Cervical cancer is cancer of the neck of the womb which is called cervix and is one of the most common cancers that affect a woman’s reproductive organs.
Cervical cancer is the 6th most common cancer among women in Singapore.
The incidence of cervical cancer has reduced considerably in the last few years due to screening with PAP smears.
Types of cervical cancer
- Squamous cell carcinomas begin in the thin flat cells at the lower part of the cervix.
- Adenocarcinomas occur in the glandular cells that line the upper portion of the cervix.
- Adenosqumous carcinomas are cancers in which both types of cells are involved in cervical cancer.
Causes
It is not clear what causes the squamous cells or glandular cells of the cervix to become abnormal and develop into cancer.
The human papilloma virus (HPV) has been implicated in causing cervical cancer. However, most women with HPV do not develop cervical cancer.
Risk factors
Factors which may increase the risk of cervical cancer include:
- Multiple sexual partners will increase the chance of acquiring HPV infection.
- Early sexual activity
- Sexually transmitted diseases (STDs) such as chlamydia, gonorrhea, syphilis or HIV/AIDS.
- Weak immune system due HIV/AIDS or the use of immunosuppressive drugs such as steroids as in organ transplant patients.
- Cigarette smoking
Symptoms
In the early stages, women with cervical cancer may not have any symptoms.
As the cancer progresses, these symptoms and signs include:
- Vaginal bleeding following intercourse, or in between periods or after menopause
- Watery, bloody vaginal discharge that may be heavy and have a foul smell
- Lower abdominal pain or pain during intercourse
Screening
Screening may include:
Pap smear test
- During a Pap smear test the doctor brushes cells from the narrow neck of the uterus (cervix) and sends the sample to be examined for abnormalities.
- A Pap test can detect the precancerous stage when the abnormal cells (dysplasia) are in the outer layer of the cervix and have not invaded deeper tissues.
HPV DNA test
- The HPV DNA test is used to determine whether a person is infected with any of the 13 types of HPV that are most likely to lead to cervical cancer.
Diagnosis
To confirm the diagnosis, the specialist may perform the following tests:
- Colposcopy involves examining the cervix using an instrument called colposcope and taking samples of cells for analysis (biopsy).
- Punch Biopsy involves taking a small sample of cervical cells and examining the tissue under microscope.
- Cone biopsy involves removing a cone-shaped area of cervical cells using a scalpel or laser.
Treatment
Early stage cancer
Treatments of early stage cancer include:
- Cone biopsy (conization).
- Laser surgery.
- Loop electrosurgical excision procedure (LEEP).
- Cryosurgery.
- Hysterectomy.
Invasive cancers
Cervical cancer that invades deeper into the cervix is referred to as invasive cancer and requires more extensive treatment.
Treatment options may include:
Surgery
A radical hysterectomy.
Radiotherapy
Radiation therapy uses high-powered energy to kill cancer cells and can be given externally using external beam radiation or internally by placing devices filled with radioactive material near the cervix.
Chemotherapy
Chemotherapy uses strong anti-cancer chemicals to kill cancer cells.
Prevention
The risk of cervical cancer can be reduced by taking measures to prevent HPV infection. HPV spreads through skin-to-skin contact with any infected part of the body not just through intercourse. These include:
- Using condoms during sex reduces the risk of contracting HPV.
- Delaying first intercourse, having fewer sexual partners and avoiding smoking.
- Getting vaccinated with the HPV vaccine. The vaccine is most effective if given to girls before they become sexually active.
- Having regular Pap smears which are the most effective way to detect cervical cancer.
