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Introducción: El cáncer de cérvix es una de las neoplasias diagnosticadas con más frecuencia durante el embarazo. El tratamiento es similar a las mujeres no embarazadas, aunque el gold estándar presenta un dilema en la actualidad. El enfoque terapéutico dependerá del estadio tumoral, el tamaño del tumor, la edad gestacional, la afectación ganglionar, el subtipo histológico y el deseo de la paciente de continuar o no con el embarazo. Objetivo y método: El objetivo primario de esta revisión bibliográfica es averiguar el manejo terapéutico del cáncer de cérvix en mujeres embarazadas que desean preservar la gestación con el fin de lograr un equilibrio entre el tratamiento eficaz del tumor y el bienestar fetal, a través de una revisión literaria de trabajos publicados hasta el momento actual. Resultados: En estadios tempranos de la enfermad la conización del cuello uterino, la traquelectomía simple o la traquelectomía radical abdominal son opciones consideradas en mujeres con deseo de preservar el embarazo. En gestaciones avanzadas, el tratamiento del tumor se suele posponer hasta después del parto. La quimioterapia, especialmente con cisplatino y paclitaxel, se puede administrar durante el embarazo y ha demostrado respuestas tumorales satisfactorias en el segundo y tercer trimestre. La NACT seguida de cirugía radical se considera factible para mejorar el pronóstico materno y fetal en estadios más avanzados. Sin embargo, la administración de quimioterapia durante las primeras 14 semanas de gestación sigue siendo controvertida por riesgo de aborto espontáneo y anomalías congénitas. Conclusiones: La bibliografía existente sobre la seguridad oncológica y fetal del tratamiento de CCU en mujeres que desean preservar la gestación es limitada, y aunque ha habido un aumento de estudios recientes con resultados favorables es necesario realizar más estudios para establecer el manejo estándar del cáncer de cuello uterino durante el embarazo, Introducción: O cáncer de cérvix é unha das neoplasias diagnosticadas con máis frecuencia durante o embarazo. O tratamento é similar as mulleres non embarazadas, aínda que o gold estándar presenta un dilema na actualidade. O enfoque terapeútico dependerá do estadio tumoral, o tamaño do tumor, a idade xestacional, a afectación ganglionar, o subtipo histolóxico e o desexo da paciente de continuar ou non co embarazo. Obxetivo e métodos: O obxetivo principal desta revisión bibliográfica é coñecer o manexo terapéutico do cancro de cérvix en mulleres embarazadas que desexan preservar o embarazo para conseguir un equilibrio entre o tratamento eficaz do tumor e o benestar do feto, a través dunha revisión literaria de traballos publicados ata o momento actual. Resultados: Nas fases iniciais da enfermidade a conización do cérvix, a traquelectomía simple ou a traquelectomía abdominal radical son opcións consideradas nas mulleres que desexan preservar o embarazo. En xestacións avanzadas, o tratamento do tumor adoita pospoñerse ata despois do parto. A quimioterapia, especialmente con cisplatino e paclitaxel, pódese administrar durante o embarazo e mostrou respostas tumorais satisfactorias no segundo e terceiro trimestre. A NACT seguida dunha cirurxía radical considérase factible para mellorar o prognóstico materno e fetal en fases máis avanzadas. Non obstante, a administración de quimioterapia durante as primeiras 14 semanas de xestación segue sendo controvertida debido ao risco de aborto espontáneo e anomalías conxénitas. Conclusións: A bibliografía existente sobre a seguridade oncolóxica e fetal do tratamento do cancro de cérvix en mulleres que queren preservar o embarazo é limitada, e aínda que houbo un aumento dos estudos recentes con resultados favorables é necesario realizar máis estudos para establecer o manexo estándar do cáncer de cérvix durante o embarazo, Introduction: Cervical cancer is one of the most frequently diagnosed neoplasms during pregnancy. Treatment is similar to non pregnant women, although gold standard presents a dilemma at present. The therapeutic approach will depend on the tumor stage, tumor size, gestational age, nodal involvement, histologic subtype, and the patient’s desire to continue or not with pregnancy. Objective: The primary objective of this narrative review is to find out the therapeutic management of cervical cancer in pregnant women who wish to preserve pregnancy in order to achieve a balance between effective tumor treatment and fetal well-being hrough a literary review of articles published until the current moment. Results: In early stages cervical conization, simple trachelectomy or radical abdominal trachelectomy are considered options in women with a desire to preserve pregnancy. In advanced pregnancies, treatment of the tumor is usually postponed until after delivery. Chemotherapy, especially with cisplatin and paclitaxel, may be given during pregnancy and has shown satisfactory tumor responses in the second and third trimester. NACT followed by radical surgery is considered feasible to improve maternal and fetal prognosis in more advanced stages. However, the administration of chemotherapy during the first 14 weeks of gestation remains controversial because of the risk of miscarriage and congenital abnormalities. Conclusions: The existing literature on the oncological and fetal safety of CCU treatment in women who wish to preserve pregnancy is limited, and although there has been an increase in recent studies with favorable results more studies are needed to establish standard management of cervical cancer during pregnancy

