Q. What is cervical cancer?
Cervical cancer is cancer of the cervix. The cervix is the lower part of the uterus,
or womb, and is situated at the top of the vagina. Cervical cancer develops when
abnormal cells in the lining of the cervix begin to multiply out of control and
form pre-cancerous abormalities. If undetected, these abnormalities can develop
into tumours and spread into the surrounding tissue.
Q. What causes cervical cancer?
While factors such as the oral contraceptive pill, smoking, a woman's immune system
and the presence of other infections also seem to play a part, a woman has to have
been infected with certain "high-risk" HPV types before cervical cancer can develop.
"High-risk" types 16 and 18 are responsible for ~70% of all cervical cancers.
Q. How common is cervical cancer?
Each year in Australia approximately 600 new cases of cervical cancer are diagnosed
and approximately 130 women die from this disease. Globally, cervical cancer is
the second most common women's cancer, which is why many countries, including Australia,
have implemented regular cervical screening (i.e. Pap smears) programs to detect
The incidence of invasive cervical cancer has fallen dramatically in the last decade
due to the formation of the National Cervical Screening Program, which takes the
form of 2-yearly Pap smears for women.
Reference: Australian Institute of Health and Welfare. Cervical Screening in Australia
2009-2010. April 2012 AIHW cat no CAN 67.
Q. What is HPV?
Human papillomavirus, or HPV, is a common virus that affects both females and males.
There are more than 100 types of the virus. In fact, certain types of HPV cause
common warts on the hands and feet. Most types of HPV are harmless, do not cause
any symptoms, and go away on their own.
About 40 types of HPV are known as genital HPV as they affect the genital area.
More than 80% of females and males will be infected with at least one type of genital
HPV at some time.
Genital HPV types may be "high-risk" types (such as HPV types 16 and 18) that can
cause cervical pre-cancer and cancer, or "low-risk" types (such as HPV types 6 and
11) that can cause genital warts and usually benign (abnormal but non-cancerous)
changes in the cervix. Both the "high-risk" and "low-risk" types of HPV can cause
abnormal Pap smears.
HPV is easily spread through direct skin to skin contact. Anyone who has any kind
of sexual activity involving genital contact could get genital HPV. That means it's
possible to get the virus without having intercourse. And, because many people who
have HPV may not show any signs or symptoms, they can transmit the virus without
even knowing it. A person can be infected with more than one type of HPV.
It is estimated that many people get their first type of HPV infection within their
first few years of becoming sexually active.
Genital HPV infection is not something to feel embarrassed or ashamed about. It
is very common and for the majority of people who have HPV, the body's defences
are enough to clear the virus. Up to 90% of infections are “cleared” within the
first 36 months. It could almost be considered a normal part of being sexually active.
Q. How will I know if I have HPV infection?
Because HPV infection does not usually show any signs or symptoms, you probably
won't know you have it. Most people can therefore get HPV and pass it on without
evening knowing it.
Most women are diagnosed with HPV disease as a result of an abnormal Pap smear.
A Pap smear is part of a gynaecological examination that aims to detect abnormal
cervical cells (pre-cancers) in the lining of the cervix before they have the chance
to become cervical cancer. In fact, invasive cervical cancer is one of the most
preventable cancers. Although distressing, pre-cancers detected during a Pap smear
can be treated. That's why it's important to follow your healthcare professional's
recommendation about regular Pap smears.
Q. What are the consequences of HPV?
In most people HPV is harmless and has no symptoms, but in some people the virus
may persist and lead to disease of the genital area.
In females, HPV has been shown to cause cervical cancer and some vaginal, vulval
and anal cancers and genital warts.
In males, HPV has been shown to cause genital warts and some anal cancers.
Q. What is a Pap smear?
The Pap smear or 'Pap test' is a test that can detect abnormal cells in the cervix
that may lead to cervical cancer. When detected early, changes to the cervix are
easy to treat. That is why having a Pap smear every 2 years is so important.
A Pap smear requires the use of a vaginal speculum but it only takes a minute or
two. It is performed by a doctor or nurse, who will take a sample of cervical cells
by touching the cervix with a small brush and spatula. The cells are then smeared
onto a glass slide, which is sent to a pathology laboratory to be examined under
Pap smears are usually performed every 2 years, unless your GP or nurse has asked
you to have them more frequently. Regular Pap smears are a very good way of picking
up abnormal cells before they progress into cervical cancer. If you are, or have
ever been, sexually active (with either male or female partners) you should be having
2-yearly Pap smears, starting when you are 18 to 20 years old, and continuing through
until age 70.
A Pap smear only tests for abnormal cells of the cervix. It does not screen for
ovarian cancer or any other gynaecological cancers.
Q. How can I help protect myself against HPV infection and disease?
Click here for more information.
Q. How are abnormal cervical cells and pre-cancers treated?
Abnormal cervical cells can be divided into low-grade and high-grade abnormalities.
Most low-grade abnormalities will clear without causing any lasting effects.
According to current Australian guidelines, if a woman's Pap smear shows low-grade
changes, her healthcare professional may advise a repeat smear sooner than 2 years
(usually after 6 or 12 months). Sometimes colposcopy (an examination of the cervix
with a special microscope) may also be offered, either straight away or after the
Pap test, if it shows that the low-grade changes are still present.
Occasionally high-grade changes will progress to cervical cancer if left untreated.
This usually takes a number of years, although in rare cases it can happen sooner.
If a woman's Pap smear shows high-grade precancerous changes she will be referred
for a colposcopy. In many cases, during the colposcopy a small piece of tissue (a
biopsy) will be taken from the cervix. If the biopsy confirms the woman has a high-grade
cervical abnormality (referred to as CIN 2 or 3), she will most likely be
offered surgery to remove the affected part of the cervix. This can be done using
a variety of ways including, amongst other techniques, surgical excision and laser
removal. This usually requires a day stay in hospital.
Q How is cervical cancer treated?
If, after colposcopy and biopsy, a woman is found to have cancer of the cervix,
rather than a pre-cancer, she will usually be referred to a specialist cancer gynaecologist
for further assessment and management. The cancer may be staged according to the
level of invasiveness. Usually, treatment for cervical cancer involves surgery to
remove the cancer (including local excision, hysterectomy) and/or radiotherapy with
or without additional chemotherapy depending on the size or stage of the tumour.
If detected early, cervical cancer can be treated, but as with any medical condition
prevention or early detection is always best if it is available.
Q. How common is anal cancer?
Anal cancer affects both males and females and, although relatively rare, in 2005
there were 149 cases in males and 176 cases in females.
Infection with certain types of "high-risk" HPV types (such as HPV types 16 and
18) is a risk factor for anal cancers as well as other risk factors including cigarette
smoking, immunodeficiency syndromes and a previous history of genital cancers.
Q. How are anal cancers treated?
For patients diagnosed with anal cancer the three main treatment options are radiation
therapy, chemotherapy and surgery.