Cancerul de ovar.doc

8/18/2019 Cancerul de ovar.doc

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SCOALA POSTLICEALĂ SANITARĂ ‘’FLORENTINA

MOSORA”BUZAU

SPECIALITATEA :ASISTENT MEDICAL DE LABORATOR

DIAGNOSTICUL DE LABORATOR IN TUMORI

EPITELIALE OVARIENE

COORDONATOR ABSOLVENTAS.PR LAB PODOSU GABRIELA RIMNICEANU LILIANA DOINA

IULIE 2012

BUZAUCUPRINS

Argument.........................................................................................................6


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I.Introducere....................................................................................................II. Et!o"#togen!# c#nceru$u! o%#r!#n...............................................................&

1.'#ctor! de r!(c..........................................................................................11#). *#r!t#te#.............................................................................................11

+). A$,"t#re#...........................................................................................12c). In-ert!$$!t#te# ! (t!mu$#to#re$e o%u$#/!e!............................................1d). Vr(t# $# men#r, ! meno"#u3,.......................................................1e. 4ormon!! e5ogen!...............................................................................1-). L!g#tur# tu+#r, ! !(terectom!#.........................................................17g). T#$cu$.................................................................................................17). '#ctor!! #$!ment#r!.............................................................................16!). I(tor!cu$ -#m!$!#$.................................................................................1

2.'#ctor! de cre(tere #! ce$u$e$or e"!te$!#$e o%#r!ene..................................1'#ctor! ormon#$!...................................................................................18

Anom#$!!$e cromo3om!#$e.....................................................................20III. C$#(!-!c#re# !(to"#to$og!c# # tumor!$or o%#r!ene...................................21

CLASI'ICAREA O9S A TU9ORILOR OVARIENE............................211. TU9ORI E*ITELIALE.....................................................................21B. Tumor! muc!no#(e.............................................................................22C. Tumor! endometr!o!de.......................................................................2D. Tumor! de ce$u$e c$#re :me3one-ro!de)..............................................2E. Tumor! Brenner..................................................................................2'. Tumor! m!5te e"!te$!#$e......................................................................2

;. C#rc!no#me ned!-erent!#te.................................................................24. Tumor! e"!te$!#$e nec$#(!-!c#+!$e.......................................................22. TU9ORI ALE 9EZENC4I9ULUI SI CORDOANELOR SEESUTURILOR 9OI NES*ECI'ICAT......................27

IV. C$#(!-!c#re# (t#d!#$# # c#nceru$u! de o%#r...............................................27V. A("ecte c$!n!ce !n c#nceru$ de o%#r...........................................................2

VI. E5"$or#r! "#r#c$!n!ce...............................................................................0Imuno!(toc!m!# (#u I4C.....................................................................7

VII. D!#gno(t!cu$ d!-erent!#$.........................................................................8VIII. E%o$ut!e (! "rogno(t!c...........................................................................70

1. C#$e# "er!tone#$#...................................................................................702. C#$e# $!m-#t!c#.......................................................................................71. C#$e# (#ngu!n#.......................................................................................71


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I


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Motto:

„ Sănătatea reprezintă comoara cea maide preţ şi cea mai uşor de pierdut.

Totuşi, cel mai prost păzită.”

R. Augier


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Argument

N!c! un #$t #("ect c$!n!c ? or!ct de gr#% #r -! ? nu "une med!cu$ @ntro(!tu#/!e $!m!t, ? #cee# de # (crut# !m"o(!+!$u$? ## cum o -#ce c#nceru$. Ace(t-$#ge$ #$ (eco$u$u! no(tru ? @nreg!(tre#3, (t#t!(t!c ! #+(o$ut o cretere re$#t!%,?(!tundu$ "e $ocu$ II @ntre c#u3e$e de dece( d!n ce$e m#! mu$te /,r! #$e $um!!.

E-ortur!$e !n%e(t!g#tor!! ! -!n#nc!#re de"u(e ? munc# $#+or!o#(, !!m#g!n#/!# ce$tu!t, "entru # g,(! no! %#r!#nte ter#"eut!ce nu #u #%utre3u$t#te ("ect#cu$o#(e. ntre c#ncer ! tr#t#mentu$ (,u nu (# "u( @nc,

(emnu$ eg#$!t,/!!.De+utu$ e5trem de !n(!d!o(? e%o$u/!# cr!"t!c, ? #nd!c#"u$ de # nu

e5!(t# @nc, o metod, de (creen!ng @n m#(, ? %#r!et#te# tr#t#mente$or ? d#r n!c!unu$ cur#t!% @n -#3e$e #%#n(#te? num,ru$ m#re de c#3ur! cu to#te !m"$!c#/!!$emed!c#$e? (oc!#$e ! "(!o$og!ce? to#te #ce(te# re"re3!nt, o (er!o#(, "ro+$em,# med!c!ne! ! g!neco$og!e! #ctu#$e.D#r m#! #$e( -#"tu$ c, cee# ce (e cuno#te de("re c#ncer e(te "#rte# %!3!+!$,# !ce+ergu$u! ? o+$!g, ("ec!#$!(tu$ $# o gnd!re med!c#$, cur#o#(,? mo+!$,?e$!+er#t, de #+$o#ne ! "reudec,/!.

De"!(t#re# "recoce # tumor!$or o%#r!ene con(t!tu!e o "ro+$em, cu #ttm#! d!-!c!$, cu ct m#n!-e(t,r!$e c$!n!ce $!"(e(c @n (t#d!!$e !nc!"!ente #$e +o$!!?#tunc! cnd e-!c!en/# tr#t#mentu$u! e(te m#5!m,.

S# o+(er%#t "r#ct!c c, o tumor, m#$!gn, o%#r!#n, (e e5"r!m, c$!n!c#+!# cnd m,(o#r, ce$ "u/!n 7 cent!metr! ! de ce$e m#! mu$te or! #ce(tem#n!-e(t,r! (unt #"#n#u$ e5t!nder!$or met#(t#t!ce.

D!n #ce(te mot!%e? c#nceru$ o%#r!#n re"re3!nt# # "#tr# c#u3# demort#$!t#te "r!n c#ncer $# -eme!? !#r !n t#r# no#(tr# # dou# du"# c#nceru$ deco$ uter!n. De #cee#? (e !nce#rc# g#(!re# unor no! metode "entru de"!(t#re#c#t m#! "recoce # #ce(te! neo"$#3!!.


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con(!der#+!$ num,ru$ 3!$e$or de !nc#"#c!t#te tem"or#r, de munc, ? -!!ndc#u3# unor !n-!rm!t,/! ! r!d!cnd m#r! "ro+$eme de ord!n -!3!c? (oc!#$ !

"(!o$og!c. I#t, de ce ? (tud!#t, @n conte5t med!c#$? med!co+!o$og!c ! (oc!#$?tumor# de o%#r # de%en!t? m#! #$e( @n u$t!me$e decen!!? /!nt# "reocu",r!$orunu! co$ect!% com"$e5 ! numero( de ("ec!#$!t!? #tt c# (u+!ect teoret!c ctm#! #$e( "entru !m"ort#n/# $u! "r#ct!c,.

D!-!cu$t#te# de"!(t,r!! "recoce # #ce(te! m#$#d!!? gr#%!t#te# e%o$u/!e!? oten!c, ter#"eut!c, @nc, "#r/!#$ e-!c!ent,? "rogno(t!cu$ -o#rte (e%er -#c d!ntumor# de o%#r un (u+!ect de "erm#nent, #ctu#$!t#te? @nc, nee"u!3#t ?

u(t!-!cnd #$egere# c# tem, # $ucr,r!! de -#/,.


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De#(u"r# -!ec#ru! o%#r (e de(c!de !n-und!+u$u$ tu+e$or '#$$o"!o? "re%#3ut cu -r#nur!? c#re -#ce $eg#tur# cu uteru$. De(! (unt -o#rte #"ro"!#te?nu e5!(t# o cone5!une d!rect# !ntre o%#r (! de(c!dere# tu+e!.

L# o -eme!e m#tur#? o%#re$e #u un #("ect re$#t!% neregu$#t. 9ot!%u$#ce(te! neregu$#r!t#t! "o#te -! dedu( "r!n e5#m!n#re# $# m!cro(co" # (tructur!!!nterne. In%e$!(u$ o%#ru$u! e(te un (tr#t de ce$u$e denum!t e"!te$!u germ!n#t!%.D!n ce$u$e #ce(tu! (tr#t de$!m!t#nt (e -orme#3# o%u$e$eF m!! de o%u$e !m#ture#-$#te !ntrun !n%e$!( (-er!c? (#u -o$!cu$? "ot -! o+(er%#te $# "er!-er!# o%#ru$u!.

9#! u(or de o+(er%#t (unt -o$!cu$!! ce cont!n o%u$e #-$#te !n d!-er!te(t#d!! de m#tur#t!e. *e m#(ur# ce #ce(t! -o$!cu$! (e m#re(c (! du"# e$!+er#re#o%u$u$u!? "roduc #("ectu$ neregu$#t c#r#cter!(t!c #$ (u"r#-ete! o%#ru$u!.Centru$ o%#ru$u! e(te ocu"#t de un te(ut e$#(t!c -!+ro( ce -unct!one#3# c# un(u"ort "entru (tr#tu$ e5tern ce cont!ne -o$!cu$!!.

Numero(! -#ctor! #u -o(t !m"$!c#t! !n "#togene3# c#nceru$u!o%#r!#n=-#ctor!! de r!(c? -#ctor!! de cre(tere #! ce$u$e$or e"!te$!#$e o%#r!ene?-#ctor!! ormon#$!? oncogene$e? #nt!oncogene$e (! #nom#$!!$e cromo3om!#$e.

'!g 2.C#ncer de o%#r


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1.Factori de risc

De! nu (# reu!t @n "re3ent de-!n!re# cu m#re e5#ct!t#te # "o"u$#/!e!cu r!(c cre(cut? c/!%# -#ctor! (#u #(oc!#t cu cretere# (#u de(cretere#r!(cu$u! de +o#$,.

Stud!!$or e"!dem!o$og!ce #u e%!den/!#t c,= %r(t#? r#(#? nu$!"#r!t#te#?!n-ert!$!t#te#? !(tor!cu$ de c#ncer endometr!#$ (#u c#ncer de (n? "recum !#ntecedente$e -#m!$!#$e de c#ncer o%#r!#n (#u @n(o/!t de cretere# r!(cu$u! de#"#r!/!e # c#nceru$u! o%#r!#n e"!te$!#$.

D!m"otr!%,? "#r!t#te#? -o$o(!re# contr#ce"t!%e$or or#$e? #$!ment#/!# $#(n :#$,"t#re#)? $!g#tur# tu+#r,? "recum ! !(terectorn!# (#u @n(o/!t de

(c,dere# r!(cu$u! de #"#r!/!e # +o$!!.De #(emene#? ro$u$ ctor%# -#ctor! e(te @nc, contro%er(#t= %r(t# $#men#r,? %r(t# $# meno"#u3,? -o$o(!re# ter#"!e! "entru -ert!$!3#re? ter#"!# de(u+(t!tu/!e cu e(trogen!? -o$o(!re# t#$cu$u!? -#ctor!! #$!ment#r!? !nto$er#n/# $#$#cto3,? #ntecedente de "#rot!d!t,.a). Paritatea determ!n, (c,dere# r!(cu$u! "entru c#nceru$ o%#r!#n . R!(cu$de #"#r!/!e # c#nceru$u! (c#de cu num,ru$ (#rc!n!$or.n #ce(t (en(? un!! cercet,tor! #u (uger#t c,? !nd!-erent de e-ectu$ "r!me!(#rc!n! du(e $# termen? #c/!une# -#%or#+!$, # "#r!t,/!! #(u"r# r!(cu$u! dec#ncer o%#r!#n #r -! #m"$!-!c#t, cu oc#3!# (#rc!n!$or urm,to#re? r!(cu$reducndu(e cu 1 "n, $# 22 cu -!ec#re n#tere .

'!g .*#r!t#te#


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E-ecte$e %r(te! $# "r!m# n#tere "recum ! # (#rc!n!$or !ncom"$ete:#%ortu$? n#tere# unu! noun,(cut mort? (#rc!n# ecto"!c,) #(u"r# r!(cu$u!

"entru c#ncer o%#r!#n? nu #u -o(t @nc, com"$et e$uc!d#te.Re3u$t#te$e (tud!!$or cumu$#t!%e e-ectu#te @n ("!t#$ @n S.U.A. ! Euro"#(ugere#3, o cretere # r!(cu$u! de c#ncer o%#r!#n od#t, cu cretere# %r(te! $#

"r!m# n#tere? !n%er( -#/, de re3u$t#te$e (tud!!$or "o"u$#/!on#$e .Une$e (tud!! #u #r,t#t e5!(ten/# unu! e-ect "rotector "entru (#rc!n!$e!ncom"$ete (!m!$#r (#rc!n!$or du(e $# termen? #$te (tud!! #u #r,t#t e5!(ten/#une! re$#/!! !n%er(? "ro"or/!on#$e ne(emn!-!c#t!%e? !#r #$te (tud!! #u "ututdemon(tr# e5!(ten/# une! core$#/!! @ntre #ce(te# ! r!(cu$ "entru c#nceru$o%#r!#n .

D!-eren/e @n #n#$!3# d#te$or? !nc$udere# @n (tud!!$e e-ectu#te @n ("!t#$ !# #$tor cond!/!! g!neco$og!ce? "recum !nc$udere# noun,(cu/!$or mor/! ! #$ted!(cre"#n/e metodo$og!ce? -#c d!-!c!$, !nter"ret#re# #ce(tor re3u$t#te .

b). Alăptarea -eme!$e c#re #u #$,"t#t #u un r!(c (c,3ut de # -#ce c#ncero%#r!#n? -#/, de -eme!$e nu$!"#re (#u de ce$e mu$t!"#re d#r c#re nu #u #$,"t#t.Su"re(!# :o%u$#/!e!) #r "ute# -! e5"$!c#/!# "o(!+!$, @n #ce(t c#3.

'!g .A$#"t#re#'eme!$e c#re #u #$,"t#t #u "re3ent#t o reducere cu 60 # r!(cu$u!#men!n/,tor de %!#/, com"#r#t!% cu nu$!"#re$e.


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ntre mu$t!"#re? r!(cu$ #men!n/,tor de %!#/, "r!n c#ncer o%#r!#n e(te cu 0 m#! (c,3ut $# ce$e c#re #u #$,"t#t -#/, de ce$e c#re nu #u #$,"t#t .De#(emene#? r!(cu$ #"#r!/!e! c#nceru$u! o%#r!#n "#re (, (c#d, cu dur#t#$#ct#/!e!? e-ectu$ "rotector @n "r!me$e 6 $un! de $#ct#/!e .

c). Infertillitatea şi stimulatoarele ovulaţiei.

R!(cu$ "r!ntre -eme!$e -,r, #ntecedente -#m!$!#$e de c#ncer o%#r!#n e(te de#"ro5!m#t!% 1? :1 d!n 0 -eme!)? !#r "entru ce$e cu !(tor!c "o3!t!% e(te m#!m#re.

'!g 7.'ert!$!3#re !n %!troTeoret!c? !n-ert!$!t#te# endocr!n,? re3u$t#nt, # #no%u$#/!e! #r tre+u! (,d!m!nue3e r!(cu$ de c#ncer? !#r med!c#/!# !nducto#re # o%u$#/!e! (, cre#(c,#ce(t r!(c.G!ttemore ! co$. #u con(t#t#t c, nu e5!(t, o cretere (t#t!(t!c,(emn!-!c#t!%, # r!(cu$u! "entru c#ncer o%#r!#n "r!ntre -eme!$e m,r!t#tenu$!"#re c#re #%e#u un d!#gno(t!c c$!n!c de !n-ert!$!t#te.D#te$e (ugere#3, c, r!(cu$ # -o(t m#! m#re "r!ntre -eme!$e cu !n-ert!$!t#te deor!g!ne o%u$#tor!e dect "r!ntre ce$e cu !n-ert!$!t#te de #$te c#u3e .'eme!$e

!n-ert!$e c#re #u -o$o(!t med!c#mente "entru cretere# -ert!$!t,/!! #u #%ut unr!(c m#! cre(cut com"#r#t!% cu ce$e c#re nu #u -o$o(!t #ce(te med!c#mente .

d). Vârsta la menarhă şi menopauă.

Re$#/!# @ntre %r(t# $# men#r, ! meno"#u3, ! r!(cu$ "entru c#ncer o%#r!#ne(te ec!%oc,.


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Stud!!$e "o"u$#/!on#$e d!n S.U.A. ! Euro"# nu #u "utut (t#+!$! o core$#/!e(emn!-!c#t!%, @ntre r!(cu$ de c#ncer o%#r!#n ! %r(t# $# men#r, .D#te$e cu

"r!%!re I# "o(!+!$# coreI#/!e @ntre r!(cu$ de c#ncer o%#r!#n ! %r(t# I#meno"#u3# n#tur#$,? (unt I# -e$ de !ncon(!(tente.Une$e (tud!! #u con(t#t#t o cretere # r!(cu$u! "entru c#nceru$ de o%#r cu%r(t# #%#n(#t, I# meno"#u3,? de #"ro5!m#t!% 1? ?6 #n!? "e cnd #$te(tud!! nu #u "utut e%!den/!# #ce#(t, $eg,tur,.

e. !ormonii e"ogeni.

Contr#ce"t!%e$e or#$e com+!n#te? reduc r!(cu$ de c#ncer de o%#r? !#r e-ectu$$or "rotector e(te unu$ d!n re3u$t#te$e c#re # -o(t "ro+#t @n c#dru$ ce$or m#!con(!(tente (tud!! e"!dem!o$og!ce #$e c#nceru$u! o%#r!#n.

'!g 6.*!$u$e contr#ce"t!%e

Ace(te (tud!! e"!dem!o$og!ce #u e(t!m#t c, e-ectu$ "rotector "r!n (c,dere#r!(cu$u! re$#t!%? %#r!#3, @ntre 0?27 ! 0?8 .

