Leczenie wspomagające w nowotworach głowy i szyi

Progress in diagnosis and therapy acheved in the last decades has not resulted in a significant improvementof therapeutic results in patients with head and neck cancer. Standard therapeutic methods, i.e. surgeryand radiotherapy, give good results with early stage patients, in other cases they are not satisfactory,and therapy applied poses high risk of undesirable effects. Supportive therapy allowing for the decreasein the percentage of complications is still a challenge for an oncologist. It should be conducted by aninterdisciplinary team. Optimization of measures allows for the avoidance of serious complications andimproves patients’ comfort of life.Postęp w zakresie diagnostyki i terapii, jaki dokonał się w ciągu ostatnich dziesięcioleci, nie spowodował znaczącej poprawy wyników leczenia u chorych na raka narządów głowy i szyi. Standardowo stosowane metody leczenia, czyli chirurgia i radioterapia, przynoszą dobre wyniki u chorych we wczesnych stopniach klinicznego zaawansowania,  w pozostałych przypadkach nie są zadowalające, a stosowana terapia jest obarczona wysokim ryzykiem działań niepożądanych. Leczenie wspomagające pozwalające na zmniejszenie odsetka powikłań nadal jest istotnym wyzwaniem dla lekarza onkologa. Powinno być prowadzone w zespole interdyscyplinarnym. Optymalizacja postępowania pozwala na uniknięcie wielu poważnych powikłań  jak również poprawia komfort życia choreg

New directions in cervical cancer prophylaxis worldwide and in Poland – Case study of the Polish rural female population

Introduction Cervical cancer is one of the most frequent malignant neoplasms in females. Such neoplasms can be almost completely eliminated by means of adequate primary and secondary prophylaxis. The most developed countries focus their attention on the improvement of prophylaxis systems, test quality, and efficacy improvement, as well as on the expansion of the primary prophylaxis. In Poland, the discussions focus on the improvement of the malfunctioning population programme. Objective Drawing on recent research findings, the article presents current Polish and global recommendations with regard to screening tests for cervical cancer. The results of the Population Programme of Prophylaxis and Early Detection of Cervical Cancer are discussed in the context of current trends of healthy behaviour among women inhabiting rural areas. Description of the state of knowledge In the future, it will be relevant to increase the number of human papillary virus (HPV) tests as part of the prophylaxis programme, especially among the high risk patient group. In particular, there is a necessity to increase the number of vaccinations among young women, especially before the beginning of their sexual activity, as well as to establish new strategies of secondary prophylaxis in this group. At present, women who had been vaccinated should undergo routine screening. In Poland, the report based on SIMP registry (IT System of Prophylaxis Monitoring), shows that only 27% of the 3.3 million of invited women participated in the cytology tests. The data analysis shows that women living in rural areas more often respond and participate in the tests, compared to women living in the cities (39.3% vs. 16.8%)

Niekontrolowana reaktywacja zakażenia wirusem EBV u 26-letniej kobiety

Niniejszy opis przypadku dotyczy 26-letniej chorej, która trafiła do ośrodka onkologicznego z podejrzeniem chłoniaka, a u której w trakcie diagnostyki rozpoznano przewlekłą aktywną infekcję wirusem Epsteina-Barr (CAEBV). Chora wcześniej nie była leczona z powodu chorób przewlekłych, a podejrzenie chłoniaka wysunięto na podstawie objawów klinicznych (limfadenopatii szyjnej, stanów gorączkowych), wyników badań obrazowych i ultrasonografii endoskopowej (TK, EUS). W trakcie diagnostyki w ośrodku onkologicznym wykluczono chorobę nowotworową, rozpoznając CAEBV. Mimo zastosowanego leczenia, zgodnego ze światowymi standardami, u chorej rozwinęła się niewydolność wielonarządowa, która doprowadziła do zgonu

Systemic complications in the hormonal treatment of prostate and breast cancer

Oncological treatment is often associated with a wide range of adverse effects. The article focuses on systemic complications that may occur during the hormonal therapy of prostate and breast cancer. Considering that current treatments are increasingly effective, the number of patients suffering from early and remote complications of can­cer therapy can be expected to rise. Many undergo radical treatment and in this group in particular, close attention should be paid to the prevention, early diagnosis, and treatment of adverse effects. Hormonal disorders and their complications considerably affect the quality of life and life expectancy by upsetting general systemic homeostasis

The efficacy and safety of ipilimumab in patients with advanced cutaneous or mucosal melanoma

