Cervical Cancer

Cervical cancer develops when cells in the cervix grow in an uncontrolled way. The cervix is the narrow, lower part of the womb (uterus) that connects to the top of the vagina.

Most cervical cancers develop slowly. Before a cancer forms, the cells of the cervix often go through gradual changes, sometimes called pre-cancerous changes or cervical intraepithelial neoplasia. These changes are not cancer, and finding and treating them is the basis of cervical screening.

The most common type is squamous cell carcinoma, which starts in the flat cells covering the outer cervix. Another type, adenocarcinoma, starts in the gland cells of the cervical canal. Knowing the type helps guide treatment.

Early cervical cancer and pre-cancerous changes often cause no symptoms at all, which is why regular screening is so important. When symptoms do appear, the most common is unusual vaginal bleeding, such as bleeding after sex, between periods, or after the menopause.

Other symptoms can include changes in vaginal discharge, discomfort or pain during sex, and pain in the pelvis or lower back. In more advanced disease, symptoms may include pain when passing urine, blood in the urine, or swelling in the legs.

These symptoms are often caused by conditions that are not cancer. But any unusual vaginal bleeding, especially bleeding after sex or after menopause, should always be checked by a doctor, and people should not wait for their next routine screening if they have symptoms.

Almost all cervical cancers are caused by infection with high-risk types of human papillomavirus (HPV), a very common virus passed on through skin-to-skin contact in the genital area. Most people are infected with HPV at some point, and in the great majority the body clears it without harm. Cancer can develop when an infection with a high-risk type, particularly HPV 16 or 18, lasts for a long time.

Several factors can increase the risk. These include smoking, a weakened immune system (for example from HIV or certain medicines), and not attending cervical screening, which means early changes are more likely to be missed.

Because HPV is the main cause, the most effective ways to lower risk are HPV vaccination and regular cervical screening. Not smoking also helps.

Cervical screening is a test offered to people with a cervix to check the health of the cervix before any cancer develops. A small sample of cells is taken from the cervix and tested for high-risk HPV, and the cells may also be examined for early changes. Screening is not a test for cancer; its purpose is to find and treat early changes so that cancer can be prevented.

If screening shows high-risk HPV or abnormal cells, or if a person has symptoms, the next step is usually a colposcopy. This is a closer examination of the cervix using a magnifying device, during which a small tissue sample (biopsy) can be taken to be examined under a microscope.

If cancer is confirmed, further tests such as MRI, CT or PET-CT scans, and sometimes an examination under anaesthetic, are used to find out the size of the cancer and whether it has spread. This staging guides treatment.

Treatment depends on the stage of the cancer, its type, and a person's general health and wishes, including whether they hope to have children in the future. A team of specialists recommends the most suitable plan.

Pre-cancerous changes found through screening can usually be treated with simple procedures that remove or destroy the abnormal cells, often in an outpatient setting. For early-stage cancer, surgery is frequently used. This may range from removing a cone-shaped piece of the cervix to removing the womb (hysterectomy), with some options designed to preserve fertility where possible.

For larger or more advanced cancers, radiotherapy combined with chemotherapy is often the main treatment. Chemotherapy, targeted therapy or immunotherapy may also be used when the cancer has spread. The team will explain which combination is recommended and why.

Cervical cancer and its treatment can affect fertility and sexual wellbeing, and these are important to discuss early. Where appropriate, there may be fertility-preserving treatment options or the chance to discuss fertility preservation before treatment begins.

Support is also available for the emotional side of diagnosis and treatment, including specialist nurses, counsellors and support groups. The team can offer practical advice on managing the effects of treatment and looking after long-term wellbeing.

Cervical cancer is one of the most preventable cancers. The HPV vaccine protects against the virus types that cause most cases and works best when given before a person is exposed to HPV, which is why it is offered to young people. Vaccination does not remove the need for screening.

Attending cervical screening when invited is the other key step, because it can find and treat early cell changes long before they become cancer. Not smoking also lowers the risk.

When cervical cancer is found early, treatment is often very effective. The outlook depends on the stage at diagnosis, so taking up vaccination and screening, and acting promptly on symptoms, makes a real difference. The medical team can give the most accurate information for an individual situation.