Cervical cancer - Complications

 Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.

Side effects

Early menopause

If your ovaries are surgically removed or they're damaged during treatment with radiotherapy, it will trigger an early menopause (if you haven't already had it). Most women experience the menopause in their early fifties.

The menopause is caused when your ovaries stop producing the hormones oestrogen and progesterone. This leads to the following symptoms:

    you no longer have monthly periods or your periods become much more irregular
    hot flushes
    vaginal dryness
    loss of sex drive
    mood changes
    stress incontinence (leaking urine when you cough or sneeze)
    night sweats
    thinning of the bones, which can lead to brittle bones (osteoporosis)

These symptoms can be relieved by taking a number of medications that stimulate the production of oestrogen and progesterone. This treatment is known as hormone replacement therapy (HRT).

Narrowing of the vagina

Radiotherapy to treat cervical cancer can often cause your vagina to become narrower, which can make having sex painful or difficult.

There are two main treatment options if you have a narrowed vagina. The first is to apply hormonal cream to your vagina. This should increase moisture within your vagina and make having sex easier.

The second is to use a vaginal dilator, which is a tampon-shaped device made of plastic. You insert it into your vagina and is designed to help make it more supple. It's usually recommended that you insert the dilator for 5 to 10 minutes at a time on a regular basis during the day over the course of 6 to 12 months.

Many women find discussing the use of a vaginal dilator embarrassing, but it's a standard and well-recognised treatment for narrowing of the vagina. Your specialist cancer nurse or radiographers in the radiotherapy department should be able to give you more information and advice.

You may find that the more times you have sex, the less painful it becomes. However, it may be several months before you feel emotionally ready to be intimate with a sexual partner.

Lymphoedema

If the lymph nodes in your pelvis are removed, it can sometimes disrupt the normal workings of your lymphatic system.

One of the functions of the lymphatic system is to drain away excess fluid from the body's tissue. A disruption to this process can lead to a build-up of fluid in the tissue known as lymphoedema. This can cause certain body parts to become swollen – usually the legs, in cases of cervical cancer.

There are exercises and massage techniques that can reduce the swelling. Wearing specially designed bandages and compression garments can also help.

Emotional impact

The emotional impact of living with cervical cancer can be significant. Many people report experiencing a "rollercoaster" effect.

For example, you may feel down when you receive a diagnosis, but feel better when removal of the cancer has been confirmed. You may then feel down again as you try to come to terms with the after-effects of your treatment.

This type of emotional disruption can sometimes trigger depression. Typical signs of depression include feeling sad, hopeless and losing interest in things you used to enjoy.

Contact your GP if you think you may be depressed. There are a range of effective treatments available, including antidepressant medication and talking therapies, such as cognitive behavioural therapy (CBT).

You may also find Jo's Cervical Cancer Trust a useful resource. It's the UK's only charity dedicated to women affected by cervical cancer.

Local cancer support groups may also be available in your area for women affected by cancer. Your specialist cancer nurse should be able to provide contact details.

Advanced cervical cancer

Some of the complications that can occur in advanced cervical cancer are discussed below.

Pain

If the cancer spreads into your nerve endings, bones or muscles, it can often cause severe pain.

A number of effective painkilling medications can usually be used to control the pain. Depending on the levels of pain, they can range from paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, to more powerful opiate-based painkillers, such as codeine and morphine.

Tell your care team if the painkillers you're prescribed aren't effective in reducing your pain. You may need to be prescribed a stronger medication. A short course of radiotherapy may also be effective in controlling the pain.

Macmillan nurses, who work both in hospitals and in the community, can also provide expert advice about pain relief.

Kidney failure

Your kidneys remove waste material from your blood. The waste is passed out of your body in urine through tubes called the ureters. Kidney function can be monitored by a simple blood test called serum creatinine level.

In some cases of advanced cervical cancer, the cancerous tumour can press against the ureters, blocking the flow of urine out of the kidneys. The build-up of urine inside the kidneys is known as hydronephrosis and can cause the kidneys to become swollen and stretched.

Severe cases of hydronephrosis can cause the kidneys to become scarred, which can lead to loss of most or all of the kidneys' functions. This is known as kidney failure.

Kidney failure can cause a wide range of symptoms, including:

    tiredness
    swollen ankles, feet or hands, caused by water retention
    shortness of breath
    feeling sick
    blood in your urine (haematuria)

Treatment options for kidney failure associated with cervical cancer include draining urine out of the kidneys using a tube inserted through the skin and into each kidney (percutaneous nephrostomy). Another option is to widen the ureters by placing a small metal tube called a stent inside them.

Blood clots

As with other types of cancer, cervical cancer can make the blood "stickier" and more prone to forming clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot.

Large tumours can press on the veins in the pelvis, which slows the flow of blood and can lead to a blood clot developing in the legs.

Symptoms of a blood clot in your legs include:

    pain, swelling and tenderness in one of your legs (usually your calf)
    a heavy ache in the affected area
    warm skin in the area of the clot
    redness of the skin, particularly at the back of your leg, below the knee

A major concern in these cases is that the blood clot from the leg vein will travel up to the lungs and block the supply of blood. This is known as a pulmonary embolism and can be fatal.

Blood clots in the legs are usually treated using a combination of blood-thinning medication, such as heparin or warfarin, and compression garments designed to help encourage the flow of blood through the limbs.

Bleeding

If the cancer spreads into your vagina, bowel or bladder, it can cause significant damage, resulting in bleeding. Bleeding can occur in your vagina or rectum (back passage), or you may pass blood when you urinate.

