Understanding Cervical Cancer

This information has been prepared to help you understand more about cervical cancer. The information is an introduction to the diagnosis, treatment and effects of cervical cancer but is by no means exhaustive. We cannot advise about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors.

• The cervix
• What is cervical cancer?
• How common is it?
• Risk factors
• Symptoms
• Prevention and detection
• Diagnosis
• Further information

The cervix

The cervix is part of the female reproductive system. The cervix is the lower part of the uterus (womb) that connects to the vagina. The cervix is sometimes called the neck of the uterus. The uterus is the hollow organ shaped like an upside down pear found at the top of the vagina.

The cervix has many functions, including:

• Producing some of the moistness that helps lubricate the vagina
  
  
• Producing the mucus that helps sperm travel up the Fallopian tube to fertilise and egg from the ovary.
  
  
• Holding the developing baby in the uterus during the pregnancy. During childbirth, the cervix widens to allow the baby to pass down into the birth canal (vagina).

The cervix is covered by two kinds of cells: squamous and glandular. The squamous cells are the flat thin cells found in the outer layer of the cervix (ectocervix). The glandular cells are found in the cervical canal (endocervix). The point where these two cells meet is called the transformation zone.

What is cervical cancer?

Cervical cell changes

Cervical cancer can take a long time to develop, on average about 10 years. However, as with all types of cancer, it occasionally develops quickly. Early changes appear on the surface of the cervix. These changes are the first step in a series of slow changes that may later develop into cancer if left untreated.

A Pap smear helps find early changes in the cells of the cervix.

What is cervical cancer?

Cervical cancer is a malignant tumour in the tissues of the cervix.

The two main types of cervical cancer are named after the type of cell from which they originate:

• Squamous cell carcinoma - This is the most common, accounting for 80% of all cervical cancers. It starts in the squamous or skin-like cells of the cervix.
  
  
• Adenocarcinoma - This is 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 smear.

Both types of cervical cancer are treated in a similar way.

Cervical cancer can spread to other parts of the body through the lymphatic system. This system protects the body from infection. It is made up of bean-shaped structures called lymph nodes which are found all over the body, including the pelvic area.

How common is it?

Each year in Australia around 740 women are diagnosed with cervical cancer and approximately 270 women die as a result.

Risk factors

The causes of cervical cancer are unknown. However, the following increase the chance of cervical cancer developing:

• Human Papilloma Virus (HPV) is the name for a group of wart viruses. It is a common infection affecting the skin surface of any part of the body, including the cervix. Around eight of every 10 women will get an HPV infection at some time in their lives, however most women who have HPV don’t develop cervical cancer. A vaccine is now available that protects women from the HPV types responsible for 70% of cervical cancers. The vaccine is offered free to all women and girls aged between 12 and 26, through a national vaccination program. Talk to your doctor. The vaccine doesn’t prevent all cervical cancers so it’s important for all women to have regular Pap tests.
  
  
• Smoking produces chemicals that may damage the cells of the cervix and makes cancer more likely to develop.
  
  
• First sexual intercourse at any early age. However, most women who have sexual intercourse at a young age do not develop cervical cancer and women who have intercourse when they are much older can still develop cervical cancer.

Many women who have these risk factors do not develop cervical cancer.

Symptoms

Early changes in the cells of the cervix (epithelial abnormalities) 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
• Lower back pain

All these symptoms are common to many conditions and may not be cervical cancer. However, if you have these symptoms you should have them checked by your doctor.

Prevention and detection

Prevention is better than cure, so The Cancer Council Australia and its state members work to raise awareness of women’s cancers and to educate women about how to lower their cancer risk.

You and your circle of friends can reduce your risk of developing cancer by:

• Learning what the risk factors are and where possible taking steps to decrease your risk
• Knowing the early warning signs and monitoring your health
• Attending screening programs
• Leading a healthy lifestyle

Cervical cancer screening

The national cervical screening program – you know it as the Pap test – has been operational for more than 20 years and is responsible for greatly reducing the number of women who die from this disease.

Pap tests pick up early warning signs that can be treated before cervical cancer develops.

Who should have a Pap test?

• All women 18 – 70 who have ever been sexually active should have a Pap test every two years.
  
  
• If you’re over 70 and have never had a high-grade lesion or you’ve had two Pap tests with normal results within the last five years, you may not need to have any more. However, it is best to discuss this with your doctor or nurse.
  
  
• If you’re over 70 and you’ve never had a Pap test, you should make an appointment to see your doctor or nurse.

Where can I have a Pap test?

You can get a test done by your:

• Doctor
• Women’s health nurse
• Family planning clinic
• Sexual health clinic
• Community health clinic or women’s health centre

• Aboriginal medical centre

Diagnosis

Abnormal cell changes in the cervix can be found with a Pap smear. This test does not diagnose cancer but finds early changes, which might later become cancer. The earlier these changes are found the better the chance of cure.

If a Pap smear detects changes, more tests will be needed to confirm the diagnosis.

Tests to find the cancer

• Colposcopy - A colposcopy is an examination that shows where the changed cells are and what they look like. It is done using an instrument called a colposcope, which is like binoculars on a stand. The colposcope gives a magnified view of the cervix and vagina but does not enter the body. An instrument called a speculum is inserted into your vagina as is done for a Pap smear. The doctor will then look at your cervix using the colposcope. The cervix will be coated with a special solution to highlight any abnormal areas. A colposcopy usually takes 10-15 minutes during which time you may experience some discomfort. Some colposcopes are fitted with a camera, which is connected to a TV screen so you are able to watch what the doctor is doing. You should feel free to ask the doctor or accompanying nurse to explain what is happening.
  
  
• Biopsy - A small sample of tissue may be taken from any abnormal area on the cervix and sent to a laboratory for examination under a microscope. This is called a biopsy. A colposcope will be used to see what area needs to be removed. A biopsy may be uncomfortable for a brief period. The biopsy can be taken in the doctor's rooms or in a clinic. The biopsy results should be back from the laboratory within a week.
  
  
• Cone biopsy - A cone biopsy removes a cone-shaped piece of tissue containing the abnormal cells from the cervix. It is usually performed under a general anaesthetic and involves a day or overnight admission to hospital. The cone biopsy results are usually available within a week.
  
  
• Large loop excision of the transformation zone - Another method that removes a large sample of the cervix for examination under a microscope is called a large loop excision of the transformation zone (LLETZ). A loop of wire carrying an electric current is used to cut out tissue from the cervix. This procedure takes about 10 minutes and may be performed under a local anaesthetic in the doctor's office or in hospital under general anaesthetic.

Further information

For further information on cervical cancer, call The Cancer Council Helpline on 13 11 20 or contact your local state or territory office of The Cancer Council (see the contact us page for details)

© 2008 Cancer Council