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Cancer Information

Cervical Cancer

Cervical Cancer

Cervical cancer is cancer of the entrance to the uterus or womb. It starts when abnormal cells grow out of control in the transformation zone (the area where squamous cells and glandular cells meet).

The cells do not suddenly transform into cancer; the normal cells in the cervix slowly change, which then turn it into cancer instead.


Long before there is cancerous growth on the cervix, the cells of the cervix undergo changes that will eventually lead to cancer. These changes in the cells of the cervix are known as cervical dysplastic changes or cervical pre-cancer. Slowly and over time the abnormal and dysplastic cells increase in number and take over more and more normal tissue. Eventually when the dysplastic cells breach an important tissue layer, the basement membrane, the dysplastic growth has formally become a cancer.

During the pre-cancerous phase of dysplastic change, there are no noticeable symptoms, and the only reliable way to detect these pre-cancerous changes is to have a series of pap smear tests. This is the main reason to recommend having regular pap smear tests. The other reason regular pap smear tests work is that the pre-cancerous phase of change in the cervix extends over a significant period of time. In some studies, it has been estimated that it could take up to 10 years from the time the first pre-cancerous cell appears to the time that there is cancer on the cervix.

The HPV vaccination works because the Human Papillomavirus is a key element in the development of cervical cancer. HPV is what is known as a DNA virus and although there are over 200 different subtypes, only a small handful are known as “high risk” HPV. They are known as “high risk” because if a woman is infected for a long time with a “high risk” HPV subtype it significantly increases the likelihood of her developing cervical cancer.  There is a growing body of evidence that suggests that women who have never been exposed to HPV and who are vaccinated against it, have a much lower likelihood of ever developing cervical pre-cancer or cancer. HPV vaccines have been around for a sufficiently long time and with almost 200 million doses delivered worldwide, the World Health Organization has declared that the vaccine is safe and that all eligible women should consider vaccination. The HPV vaccination is also part of national vaccination programs for school children in countries such as Australia and Great Britain.

It is important at this point to emphasise that HPV infection is very common, almost like catching the common cold in humans, and that cervical cancer develops only in a very small percentage of the total number of HPV infections. The vast majority of women who are infected with HPV clear it effectively.  The problem is that there is no effective way to know which women will effectively clear high-risk HPV and which won’t and among those that don’t clear the viral infection, which will go on to develop cervical cancer.  That is why doctors recommend vaccination for EVERYBODY that is eligible.

With minimal effort, you can prevent cervical cancer effectively by getting your HPV vaccine and getting regular pap smear tests. ​


  • Women over the age of 30 (The risk is strongly related to age, with higher incidence in younger women)
  • People who smoke
  • Those who have human papilloma virus (HPV) infection
  • Women who use birth control pills for about five or more years
  • Women who gave birth to three or more children
  • Women who have had several sexual partners


*People who think they may be at risk should discuss this with their doctor.

Cervical cancer may be associated with the following symptoms:


  • Abnormal vaginal bleeding (e.g. bleeding after sex, after menopause, in between periods, etc.)
  • Pain during sex
  • Unusual vaginal discharge (may contain some blood)
  • Pain in the lower belly
  • Longer and heavier menstrual bleeding


*A doctor should be consulted if the symptoms above occur.​​ 

There are two ways to prevent cervical cancer:


  • Practise safe sex
  • Avoid smoking
  • Get a HPV vaccine
  • Have regular cervical screenings and pap smear


A pap smear test is a simple procedure where cells are collected from the surface of the cervix and then sent to a laboratory to detect any abnormality. All sexually active women between 25 and 69 years old are advised to have a pap smear test regularly (every 3 years on average).

The first step in finding out if you have cervical cancer, as doctors suggest, is through a pap test. During the test, the doctor gently scrapes the outside of the vagina and cervix to take samples of cells. The cells will then be taken to the laboratory for testing.

Other than a pap test, here are some other ways cervical cancer is diagnosed.


