From HPV to cervical cancer: Understand the disease progression and discover treatment strategies that restore quality of life after cancer
Despite Thailand’s strong commitment to cervical cancer prevention, including the administration of more than 1 million doses of the HPV vaccine to girls aged 11–20 in 2024, the number of deaths from cervical cancer remains alarmingly high, at approximately 4,000–5,000 each year, meaning that, on average, at least one woman dies from the disease every two hours.
The key question, therefore, is not just “How effective is our prevention effort?” but rather “Why does this preventable disease continue to take the lives of so many Thai women?”
This article seeks answers from specialists across three fields: gynecologic oncology, medical oncology, and radiation oncology. Together, we will explore everything from the root cause of the disease (the HPV infection) and the importance of the HPV vaccine and screenings to the advanced treatment options for cervical cancer that increase the chances of recovery and help patients reclaim their quality of life with confidence.
Cervical Cancer: Preventable, Yet Still Claims the Lives of Many Thai Women
Cervical cancer is one of the few cancers that are preventable through HPV inoculation and screenings. Yet it remains a major cause of death among Thai women.
Dr. Asama Vanichtantikul, an OB/GYN doctor specializing in Gynecologic Oncology at MedPark Hospital, explains why cervical cancer mortality rates have not declined as much as expected:
“Early-stage cervical cancer is often asymptomatic, leading many women to forgo screenings. By the time symptoms such as abnormal vaginal bleeding or unusual discharge develop, patients already have advanced disease. In contrast, when detected early, treatment is less complex and offers a significantly higher likelihood of cure.”
Understanding HPV: The Root Cause of Cervical Cancer
Medical evidence confirms that up to 99% of cervical cancer cases are associated with human papillomavirus (HPV) infection, particularly high-risk strains such as HPV 16 and 18, which are commonly found in patients with cervical cancer worldwide. HPV transmission is primarily through sexual contact, including penetrative intercourse, skin-to-skin contact in the genital area, and oral sex.
Dr. Asama provides further insights that many people may not be aware of: “Approximately 80% of women acquire HPV infection at some point in their lives. The virus can persist in the body for years without causing symptoms. In most cases, the immune system naturally clears it within 1–2 years. However, in infections with high-risk strains, the virus can induce gradual cellular changes in the cervix, progressing to precancerous lesions and, ultimately, cervical cancer.”
HPV in Men: The Forgotten High-Risk Group.
In recent years, HPV has increasingly gained recognition as a contributing factor in a range of cancers affecting both women and men, including penile, anal, and oropharyngeal cancers, which are rising in incidence worldwide. However, awareness of HPV and immunization among Thai men remains minuscule.
“A common misconception stems from calling the HPV vaccine simply the ‘cervical cancer vaccine.’ It misleads men to feel it is irrelevant to them. However, men can get infected and pass HPV on to their partners. What is worse, detecting the virus in men is currently much harder than in women because there is no clear screening system like a cervical cancer screening.”
HPV Vaccination + Screenings = Proactive Prevention
The latest generation of HPV vaccines protects against up to nine high-risk strains, covering approximately 95% of those responsible for cervical cancer. Vaccination is most effective when given before the onset of sexual activity, typically between the ages of 9 and 12. However, even in individuals who are already sexually active, vaccination remains beneficial and is recommended up to age 45.
Dr. Asama emphasizes that regular screenings should complement HPV vaccination: “While the vaccine significantly reduces the risk, it does not provide 100% protection. Cervical cancer screening, therefore, remains an indispensable tool for detecting early signs of the disease.”
The two screening methods currently recommended by doctors are:
- ThinPrep (Pap test): Detects abnormal cervical cells to screen for early signs of cervical cancer; recommended for women aged 21 and above.
- HPV DNA Test: Recommended as an additional screening method for women aged 25 and above, as it can accurately detect high-risk HPV strains.
Cervical Cancer Treatment: Staging Determines the Approach.
The management of cervical cancer depends on the stage of the disease, ranging from precancerous lesions to advanced metastatic stages. Personalized treatment strategies ensure the most appropriate approach for each patient, as outlined below:
- Precancerous stage or mild to moderate cervical cell abnormalities: Doctors may recommend close monitoring, or localized therapies, such as thermal ablation or cryotherapy, may be performed. In cases of high-grade dysplastic changes, doctors would advise a cone biopsy to remove the affected tissue and prevent progression to invasive cancer.
Once the disease progresses to malignancy, the extent of spread determines treatment strategies:
- Stage I: The disease remains confined to the cervix; treatment primarily involves surgery.
- Stages II–III: The cancer has spread to nearby tissues or organs. The mainstay of treatment shifts to radiation therapy combined with chemotherapy to enhance disease control.
