Cervical cancer is the sixth most common malignancy in females. It is rare before the age of 20 years and the peak incidence is in the 45 to 55 year age group. Approximately 1000 women die from cancer of the cervix each year in the UK.
The screening programme in the UK changed in 2003.
- Women should receive their first invitation for screening at the age of 25.
- Women between 25 and 49 years of age – screened every 3 years
- Women aged 50 to 64 years – screened every 5 years
- Women aged 65 years are only screened if they have not been screened since aged 50 or have had recent abnormal tests.
Samples are routinely collected and then sent to the laboratory to detect any abnormalities.
Risk factors
Research has demonstrated a direct link between cervical cancer and sexual activity
- Sex at a young age
- Multiple sexual partners
- Promiscuous male partners
- History of sexually transmitted diseases(particularly the Human Papilloma Virus)
Other risk factors include
- High Parity (Number of childbirths)
- Low social status (Possibly due to vitamin A deficiency)
- Heavy Smoking
Diagnosis is most commonly made through the screening process and patients have no symptoms. The cells in this case are usually pre-cancerous and if treated the majority will not go on to develop cervical cancer.
Clinically, the first symptom is abnormal vaginal bleeding. At first this is irregular but may become continuous. Vaginal discomfort, discharge and dysuria (pain on passing urine) may also be evident. As a tumour grows it may invade the bladder and rectum and symptoms can evolve causing obstruction.
An urgent referral to a gynaecologist must be made by the GP when a patient presents with any symptoms suggestive of cervical cancer. Tests will then be undertaken to establish diagnosis. This will involve a colposcopy (an investigative procedure involving a camera) and biopsies.
Once diagnosis is established treatment will be started. The main choices are between radiotherapy and surgical therapy, and is usually dictated by the stage of the disease and the age and preference of the patient. Prognosis depends on early diagnosis and treatment. Negligence can occur when a patient present to her GP with typical symptoms and a referral is not made urgently. GP's are also under an obligation to ensure patients attend for smear tests. Efforts must be made to set up further appointments and warn patients of the potential risks of non-attendance. Cases have been brought and won against GP's who have not made enough effort to follow up patients who have not attended for smear tests and who have then gone on to develop cancer of the cervix.
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