Cervical Cancer

Conditions & Treatments

Cervical Cancer
Introduction	Diagnosis
Causes	Treatment
Symptoms	FAQs



Introduction
The cervix is the lowest part of the uterus or womb. In its earliest stages, cervix cancer is a highly curable disease. Early detection is the key to improving survival. Most cervix cancers are squamous cell carcinomas. *How common is Cervix Cancer?* Cervix cancer is the fourth most common female cancer in Singapore. Between 1988 and 1992, almost 1000 cases were reported in Singapore. Very early cervix cancers occur in women in their mid to late 30s. With time, early cervix cancers invade into the uterus and are therefore more common in women in their mid to late 40s.

Causes and Risks
Cervix cancer is now considered to be a sexually transmittable disease. Human papillomaviruses and possibly herpes simplex virus type 2 have been implicated in causing the cancer. These viruses are transmitted during sexual intercourse. Onset of early sexual activity before age 20 and multiple sexual partners increase the risk for cervix cancer. Cigarette smoking is a co-factor implicated in causing cervix cancer.

Symptoms
There is no characteristic symptom for cervix cancer. Bleeding is caused by ulceration of the cancer but some cancers grow without ulceration. Although it is not always reliable, abnormal bleeding from the vagina signals the need for an immediate examination. Late symptoms when the cancer is very advanced are low back pain and weight loss.

Diagnosis
Very early cervix cancers confined to just the surface of the cervix grow slowly over periods as long as 8 to 10 years. Once the cancer invades deeper tissues of the uterus, it starts to grow rapidly and can cause death within 2 to 3 years. *PAP Smear* Cervix screening, called a PAP smear, should start as soon as a woman becomes sexually active. This should be performed once a year. During this examination, a scraping of cells from the surface of the cervix is obtained during pelvic examination. This is a very simple, painless and quick test. If the PAP smear is abnormal, specialised tests such as colposcopy and biopsy is usually recommended. During colposcopy, the cervix is examined with a microscope. Certain innocuous chemicals may be painted onto the cervix to pick up abnormal cells. These areas of abnormal cells are then biopsied and the removed tissue examined under a microscope by the pathologist (doctor who examines tissue under microscopes). *Other tests* Once a cervix cancer is confirmed on biopsy, other tests are scheduled. This includes the IVU, which is a x-ray to look at the kidneys, chest x-ray and computerised scan (CT) of the region where the cancer is. Examination of the pelvic organs under general anaesthesia and cystoscopy, a test where a scope is introduced into the urethra and from there into the bladder, are also scheduled to determine the extent of the cancer. Clinical examinations, x-rays and pathology reports all help the medical team decide what the progress of an individual case of cervix cancer may be. Then, the appropriate course of treatment will be put into action. The treatment strategy will vary from person to person. With prompt and appropriate treatment, the outlook for a person with cervix cancer is excellent. If the cancer is only confined to the surface of the cervix and has not invaded further, the chance of cure is almost 100% with appropriate treatment. Once the cancer invades the underlying muscles of the cervix the chance of cure is reduced.

Treatment
If the cancer is confined to just the surface of the cervix, removal by cryosurgery or electrocautery or laser treatment is sufficient. These are types of surgery techniques where the cancer is removed using cold techniques (cryosurgery), heat techniques (electrocautery) or laser beams. Early cancers in other patients are more amenable to surgical excision of the cancer. Deeper cancers that have invaded the underlying tissues of the cervix may require a hysterectomy, which is surgical removal of the womb. The alternative is radiotherapy to the cancer. Radiotherapy uses external sources of high-energy rays focussed onto the cancer, given daily over 5 minutes for 5 to 6 weeks. This may be combined with internal radiotherapy, where the radiation source is inserted into the vagina to lie against the cervix cancer. The radiation source is a ball-like metallic object containing radioactive substances. This internal radiotherapy requires isolation of the patient in a special room within the hospital for 48 to 72 hours. If the cancer has invaded beyond 3mm of the underlying tissue, then the lymph nodes around the uterus may also need to be surgically removed together with the uterus. Cancers that have involved beyond the cervix are treated by radiotherapy. Usually a combination of internal and external radiotherapy is given over a period of 6 to 8 weeks. There may be temporary side effects, such as redness of the skin, bladder irritation, rectal irritation and diarrhoea. Long-term side effects include vaginal tightness that may interfere with sexual intercourse, and rectal irritation causing pain on defaecation. Vaginal tightness is preventable.

Frequently Asked Questions
*Pelvic examination is uncomfortable. Are there other methods to detect early cervix cancer?* Although uncomfortable, pelvic examination and PAP smear once a year are quick, reliable tests for early detection of cervix cancer. All sexually active women are urged to undergo these tests once a year. *I only have one sexual partner. Must I still undergo the PAP smear?* All sexually active women are urged to undergo these tests once a year. Early cervix cancer is highly curable but it must be detected at an early stage for cure to happen. *I have been diagnosed to have cervix cancer. I need radiotherapy. Does that mean I cannot have sexual intercourse any more?* After radiotherapy, you will be taught how to prevent vaginal tightness and methods to keep the vagina lubricated so that sexual intercourse will not be difficult. *Is cervix cancer contagious?* The bacteria that cause cervix cancer are transmitted from person to person during sexual intercourse. The cancer itself is not.