Cervical Cancer 101

Cervical cancer is a form of cancer that occurs in the cervix, which is a structure that connects the uterus to the vagina. While cervical cancer is less common and less deadly today than it once was in the United States and many other parts of the world, it remains a significant threat in some countries; according to the World Health Organization, cervical cancer is the fourth most common form of cancer globally. This article is a brief introduction to cervical cancer, with information about causes, symptoms, and treatment options.

What Is Cervical Cancer?

Cervical cancer occurs when abnormal cells form in the cervix, a cylinder-shaped structure connecting the vagina and uterus. Doctors use the term “pre-cancerous” to describe these abnormal cells. Most cases of cervical cancer are linked to human papillomavirus (HPV) infection, which can cause cells to become pre-cancerous. Pre-cancerous cells don’t necessarily become cancer and often simply disappear over time. However, in some women, pre-cancerous cells transition to cancer and form malignant tumors. Left untreated, cervical cancer can spread throughout the body and turn deadly. 

How Do You Know If You Might Have Cervical Cancer? 

As cervical cancer tumors begin to form, they usually don’t cause any symptoms, so the only way you would know you have the disease at this early stage is if you got tested. However, as a cervical cancer tumor grows and spreads to other organs, certain common signs and symptoms can occur. According to the American Cancer Society, these are some potential signs and symptoms of early-stage cervical cancer:

Abnormal vaginal bleeding. This can include any unusual bleeding, such as after vaginal sex, spotting between menstrual periods, long or heavy periods, bleeding after douching, and bleeding after menopause.
Unusual vaginal discharge, which may or may not contain blood 
Pain during sex

Pain in the pelvic region

Cervical cancer that has reached an advanced stage may cause these signs and symptoms:

Leg swelling
Problems urinating or having a bowel movement
Blood in the urine

Other medical conditions can cause these signs and symptoms, so don’t assume you have cervical cancer if you develop one or more. But if any of these signs and symptoms occur and persist, see a doctor soon. 

Where Does Cervical Cancer Usually Start?

Cervical cancer usually starts in cells in the lining of the cervix. Specifically, the cancer commonly arises in an area called the transformation zone. This is the region where the opening to the cervix into the uterus meets with the outer part of this cylinder-shaped tissue. The majority of cervical cancers begin in squamous cells. 

 

What is The Cause of Cervical Cancer?

The cause of many forms of cancers is unknown, but scientists have identified the culprit that that leads to most cases of cervical cancer, which is the human papilloma virus, more commonly called HPV. This virus is the most common sexually transmitted disease in the world. Many people infected with HPV never know it, since this virus usually doesn’t produce symptoms, though it’s capable of causing genital warts. What’s more, HPV can infect squamous cells, which line the inner surfaces of the skin and other organs, including the cervix. HPV can also infect gland cells in the cervix.

Squamous and gland cells in the cervix that become infected with HPV undergo changes that make them abnormal, a condition doctors call “pre-cancerous.” In many cases, these cells are killed off by the body’s immune system and never cause cancer. However, about 10 percent of women infected with HPV have persistent infections that increase the risk for cervical cancer. Most cases of cervical cancer fall into the category known as squamous cell carcinoma, since they arise from the squamous cells. A lesser portion begin in the gland cells and are called adenocarcinomas.

What Are the Most Common Treatments for Cervical Cancer?

Doctors consider several factors when recommending treatment for cervical cancer, including the stage of the disease, the patient’s age and overall health, and whether the patient hopes to have children in the future. Here are the most common treatments for cervical cancer.

Radiation therapy: This common cancer treatment uses intensely focused beams of energy to kill cancer cells on your cervix. The most common form is called external beam radiation, which delivers treatment from outside the body. In some cases an additional form of radiation called brachytherapy, which uses “seeds” placed near the cancer, may be used.
Chemotherapy: Another mainstay of cancer therapy, chemotherapy is the term for drugs that kill cancer cells. “Chemo” is often administered in combination with radiation therapy as initial treatment for cervical cancer. Chemotherapy may also be used to treat recurrent cervical cancer. The commonly used chemotherapy drugs for cervical cancer are injected into the veins in a clinic.
Surgery: Patients with cervical cancer may be candidates for several different forms of surgery, which include:

Cone biopsy: In which a surgeon removes a cone-shaped piece of tissue from the cervix.
Cryosurgery: Very cold gases are used to freeze and destroy cancer cells.

Hysterectomy: In a simple hysterectomy, a surgeon removes the cervix and uterus. In a radical hysterectomy, the surgeon removes some additional surrounding tissues.
Pelvic exenteration: Similar to a radical hysterectomy, but more tissues are removed, including the bladder, vagina, rectum and part of the colon.
Trachelectomy: This procedure involves removing the cervix and upper portion of the vagina, but preserves the uterus.

Targeted therapy: This cutting-edge treatment takes aim at proteins and other targets specific to cervical cancer, causing them to stop growing and spreading. There are several targeted therapies available for treating this malignancy.
Immunotherapy: Another novel treatment approach, immunotherapy is a medical strategy that helps the patient’s own immune system become stronger and more effective at fighting cancer. A drug sometimes prescribed for cervical cancer, pembrolizumab (Keytruda), disables cancer cells’ unique skill for turning “off” the ability of certain immune cells to fight tumors. By keeping immune cells in the “on” position, they are able to destroy malignant cells.

A Cervical Cancer Clinical Trial May Be an Option for You

A clinical trial is another important treatment option to consider. Clinical trials evaluate experimental therapies cancer and other diseases. Massive Bio specializes in finding clinical trials for patients with cervical cancer. Patients who choose to enroll in clinical trials can receive cutting-edge treatment and high-quality care under the direction of doctors, nurses, and other healthcare professionals who are participating in research to discover new therapies for cancer. Patients can gain access to promising drugs and innovative treatments long before they’re made available to the public. If you’ve been diagnosed with cervical cancer, we’re here to help. If you aren’t sure what type or stage your cervical cancer is, that’s okay. Additional testing can help you determine your exact diagnosis.

