Cervical Cancer and the Role of HPV Vaccine Today
What is Cervical Cancer?
Over the years, the cases of cervical cancer is on the steady rise. According to a recent study by Lancet, India is among the top five Asian countries with the highest incidence of cervical cancer and fatality because of it (Times of India, 2023). Cervical cancer is when the disease starts in the cervix. The cervix is the organ that connects the vagina to the upper portion of the uterus. As for who is at risk of this disease, it is important to know that anyone with a cervix is at risk for cervical cancer. In most cases, it usually happens in women who are above the age of 30 years.
Long-lasting infection with distinct types of human papillomavirus is thought to be the leading cause of cervical cancer today. HPV is one of the commonest viruses that are passed from one person to the other during sexual intercourse. Statistics indicate that around half of sexually active people are prone to get HPV at some point in their lives. However, out of them, not all women get cervical cancer. HPV vaccine and regular screening tests go a long way in preventing cervical cancer. In most cases, when cervical cancer is detected early, it is highly treatable and is also associated with good quality of life and long survival.
Prevalence of Cervical Cancer
It has been found that Papum Pare district in Arunachal Pradesh, India has the highest incidence rate (27.7%) of cervical cancer in Asia (Prescriptec, 2023). On a global basis, cervical cancer is the fourth most common cancer among women today. As per recent studies, it is estimated that in 2020, there were 6,04,000 new cases and 3,42,000 deaths. Around 90% of new cases and deaths worldwide in 2020 reportedly occurred in middle and low-income countries (WHO, 2022). Women living with HIV are around 6 times more prone to develop this disease as compared to women without HIV.
Cervical Cancer: Know the Signs
Cervical cancer, a malignancy that develops in the cervix or the lower part of the uterus that connects to the vagina often exhibits subtle signs and symptoms, particularly in its early stages. These symptoms might often be overlooked or attributed to other less concerning issues and therefore, regular medical check-ups and screenings must be done to ensure that it is detected on time. As the disease progresses, certain indicators become more evident, signaling the need for prompt medical attention. Read along to know some of the most common signs and symptoms related to cervical cancer:
Abnormal vaginal bleeding: One of the hallmark signs of cervical cancer is abnormal vaginal bleeding. This can encompass a range of variations, including bleeding between menstrual periods, after sexual intercourse or even post-menopause. While occasional irregularities in menstrual cycles can occur for various reasons, persistent or unexplained bleeding should raise suspicion and call for a prompt medical evaluation.
Abnormal discharge: Women suffering from cervical cancer may often notice an unusual vaginal discharge that could be watery, bloody or have a foul odor (Al-Darwish et al., 2014). Such changes could be indicative of cellular irregularities in the cervix and would need prompt medical tests and management.
Pelvic pain: As the cancer advances, discomfort or pelvic pain may emerge. This pain might originate from the cervix itself or radiate to the pelvic region. Given the diverse causes of pelvic pain, distinguishing between benign causes and potential malignancies requires the expertise of a healthcare professional. Similarly, pain during sexual intercourse can manifest as a result of cervical cancer. This discomfort arises due to the physical changes within the cervix and surrounding tissues.
Burning sensation: Some women may experience pain or a burning sensation during urination. This symptom is usually attributed to inflammation or irritation caused by the tumor.
Altered bowel habits: In more advanced cases, cervical cancer might influence bowel habits, leading to constipation or other changes in bowel movements (Chitapanarux et al., 2010). These alterations occur due to the tumor’s proximity to the rectum, impacting its normal functions.
If cancer has spread to the nearby organs and tissues, the following symptoms may be seen:
- Painful and difficult urination, sometimes with blood in the urine
- Fatigue, loss of appetite and weight loss
- Diarrhea, pain or bleeding from the rectum while passing stools
- A general feeling of illness
- Abdominal/pelvic pain
- Backache as well as swelling and pain in legs
- Persistent UTIs
While these signs and symptoms can be indicative of cervical cancer, they can also be attributed to various other conditions. Therefore, consulting a healthcare professional for accurate diagnosis and appropriate intervention is crucial. Regular cervical cancer screenings, including Pap smears and HPV tests, play a pivotal role in detecting abnormalities early on, often before noticeable symptoms emerge (Kang et al., 2020). Early detection significantly improves treatment outcomes and increases the likelihood of successful intervention.
