Onkologija
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Pogled radioterapevta onkologa na zdravljenje raka želodca
Get PDFGastric cancer is associated with a poor prognosis. At diagnosis, approximately 50% of patients have a non-resectable disease. In patients who underwent radical resection, the disease recurs in as many as 75%, of which 40-64% are local and/or regional recurrences (2-4). Despite this fact, we are observing that survival of patients has improved over the years. According to the SLORE data, relative 5-year survival was 14.7% in 1985, 17.8% in 1995, 22.1% in 2000 and 25.6% in 2005 (5). Surgical resection of the tumour and regional lymph nodes is the method of choice for treating gastric cancer with no distant metastases. Until 2000, it was also the only treatment method.Ni abstrakta
Zdravljenje lokoregionalno napredovalega karcinoma požiralnika: prikaz primera
Get PDFIn this article, we present a case of a 67-year-old patient with advanced stage T3 N2–3M0 carcinoma of the middle third of the oesophagus which is spreading to the upper and lower thirds. Despite the extensiveness of the disease, the patient received optimal treatment with pre-operative radiochemotherapy and surgery. Successful treatment was a result of an individual approach, close collaboration of all branches of oncology and use of new radiation techniques.V prispevku predstavljamo primer 67-letnega bolnika z napredovalim karcinomom srednje tretjine požiralnika, s širjenjem v zgornjo in spodnjo tretjino, v stadiju T3 N2–3M0. Kljub obsežnosti bolezni je prejel optimalno zdravljenje s predoperativno radiokemoterapijo in operacijo. Uspešen potek zdravljenja je omogočil individualen pristop, tesno sodelovanje vseh strok onkologije in uporaba novih obsevalnih tehnik
Pomen kakovosti življenja pri bolnikih z rakom
Get PDFA half of cancer survivors suffer from delayed treatment complications, e.g. physical, psychosocial, cognitive and sexual. In addition, they worry about potential later cancer recurrence or onset of new cancer. Survivors often face unemployment and discrimination at work. How they react to cancer diagnosis, treatment and consequences of it or the very disease, greatly depends on the information offered to them by the medical staff. Self-evaluation of health-related quality of life (HRQOL) in cancer patients is becoming a component part of oncology clinical practice. It is helpful in deciding the appropriate treatment for each patient. Changes in HRQOL during treatment can predict a poorer response to treatment and disease recurrence. In advanced cases it can help to estimate the expected survival rate and consequently optimal palliative treatment or supporting treatment.Polovica bolnikov, ki so ozdravljeni, trpi za kasnimi zapleti zdravljenja, npr. telesnimi, psihosocialnimi, kognitivnimi in seksualnimi. Poleg tega so zaskrbljeni zaradi morebitne kasne ponovitve tega ali pojava novega raka. Preživeli se pogosto soočajo z brezposelnostjo in diskriminacijo na delovnem mestu. Kako se bodo odzvali na diagnozo rak, zdravljenje in posledicami le-tega oz. same bolezni, pa je v veliki meri odvisno tudi od informacij, ki jim jih nudi zdravstveno osebje. Samoocena z zdravjem povezane kakovosti življenja (angl. Health-Related Quality of Life - HRQOL) bolnikov z rakom postaja sestavni del onkološke klinične prakse. Pomaga nam pri izbiri za bolnika najprimerrnejšega zdravljenja. Spremembe v HRQOL med zdravljenjem lahko napovedo slabši odgovor na zdravljenje in ponovitev bolezni. Pri napredovali bolezni je v pomoč pri presoji pričakovanega preživetja in tako pri optimalni paliativni obravnavi oziroma podpornem zdravljenju
Priporočila za obravnavo diareje ob sistemskem onkološkem zdravljenju
