Regular smear tests saved Tina’s life and her fertlilty. She talks about her experience of cervical cancer and her treatment.

In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papillomavirus (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. This means that 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 papillomavirus (HPV)

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

HPV is spread during sexual intercourse and is thought to be very common. An estimated one in three women will develop a HPV infection within two years of starting to have regular sex, and about four in every five women will develop the infection at some point in their lives.

Some types of HPV do not cause any noticeable symptoms and the infection will pass without treatment. Other types of HPV can cause genital warts, although these types are not associated with a high risk of causing cervical cancer.

About 15 types of HPV are considered high risk for cervical cancer. The two types known to have the highest risk are HPV 16 and HPV 18, which cause about 7 in 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.

See preventing cervical cancer for more information about reducing your chances of developing HPV.

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 do not 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 between 10 and 20 years.

Read more about cervical screening results.

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 a 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 be the 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/AIDS
• taking the oral contraceptive pill for more than five years – women who do this are thought to have twice the risk of developing cervical cancer than those who do not take the pill, although it is not clear why this is
• having children (the more children you have, the greater your risk) – women who have two children have twice the risk of getting cervical cancer compared with women who do not 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 could 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 that are spread throughout your body in a similar way to your blood circulation system.

The lymph nodes produce many of the specialised cells that are 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 may be swollen.

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

Prevention and early diagnosis can save lives

What you need to know about cervical cancer 

• Cervical cancer is cancer of the cervix.  The cervix connects a woman’s womb and her vagina.  It is also known as the neck of the womb
• Cervical cancer can affect women of all ages but is most common in women between 30 – 45 years of age.  It is very rare in women under 25
• Cervical screening –  previously known as a smear test – can prevent cervical cancer and saves thousands of lives each year
• In the future, most cervical cancers will be prevented by HPV vaccination. But for the next few decades, cervical screening will still be vitally important
• The earlier cervical cancer is diagnosed, the better the outcome will be, so it is important to know the signs and symptoms

What causes cervical cancer?

Nearly all cervical cancers are caused by a common sexually transmitted infection called human papilloma virus (HPV).  Most women have HPV at some time, which usually clears up on its own.  If the infection doesn’t clear up there is a risk of abnormal cells developing which could become cervical cancer over time.

What are the signs and symptoms of cervical cancer?

The following are the most common symptoms of cervical cancer.

• Any unusual bleeding from the vagina, particularly after sex or after the menopause when your periods have stopped
• Persistent vaginal discharge that is blood stained or smells unpleasant

If you have any of these symptoms, tell your doctor, even if you have been for screening. The chances are that they are not due to cancer, but it is important to have them checked.

What can I do to reduce my risk of developing cervical cancer?

• Go for cervical screening when you are invited
• Have the HPV vaccine if you are offered it
• If you smoke, try to stop
• Use a condom to reduce your risk of HPV and other sexually transmitted infections.

Even if you have had a normal screening result or have been vaccinated against HPV, it’s important to let your doctor know if you develop any of the symptoms of cervical cancer so they can be checked out.  Like all screening tests, cervical screening isn’t 100% perfect, and the HPV vaccine does not stop all types of HPV that may cause cervical cancer.

Be informed and make a plan

• Work out what you will do if you have abnormal bleeding – arrange to see a doctor
• As soon as your invitation to cervical screening arrives work out when you can go and make the appointment
• If you are 18 or under, consider having the HPV vaccination if you have not already done so.

The above information was produced by the Department of Health with grateful thanks to the cervical cancer key messages forum.

Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.

These are described in more detail below.

Side effects

Early menopause

If your ovaries are surgically removed or they’re damaged during treatment with radiotherapy, it will trigger an early menopause (if you haven’t already had it). Most women experience the menopause in their early fifties.

The menopause is caused when your ovaries stop producing the hormones oestrogen and progesterone. This leads to the following symptoms:

• you no longer have monthly periods or your periods become much more irregular
• hot flushes
• vaginal dryness
• loss of sex drive
• mood changes
• stress incontinence (leaking urine when you cough or sneeze)
• night sweats
• thinning of the bones, which can lead to brittle bones (osteoporosis)

These symptoms can be relieved by taking a number of medications that stimulate the production of oestrogen and progesterone. This treatment is known as hormone replacement therapy (HRT).

Narrowing of the vagina

Radiotherapy to treat cervical cancer can often cause your vagina to become narrower. This can make having sex painful or difficult.

