Cervical Cancer

Cervical cancer starts in the cervix, which is the opening between the vagina and the uterus. It occurs when normal cells transform into precancerous cells. So, it is important to detect these precancerous cells before they develop into cancer cells.

Cervical cancer is one of the most common cancers among women in Malaysia and it is most prevalent among women aged between 14 and 44.

Cervical cancer is caused by healthy cells that begin to develop mutations (changes in the DNA structure), causing these cells to multiply uncontrollably and resulting in tumour mass.

The occurrence of cervical cancer is increased by HPV infection, particularly HPV types 16 and 18. HPV infection is the most common sexually transmitted infection (STI). Most cases of HPV infection are caused by sexual activity, both penetrative sexual intercourse and non-penetrative sexual activity.

Most HPV infections do not cause physical symptoms; however, in some people, these infections may cause pre-malignant lesions that may become cancers of the cervix, anus, vulva and vagina in females if not detected and treated. The immune system clears the HPV infection within 2 years for a majority of people, but this is not always the case. HIV and sexually transmitted infections can also increase the risk of cervical cancer.

The following factors increase the risk of developing cervical cancer:

• Human Papillomavirus (HPV) infection
• Human immunodeficiency virus (HIV) infection
• Women aged 30 years and above
• Sexually transmitted infections
• Multiple sexual partners
• Smoking
• Long-term usage of oral contraceptives
• Family history of cervical cancer
• Previously diagnosed with cancer in other parts of your body
• Multiple children
• Weakened immune system

Most symptoms are not noticeable in the early stages of cancer and develops over time.

Symptoms of cervical cancer include:

• Unusual vaginal bleeding
• Pain at the lower back or lower abdomen/pelvis
• Pain or discomfort during sexual intercourse
• Watery, bloody, and foul-smelling vaginal discharge

These symptoms can be caused by numerous other conditions, which are more common than cervical cancer. Therefore, you should consult a gynaecologist if you notice one or more of these symptoms.

Staging describes the location of cancer and the extent of spread to other parts of the body. The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) classification is used for cervical cancer staging.

Staging is done based on physical examination, scans, and biopsies. It ranges from stage I to IV, where greater stages indicate the cancer has spread and there is a poorer prognosis of cervical cancer.

Your doctor would first question your general health and symptoms and conduct a thorough physical and gynaecological examinations. Blood and urine tests may also be requested.

Other diagnostic tests are:

• Colposcopy is the main test for cervical cancer. It is used to examine the cervix in detail. A colposcope is a large magnifying glass used by a doctor to examine the skin-like covering of the cervix. It can also detect changes that are too minute to be seen with the naked eye. If an abnormal region is noticed during colposcopy, a biopsy may be done whereby a small tissue sample would be taken and sent to the laboratory for evaluation.
• Imaging tests and scans such as X-ray, computed tomography (CT) scan, magnetic resonance imaging (MRI)

Learn more about the different types of Screening and diagnostic procedures performed to diagnose cervical cancer.

The treatment of choice for cervical cancer depends on the type and stage of cancer. The key therapies used are surgery, radiotherapy, and chemotherapy.

1. Surgery

   Surgery is the primary choice of treatment if cancer is detected early. There are various surgeries to treat cervical cancer, including:

   • Conization: Removal of a cone-shaped part of the cervix. Conization can be either used to treat or diagnose cervical cancer.
   • Trachelectomy: Removal of the cervix and upper part of the vagina, leaving the uterus in place, so pregnancy may still be possible.
   • Hysterectomy: This surgery is done when cancer has spread and requires the removal of the entire uterus and cervix. Women will not be able to become pregnant after this.
   • Pelvic exenteration: Removal of the uterus, ovaries, fallopian tubes, bladder, vagina, rectum, and part of the colon if the cancer has spread and other treatment options are not possible.
2. Radiotherapy

   Radiotherapy uses high-energy radiation to shrink tumours and destroy cancer cells. It is performed to relieve symptoms associated with advanced cancer. Radiotherapy can be given as the main mode of therapy if the tumour is large or has spread and after surgery to kill the remaining cancer cells.

   The two types of radiation therapy are:

   • External beam radiation (EBRT): Directs a radiation beam at the affected area externally.
   • Brachytherapy: Places a device with radioactive material inside or near the vagina for a few minutes.
3. Chemotherapy

   Chemotherapy is a cancer treatment that employs potent cancer-killing medications. It can be given in combination with radiotherapy, before surgery to reduce the size of the tumour or after surgery to kill the remaining cancer cells to reduce the rate of spread of cancer.

Learn more about the different types of treatment technologies to treat cervical cancer.

The best way to prevent cervical cancer is by getting vaccinated and having frequent screening tests.

• HPV vaccination: Vaccines can only prevent certain types of HPV infections and not treat an existing HPV infection. Typically, the vaccine should be taken before a person is sexually active. Other preventive measures include limiting the number of sexual partners, usage of condoms, and avoid smoking.
• Screening test: Pap test that collects a small sample of cells from the cervix to detect precancerous and cancerous conditions of the cervix. It is considered a primary screening tool for cervical cancer. Regular screenings for HPV by getting a Pap test done may help prevent cervical cancers.

Almost half of all cervical cancer cases are diagnosed early, making it highly treatable. Thus, most women should have regular cervical cancer screenings which include a Pap test, HPV test or a combination of both tests. Routine screening tests are recommended for women at 21 years of age and should be repeated once every few years.

Discuss with your doctor to understand if you would benefit from screening for cervical cancer.