Avaliação da função sexual e da atividade física em mulheres após tratamento do câncer de colo de útero: estudo transversal / Assessment of sexual function and physical activity in women after cervical cancer treatment: a cross-sectional study

Introdução: O tratamento do câncer do colo do útero (CCU) promove menopausa precoce em mulheres diagnosticadas durante o menacme. A consequente interrupção abrupta da produção dos hormônios ovarianos impacta na sexualidade e outras áreas da vida da mulher, inclusive sua atividade física. É possível que a atividade física influencie a atividade sexual nessas mulheres. Objetivo: Avaliar o nível de atividade física e a função sexual nas mulheres após o tratamento oncológico e verificar se a atividade física está associada a melhor função sexual. Método: Este estudo transversal incluiu mulheres tratadas para câncer do colo do útero em um hospital de referência em oncologia no Brasil, com idade entre 18 e 50 anos, submetidas a ooforectomia bilateral e/ou radioterapia pélvica há, no máximo 11 anos. O desfecho primário foi o estado da função sexual e do nível de atividade física e a correlação entre eles e o tratamento oncológico. As mulheres responderam os questionários Female Sexual Function Index (FSFI) e o International Physical Activity Questionnaire (IPAQ) por entrevista remota entre agosto de 2021 a julho de 2022. Resultados: 50 mulheres foram entrevistadas. A média de idade foi 50 anos (DP = ±5). Todas as mulheres que tinham atividade sexual apresentaram algum nível de disfunção sexual. A maior parte das mulheres era fisicamente ativa (60%). Não houve correlação do perfil de atividade física, nem da função sexual com o tratamento oncológico realizado. Não houve associação entre atividade física e maior qualidade na função sexual. Conclusão: Todas as mulheres que relataram relação sexual tinham disfunção sexual e a maioria delas era ativa fisicamente.

Background: Cervical cancer (CC) treatment promotes early menopause in women diagnosed during menacme. The consequent abrupt interruption of the production of ovarian hormones impacts on sexuality and other areas of a woman's life, including her physical activity. It is possible that physical activity influences sexual activity in these women. Aim: To evaluate the level of physical activity and sexual function in women after cancer treatment and to verify whether physical activity is associated with better sexual function. Method: This cross-sectional study included women aged between 18 and 50 years treated for cervical cancer at a reference hospital in oncology in Brazil, who had undergone bilateral oophorectomy and/or pelvic radiotherapy for a maximum of 11 years. The primary outcome was sexual function status and physical activity level and understanding between them and cancer treatment. The women answered the Female Sexual Function Index (FSFI) and the International Physical Activity Questionnaire (IPAQ) by remote interview between August 2021 and July 2022. Results: 50 women were interviewed. The mean age was 50 years (SD = ±5). All women who had sexual activity had some level of sexual dysfunction. Most women were physically active (60%). There was no change in the physical activity profile or sexual function with the oncological treatment performed. There was no association between physical activity and better quality of sexual function. Conclusion: All women who reported sexual intercourse had sexual dysfunction and most of them were physically active.

Efectos de la enfermedad y tratamiento en la calidad de vida sexual de la mujer con cáncer cérvico uterino / Effects of the disease and treatment in the quality of sexual life of women with cervical uterine cancer

El cáncer cérvico uterino (CaCu) corresponde al 10% de los cánceres femeninos, se describe prevenible y con viabilidad de curación, no obstante, con la optimización de las terapias las sobrevivientes superan los cinco años en el 70% de los casos, evidenciando efectos adversos producto principalmente del tratamiento que deterioran la calidad de vida e impactan sobre su sexualidad. OBJETIVO: Identificar efectos de la enfermedad y tratamiento que comprometen la calidad de vida sexual de la mujer con CaCu. METODOLOGÍA: Revisión de artículos originales entre los años 2010 y 2019 desde las bases de datos Pubmed, Scopus, Scielo, Google Académico, Science Direct, Elsevier, Redalyc, Springer Link, Wiley Online Library, Dialnet y Ovid, seleccionando 51 artículos de 90 en inglés, español y portugués a texto completo, que reportaran efectos físicos y psicosociales que comprometieran la calidad de vida sexual de mujeres con CaCu. RESULTADOS: La sexualidad de estas mujeres es impactada por efectos físicos, relacionadas con el estadio de la enfermedad y tratamiento como dispareunia, anorgasmia, alteraciones digestivas, urinarias, insomnio, inapetencia, linfedema y neuropatía periférica. Desde el ámbito psicosocial manifiestan efectos sobre su autoestima, depresión e inseguridad en la permanencia del vínculo de pareja. Emerge la comunicación sexual de pareja como condición categórica en el nivel de afectación de la calidad de vida sexual. CONCLUSIONES: la sexualidad de la mujer con CaCu está comprometida por efectos físicas y psicosociales secundarias principalmente al tratamiento recibido. La comunicación sexual de pareja surge como interviniente para superar estos efectos y debe considerarse en la atención profesional.

Cervical uterine cancer (CaCu) corresponds to 10% of female cancers, it is described as preventable and with viability of cure, however, with the optimization of therapies the survivors exceed five years in 70% of the cases, evidencing adverse effects mainly due to the treatment that deteriorates the quality of life and impact on their sexuality. OBJECTIVE: To identify the effects of the disease and treatment that compromises the quality of sexual life of women with CaCu. METHODOLOGY: Review of original articles between 2010 and 2019 from Pubmed, Scopus, Scielo, Google Scholar, Science Direct, Elsevier, Redalyc, Springer Link, Wiley Online Library, Dialnet, and Ovid databases, selecting 51 articles out of 90 in English, Spanish, and Portuguese in full text, which reported physical and psychosocial effects that compromises the quality of sexual life of women with CaCu. RESULTS: The sexuality of these women is impacted by physical effects, related to the stage of the disease and treatment, such as dyspareunia, anorgasmia, digestive and urinary disorders, insomnia, inappetence, lymphedema and peripheral neuropathy. From the psychosocial perspective, they show effects on their self-esteem, depression and insecurity in the permanence of the couple's relationship. Sexual communication between couples is emerging as a categorical condition in the level of affectation of the quality of sexual life. CONCLUSIONS: The sexuality of women with CaCu is compromised by physical and psychosocial effects mainly secondary to the treatment received. Couple's sexual communication emerges as an intervention to overcome these effects and should be considered in professional care.

