Aizkuņģa dziedzera vēzis.

1. Aizkuņģa dziedzera vēzis.

2. Aizkuņģa dziedzera vēzis.

4. Pancreatic cancer has been brought to the forefront by the diagnoses of several prominent figures, including the late actor Patrick Swayze, who died of pancreatic cancer in September 2009, Apple cofounder and CEO Steve Jobs, and U.S. Supreme Court justice Ruth Bader Ginsburg.

5. 37.680 - 34.290 = 3390 • The American Cancer Society estimated that 37,680 people in the U.S. were diagnosed with pancreatic cancer during 2008. Of those diagnosed, 34,290 will die of the disease, making this type of cancer the fourth leading cause of cancer death overall.

6. Handbook ofEvidence-BasedRadiation Oncology.2nd Edition • Eric K. Hansen, MD The Oregon Clinic Radiation Oncology Providence St. Vincent Medical Center Portland, Oregon, USA • Mack Roach, III, MD, FACR Professor, Radiation Oncology and Urology Chair, Department of Radiation Oncology UCSF Helen Diller Family Comprehensive Cancer Center University of California San Francisco San Francisco, California, USA

8. OncologyAn Evidence-Based Approach. • With 346 Figures in 501 Parts • Edited by • Alfred E. Chang, MD • Hugh Cabot Professor of Surgery; Chief, Division of Surgery Oncology; Department of Surgery, University • of Michigan, Ann Arbor, Michigan • Patricia A. Ganz, MD • American Cancer Society Clinical Research Professor, Director, Division of Cancer Prevention and • Control Research, Jonsson Comprehensive Cancer Center at UCLA, Professor, Schools of Public Health • and Medicine, University of California, Los Angeles, Los Angeles, California • Daniel F. Hayes, MD • Clinical Director, Breast Oncology Program, University of Michigan Comprehensive Cancer Center, • Ann Arbor, Michigan • Timothy J. Kinsella, MD • Vincent K. Smith Professor and Chairman, Department of Radiation Oncology, University Hospitals of • Cleveland, Case Western Reserve University, Cleveland, Ohio • Harvey I. Pass, MD • Professor and Chief of Thoracic Surgery, Department of Cardiothoracic Surgery, Head, Thoracic • Oncology, New York University School of Medicine and Comprehensive Cancer Center, New York, • New York • Joan H. Schiller, MD • Melanie Heald Professor of Medical Oncology, Department of Medicine, University of Wisconsin • Comprehensive Cancer Center, Madison, Wisconsin • Richard M. Stone, MD • Associate Professor, Department of Medicine, Harvard Medical School, Clinical Director, Adult Leukemia • Program, Dana-Farber Cancer Institute, Boston, Massachusetts • Victor J. Strecher, PhD, MPH • Professor and Director, Health Media Research Laboratory, Department of Health Behavior and Health • Education, University of Michigan School of Public Health, Associate Director, Cancer Prevention and • Control, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan • Foreword by Gabriel N. Hortobagyi, MD, FACP

13. TxNxM1 • The Anatomy and Clinics of Metastatic Cancer • By Dr. J.M. Debois • KLUWER ACADEMIC PUBLISHERS,NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW

14. Aizkuņģa dziedzera ļaundabīgs audzējs pārsvarā adenokarcinoma no aizkuņģa dziedzera vadu epitēlija • C 25.- • Incidence: 10 gadījumi/uz 100,000 populācijā/gadā; 2–3% no visiem maligniem audzējiem; vīrieši:sievietes = 4:3; vecums: 60–80 g.

15. Veicinoši faktori. • Cukura diabēts. • Diēta bagāta ar gaļu un taukiem. • Hronisks aizkuņģa dziedzera iekaisums (pankreatīts). • Smēķēšana. • Izoperēts žultspūslis. • Iedzimtība t.i., ģimenes predispozīcija (k.p., Peutz-Jeghers sindroms)

16. Ķimikālijas kā riska faktori. • Toksiskas ķimikālijas: 2-naphthylamine, benzidine, DDT.

17. Simptomi. • Vemšana. Slikta dūša. • Svara zaudēšana. • Nogurums. • Hiperglikēmija. • Vēdera tūska. • Hepatomegālija. • Caureja. • Sāpes vēderā. • -Artrīts trijās vai vairāk locītavu zonās. • Apetītes zudumi. • Tumšs urīns. • Gaišāki izkārnījumi. • Dzeltenā kaite. • Splenomegālija. • Sataustāms žultspūslis. • -Sāpes mugurā. • Sāpes pakrūtē.

18. Nav specifiski simptomi agrīnā stadijā. Vēlīnās slimības stadījās: Pamatsimptomi: slikta dūša, anoreksija • Svara zudums (80% pacientu) • Sāpes (jostveida sāpes) vēdera augšdaļā un mugurpusē. • Ikterus (50% pacientu; dzelte bez sāpēm ir aizdomīga ka notikusi ļaundabīga žultsvadu obstrukcija). • Kurvuazjē simptoms “Courvoisier”. • Ascīts

19. Ca pierādīšana. • Laboratorijas testi. • US., CT., MR. • Tumora marķeri: CEA, CA 19-9, CA 125 (izvērtējot dinamikā).

20. TU lokalizācija. • Pankreasa galvas daļā: 70% • Pankreasa ķermeņa daļā: 20% • Pankreasa astes daļā: 10%

21. Histoloģija.

22. Metastāzes. • Agrīni limfatogēniskā un hematogēniskā ceļā (reģionālie limfmezgli, aknas, peritonejs, plaušas, skeletā, CNS) • Izplatība pieguļošajās struktūrās.

