Carcinoma de células escamosas del conducto auditivo que infiltra al hueso temporal: a propósito de un caso / Squamous cell carcinoma of the ear canal infiltrating the temporal bone: A case report

El carcinoma epidermoide del conducto auditivo es una entidad derivada del estrato espinocelular, es una neoplasia poco frecuente, con baja incidencia presentándose uno a seis casos por millón de habitantes, por lo cual existe poca información bibliográfica sobre esta patología. La clínica de presentación del cáncer de hueso temporal usualmente es inespecífica, por lo que su diagnóstico es siempre tardío. El diagnóstico definitivo requiere de biopsia de la lesión para estudio histopatológico e inmunohistoquímico y así poder establecer el comportamiento y el grado de diferenciación. Presentamos a continuación el caso de una paciente adulta con antecedente clínico de osteoporosis, diagnosticada con otitis media crónica de oído izquierdo de años de evolución, acompañada de secreción purulenta del mismo que no respondió a múltiples esquemas de tratamiento. Cursó con cefalea de predominio temporal izquierdo refractaria a analgesia convencional. En tomografía computarizada de cráneo se evidenció lesión osteolítica del hueso temporal izquierdo con invasión hacia duramadre. Tras resección y toma de biopsia de la lesión se confirma carcinoma epidermoide moderadamente diferenciado (AU)

Squamous cell carcinoma of the ear canal is an entity that arises from the stratum spinosum; it is a rare neoplasm, with a low incidence presenting 1 to 6 cases per million inhabitants, so there is little literature on this pathology. The clinical presentation of temporal bone cancer is usually nonspecific, meaning that its diagnosis is always a late-stage discovery. The definitive diagnosis requires biopsy of the lesion for histopathological and immunohistochemical study to establish the behaviour and the degree of differentiation. We present the case of an adult female patient with a clinical history of osteoporosis, diagnosed with chronic otitis media of the left ear of years of evolution, accompanied by purulent secretion of the same ear that did not respond to multiple treatment regimens. The patient also presented with a headache of left temporal predominance refractory to conventional analgesia. Cranial CT scans showed an osteolytic lesion of the left temporal bone with dural invasion. After resection and biopsy of the lesion, moderately differentiated squamous cell carcinoma was confirmed (AU)

Squamous Neoplasia in the Esophagus.

CONTEXT.­: Squamous lesions of the esophagus encompass a spectrum of disorders ranging from reactive changes and benign papilloma to squamous dysplasia and squamous cell carcinoma, which may pose diagnostic challenges especially in superficial biopsies. OBJECTIVE.­: To provide a review on the typical features of squamous neoplasia in the esophagus, with an emphasis on the key diagnostic features as well as differential diagnosis from mimicking lesions. DATA SOURCES.­: Data sources include published peer-reviewed literature and personal experiences of the authors. CONCLUSIONS.­: Accurate diagnosis of squamous neoplasia requires adherence to established diagnostic criteria, attention to subtle histologic features, and correlation with clinical and imaging findings. In difficult cases, multiple biopsies may be necessary to reach a definitive diagnosis.

Common benign and malignant oral mucosal disease.

BACKGROUND: Mucosal diseases of the oral cavity are relatively common, and patients often seek initial assessment from their general practitioner. OBJECTIVE: The aim of this article is to provide an overview of common oral mucosal diseases to help with formulating a differential diagnosis and stratifying the urgency of referral. DISCUSSION: Pathological mucosal conditions of the oral cavity and jaws commonly present as a mucosal ulcer or a white, red or pigmented lesion. In this review, the authors outline the most common conditions organised according to their clinical presentation and describe their typical appearance and management.

Hydrochlorothiazide treatment and risk of non-melanoma skin cancer: Review of the literature. / Terapêutica com hidroclorotiazida e risco de cancro cutâneo não melanoma: revisão da literatura.

Non-melanoma skin cancer is the most prevalent malignancy in fair-skinned people and its incidence is increasing. Recently, studies have suggested that antihypertensive drugs may increase the risk of these tumors, particularly hydrochlorothiazide, due to its photosensitizing properties. The Portuguese National Authority for Medicines and Health Products, INFARMED, has issued an alert to healthcare professionals concerning the increased risk of non-melanoma skin cancer in patients exposed to cumulative doses of this drug. However, study results have been heterogeneous and sometimes conflicting. The high incidence of non-melanoma skin cancer and the large number of patients under chronic hydrochlorothiazide therapy may thus have important public health consequences. In this article, the authors review the published evidence and conclude that there may be an association between hydrochlorothiazide use and the risk of non-melanoma skin cancer, but also point out some limitations of the studies in the literature. It is important to promote preventive strategies against sun exposure, regular skin examinations, and individual assessment of the benefits of hydrochlorothiazide use, particularly in patients with previous skin cancer.