Minor bleeding can often be treated using a medication called tranexamic acid, which encourages the blood to clot and stop the bleeding. Radiotherapy can also be highly effective in controlling bleeding caused by cancer.

Major bleeding may be treated temporarily by vaginal packing (using gauze to stem the bleeding) and later by surgery, radiotherapy or by cutting off blood supply to the cervix.

Fistula

A fistula is an uncommon but distressing complication that occurs in around 1 in 50 cases of advanced cervical cancer.

A fistula is an abnormal channel that develops between two sections of the body. In most cases involving cervical cancer, the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. A fistula can sometimes develop between the vagina and rectum.

Surgery is usually required to repair a fistula, although it's often not possible in women with advanced cervical cancer, because they're usually too frail to withstand the effects of surgery.

In such cases, treatment often involves using medication, creams and lotions to reduce the amount of discharge and protect the vagina and surrounding tissue from damage and irritation.

Vaginal discharge

Another uncommon, but distressing, complication of advanced cervical cancer is an unpleasant-smelling discharge from your vagina.

The discharge can occur for a number of reasons, such as the breakdown of tissue, the leakage of bladder or bowel contents out of the vagina, or a bacterial infection of the vagina.

Treatment options for vaginal discharge include an antibacterial gel called metronidazole and wearing clothing that contains charcoal. Charcoal is a chemical compound that's very effective in absorbing unpleasant smells.

Palliative care

If your doctors can't do any more to treat your cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care.

Palliative care also includes psychological, social and spiritual support for you and your family or carers.

There are different options for terminal care in the late stages of cancer. You may want to think about whether you'd like to be cared for in hospital, in a hospice or at home, and discuss these issues with your doctor. Some organisations who provide care for people with cancer include:

    Macmillan Cancer Support – which has specially trained nurses who help to look after people with cancer at home. To be referred to a Macmillan nurse, ask your hospital doctor or GP, or call 0808 808 00 00.
    Marie Curie Cancer Care – have specially trained nurses who help to look after people with cancer at home. They also run hospices for people with cancer.
    Hospice UK – provides information about hospice care and how to find a hospice.
 

tags:  Cervical cancer - Complications, Complications, Cervical cancer, Cervical, cancer, Side effects, Palliative care, Vaginal discharge, Fistula, Bleeding, Blood clots, Kidney failure, Advanced cervical cancer, pain, Emotional impact, Lymphoedema, Narrowing of the vagina, Complications of cervical cancer can occur as a side effect of treatment or as the result of advanced cervical cancer.

Cervical cancer - Treatment

 Treatment for cervical cancer depends on how far the cancer has spread.

As cancer treatments are often complex, hospitals use multidisciplinary teams (MDTs) to treat cervical cancer and tailor the treatment programme to the individual.

MDTs are made up of a number of different specialists (see below) who work together to make decisions about the best way to proceed with your treatment.

Your cancer team will recommend what they think the best treatment options are, but the final decision will be yours. In most cases, the recommendations will be:

    early cervical cancer – surgery to remove some or all of the womb, radiotherapy, or a combination of the two
    advanced cervical cancer – radiotherapy and/or chemotherapy, although surgery is also sometimes used

The prospect of a complete cure is good for cervical cancer diagnosed at an early stage, although the chances of a complete cure decrease the further the cancer has spread.

In cases where cervical cancer isn't curable, it's often possible to slow its progression, prolong lifespan and relieve any associated symptoms, such as pain and vaginal bleeding. This is known as palliative care.

The different treatment options are discussed in more detail below.

Removing abnormal cells

If your screening results show that you don't have cervical cancer, but there are biological changes that could turn cancerous in the future, a number of treatment options are available. These include:

    large loop excision of the transformation zone (LLETZ) – the abnormal cells are cut away using a fine wire and an electrical current
    cone biopsy – the area of abnormal tissue is removed during surgery
    laser therapy – a laser is used to burn away the abnormal cells 

Surgery

There are three main types of surgery for cervical cancer. They are:

    radical trachelectomy – the cervix, surrounding tissue and the upper part of the vagina are removed, but the womb is left in place
    hysterectomy – the cervix and womb are removed; depending on the stage of the cancer, it may also be necessary to remove the ovaries and fallopian tubes
    pelvic exenteration – a major operation in which the cervix, vagina, womb, bladder, ovaries, fallopian tubes and rectum are removed

Radical trachelectomy

A radical trachelectomy is usually only suitable if cervical cancer is diagnosed at a very early stage. It's usually offered to women who want to preserve their child-bearing potential.

During the procedure, the surgeon will make a number of small incisions (cuts) in your abdomen. Specially designed instruments will be passed through the incisions and used to remove your cervix and the upper section of your vagina. Lymph nodes from your pelvis may also be removed. Your womb will then be reattached to the lower section of your vagina.

Compared with a hysterectomy or pelvic exenteration, the advantage of this type of surgery is that your womb remains intact, which means that you may still be able to have children. However, it's important to be aware that the surgeons carrying out this operation can't guarantee you'll still be able to have children.

If you do have children after the operation, your child would have to be delivered by caesarean section. It's also usually recommended that you wait 6 to 12 months after having surgery before trying for a baby, so that your womb and vagina have time to heal.

Radical trachelectomy is a highly skilled procedure. It's only available at a number of specialist centres in the UK, so it may not be available in your area and you may have to travel to another city to be treated.

Hysterectomy

A hysterectomy is usually recommended for early cervical cancer. This may be followed by a course of radiotherapy to help prevent the cancer coming back.

