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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 70% of cases. Adenocarcinoma is less common (about 25% of cases)and more difficult to diagnose because it starts higher in the cervix.

It is estimated that there will be 913 cases of cervical cancer diagnosed in Australia in 2021.  The risk of a woman being diagnosed by age 85 is 1 in 162.

The incidence of cervical cancer has significantly decreased since the National Cervical Screening Program began in 1991 and a national Human Papilloma Virus (HPV)vaccine program was introduced in 2007. 

The chance of surviving cervical cancer for at least five years is 74%.

Cervical Cancer Symptoms

Precancerous changes in cervical cells rarely cause symptoms. The only way to know if there are abnormal cells that may develop into cancer is to have a cervical screening test. 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

  • pain during intercourse

  • bleeding after intercourse

  • pelvic pain

  • a change in your vaginal discharge such as more discharge or it may have a strong or unusual colour or smell

  • vaginal bleeding after menopause.

These symptoms can be caused by other conditions but if you are worried or symptoms persist, contact your doctor. This is important for anyone with a cervix, whether you are straight, lesbian, gay, bisexual or transgender.

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.

There is some evidence that women who have taken the contraceptive pill for five years or more are at increased risk of developing cervical cancer in people with HPV. The risk is small and taking the pill has also been shown to reduce to risk of other cancers such as ovarian and uterine.

Other risk factors include:

  • smoking and passive smoking

  • a weakened immune system

  • if your mother was prescribed diethylstilbestrol (DES), an artificial form of the female hormone oestrogen during pregnancy (between 1939 and 1971)..

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.

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 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.

In certain cases, you can collect a sample yourself under the supervision of a healthcare professional who also offers cervical screening. You must be at least 30 years old and have never had a cervical screening test or are overdue a test by at least 2 years.

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:

Colposcopy with biopsy

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 placed near your vulva but is not put inside your body. The procedure is done by a colposcopist – usually a gynaecologist or, in some clinics a nurse practitioner.

If the colposcopist sees any suspicious looking areas, they will usually take a tissue sample (biopsy) from the surface of the cervix for examination under a microscope by a pathologist.

Large loop excision of the transformation zone (LLETZ)  or cone biopsy

If any of the tests show precancerous cell changes you may have a large loop excision procedure or a cone biopsy.

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

Staging

If cervical cancer is detected, it will be staged, from stage 1, which means abnormal cells are found only in the tissue of the cervix to stage 4 , which means the cancer has spread beyond the pelvis to the lung, liver or bones. 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 chemoradiation therapy 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 radiation therapy (radiotherapy) and chemotherapy (cisplatin) is used.

For metastatic disease, the treatment is chemotherapy (platinum/fluorouracil) or palliative care alone.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:

  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Gynaecological oncologist- diagnoses and treats cancers of the female reproductive system
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Cancer care coordinators- coordinate your care, liaise with the multidisciplinary team and support you and your family throughout treatment.
  • Dietitian- recommends an eating plan to follow while you are in treatment and recovery.
  • Other allied health professionals- such as social workers, pharmacists and counsellors..

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

HPV vaccine

This is a vaccine against specific types of HPV that cause almost all cervical cancers. Gardasil 9 has been developed to protect against nine types of HPV which cause around 90% of cervical cancers. Through the National Immunisation Program, most girls and boys girls in Australia aged 12-13 and under will receive the HPV vaccine in school-based programs. It is given as two injections. The vaccine is most effective if the second dose is given 6-12 months after the first.

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.