Cervical cancer: aetiology, earlier diagnosis and treatment

Cervical cancer which is one of the commonest genital malignancies in women worldwide including Singapore is reviewed. There is a decreased incidence and mortality rate from cervical cancer with well organised population-based screening programmes using cervical smears. Strong evidence exists for a sexually transmitted etiologic agent in cervical cancer. The evidence of an association between Herpes Simplex Virus Type 2 (HSV-2) and certain Human Papillomavirus (HPV) infections especially HPV 16 and HPV 18 in the etiology of cervical cancer is reviewed. Diagnosis of asymptomatic clinically occult lesions is by cervical cone biopsy following colposcopic evaluation of those with abnormal smears. The diagnosis of clinically invasive lesions is made by careful evaluation of the cervix and confirmed by biopsy. Treatment of occult and early clinically lesions is ideally by a spectrum of surgical procedures which are carefully tailored to the extent of the lesion but of advanced cancers mainly with radiation therapy with adjuvant surgery and/or chemotherapy in selected cases. Best results for cervical cancer treatment are obtained when treatment facilities are centralised and treatment performed by experienced individuals who individualise therapy or integrate the use of all therapeutic modalities of surgery, radiation and chemotherapy.