Onkologija
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Prehranska podpora bolnika z rakom
Get PDFOesophageal cancer patients very frequently lose their body weight, which leads to malnutrition and accelerates the development of cachexia. Weight loss and development of malnutrition accelerate the development of cachexia and deteriorate the functional state of patients and their quality of life. Functional state and quality of life of patients thus become worse. This also results in poorer tumour response to treatment, which is accompanied by adverse events and decreased survival.
There are numerous causes of weight loss and development of malnutrition in patients with gastrointestinal tumours, which often develop already at the onset of the disease. Therefore, the diagnosis of cachexia and nutritional management of the patient should be undertaken at the same time as treatment of the cancerous disease. They are performed in the same manner as any other medical therapy. Nutritional intervention, as the basic measure for preventing malnutrition and development of cachexia, must be started early enough to prevent and/or minimise further loss of body cell mass. The energy needs of cancer patients are comparable to those of patients who do not have cancer. Protein requirements are 1.2-2.0 g/kg of body weight/day. In patients with cachexia, we can use modulation of metabolism by omega-3 fatty acids.Bolniki z rakom požiralnika in želodca zelo pogosto izgubljajo telesno maso, kar vodi v podhranjenost ter pospešuje razvoj kaheksije. Hujšanje in razvoj podhranjenosti pospešujeta razvoj kaheksije, znižujeta funkcionalno stanje bolnikov ter njihovo kakovost življenja. Funkcionalno stanje in kakovost življenja bolnikov sta slabša. Slabši je odziv tumorja na zdravljenje, to spremlja več neželenih sopojavov in slabše preživetje.
Vzroki za hujšanje in razvoj podhranjenosti so pri bolnikih s tumorji zgornjih prebavil številni ter se pogosto pojavijo že ob začetku bolezni. Zato naj diagnostika kaheksije in prehranska obravnava bolnika potekata vzporedno z zdravljenjem rakaste bolezni. Izvajata se na enak način kot vsaka druga medicinska terapija. Prehransko intervencijo, kot osnovni ukrep preprečevanja podhranjenosti in razvoja kaheksije, je treba pričeti dovolj zgodaj, da preprečimo in/ali zmanjšamo nadaljnjo izgubo telesne celične mase. Energetske potrebe bolnikov z rakom so primerljive z energetskimi potrebami bolnikov, ki nimajo raka. Potrebe po beljakovinah so 1,2 do 2,0 g/kg telesne teže/dan. Pri bolnikih s kaheksijo lahko uporabimo modulacijo presnove z omega-3 maščobnimi kislinami
Predoperativno obsevanje pri bolnici z rakom želodca
Get PDFIn patients with unresectable or borderline resectable gastric cancer with no spreading of the disease, we recommend pre-operative radiochemotherapy, which may reduce the tumour and thus increase the likelihood of complete removal (R0 resection). The article present a case of a female patient with clinical stage T4 N1 M0 gastric cancer treated with pre-operative chemotherapy followed by total gastrectomy. Pre-operative treatment showed a very good response. After surgery, the patient received complementary chemotherapy and had no recurrence of the disease five years after treatment.Pri bolnikih z neresektabilnim oz. mejno resektabilnim rakom želodca, ki nimajo razsoja bolezni, priporočamo predoperativno radiokemoterapijo, s katero poskušamo zmanjšati tumor in s tem zvišati možnost popolne odstranitve (R0 resekcija). V prispevku je prikazan primer bolnice z rakom želodca v kliničnem stadiju T4 N1 M0, ki je bila zdravljena s predoperativno radiokemoterapijo, ki ji je sledila totalna gastrektomija. Dosežen je bil zelo dober odgovor na predoperativno zdravljenje. Po operaciji je bolnica prejela še dopolnilno kemoterapijo in pet let po zaključku zdravljenja ni imela ponovitve bolezni
Sekundarni maligni tumor debelega črevesja po zdravljenju raka v otroštvu: prikaz primera
