Overview
The cervix is the narrow lower part of the womb that opens into the vagina. Cervical cancer starts in the cells lining it, almost always after a long-lasting infection with certain high risk types of human papillomavirus, usually shortened to .
HPV is a common infection passed on by skin to skin sexual contact, and in most people the body clears it on its own. In a few, the infection stays for years and slowly changes the cells of the cervix. Those changes can be found and treated long before they become cancer, which is why cervical cancer is one of the most preventable cancers there is.
Symptoms
In its early stages cervical cancer usually causes nothing at all. When symptoms do appear they can include:
- Vaginal bleeding that is unusual for you, including between periods, after sex, or any bleeding after menopause
- Periods that become heavier or last longer than they used to
- Vaginal discharge that changes in amount, colour or smell
- Pain during sex
- Pain in the lower tummy, the pelvis or the lower back
- In advanced disease, weight loss, tiredness or swelling of a leg
These symptoms are common and are far more often caused by infections, fibroids or hormonal changes. They still need to be looked at rather than explained away.
When to see a doctor
See a doctor within a few days for bleeding between periods, bleeding after sex, any bleeding after menopause, a discharge that has changed, pain during sex, or pelvic pain that does not settle. Also book an appointment if a test is overdue or a result has been called abnormal.
Causes
Nearly every cervical cancer is caused by persistent infection with high risk , most often types 16 and 18. The virus changes the way cervical cells divide, and over many years abnormal cells can turn into cancer.
Having HPV is not the same as having cancer. The infection is extremely common and usually clears by itself. What matters is infection that lasts, and anything that weakens the body's ability to clear it.
Risk factors
- Infection with a high risk type of that does not clear
- Never having had cervical , or not having it at the recommended intervals
- Not having been vaccinated against HPV
- Living with HIV, or any other cause of a weakened immune system
- Smoking or chewing tobacco
- Other sexually transmitted infections
- Long term use of hormonal contraception
- A first pregnancy at a young age, and several pregnancies
Complications
If it is not treated, cancer of the cervix grows into the surrounding tissue, can block the tubes that drain the kidneys, and can spread to the lymph nodes, the bladder, the bowel, the lungs or the bones. Bleeding, pain and kidney problems become harder to manage at that stage.
Treatment can also have lasting effects. Surgery or may bring on an early menopause, change the vagina, cause bladder or bowel problems, or make future pregnancy impossible. When cancer is found early, treatment that preserves fertility is sometimes possible, so it is worth asking before treatment starts.
Prevention
- vaccination, given to girls around the ages of nine to fourteen, before any exposure to the virus
- Cervical at the recommended ages and intervals, even after vaccination
- Coming back for treatment if screening finds abnormal cells, because treating them prevents cancer
- Not smoking or chewing tobacco
- Using condoms, which lower but do not remove the chance of passing on HPV
- Getting any unusual bleeding or discharge looked at early
The World Health Organization has set out a plan to end cervical cancer as a public health problem, built on these three things: vaccinating girls, screening women, and treating what is found.
Diagnosis
is done on a sample of cells taken from the cervix. The preferred test looks for high risk , and where HPV is found the same sample is checked for abnormal cells. The World Health Organization suggests screening from the age of thirty for most women, and from twenty five for women living with HIV, repeated every few years. A sample collected by the woman herself is a reliable option where that is offered.
If screening is abnormal, or symptoms suggest cancer, the next step is colposcopy: the cervix is examined with a magnifying instrument and a small is taken. If cancer is confirmed, scans and blood tests work out how far it has spread, which decides the treatment.
Treatment
Abnormal cells found before they become cancer are removed or destroyed in a short outpatient procedure, using heat, freezing, or the removal of a small cone of tissue. This is simple and highly effective.
Cancer itself is treated by a team, and the plan depends on the stage:
- Surgery, from removing a cone of the cervix in very early disease to removing the womb and nearby lymph nodes
- , often given both from outside and from inside the vagina
- , commonly given alongside radiotherapy
- Medicines that help the immune system attack the cancer, in some advanced cases
- Care that controls pain and other symptoms, at any stage
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Only women who have had many partners get cervical cancer.”What is true?
Fact
HPV is a very common infection, and a single partner is enough to pass it on. Most people clear the virus without ever knowing they had it. Cervical cancer develops in the few whose infection persists for years, which is why screening matters for every woman with a cervix, married or not.
Myth“I feel completely well, so I do not need screening.”What is true?
Fact
Early cervical cancer, and the cell changes that come before it, cause no symptoms at all. Screening exists precisely to find those silent changes, often years before they could become cancer, when simple treatment can remove them.
Myth“The HPV vaccine encourages girls to become sexually active, or harms fertility.”What is true?
Fact
The vaccine protects against the HPV types that cause most cervical cancer, and it works best when given before any exposure to the virus, which is why it is offered to girls around the ages of nine to fourteen. It is not a reason for, or a licence for, anything else.
Myth“If my daughter has had the HPV vaccine she never needs screening.”What is true?
Fact
The vaccine covers the HPV types that cause most, but not all, cervical cancer. Women who have been vaccinated are still advised to have screening at the recommended ages.
Myth“A cervical screening test is a test for cancer.”What is true?
Fact
It is the opposite. Screening checks the health of the cervix and looks for HPV or for early cell changes, so that they can be treated before cancer ever develops. A positive HPV result is common and does not mean cancer.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
My HPV test came back positive. Do I have cancer?
No. A positive HPV test means the virus is present, which is common and usually clears on its own. It tells the doctor to look more closely, either by checking the same sample for cell changes or by arranging a colposcopy. Most women with HPV never develop cervical cancer.
My daughter is twelve. Is she too young for the HPV vaccine?
No, that is close to the ideal age. The vaccine protects against infection, so it works best when it is given before any exposure to the virus, and it is offered to girls from about nine to fourteen. The number of doses depends on the age at which the course is started.
I have had a hysterectomy. Do I still need cervical screening?
It depends on whether the cervix was removed and why the operation was done. If the cervix was taken out for a non-cancerous reason, screening is usually no longer needed. If it was left in place, or the surgery was for abnormal cells or cancer, screening or follow up continues. Ask the surgeon who did the operation.
Can cervical cancer be treated and still leave me able to have children?
Sometimes. In very early disease, an operation that removes the cervix or a cone of it while leaving the womb can be possible, and pregnancy afterwards may still happen. This depends entirely on the stage and type, so raise it with the specialist before treatment is planned, not after.