There are two main treatment options if you have a narrowed vagina. The first is to apply hormonal cream to your vagina. This should increase moisture within your vagina and make having sex easier.

The second is to use a vaginal dilator, which is a tampon-shaped device made of plastic. You insert it into your vagina and it is designed to help make it more supple. It is usually recommended that you insert the dilator for five to 10 minutes at a time on a regular basis during the day over the course of six to 12 months.

Many women find discussing the use of a vaginal dilator embarrassing, but it’s a standard and well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice.

You may find that the more times you have sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.

You can read more about sexuality and cancer on the Macmillan Cancer Support website.

Lymphoedema

If the lymph nodes in your pelvis are removed, it can sometimes disrupt the normal workings of your lymphatic system.

One of the functions of the lymphatic system is to drain away excess fluid from the body’s tissue. A disruption can cause a build-up of fluid in the tissue. This can lead to certain body parts becoming swollen, but usually the legs in cases of cervical cancer. This is known as lymphoedema.

There are a number of exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help.

Read more about treating lymphoedema.

Emotional impact

The emotional impact of living with cervical cancer can be significant. Many people report experiencing a “rollercoaster” effect.

For example, you may feel down when you receive a diagnosis, but feel up when removal of the cancer has been confirmed. Then you may feel down again as you try to come to terms with the after-effects of your treatment.

This type of emotional disruption can sometimes trigger depression. Signs that you may be depressed include feeling down or hopeless during the past month and no longer taking pleasure in the things that you enjoy.

Contact your GP for advice if you think you may be depressed. There are a range of effective treatments available, including antidepressant medication and talking therapies such as cognitive behavioural therapy (CBT).

You may also find Jo’s Cervical Cancer Trust website a useful resource. It’s the UK’s only charity dedicated to women affected by cervical cancer.

There may also be local support groups in your area for women affected by cancer. Your specialist cancer nurse should be able to provide contact details.

Read more about coping with cancer.

Advanced cervical cancer

Some of the complications that can occur in cases of advanced cervical cancer are discussed below.

Pain

If the cancer spreads into your nerve endings, bones or muscles, it can often cause severe pain.

However, a number of effective painkilling medications can usually be used to control the pain. Depending on the levels of pain, they can range from paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, to more powerful opiate-based painkillers such as codeine and morphine.

If the painkillers you are prescribed aren’t effective in reducing your pain, you should tell your care team as you may need to be prescribed a stronger medication. A short course of radiotherapy can also be effective in controlling the pain.

Macmillan nurses, who work both in hospitals and in the community, can also provide expert advice about pain relief.

Read more about coping with pain.

Kidney failure

Your kidneys remove waste material from your blood. The waste is passed out of your body in urine through tubes called the ureters. Kidney function can be monitored by a simple blood test called serum creatinine level.

In some cases of advanced cervical cancer, the cancerous tumour can press against the ureters, blocking the flow of urine out of the kidneys. The build-up of urine inside the kidneys is known as hydronephrosis and can cause the kidneys to become swollen and stretched.

Severe cases of hydronephrosis can cause the kidneys to become scarred, which can lead to loss of most or all of the kidneys’ functions. This is known as kidney failure.

Kidney failure can cause a wide range of symptoms, including:

• tiredness
• swollen ankles, feet or hands caused by water retention
• shortness of breath
• feeling sick
• blood in your urine (haematuria)

Treatment options for kidney failure associated with cervical cancer include draining urine out of the kidneys using a tube inserted through the skin and into each kidney (percutaneous nephrostomy). Another option is to widen each of the ureters by placing a small metal tube called a stent inside them.

Blood clots

Cervical cancer, like any other cancer, can make the blood more “sticky” and more prone to forming clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot.

Large tumours can press on the veins in the pelvis, which slows the flow of blood and can lead to a blood clot developing in the legs.

Symptoms of a blood clot in your legs include:

• pain, swelling and tenderness in one of your legs (usually your calf)
• a heavy ache in the affected area
• warm skin in the area of the clot
• redness of the skin, particularly at the back of your leg, below the knee

A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs and block the supply of blood to the lungs. This is known as a pulmonary embolism and can be fatal.

Blood clots in the legs are usually treated by using a combination of blood-thinning medication, such as heparin or warfarin, and compression garments designed to help encourage the flow of blood through the limbs.

