Izhodišča: Polipi materničnega vratu so prisotni pri približno 10 % žensk. So najpogostejša sprememba materničnega vratu. Med seboj pa se razlikujejo po velikosti in obliki. Okoli 65 % jih ne ...povzroča simptomov, zato diagnozo postavimo ob rutinskem ginekološkem pregledu. Raziskave so pokazale, da je večina polipov benignih, le 0,1 % naj bi bilo malignih. Namen raziskave je bil opredeliti pojavnost klinično pomembnih polipov materničnega vratu pri ženskah s polipi, ki ne povzročajo simptomov, in ugotoviti, ali obstaja povezava med histološko diagnozo ter menopavznim statusom, velikostjo polipa in izvidom brisa PAP. Metode: Retrospektivno smo pregledali histopatološke izvide polipov, ki so bili odstranjeni pri ženskah brez simptomov in znakov, ki bi lahko bili povezani s prisotnostjo polipa. Pregledali smo obdobje treh let (1. 1. 2016 – 2. 11. 2018) v ambulantah v Leonišču, ki je del Univerzitetnega kliničnega centra Ljubljana. Zbrali smo podatke o starosti in menopavznem statusu žensk, številu porodov in splavov, številu odstranjenih polipov, velikosti odstranjenega polipa in morebitnem izvidu brisa PAP, če je bil le-ta odvzet v 6 mesecih pred odstranitvijo polipa. Polipe so pregledali patologi Ginekološke klinike Univerzitetnega kliničnega centra Ljubljana. Rezultati: V opazovanem obdobju smo v naši ustanovi odstranili 167 polipov materničnega vratu pri ženskah, ki niso imele težav. 82 (49,1 %) bolnic je bilo pred menopavzo, 17 (10,2 %) ob menopavzi in 68 (40,7 %) po menopavzi. Malignih sprememb nismo našli, identificirali pa smo 3 primere (1,8 %) klinično pomembnih sprememb: en polip z atipijami ter po en s CIN 1 in CIN 2. Zaključek: Menimo, da je odstranitev vseh polipov materničnega vratu smiselna, tudi če le-ti ne povzročajo težav. Postopek odstranitve je preprost, saj ga lahko opravimo ambulantno, anestezija ni potrebna, zapleti po posegu pa so redki. Povezave med velikostjo polipa in brisom PAP ter histološkim izvidom nismo našli. Glede na podatke, ki jih pridobimo s kliničnim pregledom ter z brisom PAP torej ne moremo sklepati, ali gre za klinično pomemben polip ali ne. Histološka opredelitev je edina, ki nam lahko z zagotovostjo potrdi, da ne gre za nevarne spremembe.
Background: Development of the laparoscopic techniques for surgical treatment of pelvic malignancies was stepwise. Since the laparoscopic pelvic lymphadenectomy is accepted as standard pro- cedure, ...other advantages of laparoscopic surgery are still being valutated. Methods: The purpose of this review is to present the available information about the role of lap- aroscopy in management of early cervical cancer found in literature and to present our experiences on this issue. Results: The role of laparoscopy in the management of cervical cancer is to some extent best defined as adjuvant procedure; ie laparoscopic pelvic lymphadenectomy, to vaginal surgery; coni- sation, trachelectomy and radical vaginal hysterectomy. In literature reports of advanced laparoscopic procedures, specifically laparoscopic radical hysterectomy, are increasing in recent years, demonstrating the potential of this surgical technique. The limitation present long learning curve for advanced laparoscopic surgical radical procedures at cervical cancer and cost of endoscopic tools, that facilitate the procedure. Conclusions: Laparoscopic surgery is step by step overgrowing the role of adjuvant procedure to vaginal surgery for cervical cancer, which may represent one of the greatest challenges in the future gynecological oncological surgery.
