Frequently asked questions on Cervical cancer

This page is a selection of different questions that Jo's Cervical Cancer Trust has received about cervical cancer. The answers have been reviewed by our medical advisers.

What is cancer?

The organs and tissues on our body are made up of cells. Cells in different parts of the body may look and work differently but most reproduce themselves in the same way. Most of the cells in our body live for a period of time and are then gradually replaced with new cells. Our body has the ability to identify cells that have not been made properly and then correct any defects. This allows the cell to return to being a fully working, normal cell again.

If the body cannot correct an abnormal cell, then there is a mechanism in place to kill the cell. Sometimes these abnormal cells cannot be fixed or 'killed off'. They develop and grow without your body’s control. Sometimes they grow into a collection of abnormal cells called a tumour. Tumours can be benign or malignant.

Benign tumours are not cancerous because they do not spread to beyond the original tumour growth area; however, they may still cause problems by pressing on the surrounding organs. They can be removed by an operation and do not usually cause any further problems.

A malignant tumour is a growth (group) of cancer cells. Cancer is a general term to describe uncontrolled, abnormal growth and division of cells. Malignant tumours have the ability to spread beyond the original tumour growth area. Cancer cells have the ability to travel from one part of the body to another via the blood or lymphatic system (a system of thin tubes and nodes that is part of the body’s immune system). Newly formed tumours are called metastasis or secondary cancer. Cancer cells are also able to invade and destroy other tissue around them. Nowadays many cancers are caught before they have spread.

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How many types of cervical cancer are there?

There are two main types of cervical cancer:

  • Squamous cell – eight out of 10 (80%) cervical cancers are diagnosed as squamous cell. Squamous cell cancers are composed of the flat cells that cover the surface of the cervix and often begin where the outer surface joins with the cervical canal
  • Adenocarcinoma – more than one in 10 (15–20%) cervical cancers are diagnosed as adenocarcinoma. This cancer develops in the glandular cells which line the cervical canal. This type of cancer can be more difficult to detect with cervical screening tests because it develops within the cervical canal.

Adenosquamous cancers are tumours that contain both squamous and glandular cancer cells. Other rare types of cervical cancer can include clear cell, small cell neuroendocrine carcinomas, lymphomas and sarcomas.

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What are the symptoms of cervical cancer?

Sometimes during the early stages of cervical cancer there may not be symptoms. However, there are some recognised symptoms associated with cervical cancer that you should be aware of, including:

  • Abnormal bleeding: both during or after sexual intercourse, or between periods
  • Post menopausal bleeding, if you are not on HRT or have stopped it for six weeks or more
  • Unusual vaginal discharge
  • Discomfort or pain during sexual intercourse
  • Lower back pain.

If you are experiencing any or all of these symptoms or are concerned about any new symptom you should make an appointment to see your GP as soon as possible. Remember, these symptoms can be associated with many other conditions that are not cancer related.

Not all women diagnosed with cervical cancer experienced symptoms, which makes attending regular cervical screening even more important.

As cancer develops, it can cause further symptoms including:

  • Increased frequency of urination
  • Blood in the urine
  • Rectal bleeding
  • Diarrhoea
  • Incontinence
  • Lower limb lymphoedema (swelling).

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What causes cervical cancer?

Almost all cases of cervical cancer are caused by persistent high-risk human papillomavirus (HPV). HPV is a very common infection, and four out of five sexually active adults will contract some type of the virus during their lives. HPV can cause abnormalities in the cells of the cervix which, if left untreated, can develop into cervical cancer over time. The virus itself does not have any symptoms, which is why it is so important to attend your regular cervical screening (smear test) appointments when invited so that any abnormalities caused by high-risk HPV can be caught early, before they are given a chance to develop into cervical cancer.

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Is cervical cancer infectious?

Cervical cancer is not infectious and cannot be passed on to other people.

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How is cervical cancer detected?

Cervical cancer can be detected by taking a sample from the cervix, this is sometimes called a biopsy. This may be done because of an abnormal cervical screening (smear test) or you have symptoms of cervical cancer or during a pelvic examination your doctor sees something they are concerned about. 

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Is cervical cancer hereditary?

Cervical cancer is not caused by genetic changes that can be passed down through families, so is not thought to be hereditary.

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What is the risk of developing cervical cancer?

It has been estimated that in the UK, a woman's lifetime risk of developing cervical cancer if she does not attend cervical screening (smear test) is 1.7% [1]. This means that without screening, about one in 60 women will develop cervical cancer. Cervical screening can prevent around seven out of 10 cancers [2]. This means that with screening, about one in 200 women will develop cervical cancer.

