Author/Editor		Debevec, Lučka; Cesar, Rok; Kern, Izidor
Title		Triple synchronous cancers: a medical and ethical problem
Translated title		Trojni sočasni rak: medicinski in etični problem
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 41, št. 2
Publication year		2007
Volume		str. 80-5
Language		eng
Abstract		Background. In a patient with suspicious synchronous multiple tumours, there are limited possibilities for effective therapy. Therefore, the decision for invasive diagnostics and precise staging of tumours is questionable, especially in elderly patients suitable only for symptomatic therapy. Case report. A 78-year-old man with hypertension and angina pectoris was admitted to the hospital due to syncope. Two primary lung tumours and a kidney tumour were detected by imaging investigation. The patient refused invasive diagnostics and left the hospital. After 19 months he was readmitted in an impaired clinical condition and subsequently died of bronchopneumonia. The autopsy revealed squamous cell carcinoma of the right upper lobe with metastases to regional lymph nodes and to the brain, small-cell carcinoma of the left upper lobe with metastases to regional lymph nodes and to the spleen, and clear-cell kidney carcinoma with multiple metastases to the lungs. All tumours were necrotizing, and therefore we assumed that any attempt at specific therapy would have been ineffective. Conclusions. In an elderly patient with advanced lung tumors and suspicious synchronous triple cancers, the "wait and see" option can be suitable.
Summary		Izhodišča. Pri bolniku, pri katerem sumimo na sočasni rak, so možnosti za učinkovito zdravljenje omejene. Zato se postavlja vprašanje invazivne diagnostike in natančne zamejitve, posebno pri starejših boinikih s slabo telesno zmogljivostjo, ki so primerni le za simptomatsko zdravljenje. Opis primera. 78-letni bolnik z arterijsko hipertenzijo in angino pektoris je bil sprejet v bolnišnico zaradi sinkope. S slikovnimi preiskavami smo ugotovili dva primarna tumorja pljuč in tumor ledvice. Bolnik je odklonil invazivno diagnostiko in po nekaj dneh smo ga odpustili domov. 19 mesecev kasneje je bil ponovno sprejet v slabem kliničnem stanju in je umrl zaradi pljučnice. Avtopsija je pokazala: ploščatocelični rak desnega zgornjega pljučnega režnja z zasevki v regionalne bezgavke in možgane, drobnocelični rak levega zgornjega pljučnega režnja z zasevki v regionalne bezgavke in vranico ter svetlocelični rak desne ledvice s številnimi zasevki v obeh pljučnih krilih. Vsi tumorji so bili nekrotični. Zaradi tega sklepamo, da poskus specifičnega zdravljenja verjetno ne bi bil uspešen. Zaključki. Pri starejšem bolniku z napredovalim pljučnim rakom, pri katerem sumimo na trojni sočasni rak, je lahko najbolj ustrezna odločitev spremljanje bolnika.
Descriptors		NEOPLASMS, MULTIPLE PRIMARY PROGNOSIS ETHICS, MEDICAL AGED