MEDsan — Home of the iSelfTest Learn more

Shop our latest products! Learn more

Cervical Cancer

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 or Gynecologist as soon as possible. If your GP thinks you might have cervical cancer, you should be referred to see a specialist within 2 weeks.

Screening for cervical cancer

Cervical screening (also known as a smear test) is routinely offered to anyone with a cervix in Scotland, between the ages of 25 and 64, every 5 years. You may be recalled more often depending on your test results.

Those on non-routine screening (where screening results have shown changes that need further investigation or follow up) will be invited up to 70 years of age. 

If you have unusual discharge, or bleeding after sex, between periods or after the menopause, contact your GP practice. These symptoms are not usually caused by cancer but it’s important to have them checked. 

You will 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.

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.

Complications

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.

Outlook

The stage at which cervical cancer is diagnosed is an important factor in determining outlook. The staging, given as a number from 1 to 4, indicates how far the cancer has spread.

The chances of living for at least 5 years after being diagnosed with cervical cancer are:

  • stage 1 – 80-99%
  • stage 2 – 60-90%
  • stage 3 – 30-50%
  • stage 4 – 20%

Who’s affected by cervical cancer?

Following the success of  Cervical Screening Programs and the early detection of cell changes, the number of cervical cancer cases in the U.S. has reduced. 

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.

Symptoms of cervical cancer

The symptoms of cervical cancer aren’t always obvious, and it may not cause any symptoms at all until it’s reached an advanced stage.

This is why it’s very important that you attend all of your cervical screening appointments.

Unusual bleeding

In most cases, vaginal bleeding is the first noticeable symptom of cervical cancer. It usually occurs after having sex.

Bleeding at any other time, other than your expected monthly period is also considered unusual. This includes bleeding after the menopause (when a woman’s monthly periods stop).

Visit your GP for advice if you experience any type of unusual vaginal bleeding.

Other symptoms

Other symptoms of cervical cancer may include pain and discomfort during sex and an unpleasant smelling vaginal discharge.

Advanced cervical cancer

If the cancer spreads out of your cervix and into surrounding tissue and organs, it can trigger a range of other symptoms, including:

  • constipation
  • blood in your urine (haematuria)
  • loss of bladder control (urinary incontinence)
  • bone pain
  • swelling of one of your legs
  • severe pain in your side or back caused by swelling in your kidneys, related to a condition called hydronephrosis
  • changes to your bladder and bowel habits
  • loss of appetite
  • weight loss
  • tiredness and a lack of energy

When to seek medical advice

You should contact your GP if you experience:

  • bleeding after sex (postcoital bleeding)
  • bleeding outside of your normal periods
  • new bleeding after the menopause

Vaginal bleeding is very common and can have a wide range of causes, so it doesn’t necessarily mean you have cervical cancer. However, unusual vaginal bleeding is a symptom that needs to be investigated by your GP.

Causes of cervical cancer

In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papilloma virus (HPV).

Cancer begins with a change in the structure of the DNA that’s present in all human cells. DNA provides the cells with a basic set of instructions, including when to grow and reproduce.

A change in the DNA’s structure is known as a mutation. It can alter the instructions that control cell growth, which means the cells continue growing instead of stopping when they should. If the cells reproduce uncontrollably, they produce a lump of tissue called a tumour.

Human papilloma virus (HPV)

More than 99% of cervical cancer cases occur in women who have been previously infected with HPV. HPV is a group of viruses, rather than a single virus. There are more than 100 different types.

HPV is spread during sexual intercourse and other types of sexual activity (such as skin-to-skin contact of the genital areas, or using sex toys) and is thought to be very common. It’s estimated that 1 in 3 women will develop an HPV infection within 2 years of starting to have regular sex, and about 4 in 5 women will develop the infection at some point in their lives.

Some types of HPV don’t cause any noticeable symptoms and the infection will pass without treatment. Other types of HPV can cause genital warts, although these types aren’t linked to an increased risk of causing cervical cancer.

About 15 types of HPV are considered high-risk for cervical cancer. The 2 types known to have the highest risk are HPV 16 and HPV 18, which cause about 7 out of every 10 cervical cancers.

High-risk types of HPV are thought to contain genetic material that can be passed into the cells of the cervix. This material begins to disrupt the normal workings of the cells, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour.

As most types of HPV don’t cause any symptoms, you or your partner could have the virus for months or years without knowing it.

Cervical intraepithelial neoplasia (CIN)

Cancer of the cervix usually takes many years to develop. Before it does, the cells in the cervix often show changes known as cervical intraepithelial neoplasia (CIN) or, less commonly, cervical glandular intraepithelial neoplasia (CGIN).

CIN and CGIN are pre-cancerous conditions. Pre-cancerous conditions don’t pose an immediate threat to a person’s health, but they can potentially develop into cancer in the future.

However, even if you develop CIN or CGIN, the chances of it developing into cervical cancer are very small, and if the changes are discovered during cervical screening, treatment is highly successful.

The progression from becoming infected with HPV to developing CIN or CGIN and then developing cervical cancer is very slow, often taking 10 to 20 years.

Increased risk

The fact that HPV infection is very common but cervical cancer is relatively uncommon suggests that only a very small proportion of women are vulnerable to the effects of an HPV infection. There appear to be additional risk factors that affect a woman’s chance of developing cervical cancer. These include:

  • smoking – women who smoke are twice as likely to develop cervical cancer than women who don’t; this may be caused by the harmful effects of chemicals found in tobacco on the cells of the cervix
  • having a weakened immune system – this can occur as a result of taking certain medications, such as immunosuppressants, which are used to stop the body rejecting donated organs, or as a result of a condition such as HIV or AIDS
  • taking the oral contraceptive pill for more than 5 years – women who take the pill are thought to have twice the risk of developing cervical cancer than those who don’t, although it’s not clear why
  • having children (the more children you have, the greater your risk) – women who have 2 children have twice the risk of getting cervical cancer compared with women who don’t have any children

The reason for the link between cervical cancer and childbirth is unclear. One theory is that the hormonal changes that occur during pregnancy may make the cervix more vulnerable to the effects of HPV.

The spread of cervical cancer

If cervical cancer is undiagnosed and untreated, it will slowly spread out of the cervix and into the surrounding tissue and organs. The cancer can spread down to the vagina and the surrounding muscles that support the bones of the pelvis. Alternatively, it can spread upwards, blocking the tube that runs from your kidneys to your bladder (ureters).

The cancer can then spread into your bladder, rectum (back passage) and eventually into your liver, bones and lungs. Cancerous cells can also spread through your lymphatic system. The lymphatic system is a series of nodes (glands) and channels spread throughout your body in a similar way to the blood circulation system.

The lymph nodes produce many of the specialised cells needed by your immune system (the body’s natural defence against infection and illness). If you have an infection, the nodes in your neck or under your armpits can become swollen.

In some cases of early cervical cancer, the lymph nodes close to the cervix contain cancerous cells. In some cases of advanced cervical cancer, lymph nodes in the chest and abdomen can be affected.