What is cervical cancer? Causes, symptoms and prevention
Cervical cancer is diagnosed in more than 3,000 women every year in the UK, according to Cancer Research UK. Bleeding is a symptom, and cervical cancer is most common in women aged 30 to 34. Sadly, every year around 850 women die of it, with only 51 per cent of women surviving for 10 years after diagnosis.
Attending cervical screening appointments (when invited) is one of the best ways to protect yourself from cervical cancer. Read more about the cancer, and what signs to look out for.
What is cervical cancer?
Cervical cancer is a type of cancer that develops in a woman’s cervix, which joins the top of the vagina to the lower part of the womb. Anyone with a cervix can get cervical cancer.
If it is not caught early, cancer cells can potentially grow into surrounding tissues and spread to other areas of the body.
Symptoms of cervical cancer
Helen Hyndman is a specialist nurse at the Eve Appeal women’s health charity and co-ordinator of the charity’s Ask Eve Information Service. She says: “Cervical cancer may not have obvious symptoms in the early stages. If you do have symptoms, the most common is vaginal bleeding, which can occur after sex, in between periods or after the menopause.”
“Other symptoms may include changes to vaginal discharge, pain or discomfort during sex or unexplained pain in the lower back or between the hip bones.”
She adds that as the disease progresses, you may experience:
Loss of appetite
Weight loss
Lack of energy
Blood in your urine
Changes to bladder and bowel habits
Swollen ankles, legs and feet
Abdominal and back pain
What causes cervical cancer?
Almost all cases of cervical cancer – an estimated 99.8 per cent – are caused by human papillomavirus (HPV). The HPV virus can affect the skin and moist membranes in the body, including the:
Cervix
Vagina
Vulva
Anus
Lining of the mouth and throat
It can be passed on through any type of sexual contact. It is estimated that around eight out of 10 people will be infected with HPV at some point in their lives.
“There are more than 200 types of HPV, many of which are harmless,” Hyndman says. “However, around 14 types of HPV are known as ‘high-risk HPV’. They can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer. Two strains of the virus (HPV 16 and 18) are known to be responsible for 70 per cent of all cases of cervical cancer.”
She says: “Most women who are infected with high-risk strains don’t develop cervical cancer because usually the immune system clears HPV infections within two years. However, an infection can become persistent. Nobody knows why. If this happens, the virus may cause cells to change, and if these cells are not monitored or treated, they may turn into cervical cancer.”
Eve Appeal says: “We need more research to understand why some cervical cancers are not linked to high-risk HPV.”
What increases the risk of cervical cancer?
Here are some factors that can impact your risk of cervical cancer:
Smoking could double the risk of cervical cancer in some, possibly because it reduces the number of immune cells in the cervix.
A weakened immune system.
Taking the contraceptive pill for more than five years.
The more children you have, the greater your risk, this may be because of hormonal changes during pregnancy.
Spotting the signs of cervical cancer early
Any bleeding that is new or different should be investigated by your GP as soon as possible.
If your GP suspects cervical cancer, you should be referred to see a specialist within two weeks. Regular cervical screening tests can mean that changes to cells are picked up before they have a chance to turn into cancer.
How is cervical cancer diagnosed?
Cervical screening, which has replaced the old “smear test”, can prevent three-quarters of cases ever developing. But the latest figures show that nearly one in three eligible for screening do not come forward.
Prof Adam Rosenthal, a consultant gynaecologist at University College London Hospitals NHS Foundation Trust, explains how screening works. “During the test, a sample of cells is taken, which is tested for high-risk HPV,” he says. “If the result is negative, the cell sample will be discarded and you will be called for your next routine screening in three years if you are aged 25 to 49, or five years if you are 50 to 64. If HPV is present, the cells are checked for signs of any precancerous changes, which can be monitored or treated. These changes are not cancer but could turn to cancer in the future.”
Hyndman says: “If no cell changes are seen, the screening will be repeated in one year. If there are no cell changes then, a further screening will happen in another year. If the high-risk HPV has still not gone by then, you will be referred for a colposcopy. This is a test to have a closer look at your cervix. If high-risk HPV and cell changes are detected on your cervical screening, you will be referred for a colposcopy and biopsy.”
This HPV primary screening has been in place since 2019. “It is more effective than the old method where the samples were checked for abnormal cells first and only tested for HPV to confirm which cell changes needed acting on,” Prof Rosenthal says.
If you have any symptoms of cervical cancer, you must not wait for your next screening invitation but should make an appointment with your GP. They will refer you to the hospital for more tests.
When should you get screened for cervical cancer?
Screening is offered in England every three years to women aged 25 to 49 and every five years between 50 and 64. Similar arrangements are in place in the rest of the UK.
Hyndman says: “It is estimated that it takes between 10 and 20 years for HPV infection to develop into abnormal cervical cells and then on into cervical cancer. Because cervical cancer develops so slowly, it is unlikely that women over 65 who have been regularly screened will go on to develop the disease. If the last screening test was normal, then invitations for cervical screening stop at age 65. If it wasn’t, you will continue the screening programme until HPV is negative or any investigations and/or treatment are completed.
