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Cervix Cancer / Cervical Cancer - What it is

The cervix is the lower part of the uterus (womb). Cancers that arise in the cervix are potentially curable if detected in the early stage. Therefore, early detection is the key to improving survival. The two most common types of cervical cancers are squamous cell carcinoma and adenocarcinoma of the cervix.

How common is Cervical Cancer?

Cervical cancer is the 10th most common female cancer in Singapore. About 215 cases are diagnosed every year between 2014 - 2018.

Age of Onset

Pre-invasive cancer often occurs in women in their late 20’s to 30’s. These are termed as Cervical Intraepithelial Neoplasia (CIN). These are changes in the lining of the cervix which can lead to cervical cancer. Over time, these pre-cancerous lesions can progress and become invasive cancer if left untreated.

Cervix Cancer / Cervical Cancer - Symptoms

Abnormal bleeding from the vagina signals the need for an immediate examination. Abnormal bleeding includes bleeding after sexual intercourse or bleeding between menstrual periods. Other symptoms could include unusual vaginal discharge, pain during intercourse or even disturbances in urination or passing motion. Late symptoms that occur when the cancer is advanced include lower back pain, pelvic pain, weight loss and leg swelling.

Cervix Cancer / Cervical Cancer - How to prevent?

Primary prevention of cervical cancer is now available in the form of vaccines. In Singapore, the three commercially available vaccines are Cervarix, Gardasil and Gardasil9. The vaccines have been shown to be efficacious in protection against high risk HPV subtypes such as HPV 16 and 18, which cause up to 70% of cervical cancers. In Singapore, the recommendations for cervical cancer vaccine is for ages 9-26 years old. All women of reproductive age who are sexually active are encouraged to have Pap smear screening.

However, as some women may still develop cervical cancer after vaccination, Pap smear test screening is still recommended.

Cervix Cancer / Cervical Cancer - Causes and Risk Factors

Infection with Human Papillomavirus (HPV) is the most common cause or risk factor for cervical cancer. These viruses are transmitted during sexual intercourse, as well as via oral or anal sex. Any female who has ever been sexually active is at potential risk.

Other risk factors include:

Onset of sexual activity before age 20
Multiple sexual partners(>2)
A history of sexually transmitted infections or other co-infections eg immunosuppression/ HIV
Cigarette smoking is a co-factor associated with an increased incidence of cervix cancer

Cervix Cancer / Cervical Cancer - Diagnosis

Cervical cancer screening with a Pap smear should start as soon as a woman becomes sexually active. This should be performed at 1-3 yearly intervals depending on the age and the number of normal Pap smears. During this examination, a scraping of cells from the surface of the cervix is obtained during a vaginal examination. This is a quick, simple and painless test.

If the Pap smear has abnormal cells, a diagnostic procedure called colposcopy (i.e. Examination of the cervix with a microscope) is done. Certain solution may be applied onto the cervix to help pick up abnormal areas. These abnormal areas are then biopsied and examined under a microscope by the pathologist (a doctor who examines these tissues under a microscope).

If cervical cancer is confirmed on biopsy, other tests will be scheduled. These include radiological tests such as a CT-scan of the abdomen and MRI of the pelvis to exclude any regional spread of the cancer. Occasionally a PET scan of the body is advised to more accurately determine the extent of spread through the entire body.

Cervix Cancer / Cervical Cancer - Treatments

For pre-invasive disease, the treatment is the local removal of the abnormal lining of the cervix by local excision procedures or ablative procedures. Local excision techniques include knife or laser cone biopsies or Loop Electrosurgical Excision Procedures (LEEP). Ablative techniques include laser vaporization or cold coagulation. The technique of choice has to be discussed with the attending doctor. However, the successful treatment of precancer of the cervix almost certainly prevents cancer of the cervix from occurring.

For early invasive cancer of the cervix, a cure can be achieved with either surgery (removal of the uterus and cervix i.e hysterectomy, and surrounding tissues, including lymph nodes) or radiotherapy.

For advanced stage cervical cancer where surgery is not possible, concurrent chemo-radiotherapy or radiotherapy alone is the treatment of choice. Radiotherapy is often given in 2 parts. The first part is with external beam radiotherapy and this is usually followed by brachytherapy (internal radiotherapy). The external beam radiotherapy is usually daily lasting about 5-6 weeks. The brachytherapy is usually given at the latter part of the external beam radiotherapy, typically once a week for a total of 3 to 4 sessions. The chemotherapy is usually given once a week with the radiotherapy.

Prognosis of Cervical Cancer

The prognosis for early stage cervical cancer is very good with 5 year survival between 80% to 95%. However, for advanced stage cervical cancer, the 5 year survival rate may be less than 40%.

Cervix Cancer / Cervical Cancer - Preparing for surgery

Cervix Cancer / Cervical Cancer - Post-surgery care

Cervix Cancer / Cervical Cancer - Other Information

I heard that the pelvic examination may be uncomfortable. Are there alternatives to detect early cervical cancer?

Although uncomfortable, the pelvic examination and Pap smear are still reliable tests for early detection of cervical cancer. All sexually active women are advised to undergo these tests regularly or as instructed by your doctor.

I only have one sexual partner. Must I still undergo the Pap smear?

All women who have ever had sexual relationships are advised to undergo a Pap smear test at least once in 3 years or as instructed by your doctor. Cervical cancer, when detected early, is highly treatable.

I have been diagnosed to have cervical cancer. I need radiotherapy. Does that mean I cannot have sexual intercourse anymore?

Yes, you are still able to have sexual intercourse after radiotherapy. You will be taught methods to keep the vagina lubricated and how to prevent vaginal tightness so that sexual intercourse will not be difficult or painful.

Is cervical cancer contagious?

Cervical cancer itself is not contagious. However, the virus that is thought to cause the cancer can be transmitted from one person to another during sexual intercourse.