What is gallbladder cancer?

Gallbladder cancer is a cancer that’s found anywhere in the gallbladder.The gallbladder is a small organ in the top part of your tummy that helps you digest your food.Gallbladder cancer is often found when someone is having treatment for another condition, such as gallstones.How serious gallbladder cancer is depends on where it is in the gallbladder, how big it is, if it has spread and your general health.

Main symptoms of gallbladder cancer

Gallbladder cancer may not have any symptoms, or they might be hard to spot.

Symptoms of gallbladder cancer include:

  • your skin or the whites of your eyes turn yellow (jaundice), you may also have itchy skin, darker pee and paler poo than usual
  • loss of appetite or losing weight without trying to
  • a high temperature, or you feel hot or shivery
  • a lump in your tummy

Other symptoms can affect your digestion, such as:

  • feeling or being sick
  • aching pain in the right side of your tummy, sometimes described as a “dragging feeling”
  • sharp pain in your tummy
  • a very swollen tummy that is not related to when you eat

If you have another condition like irritable bowel syndrome you may get symptoms like these regularly.

You might find you get used to them. But it’s important to be checked by a GP if your symptoms change, get worse, or do not feel normal for you

Who is more likely to get gallbladder cancer

Anyone can get gallbladder cancer. It’s not always clear what causes it.

You might be more likely to get it if you:

  • are over the age of 75, it’s most common in people over 85
  • are a woman
  • have certain medical conditions, such as gallstones, growths (polyps) in your gallbladder, porcelain gallbladder, abnormal bile ducts, long-term swelling of the gallbladder or bile ducts, or diabetes
  • have a brother, sister or parent who had gallbladder cancer
  • have Latin American or Asian heritage

Many gallbladder cancers are linked to your lifestyle.

How to reduce your chance of getting gallbladder cancer

You cannot always prevent gallbladder cancer. But making healthy changes can lower your chances of getting it.

  • try to lose weight if you are overweight
  • try to cut down on alcohol – avoid drinking more than 14 units a week
  • try to quit smoking

You will need more tests and scans to check for gallbladder cancer if the GP refers you to a specialist.

These tests can include:

  • blood tests
  • scans, like an ultrasound scan (sometimes from inside your body using an endoscope), CT scan, PET scan, MRI scan, or a type of X-ray called a cholangiography
  • collecting a small sample of cells from the gallbladder (called a biopsy) to be checked for cancer
  • a small operation to look inside your tummy, called a laparoscopy
  • a test called an ERCP –

You may not have all these tests.

These tests can also help find problems in other nearby organs. Such as your bile ducts, pancreas or liver.

Getting your results

It can take several weeks to get the results of your tests.

Try not to worry if your results are taking a long time to get to you. It does not definitely mean anything is wrong.

You can call the hospital or GP if you are worried. They should be able to update you.

A specialist will explain what the results mean and what will happen next. You may want to bring someone with you for support.

If you’re told you have gallbladder cancer

Being told you have gallbladder cancer can feel overwhelming. You may be feeling anxious about what will happen next.

Gallbladder cancer is sometimes found when you are having an operation to remove your gallbladder.

This might be because you have another condition, such as gallstones.

You might have been having tests and scans after being referred to a specialist by a GP.

A group of specialists will look after you throughout your diagnosis, treatment and beyond.

Your team will include a clinical nurse specialist who will be your main point of contact during and after treatment.

You can ask them any questions you have.

Next steps

If you’re told you have gallbladder cancer, the specialists will use the results of some of the tests and scans to help find out the size of the cancer and how far it’s spread (called the stage).

You may need to have more tests done.

Find out more about what cancer stages and grades mean.

The specialists will use the results of these tests and work with you to decide on the best treatment plan for you.

Treatment for gallbladder cancer

Gallbladder cancer is often treatable, but it can be difficult to treat.

The treatment you have will depend on:

  • the size and type of gallbladder cancer you have
  • where it is
  • if it has spread
  • your general health

It may include surgery, chemotherapy and radiotherapy.

The specialist care team looking after you will:

  • explain the treatments, benefits and side effects
  • work with you to create a treatment plan that is best for you
  • help you manage any side effects, including changes to your diet to help you digest your food

You’ll have regular check-ups during and after any treatments. You may also have tests and scans.

If you have any symptoms or side effects that you are worried about, talk to your specialists. You do not need to wait for your next check-up.

Surgery

Your treatment will depend on if the cancer can be removed or not.

Surgery to remove gallbladder cancer

If gallbladder cancer is found early and it has not spread, you may be able to have surgery to remove it.

This will usually involve removing all of the gallbladder, as well as parts of other organs or lymph nodes around it. Lymph nodes are part of your body’s immune system.

Surgery to help control symptoms of gallbladder cancer

If the cancer has spread too far and cannot be removed, you may have surgery to help control some symptoms of gallbladder cancer.