Read more about treating deep vein thrombosis.

Bleeding

If the cancer spreads into your vagina, bowel or bladder, it can cause significant damage resulting in bleeding. Bleeding can occur in your vagina or rectum (back passage), or you may pass blood when you urinate.

Minor bleeding can often be treated using a medication called tranexamic acid, which encourages the blood to clot and stop the bleeding. Radiotherapy can also be highly effective in controlling bleeding caused by cancer.

Major bleeding can be treated using a combination of medications designed to lower blood pressure. This should help to stem the flow of blood.

Fistula

A fistula is an uncommon but distressing complication that occurs in around 1 in 50 cases of advanced cervical cancer.

A fistula is an abnormal channel that develops between two sections of the body. In most cases involving cervical cancer, the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. Sometimes a fistula develops between the vagina and rectum.

Surgery is usually required to repair a fistula, although it’s often not possible in women with advanced cervical cancer because they’re usually too frail to withstand the effects of surgery.

In such cases, treatment often involves using medication, creams and lotions to reduce the amount of discharge and protect the vagina and surrounding tissue from damage and irritation.

Vaginal discharge

Another uncommon but distressing complication of advanced cervical cancer is an unpleasant smelling discharge from your vagina.

The discharge can occur for a number of reasons, such as the breakdown of tissue, the leakage of bladder or bowel contents out of the vagina, or a bacterial infection of the vagina.

Treatment options for vaginal discharge include an antibacterial gel called metronidazole and wearing clothing that contains charcoal. Charcoal is a chemical compound that’s very effective in absorbing unpleasant smells.

Palliative care

If your doctors can’t do any more to treat your cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care.

Palliative care also includes psychological, social and spiritual support for you and your family or carers.

There are different options for terminal care in the late stages of cancer. You may want to think about whether you would like to be cared for in hospital, in a hospice or at home, and discuss these issues with your doctor. Some organisations who provide care for people with cancer include:

• Macmillan Cancer Support has specially trained nurses who help look after people with cancer at home. To be referred to a Macmillan nurse, ask your hospital doctor or GP, or call 0808 808 00 00.
• Marie Curie Cancer Care have specially trained nurses who help look after people with cancer at home. They also run hospices for people with cancer.
• Help the Hospices has information about hospice care and how to find a hospice.

If cervical cancer is suspected, you will be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system).

Referral will be recommended if the results of your cervical screening test suggest that there are abnormalities in the cells of your cervix. However, in most cases the abnormalities do not mean that you have cervical cancer.

You may also be referred to a gynaecologist if you have abnormal vaginal bleeding or your GP noticed a growth inside your cervix during an examination.

The sexually transmitted infection (STI) chlamydia is one of the most common reasons why women experience unusual vaginal bleeding. Your GP may recommend that you are tested for it first before being referred. Testing for chlamydia involves taking a small tissue sample from your cervix or carrying out a urine test.

Colposcopy

If you have had an abnormal cervical screening test result, or your symptoms suggest that you may have cervical cancer, your gynaecologist will usually carry out a colposcopy. A colposcopy is an examination to look for any abnormalities in your cervix.

During a colposcopy, a small microscope with a light source at the end (colposcope) is used. As well as examining your cervix, your gynaecologist may remove a small tissue sample (biopsy) so that it can be checked under a microscope for cancerous cells.

Cone biopsy

In some cases, a minor operation called a cone biopsy may also be carried out. This operation is carried out in hospital, usually under a local anaesthetic.

During a cone biopsy, a small, cone-shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells. You may experience vaginal bleeding for up to four weeks after the procedure. You may also have period-like pains.

Further testing

If the results of the biopsy suggest you have cervical cancer and there’s a risk that the cancer may have spread, you’ll probably need to have some further tests to assess how widespread the cancer is. These tests may include:

• a pelvic examination carried out under general anaesthetic – your womb, vagina, rectum and bladder will be checked for cancer
• blood tests – these can be used to help assess the state of your liver, kidneys and bone marrow
• computer tomography (CT) scan – scans are taken of the inside of your body and a computer is used to assemble them into a detailed three-dimensional image; this is useful for showing up cancerous tumours and checking whether the cancerous cells have spread
• magnetic resonance imaging (MRI) scan – this type of scan uses strong magnetic fields and radio waves to produce detailed pictures of the inside of your body; it can also be used to check whether cancer has spread
• chest X-ray – this will indicate whether cancer has spread to your lungs
• positive emission tomography (PET) scan – a specialised scan where a mildly radioactive substance is injected into your veins so the cancerous tissue shows up more clearly; it is often combined with a CT scan and is used to see if the cancer has spread or to check how well a person is responding to treatment

