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Cervical cancer

Cervical cancer is an uncommon type of cancer that develops in a woman's cervix. The cervix is the entrance to the womb from the vagina.

Cervical cancer is an uncommon type of cancer that develops in a woman's cervix. The cervix is the entrance to the womb from the vagina.

Cervical cancer often has no symptoms in its early stages. If you have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in-between periods or after the menopause.

Abnormal bleeding doesn't mean that you definitely have cervical cancer, but it should be investigated by your GP as soon as possible. If your GP suspects you might have cervical cancer, you should be referred to see a specialist within two weeks.

Read more about the symptoms of cervical cancer and diagnosing cervical cancer.

Screening for cervical cancer

Over the course of many years, the cells lining the surface of the cervix undergo a series of changes. In rare cases, these precancerous cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage and treatment can reduce the risk of cervical cancer developing.

The NHS offers a national screening programme open to all women from the age of 25. During screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities. This test is commonly referred to as a cervical smear test.

An abnormal smear test does not mean you definitely have cancer, as most abnormal results are caused by an infection or the presence of treatable precancerous cells rather than cancer itself.

It is recommended that women who are between the ages of 25 and 49 are screened every three years, and women between the ages of 50 and 64 are screened every five years. You should be sent a letter telling you when your screening appointment is due. Contact your GP if you think that you may be overdue for a screening appointment.

Read more about cervical cancer screening.

Why it happens

Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that's often spread during sex.

There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can disrupt the normal functioning of the cells of the cervix and can eventually trigger the onset of cancer.

Two strains of the HPV virus called HPV 16 and HPV 18 are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection have no symptoms, so many women will not realise they have the infection.

However, it is important to be aware that these infections are relatively common and most women who have them don't develop cervical cancer.

Using condoms during sex offers some protection against HPV, but it cannot always prevent infection.

Since 2008, a HPV vaccine has been routinely offered to girls between the ages of 12 and 13.

Read more about the causes of cervical cancer and preventing cervical cancer.

Treating cervical cancer

If cervical cancer is diagnosed at an early stage, it's usually possible to treat it using surgery. In some cases it's possible to leave the womb in place, but it may need to be removed. The surgical procedure used to remove the womb is called a hysterectomy.

Radiotherapy is an alternative to surgery for some women with early stage cervical cancer. In some cases it is used alongside surgery.

More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy.

Some of the treatments used can have significant and long-lasting side effects, including early menopause and infertility.

Read more about treating cervical cancer.

Complications

Many women with cervical cancer will have complications. Complications can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, surgery and chemotherapy.

Complications associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina or having to urinate frequently, to life-threatening, such as severe bleeding or kidney failure.

Read more about the complications of cervical cancer.

Outlook

The stage at which cervical cancer is diagnosed is an important factor in determining a woman's outlook. The staging, given as a number from one to four, indicates how far the cancer has spread.

The chances of living for at least five years after being diagnosed with cervical cancer are:

  • stage 1  80% to 99%
  • stage 2  60% to 90%
  • stage 3  30% to 50%
  • stage 4  20%

In the UK, just fewer than 1,000 women die from cervical cancer every year.

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Cervical cancer

The treatment for cervical cancer depends on how far the cancer has spread.

The treatment for cervical cancer depends on how far the cancer has spread.

Deciding which treatment is best for you can often be confusing, which is why hospitals use multidisciplinary teams (MDTs) to treat cervical cancer. MDTs are made up of a number of different specialists who work together to make decisions about the best way to proceed with your treatment.

Your cancer team will recommend what they think the best treatment options are, but the final decision will be yours.

In most cases, the recommendations will be:

  • early cervical cancer – surgery to remove some or all of the womb, radiotherapy, or a combination of the two
  • advanced cervical cancer – radiotherapy and/or chemotherapy, although surgery is also sometimes used

The prospect of a complete cure is good for cervical cancer diagnosed at an early stage, although the chances decrease the further the cancer has spread.

Even in cases where cervical cancer isn't curable, it's often possible to slow its progression, prolong lifespan and relieve any associated symptoms, such as pain and vaginal bleeding. This is known as palliative care.

The different treatment options are discussed in more detail below.

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 cut away using a fine wire and an electrical current
  • cone biopsy – the area of abnormal tissue is removed during surgery
  • laser therapy – a laser is used to burn away the abnormal cells

Read more about treating abnormal cells in the cervix.

Surgery

There are three main types of surgery for cervical cancer. They are:

  • radical trachelectomy – the cervix, surrounding tissue and the upper part of the vagina are removed but the womb is left in place
  • hysterectomy – the cervix and womb are removed; depending on the stage of the cancer, it may also be necessary to remove the ovaries and fallopian tubes
  • pelvic exenteration – a major operation in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed

The three types of surgery are discussed below.

