Immunotherapy for Cervical Cancer

Cervical cancer is cancer of the entrance to the uterus (womb). The cervix is the narrow part of the lower uterus, often referred to as the neck of the womb.

Gene E6 and E7 in many types of HPV causes cervical cancer. They are presented on the cervical cancer cells alone with other proteins, such as CK19, SP17, CEA, are presented on the surface of the cervical cancer cells, they are recognized by the immune system as ‘foreign’ to the human body, and are supposed to be destroyed by the T cells in the immune system. However, immune system is failed in identifying these proteins in patients with breast cancer, causing uncontrolled growth of the breast cancer cells.

The purpose of immunotherapy in cervical cancer is to remove the cancer cells or control the growth of the cancer cells by restoring the natural function of the immune cells, T cells are stimulated and strengthened in vitro, so that after being introduced back to patient’s body, they will be able to identify the cervical cancer cells and destroy them.

Causes of Cervical Cancer

Cancer is the result of the uncontrolled division of abnormal cells. Most of the cells in our body have a set lifespan; when they die, new cells are produced to replace them. Abnormal cells can have two problems:

• They do not die
• They continue dividing

This results in an excessive accumulation of cells which eventually form a lump – a tumor. Scientists are not completely sure why cells become cancerous.

However, there are some risk factors that are known to increase the risk of developing cervical cancer. These risk factors include:

HPV (human papillomavirus): a sexually transmitted virus. There are over 100 different types of HPVs, at least 13 of which can cause cervical cancer.

Many sexual partners or becoming sexually active early: Cervical cancer-causing HPV types are nearly always transmitted as a result of sexual contact with an infected individual. Women who have had many sexual partners generally have a higher risk of becoming infected with HPV, which raises their risk of developing cervical cancer.
Smoking: increases the risk of developing many cancers, including cervical cancer.

Weakened immune system: such as those with HIV/AIDS, or transplant recipients taking immunosuppressive medications.

Long-term mental stress: Women who experience high levels of stress over a sustained period may be less able to fight off HPV.

Giving birth at a very young age: Women who gave birth before the age of 17 are significantly more likely to develop cervical cancer compared with women who had their first baby when they were aged 25 or over.

Several pregnancies: Women who have had at least three children in separate pregnancies are more likely to develop cervical cancer compared with women who never had children.

Contraceptive pill: Long-term use of some common contraceptive pills slightly raises a woman’s risk.

Other sexually transmitted diseases (STD): Women who become infected with chlamydia, gonorrhea, or syphilis have a higher risk of developing cervical cancer.

Socio-economic status: Studies in several countries have revealed that women in deprived areas have significantly higher rates of cervical cancer.

Symptoms of Cervical Cancer

Often, during the early stages of cervical cancer, people may experience no symptoms at all. That is why women should have regular cervical smear tests.

The most common symptoms are:

• Bleeding between periods
• Bleeding after sexual intercourse
• Bleeding in post-menopausal women
• Discomfort during sexual intercourse
• Smelly vaginal discharge
• Vaginal discharge tinged with blood
• Pelvic pain

Tests and Diagnosis

The earlier cervical cancer is diagnosed, the more successfully it can be treated. Regular cervical screening can save thousands of lives every year.

The American College of Obstetricians and Gynecologists advises that the PAP test should be carried out at the same time as the HPV test. The College emphasized that this recommendation is just for women aged 30 years or more.

Cervical screening – LBC or Pap smear test

In the U.S., over 11,000 women are diagnosed with invasive cervical cancer each year and about 4,000 die.

The majority of these deaths could be prevented if all women had undergone cervical screening.

U.S. authorities say a female should start screening at the age of 21, or within 3 years of her first sexual encounter – whichever occurs first.

Cervical screening does not detect cancer, it simply looks for abnormal changes in the cells of the cervix. If left untreated, some abnormal cells can eventually develop into cancer.

HPV DNA test

This test determines whether the patient is infected with any of the HPV types that are most likely to cause cervical cancer. This involves collecting cells from the cervix for lab testing.

The test can detect high-risk HPV strains in cell DNA before any cervix cell abnormalities appear.

