What is cervical cancer?

Cervical cancer begins when abnormal cells in the lining of the cervix grow uncontrollably.

Cancer most commonly starts in the area of the cervix called the transformation zone, but it may spread to tissues around the cervix, such as the vagina, or to other parts of the body, such as the lymph nodes, lungs or liver.

Types of cervical cancer

There are two main types of cervical cancer which are named after the cells they start in:

• Squamous cell carcinoma – The most common type of cervical cancer, accounting for 7 out of 10 cases (70%)
• Adenocarcinoma – A less common type, starts in the glandular cells of the cervix. Adenocarcinoma is more difficult to diagnose because it occurs higher up in the cervix and the abnormal glandular cells are harder to find.

How common is cervical cancer?

About 200 women in Queensland are diagnosed with cervical cancer every year. Cervical cancer is most commonly diagnosed in women over 30, but can occur at any age. The incidence of cervical cancer in Australia has decreased significantly since a national screening programme was introduced in the 1990s. The introduction of national HPV vaccination program in 2007 and improvements to the screening program in 2017 are expected to further reduce rates of cervical cancer.

Risk factors

Almost all cases of cervical cancer are caused by an infection called human papillomavirus (HPV). HPV is a common infection that affects the surface of different areas of the body, such as the cervix, vagina and skin.

There are also other known risk factors:

• Smoking and passive smoking – chemicals in tobacco can damage the cells of the cervix, making cancer more likely to develop in women with HPV.
• Using oral contraceptive (the pill) for a long time – research has shown that taking the pill for five years or more increases the risk of developing cervical cancer in people with HPV. The reason for this is not clear. However, the risk is small and the pill can also help protect against other types of cancer, such as uterine and ovarian cancers. Talk to your doctor if you are concerned
• Having a weakened immune system – the immune system helps rid the body of HPV. Women with a weakened immune system have an increased risk of developing cervical cancer and will need to have more frequent cervical screening tests. This includes women with the human immunodeficiency virus (HIV) and women who take medicines that lower their immunity. Ask your doctor if this applies to you and how often you should have a screening test.
• Exposure to diethylstilboestrol (DES) – this is a manufactured form of the female hormone oestrogen. DES was prescribed to pregnant women from the 1940’s to the early 1970’s to prevent miscarriage. Studies have shown that women exposed to DES because their mother took it when pregnant have a small but increased risk of developing a clear cell adenocarcinoma, a rare type of cervical cancer.

Symptoms

In the early stages, cervical cancer usually has no symptoms. The only way to know if there are abnormal cells in the cervix, which may develop into cervical cancer, is to have a cervical screening test.

If symptoms occur, they usually include:

• Vaginal bleeding between periods, after menopause or during or after sexual intercourse
• Pelvic pain
• Pain during sexual intercourse
• An unusual vaginal discharge
• Heavier periods or periods that last longer than usual

Although these symptoms can also be caused by other conditions, it is very important to rule out cervical cancer. See your general practitioner (GP) if you are worried or the symptoms are ongoing. This is important for anyone with a cervix, whether straight, lesbian, gay, bisexual, transgender or intersex make sure they are up to date with their screening tests.

Diagnosis

Cancer Council recommends that all women or anyone with a cervix aged between 25 and 74 years participate in the National Cervical Screening Program.

If your screening test results suggest that you have a higher risk of developing cervical cancer, or you have symptoms of cancer, you will be referred to a specialist for tests to confirm the diagnosis of precancerous changes or cervical cancer.

Some tests allow your doctor to see the tissue in your cervix and surrounding areas more clearly. Other tests tell your doctor about your general health and whether cancer has spread. You probably won’t need to have all the tests listed here.

You may have some or all of the following tests:

• Screening test for cervical cancer – will detect cancer-causing types of HPV in a sample of cells taken from the cervix.
• Colposcopy – is a way of looking closely at the cervix to help see where abnormal or changed cells are and what they look like.
• Biopsy – is when the doctor removes some tissue from the surface of the cervix and sends it to a laboratory for examination. A biopsy may be done during a colposcopy.
• Large loop excision of the transformation zone (LLETZ) – this is the most common way of removing cervical tissue for examination and treating precancerous changes of the cervix.
• Cone Biopsy – is used when there are abnormal cells found in the cervical canal, when early-stage cancer is suspected or for women needing a larger incision.
• Laser surgery – this procedure uses a laser beam in place of a knife to remove the abnormal cells or pieces of tissue for further study.

Further tests:

• Blood test – to check your general health and how well your kidneys and liver are working.
• CT scan – uses x-rays to take pictures of the inside of your body and compiles them into a detailed three-dimensional picture.
• MRI scan – uses a powerful magnet and radio waves to build up detailed cross-sectional pictures of the inside of your body.
• PET Scan – injection with a glucose solution containing some radioactive material.
• Examination under anaesthetic – the doctor checks whether cancer has spread by examining your cervix, vagina, uterus, bladder and rectum

Waiting for the test results can be a stressful time. It may help to talk to a friend or family member, a healthcare professional, or call Cancer Council 13 11 20.

Treatment

The most common treatment for cervical cancer is surgery and/or a combination of chemotherapy and radiation therapy. When cervical cancer has spread beyond the cervix, targeted therapy may also be used.

Your medical team will recommend treatment based on:

• The results of your tests.
• The location of cancer and whether it has spread.
• Your age and general health.
• Whether you would like to have children in the future.

For more information on the treatment of cervical cancer please refer to the Understanding Cervical Cancer booklet.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis and treatment options with your doctor, but it is not possible for anyone to predict the exact course of the disease.

In general, the earlier cervical cancer is diagnosed and treated, the better the outcome. Most early-stage cervical cancers have a good prognosis with high survival rates.

To work out your prognosis, your doctor will consider:

• Your test results.
• The type of cervical cancer you have.
• The size of cancer and how far it has grown into other tissue.
• Whether cancer has spread to the lymph nodes
• Other factors such as your age, fitness and overall health.

Discussing your prognosis and thinking about the future can be challenging and stressful. It may help to talk with family and friends. You can also call Cancer Council 13 11 20 if you need more information or emotional support.

Support for Queenslanders

Whether you have been diagnosed with cervical cancer, or have a family member or friend who is affected by cancer, there are times when you may need support. Our professional services and support programs are here to help you.

Find out more about:

• Phone support
• Email support
• Cancer counselling
• Practical and financial support
• Support groups
• Information sessions

You don’t have to face cancer alone – we’re here to help.

Resources

For more information about Cervical cancer, please see these resources.

If you are a patient, family or friend and would like to order a copy of the Understanding Cervical cancer booklet, please call Cancer Council 13 11 20