Cervical Cancer

In New Zealand, approximately 160 women develop cervical cancer each year, and about 50 die from it.

Cervical smears DO NOT detect all 5 of the gynaecological cancers

Cervical screening is essential because cervical cancer can be prevented.  In New Zealand, Cervical Screening Programme recommends cervical smear tests every three years from age 20 to 69.  Some women will have an abnormal result.  This does not mean that all women with an abnormal test will develop cervical cancer.  Early treatment can prevent these cervical changes developing into cancer.

 

The Cervix

The cervix is the lower part of the womb, also called the neck of the womb. The womb and the cervix are part of a woman's reproductive system.

The reproductive system is made up of the:

  • Vagina 
  • Womb, including the cervix
  • Ovaries

The cervix is the opening to the vagina from the womb. It is a strong muscle.
The diagram shows the position of these organs in the body. 

What is cervical cancer?

Cervical cancer develops from the tissues of the cervix. It is also called cancer of the uterine cervix.  The cervix is part of the female reproductive system, which also includes the uterus, ovaries, fallopian tubes, vagina and vulva. The cervix is the lower part of the uterus that connects to the vagina. It is sometimes called the neck of the uterus.  Functions of the cervix include:
  • Producing some of the moistness that lubricates the vagina
  • Producing the mucus that helps sperm travel up to the fallopian tube to fertilise an egg from the ovary
  • Holding a developing baby in the uterus during pregnancy. During childbirth, the cervix widens to allow the baby to pass down into the birth canal (vagina).

The cervix is covered by 2 kinds of cells: squamous and glandular. Squamous cells are flat, thin cells found in the outer layer of the cervix (ectocervix). Glandular cells are found in the cervical canal (endocervix). The point where these 2 cells meet is called the squamocolumnar junction. This is where cervical cancer starts.

Types of cervical cancer

The 2 main types of cervical cancer are named after the type of cells they originate from:
  • Squamous cell carcinoma: the most common type of cervical cancer (about 80% of all cases), squamous cell carcinoma starts in the squamous cells of the cervix.
  • Adenocarcinoma: a less common type of cervical cancer that develops from the glandular cells. Adenocarcinoma is more difficult to diagnose because it starts higher in the cervix, and is more difficult to reach with the brush or spatula used in a Cervical Screening Test. Screening using HPV testing has the potential to improve detection of adenocarcinoma and its precursors.
Cervical cancer can be micro-invasive or invasive:
  • Micro-invasive cancer occurs when cancer cells have broken through the boundary between the surface of the cervix and the tissue underneath, but have not spread more than 5 millimetres into the tissues of the cervix.
  • Invasive cervical cancer occurs when cancer cells have spread more than 5 millimetres into the underlying tissue.  Cancer may have also spread to the vagina, the lymph nodes, other tissues surrounding the cervix, or nearby organs such as the bladder or rectum.

Changes to cervical cells do not usually cause any symptoms – this is why regular Cervical Screening Tests are so important. If cervical cell changes develop into cervical cancer, the most common symptoms include:

What are the symptoms of Cervical Cancer?

The most common symptom of cervical cancer is bleeding from the vagina at times other than when you are having a period.  This includes between periods, after or during sex, at any time if you are past your menopause.
  • Vaginal bleeding or spotting between periods
  • Vaginal bleeding or spotting after periods have stopped (after menopause)
  • Bleeding or spotting after sex
  • Unusual and persistent discharge from your vagina
  • Persistent pain in your pelvis
  • Pain during sex
Advanced cervical cancer is very uncommon, but it may cause:
  • Extreme tiredness
  • Leg pain or swelling
  • Lower back pain

...be sure to visit your doctor for a check up.

Remember, most women with symptoms like these do not have cancer.  Your awareness of your symptoms is the first and most important step.

EARLY DIAGNOSIS CAN SAVE LIVES.

Screening

Cervical screening aims to detect abnormal changes to the cervix (the neck of the uterus or womb) before they can develop into cancer and effective treatment for precancerous lesions detected by screening will prevent progression of cancer.

The benefits of regular screening

The best way to reduce the risk of developing cervical cancer is to have regular cervical smear tests every 3 years.  Women who have been immunised must also continue to have regular cervical smear tests because they will not be protected against all HPV types that cause cervical cancer. In New Zealand, approximately 160 women develop cancer of the cervix each year, and about 60 women die from it.  Some groups of women have higher rates of cervical cancer.These groups include:
  • Women over 40
  • Maori women
  • Pacific women
  • Asian women
  • Unscreened women
  • Under-screened women

In countries where there are organised screening programmes, the largest group of women who are diagnosed with invasive cervical cancer or who die from it are those who have never had a cervical smear test.  A cervical smear test is a screening test to look for abnormal cell changes to the cervix. You can find out more at About HPV and About cervical cancer.

Smear tests saves lives

Early treatment is highly successful... Since the national screening programme started, the number of women who die of cervical cancer has dropped by nearly two thirds. And if every woman you know got tested regularly, the number could drop even lower. 

Who can give me a Cervical Screening Test?