Get PDFThe risk of developing secondary colon cancer is larger in patients treated for childhood cancer than in the general population, and it is rapidly increasing with observation time and increased radiation dose to the abdominal area. A patient, who was successfully treated for Hodgkin’s disease at the age of 12 with chemotherapy and radiation of the affected regions, including para-aortic lymph nodes, was diagnosed with microcytic hypochromic anaemia 27 years after treatment. A suspicion that this is gastrointestinal haemorrhage was not confirmed by a single-stool examination. Half a year later, the patient was found with metastatic adenocarcinoma of the colon and was treated operatively with systemic treatment and palliative radiation of spinal and brain metastases. A year and a half after the start of treatment of secondary tumour, the patient died at the age of 40 years. Patients treated for childhood cancer experience several late consequences. Secondary malignant tumours are the second most common cause of death, right after disease recurrence. Therefore, timely detection and appropriate treatment are of utmost importance. Since 2014, the international guidelines recommend that patients receiving 30 Gy or more to the abdominal region are monitored by colonoscopy. A single-stool examination for occult blood and US of the abdomen are not reliable methods for detecting colon cancer.Tveganje za nastanek sekundarnega raka debelega črevesja je pri bolnikih, ki so se zdravili zaradi raka v otroštvu, večje od tistega v splošni populaciji in strmo narašča s časom opazovanja ter s povečano dozo obsevanja v predelu trebuha. Pri bolniku, ki je bil v starosti 12 let uspešno zdravljen zaradi Hodgkinove bolezni s kemoterapijo in obsevanjem prizadetih regij, vključno paraaortnih bezgavk, je bila 27 let po zdravljenju ugotovljena mikrocitna hipohromna anemija. Sum, da gre za gastrointestinalno krvavitev z enkratno preiskavo blata, ni bil potrjen. Pol leta kasneje je bil ugotovljen metastatski adenokarcinom debelega črevesja. Zdravljen je bil operativno, s sistemskim zdravljenjem in paliativnim obsevanjem spinalnih ter možganskih metastaz. Leto in pol po začetku zdravljenja sekundarnega tumorja je bolnik v starosti 40 let umrl. Pri bolnikih, zdravljenih zaradi raka v otroštvu, so pozne posledice številne. Sekundarni maligni tumorji so drugi najpogostejši vzrok smrti, takoj za recidivom bolezni. Zato je zelo pomembno, da jih pravočasno odkrijemo in ustrezno zdravimo. Od leta 2014 je za bolnike, ki so prejeli 30 Gy ali več na predel trebuha, v mednarodnih smernicah priporočeno spremljanje s kolonoskopijo. Enkratna preiskava blata na kri in UZ trebuha nista zanesljivi metodi za odkrivanje raka debelega črevesja
Hepatocelični rak - možnost resekcije jeter
Get PDFLiver resection (LR) has remained the main form of therapy for solitary hepatocellular cancer (HCC) in patients with preserved functional liver reserves and in good general condition. Advanced imaging has contributed to a better selection of patients. Liver surgery has advanced as there are many techniques of liver tissue transection useful and different instruments are available, which enable faster and more accurate surgery in the bloodless operating field. Improved surgical technique, maintenance of low central venous pressure and advancement in patient postoperative care have provided that mortality rates after liver surgery in selected series lowered as far as to 0%. The Barcelona Clinic Liver Cancer (BCLC) classification apart from disease control also offers recommendations with regard to therapy selection. It limits surgical therapy only to patients with early stage liver cancer. The purpose of this article is to research whether at present time it is perhaps better to perform radioiodine therapy with acceptable short- and long-term results even in patients with HCC, where there are numerous and large tumours present, macroscopically invading the veins.Resekcija jeter (RJ) je ostala glavna oblika terapije pri solitarnem hepatoceličnem raku (HCC), pri bolnikih z ohranjeno funkcijsko rezervo jeter in v primernem splošnem stanju. Izpopolnjene slikovne preiskave so pripomogle k boljši izbiri bolnikov. Kirurgija jeter je napredovala: uporabne so številne tehnike transekcije jetrnega tkiva; dosegljive so različne naprave, ki omogočajo hitrejše in natančnejše operiranje v brezkrvnem operativnem polju. Izboljšana kirurška tehnika, vzdrževanje nizkega centralnega venskega pritiska in napredek pri negi bolnika po operaciji so omogočili, da se je smrtnost po operaciji jeter v izbranih serijah znižala celo do 0%. Barcelona Clinic Liver Cancer (BCLC) klasifikacija poleg zamejitve bolezni, nudi priporočila tudi glede izbora terapije. Kirurško terapijo omejuje zgolj na bolnike z zgodnjim stadijem raka. Namen tega prispevka je raziskati, ali je v sedanjem času mogoče RJ opraviti s sprejemljivimi kratko- in dolgoročnimi rezultati tudi pri bolnikih s takšnim HCC, pri katerem so prisotni številni in veliki tumorji, ki makroskopsko vdirajo v žile
Obsevanje starostnika z rakom
