ujmajuridze.oncology.pdf · zaza ujmajurize kkopenhageni, dania. kibos prevencia axali kibosa da...

როდის უნდა მივმართოთპაციენტი ონკოლოგიური

გამოკვლევისათვისგამოკვლევისათვის

zaza ujmajuriZe

kKopenhageni, dania

kibos prevencia

axali kibosa da kiboTi gamowveuli sikvdilianobis Tavidan

acileba SesaZlebelia 50% SemTxvevaSi.

ganviTarebul qveynebSi kibos mizezebia Tambaqo

(30%), cudi sakvebi, simsuqne da umoZraoba (30%).

kibos prevencia

Tambaqos kvamli Seicavs daaxloebiT 4.000 nivTierebas,

romelTagan 55 karcinogenulia.

nikotini ar iwvevs kibos, magram iwvevs Tambaqozenikotini ar iwvevs kibos, magram iwvevs Tambaqoze

damokidebulebas.

Tambaqo sikvdilianobis 30% mizezia mTel msoflioSi, rac

yovelwliurad msoflios farglebiT 10 milion sikvdilis SemTxvevas

iwvevs.

kibos prevencia

filtvis kibos 90% gamowveulia moweviT (pirdapir

proporciuli damokidebuleba mowevasa da kibos

ganviTarebis risks Soris).

pasiuri moweva!!!

kibos prevencia

moweva mTavari mizezia – xorxis, piris Rrus, enis, xaxis,

saylapavisa da filtvis kibosi

damatebiTi faqtoria – pankreasis, Tirkmlis, kuWis, msxvili

nawlavis, Sardis buStisa da saSvilosnos yelis kiboTa

SemTxvevaSi.

Sewydes moweva sajaro TavSeyris adgilebSi!

klinikuri niSnebi

klinikuri niSnebi - paraneoplazia

zemo Rru venis sindromi

simsivnuri kompresia

PET/CT

zurgis tvinis kompresia

skriningi

janmrTeli individebis gamokvleva

sanam maT simptomebiganuviTardebaT

prostatis kibos skriningi

• aRmoaCino simsivnuri daavadeba im stadiaSi, rodesac misi

gankurneba jer kidev SesaZlebelia.

• 20 wlis win prostatis kibos 2/3 diagnostika ganukurnebel stadiaSi

xdeboda.

• axla markeris saSualebiT diagnostirebul pacientTa or mesamed

lokaluri daavadeba aqvs.

Lu-Yao GL, Greenberg ER. Changes in prostate cancer incidence and treatment in USA. Lancet 1994;

343:251-4.

prostatis kibos skriningi

prostatis kibo metad Zneli prognostirebadia

skriningis amJamindeli meTodebi sakmarisi ar aris imisaTvis,

rom Semcirdes am daavadebis sikvdilianoba da avadmyofobarom Semcirdes am daavadebis sikvdilianoba da avadmyofoba

(morbidity)

sagrZnobi hiperdiagnostika

Whitmore WF, Jr. Localised prostatic cancer: management and detection issues. Lancet 1994; 343:1263-7.

Optenberg SA, Thompson IM. Economics of screening for carcinoma of the prostate. Urol Clin North Am 1990; 17:719-37.

Littrup PJ. Future benefits and cost-effectiveness of prostate carcinoma screening. American Cancer Society. Cancer 1997; 80:1864-70.

prostatis kibos skriningi

• gaizarda incidensi (incidence), Seicvala stadiebis ganawileba,

sagrZnoblad gaizarda kuratiuli mkurnalobebis ricxvi dasavleTSi.

• skriningi Zviria da iwvevs mxolod mcired mogebas wlebSi, radgan

prostatis kibos sikvdilianobis saSualo asaki sakmaod maRalia.prostatis kibos sikvdilianobis saSualo asaki sakmaod maRalia.

• mcire kiboebis bunebrivi istoria (maTi mxolod mcire ricxvi iqceva

invaziur kibod) iwvevs gadametebul mkurnalobas.

prostatis kibos skriningi

10 koqrein reviu (Cochrane Review)

Schröder at al. N Engl J Med 360;13 March 26, 2009. Andriole at al, N Engl J Med 360;13 March 26, 2009.

evropuli kvleva (ERSPC) adasturebs, rom skriningmaevropuli kvleva (ERSPC) adasturebs, rom skriningma

Seamcira sikvdilianoba, magram Zalian maRali

morbidobisa da gadametebuli mkurnalobis xarjze

Schröder FH, Hugosson J, Roobol MJ et al. Screening and prostate-cancer mortality in a randomized

European study. N Engl J Med 360;13 March 26, 2009.

prostatis kibos skriningi

1410 individma unda gaiaros skriningi (the number needed to

screen)

da 48 pacientma unda gaiaros mkurnaloba prostatisda 48 pacientma unda gaiaros mkurnaloba prostatis

kibosaTvis (the number needed to treat),

raTa gadarCes erTi pacienti

9 wlis ganmavlobaSi.

prostatis kibos skriningi

genetikuri midrekileba

erTi an ori axlo naTesavi prostatis kiboTi (mama, mamis

Zma,babua mamis mxridan, mama dedis mxridan an dedis

Zma) 10jer zrdis prostatis kibos ganviTarebis risks ZiriTad

mosaxleobasTan SedarebiT.

Steinberg GD, Carter BS, Beaty TH, Childs B, Walsh PC. Family history and the risk of prostate cancer. Prostate

1990;17(4):337-347.

