Cervical cancer | Mate pukupuku waha kōpū

Cervical cancer (mate pukupuku waha kōpū) is cancer that forms in a woman's cervix, the lower part of the uterus, sometimes known as the neck of the womb.

​Cervical cancer is caused by several types of a virus called human papillomavirus (HPV). There is now a vaccination which can protect against certain types of HPV, including most of those that cause cervical cancer.

Cervical cancer is caused by several types of a virus called human papillomavirus (HPV). The virus spreads through sexual contact. Most HPV infections clear by themselves, but some high-risk types can cause cell changes on the cervix that may lead to cervical cancer 10 to 20 years after infection. Other types can cause genital warts, but these do not lead to cancer.

You are at higher risk of cervical cancer if you smoke, have many children, use birth control pills for a long time, or have a lowered immune system such as from HIV infection or some medications.

The best way of protecting yourself against developing cervical cancer is by having regular cervical smear tests and being vaccinated against HPV.

Cervical screening tests

It usually takes several years for normal cells in the cervix to turn into cancer cells. Your healthcare provider can find abnormal cells by doing an HPV primary screening test (via a vaginal swab) and having it tested for the presence of human papilloma virus (HPV). By getting regular cervical screening tests and pelvic exams you can find and treat changing cells before they turn into cancer. Read more about cervical smear tests.

Vaccination

A vaccine, called HPV vaccine (also called Gardasil®) protects against most types of HPV virus that cause cancer. This is already reducing the number of women developing cervical cancer. However, this vaccine does not yet protect against all HPV types; therefore, women who have been immunised must still continue to have smear tests. 

In Aotearoa New Zealand, the HPV vaccine is available free for everyone aged 9–26 years of age. People of any age can still have the vaccination by visiting their family doctor and discussing whether it would be of benefit to them and how much it will cost. Read more about the HPV vaccine.

Cervical cancer may not cause any symptoms at first, which is why you are encouraged to have regular cervical smear tests. Cervical smears look for early changes happening at a cellular level that can indicate that cancer is developing.

If early cell changes develop into cervical cancer, the most common signs include:

• vaginal bleeding between periods
• bleeding after sexual intercourse
• pain during sexual intercourse
• unusual vaginal discharge
• vaginal bleeding after menopause
• excessive tiredness
• leg pain or swelling
• low back pain.

All these symptoms are common to many conditions and may not mean you have cervical cancer. However, if you have these symptoms, have them checked by your doctor. 

Cervical sample tests

Most women with cervical cancer are identified by through cervical screening. These women usually have very early cervical cancer which is easier to treat and less likely to cause long-term problems. 

A cervical sample test  (known as a smear test) takes some of the cells from the surface of the cervix which are then examined under a microscope. Cancer cells look different to normal cells. This does not mean there is a cancer present, just that the cells have become abnormal. For a cancer to be present these cells must start to grow into the cervix and to see this a small piece of cervical tissue needs to be taken to look under the microscope. This is called a cervical biopsy.

Colposcopy

A colposcopy is like a cervical sample test test but the doctor will look at the cervix carefully and if necessary take a biopsy of any areas that look abnormal. These biopsies will tell if there is cervical cancer or not.

LLETZ

A LLETZ is a procedure which removes the abnormal cells from the cervix. The small pieces of tissues removed are sent to the laboratory to test for cancer.

If the results of the tests above suggest that cervical cancer may be present, and there's a risk that the cancer may have spread, then further tests are needed to assess how widespread the cancer is. This makes it possible to plan the best treatment. The most common investigations for cervical cancer are:

• MRI scan — this the best way of seeing how far the main part of the cancer has spread through the cervix and how close it is to the bladder and the bowel.
• CT scan — this scan is very good for looking at lymph nodes in the pelvis and the chest which is where the cancer is most likely to spread to first.
• PET scan — this is a specialised scan that is used to identify small amounts of tumour.

All cancers are classified by how far they have progressed or the stage that the cancer has reached. The higher the stage, the further the cancer has spread. The staging for cervical cancer is as follows:

• stage 0 (pre-cancer) – there are no cancerous cells in the cervix, but there are biological changes that could trigger cancer in the future
• stage 1: the cancer is still contained inside the cervix
• stage 2: the cancer has spread outside of the cervix into the surrounding tissue, but hasn't reached the tissues lining the pelvis (pelvic wall) or the lower part of the vagina
• stage 3: the cancer has spread into the lower section of the vagina and/or into the pelvic wall
• stage 4: the cancer has spread into the bowel, bladder or other organs, such as the lungs.

There are a few treatment options for cervical cancer, depending on how far the cancer has spread, age and what other health conditions a person has. 

Cone biopsy

A cone biopsy is an operation that removes a cone-shaped part of the cervix which has the cancer. This is only done when the cancer is very early and a woman wishes to have children in the future. Sometimes the whole cervix is removed. This is called a trachelectomy. 

Hysterectomy

In most cases of cervical cancer, hysterectomy is the main form of treatment. This is an operation to remove the cervix and uterus and often the fallopian tubes and ovaries. If the cancer is very early this is all that is required. The lymph nodes near the cervix will be checked carefully and if these lymph nodes have cancer cells in them, the woman will also be treated with radiation therapy.

A radical hysterectomy is the name given to an operation where the tissue around the cervix and the lymph nodes in the pelvis are removed. This surgery can have complications such as infection and bleeding, but there is a good chance that the woman will be cured of her cancer.

Radiotherapy

Radiation treatment is very useful for women with cervical cancer. There are different types of radiation used.

• Brachytherapy is used before surgery to decrease the size of the cancer and to increase the chances of surgery removing all the cancer. A type of radiation is used which only travels a very short distance so is used to treat the cancer cells in the main part of the cancer or the primary tumour.
• External bean radiotherapy is used to treat a wider area, and is used to treat the cells which may have travelled into the lymphatic system or the metastases.

Chemotherapy

Chemotherapy is being used to treat cervical cancer more often than before. Several drugs have been shown to be effective in killing cancer cells. Chemotherapy is sometimes used before surgery and sometimes after surgery.

Most people who have early stage cervical cancer will be cured, but the cancer can come back. Usually this happens within 5 years of treatment. In most cases, a patient will be seen every year to check for any signs that the cancer has reappeared. Although it is much more difficult to cure cervical cancer if it returns, it is still possible to delay its growth and improve a person’s quality of life. This is a difficult time for the person and their whānau and all cancer units in Aotearoa New Zealand have special teams to help you through this.

• Don’t smoke, or quit smoking if you already do smoke.
• If you are under the age of 26, you can be immunised to protect you from HPV infection. This decreases your chance of cervical cancer by 90%.
• Have regular smear tests. If a woman has regular smear tests then the chance of getting cervical cancer is also decreased by 90%.
• See your doctor if you have bleeding outside of your period for any reason, but especially after sex.

Emotions and cancer English/te reo Māori(external link) Cancer Society of NZ, 2020
How we can help(external link) Cancer Society of NZ
Personal stories(external link) National Screening Unit NZ
NZ cancer services – find a hospital/service near you(external link) Healthpoint, NZ
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