Author/Editor		Franić, Damir
Title		Vloga ginekologa na primarni ravni na zmanjšanje incidence invazivnega raka na materničnem vratu
Translated title		The role of the gyneacologist at the primary level in decreasing the incidence of invasive forms of the cervical cancer
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. 3
Publication year		2004
Volume		str. 127-30
Language		slo
Abstract		Background. Since 1993, an average annual crude incidence rates for cervical cancer has increased from 14/100,000 (1979-1993) to 23/100,000 (1997). Untill 1993, there was no permanently employed gynecologist in the Šmarje pri Jelšah country. In the period 1988-1992 the ratio between non-invasive vs. invasive cervical cancer was 1/18. In the same period the average annual incidence for cervical cancer was 28/100,000 women. The author was interested in whether the active approach of the gynaecologist at the primary level affected the non-invasive: invasive cervical cancer ratio, and whether that changed ratio further influenced the average annual incidence of invasive forms of cervical cancer. Methods. The data from the outpatient clinic in Rogaška Slatina showed that in the period 1993-2000 there were 54 diagnosed cases: 45 (84%) cases of non-invasive and 9 (16%) cases of invasive forms of cervical cancers. For diagnostic purposes 63 colposcopic punch biopsies were performed. Besides punch biopsies 7 diagnostic cone biopsies and 6 curretage of the cervical canal were also performed. HPV-DNA testing was performed in three women. Results. Of the 63 biopsies 45 (72%) showed CIN III and 18 (28%) other non malignant changes of the cervical canal. The CIN III cases were treated by conization in 44 cases, and by hysterectomy in 1. Mean 3 PAP smear were taken to make the diagnosis. From the first suspicious PAP smear to the diagnosis average 5.1 month were needed, and average 8.3 month to the surgery and/or the definitive diagnosis. The number of patients with invasive cervical cancer increases proportionally with the number of years the women did not visit the gynaecologist according to the FIGO classification. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Groba letna incidenca raka na materničnem vratu (RMV) je od leta 1993 začela ponovno naraščati, in sicer od 14/100.000 žensk (1979-1993) do 23/ 100.000 (1997). V upravni enoti (UE) Šmarje pri Jelšah do leta 1993 ni bilo stalno zaposlenega ginekologa. V obdobju 1988-1992 je bilo razmerje neinvazivni RMV/invazivni RMV 1/18. V istem obdobju je bila povprečna letna incidenca RMV v UE Šmarje pri Jelšah 28/100.000 žensk. Ali je aktivni pristop primarnega ginekologa spremenil to razmerje in ali se je glede na to spremenila povprečna letna incidenca invazivne oblike RMV? Metode. Po podatkih ginekološke ambulante v Rogaški Slatini je bilo v obdobju 1993-2000 skupaj diagnosticiranih 54 primerov, in sicer 45 primerov CIN III (84%) in 9 primerov invazivnega RMV (16%). V diagnostične namene je bilo narejenih 63 kolposkopsko ciljanih biopsij porcije. Poleg ciljane biopsije je bila v sedmih primerih narejena diagnostična konizacija in v šestih frakcionirana kiretaža cervikalnega kanala. Pri treh bolnicah je bila narejena tipizacija HPV-DNK (Digene Hybrid Capture 2 test). Rezultati. Od vseh biopsij (N = 63) je bilo 45 (72%) CIN III in 18 (28%) ostalih (nerakastih) sprememb na MV. Skupno je bilo zaradi 45 primerov CIN III narejenih 44 konizacij in ena totalna histerektomija. Za ugotovitev diagnoze je bil v povprečju odvzet PAP bris 3-krat. Od prvega sumljivega brisa do diagnoze je bilo povprečno potrebnih 5,1 meseca in do operacije oz dokončne diagnoze 8,3 meseca. Pri ženskah, ki so zbolele za invazivnim RMV, klasifikacija FIGO proporcionalno narašča s številom let, ko niso obiskovale ginekologa. Zaključki. Aktivno, kombinirano delo primarnega ginekologa lahko izboljša razmerje neinvazivne/invazivne oblike RMV na enem področju. Hkrati se na ta način izboljša povprečna letna incidenca invazivnih oblik RMV na istem območju. (Izvleček skrajšan na 2000 znakov).
Descriptors		CERVIX NEOPLASMS BIOPSY VAGINAL SMEARS CONIZATION CARCINOMA IN SITU NEOPLASM INVASIVENESS NEOPLASM STAGING