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Cervical Cancer

What is the cervix?

The cervix is the lower part of the womb (uterus). The cervix plays an important role in maintaining a normal pregnancy. In women who are not pregnant the cervix has no obvious function.

What is cervical cancer?

Cancer of the cervix is a cancer that begins in the lining of the cervix. Cancer of the cervix can take many years to develop and before it does, early pre-cancerous changes will take place on the cervix.

There is a very gradual change from a normal cervix to pre-cancer to cancer. This is why cervical cancer is one of the few cancers that can be prevented.

Am I at risk of developing cervical cancer?

It is not known what causes cervical cancer to develop in some women but not in others. But there are some risk factors that may increase the risk.

The biggest risk factor for the development of cervical cancer is sexual activity. Women who begin having sexual intercourse before the age of 18 and women who have many sexual partners have a greater risk of developing cancer of the cervix. This is because they are more likely to pick up the sexually transmitted disease, genital warts. Genital warts is from the H.P.V. family of viruses (Human Papilloma Virus) and can cause cells in the cervix, to begin the series of changes, that can lead to cancer. However, a woman may sleep with only one man and still catch genital warts from him. If you have any doubt about your partners sexual history, you should always use a condom.

The other major cause of cervical cancer is smoking and the risk increases with the number of years the woman has smoked. The reason for this is the chemicals from cigarette smoke damage the cells in the cervix.

What are the symptoms of cervical cancer?

Cervical cancer does not cause noticeable symptoms in the early stages, this is why a cervical smear test is so important.

Symptoms usually do not appear until abnormal cervical cells become cancerous and invade nearby tissues. When this happens the most common symptom is abnormal bleeding between periods or after sex. Another symptom of cervical cancer is an increase in vaginal discharge. None of these symptoms are conclusive in the diagnosis of cervical cancer, as the majority of sexually transmitted diseases can cause similar symptoms.

How is cervical cancer diagnosed?

Pre-cancerous changes in the cervix can be detected in a screening test known as a ‘smear test’ and treated before the cancer ever develops. The smear test is available for all women aged 20-64. In the U.K. you should have a smear test every 3-5 years. You will normally get a letter from your doctor to remind you. If you are under the age of 20 and are sexually active, you should ask your doctor for a cervical smear.

What is a smear test?

A smear test is designed to detect changes in the cells of the cervix before they develop into a cancer. The smear test is a very simple test and though it may be uncomfortable it should not painful, it will be a lot easier if you try to relax. An instrument called a speculum is used to keep the vagina open, and then a doctor/nurse will use a spatula to take a sample of the cells from the cervix. The cells are then spread onto a glass slide and sent away to a laboratory for examination.

Where can I have a smear test?

You can have a smear test at any of the following places:

  • Doctor’s surgery.
  • Well-woman clinic.
  • Family planning clinic.
  • G.U.M. clinic.

Remember, when you book an appointment for a smear test make it for the middle of your menstrual cycle (between periods). Also if you would prefer a female nurse to do your smear test, mention this when you book an appointment.

You will normally have to wait approximately 4 weeks for your results.

What is an abnormal smear test and what happens if I have one?

An abnormal smear test result usually means that changes have been found in the cells lining the cervix. The changes are not usually cancer and in most cases do not lead to cancer in the future.

You may also be called back for a repeat smear test if the results could not be read properly, this could simply be because not enough cells were on the slide.

Abnormal cells in your cervix are graded on a scale from C.I.N. 1-3, according to how many of the cells covering the cervix are affected. C.I.N. stands for Cervical Intra-epithelial Neoplasia.

C.I.N. 1 – means you have mild cell changes ( one third of cells are affected) and you will be asked to have a repeat smear test in 3-6 months times. In this time the cells will probably go back to normal.

C.I.N. 2 – means you have moderate cell changes (two thirds of cells are affected) and you will need to have some treatment. If the treatment is successful you are very unlikely to develop cervical cancer but may have to have smear tests more regularly.

C.I.N. 3 – means you have severe cell changes (the full layer of cells are affected) and you will need to have treatment as soon as possible. This does not mean that you have cancer.

If you have an abnormal smear test you may also have to have a further test known as a colposcopy. A colposcopy is an examination of the cervix, the doctor closely examines the surface of the cervix and may take a biopsy of any abnormal cells that are found.

A new test for cervical cancer.

A new improved test for cervical cancer has been developed, which is set to replace the smear test, it is due to be rolled out across the UK over the next 5 years. The new technique of liquid based cytology (LBC) involves taking the sample of cells using a brush like device rather than a spatula. The head of the device is then rinsed or broken off into a vial or preservative fluid so that most of the cervical cells are retained for examination in the laboratory. Medical trials in 4 English hospitals demonstrated the improved accuracy of the new technique, with a reduction in the rate of inadequate smears from 9.7% to less than 2%.

What treatment is available?

If you have been told you have grade C.I.N. 2 or 3 cell changes (moderate to severe) you will have to have treatment, most of which can be done in a hospital out-patients clinic. Treatment of abnormal cells include:

  • Laser therapy – a simple procedure that involves the abnormal cells being destroyed by a strong laser beam.
  • Cold Coagulation – the abnormal cells are burnt away (nothing to do with cold, despite the name) by placing a hot probe onto the surface of the cervix.
  • Cryotherapy – a cold probe is used to freeze away the abnormal cells.
  • Diathermy – this treatment is carried out under a local anaestheticbut you shouldn’t have to remain in hospital over night. Diathermy treatment involves abnormal cells being removed by an electrical current and then analysed in a laboratory.
  • Cone biopsy – this is a minor operation that can be used to diagnose and treat abnormal cells. The entire area where cells have become abnormal is removed. You will probably have to stay in hospital over night.

If cervical cancer has developed, the treatment you receive will depend on how far the cancer has spread. If cancer is caught early, treatment will be the same as that of abnormal cells (above). If cancer is in a further stage, surgery such as a hysterectomy may be recommended, especially if you are past your menopause. Cervical cancer may also be treated with radiotherapy or chemotherapy. The type of treatment you are offered will depend on your age, general health, the type of cancer and how far it has spread, your doctor will discuss all the options with you.

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