14/12

, 2013.

je
DILS







:
: . ,

:
:
: 1.000
ISBN 978-86-6235-010-7

CIP -
,
618.146-006(083.1)


/ []

,
; [
]. - :
, 2013
( : ). - 64 . :
; 30 cm. - ( ; #14,
#2013)
1.000. - : . 3. . 7: / . : . 63-64.
ISBN 978-86-6235-010-7
1. . .


a) - -
COBISS.SR-ID 199811852

 :
,
,
, ,
.

(. NICE ), ,
.
,
2000. , (Murray & Lopez, 1996). ,

.
,

- .
, ,
, ,
,
, ,
.
,
, ,
- .
, a , XX
,
. ,

,
,
, .
, .
, 7. 2012.


:
.
; ,
,
:
. .
-, ,
,
:
. .
,
.
;
,
.
; ,

.
; -
,
.
; -
,
.
;
,
. . .
,
.
; - ,

.
;
, ,
.
;
,

:
.

.

. .
, ,


.
.
, , ,
. ,
.
,
. , , . ,
,
.
, . ,
, .

.
, .
,
.
,
. ,
: , , ,
.

. ,
.


. ,

I :
ASC-US

(Atypical squamous cells of undetermined significance)

ASC-H

(Atypical squamous cells of cannot exclude High-grade squamous intraepithelial lesion)

AGUS

(Atypical glandular cells of

undetermined significance)

AGC

(Atypical glandular cells)

AIS

in situ (Adenocarcinoma in situ)

CI

(Confidence interval)

CIN

CT

(Computerised tomography)

EBRT

(External Beam Radiotherapy)

ECC

(Endocervical curettage)

FIGO

(Fdration Internationale de Gyncologie et

dObsttrique)

HDR

(High dose rate)

HR-HPV

(High risk HPV)

H-SIL

(High-grade squamous
intraepithelial lesion)

Gy

ICBT

(Intracavitary brachytherapy)

IFCPC

(International Federation
for Colposcopy and Cervical Pathology)

LDR

(Low dose rate)

LLETZ

(Large loop excision of the Transformation zone)

LVRH

LARVH

LARVT

L-SIL

(Low-grade squamous intraepithelial lesion)

LVI

LVSI

(lymphovascular space invasion)

MeV

OS

(Overall survival)

NSAID

(Non-Steroidial Anti-Inflammatory Drugs)

PFS

(Progression-free survival)

( )

- ( )

QoL

RCT

(Randomised Controlled Trial)

RR

(Response rate)

SCJ

(Squamocollumnar junction)

SIL

SLN

- (Sentinel node)

TZ

(Transformation zone)

USPIO

- (ultra-small particles of iron oxide)

WHO

(World Health Organisation)

II

II.1 II.2.
II .1.
*

/
,

II

II
II

III

/
/

/
/

* I . II , II , , .
III
II.2.

/ ,
,

10

III :
1. ............... 13
2. . .............................................................................. 14
2.1. ............................................................................................ 14
2.2. ................................................................................................................... 15
2.3. ................................................ 16
3. ........................................................................... 17
3.1. ................................................................... 17
3.2. .............................................................. 18
3.3. ................................................................ 19
4. 
. ........................................................................................... 20
4.1. .......................................... 22
5. . .............................................................................. 25
5.1. ............................................................................................................................. 25
5.2. ..................................................................................................................................... 27
5.3. ................................................................................................. 28
5.4. . ......................................................................................................... 28
6. ............................... 29
6.1. (L-SIL).............................30
6.2. (H-SIL).......................... 30
6.3. in situ (AIS) ............................................................. 31
7. ..................................................................................... 32
7.1. . ............................................................................................................................ 32
7.2. ................................................................................................................. 32
7.3. . ........................................................................................................ 33
7.4. ............................................................................................................ 33
7.5. ............................................................................................................. 33
8. 
............................................................................................. 35
8.1. 9.
.................................................................................. 35
9. ............................................................... 36
10. ................................................................................................................. 37
10.1. ............................................................. 37
11. ...................................................................................................................... 39
12. ................................................................................................................ 41
12.1. ...................................... 41
12.2. FIGO / TNM . ............................................................................ 43
12.3. (I) . ........ 44
12.4. (I II) ........... 44
11