Sources: American Cancer Society, American Society of Clinical Oncology, Johns Hopkins Medicine

Cervical Cancer Statistics

About 13,000 new cases of cervical cancer are diagnosed each year in the United States, and about 4,000 women die from the disease. Of the 604,127 women diagnosed with cervical cancer worldwide in 2020, 341,831 died of cervical cancer. The death rate in the United States has fallen by nearly 50 percent since the mid-1970s, partly because increased screening has resulted in earlier detection of cervical cancer.

Cervical Cancer by Age

Cervical cancer is most commonly diagnosed between the ages of 35 and 44 and the median age of diagnosis in the United States is 50. About 20 percent of cervical cancers are diagnosed after age 65. Cervical cancer is rare in people younger than 20 years old.

Cervical Cancer Survival Rates

The five-year survival rate for all women with cervical cancer is 66 percent. However, survival rates can vary based on race, ethnicity, and age. The five-year survival rate for white women is 71 percent. The five-year survival rate for black women is 58 percent. The five-year survival rate for white women younger than 50 is 79 percent. The five-year survival rate for black women 65 and older is 39 percent.

Survival rates also depend on the stage of a cervical cancer diagnosis. When detected early, the five-year survival rate for people with invasive cervical cancer is 92 percent. About 44 percent of people with cervical cancer are diagnosed early. If cervical cancer has spread to surrounding tissues or organs and/or nearby lymph nodes, the five-year survival rate is 58 percent. If the cancer has spread to a distant body part, the five-year survival rate is 18 percent.

Sources: Cancer.org, WHO,

Cervical Cancer Causes

Cervical cancer is the fourth most common cancer among women around the world. More than 95 percent of cases are caused by the human papillomavirus. But while the incidence of cervical cancer globally is high, effective treatments are available for this malignancy.

What is the Human Papilloma Virus?

Human papilloma virus (HPV) is a common sexually transmitted infection, though it can in some cases be passed from one person to another through nonsexual physical contact. When HPV enters the body, it can cause an infection that may result in the formation of genital warts.

There are more than 100 varieties of HPV, and scientists have learned that 13 of them cause cancer by inducing changes in the DNA of cells in the cervix. Most people who become infected never know it, since the virus often causes no symptoms and goes away. However, if the body does not eliminate the virus, it can cause cervical cancer. For this reason, it is of great importance for women to discuss how often they should be tested for HPV with their doctors.

Risk Factors for Cervical Cancer

Some risk factors for cervical cancer include:

Having the HPV infection
Having multiple sexual partners
Having sex at a young age
Smoking
A weakened or compromised immune system
Frequent occurrence of genital viral and bacterial infections
Multiple births
Low socioeconomic status, which can reduce healthcare access
Poor diet

Who Gets Cervical Cancer?

Cervical cancer is most commonly diagnosed between the ages of 35 and 44, and the median age of diagnosis in the United States is 50. It rarely develops in women under 20. Many older women are unaware that the risk of developing cervical cancer still exists as they age. More than 20 percent of cervical cancer cases are found in women over 65, though regular screening reduces the risk.

How Can I Lower My Risk for Cervical Cancer?

Getting screened for cervical cancer is the best way to lower your risk. The Centers for Disease Control and Prevention recommends that women begin cervical cancer screening at age 21. Ask your doctor if you should have the Pap test (which detects precancerous cells), the HPV test (which detects the HPV infection), or both. If your tests results are negative, you may not require annual testing. Women over 65 should ask their doctors if routine screening for cervical cancer is still necessary. Other measures that may lower your risk include avoiding tobacco and not abusing alcohol, maintaining a healthy weight, and eating a healthy diet.

Sources: American Cancer Society, Mayo Clinic

Cervical Cancer Symptoms And Signs

Cervical cancer is a disease in which abnormal cells grow uncontrollably in the lower part of the uterus (womb), called the cervix The cervix connects the uterus to the vagina. If left untreated, cervical cancer can spread to other body parts. However, cervical cancer is a preventable and treatable disease when found early. Cervical cancer is a disease that may progress slowly, and usually doesn’t cause symptoms in the early stages. That makes regular screening for cervical cancer essential. But if you do develop any of the symptoms described below, see a doctor.

What Are the Symptoms of Cervical Cancer?

Early-stage cervical cancer usually produces no signs or symptoms. As the disease progresses, the following symptoms may occur:

Vaginal bleeding: The most common symptom of cervical cancer, vaginal bleeding can occur outside of menstrual periods or after sexual intercourse. It may also occur in postmenopausal women.
Vaginal discharge: This discharge may be bloody or watery, and may be pink or brown.
Fatigue: This is one of the most common cancer symptoms. Fatigue is more common as cancer progresses, but it can also occur in the early stages. A doctor should evaluate any report of fatigue that prevents you from doing your daily activities.
Painful urination: The malignant mass that occurs due to cervical cancer may obstruct the urinary tract, and problems such as pain during urination or frequent urination may result.

Back pain: In the advanced stages of cervical cancer, back pain may be experienced due to spinal cord compression caused by the spread of cancer cells from the cervix to other parts of the body, such as the liver or lungs.
Pelvic pain: Pain or pressure below the navel that is unrelated to premenstrual syndrome. Pelvic pain is also associated with uterine cancer, ovarian cancer, fallopian tube cancer, and vaginal cancer.

Sources: American Cancer Society, Mayo Clinic

Cervical Cancer Staging

If you have cervical cancer, it’s important for your doctor to know key information about the tumor, such as how deeply it has penetrated the cervix and whether it has spread to other tissues nearby or throughout the body. Doctors use a system called staging to describe the extent of a patient’s cancer. 

What is Cancer Staging? 

Staging a patient’s cancer is essential for determining a patient’s prognosis or the most likely course of the disease. Knowing a patient’s prognosis allows a doctor to devise an appropriate treatment plan with the best chance of succeeding. There are unique staging systems for different forms of cancer.

