Cervical cancer is a condition of paradox for healthcare professionals. Doctors know what causes cervical cancer and how to reduce the likelihood of developing it. Cervical cancer has a long latent phase, which means it can take years for the condition to progress from precancerous to invasive. There is a reliable and simple screening test for cervical cancer―the Pap test―and in its early stages, the condition is highly curable. Pap smears are one of the best tests a woman can take. Despite these positive factors, every year, about 14,000 American women are diagnosed with the condition and about 3,900 die from it.

“Even though we have made great strides against cervical cancer in the United States, it still proves fatal for many women. This is despite the knowledge we have about the condition and the screening tools and the treatments we have available,” says Dr. Bernadette Cracchiolo, Director of the Division of Gynecologic Oncology at University Hospital and Assistant Professor of the Department of Obstetrics, Gynecology and Women’s Health at New Jersey Medical School. “We have answers to many of the questions about cervical cancer. The one we have been unable to answer is, How do we reach those women who do not get Pap smears?”

The answer is most likely a complicated mixture of many factors, including limited or sporadic access to health care and cultural attitudes that are fatalistic toward diseases such as cancer. At University Hospital, Dr. Cracchiolo and Dr. Mario Leitao, Jr. are two physicians with highly specialized fellowship training in both gynecology and oncology. Cervical cancer is the type of cancer that they treat most frequently. “While many women will come to our office or to the clinic for a Pap test, very few return for treatment if their Pap smear is abnormal,” she observes. “We see a lot of women with late-stage cervical cancer, and we provide the best care possible. The best results, however, occur in women in which the cancer is diagnosed early.”

Regular Screening is Invaluable

The cervix, part of the female reproductive system, is located between the uterus and the vagina. It acts as a passageway for menstrual flow. In pregnancy, a tightly closed cervix keeps the fetus within the uterus; it opens during labor, permitting the fetus to descend into the vagina.

Many cases of cervical cancer are caused by the human papillomavirus (HPV), which, like other viruses, spreads from person to person. HPV is transmitted sexually, so women who have had multiple partners or a high-risk partner or who began having intercourse at any early age are more at risk for HPV than others. Not every woman infected with HPV will develop cervical cancer. However, research indicates that women with HPV who smoke, have used birth control pills for more than five years, or have a weakened immune system have a greater chance of developing cervical cancer.

In its early stages, cervical cancer is typically a “silent” condition, but that is when it is also highly treatable. That is why screening for cervical cancer is so important. The standard screening test, the Pap test, involves a clinician taking a sample of cells from a woman’s cervix and sending the sample to a laboratory for a pathologist’s examination. A newer, liquid-based cytology test, called the ThinPrep, uses a different method of cell preparation than the Pap, but both tests have about the same rate of accuracy. “What’s important is that a woman follow her doctor’s recommendations on how frequently she needs to be screened,” notes Dr. Leitao, Jr., an assistant professor in the Department of Obstetrics, Gynecology and Women’s Health, Division of Gynecologic Oncology, at New Jersey Medical School. “For women over 21, it’s advisable to have either a Pap smear once a year or the ThinPrep once every two years. We advise sexually active teens to have their first Pap three years after they first had intercourse.” Women who are beyond childbearing still need a Pap smear, a fact that many women forget. An abnormal or unclear screening result does not always mean a woman has cervical cancer, but it does call for additional testing.

Screening tests for cervical cancer can help save lives and are strongly recommended by Dr. Cracchiolo and Dr. Leitao, but there are also symptoms of the condition that should not be ignored. Abnormal vaginal bleeding, bleeding after intercourse, or any vaginal bleeding after a woman reaches menopause are signs something might be amiss. In later stages of cervical cancer, the woman might have such symptoms as severe abdominal pain or blood in her urine.

From Screening to a Cure

If a woman’s screening test suggests the presence of precancerous or cervical cancer cells, a biopsy will be taken of tissue from the cervix. When cancer is present, the physician determines the extent of the cancer and how far it has spread, or its stage. The stages of cervical cancer range from Stage 0, in which cancer cells are found only in the top layer of cells, to Stage IV, in which the cancer has spread to other parts of the body, such as the bladder. Most women with cervical cancer are at an early stage when a cure is possible.

The treatment for cervical cancer depends on its stage. For the very earliest stage of cervical cancer, it’s possible in some cases to remove or destroy pre-cancerous or cancerous tissue without taking the uterus or damaging the cervix. For some women, however, a hysterectomy is recommended. “That might be a medically appropriate and acceptable option for women who are past their childbearing years, are happy with the number of children they have or who don’t want to have a child,” says Dr. Leitao. “However, it can be a difficult option for younger women who have a good likelihood of surviving the cancer, but then are unable to have children.”

Dr. Leitao has special training in a fertility-sparing alternative for younger women with early stage cervical cancer called a radical trachelectomy. In this procedure, the cervix and the lower part of the uterus are removed, with a sufficient amount of the uterus remaining to support a pregnancy. “Not all women are candidates for a radical trachelectomy, such as those with large tumors or whose cancer has spread beyond the pelvis,” he says, “but for those who are, it can provide the possibility of having children in the future.”

Chemotherapy and radiation are also used to treat some women with cervical cancer, most often in late stage of the disease, when the cancer has spread beyond the cervix.

Cervical cancer has a high cure rate. When the tumor is confined to the cervix and is less than four centimeters in size, the cure rate is in the high 80% to low 90% range; when the tumor is greater than four centimeters, the survival rate decreases to between 80% and 85%, but that’s still good.

“With awareness of risk factors, regular screening, early detection and sound treatment—but perhaps before any of these, a proactive attitude—cervical cancer is a beatable foe for the thousands of women at risk,” says Dr. Cracchiolo.

For more information or to make an appointment with Dr. Bernadette Cracchiolo or Dr. Mario Leitao, Jr. in the Division of Gynecologic Oncology, please call (973) 972-5903.