No full textThere is a growing number of evidence that elderly cancer patients can benefit oncology treatment. Despite this fact they are under treated, which leads to a worse outcome of the disease. Additionally, it is also concerning that a great deal of elderly people when diagnosed are in a relatively healthy and good condition and have presumably several years of life ahead of them. The chronological age, which is often the basis for deciding the type and intensity of treatments, has proven as an insufficient and misleading piece of information. Elderly people in good condition tolerate radiation just as well as younger patients and the disease has a comparable treatment response. Other contributing factors in treatment decision are false assessments of a patient’s life expectancy, doubts in therapeutic efficiency and fear because of treatment toxicity. An integral geriatric evaluation of older patients is recommended, which would help oncologists in deciding whether to refer patients for radical or palliative oncology treatment.Vse več je dokazov, da imajo stari bolniki z rakom dobrobit od specifičnega onkološkega zdravljenja. Kljub temu so pogosto premalo zdravljeni, kar ima za posledico slabši izid bolezni. Ob tem je zaskrbljujoče tudi to, da je veliko starostnikov ob diagnozi relativno dobrega zdravja in imajo po predvidevanjih pred sabo še več let življenja. Kronološka starost, ki je pogosto podlaga za odločitev o vrsti in intenzivnosti zdravljenja, se je izkazala kot nezadosten in zavajajoč podatek. Starostniki v dobrem stanju zmogljivosti prenašajo obsevanje enako dobro kot mlajši bolniki in imajo primerljiv odgovor bolezni na zdravljenje Vlogo pri odločitvi imajo tudi napačna presoja pričakovanega življenja bolnika, dvom v terapevtsko učinkovitost in strah zaradi toksičnosti zdravljenja. Priporoča se celovita geriatrična ocena starejših bolnikov, ki bi onkologom pomagala pri razmisleku o primernosti napotitve na radikalno ali paliativno onkološko zdravljenje
Rak dojke pri mladih ženskah in nosečnost
Get PDFBreast cancer in young women is a rare occurrence, and successful treatment of this disease offers long survival to the majority of young female patients. Preserving fertility is an important aspect of the quality of life, in particular if bearing in mind that the age at which women have their first child has been increasing. Therefore, young female patients must be aware of the possible negative effects of treatment on fertility already at diagnosis and should be offered counselling. At the gynaecological oncology consilium, patients or couples are presented the procedures for the storage of genetic material before commencing treatment. In the following article, we present and discuss the newest findings on the association between breast cancer and pregnancy. Moreover, we also present the data collected on pregnancy in very young patients following breast cancer treatment in Slovenia.Rak dojke pri mladih bolnicah je redek pojav. Uspešno zdravljenje te bolezni omogoča večini mladih bolnic dolgo preživetje. Pomemben vidik kakovosti življenja je nedvomno ohranjanje plodnosti, posebno ob zavedanju, da je starost žensk ob prvem otroku vse višja. Mlade bolnice je zato treba že ob postavitvi diagnoze seznaniti z možnimi negativnimi vplivi zdravljenja na plodno sposobnost in jim ponuditi možnost svetovanja. Na ginekološko-onkološkem konziliju bolnicam ali paru med drugim predstavimo postopke za shranjevanje genetskega materiala pred pričetkom zdravljenja. V pričujočem prispevku predstavljamo in razpravljamo o novejših spoznanjih, ki povezujejo rak dojke ter nosečnost. Predstavljamo tudi zbrane podatke o nosečnostih pri zelo mladih bolnicah po zdravljenju raka dojke v Sloveniji
Rezultati zdravljenja bolnikov s karcinomom požiralnika, zdravljenih na Onkološkem inštitutu Ljubljana v letih 2006-2010
Get PDFEsophageal carcinoma is a relatively rare disease with bad prognosis. The purpose of our retrospective study was to evaluate the methods and results of treatment of patients with esophageal cancer, who were treated at the Institute of Oncology in Ljubljana (OIL) from 2006 to 2010. The study included 151 patients, of whom 74 received palliative treatment and 75 radical treatment. In two patients radical treatment had been planned, but because of rapidly progressing complications and deteriorating general condition they only received supporting treatment. The five-year overall survival (OS) rate for all patients amounted to 9.5%, of those receiving palliative treatment 0% and those receiving radical treatment 18.7%. The corresponding values for five-year progression-free survival (PFS) rate were for all patients 22.4% and for radically treated patients 29.6%. In radically treated patients we also performed a survival comparison study between the group of 50 patients, who were treated only