Clinical management of the first ASCUS report in Chile. Prospective single-cohort study / Manejo clínico do primeiro relatório ASCUS no Chile. Estudo prospectivo de coorte única

ABSTRACT CONTEXT AND OBJECTIVE: Worldwide, there is no single strategy for optimal management of patients with ASCUS (atypical squamous cells of undetermined significance) cytology reports. The objective of this study was to determine the kind of clinical management conducted among women with a first ASCUS Pap smear report. DESIGN AND SETTING: Prospective single cohort study at a cervical pathology unit in Santiago, Chile. METHODS: This was an epidemiological, descriptive, observational and quantitative follow-up study on a cohort of women with ASCUS cytological reports. RESULTS: In the screening phase, 92,001 cervical cytological smears were collected in primary healthcare clinics. In the diagnostic phase, all women with a first ASCUS report were selected (n = 446). These women were asked to undergo the Pap test again and it was found that 301 women had normal results, 62 women had abnormal results and 83 did not repeat the test. In the diagnostic confirmation phase, the 62 women with abnormal results underwent colposcopy and, from these results, 58 of them underwent a biopsy. The results from the biopsies showed that 16 women had negative histological reports, 13 had CIN 1 and 29 had CIN 2+. In the treatment phase, the 42 women with lesions underwent a variety of treatments, according to the type of lesion. In the post-treatment phase, cytological and colposcopic monitoring was instituted. CONCLUSION: The clinical management consisted of traditional management of screening, diagnosis, diagnostic confirmation, treatment and post-treatment monitoring.

RESUMO CONTEXTO E OBJETIVO: Mundialmente, não existe estratégia única para o gerenciamento ideal de pacientes com laudos de citologia ASCUS ( atypical squamous cells of undetermined significance ). O objetivo do estudo foi determinar o tipo de gerenciamento clínico realizado em mulheres com o primeiro laudo de Papanicolaou ASCUS. DESENHO E LOCAL: Estudo prospectivo de coorte única em uma unidade de patologia cervical em Santiago, Chile. MÉTODOS: Estudo epidemiológico, descritivo, observacional e quantitativo de seguimento de um grupo de mulheres com laudos de citologia ASCUS. RESULTADOS: Na fase de rastreamento, 92.001 relatórios de citologia cervical foram coletados nos ambulatórios da rede pública de saúde. Na fase de diagnóstico, foi selecionada a totalidade de mulheres com relatórios citológicos de ASCUS (n = 446). Essas mulheres foram submetidas a repetição do exame de Papanicolaou, obtendo-se 301 mulheres com resultados normais, 62 mulheres com resultados anormais e 83 que não repetiram o exame. Na fase de confirmação de diagnóstico, as 62 mulheres com resultados anormais foram submetidas a colposcopia e, considerando-se os resultados obtidos, 58 foram submetidas a biópsia. Os resultados das biópsias mostraram 16 mulheres com laudos histológicos negativos, 13 com NIC 1 e 29 com NIC 2 +. Na fase terapêutica, as 42 mulheres com lesões foram submetidas a diversos tratamentos de acordo com o tipo de lesão. Para a fase pós-tratamento, foi instituído um sistema de monitoramento citocolposcópico. CONCLUSÃO: As condutas clínicas tiveram gestão tradicional de rastreamento, diagnóstico, confirmação diagnóstica, tratamento e acompanhamento pós-tratamento.

Clinical and evolving features of women diagnosed with precancerous cervical lesions, screened and treated in the Amazon region of Brazil / Características clínicas e evolutivas de mulheres com diagnóstico de lesões precursoras de câncer cervical, rastreadas e tratadas na região amazônica brasileira / Las características clínicas y los resultados de mujeres con un diagnóstico de lesiones precursoras de lesión cervical, seguimiento y tratamiento en la Amazonia brasileña

The objective of the study was to determine the dynamics of precancerous lesions in women of a cohort treated for cervical intraepithelial neoplasia (CIN) and followed up over the next two years. The conditional probability of failure was calculated using the Kaplan-Meier method, and the raw and adjusted hazard ratios (HR) were determined using Cox regression with a p-value entry of < 0.05. Of the 237 women who were treated, 51.5% were accompanied over 24 months, and treatment failed for 21.9% of those accompanied. Women who had five or more pregnancies (adjusted HR = 3.10, 95%CI: 1.28-7.51) or an initial histological diagnosis of CIN II/III demonstrated an independent risk of treatment failure (adjusted HR = 3.14, 95%CI: 1.20-8.19). Being in a stable relationship was a protective factor against treatment failure (adjusted HR = 0.47, 95%CI: 0.24-0.89). A history of more frequent pregnancies and a histological diagnosis of CIN II/III are directly correlated with risk of CIN treatment failure, whereas being in a stable relationship is inversely correlated with this risk.

O objetivo do estudo foi determinar a dinâmica da lesão intraepitelial cervical (NIC) em mulheres tratadas que foram acompanhadas em uma coorte durante dois anos. Foi calculada a probabilidade condicional de falha usando o método de Kaplan-Meier e foram calculadas as hazard ratios (HR) bruta e ajustada para o risco de falha usando a regressão de Cox com valor de p de entrada < 0,05. Das 237 mulheres que foram tratadas, 51,5% foram acompanhadas por 24 meses e 21,9% delas tiveram falha no tratamento, apresentando recidiva da lesão cervical. Mulheres que tinham mais que cinco gestações (HR = 3,10; IC95%: 1,28-7,51) ou histológico de NIC II/III demonstraram risco independente para falha no tratamento (HR = 3,14; IC95%: 1,20-8,19) e estar em um relacionamento estável mostrou ser um fator de proteção para falha de tratamento (HR = 0,47; IC95%: 0,24-0,89). A história de maior número de gestações e histológico de NIC II/III estão diretamente correlacionados com o risco de falha no tratamento, enquanto que estar em um relacionamento estável é inversamente correlacionado ao risco.

