Cervical cancer: symptoms, causes, screening and treatment

The NHS lists the main symptoms as:

• vaginal bleeding that is unusual for you, including during or after sex, between periods, after the menopause, or heavier periods than usual

• changes to vaginal discharge

• pain during sex

• pain in the lower back, between the hip bones (pelvis) or in the lower tummy

The NHS stresses that these symptoms are very common and can be caused by many different conditions, so having them does not definitely mean cervical cancer, but they should be checked by a GP because finding cancer early makes treatment more likely to be successful. If you have a condition such as fibroids or endometriosis you may get similar symptoms regularly and get used to them, so the NHS says to get checked if symptoms change, get worse or do not feel normal for you.

At the appointment the GP may ask to examine you: looking at the vulva, feeling inside the vagina, using a speculum to see the cervix, and possibly taking a swab. You can ask for a female doctor when you book, have someone with you, and ask the doctor to stop at any time. If the GP thinks symptoms could be cancer you may get an urgent referral, which the NHS says does not definitely mean you have cancer.

Cancer Research UK explains that cervical cancer grows from abnormal cells in the lining of the cervix that divide in an uncontrolled way. The cervix is the lower part of the womb, a canal connecting the top of the vagina with the womb. Squamous cell cancer, starting in the skin-like cells covering the outer surface of the cervix, is the most common type, and adenocarcinoma starts in the glandular cells of the canal. Most cervical cancers start in the transformation zone, where the two cell types meet, which is the area checked during screening.

The NHS says anyone with a cervix can get cervical cancer, and that you cannot get it if you have had surgery to remove your womb and cervix (a total hysterectomy). Cancer Research UK adds that trans men and non-binary people assigned female at birth can develop it if they have not had that operation.

The NHS says you can get HPV from any skin-to-skin contact of the genital area, from vaginal, anal or oral sex and from sharing sex toys. Cervical cancer is most common in women aged between 30 and 35 but can happen at any age. Cancer Research UK says HPV is a common virus and describes persistent infection with certain types as the main cause.

The NHS lists other factors that may make cervical cancer more likely: a weakened immune system such as with HIV, giving birth to multiple children or at an early age (under 17), the mother having taken diethylstilbestrol (DES) in pregnancy, a past vaginal, vulval, kidney or bladder cancer, smoking, and taking the contraceptive pill for more than 5 years, which it says only slightly increases risk and for many people the benefits outweigh the risks.

The NHS says cervical screening and HPV vaccination are the best ways to protect yourself. Everyone with a cervix aged 25 to 64 is invited for screening, every 5 years according to the NHS, to find and treat cell changes before they turn into cancer. Cancer Research UK points out that screening is not a test for cancer but a test for HPV, with further tests for abnormal cells if HPV is found. The NHS says all children aged 12 to 13 are offered the HPV vaccine, which helps protect against the types of HPV that cause most cervical cancers.

Screening is not recommended under 25 because cervical cancer is very rare in that group and abnormal changes often go back to normal, nor is routine screening continued past 65 if recent tests were clear, the NHS says. It also says that if you have symptoms you should not wait for your next screening appointment. Using condoms lowers the chance of HPV but does not give full protection, and quitting smoking helps because smoking can weaken the immune system.

The NHS says the main test is a colposcopy, in which a nurse or doctor uses a speculum and a microscope with a light that stays outside the body to look at the cervix, often applying a liquid to show abnormal areas and taking a small sample of cells (biopsy) for the laboratory. It takes around 15 to 30 minutes and should not be painful, though it may be uncomfortable. Results can take several weeks.

If cancer is confirmed you will usually need more tests to find the size and how far it has spread (the stage). The NHS says you may need blood tests, scans such as CT, MRI or PET scan or a chest X-ray, and an internal examination under general anaesthetic, though not necessarily all of these. A group of specialists looks after you, including a clinical nurse specialist as your main point of contact.

The NHS says cervical cancer is often treatable, and treatment depends on the size and type of cancer, where it is, whether it has spread and your general health. It will usually include surgery, chemotherapy or radiotherapy, and may include targeted medicines. The team will talk to you about the impact on fertility.

Surgery is often the main treatment, especially when found early. Depending on the case it may remove part of the cervix (only if the cancer is very small), the cervix and sometimes the upper vagina (the womb is not removed so pregnancy may be possible), or the cervix, upper vagina and womb (hysterectomy), which can include the ovaries and fallopian tubes. Some lymph nodes may be removed. Chemotherapy may be given with radiotherapy as the main treatment, or after surgery to help stop the cancer returning. Radiotherapy may be the main treatment if the cancer is large or has spread, and can be given from outside or inside the body (brachytherapy). Targeted medicines and immunotherapy are used for advanced or recurrent cancer, with the aim of making it smaller or stopping it growing rather than curing it.

If the cancer cannot be cured, the NHS says the aim is to limit the cancer and its symptoms and help you live longer, with a palliative care or symptom control team involved to help manage symptoms and support you and your family.

On the NHS the route is through the GP for symptoms, through the screening programme for invitations every 5 years from 25 to 64, and then to colposcopy and a specialist cancer team if needed. The NHS says that if the GP thinks symptoms could be cancer, you may get an urgent referral, and that this does not definitely mean you have cancer.

Private gynaecology services can offer examination, colposcopy and consultations, often with shorter waits. Screening invitations and the HPV vaccination programme for 12 to 13 year olds are delivered through the NHS. Whichever route you use, ask who will explain your results and who your main point of contact will be.