What is Cervical Cancer?

Cervical cancer is a malignant tumour found in the tissues of the cervix.


Cervical cancer usually develops slowly.


It occurs when cells in the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue, turn into cancer cells.


Over time, the abnormal cells may become cancer cells and start to grow and spread more deeply into the cervix and to surrounding areas.


Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.


References: https://www.cancer.gov/

The cervix or cervix uteri

Cervix is located at the lower part of the uterus in the female reproductive system.


The cervix is usually 2 to 3 cm long and roughly cylindrical in shape that forms a canal between the uterus and vagina.

Common Signs & Symptoms of Cervical Cancer

Cervical cancer symptoms do not usually appear unless had progressed to a fairly advanced stage.

Any of the following could be signs or symptoms of cancer:

  • Blood spots or light bleeding between or following periods
  • Menstrual bleeding that is heavier than usual
  • Bleeding after menopause
  • Bleeding after sexual intercourse
  • Increased vaginal discharge
  • Pain during sexual intercourse
  • Unexplained, persistent pelvic and/or back pain

Abnormal bleeding does not mean you have cervical cancer, but you should immediately make an appointment with your gynaecologist for further assessment.



References:  https://www.cancer.gov/

Treatment for Cervical Cancer

A definitive diagnosis of cervical cancer is made by histopathological examination of cervical tissue.


Cervical cancer is highly curable when found early and treated soon after it is diagnosed.


If you've been diagnosed with cervical cancer, your doctor will talk with you about treatment options. Your treatment plan will depend your age, your overall health, and your personal preferences.


There are different types of treatment for patients with cervical cancer.


  • Surgery for Cervical Cancer
  • Radiation Therapy for Cervical Cancer
  • Chemotherapy for Cervical Cancer
  • Targeted Therapy for Cervical Cancer

Human papillomavirus (HPV)

Human papillomavirus (HPV) is a group of viruses that are extremely common worldwide.

  • HPV is mainly transmitted through sexual contact by having vaginal, anal, or oral sex with someone who has the virus.
  • Most people are infected with HPV shortly after the onset of sexual activity but do not know they have it.
  • Usually, human immune system will fight against naturally and the HPV infections will go off within 2 years.
  • However, sometimes the infected cells remain and continue to grow, eventually forming an area of precancerous cells that, if not treated, can become cancer. Usually, the progression may take 15 to 20 years. Risk factors for HPV persistence are
    • HPV type
      • HPV types 16 and 18 cause 70% of cervical cancers and pre-cancerous cervical lesions.
    • Immune status
      • people who are immune-compromised, such as those living with HIV, are more likely to have persistent HPV infections and a more rapid progression to pre-cancer and cancer
    • Co-infection with other sexually transmitted agents
      • such as those that cause herpes simplex, chlamydia and gonorrhea
    • Parity (number of babies born) and young age at first birth
    • Tobacco smoking
  • There are more than 100 types of HPV.
    • About 40 types of HPV related to genital infection and 14 of them are classified as oncogenic as they are associated with cervical cancer
  • There is also evidence linking HPV infections with other type cancers of the:
    • Vagina and vulva in women;
    • Penis in men
    • Anus and back of the throat in both women and men.

References:  https://www.who.int/
https://www.cdc.gov/

HPV vaccine

HPV vaccines are vaccines that to protect someone against infection by different HPV subtypes which are most commonly linked to various cancers and genital warts.

  • HPV 16 & 18 that causes 70% of all cervical cancer cases
  • HPV 6 & 11 that causes 90% of all genital warts.

The Newest HPV vaccine is Gardasil 9. It protects against 9 subtypes of HPV (6, 11, 16, 18, 31, 33, 45, 52 and 58)

  • The vaccination is given by injection on the upper arm three times within 12 months period according to the schedule.
  • Example:

    • 1st dos Date of first vaccination
    • 2nd dos 2 months after the 1St vaccination
    • 3rd dos 4 months after the 2nd vaccination
  • The HPV vaccine has been routinely offered FREE for all girls in Form 1 or currently aged 13. Adolescent students were given only 2 doses of the HPV vaccine as recommended by World Health Organization.
  • Those who are not in the specified groups can have the immunization at any private clinics and hospitals at a certain charge.
  • It is recommended to get vaccinated before sexually active.
  • However, vaccination still recommended for those are sexually active and may have been infected with one strain of the HPV virus, as it still protects you against other strains for the virus and this will reduce your ultimate risk of getting genital warts and cancers in the long run.

However, those who have received the vaccine are highly advised to continue with routine cancer screenings as recommended by their medical doctors.

References:  https://cancer.org.my/
http://www.myhealth.gov.my/

Precaution for Cervical Cancer

Comprehensive cervical cancer control includes

  • Primary prevention
    • Vaccination against HPV
    • Using condoms during sexual activity
      • It offers some protection against HPV, but it cannot always prevent infection because the virus is also spread through skin-to-skin contact of the wider genital area.
  • Secondary prevention
    Screening is checking for cancer before a person has any symptoms.
    This can help detect cancer at an early stage even before the symptoms occurred.
    • If negative, appointment given for next screening
    • If positive, will advise for colposcopy assessment.

Type of Screening

Screening and treatment of pre-cancer lesions in women is a cost-effective way to prevent cervical cancer

  • Pap smear
    • to looks for precancers cells
    • most common routine screening for cervical cancer

If you are 30 years old or older, you may choose to get a Pap test.


Colposcopy might be ordered if the screening test positive.

  • Colposcopy
    A procedure in which a colposcope (a lighted, magnifying instrument) is used to check the vagina and cervix for abnormalities.

References:  https://www.cancer.gov/
https://www.cancer.gov/

Clinical Practice Guidelines (CPG) on Management of Cervical Cancer 2015

Pap Smear Test

Pap Smear is the most test to screen for cervical cancer.

Regular pap smear test is recommended for all women between the ages of 21 and 65 years old.

  • Usually done in clinic during a routine gynecological checkup.
  • During a pap smear
    • the gynecologist will use a instrument called a speculum to widen your vagina
    • a piece wooden stick or a brush is used to gently scrape cells from the cervix to get a sample. It only took few seconds.
    • The sample is placed on a glass slide and will be sent to a laboratory for a pathologist to examine under a microscope.

 

The best time to schedule your Pap test is at least 5 days after the end of your menstrual period.

  • A sample that collected while you’re menstruating could be less accurate.
  • Try to avoid having sexual intercourse, douching, using any medicine or birth control foam/cream, spermicidal products in your vagina the day before your test because these may interfere with your results.
  • If you have conceived, the gynecologist will rescheduled after you give birth to increase the accuracy of test.

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