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

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

If the body cannot correct an abnormal cell, then there is a mechanism in place to kill the cell. Sometimes these abnormal cells cannot be fixed or 'killed off'. They develop and grow without any real control, sometimes they grow into a collection of abnormal cells called a tumour. Tumours can be benign or malignant. Benign tumours are not cancerous because they do not spread to beyond the original tumour growth area, however, they may cause a problem by pressing on the surrounding organs. They can be removed by an operation and do not usually cause any further problems.

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

There are two main types of cervical cancer:

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

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

Sometimes during the early stages of cervical cancer there may not be symptoms. If symptoms are experienced they could include:

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

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

Not all women diagnosed with cervical cancer experienced symptoms this means attending regular cervical screening is even more important.
As cancer develops, it can cause further symptoms;

  • Frequency of urine
  • Blood in the urine
  • Rectal bleeding
  • Diarrhea
  • Incontinence
  • Lower limb
  • lymphoedema

Almost all cases of cervical cancer are caused by persistent high risk Human Papillomavirus (HPV). HPV is a very common infection that four out of five sexually active adults will come into contact with in their lives, without any symptoms. This is why it is so important to attend your regular cervical screening.

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

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

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

It has been estimated that 1,408 new cervical cancer cases are diagnosed annually in Canada. Cervical screening can prevent around seven out of 10 cancers is 1.7% [2].

Cervical Cancer Treatment

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

A hysterectomy is the surgical removal of the uterus and the cervix. It is undertaken under a general anaesthetic.

A hysterectomy can be given as a treatment for conditions other than cervical cancer. Whilst there are different types of hysterectomy a radical hysterectomy (Wertheim) is the standard type advised by gynae-oncologist for women diagnosed with cervical cancer. This is because it is important that the surgeon removes the cervix and uterus in one whole piece so that he/she can clearly see the surrounding tissue, and that they can take a sample or remove tissue (as appropriate) such as the upper vaginal tissue, parametrium, and/or lymph nodes.

A radical hysterectomy (often referred to as a Wertheim hysterectomy) is when the surgeon removes the uterus and cervix, and some of the tissues which normally lie closest to the cervix. These are the top part of the vagina, parametrium (the ligament below the fallopian tubes which holds the womb in place), lymph glands and fatty tissue in the pelvis. The doctor may also remove the ovaries if he/she feels that there is a risk of abnormality i.e. one or both may look larger than normal or if the patient requests this. If the ovaries are removed then Hormone Replacement Therapy (HRT) may be recommended to replace hormones produced by the ovaries. Without functioning ovaries or HRT the woman would experience an early menopause. Some women, following discussion with their consultant/GP/specialist nurse choose not to take HRT after a hysterectomy.

Yes, it is usually a horizontal line just above your pubic hair line. It tends to heal extremely well and many women can hardly see the scar once it is healed. Sometimes a doctor will need to make a vertical incision – if this is the case the doctor will explain to you where the scar will be and why he will need to perform the operation in this way. It is usually for a reason other than the cancer, such as the womb being a bit larger than normal, or a cyst is present on one of the ovaries. In some centres it is possible for the operation to be carried out using laparoscopic (keyhole) surgery.

You will usually have a drip (small plastic tube) in your arm. This means that fluids can be given to you, without you needing to drink. A catheter (small tube) will usually be put into your bladder whilst you are asleep. This drains any urine into a bag. The drip and the catheter will usually be removed very soon after your operation – when your body has recovered and you can drink independently. The catheter may need to stay longer, sometimes upto five days. This is to let the bladder recover fully after the surgery. Even when it is removed it is important that bladder function is measured to ensure that it doesn't overfill. In a few cases it is necessary to continue catheterising the bladder to make sure it empties properly. This can go on for a few weeks or even a month or two in some cases. A dressing will cover your scar – you may have stitches or clips which will need to be removed some days (usually between five and ten) after the operation. You may have one or more drains in place. These drain any blood or serous fluid from the scar area into a bag or bottle. This helps prevent infection and reduces bruising. These drains are taken out within days of the operation. You will be given pain killers to minimise any discomfort that you experience. This may be in the form of an epidural, hand held pump (where you can press the button when you need more pain relief), injections or/and suppositories. When you are able to drink, then you can have oral medications such as tablets. The staff looking after you will talk to you about your pain relief choices before your operation.

Yes, the vaginal tissues are very stretchy; this means that although the top part of the vagina is removed, you will be able to have full intercourse usually without any difficulties. Most people say that they do not notice any difference (however women who have had radiotherapy will notice some changes to the vagina after treatment). The most common changes a woman may feel are: the absence of the uterus moving during orgasm – this does not make the orgasm less pleasurable, if the ovaries have been removed and no HRT has been taken the vaginal tissues may feel a little dry. HRT or a vaginal lubricant should be helpful. Psycho-sexual issues – how a woman (or her partner) feel about their body or/and about sex may affect their arousal and therefore their satisfaction with intercourse. If this is a problem all women who have had a treatment for a cervical cancer are able to see a psycho-sexual counsellor to discuss it further. You can arrange an appointment via your GP your hospital consultant or specialist nurse.

The lymph glands in the pelvis are like those that may be affected in the neck if you have a sore throat or a cold. You cannot tell for certain if lymph nodes are free from disease unless you remove them and look at them under the microscope. There is usually no noticeable difference for you if some of these are removed. Your immune system is not compromised. There is a small risk that you could develop lymphoedema after the operation.

Lymphoedema is the accumulation of lymphatic fluid. It is not dangerous, but can be uncomfortable as one leg or both can swell after a hysterectomy. If you do develop this you should report it to your GP, consultant or specialist nurse. They will confirm that it is lymphoedema and then refer you to a specialist who will advise you how to ensure the lymphoedema is kept to a minimum. Before your operation do ask your specialist nurse what you should do to help prevent lymphoedema occurring after the operation, what signs to look for and what services are available should you develop it.

If, after initial treatment, your cancer comes back in the pelvic area, it may be possible to have an operation called a pelvic exenteration. This is a major operation that involves removing all of the structures in the pelvic area and can include the womb, cervix, vagina, ovaries, bladder and the lower end of the large bowel (rectum). This type of operation is only suitable for a small number of women and you will need to have various investigations and scans to see if it is possible.

Part of the operation involves creating two openings (stomas) on the abdominal wall. These are needed because the operation removes the bladder and the rectum and you will need two stoma bags: one to collect your bowel motions and one for urine. These stomas are known as a colostomy and a urostomy. Before the operation you will see a nurse who specialises in the care of people with stomas (a stoma nurse). The nurse will explain all about stomas and how to look after them and can answer any questions you may have. The stoma nurse will also visit you after the operation to help you.

The operation also involves making (reconstructing) a new vagina.

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

You may find it helpful to join our Jo’s Cervical Cancer Trust online forum community. There are other women who have gone through pelvic exenteration who would be willing to share their stories and help support you through your surgery and recovery.

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


References

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

 


"FAQ on Cervical Cancer." Jo's Cervical Cancer Trust. N.p., 19 Aug. 2013. Web. 02 Mar. 2015.