Human papillomavirus (HPV) - trigger for cervical cancer

Epidemiology and pathogenesis
In addition to breast cancer, cervical cancer is regarded as the second most common cancer in women.
According to estimates by the Robert Koch Institute (RKI), approximately 6,500 women in Germany suffer from invasive cervical cancer every year, and approx. 1,700 women die of it. This corresponds to 4 % of all malignant tumours in women. It is now regarded as a fact that cervical cancer is triggered by a persistent infection with certain high-risk types of the human papillomavirus (HPV). The human form of the papillomavirus has a special affinity to squamous epithelia and is closely linked with the terminal differentiation of the epidermis of the vulva, perineum, vagina, cervix and anus in its replication. The more than 100 documented types of HPV are divided into groups with high and moderate carcinogenic potential (e.g. type 16, 18, 31, 33 and 35), which are regarded as triggers for intraepithelial neoplasia, and those with low carcinogenic potential (e.g. type 6, 11, 42, 43, 44), which are responsible for the formation of condylomas.

Latent infections are also possible, but they do not become clinically evident until there is a change in the patient’s immune status. Up to 70 % of the male partners of women who have tested positive in HPV screening are also infected, although these infections usually only result in very small lesions on the penis. Men are therefore often not even aware that they have been infected with the HP virus. The virus is not transmitted first and foremost by sexual intercourse (penetration), but by mere contact of infected areas of the skin with the vaginal mucosa.

The screening formerly conducted using colposcopy and cytology (PAP test) can, in early invasive carcinomas, lead to false negative results. HPV DNA testing using the polymerase chain reaction (PCR) works as a supplement to this, providing additional information on the carcinogenic potential of the persistent infection along with a diagnosis of HPV infection. The identification and differentiation of these amplified gene segments is carried out by a hybridisation reaction with sequence-specific oligonucleotide probes that are immobilised on a DNA chip.

Taking and storing samples

  • Cervical smears
    Smears should only be taken using the special utensils from GREINER bio-one (available on request via the laboratory). Storage at room temperature for a short time, or better, refrigerate at 2-8 °C. Longer storage requires freezing at -20 °C.
  • Curettage material
    Must be cleaned immediately with 0.01 M of phosphate-buffered saline solution (pH 7.0 to 7.2). Then centrifugation (10-15 minutes at 269 g) at room temperature, then resuspension with “Vira Type specimen transport medium”. Storage as with cervical smears.
  • Biopsy material
    Immediately place in the „Vira Type specimen transport medium”. Storage over night at room temperature is possible; otherwise, freeze at -20 °C.

Recommended step-by-step diagnostics

  • HPV typing
    In the event of positive findings, you can request a follow-up HPV typing test.
    The following HPV genotypes are detected: 6, 11, 16, 18, 31, 33, 35, 39, 40, 42, 43, 44/55, 45, 51, 52, 53, 56, 58, 59, 66, 68, 70, 73 and 82.
  • High-risk HPV and E6/E7 mRNA measurement
    This test is used to distinguish between a transient and persistent infection with high-risk types of HPV.
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