Every year, around 160 Kiwi women learn they have cervical cancer. Fifty will die from the disease. Māori women are 2.5 times more likely to die from cervical cancer than non-Māori.
New Zealand has a well-supported national cervical cancer screening programme. Undergoing regular screening can reduce your risk of developing the disease by 90%; in fact, the good news is that cervical cancer is truly one of the easiest to prevent.
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What causes cancer of the cervix?
The causes of cervical cancer are nearly all connected to a sexually transmitted virus called HPV (Human Papillomavirus).
HPV is extremely widespread and affects around 80% of sexually active people in their lifetime. The virus is usually relatively harmless, however, in some cases, it causes irregular cells to grow in the lining of the cervix. These cells have the potential to multiply uncontrollably and become cancerous.
The most common form of cervical cancer is squamous cell carcinoma. This type makes up about 80% of cervical cancers in New Zealand. The second type, glandular cell cancer (or adenocarcinoma), is much rarer but also more difficult to diagnose because it begins higher up in the cervix canal.
Cervical cancer usually grows slowly and can take around 10 to 15 years to develop after the initial HPV infection. That’s why regular screening over a long period of time is so effective at identifying abnormal cells that could be cancerous. The screening procedure is known as a smear (Pap) test, soon to be replaced (or combined) with an HPV test.
RISK FACTORS
Although HPV causes most cervical cancers, some additional factors may make you more at risk of developing the disease. Other causes of cervical cancer might include:
- Smoking - the number of cigarettes smoked daily and length of time smoking
- A weakened immune system
- Early sexual activity and multiple partners
- Other sexually transmitted infections (STIs)
- Exposure to stilboestrol, a synthetic form of oestrogen, before birth.
Cervical cancer symptoms
It’s very rare to see symptoms of cervical cancer in the precancerous stage. In more advanced cases, its presence may be indicated by certain cervical cancer signs. These can include abnormal bleeding:
- Between periods
- After intercourse
- After menopause
- During periods.
Other signs of cervical cancer might include persistent pain in the pelvic area, painful intercourse, or unusual-smelling or coloured vaginal discharge.
These symptoms can also indicate a range of other issues; however, you should still see your doctor.
Remember: early diagnosis and treatment of cervical cancer increases your likelihood of a positive health outcome.
Diagnosis
The World Health Organisation (WHO) describes cervical cancer as the “fourth most common cancer among women globally and one of the greatest threats to women’s health.”
Yet, cervical cancer is also one of the easiest to prevent.
That’s why New Zealand has a two-pronged approach to the disease:
- Prevention through the HPV immunisation programme (free for anyone aged 9 to 26).
- Screening through smear testing. As of July 2023, this will change to include, or be replaced by, an HPV test.
SMEAR TEST
Routine screening currently involves a smear (or cervical) test, wherein your medical professional will gently open your vagina with a speculum and, using a soft brush, take some cells from the cervix for examination.
The new HPV test is considered very reliable. There’s an option for self-testing, and the simplicity will make screening more attractive and accessible to women. It also means that women aged between 25 and 70 will only need a test every five years instead of three.
If your cervical smear (Pap) test or HPV test identifies specific, precancerous cell changes or abnormalities, then you will need to have some follow-up tests.
COLPOSCOPY
If you require follow-up testing, your doctor will refer you for a colposcopy. An instrument known as a colposcope - which resembles a pair of binoculars - is used to view your cervix. Tissue samples (a biopsy) are taken if there are any unusual-looking cells.
CONE BIOPSY
A cone biopsy or large loop excision of the transformation zone (LLETZ) removes a cone-shaped section of the cervix for further examination. This process is performed under anaesthesia.
If early-stage cervical cancer is detected, these procedures may completely remove all abnormal tissue.
Your medical professional will also refer you for further tests, including:
- MRI scan - to identify how far the cancer has spread
- CT scan - a good tool for checking the lymph nodes
- PET scan - which helps identify the spread of cancer cells.
