Introduction
Cervical cancer, also known as carcinoma of the uterine cervix, is a prevalent global issue with an annual death rate of 266,000 (World Health Organization, 2015). Among women, cervical cancer occurs very frequently. The human papillomavirus is considered the leading factor of cervical cancer development. Such a virus is rather widespread in developing countries. According to the National Comprehensive Cancer Network (2018), prevention methods can sufficiently decrease the number of patients with cervical cancer. However, given the high global prevalence of this disease, research performed in the area of cancer prevention and treatment is still insufficient. Therefore, this paper aims to review the available preventive measures against cervical cancer, factors impacting the choice of these measures, treatment options, and implications of the later ones. The review of these aspects is crucial since it will enable finding effective solutions to the prevention of cervical cancer.
Preventive Services
Screening for human papillomavirus, one of the most widespread and influential factors in the onset of cervical cancer, is an effective countermeasure to decrease the incidence of cancer. The vaccine against the virus can be administered early, at 11 or 12 with six or twelve-month apart (Centers for Disease Control and Prevention, 2017). The most typical vaccines are human papillomavirus ones. Researchers also identify smoking, the use of oral contraceptives, frequent change of sex partners, and immunosuppression as factors influencing the onset of cervical cancer (National Comprehensive Cancer Network [NCCN], 2018). Therefore, to limit the possibility of developing cancer one needs to quit smoking (or continue to abstain from it), use condoms, decrease the number of sex partners, and use immunosuppression only in emergency cases. Also, NCCN (2018) reports that squamous cell carcinoma screening has the potential to effectively diminish the incidence of cervical cancer in developing countries.
Impact of Behavior and Ethnicity on Preventive Services Choice
Some ethnicities have a higher disposition to certain illnesses and conditions. A higher incidence of cervix cancer is documented among Hispanic, Black, and Asian women (Benard et al., 2014). Therefore, individuals identified with these ethnicities should be advised to consider screening for squamous cell carcinoma or human papillomavirus. The onset of cancer in Hispanic women is reported to be earlier than in white women, which also emphasizes the significance of earlier screening (Strohl et al., 2015). Behavior is also an important factor since many habits and lifestyle choices are reported to increase the chance of developing cervix carcinoma. Smoking is an adverse habit that increases the incidence not only of cervical cancer but also of other cancer types. Quitting smoking is advised for the prevention of cervical cancer (NCCN, 2018). Furthermore, NCCN (2018) has researched the role of sexual behavior in cancer development. The results of the studies advocate for condom use and single partner adherence.
Drug Treatment Options for Cervical Cancer Patients
Treatment options are highly dependent on the stage of cancer. For early stages, evidence-based practices usually include surgery or radiotherapy. Chemoradiation is advised at stage II to IVA. According to data from five randomized clinical trials, chemoradiation decreases the lethality of cervical cancer by 30 to 50%, depending on the parallel use of radiotherapy (NCCN, 2018). Chemotherapy is recommended when a patient is diagnosed with extrapelvic metastases, and radiotherapy alone is no more effective. A variety of chemotherapeutic solutions is available to treat cervical cancer. Most of them are combined with radiotherapy for a better effect.
Yet, patients who receive combined therapy become less responsive to the effects of single-agent chemotherapy. Cisplatin is the most commonly used and the most effective agent against cervical cancer (NCCN, 2018). Single-agent Cisplatin is sometimes used to mitigate the toxicity levels in patients who are less tolerant to side-effects of chemoradiation (NCCN, 2018). This medication is administered intravenously. The dosage is based on the stage of cancer progression, body weight, and therapy response. When Cisplatin is used as a part of chemoradiation, it should be administered before radiation therapy. The first dosage for adults is 40 milligrams per square meter of the body once a week (“Cisplatin dosage,” 2017). It is vital to note that Cisplatin should be administered with a 3-4-week pause if used in combination with Paclitaxel.
Bevacizumab is another agent used to treat cervical cancer. This drug is administered intravenously by infusion over 90 minutes (“Bevacizumab dosage,” 2018). However, subsequent administrations may take less time and finish within 60 or 30 minutes. The recommended adult dosage is 15 milligrams per kilogram of the patient’s weight every three weeks.
