Cervical Cancer

Cervical cancer is the second foremost occurring cancer in women after breast cancer. Cervical cancer is a sexually transmitted disease caused by the human papillomavirus, or HPV. Infection by HPV typically occurs in the early years of sexual activity according to the World Health Organization (WHO), but it can take up to a full twenty years for it to develop into a full-blown malignant tumor. Scientists believe that for all intents and purposes all cervical cancer cases are caused by infection with a few types of cancer.

Great strides have been made in recent years in the development of a vaccine to treat the cervical cancer. Scientists have cultivated a prophylactic vaccine that would protect against the human papillomavirus. HPV's role in generating cervical cancer was discovered in 1983. The WHO's International Agency for Research on Cancer (IARC), located in Lyon, France, has been in the forefront in epidemiological and laboratory studies needed to comprehend the disease. The IARC have chosen different methods, but the origins of most of them are based on genetically engineered Virus Like Particles (VLPs), composed of the outer structural proteins of HPV. These VLPs are not infectious or carcinogenic because they contain no DNA. Some factions are trying to produce the prophylactic vaccine alluded to earlier, while others are developing a therapeutic vaccine for individuals who are already infected. Still others are merging the two techniques. All of approaches have been presented with huge obstacles. Human papillomavirus cannot be replicated in cell culture, nor can it be transmitted to other animals, and human experimentation is limited given the carcinogenic nature of carcinogenic HPV's that are entirely infectious. All attendees that participated at the WHO conference agreed that because of the diverse dynamic that are potentially at risk of cervical cancer that it is crucial that a prophylactic vaccine be made to targeted at a younger population that has yet to become sexually active.

The WHO also found it important that any vaccine would have to include representative people to guarantee international importance. According to researcher Luisa Lina Villa of the Ludwig Institute for Cancer Research, Sao Paulo, a potential vaccine would decrease the number of cases in developing countries . There is large discrepancy between developed countries and third world nations, due in large part to the availability of screening and treatment facilities found in industrialized countries. The percentage of cervical cancer in women triggered by HPV ranges from 3% to 5% in North America and Western Europe, while in South America, Southwest Asia, and the sub-Saharan African nations it ranges from 20% to 24%.

Cervical cancer occurs in women in four stages, as well as a "pre-cancer", or "pre-malignant" stage, where abnormal cells are in the surface layer of the cervix and have not penetrated deeper tissues. This is also called "in situ", which literally means "in place".

For gynecologic cancers, the International Federation of Gynecology and Obstetrics (FIGO) system is the most widely used and highly regarded system of determining the various stages because it is both accepted internationally and supports an international standard where healthcare professionals can converse with one another when comparing their respective research, thereby ensuring a type of universal language on the subject of gynecological cancer, according to Laura Dolson's Gynecologic Cancer Resource Center. This system involves assigning a numerical stage (0 through IV) to a patient's cancer based on physical examination and other diagnostic exams, such as cystoscopy or proctoscopy.

Stage I is classified into two separate subdivisions. Stage IA involves the invasion of the cervical tissues, and can be seen with only a microscope. Stage IB is when the lesions have developed wider than 7 mm or deeper than 5 mm, or at any size that can be detected without a microscope. Stage IB is further characterized by tumors or lesions larger or smaller than 4 cm, again detectable without the aid of a microscope. Treatment for stage I cervical cancer is a simple hysterectomy, unless the cancer is more than 3 mm or has invaded the blood vessels or lymph vessels, in which case a radical hysterectomy may be needed. Radiation therapy may be used post-op if the cancer cells extend to the edges of the organs that were removed. Recent clinical trials show that a combination of radiation and cisplatin can be more effective than radiation therapy alone .

Stage II cancer occurs when the tumor(s) have extended beyond the cervix, but not as far as the pelvic wall. Stage II is also classified into two separate subdivisions. Stage IIA is when the cancer has extended to the upper portion of the vagina, but not as far as the surrounding tissue, or parametria. Stage IIB occurs when the cancer extends to the parametrial tissues, but not as far as the pelvic wall. One treatment option for Stage II cervical cancer is high-dose internal and external radiation therapy. As with Stage I treatment, radiation therapy in conjunction with medication can prove more effective than with radiation therapy alone. A second treatment option is radical hysterectomy with selective para-aortic and radical bilateral (both sides) pelvic lymph node dissection.

Stage III entails the cancer moving beyond the parametrial tissues, but not into the pelvic area. As with Stage I and II, stage III is also classified into two separate subdivisions. Stage IIIA indicates that the cancer has spread to the lower third of the vagina, but no further, Stage IIIB means that the cancer has either spread to the pelvic wall, or has blocked a ureter, which carries urine from the kidneys to the bladder.

Stage IV is considered to be advanced cervical cancer. This means that the cancer has spread to body organs outside of the cervix and parametrial tissues. Some oncologists will classify a stage IVA when the cancer has spread to the nearby organs, such as the bladder or rectum. The treatment options for those diagnosed with stage IIIA, IIIB, and IVA cervical cancer are the same as those with Stage II: radiation therapy in conjunction with medication or a radical hysterectomy with selective para-aortic and radical bilateral pelvic lymph node dissection. It is worth noting that radiation therapy was once the only option available for theses stages of cervical cancer.

Stage IVB would mean that it had spread to organs further away, such as the lungs or liver. This stage of cervical cancer is not considered by medical professionals to be curable, and the treatment options tend to focus on relieving some of the more unpleasant cancer symptoms such as pain or incontinence, as well as trying to extend the survival time of the individual.

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