Posts tagged ‘cervical cancer’
News about the risks or benefits of widespread cancer screening seem to arrive daily – 3D mammography for breast cancer, CT scans for lung cancer, PSA tests for prostate cancer and now pelvic exams for some women’s cancers. Missing in the headlines is a reflection of how cancer detection is evolving.
Today’s cancer experts say screening advice shouldn’t be one-size-fits-all. For most cancers, they advocate individual assessments based on each person’s history. This assessment may lead to more specialized screening – or to no screening at all.
An annual consultation with a primary physician, now standard in the wake of health care reform, should make patients aware of their individual risk. From there come more refined choices. » Continue Reading
New pelvic exam recommendations or not, women shouldn’t give up those routine gynecological appointments. The revised guidelines from the American College of Physicians exempt most women from pelvic examinations, but a cancer specialist at City of Hope says women should still plan on regular visits with their gynecologist for cancer screening.
The guidelines were published July 1 in the Annals of Internal Medicine, and call for routine pelvic exams to be skipped for women who are asymptomatic, of average risk for problems and not pregnant. No one is disputing the need, however, for regular Pap tests and cervical exams.
The study on which the recommendations are based found that routine pelvic exams were not beneficial to asymptomatic, average risk women who are not pregnant, as the exams rarely detect important disease and don’t reduce mortality, said Linda Humphrey, M.D., co-author of the guideline, in a news release.
The key to communicating this new guideline is making sure women understand that they should still receive Pap smear screening to detect cervical cancer. The incidence and death rates for cervical cancer have plummeted in the last 60 years, and continued to drop in the last decade, largely due to good screening, said Robert Morgan, M.D., co-director of the Gynecological Oncology/Peritoneal Malignancy Program at City of Hope. » Continue Reading
Rates of cervical cancer in the United States have been greatly underestimated, especially among women in their 60s and black women, according to a new study in the journal Cancer.
Previous estimates of cervical cancer put the rate of the disease at about 12 cases per 100,000 women. The highest rates were in women age 40 to 44, and then the rates leveled off. However, the new study concludes that rates are closer to 18.6 cases per 100,000 women when excluding women who have had hysterectomies.
The figures adjusted to account for hysterectomies show that the rates of cervical cancer peak around age 65 – when screening stops. They also found that African-American women had much higher rates of cervical cancer.
“I think it indicates that doctors need to discuss the risk versus benefits of continuing routine pap and HPV screening in women when they reach age 65,” said Robert Morgan, M.D., co-director of the gynecological cancer program at City of Hope, who was not involved in the new study.
“It also points out the continuing need to provide medical services to minority populations in order to detect this illness in its premalignant state so that curative treatment is possible,” he said. “This approach should be very cost effective, because treatment of cervical cancer after it is invasive requires intensive costly therapy, and metastatic cervical cancer is a devastating illness causing severe morbidity and very costly treatment.” » Continue Reading
If the new recommendations of a Food and Drug Administration (FDA) advisory panel are widely adopted, HPV testing eventually may replace the Pap test as the primary way to detect cervical cancer. City of Hope cervical cancer expert says the recommendations have merit.
The Pap test – named for its inventor, pathologist George Papanicolaou – is designed to identify cancers and precancers in the cervix, and has been the standard screening for cervical cancer during the past 60 years. The screening is credited with dramatically lowering death rates.
The new test, developed by Roche Molecular Systems, detects HPV’s DNA. HPV, or human papillomavirus, is now known to cause nearly all cervical cancer cases.
The 13 academic gynecologists, pathologists and microbiologists on the FDA’s Medical Devices Advisory Committee Microbiology Panel unanimously concluded that the Roche test is safe and effective as a first-line screening for cervical cancer. It reviewed data from the ATHENA trial, which included more than 47,000 women. » Continue Reading
Once unknown to most people, HPV, or human papillomavirus, has become a subject of both worry and debate. It’s directly linked to cervical cancer, head and neck and other cancers, but many parents are reluctant to vaccinate their daughters against the disease.
City of Hope’s recent “Ask the Experts” session “HPV and Links to Cancer” brought some clarity to the issues surrounding this now-common virus, answering questions about the connection between HPV and cancer.
Ellie Maghami, M.D., chief of head and neck surgery at City of Hope, and Lily Lai, M.D., associate clinical professor of colorectal surgery, discussed HPV vaccines, how HPV is contracted and the relationship between HPV and cancer. They also explored the changing patient profile of people affected by HPV-related cancers.
A few highlights:
- Up to 25 percent of oropharyngeal cancer (throat cancer) cases in the United State are not related to tobacco and alcohol abuse.
- Sexually transmitted oral HPV infection is the principal risk factor for the distinct form of head and neck cancer.
- HPV is linked to 80 to 95 percent of all anal canal cancers.
