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's a cause for concern. It’s important to see 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.

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 changed cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage, and treatments can reduce the risk of cervical cancer developing.

The NHS offers a national screening programme for all women over 24 years old. 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.

It is recommended that women who are between 25 and 49 years old are screened every three years, and women between 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 screening for 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 sometimes it will need to be removed. The surgical procedure that is used to remove the womb is known as a hysterectomy. Radiotherapy is an alternative to surgery for some women with early stage cervical cancer.

More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy. Radiotherapy can also cause infertility as a side effect.

Read more about treating cervical cancer.

Causes of cervical cancer

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

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. This causes them to reproduce uncontrollably and trigger the onset of cancer.

Two distinct strains of the HPV virus are known to be responsible for 70% of all cases of cervical cancer. They are HPV 16 and HPV 18. Most women who are infected with these two types of HPV are unaffected, which means that there must be additional factors that make some women more vulnerable to HPV infection than others.

Read more about the causes of cervical cancer.

HPV vaccination

In 2008, a national vaccination programme was launched to vaccinate girls against HPV 16 and HPV 18. The vaccine is most effective if it's given a few years before a girl becomes sexually active, so it's given to girls between the ages of 12 and 13.

The vaccine used is gardasil - which provides protection against cervical cancer and genital warts

The vaccine protects against the two strains of HPV responsible for more than 70% of cervical cancers in the U.K. However you should still attend your future screening appointments even if you have been vaccinated. 

Read more about HPV vaccination and preventing cervical cancer. 

Complications of cervical cancer

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

Read more about the complications of cervical cancer.

Who is affected by cervical cancer?

Due to the success of the NHS screening programme, cervical cancer is now an uncommon type of cancer in the UK. However, it's still a common cause of cancer-related death in countries that don't offer screening.

It's possible for women of all ages to develop cervical cancer. However, the condition mainly affects sexually active women between 25 and 45 years old. Many women who are affected did not attend their screening appointments.

In 2007, nearly 2,800 cases of cervical cancer were diagnosed in UK. In addition, about 25,000 cases were diagnosed with a precancerous condition of the cervix called cervical intraepithelial neoplasia (CIN).

Outlook

The stage at which cervical cancer is diagnosed is an important factor in determining a woman’s outlook. For example, if the cancer is still at an early stage, the outlook will usually be very good and a complete cure is often possible. See diagnosing cervical cancer for more information about staging.

More than 90% of women with stage one cervical cancer will live at least five years after receiving a diagnosis. Many women will live much longer. Researchers used five years as a cut-off point because cancer is unlikely to recur after five years and most women can consider themselves cured after five years.

Around 1 in 3 people with the more advanced type of cervical cancer will live at least five years.

Another important factor is a woman’s age when cervical cancer first develops. Older women usually have a worse outlook than younger women.

In the UK there were around 950 deaths due to cervical cancer in 2008.

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 screening appointments for a cervical smear test.

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 to be 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 (see below).

Other symptoms

Other symptoms of cervical cancer may include:

• pain in and around your vagina when having sex
• an unpleasant smelling vaginal discharge
• pain when passing urine

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
• swelling of one or both kidneys, which can become misshapen due to a build-up of urine, and cause severe pain in your side or back; this type of swelling is known as 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 (post-coital 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, despite being common, unusual vaginal bleeding is a symptom that needs to be investigated by your GP.

Discharge

Discharge is when a liquid such as pus oozes from a part of your body.

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)

Almost all 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 1 in 3 women will develop a HPV infection within two years of starting to have regular sex.

Some types of HPV do not cause any noticeable symptoms and the infection will pass without the need for treatment. Other types of HPV can cause genital warts.

Two types of HPV are known to have the highest risk of causing cervical cancer. They are:

• HPV16 - which accounts for around 50-55% of all cases
• HPV18 - which accounts for around 15-20% of all cases

A further 11 types of HPV also have a higher chance of causing cancer.

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 (see below), which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour.

Cervical intraepithelial neoplasia

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).

CIN is a pre-cancerous condition. Pre-cancerous conditions do not pose an immediate threat to a person’s health, but they can potentially develop into ‘fully-blown’ cancer in the future. However, most women who have CIN won't develop cervical cancer.