Being aware of the signs and symptoms of cervical cancer is essential for all women today. Vigilance in recognizing abnormal bleeding patterns, unusual discharge, pelvic pain, pain during intercourse, painful urination and alterations in bowel habits can contribute to early diagnosis and effective management. Engaging in routine screenings and maintaining open communication with healthcare providers ensures that any potential issues are addressed promptly, promoting overall well-being and minimizing the impact of cervical cancer.
What causes cervical cancer?
Cervical cancer is primarily caused by persistent infection with high-risk types of the human papillomavirus, commonly transmitted through sexual contact. While most HPV infections do not lead to cancer and are cleared by the immune system, certain types of HPV can cause cellular changes in the cervix that may eventually develop into cancer if left untreated. The primary causes of cervical cancer may be identified as the following:
HPV Infection: The most significant risk factor for cervical cancer is infection with high-risk types of HPV, particularly HPV-16 and HPV-18. These types of HPV are responsible for a large proportion of cervical cancer cases. HPV is very common and is often acquired shortly after becoming sexually active (Ngelange et al., 1998). In many cases, the body’s immune system clears the infection on its own, but in some cases, the virus persists and can lead to cervical cell abnormalities.
Sexual Activity: Engaging in sexual activity, especially at a young age or with multiple partners, increases the risk of being exposed to HPV. However, it is essential to know that even people with a low number of sexual partners can still contract HPV. Dr. Shailesh Puntambekar, a leading cancer surgeon from Pune, Maharashtra, also states that having multiple sexual partners is one of the commonest cervical cancer causes (Puntambekar, 2023)
Weakened Immune System: Individuals with weakened immune systems, such as those living with HIV/AIDS or those who have undergone organ transplantation, are more susceptible to HPV infections and may have a higher risk of developing cervical cancer (Sherris et al., 2001).
Smoking: Smoking tobacco increases the risk of cervical cancer. It is believed that the harmful chemicals in tobacco smoke can damage cervical cells and interfere with the body’s ability to clear HPV infections.
Long-Term Use of Oral Contraceptives: Some studies suggest that long-term use of oral contraceptives or birth control pills might slightly increase the risk of cervical cancer. However, the risk decreases after stopping the use of these contraceptives.
Lack of Screening and Vaccination: Not undergoing regular cervical cancer screenings, such as Pap smears and not receiving the HPV vaccine, can contribute to the development of cervical cancer. These measures are crucial for early detection and prevention.
While these factors may increase the risk of cervical cancer, they do not necessarily guarantee its development. Many individuals with risk factors do not develop the disease and some people without apparent risk factors may still develop cervical cancer. Practicing safe sex, getting vaccinated against HPV and attending regular screenings are essential steps to reduce the risk and detect any potential issues early.
Diagnosis of Cervical Cancer
The diagnosis of cervical cancer involves several steps, including screening, further testing and confirmation. Early detection is crucial for successful treatment outcomes and this makes regular screenings an essential part of a woman’s healthcare routine. Read along to get a comprehensive idea of the diagnostic process for cervical cancer:
Screening Tests: Pap Smear is a routine test that involves collecting cells from the cervix to examine for any abnormalities (Janicek and Averette, 2001). It can detect precancerous changes or early-stage cancer. If abnormal cells are detected, further testing is usually recommended.
HPV Test: This test detects the presence of high-risk types of the human papillomavirus in cervical cells. Since persistent HPV infection is a significant risk factor for cervical cancer, this test can identify women at higher risk and can also guide further evaluation.
Colposcopy: If abnormal cells are detected through a Pap smear or HPV test, a colposcopy might be performed. During a colposcopy, a special instrument with a magnifying lens (colposcope) is used to closely examine the cervix for any visible abnormalities (Jeronimo and Schiffman, 2006). If necessary, tissue samples can be taken during this procedure for further analysis.
Biopsy: Biopsies involve removing a small sample of cervical tissue for laboratory examination. The biopsy helps determine the extent of cellular changes and whether cancer is present. Biopsies can be taken during a colposcopy or a separate procedure, depending on the situation.
Histopathology: The tissue samples obtained through biopsies are sent to a pathology laboratory. Pathologists examine the samples under a microscope to assess the nature of the cellular changes. This evaluation confirms the presence of cancer and provides information about the type and stage of the cancer.
Staging: Staging is a process that determines the extent of cancer’s spread within the cervix and to nearby or distant areas. Staging is important as it helps to take appropriate treatment decisions and prognosis. Staging involves imaging tests such as CT scans, MRI and sometimes PET scans as well as clinical examination of the patient (Sugawara et al., 1999).
