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Healthy You

Cervical Cancer and Your Options

October 16, 2019 12:30 PM with Tilley Jenkins Vogel

About 13,240 new U.S. cases of invasive cervical cancer will be diagnosed. Increase your awareness about cervical cancer in a chat with Tilley Jenkins Vogel, MDGynecologic Oncology Program at NorthShore – she will be taking your questions and providing expertise on the symptoms, current prevention techniques and genetic tests, and the latest available treatment options.

Cervical Cancer

Ben (Moderator) - 12:21 PM:
We are going to get started in about 10 minutes. You can get your questions in now for the Dr.

Tilley Jenkins Vogel - 12:29 PM:
Hello This is Dr. Vogel- part of the gynecologic oncology team at NorthShore. I am happy to take any questions.

  Jackie (Chicago, Illinois) - 12:31 PM:
Good morning, Recently, I had a friend who had two masses; one on her cervix and the other on her uterus. Sadly, she lost her battle with cancer. My question is, would a routine pap smear have detected irregular cells in these two areas? Isn't this the reason we get yearly pap smear testing, in order to prevent further issues? Thank you for your time!
Tilley Jenkins Vogel
A routine Pap smear should detect precancerous or cancerous cells in the cervix. In fact, Pap smears are specifically targeted to detect irregularities in the cervix. (So you are correct- this is exactly why we recommend Pap smears.) Pap smears are not great for detecting abnormalities higher up in the uterus. Rarely, we do pick up uterine cancers on routine Pap smears. But in general, Pap smears are inadequate for detecting uterine cancers. Thus with any abnormal bleeding, we recommend that you have an evaluation with your gynecologist.

  Lou (Evanston, IL) - 12:35 PM:
What causes cervical cancer?
Tilley Jenkins Vogel
The vast majority of cervical cancers are caused by a virus- HPV (human papillomavirus).

  Bill (Winnetka, IL) - 12:37 PM:
What percentage of people in remission end up showing signs of cancer again?
Tilley Jenkins Vogel
This depends very much on what the stage of the cancer is at diagnosis. For example, for very early-stage cervical cancer, almost no one will experience relapse (i.e. risk of the cancer coming back is probably 2-3%). In contrast, for those with advanced (stage 4) cervical cancer, 80-90% will experience the return of cancer.

  Pat (Chicago Il) - 12:45 PM:
I'm a 31 y.o. F. No kids. I had a kidney stone when I was 22 years old and before surgery to remove my kidney stone I had a CT scan. The CT report mentioned something about a left adnexal cyst/follicle measuring 2.7 x 2.2 cm. Generally, I feel fine. Is this something I can just live with (like I've been doing for the last 9 years) or do you recommend I follow up with someone? thank you.
Tilley Jenkins Vogel
I'd recommend annual visits with a gynecologist, per routine. Follicles are normal findings on ovaries in young women. No specific follow-up is recommended based on the CT scan (especially if it has been 9 years since it was performed).

  Kathy (Lincolnwood, IL) - 12:52 PM:
Does everyone need surgery once diagnosed or are there other degrees of response to a diagnosis? What kinds of surgery can someone diagnosed typically expect?
Tilley Jenkins Vogel
For cervical cancer, many patients do NOT need surgery. Many receive a combination of chemotherapy and radiation therapy which is curative (and is more effective than surgery depending on the stage of disease). Others with early cervical cancer DO require surgery. This is typically comprised of a hysterectomy (removal of the uterus and cervix). Sometimes ovaries, fallopian tubes and, lymph nodes are also removed. For women who would like to retain the uterus in order to preserve the option for pregnancy, there are sometimes less radical surgical options. But the cancer must be very early to qualify for this type of treatment. All women will require a biopsy of the cervix to confirm the diagnosis prior to treatment. Sometimes this is performed in the operating room. Frequently, however, this can be performed in the office.

