How Much Do You Know About Cervical Cancer?

In Malaysia, cervical cancer is among the top three most common cancers and the fifth cause of cancer deaths among women. About 2,145 women in the country are diagnosed with cervical cancer and 621 of them die from the disease every year, based on estimates from 2012.

There are over 100 different types of HPV, although not all of them cause health problems. However, HPV types 16, 18, 31, 33, 45, 52 and 58 cause 90% of all cervical cancers. HPV types 52 and 58 are among the most common types found in Malaysian women.

As most Malaysians are social and mobile-centric users who spend most of their time searching for and consuming content online, the National Cancer Society Malaysia (NCSM) together with Merck Sharp & Dohme (Malaysia) Sdn Bhd (MSD) have organised ‘It’s Your Life, Why Take a Chance’ campaign aims to equip women with knowledge on cervical cancer so that they are educated on this preventable cancer. The ‘It’s Your Life, Why Take a Chance’ campaign website and Facebook page have been set up to serve as a resource centre for the public to learn more about cervical cancer.

What is cervical cancer?

• Cervical cancer refers to abnormal cell growth in the lining of the cervix at the lower part of the uterus (womb)¹.
• According to the latest report in 2012, cervical cancer is now the second most common cause of female cancer in Malaysia².
• About six new cases of cervical cancer is diagnosed in Malaysian women every day and nearly two women die from this dreaded and tragic disease every day³.
• The burden of cervical cancer is evident in older females in Malaysia, among the 40-64 age group².
• As cervical cancer takes several years to develop1, prevention of the disease needs to happen before it manifests.

What causes cervical cancer?

• Various strains of the human papillomavirus (HPV), a sexually transmitted infection (STI), play a role in causing most cervical cancer cases⁴.
• One out of two sexually active adults would have been infected once in their lifetime⁵.
• Persistent infection with certain types of HPV can lead to pre-cancerous lesions, which are precursors to cervical cancer. It can take between 15 to 20 years for cervical cancer to develop in women after HPV infection⁶.
• There are more than 40 types of HPV that can infect the genitals or sex organs of women and men⁷.
• HPV types 6 and 11 can cause 90 percent of all genital warts⁸.
• Whereas types 16, 18, 31, 33, 45, 52 and 58 can cause the following cancers and diseases:
• 90 percent of all cervical cancer⁹
• 90-95 percent of all anal cancer¹⁰
• 90 percent of vulvar cancer¹¹
• 90 percent of genital warts¹²
• In Malaysia, types 52 and 58 in particular are amongst the most common HPV types seen in Malaysian females¹³.
• mber of new HPV-related cancer and disease cases in males and females each year worldwide:

What are the signs and symptoms of cervical cancer?

• Symptoms often do not begin until a pre-cancer becomes a true invasive cancer and invades nearby tissue¹¹.
• The most common symptoms include:
• Abnormal vaginal bleeding; such as bleeding after sex, bleeding after menopause, bleeding and spotting between periods, and having longer or heavier (menstrual) periods than usual¹¹.
• An unusual discharge from the vagina – the discharge may contain some blood and may occur between periods or after menopause¹¹.
• Pain during sex (vaginal intercourse)¹¹.

How is cervical cancer diagnosed?

Pap smear (Papanicolaou test)

• The Pap smear is a routine screening test used to find abnormal cell changes of the cervix and to screen for cervical cancer¹⁸.
• Regular Pap smear screening is important in finding and treating the changes in cervical cells before it progresses to cervical cancer¹⁸.

Diagnostic tests

• There are a few tests to confirm a diagnosis of cervical cancer:
• A colposcopy and cervical biopsy to detect whether and where the cancer cells are on the surface of the cervix¹⁸.
• An endocervical biopsy to determine whether there are cancer cells in the cervical canal¹⁸.
• A cone biopsy or loop electrosurgical excision procedure (LEEP) is sometimes recommended to remove cervical tissue for examination under a microscope¹⁸.

How can cervical cancer be treated?

• Treatment choices for cervical cancer may be a single therapy or a combination of therapies, such as the following¹⁹
• Surgery – This is used to remove the cancer. The type of surgery would depend on the location and stage of the cancer, as it will determine a patient’s ability to have children¹⁹.
• Radiation therapy – This is used for certain stages of cancer as it uses high-dose X-rays or implants in the vaginal cavity to kill cancer cells. This method is also often used in combination with surgery¹⁹.
• Chemoradiation – A combination of chemotherapy and radiation. It is often used for the treatment of both early stage and late stage cervical cancer.
• Chemotherapy – This may be used to treat advanced cervical cancer to kill the cancer cells¹⁹.