Further Imaging: Additional imaging tests might be conducted to evaluate the extent of the cancer’s spread, especially if the cancer is found to be at an advanced stage. These tests can include CT scans, MRI, PET scans and chest X-rays.
Consultation with Specialists: Based on the diagnosis and staging results, a multidisciplinary team of healthcare professionals, including gynecological oncologists, medical oncologists and radiation oncologists collaborate to determine the most appropriate treatment plan for the patient. The diagnostic process may vary based on individual circumstances, healthcare facilities and advancements in medical technology. Early detection and accurate diagnosis are pivotal for effective treatment and improved outcomes. Regular cervical cancer screenings and prompt follow-up based on test results are crucial for all women today.
Treatment of Cervical Cancer
The treatment of cervical cancer depends on several factors, including the stage of the cancer, the patient’s overall health and individual preferences. Cervical cancer treatment often involves a combination of approaches, including surgery, radiation therapy, chemotherapy and targeted therapy. The goal of treatment is to remove or destroy the cancer while preserving as much of the woman’s reproductive and overall health as possible. The primary treatment options may be discussed as the following:
Surgery:
Conization (Cone Biopsy): In cases where the cancer is confined to a small area of the cervix, a conization procedure might be performed (Jemal et al., 2007). This involves removing a cone-shaped piece of tissue containing the cancerous area.
Hysterectomy: This surgical procedure involves the removal of the uterus and in some cases, the cervix along with nearby tissues (Ramirez et al., 2018). The extent of the surgery depends on the stage of the cancer and the woman’s desire to preserve fertility.
Radical Hysterectomy: For more advanced cases, a radical hysterectomy might be recommended. This involves removing the uterus, cervix, upper vagina and sometimes nearby lymph nodes.
Pelvic Exenteration: This extensive surgery is considered for very advanced cases. It involves removing the uterus, cervix, vagina, nearby lymph nodes and sometimes portions of other organs in the pelvis. It is a complex procedure and is reserved for specific and very severe situations.
Radiation Therapy:
External Beam Radiation: This involves directing high-energy rays at the tumor from outside the body. It is often used in combination with internal radiation.
Internal Radiation (Brachytherapy): In this, radioactive material is placed directly into or near the tumor (Vargo and Beriwal, 2014). Brachytherapy is highly effective for treating cervical cancer because it delivers a high dose of radiation directly to the tumor while minimizing damage to surrounding tissues.
Chemotherapy:
Systemic Chemotherapy: Chemotherapy drugs are administered intravenously or orally to target cancer cells throughout the body. It is often used in combination with other treatments, such as radiation therapy.
Neoadjuvant Chemotherapy: Sometimes, chemotherapy is given before surgery or radiation to shrink the tumor and make other treatments more effective.
Immunotherapy:
Immune Checkpoint Inhibitors: These drugs help the immune system recognize and attack cancer cells (Duranti et al., 2021). They are sometimes used in advanced cases of cervical cancer.
The choice of treatment and the sequence in which they are administered depend on factors like the stage of the cancer, the patient’s overall health and the doctor’s recommendations. Cervical cancer treatment is often customized to the individual patient’s needs. It is important for patients to discuss potential side effects, expected outcomes and long-term effects with their healthcare team to make informed decisions about their treatment plan. In addition, seeking emotional and psychological support, as well as maintaining open communication with the healthcare team, can greatly aid the patient’s journey through treatment and recovery.
Understanding the HPV Vaccine and its Impact
The Human Papillomavirus or HPV vaccine has emerged as a groundbreaking tool in the global fight against cervical cancer. The introduction of HPV vaccines has shifted the landscape of cervical cancer prevention, offering hope for reducing the incidence of this devastating disease. The vaccine’s role encompasses prevention, reducing the burden of disease and potentially eradicating the root cause.
Development of HPV Vaccines
The development of HPV vaccines marked a significant breakthrough in cancer prevention. The two most widely used vaccines are Gardasil and Cervarix. Gardasil targets HPV types 6, 11, 16, and 18, providing protection against both cancer-causing and non-cancer-causing strains. Cervarix, on the other hand, focuses specifically on HPV-16 and HPV-18.
