Cervical cancer research
This page is about research into cervical cancer. You can find information below about
Cervical cancer research
All treatments must be fully researched before they can be adopted as standard treatment for everyone. This is so that we can be sure they work better than the treatments we already use. And so we know that they are safe.
First of all, treatments are developed and tested in laboratories. Only after we know that they are likely to be safe to test are they tested in people, in clinical trials.
There is research looking into HPV vaccines and tests, surgery, chemotherapy, radiotherapy and biological therapies.
You can view and print the quick guides for all the pages in the Treating cervical cancer section.
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.
Vaccines have been developed to prevent HPV infection. There are many different HPV strains. Types 16 and 18 of HPV 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 precancerous changes in the cervix (CIN 2 and 3). In England, HPV vaccination is offered, in school, to all girls aged 12 to 13. The Government has also announced a 2 year 'catch up' programme from Autumn 2008 to vaccinate girls aged between 13 and 18, born after 1st September 1990. The Scottish Executive's immunisation programme also started in September 2008.
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 diseases of the genital area such 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 precancerous changes (CIN 2 or 3) caused by HPV 16 or 18 in about 90% of women.
HPV Tests
We know there is a link between cervical cancer and infection with the human papilloma virus (HPV). Tests have been developed to check liquid based cytology smear samples for the different types of human papilloma virus. There are many different types, or 'strains'. Types 16 and 18 are the strains most commonly linked to cervical cancer.
A test called the hybrid capture HPV Test has been in trials throughout the USA and UK. This test helps doctors identify women who are most at risk of developing cervical diseases or cervical cancer. This test is already used in the USA alongside the regular cervical smear (the PAP test) for cervical cancer screening.
Results from UK research have so far been very positive. In future, it is likely that if women have borderline smears, or repeated mild cell changes, they will be tested for HPV. 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 be treated. But the NHS say that they need more research before this system can be safely adopted. A trial in the UK called ARTISTIC is currently being evaluated. Results so far suggest that a third round of screening is needed to decide whether or not it is safe to leave routine screening for more than 3 years in women who have a negative HPV test. The researchers will report again in 2011.
Another 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.
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 also to stop the cancer from coming back after surgery. There are trials taking place looking into neoadjuvant chemotherapy. One 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
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. In March 2006, NICE (the National Institute of Health and Clinical Excellence) reviewed the results of these trials. They say that high dose rate treatment was as safe and worked as well as low dose rate treatment but that doctors using this treatment should continue to monitor results so that we can learn more. They also said that women offered this treatment should have all the possible benefits and drawbacks explained to them before they agree to it.
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.
There is a trial 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.
There is more information about these trials on our clinical trials database.
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
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.
Many women have said that getting emotional support when they have gynaecological cancer has helped them to cope. But there is little scientific evidence to back this up. A small study in London has been looking at the difference that this kind of support can make. Women in one group are contacted by a woman who has had similar treatment, and had special training in giving support. The other group go on a waiting list for this kind of support. All women in the study are asked to fill in some questionnaires. The researchers want to find out how helpful this service is for women with gynaecological cancer. This study is no longer recruiting patients and we are waiting for the results.
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