Content Supplied by NHS Choices

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.

Content Supplied by NHS Choices

Cervical cancer

Learn about the symptoms of cervical cancer, such as unusual bleeding, and when to seek medical advice.

The symptoms of cervical cancer aren't always obvious and it may not cause any symptoms at all until it has reached an advanced stage.

This is why it's very important for you to attend your cervical screening appointments.

Unusual bleeding

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.

This includes bleeding after the menopause (when a woman's monthly periods stop).

If you have any type of unusual vaginal bleeding, visit your GP for advice.

Other symptoms

Other symptoms of cervical cancer may include:

Advanced cervical cancer

If the cancer spreads out of your cervix and into surrounding tissue and organs, it can trigger a range of other symptoms, including:

  • constipation
  • blood in your urine (haematuria)
  • loss of bladder control (urinary incontinence)
  • bone pain
  • swelling of one of your legs
  • severe pain in your side or back caused by swelling in your kidneys related to a condition called hydronephrosis
  • changes to your bowel and bladder habits
  • loss of appetite
  • weight loss
  • tiredness and lack of energy

When to seek medical advice

It is recommended that you contact your GP if you experience:

  • bleeding after having sex (postcoital bleeding)
  • bleeding outside of your normal periods
  • new bleeding after the menopause

Vaginal bleeding is very common and can have a range of causes, so it doesn't necessarily mean that you have cervical cancer.

However, unusual vaginal bleeding is a symptom that needs to be investigated by your GP.

Content Supplied by NHS Choices

Cervical cancer

In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papillomavirus (HPV).

In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papillomavirus (HPV).

Cancer begins with a change in the structure of the DNA that's present in all human cells. DNA provides the cells with a basic set of instructions, including when to grow and reproduce.

A change in the DNA's structure is known as a mutation. It can alter the instructions that control cell growth. This means that the cells continue growing instead of stopping when they should. If the cells reproduce uncontrollably, they produce a lump of tissue called a tumour.

Human papillomavirus (HPV)

More than 99% of cases of cervical cancer occur in women who have been previously infected with the human papillomavirus (HPV). HPV is actually a group of viruses, rather than a single virus. There are more than 100 different types.

HPV is spread during sexual intercourse and is thought to be very common. An estimated one in three women will develop a HPV infection within two years of starting to have regular sex, and about four in every five women will develop the infection at some point in their lives.

Some types of HPV do not cause any noticeable symptoms and the infection will pass without treatment. Other types of HPV can cause genital warts, although these types are not associated with a high risk of causing cervical cancer.

About 15 types of HPV are considered high risk for cervical cancer. The two types known to have the highest risk are HPV 16 and HPV 18, which cause about 7 in every 10 cervical cancers.

High risk types of HPV are thought to contain genetic material that can be passed into the cells of the cervix. This material begins to disrupt the normal workings of the cells, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour.

See preventing cervical cancer for more information about reducing your chances of developing HPV.

Cervical intraepithelial neoplasia (CIN)

Cancer of the cervix usually takes many years to develop. Before it does, the cells in the cervix often show changes known as cervical intraepithelial neoplasia (CIN) or, less commonly, cervical glandular intraepithelial neoplasia (CGIN).

CIN and CGIN are pre-cancerous conditions. Pre-cancerous conditions do not pose an immediate threat to a person's health, but they can potentially develop into cancer in the future.

However, even if you develop CIN or CGIN, the chances of it developing into cervical cancer are very small and if the changes are discovered during cervical screening, treatment is highly successful.

The progression from becoming infected with HPV to developing CIN or CGIN and then developing cervical cancer is very slow, often taking between 10 and 20 years.

Read more about cervical screening results.

Increased risk

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 a 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
  • having a weakened immune system – this can be the result of taking certain medications, such as immunosuppressants, which are used to stop the body rejecting donated organs, or as a result of a condition such as HIV/AIDS
  • taking the oral contraceptive pill for more than five years – women who do this are thought to have twice the risk of developing cervical cancer than those who do not take the pill, although it is not clear why this is
  • 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 do not have any children

The reason for the link between cervical cancer and childbirth is unclear. One theory is that the hormonal changes that occur during pregnancy could make the cervix more vulnerable to the effects of HPV.

