Cervical arises from the cervix, which is the neck of the womb. It is the 10th most common cancer amongst Singaporean women and is the most preventable gynecological cancer in Singapore.
What causes cervical cancer?
It is caused by the virus Human Papilloma Virus (HPV). HPV infects the cells of the cervix and multiplies. Over a long period of time, the virus causes changes in the cells, which becomes pre-cancerous or abnormal. The changes take place over many years, which is why regular screenings are recommended for early detection. In the early stages, cervical cancer is highly treatable.
What is HPV and how is it transmitted?
HPV is transmitted through sexual contact. Infection is very common as it does not cause symptoms. A majority of the infections resolve on their own; however, a small percentage of women with HPV will go on to develop cervical cancer. There are many different strains of HPV. The oncogenic strains, also known as the cancer-causing strains, account for a majority of the cancers. They are strains 16 and 18. Other strains, such as HPV 6 and 11, are also common but do not cause cancer and usually only cause genital warts.
Who is at risk?
Women above the age of 30
Women who are sexually active and have had more than one sexual partner
Immunosuppressed people, or people whose immune system is compromised, such as HIV/AIDs, chronic medications that suppresses your immune system e.g., steroids
If you feel that you are at risk, please consult a doctor.
What are the symptoms?
Abnormal bleeding (e.g., bleeding in between periods, bleeding after menopause, bleeding after sex etc.)
Abnormal vaginal discharge (e.g., bloody discharge, foul-smelling discharge, heavier than normal discharge)
Lower tummy pain
Urinary or bowel symptoms (e.g., painful urination, incontinence)
What are the stages of cervical cancer?
The international guidelines for staging of cervical cancer according to FIGO:
Stage I: The cancer has spread from the cervix lining into the deeper tissue but is still just found in the uterus. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).
Stage II: The cancer has spread beyond the uterus to nearby areas, such as the vagina or tissue near the cervix, but it is still inside the pelvic area. It has not spread to other parts of the body. This stage may be divided into smaller groups to describe the cancer in more detail (see below).
Stage III: The tumor involves the lower third of the vagina and/or: has spread to the pelvic wall; causes swelling of the kidney, called hydronephrosis; stops a kidney from functioning; and/or involves regional lymph nodes. Lymph nodes are small, bean-shaped organs that help fight infection. There is no distant spread.
Stage IVA: The cancer has spread to the bladder or rectum, but it has not spread to other parts of the body.
Stage IVB: The cancer has spread to other parts of the body.
How is cervical cancer diagnosed and staged?
Your doctor may perform a series of tests, which include:
Pelvic exam - this is to ascertain whether or not there are obvious masses in the pelvic region, which may suggest that the cancer is growing or has spread to other parts of the body
Cystoscopy - this involves an instrument called the colposcope inserted through the vagina to examine the cervix and obtain biopsies for evaluation
Proctoscopy and digital rectal exam - your doctor may also examine your anus and rectum to determine there are no masses or fistulas
X-rays, CT scans, ultrasounds - these radiological investigations may help to determine the size of the tumour and/or if the cancer has spread
What are the treatment options?
Treatment depends on the staging and prognosis of the cancer. Your doctor may recommend a series of treatments, such as surgery with chemotherapy or radiation therapy, or either of the options alone. If detected early, treatment will be simple and very effective.
Loop electrosurgical excision procedure (LEEP)
Chemoradiation - this involves the use of high-powered energy or strong chemicals to treat the cancer cells
How do I screen for cervical cancer?
In Singapore, the recommended guidelines for cervical cancer screening is pap smear every three years under the age of 30, and HPV screening above 30 years old.
For pap smears, this can be done during a regular clinic session. It is usually performed 10-14 days before your next period. Your doctor may insert a speculum through your vagina and use a brush to collect a sample of cells from the cervix. The sample will be sent to a laboratory where the cells are examined under a microscope to detect any abnormal changes to the cervical cells.
For HPV tests, the process is the same as a pap smear. In addition to detecting abnormal changes, the cells will be sent for further testing to detect the presence of HPV and identify (if any) the cancer-causing strains.
You should continue to screen for cervical cancer until the age of 65. If you already have your womb removed (for a variety of reasons), you do not need to screen for cervical cancer.
How do I prevent cervical cancer?
The best way to prevent cervical cancer is to be vaccinated against HPV. There are different types of vaccine on the market, namely Cervarix, Gardasil-4 and Gardasil-9, that cover for the most common oncogenic strains. For Singaporean women under the age of 26, the vaccines are covered by Medisave.
Other ways to lower the risk of cervical cancer is to practise safe sex, quit smoking, and adopt a healthy lifestyle. Unfortunately, once you have been infected with one of the cancer-causing strains, there is no role for the HPV vaccine. However, you can still continue to screen regularly by going for pap smears or HPV tests.