Common reasons for abnormal liver function test results

When a liver is inflamed or damaged, the injured liver cells may leak higher than normal amounts of chemicals including liver enzymes into the bloodstream, which can then be detected through blood tests.

Most of the time elevated liver enzymes do not indicate a chronic or serious liver problem, especially if the enzyme levels are only mildly or temporarily elevated. There are many different conditions that can contribute to abnormal liver tests and your doctor may suggest additional tests and procedures to determine the cause of your elevated liver enzymes.

Common reasons for abnormal liver tests:

Medications
Various types of medications can cause abnormal liver enzymes levels in some individuals including some types of pain relief medication, antibiotics, anti-seizure medications, cholesterol-lowering drugs such as statins, cardiovascular medications and other drugs such as some anti-depressants.

If the liver enzyme abnormalities have been induced due to medication use they should normalise again within weeks or months of stopping the medications, during which time the patient will be monitored by their healthcare professional.

Other conditions
Mild to moderate elevations of liver enzymes (between twice the upper limits of normal and several hundred units/litre) are common and are often seen during routine blood screening tests in otherwise healthy individuals. There are a number of possible causes for these elevations including fatty liver disease, chronic hepatitis B or hepatitis C infection, obesity and chronic or acute alcohol use.

Very high levels of liver enzymes (ten times the upper limits of normal to thousands of units per litre) are seen in disorders that cause rapid cell death of numerous liver cells (extensive hepatic necrosis). This degree of liver enzyme elevation is uncommon but may occur in conditions including acute viral hepatitis A or B, profound liver damage (e.g. caused by acetaminophen (paracetamol/Tylenol) overdose), deprivation of fresh blood to the liver and severe muscle diseases.

Less common causes of abnormal liver enzyme test results
Other potential causes of abnormal liver enzyme levels include hemochromatosis (excessive absorption of dietary iron), Wilson's disease (excessive accumulation of copper), alpha-1-antitrypsin deficiency (lack of glycoprotein alpha-1-antitrypsin), autoimmune hepatitis (liver injury due to body's own immune system), celiac disease (allergy to gluten), inflammatory bowel diseases (chronic inflammation of the intestines), viral infections including cytomegalovirus and Epstein-Barr virus infections, glycogen storage disorders, and in rare cases liver cancer and Budd-Chiari Syndrome (obstruction of blood flow in the liver).

Useful resources

Mayoclinic

MedicineNet

Liver function tests

Liver blood tests are common tests used to assess liver function or liver damage by determining the levels of various chemicals in the bloodstream. One of the most common liver tests is to detect elevated levels of liver enzymes which may signal liver damage and potential liver disease.

Liver enzyme levels tests
Liver enzymes predominantly reside within the liver cells, however following liver injury or damage they can leak out into the bloodstream. 

The main type of liver enzymes are the aminotransferases that include aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Aminotranferase enzymes catalyse chemical reactions in which an amino group from one amino acid is transferred from one molecule to another. 

AST can be found in a variety of tissues including liver, heart and muscle tissue amongst others and is released into the bloodstream following damage to that tissue. For example, AST is also seen at elevated levels during heath attacks or muscle injury. Therefore its elevation is not a specific indicator for liver damage. 

In contrast, ALT is mostly concentrated in the liver and thus acts as a fairly specific indicator for liver damage following the detection of elevated levels in the bloodstream. 

In addition to AST and ALT , the levels of other enzymes including gamma-glutamyl transpeptidase (GGT) as well as others may also measured during blood tests.

What it means when tests show elevated levels of liver enzymes
Elevated liver enzyme levels are often detected during routine blood tests in otherwise healthy individuals. In general, the normal range of values for AST and ALT are:

Between ~ 5 - 40 units per litre of blood serum for AST.
Between ~ 7 - 56 units per litre of blood serum for ALT.

Individuals may present with mild-moderate elevations of liver enzymes (between twice the upper limits of normal and several hundred units/litre) or less commonly very high levels of liver enzyme elevation (ten times the upper limits of normal to thousands of units per litre).

