Cervical cancer: The need-to-know answers

When cells begin to grow abnormally in the cervix, they can become cancerous resulting in cervical cancer. Screening for cervical cancer has increased in recent years, resulting in more diagnoses. If you, or anyone you know, have been diagnosed with cervical cancer, it can be overwhelming and you’ll have a lot of questions. Highly-experienced consultant gynaecologist Mr Rahul Nath, based in London, shares his expertise on the condition and answers some of the most pressing questions.

What is cervical cancer?

The cervix is the neck of the womb, connecting it to the vagina. When the skin-like outer or glandular inner cells of the cervix grow abnormally, they can become cancerous, resulting in cervical cancer. The transformation zone, at the opening of the cervix, is where normal cells are most likely to become cancerous and during a cervical cancer screening this is the area that is examined.

Is cervical cancer common?

Approximately 3200 cases of cervical cancer were diagnosed in 2014 in the UK, making it the 13th most common cancer that affects women. Over half of all new cases (52 per cent) affect women under the age of 45, however, thanks to widespread screening programmes, these incidence rates have reduced by about a quarter over the last 30 years.

Who is at risk of cervical cancer?

Human papillomavirus (HPV) infection is linked to all cases of cervical cancer in the UK. There are different types of HPV with varying degrees of risk associated. In Europe, 75 per cent of cases are associated with HPV16 and HPV18. Thankfully, a vaccine can protect against these. People at risk of contracting HPV, and later developing cervical cancer, are those who:

• are not vaccinated against HPV
• had multiple sexual partners
• had sexual intercourse at a young age, under 14 years
• have an uncircumcised male partner

Additionally, these factors increase the risk of cervical cancer developing:

• the use of combined oral contraceptives for 5 years or more
• pregnancy, particularly under the age of 17
• smoking and breathing second-hand smoke

What are the symptoms of cervical cancer?

Typical symptoms of cervical cancer include:

• menstrual cycle changes
• vaginal bleeding between periods, during or after sexual intercourse, or after menopause
• vaginal discharge

How is cervical cancer diagnosed?

Diagnostic tests may be arranged if someone is experiencing the previously mentioned symptoms or if the results of a screening test appears abnormal. These tests can include:

• A colposcopy: is a magnifying instrument used to examine the cervix. It may remove some tissue (biopsy) as a sample or remove abnormal growths. Lasting between 10 to 15 minutes, it usually doesn’t cause any pain, but some patients may experience discomfort if a biopsy is carried out.
• A LLETZ biopsy: involves taking a tissue sample in the shape of a cone from the opening of the cervix, the transformation zone. It is performed under either local or general anaesthetic. Following the procedure, for up to four weeks, bleeding can occur but there is medication available to control this.

What treatments options are there for cervical cancer?

In most cases of early-stage cancer, surgery will be required to remove cancerous tissue. The type of surgery depends on various factors, such as the patient's wishes and overall health, as well as the size of the tumour. Radical hysterectomy, the removal of the womb, its supporting structure, top of the vagina, and the lymph nodes, is recommended for patients who don’t want any (more) children. In some instances, the patient will want to preserve their fertility and if the tumour is central and small, it may be possible to remove enough of the cervix to remove the cancerous tissue and preserve the patient’s chance of having a successful pregnancy. This surgery is called a radical trachelectomy.

If the tumour is larger than 4cm in size or has spread to other parts of the body, a combination of chemotherapy and radiation is offered. If women who have had the cancer removed surgically are considered to be at high risk for recurrence, they might also be offered this combination of chemotherapy and radiation.

If you would like to find out more about cervical cancer and book a consultation with Mr Rahul Nath, you can do so by visiting his Top Doctors profile.