CIN is graded using a number system from one to three. The higher the number, the more abnormalities there are in affected cells. It is estimated that:

• one third of women with CIN 1 will progress to CIN 2
• around half of all women with CIN 2 will progress to CIN 3
• around one third of women with CIN 3 will develop cervical cancer

Therefore if you develop CIN 1, your chances of developing cervical cancer at a later date are less than 1 in 30.

The progression from becoming infected with HPV to developing CIN and then developing cervical cancer is very slow. It usually takes at least six years to progress from an initial infection to CIN 3. It takes up to 10 years for CIN 3 to develop into cervical cancer.

Risk factors

The fact that HPV infection is very common but cervical cancer is relatively uncommon would seem to suggest 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 an individual’s chance of developing cervical cancer.

Known risk factors include:

• smoking - women who smoke are twice as likely to get cervical cancer than non-smokers; this may be due to harmful effects of chemicals found in tobacco on the cells of the cervix
• having a weakened immune system - which 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
• 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 to 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 (neck of the womb) 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 will 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.

Immune system

The immune system is the body's defence system, which helps protect it from disease, bacteria and viruses.

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 smear 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 internal vaginal 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

If your gynaecologist is unable to see your cervix properly using a colposcope, you may need to have a cone biopsy. This is a minor operation that's 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 that 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 – which 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 – this is similar to a MRI scan, except that it can also show how well different parts of the body are working; it can be used to see 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 lower the stage, the more likely a complete cure will be possible. The staging for cervical cancer is as follows:

• stage zero (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) (see Cervical cancer - causes)
• stage one – the cancer is still contained inside the cervix
• stage two – the cancer has spread outside the cervix into the upper section of the vagina or in surrounding tissue
• stage three – the cancer has spread into the lower section of the vagina and/or into the tissue of the pelvis
• stage four – the cancer has spread into the bowel, bladder or, in very advanced cases, the lungs

Anaesthetic

Anaesthetic is a drug used to either numb a part of the body (local), or to put a patient to sleep (general) during surgery.

Biopsy

A biopsy is a test that involves taking a small sample of tissue from the body so it can be examined.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Colposcopy

A colposcopy is a procedure where a doctor uses a special magnifying lens, known as a colposcope to look at the cervix through the opening of the vagina.

MRI

MRI stands for magnetic resonance imaging. It is the use of magnets and radio waves to take detailed pictures of inside the body.

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.  

Ultrasound

Ultrasound scans are a way of producing pictures of inside the body using sound waves.

Womb

The uterus (also known as the womb) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.

X-ray

An X-ray is a painless way of producing pictures of inside the body using radiation.

Cancer treatment team

Many 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.

Members of your MDT will probably include:

• a surgeon
• a clinical oncologist (a specialist in chemotherapy and radiotherapy)
• a medical oncologist (a specialist in chemotherapy only)
• a pathologist (a specialist in diseased tissue)
• a radiologist (a specialist in imaging scans)
• a gynaecologist (a doctor who specialises in treating conditions that affect the female reproductive system)
• occasionally a social worker
• occasionally a psychologist
• a specialist cancer nurse, who will usually be your first point of contact with the rest of the team

Your treatment plan

Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

The recommended treatment plan will depend on what stage the cervical cancer is at. In most cases, the recommendations will be:

• for stage zero cervical cancer (cervical intraepithelial neoplasia) - any abnormal cells are removed, which can be done by different methods, including using lasers to burn away the cells or a very cold instrument to freeze them away
• for early stage one cervical cancer - surgery is used to remove some or all of the womb
• for advanced stage one and stage two cancer - surgery or radiotherapy is used; sometimes surgery is followed by a course of radiotherapy
• for stage three and early stage four cancer - radiotherapy is combined with chemotherapy
• for advanced stage four cancer - chemotherapy, radiotherapy and possibly surgery is used to provide palliative care.

Palliative care is care provided to make a person feel as comfortable as possible when there's no prospect of a cure.

The prospect of a complete cure is usually good for stage one cervical cancer. It is moderate for stage two cervical cancer. 

