Understanding Cervical Cancer

Cervical cancer is one of the most common cancers among women in Hong Kong. Although we often see or hear information about the HPV vaccine in our daily lives, only a small number of women believe they will be infected with HPV or develop cervical cancer, and thus ignore it. In fact, HPV infection is very common; 4 out of 5 women will be infected with HPV in their lifetime. According to data from the Hong Kong Cancer Registry in 2021, the incidence rate of cervical cancer per 100,000 women in Hong Kong is 14.8, and the mortality rate is 4.2. Currently, cervical cancer is preventable. If detected early, the cure rate can be as high as 90%. However, early-stage cervical cancer may have no symptoms, making it difficult for women to detect. Therefore, regular cervical cancer screening helps monitor or detect early-stage cervical cancer, allowing for early treatment, increasing the chances of a cure, and significantly reducing the risk of death from cervical cancer!

Causes of cervical cancer

Cervical cancer is primarily caused by the human papillomavirus (HPV). HPV is a virus that can infect human skin and mucous membrane cells. There are more than 150 types of HPV, which can be further divided into two categories: harmless low-risk HPV and high-risk HPV that can cause cancer or precancerous lesions.

More than 40 high-risk HPV viruses can be transmitted through sexual contact, including vaginal, anal, and oral sex, and can infect human reproductive organs, inducing related cancers. Among them, 13 HPV viruses can cause cervical cancer. Most HPV infections are cleared by the body's immune system, but some persistent infections, even lasting for many years, can cause abnormal changes in cells, eventually developing into cervical cancer.

The following are risk factors that increase the chances of developing cervical cancer:

• Having sexual experience too early
• Excessive frequency of sexual activity and multiple sexual partners
• He had a sexually transmitted disease.
• Long-term use of birth control pills
• Low immunity
• Long-term smoking

Cervical cancer symptoms

Early-stage cervical cancer often presents with no obvious symptoms. If a woman's Pap smear reveals abnormalities in her cervical cells, early treatment of these abnormal cells can prevent them from developing into cervical cancer. If you have cervical cancer, you may experience the following symptoms:

• Similar to menstrual disorders

• Long menstrual period and heavy bleeding
• Abnormal vaginal bleeding, such as between periods, after intercourse, or after a pelvic exam.
• Postmenopausal vaginal bleeding
• Vaginal discharge with an unusual odor
• Pain during sexual intercourse
• pelvic pain

Methods for cervical cancer examination and diagnosis

• Cervical cytology test (Pap Smear): Also known as a Pap smear or cervical smear test, the doctor will insert a speculum into the vagina and use a small wooden stick, brush or plastic brush to gently scrape a sample from the surface of the cervix, which will then be sent to the laboratory for testing to detect abnormal lesions of the cervix.
• Colposcopy: The doctor will insert a speculum forceps into the woman's vagina and apply a special solution to the cervix. Using a special colposcope microscope that can magnify the surface image 10 to 40 times, the doctor can observe whether there are abnormal tissues or cancerous tumors in the cervix, vagina, and vulva. It is suitable for women whose cervical smear test results are positive.
• Pelvic ultrasound scan: This is divided into two types: non-invasive abdominal ultrasound and vaginal ultrasound, which requires inserting an ultrasound probe into the vagina. It is mainly used for women who have been diagnosed with cervical cancer. The doctor will apply gel to the ultrasound probe and place it on the abdomen or vagina. The images obtained after computer analysis of the sound waves help the doctor assess the size, location, extent of spread, and surrounding tissues of the cervical cancer.
• Magnetic resonance imaging (MRI) scan: MRI scans offer high contrast resolution, and patients need to receive a contrast agent injection before the examination. The scan results are primarily used to identify and track the stage of cervical cancer, analyze the myometrium, tumor characteristics, and lymph node metastasis, helping doctors to more accurately understand the condition and develop appropriate treatment strategies.

Cervical cancer treatment

surgery

Cone biopsy, cervicectomy, and hysterectomy are common surgical procedures for treating cervical cancer, and are more suitable for patients with early-stage cervical cancer (i.e., stage 1 to 2), in order to preserve their ovaries as much as possible. Depending on the patient's condition, the doctor may consider removing the uterus, cervix, part of the vaginal tissue, or nearby lymph nodes.

Radiation therapy

Commonly known as electrotherapy, it uses high-energy rays to specifically kill cancer cells. It can be used alone or in conjunction with surgery. It is suitable for patients with stage 1 to stage 2 cervical cancer. Depending on the stage of the patient's cervical cancer, doctors will prescribe external beam radiation therapy or internal beam radiation therapy.

Chemotherapy

Commonly known as chemotherapy, it involves injecting or taking oral anticancer drugs to shrink and interfere with the growth of cancer cells, causing most cervical cancer cells to die. Chemotherapy is often combined with radiotherapy, as the interaction between the two can enhance the effectiveness of radiotherapy, helping patients with recurrent or metastatic cervical cancer to achieve treatment results more quickly.

Targeted therapy

Currently, there are many types of targeted drugs available for treating cervical cancer. These drugs are administered intravenously, and their active ingredients inhibit angiogenesis, block blood supply to cancer cells, and prevent the formation of new blood vessels in the tumor, thereby inhibiting the growth and spread of cancer cells. They are mostly used to treat advanced or recurrent cervical cancer.

Prevention of cervical cancer

Cervical cancer is linked to HPV, so reducing HPV infection can help prevent the risk of developing cervical cancer.

• Regular cervical screening: Scientific evidence has proven that regular cervical screening is an effective way to prevent cervical cancer. All sexually active women aged 25 to 64, even without any symptoms or discomfort, should have regular human papillomavirus (HPV) testing or cervical cytology examinations (Pap smears).
• Human papillomavirus (HPV) vaccination: The HPV vaccine is a preventative vaccine that can prevent cervical cancer and other diseases or cancers caused by high-risk HPV viruses. Various HPV vaccines are currently available, generally suitable for women aged 9 to 45. However, the World Health Organization recommends that girls aged 9 to 14 who are not yet sexually active should be vaccinated first.
• Practice safe sex: Some sexual behaviors increase the risk of HPV infection, indirectly increasing the chance of developing cervical cancer. Avoiding high-risk sexual behaviors, including: not using condoms, starting sexual activity too early, having multiple sexual partners, and having excessively frequent sexual activity, can all reduce the risk of infection.