Reproductive Cancers
Gynaecological cancers- mainly to do with reproductive tract
o Doesn’t include breast cancer
Uterine cancer is the most common followed by ovarian cancer
o Ovarian cancer is the most difficult to treat
o Cervical cancer is very easy to prevent
Cervical cancer is common in women
o Major cause of death in the third world
o May cause 10% of all cancer deaths
o Western countries have lower incidence, mainly due to effectiveness of
screening
o Mean age of ~54 for invasive cancer
o Many of the risk factors suggest involvement of HPV in the aetiology of cervical
cancer (>99%)
HPV causes cervical cancer
Pathology of the cervix
o Cervix is faced with mechanical, microbiological, chemical and hormonal
challenges
o The exposure of the “transformation zone” to carcinogens begins the process
of intraepithelial neoplasia
HPV and smoking are carcinogens
Cervical cancer pathology
o 80-95% are squamous cell carcinoma
Derived from stratified squamous cells at the squamocolumnar junction
o 5-20% are adenocarcinoma
Derived from epithelial columnar cells
o Others are clear cells and sarcomas
Cervical cancer risk factors
o Many risk factors show HPV to be involved with cervical cancer
It is around a 10x greater risk than any other known risk factor
, HPV infection happen through:
Sexual intercourse at an early age
Multiple male sexual partners
Male sexual partners themselves who have had multiple sexual
partners
o Smoking
Role of cigarettes is suspected
Nicotine metabolites are identified in cervical mucous
Smoking is correlated with sexual behaviour
o Immunosuppression
HIV infection- more likely to then develop HPV
o Parity
Related to cervical trauma during labour
Giving birth makes cervix more likely to get HPV infection
o Oral contraceptives
Studies are ambiguous and suggest a slight risk with long term use
There is potential for confounding factors including:
People are unlikely to use a barrier method if they are on other
contraceptives
Increased screening of pill users
o There is in vitro evidence that HPVs contain hormone response elements and
that transformation of cells with HPV is enhanced by hormones
They may act as tumour promotors
o Barrier methods of contraception
Condoms and diaphragms may only slightly lower the risk
Can still pick up HPV infection
o Other
Older age
Race
Socioeconomic status
Country of origin
Human papilloma virus
o Known as the “wart virus”
o Have a trophism for epithelial cells
Hence why they manifest on skin
o Found in a variety of species
Over 150 distinct genotypes
o HPV types that affect mucosal layers tend to cause problems such as genital
warts and cancer
Gynaecological cancers- mainly to do with reproductive tract
o Doesn’t include breast cancer
Uterine cancer is the most common followed by ovarian cancer
o Ovarian cancer is the most difficult to treat
o Cervical cancer is very easy to prevent
Cervical cancer is common in women
o Major cause of death in the third world
o May cause 10% of all cancer deaths
o Western countries have lower incidence, mainly due to effectiveness of
screening
o Mean age of ~54 for invasive cancer
o Many of the risk factors suggest involvement of HPV in the aetiology of cervical
cancer (>99%)
HPV causes cervical cancer
Pathology of the cervix
o Cervix is faced with mechanical, microbiological, chemical and hormonal
challenges
o The exposure of the “transformation zone” to carcinogens begins the process
of intraepithelial neoplasia
HPV and smoking are carcinogens
Cervical cancer pathology
o 80-95% are squamous cell carcinoma
Derived from stratified squamous cells at the squamocolumnar junction
o 5-20% are adenocarcinoma
Derived from epithelial columnar cells
o Others are clear cells and sarcomas
Cervical cancer risk factors
o Many risk factors show HPV to be involved with cervical cancer
It is around a 10x greater risk than any other known risk factor
, HPV infection happen through:
Sexual intercourse at an early age
Multiple male sexual partners
Male sexual partners themselves who have had multiple sexual
partners
o Smoking
Role of cigarettes is suspected
Nicotine metabolites are identified in cervical mucous
Smoking is correlated with sexual behaviour
o Immunosuppression
HIV infection- more likely to then develop HPV
o Parity
Related to cervical trauma during labour
Giving birth makes cervix more likely to get HPV infection
o Oral contraceptives
Studies are ambiguous and suggest a slight risk with long term use
There is potential for confounding factors including:
People are unlikely to use a barrier method if they are on other
contraceptives
Increased screening of pill users
o There is in vitro evidence that HPVs contain hormone response elements and
that transformation of cells with HPV is enhanced by hormones
They may act as tumour promotors
o Barrier methods of contraception
Condoms and diaphragms may only slightly lower the risk
Can still pick up HPV infection
o Other
Older age
Race
Socioeconomic status
Country of origin
Human papilloma virus
o Known as the “wart virus”
o Have a trophism for epithelial cells
Hence why they manifest on skin
o Found in a variety of species
Over 150 distinct genotypes
o HPV types that affect mucosal layers tend to cause problems such as genital
warts and cancer