R!(cu$ de c#ncer o%#r!#n (c#de cu dur#t# -o$o(!r!! contr#ce"t!%e$oror#$e? @n mod e%!dent du", 7 #n! de -o$o(!re? e-ectu$ men/!nndu(e ce$ "u/!n10 17 #n! du", @ncet#re# -o$o(!r!! #ce(tor#.Ace#(t, "rotec/!e (e m#n!-e(t, $#-eme!$e c#re -o$o(e(c contr#ce"t!%e$e or#$e mono-#3!ce ce$ "u/!n 6 $un!.

E-ectu$ "rotector o-er!t de contr#ce"t!%e$e or#$e # -o(t o+(er%#t #tt

"entru nu$!"#re ct ! "entru mu$t!"#re (! "#re (, nu %#r!e3e cu #num!/! "#r#metr! c#= %r(t,? %r(t# $# "r!m# ut!$!3#re? "#r!t#te# (#u !nde5u$ "onder#$.

De #(emene# (e "#re c, -o$o(!re# contr#ce"t!%e$or or#$e re#$!3e#3, une-ect "rotector -o#rte #ccentu#t $# -eme!$e c#re #u #$,"t#t o "er!o#d, $ung, det!m"? com"#r#t!% cu ce$e c#re #u #$,"t#t o "er!o#d, (curt, de t!m"? (#u nu #u#$,"t#t de$oc .


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D#te$e curente nu #u e%!den/!#t o tend!n/, cert, de cretere # r!(cu$u! dec#ncer o%#r!#n? du", cretere# dur#te! de -o$o(!re # ter#"!e! de (u+(t!tu/!e?(#u cretere# "er!o#de! de t!m" de $# u$t!m# -o$o(!re .

f). #igatura tubară şi histerectomia.

L!g#tur# tu+#r, ! !(terectorn!# (#u @n(o/!t de (c,dere# r!(cu$u! de c#ncero%#r!#n. Ace(te "rocedur! #r "ute# determ!n# (c,dere# cont#m!n,r!!

"er!toneu$u! ! o%#re$or !? "o(!+!$ #r "ute# determ!n# (c,dere# -rec%en/e!o%u$#/!!$or.

'!g .L!g#tur# tu+u$#r# # o%#re$or

Deo#rece cont#m!n#re# "er!tone#$, e(te "u/!n "ro+#+!$ (, -!e c#u3, de "roducere # c#nceru$u! o%#r!#n? mec#n!(mu$ ce$ m#! !m"ort#nt "#re (,r,mn, de(cretere# -rec%en/e! o%u$#/!!$or.

g). $alcul.

A(oc!ere# d!ntre t#$cu$ co(met!c ! c#nceru$ o%#r!#n # -o(t "re(u"u(,#%ndu(e @n %edere "#tru $ucrur! e%!dente? o re$#/!e ontogen!c, @ntre e"!te$!u$o%#r!#n ! me3ote$!u$ "er!tone#$? re$#/!# c!m!c, d!ntre de"o3!te$e m!ner#$ede t#$c ! #3+e(t? core$#/!# d!ntre #3+e(t ! me3ote$!o#me$e "$eur#$e !

"er!tone#$e ! "o(!+!$!t#te# t#$cu$u! de # ",trunde @n c#%!t#te# "er!tone#$,de# $ungu$ c,!$or gen!t#$e? "recum ! -#"tu$ c, #u -o(t e%!den/!#te "#rt!cu$e


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de t#$c @n /e(utu$ o%#r!#n norm#$ ! c#ncero( .Re3u$t#te$e (tud!!$or "u+$!c#te@n $!ter#tur# de ("ec!#$!t#te re-er!to#re $# ro$u$ et!o$og!c #$ "udre! de t#$c @net!o$og!# c#nceru$u! o%#r!#n (unt contr#d!ctor!!.

h). %actorii alimentari.

Stud!! eco$og!ce #u #r,t#t e5!(ten/# une! core$#/!! "o3!t!%e @ntre con(umu$ degr,(!m! #n!m#$e? "rote!ne ! num,ru$ tot#$ de c#$or!! ! !nc!den/# c#nceru$u!o%#r!#n .A$te (tud!! e"!dem!o$og!ce #u con(t#t#t cretere# uo#r, # r!(cu$u!#(oc!#t creter!! con(umu$u! de gr,(!m! :gr,(!m! #n!m#$e? unt? ou,)? $#"te!ntegr#$? c#rne ! "rote!ne ! o (c,dere # r!(cu$u! core$#t, cu un #"ort cre(cutde %eget#$e? cere#$e? morco%!? 3#r3#%#tur!? c#r+o!dr#/!? %!t#m!n# A :Bc#roten)? %!t#m!n# C ! #$!mente +og#te @n ce$u$o3,.

Cr#mer ! co$. :1&8&) #u $#n(#t !"ote3#con-orm c,re!# con(umu$ de $#cto3, $# "er(o#ne$e cu o concentr#/!e (c,3ut,de g#$#cto3, 1 -o(-#t ur!d!$tr#n(-er#3#? #r "ute# -#%or!3# #"#r!/!# c#nceru$u!o%#r!#n.'#"tu$ c, !"ogon#d!(mu$ !"ergon#dotro"!c # -o(t detect#t $# #n!m#$e$e c#re#u con(um#t #$!mente +og#te @n $#cto3, ! $# -eme!$e cu g#$#cto(em!e ! cu!nc#"#c!t#te# de # (!ntet!3# tr#n(-er#3# tr#n(m!(, ered!t#r? do%edete

e5!(ten/# #ce(tu! mec#n!(m +!o$og!c.A(t-e$ (# o+(er%#t "re3en/# unu! r!(c cre(cut "entru c#ncer o%#r!#n "r!ntre-eme!$e cu un con(um cre(cut de $#cto3, ! o #ct!%!t#te (c,3ut, #tr#n(-er#3e! ? com"#r#t!% cu -eme!$e cu #"ort (c,3ut de $#cto3, ! #ct!%!t#tecre(cut, # tr#n(-er#3e! .Nu (# "utut (t#+!$! o core$#/!e @ntre con(umu$ de#$coo$ ! c#-e# ! -rec%en/# c#nceru$u! o%#r!#n .


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i). Istoricul familial.

Sunt mu$te do%e3! c, #num!te do%e3! de c#ncer #u o et!o$og!egenet!c,? m#or!t#te# c#ncere$or o%#r!ene e"!te$!#$e #"#r @n mod ("or#d!c.Do#r 7 d!n c#ncere$e o%#r!ene @m+r#c, -orm# c#nceru$u! -#m!$!#$ .

Au -o(t e%!den/!#te tre! t!"ur! de -#m!$!! @n c#re #greg#re# -#m!$!#$, #c#nceru$u! o%#r!#n # -o(t e%!den/!#t, "r!n (tud!! gene#$og!ce ! #nume=-#m!$!! cu tr#n(m!(!e ("ec!-!c, # c#nceru$u! o%#r!#n? -#m!$!! cu neo"$#(m de(n ! de o%#r ! -#m!$!! cu neo"$#(m co$orect#$ non"o$!"o$d :(!ndromu$LHnc II).

Su(ce"t!+!$!t#te# tr#n(m!(!e! ered!t#re # c#nceru$u! o%#r!#n (e "#re c,(e -#ce du", un mode$ #uto(om#$ dom!n#nt.n c#3u$ -#m!$!!$or cu r!(c cre(cut #u -o(t o+(er%#te un num,r cre(cut dec#ncere? !#r %r(t# de de+ut # +o$!! # -o(t mu$t m#! t!m"ur!e dect @n c#3u$

"o"u$#/!e! gener#$e.

Ident!-!c#re# recent, # gene! BRCA 1 c#re e(te $eg#t, de "re3en/#c#nceru$u! de (n -#m!$!#$ # -o(t cercet#t, ! e%!den/!#t, ! @n c#3u$ c#ncere$or -#m!$!#$e de (n o%#r.Re3u$t#te$e ctor%# (tud!! c#3 contro$ (u(/!n e5!(ten/# #(oc!er!! !(tor!cu$u!-#m!$!#$ cu neo"$#(mu$ o%#r!#n.R!(cu$ de c#ncer o%#r!#n "r!ntre -eme!$e cu #ntecedente -#m!$!#$e de c#ncerde (n merge de $# 1?0 "n, $# 6?1 .

2.Factori de crestere ai celulelor epiteliale ovariene

9#! mu$te (tud!! #u #r#t#t c# -rec%ent# o%u$#t!e! e(te #(oc!#t# cucre(tere# r!(cu$u! "entru de3%o$t#re# c#nceru$u! o%#r!#n. O%u$#t!# e(te!n(ot!t# de $e3#re# (u"r#-ete! e"!te$!u$u! o%#r!#n. Ace(t e"!te$!u tre+u!e (#

"ro$!-ere3e "entru # %!ndec# $e3!une# #(oc!#t# o%u$#t!e! (!? "r!n urm#re?o%u$#t!# e(te !n(ot!t# de "roducere# unor -#ctor! de cre(tere :T;'# -#ctorde cre(tere tr#n(-orm#nt (! IL6 !nter$eu!n# 6) c#re !nten(!-!c# cre(tere#(!J(#u d!-erent!ere# ce$u$e$or e"!te$!#$e o%#r!ene. C#nd ce$u$e$e e"!te$!u$u! de

(u"r#-#t# (e d!%!d? e$e (e com"ort# c# (! ce$u$e$e K(tem? m#! de gr#+#gener#t!%e dec#t regener#t!%e.

*ro+#+!$? "ro$!-er#re# re"et!t!%# # ce$u$e$or e"!te$!u$u! o%#r!#n #(oc!#t#cu o%u$#t!# contr!+u!e $# de3%o$t#re# c#nceru$u! o%#r!#n "r!n cre(tere#r!(cu$u! unu! #cc!dent genet!c :ero#re !n re"$!c#re# ADN) c#re #r "ute#contr!+u! $# #ct!%#re# une! oncogene (#u $# !n#ct!%#re# une! gene (u"re(or.


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D!%!3!une# ce$u$#r# cre(te "ro+#+!$!t#te# mut#t!!$or :!n c#3u$ !n c#re (e d!%!deo ce$u$#? ce$e 2 ce$u$e -!!ce #u "otent!#$ eg#$ de cre(tere u$ter!o#r#F d#c# !nce$u$# K(u(# !nter%!ne o mut#t!e? ce$u$e$e -!!ce %or "urt# #ce#(t# mut#t!e? c##t#re %or #"#re# un num#r d!n ce !n ce m#! m#re de ce$u$e cu #ce#(t#mod!-!c#re). *e de #$t# "#rte !ntrun# d!n ce$u$e$e -!!ce c#re "o#rt# o mut#t!e$# un moment d#t "o#te (# m#! #"#r# o #$t# mod!-!c#re :mut#t!e) (!? "r!nurm#re? "ro+#+!$!t#te# de mut#t!! #d!t!on#$e !ntro ce$u$# cont!n#nd de# omut#t!e? %# -! cre(cut#. A(emene# mut#t!! %or #ct!%# "rotooncogene (#u!n#ct!%# gene$e (u"re(or tumor#$e.

C# #rgumente !n -#%o#re# #ce(te! !"ote3e #r -! c# &0 d!n c#ncere$eo%#r!ene #"#r c# re3u$t#t #$ tr#n(-orm#r!! m#$!gne # ce$u$e$or d!n c#re e(te#$c#tu!t e"!te$!u$ de (u"r#-#t# #$ o%#ru$u!? (! c# !ntreru"ere# o%u$#t!e! "r!n(#rc!n# (#u contr#ce"t!%e or#$e (e #(oc!#3# cu (c#dere# r!(cu$u! de c#ncero%#r!#n.

'#ctor!! de cre(tere !m"$!c#t! !n et!o$og!# c#nceru$u! o%#r!#n #r -!=-#ctoru$ de cre(tere Mtr#n(-orm#nt :T;'M)F -#ctoru$ de cre(tere e"!derm#$:E;')F -#ctoru$ de necro3# tumor#$# :TN')F !nter$eu!n#1 :IL1)F-#ctoru$ de (t!mu$#re # co$on!!$or de m#cro-#geJmonoc!te :9CS')F!nter$eu!n#6 :IL6)F -#ctoru$ de cre(tere -!+ro+$#(t!c# :';T)F (u+(t#nt#!n!+!tor!e mu$$er!#n# :9IS). Un!! d!ntre #ce(t! -#ctor! de cre(tere #u ro$(t!mu$#tor #(u"r# ce$u$e$or e"!te$!#$e o%#r!ene norm#$e :E;'? ';'?c!to!ne$eIL1? IL6)? #$t!! #u ro$ !n!+!tor #(u"r# cre(ter!! ce$u$e$ore"!te$!#$e o%#r!ene :T;'? T;'M) ro$ c#re e(te #nu$#t (#u de"#(!t? #$t!!

(unt "rodu(! c!#r de ce$u$e$e neo"$#3!ce #"#rute? #%#nd ro$ !n !nten(!-!c#re#cre(ter!! ce$u$e$or tumor#$e :9CS'? ;9CS'? IL1? TN'? IL6).Tr#n(duct!# (emn#$u$u! $# n!%e$ ce$u$#r "entru -#ctor!! de cre(tere e(tere#$!3#t# "r!n t!ro3!n"rote!n!n#3e (! (er!nJtreon!n"rote!n!n#3e.

%actori hormonali

O+(er%#t!!$e con-orm c#ror# c#nceru$ o%#r!#n e(te o +o#$# m#!-rec%ent# !n "er!o#d# ce urme#3# c$!m#5u$u! (! e(te #(oc!#t# cu nu$!"#r!t#te#

#u du( $# -ormu$#re# !"ote3e! !m"$!c#r!! ormon#$e !n et!o$og!# +o$!!.4ormon!! (tero!3!? ormon!! "e"t!d!c! (! -#ctor!! de cre(tere "e"t!d!c!#u "otent!#$u$ de # !n-$uent# cre(tere# norm#$# (#u neo"$#3!# ce$u$e$ore"!te$!u$u! de (u"r#-#t# o%#r!#n

a. Hormonii steroizi. E5!(t# c!nc! c$#(e m#ore de ormon! (tero!3!=#ndrogen!? e(trogen!? "roge(teron? g$ucocort!co!3!? m!ner#$ocort!co!3!. Ace(t!


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ormon! #ct!one#3# "r!n $eg#re# $or de rece"toru$ !ntr#ce$u$#r de !n#$t##-!n!t#te (! ("ec!-!c!t#te "entru e! de $# n!%e$u$ ce$u$e$or e"!te$!u$u! de(u"r#-#t# #$ o%#ru$u! norm#$? d#r (! "#to$og!c :c#ncer o%#r!#n).

Argumentu$ !m"ort#nt #$ ro$u$u! ormon!$or (tero!3! !n #"#r!t!#c#nceru$u! o%#r!#n e(te $eg#t de -#"tu$ c# tumor!$e o%#r!ene "re3!nt# tr#(#tur!!(to$og!ce (!m!$#re cu #$e e"!te$!u$u! trom"e! uter!ne :tumor!$e (ero#(e)? cu#$e endometru$u! :tumor!$e endometr!o!de) (! #$e endocer%!5u$u! :tumor!$emuc!no#(e). Deo#rece #ce(te te(utur! r#("und !n mod norm#$ $# e(trogen! #-o(t (tud!#t m#! mu$t ro$u$ #ce(tor# !n c#nceru$ o%#r!#n. *re3ent# rece"tor!$or e(trogen!c! !n e"!te$!u$ de (u"r#-#t# o%#r!#n # #r#t#t c#e(trogenu$ e(te m!togen "entru ce$u$e$e #ce(tu! e"!te$!u? !n t!m" ce#nt!e(trogen!! (unt !n!+!tor! #! cre(ter!!. 9#! mu$te (tud!! #u demon(tr#t

"re3ent# rece"tor!$or e(trogen!c! !ntrun "rocent r!d!c#t !n tumor!$e o%#r!ene:e(trogenu$ (t!mu$#nd cre(tere# ce$u$e$or neo"$#3!ce o%#r!ene).

*roge(teronu$? "entru c#re e5!(t# rece"tor!! $# n!%e$u$ ce$u$e$or e"!te$!u$u!o%#r!#n? #r #%e# e-ect ter#"eut!c +ene-!c #(u"r# c#nceru$u! :#dm!n!(tr#re# de9edro5!"roge(teron #cet#t). Androgen!! #u ro$ !n et!o$og!# (!J(#u "rogre(!# c#nceru$u! o%#r!#n :e5!(t#rece"tor! "entru #ndrogen! !n ce$u$e$e neo"$#3!ce o%#r!ene).

b. Hormonii eti!i"i. Ace(t! ormon! re"re3ent#t! de ormon!! "!tu!t#r!?ormonu$ $ute!n!3#nt :L4)? ormonu$ (t!mu$#t!% -o$!cu$#r :'S4)? ormonu$gon#dotro-!n!c cor!on!c :4C;) (unt cre(cut! un num#r de #n! du"# !n(t#$#re#

meno"#u3e!.Ce$u$e$e e"!te$!u$u! o%#r!#n de (u"r#-#t# norm#$ (unt (t!mu$#te !n cee#ce "r!%e(te cre(tere# !n %!tro de L4? 'S4? 4C;. D#c# #ce(te mo$ecu$e (untm!togene "entru e"!te$!u$ de (u"r#-#t# o%#r!#n tr#n(-orm#t neo"$#3!c? e$e "ot#%e# !m"#ct !nd!rect !n !n!t!ere# (#u "rogre(!# c#nceru$u! o%#r!#n.

#. &ncogenele

In c#nceru$ o%#r!#n # -o(t de(cr!(# e5"r!m#re# #+er#nt# # unoroncogene= 4ER2Jneu? r#(? mHc? -m(? un? mH+. Ace(te# (unt (!tu#te d!-er!t

!n ce$u$# o%#r!#n# (! #u ro$ +!o$og!c d!-er!t. A(t-e$ 4ER2Jneu (! -m( cod!-!c#mo$ecu$e$e rece"toru$u! tr#n(mem+r#n#r !m"$!c#te !n $eg#re# $!g#ntu$u!? r#((unt "rote!ne $# n!%e$u$ mem+r#ne! !nterne !m"$!c#te !n tr#n(duct!#(emn#$u$u!? !#r mHc? mH+? un (unt "rote!ne reg$#to#re #$e tr#n(cr!"t!e!nuc$e#re.

