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How to diagnose the stages of cervical cancer caused by HPV


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The incidence of infection and cancer caused by the human papillomavirus (HPV), has increased over the years. Infections can be classified as transient, when HPV is spontaneously eliminated by the immune system, or persistent, when the infection persists and is usually caused by oncogenic types of the virus, which are capable of leading to the development of cancer (1). Of those infected, only 5% have symptoms, lesions or warts in the anogenital region (2). Warts are technically called acuminate condylomas and popularly called "cock's crest", "fig tree" or "crested horse". They look like cauliflower and vary in size. For its diagnosis, urological (penis), gynecological (vulva) and dermatological (skin) exams must be performed (3). On the other hand, precursor lesions, known as intraepithelial neoplasms, are considered subclinical and are not visible to the naked eye. These lesions can be found in both sexes: in the cervix, vagina, oropharynx, vulva, penis, scrotum, among others. As a result, preventive diagnostic tests are increasingly necessary.

The diagnosis of cervical lesions is made through cytopathological examination (preventive Pap Test), histopathological examination (biopsy), or through the use of instruments with magnifying power (magnifying glasses), after the application of chemical reagents to contrast (colposcopy) (3). These tests allow classifying neoplasms into Cervical Intraepithelial Neoplasia grade I (CIN 1; with low probability of generating cancer) (3), CIN 2 and CIN 3, the latter being considered precursor lesions of HPV-induced cervical cancer (3). The neoplasia degrees represent the level of damage of the epithelium (1/3, 2/3, 3/3), and the greater the degree, the greater the damage in the epithelial tissue. Another diagnostic modality is the detection of HPV in the body (even if there are no symptoms of its presence) through the identification of viral DNA. For this, laboratory tests for molecular diagnosis can be performed, such as the Polymerase Chain Reaction (PCR) test and the hybrid capture test, which allow the identification of 18 types of HPV and even classify them in high (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 68) or low risk (6, 11, 42, 43 and 44) ​​(4).

All these tests are available free of charge in SUS (Brazilian Unified Health System) and are part of the Ministry of Health's strategy for tracking and preventing cervical cancer caused by HPV.

Remember that early diagnosis is still the best strategy to prevent the development of lesions and cervical cancer. Periodically consult your gynecologist!


References


1. Instituto Nacional do Câncer. Estimativa Incidência de Câncer no Brasil - Biênio 2018-2019. Vol. 1, Inca. 2018. 124 p.

2. Zhai K, Ding J, Shi HZ. HPV and lung cancer risk: A meta-analysis. J Clin Virol [Internet]. 2015;63:84–90. Available at: http://dx.doi.org/10.1016/j.jcv.2014.09.014

3. https://www.inca.gov.br/perguntas-frequentes/hpv

4. RODRIGUES, Ana Lídia Nascimento; ROCHA, Márcia Santos da., A IMPORTÂNCIA DO DIAGNÓSTICO DE HPV NA DETECÇÃO DE CÂNCERES CERVICAIS.


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