Meet Dr. Tiffany Lai
Tiffany S. Lai, MD, is a gynecologic oncologist at UCLA.
She originally intended to pursue a career in basic science or cancer research after completing her undergraduate studies. She’d always been fascinated by cancer biology and oncology.
Reflecting on her next steps, she realized she also had a passion for interfacing with patients. She decided to go to medical school so she could not only study oncology but also practice it. Today, connecting with patients is what she loves most about her role as a gynecologic oncologist.
Whereas some oncologists—such as surgical oncologists—focus only on specialized aspects of cancer treatment, gynecologic oncologists manage all aspects of care for patients with gynecologic cancers.
They perform surgery and administer chemotherapy as well as other targeted agents and systemic treatments. They also care for patients after cancer treatment, watching for and treating any recurrences.
Providing this kind of comprehensive care enables gynecologic oncologists to form long-term, often lifelong, relationships with patients.
“I love getting to know my patients,” says Dr. Lai, among Los Angeles Magazine’s list of “Top Doctors” in 2023. “The patient-doctor relationship is so important to my patients and also to me.”
Cervical Cancer
Cervical cancer is a malignancy that arises from the cervix, the lower portion of the uterus. The most common gynecologic cancer globally, cervical cancer is especially prevalent in underserved areas where women don’t have reliable access to medical care.
Cervical cancer is relatively rare in the United States. According to the Centers for Disease Control and Prevention (CDC), about 11,500 new cervical cancer cases are diagnosed each year.
UCLA Health News: Steepest Annual Rise in Advanced Cervical Cancer in US Among White Women
Cervical Cancer Causes
No current evidence suggests cervical cancer is genetic.
“It does not run in families,” Dr. Lai explains. “If a patient has a family history of cervical cancer, that does not increase their risk of cervical cancer.”
A chronic human papillomavirus (HPV) infection causes a majority of cervical cancers. However, not all HPV infections lead to cervical cancer.
Compromised immune response and increased exposure to HPV heighten the risk of developing cervical cancer.
Compromised Immune Response
The immune system determines how a person will handle HPV infection, and the HPV infection determines risk for cervical cancer.
Anything that lowers the immune response—whether it’s a chronic condition, a history of smoking, or taking immunosuppressive medications—also lowers the ability to fight off infections, including an HPV infection.
Increased HPV Exposure
“HPV is sexually transmitted,” Dr. Lai says. “So factors including early age of first sexual intercourse, not using barrier contraceptives, and multiple sexual partners increase risk of exposure to HPV, therefore increasing risk of developing cervical cancer caused by HPV infection.”
Cervical Cancer Symptoms
Cervical cancer is usually asymptomatic in the early stages.
Common early symptoms include:
- Abnormal vaginal bleeding
- Bleeding after intercourse
- Abnormal discharge
Common symptoms throughout cervical cancer progression include:
- Pelvic pain
- Issues with urination
- Issues with bowel movements
Cervical Cancer Diagnosis
Screening and diagnosis for cervical cancer overlaps with screening and diagnosis for HPV.
Screening begins with a Pap test, named for its creator, George Papanicolaou.
During a Pap test, a physician collects cells from the cervix and sends them to a pathology lab. The lab analyzes the cells and looks for HPV.
If HPV is detected, the Pap test results are considered abnormal, indicating a need for further testing.
Genotyping then determines what HPV strain is present. This is important because some HPV strains are associated with a higher risk of developing cervical cancer than others.
If a high-risk HPV strain is detected, then the care team will perform a colposcopy—a more in-depth examination of the cervix. They also biopsy any abnormal appearing areas. Colposcopy and biopsy provide a more detailed diagnosis and detect any cancerous or precancerous lesions.
If lesions or other abnormalities are detected, the care team will complete a cervical diagnostic excisional procedure, where a portion of the cervix is removed. A cervical cancer diagnosis can often be made using the specimens collected during this procedure.