*r!n urm#re? oncogene$e (unt "rote!ne ce$u$#re d!%er(e? cu ro$ur!-!3!o$og!ce d!-er!te !n "roce(e$e de cre(tere (! d!-erent!ere ce$u$#r#. Ace(te


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#ct!%!t#t! (unt "ertur+#te "r!n mut#t!e (#u (u"r#e5"re(!e? re3u$t#nd -enot!"ur!tr#n(-orm#te .

;en# 4ER2Jneu # (u(c!t#t m#! mu$t# #tent!e. E"!te$!u$ o%#r!#nnorm#$ "re3!nt# o e5"r!m#re (c#3ut# (#u moder#t# de 4ER2Jneu. E# e(te(u"r#e5"r!m#t# !n c#nceru$ m#m#r :0)? (u"r#e5"re(!# -!!nd core$#t# cu un

"rogno(t!c (e%er. Acee#(! oncogen# "o#te -! ut!$!3#t# c# m#rer !n c#nceru$o%#r!#n. Su"r#e5"re(!# e! "o#te -! #%#nt#o#(# "entru ce$u$e$e tumor#$e "r!ncre(tere# re3!(tente! #ce(tor# $# c!toto5!c!t#te :$# #ct!une# TN' (#u #ce$u$e$or LAce$u$e !$$er #ct!%#te de $!n-o!ne).A$t# oncogen# (u"r#e5"r!m#t# !n c#nceru$ o%#r!#n e(te c-m( c#re cod!-!c#un rece"tor "entru -#ctoru$ de cre(tere :rece"tor "entru 9CS').

$. Antioncogenele

O #$t# $e3!une genet!c# !m"$!c#t# !n gene3# (! de3%o$t#re# c#nceru$u!o%#r!#n e(te "!erdere# -unct!e! norm#$e # gene! "7. Ace#(t# gen#? de "ecromo3omu$ 1"? e(te o gen# (u"re(or tumor#$#. *rodu(u$ gene! "7 e(te o-o(-o"rote!n# nuc$e#r# c#re (e e5"r!m# !n ce$u$e$e norm#$e uc#nd ro$ !nreg$#re# cre(ter!! (! d!%!3!un!! ce$u$#re. 9ut#t!#? (u"r#e5"r!m#re# (#u de$et!##ce(te!#? e(te #de(e# #(oc!#t# cu -enot!" m#$!gn :mut#t!# gene! e(teec!%#$#t# cu !n!+#re# #ct!%!t#t!! e!? cee# ce determ!n# #ct!%!t#te

"ro$!-er#t!%# #norm#$#).Un #$t (u"re(or gen!c tumor#$? $ocu(u$ ret!no+$#(tomu$u! :RB$ocu()?

"o#te uc# ro$ !n de3%o$t#re# c#nceru$u! o%#r!#n? con(t#t#ndu(e o -rec%ent#(emn!-!c#t!% cre(cut# # de$et!e! RB !n c#3u$ c#nceru$u! o%#r!#n.De #(emene#? (u"r#e5"re(!# gene! BRCA1 de "e cromo3omu$ 1P e(te!m"$!c#t# !n (!nte3# unor rece"tor! ("ec!-!c! "entru #num!t! -#ctor! de cre(terece$u$#r#. Determ!n#re# e! con(t!tu!e un m#rer "entru e%o$ut!# tumor#$# (!e(te "re3ent# !n "e(te 80 d!n c#3ur!$e de c#ncer de (#n (! o%#r.

'. Anomaliile cromoomiale

In c#nceru$ de o%#r ce! m#! #-ect#t! cromo3om! #u -o(t 1 (! 11 :e5"$!c##gre(!%!t#te# +!o$og!c# deo(e+!t# # #ce(tor c#ncere)? #"o! cromo3om!! (! .


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III. (lasificarea histopatologica a tumorilor ovariene

Tumor!$e o%#r!ene "ot #"#re d!n or!ce ce$u$# d!n com"onent#te(utur!$or o%#ru$u! (#u d!n ce$u$e$e "recur(o#re #$e #ce(tor#. De #!c! re3u$t#num#ru$ m#re de t!"ur! !(to$og!ce :68 t!"ur!) de tumor! o%#r!ene .

CLASIFICAREA OMS A TUMORILOR OVARIEE

. $*+&,I EPI$E#IA#E

A. T%mori seroase& Beni'ne si bor!er&(ine )(a (imita ma(i'nitati*: c!(t#denom (!c!(t#denomu$ "#"!$#rF "#"!$om de (u"r#-#t#F #deno-!+rom (!c!(t#deno-!+rom. Nu (e deo(e+e(c m#cro(co"!c de tumor!$e e"!te$!#$ecomune +en!gne core("ondente ! #nume= -orme$e (ero#(e ! muc!no#(e #"#r m#! -rec%ent c# "ro$!-er,r! c!(t!ce mu$t!$ocu$#re? cu m!c! %eget#/!!!ntr#c!(t!ce.

'!g 8.Tumor# o%#r!#n# e"!te$!#$# m#$!gn# cu numero#(e "ro!ect!! "#"!$!-ere!n (u"r#-#t# :m!cro(co"!c= c!(t#denoc#rc!nom "#"!$!-er (ero()


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Ma(i'ne: #denoc#rc!nom? #denoc#rc!nom "#"!$#r (! c!(t#denoc#rc!nom "#"!$#rF c#rc!nom "#"!$#r de (u"r#-#t#F #deno-!+rom m#$!gn (!c!(t#deno-!+rom m#$!gn. Sunt? de o+!ce!? %o$um!no#(e? cu (u"r#-e/e

+o(e$#te? #%nd $# (ec/!on#re #r!! c!(t!ce? #$ternnd cu 3one (o$!de? -oc#re denecro3, ! emor#g!e. Zone$e c!(t!ce cu con/!nut (ero( (#u (eroemor#g!c(unt c#r#cter!3#te "r!n "re3en/# unor -orm#/!un! "#"!$#re? -r!#+!$e?#r+ore(cente cu +#3# de !m"$#nt#re "e "erete$e !ntern #$ c!(tu$u!F uneor!de",e(c c#"(u$# c!(tu$u! "ro$!-ernd @n e5ter!or.

-. $umori mucinoase

Beni'ne si bor!er&(ine= c!(t#denomF #deno-!+rom (! c!(t#deno-!+rom.

Ma(i'ne= #denoc#rc!nomF #deno-!+rom m#$!gn.

'!g &.Tumor# o%#r!#n# c!(t!c# muc!no#(# cu 3one (o$!de (! emor#g!! :0

cm? 77 #n!)

Sunt de regu$, %o$um!no#(e ! mu$t!$ocu$#re? cu o con(!(ten/, %#r!#+!$, @n-unc/!e de (t#re# de ten(!une # "ere/!$or ! con/!nutu$u!F #u mu$t m#! r#r%eget#/!! !ntr#c!(t!ce. Su+(t#n/# d!n !nter!oru$ c!(tur!$or e(te g#$+entu$+ure


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(#u ro!e+run, ! #re un c#r#cter ge$#t!no(. 9u$t m#! r#r (unt (emn#$#te3one com"#cte. Su"r#-#/# tumor#$, #"#re +o(e$#t,.

(. $umori endometrioide

Beni'ne si bor!er&(ine= #denom (! c!(t#denomF #deno-!+rom (!c!(t#deno-!+rom.& Ma(i'ne= c#rc!nom? #denoc#rc!nom? #deno#c#ntom?#denoc!(t#deno-!+rom m#$!gn (! c!(t#deno-!+romF (#rcom endometro!d det!" (trom#$F tumor# m!5t# me3oderm!c# om!$og# (! etero$og# (! tumor#m!5t# mu$$er!#n#. Sunt @n gener#$ c!(t!ce cu #r!! (o$!de @nt!n(e. Con/!nutu$c!(t!c e(te de ce$e m#! mu$te or! oco$#t!u.

. $umori de celule clare /meonefroide)

'!g 10.Tumor# cu ce$u$e c$#re

Beni'ne :#deno-!+rom) (! bor!er&(ine :c#rc!nom cu "otent!#$ ($#+ dem#$!gn!3#re). Ma(i'ne= #denoc#rc!nom

http://www.epathology.ro/images/stories/6-2/picture11.jpg


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E. $umori -renner : +en!gneF $# $!m!t# m#$!gn!t#t!!F m#$!gne

%. $umori mi"te epiteliale

0. (arcinoame nediferentiate

!. $umori epiteliale neclasificabile

2. TUMORI ALE ME!EC"IMULUI SI COR#OAELOR SE$UALE

A. T%mori "% "e(%(e !e 'ran%(oasa si stroma(e: tecomF -!+rom.B. An!rob(astoame= tumor! cu ce$u$e Serto$! (! LeHd!g Tumor! +!ne d!-erent!#te= #ndro+$#(tom tu+u$#r (! #denom tu+u$#r *!cF#ndro+$#(tom tu+u$#r cu ce$u$e $!"!d!ce (! -o$!cu$om $!"!d!c LeceneF tumor#cu ce$u$e Serto$! (! LeHd!gF tumor# cu ce$u$e LeHd!gF tumor# cu ce$u$e #$e!$u$u!. Tumor! cu d!-erent!ere med!e.

Tumor! ($#+ d!-erent!#te.C. G+nan!rob(astom D. Ne"(asi,i"abi(e

%. TUMORI CU CELULE LI&OI#ICE

'. TUMORI CU CELULE (ERMIALE

A. D!(germ!nom B. Tumor# (!nu(#$# endoderm#$#C. C#rc!nom em+r!on#r

D. *o$!em+r!om#E. Cor!oc#rc!nom'. Ter#to#me= !m#turF m#tur :(o$!d (! c!(t +en!gn dermo!dJc!(t dermo!d cutr#n(-orm#re m#$!gn#)F monoderm!ce (! !n#$t ("ec!#$!3#te :gu(# o%#r!#n#(trum#? c#rc!no!d? gu(# o%#r!#n# (! c#rc!no!d? #$te$e).;. 'orme m!5te


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). (OA#O*LASTOM+ "urF #(oc!#t cu d!(germ!nom (#u #$te -orme detumo#re cu ce$u$e germ!n#$e

,. TUMORI ALE -ESUTURILOR MOI ES&ECIFICAT

-. TUMORI NECLASIICABILE/. TUMORI SECUNDARE )METASTATICE*D!n "unct de %edere !(togenet!c? #ce(te c#tegor!! de tumor! !(! #u or!g!ne#!n= e"!te$!u$ de !n%e$!( :e"!te$!u germ!n#t!%)F ce$u$e$e germ!n#$eF !nc$u3!!em+r!on#reF ce$u$e$e cordo#ne$or (e5u#$e (! (trom#$e.

IV. (lasificarea stadiala a cancerului de ovar

CLASIICAREA TNM0IGO0122-. Ce$ m#! ut!$!3#t e(te (!(temu$ TN9de (t#d!#$!3#re @n c#re Tde(cr!e e5ten(!# tumor!! "r!m#re? Nnum,ru$ !(ed!u$ g#ng$!on!$or reg!on#$! ce "ot -! !n%#d#/! m#$!gn? !#r 9(e re-er, $#$e3!un!$e (ecund#remet#(t#3e$e $# d!(t#n/, :@n #$te org#ne (#u /e(utur!) -#/,de (ed!u$ tumor!! "r!m#re.Q n -unc/!e de c#tegor!!$e T? N? 9 de(cr!(e m#! (u( (e "ot (t#d!#$!3#m#or!t#te# c#ncere$or @n urm,to#re$e (t#d!!= 0? I? II? III (#u IV.Q *entru #"rec!ere# c#tegor!!$or TN9 (e ut!$!3e#3, o (er!e de metoded!#gno(t!ce ("ec!-!ce -!ec,ru! t!" de c#ncer :+!o"(!! cu e5. !(to"#to$og!ce?!n%e(t!g#/!! !m#g!(t!ce ! de $#+or#tor).C#nceru$ o%#r!#n (e (t#d!#$!3e#3# "r!n$#"#rotom!e e5"$or#tor!e c#re "erm!te e%#$u#re# $# d!(t#nt# # +o$!! neo"$#3!cecu "unct de "$ec#re o%#r!#n.T Tumor# "r!m#r#FT5 Tumor# "r!m#r# nu # "utut -! (t#+!$!t#FTo Nu (e e%!dent!#3# tumor# "r!m#r#FT1JI Tumo#re $!m!t#t# $# o%#re=T1#JIA tumo#re $!m!t#t# $# un o%#r? c#"(u$# !nt#ct#F nu e5!(t# tumor# "e(u"r#-#t# o%#r!#n#FT1+JIB tumor# $!m!t#t# $# #m+e$e o%#re cu c#"(u$# !nt#ct#F nu e5!(t#

tumor# $# (u"r#-#t# o%#ru$u!FT1cJIC tumo#re $!m!t#t# $# unu$ (#u #m+e$e o%#re? cu un# d!n urm#to#re$ec#r#cter!(t!c!= c#"(u$# ru"t#? tumo#re "e (u"r#-#t# o%#ru$u!? ce$u$e m#$!gne !n#(c!t# (#u $!c!du$ de $#%# "er!tone#$.T2JII Tumor# !ntere(e#3# unu$ (#u #m+e$e o%#re cu e5ten(!e "e$%!#n#=


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T2#JIIA e5ten(!# (!J(#u !m"$#nt#re# $# n!%e$u$ uteru$u! (!J(#u trom"e!:trom"e$or)F nu e5!(t# ce$u$e m#$!gne !n #(c!t# (#u !n $!c!du$ de $#%#

"er!tone#$FT2+JIIB e5ten(!# $# #$te te(utur! "e$%!neF nu e5!(t# ce$u$e m#$!gne !n #(c!t#(#u $!c!du$ de $#%# "er!tone#$FT2cJIIC e5ten(!e "e$%!n# :2# (#u 2+) cu ce$u$e m#$!gne !n #(c!t# (#u$!c!du$ de $#%# "er!tone#$.TJIII Tumo#re de3%o$t#t# $# unu$ (#u #m+e$e o%#re cu met#(t#3e

"er!tone#$e? con-!rm#te m!cro(co"!c? !n #-#r# "e$%!(u$u! (#u met#(t#3e !ng#ng$!on!! $!m-#t!c! reg!on#$! :N1).T#JIIIA met#(t#3e "er!tone#$e m!cro(co"!ce !n #-#r# "e$%!(u$u!FT+JIIIB met#(t#3e "er!tone#$e m#cro(co"!ce !n #-#r# "e$%!(u$u!? cud!men(!une# m#5!m# de 2 cm.TCJIIIC met#(t#3e "er!tone#$e m#cro(co"!ce !n #-#r# "e$%!(u$u! cu

d!men(!une m#! m#re de 2 cm (!J(#u met#(t#3e !n g#ng$!on!! $!m-#t!c!reg!on#$! :N1).91JIV 9et#(t#3e $# d!(t#nt# :e5c$u(e met#(t#3e$e "er!tone#$e)


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V. Aspecte clinice in cancerul de ovar

D!#gno(t!cu$ "recoce #$ tumor!$or de o%#r (e con-runt, cu tre! d!-!cu$t,/!m#ore=

$!"(# unor metode (t#nd#rd!3#te (!m"$e? ne!n%#3!%e ! e-!c#ce de de"!(t#re @nm#(, $# "o"u$#/!# -em!n!n, de r!(cFe(te (!tu#t, @ntro 3on, #(cun(,? !n#cce(!+!$, e5#mene$or c$!n!ce d!recte !

Are un de+ut ! c!#r o e%o$u/!e ("re -orme$e #%#n(#te #(!m"tom#t!ce?cu (!m"tom#to$og!e te#r(, (#u con-u3,.

*entru !dent!-!c#re# une! tumor! o%#r!ene !nc!"!ente @n mod !de#$ #rtre+u! (, e5!(te metode (!m"$e c#re (, dem#te m#rer!! "roce(u$u! m#$!gn @n-#3e$e !nc!"!ente? "rec$!n!ce #$e #ce(tu!#.

'!g 11.C#ncer o%#r!#n

Ident!-!c#re# unu! #nt!gen ("ec!-!c tumor#$? e%entu#$ num#! "entruneo"$#3!!$e gen!t#$e (#u cu #$t, $oc#$!3#re :e5. o%#ru$) c#re #r "ute# e%entu#$#%e# ! %#$o#re "red!ct!%, #(u"r# t!"u$u! !(to$og!c ! #gre(!%!t,/!! tumor#$e #r

"erm!te tr#t#mente e-!c#ce cu %!ndec,r! !ntegr#$e? c!#r cu men/!nere# @n(t#re -unc/!on#$, # o%#ru$u! contr#$#ter#$ ne#-ect#t .9ergnd m#! de"#rte? te(te #$e c#"#c!t,/!! de #",r#re !muno$og!c, ce$u$#r, !umor#$, ? #"$!c#te $# "er(o#ne de r!(c :"r!n -#ctor! genet!c!? e5"unere $#


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c#rc!nogen!? cu +o$! !muno$og!ce? tr#t#mente !muno(u"re(!%e ? %r(t#@n#!nt#t, etc. ) #r "erm!te un tr#t#ment "re%ent!% #$ +o$!! c#ncero#(e "r!n(t!mu$#re# !munocom"eten/e!. Ace(te de3!der#te (unt deoc#md#t, @n (t#d!u$de "er("ect!%e de %!!tor cu to#te c, mu$te $#+or#to#re ("ec!#$!3#te d!n $umede(-,o#r, o #ct!%!t#te !nten(, @n #ce(t (co". Ac!3!/!!$e de $#+or#tor tre+u!e%er!-!c#te ? @n -ocu$ "r#ct!c!! c$!n!ce? #d!c, # nece(!t#/!! !m"er!o#(e de #de"!(t# "recoce un c#rc!nom (#u m,c#r de # tr#t# e-!c#ce o +o$n#%, cuc#ncer c$!n!c de# con(t!tu!t.

