Caitlin Whyte (Host): This is Healthy with VCU Health. I'm Caitlin Whyte. Approximately 13,000 cases of cervical cancer will be diagnosed this year according to the American Cancer Society. However, thanks to advances in vaccination and screening, it's actually one of the most preventable cancers today. We'll be talking more about that with Dr. Jackie Wall, a gynecologic oncologist at VCU Massey Comprehensive Cancer Center. To start us off, can you tell us how common is cervical cancer?

Dr. Jackie Wall: Worldwide cervical cancer is one of the most common gynecologic cancers. And there's over 600,000 new cases every year. In the United States, there's about 13,000 new cases estimated in this year, 2025, with, unfortunately, over 4,000 deaths due to this disease.

Host: Then, what are some of the common signs and symptoms of cervical cancer?

Dr. Jackie Wall: The signs and symptoms of cervical cancer to a large extent depend on when this cancer is diagnosed. Cancer in early stages can be detected with a Pap smear or with HPV testing. And in these cases, patients may not actually have symptoms. However, once the cancer begins to grow, the symptoms are going to vary from patient to patient, but can include things like vaginal bleeding, pain or bleeding during or following intercourse, abnormal vaginal discharge or pain in the pelvis, the abdomen, or even the back.

Host: I know screening can be so important for a number of cancers. So, what is the standard screening for cervical cancer?

Dr. Jackie Wall: Yes. Fortunately, cervical cancer is one of the cancers that has very robust and established screening protocols. So, all patients who have a cervix should start cervical cancer screening with a Pap smear at age 21. In patients who are low risk with no abnormal pap smears, we continue the screening until the age of 65. Or, if a patient is having a hysterectomy and no history of abnormal Pap smears, they can discontinue screening at that time.

Traditionally, like I said, screening has been done with both the Pap smear and an HPV test, that begins at age 30 and we call that co-testing. More recently, we are mostly switching to using primary HPV testing. This is a basically identical process to having your Pap smear done in a clinic. However, the backbone of the testing is identifying the strain, looking for strains of high-risk HPV, which are known to cause cervical pre-cancer, which is called dysplasia and cervical cancer.

Host: Well, knowing all of that, I mean, what causes cervical cancer? Can you get into that a bit more for us?

Dr. Jackie Wall: Absolutely. Almost all cervical cancer is caused by HPV, which is the human papilloma virus. There are many, many strains of this virus. There are certain high-risk types that are harder for the body in your immune system to clear spontaneously. And when these persist for extended periods of time, they can cause precancer and cancers of the cervix.

There are other types of HPV that can cause genital warts. Very importantly, HPV is also associated with other cancer types besides cervical cancer. Some important ones being cancers of the vulva and the vagina for women. Anal cancer for men, penile cancer and certain oropharyngeal cancers.

Host: And are there any ways that we can reduce the risks of cervical cancer?

Dr. Jackie Wall: Yes, definitely. This is extremely important. The most important component in preventing cervical cancer is through HPV vaccination. Fortunately, this has been available in the United States for many years now. We currently use an HPV vaccine that protects against nine different strains of HPV. These are the highest risk strains implicated in causing cervical cancer, as well as ones that cause genital warts. We recommend that this vaccine be administered before any HPV exposure, which is spread primarily through sexual contact. So, the best time to be vaccinated, and the recommendation across medical societies in the United States, including the American Association of Pediatrics, as well as the American Congress of Obstetricians and Oncologists, recommend that both males and females be vaccinated between the ages of 11 and 12. And really, this vaccine can be safely introduced even at nine years old. The current schedule is that two doses are recommended. Something that patients occasionally will ask is, "Well, I did not receive this vaccine as an adolescent or a teenager," we can actually give what's called catch-up vaccination, where this can still be offered past that time if you didn't receive it at that age. We always like to remind patients this is a really important vaccine that also, fortunately, has a very excellent and well-established safety profile.

Host: And then, how is cervical cancer treated?

Dr. Jackie Wall: The treatment of cervical cancer really depends on the stage at which it was diagnosed. Some patients who have a very early cervical cancer can be treated and cured with a simple hysterectomy. Women who are diagnosed with an early-stage cervical cancer who may desire to preserve their fertility, may be a candidate for a procedure called a cervical cone or a trachelectomy, which may be appropriate until they are able to complete childbearing.

