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15.02.2014

Treatment for hpv cancer, alternative drugs for osteoporosis - PDF Review

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This page is for women who were screened for cervical cancer with a Pap test and an HPV test. Cancer that starts to grow on a woman’s cervix is called “cervical cancer.” Cancer can grow on a woman’s cervix the same way it can grow on other body parts.
A virus, called genital human papillomavirus (pap-ah-LOmah-VYE-rus)—also called HPV—can cause normal cells on your cervix to turn abnormal. Every year in the United States, about 12,000 women get cervical cancer, but it is the most preventable type of female cancer, with both HPV vaccines and regular screening tests. Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer over time. Most of the time, the body’s immune system fights off HPV naturally within two years-- before HPV causes any health problems. HPV is passed on through genital (skin to skin) contact, most often during vaginal or anal sex.
One important way to prevent cervical cancer is through regular screening with the Pap test. Since cervical cancer often does not cause symptoms until it is advanced, it is important to get screened even when you feel healthy. Checks your cervix for the virus (HPV) that can cause abnormal cells and lead to cervical cancer.
The Pap and HPV tests can find early problems that could lead to cervical cancer over time.
Check for all HPV types –The HPV test only checks for specific HPV types that are linked to cervical cancer. HPV is less common in women over the age of 30, who are at increasing risk for cervical cancer.
Getting regular Pap tests, even without the HPV test, is still a good way to prevent cervical cancer—for both younger and older women. If your Pap test results are unclear or abnormal, you will likely need more tests so your doctor can tell if your cell changes could be related to cancer. If you have an HPV test at the same time as your Pap test, it can be confusing to get both results at the same time. Even if you do have cell changes, it is unlikely that they are caused by HPV (or related to cervical cancer). Most sexually active people get HPV at some time in their lives, though most will never know it.
HPV testing is not recommended for men, nor is it recommended for finding HPV on the genitals or in the mouth or throat.
Partners who are age 26 or younger should consider HPV vaccination to protect against the types of HPV that most commonly cause health problems in men and women. The types of HPV found on a woman’s HPV test can cause cervical cancer; they do not cause genital warts. Having HPV does not mean that you or your partner is having sex outside of your relationship. If your sex partner is female, you should talk to her about the link between HPV and cervical cancer, and encourage her to get a Pap test to screen for cervical cancer. Condoms may lower your chances of passing HPV to your new partner, if used with every sex act, from start to finish.
Three vaccines are available to prevent the HPV types that cause most cervical cancers as well as some cancers of the anus, vulva (area around the opening of the vagina), vagina, and oropharynx (back of throat including base of tongue and tonsils). Cancer (KAN-ser): A disease that starts when cells in the body turn abnormal and begin to grow out of control. HPV or human papillomavirus (pap-ah-LO-mah-VYE-rus): A very common virus that infects the skin cells. Screening test: Getting tested for early signs of disease so the problem can be treated before the disease ever develops. The Pap test—either alone or with the HPV test—is the best way to find early signs of cervical cancer. Most women who get abnormal Pap test results or who have HPV do not get cervical cancer—as long as they follow their doctor’s advice for more tests or treatment. We are trying to further expand into research about this illness and the impact it has on all of us physically, mentally, and emotionally; and we are trying to provided needed recourses for treatment and prevention.
There are over 100 strands of HPV, 40 of which are known to be related to cancer and can be sexually transmitted. Strands 6 and 11 of HPV are the most common cause of genital warts in both males and females.
Depending on your age and doctor, you may not be tested automatically for HPV so make sure you specifically ask for the test. If this trend continues, by 2020 HPV will be the cause of more throat cancer cases than cervical cancer! In the low-resource countries of the world, 700 women die every day from cervical cancer, leaving behind families and communities that depended on them. Most cervical cancer in developing countries occurs in women who take care of children, provide income for families, and work in their communities.
Poor women in industrialized countries have a higher incidence of cervical cancer than their wealthier neighbors.
Cervical cancer is caused by human papillomaviruses (HPV).6,7 Safe and effective vaccines have been developed against the HPV types responsible for most of the cancers. These vaccines are now available for girls and young women; HPV vaccine has also been approved for boys in some countries (see information about vaccinating boys in the Vaccination strategies section below).
Developing countries need strong and persistent advocates for cervical cancer screening and vaccination programs.
