About the Condition
Cervical cancer occurs when the genetic material of cells in the cervix, which is the entrance to the womb from the vagina, become damaged or changed, producing mutations that affect normal cell growth and division. The abnormal cells then replicate, causing cancer. If undetected, the cancer can spread beyond the cervix and move to other parts of the body.
Cervical cancer is deemed uncommon in the UK, with around 3,000 cases diagnosed every year*. Unlike other cancers, the main cause of cervical cancer has been identified.
Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that’s often spread during sex. HPV comes in over 100 different types, but only a few can disrupt the normal functioning of the cells and potentially trigger the onset of cancer. 70% of all cases of cervical cancers are known to be caused by HPV 16 or HPV 18*. Neither of these viruses cause noticeable symptoms, meaning it can be hard to spot the infection without tests. Using condoms during sex offers some protection against HPV, but it cannot always prevent infection.
Since 2008, a HPV vaccine has been routinely offered to girls between the ages of 12 and 13.
Other risk factors for cervical cancer have been identified, and these include:
- Cervical intraepithelial neoplasia (CIN), which is a pre-cancerous condition that does not pose an immediate risk to a person’s health, but has a small chance of developing into cancer in the future
- Smoking, which doubles the risk of cervical cancer
- Having a weakened immune system, which can be the result of taking certain medications, such as immunosuppressants, which are used to stop the body rejecting donated organs, or as a result of a condition such as HIV/AIDS
- Taking the oral contraceptive pill for more than five years – women who do this are thought to have twice the risk of developing cervical cancer than those who do not take the pill, although it is not clear why this is
- Having children – women who have two children have twice the risk of getting cervical cancer compared with women who do not have any children
Cervical cancer often has no symptoms in its early stages, but when symptoms do occur the most common is unusual vaginal bleeding. Unusual bleeding occurs at any of the following times:
- After sexual intercourse
- At any time other than your expected monthly period
- After the menopause
Vaginal bleeding is very common and can have a range of causes, so it doesn’t necessarily mean that you have cervical cancer. However, unusual vaginal bleeding is a symptom that needs to be investigated by your GP.
Other symptoms of cervical cancer may include:
- pain and discomfort during sex
- an unpleasant smelling vaginal discharge
If the cancer spreads out of your cervix and into surrounding tissue and organs, it can trigger a range of other symptoms, including:
- blood in your urine (haematuria)
- loss of bladder control (urinary incontinence)
- bone pain
- swelling of one of your legs
- severe pain in your side or back caused by swelling in your kidneys related to a condition called hydronephrosis
- changes to your bowel and bladder habits
- loss of appetite
- weight loss
- tiredness and lack of energy
Some people find it embarrassing to talk about these sorts of symptoms, but if any of the above apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early.
The NHS offers a national screening programme open to all women from the age of 25. During screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities. This test is commonly referred to as a cervical smear test. It is recommended that women who are between the ages of 25 and 49 are screened every three years, and women between the ages of 50 and 64 are screened every five years. You should be sent a letter telling you when your screening appointment is due. Contact your GP if you think that you may be overdue for a screening appointment.
If you’re referred to CCL for diagnosis, your consultant or oncologist will advise you on which tests are relevant to your individual symptoms. Following an abnormal smear test, a number of diagnostic procedures will be run to ensure a diagnosis of cervical cancer. These include:
- A Colposcopy, which is when a colposcope ( a small microscope with a light on the end) is used to examine your cervix. A sample of tissue, called a biopsy, may also be taken at this time to examine the cells for signs of cancer.
- A Cone biopsy, which is usually done under local anaesthetic, and involves the removal of a small, cone-shaped section of your cervix for examination.
If the results of the biopsy suggest you have cervical cancer and there’s a risk that the cancer may have spread, you’ll probably need to have some further tests to assess how widespread the cancer is. These tests may include:
- A pelvic examination, which is carried out under general anaesthetic – your womb, vagina, rectum and bladder will be checked for cancer
- Blood tests – these can be used to help assess the state of your liver, kidneys and bone marrow
- A Computerised Tomography (CT) scan, which shows a 3D image of the area being looked at
- A Magnetic Resonance Imaging (MRI) scan, which is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body
- A Positron Emission Tomography (PET) scan, which uses a very small amount of an injected radioactive drug to show where cells are active in the body
- A chest X-ray, which is when low level radiation is used to create an image of the heart and lungs, to check for spreading cancer
After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows:
- stage 0 (pre-cancer) – there are no cancerous cells in the cervix, but there are biological changes that could trigger the onset of cancer in the future; this is called cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS)
- stage 1 – the cancer is still contained inside the cervix
- stage 2 – the cancer has spread outside the cervix into the surrounding tissue, but has not reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina
- stage 3 – the cancer has spread into the lower section of the vagina and/or into the pelvic wall
- stage 4 – the cancer has spread into the bowel, bladder or other organs, such as the lungs
At CCL, patients with cervical cancer are treated by a team of different specialists, called a Multi-Disciplinary Team, or MDT. This team works together to create a treatment plan to suit the individual needs of the patient. Depending on the stage of the cancer, there are a wide range of treatment options available.
If the screening results indicate that the patient does not have cervical cancer, but that there have been biological changes that could turn cancerous in the future, a number of treatment options are available. These include:
- large loop excision of the transformation zone (LLETZ) – the abnormal cells are cut away using a fine wire and an electrical current
- cone biopsy – the area of abnormal tissue is removed during surgery
- laser therapy – a laser is used to burn away the abnormal cells
If the screening results indicate that the patient does have cervical cancer, surgery is often one of the first treatments. There are three main types of surgery for cervical cancer. They are:
- radical trachelectomy, which is used mainly to treat the very early stages of cervical cancer, and to preserve fertility – the cervix, surrounding tissue and the upper part of the vagina are removed but the womb is left in place
- hysterectomy, which is usually the recommended treatment for cervical cancer– the cervix and womb are removed; depending on the stage of the cancer, it may also be necessary to remove the ovaries and fallopian tubes
- pelvic exenteration, a major operation which is usually used when the cancer has spread beyond the cervix to a great extent – the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed
Following surgery, most patients undergo additional treatments to lower the chances of further spread and reoccurrence of cervical cancer. These include:
- Radiotherapy, which is where high-energy rays are used to destroy the cancer cells.
- Chemotherapy, which involves the use of chemical agents which are toxic to cancer cells, destroying them and preventing them from spreading to different areas. This can be given by injection or in tablet form.
Cancer doesn’t just leave a physical impact on an individual, it can have a huge emotional effect as well. Cancer and its treatment can be overwhelming, causing a wide variety of emotions, and it is important to remember that there is no right or wrong response. Reactions vary hugely from person to person, and most people find that it becomes easier to cope when they’re given additional support, so that’s what we do.
At CCL we provide support that caters to both the physical and emotional needs of the patient, before, during and after treatment. We offer a wide range of services for patients, as well as their loved ones, designed to make a very difficult time as easy as possible, and to give our patients the best treatment and support possible.
Following treatment for cervical cancer, many women have concerns about their sexual health and fertility, and may be experiencing physiological and emotional changes that can be difficult to deal with. CCL provides fertility specialists and psychosexual therapists to help women adapt and adjust to these changes.
Cervical Cancer Consultants