THE CERVIX: CERVICAL CANCER AND CERVIX INCOMPETENCE
MY JOURNEY (SO FAR) OF CERVICAL CANCER CELL REMOVAL AND CERVIX INCOMPETENCE DURING PREGNANCY
One of my aims with Planet Mama in 2022 is to shed light on taboos and discuss topics that are quite often not talked about. So early in my pregnancy journey I made the decision to be transparent with my own journey, the ups, downs and everything in between.
If you have been following my story you might have seen that I had to go in for a cervical stitch at the end of last year, which resulted in me being on bed rest for almost 2 weeks. As a result I’ve had to completely surrender to my journey, abandon my dreams of an active and smooth pregnancy, and am having to take each week as it comes. But I’m lucky; my stitch is preventative rather than an emergency and unlike so many I’ve not had to experience the tragedy of loss before intervention was required.
This recommendation for a preventative cervical stitch came about most likely due to procedures I had on my cervix almost 20 years ago, to remove cervical cancer cells.
So, as this week is Cervical Cancer Prevention Week, I wanted to shed some light on cervical cancer cell removal and the impacts it can have on pregnancy. Plus highlight what we can do to support Cervical Cancer Prevention Week.
WHAT IS CERVICAL CANCER?
Cervical cancer is a cancer that’s found anywhere on the cervix. It’s usually very slow growing and it can often be prevented by cervical screening which aims to find the cells before they turn into cancer. Every year 220,000 women and people with a cervix are told they have cervical cell changes after their screening, and many more are given a HPV diagnosis. Which is why it’s so important to make sure you go to your smear tests, as uncomfortable as they are!
WHAT ARE THE SYMPTOMS OF CERVICAL CANCER?
Often there are no symptoms of cervical cancer. However, you should see your GP if you notice:
· Bleeding after sex
· Bleeding between periods
· Bleeding after the menopause
· Heavy discharge
· Pain during sex
And hopefully it can be caught before it turns cancerous.
PREVENTION IS BETTER THAN CURE
As cervical cancer is slow to develop, the best route of prevention is to make sure you keep up with your cervical screenings – AKA smear tests. It’s a free health test available on the NHS as part of the national cervical screening programme. It helps prevent cervical cancer by checking for a virus called high-risk HPV and cervical cell changes. It is not a test for cancer, but it shows cell changes that will likely lead to cancer if left untreated.
In the UK, you are automatically invited for cervical screening if you are:
· between the ages of 25 to 64
· registered as female with a GP surgery
If your cervical screening test shows you have any abnormal cell changes it’s likely (depending on the grade of changes) you’ll be invited for a colposcopy, where they’ll take a closer inspection of your cervix through a camera. You can find out more about a cervical screening and colposcopy here
TREATMENTS OF CELL REMOVAL
If your colposcopy shows that your cells are pre-cancerous your doctor will talk you through the options to remove the cells. These treatments include:
1. LLETZ: The most common treatment is LLETZ, which stands for ‘large loop excision of the transformation zone’. This treatment:
– involves removing the abnormal cells using a thin wire loop that’s heated with an electric current
– can be carried out at the same time as a colposcopy
– is usually done while you’re awake – local anaesthetic is injected into your cervix to numb it during the treatment
– does not usually need an overnight stay in hospital
2. CONE BIOPSY: This is less common and involves removing larger areas of tissue. This treatment:
– is a minor operation to cut out a cone-shaped piece of tissue containing the abnormal cells
– cannot be done at the same time as a colposcopy
– is usually done under general anaesthetic (when you’re asleep)
– may require an overnight stay in hospital
Both procedures are quite minor but work well to remove cancerous cells and eliminate the risk of cervical cancer. However, if the HPV virus is still present there is a chance the cells will start to change again, so you will be asked to come back for regular checks until the body naturally clears the virus.
THE IMPACT OF CERVICAL CELL REMOVAL ON PREGNANCY
Although the procedures to remove these pre-cancer cells are successful, the removal of the part of the cervix can have an impact on pregnancy and the ability to carry a baby to full term. And although the NHS do mention this as a minor risk, the evidence seems to be that this is more common than thought – especially for women who had cells removed a while ago, when the focus was on removing the pre-cancerous cells vs preserving the cervix. I have heard that nowadays surgeons are much more conservative when removing cells and careful not to damage the cervix for the reasons I’m going to explain.
