Does HPV go away after a hysterectomy. Can HPV come back after treatment. How does a hysterectomy affect HPV infection. What are the symptoms of HPV in men. How is HPV treated in women. Should you get the HPV vaccine after a hysterectomy.

Understanding HPV: Causes, Transmission, and Persistence

Human Papillomavirus (HPV) is a sexually transmitted infection that affects millions of people worldwide. It primarily invades the cells of the vagina and cervix in women, and can persist in some individuals even after treatment. To fully grasp the implications of HPV after a hysterectomy, it’s crucial to understand its nature and behavior.

What causes HPV infection?

HPV is spread through sexual contact, including vaginal, anal, and oral sex. The virus enters the body through tiny breaks in the skin or mucous membranes. Once inside, it infects the cells of the genital area, including the cervix, vagina, vulva, and anus.

How long does HPV typically persist?

Most women clear the virus without any special form of treatment. This is because the infected cells are naturally shed from the cervix and vagina over time. However, in some cases, the virus can persist for years, increasing the risk of developing cervical cancer or, more rarely, cancer of the vagina.

• 70-90% of HPV infections clear on their own within 1-2 years
• 10-30% of cases may persist, leading to an increased risk of cancer
• It generally takes about ten years from infection to the development of HPV-related cancer

The Impact of Hysterectomy on HPV Infection

A hysterectomy is a surgical procedure that removes the uterus and, in many cases, the cervix. This raises an important question: Does HPV go away after a hysterectomy?

Does a hysterectomy eliminate HPV?

While a hysterectomy that includes removal of the cervix (total hysterectomy) significantly reduces the risk of cervical cancer due to HPV, it does not necessarily eliminate the virus entirely. HPV can persist in cells of the vagina and other genital areas even after the cervix is removed.

Can HPV recur after a hysterectomy?

The risk of developing a new, persistent HPV infection after a hysterectomy is generally low. However, it’s important to note that reinfection with HPV is possible if you or your partner has sexual contact with other partners, as there are several different strains of the virus.

HPV Symptoms and Testing in Men

While HPV is often associated with women’s health, it can also affect men. Understanding the symptoms and testing options for men is crucial for comprehensive prevention and treatment strategies.

What are the common symptoms of HPV in men?

HPV in men often presents differently than in women. The most common symptoms include:

• Penile warts
• Anal warts
• Asymptomatic infection (no visible symptoms)

It’s worth noting that men are more likely than women to have asymptomatic HPV infections.

How is HPV tested in men?

HPV testing in men is typically done by swabbing the tip of the penis with a special culture swab. This sample is then analyzed for the presence of the virus. However, routine HPV testing is not currently recommended for men in most cases.

Treatment Options for HPV in Women

While there is no cure for HPV itself, there are several treatment options available to manage the symptoms and prevent complications associated with persistent infection.

What are the primary treatment approaches for HPV?

1. Regular Pap smears: The most important aspect of HPV management is routine screening to detect abnormal cervical cells early.
2. Colposcopy: This procedure allows for closer examination of the cervix and removal of abnormal cells through biopsy.
3. Cone biopsy: In cases of persistent abnormal Pap results, a larger area of abnormal cervical tissue may be removed.
4. LEEP (Loop Electrosurgical Excision Procedure): This technique uses a thin wire loop electrode to remove abnormal cervical tissue.
5. Cryotherapy: Abnormal cells are frozen and destroyed using liquid nitrogen.

Can HPV be cured completely?

Unfortunately, there is no treatment that can completely cure or eliminate HPV from your system once you’ve been infected. However, in many cases, the immune system can clear the virus on its own over time.

HPV Vaccination: Who Should Get It and When

The development of HPV vaccines has revolutionized prevention efforts against this common virus. Understanding who should receive the vaccine and when is crucial for maximizing its effectiveness.

Who is eligible for the HPV vaccine?

The HPV vaccine, such as Gardasil, is currently recommended for:

• Girls and young women between the ages of 11 and 26
• Boys and young men between the ages of 11 and 21
• Men who have sex with men up to age 26
• People with compromised immune systems up to age 26

Should you get the HPV vaccine after a hysterectomy?

