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Cervical Cancer

What Is Cervical Cancer?

The cervix is a part of the female reproductive system. It is a small ring that sits between the vagina and the womb.

If you are pregnant, the cervix’s role is to provide support in holding the baby up until it is ready to be born. During labour, the cervix dilates to allow the baby to move from the womb into the vagina. Cancer starting in this part of the body is known as cervical cancer.

What Causes Cervical Cancer?

The most common cause of cervical cancer is a virus known as human papillomavirus (HPV). There are around 100 different types of this virus, and 15 of them are considered high risk for causing cervical cancer.

HPV is a sexually transmitted disease. It is relatively common in the UK, and you can catch it from unprotected sex, genital contact, or use of sex toys. Most HPV strains have no symptoms, so you may not know that you are infected with it.

Other factors can increase your risk of getting cervical cancer, but these are much smaller than the risk from HPV. These include;

  • smoking
  • taking the oral contraceptive pill for more than five years
  • having children at a very early age (before 17)
  • having more than five children and
  • having a weak immune system.

What is the HPV vaccine?

The HPV vaccine is now routinely given to all girls and boys in year 8 of high school (aged 12 or 13). The vaccine helps to reduce the risk of getting four types of HPV, which are the types most likely to cause cancers. Although the vaccine doesn’t eliminate the risk of getting HPV, or of getting cervical cancer, it significantly reduces the risk.

As the number of women in the population with resistance to these strains of HPV increases, this should decrease the number of people who have the disease. This will prevent even more cancers in the long term and is known as herd immunity.

Symptoms

Cervical cancer may not cause any symptoms until it is “advanced”.

Generally, one of the first symptoms women experience is abnormal vaginal bleeding. This could be after sex, or between periods. It could also be after the menopause.

Women may also experience;

  • pain during and after sex,
  • abnormal vaginal discharge and
  • pain in and around their lower back and pelvis.

If you develop any of these symptoms, it is important to see your GP.

If the disease becomes advanced and spreads to other areas of the body, it can produce different symptoms. These will depend on where the cancer has spread. For example;

Unintentional Weight loss

In advanced cancer, this is caused by a combination of loss of appetite and increased metabolism of the cancer itself.

Back Pain

If you develop cancer in your spine, you may develop severe back pain which wakes you up at night. Your kidneys could also cause pain in the sides of your back if the cancer has spread to them.

Constipation

If the cancer spreads to your bowel, it could cause constipation. Cancer in the gut can also cause diarrhoea. If you have an ongoing change in your bowel habit for more than two weeks, it is important to see your GP.

Swelling Of Legs

Large tumours in your pelvis can decrease flow in your lymphatic system or veins. This can lead to swelling of your legs.

What Is Cervical Screening?

Cervical screening is also generally known as a smear test. After the age of 25, a woman will be sent a letter by her GP asking her to attend for a test.

The test involves a quick vaginal exam, where a speculum is used to open up the vagina and identify the cervix. A small sample of cells is then taken with a brush. This might be slightly uncomfortable but should not cause pain. These cells are then sent to a lab where they will be tested for HPV and any abnormal cells. Results are typically posted to you within a couple of weeks.

If HPV isn’t identified, you will be tested every three years until you reach the age of 50. After 50, you will be tested every five years, and people who are over 65 are not tested, unless they have previously had an abnormal result.

If some of the cells in your test come back abnormal, you will be sent for another test called a colposcopyUsually, this is done in an outpatient clinic. It is another vaginal examination; only this time, a microscope is used to identify any abnormal parts of the cervix. If abnormal parts are identified, they are cut away and sent to a laboratory for testing to see if they are cancerous.

It is essential to attend your cervical screening appointments, as often women do not get any symptoms of cervical cancer until the disease is more advanced. Cervical screening allows doctors to identify the disease very early on, and this improves the outcomes dramatically.

How Is Cervical Cancer Diagnosed?