13. . ................................................................................... 45
13.1. . ................................................................................................................... 45
13.2. I ............................................... 45
13.3 I ................................................... 47
13.4. I II ........................... 48
13.5. I II ......................................... 50
13.6. ........................................................................................................... 51
13.7. I II .................. 52
13.8. ( II-IV) ......................................... 53
13.9. II-IV ............................................ 55
13.10. ............................................................................................. 56
13.11. . ..................................................... 57
13.12. ........................................................................................ 58
13.13. ...................................................................... 59
13.14. ............................... 60
14. ....................................... 61
15. ....................................................................................................................................... 62
16. ................................................................................................................................. 63

12

1.
( , ) , 8,8%
. ( 80%)
, 17,7 100.000
, , 9,1 100.000
. ,
, - 2,8
(9,7 100.000) (2,7 100.000).
2002. (27,3 100.000)
. Globocan-a,
(24,1 100.000 ) , , . ,
(10,6 100.000).
, ,
7,2% 8,7% . ,
2008. 21,4 100.000 . (24,1 100.000). 5,5% 5,94% ,
.
, 4,67 100.000 1971-1985, 6,8 100.000 2000.
. , 2008. 6,9
100.000 .
30 , 45 49 70 74 .
,
.
. 18 , , 20 100 000.
20 30 100.000 . , ,
30 100.000 ,
40,1 100.000 . (41,6 100.000),
- ,
29,0 100.000.
3,5 100.000 9,8 100.000 .

13

2.
(CIN). / in situ. Bethesda , CIN
(SIL) ( 2.1.).
(CIN) . 50 CIN.
CIN ,
, ,
.
CIN 1,7% , CIN 0,9%, CIN
0,3% . CIN
: 25-29 (2,6%), 50. 0,9%.
, .
195 100.000 , 38 100.000 CIN 3 ( in
situ).
(CIN 2 i CIN 3)
.
2.1.
/ in situ

CIN (
)

SIL ( )

CIN 1

L-SIL
(Low-grade SIL / SIL )

CIN 2

CIN 3

H-SIL
(High-grade SIL / SIL )

in situ

in situ (AIS) . in situ (AIS) ,

CIN. , AIS:CIN 3
1:26 1:237, 1:50. AIS CIN ,
24 75%.
. ( 18) 63%-89%
AIS, 80% .

2.1
()
. ,
99,7% .
120 . (
40 ) . .
14

,
- , ,
.
( 70% ) .
.
.
.

. :
( 6, 11, 42, 43, 44)
( 16, 18, 31, 33, 35, 39, 45, 51, 52, 56,
58, 59)

1,4 25,6% . 194
,
11,7%.
20 25 ( 15% 45% ).
, 6-24 . 85-90% ,
30 ( 30-65 1,7%
12,5% ). (10-15%) . 8%
CIN,
CIN 0,05% .
16/18 CIN 1, 9,3%.
CIN2 5,8%, CIN3 3,5%. , 16 / 18 52% CIN2 , 61%
CIN 3 76% .
,
, , , .
, , , :


(, )
( - )

2.2. ?
:
( 16. )




15

( , )

CIN 2 i CIN 3

( )

2.3.
, 21 .
, 6 , ( ) , .
30 , , . 65 ,
,
, .
, . ,
, , . , ,
.
, ,
98%. , :
;
;
;
().

16

3.

, . .
,
, , - .
, , .
, . 12 14 .
9
. 26
. 14 15 26 . 12 26
, .
.
100% ,
.
.
, , (). ,
.

3.1.

. .
. , , , ,
.
, .
,
. 45
80%.
:
20 30 3 5
, 6065 . , .
, .
.
17

,
.
,
. . , . ,
, .
, .