If you’ve had a hysterectomy and are within the recommended age range, getting the HPV vaccine may still be beneficial. While it won’t treat existing HPV infections, it can protect against other strains you haven’t been exposed to. Consult with your healthcare provider to determine if vaccination is appropriate for your specific situation.

Living with HPV: Long-term Management and Prevention

For those who have been diagnosed with HPV or have undergone treatment for HPV-related conditions, long-term management and prevention strategies are essential.

How can you reduce the risk of HPV complications?

• Attend regular follow-up appointments and screenings
• Practice safe sex to reduce the risk of new HPV infections
• Maintain a healthy lifestyle to support your immune system
• Quit smoking, as it can increase the risk of HPV-related cancers
• Consider getting vaccinated if you’re eligible and haven’t been previously

What should you do if HPV persists after treatment?

If HPV persists or recurs after initial treatment, your healthcare provider may recommend more frequent screenings or additional treatments. It’s important to follow their guidance closely and communicate any new symptoms or concerns promptly.

Advances in HPV Research and Future Treatments

The field of HPV research is continually evolving, with new discoveries and potential treatments on the horizon. Staying informed about these developments can provide hope and new options for those affected by HPV.

What are some promising areas of HPV research?

• Therapeutic vaccines to treat existing HPV infections
• Improved diagnostic tests for more accurate and earlier detection
• Novel antiviral treatments targeting specific HPV strains
• Immunotherapy approaches to boost the body’s natural defenses against HPV

How might future treatments change the landscape of HPV management?

As research progresses, we may see more targeted and effective treatments for persistent HPV infections. These advancements could potentially reduce the need for invasive procedures and improve outcomes for those at risk of HPV-related cancers.

In conclusion, while HPV can persist even after a hysterectomy, understanding the virus, its treatments, and prevention strategies can significantly improve management and reduce associated risks. Regular check-ups, vaccination when appropriate, and staying informed about new developments are key components of a comprehensive approach to HPV care. As always, consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

Understanding HPV and How it can be Treated

Q1. I have the human papillomavirus and I’m going to have a hysterectomy in the winter. My doctor says that I will be rid of the virus afterward because it lives in the cervix. It that true? Do I not need to worry about HPV post-hysterectomy? Can it come back?

— Lorrie, Ohio

HPV (human papillomavirus) is spread through sexual contact and invades the cells of the vagina and cervix. Most women clear the virus without any special form of treatment, since the infected cells are shed from the cervix and vagina. However, in some women the virus is not cleared but rather remains in some of the cervical and vaginal cells. This persistence of HPV increases the risk of developing cervical cancer and, more rarely, cancer of the vagina.

Unfortunately, once you have been infected with HPV, there is no treatment that can cure it or eliminate the virus from your system. A hysterectomy removes the cervix, which means that the risk of developing cervical cancer because of persistent HPV infection will essentially be eliminated. However, since HPV can also persist in cells of the vagina, a hysterectomy does not necessarily render you free of the virus.

As for the risk of reinfection with HPV, because the virus is spread from person to person through sexual contact, and because there are several different strains of HPV, you could become infected with a new strain even after a hysterectomy if you or your partner has sexual contact with other partners. However, because HPV most commonly persists in the cells of the cervix, the chance of developing a new, persistent HPV infection after a hysterectomy is low.

Q2. What are the symptoms of HPV in men? Are they the same as in women? And how can a man be tested for HPV – what tests would you recommend?

The symptoms of HPV in men differ from those in women. Men often have asymptomatic disease (meaning there are no symptoms) — even more commonly than women. That said, the most common sign of HPV in men is penile warts. HPV can also cause anal warts and is a risk factor for anal cancer in men. There is some controversy about whether HPV can also increase the risk for cancer of the tongue in men.

HPV testing in men is done by swabbing the tip of the penis with a special culture swab. This swab is then tested for the virus.

Q3. I’ve heard a lot about HPV lately. What are the common treatments for this virus? Does it go away after treatment or can it come back?