A complete cure is less likely for stage three cervical cancer, and very unlikely for stage four cervical cancer.

However, 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.

The various 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 (cervical intraepithelial neoplasia), a number of treatment options are available. These are:

• laser therapy - a laser is used to burn away the abnormal cells
• cold coagulation - a hot probe is used to destroy the abnormal cells
• cryotherapy - a cold probe is used to freeze away the abnormal cells
• cone biopsy - the area of abnormal tissue is removed during surgery

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
• radical 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 you have very early stage one cancer. 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 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.

The advantage of this type of surgery compared to a hysterectomy or pelvic exenteration is that your womb remains intact, which means that you'll still be able to have children.

However, 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 fully heal.

Radical trachelectomy is a highly skilled procedure. It's only available at a number of specialist centres in England, so you may have to travel to another city to be treated.

Hysterectomy

A hysterectomy is usually recommended for advanced stage one cervical cancer and early stage two cervical cancer. Surgery 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; 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

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

Also, if your ovaries are removed, it will trigger the menopause if you haven't already experienced it. Read more about the menopause.

Short-term complications of a hysterectomy include:

• infection
• bleeding
• blood clots
• accidental injury to your ureter, bladder and rectum

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

• your vagina becomes shortened and dryer; this can make sex painful
• urinary incontinence
• swelling of your arms and legs due to a build-up of fluid (lymphoedema)
• your bowel becomes obstructed due to a build-up of scar tissue; this may require further surgery to correct

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 elsewhere outside of the pelvis.

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 is used on its own for early stage one cancer. It can be combined with chemotherapy to treat advanced stage two, three and early stage four cervical cancer.

Radiotherapy is sometimes used after surgery. Radiotherapy is not routinely combined with surgery because of the higher risk of side effects. In advanced cancers where cancer has spread widely, radiotherapy can be used as a palliative treatment to control bleeding and pain. 

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

• externally - a machine similar to an X-ray scanner beams high energy waves into your pelvis to destroy cancerous cells
• internally - a radioactive implant is placed inside your vagina

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.

Unfortunately, as well as destroying cancerous cells, radiotherapy can sometimes harm healthy tissue too. Unlike surgery, significant side effects can occur many months and years after treatment. In spite of side effects, the benefits of radiotherapy outweigh any risks in most cases. For some patients, radiotherapy offers the only hope of getting rid of the cancer.

This means that side effects are common and 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

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 of 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.

Read more about radiotherapy.

Chemotherapy

Chemotherapy can be combined with radiotherapy to try and cure a cancer. Or it can be used as a sole palliative treatment for advanced stage four cervical cancer to slow the progression of the cancer and relieve symptoms (palliative chemotherapy).

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

Chemotherapy is usually given using an intravenous drip on an out-patient 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, and side effects are common. They 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 (due to 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 - though 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.

Read more about chemotherapy.

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, if present, your cervix.

If the examination finds anything potentially suspicious then a further biopsy can be performed.

In around 1 in 5 cases, cervical cancer can return. This usually occurs around 18 months after a course of treatment has been completed.

Follow-up appointments are quite variable and 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.

Complications of cervical cancer can occur in one of two ways:

• as a side effect of treatment
• the result of advanced cervical cancer

Side effects

Early menopause

If your ovaries are surgically removed, or if 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 that's made out of plastic. You insert it into your vagina and it is designed to help make your vagina 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, usually the arms and legs. 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 roller-coaster 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
• no longer taking pleasure in the things that you enjoy

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

Read more about depression and coping with cancer.

You may also find Jo's Cervical Cancer Trust website a useful resource. It's the UK’s only charity dedicated to women who are 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.

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. Depending on the levels of pain, they can range from paracetamol and the 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 because you may need to be prescribed a stronger medication.

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 (abnormal tissue growth) 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 kidney's functions. This is known as kidney failure.

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

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

Treatment options for kidney failure that's associated with cervical cancer include draining urine out of the kidneys using a tube that's 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 make it more prone to form clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot.

Advanced cervical cancer can spread to your blood vessels directly, which can also increase your risk of developing a blood clot.

