Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-25T06:54:55.785Z Has data issue: false hasContentIssue false

Chapter 33 - Pre-invasive Cervical Disease and Colposcopy

from Section 7 - Cervix

Published online by Cambridge University Press:  24 November 2021

By
Andre B. Kind ,
Dorothy J. Huang  and
Brigitte Frey Tirri
Edited by
Tahir Mahmood ,
Charles Savona-Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Cervical cancer remains the major cause of death from cancer in women worldwide. While well-established screening programmes and treatment of pre-invasive disease are available in economically developed countries, screening remains opportunistic to non -existent in low-income countries. Cervical cancer and its precursors are caused by persistent infections with high-risk HPV. Early-onset sexual intercourse is an important factor for HPV infection. Excisional treatment for pre-invasive disease is preferred to ablative treatment. A simple hysterectomy is adequate for most microinvasive cancers of the cervix. Virus like particles (VLPs) assembled from recombinant HPV coat proteins are used to constitute HPV vaccine. It has the advantage of being non-infectious, as they contain no viral genetic material. The vaccines prevent HPV-related cancers and ideally are given before sexual debut. Guidelines vary between countries, but vaccination is usually initiated between 9–12 years for both sexes. Preventive HPV vaccination for both sexes remains a cornerstone of preventing HPV related cancers globally.

Keywords

pre-invasive disease of cervixmicroinvasive cervical cancercervical dysplasiaCIN 1–3colposcopylarge loop excision of transformation zone ( LLETZ)HPVVLPHPV vaccine
Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Gynaecology
 , pp. 275 - 283
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Muñoz, N. Human papillomavirus and cancer: the epidemiological evidence. J Clin Virol 2000;19:1–5.Google Scholar
IARC. Human Papillomaviruses. Lyon: IARC, 2012.Google Scholar
Wiebren, AT. Differences in human papillomavirus type distribution in high‐grade cervical intraepithelial neoplasia and invasive cervical cancer in Europe. Int J Can 2013;132:854–867.Google Scholar
de Sanjose, S, Quint, WG, Alemany, L, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol 2010;11: 1048–1056.Google Scholar
Arbyn, M. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol 2017;18:1665–1679.Google Scholar
Moreno, V, Bosch, FX, Muñoz, N, et al. Effect of oral contraceptives on risk of cervical cancer in women with human papillomavirus infection: the IARC multicentric case-control study. Lancet 2002;359:1085–1092.CrossRefGoogle ScholarPubMed
Roura, E, Travier, N, Waterboer, T, et al. The influence of hormonal factors on the risk of developing cervical cancer and pre-cancer: results from the EPIC Cohort. PLoS One 2016;11:e0147029.Google Scholar
Iversen, L, Sivasubramaniam, S, Lee, AJ, et al. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol 2017;216:580e1–580e9.Google Scholar
Adhikari, I, Eriksson, T, Luostarinen, T, Lehtinen, M, Apter, D. The risk of cervical atypia in oral contraceptive users. Eur J Contraception Reprod Health Care 2018;23:12–17.CrossRefGoogle ScholarPubMed
Cortessis, V, Barrett, M, Brown, N, et al. Intrauterine device use and cervical cancer risk: a systematic review and meta-analysis. Obstet Gynecol 2017;130:1226–1236.CrossRefGoogle Scholar
McCrory, DC, Matchar, DB, Bastian, L. Evaluation of cervical cytology. Evid Rep Technol Assess (Summ) 1999;5:1–6.Google Scholar
Klug, SJ, Neis, KJ, Harlfinger, W, et al. A randomized trial comparing conventional cytology to liquid-based cytology and computer assistance. Int J Cancer 2013;132:2849–2857.Google Scholar
Ronco, G, Dillner, J, Elfström, KM, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 2014;9916:524–532.Google Scholar
Horn, J, Denecke, A, Luyten, A, et al. Reduction of cervical cancer incidence within a primary HPV screening pilot project (WOLPHSCREEN) in Wolfsburg, Germany. Br J Cancer 2019;120:1015–1022.Google Scholar
Ogilvie, GS, van Niekerk, D, Krajden, M, et al. Effect of screening with primary cervical HPV testing vs cytology testing on high-grade cervical intraepithelial neoplasia at 48 months: The HPV FOCAL Randomized Clinical Trial. JAMA 2018;320:43–52.Google Scholar
Solomon, D, Davey, D, Kurman, R, et al. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002;287:2114–2119.CrossRefGoogle ScholarPubMed
Scheungraber, C, Koenig, U, Fechtel, B, et al. The colposcopic feature ridge sign is associated with the presence of cervical intraepithelial neoplasia 2/3 and human papillomavirus 16 in young women. J Low Genit Tract Dis 2009;13:13–16.Google Scholar
Kyrgiou, M, Athanasiou, A, Paraskevaidi, M, et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ 2016;354:i3633.CrossRefGoogle ScholarPubMed
Karoliina, T, Athanasiou, A, Tikkinen, KAO, et al. Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ 2018;360:k499.Google Scholar
Arbyn, M, Ronco, G, Anttila, A, et al. Evidence regarding HPV testing in secondary prevention of cervical cancer. Vaccine 2012;30(suppl 5):F88–F99.CrossRefGoogle ScholarPubMed
Arbyn, M, Redman, CWE, Verdoodt, F, et al. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol 2017;18:1665–1679.Google Scholar
Soutter, WP, Sasieni, P, Panoskaltsis, T. Long-term risk of invasive cervical cancer after treatment of squamous cervical intraepithelial neoplasia. Int J Cancer 2006;118:2048–2055.Google Scholar
Kocken, M, Uijterwaal, MH, de Vries, ALM, et al. High-risk human papillomavirus testing versus cytology in predicting post-treatment disease in women treated for high-grade cervical disease: a systematic review and meta-analysis. Gynecol Oncol 2012;125:500–507.Google Scholar
Olsson, SE, Kjaer, SK, Sigurdsson, K, et al. Evaluation of quadrivalent HPV 6/11/16/18 vaccine efficacy against cervical and anogenital disease in subjects with serological evidence of prior vaccine type HPV infection. Hum Vaccin 2009;5:696–704.CrossRefGoogle ScholarPubMed
Palmer, T, Wallace, L, Pollock, KG, et al. Prevalence of cervical disease at age 20 after immunisation with bivalent HPV vaccine at age 12–13 in Scotland: retrospective population study. BMJ 2019;365:1161.Google Scholar
WHO. Weekly epidemiological record, July 2017.Google Scholar
Tino, F, Schwarz, TF, Galaj, A, et al. Ten‐year immune persistence and safety of the HPV‐16/18 AS04‐adjuvanted vaccine in females vaccinated at 15–55 years of age. Cancer Med 2017;6:2723–2731.Google Scholar
Arbyn, M, Xu, L, Simoens, C, Martin-Hirsch, PP. Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors. Cochrane Database Syst Rev 2018;5:CD009069.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×