What Is Cervical Cancer?

Are you experiencing unusual vaginal bleeding? This can be worrying, and while it is a symptom associated with other, less serious conditions, it is also associated with cervical cancer. If diagnosed at an early stage and treated promptly, cervical cancer can be cured. As such, understanding what cervical cancer is and partaking in regular cervical screenings is very important. 

Overview

Cervical cancer is cancer that can be located anywhere in the cervix. The cervix is the narrow passage that forms the lower end of the uterus and connects it to the vagina. Cancer occurs when abnormal cells in the lining of the cervix begin to grow in an uncontrollable manner, forming a tumour. 

Cervical cancer is the fourth most common cancer in women globally.²  Virtually all cases of cervical cancer are caused by an infection from a specific type of genital human papillomavirus (HPV), which can sometimes present itself as warts on the skin. Attending cervical screenings can help reduce the risk of cervical cancer by aiming to find and treat any cell changes before they turn into cancer. 

The treatment you receive for cervical cancer depends on a number of different considerations, but will likely include radiation therapy, chemotherapy, or surgery.

Causes of cervical cancer

Cervical cancer begins when healthy cells’ DNA begins to mutate in the cervix. 

A cell's DNA essentially tells it what to do. Healthy cells tend to grow and die at a set rate, so when the mutated DNA tells the healthy cells to grow and multiply at an uncontrolled rate, an accumulation of abnormal cells forms. These are called tumours. The cancerous cells then break off and invade nearby tissues to spread elsewhere in the body.⁴ 

HPV

Most people who are sexually active will come into contact with HPV during their lifetime. More often than not, the virus causes no harm and goes away on its own. However, if the immune system is unable to clear the infection within 2 years of its development, a long-lasting infection can occur. Long-lasting infection with high-risk types of HPV is the major cause of cervical cancer. 

You can get HPV from:⁶

• Skin-to-skin contact of the genital region
• Vaginal, anal, or oral sex
• Sharing sex toys

The use of condoms and dental dams can lower the chance of HPV transmission, but they do not prevent it completely. There is, however, an HPV vaccination which provides strong protection against new HPV infections. 

A clinical trial study showed that the HPV vaccination is estimated to prevent up to 90% of HPV-related cancers, like cervical cancer, and offers the most protection when given at ages 9-12.⁷ 

Other factors may increase your risk of cervical cancer

• Human immunodeficiency virus (HIV) or AIDS can increase your chances of developing cervical cancer because of a weakened immune system

• Sexually transmitted infections (STIs) can increase your chances of developing cervical cancer. For example, if you have chlamydia alongside HPV the risk is greater

• Smoking tobacco increases your risk of cervical cancer by making it harder to treat abnormal cells on your cervix

• The contraceptive pill can increase your risk of cervical cancer if taken for longer than 5 years, but the increased risk drops once you stop taking it. 1 in every 10 cases of cervical cancer is directly linked to taking the contraceptive pill⁸

• Family history may increase your risk of cervical cancer

• Previous cancers may also increase your risk of cervical cancer. This applies if you have had cancer of the:

            - Vagina

            - Urinary tract 

            - Vulva

            - Kidney

• Many sexual partners and early sexual activity can increase the risk of developing cervical cancer. The greater your number of sexual partners - and the greater the number of your partner's sexual partners - the greater your risk of HPV

Signs and symptoms of cervical cancer

Early-stage cervical cancer and precancerous cell changes don't usually have any signs or symptoms. Symptoms usually only begin once the cancer has spread. This is why attending regular cervical screening is so important.

When early-stage symptoms do occur, they can include:

• Vaginal bleeding after sex, between periods, or after menopause
• Pain or discomfort during sex 
• Unusual vaginal discharge that may be watery, has a foul odour, or contains blood
• Pain in the region between the hip bones during sex

Symptoms of advanced cervical cancer may include the symptoms of early-stage and the following:

• Painful bowel movements or bleeding from the rectum while having a bowel movement
• Painful urination or blood in the urine
• Backache
• Swelling of the legs
• Pain in the abdomen
• Feeling tired

These conditions are common to many other conditions. The only way to know if it is cervical cancer is to see your healthcare provider or doctor. Ignoring symptoms can make eventual treatment less effective.⁹

Management and treatment for cervical cancer

Luckily, there are ways to manage and treat cervical cancer. The treatment you receive will depend on:

• The location and size of the cancer
• The type of cervical cancer
• If the cancer has spread or not 
• The extent of abnormality of the cells under a microscope 
• Your general health

The types of treatments you receive will likely include surgery, chemotherapy, radiotherapy, or targeted medicine to treat the cancer.