This can include surgery to:

  • unblock the bile duct or stop it getting blocked, which helps with jaundice
  • bypass a blockage in the bile duct, this helps with jaundice and feeling or being sick

The aim of these operations is to help improve your symptoms, not to cure the cancer.

Chemotherapy

Chemotherapy uses medicines to kill cancer cells.

You may have chemotherapy for gallbladder cancer:

  • before surgery to help make the cancer smaller
  • after surgery to get rid of any remaining cancer and help stop the cancer coming back
  • to help make the cancer smaller, and control and improve the symptoms if you are not able to have surgery because you are very unwell, or the cancer cannot be removed by surgery

Radiotherapy

Radiotherapy uses high-energy rays of radiation to kill cancer cells.

Radiotherapy is not often used to treat gallbladder cancer. But you may have radiotherapy to help control and improve the symptoms of advanced cancer.

Eye cancer

Around 750 cases of eye cancer (ocular cancer) are diagnosed in the UK each year.

There are a number of different types of cancer that affect the eyes, including:

  • eye melanoma
  • squamous cell carcinoma
  • lymphoma
  • retinoblastoma – a childhood cancer

Cancer can also sometimes develop in the tissues surrounding your eyeball or spread to the eye from other parts of the body, such as the lungs or breasts.

This topic focuses on melanoma of the eye, one of the most common types of eye cancer. 

Symptoms of eye cancer

Eye cancer does not always cause obvious symptoms and may only be picked up during a routine eye test.

Symptoms of eye cancer can include:

  • shadows, flashes of light, or wiggly lines in your vision
  • blurred vision
  • a dark patch in your eye that’s getting bigger
  • partial or total loss of vision
  • bulging of 1 eye
  • a lump on your eyelid or in your eye that’s increasing in size
  • pain in or around your eye, although this is rare

These symptoms can also be caused by more minor eye conditions, so they’re not necessarily a sign of cancer.

But it’s important to get the symptoms checked by a doctor as soon as possible.

Melanoma of the eye

Melanoma is cancer that develops from pigment-producing cells called melanocytes.

Most melanomas develop in the skin, but it’s also possible for them to occur in other parts of the body, including the eye.

Eye melanoma most commonly affects the eyeball. Doctors sometimes call it uveal or choroidal melanoma, depending on exactly which part of your eye is affected.

It can also affect the conjunctiva (the thin layer that covers the front of the eye) or the eyelid.

What causes eye melanoma?

Eye melanoma occurs when the pigment-producing cells in the eyes divide and multiply too rapidly. This produces a lump of tissue known as a tumour.

It’s not clear exactly why this occurs, but the following factors may increase the risk of it happening:

  • lighter eye colour – if you have blue, grey or green eyes, you have a higher risk of developing eye melanoma compared with people who have brown eyes
  • white or pale skin – eye melanoma mostly affects white people and is more common in those with fair skin
  • unusual moles – if you have irregularly shaped or unusually coloured moles, you’re more at risk of developing skin cancer and eye melanoma
  • use of sunbeds – there’s some evidence to suggest that exposing yourself to ultraviolet (UV) radiation from sunbeds, for example, can increase your risk of eye melanoma
  • overexposure to sunlight – this increases your risk of skin cancer, and may also be a risk factor for eye melanoma

The risk of developing eye melanoma also increases with age, with most cases being diagnosed in people in their 50s.

Diagnosing melanoma of the eye

If your GP or optician (optometrist) suspects you have a serious problem with your eyes, they’ll refer you to a specialist eye doctor called an ophthalmologist for an assessment.

If they suspect you have melanoma of the eye, they’ll refer you to a specialist centre for eye cancer.

There are 4 centres in the UK, located in London, Sheffield, Liverpool and Glasgow.

It’s likely you’ll have a number of different tests at the centre, including:

  • an eye examination – to look at the structures of your eyes in more detail and check for abnormalities
  • an ultrasound scan of your eye – a small probe placed over your closed eye uses high-frequency sound waves to create an image of the inside of your eye; this allows your doctor to find out more about the position of the tumour and its size
  • a fluorescein angiogram – where photographs of the suspected cancer are taken using a special camera after dye has been injected into your bloodstream to highlight the tumour

Occasionally, a thin needle may be used to remove a small sample of cells from the tumour (biopsy). 

The genetic information in these cells is analysed to give an indication of the chances of the cancer spreading or coming back.

Treatments for eye melanoma

Treatment for melanoma of the eye depends on the size and location of the tumour.

Your care team will explain each treatment option in detail, including the benefits and any potential complications.

Treatment will aim to conserve the affected eye whenever possible.

The main treatments for eye melanoma are:

  • brachytherapy – tiny plates lined with radioactive material called plaques are inserted near the tumour and left in place for up to a week to kill the cancerous cells
  • external radiotherapy – a machine is used to carefully aim beams of radiation at the tumour to kill the cancerous cells
  • surgery to remove the tumour or part of the eye – this may be possible if the tumour is small and you still have some vision in your eye
  • removal of the eye (enucleation) – this may be necessary if the tumour is large or you have lost your vision; the eye will eventually be replaced with an artificial eye that matches your other eye

Chemotherapy is rarely used for eye melanoma, but may be suitable for other types of eye cancer.