Lung Cancer in a Tertiary Hospital in Nepal: Clinical-Radiological Profile and Histological Subtypes.

BACKGROUND: Lung cancer is the most common cancer worldwide and in Nepal. Non small cell carcinoma is the commoner histological type. The incidence of adenocarcinoma subtype is increasing globally. This study aims to evaluate the clinical-radiological and histological profile and the diagnostic yield of various modalities in the diagnosis of lung cancer at a tertiary hospital in Nepal. METHODS: This is a prospective cross-sectional study conducted at National Academy of Medical Sciences, Kathmandu. Patients presenting with clinical and radiological features consistent with lung cancer and undergoing tissue sampling were included. The clinical and radiological characteristics, distribution of various histological subtypes and the diagnostic yield of various modalities were evaluated. RESULTS: Of the 253 patients screened, 77 meeting the inclusion criteria were enrolled into the study. Lung cancer was diagnosed in 53 patients. Forty (75.5%) patients had non small cell carcinoma and 13 (24.5%) had small cell carcinoma. Among the non small cell variants, 20 (37.7%) had adenocarcinoma and 19 (35.9%) had squamous cell carcinoma. Hitopathological diagnosis of lung cancer was established in 39 of the 42 (92.9%) patients by bronchoscopy. Image guided biopsy and/or aspiration yielded the diagnosis in 13 (24.5%) patients. The diagnostic yields of endobronchial biopsy, needle aspiration, bronchial brush and bronchial wash cytology were 86.5%, 70%, 63% and 34.3%respectively. CONCLUSIONS: The result of this study concurs with the global trend of rising incidence of adenocarcinoma subtype. Bronchoscopy remains the most commonly used tool for diagnosis of lung cancer and combination of procedures such as biopsy, bronchial brush, needle aspiration and bronchial wash provided the highest yield in our study.

Diferencias en los metabolismos de sudor según el estadio diagnóstico en cáncer de pulmón escamoso / Metabolite differences in sweat according to diagnostic stage in squamous-cell lung cancer

Objetivo: determinar si la metabolómica aplicada a una muestra de sudor permite diferenciar la concentración relativa de ciertos metabolitos en pacientes con cáncer de pulmón en estadio inicial (I - II) respecto a estadios avanzados (III - IV). Pacientes y métodos: fueron incluidos 21 pacientes diagnosticados de cáncer escamoso de pulmón en un hospital universitario. Para la inducción del sudor se utilizaron discos de Pilogel(R) y la recolección mediante dispositivo Macroduct(R) conservando la muestra a -80 ºC. Para el análisis metabolómico se utilizó un cromatógrafo de líquidos acoplado a un espectrómetro de masas de alta resolución (LC - QTOF) provisto de fuente de ionización por electroespray. Los datos se procesaron con el software MassHunter Workstation y se realizó análisis de cambio (FC, Fold Change Analysis) para detectar las diferencias de concentración relativa de metabolitos entre los diferentes estadios tumorales. Resultados: se estudiaron 21 muestras de sudor pertenecientes a 9 pacientes en estadio I - II y 12 en estadio III - IV. En una lista preferente de 16 compuestos que incluyeron diversos aminoácidos, azúcares, ácidos carboxílicos y ácidos grasos, no se observaron cambios significativos según la extensión tumoral. El análisis de cambio mostró que una trihexosa (FC: -2,175) fue el compuesto con diferencias significativas de concentración relativa en las muestras de sudor según los dos estadios tumoral comparados. Conclusión: en muestras de sudor de pacientes con carcinoma escamoso de pulmón la huella metabolómica se mantiene relativamente estable con escasas diferencias en la concentración relativa de metabolitos, únicamente se observó un cambio significativo en una trihexosa en estadios de cáncer de pulmón inicial y avanzado

