Know yourself, know your enemy, and you will never be defeated
The medical community frequently urges the public to get vaccinated to reduce the risk of cervical cancer and has even invited well-known celebrities like Charlene Choi, G.E.M., and Gigi Leung to promote vaccination. It’s not uncommon to see related advertisements on the streets. How common is cervical cancer in Hong Kong? Who is more likely to develop cervical cancer? And if someone is unfortunately diagnosed with cervical cancer, how should it be treated?
Fatal Cancers Among Women in Hong Kong
In 2022, cervical cancer ranked as the 9th most common cancer among women in Hong Kong, accounting for 2.9% of all new cancer cases in females. There were 522 new cases of cervical cancer in 2022. The crude incidence rate per 100,000 female population was 13.1, while the age-standardized incidence rate per 100,000 standard population was 7.8.
Cervical cancer was the 9th most fatal cancer among women in Hong Kong. In 2023, a total of 173 women died from this cancer, accounting for 2.7% of all female cancer deaths. The crude mortality rate per 100,000 female population was 4.2, while the age-standardized mortality rate per 100,000 standard population was 2.1. The age-standardized incidence rate of cervical cancer has shown a declining trend over the past 40 years, but an upward trend over the past 10 years.
Seeking Medical Attention Early
Generally, early-stage cervical cancer does not show obvious symptoms, making it difficult for patients to detect promptly. As the cancer progresses to the intermediate stage, patients may begin to experience symptoms similar to menstrual irregularities, including:
When cervical cancer advances to later stages, symptoms become more pronounced, such as pain in the lower abdomen or back, difficulty urinating or defecating, blood in urine or stool, incontinence, hydronephrosis, or leg swelling. However, by the time these symptoms appear, the optimal window for treatment may have already passed. It is important to note that these symptoms are not exclusive to cervical cancer, so women experiencing potential signs of cervical cancer should consult a doctor as soon as possible.
Human Papillomavirus (HPV)
Around 70% of cervical cancer cases are caused by human papillomavirus (HPV), specifically types 16 and 18. Genital HPV is primarily transmitted through sexual contact and can remain dormant in areas such as the cervix, vagina, penis, anus, mouth, and throat. Usually, there are no symptoms, and the body’s immune system can clear the virus.
However, when cervical cells are persistently infected with HPV, it may lead to cellular changes, resulting in cervical intraepithelial neoplasia (CIN). CIN is classified into three stages based on the thickness of the cervical epithelium affected by abnormal cells. If left untreated by the third stage, it may progress to cervical cancer.
Regular Screening
Women who meet the following criteria have a higher risk of developing cervical cancer:
To prevent cervical cancer, women should practice safe sex, such as using condoms, to reduce the risk of sexually transmitted infections.
Additionally, regular cervical screening is essential. During the test, a healthcare professional inserts a speculum into the vagina to examine the cervix. A small brush or spatula is then used to collect cervical cell samples for microscopic analysis. Initially, women should undergo screening annually. If results are expected for two consecutive years, screening frequency can be reduced to once every three years, lowering cervical cancer incidence by up to 90%. The Hong Kong government recommends that women aged 25 or older who have been sexually active should undergo regular cervical screening until age 65.
For women who have not yet been sexually active, vaccination against cervical cancer (HPV vaccine) is a more suitable preventive measure. Currently, three types of HPV vaccines are registered in Hong Kong, all of which protect against HPV types 16 and 18, responsible for about 70% of cervical cancer cases. The vaccine requires two to three doses. However, since the vaccine does not protect against all cancer-causing HPV types nor eliminate existing HPV infections, women should still undergo regular cervical screening to minimise cancer risk.
Furthermore, since smoking is a high-risk factor for cervical cancer, women who smoke should quit as soon as possible to reduce their risk of developing the disease.
Seek Medical Attention Immediately
If a woman is diagnosed with cervical cancer through the aforementioned cervical cell screening, the doctor may conduct further tests to determine the cancer stage.
The doctor inserts a flexible endoscope through the urethra into the bladder, anus, rectum, or part of the large intestine. The internal tissues are visually examined on a screen for abnormalities. A small tissue sample (biopsy) may be taken for microscopic analysis if necessary.