The incidence of anal cancer has increased in the last 10 years, especially in the population considered to be at risk. Women with a history of infection in the genital tract by Human Papillomavirus (HPV) have higher risk of developing this type of cancer. The presence of high-risk (HR) HPV genotypes in the anogenital region has been shown to play a role in the etiopathogenesis of anal cancer. Many aspects of the natural history of anal lesions are unknown, but the anal transition zone is considered to have a high cell replacement. This is why a pathophysiological mechanism of HR-HPV infection and development of invasive lesions similar to those of cervical cancer has been suggested. The aim of this work was to show the current status of the epidemiological information that links the risk of developing anal cancer in women with cervical cancer precursor lesions associated with HPV infection. The relevance of this information is to provide a basis of recommendations for the timely detection of anal cancer in women considered to be at HR of suffering it, and to encourage more prospective studies in this population., La incidencia del cáncer anal ha presentado un incremento en los últimos 10 años, sobre todo en población considerada vulnerable. Las mujeres con antecedentes de infección por Virus del Papiloma Humano (VPH) en el tracto genital, tienen mayor riesgo de este tipo de cáncer. Se ha demostrado que, la infección con genotipos de VPH de alto riesgo (AR), en la región anogenital, desempeña un papel en la etiopatogenia de dicho cáncer. Se desconocen muchos aspectos de la historia natural de las lesiones anales, pero se considera que la zona de transición anal presenta un alto recambio celular, por lo que se ha planteado un mecanismo fisiopatológico de infección por VPH-AR y desarrollo de lesiones invasoras, similar al del cáncer cervical. El objetivo de este trabajo fue mostrar el estado actual sobre la información epidemiológica que vincula el riesgo de desarrollar cáncer anal en mujeres con lesiones precursoras de cáncer cervical asociadas a la infección por VPH. La relevancia de dicha información es proporcionar una base de recomendaciones para la detección oportuna de cáncer anal en mujeres consideradas de AR de padecerlo y, favorecer la realización de estudios prospectivos en la población.

Twin and family studies suggest that genetic factors play a role in cervical neoplasia susceptibility. Both rare high penetrant and common low penetrant host genetic variants have been shown to influence the risk of HPV persistence, and common variants have been shown to influence the risk of cervical neoplasia. The strongest associations with cervical neoplasia are with HLA genes, with associations having been demonstrated to both reduce and increase the risk of the disease. Fine-mapping using imputed amino-acid sequences of HLA-types has shown that the HLA associations are driven primarily by the HLA-B amino acid position 156 (B156), and HLA-DRB1 amino acid positions 13 and 71. This is informative about the types of peptides that may be useful for peptide vaccines. As cervical neoplasia is at least moderately heritable, genetics may be able to identify those at high or low disease risk. Using the findings of hundreds of disease-associated SNPs to calculate genetic risk scores, it has been shown that women with genetic risk scores in the bottom 10% of the population have very low risk of cervical neoplasia (<0.17%), whereas those in the top 5% have 22% risk of developing the disease. Further large scale genetic studies would be helpful to better define particularly the non-MHC component of genetic risk.

