Cervical cancer - Cancer Council WA

Understanding cervical cancer

This booklet has been prepared to help you understand more about cervical cancer.

Download: Understanding cervical cancer PDF 633kB

What is cervical cancer?

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 (about 25% of cases) and more difficult to diagnose because it starts higher in the cervix.

It is estimated that more than 900 people were diagnosed with cervical cancer in 2023. The average age at diagnosis is 50 years old.

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

Learn more about how Cancer Council researchers are helping Australia eliminate cervical cancer.

Cervical cancer signs and symptoms

Precancerous changes in cervical cells rarely cause symptoms. The only way to know if there are abnormal cells that may develop into cancer is to have a cervical screening test. 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
pain during intercourse
bleeding after intercourse
pelvic pain
a change in your vaginal discharge such as more discharge or it may have a strong or unusual colour or smell
vaginal bleeding after menopause.

These symptoms can be caused by other conditions but if you are worried or symptoms persist, contact your doctor. This is important for anyone with a cervix, whether you are straight, lesbian, gay bisexual or transgender.

Causes of cervical cancer

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. The other main risk factor for cervical cancer is smoking.

There is some evidence that women who have taken the contraceptive pill for five years or more are at increased risk of developing cervical cancer in people with HPV. The risk is small and taking the pill has also been shown to reduce to risk of other cancers such as ovarian and uterine.

Other risk factors include:

smoking and passive smoking
a weakened immune system
if your mother was prescribed diethylstilbestrol (DES), an artificial form of the female hormone oestrogen during pregnancy (between 1939 and 1971).

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.

Diagnosis of cervical cancer

If your screening test results suggest you have symptoms of cancer you will be referred to a specialist for further tests.

The usual tests to diagnose cervical cancer are:

Colposcopy with biopsy

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. The procedure is done by a colposcopist – usually a gynaecologist or, in some clinics a nurse practitioner.

If the colposcopist sees any suspicious looking areas, they will usually take a tissue sample (biopsy) from the surface of the cervix for examination under a microscope by a pathologist.

Large loop excision of the transformation zone (LLETZ) or cone biopsy

If any of the tests show precancerous cell changes you may have a large loop excision procedure or a cone biopsy.

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.

After a diagnosis of cervical cancer

After finding out you have cervical cancer, you may feel shocked, anxious, upset or confused. These are all normal responses. Everyone reacts differently and there is no right way to feel. You may find it helpful to talk to family and friends about your feeling. Talk about your treatment options with your doctor and seek as much information as you need.

Treatment for cervical cancer

Staging

If cervical cancer is detected, it will be staged, from stage 1, which means abnormal cells are found only in the tissue of the cervix to stage 4 , which means the cancer has spread beyond the pelvis to the lung, liver or bones. This helps your doctors plan the best treatment for you.

Types of treatment

Treatment depends on disease stage. For early and non-bulky disease (less than 4cm), treatment is surgery, sometimes with chemoradiation therapy 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 radiation therapy (radiotherapy) and chemotherapy (cisplatin) is used.

For metastatic disease, the treatment is chemotherapy (platinum/fluorouracil) or palliative care alone.

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:

GP (General Practitioner) – looks after your general health and works with your specialists to coordinate treatment.
Gynaecological oncologist- diagnoses and treats cancers of the female reproductive system
Radiation oncologist – prescribes and coordinates radiation therapy treatment.
Medical oncologist – prescribes and coordinates the course of chemotherapy.
Cancer care coordinators- coordinate your care, liaise with the multidisciplinary team and support you and your family throughout treatment.
Dietitian – recommends an eating plan to follow while you are in treatment and recovery.
Other allied health professionals – such as social workers, pharmacists, and counsellors.

Screening for cervical cancer

The Pap smear test has changed to the new Cervical Screening Test.

The incidence and mortality rates due to cervical cancer have halved in Australia since the introduction of the National Cervical Screening Program in 1991. The program offered a free Pap smear test every two years to women between the ages of 18 and 70.

As of 1 December 2017, the Pap smear test has been replaced with the new Cervical Screening Test. Under the new program, most women aged 25-74 will be tested every five years. If you have previously had a Pap smear test, you should have your first HPV test two years after your last Pap test. If you have a negative HPV result, you can wait five years before your next screening test. The changes recognise the introduction in 2006 of a vaccine against specific strains of HPV. This will be part of the renewal of the National Cervical Screening Program. The new screening program is designed to work together with the HPV vaccination program. Australian children aged 12 to 13 are offered the HPV vaccine at school through the Australian Immunisation Program. The vaccine is free for everyone aged 12-25. The new screening program is designed to work together with the HPV vaccination program.

From 1 July 2022, cervical screening participants aged 25-74 have the choice to screen either by a self-collected vaginal sample or a clinician-collected sample from the cervix, accessed through a healthcare provider in both cases.

Self-collection

Self-collection is done in a private space (e.g. a bathroom) in a health clinic. A health care provider will give you a self-collection swab and explain how to collect your own cell sample. Or, if you prefer, the provider can assist you to collect the sample without using a speculum. Self-collection is only available to people who do not have any signs or symptoms of cancer.

Health provider collected

For health provider collected tests, a doctor or nurse gently inserts an instrument (called a speculum) into the vagina to widen the vaginal walls and get a clearer view of the cervix. They will then use a brush or spatula to remove some cells from the cervix. This can feel slightly uncomfortable, but usually takes only 1–2 minutes. The cell sample is then placed in a container of liquid and sent to a laboratory to check for HPV.

For further information on HPV and testing go to Cancer Council’s cervical screening website.

Information on the renewed program can be found on the Australian Government Department of Health’s screening website. Australia is set to be the first country to eliminate cervical cancer as a public health issue which is why it is so important to have the Cervical Screening Test.

To learn more about eliminating cervical cancer as a public health issue click here to watch the video.

Preventing cervical cancer

HPV vaccine

This is a vaccine against specific types of HPV that cause almost all cervical cancers. Gardasil 9 has been developed to protect against nine types of HPV which cause around 90% of cervical cancers. Through the National Immunisation Program, most girls and boys girls in Australia aged 12-13 and under will receive the HPV vaccine in school-based programs. The vaccine is free for everyone aged 12-25 and is given as one injection.

Find out more about the HPV vaccine here.

Having the HPV vaccine does not mean that you should not have regular Cervical Cancer Screening Tests. If you have been vaccinated against HPV, you should have your first screening at age 25 and then every five years. For more information go to Cancer Council’s cervical screening page.

Prognosis for cervical cancer

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person’s individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of cervical cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

Cervical cancer can be effectively treated when it is found early. Most women with early cervical cancer will be cured.

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

Sources

- Understanding Cervical Cancer, Cancer Council Australia, © 2023. Last medical review of source booklet: December 2023.
- Australian Institute of Health and Welfare. Cancer data in Australia [Internet]. Canberra: Australian Institute of Health and Welfare, 2023 [cited 2023 Sept 04]. Available here.

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