It is important to note that elevated levels of either of these enzymes does not necessarily indicate liver disease, and the interpretation of abnormal test results depends on an entire clinical evaluation of the individual by their healthcare professional. In addition, the level of elevation does not correlate well with the extent of liver issues or prognosis (i.e. having high levels AST or ALT elevation does not necessarily mean more liver damage or worse disease outlook compared to someone with low levels of elevation).

Other liver function tests
Although AST and ALT tests are often referred to as 'liver function tests' they do not actually reflect or predict the future prognosis for liver function. There are a number of other blood tests which do reflect liver function including:

Coagulation panels
Coagulation panels measure blood clotting ability and prevention of bleeding and bruising by detecting the function of clotting factors (proteins that are usually produced in the liver).

Albumin level (hypoalbuminemia)
Albumin is a common protein produced in the liver and found in the blood. Although many conditions can cause low albumin levels, they are also suggestive of chronic liver disease or cirrhosis.

Bilirubin
Bilirubin is derived from the breakdown of haem in red blood cells and binds to albumin and taken up by the liver, combined with bile and excreted into urine. Elevated bilirubin levels may suggest liver dysfunction. 

Alkaline phosphatase (ALP)
ALP is synthesised in the liver and is mainly found in the cells lining bile ducts, but is also in bone. Its elevation is typically associated with cholestasis (impairment of bile flow from the liver), particularly when levels of liver enzyme GGT are also elevated.


Useful resources

Abnormal liver function tests – Patient info

Liver blood tests – Medicine net

Royal Australian College of General Practitioners




Treatment options for primary liver cancer

The best treatment option for primary liver cancer patients depends on many factors including the type and stage of primary liver cancer as well as the patient's general heath and personal values. 

Deciding which treatment course to take can be difficult and it is advisable to discuss options with the doctor as well as family and friends. It is important to make a well-informed decision regarding the treatment, and understanding the disease and the treatments available can help the patient weigh the pros and cons of each option to determine what would be best for them.

Treatment options for primary liver cancer

The aim of liver surgery (resection) is to remove the part of the liver that contains cancer. This may involve removing a portion of the liver (partial hepatectomy) or a liver transplant – where the whole liver is replaced by a donor liver.

Surgery is the best option for treating primary liver cancer, as the remaining part of the liver can repair itself (as long as it is undamaged) and grow back to its normal size within a few months.

However, surgery is only suitable for a small number of people with primary liver cancer and depends on the size, number and position of the tumours. People with early cirrhosis may be suitable for liver surgery as long as their liver is still working well, however those with more advanced cirrhosis are likely not healthy enough for surgery to be successful.

Chemotherapy drugs are used to kill, shrink or slow the growth of the tumours. The course will be given over several weeks or months and may be given systemically (throughout the whole body) into a vein (intravenously) via a drip, or orally via tablets. Alternatively, high levels of chemotherapy drugs can also be given directly into a tumour through Transarterial chemoembolisation (TACE).

Chemotherapy may be given following another treatment to remove any remaining cancer cells (adjuvant chemotherapy) or used as palliative treatment in order to slow down cancer growth and control symptoms including pain.

Tumour ablation destroys small tumours (<3cm) without removing them. The method of tumour ablation depends on the size, shape and location of the tumour and may involve using heat via radio waves or microwaves (thermal ablation), injecting pure alcohol into the tumour (alcohol injection) or freezing the cancer cells (cryotherapy).

Radiotherapy uses x-rays, gamma cells, electron beams or protons to kill cancer cells or prevent them from multiplying. Radiotherapy is usually given daily for several weeks, and is commonly used to treat bile duct cancer. 

SIRT (also known as radioembolisation) uses high doses of radiotherapy in tiny radioactive beads to target liver tumours directly. It's often used when there are many small tumours throughout the liver that cannot be removed by surgery, most likely for hepatocellular carcinoma (HCC) and bile duct cancer. 

