Hypoxia in uterine cervical cancer: impact on treatment

Rapid proliferation of tumour results in production of pro-angiogenic factors due to tissue hypoxia. However, the new abnormal blood supply cannot provide correct oxygenation, so low oxygen tension remains, causing resistance to radio-/chemotherapy and increasing the risk of metastases. There are known substances, hypoxia markers, whose level significantly increases in oxygen deficiency. They are: HIF-1a (hypoxia inducible factor 1a), CA9 (carboanhydrase 9) and GLUT1 (glucose transporter 1). It is proved that among patients at the same stage of cervical cancer, women with high hypoxia markers’ expression have shorter disease-free survival and overall survival time. Many attempts have been made to use hypoxia in target therapy by introducing modified radio-/chemotherapy schemes, 2C3 antibodies, which block VEGF, YC-1 inactivating HIF-1a and bortezomib, a proteasome inhibitor responsible for blocking angiogenesis and apoptosis promotion. It is believed that routine examination of hypoxia markers may allow in future the planning of treatment adjusted individually to every patient.