Sunday, 22 January 2017

Cancer Types - Cervical

Hello everyone,

This week is Cervical Screening Awareness Week and I wanted to use this opportunity to explain cervical cancer, the screening processes and what to do if you have an abnormal smear test.


I hope you find this post informative and interesting. Girls – please get your smears/Pap test done regularly, it could save your life!

The Cervix:
The cervix is basically the neck of the womb (uterus). It is the opening to the womb from the vagina. The cervix is a very strong muscle which is usually tightly shut but it does open during labour so the baby can come out. The outer surface of the cervix has a layer of cells which are almost skin-like. When these cells become cancerous it is known as squamous cell cervical cancer. There are glandular cells lining the inside of the cervix producing mucus. Cancer of these cells is called adenocarcinoma of the cervix. There is an area of the cervix known as the transformation zone. This is around the opening of the cervix leading onto a narrow passageway that runs into the womb. This zone is where cells are most likely to become cancerous.

Risks and Causes of Cervical Cancer:
* Human Pampilloma Virus (HPV) is the most common and biggest cause of cervical cancer. HPV is passed on from person to person via sexual contact. There are many different types of HPV and not all of them cause cervical cancer. One type causes genital warts but not cervical cancer. However other types are considered high risk. These types can lead to cells in the cervix changing and becoming cancerous. Most women who have HPV and develop cervical cancer will have had other infections caused by HPV in the past. However, not every woman with HPV will develop cervical cancer.
* Smoking can lead to cervical cancer; women who smoke are more likely to develop this type of cancer then women that do not smoke.
* Taking the pill can also increase your risk but the reason for this is not yet known
* Women that have bore a large number of children also have a slightly higher risk as are women with a weakened immune system.

Before I start listing the symptoms, please note that pre cancerous cells do not produce symptoms. This means having a smear test is hugely important – you can catch the cancer before it even develops. It is also important to know that the following symptoms do not instantly mean you have cervical cancer but it is important to go to your doctor if you have any of these symptoms:
* Bleeding between periods
* Bleeding during or after sex
* Bleeding at any time after the menopause
* Discomfort or pain during sex

Smear Tests:
It is hugely important to have cervical screening as preventing cervical cancer from developing is vital. Cervical cancer is actually one of the only cancers that is preventable because if pre cancerous cells are detected through screening then they can be treated before they have a chance to become cancerous.
Women between the ages of twenty five and sixty are encouraged to have smear tests every three to five years to detect any changing cells in their cervix. During a smear test, a doctor or nurse will insert a speculum into your vagina and scrape anyway a sample of cells from your cervix. These cells are then placed into a small pot of liquid and send to be analysed. You will then be contacted with your results and any abnormal smears will require further investigation.

You don’t have to be over the age of twenty five to develop cervical cancer; some younger women do develop it as well. However, in the UK, smear tests are not encouraged until twenty five because your cervix is still developing in your teens and early twenties. This means the likelihood of you getting an abnormal result is more common but usually nothing to worry about. After Jade Goody’s horrifically young death, a campaign was launched to lower the smear test age limit but medical professionals do not agree with this. If you are under twenty five and are concerned about your cervical cancer risk – please do speak to your GP and get some advice. A private gynaecologist may allow you to have a smear test but it would depend on your individual circumstances.


It is also important to note that an abnormal smear result does not mean you have cervical cancer. If you are contacted and told your test was abnormal then please do not ignore it, go and see what your doctors have to say.

Points to Consider:
You can have a smear test at several different places:
* Your GP’s surgery should offer them
* A family planning clinic
* A genito-urinary clinic
* An antenatal clinic
* A private health clinic
* Marie Stopes

You are well within your rights to request a female doctor or nurse performs your test but any male doctors will be chaperoned by a female staff member anyway. It is important to state if you require a female at the time of booking your appointment.

A smear test should be scheduled whilst you are in the middle of your menstrual cycle (between periods) as it will be very difficult to see your cervix and get a cell sample whilst you are bleeding.

Age Limits:
There are varying age limits for women in the four nations of the UK.
* Women between the ages of twenty five and sixty four are screened every three to five years in England and Northern Ireland.iu
* In Scotland, cervical screening is offered to women aged between twenty and sixty.
* Wales offers cervical screening to women aged between twenty and sixty four.

Research has shown that screening every three years prevents 84/100 cases of cervical cancer that would develop if they weren’t caught by the smears. So getting a smear test every three years is recommended by the NHS up until you are fifty years old. Abnormal cells develop at a much slower rate in women over fifty so screening is recommended after five years for women in that age group. Your local primary care trust will contact you whenever it is time for a screening for you. I cannot stress the importance of attending these appointments enough – it could save you from a battle with cancer.

