What is cervical cancer?
Cervical cancer is a malignant tumour in the tissues of the cervix.
Cervical cancer types
The two main types of cervical cancer are named after the type of cell from which they originate:
Squamous cell carcinoma - the most common, accounting for 80% of all cervical cancers. It starts in the squamous or skin-like cells of the cervix.
Adenocarcinoma - a less common type of cervical cancer, which develops from the glandular cells. This type is more difficult to diagnose because it starts higher in the cervix and is more difficult to reach with the brush or spatula used in taking a Pap test.
Cervical cancer can spread to other parts of the body through the lymphatic system.
How common is cervical cancer?
Around 800 women are diagnosed with cervical cancer each year. One in 162 women will be diagnosed with cervical cancer by the age of 85.
Cervical cancer death rates have more than halved since the National Cervical Screening Program began in 1991.
Cervical cancer causes
Risk factors for cervical cancer include:
- Infection with the human papilloma virus (HPV) – almost all cases of cervical cancer are caused by persistent infection with HPV
- Being the daughter of a woman who used the drug diethylstilboestrol (DES) during pregnancy to prevent a miscarriage
- Smoking, which increases the risk of cervical cancer fourfold
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.
Cervical cancer symptoms and diagnosis
Early changes in the cells of the cervix (epithelial abnormalities) rarely cause symptoms, which is why doctors encourage women to have regular Pap tests.
If early cell changes develop into cervical cancer, the most common signs include:
- Vaginal bleeding between periods
- Bleeding after intercourse
- Pain during intercourse
- Unusual vaginal discharge
- Vaginal bleeding after menopause
- Excessive tiredness
- Leg pain or swelling
Low back pain
All these symptoms are common to many conditions and may not mean you have cervical cancer. However, if you have these symptoms you should have them checked by your doctor.
The usual tests to diagnose cervical cancer are:
- Biopsy, cone biopsy or large loop excision of the transformation zone
Cervical cancer screening
The National Cervical Screening Program recommends Pap tests for all women 18-70 years of age who have ever had sex and have not had a hysterectomy. Women should start having Pap tests every two years from 18-20 years of age, or one to two years after sexual activity commences, whichever is earlier.
Most abnormal changes in cervical cells are detected with a Papanicolaou test (Pap test or Pap smear). However a Pap test doesn't detect ovarian cancer.
Cervical cancer prevention
A vaccine has been developed that prevents the types of HPV most commonly linked to cervical cancer. Through the National Immunisation Program, most girls in Australia will receive the 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.
Cervical cancer 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 locally advanced disease, a combination of radiotherapy and chemotherapy (cisplatin) is used.
For metastatic disease, the treatment is chemotherapy (platinum/fluorouracil) or palliative care alone.
Cervical cancer prognosis
An individual’s prognosis depends on the type and stage of cancer as well as their age and general health at the time of diagnosis. Cervical cancer can be effectively treated when it is found early. Most women with early cervical cancer will be cured. However, treatment may make it more difficult, or impossible, to become pregnant. In Australia, the overall five year survival rate for women diagnosed with cervical cancer is 72%