| Sažetak | Cilj istraživanja: Cilj istraživanja je bio ispitati pojavnost i naĉine liječenja oboljelih od IA stadija raka materničnog vrata (RMV) u Klinici za ženske bolesti i porode u KBC-u u Splitu u trinaestogodišnjem razdoblju (od 1. 1. 2000. do 1. 1. 2014.).
Materijal i metode: Retrospektivnom analizom, trinaestogodišnjeg razdoblja (od 1. 1. 2000. do 1. 1. 2014.), povijesti bolesti operiranih zbog IA stadija raka materničnog vrata u Klinici za ženske bolesti i porode u KBC-u u Splitu, ispitan je: broj operiranih, dob u trenutku operacije, patohistološka dijangoza, stadij bolesti (IA1 /IA2), limfokapilarna invazija (LKI), status rubova i vrha konizata te ukupan broj konizacija, histerektomija i radikalnih operacija.
Rezultati: Od ukupno 66 bolesnica operiranih zbog RMV-a stadija IA, 51 bolesnica imala je stadij IA1, a 15 bolesnica imale su stadij IA2. Najmlađa bolesnica s dijagnozom raka materničnog vrata stadija IA imala je 26 godina u trenutku operacije, a najstarija 76 godina. Srednja dob bolesnica bila je 46,29 godina u trenutku operacije. Planocelularni karcinom materničnog vrata dijagnosticiran je kod 55 (83,33 %) operiranih bolesnica, adenokarcinom dijagnosticiran je kod devet (13,64 %) bolesnica, multicentrični karcinom klara stanica dijagnosticiran je kod jedne (1,52 % ) bolesnice, adenoskvamozni karcinom dijagnosticiran je kod jedne (1,52 %) bolesnice. Pozitivnu limfokapilarnu invaziju (LKI) imalo je pet operiranih bolesnica s histološkom slikom planocelularnog karcinoma i jedna adenokarcinomom. Pozitivnu LKI imale tri bolesnice sa stadijem IA1 i tri bolesnice sa stadijem IA2. Podaci o zahvaćenosti rubova u trenutku operacije postoje kod 36 bolesnica. Slobodni rubovi konizata zabilježeni su kod njih 27. Zahvaćenost rubova zabilježena je kod tri bolesnice. Zahvaćenost udaljenosti < 2mm od ruba zabilježena je kod četiri bolesnice. Zahvaćenost udaljenosti ≥ 2mm od ruba zabilježena je kod tri bolesnice. Zahvaćenost vrha konizata zabilježena je kod dvije bolesnice. Najviše zahvaćenih rubova na konizatima zabilježeno je kod planocelularnih karcinoma stadija IA1, zatim adenokarcinoma stadija IA1. Od ukupno 66 zahvata, učinjena je 31 konizacija, 26 histerektomija i devet radikalnih Piver II operacija.
Zaključci: RMV pogađa široku dobnu skupinu od adolescentica do žena u postmenopauzi. Većini bolesnica dijagnosticira se mikroinvazivni (IA1) RMV histološkog tipa planocelularnog karcinoma. Drugi najčešće dijagnosticiran histološki tip tumora bio je adenokarcinom, kod devet bolesnica. LKI zabilježena je kod samo šest bolesnica; tri stadija IA1 i tri stadija IA2. Stanje rubova konizata zabilježeno je kod svega 36 pacijentica. Slobodni su bili kod njih 27. Najvažniji parametar za određivanje vrste konačnog zahvata bio je stadij (IA1 ili IA2). Najčešće korišten zahvat bila je konizacija, zatim histerektomija, a najrjeđe radikalna operacija. Od ukupno 66 zahvata, učinjena je 31 konizacija, 26 histerektomija i devet radikalnih Piver II. Najvažniji napredak u liječenju očekuje se u primjeni HPV cjepiva. |
| Sažetak (engleski) | Objectives and background: The objectives of this thesis were to determine the occurrence and different modalities of treatment of stage IA cervical cancer (CC) at the Clinic for women’s disease and labor, University Hospital of Split, during a thirteen year period.
Materials and Methods: The medical history of all women that underwent surgery upon diagnosis of stage IA cervical cancer during the thirteen year period from Jan, 1st 2000 to Jan, 1st 2014 at the Clinic for women’s disease and labor, University Hospital of Split, had been retrospectively reviewed. The following parametres had been analysed: the number of patients that underwent surgery, the patient's age during surgery, the pathohistological diagnosis, the stage of the tumor (IA1 /IA2), lymphovascular space involvement (LSI), cone-biopsy margin status (CBMS) and the sum of all conisations, hysterectomies and radical Piver II operations.
Results: Out of 66 patients that underwent surgery due to stage IA CC, 51 were diagnosed with stage IA1 and 15 with stage IA2. The youngest patient was 26 years old during surgery, and the oldest was 76. The mean age during surgery was 46,29 years. 55 (83,33 %) patients were diagnosed with squamous cell cervical cancer (SCC), nine (13,64 %) were diagnosed with adenocarcinoma (AC). One (1,52 % ) patient was diagnosed with multicentric clara-cell carcinoma (MCC) and one (1,52 % ) patient was diagnosed with adenosquamous (ASC) cell carcinoma. Five patients diagnosed with SCC and one patient diagnosed with AC had positive LVI. Three stage IA1 patients and three stage IA2 patients had positive LVI. The CBMS was mentioned in the medical history of 36 patients. Clear margins were noted in 27 patients. The cone-biopsy margins were affected in three patients. The affected distance from the margins < 2 mm was noted in four patients. The affected distance from the margins ≥ 2 mm was noted in three patients. The cone-biopsy apex was affected in two patients. Cone-biopsies belonging to patients diagnosed with stage IA1 SCC had the highest rates of affected margins. The second-highest rates belong to stage IA1 AC. Out of the 66 surgical procedures, 31 were conisations, 26 were hysterectomies and nine were radical Piver type II operations.
Conclusions: CC affects a large age group, from adolescents to postmenopausal women, most diagnosed with stage IA1 SCC. LVI was noted in six patients. The stage of disease IA1 or IA2 determines the surgical procedure. CBMS was mentioned in the medical history of 36 patients, of which 27 had clear margins. The most common surgical procedure practised in treatment of stage IA CC was conisation and subsequently hysterectomy. Radical Piver type II was the least common method. Out of the 66 surgical procedures, 31 were conisations, 26 were hysterectomies and nine were radical Piver type II operations. The most progress in treatment is expected from the application of an HPV vaccine. |