Liver cancers can obstruct bile ducts, particularly if this is where the cancer initiated. The obstruction of bile ducts causes a build up of bile in the liver, leading to jaundice symptoms. An endoscopic stent is a thin tube that can be placed into the liver to drain the bile and ease symptoms.

Recommended treatment options for primary liver cancer

For HCC the most common treatments include surgery, tumour ablation (thermal ablation) or delivering chemotherapy directly into the tumour (TACE). The choice of treatment depends on the staging of HCC:

Stage 0 (very early) – Surgery
Stage A (early) – Surgery, tumour ablation, liver transplant or TACE
Stage B (intermediate) – TACE
Stage C (advanced) – Targeted therapies or palliative treatment
Stage D (end-stage) – Palliative treatment

Cholangiocarcinoma (bile duct cancer) is usually treated with surgery, chemotherapy, radiotherapy and stenting, whereas angiosarcoma is usually treated with surgery and TACE.

Clinical trials

Your healthcare professional may offer you the opportunity to take part in a clinical trial. Clinical trials test new or modified treatments to determine whether they are better than current methods, and have improved treatments and led to better outcomes for cancer patients. For patients with secondary liver cancer in particular, clinical trial participation could allow access  to modified new therapies.

Genetic and epigenetic modifications and the pathogenesis of HCC

Hepatocellular carcinoma (HCC) - the most common type of primary liver cancer – is the sixth most common cancer globally and the third leading cause of cancer deaths worldwide. HCC incidence is increasing all around the world, with the incidence of HCC in developing countries already twice that of developed countries. Disease burden is particularly high in parts of Asia and Africa, coinciding with a high prevalence of chronic hepatitis B virus (HBV) infection. Likewise, mortality rates for HCC are also much higher in developing countries compared to developed countries.

All primary liver cancers start in the liver, with HCC malignancy specifically being found to begin in the parenchymal cells of the liver (hepatocytes). The tumour grows and progresses through local expansion, spreading within the liver (intahepatic spread) and distant metastases to other body organs.

The pathophysiology of HCC is multi-factoral, encompassing hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, cirrhosis (liver scarring), other liver disorders including non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH), type 2 diabetes, and lifestyle factors including obesity, smoking and heavy alcohol consumption.

Symptoms of HCC may sometimes only present during the advanced stages of disease, and may include pain or swelling in the upper-right quadrant and weight loss. However, earlier diagnosis is now possible due to the routine screening of patients with cirrhosis who are particularly vulnerable to developing primary liver cancer, such as those with NAFLD or NASH – both of which are becoming increasingly common, in part due to the rise in levels of obesity and type 2 diabetes. 

Genetic and epigenetic changes in HCC carcinogenesis

Various recent studies have also revealed genetic pathways that may be linked to HCC using techniques such as whole genome sequencing, RNA sequencing and genome-wide methylation assays. HCCs typically have between 20-100 mutations per genome, with p53 and β-catenin being some of the most frequently mutated genes in HCC. The occurrence of these genomic mutations seem to be influenced by the underlying etiology of the liver cancer, for example infection with HBV or HCV. 

Likewise, signalling pathways – particularly those involved in growth factor signalling, cellular differentiation and angiogenesis pathways – also appear to be involved in HCC pathogenesis. The Wnt/β-catenin pathway is commonly disrupted in HCC, with gene mutations which activate this pathway seen in up to 50% of HCCs. 

Interestingly, epigenetic modifications (heritable modifications not due to DNA sequence) also contributes to HCC carcinogenesis. For example, chromatin remodelling can contribute to cancer initiation and progression, with recent studies showing that 18.2% of HCV-associated HCC patients in the US and Europe have inactivation mutations in chromatin remodelling gene ARID2.

HCC pathogenesis
The final common pathway in HCC pathogenesis includes repeated hepatocyte damage and a vicious cycle of cell death and regeneration that results in cirrhosis. This leads to genomic instability and HCC initiation, which progresses following the accumulation of genetic and epigenetic changes.


