Nujna stanja pri pljučnem raku

Bolniki s pljučnim rakom zelo pogosto obiščejo urgentno ambulanto zaradi nenadno nastalih ali hitro napredujočih težav, ki so lahko neposredno ali posredno povezani z maligno boleznijo. Hudi simptomi so lahko znak življenjsko ogrožajočih stanj in zahtevajo takojšnje nujno ukrepanje (emergency) ali pa kažejo na t. im. neodložljiva stanja (urgency), ki jih lahko obravnavamo hitro, včasih tudi v domačem okolju, ambulantno ali na sekundarnem nivoju. Pravih nujnih stanj, ki potrebujejo takojšnje ukrepanje, je malo, < 5 odstotkov vseh obiskov v urgentni ambulanti

Poznavanje dejavnikov tveganja za nastanek raka med slovenskimi najstniki

INTRODUCTION: Based on current trends, one can expect that one in two teenage boys and one in three teenage girls will be diagnosed with cancer at the age of 75. According to the National Cancer Management Program, as many as 40% of cancers could be prevented through healthy lifestyles and avoidance of risk factors, and teens should be well aware of risk factors in order to reduce the incidence of this dangerous and common disease in the future.PURPOSE: The main aim of our study was to determine how well teenagers are aware of the cancer risk factors and to check for sex and age related differences in knowledge.METHODS: We included 185 teenagers between the ages of 12 and 15 (54% boys, 46% girls) who completed an international questionnaire on cancer risk factors. We then transmitted the questionnaires electronically using the online tool 1KA, which allowed us to prepare and partially process the results.RESULTS: 58% of teenagers worry about being diagnosed with cancer, with a significant gender gap, with 74% of girls and only 44% of boys expressing this concern. Smoking (55%), alcohol (24%), radiation (14%) and unhealthy nutrition (14%) are among the most important cancer risk factors for Slovenian teenagers. Among teenagers, 83% agree that certain foods increase the chance of cancer. When asked about the number of daily servings of fruits and vegetables required for the cancer prevention, the average answer was 3.5 servings out of the recommended 5. Most students (69%) believe that red meat is a risk factor for cancer, and only half know that we should consume less 5 g of salt daily. 81% of schoolchildren agree that maintaining a healthy body weight is one of the most important ways to prevent cancer, and 85% believe that physical activity is related to preventing cancer. 87% are well aware of the dangers of UV radiation (sunbathing) and are also good at identifying alcohol as a risk factor, although 74% are not convinced that all alcoholic beverages have the same effect.CONCLUSIONS: The study found that Slovenian teenagers are well aware of the risk factors for cancer, as they have correctly identified 6.7 factors among the top ten, which is more than e.g. in the UK, where teenagers correctly identified only 4.4 factors. We have shown that there is a difference between the sexes in the knowledge of the factors in the assessment of the risk of smoking and the influence of healthy body mass. It turns out that there are no significant differences in the knowledge of cancer risk factors among differently aged children.UVOD: Glede na trenutne trende lahko pričakujemo, da naj bi eden od dveh fantov in ena od treh deklet današnjih najstnikov do 75. leta starosti zboleli za rakom. Po podatkih državnega programa za obvladovanje raka, bi lahko kar 40 % rakov preprečili z zdravim načinom življenja in izogibanjem dejavnikom tveganja, zato bi morali najstniki dobro poznati dejavnike tveganja, da bi v prihodnosti zmanjšali pojavnost te bolezni.NAMEN: Glavni namen naše raziskave je bil ugotoviti, kako dobro najstniki poznajo dejavnike tveganja nastanka raka ter preveriti, ali obstaja razlika v znanju med spoloma ter med različno starimi najstniki.METODE DELA: V raziskavo smo vključili 185 najstnikov, starih med dvanajst in petnajst let (54 % fantov, 46 % deklic), ki so izpolnili mednarodni vprašalnik o poznavanju dejavnikov tveganja nastanka raka. Vprašalnike smo nato prenesli v elektronsko obliko s pomočjo spletnega orodja 1KA, ki nam je omogočil pripravo in tudi delno obdelavo rezultatov.REZULTATI: 58 % učencev skrbi, da bodo zboleli za rakom, pri tem pa med spoloma obstaja bistvena razlika, saj to skrb izraža 74 % deklet in le 44% fantov. Med najpomembnejšimi dejavniki tveganja slovenski najstniki na prvem mestu navajajo kajenje (55 %), na drugem alkohol (24 %), na tretjem sevanje (14 %) in na četrtem nezdravo prehrano (14 %). Med učenci se jih 83 % strinja, da nekatera živila povečajo možnost nastanka raka. Pri vprašanju o številu potrebnih dnevnih porcij sadja in zelenjave je povprečen odgovor 3,5 porcij od priporočenih 5. Večina učencev (69 %) meni, da je rdeče meso dejavnik tveganja za nastanek raka, samo polovica pa ve, da je treba dnevno zaužiti manj kot 5 g soli. Da je vzdrževanje zdrave telesne mase eden najpomembnejših načinov preprečitve raka se strinja 81 % učencev, 85 % pa jih meni, da je telesna dejavnost povezana s preprečevanjem nastanka raka. 87% učencev dobro pozna nevarnost sončenja, prav tako pa dobro opredeljujejo alkohol kot dejavnik tveganja, čeprav jih 74 % ni prepričanih ali imajo vse alkoholne pijače enak učinek.ZAKLJUČKI: V raziskavi smo ugotovili, da najstniki dobro poznajo dejavnike tveganja za nastanek raka, saj so med najpogostejšimi desetimi dejavniki pravilno opredelili 6,7 dejavnikov, kar je več kot npr. v Veliki Britaniji, kjer so najstniki pravilno opredelili samo 4,4 dejavnikov. Pokazali smo, da med spoloma obstaja razlika v poznavanju dejavnikov pri oceni nevarnosti kajenja in vpliva telesne mase. Izkazalo se je, da med različno starimi otroci ni bistvenih razlik v poznavanju dejavnikov tveganja nastanka raka

