Cervical cancer

This information has been reviewed by:
Assoc. Prof. David Allen Chair, VCOG Committee,
Gynaecological Oncologist, Mercy Hospital For Women

Use the links above or the text below to learn more about cervical cancer, or download our latest cervical cancer booklet.

The cervix

Pap test

Dysplasia

Cervical cancer

Microinvasive cervical cancer

Invasive cervical cancer

How common is cervical cancer?

Causes of cervical cancer

The cervix

The cervix is at the lower part of the uterus (womb), which extends into the vagina. The cervix is sometimes called the neck of the womb. There is a small opening in the cervix, the cervical canal, which leads through the cervix into the main part of the uterus.

The cervix has several important functions. It produces some of the moistness that helps lubricate the vagina. It also produces the mucus that helps sperm travel up to the fallopian tubes to fertilise an egg from the ovary. The cervix holds the baby in the uterus during a pregnancy. During labour the cervix opens to allow the baby to be born. 

Pap tests and dysplasia

Cervical cancer develops in stages. Pap tests are useful because they can detect abnormal cells that may one day become cancerous. Early detection means they can be treated before cancer happens. These changes are known as dysplasia. Pap tests are not designed to pick up cancer, although they sometimes do. 

Pap test

The Pap test is used to detect abnormal cell changes in the cervix.

Cell samples from the surface of the cervix are sent to a pathologist. This doctor examines the cells under a microscope. Results usually come within a week or two of the test.

The test is not painful although some women have some discomfort. You will be asked to remove your pants or skirt and underwear and lie on the examination table with your feet together and knees apart, or on your side. The doctor will place a speculum into your vagina. This holds the vaginal walls apart so that the doctor can see your cervix. The doctor will use an instrument like a brush to take the cells from your cervix. The test usually takes no more than a couple of minutes.

You may bleed a little after a Pap test.

Regular Pap tests can find most abnormal cell changes that could become cancerous if not detected and treated. It is advised that women have a Pap test once every 2 years. Women who have had abnormal changes may need to have more frequent Pap tests for a period of time. 

Dysplasia

Dysplasia describes abnormal changes in the cells of the cervix. Abnormal changes can also be categorised as:

• Low-grade squamous intraepithelial lesions (LSIL). These are minor abnormalities that normally go away within 12 months.
• High-grade squamous intraepithelial lesions (HSIL). These are more serious changes that require further investigation and sometimes treatment.

Doctors may refer to abnormal changes as cervical intraepithelial neoplasia (CIN). CIN is graded into CIN I, CIN II and CIN III: that is, mild, moderate and severe cervical cell changes. These are not cancer but could develop into cancer if not treated.

Sometimes the term ‘carcinoma in situ' is used to describe abnor-mal cell changes in the cervix. It is considered a high-grade abnormality. 

Cervical cancer

There are two main types of cervical cancer, named after the type of cell they start in. Squamous cell carcinoma, the most common type of cervical cancer, starts in the squamous or skin-like cells which cover the outer surface of the cervix at the top of the vagina. Adenocarcinoma is a less common type of cervical cancer. It starts in the glandular cells, in the cervical canal.

In addition, cervical cancer may be microinvasive or invasive.

Microinvasive cervical cancer

This is when cancer cells have just broken through the bottom layer of the skin of the cervix. At this stage, the cells have not spread more than five millimetres into the tissues of the cervix.

Invasive cervical cancer

In this, the cancer cells have spread from the surface skin of the cervix into the deeper tissues of the cervix. The cancer may also have spread to part of the vagina or to the lymph nodes and other tissues around the cervix, within the pelvis, or beyond the genital and pelvic areas into nearby organs.

How common is cervical cancer?

In Victoria about 150 women are diagnosed with cervical cancer each year.

Generally, cervical cancer takes a long time to develop. This is one reason why it is more common in women over the age of 40. However, as with all types of cancer, cervical cancer occasionally develops very quickly and is sometimes diagnosed in younger women.

Causes of cervical cancer

Some factors seem to put some women at a higher risk of cervical cancer. These risk factors include:

• human papilloma virus (HPV). Almost everyone is infected with HPV at some stage in their life. Most cases of HPV resolve without treatment and have no ill effects. Most women who have HPV don't ever show signs of abnormal cell changes. However, in some women it can cause cell changes that lead to dysplasia. If untreated, these changes may become cancer. A vaccine has now been developed that prevents the types of HPV most commonly linked to cervical cancer. The vaccine is most beneficial if given to young girls before they are exposed to HPV, that is, before they commence sexual activity. Through the government funded National Immunisation Program, most girls will receive the vaccine around the age of 12.
• daughters of women who used the drug diethylstilboestrol (DES) during pregnancy to prevent a miscarriage. The use of this drug has declined since the 1940s and 1950s.
• smoking, which increases the risk of cervical cancer fourfold.

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