T#+$ou$ c$!n!c !n c#nceru$ de o%#r e(te tot#$ ne("ec!-!c (! de o+!ce!de(co"er!t !nt#m"$#tor !n urm# !nter%ent!e! "entru #+$#t!# une! tumor!o%#r!ene #"#rent +en!gne? c# o K(ur"r!3# !ntr#o"er#tor!e.T#+$ou c$!n!c !n c#nceru$ "recoce de o%#r e(te need!-!c#tor. In (t#d!!$e#%#n(#te #ce(t# "o#te #tr#ge #tent!# "r!n #num!te (!m"to#me (! (emne. Se

con(!der# totu(! c# (! !n #ce(te (t#d!! (!m"to#me$e (! (emne$e m#ore "ot $!"(!:7 d!n c#3ur!).

Ce$e (!m"tome c#re #u -o(t g,(!te #(oc!#te cu c#nceru$ de o%#r (unt=D!(ten(!# #+dom!n#$,Ur!n,r! -rec%enteDurer! #+dom!n#$eSnger,r! du", meno"#u3,*!erdere# #"et!tu$u!Snger,r! rect#$e

B#$on#r!! #+dom!n#$en -#3# !n!/!#$,? t#+$ou$ c$!n!c "o#te -! dom!n#t de o (!m"tom#to$og!e

d!ge(t!%, nec#r#cter!(t!c, con(tnd d!n gre/ur!? meteor!(m? d!(con-ort#+dom!n#$? #de(e# !gnor#te de "#c!ente.

De3%o$t#re# tumor!! "o#te determ!n# -enomene com"re(!%e "eorg#ne$e @n%ec!n#te? c$!n!c e5"r!mndu(e "r!n con(t!"#/!e? m!c/!un!-rec%ente? com"re(!une "e$%!n,.

E%o$u/!# tumor!! "o#te determ!n# #"#r!/!# une! com"$!c#/!! cum #r -!=tor(!une#? emor#g!# (#u ru"tur#? c#re (e @n(o/e(c de #"#r!/!# une! durer!

#+dom!n#$e #cute ! !n(t#$#re# #+domenu$u! #cut c!rurg!c#$.A"#r!/!# #(c!te! !J(#u # met#(t#3e$or tumor#$e determ!n, cretere# de %o$um# #+domenu$u!? -enomen c#re #"#re do#r @n (t#d!! #%#n(#te #$e +o$!!.Uneor! "r!mu$ (emn #! +o$!! e(te re"re3ent#t de e%!den/!ere# une! tumor!#(!m"tom#t!ce I# tueu$ %#g!n#$? tueuI rect#$ (#u I# "#$"#re# #+domenu$u!.

Neregu$#r!t,/!$e men(tru#$e (e "ot #(oc!# uneor! cu "re3en/# c#nceru$u!o%#r!#n.


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'!g 12.Tumor# o%#r!#n#

Nu e5!(t, (emne c$!n!ce "#tognomon!ce "entru # deo(e+! o tumo#reo%#r!#n, +en!gn, de un# m#$!gn,. Totu!? tumor!$e o%#r!ene +en!gne (unt deo+!ce! c!(t!ce? netede? un!$#ter#$e? mo+!$e? @n t!m" ce tumor!$e m#$!gne (unt(o$!de (#u cu con(!(ten/, m!5t,? neregu$#te? !mo+!$e.

E5#m!n#re# #+domenu$u! (u"er!or I# "#c!ente$e cu +o#$# #%#n(#t,e%!den/!#3, e"#tomeg#$!# :met#(t#3e "#renc!m#to#(e)? (#u o m#(,tumor#$, #+dom!n#$, centr#$, :!n-!$tr#re# m#(!%, # e"!"$oonu$u!)? (#u c!#rnodu$! ??(!(ter o(e" I# n!%e$u$ om+!$!cu$u! :met#(t#3e om+!$!c#$e).

E5#m!n#re# #tent, # tor#ce$u! "o#te e%!den/!# un re%,r(#t "$eur#$ @nc#3u$ "re3en/e! met#(t#3e$or I# #ce(t n!%e$.V# -! e5#m!n#t cu #ten/!e (!(temu$ g#ng$!on#r "er!-er!e.De #(emene#? (c,dere# @n greut#te (e #(oc!#3, cu #nore5!# cron!c,? cretere#@n %o$um # #+domenu$u! !? uneor!? cu -enomene (u+oc$u3!%e (#u oc$u3!%e!nte(t!n#$e.


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VI. E"plorari paraclinice

In d!#gno(t!cu$ c#nceru$u! de o%#r un #"ort deo(e+!t !$ #re !m#g!(t!c#(! #nume=1. Ecografia conventionala transabdominala "erm!te un d!#gno(t!c

"recoce.3. Ecografia endovaginala "erm!te un d!#gno(t!c m#! "recoce (! m#!

"rec!(.#. Ecografia tridimensionala :ecoD)? metod# ce# m#! "er-orm#nt#?m#(o#r# !n ("ec!#$ %o$umu$ tumor!!? $oc#$!3e#3# to"ogr#-!c tumor# !n r#"ortcu ce$e$#$te (tructur! d!n %ec!n#t#te.

'!g 1.Ecogr#-!e endo%#g!n#$#

$. opplerul color si Po1er doppler "erm!t (! e$e un d!#gno(t!c c#t m#! "recoce (! m#! "rec!( !n #(oc!ere cu ecogr#-!# tr#d!t!on#$#.4. Punctia eco2ghidata "r#ct!c#t# (u+ g!d#tu$ eco(onde! tr#d!t!on#$etr#n(#+dom!n#$e (#u #$ ce$e! endo%#g!n#$e.

In "r!%!nt# tumor!$or de o%#r ecogr#-!# # de%en!t #(t#3! e5"$or#re#com"$ement#r# o+$!g#tor!e d#tor!t# !nocu!t#t!!? #cce(!+!$!t#t!! tot m#! $#rg!?#me$!or#r!! ten!ce recente :ecoD? Do""$er co$or? *oer do""$er).Cr!ter!!$e c#re con(t!tu!e (u("!c!une# de m#$!gn!t#te (unt= -orm#t!un! m#!m#r! de 70 mmF eco(tructur# (o$!d# (#u m!5t# cu "redom!n#nt# (o$!d#F "ereteneregu$#t (! gro(F (e"tur! gro#(eF #(c!t#F met#(t#3eF %#r(t# 0 #n! :J7 d!n


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c#ncere$e de o%#r (unt g#(!te $# -eme! "e(te 0 #n!)F !n "er!meno"#u3# cre(tere# de %o$um # unu! o%#r $# (u"r#%egere ecogr#-!c# (!(tem#t!c#.5. Punctia ouglasului "o3!t!%# !n c#ncere de o%#r #%#n(#te.-. 3cannerul si ,+4 :re3on#nt# m#gnet!c# nuc$e#r#) o-er# d#te c#t m#!e5#cte #(u"r# e5ten(!%!t#t!! c#nceru$u! de o%#r. Sc#nneru$ %!3u#$!3e#3# m#!

+!ne c#$c!-!c#r!$e? den(!t#t!$e gro#(e (! %#(cu$#r!3#t!# "r!n !nect#re# une!(u+(t#nte !od#te de contr#(t +!ne to$er#t#. :IO*A9IRON). R9N nu%!3u#$!3e#3# c#$c!-!c#r!$e? d#r "erm!te o "er-ect# de$!m!t#re #n#tom!c#?e%entu#$ !nt#r!t# "r!n "rodu(e de contr#(t R9N./. #imfangiografia "o#te -! -o$o(!t# "entru e%#$u#re# +o$n#%e$or cu c#ncero%#r!#n? e%!dent!!nd "r!ndere# g#ng$!on!$or $!m-#t!c! :"e$%!n!? "#r##ort!c!?#ort!c!).

'!g 1.L!m-#ng!ogr#-!#

2. ,adiografia abdominala "e go$? !r!gogr#-!#? urogr#-!#? r#d!ogr#-!# "u$mon#r# "ot d# !n-orm#t!! #(u"r# re$#t!!$or de %ec!n#t#te #$e tumor!!o%#r!ene? gr#du$ e! de e5ten(!e $ocoreg!on#$# (#u e%!dent!ere# met#(t#3e$or.16. Pelviscopia metod# endo(co"!c# ce #re %#$o#re !n tumor!$e de o%#r:m#! #$e( $# -eme!$e t!nere). E# e(te #%#nt#o#(# "entru de"!(t#re# "recoce #c#nceru$u! de o%#r? -!!nd contr#!nd!c#t# !n (t#d!!$e #%#n(#te. Are %#$o#redeo(e+!t# !n c#3u$ tumor!$or +en!gne? !n tumor!$e +order$!ne? $# -eme!$et!nere (#u $# gru"e$e de -eme! cu m#re r!(c.11. !isteroscopia & "o#te #duce !n-orm#t!! #(u"r# c#%!t#t!! uter!ne? m#! #$e(!n conte5tu$ (#nger#r!$or #norm#$e d!n "er!o#d# #du$t# (#u !n

"o(tmeno"#u3#. B!o"(!# "er!(tero(co"!c# (! e5#menu$ !(to"#to$og!c #$-r#gmente$or "re$e%#te tr#n(e#3# d!#gno(t!cu$.


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13. (hiureta5ul uterin #re #ce$e#(! !nd!c#t!! c# (! !(tero(co"!#? d#r e(te om#ne%r# o#r+#. In #+(ent# !(tero(co"!e! e(te ut!$ !n (co" d!#gno(t!c (!emo(t#t!c.1#. $omografia computeriata. *o#te e%!dent!# nodu$! tumor#$! e"#t!c! (!

"u$mon#r!? m#(e tumor#$e #+dom!n#$e (! "e$%!ne? !n%#3!# g#ng$!on!$orretro"er!tone#$!? $e3!un! (ecund#re cere+r#$e. In(# metod# #re $!m!te$e e!?ne"ut#nd detect# m#(e tumor#$e (u+ 2 cm d!#metru.1$. #aparoscopia. Nu con(t!tu!e un "rocedeu !ncur##tor !n d!#gno(t!cu$c#nceru$u! o%#r!#n. De(! e# "o#te d!-erent!# oc#3!on#$ +!om!o#me uter!ne (#uendometr!o3e de un c#ncer o%#r!#n? #ce(te c#3ur! (unt r#re.

B!o"(!# $#"#ro(co"!c# (#u "unct!# #("!r#t!%# # une! m#(e o%#r!ene!nt#cte "o#te r#("#nd! ce$u$e m#$!gne !n c#%!t#te# "er!tone#$#? !#r #("!r#t!#-$u!du$u! c!(t!c "entru e5#menu$ c!to$og!c nu con(t!tu!e o metod# ded!#gno(t!c !n c#nceru$ o%#r!#n.

*er!toneo(co"!# e(te ut!$!3#t# $# "#c!ente$e (econd$oo !n c#nceru$ o%#r!#n$# "#c!ente$e $# c#re (# o+t!nut rem!(!une c$!n!c# cu #utoru$ c!m!oter#"!e!.Se "o#te #-!rm# #(t-e$ c# $#"#ro(co"!# "o3!t!%# :cu +!o"(!e "o3!t!%#) e(teconc$udent# !n t!m" ce $#"#ro(co"!# neg#t!%# tre+u!e (# -!e urm#t# de o$#"#r#tom!e e5"$or#tor!e.

14. +ar6eri tumoraliQ Sunt (u+(t#n/e ce "ot -! determ!n#te @n (nge? ur!n, :m#rer! umor#$!)(#u /e(utur! :m#rer! t!(u$#r!) ! (unt m#! mu$t (#u m#! "u/!n ("ec!-!ce unu!

#num!t t!" de c#ncer.Q Ut!$!3#re# $or @n med!c!n, (er%ete m#! mu$tor (co"ur!= D!#gno(t!c#re# unor tumor! @n core$#/!e cu #$te !n%e(t!g#/!! ! (t#d!#$!3#re#unor tumor! :e5. A'*? +et#4C;? LD4 @n tumor!$e te(t!cu$#re) e%entu#$!t#te m#! r#r,. 9on!tor!3#re# "#c!en/!$or ce# m#! -rec%ent, ut!$!3#re.n #ce(t (en(? determ!n#re# m#rer!$or tumor#$! #ut, $# "red!c/!# r,("un(u$u!ter#"eut!c? #"rec!ere# e-!c!en/e! une! ter#"!! :(c,dere# %#$or!$or @nreg!(tr#te@n#!nte de tr#t#ment @n(e#mn, r,("un( ter#"eut!c -#%or#+!$)? de"!(t#re#

"recoce # rec!d!%e$or $oc#$e (#u # met#(t#3e$or.

9#rer!! (unt ut!$!3#/! ! @n cercet#re# med!c#$, "entru ro$u$ "o(!+!$ @ndetect#re# "recoce # c#ncere$or ! !dent!-!c#re# unor no! "o(!+!$e /!nte detr#t# ment. n genet!c,? m#rer!! "ot #ut# $# determ!n#re# r!(cu$u! genet!c r!(cu$ une! "er(o#ne de # de3%o$t# un c#ncer.


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Q 9#rer!! tumor#$! (unt (u+(t#n/e "rodu(e de ce$u$e$e tumor#$e m#$!gned#r ! de #$te ce$u$e #$e org#n!(mu$u! c# r,("un( $# #gre(!une# re"re3ent#t,de c#ncer? ! uneor! ! de #$te #-ec/!un! nonm#$!gne? cee# ce "o#te cree#con-u3!e @n !nter"ret#re# re3u$t#te$or.Q n "re3ent nu e5!(t, m#rer! ("ec!-!c! "entru to#te t!"ur!$e de c#ncer.E5!(t, m#rer! cu m#re ("ec!-!c!t#te "entru un #num!t t!" de tumor,? "recum! m#rer! ce "ot #%e# %#$or! cre(cute @n m#! mu$te t!"ur! de #-ec/!un!.Un m#rer tumor#$ !de#$ #r tre+u! (, @nde"$!ne#(c, m#! mu$te cond!/!!= (, -!e ("ec!-!c? #d!c, (, -!e nedect#+!$ $# "er(o#ne (,n,to#(e? (#u cu#-ec/!un! +en!gne)F (, #!+, o ("ec!-!c!t#te de org#nF (, #!+, o (en(!+!$!t#te cre(cut, :detect#+!$ @n "re3en/# unu! m!c num,rde ce$u$e tumor#$e)F (, #!+, %#$o#re "red!ct!%,.De! nu e5!(t, @nc, m#rer! !de#$!? mu$/! d!ntre e! (e #"ro"!e de #ce(tecer!n/e ! (unt -o#rte ut!$! @n "r#ct!c# med!c#$, curent,.

a. +ar6eri antigenici. Ace(t!# (unt #nt!gene #-$#te -!e "e (u"r#-#t#mem+r#ne! ce$u$#re? -!e !n !nter!oru$ ce$u$e! tumor#$e? -!e !n -$u!de$e

org#n!(mu$u! . 9#rer!! tumor#$! #nt!gen!c! ut!$!3#t! !n c#nceru$ de o%#r (unt=& CA 134 e(te un #nt!gen de (u"r#-#t# der!%#t d!n tumor!$e e"!te$!#$ec#ncero#(e (ero#(e (! e(te #+(ent !n ce$e muc!no#(e. E$ e(te !nt#$n!t $# %#$or!cre(cute $# "e(te 80 d!n "$#(m# "#c!ente$or cu c#ncere de o%#r nonmuc!no#(e? "ut#nd -! -o$o(!t !n e5"$or#re# c#nceru$u! o%#r!#n. *entrucre(tere# contr!+ut!e! #ce(tu!# $# #cur#tete# d!#gno(t!cu$u! (! mon!tor!3#re#ter#"eut!c# (e recom#nd# #(oc!ere# (# cu u$tr#(onogr#-!# tr#n(#+dom!n#$# (!


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tr#n(%#g!n#$# . A -o(t e%!dent!#t "entru "r!m# d#t# !n 1&8 de c#tre B#(t (!co$#+. $# 82 d!ntre "#c!ente$e cu c#ncer o%#r!#n. CA 127 e(te !dent!-!c#t

"r!n re#ct!%!t#te# (# cu #nt!cor"!! monoc$on#$! OC 127 ce recuno(cdeterm!n#nt! #nt!gen!c! re"et!t!%! d!n CA 127.

'!g 17.Tru(# "entru determ!n#re# CA 127

CA 127 e(te "re3ent !n cur(u$ de3%o$t#r!! em+r!on#re $# n!%e$u$e"!te$!u$u! ce$om!c? !#r $# #du$t !n $!n!!$e ce$u$#re d!n c#rc!nomu$ o%#r!#n(ero( (#u !n te(utur!$e #denoc#rc!nom#to#(e (ero#(e? d#r nu (! !n (tructur!$eo%#r!ene norm#$e.

V#$or!$e norm#$e "entru CA 127 (unt (u+ 7 UJm$. Cre(ter! -!3!o$og!ce(ur%!n !n cur(u$ men(tru#t!e! (! $# -eme! !n(#rc!n#te.V#$o#re# m#reru$u! CA 127 e(te cre(cut# !n (t#d!! #%#n(#te de e%o$ut!e #

+o$!! :(t#d!! II? III? IV). E$ e(te m#! "ut!n ut!$ "entru d!#gno(t!c? d#r e(te dem#re #utor !n urm#r!re# e%o$ut!e! +o$!!. V#$or!$e m#r! #$e #nt!genu$u! CA 127(e #(oc!#3# cu !n%#3!# "er!tone#$# :#(c!t# neo"$#3!c#)? cu #denoc#rc!nomu$

"#"!$#r (ero( (! cu rec!d!%e$e $oc#$e.R#("un(u$ +un $# c!m!oter#"!e (e #(oc!#3# cu %#$or! norm#$e #$e $u! CA127? cee# ce !n(e#mn# (t#+!$!3#re# +o$!!. L!"(# unu! r#("un( e-!c!ent $#

c!m!oter#"!e (e #(oc!#3# cu %#$or! cre(cute #$e #nt!genu$u! CA 127? cee# ce!m"une (c!m+#re# tr#t#mentu$u!.*entru cre(tere# %#$or!! m#reru$u! tumor#$ CA 127 m#! #$e( !n

de"!(t#re# "recoce # c#nceru$u! o%#r!#n (e !m"une #(oc!ere# determ!n#r!!(#$e cu e5#menu$ g!neco$og!c (! (onogr#-!# "e$%!n# du"# un #nume #$gor!tm=du"# 7 #n! $# #n!F du"# 0 #n! $# 2 #n! (#u du"# #$t! #utor! $# 2 #n!? du"#%#r(t# de 27 de #n!.


