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Cervical Cancer

Advances in the Treatment of Cervical Cancer

Cervical cancer is among the 3 most common types of gynecologic cancers, along with ovarian and endometrial cancers. There are currently 3 approved vaccines that differ in the HPV types that they target for the prevention of HPV infection and cervical cancer.
June 2017 Vol 3 No 3
Cheryl Bellomo, MSN, RN, OCN, HON-ONN-CG
Oncology Nurse Navigator
Intermountain-Southwest Cancer Center
Cedar City Hospital
Cedar City, UT

Cervical cancer is among the 3 most common types of gynecologic cancers, along with ovarian and endometrial cancers. The American Cancer Society estimates that 12,820 women will receive a new diagnosis of invasive cervical cancer in 2017, and 4,210 women will die from cervical cancer in the United States.

Cervical cancer was once one of the most common causes of cancer death for American women. With the introduction of the Pap smear screening test and the addition of cisplatin chemotherapy to radiation therapy, the death rate from cervical cancer has decreased by more than 50% over the past 40 years.

Cervical cancer is mainly found in women of midlife age between 30 and 50 years; however, although it rarely occurs in women younger than 20, more than 15% of cases of cervical cancer are diagnosed in women older than age 65.

In the United States, Hispanic women are at highest risk for cervical cancer, followed by African Americans, Asians and Pacific Islanders, and Caucasians. American Indians and Alaskan natives have the lowest risk for cervical cancer.

Types of Cervical Cancer

The main types of cervical cancer are squamous-cell carcinoma and adenocarcinoma. The majority (90%) of cervical cancer is squamous-cell carcinoma. Adenosquamous or mixed cervical cancers may have features of squamous-cell carcinoma and adenocarcinoma. Other types of cancer, such as melanoma, sarcoma, and lymphoma, can also be found in the cervix.

Risk Factors

Infection with the human papillomavirus (HPV) is a major known contributor to invasive cervical cancer.

Other risk factors for cervical cancer include smoking, being immunocompromised (that is, having HIV and/or AIDS), having multiple sexual partners, and the use of oral contraceptives.

  • Slideshow Cervical Cancer Female Researcher 850x567

    Cervical cancer used to be the leading cause of cancer death for U.S. women, but the rate has dropped by more than 50% thanks to increased use of Pap testing.

    Source: Center for Disease Control
  • DidYouKnow Horizontal HandQuestion2

    The most important risk factor for cervical cancer is infection with the human papillomavirus (HPV). Some types of high-risk HPV are strongly linked to cancers.

    Source: The American Cancer Society
  • Slideshow Cervical Cancer Healthy Women Outdoors 850x567

    Women ages 21 to 29 should get a Pap test every 3 years to screen for cervical cancer.

    Source: The American Congress of Obstetricians and Gynecologists
  • Slideshow Cervical Cancer Group Of Women Happiness 850x567

    Women ages 30 to 65 should get a Pap test and HPV test every 5 years to screen for cervical cancer.

    Source: The American Congress of Obstetricians and Gynecologists
  • DidYouKnow Horizontal HandQuestion2

    When detected at an early stage, the five-year survival rate for women with invasive cervical cancer is 91%.

    Source: American Society of Clinical Oncology
  • Slideshow Cervical Cancer Doctor And Patient 850x567

    About 12,900 women are diagnosed with cervical cancer each year in the United States.

    Source: The American Cancer Society
  • Slideshow Cervical Cancer Happy Senior Woman 850x567

    Have you battled cervical cancer? Would you be interested in telling your story? You can do so by going here.

HPV Vaccination for Prevention of Cervical Cancer

There are currently 3 approved vaccines that differ in the HPV types that they target for the prevention of HPV infection and cervical cancer.

Gardasil, Gardasil 9, and Cervarix are the current vaccines that have been shown to provide effective protection against HPV infection and cervical cancer.

The current guidelines recommend routine vaccination against HPV4 or HPV2 for females aged 11 or 12 years and against HPV4 for males aged 11 or 12 years. Vaccination is also recommended for females aged 13 years through 26 years and for males aged 13 years through 26 years who were not vaccinated previously.

Unfortunately, despite these vaccinations having high efficacy in the prevention of HPV, the vaccination rate is only 33% in the United States.

Recognizing the Symptoms

Women with early cervical cancer usually have no symptoms. Symptoms often do not occur until the cancer begins to invade the nearby tissue. Common symptoms for cervical cancer are:

  • Abnormal vaginal bleeding (bleeding after menopause, bleeding and spotting between periods, heavier or longer menstrual periods)
  • Unusual discharge from the vagina
  • Pain during sexual intercourse
  • An abnormal Pap smear screening test result

Diagnosis

The Pap smear test is a screening test, and is not used as a diagnostic test. An abnormal Pap test will require further testing to determine if the woman has cervical cancer. Common tests for the diagnosis of cervical cancer include:

  • Physical exam
  • Colposcopy (visual magnification of the cervix)
  • Cervical biopsy
  • Cystoscopy/proctoscopy (visual examination of the bladder and rectum to determine the spread of cancer)
  • Imaging studies: CT scan, MRI, PET scan

Treatment

Surgery, such as cryosurgery, laser surgery, conization, hysterectomy, trachelectomy, pelvic exenteration, and pelvic lymph node dissection, can yield a cure in 80% to 90% of early-stage cervical cancer.

Radiation therapy (eg, external beam radiation therapy) with concurrent chemotherapy followed by further brachytherapy radiation is the standard treatment for locally advanced disease.

Chemotherapy is the main treatment for recurrent or metastatic (spread to other body areas) cervical cancer.

Although only a few chemotherapy drugs are approved by the FDA for the treatment of cervical cancer, including cisplatin, Hycamtin (topotecan), and Gemzar (gemcitabine), several other chemotherapy agents, such as Navelbine (vinorelbine tartrate), carboplatin, Taxol (paclitaxel), and Ifex (ifosfamide), are proved to be effective therapies for cervical cancer.

Cisplatin-based combination chemotherapy represents the standard of care.

Targeted therapy is a newer type of cancer treatment that uses drugs or other substances to identify and attack the cancer cells directly, while doing little damage to normal, healthy cells. Angiogenesis inhibitors are targeted therapies that destroy cancer cells by blocking the growth of blood vessels that are nourishing the cancer cells.

Avastin (bevacizumab) is an angiogenesis inhibitor targeted therapy that is approved by the FDA, in combination with Taxol and cisplatin or Hycamtin, for patients with persistent, recurrent, or metastatic cervical cancer.

Drugs in Clinical Trials for Cervical Cancer

New treatments for cervical cancer are being evaluated on a daily basis in clinical trial research.

Votrient (pazopanib) is a targeted therapy that blocks certain growth factors that help cancer cells to grow. In early phases of clinical trials, Votrient is proving effective for the treatment of patients with advanced cervical cancer.

Immunotherapy, such as vaccines and immune checkpoint inhibitors, is designed to increase the ability of the patient’s own immune system to generate an immune response to recognize and eliminate cancer cells. Although still in early development, several immunotherapies, such as adoptive T-cell therapy and therapeutic vaccines, have shown potential in early clinical trials for the treatment of advanced cervical cancer.

In addition to speaking with your oncology team, you can learn about available clinical trials through the National Institutes of Health at www.clinicaltrials.gov.

Patient Resources

American Congress of Obstetricians and Gynecologists
www.acog.org/Womens-Health/Cervical-Cancer

American Cancer Society
www.cancer.org/cancer/cervical-cancer

Foundation for Women’s Cancer
www.foundationforwomenscancer.org

National Cancer Institute
www.cancer.gov

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