Cervical cancer
On this page: The cervix | Cervical cell changes | What is cervical cancer? | What types are there? | What are the causes? | How common is it? | What are the symptoms? | What is a Pap smear? | What is the HPV vaccine? | Reviewers
The cervix
The cervix is part of the female reproductive system. The female reproductive system also includes the uterus (womb), ovaries, Fallopian tubes, vagina and vulva.
The cervix is the lower, cylinder-shaped part of the uterus that connects to the vagina. It's also called the neck of the uterus. It has an outer surface that opens into the vagina and an inner surface that faces into the uterus. The inner part is called the cervical canal.
The functions of the cervix include:
- producing moistness to lubricate the vagina
- producing mucus that helps sperm travel up to the Fallopian tube to fertilise an egg from the ovary
- holding a developing baby in the uterus during pregnancy.
- widening so the baby can be born via the birth canal (vagina).
The cervix is covered by two kinds of cells, which line the surfaces of many organs and body systems:
- Squamous cells: flat, thin cells found in the outer layer of the cervix that opens into the vagina (ectocervix)
- Glandular cells or columnar cells: column-shaped cells that produce cervical mucus and are found in the cervical canal (endocervix).
Cervical cell changes
Sometimes the cells in the cervix start to change and no longer appear normal. This may mean you have a pre-cancerous lesion, which is not cancer but may lead to cancer. Cervical cell changes may be found during a routine Pap smear..
There are different types of early cell changes, which are also called epithelial abnormalities.
- Atypia: The cervical cells have changed slightly. The cells may return to normal by themselves or the changes may worsen. If a cell shows signs of atypia, it doesn't necessarily mean you have cancer or will get cancer. Atypia can also be caused by infection or irritation.
- Squamous abnormalities: The squamous cells of the cervix are abnormal. This may be classified as a low-grade or a high-grade abnormality on a Pap smear. High-grade abnormalities are pre-cancerous, and although they don't usually cause symptoms they can sometimes progress to early cervical cancer if they're not detected and treated. These squamous changes are also called cervical intraepithelial neoplasia (CIN) and are graded according to how severe they appear on a biopsy of the tissue. Early changes are categorised as CIN 1 and these will usually disappear without treatment. Further abnormal changes are categorised as CIN 2 or CIN 3.
- Glandular abnormalities: The glandular cells of the cervix are abnormal. These abnormalities on a Pap smear always require further assessment as they may be either pre-cancerous or cancerous.
If the results from a Pap smear show that your cervix has some abnormal changes, your doctor will recommend that you have one of the following based on the grade of the changes:
- another Pap smear in 12 months time to monitor the cells
- treatment right away
- a biopsy to look at the cervical cells in more detail under a microscope.
"My doctor said that because I had regular Pap smears, the cancer was picked up while it was small. The treatment was straightforward and my body is intact." – Jenny, 34
What is cervical cancer?
Cervical cancer is a malignant tumour found in the tissues of the cervix. It occurs when abnormal cells in the cervix turn into cancer cells. The cancer cells break through the surface cells (epithelium) and the underlying tissue (stroma) of the cervix.
Cervical cancer most commonly begins in the cells of the transformation zone. At diagnosis, the cancer is often just within the cervix, but it may spread to tissues around the cervix (e.g. the vagina) or to other parts of the body.
What types are there?
A: The two main types of cervical cancer are named after the cells they start in.
- Squamous cell carcinoma: The most common type, accounting for about eight out of ten cases.
- Adenocarcinoma: A less common type, starting in the glandular cells. It's difficult to diagnose, as it's high in the cervix and hard to reach with the tools used for testing.
What are the causes?
The main cause of cervical cancer is now known to be infection with human papillomavirus (HPV). There are also other known risk factors.
HPV
Most cases of cervical cancer occur many years after infection with a strain of human papillomavirus, which is the name for a group of wart viruses. It's a common infection affecting the surface of different body areas, such as the skin, vagina and cervix.
About eight out of ten women will become infected with genital HPV at some time in their lives. Genital HPV is usually spread via the skin during sexual contact. In most women, the virus is cleared quickly by the immune system and no treatment is needed. Because there are rarely symptoms, most women are unaware they have the virus.
