Cervical Cancer

About Cervical Cancer

The cervix is located at the lower part of the uterus and connects the uterus and the vagina.

Cervical cancer is the sixth cancer prevalent among women.

One of the main causes for the disease is the Human Papilloma Virus, HPV, which causes warts on the female genitalia.

The Gardasil® vaccine is used against the Papilloma virus with the goal to prevent infection with women, and the vaccine itself is given to both girls and boys and women up to age 45.

The disease is mostly diagnosed by laboratory examination of the cervical surface also called “Pap test” or Pap Smear”.

Early detection affects the disease treatment plan and also treatment success.

The existing therapies used on stage 4 metastatic cervical cancer are not curative, and this is a source to the need for innovative and effective treatment strategies in order to fight the disease.

The National Cancer Institute, NCI, highlights that to join one of the many clinical trials existing worldwide might increase cancer patients chances of therapeutic success.

This is also recommended by the National Comprehensive Cancer Network, NCCN.

Types of Cervical Cancer

The classification of the disease is determined according the cells as they appear under the microscope.

1. Squamous cell carcinoma

Starts at the cells that coat the cervix and occurs in 90% of patients.

2. Adenocarcinoma

A rare malignancy that develops from the gland cells

3. Squamous and Adenocarcinoma type

Cervical cancer can be localized, locally spread or metastatic, stage 4.

Stage 4 Metastatic Cervical Cancer

Stage 4 metastatic cervic cancer is a cancer that started in the cervic and its cells have spread to other body organs, distant from the cervic, and created new lesions. these lesions are called “metastases” and are made of cervic cancer cells.

Cervic cancer metastases may appear in the bones, liver, lungs and brain. the formation of metastases constitutes a threat on life

Eeven though the cancer has spread to other organs, it is still defined as a cervic cancer and is treated as cervic cancer. in this manner for example, a lesion in the lung that is a metastasis of cervic cancer shall be treated with cervic cancer drugs and not lung cancer drugs.

Risk Factors

• Papilloma virus infection
• Smoking
• Weaken immune system
• Herpes
• Prolonged use of birth control pills
• Women who were sexually involved with many men

Symptoms

• Vaginal bleeding
• Pain during intercourse
• Swollen leg
• Bone pain
• Change in bowel activity

Treatment Goals

The goal of treating local cervical cancer, not metastatic, is to remove and eradicate the tumor completely

In metastatic stage 4 disease, the primary objective of the treatment is to slow down and control disease progression and help reduce symptoms as well prolong life and improve patient’s quality of life.

Standard Treatments

A number of possible therapies are possible, and many patients shall receive more than one type of therapy.

Surgery

• Hysterectomy

The goal of the surgery is to completely remove the tumor from the cervix. Success is when the tumor is completely removed.

• Radical Hysterectomy

The goal of the surgery is to fully remove the uterus, the cervix and part of the vagina. The ovaries, fallopian tubes, and nearby lymph nodes may also be removed.

At times, different techniques will be applied to remove the tumor, such as, Laser and Cryosurgery

Two main types of treatment may be offered to patients before and after surgery

• Treatment prior to surgery is known as ‘Neoadjuvant’ 

Usually this stage of treatment will involve chemotherapy and/or radiotherapy intended to reduce the tumor’s size and improve the success of surgery.

• Post-surgery treatment, also known as ‘Adjuvant’ 

This treatment seeks to cure and prevent the appearance of metastases or recurrence of the tumor.
Cervix cancer, when metastasized is categorized as stage 4, is considered inoperable.

Radiotherapy

This involves use of radiation at higher levels of energy aims to kill the cancer cells remaining in the post-operative area.

Radiation may also cause decelerated growth of the localized tumor remaining in the area, or local recurrence.

In many cases, Neoadjuvant radiation will be used to shrink and reduce the tumor.

Chemotherapy

Chemotherapy is a medicated therapy which aims to shrink and erase cancerous cells and allow control over the disease.

Chemotherapy carries serious side effects, while its effectiveness is insufficient.

Chemotherapy’s impact has a range of side effects such as hair loss, loss of appetite, changes to bowel movements, fatigue, infection, hemorrhaging, incontinence, pain, and more.

Common chemotherapy treatments include

• Texanes, e.g. Taxol, Taxotere, Docetaxel
• Abraxane® (Paclitaxel)
• Xeloda® (Capecitabine), Adrucil® (Fluorouracil, 5-FU) & Palatinum salts, e.g. Carboplatin and Cisplatin

• Gemzar® (Gemcitabine)
• Camptosar®, Campto®, Irinotecan

Biological Therapies

Anti-Angiogenesis

Cancer tumors survive and thrive in the body by causing the body to produce a system of blood vessels around them that nourishes them and provides them with oxygen.

Anti–angiogenesis agent is a biological antibody which harms the cancerous tumor capability to induce blood vessels growth around it from the environment where it is located, to nourish it so it continues to grow and proliferate. In this way the tumor is “starved” to death.

Examples of angiogenesis inhibitors

• Avastin® (Bevacizumab)

Immunotherapy

Immunotherapy drugs assist the immune system in attacking the tumor. This type of treatment is very different from chemotherapy, for example, which directly attacks the cancerous cells but unfortunately also damages healthy tissues.

The immune system has “immune barriers” which serve to regulate the immune system and prevent it from attacking the body. In cancer these functions are readily activated and as a result, the immune system ceases to attack cancerous cells, enabling the tumor to grow and proliferate in the body.

Barriers known as PD-L1, PD-1 and CTLA-4 are found on T-cells and cancer cells. Immunotherapy is a revolutionary strategy, and one of the most widely studied worldwide for its application to numerous types of cancer and various stages of the disease’s development. Treatment is generally provided in the form of an intravenous infusion.

PD-1 drugs

• Keytruda® (Pembrolizumab)

Clinical Trials for Cervical Cancer

Facts

1. The existing therapies used on stage 4 metastatic cervical cancer are not curative, and this is a source to the need for innovative and effective treatment strategies in order to fight the disease.
2. The National Cancer Institute, NCI, highlights the fact that for a certain group of cervical cancer patients, the best treatment option is to join one of the many clinical trials existing worldwide aiming to increase their chances of therapeutic success.
3. Currently, every patient will be offered the standard protocols described above. Sometimes the oncologist may suggest integrating these therapies with trials carried out in the institute.

The opportunity

1. Advances in cancer therapies may be found in clinical trials prescribing cutting edge, innovative drugs, some of which have already been recognized by the US Food & Drug Administration, the FDA, as “breakthrough drugs” and require further information to be approved.
2. An entire world of clinical trials, Compassionate drugs and advanced new cancer treatments are available worldwide.
3. It is important to know and have access to cutting edge cancer treatments that best match the unique medical condition of the patient and increase chances in winning the fight against compared to the standard care offered.

Note to remember!

Not every patient is eligible to enter a specific clinical trial. The eligibility conditions must be fully met and each case is reviewed separately to ensure that the clinical trial matches to the specific cancer patient and vice versa.

References

https://www.fda.gov/
https://www.ema.europa.eu/
https://www.health.gov.il/
http://mbcn.org/
CERVICcancer.org
https://www.cancer.gov/types/
https://www.cancer.org/
https://www.cancerresearchuk.org/
https://www.nccn.org/

Dear Reader
This information is provided as a source of knowledge and does not constitute a medical consultation. For professional medical advice, see your attending physician. Information regarding drugs and commercial names belongs to the pharmaceutical companies