Cervical cancer

• Cervical cancer can affect women of all ages, but it affects women primarily 30-45 years of age. In women under 25 years of age, it is very rare.
• Nearly all squamous cervical cancers are caused by the common sexually transmitted infection, HPV.
• Most women will contract HPV at some stage during their life; this usually clears without the need for any treatment. If the woman is unable to clear the virus, then there is a risk of abnormal cells developing and these may become cancerous over time.
• If abnormal cervical cells are caught early, then cervical cancer can be prevented.
• There are far fewer women now getting or dying from cervical cancer than was the case in the past. This is predominantly due to the NHS cervical screening programme, which detects changes in the cells of the cervix at a pre-cancerous stage.

Cancer of the cervix is one of the few preventable cancers; it is the most common cancer in women under 35 years old. Approximately 4 in 10 cancer cases in the UK each year could be prevented (Cancer Research UK, (CRUK), 2018a). Globally, there are millions of women who are diagnosed with cancer; cervical cancer is the second most common female malignancy. There are multifactorial issues associated with gynaecological cancers. It has been demonstrated that cervical screening programmes are associated with improved rate of cure of cervical cancer.

Cervical cancer occurs when abnormal cells that line the cervix grow in an uncontrolled way. Cervical cancer is caused by a persistent infection, an infection of longer than 2 years with high-risk human papilloma virus (HPV). Virtually all cases of cervical cancer are caused by HPV. HPV can cause cancers in other genitalia, such as the vagina, vulva, penis, and anus; it

There are several risk factors associated with cervical cancer:

• The presence of the human papilloma virus (HPV) (highest risks are HPV types 16 and 18)
• Women of low socioeconomic status
• Multiparas (a woman who has had two or more viable pregnancies)
• Those engaging in sexual activity at a young age, or with multiple partners
• Cigarette smoking
• Women with a history of sexually transmitted infections, especially herpes or genital warts
• Lack of attendance at cervical screening
• Those women who are immunosuppressed have a higher risk of cervical carcinoma.

The first symptoms of established cervical carcinoma include:

• Vaginal discharge - this can vary in amount and can be intermittent or continuous
• Bleeding - this may be spontaneous, but can also occur after sex, micturition (urination) or defaecation. This may be ignored by some women, who think this is because of normal menstrual dysfunction
• There may be severe vaginal bleeding and this can require emergency hospital admission.
• There may be vaginal discomfort and urinary symptoms and the woman may be experiencing dyspareunia (painful sexual intercourse).

Late symptoms can include:

• Painless haematuria (blood in urine)
• Chronic urinary frequency
• Painless fresh rectal bleeding
• Altered bowel habit
• Leg oedema (excess of watery fluid)
• Pain and hydronephrosis (swelling of a kidney due to a build-up of urine) leading to renal failure, which can indicate late signs of pelvic wall involvement.

In more advanced disease, women may develop pelvic discomfort or poorly localised pain, describing

A detailed health history is undertaken. If the woman has had an abnormal result from the cervical screening test or if she has had symptoms that might be caused by cervical cancer, a colposcopy is undertaken. Colposcopy is a test that is undertaken to closely observe the cervix in detail using a colposcope (a lighted magnifying instrument: Figure 1). During this examination, biopsies may be taken if there are any abnormal areas.

Cervical intra-epithelial neoplasia (CIN) is the name given to the most common type of abnormal cells identified during colposcopy. CIN is graded by how deep the cell changes penetrate the surface of the cervix:

• CIN 1: one-third of the thickness of the surface layer is affected. CIN 1 will often return to normal requiring no treatment.
• CIN 2: two-thirds of the thickness of the surface layer is affected.
• CIN 3: the full thickness of the surface layer is

Treatment will depend on where in the cervix the cancer is, how large it is and if it has spread anywhere else in the body, along with the woman's general health, which is why it is important to grade and stage the cancer. Usually, treatment options include:

• Surgery
• Chemotherapy
• Radiotherapy
• A combination of chemotherapy and radiotherapy.

A multidisciplinary approach is used in the treatment of cervical cancer. The aim of any treatment is to offer the woman the best possible outcomes with the least possible side effects.

Health promotion 

There is no single way to prevent cervical cancer. Regular cervical screening is the best way to identify abnormal changes in the cells of the cervix at an early stage.

The NHS cervical cancer vaccination programme offers girls and boys protection against four types of HPV, including the 2 strains responsible for the majority of cervical cancers in the UK (HPV

I would like to thank Mrs Frances Cohen for her help and support.