Abnormal bleeding from the vagina signals the need for an immediate examination. Abnormal bleeding includes bleeding after sexual intercourse or bleeding between menstrual periods. Other symptoms could include unusual vaginal discharge, pain during intercourse or even disturbances in urination or passing motion. Late symptoms that occur when the cancer is advanced include lower back pain, pelvic pain, weight loss and leg swelling.
Primary prevention of cervical cancer is now available in the form of vaccines. In Singapore, the three commercially available vaccines are Cervarix, Gardasil and Gardasil9. The vaccines have been shown to be efficacious in protection against high risk HPV subtypes such as HPV 16 and 18, which cause up to 70% of cervical cancers. In Singapore, the recommendations for cervical cancer vaccine is for ages 9-26 years old. All women of reproductive age who are sexually active are encouraged to have Pap smear screening.
Infection with Human Papillomavirus (HPV) is the most common cause or risk factor for cervical cancer. These viruses are transmitted during sexual intercourse, as well as via oral or anal sex. Any female who has ever been sexually active is at potential risk.
Other risk factors include:
Cervical cancer screening with a Pap smear should start as soon as a woman becomes sexually active. This should be performed at 1-3 yearly intervals depending on the age and the number of normal Pap smears. During this examination, a scraping of cells from the surface of the cervix is obtained during a vaginal examination. This is a quick, simple and painless test.
For pre-invasive disease, the treatment is the local removal of the abnormal lining of the cervix by local excision procedures or ablative procedures. Local excision techniques include knife or laser cone biopsies or Loop Electrosurgical Excision Procedures (LEEP). Ablative techniques include laser vaporization or cold coagulation. The technique of choice has to be discussed with the attending doctor. However, the successful treatment of precancer of the cervix almost certainly prevents cancer of the cervix from occurring.
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