Paclitaxel is usually used in combination with Cisplatin and administered before it. The adult dosage is 175 milligrams for a square meter of body intravenously by infusion over 3 hours every 3 weeks. If adverse effects persist, the dosage can be lowered to 135 milligrams and be administered over 24 hours every 3 weeks (“Paclitaxel dosage,” 2017). There are also concerns over hypersensitivity that might need to be managed with other drugs.
Carboplatin is another agent typically used in combination with Paclitaxel. According to NCCN (2018), such a combination is no less effective than Cisplatin plus paclitaxel and able to reduce the chance of lethality. Due to that fact, such therapy can be a viable option for those, who previously received Cisplatin with no effect. Carboplatin adult dosage for cervical cancer is 200 milligrams per square meter of body intravenously followed by Paclitaxel (“Carboplatin dosage,” 2017). The second and subsequent dosages are administered in 3 weeks.
Short-Term and Long-Term Implications of Treatments
Treatment of cervical cancer is performed through the use of drugs. Thus, the implications of treatment are concerned with pain relief and disease regression. However, medicines may also have some negative impacts on the organism. Short-term effects of Cisplatin include diarrhea, loss of appetite, kidney problems, and temporary hair loss. Cisplatin can also provoke bone marrow depression, ototoxicity. Bevacizumab can induce bleeding gums, difficult urination, runny nose, and sores on the skin. A hypersensitivity reaction is often seen in patients treated with Carboplatin. Paclitaxel may invoke hypotension, nausea and vomiting, peripheral neuropathy, and a range of other side effects.
In general, all these drugs, especially when used in combination with other chemotherapeutic solutions and radiotherapy, can increase the toxicity of organs or tissues that can either subside or remain, depending on the treatment length and agent used. However, there are also positive short-term effects of chemotherapy. According to NCCN (2018), it may also provide pain relief.
Cisplatin-based chemoradiation has some long-term implications on patients. In particular, the improved chances of survival with no cancer progression have been noticed (NCCN, 2018). However, patients receiving a full-term chemoradiation treatment exhibit acute side effects of toxicity. Symptoms are particularly evident in patients treated with Cisplatin plus 5-FU. Toxicity was recorded for skin, hemoglobin, vagina, and other organs, and tissues (Astolfi et al., 2013). The symptoms included diarrhea, nausea, vomiting, and sexual dysfunction.
Conclusion
Cervical cancer is an adverse condition that can be effectively prevented and treated. Prevention measures include timely screening, the use of condoms, vaccination against human papillomavirus, and quitting smoking. Treatment options include a combination of radiotherapy with chemotherapy. The latter may include a combination of Paclitaxel, Carboplatin, Cisplatin, Bevacizumab, and a range of other options. There are negative short-term side effects of the treatment such as hypersensitivity, nausea, and vomiting. The greatest short-term implication is pain relief. Long-term outcomes include prolonged life and remission. Long-term side effects are high organ, blood, and tissue toxicity.
References
Astolfi, L., Ghiselli, S., Guaran, V., Chicca, M., Simoni, E., Olivetto, E., … Martiti, A. (2013). Correlation of adverse effects of cisplatin administration in patients affected by solid tumours: A retrospective evaluation. Oncology Reports, 29(4), 1285-1292.
Benard, V. B., Thomas, C. C., King, J., Massetti, G. M., Doria-Rose, V. P., Saraiya, M, & Centers for Disease Control and Prevention. (2014). Vital signs: Cervical cancer incidence, mortality, and screening – United States, 2007-2012. Morbidity and Mortality Weekly Report, 63(44), 1004-1009.
Bevacizumab dosage. (2018). Web.
Carboplatin dosage. (2017). Web.
Centers for Disease Control and Prevention. (2017). HPV vaccines: Vaccinating your preteen or teen. Web.
Cisplatin dosage. (2017). Web.
National Comprehensive Cancer Network. NCCN guidelines version 1.2018 Cervical Cancer. Web.
Paclitaxel dosage. (2017). Web.
Strohl, A. E., Mendoza, G., Ghant, M. S., Cameron, K. A., Simon, M. A., Schink, J. C., & Marsch, E. E. (2015). Barriers to prevention: Knowledge of HPV, cervical cancer, and HPV vaccinations among African American women. American Journal of Obstetrics and Gynecology, 212(1), 65.e1-65.e5.
World Health Organization. (2015). Cervical cancer: Estimated incidence, mortality and prevalence worldwide in 2012. Web.