Cervical cancer is cancer arising from the cervix just below the uterus.  It usually starts as pre-cancerous carcinoma-in-situ which can be detected using a PAP smear (see below).  The most common cell types of cervical cancer are squamous cell carcinoma (around 90%) and adenocarcinoma (10%) with a few other rare cell types of cervical cancer.

Causes of Cervical Cancer

Human Papilloma Virus (HPV) accounts for over 80-90% of all cervical cancers.  Other risk factors include having multiple sexual partners, smoking and having multiple pregnancies.  

Symptoms of Cervical Cancer

• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pain during sexual intercourse
• Discomfort or pain around the pelvic area
• Discomfort while urinating

Diagnostic Tests

• The PAP smear screening test is the most common screening test to detect cervical cancer
• Tissue biopsy may be required to make a definitive diagnosis
• Blood tests (to detect your blood, liver and kidney profile)
• Ultrasound and examination of the vagina, uterus, ovaries and pelvis
• CT or MRI or PET scan (to check for cancer spread)

Stages of cervical cancer according to International Federation of Gynaecology & Obstetrics (known as FIGO)

Fortunately cervical cancer can be detected early because it causes symptoms even when the cancer is small.   Staging of the cancer is one of the most important factors in deciding how to treat the cancer and in determining how successful the treatment might be. 

Stage 1A1	The cancer is less than 3 mm deep
Stage 1A2	The cancer is between 3 to 5 mm deep
Stage 1B1	The cancer is between 5 mm to 2 cm deep
Stage 1B2	The cancer is between 2 to 4 cm deep
Stage 1B3	The cancer is more than 4 cm deep but still confined to the cervix

Stage 2A1	The cancer has spread beyond the cervix and uterus but not not larger than 4 cm
Stage 2A2	The cancer has spread beyond the cervix and uterus and larger than 4 cm
Stage 2B	The cancer has spread beyond the cervix and uterus and into the parametria

Stage 3A	The cancer has spread into the vagina but not into the pelvis
Stage 3B	The cancer has spread into the vagina and into the pelvis
Stage 3C	The cancer has spread into the pelvis and pelvic lymph nodes

Stage 4A	The cancer has spread out of the pelvis
Stage 4B	The cancer has spread into distant organs such as the lung, liver or bones

Treatment Options for Cervical Cancer

The treatment option required for your cancer depends on the stage of your cancer and your gynaecologist doctor or cancer specialist recommendation based on the spread of the cancer.

• Surgery to remove the cancer and cervix.  The uterus and surrounding tissues such as lymph nodes, colon or rectum may also be removed if they are affected by cancer spread 
• Adjuvant treatment using Chemotherapy and/or Radiotherapy may be required depending on stage and type of cancer cell type
• Targeted therapy (if the cancer cell type is suitable)
• Immuno therapy (if the cancer cell type is suitable)

Screening & Prevention

Regular screening is recommended for young women from the ages of 30 to 65.  Screening is not beneficial before age 25 as the rate of disease is low and is not beneficial in women older than 60 years if they have a history of negative results.

Vaccination against HPVGirls (and also boys) are recommended to have vaccination against HPV infection from the age of 12 years.  Do discuss with your doctor about the benefits of HPV vaccination in reducing the risk of cervical cancer.

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