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Celleforandringer: Behandling

Innhold i artikkelen

Dersom vevsprøvene tatt hos gynekologen viser alvorlige celleforandringer, eller dersom lettere celleforandringer ikke har normalisert seg innen to år, anbefales behandling. Behandlingen går ut på å fjerne partiene med celleforandring på livmorhalsen.

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Ved alvorlige celleforandringer gjøres konisering. En kjegleformet bit ytterst på livmortappen fjernes med en liten elektrisk varmeslynge (LEEP-konisering) eller laser. En sjelden gang settes det noen sting for å stoppe/hindre blødning. Trådene blir borte av seg selv. Vevsbiten som fjernes, blir sendt til undersøkelse og gynekologen mottar svar etter rundt to uker.

Konisering kan medføre svakhet i livmorhalsen ved graviditet, som igjen kan øke risiko for abort og fortidlig fødsel. Risikoen er størst der større deler av livmortappen er fjernet. Derfor vil man hos kvinner under 30 år i en del tilfeller unngå konisering, og heller kontrollere tilstanden hver tredje til sjette måned. Dette kan man gjøre i opptil to år dersom celleforandringene er godt synlige ved kolposkopi og ikke omfatter livmorhalskanalen.

Les også Graviditet etter konisering.

Etter behandling, skal man fremdeles følges opp med celleprøver, og i noen tilfeller kolposkopi. Informasjon om dette får man hos gynekologen eller fastlegen.

Vil du vite mer

Dette dokumentet er basert på det profesjonelle dokumentet Premaligne forandringer i cervix . Referanselisten for dette dokumentet vises nedenfor

