Despite cervical cancer being a significant health concern affecting many women, it is one of the most treatable cancers when detected early. Being informed about the causes, symptoms, preventative measures, and treatment options for cervical cancer is key to early detection and improved patient outcomes.
What Is Cervical Cancer?
Cervical cancer occurs when abnormal cells grow in the lining of the cervix, the lower part of the womb (uterus) that connects to the vagina. This type of cancer typically progresses very slowly and begins with abnormal changes (dysplasia) in healthy cells on the surface of the cervix. If left untreated, these abnormal cells can grow uncontrollably and become cancerous.
In Singapore, cervical cancer ranks as the 11th most common cancer among women, with more than 300 new cases diagnosed each year. While cervical cancer can affect women of any age, it is more prevalent among those aged 15 to 44.
What Are the Types of Cervical Cancer?
Cervical cancer can be classified into two primary types:
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Squamous Cell Carcinoma
Squamous cell carcinoma typically develops from the thin, flat cells lining the outer surface of the cervix (ectocervix). This is the most common form of cervical cancer, accounting for approximately 80-90% of cases.
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Adenocarcinoma
This type of cervical cancer occurs in the mucus-producing glandular cells of the cervical canal (endocervix). Adenocarcinomas are less common than squamous cell carcinomas, accounting for 10-20% of cases, and typically are more challenging to detect.
What Causes Cervical Cancer?
Nearly all cervical cancer cases originate from a chronic infection with specific strains of human papillomavirus (HPV), a widespread yet silent virus that spreads through sexual or genital contact. Many HPV infections can be resolved on their own. However, infections caused by high-risk HPV strains may persist and cause abnormal cell growth. Over time, these cellular changes can turn into cervical cancer.
While there are more than 100 strains of HPV, about 70% of cervical cancer cases are caused by just two specific types: HPV-16 and HPV-18.
What Are the Risk Factors for Cervical Cancer?
Besides high-risk HPV types, several factors may increase the risk of cervical cancer. These factors include:
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Sexual Activity
Being sexually active at an early age, having multiple partners, or having a high-risk partner can increase exposure to HPV.
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Smoking
Tobacco carcinogens can damage cervical cells and raise cancer risk.
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Sexually Transmitted Infections
Infections like chlamydia, gonorrhoea, syphilis, and HIV can make it harder to clear HPV.
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Weakened Immune System
Conditions or medications that suppress immunity reduce the body’s ability to fight HPV.
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History of Precancerous Cervical Lesions
A history of cervical intraepithelial neoplasia (CIN) or abnormal cervical cells increases future cancer risk.
Can Cervical Cancer Be Prevented?
Although cervical cancer is not entirely preventable, several measures can be taken to lower the risk of developing this disease. Some preventive strategies include:
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HPV Vaccine
An HPV vaccination protects against cancer-causing HPV strains. This vaccine is most effective when administered before an individual becomes sexually active.
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Pap Tests
Cervical screening through routine Pap tests can help identify and address early cellular changes before they progress to cancer. Women should begin routine cervical screening at age 21 and continue at intervals recommended by their doctor.
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Safe Sex Practices
Using barrier protection methods like condoms during sexual intercourse can reduce the risk of HPV infection, though they do not eliminate it completely.
What Are the Signs and Symptoms of Cervical Cancer?
Cervical cancer often does not present any noticeable symptoms during its early stages. As the cancer advances, patients may begin to experience various signs, such as:
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Abnormal vaginal bleeding (e.g., bleeding between periods, after intercourse, or after menopause)
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Unusual, foul-smelling vaginal discharge
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Pain during sexual intercourse
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Pelvic or lower back pain
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Swollen legs
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Changes in urinary or bowel habits
Do not ignore ongoing symptoms. If they persist, seek medical advice from an experienced gynaecologist in Singapore for a thorough evaluation.
How Is Cervical Cancer Diagnosed?
Cervical cancer can be detected through routine screening tests, such as the Pap test and HPV test. When these screenings reveal abnormal cells or potential issues, doctors may order additional diagnostic tests to assess the severity and spread of the condition. These include:
Colposcopy
A colposcopy provides a magnified view of the abnormal cervix using a special instrument called a colposcope. During the procedure, the doctor applies a dilute acidic solution to the cervix to highlight the abnormal areas, and then a biopsy is collected to evaluate cervical cells.
Biopsy
A biopsy involves collecting a small sample of cervical tissue to check for abnormal or cancerous cells. This is typically done after a Pap test or colposcopy reveals concerning changes. Depending on the findings, the following methods may be used:
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Punch biopsy
A small section of cervical tissue is pinched and removed for analysis.
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Loop Electrosurgical Excision Procedure (LEEP)
A thin wire loop carrying an electrical current is used to remove abnormal cervical tissue.
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Cone Biopsy
A large, cone-shaped piece of tissue is removed from the cervix and cervical canal using a scalpel or laser.
What Are the Stages of Cervical Cancer?
Cervical cancer is classified into stages based on the tumour’s size and how far it has spread to nearby tissues or other parts of the body.
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Stage I
The cancer is only visible under a microscope and is still confined to the cervix.
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Stage II
At this stage, cancer has spread beyond the cervix into the upper part of the vagina or the tissues surrounding the cervix (parametria).
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Stage III
Cancer has spread to the lower part of the vagina and into the pelvic wall or to nearby lymph nodes.
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Stage IV
This is the most advanced stage, where cancer has spread to distant organs, such as the bladder or rectum, or beyond other areas of the body, such as the lungs, liver, or bones.
What Are the Treatment Options for Cervical Cancer?
Cervical cancer may be treated surgically alone or in combination with other therapies, depending on its stage and location.
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Localised Procedures
Minimally invasive treatments are often used to manage precancerous changes. These methods aim to remove or destroy abnormal tissue before cancer spreads:
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Laser surgery: A focused laser beam destroys or removes abnormal cells in the cervix.
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Cryosurgery: Abnormal cervical tissue is frozen and destroyed using liquid nitrogen.
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LEEP or Cone Biopsy: These techniques may be used therapeutically to remove affected tissue and prevent progression to cervical cancer.
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Surgery
Early-stage cervical cancer, where cancerous cells are localised in a small area of the cervix, is often treated with surgery to remove the abnormal tissue and, in some cases, to preserve fertility. Options include:
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Hysterectomy, which involves removing the uterus and cervix. A radical hysterectomy may also include nearby tissues and part of the vagina.
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Trachelectomy, where the cervix and upper part of the vagina are removed, while the uterus is preserved and reattached to the remaining vaginal tissue.
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Pelvic Exenteration, an extensive procedure to remove the cervix, uterus, and other nearby organs such as the bladder, rectum, and vagina. It is typically recommended for cases where cancer has spread or returned after treatment.
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Radiation Therapy
This procedure employs high-energy waves to kill cancer cells and inhibit their growth effectively.
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Chemotherapy
Chemotherapy involves the use of drugs to destroy cancer cells or prevent cancer growth. It is typically combined with radiation therapy for advanced cervical cancer.
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Targeted Therapy
This treatment blocks specific genes and proteins responsible for the growth and spread of cancer cells without damaging healthy cells.
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Immunotherapy
Immunotherapy uses a certain medication to help the body's immune system recognise and fight cancer cells. It may be recommended for advanced or recurrent cervical cancer.