cancerele bronho-pulmonare

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    Cancerele bronho-Cancerele bronho-pulmonarepulmonare

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    FACTORI DE RISC Carcinoamele bronhopulmonare - cea mai frecvent cauz demortalitate prin cancer att la brbai ct i la femei n Romnia - locul nti n mortalitatea la brbai i locul al

    4-lea la femei

    a) Fumatul: !" din cancerele bronhopulmonare #untdatorate fumatului$ Ri#cul de %& de ori mai mare pentru fumtori$ Ri#cul $ corelat cu doza cumulativ' cuantificat n

    (pachete-ani)$ *umatul de i+ar $ nitro#amine' hidrazine' hidrocarburi

    aromatice$ ,nhalarea pa#iv $ la fel de nociv ca fumatul activ

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    FACTORI DE RISCb .zbe#t$ mezotelioamec Radiaii ionizante

    d Radone .li carcino+eni chimici: beriliu' nichel' Cr'clormetileter' poluani atmo#ferici

    f /u#ceptibilitate +enetic

    + .fectiuni pulmonare 0#cerodermie'cicatrici+ranulomatoa#eh 12i#tena unui alt cancer 03R #au pulmn

    antecedentele per#onale

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    ISTORIA NATURAL

    Origine- %54 ori+inea n mucoa#a broniilor mari' fiind acce#ibilebronho#copiei

    - 654 localizate periferic' n teritoriul bronhiilor #e+mentare i#ub#e+mentare

    Tipuri histologiceI ) Carcinoame non!small cella Carcinomul epidermoidb Carcinomul non-epidermoide .denocarcinom Carcinomul nedifereniat cu celule mari

    Carcinom adeno#cuamo# 0rarII) Carcinom cu celule mici

    III) Tumori carcinoi"e: tipic' atipic

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    TI#URI DE E$TENSIEa prin conti+uitate$ #pre or+ane media#tinale

    $ pleur perete toracicb limfatic 76 $ hil homolateral 78 $ media#tin #up9 homolateral 7% $ /C' hil i media#tin contralateral

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    TI#URI DE E$TENSIEc hemato+ena ficat o#

    /7C /R mduv o#oa# pri moi

    pulmonard 1ndobronic $ meta9 pulm9

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    Carcinom #cuamo#

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    .denocarcinomul

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    .denocarcinom 08

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    SI%#TO%ATOLO&IEA) semne "e suspiciune: fumtor' ; 4& ani'modificarea caracterului tu#ei' epi#oadede pneumonie ob#tructiv' #puthemoptoic

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    SI%#TO%ATOLO&IEA) semne "e suspiciune: fumtor' ; 4& ani' modificareacaracterului tu#ei' epi#oade de pneumonie ob#tructiv'#put hemoptoic

    ') simptome caracteristicea tumor endobronic 0central: - tu#e'hemoptizie' tira

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    SI%#TO%ATOLO&IE') simptome caracteristicea tumor endobronic 0central: - tu#e'

    hemoptizie' tira

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    SI%#TO%ATOLO&IEc e2tindere torace =; di#fa+ie' ob#trucie traheal' di#fonie'

    di#pnee' durere umr' /dr Claude->ernard-?orner' /CC/0&" n Cc cu celule mici' aritmii' in#uf9 Cardiac' coleciepleural' cianoz

    d meta e2tra toracice /7C [email protected],C: cefalee' vr#turi' #emne de focar: convul#ii

    hemiparez' *icat 0icter' durere' in#uf9 hep9 3# 0dureri' fracturi Aduv o#oa# 0infecii' anemie' hemora+ii /uprarenale 0a#tenie

    Bri moi Blmn contralateralee /dr paraneoplazice/dr paraneoplazice

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    SCREENIN&$ nu e2i#t metode care # #ati#fac criteriileunui #creenin+ eficient 0citolo+ia #putei'microradio+rafia toracic

    #ROFILA$IE$ propa+and impotriva fumatului$ le+i#laie ferm interzicere fumat n

    in#tituii$ incidena Cc pulmonar cu !" n 8& de ani

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    3biective

    ia+no#ticul de cancer bronhopulmonar #i detip ?B /tadializare 0ia+no#ticul de e2ten#iea 12cluderea AD la di#tanta: A& v# AD 0#td9 ,

    b A & stabilirea operabilitatii1. factori care tin de boala

    - status N ?

