Cervix Cancer
What is Cervix Cancer?
The cervix is the lower part of the uterus or womb. In its earliest stages, cancers that arise in the cervix are potentially curable if detected in their early stage . Early detection is therefore the key to improving survival. Most cervix cancers are of the type called squamous cell carcinomas.
How common is Cervix Cancer?
Cervix cancer is the fourth most common female cancer in Singapore. Between 1993 and 1997, almost 1126 cases were reported in Singapore.
Age of Onset
Pre-invasive cancer often occurs in women in their mid to late 30s. These are termed as CIN (Cervical Intraepithelial Neoplasia). These are changes in the lining of the cervix which can lead to cervix cancer. With time, these pre-cancerous lesions can progress and invade surrounding tissues.
Risks and Causes
Cervix cancer is a sexually transmissible disease. Human Papilloma viruses have been implicated in causing the cancer. These viruses are transmitted during sexual intercourse. Other factors include:
- Any female who has ever had sex is at potential risk
- Onset of sexual activity before age 20
- Multiple sexual partners increases the risk
- A woman with a history of sexually transmitted infections
- A male sexual partner with a history of sexually transmitted infections and or extramarital sexual activity
- A male sexual partner with sexual partner(s) with previous cancer of the cervix have been established as a potential risk
- Cigarette smoking is a co-factor associated with an increased incidence of cervix cancer.
Symptoms and Signs of Cervix Cancer
Abnormal bleeding from the vagina signals the need for an immediate examination. Abnormal bleeding include bleeding between regular menstrual periodsor bleeding occurring after sexual intercourse. Late symptoms that occur when the cancer is advanced include low back pain, pelvic pain, weight loss and leg swelling.
Diagnostic Tests
Pre-invasive cervix disease confined just to the surface of the cervix can grow slowly over a period as long as 8 to 10 years. Once the cancer invades deeper into tissues of the uterus, it starts to grow and can cause death if left untreated.
Cervix screening with Pap smear, should start as soon as a woman becomes sexually active. This should be performed once a year. During this examination, a scraping of cells from the surface of the cervix is obtained during pelvic examination. This is a quick, simple and painless test.
If the Pap smear is abnormal, a more detailed screening such as colposcopy (ie. examination of the cervix with a microscope) is done. Certain chemicals may be applied onto the cervix to help pick up abnormal areas. These abnormal areas are then biopsied and examined under a microscope by the pathologist (a doctor who examines these tissues under a microscope).
Once cervix cancer is confirmed on biopsy, other tests maybe scheduled. These include an IVU (intravenous urogram) which is an x-ray to look at the kidneys, a chest x-ray and a CT-scan (a computerised scan) of the region. Examination of the pelvis under general anaesthesia and a cystoscopy (a scope of the urethra and bladder) are also scheduled to determine the extent of the cancer.
Treatment of Cervix Cancer
For pre-invasive disease, the treatment is the local removal of the abnormal lining in the cerivx by conventional surgery(cone biopsy) or done using lasers or liquid nitrogen (cryotherapy). This will almost certainly prevent cancer of the cervix from occurring.
For early invasive cancer of the cervix, cure can be achieved with either surgery (removal of the uterus i.e hysterectomy, and surrounding tissue including lymphnodes) or radiotherapy.
For advance disease where surgery is not possible, radiotherapy is the treatment of choice. There maybe occasions where chemotherapy (drug treatment) is given in conjunction with radiotherapy to enhance the treatment effect.
Radiotherapy is often given in 2 ways. One is with external beam radiotherapy and the other is internal beam radiotherapy. The external beam radiotherapy is carried out daily on weekdays only and may take about 5 weeks to complete. The internal beam radiotherapy is given in 3 to 4 sessions, each session is usually completed in about 10-15 minutes.
Recent evidence have shown that combination of chemotherapy and radiotherapy can be more effective in certain groups of patients with cervix cancer.
Prognosis of Cervix Cancer
In the pre-invasive stage (disease confined only to the surface of the cervix and has not invaded further), the chance of cure is almost 100% with appropriate treatment. Even in some advance disease, some cure can still be achieved with radiation therapy alone or combined with chemotherapy.
Frequently Asked Questions about Cervix Cancer
1. I heard that the pelvic examination maybe uncomfortable. Are there alternatives to detect early cervix cancer?
Although uncomfortable, the pelvic examination and Pap smear are still reliable tests for early detection of cervix cancer. All sexually active women are advised to undergo these tests once every year or as instructed by your doctor.
2. I only have one sexual partner. Must I still undergo the Pap smear?
All women who have ever had sexual relationships are advised to undergo a Pap smear test once every year or as instructed by your doctor. Cervix cancer when detected early is highly curable.
3. I have been diagnosed to have cervix cancer. I need radiotherapy. Does that mean I cannot have sexual intercourse anymore?
Yes, you are still able to have sexual intercourse after radiotherapy. You will be taught methods to keep the vagina lubricated and how to prevent vaginal tightness so that sexual intercourse will not be difficult or painful.
4. Is cervix cancer contagious?
Cervix cancer itself is not contagious. However, the virus that is thought to cause the cancer is transmitted from one person to another during sexual intercourse.
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