El objetivo del estudio fue determinar la dinámica de las lesiones intraepiteliales de cuello uterino (NIC) en mujeres que fueron tratadas dentro de una cohorte, cuyo seguimiento se realizó durante dos años. Se calculó la probabilidad condicional de error, utilizando el método de Kaplan-Meier y se calcularon los cocientes de riesgo (HR) crudos y ajustados por el riesgo de fracaso mediante la regresión de Cox con el aporte valor p < 0,05. De 237 mujeres que recibieron tratamiento, el 51,5% fueron seguidas durante 24 meses y en el 21,9% fracasó el tratamiento, mostrando la repetición del daño cervical. Las mujeres que tenían más de cinco embarazos (HR = 3,10; IC95%: 1,28-7,51) o NIC histológico II/III mostraron un factor de riesgo independiente para el fracaso del tratamiento (HR = 3,14; IC95%: 1,20-8,19) y estar en una relación estable resultó ser un factor protector para el fracaso del tratamiento (HR: 0,47; IC95%: 0,24-0,89). La historia de embarazos múltiples y con diagnóstico histológico NIC II/III se correlaciona directamente con el riesgo de fracaso del tratamiento, mientras que si está en una relación estable se correlaciona inversamente con la relación riesgo.

Determinantes sociales del abandono del diagnóstico y el tratamiento de mujeres con Papanicolaou anormal en Buenos Aires, Argentina / Social determinants of dropout from diagnosis and treatment by women with abnormal Pap smears in Buenos Aires, Argentina

OBJETIVO:Determinar la magnitud y los motivos del abandono del proceso de diagnóstico y tratamiento de las mujeres con citología anormal, así como la relación entre las características socioeconómicas de las mujeres y dicho abandono. MÉTODOS: Estudio transversal-retrospectivo. Se realizó un análisis de fuentes secundarias y entrevistas domiciliarias a mujeres con Papanicolaou (Pap) anormal atendidas en el sistema público municipal entre 2009 y 2011. RESULTADOS: El abandono confirmado en la población de estudio fue de 18,3%. Las mujeres con mayor probabilidad de abandono fueron las que vivían en hogares con presencia de niños menores de 5 años de edad (razón de probabilidades [RP]: 2,4; intervalo de confianza de 95% [IC95%]: 1,2-4,8) y las que vivían en hogares con hacinamiento (RP: 2,9; IC95%: 1,2-7,3). Las mujeres que realizaron el Pap inicial en un centro de atención primaria poseían 4,6 veces más probabilidad de abandono que las atendidas en el hospital (IC95%: 1,7-12,3). Los principales motivos de abandono reportados fueron problemas con la organización de los servicios de salud y la carga de trabajo doméstico. CONCLUSIONES: Las condiciones de vida de las mujeres, y la organización y calidad de los servicios de salud, inciden en el abandono del proceso de diagnóstico y tratamiento de las lesiones precancerosas. Es fundamental desarrollar estrategias que actúen sobre los determinantes sociales del abandono como un modo de asegurar la efectividad de los programas de tamizaje del cáncer cervicouterino.

OBJECTIVE: Determine the extent and reasons why women with abnormal Pap smears drop out from diagnosis and treatment, and the relationship between women's socioeconomic characteristics and dropping out. METHODS: Cross-sectional retrospective study. Analysis of secondary sources and household interviews with women with abnormal Pap smears seen in the public municipal system from 2009 to 2011. RESULTS: Confirmed dropout in the study population was 18.3%. Women with the greatest probability of dropping out lived in homes where there were children under five (probability ratio [PR]: 2.4; 95% confidence interval [95%CI]: 1.2-4.8) and where there was overcrowding (PR: 2.9; 95%CI: 1.2-7.3). Women whose initial Pap smear was done in a primary care center had a 4.6 times greater probability of dropping out than those seen in a hospital (95%CI: 1.7-12.3). The main reasons reported for dropping out were problems with health services organization and domestic workload. CONCLUSIONS: Women's living conditions and the organization and quality of health services affect dropout from diagnosis and treatment of precancerous lesions. Strategies need to be developed that address social determinants of dropping out as a way to ensure effectiveness of cervical cancer screening programs.

Cervical intraepithelial neoplasia in a cohort of HIV-positive women at the University Hospital of the West Indies: management and outcome / Neoplasia intraepitelial cervical en una cohorte de mujeres VIH-positivas en el Hospital Universitario de West Indies: manejo y resultados

OBJECTIVE: To determine the rate of recurrence of cervical intraepithelial neoplasia (CIN) in HIVpositive women evaluated at the University H ospital of the West Indies (UHWI). METHOD: A chart review of all non-pregnant HIV-positive women who attended the gynaecologic and colposcopic clinics between January 1994 and December 2004 identified 21 such women. Fifteen of these patients who had CIN and had at least one follow-up Pap smear were the main subjects of this study. These patients were compared to 21 HIV-negative controls who were seen during the same period and who also had at least one follow-up Pap smear. Treatment modalities for the groups included cold coagulation and large loop excision of the transformation zone (LLETZ). Cox proportional hazards analysis was used to determine the effect of HIV status on the time to first recurrence of CIN. RESULTS: The mean ages of the subjects were 32.7 ± 8.0 and 33.2 ± 8.1 years, respectively. With a mean follow-up period of 1.7 years, the rate of recurrence of CIN in patients with and without HIV was 66.24 (95% CI 27.6, 159.1) and 3.0 (95% CI 1.3, 7.3) per 100 person years. The hazards rate ratio for recurrence in subjects with HIV after adjusting for age and CIN stage was 19.1 (95% CI 4.4, 82.1). CONCLUSION: HIV increases the risk of recurrence of CIN.

