“Ask Dr. HKSH” - Cervical Cancer

Dr. TAM Kar Fai

Specialist in Obstetrics and Gynaecology

Q1. What causes cervical cancer?

Cervical cancer is primarily caused by infection of HPV virus. HPV infection itself is not a sexually transmitted disease, but the virus can spread from one person to another through sexual contact. When the virus persists in the cervix for a long time, it can cause changes in cervical cells, which may eventually develop into cancer. Most cases of cervical cancer are caused by HPV infection. Only a small proportion is not related to HPV infection.

Q2. How can the risk of cervical cancer be reduced?

Since cervical cancer is mostly caused by HPV, it can be prevented in two ways. The first one is to prevent the virus from affecting the body. The existing HPV vaccines can significantly reduce the risk of infection. However, if one misses the optimal time for vaccination and is already infected, the virus may have already caused changes in the body. If cervical cells are affected, they may undergo changes that could lead to cancer. Cervical cancer often develops from "precancerous" changes, which can be detected through regular Pap smears or screening. What can we do if abnormalities are found during screening? Doctor will usually recommend a simple procedure called colposcopy, where a solution is applied to the cervix for examination using a colposcope. The abnormal cells will change in colour, and samples will be extracted for biopsy to assess the extent of changes. While mild changes may resolve on their own without treatment, for severe changes treatment is required to remove the affected tissue and prevent cancer formation. Therefore, women should undergo regular screenings to prevent cervical cancer.

Q3. What are the common symptoms of cervical cancer? How can they be detected early?

Due to the presence of tumour in the cervix, cervical cancer often causes abnormal bleeding. What is abnormal bleeding? In women who are still menstruating, a common symptom of cervical cancer is bleeding outside the normal menstrual period, also known as "inter-menstrual bleeding". Another common symptom is bleeding after sexual intercourse, as contact with tumour during sex may cause bleeding afterwards. These two symptoms are common. No bleeding should occur in women after menopause. If it indeed occurs, one should seek medical attention as it may indicate cervical cancer.  How can the cancer be detected early? Firstly, if symptoms are present, seek medical advice immediately. Any delays could lead to a later-stage cancer diagnosis. Secondly, cervical cancer show no symptoms in some cases, especially in the very early stages. How are these asymptomatic early cases detected? As mentioned earlier, screening can detect the early cases. If cell abnormalities are found during screening, a colposcopy is required to detect asymptomatic early cases.

Q4. How is cervical cancer diagnosed? How is it staged?

When patients seek medical advice, especially those with symptoms, doctor will examine the cervix for any tumours or abnormalities. If a tumour is found, a biopsy is usually performed to take tissue for pathological examination. The pathology report can confirm the diagnosis of cervical cancer. How is cervical cancer staged? Cervical cancer used to be staged solely based on clinical examinations by doctors. Due to changes in staging methods in recent years, doctors can now use different tools like medical imaging and other pathological tests to determine cancer stages, which are crucial to treatment decisions. 

Q5. What are the treatment options for cervical cancer?

Like all cancers, cervical cancer is typically divided into different stages, namely stage 1 to stage 4. Stage 1 is the earliest stage, and stage 4 is the latest stage, in which cancer has often spread to other parts of the body. Most cervical cancers are diagnosed at an early stage, and most stage 1 patients are considered suitable for surgery after evaluation. After surgical removal of tumour, many patients need no further treatment. Some patients may have high-risk factors, and may need follow-up treatments to achieve a cure based on the results of pathology reports. If one is deemed unsuitable for surgery, doctors will often recommend "chemoradiation", the combined use of radiation therapy and chemotherapy, to enhance treatment effectiveness. Treatment plans vary from patient to patient. And one needs to consult a doctor to confirm diagnosis before developing an appropriate treatment plan.

Q6. Am I free of cervical cancer after cervical cancer vaccination?

This is a very important question, as nowadays more and more people are getting vaccinated for cervical cancer, including students through school vaccination programmes. Many people may think that vaccination can prevent cervical cancer once and for all with lifelong protection. But this is not true. The most comprehensive vaccine currently available is the 9-valent vaccine, which protects against 7 high-risk HPV types. This means it can prevent nearly 90% of cervical cancers—but not 100%. A small percentage of cervical cancers are caused by other high-risk HPV types that are not covered by the vaccine. If one has no immunity against those HPV types and becomes infected, there is still a risk of developing cervical cancer. Therefore, even after receiving the most comprehensive cervical cancer vaccine, women still need regular screenings to further reduce the risk of developing cervical cancer.

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