Overview

Cancer of the cervix
Cancer of the cervix

Cervical cancer develops in a woman's cervix (the entrance to the womb from the vagina). It mainly affects sexually active women aged between 30 and 45.

Symptoms of cervical cancer

Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is abnormal vaginal bleeding, which can occur after sex, in between periods, or new bleeding after you have been through the menopause.

Abnormal bleeding doesn't mean you have cervical cancer, but you should see your GP as soon as possible to get it checked out.

If your GP suspects you might have cervical cancer, you should be referred to see a specialist and wait for no longer than 62 days for your treatment to commence.

Screening for cervical cancer

The best way to protect yourself from cervical cancer is by attending cervical screening (previously known as a "smear test") when invited.

Cervical Screening Wales provides a national screening programme for all women who are between 25-64 years of age, for early-stage cell changes. 

During screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities.

An abnormal cervical screening test result doesn't mean you definitely have cancer. Most abnormal results are due to signs of HPV, the presence of treatable precancerous cells, or both, rather than cancer itself.

It is recommended that women aged between 25 and 49 are invited for screening every three years, and women aged between 50 and 64 are invited every five years .For women who are 65 or older, only those who haven't been screened since they were 50, or those who have had recent abnormal tests, are offered screening. 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.

What causes cervical cancer?

Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman.

There are more than 100 types (strains) of HPV, many of which are harmless. However, some types can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer.

Two strains, HPV 16 Aand HPV 18, are known to be responsible for most cases of cervical cancer. They don't have any symptoms, so women will not realise they have it.

But these infections are very 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 because the virus is also spread through skin-to-skin contact of the wider genital area.

Since 2008, a HPV vaccine has been routinely offered to girls aged 12 and 13.

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 another option for some women with early-stage cervical cancer. In some cases, it is used alongside surgery or chemotherapy, or both.

More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy.

Some of the treatments can have significant and long-lasting side effects, including early menopause and infertility.

Complications

Some women with cervical cancer may develop complications. These can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, surgery and chemotherapy.

Complications that are associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina or having to pee frequently, to life-threatening, such as severe bleeding or kidney failure.

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Symptoms

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

This is why it's very important for you to attend all your cervical screening appointments.

Unusual bleeding

In most cases, abnormal vaginal bleeding is the first noticeable symptom of cervical cancer.

It includes bleeding:

  • during or after sex
  • between your periods
  • after you have been through the menopause

Visit your GP for advice if you experience any type of abnormal vaginal bleeding.

Other symptoms

Other symptoms of cervical cancer may include pain and discomfort during sex, unusual or unpleasant smelling vaginal discharge, and pain in your lower back or pelvis.

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:

  • pain in your lower back or pelvis
  • constipation
  • blood in your urine 
  • peeing or pooing more often than usual
  • losing control of your bladder (urinary incontinence) or losing control of your bowels (bowel incontinence)
  • swelling of one or both legs
  • severe pain in your side or back caused by your kidneys
  • severe vaginal bleeding

When to seek medical advice

You should contact your GP if you experience:

  • bleeding after 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 you have cervical cancer. However, unusual vaginal bleeding needs to be investigated by your GP.

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Who can get it

Almost all cases of cervical cancer are caused by the human papillomavirus (HPV).

Human papillomavirus (HPV)

Almost all cervical cancer cases occur in women who have been previously infected with the HPV.

HPV is a group of viruses, rather than a single virus. There are more than 100 different types.

HPV is spread during sexual intercourse and other types of sexual activity, such as skin-to-skin contact of the genital areas or using sex toys, and is very common.

Most women will get some type of HPV 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 can cause genital warts, although these types are not linked to an increased risk of cervical cancer.

But at least 15 types of HPV are considered high-risk for cervical cancer. The two highest risk are HPV 16 and HPV 18, which cause the majority of cervical cancers.

High-risk types of HPV are thought to stop the cells working normally, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour.

