HPV
& CERVICAL CANCER
Introduction:
Cervical
Cancer remains one of the leading causes of cancer death in India and worldwide.
HPV can contribute 100% of Cervical Cancer and is the main causative agent.
Efforts
to improve cancer screening and vaccination can help in prevention of cancer.
What
is HPV? What does it do?
HPV
(Human Papilloma Virus) is a circular double stranded DNA virus. Most HPV
infections are Asymptomatic and resolve spontaneously, few HPV infections that
last longer can increased risk of precancer and cancer.
It
infects the genital mucosa and epithelial tissue of skin, its presence can be
presumed in more than 99% of cervical cancer.
What
are types and spectrum of HPV?
More
than 190 different types of HPV viruses are detected. At least 30 types of HPV
targets the genital mucosa of them.
The
Oncogenic types are :- 16,18,31,33,35,39,45,51,52,56,58,59,68,73 and 82.
The
Non – oncogenic types are:- 6,11,
16,
18 are the most common oncogenic type that account for 70% of cervical cancer.
The
spectrums of HPV are - Candy Loma acuminate, cervical dysplasia and cervical
cancer.
Are
there any factors that influences progression to cancer?
HPV is sexually transmitted infection
•
Immunosuppressive conditions – HIV / Long term steroid users
•
Long term use of OCP (Oral Contraceptives).
•
Multiple Sexual partners.
•
Early onset of sexual activity.
•
Smoking.
Helps
in progression of precancerous Lesions to Cervical cancer.
What
is Cervical Cancer?
A malignant tumor of lower most part of uterus
known as cervix and the tumor is derived from the cells of cervix.
What
are its symptoms?
•
Bleeding in between periods and after sexual intercourse, foul smelling white discharge,
low back pain (or) Lower abdominal pain.
•
In some cases it manifests with periods longer and heavier than before.
•
Few cases present as Bleeding after menopause.
•
In some cases there may be no symptoms.
Is
it Deadly?
Cancer
stages includes
1) Precancerous.
2) Carcinoma insitu.
3) Invasive forms.
•
Pre-cancerous which includes mild to moderate dysplasia.
•
Carcinoma insitu which remains localized.
•
But invasive forms which includes
1)
Atypical Squamous
2)
Squamous cell cancer
3)
Glandular forms including Atypical glandular and Adeno Carcinoma.
Can
spread to other parts of the body and become deadly.
How can we prevent?
Primary
Prevention Includes vaccination.
Secondary
prevention includes Screening tests which include –
PAP TEST (Cells from the cervix are stained and observed for HPV infected cells
and abnormal cells).
Liquid-based Cytology
VIA/VILI TEST
HPV DNA TEST.
If the doubtful patient can be referred for colposcopy - (Direct visualization
of cervix under Magnified Micro scope).
What are the vaccines available?
1st approved vaccine was quadrivalent formulation called GADARSIL.
Now
replaced with newest generation – GADARSIL VACCINE
(Nine
valent – 16,18,6,11,31,33,45,52,58 ).
2nd Vaccine – CERVARIX (Bivalent vaccine against 16 & 18).
Whom
and when to be given:-
Adolescent girls (9-15 years) upto 26 years before – starting sexual intercourse.
Dosing: 2 doses – every 6 months
(If
age is more than 15 years WHO recommends 3 doses).
WHO also recommends to vaccinate Young boys (11-12 years). It can help to
acquire immunity to penile cancers and even in head & Neck cancers in men
affected by Oncogenic HPV.
Who should not receive vaccine:-
Females
less than 9 yrs. (or) more than 26 years.
Contraindicated
in people with immediate hypersensitivity to yeast (or) to any vaccine
component.
What
are the TEST to evaluate the extent of disease if diagnosed with cervical cancer?
Colposcopy,
Cystoscopy, ECC,(Endocervical Curettage) Hysteroscopy, Laparoscopy,
Intravenous, Urogram, chest and Skeletal X-ray, Ultrasound, MRI, CT Scan, PET
Scan.
What are the treatment options for
Cervical Cancer?
•
Mild – moderate dysplasia’s can be treated with cryotherapy and LEEP
Procedures.
•
Moderate to Carcinoma insitu can be treated with Hysterectomy.
•
Whereas Invasive forms requires Chemotherapy with radiotherapy.
•
Treatment requires intervention from oncologists/ urologist intervention and
gynecology department.
•
However Prognosis always depends on the stage of the cancer at which it is
diagnosed.
Summary:
- To prevent cancer it is very important to identify factors related to process
and detect them very early. It is not only the duty of doctor but the
responsibility of the Society to come forward and avail the vaccines and screening
tests available for early detection and acquire adequate treatment if
diagnosed.
Dr.
Praveena G
Consultant
Obstetrician and Gynecologist
KIMS
Hospitals, Kurnool
