Cervical cancer

Thursday 1 October, 2015

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On this page: The cervix | What is cervical cancer? | What types are there? | How common is it? | What are the symptoms? | What are the causes and risk factors? | Which health professionals will I see?  


The cervix

The cervix is part of the female reproductive system, which also includes the fallopian tubes, uterus (womb), ovaries, vagina (birth canal) and vulva (external genitals).

Also called the neck of the uterus, the cervix connects the uterus to the vagina. It has an outer surface that opens into the vagina and an inner surface that faces into the uterus.

The functions of the cervix include:

  • producing moisture to lubricate the vagina, which keeps the vagina healthy
  • producing mucus that helps sperm travel up the fallopian tube to fertilise an egg that has been released from the ovary
  • holding a developing baby in the uterus during pregnancy
  • widening to enable a baby to be born via the vagina.

The cervix is covered by two kinds of cells:

Squamous cells

Flat, thin cells that cover the outer surface of the part of the cervix that opens into the vagina (ectocervix). Cancer of the squamous cells is called squamous cell carcinoma.

Glandular cells

Column-shaped cells that cover the inner surface of the cervix (cervical canal or endocervix). Cancer of the glandular cells is called adenocarcinoma.

The area where the squamous cells and glandular cells meet is called the transformation zone. This is where most cervical cancers start.

Female reproductive system

Cervical cell changes

Sometimes the squamous cells and glandular cells in the cervix start to change and no longer appear normal when they are examined under a microscope. These early cell changes may be precancerous. This means there is a lesion (area of abnormal tissue) that is not cancer but may lead to cancer.

Cervical cell changes are often caused by certain types of the human papillomavirus (HPV).

There are two main types of cervical cell changes:

Abnormal squamous cells

These are called squamous intraepithelial lesions (SIL), and they can be classified as either low-grade (LSIL) or high-grade (HSIL).

SIL used to be called cervical intraepithelial neoplasia (CIN) and was graded according to how deep the abnormal cells were within the surface of the cervix.

  • LSIL, previously graded as CIN 1, usually disappear without treatment.
  • HSIL, previously graded as CIN 2 or CIN 3, are precancerous. This means that although they do not usually cause symptoms, high-grade abnormalities have the potential to develop into early cervical cancer over about 10–15 years if they are not detected and treated. HSIL will require treatment (see finding and treating precancerous abnormalities).

Only some women with precancerous changes of the cervix will develop cervical cancer.

Abnormal glandular cells – These abnormalities always require further testing, as glandular cell changes can be harder to interpret than squamous cell changes. Adenocarcinoma refers to glandular cells that are cancerous.

These cervical cell changes may be found during a routine screening test. For most women, mild cervical cell changes will go away on their own without treatment. Moderate to severe cell changes can be treated before they develop into cervical cancer. Your doctor will recommend one of the following options depending on the grade of the changes:

  • a follow-up test in 6–12 months to monitor the cells
  • a colposcopy to have a magnified look at the cervix using an instrument called a colposcope
  • a biopsy taken from the cervix at the time of the colposcopy.

What is cervical cancer?

Cervical cancer is the growth of abnormal cells in the lining of the cervix.

Cancer most commonly begins in the area of the cervix called the transformation zone, but it may spread to tissues around the cervix, such as the vagina, or to other parts of the body, such as the lungs or liver.

What types are there?

There are two main types of cervical cancer, which are named after the cells they start in:

Squamous cell carcinoma (SCC)

The most common type, accounting for about 7 out of 10 (70%) cases.

Adenocarcinoma

A less common type (about 25% of cases), starts in the glandular cells of the cervix. Adenocarcinoma is more difficult to diagnose because it occurs higher up in the cervix and the abnormal glandular cells are harder to recognise.

A small number of cervical cancers feature both squamous cells and glandular cells. These cancers are known as adenosquamous carcinomas or mixed carcinomas.

Other rarer types of cancer that can start in the cervix include small cell carcinoma and cervical sarcoma.

How common is it?

About 800 women in Australia are diagnosed with cervical cancer every year. Cervical cancer accounts for about 2 out of 100 of all cancers diagnosed in women. It is more common in women over 40, but it can occur at any age. 2,3 About one in 200 women will develop cervical cancer before the age of 75.

The incidence of cervical cancer in Australia has decreased significantly since a national screening program was introduced in the 1990s.

What are the symptoms?

In its early stages, cervical cancer usually has no symptoms.

The only way to know if there are abnormal cells in the cervix, which may develop into cervical cancer, is to have a cervical screening test.

If symptoms are present, they usually include:

  • vaginal bleeding between periods, after menopause or during or after sexual intercourse
  • pain during sexual intercourse
  • an unusual vaginal discharge
  • heavier periods or periods that last longer than usual.

These symptoms can also be caused by other conditions. See your general practitioner (GP) if you are worried or the symptoms are ongoing.

What are the causes and risk factors?

Most cases of cervical cancer are caused by an infection called human papillomavirus (HPV). There are also other known risk factors (see below).

Infection with HPV

Human papillomavirus is the name for a group of viruses. HPV is a common infection that affects the surface of different areas of the body, such as the cervix, vagina and skin.

