Onkologija
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Kronična mieloična levkemija
Get PDFChronic myelogenous leukemia (CML) is a rare myeloproliferative disease with an incidence of approximately 1-2/100,000 population per year. It is a clonal disease of a pluripotent stem cell committed to granulopoiesis. Most patients are diagnosed in the chronic phase when the blood count typically shows leukocytosis with predominance of mature neutrophil granulocytes and there are evident signs of increased metabolism, such as fatigue, weight loss and perspiration, and splenomegaly. Through the accelerated phase, the chronic phase progresses to a blast crisis resembling acute leukemia. The diagnosis is based on the discovery of the Philadelphia chromosome arising as a consequence of chromosomal translocation t(9;22), BCRABL gene or its product, BCR-ABL tyrosine kinase, in the peripheral blood or bone marrow cells. Significant progress in the treatment of CML was accomplished by the discovery of the BCR-ABL tyrosine kinase inhibitors, which provide long-term disease control, namely with imatinib as the first choice of treatment in the chronic phase of CML. The other two possible treatments are the allogeneic transplantation of haematopoietic stem cells and palliative treatment with chemotherapeutics.Kronična mieloična levkemija (KML) je redka mieloproliferativna bolezen z incidenco okrog 1–2/100.000 prebivalcev na leto. Je klonska bolezen pluripotentne matične celice, usmerjene v granulopoezo. Večino bolnikov odkrijemo v kroničnem obdobju, za katero je značilna levkocitoza v krvni sliki, s prevladovanjem zrelih nevtrofilnih granulocitov, znaki pospešene presnove, kot so utrujenost, hujšanje in potenje, ter splenomegalija. Kronično obdobje prek pospešenega obdobja preide v blastno krizo s sliko akutne levkemije. Za postavitev diagnoze je nujna najdba kromosoma Philadelphia, ki nastane kot posledica kromosomske translokacije t(9;22), gena BCR-ABL ali njegovega produkta tirozinske kinaze BCR- -ABL v celicah periferne krvi ali kostnega mozga.
Velik napredek pri zdravljenju KML je bilo odkritje zaviralcev tirozinske kinaze BCR-ABL, s katerimi dosežemo dolgotrajen nadzor bolezni, in sicer z imatinibom kot prvo izbiro zdravljenja kroničnega obdobja KML. Drugi možni izbiri zdravljenja sta alogenična presaditev krvotvornih matičnih celic in paliativno zdravljenje s kemoterapevtiki
Karcinom Merklovih celic
Get PDFThe Merkel Cell Carcinoma (MCC) is a rare, aggressive and often deadly neuroendocrine skin carcinoma. Recently, there has been a growing interest in this type of cancer due to its increasing incidence and possible viral connection. The article presents the clinical picture, staging system, treatment and experience of the Institute of Oncology Ljubljana (IOL). Also included is a review of 40 patients treated at the IOL from 1994 to 2011.Karcinom Merklovih celic (MCC) je redek, agresiven in pogosto smrten nevroendokrini kožni karcinom. Zanimanje zanj se v zadnjem času veča zaradi naraščanja incidence in možne virusne povezave. V prispevku so opisani klinična slika, zamejitveni sistem in zdravljenje ter izkušnje Onkološkega inštituta Ljubljana (OIL). Prikazan je pregled serije 40 bolnikov, zdravljenih na OIL od 1994 do 2011
Mezoteliomi
Get PDFMalignant mesothelioma is a rare type of cancer, the incidence of which is still increasing both in our country and also throughout the world. In Slovenia, the production and use of asbestos was prohibited in 1996, but we have not yet managed to reduce the burden of this disease due to the extremely long latency period between exposure to asbestos and incidence of the disease. Different clinical trials confirmed the effectiveness of systemic treatment, such as the combination of cisplatin and gemcitabin and the combination of cisplatin and pemetrexed. So far, only the Netherlands and Slovenia have managed to prove that modern chemotherapy treatment statistically significantly prolonged the median overall survival of the entire population of patients with this disease.Maligni mezoteliom uvrščamo med redke rake, njegova incidenca pa še vedno narašča pri nas in v svetu. V Sloveniji smo zakonsko prepovedali proizvodnjo in uporabo azbesta leta 1996, vendar še nismo zmanjšali bremena te bolezni, ker je latentni čas med izpostavljenostjo azbestu ter obolevnostjo zelo dolg. Različne klinične raziskave so potrdile učinkovitost sistemskega zdravljenja, kot sta kombinaciji cisplatina in gemcitabina ter cisplatina in pemetrekseda. Do sedaj smo samo na Nizozemskem in v Sloveniji dokazali, da je sodobno kemoterapevtsko zdravljenje statistično značilno podaljšalo srednje celokupno preživetje celotne populacije bolnikov s to boleznijo
Biološka označevalca p16 in Ki-67 za opredelitev cervikalne intraepitelijske neoplazije v biopsijskih vzorcih materničnega vratu
