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Cervical cancer

Published by Bupa's health information team, July 2006.

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

In 2003, around 2300 women were diagnosed with cervical cancer in England, with 95% of cases being in women over 35. Deaths from cervical cancer have fallen over the last 20 years however. This reduction is mainly because of the NHS screening programme in the UK which can detect cervical cancer at an early stage. For more information about screening, please see the separate Bupa factsheet, Cervical screening.

Cancer animation

The cervix

The cervix is the neck of the womb. It is located at the top of the vagina.

What is cervical cancer?

Cervical cancer develops if the cells of the cervix become abnormal and grow out of control. The cancer can spread to other parts of the body. If abnormal cells are caught early however, which they often are through the cervical screening programme, cancer can be prevented or treated.

Where cervical cancer cells can be found

Symptoms

Abnormal cells found on the end of the cervix during a cervical screening test are generally at an "early warning" pre-cancer stage, and do not cause any symptoms. Treating the abnormal cells prevents cancer developing.

If abnormal cells do develop into cervical cancer, it can cause symptoms including:

• abnormal vaginal bleeding, such as between periods or after intercourse
• smelly vaginal discharge
• discomfort during intercourse
• vaginal bleeding after the menopause

If you experience any of these symptoms you should see a doctor, even though the cause is usually not cervical cancer. There are many other conditions that can cause the same symptoms, such as vaginal infections.

Causes

The exact reasons why an individual may develop cervical cancer are not fully understood at present. But there are a number of risk factors that make cervical cancer more likely, which are listed below. However, it is important to note that many women who have cervical cancer do not appear to have any of these risk factors.

Human papilloma virus (HPV)

99 percent of cervical cancers are caused by the human papilloma virus (HPV).

There are over 100 different types of HPV of which only about 12 are important. Each virus is assigned a number and the five types most commonly associated with cervical cancer are 16, 18, 31, 33 and 45.

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 the HPV types listed above will develop cervical cancer.

HPV is from the same family of virus that causes genital warts. However the types of virus that cause genital warts do not put you at greater risk of developing cervical cancer.

Other risk factors for cervical cancer include the following.

• Starting to have sex at an early age (before 17) may expose the cervix to HPV at an especially susceptible time. Plus, the more sexual partners you have, the greater the risk of getting HPV.
• Using the contraceptive pill long-term may increase the risk of cervical cancer. Using the pill may discourage women to use barrier methods such as condoms, which give some protection from HPV. However for some women the benefits of using the contraceptive pill outweigh the risk of cervical cancer.
• Women who smoke are more likely to get cervical cancer than non-smokers.
• A weakened immune system from autoimmune diseases, such as rheumatoid arthritis or human immunodeficiency virus (HIV) infection, or taking immunosuppressant drugs after an organ transplant increases the risk.

Diagnosis

If you have had an abnormal screening result, or have symptoms of cervical cancer, you will be asked to have your cervix examined in a test called a colposcopy. For more information about a colposcopy, please see the separate Bupa factsheet, Cervical screening.

Tiny samples of cells from abnormal areas on your cervix may be taken and examined in a laboratory (a biopsy). The biopsy will show if abnormal cells have spread from the skin covering your cervix to the tissue underneath.

If you are found to have cervical cancer then you may need to have other tests to assess if the cancer has spread. The process of finding out the stage of a cancer is called staging. To do this, you will need to have more tests. These may include:

• a CT scan
• an MRI scan
• an ultrasound scan

For more information, please see the separate Bupa factsheets, Ultrasound, CT scan and MRI scan.

Treatment

Treatment options for cervical cancer include surgery, radiotherapy and chemotherapy. Sometimes these treatments are used in combination. There are many factors that determine the type of treatment that you should have. These include your age and general health, as well as the stage of the cancer. Your doctor will advise you which treatment is best for you.

Surgery

Early stage

For early cervical cancer (when the cancer has not spread far outside your cervix), a minor operation to remove the cancer might be all that is needed. There are a number of procedures, which are done under local anaesthetic which numbs the area but you will be awake. Other treatments require an overnight stay in hospital and use general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain.