  1. Helsedirektoratet. Nasjonalt handlingsprogram med retninglinjer for gynekologisk kreft. Helsedirektoratet. Oslo, mai 2020. www.helsedirektoratet.no
  2. Kreftregisteret. Kvalitetsmanual for Livmorhalsprogrammet. Oslo, 27.03.2020. www.kreftregisteret.no
  3. Kreftregisteret. Årsrapport 2017-18. Resultater og forbedringstiltak fra Livmorhalsprogrammet, Oslo, mai 2020. www.kreftregisteret.no
  4. Kreftregisteret. Cancer in Norway 2019. Oslo: Kreftregisteret, 2020, www.kreftregisteret.no. www.kreftregisteret.no
  5. Danckert B, Ferlay J, Engholm G et al. NORDCAN: Cancer Incidence, Mortality, Prevalence and Survival in the Nordic Countries, Version 8.2 (26.03.2019). Hentet 29.10.2020 www.ancr.nu
  6. Molden T, Feiring B, Ambur OH et al. Human papillomavirus prevalence and type distribution in urine samples from Norwegian women aged 17 and 21 years: A nationwide cross-sectional study of three non-vaccinated birth cohorts. Papillomavirus Res 2016; 2: 153-8. pmid:29074174 PubMed
  7. Rodríguez AC, Schiffman M, Herrero R, et al. Rapid Clearance of Human Papillomavirus and Implications for Clinical Focus on Persistent Infections. J Natl Cancer Inst 2008; 100 (7): 513-7. PMID: 18364507 PubMed
  8. Plummer M, Schiffman M, Castle PE, et al. A 2-year prospective study of human papillomavirus persistence among women with a cytological diagnosis of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion. J Infect Dis 2007; 195: 1582-9. pmid:17471427 PubMed
  9. Eide LM, Baasland I. Celleprøvetaking fra cervix - er det så vanskelig?. Gynekologen 2014; 27 (2): 32-4. www.legeforeningen.no
  10. Schiffman M, Castle PE, Jeronimo J, et al. Human papillomavirus and cervical cancer. Lancet 2007; 370 (9590): 890. PMID: 17826171 PubMed
  11. Kaderli R, Schnüriger B, Brügger LE. The impact of smoking on HPV infection and the development of anogenital warts. Int J Colorectal Dis 2014. pmid:24935346 PubMed
  12. Jensen KE, Thomsen LT, Schmiedel S. Chlamydia trachomatis and risk of cervical intraepithelial neoplasia grade 3 or worse in women with persistent human papillomavirus infection: a cohort study. Sex Transm Infect 2014. PMID: 24728044 PubMed
  13. World Health Organization. Comprehensive cervical cancer control. A guide to essential practice. Second edition. Geneva: WHO; 2014. www.who.int
  14. Winer RL, Hughes JP, Feng Q, et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med 2006; 354: 2645-54. PMID: 16790697 PubMed
  15. Trottier H, Mahmud S, Costa MC, et al. Human papillomavirus infections with multiple types and risk of cervical neoplasia. Cancer Epidemiol Biomarkers Prev 2006; 15: 1274-80. PMID: 16835323 PubMed
  16. International Collaboration of Epidemiological Studies of Cervical Cancer. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16,573 women with cervical cancer and 35,509 women without cervical cancer from 24 epidemiological studies.. Lancet 2007; 370 (9599): 1609. pmid:17993361 PubMed
  17. Sørbye SW, Suhrke P, Revå BW, et al. Accuracy of cervical cytology: comparison of diagnoses of 100 Pap smears read by four pathologists at three hospitals in Norway. BMC Clin Pathol 2017 Aug 29; 17:18: eCollection 2017. pmid:28860942 PubMed
  18. Nygård M, Andreassen T, Berland J, et al. 2013. HPV-test i primærscreening mot livmorhalskreft. Kontrollert implementering og evaluering av forbedret helsetjeneste. Oslo, Helsedirektoratet. www.helsedirektoratet.no
  19. Andreassen T, Vogt C. Screening for livmorhalskreft i endring. Tidsskrift for Den norske legeforening 2014; 11: 1122-3. doi:10.4045/tidsskr.14.0240 DOI
  20. Kreftregisteret. Livmorhalsprogrammet. HPV i primærscreening. Sist oppdatert 12.03.2018. Siden besøkt 02.08.2018. www.kreftregisteret.no
  21. Carozzi FM, Tornesello ML, Burroni E, et al. Prevalence of human papillomavirus types in high-grade cervical intraepithelial neoplasia and cancer in Italy. Cancer Epidemiol Biomarkers Prev 2010; 19: 2389-2400. pmid: 20826836 PubMed
  22. Sørbye SW, Arbyn M, Fismen S, et al. HPV E6/E7 mRNA testing is more specific than cytology in post-colposcopy follow-up of women with negative cervical biopsy. PLoS One 2011; 6(10): e26022. pmid:21998748 PubMed
  23. Dillner J, Rebolj M, Birembaut P, et al. Long trem predictive values of cytology and human papillomavirus testing in cervical cancer screening: joint European cohort study. BMJ 2008; 337: a1754. pmid: 18852164 PubMed
  24. Ronco G, Dillner J, Elfstrom KM, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. Lancet 2013 Nov 1.Lancet. PubMed PMID: 24192252. PubMed