[Treatment locoregionally advanced oesophageal carcinoma - a case report]

V prispevku predstavljamo primer 67-letnega bolnika z napredovalim karcinomom srednje tretjine požiralnika, s širjenjem v zgornjo in spodnjo tretjino, v stadiju T3 N2–3M0. Kljub obsežnosti bolezni je prejel optimalno zdravljenje s predoperativno radiokemoterapijo in operacijo. Uspešen potek zdravljenja je omogočil individualen pristop, tesno sodelovanje vseh strok onkologije in uporaba novih obsevalnih tehnik.In this article, we present a case of a 67-year-old patient with advanced stage T3 N2–3M0 carcinoma of the middle third of the oesophagus which is spreading to the upper and lower thirds. Despite the extensiveness of the disease, the patient received optimal treatment with pre-operative radiochemotherapy and surgery. Successful treatment was a result of an individual approach, close collaboration of all branches of oncology and use of new radiation techniques

The impact of high and low cardiac substructure dose levels on cardiac toxicity in lung and breast cancer radiotherapy

Izhodišča: Z daljšanjem preživetja bolnikov z rakom so srčno- -žilne bolezni postale pomemben del morbiditete in mortalitete teh bolnikov. V zadnjih letih je v literaturi veliko zanimanja na področju vpliva radioterapije na pozne posledice na srcu. Metode: Literaturo smo poiskali s pomočjo spletnega iskalnika PubMed / MEDLINE z uporabo kombinacij ustreznih ključnih besed. V postopku ocenjevanja smo preučili grobe rezultate iskanja in izključili članke, ki niso pomembni za to temo. Upoštevali smo le literaturo v angleškem jeziku. Rezultati: Objavljene so različne doznovolumske omejitve na srce v povezavi s srčno-žilnimi obolenji in smrtnostjo, vendar te omejitve niso enotno veljavne. Pri dopolnilnem obsevanju raka dojk je celotno srce izpostavljeno nizki dozi in se pomembne srčne okvare najpogosteje izrazijo desetletje po zdravljenju ali še pozneje, pri visokodozni izpostavljenosti pri radikalnem obsevanju pljuč pa se smrtnost zaradi srčno-žilnih dogodkov poveča že v prvih letih po zdravljenju. Zaključek: Z nižanjem doze na srce lahko še dodatno vplivamo na preživetje bolnikov po obsevanju, kar nam že omogočajo boljše obsevalne tehnike in slikovno vodena radioterapija. Dodatno korist lahko dosežemo še z boljšim razumevanjem in upoštevanjem vpliva obsevanja na posamezne srčne strukture, tudi v povezavi z pridruženimi boleznimi, in z usmerjenim kardiološkim spremljanjem bolnikov po obsevanju prsnega koša.Background: With improved survival outcomes for patients with cancer, cardiovascular disease has become an important part of morbidity and mortality. In recent years, there has been much interest in the literature on the impact of radiotherapy on late cardiac toxicity. Methods: Published manuscripts were identified through a PubMed/MEDLINE search of the National Library of Medicine using combinations of relevant keywords. In the evaluation round, we examined rough search results and excluded articles not relevant for the topic. We considered only English language literature. Results: Various cardiac dose-volume constraints have been reported in association with cardiovascular events and mortality, but without consistent constraints. Low-dose heart exposure in adjuvant breast cancer radiotherapy can lead to important cardiac events a decade or more after treatment. However, in radical lung cancer radiotherapy, high-dose heart exposure can lead to increased cardiovascular mortality in the first few years after treatment. Conclusion: We can further influence the survival of patients with cancer after chest irradiation by lowering the absorbed dose to the heart, which is already made possible by better irradiation techniques and image-guided radiotherapy. Additional benefits can be gained by better understanding and considering the impact of radiation on individual cardiac structures, also in connection with other patients’ comorbidities, and by the close cardiac follow-up of patients after chest radiation therapy

