Uloga obiteljskog liječnika u prepoznavanju bolesnika s neuroendokrinim tumorom

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1 Uloga obiteljskog liječnika u prepoznavanju bolesnika s neuroendokrinim tumorom Dr.sc. Davorin Pezerović OB Vinkovci For Za uporabu use by Novartisovim speakers predavačima and SAMO appropriate i odgovarajućim ZA Novartis ZDRAVSTVENE associates Novartisovim when suradnicima RADNIKE delivering kada approved iznose content. odobreni Not sadržaj. for distribution. Nije za distribuciju. Svi podaci navedeni u ovoj prezentaciji, ukoliko nije drugačije navedeno, temelje se isključivo na profesionalnom iskustvu liječnika

2 Što su neuroendokrini tumori (NET)? Skupina zloćudnih bolesti koji potječu iz neuroendokrinih stanica koje se nalaze po cijelom tijelu Stanice difuznog neuroendokrinog sustava koje ne formiraju organ, razasuti su po drugim organima NET-ovi su češći nego što se prije smatralo Svi neuroendokrini tumori imaju maligni potencijal! 1. Yao JC et al. J Clin Oncol. 2008;26(18): Jensen RT, Doherty GM. Carcinoid tumors and the carcinoid syndrome. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: Principles & Practice of Oncology. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005: Modlin IM et al. Cancer. 2003;97(4): Vinik AI, Woltering EA, O Dorisio TM, et al. Neuroendocrine Tumors: A Comprehensive Guide to Diagnosis and Management. 5th ed. Inglewood, CA: Inter Science Institute; For use by Novartis speakers and appropriate Novartis associates when delivering approved content. Not for distribution. 2

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5 Klasifikacija neuroendokrinih neoplazmi SZO definira 2 velike skupine neuroendokrinih neoplazmi (NEN) Neuroendokrini tumori (NET) Gradus 1 Dobro diferencirani Broj mitoza <2/10 VVP Ki-67 indeks 2% Gradus 2 Dobro diferencirani Broj mitoza 2-20/10 VVP Ki-67 indeks 3% do 20% Neuroendokrini karcinomi (NEC) Gradus 3 Slabo diferencirani Broj mitoza >20/10 VVP Ki-67 indeks >20% VVP, veliko vidno polje; SZO, Svjetska zdravstvena organizacija. 1. Rindi G, Arnold R, Bosman FT, et al. Nomenclature and classification of neuroendocrine neoplasms of the digestive system. In: Bosman FT, Carneiro F, Hruban RH, Theise ND, eds. WHO Classification of Tumours of the Digestive System. 4th ed. Lyon, France: International Agency for Research on Cancer (IARC); 2010: Vinik AI, Woltering EA, O Dorisio TM, et al. Neuroendocrine Tumors: A Comprehensive Guide to Diagnosis and Management. 5th ed. For use by Novartis speakers and appropriate Novartis associates when delivering approved content. Not for distribution. Inglewood, CA: Inter Science Institute;

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13 Važnost ranog otkrivanja NET-a NET-ovi su skupina zloćudnih bolesti koje se često pogrešno dijagnosticiraju, što dovodi do potencijalno opasnih kašnjenja u utvrđivanju dijagnoze U trenutku dijagnosticiranja 50% bolesnika ima regionalne ili udaljene metastaze Dijagnoza utvrđena ranije u tijeku bolesti može poboljšati ishode za bolesnika 1. For Modlin use by IM Novartis et al. Lancet speakers Oncol. and 2008;9(1): appropriate Novartis 2. Modlin associates IM et al. J Natl when Cancer delivering Inst. 2008;100(18): approved content. Not for distribution

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19 Kromogranin A (CgA) Povišen u do 90% bolesnika s NET-om; detektira NET bez obzira na funkcionalni status; razine ne ovise o izlučivanju hormona Pretrage su široko dostupne (KBC Zagreb, KBC Sestre Milosrdnice, KB Dubrava, KBC Osijek, KBC Rijeka, KBC Split) Koncentracija bar 2x veća od referentne uglavnom ukazuje na NET Ferolla et al. The biological characterization of NET: the role of neuroendocrine markers. J Endocrinol Invest 2008 Campana et al. Chromogranin A Is it a useful marker in NET? Journal of Clinical Oncology 2007 O Toole For D et use al. by ENETS Novartis consensus speakers guidelines and appropriate for the Novartis standards associates of care when in NET:biochemical delivering approved markers. content. Neuroendocrinology Not for distribution. 2009;90:194:202

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28 Zaključak Svaki NET ima maligni potencijal! U trenutku postavljanja dijagnoze, kod 23% oboljelih već postoje regionalne, a kod 27% oboljelih udaljene metastaze! 28 For use by Novartis speakers and appropriate Novartis associates when delivering approved content. Not for distribution.

29 Zaključak Kod pacijenata kojima se simptomi kao što su nespecifični abdominalni bolovi, proljev, crvenilo ponavljaju i ne reagiraju na terapiju, posumnjajte na NET! 29 For use by Novartis speakers and appropriate Novartis associates when delivering approved content. Not for distribution.

30 Zaključak Kod sumnje na NET prvi korak je laboratorijska pretraga na Kromogranin A. Pripazite na pacijente koji uzimaju inhibitore protonske pumpe. S nalazima uputite pacijenta specijalistima koji se bave NETovima! 30 For use by Novartis speakers and appropriate Novartis associates when delivering approved content. Not for distribution.

31 HVALA NA POZORNOSTI! For use by Novartis speakers and appropriate Novartis associates when delivering approved content. Not for distribution.

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