January is National Cervical Cancer Awareness Month. The American Cancer Society estimates there were 140 new cases of cervical cancer in Minnesota in 2020.

Deanna Teoh with the University of Minnesota answers questions on the symptoms, treatment and screening for cervical cancer.

Q: What is cervical cancer?

Dr. Teoh: The uterus is the part of the reproductive tract that carries a baby when a person is pregnant. The cervix is the opening to the uterus. Therefore, cervical cancer is a type of cancer that starts at the opening to the uterus.

Q: Which individuals are more at risk for cervical cancer?

Dr. Teoh: The primary risk factor for cervical cancer is persistent infection with human papillomavirus (HPV). HPV is a very common infection. In fact, almost all people are infected at some point during their lifetime. Fortunately, most people (90%) are able to clear the infection and will not be at risk for cervical cancer, but some people are unable to clear the virus on their own. We know that certain conditions which suppress the immune system will increase a person’s risk of cervical cancer. Such conditions include human immunodeficiency virus (HIV), medications for solid organ transplant, hematopoietic stem cell transplant (i.e., stem cell transplant) medications to treat autoimmune diseases (e.g., lupus, inflammatory bowel disease), as well as other conditions. Smoking can also decrease the body’s ability to clear an HPV infection. However, many people have none of these risk factors but still have persistent HPV infection and are at risk for developing cervical cancer.

Q: What are the symptoms of cervical cancer and how is it detected?

Dr. Teoh: The primary symptom of cervical cancer is abnormal vaginal bleeding such as bleeding between periods, irregular periods and/or bleeding after sex. Someone who has these symptoms should see a healthcare provider who can perform a pelvic exam. However, dysplasia — a precancerous condition of the cervix — and many early-stage cervical cancers have no symptoms at all. Therefore, it is important to undergo the recommended screening for cervical cancer with a Pap test, HPV test or both. Which test(s) is performed will depend on the person’s age as well as institutional practice. It is important that once someone receives results from the screening test that they schedule recommended follow-up appointments. Abnormal screening tests may require a closer exam with a magnifier (e.g., colposcopy), may require removal of a piece of the cervix, or may be a repeat test sooner than usual. After a normal test result, it is also important that a person repeats the screening test(s) at the recommended interval, as test results can change over time.

Notably, any person with a cervix should get cervical cancer screening tests. Anyone with a cervix is at risk for cervical cancer, regardless of personal gender or the sex/gender of their sexual partner(s). For individuals who have limited or no insurance, free or low-cost screening options are available through the Minnesota Department of Health’s Sage program.

Q: What are the treatment options for cervical cancer?

Dr. Teoh: The recommended treatment for cervical cancer will depend on the stage (i.e., how far the cancer has spread) at the time of diagnosis. Cancers limited to the cervix can be treated with surgery, usually comprising a hysterectomy (i.e., removal of the uterus and cervix) and sometimes some of the tissue surrounding the cervix and the upper vagina. For individuals who have a small cancer limited to the cervix who desire future pregnancy, there is sometimes an option to remove a piece of the cervix or the entire cervix but leave the uterus in place. For larger cancers limited to the cervix or cancers that have spread beyond the cervix, chemotherapy and radiation are usually recommended. For cancers which have spread beyond the pelvis, chemotherapy with or without radiation may be recommended. The earlier a cancer is diagnosed, the more likely it is that the cancer will be curable.

The best option is to prevent cervical cancer in the first place. The best way to do this is to get vaccinated against HPV. The vaccine works best when administered between the ages of 9-12 years, and only 2 doses are recommended as long as vaccination is initiated prior to 15 years of age. For individuals over 15 years old, vaccination is still recommended up to age 26 with consideration of vaccination for individuals up to 45 years of age. However, three doses of vaccine are recommended if vaccination is initiated at age 15 years or older.

Q: What are you doing to advance cervical cancer research?

Dr. Teoh: My primary interest is prevention of cervical cancer and other HPV-associated cancers (e.g., head/neck cancers, anal cancer, vaginal cancer, vulvar cancer, penile cancer). We can best do this by increasing HPV vaccination coverage and optimizing screening. At the University of Minnesota we currently have a clinical trial open which is evaluating whether adding a new therapy to standard chemoradiation improves progression-free survival for patients with certain stages of cervical cancer. We are also in the process of opening other clinical trials testing new therapies for individuals who have advanced or recurrent cervical cancer and no other effective treatment options.

Deanna Teoh is an assistant professor and gynecologic oncologist in the Department of Obstetrics, Gynecology and Women’s Health (OBGYN) in the University of Minnesota Medical School and a Masonic Cancer Center member. Her areas of expertise include gynecologic cancers, optimizing cervical cancer screening and increasing HPV vaccination, and clinical trials.