THE IMPORTANCE OF OVERALL APPROACH TO THERAPY FOR ADVANCED BREAST CANCER: A CASE REPORT

Prikazana je 45 godišnja pacijentica hospitalizirana zbog ekspanzivnog procesa u abdomenu, godinu i pol dana nakon redukcije tumora, obostrane adneksektomije i omentektomije zbog ovarijskog metastatskog karcinoma, kad se operativnom zahvatu pristupilo nakon embolizacije u svrhu smanjenja tumorske mase i lakšeg operativnog pristupa. Pacijentica je prije sedam godina podvrgnuta amputaciji lijeve dojke zbog duktalnog invazivnog karcinoma dojke. Pri ¬relaparotomiji nađu se uterus, rektum i distalni dio sigme u bloku, povećani limfni čvorovi desno ingvinalno i mezenterijalni limfni čvorovi. Učini se ekstirpacija uterusa, resekcija rektuma sec. Dixon s termino-terminalnom anastomozom pomoću samošivača, svega par centimetara od anokutane granice, desnostrana ingvinalna limfadenektomija i ekstirpacija mezenterijalnih limfnih čvorova. Provedena je kemoterapija u trajanju od osam ciklusa. Pacijentica umire godinu dana nakon zahvata, a osam godina od dijagnosticiranog raka dojke s razmjerno dobrom kvalitetom života. S obzirom na stadij bolesti i njezin klinički tijek držimo da su duljina preživljenja i kvaliteta života rezultat multidisciplinarnog pristupa u liječenju ove bolesnice. Prilikom kontrolnih pregleda ženu oboljelu od raka dojke potrebno je uvijek upućivati i na ginekološke preglede, imajući stalno u vidu da rak dojke može metastazirati i na jajnike.A 45-year-old patient was admitted to the Clinic because of expansive process in the abdominal cavity. Previously year and half before she was operated and reduction of the tumor mass, bilateral adnexectomy and omentectomy were performed, just following embolization of the tumor in order to make it smaller and more suitable for ¬operation. A metastatic carcinoma of the ovary was found. Seven years previously a total mastectomy was performed when ductal ¬invasive carcinoma was diagnosed. During relaparotomy we found uterus, rectum and distal part of sigmoid colon in a ¬total block, enlarged right inguinal lymph nodes and mesenterial ones. We performed hysterectomy, resection of ¬rectum sec. Dixon and anastomosis, dissection of right inguinal lymph nodes and mesenteric ones. Postoperatively she underwent chemotherapy. Unfortunately, she died a year after, and eight years after the breast carcinoma has been ¬diagnosed, although her life quality was relatively good. Taking into consideration the stage of the disease and its clinical course, we believe that both the length of survival and the quality of life of our patient resulted from the multidisciplinary approach. Therefore, control examinations for any breast cancer patients should also comprise a gynecological exam, ¬always taking into consideration that breast cancer may metastasize to the ovaries

CLINICAL RECOMMENDATIONS FOR TREATING AND MONITORING PATIENTS WITH RENAL CANCER

Svjetlostanični tip karcinoma 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. 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 te s obzirom na visoku rezistenciju raka bubrega na kemoterapiju i hormonsku terapiju, primjenu ciljane terapije (imunoterapija, inhibicija aktivnosti receptora tirozin kinaze) te palijativnu radioterapiju. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, upravljanja i liječenja te praćenja bolesnika s rakom bubrega u Republici Hrvatskoj.Clear cell renal carcinoma is the most common kidney cancer. It is generally asymptomatic. A small percentage of patients present with hematuria, flank pain and abdominal mass. It is usually detected accidentally during radiologic examination. The diagnosis of kidney cancer is confirmed by pathohistological findings after completion of the diagnostic process. The decision about treatment is made based on clinical assessment of disease stage and other risk factors. Depending on that, treatment options include surgery, and considering high resistance of kidney cancer on chemotherapy and hormone therapy, use of targeted therapies (immunotherapy, tyrosine kinase inhibitors) and palliative radiotherapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for the diagnosis, management, treatment and monitoring of patients with kidney cancer in the Republic of Croatia

CLINICAL RECOMMENDATIONS FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH INVASIVE BREAST CANCER

Rak dojke najčešća je maligna bolest u žena. Razvoj preventivnih mjera i dijagnostike i svih oblika liječenja (kirurgije, radioterapije, kemoterapije, hormonske i ciljane biološke terapije) doveo je do produljenja preživljenja i poboljšanja kvalitete života bolesnica. S ciljem optimalizacije i standardizacije liječenja, a slijedeći smjernice medicine temeljene na dokazima, donosimo smjernice za dijagnostiku, liječenje i praćenje bolesnica s rakom dojke koje su rezultat rada multidisciplinarnog tima stručnjaka.Breast cancer is the most common malignancy in women. Preventive measures, early diagnosis and development of all treatment modalities (surgery, radiotherapy, chemotherapy, hormonal and targeted biologic therapy) led to improvement in survival and quality of life of the patient. In order to standardize and optimize the approach, following good clinical practice standards, we bring consensus guidelines for diagnosis, treatment and monitoring of breast cancer patients as a result of consensus of a multidisciplinary team of experts for breast cancer

