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Review Article | DOI: https://doi.org/10.31579/2640-1053/180
1 Department of Publications and Extension, Kampala International University, P. O. Box 20000, Uganda.
2 Department of Medical Laboratory Science, Kampala International University, Uganda.
*Corresponding Author: Emmanuel Ifeanyi Obeagu, Department of Medical Laboratory Science, Kampala International University, Uganda.
Citation: Esther Ugo Alum, Okechukwu P. C. Ugwu, Emmanuel Ifeanyi Obeagu, (2024). Beyond Conventional Therapies: Exploring Nutritional Interventions for Cervical Cancer Patients, J, Cancer Research and Cellular Therapeutics, 8(1); DOI:10.31579/2640-1053/180
Copyright: ©2024, Emmanuel Ifeanyi Obeagu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 14 January 2024 | Accepted: 24 January 2024 | Published: 01 February 2024
Keywords: cervical cancer; dietary micronutrients; chemotherapy; radiation therapy; antioxidants; HPV infection
All over the world, cervical cancer (CC) is the fourth most common cause of fatalities from cancer in women. This study investigates the critical role of dietary micronutrients in preventing and managing CC, considering the profound impact of malnutrition on cancer patients undergoing chemotherapy and radiation therapy. The study digs the global significance of dietary factors in cancer cases, emphasizing the preventive potential of specific nutrients. Notably, carotenoids, folate, and vitamins C and E emerge as pivotal players due to their functions in regulating DNA synthesis, repair, and cell survival. The study explores the complex landscape of CC, spanning its epidemiology, risk factors, and conventional therapies, highlighting the challenges faced in improving survival rates. The focus then shifts to the potential protective mechanisms of dietary interventions, emphasizing the need for individualized counseling and nutritional strategies. Reactive oxygen species and oxidative stress, linked to lifestyle and dietary choices, are discussed in relation to CC development. The manuscript extensively examines the impact of carotenoids, vitamins C and E, and other nutrients on CC prevention, elucidating their antioxidant properties and potential to mitigate the harmful effects of therapy-induced toxicity. The elucidation encompasses various dietary sources and their role in influencing HPV infection risk. The manuscript concludes with an in-depth analysis of specific nutrients such as carotenoids, vitamins C and E, folic acid, and additional compounds like apigenin, genistein, quercetin, sulforaphane, and tea polyphenols in the context of CC prevention and management. Understanding the intricate interplay between diet, nutrition, and CC development is crucial for devising effective preventive and therapeutic strategies at every stage of the disease.
After lung cancer, colorectal cancer, and breast cancer, cervical cancer (CC) cause of fatalities from cancer in women all over the world. Women in lower socioeconomic levels and between the ages of 25 and 69 are more common [1]. The primary risk factor for CC (96.6%) is HPV [2]. Only the 16 and 18 HPV variants (70–76%) are linked to CC [3]. There are about 100 HPV variants. The risk of having HPV increases from 2 to 10 times with the initiation of sexual activity. More sexual partners, beginning a sexual relationship before the age of 18, adolescent pregnancy, multiparity, and smoking all make it worse [4]. Cervical cancer is mostly preventable if efficient screening and immunization programs are implemented. Nonetheless, vaccination rates are still low, and few women have access to quality medical care [5]. As a result, there are significant global differences in the number of women diagnosed with cervical cancer each year, over 500,000 of whom die from the disease in low- and middle-income nations [6]. There are essentially two central therapy choices for the treatment of cervical cancer. Surgery is the recommended course of treatment for localized illness when no lymph node metastases have been found or risk factors are present. These therapeutically designed procedures range from radical hysterectomy or total mesometrial resection, which includes significant pelvic and paraaortic lymphadenectomy, to conization that preserves fertility. The mainstay of care for patients with locally advanced cervical cancer is definitive chemoradiotherapy (CRT) followed by brachytherapy (BT) [7]. BT is a key aspect of definitive therapy regimens for individuals with locally advanced cervical cancer [8]. By successfully targeting the residual amount of disease and optimally sparing neighboring organs at threat, it provides a highly uniform exposure and dispersion of radiation, maximizes local control, and minimizes toxicities [9]. When compared to radiation therapy alone, concomitant chemotherapy has greatly increased the persistence level of patients with cervical cancer. Therefore, platinum-based chemotherapy regimens are typically the first choice for patients who qualify for them [10]. Additionally, a mix of bevacizumab, an inhibitor of vascular endothelial growth factor, with cisplatin, paclitaxel, or topotecan showed a significantly higher likelihood of survival but was also linked to increased toxicity [11]. The treatment of many solid tumors has changed recently thanks to immunotherapies, which are always developing. Pembrolizumab, a programmed death 1 (PD-1) inhibitor, has been approved by the FDA for use in patients with cervical cancer who have met treatment goals and recurrence following chemotherapy. These patients' tumors