Two types of hysterectomies are used to treat cervical cancer. They are:

    simple hysterectomy – where the cervix and womb are removed and, in some cases, the ovaries and fallopian tubes are also removed; this is only appropriate for very early stage cervical cancers
    radical hysterectomy – where the cervix, womb, surrounding tissue and lymph nodes, ovaries and fallopian tubes are all removed; this is the preferred option in advanced stage one and some early stage two cervical cancers

Short-term complications of a hysterectomy include infection, bleeding, blood clots and accidental injury to your ureter, bladder or rectum.

The risk of long-term complications is small, but they can be troublesome. They include:

    the risk that your vagina can become shortened and drier, which can make sex painful
    urinary incontinence
    swelling of your arms and legs, caused by a build-up of fluid (lymphoedema)
    your bowel becomes obstructed because of a build-up of scar tissue – this may require further surgery to correct

As your womb is removed during a hysterectomy, you'll no longer be able to have children.

If your ovaries are removed, it will also trigger the menopause if you haven't already experienced it.

Pelvic exenteration

A pelvic exenteration is a major operation that's usually only recommended when cervical cancer returns after what was thought to be a previously successful course of treatment. It's offered if the cancer returns to the pelvis, but hasn't spread beyond this area.

A pelvic exenteration involves two phases of treatment:

    the cancer is removed, plus your bladder, rectum, vagina and the lower section of your bowel
    two holes called stomas are created in your abdomen – the holes are used to pass urine and faeces out of your body into collection pouches called colostomy bags

Following a pelvic exenteration, your vagina can be reconstructed using skin and tissue taken from other parts of your body. This means you'll be able to have sex after the procedure, although it may be several months until you feel well enough to do so.

Radiotherapy

Radiotherapy may be used on its own or combined with surgery for early stage cervical cancer. It may be combined with chemotherapy for advanced cervical cancer, where it can be used to control bleeding and pain.

There are two ways that radiotherapy can be delivered. These are:

    externally – a machine beams high-energy waves into your pelvis to destroy cancerous cells
    internally – a radioactive implant is placed inside your vagina and cervix

In most cases, a combination of internal and external radiotherapy will be used. A course of radiotherapy usually lasts for around five to eight weeks.

As well as destroying cancerous cells, radiotherapy can sometimes also harm healthy tissue. This means it can cause significant side effects many months, and even years, after treatment.

However, the benefits of radiotherapy often tend to outweigh the risks. For some people, radiotherapy offers the only hope of getting rid of the cancer.

Side effects of radiotherapy are common and can include:

    diarrhoea
    pain when urinating
    bleeding from your vagina or rectum
    feeling very tired (fatigue)
    feeling sick (nausea)
    sore skin in your pelvis region similar to sunburn
    narrowing of your vagina, which can make having sex painful
    infertility
    damage to the ovaries, which will usually trigger an early menopause (if you haven't already experienced it)
    bladder and bowel damage, which could lead to incontinence

Most of these side effects will resolve within about eight weeks of finishing treatment, although in some cases they can be permanent. It's also possible to develop side effects several months, or even years, after treatment has finished.

If infertility is a concern for you, it may be possible to surgically remove eggs from your ovaries before you have radiotherapy, so that they can be implanted in your womb at a later date. However, you may have to pay for this.

It may also be possible to prevent an early menopause by surgically removing your ovaries and replanting them outside the area of your pelvis that will be affected by radiation. This is known as an ovarian transposition.

Your MDT can provide more information about the possible options for treating infertility and whether you're suitable for an ovarian transposition.

Chemotherapy

Chemotherapy can be combined with radiotherapy to try to cure cervical cancer, or it can be used as a sole treatment for advanced cancer to slow its progression and relieve symptoms (palliative chemotherapy).

Chemotherapy involves using either a single chemotherapy medication called cisplatin or a combination of different chemotherapy medications to kill the cancerous cells.

Chemotherapy is usually given using an intravenous drip on an outpatient basis, so you'll be able to go home once you've received your dose.

As with radiotherapy, these medications can also damage healthy tissue. Side effects are therefore common and can include:

    nausea and vomiting
    diarrhoea
    feeling tired all the time
    reduced production of blood cells, which can make you feel tired and breathless (anaemia) and vulnerable to infection because of a lack of white blood cells
    mouth ulcers
    loss of appetite
    hair loss – your hair should grow back within three to six months of your course of chemotherapy being completed, although not all chemotherapy medications cause hair loss

Some types of chemotherapy medication can damage your kidneys, so you may need to have regular blood tests to assess the health of your kidneys.

Follow-up

After your treatment has been completed and the cancer has been removed, you'll need to attend regular appointments for testing. This will usually involve a physical examination of your vagina and cervix (if it hasn't been removed).

As there's a risk of cervical cancer returning, these examinations will be used to look for signs of this. If anything suspicious is found, a further biopsy can be carried out.

If cervical cancer does return, it usually returns around 18 months after a course of treatment has been completed.

Follow-up appointments are usually recommended every four months after treatment has been completed for the first two years, and then every six to 12 months for a further three years.
Your multidisciplinary team (MDT)

Members of your MDT may include:

    a surgeon
    a clinical oncologist (a specialist in chemotherapy and radiotherapy)
    a medical oncologist (a specialist in chemotherapy only)
    a pathologist (a specialist in diseased tissue)
    a radiologist (a specialist in imaging scans)
    a gynaecologist (a doctor who specialises in treating conditions that affect the female reproductive system)
    a social worker
    a psychologist
    a specialist cancer nurse, who'll usually be your first point of contact with the rest of the team

tags: Cervical cancer - Treatment, Cervical cancer, cancer, Cervical, Treatment, Follow-up, Chemotherapy, Radiotherapy, Pelvic exenteration, Hysterectomy, Radical trachelectomy, Removing abnormal cells, Surgery, Treatment for cervical cancer depends on how far the cancer has spread.