— Rachel, Maryland

HPV, or human papillomavirus, is a sexually transmitted virus. It causes cervical dysplasia (abnormal changes in the cells that line the cervix, which is the opening to the uterus) and results in an abnormal Pap smear. If left untreated, some cases of HPV can progress to cervical cancer.

The most important part of treatment for HPV is getting regular Pap smears so that any abnormal cells can be removed before they become cancerous. This is actually the main treatment for HPV — the elimination of cells on the cervix that are abnormal. This is done by colposcopy, whereby the cervix is examined with a microscope, and the abnormal cells are removed by means of a biopsy. If the abnormal Pap persists, the entire abnormal region of the cervix can be removed in a procedure called a cone biopsy. While some cases of HPV infection disappear spontaneously, most persist.

A new vaccine, called Gardasil, can now protect women against HPV. It is given in three parts and is very effective. However, the vaccine must be given to a woman before she becomes sexually active in order to protect against HPV. This is why it is currently recommended for girls and young women between the ages of 11 and 26.

Q4. I had HPV some years ago. I had it removed by laser, and my Pap tests have been fine since. Then I had a complete hysterectomy. Now that there is a vaccine against HPV, should someone like me get it? Can the virus come back and lead to cancer, even though I’ve had a hysterectomy?

— Marie, Kansas

The human papillomavirus (HPV) infects the cells of the cervix during sexual activity. While 70-90 percent of these infections go away without treatment, (mostly through shedding of the cells on the surface of the cervix and vagina), the virus may persist in 10-30 percent of cases. When the virus persists, there is an increased risk for cancer (cervical cancer and vaginal cancer) and genital warts, though it generally takes about ten years from the time of infection with the virus to the development of an HPV-related cancer.

It’s most likely that you were infected with HPV many years ago. The abnormal cells on your cervix were probably discovered during your Pap smear, which was being done as a standard screening test for cervical cancer. The discovery of abnormal cells on your Pap smear would prompt testing of the smear for HPV to help determine whether the abnormal cells were of high or low risk. A positive HPV test would be evidence that your abnormal cervical cells were at somewhat high risk of becoming cancerous, and so laser surgery was recommended. Subsequently, it sounds as if you had your uterus and cervix completely removed. You may want to confirm with your doctor that you in fact had a “total hysterectomy” (in which the cervix is removed), as opposed to a “subtotal hysterectomy” or a “supracervical hysterectomy”— these are surgeries in which the uterus is removed but the cervix is left in place. If you no longer have a cervix, and presuming you did not have invasive cervical cancer at the time of your laser treatment or hysterectomy, you cannot develop cervical cancer now. However, that does not change the fact that you have been infected with HPV. You should discuss with your doctor what type (or types) of HPV you were infected with, so that you can be appropriately followed. The higher-risk types are HPV serotypes 16, 18, 11, and 6.

Unfortunately, the vaccine against HPV probably won’t be of much help to you. It is designed to protect women from becoming infected with the high-risk types of HPV, so it’s most appropriate for women who have never been infected with the virus. Since you have already had HPV, and abnormal cells were probably found on your cervix, this vaccine will not be beneficial — it cannot clear up an already-established infection or reverse abnormal changes in the cells of the cervix.

Learn more in the Everyday Health Sexual Health Center.

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Cervical Cancer After Hysterectomy? Is It Still Possible?

If you’ve had a hysterectomy, you may be wondering whether you can still develop cervical cancer.

According to the Centers for Disease Control and Prevention (CDC), there are over 600,000 hysterectomies performed in the United States every year. Most hysterectomies are performed to treat or prevent underlying medical conditions, such as endometriosis or reproductive cancers.

In this article, we’ll explain how a hysterectomy may impact your risk of developing cervical cancer or other types of reproductive cancers.

A hysterectomy is the surgical removal of the uterus, also called the womb, which is the organ in which a fetus grows during pregnancy.

Depending on the type of hysterectomy that’s performed, either a portion of the uterus or the full uterus will be removed.

Types of hysterectomies

• A partial hysterectomy removes only the top portion of the uterus. The cervix isn’t removed, which is the bottom portion of the uterus that connects to the vaginal canal.
• A total hysterectomy removes both the uterus and the cervix.
• In some cases, a partial or total hysterectomy may be performed with a salpingo-oophorectomy. This involves the removal of one or both of the ovaries and fallopian tubes.