As most types of HPV don't cause any symptoms, you or your partner could have the virus for months or years without knowing it.

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

Pre-cancerous cervical abnormalities

Cancer of the cervix usually takes many years to develop. Before it does, the cells in the cervix often show changes. 

These cervical abnormalities are known as cervical intraepithelial neoplasia (CIN) or, less commonly, cervical glandular intraepithelial neoplasia (CGIN) depending on which cells are affected.

CIN and CGIN are pre-cancerous conditions. Pre-cancerous conditions do not pose an immediate threat to a person’s health. But if they're not checked and treated, they can potentially develop into cancer.

However, even if you develop CIN or CGIN, the chances of them turning into cervical cancer are very small.

And if the changes are discovered during cervical screening, treatment is highly successful.

The progression from HPV infection to developing CIN  or CGIN and then cervical cancer is very slow, often taking 10 to 20 years.

Increased risk

HPV infection being very common but cervical cancer 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 get cervical cancer than women who don't; this may be due to harmful effects of chemicals found in tobacco on the cells of the cervix
  • having a weakened immune system
  • taking the oral contraceptive pill for more than five years -  the risk is not well understood
  • having more than 5 children, or having them at an early age (under 17 years old)
  • your mother taking the hormonal drug diethylstilbestrol (DES) while pregnant with you - your GP can discuss these risks with you

The reason for the link between cervical cancer and childbirth is unclear.

One theory is that the hormonal changes that occur during pregnancy may make the cervix more vulnerable to the effects of HPV.

 

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Diagnosis

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

Colposcopy

If you have had an abnormal cervical screening test result, or any symptoms of cervical cancer, you will usually be referred for a colposcopy. This is an examination to look for abnormalities in your cervix. It's normally done by a nurse called a colposcopist.

If you have had abnormal bleeding, your GP may first recommend a chlamydia test before being referred for a colposcopy.

The colposcopist will use a device called a speculum to open your vagina, just like they do during cervical screening. A small microscope with a light at the end (a colposcope) will be used to look at your cervix. This microscope stays outside your body.

As well as examining your cervix, they may remove a small tissue sample (biopsy) so it can be checked for cancerous cells. After a biopsy, you may have some vaginal bleeding for up to 6 weeks. You may also have period-like pains.

In most cases, the abnormalities do not mean you have cervical cancer, but you may be referred to a gynaecologist for further tests.

Treatment to remove abnormal cells can sometimes be done at the same time as a colposcopy.

Further testing

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

Staging

Staging is a measurement of how far the cancer has spread.

After all the tests have been completed and the results are known, it should be possible to tell what stage the cancer is. The higher the stage, the further the cancer has spread.

The staging for cervical cancer is:

  • stage 0 – no cancerous cells in the cervix, but there are abnormal cells that could develop into cancer in the future - this is called pre-cancer or carcinoma in situ
  • stage 1 – the cancer is only inside the cervix
  • stage 2 – the cancer has spread outside the cervix into the surrounding tissue but hasn't 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 or pelvic wall
  • stage 4 – the cancer has spread into the bowel, bladder or other organs, such as the lungs
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Treatment

Treatment for cervical cancer depends on how far the cancer has spread.

As cancer treatments are often complex, hospitals use multidisciplinary teams (MDTs) to treat cervical cancer and tailor the treatment programme to the individual.

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:

  • for early cervical cancer - surgery to remove the cervix and some or all of the womb, or radiotherapy, or a combination of both
  • for advanced cervical cancer - radiotherapy with or without chemotherapy, and surgery is also sometimes used

Cervical cancer is often curable if it's diagnosed at an early stage.

When cervical cancer is not 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 in the following sections.

Removing very early cancer

Large loop excision of the transformation zone (LLETZ)

This is where the cancerous cells are removed using a fine wire and an electrical current.

