What are cervical cancer medications?

Cervical cancer
Vaccines against human papillomavirus (HPV) are the first line of defense against cervical cancer, as this virus is a leading cause. Treatment includes chemotherapy, targeted therapy, and immunotherapy.

Cervical cancer medications are drugs used in the treatment of cervical cancer. Cervical cancer medications include preventive vaccines and drugs that treat cancer, such as, chemotherapy, targeted therapy, and immunotherapy.

Vaccines are given to protect against human papillomavirus (HPV) infection, which is the primary cause of cervical cancer. Both boys and girls are administered HPV vaccinations because the majority of HPV infections are transmitted sexually, and HPV can also cause penile cancer in men, and anal, mouth, and throat cancers in both sexes.

Chemotherapy is an important part of treatment for cervical cancer, often with radiation, which is known as chemoradiation. Chemotherapy drugs kill cancer cells. Commonly prescribed chemotherapy medications include cisplatin and topotecan.

Targeted therapies do not kill cancer cells, but alter specific cell mechanisms to inhibit their growth and spread. The targeted therapy medication used in cervical cancer is bevacizumab, a lab-produced human monoclonal antibody, which prevents new blood vessel formation (angiogenesis) in tumors.

Immunotherapy medications help the natural immune system identify the cancer cells and kill them. Immunotherapy medication used in cervical cancer is also a monoclonal antibody known as pembrolizumab. Targeted therapy and immunotherapy are used for advanced cervical cancer.

What is cervical cancer?

Cervical cancer is cancer that develops in the cervix, the lower part of the uterus that connects it to the vaginal canal. Cancers are a group of diseases caused by certain cells in the body which turn abnormal and multiply out of control. Cancers are termed malignant (metastatic) when they spread to other parts of the body from where they originate.

The cervix is made of two parts:

  • Endocervix: The inner lining of the cervical opening that leads into the uterus. This part is made up of glandular cells, a type of cell that produces mucus secretions.
  • Ectocervix (exocervix): The outer surface of the cervix is made up of a flat type of cells, known as squamous cells.

Most cervical cancers start in the area known as the transformation zone, where glandular and squamous cells meet.

Types of cervical cancer

  • Squamous cell carcinoma: Squamous cell carcinoma develops in the ectocervix and is the most common type, accounting for approximately 90% of cervical cancers.
  • Adenocarcinoma: Adenocarcinoma develops in the glandular cells in the endocervix and is the second most common cervical cancer.
  • Adenosquamous carcinoma (mixed carcinoma): Cervical cancer may sometimes be in both squamous and glandular cells, though this is uncommon.
  • Rare cervical cancers: Other rare types of cancers that can develop in the cervix include:

Stages of cervical cancer

Precancerous stages

Normal cells do not suddenly turn cancerous. Usually, some cells in the cervix start turning abnormal long before cancer becomes full-blown. Low-grade precancer may resolve on its own in most women but has the potential to turn invasive.

  • Cervical intraepithelial neoplasia (CIN): Also known as squamous intraepithelial lesion or dysplasia, CIN is graded into three stages CIN1, CIN2, and CIN3. CIN1 often goes away on its own, but CIN2 and CIN3 are usually treated because they are more likely to become invasive cancer.

Invasive stages

There are four stages of invasive cervical cancer and each of the stages is further divided into sub-stages based on tumor size and the depth of tissue affected by cancer.

  • Stage I: Cancer is localized in the cervix.
  • Stage II: Cancer has grown beyond the cervix and uterus and spread into the tissue surrounding the cervix (parametria).
  • Stage III: Cancer has spread into the lower part of the vagina and/or the pelvic wall and nearby lymph nodes. It may exert pressure on the urinary passage.
  • Stage IV: Cancer has grown beyond the pelvis and spread to nearby organs such as the bladder and rectum, and/or distant sites such as lymph nodes, lung, liver, or bones.

What are the symptoms of cervical cancer?

The symptoms of early stages of cervical cancer include the following:

  • Abnormal vaginal bleeding such as:
    • After vaginal sex
    • After menopause
    • In between periods
    • Abnormally long or heavy periods
  • Discomfort in the vagina
  • Abnormal or smelly discharge
  • Pain during vaginal intercourse
  • Pain in the pelvic region
  • Difficulty or pain during urination (dysuria)

Symptoms of advanced cervical cancer include:

SLIDESHOW

Skin Cancer Symptoms, Types, Images See Slideshow

How do you get cervical cancer?

Human papillomavirus (HPV): The primary cause of cervical cancer is the human papillomavirus (HPV) infection. HPV is a large family of viruses, some of which cause benign wart-like growths. Approximately 90% of HPV infections clear up on their own. Some types of HPV carry a high risk for cancer, and persistent infection can lead to cervical cancer.