23. Komplikācijas. • Ar Ca reizē notiekošs pankreatīts. • Hiperkoagulācija → trombozes, tromboflebīts, embolisms. • Splenomegalija pie liesas vēnas obstrukcijas. • Pankreasa bojājumi → steatoreja, glukoses tolerances traucējumi / diabetes mellitus. • Subileus / ileus.

24. Ārstēšana. • Ķirurģiska. • Staru terapija. • Ķimijterapija. • vai to dažāda kombinācija.

27. RADIATION TECHNIQUESSimulation and field design.

30. Dose prescriptions. • Treat to 45 Gy at 1.8 Gy/fx followed by conedown to 50.4 Gy. In definitive chemo-RT setting, consider boosting to 54–59.4 Gy if feasible, respecting normal tissue tolerance. • Multiple dose-escalation studies with hyperfractionation, brachytherapy, IORT, radiosurgery, hypofractionation, and other methods are under investigation.

31. Paliatīva staru terapija. • Paliatīva staru terapija pie reģionāli inoperabla tumora. • Paliatīva staru terapija pie: sāpēm, citiem simptomiem. • Kombinēta staruķīmijterapija.

32. Paliatīva staru terapija ar SD 20 Gy - 5 frakcijās (4 Gy frakcijā) vai • 30 Gy - 10 frakcijās.

33. Dose limitations. • Doses up to 50 Gy are tolerated by small volumes of stomach and intestine. Most common late effects are mucosal ulceration and bleeding. Perforation is rare. • Limit the equivalent of at least one kidney to <20 Gy. • Limit the whole liver to <20 Gy and 70% of liver to <30 Gy to prevent radiation hepatitis. Small volumes of liver can be treated to high doses.

34. COMPLICATIONS. • Critical normal tissues include liver, small bowel, stomach, cord, and kidney. • Because the pancreas is a gland with both exocrine and endocrine secretions, both can decrease acutely or chronically following treatment. Adequate monitoring for diabetes is integral to treatment as is supplementation with pancreatic enzymes if exocrine insufficiency is suspected (pancrealipase with each meal). • Acute – nausea and vomiting (use antiemetics, proton pump inhibitor, or H2 blocker). Diarrhea less common. If jaundice develops during RT or following treatment, ascending cholangitis must be considered as a potential etiology. • Late – possible side effects include ulceration, stricture formation, obstruction, and (less commonly) perforation of GI tract. Side effects to cord, kidney, liver should not occur if normal tissue tolerances are followed.

35. Prognozes.

36. FOLLOW-UP. • Laboratories, and abdominal CT every 2 months to evaluate for disease recurrence/progression. • Mainly symptom-based treatment; treatment with curative intent: ultrasound examination every 3 months; relapse: primarily local or in the form of hepatic metastases

37. TxNxM1 • The Anatomy and Clinics of Metastatic Cancer • By Dr. J.M. Debois • KLUWER ACADEMIC PUBLISHERS,NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW

38. I dedicate this book toDoctor James Paget (1814-1899)He was the first to observe thenon-random nature of the metastatic process. I must acknowledge: -the continuous support of my wife Kristin, -the encouragement of Prof.Marc M.Mareel, M.D. -the artistic devotion of colleague Tony Geukens, MD. -the endeavour of the Editorial Staff of Kluwer Academic Publishers

39. METASTASES fromCARCINOMA of the PANCREAS.

40. METASTASES to the PANCREAS.

42. Patriks Sveizijs cīnoties ar vēzi ir ļoti zaudējis svaru (8 foto). • Publicēts 19. aprīlī, 2009. • Pasaules slavenajam aktierim pagājušajā gadā tika konstatēts vēzis. Pēc izieta ķīmijas terapijas kursa aktieris sver 46 kg. Pāris bildes kādu mēs viņu atceramies un pāris bildes kāds viņš izskatās tagad.  • http://das.mix.lv/articles/patriks-sveizijs-cinoties-ar-vezi-ir-loti-zaudejis-svaru-8-foto

43. "Patriks Sveizijs pēc 20 mēnešu cīņas ar slimību šodien (pirmdien) mierīgi aizgāja no dzīves, un nāves brīdī viņam līdzās bija ģimene," Vulfa pavēstīja ziņu aģentūrai AP. Sīkāka informācija netiek sniegta. • http://www.tvnet.lv/izklaide/popkultura/42584-miris_amerikanu_kinoaktieris_patriks_sveizijs_papildinata

44. Savulaik Sveizijs, cieta no smaga alkoholisma, taču atkarību pārvarēja. Šī gada janvārī kādā intervijā viņš atzina, ka viņa slimību, iespējams, izraisījusi ilgstošā alkohola lietošana un neprātīgā smēķēšana. http://izklaide.delfi.lv/archive/no-veza-miris-aktieris-patriks-sveizijs.d?id=26842369

46. Paldies par uzmanību!