References

  1. Canfell K et al., 2004. The predicted effect of changes in cervical screening practice in the UK: results from a modelling study. British Journal of Cancer 91(3), 530-6. 
  2. Sasieni P et al., 2009. Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data. British Medical Journal 339, 2968.

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Am I putting myself at risk of developing cervical cancer by becoming sexually active again later in life?

Almost all cases of cervical cancer are caused by persistent high-risk human papillomavirus (HPV). High-risk HPV is contacted through any skin-to-skin contact, including genital-to-genital contact, anal, vaginal and oral sex and HPV infections are very common, with 80% of women contracting high-risk HPV at one point in their lives. Because infected individuals will have no obvious signs or symptoms it is very difficult to tell if an individual is infected, which means you may be at risk of contracting high-risk HPV if you become sexually active with a new partner.

However, it is important to remember that cervical cancer is not caused by promiscuity or infidelity. Becoming sexually active again later in life simply increases your chance of coming into contact with a high-risk type of HPV. But, many women who have only had one sexual partner in their lifetime become infected with high-risk HPV and may go on to develop abnormal cell changes/CIN (cervical intraepithelial neoplasia) or cervical cancer.
There are several things you can do to reduce your risk of developing cervical abnormalities and cervical cancer. These include the following:

  • Practicing safe sex through the regular use of condoms: this can help reduce the risk of being infected with HPV, though it will not completely eradicate the risk as HPV lives on the skin in and around the whole genital area [1]. Genital HPV in men affects the skin of the penis, scrotum, anus and rectum [2]. In women it affects the vulva (area outside the vagina), lining of the vagina, cervix and rectum
  • Not smoking: if you do not smoke your risk of developing cervical cancer is, on average, half that of a woman who is a smoker
  • Quitting smoking (smoking cessation): if you are a smoker it is very import to try and quit in order to reduce your risk of developing cervical abnormalities and cervical cancer. Evidence shows that women who have successfully stopped smoking for at least ten years can half their risk of developing cervical cancer and precancer compared to women who currently smoke [1]. For support in helping you quit, visit the NHS Smokefree website
  • Leading a healthy lifestyle: this will help to keep your immune system (your body's natural defence against disease and infection) strong. A weakened immune system could mean that your risk of cervical cancer is higher than average
  • Attending cervical screening when invited*: this can help to find cervical abnormalities and HPV infections before they are able to develop into cervical cancer.
  • Vaccination: getting the HPV vaccination if you are eligible (please see our information pages) will protect you from the high-risk HPV types 16 and 18 that cause 70% off all cervical cancers. It will also protect you from the two HPV types that cause 90% of genital warts cases.

* From 25–64 years across the whole of the UK.


References

  1. Roura E et al, 2014. Smoking as a major risk factor for cervical cancer and pre-cancer: Results from the EPIC cohort. International Journal of Cancer 135, 453–466.
  2. Winter RL et al., 2003. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. American Journal of Epidemiology, 157 (3), 218–226.

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I have had an early cervical cancer treated by a LLETZ biopsy – will I now need a hysterectomy?

No, not necessarily. Some very early cervical cancers that are diagnosed can be treated by a LLETZ biopsy. The diagnosis of a very early cervical cancer is often made following the result of a biopsy taken at the colposcopy clinic. The specialists who examine this specimen under the microscope may see a tiny cancer, which is so small and surrounded by normal tissue that no further treatment is recommended. The doctors may, however recommend further investigation in the form of a further biopsy to check that there is no abnormal tissue in the surrounding area where the initial biopsy was taken from.

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I need a hysterectomy, what does this mean?

A hysterectomy refers to the surgical removal of the uterus (womb). It is undertaken under a general anaesthetic.

Whilst some women may have what is known as a simple hysterectomy (where the cervix, uterus (womb), and sometimes part of the fallopian tubes, are removed), the standard type advised by gynae-oncologists for most women diagnosed with cervical cancer is what is known as a radical hysterectomy. This is sometimes called a Wertheim (done with an abdominal operation) or Schauta (done with a vaginal operation) hysterectomy. During a radical hysterectomy the cervix, uterus and sometimes parts of the fallopian tubes are removed in one whole piece so that they can clearly see the surrounding tissue, as well as the tissue at the side of the uterus (the parametrium) and the top part of the vagina. It may also include the removal of some of the lymph nodes (part of the body’s fluid drainage system) in the pelvis.

