Onkologija
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Razvoj in implementacija orodja za določanje individualne ogroženosti za rakom dojk v slovenski populaciji
Get PDFVarious mathematical models for calculating individual breast cancer risk are known nowadays. Currently, the Tyrer-Cuzick algorithm included in the IBIS program is recognized as the most consistent one. In Slovenia, the S-IBIS software was developed within the framework of the Targeted Research Project Development and Implementation of Personalised Breast Cancer Risk Evaluation Tool for Slovenian Population, which is being carried out at the Institute of Oncology Ljubljana. Slovenian IBIS (S-IBIS) is specifically designed to calculate the individual risk of breast cancer in Slovenian women. It is an adjustment of the IBIS software, where Slovenian generation specific population breast cancer risks are applied. S-IBIS is ready for use in the Slovene health system and allows an evidence-based assignment of an asymptomatic individual to a group of general, moderate and high breast cancer risk. As a cut-off for the moderate risk group the S-IBIS life-time risk of 16 percent or more is suggested for a Slovene women at age 25. The cut-offs for ten-years risk are offered as well.
Compared with today's system, where the Terms of the health prevention at the primary health care level classifies breast cancer high risk women applying very subjective qualitative criteria, it is today already possible to classify asymptomatic Slovenian women to a group of general, moderate and high breast cancer risk on the basis of individual numerical criteria using S-IBIS software. Pilot testing of the S-IBIS in the national Breast Disease Centers shows encouraging results - we believe that the implementation of S-IBIS in the Slovenian healthcare system could reduce the number of unnecessary preventive interventions, while also reducing the waiting time for justified preventive examinations of moderate and high risk women.Danes poznamo različne matematične modele za izračunavanje individualne ogroženosti za raka dojk. Trenutno je kot najbolj dosleden model razpoznan Tyrer-Cuzickov algoritem vključen v program IBIS. V Sloveniji smo v okviru Ciljnega raziskovalnega projekta Razvoj in implementacija orodja za določanje individualne ogroženosti za rakom dojk v slovenski populaciji, ki ga izvajamo na Onkološkem inštitutu Ljubljana, razvili program S-IBIS, ki je namenjen izračunavanju individualne ogroženosti za raka dojk slovenskih žensk. Gre za prilagoditev programa IBIS, kjer je v izračunih uporabljena slovenska generacijsko specifična populacijska ogroženost za raka dojk. Slovenski IBIS (S-IBIS) je pripravljen za uporabo v slovenskem zdravstvenem sistemu in omogoča z dokazi podprto razvrščanje asimptomatske posameznice v skupino splošno, zmerno in visoko ogroženih za raka dojk. Kot mejo za uvrstitev Slovenke stare 25 let med zmerno ogrožene za rakom dojk predlagamo vrednost doživljenjskega tveganja izračunanega s programom S-IBIS 16 ali več odstotkov, podane pa so tudi mejne vrednosti na podlagi deset-letne ogroženosti.