Objective: To determine whether applying metabolomics to a sweat sample allows different metabolite concentrations to be differentiated in patients with early-stage lung cancer (stages I-II) compared to advanced stages (III-IV). Patients and methods: 21 patients diagnosed with squamouscell lung cancer in a university hospital were included. Pilogel(R) discs were used to induce sweat, which was collected using the Macroduct(R) system, storing the samples at -80 ºC. For the metabolomic analysis, a liquid chromatograph was used, attached to a high-resolution mass spectrometer (LC - QTOF) supplied with electrospray ionization. The data was processed using the MassHunter Workstation software and a fold change analysis (FC) was done to detect differences in metabolite concentrations between different tumor stages. Results: 21 sweat samples from 9 stage I-II patients and 12 stage III-IV patients were studied. In a list of 16 compounds that included several amino acids, sugars, carboxylic acids and fatty acids, no significant changes were observed according to tumor extension. The change analysis showed that a trihexose (FC: -2.175) was the compound with significant concentration differences in sweat samples according to the two tumor stages compared. Conclusion: In sweat samples from patients with squamouscell lung cancer, metabolomic markers remain relatively stable with slight differences in metabolite concentrations, only observing a significant change in a trihexose between early and advanced stages of lung cancer

Detección de ITS (infecciones de trasmisión sexual) en mujeres afectas de ASCUS y LSIL en la citología cervicovaginal. Estudio prospectivo de 4 meses / Detection of STI (Sexual transmitted infections) in women affected by ASCUS and LSIL in the cervicovaginal cytology. Prospective study of 4 months

Objetivo: Estudio prospectivo a lo largo de 4 meses de las ITS (infecciones de trasmisión sexual) en mujeres diagnosticadas de ASCUS (atipias de las células escamosas de significado incierto) y LSIL (lesión escamosa intraepitelial de bajo grado) en la citología cervicovaginal en medio líquido. Diseño: Estudio de edad, paridad, abortos, nuligestas, fumadoras, métodos contraceptivos, antecedentes personales, citología, análisis de VPH-AR (virus del papiloma humano de alto riesgo) e ITS mediante RCP (reacción en cadena de la polimerasa, PCR en inglés) para Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum y Trichomonas vaginalis. Resultados: La serie consta de 65 casos: 36 ASCUS y 29 LSIL. No hubo diferencias significativas en ningún parámetro entre ambos grupos. Las medias de edad fueron de 36,02 y 35,77 años, respectivamente. La paridad media fue 0,61 y 0,55 partos, respectivamente. Eran nuligestas el 44,44 y 48,27%, respectivamente. No hacían contracepción el 55,35 y 65,51%, respectivamente. Eran fumadoras el 25% en ASCUS y el 27,58% en LSIL. Hubo VPH negativo en el 41,66% en ASCUS y en el 31,03% en LSIL. El VPH-AR (+) se dio en el 68,33% en ASCUS y en el 68,96% en LSIL. Los VPH-AR más frecuentes fueron: otros de AR en el 50% en ASCUS y en el 62,06% en LSIL. VPH(+) e ITS (+) ocurrió en el 44,44% en ASCUS y en el 58,62% en LSIL, sin diferencias. El análisis para ITS fue negativo en el 30,55% en ASCUS y en el 20,68% en LSIL. Hubo más gérmenes detectados en el grupo LSIL, con diferencia significativa (p<0,05) para Gardnerella vaginalis, 17,24% en LSIL frente a 2,77% en ASCUS. Los gérmenes más frecuentes fueron: U. urealyticum en el 13,88% en ASCUS y en el 24,13% en LSIL; y U. parvum en el 36,11% en ASCUS y en el 44,82% en LSIL. Conclusion: El análisis de ITS es primordial, junto con la citología y el VPH, para detectar infecciones, a tratar, para poder regresar a la normalidad citológica

