How common is cervical cancer?
Cervical cancer is the 13th most common type of cancer in women, with about 3200 new cases being diagnosed in the UK in 2014. More than half of all new cases (52%) are diagnosed in women under 45, with the highest rates being seen in women aged 25–29. Due to successful screening programmes, incidence rates in the UK have decreased by almost a quarter since the early 1990s.
What are the risk factors?
Most cases of cervical cancer are potentially preventable, as almost all are linked to major lifestyle-related risk factors.
The most important risk factor is human papillomavirus (HPV) infection, because all cervical cancer cases in the UK are linked to this virus. There are several different types of HPV, which differ in their ability to cause cancer. About three quarters of all cases in Europe are linked to two types, HPV16 and HPV18, and vaccination can protect against both of these. The risk of HPV, and hence the risk of cervical cancer, is increased in women who have had multiple sexual partners, those who first had sexual intercourse at an early age (younger than 14 years), and those whose current male partner is uncircumcised.
In addition to HPV infection, a number of other lifestyle-related factors may increase the risk of cervical cancer. The risk is up to twice as high in women currently using combined oral contraceptives for 5 years or more, compared with women who have never used oral contraceptives. Women who have had at least one pregnancy are also at higher risk than those who have never been pregnant, and women who had their first pregnancy at under 17 years of age are at higher risk than those who were older at their first pregnancy. Smoking also increases the risk of cervical cancer, being linked to about 7% of cases in the UK; in addition, exposure to tobacco smoke increase the risk in non-smokers by almost three quarters, compared with non-smokers who aren’t exposed.
How is cervical cancer diagnosed?
Symptoms of cervical cancer include a change in menstrual cycles, abnormal vaginal bleeding (between periods, during or after sex, or at any time after the menopause), or vaginal discharge. Diagnostic tests may be needed in women with such symptoms, or if an abnormal result is found on a screening test. These tests may consist of a colposcopy and collection of a cervical biopsy. Pre-cancerous cells may be observed to see if they regress spontaneously, or they may be removed with a procedure called a LLETZ (loop cone biopsy procedure).
Colposcopy is an examination of the cervix using a special magnifying instrument called a colposcope. It may also be performed to take a sample of tissue (a biopsy) from the cervix, or to remove any abnormal cells. The procedure takes about 10-15 minutes, and is usually painless, although taking a biopsy may cause some brief discomfort.
A LLETZ biopsy involves taking a cone-shaped sample of tissue from the part of the cervix where abnormal cells are usually found. This procedure can be performed under a local or general anaesthetic. It is usual to have some bleeding for up to 4 weeks after a LLETZ biopsy, but this can be controlled with medication.
How is cervical cancer treated?
Most patients with early stage cervical cancer will need some form of surgery to remove the cancerous tissue. Patients with advanced disease may also need a combination of chemotherapy and radiotherapy. Your doctors will discuss the different options with you, to help you make the right choice for you.
The type of surgery offered for women with cervical cancer depends on the patient’s wishes, her fitness, and the size of the tumour. For women who have completed their family, removal of the womb (radical hysterectomy) is usually recommended. This is an extensive procedure that involves removing the womb and its supporting structures, the top of the vagina, and the lymph nodes surrounding the womb. In some cases, where women wish to preserve their fertility and there is a small, central tumour, it may be possible to remove most of the cervix, but to leave enough behind to allow a subsequent pregnancy and delivery. This is called a radical trachelectomy.
A combination of chemotherapy and radiotherapy is usually offered to women with a larger cervical cancer (more than 4cm in size) that is confined to the cervix, or any tumour that has spread beyond the cervix. Some patients may require a combination of chemotherapy and radiotherapy after surgery if examination of tumour specimens collected during the operation suggests that there is a higher than normal risk of cancer recurrence.