Reproductive Cancers

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