Staging

After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows:

• stage 0 (pre-cancer) – there are no cancerous cells in the cervix, but there are biological changes that could trigger the onset of cancer in the future; this is called cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS)
• stage 1 – the cancer is still contained inside the cervix
• stage 2 – the cancer has spread outside the cervix into the surrounding tissue, but has not reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina
• stage 3 – the cancer has spread into the lower section of the vagina and/or into the pelvic wall
• stage 4 – the cancer has spread into the bowel, bladder or other organs, such as the lungs

Cervical cancer is an uncommon type of cancer that develops in a woman’s cervix. The cervix is the entrance to the womb from the vagina.

Cervical cancer often has no symptoms in its early stages. If you 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 as soon as possible. If your GP suspects you might have cervical cancer, you should be referred to see a specialist within two weeks.

Read more about the symptoms of cervical cancer and diagnosing cervical cancer.

Screening for cervical cancer

Over the course of many years, the cells lining the surface of the cervix undergo a series of changes. In rare cases, these precancerous cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage and treatment can reduce the risk of cervical cancer developing.

The NHS offers a national screening programme open to all women from the age of 25. During screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities. This test is commonly referred to as a cervical smear test.

An abnormal smear test does not mean you definitely have cancer, as most abnormal results are caused by an infection or the presence of treatable precancerous cells rather than cancer itself.

It is recommended that women who are between the ages of 25 and 49 are screened every three years, and women between the ages of 50 and 64 are screened every five years. You should be sent a letter telling you when your screening appointment is due. Contact your GP if you think that you may be overdue for a screening appointment.

Read more about cervical cancer screening.

Why it happens

Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that’s often spread during sex.

There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can disrupt the normal functioning of the cells of the cervix and can eventually trigger the onset of cancer.

Two strains of the HPV virus called HPV 16 and HPV 18 are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection have no symptoms, so many women will not realise they have the infection.

However, it is 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 cannot always prevent infection.

Since 2008, a HPV vaccine has been routinely offered to girls between the ages of 12 and 13.

Read more about the causes of cervical cancer and preventing cervical cancer.

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 is 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.

Read more about treating cervical cancer.

Complications

Many women with cervical cancer will have complications. Complications can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, surgery and chemotherapy.

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.

Read more about the complications of cervical cancer.

Outlook

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

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

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

In the UK, just fewer than 1,000 women die from cervical cancer every year.

How cervical cancer affects your daily life will depend on what stage your disease is at and what treatment you’re having.

Many women with cervical cancer have a radical hysterectomy. This is a major operation that takes around six to 12 weeks to recover from. During this time you need to avoid heavy housework and lifting, such as lifting children or heavy shopping bags.

You won’t be able to drive for anything from three to eight weeks after the operation. Most women will need eight to 12 weeks off work after a radical hysterectomy.

Some of the treatments for cervical cancer can make you very tired, particularly chemotherapy and radiotherapy. You may need to take a break from some of your normal activities for a while.

Don’t be afraid to ask for practical help from family and friends if you need it. Practical help may also be available from your local authority. Ask your doctor or nurse about who to contact. 

Work

Having cervical cancer doesn’t necessarily mean you’ll have to give up work, although you may need quite a lot of time off. During treatment you may not be able to carry on completely as before.

If you have cancer, you’re covered by the Disability Discrimination Act. This means that your employer is not allowed to discriminate against you because of your illness. They have a duty to make “reasonable adjustments” to help you cope. Examples of these include:

• allowing you time off for treatment and medical appointments
• allowing flexibility with working hours, the tasks you have to perform, or your working environment

The definition of what is “reasonable” depends on the situation, such as how much it would affect your employer’s business, for example.

It helps if you give your employer as much information as possible about how much time you will need off and when. Talk to your human resources department if you have one. Your union or staff association representative should also be able to give you advice.

If you’re having difficulties with your employer, your union or local Citizens Advice Bureau may be able to help.

Want to know more?

• Macmillan Cancer Support: work and cancer

Money and benefits

If you have to reduce or stop work because of your cancer, you may find it hard to cope financially. If you have cancer or you’re caring for someone with cancer, you may be entitled to financial support.

