Beyond the Diagnosis: Innovations in Cervical Cancer Care and Clinical Trials

Cervical cancer was once a primary cause of cancer death among women in the US. Thanks to incredible advancements in prevention, screening, and treatment, cervical cancer is no longer the death sentence it once was.

Cervical cancer begins in the cells of the cervix (the very bottom part of the uterus that connects to the vagina). It is a unique cancer because healthcare experts have found a way to prevent cancer before it develops through a vaccine. Screening with Pap smears and HPV tests allow healthcare providers to identify changes in cells that can become cancer. By treating or removing problematic pre-cancer cells, healthcare providers can stop cancer development in its tracks. Over the last 50 years, the rate of cervical cancer has dropped by more than half.

However, cervical cancer can still occur, and almost 14,000 women are diagnosed in the US each year. While it can be an overwhelming diagnosis, advancements in therapeutic options, brought on by groundbreaking clinical trials, have made treatment approaches more effective and long-lasting than ever.

Revolutionizing Care: Breakthroughs in Cervical Cancer Treatment 

As with many kinds of cancer, there are a range of treatment options for cervical cancer. Your treatment plan – which may include more than one kind of treatment – will depend on factors such as your stage of cancer, general health, and personal preferences.

According to Dr. Amelia Jernigan, Medical Director of Cancer Services for University Medical Center and Associate Professor and Division Director of Gynecology at LSU Health New Orleans, treatment plan conversations can be complex, but they’re also crucial.

"It takes a really tailored approach for most patients,” says Dr. Jernigan. “The things that we're looking at are the extent of the disease, the patient's wishes with regards to future childbearing, acceptable treatment side effects, and overall quality of life. You need to have really nuanced discussions with patients about the risks and benefits.”

These conversations are particularly important considering how quickly the landscape of cervical cancer treatment is changing. While some treatments have been around for centuries, researchers have developed new approaches that reduce recurrence of cancer and side effects.

Surgery

Depending on where the cancer is located, surgery can be used to remove cancer cells and treat cancer. According to Dr. Jernigan, surgery is the standard treatment for patients with early-stage cervical cancer. It comes with fewer side effects that could accompany more invasive treatment options.

“For the earliest state cases, our cure rates with standard surgeries, like excisional procedures of the cervix or simple hysterectomy, are approximately 100%,” says Dr. Jernigan.

Cervical cancer surgical approaches include:

• Cervical conization, which removes a cone-shaped piece of cervical tissue.
• Hysterectomy, which removes the uterus and sometimes surrounding parts of the body, such as the cervix, ovaries, fallopian tubes, nearby ligaments, and parts of the vagina. A radical hysterectomy means taking wider margins and more surrounding tissues like the parametrium, upper vagina, and connective ligaments. A simple hysterectomy removes the uterus and cervix but leaves the surrounding connective tissues.
• Lymph node dissection, which may mean the removal of the sentinel lymph node (the first and most likely lymph node for cancer to spread to from the original tumor) or the entire chain of nodes that drain the cervix.
• Salpingo-oophorectomy, which means removal of fallopian tubes and ovaries.
• Trachelectomy, which removes the cervix, but not the uterus, and can be performed because the uterus is already absent or to retain the uterus for fertility purposes. This can be simple or radical.
• Total pelvic exenteration, which removes the bladder, lower colon, rectum, cervix, ovaries, vagina, and nearby lymph nodes.

Radiation Therapy

Another approach to treating cervical cancer is called radiation therapy, which uses high-energy X-rays and other forms of radiation to destroy cancer cells or prevent them from growing by damaging their DNA.

There are two forms of radiation therapy:

1. External radiation therapy, which directs radiation toward a specific area of the body with a special machine.
2. Brachytherapy or internal radiation therapy, which involves using needles, seeds, wires, or catheters to directly apply a radiation source to treat diseased tissue.

Chemotherapy

Also called chemo, chemotherapy uses drugs to halt the growth of cancer cells. It does this by killing the cells or preventing them from dividing. It is usually administered through the vein or port, but oral chemotherapies exist. There are a range of chemotherapy drugs available, and your healthcare team will determine which one (or which combination of multiple ones) is best for you.

