A 52-year-old woman with a 30-pack-year smoking history presents with postmenopausal bleeding. Examination reveals a barrel-shaped cervical lesion extending to the upper vagina. Biopsy confirms squamous cell carcinoma. In the pathogenesis of cervical carcinoma in this patient, smoking acts primarily as which type of factor?

• A Promoter that impairs clearance of HPV infection ✓
• B Initiator causing direct DNA mutations in cervical epithelium
• C Cocarcinogen that integrates HPV DNA into the host genome
• D Immunosuppressant that destroys cervical Langerhans cells

Explanation

Cigarette smoking is a well-established cocarcinogen for cervical cancer. It impairs cell-mediated immunity, reducing the clearance of persistent HPV infection and increasing the likelihood of progression to CIN and invasive carcinoma. Smoking does not directly integrate HPV DNA nor does it destroy Langerhans cells; rather, it creates a milieu where HPV persistence is favored. The distinction between initiator and promoter is key: smoking promotes progression rather than initiating the malignant transformation.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.