Cervical cancer - Prevention

 There's no single way to completely prevent cervical cancer, but there are things that can reduce your risk.

Safer sex

Most cases of cervical cancer are linked to an infection with certain types of human papillomavirus (HPV). HPV can be spread through unprotected sex, so using a condom can reduce your risk of developing the infection. However, the virus isn't just passed on through penetrative sex – it can be transmitted during other types of sexual contact, such as skin-to-skin contact between genital areas and by using sex toys.

Your risk of developing an HPV infection increases the earlier you start having regular sex and with the more sexual partners you have, although women who have only had one sexual partner can also develop it.

Cervical screening

Regular cervical screening is the best way to identify abnormal changes in the cells of the cervix at an early stage.

Women who are 25-49 years of age are invited for screening every three years. Women who are 50-64 years of age are invited every five years. For women who are 65 years of age or older, only those who haven't been screened since they were 50, or those who have had recent abnormal tests, are offered screening.

Make sure that your GP surgery has your up-to-date contact details, so that you continue getting screening invitations.

It's important that you attend your cervical screening tests, even if you've been vaccinated for HPV, because the vaccine doesn't guarantee protection against cervical cancer.

If you've been treated for abnormal cervical cell changes, you'll be invited for screening more frequently for several years after treatment. How regularly you need to go will depend on how severe the cell change is.

Although it can identify most abnormal cell changes in the cervix, cervical screening isn't always 100% accurate. Therefore, you should report symptoms such as unusual vaginal bleeding to your GP, even if you've recently been tested.

Cervical cancer vaccination

The NHS cervical cancer vaccination programme uses a vaccine called Gardasil. Gardasil protects against four types of HPV, including the two strains responsible for more than 70% of cervical cancers in the UK (HPV16 and HPV 18). It also prevents genital warts.

Girls are offered the childhood immunisation programme. The vaccine is given to girls when they're 12-13 years old, with three doses given over a six-month period.

Although the HPV vaccine can significantly reduce the risk of cervical cancer, it doesn't guarantee that you won't develop the condition. You should still attend cervical screening tests, even if you've had the vaccine.

Avoid smoking

You can reduce your chances of getting cervical cancer by not smoking. People who smoke are less able to get rid of the HPV infection from the body, which can develop into cancer.

If you decide to give up smoking, your GP can refer you to the NHS Stop Smoking Service, which gives you help and advice on the best ways to stop smoking.

You can also call the NHS Smoking Helpline (0300 123 1044) and speak to specially trained staff who will provide free expert advice and encouragement.

If you want to give up smoking, but you don't want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms that you may experience after giving up.

tags: Cervical cancer - Prevention, Prevention, Cervical cancer, cancer, Cervical, Safer sex, Avoid smoking, Cervical cancer vaccination, Cervical screening, There's no single way to completely prevent cervical cancer, but there are things that can reduce your risk.

Cervical cancer - Causes

 In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papillomavirus (HPV).

Cancer begins with a change in the structure of the DNA that's present in all human cells. DNA provides the cells with a basic set of instructions, including when to grow and reproduce.

A change in the DNA's structure is known as a mutation. It can alter the instructions that control cell growth, which means the cells continue growing instead of stopping when they should. If the cells reproduce uncontrollably, they produce a lump of tissue called a tumour.

Human papillomavirus (HPV)

More than 99% of cervical cancer cases occur in women who have been previously infected with HPV. HPV is a group of viruses, rather than a single virus. There are more than 100 different types.

HPV is spread during sexual intercourse and other types of sexual activity (such as skin-to-skin contact of the genital areas, or using sex toys) and is thought to be very common. It's estimated that 1 in 3 women will develop a HPV infection within two years of starting to have regular sex, and about 4 in 5 women will develop the infection at some point in their lives.

Some types of HPV don't cause any noticeable symptoms and the infection will pass without treatment. Other types of HPV can cause genital warts, although these types aren't linked to an increased risk of causing cervical cancer.

About 15 types of HPV are considered high-risk for cervical cancer. The two types known to have the highest risk are HPV 16 and HPV 18, which cause about 7 out of every 10 cervical cancers.

High-risk types of HPV are thought to contain genetic material that can be passed into the cells of the cervix. This material begins to disrupt the normal workings of the cells, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour.

As most types of HPV don't cause any symptoms, you or your partner could have the virus for months or years without knowing it.

Cervical intraepithelial neoplasia (CIN)

Cancer of the cervix usually takes many years to develop. Before it does, the cells in the cervix often show changes known as cervical intraepithelial neoplasia (CIN) or, less commonly, cervical glandular intraepithelial neoplasia (CGIN).

CIN and CGIN are pre-cancerous conditions. Pre-cancerous conditions don't pose an immediate threat to a person's health, but they can potentially develop into cancer in the future.

However, even if you develop CIN or CGIN, the chances of it developing into cervical cancer are very small, and if the changes are discovered during cervical screening, treatment is highly successful.

The progression from becoming infected with HPV to developing CIN or CGIN and then developing cervical cancer is very slow, often taking 10 to 20 years.

