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Cancer of cervix : a story

T was devastated when she was diagnosed to have cervical cancer.

T,42, woke up one day and saw red blobs of blood staining the bed sheets. She had had sexual intercourse with her husband the night before.

She was frightened and looked worried when I saw her the next day. “I had been spotting on and off for the past 3 months but had never experienced so much bleeding. Could it be something serious?” she asked anxiously.

A pelvic examination revealed that her cervix (neck of the womb) was totally replaced by a huge ulcer which had extended to the upper part of the vagina (birth passage). The ulcer was oozing with blood.  Biopsy of the ulcer was performed and confirmed that the it was cancerous. Further imaging procedures including MRI and PET scan indicated that the cervical cancer had spread to distant lymph nodes.

Cervical cancer is the 10th most common female cancer in Singapore with about 190 cases diagnosed every year.

It is highly preventable as it is usually slow growing. There is a progression through precancerous changes which usually occur in women in their 20s and 30s. The invasive stage of the cancer appears most often in women who are in their 50s. Cervical cancer is usually associated with human papillomavirus (HPV) infection. Early sexual contact (before age 16), multiple sexual partners, and taking oral contraceptives (birth control pills) increase the risk of cervical cancer. A history of sexually transmitted infections or other co-infections e.g. HIV, and cigarette smoking are additional risk factors. Cervical cancer may have no signs or symptoms in early stage. In later stages, the patient may experience: o             Abnormal vaginal bleeding between periods o             Post-coital bleeding (bleeding after sexual intercourse) o             Post-menopausal bleeding o             Abnormal smelly or bloody vaginal discharge o             Pelvic pain or pain during sexual intercourse o             Kidney failure due to a urinary tract blockage and bowel obstruction, when the cancer is advanced

Cervical cancer is staged depending on its size as well as the degree of spread. It ranges from stage 1 (early) to stage 4 (advanced). Staging is important, as it helps the gynaecologist decide the most appropriate and effective way of treatment.

As T had an advanced stage of cervical cancer, radiotherapy with chemotherapy was the option. She was warned of the side effects of the treatment such as loss of appetite, nausea, vomiting or frequent bowel movements.  She should avoid alcohol and engage in mild physical activity. She should also get enough rest at night. Emotional support from the family and friends would help in alleviating her depression and anxiety. She was in good spirits during her last review. “Doc, I have been redefining my life on what is best for me going forward, ” she said. I was moved by her positive attitude towards this deadly disease. I had been seeing T for follow up for the past 5 years. She remained well with no signs of relapse.

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