Onkologija
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Zdravljenje metastatskega malignega melanoma z vemurafenibom: klinični primer
Get PDFIn Slovenia, just like everywhere else in the world, we are witnessing an upward trend in the incidence of malignant melanoma of the skin. According to the data from the 2009 Cancer Registry of Slovenia, Slovenia recorded 298 and 415 new cases of malignant melanoma in the years 2000-2004 and 2005-2009, respectively. It is estimated that in 2012, there were 555 new cases of malignant melanoma. This melanoma is more common in women than in men, and it represents the sixth most common malignancy in women and the eight most common malignancy in men (1).
A multidisciplinary approach in the treatment of malignant melanoma is necessary to ensure the best possible outcome for the patient. Collaboration between the dermatologist, surgeon, pathologist, medical oncologist and radiotherapy specialist is important and necessary. The most important are prevention and early detection, because it is crucial to detect the disease soon early, when it is still curable. The higher the stage of the disease at detection, the greater the likelihood of distant metastases when the disease becomes incurable. This happens in more than 50% of patients with stage 3 malignant melanoma. Median survival for metastatic disease is short (6-9 months), and until the use of newer medicines, it rarely exceeded 12 months (2). However, new hope for patients comes with new targeted therapies, such as vemurafenib and ipilimumab, which, according to the currently available data, provide better response rates and prolong the survival of patients with metastatic malignant melanoma as opposed to cytostatic drugs (3, 4).
In our clinical case, we present a patient with metastatic malignant melanoma who has been treated with a number of lines and types of systemic therapy, including vemurafenib, a selective inhibitor of the oncogenic BRAFV600E mutant kinase.Ni abstrakta
Slikovne preiskave pri bolnikih z malignim melanomom
Get PDFImaging is performed in patients with malignant melanoma (MM):
1. To stage the disease
2. During follow-up
3. In disease recurrenceNi abstrakta
Biopsija resektabilnih jetrnih zasevkov raka debelega črevesa in danke: nepotrebna in nevarna metoda
Get PDFIf in the patient who underwent surgery for colorectal cancer (CC) a newly developed tumour is detected in the liver, it is possible to assume immediately that it is a metastasis. Moreover, it is possible to confirm the diagnosis with 99% probability based on imaging and biochemical screening. Despite this some insist that diagnosis needs to be confirmed with percutaneous core needle biopsy (PCNB). With a review of the literature and an analysis of our series of patients, we will try to show why this procedure is unnecessary and dangerous in patients with resectable liver metastases of CC.Če se pri bolniku, ki je bil operiran zaradi raka debelega črevesa in danke (RDČD), na novo pojavi tumor v jetrih, je mogoče že na podlagi tega sklepati, da gre za zasevek. Še več, diagnozo je mogoče z 99 % verjetnostjo potrditi na podlagi slikovnih in biokemičnih preiskav. Kljub temu nekateri vztrajajo, da je za potrditev diagnoze potrebna perkutana tankoigelna biopsija (PTB). Nepotrebnost in nevarnost tega postopka pri resektabilnih jetrnih zasevkih RDČD bomo poskušali utemeljiti s pregledom literature in analizo naše serije bolnikov
Biopsija resektabilnih jetrnih zasevkov raka debelega črevesa in danke: prispevek s številnimi pomanjkljivostmi
Get PDFThis year's last issue of the journal Onkologija included an article entitled “Biopsy of resectable liver metastases of colorectal cancer – an unnecessary and dangerous method”. In this article, the authors warn against the use of fine-needle biopsy (FNB) of liver metastases of colorectal cancer (CC), as this procedure could threaten the survival of patients. In this article, we want to highlight the shortcomings of the previously mentioned article and warn against the sensational title of the poorly written article which imposes its message on the readers without any clear justification.ni abstrakta
Kirurško zdravljenje raka dojk pri starejših od 80 let: koliko je dovolj?