2006. . ,
. , 54, 23. 2008. .
,
.
.
.
.
,
. / .
. , , .
, - .

3.2.

25 65 .

6 ,
.

65 , ,
.

( ).
,
(Liquid based cytology LBC).
.

,
. 99%,

10 . ( )
, .

II

,
35 .
, 8 .

18



.
- .

II

:
(
)

(
), .

II

,
, ,
.

:

(, ,
); / Nabothi

, .

.

3.3.
, ,
,
.
.
: , 24-48 , .
.
.
, , , ,
, . , ,
.


- . ,
, .
,
96% . ,
.
, , .
, .
19

4.
,
Bethesda
( 5.1.).
Bethesda , .
4.1.
Bethesda

I

II
,

III



III


IV

V

/


( )
NILM

ASC-US ( )
ASC-H ( )
AGC
L-SIL (CIN 1)
H-SIL (CIN 2)
H-SIL (CIN 3)
AIS

, , - . ,
,
.
, .
, .
,
(ASC-US), (L-SIL)
.
ASCUS,
.
( , (ASC-US) (SIL) .
(90-95%), (, , ).
, 9-17% ASC-US , CIN
.
20

 41%-50% ASC-US (29-88%)

. ASC-US CIN 2 CIN 3
. 39 ,
ASC-US 90,4% (95% CI: 88,1-92,4%) CIN 2+, 93,7% (95% CI: 90,4-95,9%) CIN 3+. 58,3% (95% CI:
53,6-62,9%) CIN 2+ 52,3% (95% CI:45,7-58,7%) CIN 3+.
( 82% 58%).
CIN 2 CIN 3 0,98 .
ASC-US, 26 % CIN, L-SIL
15%, H-SIL 11% (6% CIN 2 2,5% CIN 3). -
1970. 1996. , ASCUS-
6 0,06%, H-SIL 24 0,25%.
CIN 2 15-30%,
ASCUS/LSIL Triage Study (ALTS) CIN 3 24
ASCUS 8% 9%.
(ASC-H)
ASC-US ,
. ASC-H H-SIL,
. 5-10% ASC . ASC-H ,
85% <35 , 40% > 35 . 30-40%
CIN, 25-50 % CIN 2 CIN 3.
( L-SIL)
. L-SIL
. - CIN,
44,3% (95% CI 43,0, 45,5). 0,6% L-SIL
H-SIL (CI 95% 0,5 0,7), 0,1% (95% CI 0,0 0,1). 10
, 87,7% (L-SIL) ,
2,8% CIN 3, 0,4% .
L-SIL , 58-88%% . 35 ,
CIN. , 17% L-SIL CIN 2, 12% CIN 3.
L-SIL H-SIL 6,6% 6 20,8% 24 .
(
H-SIL) 50% CIN 2 , 2% .
, 85% 32.
() 0,5%1% .
(AGC)
. (AGC) ,
in situ (AIS).
90% . ,
, (9% 54%)
(CIN 2 CIN 3), 1%9% (,
)19. : , .
AIS, AIS 48-69%,
38%.

21

4.1.

( )
,
, 6 8 ,
.

( I II/ Bethesda
- NILM)
.
6 , .

.
.
,
(Chlamydia, Gonorrhoea, Candida, Trichomonas
).
, .

( III/ Bethesda
ASC-US)
: , , .
,
,
.
20 ,
. ASC-US ,
.
20 .
,
. ,
.
,
ASCUS (
)..
,
6 1 2
. .
,
, .
( / ,
o - Loop ).
ASC-US .
.
.

22

 -
( III/ Bethesda ASC-H)
.
.
, 6 1-2
.
,
.
,
. ,
,
.
,
(, ECC, Loop ).

( III/ Bethesda
AGC)
.
.
, .
,
(ECC).
/ (ECC)
AIS, .

6 .
AGC, /.
40 AGC
.
,
.

II

( III/ Bethesda L-SIL)

.
,
6 , .

