What is cervical cancer?
Cervical cancer is a malignant tumour in the tissues 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.
Over 800 women are diagnosed with cervical cancer each year. The risk of a woman being diagnosed by age 85 is 1 in 152.
In 2013, there were 224 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 National Cervical Screening Program recommends all women aged between 18 and 70 who have ever been sexually active have regular Pap tests. 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 later.
Symptoms and diagnosis
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.
The usual tests to diagnose cervical cancer are:
- biopsy, cone biopsy or large loop excision of the transformation zone.
After cervical cancer is diagnosed, one or more of the following tests are used to determine the extent of the cancer (its stage):
- blood tests
- examination under anaesthetic (cystoscopy and proctosigmoidoscopy)
- chest x-ray
- CT scan
- PET scan.
If cervical cancer is detected, it will be ‘staged’, from stage 0, which means abnormal cells are found only in the first 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.
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 in utero are at increased risk of cervical cancer. You can read more about this here.
A vaccine has been developed that prevent the types of HPV most commonly linked to cervical cancer. 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.
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.
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. In Australia, the five year survival rate for women diagnosed with cervical cancer is 72%.
Treatment for cervical cancer may make it more difficult, or impossible, to become pregnant.