Cervical Cancer Treatment
Cervical cancer is treatable. Treatment depends on the stage, or extent, of the cervical cancer.
Early-Stage Cervical Cancers
Treatment for most early-stage cervical cancers, where the cancer is confined to the cervix, involves surgery alone.
Some patients require additional post-surgery treatment, which usually includes radiation or a combination of radiation and chemotherapy.
Late-Stage Cervical Cancers
Treatment for most late-stage cervical cancers, where the cancer has spread to adjacent structures such as the vagina or the lymph nodes in the pelvis, involves a combination of chemotherapy and radiation.
Dr. Lai says most cervical cancers respond well to these therapies.
Late-stage cervical cancers that have spread outside the pelvis and metastasized to other areas of the body, such as the lungs, are generally not curable, but they are treatable with systemic chemotherapy. Advanced cervical cancers can be deadly.
Most cervical cancers can be treated safely and effectively, but advanced cases and treatment complications do happen. Dr. Lai finds these rare cases to be the most challenging aspect of her work.
“There is always the potential for complications or bad outcomes,” she says. “It’s incredibly hard to watch someone you know and have a relationship with suffer complications from treatment or surgery.”
Knowing these cases happen motivates her to think exhaustively about recommending the best course of action her patients while not causing any harm.
Cervical Cancer: FAQ
What Is Cervical Cancer?
- Cervical cancer is a malignancy that arises from the cervix, the lower portion of the uterus.
How Common Is Cervical Cancer?
- Cervical cancer is the most common gynecologic cancer globally and disproportionately affects underserved populations.
- It is relatively uncommon in areas with widespread access to vaccinations and screening procedures.
- Cervical cancer is relatively rare in the United States.
What Causes Cervical Cancer?
- A chronic human papillomavirus (HPV) infection causes a majority of cervical cancers.
Can You Get Cervical Cancer Without HPV?
- A few rare subtypes of cervical cancer—such as certain types of adenocarcinoma, clear cell carcinoma, and gastric type adenocarcinoma—may develop independent of HPV.
Is Cervical Cancer Genetic?
- No current evidence suggests cervical cancer is genetic.
What Are Symptoms of Cervical Cancer?
- Most cervical cancers have no symptoms at first.
- Common first symptoms include:
- Abnormal vaginal bleeding
- Bleeding after intercourse
- Abnormal discharge
- Some common later symptoms include:
- Pelvic pain
- Issues with urination
- Issues with bowel movements
How Is Cervical Cancer Diagnosed?
- Cervical cancer is often diagnosed through a cervical diagnostic excisional procedure, where a portion of the cervix is removed for comprehensive analysis.
- Several additional tests precede diagnosis:
- A Pap test to screen for HPV infection.
- Genotyping to determine the strain of HPV detected.
- A colposcopy—a thorough cervical exam.
- Initial biopsy of any apparent abnormalities.
Is Cervical Cancer Treatable?
- All cervical cancers are treatable, and many can be cured.
- Late-stage cervical cancers are generally not curable but are treatable with systemic chemotherapy.
Is Cervical Cancer Deadly?
- Advanced cervical cancers can be deadly if they have spread outside the pelvis and metastasized to other areas of the body.
HPV
HPV stands for human papillomavirus. Dr. Lai says HPV infection is very common and also asymptomatic.
“About 90% of people have HPV or have ever had HPV,” she says. “It’s so common that basically everyone has had HPV at some point.”
Like the influenza virus, HPV has many different strains with different characteristics.
“Each strain is associated with different virulence, meaning people can have a different response to different strains,” Dr. Lai explains.
High-Risk HPV Strains
HPV strains 16 and 18 carry a high risk of leading to cervical cancer.
The percentage of high-risk HPV infections that develop into cervical cancer remains unknown. Statistics revolve around pre-invasive cervical disease, or cervical intraepithelial neoplasia (CIN), caused by HPV infection.