.

( 3-SCJ ),
.

35 80%
.
L-SIL ,
( ) 35 .
, ,
.
L-SIL (See and treat) ,
- ,
.
L-SIL .
,
. .

23

( III IV/ Bethesda

H-SIL)
.
.
, .
, ECC.
,
- ,
.
H-SIL ,
.
,
. 8-12 .
.
( / SCJ
, ), H-SIL ,
.

in situ ( IV / Bethesda AIS)

AIS
.
AIS
(ECC).
,
.
.
(
), 35
35 .

( V/ Bethesda )
/ ECC.
.
,
.

24

5.
, . :


(ECC)


.

5.1.
, .
,
, . , , . , ,
.
. , ,
. ,
. 3%
.
, 3% ,
(CIN) . ,
() , .
CIN 3% ,
. -
20 . ,
CIN .

.
(International Federation of Colposcopy and Cervical Pathology IFCPC).
(/CIN 1) - .
,
. . , . , . CIN 1
: , , .
(CIN 2 CIN 3) . , .
, . ,
, ,
. . , , CIN 3 , ,
, , .
25

. (SCJ),
. (Loop )
.
, :
1. ;
2. ;
3.
;
, .
, ,
.
:

,
1.
2.
3.
4.
5.

;
CIN;
;
;
.

( 5.1).

26

 5.1.

NILM
II

ASC-US
III

ASC-H
III

4-6
*

/ ECC

AGC
III

ECC

L-SIL
III

4-6

4-6

35

H-SIL
III, IV

ECC /

/ ECC

AIS
IV

/
ECC

V
* , 6

5.2.
,
.
. , , . .

.
, .
.
,
(-).
4% , ,
, .
. , .
27

, 90%.

5.3
( ECC)

SCJ , .
, ,
. , , , 4% , .
.
, .
.

5.4.
.
, , ,
(Loop ), .
, ,
SCJ,
SCJ.

28

6.

0,17% 70%. ,
. 3 10 .
, , .
, . , , .
CIN
. ,
L-SIL (/CIN 1) 60 70 %
90 % . 15% , 0-30%
(H-SIL), 1% .
.
.
CIN 1 , - :
43% CIN 1, 41%
, 13% (CIN 2 CIN 3). , 23-55%
CIN 2 CIN 3. CIN 1 (L-SIL) , L-SIL 2-4 H-SIL 15-25%.
, (, .). L-SIL
( ) .
, 50% (1596%), 20% ( 0 53%).
29% ( 4% 67%) ,
25 CIN 2 62%, .
in situ (AIS) 2%. . 5070% AIS (CIN),
. AIS
20% .
, :

29

6.1. 
( / - 1/ L-SIL)

( )
: .

/

I

, ,
, 18 24 .

II

:
-
-
-
- 35
-
.

,
.

, .
6
.

6.2.

( / CIN 2, CIN 3/H-SIL)

.
.

CIN 2 .

II

CIN 2 .

II

25 CIN2
,
.

II

CIN 3 .

CIN 3,
.

(, ,
),
.
,
,
. 8
.

30

6.3. in situ (AIS)

AIS .

AIS
, .

II

,
, .

II

31

7.
7.1.
(CIN). ( I)
( I)
(, ,
) :
- ;
-
;
- ;
- 75% , 2 -.
, ;
- , , ;
- ;
- ;
- .
( , , ) :
- ;
- , ;
- ( );
- ;
- .

7.2.
( ) .
.
.
.
( , )
7 .
, .
12 ,
.

.
, .
.
32

 , . .
,
/
.

7.3.
;
;
,
.
, ;

. , ,
;
( ),
ECC.

7.4.
,
, .
.
. ,

, .

( II).
,
.
( I).

7.5.
/ 5,7% 53% . 15-20%. (, ), ( , CIN ) .
22%,
5%.
:
,
,
.
33

:
;
( );
;
.
, :
50% ;
;
,
;
;
.
50 CIN 3
, . ( ), .

