Author/Editor		Debevec, Lučka
Title		Pomen zamejitve bolezni in ocena sposobnosti bolnika za zdravljenje pljučnega raka
Translated title		The value of standing and estimating patient's capacity for lung cancer therapy
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 75, št. 6-7
Publication year		2006
Volume		str. 389-99
Language		slo
Abstract		Background Resection yields the best survival rate in non-small cell lung cancer, and also as an adju vant therapy to chemotherapy and radiation in small-cell lung cancer. Therefore it is suitable to search for patients with technically and medically operable tumours. Therefore it is necessary to perform the correct staging and estimation of a patient's capacity for the intended surgery. Knowledge of the capability and reliability of singular investigations and their proper sequencing enables clinical staging of the tumour. The selection of the best treatment modality is based on the last factor. The diagnostic procedure should be rational and short, and the selected treatment useful for recovery, prolongation of survival or at least the relief of symptoms. Conclusions Staging is based on TNM tumour classification. In the process and extent of staging it is necessary to carefully estimate and consider the patient's capacity, particularly clinical condition, performance status, age, comorbidity and pulmonary function, and to assess tumour resectability by imaging (X-ray, CT MRI, PET US) and invasive investigations (bronchoscopy, cervical mediastinoscopy, parasternal mediastinotomyand [video]thora- coscopy). Before final selection of treatment, modality microscopic verification of the tu- mour is needed. Exploratory thoracotomy remains the ultimate possibility for verificatication and estimation of resectability. In addition to the imaging investigations mentioned, in searching for distant metastases the following are also useful: bone scanning, fine needle biopsy of palpable or reachable lesions of the lymph nodes, skin, bone marrow, body fluids and parenchymal organs. Laboratory tests of blood, urine and other bodily fluids may also indicate that the tumour has spread. It is necessary to take into account, that negative test results do not reliably exclude metastases.
Summary		Izhodišča Resekcija omogoča najdaljše preživetje pri nedrobnoceličnem raku, kot podporno zdravljenje kemoterapiji in obsevanju pa tudi pri drobnoceličnem raku. Zato je smiselno iskati bolnike, ki imajo tehnično in medicinsko operabilen tumor. V ta namen je potrebno opraviti natančno zamejitev bolezni in oceniti sposobnost bolnika za nameravano operacijo. Poznavanje zmogljivosti in zanesljivosti posameznih preiskav ter njihovo smiselno zaporedje omogoča klinično zamejitev tumorja. Ta pa omogoča izbor najbolj primernega načina zdravljenja. Diagnostični postopek mora biti racionalen in čim manj obremenilen za bolnika, izbrani način zdravljenja pa koristen za bolnika v smislu ozdravitve, podaljšanja preživetja ali vsaj olajšanja težav. Zaključki Zamejitev temelji na TNM klasifikaciji tumorja. Pri poteku in obsegu zamejitve je potrebno skrbno oceniti in upoštevati sposobnost bolnika, predvsem njegovo klinično stanje, telesno zmogljivost, starost, spremljajoče bolezni in pljučno funkcijo ter oceniti odstranljivost tumorja s pomočjo slikovnih preiskav, kot so rentgensko slikanje, CT, MRl, PET, UZ in invazijskih preiskav: bronhoskopije, mediastinoskopije, mediastinotomije in (video)torakoskopije. Pred dokončno odločitvijo o načinu zdravljenja je potrebna mikroskopska opredelitev tumorja. Skrajna možnost za verifikacijo tumorja in oceno njegove odstranljivosti ostaja eksplorativna torakotomija. Pri odkrivanju oddaljenih zasevkov so poleg naštetih slikovnih preiskav uporabni scintigrafija skeleta, citološka punkcija tipljivih oz. dosegljivih sprememb v bezgavkah, koži, podkožju, kostnem mozgu, telesnih tekočinah in notranjih organih. Tudi iz spremenjenih vrednosti preiskav krvi, urina in drugih telesnih tekočin je mogoče sklepati na razsoj tumorja. Potrebno pa je upoštevati dejstvo, da negativni rezultati preiskav zasevkov zanesljivo ne izključujejo.
Descriptors		LUNG NEOPLASMS NEOPLASM STAGING THORACOTOMY PHYSICAL ENDURANCE LUNG VOLUME MEASUREMENTS COMORBIDITY NEOPLASM METASTASIS TOMOGRAPHY, X-RAY COMPUTED TOMOGRAPHY, EMISSION-COMPUTED MAGNETIC RESONANCE IMAGING BRONCHOSCOPY MEDIASTINOSCOPY THORACOSCOPY