Cervical cancer natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]
Overview
Cervical cancer is one of the leading causes of cancer-related morbidity and mortality among women in low- and middle-income countries (LMICs), and remains the most frequent cancer in specific high-burden regions, such as sub-Saharan Africa. There is an estimate of almost 260,000 deaths annually (2001), about 80% of which occurred in developing countries. Common complications of cervical cancer include pain, vaginal bleeding, fistula and renal failure. Prognosis is generally good, and the 5-year survival rate of patients with cervical cancer is approximately 70%. Studies have demonstrated that there is an association between age of the patients and socioeconomic status of women with higher incidence of infection with high risk HPV in underserved population in the US.
Natural history
- Cervical cancer is one of the leading causes of cancer-related morbidity and mortality among women in low- and middle-income countries (LMICs), and remains the most frequent cancer in specific high-burden regions, such as sub-Saharan Africa. There is an estimate of almost 260,000 deaths annually, about 80% of which occurred in developing countries.[1]
- Infection by high risk strain of oncogenic HPV types is an established cause of neoplastic lesions of the cervix, vagina and vulva, anus, penis and oropharynx. HPV genotypes 16 and 18 are responsible for approximately 70% of cervical cancer cases worldwide. HPV is highly transmissible through direct skin-to-skin contact and intercourse, women with persistent high-risk HPV infections are at greatest risk for developing cervical cancer.
- Since the identification of HPV as main cause of cervical cancer, prevention strategies have been developed by the introduction of HPV testing and cytology screening and utilizing HPV vaccines in preadolescent girls and young women who are at greater risk.[2]
- The most important risk factors associated with the infection by HPV are young age at time of first sexual intercourse, increased number of sexual partners throughout life, or women being with men having multiple sexual partners. Male circumcision and use of condoms are factors that can reduce, but do not eliminate the transmission of human papilloma virus.[3]
- There is an association between age and socioeconomic status of women in underserved areas of the US and higher incidence of infection with HPV. [4]
Complications
Advanced stage of cervical cancer can cause varieties of complications, some of which include:[5]
- Pain
- Vaginal hemorrhage
- Enterovaginal, rectovaginal, and vesico- or ureterovaginal fistulas
- Renal failure and/or uremia
- Malnutrition
- Anemia
- Depression
Prognosis
- The prognosis for patients with cervical cancer can vary significantly by stage at diagnosis, with an aggregate 5-year relative survival rate of 67.9%. This progress is largely attributable to annual screenings with Pap smears and the introduction of new preventive methods such as the HPV vaccination to decrease the mortality and incidence rates.
- The majority of all cervical cancer cases can be detected early through the use of screening by Pap test and HPV DNA testing.
- Prognosis of cervical cancer depends upon the clinical stage of the disease and distant metastasis.[6][7][8]
- These prognostic factors affecting survival rate include:[9]
- Patient age
- Maximum tumor diameter of ≥6 cm
- Pelvic lymph node enlargement, and distant metastasis
- Pretreatment hemoglobin level
- Concurrent chemoradiotherapy, increases survival rate significantly in patients with advanced stage of cervical cancer in comparison with those receiving radiation therapy alone
- Overall treatment period
- Clinical stage
- Human immunodeficiency virus (HIV) status: Women with HIV have more aggressive and advanced disease and a poorer prognosis.
- C-myc overexpression: A study of patients with known invasive squamous carcinoma of the cervix found that overexpression of the C-myc oncogene was associated with a poorer prognosis.
- HPV-18 DNA has been found to be an independent adverse molecular prognostic factor, studies have demonstrated a worse outcome when HPV-18 was identified in cervical cancers of patients undergoing radical hysterectomy and pelvic lymphadenectomy.
References
- ↑ Sherris J, Herdman C, Elias C (October 2001). "Cervical cancer in the developing world". West. J. Med. 175 (4): 231–3. PMC 1071564. PMID 11577044.
