II-196 ZDRAV VESTN 2003; 72: SUPPL II
ALI OBSTAJA HITRO RASTOČI RAK MATERNIČNEGA
VRATU
DOES INTERVAL CERVICAL CANCER EXIST
Špela Smrkolj, Stelio Rakar
Ginekološka klinika Ljubljana, Klinični center, Šlajmerjeva 3, 1525 Ljubljana
Key words: cervical cancer; data on screening tests; retro-
spective cytologic study; analysis of clinical data of patients
Abstract – Background. After 1994 the incidence of cervical
cancer has been dramatically increasing; the stabilized inci-
dence of 15–16/100,000 women increased to 23/100,000 wo-
men in 1997. This steep increase might not be only the conse-
quence of the women’s negligence to come to preventive gyne-
cological examinations, but very likely also the consequence
of the actual higher number of interval cervical cancer cases.
Interval cervical cancer is detected in women having the
smear regularly taken (period 1–3 years) and being relati-
vely young (30–40 years).
Methods. In order to find whether interval cervical cancer
exists also in Slovenia, we analysed 624 patients with cervi-
cal cancer, included in the Cancer Registry of the Republic of
Slovenia in the period 1995–2000. We re-evaluated cytologi-
cal smears taken from the uterine cervix and compared them
to the initial ones. Additionally, we assessed the patient data
considering histological type, stage made on clinical and sur-
gical evaluations, surgical treatment and other known pro-
gnostic factors.
Results. Of the 155 re-evaluated findings of cervical smears
we found 9 (5.8%) cases of interval cervical cancer. 43% of
patients did not come to regular gynecological examinations;
in the patients coming to regular gynecological examinati-
ons, there were errors found concerning the prescribed treat-
ment – in 16% these errors were obvious, whereas in 31.5%
they were minor; besides, there were 15.8% of false negative
cytologic diagnoses, either for inadequate sampling (7.3%)
or inaccurate interpretation (12.3%). Among all patients the-
re were 65% cases of squamous cell carcinoma and 30% ca-
ses of adenocarcinoma and adenosquamous cell carcinoma.
Conclusions. The findings of this study confirm the existence
of interval cervical cancer in Slovenia, but the incidence of
this cancer cannot be estimated. However, the actual share of
women with the rapid onset of cervical cancer is lower than
expected (5%). This analysis has brought up the issues of inap-
propriate procedures as well as inadequate quality of work
in the fields of gynecology and cytology. On the other hand, it
shows that women are still not sufficiently aware of the neces-
sity of regular gynecological examinations, which is impor-
tant for the realization of the National programme for detec-
tion of precervical lesions on the uterine cervix.
Ključne besede: rak materničnega vratu; podatki o preseja-
nju; retrospektivna citološka preiskava; analiza kliničnih po-
datkov bolnic
Izvleček – Izhodišča. Incidenca raka materničnega vratu
(RMV) je po letu 1994 v strmem porastu (od ustaljene inci-
dence 15–16/100.000 žensk je porasla na 23/100.000 žensk
leta 1997). Ta strmi porast ni samo posledica neodzivnosti
žensk na preventivne preglede, ampak zelo verjetno tudi po-
sledica večjega števila hitro rastočih RMV, ki naj bi nastali
pri ženskah, ki hodijo na redne odvzeme brisov (v obdobju
1.–3. let) in ki so še relativno mlade (30–40 let).
Metode. Z namenom ugotoviti, ali obstaja hitro rastoči RMV
tudi v Sloveniji, smo opravili analizo primerov 624 bolnic z
RMV, ki so bile vključene v Register raka RS v letih 1995–
2000 tako, da smo ponovno ovrednotili citološke brise mater-
ničnega vratu in jih primerjali s prvotnimi izvidi. Hkrati smo
ocenili podatke o bolnicah z RMV glede na histološki tip, kli-
nični in kirurški stadij, operativno zdravljenje in druge zna-
ne napovedne dejavnike.
Rezultati. Med 155 bolnicami, pri katerih smo ponovno pre-
gledali citološki bris, smo ugotovili 9 (5,8%) primerov bolnic,
pri katerih je bil bris v zadnjih 3 letih negativen. 43% bolnic
ni hodilo na redne ginekološke preglede. Pri redno pregledo-
vanih bolnicah smo ugotovili napake v postopku zdravljenja,
in sicer očitne napake v 16% primerov, manjše pa v 31,5%
primerov. Pri bolnicah, ki so hodile na redne ginekološke pre-
glede, so bili odvzeti citološki brisi materničnega vratu v
15,8% lažno negativni, bodisi zaradi neustreznega odvzema
(7,3%) ali odčitka (12,3%). Med vsemi bolnicami je bilo 65%
primerov skvamoznega RMV in 30% primerov adeno- in ade-
noskvamoznega RMV.
Zaključki. Glede na rezultate naše raziskave sklepamo, da je
verjetno tudi v Sloveniji prisoten hitro rastoči rak maternič-
nega vratu, resnične incidence hitro rastočega RMV ni mo-
goče ugotoviti, vsekakor pa je na podlagi naše analize delež
bolnic s hitro rastočim RMV manjši, kot smo pričakovali, in
sicer znaša okrog 5%. Raziskava je opozorila na: neustrezne
postopke in slabšo kakovost dela ginekološke in citološke stro-
ke ter na slabo osveščenost žensk, kar je pomembno za ustre-
zno načrtovanje odkrivanja RMV v okviru Državnega pro-
grama za organizirano odkrivanje predrakavih sprememb
materničnega vratu ZORA.