Cervical Cancer

What is Cervix Cancer?

The cervix is the lower part of the uterus (womb) (diagram). Cancers that arise in the cervix are potentially curable if detected in the early stage hence early detection is t the key to improving survival. Most cervical cancers are of the type called squamous cell carcinomas.

How common is Cervix Cancer?

Cervix cancer is the 7th most common female cancer in Singapore. About 200 cases are diagnosed every year.

Age of Onset

Pre-invasive cancer often occurs in women in their late 20s to 30s.These are termed as CIN (Cervical Intraepithelial Neoplasia). These are changes in the lining of the cervix which can lead to cervix cancer. With time, these pre-cancerous lesions can progress and become invasive cancer if left untreated.

Causes and Risks

Infection with Human Papilloma viruses (HPV) is the most common cause or risk factor for cervical cancer. These viruses are transmitted during sexual intercourse, as well as via oral or anal sex. Any female who has ever been sexually active is at potential risk.

Other risk factors include:

·         Onset of sexual activity before age 20

·         Multiple sexual partners

·         a history of sexually transmitted infections

·         A male sexual partner with a history of sexually transmitted infections and or extramarital sexual activity

·         A male sexual partner with sexual partner(s) with previous cancer of the cervix has been established as a potential risk

·         Cigarette smoking is a co-factor associated with an increased incidence of cervix cancer.

Symptoms and Signs of Cervix Cancer

Abnormal bleeding from the vagina signals the need for an immediate examination. Abnormal bleeding includes bleeding after sexual intercourse or bleeding between menstrual periods. Late symptoms that occur when the cancer is advanced include low back pain, pelvic pain, weight loss and leg swelling.

  

Diagnostic Tests

Cervical cancer screening with a Pap smear should start as soon as a woman becomes sexually active. This should be performed at1-3 yearly intervals depending on the age and the number of normal PAP smears. During this examination, a scraping of cells from the surface of the cervix is obtained during vaginal examination. This is a quick, simple and painless test.

If the Pap smear is abnormal, a diagnostic procedure called colposcopy (i.e. examination of the cervix with a microscope) is done. Certain chemicals may be applied onto the cervix to help pick up abnormal areas. These abnormal areas are then biopsied and examined under a microscope by the pathologist (a doctor who examines these tissues under a microscope).

If cervix cancer is confirmed on biopsy, other tests will be scheduled. These include radiological tests such as a chest x-ray and CT-scan or MRI of the abdomen and pelvis to exclude any regional or distant spread of the cancer.. Examination of the pelvis under general anaesthesia is often scheduled to determine the extent of the cancer.

Treatment Options

Treatment of Pre-invasive and Invasive Cervix Cancer

For pre-invasive disease, the treatment is the local removal of the abnormal lining in the cervix by local excision procedures or ablative procedures. Local excision techniques include knife or laser cone biopsies or loop electrosurgical excision procedures (LEEP). Ablative techniques include laser vaporization or cold coagulation. The technique of choice has to be discussed with the attending doctor. However, the successful treatment of precancer of the cervix almost certainly prevents cancer of the cervix from occurring.

For early invasive cancer of the cervix, cure can be achieved with either surgery (removal of the uterus i.e hysterectomy, and surrounding tissue including lymph nodes) or radiotherapy, which is often given with chemotherapy.

For advance disease where surgery is not possible, concurrent chemo-radiotherapy or radiotherapy is the treatment of choice. Radiotherapy is often given in 2 ways.  One is with external beam radiotherapy and the other is internal beam radiotherapy.  The external beam radiotherapy is carried out daily on weekdays and may take about 5 – 6 weeks to complete.  The internal beam radiotherapy is gen in 2 to 5 sessions.

Prognosis of Cervix Cancer

The prognosis for early stage cervical cancer is very good with 5 year survival between 80 to 95% However for advanced stage cervical cancer, the 5 year survival decreases to less than 40%.

Is prevention possible?

Yes, primary prevention of cervical cancer is now available in the form of vaccines. In Singapore, the two commercially available are Cervarix and Gardasil. Both vaccines have been shown to be efficacious in protection against HPV 16 and 18, which cause up to 70% of cervical cancers. All women of reproductive age are encouraged to vaccinate themselves against this preventable cancer. However, as some women may still develop cervical cancer even after vaccination, screening with PAP smear is still recommended.

Source : National Cancer Centre, Singapore