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12. Kirurško zdravljenje raka dojkJanez Žgajnar, 2022, published professional conference contribution Abstract: Zgodnji rak dojk pogosto najprej zdravimo kirurško. Zgodovinsko je razvoj zdravljenja potekal od obsežnejših posegov v smer manj invazivne kirurgije. V Sloveniji smo novosti v razvoju tudi soustvarjali in novosti hitro uvajali v klinično prakso. V kirurgiji raka dojk ločimo operacije dojke ter operacije področnih bezgavk. Pri tumorju v dojki želimo odstraniti celoten tumor skupaj
z delom zdravega tkiva, t. i. varnostnim plaščem. Če je to mogoče in je obenem preostanek dojke estetsko sprejemljiv, se odločimo za ohranitev dojke.
Pogosto je ob nekaterih indikacijah nujna odstranitev cele dojke, ki jo pogosto združimo z rekonstrukcijo. Netipne lezije dojk operiramo po predhodni slikovno vodeni lokalizaciji. V kirurgiji področnih bezgavk uporabljamo odstranitev vseh pazdušnih bezgavk ali biopsijo varovalne bezgavke (angl. Sentinel) . Če v varovalni bezgavki ni zasevkov ali pa so le-ti majhni oziroma jih je malo, lahko odstranitev vseh pazdušnih bezgavk opustimo. Indikacije za odstranitev vseh pazdušnih bezgavk se še naprej ožijo. V prihodnosti lahko pričakujemo nadaljnjo deeskalacijo kirurškega zdravljenja raka dojk.
Keywords: kirurško zdravljenje, rak dojke, bolniki
Published in DiRROS: 22.12.2022; Views: 394; Downloads: 101
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13. Državni program obvladovanja raka – kratko poročilo za leto 2021 in rak dojk v DPORSonja Tomšič, Janez Žgajnar, 2022, published professional conference contribution Abstract: Državni program obvladovanja raka (DPOR) je državni strateški dokument, ki vključuje aktivnosti s področij primarne preventive, sekundarne preventive, diagnostike, zdravljenja, celostne rehabilitacije, onkološke paliativne oskrbe, raziskovanja, spremljanje bremena raka in kakovosti obravnave ter izobraževanja. Od svoje vzpostavitve v letu 2010 do danes je pomembno prispeval k izboljšanju stanja na področju obvladovanja raka v Sloveniji. Rast incidence se je pri ženskah zmanjšala, pri moških pa je po letu 2010 opaziti celo upadanje, preživetje bolnikov z rakom se povečuje, na področju celostne rehabilitacije in onkološke paliativne oskrbe pa se dogajajo pomembni premiki. Rak dojk, ki je eden od najpogostejših rakov, ima v Državnem programu obvladovanja raka 2022–2026 pomembno mesto. Številni cilji in ukrepi se nanašajo na to vrsto raka posredno, med neposredno vezanimi pa so najpomembnejši: vzpostavitev spremljanja kakovosti obravnave ter priprava predlogov sprememb preko podatkov, zbranih v kliničnem registru raka dojk, spremljanje ciljnih vrednosti za dogovorjene kazalnike kakovosti s strani strokovne skupine DPOR za raka dojk, posodobitev organiziranega presejanja za raka dojk v skladu s posodobljenimi priporočili Sveta EU in prilagoditev za uvedbo v slovenski prostor, širitev celostne rehabilitacije bolnic/kov z rakom dojk iz pilotnega projekta na nacionalno raven ter krepitev onkološke genetike.
Keywords: obvladovanje raka, preventivni programi, javno zdravje
Published in DiRROS: 22.12.2022; Views: 361; Downloads: 106
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14. Trends and timing of risk-reducing mastectomy uptake in unaffected BRCA1 and BRCA2 carriers in SloveniaTaja Ložar, Janez Žgajnar, Andraž Perhavec, Ana Blatnik, Srdjan Novaković, Mateja Krajc, 2021, original scientific article Abstract: Objectives. Risk-reducing mastectomy (RRM) is one of key prevention strategies in female carriers of germline BRCA pathogenic/likely pathogenic variants (PV/LPV). We retrospectively investigated the rate, timing and longitudinal trends of bilateral RRM uptake and the incidence and types of cancers among unaffected BRCA carriers who underwent genetic counseling at the Institute of Oncology Ljubljana in Slovenia. Materials and Methods. Female BRCA carriers without personal history of cancer were included in the study. Clinical data on PV/LPV type, date of RRM, type of reconstructive procedure, occult carcinoma and histopathology results was collected and analyzed. