Exploration of Medicine

Special Issue Topic

Spotlight on Cervical Cancer: Prevention, Early-Diagnosis, and Treatments

Submission Deadline: February 29, 2024

Guest Editors

Dr. Andrea Giannini E-Mail

Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy

Research Keywords: cervical cancer; HPV; cervical dysplasia; radical hysterectomy; laproscopy; Robotic; surgery

Dr. Giorgio Bogani E-Mail

Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Italy

Research Keywords: cervical cancer; HPV; cervical dysplasia; radical hysterectomy; laproscopy; Robotic; surgery

About the Special Issue

Cervical cancer (CC) represents one of the most common gynecological malignancies worldwide. Despite the strong implementation of prevention protocols, cervical cancer is still a source of concern, especially in developing countries. The HPV vaccine represents the crucial resource used in primary prevention, recommended with level A evidence. Available data show that the HPV vaccine is able to reduce the HPV infection prevalence by supporting the decrease in the development of precancerous and CC. By using the cervical smear and HPV-DNA test, there is an increase of cervical dysplasia, early-stage CC, and consequently its treatments. In the last decade, these data were confirmed in industrialized countries, with an increase of early-stage CC compared to women living in developing countries, where a large proportion of advanced or metastatic CC was diagnosed. CC treatment differs in accordance with the stage at diagnosis. In last years, various trials investigated the use of conservative treatment and minimally invasive surgery for CC. Its data highlighted the safety and effectiveness of this approach, and as a result, the 2018 ESGO/ESTRO/ESP guidelines, with level B evidence, stated that the minimally invasive approach is favored. However, the LACC trial questioned the oncological outcomes of this approach, proving an increased risk of recurrence and death. To date, the choice of an adequate surgical approach in CC is still debated. Considering the history of HPV infection and the development of CC, it’s crucial to implement prevention protocols with the aim to detect early diagnosis of precancerous lesions and CC. CC management is still a source of ongoing concern. Considering the involvement of this disease in young women, also looking for a pregnancy, early diagnosis and personalized treatment is essential. This special issue of Exploration of Medicine is dedicated to focusing on the most important advancements in the prevention, early diagnosis, and treatment of CC, providing an update that will contribute to establish CC tailored-management.

Keywords: cervical cancer; early-diagnosis cervical cancer; cervical cancer prevention; cervical cancer screening; cervical cancer treatment

Published Articles

Open Access

Original Article

Aloysia citrodora extract as a chemopreventive agent against HPV16-induced lesions: findings from K14-HPV16 mice
Aim: Aloysia citrodora has a long history of traditional use in treating various ailments. This study evaluated the in vivo chemopreventive efficacy and systemic toxicity of an extract of A. ci [...] Read more.

Aim:

Aloysia citrodora has a long history of traditional use in treating various ailments. This study evaluated the in vivo chemopreventive efficacy and systemic toxicity of an extract of A. citrodora in a transgenic mouse model of HPV16 (human papillomavirus type 16)-induced cancer.

Methods:

The experiment involved six groups (n = 5): group 1 (G1, wild-type (WT), water), group 2 (G2, HPV, water), group 3 (G3, WT, 0.013 g/mL), group 4 (G4, HPV, 0.006 g/mL), group 5 (G5, HPV, 0.008 g/mL), and group 6 (G6, HPV, 0.013 g/mL). Throughout the assay, humane endpoints, body weight, food, and water consumption were recorded weekly. The internal organs and skin of the mice were collected for analysis after they were sacrificed. Toxicological parameters that were studied included hematological and biochemical blood markers, splenic and hepatic histology, and hepatic oxidative stress.

Results:

A. citrodora extract seems to reduce the incidence of dysplastic and in situ carcinoma skin lesions induced by HPV16 in this model, suggesting that dietary supplementation with concentrations of 0.008 g/mL and 0.013 g/mL may have beneficial chemopreventive effects.

Conclusions:

The extract did not induce any concentration-dependent toxicological effects on any of the parameters included in the study, indicating a favorable toxicological profile under these experimental conditions.

