Cervical Cancer: Symptoms, Risk Factors, and Prevention

Cervical cancer is preventable with early detection. Regular screening, usually conducted in the form of a simple and quick pap smear test, can detect a HPV infection. A HPV infection does not mean you have cancer, but if left unmonitored or untreated it may develop into cancer over time.  So, the prompt treatment of HPV infection can prevent cancer and save lives.

All sexually active women aged 30-65 should have regular cervical screening every 3-5 years. Less than 40% of Malaysian women have had a cervical screening. 50% of women diagnosed with cervical cancer have not had a cervical screening in the last 5 years. 

A HPV infection does not mean you have cancer. HPV infection may take decades to lead to cervical cancer, but HPV infections are the leading cause of cervical cancer. 

Causes and Risk Factors

Cervical cancer is a type of cancer that occurs in a woman's cervix, the lower part of the uterus that connects to the vagina. Cervical cancer happens when abnormal cells on the cervix grow out of control, and this often develops slowly over time. It starts as precancerous changes to cells on the cervix, which may eventually turn into cancer.. 

Cervical cancer is one of the most common gynecologic cancers. In Malaysia, cervical cancer ranks as the second most frequent cancer among women after breast cancer. It accounts for about 13% of all female cancers. According to statistics from the National Cancer Registry, there are over 2,000 new cases of cervical cancer diagnosed in Malaysia every year. The age-standardized incidence rate is 10.2 per 100,000 women annually. Cervical cancer incidence peaks in the 50-59 age group.

Although the number of new cases has been rising in recent years, cervical cancer mortality rates in Malaysia have declined. This is likely due to increased awareness, screening, and early detection efforts. However, cervical cancer remains a significant public health concern in Malaysia that requires continued vigilance.

Cervical cancer is caused by the human papillomavirus (HPV) infection in nearly all cases. HPV is a very common sexually transmitted infection that most people are exposed to at some point. HPV is transmitted through intimate skin-to-skin contact during sex, using condoms reduces, but does not eliminate, the risk of contracting HPV. Most sexually active adults will get infected with HPV at some point, though the immune system clears the infection in most cases. When the virus persists over many years, it can lead to precancer and cancer. 

Other risk factors for cervical cancer include smoking, HIV infection, chlamydia infection, diet low in fruits and vegetables, use of oral contraceptives (birth control pills)  for 5+ years, and having multiple full-term pregnancies.

Other risk factors for cervical cancer include smoking, HIV infection, chlamydia infection, diet low in fruits and vegetables, use of oral contraceptives (birth control pills)  for 5+ years, and having multiple full-term pregnancies.

Symptoms

Cervical cancer usually doesn't show symptoms until it has become more advanced. some of the most common symptoms include:

• Avnormal Vaginal Bleeding - this is common symptom of cervical cancer
  • Bleeding between periods
  • Bleeding after sexual intercourse
  • Bleeding after menopause
  • Having heavier menstrual periods than usual
• Pelvic pain
• Increase Vaginal Discharge - any increase, or changes in the consistency, smell or colour could indicate a problem.

While these can be signs of cervical cancer, they can also have other causes. It's important to discuss any new symptoms with your doctor right away to determine the cause, Many women with early cervical cancers have no symptoms at all, which is why regular screening is critical.

Screening and Diagnosis

Regular screening is important for detecting cervical cancer and precancerous changes early. There are two main tests used:

• Pap Smear Test: THis is the most common cervical cancer screening. Cells are collected from the cerix and examined under a microscope to look for abnormal cells. It can detect precancerous cell changes before they become cervical cancer.
  • Screening guidelines recommend Pap test
    • every 3 years for women ages 21-29,
    • and every 3-5 years for women 30-65
  • HPV test: This is often performed with the Pap Smear test. This looks for the virus that can cause precancerous cervical cell changes. A positive HPV test means you have a type of HPV that can cause cancer, but does no necessarily mean you have a cancer.

If abnormal cells are detected on a Pap Smear or HPV test, further test may include

• Colposcopy: This examines the cervix more closely using a special magnifying instrument. It can help determine if abnormal cells are present.
• Biopsy: A small sample of tissue is removed from the cervix or inside the opening and examined under a micrscope. This confirms if abnrormal cells are present and if they are precancerous or cancerous.

Regular cerival cancer screening aims to find precancerous changes early so they can be monitored or treated, thereby preventing progression to cervical cancer. Screening test do no diagnose cancer, so biopsy is needed if abnormal results are found. Catching precancerous changes early gives the best chance for effective treatment.

Stages and Survival Rates

Cerviclal cancer infection is classified into four main stages based on how far it has spread.

Stage I

Stage 1 cervical cancer means the cancer is only found in the cervix and has not spread to other parts of the body. The 5-year survival rate for stage I cervical cancer is 80-90%.

Stage II

Stage II cervical cancer means the cancer has spread beyong the cervix into nearby areas such as the vagina or tissue near the uterus, but is still inside the pelvic area. The 5-year survival rate for stage II cervical cancer is 60-75%.

Stage III

In stage III, the cancer has spread further into the lower part of the vagina or pelvic wall. It maybe blocking the uterus, which carry urine from the bladder. The 5-year survival rate for stage III cervical cancer is 30-50%.

Stage IV

Stage IV cervical cancer means the cancer has spread beyong the pelvis to other parts of the body. This is called metastatic cervical cancer. The cancer most of ten spreads to the lungs, liver, bones, bladder, vagina and rectum. Stage IV has the lowest 5-year survival rate at 15-20%.

Treatment

There are serveral treatment options for cervical cancer depending on the stage and factors like the patient's age and whether she still wants to have children. Treatment options include: surgery to remove the tumour, radiation, chemotherapy, targeted therapy, which would be advised by your doctor.

Recurrent Cervical Cancer

Cervical cancer that has returned following initial treatment is known as recurrent cervical cancer. Unfortunately, even after what appears to be successful intitial treatment, cervical cancer can return. The rates of recurrence vary depending on the initial treatement, cervical cancer can return. 

The reates of recurrence vary depending on the initial stage of the cervical cancer, which is why it is important to go for regular screenings and to treat it before the condition proggresses.

Prevention

Cervical cancer is one of the most preventable types of cancer, hence the call for regular screening. While no prevention method is 100% effective, the following steps can greatly reduce your chances of developing cervical cancer.

• HPV Vaccination
  
  • The human papilomavirus (HPV) is responsible for 95% of cervical cancers. Getting vaccunated against HPV as a preteen or young adult can prevent infection from the HPV strains that cause 70% of cervical cancers. The HPV vaccine is recommended for all children ages 9 to 14 years old. In Malaysia, it is also recommended for women up to age 45, if they were not previously vaccinated.
• Practice Safe Sex
  • Using condoms and limiting your number of sexual partners can reduce exposure to HPV. While condoms cannot fully protect against HPV, they can help lower transmission risk.
• Regular Cervical Cancer Screenings
  • Getting regular cervical cytology and HPV test can detect precancerous changes and cervical cancer at early stages when treatement is most effective.
• Screening guidelines recommend Pap test
  • Target women: 25-65 years old
  • Initial screening interval is yearly for 2 years
  • if results are normal, then 3 yearly interval
  • if cytology and HPV testing were done together and both results were negative, then the cervical screening interval is 5-yearly.
• Quit smoking

Early detection and prevention of HPV infection are our best defenses against cervical cancer. Vaccination, safe sexual practices, not smoking and regular screening together provide the most effective protrection. With proactive prevention measures, most women can avoid developing cervical cancer during their lifetime.