Was this helpful?

A hysterectomy is usually performed for underlying medical reasons, such as conditions that affect the uterus, cervix, or surrounding organs.

Common reasons for undergoing a hysterectomy include:

• uterine fibroids
• uterine prolapse
• pelvic inflammatory disease
• endometriosis
• adenomyosis
• uterine cancer
• cervical cancer
• ovarian cancer
• chronic pelvic pain
• abnormal bleeding

Cervical cancer is a type of reproductive cancer that develops in the cells of the cervix. Cervical cancer is most commonly caused by human papillomavirus (HPV), a virus that can be easily transmitted during sexual intercourse or other sexual activities.

Generally, people who have undergone a partial hysterectomy are still at risk of developing cervical cancer. Since only the top portion of the uterus is removed during a partial hysterectomy and the cervix remains, cancerous cells may still develop within the cervix.

People who have had a full hysterectomy are less likely to develop cervical cancer. When the entire uterus is removed — cervix included — there is no longer a cervix available for cancerous cells to develop in.

However, sometimes a full hysterectomy is performed after precancerous cells have developed or after a diagnosis of cervical cancer.

In this case, it’s possible that the cervical cancer cells may have spread beyond the cervix, even before the hysterectomy. If these cancerous cells continue to spread, you can still develop cervical cancer even after the cervix is removed.

In fact, one early study on the topic found that over 18 percent of patients who underwent a total radical hysterectomy for cervical cancer experienced a recurrence of the condition.

A Pap smear, or Pap test, is a diagnostic test that’s performed to help detect the presence of abnormal or cancerous cells in your cervix. Pap smears are generally recommended every 3 to 5 years or more frequently, depending on your cervical cancer risk.

About a Pap smear

• A Pap smear is a simple, typically painless, noninvasive test. It’s done in your doctor’s office and only takes a few minutes.
• During a Pap test, your doctor will place a swab inside your vagina to collect cells from the surface of your cervix.
• These cells will then be placed on a slide and sent to a lab where they will be examined for any abnormalities.

An HPV test is another test that’s used to screen for cervical cancer. This test is used to determine whether you have HPV in your cervical cells. HPV can be detected in the cervix about a year after infection.

About an HPV test

• An HPV test can either be done alone (known as a primary HPV test) or with a Pap smear (known as a co-test).
• A co-test won’t seem any different to having a regular Pap smear, as the cells that are collected can be tested for both cell abnormalities and HPV.
• Unlike a Pap smear, which can only detect abnormal cells once they are present, an HPV test has the ability to detect an HPV infection before any cell changes occur.

Whether you should continue to have Pap smears or HPV tests after having a hysterectomy depends on both the type of procedure you had and the reason for the hysterectomy.

If you had a partial hysterectomy

If you had a partial hysterectomy, which does not remove the cervix, it’s still possible for cervical cancer to develop. Therefore, the American Cancer Society guidelines recommend continuing to receive regular cervical cancer screening until the age of 65.

After you turn 65, if you have not had any abnormal Pap tests for 10 years, you no longer need to continue cervical cancer screening.

If you had a total hysterectomy due to cervical cancer

If you had a total hysterectomy because of cervical cancer or high-grade dysplasia, the American College of Obstetricians and Gynecologists recommends continuing screening for at least 20 years postsurgery.

Regular cervical cancer screening can help identify any new changes to the cells in this area that may develop after surgery.

If you had a total hysterectomy not due to cervical cancer

If you had a total hysterectomy that was performed for a noncancerous condition, you no longer need to undergo regular Pap or HPV testing.

Ovarian cancer is a type of reproductive cancer that affects the ovaries. These small organs, located on either side of the uterus, produce hormones and eggs.

Having a hysterectomy may reduce your ovarian cancer risk, but it doesn’t eliminate it entirely. That’s because a hysterectomy only involves the uterus — not the ovaries. Even if you undergo a full hysterectomy, the ovaries are not removed unless an oophorectomy is also performed.

If you had a hysterectomy that only involved removal of your uterus, the risk of developing ovarian cancer still remains as long as you still have your ovaries.

