Cervical cancer: What to look for and why to go to a smear test
Tuesday 5 March 2019 09:45, UK
By Rebecca Taylor, news reporter
Public Health England has launched a campaign to encourage women to attend cervical cancer tests, as research shows 83% of cases could be prevented by catching them at their earliest stages.
Every year, about 2,600 women are diagnosed with cervical cancer in England, and 690 women die from the disease, a rate of two women a day.
But despite these worrying rates, about 25% of women who are eligible for cervical cancer tests are not attending screenings with their GPs.
Why you should go for your cervical screening
Last year, actor Michelle Keegan live blogged her smear test in an effort to show women they are a simple process and are nothing to be scared of.
She admitted she had been putting it off, but said afterwards it had taken less than two minutes and been uncomfortable but not painful.
Since then, Jo's Trust, a cervical cancer charity, has launched a 'Smear for Smear' campaign with celebrities posting pictures of them smearing lipstick to encourage people to go for their tests.
Screening helps to prevent cells becoming cancerous and is the most effective way to prevent cervical cancer.
Failing to catch the cells before they become cancerous can lead to a life-threatening diagnosis.
According to Jo's Trust, smear tests can prevent 75% of cervical cancers.
What are the symptoms of cervical cancer?
Most of the time, the first sign of cervical cancer is abnormal bleeding. This could include if you bleed during or after sex, between your periods, or after you have been through the menopause.
You might also experience some pain during sex, or an unusual or unpleasant discharge.
Some people have pain in their lower back or pelvis.
If you experience these, you should book an appointment to see your GP, who can give you advice. Cancer is not the only cause of any of these issues.
What might show the cancer could be advanced?
Cervical cancer can spread from your cervix and trigger symptoms in other parts of your body.
You may experience lower back pain, or pain in your pelvis. You might get severe pain in you side or back, caused by your kidneys.
You should also be looking out for changes in how often you go to the toilet, and whether you lose control of either your bladder or bowel.
Blood in your urine, severe vaginal bleeding, and either or both of your legs swelling are also signs of the cancer spreading, according to the NHS.
What else could cause vaginal bleeding?
Cancer Research UK says that it's not just cancer in any stage that can cause bleeding after sex. sometimes this is caused by cervical erosion or ectropion.
Erosion is when cells that are normally inside the civical canal end up on the outside of the cervix. It can happen to women on the contraception pill.
It's nothing to do with cancer, and is completely harmless. If you're worried, you can see a doctor who might recommend changing your contraception.
It's always a good idea to get checked by a GP if you have bleeding after sex.
What happens at a cervical cancer screening?
Some women avoid getting their screenings done because they are nervous about the process, but it's one of the best ways to prevent cancer.
The test will help identify whether any cells in your cervix are pre-cancerous.
You'll be sent a letter by the NHS inviting you to book your screening. You'll have your first one when you are about 25, and they happen every three years until you're 49, and then every five years if you're aged between 50 and 64.
After that you'll only have them if you had abnormal cells at least once in the last three tests.
Appointments for your screening will last about 10 minutes, with the procedure itself taking half of that time. You'll need to undress from the waist down, behind a screen, and lie on a bed where you'll have a sheet placed over you.
The female nurse will ask you to bent your legs, put your feet together and keep your knees apart. You might have to alter this position through the test.
The nurse will insert a speculum into your vagina, using some lubricant, to open up into the cervix.
Then a small brush will be used to take a sample of cells, which will be sent for testing. You might experience a small scratching feeling during this part of the test.
The tool will be removed and you'll be able to get dressed behind the screen.
What if I'm nervous?
The medical staff will be used to nerves before a test and you can ask questions to make sure you know what to expect.
There are alternative positions you can ask to try if you're not comfortable, and you can ask to stop if you are in any pain.
You could also bring someone with you, if that will help, or read a book during the test to take your mind off it.
What happens afterwards?
You might experience some light bleeding, which is normal. If you have any heavy bleeding, then make sure to see a GP.
You'll get your results within 14 days.
If they take a bit longer, call your GP to check if they are on the way, but don't worry. Most people will have normal results.
Once your results arrive, if they are normal, you'll be invited back for another test in three to five years.
If there's an abnormal result, you might need another test a bit sooner, so you may have to return within one year.
You might need a colposcopy, which is a different type of test to look at your cervix.
If your results were unclear, you could need another test within three months.
What happens if they find HPV?
HPV stands for human papilloma virus. There are more than 100 types of HPV and they can affect a range of areas, including cervix, anus and mouth.
The presence of HPV in the cervix could lead to cervical cancer.
It can also cause cancers in men, including cancer of the penis, but this is more common in men who have sex with men.
If HPV is found, it does not mean cancer is present or the patient will definitely get cancer.