After these examinations, the doctor will have a clearer understanding of the patient’s condition and determine the stage of cervical cancer.
| Stage | Extent of Spread |
Stage I | Cancer cells have invaded the underlying tissue but remain confined to the cervix. |
| Stage II | Cancer has spread to nearby tissues or the upper part of the vagina. |
| Stage III | Cancer has extended to the pelvic sidewall or the lower third of the vagina. |
| Stage IV | Cancer has metastasised to distant organs such as the lungs, colon, or bladder. |
Seek Medical Attention Immediately
There are four main treatment options for cervical cancer, with the most suitable approach depending on factors such as tumour size, location, extent of spread, and the patient’s overall health. For example, early-stage tumours confined to the cervix can often be surgically removed, while advanced-stage cancers that have spread widely may require a combination of treatments.
This is typically used for early-stage (Stage I and some Stage II) patients. During the procedure, the surgeon removes the uterus, cervix, upper part of the vagina, and pelvic lymph nodes.
For younger patients in good health with small tumours that have not spread beyond the cervix, surgery is often the preferred option. It allows for ovarian preservation, maintaining reproductive hormone production, and avoids severe side effects associated with other treatments, such as vaginal atrophy and hardening caused by radiation therapy.
Although surgery has fewer long-term side effects compared to other treatments, patients may still experience complications. These can include bladder, ureter, or rectal damage leading to urinary or bowel dysfunction, nerve-related pain, and lymphedema (swelling in the legs due to lymph fluid buildup). In severe cases, vaginal bleeding or infertility may occur.
This treatment is suitable for some Stage I and Stage II patients, alone or in combination with surgery. It is also an option for patients who cannot undergo surgery or those with recurrent or metastatic cervical cancer.
Radiation therapy can be delivered externally or internally. External radiation uses a machine to target high-energy beams at the pelvis, including the cervix and surrounding tissues. Internal radiation (brachytherapy) involves placing small radioactive devices near the tumor in the vagina and cervix. Each session lasts 10 to several tens of minutes, typically requiring 3 to 4 sessions.
Short-term side effects may include nausea, diarrhoea, fatigue, frequent urination, and skin irritation. Long-term effects can include ovarian damage (leading to infertility) and vaginal narrowing, which may cause pain during intercourse.
This involves intravenous administration of anti-cancer drugs to kill cancer cells. It is often used alongside radiation therapy or for patients with metastatic or recurrent cervical cancer.
Short-term side effects may include diarrhoea, loss of appetite, nausea, fatigue, hair loss, mouth sores, and numbness or pain in the hands and feet. Long-term effects can disrupt menstrual cycles or cause temporary or permanent infertility.
This is primarily used for patients with advanced or recurrent cervical cancer. Treatment is administered intravenously every three weeks. The currently registered targeted drug for cervical cancer in Hong Kong is “bevacizumab,” which works by inhibiting blood vessel growth, cutting off the tumour’s blood supply. Clinical studies show that combining this drug with chemotherapy can extend overall survival by 3-7 months.
Healthy Living
After undergoing treatment, patients often experience a weakened physical condition. To rebuild strength, they should resume light activities as soon as possible and engage in moderate exercise such as walking or tai chi, while ensuring adequate rest. Regarding diet, spicy, irritating, greasy, or preserved foods should be avoided. Instead, focus on consuming high-protein, vitamin-rich foods, fresh fruits, and vegetables to maintain regular bowel movements.
Patients who smoke or consume excessive alcohol should quit these habits promptly. Additionally, those who have undergone surgery should abstain from sexual activity for six weeks post-operation to allow proper wound healing. Regular sexual activity can be resumed once full recovery is achieved.
Further Understanding
Note 1: A contrast agent is injected into blood vessels and travels through the bloodstream to organs, helping to weaken X-ray beams and make tissues more visible.
Sources:
Centre for Health Protection
Hospital Authority
Cancer Foundation
Hong Kong Anti-Cancer Society
Mayo Clinic
Cancer Online Resource Hub
▣ The information on this website has been reviewed by the HEAL Medical Team and is regularly updated according to the most recent clinical evidence. All content is provided for general informational purposes only and should not replace professional medical advice. Please consult your doctor or another qualified healthcare professional for personalized medical guidance.
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