Doctor gynecologist: What are the risks of CERVICAL CANCER? What are the factors that predisposes a person to contract the disease?
Student1: Doc, HPV (Human papilloma virus)
Doctor: Is it a major factor? or is it THE major factor?
Students: MAJOR factor...
Student2: In patients positive for Cervical Cancer, 99.7% are positive for HPV.
Doctor: True. In fact if it were compared to planting. HPV is the seed. The soil is the cervix. And the nutrients/fertilizers are the other factors such as?
Student3: Early sex, doc. Early sexual activity.
Doctor: What do you mean by early sex? Sex at 3AM or at 4AM?!!!
Students laugh
Student3: Early age at first sexual contact pala doc...
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Cervical cancer
Seed: HPV
Soil: Cervix
Nutrients/Fertilizers: sexual contacts at an early age (16 years old and below), multiparity, sexual promiscuity, smoking, other STDs, immunocompromised patients
Why the early age? The cervix is still immature, it is undergoing high metaplastic changes (change from one adult cell to another adult cell). During puberty, there is prominent endocervical cells/area, meaning more of the columnar cells (which is single layered, meaning prone to trauma thereby allowing HPV to adhere to the more basal layer of the cervix) than there is squamous cells (which are multilayered; area is called the ectocervix; prominent in an older/mature cervix). So that if there are sexual contacts at that particular time, there is high probability of inducing micro-trauma or micro-abrasion to the the epithelium, hence, as mentioned, contraction of HPV. Same goes to multiparous patients (mothers who has given birth more than once), the delivery of the baby would cause trauma to the cervix, hence the reaction is to repair the damaged tissue so then there is metaplasia.
The STDs make the patient more prone to acquiring HPV too. STDs cause inflammation, pruritus (itchiness)... it is likely that this is a contributing factor. Another is, by incidence if a patient has one STD, it is not unlikely that she has another STD. So the practice is to work-up the patient for HPV as well.
Smoking induces precancerous changes and also makes healing or repair process poor.
Immunocompromised patients (like patients who have HIV) are also prone to infections. This does not exclude infection with HPV.
