Cervical Cancer

1. Risk Factors

2. Pathophysiologic Etiology

3. Human papillomaviruses are small, double-stranded DNA viruses that infect the epithelium.

4. HPV infection occurs at the basal epithelium. Although the incidence of infection is high, most infections resolve spontaneously. A small proportion of infected persons become persistently infected; persistent infection is the most important risk factor for the development of cervical cancer. The most common clinically significant manifestation of persistent genital HPV infection is cervical intraepithelial neoplasia, or CIN. Within a few years of infection, low-grade CIN—called CIN 1—may develop, which may spontaneously resolve and the infection clear.

5. Persistent HPV infection, however, may progress directly to higher-grade CIN, called CIN2 or CIN3. High-grade abnormalities are at risk of progression to cancer and so are considered cancer precursors. Some high-grade abnormalities spontaneously regress. If left undetected and untreated, years or decades later CIN2 or 3 can progress to cervical cancer.

6. Most high-risk HPV infections may cause cytologic abnormalities or abnormal cell changes that disappear unexpectedly. Persistence of infection with high-risk HPV. Is a prerequisite for the development of cervical intraepithelial neoplasia, lesions, and invasive cervical cancers.

7. When an HPV virus enters an epithelial cell, the virus begins to make proteins that can interfere with normal functions in the cell, enabling the cell to grow in an uncontrolled manner, and avoid apoptosis. These infected cells are often are often recognized by the immune system and eliminated. Sometimes, however, infected cells are not destroyed and a persistent infection results. As the persistently infected cells continue to grow, they may develop more mutations that promote even more cell growth, leading to the formation of a high grade lesion, and ultimately a tumor. It can take between 10 to 20 years from the time of an initial HPV infection until tumor formation. However, even high grade lesions do not always lead to cancer.

8. Causative Factors

9. Being infected with the HPV virus. Human papilloma virus is the most common sexually transmitted virus in the United States. At least 50% of sexually active people will have genital HPV at some time in their lives. HPVs are a group of more than 150 related viruses. More than 40 of these viruses can easily spread from direct skin contact or through vaginal, rectal, or oral sex.

10. Factors that may increase the risk of developing cancer following a high risk HPV infection include smoking, decreased immunity, having many children (for increased risk of cervical cancer), long term oral contraceptive use (for increased risk of cervical cancer), and chronic inflammation.

11. Risk factors for HPV infection are primarily related to sexual behavior, including lifetime and recent sex partners. Results of epidemiologic studies are less consistent for other risk factors, including young age at sexual initiation, number of pregnancies, genetic factors, smoking, and lack of circumcision of male partner.

12. diagnostic tests Most cases and deaths from cervical cancer can be prevented through detection of precancerous changes within the cervix by cervical cytology using the Pap test. Currently available Pap test screening can be done by a conventional Pap or a liquid-based cytology. Since 2012, all organizations have recommended that screening should begin at age 21 years. While there are slight differences in other aspects of the recommendations, all groups recommend screening in women aged 21 to 65 years with cytology (Pap test) every 3 years. For women aged 30 to 65 years who want to lengthen the screening interval, screening can be done with a combination of cytology and HPV testing (“co-testing”) every 5 years.

13. Common findings and treatments associated with this certain type of cancer. Most HPV infections are asymptomatic and result in no clinical disease. Clinical manifestations of HPV infection include anogenital warts, recurrent respiratory papillomatosis, cervical cancer precursors (cervical intraepithelial neoplasia), and cancers, including cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancer.

14. Include at least one of the following pathophysiologic factors (Immunity, Inflammation, Infection or Injury) and identify its relationship with this specific type of cancer. Almost all cervical cancers are caused by HPV infections, with HPV types 16 and 18 responsible for about 70% of all cases.