Cervical Cancer
HPV-driven cancer that is largely preventable through vaccination and screening.
Overview
Almost all cervical cancers are caused by persistent high-risk HPV infection (especially types 16 and 18). HPV vaccination and high-coverage screening have made cervical cancer one of the few cancers on track for global elimination. UK screening is offered to women and people with a cervix aged 25–64.
Symptoms
- • Often none until advanced
- • Abnormal vaginal bleeding (post-coital, intermenstrual, postmenopausal)
- • Persistent watery, foul-smelling discharge
- • Pelvic pain or dyspareunia
- • Leg swelling or bone pain (advanced)
Risk factors
- • Non-attendance at screening
- • Multiple sexual partners, early coitarche
- • Long-term combined oral contraception (small increase)
- • Co-infection with other STIs
Causes
- • Persistent high-risk HPV (types 16, 18, 31, 33, 45)
- • Smoking accelerates progression
- • Immunosuppression (HIV, transplant)
🚨 Red flags — seek urgent care
- • Postmenopausal bleeding
- • Persistent post-coital bleeding
- • Visible cervical lesion on examination
- • New leg swelling and pelvic pain
When to seek care
- • Any abnormal bleeding pattern — see GP promptly
- • Attend cervical screening invitations
- • HPV-positive screen — follow up as recommended
Diagnosis
- • Primary HPV cervical screening (LBC reflex if HPV-positive)
- • Colposcopy ± punch biopsy for high-grade or persistent abnormality
- • Cone biopsy / LLETZ for diagnosis and treatment of CIN3 / early invasive
- • MRI pelvis and CT/PET-CT for staging of invasive disease
- • FIGO clinical staging (updated 2018) incorporates imaging
Treatment
- • Pre-invasive (CIN2/3): LLETZ or cone biopsy
- • Early invasive (IA1–IB1): simple/radical hysterectomy or fertility-preserving trachelectomy
- • Locally advanced (IB3–IVA): concurrent chemoradiotherapy with cisplatin + brachytherapy
- • Recurrent/metastatic: platinum + paclitaxel + bevacizumab; pembrolizumab if PD-L1 positive
- • Fertility-sparing options discussed before treatment in young women
Prevention
- • HPV vaccination — offered routinely to year 8 girls and boys; catch-up to age 25
- • Regular cervical screening (every 3 years 25–49, every 5 years 50–64)
- • Smoking cessation
- • Condom use reduces (but does not eliminate) HPV transmission
Complications
- • Hydronephrosis and renal failure (locally advanced disease)
- • Vesicovaginal/rectovaginal fistula
- • Lymphoedema, radiation cystitis/proctitis, premature menopause
- • Recurrence — local pelvic or distant (lung, bone, liver)
Prognosis
5-year survival: ~95% stage I, ~65% stage II, ~40% stage III, <20% stage IV. Pre-invasive disease is essentially 100% curable.
Education & self-care
Cervical cancer is preventable. Vaccination plus screening protects you and future generations — most cases now occur in unscreened or unvaccinated women.
Frequently asked questions
I'm vaccinated — do I still need screening?
Yes — the vaccine covers most but not all high-risk HPV types.
Does an abnormal smear mean cancer?
Almost never. It usually means HPV or pre-cancerous changes that can be monitored or treated easily.
Is HPV my partner's fault?
HPV is extremely common and can be dormant for years. Infection is not a reflection on either partner.