Cervical Cancer

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

Cervical screening ONLY detects cervical cancer.

In New Zealand, the National Cervical Screening Programme recommends cervical screening every three years from age 25 to 69.  Some women will have an abnormal result.   

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.  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. 
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 is 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
Many conditions can cause these symptoms, not just cervical cancer.  
See your GP or a Gynaecologist if you notice any changes or experience any persistent symptoms that worry you.
Any changes should ALWAYS be investigated.

Screening

Cervical screening aims to detect abnormal changes in the cells of the cervix (the neck of the uterus or womb) before the cells can develop into cancer.  Abnormal cells can be treated to prevent the progression of cancer.

The benefits of regular screening

The best way to reduce the risk of developing cervical cancer is to have regular cervical screening every 3 years.  Women who have had the HPV (human papillomavirus) vaccine must continue to have regular cervical screening 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. 

Over 85% of women who develop cervical cancer have either never been screened or have been screened infrequently.

Cervical screening 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 done by a doctor or 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?

Your doctor or nurse will use a speculum to open the vagina and see your cervix.  They will use a small soft brush to collect some cells from the cervix.  This may feel slightly uncomfortable, but it usually only takes a few minutes.  The sample is sent to a laboratory to check for cell abnormalities.

Understanding your cervical screening test results

You've gone and had your test taken now it's time to find out your results.  Getting your results normally takes two weeks.  The results will be sent out to your health provider.  They'll let you know if there's anything unusual in your results.  This can be anxious time, waiting, not knowing - so contact your health provider if you have not heard.

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 screening test in 3 years' time.

    Unsatisfactory result

    Unsatisfactory results mean that the test could not be read at the laboratory because there were not enough cells in the sample, or blood or mucus hid most of the cells.  You will need another test within 3 months.

    Inflammation or infection

    Discuss this with your health provider.  Often no treatment is required.

     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 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 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 cervical screening 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 cervical screening 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. 

    Referral to colposcopy

    You may be referred to have a follow-up test, a colposcopy, which is an examination of your cervix.  This is usually done by a gynaecologist.

    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 cervical screening 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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