• If you have a job but can’t work because of your illness, you’re entitled to Statutory Sick Pay from your employer.
• If you don’t have a job and can’t work because of your illness, you may be entitled to Employment and Support Allowance.
• If you’re caring for someone with cancer, you may be entitled to Carer’s Allowance.
• You may be eligible for other benefits if you have children living at home or you have a low household income.

It’s a good idea to find out early on what help is available to you. You could ask to speak to the social worker at your hospital, who will be able to give you the information you need.

Free prescriptions

People being treated for cancer are entitled to apply for an exemption certificate giving free prescriptions for all medication, including treatments for unrelated conditions.

The certificate is valid for five years. You can apply for a certificate by speaking to your GP or cancer specialist.

Read more about help with prescription costs.

Want to know more?

• GOV.UK: benefits information

Your sex life

Many women feel nervous about having sex soon after treatment for cervical cancer, but it’s perfectly safe. Sex won’t make the cancer come back and your partner can’t catch cancer from you.

If you want to, you can resume your normal sex life within a few weeks of finishing radiotherapy or having surgery. This gives your body time to heal.

If you are having chemotherapy, your partner should wear a condom when you have sex as it is not clear if having sex after chemotherapy can have an affect on them.

Some women find sex difficult after being treated for cervical cancer, as the side effects of some treatments can include vaginal dryness and narrowing of the vagina. If this is the case, there are some treatments that can help, such as vaginal dilators. 

See complications of cervical cancer for more information about this.

Want to know more?

• Macmillan Cancer Support: how treatment for cervical cancer may affect your sex life

There is no single way to completely prevent cervical cancer, but there are a number of things that can help reduce your risk.

These are described in more detail below.

Safer sex

Most cases of cervical cancer are linked to an infection with certain types of human papillomavirus (HPV). HPV can be spread through unprotected sex, so using a condom can help reduce your risk of developing the infection.

Your risk of developing a HPV infection increases the earlier you start having regular sex and with the more sexual partners you have, although women who have only had one sexual partner can also develop it.

However, as HPV is very common and is largely spread through skin-to-skin contact in the wider genital area, it is hard to prevent just by practising safe sex. This is why it’s important to attend all the cervical screening tests you’re invited to and why the HPV vaccine is routinely offered to children.

Read more about sexual health.

Cervical screening

Regular cervical screening is the best way to identify abnormal changes in the cells of the cervix at an early stage.

Women who are 25 to 49 years old are invited for screening every three years. Women who are 50 to 64 years old are invited every five years. Make sure that your GP surgery has your up-to-date contact details so that you continue getting screening invitations.

It’s important that you attend your smear tests even if you have been vaccinated for HPV, because the vaccine does not guarantee protection against cervical cancer.

If you have been treated for abnormal cervical cell changes, you will be invited for screening more frequently for several years after treatment. How regularly you need to go will depend on how severe the cell change is.

Although it can spot most abnormal cell changes in the cervix, cervical screening is not always 100% accurate. Therefore, you should report symptoms such as unusual vaginal bleeding to your GP even if you have recently been tested.

Cervical cancer vaccination

The human papilloma virus (HPV) vaccination protects against the two strains of virus responsible for most cases of cervical cancer.

Girls are offered the childhood immunisation programme. The vaccine is given to girls when they’re 12 to 13 years old, with three doses given over a six-month period.

Although the HPV vaccine can significantly reduce the risk of cervical cancer, it does not guarantee you won’t develop the condition. You should still attend cervical screening tests even if you have had the vaccine.

Avoid smoking

You can reduce your chances of getting cervical cancer by not smoking. People who smoke are less able to get rid of the HPV infection from the body, which can develop into cancer.

If you decide to stop smoking, your GP will be able to refer you to the NHS Stop Smoking Service, which gives you help and advice about the best ways to give up smoking.

You can also call the NHS Smoking Helpline on 0300 123 1044. The specially trained helpline staff can offer you free expert advice and encouragement.

If you want to give up smoking but you don’t want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms that you may experience after giving up.

For more information and advice about giving up smoking, see stopping smoking and treatments for stopping smoking.

The Map of Medicine is used by doctors throughout the NHS to determine the best treatment options for their patients. NHS Choices offers everyone in England exclusive and free access to this cutting-edge internet resource, which lets you see exactly what your doctor sees.

