156512256 Cancerul de Colon

8/13/2019 156512256 Cancerul de Colon

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UNIVERSITATEA DE VEST VASILE GOLDI ARAD

FACULTATEA DE MEDICIN, FARMACIE I MEDICIN DENTAR

SPECIALITATEA ASISTEN MEDICAL

CANCER DE COLONPROBLEME DE INGRIJIREIN SPITAL SI AMBULATOR

COORDONATOR TIINIFIC: ABSOLVENT:

DR.SZEKELY O. CSABA STREJA ANDREEA MARIA


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ARAD2010

Cuprins

I. No!"#! $%#%&'(% )% '#'*o+!% )%-&!.*!/

II. E*!o.'*o$%#!% -o&%('!! &')!o(o$!-%

III. S!+.*o+'*o(o$!% ! *&'*'+%#*

IV. R')!o)!'$#o*!-

V. C(!#!-' -'#-%&"("! )% -o(o#

VI D!'$#o*!-"( -'#-%&"("! )% -o(o#

VII. F!(+"( &')!o$&'3!-

VIII P&%4%#*&! )% -'4

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INTRODUCERE

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Capit!u! I

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Capit!u! II

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Capit!u! III

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-'.!*'( ' %8'+%#"("! %#)o-o.!-


17/44

Capit!u! IV.

1.,.CANCERELE RECTOCOLONULUI

Studiile epidemiologice'" -"*'* *'5!(%'- (%$*"&! 6#*&%3&%-/%#' -'#-%&"("! )% -o(o# ! 3'-*o&"( $%o$&'3!-, 3'-*o& '(!+%#*'&!,&%('!' -" .o(!.!!, -'&'-*%&"( 3'+!(!'( '( "#o& -'#-%&% -o(!-%, &%-*o-o(!*'@%+o&'$!-, %*- R')!o(o$"( *&5"!% -"#o'- ! &%-"#o'--o#-%#*&'&%' '-%*o& 3'-*o&! (' "# -'4 )'*, 6# /%)%&%' 3o-'(!4&!!%3o&*"&!(o& )!'$#o&*!-% .%#*&" )%-o.%&!&%' -%(o& +'! +!-! '--!)%#*%

!#3!(*&'*!/% '" .&o*&"4!/% '(% +"-o'%! -o(!-%R')!o)!'$#o*!-"(, 6# -')&"( %3o&*"&!(o& '(% !#/%*!$'*!/%, /'

*&%5"! !# %'+' )% "&+*o'&%(% ."#-*% )% /%)%&%:=%8'+!#'&%' &')!o(o$!- *&%5"!% =! 6#)&%.*% '*%#!' .&% 3'4%(% )%6#-%."* '(% #%o.('4!!(o& '" -%( ."!# .&% 3'4%(% "*!(% )!# ."#-* )%/%)%&% -@!&"&$!-'(=)%-o.%&!&%' (' *!+. ' (%4!"#!(o& .&o*&"4!/=.o(!.o!)% '& -o!#-!)% -")%.!*'&%' #%o.('+"("! -o(!- 6# 3'4 )% -'#-%& !#*&'%.!*%(!'( '"!#*&'+"-o

=!#/%*!$'!' &')!o(o$!- /' -"*' ."# 6# %/!)%# *o'*% -'&'-*%&%(%#%o.('+%(o& -o(!-%=!#3!(*&'#*%,/%$%*'#*%,"(-%&'*%,'/7#) 6# /%)%&%3'.*"( - %(% % !#*&!-=.&!#-!.!"( -o#3o&+ -&%!' %*% +'! "o& )%-o.%&!+ #%o.('+"(-o(!- ."#7#) 6# %/!)%# "#"( )!#*&% -%(% *&%! -'&'-*%&% +'-&o-o.!-%*&%5"!% &%.%-*'*=".&'!#3%-!' #%-&o4' ! "(-%&'!!(% +"-o'%! 6# "(-%&'!% -o+.(!-)%*"( )% &%.%)% *'5(o"( &')!o(o$!- '( #%o.('4!%! -o(!-%=&')!o(o$"( %*% '*3%( ." 6# !*"'!' )% ' )%-o)!3!-' 6+5!#'&%' $&%")%-!3&'5!( &')!o(o$!- 6#*&% -'&'-*%&"( !#3('+'*o&=&%'-!o#'( '(&%(!%3"("! ! .%&%*%("! -o(!- .% )% o .'&*%, !'& .% )% '(* .'&*%&')!o%+!o(o$!' !#3!(*&'*!/=#%o.('4!- &%3(%-*'* 6# '"*o.('*!-'+"-o'%!, *o#" ! .%&!*'(*!+=*&"-*"&' '#'*o+o=@!*o(o$!- '.'&% "5 3o&+' ')%#o-'&-!#o'+%(o&'" ' -'&-!#o+"("! -o(o!) +"-o '" ' -'&-!#o'+%(o& '#'.('4!- =!#/'4!' (o-'( ' #%o.('+"("! &%-*o-o(!- % 3'-% -!&-"+3%&%#!'()"-7#) .&o$&%!/ (' *%#o4=!#/'4!' 6# $&o!+% ' .%&%*%("! -o(!- % 3'-% .&o$&%!/, )% (' 3'4'!#*&'+"-o' (' %&o' ! .&o.'$'&%' (' o&$'#%(% /%-!#%

