Cervical Cancer Services at Hoag Gynecologic Oncology

What is cervical cancer?

The third most common type of cancer in women, cervical cancer is a cancer of the cervix–the narrow, cylinder-shaped organ at the lower part of the uterus that connects the uterus to the vagina. Cervical cancer occurs when cells in the cervix multiply out of control without eventually dying as healthy cells do. These abnormal cells can eventually accumulate into tumors that can potentially spread to other areas of the body.

It’s important to note that because cervical cancer is primarily caused by the Human Papilloma Virus (HPV), it is the only gynecologic cancer that can be prevented by vaccination and regular screenings.

There are two main types of cervical cancer:

• Squamous cell carcinoma: A type of cervical cancer that originates in the cells that line the outer part of the cervix. This is the most common type of cervical cancer.
• Adenocarcinoma: Cervical cancer that begins in the glandular cells lining the inside of the cervix.

What are the symptoms of cervical cancer?

In the early stages of cervical cancer, it often produces no symptoms, making regular gynecological screening especially important. Symptoms of more-advanced cervical cancer can include:

• Vaginal bleeding between menstrual periods, after intercourse or following menopause
• Heavy vaginal discharge that may be watery or bloody
• Pelvic pain, or pain that occurs during sexual activity

What are the risk factors for cervical cancer?

Cervical cancer is usually caused by an infection by the Human Papilloma Virus (HPV), a common sexually-transmitted condition. Most people who carry HPV will never develop cervical cancer. Other risk factors for cervical cancer can include:

• Not being vaccinated against HPV prior to beginning sexual activity as a young person
• Having other sexually -transmitted diseases, such as chlamydia, syphilis or HIV/AIDS
• Having a condition or treatment that significantly weakens your immune system
• Smoking

Women are encouraged to get regular gynecologic exams that include Pap testing as a means to identify whether they are at an increased risk. Failure to get regular exams takes away a vital opportunity for early diagnosis through cervical cancer screening.

How can I reduce my risk of developing cervical cancer?

Ways to reduce your risk of developing cervical cancer include:

• Get vaccinated against HPV before beginning sexual activity
• Get routine screenings for cervical cancer — AKA Pap tests or “Pap smears”
• Don’t smoke
• Use condoms during sexual activity

How is cervical cancer diagnosed?

Beginning around age 21, women should visit their doctor for regular Pap tests. These tests, generally done during a pelvic exam, involve using a swab to collect cells from your cervix. These cells are then sent to a lab to be tested for the presence of cancer or changes that might suggest you could develop cancer in the future. Unless you have an elevated risk of cervical cancer, it’s usually recommended that women between the ages of 21-65 have a Pap test every three years. 

I’ve been diagnosed with cervical cancer. Now what do I do?

After diagnosis, your doctor will talk to you about your current symptoms, discuss treatment options and potentially refer you to a specialist for more tests or surgery.

As a leading provider of advanced gynecologic cancer care, Hoag Family Cancer Institute treats more women than any other hospital in Orange County. Trust Hoag for your gynecologic cancer treatment. 

Hoag is helping find tomorrow’s cures for cervical cancer. Serving alongside our world-class physician team, our gynecologic cancer nurse navigators and support staff will be there for you following your diagnosis to help you find resources, review your options and make informed decisions at every step of your cancer treatment and recovery.

What are some early cervical cancer treatment options?

Treatment options for cervical cancer depend on many factors, including how advanced the cancer is when detected, your age, other health issues you may have, the size of the tumor and whether you wish to have children in the future. At Hoag, we offer the latest treatment options for cervical cancer.

• Hysterectomy is the most common surgical procedure for early cervical cancer. The surgery removes the uterus, tissues surrounding the cervix and the lymph nodes. For women with concerns about preserving their fertility options, see the “What are my fertility options?” section to the left.

The decision to remove fallopian tubes and ovaries (bilateral salpingo-oophorectomy) is individualized. Many patients with early cervical cancer are candidates for minimally invasive surgery, either through standard laparoscopy or robotic-assisted surgery. Hoag is the unmatched leader on the West Coast in the field of robotic assisted, minimally invasive surgery to help treat gynecologic cancers. Designated a Center of Excellence in Minimally Invasive Gynecology (COEMIG™), Hoag’s Gynecologic Robotic Surgery Program offers a team of experienced physicians who are specialty-trained in using the the da Vinci® Surgical System for hysterectomy – the most advanced, minimally invasive approach to hysterectomy available today. Benefits to robotic and minimally invasive surgeries include:

• Less postoperative pain and scarring
• Decreased blood loss and lower risk of blood transfusion
• Lower risk of infection
• Shorter hospital stay
• Faster return to normal activities.

What are some advanced surgery and treatment options for cervical cancer from Hoag?

Facing surgery can be a frightening prospect, but it is a vital component in the successful treatment of many gynecologic cancers. The Hoag Family Cancer Institute’s medical team includes experienced, fellowship-trained gynecologic oncologists who utilize the latest techniques and technology in the surgical management of many different cancers found in women, including cervical cancer.

