Cervical Cancer: 17 Most Asked Questions and Answers in 2016

With Dr Zaharuddin Rahmat @ Mohd.Rawi

By MyDoc Care Team

Cancer is a leading cause of death worldwide, accounting for 8.2 million deaths in 2012. Cervical cancer is one of them. In Malaysia, It is the 3rd most common cancer, accounting for 11% of all cancers in women. Over 1100 women are diagnosed with cervical cancer each year. Risk of cervical cancer increases after 30 years old and peaks at ages 60–69 years old. While in Indonesia, cervical cancer is second rank after breast cancer. Every year there are around 15,000 new cases of cervical cancer in Indonesia. WHO placing Indonesia as the country with the highest number of cervical cancer in the world. Cervical cancer is also ranked first killer of women in Indonesia.

As of March 8th is the International Women’s Day (IWD), our team has started a survey and research across 5000+ citizens in Malaysia for the topic of “what do you want to ask about cervical cancer?” back in January. We have then started a discussion about cervical cancer with a woman cancer expert, Dr Zaharuddin Rahmat @ Mohd.Rawi – Consultant Obstetrician, Gynaecologist and GynaeOncologist. Dr Zaharuddin is currently practicing at KL Gynaecologist @ Gleneagles Medini Hospital, Johor, Malaysia.

The following are the list of most asked questions and answer of cervical cancer in 2016, together with the number of “ask”.

1. what’s cervical cancer? (200 ask)

The cervix is the lower part of the uterus which extends slightly into the top of vagina. It is also called as the neck of the womb (uterus). It is covered by a thin layer of tissue made of cells. Healthy cells grow, divide and replaced as needed. Cancer of the cervix happens when these cells change, grow out of control rapidly into deeper layers or spread to other organs. The cancer cells form a mass of tissue called a cancerous (malignant) tumour.

2. Is cervical cancer hereditary? (1000 ask)

Cervical cancer is not hereditary. The main cause of cervical cancer is persistent infection of the cervix by ‘high-risk’ Human Papilloma Virus (hrHPV). HrHPV is common viruses that are passed from one person to another during sexual intercourse. At least half of sexually active people will have HPV at some point in their lives but only few women will get cervical cancer. About 9 out of 10 hrHPV infection will be cleared completely within 2 years. This means that most women who are infected with these hrHPV do not develop cancer. Only a small group of women have persistent hrHPV infection. This infection may cause abnormal cells of the cervix. If these cells are left untreated, they will be cancerous in future.

As this hrHPV is sexually transmitted, cervical cancer is not a hereditary disease.

3. is cervical cancer curable? (880 ask)

Cervical cancer progresses slow. Starting from hrHPV infection on the cervix then it develops into abnormal cells. Small percentage of untreated abnormal cells will become a cancerous tumour. This process takes years to progress to a cancerous tumour.

Regular Pap smear will detects abnormal cells before it becomes a cancer. Abnormal cells and tissues can be treated by simple procedure such as colposcopy and large loop excision of the cervix (LLETZ). This procedure will completely remove abnormal tissue before becoming cancer. If the cancer is only confined to the cervix, surgical operation such as Wertheim’s hysterectomy will remove the cancerous tumour completely.

Early stage of cervical cancer is curable if treated appropriately by trained GynaeOncologists. However, the patients still need to have follow up for surveillance.

4. can cervical cancer spread? if yes.. where does cervical cancer spread? curable… ? (600 ask)

Cervical cancer can spread to surrounding organs and to other parts of body (metastasis). A cancerous tumour is a lump of tissue made up from cancer cells which continue to multiply rapidly and out of control. These tumours invade into nearby tissues and organs, which can cause damage. These tumours may also spread to other parts of the body if some cancer cells break off from the origin (primary) tumour and are carried in the bloodstream of lymph channels to other parts of the body such as urinary bladder, large bowel, lungs, liver and spine. These small groups of cells may then multiple to form other tumours (secondary/ metastases) in one or more parts of the body. These secondary tumours may then grow, invade and damage nearby tissues and spread again.

Advanced cervical cancer with widespread disease is very hard to treat and is not curable. The aim of this advanced disease to control the disease, to make the patients have comfortable life with minimal pain and symptoms.

5. is cervical cancer considered deadly? (400 ask)

Early cervical cancer can be treated and the disease is completely removed by appropriate surgery/treatment. The patients can live like other people and risk of recurrence disease is relatively very low.

However advanced cervical cancer with widespread disease is not curable and the outcome (prognosis) is very poor.

6. is cervical cancer contagious? (320 ask)

Cervical cancer itself is not contagious – it cannot be spread form a patient to others. Only hrHPV is contagious and can be spread via sexual intercourse.

7. what causes cervical cancer besides hpv? (300 ask)

Persistent infection of the cervix by hrHPV is the main cause of cervical cancer. However, the risk of a rare form of cervical cancer (and vaginal cancer) is increased in women whose mothers used used medication diethylstilbestrol (DES) while pregnant with the women. This hormone were given to some women who had previous miscarriage but this drug is not popular now in practice.

