ABSTRACT
A escala mundial, el cáncer cervical es el cuarto tipo de cáncer más frecuente en las mujeres y tiene la cuarta tasa de mortalidad más alta de los cánceres en las mujeres. La colposcopia forma parte de los recursos con los que cuenta la medicina para el diagnóstico y seguimiento de las lesiones preinvasivas y el cáncer de cuello uterino. Se requiere de profesionales bien capacitados para realizar una colposcopia precisa y segura. El mismo resultado citológico tiene un riesgo diferente de neoplasia intraepitelial 2, 3, o cáncer en varios grupos de mujeres, por ello, varias poblaciones requieren consideraciones especiales de manejo, entre ellas, las menores de 25 años, las embarazadas, las inmunodeprimidas, las que fueron sometidas a histerectomía y las mayores de 65 años. La presente revisión se realizó para actualizar la información disponible sobre la colposcopia en estas poblaciones especiales(AU)
Globally, cervical cancer is the fourth most common type of cancer in women and has the fourth highest death rate of cancers in women. Colposcopy is part of the resources available to medicine for the diagnosis and monitoring of preinvasive lesions and cervical cancer. Well-trained professionals are required to perform an accurate and safe colposcopy. The same cytologic outcome has a different risk of intraepithelial neoplasia 2, 3, or cancer in various groups of women, so several populations require special management considerations, including those younger than 25 years, pregnant women, immunosuppressed women, those who underwent hysterectomy, and those older than 65 years. We conducted this review to update the available information on colposcopy in these special populations(AU)
Subject(s)
Humans , Female , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/mortality , Mass Screening , Colposcopy , Pregnancy , Cell Biology , PapillomaviridaeABSTRACT
Los tumores malignos de cérvix continúan siendo un problema de salud pública para nuestro país, es por ello que se consideró de importancia realizar este estudio. Se estudiaron las características clínicas más frecuentes encontradas en las pacientes sometidas dentro de los cuales encontramos como principal motivo de consulta el dolor pélvico con un 86.75%, seguido del sangrado con un 84.34% finalizando con la leucorrea con el 79.52%. En cuanto a la clasificación de los tumores malignos se comprobó que la mayoría de las pacientes presentaron el estadio CaCu IB1 con el 91.57% seguido del CaCu IA1 con el 6.02% finalizando con el CaCu IB2 con el 2.41%. Así mismo, se pudo determinar que los tumores malignos de cérvix más frecuentes en las pacientes estudiadas fue el carcinoma epitelial, seguido del adenocarcinoma de cérvix, siendo su histopatología más encontrada el carcinoma epidermoide no queratinizante de células grandes con el 53.01%. (AU)
Uterine Cervical Cancer continues to be one of the main public health problems in Guatemala, thus being important to do this type of research. The most frequent clinical characteristics found in the present study were pelvic pain (86.75%) followed by bleeding in 84.34% and vaginal discharge in 79.52%. Most of the patients were classified as Stage IB1 (91.57%) followed by Stage IA1(6/02%) and Stage IB2 (2.41%). The most frequent Histologic Type was Squamous Carcinoma. (AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Carcinoma, Squamous Cell/diagnosis , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/etiology , Hysterectomy/methods , Pelvic Pain/complications , Hemorrhage/diagnosis , Leukorrhea/diagnosisABSTRACT
INTRODUCCIÓN: Los leiomiomas uterinos son el tumor pélvico más frecuente en la mujer, derivan de las células musculares lisas del miometrio y pueden localizarse en cualquiera de las porciones uterinas. Se clasifican según su relación con las diferentes capas del útero mediante la clasificación de la FIGO. Pueden ser asintomáticos o producir síntomas como sangrado, problemas reproductivos o dolor por compresión de estructuras vecinas. El tratamiento puede ser médico o quirúrgico, teniendo dentro de este último grupo, la posibilidad de realizar una miomectomía o una histerectomía total o subtotal. La histerectomía subtotal permite mantener el cérvix uterino, de tal forma que la técnica quirúrgica es más sencilla, sin embargo, requiere de la morcelación de la pieza para su extracción; mientras que la histerectomía total elimina el riesgo de recidiva de la patología uterocervical, aunque precisa de una mayor curva de aprendizaje. CASO CLÍNICO: Presentamos el caso de una paciente de 52 años a la que se le realizó una histerectomía supracervical laparoscópica por miomas. Posteriormente, se objetivó la aparición de un nuevo mioma en el remanente cervical, que requirió de una traquelectomía vía vaginal. CONCLUSIÓN: La histerectomía subtotal laparoscópica en úteros con múltiples miomas puede tener como efecto adverso la recidiva miomatosa en el cérvix o la aparición de miomas parasitarios secundarios a la morcelación uterina no estanca. Además, implica continuar con el cribado para la prevención del cáncer de cérvix uterino.
