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The cervix (neck of the womb) is part of the female reproductive system. Cancer of the cervix is diagnosed in about 160 Victorian women each year and is almost always linked to the human papilloma virus (HPV).
Cervical cells pass through a series of changes (dysplasia) before they become cancerous and Pap tests are able to detect most of these changes. In Australia, regular Pap tests prevent more than 1,200 women each year from being diagnosed with cervical cancer. Most women who develop cervical cancer have either never had a Pap test or did not have them regularly.
The cervix
The cervix lies at the base of the uterus (womb) and opens into the vagina. Some of the functions of the cervix include:
- Producing lubrication for the vagina
- Producing mucus to help sperm movement
- Holding the baby in the uterus during pregnancy.
Symptoms
Most cervical cell changes have no symptoms. The only way to know if there are abnormal cells in the cervix is to have a Pap test. Sometimes abnormal bleeding, discharge or pain may be a sign of cervical cancer. If you have these symptoms, you should see your doctor as soon as possible.
Types of cervical cancer
There are two main types of cervical cancer:
- Squamous cell cancer – this is the most common type of cervical cancer. It starts in the cells that cover the outer surface of the cervix at the top of the vagina. The Pap test can usually find early cell changes that could lead to squamous cell cancer.
- Adenocarcinoma – this type of cervical cancer is less common. It starts in the glandular cells, which are found in the cervical canal. The Pap test cannot easily find early changes of this cancer, although occasionally it does.
Risk factors
Cervical cancer almost always develops from cell changes caused by the human papilloma virus (HPV), which is spread through genital skin-to-skin contact during sexual activity.
Other factors that can increase the risk of cervical cancer in women with HPV are smoking and lower levels of immunity (such as HIV infection or chemotherapy). Daughters of women who took the anti-miscarriage drug diethylstilboestrol (DES) also seem to be at greater risk and should be seen annually in special gynaecology clinics.
All women need to have Pap tests every two years until the age of 70. The Pap test is currently the best protection against cervical cancer for women who have ever had sex.
The HPV link
HPV infection is so common that it should be considered a normal part of being sexually active. Four out of five women will have HPV at some time in their lives.
Although HPV is very common, most women with HPV will not develop cervical cancer. In most cases, HPV clears naturally from the body. This can take one to two years and doesn’t require treatment. Occasionally the virus can persist in the cervical cells and cause cell damage. If these changes are left undetected and untreated, the risk of developing cervical cancer increases.
The Pap test
The Pap test is a quick and simple test that checks for changes to the cells of the cervix that may lead to cervical cancer. Most abnormal cell changes are not cancerous but indicate common infections or conditions, which usually clear up naturally.
Generally, cervical cancer takes a long time to develop. This is one reason why it is more common in women over the age of 50. However, cervical cancer occasionally develops very quickly and is sometimes diagnosed in younger women.
Diagnosis
Various tests are used to detect cervical cancer including:
- Colposcopy – examines the vagina and cervix with a magnifying instrument to check for abnormalities.
- Biopsy – a small tissue sample taken from the cervix during a colposcopy.
- Cone biopsy – a larger tissue sample removed from the cervix under anaesthetic.
Treatment
Some of the treatments for cervical cancer include:
- Cone biopsy – if detected early, some cervical cancers can be removed during a biopsy.
- Hysterectomy – the removal of the uterus.
- Radiotherapy – the use of x-rays to destroy the cancer cells.
- Chemotherapy – anti-cancer drugs that stop cancer cells from multiplying.
The cervical cancer vaccine
There are two vaccines currently available in Australia to help prevent cervical cancer. Both vaccines work by preventing infection with two types of the human papilloma virus (HPV) – types 16 and 18 – which have been shown to cause 70 per cent of cervical cancers. One of the vaccines (the quadrivalent vaccine, called Gardasil®) also protects against HPV types 6 and 11, which cause almost all genital warts. The vaccines do not protect against all cancer-causing HPV types or those to which a woman may have already been exposed.
The quadrivalent cervical cancer vaccine is available free of charge for all girls in year 7 throughout Australia, as part of the school-based National HPV Immunisation Program. It involves a course of three injections over a six-month period and is most effective when given to girls before starting sexual activity – that is, before they are exposed to HPV.
In 2007, the Australian government announced a two year catch-up program for females aged 13 to 26 to access the vaccine free of charge. This program ends in December 2009.
For all other women, the vaccine is available at a cost. The benefit of the vaccine may be reduced for older women who have already had sex. Talk to your doctor about whether or not the vaccine will be beneficial for you.
All women aged between 18 and 70 years who have ever had sex should continue having regular two-yearly Pap tests, whether they have been immunised or not.
Where to get help
- Your doctor
- Your local community health centre or women’s health nurse
- Family Planning Victoria Tel. (03) 9257 0100 www.fpv.org.au/
- Your gynaecologist
- The Cancer Council of Victoria Information and Support Line Tel. 13 11 20
- PapScreen Victoria – for online advice and information
- Multilingual Cancer Information Line, Victoria – see the Cancer Council Victoria’s website for contact details
Things to remember
- The Pap test is a quick and simple test that checks for changes to the cells of the cervix that may lead to cervical cancer.
- Abnormal cell changes in the cervix are not necessarily cancer.
- Treatment for cervical cancer includes surgery, radiotherapy, chemotherapy or a combination of these treatments.
- All women aged between 18 and 70 who have ever had sex should have regular two-yearly Pap tests, even if they’ve had the cervical cancer vaccine.
You might also be interested in:
Cancer screening.
Fallopian tube cancer.
Genital warts.
Palliative care - help for the terminally ill.
Palliative care explained.
Pap test abnormalities.
Pap tests after hysterectomy.
Pap tests and older women.
Pap tests explained.
Pap tests for all women.
Pregnancy related cancer.
Vaginal bleeding - irregular.
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