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 2 weeks.

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

Screening for cervical cancer

Cervical screening (also known as a smear test) is routinely offered to anyone with a cervix in Scotland, between the ages of 25 and 64, every 5 years. You may be recalled more often depending on your test results.

Those on non-routine screening (where screening results have shown changes that need further investigation or follow up) will be invited up to 70 years of age. 

If you have unusual discharge, or bleeding after sex, between periods or after the menopause, contact your GP practice. These symptoms are not usually caused my cancer but it's important to have them checked. 

You will 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.

Read more about cervical screening

What causes cervical cancer?

Almost all cases of cervical cancer are caused by the human papilloma virus (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 outlook. The staging, given as a number from 1 to 4, indicates how far the cancer has spread.

The chances of living for at least 5 years after being diagnosed with cervical cancer are:

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

Read more about the staging of cervical cancer

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.

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.

In almost all cases, cervical cancer is the result of a change in cell DNA caused by the human papilloma virus (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 papilloma virus (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 an HPV infection within 2 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 2 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.

See preventing cervical cancer for more information about reducing your chances of developing an HPV infection.

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.

Read more about cervical screening results

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 5 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 2 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.

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

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 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
• 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.

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

Read more about treating abnormal cells in the cervix

Surgery

There are 3 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.

There are 2 types of hysterectomies used to treat cervical cancer:

• 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 1 and some early stage 2 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. See complications of cervical cancer for more information about the menopause.

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
• 2 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 2 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 5 to 8 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 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 2 years, and then every 6 to 12 months for a further 3 years.

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 2 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.

The Macmillan Cancer Support website has more information about sexuality and cancer

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.

Read more about treating lymphoedema

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 is 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.

Read more about feelings and cancer

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 the 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.

Read more about treating deep vein thrombosis

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 2 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.

The impact of cervical cancer on your daily life will depend on the stage of cancer and the treatment you're having.

Many women with cervical cancer have a radical hysterectomy. This is a major operation that takes around 6 to 12 weeks to recover from. During this time, you need to avoid strenuous tasks and lifting, such as lifting children or heavy shopping bags.

You won't be able to drive for 3 to 8 weeks after the operation. Most women will also need 8 to 12 weeks off work to recover after having a radical hysterectomy.

Some of the treatments for cervical cancer can make you very tired, particularly chemotherapy and radiotherapy. Because of this, you may need to take a break from some of your normal activities for a while.

Don't be afraid to ask for practical help from family and friends if you need it. Practical help may also be available from your local authority. Ask your doctor or nurse about who to contact. 

Work

Having cervical cancer doesn't necessarily mean you'll have to give up work, although you may need quite a lot of time off. During treatment, you may not be able to carry on as you did before.

If you have cancer, you're covered by the Disability Discrimination Act. This means that your employer isn't allowed to discriminate against you because of your illness. They have a duty to make 'reasonable adjustments' to help you cope. Examples of these include:

• allowing you time off for treatment and medical appointments
• allowing flexibility with working hours, the tasks you have to perform, or your working environment

The definition of what's 'reasonable' depends on the situation, such as how much it would affect your employer's business, for example.

You should give your employer as much information as possible about how much time you'll need off and when. Speak to a member of your human resources department, if you have one. Your union or staff association representative can also give you advice.

If you're having difficulties with your employer, your union or local Citizens Advice Bureau may be able to help.

Macmillan Cancer Support also has more information and advice about work and cancer.

Money and benefits

If you have to reduce or stop work because of your cancer, you may find it difficult to cope financially. If you have cancer or you're caring for someone with cancer, you may be entitled to financial support. For example:

• if you have a job but can't work because of your illness, you're entitled to Statutory Sick Pay from your employer
• if you don't have a job and can't work because of your illness, you may be entitled to Employment and Support Allowance
• if you're caring for someone with cancer, you may be entitled to Carer's Allowance
• you may be eligible for other benefits if you have children living at home or you have a low household income

It's a good idea to find out what help is available as soon as possible. You could ask to speak to the social worker at your hospital, who can give you the information you need.

Your sex life

Many women feel nervous about having sex soon after treatment for cervical cancer, but it's perfectly safe. Sex won't make the cancer come back and your partner can't catch cancer from you.

If you want to, you can resume your normal sex life within a few weeks of finishing radiotherapy or having surgery. This will give your body time to heal.

If you're having chemotherapy, male partners should wear a condom when you have sex, because it's not clear if having sex after chemotherapy can have an effect on them.

Some women find sex difficult after being treated for cervical cancer, because the side effects of some treatments can include vaginal dryness and narrowing of the vagina. In these cases, there are treatments that can help, such as vaginal dilators. 

See complications of cervical cancer for more information

Macmillan Cancer Support has more information on how treatment for cervical cancer may affect your sex life.

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 1 sexual partner can also develop it.

Read more about sexual health

Cervical screening

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

Cervical screening (also known as a smear test) is routinely offered to anyone with a cervix in Scotland between the ages of 25 and 64 every 5 years.

You may be recalled more often depending on your test results.

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 2 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 to 13 years old, with 3 doses given over a 6-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, you could contact the Quit Your Way Scotland on 0800 84 84 84. Quit Your Way Scotland is run by NHS 24 and is staffed by trained advisors who'll be able to give you expert advice.

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.

For more information and advice on giving up smoking, see stopping smoking and treatments for stopping smoking.