Cervical cancer is the growth of abnormal cells in the lining of the cervix. The cervix is a part of the female reproductive system that connects the uterus to the vagina. It has many important functions, including fluid production for vaginal health, mucus production to assist sperm in the fertilisation process, and it acts as a barrier to hold the baby in the uterus until birth.
The most common type of cervical cancer is squamous cell carcinoma (cancer arising from the squamous cells that line organs). These cells are found on the outer surface of the cervix, called the ectocervix. A less common subtype of cervical cancer is adenocarcinoma (cancer arising from mucus-producing glands in organs). These cells line the inner surface of the cervix, which is known as the cervical canal or the endocervix. Most cervical cancers start in-between the ectocervix and endocervix in an area called the transformation zone.
Cervical cancers are most commonly diagnosed in women over 30, however, it can affect anyone with a cervix – including women, teenagers, transgender men, and intersex people - at any age.
Treatment
If cervical cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cervical cancers can be staged using the Federation of Gynecology and Obstetrics (FIGO) system from stage I to IV:
- Stage I: cancer cells are confined to cervix tissue only. This stage is also known as early-stage cancer.
- Stage II: cancer cells have spread to the upper two-thirds of the vagina and/or other nearby tissue. This is also known as localised cancer.
- Stage III: the cancer has become larger and has spread to lower third of the vagina and/or the side of the pelvic wall. Lymph nodes and kidneys may be affected. This is also known as advanced or metastatic cancer.
- Stage IV: the cancer has spread to the bladder or rectum, or to more distant organs, such as the lungs or the liver. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including fertility, type, stage of disease and overall health.
Treatment options for cervical cancers may include:
- Surgery, potentially including:
- Cone biopsy (a cone-shaped piece of tissue is removed – used for very early-stage cancers).
- Trachelectomy (removal of part or all of the cervix, and the upper portion of the vagina).
- Total hysterectomy (complete removal of the cervix and uterus).
- Radical hysterectomy (complete removal of the cervix, uterus, and soft tissue surrounding the cervix and upper part of the vagina).
- Bilateral salpingectomy (removal of both fallopian tubes).
- Bilateral salpingo-oophorectomy (removal of both fallopian tubes and ovaries).
- Radiation therapy.
- Chemotherapy.
- Targeted therapy, potentially including bevacizumab.
- Clinical trials.
- Palliative care.
For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.
Cervical Cancer Treatment and Fertility
Treatment for cervical cancer may make it difficult to become pregnant. If fertility is important to you, discuss your options with your doctor prior to the commencement of treatment.
Risk factors
Most cases of cervical cancer are caused by an infection with a human papillomavirus (HPV), which is a sexually transmitted disease (STD). HPV is a group of viruses that can affect various areas of the body, such as the cervix, vagina, and skin. It is often asymptomatic. Most people with HPV will not develop cervical cancer.
Other risk factors for cervical cancer may include:
- Smoking or passive smoking.
- Prolonged oral contraceptive use.
- Having a weakened immune system.
- Exposure to diethylstilbestrol (DES).
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Diethylstilbestrol (DES) exposure
Diethylstilbestrol (DES) is a synthetic form of the female hormone estrogen. It was prescribed to pregnant women between 1940 and 1971 to prevent miscarriage, premature labour, and related complications of pregnancy. The use of DES declined after studies in the 1950s showed that it was not effective in preventing these problems.
In 1971, researchers linked prenatal (before birth) DES exposure to a type of cancer of the cervix and vagina called clear cell adenocarcinoma in a small group of women. Soon after, the Food and Drug Administration (FDA) notified physicians throughout the country that DES should not be prescribed to pregnant women. The drug continued to be prescribed to pregnant women in Europe until 1978.
Women who have taken DES, and women whose mothers took DES whilst pregnant, may be at higher risk of cervical cancer, as well as other conditions.
Early symptoms
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.
While uncommon, advanced cervical cancer may cause the following symptoms:
- Excessive tiredness.
- Leg pain or swelling.
- Lower back pain.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have cervical cancer, they may order the following tests to confirm the diagnosis and refer you to a specialist for treatment.
Colposcopy
A colposcopy is a type of pelvic examination that looks closely at the cervix and vagina. Your doctor will use a speculum to separate the walls of the vagina, and apply a vinegar-like liquid and iodine to the cervix and vagina to help highlight any abnormal areas. The colposcope (a microscope with a light) is placed near your vulva, but does not enter your body. If any abnormalities are observed, a biopsy may be taken.
Imaging & blood tests
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), pelvic ultrasound (including abdominal and trans-vaginal ultrasounds) and/or positron emission tomography (PET scan), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis. Additionally, a blood test may be taken to assess your overall health and help guide treatment decisions.
Biopsy
Once the location of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. This is often done by a fine needle aspiration (FNA), a core needle biopsy (CNB), or during a procedure (such as a colposcopy or large loop excision of transformational zone (LLETZ)). These samples will then be analysed for cancer cells.
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage cervical cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
References
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.