Cervical cancer is one of the more common cancers of the female reproductive system. Most cervical cancers are linked to infection by HPV (human papillomavirus).
Worldwide, cervical cancer is the second-most-common type of cancer that strikes women – behind only breast cancer.
Cervical cancer is diagnosed through a series of exams, typically beginning with a Pap and – if you’re older than 30 – the HPV test, followed by a colonoscopy (in which a lighted, magnifying instrument is used to examine your cervix) and biopsy (in which a sample of tissue is removed for analysis in a laboratory).
Ernest Han, MD is here to discuss cervical cancer, it's diagnoses and treatments.
Selected Podcast
Get the Facts on Cervical Cancer: What is the Real Cause?
Featured Speaker:
Ernest Han, MD
Ernest Han, M.D., is a surgical oncologist at City of Hope specializing in the treatment of gynecological cancers. He is a foremost authority on cervical and ovarian cancers. Transcription:
Get the Facts on Cervical Cancer: What is the Real Cause?
Melanie Cole (Host): Cervical cancer is one of the more common cancers of the female reproductive system, and many cervical cancers are linked to an infection of the HPV, human papillomavirus. My guest today is Dr. Ernest Han. He is a surgical oncologist at City of Hope specializing in the treatment of gynecological cancers, and he is the foremost authority on cervical and ovarian cancers. Welcome to the show, Dr. Han. First, tell us. What is cervical cancer, and how common is it?
Dr. Ernest Han (Guest): Yeah, cervical cancer is basically worldwide probably one of the most common cancers that women will have. In the United States though, it’s not quite as prevalent. But still, it is a very significant cause of lots of distress for physicians and the patients themselves. I have to say that cervical cancer is, when you think about where it is, it’s actually located at the mouth or the opening of the uterus, which is something that gynecologists and physicians like myself can see. That’s where you can use Pap smears to screen patients. It’s been a very effective means to screen for cervical cancers and detect these early.
Melanie: If a Pap smear is what helps to detect them early, what is the cause of cervical cancer? Are there many causes, Dr. Han, or just a few?
Dr. Han: Well, the studies thus far seem to indicate that the human papillomavirus is probably the main cause of cervical cancer. I have to say that probably over 90, 95 percent of cervical cancers are caused by this. We haven’t really made any associations with genetic causes or any specific other types of viruses or other things that have been clearly linked. But the HPV virus really is coming out as the dominant player that’s involved for cervical cancer.
Melanie: If someone gets a test, if you’ve been having your Pap smears regularly and then your doctor checks for the HPV virus and you test negative, do you still get a Pap smear every year? Do you wait and do it every three years or so?
Dr. Han: Yeah, the guidelines for Pap smear screening have really changed in probably the last five or ten years. Our guidelines have been constantly being adjusted over this period of time. And recently, about 2012 or so, there has been another major shift in Pap smear screening. We used to do Pap smears once every year for patients, and there was not even an HPV test that we could even do. Over the last many years now, actually, at least five, ten years, we’ve been really adding on these extra tests with HPV testing in addition to the Pap smear. In fact, there’s been some thought about even getting away with not doing the Pap smear but just doing an HPV virus test. That’s still somewhat controversial. Right now, really, if a woman comes in and has a negative HPV and a Pap smear test and they presumably would be between the ages of 30 to 65, they’re going to be able to get another Pap smear with another HPV test in five years. Some physicians still elect to just do a Pap smear without doing HPV testing, and then for that case, you’re going to be doing that every three years.
Melanie: How long does it take cervical cancer to develop? Is this a quick moving cancer if someone does have it?
