What is cervical cancer?

Cervical cancer is a type of cancer that develops in a woman's cervix. The cervix is the entrance to the womb from the vagina.

It happens when there are changes in some cells lining the cervix. Sometimes these abnormal cells grow and multiply. They can develop into cancer. If the cancer cells are not treated, they may spread beyond into surrounding tissues, becoming invasive cancer.

The 2 main kinds of cervical cancer are named after the types of cells which started growing abnormally.

• Squamous cell carcinoma — this is the most common type of cervical cancer, accounting for about 4 out of 5 of all cases. It starts in the skin-like squamous cells of the cervix.
• Adenocarcinoma — this is a less common type of cervical cancer, which develops from the glandular cells.

What are the symptoms of cervical cancer?

Cervical cancer often has no symptoms in its early stages. That’s why it's very important for you to attend your screening appointments for a Cervical Screening Test.

In most cases, vaginal bleeding is the first noticeable symptom of cervical cancer. It usually happens after sex (post-coital bleeding). Bleeding at any other time, other than your expected monthly period, is also considered to be unusual. This includes bleeding after the menopause (when a woman's periods stop) and a period that is longer and heavier than usual.

Other symptoms of cervical cancer may include:

• pain in and around your vagina when having sex
• an unpleasant smelling vaginal discharge
• pain when passing urine

Advanced cervical cancer

If the cancer spreads out of your cervix and into surrounding tissue and organs, it can trigger a range of other symptoms, including:

• constipation
• blood in your urine (haematuria)
• loss of bladder control (urinary incontinence)
• bone pain
• lower back pain
• swelling of one of your legs
• pain in the kidneys
• changes to your bowel and bladder habits
• loss of appetite
• weight loss
• tiredness and lack of energy

What causes cervical cancer?

Almost all cervical cancers are caused by long-term infection with a sexually-transmitted virus called HPV (human papillomavirus).

Anyone who has ever had sex can have HPV; it's so common that 4 in 5 people will have had HPV at some time in their lives. In most cases, it clears up by itself within 3 years. In rare cases, if the virus doesn’t go away, it can lead to cervical cancer. This usually takes about 10 years.

While HPV is very common, most women with HPV will not develop cervical cancer.

When should I see my doctor?

It is recommended that you contact your doctor if you experience:

• bleeding after having sex (post-coital bleeding)
• bleeding outside of your normal periods
• new bleeding after the menopause

Vaginal bleeding is very common and can have a range of causes, so it doesn't necessarily mean that you have cervical cancer. However, you should always have unusual vaginal bleeding investigated by your doctor.

How is cervical cancer diagnosed?

Your doctor may want to test for cervical cancer if you have an abnormal Cervical screening test or because you have symptoms. Other tests are used to confirm a diagnosis of cervical cancer.

Colposcopy

Most women with suspected cervical cancer will be sent for a colposcopy. For this examination, the specialist uses a colposcope, which is like a large microscope. The colposcope allows the specialist to have a magnified view of the cervix to check the extent and nature of any abnormality.

During the colposcopy examination, a small sample of tissue (a biopsy) may be taken from any abnormal looking areas of the cervix.

Biopsy

A biopsy is when your doctor or specialist removes some cervical tissue and sends it to the laboratory for examination under a microscope. When the tissue is removed, you may feel uncomfortable for a brief period of time.

Biopsies are usually performed in the examination room or in a clinic. The results should be back from the laboratory within about one week.

After a biopsy, you may experience some pain, similar to menstrual cramping. You can request medication to relieve the pain. You may also have some bleeding or other vaginal discharge, but these side effects will gradually disappear.

To allow the cervix to heal after a biopsy and to reduce the chance of infection, you should not have sexual intercourse or use tampons for at least a few days.

Further tests

If the biopsy shows you have cervical cancer, a number of other tests may be carried out. These may include blood tests, x-rays, CT scans, MRI scans or PET scans. The tests will determine the extent of the cancer in your cervix and whether it has spread (metastasised) to other parts of the body. This is called 'staging'. The results will help you and your doctor decide on the best treatment for you.

How is cervical cancer treated?

If you have abnormal cells that haven’t yet developed into cancer, these can be removed in different ways:

• Wire loop excision: A wire loop is used to remove the cells from your cervix. It takes 15 to 30 minutes and is usually done with a local anaesthetic, although some women may have a general anaesthetic.
• Cone biopsy: A cone-shaped part of the cervix that contains the abnormal cells is removed. This is usually done with a general anaesthetic and you may need to stay in hospital overnight.
• Laser: A laser beam is used to remove the cells. It takes 15 to 30 minutes and is usually done with a local anaesthetic, although some women may have a general anaesthetic.

If you have cervical cancer, treatment will depend on how far it has spread.

For some women, a cone biopsy may be the only treatment they need. Some may need to have the whole cervix removed. They can still have periods and have children in future. Some women may need to have their uterus (womb) removed. This operation is called a ‘hysterectomy’. After a hysterectomy you cannot have children.

If you have early-stage cervical cancer you may also need a combination of radiotherapy and low-dose chemotherapy (known as 'chemoradiation') as well as surgery.

