Patient Care

Cervical Cancer

What is Cervical Cancer?

Cervical Cancer is cancer of the entrance to the uterus or womb. It starts when abnormal cells grow out of control in the transformation zone (the area where squamous cells and glandular cells meet).

The cells do not suddenly transform into cancer; the normal cells in the cervix slowly change, which then turn it into cancer instead.


Long before there is a cancerous growth on the cervix, the cells of the cervix undergo changes that will eventually lead to cancer. These changes in the cells of the cervix are known as cervical dysplastic changes or cervical pre-cancer. Slowly and over time the abnormal and dysplastic cells increase in number and take over more and more normal tissue. Eventually when the dysplastic cells breach an important tissue layer, the basement membrane, the dysplastic growth has formally become a cancer.

During the pre-cancerous phase of dysplastic change, there are no noticeable symptoms, and the only reliable way to detect these pre-cancerous changes is to have a series of pap smear tests. This is the main reason to recommend having regular pap smear tests. The other reason regular pap smear tests work is that the pre-cancerous phase of change in the cervix extends over a significant period of time. In some studies, it has been estimated that it could take up to 10 years from the time the first pre-cancerous cell appears to the time that there is cancer on the cervix.

cancer on the cervix

Cervical Cancer develops slowly. It develops from a few abnormal cells into a tumour over several years. That is why regular yearly pap smears are very effective in reducing a woman's risk of developing Cervical Cancer.

Cervical Cancer spreads outwards from the cervix to affect the bladder and rectum and it has a very prolonged and distinct pre-cancerous phase.

Papillomavirus is a key element in the development of Cervical Cancer. HPV is what is known as a DNA virus and although there are over 200 different subtypes, only a small handful are known as “high risk” HPV. They are known as “high risk” because if a woman is infected for a long time with a “high risk” HPV subtype it significantly increases the likelihood of her developing Cervical Cancer. There is a growing body of evidence that suggests that women who have never been exposed to HPV and who are vaccinated against it, have a much lower likelihood of ever developing Cervical Pre-Cancer or Cancer. HPV vaccines have been around for a sufficiently long time and with almost 200 million doses delivered worldwide, the World Health Organization has declared that the vaccine is safe and that all eligible women should consider vaccination. The HPV vaccination is also part of national vaccination programs for school children in countries such as Australia and Great Britain.

It is important at this point to emphasise that HPV infection is very common, almost like catching the common cold in humans, and that Cervical Cancer develops only in a very small percentage of the total number of HPV infections. The vast majority of women who are infected with HPV clear it effectively. The problem is that there is no effective way to know which women will effectively clear high-risk HPV and which will not, and among those that do not clear the viral infection, which women will go on to develop cervical cancer. This is why doctors recommend vaccination for everybody that is eligible.

With minimal effort, you can prevent Cervical Cancer effectively by getting your HPV vaccine and getting regular pap smear tests.

What are the signs & symptoms of Cervical Cancer?

Cervical Cancer may be associated with the following symptoms:

  • Abnormal vaginal bleeding (e.g. bleeding after sex, after menopause, in between periods, etc)
  • Pain during sex
  • Unusual vaginal discharge (may contain some blood)
  • Pain in the lower belly
  • Longer and heavier menstrual bleeding
  • Persistent strong smelling vaginal discharge

A doctor should be consulted if the symptoms above occur.

How is Cervical Cancer diagnosed?

The first step in finding out if you have cervical cancer, as doctors suggest, is through a pap smear test. During the test, the doctor gently scrapes the outside of the vagina and cervix to take samples of cells. The cells will then be taken to the laboratory for testing.

Other than a pap smear test, here are some other ways Cervical Cancer is diagnosed.


If you have certain symptoms suggesting cancer, your doctor may recommend a colposcopy. During the procedure, a speculum will be placed inside the vagina and use a colposcope to examine the cervix. The doctor will then apply a weak solution of acetic acid to the cervix to see any abnormal areas easily.

A colposcopic examination is exactly like having a pap smear test done except that cervix is examined under a strong light through a magnified scope from outside the body. This allows the cervix to be examined for areas that may appear to be the source of the abnormal cells that were picked up on the pap smear. If there is an area that is suspicious for pre-cancerous or cancerous change, a small portion of these abnormal areas on the cervix may be collected in a procedure known as a punch biopsy. If you do undergo this procedure, you may expect some momentary discomfort and vaginal spotting for a day or so after the procedure. The tissue that is collected is important and sent to the lab for examination under a microscope to determine the extent of pre-cancerous change.