Can cervical cancer be prevented?

• Cervical cancer may be prevented by:
• Vaccination which can protect against certain HPV infections1.
• Going for Pap smear screening to find and treat pre-cancers before they become true cancers¹.
• Reducing the risk of STI, including HPV²⁰.

References:

¹ American Cancer Society. Cervical Cancer Prevention and Early Detection. What is cervical cancer? http://www.cancer.org/cancer/cervicalcancer/moreinformation/cervicalcancerpreventionandearlydetection/cervical-cancer-prevention-and-early-detection-what-is-cervical-cancer, last accessed on 22nd December 2016.

² ICO HPV Information Centre, Human Papillomavirus And Related Diseases Report, Malaysia, February 26th, 2016. http://www.hpvcentre.net/statistics/reports/MYS.pdf, last accessed on 2nd Dec 2016.

³ The Malaysian Medical Gazette. The Burden of Cervical Cancer and Its Prevention – Dr John Teo. http://www.mmgazette.com/the-burden-of-cervical-cancer-and-its-prevention-dr-john-teo/, last accessed on 22nd December 2016.

⁴ Mayo Clinic. Cervical Cancer. Overview. http://www.mayoclinic.org/diseases-conditions/cervical-cancer/home/ovc-20210887, last accessed on 22nd December 2016.

⁵ Centers for Diseases Control and Prevention. Genital HPV Infection – Fact Sheet. https://www.cdc.gov/std/hpv/stdfact-hpv.htm, last accessed on 22nd December 2016.

⁶ World Health Organisation. Human papillomavirus (HPV) and cervical cancer. http://www.who.int/mediacentre/factsheets/fs380/en/, last accessed on 5th January 2017.

⁷ Centers for Diseases Control and Prevention. Basic Information about HPV and Cancer. https://www.cdc.gov/cancer/hpv/basic_info/, last accessed on 22nd December 2016.

⁸ Garland SM, Steben M, Sings HL, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadfrivalent HPV (types 6, 11, 16, and 18) vaccine. J Infect Dis. 2009;199(6):805-814.

⁹ De Sanjose S, Quint WGV, Alemany L, et al. HPV genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11(11): 1048-1056.

¹⁰ Alemany L, Saunier M, Alvarado-Cabrero I, et al. Human papillomavirus DNA prevalence and type distribution in anal carcinomas worldswide. Int J Cancer. 2015;136(1):98-107.

¹¹ De Sanjose S, Alemany L, Ordi J, et al. Worldwide human papillomavirus genotype attribution in over 2000 cases intraepithelial and invasive lesions of the vulva. Eur J Cancer. 2013;49(16):3450-3461.

¹² Alemany L, Saunier M, Tinoco L, et al. Large contribution of human papillomavirus in vaginal neoplastic lesions: a worldwide study in 597 samples. Eur J Cancer. 2014;50(16):2846-2854.

¹³ Woo, Yin Ling et al. Prevalence of Human Papillomavirus (HPV) infections among Females and males in Malaysia: MyHPV prevalence Study. Asia-Oceania Research Organization in Genital Infection and Neoplasia (2016).

¹⁴ Forman D et al. Vaccine. 2012;30(Suppl 5):F12−23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634690/, last accessed on 12th January 2017.

¹⁵ Executive summary: the state of world health, 1995. World Health Organization website. http://www.hpvcentre.net/statistics/reports/XWX.pdf, last accessed on 12th January 2017

¹⁶ World Health Organization. Report of a technical meeting: the current status of development of prophylactic vaccines against human papillomavirus infection. Geneva, Switzerland: World Health Organization; 1999.Guan P et al. Int J Cancer. 2012;131(10):2349-2359. Accessed Jan 12, 2017

¹⁷ Executive summary: the state of world health, 1995. World Health Organization website. http://www.who.int/whr/1995/media_centre/executive_summary1/en/index3.html, last accessed on 12th January 2017

¹⁸ WebMD. Cervical Cancer – Exams and Tests. http://www.webmd.com/cancer/cervical-cancer/cervical-cancer-exams-and-tests, last accessed on 22nd December 2016.

¹⁹ WebMD. Cervical Cancer – Treatment Overview. http://www.webmd.com/cancer/cervical-cancer/cervical-cancer-treatment-overview, last accessed on 22nd December 2016.

²⁰ WebMD. Cervical Cancer – Prevention. http://www.webmd.com/cancer/cervical-cancer/cervical-cancer-prevention, last accessed on 22nd December 2016

Source: Merck Sharp & Dohme (M) Sdn. Bhd., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

Read also: A Simple Pap Test Helps Prevent Cervical Cancer