Get PDFThe biological markers p16 and Ki-67 are indirect indicators of high-risk human papillomavirus infections (HR-HPV) connected to the formation of precancerous changes in the cervix. In diagnostically more challenging cases, they can be used to distinguish between cervical intraepithelial neoplasia and morphologically similar non-neoplastic changes. They can be determined using standard immunohistochemical methods on tissue slices from cervical biopsy samples. In the daily histopathological evaluation of the cervical biopsy samples with additional immunohistochemical staining for p16 and Ki-67, a high-grade cervical intraepithelial neoplasia (CIN2 and CIN3) is usually ruled out, which prevents excessive treatment of changes in the cervix. Such diagnostic approach can also be used in the histopathological evaluation of intraepithelial neoplastic changes of the endocervical glandular epithelium.Biološka označevalca p16 in Ki-67 sta posredna pokazatelja okužbe s humanimi papiloma virusi z velikim tveganjem (HPV-VT), ki so povezani z nastankom predrakavih sprememb na materničnem vratu. V diagnostično težavnih primerih ju lahko uporabimo za razlikovanje cervikalne intraepitelijske neoplazije od morfološko podobnih neneoplastičnih sprememb. Določamo ju lahko s standardnimi imunohistokemičnimi metodami na tkivnih rezinah bioptičnih vzorcev materničnega vratu. Pri vsakdanjem histopatološkem ocenjevanju bioptičnih vzorcev materničnega vratu z dodatnim imunohistokemičnim barvanjem na p16 in Ki-67 največkrat izključimo cervikalno intraepitelijsko neoplazijo visoke stopnje (CIN2 in CIN3), kar prepreči pretirano zdravljenje sprememb na materničnem vratu. Tak diagnostični pristop je uporaben tudi za histopatološko ocenjevanje intraepitelijskih neoplastičnih sprememb endocervikalnega žleznega epitelija
Ambulanta za onkološko genetsko svetovanje: prenovljene indikacije za napotitev na genetsko svetovanje
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Bolezni, ki jih povzročajo humani virusi papiloma in preprečevanje s cepljenjem
Get PDFHuman papillomavirus (HPV) is an extremely prevalent sexually transmited infection that is typically acquired soon after the onset of sexual activity. The burden of HPV-related malignant and nonmalignant disease is high in women and men. High-risk or oncogenic types of HPV cause cervical, vaginal, and vulvar vancer in women. These types have also been shown to cause penile cancer in men and a substantial proportion of oropharingeal and anal cancer in women and men. Low-risk types of HPV cause anogenital warts. Virus-like particle-based vaccines have recently been developed to prevent the infection with two cancer-associated HPV genotypes (HPV 16, HPV 18) and have been ~ 95% effective in preventing HPV-associated disease caused by genotypes in virus-naive subjects. The prophylactic vaccines are not therapeutic for the already present infection. HPV prophylactic vaccines are the first vaccines designed to prevent a human cancer.Okužbe s humanimi virusi papiloma (HPV) so zelo pogoste spolno prenosljive bolezni, ki se značilno pojavijo kmalu po začetku spolne dejavnosti. Breme z njimi povezanih bolezni, rakavih in nerakavih, je veliko za ženske in moške. HPV, ki prinašajo veliko tveganje, visokotvegani ali onkogeni HPV pri ženskah povzročajo raka materničnega vratu, nožnice in zunanjega spolovila, pri moških pa raka penisa ter pomemben delež raka žrela in raka zadnjika pri ženskah in moških. Pred nekaj leti sta bili izdelani cepivi, ki preprečujeta okužbo z 2 genotipoma, ki povzročata raka (HPV 16 in 18). Pri neokuženih osebah v približno 95 % učinkovito preprečujeta bolezni, ki jih povzročata oba genotipa, ne zdravita pa okužbe. Profilaktični cepivi sta prvi, ki so ju naredili, da bi pri človeku preprečevali raka
Novosti v zdravljenju melanoma in tumorjev prebavil: 47. kongres ASCO 2011
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Informatizacija zdravljenja bolnikov s protitumorskimi zdravili
Get PDFEffective IT support is a requirement for the quality treatment of patients by allowing control over the management of their treatment and by facilitating the work of the medical professionals. At the Institute of Oncology Ljubljana utilisation of drugs is supported by a computer program that enables a holistic approach to treatment with anticancer drugs as well as the preparation of these medicines. The program combines various aspects of such treatment and the preparation of medicines, and it enables an interdisciplinary team of health professionals to optimize the quality, safety and economy of treatment with antitumor drugs.Za kakovostno zdravljenje je nujna dobra informacijska podpora, ki omogoča nadzor nad zdravljenjem bolnikov in olajša delo zdravstvenim delavcem. Na Onkološkem inštitutu v Ljubljani smo uporabo zdravil nadgradili z računalniškim programom Cypro, ki omogoča celovit pristop k zdravljenju s protitumorskimi zdravili in pripravi teh zdravil. Program povezuje več vidikov zdravljenja in priprave zdravil ter interdisciplinarni ekipi zdravstvenih delavcev omogoča optimizacijo kakovosti, varnosti in ekonomičnosti zdravljenja s temi zdravili