Introduction
Cervical cancer is a type of cancer that develops in the cells of the cervix, the lower part of the uterus that connects to the vagina. It’s primarily caused by persistent infection with certain types of the human papillomavirus (HPV). It is the 4th most common cancer affecting women worldwide but in Singapore, it is the 10th most common female cancer. Every year, more than 200 women in Singapore are diagnosed with cervical cancer.The high risk strains of the human papillomavirus (HPV), play a causative role in causing most cervical cancers. The low risk strains cause genital warts but do not cause cancers.
While it may not show symptoms in its early stages, it can present with abnormal vaginal bleeding, abnormal vaginal discharge pelvic pain, or discomfort as it progresses. Regular screening through methods like Pap smears and HPV testing can detect precancerous changes early before cancer develops so that effective treatment can be rendered. Prevention efforts focus on HPV vaccination and regular screening to reduce the incidence and mortality rates associated with this highly preventable cancer.
Cervical Cancer Screening
In Singapore, cervical cancer screening is widely available and typically follows guidelines similar to those recommended by international health organizations. Here’s an overview of cervical cancer screening in Singapore:
- Screening Tests: The two primary screening tests for cervical cancer are the Pap smear (Pap test) and HPV testing. The Pap smear involves collecting cells from the cervix for examination under a microscope to detect any abnormalities. HPV testing detects the presence of high-risk strains of the human papillomavirus (HPV), which can lead to cervical cancer.
- Screening Guidelines: The recommended screening guidelines in Singapore may vary slightly among healthcare providers, but they generally align with international recommendations. Screening typically begins at age 25 or within three years of the onset of sexual activity, whichever comes later.
- Frequency: For women aged 25 to 29, Pap smears are usually recommended every three years. From age 30 onwards, it is recommended to have the HPV testing every five years.
- Vaccination: In addition to screening, HPV vaccination is an effective preventive measure against cervical cancer. In Singapore, HPV vaccination is recommended for girls aged 9 to 45 years old. The HPV vaccine is typically administered in two or three doses, depending on the age of the individual.
- Healthcare Providers: Cervical cancer screening services are available at various healthcare facilities in Singapore, including public hospitals, polyclinics, and private clinics. Women can consult their primary care physicians or gynecologists for advice on screening and vaccination.
- Follow-up Care: If abnormalities are detected during screening, women will be referred for further evaluation, which may include colposcopy (a procedure to examine the cervix more closely) and biopsy (sampling of cervical tissue for examination).
- Health Insurance Coverage: Cervical cancer screening and HPV vaccination are typically covered by health insurance plans in Singapore. However, coverage may vary depending on the specific terms and conditions of individual insurance policies.
Cervical Cancer Management
Being diagnosed with cervical cancer can be overwhelming, but it’s important to remember that there are steps you can take to manage the condition and improve your outcome. Cervical cancer management involves a multidisciplinary approach aimed at treating the cancer, controlling its spread, and improving the patient’s quality of life. The specific management plan depends on factors such as the stage of the cancer, the patient’s overall health, and individual preferences. Here are the main components of cervical cancer management:
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Treatment Modalities:
– Surgery:
Surgical procedures may be used to remove cancerous tissue from the cervix. The type of surgery depends on the stage of the cancer and may include procedures such as cone biopsy, simple hysterectomy or radical hysterectomy with pelvic lymph node dissection.
Fertility sparing surgery can also be performed on selected suitable cases of early cervical cancer if the woman wishes to have children.
– Radiation Therapy:
Radiation therapy uses high-energy rays to kill cancer cells or shrink tumors. It may be used alone or in combination with other treatments, such as surgery or chemotherapy.
– Chemotherapy:
Chemotherapy involves the use of drugs to kill cancer cells or stop them from growing. It may be used before or after surgery, or in combination with radiation therapy.
– Immunotherapy:
Immunotherapy works by stimulating the body’s immune system to recognize and attack cancer cells. It may be used in certain cases of advanced cervical cancer.
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Multidisciplinary Team Approach:
Cervical cancer management often involves a team of healthcare professionals, including gynecologic oncologists, radiation oncologists, medical oncologists, pathologists, radiologists, nurses, and other specialists. This multidisciplinary team collaborates to develop and implement an individualized treatment plan for each patient.
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Follow-up Care:
After initial treatment, patients require regular follow-up care to monitor for any signs of recurrence or complications. Follow-up visits may include physical exams, imaging tests, and laboratory tests to assess the patient’s response to treatment and detect any recurrence of cancer.
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Supportive Care:
Managing cervical cancer involves addressing the physical, emotional, and psychosocial needs of patients. Supportive care services, such as pain management, nutritional support, counseling, and palliative care, aim to improve the patient’s quality of life throughout the cancer journey.
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Clinical Trials:
Participation in clinical trials may be an option for some patients, particularly those with advanced or recurrent cervical cancer. Clinical trials evaluate new treatments or treatment combinations to improve outcomes for patients with cervical cancer.
Conclusion
Cervical cancer management requires a comprehensive and individualized approach tailored to each patient’s specific needs and circumstances. Close collaboration between patients, caregivers, and healthcare providers is essential to ensure the best possible outcomes.
Timothy Lim Clinic for Women & Cancer Surgery at Mount Alvernia Hospital offers the full spectrum of gynaecologic care for women, from adolescence through menopause, as well as treatment for a variety of gynaecologic problems including gynaecological cancers. We also provide a complete suite of obstetric services, from antenatal care, through to delivery and after delivery care. On top of that, Dr Timothy Lim is a sub-specialist in Gynaecological Cancer management.
