Should You Get the HPV Vaccine if Infected with HPV to Prevent Cervical Cancer?

The journey of cervical cancer often commences with precancerous alterations, and there exist strategies to avert the development of this malignancy. Two pivotal approaches include detecting and addressing precancers before they evolve into full-blown cancers and preventing the occurrence of precancers.

1. HPV Vaccine's Effectiveness Post-Infection

HPV vaccines can shield young individuals against certain HPV-related infections, mitigating the risk of precancer and cervical cancer. Some of these vaccines also earn approval for guarding against other cancer types, as well as anal and genital warts.

It is important to clarify that HPV vaccines are preventive, not therapeutic. They are most effective when administered before exposure to the virus, typically through sexual activity. However, if an individual is already infected with HPV, vaccination remains an option, as it activates the body's antibody response. Consulting a healthcare provider for guidance following vaccination is advisable.

HPV vaccines entail a series of shots, with side effects generally being mild, including short-lived redness, swelling, and soreness at the injection site.

The American Cancer Society's recommendations regarding HPV vaccine utilization mirror those of the Advisory Committee on Immunization Practices (ACIP):

• Routine HPV vaccination should commence for both boys and girls at ages 11 or 12, starting as early as age 9.
• Females aged 13 to 26 and males aged 13 to 21 who have not initiated or completed booster vaccinations should receive the HPV vaccine. Males between 22 and 26 may also receive the vaccine.
• Individuals aged up to 26, including men who have sex with men and those with weakened immune systems (e.g., HIV-positive individuals), may be vaccinated if they were not previously.

It is crucial to acknowledge that no vaccine provides complete protection against all cancer-causing viruses; therefore, routine cervical cancer screening remains essential.

2. Treatment Options upon Detection of Cervical Cancer

2.1 Stage 0 (Carcinoma In Situ)

While the AJCC staging system categorizes carcinoma in situ (CIS) as the earliest form of cervical cancer, medical professionals often regard it as precancerous. CIS is limited to the cervix's surface layer and does not infiltrate deeper cell layers.

CIS is entirely curable with the right treatment. Nevertheless, precancerous changes may occasionally reoccur in the cervix or vagina, necessitating close monitoring, including routine Pap tests and, in some instances, colposcopy.

Treatment options for squamous cell carcinoma in situ encompass cryosurgery, laser surgery, electrical loop excision procedures (LEEP/LEETZ), cold knife conization, and simple hysterectomy. Adenocarcinoma in situ treatment typically involves hysterectomy or cone biopsy, which may be considered for women wishing to preserve fertility, provided the specimen exhibits no cancer cells at the edges.

2.2 Stage IA1

Treatment at this stage hinges on fertility preservation preferences and the presence of cancer cells in blood or lymph vessels (lymph node invasion).

For women desiring fertility preservation, cone biopsy is favored. If the biopsy's edges contain cancer cells, close monitoring without further treatment is viable, provided cancer recurrence does not transpire. However, if cancer persists, repeat cone biopsy or radical surgical excision (removing the cervix and upper vagina) may be necessary, especially if blood or lymph vessel invasion is evident.

Women not prioritizing fertility preservation may undergo total hysterectomy if lymph node invasion is absent. If lymph node invasion is detected, radical hysterectomy, coupled with pelvic lymph node removal, is indicated.

2.3 Stage IA2

Treatment for this stage pivots partly on fertility preservation considerations.

For women prioritizing fertility preservation, treatment options encompass cone biopsy with pelvic lymph node dissection or radical hysterectomy with pelvic lymph node dissection.

For women not wishing to maintain fertility, treatment modalities encompass external beam radiation therapy (EBRT) to the pelvis combined with brachytherapy, radical hysterectomy with pelvic and aortic lymph node removal, or radiation therapy (EBRT) if no lymph nodes are cancerous, provided the tumor is sizable, has invaded blood or lymph vessels, or has infiltrated connective tissue surrounding neighboring organs like the uterus, bladder, and vagina.

2.4 Stages IB1 and IIA1

For women seeking fertility preservation, radical hysterectomy with pelvic lymph node dissection is an option.

For women not desiring fertility preservation, radical hysterectomy with pelvic and aortic lymph node removal is considered. If cancer has invaded blood or lymph vessels or adjacent tissues or if any lymph nodes are cancerous, radiation therapy (EBRT) is usually recommended. Additional treatments, often combining chemotherapy and radiation, may be advised by healthcare providers.

2.5 Stages IB2, III, and IVA

Treatment options encompass chemotherapy (commonly cisplatin or cisplatin combined with fluorouracil), radiation therapy (comprising external beam radiotherapy and brachytherapy), or a combination of these modalities.

2.6 Stage IVB

At this advanced stage, where cancer has spread beyond the pelvis, curative treatment is usually unfeasible. Treatment goals are focused on slowing cancer growth and alleviating symptoms. Options may include radiation therapy, chemotherapy (cisplatin or carboplatin, often with drugs like paclitaxel, gemcitabine, topotecan, or bevacizumab), or immunotherapy (pembrolizumab).