Pristup dijagnostici, praćenju i liječenju cističnih tumora gušterače

master's thesis

• Title (english): Approach to diagnosis, surveillance and treatment of cystic pancreatic tumors
• Author: Bruno Jurić
• Mentor: Neven Baršić (mentor)
• Committee member: Lucija Virović Jukić (predsjednik povjerenstva)
• Committee member: Ivana Vuković Brinar (član povjerenstva)
• Committee member: Neven Baršić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2024-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Cistični tumori gušterače su kompleksna skupina tumora s pet glavnih tipova: IPMN, MCN, SCN, SPN i cNET. Njihova detekcija postaje sve češća zbog napretka u radiološkim metodama i povećane primjene preventivnih pregleda. Razlikovanje među tipovima cističnih tumora je važno zbog različitog malignog potencijala i potrebe za liječenjem. Klinička prezentacija ovih tumora je često nespecifična, a većina pacijenata ostaje asimptomatska. Radiološke metode kao što su ultrazvuk, magnetska rezonancija i kompjutorizirana tomografija koriste se za dijagnozu i praćenje cističnih tumora gušterače, pri čemu magnetska rezonancija s magnetnorezonantnom kolangiopankreatografijom ima prednost zbog boljeg prikaza mekih tkiva i struktura ispunjenih tekućinom, a jednaku točnost u dijagnostici ima i endoskopski ultrazvuk. Biokemijske analize, poput razine CEA i glukoze, te molekularne analize sadržaja cisti dodatno pomažu u dijagnostici i razlikovanju tumora. Kombinacija različitih testova povećava točnost dijagnoze i omogućuje preciznije određivanje tipa tumora gušterače. Pristup cističnim tumorima gušterače ovisi o biološkom ponašanju pojedine vrste tumora. Kirurško liječenje je rezervirano za tumore koji nose rizik visokog stupnja displazije i karcinoma. Adjuvantna kemoterapija se koristi kod reseciranih invazivnih karcinoma nastalih iz IPMN-a ili MCN-a. Praćenje nereseciranih cističnih tumora gušterače uključuje redovite preglede s MR ili EUS-om, ovisno o karakteristikama tumora i osobinama pacijenta. Cilj je ovakvog integriranog pristupa poboljšati dugoročne ishode za pacijente s cističnim tumorima gušterače, smanjiti rizik od razvoja karcinoma s jedne, a istodobno izbjeći nepotrebne operacije s druge strane.

Abstract (english)

Pancreatic cystic tumors are a complex group of tumors with five main types: IPMN, MCN, SCN, SPN, and cNET. Their detection is becoming more common due to advances in radiological methods and increased use of preventive screenings. Distinguishing among the types of cystic tumors is important due to different malignant potential and the need for treatment. The clinical presentation of these tumors is often nonspecific and most patients remain asymptomatic. Radiological methods such as ultrasound, magnetic resonance imaging and computed tomography are used for diagnosis and surveillance of pancreatic cystic tumors, with magnetic resonance imaging with magnetic resonance cholangiopancreatography having an advantage due to better visualization of soft tissues and fluid-filled structures. Endoscopic ultrasound also has equal accuracy in diagnosis. Biochemical analyses, such as CEA and glucose levels, and molecular analyses of cyst contents further aid in diagnosis and tumor differentiation. Combining different tests increases the accuracy of diagnosis and enables more precise determination of pancreatic tumor type. The approach to pancreatic cystic tumors depends on the biological behavior of each tumor type. Surgical treatment is reserved for tumors with high risk of high-grade dysplasia and invasive carcinoma. Adjuvant chemotherapy is used for resected invasive carcinomas arising from IPMN or MCN. Surveillance of unresected pancreatic cystic tumors involves regular check-ups with MRI or EUS, depending on the tumor's characteristics and patient traits. The goal of this integrated approach is to improve long-term outcomes for patients with pancreatic cystic tumors, reduce the risk of carcinoma development on one hand, and avoid unnecessary surgeries on the other.

• Keywords: cistični tumori; gušterača; magnetnorezonantna kolangiopankreatografija; endoskopski ultrazvuk
• Keywords (english): cystic tumors; pancreas; magnetic resonance cholangiopancreatography; endoscopic ultrasound
• Language: croatian
• URN:NBN: urn:nbn:hr:105:572184
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-07-03 08:59:00