cancere digestive.curs asist (1)
TRANSCRIPT
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Cancere digestiveCancere digestive
Simona Mihutiu, Aniela PlatonaSimona Mihutiu, Aniela Platona
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Esopfag
Epidemiologie:
incidenta: 3-5% din Tu GI
M:F 3:1
peste 60 ani
: China, Japonia, Ian, Fin!anda"ota!itate: #0 - 100%$$$$
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Esopfag
Etiologie: Plummer-Vinson sindr
consum cronic de mancaruri si bauturi fierbinti alcohol tare & fumat achalasia: 5 t!losa "transmitere autosomal dominanta:
h!#er$eratosis #almo -#lantara: % boala 'arret(s
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Diagnostic
1. Clinic: disfagia & #erdere in greutate: )* odinofagia, durere toracica
semne ale inva+iei in organele adiacente: tardive"disfonie, hemateme+a, SVCS, inv Si #are+adiafragm, #leure+ie maligna, febra
2. Endoscopic esofagosco#!
3. Imagistic C.
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Patologie: scuamos: /* 0 loc cervicala, toracica
adenocc: 1*, 0 loc inferioara
Localizare:2 cervicala: 35
2 esofag toracic mi4l si su#erior : 152 esofag inf: 1*
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Tratament:
rata de vindecare: 5 la 5 ani
radio-chimiotera#ie concomitenta C6
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Stomac
Epidemiologie:
tendinta de descestee a incidentei si a
"ota!itatii
incidenta: 3-5% din tu GIM:F :1,
&asta nediana: 50-5# ani '
: Chi!e, Costa (ica, Japonia, )uopa )st
*+upe socio-econo"ice saace
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Etiologie meta#la+ie intestinala
Asociere mai frecventa cu gr Sg A
77 anemia 'iermer si gastrita atrofica
Consum cr de antiacide
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Factori de prognostic
Stadil !olii " cel mai important factor deprognostic pentr spra#ietire
#rofun+imea inva+iei, S5 :
2 mucosa : 85 2 mucoasa & #erete gastric 9all: 5 2 ; #erete gastric: 1
:2 regional : 3
2 e?traregional : 5 S@5: 3/-3 local vs metastatic: 5 vs *-8
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DiagnosticPresentare Clinica:
Simptome vag discomfort e#igastric Scadere #onderala Satietate #recoce Bisfagia si varsaturi
asim#tomatici 3 Semne clinice: legate de M< sau cand tu 'ul$!
ino# : masa tu Pal#abila D e#igastric, ascita, icter, ggl SCV, @AE 2 semn 7rish, im#lante D #elvin, rectal 2 semn 'lumer 6e#atomegalie
case?ia
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$ilant pre%terapetic
La!orator anemie "85, hi#oalbuminemia CFA "5* .este he#atice alterate: .@G,.@P, HAlc, @@. e?am scaun: sg oculteEndoscopie gastrosco#ie e?am scaun: sg Gculte
Imagistic C. scan
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Patologie
adenocarcinom: )52 intestinal
2 #ilorocardial
2 cel Cu #ecete
2 ana#lastic
limfoame: /* din restul de 5 ramase
leiomiosarcoame 3-, leiomioame
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macrosco#ic:2 ulcerative
2 #oli#oide2 schiroase: linita #lastica
2 su#erficial: difu+e
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Tratament
1. Cancer gastric opera!il:C6: gastrectomie radicala subtotala &
gastro4e4unostomieI.F < C. concomitent "ad4uvant: 5-HJ ".u mari-
#.%, .1, #>
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Colorectal & cc anale
Epidemiologie:
incidenta: 10-15% din cc'
"ediana - 60 .ani &s /a"i!ia! po!iposa /a"',
co!ita u!ceati&a: &' Etiologie:
1. dieta* +asi"i ani"a!e sti"u!ea2a
poductia de aci2i i!iai, 4 /ie &e+eta!e