- A total of 90 percent of women with cervical dysplasia have anal HPV infection.
Watch the full presentation above.
Sign up for our next “Ask the Experts” program, “Colon Health,” on March 19 to learn about the importance of screenings, colon cancer risk factors, cancer treatments and much more.
To view past Ask the Experts programs that feature several cancer related topics, visit our “Ask the Experts” video series.
What is HPV? How is it linked to cancer? How can I prevent it? Those are some of the questions many women have about human papillomavirus, or HPV. City of Hope physicians will provide the answers at our Feb. 20 “Ask the Experts” presentation.
The session, titled “HPV and Links to Cancer,” will feature three City of Hope experts.
Mark Wakabayashi, M.D., M.P.H., associate clinical professor and chief of gynecologic oncology, will focus on the virus’ connection to cervical cancer and on the HPV vaccine, which can help prevent the disease.
Ellie Maghami, M.D., associate clinical professor and chief of head and neck surgery, will discuss oropharyngeal cancer (throat cancer), the changing patient profile of the disease and HPV awareness.
And Lily Lai, M.D., associate clinical professor, will talk about HPV and its connection to anal cancer.
Here, our experts offer a preview of the session. » Continue Reading
Cervical cancer, once one of the leading cancer killers in women, is now one of the nation’s most treatable cancers — thanks in large part to early detection, preventive measures and increased knowledge about the human papillomavirus, which can lead to the disease.
In fact, cervical cancer is almost 100 percent preventable. Regular gynecologic care and pap smears can detect precancerous changes before they develop into cancer, and the precancerous changes themselves can often be prevented as well.
But much progress is needed in the treatment of patients with advanced disease, a fact especially relevant during January, which Congress has designated as Cervical Health Awareness Month. Annually, almost 12,000 women in the U.S. are diagnosed with cervical cancer, and almost 4,000 die from it, according to the Centers for Disease Control and Prevention.
Ernest Han, M.D., Ph.D., assistant professor and surgeon in the Division of Gynecologic Oncology at City of Hope, discusses some of the confusion and concerns about cervical cancer.
What is the most common question you get about cervical cancer?
One of the most common questions from patients is: “What’s the cause of cervix cancer?”
We know that the primary cause is the human papillomavirus (HPV), and we say that it causes almost 100 percent of cases. We don’t say that it causes 100 percent, because there are probably some cervix cancers that are very rare that are caused by other unknown factors or maybe other viruses or other things that are not as well understood. But those are rare, and predominantly everyone here has a cervical cancer that is HPV-related. That is really where the focus for our cancer prevention lies. » Continue Reading
Cervical cancer was once one of the most-common causes of cancer death for women in the United States. Now, with better screening techniques, targeted treatments and vaccinations, the death rate has declined dramatically.
“The diagnosis and treatment of cervical cancers have changed markedly in the past 10 years,” said Robert J. Morgan, M.D., co-director of the gynecological cancers program at City of Hope. “The addition of chemotherapy to radiation in locally advanced cervical cancer in the early part of this century added significantly to the long-term, disease-free survivals in this illness.”
Discovering the connection between the human papillomavirus (HPV) and cervical cancer was also groundbreaking, allowing for vaccination to lower the risk of cancer. “This discovery has increased our understanding of the pathogenesis of this illness and has allowed the development of very effective vaccines that can prevent the illness from occurring,” Morgan said.
This milestone is especially notable during January, which Congress has deemed Cervical Cancer Awareness Month. Most people will acquire the HPV infection at some point in their lives, but their immune systems will usually eliminate the virus, Morgan said. The risk of developing cervical cancer, however, rises with exposure to the HPV strains that can cause the disease.
Cancer will be defeated not in one enormous advance, experts agree, but in incremental advances. Those incremental advances often go unnoticed by the public at the time of their discovery, but in the years to come, they add up – to more life years, to greater survival rates, to more time spent with families and loved ones.
In 2014, patients will begin to see the benefits of many of those advances. Here, City of Hope’s physicians describe some of the recent scientific and medical developments they expect to benefit patients in the year ahead.
Breast cancer: A first-step therapy, now taken more seriously
Breast cancer remains a leading cancer killer of women (second only to lung cancer), but Joanne Mortimer, M.D., director of City of Hope’s Women’s Cancers Program, pointed to several studies that could begin to have a positive impact on treatment and survival.
The most significant recent development, she said, is the use of the monoclonal antibody pertuzumab as pretherapy (more formally known as neoadjuvant therapy) in HER2-positive breast cancer that has advanced locally. Such disease can be difficult to treat – and time is of the essence – so the Food and Drug Administration (FDA) earlier this year approved pertuzumab as neoadjuvant therapy when used along with the drugs Herceptin and docetaxel.
Such early treatment in high-risk patients is considered crucial to effectively fighting the disease.