Radical trachelectomy

A radical trachelectomy is usually only suitable if cervical cancer is diagnosed at a very early stage. It is usually offered to women who want to preserve their child-bearing potential.

During the procedure, the surgeon will make a number of small incisions (cuts) in your abdomen. Specially designed instruments will be passed through the incisions and used to remove your cervix and the upper section of your vagina. Lymph nodes from your pelvis may also be removed. Your womb will then be reattached to the lower section of your vagina.

Compared with a hysterectomy or pelvic exenteration, the advantage of this type of surgery is that your womb remains intact, which means that you may still be able to have children. However, it is important to be aware the surgeons carrying out this operation cannot guarantee you will still be able to have children.

If you do have children after the operation, your child would have to be delivered by caesarean section (where the baby is removed through an incision in your abdomen). It's also usually recommended that you wait six to 12 months after having surgery before trying for a baby so that your womb and vagina have time to heal.

Radical trachelectomy is a highly skilled procedure. It's only available at a number of specialist centres in the UK, so it may not be available in your area and you may have to travel to another city to be treated.

Hysterectomy

hysterectomy is usually recommended for early cervical cancer. This may be followed by a course of radiotherapy to help prevent the cancer coming back.

Two types of hysterectomies are used in treating cervical cancer. They are:

  • simple hysterectomy – where the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes are also removed; this is only appropriate for very early stage cervical cancers
  • radical hysterectomy – where the cervix, womb, surrounding tissue and lymph nodes, ovaries and fallopian tubes are all removed; this is the preferred option in advanced stage one and some early stage two cervical cancers

Short-term complications of a hysterectomy include infection, bleeding, blood clots and accidental injury to your ureter, bladder or rectum.

The risk of long-term complications is small but they can be troublesome. They include:

  • your vagina can become shortened and drier, which can make sex painful
  • urinary incontinence
  • swelling of your arms and legs caused by a build-up of fluid (lymphoedema)
  • your bowel becomes obstructed because of a build-up of scar tissue – this may require further surgery to correct

As your womb is removed during a hysterectomy, you will no longer be able to have children.

If your ovaries are removed, it will also trigger the menopause if you haven't already experienced it. See complications of cervical cancer for more information about the menopause.

Pelvic exenteration

A pelvic exenteration is a major operation that's usually only recommended when cervical cancer returns after what was thought to be a previously successful course of treatment. It is offered if the cancer returns to the pelvis but hasn't spread beyond this area.

A pelvic exenteration involves two phases of treatment:

  • the cancer is removed, plus your bladder, rectum, vagina and the lower section of your bowel
  • two holes called stomas are created in your abdomen – the holes are used to pass urine and faeces out of your body into collection pouches called colostomy bags

Following a pelvic exenteration, your vagina can be reconstructed using skin and tissue taken from other parts of your body. This means that you'll be able to have sex after the procedure, although it may be several months until you feel well enough to do so.

Radiotherapy

Radiotherapy may be used on its own or combined with surgery for early stage cervical cancer. It may be combined with chemotherapy for advanced cervical cancer, where it can be used to control bleeding and pain.

There are two ways that radiotherapy can be delivered. These are:

  • externally – a machine beams high energy waves into your pelvis to destroy cancerous cells
  • internally – a radioactive implant is placed inside your vagina and cervix

In most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts for around five to eight weeks.

As well as destroying cancerous cells, radiotherapy can sometimes also harm healthy tissue. This means it can cause significant side effects many months and even years after treatment.

However, the benefits of radiotherapy often tend to outweigh the risks. For some people, radiotherapy offers the only hope of getting rid of the cancer.

Side effects of radiotherapy are common and can include:

  • diarrhoea
  • pain when urinating
  • bleeding from your vagina or rectum
  • feeling very tired (fatigue)
  • feeling sick (nausea)
  • sore skin in your pelvis region similar to sunburn
  • narrowing of your vagina, which can make having sex painful
  • infertility
  • damage to the ovaries, which will usually trigger an early menopause (if you haven't already experienced it)
  • bladder and bowel damage, which could lead to incontinence

Most of these side effects will resolve within about eight weeks of finishing treatment, although in some cases they can be permanent. It is also possible to develop side effects several months or even years after treatment has finished.

If infertility is a concern for you, it may be possible to surgically remove eggs from your ovaries before you have radiotherapy so that they can be implanted in your womb at a later date. However, you may have to pay for this.

It may also be possible to prevent an early menopause by surgically removing your ovaries and replanting them outside the area of your pelvis that will be affected by radiation. This is known as an ovarian transposition.

