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