The Cancer Research UK website has more information about the treatment options for eye cancer and the types of eye cancer surgery.

Outlook for eye melanoma

The outlook for melanoma of the eye depends on how big the cancer is at the time it’s diagnosed and exactly which parts of the eye are affected.

Overall:

  • about 8 out of every 10 people (80%) diagnosed with a small eye melanoma will live for at least 5 years after diagnosis
  • about 7 out of every 10 people (70%) diagnosed with a medium-sized eye melanoma will live for at least 5 years after diagnosis
  • about 5 out of every 10 people (50%) diagnosed with a large eye melanoma will live for at least 5 years after diagnosis

Ewing sarcoma

Ewing sarcoma is a rare type of cancer that affects bones or the tissue around bones.

It mainly affects children and young people, but is also seen in adults. It’s more common in males than females.

Symptoms of Ewing sarcoma

Symptoms include:

  • bone pain – this may get worse over time and may be worse at night
  • a tender lump or swelling
  • a high temperature that does not go away
  • feeling tired all the time
  • unintentional weight loss

Affected bones may also be weaker and more likely to break. Some people are diagnosed after they have a fracture.

The legs (often around the knee), pelvis, arms, ribs and spine are the main areas affected by Ewing sarcoma.

Tests for Ewing sarcoma

Ewing sarcoma can be difficult to diagnose because it’s quite rare and the symptoms can be similar to lots of other conditions.

Several tests may be needed to diagnose the cancer and see where it is in the body.

These tests may include:

  • an X-ray
  • blood tests
  • an MRI scan, a CT scan or a PET scan
  • a bone scan – after having an injection of a slightly radioactive substance that makes the bones show up clearly
  • a bone biopsy, where a small sample of bone is removed so it can be checked for signs of cancer and certain genetic changes associated with Ewing sarcoma

Treatments for Ewing sarcoma

Treatment for Ewing sarcoma often involves a combination of:

  • radiotherapy – where radiation is used to kill cancer cells
  • chemotherapy – where medicine is used to kill cancer cells
  • surgery to remove the cancer

As Ewing sarcoma is rare and the treatment complicated, you should be treated by a specialist team. They’ll recommend a treatment plan based on where the cancer is and its size.

Talk to your care team about why they’ve suggested the treatment plan, and ask them to go over the benefits and any risks involved. You may also want to discuss what care you might need afterwards.

Radiotherapy

Radiotherapy is often used to treat Ewing sarcoma before and after surgery, or it may be used instead of surgery if the cancer cannot be removed safely.

Chemotherapy

Most people with Ewing sarcoma have chemotherapy to shrink the cancer and then surgery to remove as much of it as possible. This is often followed by further chemotherapy to kill any leftover cancer cells.

Surgery

If Ewing sarcoma affects your bones, you’ll need surgery at a specialist bone cancer centre.

There are 3 main types of surgery for Ewing sarcoma. Surgery can be used to remove:

  • the affected bone or tissue – this is called a resection
  • the bit of bone containing cancer and replacing it with a piece of metal or bone taken from another part of the body – this is called limb-sparing surgery
  • all or part of an arm or leg – this is called an amputation

If you have an arm or leg amputated, you may need a prosthetic limb and support to help you regain the use of the affected limb.

Outlook for Ewing sarcoma

Ewing sarcoma can spread to other parts of the body quite quickly. The earlier it’s diagnosed, the better the chance of treatment being successful.

It can sometimes be cured, but this might not be possible if the cancer has spread.

The cancer can also come back after treatment, so you’ll be offered regular check-ups to look for any signs of this. Some people need treatment for many years.

Around 6 out of 10 people with Ewing sarcoma live at least 5 years after being diagnosed. But this can vary and some people live much longer.

Speak to your care team about the chances of your treatment being successful.

Womb (uterus) cancer

Cancer of the womb (uterine or endometrial cancer) is a common cancer that affects the female reproductive system. It’s more common in women who have been through the menopause.

Symptoms of womb cancer

The most common symptom of womb cancer is vaginal bleeding that is unusual for you (abnormal).

If you’ve been through the menopause, any vaginal bleeding is considered abnormal.

If you have not yet been through the menopause, abnormal bleeding may include very heavy periods or bleeding between your periods.

When to see a GP

See your GP as soon as possible if you experience any unusual vaginal bleeding. While it’s unlikely to be caused by womb cancer, it’s best to be sure.

Your GP will ask about your symptoms and offer an internal examination. They will refer you to a specialist if necessary for further tests to rule out any serious problem.

Types of womb cancer

Most womb cancers begin in the cells that make up the lining of the womb (the endometrium). This is why cancer of the womb is often called endometrial cancer.

