Onkologija
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Samoodvzem vaginalnega vzorca za test HPV pri neodzivnicah presejalnih programov raka materničnega vratu
Get PDFBackground: In well-organised cervical cancer screening programmes in Europe and also in Slovenia, the majority of new cases of cervical cancer occur in those women who do not attend regular screening. Seeking new ways to increase coverage of the target population has thus become one of the key challenges. According to the findings of the meta-analyses, the best method is to invite the non-responders to perform vaginal self-sampling for the detection of high-risk human papillomavirus infection (HPV testing) at home. We were interested in the effectiveness of this approach in detecting pre-cancerous and early cancerous lesions of the cervix compared to the existing approaches.
Methods: A systematic review of the results of studies published in the field of HPV self-sampling within organised screening programmes in Europe.
Results: The two main results were the proportion of women who performed HPV self-sampling at home and the detection rate of the severe pre-cancerous lesions or cervical cancer. The additional results were the types of testers and methods of analyses used in the studies, quality of self-samples, prevalence of HPV among women who performed self-sampling, and participation of HPV-positive women in further diagnostics.
Conclusions: Alternative screening of non-responders by HPV self-sampling at home is currently the most promising approach to increase screening rates in order to enable further decrease of cervical cancer incidence in well organised cervical screening programmes. However, as the results differ between studies and countries, it is necessary to conduct a pilot study in an environment where regular screening takes place, before upgrading the existing screening programme.Ozadje in namen: V dobro organiziranih presejalnih programih raka materničnega vratu v Evropi in tudi Sloveniji se večina novih primerov raka materničnega vratu pojavlja pri tistih ženskah, ki se presejalnih pregledov ne udeležujejo redno. Iskanje novih načinov za povečanje pregledanosti ciljne populacije postaja zato eden vodilnih izzivov na tem področju. Po izsledkih preglednih raziskav in metaanaliz je najučinkovitejša metoda za povečanje odzivnosti vabilo neodzivnicam za samoodvzem vaginalnega vzorca za odkrivanje okužbe z visokotveganimi humanimi papilomskimi virusi (test HPV) na domu. Zanimalo nas je, kako učinkovita je ta metoda pri odkrivanju predrakavih in zgodnjih rakavih sprememb materničnega vratu v primerjavi z obstoječimi pristopi k neodzivnicam organiziranih presejalnih programov.
Metode: Sistematični pregled rezultatov objavljenih raziskav na področju presejanja neodzivnic rednih organiziranih presejalnih programov v Evropi, z metodo samoodvzema vaginalnega vzorca za test HPV na domu.
Rezultati: Glavna rezultata raziskav sta odzivnost žensk, ki so na dom prejele tester za samoodvzem, in delež odkritih hudih predrakavih sprememb ali raka materničnega vratu (CIN 2+). Dodatni rezultati so vrste v raziskavah uporabljenih testerjev in metod analize testov HPV, kakovost samoodvzetih vzorcev, prevalenca HPV v skupini žensk, ki so opravile samoodvzem vaginalnega vzorca, in udeležba v presejanju HPV-pozitivnih žensk v nadaljnji diagnostiki.
Zaključek: Številne raziskave enotno kažejo, da je za povečanje pregledanosti v dobro organiziranih presejalnih programih in nadaljnje zmanjšanje incidence raka materničnega vratu najbolj obetaven pristop alternativno presejanje neodzivnic s samoodvzemom vaginalnega vzorca za test HPV na domu. Ker pa se rezultati med raziskavami in državami razlikujejo, je treba pred nadgradnjo obstoječega presejalnega programa novo metodo pilotno preveriti v ciljni skupini neodzivnic programa v okolju, v katerem se izvaja redno presejanje
Spregledana korist neoadjuvantne kemoterapije v zdravljenju mišično invazivnega raka sečnega mehurja
