Cervical cancer

About cervical cancer

Cancer of the cervix (cervical cancer) is diagnosed in over 200 Victorians each year. These cases are almost always linked to infection with the human papillomavirus (HPV).

Cervical cancer starts in the cells of the cervix. The cervix is the lower part of the uterus (womb). It connects the uterus to the top of the vagina.

HPV can cause cervical cells to pass through a series of changes (dysplasia) which if left untreated can become cancerous. Cervical Screening Tests can test for most types of HPV known to be linked to cancer. If HPV is present, a practitioner collected test is able to detect most of these cellular changes. (If the test was self-collected, you may be asked to return to your health care provider for a further test to be able to look at the cells of the cervix.)

If HPV is not detected on the Cervical Screening Test and you have no symptoms such as abnormal bleeding, the risk of cervical cancer is extremely low, and it is safe to repeat the test in 5 years.

In Australia, regular Cervical Screening Tests enables the early detection of abnormalities, which in the absence of further investigation and treatment may have progressed to cervical cancer . Most people who develop cervical cancer have either never had a Cervical Screening Test (or Pap smear) or did not have them when recommended in the 10 years before diagnosis.

If you have had a hysterectomy you may still need to have regular cervical Screening Tests. You should discuss this with your healthcare provider.

Function of the cervix

The cervix lies at the base of the uterus and opens into the vagina. Some of the functions of the cervix include:

• producing lubrication for the vagina
• producing mucous to help the movement of sperm
• holding the foetus in the uterus during pregnancy.

Symptoms of cervical cancer

Infection with HPV and most cervical cell changes have no symptoms. The only way to know your risk of developing cervical cancer is to have a Cervical Screening Test.

Sometimes abnormal bleeding, discharge or pain may be a sign of cervical cancer. If you have these symptoms, see your healthcare provider as soon as possible.

Types of cervical cancer

There are 2 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 Cervical Screening Test is a good way of assessing your risk of 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 majority of these are also caused by HPV.

Risk factors for cervical cancer

Cervical cancer almost always develops from cell changes caused by HPV. HPV is spread through genital skin-to-skin contact during sexual activity. HPV is very common and in most cases the body clears the virus naturally.

Factors that can increase the risk of cervical cancer in people with HPV are:

• Not having regular Cervical Screening Tests
• Smoking
• Having a weakened immune system (which can occur because of HIV infection, chemotherapy, or other reasons)
• Children of people who took the anti-miscarriage drug diethylstilboestrol (DES) may also be at greater risk of cervical cancer. People in this risk group should be seen annually in special gynaecology clinics.

Cervical cancer and HPV

Although HPV is very common, most people with HPV will not develop cervical cancer.

In most cases, HPV clears naturally from the body within 1 to 2 years, and doesn't require treatment.

Sometimes, the virus persists in the cervical cells and causes cell damage. If these changes are left undetected and untreated, the risk of developing cervical cancer increases.

The Cervical Screening Test detects HPV and is expected to protect up to 30% more people from cervical cancer than the Pap test.

Cervical cancer and the Cervical Screening Test

The Cervical Screening Test is a quick and simple test that detects the presence of HPV. If HPV is detected, a further test is done, on the same sample, to check the cells of the cervix.

Most cell changes to the cervix are not cancerous, but indicate common infections or conditions, which usually clear up naturally. Usually, cervical cancer grows slowly, but sometimes it can develop and spread quickly.

Cervical cancer is one of the cancers that can occur in young people, but the incidence is low for people under 25.

The National Cervical Screening Program recommends that all people with a cervix aged between 25 and 74 years who have ever been sexually active should have a Cervical Screening Test every 5 years, even if they've had the HPV vaccine. People living with highly immunosuppressive conditions may require testing every three years.

Diagnosis of cervical cancer

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 is taken from the cervix during a colposcopy
• cone biopsy – a larger tissue sample is removed from the cervix under anaesthetic.
• Imaging tests

Treatment for cervical cancer

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– the use of anti-cancer drugs that stop cancer cells from multiplying.

Living with and beyond cervical cancer

Being told you have cervical cancer can be upsetting or frightening. Support from health professionals, family, friends and cancer support services can help during treatment and recovery.

When a cure for cervical cancer isn't possible

If cervical cancer has been diagnosed in its later stages, the cancer may have spread to the point where a cure is no longer possible.

Treatment then focuses on improving quality of life by relieving the symptoms. This is called palliative treatment.

HPV vaccine

The human papillomavirus (HPV) vaccine helps prevent the types of HPV that cause most of the HPV-related cancers and disease in people of all genders.

The HPV vaccine is most effective when given to adolescents before they become sexually active (before exposure to the virus). The recommended age is 9 to 25 years.

For most people, a single dose of HPV vaccine provides good protection from HPV infection, however people with significant immunocompromising conditions are recommended to receive three doses.

In Victoria, the HPV vaccine is available for free to all adolescents in year 7 of secondary school (aged 12 to 13 years). The vaccine is also available in GP and local council clinics and some pharmacies.

People (under 26 years) who missed the HPV vaccine at school can access free catch-up vaccination from their GP, local council or in some pharmacies.

Where to get help

• Your GP (doctor)
• Sexual Health Victoria (SHV) – to book an appointment call SHV Melbourne CBD Clinic Tel. (03) 9660 4700 or call SHV Box Hill Clinic Tel. (03) 9257 0100 or (free call) Tel. 1800 013 952 These services are youth friendly
• Local community health centre or women's health nurse
• National Cervical Screening Program Tel. 1800 627 701
• Cancer Council Victoria Tel. 13 11 20
  • Cancer support
  • Support in your own language Tel. 13 14 50
  • Cervical cancer
  • Find a cervical screening test provider
• WeCan – helps people affected by cancer find the information, resources and support services they may need following a diagnosis of cancer