|
|
Issue 3, 2008
HOT TOPICS IN ONCOLOGY
Cervical cancer
| Publ. date: | 2008 |
| ISBN: | 978-88-89881-53-8 |
| ISSN: | 1973-9656 |
| E-ISSN: | 2036-0894 |
| DOI: | 10.4147/HTO-080300 |
Abstract
Cervical cancer is mainly caused by certain strains of the human papilloma virus, a DNA virus that is generally transmitted by sexual intercourse. While Papanicolaou screening has markedly reduced the incidence of the disease in screened populations, the disease is flourishing in underdeveloped countries. Many novel insights into the mechanism of viral carcinogenesis have been learned from the study of how the human papilloma virus causes cancer. Some of those insights have led to strategies for preventing human papilloma virus infection and the diseases the virus can cause. A vaccine, called Gardasil, has been approved for use in females aged 12-26 years old; the vaccine is highly effective at preventing infection with the human papilloma virus but the vaccine is not able to eradicate cancers once they have formed. Widespread vaccination has the potential to produce a further decrease in the incidence of cervical cancer.
Once cervical cancer has developed, survival is based upon the stage of disease. Localized forms of cervical cancer are highly curable with local surgical techniques. When the disease becomes more locally invasive, combinations of surgery plus radiation therapy still have an excellent chance of producing a cure. Once the disease has metastasized, few of the many agents that have been tried have produced significant antitumor effects. Additional interventions are sorely needed.
Table of contents
Foreword
Peyton Rous’s discovery in 1910 of the Rous sarcoma virus as a transmissible cause of sarcomas in chickens provided an experimental basis to the notion that certain cancers can be caused by a virus. In fact, and according to Dr. Rous’s Nobel lecture, the first animal tumor virus had been discovered 2 years earlier by the Danish scientists Ellermann and Bang. Their work, though scientifically convincing, did not gain wide acceptance because the disease their virus caused was leukemia, which was not considered a cancer at the time. Sic transit gloria mundi. Thereafter, efforts to ascertain a viral cancer etiology in a mammalian host went largely unsuccessful until 1933 when Dr. Rous began working with a papillomavirus first described by Richard Shope as a cause of giant warts in cottontail rabbits. Rous and his colleagues demonstrated that the Shope papillomavirus was capable of producing neoplasia in other rabbit breeds.
Today, no less than 6 viruses are known to cause cancer in humans. There are 4 DNA viruses: the Epstein-Barr virus, certain human papillomavirus subtypes, hepatitis B virus, and Kaposi’s sarcoma herpesvirus (HHV-8); and 2 RNA viruses: adult T-cell leukemia virus (HTLV-1) and hepatitis C virus. The study of the carcinogenic mechanisms of these oncoviruses has yielded an amazing wealth of information on how cancers develop, and we are nowhere near the end of mining this knowledge. Among the discoveries is the useful concept of immunity: attacking the causative agent is likely to prevent the development of cancer.
Impressive data already exist for the prevention of hepatitis B-induced hepatocellular carcinoma by stimulating antiviral immunity with a vaccine. More recently, a new era in cervical cancer prevention has been ushered in by the development of the tetravalent vaccine Gardasil® against the human papillomavirus serotypes that cause the vast majority of venereal warts and about 70% of cervical cancers. In this monograph, Roden and colleagues from Johns Hopkins University review important features of human papillomavirus biology, the scientific rationale for the vaccine, and hint at future directions for the next generation of preventive vaccines.
As well, I have provided a brief outline of the clinical data that led to the United States Food and Drug Administration’s approval of the vaccine, together with recommendations for its use.
However, despite our best efforts at prevention and early detection, more than 11,000 women in the United States and nearly 500,000 women worldwide will contract cervical cancer each year. Jonathan Berek and his colleagues at Stanford University provide us with a superb review of the management of patients who develop invasive cervical cancer. Despite the advances, over 3600 women in the United States and 288,000 women worldwide will die from cervical cancer every year.
Overall, cervical cancer represents a major success story for cancer research. The development of the Pap smear for early detection made the first and largest dent in the progress of the disease. The incidence of invasive cervical cancer has declined by about 80% in the United States since the widespread implementation of screening. However, let us hope that this latest advance is not implemented as slowly as was the Pap test. Dr. Papanicolaou first reported his findings in 1928 and provided a substantial body of supportive data in 1943. However, routine Pap screening did not begin in earnest until the 1960s, and certain at-risk populations still do not benefit from screening in many countries around the world. The currently available vaccine has the potential to reduce the incidence of cervical cancer by an additional 70%. We cannot allow any barriers to block efforts in protecting women against a life-threatening but preventable disease.
ARTICLES
Human papillomavirus vaccine for cervical cancer prevention
Archana Monie, Richard B. S. Roden, T.-C. Wu
Clinical efficacy and use of Gardasil®
Dan L. Longo
Management of cervical cancer
Jonathan S. Berek, Nita K. Lee
If you have a Username and Password, you may already access to this article. Please login below.
If you do not have a Username and Password, click the "Register" button below to purchase this article.
|
 |
|
|
| |
Editor-in-chief
Dan L. Longo - MD
The investment in basic research over the last twenty-five years has led to an explosion of new agents and approaches to cancer treatment. The current unprecedented pace of discovery of novel targets ...
[EDITORS:PAST:TITLE]
[EDITORS:PAST:LIST]
|
|
|
|
|
|
| |
|
|
|