Humani papiloma virus u preinvazivnim lezijama vrata maternice

master's thesis

• Title (english): Human papillomavirus in preinvasive cervical lesions
• Author: Iva Škrabić
• Mentor: Tomislav Župić (mentor)
• Committee member: Držislav Kalafatić (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Tomislav Župić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2019-09-10, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Humani papiloma virus glavni je etiološki čimbenik u razvoju karcinoma vrata maternice koji je drugi najčešće dijagnosticiran karcinom u žena. Karcinom vrata maternice ima jasno definiranu premalignu fazu koja podrazumijeva preinvazivne lezije, a to su cervikalne intraepitelne neoplazije (CIN). Obzirom na onkogeni potencijal razvoja raka vrata maternice razlikuju se visokorizični tipovi (engl. high risk HPV, HR-HPV) i niskorizični tipovi (eng. low risk HPV, LR-HPV). Ovisno o debljini zahvaćenosti epitela displastičnim promjenama, patohistološki se razlikuju tri stupnja cervikalne instraepitelne neoplazije: CIN 1 koji predstavlja najblaži oblik, CIN2 koji označuje srednje teški poremećaj i CIN 3 koji je teška displazija. Perzistentna infekcija visokorizičnim tipovima HPV-a ključni je čimbenik u razvoju preinvazivnih lezija visokog stupnja i raka vrat maternice, dok nestanak HPV infekcije predviđa regresiju CIN-a. Obzirom na činjenicu da se preinvazivne lezije vrata maternice ne očituju karakterističnim subjektivnim simptomima, dijagnoza se uglavnom postavlja u okviru redovitih ginekoloških pregleda, a zasniva se na citološkoj dijagnostici (PAPA test-u), HPV-testu i kolposkopiji. Kod citološki i kolposkopski dvojbenih nalaza dijagnostika se dopunjuje biopsijom i endocervikalnom kiretažom, odnosno konizacijom koja može imati i terapijsko značenje. Terapijske metode liječenja preinvazivnih lezija u prvom redu podrazumijevaju kirurško liječenje jer zasad ne postoji učinkoviti lijek protiv HPV-a. Obzirom na visoku mogućnost regresije CIN promjena, dva su osnovna pristupa u liječenju. Prvi pristup podrazumijeva kontinuirano praćenje pacijentica s lezijama niskog stupnja uz citologiju, testiranje na HPV i kolposkopiju. Nasuprot tome, kod pacijentica s visokim stupnjem lezija koje perzistiraju, liječenje podrazumijeva eksciziju ili ablaciju promjene.

Abstract (english)

Human papillomavirus is a major etiologic factor in the development of cervical cancer, the second most commonly diagnosed cancer in women. Cervical cancer has a clearly defined premalignant phase that involves preinvasive lesions called cervical intraepithelial neoplasia (CIN). Due to the oncogenic potential of developing cervical cancer, high risk HPV (HR-HPV) and low risk HPV (LR-HPV) types are distinguished. Three stages of cervical instraepithelial neoplasia are pathohistologically distinguished depending on the thickness of the epithelium affected by dysplasia: CIN 1, which is the mildest form, CIN2, which is a moderate disorder, and CIN 3, which is severe dysplasia. Persistent infection with high-risk HPV types is a key factor in the development of preinvasive high-grade lesions and cervical cancer, while disappearance of HPV infection predicts regression of CIN. Due to the fact that preinvasive lesions of the cervix are not manifested by characteristic subjective symptoms, the diagnosis is usually made in the framework of regular gynecological examinations, and is based on cytology tests (PAPA test), HPV test and colposcopy. In cytologically and colposcopically ambiguous findings, the diagnosis is supplemented by biopsy and endocervical curettage in the form of conization, which may have therapeutic significance. Because there is currently no effective cure for HPV, therapeutic methods for preinvasive lesions primarily involve surgical treatment. Given the high possibility of regression of CIN changes, there are two basic approaches to treatment. The first approach involves the continuous monitoring of patients with low grade lesions using cytology, HPV testing and colposcopy. In contrast, for patients with high-grade persistent lesions, treatment of choice involves excision or ablation of said lesion.

• Keywords: HPV infekcija; preinvazivne lezije vrata maternice; dijagnostika; liječenje
• Keywords (english): HPV infection; preinvasive cervical lesions; diagnostics; treatment
• Language: croatian
• URN:NBN: urn:nbn:hr:105:251322
• 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: 2020-04-28 09:29:24