Increased risk

The fact that HPV infection is very common but cervical cancer is relatively uncommon suggests that only a very small proportion of women are vulnerable to the effects of an HPV infection. There appear to be additional risk factors that affect a woman's chance of developing cervical cancer. These include:

    smoking – women who smoke are twice as likely to develop cervical cancer than women who don't; this may be caused by the harmful effects of chemicals found in tobacco on the cells of the cervix
    having a weakened immune system – this can occur as a result of taking certain medications, such as immunosuppressants, which are used to stop the body rejecting donated organs, or as a result of a condition such as HIV or AIDS
    taking the oral contraceptive pill for more than five years – women who take the pill are thought to have twice the risk of developing cervical cancer than those who don't, although it's not clear why
    having children (the more children you have, the greater your risk) – women who have two children have twice the risk of getting cervical cancer compared with women who don't have any children

The reason for the link between cervical cancer and childbirth is unclear. One theory is that the hormonal changes that occur during pregnancy may make the cervix more vulnerable to the effects of HPV.

The spread of cervical cancer

If cervical cancer is undiagnosed and untreated, it will slowly spread out of the cervix and into the surrounding tissue and organs. The cancer can spread down to the vagina and the surrounding muscles that support the bones of the pelvis. Alternatively, it can spread upwards, blocking the tube that runs from your kidneys to your bladder (ureters).

The cancer can then spread into your bladder, rectum (back passage) and eventually into your liver, bones and lungs. Cancerous cells can also spread through your lymphatic system. The lymphatic system is a series of nodes (glands) and channels spread throughout your body in a similar way to the blood circulation system.

The lymph nodes produce many of the specialised cells needed by your immune system (the body's natural defence against infection and illness). If you have an infection, the nodes in your neck or under your armpits can become swollen.

In some cases of early cervical cancer, the lymph nodes close to the cervix contain cancerous cells. In some cases of advanced cervical cancer, lymph nodes in the chest and abdomen can be affected.

tags: The spread of cervical cancer, Increased risk, Cervical intraepithelial neoplasia (CIN), Human papillomavirus (HPV), Cervical cancer - Causes, Causes, Cervical cancer, In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papillomavirus (HPV).

Cervical cancer - Diagnosis

 If cervical cancer is suspected, you'll be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system).

Referral will be recommended if the results of your cervical screening test suggest that there are abnormalities in the cells of your cervix. However, in most cases, the abnormalities don't mean you have cervical cancer.

You may also be referred to a gynaecologist if you have abnormal vaginal bleeding, or if your GP has noticed a growth inside your cervix during an examination.

The sexually transmitted infection (STI) chlamydia is one of the most common reasons why women experience unusual vaginal bleeding. Your GP may recommend that you're tested for it first before being referred. Testing for chlamydia involves taking a small tissue sample from your cervix, or carrying out a urine test.

Colposcopy

If you've had an abnormal cervical screening test result, or your symptoms suggest that you may have cervical cancer, your gynaecologist will usually carry out a colposcopy. This is an examination to look for abnormalities in your cervix.

During a colposcopy, a small microscope with a light source at the end (colposcope) is used. As well as examining your cervix, your gynaecologist may remove a small tissue sample (biopsy) so that it can be checked under a microscope for cancerous cells.

Cone biopsy

In some cases, a minor operation called a cone biopsy may also be carried out. The operation is carried out in hospital, usually under a local anaesthetic.

During a cone biopsy, a small, cone-shaped section of your cervix will be removed so that it can be examined under a microscope for cancerous cells. You may experience vaginal bleeding for up to four weeks after the procedure. You may also have period-like pains.

Further testing

If the results of the biopsy suggest you have cervical cancer and there's a risk that the cancer may have spread, you'll probably need to have some further tests to assess how widespread the cancer is.

These tests may include:

    a pelvic examination carried out under general anaesthetic – your womb, vagina, rectum and bladder will be checked for cancer
    blood tests – these can be used to help assess the state of your liver, kidneys and bone marrow
    computerised tomography (CT) scan – scans are taken of the inside of your body and a computer is used to assemble them into a detailed three-dimensional image; the CT scan can help to identify cancerous tumours and show whether cancerous cells have spread
    magnetic resonance imaging (MRI) scan – this type of scan uses strong magnetic fields and radio waves to produce detailed pictures of the inside of your body; it can also be used to check whether cancer has spread
    chest X-ray – this will indicate whether cancer has spread to your lungs
    positive emission tomography (PET) scan – a specialised scan, where a mildly radioactive substance is injected into your veins so the cancerous tissue shows up more clearly; it's often combined with a CT scan and is used to see if the cancer has spread, or to check how well a person is responding to treatment

Staging

After all of the tests have been completed and your test results are known, it should be possible to tell you what stage cancer you have. Staging is a measurement of how far the cancer has spread. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows:

    stage 0 (pre-cancer) – there are no cancerous cells in the cervix, but there are biological changes that could trigger cancer in the future; this is called cervical intraepithelial neoplasia (CIN) or carcinoma in situ (CIS)
    stage 1 – the cancer is still contained inside the cervix
    stage 2 – the cancer has spread outside of the cervix into the surrounding tissue, but hasn't reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina
    stage 3 – the cancer has spread into the lower section of the vagina and/or into the pelvic wall
    stage 4 – the cancer has spread into the bowel, bladder or other organs, such as the lungs 

tags: Cervical cancer - Diagnosis, Diagnosis, Cervical cancer, cancer, Cervical, Staging, Further testing, Cone biopsy, Colposcopy, If cervical cancer is suspected, you'll be referred to a gynaecologist (a specialist in treating conditions of the female reproductive system).

Cervical cancer - Symptoms

 

The symptoms of cervical cancer aren't always obvious, and it may not cause any symptoms at all until it's reached an advanced stage.