If you are diagnosed with invasive cervical cancer, your doctor will advise you on the best treatment for your cancer. This will depend on the results of your tests, which will show where the cancer is in your body. It will also depend on your age, your general health and your preferences. Your specialist doctors, who commonly work together in what is known as a 'multidisciplinary team', will discuss the best treatment with you.

More advanced cases of cervical cancer are usually treated using a combination of chemotherapy and radiotherapy. After the initial treatment, some women may have additional treatment (called 'adjuvant therapy') to increase the chances of a cure.

After the initial treatment, some women may have additional treatment (called 'adjuvant therapy') to increase the chances of a cure.

If you have not yet gone through menopause, radiotherapy and chemotherapy will cause your ovaries to stop working. Your treatment team will talk to you about hormone replacement therapy, which may be more effective if started before treatment.

If you are of childbearing age and think you may yet wish to have children, your treatment team will discuss whether they can preserve your fertility. If you are pregnant, your treatment will depend on the stage of the cancer and the stage of the pregnancy. For cervical cancer found to be at a very early stage or for cancer found during the last trimester of pregnancy, it may be possible to delay treatment until after the baby is born.

You can ask to see a psychologist or counsellor at any stage in your treatment to talk about how you are feeling. A social worker can also help you and your family with practical and financial matters.

If you want to try complementary therapy to help manage symptoms and side effects, it is important that you discuss this with your doctors and health professionals.

If your doctors can't do any more to treat your cancer, your care will focus on controlling your symptoms and helping you to be as comfortable as possible. This is called palliative care. Palliative care also includes psychological, social and spiritual support for you and your family or carers.

Cancer Council Australia can provide more information on cancer treatments through their website at www.cancer.org.au/about-cancer/treatment. They also offer support for you and your loved ones via their helpline on 13 11 20.

Can cervical cancer be prevented?

Cervical cancer is one of the most preventable cancers. That’s because we know it is caused by infection with the HPV virus. Cervical cancer is prevented in 2 ways in Australia.

Vaccination: HPV vaccination protects against the types of HPV that cause almost all cases of cervical cancer. The vaccination is offered free to high school students in Years 7 or 8. They need 2 doses, 6 months apart. You can read more about the HPV vaccine on the HPV vaccine website or by calling 13 11 20.

Cervical screening: The Cervical Screening Test has replaced the old Pap test (sometimes referred to as a 'Pap smear'). All women aged 25 to 74 should have the Cervical Screening Test every 5 years. You should have the first test 2 years after your last pap test. For further information, visit the National Cervical Screening Program or call 13 15 56. You can also ask your doctor, family planning clinic or local health centre.

If your Cervical Screening Test shows you have an HPV infection, you will be asked to have a repeat test in 12 months. If the HPV infection is still present after 12 months, you may need further investigations.

Complications of cervical cancer

Complications of cervical cancer can occur as a side effect of treatment and as the result of advanced cervical cancer.

Pain

Having cancer does not always mean having pain. Pain is hardly ever a symptom of early cancer. Even people with advanced cancer do not always have pain. If the cancer spreads into your nerve endings, bones or muscles it can often cause severe pain. It is important to manage your pain effectively and you should speak to your doctor if your pain medication is not helping. However, a number of effective painkilling medications can usually be used. Depending on the levels of pain, they can range from codeine and morphine.

Kidney Failure

In some cases of advanced cervical cancer, the cancer can block the flow of urine out of the kidneys. The build-up of urine inside the kidneys can cause the kidneys to become swollen and stretched and in severe cases can lead to kidney failure.

Blood clots

Cervical cancer, like any other cancer, can make the blood more prone to forming clots. Bed rest after surgery and chemotherapy can also increase the risk of developing a clot. Some women with cervical cancer may develop a deep venous thrombosis (DVT). This needs to be treated in case it travels to the lungs, which can be fatal.

Bleeding

If the cancer spreads into your vagina, bowel or bladder, it can cause significant damage, resulting in bleeding. Bleeding can occur in your vagina, rectum (back passage), or you may pass blood when you urinate.

Fistula

A fistula is an abnormal channel that develops between two sections of the body. In most cases involving cervical cancer, the fistula develops between the bladder and the vagina. This can lead to a persistent discharge of fluid from the vagina. Sometimes a fistula develops between the vagina and rectum. It is treated with surgery, medication, creams and lotions.

Vaginal discharge

Another uncommon but distressing complication of advanced cervical cancer is an unpleasant smelling discharge from your vagina.

The discharge can occur for a number of reasons, such as the breakdown of tissue, the leakage of bladder or bowel contents out of the vagina, or a bacterial infection of the vagina. Antibiotics may be used to treat infections.

Resources and support

Sometimes it is helpful to talk to others about your experience. Cancer Council Australia offer support for you and your loved ones via their helpline on 13 11 20.

Depending on where you live, you might be able to go to a Look Good Feel Better workshop. These are free of charge and provide tips and advice about dealing with changes to the way you look caused by cancer treatment. Workshops are available in capital cities and other major centres.

Cancer Australia has developed a resource to support women and their partners in understanding and addressing issues of intimacy and sexuality following the diagnosis and treatment of gynaecological cancer.