If the patient experiences signs and symptoms of cervical cancer, or if the Pap test revealed abnormal cells, the patient might undergo additional tests:

Other tests include:

• Biopsy: A small section of tissue is taken under general anesthetic.
• Colposcopy: A speculum is placed to hold the vagina open as the gynecologist looks at the cervix through a colposcope – a lighted magnifying instrument.
• Cone biopsy: A small cone-shaped section of abnormal tissue is taken from the cervix for examination.
  LLETZ: A diathermy (wire loop with an electric current) is used to remove abnormal tissue. The tissue is sent to the lab to be checked.
• Blood tests: measures number of blood cells, and can identify any liver or kidney problems.
• Examination under anesthetic (EUA): This allows the doctor to examine the vagina and cervix more thoroughly.
• CT scan: The patient consumes a barium drink that appears white on the scan. Just before the scan, a tampon may be placed into the vagina, and a barium liquid may be inserted into the rectum.
• MRI: By using high-MRI with a special vaginal coil, a technique to measure the movement of water within tissue, researchers may be able to identify cervical cancer in its early stages.
• Pelvic ultrasound: This is a device that uses high-frequency sound waves to create an image on a monitor of the target area.

Treatments for Cervical Cancer

Cervical cancer treatment options include surgery, radiotherapy, chemotherapy, or combinations. Deciding on the kind of treatment depends on several factors, such as the stage of the cancer, as well as the patient’s age and general state of health.

Treatment for early-stage cervical cancer – cancer that is confined to the cervix – has a good success rate. The further the cancer has spread out of the area it originated from, the lower the success rate tends to be.

Early stage cancer treatment options

Surgery is commonly used when the cancer is confined to the cervix. Radiotherapy may be used after surgery if the doctor believes there may still be cancer cells inside the body.

Radiotherapy might also be used to reduce the risk of recurrence (cancer coming back). If the surgeon wants to shrink the tumor to make it easier to operate, the patient may receive chemotherapy – however, this is not very common.

Advanced cancer

When the cancer has spread beyond the cervix, surgery is not usually an option. Advanced cancer is also referred to as invasive cancer because it has invaded other areas. This type of cancer requires more extensive treatment. The patient will typically be treated with either radiotherapy or a combination of radiotherapy and chemotherapy.

In the later stages of cancer, palliative therapy is administered to relieve symptoms and improve quality of life.

Radiotherapy

Radiotherapy is also known as radiation therapy, radiation oncology, and XRT. It involves the use of beams of high-energy X-rays or particles (radiation) to destroy cancer cells.

Radiation that is aimed in the pelvic area may cause the following side effects; some of them may not emerge until well after the treatment is over:

• Diarrhea
• Nausea
• Upset stomach
• Bladder irritation
• Narrowing of the vagina
• Interrupted menstrual cycle
• Early menopause

Chemotherapy

Chemotherapy is the use of chemicals (medication) to treat any disease – in this context, it refers to the destruction of cancer cells. Cytotoxic medication prevents cancer cells from dividing and growing.

Chemotherapy for cervical cancer, as well as most other cancers, is used to target cancer cells that surgery cannot or did not remove or to help the symptoms of patients with advanced cancer.

Cisplatin, a chemotherapy drug, is frequently used in combination with radiotherapy.

Side effects of chemotherapy can vary, and depend on the specific drug being used. Below is a list of the more common side effects:

• Diarrhea
• Nausea
• Hair loss
• Fatigue
• Infertility
• Early menopause

Clinical trials

For some patients, participating in a clinical trial may be their best treatment option. Many current treatments are the results of clinical trials. Clinical trials are an integral part of the cancer research process. Clinical trials are carried out to determine how safe and effective new treatments are, and whether they are better than existing ones.

Clinical trial participants contribute to cancer research and innovation.

Prevention of Cervical Cancer

There are a number of measures that can be taken to reduce the chances of developing cervical cancer.

HPV (human papillomavirus) vaccine

The link between the development of cervical cancer and some types of HPV is clear. If every female adheres to current HPV vaccination programs, cervical cancer rates will be reduced substantially.

Safe sex

The HPV vaccine only protects against two HPV strains. There are others which can cause cervical cancer. Using a condom during sex helps protect from HPV infection.

Cervical screening

Regular cervical screening will make it much more likely that signs are picked up early and dealt with before cancer develops at all or too far.

Have fewer sexual partners

The more sexual partners a woman has, the higher the risk of developing cervical cancer.

Delay first sexual intercourse

The younger a female is when she has her first sexual intercourse, the higher the risk of developing cervical cancer. The longer she delays it, the lower her risk.