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Cervical Cancer

In New Zealand, approximately 160 women develop cervical cancer each year.

Cervical screening is the only way to detect cervical cancer. The National Cervical Screening Programme NZ recommends cervical screening every three years from age 25 to 69. Most cervical cancers are caused by certain strains of the Human Papilloma Virus(HPV) which can be prevented by having the vaccination against it.It is the only cancer that we know the cause of and can be prevented.

50

About 50 women who are diagnosed with cervical cancer die each year.

The Cervix

The cervix is the lower part of the womb that connects to the  birth canal (vagina), also called the neck of the womb. The womb( uterus)and neck of the womb(cervix )are part of a woman's reproductive system.

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, and 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).
 

What is cervical cancer?

Cervical cancer develops from the tissues of the cervix.

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:

  1. 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.
     

  2. Adenocarcinoma: a less common type of cervical cancer that develops from the glandular cells. The cervical smear  is not designed to detect glandular abnormality, but sometimes this can be found.

In early stages, the cancer is confined to the cervix. However, in later stages the cancer can spread to the vagina, the lymph nodes, other tissues surrounding the cervix, or nearby organs such as the bladder or rectum. Early changes to cervical cells do not usually cause any symptoms – this is why regular cervical screening is so important. 
 

What are the symptoms of cervical cancer?

Know the signs.

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.

Common symptoms of cervical cancer include:
 

  • 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.

Risk factors:

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

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.

Women who have a weakened immune system are at risk and should be screened on a yearly basis.

Screening

Cervical screening aims to detect abnormal changes in the cells of the cervix  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.

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

90% of smear results are normal - but if something looks concerning you'll need to act, fast.

You've gone and had your test done, 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 an anxious time, waiting, not knowing - so contact your health provider if you have not heard.

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.

If your cervical screening test shows any changes suggestive of cervical cancer, you will be referred to a gynaecological cancer 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.
 

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