? ??????? ???????? ??? ?? ??????? ??? ????????? ??? ?????????? ???????? ??? ???????? ??????????. ? ????? ??????? ?? ????? ???????????, ??????????? ? ???????????, ? ???????? ? ?? ???????? (????? 4.7). ??????, ???? ?? ???????????? ????????, ????? ??????? ?? ?????? ? ????????. ?????????? ???? ?? ????? ????? ??? ??????? ??? ??????, ???? ?? ???? ????? ??? ?????? ? ??????? ????? ??? ???????? ??????????. ??????, ? ????? ????? ??????? ?? ???????????? ?? ??????? ?????? ???? ? ????????? ????? ??? ?? ?????? ??? ?? ?????????? ??? ???? ??? ???? ????????????? ??????. ? ???????? ??? ???????? ?????????? ????????? ?? ?????? ?????? ??? ????????? ?? ????? ????????.
????? 4.8. ??????????? ???????? ???????? ??? ????????
? ???????? ??? ???????? ?????????????? ????????? ?? ???????? ??????? 45-65 ????, ????? ??????? ???? ?? ?????? ?? ???? ???? ???????? (Austin & Zhao 2012). ?? ??????????? ????????????? ???????? ??????????????? ?? ?????? ?????? ???? ??? ??????????????????? ??? ???????????? ??????? ??? ??? ??????? ??? ????????, ??? ????????? ???????? ??????????? ???? ???????? ???????? ???????????? ?? ??????? ?????????? ??? ??? ????????? ??? HPV testing ?? ????????? ???????? ??? ??????????? ???????????? ???? ?? ???????????? ? ?????????????? ??????????. ???????? ?? ????????? ??????? ????? ??????? ?????????????? ??? ?????? ?????? ??? ?????. ????? ??????? ?? ???????????? ????????? ???? ??? ?????, ?????????? ??? ?????? ? ???? ??? ???????????. ????? ??? ???? (??????? ????) ? ?????????? ????? ?????????? ???? ? ????? ????? ?? ??????????? ??????.
?????? ??? ?????????? ???????? ??? ????????
???????? 5 ??????? ?????? ??? ???????? ??? ???????? ??? ????????????? ??? ?? ?????? ?????????? ?????????? ??? ????????????? (International Federation of Obstetrics and Gynaecology - FIGO) ???? ???????? ??? ????? 4.8. ? ???????? ???? FIGO ??????????????? ??? ?????????? ??? ?? ????????? ??? ?????????. ?? TNM ??????? ?????????? ??? ???? (T), ?? ????????? ??? ?????????? (N) ??? ??? ???????? ? ??????? ??????????? (M) ???? ??????????????? ???? ?????????????? ??????.
Figure 4.9. FIGO and TNM stages of cervical cancer (WHO)
Figure 4.10. Diagrammatic view of stages of cervical cancer
?????? 0 ??? ?????? I ????????? ?? ?????????? ?????? ??? ?????????? ???????? ???? ? ?????????????? ??????? ??? ? ???????????? ??????? ????????? ???? ??? ???????? ???’ ???? ?? ???????? ????? ??????? ??????????????: ? ???????? ??? ????? ?????? ?? ????? ??????? ??? ??????? ?? ?????????? ?? ??? ????????????. ?? ????????? in situ ????? ?????? ???????? ?? CIN3 (?????? 0).
- ??????? IA ???????? ????? ??????? ?? «???????????????» ??? ??????? ???????????? ?? ??? ???????????? ?? ?????????????? ???????? ??? ??????? ??? ?????? ???????????? CIN3.
- IA1 ???????? ???????????? ???? ? ??????? ????? ????????? ??? 3mm ?? ????? ? 7mm ?? ?????. . ?? ?????????? ?????????? ????????????? ?? «?????? ??????? ??? ?????????».
- IA2 ???????? ????? ?????? 3 ??? 5mm ?? ????? ??? ????????? ??? 7mm ?? ????? ???????. ????? ??????????? ??? ?????????? ??????? ????????? ??? ??????????.
- ??????? IB1 ???????? ??????? ?? ????? ???? ?????????????? ???? ???????????? ??? ???????????? ?? ??? ????????????? ?????? (Andrea et al. 2012; Herbert et al. 2010).
-
??????? IB2 (??????????? ??? 4-cm), II, III ??? IV ?????????? ??????? ?? ??????? ?????????? ???? ????????? ???? ??? ??????????? ? ???? ??? ????? ??? ????????? ?? ??????? ????????? ?????? ??? ?????.
