Cervical Cancer

Background

Early Stage squareCervical cancer is the fourth most common cancer in the world, with estimated incidences greater than 500,000 per year and annual deaths larger than 250,000. The disease can be cured, typically with a multimodal approach. The disease process can involve unpleasant symptoms, including vaginal bleeding, discharge and intractable pain.

Current Treatment

There are several methods of treating cervical cancer, and the staging of the disease impacts which choices are considered.

Surgical options include cryosurgery or laser surgery for low stage cancers. For more advanced cancers, a cone resection of the cervix can be done, which is sometimes referred to as a loop electrosurgical (or LEEP) procedure. Higher stage cases yield consideration of hysterectomy or radical hysterectomy (which includes resection of the parametria, the uterosacral ligaments, the upper portion of the vagina and possibly the pelvic lymph nodes).

Non-surgical treatments include external beam radiation or brachytherapy. These can be used alone or in combination with other methods. Chemotherapy, which is more common when the cancer has spread beyond the local tissues or has recurred, typically involves drugs with systemic side effects and risks. A targeted therapy, such as an angiogenesis inhibitor, can be used to limit the blood flow to the growing tumor. There can be multiple combinations of these options and they may also be used in conjunction with surgical options.

There are numerous risks and side effects of the surgical and non-surgical options, including bleeding, infection, infertility, menopause, vaginal stenosis, fistula formation, white cell loss and long term impacts of radiation. An effective method of treatment that does not include these risks would be an attractive alternative.

Focused Ultrasound Research

Focused ultrasound can deliver energy to the patient’s tumor in the form of ultrasound waves. The energy is delivered to the region from either a curved extraluminal transducer or from an intracavatary transducer. In either case, the transducers have a defined target which can be located at the patient’s tumor. The impact of this energy is limited to the area of convergence, and the result is a thermal ablation of the target. Guidance of the treatment is provided by ultrasound or magnetic resonance imaging.

Focused ultrasound is non-invasive and does not carry the risks associate with the surgical and non-surgical methods listed above. It also does not have the chemotherapy type of side effects or a maximum dose like radiation therapy. These attributes make focused ultrasound a potentially attractive alternative for this care.

Case reports evidence have shown that intracavatary use of focused ultrasound can be used for treatment of cervical cancer. While this is very exciting, the process for optimal delivery of this care requires further study. As encouraging as the possibilities are for the future, one must remember that the current experience is based on just a couple of case reports, so there is more research required before this approach would become generally available.

Notable Papers

Abel M, Ahmed H, Leen E, Park E, Chen M, Wasan H, Price P, Monzon L, Gedroyc W, Abel P. Ultrasound-guided trans-rectal high-intensity focused ultrasound (HIFU) for advanced cervical cancer ablation is feasible: a case report. J Ther Ultrasound. 2015 Dec 18;3:21. doi: 10.1186/s40349-015-0043-6.

Togtema M, Pichardo S, Jackson R, Lambert PF, Curiel L, Zehbe I. Sonoporation delivery of monoclonal antibodies against human papillomavirus 16 E6 restores p53 expression in transformed cervical keratinocytes. PLoS One. 2012;7(11):e50730. doi: 10.1371/journal.pone.0050730.

Lee YY, Cho YJ, Choi JJ, Choi CH, Kim TJ, Kim BG, Bae DS, Kim YS, Lee JW. The effect of high-intensity focused ultrasound in combination with cisplatin using a Xenograft model of cervical cancer. Anticancer Res. 2012 Dec;32(12):5285-9.

Machtinger R, Inbar Y, Ben-Baruch G, et al. MRgFUS for pain relief as palliative treatment in recurrent cervical carcinoma: a case report. Gynecol Oncol. 2008;108(1):241–3.

     

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