BACKGROUND: Uterine leiomyomas are the most frequent pelvic tumor in women. They derive from smooth muscle cells of the myometrium and can be in any of the uterine parts. They are classified according to their relationship with the different layers of the uterus by the FIGO classification. Uterine leiomyomas can be asymptomatic or produce symptoms such as compression pain, reproductive problems and metrorrhagia. The treatment can be medical or surgical. Within this last group there is the possibility of performing a myomectomy or a total or subtotal hysterectomy. The subtotal hysterectomy allows the uterine cervix to be maintained and therefore the surgical technique is simpler. However, it requires the morcellation of the piece for its removal. Alternatively, total hysterectomy eliminates the risk of recurrence of uterocervical pathology, but this procedure presents a steeper learning curve. CLINICAL CASE: We present the case of a patient of 52 years who underwent a laparoscopic supracervical hysterectomy for myomas. Subsequently, the appearance of a new myoma in the cervical remnant was observed, which required a vaginal trachelectomy. CONCLUSION: Laparoscopic subtotal hysterectomy in myomatous uterus can have as an adverse effect myomatous recurrence in the cervix or the appearance of parasitic myomas secondary to non-contained uterine morcellation. In addition, it involves continuing screening for the prevention of cervical cancer.
Subject(s)
Humans , Female , Middle Aged , Uterine Cervical Neoplasms/surgery , Trachelectomy , Hysterectomy/adverse effects , Leiomyoma/surgery , Reoperation , Uterine Cervical Neoplasms/etiology , Laparoscopy/adverse effects , Morcellation/adverse effects , Hysterectomy/methods , Leiomyoma/etiology , Neoplasm Recurrence, LocalABSTRACT
Introdução: Fatores de risco associados ao trabalho podem causar, entre outros, câncer de colo uterino. Objetivo: Identificar na literatura especializada a associação entre câncer de colo de útero e a exposição aos fatores ocupacionais de risco. Métodos: Realizou-se um levantamento bibliográfico em bases de dados eletrônicos com os seguintes descritores: câncer de colo uterino e riscos ocupacionais. Resultados: Trabalhadores expostos ao tabaco nas fábricas de cigarro, fluidos de motores, exposição ocupacional a fungos e bactérias e ao tetracloroetileno, presente em produtos de limpeza usados em lavanderias e para desengraxar metais, estariam mais susceptíveis ao desenvolvimento de câncer de colo uterino. Conclusão: Há poucos estudos que identificam a relação entre o câncer de colo de útero e os fatores de risco ocupacional, dificultando a associação entre o carcinogênese e o fator de risco.
Background: Occupational risk factors are associated with many types of neoplasms including cervical cancer. Objective: To review the specialized literature for evidence on the relationship between cervical cancer and exposure to occupational hazards. Methods: Literature search in electronic databases using keywords cervical cancer and occupational risk. Results: Workers occupationally exposed to tobacco, fungi or bacteria, metalworking fluids and tetrachloroethylene used in dry cleaning and for metal degreasing exhibited higher susceptibility to cervical cancer. Conclusion: Few studies sought to investigate relationships between cervical cancer and occupational hazards, which hinders the attempts at establishing a causal link.
Subject(s)
Humans , Female , Occupational Risks , Uterine Cervical Neoplasms/etiology , Occupational Diseases/etiology , Solvents/adverse effects , Tetrachloroethylene/adverse effects , Bacterial Infections/complications , Risk Factors , Tobacco Products/adverse effects , Mycoses/complicationsABSTRACT
Abstract Objective The present study aimed to examine which development indicators are correlated with cervical cancer (CC) mortality rates in Brazil. Methods This was an ecological study that correlatedmortality rates and indicators, such as human development index (HDI), gross domestic product (GDP) per capita, illiteracy rate, fertility rate, screening coverage, proportion of private health insurance use, density of physicians, and density of radiotherapy centers. Themortality rateswere obtained fromthe Brazilian national registry, while the indicators were based on official reports from the Ministry of Health. Univariate and multivariate linear regression was used. Results Among the states of Brazil, the average age-specific CC mortality rate from 2008 to 2012 varied from 4.6 to 22.9 per 100,000 women/year. In the univariate analysis, HDI, proportion of private health insurance use, density of physicians, and density of radiotherapy centers were inversely correlated with the mortality rates. Fertility rate was positively correlated with the mortality rates. In the multivariate analysis, only fertility rate was significantly associated with the CC mortality rate (coefficient of correlation: 9.38; 95% confidence interval [CI]: 5.16-13.59). Conclusion A decrease in the fertility rate, as expected when the level of development of the regions increases, is related to a decrease in the mortality rate of CC. The results of the present study can help to better monitor the quality assessment of CC programs both among and within countries.
Resumo Objetivo O presente estudo teve como objetivo examinar quais indicadores de desenvolvimento estão correlacionados com as taxas de mortalidade por câncer do colo do útero no Brasil. Métodos Este foi um estudo ecológico que correlacionou as taxas de mortalidade com indicadores como índice de desenvolvimento humano (IDH), produto interno bruto (PIB) per capita, taxa de analfabetismo, taxa de fertilidade, cobertura do rastreamento, proporção do uso do seguro privado de saúde, densidade de médicos e densidade de centros de radioterapia. A fonte das taxas de mortalidade foi o registro nacional, enquanto que os indicadores foram baseados em relatórios oficiais do Ministério da Saúde. Foi utilizada regressão linear univariada e multivariada. Resultados Entre os estados, a taxa média de mortalidade específica por idade por câncer do colo do útero de 2008 a 2012 variou de 4.6 a 22.9 por 100.000 mulheres/ano. Na análise univariada, foram inversamente correlacionadas com as taxas de mortalidade: IDH, proporção do uso do seguro privado de saúde, densidade de médicos e densidade de centros de radioterapia. A taxa de fertilidade foi positivamente correlacionada com a mortalidade. Na análise multivariada, apenas a taxa de fertilidade foi significativamente associada à taxa de mortalidade por câncer do colo do útero (coeficiente de correlação: 9,38; índice de confiança [IC] 95%: 5,16-13,59). Conclusão A diminuição da taxa de fertilidade, como esperado quando o nível de desenvolvimento das regiões aumenta, está relacionada a uma diminuição da taxa de mortalidade por câncer do colo do útero. Os resultados do presente estudo podem ajudar amonitorarmelhor a avaliação da qualidade dos programas de câncer do colo do útero nos países tanto interna quanto externamente.