The information in the Map has been approved by the UK’s leading clinical experts, is based on the best available clinical evidence, and is continually updated. To take advantage of this unique resource go to:

Map of Medicine: cervical cancer

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

This is why it’s very important for you to attend 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).

If you have any type of unusual vaginal bleeding, visit your GP for advice.

Other symptoms

Other symptoms of cervical cancer may include:

• pain and discomfort during sex
• 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 bowel and bladder habits
• loss of appetite
• weight loss
• tiredness and lack of energy

When to seek medical advice

It is recommended that you contact your GP if you experience:

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

Vaginal bleeding is very common and can have a range of causes, so it doesn’t necessarily mean that you have cervical cancer.

However, unusual vaginal bleeding is a symptom that needs to be investigated by your GP.

The treatment for cervical cancer depends on how far the cancer has spread.

Deciding which treatment is best for you can often be confusing, which is why hospitals use multidisciplinary teams (MDTs) to treat cervical cancer. MDTs are made up of a number of different specialists who work together to make decisions about the best way to proceed with your treatment.

Your cancer team will recommend what they think the best treatment options are, but the final decision will be yours.

In most cases, the recommendations will be:

• early cervical cancer – surgery to remove some or all of the womb, radiotherapy, or a combination of the two
• advanced cervical cancer – radiotherapy and/or chemotherapy, although surgery is also sometimes used

The prospect of a complete cure is good for cervical cancer diagnosed at an early stage, although the chances decrease the further the cancer has spread.

Even in cases where cervical cancer isn’t curable, it’s often possible to slow its progression, prolong lifespan and relieve any associated symptoms, such as pain and vaginal bleeding. This is known as palliative care.

The different treatment options are discussed in more detail below.

Removing abnormal cells

If your screening results show that you don’t have cervical cancer but there are biological changes that could turn cancerous in the future, a number of treatment options are available. These include:

• large loop excision of the transformation zone (LLETZ) – the abnormal cells are cut away using a fine wire and an electrical current
• cone biopsy – the area of abnormal tissue is removed during surgery
• laser therapy – a laser is used to burn away the abnormal cells

Read more about treating abnormal cells in the cervix.

Surgery

There are three main types of surgery for cervical cancer. They are:

• radical trachelectomy – the cervix, surrounding tissue and the upper part of the vagina are removed but the womb is left in place
• hysterectomy – the cervix and womb are removed; depending on the stage of the cancer, it may also be necessary to remove the ovaries and fallopian tubes
• pelvic exenteration – a major operation in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed

The three types of surgery are discussed below.

Radical trachelectomy

A radical trachelectomy is usually only suitable if cervical cancer is diagnosed at a very early stage. It is usually offered to women who want to preserve their child-bearing potential.

During the procedure, the surgeon will make a number of small incisions (cuts) in your abdomen. Specially designed instruments will be passed through the incisions and used to remove your cervix and the upper section of your vagina. Lymph nodes from your pelvis may also be removed. Your womb will then be reattached to the lower section of your vagina.

Compared with a hysterectomy or pelvic exenteration, the advantage of this type of surgery is that your womb remains intact, which means that you may still be able to have children. However, it is important to be aware the surgeons carrying out this operation cannot guarantee you will still be able to have children.

If you do have children after the operation, your child would have to be delivered by caesarean section (where the baby is removed through an incision in your abdomen). It’s also usually recommended that you wait six to 12 months after having surgery before trying for a baby so that your womb and vagina have time to heal.

Radical trachelectomy is a highly skilled procedure. It’s only available at a number of specialist centres in the UK, so it may not be available in your area and you may have to travel to another city to be treated.

Hysterectomy

A hysterectomy is usually recommended for early cervical cancer. This may be followed by a course of radiotherapy to help prevent the cancer coming back.

Two types of hysterectomies are used in treating cervical cancer. They are:

• simple hysterectomy – where the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes are also removed; this is only appropriate for very early stage cervical cancers
• radical hysterectomy – where the cervix, womb, surrounding tissue and lymph nodes, ovaries and fallopian tubes are all removed; this is the preferred option in advanced stage one and some early stage two cervical cancers

Short-term complications of a hysterectomy include infection, bleeding, blood clots and accidental injury to your ureter, bladder or rectum.

