Radiation Therapy for

Cervical Cancer

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What is Cervical cancer?

The cervix is the lower part of the uterus (womb) connecting the body of the uterus to the vagina (birth canal). Cancer of the cervix can take many years to develop. Before cancer occurs, the cervix undergoes pre-cancerous phases. These pre-cancerous phases cause changes in the cervix known as Cervical Intraepithelial Neoplasia (CIN) and can develop to cancer if left untreated. Regular cervical check ups are highly recommended, allowing patients to get cervical cancer treatment in Singapore early, before the condition deteriorates.

What are the common signs and symptoms?

  • Early cervical cancer may not show any noticeable signs or symptoms. Below are some symptoms of cervical cancer although other conditions may also cause those symptoms:

    • Vaginal bleeding (Between periods or after sexual intercourse)
      Most cervical cancer cases are characterised by unusual vaginal bleeding as the first symptom. As the cancer develops and invades surrounding tissues, it may grow into nearby blood vessels, causing bleeding. Patients may experience unusual bleeding if they are not expecting their normal period or even after sexual intercourse. It can also take the form of heavier periods than normal or post-menopausal bleeding. Vaginal bleeding between periods is also known as intermenstrual bleeding, spotting, and metrorrhagia. STIs or trauma can also cause abnormal vaginal bleeding, so it is not an absolute indicator of cervical cancer. However, any unusual bleeding should be discussed with a doctor as soon as possible to get early cervical cancer treatment. Apart from unusual vaginal bleeding, pain and discomfort during sexual intercourse may also be a sign of cervical cancer.
    • Blood-stained vaginal discharge
      It is common for women to have brown or bloody discharge during or after menstruation. A brown discharge can occur instead of a red discharge at the end of a period. It is also possible to experience small amounts of bloody discharge between periods, known as spotting. While a blood-stained vaginal discharge may not be a cause for concern, it can be a sign of a more significant issue such as endometrial or cervical cancer. Cervical cancer can produce a bloody, brown, or watery discharge with an unpleasant odour. Therefore, it is important to have a Pap smear and pelvic examination every year. During these procedures, gynaecologists will check for abnormalities in the cervical region, enabling patients to get early cervical cancer treatment if necessary.

     Ultimately, a doctor should be consulted if the symptoms above occur.

Who is at risk?