Subject(s)
Humans , Female , Adult , Young Adult , Uterine Cervical Neoplasms/mortality , Fertility , Health Services Accessibility , Socioeconomic Factors , Brazil/epidemiology , Women's Health Services , Uterine Cervical Neoplasms/etiology , Demography , Middle AgedABSTRACT
Abstract Objective To describe a case of radiation-induced uterine carcinosarcoma 6 years after a cervical squamous cell carcinoma treatment, which imposed some diagnostic and management challenges. Case Report A 57-year-old woman with a history of pelvic chemoradiotherapy ~ 6.5 years before the event described in this study, following an International Federation of Gynecology and Obstetrics (FIGO) stage IIB cervical cancer, presented with a cervical mass, involving the uterine cavity, the cervical canal and the upper two thirds of the vagina. The biopsy showed a poorly differentiated carcinoma, and a positron emission tomography (PET) scan excluded distant metastasis, although it was unable to define the origin of the tumor as either a new primary malignancy of the endometrium/cervix or as a cervical recurrence. Surgical staging procedure was performed, and the diagnosis was endometrial carcinosarcoma, FIGO stage IIB. The patient was not able to complete the adjuvant therapy, and the progression of the disease was remarkable. Conclusion The present case highlights one of the less common but more serious consequences of radiotherapy for cervical cancer, which has an increasing incidence in younger women, raising concerns about the long-termconsequences of its management.
Subject(s)
Humans , Female , Carcinoma, Squamous Cell/therapy , Carcinosarcoma/etiology , Uterine Cervical Neoplasms/etiology , Chemoradiotherapy/adverse effects , Neoplasms, Radiation-Induced/etiology , Uterine Neoplasms/therapy , Fatal Outcome , Middle AgedSubject(s)
Humans , Female , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/epidemiology , Papillomavirus Infections/prevention & control , Papillomavirus Vaccines , Early Detection of Cancer , Forecasting , Health Promotion/organization & administration , Latin America/epidemiologyABSTRACT
Abstract Objective To evaluate the association between hormonal contraception and the appearance of human papillomavirus HPV-induced lesions in the uterine cervix of patients assisted at a school outpatient clinic - ObGyn outpatient service of the Universidade do Sul de Santa Catarina. Methods A case-control study, with women in fertile age, performed between 2012 and 2015. A total of 101 patients with cervical lesions secondary to HPV were included in the case group, and 101 patients with normal oncotic colpocytology, in the control group. The data were analyzed through the Statistical Package for the Social Sciences (SPSS, IBM Corp. Armonk, NY, US) software, version 24.0, using the 95% confidence interval. To test the homogeneity of the proportions, the chi-square (χ2) test was used for the qualitative variables, and the Student t-test, for the quantitative variables. Results When comparing the occurrence of HPV lesions in users and non-users of combined oral contraceptives (COCs), the association with doses of 0.03 mg or higher of ethinylestradiol (EE) was observed. Thus, a higher probability of developing cervical lesions induced by HPV was identified (odds ratio [OR]: 1.9 p = 0.039); and when these cases were separated by the degree of the lesion, the probability of these patients presentingwith lowgrade squamous intraepithelial lesion was 2.1 times higher (p = 0.036), but with no impact on high-grade squamous intraepithelial lesions and the occurrence of invasive cancer. No significant differences were found in the other variables analyzed. Conclusion Although the results found in the present study suggest a higher probability of the users of combined hormonal contraceptives with a concentration higher than 0.03 mg of EE to develop low-grade intraepithelial lesions, more studies are needed to conclude causality.
Resumo Objetivo Avaliar a associação entre a contracepção hormonal e a presença de lesões induzidas pelo vírus do papiloma humano (HPV) no colo uterino de pacientes do serviço de ginecologia e obstetrícia do ambulatório de especialidade médicas da Universidadedo Sul de Santa Catarina - AME/UNISUL. Métodos Estudo observacional do tipo caso-controle, commulheres no menacme, no período compreendido entre 2012 e 2015. Foram incluídas 101 pacientes com lesões cervicais secundárias ao HPV, no grupo caso, e 101 pacientes com colpocitologia oncótica normal, no grupo controle. Os dados foram analisados por meio do programa SPSS 24.0, utilizando-se o intervalo de confiança de 95%. Para testar a homogeneidade de proporções foram utilizados o teste do qui-quadrado (χ2) para as variáveis qualitativas e o teste t de Student para as variáveis quantitativas. Resultados Ao comparar-se a ocorrência das lesões pelo HPV em usuárias de contraceptivos orais combinados (COCs) com a em não usuárias, observou-se a associação com doses de 0.03 mg ou superiores de etinilestradiol (EE), na qual se identificou 1.9 vezes mais probabilidade destas desenvolverem lesões cervicais induzidas pelo HPV (p = 0.039); ao separar-se esses casos pelo grau da lesão, a probabilidade destas pacientes apresentarem lesão cervical de baixo grau foi 2.1 vezes maior (p = 0.036), porémsemimpacto nas lesões cervicais de alto grau e na ocorrência de câncer invasor. Não foram encontradas diferenças significativas nas outras variáveis analisadas. Conclusão Embora os resultados encontrados no presente estudo sugiram maior probabilidade das usuárias de contraceptivo hormonal combinado, com concentração superior a 0.03 mg de EE, desenvolverem lesão cervical de baixo grau,mais estudos são necessários para concluir causalidade.
