Understanding cervical cancer in young women

Cases of cervical cancer for people aged 49 years or younger are on the rise^1,2. Cervical cancer is the tenth most common cancer in Singaporean women. While cervical cancer can occur in women of all ages, it is more commonly diagnosed in younger women aged between 30 and 49 years old. Cervical cancer is the fifth and sixth most common women’s cancer for 30 to 39 years old and 40 to 49 years old respectively¹. It is very rare for young women under the age of 25 to develop cervical cancer².

Cervical cancer can be effectively treated and cured in its early stages. However, symptoms are unlikely to manifest until the disease becomes advanced⁴. These symptoms are consistent in women of any age, including unusual vaginal bleeding, discharge, painful periods, pain during intercourse and pelvic pain. Despite this, young women may not understand the significance of symptoms, delaying their diagnosis⁵. This is why HPV vaccination and regular screening are so important, where approximately 70% of cervical cancers caused by an infection the human papillomavirus (HPV)¹². Visit here to learn more about Icon Health Screening’s HPV vaccination services.

Treatment for cervical cancer will depend on the type and stage of your cancer, your medical history and your individual treatment preferences.

1. Surgery

There are a number of different surgical options depending on how far the cancer has spread.

• Cone biopsy – a type of surgery used to determine the spread of cancer cells and treat early-stage cervical cancer6. It removes the cone shaped section of the cervix
• Trachelectomy – removes part or all of the cervix and the upper part of the vagina, but leaves the uterus, fallopian tubes and ovaries in place⁷
• Hysterectomy – a common type of surgery where the uterus and cervix is removed^6,7

How will surgery for cervical cancer affect my fertility?

Each surgery will have a different impact on your fertility. Although any cancer treatment can affect fertility, there is less of an effect on early-stage cancer that has not spread outside the cervix. For women hoping to keep their fertility, a cone biopsy only has a small effect on reproductive organs (the cervix, uterus, fallopian tubes, and ovaries). This is because these organs are left in place. On the other hand, a trachelectomy can preserve fertility for young women. However, you may have a higher risk of miscarriage and of having the baby prematurely⁸.

Talk to your oncologist about your treatment options and how they might affect your fertility. You may be able to have treatment for cervical cancer that can preserve your fertility, or your oncologist may refer you to a fertility expert.

2. Radiation therapy

Radiation therapy may be used on its own or after surgery to help destroy any remaining cancer cells. For women with more advanced cervical cancers, it can be used in combination with chemotherapy to make the cancer cells more sensitive to radiation. This is called chemoradiation.

Radiation can be delivered in two main ways – externally and internally⁶.

• External beam radiation therapy – During external beam radiation therapy, radiation beams are delivered externally via a linear accelerator machine to the area of cancer.
• Internal radiation therapy – Internal radiation therapy is known as brachytherapy. During brachytherapy, a radiation source is placed close to the cancer, allowing a high dose of radiation to be delivered to the cancerous cells with a limited impact on healthy tissue. To deliver the radiation dose into the cervix, an applicator will be inserted through the vagina into the uterus or cervix.

3. Systemic therapy

Systemic treatments are delivered through the bloodstream. As a result, they can affect all areas of the body.

• Chemotherapy – Chemotherapy uses anti-cancer drugs to destroy and slow the growth of cervical cancer cells⁶. It is delivered in several sessions over multiple months. This is commonly combined with radiation therapy
• Targeted therapy – Targeted therapy attacks specific proteins and genes in cancer cells. Monoclonal antibodies may be used to block the growth and spread of cancer cells. This is delivered by infusion⁹
• Immunotherapy – Our immune system keeps itself from attacking the body’s normal cells by using “checkpoints” – proteins on immune cells that need to be turned on (or off) to start an immune response. Sometimes, cancer cells hide from the immune system by attaching themselves to checkpoints. Immunotherapy uses checkpoint inhibitors to train the body to identify and destroy cancer cells with these checkpoint proteins

Even after treatment for cervical cancer has finished, there is a chance that the cancer can come back in or near the cervix, or in another part of your body. This is most likely to occur within five years of completing your treatment¹⁰, especially if the cancer was diagnosed at a more advanced stage. As a result, it is very important that you keep any follow-up appointments that your doctor recommends.

Many young women diagnosed with cervical cancer will experience physical, emotional and social changes¹¹. It may affect your family life and work responsibilities or have an impact on your body image and sexual wellbeing.

Through our Young Women’s Cancer Program, our experienced oncologists will help you find the support you need to cope with your diagnosis and treatment, and what to expect after your treatment finishes.