must exhibit PD-L1 (combined positive score (CPS) ≥1). Immune checkpoint inhibitors are being studied in multiple settings, including the CALLA (durvalumab), NCT02635360 (pembrolizumab), and NRG-GY017 (atezolizumab) trials, for CC treatment, pending additional data. Moreover, therapeutic vaccination techniques (e.g., NCT02853604) and adoptive cell therapies (e.g., NCT03108495) are currently being studied [12]. Accordingly, tisotumab vedotin, an antibody-drug conjugate (ADC), has been approved against tissue factor and monomethyl auristatin E (MMAE) for the treatment of CC. This approval was granted following the completion of the NCT03438396 multicenter, open-label, single arm, phase 2 trial (innovaTV 204/GOG-3023/ENGOT-cx6), which demonstrated efficacy and safety [13]. In spite of these developments, survival rates have not increased dramatically in the last 20 years, and the prospects for women who have dogged, recurring, or metastatic illness in particular is still not good. Toxicology is the unifying denominator of all treatment plans. Finding palliative therapies for the toxicity brought on by chemotherapy is therefore critically important. It's interesting to note that numerous research point to the ability of nutrient-rich plant-based resources to shield animals against the toxicity of a common chemotherapy drug (methotrexate) [14-16]. Between 20 and 60 percent of cancer cases worldwide are thought to be caused by dietary variables [17]. Individualized counseling and nutritional intervention, which combine dietary prescription with nutritional therapy, have been shown to be highly effective in the treatment of a number of disorders, including rheumatoid arthritis [18], diabetes mellitus [22], HIV infection [20, 21], and cervical cancer [22]. In this case of cervical cancer, the stage of the malignancy is crucial [23].
It is well recognized that eating a balanced diet can help lower the risk of cervical cancer and increase resistance to HPV infection. Carotenoids (both vitamin A and non-vitamin A precursors), folate, and vitamins C and E are among the micronutrients that have been shown to have a suppressive effect on HPV infection [24-27]. Therefore, the advantages of different nutrients in CC must be investigated and taken into consideration in CC pharmacology research as a primary preventative and enhanced treatment strategy.
Effect of Dietary Nutrient Intake on Management and Prevention of Cervical Cancer
HPV infection is the main root cause of the illness. A precancerous lesion typically takes 10 to 20 years to progress to malignancy. Additionally, it has been demonstrated that CC is associated with a number of traits, more sexual partners, beginning a sexual relationship before the age of 18, adolescent pregnancy, multiparity, smoking, and contraceptive pills (OC) [4]. Furthermore, the consumption of different nutrients in the food is a major factor in the development or avoidance of CC. Reactive oxygen species are produced by normal metabolic processes as well as lifestyle choices like food, exercise, and smoking (ROS). Overproduction of reactive oxygen species (ROS) causes oxidative stress. Macromolecules such as lipids, proteins, and DNA are harmed by this [28-31]. Numerous chronic diseases like diabetes mellitus [32-38], cardiovascular conditions [39-441, and cancer [45-47] have been linked to oxidative stress. On the other hand, ROS levels can be adjusted by intracellular antioxidants such as glutathione [48, 49].
A lack of antioxidants may make people more susceptible to oxidative stress, which raises the possibility of developing cancer. It has been demonstrated that exogenous antioxidant supplementation reduces oxidative damage by scavenging reactive oxygen species and preventing the oxidation of intracellular macromolecules. It is noteworthy that exogenous antioxidants can be found in good amounts in fruits, vegetables, nuts, and legumes [50-54]. Consuming fruits, vegetables, nuts, and legumes may therefore have a preventive effect on the occurrence of cervical malignancies. Researchers have documented the protective properties of plant-based materials against a range of cancer risks [45-47].
Red and processed meats, pickles, salted or dried fish, dipping sauces, chips, snacks, instant noodles (which are categorized as part of the western diet), and a low consumption of olive oil are all linked to an increased risk of HPV infection, according to Barchitta et al. Furthermore, there was an increased risk of HPV infection for women who did not adhere to the Mediterranean diet (MD), which consists of fish, vegetables, legumes, fruits, nuts, milk, cereals, and a high proportion of polyunsaturated fats. In summary, strong adherence to MD can result in a 60
This manuscript underscores the pivotal role of dietary micronutrients, such as carotenoids, folate, and vitamins C and E, in the prevention and management of cervical cancer. Recognizing the significant impact of malnutrition on cancer patients undergoing conventional therapies, the study advocates for individualized nutritional interventions. The complex interplay between diet, oxidative stress, and HPV infection is thoroughly explored, emphasizing the potential of specific nutrients to mitigate therapy-induced toxicity and enhance overall treatment outcomes. As cervical cancer continues to pose a global health challenge, understanding and incorporating dietary strategies into comprehensive care approaches could prove instrumental in improving patient outcomes at various stages of the disease.
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