Subject(s)
Uterine Cervical Neoplasms/complications , Contraceptives, Oral, Hormonal/adverse effects , Papillomavirus Infections/complications , Case-Control Studies , Uterine Cervical Neoplasms/etiology , Retrospective Studies , Papillomavirus Infections/etiologyABSTRACT
O Papilomavírus humano (HPV) exerce um papel central na carcinogênese do colo uterino. Os mecanismos utilizados pelos HPVs de alto risco para influenciar o ciclo de divisão celular, levando-o à sua desregulação e, consequentemente, para a progressão de lesões, incluem fatores inerentes ao vírus e à sua inter-relação com a célula hospedeira. Tais interferências no metabolismo celular poderão causar modificações morfológicas e funcionais, promovendo o aparecimento de neoplasias. Compreendendo a importância do conhecimento dos processos biológicos e moleculares utilizados pelo HPV na carcinogênese para o diagnóstico precoce e na avaliação prognóstica da doença, o objetivo deste trabalho foi buscar na literatura científica a relação da biologia viral do HPV com o desenvolvimento do câncer de colo útero e novas descobertas.(AU)
The Human papillomavirus (HPV) plays a central role in carcinogenesis of the cervix. The mechanisms used by high-risk HPVs to influence the cell division cycle taking it to its deregulation and consequently for progression of lesions include factors related to the virus and its interrelationship with the host cell. Changes in cellular metabolism can cause morphological and functional changes, promoting the appearance of tumors. Understanding the importance of knowledge of the biological and molecular processes used by HPV in carcinogenesis for early diagnosis and prognostic evaluation of the disease, the objective was to search the scientific literature regarding the HPV?s viral biology to the development of cervical cancer and new discoveries.(AU)
Subject(s)
Female , Papillomaviridae/genetics , Papillomaviridae/pathogenicity , Oncogene Proteins/metabolism , Papillomavirus Infections/virology , Carcinogenesis/metabolism , Uterine Cervical Neoplasms/etiology , Risk Factors , Databases, BibliographicABSTRACT
O objetivo deste estudo foi realizar um levantamento de publicações existentes em periódicos que avaliam lesões precursoras do câncer de colo do útero e sua taxa de cobertura nas regiões brasileiras. Os resultados do levantamento de publicações já existentes apontam que os dados das lesões precursoras e o câncer de colo do útero são desencontrados em todas as regiões, este fato nos atentou para a realização do cálculo da cobertura aproximada. Baseado nos registros publicados pelo DATASUS, a cobertura por região foi de aproximadamente 8,5% no Sudeste (sendo a melhor cobertura entre as regiões do Brasil); Nordeste, 7,5%; Sul, 6,8%; Centro-Oeste, 6,4%; e Norte, 5,9%, sendo essa a pior cobertura entre as regiões brasileiras. Concluímos que a deficiência no sistema de rastreamento do câncer do colo do útero é um problema que atinge todas as regiões; logo, faz-se necessário a intensificação do programa de rastreamento para atingir o maior contingente de mulheres.(AU)
The objective of this study was to search of any existing publication in the literature that evaluates precursor lesions of cervical cancer and its rate in the Brazilian regions. The results of the researched publications already existing pointed to the data of precursor lesions of cervical cancer to be inexistent on all the regions, this fact brought up the attention to calculate the approximate coverage. Based in records published by DATASUS, the coverage by region was approximately 8.5% in the Southeast (being the best coverage of Brazil), Northeast, 7.5%; South, 6.8%; Central-West, 6.4% and 5.9% in the North, which was the worst of all the Brazilian areas. We conclude that a deficiency during the tracking research of the cervical cancer is a problem that affects all regions, so naturally it is necessary to intensify a tracking program to achieve and reach a larger number of women.(AU)
Subject(s)
Female , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Dysplasia/etiology , Uterine Cervical Dysplasia/epidemiology , Papanicolaou Test/statistics & numerical data , Unified Health System/statistics & numerical data , Brazil/epidemiology , Mass Screening , Epidemiology, Descriptive , Databases, Bibliographic , Statistical DatabasesABSTRACT
OBJETIVO: Estudar a frequência de neoplasias em uma amostra da população brasileira feminina com lúpus eritematoso sistêmico. MÉTODOS: Este é um trabalho retrospectivo de revisão de prontuários de 395 mulheres com lúpus eritematoso sistêmico, diagnosticadas pela presença de, pelo menos, 4 dos critérios classificatórios do Colégio Americano de Reumatologia para diagnóstico dessa doença e acompanhadas nos últimos 10 anos em um ambulatório especializado em Reumatologia. Foram coletados dados demográficos (idade e etnia das pacientes), dados acerca de duração de doença, de uso dos principais imunomoduladores e de diagnóstico de neoplasias. As informações obtidas foram tabuladas em tabelas de frequência e de contingência. A taxa de incidência de neoplasias nas mulheres com lúpus foi comparada com a da população em geral para a mesma região demográfica, nos últimos dez anos, utilizando, para isso, dados publicados pelo Instituto Nacional de Câncer (INCA). A associação dos dados foi feita pelos testes de Fisher e do χ2, quando os dados eram nominais, e de Mann-Whitney, quando numéricos. Foi adotada a significância de 5%. RESULTADOS: Foram identificados 22 casos de tumores malignos (22 casos/395 ou 5,5% da amostra) sendo os mais comuns os de útero (10 casos/395 ou 2,5% da amostra) e de mama (9 casos/395 ou 2,2% da amostra). A presença de tumores estava associada com tempo de duração de doença (p=0,006), não sendo observada influência de tratamento com metotrexate (p=0,1), azatioprina (p=0,9), ciclofosfamida (p=0,6) e glicocorticoides (p=0,3). Os tumores de mama e de colo do útero foram mais comuns no lúpus eritematoso sistêmico do que na população em geral (p<0,0001 para ...
