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Cervical Cancer: causes and symptoms

Cervical cancer is cancer that starts at the neck of the womb(cervix), a cylindrical shaped organ that occupies the lowermost part of the womb (uterus) (fig 1)

It is the 10th most common female cancer in Singapore (Singapore Cancer Registry 2010-2014). About 190 new cases are diagnosed every year. It is a preventable and potentially curable cancer as it can be detected easily. Due to the widespread use of the Pap smear test to detect early cervical abnormalities, the incidence of and deaths from cervical cancer have declined steadily over the last decades.

Cervical cancer usually occurs during midlife. Women under 20 are seldom affected. Half of the women diagnosed with the disease are between 35 and 55 years of age and about 20 percent of cases occur in women older than 65. Thus, it is important for women to continue having cervical cancer screening until at least the age of 70.

Pre-invasive cancer often occurs in women in their late 20’s to 30’s. These are termed Cervical Intraepithelial Neoplasia (CIN). Over time, these pre-cancerous lesions can progress and become invasive cancer if left untreated.

Causes and Risk Factors

Almost all cervical cancers are caused by human papillomavirus (HPV), a common virus that is transmitted sexually. Most people with HPV infection do not develop cancer. The infection typically resolves on its own. But if the infection persists, cervical cancer may develop.

Other risk factors include:

· Having early sexual activity before the age of 20

· Having other sexually transmitted infections (STIs) such as chlamydia, syphilis and HIV/AIDS

· Having multiple sexual partners

· Cigarette smoking

· Using birth control pills for a long time (five or more years)

· Having given birth to three or more children

· A weak immune system.

Symptoms and Signs of Cervical Cancer

· Asymptomatic: Pre-cancer and early cancer of the cervix generally do not have symptoms

· Abnormal vaginal bleeding: this can happen o after sexual intercourse (post-coital bleeding), o between menstrual periods (inter-menstrual bleeding) and/or o after menopause (postmenopausal bleeding)

· Watery, thick foul smelling vaginal dischargeIn advanced stages, symptoms may include

· lower back pain

· pelvic pain

· weight loss

· leg swelling

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