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Cervical Cancer | Symptoms, Diagnosis & Treatment

21 August 2019

Cervical cancer refers to the growth of malignant cells in the cervix. The cervix is the lower part of the uterus that connects to the vagina. It is also referred to as the neck of the womb. Cervical cancer starts to develop when healthy cells of your cervix develop sudden changes (mutations) in their DNA structure.

Typically, a cell’s DNA contains essential information and instructions that guide it on what to do. Healthy cervical cells grow and multiply at a controlled rate, and they usually die after a specific period of time.

However when cancerous mutations occur, some cells may start to grow and multiply indefinitely at a relatively fast speed. The accumulation of abnormal cells in the cervix forms a tumour. At a later stage, the cancerous cells break off from the original tumour and start spreading to other body parts as well.  

According to the Singapore Cancer Society, cervical cancer is the 10th most common women’s cancer in Singapore, and it affects at least 6.9 women per 100,000 every year. This disease mostly affects women in their 40s and 50s.

Risk Factors for Cervical Cancer

Human Papillomavirus (HPV)

The most critical risk factor is infection by the human papillomavirus (HPV), which is a group of more than 100 related viruses that affect different parts of the body. Some of these viruses cause an abnormal type of growth referred to as papillomas or warts on or around the genital organs such as the cervix, vagina, scrotum, and penis, causing cancer. They can also affect your mouth, throat, and anus. 

The HPV infection is quite common since it is sexually transmitted. Your body can usually clear the infection by itself, but things may become complicated when it becomes chronic. If the virus does not clear by itself, there is a high chance that it will cause cervical cancer. 

Other factors that may increase your risk of cervical cancer include:

  • Smoking
  • Exposure to diethylstilbestrol (DES)
  • Using birth control pills for a long time
  • Having a weakened immune system that cannot fight infections
  • Early pregnancy
  • Giving birth to many children (three or more)
  • Having multiple sexual partners
  • Being diagnosed with other sexually transmitted diseases such as gonorrhea, syphilis, and herpes

Symptoms of Cervical Cancer

In its early stages, cervical cancer may not cause any symptoms. You may not notice any signs until the abnormal cells become cancerous and affect deeper parts of your cervix and other pelvic organs. 

This is the primary reason why you should see a gynaecologist routinely for Pap smear tests. If cervical cancer is not detected early, it may cause the following symptoms:

  • Abnormal vaginal bleeding
  • Menstrual bleeding that is heavier and longer than usual
  • Bleeding after sexual intercourse
  • Painful sexual intercourse
  • Bleeding even after reaching menopause
  • Unexplained and persistent pelvic or back pain
  • Vaginal odour

It is good to keep in mind that these signs are not immediate indications that you have developed cervical cancer. Other health problems could cause these symptoms as well. It is important to see a doctor whenever you notice any of these symptoms persistently. When cancer is detected early, your chances of survival and expected treatment outcome are much better.

Diagnosis of Cervical Cancer

Doctors use a wide range of methods to diagnose cervical cancer. The following tests are essential during the diagnosis of cervical cancer:

Pelvic examination

During a pelvic exam, your doctor will check your body for any signs of unusual changes in your uterus, cervix, ovaries, vagina, and other pelvic organs. Your doctor will start by examining the outside walls of your vulva before going on to examine other internal organs.

He/she will use an instrument referred to as a speculum to keep your vaginal walls open. This is only a preliminary test, and it cannot be used to conclude whether you have developed cervical cancer or not. A Pap smear may also be done at the same time. 

Pap smear

During this test, the doctor scrapes a few cells from your cervix or uterus, which are then examined in the laboratory for any abnormalities. The primary role of this test is to help the doctor establish whether there are abnormal cells in your cervix. This test can detect cancerous cells and cells that show abnormal growth which may increase your risk of developing cervial cancer.

HPV typing test

HPV typing test is quite similar to a pap test. Typically, the test is done on a small sample of cells drawn from your cervix. Your doctor will test for HPV at the same time as a Pap smear or immediately after Pap smear results.

Certain types of HPV such as HPV-16 and HPV-18 are prominent in women diagnosed with cancer of the cervix and will help your doctor confirm a diagnosis. 

Being test positive for HPV does not mean that you have developed cervical cancer. Many women have HPV but do not have cervical cancer, and this test alone cannot be used to diagnose cervical cancer.

Colposcopy

A low-powered microscope referred to as a colposcope is used to view your cervix in order to identify any abnormalities. The microscope is positioned outside your body, and its primary purpose is to magnify the cells of your uterus and vagina. During the colposcopy examination, your doctor may remove a small sample tissue so that it can be checked for malignant cells.

Biopsy

This is the only definitive way of confirming cervical cancer. During a biopsy, your doctor will remove a small sample tissue from your cervix. A pathologist will analyze and examine it under a microscope. There are different types of biopsies, and it is the responsibility of your doctor to determine which one is suitable for you.

CT/MRI scan

CT and MRI scans provide detailed imaging of your internal organs on a computer screen. An MRI or a CT scan is done to establish how far the cancerous cells have spread in your body. An X-ray scan may also be performed to determine whether the malignant cells have reached your chest and lungs.

Cervical Cancer Treatment

If detected in its early stages, cervical cancer can be treated effectively. Before recommending a treatment method, your doctor will assess a wide range of factors, such as the stage of cancer and your general health condition. 

Surgery

In most cases, early-stage cancer will be treated with surgery. The type of operation performed depends on the stage of cancer and whether you would like to conceive in future. During surgery, the doctor removes the tumour and some surrounding healthy tissue. 

Different types of surgery performed to manage cervical cancer include:

  • Radical trachelectomy is a simple surgical procedure that removes the cervix but leaves your uterus intact. This type of surgery is usually recommended for young women who want to preserve their fertility and conceive in the future.
  • Conization is the use of a laser or surgical knife to extract a cone-shaped piece of tissue from your cervix. The primary purpose of conization is to get rid of the abnormal tissue that causes cancer. This procedure is used to get rid of cancerous cells that can only be seen with a microscope.  
  • Hysterectomy refers to the removal of both the cervix and uterus. A hysterectomy can be simple or radical. A simple hysterectomy involves the removal of the uterus and cervix while radical hysterectomy involves the removal of the uterus, cervix, upper vagina, and the entire tissue surrounding the cervix. A radical hysterectomy may also involve the removal of the lymph nodes.

Radiation therapy

This treatment option involves the use of high-powered energy beams, such as protons or X-rays to kill cancerous cells. In most cases, radiation therapy will be combined with chemotherapy as the primary treatment option for advanced cervical cancer.

Radiation therapy can be administered externally by directing a radiation beam at the affected body part or internally by carefully placing a small device filled with radioactive material inside the vagina for a few minutes.  

It can also be used after surgery if your doctor feels that there is an increased risk your cervical cancer will be recurrent.

Chemotherapy

Chemotherapy refers to the use of drugs to destroy cancerous cells. These drugs are given either orally by mouth or injected into your veins. Doctors use chemotherapy to target cancerous cells that surgery cannot remove. 

Your chemotherapy regimen will consist of a specific number of cycles over a set period. Each cycle is followed by a recovery period that allows your body some time to rest.

The chemotherapy drugs that are often used to treat cervical cancer include Topotecan, Cisplatin, Paclitaxel, Carboplatin, and Gemcitabine.  Some of the side effects of chemotherapy include hair loss, nausea & vomiting, loss of appetite, fatigue, and tiredness.

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