The pre-cancerous cell changes caused by HPV can be found by a Pap smear. There's now also a vaccination against HPV.
Smoking
Chemicals in tobacco can damage the cells of the cervix and make cancer more likely to develop.
Family history
If you have a first-degree relative (mother or sister) who has had cervical cancer, you have an increased chance of developing it too.
Diethylstilboestrol (DES) exposure
DES is an oestrogen-based medication prescribed to women from the 1950s to the early 1970s to prevent miscarriage. Although rare, studies have shown that the daughters of women who took DES have an increased risk of developing a rare type of adenocarcinoma.
How common is cervical cancer?
In Australia, about 750 women are diagnosed with the disease every year. Only 1.6% of all cancers in women in Australia are cervical cancer.
Between 1999 and 2008, the incidence rates of cervical cancer fell by 25%. This is probably because more regular Pap tests are conducted as part of the National Cervical Screening Program. With the introduction of the National Immunisation Program against HPV, there should be a further fall in cervical cancer cases in the coming years.
What are the symptoms of cervical cancer?
If early cell changes develop into cervical cancer, the most common symptoms include:
- vaginal bleeding between periods or after menopause
- bleeding after intercourse
- pain during intercourse
- unusual vaginal discharge
- excessive tiredness
- leg pain or swelling
- lower back pain.
These symptoms can also be caused by other more common conditions. However, see your general practitioner (GP) if you're worried or the symptoms are ongoing. If necessary, your GP will refer you for tests to see if you have cancer.
What's a Pap smear?
The main role of the Pap smear (also called a Pap test) is to help prevent cancer. It shows whether women have abnormal pre-cancerous cells in their cervix. If necessary, you'll have treatment so that they don't develop into cancer. If you have a test that shows abnormal cells, you can also be monitored regularly to check the health of the cervix.
All women under 70 years of age who are or who have ever been sexually active should have a Pap smear every two years. Women who have had abnormal cell changes should be tested more often.
During a Pap smear, a doctor uses an instrument such as a brush or spatula to scrape some cells from the surface of the cervix. This may feel slightly uncomfortable but usually only takes a minute or two. The cells are smeared onto a glass slide or put into a fluid. The cells will then be examined under a microscope for any changes.
Occasionally cancer cells are detected in a Pap smear, but this is uncommon. A Pap smear is not used to diagnose cancer – if cancer is suspected, you'll need other tests. If you have an abnormal result, your GP or gynaecologist will discuss whether you need treatment, further tests or another Pap smear at an earlier interval than two years.
To learn more about Pap smears, talk to your doctor. You can also call our Cancer Council Helpline on 13 11 20 to request a free copy of the National Cervical Screening Program booklet An Abnormal Pap Smear Result: What this means for you.
What is the HPV vaccine?
The National HPV Vaccination Program was introduced to Australia in 2007. The HPV vaccine provides protection against the two main strains of HPV that are known to cause cervical cancer.
The vaccine, however, can't be given to treat cancer once a woman has already been diagnosed with pre-cancerous cells or cancer. It also doesn't provide protection against all types of HPV, so it's important to continue to have Pap smears even if you've been vaccinated.
For more information, talk to your doctor or see the website www.immunise.health.gov.au.
The HPV vaccine is free for schoolgirls aged 12 or 13 in Australia. Women under 27 were able to receive free vaccinations between 2007 and 2009. Young women who missed out are still able to obtain the vaccine through their GP for a fee.
Reviewed by: Dr Rhonda Farrell, Gynaecological Oncologist, Royal Hospital for Women, NSW; A/Prof Michael Jackson, Director, Radiation Oncology, Prince of Wales Hospital, NSW; Jayne Maidens, Clinical Nurse Consultant, Gynaecological Oncology Department, Royal North Shore Hospital, NSW; Anne Mellon, Clinical Nurse Consultant, Hunter New England Centre for Gynaecological Cancer, NSW; Cate Mellor, Cancer Information Consultant, Helpline, Cancer Council NSW; and Anne Steng, Consumer.
