Previously, the cause of cervix cancer is unknown definitely, but 95% of cases are gotten HPV (Human Pappiloma Virus). Recently, by basic of etiology and its carcinogenesis have be agreed by worldwide that as the etiology of cervix cancer is high risk oncogenic of Human Papilloma Virus infection especially of HPV-16 and HPV-18.. But the influence of parity, smoking, and socioeconomic cultural can not be neglected fully yet.
As the etiology of Cervix cancer, HPV infection does not give sign that the viral be present in the blood, but the infection walk sub clinical or without symptom, and just after 12 – 15 years will appear cervix cancer. Before appear cervix cancer signs, will be begun by cervix lesion in displasia form that constitute the cervix pre cancer lesion.
Until at this time, expert have been identified more than 100 types of HPV that are spread in all of world where distribution of each type in each state are differences. For examples, HPV-16 is distributed more in Europe than HPV-18, but a moment in Asia the proportion of HPV-18 is distributed more than HPV-16. Gen early region that product on co-protein E6 and E7 very beneficial on cellular transformation and cell immortalization. Two genes L1 and L2 that are coding cap-side virus are responsible for assembling of new virus.
Natural pathogenesis of HPV infection, that HPV is epidermofitic characteristic to attack epithelial cell and mucous included epithelial of cervix. More than 50% the women who has sexual active suffer HPV infection during her life and a big part constitute HPV infection that caused low grade squamous intra epithelial lesions (L-SIL), where will become spontaneous regression or not progress become cancer. HPV is transmitted particularly by sexual connection, besides transmission by hand genital and oral genital. Maybe need once contact only which will cause infection at a month post sexual connection.
HPV infection cause L-SIL or Cervical Inter epithelial Neoplasm (CIN) 1 where will occur 57% regressions, 32% persistent, 11% progress become carcinoma in situ (CIS) and 1% progress become invasive cervix cancer. A temporary on CIN 2 be found 43% regressions, 35% persistent, 22% CIS and 5% Invasive cervix cancer. But on CIN 3 be found 32% regressions, 56% persistent, no indicate CIS be present and 12% invasive cervix cancer. So that, 15 â€“ 20% HPV infection will develop become invasive cervix cancer as the consequence of natural defense mechanism power.
The change of cell that is consequent by HPV infection is displasia that is differentiated upon: mild displasia, moderate and severe. According to Bethesda, change of that cell be differentiated above LSIL (Low grade Squamous Intra epithelial Lesions) and HSIL (High grade Squamous Intra epithelial Lesions).