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Cervical Cancer

Clinical OncologyObstetrics and Gynaecology

Cervical cancer, also known as cancer that occurs in the cervix, is statistically caused by HPV (Human Papillomavirus) infection in over 90% of cases, leading to abnormal cell growth and eventual development of cancer.

Cervical cancer is one of the common cancers among women, and women of all age groups are at risk of developing cervical cancer. In Hong Kong, cervical cancer ranks the 7th most common cancer among women and the 9th leading cause of fatal cancer among women. In 2020, there were a total of 556 new cases recorded, with 159 fatalities.

Cervical Cancer in Women

Generally, cervical cancer in its early stages does not have apparent symptoms, and patients may not notice it promptly. As the cancer progresses to the middle stage, patients may experience symptoms similar to menstrual irregularities, including:

Abnormal vaginal bleeding between menstrual periods, after sexual intercourse, after menstruation, or after gynaecological examinations. This bleeding may be accompanied by prolonged or heavy menstrual flow.
Unusual vaginal discharge with blood and an unpleasant odour.
Pain during sexual intercourse.

When cervical cancer advances to the later stages, symptoms become more pronounced, such as lower abdominal or back pain, difficulty with urination and defecation, blood in the urine and faeces, incontinence, kidney swelling, and swollen legs. However, by the time patients notice these symptoms, they may have missed the optimal window for treatment. It's important to note that these symptoms are not exclusive to cervical cancer, so if a patient suspects it, they should consult a doctor as early as possible.

Factors

The cervix is located at the top of the vagina and in the lower part of the uterus. When the cells inside the cervix continue to be infected by the Human Papillomavirus (HPV), cervical precancerous lesions may develop. Almost 70% of cervical precancerous lesions are caused by HPV-16 and HPV-18. Although these cells are not cancerous, they could potentially progress into cancerous cells if left unattended. When the HPV virus continually attacks the cells inside the cervix, it may lead to cell mutations, triggering cervical intraepithelial neoplasia (CIN). CIN is divided into three stages based on how much the cervical epithelium is affected. If a patient reaches the third stage without appropriate treatment, it could develop into cervical cancer.

The HPV virus of the genital area is primarily transmitted through sexual contact, which can lurk in the cervix, vagina, penis, anus, and even in the mouth and throat.

Risk Factors

Women who meet the following conditions are more likely to have a higher risk of developing cervical cancer compared to others:

Infection with HPV types 16 and 18.
Early onset of sexual activity, frequent sexual intercourse, or having multiple sexual partners.
Previous history of sexually transmitted infections.
Long-term use of oral contraceptives for 5 years or more.
Giving birth three times or more, particularly at a younger age during the first pregnancy.
Weakened immune system, such as having chronic kidney disease, AIDS, and so on.
Smoking habit.

Diagnosis and Treaments

Diagnostic Methods

Paps Smear Test	Involves collecting cervical cell samples from vaginal secretions. After staining the smear, suspicious cancer cells can be identified under a microscope.
Transvaginal Ultrasound	Doctors use a scanning device that is moved across the patient's skin. The sound waves emitted by the scanner are analyzed by a computer and converted into images.
CT Scan	Doctors inject a contrast agent intravenously and take X-ray images of the pelvic area from various angles. These images are then synthesized by a computer to observe the extent of cancer cell influence.
MRI	Similar to a CT scan, this method uses magnetic fields to create clear cross-sectional images of the body.
Colposcopy	Colposcopy employs a microscope that magnifies the cervix using light, allowing the doctor to observe changes in cervical epithelium and blood vessels. Suspicious lesion tissues are also extracted for examination to diagnose any abnormal changes.

Through the various examinations mentioned above, doctors have a more precise understanding of the patient's condition and will determine the stage of cervical cancer.

Stage	Extent of Spread
Stage I	Cancer cells have invaded the submucosal tissues, but the tumor remains in the cervix.
Stage II	Cancer cells have extended to nearby tissues beside the cervix or the upper part of the vagina.
Stage III	Cancer cells have spread to the sides of the pelvic region or have extended into the lower third of the vagina.
Stage IV	Cancer cells have metastasized to other significant organs in the body, such as the lungs, colon, or bladder.

Treatment

Total or Partial Hysterectomy	A total or partial hysterectomy is generally suitable for patients with stage I and some stage II cervical cancer, with no signs of tumour spread. The surgery is performed under general anaesthesia. During the procedure, the doctor removes part or all of the uterus, cervix, the upper part of the vagina, and pelvic lymph nodes to obliterate the cervical tumour.
Radiation Therapy	Radiation therapy uses radiation to kill cancer cells and control tumours. Radiation therapy is primarily suitable for some stage I and II patients and can be combined with surgery. Some patients may not be eligible for surgery due to their physical condition, and radiation therapy is an alternative. It also applies to controlling and shrinking tumours for later-stage or metastatic cervical cancer.
Chemotherapy	Chemotherapy, often abbreviated as chemo, involves the intravenous administration of anticancer drugs to kill cancer cells. Chemotherapy can be used as an adjuvant therapy with radiation or surgery to reduce the risk of recurrence. It is also used to treat patients with more advanced stages of metastatic cervical cancer.
Targeted Therapy	Targeted therapy involves monoclonal antibodies that help inhibit angiogenesis, blocking the formation of new blood vessels in tumours. This prevents tumour tissue from acquiring the necessary blood, oxygen, and nutrients, inhibiting cancer cell growth.
Immunotherapy	In recent years, there have been significant breakthroughs in treating recurrent and metastatic cervical cancer using immunotherapy. The core principle of immunotherapy is using immune checkpoint inhibitors designed explicitly for cancer cells. These inhibitors awaken T cells in the body previously suppressed by the tumour, and trained T cells can more effectively identify and eliminate tumour cells infected with Human Papillomavirus (HPV). Studies have found that cervical cancer cells induced by HPV infection typically exhibit higher expression levels of the immune checkpoint (PD-L1). As a result, cervical cancer has become one of the cancers where immunotherapy can demonstrate its strengths.

Prevention

The World Health Organization (WHO) has stated that cervical cancer is currently the only cancer that can potentially be eliminated.

In 2020, WHO launched a global strategy to eliminate cervical cancer, emphasizing the importance of preventing HPV. It also urged countries to ensure that at least 90% of eligible girls are vaccinated against HPV before the age of 15 by 2030.

HPV has been confirmed as one of the leading causes of cervical cancer, especially high-risk subtypes like HPV-16 and HPV-18, which are closely associated with the risk of cervical cancer. When we receive the HPV vaccine, our immune system begins to produce antibodies to combat HPV, reducing the risk of infection and lowering the risk of developing cervical cancer. Therefore, the HPV vaccine plays a crucial role in preventing cervical cancer.

Details of HPV Vaccine