Onkologija
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Napotitev in obravnava bolnikov z melanomom in epiteliomi
Get PDFThe population has become increasingly aware of the importance of health care and knows the risk factors for individual diseases, e.g. the harmful effects of sun rays and their influence on the development of skin cancer, which represents a major problem for a relatively large number of dermato-venereologists dealing with an increasing number of patients. Besides regular examinations, many other patients with an urgent or immediate referral visit the dermato-venereology clinics on a daily basis due to long waiting times, but this only prolongs them.V populaciji se veča zavest o skrbi za zdravje in poznavanje rizičnih dejavnikov za nastanek posameznih bolezni, kot npr. škodljivosti sončnih žarkov in njihov vpliv na nastanek kožnega raka, kar ob relativno konstantnem številu dermatovenerologov in večjem prilivu bolnikov predstavlja velik problem. Poleg rednih pregledov ambulante dermatovenerologov dodatno dnevno obišče še veliko bolnikov z nujno ali hitro napotitvijo, zaradi dolgih čakalnih dob, s čemer pa se te še daljšajo
Paliativna oskrba bolnikov z rakom debelega črevesa in danke
Get PDFPalliative care of patients with advanced colorectal cancer represents a comprehensive care of incurably ill patients. This care includes symptom management as well as psychological, social and spiritual support. The most common symptoms in colorectal cancer patients who were referred to the acute palliative care unit of the Institute of Oncology Ljubljana were pain, severe general weakness, intestinal obstruction and difficulty breathing. Palliative treatment of symptoms may differ as the disease progresses. The main objective of measures in palliative care is to maintain the best possible quality of life. In early palliative care, more complex treatment approaches (palliative surgeries, palliative irradiation, etc.) may also be used to provide a better quality of life when the disease progresses. In late palliative care (last weeks of life), the main concern is to provide comfort and the best possible well-being for the dying patients and their close relatives.Paliativna oskrba bolnikov z napredovalim rakom debelega črevesa in danke je celostna oskrba neozdravljivo bolnega. Oskrba vsebuje obvladovanje simptomov ter pomoč pri obvladovanju psihičnih, socialnih in duhovnih težav. Najpogostejši simptomi, zaradi katerih so bili bolniki z rakom debelega črevesa in danke sprejeti na oddelek za akutno paliativno oskrbo Onkološkega inštituta v Ljubljani, so bili bolečina, huda splošna oslabelost, zapora črevesja ter težko dihanje. Paliativno zdravljenje simptomov se z napredovanjem osnovne bolezni lahko razlikuje. Glavni cilj ukrepov v paliativni oskrbi je vzdrževanje čim boljše kakovosti življenja. V zgodnji paliativni oskrbi so lahko ustrezni tudi kompleksnejši pristopi zdravljenja (paliativni kirurški posegi, paliativno obsevanje ), ki služijo boljši kakovosti življenja ob nadaljnjem napredovanju bolezni. V pozni paliativni oskrbi (zadnji tedni življenja) je glavna skrb za ugodje in čim boljše počutje umirajočega ter njegovih bližnjih
Zdravljenje posledic obsevanja male medenice s hiperbaričnim kisikom
Get PDFRadiation therapy is an important part of treatment of tumours of the pelvis minor. Late effects can develop months or years after treatment, and they occur in a severe form (RTOG grades 3 or 4) in 5-15% of irradiated patients. In the last few years, besides other invasive and non-invasive methods, radiotherapy-induced late complications have also been treated with hyperbaric oxygen therapy. Such treatment first proved successful in the treatment of osteonecrosis of the jaw, while in the last few years, the studies have confirmed that hyperbaric oxygen therapy is also effective in the treatment of post-radiation cystitis and proctitis. Hyperbaric oxygen