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CANCERUL CERVICAL
Conf. Dr. Nicolae N. Suciu

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

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PRECURSORII CANCERULUI
SCUAMO-CELULAR

Carcinom in situ
Displazii (CIN1-3):

displazie usoara
displazie moderata
displazie severa
Aspectul macroscopic testul Schiller
- pozitiv negativ
- nu toate testele Schiller negative ~ leziune maligna
Aspect microscopic diagnostul histologic este instrumentul de diagnostic
definitiv = modificari nucleare (pleiomorfism nuclear, hipercromatism,
multinucleism, mitoze)
CIN = jonctiune scuamo-columnara
Invazia de la locul de origine

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TESTUL BABES-PAPANICOLAU

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Semnificatie
Caracteristici citologice
Rata fals negativa 10-35%

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ROLUL HPV
Peste 60 de subtipuri
Mai patogene: 16, 18, 31, 45, 56
Leziuni HPV:
HPV vulva
perineu
anus
col
vagin
Detectie
- microscopie electronica
- imunohistochimie
- tehnici de hibridizare
- PCR
Rol biopsie cervicala conizatie electrica

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CARCINOM INVAZIV

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Evolutia CIN urmarite individual este imprevizibila

Progresiunea displaziei = gradul de CIN
Boala poate fi vindecata

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CARACTERE HISTOLOGICE ALE

CC SCUAMO-CELULAR

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Grade histologice

Gradul I punti intercelulare vizibile

Gradul II

forma cea mai frecventa

nuclei elongati si citoplasma minima
fara punti intercelulare
mitoze mai multe

Gradul III tumori nediferentiate:

crestere foarte rapida
numeroase mitoze

ASPECT MACROSCOPIC AL
CC SCUAMO-CELULAR
Tumori

exofitice mai comune

endofitice
ulcerative

Extinderea tumorii

- vagin
- ligamentele cardinale
- endometriala - rara

Extinderea limfatica - precoce

Variabilitatea invadarii nodulilor limfatici
Invazia vasculara 30% din pacientii decedati au metastaze in ficat,
plamani, splina

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DIAGNOSTIC

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Sangerari

vaginale neregulate
in afara ciclului menstrual
post-coitale
intermenstruale
postmenopauzale

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CLASIFICAREA FIGO
Stadiul 0 carcinom in situ, carcinom intraepitelial
Stadiul I neoplasme ce nu depadsesc colul
IA invazie stromala sub 3mm grosime si sub 7mm latime
IB prezinta
IB1 diametrul maxim sub 4cm
IB2 diametrul maxim mai mare decat 4cm
Stadiul II
IIA extensia spre cele 2/3 superioare ale vaginului
IIB infiltrarea tesuturilor parametriale
Stadiul III
IIIA implicarea 1/3 anterioare vaginale
IIIB infiltrarea peretilor parametriali (prin tuseu rectal)
Stadiul IV
IVA invazia vezicii sau a rectului
IVB metastaze la distanta

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Frecventa metastazelor

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Stadiul I 15%
Stadiul II 30%

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Stadiul III 50%

Stadiul IV peste 60%

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

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

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PROGNOSTICUL BOLII

Foarte bun pentru stadiul incipient (85%)

Foarte redus pentru stadiul IV (5-10%)

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

Decesul prin - uremie

- infectie
- hemoragie

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CC IN SARCINA

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Cea mai frecventa afectiune maligna in sarcina

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Simptom principal: sangerarea (sangerare de sarcina?!)

Tratament: in fctie de varsta sarcinii
stadializare
A1 - conizatie + nastere vaginala + reevaluare

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IA2, IB, IIA operatie cezariana + histerectomie radicala

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IIB IVA radioterapie

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

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