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Cervical cancer is the second most common cancer in women worldwide. There are about 60,000 newly detected cases and 30,000 deaths annually in Europe, with the highest incidence reported from Eastern Europe countries. According to data from the National Institute of Public Health, in Croatia the incidence of cervical cancer was 14.9/100,000 in 2006, ranking eighth most common malignancy in women. Croatia has a lower incidence of the disease compared to many countries of Central and Southeast Europe. A large study carried out in 1995 by the International Agency for Research on Cancer, which included cervical cancer material collected from 22 countries all over the world revealed HPV genome in 99.7% of cases. Efficient methods of cervical cancer detection and screening methods for identification of precancerous lesions (conventional Pap smear) are available. Cervical cancer prevention programs should include education (of health care providers and women), stressing the benefits of screening, the age of the peak cervical cancer incidence, and the signs and symptoms of precancerous lesions and invasive disease. The aim of screening actions is to detect precancerous lesions that may lead to cancer if left untreated. Screening can only be effective if there is a well-organized system of follow up, diagnosis and treatment. Cervical cytology, or Papanicolaou (Pap) testing, has for decades been a cornerstone of cervical cancer screening. According to recent guidelines issued by the World Health Organization Regional Office for Europe, the primary task of the public health system is the introduction of secondary prevention through properly organized screening programs. Launching the national immunization program is only possible in the countries with well-organized secondary prevention programs and in those that can afford it.

Croatia still has opportunistic screening and the organized national screening has been planned. The European Cervical Cancer Prevention Week was held twice in Croatia, in January 2008 and 2009. Within the first one in 2008, information campaign »For All Women« via mass media was held, and women were invited to the organized free gynecological examination and Papanicolaou test (Pap test) in the University Department of Gynecology and Obstetrics, Zagreb University Hospital Center. Following invitation 481 women attended the testing; the median age was 55 years. There were more women aged ³50 (n=353), with the highest participation in the age group 55–59 years (n=94). Some women came because of subjective symptoms (n=10), but the majority of them came only for testing (n=471). According to history of previous cytological testing, 400 women have had ³1 negative findings, 71 women have had ³1 positive findings, 9 women attended Pap test for the first time, and 1 woman does not know about previous testing. Cervical cytology was abnormal in 35 women (7.28%), the median age was 42 years with the highest proportion in the age group 30–34 years (n=7); among all of them 21 women (60%) had no abnormal Pap test previously. The findings were: Atypical squamous cells of undetermined significance – ASC-US (n=9), ASC cannot exclude high-grade squamous intraepithelial lesion – ASC-H (n=1), cervical intraepithelial neoplasia – CIN 1 (n=13), CIN 2 (n=1), CIN 3 (n=6), carcinoma planocellulare (n=2), atypical glandular cells – AGC-favor reactive endocervical cells (n=3). Among women aged £49 there were 20.47% abnormal findings and among those aged ³50, 2.55%. According to ³1 positive Pap tests previously, among women aged £49 there were 30.71% while among those aged ³50 there were 9.07%. Within the European Cervical Cancer Prevention Week in 2009, employed women from one national company were invited by internal information to the same procedure. A smaller group of younger asymptomatic

With correct staging a large number of patients with cervical cancer FIGO stages IA2 and IB can be spared of unnecessary radiation therapy by laparoscopic assisted vaginal radical hysterectomy (LAVRH) as an option of radical surgical treatment in such patients. The development of laparovaginal surgery, indication and contraindication were presented. Also, the surgical technique was described in detail. Fifty-two patients were followed up in 2003 after LAVRH or open surgery, performed in our single center. Only 5 (14%) patients died from cervical cancer within 3 years following the treatment. They were all clinical stage IB treated with open surgery. There were 4 (11%) complications following treatment and they were all in patients with clinical stage IB, also treated with open surgery. There was no complication in LAVRH treated patients. The results and complications of the sole Croatian center performing LAVRH or open surgery in patients with cervical cancer FIGO stages IA and IB were similar to those in centers across the world.

Paraneoplastic cerebellar degeneration (PCD), the one of the most common paraneoplastic syndromes, refer to clinical disorders associated mostly with lung, ovarian and breast cancer, but not directly caused by the cancer or its metastases. Pathologic finding is an extensive loss of Purkinje cells in the cerebellum. Immunohistocemicaly, the auto-antibodies on the Purkinje cells had been detected. Clinically, PCD is characterized by sub-acutely evolving pancerebellar symptoms. Neurological dysfunction may appear before the detection of the underlying cancer. Therefore, the surgical exploration is necessary for the final diagnosis. The patient undergoes specific therapy. Soon, neurological status of the patient gets irreparable worse. Death come usually 2–3 years after the first symptoms of the PCD occurs. Case of a 63-years old woman with PCD as the first evidence of her cancer is reported. The patient developed brain metastases and died almost 3 years after the first symptoms of PCD occur.