| Abstract | Rak vrata maternice uzrokovan je dugogodišnjim napredovanjem perzistentne infekcije humanim papilomavirusom. Infekciju je moguće spriječiti cijepljenjem i odgovornim spolnim ponašanjem te rano otkriti programima probira no unatoč tome, rak vrata maternice još uvijek je jedan od vodećih uzročnika smrti od maligniteta u ženskoj populaciji. Iznimno se rijetko rak otkrije u trudnoći (većinom u ranom stadiju) i moguće ga je liječiti, no trenutno se preferira praćenje pacijentice do kraja trudnoće, ukoliko je to sigurno. Važan je multidisciplinarni pristup u dijagnostici i liječenju. U slučaju mikroinvazije ( stadij IA1) može se predložiti konizacija, koja je u ranoj trudnoći relativno sigurna. Prije 20. tjedna gestacije moguće se napraviti disekciju zdjeličnih limfnih čvorova, a u slučaju metastaza preporuča se prekid trudnoće i početak liječenja. Ukoliko metataza nema, za stadije IA2 i IB1 opcije uključuju jednostavnu trahelektomiju ili praćenje, a za ostale stadije neoadjuvantnu kemoterapiju uz praćenje ili prekid trudnoće. Nakon 22. gestacijskog tjedna moguća je samo neoadjuvantna kemoterapija, koju treba prekinuti 3 tjedna prije porođaja. Preferira se porod carskim rezom, budući da smanjuje mogućnost metastaziranja tumora. Ne bi trebalo planirati porod prije postizanja zrelosti fetalnih pluća, no može se razmotriti primjena antenatalnih glukokortikoida u slučaju neodgodive potrebe za početkom kemoradioterapije. Neonatalni ishodi nakon kemoterapije za sada se čine povoljnima, no potrebna su daljnja istraživanja i dugotrajno praćenje djece. |
| Abstract (english) | Cervical cancer is caused by long time progression of persistent human papillomavirus infection. The infection is preventable through vaccination and responsible sexual behaviour, and easily detectable via screening programs. Despite this, cervical cancer is still one of the leading causes of death caused by malignancy in the female population, worldwide. In extremely rare cases, cervical cancer is diagnosed during pregnancy. It is usually discovers in the early stages, and it is treatable. However, currently the preferred approach is to delay treatment until delivery and conduct regular examinations, if it is safe to do so. A multidisciplinary approach to diagnosis and therapy is very important. In the case of microinvasion (stage IA1) a conisation can be suggested, due to relative safety in early pregnancy. A pelvic lymph node dissection can safely be performed until the 20th gestation week. If nodal metastases are found, termination of pregnancy and immediate initiation of therapy is recommended. If no metastases are found, in stages IA2 and IB1, a simple trachelectomy or delay of therapy until delivery can be performed. In other, more advanced stages, options include neoadjuvant chemotherapy and follow-up, or delay of therapy. After the 22nd gestation week only neoadjuvant chemotherapy is possible. It should be ended 3 weeks before the delivery date. The preferred method of delivery is Cesarean section, because it minimizes the risk of tumour metastasis. Delivery shouldn't be planned before fetal lung maturation is achieved, but use of antenatal glucocorticoids should be considered if there is need for immediate onset of concurrent chemo- and radiotherapy. So far, neonatal outcomes after in utero exposition to chemotherapy seem positive, but further research and long term follow-up of such children is needed. |