  • Persistent Human Papillomavirus (HPV) infection
    HPV is a common sexually transmitted infection. There are 40 types of HPV that can affect the genital areas of men and women, including the penis, vulva, and anus, as well as the vaginal lining, cervix, and rectum. Normally, your immune system prevents HPV from doing serious damage, but sometimes the virus survives for years. The virus may eventually cause normal cervix cells to become cancerous. Around 10% of women with HPV infections on their cervix may develop long-lasting HPV infections that put them at risk for cervical cancer. HPV can also cause precancers when it lingers and affects the cells of the vulva, vagina, penis, or anus. Unless they are found and removed in time, these could eventually develop into cancer, requiring cervical cancer treatment.
  • Multiple sexual partners
    Having more sexual partners increases the risk of cervical cancer and the need for cervical cancer treatment. This is because a higher number of sexual partners increases a person’s exposure to HPV, creating a greater risk of developing this cancer. As HPV spreads by sexual contact, one is more likely to contract the disease during sexual intercourse with more than one partner. This rings true even with the use of a condom. Contrary to popular belief, condoms do not protect against HPV. The human papillomavirus infects large areas of skin across the groin, thighs, and buttocks, but a condom can only prevent skin-to-skin contact over a small area. While using a condom may help prevent certain HIVs and STDs, it is important to be aware that it may not protect against HPV, especially with multiple partners.”
  • Early onset of sexual intercourse
    Early age at first sexual intercourse (AFSI) has been linked to an increased risk of high-risk HPV, which is responsible for cases of invasive cervical cancer in women. In the British Journal of Cancer, researchers in Britain found that women with having sexual intercourse at an early age have double the risk of developing cervical cancer. In the study, lead researcher Dr Silvia Francheschi of International Agency for Research on Cancer found that women who had their first intercourse at 20 had a higher risk of cervical cancer than women who had their first intercourse at 25. The earlier the onset of sexual relations, the greater the chance of HPV infection, giving the virus more time to initiate a long sequence of events that lead to cancer development. In such cases, cervical cancer treatment is required.
  • Usage of oral contraceptives
    Oral contraceptives are medications containing hormones. Taking these medications prevents pregnancy by inhibiting ovulation as well as preventing sperm from entering the uterus. Some cancers are stimulated by naturally occurring estrogen and progesterone. Due to the presence of synthetic versions of these female hormones, birth control pills could also increase cancer risk. Additionally, oral contraceptives may increase the risk of cervical cancer by making cervical cells more susceptible to persistent infections with high-risk HPV types. This may eventually render the need for cervical cancer treatment. In fact, researchers found that there is a 10% increased risk of cervical cancer when oral contraceptives are used for less than five years, a 60% increased risk when used for five to nine years, and a doubling of risk when used for ten years or longer.
  • Smoking
    Women who smoke are more likely to develop cervical cancer and require cervical cancer treatment compared to those who do not. Women who smoke have been found to have tobacco by-products in their cervical mucus. Cervical cancer may be caused by these substances damaging the DNA of the cervix. Smoking also weakens the immune system’s ability to fight HPV infections. Moreover, second-hand smoke has its associations as well. Even three or four hours a day of passive smoke may raise cervical cancer risks. According to research published in the Journal of the American Medical Association, cervical cancer risk increased in women who smoked and in women who were exposed to second-hand smoke, even after other factors, such as sexual activity, were taken into account.
  • History of sexually transmitted disease
    Those who have sexually transmitted diseases including chlamydia, gonorrhoea, syphilis, or herpes are more likely to develop cervical cancer. For instance, studies have shown an increased risk of cervical cancer in women whose blood tests and cervical mucus showed evidence of past or current chlamydia infection. Chlamydia bacteria may help HPV to grow and live on in the cervix, resulting in cervical cancer. HIV-positive women are six times more likely to develop cervical cancer than HIV-negative women, and it is estimated that HIV causes 5% of all cervical cancers. There are programs in place in high-income countries to immunize girls against HPV and to screen women regularly. By implementing effective interventions and offering the appropriate cervical cancer treatment, cervical cancer mortality rates can be reduced globally.
  • Weakened immune system e.g. HIV infection
    HIV, the virus that causes AIDS, weakens the immune system and makes people more susceptible to HPV infections. The immune system plays a key role in destroying and slowing the spread of cancer cells. Pre-cancers on the cervical mucosa may become invasive cancers faster in HIV-positive women. Women who are taking drugs that suppress their immune response are also more likely to develop cervical cancer. This includes those undergoing treatment for an autoimmune disease or those who have had an organ transplant. HIV-infected women with cervical cancer are four to five times more likely to develop invasive cervical cancer compared to women without HIV. If left untreated, pre-invasive lesions can quickly progress to invasive cancer in women with HIV. By then, cervical cancer treatment is required.

How is cervical cancer diagnosed?

If you present with any of the symptoms mentioned, the doctor will perform a pelvic examination and a biopsy of the cervix may be taken to look for cancer cells.

What can you do to prevent cervical cancer?

These are two ways to prevent cervical cancer:

  • Go for regular Pap smear test
  • Get vaccinated against the Human Papillomavirus (HPV)

Pap Smear Test

A pap smear test is a simple procedure where cells are collected from the surface of the cervix and then sent to a laboratory to detect any abnormality. All sexually active women between 25 and 69 years old are advised to have a pap smear test regularly (every 3 years on average).

If you have an abnormal pap smear, the doctor may want to examine you closer by doing a procedure called colposcopy.

Colposcopy is a procedure in which the doctor uses a colposcope (a lighted, magnifying instrument) to check the vagina and cervix for abnormal areas. It is not inserted into the vagina.

Human Papillomavirus (HPV) vaccination

Cervical cancer is caused by a common virus called the Human Papillomavirus (HPV) Being vaccinated against HPV is recommended for all young women aged 9 to 26.

The HPV vaccine works best if given before the first sexual intercourse. Talk to your doctor to see if you are eligible for the vaccine. A 2 dose regime can be given for girls between the ages 9 and 14 years old. For those who are 5 years old and older, a 3 dose regime is recommended over 6 months.

What are the treatment options?

