Cervical Cancer

Cervical cancer (cancer of the cervix) is cancer of the neck of the womb. The cervix is the lower part of the uterus (womb) which extends slightly into the top of the vagina. Most cases develop in women in their 40s to 60s. If cervical cancer is diagnosed at an early stage, there is a good chance of a cure. Regular cervical screening tests can detect 'pre-cancer' which can be treated before cancer develops

A narrow passage called the cervical canal (or endocervical canal) goes from the vagina to the inside of the uterus. This is normally kept quite tightly shut, but allows blood to flow out from the uterus during a period, and sperm to travel inside if you have sex. It opens very wide during labour if you have a baby. The surface of the cervix is covered with skin-like cells. There are also some tiny glands in the lining of cervical canal which make mucus.

There are two main types of cervical cancer:

  • Squamous cell cervical cancer is the most common. This develops from a skin-like cell (a squamous cell) that covers the cervix which becomes cancerous.
  • Adenocarcinoma cervical cancer is less common. This develops from a glandular cell (a cell that makes mucus) within the cervical canal which becomes cancerous.

Cervical cancer is the second most common type of cancer in women in the UK. It kills just over 1,000 women every year in the UK. However, the number of cases diagnosed each year has fallen over recent years. This is because cervical cancer can be prevented by regular cervical screening tests (see Cervical Screening and Colposcopy).

Causes of Cervical Cancer?

In the case of cervical cancer, the cancer develops from a cell which is already abnormal. In most cases, abnormal cells are present for years before one of the abnormal cells becomes cancerous and starts to multiply out of control into a cancerous tumour. The initial 'pre-cancerous' abnormality of cervical cells is usually caused by a prior infection with the human papilloma virus.

Human papilloma virus (HPV) and cervical cancer

There are many strains of HPV. Two types, HPV 16 and 18, are involved in the development of most cases of cervical cancer. (Note: some other strains of HPV cause common warts and verrucas. These strains of HPV are not associated with cervical cancer.) The strains of HPV associated with cervical cancer are nearly always passed on by having sex with an infected person. An infection with one of these strains of HPV does not usually cause symptoms. So, you cannot tell if you or the person you have sex with are infected with one of these strains of HPV.

In some women, the strains of HPV that are associated with cervical cancer affect the cells of the cervix. This makes them more likely to become abnormal which may later (usually years later) turn into cancerous cells. Note: within two years, 9 out of 10 infections with HPV will clear completely from the body. This means that most women who are infected with these strains of HPV do not develop cancer.

The HPV vaccine has recently been introduced for girls from the age of 12 in the UK. Studies have shown that the HPV vaccine is very effective at stopping cancer of the cervix developing. The vaccine has been shown to work better for people who are given the vaccine when they are younger, before they are sexually active, compared to when it is given to adults. However, even if you have had the HPV vaccine you must attend for cervical screening. This is because the vaccine does not guarantee complete protection against cervical cancer.

Other factors

Other factors that increase the risk of developing cervical cancer include the following:

  • Smoking. Chemicals from cigarettes get into the bloodstream and can affect cells throughout the body. Smokers are more likely than non-smokers to develop certain cancers, including cervical cancer. In particular, if you smoke and have HPV infection, the risk is compounded.
  • A poor immune system. For example, people with AIDS or people taking immunosuppressant medication have an increased risk. (If your immune system is not working fully then you are less able to deal with HPV infection and abnormal cells and you are more at risk of developing cervical cancer.)
  • There is a possible link between the combined oral contraceptive pill ("the pill") and a slight increased risk of cervical cancer if the pill is taken for more than eight years.

Symptoms of Cervical Cancer

You may have no symptoms at first when the tumour is small. As the tumour becomes larger, in most cases the first symptom to develop is abnormal vaginal bleeding such as:

  • Bleeding between normal periods (intermenstrual bleeding).
  • Bleeding after having sex (post coital bleeding).
  • Any vaginal bleeding in women past the menopause.

An early symptom in some cases is a vaginal discharge that smells unpleasant, or discomfort or pain during sex. All of the above symptoms can be caused by various other common conditions. But if you develop any of these symptoms, you should have it checked out by a doctor. In time, if the cancer spreads to other parts of the body, various other symptoms can develop.

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