By Pat Carragher - January 24, 2022
According to the American Cancer Society, approximately 14,000 women will be diagnosed with cervical cancer in the United States this year. Cervical cancer was once one of the most common causes of cancer death for American women, but mortality rates have declined in recent years thanks to HPV and Pap testing.
For Cervical Cancer Awareness Month, we spoke with Dr. Robert Wenham, chair of Moffitt Cancer Center’s Department of Gynecologic Oncology, and Dr. Jing-Yi Chern, gynecologic oncologist. Here’s what they had to say in response to some of the most pressing questions about cervical cancer:
What causes cervical cancer?
Wenham: The No. 1 cause is human papillomavirus. It’s responsible for the majority of cases. Cervical cancer typically comes in a couple of different forms. There’s squamous cells, which are more often developed on the outside of the cervix. And then there are ones that are adenocarcinomas that develop on the inside of the cervix. There are some very rare types that are out there, but they don’t really constitute what most people think of when they hear cervical cancer.
What kind of tools are available to prevent cervical cancer?
Chern: The best preventative that we have is to get vaccinated against HPV. We have HPV vaccines that cover nine viruses. They include the low- and high-risk viruses, which cause common warts including genital warts and unfortunately cancer. It not only prevents cervical cancer, it also prevents other cancers including vaginal cancers, vulvar cancers, anogenital cancers, and head and neck cancers. Outside of vaccines, the way we kind of follow and prevent cervical cancer is to do Pap smears. It’s important to make sure to have your well woman exam with your gynecologist or your primary care provider so they can do a Pap smear and it allows us to detect precancer cells early.
How is cervical cancer treated?
Chern: Early stage cervical cancer is usually treated either one of two ways. It can be treated surgically if it’s deemed appropriate. This may include a radical hysterectomy, which is the removal of the uterus, cervix and the tissue right outside the cervix. That could also include removal of the lymph nodes in the pelvis. If surgery is not deemed appropriate, the treatment is generally a combination of chemotherapy and radiation. Here at Moffitt we also offer different clinical trials that address how we can treat patients either with early stage disease and advanced or recurrent stage disease.
What is cervical dysplasia?
Wenham: Dysplasia represents an opportunity to stop things before they become cancer. Dysplasia is the altered growth of cells that are visible before those cells have invaded into the body. That’s the difference between dysplasia and invasive cancer. It comes in varying degrees. We can actually tell the risk of having an underlying cancer by the level of dysplasia. When you have a Pap smear, we’re looking for cells that look bizarre, or dysplastic appearing cells. We then perform tissue biopsies to actually look at the architecture of those cells together to determine whether or not it’s high-grade or low-grade dysplasia, or whether it’s invasive cancer.
Are there genetic risks associated with cervical cancer?
Chern: When we talk about cancer, we are looking at personalized medicine for personalized treatments, based off either tumor genetics or the patient’s own inherited genetics. Currently there’s no well-established model that looks at the genetic basis of cervical cancer. There are some population studies, as well as studies of different tumor biology markers, but currently we don’t know of any genes that specifically cause cervical cancer.