Worldwide, cervical cancer is both the fourth-most common cause of cancer and deaths from cancer in women. In 2012, 528,000 cases of cervical cancer were estimated to have occurred, with 266,000 deaths. It is the second-most common cause of female-specific cancer after breast cancer, accounting for around 8% of both total cancer cases and total cancer deaths in women. About 80% of cervical cancers occur in developing countries.
Cervical cancer is a type of cancer that develops in a woman’s cervix (the entrance to the womb from the vagina).
Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.
Abnormal bleeding doesn’t mean that you definitely have cervical cancer, but it should be investigated by your GP as soon as possible. If your GP thinks you might have cervical cancer, you should be referred to see a specialist within two weeks.
Read more about the symptoms of cervical cancer and diagnosing cervical cancer.
Screening for cervical cancer
Over the course of many years, the cells lining the surface of the cervix undergo a series of changes. In rare cases, these precancerous cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage and treatment can reduce the risk of cervical cancer developing.
An abnormal cervical screening test doesn’t mean you definitely have cancer. Most abnormal results are caused by an infection or the presence of treatable precancerous cells, rather than cancer itself.
Women aged 25 to 49 years of age are offered screening every three years, and women aged 50 to 64 are offered screening every five years. For women who are 65 or older, only those who haven’t been screened since they were 50, or those who have had recent abnormal tests, are offered screening.
You should be sent a letter confirming when your screening appointment is due. Contact your GP if you think you may be overdue for a screening appointment.
What causes cervical cancer
Almost all cases of cervical cancer are caused by the human papilloma virus (HPV). HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman.
There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer.
Two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection don’t have any symptoms, so many women won’t realise they have the infection.
However, it’s important to be aware that these infections are relatively common and most women who have them don’t develop cervical cancer.
Using condoms during sex offers some protection against HPV, but it can’t always prevent infection, because the virus is also spread through skin-to-skin contact of the wider genital area.
Since 2008, a HPV vaccine has been routinely offered to girls aged 12 and 13.
Read more about the causes of cervical cancer and preventing cervical cancer.
Treating cervical cancer
If cervical cancer is diagnosed at an early stage, it’s usually possible to treat it using surgery. In some cases, it’s possible to leave the womb in place, but it may need to be removed. The surgical procedure used to remove the womb is called a hysterectomy.
Radiotherapy is an alternative to surgery for some women with early stage cervical cancer. In some cases, it’s used alongside surgery.
More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy.
Some of the treatments used can have significant and long-lasting side effects, including early menopause and infertility.
Read more about treating cervical cancer.
Many women with cervical cancer will have complications. These can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, chemotherapy and surgery.
Complications associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina or having to urinate frequently, to life-threatening, such as severe bleeding or kidney failure.
Read more about the complications of cervical cancer.
The stage at which cervical cancer is diagnosed is an important factor in determining a woman’s outlook. The staging, given as a number from one to four, indicates how far the cancer has spread.
The chances of living for at least five years after being diagnosed with cervical cancer are:
Who’s affected by cervical cancer
Following the success of the NHS Cervical Screening Programme and the early detection of cell changes
It’s possible for women of all ages to develop cervical cancer, but the condition mainly affects sexually active women aged between 30 and 45. Cervical cancer is very rare in women under 25.
Human papillomavirus (HPV)
Infection appears to be involved in the development of more than 90% of cases; most people who have had HPV infections, however, do not develop cervical cancer.. Other risk factors include smoking, a weak immune system, birth control pills, starting sex at a young age, and having many sexual partners, but these are less important. Cervical cancer typically develops from precancerous changes over 10 to 20 years. About 90% of cervical cancer cases are squamous cell carcinomas, 10% are adenocarcinoma, and a small number are other types. Diagnosis is typically by cervical screening followed by a biopsy. Medical imaging is then done to determine whether or not the cancer has spread.