34

8. 

. CIN 1-21%.
.
/ . 2,9%12%.
, 22% 28,9%. 24 .
: ( 40
), ( ),
(
) ( ).
ZT
,
.
,
CIN , .
, 10 .
, , . 100%,
44-84% , 84,2% , 15,8% ,
17,2% 82,8%. (1,27; 95%
CI,06-1,51), (0,94; 95% CI 0,8-1,01),
.

8.1. CIN

/ CIN 2, CIN 3 AIS

24 . 6 .
, 6 12
. ,
.

II

,
, 10 .
.

II

, .

, .
(CIN 2, CIN 3, GCIN AIS)
6 . ,
.

35

9.
8 10
. ,
.
( ).
, :


.
. ,
. .
,
.
. ,
, ,
.
.

.
.
(, ) , .
, , , .

.

36

10.
(, WHO) : , ()
.
70-80% , 10-15% . ,
, .

10.1.

.
WHO 2004 (
10.1.), , .
; 2.
10.1. WHO 1

-
-
-
-
-
-
-

-
-
-
-

(Clear-cell)

-
-
-
-
-

-
-
-
-
-

-
-
- -
-

37

-
-

-
-

-
-
-

Wilmsov

(Yolk sac tumor)

-
-

38

11.
CIN 3 .
, ,
, , ,
.
,
, (LVI).
:
( , ,
);
;
;
.
, .
10-30%
. . , , .
, , , , .

. ,
. .
, ( ),
, .
,
.
.
(
11.1.). 15-20% FIGO I, 2540% II (50%) .

39

11.1.

FIGO
I1 ( 1)

I1

(1-3 )

0,6%

I2

(3-5 )

4,8%

1%

I
I1 1
I1 2
I1 2-4
I2

15,9%
0
7%
26%
27-50%

2,2%

II

24,5%

11%

II

31,4%-40%

19%

III

44,8%

30%

IV

55%

40%

20.6

,
. , , .

40

12.
12.1.
,
.
, .
,
(FIGO) ,
.
, ,
.
: , , , , .
:
-
- ( , )
- , , , ,
-
- (
)
- ()
- ()
-
- I;
( , ) I.
:
- , ()
-
- .
.
(,
) .
- , -
5. (55%)
(74%). - (ultra-small particles of iron
oxide USPIO) ,
.
() 100%, 99%, . -
,
.
41

12.1. ()
%

(
)

93-100

100

93-100

100

74-85

55

85

75

60

43

84

91

91

95

75

91

73

71

,
. , .
.
,
, (14-80%).
, (, 1
) -.
.
, - . , - 53%
73% 90% 97% ,
-
75%, 95%.
, FIGO ( 12.2.). , pTNM .

42

12.2. FIGO
FIGO , 2009
I

( )
I:
, 5
7
I1: 3,0 7,0 .
I2: >3,0 , 5,0 >7,0
I:
I*
I1: 4,0
I2: >4,0
II
, ,

II:
II1: 4,0
II2: >4
II:
III
/ /
**
III: ,
III: /
IV
( )
. , , IV
IV:
IV:
( ) I .
5,00 >7,00 .
>5,00 , . , ()
(~1 ). / . , 5
*

: ,
**

43

12.3.  I
( )

,
.

,
, ,
.

CIN ,
( ), CIN
.
,
.

II

I CIN,
,
, .

12.4. (I )

,
.

(
IV) .
2W ,
- .

( , ),
/
.

II

-
.

( , I1
) / .

IV -
, .

(Sentinel nodus) ,
.

-
.
.

II

,
.

II

44

13.

. ,
.

13.1.
, . ,
.
, ,
.
()
: -, , , .