Your MDT will be able to provide more information about the possible options for treating infertility and whether you're suitable for an ovarian transposition.

Chemotherapy

Chemotherapy can be combined with radiotherapy to try to cure cervical cancer, or it can be used as a sole treatment for advanced cancer to slow its progression and relieve symptoms (palliative chemotherapy).

Chemotherapy involves using either a single chemotherapy medication called cisplatin or a combination of different chemotherapy medications to kill the cancerous cells. 

Chemotherapy is usually given using an intravenous drip on an outpatient basis, so you'll be able to go home once you have received your dose.

As with radiotherapy, these medications can also damage healthy tissue. Side effects are therefore common and can include:

  • feeling sick
  • being sick (vomiting)
  • diarrhoea
  • feeling tired all the time
  • reduced production of blood cells, which can make you feel tired and breathless (anaemia) and vulnerable to infection because of a lack of white blood cells
  • mouth ulcers 
  • loss of appetite
  • hair loss – your hair should grow back within three to six months of your course of chemotherapy being completed, although not all chemotherapy medications cause hair loss

Some types of chemotherapy medication can damage your kidneys, so you may need to have regular blood tests to assess the health of your kidneys.

Follow-up

After your treatment has been completed and the cancer has been removed from your body, you will need to attend regular appointments for testing. This will usually involve a physical examination of your vagina and your cervix, if it hasn't been removed.

As there is a risk of cervical cancer returning, these examinations are used to look for signs of this. If anything suspicious is found, a further biopsy can be performed.

In cases where cervical cancer does return, this usually occurs around 18 months after a course of treatment has been completed.

Follow-up appointments are usually recommended every four months after treatment has been completed for the first two years, and then every six to 12 months for a further three years.

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Cervical cancer

Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.

Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.

These are described in more detail below.

Side effects

Early menopause

If your ovaries are surgically removed or they're damaged during treatment with radiotherapy, it will trigger an early menopause (if you haven't already had it). Most women experience the menopause in their early fifties.

The menopause is caused when your ovaries stop producing the hormones oestrogen and progesterone. This leads to the following symptoms:

  • you no longer have monthly periods or your periods become much more irregular
  • hot flushes
  • vaginal dryness
  • loss of sex drive
  • mood changes
  • stress incontinence (leaking urine when you cough or sneeze)
  • night sweats
  • thinning of the bones, which can lead to brittle bones (osteoporosis)

These symptoms can be relieved by taking a number of medications that stimulate the production of oestrogen and progesterone. This treatment is known as hormone replacement therapy (HRT).

Narrowing of the vagina

Radiotherapy to treat cervical cancer can often cause your vagina to become narrower. This can make having sex painful or difficult.

There are two main treatment options if you have a narrowed vagina. The first is to apply hormonal cream to your vagina. This should increase moisture within your vagina and make having sex easier.

The second is to use a vaginal dilator, which is a tampon-shaped device made of plastic. You insert it into your vagina and it is designed to help make it more supple. It is usually recommended that you insert the dilator for five to 10 minutes at a time on a regular basis during the day over the course of six to 12 months.

Many women find discussing the use of a vaginal dilator embarrassing, but it's a standard and well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice.

You may find that the more times you have sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.

You can read more about sexuality and cancer on the Macmillan Cancer Support website.

Lymphoedema

If the lymph nodes in your pelvis are removed, it can sometimes disrupt the normal workings of your lymphatic system.

One of the functions of the lymphatic system is to drain away excess fluid from the body's tissue. A disruption can cause a build-up of fluid in the tissue. This can lead to certain body parts becoming swollen, but usually the legs in cases of cervical cancer. This is known as lymphoedema.

There are a number of exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help.

Read more about treating lymphoedema.

Emotional impact

The emotional impact of living with cervical cancer can be significant. Many people report experiencing a "rollercoaster" effect.

For example, you may feel down when you receive a diagnosis, but feel up when removal of the cancer has been confirmed. Then you may feel down again as you try to come to terms with the after-effects of your treatment.

This type of emotional disruption can sometimes trigger depression. Signs that you may be depressed include feeling down or hopeless during the past month and no longer taking pleasure in the things that you enjoy.

Contact your GP for advice if you think you may be depressed. There are a range of effective treatments available, including antidepressant medication and talking therapies such as cognitive behavioural therapy (CBT).

You may also find Jo's Cervical Cancer Trust website a useful resource. It's the UK's only charity dedicated to women affected by cervical cancer.

There may also be local support groups in your area for women affected by cancer. Your specialist cancer nurse should be able to provide contact details.

Read more about coping with cancer.

