8 research outputs found
Koriokarcinom maternice ā prikaz sluÄaja
Choriocarcinoma is one of the histological types of entities called gestational trophoblastic neoplasia (GTN) that refers to a rare group of malignancies that are formed by abnormal proliferation of trophoblastic tissue. Choriocarcinoma is the most aggressive GTN histological type and is characterized by early vascular invasion and disseminated disease. The clinical presentation depends on the spread of the disease and the location of the seedlings. In this paper we present the case of a 32-year-old patient sent to our Department for a specific oncological treatment of uterine choriocarcinoma diagnosed in an external institution. The disease is according to FIGO and WHO scale classified as III stage, low risk and chemotherapy with methotrexate and folic acid is indicated. The chemotherapy achieved negativity of the initially elevated tumor marker human chorionic gonadotropin (hCG) and full regression of lesions described in computerized tomography (CT).Koriokarcinom jedan je od histoloÅ”kih tipova gestacijske trofoblastiÄne neoplazije (GTN), rijetke skupine malignoma nastale abnormalnom proliferacijom tkiva trofoblasta i predstavlja najagresivniji histoloÅ”ki tip GTN. Odlikuje se ranim krvožilnim bujanjem i udaljenim presadnicama. KliniÄka slika ovisi o proÅ”irenosti bolesti i smjeÅ”taju presadnica. U ovom radu prikazan je sluÄaj 32 godiÅ”nje bolesnice upuÄene u naÅ”u ustanovu radi specifiÄnog lijeÄenja koriokarcinoma maternice dijagnosticiranog u drugoj ustanovi. Bolest je prema FIGO i WHO ljestvici klasificirana u III stadij niskog rizika. LijeÄenje metotreksatom i folnom kiselinom dovelo je do negativizacije poÄetno izrazito poviÅ”enog tumorskog biljega humanog korionskog gonadotropina (hCG) i potpunog povlaÄenja promjena opisanih CT-om
THROMBOEMBOLIC COMPLICATIONS IN ONCOLOGIC PATIENTS
Duboka venska tromboza je drugi najÄeÅ”Äi uzrok smrti bolesnika oboljelih od raka. Bolesnici oboljeli od zloÄudne bolesti imaju veÄu sklonost zgruÅ”avanju krvi i time veÄi rizik od tromboembolijskih komplikacija. Operacija, kemoterapija, radioterapija i imobilizacija tih bolesnika dodatno doprinose nastanku duboke venske tromboze. ImajuÄi u vidu preoperativne i intraoperativne prognostiÄke Äimbenike za nastanak duboke venske tromboze, u moguÄnosti smo pravovremeno intervenirati i smanjiti moguÄe komplikacije. Niskomolekularni heparin se pokazao uspjeÅ”nim u prevenciji i lijeÄenju tromboembolijskih komplikacija, a nekoliko studija izvjeÅ”tava o duljem oÄekivanom preživljenju bolesnika oboljelih od zloÄudne bolesti lijeÄenih antikoagulantnom terapijom.Deep venous thrombosis is the second most common cause of death in cancer patients. Patients with cancer are at heightened risk of venous and arterial thromboembolism due to the hypercoagulable state. Surgery, chemotherapy, radiotherapy and immobilization of the cancer patients heighten this risk even more. Having in mind all the pre- and intraoperative prognostic factors, we are capable to prevent and reduce possible complications. Low-molecular-weight heparin is proven to be beneficial in the prevention and treatment of the thrombotic complications. There are numerous studies reporting on improved survival of cancer patients treated with LMW heparin
THERAPY OF OVARIAN CANCER WITH PACLITAXEL Our Results
Cilj istraživanja. Standardna kemoterapija u bolesnica s lokalno uznapredovalim rakom jajnika stadija II do IVa je kombinacija paklitaksela s cisplatinom/karboplatinom. ViÅ”e od 75% bolesnica javlja se upravo u tim stadijima bolesti. PoÄetkom 90-tih godina proÅ”log stoljeÄa ova kombinacija lijekova koristila se u recidivima nakon incijalne kemo-terapije s cisplatinom/karboplatinom, u kombinaciji s ciklofosfamidom i/ili adriamicinom, da bi se nakon zadovoljavajuÄih rezultata nakon 1995. godine poÄela koristiti i u Ā»prvojĀ« liniji lijeÄenja. Metode. U Zavodu za ginekoloÅ”ku onkologiju Klinike za ženske bolesti i porode KBC-a Zagreb zapoÄeli smo primjenom paklitaksela 1994. godine. Od 1994.