Gynecologic Cancer Awareness Month: Progress Makes Cervical Cancer Highly Treatable, Increasingly Preventable

Partners | <b>GenesisCare</b>

For Gynecologic Cancer Awareness Month, Dr. Sonal Sura discusses the recent progress in the treatment of patients with cervical cancer.

Rates of cervical cancer diagnoses and deaths among women have dropped steadily since 1975, thanks to new targeted treatments, refined diagnostic tools and a vaccine against the virus that causes most of these reproductive system cancers.

Even though any cancer diagnosis can be frightening for women, physicians and oncologists can provide their patients with reassuring guidance about a range of preventive measures and targeted treatments that lower a woman’s lifetime risk of contracting or dying from cervical cancer.1

Depending on where the cancerous cells develop, and how invasive they are once detected, physicians have varied options for treatments that include surgery, radiation therapy, chemotherapy, targeted cellular therapy, and immunotherapy.2

Reassuring Statistics About Cervical Cancer

Several factors have changed the treatment of cervical cancer over the past 5 decades. Beginning in the 1970s, the widespread use of Pap smears to detect cervical cancer began reducing its incidence. Rates continued to decline after a German scientist conclusively linked cervical cancer to the human papillomavirus (HPV), a discovery in the 1980’s that spurred wider HPV screenings and eventually an HPV vaccine.3

Now, thanks to better screenings and earlier interventions, cervical cancer ranks as the 20th most common cancer among U.S. women, responsible for about 14,100 new cases and nearly 4,300 deaths each year. Just about 0.7% of all new cancer cases and deaths are attributed to cervical cancer, according to the American Cancer Society.4 Worldwide, cervical cancer ranks 4th among women at about 570,00 cases diagnosed in 2018 and 311,000 deaths, according to the World Health Organization.5

One hopeful message to deliver to patients is that there is a 66.7% relative survival rate for cervical cancer in the U.S., according to the American Cancer Society, and survival rates are higher for cancers that have not spread beyond the cervix and lower for cancers that metastasized.

Addressing Remaining Challenges

The key challenge for physicians and their patients is that cervical cancer often develops without symptoms, according to the National Cancer Institute. The most common are vaginal bleeding, unusual vaginal discharge, and pelvic pain.

Besides HPV, common risk factors for cervical cancer include initiation of sex at an early age; numerous sexual partners; suppressed immune system; high number of childbirths; long-term oral contraceptive use, but risks decline gradually when contraceptives are stopped.

Discussions with women about cervical cancer should focus heavily on prevention, including the value of regular Pap smears throughout a woman’s life to look for cellular changes of the lining of the cervix. In addition, women should be advised to schedule preventive HPV vaccines for their pre-teen and adolescent daughters.

The first vaccine should be administered between ages 9-12, with routine follow-ups through late adolescence and early adulthood. A 2021study from Denmark found that cervical cancer risks were lower in women vaccinated against HPV between ages 16-19 compared with unvaccinated women.6

Screening Informs Treatment Options

When your patients present with cervical cancer, following accepted guidelines will help you identify, diagnose, classify, and explore treatment options for cervical cancer.

Providing specific information about the type and stage of their cancer will give them the information they need to better understand your recommendations and their options. Cervical cancers are classified in a spectrum of stages I-IV, with stage I representing cancer cells/tumors that remain small and localized to the cervix, while stage II, III, and IV cancers progressively interfere with or invade nearby organs/tissues (e.g., block the kidneys, ureter, rectum) or spread to the vagina, uterus, pelvic wall, distant lymph nodes, liver or lungs.

It is also important to follow accepted protocols for examinations and laboratory tests to identify the specific type of cancer. These include:

  • Physical exam and health history of the patient.
  • Pelvic exam, is a physical exploration of the vagina, cervix, uterus, fallopian tubes, and rectum for signs of disease.
  • Pap test, in which a small brush collects cells in and around the cervix; the specimen is examined microscopically for signs of abnormal cells or HPV infection.
  • Endocervical curettage and/or colposcopy, usually performed as follow-ups to questionable Pap smears; both procedures involve a more extensive exam of the cervix and deeper collection of cervical tissues for signs of cancer or abnormal cells.
  • Biopsy of cells for signs of cancer.
  • DNA tests, magnetic resonance imaging (MRI) or computed tomography (CT) scans to fine-tune the location of the tumor and inform targeted, effective treatments.

Aided by data from exams and laboratory results, you can then shift the conversation options about treatments, decisions that are guided by the type of cancer, whether it is localized to the cervix or has spread to nearby tissues/organs, the size of the tumor(s), the patient’s age and/or menopause status, and whether the patient wants to have children after treatment for their cancer.

Wide-Ranging Treatment Options

The good news is that oncologists and physicians today have a range of treatment options, and they should tailor their suggestions based on input and discussions with their patients, especially if treatments will impact future decisions about childbirth and menopause.

Surgery

Small tumors can be removed through a cone biopsy, or conization. Excision of a small portion of tissue from the cervix leaves surrounding healthy tissues untouched, and if the cancer has spread, a hysterectomy involves removal of the cervix and uterus. If a woman wishes to get pregnant, gynecological surgeons can perform a trachelectomy, which involves removal of part of the cervix and vagina but leaves the uterus intact and stitches it closed. Any subsequent pregnancy will have to be delivered by cesarean section.

Radiation Therapy

This approach targets cancerous cells while preserving surrounding healthy tissue with the fewest [adverse events]. Options include external beam radiation therapy (EBRT) with radiation delivered from outside the body; internal radiation therapy (IRT) with radiation sources implanted in the body; intensity-modulated radiation therapy (IMRT) with precise radiation that matches the tumor’s shape, and intracavitary brachytherapy with radiation delivered to the tumor through small catheters.

Chemotherapy and Targeted Medicine Therapy

Whether used in conjunction with other procedures or as a standalone treatment, chemotherapy drugs destroy cancerous cells. Recent discoveries and pharmaceuticals enable oncologists to target and shut down specific cellular activities that help cancerous cells and tumors grow.

Immunotherapy

often used for tumors that continue to grow or spread after chemotherapy, musters the body’s own immune system to recognize and destroy cancerous cells. Clinical trials are also underway for cervical cancer.

Receiving a cancer diagnosis is always fraught with anxiety and fear for patients. Referring and treating physicians and oncologists can relieve the impact of those initial reactions by emphasizing the scope of successful treatment options and relatively high survival rates for a cervical cancer diagnosis.

REFERENCES:

1) Cervical Cancer Treatment (PDQ®)–Health Professional Version. National Cancer Institute. April 28, 2022. Accessed: August 30, 2022.https://bit.ly/3Sm7I6N

2) Cervical Cancer. Genesis Care. Accessed: August 28, 2022.https://bit.ly/3LCyuVz

3) Weiss RA. On viruses, discovery, and recognition. Cell. 2008 Dec 12;135(6):983-6. doi: 10.1016/j.cell.2008.11.022

4) Cancer Facts and Figures 2022. American Cancer Society. Accessed: August 30, 2022. https://bit.ly/3S8jKjM

5) Cervical Cancer. World Health Organization. Accessed: August 31, 2022. https://bit.ly/3Lz0UzO

6) Kjaer SK, Dehlendorff C, Belmonte F, Baandrup L. Real-World Effectiveness of Human Papillomavirus Vaccination Against Cervical Cancer. J Natl Cancer Inst. 2021 Oct 1;113(10):1329-1335. doi: 10.1093/jnci/djab080