? ???????? ????????? ????? ?? ?? ??????. ????????? ???????? ????? 100% ??? ?? ?????? 0, 85% ??? ?? ?????? I, 65% ??? ?? ?????? II, 35% ??? ?? ?????? III ??? 7% ??? ?? ?????? IV.
- ??? ?????? ?, ?? ???????? ?? ????? ?????????? ???????? (????????? ?? 100%) ?? ????? ?? ???? ????????? ?? (?????? ???????).
???????? ??? ???????? ??? ????????
? ???????? ??? ???????? ??? ???????? ????????? ??? ??????? ??????????. ? ?????? ?????? ??? ??????????? ???????? ???????? ????? ? ????????? ??? ???? ??? ? ???????? ??? ????? ??? ?? ??????? ???????????. ????, ???????? ??? ??????????????? ?? ????? ?????? ????? ??????? ?? ?????? ?? ?????????????, ??????? ??? ?????? ?? ???????????? ?????? ???? ??????????? ? ????????.
?? ????????? in situ/CIN3 (?????? 0) ?????????? ?????? ?????????? ? ???????? ??? ?????? ??? ??? ????? ??????????????? (TZ) ??? ????????, ???? ?? ?????????, laser, ?????? ?? ?????? ?????? ?????????? ??? ????? ??????????????? ? ?? ???????, ???????? ??? ???????? ??? ??? ????????? ???? ??????? (????? 5.10) (Jordan et al. 2008; Prendiville 2009).
Figure 4.13. Types of transformation zone (Figure 1 from Jordan et al. 2008)
??????? IA1 ???????? ????? ??????? ?? ??????????? ?? ???????? ?????? ?? ??????? ?????? ??? ? ????? ??? ? ???????????? CIN3 ??????? ?? ?????????? ??????.
? ????????????, ? ? ?????? ???????? ??? ????????, ??????? ?? ??????????? ??? ??? ??????? IA2 or IB1 ????????? ???????? ?????????? ??? 2cm ?? ???????? ?????????? ??? ???????????.
??????? IB ???????? ???????????? ?? ?????? ??????????? ?? ? ????? ????????? ??? ??????? ??????? ?? ??? ?????? ??? ????????.
?? ???????? ????????? ??? ??????????? ??????? ??? ???????? ????? ? ?????? ??????????? ???/? ? ??????? ??????????????. ??????????? ???????????? ???????? ????? ??????? ?? ??????????? ?????????????? ???/? ??????????????. ?? ??????? ?????? ???? ??? ???????? ?????? ?????? ???? ???????? ??? ????????.
??????????? ????? ??? ???????? ??? ????????
? ?????????? ?????????? ?????? (WHO) ??????????? ??? ???????? ???????????? ?????? ?????????? ???????? (WHO)
- ????????? ??? ???????? ???????? (??? ???????? ??????? ?? 85% ???? ??? ???????????)
- ?????????????? (??? ???????? ??????? 10-15% ???? ??? ???????????)
????? ????? ??? ???????? ??? ???????? ????????????? ?? ????????????? ?????????, ?????????????????? ??????, ??????? ???????????? / ????????????????? ?????? ??? ??????????? ?????????, ??? ??????? ?? 3-5% ???? ??? ???????????.
??????????? ??? ?? ???????? 4
- ?? ????????? ??? ???????? ???????? ??????? ???????????? ??? ??????? ??? ?????????? ??????????????? ?????????? (CIN).
- ? ???? CIN1-3 ??? ??? ??????????? ?????????? ????? ????????? ?? ??????, ?????? ??? ?????? ?????????.
- CIN1 ????????????? ?? ??? ?????????? HPV ??????? ??? ??? ????? ??? ??????? ?? ???????????.
- CIN1, CIN2 ??? CIN3 ?????????? ?????????? ??????? ???????? ??? ???????? ?????????? ??????? ??????????.
- ? ?????????? ???????? ????????? ??? ??? ??????? ??? HPV ??? ??? ???? ???.
- CIN2 ??? CIN3 (?????? ??? ?????? ?????????) ???????????????? ?? ??????????? ?????? ?? ??? CI?2 ????? ??? ????? ????????? ??????? ?????????.
- ? ?????????? ???????? CIN3 ????? ??? ??????? ?? ????? ?? CIN1 ??? CIN2: ? ???-???????????? ????????? ????? ???????? ??? CIN3.
- ?????????????? ????? ?????? ?????????? ?? ?? ????????? ??? ???????? ???????? ??? ???? ????????? ??????????? ?? ????????? ?? ??? ?????????? ??????.
- ?????????????? in situ ????? ??? ?????? ???????????? ???????? ??? ?????????????? ????? ????????????????? ??? ????? ???????????? ?? ??? ????????????.
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