1


18/44

=!#/'4!' $'#$(!o#'& %*% )%-!!/ .%#*&" %8-&%4 ! -" +"(* +'!%+#!3!-'*!/ )%-7* !#/'4!' .'&!%*'(=-('&!3!-'&%' TNM '" -('&!3!-'&%' D"H% &+7# o&!%#*'*!/% .%#*&"&')!o(o$, )%o'&%-% %(% #" % .&!;!# .% )'*%(% &')!o(o$!-%, .% )% o

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A.%-*%(% &')!o(o$!-% )%.!#) )% %)!"( (o-'(!4&!! (' #!/%("(-%-"("! Lo-'(!4&!(% 5'=3o#)"("! ! '(% -%-"("! .&o.&!" 4! %-'&'-*%&!4%'4 .&!# !+'$!#! ('-"#'&% +'&!, ".&'."% .% )!/%&%

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1./.L&a!i8(ri!$ tu%ra!$ a!$ &!nu!ui as&$n#$nt

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1.2.L&a!i8ar$a &an&$ru!ui !a ni'$!u! trans'$rsu!ui

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1.3.L&a!i8ar$a tu%ra!( !a ni'$!u! &!nu!ui #$s&$n#$nt

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1.4.L&a!i8(ri!$ tu%ra!$ a!$ &!nu!ui si*%i#

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1.5. Can&$r$!$ r$&ta!$

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-o(o#"( !$+o!) ! )%-%#)%#* '.%-*"( &')!o(o$!- %*% )% ('-"# '")% *%#o4:=!+'$!#!(% ('-"#'&% "#* 5!#% -!&-"+-&!%=*%#o4' .o'*% 3! .'&!'( '" -o+.(%* ! % 6#*!#)% 6# %#(o#$!*")!#'( )7#) '%-* *!.!- )% -o*o& )% +& C'#-%&%(% (o-'(!4'*% .% -o(o#"( *&'#/%& '.'& &')!o(o$!- "53o&+ )% *%#o4: !+'$!#% 6# .'#*'(o# 5"3'#* C'#-%&%(% )% -%- '" !+'$!#%' &')!o(o$!- ('-"#'& (o-'(!4'* ('#!/%("( "#"! .%&%*% '" -!&-"+3%&%#!'(

22


23/44

Examenul pe gol n ortostatism %*% 3o(o!* )o'& 6# "&$%#*,.%#*&" )!'$#o*!-"( -o+.(!-'!!(o& -'#-%&"("! &%-*o-o(o#"("! 9o-("4!!,.%&3o&'!! $adiograia toracic .o'*% %/!)%#!' +%*'*'4% ."(+o#'&%

$adiograia sau scintigraia osoas 3o(o!* .%#*&" )%.!*'&%'+%*'*'4%(o& oo'%

E&*ra+ia

Ecograia abdominal %*% "*!( .%#*&" !)%#*!3!-'&%' +'%(o&.'&!%*'(% )!$%*!/%, )'& +'! '(% .%#*&" '.&%-!%&%' *')!"("! *"+o&'( Ecograia endorectal '!$"& %8.(o&'&%' .%&%*%("! &%-*'( ! '(.'!"("! .%&!&%-*'( ! % &%'(!4%'4 3!% -" o#) &!$!) 3!% -" "#

%#)o-o. TMC .%&+!*% '#'(!4' -o+.(%* ' -')&"("! -o(!-, #" %*% "#%8'+%# )% .&!+ !#*%#!% .%#*&" )!'$#o*!- TC %*% +'! /!'5!( )%-7*%-o$&'3!', )'& #" .o'*% !)%#*!3!-' %8*%#!' .%&!-o(!- (' )%5"* E*%"*!( .%#*&" )%.!*'&%' +%*'*'4%(o& /!-%&'(%

2?


24/44

Capit!u! V

C!ini&a &an&$ru!ui #$ &!n >CRC?