therapy minimises the likelihood of complications, reduces the already developed symptoms and signs, and significantly improves the quality of life. In the last six years, only seven patients were treated with hyperbaric oxygen therapy at the Institute of Oncology Ljubljana for post-radiation injuries developed due to pelvic irradiation, although such treatment should be provided to 40-50 patients annually.Obsevanje predstavlja pomemben del zdravljenja tumorjev male medenice. Pozne posledice se lahko razvijejo od nekaj mesecev pa do več let po končanem zdravljenju in se vhudi obliki (3. ali 4. stopnje po lestvici RTOG) pojavijo pri 5 do 15 % obsevanih bolnikov. Poleg ostalih invazivnih in neinvazivnih metod se v zadnjih letih pri zdravljenju poznih zapletov obsevanja uporablja tudi zdravljenje s hiperbaričnim kisikom. Uspešnost tovrstnega zdravljenja je bila dokaza nanajprej za zdravljenje osteonekroze čeljustnice, v zadnjih letihpa so študije potrdile tudi uspešnost zdravljenja poobsevalnega cistitisa in proktitisa s hiperbaričnim kisikom. Zdravljenje s hiperbaričnim kisikom zmanjša verjetnost nastanka posledic, zmanjša že razvite simptome in znake ter pomembno izboljša kakovost življenja. V zadnjih šestih letih se je le 7 bolnikov Onkološkega inštituta Ljubljana zdravilo s hiperbaričnim kisikom zaradi poobsevalnih poškodb, ki so nastale zaradi obsevanja medenice, čeprav bi tovrstno zdravljenje letno potrebovalo 40 do 50 bolnikov. ; slv - slovensk
Kirurško zdravljenje melanoma
No full textFrom the treatment perspective, skin melanoma is a surgical disease, as surgery is a very important treatment modality for all stages of this disease. We distinguish between surgical treatments of primary lesions and regional, in-transit and distant metastases. Considering the primary lesion, we distinguish between diagnostic and wide (radical) excision, with the safety margin being up to 5 mm and 1-2 mm, respectively. Depending on their size, locoregional melanoma metastases are either clinically occult or clinically apparent. The first are detected with the help of sentinel lymph node biopsy and are afterwards treated in the same manner as clinically apparent metastases, namely with radical lymphadenectomy of the regional lymph node basin. In-transit metastases can be treated with a simple excision or, in cases of multiple metastases located on the extremities, with the help of technically demanding isolated limb perfusion or infusion. In a systematic assessment, surgical treatment is always the first choice if metastases can be removed completely.Kožni melanom je z vidika zdravljenja kirurška bolezen, saj kirurgija predstavlja zelo pomemben način zdravljenja pri vseh stadijih bolezni. Ločimo kirurško zdravljenje primarne lezije, regionalnih, in-transit in oddaljenih zasevkov. Pri primarni leziji ločimo diagnostično in široko (radikalno) ekscizijo. Varnostni rob je pri prvi do 5 mm, pri drugi pa med 1 do 2 cm, odvisno od debeline melanoma. Pri regionalnih zasevkih melanoma govorimo glede na njihovo velikost o klinično okultnih in klinično prepoznavnih zasevkih. Prve ugotovimo s pomočjo biopsije sentinel bezgavke in jih nato zdravimo tako kot klinično prepoznavne zasevke z radikalno limfadenektomijo regionalne bezgavčne lože. In-transit zasevke lahko zdravimo s preprosto ekscizijo ali pa v primerih, ko jih je več in so locirani na ekstremitetah s pomočjo tehnično zahtevnih izolirane ekstremitetne perfuzije ali infuzije. Pri sistemskem razsoju je kirurško zdravljenje vedno prvi izbor zdravljenja, v kolikor je možno zasevke odstraniti v celoti
Sistemsko zdravljenje melanoma
