About Cervical Cancer - Cervical Cancer

About Cervical Cancer
cervicalcancer.com.au

What is cervical cancer?

Cervical cancer is cancer of the cervix. The cervix is the lower part of the uterus, or womb, and is situated at the top of the vagina. Cervical cancer develops when abnormal cells in the lining of the cervix begin to multiply out of control and form pre-cancerous lesions. If undetected, these lesions can develop into tumours and spread into the surrounding tissue.

What causes cervical cancer and abnormal cervical cells?

Cervical cancer is caused by infection with certain types of a common virus, called human papillomavirus, or HPV. While other factors such as the oral contraceptive pill, smoking, a woman's immune system and the presence of other infections also seem to play a part, a woman has to have been infected with certain 'high-risk' HPV types before cervical cancer can develop. High risk types 16 & 18 are responsible for ~70% of all cervical cancers.

Abnormal cervical cells are also caused by HPV infection, and these may be detected when a woman has a routine Pap test.

HPV explained

Human papillomavirus, or HPV, is a common virus that affects both females and males. There are more than 100 types of the virus. In fact, certain types of HPV cause common warts on the hands and feet. Most types of HPV are harmless, do not cause any symptoms, and go away on their own.

About 40 types of HPV are known as genital HPV since they affect the genital area. More than 50% of people (males and females) will be infected with one type of genital HPV at some time of their life. Some are "high-risk" types (such as HPV Types 16 and 18) that can cause cervical pre-cancer and cancer. Others are "low-risk" types (such as HPV Types 6 and 11) that can cause genital warts and usually benign (abnormal but non-cancerous) changes in the cervix. Both the "high-risk" and "low-risk" types of HPV can cause abnormal Pap tests.

Anyone who has any kind of sexual activity involving genital contact could get genital HPV. That means it's possible to get the virus without having intercourse. And, because many people who have HPV may not show any signs or symptoms, they can transmit the virus without even knowing it. A person can be infected with more than one type of HPV.

HPV is highly contagious. It is estimated that many people get their first type of HPV infection within their first few years of becoming sexually active.

Genital HPV infection is not something to feel embarrassed or ashamed about. It is very common and most often goes away without any ill effects. It could almost be considered a normal part of being a healthy sexually active woman.

Does everyone with HPV get cervical cancer?

Fortunately, no. For the majority of people who have HPV, the body's defenses are
enough to clear the virus. Up to 90% of infections are "cleared" within 36 months.

However, for some people who dont clear certain "low-risk" types of the virus, benign (abnormal but non-cancerous) changes in the cervix can develop.

And for women who don't clear certain "high-risk" types of the virus, abnormal changes can occur in the cells lining the cervix that can lead to pre-cancers and even develop into cervical cancer later in life. Most often the development of pre-cancer to cervical cancer can take a number of years, although in rare cases it can happen more quickly. That's why early detection is so important. Talk to your healthcare professional about Pap tests, which help detect suspicious cell changes in the cervix.

How will I know if I have HPV?

Because HPV may not show any signs or symptoms, you probably won't know you have it. Most women are diagnosed with HPV as a result of abnormal Pap tests. A Pap test is part of a gynaecological examination that aims to detect abnormal cells in the lining of the cervix before they have the chance to become cervical cancer. In fact, invasive cervical cancer is one of the most preventable cancers. Although distressing, pre-cancers detected during a Pap test can be treated. That's why it's important to follow your healthcare professional's recommendation about Pap tests.

How common is cervical cancer?

Each year in Australia more than 800 new cases of cervical cancer are diagnosed and over 200 women die from this disease. Globally cervical cancer is the second most common women's cancer, which is why many countries, including Australia have implemented regular 'pap test' screening programs to detect cervical abnormalities.

Invasive cervical cancer used to be more common in Australia but now, because of the National Cervical Screening Program, which takes the form of 2-yearly Papanicolou smears (or 'Pap tests') for women, the incidence of invasive cervical cancer has fallen dramatically in the last decade.

Reference: Australian Institute of Health and Welfare. Cervical Screening in Australia 2002-2003. October 2005 AIHW cat no CAN 26

What are abnormal cervical cells?

These are cells from the lining of the cervix that look abnormal when a scientist examines a Papanicolou smear (also called "Pap smear" or "Pap test") under a microscope. While most Pap tests contain only normal cells, some Pap tests show mild cell changes, others show more significant changes.

HPV is a common virus that can cause cervical cancer, abnormal cervical cells and other consequences. Learn more about these conditions in the other sections of this site, and talk to your healthcare professional for more information.

How is cervical cancer detected?

Cervical cancer can be detected in two ways. A woman may present to her health professional with symptoms due to the cancer, or the cancer may be detected in its early stages with a Pap smear, before the woman has any symptoms. If a woman's Pap test shows cancerous cells, she will then be immediately seen by a specialist doctor, usually a Gynaecologist, to confirm the diagnosis and plan appropriate treatment.

What is a Pap test?

The Papanicolou smear or 'Pap test' is a test that can detect abnormal cells in the cervix that may lead to cervical cancer. When detected early, changes to the cervix are easy to treat. That is why having a Pap test every two years is so important.

A Pap test requires the use of a vaginal speculum but it only takes a minute or two. It is performed by a doctor or Pap-test nurse, who will take a sample of cervical cells by touching the cervix with a small brush and spatula. The cells are then smeared onto a glass slide and the slide is sent to a pathology laboratory to be examined under a microscope.

A Pap test only tests for abnormal cells of the cervix. It does not screen for ovarian cancer or any other gynaecological cancers.

Other consequences of HPV infection

A proportion of vaginal and vulvar cancers have also been linked to infection with high risk HPV types.

Over 90% of genital warts cases are due to infection with low risk HPV types 6 and 11.

What are genital warts?

Genital warts are benign, flesh-coloured growths that are most often caused by certain "low-risk" types of human papillomavirus (HPV). Genital warts most often appear on the external genitals or near the anus of females and males. Less commonly, genital warts can also appear inside the vagina and on the cervix. Genital warts may cause symptoms such as burning, itching, and pain. The types of HPV that cause genital warts (usually types 6 and 11) are different from the "high-risk" types that can cause cervical cancer.

How common are genital warts?

Genital warts are quite common. Probably more than 1% of the sexually active population has them at any one time.

After sexual contact with an infected person, genital warts may appear within weeks, months, or not at all.

How are genital warts diagnosed?

A healthcare professional can usually recognise genital warts just by seeing them. Because a person can be infected with more than one type of HPV, a healthcare professional may also examine women with genital warts for abnormal cervical cells caused by high- or low-risk types of HPV.

How are genital warts treated?

Genital warts can disappear on their own without treatment. However, there is no way to tell if they will grow larger or disappear. Depending on the size and location of the genital warts, there are several treatment options. A healthcare professional may choose to apply a special cream or solution to the warts. Some genital warts can be removed by either freezing, burning, or using laser treatment.

However, no matter the treatment, there's a chance that genital warts will reappear after treatment, since the types of HPV that cause them may still be present.

About vaginal and vulvar cancers?

Although relatively rare, in 2001, there were 314 cases of vulval and vaginal cancer in Australian women.

Infection with certain types of high risk HPV is a risk factor for vaginal and vulval cancers and other risk factors include cigarette smoking, immunodeficiency syndromes and a previous history of cervical cancer.