In rare cases, womb cancer can start in the muscle wall of the womb. This type of cancer is called uterine sarcoma and may be treated in a different way. Read more about soft tissue sarcomas.

Womb cancer is separate from other cancers of the female reproductive system, such as ovarian cancer and cervical cancer.

Why does womb cancer happen?

It’s not clear exactly what causes womb cancer, but certain things can increase your risk of developing it.

One of the main risk factors for womb cancer is higher levels of a hormone called oestrogen in your body.

A number of things can cause your oestrogen levels to be high, including obesity. There is also a small increase in the risk of womb cancer with long-term use of the breast cancer drug tamoxifen.

It’s not always possible to prevent womb cancer, but some things are thought to reduce your risk. This includes maintaining a healthy weight and the long-term use of some types of contraception.

Treating womb cancer

The most common treatment for womb cancer is the surgical removal of the womb (hysterectomy).

A hysterectomy can cure womb cancer in its early stages, but you will no longer be able to get pregnant. Surgery for womb cancer is also likely to include the removal of the ovaries and fallopian tubes.

Radiotherapy or chemotherapy are also sometimes given too.

A type of hormone therapy (progestogen) may be used if you have not yet been through the menopause and would still like to have children.

Even if your cancer is advanced and the chances of a cure are small, treatment can still help to relieve symptoms and prolong your life.

Living with womb cancer

Living with cancer is challenging, and womb cancer can affect your life in specific ways.

For example, your sex life may be affected if you have a hysterectomy, especially if your ovaries are removed. You may find it physically more difficult to have sex and also have a reduced sex drive.

You may find it beneficial to talk to other people about your condition, including family members, your partner or other people with womb cancer.

Neuroendocrine tumours and carcinoid syndrome

Neuroendocrine tumours (NETs) are rare tumours of the neuroendocrine system, the system in the body that produces hormones. They can be cancerous or non-cancerous.

The tumour usually grows in the bowels or appendix, but it can also be found in the stomach, pancreas, lung, breast, kidney, ovaries or testicles. It tends to grow very slowly.

Neuroendocrine tumours are sometimes referred to as carcinoid tumours, particularly when they affect the small bowel, large bowel or appendix.

Carcinoid syndrome is the collection of symptoms some people get when a neuroendocrine tumour, usually one that has spread to the liver, releases hormones such as serotonin into the bloodstream.

About 2,900 people are diagnosed with a neuroendocrine tumour each year in the UK, but not everyone with a tumour will have carcinoid syndrome.

Signs and symptoms

In the early stages of having a neuroendocrine tumour, you may not have any symptoms.

You may also not have symptoms if the tumour is just in your digestive system, as any hormones it produces will be broken down by your liver.

If symptoms do develop, they tend to be fairly general and can be easily mistaken for signs of other illnesses.

Symptoms may result from both the tumour itself and from any hormones it releases into the bloodstream.

Symptoms caused by the tumour

Symptoms will depend on where in the body the tumour develops:

  • a tumour in the bowel may cause tummy pain, a blocked bowel (diarrhoea, constipation, feeling sick or being sick) and bleeding from the bottom (rectal bleeding)
  • a tumour in the lung may cause a cough, which may make you cough up blood, and cause wheezing, shortness of breath, chest pain and tiredness
  • a tumour in the stomach may cause pain, weight loss, tiredness and weakness

Some tumours may not cause any symptoms and are discovered by chance.

For example, a tumour in the appendix may only be found when the appendix is being removed for another reason.

Symptoms caused by the hormones (carcinoid syndrome)

Typical symptoms of carcinoid syndrome include:

  • diarrhoea, tummy pain and loss of appetite
  • flushing of the skin, particularly the face
  • fast heart rate
  • breathlessness and wheezing

These symptoms may come on unexpectedly, as the hormones can be produced by the tumour at any time.

Some people may also develop carcinoid heart disease, where the heart valves thicken and stop working properly.

There’s also a risk of developing a rare but serious reaction called a carcinoid crisis, which involves severe flushing, breathlessness and a drop in blood pressure.

What causes neuroendocrine tumours?

It’s not known exactly why neuroendocrine tumours develop, but it’s thought that most occur by chance.

Your chances of developing a neuroendocrine tumour may be increased if you have:

  • a rare family syndrome called multiple endocrine neoplasia type 1 (MEN1)
  • parents or siblings (brothers or sisters) with a carcinoid tumour
  • parents with non-Hodgkin lymphoma or cancer of the brain, breast, liver, bladder or endocrine system
  • conditions called neurofibromatosis or tuberous sclerosis

You can read more about the risks and causes of neuroendocrine tumours on the Cancer Research UK website.

Diagnosing neuroendocrine tumours

A neuroendocrine tumour may be found incidentally – for example, as a surgeon is removing an appendix.

In this case, the tumour will often be caught early and removed along with the appendix, causing no further problems.

