Cervical cancer is not one of the more common cancers in women overall, with 3,378 cases diagnosed in the UK in 2009. It only accounts for about 2 per cent of the total number of women’s cancers and there are twice as many cases of ovarian cancer, for example, and 14 times as many cases of breast cancer. But the majority of cases occur in midlife rather than old age and it is the most common cancer in women under 35.
The NHS cervical screening programme has been able to half the rate of cervical cancer since the 1980s. This is because precancerous changes in the cervix can be detected preventative treatment given.
Routine vaccination of girls against HPV should cut rates further.
What is cervical cancer?
Cervical cancer affects the cervix, or neck of the womb.
There are two main types:
*Squamous cell carcinoma – accounting for about 90 per cent of cases, it starts in the surface cells lining the cervix and develops in a series of precancerous changes, starting with mild abnormalities in the cells and progressing towards full cancer. Each year, about 20,000 women are found to have the most serious form of precancerous abnormalities (CIN 3 changes) when they have a cervical screening test
*Adenocarcinoma – between five to 10 per cent of cervical cancers are this type, which forms from mucus-producing gland cells. It’s more difficult to spot as it often starts high up in the cervical canal and may not be picked up by a screening test. There are also various sub-types of adenocarcinoma
Two rare forms are small cell carcinoma and cervical sarcoma.
Cervical cancer causes
There are a number of known causes and risk factors for cervical cancer:
*Infection with certain types of human papilloma virus (HPV). HPV is an infection passed on during sex and it is found in almost all cases of cervical cancer. There are dozens of types of HPV: types 16 and 18 carry the highest risk. The HPV types that cause genital warts are not associated with cervical cancer
*Other sexually transmitted infections (such as chlamydia or HIV, which weaken the immune system) may act in combination with HPV
*Any factor that increases the risk of exposure to HPV, including e number of sexual partners, first having sex at a young age and not using barrier contraceptives such as condoms
*Smokers are twice as likely to develop squamous cell carcinoma of the cervix as non-smokers as chemicals in cigarette smoke damage special cells in the cervix that normally fight the disease
*The contraceptive pill increases the risk by a very small amount
*Not having a screening test. Almost half of all new cases of cervical cancer occur in women who’ve never had a screening test, which means pre-cancerous stages of the disease aren’t detected or treated early
Cervical cancer symptoms
In the early stages there are usually no symptoms at all from cancer of the cervix. Screening is offered to women in order to try to pick up cervical cancer at this early, symptomless stage.
However, once cancer is established, the most common symptom is bleeding between periods or after sex. Menstrual bleeding (i.e. during a period) may also be heavier and last longer than normal.
Other symptoms include:
*Any sort of unusual or unpleasant smelling vaginal discharge
*Discomfort/pain during intercourse
*Pain in the pelvic area
*Painful or difficult urination
However, any of these symptoms may be due to problems other than cervical cancer. It’s important to get them checked by your GP, even if your last screening test was normal.
Diagnosing cervical cancer
Many cervical cancers are detected by the the NHS Cervical Screening Programme, which enables the early detection of abnormal cell changes in a woman’s cervix. The programme invites women to have a screening test (previously known as a smear test) from the age of 25. Women are offered screening every three years until the age of 49, then every five years until 64.
Most positive tests show pre-cancerous changes rather than fully developed cancer and are therefore easier to treat and cure. The screening programme checks four million women a year in the UK and is estimated to save about 5,000 lives. It has helped reduce the cervical cancer death rate, which has plummeted by 60 per cent in the past 30 years.
The screening test can be done by a doctor or nurse at your GP surgery. It can also be done at a family planning clinic or well woman clinic. If the test is abnormal, you may be asked to have it repeated, or (particularly if there has been more than one abnormal test) be sent to a specialist for further checks. Women with mild or borderline cell changes are now being offered testing for high-risk types of HPV infection. If this test is negative it is most likely that the cells will return to normal without treatment. If the test is positive they should be referred straight for colposcopy.
*Pelvic examination – can be carried out by a GP, who will check the vagina, womb, ovaries, bladder and rectum for unusual lumps or changes
*Colposcopy – this involves using a microscope to look in more detail at the cervix. This may be done together with a biopsy of the area. The extent of any cancer may be confirmed by taking a more extensive tissue biopsy
Cervical cancer treatments
If caught at their earliest pre-cancerous stage, abnormal cervical cells can be dealt with simply, with local treatment to the cervix. Several techniques can be used to destroy the cells and allow normal cells to grow back in their place, including excision of the area containing the abnormalities (with a technique called LLETZ or LEEP, or by cone biopsy), laser ablation, cold coagulation, cryotherapy or diathermy. Some women who have completed their family or gone through the menopause choose to have a hysterectomy.
Once cancer has developed, tests will be done to work out the type of tumour, its grade (how abnormal the cells look under the microscope) and how far it has spread. This is called staging, and it helps to predict how the cancer is likely to progress and which treatments are most appropriate. A team of specialists including doctors, nurses, radiologists, oncologists, radiotherapists and others then get together to review all the test results and recommend a schedule of suitable treatment.
Depending on the spread of the disease and your age, a number of treatment options are available. The main options are surgery or radiotherapy. Surgery usually means complete removal of the womb and cervix although in women who want to preserve their fertility it may sometimes be possible to have more limited surgery. If there’s evidence that the cancer has spread, the ovaries and nearby lymph nodes may be removed as well.
Radiotherapy is often used in combination with surgery especially if the cancer may have spread to surrounding tissues but may be used alone if a woman is not strong enough for surgery.
Chemotherapy (anti-cancer drugs) may also be recommended, especially in more advanced stages of disease.
Survival rates have continued to improve, especially as screening picks up more cervical cancers at an early stage. Overall 88 per cent of women are still alive one year after diagnosis and 70 per cent survive to at least five years. When the cancer is found early, the results are much better, so up to 99 per cent of women with very small cancers just a few millimetres across on the cervix can be cured. This is why it is important to go for regular screening tests.