How does it develop?
Nearly all squamous cervical cancers are caused by a common sexually transmitted infection called human papillomavirus (HPV), which is why the UK government is vaccinating girls at an early age before they are potentially exposed to the HPV virus (i.e. before they experience sexual activity). Sex is a normal, healthy activity, and the wearing of condoms is advised to protect both partners from unwanted pregnancies and exposure to HPV, as well as other transmissible conditions.
However, please note that most women have HPV at some stage during their life, but this usually clears up on its own without the need for any treatment.
HPV is a group of viruses, rather than a single virus, of which there are more than 100 different types. It is spread during sexual intercourse and other types of sexual activity (such as skin-to-skin contact of the genital areas).
However, if the infection does not clear, there is a risk of abnormal cells developing, which could become cancerous over time.
Cervical cancer can affect women of all ages, but is most common in women aged 30 – 45; although in very rare cases can occur in women under 25.
Key signs and symptoms
The symptoms of cervical cancer aren’t always obvious, and it may not cause any symptoms at all until it’s reached an advanced stage.
This is why it’s very important that you attend all of your cervical screening appointments.
In most cases, vaginal bleeding is the first noticeable symptom of cervical cancer. It usually occurs after having sex.
Bleeding at any other time, other than your expected monthly period, is also considered unusual, which also includes bleeding after the menopause.
Other symptoms of cervical cancer may include pain and discomfort during sex and an unpleasant smelling vaginal discharge.
The fact that HPV infection is very common but cervical cancer is relatively uncommon suggests that only a very small proportion of women are vulnerable to the effects of an HPV infection. There appear to be additional risk factors that affect a woman’s chance of developing cervical cancer. These include:
- Smoking – women who smoke are twice as likely to develop cervical cancer than women who don’t; this may be caused by the harmful effects of chemicals found in tobacco on the cells of the cervix
- Taking the oral contraceptive pill for more than five years – women who take the pill are thought to have twice the risk of developing cervical cancer than those who don’t, although it’s not clear why
- Having children (the more children you have, the greater your risk) – women who have two children have twice the risk of getting cervical cancer compared with women who don’t have any children
How is it diagnosed?
You’ll be referred to a gynaecologist if the results of your cervical screening test suggest that there are abnormalities in the cells of your cervix. However, in most cases, the abnormalities don’t mean you have cervical cancer.
You may also be referred to a gynaecologist if you have abnormal vaginal bleeding, or if your GP has noticed a growth inside your cervix during an examination.
Additionally, your gynaecologist or a specialist nurse may perform a colposcopy – an examination to look for abnormalities in your cervix. During a colposcopy, a small microscope with a light source at the end (colposcope) is used. As well as examining your cervix, your gynaecologist may remove a small tissue sample (biopsy) so that it can be checked under a microscope for cancerous cells.
Treatment for cervical cancer is very much dependent on how far the cancer has spread. The prospect of a complete cure is good for cervical cancer diagnosed at an early stage, although the chances of a complete cure decrease the further the cancer has spread.
Removing abnormal cells
If your screening results show that you don’t have cervical cancer, but there are biological changes that could turn cancerous in the future, a number of treatment options are available. These include:
- Large loop excision of the transformation zone (LLETZ) – the abnormal cells are removed using a fine wire and an electrical current
- Cone biopsy – the area of abnormal tissue, in the shape of a cone, is removed during surgery
There are three main types of surgery for cervical cancer:
- Radical trachelectomy – the cervix, surrounding tissue and the upper part of the vagina are removed, but the womb is left in place. This is only suitable if cervical cancer is diagnosed at a very early stage
- Hysterectomy – the cervix and womb are removed, which is recommended for early cervical cancer, and a course of radiotherapy may follow to help prevent the cancer coming back
- Pelvic exenteration – a major operation that’s usually only recommended when cervical cancer returns after what was thought to be a previously successful course of treatment, in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed.
Radiotherapy is also an excellent alternative to surgery with a similar cure rate and has the advantage of avoiding an operation when the cancer is close to the bladder or colon.