Otherwise, people usually see their GP after they have developed symptoms.

A neuroendocrine tumour may be diagnosed after carrying out a series of scans and tests, which may include measuring the amount of serotonin in your urine and having an endoscopy.

Treating neuroendocrine tumours and carcinoid syndrome

If the tumour is caught early, it may be possible to completely remove it and cure the cancer altogether.

Otherwise, surgeons will remove as much of the tumour as possible (debulking).

You can read more about the surgery for neuroendocrine tumours on the Cancer Research UK website.

If the tumour can’t be removed, but it’s not growing or causing symptoms, you may not need treatment straight away – it might just be carefully monitored. 

If it’s causing symptoms, you may be offered one of the following treatments:

  • injections of medicines called somatostatin analogues, such as octreotide and lanreotide, which can slow down the growth of the tumour
  • radiotherapy to kill some of the cancer cells 
  • a procedure to block the blood supply to the tumour (for tumours in the liver), known as hepatic artery embolisation
  • a procedure that uses a heated probe to kill cancer cells (for tumours in the liver), called radiofrequency ablation
  • chemotherapy to shrink the tumour and control your symptoms

Symptoms of carcinoid syndrome can be treated with injections of octreotide and lanreotide. 

You may also be given medication to widen your airways (to relieve wheezing and breathlessness) and anti-diarrhoea medication.

What can I do to help myself?

There are things you can do yourself to manage some of the symptoms of carcinoid syndrome.

Generally, you should avoid triggers of flushing, such as:

  • alcohol
  • large meals
  • spicy foods
  • foods containing the substance tyramine, such as aged cheese and salted or pickled meats
  • stress

Some medications, such as selective serotonin reuptake inhibitor (SSRI) antidepressants, may make symptoms worse by further increasing your levels of serotonin.

But never stop taking medication without seeking medical advice.

If you have diarrhoea, it’s important to keep drinking little and often to avoid dehydration.

Outlook

If the whole tumour can be removed, this may cure the cancer and symptoms altogether.

But even if surgeons can’t remove the entire tumour, it usually grows slowly and can be controlled with medication.

Overall, people with neuroendocrine tumours have a good life expectancy compared with many other cancers. Many people remain relatively well and lead active lives, with only occasional symptoms.

But as the tumour grows or spreads, it will produce more and more hormones, and it may eventually be difficult to completely control symptoms with medication. You may need further surgery or other treatments.

Unfortunately, life expectancy isn’t as good for a cancerous tumour that’s spread to other parts of your body because it won’t usually be possible to remove all of it. But treatment can still control your symptoms and slow down the spread of cancer.

Bone cancer

Primary bone cancer is a rare type of cancer that begins in the bones. Around 550 new cases are diagnosed each year in the UK.

Signs and symptoms of bone cancer

Bone cancer can affect any bone, but most cases develop in the long bones of the legs or upper arms.

The main symptoms include:

  • persistent bone pain that gets worse over time and continues into the night
  • swelling and redness (inflammation) over a bone, which can make movement difficult if the affected bone is near a joint
  • a noticeable lump over a bone
  • a weak bone that breaks (fractures) more easily than normal

If you or your child are experiencing persistent, severe or worsening bone pain, visit your GP. While it’s highly unlikely to be the result of bone cancer, it does require further investigation.

Types of bone cancer

Some of the main types of bone cancer are:

  • osteosarcoma – the most common type, which mostly affects children and young adults under 20
  • Ewing sarcoma – which most commonly affects people aged between 10 and 20
  • chondrosarcoma – which tends to affect adults aged over 40

Young people can be affected because the rapid growth spurts that occur during puberty may make bone tumours develop.

The above types of bone cancer affect different types of cell. The treatment and outlook will depend on the type of bone cancer you have.

What causes bone cancer?

In most cases, it’s not known why a person develops bone cancer.

You’re more at risk of developing it if you:

  • have had previous exposure to radiation during radiotherapy
  • have a condition known as Paget’s disease of the bone – however, only a very small number of people with Paget’s disease will actually develop bone cancer
  • have a rare genetic condition called Li-Fraumeni syndrome – people with this condition have a faulty version of a gene that normally helps stop the growth of cancerous cells

How bone cancer is treated

Treatment for bone cancer depends on the type of bone cancer you have and how far it has spread.

Most people have a combination of:

  • surgery to remove the section of cancerous bone – it’s often possible to reconstruct or replace the bone that’s been removed, but amputation is sometimes necessary
  • chemotherapy – treatment with powerful cancer-killing medication
  • radiotherapy – where radiation is used to destroy cancerous cells

In some cases of osteosarcoma, a medication called mifamurtide may also be recommended.

Read more about treating bone cancer.

Outlook

The outlook for bone cancer depends on factors such as your age, the type of bone cancer you have, how far the cancer has spread (the stage), and how likely it is to spread further (the grade).

Generally, bone cancer is much easier to cure in otherwise healthy people whose cancer hasn’t spread.