Get PDFDiarrhea is defined as frequent passages of loose, unformed or liquid stool more than three times in 24 hours. It is one of the most common undesirable symptoms, which oncology patients face. Diarrhea can lead to dehydration, electrolytic and metabolic disorders, kidney failure and in severe cases also hemodynamic instability, which requires hospitalisation. The problem can affect the uninterrupted course of a specific cancer treatment and influence the quality of life of patients, reduce compliance to treatment and shorten the survival period. General recommendations for diarrhea in cancer treatment were first published in 1998, amended and adapted in 2004 in the Journal of Clinical Oncology (1). So far there are no updated, internationally accepted instructions. The article summarises the recognised and generally adopted recommendations, with differences in treatments of diarrhea with cytostatic and target medications.Diarejo definiramo kot pogosto odvajanje redkega, neformiranega ali vodenega blata več kot trikrat v 24 urah. Je eden izmed najpogostejših neželenih simptomov, s katerimi se srečujejo onkološki bolniki. Diareja lahko vodi v dehidracijo, elektrolitske in metabolne motnje, ledvično odpoved, v hudih oblikah tudi v hemodinamsko nestabilnost, ki zahteva hospitalizacijo. Ovira lahko nemoten potek specifičnega onkološkega zdravljenja z vplivom na kvaliteto življenja bolnikov, zmanjšano komplianco za zdravljenje in krajše preživetje. Splošna priporočila za obravnavo diareje ob onkološkem zdravljenju so bila prvič objavljena leta 1998, dopolnjena in prilagojena so izšla leta 2004 v reviji Journal of Clinical Oncology (1). Zaenkrat še ni posodobljenih, mednarodno sprejetih navodil. Prispevek povzema priznana in splošno sprejeta priporočila, z razlikovanjem obravnave diareje ob zdravljenju s citostatiki in tarčnimi zdravili
Pogled internista onkologa na zdravljenje raka želodca
Get PDFAfter resection, a large number of patients with gastric carcinoma (GC) and carcinoma of gastroesophageal junction (GEJ) have recurrences. Recurrences are local or with distant metastases, or a combination of both. Adjuvant chemotherapy can improve overall survival in some types of solid tumours primarily by minimising the residues of micro-metastases. While the importance of adjuvant chemotherapy in GC and GEJ is not entirely clear, adjuvant radiochemotherapy significantly prolongs the disease-free period and overall survival. Perioperative treatment with ECF chemotherapy significantly improves disease-free and overall survival. ECF chemotherapy or its other regimens, namely EOF, ECX or EOX, are the standard treatment for patients with advanced gastric carcinoma (GC) or GEJ. Treatment with taxans in combination with 5-FU and cisplatin (TCF) is also effective. New combinations of cytostatics and the introduction of new cytostatics have improved the median survival of patients with gastric carcinoma and GEJ. Target drugs have also been introduced for the treatment of metastatic GC and GEJ. Determination of biomarkers and introduction of target treatment in combination with chemotherapy has opened a new era of patientadapted treatment, also for patients with advanced gastric carcinoma and GEJ. After resection, a large number of patients with gastric carcinoma (GC) and carcinoma of gastroesophageal junction (GEJ) have recurrences. Recurrences are local or with distant metastases, or a combination of both. In Europe and the USA, locoregional recurrences are more common and most frequently occur in the abdominal region, regional lymph nodes or at the anastomosis. The most common systemic extensions are liver metastases and metastases to peritoneum. GEJ carcinoma can often metastasise also to the lungs.Veliko število bolnikov s karcinomom želodca (KŽ) in gastroezofegealnega prehoda (GEP) ima ponovitev bolezni po resekciji. Ponovitve so lokalne ali z oddaljenimi zasevki ali pa kombinacija obojega. Adjuvantna kemoterapija lahko podaljša celokupno preživetje pri nekaterih vrstah solidnih tumorjev predvsem z zmanjšanjem ostanka mikrozasevkov. Vloga adjuvantne kemoterapije pri KŽ in GEP ni tako jasna, adjuvantna radiokemoterapija pa značilno podaljša čas brez bolezni in celokupno preživetje. Perioperativno zdravljenje s kemoterapijo ECF značilno podaljša preživetje brez bolezni in celokupno.