Usually women contract HPV between their late teenage years and early 30s, with the peak of infection coinciding with the onset of sexual activity. Human papillomaviruses comprise a large family of viruses, with more than 100 types known.17 Some types have a high potential for causing cancer (high-risk types), whereas others have a lower potential (low-risk types). While types 16 and 18 are the most common cancer-causing types worldwide, their prevalence varies slightly in different geographic areas.
The area where the flat and columnar cells meet is called the transformation zone, and this area is particularly vulnerable to attack by HPV viruses.
Normally, the surface layers of the cervix die and slough off, with a controlled stream of new cells constantly forming and pushing upward from below, in a manner similar to skin renewal.
Most HPV infections clear up spontaneously, but 5 to 10% of women who encounter high-risk types develop persistent infections, and this can lead to precancerous changes called lesions.18,19 Neither incident nor persistent infections have symptoms, so women must be screened periodically to see if lesions have developed.
Most women are infected with a high-risk type of HPV at some time in their lives, but, as mentioned above, only a small portion develop cancer. For both men and women, the risk of contracting HPV infection is affected primarily by sexual activity; their own or that of their partners. Being faithful to a partner and regularly using condoms are not sufficient precautions for significantly reducing rates of cervical cancer. Cervical cancer can be prevented either by avoiding HPV infection, or by periodic monitoring (screening) for infection and lesions. Avoid exposure to the virus through abstinence from sexual activity or through mutual monogamy forever, provided both partners are consistently monogamous and were not previously infected (but this is not considered practical for most people).
The most familiar method of cervical cancer screening worldwide is the Pap test, but new alternatives have been shown to be as effective, or more effective, than Pap, often at a lower cost. Gardasil prevents infection with two of the most common cancer-causing types of HPV, types 16 and 18. Cervarix also protects against infection with HPV types 16 and 18, but does not include protection against any other HPV types. Further, a booster shot of the HPV vaccine stimulated a response similar to vaccines that provide long-lasting protection, such as the hepatitis B vaccine.33 These findings suggest that the duration of effectiveness could be long lasting, but definitive data will become available only when clinical trial participants have been followed for a longer time.
Both Gardasil and Cervarix appear to offer some protection against HPV types that are not specifically targeted by the vaccines (types 16 and 18), mainly against type 31, which is related to type 16. No serious adverse events and no deaths have been verified to have been caused by HPV vaccine in any of the clinical trials, even after more than five years of follow-up. Some people in low-resource countries have expressed concern that the HPV vaccines are being tested on girls in their communities.
In clinical trial reports for Gardasil,26 the most common side effect was discomfort at the injection site.
In the VAERS reporting system for tracking Gardasil, the most commonly reported adverse events following HPV immunization have been similar to those found in clinical trials: discomfort at the injection site, fainting, dizziness, nausea, and headache. Programmes introduced to prevent cervical cancer should initially prioritize high coverage in the primary target population of young adolescent girls. Once effective strategies have been developed to reach these girls, they can be used to provide additional health interventions appropriate for older children, such as other immunizations, deworming, malaria intermittent preventive treatment, provision of bed nets, nutritional supplementation, and general health and life skills education.


Boys can become infected with HPV, they can infect female partners, and they can develop HPV-associated diseases such as penile, anal, and oral cancers or genital warts.
A key goal for the future is to develop preventive vaccines that are more suitable to resource-limited areas. Currently, no therapies are available for active HPV infections, but researchers are working on vaccines that may prevent cancer in women who have persistent HPV infections. Cervical cancer screening of sexually active or formerly sexually active women can determine whether they are at risk of developing cervical cancer.
Since its introduction more than 50 years ago, the Pap or cervical smear has been used throughout the world to identify precancerous lesions for treatment or follow-up.
Visual inspection with acetic acid (VIA) can be an alternative to cytologic testing or can be used along with Pap or HPV DNA screening.
An additional advantage of VIA not offered by Pap or HPV DNA tests is that it allows providers to identify the small proportion of positive lesions that are unsuitable for treatment with cryotherapy, a mode of treatment appropriate for limited-resource settings (see Treatment of precancerous lesions below). The US FDA has approved the HPV DNA detection assay Hybrid Capture 2, which was developed by QIAGEN, Inc.
In addition to these tests, other molecular HPV tests are under development and are likely to be evaluated soon for clinical use.
The success of VIA, HPV DNA testing, and cryotherapy in field settings signals new potential for cervical cancer control in places where cytology programs are not feasible or sustainable.