Get PDFThe population of older people is increasing and so is the population of breast cancer patients aged 80 years or older. Unfortunately there is no consensus or recommendations on how to treat older breast cancer patients. The aim of our retrospective study was to identify the most appropriate surgical treatment of breast cancer in patients aged 80 years or older and to determine their survival. We reviewed the medical records of 154 patients with early-stage breast cancer (mean age of 83 years; ranging from 80 to 90 years), who underwent surgery at the Institute of Oncology Ljubljana in the period from 2000 to 2008 when they were aged 80 years or older. We collected data on the extent of the disease, pathomorphology of the tumour, treatment method, extent of breast and axillary lymph node surgery, disease recurrence, cause of death, length of survival, and length of survival for breast cancer. Using univariate and multivariate analyses, we also determined the correlation between prognostic factors, type of treatment and survival. Breast cancer was growth in the breast in 28%, whereas 47% of patients were diagnosed with regional metastases, and the extent of the disease was unknown in 25%. 75% of patients were staged as pT1/pT2, while 25% had stage pT3/pT4 tumours. Surgical treatment comprised: quadrantectomy (in 27%), mastectomy (in 73%), axillary dissection (in 57%), sentinel lymph node biopsy (in 18%), and 25% of patients had no axillary surgery. A total of 88% of patients received adjuvant hormonal treatment (tamoxifen - 53 patients, aromatase inhibitor - 45 patients, a combination of both - 37 patients), while 1.3% of patients were treated with cytostatics, and 16% underwent biopsy. During follow-up of 0.1 to 11 years (median 4.45 years), disease recurrence was observed in 23%. Local recurrence of the disease was observed in 10%, regional recurrence in 6% and distant metastases in 23%. Five-year survival for breast cancer was 90% in locally limited cancer and 62% in regionally advanced cancer. One of the patients died on the first day after surgery due to a myocardial infarction. A total of 19% of all patients died of breast cancer, and 12% died of other causes. The univariate analysis showed that the length of survival of breast cancer patients was correlated with the following factors: treatment with hormones before surgery, pathological T-stage, pathological N-stage, breast surgery, lymph node surgery, oestrogen receptors, degree of tumour differentiation, radicality of surgery, and surgical treatment according to the established guidelines. Using the multivariate statistical analysis, we found that the pathological T-stage, pathological N-stage and oestrogen receptors were independent prognostic factors for the duration of survival of breast cancer patients. The results of our multivariate analysis show that surgeons adjusted the extent of operative treatment according to the stage of the disease and the general condition of the patient. Short survival for breast cancer indicates that, in patients aged 80 years or older, breast cancer with metastases in axillary lymph nodes can be a very aggressive disease.Populacija starejših ljudi se veča, zato se povečuje tudi število bolnic z rakom dojke, ki so starejše od 80 let. Žal ni enotnega mnenja oziroma strokovnih priporočil o tem, kako zdraviti starejše bolnice z rakom dojk. Namen naše retrospektivneštudije je bil ugotoviti, kako kirurško zdravimo raka dojk pri bolnicah, starih 80 let ali več in kakšno je njihovo preživetje.Pregledali smo popise bolezni 154 bolnic z začetnim rakom dojke (povprečna starost 83 let; razpon od 80 do 90 let), ki so bile na Onkološkem inštitutu Ljubljana operirane vobdobju od leta 2000 do leta 2008 in so bile ob operaciji stare 80 let ali več. Zbrali smo podatke o obsegu bolezni, patomorfoloških značilnostih tumorja, načinu zdravljenja,obsegu operacije dojke in pazdušnih bezgavk, ponovitvi bolezni, vzroku smrti, dolžini preživetja in dolžini preživetjaglede raka dojk. Z univariatno in mutivariatno analizo smo ugotavljali povezavo med prognostičnimi dejavniki, vrsto zdravljenja in preživetjem glede raka dojk. Rak dojke je bilomejen na dojko v 28 %, v 47% so bili prisotni regionalni zasevki, obseg bolezni pa ni bil znan v 25 %. Tumorski stadij pT1/pT2 je imelo 75 % bolnic, pT3/pT4 pa je imelo 25 %bolnic. Kirurško zdravljenje je obsegalo: kvadrantektomijov 27 %, mastektomijo v 73 %, izpraznitev pazduhe v 57 %,biopsijo varovalne bezgavke v 18 %, brez posega v pazduho pa je bilo 25 % bolnic. Adjuvantno hormonsko zdravljenje je imelo 88 % bolnic (tamoxifen 53, aromatazni inhibitor 45,kombinacija obeh 37 bolnic), zdravljenje s citostatiki je imelo1,3 % bolnic, obsevanih pa je bilo 16 % bolnic. Ponovitev bolezni smo dokazali v 23 %, v času sledenja od 0,1 do 11 let(mediana 4,45 leta). Lokalno ponovitev bolezni smo dokazali v 10 %, reginalno v 6 % in oddaljene zasevke v 23 %. Petletno preživetje glede raka dojk je bilo pri lokalno omejenem raku 90 %, pri regionalno razširjenem pa 62 %. Ena od bolnicje umrla prvi dan po operativnem posegu zaradi srčnega infarkta. Zaradi raka dojk je umrlo 19 % bolnic, zaradi drugih vzrokov pa 12 % bolnic. Univariatna analiza je pokazala, da so bili z dolžino preživetja zaradi raka dojk povezani naslednji dejavniki: zdravljenje s hormoni pred operacijo, patološki Tstadij, patološki N stadij, operacija dojke, odstranitev vsehpazdušnih bezgavk, operacija bezgavk, estrogenski receptorji,stopnja diferenciacije tumorja, radikalnost kirurškega posega in kirurško zdravljenje v skladu s smernicami. Z multivariatnostatistično analizo smo ugotovili, da so bili patološki T stadij, patološki N stadij in estrogenski receptorji neodvisni prognostični dejavniki za dolžino preživetja zaradi raka dojk. Rezultati naše multivariatne analize kažejo, da so kirurgi ustrezno prilagodili obseg operativnega zdravljenja stadiju bolezni in splošnemu stanju bolnice. Kratko preživetje glede raka dojk je pokazatelj tega, da je rak dojke z zasevki v pazdušnih bezgavkah pri bolnicah, starih 80 let ali več, lahko agresivna bolezen. ; slv - slovensk
Slikovne preiskave pri raku debelega črevesa in danke
Get PDFAccording to the adopted Guidelines for the Management of Patients with Colorectal Cancer, US of the abdomen and x-ray of chest organs are sufficient in investigating patients with newly detected colorectal carcinoma.
If suspecting remote metastases, it is necessary to perform computed tomography (CT) of the chest and abdomen. Prior to the examination, the patient must take 1,000 ml of dilute contrast agent, after i.v. application of an ionic contrast agent. Imaging of the chest and, after 25 to 30 sec, the upper abdomen is performed, followed by imaging of the abdomen in the portal phase of liver opacification (70 sec after contrast agent application). Usually, we perform 5-mm reconstructions are performed in the transverse, coronal and sagittal planes, and also 10-mm MIP reconstructions.
Using CT, we are able to assess the size and position of the tumour, extension of the tumour into the adjacent structures, presence of pathologically altered lymph nodes and remote metastases.Ni abstrakta
Napredek zdravljenja bolnikov z razsejanim rakom debelega črevesa in danke z vidika internista onkologa
Get PDFMetastatic colorectal cancer is in the majority of cases still an incurable disease, but the prognosis and the survival of these patients have improved considerably in the last decade. From the median survival of 10 months achieved with 5-fluorouracil, which had been, until few years ago, the only effective drug for the treatment of these patients, we have obtained survival times of more than 20 months as a result of treatment with new cytostatic drugs. In the last ten years, six new drugs were registered for the treatment of metastatic colorectal cancer: cytostatics – capecitabine, irinotecan, oxaliplatin, and target drugs – cetuximab, bevacizumab and panitumumab. Combined treatment assures a better quality of life and longer remissions, and also increased overall survival. Combining cytostatics with target drugs further improves the median survival of these patients, and patients undergoing treatment have a median survival of more than 30 months. Such treatment in combination with surgery of lung or liver metastases also enables remissions. Identification of mutations in the KRAS gene is of utmost importance. For colorectal cancer, the KRAS gene is the first biomarker that predicts the response of patients to treatment with EGFR inhibitors.Metastatski rak debelega črevesa in danke je v večini primerov še vedno neozdravljiva bolezen, vendar pa sta se prognoza ter preživetje teh bolnikov močno