The cervix is the lowest part of the uterus or womb. In its earliest stages, cervix cancer is a highly curable disease. Early detection is the key to improving survival. Most cervix cancers are squamous cell carcinomas.
Cervix cancer is the fourth most common female cancer in Singapore. Between 1988 and 1992, almost 1000 cases were reported in Singapore.
Very early cervix cancers occur in women in their mid to late 30s. With time, early cervix cancers invade into the uterus and are therefore more common in women in their mid to late 40s.
Cervix cancer is now considered to be a sexually transmittable disease. Human papillomaviruses and possibly herpes simplex virus type 2 have been implicated in causing the cancer. These viruses are transmitted during sexual intercourse.
Onset of early sexual activity before age 20 and multiple sexual partners increase the risk for cervix cancer.
Cigarette smoking is a co-factor implicated in causing cervix cancer.
Symptoms and Signs of Cervix Cancer
There is no characteristic symptom for cervix cancer. Bleeding is caused by ulceration of the cancer but some cancers grow without ulceration. Although it is not always reliable, abnormal bleeding from the vagina signals the need for an immediate examination.
Late symptoms when the cancer is very advanced are low back pain and weight loss.
Very early cervix cancers confined to just the surface of the cervix grow slowly over periods as long as 8 to 10 years. Once the cancer invades deeper tissues of the uterus, it starts to grow rapidly and can cause death within 2 to 3 years.
Cervix screening, called a 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 very simple, painless and quick test.
If the PAP smear is abnormal, specialised tests such as colposcopy and biopsy is usually recommended. During colposcopy, the cervix is examined with a microscope. Certain innocuous chemicals may be painted onto the cervix to pick up abnormal cells. These areas of abnormal cells are then biopsied and the removed tissue examined under a microscope by the pathologist (doctor who examines tissue under microscopes).
Once a cervix cancer is confirmed on biopsy, other tests are scheduled. This includes the IVU, which is a x-ray to look at the kidneys, chest x-ray and computerised scan (CT) of the region where the cancer is. Examination of the pelvic organs under general anaesthesia and cystoscopy, a test where a scope is introduced into the urethra and from there into the bladder, are also scheduled to determine the extent of the cancer.