Cervical Cancer

This section provides information about cervical cancer. This includes its causes, risk factors, symptoms, how it is diagnosed and the different types of  cervical cancer treatments available.

Your cervix is a strong muscle between your womb and vagina. It looks a bit like a doughnut with a dimple in the middle. Normally, the dimple is just a small opening, but during labour your cervix opens wider to let the baby out.

Cervical cancer develops when the cells in your cervix start functioning abnormally. When they grow or multiply in an uncontrolled way, they can cause tumours.

Facts about cervical cancer

  • In the UK, around 3,100 women are diagnosed with cervical cancer every year1
  • Around 1 in every 50 cancer cases in women are cervical cancers2
  • Cervical cancer is the most common cancer in women under 35.3

What is cervical cancer?
Usually, the uncontrolled growth of cells in your cervix is caused by the human papilloma virus (HPV). This is a common virus, often passed on during sex.

At some point in their lives, most sexually active women will come into contact with at least one type of HPV.4 The virus doesn’t normally do any harm and goes away on its own. Out of the 100 different types of HPV, there are two strains known to cause 70% of cervical cancer cases.

There’s now a routine HPV vaccine offered to girls aged 12 to 13 that helps to protect women from cervical cancer.

1 Cancer Research UK, Cervical cancerhttp://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/about/cervical-cancer-risks-and-causes
2 Cancer Research UK, Cervical cancerhttp://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/about/cervical-cancer-risks-and-causes
3 Cancer Research UK, Cervical cancerhttp://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/about/cervical-cancer-risks-and-causes
4 Cancer Research UK, Cervical cancerhttp://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/about/cervical-cancer-risks-and-causes

There are two main types of cervical cancer. Each affects a different type of cell, but the treatment is the same for both.

Squamous cell cancer
This type of cervical cancer affects the squamous cells. These are the cells that cover the outside of your cervix. Between 70 to 80 per cent of cervical cancers are squamous cell cancers.

Adenocarcinoma
This type of cancer affects the gland cells in your cervix that produce mucus. It’s not as common as squamous cell cancer – only around 1 in 10 cases of cervical cancer are adenocarcinoma – but it’s becoming more common.

HPV infection is the biggest cause of cervical cancer. But there are other risk factors that can increase your risk.

Smoking
If you smoke, you’re twice as likely to get cervical cancer than a woman who doesn’t.5 The chemicals from cigarette smoke get into the cervix’s mucus. These chemicals can damage the cervix and stop cells called Langerhans cells from working as well. These cells help to fight against disease.

A weakened immune system
Normally, a healthy immune system protects you by getting rid of abnormal cells to stop them from becoming cancerous. So people with weakened immune systems – like those with HIV and AIDs, or people who take immunosuppressant drugs after an organ transplant – are more at risk of cervical cancer if they also have an HPV infection.

Being on the pill
Research suggests that the risk of cervical cancer doubles for women who have taken the pill for five years or more. But the risk is still low and taking the pill can help to protect you against womb and ovarian cancers.

The number of children you have
Mothers have a greater risk of squamous cell cervical cancer than women without children. Having your first baby before you’re 17 also increases your risk compared to women who have their first child after 25. The number of children you have impacts your risk too – women with seven or more children are twice as likely to develop squamous cell cervical cancer than women with one child.

5 NHS Choices, Causes of cervical cancerhttp://www.nhs.uk/Conditions/Cancer-of-the-cervix/Pages/Causes.aspx

The most common symptom of cervical cancer is bleeding when you’re not on your period. That might be between your period, during or after sex, or any time following your menopause.

Some women also find they have an unpleasant-smelling discharge, or they find sex uncomfortable.

There are lots of other things that can cause these symptoms and most of them are more common than cervical cancer. But if you notice any of these symptoms, you should see a doctor as soon as possible to find out what the problem is.

Cervical screening
In England, more than 4 million women aged between 25 and 64 are invited for NHS cervical screening every year. This is often called a smear test, pap smear or pap test. Screening isn’t a check for cancer - it helps to identify changes to your cervix before they become a problem.

It’s important that you get screened regularly – every three to five years between the ages of 25 and 64 – because pre-cancerous cells don’t normally show any symptoms.

BMI Healthcare cervical cancer screening clinics
At BMI Healthcare, we offer specialised cervical screening at our women’s health clinics across the country. Because our specialists are highly experienced, you’ll get expert advice and excellent care, with your test results delivered within 48 hours.

You can make an appointment to talk about any concerns you have with one of our consultant gynaecologist.

If you have a smear test that shows abnormalities in your cervix, or if you notice any symptoms of cervical cancer, your consultant gynaecologist might recommend you have further tests which might include the following.

Colposcopy
This test is similar to a smear test. A doctor will use a large magnifying glass called a colposcope to look at the surface of your cervix. It doesn’t go inside you. If the changes in your cervix are too small to see by eye, you’ll need to have a biopsy so some of the abnormal cells can be looked at under a microscope.

Large loop excision of the transformation zone (LLETZ)
The transformation zone is an area in your cervical canal. LLETZ is quick and straightforward procedure where a surgeon removes this area of your cervix. It gives a very clear sample of tissue to be examined under a laboratory microscope. It’s also the most common type of treatment in the UK.

Cone biopsy
This is a minor operation that removes a cone of tissue from your cervix. It’s normally done under general anaesthetic. The cone is taken from your cervical canal where there might be abnormal cells. Then it’s sent to a laboratory to be examined.

