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.

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.

There is a UK study 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 available as part of the NHS cervical cancer screening programme in some areas. It is offered to women with borderline or low grade cervical changes detected in the first round of cervical screening. If these women do not have any of the HPV strains linked to cancer, it might be safe to stop monitoring them, because they would be unlikely to develop cervical cancer. If they do have the risky HPV strains, then they can continue to have monitoring and then 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 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 of CancerHelp UK.

One vaccine, called Gardasil protects against HPV types 6 and 11, as well as 16 and 18. HPV types 6 and 11 are known to cause warts on the vulva or around the anus. Gardasil was licensed for use in the UK in 2007. But it is the vaccine Cervarix that was selected to be used in the NHS HPV vaccination programme. The PATRICIA study (PApilloma TRIal to prevent Cervical cancer In young Adults) involved 18,000 women under 26 from all over the world, including the UK. Results after 3 years of follow up, show that Cervarix prevents pre cancerous changes (CIN 2 or 3) caused by HPV 16 or 18 in about 90% of women.

A cervical smear test can pick up abnormal cells on the cervix. Cell changes can be mild, moderate or severe. A trial has been looking at whether a diet supplement can help the cells of the cervix return to normal in women who show borderline or mild cell changes. The diet supplement is called diindolymethane (DIM). This trial is now closed and we are waiting for the results.

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 ‘neoadjuvant 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 neoadjuvant 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 neoadjuvant 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 has looked at whether chemotherapy before chemoradiation is helpful and what the side effects are. This trial is no longer recruiting patients and we are waiting for the results.

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
• Gemcitabine
• Irinotecan
• Docetaxel
• Vinorelbine
• Topotecan

The links 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. It is safer and easier to use than LDR and the treatment can be given more accurately, and interrupted more easily, so that staff and visitors can enter the treatment room 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. Most side effects will get better a few months after treatment has finished. But for a small number of people the side effects may be long lasting. Many of the long term side effects of pelvic radiotherapy affect the bowel. These include frequent bowel movements, diarrhoea, pain, bleeding from the bowel and the forming of scar tissue in the bowel (radiation fibrosis). You may be able to join this trial if you still have bowel problems caused by radiotherapy you had at least a year ago, and you have no signs of cancer now. Everyone on this trial will go to one of the specialist centres taking part in this study to have hyperbaric oxygen therapy (HBO). You go every day, 5 days a week (Monday to Friday), for 8 weeks. Each treatment takes about an hour and a half. There are 2 groups in this trial. One will have 100% oxygen under pressure, the other will have 21% oxygen (the same as air) under pressure. Neither you nor your doctor will know which group you are in.

To have HBO, you sit inside a chamber on your own or with up to 5 other patients and a qualified attendant, depending on the size of the chamber at the specialist centre. The chamber is sealed, but has small windows. There is a doctor just outside the whole time. 

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. This study is now closed and we are waiting for the results. 

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 still further 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 of CancerHelp UK. 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