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Human papillomavirus (HPV) is generally spread through sexual intercourse and mainly infects the skin (penis, vulva, anus) or mucous membranes (vagina, cervix and rectum) of the genitals in both men and women. Likewise, it can also appear in the mouth and the pharynx and tonsils.
This is a frequently transmitted disease and in most cases it does not result in any pathology. It can, however, release a benign disease in the form of warts, or less commonly, different types of cancer. In women, HPV can cause cervical cancer.
HPV is spread via direct skin to skin contact during sex, and not through fluids. In around 90% of cases it disappears spontaneously, but it can be transmitted whilst the virus is present.
HPV is classified in terms of whether or not there is a risk of cancer developing:
It should be said that it is possible to be infected with more than one type of HPV. In addition, persistent infection can result in developing cancer of the cervix, vulva, penis, anus or oropharynx.
Specifically, the virus initiates dysplastic changes in the epithelial cells which continue to evolve until they produce an invasive cancer. This is a progressive process and the time from infection until developing the disease can be up to twenty years.
Genital warts or small protuberances or groups of different sizes and shapes may appear in the area of the genitals.
In the case of cancer, there are no symptoms until it is very advanced. In the case of cervical cancer, symptoms show up as:
In Catalonia, cancer of the womb occurs in 7.2 out of every 100,000 women per year (2003-2007). This represents 2.8% of all female cancers. Between the ages of 35-64 this figure rises to 16.1 cases for every 100,000 women. Furthermore, the risk of developing this disease for women who live to 75 is one in 106.
Anal cancer has an annual incidence rate of 1.8 cases for every 100,000 people, but in the case of men engaging in same-sex relations and infected with HIV, this rises to 70 or 128 cases for every 100,000.
When there is evidence of warts, diagnosis is usually clinical or by biopsy. Cancer is detected by cytology tests, which allow anomalous changes in the cells to be seen before they develop. If the test comes back anomalous it can be complemented by a colposcopy that allows magnified examination of the cervix and samples to be taken.
HPV detection is the main component of a preventative strategy to detect the virus before it reaches the point of disease.
There is no specific antiviral treatment for HPV.
In the case of warts, in most cases they can be eliminated through surgery, ointments or other treatments.
If cancer does develop, treatment will depend on the stage at which it is diagnosed. For example, if it is detected early in the cervix this can involve removing the damaged tissue, whilst in more advanced stages it may require a hysterectomy, radiotherapy or chemotherapy.
The use of condoms is essential to prevent HPV. There is also highly effective vaccine used as a way to prevent cervical cancer. Regular cervical smear tests (Papanicolau test) are also carried out as a form of screening. This strategy, however, is changing due to the techniques used to detect the virus which, together with the smear test, are enabling the different stages of the disease to be monitored (acquisition, persistence, progression to precancerous lesions and invasion).
Cancer is the abnormally fast multiplication of cells which spread and invade nearby tissue or other parts of the body. It can also spread to other organs. This is known as “metastasis”.
There are over 200 types of cancer. They are normally categorised according to the tissue or organ where they originate. Different molecular subtypes are often included which determine the course of treatment and therapeutic options.
Cancer is a complex disease that varies depending on the type of cancer, location, tumours, malignancy, causes and approaches.
Symptoms of cancer can be varied and very much depend on the type of tumour. However, many cancers may give warning signs such as:
39,900 cases were diagnosed in Catalonia in 2015, excluding skin cancer or melanoma. This breaks down as affecting 23,600 men and 13,300 women. The incidence rate is 345 cases for every 100,000 men and 217 for every 100,000 women. In men, the most common cancer is prostate cancer, followed by colorectal and lung cancer. In women, the most common cancers are breast, colorectal and lung cancer. The mortality rate for cancer is around 109 cases for every 100,000 men and 55 for every 100,000 women.
Different tests are used to detect cancer, such as:
Imaging tests can also be requested such as:
Finally, tissue analyses are requested:
Cancer is treated using a multidisciplinary approach and different medical specialisations are combined to treat it appropriately. This treatment follows a protocol: surgery, radiotherapy and chemotherapy. There are also specific therapies for some tumours such as hormone therapy, targeted therapies or immunotherapy.
A series of factors influence and have an impact on cancer:
There are also screening programmes for some kinds of cancer.
Medical Oncology, General Hospital
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