Advanced cervical cancer

Some of the complications that can occur in cases of advanced cervical cancer are discussed below.

Pain

If the cancer spreads into your nerve endings, bones or muscles, it can often cause severe pain.

However, a number of effective painkilling medications can usually be used to control the pain. Depending on the levels of pain, they can range from paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, to more powerful opiate-based painkillers such as codeine and morphine.

If the painkillers you are prescribed aren't effective in reducing your pain, you should tell your care team as you may need to be prescribed a stronger medication. A short course of radiotherapy can also be effective in controlling the pain.

Macmillan nurses, who work both in hospitals and in the community, can also provide expert advice about pain relief.

Read more about coping with pain.

Kidney failure

Your kidneys remove waste material from your blood. The waste is passed out of your body in urine through tubes called the ureters. Kidney function can be monitored by a simple blood test called serum creatinine level.

In some cases of advanced cervical cancer, the cancerous tumour can press against the ureters, blocking the flow of urine out of the kidneys. The build-up of urine inside the kidneys is known as hydronephrosis and can cause the kidneys to become swollen and stretched.

Severe cases of hydronephrosis can cause the kidneys to become scarred, which can lead to loss of most or all of the kidneys' functions. This is known as kidney failure.

Kidney failure can cause a wide range of symptoms, including:

  • tiredness
  • swollen ankles, feet or hands caused by water retention
  • shortness of breath
  • feeling sick
  • blood in your urine (haematuria)

Treatment options for kidney failure associated with cervical cancer include draining urine out of the kidneys using a tube inserted through the skin and into each kidney (percutaneous nephrostomy). Another option is to widen each of the ureters by placing a small metal tube called a stent inside them.

Blood clots

Cervical cancer, like any other cancer, can make the blood more "sticky" and more prone to forming clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot.

Large tumours can press on the veins in the pelvis, which slows the flow of blood and can lead to a blood clot developing in the legs.

Symptoms of a blood clot in your legs include:

  • pain, swelling and tenderness in one of your legs (usually your calf)
  • a heavy ache in the affected area
  • warm skin in the area of the clot
  • redness of the skin, particularly at the back of your leg, below the knee

A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs and block the supply of blood to the lungs. This is known as a pulmonary embolism and can be fatal.

Blood clots in the legs are usually treated by using a combination of blood-thinning medication, such as heparin or warfarin, and compression garments designed to help encourage the flow of blood through the limbs.

Read more about treating deep vein thrombosis.

Bleeding

If the cancer spreads into your vagina, bowel or bladder, it can cause significant damage resulting in bleeding. Bleeding can occur in your vagina or rectum (back passage), or you may pass blood when you urinate.

Minor bleeding can often be treated using a medication called tranexamic acid, which encourages the blood to clot and stop the bleeding. Radiotherapy can also be highly effective in controlling bleeding caused by cancer.

Major bleeding can be treated using a combination of medications designed to lower blood pressure. This should help to stem the flow of blood.

Fistula

A fistula is an uncommon but distressing complication that occurs in around 1 in 50 cases of advanced cervical cancer.

A fistula is an abnormal channel that develops between two sections of the body. In most cases involving cervical cancer, the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. Sometimes a fistula develops between the vagina and rectum.

Surgery is usually required to repair a fistula, although it's often not possible in women with advanced cervical cancer because they're usually too frail to withstand the effects of surgery.

In such cases, treatment often involves using medication, creams and lotions to reduce the amount of discharge and protect the vagina and surrounding tissue from damage and irritation.

Vaginal discharge

Another uncommon but distressing complication of advanced cervical cancer is an unpleasant smelling discharge from your vagina.

The discharge can occur for a number of reasons, such as the breakdown of tissue, the leakage of bladder or bowel contents out of the vagina, or a bacterial infection of the vagina.

Treatment options for vaginal discharge include an antibacterial gel called metronidazole and wearing clothing that contains charcoal. Charcoal is a chemical compound that's very effective in absorbing unpleasant smells.

Palliative care

If your doctors can't do any more to treat your cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care.

Palliative care also includes psychological, social and spiritual support for you and your family or carers.

There are different options for terminal care in the late stages of cancer. You may want to think about whether you would like to be cared for in hospital, in a hospice or at home, and discuss these issues with your doctor. Some organisations who provide care for people with cancer include:

  • Macmillan Cancer Support has specially trained nurses who help look after people with cancer at home. To be referred to a Macmillan nurse, ask your hospital doctor or GP, or call 0808 808 00 00.
  • Marie Curie Cancer Care have specially trained nurses who help look after people with cancer at home. They also run hospices for people with cancer.
  • Help the Hospices has information about hospice care and how to find a hospice.

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