What is cervical cancer?

Cervical cancer is cancer occurring in the cervix (the opening between the womb and the vagina). It is more likely to arise in women under the age of 45. ^{Footnote [1]}   

Abnormal cells usually grow slowly but can spread into surrounding tissue and beyond, to other areas of your body.

These include:

• Unusual vaginal bleeding, such as heavier bleeding than usual, bleeding during or after sex, after the menopause or between your periods.
• Painful sex.
• Unusual vaginal discharge.
• Pain in your lower back, abdomen or between hip bones.

If you experience any of these, consult your doctor. 

Note that cervical cancer doesn’t always have symptoms in the early stages, so it’s important to take up invitations for regular cervical screening (smear tests). This involves taking a sample of cells from the cervix using a soft brush.

Most cervical cancers are caused by some strains of human papillomavirus (HPV) known as high-risk HPV. People get infected with HPV through sexual contact.

HPV is a very common virus and doesn’t usually cause any symptoms. ^{Footnote [2]}  Your body’s immune system can usually fight it off so you may never know you were infected. However, if the virus stays in the body, it can cause the abnormal cells that can progress to cervical cancer. A vaccine is now available against HPV, which is offered to all children aged 12 to 13. 

Other risk factors for developing cervical cancer include:

• HPV infection.
• Smoking.
• A family history of cervical cancer.
• Having a weakened immune system.
• Having multiple pregnancies or having a child before age 17.
• If you’ve had cancer of the vagina, vulva, kidney or bladder in the past.
• If you’ve taken the oral contraceptive pill for longer than five years.

It’s diagnosed by taking a sample of cells from your cervix, during a smear test, that are then examined in a laboratory.

If you have an abnormal result, you’ll be referred to a gynaecological oncologist (a specialist in women’s reproductive cancers) for further tests. 

This would usually be a colposcopy where a doctor or nurse will take a small sample of tissue (a biopsy taken under local anaesthetic) from your cervix to be examined in a laboratory.

Your doctor will usually treat any abnormalities visible to them while performing your biopsy.

You’ll be given a return appointment to discuss your results, or you may be told you’ll receive a letter. 

If cancer is found you may need imaging tests such as MRI scan, CT scan, PET scan or a chest X-ray, to see if the cancer has spread beyond the cervix.

Doctors might also propose a more in-depth internal examination of your cervix under general anaesthesia.

Your doctor will look at your test results and suggest a treatment plan for you. This depends on your general health and if your cancer has spread.

The main treatments are surgery, if curable, but sometimes other treatments can be given to reduce the risk of cancer coming back. If your cancer has spread, you will likely be offered one or more of chemotherapy, radiotherapy and surgery. Your doctors will discuss what’s best for you.

Surgery

Surgery can range from removing a small part of your cervix to a complete hysterectomy (removal of your womb). If the cancer is found early, that’s usually the main option.

Treatment may affect your fertility, so it’s worth talking to your doctor about your options (e.g. egg freezing) before you go ahead.

If your cancer is advanced, or has returned, you may be offered more extensive surgery to remove other areas such as the bladder or lymph nodes as well as the cervix, womb and ovaries.

Cervix surgery

If your cancer is very small, you may be able to have a small part of the cervix removed.

Or your doctor may be able to remove most of your cervix, the tissue around it and the upper part of your vagina, leaving your womb in case you want to have a baby in the future.

These surgeries are done under general anaesthesia and may require a short hospital stay.

Simple hysterectomy

This is where your uterus (womb), and cervix are removed under general anaesthetic. Your ovaries may be left in place unless doctors recommend removing them.

This can treat certain types of early-stage cervical cancer and is described according to how the womb is removed from the body:

• An abdominal hysterectomy (via a cut in the tummy).
• A vaginal hysterectomy (womb removed through the vagina).
• A laparoscopic hysterectomy (keyhole surgery on the tummy).

An abdominal hysterectomy takes longer to recover from. You’ll stay for several days and it can take six weeks or more, to feel back to normal.

Laparoscopic and vaginal hysterectomies involve a shorter hospital stay and a recovery period of two to three weeks.

Chemotherapy 

Chemotherapy is medicine that destroys cancer cells by damaging how they grow and divide. It can be combined with radiotherapy to shrink cancer cells before or after your surgery.

It may also be offered if your cancer is advanced, has spread to other parts of your body, or has come back.

Radiotherapy

Radiotherapy treats cancer using high doses of radiation from an x-ray machine. Alternatively, doctors might recommend using a radiation source placed inside your body.  

Depending on the size of the womb cancer, it might be the main treatment or it might be offered after surgery (with chemotherapy) to help prevent the cancer from returning.

Radiotherapy can also be given to control bleeding by blocking blood vessels. This is called embolisation.

Regular smear tests can detect early signs that cervical cancer may be developing. 

The NHS cervical screening programme is available to women aged between 25-64. Others with a cervix (trans men and non-binary people) should liaise with their GP practice to ensure that they can access screening, as they won't be automatically included in screening invitations.

You’ll usually get a letter in the post, inviting you to go for a smear test at your local doctor’s surgery.

What happens at the smear test?

When you arrive at the GP practice for your appointment, you’ll need to undress from the waist down. Some people like to wear something they can leave on, but lift up, during the test.

You’ll lie down on a bed with a sheet over your upper legs and you’ll be asked to bend your legs keeping your feet together and knees apart. If you’re uncomfortable in this position talk to the nurse or doctor about changing your position.

The doctor or nurse will take a sample of cells from your cervix using a soft brush which is inserted through a tube-shaped speculum.

It can be uncomfortable but doesn’t usually take any longer than a few minutes.

Your sample will be sent off to be analysed at a laboratory.

The results of your smear test

Your results letter will tell you if you have HPV or any abnormal cells. If you have neither you won’t need to have another smear test for three or five years, depending on your age. 

If your test shows HPV, but no abnormal cell changes, you’ll be offered another smear test in a year’s time to check if the infection has gone. If there are abnormal cell changes, you’ll be asked to have a further test called a colposcopy.

You could use your health insurance cover to claim for treatment for cervical cancer using your health insurance. First, get a referral from your GP, or through our Digital GP app^. Then you can make a claim through MyAviva, online or call us. 

If we confirm your claim meets the terms of your policy, we’ll pay for the treatment directly. Just be sure to tell us if you need more tests or treatment, or if your hospital or specialist changes. 

It’s good to have one less thing to worry about. It takes Aviva. 

^ These services are non-contractual and can be withdrawn or amended by Aviva at any time.