Cervical cancer only affects women/girls. It is not contagious and cannot be passed on to other people.
- The cervix is the lower part of the uterus and is often called the 'neck of the uterus.'
- The uterus is a muscular, pear-shaped organ at the top of the vagina. The lining of the uterus is shed each month, and results in bleeding called a period. These periods stop temporarily during pregnancy and will normally continue until a woman has the menopause.
- Close to the cervix is a collection of lymph nodes.
- Cancer of the cervix can take many years to develop. Before it does, changes occur in the cells of the cervix. These abnormal cells are not cancerous, and are called cervical intra-epithelial neoplasia (CIN). CIN may also be referred to as dysplasia or dyskaryosis.
TIP: It is important to know that most women with CIN do not develop cancer.
HPV (human papillomavirus virus)
If your doctor, nurse or health worker has told you that your abnormal Pap smear result may be due to an infection with HPV, you be may wondering what it is, how you got it and what it means for your health.
HPV is a very common virus, with four out of five people having it at some stage of their lives. In some cases, it can increase a woman’s risk of cervical cancer. However, most women with HPV do not develop cervical cancer.
There are over 100 different types of HPV, including some that affect the genitals. Genital HPV is similar to the virus which causes warts on other parts of the body.
Genital HPV is so common that it could be considered a normal part of being a sexually active person. Most people will have HPV at some time in their lives and never know it. You may become aware of HPV if you have an abnormal Pap smear result, or if genital warts appear.
HPV infection is very common and in most people it clears up naturally in about 8-14 months.
What does HPV have to do with cervical cancer?
A few of the many types of HPV have been linked with causing abnormalities of the cervix and in some cases the development of cancer of the cervix.
It is important to remember that most women who have HPV clear the virus naturally and do not go on to develop cervical cancer. In a small number of women, the HPV stays in the cells of the cervix. When the infection is not cleared, there is an increased risk of developing abnormalities. In very rare cases, these abnormalities of the cervix can progress to cancer. When cervical cancer develops, HPV is found in almost all cases. Having regular Pap smears is the best way to ensure that any changes are monitored and managed to protect your health.
If you have early cell changes due to HPV, there is a strong likelihood that these changes will clear up naturally in 8 to 14 months. Because of this, and the fact that cancer of the cervix takes around 10 years to develop, your doctor may recommend simply having another Pap smear in 12 months time.
What causes cervical cancer?
The exact causes of cervical cancer are unknown.
However there are some identified risk factors:
- Poor Diet
- Infections: eg HIV
- Long term use of the contraceptive pill: (more than 10 years) can slightly increase the risk of developing cervical cancer.
TIP: Women/girls have heard that having sexual intercourse at an early age or having multiple sexual partners can increase the risk of developing cervical cancer. It is important to remember that although these factors can increase the chances of catching the HPV virus (not cervical cancer), many women who have only had one sexual partner have HPV, and may go on to develop CIN or cervical cancer.
What are the symptoms?
The most common symptoms of cervical cancer are:
- Abnormal bleeding, such as between periods or after intercourse.
- Bad-smelling vaginal discharge
- Discomfort during intercourse
TIP: If you have any of these symptoms you should have them checked by your doctor - but remember, they are common to many illnesses other than cervical cancer.
How is it diagnosed?
After visiting a GP a referral will probably be made to a hospital for some tests.
These may include:
- Colposcopy: A colposcope is like a small microscope with a light and allows the nurse or doctor to make a more thorough examination of the abnormal cells on the cervix.
- Blood test
- Large loop excision of the transformation zone (LLETZ): remove the area of the cervix that contains the abnormal cells, which can then be examined under a microscope in the laboratory.
- Cone biopsy: A small cone-shaped section of the cervix is taken, that is aimed to be large enough to remove any abnormal cells. It may result in some bleeding and strenuous physical activity and sexual intercourse should be avoided for 4–6 weeks to allow the cervix to heal.
Examination of the Cervix
- For the examination, a nurse will help the patient to position themself on a couch that has special leg supports (like stirrups on a riding saddle).
- The doctor will use a bright light and a magnifier to examine the cervix. They may then take small samples of tissue (biopsies).
- They will also conduct an internal examination to check the vagina and cervix for any abnormality. Using a speculum (a plastic or metal instrument) to hold the vaginal walls open, a liquid will be dabbed on to the cervix to help show up any abnormal areas.
- They may also take a cervical smear (a small sample of cells taken from the cervix). The doctor will also examine the back passage (anus).
If the results of the test show cervical cancer, another referral will be made to a doctor who specialises in the treatment of the cervix (called an gynaecologist).
The stage of a cancer describes its size and whether it has spread beyond its original site.
The stages of cervical cancer are described below:
- Stage 1: Cancer cells only within the cervix.
- Stage 2 Cancer has spread into surrounding structures such as the upper part of the vagina or tissues next to the cervix.
- Stage 3 Cancer has spread to surrounding structures such as the lower part of the vagina, lymph nodes, or tissues at the sides of the pelvic area. If the tumour is causing pressure on a ureter there may be a build up of urine in the kidney.
- Stage 4 Cancer has spread to the bladder, bowel or beyond the pelvic area. Also includes tumours that have spread into the lungs, liver or bone, although this is not common.
If the cancer comes back after initial treatment this is known as recurrent cancer.
The grade of a cancer gives an idea of how quickly it may develop.
It may be graded as:
- Grade 1 (low grade) – the cancer cells tend to be slow growing.
- Grade 2 (moderate grade) – the cells look more abnormal and are slightly faster-growing.
- Grade 3 (high grade) – the cancer cells tend to be more quickly growing, look very abnormal.
How is it treated?
A team of doctors and other staff at the hospital will plan treatment. It will depend on the size of the tumour and where it is.
Treatment may be coordinated by an oncologist (a doctor who specialises in treating cancer with chemotherapy) a gynaecologist (a surgeon who specialises in the cervix) and a radiologist (a doctor who specialises in treating cancer with radiation) .
Treatment may involve:
Chemotherapy for cervical cancer
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. There are several chemotherapy drugs that can be used to treat cervical cancer.
It is thought that the chemotherapy makes cervical cancer more sensitive to the effects of the radiotherapy, so sometimes they are used in conjunction with each other.
Surgery for cervical cancer
The aim of surgery is to remove the tumour. Surgery is used more often for young women/girls than radiotherapy, as radiotherapy to the pelvic area stops the ovaries from working and brings on an early menopause.
Other surgical procedures include:
- Bilateral salpingo-oophorectomy: ovaries and fallopian tubes may also be removed.
- Hysterectomy: involves removing the uterus
TIP: If ovaries are removed the symptoms of the menopause can often be prevented by giving hormone replacement therapy (HRT) as tablets, skin patches or creams.
Radiotherapy for cervical cancer
Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells. Radiotherapy for cancer of the cervix can be given externally or internally, and often as a combination of the two.
Radiotherapy is usually given if the cancer has spread beyond the cervix and is not curable with surgery alone. Radiotherapy may also be used after surgery if there is a high risk that the cancer returning.