Overall, around 6 in every 10 people with bone cancer will live for at least 5 years from the time of their diagnosis, and many of these may be cured completely.

Bone pain is the most common symptom of bone cancer. Some people experience other symptoms as well.

Bone pain

Pain caused by bone cancer usually begins with a feeling of tenderness in the affected bone. This gradually progresses to a persistent ache or an ache that comes and goes, which continues at night and when resting.

Any bone can be affected, although bone cancer most often develops in the long bones of the legs or upper arms.

The pain can sometimes be wrongly mistaken for arthritis in adults and growing pains in children and teenagers.

Other symptoms

Some people also experience swelling and redness (inflammation) or notice a lump on or around the affected bone. If the bone is near a joint, the swelling may make it difficult to use the joint.

In some cases, the cancer can weaken a bone, causing it to break (fracture) easily after a minor injury or fall.

Less common symptoms can include:

  • a high temperature (fever) of 38C (100.4F) or above
  • unexplained weight loss
  • sweating, particularly at night

When to seek medical advice

See your GP if you or your child experiences persistent, severe or worsening bone pain, or if you’re worried about any of the symptoms mentioned above.

While it’s highly unlikely that your symptoms are caused by cancer, it’s best to be sure by getting a proper diagnosis.

Cervical cancer

Cervical cancer develops in a woman’s cervix (the entrance to the womb from the vagina). It mainly affects sexually active women aged between 30 and 45.

Symptoms of cervical cancer

Cancer of the cervix often has no symptoms in its early stages.

If you do have symptoms, the most common is abnormal vaginal bleeding, which can occur during or after sex, in between periods, or new bleeding after you have been through the menopause.

Abnormal bleeding does not mean you have cervical cancer, but you should see a GP as soon as possible to get it checked out.

If a GP thinks you might have cervical cancer, you should be referred to see a specialist within 2 weeks.

Screening for cervical cancer

The best way to protect yourself from cervical cancer is by attending cervical screening (previously known as a “smear test”) when invited.

The NHS Cervical Screening Programme invites all women from the age of 25 to 64 to attend cervical screening.

Women aged 25 to 49 are offered screening every 3 years, and those aged 50 to 64 are offered screening every 5 years.

During cervical screening, a small sample of cells is taken from the cervix and checked under a microscope for abnormalities.

In some areas, the screening sample is first checked for human papillomavirus (HPV), the virus that can cause abnormal cells.

An abnormal cervical screening test result does not mean you definitely have cancer.

Most abnormal results are due to signs of HPV, the presence of treatable precancerous cells, or both, rather than cancer itself.

You should be sent a letter confirming when it’s time for your screening appointment. Contact a GP if you think you may be overdue.

What causes cervical cancer?

Almost all cases of cervical cancer are caused by 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 types of HPV, many of which are harmless. But some types can cause abnormal changes to the cells of the cervix, which can eventually lead to cervical cancer.

Two strains, HPV 16 and HPV 18, are known to be responsible for most cases of cervical cancer.

They do not have any symptoms, so women will not realise they have it.

But these infections are very common and most women who have them do not develop cervical cancer.

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

The HPV vaccine has been routinely offered to girls aged 12 and 13 since 2008.

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 another option for some women with early-stage cervical cancer.

In some cases, it’s used alongside surgery or chemotherapy, or both.

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

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

Complications

Some women with cervical cancer may develop complications.

These can arise as a direct result of the cancer or as a side effect of treatments like radiotherapy, chemotherapy and surgery.

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

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

This is why it’s very important to you attend all your cervical screening appointments.

Unusual bleeding

In most cases, abnormal vaginal bleeding is the first noticeable symptom of cervical cancer.

This includes bleeding:

  • during or after sex
  • between your periods
  • after you have been through the menopause

Visit your GP for advice if you experience any type of abnormal vaginal bleeding.

Other symptoms

Other symptoms of cervical cancer may include pain and discomfort during sex, unusual or unpleasant vaginal discharge, and pain in your lower back or pelvis.

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:

  • pain in your lower back or pelvis
  • severe pain in your side or back caused by your kidneys
  • constipation
  • peeing or pooing more often than normal
  • losing control of your bladder (urinary incontinence) or losing control of your bowels (bowel incontinence)
  • blood in your pee
  • swelling of one or both legs
  • severe vaginal bleeding

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 does not necessarily mean you have cervical cancer. However, unusual vaginal bleeding needs to be investigated by your GP.

Almost all cases of cervical cancer are caused by the human papillomavirus (HPV).

Human papillomavirus (HPV)

Almost all 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 very common.

Most women will get some type of HPV infection at some point in their lives.

Some types of HPV do not cause any noticeable symptoms and the infection will pass without treatment.

Others can cause genital warts, although these types are not linked to an increased risk of cervical cancer.

But at least 15 types of HPV are considered high-risk for cervical cancer. The 2 highest risk are HPV 16 and HPV 18, which cause the majority of cervical cancers.

