Onkologija
Not a member yet
431 research outputs found
Sort by
Uporaba testov HPV DNK za presejanje za raka materničnega vratu
Get PDFAn infection with oncogenic types of Human Papillomavirus (HPV) is a necessary condition for development of cervical cancer. The incidence of cervical cancer has decreased over the years in line with the use of cytology screening. Nevertheless, cytology is not an optimally sensitive screening test for cervical intraepithelial neoplasia (CIN), and a more sensitive test would be beneficial. The aim of this paper was to describe the characteristics of HPV DNA tests as observed in all eight randomized controlled trials with published data that compared HPV tests and cytology in primary screening. These trials showed that the sensitivity of HPV tests for ≥CIN3 is higher than the sensitivity of cytology. In several trials, the higher sensitivity in the baseline screening rounds led to fewer diagnoses of cervical cancer by the subsequent screening round than was the case with cytology, although these observations were based on few cases per trial. It will be a greater challenge to limit the amount of extra unwanted side effects of HPV testing compared with cytology. These are predominantly false-positive tests, i.e. positive screening tests without a subsequent diagnosis of ≥CIN3, and extra diagnoses of CIN grades with a low probability of progression to cervical cancer, i.e. CIN1 and to some degree also CIN2. The three most widely discussed approaches to reducing the burden of the extra unwanted effects were discussed in this paper: the use of triage tests in women with positive HPV screening tests, the use of HPV tests from the age of 30 years onwards only, and a change in the threshold value for a positive HPV test. Each of these approaches is associated with distinct advantages and disadvantages.Okužba z onkogenimi tipi humanih papilomavirusov (HPV) je potreben pogoj za razvoj raka materničnega vratu. Zaradi dolgoletne uporabe citoloških brisov se je incidenca tega raka zmanjšala, a kljub temu bi bilo treba najti nov presejalni test, ki bi bil občutljivejši za progresivne predrakave spremembe, cervikalno intraepitelialno neoplazijo (CIN). Med te teste spadajo testi HPV DNK. V tem članku so opisane njihove značilnosti, kakor jih je mogoče presoditi na podlagi vseh 8 randomiziranih kontroliranih raziskav z objavljenimi podatki, ki so primerjale uporabo testov HPV s citološkimi brisi za primarno presejanje. Te raziskave so potrdile, da je mogoče na podlagi testov HPV diagnosticirati večje število ≥ CIN 3 kot na podlagi citoloških brisov, čeprav razlika v nekaterih od raziskav, tudi zaradi njihove velikosti, ni bila statistično značilna. Razveseljivo je, da večja občutljivost za ≥ CIN 3 verjetno pomeni tudi boljšo zaščito pred rakom materničnega vratu, čeprav ocena temelji na majhnem številu opazovanih primerov v vsaki izmed raziskav. Pri uporabi testov HPV bo večji izziv omejiti njihove neželene učinke. To so predvsem pogostejši napačno pozitivni testi (ki jih definiramo kot pozitivne presejalne teste brez diagnoze ≥ CIN 3 ali ≥ CIN 2) ter pogostejše diagnoze in morebitno zdravljenje manj nevarnih stopenj CIN (predvsem CIN 1, deloma tudi CIN 2). V tem članku so kritično ovrednoteni 3 pristopi k zmanjšanju bremena testov HPV v primerjavi s citološkimi brisi, in sicer uporaba triažnih testov pri ženskah s pozitivnimi presejalnimi testi HPV, omejitev uporabe testov HPV pri mlajših ženskah in sprememba mejne vrednosti, pri kateri se test HPV odčita kot pozitiven. Vsi ti pristopi imajo svoje prednosti in slabosti
Oskrba bolnika ob koncu življenja