There are different treatments available for cervical cancer depending on the stage of cervical cancer, Factors other than the stage of the cancer that might have an impact on your treatment decision include your age, your overall health, and your own preferences. The three main types of treatment include surgery, radiation and chemotherapy.


Surgery is usually the first treatment for cancer of the cervix in the early stages (where cancer is confined to the cervix). The most common treatment is the hysterectomy to remove the uterus (womb) and cervix. The neighbouring reproductive organs such as the ovaries and fallopian tubes may be removed. However this depends on other factors such as your age.

Some patients with the earliest stage cervical cancers can be treated with cervical conisation (cone biopsy) or simple hysterectomy alone.

Radiation Therapy

Radiation therapy is cancer treatment that uses high energy x-rays or other types of radiation to kill cancer cells or to keep them from growing. There are two types of radiation therapy – external and internal. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Radiation can be used after surgery for early stage cervical cancer. It is also the main treatment for later stage (stage 2 and above) cancers. For cervical cancer, when radiation is the main treatment, it is often given along with low doses of chemotherapy for it to work better.


Chemotherapy is the use of drugs to help kill cancer cells and shrink the size of the tumour. It is often combined with radiation therapy. Usually the drugs are given into a vein. Once the drugs enter the bloodstream, they spread throughout the body. In cervical cancer, chemotherapy is also given to women with advanced or recurrent cancer.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

About Dr Johann Tang

Senior Consultant Radiation Oncologist
Medical Director
MBBS (Aust), FRANZCR (Radiation Oncology), FAMS

Dr Tang obtained his medical degree from the University of Newcastle, Australia in 1998, and completed his house officer training at the Hunter Area Health Service in Australia. After his successful training, Dr Tang returned to Singapore to start his speciality training in Radiation Oncology at the National University Hospital (NUH). Obtaining his fellowship from the Royal Australian College of Radiologist (FRANZCR) in 2006, Dr Tang underwent fellowships in breast brachytherapy at the University of Wisconsin and Arizona Breast Cancer Specialist Centre, as well as prostate brachytherapy, skin and paediatric fellowships at Peter Maccallum Cancer Institute, Australia. In 2021, Dr Tang underwent a fellowship at the New York Proton Centre with Dr Charles Simone in Head and Neck, Reirradiation, Paediatric, Prostate and Lung cancers.

Why Choose Dr Johann Tang

Dr Johann Tang is an experienced radiation oncologist who aims to deliver the highest level of care to his patients. He is dedicated to understanding each patient’s condition and provides holistic customized care that is both effective and compassionate. With ethics and empathy held at the core of our practice, we strive to understand your individual needs and provide care that is compassionate and responsive.

Experienced Radiation Oncologist

Dr. Johann Tang is a highly experienced radiation oncologist with over 20 years treating various cancers in both adults and children and several accolades to his name. Prior to entering private practice where he is currently a Senior Consultant and Medical Director. Dr Tang was at NUH for 18 years from 2001 to 2019. Dr Tang spearheaded and built up the breast brachytherapy (Accelerated Partial Breast Irradiation APBI), outpatient interstitial image- guided cervical brachytherapy and paediatric radiotherapy services at NUH, to provide an array of the latest and best treatment options for patients. Dr. Tang is also passionately involved in research having authored numerous peer reviewed publications, and has won several research prizes.

Evidence-based Treatments

Dr. Johann Tang and his team utilizes technology that has proven to be effective in cancer treatment. Having decades of experience in treating and researching the disease has enabled Dr Tang to remain current and on top of best practices and novel techniques, providing his patients with full assurance that they are receiving the most effective treatment available.

Patient-centered Care

Dr Johann Tang’s patients are his top priority. He journeys with them from diagnosis till the completion of treatment. With Dr Tang, all patients can be fully assured that their clinical needs and well being are attended to. Dr. Tang is also passionately involved in research having authored numerous peer reviewed publications, and has won several research prizes.

"I guarantee my very best expertise delivered with compassion and dignity as we journey TOGETHER to BEAT this dreaded illness."

- Dr Johann Tang

Make An Enquiry

Got Queries? Book an appointment with Dr Johann Tang by filling up this form. We'll get on a call with you as soon as possible.

Prefer to talk? Call us directly at +65 6690 6811
or email us at drjohanntang@gmail.com

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