Beatriz Medeiros-Fonseca ... Paula A. Oliveira

Published: June 18, 2024 Explor Med. 2024;5:416–433
DOI: https://doi.org/10.37349/emed.2024.00228

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Aim:

Aloysia citrodora has a long history of traditional use in treating various ailments. This study evaluated the in vivo chemopreventive efficacy and systemic toxicity of an extract of A. citrodora in a transgenic mouse model of HPV16 (human papillomavirus type 16)-induced cancer.

Methods:

The experiment involved six groups (n = 5): group 1 (G1, wild-type (WT), water), group 2 (G2, HPV, water), group 3 (G3, WT, 0.013 g/mL), group 4 (G4, HPV, 0.006 g/mL), group 5 (G5, HPV, 0.008 g/mL), and group 6 (G6, HPV, 0.013 g/mL). Throughout the assay, humane endpoints, body weight, food, and water consumption were recorded weekly. The internal organs and skin of the mice were collected for analysis after they were sacrificed. Toxicological parameters that were studied included hematological and biochemical blood markers, splenic and hepatic histology, and hepatic oxidative stress.

Results:

A. citrodora extract seems to reduce the incidence of dysplastic and in situ carcinoma skin lesions induced by HPV16 in this model, suggesting that dietary supplementation with concentrations of 0.008 g/mL and 0.013 g/mL may have beneficial chemopreventive effects.

Conclusions:

The extract did not induce any concentration-dependent toxicological effects on any of the parameters included in the study, indicating a favorable toxicological profile under these experimental conditions.

Open Access

Review

The future of cervical cancer prevention: advances in research and technology
This article provides an informative overview of the current situation and future trends in cervical cancer prevention. Cervical cancer remains a significant public health concern worldwide and is c [...] Read more.

This article provides an informative overview of the current situation and future trends in cervical cancer prevention. Cervical cancer remains a significant public health concern worldwide and is characterized by notable variations in both incidence and mortality rates between developed and developing countries. This underscores the importance of understanding the pathophysiology of cervical cancer, stressing the involvement of high-risk HPV types. The presence of supplementary risk factors facilitates the transition from infection to cancer. This review examines current preventive methods, including the success of HPV vaccines such as Gardasil and Cervarix, and the effectiveness of screening techniques, from cytology to HPV DNA testing. It noted the limitations faced by primary and secondary preventive measures, particularly in low-resource settings, which include access to vaccines and effective screening procedures. Emerging technologies in cervical cancer prevention, such as liquid-based cytology, molecular testing, and AI, promise to improve early detection and diagnosis accuracy and efficiency. The potential of precision medicine to customize treatment based on individual risk factors was discussed. It explores the innovation in genetic editing techniques, such as CRISPR/Cas9, in targeting HPV oncoproteins, the advent of immunotherapy, the role of tumor-infiltrating lymphocytes, and the prospects of biomarkers in improving early detection. Research and technological advancements are leading to transformative changes in cervical cancer prevention. These developments suggest a path toward improved screening, diagnosis, and treatment that could significantly reduce the global burden of the disease. However, realizing the full potential of these advances requires inclusive research and international collaboration to overcome access disparities, particularly in resource-limited settings.

Praveen Kumar Chandra Sekar ... Ramakrishnan Veerabathiran

Published: May 22, 2024 Explor Med. 2024;5:384–400
DOI: https://doi.org/10.37349/emed.2024.00226

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This article provides an informative overview of the current situation and future trends in cervical cancer prevention. Cervical cancer remains a significant public health concern worldwide and is characterized by notable variations in both incidence and mortality rates between developed and developing countries. This underscores the importance of understanding the pathophysiology of cervical cancer, stressing the involvement of high-risk HPV types. The presence of supplementary risk factors facilitates the transition from infection to cancer. This review examines current preventive methods, including the success of HPV vaccines such as Gardasil and Cervarix, and the effectiveness of screening techniques, from cytology to HPV DNA testing. It noted the limitations faced by primary and secondary preventive measures, particularly in low-resource settings, which include access to vaccines and effective screening procedures. Emerging technologies in cervical cancer prevention, such as liquid-based cytology, molecular testing, and AI, promise to improve early detection and diagnosis accuracy and efficiency. The potential of precision medicine to customize treatment based on individual risk factors was discussed. It explores the innovation in genetic editing techniques, such as CRISPR/Cas9, in targeting HPV oncoproteins, the advent of immunotherapy, the role of tumor-infiltrating lymphocytes, and the prospects of biomarkers in improving early detection. Research and technological advancements are leading to transformative changes in cervical cancer prevention. These developments suggest a path toward improved screening, diagnosis, and treatment that could significantly reduce the global burden of the disease. However, realizing the full potential of these advances requires inclusive research and international collaboration to overcome access disparities, particularly in resource-limited settings.