PURPOSE: To study the incidence of tumors in a Brazilian sample of women with systemic lupus erythematosus. METHODS: This is a retrospective study of 395 medical charts from women with systemic lupus erythematosus diagnosed by the presence of at least 4 of the American College of Rheumatology classification criteria for the diagnosis of this disease and followed for the last 10 years in a rheumatology outpatient clinic. Demographic data (age and ethnicity of patients), data on disease duration, use of immunomodulators and on the presence of neoplasms were listed. Results are presented in frequency and contingency tables. The incidence rate of malignancies in women with lupus was compared with that of the general population for the same demographic region for the past ten years, using data published by the Brazilian National Cancer Institute (INCA). Association studies were carried out by the Fisher and χ2 tests, when the data were nominal, and by Mann-Whitney test, when numeric. The level of significance was set at 5%. RESULTS: Twenty-two cases of malignant tumors were identified during these 10 years of follow-up (22 cases/395 or 5.5% of the sample), being the most common those of the uterine cervix (10 cases/395 or 2.5% of the sample) and breast cancer (9 cases/395 or 2.2% of the sample). The presence of tumors was associated with disease duration (p=0.006) and was not influenced by treatment with methotrexate (p=0.1), azathioprine (p=0.9), cyclophosphamide (p=0.6) and glucocorticoids (p=0.3). Breast and uterine cervix tumors were more common in systemic lupus erythematosus women than in the general population (p<0.0001 for both). CONCLUSION: A high prevalence of malignant tumors was found in this sample, with tumors being more common in patients with longer disease duration. The most frequent tumors affected the breast and uterus at a higher incidence than in the general population. The presence of tumors was ...
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Young Adult , Breast Neoplasms/etiology , Lupus Erythematosus, Systemic/complications , Uterine Cervical Neoplasms/etiology , Brazil/epidemiology , Breast Neoplasms/epidemiology , Incidence , Retrospective Studies , Uterine Cervical Neoplasms/epidemiologyABSTRACT
Background: Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer death in women worldwide. India accounts for 27% of the total cervical cancer deaths. Objectives: 1.To assess the risk factors associated with cancer cervix among the study population. 2. To study socio de-mographic profile of the study population. Materials and Methods: A community based, cross sectional study was conducted by the department of Community Medicine, A J Institute of Medical Sciences, in the urban field practice area, Kavoor among married women in the reproductive age group of 15-49years from April 2011 to September 2011. Socio demographic details and risk factors for cervical cancer were assessed. Results: A total of 357 women in the reproductive age group participated in the study. More than two third (87.2%) of the study population belonged to the age group of 30 – 49 years. 52.7% of the respondents be-longed to class IV socio economic status and 22.1% of the respondents were married before the age of 18 years. In this study 14% had their first child before the age of 18 years and43.2% respondents had 3 or more than 3 children. Cervical erosion was found in 38.4% of the respondents. Conclusion: Various risk factors like early age at marriage, low socioeconomic status, and multi parity are present in the study population. Screening and early detection efforts can be directed to the group at risk.
