Green tea studied in search to stop cervical cancer

Tuscon, AZ

The group of viruses known as HPV is a known cause of cervical cancer. It’s also the most common sexually transmitted disease in the United States. It’s estimated that half of all sexually active Americans will contract HPV during their lifetime and at any given time approximately 20,000,000 people in the United States are carrying the disease.

Most people who get HPV clear the infection on their own, but some people have persistent HPV which can lead to precancerous lesions and other damage to a woman’s cervix. Although the Food and Drug administration approved Gardasil, a vaccine for the virus, in 2006, it cannot be given to women who have already been infected, even if the disease in no longer present in their bodies.

Up until now, all known treatment for persistent HPV have been painful and invasive, involving freezing or surgical removal of part of the woman’s cervix. Both procedures also make it difficult for a pregnant woman to carry a baby to full term. This has lead scientists to search for a better, less invasive method of stopping HPV before it causes the precancerous lesions.

Now Arizona Cancer Center is testing a green tea extract known as Polyphenon E, to see if it is effective against HPV. The $1 million clinical trial will include 150 women in Arizona, California, and North Carolina, all of whom currently are currently infected with HPV. Half of the women will be given a placebo. The other have will be given 800-milligram capsules of green tea extract. This is about the same amount of green tea flavonoids one would receive from drinking approximately 8 cups a day of green tea.

According to Wendy Thomas, research specialist at the Arizona Cancer Center, which is affiliated with the University of Arizona, “Finally we will have a yes or a no. And it may not work, but at least we will know."

The study is being funded by National Cancer Institute’s Division of Cancer Prevention.

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Doctor tries to boost the odds for cervical cancer patients

Baltimore, MD

Dr. Robert Bristow is an associate professor in Johns Hopkins School of Medicine's Department of Gynecology and Obstetrics and the director of the Kelly Gynecologic Oncology Service at the Johns Hopkins Ovarian Cancer Center. For Cervical Cancer Awareness Month in January, Bristow discussed the move toward robot-assisted minimally invasive surgery and how to reduce cervical cancer rates. More than 11,000 new cases of cervical cancer will be diagnosed in the United States this year, and 3,870 people are expected to die from the disease.

What kinds of gynecologic cancers are there, and are you more focused on cervical cancer?

The three main gynecologic cancers are ovarian, endometrial and cervical cancer. Endometrial is uterine cancer, and that's the most common. Ovarian is the second-most common, but has the highest mortality rate. Ovarian cancer by itself has a higher mortality rate than cervical and uterine combined. It tends to present at a more advanced stage. It's harder to detect early and harder to treat in an advanced stage.

Cervical and uterine tend to present at an earlier stage, and therefore have a higher cure rate.

One of my principal areas of interest is surgery and surgical techniques and research, and one of the things I have been very excited about in the last 12 to 18 months is [the] push to start doing surgeries for cervical cancer and uterine cancer using a minimally invasive approach using the robot.

How does it work?

With standard laproscopic surgery, which is known as keyhole surgery, you are doing an operation in the abdomen through three or four very small incisions using instruments that are a foot or a foot-and-a-half long.

There is a fairly flat learning curve for that. It takes a long time to get proficient in operating that way, because you are operating at the end of a stick, and all your motions with your hands are in reverse.

The robotic surgery is a system set up with computer-enhanced instruments that are similar to the laproscopy instruments but the surgeon sits at a console 10 or 15 feet away from the patient.

The advantage is the instruments are wristed so they can move like the human wrist, so you have about 270 degrees of motion. There are two optical tubes so when you sit down at the console, you are seeing it in three dimensions.

It really expands our capabilities in terms of what we are able to do from a technical standpoint. It's faster and it's also better for the patients.

Patients have virtually no pain after this procedure. You go and see them the day after the surgery and they are up packing their bags getting ready to get out of the hospital after a radical hysterectomy for cervical cancer, where they would normally be in the hospital for three or four days.

So what is the catch?

Part of the catch is for a hospital, there is a big capital investment and the expense to invest in the robot. And there is a learning curve to it.

It's much easier to learn than straight laproscopy, but you can't take someone without any prior experience and sit them down at the console and expect them to be able to do the operation in a reasonable amount of time.

You are using this with cervical and uterine cancer and some early ovarian cancers. Why not more ovarian cancers?

About 70 percent of ovarian cancers present with advanced disease where the tumor has spread out of the ovaries and the uterus and is in the colon or the liver. The goal for those surgeries is to do a debulking, which is basically to get all the cancer out you can see. That is not a procedure that lends itself readily to the keyhole surgery.

How did you get interested in this field of gynecologic oncology?

I ultimately decided to go into obstetrics/gynecology for a selfish reason. It was the rotation I had as a medical student I had the most fun on. I originally wanted to go into just obstetrics, because that was the most enjoyable to me.

Then I came to Hopkins for my residency and the first rotation I did was oncology. I started on July 1, and by the Fourth of July, I knew this was what I wanted to do.

The patients were so sick and so challenging, and they were really the patients that needed someone to take care of them. I really gravitated to that.

Isn't it hard to cope with patients that don't always have good outcomes?

It has a lot to do with your perspective and the old adage of whether the glass is half-empty or -full.

We are always going to hope to cure the cancer, but realistically we aren't going to be able to do that for everybody. We may not even do that for most people.

The question becomes how are you going to help the folks that aren't going to survive their cancer really survive in the time they have left and have a good quality of life.

Have screening techniques improved for cervical cancer?

I think we are getting better. The Pap test is the conventional test for cervical cancer. It has its limitations. It's not a perfect test, and the reason women get annual tests is because it can miss some signs of early cancers. But if you string together enough tests in a row, you will be likely to pick them up.

