Introduction:

Previously attributed to older group of women , carcinoma of cervix is increasingly seen in young , unmarried girls.It is the second most frequently diagnosed cancer in women worldwide after breast cancer.

About 80% of the cases are seen in developing countries.It is attributed to    multiparity, child marriage (early sexual contact), poor socio-economic status, lack of standardised screening.

Clinical presentation:

A female 20years old, unmarried presented with irregular bleeding/spotting per vaginum since 6 months. On speculum examination,a cauliflower like mass of about 3x2 cms was seen occupying the whole external Os. On bimanual  and rectal examination it was  staged IIa ( FIGO-growth in cervix and not in parametrium). HPE revealed squamous cell carcinoma (large cell undifferentiated).

Considering the benefit of surgery in this case,extensive laparoscopic hysterectomy with bilateral salpingo -oophorectomy with generous excision of vaginal tissue was performed without any untoward incident. Post-op radiation was given.

Post- hysterectomy, hot flushes was prominent in just 3 months. Life expectancy was prolonged and likely to be cancer free after a year of surgery.

Discussion:

HPV infection is present in 99.7% of all cervical cancer.HPV is a nonenveloped,double-stranded DNA virus.High risk HPV types 16,18,31,33,35,45,52 and 58 are associated with 95% of squamous cell carcinoma, HPV 18 is commonly linked with adenocarcinoma.

Pap smear has significantly reduced mortality and morbidity rates by early and correct diagnosis of even carcinoma-in-situ. Prompt treatment by radiation or surgery has extended the life expectancy worldwide.

Squamous cell carcinoma followed by adenocarcinoma is the commonest type. With obvious exophytic lesions,cervical biopsy is all that is needed  for histological confirmation.If a definite diagnosis cannot be made on the basis of office biopsies, cervical conization may be necessary.The disease can be spread by direct extension,lymphatic spread,haematologic metastases.

Conclusion:

Spread frequently among sexually active females irrespective of age group, HPV infection is preventable by practising safe sex( increased rate is seen among those having multiple sexual partners), routine screening protocol (PAP smear),prompt medical assistance for any STD’s, educating and counsel long especially among those in developing countries. My personal opinion is,revision of Office screening protocols be made mandatory by all healthcare professionals to women who are sexually active. Early detection of cervical cancer and prompt treatment will drastically reduce the mortality and morbidity rates in women especially in the developing countries.Government sponsored screening tests be made mandatory and strictly adhered by the population will reduce the mental and physical trauma .