Introduction to cervical cancer
In this section, you can find information on:
- The cervix and cervical cancer
- The treatment options available
- Specific information on brachytherapy and the procedure
- The healthcare professionals involved in delivering brachytherapy
- Potential benefits of brachytherapy
- Potential side effects to consider
- Frequently asked questions
- Useful questions to ask your doctor
What is the cervix?
The cervix is part of the female reproductive system.1
It is a small cone-shaped passageway or canal, which is about 2cm in length. It is based at the neck of the womb and connects the uterus to the vagina. The cervical passageway is usually closed, however during childbirth, it opens allowing the baby to be delivered from the uterus.
What is cervical cancer?
Cervical cancer is the fourth most common cancer in females worldwide,, affecting approximately 500,000 women globally each year.2
The cervix is made up of two layers of cells; an outer layer and an inner layer:3
- Cancer of the cells making up the outer layer of the cervix (skin-like cells) is called squamous cell carcinoma. This is the most common type of cervical cancer.3
- Cancer of the cells making up the inner layer of the cervix (glandular cells that produce mucus) is called cervical adenocarcinoma.3
What are the typical symptoms of cervical cancer?
Typical symptoms of cervical cancer include:4
- Bleeding from the vagina
- Between periods
- After or during sexual intercourse
- Discharge that smells unpleasant
- Uncomfortable or painful sexual intercourse
However, these symptoms may be caused by something other than cervical cancer – if you experience any of the above symptoms you should contact your healthcare professional.
Various risk factors make some women more likely to develop cervical cancer than others.
- Human papillomavirus (HPV infection) – sometimes called genital wart virus and passed on through sexual contact5
- Smoking – chemicals in cigarettes can damage cells in the cervix5
- The contraceptive pill – taking the contraceptive pill may increase the risk of developing cervical cancer, but it is not yet fully understood why5
- Weak immune system5
- Having a lot of children – women who have had 7 or more children have about twice the risk of developing cervical cancer compared to those who have had only 1 or 2 children.6
- Age at childbirth – women who had their first child before they were 17 years of age have about twice the risk of developing cervical cancer compared to those who give birth after they were 25 years old.5
- Genetics – there is an increased risk of developing cervical cancer if another female member of the family has suffered from it.5
What tests are used to confirm a diagnosis?
The most common tests used by doctors to check a suspected case of cervical cancer are shown in the table below:7
|Test||What's being tested?||What happens after?|
|Cervical cancer screening|
|A small sample of cells is taken from the surface of the cervix. A speculum (device used to help open access into the cervix) is used so that a sample of cervical cell can be collected.||Pre-cancerous cell changes (these may occur before cancer actually develops).||Cells are sent to be tested in a laboratory. An abnormal result does not definitely mean cervical cancer, but is the basis for further testing.|
|A colposcope is like a large magnifying glass, which is used to look at the surface of the cervix. (The colposcope is not inserted into the body).||Abnormal cancerous cells.||If abnormal cells are identified, further testing may be required to confirm a diagnosis.|
|Minor operation under general anesthetic. A small cone like shape of tissue is taken from the cervix.||Abnormal cancerous cells.||The tissue is examined under a microscope to identify if any cancer is present.|
|Full examination under anesthetic|
|Full examination of the womb, vagina, rectum and bladder.||To check whether the cancer has spread to other organs and/or take further tissue samples.||The tissue samples are examined under a microscope to identify if any cancer is present.|
|An MRI (magnetic resonance imaging) or CT (computed tomography) scan.||To check the shape and size of the cancer and whether it has spread to other organs||The visual image of the cancer helps to inform the best treatment options.|
How do I know how advanced the cancer is?
Terms such as ‘staging’ or ‘grading’ are used by healthcare professionals to describe the level of progression of the cancer and help inform which treatment options might be best.7
The various stages of cervical cancer are summarised below.
Early / Stage 1
The cancer is small (between 3–5 mm deep and 7–40 mm wide) and has not spread beyond the cervix.
This is called a low risk tumor and is classified as one of the following:
|Early cervical cancer||1A1||Tumor is less than 3 mm deep and less than 7 mm wide.|
|1A2||Tumor is between 3–5 mm deep and less than 7 mm wide.|
|1B1||Tumor is less than 40 mm in width and depth.|
|1B2||Tumor is larger than 40 mm in width or depth.|
Locally advanced/ Stage 2
The cancer may have spread from the cervix into the vagina or into the surrounding lymph nodes in the pelvis.
This is called a medium risk tumor and is classified as one of the following:
|Locally advanced cervical cancer||2A||The cancer has spread to the top of the vagina.|
|2B||The cancer has spread into the tissues surrounding the cervix.|
Advanced (metastatic) / Stages 3 and 4
The tumor has spread to other tissues and organs within the body such as the bladder, rectum (back passage) and lungs.
This is called a high risk tumor and is classified as one of the following:
|Advanced cervical cancer||3A||The cancer has spread to the vagina but not the pelvic wall.|
|3B||The cancer has spread to the vagina and the pelvic wall and may be blocking the tubes to the kidney (ureters).|
|4A||The cancer has spread to nearby organs like the bladder or rectum.|
|4B||The cancer has spread to organs further away like the lungs.|
1. National Cancer Institute. Available at: http://www.cancer.gov/cancertopics/wyntk/cervix/page2. Accessed March 2014.
2. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed March 2014
3. http://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/about/the-cervix Accessed March 2014
4. http://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/about/cervical-cancer-symptoms Accessed March 2014
5. http://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/about/cervical-cancer-risks-and-causes. Accessed March 2014.
6. http://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/diagnosis/cervical-cancer-tests Accessed March 2014.
7. http://www.cancerresearchuk.org/cancer-help/type/cervical-cancer/treatment/cervical-cancer-stages Accessed March 2104