Lisa, Shalini and I attended a cancer awareness campaign last week, being particularly interested in the rising concern about cervical cancer.
How much do you know about cervical cancer?
Cancer is a leading cause of death worldwide, accounting for 8.2 million deaths in 2012. Cervical cancer is one of them.
In Malaysia, it is the 3rd most common cancer, accounting for 11% of all cancers in women. Over 1,100 women are diagnosed with cervical cancer each year.
The risk of cervical cancer increases after 30 years old and peaks at ages 60–69 years old.
In Indonesia, cervical cancer is ranked 2nd after breast cancer. Every year there are around 15,000 new cases of cervical cancer in Indonesia.
WHO placed Indonesia as the country with the highest number of cervical cancer in the world. Cervical cancer is also ranked as the first killer of women in Indonesia.
So we started a survey with research across 5000+ citizens in Malaysia, asking them "what do you want to ask most about cervical cancer?".
I then met up with a specialist doctor in women cancer, Dr Zaharuddin Rahmat @ Mohd. Rawi - Consultant Obstetrician, Gynaecologist and GynaeOncologist - to answer these most asked questions from you about cervical cancer.
Dr Zaharuddin Rahmat @ Mohd.Rawi completed his undergraduate (MBBS) and post-graduate studies, Master in Obstetrics & Gynaecology (MObGyn) University of Malaya in 1998 & 2006 respectively.
He obtained his ‘Member of Royal College of Obstetricians & Gynaecologists’ (MRCOG) London in 2007.
He is a certified Colposcopist (diagnosis & therapeutic) from the British Society for Colposcopy & Cervical Pathology (BSCCP/RCOG) UK and a certified GynaeOncologist, CGO from Ministry of Health, Malaysia (Certificate of Completion for Fellowship (Subspeciality) Training in GynaeOncology ,CCST).
His interest covers an extensive range of gynaecological & obstetric services, treatment and care which includes GynaeOncology (women’s cancer), abnormal Pap smear, colposcopy, laparoscopy (key-hole surgery), gynaecological tumours (fibroids, ovarian cysts, endometriosis) and general obstetric cases.
The former Senior Medical Lecturer from University of Malaya is still actively conducting courses, seminars and talks to undergraduate, post-graduates students and medical practitioners.
Dr Zaharuddin is currently a council member of the Malaysian Gynaecological Cancer Society, MGCS and a visiting lecturer at Newcastle University Medicine Malaysia.
So, what do you want to know about cervical cancer?
Following our studies, these are the most asked questions about this deadly disease. Pick one below to see the answer to your question by Dr. Zaharuddin, or read all of them here!
|1. What is cervical cancer?||200 asks|
|2. Is cervical cancer hereditary?||1,000 asks|
|3. Is cervical cancer curable?||880 asks|
|4. Can cervical cancer spread? Is it curable?||600 asks|
|5. Is cervical cancer deadly?||400 asks|
|6. Is cervical cancer contagious?||320 asks|
|7. What causes cervical cancer besides HPV?||300 asks|
|8. How does cervical cancer feel like? Is it painful?||700 asks|
|9. Do I have cervical cancer? How do I check?||250 asks|
|10. Does cervical cancer smell?||200 asks|
|11. Is cervical cancer sexually transmitted?||140 asks|
|12. Can cervical cancer come back?||110 asks|
|13. Is cervical cancer preventable?||70 asks|
|14. Can cervical cancer develop within a year?||30 asks|
|15. Does cervical cancer spread fast?||30 asks|
|16. Can cervical cancer cause infertility?||170 asks|
|17. Can cervical cancer stop your period?||110 asks|
1. What's cervical cancer? (200 asks)
The cervix is the lower part of the uterus which extends slightly into the top of vagina. It is also called as the neck of the womb (uterus). It is covered by a thin layer of tissue made of cells. Healthy cells grow, divide and replaced as needed.
Cancer of the cervix happens when these cells change, grow out of control rapidly into deeper layers or spread to other organs. The cancer cells form a mass of tissue called a cancerous (malignant) tumour.
2. Is cervical cancer hereditary? (1,000 asks)
Cervical cancer is not hereditary.
The main cause of cervical cancer is a persistent infection of the cervix by ‘high-risk’ Human Papilloma Virus (hrHPV). HrHPV is a common virus that is passed from one person to another during sexual intercourse.
At least half of sexually active people will have HPV at some point in their lives but only few women will get cervical cancer. About 9 out of 10 hrHPV infection will be cleared completely within 2 years. This means that most women who are infected with hrHPV do not develop cancer.
Only a small group of women have persistent hrHPV infection. This infection may cause abnormal cell reproduction in the cervix. If these cells are left untreated, they can be cancerous in future.