Background. To establish the distribution of human papillomavirus (HPV) genotypes in representative population of women with cervical cancer (CC) in Slovenia in order to contribute the lacking data ...on HPV in CC and to assess the potential local benefit of future prophylactic HPV vaccination. Furthermore, we wanted to determine genomic variants of the most common HPV genotypes. Methods. Polymerase chain reaction with GP5+/GP6+ primers was performed in all 278 CC samples for HPV DNA detection and genotyping. Negative samples were additionally tested using CPI/CPIIg primers and INNO-LiPA HPV genotyping assay. Genomic variants of HPV 16, HPV 18 and HPV 33 were determined by sequencing of LCR, E6 and E7 genetic regions. Results. A total of 262/278 CC samples (94.2 %) were HPV DNA positive. HPV genotypes in Slovenian women with CC, in decreasing order of frequency, were: 16, 18, 33, 45, 31, 51, 58, 59, 35, 52, 73 and 82. Detailed genomic analysis was carried out on 40/178 isolates of HPV 16, 20/34 isolates of HPV 18 and 11/13 isolates of HPV 33. A total of 26 genomic variants of HPV 16 were identified. Thirty-eight isolates (95 %) belonged to the European branch; one isolate (2.5 %) belonged to the Asian-American branch and one (2.5 %) to African branch.1, 2 A total of 18 genomic variants of HPV 18 were identified. Nineteen isolates (95 %) belonged to the European branch and one isolate (5 %) belonged to the African branch.2, 3 Seven genomic variants of HPV 33 were identified. Five isolates (45.5 %) belonged to prototypic variants and 6 (54.5 %) belonged to non-prototypic variants.4 Conclusions. Distribution of all HPV genotypes in Slovenian women with CC was in the present study established for the first time and represents baseline distribution before mandatory HPV vaccination. Prophylactic HPV vaccination with currently available vaccines could prevent up to 77.1 % of CC in Slovenia caused by HPV 16 or HPV 18. Almost all isolates of HPV 16 and HPV 18 belonged to European branches; prototypic and non-prototypic HPV 33 variants were almost equally distributed among Slovenian patients with CC.
THE EFFECT OF EARLY CERVICAL CANCER DIAGNOSIS Herman Haller; Maja Krašević; Ozren Mamula ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Letnik:
78
Journal Article
Recenzirano
Odprti dostop
Background: Treatment effectiveness and clinical outcome of patients with cervical carcinoma FIGO stage IA1 and IA2 are analyzed in three different time period at the Department of Obstetrics and ...Gynecology Rijeka, Croatia. Method: Retrospective analysis of the hospital chart of all cervical cancer patients between 1991 and 2005 was conducted with five-year follow up. Results: Data on cervical cancer distribution by stage and five-year survival are presented. Separately analyzed age, histology type and treatment modalities in stage FIGO IA1 and IA2 during three consecutive five-year periods are presented. Conclusions: Conservative surgical approach – conization alone in stage IA1 of the squamous cell car- cinoma is reasonable and safe treatment option for reproductive active women. During observed periods conization became the most used surgical technique applied in almost two third of FIGO IA1 cervical cancer patients. Lymph vascular space invasion in stage IA1 lead to adjunct pelvic lymphadenectomy with unclear clinical benefit. In cervical cancer patients stage IA2 simple hysterectomy and pelvic lymphadenectomy could be accepted as a standard treatment. In these patients further studies are recommended to evaluate other less radical surgical techniques – simple and radical trachelectomy with or without pelvic lymphadenectomy. Radical hysterectomy in both stages IA1 and IA2, based on personal experience and literature data represents a surgical overtreatment and should be abandoned.
HPV AND CERVICAL CANCER PREVENTION Marjetka Uršič-Vrščaj; Milan Bašković; Sonja Bebar ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Letnik:
78
Journal Article
Recenzirano
Odprti dostop
Background: The causal role of human papilloma virus (HPV) in all cancers of the uterine cervix has been firmly established biologically and epidemiologically. HPV types 16 and 18 account for about ...70 % of the cases worldwide. HPV has been recognized as a necessary cause of cervical cancer, meaning that in the absence of the persistent presence of HPV DNA in the cervical cells, cervical cancer will not occur. Thus preventive strategies based on HPV testing in screening programmes or HPV type-specific vaccination are based on solid ground. Most cancers of the vagina and anus are likewise caused by HPV 16, as are a siteable fraction of cancers of the vulva, the penis and the oropharynx. Cervical cancer screening can be a highly effective secondary intervention. In the developing countries these programmes are either not available or are ineffective. HPV vaccination represents the most effective intervention in that scenario. Prophylactic vaccination with human papillomavirus (HPV) virus-like particle (VPL) vaccines against HPV 16 and HPV 18, has transformed our prospects for reducing the in- cidence of cervical cancer on global scale. HPV vaccines are immunogenic, well tolerated and show remarkable efficacy. Screening will have to continue, as two of the 15 oncogenic HPV types are in the vaccines and for two to three decades at least unvaccinated sexually active women still remain at risk for the disease. Conclusions: If vaccination, screening and HPV testing are combined then the virtual elimination of cervical cancer is possible.