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Radical (Wertheim) Hysterectomy

A radical (Wertheim) hysterectomy (done with an abdominal operation) is when the surgeon removes the whole of the cervix, uterus (womb) and sometimes parts of the fallopian tubes are removed, as well as the tissue at the side of the uterus (the parametrium) and the top part of the vagina.

It may also involve removing some of the lymph nodes (part of the body’s fluid drainage system) located in the pelvis if they have been affected. This is called a lymph node dissection or lymphadenectomy.

If a woman has already gone through the menopause then the ovaries are usually removed as well. However, in younger pre-menopausal women the ovaries will ideally be left as removing them brings on an early menopause. If it is necessary to remove the ovaries before natural menopause, the symptoms of the menopause can often be prevented by giving hormone replacement therapy (HRT) as tablets or skin patches. Your gynae-oncologist or clinical nurse specialist will be able to discuss this with you in detail. Without functioning ovaries or HRT the woman would experience the menopause. Some women, following discussion with their consultant/GP/specialist nurse are not able/choose not to take HRT after a hysterectomy.

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Where will the scar be after a hysterectomy?

It is usually a horizontal line just above your pubic hair line. It tends to heal extremely well and many women can hardly see the scar once it is healed. Sometimes a doctor will need to make a vertical incision – if this is the case the doctor will explain to you where the scar will be and why he will need to perform the operation in this way. It is usually for a reason other than the cancer, such as the womb being a bit larger than normal. In some centres it is possible for the operation to be carried out using laparoscopic (keyhole) surgery. In this case you will usually have two or three small scars either side of your tummy button at the level of your pubic hair line or slightly higher. Having laparoscopic surgery causes less blood loss, speeds up the recovery time and less pain relief is needed. You will be offered this if it is available at your centre. 

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What will I experience straight after a radical hysterectomy?

You will usually have a drip (small plastic tube) in your arm. This means that fluids can be given to you, without you needing to drink. A catheter (small tube) will usually be put into your bladder whilst you are asleep. This drains any urine into a bag. The drip will usually be removed very soon after your operation – once your body has recovered and you can drink independently. The catheter may need to stay longer, sometimes up to five days. This is to let the bladder fully recover after the surgery. Even when the catheter has been removed it is important that bladder function is measured, to ensure that it doesn't overfill. In a few cases it is necessary to continue catheterising the bladder to make sure it empties properly. This can go on for a few weeks or even a month or two in some cases. In some cases a woman’s medical team may teach her how to do intermittent self-catheterisation. This is when you insert a catheter into your own bladder at regular intervals during the day (or when you need the toilet). Then, once all of the urine has been drained from your bladder, you remove the catheter again. This means you are able to control the emptying of your own bladder.

A dressing will cover your scar – you may have stitches or clips which will need to be removed some days (usually between five and ten) after the operation. If you have had a laparoscopic procedure the wounds are often held together with glue which dissolves on its own to form a barely noticeable scar.

You may have one or more wound drains in place. These small tubes drain any blood or serous fluid from the scar area into a bag or bottle. This helps prevent infection and reduces bruising. These wound drains are taken out within days of the operation. You will be given pain killers to minimise any discomfort that you experience. This may be in the form of an epidural, hand held pump (where you can press the button when you need more pain relief), injections or/and suppositories. When you are able to drink, then you can have oral medications such as tablets. The staff looking after you will talk to you about your pain relief choices before your operation.

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Will I still be able to have sex after a radical hysterectomy?

Yes, the vaginal tissues are very stretchy; this means that although the top part of the vagina is removed, you will be able to have full intercourse, usually without any difficulties. Most people say that they do not notice any difference (however women who have had radiotherapy will notice some changes to the vagina after treatment). The most common changes a woman may feel are: the absence of the uterus moving during orgasm – this does not make the orgasm less pleasurable – and if the ovaries have been removed and no HRT has been taken the vaginal tissues may feel a little dry. HRT or a vaginal lubricant should be helpful. The cervix also provides some lubrication and removing the cervix, even if the ovaries have been left behind can lead to vaginal dryness. A water-based lubricant of vaginal moisturiser should help address this.

Psycho-sexual issues – how a woman (or her partner) feel about their body or/and about sex may affect their arousal and, therefore, their satisfaction with intercourse. If this is a problem all women who have had a treatment for a cervical cancer should be able to see a psycho-sexual counsellor to discuss it further. You can arrange an appointment via your GP, your hospital consultant or specialist nurse. Please see the Jo’s Cervical Cancer Trust website pages on sex and intimacy for further information about possible changes to your sex life after hysterectomy and where to find help.