Mechanism of HPV Vaccination
HPV vaccines are designed to stimulate the immune system to produce antibodies against the specific types of HPV included in the vaccine. When an individual is vaccinated, the immune system learns to recognize the viral proteins from the vaccine (Schiller et al., 2010). If the person is later exposed to the actual virus, their immune system can mount a rapid response, preventing the virus from establishing a persistent infection that could lead to cancerous changes.
Impact on Cervical Cancer Incidence
The impact of HPV vaccination on cervical cancer incidence is already evident in many parts of the world. Studies have shown a substantial decrease in the prevalence of the targeted HPV types and related cervical abnormalities among vaccinated populations. As these vaccinated individuals age, the anticipated reduction in cervical cancer rates is promising. In countries with high vaccine coverage, a significant decline in precancerous lesions and genital warts caused by vaccine-targeted HPV types has been observed.
HPV Vaccination and Herd Immunity
One of the remarkable aspects of HPV vaccination is its potential to establish herd immunity. When a large portion of the population is vaccinated, the overall transmission of the virus is reduced, protecting even those who have not been vaccinated (Brisson et al., 2016). This phenomenon is particularly crucial for individuals who might not have access to vaccination or who might have compromised immune systems, as they are also indirectly shielded from the virus.
Preventing Cervical Cancer through the HPV Vaccine
The HPV vaccine is a highly effective tool in preventing cervical cancer. HPV vaccines target the specific types of HPV that are most commonly associated with the development of cervical cancer. By providing protection against these high-risk HPV types, the vaccine helps to prevent the infection that can lead to cellular changes in the cervix and ultimately, cervical cancer. Here’s how the HPV vaccine works to prevent cervical cancer:
Targeting High-Risk HPV Types: The HPV vaccine is designed to stimulate the immune system to produce antibodies against the specific high-risk HPV types included in the vaccine. These high-risk types, particularly HPV-16 and HPV-18, are responsible for a significant proportion of cervical cancer cases.
Creating Immune Memory: When a person is vaccinated with the HPV vaccine, their immune system learns to recognize the viral proteins from the vaccine (Olsson et al., 2007). This means that if they are later exposed to the actual HPV virus, their immune system can mount a rapid response to prevent the virus from establishing a persistent infection.
Preventing Cellular Changes: Cervical cancer typically develops over time from cellular changes in the cervix caused by persistent HPV infection. By preventing infection with the high-risk HPV types, the vaccine reduces the risk of these cellular changes and the subsequent progression to cervical cancer.
Impact on Precancerous Lesions: Studies have shown that HPV vaccination leads to a significant reduction in the prevalence of precancerous lesions caused by the targeted HPV types (Powell et al., 2012). This indicates the vaccine’s ability to prevent the early stages of cervical cancer development.
Long-Term Impact: As vaccinated individuals age, the benefits of the vaccine continue to be seen in terms of reduced rates of HPV infection, precancerous lesions and ultimately lowered chances of cervical cancer.
It is important to take into consideration that HPV vaccination is most effective when administered before exposure to the virus, ideally before the onset of sexual activity. This is because the vaccine provides the best protection when given before a person becomes exposed to the high-risk HPV types. However, even individuals who have been exposed to HPV can still benefit from the vaccine if they have not been exposed to all the targeted HPV types.
HPV Vaccine: Future Prospects
The future of cervical cancer prevention through HPV vaccination holds excellent promise. With ongoing research, improvements in vaccine technology and efforts to enhance global access, the potential to further reduce cervical cancer incidence is substantial. Additionally, the success of HPV vaccination against cervical cancer has inspired exploration into its role in preventing other HPV-related cancers, such as oropharyngeal cancer. It may therefore be concluded that the HPV vaccine’s role in cervical cancer prevention cannot be overstated. By targeting the root cause of the disease, the persistent high-risk HPV infection, vaccination provides a powerful tool to reduce the burden of cervical cancer. As vaccine coverage increases and public awareness grows, there is hope that cervical cancer could become a preventable disease in the not-so-distant future. However, addressing barriers to access, combating vaccine hesitancy and ensuring equity in vaccine distribution remain vital to realizing this vision of a world with fewer cases of cervical cancer and improved women’s health.
Therefore, to win the battle against cervical cancer:
Get informed: Learn about cervical cancer and the HPV that causes it.
Get screened: Cervical cancer screening must start by the age of 30 and must be repeated periodically (WHO, 2023).
Get vaccinated: The HPV vaccine is given in 2 doses and must be begun when a girl is 9-14 years old.
References
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