It's usually done under local anaesthetic (while you're awake but the area is numbed) and can be done at the same time as a colposcopy.

Cone biopsy

A cone-shaped area of abnormal tissue is removed during surgery. This is usually done under general anaesthetic (while you're asleep).

Surgery

There are three main types of surgery for cervical cancer:

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

Pelvic exenteration is only offered when cervical cancer has come back.

Trachelectomy

A radical trachelectomy is usually only suitable if cervical cancer is diagnosed at a very early stage. It's usually offered to women who want to have children in the future.

During the procedure, the cervix and upper section of the vagina are removed, leaving the womb in place. Your womb will then be reattached to the lower section of your vagina.

It's usually done by keyhole surgery.

Lymph nodes (part of the lymphatic system, the body's waste-removal system) from your pelvis may also be removed.

Compared with a hysterectomy or pelvic exenteration, the advantage of this type of surgery is that your womb remains in place. This means you may still be able to have children.

However, it's important to be aware that the surgeons carrying out this operation can't guarantee you'll still be able to have children.

A stitch will be put in the bottom of your womb during the surgery. This is to help support and keep a baby in your womb in future pregnancies. If you do get pregnant after the operation, your baby will have to be delivered by caesarean section.

It's also usually recommended you wait 6 to 12 months after surgery before trying for a baby so your womb and vagina have time to heal.

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

Hysterectomy

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:

  • simple hysterectomy - the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes are too; only appropriate for very early-stage cervical cancers
  • radical hysterectomy - preferred option in advanced stage one and some early stage two cervical cancers; the cervix, womb, top of the vagina, surrounding tissue, lymph nodes, fallopian tubes and, sometimes, ovaries are all removed

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

Although the risk of them is small, long-term complications can be troublesome. They include:

  • your vagina becomes 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 becoming blocked by a build-up of scar tissue - this may require further surgery

Because your womb is removed during a hysterectomy, you will not be able to have children.

If your ovaries are removed, it will also trigger the menopause if you have not already experienced it.

Pelvic exenteration

A pelvic exenteration is a major operation that's usually only recommended when cervical cancer comes back. It is offered if the cancer returns to the pelvis but hasn't spread beyond this area.

A pelvic exenteration involves two phases:

  • the cancer and the vagina are removed - it may also involve removing the bladder, rectum or lower section of the bowel, or all 3
  • 1 or 2 holes, called stomas, are created in your tummy - the holes are used to pass pee and poo out of your body into pouches called colostomy bags

Following pelvic exenteration, it may be possible to reconstruct your vagina using skin and tissue taken from other parts of your body. This would mean you could still 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 in combination 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.

Radiotherapy can be delivered either:

  • externally - a machine beams high-energy waves into your pelvis to destroy cancerous cells
  • internally (brachytherapy) - a radioactive implant is placed next to the tumout inside your vagina

In most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts for about 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.

Brachytherapy aims to reduce harm to surrounding tissue by delivering the radiation as close as possible to the tumour, but it can still cause side effects.

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 peeing
  • bleeding from your vagina or rectum
  • feeling very tired
  • feeling or being sick
  • sore skin, like sunburn, in your pelvis region
  • 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 gone through 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 of the area of your pelvis that will be affected by radiation. This is known as an ovarian transposition.

Your doctors can 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 and cure cervical cancer, or it can be used as a sole palliative treatment for advanced cancer to slow the progression and relieve symptoms (palliative chemotherapy).

Chemotherapy for cervical cancer usually involves using either a single chemotherapy drug, called cisplatin, or a combination of different chemotherapy drugs to kill cancerous cells.

Chemotherapy is usually given straight into your vein using a drip. You will probably be seen as an outpatient 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 and being sick
  • diarrhoea
  • feeling tired all the time
  • reduced production of blood cells, which can make you feel tired and breathless and vulnerable to infection
  • mouth ulcers
  • loss of appetite
  • hair loss - cisplatin does not usually cause you to lose your hair, but other chemotherapy drugs may

If you do lose your hair, it usually should grow back within 6 months of the completion of your course of chemotherapy.

