Salud Publica Mex. Jul-Aug;40(4) [Risk factors for cervico-uterine cancer in women in Zacatecas]. [Article in Spanish]. Castañeda-Iñiguez MS(1). Introduction: Cervicouterine cancer (CC) is a health problem worldwide and is the fourth most common cancer in women, with a greater. Download Citation on ResearchGate | Risk factors of cervicouterine cancer | OBJECTIVES: To expose the results of an analytical case-control study conducted.
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Cervical cancer is a cancer arising from the cervix. Worldwide, cervical cancer is both the fourth-most common cause of cancer and the fourth-most common cause of death from cancer in women. The early stages of cervical cancer may be completely free of symptoms. Also, moderate pain during sexual intercourse and vaginal discharge are symptoms of cervical cancer.
Symptoms of advanced cervical cancer may include: Infection with some types of HPV is the greatest risk factor for cervical cancer, followed by smoking.
Women who have sex with men who have many other sexual partners or women who have many sexual partners have a greater risk. Of the types of HPV known,   15 are classified as high-risk types cervicoiterine, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82three as probable high-risk 26, 53, and 66and 12 as low-risk 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP Genital wartswhich are a form of benign tumor of epithelial cells, are also caused by various strains of HPV.
However, these serotypes are usually not related to cervical cancer. It is common to have multiple strains at the same time, including those that can cause cervical cancer along with those that cause warts. Infection with HPV is generally believed to be required for cervical cancer to occur.
Cigarette smoking, both active and passive, increases the risk of cervical cancer. Among HPV-infected women, current and former smokers have roughly two to three times the incidence of invasive cancer. Passive smoking is also associated with increased risk, but to cerviccouterine lesser extent.
Smoking has also been linked to the development of cervical cervicouterind. Long-term use of oral contraceptives is associated with increased risk of cervical cancer.
Women who have used oral contraceptives for 5 to 9 years have about three times the incidence of invasive cancer, and those who used them for 10 years or longer have about four times the risk. Having many pregnancies is associated with an increased risk of cervical cancer.
Among HPV-infected women, those who have had seven or more full-term pregnancies have around four times the risk of cancer compared with women with no pregnancies, and two to three times the risk of women who have had one or two full-term pregnancies.
[Risk factors for cervico-uterine cancer in women in Zacatecas].
Confirmation of the diagnosis of cervical cancer or precancer requires a biopsy of the cervix. This is often done through colposcopya magnified visual inspection of the cervix aided by using a dilute acetic acid e. Colposcopic impression, the estimate of disease severity based on the visual inspection, forms part of the diagnosis.
Further diagnostic and treatment procedures are loop electrical excision procedure and cervical conizationin which the inner lining of the cervix is removed to be examined pathologically.
These are carried out if the biopsy confirms severe cervical intraepithelial neoplasia. Often before the biopsy, the doctor asks for medical imaging to rule out other causes of woman’s symptoms.
Imaging modalities such as ultrasoundCT scan and MRI have been used to look for alternating disease, spread of tumor and effect on adjacent structures. Typically, they appear as heterogeneous mass in the cervix. Cervical intraepithelial neoplasiathe potential precursor to cervical cancer, is often diagnosed on examination of cervical biopsies by a pathologist. For premalignant dysplastic changes, cervical intraepithelial neoplasia grading is used. The naming and histologic classification of cervical carcinoma precursor lesions has changed many times over the 20th century.
The World Health Organization classification   system was descriptive of the lesions, naming them mild, moderate, or severe dysplasia or carcinoma in situ CIS. The term, cervical intraepithelial neoplasia CIN was developed to place emphasis on the spectrum of abnormality in these lesions, and to help standardise treatment. These results are what a pathologist might report from a biopsy.
These should not be confused with the Bethesda system terms for Pap test cytopathology results. Among the Bethesda results: Histologic subtypes of invasive cervical carcinoma include the following: Noncarcinoma malignancies which can rarely occur in the cervix include melanoma and lymphoma. For cases treated surgically, information obtained from the pathologist can be used in assigning a separate pathologic stage, but is not to replace the original clinical stage.
Cervical cancer is staged by the International Federation of Gynecology and Obstetrics FIGO staging system, which is based on clinical examination, rather than surgical findings.
It allows only these diagnostic tests to be used in determining the stage: Checking the cervix by the Papanicolaou test Pap testfor cervical cancer has dramatically reduced the number of cases of and mortality from cervical cancer in developed countries.
The treatment of low-grade lesions may adversely affect subsequent fertility and pregnancy.
Educational materials also help increase the likelihood women will go for screening, but they are not as effective as invitations. According to the European guidelines, the age at which to start screening ranges between 20 and 30 years of age, but preferentially not before age 25 or 30 years, and depends on burden of the disease in the population and the available resources.