HPV vaccines protect against between two and seven high-risk strains of this family of viruses and may prevent up to 90% of cervical cancers. As a risk of cancer still exists, guidelines recommend continuing regular Pap smears. Other methods of prevention include: having few or no sexual partners and the use of condoms.
Cervical cancer screening using the Pap smear or acetic acid can identify precancerous changes which when treated can prevent the development of cancer. Treatment of cervical cancer may consist of some combination of surgery, chemotherapy, and radiotherapy. Five year survival rates in the United States are 68%. Outcomes, however, depend very much on how early the cancer is detected.
Signs and symptoms
The early stages of cervical cancer may be completely free of symptoms. Vaginal bleeding, contact bleeding (one most common form being bleeding after sexual intercourse), or (rarely) a vaginal mass may indicate the presence of malignancy. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer. In advanced disease, metastases may be present in the abdomen, lungs, or elsewhere.
Symptoms of advanced cervical cancer may include: loss of appetite, weight loss, fatigue, pelvic pain, back pain, leg pain, swollen legs, heavy vaginal bleeding, bone fractures, and/or (rarely) leakage of urine or feces from the vagina. Bleeding after douching or after a pelvic exam is a common symptom of cervical cancer.
In most cases, cells infected with the HPV virus heal on their own. In some cases, however, the virus continues to spread and becomes an invasive cancer.
Cervix in relation to upper part of vagina and posterior portion of uterus., showing difference in covering epithelium of inner structures
Infection with some types of HPV is the greatest risk factor for cervical cancer, followed by smoking. Other risk factors include human immunodeficiency virus. Not all of the causes of cervical cancer are known, however, and several other contributing factors have been implicated.
Infection with HPV is generally believed to be required for cervical cancer to occur.
Long-term use of oral contraceptives is associated with increased risk of cervical cancer. Women who have used oral contraceptives for 5 to 9 years have about three times the incidence of
Multiple pregnancies (high number of pregnancies)
Having many pregnancies is associated with an increased risk of cervical cancer. Among HPV-infected women, those who have had seven or more full-term pregnancies have around four times the risk of cancer compared with women with no pregnancies, and two to three times the risk of women who have had one or two full-term pregnancies.
Checking the cervix by the Papanicolaou test, or Pap smear, for cervical cancer has been credited with dramatically reducing the number of cases of and mortality from cervical cancer in developed countries.
Pap smear screening every 3–5 years with appropriate follow-up can reduce cervical cancer incidence up to 80%. Abnormal results may suggest the presence of precancerous changes, allowing examination and possible preventive treatment.
The treatment of low-grade lesions may adversely affect subsequent fertility and pregnancy.
Personal invitations encouraging women to get screened are effective at increasing the likelihood they will do so. Educational materials also help increase the likelihood women will go for screening, but they are not as effective as invitations.
According to the 2010 European guidelines, the age at which to start screening ranges between 20 and 30 years of age, “but preferentially not before age 25 or 30 years”, and depends on burden of the disease in the population and the available resources.
Two HPV vaccines (Gardasil and Cervix) reduce the risk of cancerous or precancerous changes of the cervix and perineum by about 93% and 62%, respectively.
The vaccines are between 92% and 100% effective against HPV 16 and 18 up to at least 8 years.
HPV vaccines are typically given to age 9 to 26 as the vaccine is only effective if given before infection occurs. The vaccines have been shown to be effective for at least 4 to 6 years, and they are believed to be effective for longer; however, the duration of effectiveness and whether a booster will be needed is unknown. The high cost of this vaccine has been a cause for concern. Several countries have considered (or are considering) programs to fund HPV vaccination.
For further information visit EFSTH, number of NGO and private clinics, Email to firstname.lastname@example.org, text to Dr Azadeh 002207774469/3774469.
Author DR AZADEH Senior Lecturer at the university of the Gambia , Senior Consultant in Obstetrics and Gynaecology, Clinical Director at Medicare Health Sevices