V primerjavi z današnjim sistemom, ko Pravilnik za izvajanje preventivnega zdravstvenega varstva na primarni ravni opredeljuje bolj ogrožene ženske samo na podlagi nekaj zelo ohlapnih kvalitativnih kriterijev, je možno s programom S-IBIS asimptomaske ženske v skupine ogroženosti razvrstiti na podlagi individualnih numeričnih kriterijev. Pilotno preizkušanje programa v Centrih za bolezni dojk kaže spodbudne rezultate – verjamemo, da bi implementacija S-IBIS v slovenski zdravstveni sistem lahko zmanjšala število nepotrebnih preventivnih intervencij, hkrati pa bi se zmanjšale tudi čakalne dobe za upravičene preventivne preglede zmerno in visoko ogroženih žensk
Smernice za diagnostiko, zdravljenje in sledenje bolnikov s sarkomi mehkih tkiv in kosti
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Akutni stranski učinki obsevanja glave in vratu ter prsnega koša
Get PDFIn spite of the advances in radiation therapy in the last decades, radiation side effects still remain an important and unavoidable issue, with a great impact on cancer patients' quality of life. Acute side effects develop up to 90 days from the beginning of therapy. In patients receiving treatment in the head, neck and thoracic region, radiodermatitis and radiomucositis are the most common acute side effects, followed by lack of saliva (xerostomia), altered taste (dysgeusia) and difficulties in swallowing (dysphagia). This article offers a short description of aforementioned side effects and presents the preventive and therapeutic measures.Stranski učinki so kljub napredku radioterapije v zadnjih desetletjih še vedno pomemben in neizogiben sopojav tovrstnega zdravljenja, ki pomembno vpliva na kvaliteto življenja bolnikov z rakom. Akutni stranski učinki se razvijejo znotraj 90 dni od pričetka obsevanja. Pri zdravljenju raka v področju glave in vratu ter prsnega koša se najpogosteje srečujemo z radiodermatitisom in radiomukozitisom, ki se pojavljata pri več kot 90% obsevanih bolnikov, pogosto pa se jima pridružujejo tudi pomanjkanje sline (kserostomija), motnje okusa (disgevzija) in težave pri požiranju (disfagija). V pričujočem članku so omenjeni stranski učinki na kratko predstavljeni, navedeni pa so tudi ukrepi za preprečevanje in zdravljenje le-teh
Akutni stranski učinki obsevanja trebuha in medenice
Get PDFIrradiation of the abdominal and pelvic cavities can result in acute side effects that are seen in the organs situated near the radiation target volume. The effect of radiotherapy is most potent against tissues with a high cell turnover – mucosa of the bladder and gastrointestinal tract, bone marrow, and skin. The acute symptoms are based on the radiation-induced damage to stem cells, resulting in an imbalance between ongoing cell loss and new cell production. This process is accompanied by inflammatory changes. Acute side effects usually present within 2-3 weeks after the onset of radiation and resolve in a couple of weeks after the completion of treatment. Encouraging patients to take appropriate preventive measures is of utmost importance. Treatment is conservative and depends on the severity of side effects.Obsevanje v področju trebuha in medenice je povezano s pojavom akutnih stranskih učinkov organov, ki se nahajajo v bližini obsevalnega tarčnega volumna. Prizadeto je predvsem tkivo z visoko proliferativno aktivnostjo celic - sluznice sečnega mehurja in gastrointestinalnega trakta, kostni mozeg in koža. Osnovni mehanizem nastanka je poškodba zarodnih celic, ki poruši ravnotežje med odmiranjem zrelih celic in nastajanjem novih. Temu se pridruži še vnetni odziv. Simptomi se običajno pojavijo 2 do 3 tedne po začetku obsevanja in trajajo še nekaj tednov po zaključku zdravljenja. Izrednega pomena je spodbujanje bolnikov k ustreznim preventivnim ukrepom. Zdravljenje je konzervativno in odvisno od stopnje izraženosti težav
Klinične raziskave v onkologiji
Get PDFClinical trials or clinical studies refer to research that is done in people. Their results are the backbone of daily clinical practice, namely evidence- based medicine. Clinical trials involve several phases. The main purpose of a phase I trial is to determine the safety of treatment, a phase II trial aims to determine if the new treatment is effective in treating a certain cancer, and a phase III trial compares the new treatment to the current standard treatment for a certain type of cancer. Aimed at providing prompt information on the effectiveness of many new agents, especially targeted drugs, new types of clinical study designs have been developed, namely basket trials, umbrella trials, and adaptive trials. All