Get PDFMelanoma is a curable disease if detected early, but in its advanced stages, it remains incurable. Surgery is still the primary treatment for local, regional and isolated metastatic disease. The risk for disease recurrence is 50% in patients with melanoma thicker than 4 mm and 50-85% in patients with lymph node involvement, depending on the number of the involved lymph nodes. To reduce the number of disease recurrences in high-risk melanoma patients, they are treated adjuvantly with interferon-α (IFN-α). The IFN-α is effective if used in high doses. Patients undergoing such treatment are less likely to experience disease recurrence and their 5-year overall survival rate has improved by 24%. Treatment also has adverse effects that are controllable. Other medicines used in adjuvant treatment are not effective enough to significantly impact patients' survival. Metastatic melanoma is an incurable disease and patient survival is short despite treatment. Different schemes, in combination with either cytostatics alone or cytostatics with immunotherapy, induced more responses to treatment than monotherapy with cytostatics. However, they failed to prolong the survival of these patients, and resulted in a higher incidence of adverse effects. Monotherapy with the cytostatic dacarbazine thus remains the standard chemotherapy for treatment of patients with metastatic melanoma. In the last few years, clinical trials tested several new target drugs and immunotherapy. Ipilimumab and vemurafenib showed clinical effectiveness in terms of prolonging the time to disease progression and overall survival. Moreover, there are also several ongoing studies examining the effectiveness of different target drugs, antibodies and various combinations thereof.Melanom, če je odkrit dovolj zgodaj, je ozdravljiva bolezen, medtem ko v bolj napredovalih stadijih ostaja neozdravljiv. Kirurgija je še vedno osnovni način zdravljenja za lokalno, regionalno in izolirano metastatsko bolezen. Tveganje bolnikov z melanomom, debelejšim od 4 mm, za ponovitev bolezni je 50 %, bolnikov z zajetimi bezgavkami pa 50 do 85 % in je odvisno od števila zajetih bezgavk. Za to, da bi zmanjšali število ponovitev bolezni pri bolnikih z melanomom z velikim tveganjem, jih adjuvantno zdravimo z interferonom α (IFN α). IFN α je učinkovit, če ga uporabimo v visokih odmerkih. Tako zdravljeni bolniki imajo manj ponovitev bolezni in izboljšano 5-letno celokupno preživetje za 24 %. Zdravljenje ima tudi neželene učinke, ki pa so obvladljivi. Ostala zdravila v adjuvantnem zdravljenju niso toliko učinkovita, da bi značilno vplivala na preživetje. Metastatski melanom je neozdravljiva bolezen, kljub zdravljenju je preživetje bolnikov kratko. Različne sheme s kombinacijo tako citostatikov samih kot kombinacije citostatikov z imunoterapijo so dale več odgovorov na zdravljenje kot citostatiki v monoterapiji, vendar pa niso podaljšale preživetja teh bolnikov, več je bilo tudi neželenih učinkov. Tako citostatik dakarbazin v monoterapiji ostaja standardna kemoterapija zdravljenja bolnikov z metastatskim melanomom. V zadnjih letih je bilo v kliničnih raziskavah preizkušenih več novih tarčnih zdravil in imunoterapije. Klinično učinkovitost v podaljšanju časa do napredovanja bolezni in celokupnem preživetju sta izkazala ipilimumab in vemurafenib. V teku pa je še več raziskav o učinkovitosti različnih tarčnih zdravil, protiteles in najrazličnejših njihovih kombinacijah
Limfedem pri bolnikih z melanomom
Get PDFSecondary lymphoedema is one of the most common complications after the surgical treatment of malignancies. The incidence rate depends on the cancer site and therapeutic measures. It occurs in one third of all cancers, either due to the disease itself or because of the growth of metastases interfering with the lymphatic fluid drainage, due to lymphadenectomy or surgical removal of the primary tumour, where the surgical procedure can damage the lymphatic pathways, or as a result of fibrous changes to the tissue after radiotherapy, which also interferes with lymphatic fluid drainage. The incidence of lymphoedema is common in the treatment of melanoma, yet still unrecognised in Slovenia. If left untreated, lymphoedema often leads to