Cervical cancer is a malignant tumour found in the tissues of the cervix. It occurs when abnormal cells in the cervix turn into cancer cells. The cancer cells break through the surface cells (epithelium) and the underlying tissue (stroma) of the cervix.
Cervical cancer most commonly begins in the cells of the transformation zone. At diagnosis, the cancer is often just within the cervix, but it may spread to tissues around the cervix (e.g. the vagina) or to other parts of the body.
What are the causes?
The main cause of cervical cancer is now known to be infection with human papillomavirus (HPV). There are also other known risk factors.
HPV
Most cases of cervical cancer occur many years after infection with a strain of human papillomavirus, which is the name for a group of wart viruses. It's a common infection affecting the surface of different body areas, such as the skin, vagina and cervix.
The pre-cancerous cell changes caused by HPV can be found by a Pap smear. There's now also a vaccination against HPV.
Smoking
Chemicals in tobacco can damage the cells of the cervix and make cancer more likely to develop.
Family history
If you have a first-degree relative (mother or sister) who has had cervical cancer, you have an increased chance of developing it too.
Diethylstilboestrol (DES) exposure
DES is an oestrogen-based medication prescribed to women from the 1950s to the early 1970s to prevent miscarriage. Although rare, studies have shown that the daughters of women who took DES have an increased risk of developing a rare type of adenocarcinoma.
What are the symptoms of cervical cancer?
If early cell changes develop into cervical cancer, the most common symptoms include:
- vaginal bleeding between periods or after menopause
- bleeding after intercourse
- pain during intercourse
- unusual vaginal discharge
- excessive tiredness
- leg pain or swelling
- lower back pain.
These symptoms can also be caused by other more common conditions. However, see your general practitioner (GP) if you're worried or the symptoms are ongoing. If necessary, your GP will refer you for tests to see if you have cancer.
Treatment
The doctor will advise you on the best treatment for the cancer. This will depend on the results of your tests, the location of the cancer and whether it's spread, your age and general health.
Surgery or a combination of chemotherapy and radiotherapy are the most common treatments for cervical cancer.
Surgery
Surgery is common for women who have small tumours found only within the cervix. The type of surgery will depend on the extent of the cancer.
Hysterectomy
A hysterectomy is the surgical removal of the uterus and cervix.
Depending on the extent of the cancer, you may also need to have a bilateral salpingo oophorectomy. This is when the ovaries and the Fallopian tubes are removed. They will be taken out at the same time as the hysterectomy. Women who have a bilateral salpingo oophorectomy and/or a hysterectomy will no longer be able to have children naturally (infertility).
If the tumour is very small, a cone biopsy may be the only treatment you need.
Removing lymph nodes
The doctor may decide to surgically remove some lymph nodes in your pelvic and/or abdominal area to see if the cancer has spread beyond the cervix. This is called a lymph node dissection or a lymphadenectomy. If you have cancer in your lymph nodes, the doctor may advise you to have additional treatment.
Trachelectomy
A radical trachelectomy is the removal of only the cervix. This isn't a common procedure, but it may be done in young women who have a small cancer. A trachelectomy preserves a woman's ability to become pregnant (fertility).
Radiotherapy
Radiotherapy uses x-rays to kill cancer cells or injure them so they can't multiply. The radiation is targeted at cancer sites and treatment is carefully planned to do as little harm as possible to your healthy body tissues.
Radiotherapy is usually given if you're not well enough for a major operation or if the cancer has spread into the tissues or lymph nodes surrounding the cervix. It may also be used after surgery or in combination with chemotherapy.
Chemotherapy
Chemotherapy uses drugs to kill or slow the growth of cancer cells. The aim is to destroy fast-growing cancer cells while causing the least possible damage to healthy cells. However, some healthy, fast-growing cells in your body, such as hair and bone marrow cells, may be affected.
Chemotherapy is usually given through a vein (intravenously). You may need to stay overnight in hospital or you may be treated as an outpatient.
The number of chemotherapy sessions you have will depend on the cancer and what other treatment you're having.
Palliative treatment
Palliative treatment helps to improve people's quality of life by alleviating symptoms of cancer without trying to cure the disease. It's particularly important for people with advanced cancer. However, it's not just for end-of-life care and it can be used at different stages of cancer.
Often treatment is concerned with pain relief and stopping the spread of cancer, but it also involves the management of other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication.