What is cervical cancer?
Cervical cancer is the growth of abnormal cells in the lining of the cervix. The most common cervical cancer is squamous cell carcinoma, accounting for 80% of cases. Adenocarcinoma is less common and more difficult to diagnose because it starts higher in the cervix.
There were 898 new cases of cervical cancer diagnosed in Australia in 2014. The risk of a woman being diagnosed by age 85 is 1 in 167.
In 2016, there were 259 deaths caused by cervical cancer in Australia. Cervical cancer death rates in Australia have halved since the National Cervical Screening Program began in 1991.
The five year survival rate for cervical cancer is 73%.
Cervical cancer symptoms
Early changes in cervical cells rarely cause symptoms. If early cell changes develop into cervical cancer, the most common signs include:
- vaginal bleeding between periods
- menstrual bleeding that is longer or heavier than usual
- bleeding after intercourse
- pain during intercourse
- unusual vaginal discharge
- vaginal bleeding after menopause
- excessive tiredness
- leg pain or swelling
- low back pain.
These symptoms can be caused by other conditions but if you are worried or symptoms persist, contact you doctor.
Causes of cervical cancer
Almost all cases of cervical cancer are caused by persistent infection with some high-risk types of the human papillomavirus (HPV); this is the biggest risk factor for cervical cancer. The other main risk factor for cervical cancer is smoking.
Around eight out of 10 women will become infected with genital HPV at some time in their lives. Most women who have the HPV infection never get cervical cancer; only a few types of the HPV result in cervical cancer.
Women exposed to diethylstilbestrol (DES), an artificial form of female hormone oestrogen, in utero are at increased risk of cervical cancer.
Screening for cervical cancer
The Pap smear test has changed to the new Cervical Screening Test.
The incidence and mortality rates due to cervical cancer have halved in Australia since the introduction of the National Cervical Screening Program in 1991. The program offered a free Pap smear test every two years to women between the ages of 18 and 70.
As of 1 December 2017, the Pap smear test has been replaced with the new Cervical Screening Test. Under the new program, most women aged 25-74 will be tested every five years. If you have previously had a Pap smear test, you should have your first HPV test two years after your last Pap test. If you have a negative HPV result, you can wait five years before your next screening test. The changes recognise the introduction in 2006 of a vaccine against specific strains of the human papilloma virus (HPV). This will be part of the renewal of the National Cervical Screening Program. The new screening program is designed to work together with the HPV vaccination program, offered to teenage boys and girls, to help reduce the incidence of cervical cancer.
For further information on HPV and testing go to Cancer Council’s cervical screening website.
Information on the renewed program can be found on the Australian Government Department of Health’s screening website. Australia is set to be the first country to eliminate cervical cancer as a public health issue which is why it is so important to have the Cervical Screening Test.
To learn more about eliminating cervical cancer as a public health issue click here to watch the video.
Diagnosis for cervical cancer
If your screening test results suggest you have symptoms of cancer you will be referred to a specialist for further tests.
The usual tests to diagnose cervical cancer are:
A colposcopy identifies where abnormal cells are located in the cervix, and what they look like. A speculum is inserted into your vagina so that the doctor can view the cervix and vagina via a colposcope, an instrument that magnifies the area, like binoculars. It is not put inside your body.
Biopsy, cone biopsy or large loop excision of the transformation zone
A biopsy is when the doctor removes some tissue from the surface of the cervix and sends it to a laboratory for examination under a microscope. The biopsy may be done during the colposcopy.
LLETZ is the most common method to remove cervical tissue for examination and treating precancerous changes of the cervix. It is usually done under a local anaesthetic.
A cone biopsy is used where there are abnormal glandular cells in the cervix or if early-stage cancer is suspected.
Treatment for cervical cancer
If cervical cancer is detected, it will be ‘staged’, from stage 0, which means abnormal cells are found only in the surface layer of cells lining the cervix to stage IV, which means the cancer has spread to nearby organs such as the bladder or rectum or possibly other organs. This helps your doctors plan the best treatment for you.
Types of treatment
Treatment depends on disease stage. For early and non bulky disease (less than 4cm), treatment is surgery, sometimes with chemoradiotherapy afterwards.
If the tumour is small, a cone biopsy may suffice; in some cases hysterectomy (surgical removal of the uterus) is required.
For metastatic disease, the treatment is chemotherapy (platinum/fluorouracil) or palliative care alone.
In some cases of cervical cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.
As well as slowing the spread of cervical cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.
Initial test will be arranged by your GP who will also be part of your overall treatment team. Depending on your treatment, your treatment team may consist of a number of different specialist staff, such as:
- a gynaecologist
- a gynaecological oncologist
- a radiation oncologist
- a medical oncologist
- a cancer care coordinator
- a dietician
- other allied health professionals, such as a psychologist and physiotherapists.
Prognosis for cervical cancer
It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of cervical cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.
Cervical cancer can be effectively treated when it is found early. Most women with early cervical cancer will be cured.
Treatment for cervical cancer may make it more difficult, or impossible, to become pregnant. If fertility is important to you, talk to you doctor before treatment commences.
Preventing cervical cancer
A vaccine against specific types of HPV that cause almost all cervical cancers. The vaccines currently available in Australia are Gardasil and Cervarix. Through the National Immunisation Program, most girls in Australia will receive the HPV vaccine around the age of 12. Since 2013, boys have also been included in the National HPV Immunisation Program because the vaccine also helps prevent some HPV-related cancers and disease that affect men. Find out more about the HPV vaccine here.
Having the HPV vaccine does not mean that you should not have regular Cervical Cancer Screening Tests. If you have been vaccinated against HPV, you should have your first screening at age 25 and then every five years. For more information go to Cancer Council’s cervical screening page.