Cervical Cancer: Risk Factors, Aetiology, and Clinical Manifestations

This presentation discusses the risk factors, aetiology, and clinical manifestations of cervical cancer. It explores the role of HPV infection as a critical risk factor and highlights the importance of screening tests for early detection. The case study of Adina, an indigenous woman from North Queensland, illustrates the impact of risky behaviors and lack of access to screening on the development of advanced cervical cancer. The presentation also provides references to relevant research studies.

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Pathophysiology: HPV infection is the
leading pathogenic factor
Development of lesions in the
intraepithelial tissues
HPV genotype and
duration of infection [6]
Compromised immune
system in the host
Pathophysiology
Risk Factors
Aetiology
Clinical
manifestations
Diagnostic tests
Treatment
HPV infection of certain genotypes is a critical risk factor
Risk factors: smoking, alcohol. Environmental pollution , tar-based vaginal douches, age at the time of
first intercourse, risky sexual behaviour, more number of male sexual partners, parity, age, origin;
Adina displays smoking behaviour at a high degree
Lack of screening
methods
Adina had her first
intercourse at 14-
HPV transmission
causing painful
intercourse
Aetiology: Certain HPV genotypes are main causative factors;
smoking, tar exposure, alcohol, sexual transmission of infection,
more number of male sexual partners, early age of first intercourse
are primary aetiological factors [7]
Pelvic pain, pain after intercourse
Radioactive substance placed in
the vagina for brachytherapy
Surgery, chemotherapy,
radiation therapy
Environmental factors such as
air pollution
Place of origin and genetic
susceptibility: Adina, as an indigenous
Australian woman as higher risk
Smoking and alcohol
addiction: Adina has high
degree smoking
Use of oral contraceptives, sexual
activeness; Adina has had six male
sexual partners leading to increased risk
Adina complains of severe
pelvic pain and vaginal bleeding
due to presence of advanced
stage of cancer
Various
gynaecological
factors lead to HPV
infection
Comorbidity with asthma and Budesonide inhalation suspension
can worsen the condition as in the case of Adina, leading to
cervical lymphoma [7]
Sometimes, a combination of all
three techniques is used
Surgery: Simple and radical
hysterectomy
Treatment: The stage of cancer
determines the treatment method
Radiation: X-ray or proton
radiation, non-invasive
Weight loss and fatigue
Adina has a history of unsafe
sex
Diagnosis: Screening tests: a) Pap smear test: primary
screening test where cells of the cervix are smeared and
examined in the lab; b) HPV DNA test: determination of the
genotype (if it will lead to cervical cancer) [8]
Key
Chemotherapy: medications are
administered intravenously

