Cervical Cancer: What Patients and Clinicians Should Know

An expert Q&A with Dr. Tashanna Myers, Gynecologic Oncologist

Introduction: Why Cervical Cancer Still Matters

Cervical cancer remains one of the most preventable yet still devastating cancers affecting women worldwide. According to the World Health Organization, it is the fourth most common cancer in women globally, with approximately 600,000 new cases and 350,000 deaths in 2022. Despite effective screening and vaccination strategies, disparities in access to care, delayed diagnosis, and treatment-related complications continue to drive morbidity and mortality.

There is a global effort to eradicate cervical cancer using the 90–70–90 strategy:

• 90% of girls fully vaccinated with the HPV vaccine by age 15
• 70% of women screened by ages 35 and 45
• 90% of women with pre-cancer or invasive cancer receiving appropriate treatment

Cervical cancer is largely preventable with effective global vaccination and screening.

This article is presented in a blog-style Q&A format based on written expert responses from Dr. Tashanna Myers, a board-certified gynecologic oncologist to reflect common clinical scenarios and patient concerns related to modern cervical cancer treatment, toxicity, cardiovascular considerations, and survivorship.

About Dr. Tashanna Myers

Q&A: Cervical Cancer Treatment, Toxicity, and Cardiovascular Considerations

1) What are the most common treatment options for cervical cancer, and what should patients understand before starting chemotherapy or radiation?

Cervical cancer treatment is guided primarily by the stage of disease. Very early-stage cervical cancer can often be treated—and cured—with fertility-sparing procedures or radical hysterectomy. In contrast, more advanced disease usually requires chemotherapy and radiation, with advanced stages most commonly treated using chemotherapy along with selective use of radiation.

Before starting treatment, patients should understand three key things:

• The stage of their cancer. Stage determines how far the cancer has spread in the body and provides important information about prognosis, with earlier stages generally having better outcomes than later stages.
• The goal of treatment. Is the intent to cure the cancer, or is the goal to control the disease and relieve symptoms? Clarifying this helps align treatment choices with patient expectations and priorities.
• The expected side effects. Understanding common treatment-related side effects allows patients and their doctors to plan how to manage them—or, when appropriate, choose a treatment approach that may be safer for the individual.

2) Which symptoms during treatment should prompt patients to contact their care team immediately?

Cancer treatment can suppress the immune system, making FEVER a medical red flag that always warrants urgent attention. During therapy, the body’s ability to fight infection is reduced, and even minor infections can become severe quickly.

Patients should also report NAUSEA, VOMITING, and DIARRHEA, as these symptoms can lead to poor oral intake and excessive fluid losses, resulting in dehydration and electrolyte abnormalities.

3) Which cardiovascular risk factors most influence how you plan cervical cancer treatment?

Patients with baseline cardiovascular disease—including heart failure, prior myocardial infarction, or coronary artery disease—as well as those with diabetes, hypertension, hyperlipidemia, smoking history, obesity, or age >60 years, are at higher risk for treatment-related cardiovascular toxicity. These patients require aggressive risk-factor modification, and those with established heart disease may need multidisciplinary input from cardiology or cardio-oncology.

A patient’s overall health and baseline functional status are central to treatment planning. Care is individualized through collaboration with the patient, their family, and their regular physicians to select a treatment that offers benefit with the least harm.

Each treatment modality places a different level of stress on the body. Surgical risks differ from those of radiation or chemotherapy, and patients who are not candidates for surgery may still tolerate radiation.

4) Are there specific cervical cancer therapies that commonly complicate cardiovascular management?

Studies show that patients receiving chemotherapy and radiation for cervical cancer are at increased risk of myocardial infarction, thromboembolic events, and stroke. Those undergoing radiation therapy are often older and may already have pre-existing cardiovascular risk factors, placing them at higher risk for treatment-related cardiac toxicity. Radiation to the pelvis also increases the risk of peripheral arterial disease.

As precision medicine expands in gynecologic oncology, newer therapies come with unique side-effect profiles:

• Immunotherapy can cause immune-mediated toxicity affecting the heart, lungs, and kidneys.
• Bevacizumab, a monoclonal antibody, can cause hypertension, heart attack, blood clots and proteinuria.
• Antibody–drug conjugates (ADCs) are associated with blood clots (DVT and pulmonary embolism), though they are not known to directly cause cardiac toxicity.
• Cisplatin- based chemotherapy: can cause vascular disease including high blood pressure, heart attack, stroke, blood clots etc.
• Pelvic radiation:vascular damage at the location of radiation.

With pan-tumor drug approvals, patients now receive more therapies across their cancer journey. While this improves survival, it also increases cumulative exposure to potential toxicities.

5) How can patients best protect their overall health—particularly heart health—while undergoing cervical cancer treatment?

To reduce these risks, patients should continue to actively manage chronic conditions such as high blood pressure, diabetes, and thyroid disease throughout cancer therapy. Because treatments can alter taste and appetite, dietary changes are common and should be addressed proactively.

Physical activity is generally encouraged. Patients should consider their baseline fitness level and continue physical activity as tolerated, rather than becoming sedentary during treatment.

6) When is early cardiology or cardio-oncology involvement most helpful—before treatment begins, during therapy, or after complications arise?

Cardio-oncology consultation is an invaluable resource. Many newer targeted therapies carry cardiac risks, and women may present atypically with serious cardiac conditions.

Consultation is most helpful when treatment has known cardiac toxicity or when patients have pre-existing risk factors that increase vulnerability to treatment-related heart injury.

7) What is one key insight you want cardiologists to understand when caring for patients undergoing cervical cancer therapy?

The primary role of cardiologists is to optimize cardiovascular health through aggressive risk-factor management, assessment of complications, use of cardio-protective medications, and close monitoring for treatment-related cardiac toxicity, with clear communication alongside the oncology team.

Many patients treated for cervical cancer are young women. Some develop long-term electrolyte abnormalities and malabsorption as late effects of chemotherapy and radiation, which can also affect medication absorption and long-term cardiovascular management.

8) How do treatment decisions change for patients with pre-existing cardiovascular disease or multiple cardiac risk factors?

Aggressive optimization of cardiac issues is the primary concern. Treatment is only interrupted with evidence of cardiotoxicity such as a drastic drop in heart function or severe blood pressure elevation, or other clinically relevant cardiotoxicity.

Risk adjustments are made for every patient with a new cancer diagnosis. Treatment decisions incorporate:

• Competing life-limiting illnesses
• Performance status
• Stage of disease
• Personal goals (quality of life versus longevity)

These considerations are addressed at the very start of the treatment consultation.

9) After treatment is completed, what long-term follow-up is most important for cervical cancer survivors?

The greatest concern remains cancer recurrence, followed by long-term treatment toxicity. Radiation can cause late side effects 10–20 years after therapy.

Radiation injury may affect:

• The bladder (radiation cystitis)
• The rectum (radiation proctitis)
• The small bowel (radiation enteritis)

Patients should report pain, bowel or bladder changes, or bleeding. Survivors are followed for a minimum of five years.

Guest contribution by Dr. Tashanna Myers, Gynecologic Oncologist.