The most common cervical cancer is squamous cell carcinoma, accounting for 80% of cases. Adenocarcinoma is less common and more difficult to diagnose because it starts higher in the cervix.
Incidence and mortality
There were 739 new cases of cervical cancer diagnosed in Australia in 2007. The risk of a woman being diagnosed by age 85 is 1 in 158.
In 2007, there were 208 deaths from cervical cancer. Cervical cancer death rates have more than halved since the National Cervical Screening Program began in 1991.
Screening
The National Cervical Screening Program recommends Pap tests for all women 18-70 years of age who have ever had sex and have not had a hysterectomy. Women should start having Pap tests every two years from 18-20 years of age, or one to two years after sexual activity commences, whichever is earlier.
Symptoms and diagnosis
Early changes in cervical cells rarely cause symptoms. If early cell changes develop into cervical cancer, the most common signs include:
- vaginal bleeding between periods
- menstrual bleeding that is longer or heavier than usual
- bleeding after intercourse
- pain during intercourse
- unusual vaginal discharge
- vaginal bleeding after menopause
- excessive tiredness
- leg pain or swelling
- low back pain.
The usual tests to diagnose cervical cancer are:
- colposcopy
- biopsy, cone biopsy or large loop excision of the transformation zone.
Staging
After cervical cancer is diagnosed, one or more of the following tests are used to determine the extent of the cancer (its stage):
- blood tests
- examination under anaesthetic (cystoscopy and proctosigmoidoscopy)
- chest x-ray
- CT scan
- MRI
- PET scan.
If cervical cancer is detected, it will be ‘staged’, from stage 0, which means abnormal cells are found only in the first layer of cells lining the cervix to stage IV, which means the cancer has spread to nearby organs such as the bladder or rectum or possibly other organs.
Causes
The cause of cervical cancer is unknown. Factors that put some women at a higher risk of cervical cancer include:
- infection with the human papilloma virus (HPV)
- being the daughter of a woman who used the drug diethylstilboestrol (DES) during pregnancy to prevent a miscarriage
- smoking, which increases the risk of cervical cancer fourfold.
Around eight out of 10 women will become infected with genital HPV at some time in their lives. It causes no symptoms. Most women who have the HPV infection never get cervical cancer; only a few types of the HPV result in cervical cancer.
Prevention
A vaccine has been developed that prevents the types of HPV most commonly linked to cervical cancer. Through the National Immunisation Program, most girls in Australia will receive the vaccine around the age of 12.
Treatment
Treatment depends on disease stage.
For early and non bulky disease (less than 4cm), treatment is surgery, sometimes with chemoradiotherapy afterwards.
If the tumour is small, a cone biopsy may suffice; in some cases hysterectomy (surgical removal of the uterus) is required.
For locally advanced disease, a combination of radiotherapy and chemotherapy (cisplatin) is used.
For metastatic disease, the treatment is chemotherapy (platinum/fluorouracil) or palliative care alone.
Prognosis
An individual’s prognosis depends on the type and stage of cancer as well as their age and general health at the time of diagnosis. Cervical cancer can be effectively treated when it is found early. Most women with early cervical cancer will be cured. However, treatment may make it more difficult, or impossible, to become pregnant.
For more information, contact Cancer Council Helpline on 13 11 20 (cost of a local call).