clinical trials have to meet strict criteria to ensure that patient rights are protected and that the results are properly evaluated. Accessibility to clinical trials is important for the development of oncology and for patients as well, as clinical trials may provide them with additional treatment. It is, therefore, important that doctors encourage patients to participate in clinical trials.Klinične raziskave ali klinična preskušanja so raziskave, ki vključujejo ljudi. Na njihovih izsledkih temelji vsakodnevna obravnava bolnikov, zdravljenje, ki temelji na dokazih. Klinična preskušanja razvrščamo v več faz. V fazi I ugotavljamo predvsem toksičnost, v fazi II aktivnost zdravila pri določeni bolezni in v fazi III primerjamo učinkovitost nove oblike zdravljenja s trenutno priporočenim zdravljenjem določene bolezni. V želji po hitrejši informaciji o učinkovitosti številnih novih, predvsem tarčnih zdravil, se je razvil novi tip kliničnih raziskav, klinične raziskave tipa %košara%, %dežnik% in %prilagoditev%. Vse klinične raziskave morajo izpolnjevati stroga merila, ki zagotavljajo, da so bolniki v raziskavah zaščiteni in so rezultati pravilno ovrednoteni. Dostopnost do raziskav je pomembna za razvoj stroke, pa tudi za bolnike, saj v okviru teh lahko dobijo dodatne možnosti zdravljenja. Zato je pomembno, da zdravniki bolnike spodbujamo k sodelovanju v kliničnih raziskavah
Depresija – stres, maligna bolezen in zdravljenje
Get PDFThis article shows the significance of depression with the emphasis on genetic and stress factors that influence its outburst. Severe chronic physical diseases like cancer are long-term stress factors that significantly contribute to the development of depression. Major depression is most efficiently treated with medications from the group of antidepressants that differ in the effect and are chosen based on the leading symptoms of depression. So, it is important that the antidepressant is chosen in respect of the clinical presentation of depression, as it influences the success of treatment. This significantly affects not only the prognosis of depression itself, but also the prognosis of the already present physical diseases such as cancer.V pričujočem članku je prikazan pomen depresije s poudarkom na genetskih in stresnih dejavnikih, ki vplivajo na njen izbruh. Težje kronične telesne bolezni, kot so maligne, so dolgotrajni stresni dejavniki, ki pomembno prispevajo k razvoju depresije. Najučinkovitejši način zdravljenja velike depresije so zdravila iz skupine antidepresivov, ki se razlikujejo po načinu učinkovanja in jih izbiramo glede na vodilno simptomatiko depresije. Zato je pomembno, kateri antidepresiv izbrati glede na klinično sliko depresije, ker to vpliva na uspeh pri njenem zdravljenju. Na takšen način se pomembno vpliva na prognozo, ne samo depresije, temveč tudi prisotnih telesnih bolezni, kot so maligne bolezni
Stranski učinki ob zdravljenju rakavih bolezni z zaviralci tirozinskih kinaz
Get PDFTyrosine kinase inhibitors are multicentric drugs that inhibit different cellular processes and are effective in the treatment of many types of cancer. Although the side effects of tyrosine kinase inhibitors are generally tolerable, they may also be serious and cause numerous problems in patients receiving long-term medication. Dosage reductions or transient withdrawal are often required, but only rarely is the treatment permanently discontinued. Typical complications include skin toxicity, cardiovascular complications, problems in the gastrointestinal tract, in particular diarrhoea, thyroid malfunction, and treatment-specific fatigue.Zaviralci tirozin-kinaz so multitarčna zdravila, ki prek zaviranja različnih celičnih procesov učinkujejo pri več vrstah rakavih boleznih. Čeprav so stranski učinki ob zaviralcih tirozinskih kinaz v splošnem prenosljivi, pa so lahko tudi resni in povzročajo nemalo preglavic bolnikom, ki prejemajo zdravila dolgotrajno. Pogosto je potrebno zmanjšanje odmerkov ali prehodna ukinitev, redkeje pa se odločimo za trajno prekinitev zdravljenja. Značilni so kožna toksičnost, kardiovaskularni zapleti, težave gastrointestinalnega trakta - predvsem diareja, nepravilno delovanje ščitnice in utrujenost ob zdravljenju rakave bolezni
Psihoonkološka obravnava bolnika z rakom