Targeted Therapy

Using drugs and other substances, targeted therapy stops the actions of certain proteins, enzymes, and other molecules that play a role in cancer growth. This differs from chemotherapy, which destroys all cells that divide and grow at a rapid rate. Instead, these treatments take advantage of a very specific molecular target.

Immunotherapy

The immune system is key in fighting all illnesses, including cancer. Immunotherapy supports the immune system in this role.

"Across all of oncology, we’ve seen an embrace of immunotherapy-based strategies,” explains Dr. Jernigan. When it comes to cervical cancer, this is largely thanks to a clinical trial called KEYNOTE 826, which confirmed the benefit of adding pembrolizumab (a type of immunotherapy) to our previous standard chemotherapy, carboplatin with paclitaxel with or without bevacizumab, when treating persistent, recurrent, or metastatic cervical cancer.

“There are new, even more targeted ways of harnessing the immune system. The LSU team has opened a clinical trial, GOG 3091, which utilizes a therapeutic vaccine against HPV and tests this approach with or without immunotherapy,” says Dr. Castellano, Assistant Professor of Gynecologic Oncology at LSU Health New Orleans and National Principal Investigator on this trial.

Dr. Jernigan added, “We should be so proud to have a member of our homegrown team leading this innovative national cooperative group trial that stands to seismically shift our approach to cervical cancer treatment.”

The Role of Clinical Trials in Advancing Cervical Cancer Treatment

Cervical cancer treatment is constantly improving as researchers discover the most effective treatment options with the least amount of side effects.

One way to access the latest cancer treatments is through clinical trials. In addition to receiving groundbreaking care, these studies also allow you to contribute to the understanding of cancer, helping to improve current and future treatments for everyone with the disease.

“We encourage patients to participate in clinical trials whenever available,” explains Dr. Jernigan. “But especially in recurrent settings when we start running low on therapies with high response rates, we really want people to consider participation in trials.”

“Breakthroughs from clinical trials have become key parts of treatment plans,” adds Dr. Jernigan. “It’s been a very exciting time. Things are moving so quickly. If you’re on a trial, you’re getting today’s best treatment and maybe tomorrow’s best treatment. If you’re not on trial, you might be getting yesterday’s best treatment.”

Multiple studies recently transformed the way cancer providers use systemic therapy (treatment that affects the entire body). “2023 was a very big year because multiple studies looking at systemic therapy for locally advanced and advanced or recurrent disease shifted the landscape,” says Dr. Jernigan.

Another standard approach to recurrent or metastasized cervical cancer is antibody drug conjugates (ADCs), which send powerful chemotherapy drugs to cancerous cells without damaging nearby cells.

According to Dr. Jernigan, “The idea of a ‘magic bullet’ that could selectively target tumor cells has been around since the early 1910s but has taken a century to come to fruition.” As a result of clinical trials, there are over a dozen ADCs on the market and hundreds under investigation.

The Gulf South Clinical Trials Network is committed to providing the most advanced cancer treatments to patients in the Gulf South region. To find a clinical trial near you, visit their clinical study online search.

Preventing, Treating, and Navigating Cervical Cancer

Thanks to the dedication and expertise of healthcare researchers and providers, cervical cancer is not only treatable, but it’s also preventable. Getting vaccinated against HPV, staying on top of cervical cancer screening (such as Pap tests and HPV tests), and committing to a healthy lifestyle are all key in preventing cervical cancer.

Cervical cancer screening is also crucial in catching cancer in its early stages. “If you catch it early with screening, it's very simple to treat,” says Dr. Jernigan.

For instance, Pap smears (or Pap tests) can detect cancer before it develops. “The Pap smear is the quintessential screening tool in all of medicine,” she says. “Everybody wants a version of the Pap smear.”

While screening is a powerful tool, follow-up care is just as important if abnormal results occur. According to Dr. Jernigan, this is where some patients fall through the cracks due to barriers to care, like finances, travel, and insurance. University Medical Center offers resources to help all patients get the care they need. Talk to your healthcare provider about the challenges you’re facing, and they can direct you to the right place for support.

The advancements in screening for and treating cervical cancer are saving more lives every day. By being proactive about your health and staying in close contact with your healthcare providers, you can support your cervical health now and in the future.