Cancer, cervical

Page last reviewed: 13/07/2011

Information for people concerned about repeat screening tests and HPV tests is available here.

Cancer of the cervix is a relatively rare type of cancer. In Ireland , around 292 women are diagnosed with it each year.

The symptoms of cervical cancer are not always obvious. It may not cause any symptoms at all until it has reached an advanced stage.

If cervical cancer causes symptoms, the most common is abnormal vaginal bleeding, such as between periods or after sexual intercourse (see Cervical cancer - Symptoms).

The cervix

The cervix is the lower part (or neck) of the womb. It is made of muscle tissue and is the entrance to the womb from the vagina.

Types of cervical cancer

There are two main types of cervical cancer:

  • Squamous cell carcinoma is the most common type of cervical cancer. It develops from the squamous cells, which are the flat cells in the outer layer of the cervix at the top of the vagina.
  • Adenocarcinoma develops from the cells that line the glands in the cervix. Adenocarcinoma can be more difficult to detect using cervical screening tests.

Who is affected?

Cervical cancer is often diagnosed in younger women. It is the second most common cancer in women aged under 35, after breast cancer.

What is the cause?

More than 99% of cases of cervical cancers are thought to be caused by the human papilloma virus (HPV). See Cervical cancer - Causes for more information.

In 2010, the HSE launched a vaccination programme for HPV. The vaccine provides protection against two of the types of HPV that cause cervical cancer (see Cervical cancer - Prevention).

Outlook

Early-stage cancer that is confined to the cervix can usually be successfully treated through surgery and/or radiotherapy. However, if the cancer has spread to the surrounding areas, such as the vagina, bladder or lymph nodes, the outlook is less positive.

Cervical cancer can be prevented if it is detected in the early stages via cervical screening which aims to detect changes in the cells of the cervix before they become cancer.

Disease
A disease is an illness or condition that interferes with normal body functions.

Page last reviewed: 13/07/2011

Information for people concerned about repeat screening tests and HPV tests is available here

The symptoms of cervical cancer are not always obvious and it may not cause any symptoms at all until it has reached an advanced stage.

This is why it is extremely important for you to have regular cervical  screening (smear) tests. www.cervicalcheck.ie

Bleeding

If cervical cancer does cause symptoms, the most common is abnormal vaginal bleeding, such as between periods or after sexual intercourse.

In post-menopausal women (those who have stopped having periods), there may be new bleeding.

Other symptoms

Other symptoms of cervical cancer may include smelly vaginal discharge and discomfort when having sex.

When to seek medical advice

There are many other conditions that can cause vaginal bleeding, smelly discharge and discomfort during sex. However, visit your GP or practice nurse if you experience any of these symptoms (see Diagnosis).

Glossary

Discharge

Discharge is when a liquid such as mucous comes from a part of your body.

Page last reviewed: 13/07/2011

Information for people concerned about repeat screening tests and HPV tests is available here.

How does cancer begin?

Cancer begins with a change in the structure of DNA, which is found in all human cells. DNA provides cells with a basic set of instructions, such as when to grow and when to reproduce.

A change in the DNA's structure (genetic mutation) changes these instructions so that the cells carry on growing and reproducing uncontrollably. This produces a lump of tissue known as a tumour.

How does cancer spread?

Left untreated, cancer can quickly grow and spread to other parts of the body, usually through the lymphatic system.

The lymphatic system is a series of glands (or nodes) located throughout your body. It is similar to the blood circulatory system. Lymph glands produce many specialised cells that are needed by your immune system to fight infection.

Once the cancer reaches the lymphatic system, it can spread to anywhere in the body, including the bones, blood and organs.

Risk factors

The exact cause of cervical cancer is unknown. However, evidence suggests that the human papilloma virus (HPV) and smoking can increase your likelihood of developing cervical cancer:

Human papilloma virus (HPV)

Human papilloma virus (HPV) is the name given to a family of viruses that affect the skin and the moist membranes that line the body, such as those in the cervix, anus, mouth and throat. HPV is spread by skin-to-skin contact during sexual activity, including anal and oral sex.

There are many different types of HPV, some of which are more high risk than others.

Over 99% of all cases of cervical cancer are associated with HPV. The virus can lay dormant for many years before it can start changing the cells of the cervix, which may cause a pre-cancerous condition called Cervical Intraepithelial Neoplasia (CIN). If left untreated, CIN can lead to cervical cancer. Most women who are infected with HPV will not develop CIN.

Smoking

Chemicals from cigarettes get into the bloodstream and can affect cells throughout the body. Smokers are more likely to develop certain cancers, including cervical cancer.

Immune system
The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

Page last reviewed: 13/07/2011

Colposcopy

If you have had an abnormal cervical screening test result or your symptoms suggest cervical cancer, your doctor will refer you to a colposcopy clinic where an examination called a colposcopy may be carried out.

