Author/Editor		Takač, Iztok
Title		Rak jajčnikov - diagnostika in zdravljenje
Translated title		Ovarian cancer - detection methods and treatment
Type		članek
Source		In: Mlakar-Mastnak D, Lokar K, editors. 34. strokovni seminar "Ženske, moški in rak". Ljubljana: Sekcija medicinskih sester in zdravstvenih tehnikov v onkologiji,
Publication year		2007
Volume		str. 65-74
Language		slo
Abstract		Ovarian cancer (OC) in its early stages does not usually produce symptoms or signs that would alert the clinician to this diagnosis. A detailed medical history must be taken and a complete physical examination, including pelvic and rectal examination must be performed. Prior to surgery a chest radiograph should be taken and CT scan of the abdomen and pelvis should be performed. Tumour markers including CA 125, and carcinoembryonic antigen (CEA) should be considered. A thorough staging laparotomy with removal of all obvious sites oftumour in addition to total hysterectomy and bilateral salpingo-oophorectomy is the most important part of early management. Further, the omentum, pelvic and para-aortic lymph nodes should also be removed. In patients with stage IA and IB adjuvant chemotherapy would not provide further benefits. All other patients should receive adjuvant chemotherapy. For systemic chemotherapy, a combination of a paclitaxel or docetaxel with carboplatin is the first choice. The number of cycles is usually between 3-6. The most critical prognostic indicators in patients is the volume of residual disease. In some patients secondary cytoreduction, which is defined as an attempt at cytoreductive surgery at some stage following completion of first-line chemotherapy, is necessary. Patientswith relapsed OC, who are platinum refractory, could be enrolled in available clinical trials or treated with liposomal doxorubicin, topotecan, etoposide and gemcitabine.
Summary		Rak jajčnikov (RJ) v zgodnjih stadijih navadno ne povzroča simptomov ali znakov, na osnovi katerih bi lahko posumili na njegovo prisotnost. Pri obravnavi bolnic je potrebna natančna anamneza, klinični pregled celega telesa ter ginekološki in rektalni pregled. Pred operativnim posegom rentgensko slikamo pljuča in naredimo CT preiskavo trebuha in medenice. Potrebno je tudi določiti tumorkse markerje CA 125 in karcinoembrionalni antigen (CEA). Najpomembnejši del zgodnjega zdravljenja je natančna staging laparotomija z odstranitvijo vseh vidnih delov tumorja, skupaj s popolno histerektomijo in z obojestransko adneksektomijo. Odstraniti je potrebno tudi omentum in pelvične ter paraaortne bezgavke. Pri dobro diferenciranih tumorjihv stadijih IA in IB dopolnilno zdravljenje s citostatiki ni potrebno. Pri vseh ostalih bolnicah je indicirano dopolnilno zdravljenje. Prva izbira sistemskega zdravljenja je kombinacija paklitaksela ali docetaksela s karboplatino. Navadno apliciramo tri do šest krogov kemoterapije. Najpomembnejši napovedni dejavnik poteka bolezni je prostornina preostale bolezni. V nekaterih primerih je potrebna sekundarna citoredukcija, pri kateri odstranimo rakasto tkivo kadarkoli po končanem sistemskem zdravljenju. Ponovitve RJ pri bolnicah, ki so občutljive na platino, zdravimo s kombinacijo platine in paklitaksela. Bolnice s ponovitvijo RJ, ki so odporne na platino, lahko vključimo v klinične raziskave ali jih zdravimo z zdravili, ki ne vsebujejo platine: liposomski doksorubicin, topotekan, etopozid in gemcitabin.
Descriptors		OVARIAN NEOPLASMS CHEMOTHERAPY, ADJUVANT NEOPLASM STAGING