Not All Cervical Cancers Are Caused by HPV: The Danger of Gastric-Type Adenocarcinoma

Cervical cancer has long been identified with Human Papillomavirus (HPV) infection, making screening programmes such as HPV tests and Pap smears the primary weapons for early detection. However, not all cervical cancers develop due to HPV. One subtype that warrants attention is gastric-type adenocarcinoma (GAS), a rare but highly aggressive form of cervical cancer. Unlike the majority of cervical cancers, GAS is not associated with HPV infection, meaning it often goes undetected through conventional screening methods. Information released by Universitas Airlangga highlights that this condition poses a distinct challenge for the medical community, as many cases are only discovered when the disease has already reached an advanced stage. Typically, HPV tests and Pap smears can help detect cellular changes that may develop into cervical cancer. However, because gastric-type adenocarcinoma does not develop through HPV-related pathways, screening results can appear normal even when cancerous cells are already growing. Consequently, patients often remain unaware of the disease until symptoms emerge and increasingly disrupt daily activities. This makes early diagnosis considerably more difficult compared to HPV-related cervical cancers. Based on a systematic review of 59 studies involving 150 patients from various countries, the average age at first diagnosis is 52.8 years. The most common symptoms include abnormal vaginal bleeding and watery discharge. However, early signs of the disease are often non-specific and mild. Due to these vague symptoms, many patients only seek medical attention when the cancer has progressed to a more advanced stage. The research also indicates that gastric-type adenocarcinoma carries a fairly high risk of recurrence, with approximately 28.7 per cent of patients experiencing a return of the cancer after treatment. The spread of the cancer commonly affects various organs, including the lungs, liver, and peritoneum. The five-year survival rate for patients is recorded at only about 26.7 per cent, demonstrating that GAS has a higher level of malignancy compared to many other types of cervical cancer. Microscopically, gastric-type adenocarcinoma exhibits characteristics resembling gastric tissue. Therefore, doctors cannot rely solely on routine examinations to confirm a diagnosis. Immunohistochemical tests using markers such as MUC6, CK7, and p53 are often required to identify the disease more accurately. However, access to these advanced diagnostic facilities is not evenly distributed, particularly in certain regions and developing countries. This limited access to diagnostic technology is one of the factors contributing to the frequent delays in recognising GAS cases. In terms of management, radical hysterectomy remains the primary option for patients diagnosed at an early stage. However, a significant challenge arises because this type of cancer is known to have a lower response to conventional chemotherapy and radiotherapy compared to HPV-associated cervical cancers. This situation underscores the need for more specific and targeted therapeutic approaches tailored to the biological characteristics of the disease. Researchers also believe that the development of new therapies based on molecular research is a crucial step towards improving treatment effectiveness in the future. Although classified as rare, gastric-type adenocarcinoma serves as a reminder that not all cervical cancers can be detected through HPV screening or Pap smears. Therefore, women experiencing symptoms such as abnormal vaginal bleeding or prolonged discharge are still advised to consult a medical professional, even if their HPV test results are negative. Increased clinical vigilance, strengthened diagnostic services, and further research into this disease are expected to help accelerate diagnosis and improve patient survival chances.