Cervical cancer

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Research in cervical cancer

We are always learning more about cancer. Researchers and healthcare professionals use what they learn from research studies to develop better practices that will help prevent, find and treat cervical cancer. They are also looking for ways to improve the quality of life of people with cervical cancer.

The following is a selection of research showing promise for cervical cancer. We’ve included information from PubMed, which is the research database of the National Library of Medicine. Each research article in PubMed has an identity number (called a PMID) that links to a brief overview (called an abstract). We have also included links to abstracts of the research presented at meetings of the American Society of Clinical Oncology (ASCO), which are held throughout the year. You can find information about ongoing clinical trials in Canada from CanadianCancerTrials.ca and ClinicalTrials.gov. Clinical trials are given an identifier called a national clinical trial (NCT) number. The NCT number links to information about the clinical trial.

Preventing cervical cancer

Some substances or behaviours may prevent cervical cancer or lower your risk of developing it. The following is noteworthy research into ways to prevent cervical cancer or lower you risk.

 

Lopimune is a combination of the drugs lopinavir and ritonavir. Lopimune is a chemotherapy drug in the form of a cream that is put directly on the cervix to treat precancerous HPV-related changes. A study showed that after 12 weeks of treatment, some of the high-grade precancerous cells changed back to normal-looking or low-grade precancerous cells. More research is needed to better understand if lopimune is a useful option for treating HPV infection and precancerous changes to cells to prevent cervical cancer from developing (PLoS One, PMID 26824902).

Researchers are also looking at substances or behaviours that might prevent cervical cancer or lower the risk of developing it. They are studying people who eat certain foods, take certain drugs or vitamin supplements or do physical activity to see if these women develop cervical cancer less often than people with different habits.

Find out more about research in cancer prevention.

Screening

Screening tests help find precancerous conditions of the cervix and cervical cancer before any signs or symptoms develop. When cancer is found and treated early, the chances of successful treatment are much better. The following is noteworthy research into screening for cervical cancer.

A human papillomavirus (HPV) test can find out if a woman has a high-risk type of HPV that can increase the risk of developing cervical cancer. Researchers are studying the HPV test to see if it would be better than the Pap test as the main screening tool for cervical cancer (PLoS Medicine, PMID 28926579; Gynecologic Oncology, PMID 25579108; PLoS One, PMID 26789267, PMID 27187495).

Home kits can be used to collect cervical cells for HPV testing. Researchers are trying to find out if more women would participate in cervical cancer screening if they could collect their own cell samples at home. They hope that home kits may also help encourage women who live in rural areas or places where it is more difficult to access healthcare to participate in cervical cancer screening programs (Sexually Transmitted Infections, PMID 28100761; Journal of Women’s Health, PMID 26598955; BMC Women’s Health, PMID 26060041).

Testing urine for HPV may be a useful way to screen for cervical cancer. Research so far has shown that HPV can be found in the urine of most women who also test positive for HPV in cells removed from the cervix. This approach to screening for cervical cancer has the advantage of being less invasive, and so it may lead to more women being screened for cervical cancer. This includes women who are unlikely to go for a regular Pap test or HPV test by a doctor or nurse because of their discomfort with the procedure or because these tests aren’t easily available where they live. More research is needed to understand whether testing urine for HPV can be a useful way to screen for cervical cancer (Cancer Epidemiology, PMID 29120838; Cancer, Epidemiology, Biomarkers & Prevention, PMID 28223432).

Find out more about research in screening and finding cancer early.

Diagnosis and prognosis

A key area of research looks at better ways to diagnose and stage cervical cancer. Researchers are also trying to find ways to help doctors predict a prognosis (the probability that the cancer can be successfully treated or that it will come back after treatment). The following is noteworthy research into diagnosis and prognosis.

Gene-based tests find differences between normal genes and genes that are changed (mutated) in cancer cells. Microarray analysis is a type of gene-based test that allows researchers to look at many genes together to see which ones are turned on and which ones are turned off or changed in any way. Analyzing many genes at the same time to see which are turned on and which are turned off is called gene expression profiling. Looking at the big picture of genes that are turned on and turned off can sometimes allow researchers to see patterns that can help them better understand a disease, such as finding out which cancers are more likely to spread. Researchers hope that developing more gene-based tests will help doctors identify the best treatments for certain cancers, including cervical cancer. Gene-based tests will also help doctors tailor more treatments to each person’s cancer based on their unique genetic makeup (Nature, PMID 28112728; Current Opinion in Obstetrics & Gynecology, PMID 27984344; Gynecologic Oncology, PMID 27016225).

Diffusion-weighted magnetic resonance imaging (diffusion-weighted MRI) is a type of MRI that creates an image of an area of the body by looking at the flow of water inside and outside cells. Researchers have found that diffusion-weighted MRI may help predict survival and the risk of the cancer coming back (recurring) after chemoradiation in women with cervical cancer (International Journal of Radiation Oncology, Biology, Physics, PMID 28011045; BMC Cancer, PMID 27469349).

Find out more about research in diagnosis and prognosis.

Treatment

Researchers are looking for new ways to improve treatment for cervical cancer. Advances in cancer treatment and new ways to manage the side effects from treatment have improved the outlook and quality of life for many people with cancer. The following is noteworthy research into treatment for cervical cancer.

Chemotherapy

Researchers are studying different types of drugs and when to deliver them to help improve chemotherapy for cervical cancer.