13.2. I
1947.
5 ,
I .
(FIGO),
5 7 ,
(FIGO I).
,
. ,
(Loop ) ( ).
, (
). I CIN, , / .
( I).
,
.
() :



- (LVI)

I 1
, 0,1% ( 13.1.).
( )
45

.
.
,
I1 .
2%, .
13.1. I
( )

LVI

03

< 1 / 1000

03

2 / 100

35

2/ 100

35

5 / 100

FIGO I2 , , . ,
10 ,
(
20 ), ( II
).
I2, .
. I2
.
. , . ,
. , .
,
.
, .

46

13.3. I :

I1

I1
FIGO I1 ,
.
.
I1 (LVI 0)
. ,

()

I1 (I1, LVI+)
,




( ) 3-5

I2

I2

,
, 3-5
I2 ,

I2 (I2, LVI 0)
,



I2 (I 2, LVI+)
,
.
.

II

II

,
,
.

47

13.4. 
- I II
,
, (FIGO I). FIGO , I
I1 I2, ,
4 .
II. FIGO 2009. , II1 II2 (II1 4 , II2 4 ).
I II
.
, 19. ,
, ,
, .
.
. ,
.
( )
, .
:
() III Piver ( 13.2)

( 2 )

(I1)

13.2 Piver-

, (TeLinde)

II

+ + 1/3

III

(Meigs-Latzko) + +

IV

+ +

,
. , .

. I1 I1 48

 ( 2 , 10
) 0,4%-0,6%,
0,7% 4%.
.
(. tailoring ) .
, ( II III Piver-) ,
.
,
, Morrow Querlo.
,
(nerve sparing )
.

, .
23-28. ,
. , ,
10,5% , 20 , 26,5%
50 .
.
.
. , (, , ), , (Snetinel
lymph node biopsy SLN)
. 91% 97% -
. ,
.

()
.

, , . , .

- . , : () (). ,

. 4%,
.
I II,
() (
).
49

() , () .
, .
1
, .
(T), FIGO I2.
() (: ,
, - )
I2 ( ).

13.5. I II

I II

( ).

FIGO I1,
.

(2 ) ,
.

4 (I2), ,
,
.

2 . .

. ,
.

, .
3-5 .

,
,

.

,
.

(- )

.

50

 ,
:
(, , )
<2 (I, I1)


(0, >5 )

1
< 39

, .

, .

.
,
.

13.6.
FIGO I II ,
, , . , -.
()



/

- (LVI)

( )


( )

.
5-
90%.
5- 59,5%,
/ .
.
( ), , .
, , , , ao
,
51

I II .
.

, -
. ( 120),
.
( , LVI, >4 ), ( ,
) . 60-65 Gy,

(Gudelines of American Brachytherapy Society) ( II).
, ( 20%),
. .

13.7. 
I II

3-5

,
,


4

-
,

, , :
/ - :
- (1 3)
- ,
- (3)
- ( )
- 3 ( 3 )
- ( barrel shaped )
-
-
,
,
.
/ - :
- 3
-
- ( )
-

52


, - . 120 ( 40%
120), .

13.8. II-IV
( FIGO II
) . .

/
. , ,
. :




.
,
. 50
. 1%.
() ,
45-50 Gy, , , 4-5 TD7Gy .
, (1 - I1) 75 Gy, 80-90 Gy/
. , ( I).
, (10 MEV),
, , . , ,
,
(, ), . - ,
, . .
- , 45 Gy, , 60 Gy
().
, : ( ) / ,
( , , ) .

, ,

. () .
53

, (II,).
() () , (RR response rate),
. , 14%
5- ,
(II,)
-.
- () (: , -
) .
,
I2-IV. -,
18 (3.452 )
6% 5- ( 60% 66%) 8%-16% (DFS - disease free survival)
- . ,
I2-II/ III IV. ,
( ). .
.
, ( IV) .

,
, ,. (RR) 20 30%,
RR (50 /2 100 /2: RR 21% 31%), PFS OS .

( ) ( , , .
, , ). , , RR (RR 3040%), PFS ( , 169, 179) , (
, 179), (). ,
.
,
, /. /
- , /.

,
,
( ).
54


,
.

, IV 15.

.
, , .
, , , , ,
. ,
.
(31%) (6%).