CIN is given a grade of 1, 2, or 3.
- CIN 1 is considered low grade. It requires close monitoring but may not require additional treatment.
- CIN 2 and 3 are both considered high grade. They require treatment and close post-treatment monitoring.
“We try to treat CIN 2 or 3 lesions mostly with surgery,” Dr. Lai says. “We know that if left untreated, CIN 2 or 3 has about a 50% risk of developing into cervical cancer over the course of the next decade or so.”
There are promising clinical trials looking into using immunotherapy in the treatment for CIN. Investigators hope to find out if they can augment the immune system, enabling it to recognize and eliminate abnormal cells.
Low-Risk HPV Strains
HPV strains 6 and 11 are not associated with cervical cancer. They are associated with less serious diseases, such as genital warts.
HPV Causes
Sexual contact with an HPV-infected person causes HPV. It is a sexually transmitted disease (STD).
“Cervical cancer screenings test for HPV, but standard STD screening panels do not,” Dr. Lai says. “Men do not generally get tested for HPV.”
HPV Symptoms
HPV itself causes no symptoms. Dr. Lai says most people don’t even know they have HPV until it shows up on a Pap test.
As some low-risk HPV strains cause genital warts, genital warts may be an indication of infection. Infection from high-risk HPV strains of HPV is asymptomatic.
Pap tests, part of routine cervical cancer screenings, detect HPV.
HPV can be dormant for long periods before showing up in a Pap test. Experts in the field aren’t certain exactly how long the dormant period can last, but they know it can be lengthy.
Dr. Lai says this is one key reason why regular Pap tests are so important. A normal test one year does not guarantee a normal test the following year, even if someone has no new sexual partners to report.
Dr. Lai says an HPV-only test may be available in the future.
“This opens doors to improve cervical cancer screening,” Dr. Lai says. “In an ideal world, women could potentially swab themselves and send it into a lab if they’re unable to see a gynecologist.”
A readily available, easy to administer HPV-only test would improve access to screenings in underserved areas and could lower the global rate of preventable cervical cancer cases.
HPV Treatment
Currently, there is no specific treatment or cure for an HPV infection itself. Many HPV infections require no treatment at all.
“The majority of women are able to clear HPV infection on their own,” Dr. Lai says. “But in a subset of women, HPV infection is persistent. That’s when further workup and treatment is necessary.”
If necessary, treatment will target issues that arise from HPV infection. In low-risk HPV strain infections, this might involve treating genital warts.
Physicians will closely monitor patients with infections from high-risk HPV strains, looking for and treating any pre-cancerous lesions.
HPV Cancer: What Kind of Cancers Are Caused by HPV?
- HPV Throat Cancer / HPV Tongue Cancer / HPV Tonsil Cancer: HPV can cause oropharyngeal cancer, or cancer affecting the tonsils, soft palate, back of the throat, and/or back of the tongue.
- HPV Anal Cancer: HPV can cause anal cancer, or cancer affecting the area inside or outside the anal canal.
- HPV Cervical Cancer: HPV can cause cervical cancer, or cancer affecting the cervix.
- HPV Vaginal Cancer: HPV can cause vaginal cancer, or cancer affecting the vagina.
- HPV Vulva Cancer: HPV can cause vulvar cancer, or cancer affecting the vulva.
HPV Prevention
The most effective way to prevent HPV is through vaccination, and vaccination is most effective when given prior to initiation of sexual activity.
Dr. Lai says studies have shown cervical cancer incidence significantly decreases among people vaccinated prior to the age of 17.
Other effective preventative measures include getting regular gynecologic exams and Pap smears, as well as using barrier contraception.
“Screening tools allow us to pick up some of the early changes in the cells of the cervix caused by HPV infection. We can treat some of these pre-invasive lesions before they get a chance to turn into cervical cancer,” Dr. Lai says, adding that it can take up to a decade after the onset of HPV infection for cervical cancer to develop.
