Cervical cancer: what you need to know

A cervical cancer sufferer who has been told she has just months to live has urged women not to put off getting a smear test and to be vigilant against symptoms.

Samantha Hickling, 26, who married her fiancé at their home on March 1 after being told there was no more doctors could do for her, has spoken out in the hope of savings others.

Samantha was first diagnosed with a rare form of cervical cancer in 2011. She said: “If my cancer had been caught earlier, then I might have been able to have surgery to remove it and my outlook could have been very different."

She added: “A smear test can save your life and I'd tell anybody who is putting off going for theirs to go and do it.”

Sam's mum, Wanda Fischer, said: “There really isn't enough information about how cervical cancer can affect young women in particular.”

So what is cervical cancer and what are the symptoms, and how are young women being affected?

The basics

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

Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus, 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, which causes them to reproduce uncontrollably and trigger the onset of cancer.

The NHS offers a national screening programme - a cervical smear test - for all women over 24 years old (find out more below).

Symptoms

Cervical cancer often has no symptoms in its early stages. But 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 you definitely have cervical cancer, but it is important to see your GP as soon as possible.

Seek medical advice if you experience:

- bleeding after having sex

- bleeding outside of your normal periods

- new bleeding after the menopause

Other symptoms of cervical cancer may include:

- pain in and around your vagina when having sex

- pain when passing urine

- an unpleasant smelling vaginal discharge

If the cancer spreads out of your cervix and into surrounding tissue and organs it can lead to other symptoms, including:

- changes to your bowel and bladder habits

- loss of appetite

- weight loss

- tiredness and lack of energy

- constipation

- blood in your urine

- loss of bladder control (urinary incontinence)

- bone pain

- swelling of one of your legs

- swelling of one or both kidneys, which can become misshapen due to a build-up of urine, and cause severe pain in your side or back; this type of swelling is known as hydronephrosis

Smear test

The NHS offers a national screening programme - a cervical smear test - for all women over 24 years old.

It is not a test for cancer but a screening test to detect abnormalities (pre-cancer) at an early stage in the cells in the cervix. During screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities.

Most women's test results show everything is normal, but for one in 20 women the test will show some abnormal changes in the cells of the cervix.

Most of these changes won’t lead to cervical cancer and the cells may go back to normal on their own. But in some cases the abnormal cells need to be treated to prevent them becoming cancerous.

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 crucial for you to attend your screening appointments for a cervical smear test.

It is recommended women between the ages of 25 and 49 are screened every three years, and women between 50 and 64 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 screening here.

Young women

It's possible for women of all ages to develop cervical cancer, but the condition mainly affects sexually active women between the ages of 25 and 45.

The highest incidence of cervical cancer occurs in women aged between 30 and 39, with the under-35s most likely to be affected.

Many women who are affected did not attend their screening appointments.

The incidence of cervical cancer in women in their twenties has risen by more than 40 per cent between 1992 and 2006 in England, despite the overall incidence of cervical cancer dropping by 30 per cent.

The findings show after initially dropping following the introduction of cervical screening in England, the number of women aged between 20 and 29 diagnosed with cervical cancer is now rising in most areas of the country.

In 2007 nearly 2,800 cases of cervical cancer were diagnosed in UK. In addition, about 25,000 cases were diagnosed with a precancerous condition of the cervix called cervical intraepithelial neoplasia (CIN).

But due to the success of the NHS screening programme, cervical cancer is now an uncommon type of cancer in the UK.

The number of women who develop cervical cancer has halved since the 1980s due to most women regularly having cervical screening, and NHS cervical screening saves around 5,000 lives a year in England.

Causes

Cancer begins with a change in the structure of the DNA which is present in all human cells.

Almost all cases of cervical cancer occur in women who have been previously infected with the human papillomavirus (HPV), a group of viruses.

There are additional risk factors which affect the chance of developing cervical cancer. These include:

- Smoking: women who smoke are twice as likely to get cervical cancer than non-smokers

- Having a weakened immune system: which 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

- 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 to women who do not have any children

Treating cervical cancer

If cervical cancer is diagnosed at an early stage, it's usually possible to treat it using surgery or radiotherapy.

In some cases it's possible to leave the womb in place, but sometimes it will need to be surgically removed – this procedure is called a hysterectomy.

More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy. Radiotherapy can also cause infertility as a side effect.

For more information, visit:

• Cervical cancer - NHS

• Jo’s cervical cancer trust

• Cervical cancer – Cancer Research UK

• Cervical cancer - Macmillan