Cervical cancer is a type of cancer that occurs in the cervix, which is the lower portion of the uterus. It is one of the highly curable and preventable cancers. According to MedicalDaily.com, cervical cancer has a five-year survival rate of about 100 percent. This is because cervical cancer is a slow grower and spreader. Upon detection, the appropriate treatment based on stage can be given promptly.
In Singapore, while it is listed in the 2015 Singapore Cancer Registry Annual Registry Report as the number 10 most common cancer among females (with 190 cases diagnosed annually) and the number eight cause of cancer deaths among females, the statistics of cervical cancer are on the decline because of preventive Human Papillomavirus (HPV) vaccinations and prompt treatment of diagnosed cases. There is the expectation that cervical cancer will drop off from the top 10 in the Cancer Registry list in the very near future.
How Cervical Cancer Develops
The most common age of onset of cervical cancer is between the late twenties and early thirties, the period when a woman’s sexual activity is at its height.
It starts with a woman getting infected with the HPV through sexual intercourse with an infected partner. Since the HPV strains that cause cervical cancer do not present the characteristic genital warts, the virus can stay inside the body for a long period of time without the woman noticing it.
Infection with Types 16 and 18 of the HPV causes abnormal changes to occur in the active squamocolumnar junction of the cervix. These dysplastic or premalignant lesions are where cervical cancer originates and are known as cervical dysplasia or cervical intraepithelial neoplasia (CIN). The transformation from mild dysplastic lesions to invasive carcinoma takes place very slowly over several years. Removal and treatment of CIN greatly reduce a woman’s risk of cervical cancer development.
The risk factors for cervical cancer are listed below:
- Infection with HPV-16 or HPV-18 through sexual intercourse
- Women who become sexually active before the age of 20
- Having multiple sex partners
- History of persistent high-risk types of HPV infection
- Weakened immune system
Signs and Symptoms of Cervical Cancer
In the early stages, cervical cancer does not present any signs or symptoms. In some rare cases, the cancer may not manifest symptoms at all, even in advanced stages.
The most common symptoms of cervical cancer are:
- Vaginal bleeding following sexual intercourse
- Abnormal vaginal bleeding between menstrual periods
- Pain and discomfort during sexual intercourse
- Foul smelling vaginal discharge
- Bleeding after menopause
Diagnosing Cervical Cancer
According to the American Cancer Society, most cases of cervical cancer are detected in their pre-cancer stage during a Pap smear test. Because it is a slow grower, the cancer itself is most frequently diagnosed in women aged 35 and 44. For this reason, women are strongly encouraged by doctors to have routine Pap smear and pelvic examination done.
During routine pelvic examination, the doctor may detect a lump in the cervix through inspection and palpation. Even in the absence of a lump, a Pap smear test may reveal dysplastic lesions and/or early cervical cancer. Confirmation of the presence of the disease is done through colposcopy, wherein a special instrument called a colposcope is inserted into the vagina to allow the doctor better visualisation of the vulva, vagina, and cervix. If abnormalities are detected, the doctor takes tissue samples for further screening (biopsy) by a pathologist.
Several algorithms have been proposed for the management of minimally abnormal Pap smears, but these are only representative of initial attempts at developing the best triage plans.
Current triage plans include:
- Repeating Pap smear at specific intervals
- The referral of all patients initially for colposcopy
- Performing adjunctive tests, such as cervicography or HPV testing
Until ongoing clinical trials are completed, it is the physician’s decision on how he/she intends to manage minimally abnormal Pap smears based on best available evidence. Hence, the physician’s advice on whether or not to perform additional tests or treatments becomes crucial.
Prevention of Cervical Cancer
The main preventive measure against cervical cancer is HPV vaccination. The two vaccines that are approved for use in Singapore are Gardasil and Cervarix. The recommended age range for vaccination in Singapore is between the ages of 9 and 26 years old for both men and women. The vaccine is given in three doses within a period of six months. Women can avail of SGD $400 for the vaccination from their Medisave account through the Medisave400 plan.
It should be emphasised, however, that all women aged 25 years and above and who are sexually active should still get a routine Pap smear done once every three years, even after being vaccinated. The vaccine only accords protection from HPV-16 and HPV-18, which are the most common types. There are still 30 percent of cervical cancer causes which are not protected by the vaccine.
The Singapore Cancer Society also offers these additional prevention tips for cervical cancer:
- Practise good intimate hygiene by washing external genitalia regularly using water and unscented soap.
- Avoid vaginal infections by changing sanitary pads and/or tampons regularly.
- Practise safe sex.
- Change into fresh, clean underwear daily.
- Maintain healthy body weight and Body Mass Index (BMI). Being underweight or overweight/obese causes disturbances in oestrogen production.
- Exercise regularly.
- Quit smoking.
- Track your monthly periods and observe for any abnormalities.
Sincere Healthcare Group upholds the Singapore Ministry of Health’s fight against cervical cancer. Not only do we have comprehensive screening programmes for this cancer, but our doctors are also specialists in the latest treatments for this disease. Schedule an appointment with one of our resident gynaecologists today.