Staging is performed after a patient is diagnosed with cancer. To confirm a diagnosis of cervical cancer, a doctor will perform a biopsy, in which a small specimen of tissue is removed and studied under a microscope. The doctor will perform certain tests to stage the malignancy if cervical cancer is diagnosed. Tests doctors use in staging cervical cancer include the following:

Cystoscopy: This exam is performed with an instrument called a cystoscope, which is a thin tube with a light and video camera on one end. The doctor inserts the cystoscope into the urethra (the tube that allows urine to pass out of your body) and uses it to examine the inside of the urethra and bladder (which holds urine before it is eliminated). A doctor may perform a biopsy while conducting a cystoscopy.

Proctoscopy: In this exam, a doctor uses an instrument similar to a cystoscope, called a proctoscope, to examine the inside of the anus and rectum. A biopsy may be performed, too.
Imaging: To determine whether cervical cancer has spread to tissues far away from the cervix, doctors may use any of the following imaging techniques:

X-ray: Cervical cancer may spread to the lungs, which can be detected with a chest x-ray. 
Computed tomography (CT): A CT scan takes multiple x-rays from different angles, which are processed in a computer to produce slice-like images of inside the body.
Magnetic resonance imaging (MRI): An MRI uses magnetic fields to produce 3-dimensional images of structures in the body.

Positron emission tomography (PET): For this scanning technique, a harmless radioactive substance (it’s actually a form of sugar) is injected into the patient’s bloodstream. The substance causes cancer cells to light up on the scan.  
PET/CT scan: This combination of PET and CT scans is commonly used in patients with cervical cancer since it provides doctors with the most information about a tumor and whether it has spread.
Intravenous urography: This special form of x-ray gives doctors a view of the urinary tract. It is not frequently used for detecting the spread of cervical cancer.

The Stages of Cervical Cancer

Doctors frequently use the FIGO (International Federation of Gynecology and Obstetrics) staging system to stage cervical cancer and other cancers of the female reproductive system. The FIGO system stages cervical cancer on a range of 1 to 4, often using roman numerals. Higher numbers indicate more advanced cancers. Within each numerical stage of cervical cancer, letters are used to describe distinctions that indicate factors such as the size of the tumor or its location. An additional number is sometimes added to the stage after the letter to fine-tune the staging even further. As a result, a cervical cancer stage might be IA2 or IIIC. 

Indeed, staging of cervical cancer is highly complex, so what follows is a simplified version of the FIGO system. If you are diagnosed with cervical cancer, and your doctor discusses your stage of disease, be sure you understand what it means. 

Stage I

The cancer is very small and, in many cases, can only be seen under a microscope. It has not penetrated very deeply from the surface of the cervix and into deeper tissues, often no more than 1/5 of an inch, though it may be somewhat deeper. The cancer has not spread to any nearby lymph nodes or distant tissues in the body. 

Stage Ia: Cancer can only be seen under a microscope.
Stage Ib: The tumor is visible but confined to the cervix.
Stage Ib1: The primary tumor is 4.0 centimeters (about 1 ½ inch) or less in diameter.
Stage Ib2: The primary tumor is greater than 4.0 centimeters in diameter.

Stage II

The cancer has grown beyond the cervix and uterus but hasn’t spread to any neighboring organs or tissues nor to lymph nodes or distant tissues. The tumor may or may not be larger than 4 centimeters.

Stage IIa: Cancer has spread into the upper two-thirds of the vagina but not the parametrium (outer layer of the uterus).
Stage IIb: Cancer extends to the parametrium but not into the sidewall of the pelvis.

Stage III

The cancer may be any size and has spread to the lower part of the vagina and may or may not have spread to the walls of the pelvis. It may be blocking the ureters, which are the tubes that carry urine from the kidneys to the bladder. The cancer may or may not have spread to nearby lymph nodes, but it has not spread to distant tissues.

Stage IIIa: Cancer has spread into the lower third of the vagina but not to the sidewall of the pelvis. 
Stage IIIb: Cancer extends to the pelvis and/or the ureter’s sidewall, resulting in a blockage and nonfunctioning kidney.

Stage IV

The cancer has grown into the bladder or rectum or is growing out of the pelvis. Or it has spread to distant tissues such as the lungs or bones.

Stage IVa: Cancer has spread to the inner lining of the bladder or rectum.
Stage IVb: Cancer has spread to the pelvis and/or to distant organs.

Sources: American Cancer Society, American Society of Clinical Oncology, Johns Hopkins Medicine

Treating Cervical Cancer

Cervical cancer occurs when a malignant tumor forms on the cervix, part of the female reproductive system. This article describes the various treatments available for cervical cancer. Some patients with this form of cancer may be candidates for clinical trials, which will be discussed. 

How is Cervical Cancer Treated?

There are several different approaches to treating cervical cancer. The treatment options your doctor recommends will depend on several factors, including the stage of your cancer, whether it’s your initial treatment or treatment for recurrent cancer and your personal preferences. All treatments for cervical cancer can cause side effects, so be sure to ask your doctor to explain the potential benefits and consequences accompanying the therapy you are considering.

Surgery for Cervical Cancer

Surgery is often an option if cancer has not spread beyond the pelvic region. The type of surgery your doctor recommends will depend on the size of the tumor and its location. 

When pre-cancerous cells are detected, surgeons may use one of the following techniques to remove them:

Conization: In this procedure, a surgeon removes a cone-shaped piece of tissue from the cervix. Conization may be performed with a scalpel, laser, or in a procedure called loop electrosurgical excision procedure (LEEP), which delivers an electrical current through a thin wire loop to remove tissue. 
Cryosurgery: Using a very cold probe, a surgeon freezes and destroys pre-cancerous cells. 
Ablation: A laser is used to burn off abnormal cells.

For cervical cancer that is more advanced but has not spread throughout the body, a surgeon may recommend one of the following procedures:

Hysterectomy: A surgeon removes the cervix and uterus in a simple hysterectomy. In a radical hysterectomy, the surgeon removes some additional surrounding tissues. 
Trachelectomy: This procedure involves removing the cervix and upper portion of the vagina but preserves the uterus.
Lymph node surgery: While performing a hysterectomy or trachelectomy, a surgeon may also remove nearby lymph nodes
Pelvic exenteration: Similar to a radical hysterectomy, more tissues are removed, including the bladder, vagina, rectum, and part of the colon. This procedure is typically offered when patients have recurrent cervical cancer.

