What is Cervical Cancer?

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 a part 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

The risk factors associated with cervical cancer are:  

• Infection with the Human Papillomavirus (HPV)
• Smoking
• Weak immune system
• Family history
• Exposure to Diethylstilboestrol (DES)
• Lack of regular cervical screening tests

Nearly all cases of cervical cancer are caused by an infection with the Human Papillomavirus (HPV).

HPV is an extremely common group of viruses that can affect both males and females. In fact, up to 80% of people will be infected with at least one type of HPV at some point in their lives.

There are over 100 different strains of HPV, which affect different parts of the body.

Some types of HPV are completely harmless and many have no symptoms. Other types of HPV cause common warts on the hands and feet.

Approximately 40 types of HPV affect the genital area.  Some ‘low risk’ types of HPV (HPV 6 & 11) are responsible for genital warts in both men and women.

The types of HPV that affect the genitals are transmitted via direct skin-to-skin contact with the genital area. This means that is possible to contract genital HPV without having intercourse.

Because the types of HPV that affect the genitals are transmitted through sexual contact; HPV can lead to other cancers including penile cancer in men, as well as anal cancer and head, neck, throat and mouth cancers in men and women.

You may become aware of HPV if you have a positive Cervical Screening Test result, or if genital warts appear.

To read more about HPV please visit: http://www.hpv.com.au/

After entering the body, HPV will behave in one of two ways: either remaining dormant (inside the body’s cells), or becoming active. It can take many years for the virus to become active and its presence is usually short-lived. Once you have been exposed to a particular strain of HPV, you are unlikely to catch it again, as the body usually becomes immune to that type.

In the most cases, the body’s immune system will clear the virus from the body naturally within 8 to 14 months. If the immune system does not clear a HPV infection, it can cause normal cells in the lining of the cervix to turn abnormal, which in rare cases can develop into cervical cancer. It usually takes 10 to 15 years for HPV to develop into cervical cancer. Most women who contract HPV do not develop cervical cancer.

Fortunately, the HPV vaccine (Gardasil 9®) protects against nine of the main HPV types that cause 90% of 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 cervical screenings can detect the presence of HPV and any abnormalities in the cells of the cervix which may then be treated before becoming cancerous.

There are different types of early cell changes, which are also called epithelial abnormalities. They are characterised as the following:

• Atypia:The cervical cells have changed slightly. The cell changes may spontaneously regress naturally, but in some cases can 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 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 require further assessment, as they may be either pre-cancerous or cancerous.

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 cervical screenings, 5 yearly or as recommended by your doctor.

Chemicals in tobacco can damage the cells of the cervix and increase the chance of cancer cell development.

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.

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.

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.

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 270,000 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.