Pathogenesis of hepatocellular carcinoma figure available from 'Molecular pathogenesis of hepatocellular carcinoma and impact of therapeutic advances'. 

As advances in next-generation sequencing continue to further our understanding of the genomic landscape of HCC, identifying mutations and molecular pathways commonly involved in HCC initiation and progression, we gain a deeper understanding of HCC pathogenesis which will be essential in discovering novel drug targets to tackle this malignancy.

Other resources:
Hepatocellular Carcinoma - Medscape

Why is the incidence of liver cancer increasing?

Over the last 35 years liver cancer has had the second highest percentage change in incidence rate of all cancers with an increase of over 300%. According to the an AIHW report on Cancer in Australia 2017, an estimated 1 in 190 Australians under the age of 75 years are affected by liver cancer, with incidence rate increasing with age to 1 in 113 Australians estimated to be affected over the age of 85 years. Additionally, men are approximately 3 times more likely to develop liver cancer compared to women.

Furthermore, liver cancer has maintained a very low rate of 5-year relative survival at approximately only 17%. It is currently the 6th most common cause of death by cancer in men, and ninth in women. In fact, liver cancers also have the second greatest estimated percentage increase in mortality rate out of all cancers and has continued to see an upward trend since the 1980's (from 2.3 to 6.8 per 100,000). In 2014, mortality due to liver cancer was 1,732 people, and the projected numbers for 2017 and 2018 are estimated at 1,979 and 2,088 people respectively.


What's causing this increase in liver cancer?

It is estimated that approximately 71% of liver cancer cases globally are caused by chronic infections with hepatitis B virus (HBV) or hepatitis C virus (HCV). Roughly 450,000 Australians currently live with either hepatitis B or hepatitis C, and chronic infection is highly associated with infection and inflammation of the liver as well as cirrhosis, which can lead to liver cancer. 

The rise in liver cancer incidence is particularly high amongst those born between 1945 and 1965 and is likely linked to the prevalence of HCV infection which was very high during the 1960's to 1980's before hepatitis was discovered to be transmitted through contaminated blood transfusions and injected drug use. 

Smoking, high alcohol consumption and obesity are also all factors that are linked to liver cancer. Although smoking rates are now falling amongst Australians, there remains a time gap between when people smoked and a cancer diagnosis. A similar situation is apparent with alcohol consumption. This may contribute to the reason why liver cancer is more common in older people, as the damage caused by lifestyle habits when smoking and drinking habits were higher is only now becoming apparent. However, the declining rates of smoking and drinking suggest that hopefully there will be less of a contribution to liver cancer cases from these factors in the future. 

On the other hand, as obesity rate increases there is also a rise in cases of diabetes and non-alcoholic fatty liver disease (NAFLD) where obesity is one of the main risk factors. Both diabetes and NAFLD are risk factors for developing liver cancer thus if these conditions continue to rise it is likely that so will the incidence of liver cancer.

Reducing the rate of liver cancer

A vaccine against HBV has been available since 1982, with Australia's hepatitis B vaccination programme commencing in 1988. A number of preventative interventions are also in place to tackle the issue of HCV infection as well as new strategies for screening and treatment. These vaccination and health monitoring programmes are the best prevention strategies to reduce incidence of liver cancer, followed by lifestyle changes to encourage health living. 

Resources:

Cancer in Australia 2017

Cancer Council Australia – Causes of liver cancer

Hepatitis C strategy 2014-2017

Primary Liver Cancer

Primary liver cancer occurs when a malignant tumour begins in the liver. You can also get secondary liver cancers which start in another part of the body but have spread (metastasis) to the liver.

There are three main types of primary liver cancer depending on the starting location of the cancer:


Causes of liver cancer
The biggest risk factor for primary liver cancer is a chronic infection with viral hepatitis, with an estimated 71% of liver cancer cases globally thought to be caused by viral hepatitis infections. Vaccinating all at-risk people against hepatitis B virus and monitoring those already infected with hepatitis B or hepatitis C are important prevention strategies to reduce the incidence of primary liver cancer.  Other liver issues such as fatty liver disease and liver scarring (cirrhosis) can also increase the risk of developing liver cancer; as well as genetic disorders including  haemochromatosis (overload of iron) and alpha 1-antitrypsin deficiency. Type 2 diabetes has also been shown to increase the risk of developing liver cancer, as has lifestyle factors such as high alcohol consumption, obesity and smoking.

