Tilley Jenkins Vogel
A routine Pap smear should detect precancerous or cancerous cells in the cervix. In fact, Pap smears are specifically targeted to detect irregularities in the cervix. (So you are correct- this is exactly why we recommend Pap smears.) Pap smears are not great for detecting abnormalities higher up in the uterus. Rarely, we do pick up uterine cancers on routine Pap smears. But in general, Pap smears are inadequate for detecting uterine cancers. Thus with any abnormal bleeding, we recommend that you have an evaluation with your gynecologist.

Tilley Jenkins Vogel
The vast majority of cervical cancers are caused by a virus- HPV (human papillomavirus).

Tilley Jenkins Vogel
This depends very much on what the stage of the cancer is at diagnosis. For example, for very early-stage cervical cancer, almost no one will experience relapse (i.e. risk of the cancer coming back is probably 2-3%). In contrast, for those with advanced (stage 4) cervical cancer, 80-90% will experience the return of cancer.

Tilley Jenkins Vogel
I'd recommend annual visits with a gynecologist, per routine. Follicles are normal findings on ovaries in young women. No specific follow-up is recommended based on the CT scan (especially if it has been 9 years since it was performed).

Tilley Jenkins Vogel
For cervical cancer, many patients do NOT need surgery. Many receive a combination of chemotherapy and radiation therapy which is curative (and is more effective than surgery depending on the stage of disease). Others with early cervical cancer DO require surgery. This is typically comprised of a hysterectomy (removal of the uterus and cervix). Sometimes ovaries, fallopian tubes and, lymph nodes are also removed. For women who would like to retain the uterus in order to preserve the option for pregnancy, there are sometimes less radical surgical options. But the cancer must be very early to qualify for this type of treatment. All women will require a biopsy of the cervix to confirm the diagnosis prior to treatment. Sometimes this is performed in the operating room. Frequently, however, this can be performed in the office.

Tilley Jenkins Vogel
Good question. In any woman with postmenopausal bleeding, I would recommend an evaluation. So very good that you went for testing. An ultrasound is a pretty good test. A biopsy of the lining of the uterus, however, is a better test (as it allows us to get a concrete diagnosis of what is going on inside the uterus). So I would NOT recommend that you simply take meds to shed the lining. I would recommend that you have a procedure called an endometrial biopsy. This can be performed in the office and is uncomfortable, but minor. If this is normal and the bleeding stops, this is reassuring. However, in the absence of a biopsy to confirm exactly what the lining of the uterus is doing we do not have an explanation for the bleeding. So this is a long answer to a very good question. I am glad that you asked. You are absolutely correct. We otherwise would not know what is happening in the uterus without a biopsy.

Tilley Jenkins Vogel
There have been advances in treatment, absolutely. We are now using immunotherapy for women in whom the cancer has returned with some success. As far as detection goes, we have tailored the guidelines for Pap smear testing and are using HPV testing as a primary means to identify patients at risk. This has been helpful in detecting some patients that would have been missed by regular Pap smears alone. As Pap smear guidelines are changing frequently (and there will be new guidelines out in 2020), I recommend that you keep a dialogue open with your primary provider/ GYN. What is super important for prevention is to have the HPV vaccine. Women up to 45 years of age are eligible (and it should be covered by insurance).

Tilley Jenkins Vogel
Great question. The best way to lower your risk of cervical cancer is to continue regular screening with your gynecologist. Depending on your specific history, some patients require Pap smears every 3 years while others need Pap smears more frequently. Regardless of timing of Pap smears, you do need a yearly visit with a gynecologist to assess for any abnormalities. IF you are having symptoms such as irregular bleeding or bleeding after sex then I would recommend an early assessment. A healthy diet has not necessarily been linked to cervical cancer prevention but IS important for other cancer prevention and general good health. It is also very important that you do not smoke cigarettes (as tobacco use is associated with a higher cervix cancer risk). Safe sex practices (i.e. condom use) are also helpful for preventing cervix cancer as it is caused by a virus that is transmitted sexually.

Tilley Jenkins Vogel
Breast cancer and cervical cancer are not typically linked (as most cervix cancers are not hereditary, rather they are caused by an infection- a virus). As such we do not recommend genetic testing for cervix cancer aside from very rare, specific circumstances. Depending on the age at which your mother was diagnosed and the cancer history in other family members, you may be at increased risk for breast and other cancers. I would recommend that you discuss with your primary care physician or gynecologist further to better understand your risk.

Tilley Jenkins Vogel
Immunotherapy is an IV treatment, similar to chemotherapy in many ways (but with different side effects). It is usually given when cervical cancer has returned after initial treatment. Not all women with cervical cancer are candidates. The cancer needs to have a specific profile under the microscope in order for someone to qualify for this type of therapy (outside of treatment on a clinical trial). If you or someone you know has cervical cancer and is interested in learning more about immunotherapy options, I would encourage you (or she) to discuss with the treating oncologist.