CERVICAL CANCER

The information on cervical cancer on this website is not designed to provide medical or professional advice. It is designed to provide information only and if you have any health questions or problems please consult a medical doctor.

What is cervical cancer?

The cervix is the lower part of the uterus which protrudes into the inner end of the vagina and it forms the neck of the uterus. Cervical cancer occurs in the cells that forms the cervix. Cervical cancer is one of the most preventable cancers and it grows slowly over many years.

The main types of cervical cancer are called:

• Squamous cell carcinoma (which occurs in the squamous cells lining the outer surface of the cervix) and accounts for approximately 80% of all cervical cancers.
• Adenocarcinoma (which occurs in the glandular cells of the cervix lining the inner surface of the cervix) accounts for approximately 20% per cent of cervical cancers.
• Neuroendocrine or small cell cervical cancer which is rare but very aggressive.
• other cervical cancers which are very very rare.

Cervical cancer in Australia

Since the introduction of the National Cervical Screening program in 1991, the number of women found to have the common most cervical cancer has fallen by 50%. In Australia in 2016, 903 women were diagnosed with cervical cancer and 250 women died from cervical cancer the same year. In 2017, it is estimated that 912 new cases of cervical cancer will be diagnosed in Australia and it is estimated that there will be 254 deaths.

Australia has the lowest death rates from cervical cancer in the world. {300,000 women a year worldwide die of cervical cancer, that is, a woman dies every 2 minutes due to cervical cancer}.

Cervical cancer risk factors

The risk factors for cervical cancer include the following;

• Human papillomavirus (HPV) infection - HPV infection is found in almost all cases of cervical cancer and there's a strong association between persistent infection with certain types of HPV with cervical cancer. Even though HPV is a very common virus, most women with HPV do not develop cervical cancer. It is passed on through genital skin contact and its presence is usually short-lived and in most cases the body takes between 8 to 14 months to clear or get rid of the virus naturally. There are about 200 different strains of HPV and only a few strains are associated with cervical cancer. The main culprits are HPV type 16 and 18 which result in 75% of cervical cancer cases and HPV type 31 and 45 which causes about 10% of cervical cancer cases.
• Increasing age - the risk of a woman being diagnosed with cervical cancer by age 85 is 1 in 168 and cervical cancer is more common in women over the age of 35years.
• Smoking (both active and passive) - chemicals in cigarettes can damage cells of the cervix causing them to become cancerous resulting in about two to three times increased risk.  Chemicals in cigarettes also makes cells in the cervix that fight infection less able to fight the infection.
• Lowered immunity - this result in the body not being able to clear the HPV infection quickly enough leading to persistent infection.
• Family history - you are at in increased risk of developing cervical cancer if you have first degree relatives who have had cervical cancer.
• Medication - being a daughter of a woman who took an oestrogen-based medication called DES that was prescribed to women from the 1950s to the early 1970s to prevent miscarriages, has been associated with an increased risk of developing a rare type of cervical adenocarcinoma.
• Oral contraceptives in HPV infected women - long term usage of oral contraceptive pills is linked with an increased risk of cervical cancer, for example using oral contraception for five to nine years increases one 's risk by three times and by four times if one uses the contraception pill for more than ten years. It is known that 1 in 10 cases of cervical cancer is somewhat linked to taking the oral contraceptive pill.
• Multiple Pregnancies in HPV infected women - having many children is linked with an increased risk of cervical cancer in HPV infected women, for example, having seven or more children increases one 's risk of developing cervical cancer by four times.
• Having many sexual partners and starting sex at a very young age is linked to high chances of developing cervical cancer as both are associated with increased risk of HPV infection.
• Not having regular pap-smears.
• Having had cervical cancer in the past and previous other cancers - cervical cancer risk is higher in those who have survived other cancers such as vaginal, kidney, urinary tract and skin cancers.
• Other sexually transmitted diseases - there is an increased risk of developing cervical cancer in women with other sexually transmitted diseases such as chlamydia.
• Social class - cervical cancer is more common in poor communities than in rich and wealth communities.
• Overweight - women who carry extra weight are more likely to develop cancer of the cervix.
• Diet - women who do not have a diet which includes fruits and vegetables may be at an increased risk of developing cervical cancer.