This is why it's very important that you attend all of your cervical screening appointments.

Unusual bleeding

In most cases, vaginal bleeding is the first noticeable symptom of cervical cancer. It usually occurs after having sex.

Bleeding at any other time, other than your expected monthly period, is also considered unusual. This includes bleeding after the menopause (when a woman's monthly periods stop).

Visit your GP for advice if you experience any type of unusual vaginal bleeding.
Other symptoms

Other symptoms of cervical cancer may include pain and discomfort during sex and an unpleasant smelling vaginal discharge.

Advanced cervical cancer

If the cancer spreads out of your cervix and into surrounding tissue and organs, it can trigger a range of other symptoms, including:

    constipation
    blood in your urine (haematuria)
    loss of bladder control (urinary incontinence)
    bone pain
    swelling of one of your legs
    severe pain in your side or back caused by swelling in your kidneys, related to a condition called hydronephrosis
    changes to your bladder and bowel habits
    loss of appetite
    weight loss
    tiredness and a lack of energy

When to seek medical advice

You should contact your GP if you experience:

    bleeding after sex (postcoital bleeding)
    bleeding outside of your normal periods
    new bleeding after the menopause

Vaginal bleeding is very common and can have a wide range of causes, so it doesn't necessarily mean you have cervical cancer. However, unusual vaginal bleeding is a symptom that needs to be investigated by your GP.

tags: Cervical cancer - Symptoms, Symptoms, Cervical cancer, cancer, Cervical, When to seek medical advice, Advanced cervical cancer, Unusual bleeding, The symptoms of cervical cancer aren't always obvious, and it may not cause any symptoms at all until it's reached an advanced stage.

Cervical cancer

 Cervical cancer is a type of cancer that develops in a woman's cervix (the entrance to the womb from the vagina).

Cancer of the cervix often has no symptoms in its early stages. If you do have symptoms, the most common is unusual vaginal bleeding, which can occur after sex, in between periods or after the menopause.

Abnormal bleeding doesn't mean that you definitely have cervical cancer, but it should be investigated by your GP as soon as possible. If your GP thinks you might have cervical cancer, you should be referred to see a specialist within two weeks.

Read more about the symptoms of cervical cancer and diagnosing cervical cancer.

Screening for cervical cancer

Over the course of many years, the cells lining the surface of the cervix undergo a series of changes. In rare cases, these precancerous cells can become cancerous. However, cell changes in the cervix can be detected at a very early stage and treatment can reduce the risk of cervical cancer developing.

The NHS offers a cervical screening programme to all women from the age of 25. During cervical screening (previously known as a "smear test"), a small sample of cells is taken from the cervix and checked under a microscope for abnormalities.

An abnormal cervical screening test doesn't mean you definitely have cancer. Most abnormal results are caused by an infection or the presence of treatable precancerous cells, rather than cancer itself.

Women aged 25 to 49 years of age are offered screening every three years, and women aged 50 to 64 are offered screening every five years. For women who are 65 or older, only those who haven't been screened since they were 50, or those who have had recent abnormal tests, are offered screening.

You should be sent a letter confirming when your screening appointment is due. Contact your GP if you think you may be overdue for a screening appointment.

What causes cervical cancer?

Almost all cases of cervical cancer are caused by the human papillomavirus (HPV). HPV is a very common virus that can be passed on through any type of sexual contact with a man or a woman.

There are more than 100 different types of HPV, many of which are harmless. However, some types of HPV can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer.

Two strains of the HPV virus (HPV 16 and HPV 18) are known to be responsible for 70% of all cases of cervical cancer. These types of HPV infection don't have any symptoms, so many women won't realise they have the infection.

However, it's important to be aware that these infections are relatively common and most women who have them don't develop cervical cancer.

Using condoms during sex offers some protection against HPV, but it can't always prevent infection, because the virus is also spread through skin-to-skin contact of the wider genital area.

Since 2008, a HPV vaccine has been routinely offered to girls aged 12 and 13.

Read more about the causes of cervical cancer and preventing cervical cancer.

Treating cervical cancer

If cervical cancer is diagnosed at an early stage, it's usually possible to treat it using surgery. In some cases, it's possible to leave the womb in place, but it may need to be removed. The surgical procedure used to remove the womb is called a hysterectomy.

Radiotherapy is an alternative to surgery for some women with early stage cervical cancer. In some cases, it's used alongside surgery.

More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy.

Some of the treatments used can have significant and long-lasting side effects, including early menopause and infertility.

Read more about treating cervical cancer.

Complications

Many women with cervical cancer will have complications. These can arise as a direct result of the cancer or as a side effect of treatments such as radiotherapy, chemotherapy and surgery.

Complications associated with cervical cancer can range from the relatively minor, such as minor bleeding from the vagina or having to urinate frequently, to life-threatening, such as severe bleeding or kidney failure.

Read more about the complications of cervical cancer.

Outlook

The stage at which cervical cancer is diagnosed is an important factor in determining a woman's outlook. The staging, given as a number from one to four, indicates how far the cancer has spread.

The chances of living for at least five years after being diagnosed with cervical cancer are:

    stage 1 – 80-99%
    stage 2 – 60-90%
    stage 3 – 30-50%
    stage 4 – 20%
 

n the UK, just under 1,000 women die from cervical cancer every year.

Who's affected by cervical cancer?

Following the success of the NHS Cervical Screening Programme and the early detection of cell changes, the number of cervical cancer cases in the UK has reduced. Around 3,000 cases of cervical cancer are diagnosed in the UK each year.