13.9. IIIV

( , I2,
) -
, .

.
,
40 /2

()

II
II

- :
,
( ) - 5 .
III, III
III III

- * :
,
( ) - 5

55

IV
IV
IV

- .

IV.
,

.
,
.
IV
:

( , , )
1. 20-30%.
,

o /

o -

/ 2. ( , , , ,
, )
/ 3.
/ 4. /
/ 4. /

II

II

13.10. /
10-20% FIGO
I-II 50-70% ( II-IV).. (), .
,
, .
,
.

/
-

( )


( )



,

56

.
, 10% 15%.
, .
.


.
.

.
, . , 10%, ,
.
5- 30-60%.
( 2
), .
( )
/ .

13.11. /

()

(, , )
, /

-
- (salvage) ,
,

II

,
,

,
(
2 )


/

57

:
,

/

( )
/
/

II

FIGO IV
,
.

II

:
50-100 /2 , .
.

, ( ):
50 /2 1 + 135 /2, ( RR PFS
)

50 /2 1 + 0,75 /2 1 3, ( RR, PFS

OS , )

13.12.

.
(Stump )

. .
,
.
( )
4% .
(, ...), .

:
1.  ( )

2.
(Small cell carcinoma)
.
. () ,
, .
58

 :
( , ).
( , , , / , /
). ()
:
I II
1. , ,
II, III III ( )
1. , ,

1.
/
2. (, , , )

13.13.

. 7,5 100.000 11,1
100.000 .
, .
. () , , .
. .
, ().
/ , . , .
.
,
, , . I, (210 , 6-15 ),
. .
, , , . , ,
. ,
, 16. . ,
.

, 12 .
, .
59

13.14.

. / .

, ,
.

,
.

,
.
. , .
,
.

II

II

I
) (I II)
- : ,
.
- -

)  ; (II, III IV; I2 II2
)
- ( ).
2-5 , .
,
.
II
II (<20 )
)
(I II)
- I
- I
)
; (I2, II, III IV)
- I
II (>20 )
( 2 ,
II 20 ), 2 10
. III .
.
III
)
(I II)
1. ,
()
I . ,
, .
)
(II, III IV; I2
II2 )
1. , () ,
10 .

.
,
.

60

14.
, ,
.

. , , -
, , , ,
. - .
75-90% .
, . . 90%
.
.
.
, .
. , .

/
. , , . .

/ .
. , () .
, , 65-100% . ,
. .
, , ,
NSAID .
, , , , 5HT3 , , .
( /) 80%
.
50% . , , ,
, , , COX-2 , TNF ,
.

61

15.
, 50% , 75%
95%
. .

15.1. 

II

.
.

II

3-4 ,
6 3-5 .61

,
, / .

:
, ,
, .

/ ,
.
, / .

II

II

. ,
.

, :





,
.

62


1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM.GLOBOCAN 2008, Cancer

Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet].Lyon, France:

