Giới thiệu
- The fourth most common cancer in women and the leading cause of mortality in women worldwide
- The third most common cancer among women in Malaysia in 2017; seventh in Hong Kong in 2018; second in the Philippines and Indonesia in 2020, and Thailand in 2021
Routine Vaccination1
- Children aged 11 to 12 years are recommended to receive 2 doses of human papilloma virus (HPV) vaccine 6 to 12 months apart
- Vaccination may be started as early as 9 years old
- The World Health Organization (WHO) recommends a 2-dose vaccination schedule for children <15 years old (9-14 years), at 0 and 6 months
- If the interval between doses is <5 months, a third dose is given 6 months after the first dose
- Those who are 15 to 26 years old and immunocompromised individuals, the 3-dose vaccination schedule is recommended (0, 2, 6 months)
Catch-Up Dose1
- Routine catch-up vaccination is recommended in females, 13 to 26 years of age and males 22 to 26 years of age, who have not been previously vaccinated or those who have not completed the doses
- Those who have not received any previous HPV vaccination should receive a 3-dose vaccine series
- Those who have received only 1 dose or 2 doses <5 months apart before the age of 15 years are not adequately vaccinated and must receive an additional HPV vaccine dose
- Catch-up HPV vaccination is not recommended for adults 27 to 45 years of age
- Thus, shared clinical decision-making regarding HPV vaccination in this age group is recommended
- HPV exposure risks should be discussed with individuals 18 to 45 years old
- Vaccination would provide full benefit to sexually active females who have not been infected by HPV
- Less benefit is provided to sexually active females who have been infected by one or more HPV types
- HPV vaccines are not licensed for use in adults >45 years of age
1Recommendations for vaccination may vary between countries. Please refer to the local guidelines.
Signs and Symptoms
- Asymptomatic in early stages
- Abnormal vaginal bleeding: Initially, post-coital bleeding then later becoming profuse
- Vaginal discharge
- Lower back pain, pelvic pain
- Dyspareunia
- Painful urination or dysuria
Yếu tố nguy cơ
- Multiple sexual partners
- Early sexual intercourse (<18 years of age)
- ≥5 years’ use of oral contraceptives
- First delivery at <17 years of age
- Multiparity; high parity (≥3 full-term pregnancies)
- History of sexually transmitted disease (STD)
- Immunocompromised (eg human immunodeficiency virus [HIV] infection)
- History of Diethylstilbestrol exposure
- Smoking
- Lower socioeconomic status
- Family history
Pathogenesis
- HPV infection is the most common cause of cervical cancer
- HPV are small, double-stranded DNA viruses which infect the epithelium which is transmitted through intimate or skin-to-skin contact with an infected person
- Persistent infection with high-risk HPV causes cervical pre-cancer and cancer
- HPV types 16 and 18 cause approximately 70% of cervical cancer
- HPV types 31, 33, 45, 52 and 58 are the less common high-risk HPV types causing cervical cancer
- 80% of cervical cancers are squamous cell cancers arising in the transformation zone of the ectocervix
- 20% of cervical cancers are adenocarcinomas arising from the glandular columnar layer of the endocervix
- High-risk HPV infection of the metaplastic epithelium at the cervical transformation zone interferes with the normal function of cervical epithelial cells upon entrance of the virus into the cells causing changes characteristic of pre-cancer or dysplasia which, if left untreated, may invade the basement membrane and develop into cancer
- An enlarged transformation zone of the ectocervix during puberty and pregnancy makes these women prone to HPV infection when exposed to HPV