| Abstract | Rak vrata maternice (carcinoma cervicis uteri) je bolest koja sporo napreduje i
dugo vrijeme može ostati neprepoznata. Javlja se kada se stanice vrata
maternice promijene i počnu nekontrolirano rasti. Najčešći je malignom genitala
žene, a po smrtnosti je na drugome mjestu, odmah poslije raka dojke. Pojavljuje
se u 33% malignoma svih genitala, najčešće u mlađoj i srednjoj životnoj dobi
(spolno aktivne žene). Rizični čimbenici za nastanak raka cerviksa jesu
kronične upale – cervikovaginoze (infekcija klamidijom, HPV-om tip 6,11,16,18),
rano stupanje u spolne odnose (nezreli, tj. spljošteni epitel porcije),
promiskuitet, pušenje, manjkava seksualna higijena. S obzirom na postojeće
etiološke čimbenike, smatra se da je rak vrata maternice spolno prenosiva
bolest! U početnom stadiju bolesti nema simptoma, a kasnije se pojavljuje
pojačani iscjedak, kontaktno krvarenje nakon koitusa, te bolovi u odmaklom
stadiju karcinoma sa smetnjama mokrenja i defekacije.
Dijagnoza raka vrata maternice postavlja se na osnovi anamneze, ginekološkog
pregleda u spekulima i digitorektalno, zatim citološki (PAPA test) i kolposkopski.
Potrebno je učiniti cistoskopiju, rektoskopiju i intravensku urografiju.
Patohistološki najčešće je posrijedi planocelularni karcinom. U endocerviklanom
kanalu je isključivo adenokarcinom, koji se vrlo brzo širi kroz lateralne
parametrije i ima lošu prognozu.
Liječenje karcinoma cerviksa se sastoji od kirurške terapije i iradijacije. CIS
(carcinoma in situ) se liječi konizacijom (100% - tno izliječenje). I. i II. Stupanj
karcinoma cerviksa liječe se iradijacijom i kirurški, radikalnom operacijom po
Wertheimu, kojom se uz maternicu i adnekse, odstranjuju parametriji i limfni
čvorovi u maloj zdjelici. III. i IV. Stupanj raka cerviksa se liječe iradijacijom i u
rijetkim slučajevima radikalnom operacijom egzenteracije zdjelice sa
derivacijom urina i stolice (anus praeternaturalis i uretherocutaneostomia).
Prosječno petogodišnje preživljenje I. stupnja je oko 75%, II. Stupnja oko 50%,
III.stupnja raka vrata maternice oko 25%, a IV.stupnja 0 do 5%.
Prevencija raka vrata maternice provodi se zdravstvenim prosjvjećivanjem
mladih, upućivanjem u seksualnu higijenu, prekidanjem loših navika (pušenje
duhana), liječenje SPB u partnera, sistematskim pregledima žene generativne
dobi jedanput godišnje s PAPA testom, a u atipijama cerviksa i nekoliko puta
godišnje, ovisno o tipu displazije i liječenja. |
| Abstract (english) | Cervical cancer (carcinoma cervicis uteri) is a disease that progresses slowly
and for a long time can remain unrecognized. It occurs when cells of the cervix
become abnormal and start to grow uncontrollably. It is the most common
genital malignant among women, and by mortality in second place, immediately
after breast cancer. It occurs in 33% of all genital malignancies, mostly in young
and middle age (sexually active women). Risk factors for cervical cancer include
chronic inflammation – cervical vaginitis (infection with chlamydia, HPV type 6,
11, 16, 18), early practice of sexual intercourse (immature, i.e. Flattened
portions of the epithelium), promiscuity, smoking, deficient sexual hygiene.
Given existing etiological factors, it is considered that the cervical cancer is
sexually transmitted disease! In the initial stages of the disease there are no
symptoms, and later appears heightened discharge, contact bleeding after
coitus, and pain in the advanced stage of cancer with disabilities at urination
and defecation.
The diagnosis of cervical cancer raises the anamnesis, gynecological
examination speculum and rectal, then cytology (Papanicolaou test) and
colposcopy. It is necessary to do cystoscopy, intravenous urography and
rectoscopy. Pathohistologically, usually it is the case of squamous cell
carcinoma. In endocerviklanom channel exclusively adenocarcinoma, which
spreads very quickly through lateral parametrium and has a poor prognosis.
Treatment of cervical cancer consists of surgical therapy and irradiation. CIS
(carcinoma in situ) is treated with conization (100% - ly cure). I. and II. degree of
cervical cancer are treated with irradiation and surgery, radical operation by
Wertheim, which along with the uterus and appendages, removes the
parametrium and lymph nodes in the pelvic. III. and IV. degree of cervical
cancer are treated by irradiation and in rare cases, radical surgery with pelvic
exoneration derivation of urine and stool (anus and uretherocutaneostomia).
The average five-year survival rate of grade I is about 75%, II. Step about 50%
of III. degree of cervical cancer, about 25%, and od IV. degree from 0 to 5%.
Prevention of cervical cancer is conducted by medical educations for youth,
referring to sexual hygiene, breaking bad habits (smoking tobacco), treatment of
STDs in partners, medical examinations of women of childbearing age with an
annual Pap test, and in cervical atypia even few times a year, depending on the
type dysplasia and treatment. |
