From Diagnosis to Treatment Options
While HPV infection itself does not lead directly to cancer, persistent infection with high-risk HPV types can cause changes in the cells that may progress to cancer over time.
Diagnosis
The diagnosis of cancer in the context of HPV-related cancers involves a combination of clinical assessments, imaging studies, biopsies, and laboratory tests.
Imaging Studies:
Imaging studies may be conducted to visualize the affected area and assess the extent of the cancer. Common imaging modalities include CT scans, MRI scans, ultrasound, and PET scans.
Biopsy:
A biopsy is a crucial step in diagnosing cancer. During a biopsy, a small sample of tissue is collected from the suspected cancer site. For example:
- In cervical cancer, a colposcopy-guided biopsy may be performed on abnormal areas of the cervix.
- For other cancers, such as those in the oropharynx, a biopsy may involve removing a small piece of tissue for analysis.
Pathology Examination:
The biopsy specimen is sent to a pathology laboratory, where it is examined by a pathologist.
Pathologists analyze the tissue to confirm the presence of cancer, identify the type of cancer, and determine the cancer’s grade and stage.
Staging:
Staging involves determining the extent of cancer spread. Staging helps healthcare providers plan the most appropriate treatment and estimate prognosis.
Staging may involve additional imaging studies, such as CT scans or PET scans, to assess lymph node involvement and the presence of distant metastases.
Counting mitotic figures (MF)
In hematoxylin and eosin-stained histologic sections is an integral part of the diagnostic pathologist’s tumor evaluation. The mitotic count (MC) is used alone or as part of a grading scheme for assessment of prognosis and clinical decisions.
Multidisciplinary Consultation:
A multidisciplinary team, including oncologists, surgeons, pathologists, and radiologists, often collaborates to review diagnostic findings and develop a comprehensive treatment plan.
Cervical cancer forms when an oncogenic HPV virus transforms cells in the cervix into abnormal cells by inducing alterations to their deoxyribonucleic acid (DNA) or ribonucleic acid (RNA).
Types of cervical cancer
Cervical cancers are named after the type of cell where the cancer started. The two main types are:
- Squamous cell carcinoma: Most cervical cancers (up to 90%) are squamous cell carcinomas. These cancers develop from cells in the ectocervix.
- Adenocarcinoma: Cervical adenocarcinomas develop in the glandular cells of the endocervix. Clear cell adenocarcinoma, also called clear cell carcinoma or mesonephroma, is a rare type of cervical adenocarcinoma.
Sometimes, cervical cancer has features of both squamous cell carcinoma and adenocarcinoma. This is called mixed carcinoma or adenosquamous carcinoma. Very rarely, cancer develops in other cells in the cervix.
The ectocervix is the part of the cervix which faces the vagina. It is lined by a layer of epithelium. It is continuous with the cervical canal, lined by glandular epithelial cells. This is also called the endocervix.
The meeting point between the ectocervical and endocervical cells is called the transformation zone. Cells in this transformation zone are most likely to become cancerous.
Treatments Stage Cancer
The treatment for cervical cancer depends on the stage of the cancer, the size and location of the tumor, and the overall health of the patient. Treatment options may include surgery, radiation therapy, chemotherapy, or a combination of these. Here is an overview of the common treatment modalities:
Surgery:
- Conization: Removal of a cone-shaped piece of tissue containing the abnormal cells.
- Hysterectomy: Removal of the uterus and possibly nearby tissues. This may be a total hysterectomy (removal of the uterus and cervix) or a radical hysterectomy (removal of the uterus, cervix, part of the vagina, and surrounding tissues).
Radiation Therapy:
- External Beam Radiation: Directed at the cancer from outside the body.
- Brachytherapy: Radioactive sources are placed directly into or very close to the tumor.
Chemotherapy:
- The use of drugs to kill cancer cells or stop their growth. It can be given orally or intravenously.
Targeted Therapy:
- Drugs that specifically target cancer cells, often with fewer side effects than traditional chemotherapy.
Immunotherapy:
- Boosting the body’s immune system to fight cancer cells.
Clinical Trials:
- Participation in clinical trials testing new treatments or combinations of treatments.
The choice of treatment depends on factors such as the stage of the cancer, the patient’s age and overall health, and their preferences. Early-stage cervical cancer is often treated with surgery or radiation, while more advanced stages may require a combination of surgery, radiation, and chemotherapy.
Regular follow-up care is essential after treatment to monitor for any signs of recurrence and to manage potential side effects of treatment.
It’s important for individuals diagnosed with cervical cancer to consult with their healthcare team to determine the most appropriate treatment plan for their specific situation. Treatment decisions should be made in consultation with a multidisciplinary team of healthcare professionals, including gynecologic oncologists, radiation oncologists, medical oncologists, and other specialists.
