Quick answer

What is cervical cancer?

Cervical cancer develops in the cervix — almost always linked to persistent high-risk HPV infection. Cervical screening (smear test) detects abnormal cells before cancer forms — offered every 3 to 5 years to women and people with a cervix aged 25 to 64. HPV vaccination in school-age girls and boys prevents most cases. Symptoms include bleeding between periods, after sex, or after menopause — see a GP promptly. Highly preventable and curable when caught early.

Cervical cancer — largely preventable

Cervical cancer develops when cells of the cervix become malignant — almost always following persistent infection with high-risk human papillomavirus (HPV).

UK: ~3,200 cases yearly — falling in screened/vaccinated populations — 850 deaths — almost all preventable with screening + HPV vaccine.

HPV and cancer pathway

HPV — extremely common sexually transmitted virus — most sexually active people encounter.

High-risk types — 16, 18 — cause >70% cervical cancers.

Natural history:

  1. HPV infection — often clears <2 years
  2. Persistent HPV — CIN 1, 2, 3 (dysplasia)
  3. Invasive cancer — years — window for screening intervention

Smoking — impairs clearance — doubles risk.

Symptoms — do not wait for smear

Postcoital bleeding — classic early sign

Also:

  • intermenstrual bleeding
  • postmenopausal bleeding — see menopause bleeding guidance — always investigate
  • discharge
  • dyspareunia
  • pelvic pain — later

Screening is for asymptomatic prevention — symptoms need GP regardless of smear due date.

Cervical screening programme

England (HPV primary testing):

  • 25–49 — every 3 years
  • 50–64 — every 5 years

Sample from cervix — HPV test first:

  • HPV negative — routine recall
  • HPV positive — cytology — colposcopy if abnormal

Non-attendance — biggest risk factor in screened populations.

Colposcopy and pre-cancer treatment

Colposcopy — magnified cervix view — biopsy

CIN treatment:

  • LLETZ/LEEP — loop excision — ** outpatient**
  • cold coagulation, laser

Cures pre-cancer — follow-up smears essential.

HPV vaccination

Gardasil 9 — school programme Year 8 (~12–13) — girls and boys

Protects against HPV 16, 18 and other types — anal, oropharyngeal, penile cancers too.

Catch-up for missed doses — GP/school nurse.

Australia/Scotland data — precancer rates plummeting in vaccinated cohorts.

Cancer treatment

FIGO staging — I to IV

Early:

  • cone biopsy — fertility-sparing microinvasive
  • radical trachelectomy — selected young women
  • hysterectomy — open/laparoscopic/robotic

Locally advanced:

  • chemoradiotherapy — cisplatin weekly + external beam + brachytherapy

Metastatic:

  • chemotherapy, bevacizumab, immunotherapy (pembrolizumab selected)

Survival: Stage I >80% 5-year — reason early detection matters.

After treatment

Menopause if radiotherapy/hysterectomy — HRT discussion

Lymphoedema — rare post-surgery

Fertility counselling — pre-treatment

Jo’s Cervical Cancer Trust — helpline.

Myths

“I’ve had HPV vaccine — no smears needed” — FALSE — screen still required

“Only promiscuous people get cervical cancer” — stigmatising falsehood — HPV is near-universal

Cervical cancer is the success story waiting to complete — attend smear, vaccinate children, never ignore bleeding after sex.

Common questions

What are the symptoms of cervical cancer?
Abnormal vaginal bleeding — between periods, after sex (postcoital), or after menopause; increased or foul-smelling discharge; pelvic pain or pain during sex; advanced — leg swelling, urinary symptoms. Early disease often silent — reason screening saves lives.
What is a smear test?
Sample of cells taken from cervix — now tested for high-risk HPV first in England. If HPV positive, cells examined for abnormalities ( cytology). If HPV negative, return to routine recall — very low cancer risk until next screen. Quick procedure — some discomfort, not usually painful.
Does HPV mean I will get cervical cancer?
No — most HPV infections clear within 2 years without treatment. Persistent high-risk HPV (16, 18 and others) over years can cause CIN (cervical intraepithelial neoplasia) then cancer if untreated. Colposcopy treats pre-cancer — LLETZ procedure removes abnormal area.
How is cervical cancer treated?
Stage dependent — early — surgery (cone biopsy, trachelectomy preserving fertility selected cases, hysterectomy); radiotherapy with chemotherapy for locally advanced; chemotherapy for metastatic. Survival over 80% for stage 1 — drops with advanced stage — screening prevents late presentation.
Can cervical cancer be prevented?
Yes — HPV vaccination before sexual debut, cervical screening attendance, condoms reduce HPV transmission partially, stopping smoking (smoking aids HPV persistence). Vaccination plus screening nearly eliminates cervical cancer as public health problem long term.

Sources