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Cervical cancer is the growth of abnormal cells in the lining of the cervix. The most common cervical cancer is squamous cell carcinoma, accounting for 70% of cases. Adenocarcinoma is less common and more challenging to diagnose because it starts higher in the cervix.

It is estimated that there will be 913 cases of cervical cancer diagnosed in Australia in 2021.  The risk of a woman being diagnosed by age 85 is 1 in 162.

The incidence of cervical cancer has significantly decreased since the National Cervical Screening Program began in 1991. Also, with the National Human Papilloma Virus (HPV) vaccine program introduced in 2007. 

Treatment

Treatment for cervical cancer may make it more difficult to become pregnant. If fertility is important to you, talk to you doctor before treatment commences.

If cervical cancer is detected, it will be staged, from stage 0, which means abnormal cells are found only in the surface 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. Staging helps your doctors determine the best treatment for you.

Treatment depends on the disease stage. For early and non-bulky disease (less than 4cm), treatment is surgery, sometimes with chemoradiation therapy afterwards. For locally advanced disease, a combination of radiation therapy (radiotherapy) and chemotherapy (cisplatin) is used. For metastatic disease, the treatment is chemotherapy (platinum/fluorouracil) or palliative care alone.

Surgery

For some women, surgery may be the only treatment needed. Surgery is usually recommended for women who have a tumour that is in the cervix only. The type of surgery you have will depend on how far within the cervix the cancer has spread. Your surgeon will talk to you about the most appropriate surgery, as well as the risks and any possible complications (in both the short and long term).

The primary type of surgery is called a hysterectomy, which is done under general anaesthetic. A hysterectomy is an operation to remove the uterus (womb) and cervix. The surgeon may also remove other organs of the reproductive system or the lymph glands on the sidewall of the pelvis.

Radiation therapy

Also called radiotherapy, radiation therapy for cervical cancer uses x-rays to kill or damage cancer cells. Radiation is targeted at the parts of the body with cancer or areas the cancer cells might have spread. Treatment is carefully planned to do as little harm as possible to healthy tissues.

You may have radiation therapy on its own as the primary treatment for cervical cancer, or you may have it after surgery to help get rid of any remaining cancer cells. Women with cervical cancer that has spread to the tissues or lymph nodes surrounding the cervix will usually have radiation therapy combined with chemotherapy (chemoradiation) to reduce the chance of the cancer coming back.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells or slow their growth while causing the least possible damage to healthy cells. Chemotherapy may be given if the cervical cancer is advanced or returns after treatment and may be combined with radiation therapy.

Targeted therapy

Targeted therapy drugs affect specific molecules within cells to block cell growth. They are used to treat some women with cervical cancer that has spread to other parts of the body or has come back and cannot be treated by surgery or radiation therapy.

Cancers develop their own blood vessels to help them grow. This process is called angiogenesis. Some targeted therapy drugs known as angiogenesis inhibitors are designed to stop this process.

Bevacizumab is an angiogenesis inhibitor that can be used to treat advanced cervical cancer. It is given with chemotherapy every three weeks through a drip into a vein (infusion). The total number of infusions you receive will depend on how you respond to treatment.

Palliative care

Palliative treatment helps improve people's quality of life by managing the symptoms of cancer without trying to cure the disease.

As well as slowing the spread of cancer, palliative treatment can relieve any pain and help manage other symptoms. Treatment may include radiation therapy, chemotherapy, targeted therapy or other medicines such as hormone treatment.

Palliative treatment is one aspect of palliative care, in which a team of health professionals aim to meet your physical, emotional, practical and spiritual needs. The team also provides support to families and carers.

Risk factors

Almost all cases of cervical cancer are caused by persistent infection with some high-risk types of the human papillomavirus (HPV); this is the biggest risk factor for cervical cancer.

Around eight out of 10 women will become infected with genital HPV at some time in their lives. Most women who have the HPV infection never get cervical cancer; only a few types of the HPV result in cervical cancer.

Other risk factors include:

  • Smoking and passive smoking - Chemicals in tobacco can damage the cells of the cervix, making cancer more likely to develop in women with HPV.
  • Long-term use of oral contraceptive (the pill) - Research has shown that women who have taken the pill for five years or more are at increased risk of developing cervical cancer. However, the risk is small and the pill can also help protect against other types of cancer, such as uterine and ovarian cancers. 
  • Having a weakened immune system - The immune system helps rid the body of HPV. Women with a weakened immune system have an increased risk of developing cervical cancer and need more frequent cervical screening tests. This includes women with the human immunodeficiency virus (HIV) and women who take medicines that lower their immunity. Ask your doctor if this applies to you and how often you should have a screening test.
  • Exposure to diethylstilbestrol (DES) - DES is a synthetic (artificial) form of the female hormone oestrogen. DES was prescribed to pregnant women from the 1940s to the early 1970s to prevent miscarriage. Studies have shown that the daughters of women who took DES have a small but increased risk of developing a rare type of cervical adenocarcinoma.

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 general practitioner (GP) if you are concerned.

Diagnosis/diagnosing

You may have tests for cervical cancer because you have symptoms or because your cervical screening test results suggest that you have a higher risk of developing cervical cancer.

Some tests allow your doctor to see the tissue in your cervix and surrounding areas more clearly. Other tests tell the doctor about your general health and whether the cancer has spread. 

Screening for cervical cancer

Cervical screening is the process of looking for cancer or precancerous changes in women who don't have any symptoms. The cervical screening test detects cancer-causing types of human papillomavirus (HPV) in a sample of cells taken from the cervix.

Colposcopy

A colposcopy identifies where abnormal cells are located in the cervix, and what they look like. A speculum is inserted into your vagina so that the doctor can view the cervix and vagina via a colposcope, an instrument that magnifies the area, like binoculars. It is placed near your vulva but is not put inside your body.

Biopsy, cone biopsy or large loop excision of the transformation zone (LLETZ)

A biopsy is when the doctor removes some tissue from the surface of the cervix and sends it to a laboratory for examination under a microscope. The biopsy may be done during the colposcopy.

LLETZ is the most common method to remove cervical tissue for examination and treating precancerous changes of the cervix. It is usually done under a local anaesthetic.

A cone biopsy is used where there are abnormal glandular cells in the cervix or if early-stage cancer is suspected.

Further tests to see if cervical cancer has spread

If any of these tests or procedures show that you have cervical cancer, you may need further tests to find out whether the cancer has spread to other parts of your body. These tests include Blood tests, Imaging scans or an examination under anaesthetic.

Prognosis (Certain factors affect the prognosis and treatment options)

Cervical cancer can be effectively treated when found early. Most women with early cervical cancer will be cured. The five year survival rate for cervical cancer is 74%.

References

Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.