    - status T ?

    2. factori care tin de pacient

    - teste respiratorii

    - ex. C-V

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    ETA#E "g6 129 clinic +eneral:

    - anamneza 0*R' indice taba+ic' #impt- 12 adenopatii 0/C' a2ilar' cervical- 12 obiectiv torace 0col pleural' atelectazie'pneumonit- 12 abdomen 0hepatome+alia- Buncte #en#ibile o#oa#e' tumefieri n primoi- 12 neurolo+ic [email protected],C' #emne de focar- ,ndice de performa' ponderal

    8 12 3R- parez recurenial

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    ETA#E "g% R+r toracic4 @C torace D abdomen4 Confirmare ?B:

    - bronho#copie cu biop#ie' bro#a

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    'ILAN( #RETERA#EUTIC

    @C torace 5 abdomen #uperior [email protected] [email protected] Aedia#tino#copie' @oraco#copie video-a#i#t9

    a dureri o#oa#e' *.C' hipercalcemie' =;#cinti+rafie o#b zone hipercaptante la #cinti+rafie =;

    radio+rafie o#oa#' @Cc #emne ?,C #au de focar =; @C cerebral ab: hemoleuco+ram' probe hep9' renale

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    Factori "e prognostic

    Factor "e prognostic! st" TN%[email protected] primara' 7-adenopatia' A-meta#taze/td , $ @mic' 7o/td ,, $ @ mare ' 76/td ,,,- @ mare ' 78=avan#at loco-

    re+ional/td ,- AD

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    NSCLC: SV 5 ani in functie de stadiu

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    TRATA%ENT) #acienti opera*ili +T,T-. N/,N.%/)

    C?= de electie' 8!-%&" [email protected] ad

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    7/CC

    epidermoid inia 6 [email protected] 0combinatii de a+enti pe baza de Blatina:Ci#platin #au Carboplatin #i a+enti +en9,,,

    7r9 Cicluri: 4 0ra#pun# ma2imal v# GFemcitabina D Ci#platin 0CarboplatinBaclita2el D Ci#platin 0Carboplatin

    oceta2el D Ci#platin 0Carboplatin inia 8

    @a2otere

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    7/CC non-epidermoid0adenocc' bro#ioloalveolar

    Linia a [email protected]: : 1rlotinib' Fefitinib 0,re##a

    $ Bemetre2ed D Ci#platin'- FB 0Femcitabina D Ci#platin'- @B 0Baclita2el D Ci#platinD5- >ev #[email protected] [email protected] D Ci#

    - Bemetre2ed D Ci#platinb @ratament molecular tintit terapie biolo+ica:

    1rlotinib' .va#tin Linia -

    a [email protected] : Bemetre2ed' oceta2elb @ratament molecular tintit : 1rlotinib

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    /CCa) ' limitata: radiochimioterapieD5- C?*) ' e3tinsa: [email protected] D5- [email protected]

    - fara AD cerebrale: [email protected] 5 cerebral profilactic- cu AD cerebrale: [email protected] 5 cerebral paliativ

    Linia - [email protected]: 1topozid D Ci#platin- Chimio#en#ibil 0RC frecvent' dar mec9 de rezi#tenta

    resuta dupa o ediana de ! luni

    Linia -

    - [email protected]: C.- [email protected]: ?Icamptin- chimiorezi#tente

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    UR%ARIRE

    3biectiv:d+ D trat la timp al recurentelorlocale #i la di#tanta' complicatiilor'#echelelor tardive

    - .namneza- 12 clinic +eneralDloco-re+ional: F' ,B' #emne

    +enerale 0febra' tran#piratii' #cadere in

    +reutate- 12 ima+i#tic 0acelea#i te#te- aborator