Once diagnosed, it’s essential to start treatment as early as possible. Delays can mean your cancer spreads further, making it harder to eliminate, and possibly lowering your potential survival.
The size and spread of cancer will shape the treatment options your doctors recommend. This is known as staging.
Cervical cancer staging
The stages of cervical cancer are classified in a zero to five system which indicates the size and spread of any cancer cells.
- Stage 0 - abnormal cells are identified in the lining of the cervix’s first cell layer.
- Stage I - cancer is only seen in the cervix.
- Stage II - cancer is seen in the cervix and in the upper part of the vagina.
- Stage III - cancer is present throughout the lower part of the vagina and entire pelvic area. It might also be evident in nearby lymph nodes and may be blocking the ureters.
- Stage IV - cancer is present in organs such as the rectum, bladder, lungs, bones, or liver.
Treatment
Your medical team will use the staging classification to guide your treatment process. They’ll also consider the precise location of the cancer, your age, general health, and any plans to have children.
Treatment for early-stage cervical cancer
Identifying cervical cancer in its preliminary stage means treatment is less invasive and more effective. Doctors can completely remove many early-stage cervical cancers with one or more of the following:
- Cone biopsy (or LLETZ ) - removes any abnormal cells in early-stage cancer cases.
- Laser surgery - a laser beam cuts out part of the cervix or destroys abnormal tissue.
- Cryosurgery - a nitrogen-cooled instrument, instantly freezes and kills abnormal cells.
Surgery
If the cancer is advanced, your medical team might recommend more intensive surgery. This might include:
- Trachelectomy - removes the cervix but leaves the uterus intact. Often used when the patient wants to have children.
- Hysterectomy - either a total hysterectomy, where doctors remove the cervix and uterus, or a radical hysterectomy, where the cervix, uterus, ligaments, and a section of the vagina are removed.
Radiotherapy
Is often used in combination with surgery. It can be administered either externally, with an x-ray-type device, or internally, using radioactive application devices placed as close to the tumour as possible.
Chemotherapy
May be necessary if the cancer has spread to other areas of the body. Powerful chemo drugs kill cancer cells but may also harm healthy cells. Both radiotherapy and chemotherapy often cause side effects, including:
- Fatigue
- Nausea and vomiting
- Altered menstrual cycles
- Infertility
After treatment, you’ll need regular follow-up testing to check that all cancer has been removed and is showing no sign of recurrency.
Prognosis
Your chances of surviving cervical cancer are extremely good if you catch the disease early enough. But as with all cancers, delays in accessing diagnostic tools, specialist consultations, and life-saving drugs can have an impact on your survival.
Your chances of beating cancer (in general) are often much higher if you live in Australia. Australians have government-funded access to 28 more cancer-treating drugs than we do in New Zealand.
Medical insurance can give Kiwis that access, too, and some policies will even pay for you to utilise private healthcare in Australia. Insurance is certainly worth considering, and a quick chat with our Policywise advisers might well be a move in the right direction.
Cervical cancer prevention
Cervical cancer is easily preventable. HPV immunisation protects against the high-risk HPV variants 16 and 18. This is an important step in eliminating up to 70% of cervical cancer cases.
The HPV self-testing option and smear test screening programmes also help to eliminate cervical cancer. And even if you have high-grade abnormalities in your smear test, this still doesn’t necessarily indicate that you have cervical cancer. But it’s always better to be safe than sorry.
Are you prepared for life’s uncertainties?
You may not have cervical cancer but there’s no guarantee it won’t happen to you or someone you love. Think about how health insurance can prepare you for the possibility.
And not all health insurance plans are the same. Some plans only pay for a tiny fraction of your treatment expenses.
Don’t let this happen to you. When buying health insurance, talk to a Policywise adviser about maximum benefit amounts for cancer treatments, non-Pharmac cover, inclusions, and any exclusions.
We provide clear, easy-to-understand plan comparisons from different insurers so you can choose the policy with the best cover. Our service is free - and might just change your life for the better.