*2.2.5. Cervical cancer*

level, then at the pelvis; finally, they migrate to distant areas. The hematogenous spread can

206 Human Papillomavirus and Related Diseases – From Bench to Bedside A Diagnostic and Preventive Perspective

Clinically, penile carcinoma initially manifests as an elevated papular-type or pustulous lesion that does not resolve with topical treatment and can evolve into an exophytic, polypous or infiltrating lesion (Figure 15). Erythematous and superficial lesions can also appear. They are usually located in the glans and less frequently in the balanopreputial sulcus. If the patient presents phimosis or if the lesion is under the prepuce or is evolved, it protrudes outside the prepuce. These patients can present initially with an inguinal-level adenopathic lesion resulting from an inflammatory or metastatic reaction. The lesions can be single or multiple,

**Figure 15.** Excrescent lesion on the penis, that after surgery, histological study confirmed penile cancer

sexual promiscuity, passive anal sex, anal fistulas and other less-relevant factors.

distant metastases that are uncommon upon initial diagnosis.

*2.2.4. Anal carcinoma*

The natural clinical evolution of the disease normally progresses through several stages. Initially a papillar lesion appears, gradually ulcerates and overinfects, affecting Buck's fascia and potentially invading the cavernous bodies [64]. In a second stage, the lesion disseminates via the lymphatic pathway, especially at the inguinal level. Finally, the disease produces

Anal carcinoma is not very frequent, representing 1 to 2% of digestive system cancers. Among the risk factors that influence the development and genesis of this cancer, in addition to human papillomavirus (fundamentally, Types 16, 18 and 31), are poor hygiene, chronic anal irritation, smoking, seropositivity for herpes virus, seropositivity for human immunodeficiency virus,

Generally, the most frequent type of anal carcinoma associated with papilloma virus is squamous or spinocellular carcinoma. There are also other types, such as basaloid, cloacogenic, basal-squamous, epithelioid, trasitional and mucoepidermoid cancer. As observed with cancer in other locations, there may be premalignant lesions with the potential for developing into

affect the lungs, liver, brain, pleura, bone, skin and other organs [63].

fixed or free and can become overinfected.

Cancer in the neck of the uterus is the second most common cancer in women (the first is breast cancer). Among the multiple causes related to the development of this neoplasia are smoking, immunosuppression, chlamydia infection, poverty, poor hygienic/dietary conditions, differ‐ ent dietary habits, diethylstilbestrol, promiscuity, early-age pregnancy and infection with human papillomavirus. Different types of human papillomavirus have been implicated in the development of cervical cancer. The most important types are 16, 18, 31, 33 and 45, and the first two are responsible for approximately 2/3 of all cancers in the neck of the uterus.

Cervical cancer can be prevented with cytologic techniques and by applying the Papanicolaou method. The objective is to establish an early diagnosis so that therapy can begin quickly; because the initial stages of this cancer are asymptomatic, frequent and exhaustive reviews are important [67].

As we have previously mentioned, the initial stages of cervical cancer do not produce symp‐ toms; however, when the tumor increases (Figure 16), women present abnormal vaginal bleeding that can occur between menstrual cycles, following sexual relations and after menopause, or the bleeding can prolong menstrual-bleeding periods [68]. Cervical cancer can also be associated with other symptoms, such as pelvic pain and dyspareunia, and it can increase flux and vaginal secretions.