You can get a Cervical Screening Test done by a doctor or women’s health nurse at a:
  • General practice
  • Family planning clinic
  • Sexual health clinic
  • Community health clinic
  • Women’s health centre

How is a Cervical Screening Test done?

If you have ever had a Pap test before, the way the Cervical Screening Test is done will look and feel the same. Your doctor or nurse will use a device called a speculum to open the vagina and see your cervix. They will use a small brush or spatula to collect some cells from the cervix. This may feel slightly uncomfortable, but it usually only takes a few minutes. The cells are sent to a laboratory and tested for HPV.

What do the results mean?

Your healthcare provider will talk to you about your Cervical Screening Test results.  Possible results include: Return to screen in 3 years - Your results show you do not have HPV infection. The National Cervical Screening Program will send you a reminder to have your next Cervical Screening Test in three years. Return to screen in 12 months - Your results show you do not need further investigation but you should have a repeat test in 12 months. This is because you have HPV infection. It is likely to be cleared by your body within the next 12 months.The repeat test checks if the infection has gone and if so, you can return to five yearly screening. If the repeat test shows HPV infection is still present, you may need further investigation from a specialist.If you have HPV infection, it does not mean you have cervical cancer. It takes about 10 to 15 years for cervical cancer to develop, and cervical cancer is a rare outcome.  Refer to a specialist - Your results show you have:
  • A type of HPV infection that requires further investigation, or,
  • Abnormal cells were found that require treatment 

These results do not necessarily mean you have cervical cancer. Your healthcare provider will refer you to a specialist for a follow-up test called a colposcopy examination. It is very important you follow the instructions of your healthcare provider if you received this test result. What happens if I am referred to a specialist? If your healthcare provider refers you to a specialist for a follow-up test, they will perform a colposcopy examination, which is an examination of your cervix. This is usually done by a gynaecologist. Your healthcare provider can help you decide who to see for a colposcopy, if you need one.

Your smear test results

You've gone and had your smear taken, now it's time to find out your results.

Getting your results

Getting your results normally takes two weeks.The results will be sent out to your doctor or smear taker at first.  They'll let you know if there's anything unusual in your results.This can be an anxious time, waiting, not knowing - so feel free to ask, call your doctor or smear taker, ask them to let you know as soon at your results come back.

Understanding your results

Your smear test detects whether there are cell changes.  Remember, 90% of smear results are perfectly normal - but if something looks concerning, you'll need to act.

Normal

Things look good, so just have your regular smear in 3 years' time.

Unsatisfactory result

Sometimes the sample may be insufficient to be sure that everything is OK.  Don't worry, it doesn't mean you have a problem - but get a repeat smear within 3 months.

Inflammation or infection

There are a number of infections that you can have - see your doctor to clear up the infection.

 Atypical Cells

It is difficult to be sure whether cell changes are starting to develop or not.  Mild atypical changes (called ASC-US cells) are usually the problem and these often clear up before your next test. If you are 30 years of age or older, a test for HPV (human papillomavirus) will be done automatically. If HPV is detected, you will be referred to a specialist for a colposcopy. If HPV is not detected, or if you are under 30, have another smear test in a year’s time. If the atypical cells are still there you will be referred to a specialist for further investigation.   Occasionally the atypical cells are more developed and might mean a moderate to severe change. It doesn't mean there is a problem, but you will be referred to a specialist for colposcopy to check it out.

Mild (low-grade) changes (LSIL)

Looks like the cells are beginning to change, but it may take several years to become a problem. LSIL is due to an HPV infection and it usually clears up by itself. If you are 30 years of age or older, a test for HPV (human papillomavirus) will be done automatically. If HPV is detected, you will be referred to a specialist for a colposcopy.  If HPV is not detected, or if you are under 30, have another smear test in a year’s time. If the atypical cells are still there you will be referred to a specialist for further investigation.  

Moderate to severe (high-grade) changes (HSIL)

These are more developed cell changes. This doesn’t mean cancer (most women will have cell changes that can be successfully treated) but you’ll need another check called a colposcopy examination to be sure.

Glandular cell changes or adenocarcinoma-in-situ (AIS)

Although the cervical smear test is not designed to detect glandular cell changes, such changes are sometimes found. You will be referred for a colposcopy, and it is important for you to go to your appointment.

Cancer

If your smear test shows any changes suggestive of cervical cancer, you will be referred to a specialist. The sooner this is treated, the better the chances of success. It's important for you to go to your appointment. An unsatisfactory test result means the laboratory cannot read your sample. This means you will need to come back for a repeat test in six to twelve weeks. This result might happen if the number of cells collected is too small. An unsatisfactory result does not mean there is something wrong. Talk to your healthcare provider if you have any questions about your result.

Cervical Cancer - Risk Factors

The most important risk factor for cervical cancer is persistent HPV infection.  Other factors may contribute include:

  • HPV: Infection with the human papillomavirus is the most important risk factor for cervical cancer.
  • NOT having regular smear tests increases a woman's risk of developing cervical cancer as early changes to cells go undetected.
  • Smoking tobacco is a factor in causing many types of cancer, including cervical cancer.  Women who smoke are twice as likely as non-smokers to develop cervical cancer.
  • Genetics: some women are more likely to get cancer than others (family history).

 

 

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