If you have certain symptoms suggesting cancer, your doctor may recommend a colposcopy. During the procedure, a speculum will be placed inside the vagina and use a colposcope to examine the cervix. The doctor will then apply a weak solution of acetic acid to the cervix to see any abnormal areas easily.

Cone Biopsy

During a biopsy, some tissue in the cervix will be removed for examination under a microscope. Other tests can only suggest cancer, but only a biopsy can give a clear-cut answer.

Depending on the stage of the cervical cancer, there are various treatment options available. Here are the main types of treatment.


During a surgery, a surgical oncologist will remove the tumour and surrounding tissue. There are three main types of surgery for cervical cancer: (1) Radical trachelectomy, (2) Hysterectomy, and (3) Pelvic exenteration.

Radiation Therapy​

Radiation therapy uses a high-dose of X-ray in the vagina to destroy the cancer cells. This type of therapy may be given alone, before surgery, or instead of surgery to shrink the tumour. Radiation therapy is particularly used for certain stages of cervical cancer.


Chemotherapy uses medicines to kill cancer cells. It may be used to treat advanced cervical cancer. Chemotherapy may be combined with radiotherapy to cure cervical cancer, or it can be used as the only treatment for advanced cervical cancer.

Cancer is a complex condition and knowledge about cancer and cancer treatment is constantly changing and getting more sophisticated to deliver ever better patient outcomes. The very best cancer care is therefore best delivered by a team of professionals, with each member of the team being an expert in their own field and working TOGETHER to take care of the whole person.

At the NCIS, we believe that when we treat the WHOLE PERSON, a WHOLE PERSON walks out our doors. This is the philosophy and thinking that lies at the heart of our Whole Person Approach to Cervical Cancer Care at the NCIS.

How the NCIS Helps Keep You and Your Loved Ones Safe from Cervical Cancer

If you have been having regular pap smear tests, it does not mean that you have cancer if you get an “abnormal” pap smear test result. The pap smear is known as a screening test which means that it is a “positive” or “abnormal” result just means that there needs to be confirmation of whether disease is present or not. This confirmation in cervical cancer screening comes in the form of a colposcopic examination, often known simply as “colpo” or “colposcopy”. At the NCIS, our Cervical Cancer Care Team specialists are all well-equipped with a wealth of experience in diagnosing cervical cancer and pre-cancer through careful colposcopic examination and biopsy.

A colposcopic examination is exactly like having a pap smear test done except that cervix is examined under a strong light through a magnified scope from outside the body. This allows the cervix to be examined for areas that may appear to be the source of the abnormal cells that were picked up on the pap smear. If there is an area that is suspicious for pre-cancerous or cancerous change, a small portion of these abnormal areas on the cervix may be collected in a procedure known as a punch biopsy. If you do undergo this procedure, you may expect some momentary discomfort and vaginal spotting for a day or so after the procedure. The tissue that is collected is important and sent to the lab for examination under a microscope to determine the extent of pre-cancerous change.

If the biopsy result shows that there is indeed an area of pre-cancer on the cervix, your specialist may recommend a simple office procedure to arrest or stop the pre-cancerous change from worsening and eventually becoming cancer. These simple office procedures can either be ablative, which means that abnormal areas on the cervix are destroyed, or excision, which means that the abnormal areas are separated from the normal cervix by fine cutting or excision. Office procedures are simple, effective and do not require anesthesia or hospitalization.

Here are some commonly performed office procedures at the NCIS for cervical pre-cancer, and what to expect after each procedure.

Cold Coagulation

This procedure is actually hot. A special instrument known as a cold coagulator is placed in contact with the abnormal area of the cervix and delivers heat to the abnormal area coagulating any abnormal tissue which then slowly sloughs off over the next few days and is eventually replaced by healthy tissue. Women who have cold coagulation can expect some crampy discomfort during the procedure which lasts about 2 minutes. There may be watery or mucoid discharge over the next 7-10 days accompanied by some spotting or bleeding as the cervix heals.