Radiation Therapy

This common cancer therapy may be used alone or in combination with chemotherapy as an initial treatment for cervical cancer or malignancy that returns after initial treatment. The most common form is external beam radiation, which delivers intensely focused energy from outside the body to kill cancer cells. In some cases, an additional form of radiation called brachytherapy, which uses “seeds” placed near the cancer, may be used.

Chemotherapy: Cervical cancer may be treated with several different forms of chemotherapy, which is the name for drugs that slow or stop the growth and spread of cancer cells. As mentioned, chemotherapy may be used with radiation to treat early-stage cervical cancer. Chemotherapy is also used (often in a combination of drugs) to treat cervical cancer that has returned or spread throughout the body. The chemotherapy used for cervical cancer is typically infused into a vein at a clinic or doctor’s office.

Targeted Drug Therapy: Targeted therapies block or disable specific proteins that cancer cells need to survive. Two forms of targeted therapy may be offered to patients with cervical cancer.

Bevacizumab (Avastin): This drug works by preventing tumors from forming blood vessels, causing cancer cells to die. It’s usually given with chemotherapy. 
Tisotumab vedotin-tftv (Tivdak): This treatment is made up of a chemotherapy drug that’s guided to cancer cells by a second drug. It’s approved for treating cervical cancer that has spread or returned.

Immunotherapy: The human body has a built-in defense network called the immune system that fights diseases, including cancer. Immunotherapy is a medicine that helps the patient’s immune system become stronger and more effective at killing cancer cells. A drug sometimes prescribed for cervical cancer, pembrolizumab (Keytruda), disables cancer cells’ unique skill for turning “off” the ability of certain immune cells to fight tumors. By keeping immune cells in the “on” position, they are able to destroy malignant cells. Pembrolizumab is usually given with chemotherapy and only to patients whose cancer has spread and whose tumors produce a protein called PD-L1.

Who Treats Cervical Cancer?

If you have cervical cancer, your treatment team may include one or more of the following doctors, depending on how advanced your malignancy is and what treatment you receive:

Gynecologic oncologist: A doctor who treats cancers affecting female reproductive organs.
Surgeon: A doctor who is trained to perform surgery.
Medical oncologist: A doctor who treats cancer with chemotherapy and other medicines.
Radiation oncologist: A doctor trained to treat cancer with radiation therapy.

Making Treatment Decisions

Making decisions about treatment for cervical cancer can be challenging and stressful. Sometimes, your options will be limited by factors such as what treatments you have already received. For example, if you have cervical cancer that has returned after undergoing treatment with radiation therapy, receiving a second round of radiation to the same part of your body is not an option since it could be dangerous. What’s more, the side effects of recovery from some treatments, especially for advanced cervical cancer, can be physically and emotionally taxing. Engaging in shared decision-making with your doctor and healthcare team, then weighing all your options, is essential. For some patients, getting a second opinion from another doctor can help with decision-making. 

Thinking About Taking Part in a Clinical Trial

An important treatment option to consider is participating in a clinical trial. A clinical trial is a research study in which scientists evaluate the effectiveness and safety of new medical treatments. By enrolling in a clinical trial, you can gain access to potentially life-changing therapies before they are available to the general public. Massive Bio specializes in finding clinical trials for patients with cervical cancer. Our team of experts and our SYNERGY-AI technology platform can rapidly screen thousands of clinical trials and identify those that are right for you. If you’ve been diagnosed with cervical cancer, we’re here to help. If you aren’t sure what type or stage your cervical cancer is, that’s okay. Additional testing can help you determine your exact diagnosis.

Considering Complementary and Alternative Medicine

Complementary and alternative forms of medicine for cancer are treatments that aren’t part of the standard therapies most oncologists recommend. They might include practices such as yoga, meditation, herbal therapies, and dietary supplements. Technically, complementary medicine is used in addition to standard treatment, while alternative medicine is used instead of standard treatment, though these terms are often used interchangeably. Complementary and alternative medical therapies have generally not been well studied for treating cancer. Do not stop taking or receiving medicine your doctor prescribed in favor of alternative medicine. Practices like yoga and meditation can help relieve the stress of coping with cancer. However, tell your doctor before taking herbal supplements, dietary supplements, or any other non-Western medicine since they could interfere with your treatment.  

Help Getting Through Cancer Treatment

Undergoing treatment for any form of cancer can be difficult and coping with cervical cancer care is no exception. Now is not the time to “tough it out” alone. Spend time with family and friends and share your feelings about undergoing cancer treatment. Keeping these thoughts and feelings to yourself can increase stress and take a toll on your psyche. 

Choosing To Stop Treatment or Choosing No Treatment

Aggressive cervical cancer that has spread is often incurable, so the goal of treatment for a patient is to prolong survival and control symptoms. Some patients may decide to stop receiving treatment, especially if it causes intolerable side effects. Others may choose not to undergo treatment, especially if a patient’s expected lifespan is relatively short. It may help to discuss these decisions with loved ones, but ultimately it’s up to the patient. Both are reasonable choices and should be respected by family, friends, and caregivers.

Sources: American Cancer Society, American Society of Clinical Oncology, Centers for Disease Control and Prevention

Diagnosis of Cervical Cancer

Cervical cancer was once one of the most feared malignancies among women, but over the last few generations, the number of cases and deaths from this disease have dropped dramatically. That’s due to the availability of better screening methods that can detect abnormal changes in cervical cells that can turn cancerous and allow women to get prompt treatment. This article describes cervical cancer, its symptoms, and how doctors diagnose this malignancy.

How is Cervical Cancer Diagnosed?

Fortunately, cervical cancer is often prevented because pre-cancerous cells are detected when women are screened for this disease. In a routine gynecological exam (or pelvic exam), a doctor will check the cervix and surrounding organs (including the uterus, vagina, and ovaries) for any signs of concern. During this exam, several screening tests can be conducted to detect pre-cancerous or malignant cells.