- ↑ Bosch, F. Xavier; Broker, Thomas R.; Forman, David; Moscicki, Anna-Barbara; Gillison, Maura L.; Doorbar, John; Stern, Peter L.; Stanley, Margaret; Arbyn, Marc; Poljak, Mario; Cuzick, Jack; Castle, Philip E.; Schiller, John T.; Markowitz, Lauri E.; Fisher, William A.; Canfell, Karen; Denny, Lynette A.; Franco, Eduardo L.; Steben, Marc; Kane, Mark A.; Schiffman, Mark; Meijer, Chris J.L.M.; Sankaranarayanan, Rengaswamy; Castellsagué, Xavier; Kim, Jane J.; Brotons, Maria; Alemany, Laia; Albero, Ginesa; Diaz, Mireia; Sanjosé, Silvia de (2013). "Comprehensive Control of Human Papillomavirus Infections and Related Diseases". Vaccine. 31: I1–I31. doi:10.1016/j.vaccine.2013.07.026. ISSN 0264-410X.
- ↑ Castellsagué, Xavier (2008). "Natural history and epidemiology of HPV infection and cervical cancer". Gynecologic Oncology. 110 (3): S4–S7. doi:10.1016/j.ygyno.2008.07.045. ISSN 0090-8258.
- ↑ Karuri AR, Kashyap VK, Yallapu MM, Zafar N, Kedia SK, Jaggi M, Chauhan SC (June 2017). "Disparity in rates of HPV infection and cervical cancer in underserved US populations". Front Biosci (Schol Ed). 9: 254–269. PMC 5935458. PMID 28410118.
- ↑ Schmitz, Herbert E.; Isaacs, John H. (1957). "Complications of Advanced Cervical Cancer and Their Management". Radiology. 69 (3): 324–329. doi:10.1148/69.3.324. ISSN 0033-8419.
- ↑ Yuan, Chiou-Chung; Wang, Peng-Hui; Lai, Chiung-Ru; Tsu, En-Jie; Yen, Ming-Shyen; Ng, Heung-Tat (1999). "Recurrence and Survival Analyses of 1,115 Cervical Cancer Patients Treated with Radical Hysterectomy". Gynecologic and Obstetric Investigation. 47 (2): 127–132. doi:10.1159/000010076. ISSN 0378-7346.
- ↑ B.K., Vishma; B., Prakash; Kulkarni, Praveen; M., Renuka (2016). "Survival and prognostic factors for cervical cancer: a hospital based study in Mysuru, India". International Journal of Community Medicine and Public Health: 218–223. doi:10.18203/2394-6040.ijcmph20151566. ISSN 2394-6032.
- ↑ Jung, Kyu-Won; Won, Young-Joo; Kong, Hyun-Joo; Oh, Chang-Mo; Shin, Aesun; Lee, Jin-Soo (2013). "Survival of Korean Adult Cancer Patients by Stage at Diagnosis, 2006-2010: National Cancer Registry Study". Cancer Research and Treatment. 45 (3): 162–171. doi:10.4143/crt.2013.45.3.162. ISSN 1598-2998.
- ↑ Endo, Daisuke; Todo, Yukiharu; Okamoto, Kazuhira; Minobe, Shinichiro; Kato, Hidenori; Nishiyama, Noriaki (2015). "Prognostic factors for patients with cervical cancer treated with concurrent chemoradiotherapy: a retrospective analysis in a Japanese cohort". Journal of Gynecologic Oncology. 26 (1): 12. doi:10.3802/jgo.2015.26.1.12. ISSN 2005-0380.
- ↑ Kang, Woo Dae; Kim, Cheol Hong; Cho, Moon Kyoung; Kim, Jong Woon; Cho, Hye Yon; Kim, Yoon Ha; Choi, Ho Sun; Kim, Seok Mo (2011). "HPV-18 is a poor prognostic factor, unlike the HPV viral load, in patients with stage IB–IIA cervical cancer undergoing radical hysterectomy". Gynecologic Oncology. 121 (3): 546–550. doi:10.1016/j.ygyno.2011.01.015. ISSN 0090-8258.
- ↑ Maiman M, Fruchter RG, Guy L, Cuthill S, Levine P, Serur E (January 1993). "Human immunodeficiency virus infection and invasive cervical carcinoma". Cancer. 71 (2): 402–6. PMID 8093678.
- ↑ Kübler, Kirsten; Heinenberg, Sally; Rudlowski, Christian; Keyver-Paik, Mignon-Denise; Abramian, Alina; Merkelbach-Bruse, Sabine; Büttner, Reinhard; Kuhn, Walther; Schildhaus, Hans-Ulrich (2015). "c-myc copy number gain is a powerful prognosticator of disease outcome in cervical dysplasia". Oncotarget. 6 (2). doi:10.18632/oncotarget.2706. ISSN 1949-2553.