ā1996. godine davali smo ga iskljuÄivo u sluÄaju recidiva da bismo 1996. godine prvi puta zapoÄeli lijeÄenje spomenutom kombi-nacijom kao prvom linijom. Od 1994. do 2002. godine ukupno je lijeÄeno 65 bolesnica; paklitaksel je uÅ”ao na listu lijekova Hrvatskog Zavoda za zdravstveno osiguranje (HZZO) za recidiv bolesti 1997. godine, a tek 1998. godine za prvu liniju uz posebne zamolbe HZZO-u. Svaka je bolesnica primila izmeÄu 4ā10 ciklusa kemoterapije te je ukupno primijenjeno preko 650 ciklusa kemoterapije. Rezultati. Tijekom primjene ni u jedne bolesnice nismo imali smrtni ishod, a samo kod dvije (3%) ozbiljnije alergijske reakcije koje su uspjeÅ”no zbrinute, pa je nastavljeno s kemoterapijom. ZakljuÄak. Na temelju naÅ”ega iskustva možemo reÄi da je paklitaksel u kombinaciji s cisplatinom/karboplatinom vrlo uÄinkovit citostatik te da se naÅ”i rezultati lijeÄenja ne razlikuju od rezultata objavljenih u svjetskoj literaturi.The aim of investigation. Standard chemotherapy in patients with locally advanced ovarian cancer stage II to stage IV is the combination of paclitaxel with cisplatin/carboplatin. More than 75% of patients are diagnosed at these stage of disease. At the begining of the 90ās of last century this combination of agents was used in recurrencies after initial chemotherapy with cisplatin/carboplatin with cyclophosphamide and/or adriamycin and has, proving to have satisfactory results, since 1995 been used in the first-line therapy. Methods. At Gynecologic Cancer Center, University Hospital Zagreb the use of paclitaxel started in 1994; from 1994 to 1996 paclitaxel was exclusively used for patients with recurrent disease. The use of paclitaxel plus cisplatin/carboplatin combination began as the first-line therapy in 1996. From 1994 to 2002 a total of 65 patients were treated with this combination. In 1997 paclitaxel was listed by the Croatian Health Insurance Agency (HZZO) as therapy for recurrent disease; in 1998 was the special request to HZZO for the first-line therapy and in 2002 separate funds were allocated for the treatment of patients with ovarian cancer stage II to IV with paclitaxel. From 1994 to 2001 paclitaxel was used in 23 patients, of which 5 in the first-line therapy and 18 after recurrencies as second-line therapy. In 2002, 42 patients were treated with paclitaxel ā 32 in the first-line and 10 in the second-line therapy. Considering the fact that each patient was treated with between 4 to 10 cycles of chemoterapy, it has amounted to a total of more than 650 cycles of chemotherapy. Results. No treatment had a death outcome, only two patients (3%) experienced a serious allergic reaction but were successfully managed and chemotherapy was continued. Conclusion. Our experience confirms that paclitaxel in combination with cisplatin/carboplatin is a very effective drug and our results of chemotherapy do not differ from the results published in the world literature
CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH OVARIAN CANCER ā CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY
Rak jajnika i jajovoda po uÄestalosti je peta zloÄudna bolest žena u Hrvatskoj. HistoloÅ”ki je rak jajnika najÄeÅ”Äe epitelnog podrijetla, i to seroznog podtipa. RjeÄi su razliÄiti neepitelni malignomi jajnika, a posebnu skupinu Äine epitelni karcinomi niskoga zloÄudnog potencijala karakterizirani neinvazivnoÅ”Äu, kliniÄki indolentnim tijekom i dobrom prognozom te primarni rak potrbuÅ”nice i rak jajovoda. KliniÄki su ovi zloÄudni tumori u ranim stadijima razvoja uglavnom asimptomatski, zbog Äega se najÄeÅ”Äe dijagnosticiraju u kasnijim stadijima bolesti. Dijagnoza se potvrÄuje patohistoloÅ”kim nalazom, a iznimno citoloÅ”kim nalazom nakon provedene dijagnostiÄke obrade. O lijeÄenju odluÄuje multidisciplinarni tim uzimajuÄi u obzir dob, opÄe stanje i komorbiditete bolesnice, kao i obilježja samog tumora ukljuÄujuÄi stadij bolesti, histoloÅ”ki tip i gradus tumora. Principi lijeÄenja primarnog raka potrbuÅ”nice i jajovoda temelje se na principima lijeÄenja epitelnog raka jajnika koji obuhvaÄaju primjenu kirurÅ”kih zahvata, kemoterapije, imunoterapije i hormonske terapije, kao i suportivno-simptomatskih mjera tijekom cijelog lijeÄenja. Razlikuje se terapijski pristup rjeÄim, neepitelnim histoloÅ”kim tipovima tumora koji se ÄeÅ”Äe dijagnosticiraju u ranim stadijima bolesti, imaju indolentniji tijek pa se kod ovih bolesnica ÄeÅ”Äe primjenjuju poÅ”tedni kirurÅ”ki zahvati s ciljem oÄuvanja plodnosti. U tekstu koji slijedi predstavljene su kliniÄke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, lijeÄenja te praÄenja bolesnica s rakom jajnika, jajovoda i potrbuÅ”nice u Republici Hrvatskoj.Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia
CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER ā CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY
Rak trupa maternice javlja se u veÄini sluÄajeva u poslijemenopauzalnih žena, a najÄeÅ”Äe se oÄituje ginekoloÅ”kim krvarenjem. Nakon raka jajnika i vrata maternice treÄi je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistoloÅ”kim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrÄuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeliÄnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliniÄke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, lijeÄenja i praÄenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia
KliniÄke upute za dijagnostiku, lijeÄenje i praÄenje bolesnica oboljelih od raka jajnika Hrvatskoga onkoloÅ”kog druÅ”tva i Hrvatskog druÅ”tva za ginekologiju i opstetriciju Hrvatskoga lijeÄniÄkog zbora te Hrvatskoga ginekoloÅ”koonkoloÅ”kog druÅ”tva [Clinical recommendations for diagnosing, treatment and monitoring of patients with ovarian cancer - Croatian Oncology Society and Croatian Society for Gynecology and Obstetrics as Croatian Medical Association units and Croatian Society of Gynecological Oncology]
Ovarian cancer together with fallopian tube represents the fifth most common female cancer in the Republic of Croatia. Epithelial ovarian cancer, serous subtype, encompasses most of malignant ovarian neoplasms. Less common are various non-epithelial ovarian malignancies. A special group consists of epithelial carcinomas of low malignant potential with clinically indolent flow, good prognosis and no invasion, and primary cancer of the peritoneum and fallopian tube cancer. Clinically, these malignant tumors are generally asymptomatic in early stages, and usually diagnosed in advanced stages. The diagnosis is confirmed by pathological examination, and occasionally, cytological findings after completing diagnostic procedures. Multidisciplinary team makes treatment decisions, taking into account age, general condition and comorbidities of the patient and characteristics of the tumor itself, including disease stage, histological type and grade of the tumor. The principles of treatment of primary peritoneal and fallopian tube cancer are based on the principles of treatment of epithelial ovarian cancer involving surgery, chemotherapy, immune and hormone therapy, and symptomatic-supportive care throughout the treatment. Less common histological types have a different treatment approach being more frequently diagnosed in the early stages of the disease, have more indolent flow, so in these patients conservative surgeries with the goal of preserving fertility are more often employed. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, management, treatment and monitoring of patients with ovarian carcinoma, fallopian tube and primary peritoneal cancer in the Republic of Croatia
CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER ā CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY
Rak trupa maternice javlja se u veÄini sluÄajeva u poslijemenopauzalnih žena, a najÄeÅ”Äe se oÄituje ginekoloÅ”kim krvarenjem. Nakon raka jajnika i vrata maternice treÄi je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistoloÅ”kim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrÄuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeliÄnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliniÄke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, lijeÄenja i praÄenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia
CLINICAL RECOMMENDATIONS FOR DIAGNOSING, TREATMENT AND MONITORING OF PATIENTS WITH ENDOMETRIAL CANCER ā CROATIAN ONCOLOGY SOCIETY AND CROATIAN SOCIETY FOR GYNECOLOGY AND OBSTETRICS AS CROATIAN MEDICAL ASSOCIATION UNITS AND CROATIAN SOCIETY OF GYNECOLOGICAL ONCOLOGY
Rak trupa maternice javlja se u veÄini sluÄajeva u poslijemenopauzalnih žena, a najÄeÅ”Äe se oÄituje ginekoloÅ”kim krvarenjem. Nakon raka jajnika i vrata maternice treÄi je uzrok smrti žena od raka spolnog sustava. Dijagnoza se postavlja patohistoloÅ”kim pregledom kiretmana ili bioptata, a definitivni stadij bolesti utvrÄuje se analizom uzoraka dobivenih histerektomijom i obostranom salpingoovariektomijom sa zdjeliÄnom i paraaortalnom limfadenektomijom. U tekstu koji slijedi sadržane su kliniÄke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, lijeÄenja i praÄenja bolesnica s rakom trupa maternice u Republici Hrvatskoj.Uterine cancer occurs mainly in postmenopausal women, usually as vaginal bleeding. Following ovarian and cervical cancer it is the third most common cause of female reproductive system cancer death. Diagnosis is set by analyzing samples obtained via hysterectomy with salpingo-oophorectomy and pelvic / paraaortal lymphadenectomy. The following text presents the clinical guidelines in order to standardize the procedures and criteria for the diagnosis, treatment and monitoring of patients with uterine cancer in the Republic of Croatia