recurrences of erysipelas and an enormous enlargement of a specific body part. Therefore, prevention and early detection of lymphoedema with referral for appropriate treatment are of utmost importance. To prevent late diagnosis and treatment of lymphoedema after cancer treatment and subsequent complications, the physician must actively look for signs and symptoms of lymphoedema during patient follow-up and immediately treat such patients or refer them for further treatment. To continue, it is even more important that the patient gets the information about the possibility of developing lymphoedema already during treatment of the primary disease, and that the patient detects the swelling early enough and reports it to his/her therapist who must then refer the patient for immediate lymphoedema treatment. The treatment consists of a decongestion phase, where the oedema is evacuated using different methods, most often compression therapy with short-stretch bandages, and a maintenance phase, where we maintain the non-oedematous state using medical compression aids.Po zdravljenju malignomov je eden izmed najpogostejših zapletov pojav sekundarnega limfedema. Pogostnost pojavljanja je odvisna od mesta rakavega obolenja in terapevtskih ukrepov. Pojavlja se pri eni tretjini vseh rakavih obolenj, ali zaradi samega obolenja oziroma razrasta metastaz, ki moti odtok limfne tekočine, ali zaradi limfadenektomije, ter operativne odstranitve primarnega tumorja, kjer operacija poškoduje limfne poti, ali kot posledica fibrozno spremenjenega tkiva po radioterapiji, kjer je prav tako moten limfni odtok. Pojavnost limfedema pri zdravljenju melanoma je pogosta, vendar pri nas še vedno neprepoznana. Nezdravljen limfedem pogosto vodi v ponovitve erizipelov in v enormno povečanje določenega predela telesa. Zato sta izredno pomembna preventiva in hitro prepoznavanje limfedema z napotitvijo na ustrezno zdravljenje. Da bi preprečili zapoznelo diagnozo in zdravljenje limfedema po zdravljenju raka ter posledične zaplete, mora zdravnik v času spremljanja bolnika aktivno iskati znake in simptome limfedema ter bolnike s težavami takoj zdraviti ali napotiti. Še pomembneje pa je, da bolnik že ob zdravljenju osnovne bolezni dobi ustrezne informacije o možnosti nastanka lifedema ter sam zazna že zgodnje otekanje in na to opozori svojega terapevta, ki nato bolnika napoti na čim prejšnje ustrezno zdravljenje limfedema. Zdravljenje se sestoji iz faze dekongestije, kjer z različnimi metodami, najpogosteje kompresijsko terapijo s kratkoelastičnimi povoji, evakuiramo edem. Tej fazi sledi vzdrževalna faza, kjer z medicinskimi kompresijskimi pripomočki vzdržujemo needematozno stanje
Melanom: zdravljenje z radioterapijo
Get PDFSurgery is the therapy of choice for melanoma. However, as it is non-radical, or if the histopathological examination shows presence of adverse predictive indicators, additional (adjuvant) treatment is necessary. Radiation therapy, either curative or palliative, proved to be effective. Moreover, if we follow the modern principles of the discipline and use advanced technology, it is also safe. Therefore, radiation therapy is today an indispensable part of the multidisciplinary management of melanoma patients.Ni abstrakta
Sledenje bolnikov z rakom debelega črevesa in danke po radikalnem zdravljenju
Get PDFAfter completed treatment, either surgical or combined treatment of colorectal carcinoma, it is necessary to follow up patients regularly and in accordance with the recommended protocol. The purpose of such follow-up is to detect the disease or its recurrence as early as possible, including pre-cancerous lesions or potential metachronous (newly developed) tumours which can be treated successfully at an early stage. Follow-up is important also for the treatment of late complications, it enables psychological support to the patients, and finally, we can also track and assess our own performance.
