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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 HPV, 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.
There are other factors that can increase your risk of getting cervical cancer, but these are much smaller than the risk from HPV. Other risks include;
• taking the oral contraceptive pill for more than five years,
• having children at an early age (before 17),
• having more than five children and
• having a weak immune system.
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.
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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 your legs. Large tumours in your pelvis can decrease flow in your lymphatic system, or veins. This can lead to a 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 come in 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 sent to you within a couple of weeks. If HPV isn’t identified, you will be tested every three years until you reach 50 years old. After the age of 50, you will be tested every five years. People over 65 are not tested, unless they 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 colposcopy. Usually, 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 women often do not get any symptoms of cervical cancer until the disease is more advanced. Cervical screening allows doctors to identify the disease early on, and this improves the outcome 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 a colposcopy. If cancer is identified during the colposcopy, then there are many tests that 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 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 cancerous.
• CT, or MRI scanning. These scans can be used to check for tumours, and to see if the cancer has spread to other areas of your body.
• Chest x-ray. Occasionally, this can be used to look for the 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.
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 able 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 muscles and bones.
• Stage 3 – 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.
For up to date statistics on cervical cancer, visit Cancer Research UK.
What Is The Treatment For Cervical Cancer?
The type of cancer treatment you might get will differ depending on how advanced the disease is. For example, at Stage 0, no treatment may be required beyond a colposcopy. At Stage 1, you may need a larger part of your cervix removed. This is called a large loop excision of the transformation zone, or LLETZ. This is generally actioned 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 removed under a local anaesthetic with you awake, you might need to be "put to sleep". A cone biopsy would then be done, 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 and 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, or you may just need to remove the cervix.
The aim of the cancer treatment 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 the quality of life by reducing the 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.
Generally, a course of radiotherapy lasts 5 to 8 weeks. It is a good 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,
• painful skin in the areas being treated,
• early menopause and
• in some cases, incontinence.
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 drug.
Common side effects include:
• nausea and vomiting,
• 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 as soon as possible. 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.
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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.
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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.
• Anaesthetic – is a medication that causes anaesthesia (loss of sensation)
• Bladder – the organ in the body that holds urine
• Bowel – the lower part of the digestive system
• Chemotherapy – chemical drugs therapy used to destroy rapidly growing cells in the body, usually used to treat cancer
• 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
• Constipation – a condition where there is difficulty regularly emptying the bowels
• Diarrhoea – a condition of having at least three loose, liquid, or watery bowel movements each day
• Dilate – to enlarge, stretch, or cause to expand
• 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
• Gynaecologist – a doctor who specialises in women’s health, with a focus on the reproductive system
• Human Papilloma Virus (HPV) – a group of different viruses which are sexually transmitted. Some of these viruses are known to cause cervical cancer
• Immune system – a complex system of special organs, cells and chemicals that fight infection
• Incontinence – the involuntary loss of bladder and/or bowel control
• Menopause – when a woman stops having periods and is no longer able to get pregnant naturally
• Metabolism – a term used to describe all chemical reactions involved in maintaining the living state of cells in a living organism
• Nausea – the sensation of an urge to vomit (be sick)
• 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.
• Pelvis – basin shaped structure that supports the spinal column and protects abdominal organs
• Periods – part of the menstrual cycle
• Radiotherapy – a treatment where radiation is used to kill cancer cells
• Rectum – the chamber that starts at the end of the large intestine and ends at the anus (bottom)
• Tumour – an abnormal mass of tissue
• Vomiting – a discharge of the stomach’s contents through the mouth (also called being sick, throwing up)