Ultimately, your risk of developing cervical cancer after a hysterectomy depends on several factors. The two most important factors are the type of hysterectomy you had and whether you had a hysterectomy because of cervical cancer or high-grade dysplasia.

If you have had any type of hysterectomy to prevent or treat cervical cancer, you may still be at risk of developing cervical cancer. Also, if you only had a partial hysterectomy, which does not remove the cervix, it’s still possible for cervical cancer to develop.

However, if you had a total hysterectomy for another condition not related to cervical cancer, your risk of developing this type of cancer is extremely low.

If you’re concerned about your risk of developing cervical cancer, be sure to ask your doctor about the cervical cancer screening recommendations that are right for you.

Removal of the uterus. Conversation Without Taboo

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Uterus removal. Conversation without taboo

– Alla Borisovna, let’s discuss a topic that worries many women. But they are simply afraid to ask a doctor about it…

— It seems to me that many women do not ask questions not because they are afraid, but because they are sure that they are well versed in this. Let’s take the most well-established myth: “They will remove my uterus – and I will immediately grow old.” This is wrong. The uterus is a muscular organ whose only purpose is to bear children. During pregnancy, it increases many times in size, and after childbirth it decreases. And this process can be repeated a certain number of times during life. The removal of this organ and the advent of old age are in no way connected. Agree that no one gets old from removing, for example, the phalanx of a finger. The same is with the mother.

– If we talk about the need to remove the uterus, in what diseases does it occur? Is it only oncological diseases or can there be some benign pathologies?

– And so, and so. We remove the uterus for certain malignant neoplasms – when it comes to endometrial cancer, ovarian cancer, uterine sarcoma, and cervical cancer (by the way, we can also perform organ-preserving operations for this disease, but this is a topic for a separate discussion). In fact, all major oncogynecological pathologies involve the removal of the uterus.

In addition, there are other pathologies when a hysterectomy is recommended. Despite the fact that I said that the uterus is a muscular organ, in fact it consists of two components. The first is the muscle layer itself. And the second is the endometrium, the lining of the uterus, which in menstruating women, under the influence of ovarian hormones, grows during the cycle and is rejected during menstruation. So, the pathology can concern both the endometrium and the muscle layer. In menopause, women may develop, for example, endometrial hyperplasia. Normally, it can only be in menstruating women in a certain phase of the cycle. And in menopause, it should not be, so such a problem can be a reason for removing the uterus.

Another indication for surgery is benign tumors, such as fibroids. But it is not always removed, but only in three cases – it hurts, bleeds, grows.

I emphasize: the decision to remove the uterus is made individually in each specific case and must be done jointly by the doctor and the patient. Because from the moment of the first consultation we are one team and we decide everything together. We definitely take into account a lot of indicators, up to what kind of marriage, what reproductive plans, whether the woman is going to give birth again, etc. That is, we discuss life priorities. And based on this, we understand whether it is necessary to carry out the operation or not.

— Sometimes the uterus is removed prophylactically. What diseases can be prevented in this way?

— You know, I always tell my patients that there is such a tendency abroad: women who have fulfilled their reproductive function (have given birth to children), have approached the menopausal age (i. e., the ovaries and uterus have already completed their program and completed their life cycle, they are like ballast in the body), go for preventive laparoscopic hysterectomy. There are no incisions on the abdomen. Such an operation lasts about 30 minutes, they did it in the morning, and in the evening the patient is already at home. What is achieved by this? This is the prevention of cervical cancer, endometrial cancer, uterine sarcoma, ovarian cancer and tube cancer. In my opinion, it’s worth it. That is, if there is no organ (which is no longer functioning), there is no problem. Because all these diseases, as a rule, do not occur in a working organ, but in menopausal women after 50-60 years. In my opinion, prophylactic hysterectomy is quite promising in terms of preventing cancer.

— Is a histological examination of the removed material always performed? If we are talking about preventive removal, is it necessary to perform such a study?