Who gets liver cancer?
The incidence of liver cancer has been increasing over the last 35 years, likely due in part to increased rates of hepatitis infection, more damage from fatty liver disease and lifestyle factors. An estimated 1 in 190 Australians under the age of 75 years are affected by liver cancer with men being 3 times more likely to develop liver cancer compared to women. The rate of liver cancer increases with age with 1 in 113 Australians estimated to be affected over the age of 85 years.

Symptoms of liver cancer
Primary liver cancer rarely causes symptoms in it's early stages but they are more likely to become apparent as the cancer grows or becomes more advanced. Symptoms may include:
  • Severe pain and/or swelling of the abdomen, particularly in the upper right side
  •  Weakness and tiredness
  •  Loss of appetite and weight loss
  •  Nausea
  •  Jaundice (yellowing of the skin and eyes)
  •  Pale bowel motions
  •  Fever

Diagnosing liver cancer
There is no current screening for liver cancer in Australia, however there are a number of tests that may be performed in order to diagnose liver cancer including:

Ultrasound
  • Detects the size and location of abnormal tissue in the liver.

Blood test
  • Detects liver function, how well blood clots, checks for tumour markers and presence of hepatitis B or C.

Scans
  • Various scans including CT scans (produce 3D pictures of organs to assist doctors in planning surgery and seeing whether cancer has spread), MRI scans (produce detailed cross-sectional pictures showing the extent of a tumour and whether it affects the main blood vessels around the liver) and PET-CT scans (produce 3D colour images to show any cancers in the body).

Biopsy
  • Removal of a small sample of tissue for microscopic examination, rarely used as a diagnostic tool.

Stages of liver cancer
If the tests show a positive result for primary liver cancer a specialist will determine how far it has spread in a process known as 'staging'. Knowing what stage the cancer is at allows health care professionals to determine what would be the best treatment course.

The most common staging system used for primary liver cancer is the Barcelona Clinic Liver Cancer (BCLC) system. The BCLC system is based on a combination of performance status (how well the patient can perform daily tasks), tumour characteristics and the Child-Pugh score (assesses how well the liver is working by measuring the level of liver damage caused by cirrhosis).

The Child-Pugh score has 3 levels:
  • Child-Pugh A – Liver works well, less advanced cirrhosis
  • Child-Pugh B – Liver works moderately well
  • Child-Pugh C – Liver is not working well, advanced cirrhosis

The BCLC staging system has 5 levels:


Treating primary liver cancer
There are many different treatment options for primary liver cancer, but the most common are tumour ablation (using radio waves and microwaves to heat and destroy cancer cells) and chemotherapy. Liver transplants or surgical resection to remove the diseased portion may also be used to treat the disease. Some treatments offer the chance of a cure whereas others are aimed at relieving symptoms and improving the quality of life. The treatment for primary liver cancer depends on the stage of liver cancer, the size and spread of the cancer, and whether there is cirrhosis.

Prognosis of liver cancer
An individual's prognosis (expected outcome) for liver cancer depends on many factors including the type and stage of the cancer, the test results, whether there is cirrhosis, the rate of tumour growth, their age, medical history and general health at diagnosis. Their doctor or specialist can consider all of these factors as well as statistics but cannot necessarily accurately predict the course or timeline of an individual's disease progression. 

Resources

Screening for cervical cancer

The National Cervical Screening Program initiated in 1991 currently provides cervical screening tests via a Pap smear. Pap smears do not detect or diagnose cervical cancer, however they are important for identifying cellular changes or abnormalities which may be pre-cancerous. This allows the identification of people who need further tests and can improve the chances of successful treatment through early detection.

