Cervical Cancer

Cervical cancer affects the cervix, or neck of the womb.

Types of Cervical Cancer

Squamous Cell Carcinoma Cervical Cancer

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 Cervical Cancer

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 of cervical cancer 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.

Cervical Cancer Diagnosis

The screening test can be done by a doctor or nursey. 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 your doctor, 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.

Cervical Cancer Treatment Options

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 for Cervical Cancer

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 for Cervical Cancer

Chemotherapy (anti-cancer drugs) may also be recommended, especially in more advanced stages of the disease.

Cervical Cancer Survival Rate

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.

Cervical Cancer Screening

What a Cervical Screening Test Involves

During a cervical cancer screening test, some cells are taken from the cervix. These are sent to a laboratory for examination under a microscope. To be able to judge the cells properly, this is best done in the middle of your menstrual cycle, halfway between one period and the next.

Pap Smear Test

The technique used is known as Liquid Based Cytology or LBC. This has now completely replaced the more old fashioned and less accurate cervical smear test, and while people often casually refer to the test as a smear, you will no longer see it called this on official documents.

The doctor or nurse will insert an instrument called a speculum into the vagina to allow them to see the cervix. A spatula is then wiped or scraped over the surface of the cervix to remove some cells. Then the end of the spatula, covered in cells, is broken off into a small vial of preservative liquid and sent to the laboratory. The doctor or nurse may also do an internal examination to check for any problems. The procedure can be uncomfortable but shouldn’t be painful. Try to relax. Talk to the doctor or nurse if you’re worried.

In the laboratory, cells from the fluid vial are examined under the microscope to check for abnormalities.

Cervical Screening Results: Pap Smear Results

You should receive the result of your cervical screening test in writing within six weeks, although 98% of women now receive their result within 2 weeks. The result will be either normal (negative) or abnormal. A small proportion of tests can’t be completed because of a lack of visible cells. In such cases, you’ll be invited for a repeat test.

Abnormal Pap Smear Results

An abnormal cervical test doesn’t necessarily mean cancer has been found or that it’s likely to develop. The laboratory has simply identified some changes in the cells that require further investigation. In many cases, these are just minor abnormalities that would disappear without treatment. However, a few will progress to cancer, which is why further investigation is warranted.

Depending upon the degree of abnormality, women may be asked to have a repeat test in six or 12 months or they may be sent to the hospital for a further test of the cervix known as a colposcopy and a review by a specialist.

Problems With Ccervical Screening Tests

Screening is one of the best defences against cervical cancer and can prevent about 75 per cent of cancer cases in women who attend regularly. Put another way, for women aged between 25 and 39 undergoing tests every three years, a single negative result means a 41 per cent reduction in the chances of developing cervical cancer.

However, that doesn’t mean the test is without problems.

Cervical screening isn’t perfect. It can be difficult to tell an abnormal cell from a normal one, especially in the early stages of precancerous changes. In some cases that are reported as normal, abnormal cells are in fact present (a ‘false negative’ result). This occurs in between two and 20 per cent of tests, depending on the technique. However, more reliable tests are being developed.

Conversely, some tests are read as showing an abnormality when no disease is present (a ‘false positive’ result), which can lead to women undergoing unnecessary intensive treatment. However, it’s difficult to know exactly how many false positives occur because treatment usually destroys the cells in question.

Perhaps the biggest problem is that almost half of new cases of cervical cancer occur in those women who’ve never had a screening test. In fact, the biggest risk factor for the disease is not going for screening. The most important thing you can do to avoid cervical cancer is make sure you go for screening.

Human Papilloma Virus (HPV) and Vaccines

Although it’s not clear what causes abnormalities in the cervix to become cancerous, it is known that the human papilloma virus (HPV) plays an important role.

There are many types of HPV. Some are well known for causing genital warts, although these don’t lead to cervical cancer. Others have been shown to cause abnormalities in the cells lining the cervix. These ‘high-risk’ types have been found in nearly every case of cancer of the cervix. Research has also shown that women with a mildly abnormal screening test result who don’t have a high-risk type of HPV infection are unlikely to develop cervical cancer.