izboljšala v zadnjem desetletju. Od srednjega desetmesečnega preživetja, ki smo ga dosegali z zdravljenjem s 5-fluorouracilom, ki je bilo do pred nekaj leti edino učinkovito zdravilo za zdravljenje teh bolnikov, smo prešli na preživetja daljša od 20 mesecev, kar so omogočila nova citostatska zdravila. V zadnjih desetih letih je bilo registriranih šest novih zdravil za zdravljenje matastatskega raka debelega črevesa in danke: citostatiki - kapecitabin, irinotekan, oksaliplatin in tarčna zdravila - cetuksimab, bevacizumab in panitumumab. Kombinirano zdravljenje omogoča boljšo kakovost življenja in daljše remisije, s tem pa tudi daljša celotna preživetja. Uporaba kombinacije citostatikov s tarčnimi zdravili vodi še v nadaljnje podaljšanje srednjega preživetja teh bolnikov, tako zdravljeni bolniki imajo srednja preživetja daljša od 30 mesecev. Tovrstno zdravljenje, v kombinaciji z operacijo pljučnih ali jetrnih zasevkov, pa omogoča tudi zazdravitve. Pomembno je določanje mutacij na genu KRAS. Za kolorektalni rak je gen KRAS prvi biomarker, ki napoveduje, kako se bodo bolniki odzvali na zdravljenja z EGFR inhibitorji. ; slv - slovensk
Smernice za obravnavo bolnic z rakom materničnega vratu v Sloveniji: povzetek
Get PDFNo abstract.Ni abstrakta
Rastlinske celice v urinu pri bolnikih z Brickerjevim mehurjem
Get PDFCytology samples occasionally reveal different contaminants, such as talc, crystals and cotton wool strings. The routine examination of cytology urine samples to confirm malignancy occasionally showed contamination with plant cell. We have established that they were present only in patients with a Bricker ileal conduit. Urine preparations for the routine cytopathological examination were prepared with membrane filtration, fixed in Delaunay solution and stained according to Papanicolaou. They were examined using the light microscope. We also prepared adhesives preparations made by the companies Coloplast and ConvaTec, which are used by the ostomist to attach the bag on the urostomy. Plant cells were found only in the Coloplast adhesives. Morphologically, they were equal to the plant cells found in the urine of patients with a Bricker ileal conduit. To continue, we also provided preparations from different substances, namely adhesives components. Plant cells were present only in the preparations of guar gum, which is produced from Cyamopsis Tetragonoloba seeds. The size, shape and colour of plant cells differed from those of epithelial intestinal cells. The latter are present in the urine of patients with a Bricker ileal conduit, thus even an inexperienced cytotechnologist would have difficulty confusing them with dysplastic human cells. Nevertheless, it is important to take knowledge of all elements found in cell samples and to provide an explanation for sample contamination in the event of unusual findings, such as plant cells.V citoloških vzorcih občasno opazimo različne kontaminante, kot so smukec, kristali in nitke bombažne vate. Pri rutinskem pregledovanju citoloških vzorcev urina za malignost smo občasno opazili kontaminacijo preparatov z rastlinskimi celicami. Ugotovili smo, da so bile prisotne samo pri bolnikih, ki so imeli narejen obvod urina po Brickerju. Preparate urina za rutinsko citopatološko preiskavo smo pripravili z membransko filtracijo, jih fiksirali v Delaunayu in jih pobarvali po Papanicolaouu. Pregledali smo jih s svetlobnim mikroskopom. Pripravili smo tudi preparate iz kožnih podlog podjetij Coloplast in ConvaTec, ki jih stomisti uporabljajo za pritrditev vrečke na urostomo. Samo v Coloplastovih kožnih podlogah smo našli rastlinske celice, ki so bile morfološko enake rastlinskim celicam v urinu bolnikov z Brickerjevim mehurjem. Pripravili smo tudi preparate iz različnih snovi, ki so sestavni del kožnih podlog. Rastlinske celice so bile prisotne samo v preparatih guar gumija, ki ga pridobivajo iz semen rastline Cyamopsis tetragonoloba. Rastlinske celice so se po velikosti, obliki in barvi močno razlikovale od epitelijskih črevesnih celic, ki so prisotne v urinu bolnikov z Brickerjevim mehurjem, zato bi jih tudi neizkušen presejalec težko zamenjal z displastičnimi človeškimi celicami. Pomembno pa je, da vse elemente, ki jih najdemo v celičnih vzorcih, prepoznamo in da pri neobičajnih najdbah, kot so rastlinske celice, tudi razložimo, kako je prišlo do kontaminacije vzorca