Surgery

Surgery is often the main treatment for cervical cancer. There are different surgical options depending on what stage the cancer is at. 

If discovered at an early stage, surgery can remove part of the cervix or the cervix and the upper part of the vagina while still allowing you to get pregnant in the future. If found at a later stage, a hysterectomy may be necessary, which involves having the cervix and womb completely removed. 

You may also need to have your lymph nodes removed if the cancer has begun spreading to the nearby tissues of the cervix.

Chemotherapy

Chemotherapy utilises anti-cancer drugs to kill cancerous cells. It does this by entering the bloodstream via injection into the vein or given orally, allowing the drugs to quickly reach almost all areas of the body.

Chemotherapy can be used in the management of cervical cancer:

• As part of the main treatment with radiotherapy 
• If the cancer has spread to other parts of the body or returned after previous treatment
• Before treatment to shrink the cancer 
• After surgery to help prevent the cancer from returning

Radiotherapy

Radiotherapy uses high energy x-rays to kill cancerous cells.

You may have radiotherapy for cervical cancer:

• As part of the main treatment if the cancer has reached a stage where it has spread
• After surgery (usually with chemotherapy) to help prevent the cancer from returning
• To help improve symptoms such as bleeding

Radiotherapy for cervical cancer may be given from outside or inside the body.

Targeted Medicines

There is a targeted medicine called bevacizumab (Avastin) which can be used to help make the cancer smaller or stop it from getting any larger in patients with advanced or returned cervical cancer. This does not cure the cancer. 

FAQs

How is cervical cancer diagnosed?

The test used to diagnose cervical cancer is called a colposcopy. The test usually takes around 15 to 30 minutes and should not be painful but may be found uncomfortable. If you have a biopsy, a small amount of bleeding or cramping afterwards can be expected.

How can I prevent cervical cancer?

You can help prevent cervical cancer by having:

• A Pap test 
• A HPV test 
• The HPV vaccine

What are the types of cervical cancer?

Squamous cell carcinoma - These cancers develop from the cells in the ectocervix and they are the most common type.

Adenocarcinoma - These cancers develop in the glandular cells of the endocervix and are the second main type.

Small cell cancer of the cervix - This is a neuroendocrine cancer and is the rarest type of cervical cancer.

How common is cervical cancer?

Worldwide, cervical cancer is the fourth most frequent cancer in women.²  And in the UK, it is the 14th most common.⁸

Who is at risk of cervical cancer?

You may be more likely to get cervical cancer if:

• You are under the age of 45 - cervical cancer is more common in younger women, and women under 45 make up more than half of the cervical cancer cases in the UK⁸
• Your mother took the hormonal medicine diethylstilbestrol (DES) whilst pregnant with you
• You have a weakened immune system

What are the stages of cervical cancer?

Stage i - This means the cancer is only in the cervix. Surgery is the main treatment but some people may need chemoradiotherapy too.

Stage ii - This means the cancer has spread outside of the cervix into the surrounding tissues. Chemoradiotherapy, the combination of chemotherapy and radiotherapy, and sometimes surgery are often the main treatments for this stage.

Stage iii - This means the cancer has spread from the cervix into the lymph nodes in the pelvis or abdomen or surrounding structures. The usual treatment is chemoradiotherapy. 

Stage iv - This means the cancer has spread to the bladder, rectum, or even further. The main treatments are chemotherapy with a targeted cancer drug, radiotherapy, surgery, or symptom control.¹⁰

When should I see a doctor?

If you notice a change that isn't normal for you, or you are experiencing symptoms, please see a doctor. 

Summary

Cervical cancer is a common type of cancer found in women globally, but is also one of the most preventable types of cancer with the use of cervical screening, HPV tests, and the HPV vaccine. These measures enable early detection of cervical abnormalities, allowing for early treatment.

 HPV infection is the main cause of cervical cancer and is often acquired by most sexually active people. There are different treatment options available for cervical cancer, which will be dependent on a number of factors regarding the cancer. If you are concerned that you may have cervical cancer, please contact your doctor.