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Cervical cancer
Cervical cancer, also known as cancer of the cervix, is an abnormal growth of cells of the cervix, the entrance to the uterus or womb. It is a serious condition which, if not recognised and treated early, can be fatal.

The disease often affects women in their mid-30s. In the UK, cervical cancer is the second most common cause of cancer in women under the age of 35. Each year in the UK, there are almost 3000 new cases of cervical cancer and over 1000 deaths from the disease.
The most common form of cervical cancer affects the cells that cover the outer surface of the cervix. When these cells start to grow abnormally, the condition is referred to as cervical intraepithelial neoplasia (CIN). Other terms that are used include cervical dysplasia and cervical dyskariosis. At this stage, these abnormal cells are pre-cancerous but if they are not cleared by the body’s immune system they may grow deeper into the cells of the cervix, become cancerous and cause cervical cancer. Thankfully, most women with CIN do not develop cervical cancer.

CIN is almost always caused by an infection with a virus known as the human papillomavirus (HPV). There are over a hundred different types of HPV and each type is identified by a number, for example HPV18. Some types of HPV cause genital warts, ordinary warts and verrucae and others cause CIN. The types of HPV most likely to cause CIN are HPV16, HPV18, HPV31 and HPV33.

HPV is a very common virus and is passed on primarily through sexual contact. Most women who have had sexual intercourse will be infected with HPV at some point in their lives. Usually, the infection will be cleared by the body’s immune system within about a year. If the infection is not cleared, it may stay unnoticed in the cervix for years, developing into CIN then cervical cancer.

As HPV is passed on through sexual contact, having a large number of sexual partners or having sex from a young age can increase the chances of a woman becoming infected with HPV. Other risk factors include smoking, long-term use of oral contraceptives, a weakened immune system, not wearing a condom during sexual intercourse and getting pregnant in the early teenage years.
CIN does not usually cause any symptoms until it reaches an advanced stage and so women will not be aware that there is a problem. When it does reach an advanced stage, the most common symptoms are abnormal bleeding from the vagina, occurring between periods or after intercourse. Women who have reached the menopause, may notice bleeding again. Other symptoms include pain or discomfort during sexual intercourse and an unpleasant smelling discharge from the vagina.
Smear tests or Pap tests As CIN does not usually cause any symptoms, cervical screening, more commonly known as the smear test or Pap test, is the best way to detect abnormal cells before they develop into cervical cancer.

The smear test is not a test for cancer but a method of preventing cancer by detecting early abnormalities which, if found, can be treated before they cause cancer. The smear test involves taking a sample of the cells from the surface of the cervix. These cells are looked at under a microscope to see if there are any signs of abnormalities. Regular smear tests are the best way of preventing cervical cancer. Early detection can prevent about 75 out of every 100 cancers developing. In the UK, all women between the ages of 25 and 64 are eligible for a free smear test. Women aged 25-49 should be tested every three years, women aged 50-64 should be tested every five years. Women aged 65 and over are only screened if they have not had a smear test since age 50 or have had recent abnormal tests.

Although the smear test is the best early detection system, health experts are worried that not enough women are having the test. In the 25-29 age group, only about 7 out of 10 women have the test and the numbers tested are falling.

If CIN is detected, its treatment is usually performed during an outpatient visit to the hospital. Vaccination

Although screening is important it does not detect all pre-cancerous cells or cancer. Vaccination against HPV, together with regular smear tests, is considered to provide women with the best possible protection. There are two vaccines available, Cervarix and Gardasil, which provide protection against HPV16 and HPV18, the two types of virus most likely to cause CIN. Gardasil also offers protection against HPV6 and HPV11, two types of virus responsible for genital warts.

The vaccines are not a treatment for CIN or cervical cancer, they only offer protection against the types of virus most likely to cause CIN. Consequently, the vaccines are most effective if used before there has been a chance of catching the virus. As HPV is mainly transmitted through sexual intercourse, this means vaccinating women before they become sexually active and before losing their virginity.

In the UK, HPV vaccination using Cervarix is offered to all girls aged 12 to 13. The vaccine is given as a course of three injections over 6 months. Girls aged 13 to 18 who missed the vaccine when the Department of Health introduced the HPV vaccination programme in September 2008 are being offered the vaccine as part of a 2 year catch-up programme.

As the vaccine is less effective in sexually active women who may have already been exposed to the virus, the Department of Health has no plans at present to offer the vaccine to women aged 18 years and over as part of a national programme. Women who are over 18 years of age can talk to their doctor, nurse or pharmacist about local availability of vaccination.

As other, less common types of HPV can also cause cervical cancer, it is essential that women continue to have a smear test even though they've been vaccinated.

Cervical cancer If cervical cancer does develop, there are three main types of treatment, surgery, chemotherapy and radiotherapy, used alone or in combination with one another. The actual treatment chosen will depend upon the person's age and general state of health, how far the cancer has advanced and whether other parts of the body are affected.
When to consult your doctor
Cervical screening using the smear test is the best possible way of detecting whether there are any signs of CIN, and stopping cervical cancer from developing. If you are a woman aged 25 to 64, you should make every effort to attend for your smear test when called at regular routine intervals. Talk to your doctor or nurse if you are worried about the test or the procedure involved.

If you have any of the symptoms described above, you should not hesitate to see your doctor and have an examination. If you are a parent or guardian of a young girl being offered the HPV vaccine, discuss any concerns that you may have about the vaccine with your doctor or nurse.
Living with cervical cancer
If you have been diagnosed with cervical cancer your doctor will talk to you about the options available, the procedures involved, the length of treatment, the side effects that you may experience and how to cope or prepare for becoming infertile. Involve your partner or close friend in any discussions to provide support and to ask any questions that you may not have considered.

After your treatment has finished, you will be called back for regular check-ups. These will often go on for several years and may involve X-rays, CT scans, ultrasound and biopsies to ensure that there is no sign of the cancer returning. Adopting a healthy lifestyle will help speed recovery after treatment; do not smoke, eat a balanced diet rich in fruit and vegetables, drink alcohol in moderation and take regular exercise.

Even when cervical cancer is not life-threatening, the consequences of the disease and its treatment can be life-changing. You may experience potentially overwhelming emotional and physical changes that may affect you and your partner. Do not try to struggle on alone, there's lots of help available. Talk to your doctor, there are medicines to control symptoms that you may be experiencing and there are counsellors available to provide guidance and support.

Reviewed on 5 July 2010