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Cervical cancer is a common form of cancer among women. In its early stages, the tumor may not produce any noticeable symptoms but it can be detected through regular cervical smears. If left undiagnosed and untreated, it may metastasize and become a fatal disease. As cervical cancer is associated with early sexual activity, once you have started your sex life, you should go in for a cervical screening regularly.
Types of cervical cancer
There are two main types of cervical cancer - squamous cell cancer (the most common) and adenocarcinoma, although they are often mixed. They are named after the types of cell that become cancerous. Squamous cells are flat cells covering your cervix; adenomatous cells produce mucus and are found in the passageway from your cervix to your womb. Other rarer cancers of the cervix include small cell cancer.
Causes of cervical cancer
The main cause of cervical cancer is the human papilloma virus (HPV). There are over a hundred different types, or strains, of HPV and each type has a specific number. Some types of HPV cause warts and verrucas, and others increase the risk of cervical cancers.
You may have caught this common virus through sex and be unaware that you have it as it usually causes no symptoms. Your immune system may get rid of the infection so you may never be aware of it. Only a very small proportion of women with HPV will develop cervical cancer.
Although HPV is from the same family as the virus that causes genital warts, having genital warts doesn’t make you more likely to develop cervical cancer. Cervical cancer is caused by a different type of HPV.
Risk factors of cervical cancer include:
- having sex at an early age
- having other sexually transmitted infections such as chlamydia and herpes
- having many sexual partners, or have a partner who has had many partners
- taking the contraceptive pill long-term
- having a weakened immune system
Symptoms of cervical cancer
If your smear detects abnormal cells on your cervix, they are usually at an early pre-cancer stage, and don't cause any symptoms. Treating the abnormal cells prevents cancer developing.
- abnormal vaginal bleeding, for example between periods or after sex
- smelly vaginal discharge
- pain during sex
- vaginal bleeding after the menopause
- pain in your pelvis
These symptoms aren't always due to cervical cancer but if you have them, see your doctor.
Diagnosis of cervical cancer
If you have had an abnormal screening result, or have symptoms of cervical cancer, your doctor will refer you to a gynaecologist.
You may have a number of tests including the following.
- A colposcopy – your doctor uses a lighted magnifying instrument called a colposcope to examine your cervix and take a small sample of tissue (a biopsy) to be sent to a laboratory for testing to see if the abnormal cells have spread.
- A cone biopsy – your doctor will take a cone of your cervix tissue under general anaesthesia, The sample will be sent to a laboratory for testing.
- LLETZ (large-loop excision of the transformation zone) or loop diathermy – your doctor uses a heated loop of wire to remove the abnormal cells which are then sent to a laboratory for testing.
- A CT, MRI, PET or ultrasound scan – to check your health and show how far the cancer has spread (if at all).
If you’re pregnant, it’s safe for you to have a colposcopy. If any pre-cancerous cells are found, treatment is normally arranged for after your baby has been born. If your doctor suspects you have cancer, you may have a cone biopsy, although this can cause a miscarriage and affect future pregnancies. The results will show what stage your cervical cancer is and how far it has spread.
Treatment of cervical cancer
Your treatment will depend on the stage of your cervical cancer and your general health. You may have a combination of treatments. Your surgeon or oncologist will advise you which treatment is best for you.
If you have very early stage cervical cancer, a cone biopsy may be all you need.
The most common surgical treatment for cervical cancer is a hysterectomy, including removal of the top few centimetres of your vagina and the lymph nodes in your pelvis.
If you have early stage cancer and still wish to have more children, a radical trachelectomy might be possible. Your surgeon will remove most of your cervix but leave the opening behind, so that you may still have a baby afterwards.
Radiotherapy is a treatment to destroy cancer cells with radiation. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. You may have only radiation, or you may have radiation following surgery.
You may have radiation combined with chemotherapy if the cancer is more advanced or has spread to other areas. This reduces the risk of the cancer coming back. Radiotherapy can be given either from outside the body (external beam radiotherapy) or internally (brachytherapy). These treatments are usually given in sequence.
Chemotherapy is a treatment to destroy cancer cells with medicines. It’s used with radiotherapy, or to help to shrink a tumour before radiotherapy or surgery. It can also control symptoms if cancer comes back after an initial treatment.
Prevention of cervical cancer
The following steps may help to reduce your risk of cervical cancer.
- Condoms – using these during sex gives you some protection.
- Regular smears – Department of Health recommends cervical smear screening at 3-yearly intervals for women aged 25-64 after two consecutive normal annual smears have been obtained. Screening may be discontinued in women aged 65 or above if three previous consecutive smears within 10 years are normal. Women who have never had sex or who have total hysterectomy need not receive cervical screening. For women at high risk of developing cervical cancer, for example, immuno-compromised women, annual screening is advised.
- HPV vaccine – HPV vaccine can protect against the HPV strains most likely to cause cervical cancer. There are three HPV vaccines available in Hong Kong including 9-valent HPV vaccine, Quadrivalent HPV vaccine and Bivalent HPV vaccine. The 9-valent HPV vaccine and Quadrivalent HPV vaccine indicated in female and male from the age of 9 years or above, while the Bivalent HPV vaccine indicated in female from the age 9 years or above.
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