Cervical Cancer

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean you will get cancer, not having risk factors does not mean that you will not get cancer.

Human Papilloma Virus (HPV) infection is the major risk factor in the development of this cancer. These viruses are transmitted during sexual intercourse, as well as oral or anal sex.

All women who engage in sexual activity are at risk of developing cervical cancer. Some sexual behaviours, such as multiple sexual partners, having partners who have had multiple sex partners, and having sex at an early age further increase the risk. Other risk factors include:

• Cigarette smoking
• Long term use of oral contraceptives
• Have a weakened immune system which weakens the body’s ability to fight infections and other diseases. This may be due to infection with human immunodeficiency virus (HIV) or taking medicine to help prevent organ rejection after a transplant
• Having given birth to many children

Early cervical cancer may have no symptoms. You may experience the following symptoms:

• Vaginal bleeding
• Back pain/pelvic pain
• Pain during sexual intercourse, bleeding after sexual intercourse
• Abnormal vaginal discharge
• Painful or difficult urination or cloudy urine
• Chronic constipation and feeling of presence of stool despite having emptied bowel
• Leaking of urine or faeces from the vagina

While the Pap smear is an effective cervical cancer screening test, confirmation of the diagnosis of cervical cancer or pre-cancer requires a biopsy of the cervix. This is often done through colposcopy, a magnified visual inspection of the cervix aided by using a dilute acidic solution to highlight abnormal cells on the surface of the cervix. It is a painless 15-minute outpatient procedure.

Further diagnostic procedures include Loop Electrical Excision Procedure (LEEP), cone biopsies, and punch biopsies.

Cervical cancer is treated with surgery, radiation therapy, chemotherapy, targeted therapy and immunotherapy. Depending on the stage and type of the cancer, you may need more than one type of treatment.

• Surgery
  Surgery is often performed for early cervical cancer. The extent of surgery is dependant on the stage of presentation.
• Radiotherapy
  Radiation therapy is the use of high energy X-rays or radiation to kill cancer cells. It is often used in combination with chemotherapy to treat cervical cancer.
• Chemotherapy
  Chemotherapy are medicines which are either injected or taken orally to treat cancers. They enter the bloodstream and work by interfering with the ability of cancer cells to grow and divide. In cervical cancer, chemotherapy is often given with radiation to treat cancer that has not spread to distant organs. It is also used in treating cancer which has spread to other organs or tissues.
• Targeted therapy
  All cells including cancer cells need blood vessels to sustain and grow. By giving a treatment that targets against a protein that helps new blood vessels to form, cancer cells will not be able to grow and die. Targeted therapy is given with chemotherapy in the treatment of cervical cancer.
• Immunotherapy
  Immunotherapy are medications that harness the body’s own immune system and allow it to recognise and destroy cancer cells. Immunotherapy is a treatment option for cervical cancer which has come back (recurred), or has spread to distant organs.

Early cervical cancer usually have no signs or symptoms. However, it can be detected early with regular check ups. The earlier the detection, the higher the chance of successful treatment.

The Pap test, also called the Pap smear, is a cervical cancer screening test. This is done in an outpatient setting. The test is conducted by using a plastic or metal instrument, called a speculum, to widen the vagina. The doctor or nurse will then examine the vagina and cervix, and collect a few cells from the cervix and the area around it with a swab. These cells are then placed on a slide and sent to laboratory to be checked for abnormal cells. The high risk HPV (hrHPV) test can also be done on these cells to look for the type of HPV virus that causes cervical cancer.

Women should begin having cervical cancer screening at age 21, or within three years of first sexual activity – whichever happens first.

• If you are between 21 and 29, you should get a Pap test every 3 years
• If you are between 30 and 64, you should get a Pap test and HPV test together every 5 years or a Pap test alone every 3 years
• If you are 65 years or older, you can stop screening if prior cervical cancer screening results have been normal.

You can lower your risk of getting cervical cancer with the following steps:

• HPV vaccine have been developed that are effective against the strains of HPV responsible for 70 to 85 per cent of all cervical cancers. HPV vaccines are targeted at girls and women of ages 9-26 and works best before the start of their sexual activities.
• Get regular cervical screening test, even though one has had HPV vaccination. This will help detect and treat early changing cells that may turn into cancer.
• Alter sexual behaviour. Reduced exposure to HPV infection reduces risk of cervical cancer. Use condoms to prevent any sexually transmitted disease including HPV.