Radiotherapy of secondary liver cancer

Sekundarni tumorji jeter, med njimi zasevki tumorjev gastrointestinalnega trakta, raka dojk in pljuč pogosto povzročajo simptome, ki niso obvladljivi s sistemskim zdravljenjem. V primeru difuznih jetrnih zasevkov lahko z obsevanjem celotnih jeter hitro, učinkovito in z majhnimi stroški dosežemo dobro paliacijo simptomov z blagimi neželenimi učinki. Ko je zasevkov manj in je tudi obseg bolezni v telesu manjši, lahko pri izbranih bolnikih z dodatnim lokalnim (ablativnim) zdravljenjem jetrnih zasevkov dosežemo izboljšanje časa do progresa bolezni in celokupnega preživetja. V nadaljevanju prispevka sta opisana radiacijska poškodba jeter in obsevanje jeter z različnimi radioterapevtskimi tehnikami, med katerimi izberemo najustreznejšo glede na obseg bolezni, velikost jetrnih zasevkov, simptome, laboratorijske izvide in stanje zmogljivosti bolnika.Liver is commonly involved in a metastatic setting of gastrointestinal, lung and breast cancers. Symptoms of liver metastases are rarely mitigated by systemic (palliative) treatments only. Whole or partial liver radiotherapy is a cost-effective treatment option with minimal treatment toxicity to offer the mitigation of symptoms to patients with diffuse liver metastatic involvement. This treatment approach is different (and sometimes with curative intent) for selected patients with a lower tumour burden and an oligo-metastatic disease. Local ablative treatments of limited number and size of liver metastases show improvements in local control of the tumour, disease-free survival and overall survival. This article describes radiation induced liver disease and different radiation therapy approaches that can be chosen while taking into account the burden of the disease, size and number of liver metastases, symptoms, laboratory tests, possibilities of other local treatments and the clinical performance status of the patient

[Breast cancer in young women and pregnancy]

Rak dojke pri mladih bolnicah je redek pojav. Uspešno zdravljenje te bolezni omogoča večini mladih bolnic dolgo preživetje. Pomemben vidik kakovosti življenja je nedvomno ohranjanje plodnosti, posebno ob zavedanju, da je starost žensk ob prvem otroku vse višja. Mlade bolnice je zato treba že ob postavitvi diagnoze seznaniti z možnimi negativnimi vplivi zdravljenja na plodno sposobnost in jim ponuditi možnost svetovanja. Na ginekološko-onkološkem konziliju bolnicam ali paru med drugim predstavimo postopke za shranjevanje genetskega materiala pred pričetkom zdravljenja. V pričujočem prispevku predstavljamo in razpravljamo o novejših spoznanjih, ki povezujejo rak dojke ter nosečnost. Predstavljamo tudi zbrane podatke o nosečnostih pri zelo mladih bolnicah po zdravljenju raka dojke v Sloveniji.Breast cancer in young women is a rare occurrence, and successful treatment of this disease offers long survival to the majority of young female patients. Preserving fertility is an important aspect of the quality of life, in particular if bearing in mind that the age at which women have their first child has been increasing. Therefore, young female patients must be aware of the possible negative effects of treatment on fertility already at diagnosis and should be offered counselling. At the gynaecological oncology consilium, patients or couples are presented the procedures for the storage of genetic material before commencing treatment. In the following article, we present and discuss the newest findings on the association between breast cancer and pregnancy. Moreover, we also present the data collected on pregnancy in very young patients following breast cancer treatment in Slovenia