The spread of cervical cancer

If cervical cancer is undiagnosed and untreated, it will slowly spread out of the cervix and into the surrounding tissue and organs. The cancer can spread down to the vagina and the surrounding muscles that support the bones of the pelvis. Alternatively, it can spread upwards, blocking the tube that runs from your kidneys to your bladder (ureters).

The cancer can then spread into your bladder, rectum (back passage) and eventually into your liver, bones and lungs. Cancerous cells can also spread through your lymphatic system. The lymphatic system is a series of nodes (glands) and channels that are spread throughout your body in a similar way to your blood circulation system.

The lymph nodes produce many of the specialised cells that are needed by your immune system (the body's natural defence against infection and illness). If you have an infection, the nodes in your neck or under your armpits may be swollen.

In some cases of early cervical cancer, the lymph nodes close to the cervix contain cancerous cells. And in some cases of advanced cervical cancer, lymph nodes in the chest and abdomen can be affected.

Content Supplied by NHS Choices

Cervical cancer

If cervical cancer is suspected, you will be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system).

If cervical cancer is suspected, you will be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system).

Referral will be recommended 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 do not mean that you have cervical cancer.

You may also be referred to a gynaecologist if you have abnormal vaginal bleeding or your GP noticed a growth inside your cervix during an examination.

The sexually transmitted infection (STI) chlamydia is one of the most common reasons why women experience unusual vaginal bleeding. Your GP may recommend that you are tested for it first before being referred. Testing for chlamydia involves taking a small tissue sample from your cervix or carrying out a urine test.

Colposcopy

If you have had an abnormal cervical screening test result, or your symptoms suggest that you may have cervical cancer, your gynaecologist will usually carry out a colposcopy. A colposcopy is an examination to look for any 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.

Cone biopsy

In some cases, a minor operation called a cone biopsy may also be carried out. This operation is carried out in hospital, usually under a local anaesthetic.

During a cone biopsy, a small, cone-shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells. You may experience vaginal bleeding for up to four weeks after the procedure. You may also have period-like pains.

Further testing

If the results of the biopsy suggest you have cervical cancer and there's a risk that the cancer may have spread, you'll probably need to have some further tests to assess how widespread the cancer is. These tests may include:

  • a pelvic examination carried out under general anaesthetic – your womb, vagina, rectum and bladder will be checked for cancer
  • blood tests – these can be used to help assess the state of your liver, kidneys and bone marrow
  • computer tomography (CT) scan – scans are taken of the inside of your body and a computer is used to assemble them into a detailed three-dimensional image; this is useful for showing up cancerous tumours and checking whether the cancerous cells have spread
  • magnetic resonance imaging (MRI) scan – this type of scan uses strong magnetic fields and radio waves to produce detailed pictures of the inside of your body; it can also be used to check whether cancer has spread
  • chest X-ray – this will indicate whether cancer has spread to your lungs
  • positive emission tomography (PET) scan – a specialised scan where a mildly radioactive substance is injected into your veins so the cancerous tissue shows up more clearly; it is often combined with a CT scan and is used to see if the cancer has spread or to check how well a person is responding to treatment

Staging

After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows:

  • stage 0 (pre-cancer) – there are no cancerous cells in the cervix, but there are biological changes that could trigger the onset of cancer in the future; this is called cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS)
  • stage 1 – the cancer is still contained inside the cervix
  • stage 2 – the cancer has spread outside the cervix into the surrounding tissue, but has not reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina
  • stage 3 – the cancer has spread into the lower section of the vagina and/or into the pelvic wall
  • stage 4 – the cancer has spread into the bowel, bladder or other organs, such as the lungs
Content Supplied by NHS Choices

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.

Share this page