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*entru !m+un#t#t!re# e%#$u#r!! r!(cu$u! de c#ncer o%#r!#n #u #"#rut dou# no!te(te d!#gno(t!ce.

In (e"tem+r!e 200&? 'ood #nd Drug Adm!n!(tr#t!on :'DA) # #%!3#tte(tu$ OVA1W "r!mu$ te(t (#ng%!n c#re? !n#!nte de !nter%ent!# c!rurg!c#$#e5"$or#tor!e (#u +!o"(!e? "o#te #ut# med!cu$ (# (t#+!$e#(c# d#c# o -eme!e cuo -orm#t!une tumor#$# #ne5!#$# #re r!(c de m#$!gn!t#te (#u nu? cu o(en(!+!$!t#te r!d!c#t#? c!#r d#c# e5"$or#r!$e r#d!o$og!ce nu !nd!c#m#$!gn!t#te#.

Te(tu$ e(te de3%o$t#t de -!rm# Verm!$$!on Inc. o com"#n!e ded!#gno(t!c mo$ecu$#r? !n coo"er#re cu -!rm# Xue(t D!#gno(t!c( $!deru$mond!#$ !n d!#gno(t!cu$ c#nceru$u!. Oue(t D!#gno(t!c( !n%e(t!tor "e termen$ung !n cercet#re# (! de3%o$t#re# teno$og!e! "entru OVA1W det!ne dre"tu$e5c$u(!% de "unere "e "!#t# "entru $#+or#to#re$e c$!n!ce de re-er!nt# d!n SUA

"entru urm#tor!! #n!.

'!g 16.C#ncer o%#r!#n

OVA1W e(te un te(t c#$!t#t!%? de d!#gno(t!c !n %!tro? ce o-er# un !nde5o+t!nut "r!n com+!n#re# re3u$t#te$or # 7 te(te !muno$og!ce -o$o(!nd un

#$gor!tm "#tent#t? (coru$ numer!c o+t!nut :!ntre 0 10) !nd!c#nd r!(cu$ dem#$!gn!t#te. Ace(t te(t e(te !nd!c#t -eme!$or cu %#r(t# "e(te 18 #n!? c#re "re3!nt# o -orm#t!une tumor#$# #ne5!#$# "entru c#re (#u "rogr#m#t "entru!nter%ent!e c!rurg!c#$# (! c#re !nc# nu (#u #dre(#t med!cu$u! onco$og.

Te(tu$ ut!$!3e#3# urm#tor!! m#rer! +!o$og!c! =tr#n(tHret!n :TT (#u "re#$+um!n#)#"o$!"o"rote!n# A1


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+et#2 m!crog$o+u$!n#tr#n(-er!n#CA 127 :C#ncer Ant!gen 127)Te(tu$ nu tre+u!e -o$o(!t -#r# e%#$u#re c$!n!c# (! r#d!o$og!c# (! nu tre+u!e!nd!c#t c# un te(t de (creen!ng.

L# !nce"utu$ $un!! -e+ru#r!e 2010? com"#n!# A++ott $!der mond!#$ !nd!#gno(t!cu$ !n %!tro # (u"u( #"ro+#r!! 'DA un nou te(t d!#gno(t!c ut!$ !nmon!tor!3#re# "#c!ente$or cu c#ncer o%#r!#n e"!te$!#$ Arc!tect 4E:4um#n E"!d!dHm#$ *rote!n ). D#c# %# "r!m! #"ro+#re#? #ce(t !m"ort#ntte(t !muno$og!c %# -! "r!mu$ te(t #utom#t de #ce(t t!".&HE$ e(te un m#rer +!o$og!c "entru detect#re# c#nceru$u! o%#r!#n? cu o-o#rte (c#3ut# e5"re(!e !n te(utu$ o%#r!#n norm#$. Core("un3#tor e5"re(!e! $#n!%e$ ce$u$#r? n!%e$e cre(cute de 4E #u -o(t detect#te !n (eru$ "#c!ente$or cu

c#ncer o%#r!#n. 4E #re o (en(!+!$!t#te de 0 80 $# o ("ec!-!c!t#te de &7 &6 !n d!#gno(t!cu$ c#nceru$u! o%#r!#n.Determ!n#r!$e re"et#te #$e 4E (! e(t!m#re# cre(ter!! "rocentu#$e (unt ut!$e !nmon!tor!3#re# e%o$ut!e! +o$!! (! #"#r!t!# recurente$or $# "#c!ente$e cu c#ncero%#r!#n e"!te$!#$. Ace(t te(t nu tre+u!e -o$o(!t c# un te(t de (creen!ng (! nu (erecom#nd# !n mon!tor!3#re# "#c!ente$or cu #$te t!"ur! de tumor! o%#r!ene:muc!no#(e? cu ce$u$e germ!n#$e) !n c#re nu #"#r cre(ter! #$e 4E.Stud!!$e demon(tre#3# c# 4E e(te m#! (en(!+!$ dec#t CA 127? com+!n#t!#HE$ 7 CA134 e(te m#! (en(!+!$# dec#t -!ec#re m#rer (!ngur? !#r "entru

(t#d!u$ I? 4E (!ngur e(te ce$ m#! (en(!+!$ m#rer.An#$!3oru$ Arc!tect :A++ott) #re "o(!+!$!t#e# de # e-ectu# #m+e$edeterm!n#r! (! de # e(t!m# r!(cu$ de c#ncer o%#r!#n $# -eme!? !n -unct!e de(t#tu(u$ "re (#u "o(t meno"#u3#? "r!ntrun #$gor!tm denum!t RO9A Y R!( o- O%#r!#n 9#$!gn#ncH A$gor!tm? (t#+!$!t !n c#dru$ unu! (tud!u c$!n!cmu$t!centr!c? "ro("ect!%? du+$u or+? cu o+t!nere# unu! !nde5 "red!ct!% =

"remeno"#u3# RO9A . r!(c (c#3utF Y. r!(c cre(cutF "o(tmeno"#u3# RO9A 27. r!(c (c#3utF Y27. r!(c cre(cut. CA 14 un #nt!gen muc!n$!e? e(te m#rer tumor#$ "entru c#nceru$ de

(#n? d#r "o#te -! cre(cut (! !n ce$ de o%#r.& CA 12&2 e(te un m#rer tumor#$ "r!nce"( !n c#nceru$ de "#ncre#(? d#r

"o#te #%e# %#$or! cre(cute (! !n c#nceru$ de o%#r.& CEA )anti'en%( "ar"inoembrionar* "o#te #%e# %#$or! cre(cute !n c#nceru$de o%#r :m#! ("ec!-!c -!!nd "entru c#nceru$ de co$on (! c#nceru$ g#(tr!c). AP )a(,a ,eto&roteina* "o#te "re3ent# %#$or! cre(cute !nter#toc#rc!no#me$e o%#r!ene.


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TPA )anti'en%( o(ieti!i" tis%(ar* e(te o "o$!"e"t!d# cu "ro"r!et#t!#nt!gen!ce ("ec!-!ce "rodu( !n "$#cent# um#n#? !n tumor!$e m#$!gne um#ne (!!n -$u!de$e "#c!ent!$or cu c#ncer. E(te -o$o(!t c# m#rer m#! #$e( "entrumon!tor!3#re# e%o$ut!e! "#c!ent!$or cu c#ncer m#m#r (#u o%#r!#n !n cur(u$ter#"!e!.

S"ec!-!c!t#te# T*A "entru d!#gno(t!c e(te med!eJ($#+#. *o#te -! -o$o(!t(! c# m#rer un!c !n c#3ur!$e !n c#re nu (unt d!("on!+!$! #$t! m#rer! ("ec!-!c!?!n(# !n com+!n#t!e cu #$t! m#rer! tumor#$! ("ec!-!c!t#te# te(t#r!! cre(te(emn!-!c#t!%. S"re deo(e+!re de ce!$#$t! m#rer! # c#ror concentr#t!e (ecore$e#3# cu m#(# tumor#$#? T*A !nd!c# #ct!%!t#te# #ctu#$# # tumor!!? de#cee# e(te num!t (! K#nt!gen de "ro$!-er#re. T*A e(te (!ntet!3#t !n -#3# S #c!c$u$u! ce$u$#r !#r concentr#t!# T*A (e core$e#3# cu "ro$!-er#re# t!(u$#r#.V#$or!$e cre(cute (e #(oc!#3# cu "roce(e$e "ro$!-er#t!%e c#re "ot -! de n#tur#

+en!gn# (#u m#$!gn#. A(t-e$? T*A !nd!c# m#! r#"!d (! m#! "rec!( (c!m+#r!$e

(ur%en!te !n "roce(u$ m#$!gn? -!!nd ut!$ #t#t !n mon!tor!3#re# ter#"!e! c#t (! !nde"!(t#re# recurente$or. *o#te -! !dent!-!c#t !n ur!n#? (#$!%#? $!c!d de $#%#

+rono#$%eo$#r (#u de #(c!t#? #ce(te determ!n#r! -!!nd de mu$te or! m#!%#$oro#(e dec#t ce$e d!n (er.T*A cre(te -rec%ent !n !n-$#m#t!!? !n-ect!! re("!r#tor!!? d!#+et? e"#t!t#? c!ro3#e"#t!c#? "#ncre#t!t#? !n(u-!c!ent# ren#$#.Inter-erente #n#$!t!ce (e "ot "roduce (! $# "#c!ent!! tr#t#t! cu r#d!o!3oto"!!n#!nte de reco$t#re# (#nge$u!

b. +ar6eri enimatici7& os,ataza a("a(ina )izoenzima Re'an*. I3oen3!me$e -o(-#3#te! #$c#$!ne#"#r !n (er der!%#nd d!n -!c#t? o(? "$#m#n? tr#ct !nte(t!n#$ (! "$#cent#.I3oen3!m# "$#cent#r# # -o(-#t#3e! #$c#$!ne #"#re !n (er $# %#$or! cre(cute !nc#3u$ m#! mu$tor t!"ur! de c#ncer? "r!ntre c#re (! ce$ o%#r!#n.& LDH )(a"tat !e8i!ro'enaza* tot#$# e(te moder#t cre(cut# $# ce$e m#!mu$te "#c!ente cu neo"$#3!! e5t!n(e $# n!%e$u$ e"#t!c :met#(t#3e). In c#3u$neo"$#3!!$or o%#r!ene cu e-u3!un! "$euro (#u "er!tone#$e %#$or!$e LD4 (untm#! cre(cute !n #ce(te "rodu(e dec#t !n (er.

". +ar6eri hormonali& HCG e(te !n mod norm#$ (ecret#t de "$#cent#F cre(te !n cur(u$ (#rc!n!! (! !ntumor! o%#r!ene.& 9&HCG )8ormon%( 'ona!otroi" "orioni" %man ,ra"ti%nea 9* e(te-o$o(!t c# m#rer tumor#$ !n tumor!$e cu ce$u$e germ!n#t!%e :em+r!on#re) deo%#r (#u tumor! te(t!cu$#re. C# (! !n c#3u$ A'*? e(te deo(e+!t de ut!$#determ!n#re# "reter#"eut!c# # n!%e$u$u! +4C;.


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8ormonii an!ro'eni )testosteron%(* cre(cut! m#! #$e( !n tumor!$e(ecret#nte de o%#r.& estro'enii n!%e$u$ $or ur!n#r cre(te !n tumor!$e #(oc!#te cu!"ere(trogen!(m :tecom? tumor# de gr#nu$o#(#).

D#r (tud!! "r!n metod# RIA #u demon(tr#t c, c!rc# 0 d!nc#rc!no#me$e o%#r!ene (ecret, e(tron, ! #ndro(tend!on.Stud!!$e $u! 9#$oc :1&86) #u demon(tr#t c, (trom# tumor!$or o%#r!ene

"roduce c#nt!t,/! m!c! d#r (emn!-!c#t!%e de #ndro(tend!on ? "roge(teron !e(tr#d!o$ . V#$or!$e "$#(m#t!ce (unt @n $eg,tur, cu m#(# tumor#$, ! (t#d!u$c$!n!cF (c#d du", reducere# c!rurg!c#$, # m#(e! tumor!! (#u @n urm# unortr#t#mente c!m!ce e-!c#ce ? cre(c @n rec!d!%e ! #u %#$o#re "rogno(t!c,#(u"r# e%o$u/!e! +o$!!.

0 d!n c#rc!no#me$e o%#r!ene ? m#! #$e( ned!-eren/!#te? (!ntet!3e#3,

4C; ! un d!#gno(t!c "recoce "o#te -! (uger#t de cretere# -r#c/!un!! +et#4C; ? "ot -! -o$o(!te ! "entru mon!tor!3#re# ter#"!e!? e%entu#$ @n #(oc!ere cu#$/! m#rer!.B S"orong ! co$#+or#tor!! :1&81) (tud!!nd 7 de c#rc!no#me o%#r!ene!dent!-!c#te $# 9#$en ! 4#r#rd "r!n metode !muno!(toc!m!ce #udemon(tr#t c, #ce(te# (ecret, (om#to(t#t!n,? g$uc#gon ? 9etence-#$!n? VI* !Bet# endor-!n, "recum ! #$te neuro"e"t!de ! !dent!-!c#re# #ce(tor# #r

"ute# con(t!tu! o metod, de d!#gno(t!c "recoce #$ #ce(tor tumor! r#re.

15.Alte investigatii generale de laborator =&Hemo(e%"o'rama = e(te un te(t (creen!ng de +#3#? -!!nd unu$ d!n ce$e m#!-rec%ent cerute te(te de $#+or#tor? re"re3ent#nd #de(e# "r!mu$ "#( !n(t#+!$!re# (t#tu(u$u! em#to$og!c (! d!#gno(t!cu$ d!%er(e$or #-ect!un!em#to$og!ce (! neem#to$og!ce. Cu#nt!-!c#re# "#r#metr!$or em#to$og!c!#(oc!#t# uneor! cu e5#m!n#re# -rot!u$u! de (#nge #duce !n-orm#t!! "ret!o#(e?or!ent#nd !n cont!nu#re ("re e-ectu#re# #$tor te(te ("ec!-!ce.4emogr#m# com"$et, e(te o #n#$!3, c#re m,(o#r, urm,to#re$e= Num,ru$ de g$o+u$e ro!! d!n (nge er!troc!te :RBC). Num,ru$ de g$o+u$e #$+e d!n (nge $eucoc!te :GBC).

C#nt!t#te# tot#$, de emog$o+!n, d!n (nge :4;B). *rocentu$ de g$o+u$e ro!! :em#tocr!t) :4CT). 9ed!# %o$umu$u! g$o+u$e$or ro!! :9CV). 9ed!# g$o+u$#r, # emog$o+!ne! :9C4). Concentr#/!# med!e # emog$o+!ne! @n er!troc!te :9C4C). Num,ru$ de trom+oc!te :*LT).G(i"emie =re"re3!nt# n!%e$u$ de g$uco3# d!n (#nge


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Uree si "reatinina san'%ina ana(iza bio"8imi"a a %rinei c#re (e -#ce nu num#! !n +o$!$e #"#r#tu$u!ur!n#r c! (! !n +o$!$e #$tor org#ne. Reco$t#re# ur!ne! (e "o#te -#ce #t#t $#n!%e$u$ $#+or#toru$u! c#t (! $# dom!c!$!u.

1-. Uneor! (e recom#nd# testarea genetica "entru # (e %ede# d#c# "er(o#n# "re3!nt# o m%tatie se"i,i"a a 'ene(or BRCA 1 sa% BRCA 3 $#c#re (# demon(tr#t o $eg#tur# cu c#nceru$ o%#r!#n (! cu ce$ m#m#r.S!ndromu$ c#nceru$u! ered!t#r de (#n (! de o%#r :4BOC Y ered!t#rH +re#(to%#r!#n c#ncer (Hndrome) #re $# +#3# o "red!("o3!t!e genet!c# de # de3%o$t#c#ncer (! (e c#r#cter!3e#3# "r!n=[ e5!(tent# !ntro -#m!$!e # m#! mu$tor c#3ur! de c#ncer m#m#r? o%#r!#n (#u ##m+e$or -ormeF[ #(oc!ere# $# #cee#(! "er(o#n# # #m+e$or -orme de c#ncerF

[ c#ncer m#m#r cu de+ut "recoce.De(! ce$e m#! mu$te c#3ur! de c#ncer m#m#r (! o%#r!#n nu (unt mo(ten!te?#"ro5!m#t!% 7 d!ntre c#ncere$e de (#n (! 10 d!ntre c#ncere$e de o%#r(unt !nc#dr#te !n 4BOC. Numero#(e$e (tud!! e-ectu#te #u #r#t#t c# mut#t!!$egene$or BRCA1 (! BRCA2 c#re #-ecte#3# $!n!# germ!n#$# (unt re("on(#+!$ede m#re# m#or!t#te # c#ncere$or ered!t#re de (#n (! o%#r.

BRCA1 )Breast Can"er 1 Gene* si BRCA3 )Breast Can"er 3Gene* (unt gene (u"re(o#re #$e tumor!$or c#re cod!-!c# "rote!ne cu ro$ !n

"roce(e$e de re"#r#re # ADNu$u!. Au -o(t comun!c#te "e(te 1200 mut#t!! #$e

gene! BRCA1 (! "e(te 100 mut#t!! #$e gene! BRCA2. De(! "er(o#ne$e cu4BOC mo(tene(c o #$e$# BRCA1 (#u BRCA2 de-ectuo#(# de $# unu$ d!ntre "#r!nt!? #ce(t!# "re3!nt# o # dou# #$e$# -unct!on#$#F !n c#3u$ !n c#re (! ce# de# dou# #$e$# de%!ne ne-unct!on#$# (e de3%o$t# "roce(u$ neo"$#3!c? "r!n#cumu$#re# de mut#t!! #d!t!on#$e. Se e(t!me#3# c# "re%#$ent# mut#t!!$orBRCA !n "o"u$#t!# gener#$# e(te de 1J00 1J800. In "o"u$#t!!$e !nteme!#tede un gru" #nce(tr#$ m!c? #num!te mut#t!! BRCA1 (#u BRCA2 (e "ot !nt#$n!m#! -rec%ent (! (unt denum!te Kmut#t!! -ond#to#re. Ace(te t!"ur! de mut#t!!#u -o(t !dent!-!c#te "redom!n#nt $# e%re!! A(en#3! :d!n Euro"# de E(t)?c#n#d!en!! -r#nce3! (! $# !($#nde3!.

