The cervix is a canal between your uterus and vagina. When you’re pregnant, your cervix helps keep your baby in place until it’s fully developed. Cervical cancer occurs when abnormal cells develop in the lining of the cervix and form a tumour.

Anyone with a cervix can get cervical cancer. This includes women, transgender men and intersex people.

There are two main types of cervical cancer:

• Squamous cell carcinoma Starts in the flat squamous cells that line the outer surface of the cervix and is the most common form of cervical cancer¹.
• Adenocarcinoma Develops in the glandular cells that line the inner surface of the cervix. This type of cancer is relatively difficult to diagnose because it starts high in the cervix and isn’t always reached during a cervical screening test.

Cells in the cervix don’t suddenly become cancerous. Instead, they gradually develop abnormal changes. The main risk factor for these changes is HPV (human papillomavirus), a common sexually transmitted infection².

Some HPVs, such as genital warts, are considered low risk. Other HPVs are regarded as high risk and can cause serious illness. Usually, your immune system clears the HPV from the body. However, when this doesn’t happen, it’s called persistent infection.

This persistent infection can cause abnormal cells to develop in the cervix. When this happens, the cells are described as precancerous. Not all people with precancerous cells in the cervix will develop cervical cancer, but it’s important to identify them and treat them.

Precancerous cells in the cervix rarely cause symptoms. Therefore, the only way to discover precancerous cells is to have a cervical screening test (formerly called a PAP smear). Screening is free in Australia and is recommended every 5 years from the age of 25 to 74. 

Cervical Screening Test – a doctor or nurse will insert a speculum (a small instrument) into your vagina to hold it open and then take a swab of cells from your cervix. The swab will be sent to a laboratory to be tested for HPV, which can cause cervical cancer.

If symptoms do occur in cervical cancer, they might include:

• vaginal bleeding between periods, during or after sex, or after menopause
• pain during sex
• pelvic pain
• heavier or longer lasting periods
• changes to vaginal discharge, such as unusual colour, smell, or volume

Having any of these symptoms doesn’t mean you have cervical cancer, but you should see your doctor for a check-up even if you’re up to date with your cervical screening tests. 

Nearly all cases of cervical cancer are linked to a high-risk type of HPV³. Not everyone with HPV will get cervical cancer, but everyone with cervical cancer has a link to HPV. Other risks include:

• smoking⁴
• long-term use of the contraceptive pill gives a small increased risk⁵
• weakened immune system⁶
• people whose mother was given DES during pregnancy, an artificial form of oestrogen used between 1939 and 1971⁷

The HPV vaccine, Gardasil 9, gives almost 100% protection against 9 HPV types⁸. It’s advised that people receive the vaccine before becoming sexually active. It’s provided free in Australian secondary schools to children aged 12-13 as part of the National Immunisation Program. If you are over 20 and would like the vaccination, you will need to pay for it. Ask your GP for more information.

If your screening test shows any precancerous or cancerous cells, your GP will refer you to a specialist for more tests. These may include:

• Colposcopy – Your doctor will use a magnifying device called a colposcope to examine your cervix. As with cervical screening, the doctor will insert a speculum (a small instrument) into your vagina to hold it open, but the colposcope does not enter your body.
• Biopsy – The doctor will take a tissue sample of any suspicious looking cells they see during the colposcopy. The sample will be sent to a laboratory for analysis.

If you are found to have precancerous cells, your doctor will talk to you about the next steps. These may include:

• Large loop excision of the transformation zone (LLETZ) – A heated, thin wire loop is used to remove precancerous cells to help prevent cancer from developing. The procedure takes about 20 minutes and may be done with either a local or general anaesthetic.
• Cone biopsy – This is done when a large area of abnormal cells is found. It’s performed under general anaesthetic. A surgeon removes a cone-shaped piece of tissue from the cervix.
• Laser surgery – A laser beam is delivered through the vagina to remove abnormal cells. The procedure takes about 5 minutes and is performed with either a local or general anaesthetic.

If you are found to have cervical cancer, your doctor will explain which of the four stages you have and how far your cancer has progressed. Stage 1 is the least advanced, and Stage 4 is the most advanced. 

