Cervical cancer: Q&A with Dr. Tucker

1. What actually causes cervical cancer?

There is no one specific cause of cervical cancer but we do know of a few very important risk factors. The most important risk factor for cervical cancer is infection with a virus called the human papillomavirus (HPV). HPV is spread by direct skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (eg, hand-to-genital contact). HPV can also cause a noncancerous condition called genital warts (condyloma). 
Most HPV infections are temporary because the body’s immune system clears the infection. When certain types of HPV virus persist (in 10 to 20 percent of cases), there is a higher likelihood of developing cervical cell abnormalities and cervical cancer. HPV can be detected in almost all cervical Additional risk factors for cervical cancer include cigarette smoking, or a weakened immune system (caused by certain diseases, medications, and HIV/AIDS).

2. Does it has something to do with lifestyle? As you are mentioning to me that girls actually gets that from boys?

Cervical cancer does have some life-style risk factors such as a tobacco use which increases the risk of cervical cancer. Smoking cigarettes increases the risk of cervical cancer and pre-cancer by up to seven times that of women who do not smoke. Stopping smoking can decrease this risk.

HPV is spread by direct skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (eg, hand to genital contact). It is not possible to become infected with HPV by touching an object, such as a toilet seat.

Infection of the cervix with certain types of human papillomavirus (HPV) is the most significant risk factor for cervical abnormalities and cancer. Over 100 different types of HPV have been identified, however not all types infect the cervix or cause cancer. Doctors have labeled the HPV types as being high or low risk for causing cervical cancer. HPV types 6 and 11 can cause warts and are low- risk types because they rarely cause cervical cancer; types 16 and 18 are considered high-risk types because they may cause cervical cancer in some women.

3. Does vaccination really work? When is the best time to have the vaccination? Does it work for a 30 year-old lady?

YES! Vaccination really works for preventing cervical cancer. Human papillomavirus (HPV) causes more than 99 percent of cases of cervical cancer and genital warts. Persistent infection with certain types of HPV can lead to cancer of the cervix, which affects hundreds of thousands women every year. Cervical cancer is the 3rd most common cancer world-wide. The virus less commonly causes cancer of the anus, vagina, vulva, penis, mouth, or sinuses.

Two vaccines (Gardasil® and Cervarix®) are now available to prevent infection with the two types of HPV known to cause cervical cancer. It is expected that the use of these vaccines will significantly reduce the number of women who develop cervical cancer.

In the United States, Gardasil® is recommended for all girls and women who are between ages nine and 26 years. Cervarix® is not yet available in the United States; in Australia, Cervarix® is recommended for all females between age 10 and 45 years and for boys age nine to 15 years.

With both vaccines, it is important to be vaccinated before becoming sexually active since the vaccine does not help to eliminate HPV infection after it has occurred. However, women age 26 years or less who have been sexually active or who have had genital warts, a positive HPV test, or an abnormal Pap smear may still benefit from the HPV vaccine, and are encouraged to get vaccinated.

Gardasil® is not currently recommended for women over 26 years old because most women have already been exposed to the virus by this age. However, the vaccine is probably safe and effective for older women as well; studies are underway to answer these questions.

4. What kind of lifestyle changes we can undertake to prevent cervical cancer?

Key lifestyle choices to prevent cervical cancer relate to sexual activity and HPV vaccination. HPV is a sexually transmitted disease thus any unprotected sexual activity will increase the risk of HPV and ultimately cervical cancer. As noted above, smoking cigarettes also significantly increases the risk of cervical cancer. There is absolutely no advantage or benefit to smoking cigarettes!

5. Is there any specific symptom that we should be aware of?

Most people who are infected with HPV have no signs or symptoms. Most HPV infections are temporary and resolve within two years. When the virus persists (in 10 to 20 percent of cases), there is a higher likelihood of developing cervical cell abnormalities and cancer. However, it usually takes many years for HPV infection to cause cervical cancer.

6. What is actually happens when someone diagnosed with cervical cancer?

There are several options for treatment of early stage cervical cancer. The ideal treatment depends upon the woman’s age and her childbearing plans, the stage of the cancer, whether underlying medical conditions are present, and the physician’s and patient’s preferences.

The most common treatment for early stage cervical cancers is radical hysterectomy (surgical removal of the cervix and uterus).

The alternative is radiation therapy, which is usually given in combination with chemotherapy. Patients with the earliest stage cervical cancers may also be treated by cervical conization or simple hysterectomy alone.

Most women who undergo radiation for cervical cancer also receive chemotherapy during the radiation therapy (an approach termed chemo-radiotherapy). Chemotherapy drugs are medicines that stop or slow the growth of cancer cells. In general, these drugs work by interfering with the ability of rapidly growing cells (like cancer cells) to divide or multiply.

Chemotherapy also has the ability to enhance the damaging effect of radiation therapy on cervical cancer cells; when chemotherapy drugs are used in this manner, they are referred to as “radiation sensitizers”. The chemotherapy is usually given once per week through a vein during the course of EBRT.

7. What is the best treatment for CC?

See above.

8. What can a family do to support the patient?

The women and families affected by cervical cancer commonly experience distress as they worry about their short and long- term health and risk of recurrence. In some cases, this distress continues for many years after treatment ends.
Communication between the woman, her family, and her healthcare team is a vital part of the treatment process. Many women benefit from bringing a family member or friend to physician visits; this person can help the woman to understand her options, ask important questions, take notes, and feel supported.

9. Is there any comprehensive treatment for cervical cancer which combines food combining, eastern medicine, meditation approach that you know in Singapore or elsewhere? I remember clearly that you mentioned a lot of things about the new approach during our last meeting. Is your center is the only such center offering this approach in SE Asia?

All of the above items are beneficial and available in Singapore. However the best results come from using both conventional therapy (surgery, radiation, and chemotherapy) along with the complementary approaches listed above. We would not advise that cervical cancer be treated solely with complementary medicine. Only by integrating the Western (conventional) medicine and the Eastern (complementary) medicine can the best results be obtained.

[Image source: Wikimedia Commons]

Original article was written on 8 January 2014