Cervical Cancer Diagnosis & Treatment in Singapore

What are the Cervical Cancer Treatments in Singapore?

Squamous cell carcinoma and adenocarcinoma of the cervix are the most common types of cervical cancer and are treated in similar fashion. Neuroendocrine small cell cancer of the cervix is a rare cancer and the treatment will not be discussed here.

Treatments of cervical cancer depend on the extent of disease spread as well as the fitness level of the patient. Surgery, radiation, chemotherapy, targeted drug therapy; immunotherapy or a combination of the above therapies may be used.

When deciding on treatment plans, cervical cancer can be classified into

  • Early cancer
  • Locally advanced cancer
  • Advanced cancer

Early Cervical Cancer


Early cervix cancers are cancers that are confined to the cervix. Most early stage cervical cancers are treated with surgery – hysterectomy which involves removing the cervix and the womb (uterus). Part of the vagina, the ovaries and nearby lymph nodes in the pelvis may also be removed. For many women, surgery is all the treatment that is required, but some women may require additional treatments such as radiation and chemotherapy to reduce the risk of the cancer recurring. Majority of women with early cervical cancer can expect to be cured.

Fertility sparing surgery for early stage cervical cancer:

Removing the uterus makes it impossible to become pregnant. Women who have not completed their family can discuss with their oncologist about the feasibility of surgical procedures that will retain fertility.

  • Cone biopsy:

For very small cancers, it may be possible just to remove the cancer with a cone biopsy. This procedure involves cutting away a cone-shaped piece of cervical tissue, but leaving the rest of the cervix intact.

  • Trachelectomy

Removal of the cervix and some surrounding tissue. The uterus remains intact and pregnancy is still possible.

Ovarian Transposition:

Young women may discuss with their oncologist about ovarian transposition surgery in case radiation treatment is required after the surgery. Ovaries are hitched to a higher position to prevent ovarian failure induced by radiation treatment.


Radiation treatment is an alternative option for cervical cancer patients who are not fit for surgery.

Locally Advanced Cervical Cancer:

These are cancers that are bulky or have spread to the surrounding organs or to the lymph nodes in the pelvis. Radiation treatment is often combined with chemotherapy (concurrent chemo-radiation). Chemotherapy enhances the effectiveness of the radiation treatment. 


High Energy X-rays are used to kill cancer cells. Radiation therapy consists of external beam and internal radiation:

  • External beam Radiation: Radiation beam is directed at the affected area from outside the body.
  • Internal Radiation (Brachytherapy): Insertion of hollow tube (applicator) that contains radioactive material into the vagina. This allows high-dose radiation to be delivered to the cervix and the vagina. The radioactive material is inserted for a few minutes and then removed.

Possible Side Effects of Radiation may include:

  • Tiredness
  • Diarrhea
  • Skin changes
  • Radiation cystitis: Radiation to the pelvis can irritate the bladder (radiation cystitis), causing painful urination or an urge to urinate often.
  • Vaginal pain: Radiation can make the vulva and vagina more sensitive and sore, and sometimes causes a discharge.
  • Infertility: Pelvic radiation can affect the uterus leading to inability to become pregnant.
  • Early menopause: Pelvic radiation can affect the ovaries, leading to early menopause in pre-menopausal women.

Long-term side effects include:

  • Vagina stenosis: Narrowing of the vagina due to the formation of scar tissue which may make sexual intercourse painful. This can be prevented with the use of a vaginal dilator.
  • Second cancer: Rarely, women may develop a second cancer many years after their radiation treatment.


The most commonly used chemotherapy is a drug called cisplatin. This is given in low-doses.

The radiation treatments are given 5 days a week for a total of 6 weeks. Each radiation treatment lasts only a few minutes. The cisplatin chemotherapy is an infusional treatment given once a week during the radiation and can be administered in the outpatient setting without a need for hospital stay.

Possible side effects of Cisplatin Chemotherapy:

  • Tiredness
  • Nausea and vomiting
  • Loss of appetite
  • Lowering of white blood count which may increase the risk of infection
  • Anaemia
  • Bleeding due to lowering of platelets
  • Kidney damage
  • Tingling or numbness in hands and feet

Cisplatin chemotherapy is given in low doses and therefore generally well-tolerated. Of note, it does not cause hair loss.

Treatment of Advanced or Recurrent Cancer of the Ovary:

Advanced cancers are those that have spread to distant organs such as the lungs, the liver or the bones. Recurrent cancers are those that have returned after treatment. The mainstay treatments of advanced or recurrent cervical cancers involve drug treatment to control the cancer and to minimise any symptoms caused. In the past, chemotherapy was the most common drug treatment for cervical cancer in Singapore. There are now newer drug options beyond chemotherapy such as targeted drug treatment and immunotherapy. These drug therapies can be administered in an outpatient setting.