T'5(o" -(!#!-


25/44

%+o&'$!!(% )!$%*!/% ".%&!o'&% .o* 3! '-"*% '" +'! 3&%-/%#*-&o#!-% S%ngerrile acute% +'#!3%* )!3%&!* 6# 3"#-!% )% (o-'(!4'&%'*"+o&!! -'&% =' "(-%&'*


26/44

'+."(%(o& &%-*'(%, .%&+!*% '.&%-!%&%' .&%4%#%! !#/'4!%! .%&!&%-*'(%I+.o&*'#' *"%"("! &%-*'( -' *%* )% -&%%#!#$ ' 3o* !#3!&+'* .%*")!! *'*!*!-%

Capit!u! VI

Dia*nsti& p8iti'

E8!* ? +o)"&! )% )!'$#o*!- ' .'-!%#!(o& : 1D%.!*'&%' -'4"&!(o& !4o('*% )'*o&!* ')&%'5!(!*!! .'-!%#!(o&

(' +%)!- 3!% .%#*&" o !+.*o+'*o(o$!% "$%*!/ 3!% -' "&+'&% '%8'+!#&! -(!#!-% .%#*&" '-"4% (%$'*% )% '(*% o&$'#% A#'+#%4' !%8'+%#"( -(!#!- &!)!- ".!-!"#%' )% -'#-%& )% -o(o#, %8.(o&&!(%%#)o-o.!-% !'" !+'$!*!-% )%*%-*%'4 *"+o&', !'& @!*o.'*o(o$!'-o#3!&+ #'*"&' +'(!$# ' '-%*"!' 2S-&%%#!#$"( .o."('!!(o& -" &!- +%)!" '" -&%-"* )% -'#-%& )%-o(o# S% &%'(!4%'4 6# -')&"( .&o3!('8!%! %-"#)'&% ! !)%#*!3!-!#)!/!4!! -" -%' +'! +'&% .&o5'5!(!*'*% )% ' '/%' -'#-%& )% -o(o# '"

.o(!.! -o(o#!-! )!# $&"."( -%(o& 3& %+#% '" !+.*o+% )% 5o'(?S".&'/%$@%&%', ')!- +o#!*o&!4'&%' !#)!/!4!(o& -" '#*%-%)%#*%

)% 5o'( &%-*o-o(o#!- .&%)!.o4'#* (' -'#-%& )% -o(o#

Dia*nsti&u! #i+$r$n"ia! a! &an&$ru!ui &!r$&ta!

Nr. Ba!a Crit$rii!$ #$ #ia*nsti& #i+ $r$n"ia!

1 R%-*o-o(!*' "(-%&o@%+o&'$!- !5o'(' C&o@!# -o(o#!-

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Co(!*' !-@%+!- =5*&7#!=+'#!3%*&! -(!#!-%: &%-*o&'$!%, )"&%&%=&%-* !#)%+# %#)o-o.!-=!+'$!#% '&*%&!o$&'3!- "$%*!/

T"5%&-"(o4' -o(o#!- ='o-!%&% -" *"5%&-"(o4' ."(+o#'& 9)%%o&!=!)%#*!3!-'&% BJ 6# -'"#='.%-*% !+'$!*!-% -'&'-*%&!*!-%

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2


27/44

9r%$ &!ini&$ sp$&i+i&$ a!$ CRC

D!/!4'&%' *&')!!o#'( ' CRC 6# -'#-%&%(% -o(o#!-% ! -'#-%&"(&%-*'( #" +'! %*% '-*"'( )%o'&%-% #" '" 6# /%)%&% 5'4%(%%*!o.'*o$%#!-% S*")!"( !*%+'*!- '( -%("(%(o& $%#%*!-% ' .%&o'#%(o&!)%#*!3!- )o" 3o&+% )% CRC1C'#-%& -o(o&%-*'( LO2C'#-%&"( -o(o&%-*'( LER