Subject(s)
Adult , Demography , Female , Health Behavior , Humans , India , Middle Aged , Risk Factors , Urban Population , Uterine Cervical Neoplasms/epidemiology , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/mortalityABSTRACT
BACKGROUND.Cervical cancer though a preventable disease; still has an estimated mortality of 80% from invasive cervical cancer in developing countries. The aim of this paper is to present an overview of cervical cancer and the various modalities available for screening and prevention of cervical cancer.METHODOLOGY: Google search and review of the literature of published works on overview of cervical cancer and its various modalities for screening and prevention were utilised.RESULTS.The incidence; aetiology; risk factors; clinical features; management and prevention of cervical cancer in Nigeria and as compared worldwide is presented. The reduction in incidence and mortality of cervical cancer in developed countries is related to the fact that cervical cancer screening is well institutionalized.CONCLUSION.Cervical cancer is the commonest genital tract malignancy in Nigeria. It is a sexually transmitted infection caused by the HPV. It is preventable! Vaccination against HPV is available worldwide and in Nigeria. It is thus imperative that the general public and medical personnel in particular appreciate the clinical importance of cervical cancer; and effectively outline the modalities for preventing cervical cancer; and thus advocate for institutionalizing cervical cancer screening activities in the Nigerian setting
Subject(s)
Papanicolaou Test , Papillomaviridae , Uterine Cervical Neoplasms , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/therapyABSTRACT
CONTEXT AND OBJECTIVES: Cervical cancer is an important cause of morbidity and mortality throughout the world. There is some controversy about the factors that may be associated with infection by the human papillomavirus (HPV) that may favor or protect against evolution from a low-grade intraepithelial lesion to a high-grade intraepithelial lesion or invasive neoplasia. The objective here was to evaluate the evolution of low-grade intraepithelial lesions and squamous or glandular lesions of undetermined significance, the associated factors and cytohistological correlations. DESIGN AND SETTING: Retrospective study conducted in a public tertiary-level university hospital. METHODS: Information was obtained by reviewing patient records and/or colposcopy reports. A statistical analysis was performed using logistic regression, calculating the odds ratio and applying chi-square tests. RESULTS: Of the 3390 patients, 409 evolved to high-grade intraepithelial lesions, of which 354 had an initial diagnosis of HPV infection, 27 of squamous atypia of undetermined significance, 22 of low-grade intraepithelial lesions with or without cytological diagnosis of infection by associated HPV and six of glandular cell atypia of undetermined significance. CONCLUSIONS: Lactobacillus sp and bacterial vaginosis on the smears, smoking and immunodepression were factors associated with evolution. A single partner, use of hormonal contraceptives, lower parity, age and a cytological diagnosis of cytolytic vaginosis, T. vaginalis, Candida sp or cocci were factors associated with protection. With regard to cytohistological correlation, there was a 74.08% agreement among patients with high-grade lesions and a biopsy obtained during the same period. .
CONTEXTO E OBJETIVOS: O câncer do colo uterino é importante causa de morbidade e mortalidade no mundo. Existem controvérsias sobre fatores que podem estar associados à infecção por papilomavírus humano (HPV) e favorecer ou proteger contra a evolução de lesão intraepitelial de baixo grau até lesão intraepitelial de alto grau ou neoplasia invasiva. O objetivo aqui foi de avaliar a evolução de lesões intraepiteliais de baixo grau e de significado indeterminado, escamosas ou glandulares, os fatores associados e as correlações citohistológicas. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo realizado em hospital universitário público terciário. MÉTODOS: As informações foram obtidas por meio de revisão de prontuários e/ou fichas de colposcopia. A análise estatística foi realizada por meio de regressão logística, calculando-se o odds ratio e aplicando-se o teste qui-quadrado. RESULTADOS: Das 3.390 pacientes, 409 evoluíram para lesão intraepitelial de alto grau, das quais 354 tinham diagnóstico inicial de infecção por HPV, 27 de atipias escamosas de significado indeterminado, 22 de lesão intraepitelial de baixo grau com ou sem diagnóstico citológico de infecção por HPV associado e 6 de atipias em células glandulares de significado indeterminado. CONCLUSÕES: Lactobacillus sp e vaginose bacteriana nos esfregaços, tabagismo e imunodepressão foram fatores associados com a evolução. Único parceiro, uso de contraceptivo hormonal, baixa paridade, idade e diagnóstico citológico de vaginose citolítica, T. vaginalis, Candida sp ou cocos foram fatores associados a proteção. Com relação à correlação citohistológica, encontramos concordância de 74,08% ...
Subject(s)
Adolescent , Adult , Female , Humans , Middle Aged , Young Adult , Uterine Cervical Dysplasia/pathology , Papillomavirus Infections/pathology , Uterine Cervical Neoplasms/pathology , Biopsy , Uterine Cervical Dysplasia/etiology , Colposcopy , Disease Progression , Neoplasm Grading , Papillomavirus Infections/complications , Retrospective Studies , Risk Factors , Uterine Cervical Neoplasms/etiology , Vagina/microbiologyABSTRACT
A infecção pelo Papilomavírus humano (HPV) é o principal responsável pela ocorrência do câncer cervical, sendo que o seu estudo por meio de técnicas moleculares sofreu um aumento significativo na última década. Objetivo: Analisar as publicações sobre a identificação molecular do HPV no colo uterino no Brasil. Metodologia:Trata-se de revisão sistemática nos portais PubMed e Biblioteca Virtual em Saúde entre os anos de 2007 a 2012, utilizando os termos: human papillomavirus, cervical cancer, polymerase chain reaction e Brazil. Dos 37 artigos identificados, 16 permaneceram após leitura dos mesmos na integra, sendo excluídos: os disponíveis apenas o resumo; os estudos que focaram a população masculina; os retrospectivos; com dados dos tipos de HPV indisponíveis; estudos experimentais; comparativo de técnicas; e de variantes intratípicas. De posse desses artigos, realizou-se a distribuição entre a frequência dos tipos de HPV em relação às diferentes técnicas de genotipagem e regiões do Brasil onde ocorreram as pesquisas que originaram os artigos. Resultados: Houve um predomínio das publicações na região Sudeste (43,7%), seguido pelo Nordeste (25,0%) e Sul (18,7%). Dos 16 artigos incluídos, observou-se uma maior frequência pelo HPV tipo 16 seguido do 31. Conclusão:As técnicas de diagnóstico moleculares são importantes ferramentas para a identificação dos tipos de HPV presentes em infecções do colo uterino, observando a necessidade de identificação dos genótipos que predominam na população brasileira, com a finalidade de melhoria na elaboração de políticas públicas em saúde.
