Cervical cancer research

All treatments have to be fully researched before they can be adopted as standard treatment for everyone. This is so that

• We can be sure they work
• We can be sure they work better than the treatments that are available at the moment
• They are known to be safe

First, treatments are developed and tested in laboratories. For ethical and safety reasons, experimental treatments must be tested in the laboratory before they can be tried in people. If a treatment described here is said to be at the laboratory stage of research, it is not ready for patients and is not available either within or outside the NHS.

Research studies involving patients are called clinical trials. The trials and research section has information about what trials are including information about the 4 phases of clinical trials.  If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials recruiting in the UK. If there is a trial you are interested in, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to make the referral to the research team. The database also has information about closed trials and trial results.

All the new approaches covered here are the subject of ongoing research. Until studies are completed and new effective treatments are found, these treatments cannot be used as standard therapy for cervical cancer.

A UK study is looking at young women's symptoms of cervical cancer. The researchers want to find out about the symptoms and experiences that young women have before they are diagnosed with cervical cancer. They want to try to make sure that in the future, young women with cervical cancer can be diagnosed as quickly as possible.

We know there is a link between cervical cancer and infection with the human papilloma virus (HPV). Researchers have developed tests to check liquid based cytology smear samples for the different types of human papilloma virus. There are many different types (strains). Types 16 and 18 are the strains most commonly linked to cervical cancer. 

HPV testing is currently being introduced as part of the NHS cervical cancer screening programme. It will be offered to women with borderline or low grade cervical changes. If these women do not have any of the HPV strains linked to cancer, it would be unlikely for them to develop cervical cancer and so they can return to routine screening. If they do have high risk HPV strains, they can be referred to colposcopy for further examination and have treatment if necessary.

One trial has looked at whether women can collect their own samples for the HPV test. The results show that there is no real difference in test results between the HPV sample taken by the women themselves, and those done by a doctor or nurse. Most women preferred doing the HPV test themselves and would use the self sampling test again if they were offered it.

Vaccines, such as Cervarix and Gardasil, have been developed to prevent HPV infection. There are many different HPV strains. HPV types 16 and 18 are known to be high risk for cervical cancer. Several research trials have tested vaccines as a way of preventing infection with HPV, and have shown that they help to prevent pre cancerous changes in the cervix (CIN 2 and 3). In the UK, HPV vaccination is offered in school to all girls aged 12 to 13.

Research suggests that this vaccination programme will dramatically lower the number of cases of cervical cancer. It will also reduce the need for colposcopy. There is more information about HPV vaccines and cervical cancer in the cervical cancer questions and answers section.

From September 2012, the vaccination programme will use Gardasil. This protects against HPV types 6 and 11, as well as 16 and 18. HPV 6 and 11 are known to cause warts on the vulva or around the anus.

Vaccines for HPV do not protect against all the types of HPV that are linked to cervical cancer. So, even if you have been vaccinated you will still need to go to future screening appointments.

Less radical surgery for very early cervical cancer is increasingly available. Either a cone biopsy or a radical trachelectomy may help some women with early stage cervical cancer (stage 1A or 1B) to have children after their treatment. In trachelectomy, the lower part of the cervix is removed, but the womb is left intact. This procedure is being used as standard treatment in some UK hospitals already. You may also have keyhole surgery, so that the lymph nodes around the womb can be examined as well.

In a recent study in Germany, 212 women with early stage cervical cancer (Stage 1 or 2) have had a new type of hysterectomy called a total mesometrial resection (TMMR). The actual tissue removed is based on improved knowledge of where the cancer is most likely to spread. The results are encouraging and suggest this operation could improve rates of survival. It may cause fewer side effects because there is less risk of damage to the nerve supply to the bowel, bladder and vagina. In this trial the women had not been given radiotherapy and this too helps to reduce side effects. Randomised controlled trials are now needed to see if this new technique works better than the standard treatment which is radical hysterectomy followed by radiotherapy.

Researchers are testing chemotherapy before surgery. The aim of this neo adjuvant treatment is to shrink the cancer before surgery, making surgery easier, and also to stop the cancer coming back after surgery. We don't know yet if giving chemotherapy before surgery is better than surgery on its own. In 2010, the Cochrane Collaboration reviewed 6 trials that have looked at this so far. They found that neo adjuvant chemotherapy helped women to live longer without cancer and reduced the risk of cancer spreading.  However, it was not clear if having chemotherapy before surgery made it easier to remove the cancer or if it reduced the chance of the cancer coming back.  