Who needs a Pap smear?
All women who have ever had sex or skin-to-skin genital contact are recommended to have Pap smears. Even HPV-vaccinated women need to have regular cervical screenings as the vaccine does not protect against all HPV strains which may cause cancer.
Women aged 18-69 are eligible to take part in the National Cervical Screening Program which provides Pap smears for cervical screening every 2 years. Pap tests are not recommended before the age of 18, and from the age of 70 your health care professional may advise that it is safe for you to stop having Pap tests providing that you have had 2 normal screens within the last 5 years.

From the 1st December 2017 changes are being made to the National Cervical Screening Program. These changes include increasing the age of first screening from 18 to 25 years, increasing the time between tests from 2 years to 5 years and replacing the Pap smear with a more accurate Cervical Screening Test which will also detect HPV infection. 

What happens during a Pap smear?
During a Pap smear, the doctor inserts a speculum to open the vaginal canal and view the cervix. A swab is used to collect cells from the transformation zone (where the outer squamous cervical cells meet the inner glandular cervical cells) at the surface of the cervix. These cells are then sent to the laboratory for testing.

I'm scared it will hurt
Pap tests are very quick and are not painful, although there may be a little discomfort. Many women avoid Pap smears due to embarrassment, however they are an essential defence against cervical cancer. It is estimated that regular cervical screening saves over 1200 Australian women from cervical cancer each year, whereas approximately three out of four women who develop cervical cancer have either never had a cervical screening test or else have not had one within the last 5 years. 

What do the results mean?
Although the majority of Pap smear results are normal, approximately 10% show changes in the cells of the cervix. 

There are 3 main types of abnormalities:

1) Low-grade abnormalities

  • Cervical cell changes are present due to minor inflammation caused by an acute infection with HPV. 
  • Most women with low-grade abnormalities are usually asked to return for a repeat Pap smear in 12 months to ensure that HPV has been cleared by the body, or to be referred for further tests.

2) High-grade abnormalities

  • Cervical cells appear abnormal and have undergone greater changes, likely due to a persistent HPV infection. These cells are rarely cancer but need to be investigated further to prevent progression. 
  • Women with high-grade abnormalities are referred to a specialist for a colposcopy.

3) Glandular abnormalities

  • There abnormalities are located in the cells at the top part of the cervix leading to the uterus/womb. These changes are difficult to monitor by Pap smear alone, therefore all women with glandular abnormalities are referred to a specialist for a colposcopy.
  • These changes are usually not cancer, however finding these abnormalities allows them to be treated earlier and more easily before the possible progression to cervical cancer. 

What happens next?
Following a diagnosis of cervical cell changes, you may require further tests, and be referred to a specialist who will discuss your treatment options with you.

Colposcopy
If you have been diagnosed with high-grade or glandular abnormalities it is likely that you will be referred for a colposcopy. A colposcopy helps identify where abnormal cells are and what they look like. During a colposcopy the doctor will insert a speculum to open the vaginal canal, and then use a colposcope (similar to a pair of binoculars on a stand) to see a magnified picture of your cervix, vagina and vulva. If the colposcope is fitted with a camera you may be able to view the procedure yourself on a screen. The doctor may also coat your vagina and cervix with a fluid to highlight any abnormal areas. A colposcopy is not painful, but you may experience 10-15 minutes of mild discomfort during the procedure.

Biopsy
During a colposcopy it is likely that the doctor will also take a small tissue biopsy (sample) to be examined under a microscope in the laboratory. This may feel like a sharp pinch and you may feel some discomfort or pain similar to menstrual cramping for a short time after the biopsy. It is possible that there will be some bleeding or vaginal discharge for a few hours following the procedure, and the doctor will advise you to avoid sexual intercourse or using tampons for 2-3 days to allow healing and reduce the chance of infection.


Cervical cancer – Cause, prevention and treatment


Cervical cancer is the growth of abnormal cells in the cervix (the lower part of the uterus/womb). There are two main types of cell that cover the cervix: squamous cells (making up the outer cervix) and glandular cells (making up the inner cervix). Most cervical cancers begin in the 'transformation zone', which is where these two cell types meet.