Radical cancer surgery is a surgical procedure in which physicians remove the entire tumor, a margin of normal tissues, and in some cases, nearby lymph nodes. At Hoag, our surgeons have undergone extensive training in radical gynecologic cancer surgery and procedures, including in the areas of:

• Debulking surgery: In cases where the cancer has spread, as much of the cancer is removed as possible. This can often involve extensive surgery including removal of sections of the small or large intestine, as well as tumors from the liver, diaphragm and pelvis.
• Radical hysterectomy
• Excision of vulvar and vaginal cancers

At Hoag, our team applies a multidisciplinary approach to cancer surgery. Our physicians work together on your care, consulting with colleagues in plastic surgery, anesthesia and other specialties to help patients achieve better outcomes, maintain sexual and urinary function and preserve overall quality of life.

Hoag surgeons utilize the Enhanced Recovery After Surgery (ERAS) pathway, an approach focused on understanding a patient’s specific biology to improve recovery time and pain management. With ERAS, patients become an active participant in their recovery in four key areas:

• Planning and preparing before surgery
• Reducing the physical stress of surgery
• Post-surgery pain relief planning
• Early feeding and movement after surgery

With ERAS, post-surgical patients require fewer narcotics, suffer from less constipation, are able to return to eating normally sooner and have a recovery period that is, on average, two days faster.

What are the non-surgical options?

Hoag’s non-surgical options, including chemotherapy and radiation therapies, are world-class as well. Hoag was recently named a Radiopharmaceutical Therapy Center of Excellence (RTCoE) by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S. including Stanford Health Care, Harvard Medical School and the University of California, San Francisco.

Explore advanced treatment technologies for cervical cancer available at Hoag.

Non-Surgical Treatment Options for Advanced Stage Cervical Cancer

For women with advanced-stage cervical cancer, treatment combining radiation therapy and chemotherapy remains the standard of care.

• Chemotherapy involves the use of drugs to kill cancer cells. It is usually given intravenously, through the veins, and treatment may be administered either at the doctor’s office or in an outpatient center.

  Chemotherapy can be an effective treatment for cervical cancer that has spread because it travels through the bloodstream, reaching all parts of the body. However, the same drugs that kill cancer cells can also damage healthy cells. Chemotherapy is generally given in cycles, with periods of treatment alternating with periods of rest.

• Hoag Family Cancer Institute offers a state-of-the-art facility for radiation therapy that is equipped with the latest in radiation technology, handled by an expert team of radiation oncologists, medical physicists, medical dosimetrists, radiation oncology nurses and radiation therapists. Hoag’s Radiation Oncology department is the highest volume provider in Orange County, treating more than 100 patients every day. Learn more about Hoag Radiation Oncology.
• ViewRay MRIdian™ linear accelerator — Hoag is one of only two hospitals in California with the ViewRay MRIdian™ linear accelerator, the most advanced radiation treatment available in the United States for cancers of the abdomen. By utilizing MRI imaging with a linear accelerator, Hoag clinicians can obtain real-time, high resolution images of tumors and surrounding soft tissues. This allows for precise application of radiation during treatment, even if the tumor shifts due to breathing or other factors. That level of precision allows Hoag clinicians to deliver a higher and potentially more effective radiation dose to the tumor, with minimal impact on healthy surrounding tissue. Find more information about Hoag’s ViewRay MRIdian™ linear accelerator.
• Brachytherapy, also known as “internal radiation therapy,” is a radiation treatment in which a small radioactive source is temporarily placed inside the body. Because of the high dose rate, brachytherapy treatments are usually delivered on an outpatient basis or with a minimal hospital stay. Explore advanced treatment options at Hoag.
• Precision Medicine, in which Hoag physicians test the DNA of patients’ tumors, then develop treatments tailored specifically to the mutations that caused the cancer. That allows physicians to treat the cancer very precisely. Hoag is a national leader in the use of precision medicine in several types of cancer. Find more information about precision medicine at Hoag.

What are my fertility options?

The stages of cervical cancer treatment, including radiation therapy and surgery, can sometimes impact a person’s ability to conceive and bear a child. If you are considering having children in the future, you can discuss fertility options with your doctor. These may include:

• Egg freezing
• Embryo freezing
• Fertility-preserving surgery
• Gestational surrogacy

Fertility preservation works best if initiated prior to your cancer treatment. These options can be completed within approximately two weeks of diagnosis so as not to compromise initiation of your cancer treatment.

To help patients understand the impact of gynecological cancer treatment on their fertility, Hoag has developed a series of questions you can ask your oncologist or fertility specialist.

Advanced fertility-preserving surgery at Hoag

Because cervical cancer is often diagnosed in young women during their prime reproductive years, surgical advances have been made that allow women to potentially preserve their fertility during cancer treatment. One of these surgical advances is radical trachelectomy.

In this procedure, the cervix and surrounding tissues are removed, but the uterus remains, allowing a woman to carry a pregnancy. This is an option for some early-stage cervical cancer patients. Explore advanced surgical options for cervical cancer at Hoag.