Open Access

Original Article

Prevalence of specific human papillomavirus genotypes among Moroccan women with invasive cervical cancer
Aim: The aim of this study is to investigate the prevalence of human papillomavirus (HPV) genotypes in Moroccan women diagnosed with invasive cervical cancer and to assess the association between [...] Read more.

Aim:

The aim of this study is to investigate the prevalence of human papillomavirus (HPV) genotypes in Moroccan women diagnosed with invasive cervical cancer and to assess the association between HPV infection and some socio-demographic characteristics and clinicopathological features.

Methods:

In this study, 80 fresh biopsies from patients with confirmed diagnoses of cervical cancer during the study period (2020–2021) were collected. All cases were subject to HPV detection by nested PCR using MY09/11 and GP5+/6+ primers. HPV genotyping was performed by type-specific PCR targeting HPV 6, 11, 16, 18, 31, and 33.

Results:

The average age of patients was 54 years. Most patients were diagnosed with squamous cell carcinoma (SCC; 82.5%) at stage II (71.3%). Overall, 91.3% of cervical cancer cases were HPV-positive. HPV 16 is the most prevalent genotype, reported in 60.3% of HPV-positive cases, followed by HPV 18, 33, and 31 genotypes, identified in 20.5%, 12.3%, and 6.8%, respectively. No double infection with these genotypes was observed. Statistical analysis showed a significant correlation between HPV infection and age at menarche (P = 0.028), parity (P = 0.004), childbirth delivery (P = 0.040), and marital status (P = 0.042).

Conclusions:

HPV-DNA was prevalent in most examined cervical cancer tissues and HPV 16, HPV 18, HPV 33, and HPV 31 were present, at single infection, in all HPV-positive cases. These results emphasize already reported data on HPV distribution in Morocco and may contribute significantly to promoting the use of HPV DNA-based screening tests and available vaccines to limit HPV infection, viral dissemination, and cancer cervical development.

Kaoutar Anouar Tadlaoui ... Moulay Mustapha Ennaji

Published: February 28, 2024 Explor Med. 2024;5:76–88
DOI: https://doi.org/10.37349/emed.2024.00207

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Aim:

The aim of this study is to investigate the prevalence of human papillomavirus (HPV) genotypes in Moroccan women diagnosed with invasive cervical cancer and to assess the association between HPV infection and some socio-demographic characteristics and clinicopathological features.

Methods:

In this study, 80 fresh biopsies from patients with confirmed diagnoses of cervical cancer during the study period (2020–2021) were collected. All cases were subject to HPV detection by nested PCR using MY09/11 and GP5+/6+ primers. HPV genotyping was performed by type-specific PCR targeting HPV 6, 11, 16, 18, 31, and 33.

Results:

The average age of patients was 54 years. Most patients were diagnosed with squamous cell carcinoma (SCC; 82.5%) at stage II (71.3%). Overall, 91.3% of cervical cancer cases were HPV-positive. HPV 16 is the most prevalent genotype, reported in 60.3% of HPV-positive cases, followed by HPV 18, 33, and 31 genotypes, identified in 20.5%, 12.3%, and 6.8%, respectively. No double infection with these genotypes was observed. Statistical analysis showed a significant correlation between HPV infection and age at menarche (P = 0.028), parity (P = 0.004), childbirth delivery (P = 0.040), and marital status (P = 0.042).

Conclusions:

HPV-DNA was prevalent in most examined cervical cancer tissues and HPV 16, HPV 18, HPV 33, and HPV 31 were present, at single infection, in all HPV-positive cases. These results emphasize already reported data on HPV distribution in Morocco and may contribute significantly to promoting the use of HPV DNA-based screening tests and available vaccines to limit HPV infection, viral dissemination, and cancer cervical development.

Guest Editors

About the Special Issue

Published Articles

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