In the United States, screening is recommended to begin at age 21, regardless of age at which a woman began having sex or other risk factors. There are a number of recommended options for screening those 30 cervicuterine Screening is not beneficial cervicoterine women older than 60 years if they have a history of negative results. Liquid-based cytology is another potential screening method. The United States Preventive Services Task Force supports screening every 5 years in those who are between 30 and 65 years when cytology is used in combination with HPV testing.
Pap tests have not been as effective in developing countries. Condoms may also be useful in treating potentially precancerous changes in the cervix. Exposure to semen appears to increase the risk of precancerous changes CIN 3and use of condoms helps to cause these changes to regress and helps clear HPV. Abstinence also prevents HPV infection.
HPV vaccines are typically given to age 9 to 26, as the cervidouterine is only effective if given before infection occurs. The vaccines have been shown to be effective for at least four  to six  years, and they are believed to be effective for longer;  however, the duration of effectiveness and whether a booster will be needed is unknown.
The high cost of this vaccine has been a cause for concern. Several countries have considered or are considering programs to fund HPV vaccination. Sinceyoung women in Japan have been eligible to receive the cervical cancer vaccination for free.
Vitamin A is associated with a lower risk  as are vitamin B12vitamin Cvitamin Eand beta-Carotene. The treatment of cervical cancer varies worldwide, largely due to access to surgeons skilled in radical pelvic surgery, and the emergence of fertility-sparing therapy in developed nations.
Because cervical cancers are radiosensitive, radiation may be used in all stages where surgical options do not exist. Surgical intervention may have better outcomes than radiological approaches. Microinvasive cancer stage IA may be treated by hysterectomy removal of the whole uterus including part of the vagina.
Alternatives include local surgical procedures such as a loop electrical excision procedure or cone biopsy.
If a cone biopsy does not produce clear margins  findings on biopsy showing that the tumor is surrounded by cancer free tissue, suggesting all of the tumor is removedone more possible treatment option for women who want to preserve their fertility is a trachelectomy. It is a viable option for those in stage I cervical cancer which has not spread; however, it is not yet considered a standard of care,  as few doctors are skilled in this procedure. Even the most experienced surgeon cannot promise that a trachelectomy can be performed until after surgical microscopic examination, as the extent of the spread of cancer is unknown.
If the surgeon is not able to microscopically confirm clear margins of cervical tissue once the woman is under general anesthesia in the operating room, a hysterectomy may still be needed.
This can only be done during the same operation if the woman has given prior consent.
Due to the possible risk of cancer spread to the lymph nodes in stage 1b cancers and some stage 1a cancers, the surgeon may also cdrvicouterine to remove some lymph nodes from around the uterus for pathologic evaluation. A radical trachelectomy can be performed abdominally  or vaginally  and opinions are conflicting as to which is better.
Complications are uncommon, although women who are able to conceive after surgery are susceptible to preterm labor and possible late miscarriage. Radiation therapy is given as external beam radiotherapy to the pelvis and brachytherapy internal radiation. Women treated with surgery who have high-risk features found on pathologic examination are given radiation therapy with or without chemotherapy to reduce the risk of relapse.
When cisplatin is present, it is thought to be the most active single agent in periodic diseases. On June 15,the US Food and Drug Administration approved the use of a combination of two chemotherapy drugs, hycamtin and cisplatin, for women with late-stage IVB cervical cancer treatment. For surgery to be curative, the entire cancer must be removed with no cancer found at the margins of the removed tissue on examination under a microscope.
Prognosis depends on the stage of the cancer. These statistics may be improved when applied to women newly diagnosed, bearing in mind that these outcomes may be partly based on the state of treatment five years ago when the women studied were first diagnosed. Regular screening has meant that precancerous changes and early-stage cervical cancers have been detected and treated early.
Figures suggest that cervical screening is saving 5, lives each year in the UK by preventing cervical cancer. All of the Nordic countries have cervical cancer-screening programs in place.
In Africa outcomes are often worse as diagnosis is frequently at a latter stage of disease. Worldwide, cervical cancer is both the fourth-most common cause of cancer and deaths from cancer in women. Australia had cases of cervical cancer in The number of women diagnosed with cervical cancer has dropped on average by 4. In Canada, an estimated 1, women will have been diagnosed with cervical cancer in and will have died.
In India, the number of people with cervical cancer is rising, but overall the age-adjusted rates are decreasing. In the European Union, about 34, new cases per year and over 16, deaths due to cervical cancer occurred in An estimated 12, new cervical cancers and 4, cervical cancer deaths will occur in the United States in The median age at diagnosis is Hispanic women are significantly more likely to be diagnosed with cervical cancer than the general population.
The rates of new cases in the United States was 7 perwomen in Epidemiologists working in the early 20th century noted that cervical cancer behaved like a sexually transmitted disease. These historical observations suggested that cervical cancer could be caused by a sexually transmitted agent.
Initial research in the s and s attributed cervical cancer to smegma e. In summary, HSV was seen as a likely cause because it is known to survive in the female reproductive tract, to be transmitted sexually in a way compatible with known risk factors, such as promiscuity and low socioeconomic status.
HSV was recovered from cervical tumour cells.