Cervical Cancer

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Latest Edit: Hector 2013-10-01 (EDT)

Cervical Cancer

Article New Guidelines Released for Screening of Cervical Cancer and Cervical Dysplasia , 2013 February NDNR

The mortality of uterine cervical cancer has declined 50% since the 1950s mainly due to early detection and treatment.

The majority of cervical cancers are squamous cancer. The minority of cervical cancers are adenocarcinomas. [1] The rare cervical cancers are: Adenosquamous, Glassy cell carcinoma, Neuroendocrine small cell carcinoma.

Squamous cell cervical cancer has 4 subtypes:

  1. Large cell, keratinizing
  2. Large cell, non-keratinizing
  3. Small cell (not neuroendocrine)
  4. Verroucous carcinoma

Adenomatous cervical cancer has 6 subtypes:

  1. Adenoma malignum
  2. Mucinous
  3. Papillary
  4. Endometroid
  5. Clear Cell
  6. Adenoid cystic

Assessment

  • Early Stage:

complete history and physical examination

  • Lab Testing:

CBC with platelet count, Liver Function, Blood Urea Nitrogen, Creatinine

  • Histology:

Cervical biopsy for pathologic review Cone biopsy if indicated

  • Imaging:

Chest X-ray CT/MRI and PET scans Cystoscopy and proctoscopy


Common Causes of Cervical Cancer

  1. Early age at first sexual intercourse, first pregnancy, multiple sexual partners, and contracting sexually transmitted diseases such as Human Papilloma Virus (HPV). This data is not proven by research and is empirically derived.
  2. HPV infection: a large body of evidence supports the relationship of HPV transmission causing the progression from cervical intraepithelial neoplasia (dysplasia) to invasive carcinoma. More than 60 HPV subtypes have been determined. HPV type 16, 18, 31 and 33 are more likely associated with malignant transformation, with poorly differentiated histology on PAP smear examination as the earliest indication of possible cancer disease development.
  3. Smoking - there is evidence that personal history of smoking increases the risk for cervical cancer. [2]
  4. Unopposed estrogens: Classically unopposed estrogens cause a continuum of changes ranging from mild hyperplasia to definitive invasive carcinoma. Along the same line of thinking, unopposed progestin therapy has been used for reversing hyperplasia without atypia only. There is limitation to this line of thinking in regards to other tissues in the body where estrogen and progesterone receptors are found, such as the lung, bone, brain and breast tissues.

Diagnosis

A diagnosis of uterine cervical cancer is made upon investigation and evaluation of a woman's reported symptoms and physical examination findings. Most commonly the complaint of abnormal uterine bleeding starts the clinical investigation.

Other categories of signs and symptoms include the following

  1. Premenopausal women with menorrhagia, metrorrhagia, or dysmenorrhea, particularly with diabetes, hypertension, obesity or infertility as concurrent health conditions
  2. All Postmenopausal women with vaginal bleeding more than 1 year after the last menstrual cycle.
  3. All Postmenopausal women who have withdrawal bleeding from discontinuation of estrogen hormones have cervical cancer until proven otherwise by histology.
  4. Women without symptoms but with atypical endometrial cells should undergo endometrial biopsies
  5. Women with atypical glandular cells who are over age 35, and younger women who have unexplained vaginal bleeding and atypical glandular cells should undergo cervical biopsies
  6. Presence of advanced disease such as ascites, jaundice, bowel obstruction,respiratory distress, and locally extensive tumor [3]

Treatment

Early detection via regular PAP testing has had the most effect in reducing mortality. The use of concurrent (at the same time) radiation and chemotherapy has reduced the overall mortality by 50% in women with local and early stage disease. Single agent chemotherapy alone does not have much impact on overall survival, and combination treatment (more than one chemotherapy drug) is recommended for any survival impact. [4]

Naturopathic Approaches

Early Detection and Intervention

  • The natural incidence of HPV infection is influenced by the immune system of the woman, due to the fact that any stage of Cervical Intraepithelial Neoplasia can regress spontaneously, remain unchanged, or progress to invasive carcinoma. [5]
  • Green tea extract, drinking green tea daily both influence the immune system's ability to ward off or eliminate HPV infection and thus may serve as prevention against HPV related risks for cervical cancer. This is through their EGCG and polyphenol content. It requires a large amount to be ingested daily as a tea, for a long period of time before efficacious. [6], [7], [8], [9], [10]
  • Topical in-office procedures completed by your ND to address the HPV and/or dysplasia are available.
  • Conventional HPV treatment: prescription topical green tea extract approved by the FDA in 2006 called VEREGEN ® (sinecatechins) Ointment, 15% concentration. [11]
  • Cervical Cancer Vaccine: GARDASIL ® [Human Papillomavirus Quadrivalent (Types 6,11, 16, and 18) Vaccine, Recombinant. Much controversy exists over the efficacy of this vaccine. [12]


References

  1. ↑ Casciato DA. Manual of Clinical Oncology 5th ed. Lippincott Williams & Wilkins 2004. Pp 254-262
  2. ↑ Casciato DA. Manual of Clinical Oncology 5th ed. Lippincott Williams & Wilkins 2004. Pp 254-262
  3. ↑ Casciato DA. Manual of Clinical Oncology 5th ed. Lippincott Williams & Wilkins 2004. Pp 254-262
  4. ↑ O'Mahoney D, Rose P. (2007). Cervical Cancer. In Boyiadzis MM Editor, Lebowitz PF Editor, Frame JN Editor, and Fojo, T. Editor (Eds.) Hematology - Oncology Therapy; (pp 85-100). New York, USA: McGraw-Hill Medical
  5. ↑ Casciato DA. Manual of Clinical Oncology 5th ed. Lippincott Williams & Wilkins 2004. Pp 254-262
  6. ↑ Stockfleth E, Meyer T. The use of sinecatechins (polyphenon E) ointment for treatment of external genital warts. Expert Opin Biol Ther. 2012 Jun;12(6):783-93
  7. ↑ Rosen T. Green tea catechins: biologic properties, proposed mechanisms of action, and clinical implications. J Drugs Dermatol. 2012 Nov;11(11):e55-60
  8. ↑ Zou C, Liu H, Feugang JM, Hao Z, Chow HH, Garcia F. Green tea compound in chemoprevention of cervical cancer. Int J Gynecol Cancer. 2010 May;20(4):617-24
  9. ↑ Singh M, Tyagi S, Bhui K, Prasad S, Shukla Y. Regulation of cell growth through cell cycle arrest and apoptosis in HPV 16 positive human cervical cancer cells by tea polyphenols. Invest New Drugs. 2010 Jun;28(3):216-24.
  10. ↑ Ahn WS, Yoo J, Huh SW, Kim CK, Lee JM, Namkoong SE, Bae SM, Lee IP. Protective effects of green tea extracts (polyphenon E and EGCG) on human cervical lesions. Eur J Cancer Prev. 2003 Oct;12(5):383-90
  11. ↑ http://www.veregen.com/
  12. ↑ http://www.gardasil.com/
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