OBJETIVO: Determinar la tasa de recurrencia de la neoplasia intraepitelial cervical (NIC) en las mujeres VIH-positivas evaluadas en el Hospital Universitario de West Indies (HUWI). MÉTODO: Una revisión de las historias clínicas de todas las mujeres VIH-positivas no embarazadas que asistieron a la clínica ginecológica y la clínica colposcópica entre enero de 1994 y diciembre de 2004, identificó 21 de estas mujeres. Quince de estas pacientes que tenían NIC y habían tenido al menos una prueba de Papanicolaou de seguimiento, fueron los sujetos principales de este estudio. Estas pacientes fueron comparadas con 21 controles de VIH-negativos que fueron vistos durante el mismo período y que también tuvieron al menos una prueba de Papanicolaou de seguimiento. Las modalidades de tratamiento para los grupos incluyeron coagulación fría y escisión con asa grande de la zona de transformación (LLETZ). El modelo de análisis de riesgos proporcionales de Cox fue utilizado para determinar el efecto del estatus de VIH al momento de la primera recurrencia de CIN. RESULTADOS: Las edades promedios de los sujetos fueron 32.7 ± 8.0 y 33.2 ± 8.1 años, respectivamente. Con un período de seguimiento promedio de 1.7 años, la tasa de recurrencia de NIC en pacientes con y sin VIH fue 66.24 (95% IC 27.6, 159.1) y 3.0 (95% IC 1.3, 7.3) por 100 persona/años. El cociente de tasas de riesgo de recurrencia en pacientes con VIH después de ajustar por edad y etapa de CIN fue 19.1 (95% IC 4.4, 82.1). CONCLUSIÓN: El VIH aumenta el riesgo de recurrencia de la NIC.

Avaliação da conduta conservadora na lesão intraepitelial cervical de alto grau / Evaluation of conservative management of high-grade cervical squamous intraepithelial lesion

OBJETIVO: Analisar a associação entre a conduta conservadora em lesão intraepitelial cervical de alto grau com o índice de recidiva da neoplasia e faixa etária. MÉTODOS: Estudo transversal e retrospectivo realizado com 509 mulheres (15-76 anos) atendidas no período de 1996 a 2006, com colpocitologia oncótica alterada, em um serviço público de referência em Maringá, PR. Os dados foram coletados dos prontuários médicos e estudadas as variáveis diagnóstico definitivo, tipos de tratamento, ocorrência da lesão e recidivas, analisados por meio de testes de associação de qui-quadrado de Pearson e teste exato de Fisher. RESULTADOS: A lesão intraepitelial cervical de alto grau ocorreu em 168 casos; destes, 31 mulheres foram submetidas à amputação cônica, 104 a cirurgias de alta frequência, nove histerectomizadas e 24 receberam conduta conservadora. Dentre as mulheres com lesão de alto grau e tratadas de forma conservadora, oito (33,3%) recidivaram, enquanto dentre as submetidas à conduta não conservadora dez (6,9%) recidivaram, sendo essa diferença estatisticamente significante (p = 0,0009), RP = 4,8 (IC95% 2,11;10,93). Para aquelas que fizeram o seguimento clínico-citológico, três (30,0%) e, dentre as cauterizadas, cinco (35,7%) recidivaram no prazo de três anos, sem diferença significante (p = 0,5611). A recidiva abaixo e acima de 30 anos ocorreu, respectivamente, em sete (13,8%) e 11 (12,2%) mulheres (p = 0,9955). CONCLUSÕES: A idade da mulher não influencia o prognóstico de recidiva. O tratamento conservador deve ser indicado como conduta de exceção, dada a alta taxa de recidiva, e o seguimento deve ser rigoroso, com acompanhamento citológico e colposcópico de até três anos, período em que ocorre a maioria das recidivas.

OBJECTIVE: To assess the association between conservative management of high-grade cervical squamous intraepithelial lesions and recurrence rates and age groups. METHODS: Cross-sectional, retrospective, analytical observational study of 509 women (aged 15 to 76) with abnormal Pap smears attending a public reference center in the city of Maringá, southern Brazil, from 1996 to 2006. Data was collected from medical records, and the variables definitive diagnosis, type of treatment provided, occurrence of high-grade cervical squamous intraepithelial lesions and recurrence were studied. Pearson's chi-square test and Fisher's exact test were used in the statistical analyses. RESULTS: There were 168 cases of cervical high-grade cervical squamous intraepithelial lesions, of these, 31 were treated with cold-knife conization, 104 loop electrosurgical excision procedure, 9 hysterectomy and 24 conservative treatment (i.e., clinical and cytological follow-up or cervical electrocoagulation). A total of 8 (33.3%) women receiving conservative and 10 (6.9%) receiving non-conservative management had recurrent disease and this difference was statistically significant (p=0.0009), PR = 4.8 (95%CI 2.11;10.93). Three (30.0%) women among those undergoing clinical and cytological follow-up and five 5 (35.7%) among those submitted to cervical electrocoagulation had recurrent disease within three years, but the difference was not significant (p=0.5611). Recurrent rates in those younger and older than 30 were 13.8% (7 women) and 12.2% (11 women) (p = 0.9955). CONCLUSIONS: Age is not a predictor of disease recurrence. Conservative treatment is only recommended in exceptional situations due to its high recurrence rates. Careful cytological and colposcopic follow-up is required for three years when most recurrences occur.

Lesões cervicais de baixo e alto grau em adolescentes soropositivas para o HIV / Low and high-grade cervical lesions among HIV-infected adolescents

Foi realizada uma revisão da literatura sobre a incidência de lesões intraepiteliais escamosas de baixo e de alto grau em adolescentes soropositivas para o HIV. Os estudos mostraram diferenças na incidência dessas lesões nas pacientes adultas soropositivas (13 a 30% de lesões intraepiteliais escamosas de baixo grau; 1 a 32,6% de alto grau), nas adolescentes com sorologia desconhecida para o HIV (5,7 a 20% de lesões intraepiteliais escamosas de baixo grau; 0 a 4,8% de alto grau) e nas adolescentes soropositivas para o HIV (19,5 a 55% de lesões intraepiteliais escamosas de baixo grau; 4,8 a 21,5% de alto grau). Comentou-se sobre as diferenças na positividade para o HPV em adolescentes HIV positivo e negativo. As recomendações atuais sobre o rastreamento do câncer cervical e a conduta nas alterações cervicais em adolescentes foram revistas

