By Justhesya Fitriani F.P 030.2007.

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THE CORRELATION BETWEEN HPV INFECTION AND CERVICAL CANCER

Epidemiology
HPV can infect men and women equally, but women are

more likely to present symptoms of disease. Men who are infected with HPV are at risk to develop genital warts. The 24-month risk varied from 57.9% in men who were infected with HPV type 6 or type 11 to 2% in men who were infected with other HPV types (6). These lesions can undergo malignant transformation. Cervical cancer is the second most common malignancy in women worldwide, and it remains a leading cause of cancer-related death for women in developing countries. , but then it decreases drastically since the pap-smear screening technique was found by Papanicolau.

HPV Infection
HPV infections associated with genital warts and related

lesions are contracted through sexual intercourse, anal sex and other skin-to-skin contact in the genital regions. Some HPV infections that result in oral or upper respiratory lesions are contracted through oral sex. Rarely a mother with an HPV infection may transmit the virus to her infant during delivery. This exposure may cause HPV infection in the baby's genitals or upper respiratory system.

HPV virus

Management of HPV Infection

There are 2 catogories :
The immune modifiers is primarily used in treatment of external

anogenital warts or condyloma acuminata. Example : imiquimod, interferon alfa

The antiproliferative drugs

Example : podofilox, podophylin, and 5-fluorouracil As well as the chemodestructive or keratolytic agents salicyclic acid, trichloroacetic acid (TCA), and bichloroacetic acid (BCA)

The cervical cancer

Cervical cancer begins with abnormal changes in the cervical tissue. The risk of developing these abnormal changes has been associated with certain factors : including previous infection with human papillomavirus (HPV), early sexual contact, multiple sexual partners, cigarette smoking, and taking oral contraceptives (birth control pills).

Stage

Description

Stage 0 Carcinoma in situ Stage 1 Invasive carcinoma that is strictly confined to the cervix 1a. Confined to the cervix, diagnosed only by microscopy with invasion. 1b. Clinically visible lesion, < 4 cm and >4 cm in greatest dimension. Stage 2 Locoregional spread of the cancer beyond the uterus but not to the pelvic sidewall or the lower third of the vagina 2a. Involvement of the upper two-thirds of the vagina, without parametrial invasion, < 4 cm and >4 cm in greatest dimension 2b. With parametrial involvement Stage 3 Cancerous spread to the pelvic sidewall or the lower third of the vagina, and/or hydronephrosis or a nonfunctioning kidney that is incident to invasion of the ureter Stage 4 Cancerous spread beyond the true pelvis or into the mucosa of the bladder or rectum

The management of cervical cancer

Diagnosis of cervical cancer requires that a sample of cervical tissue (called a biopsy) be taken and analyzed under a microscope. A cervical biopsy is usually done by a specialist in diseases of women's reproductive and sexual organs (a gynecologist). The biopsy is examined by a physician who specializes in diagnosing diseases by looking at cells and tissues under a microscope (a pathologist). Methods commonly used to treat cervical lesions include cryosurgery (freezing that destroys tissue), LEEP (loop electrosurgical excision procedure, or the removal of tissue using a hot wire loop), and conization (surgery to remove a cone-shaped piece of tissue from the cervix and cervical canal). Similar treatments may be used for external genital warts. In addition, some drugs may be used to treat external genital warts (6,10).

Conclusion
Human papillomavirus (HPV) is now recognized as the most important causative agent in cervical carcinogenesis at the molecular level, although HPV may not induce many of the identified molecular alterations(11,12). First intercourse at an early age, sexual promiscuity, high parity, race, and low socioeconomic status are presently thought to increase the risk for cervical cancer because these factors are linked to sexual behavior that increases the likelihood of exposure to HPV and/or because they are cofactors that modify the risk in women who are infected with HPV.

References

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