1C'#-%&"( -o(o&%-*'( LO &%.&%4!#* $&"."( -%( +'! #"+%&o

)% CRC 90 -'&'-*%&!4'* +o(%-"('& .&!# .!%&)%&%' @%*%&o4!$o4!*!!(' o +!% )% (o-, -" !+.(!-!*' &%)"-%&% (' @%+!4!$o4!*'*%' '"@o+o4!$o4!*'*% LO % )%4/o(* (' #!/%("( .o(!.!(o& .&%%8!*%#! !"#* (o-'(!4'! .% -o(o#"( *7#$ 90 )!# *o* C'&'-*%&%(% %*!o.'*o$%#!-% .&!#-!.'(% "#* :=!#*'5!(!*'*% -&o+o4o+!'( +'#!3%*'* .&!# '#o+'(!! -&o+o4o+!'(%=+"*'!!(% $%#%*!-% APC ! .!%&)%&!(% o5(!-% '(% $%#%(o& P?, DCC !DPC P'&*!-"('&!*!(% -(!#!-% -' "&+'&% ' -'&'-*%&"("! -!&-"+3%&%#!'('( *"+o&!(o& ! ' )!+%#!"#!(o& +'! &%)"% ' ("+%#"("! -o(o#"("! *7#$-%' +'! 3&%-/%#* +'#!3%*'&% -(!#!- 3!!#) *"(5"&'&%' *&'#4!*"("!!#*%*!#'( S7#$%&'&%' % %8.&!+ +'! '(% .&!# @%+'*o-@%4!% D!'$#o*!-"( %#)o-o.!- %*% -" '*7* +'! "o& )% &%'(!4'* -" -7*(o-'(!4'&%' #%o.('+"("! %*% +'! '.&o'.% )% o&!3!-!"( '#'( 2T"+o&!(% RER "#* !*"'*% '.&o'.% %8-("!/ .% -o(o#"( )!*'(9)&%'.*' ! &%.&%4!#* 1=20 )!# -'#-%&"( )% -o(o# ! .%*% )!#-'#-%&%(% NPCC E(%+%#*%(% %*!o.'*o$%#!-% )!*!#-*% 3' )% -%(%'(% CRC LO "#* : !#*'5!(!*'*%' +!-&o'*%(!!(o&, )'*o&'*)!3%&%#%(o& )% &%.'&'&% ' 6+.%&%-@%&!(o& '.&"*% (' 5'4% '4o*'*%

C(!#!- -%( +'! 3&%-/%#* "#* .&%4%#*% !+.*o'+%(% $%#%&'(% 9'*%#!%,!#'.%*%# M'! &'& % .&o)"- 7#$%&&! +'-&o-o.!-% M'''5)o+!#'( .'(.'5!( '.'&% *'&)!/

Pr+i!a=ia CRC

P&o3!('8!' .&!+'&O5!%-*!/"( .&o3!('8!%! .&!+'&% %*% %/!*'&%' !#!!%&!! .&o-%"("!

.'*o$%#!- .&!# !)%#*!3!-'&%' ! %&')!-'&%' 3'-*o&!(o& %*!o(o$!-! '! CRC

S% 3o(o%- )o" -! .%#*&" '*!#$%&%' '-%*"! -o.:

2


28/44

1C@%+o*%&'.!' '&% (' 5'4 -o#*'*'&%' 6#- #%3"#)'+%#*'*.'*o$%#!- S*")!!(% *'*!*!-% ! '#'(!*!-% %3%-*"'*% "(*%&!o& '" )o/%)!*- '.!&!#' ')+!#!*&'* *!+. )% +'8!+"+ 1 )%-') 6# )o4%(% !#)!-'*%6# .&o3!('8!' 5o(!(o& -'&)!o/'-"('&% )!+!#"%'4 "5*'#!'( &!-"( )%

'.'&!!% '( CRC, !+!('-"( "*!(!4'* &%$"('* *!+. )% -%( ."!# ("#!-')% %+#!3!-'*!/ #"+&"( ! )!+%#!"#%' .o(!.!(o& ')%#o+'*o! ('.'-!%#!! -" PAP, %3%-*"( AINS '".&' .o(!.!(o& -o(o#!-! .o&')!-! #"%*% !+.o&*'#*

2D!%*' .&o*%-*!/ '&% &%-o+'#)&!(% :=)!+!#"'&%' -o#"+"("! )% (!.!)% '(!+%#*'&% 9'#!+'(% ! /%$%*'(% ('#"+'! 20 )!# *o*'("( -'(o&!-=-&%*%&%' -'#*!*!! )% 3!5&% !#$%&'*% -%( ."!# 2 $4!=-o#"+"( 4!(#!- )% 3&"-*% ! (%$"+%

=%/!*'&%' -o#"+"("! -'(o&!- %8-%!/ ! ' %8-%"("! .o#)%&'( P&o3!('8!' %-"#)'& O5!%-*!/"( .&o3!('8!%! %-"#)'&% %*% )!'$#o*!-"( .&%-o-% '(CRC, 6#'!#*% -' *&'"+' )%.%'- +"-o'' ! +%*'*'4%4%,

.%#*&" -' !#*%&/%#!' *%&'.%"*!- '!5 %3!-'-!*'*% +'8!+

Trata%$ntu! CRC

Trata%$ntu! &0irur*i&a!