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Will having my lymph nodes removed affect me?

The lymph nodes are part of the body’s fluid drainage (lymphatic) system which helps its natural defences (immune system) to fight off infections. These nodes are all over your body, but the nodes that are affected by cervical cancer tend to be those in the pelvis. While lymph nodes can be seen with an MRI scans, you cannot tell for certain if lymph nodes are free from cancer unless you remove them and look at them under the microscope.

You will likely experience some discomfort or pain after having lymph nodes removed, which will be managed by your health care team with painkillers. Your immune system is not compromised with the removal of lymph nodes.

There is a small risk that you could experience some swelling in the area of one or both of your legs, called lymphoedema, after the operation.

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What is lymphoedema?

Lymphoedema is the accumulation of lymphatic fluid that cannot drain away normally. It is not dangerous, but can be uncomfortable as one or both legs can swell.

You are at risk of developing lymphoedema if you have had to have any lymph nodes removed, and it is more likely to happen if you have had radiotherapy to the pelvic area as well as surgery. If you do develop this you should report it to your GP, consultant or specialist nurse. They will confirm that it is lymphoedema and then refer you to a specialist who will advise you how to ensure the lymphoedema is kept to a minimum. This includes massage, exercise, and wearing a tight elastic sleeve or stocking. Before your operation do ask your specialist nurse what you should do to help prevent lymphoedema occurring after the operation, what signs to look for and what services are available should you develop it. Your surgeon may also put a small drainage tube in place during your surgery to help reduce the build up of this fluid, which will be removed a few days later.

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What is pelvic exenteration surgery?

If, after initial treatment, your cancer comes back in the pelvic area, it may be possible to have an operation called a pelvic exenteration. This is usually only offered after chemoradiotherapy has been given. Pelvic exenteration is a major operation that involves removing all of the structures in the pelvic area and can include the cervix, uterus (womb), vagina, ovaries, bladder and the lower end of the large bowel (rectum). If all of these structures are removed it is called a total exenteration. If the bladder is removed but the bowel and rectum are left it is called an anterior exenteration and if the bladder is left and the bowels and rectum are removed it is called a posterior exenteration. Pelvic exenteration surgery is only suitable for a small number of women and you will need to have various investigations and scans to see if it is possible for you.

The operation can vary depending on the extent of the cancer and which organs are affected. Part of the operation involves creating one or two openings (stomas) on the abdominal wall. These are needed because the operation can involve removing the bladder, the bowel and rectum, or both. This means you will need either one or two stoma bags: one to collect your bowel motions and/or one for urine. These stomas are known as a colostomy (bowel motions) and a urostomy (urine). In some centres, instead of having a urostomy they may offer you a procedure called a continent urinary diversion. This is where a pouch or reservoir is made instead of an opening attached to a bag. This means you yourself have control of when you empty your new bladder. This procedure is not offered at all cancer centres and your gynae-oncologist will discuss this option with you if it is available.

Before pelvic exenteration you will see a nurse who specialises in the care of people with stomas (a stoma nurse). The nurse will explain all about stomas and how to look after them and can answer any questions you may have. The stoma nurse will also visit you after the operation to help you.
The operation may also involve making (reconstructing) a new vagina. Your medical team will be able to discuss this with you in detail.

A pelvic exenteration is a big operation, and many women find that recovery can be difficult, both physically and emotionally. It is important that you understand exactly how the operation may affect you so it is a good idea to talk to your surgeon or specialist nurse. They can support you in deciding whether pelvic exenteration is right for you.

You may find it helpful to join our online Forum community. There are other women who have gone through pelvic exenteration who are willing to share their stories and help support you through your surgery and recovery. There is also a closed forum there specifically for women with who are living with advanced cervical cancer.

If you are being offered or have had pelvic exenteration surgery and you are looking to connect with other women who have been through this, please contact us at support@jostrust.org.uk and we will do our best to put you in touch with someone.

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I have been advised to have pelvic radiotherapy treatment for my cancer. Why have I not been offered a hysterectomy?

Sometimes radiotherapy treatment can be more effective than surgical treatment. Radiotherapy treatment can be used to cure a woman with a cervical cancer diagnosis. It will depend on the size and place of the cancer as to whether an operation or/and radiotherapy is offered/recommended.

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How do they treat a cervical cancer with radiotherapy?

Radiotherapy cancer treatment uses high energy beams of radiation directed at the body, which destroy the cancer cells while doing as little harm as possible to normal cells. For cervical cancer radiotherapy can be given externally or internally (brachytherapy) and often you will be recommended to a combination of the two.

