Understanding the Biology and Staging of Cervical Cancer

Experts provide a brief overview of cervical cancer, focusing on the driving biology and FIGO staging system.


Bradley Monk, MD, FACOG, FACS: Greetings and welcome to OncLive® Peer Exchange entitled “Recent Advances in Cervical Cancer Treatment.” We’re sharing a negative phase 3 trial, 2 positive practice-changing phase 3 trials, and a recent approval of the first antibody-drug conjugate in a gynecologic malignancy; this will be a robust discussion. My name is Brad Monk, I’m a gynecologic oncologist from Phoenix, Arizona, and a professor at the University of Arizona and Creighton University, both in Phoenix. I am joined by 4 experts from across the country, and I want to introduce to you Warner Huh.

Warner K. Huh, MD, FACOG, FACS: Thanks, Dr. Monk. Warner Huh, I’m the chair of ob-gyn at the University of Alabama at Birmingham, practicing gynecologic oncologist, and I am excited to be here.

Bradley Monk, MD, FACOG, FACS: My pleasure. I’m glad you could join us. Warner was a former president of the Society of Gynecologic Oncology. He has held every meaningful position, and now he’s chair of ob-gyn and likely leading gynecologic oncologist in cervical cancer screening and a thought leader in treatment. Bhavana Pothuri, greetings, please introduce yourself.

Bhavana Pothuri, MD: Hi, I am Bhavana Pothuri. I am a GYN [gynecologic] oncologist at NYU Langone Health and Perlmutter Cancer Center [New York, New York]. I’m a professor there and I’m also the director of GYN oncology clinical trials. I am active with GOG [Gynecologic Oncology Group] Partners and serve as an associate clinical trial advisor for ovarian and endometrial cancers, and have an interest in cervical cancer. Thank you.

Bradley Monk, MD, FACOG, FACS: We appreciate your leadership in the GOG Partners program. You’re changing the world, and many of these trials that we’re going to discuss are GOG Partners trials. Krish Tewari, greetings, how are you?

Krishnansu S. Tewari, MD: Great, thank you. My name is Krish Tewari. I’m a practicing GYN oncologist at the University of California Irvine [Orange, California].

Bradley Monk, MD, FACOG, FACS: We’re going to discuss more than one New England Journal paper that Dr. Tewari has coauthored, so we’re interested to hear your perspectives. Last, but not least, Premal Thaker.

Premal H. Thaker, MD, MS: Hi, thank you for this opportunity. I’m Premal Thaker. I’m a professor of GYN oncology at Washington University School of Medicine and Siteman Cancer Center in St. Louis, and I am the director of our gynecologic oncology clinical research.

Bradley Monk, MD, FACOG, FACS: Washington University St. Louis is one of our top enrolling sites. It’s one thing to talk, and we’re going to talk today, but when it comes to getting things done, Dr. Thaker and her colleagues in St. Louis always do. I’d like to discuss biology and screening. Most people acknowledge that this is a preventable disease. Bhavana, can you talk about the histology’s and the staging for cervical cancer.

Bhavana Pothuri, MD: Yes, cervical cancer is important to discuss. It’s the fourth leading cause of cancer death in women worldwide, and over 99% are caused by HPV [human papillomavirus]. It is the causative agent. This is a cancer that affects younger women, most are diagnosed between the ages of 35 and 44. It’s important that we’re having this discussion and focusing on these patients. The majority are classified as squamous cell cancers, about 80%, and the remainder are largely adenocarcinomas.

Bradley Monk, MD, FACOG, FACS: There’s a staging system. Dr. Tewari, tell us about the FIGO [International Federation of Gynecology and Obstetrics] staging system. It’s different than what people are used to, the TNM [tumor nodes metastases] staging system.

Krishnansu S. Tewari, MD: We’ve been using FIGO for years to stage cervical cancer, and for a long time it was a clinically assigned staging. If the cancer is involving the cervix, it’s a stage I; if it spreads into the upper vagina or the perimetrial tissues surrounding the cervix, it’s a stage II; if it goes up the pelvic side wall, it’s a stage III; if it’s involving the bladder or rectum, it’s a IVA; and if it’s metastasized, it’s a IVB. Recently, in 2018, FIGO updated their staging to allow for radiographic and/or pathologic evaluation specifically of lymph nodes. We have guidance and can designate a patient with stage III disease by virtue of their lymph nodes, whether they’re positive on pathologic examination or by radiographic imaging. You should denote that with a subscript.

Bradley Monk, MD, FACOG, FACS: I like it because it’s the same as endometrial or uterine cancer, right? IIIC1 means it’s in the pelvic lymph nodes, and IIIC2 means it’s in the aortic lymph nodes. There’s not much to remember there.

Transcript edited for clarity.

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