Cervical cancer is a cancer that starts in the cervix, which is the lower part of womb. It is an invasive tumour affecting the cervix, which means that the tumour can spread from the surface of cervix into the deeper tissues, which in turn may spread to adjacent structures (e.g. vagina, nerve, pelvis and kidney) and finally to distant organs such as liver, lung and brain.

 

 

 

Causes and risk factors

 

Almost all cervical cancers are caused by persistent infection with one of the cancer-causing or high-risk human papillomavirus (HPV) types. Risk factors for the progression from HPV infection to cervical cancer include:

• multiple sexual partners or sexual partner with multiple sexual partners
• sexual intercourse at earlier age
• co-infection with sexually-transmitted diseases
• smoking
• weakened immunity such as infected with Human Immunodeficiency Virus (HIV)
• long term use of oral contraceptive pills for more than 5 years ( the risk returns to normal after 10 years of stopping use)
• increasing parity (number of babies born) and younger age at first pregnancy

 

 

Symptoms

 

Early stage of cancer and pre-cancerous cell changes may produce no symptoms at all. The commonest symptom is abnormal vaginal bleeding, which include vaginal bleeding:

• between periods
• during or after sex
• after menopause

Patients could experience other symptoms include: vaginal discharge with foul smell, pelvic pain, backache (if involvement of nerve or bone is affected), blood in urine or pain on passing urine (if urinary system is affected), leg swelling (if lymphatic system is affected), general malaise and weight loss.

 

 

 

Screening

1. Women aged 25-64 years who ever had sex, irrespective of marital status, are recommended to receive regular cervical cancer screening.
2. Women aged 65 years or above who ever had sex and have never had cervical cancer screening should talk to the doctor about having a cervical smear, even if they no longer have periods, haven’t had sex for many years or had sterilisation.
3. Women aged below 25 years who ever had sex and risk factors for cervical cancer (such as multiple sexual partners, smoking, weakened immunity), should seek advice from doctors concerning the need for cervical cancer screening.

 

 

Diagnosis

 

Common tests and procedures can help diagnose the cervical cancer.

• Colposcopy: Colposcopy is like a microscope put near the vagina to allow more detailed examination of the cervix. It is usually done in a gynaecological out-patient clinic. The examination usually takes about 20-30 minutes.
• Punch biopsy or target biopsy: Under the guidance of colposcopy, a small piece of tissue with lesion is obtained (biopsy), which is then sent to the lab for examination. 
• Cone biopsy: If the area of the lesion is large or the doctor cannot see the abnormal area clearly with colposcopy because the abnormal cells are high up in the cervical canal, a ring of tissue will be removed and sent to the lab for examination to make sure the whole cancer is removed. 

 

 

Treatment

 

Treatment options include surgery, radiotherapy and chemotherapy, alone or in combination, but depends on the stage of the cancer. The general rule is that the earlier stage of the cancer and the earlier it is treated, the higher cure rate would be and less aggressive treatment is required.

 

 

 

Prevention

• Practise safer sex (such as avoid having multiple sexual partners and use condoms) to reduce the chance of HPV infection and to protect against sexually transmitted diseases;
• Do not smoke;
• Get HPV vaccination before initiation of sexual activity.

 

*The above information is for reference only, please consult your doctor for detail.