The risk of long-term complications is small but they can be troublesome. They include:

• your vagina can become shortened and drier, which can make sex painful
• urinary incontinence
• swelling of your arms and legs caused by a build-up of fluid (lymphoedema)
• your bowel becomes obstructed because of a build-up of scar tissue – this may require further surgery to correct

As your womb is removed during a hysterectomy, you will no longer be able to have children.

If your ovaries are removed, it will also trigger the menopause if you haven’t already experienced it. See complications of cervical cancer for more information about the menopause.

Pelvic exenteration

A pelvic exenteration is a major operation that’s usually only recommended when cervical cancer returns after what was thought to be a previously successful course of treatment. It is offered if the cancer returns to the pelvis but hasn’t spread beyond this area.

A pelvic exenteration involves two phases of treatment:

• the cancer is removed, plus your bladder, rectum, vagina and the lower section of your bowel
• two holes called stomas are created in your abdomen – the holes are used to pass urine and faeces out of your body into collection pouches called colostomy bags

Following a pelvic exenteration, your vagina can be reconstructed using skin and tissue taken from other parts of your body. This means that you’ll be able to have sex after the procedure, although it may be several months until you feel well enough to do so.

Radiotherapy

Radiotherapy may be used on its own or combined with surgery for early stage cervical cancer. It may be combined with chemotherapy for advanced cervical cancer, where it can be used to control bleeding and pain.

There are two ways that radiotherapy can be delivered. These are:

• externally – a machine beams high energy waves into your pelvis to destroy cancerous cells
• internally – a radioactive implant is placed inside your vagina and cervix

In most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts for around five to eight weeks.

As well as destroying cancerous cells, radiotherapy can sometimes also harm healthy tissue. This means it can cause significant side effects many months and even years after treatment.

However, the benefits of radiotherapy often tend to outweigh the risks. For some people, radiotherapy offers the only hope of getting rid of the cancer.

Side effects of radiotherapy are common and can include:

• diarrhoea
• pain when urinating
• bleeding from your vagina or rectum
• feeling very tired (fatigue)
• feeling sick (nausea)
• sore skin in your pelvis region similar to sunburn
• narrowing of your vagina, which can make having sex painful
• infertility
• damage to the ovaries, which will usually trigger an early menopause (if you haven’t already experienced it)
• bladder and bowel damage, which could lead to incontinence

Most of these side effects will resolve within about eight weeks of finishing treatment, although in some cases they can be permanent. It is also possible to develop side effects several months or even years after treatment has finished.

If infertility is a concern for you, it may be possible to surgically remove eggs from your ovaries before you have radiotherapy so that they can be implanted in your womb at a later date. However, you may have to pay for this.

It may also be possible to prevent an early menopause by surgically removing your ovaries and replanting them outside the area of your pelvis that will be affected by radiation. This is known as an ovarian transposition.

Your MDT will be able to provide more information about the possible options for treating infertility and whether you’re suitable for an ovarian transposition.

Chemotherapy

Chemotherapy can be combined with radiotherapy to try to cure cervical cancer, or it can be used as a sole treatment for advanced cancer to slow its progression and relieve symptoms (palliative chemotherapy).

Chemotherapy involves using either a single chemotherapy medication called cisplatin or a combination of different chemotherapy medications to kill the cancerous cells. 

Chemotherapy is usually given using an intravenous drip on an outpatient basis, so you’ll be able to go home once you have received your dose.

As with radiotherapy, these medications can also damage healthy tissue. Side effects are therefore common and can include:

• feeling sick
• being sick (vomiting)
• diarrhoea
• feeling tired all the time
• reduced production of blood cells, which can make you feel tired and breathless (anaemia) and vulnerable to infection because of a lack of white blood cells
• mouth ulcers 
• loss of appetite
• hair loss – your hair should grow back within three to six months of your course of chemotherapy being completed, although not all chemotherapy medications cause hair loss

Some types of chemotherapy medication can damage your kidneys, so you may need to have regular blood tests to assess the health of your kidneys.

Follow-up

After your treatment has been completed and the cancer has been removed from your body, you will need to attend regular appointments for testing. This will usually involve a physical examination of your vagina and your cervix, if it hasn’t been removed.

As there is a risk of cervical cancer returning, these examinations are used to look for signs of this. If anything suspicious is found, a further biopsy can be performed.

In cases where cervical cancer does return, this usually occurs around 18 months after a course of treatment has been completed.

Follow-up appointments are usually recommended every four months after treatment has been completed for the first two years, and then every six to 12 months for a further three years.