Often in the news, cancer of the cervix is still a concern for the insurance sector, as Mary Randall explains.
Cervical erosion is a condition often found during a screening. However, it is not linked to cervical cancer and does not generally require any further treatment.
CIN stands for cervical intraepithelial neoplasia (cervical cell changes).
The following grades relate to the thickness of the skin covering the cervix that is affected. For example, CIN 1 means one-third of the thickness of the skin has abnormal cells, while CIN 3 means the full thickness is involved.
- CIN 1 – mild or slight cell changes, also known as low grade or mild dyskaryosis;
- CIN 2 – moderate cell changes or high grade/moderate dyskaryosis;
- CIN 3 – Severe cell changes or high grade/severe dyskaryosis.
Borderline changes or mild dyskaryosis often go back to normal by themselves. But if they don’t, or the changes are more severe, then closer investigation of the abnormal cells via a colposcopy (a magnifying tool) may be performed and a biopsy sometimes taken.
Carcinoma in Situ (CIS) – This means the cells appear cancerous but are contained within the skin layer covering the cervix and have not yet invaded into the tissue underneath. CIN 3 is sometimes called CIS. By removing the affected area quickly, invasive cancer can be prevented.
Like most other parts of the body, there are lymph nodes around the cervix and womb. If abnormal cells are not detected early and cancerous cells develop, the cancer can go on to spread to other organs of the body.
Treatment
The treatment for abnormalities is to remove or destroy the affected cells. Laser ablation and cryotherapy just treat the part of the cervix containing the abnormal cells and allows normal cells to grow back in their place.
However, when the abnormalities are severe, it may be necessary to remove the whole area containing the cells to prevent invasive cervical cancer from developing. This can be performed by Diathermy, LLETZ or loop excision, where an electrical current cuts away the tissue containing the abnormal cells.
A cone biopsy may also be carried out to either treat abnormal cells or to diagnose cervical cancer. Here, a cone-shaped wedge of tissue from the cervix, containing the whole area affected with abnormal cells is removed. A hysterectomy is usually performed only for persistent abnormalities or when the cell changes are severe and likely to develop into cervical cancer.
Stages of cervical cancer
The stage for pre-invasive cervical cancer; CINs and Carcinoma in Situ, is Stage 0 or Tis. There are four main stages when the abnormal cells have developed into cervical cancer.
Stage 1A and 1B – Stage 1 means the cancer has invaded only into the neck of the womb. 1A is split into 1A1 and 1A2 depending on the size of the growth. However, in both stages the growth is so small (less than 7mm wide) it can be seen only via a microscope or colposcope. In stage 1B the cancerous area is larger but still contained in the tissues of the cervix.
Stage 1 cervical cancer is usually treated with surgery or radiotherapy, or sometimes a combined chemotherapy and radiotherapy treatment, known as chemoradiation.
Stage 2A and 2B – In stage 2 the cancer has begun to spread outside the neck of the womb into surrounding tissue. 2A is where the cancer has spread down into the top of the vagina and in 2B the spread is into the tissues around the cervix.
Stage 3A and 3B – In stage 3 the cancer has invaded into other tissue and structures in the pelvic area. The growth may have spread to the lower part of the vagina, through the pelvic wall or blocking the ureters (tubes that drain the kidneys).
Stages 2 and 3 are usually treated by chemoradiation, as studies have shown there is a greater survival rate with this type of therapy.
Stage 4 – This is advanced cancer and means the cancerous cells have spread to other organs outside the cervix and womb. While surgery and chemoradiation can be given, palliative treatment may be the only option.
Symptoms
There are usually no signs to warn a woman that she may have abnormal or pre-cancerous cells. Symptoms often appear only once invasive cervical cancer has developed. That is why routine regular screening is so important.
The most common symptoms of cervical cancer include: bleeding between periods, after sexual intercourse or after the menopause. Some women may also have an unpleasant vaginal discharge or pain or discomfort during sex (dyspareunia).
Survival statistics
Since the UK introduced screening programmes in the 1960s, the number of deaths from cervical cancer has fallen significantly. It is estimated that 5,000 lives are saved by having regular smear tests each year.
Currently, for all women diagnosed with cervical cancer, the overall survival rate after five years is 67%, with 63% surviving more than 10 years after diagnosis. Younger women tend to have a greater survival rate than older women because the disease tends to be diagnosed at an earlier stage.
The survival rate for those with stage 1A cancer is almost 100%, falling to 80% for the larger 1B tumours. For stage 2 cancers, the survival rate after five years following treatment is still relatively high, at between 70% and 90%. As you would expect, for the more advanced stage 3 cancers the survival rate falls to between 30% and 50% and with stage 4 it is about 20%.
Underwriting considerations
Assessments for life cover will be based on the stage of the cancer and duration since diagnosis or completion of treatment. Pre-cancerous stages are generally accepted on standard terms as long as follow up screenings are undergone and remain normal.
For early cancers, stage 1, rated terms can usually be offered immediately following successful treatment, with standard terms being available after five or six years, if there has been no recurrence. More advanced stages will result in a postponement period and ratings may be applied for many years after the initial diagnosis.
Cover is not usually available for stage 4. Appropriate exclusions would be applied to critical/serious illness cover or in some instances the cover declined.
Mary Randell is underwriting training and development manager at VitalityLife (formerly PruProtect)
