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 14^th 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/