The Screening Process:
Cervical cancer is preventable. This is because pre cancerous cell changes can be picked up before they have a chance to develop. A cervical cancer screening test is known as a smear test. This involves a doctor or a nurse using a speculum to take a small sample of cells from the surface of your cervix. It sounds horrific and it can be very uncomfortable but I am going to try and explain it as clearly as I can!
You will need to take off your underwear and lie back on the couch/bed. Being as relaxed as you possibly can be will make the procedure less uncomfortable.

Occasionally, the person doing the test will perform a vaginal examination first. This means they will place two gloved fingers inside your vagina to make sure your womb is in the correct position and that it feels like it’s a normal size. They will use their other hand to press down on your abdomen and gently feel your womb.

Then comes the actual smear test: The speculum is placed inside your vagina and has two arms which are used to spread the sides of your vagina apart so the cervix can be clearly seen. A small brush is then inserted and used scraped along the surface of your cervix to collect a sample of your cells. The brush and the cells are then sent to a lab in a pot of liquid and examined under a microscope. Any abnormal cells are reported and further investigation on these cells will be needed.

The Results:
The important thing to remember with smear tests results is: DON’T PANIC!!! Cancer is not the only cause of abnormal cells or an abnormal result. Sometimes you may be asked to go back for a repeat test, again don’t panic, it could be because:
* You were on your period and the blood meant your cells weren’t visible enough
* Your cervix was inflamed and the cells weren’t visible enough
* An infection was blocking the view of the cells
* There were not enough cells collected in the first test

You may also be told that your test was borderline. This means cell changes have been noted but they were so very close to normal that they are probably nothing to worry yourself about and they will probably return to normal by themselves. You may be asked to go back and have another test in a few months to monitor the situation. You may also be offered a HPV test as HPV is a cause of cervical cancer. If you do test positive for HPV then you will probably been sent for more tests, including a colposcopy to monitor your cervix and the cell changes.

Cervical erosion can be picked up by smear tests. This is not cervical cancer. This means the glandular cells which are normally found inside your cervical canal are now visible on the surface of your cervix and it can be inflamed. This is a common condition for teenage girls, pregnant women and women on the pill. It can make you bleed slightly but it usually goes away by itself with no need for treatment.

Abnormal Tests Results:
Abnormal results are usually reported like this:

Mild Dyskaryosis or CIN 1(mild or slight cell changes)
If you are told that you have mild cell changes then you will probably be told to get a colposcopy straight away or to wait and have another smear in six months. Sometimes mild cell changes will go back to normal by themselves but it is important to monitor them and go back for any tests advised by your medical team. If a second test shows abnormal cells then a colposcopy is definitely needed to assess the situation.

Moderate Dyskaryosis or CIN 2 (moderate cell changes)
Treatment will be needed if you have moderate cell changes but you only usually need it once. Then you will have follow up tests to monitor the cells in your cervix. If you have successful treatment after an abnormal smear and carry on having regular smears then you are unlikely to get cervical cancer. If you do not have treatment then you are at real risk of developing cervical cancer

Severe Dyskaryosis or CIN 3 (severe cell changes)
This is also sometimes known as carcinoma in situ (CIS) which sounds like cancer but it isn’t. This means some cells in your cervix look cancerous but are all found in the skin layer which covers your cervix. It won’t be “true” cancer until it breaks through the layer and starts to spread into the surrounding tissue. Urgent treatment is needed for this kind of smear result but if it is moved ASAP then cancer can be prevented.

All these results mean the cells found are pre cancerous meaning if they are left to go untreated, they could develop into cancer of the cervix. YOU DO NOT HAVE CERVICAL CANCER IF YOU ARE TOLD YOU HAVE ABNORMAL CELLS.

9/10 smears come back normal. 1/20 shows a borderline or mild cell change. Most of the time these cells will return to normal by themselves. 1/100 shows moderate cell changes whilst 1/200 show severe changes. Less than 1/1000 shows cancer.

First Steps:
If you have mild cell changes then you may be told to wait six months and have a repeat test. This is because mild cell changes usually sort themselves out. If you have moderate to severe cell changes then you will probably be referred to your local hospital for a colposcopy. This is an outpatient procedure and it is basically a close examination of your cervix which doesn’t actually go inside your vagina. The doctor or nurse specialist uses something like a magnifying glass to look at the cells on your cervix in more detail and takes a biopsy to send to the lab for further examination.

