American Journal Of Biomedical Science & Pharmaceutical Innovation
7
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VOLUME
Vol.05 Issue03 2025
PAGE NO.
7-10
10.37547/ajbspi/Volume05Issue03-02
The role of HPV in the development of cervical
intraepithelial neoplasia and cervical cancer
Abdusamieva Nargiza Khudratovna
Assistant, Department of Medical Clinical Sciences, Termiz Economics service University, Uzbekistan
Received:
03 January 2025;
Accepted:
05 February 2025;
Published:
07 March 2025
Abstract:
Despite impressive achievements in the field of molecular biology, which made it possible to reveal the
main mechanisms and stages of carcinogenesis and to significantly improve the capabilities of instrumental
diagnostics, every year there is a disappointing trend in the world towards an increase in the number of patients
with oncological diseases.
Keywords:
Oncological diseases, stages of carcinogenesis.
Introduction:
Despite impressive achievements in the
field of molecular biology, which made it possible to
reveal the main mechanisms and stages of
carcinogenesis and to significantly improve the
capabilities of instrumental diagnostics, every year
there is a disappointing trend in the world towards an
increase in the number of patients with oncological
diseases.
According to the World Health Organization (WHO), the
average annual increase in human papillomavirus
infection exceeds 2.5-3 million, the frequency of
asymptomatic virus carriage in the world is high and
amounts to 15.5% in Russia; in the USA - 28.6%; in
Europe - 2-12%. HPV-associated cervical cancer is the
third most common cancer among women in the world,
with -70% of cases due to infection with HPV types 16
and 18. Compared to other gynecological diseases,
cervical cancer is more common in young women, with
an average age of about 49 years. Over the past 50
years, the introduction of "... Pap smear testing and
HPV vaccination in developed countries has reduced
morbidity and mortality by 75% ...". Despite widely
implemented prevention programs, the prevalence of
cervical cancer continues to remain high.
Cervical cancer is a dangerous disease, the second most
common type of cancer among women in Uzbekistan.
In 2021, 1,827 new cases were identified, 997 women
died. Morbidity and mortality are steadily increasing,
and cervical cancer is projected to cause 2,100 new
cases and 1,300 deaths per year by 2030. [1].
In Karakalpakstan, the incidence of cervical cancer
ranks second after breast cancer among the female
population. A malignant tumor of the cervix in 2020
claimed the life of 71 women in Karakalpakstan.
Despite the widespread use in clinical practice of
various destructive and excisional methods of
treatment of cervical intraepithelial neoplasia (CIN) and
carcinoma in situ, a number of patients subsequently
revealed the persistence of human papillomavirus
(HPV) of high carcinogenic risk, which contributes to
the recurrence of the disease and repeated surgical
interventions on the cervix [9; 10].
In order to accurately diagnose the severity of CIN,
assess the prognosis of the course of small forms of
cervical lesions, and select the most optimal
management tactics for patients, it is necessary to
search for effective biomarkers with high diagnostic
and prognostic significance.
Currently, the human genome and transcriptome are
widely studied to search for biomarkers of CIN and PCM
[2;3].
The purpose of the study
To develop differentiated approaches to the
management of patients with cervical intraepithelial
neoplasia of varying severity based on the study of
clinical, morphological methods.
METHODS
According to the inclusion and exclusion criteria, 110
patients were recruited into a single-stage prospective
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
cohort study. Depending on the results of histological
examination of cervical biopsies, 4 groups were
formed: chronic cervicitis in combination with HPV
infection (n=30), LSIL (n=30), HSIL (n=30) and cervical
cancer (n=20).
Research methods
Mandatory research methods:
1. A clinical study that includes the collection of
complaints, anamnesis, assessment of reproductive
function and risk factors for HPV-associated cervical
diseases, general examination and gynecological
examination, calculation of div mass index (BMI),
examination and palpation of the mammary glands.
2. Cytological method (liquid cytology).
3. Molecular genetic methods (genotyping of 21 HPV
types with determination of viral load by real-time
PCR).
4. Advanced colposcopy.
Table 1
Classification of HPV depending on oncogenicity (IARC, 2003)
The degree of oncogenicity of HPV
Highly oncogenic
Low-oncogenic
Medium oncogenic
Type of HPV
Highly oncogenic
16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73,
82
Low-oncogenic
6, 11, 40, 42, 43, 44, 54, 61, 70, 72, 81
Medium oncogenic
26, 53, 66
In 2012, the IARC identified 3 groups of oncogenic HPV:
group 1 - high carcinogenic risk, group 2 A - probable
carcinogenic risk, group 2B - possible carcinogenic risk
(Table 2).
It is known that the human papillomavirus plays a key
role in the development of breast cancer. In 2008,
German physician and scientist Harald zur Hausen was
awarded the Nobel Prize in Physiology or Medicine for
his study of HPV and its role in the pathogenesis of
breast cancer.
