Cervical cancer

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 771 new cases of cervical cancer diagnosed in Australia in 2009. The risk of a woman being diagnosed by age 85 is 1 in 162.

In 2007, there were 208 deaths caused by cervical cancer in Australia. Cervical cancer death rates in Australia have 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

Vaccines have been developed that prevent the types of HPV most commonly linked to cervical cancer. Through the National Immunisation Program, most girls in Australia will receive a HPV vaccine around the age of 12. From 2013, boys will be included in the National HPV Immunisation Program

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. In Australia, the five year survival rate for women diagnosed with cervical cancer is 72%.

Treatment for cervical cancer 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).

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For more information

Sources

Australian Institute of Health and Welfare 2012. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Cancer Series no. 69. Cat. no. CAN 65. Canberra: AIHW.
Australian Institute of Health and Welfare (AIHW) 2012. ACIM (Australian Cancer Incidence and Mortality) Books. AIHW: Canberra.
Australian Institute of Health and Welfare & Australasian Association of Cancer Registries 2012. Cancer in Australia: an overview, 2012. Cancer series no. 74. Cat. no. CAN 70. Canberra: AIHW.

This page was last updated on: Tuesday, April 16, 2013