Key Facts
Cancer of the cervix may affect women under 35 years old.
It is the second most common form of cancer in this age group – only breast cancer occurs more frequently.
In Western Europe, the treatment of cervical cancer is a success story. Because of the introduction of cervical screening, cases are diagnosed early. Earlier diagnosis means simpler treatments and better results.
However, in some parts of Eastern Europe cervical cancer rates have increased over the past 20 years.
Surgery and radiotherapy are both very effective treatments for cervical cancer.
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Key Figures
| Total number of new cancer cases in Europe (2006) |
3.2 million |
| Total number of cancer deaths in Europe (2006) |
1.7 million |
| Number of new cervical cancer cases in Europe (2002) |
59,931 |
| Number of cervical cancer deaths in Europe (2002) |
29,812 |
Worldwide, cervical cancer is the fifth most deadly cancer in women. It affects about 1 per 123 women each year and kills about 9 per 100,000 women each year. This is equivalent to 473,000 cases of cervical cancer and 253,500 deaths per year.
In Northern Europe, the incidence is approximately 8.8/100,000 per year (2001 data) and mortality is 2.8/100,000 per year (2003 data).
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Cancer Types
The cancer that develops on the outside of the cervix is squamous cell carcinoma whilst those that occur on the inside of the cervix are adenocarcinomas.
Some cervical cancers are very slow growing but others are more aggressive.
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Causes of Cervical Cancer
One important cause of cervical cancer is infection with certain strains of the Human Papilloma Virus (HPV) which triggers alterations in the cells of the cervix. This can lead to cervical intraepithelial neoplasia (CIN) which in turn can lead to cancer.
15 types of HPV are classified as high-risk types for cervical cancer. They are types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73 and 82.
In addition, having many sexual partners creates a greater risk.
A poor immune response increases the chances of CIN developing into cervical cancer.
Smoking, poor diet, drugs used to treat other cancers and auto-immune and other infections (such as HIV) are all risk factors for developing cervical cancer.
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Prevention of Cervical Cancer
Use of condoms reduces, but does not always prevent transmission of HPV.
It is important that women are aware of the common symptoms which are listed below.
Screening detects early changes in cervical cells meaning that with immediate treatment the development of these cells into cancer can be prevented.
Vaccination against HPV can prevent one important cause of the cancer- however, even where a vaccination programme is in place, it will take years before all women at risk are protected.
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HPV Vaccination
Vaccines have now been developed against HPV. Different vaccines provide different strains of the virus.
Gardasil® provides immunity to HPV types 6, 11, 16, and 18, which are responsible for approximately 75% of all cervical cancers.
The vaccine is most effective in women who have not been exposed to HPV infection and so is best given to females who have not been sexually active. This is why vaccination programmes are aimed at pre-teen and teenage girls (the UK national programme targets girls at the age of 12).
There is no evidence that the vaccine is of benefit to men.
The vaccine consists of three injections given over a 6 month period. A booster may be required after some years.
Possible side effects of the vaccine include pain and swelling where the vaccination is given. Very rarely, allergic reactions may occur.
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Common Symptoms
However, where there are symptoms, they typically include:
- bleeding after sexual intercourse
- bleeding between menstrual periods
- bleeding after the menopause
- discomfort or pain during sex
- an unusual vaginal discharge
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Diagnostic Tests
Cervical Screening
Two forms of screening test are used:
- A sample of cells is taken from the cervix using a small spatula or brush and this is spread onto a slide for examination under the microscope.
- A sample can be taken using a brush to remove cells from the cervix and these cells are then preserved in a liquid before being examined under a microscope (liquid-based cytology).
Cervical smears should be taken in the middle of the menstrual cycle.
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Treatment
Treating Cervical Intraepithelial Neoplasia
A colposcopy is a detailed examination of the cervix which is often recommended if a cervical smear result is abnormal – the aim being to prevent CIN progressing to cervical cancer.
The colposcope is a specialised small camera used to examine the cervix. It can detect areas of CIN so that samples can be taken for examination under the microscope.
Various surgical treatments, such as freezing the affected areas (cryotherapy) or using lasers or a loop electrical excision procedure (LEEP) can be used to treat abnormal areas.
Treating Cervical Cancer
Successful treatment of cervical cancer requires a team of health professionals each with their own expertise. The team includes a gynaecologist, pathologist, medical oncologist, radiation oncologist and their support teams.
Together they analyse information about the exact type of cancer, how fast growing the tumour is, and whether there has been any spread to other areas of the body.
They will also consider the patient’s general health and their own preferences with regard to treatment.
Ultimately, the choice of treatment rests with the patient based on the advice of all the specialists involved.
Radiotherapy and surgery are both used to treat cervical cancer.
Surgery
Early cervical cancer can usually be cured. Very early small cervical cancers can be treated by taking a cone biopsy - cutting away a wedge of the cervix or removing the cervix completely but leaving the rest of the uterus in place.
Surgical treatment for more advanced cancers involves complete removal of the uterus and cervix (hysterectomy), the ovaries and lymph nodes.
About 20% of patients need radiotherapy after surgery.
Radiotherapy
Brachytherapy is a type of radiotherapy where radioactive material is placed against or in the cervix to gives a high dose of radiation to all nearby tissues.
Radiotherapy can cause side effects including:
- diarrhoea
- cystitis
- nausea
- discomfort in the vagina
- possible vaginal bleeding after treatment
Radiotherapy - External Beam Radiotherapy
External beam radiotherapy uses high energy x-ray beams generated from machines to kill cancer cells.
External beam radiotherapy is normally given as a series of short regular treatments in a radiotherapy department (each treatment may be referred to as a fraction).
All radiotherapy treatment is delivered to an area that follows as closely as possible the shape of the cancer. This means that a higher dose of radiation can be more precisely targeted at the cancer.
Each treatment takes a few minutes.
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Key Trends
Cervical cancer is becoming less common in Europe although there are variations in incidence from country to country.
The cervical screening programme has proved very effective in detecting early cancers and pre-cancerous conditions (CIN).
The cervical cancers that do occur in countries with effective screening programmes tend to be faster growing tumours.
Vaccination against HPV is becoming established in some countries but will not provide complete protection - particularly for women who have been sexually active before vaccination.
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Important Research Areas
- The use of targeted molecular therapies – as yet no definite therapies have been identified but this is an important research area.
- The use of imaging technology including CT, MRI and PET scans to further refine treatment planning.
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Unresolved Questions
- Whether or not the cervical screening programme will be required in 30 – 40 years time? If all countries across the world develop vaccination programmes using more effective vaccines than those currently available, cervical cancer could become a disease of the past.
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