Introduction :
Cancer of the cervix, which is where the womb (uterus) opens into the vagina.

Cause :
Cancer of the cervix is more common in women who have multiple sexual partners, and much more common in women who have been infected with the human pappiloma virus, which causes genital warts. It is very rare in women who are virgins.

Incidence :
One of the more common forms of female cancer.

Investigations :
If a suspicious Pap smear indicates the possibility of cancer of the cervix, the cervix will be more closely examined by a gynaecologist using a colposcope, which is a microscope that is inserted into the vagina. A biopsy of any suspicious areas of the cervix will be taken.

Screening :
All women who are sexually active at any age should have regular Pap smear tests. The doctor will often examine the breasts and check the blood pressure at the same time. The test itself is remarkably simple. A collapsible metal tube, known asa speculum, is introduced into the woman’s vagina. Through this the doctor can see the cervix, and s/he gently twists a wooden stick or fine brush into the opening of the canal through the middle of the cervix.This lifts off a superficial layer of cells. The stick or brush is then wiped across a glass slide to form a smear on the glass. The slide is then sent to a pathologist who examines the smeared cells under a microscope before sending a report to the doctor. In 1996, a new method of slide examination using a sophisticated computer program was introduced. The whole procedure takes less than a minute, and the report is usually available in the next day or two. It is just as important for older women to have the smear test, even after the menopause, every two years.

Course :
There may be no symptoms to indicate that anything is wrong for several years. Then abnormal vaginal bleeding, foul discharge, pain and/or bleeding on intercourse, and discomfort in the lower abdomen may occur.

Treatment :
If a Pap smear test detects an early stage of cancer, it can be easily treated. The abnormal area of the cervix may be burnt away by diathermy or laser, or a cone-shaped area of tissue may be excised. These forms of treatment do not interfere with the woman’s ability to fall pregnant, or function normally in her sexual responses. Only if the cancer has already spread is a hysterectomy required or radiation therapy used.

Complications :
The cancer may spread to the lymph nodes in the pelvis and other organs if not treated soon enough. The uterus, ureters and pelvic nerves are commonly involved in advanced stages.

Outcome :
The prognosis depends on how early the cancer is detected. 99% of early stage cancer is cured, 65% of cases with medium stage survive, but only 5% of those with spread outside the pelvis are alive after five years. Early diagnosis is therefore critical.

Further information:
The Australian Cancer Society has branches in every state which can assist patients, their family and friends with information and support. Palliative Care Associations assist patients with terminal cancer. Oncology clinics are attached to many major public and privatehospitals.

Medical curiosity :
The Papanicolou smear test is named after the Greek/American doctor who developed the procedure in the 1950s. It is abbreviated to "Pap" smear for obvious reasons!