Testing For Cervical Cancer

If a doctor suspects cervical cancer, a combination of additional tests will be used to confirm the diagnosis. 

Pap test: This test, also called a Pap smear, revolutionized cervical cancer diagnosis by making early detection of both malignant and pre-cancerous cells possible. A gynecologist will perform the Pap test while conducting a pelvic exam. Using a small brush, the gynecologist removes cells from the inside and outside of the cervix. These cells are sent to a lab, where a specially trained pathologist views them under a microscope to determine if any are pre-cancerous or malignant. At some hospitals, special computer software can scan for abnormal cells. 
HPV test: Human papillomavirus (HPV) is the most common sexually transmitted disease in the United States, according to the Centers for Disease Control and Prevention. Most women infected with HPV do not develop cervical cancer, but about 10 percent have long-term infections that increase the risk for this malignancy. An HPV test can check for this infection in the same specimen used for Pap smears to look for pre-cancerous or malignant cells. There are many different HPV types, but only some are capable of causing cervical cancer. The HPV test can detect the DNA or RNA of HPV types that increase the risk for cancer.

HPV/Pap cotest: This test checks for pre-cancerous and malignant cells, as well as high-risk HPV types, at the same time. 
Colposcopy: If cervical cancer is suspected, a doctor may use an instrument called a colposcope to examine the cervix and vagina. A colposcope has a light and magnifying lens that allows a doctor to view cells closely.

These tests can raise suspicion that a patient has cervical cancer. To confirm the diagnosis, a doctor will remove a small tissue sample from the cervix, known as a biopsy. This sample will be sent to a lab, where a pathologist will study it under a microscope to look for malignant cells. A biopsy is often performed at the same time as a colposcopy. There are several methods that may be used for performing a biopsy, including the techniques described below. 

Punch biopsy: A doctor removes one or more pieces of tissue from the cervix using a particular instrument with a small circular blade. 
Endocervical curettage: A portion of the cervix, called the endocervical canal, cannot be viewed with a colposcope. A doctor who wishes to check this region for malignant cells may use this method. Using a small, spoon-shaped instrument, the doctor scrapes the lining of the endocervical canal to obtain a tissue sample.  
Electrical wire loop: This method involves using a small wire loop that carries a very low voltage of electrical current to remove a tissue sample from the cervix. It’s also called loop electrosurgical excision procedure, or simply LEEP.
Cone biopsy: Sometimes called conization, this procedure can be performed with a scalpel or laser. The goal is to remove a cone-shaped section of the cervix. It’s also sometimes performed to treat pre-cancerous cells or small, early-stage tumors. A cone biopsy requires general anesthesia and can be performed in a doctor’s office or hospital.

What Are the Stages of Cervical Cancer?

Doctors use a system called staging to describe the extent of a patient’s cancer. Staging a patient’s cancer is important for determining a patient’s prognosis, or the most likely course of the disease. Knowing a patient’s prognosis allows a doctor to devise an appropriate treatment plan with the best chance of succeeding. To determine a patient’s cancer stage, doctors incorporate a great deal of data about the patient and the tumor, including the findings and results from physical exam, biopsy, and imaging tests, as well as other tests, which may include cystoscopy and proctoscopy.

There are unique staging systems for different forms of cancer. To stage cervical cancer and other cancers of the female reproductive system, doctors frequently use the FIGO (International Federation of Gynecology and Obstetrics) staging system. The FIGO system stages cervical cancer on a range of 1 to 4, often using roman numerals. Higher numbers indicate more advanced cancers. Within each numerical stage of cervical cancer, letters are used to describe small distinctions that indicate factors such as the size of the tumor. An additional number is sometimes added to the stage after the letter to fine-tune the staging even further. As a result, a cervical cancer stage might be IA2 or IIIC.

Indeed, staging of cervical cancer is highly complex, so what follows is a simplified version of the FIGO system. If you are diagnosed with cervical cancer and your doctor discusses your stage of disease, be sure you understand what it means.

Stage I: The cancer is very small and in many cases can only be seen under a microscope. It has not penetrated very deeply from the surface of the cervix and into deeper tissues, often no more than 1/5 of an inch, though it may be somewhat deeper. The cancer has not spread to any nearby lymph nodes or any other distant tissues in the body.
Stage II: The cancer has grown beyond the cervix and uterus, but hasn’t spread to any neighboring organs or tissues, nor has it spread to lymph nodes or distant tissues. The tumor may or may not be larger than 1 3/5 inches.
Stage III: The cancer may be any size and has spread to the lower part of the vagina and may or may not have spread to the walls of the pelvis. It may be blocking the ureters, which are the tubes that carry urine from the kidneys to the bladder. The cancer may or may not have spread to nearby lymph nodes, but it has not spread to distant tissues.
Stage IV: The cancer has grown into the bladder or rectum, or is growing out of the pelvis. Or it has spread to distant tissues such as the lungs or bones.

Sources: American Cancer Society, American Society of Clinical Oncology, Johns Hopkins Medicine

Cervical Cancer Follow-Up Care

Completing treatment for cervical cancer can bring a huge sigh of relief. However, as a cancer survivor, it’s important to adopt some smart habits and strategies that can help you stay healthy as you get on with your life. Follow-up care includes routine checkups with your healthcare team to monitor whether your cancer has returned and follow any instructions or advice they may offer about steps you can take to keep it at bay. To be sure, you are an active player in your follow-up care. Here are some steps you can take to help enhance your post-treatment quality of life.

Creating a Survivorship Care Plan

Without a plan, you wouldn’t build a house or launch a new business. Likewise, you should form a detailed plan for embarking on your post-treatment life. Talk to your doctor and healthcare team about creating a survivorship care plan, a detailed document that spells out everything you should be doing as part of your follow-up care. The American Society of Clinical Oncology (ASCO) has created survivorship care plans for different forms of cancer, including cervical cancer. Using a survivorship plan can help you:

Avoid missing needed follow-up exams and tests. These will likely include routine Pap tests, regardless of which form of treatment you received.
Get screened for other forms of cancer.
Watch for and manage any long-term or late health effects that you may experience from your cancer or its treatment.
Adopt healthy lifestyle habits, such as a balanced diet and regular exercise.

