What's New With Cervical Cancer

There are a number of new research findings, which in time will likely be incorporated into clinical practice. Here are some examples: Genotyping with DNA amplification was used to analyze the subtypes of human papilloma virus (HPV) in scrapings and biopsy samples from patients with or without cervical cancer (Ref.3). As HPV is known to be a high risk factor for cervical cancer, the technique of genotyping can be used to identify the transmission of the virus and also to track the subtypes and detect it as much as two years later in the biopsy material of an early cancer.

Here are some points worth noting:

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1. Chemotherapy is known to improve survival of patients with cervical cancer. However, often the toxic side-effects on the bone marrow can limit its usefulness. Ref. 4 researched the use of low-dose cisplatin in combination with gemcitabine as a chemotherapy, given in weekly intervals. Patients with advanced cancer of the pelvis with extensive pelvic metastases survived 36% after 15 months and another 36% had a partial response. The authors noted that this low dose combinaion had a remarkable lack of bone marrow toxicity, but had a good clinical response. On average 10 treatment courses had to be given.

2. Radiotherapy, as shown above, is useful for treatment of early stages of cervical cancer. However, Ref. 5 showed that "concomitant boost accelerated radiotherapy" can give even better results. It does so by optimizing the delivery of optimal radiation to where the tumor cells are in the pelvis and the para-aortic regions. It is achieved by using fractionated radiotherapy treatments to the tumor, the pelvic region and by using brachytherapy (radioactive caesium implants) as well. This way even micro-metastases can be treated before they have a chance of becoming larger and reduce survival.

3. Radiotherapy can for a small percentage of patients have serious late complications.

One of the serious late side-effects is the development of a radiation induced sarcoma. Ref. 6 examined 5 such cases. They all developed in the pelvic bone behind the sacroiliac joint. The latent period was 5 years or more following the radiation therapy. CT and MRI scans were utilized in evaluating the extent of the tumor. Treatment is like any other bone tumor.

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4. Chemoprevention is something that works for breast cancer with Tamoxifen. For cervical cancer a similar approach is a new concept. Ref. 7 examines the possibility to exploit the strong correlation between human papilloma virus (HPV) infection and cervical cancer. These authors are suggesting that it should be possible to prevent a lot, if not all of cervical cancers through treatment of the HPV viruses with ongoing antiviral antibiotics.

5. Here is a thought provoking article that examines the implications of an HPV vaccine that is being manufactured by GlaxoSmithKline and also by Merck. If this is used in young girls before they are sexually active, it could prevent millions of cervical cancer cases in the world. However there have been some negative reactions about the vaccine, reports that the vaccine stings when injected, and recently some deaths were reported, but it is not clear whether or not that was vaccine related. At this point it is my opinion that it is safer not to give the vaccine than to give it, as alternatives (regular Pap tests) are available that have been shown to reduce the risk for cervical cancer. Read and listen to this:

http://www.nvic.org/NVIC-Vaccine-News/July-2009/Preventing-Gardasil-Vaccine-Injuries-Deaths.aspx

Summary:

Despite all of the progress in the treatment of cancer of the cervix, the statistics of longterm survival remain poor for the further advanced cancer with local and distant metastases. It is clear that the deeper the invasion at the time of diagnosis, the higher the %-age of metastases and the less the longterm survival. Early diagnosis or better still, prevention by regular Pap tests and pelvic exams, will lead to the goal of a cure for cancer of the cervix. Eventually immunization of both males and females on a large population base has a chance of preventing further unnecessary mortality of women from cancer of the cervix.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. Cancer: Principles &Practice of Oncology.4th edition. Edited by Vincent T. DeVita, Jr. et al. Lippincott, Philadelphia,PA, 1993. Chapter on gynecological tumors.

2. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter on gynecological tumors.

3. WG Quint et al. J Pathol 2001 May;194(1):51-58.

4. A Duenas-Gonzalez et al. Am J Clin Oncol 2001 Apr;24(2):201-203.

5. BD Kavanagh et al. Am J Clin Oncol 2001 Apr;24(2):113-119.

6. K Nakanishi et al. Skeletal Radiol 2001 Mar;30(3):132-137.

7. M Follen et al. Cancer 2001 May 1;91(9):1758-1776.

Last Modified: July 18, 2009