We performed a review of literature on the incidence of low-grade squamous intraepithelial lesion and high-grade squamous intraepithelial lesion in adolescents seropositive for the human immunodeficiency virus (HIV). The studies showed differences in the incidence of these lesions in seropositive adult patients (13 to 30% of low-grade squamous intraepithelial lesion; 1 to 32.6% of high-grade squamous intraepithelial lesion), in adolescents with unknown HIV serology (5.7 to 20% of low-grade scamous intraepithelial lesion; 0 to 4.8% of high-grade scamous intraepithelial lesion) and in adolescents seropositive for HIV (19.5 to 55% of low-grade squamous intraepithelial lesion; 4.8 to 21,5% of high-grade squamous intraepithelial lesion). We commented on the differences in positivity for the Human Papiloma Virus (HPV) in HIV positive and negative adolescents. Current recommendations on the screening of cervical cancer and management of cervical abnormalities in adolescents were reviewed

Neoplasias intraepiteliales cervicales (NIC) tratadas con cono leep en la modalidad de ver y tratar en el instituto regional de enfermedades neoplásicas norte, del 2008 al 2009 / Cervical intraepithelial neoplasia (CIN) treated with leep in the mode of seeing and dealing in the regional institute of infection north, from 2008 to 2009

Objetivos: Evaluar los casos con LESIONES INTRAEPITELIALES CERVICALES DE ALTO GRADO (NIC II, III, CIS) y tratarlas mediante el Procedimiento de Escisión con Asa Electro quirúrgica del Cuello uterino (CONO LEEP) en la modalidad de VER Y TRATAR en el IREN Norte - Trujillo; para determinar la efectividad del tratamiento, frecuencia, grados, complicaciones y recurrencia de la enfermedad. Materiales y Métodos: Se realizó un estudio prospectivo, descriptivo llevado a cabo del 05 de Enero del 2008 al 30 de Diciembre del 2009, de todas las pacientes que presentaban a su ingreso Diagnóstico de NIC AG, quienes fueron sometidas en la primera y única consulta a CONO LEEP (PROCEDIMIENTO DE ESCISIÓN CON ASA ELECTROQUIRÚRGICA), en la modalidad de VER y TRATAR. Se incluyeron los casos con Citología positiva, biopsia positiva o Colposcopia sugestiva de NIC de AG, que afectan el 50% o menos del cérvix. Resultados: El 79.0% (151) de las pacientes con NIC alto grado, cumplieron con los criterios y fueron sometidas a CONO LEEP modalidad de VER y TRATAR. El 21% (40 casos) no cumplieron con los criterios de inclusión y fueron sometidas a otros procedimientos. La edad media fue 39.29 años y la desviación estándar de 9.96. Los resultados histológicos fueron: CIS: 23%(34), NIC III: 25 %(37) y NIC II: 46%(70); Cáncer microinvasor: 2%(3) y NIC I + VPH: 4%(7). El Test Chi square fue aplicado para determinar que variables afectan la recurrencia, obteniendo un valor de p= 0.038, 0.03, 0.019 significativo para los NIC endocervical, borde comprometido y tipo de cono. Las complicaciones del procedimiento son mínimas. Durante el seguimiento, 146 casos (96.7 %) se encuentran sin evidencia de enfermedad y 05 casos (3.3%) presento recurrencia. Las pacientes con recurrencia fueron reconizadas.Conclusión: El cono LEEP en la Modalidad de VER Y TRATAR, en la consulta ambulatoria, es segura, de bajo costo, efectiva, fácil de reproducir en servicios de salud, con una curva de aprendizaje corta...

Objectives: To evaluate the cases with cervical intraepithelial lesions high grade (CIN II, III, CIS) and treated by loop excision procedure Electro surgical cervix (LEEP) in the form of seeing and dealing in the North IREN - Trujillo, to determine the effectiveness of treatment, frequency, degree, complications and recurrence. Materials and Methods: We conducted a prospective, descriptive study conducted from January 5, 2008 to December 30, 2009, all patients presentingto joining NIC Diagnostics AG, who were subjected in the first and only LEEP CONE consultation (PROCEDURE loop electrical excision procedure), in the form of seeing and dealing. We included cases with positive cytology, positive biopsy or colposcopy suggestive of CIN AG, affecting 50% or less of the cervix. Results: The 79.0% (151) of patients with high grade CIN, met the criteria and underwent LEEP CONE see and treat modality. 21% (40 cases) did not meet the inclusion criteria and were subjected to other procedures. The mean age was 39.29 years and standard deviation of 9.96. Histological findings were: CIS: 23% (34), CIN III: 25% (37) and CIN II: 46% (70), microinvasive cancer: 2% (3) and CIN I + HPV: 4% (7). The Chi square test was applied to determine which variables affect recurrence, yielding a value of p = 0.038, 0.03, 0.019 significant to the endocervical CIN, positive margins and type of cone. Complications of the procedure are minimal. During follow up, 146 cases (96.7%) are free of disease and 05 cases (3.3%) had recurrence. Patients with recurrence were reconized. Conclusion: The cone LEEP in the mode of viewing and treatment in the outpatient department, is safe, inexpensive, effective, easy to play in health services, with a short learning curve and beneficial for younger patients who wish to preserve fertility. This mode is useful in the regions and peripheral health facilities where people have difficulty to attend several appointments and thus avoiding the drop.

