Cervical Cancer 101: Causes, Symptoms, Diagnosis & Treatments

Australia has a very low incidence of cervical cancer compared to other countries, which is thanks to our sensitive screening processes, funded screenings for eligible women, and good public health messaging.

Just under 1000 women have been diagnosed with cervical cancer this year, and it’s estimated that over 200 will die. However, Australia is well on its way to being one of the first countries to eradicate cervical cancer! This is due to our preventative measures for detecting abnormal cell changes before they become cancerous. Australia’s system for identifying pre-cancerous indications has changed in recent years, becoming both more sensitive and less invasive for women.

Causes of cervical cancer

HPV (the Human Papillomavirus) is the cause of almost all cervical cancers. HPV is a sexually transmitted infection that is incredibly common in most sexually active people – almost everyone who engages in sexual contact will pick up a strain of HPV at some point in their lives, but most strains will be harmless until the body passes them naturally – usually within a few years. HPV is also the virus that contributes to other benign health issues, like warts on the hands and feet. There are, however, a few strains that are very likely to cause cervical cancer. It does this by causing cancerous cervical changes, usually in a small portion of the cervix. It takes 10-15 years to develop cancer after an initial dangerous HPV infection – which is why prevention and early detection are working so well to decrease the incidence of cervical cancer in Australia.

Pre-2017, The National Cervical Screening Program used to use Pap Smears to detect cervical changes that were caused by HPV, rather than testing for HPV. This meant there was no test for HPV until cervical changes had been caused. HPV is also transmitted through skin-to-skin contact rather than fluid. This is why that employing usual safe-sex practices, such as using condoms and getting regular sexual health check-ups, are not helpful in the efforts of preventing HPV infection.

There is a small percentage of cervical cancer that is not caused by HPV – these are extremely rare but usually signalled by symptoms such as pain and abnormal bleeding between periods and females should see their GP if they experience these symptoms regardless of the recency of their last HPV screen.

Cervical cancer detection and prevention

Vaccines

The HPV vaccine supplies a person’s body with immunity against two of the most dangerous forms of HPV that contribute to cervical cancer – strains 16 and 18. The vaccine is given to children during their secondary school years in two doses six months apart. Females have been recommended to get the vaccine since 2006, and males recommended since 2011 (as there is no test for HPV in men at all, but they contribute to carrying and spreading the virus, too).  The vaccine has been wildly successful in reducing instances of HPV and cancer among women, with a 92% reduction in HPV strains that cause 75% of cancer since the national rollout.

Screening

The National Cervical Screening Program, since 2017, checks for the presence of HPV. If you are female, your first test will be at the age of 25. This involves a GP or other qualified healthcare provider taking a sample from inside the cervix. This involves a procedure in which a speculum will be inserted into your vagina to give your healthcare provider space to take the sample, and then a swab will be inserted into the cervix, only momentarily. This is unlikely to be painful at all, but it can feel uncomfortable. The good news is – the whole process takes less than a minute. Screening includes:

• Your results are then interpreted – if no HPV is found, you can repeat the test in 5 years.
• If HPV is found, but it is not strained 16 or 18, you will repeat the test in one year to see if the HPV has progressed or cleared.
• If strains 16 or 18 are found, there is more urgency for treating such strains, and your GP will discuss the next steps with you, which is likely to be a referral to a gynaecologist.

If you begin this testing at the recommended age of 25 and attend all follow-up appointments as required, your chance of ever developing cervical cancer is almost minute, as the whole point of the screening process is to detect HPV before it has a chance to turn into cervical cancer.

Pre-cancerous treatment

Colposcopy

If your GP determines that your HPV should be investigated further, you will be referred to a gynaecologist for a colposcopy procedure. A colposcopy will have the same speculum inserted as an HPV screening, but the gynaecologist will put a special liquid onto your cervix in order to highlight any abnormal changes in your cells and then take a good look through a special lens to better see any abnormal changes.

Biopsy

You may also need a further procedure called a biopsy after the colposcopy if abnormal cells in what is called the “transformation zone” in your cervix have been identified. A biopsy involves taking a tiny sample of tissue from the cervix so this can be sent off for testing and more accurately analysed. A biopsy, again, shouldn’t be painful, but it is more invasive than the previously identified procedures. You should avoid sexual penetration, tampons, swimming or baths for a few days after the procedure until the spotting has cleared up.

Through these procedures, your provider will tell you if you qualify for pre-cancerous treatment, which involves removing the abnormal cells before they become cancerous.

Loop excision

This can be done under local or general anaesthetic and only takes 10-15 minutes, in which the abnormal cells are removed using a wire loop.

Laser treatment

Laser treatment can also be done under general or local anaesthetic and uses a laser to burn off the abnormal cells.

Cone biopsy

A cone biopsy is done under general anaesthetic and is used for abnormal changes that are higher up in the cervix – this is done by removing a cone-shaped portion of the cervix that involves the abnormal cells.

After any of these procedures, your GP will keep on track as to how to continue your preventative check-ups.

Staging and treatment of cervical cancer

If someone hasn’t been engaged in preventative screening – which can happen for a number of barriers, including cultural or language barriers to public health messaging or low socioeconomic groups that don’t have equal access to healthcare – then cervical cancer may be detected upon screening. Cervical cancer is defined via stages 1-4, with 1 being cancer local to the cervix and stage 4 being metastatic cancer that has spread to nearby organs and tissues. The prognosis of survival beyond 5 years is 74% as it currently stands. Treatment of cervical cancer involves usual standard cancer treatment, such as surgical, medical, and immunosuppressant interventions.

Chemotherapy

Chemotherapy is a medicine that can be delivered orally or intravenously (through the veins) to target and kill cancer cells. Unfortunately, in the process, it can also kill healthy cells in our bodies. This can lead to side effects like nausea, vomiting, hair loss, lethargy and weight loss.

Radiotherapy

Radiotherapy kills off cancer cells and prevents them from multiplying by using certain types of high-energy X-Rays delivered to a specific area of the body, making the side effects less systemic than chemotherapy. However, it is not without risk of side effects and can also damage cells in the area in which it is delivered, most commonly leading to burning or blistering of the skin. 

Surgery

Surgery can be indicated with cervical cancer, depending on the staging. Surgery may include removing the entire cervix in order to get rid of the cancerous zone and prevent spreading. This is a common choice for young women who find themselves with staged cervical cancer, as it saves the uterus and ovaries and gives them an opportunity to become pregnant in the future. However, the most common surgical option is a total hysterectomy, in which the cervix, uterus, and ovaries are removed. This removes the ability to have children but is often done for post-menopausal women who have passed their childbearing years. Thankfully, Australia’s exemplary HPV screening system means most people’s abnormal cervical cells will not proceed to a stage where a hysterectomy is indicated.

Having symptoms outside of screening

If you are experiencing the following symptoms, it’s important to check in with your GP regardless of the timeline of your screening process so far:

• 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.

How can Homage help?

Homage has a dedicated team of health professionals, including Registered Nurses and support workers, to help you with innumerable steps during your treatment of cancer. These team members can help you with transport to medical appointments, medication management at home, post-surgical care or wound care, or simply accompaniment and companionship at home during the difficult recovery time.

Provide the best care to your loved one today!