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CERVICAL CANCER
About 60%
regress within HPV Infection
2-3 yrs
HPV-related Changes
Sustained
Immune About clinical
First lesion response 9 mo remission
Persistent
See and Treat
Natural History or recurrent disease
2007
HPV
Human Papilloma Virus
➢ > 150 tipe
➢ 40 tipe mengenai anogenital
➢ pada remaja & dewasa muda
➢ Infeksi HPV
➢ Berganti-ganti pasangan
➢ Status ekonomi rendah
➢ Perokok
➢ Riwayat PMS
Radiation, chemical,
mutagenic, virus, spontan DNA Repair
mutation
Initiated Cell
Tumor promotor growth
factor, virus
GF Inhibition
Preneoplasia Differentiation,
Radiation, chemical, Immune factors,
mutagenic, virus, spontan Surveillance lack,
mutation Angiogenesis,
Invasive Tumor Apoptosis
See and Treat
Natural History 2007
Transient C. trachomatis
Infection
HPV
Infection
Decreasing
Immune Basal epithelial cells Viral Age
Surveillance persistence
20
Morphologically non-expressed (latent) HPV
25
CIN3, VIN3, VAIN3
30
In activation of Oncogenic HPV
tumor suppressor
gene Cancer 45
Viral integration
See and Treat
Natural History 2007
Expression of HPV as Early Cytologic and Histologic Abnormalities
See and Treat
Natural History 2007
Jalur Transmisi Potential
● oral sex - rare
● perinatal - rare
● digital - rare
● “outercourse” – rare
● anal intercourse - common
● vaginal intercourse - common
See and Treat
Natural History 2007
Tipe HPV
● High Risk types :
16, 18,
31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82
● Probable high risk types :
26, 53, and 66
● Low risk type :
6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81, and CP6108
(Munos et al, N Engl J Med 2003; 348:518-27)
Responsible for recognition and binding of origin of replication. Exists in two forms:
full length (transcriptional transactivator) and truncated (transcriptional repressor).
E2 The ratio of these found in the heterotrimeric complex formed before complexing
with E1 regulates transcription of viral genome.
E3 ???
E8 ???