Experiencia en el tratamiento de la neoplasia intraepitelial cervical y el carcinoma in situ con radiocirugía / Experience in cervix intraepithelial neoplasia and the in situ carcinoma with radiosurgery

OBJETIVOS: Exponer los resultados de un estudio descriptivo, prospectivo y longitudinal, de 1 437 pacientes con neoplasia intraepitelial cervical y carcinoma in situ tratadas con radiocirugía en la consulta de patología de cuello del Hospital Provincial Universitario Carlos Manuel de Céspedes de Bayamo, en el quinquenio 2004-2009. MÉTODOS: Se realizó un estudio descriptivo, prospectivo y longitudinal, de 1 437 pacientes que se les realizó cono por asa diatérmica, donde se estudiaron como variables, la edad, el diagnóstico preoperatorio, las complicaciones transoperatorias y posoperatorias, la calidad del tejido extirpado y la radicalidad del proceder, se utilizó como método estadístico para el procesamiento de los datos el método de los porcentajes. RESULTADOS: Las pacientes con edades comprendidas entre 35 y 45 años resultaron el grupo donde un mayor número de conizaciones se realizó la NIC II, constituyó el diagnóstico preoperatorio más frecuente, las complicaciones transoperatorias y posoperatorias fueron mínimas, la calidad del tejido extirpado para la interpretación anatomopatológica fue buena en más de un 95 por ciento de los casos, los bordes de sección comprometidos no superaron el 2 por ciento. CONCLUSIONES: El cono realizado por radiocirugía en el tratamiento de la NIC y el CIS, es un proceder eficaz y seguro

OBJECTIVES: To expose the results from a longitudinal, prospective and descriptive study conducted in 1 437 patients diagnosed with cervical intraepithelial neoplasm (CIN) and in situ carcinoma (ISC) treated by radiosurgery in the neck pathology consultation of the Carlos Manuel de Céspedes University Provincial Hospital during 2004-2009. METHODS: A longitudinal, prospective and descriptive study conducted in 1 437 patients underwent conus by diathermy loop where variables studied included: age, preoperative diagnosis, transoperative and postoperative complications, quality of the removed tissue and procedure radicalization and for the percentage method we used statistics for data processing. RESULTS: Patients aged between 35 and 45 were the group with more conizations, NIC II was the more frequent preoperative diagnosis, transoperative and postoperative complications were minimal, quality of removed tissue for anatomy and pathology interpretation was good in more than 95 percent of cases, borders of involved section were lower than 2 percent. CONCLUSIONS: Conus carried out by radiosurgery in treatment of NIC and ISC is a safe and effective procedure

Seguimiento de mujeres con anormalidad citológica de cuello uterino, en Colombia / Following-up females having an abnormal Pap smear in Colombia

Objetivo Evaluar el acceso y la oportunidad al diagnóstico y al tratamiento que tienen las pacientes con lesiones cervicales de alto grado o cáncer de acuerdo con el reporte citológico, en Colombia entre junio 2005 a junio del 2006. Metodología Estudio retrospectivo mediante encuestas a una muestra de mujeres con anormalidad citológica residentes de cuatro departamentos de Colombia seleccionados por conveniencia en relación con diferentes tasas de mortalidad. Se realizó análisis descriptivo y se compararon las diferencias entre los departamentos. Resultados El 27 por ciento de las mujeres con lesiones de alto grado o invasoras no tuvieron acceso a alguno de los servicios diagnósticos o terapéuticos por razones de tipo administrativo de los servicios de salud, razones clínicas y culturales de las mujeres. Discusión Un elemento crítico que explica el bajo impacto en la mortalidad por cáncer de cuello uterino en la mayoría de los países de Latino América es la disociación entre actividades de tamización y las de tratamiento.

Objective Evaluating the opportunity and access to diagnosis and treatment for females having had an abnormal Pap smear (high-grade epithelial lesion and cervical cancer) in Colombia from June 2005 to June 2006. Materials and Methods This was a retrospective appraisal using a semi-closed survey of females having had an abnormal Pap smear with high squamous intraepithelial lesions or cervical cancer living in four Colombian departments. These areas were conveniently selected according to their different mortality rates. A descriptive analysis was made and the departments differences compared. Results It was found that 27 percent of females having high-grade squamous intraepithelial lesion or cervical cancer had no access to any of the diagnostic or therapeutic services. Health service administration problems and clinical and cultural ones affecting the females in the study could explain such results. Discussion Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.

Neoplasia intraepitelial cervical de alto grau durante a gestação: experiência de um serviço do Sul do Brasil / High-grade cervical intraepithelial neoplasia during pregnancy: experience in a service in southern Brazil

OBJETIVO: avaliar o tratamento instituído a portadoras de neoplasia intraepitelial cervical de alto grau e o seguimento destas pacientes durante a gestação. MÉTODOS: estudo retrospectivo baseado na revisão dos prontuários de 30 pacientes atendidas no período de 1990 a 2002 no Hospital Erasto Gaertner, com diagnóstico de neoplasia intraepitelial cervical de alto grau durante a gestação. O diagnóstico foi realizado por colposcopia e biópsia, e a colposcopia foi realizada novamente durante o período gestacional e após o parto. Foram avaliados os diagnósticos de regressão e progressão das lesões. RESULTADOS: das 30 pacientes, 3 foram excluídas por não-confirmação do diagnóstico de lesão intraepitelial escamosa de alto grau (LEAG) pela colposcopia com biópsia. Quatro pacientes foram submetidas ao tratamento durante a gestação, e uma delas apresentou parto pré-termo na 32ª semana de gestação. Vinte e três pacientes foram submetidas a tratamento expectante, realizando-se nova colposcopia e biópsia, sendo então submetidas à conização ou cirurgia de alta frequência em média na 11ª semana de gestação. Em 7,4 por cento dos casos houve regressão da lesão na peça cirúrgica, embora a biópsia evidenciasse lesão de alto grau após o término da gestação. CONCLUSÕES: toda paciente com diagnóstico de lesão intraepitelial escamosa de alto grau (LEAG) deve ser submetida à colposcopia e biópsia para excluir lesão invasiva. A conduta expectante para as lesões intraepiteliais é o tratamento de escolha e mais seguro pela possibilidade de regressão destas lesões no período pós-parto.