The aim of this study was to assess whether negative psychological consequences of conization reported in questionnaire studies translated into increased use of the healthcare services that could relieve such symptoms. This was a population-based register study comparing women undergoing conization with a control group of women with normal cytology results. Data were derived from Danish registers. Using the difference-in-differences method, we measured contacts with general practitioners (GPs), hospitals, psychiatrist/psychologists, and use of anxiolytic and antidepressant prescription drugs over 5 years 'before' and 'after' the conization in the study group, and in comparable periods in the control group. During the 'before' period, women who later had a conization had greater contact with GPs and hospitals, and slightly more contact with psychiatrist/psychologists, than control women. In both groups, healthcare use increased significantly from the 'before' to the 'after' period. For contacts with GPs and hospitals, the increase was significantly larger for the conization group than for the control group, but this could be attributed to the standard postconization follow-up process. In the 'before' period, women who later had a conization used fewer drugs than women of the control-group, but their drug use increased similarly over time. The conization event did not result in an increased use of the healthcare services that could relieve potential negative side effects. However, women who underwent a conization seemed to constitute a select group as they already used GPs and hospitals more frequently, and anxiolytic and antidepressant drugs less frequently, than other women in the years 'before' the conization event.

BackgroundCervical cancer is the fourth most common cancer in women, and we recently reported human leukocyte antigen (HLA) alleles showing strong associations with cervical neoplasia risk and protection. HLA ligands are recognized by killer immunoglobulin-like receptors (KIRs) expressed on a range of immune cell subsets, governing their proinflammatory activity. We hypothesized that the inheritance of particular HLA-KIR combinations would increase cervical neoplasia risk. MethodsHere, we used HLA and KIR dosages imputed from single-nucleotide polymorphism genotype data from 2143 cervical neoplasia cases and 13858 healthy controls of European decent. ResultsThe following 4 novel HLA alleles were identified in association with cervical neoplasia, owing to their linkage disequilibrium with known cervical neoplasia–associated HLA-DRB1 alleles: HLA-DRB3*9901 (odds ratio [OR], 1.24; P = 2.49 × 10−9), HLA-DRB5*0101 (OR, 1.29; P = 2.26 × 10−8), HLA-DRB5*9901 (OR, 0.77; P = 1.90 × 10−9), and HLA-DRB3*0301 (OR, 0.63; P = 4.06 × 10−5). We also found that homozygosity of HLA-C1 group alleles is a protective factor for human papillomavirus type 16 (HPV16)–related cervical neoplasia (C1/C1; OR, 0.79; P = .005). This protective association was restricted to carriers of either KIR2DL2 (OR, 0.67; P = .00045) or KIR2DS2 (OR, 0.69; P = .0006). ConclusionsOur findings suggest that HLA-C1 group alleles play a role in protecting against HPV16-related cervical neoplasia, mainly through a KIR-mediated mechanism.

A small percentage of women with cervical HPV infection progress to cervical neoplasia, and the risk factors determining progression are incompletely understood. We sought to define the genetic loci involved in cervical neoplasia and to assess its heritability using unbiased unrelated case/control statistical approaches. We demonstrated strong association of cervical neoplasia with risk and protective HLA haplotypes that are determined by the amino-acids carried at positions 13 and 71 in pocket 4 of HLA-DRB1 and position 156 in HLA-B. Furthermore, 36% (standard error 2.4%) of liability of HPV-associated cervical pre-cancer and cancer is determined by common genetic variants. Women in the highest 10% of genetic risk scores have approximately >7.1% risk, and those in the highest 5% have approximately >21.6% risk, of developing cervical neoplasia. Future studies should examine genetic risk prediction in assessing the risk of cervical neoplasia further, in combination with other screening methods.

ABSTRACT A small percentage of women with cervical HPV infection progress to cervical neoplasia, and the risk factors determining progression are incompletely understood. We sought to define the genetic loci involved in cervical neoplasia and to assess its heritability using unbiased unrelated case/control statistical approaches. We demonstrated strong association of cervical neoplasia with risk and protective HLA haplotypes that are determined by the amino-acids carried at positions 13 and 71 in pocket 4 of HLA-DRB1 and position 156 in HLA-B. Furthermore, 36% (standard error 2.4%) of liability of HPV-associated cervical pre-cancer and cancer is determined by common genetic variants. Women in the highest 10% of genetic risk scores have approximately >7.1% risk, and those in the highest 5% have approximately >21.6% risk, of developing cervical neoplasia. Future studies should examine genetic risk prediction in assessing the risk of cervical neoplasia further, in combination with other screening methods. AUTHOR SUMMARY Around 1% of women with cervical human papillomavirus (HPV) infection progress to cervical cancer. Previous studies had indicated that a person’s genetic makeup could predispose to HPV-associated cervical cancer, and that some of the genes likely to be involved include the immune-related human leukocyte antigen (HLA) genes among the major histocompatibility complex (MHC). However, it has been difficult to determine which alleles might be associated with cervical pre-cancer or cancer due to the complex and high level of co-inheritance of MHC alleles. Here, we performed a genome-wide association study that assessed the correlation of genetic variants among those with cervical cancer and healthy controls. We show that host genetics is a major determinant of HPV-associated cervical cancer, with 36% of liability due to common genetic variants in the population, and identify both risk and protective HLA alleles. Our study was also sufficiently p

