Cervical cancer: The basics
It's currently Cervical Cancer Prevention Week, so why not take this opportunity to learn or refresh your memory about this largely preventable kind of cancer.
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There may be no symptoms at all during the early stages of cervical cancer, but in most cases the earliest noticeable symptom is vaginal bleeding.
The NHS Choices website advises that bleeding at any time apart from during periods, particularly after sex and in women who have already been through the menopause should all be signals to see a doctor.
Other symptoms can include pain in and around the vagina during sex, smelly vaginal discharge and pain when urinating. Further symptoms can be experienced if the cancer spreads beyond the cervix.
All cancer is caused by a mutation in the DNA of human cells, and in the case of cervical cancer it is almost always preceded by an infection with the human papillomavirus (HPV). This is actually a group of around 100 types of virus, which one-in-three women are estimated to contract within a year or two of starting to have sex.
Some types of HPV are symptomless, others cause genital warts - but there are two particular varieties (HPV16 and HPV18) which together cause up to 75 per cent of cervical cancers.
But although HPVs are very common, cervical cancer is actually quite rare and it seems only a very small proportion of women infected are susceptible.
Women who smoke are twice as likely to get cervical cancer as non-smokers.
Women who have been taking the oral contraceptive pill for more than five years are also at heightened risk, and risk also increases with the number of children a woman has given birth to.
Additionally, women with weakened immune systems are at greater risk - which includes those on immunosuppressant drugs and those with conditions such as HIV or Aids.
Screening and diagnosis
Screening programmes are in operation for the disease in the UK and most women aged between 25 and 64 will be invited to come to hospital or a clinic for a smear test, the results of which will be tested for HPV.
Alternatively, if a woman goes to her GP with symptoms which might point towards HPV or cervical cancer, the GP may wish to rule out chlamydia before progressing.
Then further gynaecological examinations and tests may be carried out to confirm the diagnosis.
Most hospitals will use multi-disciplinary teams to deal with cervical cancer, usually composed of a specialist cancer nurse, a surgeon, a gynaecologist, a pathologist, a radiologist, a medical oncologist and a clinical oncologist.
If pre-cancerous abnormal cells have been discovered then they can be lasered or frozen off of the cervix.
If stage one cervical cancer is discovered then surgery is used. If it is advanced stage one or stage two then either surgery or radiotherapy - or a combination of both - is used.
For stage three and early stage four cases radiotherapy and chemotherapy is combined.
Since 2008 a programme has been in place to vaccinate girls aged 12 and 13 against HPV, usually administered in year eight at school (in England).
At the same time a three-year catch-up programme was launched to offer the jab to older girls aged 14 to 17.
- NHS Choices: Cervical cancer
- Cervical cancer screening in the NHS
- European Cervical Cancer Association