Cervical Cancer Awareness Month

What is Cervical Cancer?

Cervical cancer is the transformation of abnormal cells (cancer cells) in the cervix lining. Cervix is the entrance to the uterus from the vagina.

Cervical cancer ranks as the 4th most common type of cancer for women in the world. In Malaysia, cervical cancer ranks as the 3rd most frequent cancer among women (~12.9% of all female cancers). It was estimated that 1682 women are diagnosed with cervical cancer annually and 944 women die from the disease (HPV Information Centre, 2018). Women aged 15 years and older are at risk of developing cervical cancer. 

Image Credit: Centers for Disease Control and Prevention (CDC)

Risk factors of Cervical Cancer

Almost all cervical cancer cases (99%) are due to human papillomavirus infection (HPV) infection, which is a common virus transmitted through sexual contact (including genital skin-to-skin and oral).

Risk factors for developing cervical cancer may also be due to:

• First sexual intercourse at a young age (<17 years old)
• Having multiple sex partners
• High parity (≥7 full term pregnancies)
• Use of birth control pills for 5 years or more 
• Smoking cigarettes: Women with HPV who smoke are twice likely to develop cancer than those who do not smoke
• Lower socioeconomic status
• Having a weakened immune system due to disorders such as cancer, AIDS, HIV or taking drugs such as chemotherapy drugs or corticosteroids. This can make it hard for the body to fight infection.

Symptoms of Cervical Cancer

You may not have any symptoms until the cancer has grown or spread. Cervical cancer can spread to tissues around the cervix (e.g. the vagina) or throughout your body. Cervical cancer can cause death if not treated.

First symptom of cervical cancer is abnormal vaginal bleeding, which usually occurs after sexual intercourse.

Later symptoms of cervical cancer include:

• More bleeding during periods or bleeding between periods
• Badsmelling discharge (fluid) from vagina
• Pain in pelvic area (area below your belly and between your hips)
• Lower back pain

Image Credit: Check4Cancer

Screening and Diagnosis of Cervical Cancer

1. Papanicolaou (PAP) smear test:

PAP smear test is recommended for all women aged 21 and 65 years old. Doctors can check for cervical cancer or cervical dysplasia (pre-cancer growths) with a PAP test, which is done during a pelvic exam. The doctor will examine the inside of your vagina and cervix, holding it open with a speculum (a small instrument). Some cells and mucus from the cervix and area around it will be collected using a swab, which will then be examined under a microscope to detect any cellular changes on the wall of the cervix. Annual PAP smear test is recommended once a woman is sexually active. Screening is recommended every 3 years if the first 2 consecutive smear results are negative.

2. Other Solutions: The Rose Solution!

The Fifth Malaysia Population and Family Survey 2014 found that less than half of women surveyed had a PAP smear test 2 years prior, as many women find it embarrassing and inconvenient. The University Malaya Medical Centre and VCS Foundation of Australia launched the Rose Foundation and Laboratory to help eliminate the social and health barriers of screening by adopting mobile technology and molecular testing. The Rose solution consists of 3 components:

1. 1st step (Self-sampling): The patient performs a vaginal self-swab on herself to collect the sample, instead of pelvic examination by healthcare professionals. The sample must then be returned to the Rose Laboratory at University Malaya.
2. 2nd step (HPV testing): This test looks for HPV DNA before changes or irregularities take place. A negative result on the HPV test only requires the patient to test again after 5-10 years.
3. 3rd step (Digital result): The results will then be sent via SMS to the patient’s mobile phones within 3 weeks. The features also ensure results are linked to government hospitals for follow up.

 The Rose programme is specifically designed for Malaysian women, and is offered at government clinics in Taman Medan, Port Klang and Kalumpang, Selangor.

Image Credit: Rose Foundation

Staging of Cervical Cancer

The stages of cervical cancer are as follows:

1. Precancerous stage: Abnormal PAP smear- precancerous cells may develop into cancer if left untreated.
2. Stage I: Cancer confined to the cervix
3. Stage II: Cancer involving the upper vagina and some surrounding tissue
4. Stage III: Cancer spread to the lower vagina and more surrounding tissues (may affect kidneys)
5. Stage IV: Cancer has spread to another organ (also known as metastatic cancer)

Treatment of Cervical Cancer

Treatment can include:

• Surgery
• Radiation
• Chemotherapy

Surgery will be done if it is still the early cancer stage (Stage I and some early Stage II) where cancer cells have not spread beyond the surface of your cervix. Examples of surgical options include hysterectomy (removal of uterus), cone biopsy (removal of inside of cervix where cancer started growing), or a trachelectomy (removal of upper vagina and cervix). If the patient wishes to preserve her fertility, the uterus will not be removed.

For late stages of cancer (advanced stage II-IV), chemotherapy is given along with radiotherapy as they provide a better treatment response. After chemotherapy and radiotherapy, surgery may also be conducted to remove the remaining cancer. There is also palliative care for those with advanced cancer or patients with multiple other medical conditions etc. 

Prevention of Cervical Cancer

The high mortality rate from cervical cancer can be reduced through prevention, early diagnosis, screening and treatments. Cervical cancer is the easiest preventable gynecological cancer by: 

• Get HPV vaccinations before you are sexually active
• Regular screening such as PAP smear test once every 3 years after turning 20 years old or HPV testing (The Rose solution as explained above in the diagnosis section). Screening aims to detect precancerous changes, as it can lead to cancer if left untreated.
• Regular follow up for diagnosis and treatment with your doctor to check your risk of getting cervical cancer if there are abnormalities on screening. This is to prevent the development of cancer or to treat cancer at an early stage.
• Stop smoking. Join smoking cessation program such as nicotine replacement therapy or journey with Quit Smoking Clinic, Malaysia council for tobacco control (MCTC), USM Tobacco Quitline etc.

Image Credit: Centers for Disease Control and Prevention (CDC)

A WORD FROM DOC2US

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Reference: 

1. MSD Manual Consumer Version. Cervical Cancer. Available from https://www.msdmanuals.com/home/quick-facts-women-s-health-issues/cancers-of-the-female-reproductive-system/cervical-cancer
2. NHS. Hysterectomy.  Available from https://www.nhs.uk/conditions/hysterectomy/#:~:text=A%20hysterectomy%20is%20a%20surgical,women%20aged%2040%20to%2050.
3. WHO. Cervical Cancer. Available from https://www.who.int/health-topics/cervical-cancer#tab=tab_1
4. Beacon Hospital. Cervical Cancer. Available from https://www.beaconhospital.com.my/cervical-cancer/
5. Rose Foundation. Removing Obstacles to Cervical Screening. Available from https://www.programrose.org/

Written By

Ms. Rosamund Koo Wei Xin

Reviewed By

Doc2us Medical Board