;en# BRCA 1 $oc#$!3#t# $# n!%e$u$ cromo3omu$u! 1P21 e(te -orm#t#d!n 22 de e5on! (! cod!-!c# o "rote!n# de 186 de #m!no#c!3!. *rote!n#BRCA1 e(te o -o(-o"rote!n# nuc$e#r# cu ro$ !m"ort#nt !n ment!nere#(t#+!$!t#t!! genom!ce (! !n (u"re(!# tumor#$#F !m"reun# cu #$te "rote!ne(u"re(o#re #$e tumor!$or (#u cu ro$ !n tr#n(m!tere# (emn#$u$u! ce$u$#r?-orme#3# un com"$e5 cu (u+un!t#t! mu$t!"$e denum!t BASC :BRCA1#(oc!#ted genome (ur%e!$$#nce com"$e5)F de #(emene# (e #(oc!#3# cu ARN

http://www.sfatulmedicului.ro/Investigatii/testele-genetice-intra-in-practica-medicala_1321http://www.sfatulmedicului.ro/Investigatii/testele-genetice-intra-in-practica-medicala_1321


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"o$!mer#3# II !nter%en!nd #(t-e$ !n tr#n(cr!"t!e? re"#r#re# ADN$u! du+$uc#ten#r? "recum (! !n recom+!n#re.

9ut#t!!$e gene! BRCA1? ce conduc $# eror! !n re"$!c#re# ADNu$u! (! "ro$!-er#re# necontro$#t# # ce$u$e$or e"!te$!#$e? (unt r#("un3#to#re de#"ro5!m#t!% 0 d!n c#3ur!$e de c#ncer m#m#r ered!t#r (! m#! mu$t de 80d!n c#3ur!$e de c#ncer m#m#r (! o%#r!#n ered!t#re. S"$!c!ngu$ #$tern#t!%det!ne ro$ !n modu$#re# $oc#$!3#r!! mo$ecu$#re (! -unct!on#re# norm#$# #gene! BRCA1. Au -o(t de(cr!(e m#! mu$te %#r!#nte de "rodu(! de tr#n(cr!"t!eune$e -!!nd #(oc!#te cu mut#t!! c#u3#to#re de +o#$#. A -o(t !dent!-!c#t# (! o

"(eudogen#? $oc#$!3#t# tot "e cromo3omu$ 1. In $!ter#tur# de ("ec!#$!t#tee(te ("ec!-!c#t c# #ce#(t# reg!une de "e cromo3omu$ 1 cont!ne o du"$!c#t!e!n t#ndem :\BRCA1)? de #"ro5!m#t!% 0+? c#re duce $# #"#r!t!# # 2 co"!!#$e e5on!$or 1 (! 2 #! BRCA1? #$e e5on!$or 1 (! #! gene! #d!#cente denum!t#1A1B? "recum (! # une! reg!un! !ntergen!ce de 2&7 +". *r!n (ec%ent!ere

(# demon(tr#t c# #ce(t! e5on! du"$!c#t! con(t!tu!e "(eudogene ne"roce(#te.Ace(te con(t#t#r! "ot nu num#! (# !ngreune3e #n#$!3# mut#t!!$or

BRCA1? c! (# #!+# (! !m"$!c#t!! #(u"r# reg$#r!! norm#$e (#u #norm#$e #tr#n(cr!"t!e!? tr#n($#t!e! (! -unct!e! BRCA1.

L# -eme!$e c#re mo(tene(c o mut#t!e !n#ct!%#to#re? de-!c!tu$ une! "rote!ne BRCA e(te cr!t!c "entru #"#r!t!# +o$!!? -!!nd gener#t #t#t de #$e$#!n#ct!%#t# mo(ten!t#? c#t (! de "!erdere# (om#t!c# # #$e$e! (#$+#t!ce !nce$u$e$e e"!te$!#$e m#m#re (#u o%#r!ene. In "$u( (# con(t#t#t c# e5"re(!#gene$or e(te (u"r#reg$#t# !n t!m"u$ "u+ert#t!! (! (#rc!n!!? -!!nd #(oc!#t# cu

cre(tere# (ecret!e! de e(trogen!F #ce#(t# o+(er%#t!e (ugere#3# c# e(trogen!! #r "ute# (t!mu$# e5"re(!# BRCA1 (!J(#u BRCA2. A -o(t "ro"u( (! un mode$ detumor!gene3# $# -eme!$e "urt#to#re de mut#t!! BRCA #$e $!n!e! germ!n#$e= $#

"u+ert#te? c# urm#re # n!%e$u$u! cre(cut de e(trogen!? ce$u$e$e e"!te$!#$e #$eg$#nde! m#m#re "ro$!-ere#3# r#"!dF "re3ent# une! mut#t!! BRCA!n#ct!%#to#re !n conte5tu$ une! re"$!c#r! cre(cute reduce mu$t c#"#c!t#te# dere"#r#re # ADNu$u! (! cre(te -rec%ent# #$ter#r!$or genom!ce (om#t!ce $#n!%e$u$ e$emente$or re"et!t!%e d!n gene$e BRCA1 (! BRCA2. 9#or!t#te#ce$u$e$or c#re "re3!nt# #m+e$e t!"ur! de mut#t!! nu (u"r#%!etu!e(c !n c!c$u$ce$u$#r urm#tor d#tor!t# !nc#"#c!t#t!! de re"#r#re # ADNu$u!? !n(# !n c#3u$ !n

c#re (e "roduc mut#t!! #d!t!on#$e $# n!%e$e$or unor gene c#re contro$e#3#c!c$u$ ce$u$#r :Kcec"o!nt gene()? une$e ce$u$e BRCAnu$e (e!mort#$!3e#3# (! "ot con(t!tu! "unctu$ de "$ec#re !n de3%o$t#re# tumor!$or.

*enetr#nt# mut#t!!$or BRCA1 (! BRCA2? de-!n!t# c# "ro+#+!$!t#te# de# de3%o$t# c#ncer #tunc! c#nd e(te "re3ent# o mut#t!e? e(te %#r!#+!$#? -!!nd!n-$uent#t# "ro+#+!$ de etn!c!t#te? %#r(t#? t!"u$ de c#ncer.


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In t#+e$u$ de m#! o( e(te "re3ent#t r!(cu$ cumu$#t de c#ncer de (#n? !n-unct!e de dec#d# de %!#t#? $# -eme!$e "urt#to#re de mut#t!! BRCA1 (#uBRCA2? "ro%en!te d!n -#m!$!!$e cu r!(c cre(cut =V#r(t# R!(c cumu$#t

BRCA1 BRCA20 #n! .2 .60 #n! 1&.1 1270 #n! 70.8 660 #n! 7.2 610 #n! 87 86

L# -eme!$e cu mut#t!! BRCA1 (#u BRCA2 r!(cu$ de c#ncer o%#r!#n e(te de&6 (!? re("ect!%? de 1220. C#nceru$ o%#r!#n "re3!nt# un -enot!"!(to$og!c d!(t!nct $# #ce#(t# c#tegor!e de "#c!ente? !nreg!(tr#ndu(e !n

"r!nc!"#$ tumor! (ero#(e (#u endometr!o!de de gr#d !n#$t.In #-#r# c#nceru$u! ered!t#r de (#n (! o%#r mut#t!!$e BRCA1 (! BRCA2

"ot -! #(oc!#te (! cu #$te -orme de c#ncer. A(t-e$? (# e(t!m#t c# r!(cu$ dec#ncer de "ro(t#t# e(te de or! m#! m#re $# +#r+#t!! "urt#tor! de mut#t!!BRCA1 !n com"#r#t!e cu "o"u$#t!# gener#$#. 9#! mu$t? c#3ur! de c#ncer de

"#ncre#(? "ro(t#t#? e(o-#g? $#r!nge? (tom#c? co$on? %e3!c# +!$!#r#? duct +!$!#r?me$#nom #u -o(t r#"ort#te !n -#m!$!!$e cu mut#t!! BRCA2 ce "red!("un $#c#ncer. De #(emene# !n #nem!# '#ncon! (# con(t#t#t !n#ct!%#re# +!#$e$!c#

BRCA2.Te(t#re# genet!c# e(te !m"ort#nt# !n "r#ct!c# c$!n!c# "entru

!dent!-!c#re# "er(o#ne$or c#re "re3!nt# un r!(c (emn!-!c#t!% de c#ncer de (#n(#u de o%#r (! #"$!c#re# (tr#teg!!$or #dec%#te de (creen!ng (! "re%ent!e.

Re"oman!ari entr% ana(iza m%tatii(or 'ene(or BRCA1 si BRCA3Se recom#nd# te(t#re# genet!c# $# "er(o#ne$e cu un r!(c ]2027 de # #%e# o

"red!("o3!t!e mo(ten!t# "entru c#nceru$ m#m#r (#u o%#r!#n=[ -eme! cu #ntecedente "er(on#$e #t#t de c#ncer m#m#r? c#t (! o%#r!#nF

[ -eme! cu c#ncer o%#r!#n ce #u o rud# #"ro"!#t# -!e cu c#ncer o%#r!#n? -!em#m#r cu de+ut !n#!nte de meno"#u3# (#u #m+e$eF[ -eme! cu c#ncer o%#r!#n ce #"#rt!n gru"u$u! etn!c #$ e%re!$or A(en#3!F[ -eme! cu c#ncer o%#r!#n de"!(t#t $# %#r(t# de 70 #n! (#u m#! de%reme? ce#u o rud# #"ro"!#t# -!e cu c#ncer o%#r!#n? -!e cu c#ncer m#m#r $# +#r+#tde3%o$t#t $# or!ce %#r(t#F


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[ -eme! #%#nd o rud# #"ro"!#t# ce "re3!nt# o mut#t!e BRCA1 (#u BRCA2cuno(cut#.[ -eme! cu c#ncer o%#r!#n? "er!tone#$ "r!m#r (#u de trom"# uter!n#?!(to$og!c de gr#d !n#$t (! de t!" (ero(? de3%o$t#t $# or!ce %#r(t#F[ -eme! (#n#to#(e #%#nd o rud# #"ro"!#t# c#re !ntrune(te unu$ d!n cr!ter!!$em#! (u( ment!on#te.Menti%ni:c#nceru$ "r!m#r de trom"# uter!n# (#u "er!tone#$ "r!m#r -#c "#rte d!n("ectru$ de m#n!-e(t#r! c#r#cter!(t!ce 4BOCFo rud# #"ro"!#t# e(te de-!n!t# c# or!ce rud# de gr#du$ I :m#m#? (or#? -!!c#)(#u de gr#du$ II :+un!c#? ne"o#t#? m#tu(#).

D#c# e(te "o(!+!$? te(t#re# genet!c# tre+u!e !n!t!#t# $# "er(o#n##-ect#t#F deo#rece num#ru$ mut#t!!$or BRCA1 (! BRCA2 e(te -o#rte m#re (e%# e-ectu# (ec%ent!ere# com"$et# # #m+e$or gene. O d#t# !dent!-!c#t# o

mut#t!e ("ec!-!c# #ce#(t# %# -! c#ut#t# t!nt!t $# rude$e cu r!(c cre(cut :te(t#re#!n (co" "red!ct!%).

In c#3u$ !n c#re nu e(te "o(!+!$# te(t#re# "er(o#ne$or #-ect#te (e %#recurge $# (ec%ent!ere# com"$et# # gene$or BRCA1 (! BRCA2 $# mem+r!!-#m!$!e! cu r!(c cre(cut.In#!nte# recom#nd#r!! de e-ectu#re # te(t#r!! e(te !nd!c#t c# "#c!entu$ (# -!econ(!$!#t de c#tre med!cu$ tr!m!t#tor? !n (en(u$ c# "er(o#n# tre+u!e (# -!e!n-orm#t# #(u"r# (emn!-!c#t!e! (! con(ec!nte$or unu! re3u$t#t "o3!t!%? neg#t!%(#u de (emn!-!c#t!e necuno(cut#.

Meto!a (ec%ent!ere# tuturor e5on!$or gene! BRCA1 (! BRCA2 ^ #n#$!3#de$et!!$orJdu"$!c#t!!$or :9L*A)F (e "ot !dent!-!c# &0&7 d!ntre mut#t!!$ecuno(cute (! (e "ot de"!(t# #$te$e no!.Raortarea si interretarea rez%(tate(or

Un re3u$t#t neg#t!% e(te de-!n!t "r!n #+(ent# mut#t!!$or $!n!e! germ!n#$e!n gene$e BRCA1 (! BRCA2. In c#3u$ une! "er(o#ne #-ect#te #ce(t# !nd!c# c#

"roce(u$ neo"$#3!c # #"#rut ("ont#n (! nu c# urm#re # mut#t!!$or "e $!n!egerm!n#$#. In c#3u$ une! "er(o#ne cu r!(c cre(cut un re3u$t#t neg#t!% "o#te#%e# urm#to#re$e (emn!-!c#t!!=

nu # -o(t mo(ten!t# mut#t!# ("ec!-!c# -#m!$!e!Fe(te "re3ent# o mut#t!e BRCA1 (#u BRCA2 c#re nu "o#te -! detect#t# (#unu # -o(t !nc# !dent!-!c#t#F !n #ce(t c#3 "red!("o3!t!# "er(o#ne! !n c#u3#

"entru c#nceru$ m#m#r (#u o%#r!#n ered!t#r r#m#ne necuno(cut#Fnu e5!(t# o "red!("o3!t!e -#m!$!#$# "entru c#nceru$ m#m#r (#u o%#r!#nered!t#r.


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D#c# nu e(te detect#t# o mut#t!e $# "er(o#ne$e cu r!(c cre(cut? "ro+#+!$!t#te# de #"#r!t!e # c#nceru$u! de (#n? re("ect!%? de o%#r e(tecom"#r#+!$# cu ce# d!n "o"u$#t!# gener#$#.

*re3ent# une! mut#t!! # $!n!e! germ!n#$e $# o "er(o#n# #-ect#t# con-er#un r!(c cre(cut de de3%o$t#re !n %!!tor # une! tumor! no! :#(oc!#te cu BRCA1(! BRCA2).

In c#3u$ unu! re3u$t#t "o3!t!% "entru mut#t!!$e BRCA1 (! BRCA2 #$e$!n!e! germ!n#$e $# o "er(o#n# cu r!(c cre(cut? e(te nece(#r c# med!cu$tr!m!t#tor (# -urn!3e3e to#te !n-orm#t!!$e cu "r!%!re $# o"t!un!$e demon!tor!3#re? (creen!ng? c!m!o"ro-!$#5!e (#u c!rurg!e "ro-!$#ct!c#d!("on!+!$eF tre+u!e (# (e !# o+$!g#tor!u !n con(!der#re !m"$!c#t!!$e

"(!o$og!ce (! -#m!$!#$e.Screen!ngu$ (! "re%ent!# c#nceru$u! o%#r!#n= de(! #re o %#$o#re

$!m!t#t# !n de"!(t#re# "recoce # tumor!$or o%#r!ene? (e recom#nd# e-ectu#re#

"er!od!c# :$# 6 $un!) # m#reru$u! CA127 !n #(oc!ere cu ecogr#-!#tr#n(%#g!n#$# $# "er(o#ne$e cu mut#t!! BRCA1 (#u BRCA2? !nce"#nd cu%#r(t# de 07 #n!.

S#$"!ngoo%#r!ectom!# "ro-!$#ct!c# !n uru$ %#r(te! de 0 #n! "o#tereduce r!(cu$ de c#ncer o%#r!#n $# #ce#(t# c#tegor!e de "er(o#ne cu _ 87&0.

1/. E"amenul histopatologic #$ "!e(e! o+t!nut# !n urm# !nter%ent!e!c!rurg!c#$e e(te de Kc#"#t#!. E$ "une d!#gno(t!cu$ de m#$!gn!t#te? (t#+!$!nd

t!"u$ !(to$og!c #$ tumor!! o%#r!ene? (en(!+!$!3#nd #(t-e$ c$!n!c!#nu$ !n cee# ce "r!%e(te t!"u$ ter#"!e! "entru c#re %# o"t#? com"$!c#t!!$e ce "ot #"#re (! un#nume re3u$t#t #$ ter#"!e! (#$e.

E(te #n#$!3#re# m!cro(co"!c, # unor -r#gmente de org#ne (#u /e(utur!.Ace(te# (e reco$te#3, "r!n +!o"(!e? re#$!3#t, "r!ntro !nter%en/!e c!rurg!c#$,.'r#gmente$e (unt "re$ucr#te c!m!c ! #"o! e5#m!n#te $# m!cro(co"?o+/!nndu(e #(t-e$ e5#menu$ !(to"#to$og!c.

n #-#r# +!o"(!e! c!rurg!c#$e c$#(!ce? -r#gmente de /e(ut (e m#! o+/!ncu #utoru$ unor d!("o3!t!%e ("ec!#$e c#re re#$!3e#3, "re$e%#re# une! mo(trede /e(ut tumor#$ d!n Km!e3u$`` tumor!! ## num!te$e Kcore+!o"(H ut!$!3#te

"entru d!#gno(t!cu$ de cert!tud!ne #$ tumor!$or de (n c#re nu #u dre"t "r!m,!nd!c#/!e ter#"eut!c,? re3ec/!# c!rurg!c#$, # tumor!!. De #(emene# m#! e5!(t,

"unc/!#+!o"(!e #("!r#t!%, c#re (e re#$!3e#3, cu #ce -!ne ("ec!#$e? !#r#("!r#tu$ o+/!nut e(te ut!$!3#t "entru o+/!nere# unu! e5#men c!to$og!c? #d!c, #$ce$u$e$or :("re deo(e+!re de +!o"(!e "r!n c#re (e reco$te#3, -r#gmente de/e(utur!).


