| Abstract | Karcinom vrata maternice četvrto je najčešće sijelo i četvrti najčešći uzrok smrti od raka u žena u svijetu. Razvoj gotovo svih slučajeva posljedica je perzistentne infekcije jednim od humanih papilomavirusa visokog onkogenog rizika, koja će se nakon primoinfekcije razviti u tek oko 10% žena. Unutar nekoliko godina, samo 1 do 2% perzistentnih infekcija progredirati će u preinvazivnu leziju, a tek manji broj preinvazivnih lezija tijekom određenog perioda u karcinom vrata maternice. Faktori rizika za razvoj karcinoma su rizično spolno ponašanje, veći broj porođaja, infekcije s drugim spolno prenosivim uzročnicima, dugotrajna uporaba oralne hormonske kontracepcije i pušenje. S obzirom na utvrđenu etiopatogenezu i činjenicu da se razvija u dugačkom periodu i do 20 godina ili više, karcinom vrata maternice lako je dostupan kontroli i prevenciji. Prevencija pritom podrazumijeva provođenje različitih aktivnosti primarne, sekundarne i tercijarne razine kako bi se spriječio njegov razvoj te umanjio utjecaj na kvalitetu života i životni vijek. Metode primarne prevencije su pravodobna i kontinuirana zdravstvena edukacija te primjena jednog od tri trenutno dostupna cjepiva – dvovalentnog HPV 16/18 cjepiva Cervarix®, četverovalentnog HPV 6/11/16/18 cjepiva Gardasil® ili deveterovalentnog HPV 6/11/16/18/31/33/45/52/58 cjepiva Gardasil®9. Sekundarna se prevencija odnosi na detekciju i adekvatno zbrinjavanje preinvazivnih lezija i ranih karcinoma. Uz konvencionalnu cervikalnu citologiju ili ″Papa-test″ kao standardni test probira, za detekciju su na raspolaganju i tekućinska citologija, proširena kolposkopija i molekularno HPV testiranje. Pozitivan se rezultat testa probira može potvrditi biopsijom, endocervikalnom kiretažom ili dijagnostičkom konizacijom, a za liječenje su dostupne različite lokalno destruktivne i ekscizijske metode. Tercijarna prevencija karcinoma vrata maternice podrazumijeva liječenje invazivnih lezija kirurški, radioterapijom ili kemoterapijom kako bi se spriječile komplikacije i pogoršanje bolesti te očuvala kvaliteta života i životni vijek žena. |
| Abstract (english) | Cervical cancer represents the fourth most common cancer site, as well as the fourth most frequent cause of death in women. In almost all cases, the cancer develops due to a persistent infection by a high-risk human papillomavirus, following an initial infection in about 10% of the infected women. Within several years, only 1-2% of persistent infections progress into cervical precancerous lesions, while only a small number of precancers later progress into cervical cancer. Risk factors related to the development of cervical cancer include risky sexual behavior, several full-time pregnancies, infections by other STD agents, long-term use of oral hormonal contraceptives, and smoking. Considering that its etiopathogenesis has been identified and that it takes a long time to develop, the disease can easily be managed and prevented. In this sense, various measures can be taken with regard to primary, secondary, and tertiary prevention in order to stop the cancer from developing and to diminish its impact on the quality and duration of life. Primary prevention methods include early and sustained health education and the use of one of the three available vaccines: Cervarix®, a bivalent HPV 16/18 vaccine; Gardasil®, a quadrivalent HPV 6/11/16/18 vaccine, and Gardasil®9, a 9-valent HPV 6/11/16/18/31/33/45/52/58 vaccine. Secondary prevention aims to detect and adequately treat cervical precancer and early cancer. Apart from the commonly used cervical cytology or the ″Pap smear″, which is the standard screening method, other detection methods include liquid-based cytology, expanded colposcopy and molecular HPV testing. A positive screening test result can be confirmed by means of biopsy, endocervical curettage, or diagnostic conization, while the available treatment methods include various local destructive and excisional methods. Tertiary cervical cancer prevention is based on the treatment of invasive lesions by surgery, radiation, or chemotherapy in order to prevent complications and an aggravation of the disease, as well as to ensure a good quality and duration of life of women. |