It is known that colorectal cancer recurs in 30 do 50% of patients. As many as 70% of recurrences are detected within the first two years, 80% in the first three years, and 90% or more disease recurrences are found within five years after surgery of the primary tumour. It has been shown that regular follow-up of patients after their treatment improves the outcome of their disease and reduces mortality in patients by 9% to 13%.
We must adapt it to each patient separately, taking into account both his age and general condition, stage of the disease, concurrent diseases, and further treatment possibilities in the event of a recurrence.Ni abstrakta
Bolnica s primarno razsejanim karcinomom danke z zasevki v jetrih: prikaz primera
No full textColorectal cancer (CC) is the most common cancer in Slovenia. According to the Cancer Registry of the Republic of Slovenia, a total of 1,450 people were diagnosed with colorectal cancer in Slovenia in 2008(1). The increasing incidence also means increasing morbidity, as in half of the patients, the disease is diagnosed when already at an advanced stage. Metastatic disease is incurable, but the prognosis and the survival of these patients have improved considerably, as in the last decade, with the use of new drugs, namely a combination of cytostatics (capecitabine, irinotecan, oxaliplatin) and target drugs (cetuximab, bevacizumab, panitumumab) we have achieved a median survival of more than 30 months(2). When combining systemic and surgical treatment in patients with liver metastases, in particular if these are solitary metastases, the 5-year survival can exceed 50%.
In this paper, we present a case of a patient with primary metastatic rectal carcinoma with metastases in the liver. Within the framework of a multidisciplinary approach with a combination of systemic therapy and multiple surgeries of liver metastases, and using also other therapeutic approaches, we have achieved a survival of more than 50 months.Rak debelega črevesa in danke (RDČD) je najpogostejši rak v Sloveniji. Po podatkih Registra raka Slovenije za leto 2008 je v Sloveniji zbolelo 1.450 ljudi(1). Z naraščajočo incidenco narašča tudi umrljivost bolnikov, saj bolezen pri polovici bolnikov še vedno ugotovimo v napredovali obliki. Razsejana bolezen je neozdravljiva bolezen, sta se pa prognoza in preživetje teh bolnikov močno izboljšala, saj zadnjih deset let z uporabo novih zdravil, to je kombinacijo citostatikov (kapecitabin, irinotekan, oksaliplatin) in tarčnih zdravil (cetuksimab, bevacizumab, panitumumab), dosegamo srednja preživetja, ki so daljša od 30 mesecev(2). Kadar kombiniramo sistemsko in kirurško zdravljenje pri bolnikih s samo jetrnimi zasevki, še posebej, če gre za solitarne zasevke, pa 5-letno preživetje lahko presega 50 %. V tem prispevku opisujemo primer bolnice s primarno razsejanim karcinomom danke z zasevki v jetrih, kjer smo v okviru multidisciplinarnega pristopa, s kombinacijo sistemske terapije in večkratne operacije jetrnih zasevkov ter tudi drugimi terapevtskimi pristopi dosegli preživetje, daljše od 50 mesecev
Kirurško zdravljenje raka debelega črevesa
Get PDFThe extent of resection for colon cancer depends on the tumour site and vascular anatomy. Lymphatic drainage is applied along the veins in one, two or three directions, where cancer might metastasise. In surgery, it is necessary to maintain a safety margin proximally and distally to the tumour and to remove the potentially affected locoregional lymph nodes. The aim of surgical treatment is radical resection (R0), which is the only potentially curative treatment for this disease.Obseg resekcije debelega črevesa zaradi raka je odvisen od mesta tumorja in vaskularne anatomije. Limfna drenaža poteka ob žilah v eni, dveh ali treh smereh, kamor rak lahko zaseva. Pri operaciji moramo doseči zadosten varnostni rob proksimalno in distalno od tumorja ter odstraniti potencialno prizadete področne bezgavke. Cilj kirurškega zdravljenja je radikalna resekcija (R0), ki edina nudi možnost ozdravitve