he infection by human papillomavirus (HPV) is the main responsible for the occurrence of cervical cancer, and their study using molecular techniques has increased significantly in the last decade. Objective: To analyze the publications on the molecular identification of HPV in cervical cancer in Brazil. Methodology: This is a systematic review in PubMed and Virtual Health Library postals between the years 2007 and 2012 using the terms: humanpapillomavirus, cervical cancer, polymerasechainreaction and Brazil. Out of the 37 articles identified, 16 remained after their fully reading, being excluded: available only the summary, the studies that focused on the male population; retrospective; with data of HPV types unavailable; experimental studies, comparative techniques; and intratypical variants. Based on these articles the frequency distribution of HPV types was held relative to different genotyping techniques and regions of Brazil where the articles research took place. Results: There was a predominance of publications in the Southeast (43.7%), followed by the Northeast (25.0%) and South (18.7%) out of the 16 articles included, we observed a higher frequency of HPtion of HPV types in cervical infections, observing the need for identification of genotypes that predominate in the Brazilian population, with the aim of improving the development of public health policies.
Subject(s)
Humans , Female , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/genetics , Papillomaviridae/genetics , Molecular Diagnostic Techniques , Brazil , In Situ Hybridization/methods , Papillomavirus Infections/genetics , Papillomavirus Infections/transmission , /genetics , /isolation & purification , /genetics , /isolation & purification , Polymerase Chain Reaction/methods , Genotyping Techniques/methodsABSTRACT
Introdução: O câncer do colo do útero é um problema de saúde pública devido aos altos índices de morbimortalidade.Objetivo: Analisar a evolução da mortalidade por câncer do colo do útero em Goiás entre os anos de 1989 e 2009. Método: Estudo retrospectivo de série temporal. Os dados foram obtidos do Sistema de Informação sobre Mortalidade, pesquisados na base de dados do Departamento de Informática do Sistema Único de Saúde, e os da população do Instituto Brasileiro de Geografia e Estatística. Para a análise de tendência, foi utilizado o programa joinpoint. Resultados: Na faixa etária de 30 a 59 anos, as taxas são crescentes e evoluem acompanhando o envelhecimento. A análise de tendência para óbitos por câncer do colo do útero em mulheres dos 50 aos 59 anos de idade mostrou uma redução da mudança percentual anual a partir de 2004 e tendência de estabilidade para as outras faixas etárias. No Estado de Goiás, houve uma estabilização da mudança percentual anual para o primeiro período analisado, com posterior redução após a implantação do Programa Viva Mulher. Conclusão: Concluiu-se, neste estudo, que houve tendência de estabilidade da mortalidade por câncer do colo do útero ao longo da série analisada; porém, ao observar antes e após a implantação do Programa, houve uma diminuição da mudança percentual anual, com valores de p significativos, o que reflete certa eficiência das ações de prevenção, diagnóstico e tratamento impulsionadas em Goiás a partir Programa Viva Mulher.
Subject(s)
Adult , Middle Aged , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/mortality , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/therapyABSTRACT
La infección persistente por ciertos tipos de alto riesgo oncogénico de virus papiloma humano (VPHAR) es el principal factor de riesgo para el desarrollo de cáncer de cuello uterino y sus lesiones precursoras. Los VPHAR inducen alteraciones moleculares durante todo el proceso de carcinogénesis cervical, que provocan la acumulación de errores genéticos, con la consecuente inestabilidad genética y transformación maligna. Estas alteraciones son producidas por la acción directa de las oncoproteínas virales E6 y E7 sobre las principales proteínas celulares supresoras de tumor, p53 y pRb, respectivamente, y pueden ser monitoreadas durante el surgimiento de la lesión neoplásica, mediante el uso de biomarcadores. En este artículo se revisan las últimas tendencias sobre el uso del estudio inmunocitoquímico, como una prueba complementaria a la citología y a la detección y tipificación de VPHAR en la evaluación de la expresión de biomarcadores como la proteína inhibidora de la proliferación celular p16INK4a, marcador único o combinada con otros biomarcadores, que puedan contribuir eficazmente en la detección de las pacientes con mayor riesgo a desarrollar neoplasia del cuello uterino asociada a la infección por VPHAR, durante la pesquisa de cáncer de cuello uterino de rutina y en el manejo clínico adecuado y oportuno.
Persistent infection with certain types of high oncogenic risk human papillomavirus (HR-HPV) is the main risk factor for developing cervical cancer and its precursor lesions. HR-HPV induces molecular changes during cervical carcinogenesis, causing the accumulation of genetic anomalies, with subsequent genetic instability and malignant transformation. These alterations are produced by the direct action of the E6 and E7 viral oncoproteins on principal tumor cell suppressor proteins, p53 and pRb, respectively, and can be monitored during growth of the neoplastic lesion using biomarkers. In this paper we review the latest trends on the use of immunocytochemistry as a complementary test to cytology and HR-HPV detection and typing in evaluating expression of biomarkers such as the p16INK4a cell proliferation inhibitor protein, as a single marker or combined with other biomarkers, which can contribute effectively to the detection of patients with increased risk of developing cervical neoplasia associated with HR-HPV infection during routine screening for cervical cancer and in appropriate clinical management.