“The results of this trial paved the way for using response to neoadjuvant chemotherapy as a surrogate for response and benefit to treatment of metastatic disease,” Mortimer said.
Other recent research suggests more effective therapies for women with metastatic disease. Mortimer pointed to a study that found neither mastectomy or lumpectomy and radiation were of benefit in treating the primary cancer, either initially or after response to systemic therapy.
“That suggests surgery may actually result in more rapid progression of metastatic disease,” she said. “In the absence of pain or local problems, mastectomy should not be performed outside of a clinical trial in this population.”
Cervical cancer: A notable drug advance and a simple, but powerful, test
Adding one drug to a treatment regimen can often have a significant difference; that appears to be the case with cervical cancer and the drug bevacizumab, which slows the growth of new blood vessels.
Robert J. Morgan M.D., co-director of the Gynecological Oncology/Peritoneal Malignancy Program at City of Hope, explained a recent study evaluating the role of the drug in addition to chemotherapy in metastatic carcinoma of the uterine cervix. “The addition of bevacizumab to chemotherapy resulted in a survival benefit from 13.3 months to an improved 17 months with very acceptable toxicity,” Morgan said.
“This is the first study that has resulted in a meaningful survival benefit for recurrent cervical cancer compared to the ‘standard’ chemotherapy of cisplatin and paclitaxel,” he added.
But cervical cancer must be detected before it can be treated and, for many parts of the world, that detection remains a significant hurdle. Recent findings could begin to change the outlook.
“In India, a study was carried out that used a simple method of identifying potential cervical cancers in areas that are too poor to have access to pap smear technology,” Morgan said. The method? The application of vinegar.
“Using trained observers and using acetic acid (vinegar) on the cervix, many early cervical cancers were identified,” Morgan said. “It is estimated that the mortality rate of this illness can be slashed by up to one third by this simple technique. “
He added: “It is still though important, particularly in this country, that women obtain regular gynecologic care and also that pre-teens and teenagers obtain the HPV vaccine.”
Endometrial (uterine) cancer: Understanding molecular changes
To fight a disease, doctors need to understand it.
“One problem with uterine and all gynecologic cancer is that we have not had a good understanding of how molecular changes in combination with histology may be beneficial in directing treatments,” said Morgan, also a professor and associate director for medical education in the Department of Medical Oncology & Therapeutics Research at City of Hope.
One recent study has improved that understanding considerably, giving researchers new avenues to explore. Morgan points to a large study using the Cancer Genome Atlas that analyzed molecular characteristics of 373 endometrial cancers, including low-grade endometrioid cancers, high-grade endometrioid cancers and papillary serous cancers. Researchers were able to identify four new categories of endometrial cancer based on the molecular characterizations of the tumors.
“This may well lead to treatment decisions based on molecular markers in addition to histological markers and allow better treatment with targeted agents,” Morgan said. “For example, one subset of high-grade endometrioid tumors had p53 mutations similar to papillary serous tumors, and the supposition is made that these may respond better to treatments designed for serous tumors.”
For women with endometrial cancer – and the doctors treating them – that kind of research-based guidance will be crucial to better outcomes.
Lung cancer: The benefit of precision therapies
In treating lung cancer, think “precision.”
Karen L. Reckamp, M.D. M.S., co-director of the Lung Cancer and Thoracic Oncology Program at City of Hope, said physicians are increasingly using information on the genomics of lung tumors. With this information, they can better block cancer growth and improve outcomes by providing precision therapy for patients.
“In addition, we are beginning to understand the impact of activating the immune system to enhance the attack on tumor cells,” Reckamp said. “We may see a day when a patient’s own immune system can be directed against lung cancer.”
Meanwhile, Dan J. Raz, M.D., co-director of the Lung Cancer and Thoracic Oncology Program at City of Hope, is emphasizing the importance of screening.
“Lung cancer screening is recommended by the U.S. Preventive Services Task Force,” he said. “Widespread adoption of lung cancer screening with low-dose radiation CT scanning has the potential to dramatically reduce death from lung cancer and turn lung cancer into a disease that is detected at an early stage a majority of the time.”
Ovarian cancer: Improved treatments on the way
The treatment of ovarian cancer is becoming both more effective and more complex.
“There are problems with the current standard treatments of ovarian cancer, including the fact that our treatments are similar despite differences in histology and grading of the tumors,” acknowledged Morgan. He cites a lack of research in smaller subsets of ovarian cancer and a lack of effective alternative therapies, despite the development of many targeted agents in the past decade.
But several developments suggest room for improvement in the coming year. For starters, a new drug, salumetinib, is showing promise against low-grade ovarian tumors that have been very difficult to treat. Further, Morgan added: “More agents directed at specific genomic mutations should result in improved treatments in the next few years.”
He also said that treatments could become easier on the patients themselves, pointing to new research on weekly schedules of the chemotherapy drugs carboplatin and taxol that suggests the regimen is just as effective, but less toxic than more traditional regimens.