The following risk factors are thought to increase risk of developing cervical cancer when women have also been exposed to hrHPV:

  • Skipping Pap smear or never had Pap smear test. Women who do not have regular Pap tests are more likely to develop cervical cancer, since Pap tests allow doctors to detect and remove abnormal cervical cells before they become cervical cancer.
  • Smoking cigarettes. Women who smoke are associated with persistent hrHPV infection because their immunity are unable to eradicate hrHPV.
  • Decreased immunity. Women who have conditions that weaken their immune system, such as HIV infection, chronic illnesses especially on immunosuppressive drugs such as renal transplant patients and diabetic mellitus may be at increased risk of developing cervical cancer.
  • Sexually transmitted diseases (STDs). Women who had contracted with STDs are also at high risk to get hrHPV infections.
  • Having more than four children. Women who have five or more children may have a slightly elevated risk of developing cervical cancer. This is because it is associated with recurrent trauma of the cervix during vaginal deliveries and increased risk of persistent hrHPV infections.

8. what does cervical cancer feel like? does cervical cancer hurt/cause pain? (700 ask)

Early cervical cancer may not cause signs and symptoms. Cervical cancer usually presented as abnormal vaginal bleeding, spotting or watery discharge. Menses may be heavier than usual, irregular and bleeding after sexual intercourse. Symptoms of advanced disease include pelvic pain, problems urinating, bloody urine and swollen legs. This is because the cancer has spread to nearby organs and the cancer tumours can affect how those organs work.

9. do i have cervical cancer? can I do self-check to prevent? how? (250 ask)

Please see answer no.7

10. does cervical cancer smell? (200 ask)

Early cervical cancer has no symptom such as smell or bleeding. However, when a cervical tumour becomes infected, there will be foul-smelly or blood-stained vaginal discharge.

11. is cervical cancer sexually transmitted? (140 ask)

Cervical cancer itself is not contagious – it cannot be spread form a patient to others. Only hrHPV is contagious and can be spread via sexual intercourse.

12. can cervical cancer come back? (110 ask)

As any other cancers, cervical cancer can come back especially advanced stage of disease on the first diagnosis. After completion of initial treatment of cervical cancer, patients are advised to have regular follow as planned such as follow up every 3 months for the first 2 years of completion treatment, then follow up every 6 months for the next 2 years and if no evidence of recurrence during first 5 years, patients will have yearly follow up. During these follow up visit, gyneoncologists will look for symptoms and signs of recurrence disease. Vaginal examination including vault smear ( like Pap smear) on the top of the vagina.

13. is cervical cancer preventable? (70 ask)

Cervical cancer is preventable. Women can prevent the disease by;

  • Get the HPV vaccination. It protects against the types of HPV that most often cause cervical, vaginal and vulvar cancers. It is given in a series of 3 injections. The vaccine can be given to girls beginning at age 9.
  • Do Pap smear regularly to find pre-cancerous cervical cells.
  • Follow up with the doctor as scheduled if Pap smear results are not normal. Abnormal cells, if left untreated will become cancerous in future.
  • Do not smoke because smoking is associated with persistent HPV infection which cause abnormal cells.
  • Practice safe sex by using condoms and having fewer/limited sexual partners may reduce risk of cervical cancer.

14. can cervical cancer develop in a year? (30 ask)

Cervical cancer usually takes several years to develop. The early cervical cell changes become abnormal occur before cancer is present. These changes are called cervical intraepithelial neoplasia (CIN) or dysplasia. If these changes left untreated for years, these cells become cancerous cells after a few years.

15. does cervical cancer spread fast? (30 ask)

Once a patient has cervical cancer, the disease initially will spread to surrounding organs such as uterus, tissue surrounding uterus (parametrium), ureters, urinary bladder and rectum. The cancer can spread to distant part of body such as lungs, spine and liver. This process takes months to years.

After completion of primary treatment of cervical cancer (radical surgery with or without chemotherapy/radiotherapy), the patient is advised to have follow up as schedule to detect early recurrent of the disease.

16. can cervical cancer cause infertility? (170 ask)

Treatment for cervical cancer involves hysterectomy with or without chemotherapy/radiation therapy. Hysterectomy means removal of the uterus. Both hysterectomy and radiation therapy cause the patients are unable to get pregnant.

However, early stage of cervical cancer (e.g. stage 1A), surgery may involves only the cervix (with surrounding tissue) and upper part of the vagina. This procedure is called radical trachelectomy. Decision for this surgery usually reserved for young patients who have not completed family.

17. can cervical cancer stop your period? (110 ask)

Symptoms of cervical cancer are irregular menses, postcoital bleeding and prolonged menses. Treatment of cervical cancer can stop menses because the uterus will be removed and radiation therapy can cause ovaries stop working (menopause).

If the treatment is only radical trachelectomy, the uterus is preserved and the patient can have regular menses as usual.


Dr Zaharuddin Rahmat @ Mohd.Rawi completed his undergraduate (MBBS) and post-graduate studies, Master in Obstetrics & Gynaecology (MObGyn) University of Malaya in 1998 & 2006 respectively. He obtained his ‘Member of Royal College of Obstetricians & Gynaecologists’ (MRCOG) London in 2007. He is a certified Colposcopist (diagnosis & therapeutic) from the British Society for Colposcopy & Cervical Pathology (BSCCP/RCOG) UK and a certified GynaeOncologist, CGO from Ministry of Health, Malaysia (Certificate of Completion for Fellowship (Subspeciality) Training in GynaeOncology ,CCST). Dr Zaharuddin is currently a council member of the Malaysian Gynaecological Cancer Society, MGCS and a visiting lecturer at Newcastle University Medicine Malaysia. He currently practices at KL Gynaecologist @ Gleneagles Medini, Johor Bahru, Malaysia.

Source: MyDoc.asia | 7 March 2016


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