Objective: Prospective study along 4 months of STI (sexually transmitted infections) in women diagnosed with ASCUS (atypias of squamous cells of undetermined significance) and LSIL (low-grade squamous intraepithelial lesion) in the cervicovaginal cytology by liquid medium. Design: Study of: age, parity, abortions, nulligravides, smokers, contraceptive methods, personal antecedents, cytology, HR-HPV(high-risk human papilloma virus) analysis, STI analysis by PCR (polymerase chain reaction) for: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma urealyticum, Ureaplasma parvum, and Trichomonas vaginalis. Results: The series are 65 cases: 36 ASCUS and 29 LSIL. There weren't significant differences in any parameter between both groups. The means of age there were 36.02 and 35.77 years, respectively. The mean of parity was 0.61 and 0.55, respectively. They were nulligravides 44.44% in ASCUS and 48.27% in LSIL. No contraception was used in 55.35% in ASCUS and 65.51% in LSIL. The active smokers were 25% in ASCUS and 27.58% in LSIL. There was HPV negative in 41.66% in ASCUS and 31.03% in LSIL. There was HPV (+) in 68.33% in ASCUS and 68.86% in LSIL. The HPV-AR more frequent were: HR others in 50% in ASCUS and 62.06% in LSIL. HPV (+) and STI (+) occurred in 44.44% in ASCUS and 58.62% in LSIL. The STI analysis was negative in 30.55% in ASCUS and 20.68% in LSIL, without differences. There were more detected microorganisms in LSIL group, with significant difference (p<0.05) for Gardnerella vaginalis, 17,24% in LSIL versus 2,77% in ASCUS group. The more frequent microorganisms were: U. urealyticum, in 13.88% in ASCUS and 24.13% in LSIL; and U. parvum, in 36.11% in ASCUS and 44.82% in LSIL. Conclusion: The STI analysis is primordial, together to cytology and HPV-HR, for detect infections, to treat, to advance to the cytologic normality

Oral squamous papilloma: a view under clinical, fluorescence and histopathological aspects.

Oral squamous papilloma is a benign tumor whose pathogenesis has been associated with human papillomavirus infection. Thus, it is noteworthy that human papillomavirus infection is one of the risk factors associated with the development of cervical, anogenital, pharynx, larynx and oral cavity carcinomas. Oral squamous papilloma can affect any region of the oral cavity, and transmission of human papillomavirus can occur by direct contact, sexual intercourse or from mother to child during delivery. The diagnosis is clinical and histopathological, with surgical removal representing the treatment of choice. Recently, widefield optical fluorescence has been used as a complementary examination to the conventional clinical examination in the screening of oral pathological lesions and for the delimitation of surgical margins. We report a case of oral squamous papilloma with its clinical, histopathological features and, in addition, from the perspective of wide field optical fluorescence.

Retalho de peitoral maior estendido e pediculado para reconstrução de região orbito-fronto-parietal direita após exérese de carcinoma espinocelular invasivo / Extended and pedicled pectoralis major flap for right orbitofrontal-parietal reconstruction following invasive squamous cell carcinoma resection

Introdução: O retalho miocutâneo de peitoral maior é um dos mais usados na reconstrução de defeitos da cabeça e pescoço, porém com restrição ao terço médio da face. Com técnicas de dissecção de perfurantes, consegue-se alongar mais o pedículo, obtendo coberturas da região orbito-fronto-parietal. Relato de Caso: Paciente masculino de 63 anos apresentando carcinoma espinocelular invasivo pouco diferenciado, que após sua ressecção cirúrgica apresentou defeito final de 12,0 x 18,0cm na região órbito-fronto-parietal direita com exposição de dura-máter, seio frontal e órbita superior direita. Foi desenhado retalho de peitoral maior com ilha cutânea de dimensões iguais ao defeito na região paraesternal direita, desde o quarto espaço intercostal até a região subcostal (estendido). O pedículo foi seccionado após 4 semanas. A cobertura foi efetiva, sem complicações maiores e resultado estético satisfatório. Conclusão: Este retalho mostrou ser uma excelente opção para reconstrução do terço superior da cabeça quando existam limitações para a realização de microcirurgia.

Introdução: O retalho miocutâneo de peitoral maior é um dos mais usados na reconstrução de defeitos da cabeça e pescoço, porém com restrição ao terço médio da face. Com técnicas de dissecção de perfurantes, consegue-se alongar mais o pedículo, obtendo coberturas da região orbito-fronto-parietal. Relato de Caso: Paciente masculino de 63 anos apresentando carcinoma espinocelular invasivo pouco diferenciado, que após sua ressecção cirúrgica apresentou defeito final de 12,0 x 18,0cm na região órbito-fronto-parietal direita com exposição de dura-máter, seio frontal e órbita superior direita. Foi desenhado retalho de peitoral maior com ilha cutânea de dimensões iguais ao defeito na região paraesternal direita, desde o quarto espaço intercostal até a região subcostal (estendido). O pedículo foi seccionado após 4 semanas. A cobertura foi efetiva, sem complicações maiores e resultado estético satisfatório. Conclusão: Este retalho mostrou ser uma excelente opção para reconstrução do terço superior da cabeça quando existam limitações para a realização de microcirurgia.

