Cervical cancer forms in the cells that line the cervix, which is the lower part of the uterus (womb). The cervix connects the body of the uterus to the vagina. Cervical cancer is the third most common cancer in Malaysia and is the easiest gynaecological cancer to prevent with regular pap smear tests, testing for high risk HPV infections, HPV vaccinations and follow-ups.
We recommend getting yourself vaccinated before you are sexually active. *All women who are, or who have been sexually active, between the ages of 20 and 65 years are required to get a pap smear test once every 3 years.
Cervical screening also known as pap smear, checks the health of your cervix.
A Pap test can detect cervical cancer and changes in your cervical cells that may increase your risk of cervical cancer in the future. Every year, 2,145 Malaysian women are diagnosed with cervical cancer. Cervical cancer is common among women in Malaysia and the 2nd most common cancer in women between 15 and 44 years of age.
COMMON CERVICAL CANCER
SQUAMOUS CELL CARCINOMAS:
Squamous cell carcinomas begin in the thin, flat cells that line the bottom of the cervix, or the exocervix. Known as the most common type of cervical cancer, it accounts for 80 to 90 percent of cervical cancers.
Adenocarcinomas develop in the mucus-producing glandular cells that line the upper portion of the cervix, or the endocervix. This type of cancer makes up 10 to 20 percent of cervical cancers and seems to have become more common in the past 20 to 30 years.
- Human papillomavirus (HPV) infection. The most important risk factor for cervical cancer is infection with HPV. HPV is common in populations with multiple sexual partners. Most people are infected with HPV when they become sexually active, and most people clear the virus without problems. There are over 100 different types of HPV. Not all of them are linked to cancer. The HPV types, or strains, that are most frequently associated with cervical cancer are HPV16 and HPV18. Starting to have sex at an earlier age or having multiple sexual partners puts a person at higher risk of being infected with high-risk HPV types.
- Lowered immune systems have a higher risk of developing cervical cancer
- Women who smoke are about twice as likely to develop cervical cancer as women who do not smoke.
- Age. The risk goes up between the late teens and mid-30s.
- Genetics. This is a non-modifiable risk factor
- Unusual vaginal bleeding
- Abnormal vaginal discharge: may contain blood that occurs in between periods or menopause
- Pelvic pain
- Experiencing pain during sexual intercourse
HOW IS PAP SMEAR DONE?
Ideally, cervical screening should be scheduled when the patient is not menstruating.
Avoid vaginal intercourse, douching, use of tampons, use of medicinal vaginal cream or contraceptive cream for 24-48 hrs prior to cervical screening.
During the screening appointment, a small sample of cells will be taken from your cervix.A metal or plastic speculum is placed in the vagina to examine the cervix. Cells from the surface of the cervix and vagina will be collected. A piece of brush, or a small wooden stick is used to gently scrape cells from the cervix and vagina. The cells are viewed under a microscope to find out if they are abnormal. The procedure may cause slight discomfort but should not cause any pain. Mild light bleeding may occur post procedure.
The sample is checked for certain types of human papillomavirus (HPV) that can cause changes to the cells of your cervix. These are called “high risk” types of HPV.
If these types of HPV are not found, you do not need any further tests.
If these types of HPV are found, the sample is then checked for any changes in the cells of your cervix. These can then be treated before they get a chance to turn into cervical cancer.
You’ll get your results, usually in about 1-2 weeks. It will explain what happens next.
MANAGING THE REPORT
Results showing ASC-US (Atypical Squamous Cells of Undetermined Significance)
- Repeat cytology in 12 months
- If repeat cytology is ASC-H, AGC, or HSIL, perform colposcopy; otherwise, repeat cytology in another 12 months
- If repeat cytology at 24 months is negative, resume routine screening; otherwise, perform colposcopy
- Alternative is to perform HPV testing; if positive, repeat cytology in 12 and 24 months as above; if negative, resume routine screening.
Management of women with ASC-H (high-grade squamous intraepithelial lesion)
- Perform colposcopy (regardless of HPV status).
Management of women with LSIL (Low-grade squamous intraepithelial lesion)
- Perform colposcopy
- If HPV co-testing was performed and negative, repeat co-testing in 1 year is preferred
Low risk vs High risk HPV
Low-risk mucosal (genital) HPV types: this type tends to cause warts and rarely cause cancer are called low-risk types. Low-risk genital HPV infection can cause warts (usually resembles cauliflower) on or around the genitals and anus of both men and women. In women, warts may appear in areas that aren’t always noticed, such as the cervix and vagina.
High-risk mucosal (genital) HPV types: these are the types of viruses that are usually linked to cancer thus called high-risk types. These types have been linked to certain cancers in both men and women.
Difference between PAP SMEAR and HPV testing:
A Pap test detects cell changes or abnormal cells in the cervix. These abnormal cells may be pre-cancer or cancer, but they may also be other things, too. Cells are lightly scraped or brushed off the cervix. The Pap test is a very good test for finding cancer cells and cells that might become cancer.
As we all know, HPV is closely linked to cervical cancer. The HPV test checks for the virus, not cell changes. There is an option called co-testing. In this co- testing, Pap smear and HPV testing will be done together. This is by far the most preferred way to find early cervical cancers or pre-cancers in women 30 and older.
Should i get tested?
- Under age 30:
*women between ages 21 and 29 (sexually active females) should have a Pap test every 3 years to test for cervical cancer and pre-cancers. These women should not get the HPV test with the Pap test (co-testing) because HPV is so common in women these ages that it’s not helpful to test for it and also in many cases these HPV infections clear spontaneously in 1-2 yrs. However, HPV testing may be used in this age group after an abnormal Pap test result.
- Woman aged above 30:
*It is recommended that women aged above 30 to have an HPV test along with their Pap test (co-testing) every 5 years to test for cervical cancer. It is still Okay to continue to have Pap tests every 3 years.
(* cited from AMERICAN CANCER SOCIETY)
Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light into the vagina and onto the cervix. A colposcope can greatly enlarge the normal view. This exam allows the health care provider to find problems that cannot be seen by the eye alone.
During colposcopy, the health care provider may see abnormal areas. A biopsy of these areas may be done. During a biopsy, a small piece of tissue is removed from the cervix. The sample is removed with a special device. Cells also may be taken from the canal of the cervix. A special device is used to collect the cells. This is called endocervical curettage (ECC).
You may be referred for a colposcopy within a few weeks of cervical screening if:
- some of the cells in your screening sample are abnormal
- your cervix did not look as healthy as it should during pap smear
- it was not possible to give you a clear result after several screening tests
A colposcopy can also be used to find out the cause of problems such as unusual vaginal or prolonged bleeding.
First step to not being worried is getting tested. Make appointment and clear your doubts!