with radiation with or without simultaneous chemotherapy and the group of 25 patients, who had also been operated either prior or post radio and/ or chemotherapy. There were no significant differences among the subgroups in OS (p=0.42) or PFS (p=0.31). The results of treatment of these patients in Slovenia are poor, but do not substantially differ from the likely poor results from the EUROCARE-5 study. Whether consistent trimodality therapy in treating esophageal cancer (in selected patients) and potential use of new chemotherapeutic schemes can achieve any kind of progress, is a question, which only carefully planned and implemented prospective studies can answer.Karcinom požiralnika je relativno redka bolezen s slabo prognozo. Namen naše retrospektivne raziskave je bil oceniti različne načine in rezultate zdravljenja bolnikov z rakom požiralnika, ki so bili v obdobju od leta 2006 do 2010 obravnavani na Onkološkem inštitutu v Ljubljani (OIL). V raziskavo je bilo vključenih 151 bolnikov, od katerih jih je bilo 74 zdravljenih paliativno in 75 radikalno. Pri dveh bolnikih je bilo načrtovano radikalno zdravljenje, vendar sta zaradi zapletov s hitrim poslabšenjem splošnega stanja prejela le podporno zdravljenje. Petletno celokupno preživetje (CP) je za vse bolnike znašalo 9.5%, za zdravljene paliativno 0% in zdravljene radikalno 18.7%. Ustrezne vrednosti za petletno preživetje brez progresa bolezni (PBP) so bile za vse bolnike 22.4% in za zdravljene radikalno 29.6%. V skupini radikalno zdravljenih bolnikov je bila opravljena tudi primerjava preživetij med skupino 50 bolnikov, ki so bili zdravljeni samo z obsevanjem z ali brez sočasne kemoterapije in skupino 25 bolnikov, ki so bili pred ali po radio- in/ali kemoterapiji tudi operirani. Med podskupinama statistično pomembne razlike v CP (p=0.42) in v PBP (p=0.31) ni bilo. Rezultati zdravljenja teh bolnikov so v Sloveniji slabi, vendar ne odstopajo bistveno od prav tako slabih rezultatov iz raziskave EUROCARE-5. Odgovor na vprašanje ali bomo pri zdravljenju raka požiralnika z dosledno uporabo trimodalnega zdravljenja (pri izbranih bolnikih) in morebitno uporabo novih kemoterapevtskih shem dosegli kakršenkoli napredek, bodo lahko dale samo dobro načrtovane in izpeljane prospektivne raziskave
Priporočila za preprečevanje in zdravljenje slabosti in bruhanja ob sistemskem onkološkem zdravljenju
Get PDFIn spite of great advancement, nausea and vomiting remain the most common undesirable effects of systemic cancer treatment, which substantially lower the patients’ quality of life and reduce their compliance to continue systemic treatment. Recommendations for prevention and treatment of nausea and vomiting resulting from cytostatic treatment were published in 2003 in Oncology magazine. This article complements the recommendations for treatment of nausea and vomiting with new developments, which were published in the NCCN guidelines in 2014 and MASCC and ESMO in 2010 (1, 2). We present our method for treating dysphagia with the help of intraluminal oesophageal stents. In our practice, the intraluminal oesophageal stent has proven to be a very effective and the most patient-friendly method for optimal delivery of nutrients before and during neoadjuvant therapy. There are few complications, and insertions do not have a negative impact on the perioperative outcomes.Ni abstrakta
Sistemsko zdravljenje napredovalega diferenciranega raka ščitnice
Get PDFDifferentiated thyroid cancer represents over 90 percents of thyroid cancers. It arises from thyroid follicular cells and is one of highly treatable cancers. Primary treatment is surgical and patients at high risk of carcinoma recurrence also receive adjuvant radioiodine therapy and a suppressive dose of thyroxin. In 7–23% of patients metastases appear in remote organs (lungs, skeleton). The basic treatment for metastatic differentiated thyroid cancer is radioiodine therapy. In case of resistance to radioiodine therapy during disease progression, treatment is now also possible with target medication sorafenib.Diferencirani rak ščitnice predstavlja preko 90 odstotkov raka ščitnice. Nastane iz folikularnih celic ščitnice in spada med visoko ozdravljive rake. Primarno zdravljenje je kirurško, visoko rizični za ponovitev prejmejo še adjuvantno radiojodno terapijo in tiroksin v supresijskem odmerku. Pri 7-23% bolnikov pride do pojava zasevkov v oddaljenih organih (pljuča, skelet). Temelj zdravljenja metastatskega diferenciranega raka ščitnice je radiojodna terapija. Pri pojavu rezistence na radiojodno terapijo je ob napredovanju bolezni sedaj na voljo zdravljenje s tarčnim zdravilom sorafenibom