Publication: Manejo conservador de lesiones de alto grado cervicales en mujeres jóvenes. Estudio longitudinal prospectivo
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2018-04-03
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Universidad Complutense de Madrid
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Abstract
Uno de los descubrimientos más importantes en la investigación etiológica del cáncer de estos últimos 25 años ha sido la demostración de que el cáncer de cuello uterino y la mayoría de sus lesiones preinvasivas están causados por la infección persistente de ciertos serotipos del Virus del Papiloma Humano (VPH). La infección por VPH no tiene tratamiento y solo podemos luchar contra ella de la mano de la prevención primaria, mediante la educación, la información y las vacunas anti VPH y de la prevención secundaria o cribado cuyo objetivo es la identificación o diagnóstico de lesiones de alto grado o premalignas para así poder tratarlas y evitar la progresión a cáncer. En mujeres adultas el tratamiento estándar de estas lesiones preinvasivas es quirúrgico mediante una conización (extirpación de parte de tejido cervical), pero esta técnica no deja de ser un procedimiento invasivo que puede condicionar resultados reproductivos adversos (abortos, partos pretérminos, rotura prematura de membrana, etc.). Las mujeres jóvenes soportan la mayor prevalencia de esta infección pero también constituyen el colectivo que más fácilmente la aclara. Durante el período de infección el VPH puede producir displasias cervicales, sobre todo de bajo grado, que desaparecen espontáneamente cuando se aclara la infección. Por eso, ante una anormalidad citológica de grado menor, en este grupo de mujeres, la actitud recomendada es la observación sin tratamiento. En las lesiones de alto grado la actitud no está tan consensuada. Hasta hace unos años el tratamiento escisional también era el tratamiento de primera elección en la mujer joven pero a medida que se va conociendo más la historia natural del virus en este grupo etario se va abriendo la puerta al tratamiento conservador, es decir, a la observación sin tratamiento esperando que la lesión regrese espontáneamente. El objetivo principal de nuestro trabajo es analizar la regresión espontánea de alteraciones citológicas HSIL y lesiones de alto grado CIN 2 y CIN 2-3 en mujeres de edad menor o igual a 25 años...
One of the most important developments, in the etiological investigation of cervical cancer in the last 25 years, has been the demonstration that cervical cancer and most of its preinvasive lesions are caused by persistent infection of certain serotypes of Human Papilloma Virus (HPV). HPV infection has no treatment and due to this, our efforts dealing with it are focus on primary prevention through education, information and against HPV vaccines, and secondary prevention or screening, the purpose of which is to identify or diagnose high grade or premalignant lesions in order to treat them and prevent progression to cancer. In adult women, standard treatment of preinvasive lesions is surgical by conization (excision of a cone-shaped of tissue from the cervix). Although, this technique is an aggressive procedure that might result in obstetric and reproductive adverse outcomes as miscarriage, preterm delivery, premature rupture of membrane, etc. Young women bear the greatest prevalence rate of this infection. On the other hand, they also constitute the group that has the highest clearance rate of the virus. During infection period, cervical dysplasia could occur, especially low grade lesions that might spontaneously disappear when infection of the virus is cleared. Therefore, when facing a minor cytologic abnormality, observation without treatment, is the recommended attitude in this group of patients. Whereas when considering high grade lesions, the management of them is not so well established. Until few years ago, excisional treatment was also first choice treatment in young women. However, the natural history of HPV became better known and knowledge about HPV behavior is improving. According to this, nowadays also a conservative approach of high grade lesions has been proposed among younger patients. That is observation without treatment waiting for the lesion to spontaneously regress, as an alternative option for management in this particular scenario. The main objective of our study is to analyze the spontaneous regression of cytologic abnormality HSIL and high grade lesions CIN 2 and CIN 2-3 in women under the age of 25 (included)...
One of the most important developments, in the etiological investigation of cervical cancer in the last 25 years, has been the demonstration that cervical cancer and most of its preinvasive lesions are caused by persistent infection of certain serotypes of Human Papilloma Virus (HPV). HPV infection has no treatment and due to this, our efforts dealing with it are focus on primary prevention through education, information and against HPV vaccines, and secondary prevention or screening, the purpose of which is to identify or diagnose high grade or premalignant lesions in order to treat them and prevent progression to cancer. In adult women, standard treatment of preinvasive lesions is surgical by conization (excision of a cone-shaped of tissue from the cervix). Although, this technique is an aggressive procedure that might result in obstetric and reproductive adverse outcomes as miscarriage, preterm delivery, premature rupture of membrane, etc. Young women bear the greatest prevalence rate of this infection. On the other hand, they also constitute the group that has the highest clearance rate of the virus. During infection period, cervical dysplasia could occur, especially low grade lesions that might spontaneously disappear when infection of the virus is cleared. Therefore, when facing a minor cytologic abnormality, observation without treatment, is the recommended attitude in this group of patients. Whereas when considering high grade lesions, the management of them is not so well established. Until few years ago, excisional treatment was also first choice treatment in young women. However, the natural history of HPV became better known and knowledge about HPV behavior is improving. According to this, nowadays also a conservative approach of high grade lesions has been proposed among younger patients. That is observation without treatment waiting for the lesion to spontaneously regress, as an alternative option for management in this particular scenario. The main objective of our study is to analyze the spontaneous regression of cytologic abnormality HSIL and high grade lesions CIN 2 and CIN 2-3 in women under the age of 25 (included)...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Obstetricia y Ginecología, leída el 25/04/2017