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 you finish your treatment and the cancer has been removed, you will need to attend regular appointments for testing. This will usually involve a physical examination of your vagina and cervix (if it has not be removed).

Because cervical cancer can return, these examinations will be used to look for signs of this happening. If the examination finds anything suspicious, a further biopsy can be done.

Follow-up appointments are usually recommended every 3-6 months for the first two years, and then every six to 12 months for a further three years.

Your multidisciplinary team (MDT)

Members of your MDT may include:

  • a surgeon
  • a clinical oncologist (a specialist in chemotherapy and radiotherapy)
  • a medical oncologist (a specialist in chemotherapy only)
  • a pathologist (a specialist in diseased tissue)
  • a radiologist (a specialist in imaging scans)
  • a gynaecologist (a doctor specialising in treating conditions that affect the female reproductive system)
  • a social worker
  • a psychologist
  • a specialist cancer nurse, who'll usually be your first point of contact with the rest of the team
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Living with

The effect cervical cancer has on your daily life will depend on the stage of cancer and the treatment you're having.

Many women with cervical cancer have a radical hysterectomy. This is a major operation that takes time to recover from. Most women will need 6 to 12 weeks off work after a radical hysterectomy.

During recovery, try to avoid strenuous tasks and lifting, such as lifting children or heavy shopping bags. You probably will not be able to drive for at least 3 to 6 weeks after the operation, but you should check with your insurance company what their rules are.

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

You should not 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 you should contact.

Work

Having cervical cancer does not 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 as you did before.

If you have cancer, you're covered by the Disability Discrimination Act.

This means 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 "reasonable" depends on the situation, such as how much it would affect your employer's business, for example.

You should give your employer as much information as possible about how much time you will need off and when. Speak to a member of your human resources department, if you have one. Your union or staff association representative can also give you advice.

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

Money and benefits

If you have to reduce or stop work because of your cancer, you may find it difficult to cope financially. If you have cancer or are caring for someone with cancer, you may be entitled to financial support. For example:

  • 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 what help is available as soon as possible. You could ask to speak to the social worker at your hospital who can give you the information you need.

Your sex life

Many women feel nervous about having sex after treatment for cervical cancer, but it's perfectly safe. Sex won't make the cancer come back, and your partner cannot 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 will give your body time to heal.

If you're having chemotherapy, male partners should wear a condom as a precaution when you have sex. This is because at the moment it is not clear whether chemotherapy medication can come through in the vaginal mucus and affect male partners.

Some women find sex difficult after being treated for cervical cancer because the side effects of some treatments can include vaginal narrowing and dryness. In these cases, there are treatments that can help, such as vaginal dilators, moisturisers and lubricants.

See complications of cervical cancer for further information.

Macmillan Cancer Support has more on how treatment for cervical cancer may affect your sex life.

More information and support

The charity Jo's Cervical Cancer Trust has information on all aspects of cervical cancer.

It also has an online forum, free helpline and Ask the Expert section, and runs face-to-face support groups and information days for women affected by cervical cancer.

Local cancer support groups may also be available in your area. Your specialist cancer nurse should be able to provide contact details.

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Complications

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

Side effects:

Early menopause

If your ovaries are surgically removed or are damaged during treatment with radiotherapy, it will trigger an early menopause if you haven't already been through it. Most women experience the menopause in their early fifties.

Symptoms of the menopause include:

  • no longer having monthly periods or your periods becoming 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 the hormones 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, which can make having sex painful or difficult.

There are 2 main treatment options if you have a narrowed vagina. The first is to apply a hormone cream to your vagina. This should increase moisture within your vagina and make having sex easier.

The second is to use a vaginal dilators, sometimes called vaginal trainers. These are tampon-shaped plastic tubes that come in many different sizes. You insert one into your vagina, usually starting with the smallest size.

