Cervical Cancer Program

Why Choose Us?

Our multidisciplinary team is led by one of the region’s only female Gynecologic Oncologists, Dr. Stephanie Ricci. She is a specialist in the treatment of female cancers, and one of only a handful in the UAE. Treatment for cervical cancer by a gynecologic oncologist is extremely important as they have the dedicated training, specialist experience and technical skills needed to diagnose and treat the cancer as effectively as possible. Dr. Ricci qualified is a fellowship trained, American board-certified and spent 6 years at Cleveland Clinic in the US. She has dedicated her career to helping women affected by cancer.

Our multidisciplinary approach brings together a team of experts to provide coordinated and exceptional patient care to those diagnosed with gynecologic cancers. The team meets regularly as a multidisciplinary tumor board to discuss each patient and ensure the best treatment options are considered for each individual.

What We Treat

The cervix is the lower part of the uterus, or womb, that connects to the vagina. Cervical cancer starts on the surface of the cervix, and there are two types:

• Squamous cell carcinomas, which account for around 80% to 90% of all cervical cancers
• Adenocarcinomas, which account for around 10% to 20%

Non-HPV related cervical cancers are rare, approximately less than 1% of all cases.

The Cervical Cancer Program at Cleveland Clinic Abu Dhabi treats women diagnosed with cervical cancer as well as precancerous conditions of the cervix, including cervical intraepithelial neoplasia (CIN).

Our team of specialists are highly trained in a variety of diagnostic techniques and state-of-the-art therapeutic treatments for cervical cancers and precancerous conditions.

Symptoms, Causes & Risk Factors

The first symptoms of cervical cancer might include:

• Discharge that is watery or has blood in it, and may smell bad
• Unusual bleeding, including between menstrual periods or after exercise
• Longer or heavier menstrual periods

When the cancer has spread to other tissues, symptoms might include:

• Pain when urinating
• Bleeding or pain from the rectum
• Feeling tired, losing your appetite or weight loss
• Generally feeling unwell
• Swelling in the legs or a dull back ache

If you experience any of these symptoms for more than 2 weeks, always see your doctor.

Causes & Risk Factors of Cervical Cancer

Many cases of cervical cancer are linked to known risk factors. Some of these can be avoided, while others cannot. Risk factors include:

Irregular screening: If regular pap or smear tests are not taken, there is an increased risk of cervical cancer.

• HPV Infection: Infection with the human papillomavirus (HPV) is a risk factor for cervical cancer, but only a very small number of women with HPV will go on to develop cervical cancer.
• Smoking: Smoking is linked to an increased risk of cervical cancer.

Diagnosis & Treatment

Diagnosis of Cervical Cancer

We offer a range of techniques that allow for the quick and accurate diagnosis of conditions that affect the cervix. A pelvic examination and Pap smear together can detect most cases of cervical cancer, but to confirm a diagnosis, further examination and tissue samples will be required. Diagnostic tests might include:

• Colposcopy and biopsy: If abnormal cells are found during a Pap smear or the patient is high-risk HPV positive, a colposcopy may be recommended. This procedure involves a detailed examination of the cervix, vagina, and vulva using a colposcope, a special magnifying instrument. During a colposcopy, a biopsy might be performed. This involves taking a small sample of tissue from the cervix to be analyzed in a lab for cancerous cells.
• HPV typing: Knowing the specific type of HPV present (especially high-risk types like HPV 16 and 18) can help assess the risk of cervical cancer and guide treatment and follow-up.
• Visual inspection with acetic acid (VIA): Applying diluted acetic acid solution to the cervix causes abnormal areas to turn white and become visible, allowing for immediate identification and treatment of precancerous lesions.
• Loop electrical excision procedure (LEEP): Used for both diagnosis and treatment, LEEP removes abnormal tissue for examination while also treating precancerous lesions.
• Cone biopsy: Both a diagnostic and therapeutic procedure, in which a cone-shaped piece of tissue is removed from the cervix. This method is used when a Pap smear or colposcopy indicates abnormal cells deep within the cervix.
• Laparoscopy
• Blood tests
• Ultrasound
• CT scan or MRI

Treatment of Cervical Cancer

We offer a range of advanced and minimally invasive treatments for cervical cancer, all of which are overseen by our gynecologic oncologist. The treatment given will depend on how advanced the cancer is, the patient’s age, and its exact location. Treatment will usually include radiation therapy, surgery or chemotherapy, or a combination of these.

• Radiation therapy: A high dose of radiation is delivered to kill cancer cells. A device which delivers radioactive pellets can be placed internally, near the cancer, or an external device can send radiation beams to the targeted area.
• Chemotherapy: There are a number of drugs that can be used on their own or in combination to kill cancer cells. Sometimes, chemotherapy and radiation are both given.
• Targeted therapy: Uses drugs designed to target specific pathways or mutations in cancer cells and is used in combination with chemotherapy.
• Immunotherapy: Uses drugs which boost the body's immune system to better fight cancer cells. These are particularly useful for advanced or recurrent cervical cancer.
• Intensity-modulated radiation therapy (IMRT): An advanced form of radiation therapy that allows the radiation dose to conform more precisely to the 3D shape of the tumor, minimizing damage to surrounding healthy tissues.
• Image-guided radiation therapy (IGRT): Uses frequent imaging during a course of radiation therapy to improve the precision and accuracy of the treatment.
• Chemoradiation: Combines chemotherapy with IMRT, enhancing the effectiveness of both. It's often the standard treatment for locally advanced cervical cancer.
• Surgery: There are a number of types of surgery used to treat cervical cancer, including:
• Laser surgery: A laser burns off cells or can remove a piece of tissue for doctors to study.
• Cone biopsy: A cone-shaped piece of tissue is taken from the cervix.
• Simple hysterectomy: The uterus is removed but not the tissue next to the uterus, the lymph nodes, or the vagina.
• Radical hysterectomy: The uterus, a small part of the vagina, pelvic lymph nodes and the surrounding tissue are removed.

Prevention & Screening

Having regular Pap smears and gynecological examinations is the most important thing you can do to prevent cervical cancer. The Department of Health – Abu Dhabi recommends that all women aged 25 to 29 have a Pap smear every 3 years, and women aged 30 to 65 have a pap smear every 5 years. Women over 30 should also receive an HPV test. Testing should be more frequent if there is a history of abnormal pap smears or if HPV is present.

A vaccination is approved for use in females aged 9 to 45, to offer protection against cervical cancer, by building immunity against HPV.

Managing lifestyle risk factors, such as leading a healthy lifestyle and not smoking, can also reduce the risk of cervical cancer.

Program Caregivers

Our multidisciplinary team of caregivers includes:

• Gynecologic Oncologist
• Medical Oncologists
• Radiation Oncologists
• Radiologists
• Pathologists
• Consultant physicians
• Nurses