You can find a printable version of ASCO’s cervical cancer survivorship care plan here.

Managing Long-term and Late Side Effects

You may have experienced side effects from cervical cancer therapy. Unfortunately, some may persist long past the date of your last treatment. A survey of cervical cancer patients in the United Kingdom by the advocacy group Jo’s Cervical Cancer Trust found that 88 percent had experienced at least one long-term side effect, 63 percent had at least three, and nearly one in four had at least six physical long-term consequences. Patients’ five most common side effects were changes in their sex lives, fatigue, the onset of menopause, bowel difficulties, and bladder difficulties. Cervical cancer patients may experience other problems during and after treatment, including anxiety, depression, fertility issues, and weight changes.  

Late side effects are treatment-related problems that can emerge months and even years after treatment. Some late effects associated with common cancer therapies include bone loss, cognitive problems, and vision loss. Tell your doctor about any long-term or late side effects you experience, including those you have had since undergoing treatment and any new ones you develop. He or she may be able to prescribe medication or recommend lifestyle changes that can help.

Maintaining Health Insurance

Your cancer treatment may be over, but you will still be seeing your healthcare team for routine checkups and making trips to the lab for tests to monitor whether your cancer has returned. These and other aspects of follow-up care are costly, so be sure you have health insurance and don’t let it lapse.  

Keeping Copies of Your Medical Records

Your doctor must maintain comprehensive records of all the care you receive. It’s a good idea—and your right—to obtain and keep copies of your medical records. In the United States, a provision of the Health Insurance Portability and Accountability Act (better known as HIPAA) grants all patients the right to review and receive copies of their medical records. It’s wise to have your copy if you switch doctors and your former physician is unavailable or has lost your records.

Can I Lower the Risk of My Cancer Progressing or Coming Back?

You can play an important role in your follow-up care by making healthy lifestyle choices and sticking with them. Research indicates that people who adopt certain habits tend to lower their overall risk for cancer. At a minimum, following these steps and others that your healthcare team recommends can help you feel better and improve your quality of life.

Eat a healthy, balanced diet: Scientists have not definitively identified a specific diet that prevents cancer. However, recent research suggests that some culinary styles may help toward that cause. For example, evidence hints that the Mediterranean diet has anti-cancer benefits, such as reducing inflammation and oxidative stress. It’s rich in fish, fruits and vegetables, nuts, and olive oil and avoids red meat, full-fat dairy, and unhealthy food and beverages such as soda, sweets, and salty snacks. Talk to a registered dietitian about designing a nutritious meal plan that you’ll enjoy.
Get plenty of physical activity: Growing research indicates that regular exercise and staying physically active reduce the incidence of certain cancers and improve the quality of life for cancer patients and survivors. Most experts recommend getting at least 150 minutes of moderately intense exercise per week. That can be as simple as taking a brisk 20- to 25-minute walk every day, though a longer stroll might have even more benefits. Find an activity you enjoy, so you’ll keep at it.
If you smoke, quit: Cervical cancer is one of many cancers linked to lighting up. If you struggle to quit, talk to your doctor about strategies that might help. Studies suggest that the most effective smoking-cessation approach combines mental health counseling with another form of therapy, such as nicotine replacement or the medications bupropion (Zyban) or varenicline (Chantix).

If you drink alcohol, do so in moderation: Consuming alcohol regularly is also linked to an increased risk for various cancers. A 2017 American Journal of Clinical Oncology study found that women with cervical cancer who had undergone radiation therapy were much more likely to suffer a recurrence and die if they abused alcohol. Most experts say women should limit themselves to one alcoholic drink per day.

Sources: American Cancer Society, American Society of Clinical Oncology

Recurrence of Cervical Cancer

Cervical cancer responds well to therapy when detected early, and effective treatments are available for patients with all stages of this malignancy. However, about one-third of patients treated for cervical cancer will experience a recurrence of the disease, also known as a relapse. Recurrence of cervical cancer typically happens within three years of initial treatment. Often, a diagnosis of recurrence is made after a patient who has been treated for cervical cancer complains of symptoms such as pain in the lower back, pelvis, or chest or abnormal bleeding from the uterus.

The treatment your doctor will recommend for recurrence of cervical cancer will depend on several factors, including how your malignancy was originally treated, the location of the recurrence, and your overall health. Here’s a look at what treatment options your doctor will discuss if you have recurrent cervical cancer.

Recurrent Cervical Cancer After Surgery

Surgery is a common treatment choice for cervical cancer that has not spread far beyond the cervix. The most commonly used procedure is the radical hysterectomy, in which a surgeon removes the cervix, uterus, part of the vagina, and certain other tissues. In some cases, the ovaries, fallopian tubes, and nearby lymph nodes may also be removed. Unfortunately, microscopic cancer cells may remain after surgery, which can grow and cause a recurrence. There are two main treatment options for these patients.

Radiation therapy: If the patient hasn’t already had radiation therapy for cervical cancer before recurrence, this treatment is an option. Radiation therapy is usually delivered from outside the body (known as external beam radiation), though some patients may also receive brachytherapy, which uses radioactive “seeds” planted near the cancer. However, if the patient has already received radiation as part of cervical cancer treatment, this option is ruled out.
Pelvic exenteration: If radiation is not an option, your oncologist may recommend this procedure. A surgeon removes the cervix, vagina, ovaries, and uterus during pelvic exenteration. In some cases, the surgeon will remove additional tissues, including the bladder, anus, and part of the intestine. This procedure is only performed if cancer is not present elsewhere in the body.

Recurrent Cervical Cancer After Radiation Therapy

 If you experience a recurrence following radiation therapy, either the treatment failed to destroy all cancer cells, or you may have had micrometastases, which are tiny collections of cancer cells that have escaped and spread outside the pelvic region but can’t be detected by imaging tests. Because you have previously had radiation therapy in the pelvis, you are not a candidate for a second round. In that event, a doctor may recommend pelvic exenteration if cancer is undetectable in other parts of the body away from the pelvis.

