Cervical cancer Dr Trisha Macnair Cervical cancer is the second most common cancer in women under 35. In 2005, 1,061 women in the UK died from the disease. But precancerous changes in the cervix can be detected, allowing for prompt treatment.

In this article

What is it? What's the cause?

What are the symptoms? How's it diagnosed?

What's the treatment?

Cancer of the cervix affects the cells lining the entrance to the womb.

About 2,700 women are diagnosed with cervical cancer each year in the UK. Thanks to the cervical cancer screening programme, which checks 4.4 million women every year, the number of women being diagnosed has fallen by more than 40 per cent since 1988.

More then 90 per cent of cervical cancers are a type called squamous cell carcinoma, which start in the surface cells lining the cervix. Between five to ten per cent are a different type, called adenocarcinoma, which form from mucus-producing gland cells (there are also various sub-types of adenocarcinoma). There are also two much more rare types of cervical carcinoma known as small cell carcinoma and cervical sarcoma.

Squamos cell cervical cancer 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 is more difficult to spot as it usually starts high up in the cervical canal and may not be picked up by a smear test.

By detecting early changes before cancer has become fully established or spread, cervical screening now saves approximately 4,500 lives a year in England. As a result, the death rate has plummeted by 60 per cent in the past 30 years.

About 70 per cent of women treated for invasive cervical cancer are alive five years later, although survival rates are much higher when the disease is caught in its earlier stages.

Exactly how cervical cancer develops isn't known, but it's most likely to result from a combination of triggers. Risk factors include:

• Infection with certain types of human papilloma virus (HPV), but not the type that causes genital warts. HPV is found in virtually all cases of cervical cancer (both squamous cell carcinoma and adenocarcinoma) and HPV types 16 and 18 carry the highest risk.
• Other sexually transmitted infections in combination with HPV. Women with chlamydia or HIV as well as HPV have a significantly increased risk of cervical cancer.
• Any factor that increases the risk of exposure to HPV, including having many 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 because chemicals in cigarette smoke damage special cells in the cervix that normally fight the disease.
• The contraceptive pill directly 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 early, pre-cancerous stages of the disease aren't detected or treated.

The most common symptoms of cervical cancer include:

• Bleeding between periods or after sex, or new bleeding after the menopause
• Unpleasant smelling vaginal discharge
• Discomfort/pain during intercourse

Any of these symptoms may have causes other than cervical cancer, but it is important to get them checked by your GP, even if you've attended your routine cervical smear test.

All women aged 20 to 64 who've had sexual intercourse should have a smear test every three to five years. This can be taken by a doctor or nurse at your GP surgery, family planning clinic or well woman clinic.

The NHS Cervical Screening Programme first invites a woman to have a smear test at the age of 25. After that, women are offered screening every three years until the age of 49, and then every five years until 64.

Women over 64 can stop having smear tests if the previous two in the past ten years were negative.

Smear tests detect the early changes of cervical cancer. This is a positive test. Sometimes all that's needed is to repeat the test a few months later to see if the abnormalities have healed.

Most women will be offered further tests, in particular a colposcopy, where the doctor examines the cervix with a microscope to get a closer look at the cells and take a biopsy (rather like a more intensive smear test).

This will depend on the stage of the cancer, but generally aims to destroy or remove abnormal cells. Treatments for precancerous changes include laser, cryotherapy (freezing), cone biopsy (removing a cone-shaped piece of tissue) and hysterectomy.

In invasive cancer, radiotherapy and chemotherapy may be offered.

A vaccine against HPV types 16 and 18 has recently been added to the childhood immunisation schedule in the UK and is now offered to girls aged 12-13 (a three-year catch-up programme is also offering the vaccine to older girls aged 13-18).

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This article was last medically reviewed by Dr Trisha Macnair in February 2009.