Daily Checkup: Cervical cancer's challenges

Dr. Konstantin Zakashansky, an associate professor of obstetrics and gynecology at Mount Sinai, breaks down the relationship between the HPV virus and cervical cancer.

Dr. Konstantin Zakashansky, an associate professor of obstetrics and gynecology at Mount Sinai, breaks down the relationship between the HPV virus and cervical cancer.

The Specialist:

An associate professor of obstetrics and gynecology at Mount Sinai, Dr. Konstantin Zakashansky specializes in treating women for cancers of the reproductive system. January is Cervical Cancer Awareness Month.

Who’s at risk:

Over the years cervical cancer has claimed the lives of “Moesha” star Yvette Wilson, Argentinian First Lady Eva Peron and many others. Thankfully, though, more and more women are able to prevent cervical cancer entirely — or get diagnosed early enough to be cured.

“There are several types of cervical cancer, all of which attack the fibrous tissue and glands that make up the very bottom of the uterus, which is called the cervix,” Zakashansky explains. “The good news is that we now have screening that can diagnose patients while the disease is still precancerous, so we’re doing a better and better job of detecting this cancer early and curing people.”

Although the number of American women diagnosed with cervical cancer has been dropping for decades, the disease is still a major global health problem.

“Fewer than 13,000 American women are diagnosed with cervical cancer annually, and we can offer effective treatment for most of them,” Zakashansky says. “Globally, however, cervical cancer affects over 500,000 women, and more than half of them die.”

Most cervical cancers are associated with exposure to HPV, the human papillomavirus. “At this point, almost every woman in the U.S. will be exposed to HPV, but most of them can clear it through the immune system,” Zakashansky says. “Sometimes, however, the HPV virus invades the cells of the cervix, transforms the DNA and turns a normal cell into a cancer cell. Our screening actually allows us to catch this process midway while the cells are still precancerous, and the disease is easier to treat.”

It usually takes about 15 to 20 years between HPV exposure and developing cancer. “There are many different types of HPV, but two HPV subtypes (16 and 18) are responsible for 70% of cervical cancers and precancerous cervical lesions,” Zakashansky says.

Some women have an elevated risk of developing cervical cancer. “We consider patients at high risk if they are immunosuppressed, which can be the result of HIV, taking steroid treatments or smoking,” Zakashansky says. “Something we don’t know is why most healthy women can fight off HPV but some can’t.”

Unlike many other cancers, cervical cancer is not increasingly likely with age. “Most women are diagnosed in middle age. The median age of diagnosis is something like 48,” Zakashansky says. “Most women are under 50 when they receive this diagnosis.”

Signs and symptoms:

Most cervical cancers do not cause any symptoms while the disease is in the early stages or still pre-cancerous. “The reason regular Pap smear with HPV testing and pelvic exams are so important is because these tests make early detection of cervical cancer possible,” Zakashansky says. “As much as possible, we want to make this diagnosis before women begin to experience symptoms.” Pap smears can catch precancerous cells while the disease is still microscopic.

There are certain red flags to keep an eye out for. “Because cervical cancer masses on the cervix, it can lead to symptoms like bleeding after intercourse or examination, spontaneous bleeding and eventually pain,” Zakashansky says. “If the cancer spreads to the side wall, it can cause back pain or leg swelling.”

Traditional treatment:

The appropriate course of treatment will depend on the type of cervical cancer and how advanced it is. “Microscopic levels of cancer can be treated by removing only the cancerous cells through what is called a cone procedure,” Zakashansky says. “the cone procedure is basically a large biopsy. It removes the lesion with just a bit of adjacent tissue.”

Larger cancers can require the removal of the whole uterus. “For women who want to preserve fertility, we now have surgical options that allow us to remove the cervix while preserving the uterus to support a future pregnancy,” says Zakashansky. “Chemo-radiation (a combination of chemotherapy and radiation) is a primary treatment option for more advanced cancers.”

Increasingly, cervical cancer is a treatable and curable disease. “The vast majority of patients who are diagnosed with stage 1 or 2 cervical cancer will be cured,” Zakashansky says. “It’s certainly a serious diagnosis and treatment can be intense, but most of the time the prognosis for cervical cancer is good.”

Research breakthroughs:

Doctors are making headway in the fight against cervical cancer.

“The vaccines we now have for HPV are preventive, but now researchers are developing vaccines that might be able to be used to treat cervical cancer,” Zakashansky says. “There are also several trials underway to improve our ability to treat young women with less radical surgery — so they are more able to carry a pregnancy in the future.”

Questions for your doctor:

Every woman should ask her doctor, “How often should I be getting Pap smears?” The answer will depend on your age and factors like your personal health history. If you do get an irregular Pap smear result, ask “What does this result mean?” Follow up with, “How can I stay on top this?” And if you do receive a cervical cancer diagnosis, then ask, “Can you refer me to a specialist?”

“One of the best things you can do for your health is to stay on top of visits to the gynecologist and not ignore irregular Pap smears,” Zakashansky says. “If you do get this diagnosis, the good news is that the majority of patients can be treated and cured.”

What you can do:

Get informed. To read more about cervical cancer, try the American Cancer Society (cancer.org/cancer/cervicalcancer/) or Mount Sinai (mountsinai.org/).

Have a regular checkup. Regular obgyn visits and Pap smears are the best defense against cervical cancer. “Don’t ignore irregular Pap smear results. If there is a problem, staying on top of it can prevent the abnormal cells from progressing to cancer,” Zakashansky says.

Get vaccinated for HPV. Doctors recommend that all children be vaccinated for HPV between age 9-11.

See a specialist. If you’ve been diagnosed with cervical cancer, consult a specialist who will know the full range of treatment options available.

By the numbers:

— About 200,000 women are diagnosed with cervical cancer annually.

— Under 13,000 of those cancers will be invasive at the time of diagnosis.

— About 4,100 women die of cervical cancer each year.

— Most cervical cancer is diagnosed in women under the age of 50.

Source: American Cancer Society.

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