CLINICAL RECOMMENDATIONS FOR DIAGNOSIS, TREATMENT AND MONITORING OF PATIENTS WITH INVASIVE BREAST CANCER

Rak dojke najčešća je maligna bolest u žena. Razvoj preventivnih mjera i dijagnostike i svih oblika liječenja (kirurgije, radioterapije, kemoterapije, hormonske i ciljane biološke terapije) doveo je do produljenja preživljenja i poboljšanja kvalitete života bolesnica. S ciljem optimalizacije i standardizacije liječenja, a slijedeći smjernice medicine temeljene na dokazima, donosimo smjernice za dijagnostiku, liječenje i praćenje bolesnica s rakom dojke koje su rezultat rada multidisciplinarnog tima stručnjaka.Breast cancer is the most common malignancy in women. Preventive measures, early diagnosis and development of all treatment modalities (surgery, radiotherapy, chemotherapy, hormonal and targeted biologic therapy) led to improvement in survival and quality of life of the patient. In order to standardize and optimize the approach, following good clinical practice standards, we bring consensus guidelines for diagnosis, treatment and monitoring of breast cancer patients as a result of consensus of a multidisciplinary team of experts for breast cancer

Phenotype-dependent apoptosis signalling in mesothelioma cells after selenite exposure

<p>Abstract</p> <p>Background</p> <p>Selenite is a promising anticancer agent which has been shown to induce apoptosis in malignant mesothelioma cells in a phenotype-dependent manner, where cells of the chemoresistant sarcomatoid phenotype are more sensitive.</p> <p>Methods</p> <p>In this paper, we investigate the apoptosis signalling mechanisms in sarcomatoid and epithelioid mesothelioma cells after selenite treatment. Apoptosis was measured with the Annexin-PI assay. The mitochondrial membrane potential, the expression of Bax, Bcl-XL, and the activation of caspase-3 were assayed with flow cytometry and a cytokeratin 18 cleavage assay. Signalling through JNK, p38, p53, and cathepsins B, D, and E was investigated with chemical inhibitors. Furthermore, the expression, nuclear translocation and DNA-binding activity of p53 was investigated using ICC, EMSA and the monitoring of p21 expression as a downstream event. Levels of thioredoxin (Trx) were measured by ELISA.</p> <p>Results</p> <p>In both cell lines, 10 μM selenite caused apoptosis and a marked loss of mitochondrial membrane potential. Bax was up-regulated only in the sarcomatoid cell line, while the epithelioid cell line down-regulated Bcl-XL and showed greater caspase-3 activation. Nuclear translocation of p53 was seen in both cell lines, but very little p21 expression was induced. Chemical inhibition of p53 did not protect the cells from apoptosis. p53 lost its DNA binding ability after selenite treatment and was enriched in an inactive form. Levels of thioredoxin decreased after selenite treatment. Chemical inhibition of MAP kinases and cathepsins showed that p38 and cathepsin B had some mediatory effect while JNK had an anti-apoptotic role.</p> <p>Conclusion</p> <p>We delineate pathways of apoptosis signalling in response to selenite, showing differences between epithelioid and sarcomatoid mesothelioma cells. These differences may partly explain why sarcomatoid cells are more sensitive to selenite.</p

Kliničke upute za dijagnozu, liječenje i praćenje bolesnika oboljelih od invazivnog raka dojke [Clinical recommendations for diagnosis, treatment and monitoring of patients with invasive breast cancer]

Breast cancer is the most common malignancy in women. Preventive measures, early diagnosis and development of all treatment modalities (surgery, radiotherapy, chemotherapy, hormonal and targeted biologic therapy) led to improvement in survival and quality of life of the patient. In order to standardize and optimize the approach, following good clinical practice standards, we bring consensus guidelines for diagnosis, treatment and monitoring of breast cancer patients as a result of consensus of a multidisciplinary team of experts for breast cancer

CROATIAN GUIDELINESS FOR PREVENTION OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

70–80% bolesnika liječenih kemoterapijom izloženo je mučnini i povraćanju. Mučnina i povraćanje važne su nuspojave onkološkog liječenja te značajno utječu na kvalitetu života bolesnika, a često uzrokuju odgodu i prekid liječenja (slabiju suradljivost bolesnika tijekom liječenja). Ključno načelo antiemetske kontrole je prevencija. Trenutačno dostupni antiemetski lijekovi (kortikosteroidi, antagonisti 5-HT3-receptora i NK-1-antagonisti) primjenjuju se sami ili u kombinaciji. Koji će antiemetik biti primijenjen ovisi o emetogenom potencijalu pojedinoga kemoterapijskog protokola, prethodnom iskustvu s antiemeticima i predispozicijskim čimbenicima sa strane bolesnika. Noviji lijekovi, uključujući antagoniste 5HT3-receptora druge generacije palonosetron i NK-1-antagonist aprepitant, nude dodatnu kliničku korist u visoko i umjereno emetogenoj kemoterapiji, posebno za odgo|enu mučninu i povraćanje. Namjera ovog antiemetskog vodiča je dosegnuti jedinstvene standarde u zbrinjavanju i liječenju mučnine i povraćanja u Hrvatskoj, a koji bi bili prihvatljivi u našem okružju – u vodič su uključeni dostupni lijekovi.Approximately 70–80% of all cancer patients receiving chemotherapy experience nausea and/or vomiting. Nausea and vomiting are important side effects of cancer treatment, which can significantly affect a patient’s quality of life, leading to poor compliance with further chemotherapy treatment. The main principle of emesis control is prevention. Currently available antiemetic agents corticosteroids, 5-hydroxytriptamine receptor antagonists, and neurokinin-1 antagonists, are used alone or in combination. Antiemetic regimen should be chosen based on the emetogenic potential of the chemotherapy regimen, previous experience with antiemetics, and patient-specific risk factors. Newer agents, including second generation 5-HT3 receptor antagonist palonosetron and the NK-1 antagonist aprepitant, offer additional clinical benefit in highly and moderately emetogenic therapy, especially in delayed nausea and vomiting. The aim of this Guidelines is to achieve same standards of care in the treatment of nausea and vomiting across Croatia that are applicable in our environment – only available drugs are included in the Guidelines