Jayanthi Lea, M.D. Answers Questions On: Cervical Cancer: Prevention, Early Detection, and Treatment

Cervical cancer is the fourth most common cancer in women. In 2018, there were approximately 570,000 new cases worldwide and about 311,000 deaths.

The majority of cervical cancers are caused by high-risk human papillomavirus (HPV), which is transmitted by sexual contact. Although most HPV infections are asymptomatic and go away on their own, some can persist, leading to precancerous cell changes and, occasionally, cervical cancer.

Persistent HPV infection that causes mild cellular abnormality is referred to as mild dysplasia. Mild cervical dysplasia can often regress and become normal. Occasionally, however, mild cervical dysplasia can progress to high-grade dysplasia, which can result when high-risk HPV invades the cervical cell nucleus. High-grade cervical dysplasia has a high possibility of progressing to cancer of the cervix. Therefore, when high-grade dysplasia is identified, it’s important that it be treated.

Identification of cervical dysplasia is made possible by Pap smear screening. A Pap smear (or Pap test) is a painless procedure, done at a doctor’s office, that gently removes cells from the surface of the cervix and the area around it so they can be checked under a microscope for cervical cancer or cell changes that may lead to cervical cancer.

Cervical dysplasia and cancer can be prevented. Primary prevention of cervical cancer can be accomplished by HPV vaccination, which triggers our body to produce antibodies against some high-risk HPV strains. These antibodies can prevent HPV infection.

We also recommend regular screenings with Pap smears and/or HPV testing, even if women have received HPV vaccination. The U.S. Preventive Services Task Force (USPSTF) recommends a Pap smear every three years for women aged 21 to 29 years. For women aged 30 to 65 years, screening recommendations are:

• Every three years with a Pap smear alone
• Every five years with high-risk HPV testing alone, or
• Every five years with high-risk HPV testing in combination with a Pap smear

The USPSTF does not recommend screening for cervical cancer in women who have had a hysterectomy.

There is currently a nine-valent vaccine that protects against the most common high-risk human papillomavirus types, HPV 16 and 18, as well as five other high-risk HPV subtypes and two low-risk subtypes that most commonly cause warts. Findings in a study published in November 2019 showed that, among women who had been vaccinated, the percentage of precancers caused by HPV 16 and 18 dropped from 55.2% to 33.3%. Another study, published in The Lancet medical journal in December 2021, showed a substantial decrease in the incidence of cervical cancer and dysplasia among women in the United Kingdom who had received the HPV vaccine.

We recommend that a gynecologic oncologist see and treat women who are diagnosed with cervical cancer. Cervical cancer is staged clinically with the use of a physical examination. Sometimes it’s necessary to do an exam under anesthesia to adequately determine whether cancer has spread outside the cervix. Radiographic evaluation of organs and tissues with a PET CT (also known as a PET scan or PET imaging) as well as a pelvic MRI (magnetic resonance imaging) is frequently used in the evaluation of women with cervical cancer. Radiographic evaluation is critical when advanced disease is suspected.

Patients with early-stage cancer can be treated either with surgery or radiation therapy. Surgical treatment of visible, early-stage cervical cancer typically involves a radical hysterectomy. Preservation of ovarian function is usually possible in premenopausal women who are undergoing surgical treatment. Women with early-stage cervical cancer have a five-year survival rate of approximately 85 to 90%.

Patients with advanced-stage cervical cancer are typically treated with a combination of radiation and chemotherapy. Advanced-stage cervical cancer has a five-year survival rate of 30 to 50%; however, clinical trials involving novel therapies are currently underway to improve survival rates.

Recent developments in the treatment of cervical cancer include the use of targeted therapy that attacks cancer cells without harming normal cells. A combination of standard platinum-based chemotherapy and anti-angiogenic targeted therapy, which starves a tumor of needed blood supply, has been shown to significantly increase survival in comparison to chemotherapy alone. Immunotherapy agents, which boost the immune system’s response to cancer, have also shown promise in treating women with recurring cervical cancer. Additionally, a novel antibody-drug conjugate (ADC) called tisotumab vedotin has gained FDA approval for use in recurrent cervical cancer. This treatment combines a cancer-killing drug with a monoclonal antibody designed to seek out and bind to tumor cells.

Fertility preservation is sometimes possible in certain cases of early-stage cervical cancer. Women who have small tumors and no evidence of metastatic disease may be candidates for fertility preservation after further evaluation and counseling. In instances where fertility preservation is desired, the cervix is surgically removed and the uterus is preserved in order to maintain the possibility of a future pregnancy. Seventy percent of women who undergo fertility preservation surgery for early-stage cervical cancer are able to become pregnant.