Dilators are designed to help stretch the vagina and make it more supple. As you get used to the smaller sizes, you can work your way up to slightly larger ones.

It's usually recommended to use dilators for five to 10 minutes at a time on a regular basis during the day over the course of six to 12 months.

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 to this process can lead to a build-up of fluid in the tissue, called lymphoedema. This can cause certain body parts to become swollen – usually the legs, in cases of cervical cancer.

There are 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 happy when removal of the cancer has been confirmed. You may then 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. Typical signs of depression include feeling sad and hopeless, and losing interest in things you used to enjoy.

Contact your GP 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).

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, which can usually be controlled with painkilling medications.

These painkillers 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, depending on pain levels.

Tell your care team if the painkillers you're prescribed aren't effective. You may need to be prescribed a stronger medication. A short course of radiotherapy may 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.

Kidney failure

In some cases of advanced cervical cancer, the tumour can cause a build-up of urine inside the kidneys (hydronephrosis), which can lead to loss of most or all of the kidneys' functions. This is called 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 pee (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, or widening the ureters by placing a small metal tube, called a stent, inside them.

Blood clots

As with other types of cancer, cervical cancer can make the blood "stickier" 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. This 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)
  • the skin of your leg being warm and red

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. This is known as a pulmonary embolism and can be fatal.

Blood clots in the legs are usually treated using a combination of blood-thinning medication, such as heparin or warfarin, and compression garments designed to help encourage blood flow 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 back passage (rectum), or you may pass blood when you pee.

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

Major bleeding may be temporarily treated by using gauze to stem the bleeding and, later, by surgery, radiotherapy or cutting off blood supply to the cervix.

Fistula

A fistula is a rare but distressing complication of advanced cervical cancer.

In most cases involving cervical cancer, the fistula is a channel that develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. A fistula can sometimes develop 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.

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 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 palliative care in the late stages of cancer. You may want to think about whether you'd like to be cared for in hospital, in a hospice or at home, and discuss these issues with your doctor.

Organisations that provide care for people with cancer include:

  • Macmillan Cancer Support, which has specially trained nurses who help to 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, which has specially trained nurses who help look after people with cancer at home – it also runs hospices for people with cancer
  • Hospice UK, which provides information about hospice care and how to find a hospice.
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Prevention

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

Cervical screening

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

Cervical Screening Wales invite women aged 25 to 49 years old for screening every three years, and those 50 to 64 years old every 5 years. For women who are 65 or over, only those who have not been screened since they were 50, have had recent abnormal tests or have never been screened before are still eligible for screening. 

Make sure your GP surgery has your up-to-date contact details so that you continue getting screening invitations.

It's important to attend your cervical screening 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 may be invited for screening more frequently for several years after treatment. How regularly you need to go depends on how severe the cell change is.

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

HPV vaccination

The NHS cervical cancer vaccination programme uses a vaccine called Gardasil. Gardasil protects against four types of HPV, including the two strains responsible for more than 70% of cervical cancers in the UK (HPV16 and HPV 18). It also prevents genital warts.

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

Although the HPV vaccine can significantly reduce the risk of cervical cancer, it doesn't guarantee that you won't develop the condition. You should still attend cervical screening tests, even if you've 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 want to give up smoking a good first step is to contact Help Me Quit on 0808 252 8216.  They offer the most effective support for people who want to give up smoking. Studies show you are four times more likely to give up smoking successfully if you do it with the help of the NHS.

Alternatively, your GP can provide help and advice about quitting.

For more information and advice about giving up smoking, see treatment for quitting smoking.

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.

However, the virus isn't just passed on through penetrative sex: it can be transmitted during any type of sexual contact. This includes any skin-to-skin contact between genitals; oral, vaginal or anal sex; and using sex toys.

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

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 09/03/2020 14:08:09