The cervix is the lower part of the uterus and is often called the “neck of the uterus”.

The uterus is a muscular, pear-shaped organ at the top of the vagina. The lining of the uterus is shed each month, and results in bleeding called a period. These periods stop temporarily during pregnancy and will normally continue until a woman has the menopause.

Close to the cervix is a collection of lymph nodes

Cancer of the cervix can take many years to develop. Before it does, changes occur in the cells of the cervix. These abnormal cells are not cancerous, and are called cervical intra-epithelial neoplasia (CIN). CIN may also be referred to as dysplasia or dyskaryosis.

TIP: It is important to know that most women with CIN do not develop cancer.

HPV (human papillomavirus virus) is a very common virus that can affect the cells of the cervix. It is mainly passed on during sexual intercourse. Many women who have had sexual intercourse will have the virus at some time in their life, but their immune system should get rid of the virus.

What causes it?

The exact causes of cervical cancer are unknown. However there are some identified risk factors:

• Smoking
• Poor Diet
• Infections: eg HIV
• Long term use of the contraceptive pill: (more than 10 years) can slightly increase the risk of developing cervical cancer.

TIP: Women/girls have heard that having sexual intercourse at an early age or having multiple sexual partners can increase the risk of developing cervical cancer. It is important to remember that although these factors can increase the chances of catching the HPV virus (not cervical cancer), many women who have only had one sexual partner have HPV, and may go on to develop CIN or cervical cancer.

What are the symptoms?

The most common symptoms of cervical cancer are

• Abnormal bleeding, such as between periods or after intercourse.
• Bad-smelling vaginal discharge
• Discomfort during intercourse

TIP: If you have any of these symptoms you should have them checked by your doctor - but remember, they are common to many illnesses other than cervical cancer.

How is it diagnosed?

After visiting your GP you will probably be referred to a hospital for some tests. These may include:

• Colposcopy: A colposcope is like a small microscope with a light and allows the nurse or doctor to make a more thorough examination of the abnormal cells on the cervix.
• Blood test
• Large loop excision of the transformation zone (LLETZ): remove the area of the cervix that contains the abnormal cells, which can then be examined under a microscope in the laboratory
• Cone biopsy: A small cone-shaped section of the cervix is taken, that is aimed to be large enough to remove any abnormal cells. It may result in some bleeding and strenuous physical activity and sexual intercourse should be avoided for 4–6 weeks to allow the cervix to heal.

Examination of the Cervix
For the examination, a nurse will help you to position yourself on a couch that has special leg supports (like stirrups on a riding saddle).

• The doctor will use a bright light and a magnifier to examine the cervix. They may then take small samples of tissue (biopsies).
• You will also have an internal examination to check your vagina and cervix for any abnormality. Using a speculum (a plastic or metal instrument) to hold the vaginal walls open, a liquid will be dabbed on to your cervix to help show up any abnormal areas.
• They may also take a cervical  smear (a small sample of cells taken from the cervix). The doctor will also examine your back passage (anus).

If the results of the test show you have cervical cancer, you will be referred to a doctor who specialises in the treatment of the cervix (called an gynaecologist).

Staging

The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the extent of the cancer. The stages of cervical cancer are described below:

• Stage 1: Cancer cells only within the cervix.
• Stage 2 Cancer has spread into surrounding structures such as the upper part of the vagina or tissues next to the cervix.
• Stage 3 Cancer has spread to surrounding structures such as the lower part of the vagina, lymph nodes, or tissues at the sides of the pelvic area. If the tumour is causing pressure on a ureter there may be a build up of urine in the kidney.
• Stage 4 Cancer has spread to the bladder, bowel or beyond the pelvic area. Also includes tumours that have spread into the lungs, liver or bone, although this is not common.

If the cancer comes back after initial treatment this is known as recurrent cancer.

Grading

The grade of a cancer gives an idea of how quickly it may develop. It may be graded as

• Grade 1 (low grade) – the cancer cells tend to be slow growing.
• Grade 2 (moderate grade) – the cells look more abnormal and are slightly faster-growing.
• Grade 3 (high grade) – the cancer cells tend to be more quickly growing, look very abnormal.

How is it treated?

Your team of doctors and other staff at the hospital will plan your treatment. It will depend on the size of the tumour and where it is. You may be treated by an oncologist (a doctor who specialises in treating cancer with chemotherapy) a gynaecologist (a surgeon who specialises in the cervix) and a radiologist (a doctor who specialises in treating cancer with radiation) .

Treatment may involve

• Chemotherapy
• Radiotherapy
• Surgery

Chemotherapy for cervical cancer

Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells. There are several chemotherapy drugs that can be used to treat cervical cancer.

It is thought that the chemotherapy makes cervical cancer more sensitive to the effects of the radiotherapy, so sometimes they are used in conjunction with each other.

For more information about chemotherapy, go to our chemotherapy fact sheet

Surgery for cervical cancer

The aim of surgery is to remove the tumour. Surgery is used more often for young women/girls than radiotherapy, as radiotherapy to the pelvic area stops the ovaries from working and brings on an early menopause. Other surgical procedures include

• Bilateral salpingo-oophorectomy: ovaries and fallopian tubes may also be removed
• Hysterectomy: involves removing the uterus

TIP: If ovaries are removed the symptoms of the menopause can often be prevented by giving hormone replacement therapy (HRT) as tablets, skin patches or creams.

For more information about surgery, go to our surgery fact sheet

Radiotherapy for cervical cancer

Radiotherapy treats cancer by using high-energy rays which destroy the cancer cells. Radiotherapy for cancer of the cervix can be given externally or internally, and often as a combination of the two.

Radiotherapy is usually given if the cancer has spread beyond the cervix and is not curable with surgery alone. Radiotherapy may also be used after surgery if there is a high risk that the cancer returning.

For more information about radiotherapy, go to our radiotherapy fact sheet

Side Effects

There are some side effects of the treatments for cervical cancer which can be found in our side effects fact sheet

More information

You may want to check out the websites or fact sheets on the left hand side for more information other bone cancers, and related topics.

Check out our community pages  to chat with other young people about cervical cancer, or its treatment….or anything really.