Statistics from the Australian Institute of Health and Welfare (AIHW) estimate that cervical cancer will remain the 14th most common cancer affecting Australian women, with approximately 912 new cases to be diagnosed (1.5% of all female cancer cases) and 254 deaths resulting from cervical cancer expected in 2017.

What causes cervical cancer?
Certain strains of human papillomavirus (HPV) have been identified as a major risk factor for cervical cancer development. HPV infection is common, affecting approximately 80% of people during their lifetime, and can be transmitted through sexual activity and genital contact. Anyone can develop cervical cancer after they become sexually active, however the risk increases after the age of 30. Usually an HPV infection is cleared naturally by the body within two years, however a persistent (long-term) HPV infection can lead to the development of cervical cancer.

Symptoms
Symptoms are rarely seen during early changes in cervical cells, however if they are left undetected and develop into cervical cancer common symptoms include:
  • Unusual vaginal bleeding – between periods, after menopause, after intercourse, longer or heavier menstrual bleeding etc
  • Pain during intercourse
  • Lower back pain
  • Pain or swelling in the legs
  • Unusual vaginal discharge
  • Excessive tiredness
Preventing cervical cancer
Cervical cancer is highly preventable through vaccination and early detection. Through the National Immunisation Program most girls (and since 2013, also boys) are offered the vaccination free of charge at around the age of 12-13 years at school. You can speak to your doctor about being vaccinated against HPV later in life if you missed out in school, however the cost is not covered by the National Immunisation Program.

Other than vaccination, early detection is a critical defence against cervical cancer. Women aged 18-69 are eligible to take part in the National Cervical Screening Program which provides PAP smears for cervical screening every 2 years. Having regular cervical screenings help identify abnormal cells and begin treatment before they become cancerous. Even HPV-vaccinated women need to have regular cervical screenings as the vaccine does not protect against all strains of HPV which may cause cancer. Approximately three out of four women who develop cervical cancer have either never had a cervical screening test or else have not had one within the last 5 years. It is estimated that regular cervical screening saves over 1200 Australian women from cervical cancer each year.

Other lifestyle changes such as quitting smoking, eating healthily, exercising regularly, maintaining a healthy weight and avoiding/limiting alcohol consumption all help prevent the development of cancer.

Treating cervical cancer
Cervical screening can detect cell abnormalities and early signs of cervical cancer, however further tests (colposcopy, biopsy) are required to confirm a diagnosis. If cervical cancer is confirmed, your doctor will refer you to a specialist to discuss your treatment options.
Treatment options and survival outcomes (prognosis) differs depending on the stage of the cervical cancer (how far it has spread). In Australia the cervical cancer stages are described as:
  • Stage 0 – Abnormal cells are found only in the first layer of cells lining the cervix.
  • Stage 1 – The cancer is found only in the tissues of the cervix
  • Stage 2 – The tumour has spread to the vagina and the tissues next to the cervix
  • Stage 3 – The cancer has spread throughout the pelvic area
  • Stage 4 – The cancer has spread beyond the pelvic area to nearby organs such as the bladder or rectum, or possibly others.
  • Recurrent – If the cancer returns after initial treatment (either in the cervix or another part of the body), this is known as recurrent cancer.
The earlier that pre-cancerous cell changes or cervical cancer is diagnosed, the better the prognosis. If your biopsy has confirmed pre-cancerous cervical cell changes treatments (i.e. laser, wire loop excision, cone biopsy) will focus on preventing the progression to cervical cancer. Treatment for cervical cancer may include a combination of: surgery, chemotherapy and radiation therapy.

Resources
http://www.cancer.org.au/about-cancer/types-of-cancer/cervical-cancer.html
https://cervical-cancer.canceraustralia.gov.au/statistics
https://www.cancerwa.asn.au/resources/specific-cancers/gynaecological-cancers/cervical-cancer/




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