Cervical Cancer

This factsheet is for women who have cervical cancer, or who would like information about it.

Cervical cancer develops if the cells of the cervix (the neck of the womb) become abnormal and grow out of control.

About cervical cancer
In 2005, around 2,800 women were diagnosed with cervical cancer in the UK.

Deaths from cervical cancer in the UK have fallen over the last 20 years. This reduction is mainly because of the NHS cervical screening programme which may detect changes in the cells of the cervix at a pre-cancerous stage. If abnormal cells are caught early, cancer can be prevented or treated.

The changes can be detected by a laboratory test on a small sample of cells. The cells are taken from an area called the transformation zone on the surface of your cervix, and preserved using a procedure called liquid-based cytology.

The cervix and transformation zone

Types of cervical cancer
There are two main types of cervical cancer - squamous cell cancer (the most common) and adenocarcinoma, although they are often mixed. They are named after the types of cell that become cancerous. Squamous cells are flat cells covering your cervix; adenomatous cells are found in the passageway from your cervix to your womb. Other rarer cancers of the cervix include small cell cancer.

Symptoms of cervical cancer
Abnormal cells found on the cervix during a cervical screening test are usually at an early pre-cancer stage, and don't cause any symptoms. Treating the abnormal cells prevents cancer developing.

If abnormal cells do develop into cervical cancer, you may have the following symptoms:
* abnormal vaginal bleeding, for example between periods or after sex;
* smelly vaginal discharge;
* discomfort during sex;
* vaginal bleeding after the menopause;

These symptoms aren't always due to cervical cancer, but if you have them, you should visit your GP.

Causes of cervical cancer
The exact cause of cervical cancer isn't fully understood at present. But there are a number of factors that make cervical cancer more likely. However, it's important to note that some women who have cervical cancer don't appear to have any of these risk factors.

Ninety-nine out of 100 cervical cancers are associated with some 'high-risk' types of human papilloma virus (HPV).

HPV is a common virus that can be passed on through sex. It usually causes no symptoms at all. In most women, the immune system will get rid of the infection so they might never be aware of it. Only a small proportion of women with HPV will develop cervical cancer.

HPV is from the same family of virus that causes genital warts. However, having genital warts doesn't make you more likely to develop cervical cancer as it's caused by a different type of HPV.

You're more likely to develop cervical cancer if you:
* smoke;
* start to have sex at an early age;
* have many sexual partners, or have a partner who has had many partners;
* have taken the contraceptive pill long-term;
* have a weakened immune system;

Diagnosis of cervical cancer
If you have had an abnormal screening result, or have symptoms of cervical cancer, your GP will recommend a colposcopy. A colposcopy is simply a close examination of your cervix by a specially trained doctor or nurse using a lighted magnifying instrument called a colposcope.

A small sample of tissue (a biopsy) may be taken from your cervix and sent to a laboratory for testing. This will show if abnormal cells have spread from the skin covering your cervix to the tissue underneath.

If you're found to have cervical cancer you may need to have other tests to find out if the cancer has spread. These may include a computed tomography (CT) scan, a magnetic resonance imaging (MRI) scan or an ultrasound scan. Over the next few years positron emission tomography (PET)-CT scanning will replace these as the best procedure.

Treatment of cervical cancer
Treatment options for cervical cancer include surgery, radiotherapy and chemotherapy. Sometimes these treatments are used in combination. Your surgeon or oncologist will advise you which treatment is best for you.

Microinvasive disease
Microinvasive disease means that the cancer hasn't spread outside your cervix and has not penetrated very far into the cervix. A minor operation to remove the cancer might be all that is needed.

You may have one of the procedures listed below:
* Laser therapy (also known as laser ablation) uses heat to destroy the abnormal cells;
* Cold coagulation, which, despite the name, also uses heat to destroy abnormal cells;
* LLETZ (large-loop excision of the transformation zone) or loop diathermy, uses a heated loop of wire to remove the abnormal areas. The cells aren't destroyed so the tissue can be sent to a laboratory for testing;

If you're older and have completed your family, your surgeon may offer a total hysterectomy (removal of the cervix and womb).

