Cervical Cancer

Is your treatment what more than 1,100 Oncologists recommend?

The information provided below is meant to help you understand the role of your cervical cancer biology treatment decisions, as well as the role of other tools used in determining your ability to receive chemotherapy or targeted therapy (precision medicine).

Cervical Cancer Statistics

Cervical cancer is the most common cause of gynecologic cancer death. Generally, cervical cancer tends to occur in women younger than age 50. However, older women are still at risk, with more than 15% of new cases being diagnosed in women over 65. Cervical cancer rarely develops in women younger than age 20.

The most common site for cervical cancer cells to develop is in the lining of the cervix (66%), and this type of cancer is called squamous cell carcinoma, as it arises in the squamous cells of the cervical lining.  About 28% of all cervical cancers develop from mucus-producing cells in the endocervix (opening of the uterus), and it is called adenocarcinoma. Other types of cervical cancer comprise the remaining 6%.

The number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly in the last 20 years, mainly due to advances in prevention, early detection, and treatment. Cervical cancer, when detected early, has a 5-year relative survival rate of 92%. If the cancer has spread to the surrounding area, then the relative survival is about 57%. If the cancer has spread to other areas of the body (liver, lungs, bones, etc.) then the 5-year survival drops to approximately 15%.

The main risk factor for developing cervical cancer is the persistent infection with human papilloma virus (HPV), accounting for 99.7% of all cervical cancers. HPV is transmitted by sexual contact; therefore, sexually active women should be screened with a pap smear regularly by their physician. There are two types of HPV that are responsible for most of the cervical cancers: HPV16 and HPV18. Most infections with the high-risk HPV infections do not lead to cervical cancer, as most infections clear within two years. For cervical cancer to develop in women with high-risk HPV infections, the infection must also be persistent. The low-risk types of HPV, may cause genital warts but are not associated with cervical cancer.

Cervical cancer is detected via Pap smear test. Pap smear screening is also effective in detecting pre-cancerous cervical changes, termed cervical intraepithelial neoplasia (CIN) that can be treated successfully. There are 3 different grades of cervical abnormalities seen on the PAP smear and the treatment for these include:

• CIN I: observation
• CIN II: loop electrosurgical excision procedure
• CIN III: loop electrosurgical excision procedure

Treatment

Cervical cancer treatment often involves a combination of interventions including: surgery (if operable), radiation (if indicated), chemotherapy and/or targeted therapy (precision medicine). Your treatment depends on the stage of your cancer, your age, and your general state of health.

Surgery

The goal of surgery is to completely remove the tumor. The type of surgery will depend mostly on the stage, but other factors such as the location of the cancer within the cervix, the type of cancer, your age, your overall general health, and whether you want to have children, can greatly affect the surgical decision. Your gynecologic surgeon will let you know which of these options is best for you, considering these factors in achieving the best outcome. You will need to discuss your individual case with your gynecologic surgeon.

Radiation

Radiation therapy, or radiotherapy are commonly used in the treatment of cervical cancer.  The radiation oncologist will determine whether you will need to receive radiation for your cancer, this depends on your age and overall health status.

Chemotherapy

This website is designed to address the medical oncology portion of your treatment and offer you personalized information about your treatment options that will yield in best survival and quality of life.

The treatment with chemotherapy and/or targeted therapy (precision medicine) depends on the stage of your cancer. The stage of your cancer is determined from the physical examination and imaging tests (if needed). The stages are as follow:

Stage 0: the tumor is in the innermost lining of the cervix

Stage I: tumor confined to the cervix

• T1A-1 tumor 3mm deep, T1A-2 tumor is 3-5mm deep, tumor can only be seen under a microscope and <7mm wide
• T1B-1 tumor can be seen with naked eyes but it is <4cm and T1B-2 tumor can be seen and is >4cm

Stage II: tumor extends beyond the cervix and uterus but not into the walls of the pelvis or the lower part of the vagina

• T2A-1 tumor is < 4cm, T2A-2 tumor is >4cm
• T2B tumor spreads into the surrounding tissues next to the cervix (the parametria)

Stage III: tumor extends to the walls of the pelvis or the lower part of the vagina

• T3A tumor spreads to the lower part of the vagina but not to the walls of the pelvis
• T3B tumor spreads into the walls of the pelvis or block the ureter(s) (this is called hydronephrosis)

Stage IV: tumor spreads to other parts of the body

Chemotherapy is generally indicated for stages IB or higher. This can be given in combination with radiation or in combination with targeted therapy after the tumor is surgically removed. There are several chemotherapeutic drugs that can be used, however, cisplatin is the most used drug, followed by carboplatin, paclitaxel, topotecan, vinorelbine, or gemcitabine.

Targeted therapies, also called precision medicines, are drugs that interfere with the growth or spread of cancer by targeting and blocking specific molecules that are involved in the growth and spread of cancer. In cervical cancer, bevacizumab is used to target the vascular endothelial growth factor (VEGF), a protein normally made by tumor cells. The VEGF is responsible for increasing the blood flow to the tumor to facilitate the growth of the tumor.  Bevacizumab blocks this protein from stimulating new blood vessels formation.

Finally, chemotherapy, and targeted therapies can result in unpleasant side effects such as hair loss, numbness of fingers or toes, cardiac toxicity, nausea, vomiting, diarrhea, abnormal liver function or low white blood cell count that could cause infection, and fatigue.  However, advances in the oncology field have led to numerous supportive measures, such as white blood cell growth support (i.e. Neulasta) or anti-nausea medications (such as Zofran, Emend), that help to control most side effects when used as prescribed.

The best time to use this service (based on more than 1,100 cancer experts) is after you have learned the details of your cancer and treatment plan from your treating physicians, and would like to clarify and confirm that your treatment is the best option for your cancer.  This questionnaire is used mainly for drug treatment in medical oncology.