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What is the difference between external and internal radiotherapy?

External beam radiotherapy is a treatment where high energy x-rays are directed from a machine outside of your body at the area of your cancer. This treatment is usually given in a hospital radiotherapy department in short doses on a daily basis for some weeks, with breaks at the weekend. The number of treatments you get will depend on the type, size and location of the cancer.

Internal radiotherapy, which is also called brachytherapy, is often given after a course of external radiotherapy has been given. In brachytherapy a controlled high dose of radiation is given directly next to the tumour. How it is given depends on whether or not you have had a hysterectomy. If a woman has not had a hysterectomy a thin tube is placed into the vagina and uterus and a radioactive ball (known as a source) is then fed into the tube so that it sits next to the tumour. If a woman has had a hysterectomy before beginning radiotherapy then either one or two tubes are put into her vagina and then the controlled dose of radiation will be given to the top of the vagina instead.

In both cases the length of time of the treatment can vary and your specialist nurse or clinical oncologist will give you more information on your individual treatment.

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Are there side effects after radiotherapy?

There are potential side effects with any treatment. The side effects with radiotherapy are less now than they used to be. This is because of the advancement of technology – treatments are more precise now. We also have more knowledge now as to how to prevent or minimise side effects during and after treatment.

The most common side effects are those to the vagina, bowel and bladder, and bones. The walls of the vagina may become more fragile with the blood vessels closer to the surface, which together can cause bleeding, vaginal tissues can become drier and less stretchy and the walls of the vagina can, in some circumstances, stick together. The radiotherapy staff will advise you about using vaginal dilators and lubricants designed to prevent or minimise these effects. Sexual intercourse can be continued during and after treatment. If discomfort is experienced during intercourse, speak to your specialist nurse or radiographer who will advise you further. Psycho-sexual issues – how a woman, (or her partner), feels about their body or/and about sex may affect arousal and therefore their satisfaction with intercourse. If this is a problem all women who have had a treatment for a cervical cancer should be able to see a psycho-sexual counsellor to discuss it further. You can arrange an appointment via your GP, your hospital consultant or specialist nurse. Please see the Jo’s Cervical Cancer Trust website pages on sex and intimacy for further information about possible changes to your sex life after radiotherapy and where to find help.

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My doctor has said that I will have radiotherapy and chemotherapy – does this mean my cancer is very advanced?

No, not necessarily. Chemotherapy and radiotherapy (known as chemo-radiotherapy) are often used together for an advanced cancer, but increasingly chemo-radiotherapy is being used for an early cancer. The chemotherapy appears, in some situations, to sensitise the cells, making the radiotherapy more effective.

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Is chemotherapy ever used on its own to treat a cervical cancer?

Yes, it can be used on its own. Sometimes this is because the cancer is advanced or it has come back. Sometimes it is used before another treatment is started – such as radiotherapy.

Bevacizumab, sometimes called by the drug name Avastin®, is a different kind of drug treatment that is sometimes used to treat women who have recurrent or advanced stage cervical cancer. This treatment does not cure cervical cancer; it is a life-extending drug. Bevacizumab is given through a drip in a similar way to chemotherapy. Usually this drug can be given for up to and no more than 10 cycles. Your oncologist will be able to let you know if this treatment is suitable for your stage and type of cancer.

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I have been given a diagnosis of CIN or dyskaryosis, what does this mean?

A diagnosis of cervical intraepithelial neoplasia (CIN), which may also be referred to as dyskaryosis, means that you have abnormal/precancerous changes to cells in your cervix. These changes are not cancerous, but without treatment these cells could change into cancerous cells.

CIN/dyskaryosis is graded depending on how severe or extensive the changes in the cervical cells are. The different grades are:

  • Mild or low grade dyskaryosis, also know as CIN1, means that the lower 1/3 of the lining of the cervix has abnormal cells
  • Moderate or high grade dyskaryosis, also know as CIN2, means that the lower 2/3 of the lining of the cervix has immature abnormal cells
  • Severe or high grade dyskaryosis, also known as CIN3, means all of the lining covering the cervix has abnormal cells.

You may also get a diagnosis of glandular cervical intraepithelial neoplasia (CGIN), which is when the abnormal cells are within the glandular cells (those found within the cervical canal that goes up the middle of the cervix) rather than in the squamous cells (those found on the outer surface of the cervix).

For more information on the different types of abnormalities and how they are treated, please visit our information page on the results of cervical screening and our ‘Understanding screening results and abnormal cells’ PDF.

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