What is the cervix?

What is the cervix?

• The cervix is the lower part of the womb or uterus and is still sometimes referred to as the 'neck of the womb'.
• You can touch it with your fingertip at the far end of your vagina; it feels like the end of somebody's nose. It has a small hole through it, which leads up into the womb.
• The cervix opens up when a woman goes into labour, so as to let the baby through.
• In non-pregnant women, the cervix has no vital functions, although it is often important to the enjoyment of sex.
• During intercourse, the tip of the penis usually touches it.

What is cervical cancer?

• Cervical cancer is a malignant growth that develops in the area around the opening in the cervix.
• This is the sixth most common cancer in women in the UK. In 2010, 2,850 females were diagnosed with cervical cancer.
• Although British death rates have come down dramatically in recent times, the disease still kills nearly 1,000 women per year. But it is almost entirely preventable, if you have regular screening tests.
• The number of deaths worldwide is shocking: over 275,000 a year. These mainly occur because routine screening is not available in most poorer countries.
• So women should have a cervical smear test, often known as a Pap smear, performed on a regular basis in order to detect the cell changes that happen long before cancer develops.
• It usually takes many years for the very early cell changes that can be detected on a cervical smear to become cancerous and in most cases the changes go away by themselves.
• So the vast majority of abnormal smear test results do not indicate that the woman has cancer.
• It is by diagnosing and treating pre-cancerous changes that the development of actual cancer can be prevented.
• However, actual cancer of the cervix is a life-threatening condition of which there are two types called squamous cell cancer and (much rarer) adenocarcinoma.
• Cervical screening tests aim to detect the early changes of squamous cell cancer.

What causes cervical cancer?

• There are various factors that help to cause cervix cancer.
• For instance, the disease is much commoner in smokers, probably because of the many carcinogens (cancer-provokers) that are inhaled in cigarette smoke.
• Also, it has been known for years that the disorder is more frequent among women whose partners are manual workers, and in women from the north of England, compared with the south.
• But in the 21st century, it has become clear that the main cause of this carcinoma is a virus that is passed on during sex. That is why the disease is virtually unknown in virgins.
• The organism in question is the human papilloma virus (HPV). HPV is extremely common, and these days most sexually-active adult women have had it at some stage.
• Fortunately, the body’s immune defences usually overcome it fairly rapidly.
• But in some cases it persists in the cells of the cervix, where it can cause cancer many years later.
• It's worth noting that there are now known to be over 120 different types of HPV and only a few of them – notably Types 16 and 18 – can cause cervical cancer.

What are the symptoms of cervical cancer?

• Pre-cancerous changes of the cervix (CIN), which can be detected with a cervical screening test, do not give any symptoms at all.
• That's why women should have 'Pap smear tests', in order to detect the first signs of potential trouble long before any symptoms occur.
• When an actual cancer develops, there might be no symptoms for a while.
• But most women will develop bleeding between the periods or bleeding after sex. In older age groups, there may be post-menopause bleeding.

How is cervical cancer diagnosed?

• If the doctor looks at your cervix, she may be able to see appearances suggestive of cancer – but only if the disease is far advanced.
• In most cases, cervical cancer can only be diagnosed with certainty through a biopsy of the cervix. This means taking away a small piece of tissue and sending it to the lab for examination under the microscope.
• The biopsy is usually performed at the time of an internal examination called a colposcopy, in which the doctor inspects the cervix with a binocular-like device.

How is pre-cancer treated?

• Early changes in the cervix can fairly easily be treated and cured.
• Methods of treatment include:
•  Laser ablation – which means cutting away a small area of the cervix with a laser beam
• Cryotherapy – treating the area with a freezing probe
• Cone biopsy – cutting out a cone shaped piece of tissue with a scalpel
•   LLETZ – which stands for 'large loop excision of transformation zone'. This means cutting out the affected area with a loop-shaped electrical probe. (In some countries, that’s known as 'LEEP' – short for 'loop electrosurgical excision procedure').
• How is cervical cancer treated?
• If actual cervical cancer is diagnosed; the gynaecologist or oncologist (cancer specialist) should discuss treatment options with the woman.
• The type of treatment will depend upon what stage the cancer has reached.

Cancer of the cervix is always 'rated' as being in one of five stages, which are:

Stage 0

This is the very early stage, and it’s often described as 'carcinoma-in-situ', meaning 'in its original place'. The cancerous cells are still only in the outer layer of the cervix, and have not penetrated any deeper.

Treatment choices include cryosurgery, laser therapy, the LLETZ procedure,and cone biopsy (where a conical piece of cervix is cut away).

Stage 1                            

The cancer is still confined to the cervix.

Treatment possibilities include cone biopsy, hysterectomy (womb removal) radiotherapy and chemotherapy.

Stage 2

The cancer has spread into the surrounding tissues, but not into the ligaments or muscles or to the lower part of the vagina.

Treatment usually involves radiotherapy, often combined with hysterectomy and/or 'chemo'.

Stage 3

The cancer has grown into other pelvic structures, like the urinary tract, Fallopian tubes, and the lower part of the vagina.

Usually treated with internal and external radiation therapy, often with 'chemo'.

Stage 4

This is an advanced cancer which has spread to other organs of the body, like the bladder, the rectum or the lungs.

Generally treated with radiotherapy and combinations of chemotherapeutic drugs, plus pain-relievers.