Validation of a Clinical Cancer Register at the Head and Neck Oncology Center in Örebro.

BACKGROUND: This was a validation study of a regional register of oral cancer in Örebro, Sweden. The purpose was to assess the rate of errors in baseline, and treatment, and the completeness and accuracy of data on recurrences. MATERIALS AND METHODS: A total of 653 cases with squamous cell cancer in the oral cavity were identified from the register. A randomized sample of 73 (11%) was selected, and a set of relevant data was compared to medical records. RESULTS: Data on patient and tumour characteristics showed high accuracy, with 98% correct data and more than 99% of treatment data were correct. Follow-up data had a higher rate of errors, with 23% of recurrences not recorded, 13.6% misclassified, and 9.1% of cases showing errors in timing of the recurrence. CONCLUSION: data concerning patients, tumour status, and treatment in the Regional Head and Neck Register in Örebro are highly accurate. However, the follow-up data contain a higher rate of errors, that must be taken into consideration when evaluating outcome after treatment.

Oral squamous papilloma: a view under clinical, fluorescence and histopathological aspects / Papiloma escamoso oral: uma visão sob aspectos clínicos, de fluorescência e histopatológicos

ABSTRACT Oral squamous papilloma is a benign tumor whose pathogenesis has been associated with human papillomavirus infection. Thus, it is noteworthy that human papillomavirus infection is one of the risk factors associated with the development of cervical, anogenital, pharynx, larynx and oral cavity carcinomas. Oral squamous papilloma can affect any region of the oral cavity, and transmission of human papillomavirus can occur by direct contact, sexual intercourse or from mother to child during delivery. The diagnosis is clinical and histopathological, with surgical removal representing the treatment of choice. Recently, widefield optical fluorescence has been used as a complementary examination to the conventional clinical examination in the screening of oral pathological lesions and for the delimitation of surgical margins. We report a case of oral squamous papilloma with its clinical, histopathological features and, in addition, from the perspective of wide field optical fluorescence.

RESUMO O papiloma escamoso oral é um tumor benigno, cuja patogênese tem sido associada à infecção pelo papilomavírus humano. A infecção pelo papilomavírus humano é um dos fatores de risco associado ao desenvolvimento dos carcinomas cervicais, anogenitais, faríngeos, laríngeos e da cavidade oral. O papiloma escamoso oral pode acometer qualquer região da cavidade oral, e a transmissão do papilomavírus humano ocorre por contato direto, relação sexual ou de mãe para filho durante o parto. O diagnóstico é clínico e histopatológico, e a remoção cirúrgica representa o tratamento de escolha. Recentemente, a fluorescência óptica de campo amplo tem sido empregada como exame complementar ao exame clínico convencional, no rastreio de lesões patológicas orais e para delimitação de margens cirúrgicas. Relatamos um caso de papiloma escamoso oral com suas características clínicas e histopatológicas, sob a perspectiva da fluorescência óptica de campo amplo.

Circulating Heat Shock Protein 70 Is a Novel Biomarker for Early Diagnosis of Lung Cancer.

Heat shock protein 70 (HSP70) was a highly conserved protein which was significantly induced in response to cellular stresses. HSP70 played an important role in the pathogenesis of cancer which stabilized the production of large amount of oncogenic proteins and finally supported growth and survival of tumor. However, there was no report about the diagnosis of circulating HSP70 in lung cancer patients. In this study, a total of 297 participants (lung cancer: 197, healthy control: 100) were enrolled in the detection of circulating HSP70 level in plasma by ELISA assay. The results indicated that circulating HSP70 significantly decreased in lung cancer patients compared to healthy controls (P < 0.0001). Receiver operating characteristic (ROC) analysis showed that HSP70 (AUC: 82.2%, SN: 74.1%, SP: 80.0%) had higher diagnosis value than clinical existing biomarkers CEA (AUC: 80.1%, SN: 76.8%, SP: 67.3%) and CA 19-9 (AUC: 63.7%, SN: 64.2%, SP: 54.0%). In the analysis of early lung cancer patients, ROC results also revealed that HSP70 (AUC: 83.8%, SN: 71.2%, SP: 84.0%) have higher sensitivity, specificity, and AUC than CEA (AUC: 73.7%, SN: 73.2%, SP: 69.1%) and CA 19-9 (AUC: 61.5%, SN: 69.4%, SP: 53.4%). In analysis of specific histological classifications, HSP70 showed more valuable in the diagnosis of SCC (AUC: 85.9%, SN: 86.1.9%, SP: 81.0%) than ADC (AUC: 81.0%, SN: 69.1%, SP: 81.0%). Combined analysis of HSP70 and existing biomarker: CEA and CA 19-9 exhibited that HSP70 combined CEA and CA 19-9 showed the highest AUC (0.945, 95% CI, 0.855-1.000). The importance of our results was that we found decreased circulating HSP70, in combination with elevated CEA and CA 19-9, could be utilized in the diagnosis of early (stage I and II) lung cancer.