— Needed. There is an unwritten rule in surgery and oncology: everything that is removed must be examined. We make sure to send the material to the lab to make sure everything is fine and to be sure that we haven’t missed anything at the initial stage. Any little thing that has not been given due attention can later “shoot” and cause trouble. The person must be fully equipped. He must know everything about himself.

— Is there any special preparation required for this operation?

— No, this is a fairly standard, completely uncomplicated laparoscopic operation, which practically does not pose any danger to the body. Of course, any violation of the integrity of the skin cover, any invasive procedures can lead to some complications. But with a competent approach, they are practically reduced to zero. Therefore, no special preparation is needed.

The best prevention of complications is the qualification of the surgeon, his skills and experience. Now such operations in the open way are practically not performed, they have remained in the last century. All interventions, even with fairly large benign and malignant tumors, we perform laparoscopically. And this is a worldwide trend.

Patients are admitted to the hospital either the night before or early in the morning on the day of surgery and can go home the next day. Everything is very simple. This is fast track surgery, i.e. quick recovery surgery.

— And how long can the recovery after the operation last in general? What are the recommendations for patients for this period, which is absolutely impossible?

— Patients usually return to their normal lives within a week, both in terms of work and family. We ask you to refrain from sexual intercourse for about a month after the operation, so that all tissues heal well. This is the only limitation. Of course, I will not even say that we do not recommend unloading wagons with coal or sugar. But within reason, absolutely everything is permissible.

– Probably, many are convinced that after such an operation, in principle, you can put an end to your sexual life . ..

– On the contrary! She’s getting better. Judge for yourself: the threat of pregnancy is gone, the threat of bleeding is gone. And a woman can completely relax and experience only pleasure.

— Does removal of the uterus lead to menopause?

— Of course not. This is where we started the conversation. Removal of the uterus does not lead to menopause. This results in ovarian failure. That is, when the uterus is removed, and the ovaries remain, the woman does not have menopause. It continues to function exactly the same. All hormonal processes remain unchanged. The only thing missing is menstruation. And the hormonal background does not change in any way.

— And if the uterus is removed along with the ovaries, does surgical menopause occur?

— Only if the woman was in the reproductive period before the operation, that is, she had menstruation. If a woman has already been in menopause, then the removal of the uterus and ovaries, in principle, cannot have any effect.

– Do women who go through natural menopause feel different than women who go through surgical menopause?

– Yes, they are slightly different. Still, a woman approaches natural menopause more smoothly. Although here, too, different situations are possible. Sometimes surgical menopause, that is, the abrupt removal of hormone-producing organs, passes quite calmly. Conversely, natural menopause can come with quite severe side effects. We have the opportunity to make adjustments to this process through hormone replacement therapy.

Patients for some reason are terribly afraid of the phrase “hormone therapy”, not even understanding what it is about. See, during menstrual life and active ovarian activity, the woman was protected by her natural estrogens, which were produced by the ovaries. And when menopause came, all this disappeared. And doctors, prescribing hormone replacement therapy, help to restore the protection of the female body again. Everything that the body previously received from the ovaries, it receives from one tablet. It contains a little estrogen and a little progesterone – and allows you to keep the sparkle in the eyes, excellent hair, skin turgor, good mood. It also prevents cardiovascular disease and osteoporosis. Hormone replacement therapy, as a rule, is prescribed not for a year or two, but maybe even for a decade. In fact, we know how to deal with the manifestations of menopause in any form, in whatever form it comes – surgical or natural.

If earlier at the age of 50-60 a woman was already at the end of her life, she was already a grandmother in her natural form, she felt herself accordingly, now a woman at 50 is energetic and active, she still has almost half of her life ahead of her. She wants to walk in heels, look spectacular. And hormone replacement therapy helps a lot.

— Let’s consider another situation where a woman, for some personal reasons, does not want to let a man know about the details of the operation…

— I don’t think it’s always necessary to do this. Most partners will not understand anything. Of course, exceptions are possible: a man who knows anatomy well can guess that during intercourse he rests not on the neck, but on the dome of the vagina. But this seems very unlikely to me.

— Do you still need to visit a gynecologist and do a Pap test after a hysterectomy?

– If the uterus is removed along with the cervix, then a Pap test is not necessary. It is performed to detect precancerous conditions of the cervix. And if it is not there, then why take some cytology?