Get PDFUrinary bladder cancer is the third most frequent malignancy of the genitourinary tract, and its incidence and mortality have been increasing in Slovenia. Loco-regional treatment is key in radical treatment of the muscle-invasive cancer of the urinary bladder, and systemic chemotherapy treatment may provide additional benefits to the patients. Phase III clinical trials have demonstrated a significant prolongation of the overall survival of patients treated with neoadjuvant cisplatin-based combination chemotherapy. However, neoadjuvant chemotherapy has not yet been established sufficiently in everyday clinical practice, despite its clearly demonstrated effectiveness. Every patient with muscle-invasive cancer of the urinary bladder, who is receiving treatment with a curative intent and is a candidate for systemic treatment, should be informed of the possibility of receiving neoadjuvant chemotherapy treatment.Rak sečnega mehurja predstavlja tretji najpogostejši malignom genitourinarnega trakta, incidenca in umrljivost za rakom sečnega mehurja pa sta v Sloveniji v porastu. V radikalnem zdravljenju mišično invazivnega raka sečnega mehurja je ključnega pomena lokoregionalno zdravljenje, bolniki pa so lahko deležni tudi dodatnih koristi od sistemskega zdravljenja s kemoterapijo. Klinične raziskave faze III so pokazale pomembno podaljšanje skupnega preživetja bolnikov, ki so bili zdravljeni s kombinirano neoadjuvantno kemoterapijo na osnovi cisplatina. Kljub njeni jasno dokazani učinkovitosti se neoadjuvantna kemoterapija v vsakodnevni klinični praksi širom po svetu ni uveljavila v zadostni meri. Vsak bolnik z mišično invazivnim rakom sečnega mehurja, ki je zdravljen z namenom ozdravitve in je kandidat za sistemsko zdravljenje, bi moral biti seznanjen z možnostjo zdravljenja z neoadjuvantno kemoterapijo
Klinične poti onkološkega genetskega svetovanja in testiranja na Onkološkem inštitutu Ljubljana
Get PDFFour clinical pathways for patient management have been prepared within the scope of the Cancer Genetic Counselling and Testing Clinic. In the preparation of clinical pathways, we focused on the patient as the basic guideline for the establishment of the management algorithm. The objectives of clinical pathways for cancer genetic counselling and testing do not differ from clinical pathways in other areas. They represent the basis for equal management of patients, the basis for improving continuously the quality of management, and they also enable the measurement of management effectiveness. The health care system considers the safe and quality treatment of each patient to be the highest value and priority of all providers of health services. The manner in which the health services are provided is of utmost importance: the approach to patient management must be based on scientific evidence and uniform within each single health organisation. Such approach is enabled by the use of clinical pathways.
Patient management has been changing continuously, depending on the management doctrine. Within the framework of multi-disciplinary meetings, it is also subject to constant amendments and improvements. The clinical pathways for cancer genetic counselling are being improved continuously, thus they are not a static document but a live substance constructed daily to improve the quality of patient management.Ni abstrakta
Odkrivanje dednega sindroma von Hippel-Lindau: določanje mutacij v genu VHL
Get PDFThe Department of Molecular Diagnostics at the Institute of Oncology Ljubljana has introduced testing of mutations in the von Hippel-Lindau (VHL) suppressor gene. Mutations in this gene increase the probability for the development of cancerous diseases associated with the »von Hippel-Lindau« (VHL) syndrome and also the development of sporadic kidney cancer. Testing of hereditary mutations in patients suspected of having the VHL syndrome enables early and correct diagnosis of the disease. Presence of a mutation in the VHL gene is sufficient to confirm the diagnosis of VHL syndrome also in the absence of typical tumours. It is tested using the direct sequencing method and the MLPA multiplex ligation-dependent probe amplification) method. While sequencing allows us to detect point mutations and small deletions and insertions, the MLPA method is used to detect the presence of large deletions and insertions in the gene or a deletion of the entire gene. Timely detection of mutations in genes associated with the development of cancer is important for the carriers of mutations, as a proven mutation is a reason for an adapted clinical monitoring and/or preventive measures in mutation carriers. This results in increased possibilities for the prevention and early detection of cancer.Na Oddelku za molekularno diagnostiko Onkološkega inštituta Ljubljana smo uvedli testiranje mutacij v tumorskem supresorskem genu von Hippel-Lindau (VHL). Mutacije v