- Stage IV: The cancer has metastasized to distant organs. Treatment focuses on systemic therapies, including chemotherapy, targeted therapy, and immunotherapy. Localized radiation therapy may also be used for palliative purposes, helping to relieve symptoms such as pain, bleeding, or other complications caused by the tumor.
Surgery: A Key Treatment Option for Early-Stage Cervical Cancer
Dr. Asama explains that several factors, including tumor size, stage of the disease, and the desire for future fertility, determine the surgical approach to cervical cancer.
“Currently, there are several surgical approaches available, ranging from excision of localized lesions and partial removal of the cervix to hysterectomy with lymph node dissection, depending on what is most appropriate for each patient. When diseases are early-stage, surgery alone may be sufficient, without the need for additional chemotherapy or radiation therapy.”
“For patients who desire to have children in the future, certain surgical procedures may shorten the cervix and increase the risk of preterm birth. Pregnancy following the cancer treatment, therefore, requires close monitoring and specialized care throughout gestation.”
Chemotherapy and Radiation Therapy: When Cancer Becomes Invasive
For patients with locally advanced disease, radiation therapy combined with chemotherapy is the standard of care, enhancing treatment effectiveness and improving disease control. The primary goals are to achieve optimal therapeutic outcomes while minimizing side effects on surrounding organs.
Asst. Prof. Dr. Sunantha Srisubut-Ploysongsang, a Radiation Oncologist, explains:
“Modern radiation therapy is far more precise than in the past. With the use of three-dimensional treatment planning, radiation can be accurately targeted to the tumor, significantly reducing radiation exposure of surrounding organs such as the bladder, intestines, and rectum.”
Brachytherapy: Internal Radiation Therapy for Higher Precision
Another pivotal technology is brachytherapy, which involves placing radioactive sources directly into the uterine cavity or cervix. It allows a high dose of radiation to target and treat the tumor precisely.
Asst. Prof. Dr. Sunantha explains the key procedural advantages of brachytherapy for cervical cancer: “One of the main advantages of brachytherapy is that radiation intensity drops off rapidly with increased distance from the source, allowing surrounding organs such as the bladder, intestines, and rectum to be minimally affected. Before each treatment session, the radiation oncology team performs detailed planning using CT or MRI imaging to accurately determine the optimal placement and radiation dose tailored to each patient.”
Targeted Therapy and Immunotherapy: New Hope for Patients with Metastatic Cancer
For patients with advanced-stage or recurrent cancer, targeted therapy and immunotherapy are increasingly being adopted into clinical practice.
Dr. Sudpreeda Chainitikun, a Medical Oncologist, explains a new class of therapies: “New drug classes like ADC (Antibody-Drug Conjugate) are a novel approach that binds targeted and chemotherapeutic agents together. They function much like a ‘guided missile’ that zeroes in specifically on cancer cells. The antibody acts like a guided, smart missile equipped with radar, while the chemotherapy payload is the explosive destined to destroy the cancer cells from within.”
The benefit of ADC drugs is that they improve precision and lessen the impact on healthy cells compared to traditional chemotherapy. Although currently applied to select patient groups and associated with high costs, this approach represents a significant advance in cancer treatment.
Multidisciplinary Care: One Team, One Goal
Cervical cancer treatment depends on the collaboration of an interprofessional team rather than a single specialty. Gynecologic oncologists, medical oncologists, radiation oncologists, and specialized oncology nurses work together to design the most appropriate, personalized treatment plan for each patient.
Particularly for highly complex cases, the team meets in a tumor board conference to comprehensively evaluate the disease stage, treatment pathways, potential adverse effects, and long-term quality of life. The ultimate goal is to enable patients to sustain a high quality of life post-treatment, not just to treat the disease.
Beyond a Cure: Post-Cancer Quality of Life
For many cancer patients, achieving remission does not mark the end of their cervical cancer battle. Post-treatment management involves gradual physical and emotional healing to resume their daily routines. For women in relationships, concerns regarding intimacy with their partners often arise, leading to doubt about whether their lives can truly return to normal.
Dr. Asama advises: “Following the conclusion of treatment and in the absence of residual disease, patients can safely resume sexual activity. It not only reestablishes intimacy but also helps reduce the risk of long-term complications such as vaginal dryness and stenosis.”
The three specialists collectively emphasize that regular post-treatment follow-up is just as important as the treatment itself. Ongoing monitoring is essential for the early detection of recurrence and the management of potential long-term adverse effects.
Ultimately, the goal of cancer treatment extends beyond extending survival; it is to enable patients to move forward with confidence, well-being, and a sustained quality of life.