As for visiting a gynecologist, I will answer that it is mandatory. First, situations are different. We consider both malignant and benign tumors. In malignant tumors, even with high-quality operations and the most modern treatment, there is a risk of relapse. And just visits to the gynecologist allow you to find it in time in case of a relapse. If we are talking about benign processes, then there are no such strict requirements, especially if the ovaries are also removed. But if the ovaries remain, then, on the contrary, the woman even goes into the risk group for the development of ovarian tumors, because the ovaries are already injured by the operation, their blood supply is disrupted and the woman can, unfortunately, develop a tumor in the future. In this case, a regular annual inspection is required. If both the uterus with the cervix and both ovaries are removed, it is permissible to come for an examination every 2-3 years and do a vaginal ultrasound to make sure that everything is fine.

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Cervical cancer recurrence – causes, treatment

Cervical cancer recurrence is not uncommon. The reasons for this lie in the molecular features of tumor cells. In order to qualitatively treat a relapse, it is necessary to detect the disease as early as possible. Modern diagnostic methods make it possible to notice mutations in cells even at the molecular level.

General information

The cervix is ​​the canal that connects the vagina and uterus. Cancer in this area is more common after the age of 30. Human papillomavirus (HPV) infection is the main cause of this disease.

HPV is a common virus that is transmitted from one person to another during sexual contact. At least half of sexually active women become infected with HPV, but not all develop the tumor.

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What is a relapse?

Recurrence refers to the reappearance of cancer after its removal (from the remaining undetected cells). With tumors of some localizations (for example, the prostate), recurrence does not affect the patient’s survival in any way. However, with a recurrence of uterine cancer, everything is not so clear and simple.

Is it always due to poor quality treatment?

There is an opinion that relapse occurs after poor-quality treatment and surgery. How so, you ask? Indeed, in the case history they write “residual tumor is absent (R0)”. Where could she come from? It turns out that the surgeon cut badly or the chemotherapist chose the wrong treatment? Science has helped to figure out why cervical cancer relapses.

Recurrence in the rest of the organ

There are several theories about the occurrence of cancer, and one of them will help to understand the cause of cervical cancer recurrence.

Sometimes the spread of a tumor is like an earthquake on a small island. The shock wave passes through the entire layer of the earth. Somewhere it causes strong faults, somewhere it deforms the lower layers. When exposed to a carcinogen, damage occurs throughout the entire epithelium (integumentary tissue, cancer = tumor of epithelial cells). In some places, these damages are highly visible to the naked eye, and in some places they are invisible even with a microscope, but they are there! From such microscopic foci, a tumor develops over time. Therefore, even if only healthy (outwardly) tissue remains after the operation, mutations at the molecular level could already begin in it.

Recurrence in the scar at the resection site

Every oncosurgeon faces a difficult task. It is important not only to remove the tumor, but also to prevent the spread of malignant cells outside the affected tissue. After all, otherwise the cell will enter the bloodstream and begin to migrate, increasing the risk of relapse. The tumor cell is very tenacious and clings to every opportunity to stay in the surgical wound, and then develop into a new tumor in it. Inflammation of the wound and the “gluing” effect of healing agents help to ensure that malignant cells linger at the site of the “cut”.

Distant recurrence

Distant (from the uterus) recurrence occurs when the cancer has spread to other organs such as the kidneys, bladder or lymph nodes. It occurs when cervical cancer cells break away from the original tumor and travel to other parts of the body via the lymphatic or circulatory system.

Symptoms of local recurrence

Symptoms of local recurrence of cervical cancer may include:

• Bleeding between periods, after intercourse, or during menopause;
• Menses that are heavier and last longer than usual;
• Unusual vaginal discharge which may be watery, pink or foul-smelling;
• Pelvic pain or pain during intercourse;
• Urinary incontinence.

Symptoms of distant recurrence

Symptoms of distant recurrence of cervical cancer may include:

• Weight loss
• Prolonged fatigue, weakness;
• Back pain;
• Pain in legs, swelling;
• Persistent bone pain.

