Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/313224
Type: DISSERTAÇÃO
Degree Level: Mestrado
Title: Rastreamento, diagnostico e tratamento das lesões precursoras e do cancer invasor de colo uterino no municipio de Franco da Rocha, SP
Author: Guarisi, Renata
Advisor: Hardy, Ellen Elizabeth, 1939-
Abstract: Resumo: Objetivo: Avaliar a proporção de lesões precursoras e de câncer invasor de colo do útero nas biopsias alteradas, bem como os procedimentos de rastreamento, diagnóstico e tratamento realizados no único hospital público e nos três postos de saúde do Municipio de Franco da Rocha, no periódo de 1998 a 2002. Casuística e Método: Estudo de corte transversal, com componentes descritivos e analíticos. Foram revisados todos os prontuários de mulheres com diagnósticos histológicos de HPV, NIC 1, NIC 2, NIC 3 e câncer invasor, atendidas no Hospital. Estes prontuários foram identificados através do livro de registro no Laboratório de Anatomia Patológica do Hospital. A cobertura do exame de Papanicolaou entre 2000 e 2002 foi estimada através dos dados do Datasus (www.datasus.org), e para 1998 a 1999 estimou-se com base nas citologias colhidas nos postos e no Hospital. Para a avaliação dos recursos existentes no Hospital e nos postos foi realizada entrevista com um funcionário de cada local. Para a análise da associação entre as variáveis e o diagnóstico histológico foram calculados os Odds Ratio com intervalo de confiança de 95%. Resultados: Foram identificados 87 prontuários, sendo 52% HPV I NIC 1, 28% NIC 2 I NIC 3, e 21% câncer invasor. A maior parte das mulheres com NIC 2/ NIC 3 procurou o hospital por apresentar CO e/ou biópsia alteradas. A procura por sintoma específico de câncer esteve associada positivamente com diagnóstico da neoplasia invasora. Quase a totalidade das mulheres com lesão precursora chegaram ao hospital referidas por outro serviço. Ao contrário, mais da metade daquelas com câncer invasor procuraram o hospital espontaneamente. As faixas etárias de 50 anos ou mais e 35 a 49 anos se associaram positivamente ao diagnóstico de câncer invasor, e apenas esta última faixa etária mostrou associação positiva com NIC 2 /NIC 3. Não possuir CO prévia esteve associada positivamente ao diagnóstico de câncer invasor. Ter tido cinco partos ou mais esteve associado com NIC 21 NIC 3 e câncer invasor. Houve alta taxa de aderência ao tratamento e seguimento. A cobertura do exame de Papanicolaou ficou abaixo dos 25% em todos os anos estudados. Todos os postos de saúde visitados possuíam ginecologistas, enfermeiros e material para coleta de CO. As lâminas eram encaminhadas para laboratório terceirizado. Apenas um posto possuía registro dos resultados de CO. O diagnostico final era feito em só um posto e no Hospital. O Ambulatório do Hospital era o único local que possuía aparelho para cirurgia de alta freqüência e realizava tratamento das lesões precursoras. O tratamento cirúrgico era realizado no Hospital e a radioterapia no Município de São Paulo, pois Franco da Rocha não possuía aparelho para este fim. Conclusões: A taxa de câncer invasor no Hospital de Franco da Rocha foi alta, havendo necessidade urgente de implementação de um programa organizado com busca ativa das mulheres a fim de melhorar o rastreamento das lesões precursoras e do câncer cervical invasor

Abstract: Objective: To evaluate the proportion of precursor lesions and of invasive cervical cancer among abnormal biopsy results, as well as the procedures in use for screening, diagnosis and treatment in the only public hospital and in the three primary healthcare clinics of the municipality of Franco da Rocha (Brazil), between 1998 and 2002. Material and Method: A cross-sectional study, with descriptive and analytic components, was carried out. The files of ali women who attended the hospital and who had a histological diagnosis of HPV, cervical intraepithelial neoplasia (CIN) 1, CIN 2, CIN 3 or invasive cervical cancer were reviewed. The records of the hospital's Pathology Department were used to identify the files. The Pap test coverage between 2000 and 2002 was estimated using data from Datasus (www.datasus.org), and for 1998 and 1999 it was estimated based on the number of cytological examinations carried out in the primary healthcare clinics and in the hospital. In order to evaluate the resources and material available in the hospital and in the healthcare clinics, an interview was carried out with one employee from each site. Odds Ratios with a confidence interval of 95% were calculated for the analysis of the association between the variables and the histological diagnosis. Results: Eighty-seven files were identified - 52% with a diagnosis of HPV I CIN 1, 28% diagnosed as CIN 2 I CIN 3, and 21% as invasive cervical cancer. Most of the women with CIN 2 I CIN 3 sought the hospital because of an abnormal cytology andlor biopsy result. Presenting for a specific symptom of cancer was positively associated with a diagnosis of invasive neoplasia. Almost ali the women who had precursor lesions were referred to the hospital by another health service. On the other hand, more than half of those with invasive cervical cancer sought the hospital spontaneously. Aged 50 or older and between 35 and 49 years of age were factors positively associated with the diagnosis of invasive cervical cancer. Only the latter age group showed a positive association with a diagnosis of CIN 2 I CIN 3. Not having carried out a previous Pap smear was positively associated with the diagnosis of invasive cervical cancer. Having had five or more deliveries was associated with CIN 2 I CIN 3 and with invasive cervical cancer. There was a high rate of adherence both to treatment and follow-up. The Pap smear coverage was below 25% in every year studied. Ali the primary healthcare clinics visited had gynecologists, nurses and material necessary for carrying out Pap smears. The smears were sent to an out-sourced laboratory. Only one of the healthcare clinics maintained records of the results of the Pap smears. Final diagnosis was made at only one healthcare clinic and at the hospital. The hospital's outpatient department was the only site equipped for carrying out loop electrosurgical excision procedures and which treated precursor lesions. Surgical treatment was carried out at the hospital but radiotherapy was only performed in the city of Sao Paulo since the municipality of Franco da Rocha did not have the necessary equipment. Conclusions: The rate of invasive cervical cancer in the Franco da Rocha Hospital was high, showing the urgent need for the implementation of an organized program that would actively identify these women in order to improve the screening of precursor lesions and of invasive cervical cancer
Subject: Colposcopia
Epidemiologia
Colo uterino - Câncer
Language: Português
Editor: [s.n.]
Date Issue: 2003
Appears in Collections:FCM - Tese e Dissertação

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