There are more than 100 different types of HPV, including more than 40 types of genital HPV. Some other types of HPV cause common warts on the hands and feet.

Genital HPV is usually spread via the skin during sexual contact. About four out of five people will become infected with genital HPV at some time in their lives.

Most people will not be aware they have HPV as it is usually harmless and doesn't cause symptoms. In most women, the virus is cleared quickly by the immune system and no treatment is needed.

Approximately 15 types of genital HPV cause cervical cancer. Screening tests are used to detect these types of HPV or the precancerous cell changes caused by the virus. See more information on screening tests . There is also a vaccination against HPV (see below).

National HPV Vaccination Program

The HPV vaccine provides protection against two strains of HPV, 16 and 18, that are known to cause 70–80% of cervical cancers. The vaccine also offers some protection against other less common cancers associated with HPV, including vaginal, vulvar and anal cancers.

As part of the National HPV Vaccination Program, the vaccine is free for girls and boys aged 12–13. (The vaccine helps to protect males against penile and anal cancers.)

People who are already sexually active may still benefit from the HPV vaccine. Ask your GP for information.

The HPV vaccine cannot be given to treat precancerous changes or cervical cancer.

If you've been vaccinated, you will still need regular screening tests as the HPV vaccine does not provide protection against all types of HPV.

For more information, visit hpvvaccine.org.au.

Smoking and passive smoking

Chemicals in tobacco can damage the cells of the cervix, making cancer more likely to develop in women with HPV.

Having a weakened immune system

The immune system helps rid the body of HPV. Women with a weakened immune system are at increased risk of developing cervical cancer. This includes women with the human immunodeficiency virus (HIV) and women who take medicines that lower their immunity. Ask your doctor if this applies to you.

Long-term use of oral contraceptive (the pill)

Research has shown that women who have taken the pill for five years or more are at increased risk of developing cervical cancer. The reason for this is not clear. However, the risk is small and the pill can also help protect against other types of cancer, such as uterine and ovarian cancers. Talk to your doctor if you are concerned.

Exposure to diethylstilbestrol (DES)

This is a synthetic (artificial) form of the female hormone oestrogen. DES was prescribed to pregnant women from the 1940s to the early 1970s to prevent miscarriage. Studies have shown that the daughters of women who took DES have a small but increased risk of developing a rare type of cervical adenocarcinoma.

Which health professionals will I see?

Your GP will arrange the first tests to assess your symptoms or investigate the results of an abnormal screening test. If these initial tests do not rule out cancer, you will be referred to a gynaecologist or gynaecological oncologist for more tests and treatment.

You will be cared for by a range of health professionals who are part of a multidisciplinary team (MDT). The table below describes the roles of the people who may be in your MDT.

Health professional Role
gynaecologist* specialises in treating diseases of the female reproductive system
gynaecological oncologist* treats women with cancers of the reproductive system, e.g. cervical, ovarian, uterine, vulvar and vaginal cancers
radiation oncologist* prescribes and coordinates the course of radiotherapy
medical oncologist* prescribes and coordinates the course of chemotherapy
radiologist* reads and interprets x-rays and diagnostic scans, e.g. CT, MRI and PET scans
cancer nurse coordinator, cancer care coordinator support patients and families throughout treatment and liaise with other members of the treatment team
nurses care for you during and after surgery; help administer drugs; and provide care, information and support throughout treatment
dietitian recommends an eating plan to follow during treatment and recovery
social worker, psychologist link you to support services; help with emotional and practical problems associated with cancer and treatment
physiotherapist, occupational therapist help with any physical or practical problems associated with cancer and treatment

* Specialist doctor


Reviewed by: Prof Ian Hammond, Gynaecological Oncologist (retired), WA and Chair, Cancer Council Australia Cervical Cancer Screening Guidelines Working Party, National Cervical Screening Program: Guidelines for the management of screen-detected abnormalities, screening in specific populations and investigation of abnormal vaginal bleeding. Cancer Council Australia, Sydney, 2016; Jennifer Duggan, Clinical Nurse Consultant Gynaecological Oncology, Royal Hospital for Women, NSW; Dr Rhonda Farrell, Gynaecological Oncologist, Royal Hospital for Women, Prince of Wales Private Hospital, St George Hospital, and Conjoint Lecturer, School of Women's & Children's Health, University of NSW; Melinda Grant, Consumer; Karen Hall, 13 11 20 Consultant, Cancer Council SA; Dr Pearly Khaw, Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Megan Smith, Program Manager – Cervix/HPV and Breast Group, Cancer Research Division, Cancer Council NSW.

 

The illustration on this page has been adapted from An abnormal Pap smear result – what this means for you (National Cervical Screening Program, 2006). Used by permission of the Australian Government.

2. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: Cervical cancer, AIHW, Canberra, 2017.
3. Australian Institute of Health and Welfare (AIHW), Australian Cancer Incidence and Mortality (ACIM) books: All cancers combined, AIHW, Canberra, 2017.

Diagnosing cervical cancer

Thursday 1 October 2015

Treatment for cervical cancer

Thursday 1 October 2015

Managing side effects

Thursday 1 October 2015

 

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