TUMOUR SIZE DISTRIBUTION OF INVASIVE BREAST CANCER IN A ONE-YEAR PERIOD: CASE STUDY HERZEGOVINA

Background: To analyse the early stage breast cancer tumour size distribution as an important prognostic factor among the female patients within our local geographic region of Herzegovina. Subjects and methods: This cross-sectional retrospective study included 379 patients who were treated in 2017 at the Oncology Clinic, University Clinical Hospital Mostar. The patients were divided into two groups based on their primary tumour size: early (2 cm) and late (>2 cm) stage groups. Results: The number of patients tested for advanced stage tumours surpassing 2 cm was statistically higher (2=106,325; p<0,001). 39,32% (N=149) of the patients presented with tumours 2 cm (T1) and 52.24% (N=198) of the total number of the patients presented with tumours >2 cm but 5 cm in greatest dimension (T2). The patients’ knowledge about breast cancer, availability and adherence of mammography did not show any statistically significant difference with regard to tumour size, while the number of patients with smaller tumours who indicated that they underwent regular mammography was statistically significantly higher (2=13,629; p<0,003). Conclusions: Our data shows that in our region, more women with a diagnosis of breast cancer presented with a larger tumor size. Although there was no statistically significant difference with regard to prior knowledge about breast cancer and availability to mammography, this may be due to a small sample size. Our region does not have a screening mammogram program and this data suggests that the implementation of such a program may improve adherence to existing mammography guidelines which might capture tumors at a smaller size and hence an earlier stage

Utjecaj COVID-19 pandemije na bolesnike s novootkrivenim kolorektalnim karcinomom u Općoj bolnici Zadar

Kolorektalni karcinom je jedna od najučestalijih zloćudnih bolesti u Republici Hrvatskoj.1 Ako se otkrije u ranom, odnosno lokaliziranom stadiju bolesti, petogodišnje preživljenje iznosi oko 90%.5 Iznimno je važno dijagnosticirati bolest u što ranijem stadiju radi boljeg ishoda liječenja. Stoga je odlukom Vlade Republike Hrvatske 2007. godine usvojen Nacionalni program ranog otkrivanja raka debelog crijeva.1 Pojava pandemije koronavirusne bolesti dovela je do izazova u funkcioniranju zdravstvenog sustava diljem svjeta, pa tako i programa ranog otkrivanja raka debelog crijeva.3 Za vrijeme Covid-19 pandemije zabilježen je smanjen broj obavljenih kolonoskopija i odaziv na program ranog otkrivanja raka debelog crijeva. Cilj ovog istraživanja je retrospektivno otvrditi utjecaj COVID-19 pandemije na bolesnike s novootkrivenim kolorektalnim karcinomom u razdoblju od 01.04.2020. do 30.09.2021. (za vrijeme COVID-19 pandemije) u odnosu na razdoblje od 01.04.2018. do 30.09.2019. (vrijeme prije COVID-19 pandemije) u Općoj bolnici Zadar. Glavni cilj istraživanja bio je odrediti vrstu operacije primarnog tumora (elektivne i hitne operacije) prije i za vrijeme COVID-19 pandemije. U našem istraživanju uspjeli smo dokazati hipotezu da će u COVID-19 pandemiji biti povećan udio hitnih operacijskih zahvata u odnosu na elektivne, što se može povezati sa smanjenim brojem preventivnih pregleda u sekundarnim zdravstvenim ustanovama, odnosno smanjenim odazivom na program za rano otkrivanje raka debelog crijeva