As hrHPV is sexually transmitted, cervical cancer is hence not a hereditary disease.
3. Is cervical cancer curable? (880 asks)
Cervical cancer progresses slowly. Starting from hrHPV infection on the cervix, it then develops into abnormal cells. A small percentage of untreated abnormal cells will become a cancerous tumour. This process can take years.
A regular Pap smear test can detect abnormal cells before they become a cancer. Abnormal cells and tissues can be treated by simple procedures such as colposcopy* and large loop excision of the cervix (LLETZ)*.
These procedures can completely remove abnormal tissue before becoming cancer. If the cancer is only confined to the cervix, surgical operations like the Wertheim’s hysterectomy* can remove the cancerous tumour completely.
Cervical cancer at the early stage is curable if treated appropriately by trained Gynae-Oncologists. However, patients still need to have follow up for surveillance.
*Colposcopy: A procedure to examine the cervix, vagina and vulva using a colposcope. Colposcopy is usually recommended if a regular Pap smear test shows abnormal results.
*LLETZ: A procedure where a wire loop with electric current is used to remove abnormal cells in the cervix
*Wertheim’s hysterectomy: A surgical procedure for cervical cancer where all or parts of the uterus, its connective tissues and lymph nodes, Fallopian tubes, ovaries or the upper part of the vagina is removed.
4. Can cervical cancer spread? Is it curable? (600 asks)
Cervical cancer can spread to the surrounding organs and other parts of the body (metastasis*).
A cancerous tumour is a lump of tissue made up from cancer cells which continue to multiply rapidly and out of control. These tumours invade nearby tissues and organs, causing damage.
They may also spread to other parts of the body if some of the cancer cells break off from the origin (primary) tumour and are carried in the bloodstream of lymph channels to other parts of the body such as the urinary bladder, large bowel, lungs, liver and spine.
These small groups of cells may then multiply to form other tumours (secondary/ metastases) in one or more parts of the body.
These secondary tumours may then grow, invade and damage nearby tissues and spread again.
Advanced cervical cancer with widespread disease is very hard to treat and is not curable. The treatment aim of this advanced disease is to control the disease, so that patients can have a comfortable life with minimal pain and symptoms.
*metastasis: the growth of an infected cell away from the original cell.
5. Is cervical cancer deadly? (400 asks)
Early cervical cancer can be treated and the disease can be completely removed by appropriate surgery/treatment. Patients can live a normal life and the risk of disease recurrence is relatively very low.
However, advanced cervical cancer with widespread disease is not curable and the outcome (prognosis*) is very poor.
*prognosis: the likely outcome of the disease
6. Is cervical cancer contagious? (320 asks)
Cervical cancer in itself is not contagious – it cannot be spread from a patient to others.
However, hrHPV, the cause of cervical cancer, is contagious and can be spread via sexual intercourse.
7. What causes cervical cancer besides HPV? (300 asks)
Persistent infection of the cervix by hrHPV is the main cause of cervical cancer.
However, the risk of a rare form of cervical cancer (and vaginal cancer) is increased in women whose mothers used medication diethylstilbestrol (DES) while pregnant. This hormone is given to some women who had previous miscarriage experiences but this drug is not popular in practice now.
The following risk factors can increase the risk of developing cervical cancer for women who have also been exposed to hrHPV:
- Skipping Pap smear test or never had Pap smear test. Women who do not have regular Pap tests are more likely to develop cervical cancer, since Pap tests allow doctors to detect and remove abnormal cervical cells before they become cervical cancer.
- Smoking cigarettes. Women who smoke are associated with persistent hrHPV infection because their immunity levels are unable to eradicate hrHPV.
- Decreased immunity. Women who have conditions that weaken their immune system, such as HIV infection or chronic illnesses, especially those who are on immunosuppressive drugs*, such as renal transplant and diabetic mellitus patients may be at an increased risk of developing cervical cancer.
- Sexually transmitted diseases (STDs). Women who have been contacted with STDs are also at high risk to get hrHPV infections.
- Having more than four children. Women who have five or more children may have a slightly elevated risk of developing cervical cancer. This is because it is associated with recurrent trauma of the cervix during vaginal deliveries and increases the risk of persistent hrHPV infections.
*Immunosuppressive drugs: Drugs or agents that are used to prevent our body’s immune reaction, usually used to avoid body rejection of transplants or major illnesses.
8. How does cervical cancer feel like? Is it painful? (700 asks)
Early cervical cancer may not cause signs and symptoms.
Cervical cancer is usually presented as abnormal vaginal bleeding, spotting or watery discharge. Menstruations may be heavier than usual and irregular, while bleeding after sexual intercourse may occur.