Cervical cancer can be diagnosed at routine screening appointments, as described above. If you go to your GP with symptoms that could suggest cervical cancer, you will probably be referred to a specialist. This should happen within two weeks of your appointment with the GP.

Your first test will likely be colposcopy. If cancer is identified during the colposcopy, then there are many tests which can be performed after this such as;

  • pelvic examination under anaesthetic. This is where you are put to sleep so a gynaecologist can make sure there isn’t a visible spread of the cancer in your pelvis. Medical staff use small cameras to look inside your womb, bladder and rectum. If any suspicious areas are identified, small biopsies will be taken and sent for testing to see if they are cancer.
  • CT or MRI scanning. These scans can be used to check for tumours or spread to other areas of your body.
  • Chest x-ray. Occasionally, this can be used to look for spread of the disease. It can also be performed before an anaesthetic to check that you are well enough to be put to sleep.

You will probably also get blood tests. Although blood tests cannot be used to diagnose cancer, they give information about how well certain parts of your body are working, such as your kidneys and liver. This can be used to develop an idea about whether there may be any spread to these areas, and also how fit you are.

What Are The Different Stages Of Cervical Cancer?

Cervical cancer can be split into stages depending on how advanced the disease is. The less developed the disease, the more likely treatment will be to cure the cancer. The stages are:

  • Stage 0. At your smear test, some slightly abnormal cells are seen. They are not cancerous now, but could turn into cancer in the future. These are usually removed, and you will require no further treatment, but should continue with your regular cervical screening.
  • Stage 1. There are cancerous cells, but they are only on your cervix.
  • Stage 2. The cancer has spread slightly beyond your cervix, but not to your lower vagina or onto the pelvic wall. Your pelvic wall is the outer part of your pelvis made up of the muscles and bones.
  • Stage 3. The cancer has spread into the pelvic wall or the lower part of the vagina.
  • Stage 4. Cancer has spread to other organs in the body.

In the UK, 96% of women will be alive at one year following diagnosis of stage 1 cervical cancer, compared to only 50% of those diagnosed with stage 4. This statistic includes women of all ages diagnosed between 2013 and 2018. It is important to remember that younger women, and those who are healthier, will have better survival rates. Five-year survival rates for cervical cancer in 15-39 year-olds is 89%, whereas for those aged 80 or over, it drops to 26%.

For up to date statistics on cervical cancer, visit Cancer Research UK.

What Is The Treatment For Cervical Cancer?

The type of treatments you might get for cervical cancer will differ depending on how advanced the disease is. At Stage 0, no treatment may be required beyond colposcopy.

Stage 1 cancer may need a larger part of the cervix to be removed than you would typically get in a colposcopy. This is called a large loop excision of the transformation zone or LLETZ. This is generally done with local anaesthetic and can be done at the same time as your colposcopy.

 If the abnormal area on your cervix is too large to be done under a local anaesthetic with you awake, you might need to be put to sleep. A cone biopsy is then taken of the cervix, which is where a cone-shaped piece around any abnormal cells is removed and sent to the lab to be looked at under a microscope. This is to make sure that all of the abnormal cells have been removed. 

If cervical cancer is more advanced, then it is likely that you may need surgery, radiotherapy, chemotherapy, or any combination of the three. Surgery is aimed at taking away as much of the cancer as possible, where radiotherapy and chemotherapy are used to try to kill any remaining cells.

Surgery can be extensive, depending on the spread of the disease. It may be necessary to remove the whole of the womb, fallopian tubes, and ovaries, for example, or you may just need to remove the cervix.

The aim of these treatments can be curative or palliative. If the cancer has spread to the extent that it would be impossible to cure, then these treatments are used to prolong life and improve quality of life by reducing symptoms.

Are There Any Side Effects Of Treatment?