Standardno zdravljenje za bolnike z napredovalim karcinomom želodca in GEP je kemoterapija ECF ali njene izpeljanke EOF, ECX oziroma EOX. Učinkovito je tudi zdravljenje s taksani v kombinaciji s 5-FU in cisplatinom (TCF). Z novimi kombinacijami citostatikov in z uvajanjem novih citostatikov se srednja preživetja bolnikov s karcinomom želodca in GEP podaljšujejo. V zdravljenje metastatskega KŽ in GEP pa prihajajo tudi tarčna zdravila. Določanje biomarkerjev in uvajanje tarčnega zdravljenja v kombinaciji s kemoterapijo pa odpira novo ero bolniku prilagojenega zdravljenja, tudi pri bolnikih z napredovalim karcinomom želodca in GEP.
Veliko število bolnikov s karcinomom želodca (KŽ) in gastroezofegealnega prehoda (GEP) ima ponovitev bolezni po resekciji. Ponovitve so lokalne ali z oddaljenimi zasevki ali pa kombinacija obojega. V Evropi in ZDA so bolj pogoste lokoregionalne ponovitve, med katerimi se največkrat pojavijo na mestu želodca, regionalnih bezgavk in anostomozi. Med sistemskimi razširitvami bolezni so najpogostejši jetrni zasevki in zasevki po potrebušnici. Karcinom GEP pa lahko pogosto zaseva tudi v pljuča
Paliativna oskrba
Get PDFPalliative care (PC) is an important, indispensable and integral part of medical care of patients with incurable diseases, and it is performed at all levels of healthcare system. Comprehensive care of palliative patients is provided by a multi-professional team, which resolves physical, psychological, social and spiritual problems faced by palliative patients and their families. The main goal is to ensure the best possible quality of life. PC recognises life and death as natural processes.Paliativna oskrba (PO) je pomemben, nepogrešljiv sestavni del zdravstvene oskrbe bolnikov z neozdravljivo boleznijo in se izvaja na vseh ravneh zdravstvenega sistema. Za celostno oskrbo paliativnih bolnikov skrbi multiprofesionalen tim, ki zagotavlja razreševanje fizičnih, psihičnih, socialnih in duhovnih težav, s katerimi se soočajo paliativni bolniki ter njihov isvojci. Glavni cilj je skrb za čim boljšo kakovost življenja. PO priznava življenje in umiranje kot naraven proces
Določanje mutacij v genih c-KIT in PDGFRA pri bolnikih z gastrointestinalnimi stromalnimi tumorji
Get PDFAt the Institute of Oncology Ljubljana, the Department of Molecular Diagnostics introduced testing of mutations in the c-KIT and PDGFRA proto-oncogenes using the direct sequencing method. The use of tyrosine kinase inhibitors to treat patients with gastrointestinal stromal tumours (GIST) enables a more successful treatment. Selection of the most appropriate drug for patients with GIST depends on the activation mutations in the c-KIT and PDGFRA genes. Mutations in these genes are found in approximately 90% of patients with GIST. The majority of these mutations show a good response to treatment with tyrosine kinase inhibitors (e.g. imatinib in the first-line treatment), while some mutations cause the patient to become unresponsive to treatment. Secondary mutations are also common, which cause patient’s lack of response to the original drug despite the originally good response to treatment with tyrosine kinase inhibitors. In this case, it is necessary to choose a different type of tyrosine kinase inhibitor (e.g. sunitinib, sorafenib, nilotinib). Identification of the c-KIT and PDGFRA gene mutation status represents important information for the doctor when deciding on the appropriate treatment for individual patients.Na Oddelku za molekularno diagnostiko Onkološkega inštituta Ljubljana smo uvedli testiranje mutacij v protoonkogenih c-KIT in PDGFRA z metodo neposrednega sekvenciranja. Uporaba zaviralcev tirozin kinaz za zdravljenje bolnikov z