11 Things You Need to Know About Cervical Cancer, According to a Gynecologic Oncologistby Stephanie Stephens Health Writer
Before a detailed discussion about cervical cancer, it's important to understand your basic reproductive anatomy. That's the suggestion of Shannon Neville Westin, M.D. MPH, an associate professor in the Department of Gynecologic Oncology and Reproductive Medicine in the Division of Surgery at MD Anderson Cancer Center in Houston. She is also an expert in cervical cancer for the American Society of Clinical Oncology. Here, she shares 11 important facts about this cancer she wants you to know.
Know your cervix
Cervical cancer is found on — that's right — the cervix, located at the lower part of your uterus and at the top of your vagina, Dr. Westin says. Your cervix opens up (dilates) when you have a baby and may play a role in sexual function and pleasure. Cancer begins in the cervical cells and can either take years to develop or come on more quickly. Cell changes that ultimately develop into cancer are called dysplasia, cervical intraepithelial neoplasia, or squamous intraepithelial lesions.
Cervical cancer stats
Cervical cancer is the third most common gynecological cancer, and is the 14th most frequent cancer affecting American women. It occurs often in two age ranges: 1) most frequently, in women in their 30s and 40s, and 2) in 15 to 20 percent of women older than 65.
"There's a risk as you get older, and just because you're no longer of childbearing age doesn't mean you're in the clear," says Dr. Westin.
About those Pap smears
"Regular pelvic exams with a Pap smear have reduced cervical cancer incidence," says Dr. Westin. The United States Preventive Services Task Force (USPTF) recommends screening for women age 21 to 65 years with a Pap test (also called Pap smear) every three years or, for women age 30 to 65, screening with a combination of a Pap test and human papillomavirus (HPV) testing every five years.
"Not all HPV viruses, but higher-risk HPV subtypes, cause cervical cancer," she says.
Who else needs cervical cancer screening?
The USPTF also recommends against screening for cervical cancer with HPV testing, alone or in combination with a Pap test, in women under age 30; in women under age 21; in women over 65 who've had adequate prior screening and aren't otherwise at high risk; and in women who've had a hysterectomy with removal of the cervix and with no history of a high-grade precancerous lesion (cervical intraepithelial neoplasia grade 2 or 3) or cervical cancer.
The role of HPV in cervical cancer
To help prevent this cancer, Dr. Westin wants you to understand the main risk factors.
Exposure to HPV's more than 150 viruses spread by sexual contact causes the majority. "If you've had sex, you've been exposed to HPV," says Dr. Westin. "Eighty percent of all men and women who have had sex have the virus, and most of the time, the body immediately 'handles' it. Sometimes it can manifest with genital warts or cervical abnormalities, or it can cause other cancers such as penile or head and neck."
Other important risk factors
Certain types of sexual activity increase risk, such as having multiple partners or partners who are themselves at high risk, says Dr. Westin. Female smokers are twice as likely as non-smokers to develop cervical cancer. Women with compromised immune systems, such as human immunodeficiency virus or HIV, have a higher HPV infection risk. Research has also shown that excess weight and low consumption of fruits and vegetables are risk factors, along with prolonged use of birth control pills.
"[The] HPV vaccine absolutely can prevent the development of cervical cancer," says Dr. Westin. The HPV vaccine is recommended in boys and girls at age 11 or 12, or as early as age 9; for women age 13 to 26, and men 13 to 21, not previously vaccinated; through age 26 for people who are not heterosexual and for people with compromised immune systems not previously vaccinated. "Talk to your doctor about the appropriate schedule for you," she says.
If you are diagnosed
"An early diagnosis may mean fertility-sparing treatment options and opportunities to save the uterus," Dr. Westin says. "We may remove just the cervix or a portion of it, after a thorough lymph node assessment. It's all based on the stage of cancer and extent of disease. When adequate margins are removed — meaning there is no tumor in the tissue surrounding a tumor — risk of recurrence is quite low. We will follow you closely for years to ensure the cancer hasn't returned."
Surgery, chemotherapy, or radiation
For any advanced stage cervical cancer (stage 1b2 and above to stage 4), a patient may have surgery, radiation, or chemotherapy — or all three. "In early-stage disease, we typically perform surgery first, while later stages 2, 3, and 4 may not require surgery, but do require chemo, radiation, or both," Dr. Westin says. "What transpires can definitely impact sexual function, so patients are carefully counseled while in the process to minimize negative impact."
Promising treatments are here
"Immunotherapies use your immune system to fight cancer," Dr. Westin says. "In March , the FDA granted a priority review to pembrolizumab or Keytruda for treatment of patients with advanced cervical cancer with disease progression on or after chemotherapy. Targeted therapies such as Bevacizumab work well in combination with chemotherapy, leading to increased survival in patients with advanced stage disease."
Thriving after cancer treatment
"Psychotherapy can help a great deal after treatment," says Dr. Westin, "especially if patients have low libido, or difficulty with arousal and orgasm. Physical therapy for the pelvic floor can help control muscle spasms, and use of lubricants, moisturizers and other aids help with vaginal atrophy and pain from sex. We can also refer you to a sexual health provider to help with all of these challenges, if they occur."