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'!g 1.C!(t#deno-!+rom o%#r!#n? det#$!u cu ce$u$e c!$!ndr!ce (! (trom# den(#cu ce$u$e -u(!-orme !n %#rteur! (curte? 4E? 105


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'!g 18.C!(t#denoc#rc!nom "#"!$!-er (ero( o%#r!#n? 4E? 105

De! e5#m!n#re# $# m!cro(co" de c,tre med!cu$ #n#tomo"#to$og e(tece# c#re "rec!3e#3, d!#gno(t!cu$ cert de m#$!gn!t#te? uneor! #ce(t $ucru nue(te (u-!c!ent "entru un tr#t#ment corect #$ tumor!! ! #tunc! (e m#!e-ectue#3, ! un e5#men I4C :!muno!(toc!m!c).

Imunohistochimia sau I!( (e re-er# $# "roce(u$ de detect#re #$

#nt!gen!$or :de e5em"$u #$ "rote!ne$or )? d!ntro (ect!une # te(utu$u! ce$u$e$or? "r!n e5"$o#t#re# "r!nc!"!u$u! $eg#tur!! d!ntre #nt!cor"!? !n mod ("ec!#$ !nc#3u$ #nt!cor"!$or "re3ent! !n te(utur!$e +!o$og!ce.Et!mo$og!# cu%#ntu$u! "ro%!ne de $# !muno$og!e cu re-er!re $# #nt!cor"!! #n#$!3#t! !n c#dru$ "rocedur!! (! !(to? c#re !n(e#mn# te(ut. Co$or#re#!muno!(toc!m!c# e(te ut!$!3#t# "e (c#r# $#g# !n d!#gno(t!cu$ (! de"!(t#re#ce$u$e$or #norm#$e? cum #r -! ce$e ("ec!-!ce tumor!$or c#ncero#(e. 9#rer!!mo$ecu$#r! ("ec!-!c! (unt c#r#cter!(t!c! #num!tor "roce(e ce$u$#$re cum #r -!

"ro$!-er#re# (#u mo#rte# ce$u$#r# :#"o"to3#).

I4C e(te ut!$!3#t# (! !n cercet#r!$e -und#ment#$e re#$!3#te "entru !nte$egere#d!(tr!+ut!e! (! $oc#$!3#r!! +!om#rer!$or (! # d!-erent!er!! "rote!ne$or d!nd!-er!te "#rt! #$e te(utu$u! +!o$og!c. %!3u#$!3#re# une! !nter#ct!un! #nt!cor"#nt!gen "o#te -! re#$!3#t# !n d!%er(e modur!. De(eor!? un #nt!cor" e(teconug#t cu o en3!m#? c# !n "roce(u$ "ero5!d#3e!? "entru # #%e# $orc#t#$!3#re# une! re#ct!! !n urm# c#re!# (e o+t!ne o #num!t# co$or#t!e :dee5em"$u? !muno"er!o5!#3# de co$or#t!e).

http://www.sfatulmedicului.ro/Alimentatia-sanatoasa/proteinele-mit-si-realitate_1495http://www.sfatulmedicului.ro/dictionar-medical/anticorp_424http://www.sfatulmedicului.ro/dictionar-medical/terapie-biologica_6077http://www.sfatulmedicului.ro/dictionar-medical/imunologie_1171http://www.sfatulmedicului.ro/Alergiile/anticorpii-ige-si-alergiile_827http://www.sfatulmedicului.ro/dictionar-medical/tumora_6583http://www.sfatulmedicului.ro/Cancerul/cancerul_4719http://www.sfatulmedicului.ro/Alimentatia-sanatoasa/proteinele-mit-si-realitate_1495http://www.sfatulmedicului.ro/Terapii-complementare/vizualizarea-un-alt-mod-de-a-combate-celulita_1450http://www.sfatulmedicului.ro/dictionar-medical/interactiune-medicamentoasa_3924http://www.sfatulmedicului.ro/dictionar-medical/anticorp_424http://www.sfatulmedicului.ro/Alimentatia-sanatoasa/proteinele-mit-si-realitate_1495http://www.sfatulmedicului.ro/dictionar-medical/anticorp_424http://www.sfatulmedicului.ro/dictionar-medical/terapie-biologica_6077http://www.sfatulmedicului.ro/dictionar-medical/imunologie_1171http://www.sfatulmedicului.ro/Alergiile/anticorpii-ige-si-alergiile_827http://www.sfatulmedicului.ro/dictionar-medical/tumora_6583http://www.sfatulmedicului.ro/Cancerul/cancerul_4719http://www.sfatulmedicului.ro/Alimentatia-sanatoasa/proteinele-mit-si-realitate_1495http://www.sfatulmedicului.ro/Terapii-complementare/vizualizarea-un-alt-mod-de-a-combate-celulita_1450http://www.sfatulmedicului.ro/dictionar-medical/interactiune-medicamentoasa_3924http://www.sfatulmedicului.ro/dictionar-medical/anticorp_424


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'!g 1&.C!(t#deno-!+rom o%#r!#n? CA127 "o3!t!% !n e"!te$!u? I4C? 105

Teste im%no8isto"8imi"e )IHC* o-er# = Con-!rm#re# (#u !n-!rm#re# d!#gno(t!cu$u! !(to"#to$og!c c$#(!c de $e3!une St#+!$!re# !(togene3e! tumor!$or m#$!gne ned!-erent!#te D!(t!nct!# !ntre $e3!un! neo"$#3!ce !n (!tu? $e3!un! neo"$#3!ce !n%#3!%e (!$e3!un! "(eudotumor#$e

A"rec!ere# -#ctor!$or mo$ecu$#r! de "rogno(t!c !n tumor! E%#$u#re# -#ctor!$or mo$ecu$#r! "red!ct!%! !n tumor! m#$!gne? "entrumodu$#re# ter#"!!$or ("ec!-!ce Ident!-!c#re# m!cromet#(t#3e$or tumor#$e? d!-!c!$ de !dent!-!c#t cucert!tud!ne "e "re"#r#te !(to"#to$og!ce (t#nd#rd :co$or#t!e 4aE) C#r#cter!3#re# mo$ecu$#r# # tumor!$or cu "unct de "$ec#re nedeterm!n#t Ident!-!c#re# unor #gent! !n-ect!o(! !n $e3!un! d(!"$#3!ce= 4*V (!4e$!co+#cter "H$or!


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'!g 20.CA127 "o3!t!% !ntro met#(t#3# de #denoc#rc!nom o%#r!#n? I4C? 105

Eamen%( im%no&8isto"8imi" e(te o metod, #du%#nt, "entru e5#menu$!(to"#to$og!c c#re "o#te "rec!3# o (er!e de c#r#cter!(t!c! !ntr!n(ec! #$etumor!! :"re3en/# unor rece"tor!? # unor #nom#$!! ce$u$#re ("ec!-!ce) ut!$!3#te

"entru !nd!%!du#$!3#re# tr#t#mente$or onco$og!ce :#d!c, -!ec#re "#c!ent (, "r!me#(c, un #num!t t!" de tr#t#ment? ct m#! #dec%#t tumor!! "e c#re o #re?cu to#te c#r#cter!(t!c!$e e!).

*r!n #ce(t e5#men (e "o#te (t#+!$! m#! e5#ct t!"u$ de c#ncer "recum !mod#$!t#te# ter#"eut!c, ce# m#! e-!c!ent,.In #num!te c#3ur!? co$or#t!!$e !muno!(toc!m!ce (unt e(ent!#$e "entru #con-!rm# "re3ent# unor #nt!gene -#r# de c#re nu (e "o#te "rec!3# und!#gno(t!c e5#ct. In #ce(t c#3? %! (e %# cere #cordu$ "re#$#+!$? #%#nd !n%edere co(tur!$e (u"$!ment#re "e c#re $e !m"$!c#. In #$te c#3ur!?

#n#tomo"#to$ogu$ %# "rec!3# un d!#gno(t!c d#r %# recom#nd# com"$et#re#$u! cu te(te !muno!(toc!m!ce. Ace(te det#$!! (unt -o#rte !m"ort#nte "entrucondu!t# ter#"eut!c# u$ter!o#r#? "ut#nd (# -#c# c!#r d!-erent# !n (ucce(u$tr#t#mentu$u!. Ten!c!$e !muno!(toc!m!ce d#u #de(e# !n-orm#t!! mu$t m#!

"ret!o#(e c!#r dec#t #$te #n#$!3e "er-orm#nte? cum e(te R9Nu$.


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VII. iagnosticul diferentialL# -eme!# #du$t# d!#gno(t!cu$ d!-erent!#$ (e -#ce cu=(#rc!n# !ntr#uter!n#Fmo$# !d#t!-orm#F (#rc!n# ecto"!c#Fc!(te$e de o%#r -unct!on#$eF

-!+ro#me uter!neFc!(te #(oc!#te (#rc!n!!F endometr!o3#Fm#$-orm#t!! uter!ne :uter du+$u)F r!n!c! ecto"!cF tumor! !ntr#"er!tone#$e :de co$on? rect? cec? (!ngur#? me3enter)Ftumor! retro"er!tone#$eF


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tumor! #$e o#(e$or "e$%!neF "#to$og!# !n-ect!o#(# tu+#r#F #"end!c!t#F #+ce(eF-$egmo#ne de $!g#ment $#rg (#u de -o(# "e$%!n#F c!(t !d#t!c !ntr#"er!tone#$.

In "o(tmeno"#u3# r#m#n %#$#+!$e #-ect!un!$e m#! (u( #m!nt!te? e5ce"t#nd#-ect!un!$e "#rt!cu$#re "er!o#de! #du$te.

Nu tre+u!e u!t#t c# #-ect!une# :c#nceru$ de o%#r) #t!nge un %#r- m#5!m$# 777& de #n! (! c# !n 80 d!n c#3ur! e(te %or+# de #denoc#rc!no#me.

D!#gno(t!cu$ d!-erent!#$ -#ce #"e$ $# d#te$e -urn!3#te de= #n#mne3#Fe5#men c$!n!c gener#$ (! gen!t#$F e5"$or#r! "#r#c$!n!ce t!nt!te "e

"#rt!cu$#r!t#t!$e -!ec#ru! c#3.A"#r!/!# (ec%en/!#$# # mod!-!c,r!$or e"!te$!u$u! germ!n#t!% #$

o%#ru$u! @n c#dru$ e%o$u/!e! n#tur#$e # "ro$!-er,r!$or +en!gne c,tre tumor! $!m!t, : +order$!ne ) ! #"o! c,tre tumor! e"!te$!#$e comune m#$!gne?determ!n, d!-!cu$t,/! d!#gno(t!ce ! !m"un un r!guro( d!#gno(t!c d!-eren/!#$.Tumor!$e e"!te$!#$e comune (ero#(e $# $!m!t# m#$!gn!t,/!! :+order$!ne)(e d!-eren/!#3, !(to$og!c de ce$e m#$!gne "r!n -#"tu$ c, "ro$!-er#re#e"!te$!#$, e(te d!("u(, "e 1 rndur! ! c#"(u$# e(te ne!n%#d#t,. Totu!? (untc!t#te c#3ur! de tumor, $!m!t, cu o cretere "#"!$#r, e5ce(!%, ? cu tend!n/#de !m"$#nt,r! "er!tone#$e ! cu "roducere# de #(c!t,.

n -#/# unu! #denoc#rc!nom muc!no(? tre+u!e $u#t, @n con(!der#re

"o(!+!$!t#te# une! met#(t#3e #denoc#rc!nom#to#(e? tumor# "r!m#r, -!!ndde3%o$t#t, @n !nte(t!nu$ gro(. n tumor# "r!m!t!%, o%#r!#n,? 3one$e m#$!gne(unt mu$t m#! re(trn(e? #t!"!!$e ce$u$#re "u/!ne? (u"r#-#/# ce# m#! m#re -!!ndocu"#t, de "ro$!-er#re# +en!gn,= @n (c!m+ ? @n "roce(u$ met#(t#t!c (tructur!$eg$#ndu$#re (unt de c#$!+ru m!c? #t!"!!$e ce$u$#re mu$t m#! m#rc#te.

Adenoc#rc!no#me$e endometr!o!de (unt -o#rte greu de d!-eren/!#t!(to$og!c de e5ten(!# o%#r!#n, # unu! c#ncer endometr!#$. E5!(ten/# unor-oc#re endometr!o3!ce @n o%#ru$ cu $e3!une m#$!gn, d!r!e#3, d!#gno(t!cu$("re tumor# o%#r!#n, "r!m!t!%,. L# #ce(te# (e #d#ug, urm,to#re$e cr!ter!!c#re (ugere#3, or!g!ne# m#! curnd o%#r!#n,= c#r#cter "#"!$#r "ronun/#t #$

"ro$!-er,r!! o%#r!eneF $e3!une m#! m!c, de 2 cm $# n!%e$u$ endometru$u! ! cu!n%#3!e m!n!m, # m!ometru$u!.

*o(!+!$!t#te# !dent!-!c,r!! e-ecte$or endocr!ne ! # m#rer!$or +!oc!m!c! @n tumor!$e o%#r!ene @ntregete d!#gno(t!cu$ ! "erm!temon!tor!3#re# tr#t#mentu$u!. Se con(!der, c, "re3!nt,= e-ecte #norm#$e= oe(trogen!ce= c!(t#denomu$ muc!no(F c#rc!no#me

"r!m#reF c#rc!no#me (ecund#reF #ndrogen!ce= tumor!$e Brenner.


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*roducere# de ormon! de c,tre une$e tumor! o%#r!ene # -o(t e%#$u#t, "r!nten!c! #n#$!t!ce con(t#tndu(e o (tero!dogene3, (emn!-!c#t!%, @n tumor!$ecordo#ne$or (e5u#$eF ormon!! "o$!"e"t!d!c! (unt #(oc!#/! cu tumor!$ee"!te$!#$e .

n cee# ce "r!%ete m#rer!! +!oc!m!c!? (e "o#te conc!de c, "n, $#or# #ctu#$, nu e5!(t, un m#rer "entru detect#re# c#nceru$u! o%#r!#n. Totu! ?mu$/! m#rer!? :CEA? A'*? 4C;? OVCAA? OVC1) (unt deo(e+!t de!m"ort#n/! @n mon!tor!3#re# tr#t#mentu$u! . A$-#-eto"rote!n# e(te ut!$, @ne%#$u#re# ter#"!e! tumor!$or (!nu(u$u! endoderm#$? gon#dotro-!n# cor!on!c,um#n, :4C;) @n c#r!oc#rc!nom ? #nt!genu$ c#rc!noem+r!on!c :CEA) @nc!(t#denoc#rc!no#me$e muc!no#(e.

VIII. Evolutie si prognostic

C#nceru$ de o%#r e(te un c#ncer gr#%? cu e%o$ut!e r#"!d# c!#r (u+tr#t#mentu$ com"$e5? r#t# de (u"r#%!etu!re -!!nd de 177. ;r#%!t#te# (!e%o$ut!# (unt de"endente de m#! mu$t! -#ctor!= t!"u$ !(to$og!cF gr#nd!ngu$ dem#$!gn!t#teF e5ten(!%!t#te# e5tr#o%#r!#n#F (t#d!u$ c$!n!c #$ +o$!!.

E%o$ut!# "o#te -!= r#"!d# ("re com"$!c#t!! (! met#(t#3e? cu "rogno(t!c

(um+ru :!n ("ec!#$ #denoc#rc!no#me$e (ero#(e (! c#rc!nomu$ ned!-erent!#t)?(#u $ent#? cu "rogno(t!c +un :+order$!ne tumor() (#u L9* :$o m#$!gn#nt

"otent!#$).E%o$ut!# ("re com"$!c#t!! (! met#(t#3e (e re#$!3e#3# "e urm#to#re$e

c#!=c#$e# "er!tone#$#?c#$e# $!m-#t!c#


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c#$e# (#ngu!n# .1. Calea peritoneala e(te "r!nc!"#$# c#$e de d!(em!n#re !n c#3u$ tumor!$ore"!te$!#$e. Ace(t -#"t (#r e5"$!c# "r!n tro"!(mu$ "entru "er!toneu "e c#re !$

"re3!nt# ce$u$e$e m#$!gne de("r!n(e d!n tumor!$e e"!te$!#$e o%#r!ene? "ro+#+!$ "r!n or!g!ne# em+r!o$og!c# comun#.

D!(em!n#r!$e "r!nd "er!toneu$ "#r!et#$? m#! r#r "e ce$ %!(cer#$? gre-#re#ce$u$e$or de(cu#m#te -#c#ndu(e de "re-er!nt# !n $ocur!$e dec$!%e= -undu$ de(#c Doug$#(? "er!toneu$ "e$%!n :ce$ m#! -rec%ent)? ("#t!!$e "#r!etoco$!ce (!

"er!toneu$ "#r!et#$? "#n# "e -#t# !n-er!o#r# # d!#-r#gmu$u! dre"t? unde (ere#$!3e#3# tumor!$e (ecund#re.

In(#m#nt#r!$e de $# n!%e$u$ m#re$u! e"!"$on con%erg ("re re#$!3#re#une! #de%#r#te "$#to(e e"!"$o!ce c#re !n -!n#$ "roduce oc$u3!!$e !nte(t!n#$e.Vec!n#t#te# #"ro"!#t# de "e$%!( # m#re$u! e"!"$on :rect? !$eon term!n#$ !ndre#"t#? co$on (!gmo!d !n (t#ng#) -#ce c# (! "er!toneu$ org#ne$or (# -!e (ed!u$

unor d!(em!n#r! (ecund#re= e5ten(!# $# o%#ru$ o"u( :61 d!n "#c!ente$e cu +o#$# !n (t#d!u$ I)? uter (! trom"e uter!ne :7 d!n +o$n#%e !n (t#d!u$ I). In(t#d!!$e m#! #%#n(#te uteru$ e(te !n%#d#t $# 27 d!n "#c!ente. *o#te -!!ntere(#t#? de #(emene#? (u"r#-#t# %e3!c!! ur!n#re? recto(!gmo!du$ (#u

"er!toneu$ "e$%!n.D!(em!n#re# "r!n !m"$#nt#re duce $# c#rc!no3# "er!tone#$#?

re("on(#+!$# !n m#re m#(ur# de dr#m# #+dom!n#$# # c#nceru$u! o%#r!#n (!ndromu$ oc$u(!%? d#tor#t -!e -enomene$or o+(truct!%e d#te de "roce(e$etumor#$e? -!e "roce(u$u! de com"re(!une. Ce$ m#! gr#% e(te !n-!$tr#re#

me3enteru$u!? cu retr#ct!# #ce(tu!# (! cu oc$u3!! mu$t!"$e ce nu #u (o$ut!!ter#"eut!ce.