In very early stages of cervical cancer where the cancer’s still small, cone biopsy can sometimes treat the cancer.

If results from your tests show you might have invasive cancer, you’ll probably need to have further tests. These might be one or a combination of:

  • pelvic examination
  • MRI or CT scan
  • PET-CT scan
  • blood tests
  • chest X-ray.

The stages and grades of cervical cancer
If you’re diagnosed with cervical cancer, your consultant surgeon will tell you what stage the cancer’s at. This describes the size of the tumour and how far the cancer cells have spread.

When you’re diagnosed with cervical cancer, your consultant gynaecologist will tell you what stage the cancer’s at. This describes the size of the tumour, whether it’s spread to your lymph nodes and if the cancer cells have spread to any other part of your body.

The stage of your cervical cancer will help to inform the decisions you and your consultant make about your cancer treatment options.

  • Stage 0 (pre-cancer): There are no cancer cells in your cervix, but there are changes that mean you might develop cancer in the future. Having treatment as soon as possible can help to prevent cancer
  • Stage 1: The cancer is only inside your cervix
  • Stage 2: The cancer has spread into the tissue surrounding your cervix. It hasn’t grown into the pelvis or lower part of the vagina
  • Stage 3: The cancer has spread to the pelvis, the lower part of the vagina, or both
  • Stage 4: The cancer has spread to the bowel, bladder and other organs.

Read Cancer Research UK’s more in-depth article about the stages of cervical cancer.

The cervical cancer treatment depends on how far the cancer’s spread and  personal wishes. Your cervical cancer specialist will talk with you about your options and the best way to proceed.

If results from your cervical screening show that you don’t have cervical cancer but there are changes that might become cancerous later, you may need the abnormal cells removing. There are a few ways of doing this, including cone biopsy, large loop excision of the transformation zone (LLETZ) and laser therapy.

If you have early cervical cancer, you’re likely to be recommended:

  • surgery to remove some or all of your womb
  • radiotherapy
  • a combination of the two.

If you have advanced cervical cancer, you might need one or a combination of:

Laser therapy
Abnormal cells in your cervix are burned away using a laser.

Removing part of the cervix (radical tralechtomy)
This type of surgery is performed by one of our specialist gynaecologists called gynaecological oncologists. The procedure’s only possible if you’re in stage 1 of cervical cancer, when the cancer’s still small.

Your specialist surgeon will try to remove all of the cancer, but leave the opening of your cervix then stitch it closed. The aim is that you’ll still be able to have a baby – the stitch will support a growing baby until it’s ready to be born by a caesarean.

Removing part of the womb (radical hysterectomy)
You might need to have surgery to remove your womb to make sure all the cancer has gone. Radical hysterectomy is the standard operation for early cervical cancer.

At BMI Healthcare, our specialist consultant gynaecologists use keyhole surgery to operate. This is also called minimal access surgery or laparoscopic surgery. Keyhole surgery causes less trauma to the skin and tissues around your pelvis, which means recovery time is a lot quicker than if you had the standard procedure.

The standard procedure without keyhole surgery usually involves a four to seven-day hospital stay, and it can take a month or so to recover at home.6 On the other hand, keyhole surgery normally only requires a two-day hospital stay, and most people get back to their normal activity very quickly. More about laparoscopic radical hysterectomy for cervical cancer.

Fertility-sparing surgery for cervical cancer treatment
Trachelectomy is an operation to treat cervical cancer that can help to preserve the uterus for women who want a future pregnancy.

The cervix (neck of womb) is not essential for a successful pregnancy. So if the cancer is confined to the neck of the womb, then removing the cancerous cervix can still preserve the womb to allow the baby to grow. More about fertility-sparing surgery for cervical cancer.

Radiotherapy
Radiotherapy is a common cancer treatment that uses radiation to get rid of any cancer cells left behind after you’ve had surgery. Radiotherapy is usually split into a course of treatments. How long and how often you need treatment depends on your needs.

Chemotherapy 
Chemotherapy uses drugs to disrupt the growth of cancer cells. It can also shrink advanced cervical cancer. Usually, chemotherapy involves being injected with the drug every few days for around a month. Your doctor might recommend chemotherapy as part of your treatment when you’re diagnosed, to treat cancer that’s come back, or before surgery.

Chemoradiation
Giving radiotherapy and chemotherapy at the same time is called chemoradiation, and is generally more effective at getting rid of cancer cells than having either treatment on its own.

Pelvic exenteration
This operation is usually only recommended if the cancer comes back after other treatment hasn’t worked. It’s a big operation that involves removing the cancer, your bladder, rectum, vagina and lower section of your bowel. Following this type of surgery, your vagina can be reconstructed so you’ll still be able to have sex.

After treatment
For a few years after your cervical cancer treatment, you’ll need regular follow-up appointments with your specialist. These check-ups might involve:

  • being examined
  • taking a sample of cells from your cervix
  • blood tests
  • X-rays
  • MRI or CT scans
  • liver ultrasound scans.

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself. Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy. If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation. Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure. 

Want to know more?
If you’d like to read more about cervical cancer, treatment or living with cervical cancer, please visit cancerresearchuk.org.uk.

6 Cancer Research UK, Surgery for cervical cancerhttp://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/treatment/surgery/surgery-for-cervical-cancer#trach

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