Drug Treatments:

  • Chemotherapy

Anti-cancer drugs given as infusions. The drugs enter the bloodstream and reach all areas of the body to kill cancer cells that have spread. There are several drugs that are effective in the treatment of cervical cancer. Commonly used drugs include cisplatin, carboplatin, paclitaxel, gemcitabine and vinorelbine. It can be used on its own, but more commonly given as a two-drug cocktail. A typical course of chemotherapy treatment takes approximately five months.

Possible side effects of treatment do vary depending on the drugs used and the cervical cancer individuals. They are mostly reversible upon the completion of treatment. Not all chemotherapy drugs will cause hair loss.


  • Targeted treatment

Bevacizumab is a targeted treatment that disrupts the blood vessels which supply nutrients to the cancer cells, thereby causing cancer cell death through deprivation of nutrients. This is a short infusional treatment, given once every 3-weekly, usually given with chemotherapy and as maintenance treatment to control the cancer better.

Possible Side effects :

Common side effects can include:

  • High blood pressure
  • Loss of protein in the urine

Less common but more serious side effects can include:

  • Bleeding
  • Blood clots
  • Poor wound healing
  • Fistula is an abnormal connection between the vagina and part of the intestine. This is more common in women who have undergone radiation to the pelvis previously.


  • Immunotherapy

These are drugs that boost the body’s immune system to recognize and fight cancer cells. Immune checkpoint inhibitors, such as Pembrolizumab, work by releasing the natural brake on the immune system so that the immune system can attack the cancer. It is given as a short infusion every 3 weeks.

Possible side effects

Side effects of these drugs can include fatigue, nausea, skin rash, loss of appetite, joint, or muscle pain.

Immune checkpoint inhibitors are generally well tolerated, though their serious side effects may occur due to the activation of the immune system attacking the organs in the body, such as the intestines, the thyroid gland, the lung , the liver or other organs.

What do I need to do if I have Cervical Cancer?

If you’re worried about getting cervical cancer, you can ask your cervical cancer specialist in Singapore about getting vaccinated against HPV (Human Papillomavirus). Going for regular HPV or pap test screenings can also help reduce your risk for cervical cancer.

If you or your loved one already have cervical cancer, do schedule an appointment with a qualified and experienced medical oncologist with experience in treating gynecological cancers. OncoCare specialises in treating patients with late stage or advanced stages of cervical cancer. Many of our patients come to us when they need to seek a second opinion on their condition.

Oncologists at OncoCare with Clinical Interests in Cervical Cancers

At Oncocare, our team of cervical cancer specialists is dedicated to providing you with personalised treatments for your condition. Other than cervical cancer, we also treat other cancers such as breast, colon and colorectal, hepatobiliary, and liver cancer. You can be confident that you will be getting the best possible care with us.

Senior Consultant, Medical Oncologist

MBBS (Australia, Honours), MRCP (United Kingdom), MD (United Kingdom) 

Dr Lim specialises in the treatment of gynaecological cancers, such as cancer of the ovary, uterus, cervix and vulva. She trained under several renowned oncologists, including Professor Hani Gabra, a world renowned expert on ovarian cancer.  

Dr Lim joined the Department of Gynaecological Oncology at KK Women’s and Children’s Hospital, specialising in the treatment of gynaecological cancers (cancers of the ovary, uterus, cervix and vulva). She also led the Chemotherapy Centre at KK Hospital and served as chairperson of the Singapore Cancer Network (SCAN).


  • Graduated from Monash University, Australia (Honours) in 1996 
  • MRCP (UK), Royal College of Physicians of the United Kingdom, 2001 
  • Certification in Medical Oncology by the United Kingdom Postgraduate Medical Education Training Board in 2008 
  • Doctor of Medicine (MD) , United Kingdom in 2009 
  • Executive Committee Member of the GyneCologic Cancer Group Singapore (GCGS) since 2018 
  • Former Senior Consultant Medical Oncologist at the Department of Gynaecological Oncology at the KK Women’s and Children’s Hospital (KKH), Adjunct Associate Professor at DUKE-NUS Medical School 
  • Visiting Consultant at KK Women’s and Children’s Hospital

Senior Consultant, Medical Oncologist

MBBS (Singapore) – ABIM Int. Med (USA) – ABIM Med Onc(USA) – FAMS (Medical Oncology)

Dr. Tay has been recognised as one of the top cancer doctors doing research. He was awarded the prestigious center grant by the National Medical Research Council of Singapore.  He actively collaborates with other leading Asian researchers based in Korea, Taiwan, Hong Kong and USA. Dr Tay has published his findings in numerous journals, including Nature Genetics, the Journal of Clinical Oncology, The Lancet Hematology, American Journal of Medicine, Leukemia & Lymphoma and Seminars in Hematology.