Once HPV vaccination becomes routine, and more sensitive tests than Pap or VIA are in widespread use, it is likely that the screening strategies common today (such as Pap smears repeated every one to three years, as in the United States, or every three to five years, as in other countries) will change. Another concern for the future is what will happen when the current generation of newly vaccinated girls reaches the appropriate age for screening. In industrialized countries, women who test positive by either Pap smear or HPV DNA tests then undergo diagnostic testing, with colposcopy, for example.
Costs for delivering the HPV vaccine probably will be greater than those for existing infant vaccination programs. Accurate information is essential to improving understanding of both HPV and cervical cancer among health care workers, educators, policymakers, parents, and patients. Recent experience in India, Peru, Uganda, and Vietnam provides guidance in ways to frame HPV vaccination in developing countries.
Because clinicians are often the primary source of information for both parents and adolescents, educating clinicians helps parents to understand the benefits of any vaccine.5,52 Health care workers in many developing countries might not have a clear understanding of HPV infection and its relationship to cervical cancer development and prevention. HPV is a common and highly contagious infection that can affect your skin, cervix, anus, mouth and throat.
HPV is a virus which is passed skin-to-skin through sexual intercourse or other forms of skin-to-skin contact of the genitals. HPV generally self-resolves however when it persists, it can cause warts, such as genital warts, or certain cancers.1 When genital warts become present, they may appear as a small bump, cluster of bumps or stem-like protrusions. HPV may contribute to the development of cancer of the cervix, vulva, vagina, penis, anus and oropharynx. Other warts associated with HPV include common warts, plantar and flat warts.3 Common warts are rough, raised bumps most commonly found on the hands, fingers and elbows. If HPV has contributed to the development of cancer, a person may become symptomatic of the cancer itself in the later stages of the disease.1 These cancers include cancer of the cervix, vulva, vagina, penis, anus and oropharynx.
Knowledge about HPV and the benefits of vaccination does not appear to spur parents - or the kids who need it - to take it up. On the next page we look at the testing and diagnosis methods, the treatments for human papillomavirus and the ways in which you can prevent contracting it.
For any corrections of factual information, or to contact our editorial team, please see our contact page. Note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional. Over many years, abnormal cells can turn into cancer if they are not found and treated by your doctor. There are about 40 types of HPV that can infect the genitals or sex organs of men and women.
These HPV types can also infect other parts of the body and cause other, less common cancers in men and women. But the HPV types that can cause genital warts are different from the types that can cause cancer. It is only when HPV stays on a woman’s cervix for many years that it can cause cervical cancer. An HPV test can also be used at the same time as the Pap test for women 30 years and older.
Your doctor should offer you an HPV test if you need it and it is available in their practice. But it is not useful to test women under age 30 for HPV, since most HPV that is found in these women will never cause them health problems. HPV is also more likely to signal a health problem for these women, who may have had the virus for many years.
But few of them get cervical cancer—as long as they get the tests and treatments their doctor recommends. HPV vaccines do not cure existing HPV or related problems (like abnormal cervical cells), but they can protect you from getting new HPV infections in the future.
Even people with only one lifetime sex partner can get HPV, if their partner had it when the relationship started.
This means that your partner likely has HPV already, even though your partner may have no signs or symptoms. The type of HPV that is linked to cancer should not affect the health of your future babies. But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV. The approved HPV tests on the market are not useful for screening for HPV-related cancers or genital warts in men. If you got a total hysterectomy for reasons other than cancer, you may not need cervical cancer screening. Cancer screening tests look for early signs of cancer so you can take steps to avoid ever getting cancer.
Cervical cancer is the second most common cancer in women worldwide and the leading cause of cancer deaths in women in developing countries. Among these are the hepatitis B and C viruses, which cause liver cancer, and the Epstein-Barr virus, which is responsible for several forms of lymphoma. Most often, cervical cancer is found much later, usually after age 40 (Figure 2), with peak incidence around age 45 and peak mortality in the late 50s. Both pre-cancer and cancer usually arise in the transformation zone, which is larger during puberty.3 In older women, the transformation zone is deeper inside the canal, and the epithelium is not as susceptible to infection. With persistent HPV infection, however, this process is disrupted; cells from the lower layer continue multiplying as they move toward the surface, rather than maturing and eventually dying. Some lesions resolve spontaneously, but others can progress to invasive cervical cancer (Figure 4). But this is not true, because HPV resides in the skin, not in body fluids, and the virus can be present in genital regions not covered by a condom sheath. But while risk of HIV infection increases dramatically as the number of sexual partners increases, the situation with HPV is more complex. Women can decrease their chances of developing cervical cancer by reducing some of the risk factors in the list above, but vaccination of adolescent girls against HPV and screening of adult women are the best ways of preventing this disease.
