What is cervical cancer?

Cervical cancer occurs when abnormal cells develop and spread in the cervix, the lower part of the uterus. There are around 2,800 new cases of cervical cancer diagnosed in the UK each year, which is around 55 women every week. A unique fact about cervical cancer is that most cases are triggered by a type of virus. When found early, cervical cancer is highly curable.

Symptoms of cervical cancer

When cervical cells first become abnormal, there are rarely any warning signs. As the cancer progresses, symptoms may include:

• Unusual vaginal discharge
• Vaginal bleeding between periods
• Bleeding after menopause
• Bleeding or pain during sex

Top cause of cervical cancer: HPV

The human papillomavirus(HPV) is a large group of viruses. About 40 types can infect the genital areas, and some are high risk for cervical cancer. Genital HPV infections usually clear up on their own. If one becomes chronic, it can cause changes in the cells of the cervix. It’s these changes that may lead to cancer. Worldwide, more than 90% of cervical cancers are caused by HPV infection.

Symptoms of HPV

HPV infections usually have no symptoms and go away on their own. Some types of the HPV virus may cause genital warts, but these are not the same strains linked to cervical cancer. It's important to note that genital warts will not turn into cancer, even if they are not treated. The dangerous types of HPV can stay in the body for years without causing any symptoms.

Who is at risk of HPV?

HPV is so common that most people who have ever had sex - both women and men - will get the virus at some point in life. Because HPV can linger quietly, it's possible to carry the infection even if it has been years since you had sex. Condoms can lower your risk of getting HPV, but they do not fully protect against the virus. HPV is also linked to cancers of the vulva, vagina, penis and to anal and oral cancers in both sexes.

How HPV causes cervical cancer

If one of the high-risk strains of HPV lingers in the body, it can cause abnormal cells to develop in the cervix. These precancerous changes do not mean that you have cervical cancer, but over time, the abnormal cells may give way to cancer cells. Once cancer appears, it tends to spread in the cervix and surrounding areas.

What else raises your risk?

The risk of cervical cancer is higher in women who:

• Smoke
• Have many children
• Are HIV positive or have a weakened immune system

The risk may also be higher in women who use contraceptive pills for a long time.

Early detection: Smear test

The cervical smear test is one of the great success stories in early detection. A painless swab of the cervix can reveal abnormalities, often before cancer appears. All women in England are invited for cervical screening from the age of 25, and women in Scotland, Northern Ireland and Wales are invited from the age of 20. Skipping smear tests raises your risk of invasive cervical cancer.

Of note: You'll still need smear tests after getting the HPV vaccine because it doesn't prevent all cervical cancers.

What if your smear test is abnormal?

If test results show a minor abnormality, you may need a repeat smear test. Your GP may refer you for a colposcopy - an examination with a lighted magnifying device that allows a more detailed look at the cervix and abnormal cells to be identified. During this a biopsy may be performed. If abnormal cells are identified these can then be removed or destroyed. Treatments are highly successful in preventing precancerous cells from developing into cancer.

Early detection: HPV DNA test

An HPV DNA test can sometimes be done using cells collected during a routine smear test. This test checks for the presence of high-risk forms of HPV. However, HPV DNA tests are not widely available in the UK.

Diagnosing cervical cancer: Biopsy

Your GP may refer you to hospital for a biopsy after finding cervical changes. A biopsy involves the removal of cervical tissue for examination in a lab. A pathologist will check the tissue sample for abnormal changes, precancerous cells and cancer cells. A cone biopsy allows the pathologist to check for abnormal cells beneath the surface of the cervix. This test may require general anaesthesia.

Stages of cervical cancer

Cervical cancer is separated into four stages. Stage I is when the cancer has not spread beyond the cervix. Stage II means the cancer has spread to surrounding structures such as the upper part of the vagina. A Stage III cancer extends to the lower part of the vagina and may block urine flow. In Stage IV, the cancer has reached the bladder or bowel, or beyond the pelvic area.

Treatment: Surgery

If the cancer has not progressed past Stage II, surgery is usually recommended to remove any tissue that might contain cancer. Typically this involves a hysterectomy, the removal of the cervix and uterus as well as some of the surrounding tissue. The surgeon may also remove the fallopian tubes, ovaries and lymph nodes near the tumour.

Treatment: Radiotherapy

External radiotherapy uses high-energy X-rays to kill cancer cells in a targeted area. It can also help destroy any remaining cancer cells after surgery. Internal radiation, or brachytherapy, uses radioactive material that is inserted into the vagina near to the cervix, or the top of the vagina if the cervix has been removed. Women with cervical cancer are often treated with a combination of radiotherapy and chemotherapy. Side effects can include low blood cell counts, feeling tired, upset stomach, nausea, vomiting and loose stools.

Treatment: Chemotherapy

Chemotherapy uses drugs to destroy cancer cells wherever they are in the body. When cervical cancer has spread to distant organs, chemotherapy may be the main treatment option. Depending on the specific drugs and dosages, side effects may include fatigue, bruising easily, hair loss, nausea, vomiting and loss of appetite.

Coping with cancer treatments

Cancer treatments may make you tired or disinterested in food, but it's important to take in enough calories to maintain a healthy weight. Check with a dietitian for tips on eating well during cancer treatment. Staying active is also important. Gentle exercise can increase your energy while reducing nausea and stress. Check with your doctor or cancer nurse to find out which activities are appropriate for you.

Cervical cancer and fertility

Treatment for cervical cancer often involves removing the uterus and may also involve removing the ovaries, ruling out a future pregnancy. However, if the cancer is caught very early, you still may be able to have children after surgical treatment. A procedure called a radical trachelectomy, known as fertility preserving surgery, can remove the cervix and part of the vagina while leaving the majority of the uterus intact. This is only done in a few hospitals in the UK.

Survival rates for cervical cancer

The odds of surviving cervical cancer are tied to how early it's found. The latest rates available for patients in England and Wales show more than 80% of women survive their disease beyond one year of diagnosis and 64% survive beyond five to ten years of diagnosis. These numbers are based on women treated between 2004 and 2006. The treatments and outlook may be better for those diagnosed today, and statistics don't predict how well any one individual will respond to treatment.

Vaccine to help prevent cervical cancer

A vaccine is now available to protect against the two types of HPV most strongly linked to cervical cancer. HPV jabs are usually offered to girls through secondary schools and require three doses over a six-month period. Studies suggest the vaccine is effective at preventing chronic infections with the two types of HPV that cause 70% of cervical cancers.

Who should get the HPV vaccine?

The vaccines are only used to prevent, not treat, HPV infection. The NHS recommends vaccinating prior to age 14, before girls become sexually active. Girls aged 12 to 13 are offered HPV jabs, usually in year eight at school. The NHS says it provides effective protection for at least six years after the three doses. Its long-term protection is not yet known.

Related reading

• HPV : What girls should know
• Cervical cancer symptoms
• Cervical cancer treatment
• A jab against cervical cancer
• Cervical cancer prevention