Neoadjuvant chemotherapy is given before the main treatment for cancer. Researchers are studying neoadjuvant chemotherapy in women with stage IB2 to IIIB cervical cancer (also called locally advanced cervical cancer) to see if it can help shrink the tumour so it is easier to remove with surgery. Giving chemotherapy before surgery may even help shrink a tumour enough that some women with stage IB2 cervical cancer can have a cone biopsy or a radical trachelectomy instead of a hysterectomy. A cone biopsy and a radical trachelectomy are examples of fertility-sparing surgeries because a woman can still get pregnant afterward. Research also shows that neoadjuvant chemotherapy may lessen the need for radiation therapy after surgery (ASCO, Abstract e17002; International Journal of Clinical Oncology, PMID 27380169, PMID 27342833; Gynecologic Oncology, PMID 26050921, PMID 25827293).

Find out more about research in chemotherapy.

Immunotherapy

Immunotherapy helps strengthen or restore the immune system’s ability to fight cancer. Researchers are trying to find out if immunotherapy will be a useful treatment for cervical cancer.

Immune checkpoint inhibitors are showing a lot of promise in the treatment of many types of cancer. The immune system normally stops itself from attacking normal cells in the body. It does this by using specific proteins called checkpoints, which are made by some types of immune system cells. Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. Immune checkpoint inhibitors work by blocking the checkpoint proteins so T cells (a type of immune system cell) can attack and kill the cancer cells. More research is needed to understand the role that immune checkpoint inhibitors may have in treating cervical cancer (Anticancer Research, PMID 29061774; Medical Oncology, PMID 28477178).

Human papillomavirus (HPV)vaccines protect against HPV infections, which are linked to cervical and other types of cancer. Researchers are developing vaccines to treat HPV infections. These vaccines stimulate the body to have an immune response and attack HPV-infected cells. This may help destroy precancerous cells in the cervix and cervical cancer cells (Best Practice & Research: Obstetrics & Gynecology, PMID 29108943; Lancet, PMID 26386540; Lancet Oncology, PMID 26071347; Journal of the National Cancer Institute, PMID 26467666; Journal of Infectious Diseases, PMID 26518044).

Find out more about research in immunotherapy.

Targeted therapy

Targeted therapy uses drugs to target specific molecules on the surface of or inside cancer cells. Bevacizumab (Avastin) is a targeted therapy drug that is sometimes used to treat cervical cancer that has spread to distant parts of the body (called metastatic cervical cancer) or when cervical cancer comes back after it has been treated (called recurrent cervical cancer). Other targeted therapy drugs that researchers are studying to treat cervical cancer include pazopanib (Votrient), nivolumab (Opdivo) and cediranib (Recentin) (Medical Oncology, PMID 28477178; NCT02488759).

Find out more about research in targeted therapy.

Surgery

Doctors are trying to find out if removing less tissue than standard surgery can lead to good outcomes in women with early stage cervical cancer.

A total (simple) hysterectomy is a surgery to remove the cervix and uterus. It is often used to treat women with stage IA1 cervical cancer. Women with other early stages of cervical cancer (including all other types of stage I) usually have a radical hysterectomy to remove the cervix, uterus, upper part of the vagina and some surrounding tissue. Researchers are trying to find out if these women may benefit from having a total hysterectomy instead of a radical hysterectomy. They are trying to find out if removing less tissue allows women to have better quality of life and sexual health while still preventing the cancer from coming back. Canadian researchers are doing a phase III trial to compare radical hysterectomy with total hysterectomy in women with early stage cervical cancer. In both groups of women, pelvic lymph nodes are also removed at the time of surgery. The study is currently looking for participants, and the results of the trial are expected in 2020 (NCT01658930).

Women with stage IB1 cervical cancer are often treated with a radical hysterectomy. Researchers studied a group of women with stage IB1 cervical cancer who were younger than 45. They compared the results in those who had less tissue removed (with a total hysterectomy, cone biopsy or radical trachelectomy) to those who had more tissue removed (with a radical hysterectomy). They found that women who had less tissue removed were no more likely to die from cervical cancer than those who had more tissue removed (ASCO, Abstract 5525). This is important for women because side effects related to sexuality and fertility tend to be worse in women who have a radical hysterectomy.

Find out more about research in cancer surgery.

Supportive care

Living with cancer can be challenging in many different ways. Supportive care can help people cope with cancer, its treatment and possible side effects. The following is noteworthy research into supportive care for cervical cancer.

Fertility-preserving techniques may help improve a woman’s chances of getting pregnant after treatment for cervical cancer. Researchers are looking at freezing a woman’s eggs (called oocytes) or tissue from the ovaries and using new radiation therapy techniques (Radiation Oncology, PMID 25890342).

Antinausea drugs help protect against nausea and vomiting. Rolapitant (Varubi) is a new antinausea drug. Research shows that it helped protect against nausea and vomiting in women having chemotherapy for cervical cancer and other types of cancer that develop in the female reproductive system (called gynecological cancer) (ASCO, Abstract 10122).

Find out more about research in fertility options.

Learn more about cancer research

Researchers continue to try to find out more about cervical cancer. Clinical trials are research studies that test new ways to prevent, detect, treat or manage cervical cancer. Clinical trials provide information about the safety and effectiveness of new approaches to see if they should become widely available. Most of the standard treatments for cervical cancer were first shown to be effective through clinical trials.

Find out more about cancer research and clinical trials.

hysterectomy

A surgical procedure to remove the uterus (womb). The cervix (the lower, narrow part of the uterus) may also be removed.

Other structures may be removed during a hysterectomy, including the ovaries (oophorectomy).

Different types of hysterectomy include partial hysterectomy, total hysterectomy and radical hysterectomy.

A hysterectomy may be performed through the vagina (vaginal hysterectomy) or through the abdomen wall (abdominal hysterectomy).

T cell

A type of lymphocyte (white blood cell) that helps control immune response (the immune system’s reaction to the presence of foreign substances in the body), fight infection and destroy abnormal cells, including cancer cells.

Also called T lymphocyte.

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