Dr Tay’s subspecialty interest is in women related cancers such as breast cancers & gynaecological cancers, melanoma, brain cancers, soft tissue & bone sarcomas and also hematological malignancies such as lymphoma, multiple myeloma and leukemia.


  • Graduated from the National University of Singapore in 1998. 
  • Board Certified, Internal Medicine, American Board of Internal Medicine, 2006 
  • Board Certified, Medical Oncology, American Board of Internal Medicine, 2009 
  • Chief Resident, Department of Medicine, John A. Burns School of Medicine, University of Hawaii, 2006 
  • Chief Fellow, Medical Oncology Branch, National Cancer Institute, National Institute of Health, Bethesda, 2008

What is Cervical Cancer?

Cervical Cancer is cancer that arises from the cervix, an organ situated between the vagina and the womb (uterus). In Southeast Asia, cervical cancer is the 2nd most common cancer affecting women. In Singapore, the incidence of cervical cancer has been falling, largely due to cervical cancer screening, and is now the 10th most common cancer affecting women in Singapore.

What are the Signs and Symptoms of Cervical Cancer?

Early cervical cancer may not produce any symptoms. Signs and symptoms of cervical cancer may include : 

  • Vaginal bleeding after intercourse, between periods or after menopause 
  • Watery or bloody vaginal discharge that may be heavy and have a foul odor 
  • Pelvic pain or pain during sexual intercourse
  • Frequent urge to urinate or discomfort when urinating
  • Back pain
  • Unexplained weight loss, fatigue or loss of appetite

How is Cervical Cancer Diagnosed

If cervical cancer is suspected, several investigations will be undertaken. This often involves colposcopy examination by a cervical cancer specialist. A magnifying instrument (colposcope) will be used to inspect the cervix and any abnormal areas will be biopsied and sent to the laboratory to test for cancer.  

If cervical cancer diagnosis is confirmed, further tests, such as MRI scan of the pelvis,  CT scan or PET-CT scan, will be undertaken to determine if the cancer has spread and help to stage the cancer.

What are the Causes and Risk Factors of Cervical Cancer?

Almost all cases of cervical cancer (99.7%) are due to infection with the human papillomavirus (HPV). 

HPV infection, acquired through sexual contact, is the single most important risk factor for cervical cancer. It is a prevalent infection in sexually active women. However, most women’s immune systems are able to get rid of this infection spontaneously. In the minority of women, there will be persistent infection of the cancer-causing HPV strains (“high-risk” HPV), which may lead to cervical cancer.  

Other risk factors include: 

Multiple sexual partners
Starting to have sex at an early age (before age 18)
Weakened immune system and therefore less likely to clear the HPV infection. For example, organ transplant recipients on medications to suppress the immune system  and women with Human Immunodeficiency virus (HIV) infection
Oral contraceptive pills

Can Cervix Cancer be Prevented?

The HPV vaccine is very effective in preventing HPV infections that cause cervical pre-cancers or cancers. It provides up to 90% protection against cervix cancer. The Singapore Cancer Society recommends HPV vaccination for females between the ages of 9-26 year old. This vaccine has also been shown to be effective in women below the age of 45. It is most effective if administered prior to the first sexual encounter as it cannot cure an existing HPV infection. Women who are vaccinated need to continue with Pap smear screening or HPV testing as the HPV vaccine does not guarantee 100% protection.  

Screening for cervix cancer with Pap smear helps to detect cervical pre-cancers and early cancers. Meanwhile, the HPV testing is a newer and more effective screening test than Pap smear as it detects the HPV virus. The presence of high-risk cancer-causing HPV strains predicts a higher risk of cervical pre-cancers. The Singapore Cancer Society recommends sexually active women to commence PAP smear screening starting from age 25 and HPV testing from age 30.  

What are the Stages of Cervical Cancer?

The International Federation of Obstetrics and Gynaecology (FIGO)  is the most commonly used staging system for cervical cancer.  

Stage I : Cancer confined to cervix 

Stage II : Cancer has spread to surrounding organs – uterus, upper vagina or tissues surrounding the cervix (parametrium) 

Stage III : Cancer has spread to lower vagina or pelvic wall or causing kidney blockage or spread to lymph nodes in pelvis or abdomen 

Stage IV :  Cancer has spread to organs such as bladder or rectum or to distant organs such as lung, liver or bones

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