Cervical Cancer : Center of Excellence
Cervical Cancer Care: High-Tech Personalized
When fighting cervical cancer, you want treatment options that fit you as a person. This means not only are cancers different but so is each individual. Treatment options are based on how early the cancer is, what the most effective treatments are and the risk and benefit of each. In addition, and more importantly, individual situations call for different solutions to help you not only survive but also thrive in survivorship.
About Cervical Cancer
Types of Cervical Cancer
These are the main types of cervical cancer and we treat them all at the Gynecologic Oncology Institute. Some are more aggressive than others, so a personalized treatment plan that fits you and your exact type of cervical cancer is crucial for best results.
- Squamous Cell Cancer of the cervix
- Adenocarcinoma of the uterine cervix
- Neuroendocrine cervical carcinoma
- Small Cell cervical cancer
Human Papilloma Virus (HPV) & Cervical Cancer
We know that cervical carcinoma is virtually all related to infection with HPV and is the primary causative factor. However, it is a very common infection, present in up to 80% of college-age women, and certainly does not cause pre-cancer or cancer in everyone. The virus clears in most women within a year and does not cause harm. But when it persists or is associated with some of the other factors on this list, it can cause cancer. There are effective prevention vaccines when given before exposure to the virus through sexual activity. The virus can also be tested for along with a standard Pap smear. This screening and potential early detection is the next best thing to vaccination towards prevention.
Cervical Cancer Prevention & Detection
Multiple Sexual Partners
The more sexual partners you have the greater the chances of getting an HPV infection.
Either through infection with HIV or due to some immunosuppresive drugs or a generally bad lifestyle can cause your immune system to be less effective. This interferes with your body’s ability to clear the HPV virus.
Contraceptive pills on their own do not likely cause cancer but in most studies are related to cervical cancer. This may merely be an association with a very active sex life or a yet undiscovered direct effect.
High Number of Pregnancies
Pregnancy by itself also does not cause cervical cancer. However, it means there was a very active sex life and thus can be associated with cervical cancer. It is highly likely that this just means that the number of pregnancies is a proxy for increased sexual activity, potentially with multiple partners. Therefore it is not a “cause” but only an “association”.
Smoking is a definite co-factor in cervical cancer causation. There are so many toxins in cigarette smoke that the exact relationship is not known.
Sexually Transmitted Diseases (STDs)
Multiple inflammatory infections with various sexually transmitted diseases may be a partial cause but other than HPV there is no known STD that causes cervical cancer. The inflammation however may weaken the ability to resist HPV virus carcinogenic effect.
Cervical Cancer Diagnosis
If cervical cancer is suspected, the first step is a thorough visual examination of your cervix through a speculum. This is like a Pap smear type of pelvic exam, except a lot more attention is focused on looking at the cervix and seeing if anything needs to be biopsied. A magnifying instrument called a colposcope is sometimes used to look for the best place to biopsy the cervix. If an area looks suspicious, a biopsy is performed and might use one of the following instruments or techniques:
- Punch biopsy: a special instrument is used to pinch off a small amount of the abnormal looking area
- Endocervical curettage: a small scraping instument is used to scrape or brush tissue from the inside of the cervical canal
If either the punch biopsy or endocervical curettage show precancer or cancer cells after the pathologist reviews the biopsy under a microscope, one of the following might be done:
- LEEP: using a thin, electrical wire a larger area of the cervix is removed while limiting the bleeding using the electical current for cautery. This can often be done in the doctor’s office.
- Cone biopsy: A cone biopsy uses a scalpel, is more involved and is usually done in a surgicenter or a hospital under general anesthesia.
Cervical Cancer Treatment
Treatment of uterine cervix cancer strongly depends on the “stage”. The stage means where is the cancer located? Is it still confined to the cervix or has it spread to lymph nodes or other organs like the liver or lungs? Staging uses physical examination and basic X-ray tests. In addition, advanced technologies like CT scans and PET scans are used to help plan treatment, although they do not technically influence the stage of the cervical cancer.
Stages of Cervical Cancer:
- Stage I : Cancer is confined to the cervix.
- Stage II : Cancer is present in the cervix and upper portion of the vagina.
- Stage III : Cancer has moved to the lower portion of the vagina or laterally to the pelvic side wall where the bones, blood vessels, big nerves and muscles of the pelvis are.
- Stage IV : Cancer has spread to nearby organs, such as the bladder or rectum (IV-A), or it has spread to other areas of the body, such as the lungs, liver or bones(IV-B).
Cancer of the Uterine Cervix Treatment by Stage
Treatment is based partly on stage and partly on what your individual wants and needs are. For example, fertility preservation is often possible in early-stage cervical cancer. In addition, medical conditions and other factors might help guide the best treatment options for you individually. Stage I is usually treated surgically, but does not always require a hysterectomy. Radiation is just as effective but may have different side effects. Stage II may be treated surgically but is usually treated with radiation therapy. Stage III is treated with radiation because it is not possible to get around the tumor with surgery without cutting across tumor. Stage IVA is also treated with radiation but may include surgery and chemo. Stage IVB is treated with chemotherapy. In all cases where radiation is used a small amount of chemo may be used to help make the radiation more effective. At the Gynecologic Oncology Institute, we specialize in tailoring treatment and use the most advanced surgical technologies like robotically assisted laparoscopy. In addition, we look at molecular profiling of your tumor to see if targeted biological therapy or immunomodulation would be appropriate for your treatment plan.
Cervical Cancer Outcomes
Survival rates are only estimates and there are survivors of any stage of any cancer, including survivors of Stage IV cervical cancer. Dr. Vasilev has personally led patients with advanced stage cervical cancer to thriving in survivorship.
Cervical Cancer Survival Rates
According to the American Cancer Society, the survival rates for cervical cancer by stage on average are:
- For stage IA cervical cancer, the 5-year survival rate is about 93% For stage IB cancer, the 5-year survival rate is about 80%.
- For stage IIA cervical cancer, the 5-year survival rate is about 63%. For stage IIB cancer, the 5-year survival rate is about 58%.
- The 5-year survival rate for stage IIIA cervical cancer is about 35%. For stage IIIB cancer, the 5-year survival rate is about 32%
- Stage IVA cervical cancer has a 5-year survival rate of about 16%, and stage IVB cancer has a 5-year survival rate of about 15%.
Dr.Vasilev has extensive experience in fertility-sparing options in the management of cervical cancer. This includes robotic radical trachelectomy (removal of the cervix with preservation of the uterus), which offers the possibility of pregnancy and carrying a baby to term.
Cervical Cancer Survivorship Planning
Beyond survival there is quality of life, which can be equally as important. To achieve the best quality of life after a diagnosis of cervical cancer, a personalized treatment plan is crucial to beat your cancer and thrive. We start by focusing on you as an individual and not just on your cancer. At the Gynecologic Oncology Institute, we specialize in helping you plan out the best outcomes possible based not just on your cancer but also on your body, mind and spirit.
Cervical Cancer Tips
Did You Know? Raw or lightly steamed broccoli and turmeric help clear HPV. This can help prevent recurrent damage from the virus, BUT you can’t cook the broccoli before eating it. That destroys the enzyme which helps create sulforaphane, the most active anti-cancer nutrient.