# Cervical Cancer

> Cervical cancer for NEET-PG: HPV 16 and 18, E6 and E7 oncoproteins, CIN grading, Pap smear and HPV screening, and current vaccination guidance.

- Canonical URL: https://prepelephant.com/topics/neet-pg/pathology/cervical-cancer
- Exam / course: NEET-PG · Subject: Pathology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Cervical Cancer", PrepElephant, https://prepelephant.com/topics/neet-pg/pathology/cervical-cancer

## Direct answer

Cervical cancer is a human papillomavirus-driven malignancy in which viral oncoproteins disable the two great tumour suppressors: E6 degrades p53 and E7 inactivates Rb. HPV 16 and 18 together cause about 70 per cent of cases — type 16 predominating in squamous cell carcinoma, with 18 strongly linked to adenocarcinoma. Because it evolves slowly through cervical intraepithelial neoplasia, cervical cancer is the most screenable and vaccine-preventable cancer, which is the theme of most modern exam questions.

## What you must remember

- **E6 and E7:** E6 directs proteasomal degradation of p53, and E7 inactivates retinoblastoma protein, freeing E2F-driven cell-cycle entry — the most tested pair in this topic.
- **HPV types:** 16 and 18 cause about 70 per cent of cancers worldwide; 31, 33 and 45 come next; types 6 and 11 cause condylomas and low-grade lesions, not cancer.
- **Precursor spectrum:** koilocytic atypia and CIN 1 (low-grade, often regressing) progress through CIN 2 and 3 (high-grade, treatment warranted) over years; adenocarcinoma in situ is the glandular precursor.
- **Morphology and spread:** squamous cell carcinoma predominates, exophytic at the transformation zone; spread is direct into parametrium, then lymphatic to obturator and iliac nodes, with haematogenous spread late.
- **Screening:** Pap smear showing koilocytes, visual inspection with acetic acid in programme settings, and HPV DNA testing — recommended by WHO as the primary screen from age 30.
- **Vaccination:** prophylactic L1 virus-like particle vaccines, including India's indigenous quadrivalent CERVAVAC, given as two doses to girls aged 9 to 14 before sexual debut; WHO's 90-70-90 strategy targets vaccination, screening and treatment coverage by 2030.

## Common confusion

E6 versus E7 is the classic memory trap: E6 pairs with p53 and E7 with Rb. The second confusion is lesion grade — CIN 1 with koilocytosis reflects productive viral infection that mostly regresses, whereas CIN 2 and 3 are true neoplasia requiring treatment. Finally, vaccination and screening are complementary, not alternatives: vaccines prevent new infection but neither treat established lesions nor replace screening in vaccinated populations.

## Exam-focused takeaway

NEET-PG questions test the E6-p53 and E7-Rb pairing, the HPV type associations (16 with squamous carcinoma, 18 with adenocarcinoma, 6 and 11 with warts), the CIN-to-invasion natural history, and koilocyte recognition on cytology. Programme-level stems ask for the primary screening modality (HPV DNA testing per WHO), the vaccine schedule for girls aged 9 to 14, and the 90-70-90 elimination targets; clinical vignettes feature postcoital bleeding in a young woman. The same facts earn marks in pathology, gynaecology and community medicine.

## Frequently asked questions

### How does HPV cause cervical cancer?

E6 degrades p53 and E7 inactivates retinoblastoma protein, jointly disabling apoptosis and cell-cycle control; persistent high-risk infection then drives CIN and invasion.

### Which HPV types cause cervical cancer?

Types 16 and 18 cause about 70 per cent of cases, then 31, 33 and 45; types 6 and 11 cause warts, not cancer.

### What is the difference between CIN 1 and CIN 2-3?

CIN 1 is a low-grade productive viral lesion that usually regresses; CIN 2 and 3 are high-grade neoplasia with real progression risk, requiring treatment.

### What is the current screening approach?

WHO recommends HPV DNA testing as the primary screen from age 30; Pap cytology and visual inspection with acetic acid are alternatives; positives go to colposcopy.

### Who should receive the HPV vaccine and in what schedule?

Girls aged 9 to 14 before sexual debut, two doses; India's indigenous quadrivalent CERVAVAC uses the 0 and 6 month schedule.

### What are the WHO 90-70-90 targets?

By 2030 — 90 per cent of girls vaccinated by 15, 70 per cent of women screened by 35 and 45, and 90 per cent of affected women treated.