Dr. Han: Generally, I would say that no. And that’s what’s really great about Pap smears is because you can detect these pre-cancerous changes early. Typically, cervical cancers are going to be things that evolve within five to ten years, and maybe even longer. These are not something that I would say that develops overnight. Again, that’s why Pap smears are very effective. Unfortunately, as an oncologist, we will see patients who never had gone to their gynecologist or had a Pap smear examination. Unfortunately, these women, if they haven’t had exams over five, ten years, you see unfortunately these kinds of cancers in these patients, and they’re unfortunately very advanced. This is not something if a woman’s been getting a Pap smear on a routine basis, as per our guidelines, the chances that you’re going to miss a cervix cancer is going to be very, very uncommon.
Melanie: Now, what about the symptoms? If someone does have some unusual symptoms, what would send them to see a doctor?
Dr. Han: Well, with cervical cancers, it is a mouth or opening to the uterus, and this is essentially in communication with the vaginal area. Very commonly, patients can develop bleeding or they can have discharge, sometimes even pain. Sometimes, these things occur during having intercourse. They sometimes notice some bleeding or spotting during intercourse. There are generally symptoms that patients may see. Unfortunately, if it’s become very advanced, we will typically see sometimes changes to even the bowel, the bladder. Bleeding and discharge are very common symptoms.
Melanie: How is it treated if you are diagnosed with cervical cancer?
Dr. Han: Well, nowadays again, the treatment paradigm has really been changed in the recent years. We went away from going to very aggressive surgical techniques to now maybe doing less aggressive surgical techniques. We’ve gone from doing surgeries from an open type of procedures now going to minimally invasive. We’ve even talked about fertility sparing options for women as well. I can say so depending on how early the cancer has been diagnosed, we really kind of tailor the treatments. Generally speaking, for more locally advanced cancers, typically those patients will actually undergo a combination of radiation with chemotherapy. That’s been shown to be a pretty effective treatment for cervical cancer in more advanced stages. However, in early stages, patients can often be candidates for surgery where you can remove the tumor. And if the patient happens to be a young woman who still desires to have children potentially, you can actually do fertility sparing options where you’re just taking out the cancer with a margin around it and still be able to preserve the uterus, which is what holds the pregnancy in place, and doing some special techniques to try to maintain that in place. Several centers across the country and even the world are doing these types of fertility sparing treatments and having some reasonable pregnancy outcomes from that.
Melanie: Is there anything you can do to prevent cervical cancer?
Dr. Han: Yeah, so because of the HPV virus being very highly associated with this, a lot of patients have come in and asked how do you prevent getting HPV. Well, right now, again in the field of cervical cancer, vaccinations have become a really important part, I think, for trying to prevent patients from getting cervical cancers. Now, have we been able to show that clearly in studies? Probably not for some time will we maybe see a shift in our cervical cancer incidence rates. But there are a lot of studies to show that definitely you can reduce your exposure to HPV with these vaccinations, which are done in young women before exposure to the HPV virus itself. I think we don’t know if we have to do any additional boosters or other things right now, but at least a sort of a one-time set of injections, I think, is at least recommended at this point. That’s probably one of the main things that have come out as a very important piece to preventing cervical cancers. I guess we will yet to see, I think in the future, how cervical cancer rates, if there are any significant changes that occur with this.
Melanie: In just the last minute or so, Dr. Han, tell us what research for cervical cancer on the horizon is being done at City of Hope, and give some hope to people that are worried about cervical cancer.
Dr. Han: We’ve been very much interested in both surgical and therapeutic options. One of the major things that we’ve been looking at is immunotherapy. Immunotherapy has become very, I think, an interesting area of research that has not been really explored very much, but newer drugs are now coming online for things like melanoma and other types of cancers. I think this is another unique opportunity where immunotherapy is maybe important. In addition, surgical options have been pretty much standard for a while. Again, we are trying to go to less aggressive surgeries and maybe doing procedures that can try to reduce some of the potential side effects for patients. For example, we often take lymph nodes out in patients to assess for the cancer spread, and there has been some shift now thinking that maybe we can do this more precisely with robotic surgery and special dyes that can actually detect what we call the sentinel lymph node in the patients in the lymph node areas, just like for breast cancer, where patients have a sentinel lymph node biopsy to prevent what they call lymphedema to the extremities. Similar things are being looked at also now for even pelvic cancers like cervical and uterine cancers. This may be a way to try to reduce potential side effects such as lymphedema, other kind of quality-of-life issues. But yes, still getting pertinent information for patients for their treatment.