If the biopsy result shows that there is indeed an area of pre-cancer on the cervix, your specialist may recommend a simple office procedure to arrest or stop the pre-cancerous change from worsening and eventually becoming cancer. These simple office procedures can either be ablative, which means that abnormal areas on the cervix are destroyed, or excision, which means that the abnormal areas are separated from the normal cervix by fine cutting or excision. Office procedures are simple, effective and do not require anaesthesia or hospitalisation.

Cone Biopsy

During a biopsy, some tissue in the cervix will be removed for examination under a microscope. Other tests can only suggest cancer, but only a biopsy can give a clear-cut answer.

Who is at risk of Cervical Cancer?
  • Women over the age of 30 (The risk is strongly related to age, with higher incidence in younger women)
  • People who smoke
  • Those who have human papilloma virus (HPV) infection
  • Women who use birth control pills for about five or more years
  • Women who gave birth to three or more children
  • Women who have had several sexual partners
  • Women who started having intercourse at a young age (younger than 16 years of age at first intercourse) have a higher risk of developing cervical cancer.
  • Being infected with HPV types for a long period of time can increase a woman's risk of developing Cervical Cancer

People who think they may be at risk should discuss this with their doctor.

There are several ways to prevent Cervical Cancer:

  • Practise safe sex
  • Avoid smoking
  • Get a HPV vaccine
  • Go for regular cervical screenings and pap smears

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).

HPV Vaccines

HPV only infects humans and prefers to infect the skin cells of the genitals. There are some 200 sub-types of HPV and only 15 of these 200 sub-types have been implicated in Cervical Cancer. HPV infection is very common in the general population and most women (>95%) are able to clear this viral infection on their own without the need for special vaccines or medicines.

Only a very small percentage of women who are infected by HPV go on to develop Cervical Cancer.

What are the treatment options for Cervical Cancer?

Pre-cancerous changes of the cervix are easily treated. All the can be easily completed in the clinic or as a day surgery.

These options include:

  • Laser ablation - where the pre-cancerous changes are completely removed using laser energy. This can be easily done in the clinic without the need to be put to sleep or for general anaesthesia.
  • Cold coagulation - where heat is applied to the pre-cancerous areas of the cervix cauterising and destroying the abnormal areas. This procedure is also easily performed in the clinic.
  • LEEP or Loop Electro-Excision Procedure - where a powered loop device removes abnormal or pre-cancerous areas of the cervix and cauterizes at the same time resulting in virtually no blood loss.
  • Laser conisation
  • Needle conisation
  • Cold knife conisation
Cold Coagulation

This procedure is actually hot. A special instrument known as a cold coagulator is placed in contact with the abnormal area of the cervix and delivers heat to the abnormal area coagulating any abnormal tissue which then slowly sloughs off over the next few days and is eventually replaced by healthy tissue.

Women who have cold coagulation can expect some cramps and discomfort during the procedure which lasts about 2 minutes. There may be watery or mucoid discharge over the next 7-10 days accompanied by some spotting or bleeding as the cervix heals.

Loop Electro-Excision Procedure (LEEP)

The Loop Electro-Excision Procedure (LEEP) is a procedure where a high-energy loop or wire device is used to cleanly and bloodlessly remove a portion of the cervix that is diseased or unhealthy, leaving behind only healthy tissue. This is a very effective way to treat pre-cancer of the cervix and also provide tissue that can be further analysed by a specialist pathologist in the lab to better understand exactly what kind of pre-cancerous change are taking place in the cervix. The entire procedure takes 3-5 minutes, and most of the women who undergo the procedure report little or no pain during the procedure.

Some spotting and light menses-like bleeding usually starts 2-3 days after the procedure and is part of the normal healing process after a LEEP. Women who have the LEEP can also expect some brown or black discharge after the procedure, as a solution known as Monsell's solution is typically applied to the cervix to prevent bleeding and promote healing after the procedure.

Laser Ablation

A carbon-dioxide laser produces enough energy to completely vaporize any pre-cancerous changes on the cervix. Laser vaporisation is a very effective way to completely treat pre-cancerous changes of the cervix. The laser allows precise treatment of the pre-cancerous areas of the cervix without affecting the normal tissue of the cervix. The procedure typically takes about 3-5 minutes to complete.

Cancer of the cervix is usually treated with:

  • An operation known as a hysterectomy where the womb is removed together with the cervix. More complex surgery will be necessary for the effective treatment of cancer that has spread more extensively outside the cervix.
  • Radiation combined with chemotherapy for advanced Cervical Cancer where surgery cannot remove all the cancer.

Pre-cancerous changes are easily and quickly treated in the specialist clinic and when they are effectively treated, cancer is prevented.

Treatment of early-stage cancer results in a better than 90% chance of completely being cured of the disease.

Late-stage cancer of the cervix is also highly treatable with positive response rates when both chemotherapy and radiation treatments are given.

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  • National University Hospital
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  • National University Cancer Institute, Singapore
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