A colposcopy is a detailed examination of the cervix carried out by a doctor or a nurse. The doctor or nurse (colposcopist) will look at the cervix using a type of microscope called a colposcope which does not go inside you. The examination should be painless but some women may find it uncomfortable. During the examination, a liquid or dye will be applied to the cervix to help identify any changes to the cells. The doctor or nurse might take a sample of tissue (biopsy).

Referral to a gynaecologist


Your GP may refer you to a gynaecologist (specialist in treating conditions of the female reproductive system) for further tests if your symptoms suggest cervical cancer.

You should be referred to a gynaecologist urgently if:

  • Your GP sees that you have cervical cancer after examining you.
  • You are past the menopause and have had one or more episodes of heavy vaginal bleeding, and are not on hormone replacement therapy (HRT).
  • You have had unexplained or persistent bleeding after stopping HRT for six weeks or more.
  • You frequently bleed after sex for no apparent reason.
  • You frequently bleed between periods for no apparent reason.

Further testing

If the results of the biopsy suggest that you have cancer, and there is a risk that the cancer may have spread, you will probably require further testing to assess how widespread the cancer is.

These tests may include:

  • a pelvic examination under general anaesthetic. Your womb, vagina, rectum and bladder are checked for cancer.
  • blood tests
  • CT scan. This is a computerised X-ray that can take detailed pictures of the inside of the body. It is useful for showing up cancer tumours, and checking whether cancer cells have spread.
  • MRI scan. This is a scan that uses radio waves and magnets to produce detailed pictures of the inside of the body. It is used to check whether cancer has spread.
  • chest X-ray. This will show up any cancer that has spread to your lungs.
Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.
Biopsy
A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Colposcopy
A colposcopy is a procedure where a doctor uses a special magnifying lens, known as a colposcope to look at the cervix through the opening of the vagina.
MRI
MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Womb
The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.

Page last reviewed: 13/07/2011

Information for people concerned about repeat screening tests and HPV tests is available here

Cancer treatment team

Many hospitals have multi-disciplinary teams of specialists that treat cervical cancer.

If you have cervical cancer, you may see several or all of these professionals as part of your treatment.

Deciding what treatment is best for you can be difficult. Your cancer team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may find it useful to write a list of questions to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

Staging

Health professionals use a staging system to describe how far cervical cancer has spread.

  • Stage 0: this is very early cancer (sometimes called carcinoma in situ) found only in the surface layer of the cervix. It may be treated with a cone biopsy (see box, bottom left).
  • Stage 1: the cancer is only in the neck of the womb. It is generally treated with surgery or radiotherapy. 
  • Stage 2: the cancer has begun to spread outside the neck of the womb and into the surrounding areas, such as the vagina. It is usually treated with surgery or radiotherapy, or both. 
  • Stage 3: the cancer has spread into the pelvic area. It is usually treated with radiotherapy and chemotherapy (called chemoradiation).
  • Stage 4 (advanced cancer): the cancer has spread to other organs, such as your bladder, rectum or even your lungs. It is treated with surgery and chemoradiation  

Your doctor will be able to advise you on the best treatment plan for you, depending on factors such as your age, general health, the type and size of tumour, and whether it has spread beyond the cervix.

Surgery

Surgery usually means having a hysterectomy, which is the removal of your womb and cervix.

However, if you have early-stage cancer, it may be possible to leave enough of your cervix behind so that you may be able to become pregnant afterwards. This is called a trachelectomy.

If your cancer is advanced, you may need to have other organs removed, such as your vagina and lymph nodes, as well as your womb and cervix.

If surgery does not remove all the cancer cells, or if cancer cells were found in your nearby lymph nodes, your doctor may recommend a course of radiotherapy to follow.

Radiotherapy

Radiotherapy may be used after surgery if there is a risk that some cancer cells may be left behind, or to reduce the risk of cancerous cells returning.

If cervical cancer has spread beyond the cervix and cannot be treated using surgery, radiotherapy is usually used instead and may be given in combination with chemotherapy (see below). It can also help patients whose cancer cannot be cured by relieving symptoms and prolonging a good quality of life.

Radiotherapy uses radiation to kill cancer cells.

  • If it is given internally, a small radioactive metal object is placed inside your vagina and left for a few hours or days.
  • If it is given externally, it is given from outside the body using a machine that directs high energy X-rays at the cancer. You have a few minutes of radiotherapy daily, five days a week for several weeks.

While it kills cancerous cells, radiotherapy can also affect healthy tissue and has a number of side effects, including:

  • sore, red skin (like sunburn)
  • pain while passing urine
  • diarrhoea
  • tiredness
  • nausea

If you have external radiotherapy to the pelvis, you may experience an early menopause (if you have not had the menopause already). This means you will no longer be able to have children.

Chemoradiation

Chemotherapy taken alongside radiotherapy, called chemoradiation, improves overall survival rates by lowering the risk of the cancer coming back.