Melanie: Thank you so much, Dr. Ernest Han. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening and have a great day.
Get the Facts on Cervical Cancer: What is the Real Cause?
Melanie Cole (Host): Cervical cancer is one of the more common cancers of the female reproductive system, and many cervical cancers are linked to an infection of the HPV, human papillomavirus. My guest today is Dr. Ernest Han. He is a surgical oncologist at City of Hope specializing in the treatment of gynecological cancers, and he is the foremost authority on cervical and ovarian cancers. Welcome to the show, Dr. Han. First, tell us. What is cervical cancer, and how common is it?
Dr. Ernest Han (Guest): Yeah, cervical cancer is basically worldwide probably one of the most common cancers that women will have. In the United States though, it’s not quite as prevalent. But still, it is a very significant cause of lots of distress for physicians and the patients themselves. I have to say that cervical cancer is, when you think about where it is, it’s actually located at the mouth or the opening of the uterus, which is something that gynecologists and physicians like myself can see. That’s where you can use Pap smears to screen patients. It’s been a very effective means to screen for cervical cancers and detect these early.
Melanie: If a Pap smear is what helps to detect them early, what is the cause of cervical cancer? Are there many causes, Dr. Han, or just a few?
Dr. Han: Well, the studies thus far seem to indicate that the human papillomavirus is probably the main cause of cervical cancer. I have to say that probably over 90, 95 percent of cervical cancers are caused by this. We haven’t really made any associations with genetic causes or any specific other types of viruses or other things that have been clearly linked. But the HPV virus really is coming out as the dominant player that’s involved for cervical cancer.
Melanie: If someone gets a test, if you’ve been having your Pap smears regularly and then your doctor checks for the HPV virus and you test negative, do you still get a Pap smear every year? Do you wait and do it every three years or so?
Dr. Han: Yeah, the guidelines for Pap smear screening have really changed in probably the last five or ten years. Our guidelines have been constantly being adjusted over this period of time. And recently, about 2012 or so, there has been another major shift in Pap smear screening. We used to do Pap smears once every year for patients, and there was not even an HPV test that we could even do. Over the last many years now, actually, at least five, ten years, we’ve been really adding on these extra tests with HPV testing in addition to the Pap smear. In fact, there’s been some thought about even getting away with not doing the Pap smear but just doing an HPV virus test. That’s still somewhat controversial. Right now, really, if a woman comes in and has a negative HPV and a Pap smear test and they presumably would be between the ages of 30 to 65, they’re going to be able to get another Pap smear with another HPV test in five years. Some physicians still elect to just do a Pap smear without doing HPV testing, and then for that case, you’re going to be doing that every three years.
Melanie: How long does it take cervical cancer to develop? Is this a quick moving cancer if someone does have it?
Dr. Han: Generally, I would say that no. And that’s what’s really great about Pap smears is because you can detect these pre-cancerous changes early. Typically, cervical cancers are going to be things that evolve within five to ten years, and maybe even longer. These are not something that I would say that develops overnight. Again, that’s why Pap smears are very effective. Unfortunately, as an oncologist, we will see patients who never had gone to their gynecologist or had a Pap smear examination. Unfortunately, these women, if they haven’t had exams over five, ten years, you see unfortunately these kinds of cancers in these patients, and they’re unfortunately very advanced. This is not something if a woman’s been getting a Pap smear on a routine basis, as per our guidelines, the chances that you’re going to miss a cervix cancer is going to be very, very uncommon.