Introduction. Ipilimumab is a monoclonal antibody registered for the treatment of patients with unresectable or metastatic melanoma. Studies have shown prolongation of overall survival in patients treated with ipilimumab. Adverse events related to excessive stimulation of the immune system may occur during treatment. The aim of this paper was to analyse the results of treatment with the use of ipilimumab, which were achieved in one institution in the frame of a therapeutic program established in Poland. Materials and methods. Forty-seven patients (27 men, 20 women) were treated from April 2014 to February 2015 with ipilimumab in a dose of 3 mg/kg of body weight after failure of one previous systemic line of treatment. Median age at the beginning of the treatment was 54 years (range 18–73). Nineteen patients (40%) had BRAF mutation. Thirty patients received chemotherapy as first-line treatment prior to ipilimumab, 14 patients were given vemurafenib, and three patients were treated in clinical trials. Performance status 0 or 1 was found in 15 patients and 32 patients, respectively. Five patients (10.6%) had asymptomatic brain metastases. Twenty-four (51%) patients had metastatic disease with three or less organs involved, whereas 23 (49%) patients had metastases in more than three organs. Lactate dehydrogenase (LDH) activity and neutrophil count was elevated at the beginning of treatment in 40% and 30% of patients, respectively. Results. Thirty-five patients (74%) completed four doses of treatment. Four patients (8.5%) had partial response to the treatment, 12 patients (25.5%) had stable disease (SD) for three or more months, and 31 (66%) had progressive disease. Sixteen patients (34%) had clinical benefit from the treatment (PR + SD). Median progression-free survival (PFS) time was two months. Median overall survival (OS) time was 7.5 months. Increased LDH activity at the beginning of treatment and elevated neutrophil count significantly influenced overall survival of patients (p = 0.005 and p = 0.01, respectively). After progression on ipilimumab 25 patients (53%) received further lines of systemic treatment. Conclusions. This analysis confirms the efficacy of ipilimumab in some patients with advanced melanoma in second-line systemic therapy. A limited proportion of patients obtain long lasting control of the disease after use of ipilimumab with good tolerance to the treatment. There is a need to determine predictive factors of response to treatment for better selection of patients.Introduction. Ipilimumab is a monoclonal antibody registered for the treatment of patients with unresectable or metastatic melanoma. Studies have shown prolongation of overall survival in patients treated with ipilimumab. Adverse events related to excessive stimulation of the immune system may occur during treatment. The aim of this paper was to analyse the results of treatment with the use of ipilimumab, which were achieved in one institution in the frame of a therapeutic program established in Poland. Materials and methods. Forty-seven patients (27 men, 20 women) were treated from April 2014 to February 2015 with ipilimumab in a dose of 3 mg/kg of body weight after failure of one previous systemic line of treatment. Median age at the beginning of the treatment was 54 years (range 18–73). Nineteen patients (40%) had BRAF mutation. Thirty patients received chemotherapy as first-line treatment prior to ipilimumab, 14 patients were given vemurafenib, and three patients were treated in clinical trials. Performance status 0 or 1 was found in 15 patients and 32 patients, respectively. Five patients (10.6%) had asymptomatic brain metastases. Twenty-four (51%) patients had metastatic disease with three or less organs involved, whereas 23 (49%) patients had metastases in more than three organs. Lactate dehydrogenase (LDH) activity and neutrophil count was elevated at the beginning of treatment in 40% and 30% of patients, respectively. Results. Thirty-five patients (74%) completed four doses of treatment. Four patients (8.5%) had partial response to the treatment, 12 patients (25.5%) had stable disease (SD) for three or more months, and 31 (66%) had progressive disease. Sixteen patients (34%) had clinical benefit from the treatment (PR + SD). Median progression-free survival (PFS) time was two months. Median overall survival (OS) time was 7.5 months. Increased LDH activity at the beginning of treatment and elevated neutrophil count significantly influenced overall survival of patients (p = 0.005 and p = 0.01, respectively). After progression on ipilimumab 25 patients (53%) received further lines of systemic treatment. Conclusions. This analysis confirms the efficacy of ipilimumab in some patients with advanced melanoma in second-line systemic therapy. A limited proportion of patients obtain long lasting control of the disease after use of ipilimumab with good tolerance to the treatment. There is a need to determine predictive factors of response to treatment for better selection of patients

Application of dignity therapy in an advanced cancer patient — wider therapeutic implications

