CONDITION
The female reproductive system consists of ovaries, fallopian tubes, uterus (womb) and the vagina. The cervix is the neck of the womb and is visible during a vaginal examination. The cervix is made up of millions of tiny cells. Sometimes, changes can occur to these cells without you knowing it.
When abnormal cells grow out of control, cervix cancer occurs. Normally, it can be successfully treated if it’s detected early. It is normally detected at an early stage through a pap test.
Is cervical cancer common?
Yes, it is one of the most common cancers in women worldwide. Most cervical cancer is caused by a virus known as human papillomavirus (HPV).
How is HPV contracted?
Through sexual contact with someone who has it. There are many different strains of HPV viruses and not all types of HPV cause cervical cancer. Some HPV viruses cause genital warts but other types may not cause any symptoms at all.
Statistically, most adults have been infected with a strain of HPV virus at some point. The infection may go away without treatment. However, sometimes it may cause genital warts or lead to cervical cancer and that’s why it’s important to go for regular pap tests.
A pap test will be able to detect changes in cervical cells before they turn cancerous. You may prevent cervical cancer if these cells are treated.
Abnormal-looking cells (dysplasia) are not cancer cells but they may be pre-cancerous. Squamous intraepithelial lesion (SIL) is when dysplasia is detected at the time of a pap test. Another term to classify pre-cancerous changes in the cervix that are found in tissue samples such as biopsies are known as cervical intraepithelial neoplasia (CIN).
These pre-cancerous changes can normally be treated to prevent the development of cervical cancer.
There are two types of cells in the cervix:
- Cells lining the outer cervix (squamous cells)
- Cells that line the interior channel of the cervix (have features of glandular cells)
The meeting point of the squamous cells and glandular cells is known as the transition zone. This is the area where most pre-cancerous and cancer cells develop. Ninety percent of cervical cancers develop from the squamous cells and are called squamous cell carcinomas while most of the reminder comes from the glandular cells known as adenocarcinomas.
Are you at risk?
All women are at risk of developing cervical cancer. Your risk increases if you:
- Sex. Ever had sex and/or are sexually active
- Smoke. If you smoke
- Sexual partners. Have had multiple sexual partners
- Infections. Have had a history of sexually transmitted infections, such as genital warts or genital herpes
How to prevent?
There are two effective methods:
- Minimising early sexual activity and number of sexual partners. The use of a diaphragm or condom may have protective effect.
- Regular Pap smear test. The accessibility of the cervix allows a Pap smear test to be performed easily and quickly. During a vaginal examination, a specimen of cells is obtained with a spatula from the cervical lining and examined under the microscope. The Pap smear test can detect pre-cancerous changes or early cancer which have better survival outcome. If Pap smear is abnormal, further tests are needed.
All sexually active women between 25 and 69 years old are advised to have a pap smear regularly. An initial smear is performed once a woman is sexually active and repeated after one year. After that, the Pap smear can be done once in one to three years as advised by the doctor.
I heard that the pelvic examination may be uncomfortable. Are there other tests to detect early cervical cancer?
The pelvic tests and Pap smear are still the only reliable tests for early detection of cervical cancer. Adult women who are sexually active are advised to go for these check-ups once every year or as instructed by your doctor.
Yes, all women who have had sexual relationships are advised to go for a Pap smear test at least once every three years or as per instructed by your doctor. Early cervical cancer is highly treatable.
I’ve been diagnosed with cervical cancer and I need radiotherapy. Can I still have sexual intercourse?
You will still be able to have sexual intercourse after radiotherapy. To ensure that the vagina is lubricated, you will be taught certain methods so that sexual intercourse will not be difficult or painful.
Is cervical cancer contagious?
No, cervical cancer is not contagious. However, the virus that causes cervical cancer is thought to be spread from one person to another during sexual intercourse.
SYMPTOMS
There are rarely any symptoms caused by abnormal cervical cells. However, when these abnormal cells progress to cancer, the signs and symptoms you may experience include:
- Abnormal vaginal bleeding (between periods, after sex or after menopause
- Pain during sex
- Abnormal vaginal discharge
- Significant unexplainable changes in your menstrual cycle
When your cervical cancer progress to the advanced stage, the signs and symptoms may include:
- Anaemia (caused by heavy bleeding)
- Constant pelvic, back and leg pain
- Urinary problems (blockage of a kidney or ureter)
- Leakage of urine or faeces into the vagina (this may occur when an abnormal opening has developed between the vagina and bladder or rectum)
- Weight loss
TREATMENTS
Your doctor will decide on the treatment for you based on a few factors including the stage of the cancer at the time of diagnosis. The common methods of treatment for cervical cancer include surgery, radiation therapy, chemotherapy and targeted therapy.