Gronberg H, Damber L, Damber JE. Familial prostate cancer in Sweden. A nationwide register cohort study. Cancer 1996;77:138-43.

prostatis kibos skriningi

sami an meti naTesavis, roca minimum ori 55 wlis asakze

adre daavadda, SemTxvevaSi namdvil ojaxur daavadebasTan

gvaqvs saqme

ojaxuri simsivne 6-7 wliT adre viTardeba spontanurad

aRmocenebul prostatis kibosTan SedarebiT

Bratt O. Hereditary prostate cancer: clinical aspects. J Urol 2002;168:906-13.

prostatis kibos skriningi

dokumentirebuli hiperdiagnostikisa da hipermkurnalobis gamo

amJamad arsebuli codna ar gvaZlevs imis safuZvels, rom

sistematurad Catardes prostatis kibos skriningi

prostatis kibos skriningi

rekomendacia: mamakacebma, romelTa axlo

naTesavebidan ors an mets prostatis kibo aqvs,

yovelwliurad gaizomos PSA da Caitaros reqtaluri

digitaluri gamokvleva 50 wlis asakidan, magram ara

ugvianes yvelaze axalgazrda naTesavis diagnozis

asakidan 5 an 10 wliT adre.

koloreqtaluri simsivneebi

• ganavlis gamokvleva farul sisxlze

• sigmoideoskopia

• koloskopia

• CT- da MR-kolografia

koloreqtaluri simsivneebi

klinikuri kontrolirebuli kvlevebis metaanalizi (dafuZnebuli ganavalSi

sisxlis analizze) 1998w da Cochrane Review, 2006, gviCvenebs,

rom skrinigSi monawile asakobriv jgufSi kibos incidensi Semcirdarom skrinigSi monawile asakobriv jgufSi kibos incidensi Semcirda

20%-iT, xolo sikvdilianoba 16%-iT.

(Towler 1998 Ia, Hewitson 2006 Ia).

koloreqtaluri simsivneebi

miCneulia, rom saWiroa 1400 individis skriningi, raTa Tavidan

aviciloT koloreqtaluri simsivniT gamowveuli erTi sikvdili 5 wlis

ganmavlobaSi. (Anderson 2002 IV).

rekomendaciarekomendacia

mosaxleobis skriningi hemokultiTa da, dadebiTi Sedegis

SemTxvevaSi, koloskopiiT, radgan amiT mcirdeba

sikvdilianoba 16-30%-iT.

saSvilosnos yelis kibo

skriningi 23-50 wlamde yovel 3 wels

50-65 wlamde yovel 5 wels

saSvilosnos yelis kibo

asamde papiloma virusi (Human Papilloma Virus – HPV),

aqamde 15 onkogenuria

kibo 70% gamowveulia 16-iTa da da 18-iT

Franco at al, J Natl.Cancer Inst. 1999;91:506-11.

sicocxlis manZilze inficirebis riski 80%.

infeqcia asimptomatiuria, 90% alagdeba erT welSi.

persistentuli infeqciaiwvevs displaziasa da kibos

saSvilosnos yelis kibo

Gardasil® og Cervarix®

icavs 16 da 18-gan, gardasili ki 6 da 11-gan, rac

dakavSirebulia 90% kondilomebTan

daniaSi ufaso vaqcinacia 12 wlis gogoebisTvis

rekomendirebulia acra 15-26 wlamde (maRali riskis qalebi)

dacva ar aris 100%, amitom qalebma unda gaagrZelon

skriningi

mamografia

mamografiuli skriningi amcirebs sikvdilianobas 35%-iT.

2000 qalma unda gaiaros skriningi 10 wlis

ganmavlobaSi, raTa Tavidan aviciloT ZuZus kiboTi

gamowveuli erTi sikvdilis SemTxveva

amas mowmobs 7 didi kontrolirebuli kvleva

simsivineebis zogierTi pirveladi

niSani

zogadi: saerTo sisuste

ganuzraxavi wonaSi dakleba

umadobaumadoba

tkivili

apaTia, uiniciativoba

b-simptomebi

ganavlis Cvevebis Secvla

simsivineebis zogierTi pirveladi

niSani

obieqturad:

horneris sindromi

virxovis kvanZi

zemo Rru venis sindromizemo Rru venis sindromi

organomegalia (RviZli, elenTa)

zurgis tvinis kompresiis

sindromi

siyviTle

asciti / eqsudati

paraneoplaziebi

paraneoplastiuri sindromebi

(simptomebi daSorebulia pirvelad keras da atarebs

sistemur xasiaTs – simsivnuri ujredebis mier

hormonebisa an gansakuTrebuli cilebis

sekreciis gamo)sekreciis gamo)

paraneoplaziebi

SIADH (wvrilujredovani filtvis kibo)

eqtopiuri ACTH-is sekrecia (kuSingioidi)

anemia

Hiponatriemia

hiperkalciemiahiperkalciemia

Lambert-Eatons miastenia

polinevropaTiebi

karcinoiduri simptomebi

ginekomastia (gonatropinis warmoeba – hipofizis simsivneebi)

cxeleba

paraneoplaziebi

hematologiuri

endokrinuli

nevrologiuri

hematologiurihematologiuri

revmatologiuri

dermatologiuri

rodis mivmarToT?

Tu warmoiSva

dasabuTebuli eWvi avTvisebiani

daavadebisa