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A Brief History of Cervical Cancer


Background

The first description of cervical cancer was found in 400 BCE by the Greek physician of the name Pericles Hippocrates. It was considered incurable at the time. Until some 2000 years later, the perception of the pathogenic mechanism was recognized through a pioneer work by an Italian surgeon during in the mid-19th century, Dr. Rigoni Stern noticed that the incidence of cervical cancer was rare among nuns (Rigoni-Stern, 1842). 20 century epidemiology work further demonstrated that cervical cancer is common among sex workers (Mak et al., 2004) and among women whose husbands hired prostitutes on a regular basis (Bayo et al., 2002). All these work has indications that the causation of cervical cancer is linked with sexual intercourse. Hence cervical cancer was considered highly transmissible. However the transmitting agent was only reported later in the 1976 publication by German scientist zur Hausen where they identified Human papillomavirus (HPV) DNA in cervical cancer and warts. In the 1985 nature paper, zur Hausen, Gissmann and their co-workers further identified the structure and sequence of HPV (Schwarz et al., 1985), established a foundational work for the later discovery of HPV vaccine.

Diagnosis

Cervical cancer is often diagnosed through the findings of an abnormal pap smear test. Symptoms of the disease may lead to the testing procedure such as abnormal vaginal bleeding and pain. The pap smear is conducted by taking cells from the cervix. Abnormalities in those cells are strong predictors of potential for development into cervical cancer. While the medical community in developed countries strongly rely on pap smear testing, there are challenges with this form of initial diagnosis. Blood or inflammatory cells can obscure abnormal cells, making detection a highly subjective process. Also, an inadequate collection of cells can further hinder the diagnosis. The development of cervical cancer is also strongly linked to HPV, humanpapillomaviruses. HPVs are spread through sexual contact and variations of the virus are also responsible for non-genital warts, which are not sexually transmitted. There are over 40 strains of the virus and high-risk strains can lead to the development of cervical and anal cancer (Mayo Clinic Staff, 2016). When a positive pap test is identified, further stages of diagnosis are considered, such as colposcopy to check the cervix or a biopsy to remove and test a small amount of tissue. Other diagnosis methodologies include but are not limited to pelvic examination, x ray, CT scans, MRI, and PET scans (National Cancer Institute, 2016).

Treatment

Cervical cancer is categorized by stages depending on the extent to which the cancer has spread. The stage of the cancer is the most important factor in determining the type of treatment a patient receives. Other factors that are considered include age and overall health of the patient, location and type of cancer on the cervix, and whether the patient wants to have children (“Treatment Options,” 2016). Treatment of cervical cancer consists of either surgery, chemotherapy, radiation therapy, or a combination of therapies. Surgery involves the removal of the tumor and surrounding tissue. For cancers that have not spread beyond the cervix, a cone biopsy can be conducted to remove the abnormal tissue and can be used to treat microinvasive cancers. Another surgical procedure that also treats microinvasive cancers is the loop electrosurgical excision procedure (LEEP). LEEP uses a wired hoop that is heated by an electrical current to remove tissue. A hysterectomy is also used as a treatment for cervical cancer. A simple hysterectomy involves the removal of the uterus and the cervix. A radical hysterectomy involves the removal of the uterus,upper vagina, cervix and the tissues surrounding the cervix. Radical trachelectomy is another type of surgery that removes the cervix, but leaves the uterus intact. This is type of surgery is ideal for young patients who still want the option of childbirth (“Cervical Cancer - Treatment”, 2016). Radiation therapy involves using high-energy x-rays or other particles to kill cancer cells and to shrink the tumor. Radiation therapy can be given alone or in conjunction with surgery or chemotherapy. Chemotherapy involves the use of drugs to attack cancer cells, by inferring with the cell’s ability to divide and grow. Chemotherapy is usually used with radiation therapy to improve the effectiveness of radiation or used after surgery to destroy any remaining cancer cells.

Trends

The implementation of early screening and treatment has improved the survival rate of cervical cancer. A localized data focusing on the population in UK showed that one-year age-standardised net survival has increased from 74% during 1971-1972 to 83% during 2010-2011, while the ten-year net survival increased from 46% to 63% respectively (“Cervical Cancer Survival,” 2016). In the United States, the incidence rate of cervical cancer decreased significantly by 1.3% per year from 2003 to 2012. The death rate also decreased by 0.9% per year among women (Blythe et al. 2016).

References

1. Rigoni-Stern DA. Fatti statistici relativi alle malattie cancerose. Giornale per servire ai progressi della Patologia e della Terapia 1842;2:507–17. 2. Mak R, Van Renterghem L, Cuvelier C. Cervical smears and human papillo- mavirus typing in sex workers. Sex Transm Infect 2004;80:118–20. 3. Bayo S, Bosch FX, de Sanjosé S, Mun ̃oz N, Combita AL, Coursaget P, et al. Risk factors of invasive cervical cancer in Mali. Int J Epidemiol 2002;31:202–9. 4. Schwarz E, Freese UK, Gissmann L, Mayer W, Roggenbuck B, Stremlau A, et al. Structure and transcription of human papillomavirus sequences in cervical carcinoma cells. Nature 1985;314:111–4. 5. Staff, By Mayo Clinic. "Pap Smear." What You Can Expect. N.p., n.d. Web. 24 Sept. 2016. http://www.mayoclinic.org/tests-procedures/pap-smear/basics/what-you-can-expect/prc-20013038 6. "HPV and Cancer." National Cancer Institute. N.p., n.d. Web. 24 Sept. 2016. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-fact-sheet 7. Treatment options for cervical cancer, by stage. (n.d.). Retrieved September 24, 2016, fromhttp://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-treating-by-stage 8. Cervical Cancer - Treatment Options. (2012, June 25). Retrieved September 24, 2016, from http://www.cancer.net/cancer-types/cervical-cancer/treatment-options 9. “Cervical Cancer Survival Statistics.” Cancer Research UK. N.p., 2015. Web. 23 Sept. 2016.

10. Ryerson, A. Blythe et al. “Annual Report to the Nation on the Status of Cancer, 1975-2012, Featuring the Increasing Incidence of Liver Cancer.” Cancer 122.9 (2016): 1312–1337. Web. 25 Sept. 2016.


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