Cervical Cancer

Introduction

Cervical cancer forms in the tissues of the cervix, the short tube of muscle which forms the neck of the uterus (womb) and connects to the top of the vagina. It is usually a slow-growing cancer that may not have symptoms, but cervical cancer can be found early and treated successfully, if you have regular testing.

1. What is cervical cancer?
2. What causes cervical cancer?
3. What are the symptoms?
4. How does cervical screening work?
5. What are the treatments?
6. What are the stages of cervical cancer?

What is cervical cancer? 

Cervical cancer is the second commonest cancer after breast cancer in women under 35 years of age, with 686 new cases diagnosed in the UK in 2006.

During childbirth the cervix expands so that the baby can pass through to the vagina.  At the lower part of the cervix, where it meets the vagina, there is skin tissue which is the area prone to cancer.

Cervical cancer occurs when abnormal cells develop in and around the cervix and are left untreated.  They can then go on to multiply and form tumours which can become cancerous and spread.

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What causes cervical cancer? 

Cervical cancer is unusual in that it is normally caused by a common virus. The virus, known as human papilloma virus (HPV), is extremely common and responsible for minor conditions like skin warts as well as genital warts.

Most sexually active women will experience one of these viruses at some point in their lives and the majority of these infections will be cleared by the body’s own immune system.

The infections that aren’t cleared in the cervix can develop into abnormal cells, referred to as CIN (Cervical Intra-epithelial Neoplasia), and, if left untreated, these cells can become cancerous.

On rare occasions, these abnormal cells may develop more quickly.  HPV can be transmitted through sex, therefore sexual activity from an early age and numerous sexual partners will increase the risk of infection.

Smoking has also been linked with cervical cancer because cigarettes contain chemicals which can alter cervical cells to make them cancerous over time (2).  The contraceptive pill, also, if taken for more than five years, can increase the risk of cervical cancer.

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What are the symptoms? 

It is very possible that cervical cancer can develop without any signs or symptoms, which is why regular screening is so important.

Cervical cancer is unlikely to cause pain unless it has developed to an advanced stage. The most common symptom of cervical cancer is abnormal vaginal bleeding, although there are other possible reasons for this depending on age, fertility and medical history.  The bleeding may be mistaken for very heavy or very light periods, frequent or irregular periods or bleeding between periods.  There is also a possibility that unusual discharges from the vagina will occur.

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How does cervical screening work?  

All women are offered free cervical screening from the age of 25. They are then invited on a regular basis, depending on age, until the age of 64 (3).

Contrary to popular opinion cervical screening is not a test for cancer.  A smear test, or the newer method of Liquid-Based Cytology (LBC), is designed to prevent cancer by identifying abnormal cells which may lead to cancer.

In a conventional smear test a doctor or nurse uses a device called a speculum to open the vagina and use a spatula or cotton swab to collect cells from the cervix.  The cells are then smeared on to a slide, which is then sent to a lab for examination.

LBC is similar but uses a special device which collects cells with a small brush, which is then detached and sent to a lab for examination.

Ninety per cent of results are normal.  Abnormal results do not mean that cervical cancer has been detected.  Results are recorded in different ways.  Mild abnormality may also be referred to as CIN 1, moderate abnormality may be given as CIN 2 and severe can be reported as CIN 3.

In the case of mild and some moderate cases of cervical cancer, the cells will return to normal without medical help.  In the case of severe or CIN 3, which is sometimes called ‘carcinoma in situ’, women will go on to have a colposcopy (a procedure using a binocular microscope) to investigate further.

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What are the treatments? 

Once diagnosed, the treatment for cervical cancer depends on a variety of factors including what stage (see below) the cancer is at, the medical history of the patient, the age of the patient, the patient’s wishes and the doctor’s recommendations.

Some treatments may result in an early menopause and this can result in a lack of sex drive combined with other symptoms including low self-esteem and depression, as well as physical symptoms, such as vaginal dryness, increased sensitivity and hot flushes. A doctor may prescribe HRT to combat some of these symptoms.

What are the stages of cervical cancer? 

Stages 0 – 2 are considered the early stages and the most easily treated with either surgery (this may involve a hysterectomy), radiotherapy (treatment to the cervix, uterus and surrounding tissue) or both.

Radiotherapy uses high-energy X-rays to reduce the chances of cancer returning following surgery, or as an alternative to surgery, if the doctor feels that this is more appropriate.

For very early-stage cervical cancer treatment can simply require a cone biopsy (when a cone-shaped piece of cervical tissue is removed and sent for testing). The procedure involves an overnight stay in hospital and is conducted under general anaesthetic. 

Stage 3 means that the spread has gone at least as far as the lower vagina and, in more severe cases, has penetrated through the vagina into the pelvis. 

Stage 4 is the most advanced stage and means that the cancer reached organs outside the cervix and uterus. This might include the bladder or rectum or, in the most advanced cases, it could include an organ like the lungs.

Treatment outcomes

For most women diagnosed with pre-cancerous cell abnormalities or dysplasia (cells which are unusual, but not yet cancerous), the chances of successful treatment are excellent.  This is why regular screening is so important.

The chance of recovery for women with cervical cancer largely depends on the stage of the cancer, how far it has spread, the size of the tumour and the patient herself.  A doctor or gynaecologist will be able to give a more accurate prognosis for each individual.

The HPV vaccination programme

A vaccination programme will begin in the UK from September 2008. Girls aged 12 to 13 years will be offered the HPV vaccine, Cervarix. The programme will offer three injections over six months, which will be administered by a nurse. 

The government will sent parents a letter informing them about the vaccine programme, what the vaccine is and will include a consent form, but it is the girl’s decision as to whether she has the vaccine or not. A two-year catch up programme will begin in the autumn of 2009 to immunise girls aged under 18 years. 

Research does not show how long the vaccination will protect those given it, but follow up trials of six years show that it protects for at least this long. More clinical studies are needed to discover how long the vaccine actually lasts and when

women will need a booster injection.

The vaccine is also available privately and costs vary, but Cancer Research UK says that a course of three injections will cost £500.

The Cervarix vaccine side-effects are reported to be not serious, but include:

• Nausea and vomiting
• Headache
• Redness and soreness at the injection site
• Fever
• Aching muscles
• Diarrhea
• Itching or rash
• Stomach ache
• Dizziness

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Clickthrough information and support links:

Macmillan Cancer Support

Cancer Research UK

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