Get PDFCare of patients nearing the end of life is primarily aimed at providing the best possible quality of life to the terminally ill patient and offering support to his family members. To assure appropriate help and to offer it in time, the length of patient’s survival should be assessed. Non-palliative approach to the care of patient nearing the end of life is a path that leads to medical futility; it only increases the patient’s pain and suffering. The treatment of symptoms is similar to that in early stages of palliative care. A special challenge in the care of patients nearing the end of life is the choice of proper drug therapy. The care should be carried on also after the patient’s death by completing the formalities required in the event of death and by giving support to the grieving family members.Oskrba bolnika ob koncu življenja skuša doseči dva cilja: bolniku omogočiti najboljšo kakovost življenja (umiranja) in poskrbeti za svojce. Za pravilno in pravočasno izvajanje je ključna prava ocena bolnikovega preživetja. Nepaliativni pristop pri oskrbi ob koncu življenja vodi v medicinsko neučinkovito zdravljenje in povečuje bolnikovo trpljenje. Obravnava simptomov je podobna kot v zgodnejših obdobjih paliativne oskrbe. Poseben izziv predstavlja zdravljenje z zdravili. Oskrba se nadaljuje tudi po bolnikovi smrti
Obravnava težkega dihanja pri bolnikih v zadnjih dneh življenja
Get PDFDyspnoea is a distressing symptom frequently present in patients with incurable diseases. The goal of treatment for patients in the terminal stage is symptom control. Unfortunately, optimal treatment of dyspnoea has not been achieved in all patients yet. Frequent mistakes include unnecessary diagnostic procedures and suboptimal symptom control. In this review, the definition of dyspnoea is presented, followed by etiologic and epidemiologic data and pharmacological and non-pharmacological measures for relief. At the end, two more symptoms are presented; terminal rattle and massive pulmonary haemorrhagia.Občutek težkega dihanja (dispneja) je pogost simptom v zadnjih dneh življenja. Bolnik je zaradi dispneje zelo prizadet in velikokrat prestrašen. Ključno je, da ob takem bolniku ukrepamo hitro in pravilno. Pogoste napake so pretirana uporaba nepotrebnih diagnostičnih metod in neustrezno lajšanje simptomov. V prispevku prikazujemo obravnavo bolnika z dispnejo v terminalni fazi bolezni, ko vzročno zdravljenje ni več mogoče in je v ospredju lajšanje težav. Definiciji dispneje sledijo patofiziološka razlaga in praktični nasveti za uporabo farmakoloških in nefarmakoloških ukrepov. Na koncu so opisani ukrepi pri terminalnem hropenju in akutni obsežni krvavitvi iz dihal
Aktivnosti največjega mednarodnega strokovnega združenja onkologov ASCO in pogled na srečanje ASCO 2011
No full textNo abstract.Ni abstrakta
Pomen mutacije gena receptorja za epidermalni rastni dejavnik za zdravljenje nedrobnoceličnega raka pljuč
Get PDFThe 5-year relative survival rates of patients with lung cancer are approximately 12%, and have increased only by 2.2% during the last 15 years. Third generation chemotherapy based on platinum derivates is currently a standard treatment for the advanced non-small-cell lung cancer (NSCLC) but has probably reached a plateau. With the advent of targeted therapy it has been introduced into the clinical management of advanced NSCLC as well. Epidermal growth factor (EGFR) is a transmembrane glycoprotein which is expressed on the cell surface of a tumor as well as on normal cells. It belongs to the ErbB receptor family, which includes four types of receptors. In the article only EGFR (HER1/ErbB1) will be considered. Treatment with two small molecules, tyrosine kinase inhibitors (TKIs) directed against the epidermal growth factor receptor (EGFR), namely gefintib and erlotinib, already proved to be an effective treatment strategy in patients with advanced NSCLC. Among different methods used for EGFR status determination, only identification of activating mutations in the EGFR gene domain proved to be a very reliable and significant predictor for the response to EGFRdirected TKIs therapy in NSCLC. Even though the