High-risk types of HPV are thought to stop the cells working normally, which can eventually cause them to reproduce uncontrollably, leading to the growth of a cancerous tumour.

As most types of HPV do not 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.

Pre-cancerous cervical abnormalities

Cancer of the cervix usually takes many years to develop. Before it does, the cells in the cervix often show changes.

These cervical abnormalities are known as cervical intraepithelial neoplasia (CIN) or, less commonly, cervical glandular intraepithelial neoplasia (CGIN) depending on which cells are affected.

CIN and CGIN are pre-cancerous conditions. Pre-cancerous conditions do not pose an immediate threat to a person’s health. But if they’re not checked and treated, they can potentially develop into cancer.

However, even if you develop CIN or CGIN, the chances of them turning into cervical cancer are very small.

And if the changes are discovered during cervical screening, treatment is highly successful.

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

Increased risk

HPV infection being very common but cervical cancer 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 those who do not smoke; this may be because of the harmful effects of chemicals found in tobacco on the cells of the cervix
  • having a weakened immune system
  • taking the oral contraceptive pill for more than 5 years – this risk is not well understood
  • having more than 5 children, or having them at an early age (under 17 years old)
  • your mother taking the hormonal drug diethylstilbestrol (DES) while pregnant with you – your GP can discuss these risks with you

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.

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

Colposcopy

If you’ve had an abnormal cervical screening test result, or any symptoms of cervical cancer, you will usually be referred for a colposcopy. This is an examination to look for abnormalities in your cervix. It’s norm6ally done by a nurse called a colposcopist.

If you have had abnormal bleeding, your GP may first recommend a chlamydia test before being referred for a colposcopy.

The colposcopist will use a device called a speculum to open your vagina, just like they do during cervical screening. A small microscope with a light at the end (a colposcope) will be used to look at your cervix. This microscope stays outside your body.

As well as examining your cervix, they may remove a small tissue sample (biopsy) so it can be checked for cancerous cells. After a biopsy, you may have some vaginal bleeding for up to 6 weeks. You may also have period-like pains.

In most cases, the abnormalities do not mean you have cervical cancer, but you may be referred to a gynaecologist for further tests.

Treatment to remove abnormal cells can sometimes be done at the same time as a colposcopy.

Further testing

If the results of the colposcopy or biopsy suggest you have cervical cancer and there’s a risk it 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 done under general anaesthetic (while you’re asleep) – your womb, vagina, rectum and bladder will be checked for cancer
  • blood tests – to help assess the state of your liver, kidneys and bone marrow
  • a CT scan – used to help identify cancerous tumours and show whether cancerous cells have spread
  • an MRI scan – also used to check whether the cancer has spread
  • a chest X-ray – to check if the cancer has spread to the lungs
  • a PET scan – often combined with a CT scan to see if the cancer has spread, or to check how well a person is responding to treatment

Staging 

Staging is a measurement of how far the cancer has spread.

After all the tests have been completed and the results are known, it should be possible to tell what stage the cancer is. The higher the stage, the further the cancer has spread.

The staging for cervical cancer is:

  • stage 0 – no cancerous cells in the cervix, but there are abnormal cells that could develop into cancer in the future – this is called pre-cancer or carcinoma in situ
  • stage 1 – the cancer is only inside the cervix
  • stage 2 – the cancer has spread outside 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 or 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:

  • for early cervical cancer – surgery to remove the cervix and some or all of the womb, or radiotherapy, or a combination of both
  • for advanced cervical cancer – radiotherapy with or without chemotherapy, and surgery is also sometimes used

Cervical cancer is often curable if it’s diagnosed at an early stage.

When cervical cancer is not 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 in the following sections.

Removing very early cancer

Large loop excision of the transformation zone (LLETZ)

This is where the cancerous cells are removed using a fine wire and an electrical current.

It’s usually done under local anaesthetic (while you’re awake but the area is numbed) and can be done at the same time as a colposcopy.

Cone biopsy

A cone-shaped area of abnormal tissue is removed during surgery. This is usually done under general anaesthetic (while you’re asleep).

Surgery

There are 3 main types of surgery for cervical cancer:

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

Pelvic exenteration is only offered when cervical cancer has come back.

Trachelectomy

A trachelectomy is usually only suitable if cervical cancer is diagnosed at a very early stage. It’s usually offered to women who want to have children in the future.

During the procedure, the cervix and upper section of the vagina are removed, leaving the womb in place. Your womb will then be reattached to the lower section of your vagina.

It’s usually done by keyhole surgery.

Lymph nodes (part of the lymphatic system, the body’s waste-removal system) from your pelvis may also be removed.

Compared with a hysterectomy or pelvic exenteration, the advantage of this type of surgery is that your womb remains in place. This means you may still be able to have children.

However, it’s important to be aware that the surgeons carrying out this operation cannot guarantee you will still be able to have children.

