HEALTH LINE: In HPV-Associated Gynecologic Cancers, Prevention and Awareness Are Key

CINCINNATI—Cervical cancers often have silent symptoms that go undetected until they are in an advanced stage. Jess Guarnaschelli, MD, of the University of Cincinnati Cancer Institute, encourages women to empower themselves with the facts about gynecologic cancer, then actively commit to control their risk. 

"Human papillomavirus (HPV) has been strongly linked to an increased risk for many cancers of the genital tract as well as the oropharynx,” says Guarnaschelli, an assistant professor in the UC College of Medicine Department of Radiation Oncology and UC Health radiation oncologist. "Although some strands of HPV result in physical manifestations——most people who are infected with HPV do not know it.”

The U.S. Centers for Disease Control and Prevention estimates that at least 20 million people are currently infected with HPV. An additional 6 million become newly infected each year with this sexually transmitted disease. About 50 percent of all men and women will become infected with HPV at some point in their lives. (About 80 percent of college-aged women will become infected with HPV.)

"Prevention is preferable to treatment, though, so both men and women need to understand that HPV is insidious and take steps to reduce their risk of infection and see a physician immediately for concerning symptoms,” adds Guarnaschelli. 

For women, this means having an annual gynecologic exam and cervical cancer screening upon becoming sexually active. Using condoms during intercourse can reduce the risk of HPV and other sexually transmitted diseases. Limiting the number of partners also reduces the risk of infection, but even people with one lifetime sex partner can get HPV.

Individuals under the age of 26 may also be eligible for the HPV vaccine. (The potential for benefit in the overall population drops at age 26 and above.) 

Targeted Radiation Treatment Options Available

Treatment options for women facing a diagnosis of advanced cervical or vulvar cancer have improved, offering women new options for cancer control. 

Through UC Health, the UC Cancer Institute Gynecologic Oncology team offers many forms of internal radiation therapy called brachytherapy. Brachytherapy can be delivered in multiple ways, including tandem and ovoid implants or Syed implants. William Barrett, chair of the UC College of Medicine Department of Radiation Oncology, leads the brachytherapy program at the UC Cancer Institute. 

The Syed method involves inserting thin radiation needles into the pelvic floor to generate a "radiation cloud” that covers both the primary tumor site as well as tissue surrounding the cervix, the parametrium. 

"Delivering the most effective dose in the most precise way is always our goal in radiation oncology, but it is especially important in areas of the body like the reproductive tract where we must work hard to reduce toxicities to the bladder and bowel,” says Guarnaschelli.

By combining this internal brachytherapy and external beam radiotherapy with image-guidance, radiation oncologists can deliver highly focused intensity-modulated radiation therapy (IMRT) adjusted  to patient’s changing anatomy. 

IMRT and image-guided radiation therapy (IGRT) allows radiation oncologists to  provide more precise treatment at higher dosages with fewer side effects. Previously, patients with advanced cervical cancers that involved the para-aortic nodes would have received standard radiation therapy at lower doses to nodes that harbored cancer.  

Clinical Trials and Appointments

The UC Cancer Institute offers clinical trials for all forms and stages of gynecologic cancer. To learn more, visit uccancer.com/clinicaltrials. To learn more about the gynecologic oncology team, visit uccancer.com/gyn. Physician consultation appointments are available at various UC Health clinical facilities, including the UC Health Barrett Center and UC Health Physicians Office North.