I#)!-'!! *%o&%*!- o&!-% .'-!%#* -" -'#-%& )% -o(o# .o'*% 3!"." *&'*'+%#*"("! -@!&"&$!-'( :=.%#*&" CRC (o-'(!4'* (' .%&%*%(% !#*%*!#'( 9S*')!"( 1 TNM,!#*%&/%#!' '&% -o. -"&'*!/=.%#*&" %8*%#!' (' CRC &%$!o#'( ! (' )!*'# 9*')!"( 2=? TNM,-@!&"&$"( '!$"& %8-%4!' *"+o&!! .&o&'*!/% ! 6#-%'&- 6#)%.&*'&%' -7*+'! -o+.(%* ' *"+o&!(o& !#/')'*% ! ' +%*'*'4%(o&=.%#*&" CRC -o+.(!-'* 9o5*&"-!%, @%+o&'$!% !'" -" +%*'*'4% ('

)!*'# 9*')!"( TNM, *&'*'+%#*"( -@!&"&$!-'( !#!!'( , '&% 6# $%#%&'(, "# &o( .'(%'*!/="(*%&!o& % .o'*% -o+.(%*' -" o !#*%&/%#!% -"&'*!/ Co#*&'!#)!-'!! 6# "#%(% !*"'!! .'&*!-"('&% *&'*'+%#*"(-@!&"&$!-'( #" % .o'*% %3%-*"' -' 6# CRC -" +%*o)% .&'-*!-%)!%+!#'*% '" -" +%*'*'4% 6# o&$'#% )!3%&!*% 93!-'* ! .(+7#, '" 6#-o#)!!! .'*o(o$!-% 'o-!'*% -'&% -o#*&'!#)!- !#*%&/%#!' -@!&"&$!-'(

P&!#-!.!! $%#%&'(%1 E8*%#!' &%4%-!%! -o."( .&!#-!.'( '( -@!&"&$"("! 6# CRC

%*% &%4%-!' -o+.(%* ' *"+o&!! T&'*'+%#*"( -@!&"&$!-'( -o#* )!#

2


29/44

%8-!4!' "#"! %$+%#* )% !#*%*!# -" ("#$!+% ')%-/'* )!*'( !.&o8!+'( '( *"+o&!! 2 D!%-!' $'#$(!o#!(o& (!+3'*!-! !#*%&/%#!' -@!&"&$!-'(-"&'*!/ #%-%!* o5(!$'*o&!" %/!*'&%' ('&$ ' $'#$(!o#!(o& )!# *%&!*o&!"(

)% )&%#'; (!+3'*!- -o&%."#4*o& V!4"'( % 6#)%.&*%'4 $'#$(!o#!!.'&'-o(!-! ! -%! %#*%&o-o(!-! .%#*&" )!*&"$%&%' -%(o& -%#*&'(! % !'" 6#-o#!)%&'!% /7&*' .'-!%#*"("! -o#)!!!(% +%)!-'(% 'o-!'*% .&%-"+ !

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30/44

.&!# )!+!#"'&%' )!+%#!"#!(o& *"+o&!! ! ' #"+&"("! )% $'#$(!o#!)!%+!#'!, -&%-7#) '#%(% )% &')!-'(!*'*% '( !#*%&/%#!%! -@!&"&$!-'(%

Mo)'(!*! )% %3%-*"'&% !&')!%&%' '5)o+!#'( *o*'( #" '&% "#&'.o&* %3!-!%#%3%-*% *o8!-% )o/%)!*% C%' +'! "*!(!4'* %*%

&')!o*%&'.!' (o-'( &%'(!4'* .% -'(% %8*% '" !#*%R')!o*%&'.!' ');"/'#* % %3%-*"!'4 6# -o+.(%*'&%'!#*%&/%#!%! -@!&"&$!-'(% (' .'-!%#!! 6# *')!!(% 2 ! ? TNM ! '" -'o5!%-*!/!*'*% .&!#-!.'( -&%*%&%' )"&'*%! )% ".&'/%"!&% ' .'-!%#!(o&! -)%&%' &!-"("! )% &%-!)!/ (o-'(

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31/44

Prin&ipa!$!$ s&0$%$ &0i%it$rapi&$ ;n &an&$ru! &!ni&

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32/44

S*')!"( TNM Q 9F& =FU L%"-o/o&!#

A-%*% &%-o+'#)&! "#* "."% -@!+5&!(o& )'*o&!*

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STUDIU STATISTIC

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Am analizat retrospectiv pacienii cu cancer de n perioadaianuarie 2001 decembrie 2001.

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156512256 Cancerul de Colon

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