Understanding and Overcoming Cervical Cancer

Clara Jennings

Let's start with the basics, Professor Obermair. Cervical cancer is often linked to a persistent infection with high-risk HPV. Can you explain how that connection works?

Professor Andreas Obermair

Of course. Nearly all cases of cervical cancer are caused by long-term infection with high-risk strains of human papillomavirus, or HPV. While most HPV infections clear naturally, in some individuals - and unfortunately we don't know why that is the case and what causes that - the virus persists and causes damaging changes to the cells of the cervix, potentially leading to cancer over time. This process can take years, even decades.

Clara Jennings

That's why the HPV vaccine is so crucial. I understand there's been an expansion in vaccination recommendations now?

Professor Andreas Obermair

Absolutely. Initially, HPV vaccination was targeted at adolescents, as the vaccine is most effective before exposure to the virus. However, recent guidelines now recommend it for adults up to age 45. Studies have shown it can still provide substantial protection, even in those who may have already been exposed to HPV.

Clara Jennings

That's really important to know. Now, aside from HPV, what other risk factors should people be aware of?

Professor Andreas Obermair

Several factors can increase the risk of developing cervical cancer. These include smoking, which doubles the risk by weakening the immune system's ability to fight HPV, and high parity, or giving birth multiple times. Additionally, early sexual activity and having many sexual partners are also significant, as they increase the likelihood of HPV exposure. Notably, a history of sexually transmitted infections and a weakened immune system, such as from HIV, can also contribute.

Clara Jennings

Hmm. Those are critical insights. Let’s pivot to the FIGO staging system for cervical cancer, which I understand is vital for treatment decisions. Could you walk us through the basics?

Professor Andreas Obermair

Certainly. The FIGO system, developed by the International Federation of Gynecology and Obstetrics, categorizes cervical cancer into stages based on how far the disease has spread. Stage I is localized to the cervix, with excellent outcomes if treated early. Stage IV, however, indicates that the cancer has spread to distant organs like the lungs or liver, which is significantly complicating treatment and prognosis. It's this staging that informs whether surgery, chemoradiation, or palliative care is the best course of action.

Clara Jennings

So the difference between these stages really shapes a patient's options.

Professor Andreas Obermair

Exactly. For instance, a Stage I diagnosis may only require surgical intervention, whereas Stage IV involves systemic therapies focused on managing symptoms and quality of life.

Clara Jennings

Building on your explanation of the FIGO staging system, Professor Obermair, it's clear that treatment strategies vary greatly depending on the stage. Could you outline the primary approaches and explain why they're so closely tied to the stage of the disease?

Professor Andreas Obermair

Absolutely. Treatment starts with identifying the stage of the disease, which guides whether we focus on surgery, radiation, or systemic therapies. In Australia virtually all patients will have a PET-CT scan before any treatment for staging to determine the extent of the cancer. For early-stage cervical cancers, surgery is often the mainstay. This might involve procedures like a cone biopsy in super early cases; or a simple hysterectomy for very early cases or a radical hysterectomy for patients where the tumour is slightly larger but still limited to the cervix. In some cases, a fertility-sparing surgery like trachelectomy—removing only the cervix while preserving the uterus—may be possible for those who wish to have children in the future. However, we need to keep in mind that surgery is only a reasonable option if the cancer is limited to the cervix.

Clara Jennings

And for locally advanced stages—when the cancer has grown beyond the cervix - for example into lymph nodes - but hasn't spread to distant organs—what are the options?

Professor Andreas Obermair

In those cases, chemoradiation is typically the preferred treatment. This combines external beam radiation therapy, or EBRT, with chemotherapy, often a platinum-based drug like cisplatin. The chemotherapy enhances the effectiveness of the radiation, and together they work to shrink tumors, control local spread, and address nearby lymphatic involvement. The addition of immunotherapy also has shown patient benefit. Additionally, brachytherapy, which delivers radiation directly to the tumor site internally, almost always complements this approach.

Clara Jennings

Now when cancer spreads further, into a stage of metastatic disease, things understandably become more complex. What does treatment look like at that point?

Professor Andreas Obermair

You're correct, metastatic disease presents unique challenges. In such cases, the focus shifts to systemic treatments like chemotherapy and, increasingly, targeted therapies or immunotherapies based on specific biomarkers. These approaches aim to control the disease and alleviate symptoms rather than cure it. Palliative care plays a critical role here, ensuring that patients maintain the best possible quality of life by managing pain and other symptoms effectively.