However, once cancers are larger or more advanced, treatment does change. So even in early cervical cancer that is larger, but still combined to the cervix, can be treated with a special kind of hysterectomy that is called a radical hysterectomy. This differs from a simple hysterectomy in the amount of tissue that is required to be removed at the time of surgery in order to be curative. Patients that then have cancers that have spread beyond the cervix within the pelvis or are too large to be treated with the radical hysterectomy are treated with a combination of radiation to the pelvis and chemotherapy. The chemotherapy in this setting is used because it improves the efficacy of the radiation. Once cervical cancer has spread beyond the pelvis and has distant metastatic disease at the time of diagnosis, these patients are treated with systemic chemotherapy.

Host: All right. And what are the side effects of that cervical cancer treatment?

Dr. Jackie Wall: Understanding the side effects of these treatments is extremely important, and we really strive to discuss these before initiating treatment as well as throughout treatment, because obviously things change as time goes on. The side effects really do depend specifically on the kind of treatment being utilized.

Fortunately, most patients who are having surgery as treatment do very well, both following surgery initially and with few long-term side effects. We see the most side effects from radiation. However, as this treatment has improved over the years, there are some common side effects from radiation that can cause skin changes while the treatment's being received. It can cause issues with the gastrointestinal systems such as diarrhea and can impact the bone marrow. Additionally important too, the field of radiation does include the ovaries, which does lead to menopause.

Host: Well, with all of that being known, how can cervical cancer patients improve their quality of life during and after treatment?

Dr. Jackie Wall: I always really try to emphasize to patients who are going through this care how important it is to keep your care team informed of your own unique experience during your treatment. Both the treatment and the side effects, which I alluded to a little bit, are really not one-size-fits-all. And so, for us to understand how this is impacting a particular patient's own life is extremely important to me. We work very hard to be proactive in symptom management, because this is such a large ordeal that patients are going through.

For example, patients who are going through radiation are provided with a bunch of supplies at the beginning of their treatment from our wonderful radiation oncology colleagues to help them manage some of the most common and expected symptoms. I think a point that is often missed is that we routinely use hormone replacement therapy in these patients to treat the symptoms that result from going through menopause, due to radiation to the ovaries. And we also use vaginal estrogen to help treat the changes in the vagina that occur as a result of both radiation and the loss of ovarian hormone function.

We have really great social support resources, which include social work, support groups and wellness activities. It's really, really important to us that we can support patients and their families and their caregivers through their treatment and help them to live longer and to live well following their cancer treatment.

Host: Of course. And what are some misconceptions around cervical cancer?

Dr. Jackie Wall: I think one of the biggest ones is that, unfortunately, cervical cancer traditionally has really been stigmatized given its association with a virus that is spread through sexual contact. I think that this is just really extremely unfair, and it really ignores the complexities that each unique patient has experienced in life and then brings in with them at the time of their diagnosis and when we're meeting them for the first time in clinic.

Really, no two stories and no two experiences are the same. And there's a lot of really important work going into dismantling these misconceptions about cervical cancer and also addressing the social inequalities that many patients continue to face that impact their healthcare.

Host: And to wrap us up today, is there anything else you want folks to know about cervical cancer, whether it's prevention, treatment, anything else?

Dr. Jackie Wall: I think the primary thing is this is a preventable cancer, that we have a lot of tools now that we can really use to our advantage to make that happen. I hope that anyone who's facing this diagnosis or it's impacting a loved one in their life knows that there are many options available to them for treatment and support, and that their care team is fighting really hard for them to succeed. And additionally, you know, I really, really hope that we do see a day when we can eradicate this cancer, because we have all the tools at our disposal to make this a reality.

Host: Thank you so much for this conversation. That was Dr. Jackie Wall. For more information or to schedule an appointment with our gynecologic team, call 800-762-6161 or visit masseycancercenter.org. If you enjoyed this podcast, please share it online and explore our podcast library for more topics of interest. I'm Caitlin Whyte, and this is Healthy with VCU Health. Thank you for listening.