Definition
After breast cancer, cervical cancer represents one of the most frequent forms of cancer in the female world; however, the Pap test, diagnosing the neoplasm in an early and safe way, allows the cancer to be treated already at the initial stage. Thanks to this simple cytological screening test, mortality from cervical cancer has significantly decreased in recent years.
N.B. For the prevention of cervical cancer, it is recommended to undergo regular PAP test: the first examination should be carried out between 21 and 25 years, then it is recommended to undergo PAP test every 3 years up to 65 years of age. age.
Causes
The HPV virus (papilloma virus) is the causative agent responsible for cervical cancer: we are talking about a viral pathogen with DNA, sexually transmitted, implicated in the neoplastic transformation of uterine cervical cells. Risk factors: early onset of sexual activity, frequent unprotected sexual intercourse with different partners, multiple pregnancies, poor sexual hygiene.
Symptoms
In the overwhelming majority of cases, cervical cancer does not begin with any significant symptoms: what has been said is a limit to early diagnosis - and therefore to cure - the tumor. In an advanced stage, cervical cancer can begin with dysuria, dyspareunia, abdominal pain, blood loss with stool, vaginal bleeding outside the cycle, foul-smelling leukorrhea and rectal tenesmus.
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Medicines
We have seen how the early diagnosis of cervical cancer is able to greatly reduce the risk of metastasis and bad outcome: for this reason - it is necessary to highlight it for the umpteenth time - it is a good rule to undergo a PAP test regularly.
Before listing the most used drugs in therapy, it is good to remember that:
- some forms of mild dysplasia affecting the basal layer of the cervical epithelium (pre-neoplastic forms) tend to regress spontaneously, without leaving traces or lesions.
- Most HPV lesions remain asymptomatic and tend to self-resolve
- Vaccination is part of the cervical cancer prevention rules
- It is also possible to use laser therapy, conization, cryotherapy and electrocoagulation
- The surgical approach is recommended for patients with early-stage cervical cancer
- Radiation therapy is indicated for patients with cervical cancer that is not amenable to surgical resection
The following are the classes of drugs most used in the therapy against cervical cancer and some examples of pharmacological specialties; it is up to the doctor to choose the active ingredient and the dosage most suitable for the patient, based on the severity of the disease. the state of health of the patient and his response to treatment:
- Cisplatin (eg. Cisplatin ACC, Platamine, Pronto Platamine) although this drug is the most widely used against cervical cancer, the remarriage rates are not always satisfactory. However, it should be remembered that none " another drug - or drug combination - was better or better than cisplatin in terms of overall survival. Typically, the drug is associated with radiotherapy and is taken at a dose of 40 mg per square meter, intravenously, once a week. Do not exceed 70 mg per week. The drug is administered 4 hours before radiotherapy, for 1-6 weeks. In combination with other chemotherapy drugs, the drug is taken at a dosage of 50 mg / m2 on the second day. The cycle must be repeated for 21 days.
- Fluorouracil (eg. Fluorouracil Teva, 250-500 mg): the recommended dose is 1 g / m2, on the first day. Repeat the cycle every 21 days. Typically, the drug is taken in combination with Cisplatin.
- Methotrexate (eg Reumaflex, Methotrexate HSP, Securact) the drug is an antagonist of folic acid synthesis, capable of heavily influencing the body's immune response. In this regard, it is used in the treatment of some neoplasms, including cancer of the cervix. Ideal dosage varies from 30-40 mg / m2 per week to 100-12,000 mg / m2 in combination with leucovorin.
- Carboplatin (eg. Carboplatin AHCL, Paraplatin, Carboplatin TEVA) associated with other chemotherapy drugs, the drug is generally used in therapy against cervical cancer. The dosage is: 200 mg per square meter intravenously, on day 1. Repeat administration every 21 days.
- Ifosfamide (eg. Holoxan) the drug is used in therapy against cervical cancer at a dosage of 2-5 mg per square meter, intravenously, every 24 hours, on the second day; the drug is taken again. every 21 days. The duration of therapy must be determined by the doctor.
Prevention of cervical cancer
Vaccination is one of the strategies for preventing cervical cancer: the vaccine must be administered in three divided doses, and injected intramuscularly. The second dose must be administered after 2 months from the first, and the third after 4 months from the second. ; although the duration of immunity from the HPV virus is not established with absolute precision, it has been observed that vaccinated women have a prolonged immunity (up to 4.5 years from the first vaccine cycle).
The PAP test must however be carried out periodically, since the vaccine does not protect against all forms of papilloma virus.
Below, the vaccines most used to prevent uterine cancer.
- Cervarix: consisting of purified L1 proteins obtained from 2 types of human papillomavirus (HPV, type 16 and 18)
- Gardasil and Silgard: contain purified proteins for 4 types of the human HPV virus (types 6, 11, 16 and 18).
- Gardasil 9: Contains purified proteins for 9 types of the human HPV virus (types 6, 11, 16, 18, 31, 33, 45, 52 and 58).
Since the HPV virus is sexually transmitted, the use of condoms for sexual intercourse with subjects at risk cannot be omitted among the rules of prevention from cervical cancer.
