Cervical cancer

What is cervical cancer?

Different types of cancer affect different areas of the womb, or uterus. The best known, perhaps as a result of a nationwide screening programme, is cervical cancer, which affects the cervix, or neck, of the womb.

More than 90 per cent of cervical cancers can be split in to two types:

• Squamous cell carcinoma - 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 24,000 women are found to have the most serious form of precancerous abnormalities (CIN 3 changes) when they have a cervical smear 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 smear test. There are also various sub-types of adenocarcinoma.

Two rare forms are small cell carcinoma and cervical sarcoma. A far less common cancer of the womb is uterine sarcoma, which affects the powerful muscles of the womb. This is more similar to other cancers that affect muscles than to either uterine or cervical cancer.

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), although not the type that causes genital warts. HPV is found in almost all cases of cervical cancer and HPV types 16 and 18 carry the highest risk
• Other sexually transmitted infections (such as chlamydia or HIV, which weakens the immune system) 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 smear test. Almost half of all new cases of cervical cancer occur in women who've never had a smear test, which means pre-cancerous stages of the disease aren't detected or treated early
• Those taking oestrogen-only hormone replacement therapies to alleviate menopausal symptoms are at higher risk. Most HRT formulations include other hormones such as progestin which appear to reduce that risk
• Overweight or obese women are thought to have more natural oestrogen in their bodies - another reason why they are more vulnerable
• Women who suffer from a condition known as benign endometrial hyperplasia, in which the lining of the womb is naturally thicker, also are more likely to develop endometrial cancer
• Having babies at a young age; a woman who has a baby at the age of 17 has twice the risk of a woman having her first baby at the age of 25 or older

Cervical cancer symptoms

If a smear is abnormal, you may be asked to have a repeat smear, or (particularly if there has been more than one abnormal smear) be sent to a specialist for further checks.

Once cancer is established however, the most common symptom is bleeding between periods or after sex.

Menstrual bleeding may be heavier and last longer. Abnormal vaginal bleeding, particularly after the menopause, can also be a symptom of uterine cancer. However, any of these symptoms may have causes other than cervical cancer, so it's important to get them checked by your GP, even if your last smear was 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

Diagnosing cervical cancer

Many cervical cancers are detected by the the NHS Cervical Screening Programme, which invites women to have a smear test at the age of 25. Women are offered screening every three years until the age of 49, then every five years until 64. This can be done by a doctor or nurse at your GP surgery, family planning clinic or well woman clinic.

The cervical cancer screening programme allows for early detection of abnormal cell changes in a woman's womb. Most of these can't be classed as fully cancerous and are far easier to treat. The screening programme checks 4.4 million women a year and currently saves approximately 4,500 lives a year in England. About 2,800 women are diagnosed with cervical cancer in the UK each year – a reduction of 40 per cent since 1988. The screening programme has helped reduce the cervical cancer death rate, which has plummeted by 60 per cent in the past 30 years.

Other techniques used by doctors to diagnose cervical cancer include:

• Pelvic examination - can be carried out by a GP, who will check the vagina, womb, ovaries, bladder and rectum for unusual lumps or changes.
• A further smear test - taking samples of cells from different areas around the womb neck and looking at them under a microscope for signs of abnormality. Sometimes all that's needed is to repeat the test a few months later to see if the abnormalities have healed.
• Colposcopy - using a microscope to look in more detail at the cervix is sometimes used 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. Depending on the spread of the disease and your age, a number of options are available, including surgery to remove abnormal tissue or the entire womb.

If there's evidence that the cancer has spread, the ovaries and nearby lymph nodes may be removed as well. If the cancer has spread beyond the wall of the womb, radiotherapy and chemotherapy may be required.

Survival rates are over 70 per cent when it's caught in its earlier stages, so it's essential to have regular smear tests.