Tests for HPV DNA have become available and may become a more common way of screening for infection. It is well-known from years of research that cancer is preceded by these precancerous lesions. While the two vaccines cannot be compared directly because of differences in the way antibody levels are measured for the clinical trials, they both produce levels between 10 and 80 times that found in natural infections.
Gardasil was 70% effective, and Cervarix 92% effective, against lesions caused by HPV 31 in study participants naïve to that virus. Data from randomized clinical trials are highly reliable, since reports of serious adverse events can be investigated and verified and there is a built-in control group for comparison.
Because of the reports of fainting, in June 2009, the US Food and Drug Administration required Merck to add a warning to the Gardasil package insert stating that individuals should be watched carefully for 15 minutes after vaccination to avoid potential injury from a fall.
In regard to serious side effects, these accounted for only 6% of all VAERS reports—and remember, these were not confirmed to be caused by the vaccine. HPV vaccines are most efficacious in females who are naive to vaccine-related HPV types; therefore, the primary target population should be selected based on data on the age of initiation of sexual activity and the feasibility of reaching young adolescent girls through schools, health-care facilities or community-based settings.
The GAVI Alliance37 is considering providing HPV vaccine at a reduced cost to the poorest countries in the world.


Forecasting and delivery strategies (in schools or community programs) can also be guided by this information. In countries without screening programs, policymakers should consider initiating screening of women aged 30 and older once or twice in their lifetimes, in conjunction with vaccination of girls and young women who are not yet sexually active.15,40,41 To learn more, visit the Screening and treatment section. Routine use of Pap smear screening in the industrialized world has contributed to the 70% to 80% reduction of cervical cancer incidence in developed countries since the 1960s.48 Even in industrialized countries, however, the level of success can vary. VIA involves washing the cervix with 3% to 5% acetic acid (vinegar) for one minute and observing the cervix with the naked eye afterward. An implication of this is that whether primary screening is done by Pap, VIA, or HPV testing, the decision not to treat with cryotherapy can be made only with VIA (unless a colposcope is available). A sample of cells is collected from the cervix or vagina using a small brush or swab, and the specimen is sent to a laboratory for processing. This test is able to detect DNA from 14 cancer-causing types of HPV, with test results available in two to four hours. Single-visit approaches using VIA to screen can be offered now, and screen-and-treat approaches using HPV DNA tests for primary screening and VIA for triage may be possible in the near future in many low- to medium-resource settings. One proposed scenario is to vaccinate prior to sexual debut, then screen only a few times when the woman is in her 30s and 40s using HPV DNA testing (or other future molecular tests that may give a better indication of which women are at highest risk of pre-cancer).65 Such a strategy would be feasible in low-resource settings and would save considerable costs in wealthier countries.
The vaccines protect against the two HPV types that cause 70% of cervical cancer, but not against those that cause the other 30%. For advanced disease, radiotherapy (radiation) is frequently used to cure or ease symptoms, but in developing countries it is not widely available or accessible. Pain control for women with advanced cervical cancer is often inadequate in developing countries. Many do not know the cause and burden of cervical cancer and may not be able to understand the value of HPV vaccines or cervical screening for improving the current situation.
Effective framing can help to avoid social resistance from, for example, groups that fear that HPV vaccines will promote promiscuity (even though studies have shown that sex education has the opposite effect).5,79,80 Community readiness and acceptance will help to ensure access to vaccination and screening programs, so community leaders should be involved in the design and implementation from the beginning. Based on the results of extensive audience and systems research, all four country programs made the strategic decision to emphasize the protective effect of the vaccine against cancer rather than emphasizing the mode of transmission (sexual activity) or the disease agent (HPV) when educating community members. As mentioned in the HPV and cervical cancer section above, sometimes people assume that because both HIV and HPV are sexually transmitted, prevention strategies would be similar.
It can take 10 to 15 years (or more) for cells to change from normal to abnormal, and then into cancer.
