| Abstract | Karcinom rektuma predstavlja veliki problem kako za pacijenta, tako i u javnozdrastvenom smislu. Usko je povezan s životnim navikama, dobi i spolu te je treći najčešće dijagnosticirani karcinom uopće. U Republici Hrvatskoj bilo je zabilježeno oko 20 000 novootkrivenih slučajeva zloćudnih bolesti. U 2014. godini se karcinom debelog crijeva prema incidenciji nalazio na 2. mjestu i u muškaraca i u žena. Uzrokovan je mutacijama koje ciljaju onkogene, tumor supresor gene ili gene odgovornima za popravak DNK. Te mutacije su posljedica sporadičnih mutacija (koje su najčešće), naslijeđenih ili obiteljski povezanih. Terapija prvog izbora karcinoma debeloga crijeva usko je povezana s njegovim stupnjem odnosno stadijem. Ona je bazirana na mutlimodalnome pristupu koji u obzir uzima faktore vezanima uz tumor poput veličine, lokalne invazivnosti, zahvaćenosti limfnih
čvorova, udaljenih metastaza, oblika zdjelice, adipoznog statusa osobe, općeg stanja i konkomitatnih bolesti. Otvorena totalna mezorektalna ekscizija (TME) metoda je izbora i zlatni standard u kirurškome načinu liječenja ove bolesti. Minimalno invazivni postupci počeli su sve više zamijenjivati otvoreni pristup s dobrim rezultatima. Uz kirurško liječenje tu su još i radioterapija i terapija kemoterapeuticima, neoadjuvantna citoredukcijska ili adjuvantna kurativna, odnosno palijativna terapija. One ovise o
lokalnim faktorima i stupnju bolesti. Također se uz kemoterapiju koriste i monoklonalna protutijela, ali i neki novi modaliteti liječenja poput NSAIDova, antibiotika i agaroznih tumorskih makroperli. Digitorektalni pregled standardni je pregled za donji segment rektuma i pomoću njega dobivamo kvalitetne informacije o stanju muskulature i sluznice. Najčešći simptomi su rektalno krvarenje, abdominalna bol, i promjena u ponašanju peristaltike. Dijagnostika karcinoma kolona postavlja se na temelju patohistološkog nalaza uzetog biopsijom tokom endoskopije ili nakon operacije. Kao dodatne pretrage služe na CT, MR odnosno ultrazvučni pregled. Osim primarne prevencije bitne su nam i metode sekundarne prevencije poput testa na okultno
krvarenje (koji je uvršten u nacionalni program otkrivanja raka debelog crijeva), periodične sigmoidoskopije i kolonoskopije. |
| Abstract (english) | Rectal cancer is considered amajor problem for the patient as well as in the public eye. It is closely related to lifestyle habits, age and gender and it is the third most commonly diagnosed cancer in general. In Republic of Croatia there were about 20,000 newly discovered cases of malignant diseases. In 2014, colorectal cancer by incidence was ranked 2nd, both in men and women respectively. It is induced by mutations targeting oncogenes, tumor suppressor genes or genes responsible for DNA repair. These mutations are the result of sporadic mutations (which are most common),they can be inherited or family related. The choice of first line therapy for colon cancer is closely related to its degree or stage. It is based on a mulimodal approach which includes factors related to tumors such as size, local invasiveness, lymph node involvement, distant metastases, pelvic shape, adipose status, general condition, and concomitant diseases. Open total mesorectal excision (TME) method is the choice and the gold standard in the surgical line of treating this disease. Minimally invasive procedures have increasingly begun to chalenge the open approach with good results. In addition to surgical treatment, there are also radiotherapy and chemotherapy therapy, neoadjuvant cytoreductive or adjuvant curative or palliative therapy. They depend on local factors and degree of disease. Therapy with monoclonal antibodies is also used together with chemotherapy, but also some new treatment modalities such as NSAIDs, antibiotics, and agarose macrobeads. The digital rectal exam is a standard exam for the lower segment of the rectum, and through it we get good information about the condition of the musculature and mucous membranes. The most common symptoms are rectal bleeding, abdominal pain, and behavioral changes in peristalsis. Diagnosis of colon cancer is based on the histopathological findings taken by biopsy during endoscopy or after surgery. The use CT, MR or ultrasound scan is widely suggested for further diagnosis. In addition to primary prevention, secondary prevention methods such as ocult
bleeding test (included in the national colon cancer detection program), periodic sigmoidoskopy or colonoscopy play a major role in prevention of this disease. |
