Cervical Cancer

What is Cervical Cancer?

Cervical cancer is the 10th most common cancer among women in Singapore. It is also considered one of the most preventable cancers, as there are vaccines that can help protect women.

The cervix is part of the female reproductive system. It is located at the neck of the womb (refer to the image below). Cervical cancer arises when cells in the cervix mutate, creating abnormal growths.

What Causes Cervical Cancer?

Cervical cancer can be caused by the Human papillomavirus (HPV), which is transmitted through sexual contact. HPV is a group of more than 150 viruses, and at least 13 types of them can lead to cervica’ cancer. The types that may lead to cancer include HPV 6, 11, 16, 18, 31, 33, 45, 52, and 58. HPV 16 and 18 are involved in 70% of all cervical cancers. The risk of developing cervical cancer increases when a person has many sexual partners and becom es sexually active at a young age, smokes, has a weakened immune system, long-term stress, gives birth at a young age, or had several pregnancies.

Can You Prevent Cervical Cancer?

HPV vaccination is a very effective preventive tool for cervical cancer, as almost 100% of cervical cancers are HPV- related. There are 3 HPV vaccines approved for use in the market at present. These are

The bivalent Cervarix (HPV 16 and 18),
The quadrivalent Gardasil (HPV 6, 11, 16 and 18), and
The nine-valent Gardasil 9 (HPV 6, 11, 16, 18, 31, 33, 45, 52, 58).

Each vaccine offers protection against the respective types of HPV. HPV does not only cause cervical cancer. It can also lead to anal, vaginal, vulva, and oropharyngeal cancer. By targeting the virus, incidences of these cancers will reduce as well. Due to the benefits, some countries have begun giving HPV vaccinations to boys as well.

When Should I Get the HPV Vaccine?

The general recommendation is to administer 3 serial doses of vaccines to young girls before they become sexually active. The American Cancer Society’s recommended age for HPV vaccination is 11–12 years old. In Singapore, the Ministry of Health has also recently introduced an opt-in scheme for free HPV vaccination in secondary 1 girls, effective from April 2019. Catch-up HPV vaccination among females aged 13–26, who are not previously vaccinated, is also recommended. Males are also recommended to get vaccinated at ages 11–12, or from ages 13–26 if one is not yet vaccinated. After the age of 25–26, you can still get the HPV vaccine. However, the vaccine is most effective when administered before sexual activity has commenced. Hence, it is ideal to get vaccinated while young.

What are the Signs & Symptoms of Cervical Cancer?

Early cervical cancer is frequently asymptomatic (shows no symptoms). Thus, cervical cancer screening is important in order to detect cancer early. The earlier it is detected, the better the treatment outcomes. This is why every woman should have a regular PAP smear test done at the gynaecologist to detect early signs of cervical cancer. The common symptoms for a local disease (meaning the cancer has not spread) are:

Abnormal vaginal bleeding (Such as bleeding between periods)
Postcoital bleeding (Bleeding after sexual intercourse)
Pain during sexual intercourse
Vaginal discharge that smells or has blood

If the cancer has spread from the cervix to other areas of the body, there might be other symptoms such as:

Pelvic or lower back pain
Blood in urine
Bleeding from the rectum

What is the Screening for Cervical Cancer?

A Pap smear test is the common option for screening for cervical cancer. It is a simple, routine procedure, where the doctor or nurse gently brushes some cells from the cervix, and sends them to the laboratory for testing. Most guidelines recommend Pap smear every 2–3 years, even if women report sexual abstinence. Another screening method is a HPV DNA test. Compared to the conventional pap smear, a HPV DNA test has the potential to detect more high-grade precancerous lesions. This early detection can help to reduce the chances of the lesions developing into cervical cancer. Co-testing of HPV DNA test with Pap smear can be considered for women older than 30 years old.

How is the HPV DNA test conducted?

The procedure to obtain a sample for the HPV DNA test is similar to a Pap smear. The collected sample is then transported in specialised liquid for further processing at a lab. Similar to a pap smear, any abnormalities detected would need to be further investigated with a colposcopy procedure done by a gynaecologist. During a colposcopy, the cervix will be examined with a microscope. A biopsy sample will also be taken.

Cervical Cancer Treatment at The Cancer Centre, Singapore

Pre-invasive and early stages of cervical cancer is treated with either primary surgery or radiotherapy. The treatment process starts with a surgery. This may entail the removal of the uterus (hysterectomy) as well as the surrounding tissue. This often gives a good treatment outcome for patients. Patients with high-risk features may benefit from additional radiotherapy after initial surgery. For women with locally advanced disease, the ideal management is concurrent chemotherapy and radiotherapy. Following treatment of early-stage cervical cancer, distant metastases or multiple recurrence sites develop in 15 to 61 percent of cases, usually within the first two years of completing treatment. Women who have isolated local recurrence in the pelvis or limited relapse in the lungs may be considered for surgery. For women with more widespread metastatic disease, the standard of care is platinum-based chemotherapy with addition of anti-angiogenic therapy for better outcomes.

Conclusion

Cervical cancer is highly preventable, and the benefits of vaccination and regular tests such as having a pap smear or HPV DNA test definitely outweigh the costs of treatment. If you are looking to get vaccinated against HPV, or wish to get cervical cancer screening test (pap smear or HPV DNA test), book an appointment with our oncologists in Singapore today.