gastrointestinalnimi stromalnimi tumorji (GIST) je omogočila uspešnejše zdravljenje. Na izbiro najustreznejšega zdravila za bolnike z GIST vplivajo aktivacijske mutacije v genih c-KIT in PDGFRA. Mutacije v navedenih genih najdemo pri približno 90 % bolnikov z GIST. Večina izmed teh mutacij omogoči dober odgovor na zdravljenje z zaviralci tirozin kinaz (npr.imatinibom v prvi liniji zdravljenja), nekatere izmed mutacij pa povzročijo neodzivnost bolnika na zdravljenje. Pogosto se pojavijo tudi sekundarne mutacije, ki kljub prvotnemu dobremu odgovoru na zdravljenje z zaviralci tirozin kinaz povzročijo neodzivnost bolnika na prvotno zdravilo. V tem primeru je treba izbrati drugo vrsto zaviralca tirozin kinaz (npr. sunitinib, sorafenib, nilotinib). Poznavanje mutacijskega statusa genov c-KIT in PDGFRA predstavlja pomemben podatek za zdravnika pri izbiri ustreznega zdravljenja za posameznega bolnika
Pogled internista onkologa na sistemsko zdravljenje raka požiralnika
Get PDFThe incidence of carcinoma of the oesophagus in Slovenia is small and has not changed in years. The prognosis of patients with metastatic carcinoma of the oesophagus is poor, with less than 10% 5-year survival. In the early stages of the disease, we recommend surgical treatment in combination with neoadjuvant chemoradiation for squamous cell carcinoma or perioperative systemic chemotherapy for adenocarcinoma of the gastroesophageal junction. In locoregionally advanced carcinoma, we recommend neoadjuvant chemoradiation. In the case of cervical carcinoma of the oesophagus or in high-risk patients not fit for surgery, we recommend definitive chemoradiation. The most optimal systemic therapy for metastatic disease is selected based on the general state of the patient, his concurrent diseases, the expected toxicity of systemic therapy, and HER2 status in patients with adenocarcinoma. For first-line treatment, we recommend doublet chemotherapy, mainly due to a better toxicity profile. In the case of HER2-positive adenocarcinoma, doublet may be combined with trastuzumab. In patients who are in good general condition, we can try with a combination of three cytostatics. For patients in poor general condition, only palliative supportive care is recommended, since the benefit of such treatment outweighs the potential treatment complications. We are eagerly awaiting the results of the ongoing clinical trials of new combinations of cytostatics and targeted drugs, hoping for more effective combinations of drugs that would enable us to treat patients with metastatic carcinoma of the oesophagus and gastroesophageal junction more effectivelyNi abstrakta
Primarni razsoj adenokarcinoma gastroezofagealnega prehoda v možgane
Get PDFIn the last years, we have noted a decline in the incidence of gastric adenocarcinoma but at the same time also an increase in the incidence of adenocarcinoma of gastroesophageal (GE) junction (1). According to the 2012 Cancer Registry of Slovenia data, a total of 55 patients were diagnosed with gastric cancer in 2009, of which 363 were men and 192 were women (2). Generally, gastric cancer patients have a poor prognosis, especially in the case of primarily metastatic disease. Gastric cancer most commonly spreads to peritoneum, which is followed by lymph nodes, bones, lungs and liver (3-5). Metastases in the central nervous system mostly represent a late or rare manifestation (< 4%) (6). In the article, we present a patient with adenocarcinoma of GE junction with primary spread of the disease to the brain, who was treated with two lines of systemic therapyNi abstrakta
Biopsija resektabilnih jetrnih zasevkov raka debelega črevesa in danke
Get PDFNo abstract.Ni abstrakta