Before pregnancy, your cervix is closed, long and firm, however during pregnancy, the cervix gradually softens and starts to shorten. When the cervix gets to a certain point, the body begins to think it’s ready to go into labour and the cervix begins to open or funnel. This usually happens at around 37 weeks, however if you’ve had treatment on your cervix or a compromised cervix, this can trick the body into thinking it’s ready for birth and lead to preterm labour and the loss of your baby in the second trimester. Devastating consequences.
In quite a few instances pregnant women have had to go through the trauma of loss, before realising that their cervix is compromised, which is why it’s so important to make sure you mention if you’ve had any treatments to your cervix at your booking appointment with your midwife.
It’s important to add though, that not all cervical cell removal leads to a compromised cervix, however it’s important to be honest about it as you will be closely monitored and your cervix will be screened, just in case your cervix shortens too much and too fast.
You can read more about this here.
WHAT IS CERVIC INCOMPETENCE?
Unfortunately, in medical jargon having a compromised cervix is labelled ‘Cervix incompetence’ – I’m sure you agree this is a horrible label. No one likes to be told they’re incompetent but being told that your cervix is incompetent is a whole other level! It can feel that your body has failed and is failing you. Like you have no trust in your body and it’s just not good enough.
So although, I believe a lot needs to be done around this labelling, the good news is a lot can be done to help strengthen the cervix and give your body the best chance at holding a baby full term.
There are really good treatments available now, including progesterone pessaries, however the one with the most success rate is the cervical cerclage, AKA the cervical stitch.
WHAT IS A CERVICAL STITCH?
There are a few different types of stitch, but they all involve inserting a stitch around the cervix to keep it from shortening too much and opening up too early. It’s usually done between 12 to 14 weeks of pregnancy though occasionally it is done in later stages, I had mine just over a month ago now.
The procedure takes place in an operating theatre, under a spinal anaesthetic which can be quite an ordeal in itself. Numb from the waist down, the stitch is usually inserted transvaginally, but in some instances it needs to be inserted transabdominally. The latter is quite rare.
All being well, the stitch is then removed at 36/37 weeks and in most instances your baby is delivered at full term.
The journey after a stitch varies between women, but you’re commonly monitored every few weeks to check that everything is ok. It’s common that you’re told to reduce exercise and to take it easy so to not tear the stitch or bring on labour – basically not to do anything to risk the baby.
This is a big step on from the traditionally recommended bed rest, however it’s a difficult and anxiety inducing time for many women and there is a certain amount of trust lost in the body. But as all the support groups say #trustthestitch! The success rate of the stitch is super high, with 90% of pregnancies going on to full term so the science is in its favour! However if you have had a stitch inserted or are being monitored I would recommend joining the Cervix Incompetence UK Facebook group, as it has lots of active people on the same pregnancy journey as you.
CERVICAL CANCER AWARENESS WEEK
So this is how the treatment of my cancerous cells has impacted my pregnancy journey, but all so far is well and I am learning to trust the stitch and surrender to a slower and softer pregnancy – a lesson in itself. I am sure however that having the cells removed saved my life. I had CN3 cells removed at 17, so if I had waited until getting my smear test until the recommended age of 24 it is likely it would have developed into Cervical Cancer, which would have had a great impact on my life and ability to have children. So although I’m writing this highlighting this potential complication, I fully endorse and support the need for cervical cancer screening.
Also, this week is #CervicalCancerPreventionWeek. Cervical screening can stop cervical cancer, but it isn’t always easy. If you have questions or need support with results then visit this amazing charity Jo’s Trust and see their support services here.
How you can support:
1) Raise awareness by talking about your cervical screening on social media
2) Share your experience of colposcopy or getting unexpected cervical screening results: what do you wish you had known and what would you say to someone feeling anxious about theirs?
Love Lettie x
MORE SUPPORT AND INFORMATION:
Information on cervical cancer, treatment and symptoms from the Teenage Cancer Trust.
Good resources for Cervical Cancer prevention Week here.
Information about pregnancy and abnormal cervical cells from Cancer Research.
Jo’s Cervical Cancer Trust is a very good resource for all things cervical cancer here.