tem genu povečajo verjetnost za nastanek rakastih bolezni, povezanih s sindromom »von Hippel-Lindau« (VHL), kakor tudi z nastankom sporadičnega raka ledvic. Testiranje dednih mutacij pri bolnikih s sumom na sindrom VHL omogoča zgodnjo pravilno diagnozo bolezni. Prisotnost mutacije v genu VHL je dovolj za potrditev diagnoze sindroma VHL tudi ob odsotnosti značilnih tumorjev. Za testiranje prisotnosti mutacij v genu VHL uporabljamo metodo neposrednega sekvenciranja in metodo MLPA (ang. multiplex ligation-dependent probe amplification). S sekvenciranjem odkrivamo točkovne mutacije in manjše delecije ter insercije. Z metodo MLPA pa prisotnost večjih delecij in insercij v genu oziroma delecijo celotnega gena. Pravočasno odkrivanje mutacij v genih, povezanih z nastankom raka, je za nosilce mutacij pomembno, saj je dokazana mutacija razlog za prilagojeno klinično spremljanje in/ali preventivne ukrepe pri nosilcih mutacije. Posledično so zaradi tega povečane možnosti za preprečevanje ali zgodnejše odkrivanje raka
Samo ozdravljenje ni dovolj: prikaz primera
No full textAdvances in the treatment of malignancies in children have improved their survival rates. However, the recovery may eventually be followed by the development of adverse late effects of treatment. These changes, which are often asymptomatic, may be detected on time only if the patients are monitored regularly even after they have completed their treatment. The article presents a case of a patient who was irradiated in childhood and treated with chemotherapy, dying at a young age with signs of cardiac dysfunction, which was most likely a result of cancer treatment. Cardiac changes were diagnosed only at autopsyZ izboljšanjem zdravljenja malignomov pri otrocih se je izboljšalo njihovo preživetje, vendar se po ozdravitvi sčasoma lahko razvijejo škodljive pozne posledice zdravljenja. Te spremembe, ki so pogosto asimptomatske, lahko pravočasno odkrijemo le, če bolnike redno spremljamo tudi po končanem zdravljenju. V prispevku predstavljamo primer bolnika, ki je bil v otroštvu obsevan in zdravljen s kemoterapijo, umrl pa je mlad z znaki srčne okvare, h kateri je verjetno prispevalo onkološko zdravljenje. Spremembe na srcu je pokazala šele obdukcija
25. Onkološki vikend: Raziskovanje v onkologiji in Priporočila za obravnavo kaheksije pri bolnikih z rakom
Get PDFNo abstract.Ni abstrakta
Prediagnosticiranje
Get PDFIn this article we will describe a phenomenon in cancer medicine known as overdiagnosis. As there is still no official Slovenian translation for this term, a Slovenian term “prediagnosticiranje” is used in the article, specifying cancer that does not cause symptoms or death if undiagnosed. This requires two conditions: an existence of a larger sub-clinical cancer base and active detection of this base, screening. Randomised studies have provided estimates of overdiagnosis in screening, being: 25% for breast cancer, 50% for lung cancer, and more than 60% for prostate cancer. Restrospective studies and population statistics show overdiagnosis of neuroblastoma, thyroid cancer, kidney cancer and melanoma. Therefore, the patients must be informed of the size of the problem and the possible negative effects of treatment of this disease, which might otherwise never have affected them at all. Thus, it would be necessary to provide better estimates of overdiagnosis frequency and discover the methods to minimise this problem.V tem prispevku bomo opisali pojav pri raku, ki ga po angleško imenujemo overdiagnosis. Za izraz še ni uradno sprejetega slovenskega prevoda, v tem prispevku pa bomo uporabili izraz prediagnosticiranje, ki označuje raka, ki ne bi povzročil simptomov ali smrti, če ne bi bil diagnosticiran. Za to sta potrebna 2 pogoja: obstoj večje baze subkliničnega raka in aktivno odkrivanje te baze, presejanje. Ocena prediagnosticiranja pri presejanju je znana iz randomiziranih študij: 25 % za raka dojk, 50 % za pljučnega raka in več kot 60 % za raka prostate. Retrospektivne študije in populacijska statistika kažejo na prediagnosticiranje pri nevroblastomu, ščitničnem raku, raku ledvic in melanomu. Zato je treba bolnike seznaniti z velikostjo problema in možnostmi negativnih učinkov zdravljenja bolezni, ki jih morda ne bi nikoli prizadela. Pogostost prediagnosticiranja bi bilo treba bolje oceniti in odkriti metode, s katerimi bi ta problem zmanjšali
Klinično preizkušanje novih vrst zdravljenja v onkologiji: zahtevajmo več!