2. Calea li/atica. E5ten(!# $!m-#t!c# (e -#ce "e tre! c#!= C#$e# $!m-#t!ce$or (u+"er!tone#$e e5"$!c#t# "r!n -#"tu$ c# b d!n o%#r e(te !nc#%!t#te# "er!tone#$# (! b e(te "$#(#t (u+"er!tone#$. Trunc!ur!$e $!m-#t!cemerg -!e ("re g#ng$!on!! !$!#c! e5tern!? !ntern! (! "r!m!t!%!? -!e ("re g#ng$!on!!me3enter!c! (! retro"er!tone#$! #ort!coc#%!. C#$e# $!m-#t!ce$or %#(e$or o%#r!ene. C#ncere$e o%#r!ene de3%o$t#te (u+ $!n!#'#rreG#$deHer :ot#ru$ d!ntre "er!toneu (! e"!te$!u$ germ!n#t!% o%#r!#n)

met#(t#3e#3# !n g#ng$!on!! !ng!n#$!F c#ncere$e o%#r!ene c#re (e de3%o$t#de#(u"r# $!n!e! '#rreG#$deHer d#u met#(t#3e d!rect !n g#ng$!on!! $om+o#ort!c! "e c#$e# $!g#mentu$u! $om+oo%#r!#n? -#r# !ntere(#re# g#ng$!on!$or

"e$%!n!. C#$e# $!m-#t!c# tr#n(d!#-r#gm#t!c# e(te "r!nc!"#$# c#$e de d!(em!n#re$!m-#t!c#? "entru c# 80 d!n -$u!du$ "er!tone#$ (e drene#3# "r!n c#"!$#re$e$!m-#t!ce #$e "er!toneu$u! (u+d!#-r#gm#t!c ("re un "$e5 !ntr#d!#-r#gm#t!c? de


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#co$o ("re "$e5u$ (u+"$eur#$? c#n#$e$e $!m-#t!ce retro(tern#$e? g#ng$!on!!med!#(t!n#$! #nter!or!? m#re# %en# $!m-#t!c# (! %en# (u+c$#%!cu$#r# dre#"t#.

L!m-# "er!toneu$u! "#r!et#$ e(te dren#t# "r!n "$e5u$ $!m-#t!c(u+d!#-r#gm#t!c? m#! #$e( !n dre#"t#F ce$u$e$e neo"$#3!ce (e "ot -!5# #!c! (#u

"ot trece m#! de"#rte "e c#!$e ment!on#te. Ce$u$e$e neo"$#3!ce "ot +$oc# "$e5u$ $!m-#t!c (u+d!#-r#gm#t!c? #ce(t# con(t!tu!nd unu$ d!n mec#n!(me$e de "roducere # #(c!te! neo"$#3!ce.%. Calea san0uina. E(te re("on(#+!$# de met#(t#3e$e $# d!(t#nt# de o+!ce!e5tr##+dom!n#$e :"u$mon#re? "$eur#$e? cere+r#$e? !ntr#e"#t!ce). Org#ne$e ce

"ot -! (ed!u$ met#(t#3e$or $# d!(t#nt# (unt !n ord!ne# de(cre(c#to#re #-rec%ente!= -!c#t? "$#m#n? "$eur#? r!n!c!? o#(e? g$#nde (u"r#ren#$e? %e3!c#?("$!n#. In gener#$? c#ncere$e o%#r!ene met#(t#3e#3# $# d!(t#nt# re$#t!% t#r3!u(! r#r? (cen# "r!nc!"#$# # dr#me! (! -!n#$u$ #"#rt!n#nd c#%!t#t!! "er!tone#$e.Tumor!$e o%#r!ene (unt e5"u(e r!(cu$u! de r#("#nd!re $# ce$e$#$te org#ne?

"roce( num!t met#(t#3#.

C#nceru$ o%#r!#n "o#te (# met#(t#3e3e !n tre! modur!= Q In%#3!e= tumor# cre(te (u-!c!ent de m#re "entru # !n%#d# org#ne$e d!n#"ro"!ereQ *urt#to#re= Ce$u$e$e c#ncero#(e !nd!%!du#$e (e de("r!nd d!n tumor#o%#r!#n# "r!nc!"#$# (! (e tr#n("$#nte#3# $# org#ne$e d!n #"ro"!ereQ Se !m"r#(t!e= Ce$u$e$e c#ncero#(e c#$#tore(c "r!n !ntermed!u$ (!(temu$u!$!m-#t!c "r!n g#ng$!on!! $!m-#t!c!? !n #$te org#ne= !n "e$%!(? #+domen (! !n

"!e"t.

I8. $ratament

Tr#t#mentu$ c#nceru$u! o%#r!#n e(te com"$e5 !nc$u3#nd #(oc!ere# m#!mu$tor #cte ter#"eut!ce "r!n c#re (e urm#re(te !m+un#t#t!re# dur#te! de(u"r#%!etu!re. Inter%ent!# ter#"eut!c# (e re#$!3e#3# !n -unct!e de (t#d!u$c$!n!c.

Tr#t#mentu$ c#nceru$u! o%#r!#n "o#te -!= tr#t#ment c!rurg!c#$F tr#t#ment c!m!oter#"!cF


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r#d!oter#"!#F ormonoter#"!#F !munoter#"!#.

Interventia cirur0icala det!ne "r!or!t#te# #(u"r# ce$or$#$te m!$o#ceter#"eut!ce .

O !nter%ent!e c!rurg!c#$# !n!t!#$# com"$et# (! corect# e(te cruc!#$# "entru tr#t#mentu$ c#nceru$u! o%#r!#n. Succe(u$ ter#"!e! u$ter!o#re e(te? !nm#re "#rte? determ!n#t de #ctu$ c!rurg!c#$ !n!t!#$. E5ere3# c!rurg!c#$# (e

"r#ct!c# !n c#3u$ tumor!$or o%#r!ene de gr#n!t# :+order$!ne) (! c#ncere$oro%#r!ene (t#d!$e I (! II. A de%en!t !n(# c$#r c# e5ere3# c!rurg!c#$#? or!c#t de$#rg# #r -!? nu cree#3# (ent!mentu$ de (!gur#nt# onco$og!c# #+(o$ut# n!c!m#c#r "entru (t#d!u$ I #$ +o$!!. Ce$u$e$e neo"$#3!ce e5-o$!#te !n m#re#c#%!t#te "er!tone#$# "ot or!c#nd gener# no! tumor!.

Se con(!der# !n "re3ent c#? num#! "#c!ente$e !n (t#d!!$e I # (! I + cu

tumor! +!neJmed!u d!-erent!#te d!n "unct de %edere !(to$og!c? nu nece(!t#tr#t#ment #du%#nt "o(to"er#tor.

*e(te 2J d!n c#ncere$e o%#r!ene (e #-$# !n momentu$ d!#gno(t!cu$u! !n(t#d!!$e II (! III? !n c#re tumor# e(te d!(em!n#t# !n "e$%!(? re("ect!% !n m#re#c#%!t#te "er!tone#$#? re#$!3#nd o m#(# tumor#$# #"rec!#+!$#. Actu$ c!rurg!c#$!n #ce(te c#3ur! #re c# (co" !nde"#rt#re# ce$e! m#! m#r! "#rt! # $e3!un!$or?dec!(!%# "entru e%o$ut!# u$ter!o#r# -!!nd? nu c#nt!t#te# de m#(# tumor#$#e5t!r"#t#? c! m#(# re3!du#$#.

In "o-!d# unor !nter%ent!! "r!m#re e5t!n(e? mu$te "#c!ente cu c#ncer

o%#r!#n decede#3#. *$ec#nd de $# #ce#(t# o+(er%#t!e? (# "ro"u( #"$!c#re#re!nter%ent!e! de contro$ :(econd $oo e5#m!n#re #m#nunt!t# # #+domenu$u!(! "e$%!(u$u!? urm#r!ndu(e #cee#(! "rocedur# c# !n c#3u$ !nter%ent!e!c!rurg!c#$e "r!m#re). D#c# e5!(t# m#(e tumor#$e e%!dente tre+u!e +!o"(!#t!g#ng$!on!! $!m-#t!c! "e$%!n! (! "#r##ort!c!. 9#(# tumor#$# re3!du#$# tre+u!ere3ec#t# d#c# e(te "o(!+!$.

E5!(t# (!tu#t!! !n c#re !nter%ent!# c!rurg!c#$# (e re(tr#nge de $#!nce"ut $# un #ct "#$e#t!% (#u o #(emene# #t!tud!ne (e !m"une cu oc#3!#une!# d!n !nter%ent!!$e de contro$.

Ciioterapia.

E(te "r!nc!"#$# metod# ter#"eut!c# #du%#nt# #ctu$u! c!rurg!c#$ (#uut!$!3#t# c# tr#t#ment !n!t!#$ !n c#ncere$e o%#r!ene #%#n(#te .Cm!oter#"!# "o#te -! #"$!c#t# c#= monoter#"!e (#u "o$!c!m!oter#"!e.


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a. +onoterapia. Agent!! -o$o(!t! (unt cu "rec#dere #gent!! #$!$#nt!:9e$"#$#n? C$or#m+uc!$? C!c$o"o("#m!d#? T!ote"#)? d#r (! C#r+o"$#t!n?C!("$#t!n? Do5oru+!c!n? Ne5#met!$me$#m!n#? T#5o$.

C!c$o-o(-#m!d# :c!c$o-o(-#m!de? cHto5#m? endo5#n) ce$ m#! -rec%entc!to(t#t!c -o$o(!t @n c!m!oter#"!# c#nceru$u! o%#r!#n m#! #$e( @n #(oc!#/!ee(te #ct!%, num#! du", +!o#ct!%#re# e"#t!c, F de #cee# nu (e m#!#dm!n!(tre#3, @n c#%!t,/! (ero#(e ? #ce#(t, condu!t, -!!nd !r#/!on#$,. n ter#"!#un!c, (e "ot #dm!n!(tr# 7001700 mgJm" !.%. (#u 60120 mgJm"J3! "er o(.Do3e$e (e (c#d d#c, #"#re o $euco"en!e (e%er, :(u+ 2000 neutro-!$eJmm).

9e$-#$#nu$ :me$"#$#n? #$er#n? (#rco$H(!n) #%e# o m#re "o"u$#r!t#te @ntr#t#mentu$ c#nceru$u! o%#r!#n? "n, @n urm, cu 12 decen!! deo#rece (e

"o#te #dm!n!(tr# #m+u$#tor "er o( ? @n cure $un#re cu contro$u$ r!guro( #$

$eucoc!te$or ! trom+oc!te$or. Do3e$e (unt de 0?2 mgJg cor" "e 3!? t!m" de 3!$e ! (e re"et, $# 6 (,"t,mn!.Dur#t# tr#t#mentu$u! e(te de 1218 $un! @n#!nte de un (econd $oo .R,("un(ur!$e -#%or#+!$e #"rec!#te d!n $ucr,r! c#re cu"r!nd &7 +o$n#%etr#t#te (unt de 767. Are to5!c!t#te medu$#r, cre(cut, ? "roduce $euco !trom+oc!to"en!e ! nece(!t, o e%#$u#re #tent, @n t!m"u$ cure$or. L# +o$n#%e$etr#t#te cu (ucce( (# o+(er%#t -rec%ent du", tr#t#mente "re$ung!te #"#r!/!# $#!nter%#$e m#r! du", %!ndec#re de $eucem!! ne$!m-oc!t#re :710).

C$or#m+uc!$u$ :$euer#n) (e -o$o(ete @n #dm!n!(tr#re# or#$, @n do3e de 0?10?2 mgJg cor" "e 3! t!m" de 6 (,"t,mn!? du", c#re (e @ntreru"e "entrure-#cere# medu$#r, (#u @n cure $un#re !nterm!tente.

C!("$#t!nu$ :c!("$#tH$) e(te un com"u( org#n!c de "$#t!n,. n org#n!(mcom"$e5u$ "!erde ce! do! !on! de c$or ! (e $e#g, de ADN? -ormnd "un/!!ntr# (#u !nterc#ten#re cu ru"ere# m#cromo$ecu$e$or. A -o(t !ntrodu( @ntr#t#mentu$ c#nceru$u! o%#r!#n @n 1&6 ? $# @nce"ut @n #dm!n!(tr#re# un!c,?d#r #cum e(te -rec%ent #(oc!#t cu #$te c!to(t#t!ce ? tr#t#mentu$ com+!n#t#m"$!-!cnd rem#rc#+!$ re3u$t#te$e -#%or#+!$e. E(te un med!c#ment to5!c c#re

(e #dm!n!(tre#3, num#! @n ("!t#$ du", o metodo$og!e r!guro#(, cu e%#$u#re#ter#"eut!c, "r!n e5#mene de $#+or#tor # (t,r!! +o$n#%e!. Nu (e #dm!n!(tre#3,: nu (e reduc do3e$e) cnd ure# (#ngu!n# e(te "e(te 0 mgJd$ ? cre#t!n!n#

"e(te 1?2 mgJ d$ ! c$e#renceu$ cre#t!n!ne! (u+ 70 m$Jm!n d#tor!t,ne-roto5!c!t,/!! cre(cute # drogu$u!. C!("$#t!n# m#! #re o ototo5!c!t#te("ec!-!c, ? c#m 1J d!n +o$n#%e "re3!nt, tu$+ur,r! #ud!t!%e ce (e "ot e%!den/!#

"e o #ud!ogr#m, ! $# 710 (e "o#te !n(t#$# (urd!t#te com"$et, !re%er(!+!$,.


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b. Polichimioterapia. Com+!n#t!!$e c!m!oter#"!ce #u un r#("un( com"$et!ntre 20&0 :!m+un#t#t!re# (emn!-!c#t!%# # (u"r#%!etu!r!!). Com+!n#t!#

"o#te (# cu"r!nd#= dou# c!to(t#t!ce :CT


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g#mm#? TN'? IL2? LA? %#cc!n cu CorHne+#cter!um "#r%um? 9e$"#$#n?Le%#m!(o$? BC;? *o$!d!n. Imunoter#"!# ne("ec!-!c# #(oc!#t# c!m!oter#"!e!(# do%ed!t #ct!%# !n c#nceru$ o%#r!#n? d#r ut!$!3#re# (!ngu$#r# # #ce(te!# e(te#m+!gu#

8. Prognostic

In%e(t!g#/!!$e mor-o$og!ce (unt -o$o(!te @n e5"$or#re# tumor!$oro%#r!ene "entru e$#+or#re# d!#gno(t!cu$u! de cert!tud!ne? e%#$u#re# e5ten(!e!

tumor#$e ! !dent!-!c#re# !nd!c#tor!$or t!(u$#r! de "rogno(t!c.n #ce(t (co"? dou, metode mor-o$og!ce (unt ut!$!3#te @n "r#ct!c# de rut!n, =metod# c!to$og!c, ! ce# !(to"#to$og!c, .

S"re deo(e+!re de c#rc!no#me$e tr#ctu$u! gen!t#$ -em!n!n? !n%e(t!g#/!#c!to$og!c, #re o %#$o#re -o#rte m!c, @n d!#gno(t!cu$ c#nceru$u! o%#r!#n. S#@ncerc#t (, (e -#c, d!n "unc/!# tr#n(%#g!n#$, # ("#/!u$u! Doug$#( o!n%e(t!g#/!e de rut!n,. Cu e5ce"/!# !n%#3!e! -o#rte e5t!n(e? d!#gno(t!cu$


57/79

c!to$og!c #$ "rodu(u$u! e5tr#( "r!n #ce#(t, ten!c, "re3!nt, @n(, e5trem dem#r! d!-!cu$t,/!. D#tor!t, @n(, #cur#te/e! metode!? e5#menu$ m!cro(co"!c #$$!c!du$u! de #(c!t,? #$ ce$u! "er!tone#$ (#u #$ "rodu(u$u! de $#%# "er!tone#$ #de%en!t o+$!g#tor!u "entru (t#d!#$!3#re# c#nceru$u! o%#r!#n. S# #r,t#t c, @n(t#d!u$ I $!c!du$ "er!tone#$ "o#te "re3ent# ce$u$e m#$!gne @n 6? .Totod#t, ? re"et#re# e5#menu$u! c!to$og!c or! de cte or! (e "r#ct!c,

"#r#cente3,? "erm!te #"rec!ere# e%o$u/!e! "roce(u$u! "ro$!-er#t!%? ! #nume?#me$!or#re# (#u "rogre(!# #ce(tu!#? e5"r!m#t, "r!n cretere# (#u d!m!nu#re#num,ru$u! de ce$u$e m#$!gne d!n $!c!du$ #(c!t!c. In%e(t!g#/!# c!to$og!c, m#!con(t!tu!e ! (!ngur# metod, de de"!(t#re @ntrun (t#d!u "recoce # une!e%entu#$e rec!d!%e. 9#! "o#te -! ! un #dut#nt #$ d!#gno(t!cu$u!!(to"#to$og!c @n c#3u$ @n c#re (e e5#m!ne#3, "rodu(u$ $!c!d!#n #$ une!tumor! e5t!r"#te c!rurg!c#$.

In%e(t!g#/!# !(to"#to$og!c, re"re3!nt, metod# -o$o(!t# "entru

e$#+or#re# d!#gno(t!cu$u! de cert!tud!ne ! (t#+!$!3#re# c#rc!nomu$u!. n #ce(t(co"? #n#tomo"#to$ogu$ %# e-ectu# e5#menu$ m#cro(co"!c #$ "!e(e! dee5ere3, ? con(emnnd=#r!# to"ogr#-!c, @n c#re (e (emn#$e#3, tumor# o%#r!#n, un! (#u +!$#ter#$,:(u"r#-#/,? cort!c#$,? medu$#r,? !$? o%#r @n tot#$!t#te)Fd!men(!une# tumor!!? #"rec!#t, @n cmFt!"u$ m#cro(co"!c #$ "ro$!-er,

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