This study focused on screening a population of women served by the Unified Health System (SUS) and to determine the prevalence, cytologic changes in the cervix. It was performed a retrospective search of SUS examinations, cervicovaginal cytology performed from January 2007 to December 2011. Data collection was conducted from laboratory. During the study period were conducted 62280 examinations of SUS, with 2049 (3,3%) of positive reports for some kind of injury, being observed a high prevalence 36,99% of cytologic changes in the cervix. This index is worrying, which indicates the need to establish a prevention policy to health in all women our country. This screening was the basis for discussing strategies on prevention, treatment and control of precursor lesions of cervical cancer in the extension project, O presente estudo teve como foco rastrear uma população de mulheres atendidas pelo Sistema Único de Saúde (SUS) e verificar a prevalência, de alterações citológicas no colo do útero. Foi realizada uma busca retrospectiva dos exames SUS, de citologia cervicovaginal realizados no período de janeiro de 2007 a dezembro de 2011. A coleta dos dados foi realizada a partir dos laudos laboratoriais. No período do estudo foram realizados 62280 exames do SUS, com 2049 (3,3%) de laudos positivos para algum tipo de lesão, sendo observada uma alta prevalência 36,99% de alterações citológicas no colo do útero. Este índice é preocupante, o que permite concluir sobre a necessidade de estabelecer uma política de prevenção à saúde de todas as mulheres no nosso país. Este rastreamento serviu de base para discussão de estratégias sobre prevenção, tratamento e controle das lesões precursoras do câncer do colo do útero num projeto de extensão, Este estudio se centró en el cribado de una población de mujeres atendidas por el Sistema Único de Salud (SUS) y para determinar la prevalencia, los cambios citológicos en el cuello uterino. Se realizó una búsqueda retrospectiva de los exámenes SUS, la citología cervicovaginal realizado entre enero de 2007 diciembre de 2011. La recolección de datos se llevó a cabo a partir de los informes de laboratorio. Durante el período de estudio se realizaron 62280 exámenes del SUS, con 2049 (3,3%) de los informes positivos para algún tipo de lesión, observándose una alta prevalencia 36,99% de los cambios citológicos en el cuello uterino. Este índice es preocupante, lo que indica la necesidad de establecer una política de prevención para la salud de todas las mujeres de nuestro país. Esta evaluación fue la base para la discusión de las estrategias sobre prevención, tratamiento y control de las lesiones precursoras del cáncer de cuello uterino en uno proyecto de ampliación

ObjectivePlasma HIV RNA levels have been associated with the risk of human papillomavirus (HPV) and cervical neoplasia in HIV-seropositive women. However, little is known regarding local genital tract HIV RNA levels and their relation with cervical HPV and neoplasia.Design/methodsIn an HIV-seropositive women's cohort with semiannual follow-up, we conducted a nested case-control study of genital tract HIV RNA levels and their relation with incident high-grade squamous intraepithelial lesions (HSIL) subclassified as severe (severe HSIL), as provided for under the Bethesda 2001 classification system. Specifically, 66 incidents of severe HSIL were matched to 130 controls by age, CD4 count, highly active antiretroviral therapy use, and other factors. We also studied HPV prevalence, incident detection, and persistence in a random sample of 250 subjects.ResultsRisk of severe HSIL was associated with genital tract HIV RNA levels (odds ratio comparing HIV RNA ≥ the median among women with detectable levels versus undetectable, 2.96; 95% confidence interval: 0.99 to 8.84; Ptrend = 0.03). However, this association became nonsignificant (Ptrend = 0.51) after adjustment for plasma HIV RNA levels. There was also no association between genital tract HIV RNA levels and the prevalence of any HPV or oncogenic HPV. However, the incident detection of any HPV (Ptrend = 0.02) and persistence of oncogenic HPV (Ptrend = 0.04) were associated with genital tract HIV RNA levels, after controlling plasma HIV RNA levels.ConclusionsThese prospective data suggest that genital tract HIV RNA levels are not a significant independent risk factor for cervical precancer in HIV-seropositive women, but they leave open the possibility that they may modestly influence HPV infection, an early stage of cervical tumorigenesis.