Aim: Dignity therapy is a short-term, individualized, patient-focused form of therapy reducing stress and helping both the patient and his family appreciate the end-of-life situation. The present study describes the impact of dignity therapy on an advanced cancer patient within a Polish hospital setting.Methods: MH. Chochinov’s dignity therapy protocol was applied. A session was conducted during which an interview with the patient was recorded; subsequently subjected to a statistical analysis. The competent judges’ approach was used to effectively preclude subjective interpretation of the patient’s statement by an investigator. The judges’ appraisal was then checked for concordance (W Kendall). The patient was also asked to complete a survey questionnaire designed to assess the therapeutic effectiveness of dignity therapy in the intervention.Results: The patient indicated that family epitomized the most crucial values. He also highlighted othe  issues, i.e. his work and life’s passion — playing the drums. The survey questionnaire indicated that by far the greatest benefit consisted in an overall improvement of his mental well–being (4.67). Benefits for the family followed (4), including his hope for recovering family ties (4). An unexpected therapeutic effect consisted in re–establishing a broken relationship with his daughters.Conclusions: Dignity therapy proved effective not only as a method of enhancing the patient’s own sense of dignity in the face of impending death but also tangibly instrumental in overcoming a dramatic communication break within a family.Palliat Med Pract 2018; 12, 4: 218–22

Multiple brown tumors in the course of primary hyperparathyroidism mimicking bone metastases – case report

Brown tumours (especially multiple) are uncommon manifestations of primary hyperparathyroidism (PHPT) in developed countries. Although PHTP can cause various symptoms, it can often be mistaken for malignancy. The disease itself (although curable) can lead to disabilities and other serious complications. Herein we report the case of a 65-year-old patient with multiple brown tumours as a very rare first manifestation of normocalcaemic form of primary hyperparathyroidism caused by a giant parathyroid adenoma

Mnogie guzy brunatne w przebiegu pierwotnej nadczynności przytarczyc imitujące zmiany przerzutowe w kościach — opis przypadku

Guzy brunatne, a szczególnie ich mnoga postać, są rzadką manifestacją kliniczną pierwotnej nadczynności przytarczyc (PHPT) w krajach uprzemysłowionych. Mimo że PHPT powoduje różnorodne objawy, obecność zmian kostnych może sugerować rozpoznanie uogólnionej choroby nowotworowej. Pierwotna nadczynność przytarczyc, choć sama w sobie jest uleczalna, może prowadzić do poważnych powikłań i niepełnosprawności. W pracy przedstawiono przypadek 65-letniego chorego z mnogimi guzami brunatnymi w kościach, które były pierwszym objawem normokalcemicznej nadczynności przytarczyc spowodowanej olbrzymim gruczolakiem przytarczyc

Implementation of the Polish version of the 11th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11): importance for oncology

Member States of the World Health Organization (WHO), after several years of joint review, approved and implemented the update of the International Statistical Classification of Diseases and Related Health Problems (ICD) in May 2019. Usually, the abbreviated name ICD-11 (International Classification of Diseases, 11th Revision) is used. The new version was created in fully digital form with a search easy-to-use search engine available to every user. Many changes were introduced, and the most important is the redesign of the coding system to adapt it for digital use. ICD-11 codes are divided into main and supplementary codes. Main codes are at least 4 characters long, and 2 levels of extensions, up to 7 characters, are possible. In Poland, the entire process of implementing the ICD-11 is carried out as part of a project coordinated by the Medical Center for Postgraduate Education in cooperation with the Department of Healthcare of the Ministry of Health and the e-Health Centre. The implementation of the new version and the official introduction of ICD-11 in Poland must be preceded primarily by the amendment of legal acts (laws and regulations) and orders of the President of the National Health Fund, such as those regarding the reimbursement for refunded services and the keeping of medical records. An important element is the change in the cluster codes in oncology. Selected oncology groups were based on analyses of international reports on morbidity, mortality, cancer registries, and clinical reports. Cluster 02, which deals with cancer, contains 8 subsections detailing disease states associated with abnormal or uncontrolled cell proliferation. This article summarizes and discusses the most important changes in ICD-11, along with providing an introduction to the classification rules in the coding system and individual subsections on cancer

Powikłania ogólnoustrojowe leczenia hormonalnego chorych na raka gruczołu krokowego i raka piersi

Leczenie onkologiczne niesie ze sobą ryzyko wielu działań ubocznych. W niniejszej pracy przedstawimy powikłania ogólnoustrojowe hormonoterapii raka piersi i raka gruczołu krokowego. W związku z tym, że obecnie wyniki lecze­nia nowotworów są coraz lepsze i chorzy osiągają wieloletnie przeżycia całkowite, z roku na rok będzie rosła liczba pacjentów borykających się zarówno z wczesnymi, jak i odległymi powikłaniami leczenia onkologicznego. Wielu chorych jest leczonych radykalnie i u nich w szczególny sposób należy zapobiegać, jak najwcześniej wykrywać i w miarę możliwości leczyć powikłania terapii przeciwnowotworowej. Zaburzenia hormonalne i ich powikłania w znaczący sposób wpływają na pogorszenie jakości życia oraz długości życia poprzez wpływ na homeostazę ogólnoustrojową