PURPOSE: to evaluate the results of treatment to which patients with high grade intraepithelial cervical neoplasia (HSIL) are submitted, as well as their follow-up during pregnancy. METHODS: retrospective study based on the review of the medical report of 30 patients with diagnosis of high-grade squamous intraepithelial lesions (HSIL) during pregnancy and attended to at a tertiary hospital in southern Brazil from 1990 to 2002. Diagnosis was performed by colposcopy and biopsy, with repetition of the colposcopy during the pregnancy and after delivery. The diagnoses of regression and progression of lesions were evaluated. RESULTS: from 30 patients, 3 were excluded of the sample because the diagnosis of high-grade squamous intraepithelial lesions (HSIL) was not confirmed by the colposcopy with biopsia. Four patients were submitted to treatment during pregnancy, and one of them presented preterm delivery at the 32nd week. Twenty-three patients were submitted to expectant treatment, underwent a new colposcopy and biopsy, and then were submitted to conisation surgery at about the 11th week after the end of pregnancy. In 7.4 percent of the cases, there was lesion regression in the surgical specimen. CONCLUSIONS: all patients with diagnosis should be submitted to colposcopy and biopsy to exclude the possibility of invasive lesion. The expectant procedure for intraepithelial lesions is the most widely chosen and safe due to the possibility of regression in the postpartum period.

Naturaleza de la infección por papillomavirus en mujeres infectadas por el virus de la inmunodeficiencia humana / Nature of the papillomavirus infection in human immunodeficiency virus-infected women

Numerosos estudios demuestran que los individuos VIH-positivos presentan elevado riesgo de adquirir infecciones por papillomavirus humanos (HPV) en mucosa oral y anogenital...

Many studies have shown that HIV-infected individuals are at increased risk of anogenital and oral PV infection. The prevalence of HPV infection and the severity of the associated intra-epithelial lesions in HIV-positive individuals are associated to progressively decrease fo CD4+ levels...

Unidades de tratamiento de las displasias de cuello uterino una alternativa en la lucha contra el cáncer de cuello uterino / Units treatment of cervical dysplasia an alternative in the fight against cervical cancer

Los países que han disminuido la morbimortalidad por cáncer de cuello uterino en aproximadamente un 60%, desarrollaron programas de prevención a través del tamizaje periódico y frecuente logrando coberturas altas en la población de riesgo brindando tratamiento inmediato y posterior seguimiento de las lesiones precancerosas. En el Perú los esfuerzos para combatir el cáncer de cuello uterino se enfoco en tomar muestras de papanicolou en la población de riesgo sin seguimiento posterior de las pacientes con citología positiva. En Junín departamento de la sierra central el 28 de Noviembre del 2006, se crea la primera Unidad de tratamiento de displasia de cuello uterino en el País, con claros objetivos; evaluación, diagnostico y tratamiento de lesiones precancerosas de cuello uterino de la población femenina de la región Junín. Después de 30 meses de funcionamiento se han logrado las siguientes actos médicos: 3064 consultas especializadas , 1135 paps, 363 colposcopias, 81 Conos Leep,98 criotrapia y 109 referencias al INEN(carcinomas de cuello uterino infiltrante). Esta experiencia de la unidad de displasia de cuello uterino, realiza en Concepción, Junín se podrá implementar en las distintas regiones a lo largo de todo nuestro país dando así un paso importante para cerrar el circulo de un programa exitoso en la lucha contra el cáncer de cuello Uterino en el Perú.

The countries who have reduced morbidity and mortality of cervical cancer by about 60%, implemented prevention programs and developed through regular and frequent screening in female patients achieving high coverage in the population at risk by providing immediate treatment and subsequent monitoring of precancerous lesions. In Peru's efforts to combat cervical cancer are focused by taking samples of cervical citology in the risk population without subsequent monitoring of patients with positive cytology. Junin department of the central highlands, two years ago ( November, 28, 2006) establishing the first treatment unit of cervical dysplasia in our Country, with clear objectives, evaluation, diagnosis and treatment of cervical precancerous lesions in female population the Concepcion - Junin and around cities. After 30 months of activity at the Unit of cervical dysplasia have been made following medical events: 3064 specialized consultations, 1135 samples of cervical citology, 363 colposcopy, 81 Cono Leep, 98 criotherapy and 109 references to INEN (invasive cervical Carcinoma). This experience of the Unit of cervical dysplasia, held in Concepcion, Junin could be implemented in different regions throughout our country, giving thus an important step to close the loop of a successful program to combat cancer cervix in Peru.

Características de la infección por virus papiloma humano en la adolescencia y su manejo / Human papilloma virus in adolescents: characteristics and management

El virus papiloma humano es una infección de transmisión sexual frecuente en las adolescentes. En la mayoría de los casos la infección es asintomática. Sin embargo en un porcentaje de los casos, la infección produce manifestaciones clínicas como verrugas genitales, alteraciones citológicas e histológicas cuyo manejo es distinto que en las mujeres adultas debido a las características especificas de la infección por HPV en este grupo etario.

Human papilloma virus is a frecuent sexually transmitted disease in adolescents. The infection is asintomatic in most cases and needs no treatment spontaneously eliminated. However, in a few cases, the infection produces clinical manifestations as genital warts, citological and histologycal abnormalities whose management differs from adult women because of especific characteristics of HPV infection in adolescents.

Neoplasia intra-epitelial cervical: diagnóstico, tratamento e seguimento em uma unidade básica de saúde / Cervical intraepithelial neoplasia: diagnosis, treatment and follow-up in a primary care unit

Objetivo: Apresentar os resultados da atenção a pacientes com citologia oncótica vaginal anormal em unidade básica de saúde. Casuística e Métodos: Avaliação de mulheres com citologia anormal, por meio de colposcopia e biópsia, como parte do atendimento rotineiro da unidade integrada a serviço de referência. As pacientes com biópsia mostrando neoplasia intra-epitelial cervical (NIC) I, NIC II, cervicite, HPV ou colposcopia normal foram mantidas na unidade básica e tratadas quando indicado. Resultados: Em pouco mais de dez anos, 115 mulheres foram incluídas na série. Na primeira avaliação, 13 tiveram NIC III à biópsia e foram encaminhadas. As 102 pacientes restantes foram seguidas por um período médio de 38 meses; entre elas duas evoluíram para NIC III, ambas com biópsia inicial mostrando NIC II. Conclusão: O estudo sugere que é possível realizar esse tipo de atendimento em uma unidade básica com segurança aceitável, desde que a mesma disponha da estrutura mínima que é descrita no texto.

