Cancer of the cervix – the section of tissue forming the lower opening of the uterus – may not have any initial symptoms. However, it can be detected earlier than other cancers, provided a woman sees her physician for an annual gynecological exam, including a Pap test. What’s more, thanks to a recently-introduced vaccine protecting against HPV (human papilloma virus, the major cause of cervical cancer), this disease is now more preventable than ever.
If you are one of the approximately 11,000 women who have been diagnosed with cervical cancer in the past year - including more than 200 in the Houston area alone - or if you have received a diagnosis of dysplasia (a pre-cancerous condition), we are here to help. Please visit the links below to find out how Methodist Obstetrics and Gynecology Group can provide you with the most advanced and effective treatment available for your condition.
- Clinical Trials for Cervical Cancer
- Multidisciplinary Approach to Cervical Cancer Treatment
- Chemoradiation Therapy
- Radical Surgery/Pelvic Exenteration
- Fertility-Preserving Surgery
- Cervical Dysplasia Screening and Treatment
- HPV Testing and Vaccination
As part of our ongoing commitment to groundbreaking research and advances in women’s health, The Methodist Hospital offers our patients the opportunity to participate in surgical and medical clinical trials. Please click here for information on our current studies. If you are interested in being a candidate for one of these trials, please talk to your physician and contact Dr. Carol Hodgson at 713-441-6616 to find out if you meet the criteria for participation.
We invite you to learn more about our clinical trials, including the types of trials we conduct, the benefits of participation and our commitment to patient safety.
After a diagnosis of cancer, you may be overwhelmed by all the steps to be taken and specialists to see on your road to wellness. Methodist’s multidisciplinary care helps you – and those who are treating you – by creating a cancer care “team” working and communicating closely with each other. Your team will be composed of your physicians, oncologists and specialists as well as those providing emotional and spiritual care (such as therapists and chaplains). As a group, your caregivers are able to not only devise the best possible treatment plan for your needs, but they can provide an ever-important means of support to you in your treatment and recovery.
Chemoradiation therapy combines both chemotherapy (intravenous and/or orally-administered anti-cancer medications) and radiation therapy. Chemoradiation may be induction therapy – an initial treatment meant to destroy some of the cancer cells – or adjuvant therapy, which is given after surgical or medical treatment to destroy any remaining cancer cells which may not be detectable. The Gynecologic Oncology Group (GOG), of which Methodist Gynecology Associates is a member, recently announced results of clinical trials which supported the greater effectiveness of chemoradiation, when compared with either chemotherapy or radiation alone, in cervical cancer treatment.
Radical surgery, a treatment option for advanced cervical cancer, is the removal of the uterus, cervix, vagina and parts of any nearby organs with which the cancer may be involved. The most extreme version of this surgery is called pelvic exenteration, which entails removing all pelvic organs, including reproductive organs, the bladder and rectum. The surgeon creates stomata (openings) for digestive waste to pass from the body; colostomy bags, or external collection bags for wastes, are used.
Radical surgery is used in cases of recurrent or extremely advanced cervical cancer, if previous treatments have not helped and it is the only option for survival. Since the surgery first came into use, however, there has been great innovation in the area of pelvic reconstruction. The Center for Restorative Pelvic Medicine at The Methodist Hospital offers the most advanced forms of restoration available after radical surgery.
In the case of dysplasia or early-stage cervical cancer, it may be possible to treat the cancer while still preserving a woman’s ability to conceive. This is an important option because of the number of women now waiting longer to have children than they did in the past.
If the cancer is diagnosed very early, a remedy as simple as conization (removal of a cone-shaped portion of the cervix, including the abnormal cells and a small amount of the surrounding normal cells) may be sufficient. However, most cases will require a procedure known as a vaginal radical trachelectomy, also known as D’Argent’s operation. In this surgery, which is performed through the vagina, the cervix, some surrounding tissues and possibly nearby lymph nodes are removed. Since the uterus and ovaries remain, pregnancy is still possible. In the case of somewhat more advanced disease, chemotherapy may precede this surgery.
Although a vaginal radical trachelectomy results in a short cervix, which increases risk of miscarriage or preterm birth, this condition can be managed with the help of your doctor.
Cervical dysplasia is a term describing an area of abnormal cells, also known as a lesion, growing upon on the cervix. Dysplasia must be diagnosed and treated promptly, as it is a precursor to cervical cancer. Diagnosis of cervical dysplasia begins with your annual pelvic exam and Pap test; which detects inflammation or abnormality of your cervix. You should see your doctor for this test each year after age 18, unless he or she instructs you otherwise. If you are over the age of 30, an HPV test is also important.
If test results show you have abnormal cells, additional testing will be done to determine what type of cells they are, and therefore, what kind of treatment will be needed. Pre-cancerous lesions can be treated through one of several methods, most of which are simple procedures performed on an outpatient basis. These include:
- Cryosurgery: This surgery uses a cooled probe to freeze and kill pre-cancerous cells.
- Laser surgery: Abnormal cells are destroyed using a laser. In laser surgery and cryosurgery, the dead cells will slough off after the procedure.
- Conization (cone biopsy): This method involves the removal of a cone-shaped portion of the cervix, including the abnormal cells and a small amount of the surrounding normal cells. Cone biopsy is also used to diagnose dysplasia after the Pap and other tests indicate abnormalities.
- LEEP (loop electrosurgical excision procedure): In this surgery, pre-cancerous cells are scraped away using an electrified wire loop.
- Hysterectomy: This procedure entails the removal of all or part of the uterus, including the cervix. Hysterectomy is usually performed in the most extreme cases, when other methods would not be effective.
Due to a recent increase in information and education, you may already be familiar with HPV, or human papilloma virus, which infects the cervix. HPV is transmitted through sexual contact, but it is far more common than sexually transmitted diseases. Up to 80% of women will contract HPV at some point in their lives, even with safe sexual practices. Since it is a virus, not a disease, it is not classified as an STD.
There are many different forms of HPV; these are classified as “high-risk” and “low-risk” types, based upon their likelihood of causing dysplasia, cancer and/or genital warts. Most people fight this virus off on their own (particularly in the case of low-risk forms of HPV), but in some cases, the infection remains – causing abnormalities in cervical cells that may lead to cancer.
Seeing your doctor for an annual Pap test is important for your cervical health. If you are over the age of 30, the combination of a Pap test and an HPV test is recommended. This combination is not normally recommended for women under 30, as they are less likely to have cervical cancer and more likely to have HPV (which will likely go away on its own); however, if you are under 30 and you have an abnormal Pap test, your doctor may perform an HPV test as well. An HPV test is simple, conducted just like a Pap test (and is often performed at the same time) and looks for possible high-risk forms of HPV.
For teenagers and young adults, a recently introduced HPV vaccine (known as Gardasil) can be an important part of preventing the HPV infections most likely to cause cervical cancer. Initial data has shown Gardasil to be extremely effective against HPV 16 and HPV 18, the types responsible for more than two thirds of cervical cancer cases.