It's possible for women of all ages to develop cervical cancer, but the condition mainly affects sexually active women aged between 30 and 45. Cervical cancer is very rare in women under 25.

tags: Who's affected by cervical cancer?, Outlook, Complications, Treating cervical cancer, What causes cervical cancer?, Screening for cervical cancer, Cervical cancer is a type of cancer that develops in a woman's cervix (the entrance to the womb from the vagina).

Healthy-Fat Foods: 10 Foods that have healthy fats

 
1. Fish

Naturally fatty fish like salmon, mackerel, herring, lake trout, sardines, and albacore tuna are good sources of omega-3 fatty acids. These are "good" fats that help keep your heart healthy. They may also help keep your brain sharp, especially as you get older. The American Heart Association suggests eating two servings of fatty fish a week. A serving is 3 ounces -- about the size of a deck of cards. Try it baked, grilled, or poached.

 
2. Avocado

Eat it on your sandwich, or serve it up in guacamole. Tasty avocado is good for your heart and may help with osteoarthritis symptoms, thanks to healthy fats.

An extra benefit? When you eat avocado with other foods, it helps your body better absorb their nutrients. Half a medium avocado is one serving and about 115-160 calories.

 
3. Seeds

Little pumpkin seeds, sunflower seeds, and sesame seeds pack a big punch. They have "good" fats that can lower cholesterol. In general, fats that come from plants are healthier than those from animal products. "Bad" fats are in foods like fatty cuts of meat, full-fat dairy products, and some packaged foods. Check food labels to see how much fat, and what type, you're getting. Limit saturated fats and avoid trans fats.

4. Nuts

From hazelnuts to pecans, all nuts are good for your heart. Walnuts, especially, deliver heart-healthy fats. But don't overdo it. Just because the fats are healthy doesn't mean you can eat as much as you want. A serving is 1 ounce. That's about 14 walnut halves, 24 almonds, 35 peanuts, 18 cashews, or 15 pecan halves.

5. Olive Oil

Whether you're cooking or dressing your salad, try olive oil. It's high in good fat. Remember, though: It's always smart to watch how much fat -- even good fat -- you eat. So cook with less oil than a recipe calls for. Or use an olive oil spray. In baking, you can use applesauce for half the oil to cut back on some fat and shave calories.

 
6. Vegetables

Dark green veggies like spinach, kale, and Brussels sprouts offer some omega 3s. Because our bodies can't make these good fats, you have to get them from food. Aim for 2-3 cups of vegetables every day. Include fish in your diet, too, since fish have a different kind of omega-3 fat that you need. Plants only offer a fraction of the omega-3s that fish do.

 7. Eggs

Eggs are a great source of inexpensive protein, and a large egg has less than 5 grams of fat, most from healthy fats. Some eggs are also enriched with extra omega-3s. It will say so on the carton. To stay healthy, limit yourself to just one egg a day.

8. Ground Flaxseed

As part of a healthy diet, good-for-you fats can help make your skin look great -- plumper and younger. Plus, they add fiber and can help ease inflammation. Get good fats by sprinkling a teaspoon of ground flaxseed on your salad or your cereal, or use it when you're baking.

9. Beans

Whether they're kidney, Great Northern, navy, or soybeans, adding beans to your diet can be good for you mentally and physically. Beans have omega 3s, which may help with mood.

10. Omega-3-Fortified Foods

There are also many foods that have added omega-3s to make them healthier. You can find enriched milk and eggs, bread, and breakfast bars, for example. Check product labels to make sure. Plus, you may get more health benefits by getting omega-3s through fortified products than from a supplement.

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Breast cancer (female) - Living with

Breast cancer can affect your daily life in different ways, depending on what stage it's at and what treatment you're having.

How women cope with their diagnosis and treatment varies from person to person. There are several forms of support if you need it. Not all of them work for everybody, but one or more of them should help. You could:

talk to your friends and family; they can be a powerful support system

communicate with other people in the same situation

find out as much as possible about your condition

avoid doing too much or overexerting yourself

make time for yourself

tags: Breast cancer (female) - Living with, Breast cancer (female), Breast cancer, Breast, cancer, Living with, Living with Breast cancer, Living with cancer.

Breast cancer (female) - Prevention

As the causes of breast cancer aren't fully understood, it's not known if it can be prevented altogether.

Some treatments are available to reduce the risk in women who have a higher risk of developing the condition than the general population.

Diet and lifestyle

Regular exercise and a healthy, balanced diet are recommended for all women because they can help prevent many conditions, including heart disease, diabetes and many forms of cancer.

Studies have looked at the link between breast cancer and diet and, although there are no definite conclusions, there are benefits for women who maintain a healthy weight, exercise regularly and who have a low intake of saturated fat and alcohol. Use our healthy weight calculator to check if you're a healthy weight.

It's also been suggested that regular exercise can reduce your risk of developing breast cancer by as much as a third. If you have been through the menopause, it's particularly important that you're not overweight or obese. This is because these conditions cause more oestrogen to be produced, which can increase the risk of breast cancer.

Breastfeeding

Studies have shown that women who breastfeed are statistically less likely to develop breast cancer than those who don't. The reasons aren't fully understood, but it could be because women don't ovulate as regularly while they're breastfeeding and oestrogen levels remain stable.

Treatments to reduce your risk

If you have an increased risk of developing breast cancer, treatment is available to reduce your risk.

Your level of risk is determined by factors such as your age, your family's medical history and the results of genetic tests.

You will usually be referred to a specialist genetics service if it's thought you have an increased risk of breast cancer. Healthcare professionals working at these services should discuss treatment options with you.