Eight types of HPV cause 90% of all cervical cancers worldwide. The high-risk types of HPV turn off certain tumor suppressor genes that are responsible for regulating cell growth and division, leading to uncontrolled growth of cells.

In addition to cervical, vaginal and vulvar cancers in women, HPV infection can cause penile cancer in men, and mouth, throat, and anal cancers in both men and women.

Genetic factors: Genetic susceptibility also plays a role in cervical cancer. People with certain genetic mutations are found to be more likely to develop cervical cancer from HPV infection.

Human immunodeficiency virus (HIV): Though HIV infection does not directly cause cervical cancer, it lowers immunity, providing a fertile bed for chronic HPV infection.

Additional risk factors:

  • Sexual practices that can increase the risk of HPV infection such as:
    • Becoming sexually active at an age younger than 18
    • Having multiple sexual partners
    • Having a promiscuous partner
  • Smoking
  • Chlamydia infection, a bacterial infection of the reproductive system
  • Long-term use of birth control pills
  • Teenage pregnancies
  • Poor nutrition and vitamin deficiencies
  • Use of diethylstilbestrol (DES) by the mother, a drug that was prescribed until 1971 to pregnant women to prevent miscarriage, though this is more associated with vaginal cancer
  • Family history of cervical cancer

Can cervical cancer be prevented?

Cervical cancer is preventable in most cases. Up to 93% of cervical cancers can be prevented by taking two important precautions:

HPV vaccination: To be most effective, HPV vaccination must be given before a person is exposed to HPV. Current CDC recommendations are that all boys and girls should ideally receive HPV vaccination between ages 11 and 12. If not vaccinated by 12, boys can still get their vaccination as early as possible up to age 21, and girls up to age 26.

Screening tests: Regular screening can detect cervical cancer at precancerous stages which can be treated successfully in more than 90% of the cases. Two types of tests are done to screen for cervical cancer:

  • Pap test: Papanicolaou or Pap smear test involves scraping a tiny amount of tissue from the cervix and checking for the presence of precancerous cells. The CDC recommends Pap tests every three years from age 21 to 65.
  • HPV test: HPV test looks for infection by high-risk types of HPV which can cause cancer. The CDC recommends HPV tests once every five years for women from age 30 to 65. 

A woman of 30 and above can opt to have just a Pap test every three years or both tests together every five years. If Pap and/or HPV tests are positive, more tests will be required to plan treatment.

Other precautions to prevent cervical cancer include the following:

  • Limit exposure to HPV by limiting sexual partners and avoiding sex with a person who has many sexual partners. HPV is not transmitted only sexually, skin contact with the infected area, such as hand-to-genital contact, can transmit the virus. Some people may carry the virus without any symptoms and pass it on.
  • Use a condom. Condoms offer some protection, though they do not cover all the areas that can be infected by HPV.
  • Avoid smoking, which increases the risk for all types of cancers. 

Can cervical cancer be cured completely?

With early detection, cervical cancer can be successfully treated in most cases. Stage I cervical cancer has a five-year survival rate of 92%. In more advanced stages, even if cervical cancer is not curable, it is often possible to slow down the progression of the disease, alleviate symptoms, prolong survival and improve quality of life.

What is the most common treatment for cervical cancer?

Cervical cancer treatment depends on the type and stage of cancer, and the woman’s preferences, and overall health. In addition to standard treatments, women also have the option of enrolling in clinical trials for new treatments. The standard treatments for cervical cancer include the following:

Surgery

Surgical procedures for cervical cancer have three purposes:

  • To diagnose
  • To determine the extent of its spread
  • To treat early stages of cancer and pre-cancer

Following are the surgical procedures used to treat precancerous stages of CIN2 and CIN3:

  • Cryosurgery: A type of ablation in which an extremely cold metal probe is placed on the cervix, which freezes the abnormal cells to death.
  • Laser ablation: Laser beams are directed at the cervix to vaporize the abnormal cells.
  • Conization: Conization, also known as a cone biopsy, is the removal of cone-shaped cervical tissue from the transformation zone where abnormal cells usually develop. Cone biopsy can be used for diagnosis as well as a treatment for pre-cancer and very early stages of cancer.

Cone biopsy can be performed in the following ways:

Surgical procedures for invasive cervical cancer include the following:

  • Hysterectomy: Removal of the uterus and cervix, known as simple hysterectomy, used for high-grade CIN and early invasive cancer, an option for women who do not plan to have children. If cancer has spread into nearby tissue, a radical hysterectomy may be performed, in which the ligaments holding the uterus in place and parts of the upper vagina are also removed.
  • Trachelectomy: Trachelectomy is the removal of the cervix and the upper part of the vagina, leaving the body of the uterus intact. This treatment may be an option for women who want to have children and have cancer limited to the cervix. Some women can carry a child to term after this procedure, but the risk for miscarriages is high.
  • Lymphadenectomy: Removal of all the nearby lymph nodes in the pelvis, or sentinel lymph nodes which are lymph nodes where the cancer is likely to spread first.
  • Pelvic exenteration: Removal of nearby pelvic organs such as the vagina, ovaries, rectum, lower colon, or bladder, depending on the extent of cancer spread.