Trials are continuing to look into neo adjuvant chemotherapy. One trial is comparing chemotherapy before surgery with chemotherapy and radiotherapy. The aim of this trial is to find out which treatment works best for cervical cancer. The CXII trial and the INTERLACE study are looking at whether chemotherapy before chemoradiation is helpful and what the side effects are.

Chemotherapy is also being tested for advanced cervical cancer. This hasn't been used much in the past, but doctors hope they will find a drug, or combination of drugs, that can help to slow down the cancer or control symptoms. Drugs that have been tested include

• Cisplatin
• Carboplatin
• Gemcitabine
• Irinotecan
• Docetaxel
• Vinorelbine
• Topotecan

The links above take you to information about the side effects of these drugs.

Internal radiotherapy (brachytherapy) has been used for many years to treat cervical cancer and plays a major role in the treatment of this disease. But doctors believe that they can improve on how well this works in cervical cancer. With all cancers, doctors want to give high enough doses to control or cure the cancer, but not so much that they cause unnecessary side effects. 

There are different ways of giving internal radiotherapy for cervical cancer. You may have continuous treatment over a few days called low dose rate brachytherapy (LDR) or 2 or more short treatments a few days apart called high dose rate brachytherapy (HDR). Trials around the world have been monitoring the short and long term side effects of high dose brachytherapy, so that doctors and patients will have a complete picture of the pros and cons of this type of treatment. 

Most brachytherapy centres in the UK are phasing out the Selectron equipment, which gives low dose rate treatment (LDR). They are switching to a different system that can use either high dose rate brachytherapy (HDR) or pulsed dose rate brachytherapy (PDR). The PDR source is Iridium 192, which is loaded by remote control in a similar way to HDR treatment. And can be interrupted easily so that staff and visitors can enter the room safely. New imaging equipment with HDR and PDR allows doctors to see the tumour and areas of healthy tissue more clearly, so that they can deliver the treatment more accurately and safely.

The DEPICT trial is looking at increasing the radiation dose when giving external radiotherapy for cancer of the cervix. It uses Intensity Modulated Radiotherapy (IMRT). IMRT shapes the radiation beams to closely fit the shape of the cancer. But it also changes the radiotherapy dose, according to the shape of the cancer. This means that the central part of the cancer receives the highest dose of radiotherapy and a surrounding area of tissue gets lower doses. The aim of this trial is to see if doctors can increase the radiation dose to the cancer, without causing more side effects than standard radiotherapy treatment.

The HOT II trial is looking at whether using a high pressure oxygen treatment called hyberbaric oxygen (HBO) therapy can help to relieve the long term side effects of having radiotherapy to the pelvic region. 

The PRESident study is looking to see if taking a carbohydrate called FOS (fructo oligosaccharide) during radiotherapy can help to reduce long term bowel problems caused by radiotherapy. And another study is looking to see if fibre can help to control side effects in people having radiotherapy that affects the bowel.

A study called PRECIOUS is looking into how doctors and nurses collect information about the side effects of radiotherapy for cancer of the cervix. Researchers have developed a questionnaire which people answer on a computer. They want to test the questionnaire to find out how good it is at helping doctors understand and treat the side effects.

There is also research looking into using different chemotherapy drugs alongside radiotherapy for cervical cancer. Combined chemoradiation is the accepted best treatment for most stages of cervical cancer, but researchers think they may be able to improve results further still by investigating other combinations of drugs.

Biological therapies are treatments that use natural body substances or drugs made from natural body substances. There is detailed information about biological therapies in the about cancer treatment section. Current research for cervical cancer is looking at

• Cetuximab (Erbitux)
• Erlotinib (Tarceva)
• Bevacizumab (Avastin)
• Pazopanib

These drugs are being tested alone or in combination with radiotherapy or chemotherapy to treat cervical cancer, in trials outside the UK. Pazopanib is a new type of tyrosine kinase inhibitor. It is taken as a tablet and stops tumour cells developing blood vessels. It has been used to treat kidney and ovarian cancer and is in early stage clinical trials for bowel and cervical cancer.

A trial called CIRCCa is looking at cediranib for advanced cervical cancer. Cediranib is a type of biological therapy called an anti angiogenic. Anti angiogenic drugs stop the cancer growing new blood vessels. All cells need a blood supply to grow, so the researchers hope that cediranib will stop the cancer growing. Doctors often treat cervical cancer that has spread with chemotherapy. The aims of this trial are to find out how well cediranib with carboplatin and paclitaxel chemotherapy works for cervical cancer that has spread