cantitatea scaunu!ui, dt' contact ine /eca!e si
"ucoasa, p scaunu!ui sca2ut
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2. factori genetici:2 #oli#osa fam - HAP: transm autosomal dominante
K #oli#i #ancolonice adenomatoase2 sndr@ardner(s .u desmoide, osteome, fibroame,
adenoame colorectale2 6>PCC: tineri, #oli#o+a multi#la, alte ccintra-abd2 sndr .urcot(s s!ndr: asociere cu .u cerebrale
3. 'arsta
(. $oli inflamatorii intestinale: recto2 rectocolita ulcero-hemoragica chr "durata ; !rs,- boala Chron disease: ). polipii colonici
*. di#erticloza+. cc. colon metacron,. C- anterioara: ureterosigmoidostomie
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Diagnostic
1. Prezentare Clinica: APP: dureri abdoiale vagi, flatulenta , modif ale scaunului sim#tome de#endente de locatie:
2 Br colon: anemia feri#riva, @regersen
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-P
adenoCa: )*-)5
adenocc mucinoase: 3*
cc cel in inel cu #ecete: 1 scuoamos, adenoscuamous - rar
nediferentiat: L 3
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$ilant pre%terapetic1. La!orator: teste he#atice " Halc,@@., @P., @G., creatinina,
hemograma2. TC a!domino%pel#in
3. /gf. Plmonara 0TC torace#entru
cc rectale inferioare si anale
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Istorie natrala
distri!tie: ascend: 1 transvers: 3/ descend: sigmoid: 38 rect: 35
Etensie locala prin contigitate& implanteperitonealesi : circumf vs longitudin
Etensie limfatica: =imfatice submucoasei 2 recur
loc si regionale, in > regionali Etensie ematogena: ficat " rect inf 2 #ulm
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Tratament
C-:2 la#arotomie #t stad2 resectie larga en bloc a . #rimara < limfadenectomie
Cimioterapia:a #osto#, ad4uvanta:2 5HJ sau Eeloda sau combinatiile lor cu GEPb Paliativa 2 #entru stadiile metastatice sau resuta- 5HJDEeloda < GEP sau 5HJDEeloda < 7rinotecan
Tratament moleclar: 'evaci+umab sau Cetu?imab
2 #entru stadiile metastatice /adioterapieneoad4uvanta sau ad4uvanta: numai incc rectal: neoad4 ; ad4
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CC Pancreas
Incidenta
M F
&: 73 peste 65 ani
8denocc: cea "ai /ec&' histo!o+i,
9 "ed #-1 "o', 9 5 ; 3%
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Epidemiologie: fumat dieta: com#usi nitrati, cafeine,
alcohol diabetes: 3* din cc#ancreatice
genetici: cc familial #ancreatic "min
rude
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Diagnostic1.Clinic
boala #recoce: anore?ia, scadere #onderala, scadere#onderala, discomfort abdominal, durere, greata
durere: - inva+ia #le?ului s#lanchnic, retro-#eritoneului severa, radia+a in s#ate
icter: ; )*, greturi 2 inva+ia duodenului, stomacului steatorea intoleranta la gluco+a V' #al#abila - semn Courvoisier(s : 5 @SC stg- semnul Vircho9
flebita migratorie - .rousseau(s sign masa tu Periombilicala 2 nodulii Sister Mar! Nose#h mase tu #al#abile D#elvin - 'lumer(s shelf semne, sim#tome indicator #t M< la distanta
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2. Imagistic
echo
C. scan
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Istorie natrala
inva+ie #erineurala
7nva+ie limfatica: > #ancreaticoduodenal,sub#ilorici, gr inferior #ancreatic ai ca#ului#ancreasului
Patologie
a gl e?ocrina K adenocarcinoamec - )5 locali+are: ca# "D%, cor#, coadab gl Fndocrina: insulinoame, glucagonoame, etc
Fact. Prognostic: . - dimensiunea > status: Sm K %/ luniD-=> vs /-8 luniD M a&a
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