POBOLJŠANJE ZBRINJAVANJA BOLESNIKA S RIJETKIM BOLESTIMA U HRVATSKOJ - TEMELJENO NA PROTOKOLU ZA HEREDITARNI ANGIOEDEM

Rare diseases affect up to 6%-8% of the population and pose a challenge to healthcare professionals and healthcare system. Hereditary angioedema is a rare life-threatening, debilitating disease characterized by recurrent edema attacks. It is essential to establish the diagnosis as quickly as possible. The Healthcare Network was created in o der to prevent mistreatment of hereditary angioedema. This study evaluated the usefulness of the Hospital Information System and the Healthcare Network in urgent management of hereditary angioedema. The Instructions for Hereditary Angioedema that contain information on the diagnosis, instructions for treatment, preventive measures prior to a dental procedure, endoscopy or surgery under general anesthesia, available regimens and storage location in the Hospital, specialist’s telephone number in emergency, and name of the family member to be contacted, were implemented in the Hospital Information System, Šibenik General Hospital as a protocol for urgent management. Data on the treatment before and after implementation of the Instructions for Hereditary Angioedema were compared. Comparing medical decisions before and after implementing the Instructions for Hereditary Angioedema in the Hospital Information System revealed that following implementation of the Instructions, correct therapy was administered more often (p=0.006, Fisher exact test) and shortterm prophylaxis applied more often before medical procedures (p=0.011, Fisher exact test). Healthcare Network raised the physician awareness of this disabling and potentially fatal disease, led to accurate diagnosis and timely treatment, enabled short hospital stay, prompt recovery, and reduced absenteeism from work due to hereditary angioedema. With specific modifications, it could also be extrapolated to other rare diseases.Rijetke bolesti su izazov zdravstvenim stručnjacima i sustavima. Smatra se da 6-8 % populacije boluje od rijetkih bolesti. Nasljedni angioedem (HAE) jedna je od rijetkih bolesti, karakterizirana ponavljajućim napadima oteklina (edema) različitih dijelova tijela te se vrlo često ne dijagnosticira pravodobno, a težina ponavljajućih napadaja se pogoršava i za život je opasno stanje. Bitno je posumnjati na rijetku bolest i postaviti dijagnozu što je brže moguće. Ova je probna studija procijenila korisnost implementacije podataka o bolesnicima s HAE u Bolnički informacijski sustav (BIS) Opće bolnice Šibenskokninske županije kao i primjenu protokola za hitno zbrinjavanje i formiranje mreže zdravstvene zaštite (MZZ). Upute u BIS-u za HAE sadrže podatke o dijagnozi HAE-a, upute za liječenje, preventivne mjere prije stomatološkog, endoskopskog ili kirurškog postupka (pod lokalnom/općom anestezijom); popis raspoloživih lijekova u hitnoći i mjesto njihove pohrane u bolnici; telefonski broj specijalista u hitnoći te ime člana obitelji (kontakt osoba). Podatci o liječenju prije primjene uputa za HAE uspoređeni su s podatcima prikupljenima u razdoblju nakon provedbe implementacije novog sustava. Uspoređujući medicinske odluke prije i nakon implementacije uputa za HAE u BIS-u, pravilna je terapija bila češće primijenjena (p =0,006, Fisherov test), kao i kratkotrajna profi laksa prije medicinskih postupaka (p = 0,011, Fisherov test). Uspostava MZZ pospješuje informiranost medicinskog osoblja, pravilan odabir liječenja i zbrinjavanje bolesnika s HAE. Omogućuje brži oporavak, kraći boravak u bolnici i smanjenje radne odsutnosti bolesnika s HAE. Temeljem ove studije otvara se mogućnost primjene MZZ i za druge rijetke bolesti

Clinical guidelines for diagnostics, treatment and monitoring of patients with kidney cancer

Svjetlostanični karcinom bubrežnih stanica najčešći je oblik raka bubrega. Klinički je uglavnom asimptomatski, a samo se kod manjeg postotka bolesnika očituje hematurijom, tupom boli i palpabilnom masom u trbuhu. Najčešće se otkrije slučajno tijekom radioloških pregleda zbog nekoga drugog razloga. Dijagnoza raka bubrega potvrđuje se patohistološkim nalazom nakon provedene dijagnostičke obrade. Odluka o liječenju donosi se temeljem kliničke procjene stadija bolesti i drugih čimbenika rizika. Ovisno o tome, mogućnosti liječenja uključuju kirurški zahvat, sustavnu terapiju malim molekulama, imunoterapiju, kemoterapiju u odabranih bolesnika te palijativnu radioterapiju. U tekstu koji slijedi predstavljene su kliničke upute radi standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja i praćenja bolesnika s rakom bubrega u Republici Hrvatskoj.Clear cell cancer is the most common form of kidney cancer. Clinically, it is mostly asymptomatic, and only a small proportion of patients present with hematuria, pain, and palpable abdominal mass. It is most commonly detected incidentally during radiological examinations for other causes. Diagnosis of kidney cancer is confirmed by pathohistological findings after the radiological imaging procedures. The decision on optimal treatment is based on a clinical assessment, stage of the disease and the presence of other risk factors. Depending on this, treatment options include surgical procedure, systemic treatment with small molecules, immunotherapy, chemotherapy in selected patients, and palliative radiotherapy. In the following text clinical guidelines have been presented to standardize procedures and criteria for diagnosing, treating and monitoring kidney cancer patients in the Republic of Croatia