500 word written explanation.Introduction: Cervical cancer is one of the most common types of cancer occurrence amongst women in the world [1]. The mortality rates of cervical cancer are also alarmingly high
worldwide [1]. Research has demonstrated that the human papilloma virus (HPV) is one of the most primary causes for cervical cancer [1]. Certain genotypic strains of the HPV lead to
infections of a highly persistent nature [1]. Several molecular, virological, and clinical datasets obtained through research have demonstrated consensus that the occurrence of
cervical cancer is often preceded by episodes of infections of the unresolved kind with certain genotypes of HPV [1]. Scientists have confirmed that viral infection leads to cervical
cancer as the end result [1]. Thus, HPV infection is regarded a critical risk factor in the aetiology of cervical cancer over the world [1].
Risk factors and aetiology: The common risk factors of cervical cancer in most studies globally indicate HPV infection as the most critical risk factor [2, 3]. Studies have identified the
following as the major risk factors of cervical cancer: excessive smoking, alcohol consumption, unsafe sexual practices, obesity, diet inappropriateness, and sedentary lifestyle, and
environmental causes such as air pollution etc [4]. Parity, sexual behaviour, age at the time of first sexual intercourse, number of male sexual partners etc. are critical determiners of
the likelihood of risk of cervical cancer occurrence [4]. Although HPV infection is an important causal factor, all HPV infections do not result in cervical cancer [4]. The genetic origin and
place of belongingness of women largely determine the risk of cervical cancer as well [4].
Pathophysiology: The pathogenesis of cervical cancer occurs due to the presence of infection with HPV [5]. HPV is sexually transmitted and thus the infection is predominant in
sexually active women [5]. Most of the HPV infections lead to squamous lesions in intraepithelial tissues [5]. Environmental factors and lack of routine screening of cervical cancer also
lead to the development of cervical cancer [5].
Clinical manifestations of the case study: signs and symptoms: Adina is an indigenous woman belonging to North Queensland [5]. Research has shown that indigenous women of
Australia are at a high natural risk of cervical cancer [5]. Adina’s case report clearly indicates risky behaviours for the development of cervical cancer including smoking, high number of
male sexual partners, and relatively low age at the time of first intercourse [5]. These risk factors evidently develop into the aetiological factors of cervical cancer [5]. Adina is positive
for HPV infection, which is a significant risk factor in her case [5]. Her clinical presentation includes complaint of vaginal bleeding following intercourse [5]. In indigenous women of
North Queensland and other parts of Australia, where Adina comes from, do not have access to pap smear tests and other diagnostic tests of cervical cancer [5]. The patient has a
comorbid condition of chronic asthma. She has been taking Budesonide on most days. Budesonide inhalantion suspension has a common adverse effect of cervical lymphadenopathy
[6]. The most common symptoms of cervical cancer include vaginal bleeding, foul-smelling and unusual discharge in the vagina or dryness of the vagina, in certain women, these signs
are accompanied by severe pain in the pelvic region [6]. In severe cases of cervical cancer, weight loss and fatigue are common observations [6]. From the signs and symptoms
observed in Adina, it is evident that she has an advanced stage of cervical cancer, perhaps not screened at early stages due to the lack of access to screening tests in North Queensland
[6]. She displays most risky behaviours associated with the aetiology of cervical cancer along with being pre-disposed to it from being an indigenous woman of Australia [6].

Reference list
1. Castellsague, X. (2008). Natural history and epidemiology of HPV infection and cervical cancer. Gynecologic Oncology, 110: S4-S7
2. Danaei, G., Hoorn, S.V., Lopez, A.D., Murray, C.J.L., & Ezzati, M. (2005). Causes of cancer in the world: compartitive risk assessment of nine
behavioural and environmental risk factors. the Lancet, 366(9499): 1784-1793.
3. Haverkos, H.W. (2005). Multifactorial etiology of cervical cancer: a hypothesis. Medscape, 7(4): 56
4. Whop, L.J., Baade, P., Garvey, G., Cunningham, J., Brotherton, J.M.L., Lokuge, K., Valery, P.C., Connell, D.L.O., Canfell, K., Diaz, A., Roder, D.,
Gertig, D.M., Moore, S.P., & Condon, J.R. (2016). Cervical abnormalities are more common among indigenous than other Australian women: a
retrospective record-linkage study , 2000-2011. PLoS One, 11(4): e0150473.
5. Australian Government Department of Health (2013). National Cervical Screening Program. Canberra.
6. Bosch, F.X., & Sanjose, S.D. (2002). Human papillomavirus in cervical cancer. Current oncology reports, 4(2): 175-184
7. Bosch, F.X., Manos, M.M., Munoz, N., Sherman, M., Jansen, A.M., Peto, J., Chiffman, M.H., Moreno, V., Kurman, R., & Shan, K.V. (1995).
Prevalence of human papillomavirus in cervical cancer: a worldwide perspective. J Natl Cancer Inst; 87(11): 796-802
8. Herrero, R., Brinton, L.A., Reeves, W.C., et al. (1990). Sexual behavior, venereal diseases, hygiene practices, and invasive cervical cancer in a high-
risk population. Cancer, 65:380-386.
9. Hildesheim, A., Herrero, R., Castle, P.E., et al. (2001). HPV co-factors related to the development of cervical cancer: results from a population-based
study in Costa Rica. Br J Cancer, 84:1219-1226.
10. Winkelstein, W. Jr. (1977). Smoking and cancer of the uterine cervix: hypothesis. Am J Epidemiol, 106:257.