General principles of treatment

Treatment of recurrent cervical cancer depends on the location of the recurrence and what treatment the patient has received previously. Some patients who have recurrence of cervical cancer within the pelvis may be treated with additional surgery or radiation therapy if no previous radiation therapy was given.

Recurrent cervical cancer outside the pelvis is more difficult to treat. Chemotherapy and/or radiation therapy is indicated.

Cervical cancer recurrence after surgery

If the tumor reappears after removal of a part of the organ, it is necessary to resort to “expansion” of the surgical field. A radical hysterectomy (removal of the uterus) is effective if the cancer has not spread beyond the cervix. The presence of microscopic areas of cancer cells outside the removed area can cause the cancer to return some time after surgery.

If the tumor returns again and again, and radiation therapy does not help, pelvic exenteration (extensive removal of several organs) is suggested.

Cervical cancer recurrence after radiation therapy

In some patients, cancer cells survive despite radiation therapy. In others, a small number of cancer cells have time to spread beyond the pelvis before radiation. Once a patient has received radiation therapy, it is no longer safe to apply it to that area. If there is reason to believe that the tumor has not spread throughout the body, patients are offered the removal of the pelvic organs.

Recurrent cervical cancer outside the pelvis

In some patients, cancer cells have time to spread beyond the pelvis. Unfortunately, these cells (micrometastases) cannot be found with any of the currently available tests. The presence of microscopic areas of cancer cells can cause cancer to develop outside the pelvis.

Cervical cancer that has spread to distant organs and bones is difficult to treat. Chemotherapy is suggested for cancer recurrence combined with radiation therapy to increase life expectancy and relieve symptoms of advanced cancer.

There is no single approach to drug therapy, everything is decided individually. Every year, more and more effective treatment regimens are being discovered, stronger drugs are being created.

Molecular genetic testing for cervical cancer recurrence

Thanks to modern molecular genetic methods, it is possible to detect the recurrence of the tumor process as early as possible. The success of the treatment consists of early detection of the disease and a personalized approach to the choice of treatment. To do this, the doctor needs to understand the process that occurs in the tissue at the molecular level – a genetic study of the tumor is carried out.

How can ONCOGENOTEST extended genetic testing help me?

The ONCOGENOTEST study allows you to determine the genetic profile of the tumor and, on its basis, select personalized therapy and evaluate the prognosis of the disease. Includes 411 gene sequencing, TMB analysis and a broad IHC panel.

This treatment approach is called personalized medicine because it is based on your unique genomic profile and type of cancer. The ONCOGENOTEST study can help your doctor prescribe targeted therapies, immunotherapy, and chemotherapy that are right for you.

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Tissue immunohistochemistry

Immunohistochemistry helps to assess not only the type of cells, but also the processes occurring in them. On the surface of epithelial cells there is a p16INK4a (p16) protein that regulates their growth and development. Its task is to prevent cells from dividing uncontrollably. When they mutate, the normal developmental cycles get messed up and become chaotic. The protein tries to have time to delay uncontrolled division, divides itself, but even its increased amount is not enough to cope with the tumor. However, it is the increased amount of p16INK4a that makes it possible to judge that the tumor process begins again in the tissue.

The Ki-67 protein will help to suggest the beginning of the tumor process in the tissue. It is needed by cancer cells for division. Its level reflects the “aggressiveness” of the disease.

Research of genes

Scientists are trying to find a way to detect the beginning of tissue transformation at the earliest stage. Long non-coding RNAs (lncRNAs) are responsible for many intracellular processes. An association has been observed between an increase in the level of some of these RNAs and the development of a relapse of the disease. This discovery makes it possible to suspect a relapse at a very early stage, even at the level of predisposition to it.

Cervical cancer, especially in advanced stages, is a serious adversary. It sometimes comes back even after successful treatment for stage 1 cervical cancer. Responsible attitude to the passage of regular examinations (as directed by a doctor) will help to begin treatment while the tumor is detected at an early stage.

References

1. Mao, Yu et al. “Prediction of Recurrence in Cervical Cancer Using a Nine-lncRNA Signature.” Frontiers in genetics vol. 10 284. 3 Apr. 2019, doi:10.3389/fgene.