| Abstract | Karcinom endometrija zloćudna je novotvorina unutrašnjeg sloja maternice koji se u reproduktivnoj dobi žene ciklički zadebljava i ljušti pod utjecajem spolnih hormona – najčešće svaki mjesec. Najčešći je karcinom ženskog spolnog sustava. Prema službenim objavljenim podatcima za 2021. godinu/HZJZ, tijekom 2021. godine ukupno je od karcinoma endometrija oboljelo 5.810 žena što čini 18,40 % svih karcinoma te spada među četiri najčešća karcinoma u žena u našoj zemlji. Incidencija karcinoma endometrija približno iznosi 30.3/100,000 žena i ima tendenciju daljnjeg porasta. Drugi je najčešći karcinom u žena (iza karcinoma dojke) u dobi između 50 – 69 godina, a rizik obolijevanja raste sa životnom dobi. Oko 2/3 novotvorina javlja se u postmenopauzi, a tek oko 1/3 u razdoblju perimenopauze. Vrlo rijetko se nalazi u pacijentica mlađih od 40 godina.
Predisponirajući rizični čimbenici za nastanak karcinoma endometrija su: starija životna dob, dijabetes, hipertenzija, pretilost, dugotrajna estrogenska dominacija (npr. kod dugotrajnih izostanaka menstruacije, amenoreja i anovulacija), PCOS, tumori koji stvaraju estrogene, Turnerov sindrom, estrogensko (mono – estrogensko) nadomjesno liječenje, nuliparitet (nerotkinje), karcinom dojke, karcinom kolona, liječenje tamoksifenom, genetski čimbenici rizika, kao što je Lynchov sindrom itd.
Najznačajniji epidemiološki faktor je udruženost s dugotrajnom abnormalnom estrogenskom stimulacijom, bez kompenzirajuće gestagenske protuaktivnosti što pospješuje nekontrolirano dijeljenje stanica, smanjuje apoptozu i potiče malignu transformaciju endometrija.
Glavni simptomi endometralnog karcinoma su: nepravilna vaginalna krvarenja ( 80 – 90%), purulentni (gnojni) ili roskasti iscjedak, bolovi u donjem dijelu trbuha itd. Nenormalna vaginalna krvarenja najčešći su rani simptom endometralnog karcinoma. Krvarenja u postmenopauzi u 40 – 60% slučajeva izazivaju sumnju na karcinom endometrija. Rano otkrivanje karcinoma najvažniji je preduvjet za uspješno liječenje i suzbijanje trajnih neželjenih i fatalnih posljedica.
Redoviti godišnji ginekološki pregledi uvelike povećavaju vjerojatnost za pravovremeno otkrivanje i adekvatno liječenje. Ovisno o stadiju bolesti koji se definira na osnovu međunarodne FIGO klasifikacije ista se može liječiti operativnim zahvatom,
radioterapijom, kemoterapijom ili svime navedenim. Svrha pisanja ovog završnog rada je iznošenje i sažimanje elementarnih saznanja o karcinomu endometrija, njegovoj prevenciji, ranom otkrivanje te trenutno dostupnim metodama liječenja. |
| Abstract (english) | Endometrial cancer is a malignant neoplasm of the inner layer of the uterus, which in a woman's reproductive age cyclically thickens and peels under the influence of sex hormones – usually every month. It is the most common cancer of the female reproductive system. According to official published data for 2021/HZJZ, during 2021 a total of 5,810 women were diagnosed with endometrial cancer, which accounts for 18.40% of all cancers and is among the four most common cancers in women in our country. The incidence of endometrial cancer is approximately 30.3/100,000 womens and tends to increase further. After breast cancer, it is the second most common cancer in women between the ages of 50 and 69, and the risk of the disease increases with age. About 2/3 of neoplasms occur in postmenopause, and only about 1/3 in perimenopause. It is very rarely found in patients under the age of 40.
Predisposing risk factors for endometrial cancer are: older age, diabetes, hypertension, obesity, long-term estrogen dominance (e.g. in long-term absence of menstruation, (amenorrhea and anovulation), PCOS, tumors that produce estrogens, Turner's syndrome, estrogenic (mono- estrogen) replacement therapy, nulliparity (infertility), breast cancer, colon cancer, tamoxifen treatment, genetic risk factors, such as Lynch syndrome, etc.
The most significant epidemiological factor is the association with long-term abnormal estrogen stimulation, without compensating gestagenic counteractivity, which promotes uncontrolled cell division, reduces apoptosis and promotes malignant transformation of the endometrium. The main symptoms of endometrial cancer are: irregular vaginal bleeding (80 – 90%), purulent or rosy discharge, pain in the lower abdomen, etc. Abnormal vaginal bleeding is the most common early symptom of endometrial cancer. Postmenopausal bleeding in 40 – 60% of cases raises the suspicion of endometrial cancer. Early detection of cancer is the most important prerequisite for successful treatment and suppression of permanent unwanted and fatal consequences.
Regular annual gynecological examinations greatly increase the probability of timely detection and adequate treatment. Depending on the stage of the disease, which is defined on the basis of the international FIGO classification, it can be treated with surgery,
radiotherapy, chemotherapy or all of the above. The purpose of writing this thesis is to present and summarize elementary knowledge about endometrial cancer, its prevention, early detection and currently available treatment methods. |
