Cervical cancer

Last updated 26 May 2016 — Last reviewed 24 February 2014

Cervical cancer is a cancer that develops in a woman’s cervix. It is the second most common cancer experienced by women worldwide. The most common cause of cervical cancer is the human papilloma virus (HPV). Regular Pap smear tests are vital to check on changes to the cells in your cervix and alert you if there are any abnormal cells. Cervical cancer vaccines are now also available.

What is cervical cancer?

female reproductive systemCervical cancer (cancer of the cervix) is a cancer that develops in a woman’s cervix. The cervix is the entrance to the uterus (womb) from the vagina.

Over time the cells of the cervix change and in some cases the changed cells can become cancerous.

Cervical cancer is the second most common cancer experienced by women worldwide. In Australia every year, around 800 women are diagnosed with cervical cancer.

It can be prevented by regular Pap smear tests to detect early changes in the cells in the cervix. 

There are two forms of cervical cancer

  • Squamous cell carcinoma (80-85% of cases)  
  • Adenocarcinoma (12-15% of cases)

Cancer of the cervix is very rare in women under the age of 25, it mostly occurs in women aged 55-60. 

What causes cervical cancer? 

Cervical cancer is almost always caused by the human papilloma virus (HPV).

HPV is a common sexually transmitted infection that affects the surface cells of the genital area including the cervix, vagina and vulva. It can also cause visible warts.

HPV is very common in women aged 20-30 and four out of five women will be exposed to the virus at some point in their lifetime. While HPV is common, most women with the infection do not go on to develop cervical cancer. Only certain types of HPV cause cancer.

Cervical cancer usually occurs many years after the infection caused by the HPV virus.

What increases your risk of cervical cancer?

  • Smoking
  • Not having regular Pap tests
  • Age (more common in women over 35 years)
  • Exposure to DES (a drug given to women from the 1940s-1970s to prevent miscarriage)

Diagnosis

Cervical cancer, especially in the early stages, may not have any obvious symptoms and is most commonly identified because of a Pap smear test. In most cases vaginal bleeding (often following sex) is the first noticeable symptom of cervical cancer so this should always be discussed with a doctor. 

If abnormal or cancerous cells are detected from a Pap test, your doctor will refer you to a specialist, usually a gynaecologist who specialises in cancer treatment.  

Prevention of cervical cancer: the cervical cancer vaccine  

Because most cervical cancers are caused by the human papilloma virus (HPV), one form of prevention involves vaccination against the virus. There are different types of HPV and there are two types of cervical cancer vaccines – Gardasil and Cervarix – to protect against these.

Vaccine Protection against HPV type Use Cost: $150 per dose Dosage
Gardasil

6, 11, 16 and 18

  • types 6 and 11 are known to cause up to 90% of genital warts
  • types 16 and 18 cause around 70% of cervical cancer cases
  • Approved for use in females aged 9-26
  • It is recommended girls have the vaccine between 9-12
  • Best given before becoming sexually active
Free to all Year 7 girls. Three separate doses over a period of 6 months.
Cervarix

16 and 18

  • types 16 and 18 cause around 70% of cervical cancer cases
 

Approved for use in women aged 27-45 years.

Not covered by Australian government vaccination program.

Do you still need to have Pap smear tests if you have had the vaccine? 

Even if you have had the vaccine (either before or after becoming sexually active), you need to continue to have regular Pap smear tests once every two years because the vaccine only protects against 70% of cervical cancers.

Prevention of cervical cancer: detection of cervical changes

Regular screening or Pap smear tests can prevent 9 out of 10 cervical cancers. Most women diagnosed with cervical cancer have not had regular Pap smear tests.

A Pap test checks for changes to the cells of the cervix, it does not test for or diagnose cervical cancer.  These changes can almost always be treated if found early.

For information on pap smear tests see our webpages in Health checks.

Does an abnormal Paptest result mean cervical cancer? 

Not necessarily but, an abnormal Paptest result means there is some change in the cells taken from the cervix.

Cervical cells turn over or regenerate rapidly, and in this process can become abnormal or changed.

There are many reasons for a change or difference including:

  • infection
  • inflammation
  • pre-cancerous changes

The abnormal changes are classified according to the changes seen in the surface cells (squamous cells) of the cervix.

Previously changes in the cervical surface (squamous) cells were described as dysplasia and Cervical Intraepithelial Neplasia (CIN). The degree and extent of abnormality seen on a Pap smear test was formerly referred to as mild, moderate or severe dysplasia.

Current terminology to describe cervical changes is as follows:

  • Squamous intraepithelial lesion (SIL): low grade and high grade
    • 'squamous' describes the type of cell in the surface lining of the cervix
    • 'intraepithelial' describes the cells in the lining tissue of the cervix
Change What it means What to do
Low-grade or LSIL
(previously known as mild dysplasia or CIN1).

These are:

  • Non-specific minor changes such as inflammation
  • Changes to less than 1/3 of the surface cells including human papilloma virus (HPV) associated changes
  • In 60% of women the change will resolve spontaneously
  • Repeat Pap smear tests are recommended to follow up these changes:
    • If you are under 30 years you will need another Pap smear test within 12 months
    • If you are over 30 years you will need another Pap smear test within 6-12 months

High–grade or HSIL
(previously known as moderate to severe dysplasia or CIN 2 and CIN 3).

These changes are precancerous and require further investigation.

Investigation by a gynaecologist who is likely to:

  • conduct a colposcopy to create an illuminated and magnified view of the cervix and surrounding tissues in order to examine any lesions (damage)
  • take a biopsy to remove a small amount of tissue from the lesions to confirm the diagnosis

The progression from high-grade changes to cancer takes between one and 30 years with an average of 10 years. This is why it is important to have regular Pap smear tests and have abnormal changes picked up as early as possible.

Treatment for precancerous changes in the cervix

You will be referred to a gynaecologist who specialises in cancer treatment. Treatment options for any confirmed high-grade lesions include:

  • laser therapy
  • electrocoagulation (high frequency electrical current)
  • loop excision
  • removal of the abnormal area on the cervix

Treatment for cervical cancer

This depends on the size and type of cervical cancer but can include:

  • surgery
  • radiotherapy
  • chemotherapy

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at February 2014.

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