Kuzeva N. Structured approach to management of cervical intraepithelial neoplasia

This dissertation deals with various ways of improvement of treatment outcome in premalignant cervical lesions, asso-ciated with Human Papilloma Virus (HPV) of different oncogenecity. A review of the patients' medical notes have been retrospectively carried out. This included women, who either have been operated upon, or are on the waiting list for an operation for histologically verified cervical cancer, as well as those with cervical intraepithelial neoplasms of various se-verity. Their past medical history, menstrual and reproductive functions, as well as sexual behavior and preferred meth-ods of contraception have been studied. We have developed and introduced a structured approach to treatment of this pa-tient group into clinical practice. We have found, that HPV strains of higher oncogenecity tend to cause more severe epithelial damage with pronounced "rough" cervical changes seen during colposcopy. On the contrary, HPV strains of lower oncogenicity lead to milder cervical lesions with "tender" cervical changes seen during colposcopy. Moreover, the latent phase of progression of premalignant stage (cervical intraepithelial neoplasm) into a more severe malignant one, is markedly shortened in cases affected by 11PV of higher, rather than lower oncogenecity. Our structured approach to treatment of cervical intraepithelial neoplasms is based on determination of: HPV oncogenic potential, morphological stage of epithelial lesion, severity and area of changes seen during colposcopy.