International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr
2. M. Arbyn M, Castellsague X, de Sanjose S, Bruni L, Saraiya M, Bray F, Ferlay J. Worldwide
burden of cervical cancer in 2008. Annals of Oncology 2011; 22: 26752686
3. , 2009. ,
,
, , 2011
4. Bruni L, Diaz M, Castellsague X, Ferrer E, Bosch XF de Sanjose S. Cervical Human
Papillomavirus Prevalence in 5 Continents: Meta-Analysis of 1 Million Women with Normal
Cytological Findings. The Journal of Infectious Diseases, 2010;202:17891799
5. Smernice za celostno obravnavo ensk s predrakavimi spremembami materninega vratu /
[strokovna skupina za pripravo smernic Vraj-Uri M. ed Ljubljana: Onkoloki intitut, 2011
6. Arbyn M, Anttila A, Jordan J, Ronco G, Schenck U, Segnan N, Wiener A. Herbert A, L von
Karsa. European guidelines for quality assurance in cervical cancer screening (2nd ed.).
Brussels, Luxembourg: European Community, Office for Official Publications of the European
Communities, 2008.
7. Colombo N, Carinelli S, Colombo Am Marini C, Rollo D, Sessa C on behalf of the ESMO
Guidelines Working Group. Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis,
treatment and follow/up. Annals of Oncology, 2012; 23 (supplement 7): vii27-vii32
8. Arbyn M, Ronco G, Anttila A, Meijer CJLM, Poljak M et al. Evidence Regarding Human
Papillomavirus Testing in Secondary Prevention of Cervical Cancer. Vaccine, 2012 (in press)
9. Melnikow J, Nuovo J, Willan AR, Chan BKS, Howell L. Natural history of cervical squamous
intraepitheliallesions: A meta-analysis. Obst Gynecol, 1998;92: 727-735
10. Colposcopy and Programme Management. Guidelines for the NHS Cervical Screening
Programme. Second edition David Luesley, Simon Leeson eds, NHSCSP Publication No 20
May 2010
11. MartinHirsch PP, Paraskevaidis E, Bryant A, Dickinson HO, Keep SL. Surgery for cervical
intraepithelial neoplasia. Cochrane Database Syst Rev 2010;6:CD001318.
12. Scottish Intercollegiate Guidelines Network. Management of cervical cancer. A national clinical
guideline, SIGN, 2008
13. Fischerova D. Ultrasound scanning of the pelvis and abdomen for staging of gynecological
tumors: a review. Ultrasound Obstet Gynecol, 2011; 38:246.266
14. Vergote I, Vlayen J, Robays J, Stordeur S, Stemkens D, Smit Y, Bourgain C, De Grve J,
Kridelka F, Scalliet P, Simon P, Stroobants S, Van Dam P, Van Limbergen E, Villeirs G. Een
nationale praktijkrichtlijn voor de aanpak van cervixkanker. Good Clinical Practice (GCP).
Brussel: Federaal Kenniscentrum voor de Gezondheidszorg (KCE). 2011. KCE Reports vol A.
D/2011/10.273/69
15. Landoni F, Maneo A, Colombo A et al. Randomized study of radical surgery versus radiotherapy
for stage Ib-IIa cervical cancer. Lancet, 1997; 350: 535Stegman M, Louwen M, van der Velden
J, ten Kate FJ, den Bakker MA, Burger CW et al. The incidence of parametrial involvement in
select patients with early cervix xancer is too low to justify parametrectomy. Gynecol Oncol,
2007; 105: 475-80
16. Wright JD, Grigsby PW, Brooks R, Powell MA, Gibb RK, Gao F et al. Utility of parametrectomy
for early stage cervical cancer treated with radical hysterectomy. Cancer, 2007; 110: 1281-677
17. Eriksson LR, Covens A. Snetinel lymphnode mapping in cervical cancer: the future? BJOG,
2012; 119:129-133
63

18. Schneider A, Erdemoglu E, Chiantera V, Reed N, Morice P, Rodolais A, Denschlag D, Kesic

V. Clinical Recommendation Radical Trachelecotmy for fertility Preservation in Patients With

Early-Stage Cervical Cancer. Int J Gynaecol. Cancer, 2012; 22:659-666
19. Viswanathan AN, Thomadsen B; American Brachytherapy Society Cervical Cancer
Recommendations Committee. American Brachytherapy Society consensus guidelines for
locally advanced carcinoma of the cervix. Part I: general principles. American Brachytherapy
Society. Brachytherapy., 2012 Jan-Feb;11(1):33-4
20. Vale C, Tierney JF, Stewart LA et al. Chemoradiotherapy for Cervical Cancer Meta-Analysis
Collaboration: Reducing uncertainties about the effects of chemoradiotherapy for cervical
cancer: a systematic review and meta-analysis of individual patient data from 18 randomized
trials. J Clin Oncol, 2008; 26: 5802-12.

64



5, 11000
. 011 71 51 722, x: 011 71 51 724
E-mail: office@azus.gov.rs