activating EGFR mutations were found to be more frequent in patients with particular clinico-pathological characteristics, such as females, non-smokers, those with adenocarcinoma histology, a selection of patients based on these characteristics does not allow for a proper selection of patients for EGFR-directed TKI therapy. Only by determining the activating EGFR mutations in the primary tumor can the identification of NSCLC patients with expected high response rates to EGFR-directed TKI therapy leading to long survival and a good quality of life be achieved. Personalized medicine for NSCLC patients is now reality, and EGFR mutation status should be determined in the primary tumor of all patients prior to any systemic therapy for advanced disease, thus allowing us a tailored first-line and subsequent lines of systemic therapy in each individual patient.Petletno preživetje bolnikov s pljučnim rakom je slabo, samo 12-odstotno, in se v zadnjih 15 letih ni bistveno izboljšalo. Standardno zdravljenje razsejanega nedrobnoceličnega raka pljuč (NDRP), ki je danes najpogostejši tip raka pljuč, je kemoterapija na osnovi citostatika cisplatina. S tem je citostatsko zdravljenje razsejanega NDRP najbrž doseglo največ, kar je lahko. V zadnjih letih pa smo tudi pri zdravljenju NDRP priča razmahu tarčnega zdravljenja. Kot učinkovita so se izkazala tarčna zdravila, ki delujejo na receptor za epidermalni rastni dejavnik (EGFR), in to predvsem mali molekuli, zaviralca tirozinske kinaze (TKI) erlotinib in gefitinib. EGFR je transmembranski glikoprotein, ki se nahaja tako na površini zdravih kot tudi tumorskih celic različnih rakov. Pripada družini proteinov ErbB, ki vključuje 4 receptorje. Od vseh določanj izraženosti EGFR se je določitev aktivirajočih mutacij gena za EGFR v primarnem tumorju izkazala za najboljši pozitivni napovedni dejavnik odgovora na zdravljenje s proti EGFR usmerjenimi TKI. Čeprav je bila povezava med mutacijami gena za EGFR ter nekaterimi kliničnimi in patološkimi značilnostmi NDRP dokazana, pa na podlagi kliničnih in patoloških značilnosti bolnikov ne moremo zanesljivo prepoznati tistih, ki bodo imeli največjo korist od zdravljenja s TKI. Samo z določitvijo aktivirajočih mutacij gena za EGFR je mogoče prepoznati bolnike, ki bodo značilno bolje odgovorili na zdravljenje s TKI kot na kemoterapijo in pri katerih je ob zdravljenju s proti EGFR usmerjenimi TKI utemeljeno pričakovati razmeroma dolgo preživetje in dobro kakovost življenja. Zato je danes pri vseh bolnikih s pljučnim adenokarcinomom pred uvedbo prvega sistemskega zdravljenja napredovale bolezni priporočeno določanje mutacij gena za EGFR v primarnem tumorju. Na podlagi tega podatka je namreč mogoča ustreznejša izbira prvega in tudi poznejših redov sistemskega zdravljenja pri vsakem bolniku
Cirkulirajoče tumorske celice in njihov pomen pri raku dojke: pregled izsledkov dosedanjih raziskav
Get PDFCirculating tumor cells (CTCs) are epithelial tumor cells detected in the peripheral blood of patients with solid malignant tumors. They originate from the primary tumor or metastatic sites. New techniques have been developed to isolate and characterise these cells, including the FDA-approved Cell-Search, which are using mainly cytometric/antibody-based and molecular approaches. Recent advances in theories regarding metastasis support the role of early release of tumor cells in the neoplastic process. It has been found that phenotypic variation exists between the primary tumor and CTCs. Of particular interest is the difference found between primary tumor and CTC HER-2 status in both metastatic and early breast cancer. CTC enumeration has been incorporated into different fields of oncology as a prognostic marker, a tool to monitor therapy response, and a method to understand basic tumor characteristics. But currently, there is still no role for CTCs in clinical practice.Ni abstrakta
