**3. Treatment and prevention: microbiota-derived factors**

Finally, as suggested by other authors, it may be possible to expand the use of probiotics in the treatment of gynecologic cancers. The study of the role of probiotic bacteria for the prevention of colon and cervical cancer has led to the conclusion the tumour preventive effects of probiotic bacteria might be due to their control of the microbial flora, establishment of beneficial metabolic effects and stimulation of the immune system [37, 47]. Therefore, we can act in the prevention, specifically, the relapses.

Genetic analysis based on single nucleotide polymorphisms identified genetic variants associated with tumour rejection in mice, which could potentially affect ROS production and NK cell activity. That results also supports that B cells play a detrimental role in antitumour immunity and suggest that targeting B cells could enhance the antitumour response and improve the efficacy of therapeutic cancer vaccines [8].

The conventional photon radiotherapy for cervical cancer irradiates parts of the healthy tissue. This treatment perturbs the vaginal microbiome and disrupt the epithelial barrier function, permitting translocation of pathogenic bacteria and causing an inflammatory response [48]. The role of probiotic bacteria for the prevention of colon cancer has led to conclusion of the tumour preventive potential by the microbes. Additionally, the genetic polymorphism might be related to genetic susceptibility to infections and so, the implementations of probiotics may reinforce the immune system. A better understanding of this line will allow for the development of therapies that can manipulate the microbiome to reinstate homeostasis.

**Conflict of interest**

**Author details**

Maria Clara Bicho1,2,6

Lisbon, Lisbon, Portugal

**References**

S120-S138

The authors declare that they have no competing interests.

\*Address all correspondence to: andreiamatos@medicina.ulisboa.pt

1 Genetics Laboratory and Environmental Health of Faculty of Medicine of University of

[1] Villain P, Gonzalez P, Almonte M, Franceschi S, Dillner J, Anttila A, et al. European code against cancer 4th edition: Infections and cancer. Cancer Epidemiology. 2015;**39**(Suppl 1):

[2] Bui TC, Thai TN, Tran LT-H, Shete SS, Ramondetta LM, Basen-Engquist KM. Association between vaginal douching and genital human papillomavirus infection among women

[3] Tamburini S, Shen N, Wu HC, Clemente JC. The microbiome in early life: Implications

[4] Blaser MJ. The theory of disappearing microbiota and the epidemics of chronic diseases.

[5] de Abreu AL, Malaguti N, Souza RP, Uchimura NS, Ferreira EC, Pereira MW, et al. Association of human papillomavirus, Neisseria gonorrhoeae and chlamydia trachomatis co-infections on the risk of high-grade squamous intraepithelial cervical lesion.

[6] Heong V, Ngoi N, Tan DSP. Update on immune checkpoint inhibitors in gynecological

in the United States. The Journal of Infectious Diseases. 2016;**214**(9):1370-1375

for health outcomes. Nature Medicine. 2016;**22**(7):713-722

American Journal of Cancer Research 2016;**6**(6):1371-1383

cancers. Journal of Gynecologic Oncology. 2017;**28**(2):e20

Nature Reviews. Immunology. 2017;**17**(8):461-463

2 Instituto de Investigação Científica Bento da Rocha Cabral, Lisbon, Portugal

4 Research Department, Portuguese League Against Cancer, CEBIMED, Portugal 5 Faculty of Health Sciences of the Fernando Pessoa University, Porto, Portugal 6 Dermatology Research Unit, Instituto de Medicina Molecular, Lisboa, Portugal

, Rui Medeiros3,4,5, Manuel Bicho1,2 and

Microenvironment in Vagina as a Key-Player on Cervical Cancer: Interaction of Polymorphic…

http://dx.doi.org/10.5772/intechopen.73108

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Andreia Matos1,2\*, Alda Pereira da Silva1

3 Faculty of Medicine, University of Porto, Portugal

The application of probiotic strains *Lactobacillus rhamnosus* GR-1 and *Lactobacillus reuteri* RC-14 concomitantly with specific anti-infective agents provides more reliable cytological diagnostics, reduces the number of false positive and false negative findings on cervical malignancy and normalizes vaginal microflora in higher percentage of patients with vaginal infections compared with therapy including anti-infective agents only [49].

The use of probiotics, such as L. acidophilus, concomitant with the subsequent use of antibiotics, helps to restore the natural bacteria in the digestive tract that eventually are killed by antibiotics.

Recently, due to changes in the sexual behaviour of the general population, especially in developed countries, there has been an increase in the incidence of HPV infection in other parts of the body, including oropharynx and anus, among others.

In summary, a personalized clinical / therapeutic approach is suggested to avoid unnecessary treatments, based on previous history (onset of sexual activity, number of partners, anovulatory, parity, nutrition, alcohol, tobacco, genetics-immunity, etc.), in vaginal pH, Lactobacillus, in the diagnosis of HPV, viral load, mRNA, HSV, CMV, HSIL, AGC, CINI and CINII / III. *Chlamydia trachomatis, Mycoplasma, Ureaplasma, Neisseria gonorrhoeae*) and in the immunohistochemical study (p16 and Ki-67) of dysplasia [50, 51].
