Cervical Cancer

The national screening programme, celebrity sufferers and the HPV vaccination schedule mean that cervical cancer awareness has increased. That’s good news because cervical cancer affects more than three thousand women in the UK [1] annually and rates are projected to go up over the decades to come.

Nationally we are working hard to prevent cervical cancer. However, many women are still affected every year. Expert treatment will help you fight the disease, but as with most cancers, it’s better if the condition is identified earlier. There will be a wider range of therapeutic options and a better chance of survival.

Mr Thomas Ind is an experienced gynaecological surgeon with a special interest in cancer care. He works with a team of professionals who will support and guide you through your cancer surgery and help you make a safe recovery.

What is the cervix?

The cervix is the neck of the womb. The uterus extends down towards the vagina and the narrow area of the womb where the two join is known as the cervix. It opens up in childbirth to let the baby through.

There is a membrane lining the cervix. The cells in this have a tendency to change over time.  This can be triggered by a several factors including infection with certain types of the human papilloma virus (HPV). Sometimes, these mutated cells become cancerous and grow into larger tumours.

Who is at risk of cervical cancer?

Each individual’s risk of developing cancer depends on a number of factors including their age, their lifestyle and their genetic heritage. In cervical cancer, a type of high-risk human papillomavirus (HPV) infection is the main contributory cause. In fact, in research [2] it is estimated to be linked to almost all cases of the disease.

Other lifestyle features are related to cervical cancer risk, including taking the oral contraceptive pill, smoking, early age of first intercourse, [3] number of sexual partners and HIV infection. However, this link may be because all of these can also increase the risk of contracting HPV.

Does age affect the chance of developing cervical cancer?

Younger women are at increased risk of cervical cancer. In the UK, more than half of all women affected are under the age of 45. That’s why the NHS offers a screening programme for women between the ages of 25 and 64. A cervical smear can identify abnormal cells in the membrane of the cervix that could potentially lead to cancer. These can be destroyed, reducing the danger of developing the disease.

It’s important to remember that although cervical cancer is more common in the young, it still frequently occurs in older women. If you have noticed concerning symptoms, it’s vital to get timely medical assessment and advice whatever your age.

What are the symptoms of cervical cancer?

In the early stages, most women will be unaware that cancer cells are growing in their cervix. There are often no clear symptoms, which is why regular smear testing is so important. It can highlight the presence of dysplasia, or abnormal cells, while the cancer is still invisible to the naked eye.

If the disease develops, you may notice abnormal vaginal bleeding. Look out for:

  • Vaginal bleeding between periods
  • Bleeding after sexual intercourse
  • Unusual vaginal discharge
  • Later on, the cancerous growths can start blocking the kidneys and surrounding area, which can be felt as back pain

What causes cervical cancer?

Certain types of the human papillomavirus (HPV) can trigger the cell changes that lead to cervical cancer [4]. There are a number of different strains of HPV, some appear to be harmless whereas others are clearly associated with cancer development. These are known as high-risk HPV and include Types 16 and 18, which are thought to be linked to around 70% of cervical cancer cases.

HPV is incredibly common and easy to pass on during normal sexual contact. Although some women may notice vulval or vaginal wart development, most cases of infection will have no symptoms. They can silently infect and potentially cause cell changes in the cervix.

The risk of getting HPV increases with the number of sexual partners, having sex at an earlier age and any immune system deficiency. Early vaccination against the HPV virus is the best way of protecting your cervical health.

Preventing cervical cancer

There are a number of ways of preventing cervical cancer. The best options are to prevent initial HPV infection and to catch abnormal cells on the cervix before they become cancerous:

Preventing HPV

  • Early vaccination against the virus is the best way of protecting your cervical health. There are vaccination programmes in schools and the vaccine is also available here at the Sloane Street Gynaecology Clinic.
  • Safe sex: Having fewer partners, delaying the age of first intercourse and using a condom may reduce the chance of contracting HPV.
  • Stop smoking: Smoking affects your ability to fight the HPV infection.

Cervical screening

  • Regular smear testing is an important way of preventing cancer. It can identify pre-cancerous cells on the cervix, so that the area can be further investigated by colposcopy and treatment started before cancer develops.

The treatment of cervical cancer

The best treatment for your cancer will depend on the size, severity and extent of the disease.  Mr Ind will talk you through the various options and make his therapeutic recommendation, taking into account your personal feelings and your general health and wellbeing.

Cone biopsy: If the cancer has been caught at an early stage and only a small area of the cervix is identified as cancerous, this can be taken out with a cone biopsy. A cone of tissue is removed under general anaesthetic. This can be examined under a microscope to check that all the cancer cells have been excised.

This treatment leaves the womb intact and maintains the ability to have children in the future, however it can slightly increase the changes of miscarriage and mid-pregnancy loss.

Radical hysterectomy: For more advanced cervical cancer, a radical hysterectomy may be required. This is an extensive operation which will be done under general anaesthetic. The uterus will be removed including the cervix and the top section of the vagina. Some surrounding tissue and the ligaments that hold the womb in place will also be removed. This is a big operation, which is always associated with some risk.

Trachelectomy:  Trachelectomy is a less well known procedure than hysterectomy, but it may be a viable alternative in some women with cervical cancer. The surgery can preserve the body of the womb. This means that fertility can be preserved if the procedure is successful.

Non-surgical treatment for cervical cancer:  Depending on the stage and severity of your cervical cancer, you may need further treatment to prevent recurrence of the disease. Options include: Chemotherapy, which uses a combination of drugs to prevent the cancer cells dividing and spreading, and Radiotherapy, which uses high strength radiation to destroy any remaining cancer cells. The two treatments are often used together, to increase effectiveness and improve the results.

Radiotherapy and chemotherapy can both cause serious side effects. They can affect your general health in the short term and could have long-term impacts in some patients. Find out more at Macmillan.org.uk.

Recovery from cervical cancer

The good news is that we’re getting better at treating cervical cancer. The survival of women in the UK with this condition has increased in the last 40 years. If cancer of the cervix is treated quickly before it can reach a more serious stage, the vast majority of women make a full recovery. After it has spread to other areas, it is much more difficult to treat and the chance of the cancer returning is greater. Overall 63% of women survive their cervical cancer for more than ten years [5].

Recurrence of cervical cancer

In the unlikely event that cervical cancer returns after being treated, it usually means the cancer has reached a more aggressive stage. This can be devastating news; however, you will not be alone. There will be a team of health professionals supporting you at this difficult time. Further treatment may help improve your chances of surviving the disease.

Careful assessment and consultation will help Mr Ind and his team work out the best therapeutic options. Sometimes further surgery to remove the vagina and other organs in the lower part of the body may be able to prevent the disease from spreading.

[1] http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer#heading-Zero

[2] https://academic.oup.com/jnci/article/95/6/E2/2520668

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982220/

[4] https://academic.oup.com/jnci/article/95/6/E2/2520668

[5] http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/cervical-cancer#heading-Zero