Očuvanje plodnosti liječenih od preinvazivnih lezija i raka endometrija

master's thesis

• Title (english): Fertility-sparing treatment of preinvasive lesions and endometrial cancer
• Author: Ivana Vukičević
• Mentor: Goran Vujić (mentor)
• Committee member: Ratko Matijević (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Goran Vujić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Oncology

Abstract

Rak endometrija jedan je od najčešćih ginekoloških karcinoma, s preko 380000
dijagnosticiranih slučajeva 2018. godine u svijetu. Dok se većina slučajeva
dijagnosticira u postmenopauzalnih žena, 3-14% slučajeva dijagnosticira se u žena
mlađih od 40 godina. Naime, povećanjem incidencije rizičnih faktora među mlađim
ženama, kao što su pretilost i anovulacijska stanja, raste incidencija raka endometrija
u toj dobnoj skupini. Mnoge žene u reproduktivnoj dobi žele očuvati plodnost i ostvariti
trudnoću, zbog čega standardni postupak histerektomije i obostrane
salpingoovarijektomije nije prihvatljiva metoda. U tim slučajevima, razmatra se
konzervativno liječenje u svrhu očuvanja plodnosti. Konzervativno liječenje
preinvazivnih lezija i raka endometrija u žena koje žele očuvati plodnost je učinkovita i
sigurna metoda za pacijentice sa složenom atipičnom hiperplazijom i dobro
diferenciranim endometrioidnim tipom raka endometrija ranog stadija, sa dokazanim
odsustvom invazije miometrija i širenja bolesti izvan maternice. Najčešće korištena
vrsta terapije je terapija sintetskim progesteronima, progestinima. Međutim, ne postoji
određena optimalna doza i trajanje terapije progestinima. Praćenje pacijentica tijekom
liječenja preporučuje se provoditi histološkom analizom endometrija svaka 3 mjeseca
do postizanja potpunog odgovora. Uzevši u obzir visoku stopu povratka bolesti,
preporuča se pokušati ostvariti trudnoću odmah nakon postizanja potpunog odgovora
na liječenje te učiniti histerektomiju nakon uspješne trudnoće. U najvećem broju
slučajeva trudnoća se ostvaruje uz metode medicinski potpomognute oplodnje.

Abstract (english)

Endometrial cancer is one of the most common gynecologic cancers, with over 380000
cases diagnosed worldwide in 2018. While most of the cases are diagnosed in
postmenopausal women, 3-14% cases are diagnosed in women under 40 years of
age. Given the rising incidence of risk factors such as obesity and anovulatory
conditions among younger women, the incidence of endometrial cancer is increasing
in that age group. Many women want to preserve fertility and achieve pregnancy
wherefore standard treatment of hysterectomy and bilateral salpingo-oophorectomy is
not acceptable method. In that cases, conservative, fertility-sparing treatment should
be considered. Fertility-sparing treatment of preinvasive lesions and endometrial
cancer is safe and effective option for patients with complex atypical hyperplasia and
well-differentiated, early-stage, endometrioid type endometrial cancer, with no
evidence of myometrial invasion and extrauterine spread of disease. Progestin
therapy, made of synthetic progesterone, is the most commonly used type of therapy.
However, optimal dose and duration of progestin therapy is not determined.
Recommended surveillance during treatment includes histopathological analysis of
endometrium every 3 months until complete response is achieved. Considering the
high rate of disease recurrence, patients are recommended to promptly attempt
pregnancy following complete response to treatment and undergo hysterectomy after
successful pregnancy. In a majority of cases, pregnancy is achieved by assisted
reproductive technologies.

• Keywords: rak endometrija; plodnost; progestin
• Keywords (english): endometrial cancer; fertility; progestin
• Language: croatian
• URN:NBN: urn:nbn:hr:105:351172
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-03-06 12:35:27