of cancer. There are two HPV vaccines but they don't protect against all types of HPV that are associated with cervical changes and cancer. Therefore, the vaccination doesn't provide complete protection against the disease. It's thought that vaccination will prevent about nine out of 10 of the most common type of cervical cancer (squamous cell cancer) from developing. So it's important to attend for routine smear tests even if you’ve had the HPV vaccine.

FAQ: Does human papilloma virus cause cancer in men?

Yes, the human papilloma virus (HPV) is linked with cancer of the penis and anus. It’s also linked with head and neck cancer – this includes your tonsils, tongue, and the back of your throat (known as the pharynx).

HPV is a common virus that can be passed on through sex but it doesn't usually cause any symptoms. There are over 130 types of HPV, and some of these can increase the risk of developing a particular cancer, which are called 'high-risk' HPV. Your immune system usually removes the virus from your body. But the virus can also remain in your body without causing any harm for a long time.

High-risk HPV can increase your risk of getting penile or anal cancers, although these are rare in the UK.

Symptoms of penile cancer include:

  • a lump, ulcer or growth on the skin of your penis, or under your foreskin
  • red skin on the skin of your penis
  • discharge or bleeding from your penis
  • feeling itchy or a burning sensation – especially under your foreskin

High-risk HPV can also cause changes in the cells around your anus, and these changes may develop into anal cancer after many years. See our separate topic on anal cancer to learn about the symptoms.

High-risk HPV may be linked to head and neck cancer, which affects your tonsils, tongue and pharynx (back of your throat). This type of HPV is most likely to be transmitted if you have oral sex. Symptoms depend on which part of your head or neck has cancer but they include:

  • an ulcer that doesn't heal
  • difficult or painful swallowing
  • problems with your teeth, such as loose teeth or dentures not fitting anymore
  • a constant sore throat
  • a lump in your throat
  • a numb mouth or lips

If you have any of these symptoms, they may not be caused by these cancers, but contact your GP.

Details

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    Further information

    Sources

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    • Marth C, Landoni F, Mahner S, et al. Cervical cancer: ESMO clinical practice guidelines. Ann Oncol 2017; 27(4):iv72–iv83. doi:10.1093/annonc/mdx220 | iv73
    • Cervical cancer and HPV. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2017
    • NHS cervical screening programme: colposcopy and programme management. Public Health England. www.gov.uk, published March 2016
    • What is cervical cancer? American Cancer Society. www.cancer.org, last medical review 16 November 2016
    • Types and grades | Cervical cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed 26 May 2017
    • Cervical screening. BMJ Best Practice. bestpractice.bmj.com, last updated 12 April 2017
    • Cervical screening. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised February 2015
    • Cervical screening (cervical smear test). PatientPlus. patient.info/patientplus, last checked 20 October 2014
    • Loop electrosurgical excision procedure (LEEP). Medscape. emedicine.medscape.com, updated 3 August 2016
    • Lymphatic system anatomy. Medscape. emedicine.medscape.com, updated September 19 2013
    • Radical and simple trachelectomy. Medscape. emedicine.medscape.com, updated 23 December 2015
    • Guidance on cancer services. Improving supportive and palliative care for adults with cancer. The manual. National Institute for Health and Care Excellence (NICE), March 2004. www.nice.org.uk
    • Human papillomavirus (HPV) immunisation. PatientPlus. patient.info/patientplus, last checked 20 September 2014
    • Your sex life and cervical cancer. Cancer Research UK. www.cancerresearchuk.org, last reviewed 10 June 2014
    • Cervical screening: programme overview. Public Health England. www.gov.uk, published 1 April 2015
    • HPV and cancer. American Society of Clinical Oncology. www.cancer.net, approved February 2017
    • Penile cancer. PatientPlus. patient.info/patientplus, last checked 19 May 2016
    • Head and neck cancer – resection and neck dissection. Medscape. emedicine.medscape.com, updated 19 June 2017
    • Head and neck cancers. Oxford handbook of oncology. Oxford Medicine Online. oxfordmedicine.com, published September 2015

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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, August 2017
    Expert reviewer, Mr Robin Crawford, Consultant Gynaecologist
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