Cervical cancer symptoms

There are no specific symptoms for cervical cancer. In the early stages of cervical cancer there are no symptoms at all. Later on symptoms may occur and if they occur they may include:

• vaginal bleeding between your periods
• vaginal bleeding after menopause
• heavy periods than usual
• longer lasting periods than usual
• unusual vaginal discharge
• pain during intercourse
• vaginal bleeding after intercourse
• pelvic pain
• excessive tiredness
• leg pain or swelling
• lower back pain

The last 3 symptoms usually occur in advanced cervical cancer.

Cervical screening

1. Cervical screening is designed to reduce the number of women who develop or die from cervical cancer.
2. Cervical screening is accomplished by testing for the human papillomavirus (HPV) test for women aged 25 to 74 years old every 5years.
3. Cervical screening is provided in general practice, community or women's health center, family planning clinic, sexual health clinic or Aboriginal Medical Service.
REMEMBER cervical screening does not DETECT ovarian cancer OR sexually transmitted infections AND if you have any symptoms please see a medical doctor.
4. HPV vaccinated women still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.

Cervical cancer Prevention

• Sexual abstinence - this eliminates the risk of developing cervical cancer by reducing infection from the HPV.
• Safe Sex - HPV is spread through unprotected sex and there is proven strong association between certain types of HPV and abnormalities that may develop into cervical cancer.
• Cervical Screening - regular cervical screening is the only way to detect and prevent cervical cancer.
• HPV vaccination - HPV vaccination provides protection against the main strains of HPV that are associated with most cases of cervical cancer. The vaccines currently available in Australia are Gardasil and Cervarix and they available through the National Immunization Program for both girls and boys in high school (boys have been included as they can transmit the HPV and it also helps prevent some HPV-related cancers and disease that affect men).

Cervical cancer diagnosis

There are several tests that are used to diagnose cervical cancer namely:

• Colposcopy
• Biopsy- samples of tissue from the cervix are taken and sent to pathology labs for testing. There are two types of biopsies namely,

1. cone biopsy
2. large loop excision of the transformation zone

Cervical cancer prognosis

In Australia, the five year survival rate for women diagnosed with cervical cancer is 72% for non-indigenous women and 27% for Indigenous women. Cervical cancer can be effectively treated and cured if it's found early and most women with early cervical cancer are cured.
In the UK 
Stage 1 cervical cancer - 95% of women will survive their cancer for 5 years or more after diagnosis.
Stage 2 cervical cancer - 50% of women will survive their cancer for 5 years or more after diagnosis
Stage 3 cervical cancer - 40% of women will survive their cancer for 5 years or more after diagnosis
Stage 4 cervical cancer - 5% of women will survive their cancer for 5 years or more after diagnosis

Cervical cancer treatment

Treatment of cervical cancer depends on staging, that is, how far the cervical cancer has spread or not in your body and it includes:

• Surgery cone biopsy, hysterectomy
• Radiation
• Chemotherapy
• Palliative Care

Help

You are able to get help if you have cervical cancer from various professionals and organizations such as:
1. Doctor
2. Gynecologist/Oncologist
3. Local community health center
4. Cancer Council of Australia: Tel - 13 11 20 (http://www.cancer.org.au) and States organizations

Summary

• A pap-smear is a very easy and fast way to screen for cervical cancer.
• Changes in the cervix does not necessarily mean that you will develop cervical cancer.
• HPV infection in the cervix does not necessarily mean that you will develop cervical cancer.
• Most HPV infection in the cervix goes away by themselves after several months.
• Most women diagnosed with cervical cancer haven't had regular pap-smear tests.
• The National Cervical Screening Program recommends that all women aged between 25 and 74 years have a HPV test every 5 years, even if they have had the HPV vaccine.