Carcinogenic risk groups depending on the type of HPV (IARC, 2012)
Carcinogenic risk group
Type of HPV
1
HPV 16, HPV 18, HPV 31, HPV 33, PO 35, HPV 39, HPV 45, HPV 51,
HPV 52, HPV 56, HPV 58 and HPV 59
2А
HPV 68
2В
P 26, PCH 30, PCH 34, PCH 53, PCH 66, PCH 67, PCH 69, PCH 70, PCH
73, PCH 82, HPV 85, HPV 97
In August 2020, the World Health Assembly adopted
the Global Strategy for cervical cancer elimination. The
WHO has set up global 90-70-90 targets to be reached
by 2030: 90% of girls fully vaccinated with the human
papillomavirus (HPV) vaccine by age 15; 70% of women
are screened by 35, and again by 45 years of age; and
90% of women identified with cervical disease receive
treatment.
Cervical endometriosis (Figure 1) was detected in 12%
of cases. Cervical endometriosis was most often found
in patients who underwent knife conization, DEC and
CO2 laser vaporization of the cervix - 23%. Less often,
endometriosis was detected after the use of radio wave
treatment (19%) and cryodestruction of the cervix
(12%).
The results of a retrospective analysis showed that in
30% of women, after excision and/or destructive
treatment of the cervix, pregnancy was complicated by
ICN, in connection with which such patients had
stitches on the cervix (67%), obstetric pessaries were
also used (33%). An analysis of the obstetric history
showed that premature birth was observed in 15% of
pregnant women who underwent cervical surgery, and
most often they were operative (cesarean section in
60% of cases). A case of very early premature birth at
the age of 27 weeks of pregnancy in a patient 4 years
after cervical electroconization for HSIL deserves
attention. As a result of this complication, the patient
had a child with cerebral palsy (cerebral palsy).
American Journal of Applied Science and Technology
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
Figure 1. Consequences of surgical treatment of the cervix:
A)
scarring of the cervix, B) endometriosis of the
cervix, C) complete stenosis of the external pharynx of
the cervix
68% of excisional and destructive interventions on the
cervix were performed outside the Republican
Specialized Scientific and practical Medical Center of
Oncology and Radiology. It should be noted that before
surgical treatment of the cervix, as well as in the
process of monitoring its condition after treatment
outside the walls of the Republican Specialized
Scientific and practical Medical Center of Oncology and
RadiologyAGP, most patients were not typed for HPV,
therefore it is not possible to assess the persistence of
a certain type of HPV or reinfection with other types in
these patients. According to the results of HPV testing,
HPV infection was detected in almost half (48%) of the
patients. Of these, HPV BP was detected in 96% of
cases. The most common type of HPV was type 16
(33%). Then we met 33 (7%), 52 (7%), 56 (7%), 59 (7%)
types of HPV. 35 and 39 HPV types were detected with
a frequency of 6% each. HPV 31, 44(55), 45, 51, 58 The
types were identified with the same frequency - 4%.
There were also 68 (3%) and 18 (3%) HPV types in
patients with HPV infection. Type 82 HPV was detected
in 1% of patients with HPV infection (Figure 10). From a
cytological point of view, chronic cervicitis consists of
cells of flat, cylindrical and metaplastic epithelium,
elements of chronic inflammation (lymphocytes,
histiocytes, cells of the plasma and fibroblastic series),
non-specific signs such as acanthosis, hyper- and
parakeratosis were often noted (Figure 2).
Figure 2. Cytological picture of chronic cervicitis in combination with HPV infection
The cytological picture in ASCUS was characterized by
the presence of single squamous epithelial cells with
signs of atypia, the interpretation of which caused
difficulty. Coilocytes were often found - cells of the
intermediate layer with enlarged nuclei, an uneven
membrane and hyperchromia, with the presence of an
extensive perinuclear zone of enlightenment, clearly
delimited from the peripheral parts of the cytoplasm,
which were stained more evenly and intensively. The
perinuclear zone of enlightenment is the result of
degenerative changes, necrosis of the cytoplasm,
which begins with the nucleus with a gradual spread to
the periphery.
American Journal of Applied Science and Technology
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American Journal of Applied Science and Technology (ISSN: 2771-2745)
Figure 3. The prevalence of various types of HPV in patients with a history of
cervical surgery
CONCLUSION
Thus, the presence of relapses of SIL and breast cancer
(22%) indicates the use of excessively gentle, non-
excisional HSIL treatment methods with the lack of
adequate colposcopic control, as well as the
subsequent persistence of HPV BP, the timely diagnosis
of which was not given sufficient attention. The results
of simultaneous HPV testing revealed a high incidence
of HPV infection (48%), including HPV BP 96% in
patients who had previously undergone destructive
and excisional interventions on the cervix for
precancerous and malignant diseases. Thus, HPV
testing is advisable to use in addition to annual
cytological screening in patients who have undergone
cervical surgery to identify risk groups for the
development of HSIL and breast cancer relapses.
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