Radiation therapy

Radiation therapy is the use of high-energy X-rays to destroy cancer cells. Radiation therapy is used as the main treatment for some stages of cervical cancer and is used after or before surgery, or with concurrent chemotherapy (chemoradiation). Radiation is used for treating cervical cancer that has spread to other parts of the body or has recurred after treatment.

Radiation therapy is of two types:

External beam radiation therapy (EBRT): X-rays are directed at the cervix from a device that is placed outside the body.

Internal radiation: Also known as brachytherapy, in internal radiation, the X-ray device is placed inside the uterus close to the cervix. In women who have had a hysterectomy, it is placed in the vagina.

Medications

Medications are used in most stages of cervical cancer. Medications are primarily oral formulations and intravenous injections or infusions. Studies have also shown some efficacy of intravaginal application of chemotherapy medication in preventing CIN2 from developing into invasive cancer.

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What are the types of cervical cancer medications?

Different types of medications are prescribed depending on the stage of the disease. The types of cervical cancer medications include the following:

HPV vaccines

Chemotherapy

Targeted therapy

Immunotherapy

 

How do cervical cancer medications work?

  • HPV vaccines
  • HPV vaccines prevent HPV infection, the primary cause of cervical cancer. The FDA approved HPV vaccines for cervical cancer are:
  • Recombinant HPV bivalent vaccine (Cervarix)
  • Recombinant HPV quadrivalent vaccine (Gardasil)
  • Recombinant HPV nonavalent vaccine (Gardasil 9)

Chemotherapy

Chemotherapy drugs kill all cells, including healthy cells, in the phase of growth and division. Chemotherapy drugs are directly toxic to cancer cells because they are always in a growth and division phase. Chemotherapy also enhances the effects of radiation.

FDA-approved chemotherapy drugs for cervical cancer include:

  • Bleomycin sulfate
  • Topotecan hydrochloride (Hycamtin)
  • Gemcitabine/cisplatin combination
  • Commonly used off-label chemotherapy drugs include:
  • Cisplatin
  • Carboplatin
  • Ifosfamide (Ifex)
  • Paclitaxel
  • Fluorouracil

Fluorouracil ointment applied intravaginally has been shown to be effective in preventing CIN2 from progressing into invasive cancer.

Targeted therapy

Targeted therapy used in cervical cancer is a lab-produced monoclonal antibody that prevents new blood vessel formation in the tumor. The monoclonal antibody blocks the activity of a protein known as a vascular endothelial growth factor (VEGF) which is essential for angiogenesis and starves the tumor of the nutrition and oxygen it needs to grow.

The FDA-approved monoclonal antibody, in combination with paclitaxel and cisplatin or topotecan, for persistent, recurrent, and metastatic cervical cancer is:

  • Bevacizumab (Avastin, Mvasi, Zirabev)

Immunotherapy

Immunotherapy helps enhance the patient’s own immune system’s ability to kill cancer cells. Immunotherapy used in the treatment of cervical cancer is a monoclonal antibody known as PD-1/PD-L1 inhibitor.

PD-1/PD-L1 inhibitors stimulate the T-cell, a type of killer immune cell, by blocking the interaction between two protein molecules known as PD-1 and PD-L1 in T-cells. T-cells are inactivated when these two proteins interact, and cancer cells in some types of cervical cancer secrete PD-L1 to escape being killed by the T-cell.

The FDA-approved PD-1/PD-L1 inhibitor for treating recurrent or metastatic cervical cancer which produces PD-1 protein is:

  • Pembrolizumab (Keytruda)

Additional information

  • Please visit our medication section of each drug within its class for more detailed information.
  • If your prescription medication isn’t on this list, remember to look on MedicineNet.com drug information or discuss with your healthcare provider and pharmacist.
  • It is important to discuss all the drugs you take with your doctor and understand their effects, possible side effects, and interaction with each other.
  • Never stop taking your medication and never change your dose or frequency without consulting with your doctor.

SLIDESHOW

Skin Cancer Symptoms, Types, Images See Slideshow

Treatment & Diagnosis

Medications & Supplements

Medically Reviewed by a Doctor on 4/5/2021

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Medically Reviewed on 4/5/2021
References
https://emedicine.medscape.com/article/253513-medication#1

https://www.cancer.org/cancer/cervical-cancer/treating.html

https://www.cdc.gov/cancer/cervical/basic_info/diagnosis_treatment.htm

https://www.cancer.net/cancer-types/cervical-cancer/types-treatment

https://www.cancer.gov/about-cancer/treatment/drugs/cervical