Background: In Slovenia a national screening programme for early detection of cervical cancer (ZORA) was introduced in 2003. The efficiency of the screening programme requires an evaluation of ...cytology findings of cervical smears, and of the agreement between cytology findings and histologic findings of a biopsy specimen and of the tissue taken during surgery. Methods: We collected the cytology findings of cervical smears taken at the outpatient gynecology clinic Skofja Loka in the years 2006, 2007 and 2008, and compared them to the Slovene averages, and we analyzed the histologic findings of all biopsies and of the tissue samples obtained during surgery in the same years. Results: The findings of cervical smears are comparable to Slovene averages. Specific are a high percentage of cervical smears with atypical squamous cells and few reactive changes, which resulted in a higher percentage of repeated smears. In the 3-year period a cervical biopsy was performed in 144 women: in 111 cases (77.0 %) the result of cervical biopsy was abnormal. Histologic findings of biopsies agreed well with histologic findings of tissues taken during surgery. Conclusions: Early detection and treatment of precancerous lesions and early forms of cervical cancer may lead to a further decrease in the incidence and mortality from cervical cancer. A con- stant analysis of our results helps us in making appropriate decisions both for a cervical biopsy and for the type of treatment.
Biološka označevalca p16 in Ki-67 sta posredna pokazatelja okužbe s humanimi papiloma virusi z velikim tveganjem (HPV-VT), ki so povezani z nastankom predrakavih sprememb na materničnem vratu. V ...diagnostično težavnih primerih ju lahko uporabimo za razlikovanje cervikalne intraepitelijske neoplazije od morfološko podobnih neneoplastičnih sprememb. Določamo ju lahko s standardnimi imunohistokemičnimi metodami na tkivnih rezinah bioptičnih vzorcev materničnega vratu. Pri vsakdanjem histopatološkem ocenjevanju bioptičnih vzorcev materničnega vratu z dodatnim imunohistokemičnim barvanjem na p16 in Ki-67 največkrat izključimo cervikalno intraepitelijsko neoplazijo visoke stopnje (CIN2 in CIN3), kar prepreči pretirano zdravljenje sprememb na materničnem vratu. Tak diagnostični pristop je uporaben tudi za histopatološko ocenjevanje intraepitelijskih neoplastičnih sprememb endocervikalnega žleznega epitelija.
Rak materničnega vratu (RMV) se razvije prek več stopenj predrakavih sprememb in ga je z učinkovitim presejalnim programom mogoče preprečiti oz. odkriti in v zgodnjem stadiju uspešno zdraviti. Spolno ...prenosljiva okužba z visokotveganimi genotipi človeških virusov papiloma (angl. human papillomavirus, HPV) je nujni dejavnik tveganja za nastanek predrakavih sprememb na materničnem vratu in RMV. Pred uvedbo cepljenja proti HPV smo želeli opredeliti razporeditev genotipov HPV pri bolnicah z RMV in bolnicah s predrakavimi spremembami najvišje stopnje (CIN 3) v Sloveniji. Razporeditev genotipov HPV smo analizirali na 284 vzorcih RMV. HPV dezoksiribonukleinsko kislino (DNK) smo dokazali v 262 od 278 vzorcev RMV (94,2 %). Ugotovili smo, da RMV najpogosteje povzročajo HPV 16, HPV 18 in HPV 33. Razporeditev genotipov HPV smo določili tudi na 261 vzorcih brisov materničnega vratu, odvzetih ženskam s CIN 3. V 253 od 261 vzorcev CIN 3 (96,9 %) smo dokazali prisotnost HPV DNK. V 80,6 % vzorcev smo našli le en visokotvegani genotip, v drugih vzorcih smo našli po več genotipov HPV (2 do 9 genotipov). Pri ženskah s CIN 3 so bili najpogosteje zastopani HPV 16, HPV 31 in HPV 33. Profilaktično cepljenje s trenutno dostopnimi cepivi proti HPV bi lahko preprečilo do 77 % primerov RMV in do 60 % primerov CIN 3 v Sloveniji, ki ju povzročata HPV 16 in HPV 18.
