Krvarenje u postmenopauzi kao mogući simptom karcinoma endometrija

master's thesis

• Title (english): Postmenopausal bleeding as a possible symptom of endometrial cancer
• Author: Maja Maradin
• Mentor: Ivana Maurac (mentor)
• Committee member: Slavko Orešković (predsjednik povjerenstva)
• Committee member: Dinka Pavičić Baldani (član povjerenstva)
• Committee member: Ivana Maurac (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2021-07-16, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Karcinom endometrija je zloćudni tumor sluznice tijela maternice. Najčešći je ginekološki tumor u Hrvatskoj. Obuhvaća više od 95% svih karcinoma maternice. Najviše novih slučajeva bolesti zamijećeno je u žena starijih od 50 godina, nakon početka menopauze, s tim da su to uglavnom žene u šestom i sedmom desetljeću života, koje su u postmenopauzi. Razlog tome su bolji socio-ekonomski uvjeti koji omogućavaju sve većem broju populacije da dosegne odmaklu životnu dob i dostupnija i bolja dijagnostika bolesti. Karcinomi se klasificiraju prema histološkim značajkama u sedam kategorija. Od svih su endometrioidni adenokarcinomi najčešći, čine više od 80% svih karcinoma endometrija. S obzirom na ovisnost o estrogenu dijele se u dvije skupine, tip I – estrogen ovisan i tip II – estrogen neovisan. Rizični čimbenici za njegov razvoj vezani su uz višu izloženost estrogenu, a uključuju mlađu dob početka menstruacije i kasniju dob početka menopauze, neplodnost, nerađanje, dugotrajnu primjenu estrogena u hormonskoj nadomjesnoj terapiji, sindrom policističnih jajnika i terapiju tamoksifenom. Glavni rizični čimbenik koji nije povezan s reprodukcijom je pretilost. Oko 90% karcinoma endometrija klinički se očituje krvarenjem, stoga je postmenopauzalno krvarenje najčešći simptom karcinoma. Prisutnost krvarenja u postmenopauzi nije fiziološka i uvijek treba potaknuti kliničara na otkrivanje uzroka. Dijagnoza uključuje uzimanje opširne anamneze, klinički ginekološki pregled, transvaginalni ultrazvuk, citološki nalaz (PAPA i/ili Utero brush (citološki obrisak endometrija)), uzimanje uzoraka endometrija frakcioniranom kiretažom za PHD analizu, histeroskopiju. Može se nadopunjivati i radiološkim pretragama, određivanjem tumorskih biljega i steroidnih receptora. Liječenje karcinoma u osnovi je operativni zahvat koji uključuje totalnu histerektomiju i obostranu salpingo – ooforektomiju. Ostale metode liječenja uključuju radioterapiju, kemoterapiju i hormonsku terapiju. Sveukupno je više od 5 godina nakon liječenja 63% pacijentica bez znakova bolesti.

Abstract (english)

Endometrial cancer is a malignant tumour of the uterine mucosa. It is the most common gynaecological tumour in Croatia. It includes more than 95% of all uterine cancers. Most recent cases of illness have been observed in women over 50 years of age after the onset of menopause, mostly in women in the sixth and seventh decade of life, who are in postmenopausal period. This is due to better socio-economic conditions that enable an increasing number of population to reach an advanced age and more accessible and better diagnostics of disease. Cancers are classified according to histological characteristics in seven categories. Of all endometrioid adenocarcinomas are the most common, accounting for more than 80% of all endometrial cancer. Given the oestrogen dependence, they are divided into two groups: type I — estrogen dependent and type II — estrogen independent. Risk factors for its development are related to higher estrogen levels and include starting period at a younger age and later onset of menopause, infertility, non-birth, long-term estrogen use in hormone replacement therapy, polycystic ovarian syndrome and Tamoxifen therapy. The main risk factor that is not related to reproduction is obesity. Approximately 90% of endometrial cancers clinically present as bleeding - therefore postmenopausal bleeding is the most common symptom of cancer. The presence of postmenopausal bleeding is not physiological and should always encourage the clinician to detect the cause. The diagnosis includes taking an extensive medical history, clinical gynaecological examination, transvaginal ultrasound, cytological findings (Pap test and/or Utero brush (cytological endometrium swab)), endometrial sampling by fractional curettage for the PHD analysis, hysteroscopy. It can also be supplemented by radiological tests, tumour markers and steroid receptors. Treatment of cancer is basically an operation involving total hysterectomy and bilateral salpingo–oophorectomy. Other treatment methods include radiotherapy, chemotherapy, and hormone therapy. Overall, 63% of patients are without signs of disease more than 5 years after treatment.

• Keywords: krvarenje; postmenopauza; karcinom; endometrij
• Keywords (english): bleeding; postmenopausa; cancer; endometrium
• Language: croatian
• URN:NBN: urn:nbn:hr:105:778812
• 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: 2022-03-11 09:13:17