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_1258749195.ppt

TESTUL BABES-PAPANICOLAU

SemnificatieCaracteristici citologiceRata fals negativa 10-35%

_1258749197.ppt

Romania al II-lea dupa cancerul de sanFactori de risc: nivel socio-economic scazut varsta 45-55 ani femei cu mai multi parteneri sexuali prostitutia relatii sexuale precoce infectii cu HPV sau HSV2 rasa neagra are o incidenta crescuta fumat NU este intalnita la virgine

_1258749198.ppt

CANCERUL CERVICAL

Conf. Dr. Nicolae N. Suciu

_1258749196.ppt

PRECURSORII CANCERULUI SCUAMO-CELULAR

Carcinom in situDisplazii (CIN1-3): displazie usoara displazie moderata displazie severaAspectul macroscopic testul Schiller - pozitiv negativ - nu toate testele Schiller negative ~ leziune malignaAspect microscopic diagnostul histologic este instrumentul de diagnostic definitiv = modificari nucleare (pleiomorfism nuclear, hipercromatism, multinucleism, mitoze)CIN = jonctiune scuamo-columnaraInvazia de la locul de origine

_1258749191.ppt

ASPECT MACROSCOPIC AL CC SCUAMO-CELULAR

Tumori exofitice mai comune endofitice ulcerative

Extinderea tumorii- vagin- ligamentele cardinale- endometriala - rara

Extinderea limfatica - precoce

Variabilitatea invadarii nodulilor limfatici

Invazia vasculara 30% din pacientii decedati au metastaze in ficat, plamani, splina

_1258749193.ppt

CARCINOM INVAZIV

Evolutia CIN urmarite individual este imprevizibilaProgresiunea displaziei = gradul de CINBoala poate fi vindecata

_1258749194.ppt

ROLUL HPV

Peste 60 de subtipuriMai patogene: 16, 18, 31, 45, 56Leziuni HPV: vulva perineu anus col vaginDetectie- microscopie electronica- imunohistochimie- tehnici de hibridizare- PCRRol biopsie cervicala conizatie electrica

_1258749192.ppt

CARACTERE HISTOLOGICE ALE CC SCUAMO-CELULAR

Grade histologice Gradul I punti intercelulare vizibileGradul II forma cea mai frecventa nuclei elongati si citoplasma minima fara punti intercelulare mitoze mai multeGradul III tumori nediferentiate: crestere foarte rapida numeroase mitoze

_1258749189.ppt

CLASIFICAREA FIGO

Stadiul 0 carcinom in situ, carcinom intraepitelialStadiul I neoplasme ce nu depadsesc colulIA invazie stromala sub 3mm grosime si sub 7mm latimeIB prezintaIB1 diametrul maxim sub 4cmIB2 diametrul maxim mai mare decat 4cmStadiul IIIIA extensia spre cele 2/3 superioare ale vaginuluiIIB infiltrarea tesuturilor parametrialeStadiul IIIIIIA implicarea 1/3 anterioare vaginaleIIIB infiltrarea peretilor parametriali (prin tuseu rectal)Stadiul IVIVA invazia vezicii sau a rectuluiIVB metastaze la distanta

_1258749190.ppt

DIAGNOSTIC

Sangerari vaginale neregulate in afara ciclului menstrual post-coitale intermenstruale postmenopauzale

_1258749187.ppt

TRATAMENT

Faza preinvaziva: chiuretaj endocervical negativ chiuretaj endocervical pozitiv = conizatie formele incipiente de CIN: biopsie sau DCC CC in situ~ dorinta pacientei vis--vis de reproducere ~ stadiul cervical chirurgia preferata radioterapiei criochirurgia laser terapia cu CO2

_1258749188.ppt

Frecventa metastazelor

Stadiul I 15%

Stadiul II 30%

Stadiul III 50%

Stadiul IV peste 60%

_1258749185.ppt

PROGNOSTICUL BOLII

Foarte bun pentru stadiul incipient (85%)

Foarte redus pentru stadiul IV (5-10%)

90% din recurente apar in primii 2 ani (nodulii paraaortici, ficat, plamani)

Decesul prin- uremie- infectie- hemoragie

_1258749186.ppt

TRATAMENT

Faza invaziva: stadializarea clinica limitele bolii chirurgia si radioterapia = principale metode de tratament informarea pacientei chirurgia radicala invadarea ggl paraaortici radioterapie complicatiile chimioterapia si imunoterapia exenteratia pelvina

_1258749184.ppt

CC IN SARCINA

Cea mai frecventa afectiune maligna in sarcina

Simptom principal: sangerarea (sangerare de sarcina?!)

Tratament: in fctie de varsta sarcinii stadializare

A1 - conizatie + nastere vaginala + reevaluare

IA2, IB, IIA operatie cezariana + histerectomie radicala

IIB IVA radioterapie (daca fatul e viabil = operatie cezariana + radioterapie la 2-3 sapt.)