Cervical cancer

Body Diagram showing Cervical Cancer

Facts and figures about cervical cancer

Cervical Cancer is the 12th most common female cancer in the UK, accounting for approximately 2% of all female cases. Age related but unlike most cancers it is more common in younger females with the highest incidence occurring in the 30-34 year age group and a further peak in those aged 80-84 years.

Dramatic decrease following the introduction of a national screening programme in 1988, though rates have increased in recent years in the 25-34 year age group which is thought to be due to HPV infection and smoking.

85% of these tumours are squamous cell carcinoma, 10% adenocarcinomas and others are few rare types. Risk factors are HPV exposure and infection, multiple partners, early sexual intercourse (14 years old or younger), possibly other sexually transmitted diseases and use of oestrogen-progestagen oral contraceptives.

Risk is reduced by 50% in those whose partner is circumcised (HPV prevalence is lower in circumcised males).

Cervical cancer symptoms

  • There may be no symptoms as sometimes pre-cancerous abnormal cells or very early stage.
  • cancer may be detected at cervical screening.
  • Post-menopausal bleeding.
  • Irregular bleeding in pre-menopausal women.
  • Pain/discomfort during sexual intercourse or bleeding afterwards (post-coital bleeding).
  • Foul smelling vaginal discharge.
  • Pelvic pain.

Diagnosis of cervical cancer

Investigations may include:

  • Physical examination (including internal).
  • Blood tests.
  • Colposcopy: enables a more detailed examination of the cervix, tissue samples may be taken for analysis. If abnormal cells are detected a large loop excision of the transformation zone (LLETZ) may be performed. This involves cutting away the area of the cervix to remove them.
  • Cone biopsy: this is a minor operation that involves cutting out a cone of tissue from the cervix (whole area of the cervical canal) and sending it for analysis.

Cervical cancer treatment

Depends on several factors:

  • The type of tumour.
  • The position of the tumour.
  • The stage of the cancer.
  • Age and general health.

Surgery

Surgery alone may be adequate to cure the disease. In very early stage cervical cancer, this may just be a cone biopsy or removal of the cervix (radical trachelectomy).

Surgery for early stage usually involves removing the cervix and uterus (hysterectomy) and may include removing the lymph nodes if the disease has spread into the tissues of the cervix.

Post-operative radiotherapy may be advised to reduce the risk of recurrence. Extensive surgery to remove other pelvic organs may be required in advanced cases where it has spread within the pelvis, but this is only recommended in a small number of cases.

Radiotherapy

Radiotherapy is also an effective treatment for early stage cervical cancer and may be used if the patient is unfit for surgery or declines it and for larger tumours it can be recommended as it may be difficult to surgically remove all the disease. Also, radiotherapy may be advised post-operatively or in combination with chemotherapy (chemoradiation) for larger tumours.

Radiotherapy can be given externally or internally, external radiotherapy being planned to treat the cervix, uterus and surrounding tissues if main treatment or pelvis if post-surgery.

Internal radiotherapy involves small radioactive sources being placed inside the vagina to give a high dose of radiation directly to the cervix and uterus.

Chemotherapy

Trials have shown that the combination of radiotherapy and chemotherapy (chemoradiation) have improved the outlook for locally advanced disease.

Cisplatin is one of the drugs that have been shown to reduce the risk of recurrence or spread. It is thought to increase the sensitivity of the cancer cells to radiotherapy.

In more advanced disease, chemotherapy may be used to treat disease that has spread to other parts of the body.

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