Recurrent Cervical Cancer Outside the Pelvis

The goal of treatment when cervical cancer relapses and spreads or metastasizes to regions outside the pelvis is to prolong survival and ease symptoms if necessary. If metastases are causing pain, radiation may be recommended for relief. If cancer has metastasized to a single site (such as a lung or the liver), surgery may be an option for some patients and may induce remission.

However, the primary treatment option for recurrent metastatic cervical cancer is chemotherapy, the general name for drugs that stop or slow the growth of cancer cells. (Chemotherapy may also be offered along with other treatments for recurrent cervical cancer that has not spread.) Doctors often use combinations of two or more chemotherapy drugs in attempt to slow the growth of recurrent cervical cancer that has metastasized. Combining more than one form of chemotherapy may improve survival but can also increase the occurrence of side effects from these drugs.

New Options for Recurrent Cervical Cancer

Some doctors combine chemotherapy with additional medications known as monoclonal antibodies when treating patients with recurrent metastatic cervical cancer. Monoclonal antibodies are drugs made in a laboratory designed to fight cancer in several ways. For example, the drug pembrolizumab (Keytruda) boosts the immune system, helping it to kill cancer cells. Meanwhile, bevacizumab (Avastin) blocks tumors from forming blood vessels, which they need to survive. Another drug approved for recurrent cervical cancer that has progressed on chemotherapy, called tisotumab vedotin-tftv (Tivdak), is sold in combination with a chemotherapy drug. Studies indicate that adding these novel drugs to chemotherapy prolongs survival in women with recurrent metastatic cervical cancer. These drugs can cause side effects, and not all patients are candidates to receive them.

Scientists continue searching for new ways to treat recurrent cervical cancer in clinical trials, which are research studies that evaluate the effectiveness and safety of new medicines. Massive Bio specializes in finding clinical trials for patients with cervical cancer. Our team of experts and our SYNERGY-AI technology platform can rapidly screen thousands of clinical trials and identify those that are right for you. By participating in a clinical trial, you can gain access to promising drugs and innovative treatments long before they’re made available to the public. If you’ve been diagnosed with cervical cancer, we’re here to help. If you aren’t sure what type or stage your cervical cancer is, that’s okay. Additional testing can help you determine your exact diagnosis.

Sources: Diagnostic and Interventional Radiology, Texas Oncology, UpToDate

Cervical Cancer Clinical Trials

There are effective treatments available for cervical cancer, yet not all patients respond to these existing therapies: In the United States, about 4,000 women die of this malignancy each year. Fortunately, researchers are exploring new treatment options for patients with cervical cancer in clinical trials. If you have heard about clinical trials but don’t know what they’re all about, this article explains the basics: What are they, what purpose do they serve, and is a clinical trial right for you? It also highlights what new therapies for cervical cancer are being studied in clinical trials.

What Are Clinical Trials?

A clinical trial is a research study in which scientists evaluate the effectiveness and safety of new medical treatments. That includes new drugs, novel combinations of existing drugs, and other tools doctors use, such as surgical instruments and methods, medical devices, and diagnostic tests. Every drug approved by the U.S. Food and Drug Administration (FDA) had to be tested first in clinical trials. 

Researchers recruit human volunteers to participate in clinical trials. Some clinical trials compare a new drug designed to treat a disease with the standard treatment for that disease. In other clinical trials, a volunteer may be given the studied drug or a placebo, an inactive substance that resembles a drug (sometimes called a “sugar pill”). In both cases, you may not be told which treatment you will receive. However, if you receive a placebo, you will still get the standard treatment for your condition. 

There are several good reasons to participate in a clinical trial. You can gain access to potentially life-changing and even life-saving therapies before they are available to the general public. If you have a disease and standard treatments are not improving your quality of life or offering a cure. A therapy being studied in a clinical trial may represent new hope. What’s more, many people who participate in clinical trials gain great satisfaction from contributing to the goal of discovering new treatments that will help others in the future. 

What Are the Phases of a Clinical Trial?

Clinical trials are usually conducted in several stages, known as phases. Technically, the phases can run from phase 0 to phase IV. However, this section will focus primarily on phase I, phase II, and phase III clinical trials for new medications, which are of most relevance to patients with cervical cancer and other forms of cancer.

Phase I clinical trial

After a new medication has been developed and tested in the lab, a modest number of human volunteers (usually no more than a few dozen) are recruited to receive a small dose of the substance in phase I clinical trial. (In some cases, researchers first conduct a very small study called a phase 0 trial with just a few volunteers.) One of the most important purposes of a phase I trial is to find out whether the new medicine is safe, so researchers will closely monitor the volunteers to see if they develop side effects. However, the research team will also look for the benefits of the new medicine. So, while participating in a phase I trial means accepting a degree of risk, some patients experience improved outcomes by taking part. 

Phase II clinical trial

Suppose a new medication is determined to be safe and shows promise in a phase I clinical trial. In that case, it will usually move on to being evaluated in a phase II trial. This next stage will include a larger number of volunteers, but usually no more than 100. In a phase II trial, some participants may get different doses of the new medication. Again, researchers will look for what side effects the volunteers develop. However, they will focus closely on benefits. In the case of novel cancer therapy, does it appear to shrink tumors? Extend how long patients go without their cancer recurring. Prolong survival? Treatments that look safe and effective will then move on to phase III.

Phase III clinical trials

When you read about the FDA (or regulators in other countries) approving a new drug, it’s because that medication was demonstrated to be safe and effective in a phase III trial. In this phase, researchers recruit a large number of volunteers, usually hundreds, which may include participants from around the world. The effects of the new medication will typically be studied over a long period, too. A phase III trial compares a new treatment for a disease with the standard of care. In some cases, a portion of the participants in a phase III trial will receive placebos, though they may be switched to the medication being studied at some point during the study. 