Loop Electro-Excision Procedure (LEEP)

The Loop Electro-Excision Procedure (LEEP) is a procedure where a high-energy loop or wire device is used to cleanly and bloodlessly remove a portion of the cervix that is diseased or unhealthy, leaving behind only healthy tissue. This is a very effective way to treat pre-cancer of the cervix and also provide tissue that can be further analysed by an NCIS specialist pathologist in the lab to better understand exactly what kind of pre-cancerous change in taking place in the cervix. The entire procedure takes 3-5 minutes and most of the women who undergo the procedure at the NCIS report little or no pain during the procedure.

Some spotting and light menses-like bleeding usually starts 2-3 days after the procedure and is part of the normal healing process after a LEEP. Women who have the LEEP at the NCIS can also expect some brown or black discharge after the procedure as a solution known as Monsell's solution is typically applied to the cervix to prevent bleeding and promote healing after the procedure.

Laser Ablation

A carbon-dioxide laser produces enough energy to completely vaporize any pre-cancerous changes on the cervix. Laser vaporization is a very effective way to completely treat pre-cancerous changes of the cervix. The laser allows precise treatment of the pre-cancerous areas of the cervix without affecting the normal tissue of the cervix. Laser ablation typically takes about 3-5 minutes to complete and is a procedure offered at the NCIS that most women are able to undergo without too much discomfort.

The Cervical Cancer Journey @ the NCIS

The women we care for may have ovarian cancer, but the disease is only one part of a whole person who is a living, breathing and feeling entity. At the NCIS, we believe in not only treating cancer but making people whole after their time with us, and this starts with having a team of dedicated healthcare professionals support each and every aspect of the whole person as we journey with our patients through diagnosis, treatment, recovery and beyond.

The Women’s Emotional Health Service (WEHS)

This team of emotional health specialists are an important component of the ovarian cancer care solution. Quite simply, a fit emotional state ensures a healthy immune system that fights cancer more effectively. Effective emotional assessment and support is a complex, constantly evolving process and something the Women’s Emotional Health team does exceptionally well, supporting a growing community of healthy, happy ovarian cancer survivors, one woman at a time. Our patients are supported through a combination of CARE therapy, hypnotherapy and medical therapeutics. At the NCIS, we are proud of the important work that our WEHS team does, and our cancer survivors agree!

The Total Lymphoedema Team

Lymphoedema is a complex and potentially debilitating condition that develops as a result of cancer surgery and therapy in some patients. At the NCIS, we believe that the best treatment is prevention! This belief is embodied in the creation of the Total Lymphoedema Clinic (TLC) to support all the women living with cancer that we care for at the NCIS who may be at risk for lymphoedema. The team at the TLC consists of surgeons, physicians, physiotherapists, nurses and occupational therapists who are all committed to one thing, helping our patients come out of ovarian cancer care WHOLE and functional with sub-specialty professionalism and a little Tender Loving Care.

Advanced Practice and Specialty Nursing

At the NCIS, we love our nurses for one very simple reason. Our Advanced Practice and Specialty nurses translate all the expertise available at NUH in to the care that our patients receive. The women living with ovarian cancer that walk in our doors walk out whole because of the dedication and professionalism that these cancer professionals show all day, every day. Effective cancer care is an incredibly complex process which our Advanced Practice and Specialty nursing team has the training, education and expertise to understand, coordinate and help deliver to the women receiving care for ovarian cancer at the NCIS. It’s no wonder that the NCIS cancer survivors hug a cancer specialty nurse wherever they meet one!

Radiation Oncology Team

This team of dedicated professionals is behind the NCIS' success in treating advanced stage cervical cancer. The use of ionizing radiation in the battle against cervical cancer is constantly evolving. The treatments offered to patients today would have been unimaginable till quite recently. An important example of this evolution in radiation therapy is the use of High-Dose Rate or HDR brachytherapy for cervical cancer. Treatments that traditionally required patients to be bed bound for two days can now be completed in less than half an hour. What this means for the women we care for at the NCIS is much less time in hospital, not allowing cervical cancer to interrupt the business of living full productive lives.