Cervical Cancer Surgery

Where Is The Cervix?

The cervix is the neck of the womb (uterus) that connects the body of the womb to the birth canal (vagina).

How Does Cervical Cancer Develop?

Most cervical cancers arises in the little cells in the inner lining of the cervix. Cervical cancers take many years to develop. Over a period of time, the cells lining in the cervix may slowly develop pre-cancerous changes and eventually turn into cancer cells if left untreated. The most commonly used term by doctors to describe these pre-cancerous cells is “Cervical Intra-epithelial Neoplasia (CIN)”.

What Are The Signs and Symptoms Of Cervical Cancer?

Common symptoms:

• Vaginal bleeding after sexual intercourse
• Abnormal vaginal bleeding between periods
• Discomfort during sexual intercourse
• Foul vaginal discharge
• Bleeding after menopause

Very rarely, some cervical cancers may not have any symptoms. 

​Who Are At Risk?

Your risk will increase if you:

• Start sexual intercourse at an early age
• Have multiple sexual partners
• Smoke
• Have a history of sexually transmitted disease
• Have HIV infection
• Have persistent high risk types of Human Papillomavirus (HPV) infection
• Have a weakened immune

Pap smear
Pap smear test is commonly used as a screening test to detect pre-cancer changes. In general, women with pre-cancer changes do not have any symptoms. If any abnormalities are detected, further investigations such as colposcopy need to be performed.

Colposcopy
A colposcopy is a simple outpatient procedure done using a colposcope (microscope) to check for any abnormal changes of the cervix. A biopsy may be taken and sent to the laboratory for further evaluation.

What Other Tests Will I Need?

Once cancer is confirmed, further tests may be done to determine the extent of the cancer. These would help your doctor determine which treatment is most suitable for your condition.

• Chest X-ray
• Computed Tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET-CT scan)
• Examination under general anaesthesia. This enables your doctor to thoroughly examine your cervix and vagina so that you will not feel any discomfort. Also, a video scope (cystoscopy) will be used to check the inner lining of your bladder. This allows the doctor to determine the stage of the cancer.

What Are The Different Stages Of Cervical Cancer And Their Treatment?

The stage of a cancer is described by its size and whether it has spread beyond its original site. Knowing the stage and grade of cancer helps your doctor to decide on the most appropriate treatment.

Early Cancer

The cancer cells are localised in a small area of cervix. For early cancer, the treatment options are:

Surgery
The type of surgery will depend on the stage of the cancer.

i. Simple Hysterectomy – removal of the womb and cervix.
ii. Radical Hysterectomy – removal of the womb, cervix, surrounding tissues and draining lymphatics (please refer to brochure on Radical Hysterectomy).
iii. Fertility Sparing Surgery – please discuss with your doctor for more information.

Radiotherapy
Radiotherapy treats cancer by using high energy rays to destroy the cancer cells without harming the normal cells as much as possible. It can be given externally, internally or a combination of the two. Radiotherapy can also be used after surgery if there is high risk of cancer recurring. It can also be used in combination with chemotherapy.

Advanced Cancer
Advanced cervical cancers are cancers that have spread beyond the cervix region. The treatment will involve one of the following:

• Chemotherapy
• Radiotherapy
• Combination of chemotherapy and radiotherapy

Chemotherapy is the use of anti-cancer drugs to destroy cancer cells. It can be used in combination with radiotherapy to improve the effectiveness of the treatment for better cure rates.

Chemotherapy is used to shrink, control and relieve symptoms to prolong good quality life and may also be used if the cancer has spread to other parts of the body or when the disease has recurred after radiotherapy treatment.

What Happens After My Treatment?

It is important to return for follow up with your doctor to ensure that the cancer does not recur. You will need regular check-ups or even scans. This will continue for many years. Do inform your doctor if you have any side effects from the treatment or if you notice any new symptoms.