If you have disease that has penetrated further into the cervix you may have a:
* radical hysterectomy (removal of your cervix and womb, nearby tissue and the top of your vagina);
* hysterectomy with lymphadenectomy (removal of the lymph nodes in your pelvis);
* hysterectomy with radiotherapy (a treatment to destroy cancer cells with radiation);

Radical trachelectomy may be an option for some early cancers if you still want to have children. In this procedure your surgeon will remove most of your cervix, but leave enough behind so that it may still be possible for you to have a baby afterwards. There is a slightly higher risk of treatment failure when trachelectomy is used in place of radical hysterectomy.

Invasive disease
If your disease is at a later stage, you may need surgery, radiotherapy and/or chemotherapy.

Surgery
A radical hysterectomy may be performed. Your surgeon will also remove your nearby lymph tissue to see if the cancer has spread.

Radiotherapy
A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. If the cancer has spread beyond your cervix, it's unlikely that surgery alone will be able to treat it and radiotherapy with chemotherapy is the usual treatment. Radiotherapy can also be used after surgery to help reduce the risk of the cancer coming back.

Radiotherapy can be given either from outside the body (external beam radiotherapy) or internally (brachytherapy). These treatments are usually given in sequence.

Chemotherapy
Chemotherapy is a treatment to destroy cancer cells with medicines. It's usually given as a series of injections into a vein. Chemotherapy is usually given at the same time as radiotherapy to make the radiotherapy treatment more effective. This is called concomitant chemoradiotherapy. Chemotherapy is sometimes used before radiotherapy or surgery to shrink a tumour. It can also control symptoms if cancer comes back after an initial treatment.

Prevention of cervical cancer
Using a condom during sex will give you some protection from HPV.

Screening
The NHS cervical screening programme in the UK may detect changes in the cells of the cervix at a pre-cancerous stage. If abnormal cells are caught early, cancer can be prevented or treated.

If you're aged between 25 and 60 in the UK, you will be invited at least every five years for a cervical screening test. The exact age groups for screening vary between the different counties of the UK.

HPV vaccine
A vaccine to protect against the strains of HPV that are most likely to cause cervical cancer has been developed. However, it isn't a complete protection against all strains. As it can take 10 to 20 years for cervical cancer to develop after HPV infection, it will take many years for an effect on the rates of cervical cancer to be seen.

From September 2008, all girls aged 12 or 13 across the UK will be offered the HPV vaccine. A catch-up programme to vaccinate girls under 18 will begin in 2009.

Although the vaccination programme against HPV has started to be implemented, the screening programme remains a vital process and shouldn't be ignored.

Help and support
Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, and this is called palliative care.

Cervical cancer Q&As
See our answers to common questions about cervical cancer, including:
* Does human papilloma virus (HPV) cause cancer in men?
* Will treatment for cervical cancer affect my sex life?;
* Will I still need cervical screening tests if I have had the HPV vaccine?

Related topics
* Sexual Health Advice & Leaflets

Further information
* Macmillan Cancer Support
0808 800 1234
www.macmillan.org.uk;
* Cancer Research UK
0808 800 4040
www.cancerhelp.org.uk;
* Jo's cervical cancer trust
www.jostrust.org.uk;

Sources
* Cervical cancer. UK cervical cancer statistics. Cancer Research UK. http://info.cancerresearchuk.org, accessed 25 September 2008;
* Cervical cancer. UK cervical cancer mortality statistics. Cancer Research UK. http://info.cancerresearchuk.org, accessed 25 November 2008;
* Cervical screening: a pocket guide. NHS Cervical Screening Programme. 2004. www.cancerscreening.nhs.uk;
* Arulkumaran S, Symonds IM, Fowlie A. Oxford Handbook of Obstetrics & Gynaecology. Oxford: Oxford University Press, 2004:700;
* Cervical cancer. Cancer Research UK. www.cancerhelp.org.uk, accessed 16 April 2008;
* NHS Cervical Screening Programme. Cancer Screening Programmes. National Health Service (NHS). www.cancerscreening.nhs.uk, accessed 21 October 2008;
* Cervical cancer information centre. Macmillan Cancer Support. www.macmillan.org.uk, accessed 22 October 2008;
* Human papilloma virus (HPV) and cervical cancer - the facts. Royal College of Nursing. 2006. www.rcn.org.uk;
* anagement of cervical cancer. Quick reference guide. Intercollegiate Guidelines Network (SIGN). 2008. www.sign.ac.uk;
* Personal communication, Dr Nicholas Reed, Consultant Clinical Oncologist, Gartnavel General Hospital, Glasgow, 17 September 2008;