The two main treatments are surgery to remove the breasts (mastectomy) or medication. These are described in more detail below.

Mastectomy

A mastectomy is surgery to remove the breasts. It can be used to treat breast cancer and reduce the chances of developing the condition in the small number of women from high-risk families.

By removing as much breast tissue as possible, a mastectomy can reduce your risk of breast cancer by up to 90%.

However, like all operations, there's a risk of complications, and having your breasts removed can have a significant effect on your body image and sexual relationships.

If you want to, you can usually choose to have a breast reconstruction either during the mastectomy operation, or at a later date. During breast reconstruction surgery, your original breast shape is recreated using either breast implants or tissue from elsewhere in your body.

An alternative is to use breast prostheses. These are artificial breasts that can be worn inside your bra.

Medication

In June 2013, the National Institute for Health and Care Excellence (NICE) announced that two medications, called tamoxifen and raloxifene, would be available on the NHS for women who have an increased risk of developing breast cancer.

Either tamoxifen or raloxifene can be used in women who've been through the menopause, but only tamoxifen should be used in women who haven't.

These medications may not be suitable if in the past you've had blood clots or womb cancer, or if you have an increased risk of developing these problems in the future.

Women who've already had a mastectomy to remove both breasts won't be offered these medications, because their risk of developing breast cancer is very small.

A course of treatment with tamoxifen or raloxifene will usually involve taking a tablet every day for five years.

Raloxifene can cause side effects including flu-like symptoms, hot flushes and leg cramps. Side effects of tamoxifen can include hot flushes and sweats, changes to your periods, and nausea and vomiting.

Your chances of giving birth to a child with birth defects increase while you're taking tamoxifen, so you'll be advised to stop taking it at least two months before trying for a baby. The medication can also increase your risk of blood clots, so you should stop taking it six weeks before having any planned surgery.

Tamoxifen and raloxifene aren't currently licensed for the purpose of reducing the risk of breast cancer in women with an increased risk of developing the condition. However, they can still be used if you understand the benefits and risks, and your doctor believes the treatment will be helpful.

tags: Breast cancer (female) - Prevention, Breast cancer (female), Breast cancer, Breast, cancer, Prevention, Breast cancer Prevention, Medication, Mastectomy, Treatments to reduce your risk, Treatments, risk, Breastfeeding, Diet and lifestyle, Diet, lifestyle.

Breast cancer (female) - Treatment

If you have cancer you should be assigned a multidisciplinary team (MDT) – a team of specialists who work together to provide the best treatment and care.

The main treatments for breast cancer are:

surgery

radiotherapy

chemotherapy

hormone therapy

biological therapy (targeted therapy)

You may have one of these treatments, or a combination. The type or combination of treatments you have will depend on how the cancer was diagnosed and the stage it's at.

Breast cancer diagnosed at screening may be at an early stage, but breast cancer diagnosed when you have symptoms may be at a later stage and require a different treatment. Your healthcare team will discuss with you which treatments are most suitable.

Choosing the right treatment for you 

When deciding what treatment is best for you, your doctors will consider:

the stage and grade of your cancer (how big it is and how far it's spread)

your general health

whether you've experienced the menopause

You should be able to discuss your treatment with your care team at any time and ask questions.

tags: Breast cancer (female) - Treatment, Breast cancer (female), Breast cancer, Breast, cancer, Breast cancer Treatment, female, Choosing the right treatment for you, Treatment.

Breast cancer (female) - Diagnosis

You may be diagnosed with breast cancer following routine breast screening, or you may have symptoms that you've seen your GP about.

Seeing your GP

See your GP as soon as possible if you notice any symptoms of breast cancer, such as an unusual lump in your breast or any change in the appearance, feel or shape of your breasts.

Your GP will examine you and, if they think your symptoms need further assessment, they'll refer you to a specialist breast cancer clinic.

tags: Breast cancer (female) - Diagnosis, Breast cancer (female), Breast cancer, Breast, cancer, female, Diagnosis, Breast cancer Diagnosis, Seeing your GP.

Breast cancer screening

About one in eight women in the UK are diagnosed with breast cancer during their lifetime. There's a good chance of recovery if it's detected in its early stages.

Breast screening aims to find breast cancers early. It uses an X-ray test called a mammogram that can spot cancers when they are too small to see or feel.

Breast screening does, however, have some risks you should be aware of (see below).

As the likelihood of getting breast cancer increases with age, all women who are aged 50-70 and registered with a GP are automatically invited for breast cancer screening every three years.

In the meantime, if you are worried about breast cancer symptoms, such as a lump or area of thickened tissue in a breast, don't wait to be offered screening – see your GP.

This page gives an overview of breast cancer screening, with links to information on why and when it is offered, what happens when you go for breast screening, and receiving your results.

Why is breast screening offered?

Most experts agree that regular breast screening is beneficial in identifying breast cancer early. The earlier the condition is found, the better the chances of surviving it.

You're also less likely to need a mastectomy (breast removal) or chemotherapy if breast cancer is detected at an early stage.

The main risk is that breast screening sometimes picks up cancers that may not have caused any symptoms or become life-threatening. You may end up having unnecessary extra tests and treatment.

What happens during breast screening?

Breast screening is carried out at special clinics or mobile breast screening units. The procedure is carried out by female members of staff who take mammograms.

During screening, your breasts will be X-rayed one at a time. The breast is placed on the X-ray machine and gently but firmly compressed with a clear plate. Two X-rays are taken of each breast at different angles.

tags: Breast cancer screening, Breast cancer, Breast, cancer, screening, Breast screening, What happens during breast screening.