Prophyllactic HPV vaccines are efficacious in preventing persistent infections by vaccine-HPV types and re- lated cervical disease. The maximum effect is achieved in women who are not exposed to HPV vaccine types at the time of vaccination (HPV DNA negative women). Today's published data demonstrate equal clinical vaccine efficacy in women between 15 and 26 years and women between 24 and 45 years. The public health effect of vaccinating women older than 25 years is not clear yet, but may be smaller than after vaccination of adolescents. Unresolved issues are dura- tion of protection and long-term preventive effects after treatment of HPV-related disease or natural clearance of HPV in- fection. Furthermore, it remains difficult to define subgroups of older women who would benefit from the vaccine. It may be that older women exposed to HPV or who are being treated for HPV related disease will benefit most at long term. This needs longer follow-up of vaccinated women and more detailed analysis of data from vaccine trials. © 2010 Bentham Science Publishers Ltd., SCOPUS: ar.j, info:eu-repo/semantics/published

Cervical cancer screening is an essential component of prenatal care. The diagnosis and management of cervical intraepithelial neoplasia (CIN) during pregnancy are challenging, and sufficient information does not exist to allow for a definitive evidence-based approach. The American Society for Colposcopy and Cervical Pathology has recently published guidelines regarding the evaluation of abnormal Papanicolaou tests and the treatment of CIN in this setting. Many techniques traditionally recommended in the evaluation of abnormal cervical cytology and the treatment of CIN in the nonpregnant woman, such as colposcopy, cervical biopsy, and electrosurgical excision, can be applied to the pregnant patient with important exceptions. The vascular cervix associated with the gravid condition and the risk of premature pregnancy loss mandates deviation from existing consensus guidelines in screening for cervical cancer in pregnancy and treating associated CIN. In the present review, current guidelines regarding cervical cancer screening are reviewed, and data from studies of pregnant populations are summarized.

Three major neoplasms are associated with AIDS definition in the course of HIV infection due to their increased incidence. The relationship between the immune system and the epidemiology of these virus-induced tumors is of importance in order to identify new therapeutic approaches for treating or preventing these neoplasms. Major improvements in the understanding of the pathogenesis have already been performed. The impact of highly active antiretroviral therapy (HAART) on their incidence likely confirms the concept of 'opportunistic malignancies'. Other neoplasms are likely more prevalent in HIV-infected individuals, but their relative importance requires further prospective case-control cohort studies. (C) 2000 Editions scientifiques et medicales Elsevier SAS., SCOPUS: re.j, info:eu-repo/semantics/published

Diagnostic conization is performed especially in the case of endocervical lesions with early cervical neoplasia because it is diffiucult to biopsy endocervical canal lesions in such cases. We analyzed the indications and usefulness of diagnostic conization by comparing its results with those of preoperative cytology and histology. The subjects consisted of 69 patients who underwent diagnostic conization at our hospital between January 1, 1988 and August 31, 1995. Preoperative histology by biopsy showed under diagnosis in 34 (49.3%), and over diagnosis in 16 (23.2%) compared with the diagnosis by conization, respectively. When the cytology indicated mild or moderate dysplasia and biopsy indicated moderate dysplasia or a less advanced lesion, no diagnostic conization was required because the final diagnosis bore out the earlier indications. When the cytology indicated carcinoma in situ (CIS) or invasive cancer, diagnostic conization was required because CIS or microinvasive cancer was ultimately diagnosed even if the biopsy showed no neplastic change. When the cytology indicated severe dysplasia to invasive carcinoma, 18.2% of the patients diagnosed as moderate dysplasia or a less advanced lesion by conization did not undergo hysterectomy. This study showed indication for diagnostic conization and the usefulness of conization for the reservation of the uterus.