 Suppose a new treatment is demonstrated to be safe and effective in a phase III clinical trial. In that case, the company that developed the medication asks the FDA for permission to sell it. (Occasionally, companies submit data for approval following a phase II trial.) FDA officials examine data submitted by the company and decide whether to approve the request. If a drug is approved for sale, the FDA often requires companies to conduct further research, known as a phase IV trial, to gather more information about the treatment’s benefits and potential risks. 

 

What is the Latest Research on Cervical Cancer?

Researchers are studying several different novel approaches to treating cervical cancer. They include:

Immunotherapy: This cutting-edge strategy bolsters your body’s ability to fight cancer. Cancer cells can grow and spread by turning “off” certain immune cells, making them unable to block tumors from advancing. An immunotherapy medication already available for cervical cancer patients called pembrolizumab (Keytruda) prevents cancer cells from doing this, allowing the immune system to shrink tumors. More immunotherapy drugs for cervical cancer are being studied. 
Targeted therapy: This cutting-edge treatment takes aim at proteins and other targets specific to cervical cancer, causing tumors to stop growing and spreading. There are several targeted therapies available for treating this malignancy, with others under investigation in clinical trials.
Vaccines: You may have heard of the HPV vaccine, which reduces the risk of cervical cancer. However, new vaccines are being studied in clinical trials for patients diagnosed with cervical cancer. They work by triggering an immune response against certain proteins in HPV, the virus that causes most cervical cancer cases. Studies indicate that these vaccines may prevent recurrence in patients with early-stage cervical cancer and shrink tumors in patients with advanced disease.

How Do I Find a Clinical Trial?

Your doctor may know about one or more clinical trials of new treatments for your cancer. However, Massive Bio specializes in finding clinical trials for patients with cervical cancer. Our expert team and SYNERGY-AI technology platform rapidly identify which clinical trials are right for you, giving you access to cutting-edge treatment and high-quality care under the direction of doctors, nurses, and other healthcare professionals who are exploring new therapies for cancer. If you’ve been diagnosed with cervical cancer, we’re here to help. If you aren’t sure what type or stage your cervical cancer is, that’s okay. Additional testing can help you determine your exact diagnosis.

Sources: American Cancer Society, American Society of Clinical Oncology, Centers for Disease Control and Prevention,

Non-Hodgkin’s Lymphoma Clinical Trials

Clinical trials focusing on Non-Hodgkin’s Lymphoma are aiming to find safe and effective new treatments, drugs or approaches to better care for the patients suffering from the disease. For these new methods to be widely available, they first need to be tested and approved. Non-Hodgkin’s lymphoma (NHL) is one of the most frequent cancers in the US, accounting for approximately 4 percent of all cancers. According to the American Cancer Society, the overall 5-year survival rate for Non-Hodgkin’s Lymphoma is 73 percent. These numbers are possible because medical science puts an enormous effort into advancement. That is why joining a clinical trial is valuable not only for the patients themselves but also anyone who is suffering from NHL.

According to the information provided by the clinicaltrials.gov, there are currently 469 clinical trials (either active, recruiting or enrolling by invitation) on Non-Hodgkin’s Lymphoma in the United States as of March 2022. There are various methods scientists are working on to improve:

Immunotherapy: The research evolving around the CAR (Chimeric antigen receptor) T-cell therapy is included under the immunotherapy studies. The patient’s healthy T-cells (a type of immune cells) are collected and engineered in the laboratory to recognize, bind to and defeat the cancer cells. In addition to four approved CAR T-cell therapies that are currently available as treatment, more is expected to be approved soon. Among the ongoing studies, several are targeting CD19, and assessing the competence of the CAR T-cell therapies for treating refectory and relapsed Non-Hodgkin’s Lymphoma.

Chemotherapy: A common treatment for all cancer patients, chemotherapy has positive results for Non-Hodgkin’s Lymphoma as well. Researchers are focusing on combining different chemotherapies and treatment methods such as immunotherapy and radiation. They are looking for ways to improve the current drugs and develop or combine new ones.

Genetic testing: Genetics is an important element in classification and diagnosis of Non-Hodgkin’s Lymphoma subtypes. Researchers are trying to find out more about the mutations (gene changes) in the development of cancer. The expectation with these studies is to identify the specific mutations to design the best treatment for each patient.

Vaccines: Especially for Non-Hodgkin’s Lymphoma in indolent nature, therapeutic vaccines are a wide area of study. Main goal is preventing or diminishing the chance of relapse of the disease after chemotherapy or targeted therapy, rather than prevention.

Targeted therapies: Targeted therapy is the most prominent and promising area of clinical trials for the Non-Hodgkin’s Lymphoma studies. The targeted drugs such as proteasome inhibitors, Histone Deacetylase (HDAC) inhibitor, Bruton Tyrosine Kinase (BTK) inhibitors, Phosphoinositide 3-kinase (PI3K) inhibitors, EZH2 inhibitor, mTOR inhibitor, nuclear export inhibitor and other agents are being carefully studied to provide new options for patients.

Bone Marrow Transplantation/Reduced-Intensity Stem Cell Transplantation (Nonmyeloablative Allogeneic Transplantation): This method is being tested both for patients that re newly diagnosed and for those already received a treatment but experienced a relapse. Current studies are looking into the procedure to determine its effectiveness for different types of lymphoma, including some subtypes of Non-Hodgkin’s Lymphoma. For preparation, the patients first receive a low dose of chemotherapy drug/s and/or radiation therapy for a while before the reduced-intensity transplant.

Supportive care/palliative care: The clinical trials also focus on diminishing the symptoms and side effects of Non-Hodgkin’s Lymphoma treatments that are already available, as improving the patients’ comfort and quality of life is one of the main concerns.

How to find clinical trials for Non-Hodgkin’s Lymphoma?

This is a question that needs to be answered in guidance of a medical team who know your medical history, your current stage and condition along with the match your case has with the requirements of a given clinical trial. Here at Massive Bio our patient relations coordinators consist of oncology nurses, and our artificial intelligence-based clinical trial matching system can assist you to choose the best option and enroll as soon as possible. You can get a free consultation, or directly start your journey to advanced treatment options.

Sources:

cancer.org

lls.org

cancer.net