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Cervical cancer - Cervical smear test
















What is cervical cancer?

The body is made up of billions of tiny cells, which are constantly growing, dying and reforming. If the cells become abnormal for any reason, this turnover cycle can lose control. The abnormal cells start dividing and growing faster than normal, forming a growth of abnormal cells (cancer). Cancers cause problems because they replace normal cells with abnormal non-functioning cells, destroying nearby areas as they grow.

A benign cervical growth is one that forms a lump, but is not dangerous. A pre-malignant cervical growth is one that has the potential to turn into a cancer, but has not done so yet. A malignant cervical growth is a cancer that has the potential to spread elsewhere.


What is the cervix?

Cervical cancer anatomy


The cervix is the lowest part of the uterus (womb), found high up inside the vagina.





What symptoms might cervical cancer cause?

Often, early cervical cancer causes no symptoms at all.

The most common symptom caused by cervical cancer is vaginal bleeding, which can occur even between periods or after the menopause. Continuous vaginal discharge may also be experienced, which can be foul-smelling.

Pain can occasionally be experienced by cervical cancer, as well as weight loss, tiredness and heavy bleeding. These may occur due to more advanced cancer or as a result of the cancer spreading to other parts of the body, which is life-threatening.


What causes cervical cancer?

The most identifiable risk for cervical cancer is Human Papilloma Virus (HPV), types 16 and 18; HPV is sexually transmitted and so is seen more in those who have had several diffferent partners.


Can cervical cancer be prevented?

Cervical cancer cannot be completely prevented, but risks can be reduced. The introduction of a vaccine against HPV should hopefully dramatically reduce cases of cervical cancer and, depending on which vaccine is used, may also reduce the incidence of genital warts.

The HPV vaccine is usually given by an injection to girls aged 12-13, with two further injections being given at 2 months and 6 months after.

The vaccine does not prevent against all forms of HPV though, and not all cases of cervical cancer are caused by HPV. For this reason, it is important that cervical screens are still undertaken by women, even if they have had the vaccine.


What tests are there for cervical cancer?

Routine cervical smear tests are available generally to those over 20 years old; cervical cancer in those younger than this is extremely rare. Those over 64 years, who have had 3 successive normal smears, will not usually have further tests.

A smear test is best performed about half-way between periods. Smear tests will Cervical canceroften be performed by a female specialist, but may occasionally be by a male; if this concerns you, make sure you state this when making your appointment and a female specialist may be made available for you.

A vaginal examination is performed, whereby a speculum is used to hold open the vagina - this feels like a slight pressure. The cervix can then be examined and a sample of cells is gently brushed away and put onto a slide for examination under a microscope (cervical smear). In all, this takes about 5 minutes. The sample is sent to a lab, and the results will usually be available in a couple of weeks.

About 1 in 10 smears will be returned as 'inadequate' - this may be due to such problems as slide preparation, or presence of mucuc or blood in the sample. Your specialist may need to repeat the smear.

You may also be offered a pelvic examination at the same time, whereby the specialist feels for any abnormal lumps in the pelvis.

The cervical smear test is a routine screening test that is quick and relatively painless, but can identify cancer at an early stage and so save lives. It is therefore very important that you keep up with your regular check-ups.

If the specialist has any further concerns, then blood tests and scans may also be organised to check for any possible spread or other causes for symptoms.


What treatment is there for cervical cancer?

Occasionally, the smear result may be returned as 'borderline' - this means that there are mild cell changes, but no signs of obvious cancer. Most of these cases will settle in time, and you will usually have a repeat smear after 3 to 6 months to check that all is settling down.

If an abnormal area is seen, then it does not necessarily mean you have cervical cancer. The cells may be 'dysplastic', in that they are abnormal but not yet cancerous. Very mild changes may simply be observed by a repeat test in a few months, as many of these cases will settle on their own.

If the results show more advanced changes, then the specialist may want to examine the cervix more closely by using a special microscope called a 'colposcope'. A speculum is used to hold the vagina open, and the colposcope then used to look at the cervix - the colposcope does not go inside or touch you at all. Any abnormal area may then have a small sample taken (biopsy), which feels like a pinch. This is sent to a lab for examination.

If the doctor cannot see a specific abnormal area then they may arrange for you to have a procedure under anaesthetic; a cone biopsy takes a cone-shaped sample from the cervix, which is then sent to a lab. More commonly, LLETZ (Large Loop Excision of the Transformation Zone) may be used - this is often at the time of colposcopy, and is performed in 5-10 minutes with local anaesthetic. A wire is heated by an electrical current and used to cut and seal tissue at the same time. These procedures may in fact remove all the involved area in one sitting, and so no further treatment may be needed.

If the growth is more advanced, or problems persist despite repeated treatments, then hysterectomy may be required, whereby the womb, ovaries and possibly nearby glands are removed. Radiotherapy may also be used after the surgery to help reduce the risk of recurrence.


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