Types of Treatment:
Laser Therapy (Laser Ablation): some cells can be burned away by a laser in an outpatient procedure. For this kind of treatment you will lie on a bed with your legs in stirrups whilst a doctor places a speculum into your vagina to hold it open whilst they point a laser beam at the abnormal areas. You will be given local anaesthetic to numb the area and prevent pain. The laser is a very strong and hot beam of light and it burns away the abnormal cells. This can cause a slight burning smell whist you are having the treatment but that just means the laser is working so try not to worry. You should be able to go home as soon as the treatment is finished. You may experience period type pains but they should go away with the normal paracetamol or ibuprofen and some bed rest.

Cold Coagulation: This name is a little misleading as the treatment isn’t cold at all! You lie on a bed with your legs in stirrups whilst a doctor inserts a speculum to hold your vagina open. A hot probe is then used to burn away the abnormal cells. You shouldn’t be able to feel the probe but it can cause some period type pains which should go away a few hours after the treatment has finished.

Cryotherapy: This is basically cold coagulation but with a cold probe instead of a hot one. The cold probe freezes the abnormal cells. The procedure is exactly the same as the cold coagulation.

Diathermy: This is done under local anaesthetic. An electronic current is used to cut away the tissue that contains the abnormal cells. It is a fairly quick procedure and it usually done as an outpatient case which means you should be able to go home afterwards. It can cause bleeding or discharge for about four weeks after the treatment but sanitary towels will have to be used as tampons have to be avoided for four weeks. Sex must also be avoided for four weeks following a diathermy procedure.

Cone Biopsy: This is a minor operation that can be used to diagnose cervical cancer or to treat abnormal cells. The entire area containing possible abnormal cells is removed. It is called a cone biopsy because a cone shaped area of tissue is removed from the cervix. This is called the transformation zone. This can be done under general or local anaesthetic.

Hysterectomy: If you are past menopause, or have had all your children, then your doctor may suggest removing your uterus. This is usually suggested if you have had abnormal cells more then once or if the cells are severely abnormal.

These treatments do sound rather uncomfortable and scary but it is massively important to have abnormal cells treated to prevent them developing into cervical cancer. Please do remember to book yourself in for a smear if you are due one. As I’ve said before, a little discomfort is nothing compared to a battle with cervical cancer.

HPV Vaccines:
Some cervical cancer cases are caused by the human papilloma virus (HPV) which is also sometimes known as genital warts or the wart virus. There are over one hundred different types of HPV and some cause genital warts. Lots of types of HPV are passed on through sexual contact and most women will be atffected by HPV at some point. Most of the time the virus will just go away with no treatment but some types can increase your risk of developing cervical cancer.  HPV types sixteen and eighteen cause about 70% of cervical cancer cases, which is roughly about 7/10 and most of the other 30% are caused by other high risk types of HPV.

Extensive research into HPV has been done over the years and two cervical cancer vaccines have been created. These are celled Gardasil and Cervarix. Research is on-going into these vaccines and their effects will become clearer as time goes on but here is some information on the two vaccines:

Trials have been done with Gardasil, using women between the ages of sixteen and twenty six. Some were given the vaccine and some were given placebos. They were all monitored to see if they went on to develop HPV. Research has shown that Gardasil protects against some types of HPV including types sixteen and eighteen. Since then Gardasil has been given a licence in the UK and can be used on young girls and women between the ages of nine and twenty six.

Cervarix has also gone through rigorous trials involving women under the age of twenty six. They discovered that Cervarix can prevent HPV. It has also been licenced for use in the UK and is used to prevent pre cancerous cervical changes in women between the ages of ten and twenty five.

UK schoolgirls aged between twelve and thirteen (year eight at secondary school are currently being offered the Cervarix vaccine as part of the HPV vaccination programme. This involved the girls having three injections over a six month period. Their parents have to sign a consent form before their daughter can have the vaccinations and they should discuss the vaccine with their daughter so she can decide whether or not she would like it. From September 2012 the vaccination programme will switch to the Gardasil vaccine as this protects them against genital warts as well as cervical cancer. It is also possible to have the vaccination done privately should you wish to do so.

The vaccines are given to twelve year olds because they are unlikely to have already become sexually active and caught HPV. Research has shown that the vaccine works best in younger women. You can still have the vaccine if you are already sexually active; it won’t get rid of HPV if you already have it but it can protect you from developing other types of the infection. It may be worth having if the type you have isn’t type sixteen or eighteen as these are the two that are most likely to cause cervical cancer. It is vital to have all three injections to make sure you are properly vaccinated.

Side effects of the vaccine are usually very mild but they can include:
Headaches and aching muscles, dizziness, fever, diarrhoea stomach pains and itching and soreness around the injection area.


If you are interested in having a cervical cancer vaccination – please contact your GP.

I hope this blog post has given you all the facts. I hope it has persuaded you to have a smear test if you haven’t already. Let me know!


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