- Surgery: This is normally performed to remove the cancer especially in early-stages. The removal of your uterus (hysterectomy) may be performed. Other procedures that preserve the ability to carry a pregnancy will be performed in younger women with small tumors.
There are two options that can be performed to remove small tumors in order to preserve fertility:
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- Cone biopsy: The removal of the inside of the cervix where most tumors start
- Trachelectomy: The removal of the upper vagina and cervix
For advanced cancer, a procedure known as pelvic exenteration is used to remove the uterus, surrounding lymph nodes and parts of other organs surrounding the cancer depending on the location of the cancer.
- Radiation therapy: This is another common treatment for cervical cancer. The two types of radiotherapy used to treat cervical cancer are:
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- External beam radiation therapy: Administered from an outside source of radiation
- Brachytherapy: Involves the insertion of radioactive sources near the tumor for a fixed period of time.
They have also been used together. When radiation therapy is administered as the main treatment for cervical cancer, it is often combined with chemotherapy. The side effects of this therapy include:
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- Diarrhoea
- Fatigues
- Skin changes
- Vomiting
- Nausea
- Irritation of the bladder
- Vaginal irritation and discharge
- Menstrual changes
- Early menopause (if the ovaries are exposed to radiation)
- Chemotherapy: Chemoradiation (chemotherapy combined with radiation therapy) may be recommended for some stages of chemotherapy. It may also be administered before or after radiation treatment. The drugs commonly used in chemotherapy include cisplatin and 5-fluorouracil. It may also be the treatment choice for recurring cervical cancer. The side effects of chemotherapy include:
- Nausea
- Fatigue
- Vomiting
- Hair loss
- Mouth sores
Targeted therapy: This therapy refers to drugs that have been specifically developed or targeted to interrupt the cellular processes that promote the growth of cancer cells. An example of a drug used is called Bavacizumab (Avastin). It is a drug that inhibits the ability of tumors to make new blood vessels that is necessary for tumor growth. This type of targeted therapy is sometimes used for advanced cervical cancers
DIAGNOSTIC SERVICES
- Pap test: Abnormal cell changes in the cervix can be detected in a pap test in the early stages. A pap test is a routine screening test to detect abnormal cell changes in the cervix and to screen for cervical cancer. It is the most important tool in finding and treating cervical cell changes before they progress to cervical cancer. Talk to your doctor about how often you should have this test done. The recommended Pap test schedule is based on how old you are and factors that may increase your risk.
- History taking and physical exam. You will be asked by your doctor about your periods, symptoms and family medical history. A pelvic examination will be performed to look for vital signs of the disease. Your doctor will also perform a pap smear during the physical examination.
- Colposcopy and cervical biopsy: This will be able to tell you whether and where the cancer cells are on the surface of the cervix.
- Endocervical biopsy (or curettage): This will be able to tell you whether the cancer cells are in the cervical canal.
- Cone biopsy or loop electrosurgical excision procedure (LEEP): Sometimes recommend to remove cervical tissue for examination under a microscope.
The tests to find out the stage of cervical cancer and treatment include:
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- Chest X-ray to check your lungs
- CT scan; a type of X-ray to look inside the body
- Ultrasound; uses sound waves to check internal tissues and organs
- MRI; uses magnets to see inside the body
- PET scan; check for cancer that has spread (metastasized) to other parts of the body
- Fine needle aspiration biopsy
Can cervical cancer be prevented? What is the cervical cancer vaccine?
Yes, it can be prevented with vaccination and modern screening techniques that can detect pre-cancerous changes in the cervix. Cervical cancer in developed country has declined significantly after the introduction of pap screening that has the ability to detect pre-cancerous changes that can be easily treated before they progress to become cancer.
Vaccines are also available to fight against the common types of HPV viruses that cause cervical cancer. The three different types of HPV vaccines are:
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- Gardasil: Shown to be a hundred percent effective. Provides immunity to four common HPV viruses; 6, 11, 16, 18
- Gardasil-9: A newer version of Gardasil approved in December 2004. It provides immunity to nine 9 HPV types; 6, 11, 16, 18, 31, 33, 45, 52 and 58
- Cervarix: Prevents infection from HPV type 16 and 18 (the two most common type to cause cervical cancer)
To receive the full benefits of the vaccine, it should be administered before any sexual activity. The CDC recommends that girls between eleven to twelve years of age receive the vaccination. Young women between the ages of thirteen to twenty six should get the vaccine if they have not received any when they were younger.
Gardasil has also been approved to be used in males aged nine to twenty six. The CDC recommends Gardasil for boys aged eleven to twelve and boys aged thirteen to twenty one who have never received any doses. Men can receive the vaccination up to age twenty six.