Melanie: Now, what about the symptoms? If someone does have some unusual symptoms, what would send them to see a doctor?
Dr. Han: Well, with cervical cancers, it is a mouth or opening to the uterus, and this is essentially in communication with the vaginal area. Very commonly, patients can develop bleeding or they can have discharge, sometimes even pain. Sometimes, these things occur during having intercourse. They sometimes notice some bleeding or spotting during intercourse. There are generally symptoms that patients may see. Unfortunately, if it’s become very advanced, we will typically see sometimes changes to even the bowel, the bladder. Bleeding and discharge are very common symptoms.
Melanie: How is it treated if you are diagnosed with cervical cancer?
Dr. Han: Well, nowadays again, the treatment paradigm has really been changed in the recent years. We went away from going to very aggressive surgical techniques to now maybe doing less aggressive surgical techniques. We’ve gone from doing surgeries from an open type of procedures now going to minimally invasive. We’ve even talked about fertility sparing options for women as well. I can say so depending on how early the cancer has been diagnosed, we really kind of tailor the treatments. Generally speaking, for more locally advanced cancers, typically those patients will actually undergo a combination of radiation with chemotherapy. That’s been shown to be a pretty effective treatment for cervical cancer in more advanced stages. However, in early stages, patients can often be candidates for surgery where you can remove the tumor. And if the patient happens to be a young woman who still desires to have children potentially, you can actually do fertility sparing options where you’re just taking out the cancer with a margin around it and still be able to preserve the uterus, which is what holds the pregnancy in place, and doing some special techniques to try to maintain that in place. Several centers across the country and even the world are doing these types of fertility sparing treatments and having some reasonable pregnancy outcomes from that.
Melanie: Is there anything you can do to prevent cervical cancer?
Dr. Han: Yeah, so because of the HPV virus being very highly associated with this, a lot of patients have come in and asked how do you prevent getting HPV. Well, right now, again in the field of cervical cancer, vaccinations have become a really important part, I think, for trying to prevent patients from getting cervical cancers. Now, have we been able to show that clearly in studies? Probably not for some time will we maybe see a shift in our cervical cancer incidence rates. But there are a lot of studies to show that definitely you can reduce your exposure to HPV with these vaccinations, which are done in young women before exposure to the HPV virus itself. I think we don’t know if we have to do any additional boosters or other things right now, but at least a sort of a one-time set of injections, I think, is at least recommended at this point. That’s probably one of the main things that have come out as a very important piece to preventing cervical cancers. I guess we will yet to see, I think in the future, how cervical cancer rates, if there are any significant changes that occur with this.
Melanie: In just the last minute or so, Dr. Han, tell us what research for cervical cancer on the horizon is being done at City of Hope, and give some hope to people that are worried about cervical cancer.
Dr. Han: We’ve been very much interested in both surgical and therapeutic options. One of the major things that we’ve been looking at is immunotherapy. Immunotherapy has become very, I think, an interesting area of research that has not been really explored very much, but newer drugs are now coming online for things like melanoma and other types of cancers. I think this is another unique opportunity where immunotherapy is maybe important. In addition, surgical options have been pretty much standard for a while. Again, we are trying to go to less aggressive surgeries and maybe doing procedures that can try to reduce some of the potential side effects for patients. For example, we often take lymph nodes out in patients to assess for the cancer spread, and there has been some shift now thinking that maybe we can do this more precisely with robotic surgery and special dyes that can actually detect what we call the sentinel lymph node in the patients in the lymph node areas, just like for breast cancer, where patients have a sentinel lymph node biopsy to prevent what they call lymphedema to the extremities. Similar things are being looked at also now for even pelvic cancers like cervical and uterine cancers. This may be a way to try to reduce potential side effects such as lymphedema, other kind of quality-of-life issues. But yes, still getting pertinent information for patients for their treatment.
Melanie: Thank you so much, Dr. Ernest Han. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening and have a great day.