Cervical Cancer

Cervical Cancer is the only preventable gynaecological cancer. 

Primary prevention (cervical cancer vaccines)

• Ccurrently, vaccines available can reduce the risk of cervical cancer by up to 90%.
• While most women are eligible for vaccination, effectiveness may vary depending on individual circumstances.
• It is important to thoroughly understand the available vaccines and their benefits before proceeding with vaccination. 
   

Secondary prevention (cervical cytology screening

• Cervical cytology screening, commonly known as the Pap smear, remains the most effective method for preventing cervical cancer.
• This test involves collecting cervical cells by a gynaecological examination.
• The collected cells are then carefully examined under a microscope to detect any abnormalities.
• If the screening reveals unusual results, patients may be referred for a colposcopy, a more detailed examination of the cervix and vagina.
• If pre-malignant lesions are identified during this process, they can be surgically removed, significantly reducing the risk of cervical cancer development.

Diagnosis

• Cervical cancer often manifests through abnormal vaginal bleeding, which may include irregular menstruation or bleeding after sexual intercourse. In some cases, the only noticeable symptom is an unusual vaginal discharge. 
• Diagnosis of cervical cancer typically involves a biopsy of suspicious cervical lesions, with confirmation through histological examination. 

Some patients with microinvasive cervical cancer, however, rarely experience symptoms. These early-stage cases are usually detected through routine cervical smears that reveal abnormalities, prompting further investigation via colposcopy examination and biopsy.

Assessment

• After confirming a cervical cancer diagnosis, patients undergo clinical staging.
• For those eligible for surgical treatment, MRI or PET/CT scans are required for ruling out involvement of surrounding structures and distant metastases. This is vital because surgical treatment is typically not performed if the disease has spread beyond the cervix.
• Patients ineligible for surgery usually undergo radiotherapy or chemoradiation, necessitating an assessment of their general fitness for treatment.
• Basic investigations, including tumour marker levels, should be conducted for all patients.

• Stage 1a1, the earliest stage, can be treated with a simple hysterectomy or local excision procedures such as a large loop excision of the transformation zone or cone biopsy, depending on individual circumstances.
• For stage 1b1 and early 2a1 diseases, a radical hysterectomy with bilateral pelvic lymph node dissection is necessary. Many of these operations can be performed laparoscopically, often with robotic assistance using systems like the da Vinci Surgical System.
• Locally advanced diseases typically require chemoradiation or radiotherapy.
• In cases where the disease has metastasised beyond the pelvis, chemotherapy may be the primary treatment option.

After completion of treatment, patients should be followed up regularly to 

• Deal with the side-effects and complications arising from the treatment
• Monitor the disease status 

Side-effects and Complications from Treatment 

• Extensive operation involves the removal of and insults to normal structures, e.g. lower limb oedema after pelvic lymphadenectomy
• Chemotherapy side-effects can be long-lasting, e.g. numbness over extremities after chemotherapy using platinum agents
• Patients who have received radiotherapy can also develop post-treatment complications 

Monitoring of Disease Status 

• Physical examination
• Vaginal cytology
• Blood test for tumour markers
• Repeated imaging studies if necessary. It helps pick up recurrent diseases