You may have one of the following operations.

• A cone biopsy which removes the whole area where there are abnormal cells.
• Laser therapy (also known as laser ablation) in which heat is used to destroy the abnormal cells. A laser beam is pointed at the abnormal area which burns away the abnormal area.
• Cold coagulation, which unlike the name suggests, also uses heat to destroy abnormal cells.
• Laparoscopic 'radical hysterectomy' may be an option if the cancer has not spread beyond your cervix. In this procedure the cervix and the upper part of the vagina is removed, but the rest of the womb is left in place. The lymph glands in the pelvis are also removed. As the womb is not removed, it may still be possible to have children. However there is a higher chance of miscarriage for women who have this procedure and the baby needs to be delivered by caesarean section. This procedure is not suitable for all women - ask your doctor for more advice.

Late stage

If the disease is at a later stage, an extended hysterectomy may be needed, where the uterus, nearby tissue and top of the vagina are removed. The nearby lymph tissue will also be removed to see if the cancer has spread.

You will not be able to become pregnant after a hysterectomy.

Radiotherapy

If the cancer has spread substantially more beyond your cervix, it is unlikely that surgery alone can treat it and radiotherapy is the usual treatment. Radiotherapy can also be used after surgery if there is a risk that some cancer cells may be left behind, to help reduce the risk of the cancer coming back. High-energy radiation is used to destroy the cancer cells. The treatment is usually given from an external machine.

Alternatively, a radioactive implant may also be inserted into your vagina so the radiation is closer to the area that needs treatment. This is sometimes called brachytherapy. For more information, please see the separate Bupa factsheet, Radiotherapy.

Chemotherapy

Chemotherapy means using drugs to destroy cancer cells. It is sometimes used before radiotherapy or surgery to shrink a tumour. It may also be used after surgery, to ensure no cancer cells are left, and can control symptoms if cancer comes back after an initial treatment. Chemotherapy is usually given as a series of injections into a vein.

For more information about chemotherapy, please see the separate Bupa factsheet, Chemotherapy.

Reducing the risk of cervical cancer

Screening

The best way to reduce your risk of cervical cancer is to attend screening tests.

The Department of Health (DoH) advises that women have their first screening test at 25 and then every three years until they are 49 and five yearly until they are 64. For more information, please see the separate Bupa factsheet, Cervical screening.

HPV vaccine

At present there is not an HPV vaccine available in the UK. Researchers are currently developing vaccines against the HPV type 16 virus. A vaccine called Gardasil has been approved in the US.

Further information

• Cancerbackup
  0808 800 1234
  www.cancerbackup.org.uk
• CancerHelp UK
  0800 226 237
  www.cancerhelp.org.uk

Sources

• Cancer: number of new cases 2003, by sex and age. National Statistics.
  www.statistics.gov.uk
  accessed 16 January 2006
• Cervical screening a pocket guide. NHS Cervical Screening Programme. January 2004.
  www.cancerscreening.nhs.uk/cervical/index.html
• Cassidy J, Bissett D, Spence RAJ. Oxford Handbook of Oncology. Oxford:Oxford University Press, 2002.
• Cervical cancer. Cancer Research UK.
  www.cancerhelp.org.uk
  accessed 16 February 2006
• NHS Cervical Screening Programme. Cancer Screening Programmes. National Health Service (NHS).
  www.cancerscreening.nhs.uk
  accessed 13 January 2006
• Collier J, Longmore M, Scally P. Oxford Handbook of Clinical Specialities. 6th edition. Oxford: Oxford University Press, 2003.
• Laparoscopic radical hysterectomy for early stage cervical cancer. Interventional procedure guidance 24. National Institute of Clinical Excellence. November 2003.
• Cervical cancer information centre. Cancerbackup.
  www.cancerbackup.org.uk
  accessed 24 March 2006
• Cervical screening: the facts. Department of Health. March 2004
  www.dh.gov.uk
• A vaccine for cervical cancer? National electronic Library for Health.
  www.nelh.nhs.uk
  accessed 16 February 2006

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