Cervical cancer
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist
What is the cervix?
The cervix is the lower part of the womb or uterus and is commonly referred to as the 'neck of the womb'.
The cervix plays an important role in maintaining a normal pregnancy. In non-pregnant women, the cervix has no obvious function although it may be important to the enjoyment of sex in some women.
If you squat or stand with one leg on a chair and put one or two fingers into your vagina, you will be able to feel the smooth, rounded cervix at the top of your vagina.
What is cervical cancer?
Cervical cancer is the sixth most common cancer in women in the UK.
It is important to be clear about what is and what is not cervical cancer. Women should have a cervical smear test, often known as a Pap smear test, performed on a regular basis in order to detect the cell changes that come before cancer.
It takes many years for the early cell changes that can be detected on a cervical smear to become cancer and in many cases the changes can go away by themselves.
The vast majority of abnormal smear test results do not indicate that the woman has cancer. It is by diagnosing and treating these pre-cancerous changes (also called CIN) that the development of actual cancer can be prevented.
Cancer of the cervix is a life-threatening condition of which there are two types called squamous cell cancer and adenocarcinoma. Cervical smear tests aim to detect the early changes of squamous cell cancer.
If it is detected in the early stages, cervical cancer can be treated and cured with surgery or radiotherapy.
What causes cervical cancer?
There is no definite single cause in most cases. A viral infection of the cervix is present in most cases. Smoking appears to increase a woman's risk of developing cervical cancer, and there may also be a link to the numbers of sexual partners a woman has had at a young age.
Cervical cancer is commonest among the over 50s but it can affect all age groups.
One of the ways a woman can reduce her risk of developing cervical cancer is to attend regular cervical smear tests. In the UK, these are routinely performed every three years.
What are the symptoms of cervical cancer?
Pre-cancerous changes of the cervix (CIN), which can be detected with a cervical smear test, do not give any symptoms. While some actual cancers of the cervix do not give rise to symptoms, most cause the woman to experience bleeding between her periods or after sex.
How is cervical cancer diagnosed?
It can only be diagnosed through a biopsy of the cervix. This is usually performed at the time of an internal examination called a colposcopy.
How is cervical cancer treated?
If cervical cancer is diagnosed the treatment options will be discussed. The treatment will depend upon whether the cancer has spread to involve other tissues in the pelvis or if it only involves the cervix.
Most women's treatment will include a type of hysterectomy called a radical hysterectomy or Wertheim's hysterectomy. This type of operation is only carried out by specially trained gynaecologists.
Radiotherapy may also form part of the treatment and is aimed at destroying tumour cells that the gynaecologist cannot see.
The cure rate for cervical cancer depends upon whether or not it has spread beyond the cervix.
References
National Cancer Guidance Steering Group. Improving Outcomes in Gynaecological Cancers: The Research Evidence London: NHS Executive, Department of Health, 1999.
Based on a text by Dr Erik Fangel Poulsen, specialist
Last updated 01.05.2005
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