  25. Ogilvie GS, van Niekerk D, Krajden M, et al. Effect of Screening With Primary Cervical HPV Testing vs Cytology Testing on High-grade Cervical Intraepithelial Neoplasia at 48 Months The HPV FOCAL Randomized Clinical Trial. JAMA 2018; 320: 43-52. pmid:29971397 PubMed
  26. Koliopoulos G, Nyaga VN, Santesso N et al. Cytology versus HPV testing for cervical cancer screening in the general population. Cochrane Database Syst Rev 2017; 8: CD008587. DOI: 10.1002/14651858.CD008587.pub2. The Cochrane Library
  27. Arbyn M, Smith SB, Temin S et al. Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: updated meta-analyses. BMJ 2018. PMID: 30518635 PubMed
  28. Polman NJ, Ebisch RMF, Heideman DAM et al. Performance of human papillomavirus testing on self-collected versus clinician-collected samples for the detection of cervical intraepithelial neoplasia of grade 2 or worse: a randomised, paired screen-positive, non-inferiority trial. Lancet Oncol 2019; 20: 229-38. pmid:30658933 PubMed
  29. Leinonen MK, Schee K, Jonassen CM et al. Safety and acceptability of human papillomavirus testing of self-collected specimens: A methodologic study of the impact of collection devices and HPV assays on sensitivity for cervical cancer and high-grade lesions. J Clin Virol 2018; 99: 22-30. pmid:29289814 PubMed
  30. International Agency for Research on Cancer/World Health Organization. IARC Handbooks of Cancer Prevention: Cervix cancer screening. Volume 10. Lyon: IARC Press, 2005. publications.iarc.fr
  31. Skjeldestad FE, Hagen B, Hagmar B, Iversen O-E, Juvkam KH, Steen R, Thoresen S, Hareide B. Er cervixcytologisk undersøkelse av unge kvinner mer til skade enn til gagn?. Tidsskr Nor Lægeforen 2007; 127: 1782-5. PubMed
  32. Galgano MT, Castle PE, Atkins KA, et al. Using biomarkers as objective standards in the diagnosis of cervical biopsies. Am J Surg Pathol 2010 Aug; 34(8): 1077-87. pmid:20661011 PubMed
  33. Baasland I, Munk AC, Ernø LE et al. Premaligne og maligne forandringer i cervix i graviditet. Veileder i fødselshjelp. Norsk gynekologisk forening. Oslo, 2020. Siden besøkt 02.11.2020 www.legeforeningen.no
  34. Nordland K, Skjeldestad FE, Hagen B. Behandling av cervikal intraepitelial neoplasi før og etter innføring av laserkonisering. Tidsskr Nor Lægeforen 2005; 125: 167-9. PubMed
  35. Gynekologisk kreft - handlingsprogram. Nasjonalt handlingsprogram med retningslinjer for diagnostikk, behandling og oppfølging av gynekologisk kreft. IS-2462. Utgitt 20.09.16. helsedirektoratet.no
  36. Kang WD, Choi HS, Kim SM. Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)?. Gynecol Oncol 2013 Aug;130(2):264-8. doi:10.1016/j.ygyno.2013.04.050. PMID: 23623831 PubMed
  37. Grimm C, Polterauer S, Natter C, et al. Treatment of cervical intraepithelial neoplasia with topical imiquimod: A randomized controlled trial. Obstet Gynecol 2012; 120(1):152-9. PMID: 22914404 PubMed
  38. Tao XH, Guan Y, Shao D, et al. . Efficacy and safety of photodynamic therapy for cervical intraepithelial neoplasia: a systemic review. Photodiagnosis Photodyn Ther 2014 Jun; 11(2): 104-12. pmid:24631593 PubMed
  39. Vaksinasjonsveilederen: HPV-vaksine - veileder for helsepersonell. Folkehelseinstituttet. Oppdatert: 17.06.2020. www.fhi.no
  40. Tainio K, Athanasiou A, Tikkinen KAO et al. Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ 2018; 360 :k499. PMID: 29487049 PubMed
  41. Koeneman MM, van Lint FHM, van Kuijk SMJ et al. A prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2, based on simple clinical parameters. Hum Pathol 2017; 59: 62-9. pmid:27697590 PubMed
  42. Bjørge T, Skare GB, Bjørge L, Tropé A, Lönnberg S. Adverse Pregnancy Outcomes After Treatment for Cervical Intraepithelial Neoplasia. Obstet Gynecol. 2016;128(6):1265-1273. PMID: 27824756 PubMed
  43. Kyrgiou M, Athanasiou A, Paraskevaidi M, et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ. 2016;354:i3633. Published 2016 Jul 28. PMID: 27469988 PubMed
  44. Kyrgiou M, Athanasiou A, Kalliala IEJ et al. Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD012847. DOI: 10.1002/14651858.CD012847. The Cochrane Library
  45. Skjeldestad FE, Hagen B, Lie AK, Isaksen C: Residual and recurrent disease after laser conization for Cervical Intraepithelial Neoplasia. Obstet Gynecol 1997; 90: 428-33. PubMed
  46. Strander B, Andersson-Ellstrøm A, Milsom I,Sparen P. Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: a population based cohort study. BMJ 2007; 335-1077-83. PMID: 17959735 PubMed
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