A type of blood clot known as deep venous thrombosis (DVT) can occur in cases of cervical cancer. DVT is a blood clot that develops in one of the deep veins in the body, usually in the leg.

Symptoms of a DVT 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 your skin, particularly at the back of your leg, below the knee

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

DVT is usually treated by using a combination of blood-thinning medication, such as heparin or warfarin, and compression garments that are specially 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, 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.

Major bleeding can be treated using a combination of medications that are 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 people 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 anti-bacterial 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 to discuss these issues with your doctor. Some organisations who provide care for people with cancer include:

• Macmillan Cancer Support - it 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 The Macmillan Cancerline (freephone 0808 808 2020).
• 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.

Safer sex

There's a strong link between certain types of human papilloma virus (HPV) and abnormalities that may develop into cervical cancer. HPV is spread through unprotected sex, so using a condom is the best way to avoid it.

Before beginning a sexual relationship with a new partner, it's a good idea for you both to be tested for sexually transmitted infections (STIs) at a sexual health clinic. All tests are free and confidential.

Read more about sexual health.

Cervical screening

Regular cervical screening, known as smear tests, are the best way to identify abnormal changes in the cells of the cervix at an early stage.

Women who are 25 to 49 years old are invited for screening every three years. Women who are 50 to 64 years old are invited every five years. Make sure that your GP surgery has your up-to-date contact details so that you continue getting screening invitations.

It's important that you attend your smear tests even if you have been vaccinated for HPV (see below) because the vaccine does not guarantee protection against cervical cancer.

If you have been treated for abnormal cervical cell changes, you will be invited for screening more frequently for several years after treatment. How regularly you need to go will depend on how severe the cell change is.

Read more about cervical screening.

HPV vaccination

There is now a vaccine which provides protection against the two strains of HPV that are thought to be responsible for most cases of cervical cancer.

Girls should be offered the HPV vaccine as part of their routine childhood immunisation programme. The vaccine should be given to girls who are 12 to 13 years old, with three doses provided over a six-month period.

Read more about HPV vaccination.

Quit smoking

You can lower your chances of getting cervical cancer by not smoking. Smokers are less able to get rid of the HPV infection from the body, which can develop into cancer.

If you decide to stop smoking, your GP will be able to refer you to the NHS Stop Smoking Service, which gives you help and advice about the best ways to give up smoking. You can also call the NHS Smoking Helpline on 0800 022 4332 (7am to 11pm). The specially trained helpline staff can offer you free expert advice and encouragement.

If you want to give up smoking but you don't want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms that you may experience after giving up.

For more information and advice about giving up smoking, see treatment for quitting smoking and stop smoking.

Life after treatment

How cervical cancer affects your daily life will depend very much on what stage your disease is at, and what treatment you're having.

Many women with cervical cancer have a radical hysterectomy. This is a major operation, and it takes around six to 12 weeks to recover from it. During this time you need to avoid lifting (e.g. children, heavy shopping bags) and heavy housework. You won’t be able to drive for anything from three to eight weeks after the operation. Most women will need eight to 12 weeks off work after a radical hysterectomy.

Some of the treatments for cervical cancer, particularly chemotherapy and radiotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Don’t be afraid to ask for practical help from family and friends if you need it.

Practical help may be available from your local authority. Ask your doctor or nurse about who to contact.

Want to know more?

• Macmillan Cancer Support

Work

Having cervical cancer doesn't necessarily mean you'll have to give up work. But you may need quite a lot of time off, and you may not be able to carry on completely as before during your treatment.

If you have cancer you're covered by the Disability Discrimination Act. This means that your employer is not allowed to discriminate against you because of your illness. They have a duty to make ‘reasonable adjustments’ to help you cope. Examples of these include:

• allowing you time off for treatment and medical appointments
• allowing flexibility with working hours, the tasks you have to perform or your working environment.

The definition of what is ‘reasonable’ depends on the situation. For example, how much it would affect your employer’s business.

It will help if you give your employer as much information as possible about how much time you will need off and when. Talk to your human resources department if you have one. Your union or staff association representative should also be able to give you advice.

If you're having difficulties with your employer, your union or your local Citizens Advice Bureau may be able to help.