Factores que influencian el retraso diagnóstico en el cáncer oral / Factors that influence the diagnostic delay of oral cancer

No disponible

[Clinical analysis of 128 cases of cervical lesion diagnosed by multi-point biopsy of colposcopy and endocervical curettage].

Objective: To investigate the clinical values of colposcopy and cervical biopsy and/or endocervical curettage (ECC) in the diagnosis of cervical lesion. Methods: Clinical data of 128 cases of cervical lesion diagnosed by Xuzhou Cancer Hospital from January 23, 2014 to October 11, 2016 were collected and retrospectively analyzed, all patients underwent colposcopy and cervical biopsy and/or ECC. Results: Among them, the age between 30 to 50 years old were 70 cases, whose transformation zone types of Ⅰ, Ⅱ and Ⅲ were 28 cases (40.0%), 23 cases (32.9%) and 19 cases (27.1%), respectively. The age older than 50 years were 45 cases, whose transformation zone types of Ⅱ and Ⅲ were 1 case (2.2%) and 44 cases (97.8%), respectively. Among the 128 cases of cervical lesions, diagnostic results of colposcopy showed that the chronic inflammation were 57 cases, cervical intraepithelial neoplasia (CIN)Ⅰwere 35 cases, CINⅡor CINⅡ~Ⅲ were 8 cases, CIN Ⅲ were 5 cases and cervical cancer were 23 cases. Alternatively, the pathological results showed that the chronic inflammation were 81 cases, CINⅠwere 17 cases, CINⅡor CINⅡ~Ⅲ were 7 cases, CIN Ⅲ were 5 cases and cervical cancer were 18 cases, respectively. Among the 81 cases of chronic inflammation diagnosed by pathology, 52 cases (64.2%) were consistent with the diagnostic results of colposcopy. Among the 17 cases of low grade squamous epithelial cell lesion (LSIL) diagnosed by pathology, 10 cases were in agree with the diagnostic results of colposcopy. Among the 12 cases of high-grade squamous epithelial cell lesion (HSIL) diagnosed by pathology, 9 cases were concordant with the diagnostic results of colposcopy. Among the 18 cases of cervical cancer diagnosed by pathology, 17 cases were consistent with the diagnostic results of colposcopy. Conclusions: The type of transformation zone is positively correlated with the age, and it can help to choose biopsy and therapeutic manner. The diagnostic accuracies of HSIL and early stage of cervical cancer by multi-point biopsy of colposcopy and/or ECC are high. The cervical lesions which are difficultly found by direct visualization can be identified by colposcopy, and thus provides objective evidence to determine the therapeutic manner for patients with stage ⅡA of cervical cancer.

[Cervical cancer has increased in Sweden in women who had a normal cell sample]. / Livmoderhalscancer ökar hos kvinnor med normalt cellprov - Skillnader mellan laboratorier tyder på att ökningen orsakas av faktorer som kan åtgärdas.

Cervical cancer has increased in Sweden in recent years. The increase is 17% in 2014-15 compared to the reference period 2002-13. The increase is largest for adenocarcinoma (+ 31%) and shows remarkable differences between counties, from continued incidence decreases to increases of >80%. The increase is seen in most ages that are offered screening, but is confined to early stage cancers and there is no increase in mortality. Population test coverage of screening has increased since 2002. The Swedish National Cervical Screening Registry has analysed the increase in relation to screening history. The most significant increase (+ 30%) is seen in women who had a normal cervical smear (P < 0.0001) in the preceding screening interval. The cancer risk for women who previously had a high grade abnormality has also increased (P = 0.0009). Data from several laboratories still show very low cancer risk following normal cytology, indicating that the increase is related to factors that can be addressed. All data on re-review of samples taken before cancer and high grade intraepithelial neoplasia will be requested and nationally analyzed to further elucidate the exact cause.