One of the things that came out about five years ago or so is the idea of testing for the human papillomavirus, or HPV, which is a causative agent for about 90 percent of cervical cancers. Now that can be coupled with the Pap test to identify a higher-risk population of women who may benefit from a more aggressive screening program.

So I think those two testing tools are probably as good as we really need to identify precancer and be able to treat it.

But the big problem we have with cervical cancer is access to screening techniques.

If you could guarantee that every woman in Maryland could get a Pap test plus or minus an HPV test for her whole life, we could probably eradicate cervical cancer.

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PET Scan tracks cervical cancer

St. Louis, MO

A machine invented at Washington University to reveal the inner workings of brains and hearts is emerging as a premier tool for tracking cervical cancer.

The device, called a positron emission tomography (PET) scanner, is similar to MRI scanners but uses radioactivity instead of X-rays to create images of blood flowing through organs, brain activity and other processes.

New research from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University show that PET scans are more accurate than any other method at predicting the aggressiveness of a cervical cancer tumor. The device also effectively shows whether treatments had destroyed the cancer.

Previously, doctors had no way to determine whether radiation or other therapies were working until a patient experienced symptoms or another tumor was found. More >>

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PET Scan tracks cervical cancer

December 17, 2007

A machine invented at Washington University to reveal the inner workings of brains and hearts is emerging as a premier tool for tracking cervical cancer.

The device, called a positron emission tomography (PET) scanner, is similar to MRI scanners but uses radioactivity instead of X-rays to create images of blood flowing through organs, brain activity and other processes.

New research from the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University show that PET scans are more accurate than any other method at predicting the aggressiveness of a cervical cancer tumor. The device also effectively shows whether treatments had destroyed the cancer.

Previously, doctors had no way to determine whether radiation or other therapies were working until a patient experienced symptoms or another tumor was found.
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"The look on (patients') faces, the happiness and the joy when you tell them, 'It looks like you're going to do really well.' That's really powerful," said Dr. Julie K. Schwarz, a Barnes-Jewish Hospital resident in the Department of Radiation Oncology.

Schwarz was the lead author on one of the PET studies that was published last month in the Journal of the American Medical Association. Her research team studied women who had PET scans three months after completing radiation and chemotherapy between 2003 and 2006. The scans provided a more reliable measure of whether the cancer would recur, and, just as importantly, revealed whether the cancer was already beginning to return.

Each year, more than 10,000 women develop cervical cancer in the United States; about 3,900 die of the disease.

Kristy Monroe, 40, was lying on her back recently in Barnes-Jewish Hospital, swathed from chin to toe in white blankets. Red lasers painted stripes across her body and bald head as she passed through the large doughnut-shaped PET scanner. Monroe was diagnosed with cervical cancer in September, and nearly every day since, she has spent at Siteman Cancer Center being bombarded with radiation and dosed with chemotherapy.

Monroe also is part of a continuing study to determine whether PET scans can effectively monitor treatment. More >>

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New Study Shows Listeria Vaccine for Cervical Cancer Found Safe

New Study Shows Listeria Vaccine for Cervical Cancer Found Safe
CNN Money
October 16, 2007: 05:05 AM EST

NORTH BRUNSWICK, N.J., Oct. 16 -- Researchers testing a vaccine based on the live bacteria Listeria, in women with advanced cervical cancer found it to be safe. The Lovaxin C vaccine being developed by Advaxis Inc. , is intended to treat cervical cancer and head and neck cancers that result from the human papilloma virus (HPV). This marked the first time the vaccine had been treated in humans.

"Our long held belief that live Listeria vaccines are safe, even in end stage cancer patients, has been confirmed with the results from our recent Phase I/II study. We have just entered the age of safe bacterial therapies," said Dr. John Rothman, VP of Clinical Development.

The immune response that Listeria generates is called "cellular" immunity, the type needed to attack cancer. Listeria is one of the strongest stimulators of cellular immunity known. "By redirecting it against specific tumor types safely, we have created a new, and potentially very effective, class of cancer therapy," says Rothman. More >>

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Gene-Based Screen Spots Cervical Cancer Earlier

THURSDAY, Oct. 4 (HealthDay News) -- Compared to conventional tests, human papillomavirus (HPV) DNA testing enables earlier detection of lesions that lead to cervical cancer, Dutch researchers say.

That means women could go longer between screenings, say researchers at the VU University Medical Center in Amsterdam.

The study included more than 17,000 women ages 29 to 56. Of those, close to 8,600 were assigned to receive HPV DNA testing to detect the high-risk types of HPV that can cause cervical cancer. The other half underwent conventional cytological testing. Five years later, both groups of women received both cytological and HPV DNA testing.

At the start of the study, more CIN3+ lesions (cervical cancer and its most serious precursor lesions) were detected in women who had HPV DNA testing (68 of 8,575) than in those who had conventional cytological testing (40 of 8,580). Five years later, fewer CIN3+ lesions were detected in the women who'd had HPV DNA testing (24 of 8,413) than in those who'd had conventional cytological testing (56 of 8,456).

While the number of lesions detected over the two rounds of testing didn't differ between the groups, the lesions were detected earlier in the HPV DNA testing group, the researchers said.

"Our results show that implementation of HPV DNA testing in cervical screening leads to earlier detection of clinically relevant cervical lesions. On the basis of this data, we suggest that the current screening interval of five years could be extended by at least one year. The extension will be advantageous to women because of a reduction in the lifetime number of screening tests and referrals," the study authors wrote.

"A full cost-effectiveness analysis will help to determine whether primary HPV testing alone is the preferred strategy for primary cervical screening," they concluded.

The study was published in The Lancet medical journal.

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