  Jackie (Chicago, IL) - 1:00 PM:
I'm in menopause (7 years). Had 2 periods within that time, the latest this past January. Had testing done and the diagnosis was an "enlarged uterus w/a thickened endometrial stripe measuring up to 9 mm w/is abnormal for a postmenopausal female w/vaginal bleeding." My physician gave me meds to have a period to shed the lining. Should I be concerned that my uterus lining will get even thicker and become cancerous? Can this happen even though a period isn't there to "warn" me something is wrong?
Tilley Jenkins Vogel
Good question. In any woman with postmenopausal bleeding, I would recommend an evaluation. So very good that you went for testing. An ultrasound is a pretty good test. A biopsy of the lining of the uterus, however, is a better test (as it allows us to get a concrete diagnosis of what is going on inside the uterus). So I would NOT recommend that you simply take meds to shed the lining. I would recommend that you have a procedure called an endometrial biopsy. This can be performed in the office and is uncomfortable, but minor. If this is normal and the bleeding stops, this is reassuring. However, in the absence of a biopsy to confirm exactly what the lining of the uterus is doing we do not have an explanation for the bleeding. So this is a long answer to a very good question. I am glad that you asked. You are absolutely correct. We otherwise would not know what is happening in the uterus without a biopsy.

  Jenny (Evanston, IL) - 1:09 PM:
Have there been any new advancements or changes in the detection and treatment of cervical cancer in the last few years?
Tilley Jenkins Vogel
There have been advances in treatment, absolutely. We are now using immunotherapy for women in whom the cancer has returned with some success. As far as detection goes, we have tailored the guidelines for Pap smear testing and are using HPV testing as a primary means to identify patients at risk. This has been helpful in detecting some patients that would have been missed by regular Pap smears alone. As Pap smear guidelines are changing frequently (and there will be new guidelines out in 2020), I recommend that you keep a dialogue open with your primary provider/ GYN. What is super important for prevention is to have the HPV vaccine. Women up to 45 years of age are eligible (and it should be covered by insurance).

  Jill (Niles, IL) - 1:16 PM:
Can I lower my risk for getting cervical cancer? Like a specific diet or other steps I can take before anything is detected?
Tilley Jenkins Vogel
Great question. The best way to lower your risk of cervical cancer is to continue regular screening with your gynecologist. Depending on your specific history, some patients require Pap smears every 3 years while others need Pap smears more frequently. Regardless of timing of Pap smears, you do need a yearly visit with a gynecologist to assess for any abnormalities. IF you are having symptoms such as irregular bleeding or bleeding after sex then I would recommend an early assessment. A healthy diet has not necessarily been linked to cervical cancer prevention but IS important for other cancer prevention and general good health. It is also very important that you do not smoke cigarettes (as tobacco use is associated with a higher cervix cancer risk). Safe sex practices (i.e. condom use) are also helpful for preventing cervix cancer as it is caused by a virus that is transmitted sexually.

  Anastasia (Westfield, IL) - 1:23 PM:
If my mom had breast cancer, am I at higher risk for cervical cancer? Are there any genetic tests I should get to find out if I’m at increased risk for cervical cancer?
Tilley Jenkins Vogel
Breast cancer and cervical cancer are not typically linked (as most cervix cancers are not hereditary, rather they are caused by an infection- a virus). As such we do not recommend genetic testing for cervix cancer aside from very rare, specific circumstances. Depending on the age at which your mother was diagnosed and the cancer history in other family members, you may be at increased risk for breast and other cancers. I would recommend that you discuss with your primary care physician or gynecologist further to better understand your risk.

  Phoebe (Morton Grove, IL) - 1:26 PM:
You mentioned immunotherapy to treat cervical cancer...what does that all entail/mean?
Tilley Jenkins Vogel
Immunotherapy is an IV treatment, similar to chemotherapy in many ways (but with different side effects). It is usually given when cervical cancer has returned after initial treatment. Not all women with cervical cancer are candidates. The cancer needs to have a specific profile under the microscope in order for someone to qualify for this type of therapy (outside of treatment on a clinical trial). If you or someone you know has cervical cancer and is interested in learning more about immunotherapy options, I would encourage you (or she) to discuss with the treating oncologist.

Ben (Moderator) - 1:30 PM:
That's all the time we have today for questions. Thank you Dr. Vogel for your time and expertise!

Tilley Jenkins Vogel - 1:34 PM:
Thanks for all of the great questions. I hope that this discussion was helpful. Have a great day.
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