Cervical cancer is the growth of abnormal cells in the lining of the cervix. These abnormal cells can develop into tumours and in worst case scenarios – spread throughout the body. The cervix is part of the female reproductive system and is the narrow lower portion (or “neck”) of the uterus.
The cervix is the narrow, lower part of the uterus, which connects to the upper end of the vagina. This is often referred to as the neck of the womb and is apart of the female reproductive system. It has an inner surface that is facing into the uterus, which is called the cervical canal – whilst the outer surface opens into the vagina. The cervix has various functions including:
- Producing moistness to lubricate the vagina
- Producing mucus that helps sperm travel up to the Fallopian tube to fertilise an egg from an ovary
- Holding a developing baby in the uterus during pregnancy
- Widening so the baby can be born via the birth canal (vagina).
Two types of cells, which line the surfaces of many organs and body systems, cover the cervix:
- Squamous cells: these are flat, thin cells found in the outer layer of the cervix that opens into the vagina
- Glandular cells or columnar cells: column-shaped cells that produce cervical mucus and are found in the cervical canal
How do you get cervical cancer?
Factors contributing to cervical cancer:
- Human Papillomavirus (HPV)
- Weak Immune System
- Family History
- Diethylstilboestrol (DES)
Human Papilloma Virus (HPV)
Long term infection with certain types of the Human Papillomavirus (HPV) is now known to be the cause of almost all cervical cancers. Almost all abnormal Pap test results are caused by HPV. Anyone who has ever had sex can have HPV as it is commonly spread by sexual contact even though people may not be aware of any signs of symptoms at all. In rare cases, if the virus persists and is left undetected, it can lead to cervical cancer. This usually takes about 10 years but in some cases can happen quicker than that. While HPV is very common, most women with HPV will not develop cervical cancer. Interestingly and astonishing – about 80% of people will come into contact with HPV at some point in their lives! Every man and woman, young and old, need to know how to reduce the risk of HPV and cervical cancer. A Pap test is performed to detect early cell changes, which could potentially develop into cervical cancer. There are different types of early cell changes, which are also called epithelial abnormalities. They are the following:
- Atypia: The cervical cells have changed slightly. The cells may return to normal by themselves, but they may worsen. If a cell shows signs of atypia, it doesn’t necessarily mean you have cancer or will get cancer. Atypia can also be caused by infection or irritation.
- Squamous abnormalities: The squamous cells of the cervix are abnormal. This may be classified as a low-grade or a high-grade abnormality on a Pap test. High-grade abnormalities are pre-cancerous, and although they don’t usually cause symptoms they can sometimes progress to early cervical cancer if they’re not detected and treated appropriately.
These squamous changes are also called Cervical Intraepithelial Neoplasia (CIN) and are graded according to how severe they appear on a biopsy of the tissue. Early changes are categorised as CIN 1 and these will usually disappear without treatment. Further abnormal changes are categorised as CIN 2 or CIN 3.
- Glandular abnormalities: The glandular cells of the cervix are abnormal. These abnormalities on a Pap test always require further assessment, as they may be either pre-cancerous or cancerous.
If your Pap test does come back as abnormal then your doctor will most probably recommend one of these actions:
- Another Pap test in 12 months time to monitor the cells
- Treatment right away
- A biopsy to look at the cervical cells in more detail under a microscope.
What is the HPV virus?
Human papillomavirus (HPV) is a very common virus, with four out of five people having it at some stage in their lives. In some cases, it can increase a woman’s risk of cervical cancer. However, most women with HPV do not develop cervical cancer. HPV is passed on through genital skin contact and is so common that it could be considered a normal part of being sexually active.
After entering the body, HPV will behave in one of two ways: either remaining dormant (inside the body’s cells), or becoming active. When active, warts can develop or it can affect cervical cells. It can take many years for the virus to become active and its presence is usually short-lived. In most cases the body takes between 8 to 14 months to clear the virus naturally.
Most people will have HPV at some time in their lives and never know it. You may become aware of HPV if you have an abnormal Pap test result, or if genital warts appear. Once you have been exposed to a particular type of HPV, you are unlikely to catch it again, as the body usually becomes immune to that type. There are about 100 different strains of HPV. Fortunately, the HPV vaccine (Gardasil®) protects against two of the main HPV types that cause 70-80% of cervical cancer.
Does everyone with HPV get cervical cancer?
No. HPV is an extremely common virus that in most cases will remain undetected and clear up naturally. Some strains of HPV cause genital warts. However, HPV will typically remain present in the body without showing any symptoms. Regular Pap tests can detect the presence of HPV and any abnormalities in the cells of the cervix which may then be treated before becoming cancerous.
How will I know if I have HPV?
Approximately four out of five people will contract HPV at some point in their life. Most of these people will not know that they have contracted the virus and in the majority of cases it will clear up naturally. There are around 100 types of HPV. Some of these can cause genital warts. However, the majority, including those that most commonly lead to cervical cancer, do not carry any noticeable symptoms. The most effective way to detect HPV is through regular Pap tests, 2 yearly or as recommended by your doctor.
Does smoking affect my chances of getting cervical cancer?
Chemicals in tobacco can damage the cells of the cervix and increase the chance of cancer cell development.
Does family history play a part?
If you have a first-degree relative (mother or sister) who has had cervical cancer, you have an increased chance of also developing cervical cancer.
What is Diethylstilboestrol (DES) exposure?
DES is an oestrogen-based medication prescribed to women from the 1950s to the early 1970s to prevent miscarriage. Although rare, studies have shown that the daughters of women who took DES have an increased risk of developing a rare type of adenocarcinoma.
Are there any symptoms of cervical cancer?
If early cell changes develop into cervical cancer, the most common symptoms that might be present are:
- vaginal bleeding between periods or after menopause
- pain during intercourse
- excessive tiredness
- lower back pain
- bleeding after intercourse
- unusual vaginal discharge
- leg pain or swelling
These symptoms can also be caused by other more common conditions so please don’t panic if you do experience them. However, see your general practitioner (GP) if you’re worried or if the symptoms are ongoing. If necessary, your GP will refer you for further tests. In many cases cervical cancer does not usually carry any external symptoms until it is in advanced stages, and so the best way to detect changes to the cervix cells is through the recommended 2-yearly pap test.
What types of cervical cancer are there?
The two main types of cervical cancer are named after the cells they start in:
- Squamous cell carcinoma: The most common type, accounting for about eight out of ten cases.
- Adenocarcinoma: A less common type, starting in the glandular cells. It’s difficult to diagnose, as it’s high in the cervix and hard to reach with the tools used for testing.
How common is cervical cancer?
The Australian Institute for Health and Welfare
(AIHW) reported that in 2009, 631 Australian women were diagnosed with cervical cancer and in 2009, 152 women died. It ranks as the 15th most frequent cancer among women in Australia and the 5th most frequent between women from 15-44 years of age. About 5% of Pap tests are diagnosed as being abnormal. In 2009, 2,086,583 Pap tests were conducted and of these 112,000 were diagnosed as being abnormal of which 84,000 were low-grade abnormalities and 28,000 were high-grade abnormalities or cervical cancer. It is believed that over 300,000 women a year worldwide die of cervical cancer, which means a woman dies every 2 minutes. In developing countries where vaccines and screening are usually not available, cervical cancer is one of the leading cancer killers of women.
Is cervical cancer considered a sexually transmitted disease (STD)?
No. Cervical cancer is not a sexually transmitted disease. Cervical cancer is caused by Human Papillomavirus, which is contracted through sexual contact. For more information about cervical cancer please visit the Cancer Council