“People who are 65 or older and have never been for cervical screening or have not had cervical screening since the age of 50 can ask their GP for a test.” If you have any symptoms, especially bleeding, see your GP immediately.
Treatments for cervical cancer
Options may include:
Surgery
Surgery is often the primary treatment for cervical cancer, especially if the cancer is found early. This may be to remove part of the cervix, the upper part of the vagina and some tissue around the womb. If the cancer is bigger, a hysterectomy may be necessary. This may involve removing the ovaries and fallopian tubes. Surgeons may also need to remove some lymph nodes.
More radical surgery can involve removing all or parts of the bladder, bowel or vagina. This may be suggested if the cancer has returned and other treatment is impossible.
Chemotherapy and radiotherapy
Chemotherapy may be offered with radiotherapy (chemoradiotherapy) as the primary treatment for cervical cancer. It can be given before surgery to shrink the tumour or after surgery (usually with radiotherapy) to help prevent the cancer from coming back.
Radiotherapy uses high-energy radiation to kill cancer cells. It can be the primary treatment if the cancer is large or has spread, or given after surgery, usually with chemotherapy to help prevent the cancer coming back. Radiotherapy for cervical cancer can be delivered from outside or inside the body, which is called brachytherapy.
A new study has found that offering patients a short course of chemotherapy before standard treatment (chemoradiation) can reduce the risk of death or their cancer coming back by 35 per cent.
Targeted therapy
In cases of advanced cervical cancer, which has spread to other organs such as the liver or lungs, or if the cancer has come back, a targeted drug called bevacizumab (known by the brand name Avastin) may help shrink the cancer or stop it getting any bigger, but it won’t cure it.
In pregnancy
Cervical cancer in pregnancy is often treated differently.
“Most pre-cancers will stay the same or regress in pregnancy – a minority will progress to cancer,” says Prof Rosenthal. “Depending on the stage of pregnancy at which the cancer is found, it may be necessary to delay treatment in order to allow the pregnancy to get to a gestation at which the baby would be expected to do well after delivery. Obviously if you delay treatment, the cancer may grow in the meantime.”
Common adverse effects of cervical cancer treatment
This will largely depend on the type of treatment a person gets.
Radiotherapy and brachytherapy can cause:
Sore skin
Lack of energy
Bladder and bowel changes
Pain
Vaginal shortening and dryness
Also, radiotherapy may result in a loss of pubic hair.
Chemotherapy can cause similar side effects but can lead to hair loss, nausea, vomiting and an increased risk of infection.
Living with cervical cancer
Advanced cervical cancer can be challenging to treat. It may not be possible to cure the cancer, but you can have treatment to help you live longer and control symptoms.
Coping with a cervical cancer diagnosis can also be challenging. Everyone has different experiences, read Rhea’s story below:
What can you do to help prevent cervical cancer?
Cervical cancer could be prevented by:
Attending cervical screening, this is vital.
Giving up smoking, doing so can also help the body clear HPV to lower your risk of cervical cancer.
Get vaccinated, the HPV vaccine is 99 per cent effective against the most high-risk strains of HPV.
Practice safer sex, using condoms reduces the risk of passing HPV on and catching it.
Cervical cancer rates have been reduced by almost 90 per cent in women in their 20s who have been immunised as part of the NHS free HPV vaccination in schools programme. Anyone under 25 who did not receive the vaccine at school is eligible for a free vaccine. For those who have not had the vaccine and want to have it, it can be obtained privately through GP surgeries, travel clinics and pharmacies up to the age of 45.
Is there an alternative to cervical screening?
Many women find testing embarrassing or painful, but other tests are being developed, such as:
Urine tests
A study led by Dr Emma Crosbie and published in BMJ Open in 2019 found that urine testing was just as good as the cervical smear at picking up the HPV virus, and trials are ongoing. “We’re really excited by this study, which we think has the potential to significantly increase participation rates for cervical cancer screening,” she said.
Self-sampling tests
The results of a clinical trial, YouScreen showed that self-sampling HPV testing works well. It involves women taking a sample from their vagina at home using a similar swab to that used in a Covid test and posting it off for testing.
Hannah Drysdale, a cancer researcher at the Cancer Prevention Group at King’s College London, says: “Only about one in six women who will have used the self-sampling test will have to go to a doctor for screening to test for cell changes.”
More research is currently underway on the accuracy of self-sampling and how it can be rolled out.
Forecee
Prof Rosenthal says: “Other research in the area hopes to improve cervical screening, including work funded by The Eve Appeal called Forecee. This research programme is developing a test done on routine cervical screening samples which can detect not only cervical pre-cancer, but also breast, womb and ovarian cancer. This work is still in its early stages but yielding encouraging results that could transform screening.”
Papcup
This is a non-invasive alternative. The Papcup is a handheld device that scans menstrual blood which can be collected while a woman has her period, and looks to see if HPV is present. Those that test positive for HPV would then go in for a smear test.
The device does still need to be tested in clinical trials, but could be available on the NHS in the future.
The Eve Appeal is the UK’s leading gynaecological cancer charity. Ask Eve is a free and confidential nurse-led information service. You can get in touch to speak to a nurse about any questions you have on HPV, cervical screening or cervical cancer; eveappeal.org.uk