Want to know more?

• Cancer Backup/Macmillan Cancer Support: work and cancer

Money and benefits

If you have to reduce or stop work because of your cancer, you may find it hard to cope financially. If you have cancer or you're caring for someone with cancer, you may be entitled to financial support.

• If you have a job but can’t work because of your illness, you're entitled to Statutory Sick Pay from your employer.
• If you don't have a job and can't work because of your illness, you may be entitled to Employment and Support Allowance.
• If you're caring for someone with cancer, you may be entitled to Carer’s Allowance.
• You may be eligible for other benefits if you have children living at home or you have a low household income.

It's a good idea to find out early on what help is available to you. You could ask to speak to the social worker at your hospital, who will be able give you the information you need.

Free prescriptions

People being treated for cancer are entitled to apply for an exemption certificate giving free prescriptions for all medication, including that which treats unrelated conditions.

The certificate is valid for five years. You can apply for a certificate by speaking to your GP or cancer specialist.

Want to know more?

• Directgov: benefits information

Cervical cancer doesn’t always mean you won’t be able to have a baby. Gynaecologist Dr Andy Nordin says, “For very early stage cervical cancer, where the cancer is very small and confined to the cervix, there are a number of different approaches that can preserve fertility.

“A simple treatment to the cervix called a cone biopsy may be all that is required to remove the cancer, with or without an operation to remove lymph nodes in the pelvis (depending on the size of the cancer).

“Even when the cancer is a little bit larger, generally up to 2cm in diameter, there is a relatively new operation called a trachelectomy that removes the cervix and the tissues adjacent to it, but preserves the womb and the ovaries, enabling a pregnancy to be achieved. 

“However, treatments for advanced stage cervical cancer generally do not enable a woman to preserve the possibility of carrying a pregnancy in the future, although for some women it is possible to effectively treat the cancer and enable the function of the ovaries to be preserved.”

For more information

Cancer Research UK

Cancerbackup (both link to external sites).

Prevention and early diagnosis can save lives

What you need to know about cervical cancer 

• Cervical cancer is cancer of the cervix.  The cervix connects a woman’s womb and her vagina.  It is also known as the neck of the womb
• Cervical cancer can affect women of all ages but is most common in women between 30 – 45 years of age.  It is very rare in women under 25
• Cervical screening –  previously known as a smear test - can prevent cervical cancer and saves thousands of lives each year
• In the future, most cervical cancers will be prevented by HPV vaccination. But for the next few decades, cervical screening will still be vitally important
• The earlier cervical cancer is diagnosed, the better the outcome will be, so it is important to know the signs and symptoms

What causes cervical cancer?

Nearly all cervical cancers are caused by a common sexually transmitted infection called human papilloma virus (HPV).  Most women have HPV at some time, which usually clears up on its own.  If the infection doesn’t clear up there is a risk of abnormal cells developing which could become cervical cancer over time.

What are the signs and symptoms of cervical cancer?

The following are the most common symptoms of cervical cancer.

• Any unusual bleeding from the vagina, particularly after sex or after the menopause when your periods have stopped
• Persistent vaginal discharge that is blood stained or smells unpleasant

If you have any of these symptoms, tell your doctor, even if you have been for screening. The chances are that they are not due to cancer, but it is important to have them checked.

What can I do to reduce my risk of developing cervical cancer?

• Go for cervical screening when you are invited
• Have the HPV vaccine if you are offered it
• If you smoke, try to stop
• Use a condom to reduce your risk of HPV and other sexually transmitted infections.

Even if you have had a normal screening result or have been vaccinated against HPV, it’s important to let your doctor know if you develop any of the symptoms of cervical cancer so they can be checked out.  Like all screening tests, cervical screening isn’t 100% perfect, and the HPV vaccine does not stop all types of HPV that may cause cervical cancer.

Be informed and make a plan

• Work out what you will do if you have abnormal bleeding – arrange to see a doctor
• As soon as your invitation to cervical screening arrives work out when you can go and make the appointment
• If you are 18 or under, consider having the HPV vaccination if you have not already done so.

The above information was produced by the Department of Health with grateful thanks to the cervical cancer key messages forum.