Doctors may use the HPV test with the Pap test to tell if these women are more likely to get cervical cancer in the future, and if they need to be screened more often. These treatments may be uncomfortable, but they can be done during one visit to your doctor. Most times, problems that are found can be treated before they ever turn into cervical cancer.
Usually, HPV has no signs or symptoms, and the body fights it off naturally before it causes health problems. So an HPV infection that is found today will most likely not be there a year or two from now.
But if you need treatment for your cell changes, the treatment could affect your chance of having babies, in rare cases. If your partner is age 26 years or younger, vaccinations are available to prevent the types of HPV that most commonly cause health problems in men and women. For this test, your doctor takes cells from your cervix so that they can be looked at with a microscope. Your doctor will look at the outside of your genitals, or sex organs, to look for problems.
In the early 1980s, certain HPV types were identified as the cause of cervical cancer by zur Hausen and colleagues. There is no treatment once a person acquires an HPV infection, but recently approved vaccines can prevent infection if given before sexual activity begins.
Thus, there is typically a long delay between infection and invasive cancer.13,15,16 This is the reason that screening programs can be so effective, as discussed in the Screening and treatment section.
They first become abnormal (precancerous), and after a time, they develop cancerous properties.
Further, people who have had many sexual partners, have other sexually transmitted infections, or are immunosuppressed are more likely to have active HPV infections and to transmit them. These vaccines do not protect against all HPV viruses that can cause cervical cancer, so screening is still necessary. Thus far, it is not recommended that sexually active, older women be vaccinated, since both vaccines show much lower effectiveness after HPV infection.
If characteristic, well-defined white areas are seen near the transformation zone, the test is considered positive for precancerous cell changes or early invasive cancer. VIA therefore can be used as a primary screening test or for treatment triage subsequent to primary Pap or HPV testing. One advantage of HPV DNA testing is that when conditions are ideal, it is not as subjective as visual and cytologic screening. The main benefit is that women are less likely to be lost to treatment because they cannot return to the clinic.47 Screen-and-treat programs have been evaluated in Ghana, South Africa, and Thailand with good results. There are, however, effective and inexpensive options for providing pain control, such as the use of morphine. There also was concern that conservative religious leaders might take a stand against HPV vaccination for the same reasons.
However, while reducing numbers of sexual partners and consistent use of condoms can dramatically reduce HIV infection, those strategies are not as effective against HPV. Conversely, the immunization community may have limited knowledge of cervical cancer and HPV. Abnormal cells are sometimes called “pre-cancer” because they are not normal, but they are not yet cancer. If you need treatment, ask your doctor if the treatment can affect your ability to get pregnant or have a normal delivery. When they invade the deep muscle and fibrous tissue, and then the organs surrounding the uterus, the patient has invasive cancer. Because cervical cancer develops slowly, over years, regular screening, along with removal of any lesions, is very effective in preventing invasive cancer.
Rather, cervical screening is the best approach for this group.1,36 Because the incidence of cervical cancer is highest in women more than 40 years of age, screening is especially important in older women (see Continued need for screening below). A review of studies concluded that HPV DNA testing is particularly valuable in detecting high-grade precancerous lesions in women older than 30. It is more sensitive than visual inspection methods and cytology, but it is unaffordable for low-resource areas.
An HPV test may also be used with the Pap test for women 30 years or older, as part of routine screening.
The more serious changes are often called “precancer” because they are not yet cancer, but they can turn into cancer over time. Since treatment can have risks and side effects, it is best to make sure you really need it. LSIL stands for “low-grade squamous intra-epithelial lesions”— which means minor cell changes on the cervix. The results are immediately available, allowing treatment at a single visit and thus reducing loss to patient follow-up.
Both cryotherapy and LEEP are less radical than the previous standard treatment, cold-knife cone biopsy. In this sense, the clear and objective results of the new HPV DNA or other molecular tests will provide an advantage.
HSIL stands for “high-grade squamous intra-epithelial lesions”— which means more serious cell changes. VIA’s sensitivity is as good as or better than that of the Pap smear, but like the Pap smear, visual inspection is subjective, and supervision is needed for quality control of visual inspection methods. More generally, the principles of public health screening will help to determine how resources should be allocated in future decades, taking into consideration factors such as vaccine coverage and cervical cancer prevalence. Go back to your doctor for all appointments and testing—to make sure your cell changes do not get worse. These vaccines may one day become available to women older than 26 years, if they are found to be safe and effective for them.



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Comments to “Treatment for hpv cancer”

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