A stitch will be put in the bottom of your womb during the surgery. This is to help support and keep a baby in your womb in future pregnancies. If you do get pregnant after the operation, your baby will have to be delivered by caesarean section.

It’s also usually recommended you wait 6 to 12 months after surgery before trying for a baby so your womb and vagina have time to heal.

Trachelectomy is a highly skilled procedure. It’s only available at certain specialist centres in the UK, so it may not be offered in your area and you may need to travel to another city for treatment.

What is bile duct cancer?

Bile duct cancer, also called cholangiocarcinoma, is a cancer that’s found anywhere in the bile ducts.The bile ducts are small tubes that connect different organs. They are part of the digestive system.How serious bile duct cancer is depends on where it is in the bile ducts, how big it is, if it has spread and your general health.

Main symptoms of bile duct cancer

Bile duct cancer may not have any symptoms, or they can be hard to spot.

Symptoms of bile duct cancer can include:

  • your skin or the whites of your eyes turn yellow (jaundice), you may also have itchy skin, darker pee and paler poo than usual
  • loss of appetite or losing weight without trying to
  • feeling generally unwell
  • feeling tired or having no energy
  • a high temperature, or you feel hot or shivery

Other symptoms can affect your tummy, such as:

  • feeling or being sick
  • pain in your tummy

Who is more likely to get bile duct cancer

Anyone can get bile duct cancer. It’s not always clear what causes it.

You might be more likely to get it if you:

  • are over the age of 65
  • have certain medical conditions, such as abnormal bile ducts, long term swelling in the bowel (ulcerative colitis) or bile ducts, a parasite in the liver (liver flukes), bile duct stones and liver cirrhosis

Information:

It’s important to get any symptoms of bile duct cancer checked by a GP.

Anyone can get bile duct cancer, even if you do not think you have a higher chance of getting it.

You will need more tests and scans to check for bile duct cancer if the GP refers you to a specialist.

These tests can include:

  • blood tests
  • scans, like an ultrasound scan (sometimes from inside your body using an endoscope), CT scan, or MRI scan
  • collecting a small sample of cells from the bile ducts (called a biopsy) to be checked for cancer
  • a test called an ERCP
  • a special kind of X-ray called PTC

You may not have all these tests.

These tests can also help find problems in other nearby organs. Such as your pancreas, gallbladder or liver.

Getting your results

It can take several weeks to get the results of your tests.

Try not to worry if your results are taking a long time to get to you. It does not definitely mean anything is wrong.

You can call the hospital or GP if you are worried. They should be able to update you.

A specialist will explain what the results mean and what will happen next. You may want to bring someone with you for support.

If you’re told you have bile duct cancer

Being told you have bile duct cancer can feel overwhelming. You may be feeling anxious about what will happen next.

It can help to bring someone with you to any appointments you have.

A group of specialists will look after you throughout your diagnosis, treatment and beyond.

Your team will include a clinical nurse specialist who will be your main point of contact during and after treatment.

You can ask them any questions you have.

If you’ve been told you have bile duct cancer, you may need more tests.

These, along with the tests you’ve had already, will help the specialists find out the size of the cancer and how far it’s spread (called the stage).

Find out more about what cancer stages and grades mean.

You may need:

  • a PET scan, sometimes with a CT scan (PET-CT)
  • a small operation to look inside your tummy, called a laparoscopy

The specialists will use the results of these tests and work with you to decide on the best treatment plan for you.

Treatment for bile duct cancer

Bile duct cancer is often treatable. But it can be difficult to treat.

The treatment you have will depend on:

  • the size and type of bile duct cancer you have
  • where it is
  • if it has spread
  • your general health

It may include surgery, chemotherapy and radiotherapy.

The specialist care team looking after you will:

  • explain the treatments, benefits and side effects
  • work with you to create a treatment plan that is best for you
  • help you manage any side effects, including changes to your diet to help with your digestion

You’ll have regular check-ups during and after any treatments. You may also have tests and scans.

If you have any symptoms or side effects that you are worried about, talk to your specialists. You do not need to wait for your next check-up.

Surgery

Your treatment will depend on if the cancer can be removed or not.

Surgery to remove bile duct cancer

If bile duct cancer is found early and it has not spread, you should be able to have surgery to remove it.

This will usually involve removing all or parts of the bile duct, as well as parts of other organs or lymph nodes around it. Lymph nodes are part of your body’s immune system.

Surgery to help control symptoms of bile duct cancer

If the cancer has spread too far and cannot be removed, you may have surgery to help control some symptoms of bile duct cancer.

This can include surgery to:

  • unblock the bile duct or stop it getting blocked, which helps with jaundice
  • unblock the first part of the small intestine or stop it getting blocked, which helps with feeling or being sick
  • bypass a blockage in the bile duct or small intestine, which helps with jaundice and feeling or being sick

The aim of these operations is to help improve your symptoms and help you live longer, not to cure the cancer.