Subject(s)
Humans , Adult , Female , Young Adult , Biomarkers, Pharmacological/analysis , Biomarkers, Pharmacological/blood , Epithelial Cells/chemistry , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/pathology , Papilloma/etiology , Papilloma/chemistry , Papilloma/blood , Blood Chemical Analysis , Hematology , Immunohistochemistry , Medical OncologyABSTRACT
La infección persistente por el virus del papiloma humano de alto riesgo (HR-HPV) está relacionada con la aparición de cáncer cervical (CC), una de las principales causas de mortalidad por cáncer en todo el mundo. La infección se produce en la zona de transformación, la región más sensible del cérvix a estrógenos y retinoides. El CC afecta a un bajo porcentaje de mujeres infectadas por HR-HPV y tarda en desarrollarse hasta décadas después de la infección, lo que sugiere que el HR-HPV es necesario pero no suficiente para causar CC. Otros factores son necesarios para la progresión desde la infección por HR-HPV hasta el cáncer, como por ejemplo: uso de anticonceptivos orales por largos períodos, fumar, partos múltiples, falta de micronutrientes, particularmente una dieta baja en retinoides, los cuales alteran la diferenciación epitelial, el crecimiento celular y la apoptosis de las células malignas. La detección precoz del HR-HPV y el manejo de lesiones precancerosas, aunado a un conocimiento detallado de factores de riesgo adicionales, puede ser una estrategia para prevenir esta enfermedad. La presente revisión se enfoca en explicar el efecto de los estrógenos, la deficiencia de retinoides y el HR-HPV en la aparición del CC. Dichos cofactores pueden actuar en conjunto para inducir transformación neoplásica en el epitelio escamoso del cérvix, promoviendo un segundo evento genético o epigenético que lleve a la aparición del CC.
ersistent infection with high-risk human papillomaviruses (HR-HPVs) is involved in cervical cancer (CC),a major cause of cancer mortality worldwide. Infection occurs primarily at the transformation zone (TZ),the most estrogen- and retinoid-sensitive region of the cervix. Development of CC affects a small per-centage of HR-HPV-infected women and often takes decades after infection, suggesting that HR-HPVis a necessary but not sufficient cause of CC. Thus, other cofactors are necessary for progression fromcervical HR-HPV infection to cancer such as long-term use of hormonal contraceptives, multiparity, smo-king, as well as micronutrient depletion and in particular retinoid deficiency, which alters epithelial diffe-rentiation, cellular growth and apoptosis of malignant cells. Therefore, early detection of HR-HPV andmanagement of precancerous lesions together with a profound understanding of additional risk factorscould be a strategy to avoid this disease. In this review we focus on the synergic effect of estrogens,retinoid deficiency and HR-HPVs in the development of CC. These risk factors may act in concert to indu-ce neoplastic transformation in the squamous epithelium of the cervix, setting the stage for secondarygenetic or epigenetic events leading to cervical cancer.
Subject(s)
Estrogens , Papillomavirus Infections , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/etiology , Uterine Cervical Neoplasms/prevention & control , RetinoidsABSTRACT
Objetivos Establecer la prevalencia del resultado de citología anormal e inflamación y su asociación con factores de riesgo para neoplasias del cuello uterino en mujeres del departamento del Cauca, Colombia. Metodología Después de la Arma voluntaria del consentimiento informado, las mujeres fueron entrevistadas a través de un cuestionario para colectar variables de tipo sociodemográfico y clínico, incluyendo historia reproductiva, actividad sexual, historia de citología y hábito de fumar. Posteriormente, se procedió a la toma de la citología para su análisis y clasificación según el sistema Bethesda 2001. Un total de 1735 mujeres fueron reclutadas para este estudio. Resultados Acorde con el resultado de citología, 1061 mujeres presentaron citología normal (61 %), 36 citología anormal (2 %) y 638 cambios celulares reactivos asociados a inflamación (37 %). Los resultados indican que tener relaciones sexuales a temprana edad, la multiparidad, el uso de anticonceptivos hormonales y no realizarse la citología anualmente fueron factores de riesgo asociados a citología anormal. Conclusiones Estos resultados brindan información valiosa a las instituciones de salud pública para desarrollar mejores programas de cribado para la prevención de neoplasias del cuello uterino en mujeres de la región y el país.
Objectives Establishing the prevalence of abnormal and inflammation cytology reports and its association with risks factors for uterine cervical neoplasms amongst females from the Cauca department in Colombia. Methodology After signing a consent-form, females were interviewed using a questionnaire to collect socio-demographic and clinical data, including reproductive history, sexual activity, cytology history and smoking habits. Cytology was then taken for analysis and classification according to the 2001 Bethesda System. A total of 1,735 females were recruited for the study. Results According to the cytology report, 1061 women had normal cytology (61 %), 36 abnormal cytology (2 %) and 638 reactive cellular changes associated with inflammation (37 %). The results indicated that having sexual intercourse at an early age, multiparity, using hormonal contraceptives and not having annual cytology screening were associated with abnormal cytology reports. Conclusions These results provided valuable information for public health institutions for developing better screening programmes to prevent risks of uterine cervical neoplasms amongst females from our region and throughout Colombia.