Retrospektivna analiza učinkovitosti i podnošljivosti trifluridin/tipiracila u bolesnika s refraktornim metastatskim kolorektalnim karcinomom u općoj bolnici Šibensko-kninske županije

In randomized clinical trials, trifluridine / tipiracil (TT) demonstrated beneficial effects on progression-free survival (PFS) and overall survival (OS) in patients with refractory metastatic colorectal cancer (mCRC). The aim of this unicentric study was to evaluate the efficacy and safety of TT in patients with refractory mCRC in everyday clinical practice. Treatment outcomes of 20 patients were retrospectively analyzed. The median OS was 6.25 months (range 1-18) and the median PFS was 3 months (range 2–13). The most common (80%) side effect of TT was neutropenia and 35% of patients had neutropeniagrades 3 of 4; however, only two patients (10%) had neutropenic fever and no deaths wereattributable to neutropenia. In conclusion, treatment outcomes in this real-life study seem comparable to those from randomized clinical trials.U randomiziranim kliničkim studijama trifluridin/tipiracil (TT) je pokazao povoljan učinak na preživljenje bez progresije bolesti (PFS) i na ukupno preživljenje (OS) u bolesnika s refraktornim metastatskim kolorektalnim karcinomom (mKRK). Cilj ovog unicentričnog istraživanja bio je procijeniti učinkovitost i sigurnost primjene TT kod bolesnika s refraktornim mKRK u svakodnevnoj kliničkoj praksi. Retrospektivno su analizirani ishodi liječenja 20 bolesnika. Medijan OS bio je 6.25 mjeseci (raspon 1-18) a medijan PFS 3 mjeseca (raspon 2-13). Najčešća (80%) nuspojava TT bila je neutropenija, u 35% bolesnika gradusa 3 i 4. Ipak, u samo dva bolesnika (10%) zabilježena je neutropenična vrućica, a nijedan bolesnik nije preminuo zbog neutropenije. Zaključno, ishodi liječenja bolesnika s mKRK s TT u svakodnevnom kliničkom radu usporedivi su s onima iz randomiziranih kliničkih studija

Clinical guidelines for diagnosis, treatment and monitoring of patients with invasive breast cancer – Croatian Oncology Society (BC-3 COS)

Rak dojke je najčešći zloćudni tumor u žena koji se može probirom, redovitim kontrolama i zdravstvenim odgojem otkriti u ranim stadijima bolesti i uspješno liječiti. Metode liječenja uključuju kirurgiju, kemoterapiju, radioterapiju, endokrinu terapiju, imunoterapiju, ciljanu terapiju te simptomatsko-suportivnu terapiju, koja se primjenjuje ovisno o stadiju bolesti, biološkim obilježjima tumora i općem stanju, dobi i komorbidetima bolesnica. Plan liječenja definira multidisciplinarni tim. S obzirom na pojavnost ove bolesti, mogućnost ranog otkrivanja i mogućeg značajnog učinka terapijskih postupaka na tijek bolesti, potrebno je definirati i pravilno standardizirati pristup u dijagnostici, liječenju i praćenju ovih bolesnica. U tekstu su iznesene smjernice s ciljem primjene standardiziranih postupaka u svakodnevnom radu s bolesnicama s rakom dojke u Republici Hrvatskoj.Breast cancer is the most common cancer in women, which can be diagnosed early through screening, early detection and through education. When diagnosed early, it can be successfully treated. Treatment modalities include surgery, chemotherapy, radiotherapy, endocrine therapy, immunotherapy, targeted therapy and supportive therapy applied depending on the stage of the disease, tumor and patient´s characteristics. Treatment should be defined by a multidisciplinary team. Due to the incidence of this disease, opportunity of early detection and possible significant influence of various treatment modalities on the course of the disease, it is important to define and implement a standardized approach for diagnosis , treatment and monitoring algorithm. The following text presents the clinical guidelines in order to standardize the procedures and criteria for diagnosis,treatment and monitoring of breast cancer patients in the Republic of Croatia