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. It is usually given by injection (called intravenous chemotherapy).

Like radiotherapy, the powerful medicines used in chemotherapy can also damage healthy tissue and cause a range of side effects. Side effects include:

  • nausea
  • vomiting
  • hair loss
  • fatigue

Chemotherapy can also weaken your immune system, making you more vulnerable to infection. However, the side effects should stop once treatment has finished.

Clinical trials

As cervical cancer is relatively rare, you may be asked to take part in a clinical trial. Clinical trials are an important way for health professionals to learn more about the best way to treat specific conditions.

Most clinical trials involve comparing a new treatment with an existing treatment to determine whether the new treatment is more or less effective.

If you do receive a new treatment, there is no guarantee that it will be more effective than an existing one.

Your care team can tell you if there are clinical trials in your area, and explain the advantages and disadvantages of taking part.

Team of specialists

The team of cervical cancer specialists you may see are:

  • a surgeon
  • a clinical oncologist (a specialist in the non-surgical treatment of cancer
  • a pathologist (a specialist in diseased tissue)
  • a radiologist (a specialist in radiotherapy)
  • a gynaecologist
  • a social worker
  • a psychologist
  • a specialist cancer nurse, who will usually be your first point of contact

Page last reviewed: 13/07/2011

Practising safe sex

There is a strong link between certain types of human papilloma virus (HPV) and the development of abnormalities that may turn into cervical cancer.

Using a condom will reduce your risk of catching HPV and spreading it to others. Although it will not protect you completely, it is one of the best ways you can prevent transmission of the infection.

Before beginning a sexual relationship with a new partner, it is a good idea for you both to be tested for sexually transmitted infections at a sexual health (GUM) clinic. All tests are free and confidential.

Cervical screening

Information for people concerned about repeat screening tests and HPV tests is available here

Regular cervical screening is one of the best ways to identify early changes in cells of the cervix.

CervicalCheck invites women aged 25-44 are invited for cervical screening every three years, and women aged 45-60 are invited every five years.

It is still important to attend for cervical screening even if you have been vaccinated against HPV as the current vaccine does not guarantee protection against all of the HPV types which cause cervical cancer.

HPV vaccination

There is now a vaccine that provides protection against the two strains of HPV that are thought to be responsible for most cases of cervical cancer.

Girls should be offered the HPV vaccine as part of their routine childhood immunisation programme. The vaccine should be given to girls who are 12 to 13 years old, with three doses given over six months.

Quit smoking

You can lower your chances of getting cervical cancer by not smoking. Smokers are less able to get rid of the HPV infection from the body, which can cause cancer to develop.

Useful Links

Page last reviewed: 13/07/2011

Information for people concerned about repeat screening tests and HPV tests is available here.

Prevention and early diagnosis can save lives

What you need to know about cervical cancer 

  • Cervical cancer is cancer of the cervix.  The cervix connects a woman's womb and her vagina.  It is also known as the neck of the womb
  • Cervical cancer can affect women of all ages but is most common in women between 30 - 45 years of age.  It is very rare in women under 25
  • Cervical screening -  previously known as a smear test - can prevent cervical cancer and saves many lives each year
  • In the future, most cervical cancers will be prevented by HPV vaccination. But for the next few decades, cervical screening will still be vitally important
  • The earlier cervical cancer is diagnosed, the better the outcome will be, so it is important to know the signs and symptoms

What causes cervical cancer?

Nearly all cervical cancers are caused by a common sexually transmitted infection called human papilloma virus (HPV).  Most women have HPV at some time, which usually clears up on its own.  If the infection doesn't clear up there is a risk of abnormal cells developing which could become cervical cancer over time.

What are the signs and symptoms of cervical cancer?

The following are the most common symptoms of cervical cancer.

  • Any unusual bleeding from the vagina, particularly after sex or after the menopause when your periods have stopped
  • Persistent vaginal discharge that is blood stained or smells unpleasant

If you have any of these symptoms,tell your doctor, even if you have been for screening. The chances are that they are not due to cancer, but it is important to have them checked.

What can I do to reduce my risk of developing cervical cancer?

  • Go for cervical screening when you are invited
  • Have the HPV vaccine if you are offered it
  • If you smoke, try to stop
  • Use a condom to reduce your risk of HPV and other sexually transmitted infections.

Even if you have had a normal screening result or have been vaccinated against HPV, it's important to let your doctor know if you develop any of the symptoms of cervical cancer so they can be checked out.  Like all screening tests, cervical screening isn't 100% perfect, and the HPV vaccine does not stop all types of HPV that may cause cervical cancer.

Be informed and make a plan

  • Work out what you will do if you have abnormal bleeding - arrange to see a doctor
  • As soon as your invitation to cervical screening arrives work out when you can go and make the appointment
  • If you are 18 or under, consider having the HPV vaccination if you have not already done so.

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Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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