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Carcinoma of the Cervix

Carcinoma of the Cervix

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Published by: api-3705046 on Oct 14, 2008
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03/18/2014

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CARCINOMA OF THE CERVIX

Carcinoma of the cervix is the commonest form of female genital cancer seen worldwide and it is the second commonest cancer in women, it is very nearly as common as breast cancer.

In Europe and America, the incidence has fallen considerably due to the
screening procedures adopted in the 2nd half of the last century.
AETIOLOGY AND EPIDEMIOLOGICAL FACTORS
1.
AGE:Invasive cancer has 2 distinct peaks of incidence due to rising

rate in younger cohorts. These age of peak incidence have been identified at about 35years and 50-55years. There is reduced incidence after 55years. CIN occurs in much lower age group.

2.
RACE: Commoner among Africans than in caucasians.
It may show familial tendencies.
3.
SOCIO-ECONOMIC STATUS: Low socio-economic status is
associated with increased incidence of the disease.
4.
SEXUAL HISTORY:
(a)Low risk of the dx. among women of fanatical religions group \u2013 viz.
Nuns, Amish, Jews and Muslims. The dx is rare among virgins.
(b) High risk behaviour is associated with the following:
1
(i) Early coitache \u2013 before 20th birthday \u2013 50% excess of

cases.
(ii) Early marriage
(iii)Multiple childbirths (High parity).

(iv)Frequent change of partners (Promiscuity and prostitution)
\u2013 multiple sexual partners. No correlation between the no. of
sexual acts and cervical neoplasia among women with two or
less lifetime partners.

(c) Male factors: 2.7 fold increased risk of developing cervical neoplasia for a woman whose husband had previously married a woman with cervical carcinoma.

Recent evidence refutes association of penile cancer and cervical cancer.

A history of 15 or more partners is associated with a 7.8% increased risk of the current female partner developing cervical neoplasia (Buckley et al 1981).

Several immunosuppressive agents are present in human seminal plasma. These may influence the development of cervical neoplasia by reducing the local immune response to viral infections or to cells transformed by other agents.

5. INFECTIONS:Cervical infection with the following viruses have been
implicated.
2

- Human papilloma virus (HPV) types 16, 18 and 33, while types 6, 11,31, 35, 42 and 50 is associated with condylomata acuminata, low-grade CIN and only rarely in invasive tumours.

- Herpes simplex hominis type II has a possible link but this has not been
proven by large population study.
- Human immunodeficiency virus or other causes of immunodeficiency
status.
6. SMOKING: There is a strong epidemiological link between smoking

and the dx. Smoking reduces the number of Langerhan\u2019s cell present in the cervical epithelium which plays a role in local immune surveillance.

- A 12.7 fold greater risk of developing carcinoma-in-situ has been found
after 12years of smoking.
Products of cigarette smoking \u2013 cotine and nicotine are found in higher

concentrations in cervical mucus than in serum from women with CIN.
Another product Nitrosamines, a chemical carcinogen has also been linked
with \u2013 related cancers of the cervix.

7. CONTRACEPTION: oral contraceptive increases the risk of cancer of
the cervix while diaphragm decreases the risk.
PATHOLOGY
The main histological types are:
(i)
SQUAMOUS CELL CARCINOMA \u2013 90-95% of all invasive Ca.
3

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