Pojavnost i analiza kliničko-patoloških podataka djece s Wilmsovim tumorom u 10 godišnjem razdoblju u Klinici za dječje bolesti Zagreb

master's thesis

• Title (english): Occurence and analysis of clinical pathological data in children with Wilms tumor at the Children's Hospital Zagreb during a 10-year period
• Author: Mirela Namjesnik
• Mentor: Jasminka Stepan Giljević (mentor)
• Committee member: Ernest Bilić (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Jasminka Stepan Giljević (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Oncology

Abstract

Wilmsov tumor je embrionalna zloćudna novotvorina bubrega, najveće pojavnosti u dobi do pet godina. Smješten je među najčešće ekstrakranijalne solidne novotvorine dječje dobi. Kako bi se postigao uspješan ishod liječenja, nužno je pravodobno postavljanje sumnje na Wilmsov tumor, uz primjenu UZV-a abdomena kao primarnog dijagnostičkog postupka. Cilj ovog rada je sagledati slijed događaja u dijagnozi Wilmsovog tumora. Naglasak je stavljen na ulogu roditelja i primarnog liječnika u postavljanju sumnje na Wilmsov tumor. Analizirane su karakteristike pacijenata, vodeći simptomi i znakovi te vremensko razdoblje proteklo do dolaska u onkološki centar, a sve s namjerom pravodobne dijagnoze Wilmsovog tumora te otkrivanja mogućih mjesta pomaka u zdravstvenom sustavu. Ovo istraživanje je retrospektivno i deskriptivno. Uključivalo je 44 djece s pozitivnim ishodom liječenja Wilmsovog tumora u 10 godišnjem razdoblju između 2005. i 2015. godine u Klinici za dječje bolesti Zagreb. Prikupljeni podaci su opće i patološke karakteristike pacijenata te kliničke karakteristike koje se odnose na simptome i znakove prisutne u oboljele djece te, prema iskazima roditelja, vremenski tijek od pojave simptoma do dolaska u onkološki centar. U istraživanoj skupini, medijan dobi djeteta pri dijagnozi u dječaka je iznosio dvije godine i deset mjeseci, a u djevojčica dvije godine i devet mjeseci. Predispoziciju za razvoj tumora imalo je 20% djece. Najčešći simptomi bili su bol u abdomenu, abdominalna masa i hematurija. Zadrške u javljanju liječniku, od prvog dana naviše, zamijećene su kod 19% pacijenata. Na UZV je pri prvom javljanju liječniku upućeno 29 djece, pri drugom dvoje, pri trećem četiri te dvoje djece pri četvrtom javljanju. Najpovoljniji vremenski omjer između javljanja simptoma i upućivanja na UZV bio je kod abdominalne mase. Prikazana individualnost u koracima vezana uz dijagnostiku Wilmsovog tumora i problematiku odgađanja dijagnoze ukazuje na potrebne korekcije i pomake na roditeljskoj razini i razini primarne zdravstvene zaštite u hrvatskom zdravstvenom sustavu. Prijedlozi su
edukacija roditelja, povećana svijest za prepoznavanje tumora kod djece s predispozicijom, postavljanje ciljanih pitanja u odnosu na simptomatologiju te mogućnost vršenja ultrazvučne dijagnostike u ordinacijama primarne zdravstvene zaštite.

Abstract (english)

Wilms tumour is a malignant kidney neoplasm in children. It is one of the most common extracranial solid neoplasm in children. The largest incidence is in children until five years old. To achieve favorable outcome, it is necessary early diagnose Wilms tumour when possible symptoms and signs occur. As a primer diagnostic modality, US is used.
The aim of this study is to reconstruct the events leading to the diagnosis of Wilms tumour, determine symptoms and signs, pay attention to parental role and the role of primary physicians in early diagnosis. Continuing we evaluate time passed from the moment symptoms occurred when children came to the oncology center, so we could find the possibility for intervention in our health system. This study was retrospective and descriptive. It included 44 children with Wilms tumour, treated in Children´s Hospital Zagreb in 10-year period, from the 2005 – 2015, with favorable outcomes. Collected data are general with pathological characteristics of patients and clinical characteristics. All this correspond on symptoms and signs and time passed from the moment symptoms occurred until children came to oncology center due to parents' statements.
Results showed that children age at diagnosis median is two years and ten months in boys and two years and nine months in girls. 20% of children had a predisposition for tumour development. The most common symptoms and signs were a pain in the abdomen, abdominal mass and hematuria. Parental delay, from one day on, was registered in 19% of the patient. 29
of the patient were sent to US at first, seven patients at second, four patients at third, and two at the fourth primary physician visit. The most favorable time ratio for symptoms and US was at the sign of abdominal mass. In conclusion, individuality is shown in the diagnosis of Wilms tumour, and the delay issues are recognized. This shows a need and possibility of an intervention on the parental level and primary health care level in the Croatian health care system. Suggestions are the education of parents, increase awareness for tumour detection at children with a predisposition, setting a targeted questions regarding to diagnosis and possibility for US examination in primary health care units.

• Keywords: Wilmsov tumor; simptomi i znakovi; vrijeme uspostave dijagnoze; UZV
• Keywords (english): Wilms tumour; symptoms and signs; timeframe; US
• Language: croatian
• URN:NBN: urn:nbn:hr:105:385090
• 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: 2021-03-26 13:58:04