The cervix is the lower end of the womb, which connects the womb to the top of the vagina.
Cancer of the cervix normally takes many years to develop. There are two main types of cervical cancer:
- Squamous cell cervical cancer is the most common. This develops from a skin-like cell (a squamous cell) that covers the cervix, which becomes cancerous.
- Adenocarcinoma cervical cancer is much less common. This develops from a glandular cell (a cell that makes mucus) within the cervical canal, which becomes cancerous.
What causes Cervical Cancer?
When something damages or alters certain genes in the cell, it makes the cell very abnormal and multiplies 'out of control'.
In the case of cervical cancer, a cancer-causing strain of human papilloma virus (HPV) is a necessary factor involved in the development of cervical cancer. Up to 50% of men and women may contract a HPV infection in a lifetime. But only 10-20% of such infections involve HPVs which have the potential to cause cancer.
While cervical HPV infection plays a central etiological role, the development of cancer is only an uncommon complication to such an infection, as most healthy women would be able to overcome such infection naturally.
Cervical cancer is largely a preventable disease and usually occurs in women who fail to go for regular Pap smear screening. The other risk factors include smoking and women with impaired immune system e.g. patients who are long term steroids therapy & transplant patients.
Women with impaired immune responses, in particular, may fail to overcome such HPV infection and its potential cancer-causing effect. The cells of the cervix will then transform into pre-cancerous changes and then, if undetected, the latter may progress to cancer, usually after the age of 40.
Four Key Messages to all Women
- Cervical Cancer is Highly Preventable.
- A Pap test is an Easy Test to prevent cervical cancer.
- Early detection saves womb and saves life.
- HPV vaccination is a New Tool in preventing cervical cancer.
What can a woman do to reduce her risk of developing cervical cancer?
- Don’t smoke.
- Go for regular Pap smear screening, at least 3-yearly.
- Reduce exposure to HPV infection, which is transmitted by skin-to-skin contact. It is largely, but not exclusively transmitted sexually or by intimate contact.
- Go for HPV vaccination (where appropriate).
How does a Pap smear reduce the risk of cervical cancer ?
The normal cervix develops into a state of pre-cancer, prior to the progression to frank cancer. In the pre-cancerous and very early stage of the disease, there is no symptom. Most of these are detected by Pap smears.
- A speculum is introduced into the woman’s vaginal canal to expose the cervix.
- A special brush is used to scrape some cells from the surface of the cervix.
- These scrapings are placed onto a medical slide.
- The slides are sent to the Laboratory for staining and microscopic examination.
However, Pap smear is not 100% sensitive, but repeated Pap smears make screening effective.
What is an abnormal smear and its management ?
- The majority of abnormal smear include those showing infective, pre-cancerous or cancerous changes.
- Not all abnormal smears indicate cancerous transformation. Many of these changes are minor disturbances, which is of no significant concern to the woman.
- However, if there is any cancerous or pre-cancerous changes, the Pap smear will show cells with these changes and the patient will be referred to the gynaecologist for further assessment.
What are the symptoms of cervical cancer?
There is no symptom for pre-cancerous disease. They manifest through an abnormal Pap smear test.
Even when cervix cancer has occurred, the patient may not have any symptom at first when the tumour is small.
As the tumour becomes larger, in most cases the first symptom to develop is abnormal vaginal bleeding such as
- Bleeding between normal periods (intermenstrual bleeding).
- Bleeding after having sex (post coital bleeding).
- Any vaginal bleeding in women past the menopause.
- Vaginal discharge, or pain when having sex.
But please note that all of the above symptoms can be caused by other common conditions as well. Should you develop any of these symptoms, please have it checked out by a doctor.
In time, if the cancer spreads to other parts of the body, various other symptoms can develop.