If HPV is found but there are no cell changes, you will need to return for another screening in a year to make sure it's gone. But if the same result comes back three times, you'll have a colposcopy.
If HPV is found the first time, with cell changes, you'll go for a colposcopy straight away.
What is a colposcopy?
This procedure will help doctors determine whether the HPV cells they have found in your cervix are harmful.
You'll be referred for the treatment if your test came back showing abnormal results, or if your results were unclear on several occasions.
The procedure will take place in a hospital, and lasts a bit longer to the smear test, but it's similar in the process.
The patient will undress from the waist down, but this time will sit in a chair with leg supports instead of lying on a bed.
A speculum will widen the vagina to allow a doctor to look inside at the cervix with a microscope. The microscope won't make contact with the patient.
A liquid will be applied to highlight any abnormal areas, and then a sample will be taken for examination. There may be some discomfort at this point.
The doctor may be able to offer a result straight away, but results of a biopsy, the tissue sample, will take longer - anywhere from four to eight weeks. If those cells were abnormal, then the patient will have to have them removed.
This could be done via electrical current and fine wire, in a large loop excision of the transformation zone (LLETZ) procedure, or with a cone biopsy, where a segment of the tissue containing the cells is cut out of the cervix.
What are the stages of cervical cancer?
Stages help divide cancer, indicating how big it is and whether it has spread.
Stage 1 is often divided into 1A and 1B, but in general, means the cancer is just within the neck of the womb, which is the cervix.
Stage 1A covers two small subsections. and is the point at which cancer is so small it can only be seen with a microscope or a colposcope. The cancer will be anywhere between 3mm and 5mm at this stage.
If the cancer has grown to stage 1B, then the cells will be larger, but still only within the cervix tissues.
At 1B, cells could be up to 4cm or larger in the neck of the womb.
If cancer is caught at stage 1, it can be treated with surgery and a combined treatment of chemotherapy and radiotherapy.
Surgery could involve removing the cervix and the womb, a hysteroctomy. But for some cases, where it's caught very early, it will be possible to remove most of the cervix but leave enough behind to be able to become pregnant.
At the really early stages, some women can just have a small area removed, called the tranformation zone, or a cone biopsy. These are similar to treatments that women with abnormal cells that need removing will have.
At stage 2, the cancer has begun to spread from the cervix and into the surrounding tissues. This stage is before anything has spread into muscles or ligaments, or the lower part of the vagina.
This stage is divided into 2A and 2B, which are also sub-divided into lower sections.
The sections in 2A cover the cancer being 4cm or less, and 4cm and above, but only covering the top of the vagina and the cervix.
In 2B, the cancer will have spread to the tissues around the cervix.
Stage 2A is usually treated with surgery and chemoradiotherapy (a combination of chemotherapy and radiotherapy) but stage 2B is usually covered just with the chemoradiotherapy.
Stage 2A usually means the womb and cervix are completely removed, called a radical hysterectomy.
Chemoradiotherapy is likely to involve daily sessions for five days a week, for five weeks of radiotherapy, and then chemotherapy once every two or three weeks, depending on which drugs are needed.
Stage 3 means the cancer has spread further, up to the structures around the cervix. At this stage, the cancer will be present in the cervis, and surrounding structures in the pelvis.
In stage 3A, there will be cancer in the lower third of the vagina, but not the pelvic wall.
Stage 3B means there's cancer in the pelvic wall and it is blocking the tubes which drain the kidneys.
This stage of cancer usually requires a combination of chemotherapy and radiotherapy, as in stage 2.
Stage 4 is the last stage of cervical cancer and means it has spread into the bladder or rectum. It indicates the cancer is now outside of the womb and cervix.
4A indicates there is cancer in the bladder or nearby organs. Once the cancer is labelled 4B, it means there is cancer further away from the cervix, such as in the lungs.
At stage 4B, the cancer could also be called metastatic or secondary.
Stage 4 treatment usually consists of a combination of surgery, radiotherapy and chemotherapy.
Cancer caught in the earlier stages can be much easier, and the NHS says it can even be curable when caught at early stages.
But the progression of the cancer can be slowed down and symptoms relieved if it is caught later, helping to improve quality of life.
In the early stages, it can be removed by a process called large loop excision of the transformation zone (LLETZ), which uses a fine wire and an electrical current.
It's done under local anaesthetic only, so the patient will be awake during the procedure.
At higher stages, it's far more likely the patient will need a level of hysterectomy, and some chemo or radiotherapy.
What should I do next?
If you're aged between 25 and 64 and you think you've missed a smear test, get in touch with your GP to find out if you can book an appointment.
If you last test came back within the time limit and it was normal, then there's no need to worry.
If you notice any symptoms, keep a log of what is happening and go to your GP to seek advice.
Above all, attend screenings at your GP each time you are invited.