Meanwhile, ongoing research into the PARP inhibitor olaparib suggests that it may improve treatment of hereditary ovarian cancers when used in the maintenance setting and that the angiogenesis inhibitor cediranib could improve survival in recurrent ovarian cancer.
More research is needed on these drugs before they can be used routinely, but the potential is promising.
Drugs aren’t the only option. “At City of Hope, we are collaborating in a T cell study investigating whether immune therapy may be beneficial in specific subsets of ovarian cancer patients,” Morgan said. “This is based on new knowledge of the immune system and how it plays a role in ovarian cancer.”
Pancreatic cancer: A novel approach to improve survivability
Pancreatic cancer’s lethal reputation comes from its stealth. As Gagandeep Singh, M.D., interim chair of the Department of Surgery at City of Hope, described the disease: “Fifty percent of pancreatic cancer is diagnosed at Stage IV, i.e., after it has spread, giving it a very bleak outlook.”
On the positive side, he noted, 50 percent of patients do not have metastatic disease. “While only 10 percent are operable at the time of diagnosis, the remaining 35 to 40 percent are considered locally advanced,” he said. “We strive to make these 40 percent operable, too, by a combination of neoadjuvant chemotherapy with radiotherapy followed by aggressive surgery or just aggressive surgery up front.”
Singh is optimistic about the future, especially as it relates to improvements in a procedure known as the Whipple, which involves the removal of the head of the pancreas along with the bile duct and the upper part of the intestine. During the surgery, tissue from the intestine is used to reconstruct the bile system, intestine and pancreas.
“We have been able to harness the advantage of the robot to do robotic-assisted Whipples by inserting hand-simulated instruments through tiny holes and then conducting the operation through these keyhole incisions,” Singh said. “The magnification, coupled with ease of use of these robotic instruments, adds to better and more radical clearance of the cancer.”
But choosing the right institution is crucial. “This is what is key – making sure those patients that have nonmetastatic pancreatic cancer go to the right institution at the right time to improve their survivability,” Singh said.
Prostate cancer: Using fluorescents to target disease
Timothy Wilson, M.D., the Pauline & Martin Collins Family Chair in Urology at City of Hope and director of the Prostate Cancer Program, has high hopes for doctors increasing ability to see precisely where cancerous cells stop and non-diseased cells begin. The key is fluorescence.
“The concept is the fluorescent label antibody against an antigen that sits on prostate cells, cancerous or not,” Wilson said. “You inject the fluorescent label antibody into the patient; it then targets and locates the prostate cell. And then during surgery, while doing it robotically, a switch is flipped that lights up that fluorescent label antibody so you see prostate tissue.”
He added: “This helps make sure we get all the cancer out or will help us see prostate cancer cells in lymph nodes.”
City of Hope plans to begin a clinical trial of that technique within months. It’s also exploring how to improve active surveillance, also known as “watchful waiting,” in men who have prostate cancer but who may not need immediate treatment. One method uses magnetic resonance imaging assessment of the prostate; another uses biomarkers.
Wilson referred specifically to the promise of a biomarker study by Steven Smith, Ph.D., professor of molecular science, urology and urologic oncology, that could help determine which men should stay on active surveillance and which men should receive treatment.
Radiation oncology: Getting a clear picture
For Jeffrey Wong, M.D., chair of City of Hope’s Department of Radiation Oncology, the future is looking not only brighter, but much clearer.
“There are two exciting trends for the field with the integration of imaging in radiation oncology,” he said. One involves what’s known as SBRT, for stereotactic body radiation therapy. This type of therapy uses very precise, very concentrated beams of radiation directed directly at the tumor. The other trend to watch uses ultrafocused sound with magnetic resonance imaging.
“For patients who refuse surgery or are medically unable to have surgery, SBRT can be used for lung patients with a 90 percent effectiveness in controlling the cancer,” Wong said.
As for magnetic resonance-guided focused ultrasound, or MRgFUS, it’s currently being evaluated by the Food and Drug Administration and is being tested to ablate prostate cancer, Wong said.
City of Hope’s Vicky Hoffman contributed to this report.
Although the human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration in 2006, vaccination rates among U.S. adolescents remain low.
In a review article published online in JAMA Pediatrics on Nov. 25, researchers reported that 34.8 percent of girls 13 to 17 had completed the three-cycle series of HPV vaccines and that only 8.3 percent of boys in the same age range had even initiated it. The federal Centers for Disease Control and Prevention (CDC) has recommended the vaccine for all girls and young women ages 11 through 26 — as well as all boys and young men ages 11 through 21.
The authors examined 55 studies to determine barriers to adolescents getting, and completing, their HPV immunization shot cycle. Recurring barriers that they found in these studies include: » Continue Reading