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Cervix Cancer (Cervical Cancer)

Overview
Causes and Risks
Symptoms
Diagnosis
Treatment Options
Frequently Asked Questions
National Cancer Centre Singapore
Contributed by National Cancer Centre Singapore

Overview

What is Cervical Cancer?

The cervix is the lower part of the uterus (womb). Cancers that arise in the cervix are potentially curable if detected in the early stage. Therefore, early detection is the key to improving survival. Most cervical cancers are the type called squamous cell carcinomas.

How common is Cervical Cancer?


Cervical cancer is the 10th most common female cancer in Singapore. About 190 cases are diagnosed every year.

Age of Onset

Pre-invasive cancer often occurs in women in their late 20’s to 30’s. These are termed as Cervical Intraepithelial Neoplasia (CIN). These are changes in the lining of the cervix which can lead to cervical cancer. Over time, these pre-cancerous lesions can progress and become invasive cancer if left untreated.


Causes and Risks

Infection with Human Papillomavirus (HPV) is the most common cause or risk factor for cervical cancer. These viruses are transmitted during sexual intercourse, as well as via oral or anal sex. Any female who has ever been sexually active is at potential risk.

Other risk factors include:

  • Onset of sexual activity before age 20
  • Multiple sexual partners
  • A history of sexually transmitted infections
  • A male sexual partner with a history of sexually transmitted infections and or extramarital sexual activity
  • A male sexual partner with sexual partner(s) with previous cancer of the cervix has been established as a potential risk
  • Cigarette smoking is a co-factor associated with an increased incidence of cervix cancer.


Symptoms

Symptoms and Signs of Cervical Cancer

Abnormal bleeding from the vagina signals the need for an immediate examination. Abnormal bleeding includes bleeding after sexual intercourse or bleeding between menstrual periods. Late symptoms that occur when the cancer is advanced include lower back pain, pelvic pain, weight loss and leg swelling.


Diagnosis

Diagnostic Tests

Cervical cancer screening with a Pap smear should start as soon as a woman becomes sexually active. This should be performed at 1-3 yearly intervals depending on the age and the number of normal Pap smears. During this examination, a scraping of cells from the surface of the cervix is obtained during a vaginal examination. This is a quick, simple and painless test.

If the Pap smear has abnormal cells, a diagnostic procedure called colposcopy (i.e. Examination of the cervix with a microscope) is done. Certain chemicals may be applied onto the cervix to help pick up abnormal areas. These abnormal areas are then biopsied and examined under a microscope by the pathologist (a doctor who examines these tissues under a microscope).

If cervical cancer is confirmed on biopsy, other tests will be scheduled. These include radiological tests such as a chest x-ray and CT-scan or MRI of the abdomen and pelvis to exclude any regional or distant spread of the cancer. Examination of the pelvis under general anaesthesia is often scheduled to determine the extent of the cancer.


Treatment Options

Treatment of Pre-invasive and Invasive Cervical Cancer

For pre-invasive disease, the treatment is the local removal of the abnormal lining of the cervix by local excision procedures or ablative procedures. Local excision techniques include knife or laser cone biopsies or Loop Electrosurgical Excision Procedures (LEEP). Ablative techniques include laser vaporization or cold coagulation. The technique of choice has to be discussed with the attending doctor. However, the successful treatment of precancer of the cervix almost certainly prevents cancer of the cervix from occurring.

For early invasive cancer of the cervix, a cure can be achieved with either surgery (removal of the uterus i.e hysterectomy, and surrounding tissue, including lymph nodes) or radiotherapy, which is often given with chemotherapy.

For advanced stage cervical cancer where surgery is not possible, concurrent chemo-radiotherapy or radiotherapy is the treatment of choice. Radiotherapy is often given in 2 ways. One method is with external beam radiotherapy and the other is internal beam radiotherapy. The external beam radiotherapy is carried out daily on weekdays and may take about 5-6 weeks to complete. The internal beam radiotherapy is given in 2 to 5 sessions.

Prognosis of Cervical Cancer

The prognosis for early stage cervical cancer is very good with 5 year survival between 80% to 95%. However, for advanced stage cervical cancer, the 5 year survival rate is less than 40%.

Is prevention possible?

Yes, primary prevention of cervical cancer is now available in the form of vaccines. In Singapore, the two commercially vaccines available are Cervarix and Gardasil. Both vaccines have been shown to be efficacious in protection against HPV 16 and 18, which cause up to 70% of cervical cancers. All women of reproductive age are encouraged to vaccinate themselves against this preventable cancer. However, as some women may still develop cervical cancer after vaccination, Pap smear test screening is still recommended.


Frequently Asked Questions

I heard that the pelvic examination may be uncomfortable. Are there alternatives to detect early cervical cancer?

Although uncomfortable, the pelvic examination and Pap smear are still reliable tests for early detection of cervical cancer. All sexually active women are advised to undergo these tests once every year or as instructed by your doctor.

I only have one sexual partner. Must I still undergo the Pap smear?

All women who have ever had sexual relationships are advised to undergo a Pap smear test at least once in 3 years or as instructed by your doctor. Cervical cancer, when detected early, is highly treatable.

I have been diagnosed to have cervical cancer. I need radiotherapy. Does that mean I cannot have sexual intercourse anymore?

Yes, you are still able to have sexual intercourse after radiotherapy. You will be taught methods to keep the vagina lubricated and how to prevent vaginal tightness so that sexual intercourse will not be difficult or painful.

Is cervical cancer contagious?

Cervical cancer itself is not contagious. However, the virus that is thought to cause the cancer can be transmitted from one person to another during sexual intercourse


Cancer Resources on the Internet

American Cancer Society www.cancer.org
Cancer Care, inc. www.cancercare.org
Cancer Information Service (National Cancer Institute, USA) www.nci.nih.gov
CancerNet (National Cancer Institute, USA) www.cancernet.nci.nih.gov


For further enquiries on cervical cancer, please call the Cancer Helpline at (65) 6225 5655 or email to cancerhelpline@nccs.com.sg.

Need indepth information ?

Access our Conditions & Treatments sections for related topics on Low Back Pain.


Where to Seek Treatment

The medical institutions within SingHealth that offer consultation and treatment for this condition include:

1. National Cancer Centre Singapore
Clinical Services
11 Hospital Drive, Singapore 169610

For Enquiries and Appointments:


Use
Email: nccappt@nccs.com.sg or
Call: +65 6436 8088

For International Patients:
Use Overseas Referral
Email: foreign_patient@nccs.com.sg or
Call: +65 6236 9433

   
2. Singapore General Hospital
Dept of Obstetrics and Gynaecology
Outram Road, Singapore 169608

For Enquiries and Appointments:


Use
Email: appointments@sgh.com.sg or
Call: +65 6321 4377

For International Patients:
Use Overseas Referral
Email: ims@singhealth.com.sg or
Call: +65 6326 5656

   
3. KK Women's and Children's Hospital
KK Gynaecological Cancer Centre
100 Bukit Timah Road Singapore 229899

For Enquiries and Appointments:


Use
Email: centralappt@kkh.com.sg or
Call: +65 6294 4050

For International Patients:
Use Overseas Referral
Email: international@kkh.com.sg or
Call: +65 6394 8888





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