Symptoms of the advanced disease include pelvic pain, urinating problems, bloody urine and swollen legs. This is because the cancer has spread to nearby organs and the cancer tumours can affect how other organs work.
9. Do I have cervical cancer? How do I check? (250 asks)
As with No. 7, conducting regular Pap smear tests can help to detect any abnormalities early and prevent the development of cervical cancer.
10. Does cervical cancer smell? (200 asks)
Early cervical cancer has no symptoms such as smell or bleeding.
However, when a cervical tumour becomes infected, there will be foul-smelling or blood-stained vaginal discharge.
11. Is cervical cancer sexually transmitted? (140 asks)
Cervical cancer itself is not contagious – it cannot be spread from a patient to others. Only hrHPV is contagious and can be spread via sexual intercourse.
12. Can cervical cancer come back? (110 asks)
As with any other cancers, cervical cancer can come back, especially those that were already at the advanced stage of the disease during the first diagnosis.
After completion of the initial treatment of cervical cancer, patients are advised to have regular follow-ups as planned such as following up every 3 months for the first 2 years of treatment completion, then following up every 6 months for the next 2 years.
If no evidence of recurrence is found during the first 5 years, patients would then have yearly follow-ups.
During these follow-up visits, gyneoncologists will look for symptoms and signs of recurrence disease. Vaginal examinations include vault smear ( like Pap smear) on the top of the vagina.
13. Is cervical cancer preventable? (70 asks)
Cervical cancer is preventable. Women can prevent the disease by following these steps:
- Get a HPV vaccination. It protects against the types of HPV that most often cause cervical, vaginal and vulvar cancers. It is given in a series of 3 injections. The vaccine can be given to girls beginning at age 9.
- Do Pap smear tests regularly to find pre-cancerous cervical cells.
- Follow up with the doctor as scheduled if Pap smear test results are not normal. Abnormal cells, if left untreated, can become cancerous in future.
- Do not smoke because smoking is associated with persistent HPV infection which cause the development of abnormal cells.
- Practise safe sex using condoms and have fewer/limited sexual partners to reduce the risk of cervical cancer.
14. Can cervical cancer develop within a year? (30 asks)
Cervical cancer usually takes several years to develop. Before a cancer is present, the early cervical cell changes and becomes abnormal. These changes are called cervical intraepithelial neoplasia (CIN) or dysplasia.
If these changes are left untreated for years, these cells become cancerous cells after a few years.
15. Does cervical cancer spread fast? (30 asks)
Once a patient has cervical cancer, the disease initially spreads to surrounding organs such as the uterus, the tissues surrounding the uterus (parametrium), ureters, urinary bladder and rectum.
The cancer can spread to distant parts of the body such as lungs, spine and liver. This process can take months or up to years.
After the completion of the primary treatment of cervical cancer (radical surgery with or without chemotherapy/radiotherapy), the patient is advised to have a follow-up schedule to detect early recurrence of the disease.
16. Can cervical cancer cause infertility? (170 asks)
Treatment for cervical cancer involves hysterectomy with or without chemotherapy/radiation therapy.
Hysterectomy means the removal of the uterus. Both hysterectomy and radiation therapy can cause the inability to get pregnant.
However, during the early stages of cervical cancer (e.g. stage 1A), surgery may involve only the cervix (with surrounding tissue) and the upper part of the vagina. This procedure is called radical trachelectomy. This surgery is usually reserved for young patients who have not had their own families.
17. Can cervical cancer stop your period? (110 asks)
Symptoms of cervical cancer are irregular menstruations, postcoital bleeding* and prolonged menstruation.
Treatment of cervical cancer can stop menstruation because the uterus will be removed and radiation therapy can also cause ovaries to stop working (menopause).
If the treatment is only radical trachelectomy, the uterus is preserved and the patient can have regular menstruation as usual.
*Postcoital bleeding: The bleeding from the vagina after a sexual intercourse
After our discussion with Dr Zaharuddin, we had a much better understanding on cervical cancer.
“Wow, I’d better have a pap smear test soon - maybe next week! Shalini, let’s go together!”
Have you done your medical check-up? Prevention is always better than cure. Get your condition checked early so that you can avoid any possibilities of future complications.
You can look for a women specialist near you today here: List of Women Specialist Clinics in Malaysia.
And don't forget, if you have any questions or comments, come chat with me in the comments below!
Obstetrics and Gynaecology Clinic with subspeciality (expertise) in GynaeOncology (Women's cancer). We provide women's healthcare service includes screening, prevention, diagnosis, treatment and surgeries for abnormal Pap smear (colposcopy), ovarian cancer, uterine cancer, cervical cancer, gynaecological tumours (fibroids, ovarian cysts, endometriosis), general obstetrics (pregnancy) and gynaecology.
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