Clara Jennings

And what about fertility preservation? For patients with early-stage diagnoses, how viable is preserving fertility, and what options are available?

Professor Andreas Obermair

Fertility preservation is indeed a consideration for many younger patients with early cervical cancer. It typically hinges on the size of the tumor, the absence of certain risk factors like lymphovascular space invasion, and patient preference. The main approach is a radical trachelectomy, which removes the cervix but retains the uterus. This is often accompanied by the removal and examination of pelvic lymph nodes to ensure the cancer hasn’t spread. It's a meticulous process, but in suitable candidates, it offers hope for future pregnancies.

Clara Jennings

It must be incredibly empowering for patients to have those options. But, of course, treatments aren't without their side effects, right?

Professor Andreas Obermair

Indeed, side effects are a significant aspect of cancer treatment. Radiation, for example, can lead to fatigue, pelvic discomfort, or even changes in bowel and bladder function over time. Chemotherapy often brings its own challenges: nausea, hair loss, even nerve damage in some cases. Surgical menopause is another consideration when ovaries are removed during treatment. Importantly, we encourage integrating support systems into care—mental health professionals, support groups, and physical therapy for pelvic floor strengthening. These measures go a long way in helping patients manage post-treatment quality of life.

Clara Jennings

It’s clear that a multidisciplinary approach and a strong support system are essential through all these stages of treatment.

Clara Jennings

Coming up to what life looks like after treatment is completed: Professor Obermair, survivors face an entirely new set of challenges and priorities. Could you explain why post-treatment surveillance is such a vital part of the recovery journey?

Professor Andreas Obermair

Certainly, Clara. After treatment, the risk of recurrence remains a concern, particularly within the first two to five years. Post-treatment surveillance involves routine follow-up visits, including physical exams and imaging, to detect any early signs of recurrence. For instance, patients with more advanced stages may benefit from regular PET or CT scans to monitor their recovery. What's equally important is staying vigilant—paying attention to symptoms like unusual bleeding, pain, or weight loss and reporting them promptly.

Clara Jennings

It sounds like survivor engagement and proactive monitoring are vital. Beyond recurrence prevention, how can survivors maintain their overall health?

Professor Andreas Obermair

That's a great question. Committing to a healthy lifestyle can significantly influence long-term outcomes. Regular physical activity, a balanced diet with plenty of plant-based foods, and maintaining a healthy weight are key elements. Also, avoiding smoking and limiting alcohol intake can reduce the risk of other cancers and chronic conditions. Survivorship care often includes addressing side effects, such as pelvic floor therapy for bowel and bladder health or the use of vaginal dilators to mitigate effects of radiation-induced stenosis.

Clara Jennings

And mental health support?

Professor Andreas Obermair

Absolutely essential. Many survivors experience anxiety, depression, or fear of recurrence. Mental health professionals, support groups, and even mindfulness activities, like yoga or meditation, can be really beneficial. We encourage discussing these openly with the care team, as emotional wellness is just as crucial as physical recovery.

Clara Jennings

You’ve touched on some incredibly practical strategies. Now, let’s discuss clinical trials and ongoing research. What advances are making the biggest impact for cervical cancer survivors?

Professor Andreas Obermair

We've seen exciting progress, particularly in biomarker-driven therapies. These therapies tailor treatment to the unique characteristics of an individual's cancer, improving effectiveness while reducing unnecessary side effects. Immunotherapies like pembrolizumab, for example, have shown promise in treating advanced cases with certain biomarkers such as PD-L1 positivity. Engaging in clinical trials not only gives patients access to cutting-edge treatments but also contributes to improving care for future patients.

Clara Jennings

It must be empowering for patients to play an active role in advancing medicine. As we conclude, Professor Obermair, do you have any final words of advice for survivors and their families?

Professor Andreas Obermair

Yes, Clara. Being alive well - and not just being alive - is a collaborative effort—between patients, families, and healthcare providers. Educate yourself, ask questions, and build a strong support network. And remember, by embracing a proactive approach to health and engaging in ongoing research, we pave the way for better outcomes for everyone. Resilience and vigilance truly make a difference.

Clara Jennings

Thank you, Professor Obermair. And to our listeners, that wraps up our exploration of cervical cancer—from understanding the disease, navigating treatments, and now, life after treatment. If you or someone you know has been impacted, we hope this conversation brings insight and encouragement. Until next time, stay informed, stay inspired, and we’ll see you soon.