Objective: The purpose of this study was to relate the results of the care of women with abnormal cervical cytology in a primary care unit. Subjects and Methods: Women with abnormal cytology were evaluated with colposcopy and, if necessary, biopsy, as part of the routine care of the unit. The cases in which biopsy showed cervical intra-epithelial neoplasia (CIN) III were referred to a specialized unit, and the remainder (CIN I, II and other results) were kept in the unit and treated when indicated. Results: In ten and half years, 115 women were included in the series. In the first biopsy, 13 had CIN III and were then referred. The remainder 102 were followed for an average period of 38 months. Two of them progressed to CIN III, both initially CIN II. Conclusion: This series suggests that this kind of care can be given in a primary care unit, provided this unit has the minimum resources described in the text.

Lesiones intraepiteliales escamosas del cervix: diagnóstico y tratamiento / The squamous intraepithelial lesions the cervix: diagnosis and treatment

El cáncer cérvico-uterino es actualmente una enfermedad que puede , al menos teóricamente, prevenirse haciendo screening a la población en riesgo, detectando sus lesiones precursoras y tratándolas apropiadamente, evitando así el desarrollo del cáncer invasor. Hay una relación etiológica establecida entre la infección por virus papiloma con genotipo de alto riesgo oncogénico (VPH-AR) y el cáncer del cuello uterino, así como sus lesiones precursoras. Se describen las técnicas de screening poblacional, los métodos diagnósticos, conductas y manejo de las lesiones intraepiteliales escamosas (LIE), así como las modalidades terapéuticas actuales.

Motivos de abandono en el proceso de atención médica de lesiones precursoras de cáncer cervicouterino / Medical care abandon factors in precursor lesions of cervical cancer

Objective. To determine factors associated with medical care abandon of women with CIN. Material and methods. A nested case-control study in a cohort was done. Patients referred to clinical Dysplasia of Gyneco-Obstetrician Services in third level Hospitals were considered. Cases: Patients who abandoned medical care. Controls: women who attend their medical appointments during follow-up. All subjects underwent structured interviews focused on social, clinical and health services factors in two different times, applied at the beginning of study and the end of follow-up. Clinical records were reviewed to obtain clinical information. Analysis: Descriptive and inferential statistical was done. Non conditional Logistic Regression analysis was done to obtain adjusted association. Results. Abandon cumulative incidence rate was 108/525 = 20.7% (I.C 95% = 17.2-24.3); 60.2% happened in diagnosis phase, 17.7% ocured during therapeutic phase and 23.1% happened in surveillance phase. We studied 108 cases and 417 controls to analysis. Next adjusted risk factors were obtained: Afraid to death (ORa = 4.2, I.C.95% = 1.8-9.5), long appointments (ORa = 6.6, I.C95% = 3.4-13.0), lack of privacity (ORa = 12.5, I.C.95% = 2.6-59.8), reject to treatment (ORa = 40.4, I.C.95% = 2.1-785.4), lack of information (ORa = 41.9, I.C95% =14.2-124.1) and other factors. Conclusions. Patient perception, access and barriers in health services were the most important factors associated with medical care abandon.

Objetivo. Determinar factores asociados al abandono del proceso de atención de NIC. Material y métodos. Se realizó un estudio de casos y controles anidado en una cohorte de mujeres referidas a las clínicas de displasias de dos hospitales de tercer nivel. Casos: pacientes que abandonaron su atención médica. Controles: pacientes que cumplieron con sus citas médicas. Las pacientes contestaron una entrevista estructurada respecto a variables sociodemográficas y de atención médica al inicio y al final del seguimiento. Los datos clínicos se obtuvieron de la revisión de expedientes. Análisis: Medidas de frecuencia y asociación, ajustando variables con Regresión Logística no Condicionada. Resultados. La tasa de abandono fue de 108/525 = 20.7% (17.2-24.3); 60.2% ocurrieron en la fase diagnóstica, 17.7% durante el tratamiento y 23.1% en la fase de vigilancia y/o control. Un total de 108 casos y 417 controles fueron considerados para el análisis. Los factores de riesgo ajustados fueron: miedo a la muerte (ORa = 4.2, I.C.95% = 1.8-9.5), citas prolongadas (ORa = 6.6, I.C.95% = 3.4-13.0), falta de privacidad (ORa = 12.5, I.C.95% = 2.6-59.8), rechazo al tratamiento propuesto (ORa = 40.4, I.C.95% = 2.1-785.4) y falta de información (ORa = 41.9, I.C.95% = 14.2-124.1) entre otros. Conclusiones. Los factores relacionados con la percepción de gravedad de la enfermedad y las barreras al acceso de los servicios de salud fueron los de mayor importancia para abandonar la atención médica.

El significado clínico de dos papanicolaou atípicos consecutivos / Clinical significance of 2 consecutive atypical Pap smears

Objetivo: Determinar la trascendencia patológica de dos Papanicolaou atípicos consecutivos y analizar la eficacia de la colposcopia y del tratamiento de las patologías encontradas. Material y Método: El estudio se basa en 202 pacientes que presentaban 2 Papanicolaou atípicos consecutivos. A todas se les efectuó colposcopia y biopsia según hallazgo. Resultados: Se detectó patología cervical en 53 por ciento de los casos, incluyendo 3 casos de cáncer invasor (1,5 por ciento ), y 94 casos de neoplasia intraepitelial (46,5 por ciento ). La eficacia colposcópica y la efectividad terapéutica fue 100 por ciento . Conclusión: Se concluye que toda paciente con dos Papanicolaou atípicos consecutivos debe ser sometida a evaluación colposcópica inmediata.

Doença intra-epitelial de cérvice uterina / Cervical intraepithelial neoplasia

Os autores apresentam uma revisão sobre lesões precursoras do carcinoma de colo uterino com o objetivo de agregar conceitos dispersos pela literatura em ginecologia e patologia, auxiliando o aluno na compreensão da patologia cervical uterina e seus métodos diagnósticos e de tratamento