Barrier contraception is a good way to prevent the spread of HPV and should always be used as part of a safe-sex practice. However, barrier contraception does not provide absolute protection because HPV is spread not only through penetrative vaginal intercourse, but also through contact in other areas of the genital tract and orally.
Vaccinations and screenings, in addition to using barrier contraception, are still necessary to prevent or catch HPV.
HPV: FAQ
What Is HPV?
- HPV is a sexually transmitted virus.
What Does HPV Stand For?
- HPV stands for human papillomavirus.
How Common Is HPV?
- HPV is very common. It is the most common sexually transmitted infection.
How Many People Have HPV?
- Experts estimate that around 90% of sexually active people have HPV.
Does HPV Cause Cancer?
- Chronic HPV infection causes a majority of cervical cancer cases. However, not all HPV infections cause cervical cancer.
What Is High Risk HPV?
- High risk HPV refers to HPV strains, such as 16 and 18, that have a high risk of leading to cervical cancer.
What Percentage of High-Risk HPV Turns to Cancer?
- It is unknown what overall percentage of high-risk HPV leads to cervical cancer. If any high-grade precancerous lesions that result from HPV infection remain untreated, about 50% can develop into cervical cancer over the next several decades.
What Are The Symptoms For HPV?
- HPV itself causes no symptoms.
What Does HPV Look Like?
- HPV causes no visible symptoms.
Is There an HPV Test?
- Currently, Pap tests screen for HPV.
How to Test for HPV
- Test for HPV by getting a Pap test, part of a routine cervical cancer screening.
How Long Can HPV Be Dormant?
- Experts aren’t certain exactly how long HPV can be dormant, but they know the dormant period can last for several years and likely longer.
How Do You Get HPV?
- You get HPV through sexual contact (vaginal, anal, or oral sex) with an HPV-infected person.
How Is HPV Transmitted?
- HPV is transmitted sexually.
Is HPV an STD?
- Yes, HPV is an STD.
Is HPV Curable?
- HPV is not curable or treatable. However, many HPV infections do not cause any symptoms and require no treatment. HPV infection can be cleared by the immune system.
Does HPV Go Away?
- Many people can fight off HPV without treatment.
How to Prevent HPV
- Prevent HPV infection through:
- Vaccination.
- Regular gynecologic exams and pap smears, which are not specifically preventative of HPV but can pick up early signs of and diagnose HPV infection.
- Barrier contraception.
HPV Vaccine Age
- HPV vaccination is most effective when given prior to initiation of sexual activity. Studies suggest the vaccine works best when administered before 17 years of age.
Do Condoms Prevent HPV?
- Condoms prevent HPV but they are not 100% effective because HPV can be spread through contact across the genital tract and also orally.
Cervical Cancer Awareness Month
Common Misconceptions About HPV and Cervical Cancer
Dr. Lai says patients often come to her feeling ashamed because HPV comes from an STD.
“HPV is very common, and unfortunately in a subset of people, it causes problems,” she says. “A lot of women deal with HPV. It’s not something to be ashamed of. It’s not something that you are at fault for.”
Dr. Lai wants women to feel empowered to seek care and advice when they know something is off instead of feeling ashamed.
“If someone has any symptoms, I recommend seeing a doctor to check it out sooner rather than later. They should not be ashamed about whatever may be causing it.”
Cervical Cancer Awareness Month Message
In honor of Cervical Cancer Awareness Month, which happens every January, Dr. Lai wants to underscore the importance of HPV vaccinations and regular cervical cancer screenings.
UCLA Health News: Wondering About Cancer screenings? Here's Why They're Important
“Cervical cancer is one of the few cancers we have a vaccine for,” she says. “It’s preventable, so we shouldn’t have to see women suffering from advanced cervical cancers when we have such good preventative and screening measures.”