Get PDFIn phase III randomised clinical trials (RCT), which are more and more often sponsored by profit-oriented pharmaceutical companies, the researchers compare the new anti-cancer treatments with the standard ones. If the new treatment proves to be more effective in the RCT, it is usually approved for use in daily clinical practice. As health care professionals, we are obliged to provide critical evaluations of new treatments and demand transparency of their benefits. The transparency of the indicated benefits of new anti-cancer treatments can be additionally improved by providing access to clinical research protocols, based on which the new treatments are approved for use, and impartial reports on their adverse effects. The researchers and sponsors should conduct updated and secondary analyses of RCT more often, as they might be a source of additional significant findings.V randomiziranih kliničnih raziskavah faze III (RKR), ki jih vse pogosteje sponzorirajo k dobičku naravnane farmacevtske družbe, raziskovalci primerjajo nova protirakava zdravljenja s standardnimi. Če se v RKR novo zdravljenje izkaže za učinkovitejše, je običajno odobreno za uporabo v vsakodnevni klinični praksi. V vlogi zdravstvenih strokovnjakov smo dolžni kritično vrednotiti nova zdravljenja in zahtevati preglednost njihovih prikazanih koristi. Z možnostjo dostopa do protokolov kliničnih raziskav, na podlagi katerih so nova zdravljenja odobrena za uporabo, in z nepristranskim poročanjem o njihovih škodljivih učinkih lahko dodatno izboljšamo preglednost prikazanih koristi novih protirakavih zdravljenj. Raziskovalci in sponzorji bi morali pogosteje opravljati posodobljene in sekundarne analize RKR, saj so lahko vir dodatnih pomembnih izsledkov
Poraba zdravil v zadnjih šestih dneh življenja in njihova finančna ocena
Get PDFPalliative care offers numerous benefits to the incurably ill patients. In the last days before death, patients may experience 5 most frequent symptoms (pain, nausea and vomiting, restlessness and confusion, dyspnea, increased secretion from the respiratory tract), which are alleviated by medicines prescribed in advance. The purpose of the retrospective research was to determine the differences in the use of medicines in the last 6 days of life among patients in palliative care who were managed by the palliative care team and patients managed at other departments of the Institute of Oncology without the help of the palliative care team (control group). Each group consisted of 25 patients; the groups were comparable with regard to the primary tumour site and age of the patients. We have established that the majority of patients in both groups received strong opioids, while more patients in palliative care also received other medicines for the relief of symptoms (haloperidol, midazolam, dexamethasone, butylscopolamine, metoclopramide). On average, the patients in palliative care were given 10 different active substances, and the control group received 14. The cost of medicines in the palliative care group of patients was 15 € per patient per day, which was 2.7 times lower than in the control group, where the cost of medicines amounted to 42 € per patient per day. The difference in the costs was primarily a result of the unnecessary prescribing of low-molecular heparins, systemic antibiotics and antimycotics, and parenteral nutrition.Paliativna oskrba prinaša neozdravljivo bolnim mnoge prednosti. V zadnjih dnevih pred smrtjo se lahko pojavi 5 najpogostejših simptomov (bolečina, slabost in bruhanje, nemir in zmedenost, dispneja, povečan izloček dihalnih poti), ki jih blažimo z vnaprej predpisanimi zdravili. Namen retrospektivne raziskave je bil ugotoviti razlike v porabi zdravil v zadnjih 6 dnevih med bolniki v paliativni oskrbi, ki jih je vodil tim za paliativno oskrbo, in bolniki, ki so bili vodeni na drugih oddelkih Onkološkega inštituta in paliativni tim v njihovo oskrbo ni bil vključen (kontrolna skupina). V vsaki skupini je bilo po 25 bolnikov; skupini sta bili primerljivi glede na mesto primarnega tumorja in starost bolnikov. Ugotovili smo, da je večina bolnikov v obeh skupinah prejemala močne opioide, druga zdravila za blaženje simptomov (haloperidol, midazolam, deksametazon, butilskopolamin, metoklopramid) pa je prejelo več bolnikov v paliativni oskrbi. Bolniki v paliativni oskrbi so v povprečju prejeli 10 različnih zdravilnih učinkovin, v kontrolni skupini pa 14. Stroški za zdravila so bili 2,7-krat manjši v skupini bolnikov, vključenih v paliativno oskrbo, in so znašali 15 € na bolnika na dan, medtem ko so za bolnika v kontrolni skupini znašali 42 € na dan. Razlika v stroških je bila predvsem posledica nepotrebnega predpisovanja nizkomolekularnih heparinov, sistemskih antibiotikov in antimikotikov ter parenteralne prehrane
Kirurško zdravljenje endometrijskega karcinoma - nerešena vprašanja
Get PDFEndometrial carcinoma is the most common type of gynaecological cancer in the developed world. The selected treatment is surgery, complemented by radiotherapy in the event of a more advanced disease, and increasingly also by chemotherapy. The scope of a surgical treatment is still to be determined, which requires adoption of new doctrines. New approaches to treatment are being developed, but it is necessary to consider also the specificity of the treatment of younger patients.V razvitem svetu je med ginekološkimi raki najpogostejši endometrijski karcinom. Zdravljenje izbora je kirurgija, ki jo pri obsežnejši bolezni dopolnjuje radioterapija in vedno pogosteje tudi kemoterapija. Obsežnost kirurškega posega je še vedno nedorečena, kar zahteva novejše doktrine. Pojavljajo se novi pristopi v zdravljenju, upoštevati pa moramo tudi specifičnost zdravljenja pri mlajših bolnicah