Treatment for cervical cancer depends on how advanced it is and whether you would like to have children. If you would like to have children in the future, talk to your doctor about your fertility options before you start treatment. Treatments that may be offered include:

• Chemotherapy
  
• Radiation therapy
• Surgery
• Targeted therapy

We understand that a cancer diagnosis can be emotional and life-changing. It’s natural to feel disbelief, anxiety, sadness, anger and loneliness. At GenesisCare, we strive to strengthen your confidence, settle your emotions and create care experiences that give you the best possible outcomes.

Our care team will know your name and get to know who you are as a person. We don’t want you to feel alone when you’re with GenesisCare. Your nursing team and oncology team are here to support you before, during and after your cancer treatment. We are here to guide you to get you the support you need from experts such as psychologists, exercise physiologists, physiotherapists and dietitians.

Please contact your local GenesisCare centre for more details on the services available. View a list of our centres here.

Whether you experience side effects and how severe they are, depends on the type and dose of chemotherapy treatment you are given and your reaction from one treatment cycle to the next. Most side effects are short-term and can be managed. These may include:

• fatigue
• nausea or vomiting
• constipation or diarrhoea
• hair loss
• easily bruising or bleeding
• weight changes
• skin changes
• dryness during sex
• permanent or temporary menopause
• mood changes

These symptoms tend to improve gradually once treatment stops. Talk to your doctor or nurse if you feel upset or anxious about how long treatment is taking or the impact of side effects

• Get as much rest as possible
• Aim for a wholefood, varied diet, but we also encourage you to eat foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea
• Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous
• Drink lots of water
• Reach out to support groups and others who have had chemotherapy
• Ask your team about topical treatments for your skin if you have irritation or pain
• Stay out of the sun as much as possible throughout your treatment
• Record your side effects in a diary or journal
• Take some gentle exercise, such as walking, if you feel up to it. Light to moderate exercise can reduce treatment-related fatigue and improve your mood. Plan your exercise for times in the day when you know you have more energy
• It is important to acknowledge when you are fatigued and rest when you need to
• Ask for and accept help from family, friends and neighbours
• Be open with employers about your treatment and discuss flexible working options if you need them

General side effects include:

• Nausea
• frequent urination
• diarrhoea
• loss of appetite
• tiredness and lethargy for a few weeks after you finish

Specific side effects (depending on the area being treated):

• bladder or bowel changes
  
• vaginal discharge
• menopause

These side effects will usually ease soon after treatment is finished. Your team will discuss any long-term considerations with you, depending on the tumour type.

General side effects include:

• swelling and pain
• difficulty emptying your bladder
• constipation
• build-up of fluid in the skin
• menopause if your ovaries are removed
• abdominal pain 

The side effects may vary depending on the type of targeted therapy you have and how your body reacts. These may include:

• high blood pressure
  
• loss of appetite
• fatigue
• blood clots or bleeding
• bowel damage

Other information, resources and support services are available to assist you during your cancer journey. These include:

Cancer Council Australia

13 11 20

cancer.org.au

Australian Cancer Research Foundation

02 9223 7833

acrf.com.au

References

1. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies.  International Collaboration of Epidemiological Studies of Cervical Cancer. https://pubmed.ncbi.nlm.nih.gov/17131323/
2. Human Papillomavirus and Cervical Cancer. Clin Microbiol Rev. 2003 Jan; 16(1): 1–17. doi: 10.1128/CMR.16.1.1-17.2003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC145302/
3. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999 Sep;189(1):12-9. doi: 10.1002/(SICI)1096-9896(199909)189:1<12::AID-PATH431>3.0.CO;2-F. https://pubmed.ncbi.nlm.nih.gov/10451482/
4. Smoking and Cervical Cancer. ISRN Obstet Gynecol. 2011; 2011: 847684. Published online 2011 Jul 14. doi: 10.5402/2011/847684. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140050/
5. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet. 2002 Mar 30;359(9312):1085-92. doi: 10.1016/S0140-6736(02)08150-3. https://pubmed.ncbi.nlm.nih.gov/11943255/
6.  Immune deviation and cervical carcinogenesis. Papillomavirus Res. 2019 Jun; 7: 164–167. Published online 2019 Apr 10. doi: 10.1016/j.pvr.2019.03.006. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477167/
7. Women exposed to DES in the womb face increased cancer risk. https://www.nih.gov/news-events/news-releases/women-exposed-des-womb-face-increased-cancer-risk
8. Final analysis of a 14-year long-term follow-up study of the effectiveness and immunogenicity of the quadrivalent human papillomavirus vaccine in women from four nordic countries. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30145-0/fulltext