What are the common signs and symptoms?
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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 leeding (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 signs 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.
- Vaginal leeding (between periods or after sexual intercourse)
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 who have had sexual intercourse at an early age have double the risk of developing cervical cancer. In the study, lead researcher Dr Silvia Francheschi of the 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 and 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 reduce the need for cervical cancer treatment. 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 diseases
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 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 programmes in place in high-income countries to immunise 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.
What can you do to prevent cervical cancer?
These are two ways to prevent cervical cancer:
- Go for a 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 two-dose regimen can be given to girls between the ages of 9 and 14 years old. For those who are 5 years old and older, a three-dose regimen is recommended over 6 months.
What are the treatment options?
There are different treatments available for cervical cancer, depending on the stage of the 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
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 a 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 of cervical cancer can be treated with cervical conization (cone biopsy) or simple hysterectomy alone.
Radiation Therapy
Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or 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
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 in 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.
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