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The cervix is about 4cm long and is located at the top of the vagina & in pregnancy holds the baby in the uterus until labour commences. It then dilates to 10 cm & allows the baby to be born. Cancer is detected with symptoms of abnormal vaginal bleeding particularly after intercourse, after menopause, or on routine Pap smear screening.
What is a Pap Smear?
A pap smear is performed by a doctor scraping a spatula gently across the surface of the cervix, using a speculum instrument in the vagina. This can cause some minor discomfort similar to inserting a tampon. There is usually no need for any local anaesthetic or pain relief. The cells are placed on a glass slide or in some fluid (thin prep) and sent to the laboratory for analysis. Results are usually available within several working days.
A normal pap smear is usually very reliable & should only need to be repeated every two years in Australia for all women who are sexually active up to age 70. An abnormal pap smear should be discussed with your doctor & in some cases may need referral to a gynaecologist. High grade changes can progress to cancer, usually over a number of years. Early detection can result in cure of high grade changes.
Regular Pap smears are a very good way of picking up abnormal cells before they progress into cervical cancer.
What is role of Human Papilloma Virus?
Cancer of the cervix is associated with the human papilloma virus (HPV), in particular the more aggressive types 16 & 18 HPV. There are over 100 types of HPV and the lower risk HPV types are very common in all sexually active females (up to 50%) and mostly the body’s immune system clears the virus. A swab performed at the same time as a pap smear can detect if high risk HPV is present.
How likely is Cervical Cancer?
The incidence is about 1% & has a double peak in occurrence. The first is from ages 35 – 39 & the second is 60-64. The incidence of invasive disease is decreasing with the rise in Pap smear screening & more recently the introduction of vaccination.
Those women at higher risk of cancer of the cervix include:
- multiple sexual partners
- earlier age of commencement sexual activity
Is Vaccination recommended?
Research has shown that vaccination is highly effective in preventing around 80% of high risk HPV types. Vaccination is recommended for all females at around age 12-13 & has rare side effects. It is still important to continue regular pap tests as together, vaccination and regular Pap smears offer an ideal prevention strategy against both cervical cancer and pre-cancerous cervical abnormalities.
What treatments are needed?
Minor Pap smear changes may resolve & just need regular 6 monthly or yearly checks with your general practitioner. Once the pap smear shows the chance of higher grade changes then referral to a gynaecologist is recommended. Further investigation will require confirmation of the pap smear changes by a biopsy of the cervix (usually about 1mm of tissue is removed). This is usually performed in a doctors rooms using a speculum and under magnification with an instrument called a colposcope. The biopsy causes some minor discomfort similar to pinching the skin. Some haemorrhage may result which is usually controlled using a small chemical stick (silver nitrate) to seal the small blood vessels.
Loop excision of the tip of the cervix as day surgery may be recommended for confirmed higher grade changes, to remove the abnormal cells. Only the last 1cm of the cervix is usually treated and future childbearing should not be compromised. This usually cures the high grade changes, however close monitoring is required for 2 years after the surgery.
Invasive cancer of the cervix usually requires a radical hysterectomy with removal of pelvic and abdominal lymph glands through a laparotomy (cut on the abdomen). Depending on the nature of the cervical cancer & any spread, additional treatment may be needed after the initial surgery, such as chemotherapy and radiation therapy.