Surgery always carries risks. These risks will vary depending on how big the operation needs to be to remove the tumour. If you are being considered for surgery, your gynaecologist will discuss these risks with you, and any other options you might have.

Radiotherapy and chemotherapy are both known to have commonly occurring side effects.

Radiotherapy

Generally, a course of radiotherapy lasts 5 to 8 weeks. It is an excellent way to target the radiation at the cancer cells, causing them to die. In some cases, this can be used to completely cure the cancer.

Side effects include:

  • vaginal or rectal bleeding
  • severe lethargy
  • nausea
  • diarrhoea
  • painful skin in the areas being treated
  • infertility
  • early menopause and
  • in some cases, incontinence.

Chemotherapy

Chemotherapy is usually delivered by a drug injected into your vein. This can be done as an outpatient, which means you can go home after being given the dose.

Common side effects include:

  • nausea and vomiting,
  • diarrhoea,
  • severe lethargy,
  • decreased production of a number of different types of blood cells. This can lead you to be more vulnerable to infections or make you tired and breathless
  • hair loss and
  • decreased appetite.

What Kind Of Follow Up Can I expect?

When cervical cancer is cured, it is necessary to attend regular follow up appointments to make sure that if it does come back, it can be picked up and treated early. For this reason, appointments following treatment are usually at least once every six months for the first two years and then once every year for another three years after that.

If you still have your cervix, these appointments will include a vaginal and cervical examination to look for signs of any recurrence.

Support

You may be entitled to certain benefits if you have been diagnosed with cancer. If you are continuing to work, you are protected by the Disability Discrimination Act, which means that your employer should make reasonable adjustments to help you to continue work. These include allowing you time off to undergo medical treatments. If you feel that your employer is unreasonable in their expectations, you should get in touch with your union or local Citizens Advice Bureau.

You will be entitled to free prescriptions, and if you are in financial difficulty, you may be eligible for several benefits. For more information, visit Cancer Research UK’s advice page on useful contacts for benefits.

Jo’s trust is a UK based charity dedicated to helping people with cervical cancer and research into the condition. They operate a helpline, online forums, and support groups.

Glossary

Medical terminology can sometimes be difficult to understand. Below are some key terms that you’ll find in this article to try and help you have a better understanding of the condition.

Abnormal

Advanced

Anaesthetic

Biopsies

Bladder

Bowel

Cervix / cervical

Chemotherapy – drugs that are used to kill or stop the growth of cancer cells. They can be given by injection into a vein, orally, or even topically onto the skin depending on the type of cancer, and the aim of treatment.

Colposcopy – a procedure where a doctor looks closely at your cervix with a small camera which magnifies the cells. This can identify abnormal parts of the cervix which need testing for cancer.y

Cone biopsy

Constipation

CT scanning

Curative

Diagnosed / diagnose

Diarrhoea

Dilates

Discharge

Fallopian tubes – these are a part of the female reproductive system. They join the ovaries and the womb. These small tubes are what the unfertilised egg travels down on its way from the ovaries to the womb.

Genital

Gynaecologist

Herd immunity 

Immune system

Incontinence

Infertility

Kidneys

Labour

Large loop excision

Lethargy

Liver

LLETZ

Local anaesthetic

Lymphatic system

Menopause – the period in a woman’s life where menstruation (having periods) stops.

Metabolism

Microscope

MRI scanning

Nausea

Oral contraceptive pill

Ovaries – a part of the female reproductive system, the ovaries are responsible for producing eggs. They also produce hormones which are a part of a woman’s normal menstrual cycle.

Palliative

Pelvic wall

Pelvis

Periods

Radiation

Radiotherapy – the treatment of cancer with x-rays or other forms of radiation.

Rectal

Rectum

Reproductive system

Smear test

Speculum

Transformation zone

Tumours

Vaccine – a substance which is used to produce an immune reaction which will protect someone from developing a disease if exposed to it in the future.

Vagina / vaginal

Virus

Vomiting

Womb