Get PDFWith the increase of cancer incidence, prolonged survival, and a rising awareness about the importance of mental wellbeing, psycho- -oncology care presents an important part of comprehensive cancer patient treatment. The Department of Psycho-Oncology at the Institute of Oncology Ljubljana was established in 1984 to provide psycho-oncology care to patients and their relatives. Behavioural cognitive therapy and supportive therapy are the most common therapeutic modalities used in individual and group treatment of cancer patients. Nevertheless, timely recognition of psychological distress and the availability of psycho-oncology treatment remain a challenge.Ob porastu števila onkoloških bolnikov, vse daljšem preživetju in vse večji ozaveščenosti o pomenu duševnega zdravja je psihoonkološka obravnava pomemben del celostne obravnave bolnikov z rakom. Oddelek za psihoonkologijo deluje na Onkološkem inštitutu Ljubljana od leta 1984 in zagotavlja psihoonkološko obravnavo tako bolnikom kot tudi njihovim svojcem. Kognitivno vedenjska terapija in suportivna psihoterapija sta najpogostejši terapevtski modaliteti individualnega in skupinskega terapevtskega dela z bolniki z rakom. Pravočasno prepoznavanje duševnih stisk in dostopnost psihoonkološke obravnave pa še vedno ostajata izziv
Maligni melanom: poznavanje bolezni, dejavnikov tveganja in odnos do njih v mladi odrasli populaciji v Sloveniji
Get PDFMalignant melanoma in Slovenia continues to increase rapidly in incidence over the last decades. Knowledge and risk factors amongst the population is still questionable and poorly investigated. Exposure to ultraviolet radiation is the leading risk factor for melanoma development, therefore physical protection and use of sunscreens with sun protection factors is crucial. The study aimed to investigate awareness of melanoma, risk factors and related behavior towards them among students of four faculties of University of Ljubljana: Faculty of Medicine, Faculty of Electrical Engineering, Faculty of Pharmacy and Faculty of Mathematics and Physics and to compare the answers between medical students and students of the other three faculties. The study was cross-sectional and survey-based. Students answered an anonymous questionnaire, which was sent to them through a website link. Answers obtained by 66.3% medical students and 33.7% students of other three faculties showed that medical students have statistically significant better knowledge about melanoma, (p=0.0001). It has also been found that there was statistical difference in frequency of protecting themselves from the sun (p=0.0001) and in used sun protection factor (p=0.015). Medical students with fair skin types more frequently used some means of protection from ultraviolet radiation, the measured difference was statistically significant (p=0.001). Medical students significantly better recognize malignant melanoma as the most threatening type of skin cancer. They also protect themselves from the sun more often and use higher sun protection factors. Slovenian adolescent population has high knowledge about harmful effects of exposure to ultraviolet radiation, but responds poorly to it.Incidenca malignega melanoma v Sloveniji v zadnjih desetletjih strmo narašča, poznavanje malignega melanoma in dejavnikov tveganja pa je med populacijo še vedno vprašljivo in malo raziskano. Najpomembnejši dejavnik tveganja za nastanek bolezni je delovanje ultravijoličnih žarkov, pred katerimi se je treba fizično zaščititi in uporabljati sredstva za zaščito pred soncem, predvsem v mladosti. Namen raziskave je bil pridobiti podatke o poznavanju malignega melanoma, dejavnikov tveganja in odnosu do njih ter primerjava odgovorov med študenti Medicinske fakultete in študenti treh ostalih fakultet. V presečno in anketno raziskavo so bili vključeni študentje štirih fakultet Univerze v Ljubljani: Medicinske fakultete, Fakultete za elektrotehniko, Fakultete za farmacijo ter Fakultete za matematiko in fiziko, ki so prek spletne povezave odgovarjali na anonimni vprašalnik. Odgovori 66,3 odstotka študentov Medicinske fakultete in 33,7 odstotka študentov ostalih fakultet kažejo, da je poznavanje malignega melanoma boljše med študenti Medicinske fakultete, razlika je statistično značilna (p = 0,0001). Študenti se v poznavanju dejavnikov tveganja statistično značilno razlikujejo le v pogostnosti uporabe zaščite pred soncem (p = 0,0001) in uporabljenem zaščitnem faktorju (p = 0,015). Študenti medicine s svetlimi tipi kože se pred soncem zaščitijo pogosteje, obstaja statistično značilna razlika (p = 0,001). Študenti Medicinske fakultete statistično značilno bolje prepoznavajo maligni melanom kot nevarno obliko kožnega raka. Pogosteje se tudi zaščitijo pred ultravijoličnimi žarki in uporabljajo višje zaščitne faktorje kot študenti ostalih fakultet. Kljub zelo visokem vedenju o škodljivosti izpostavljanja UV-žarkom med mlado slovensko populacijo je ukrepanje bistveno slabše
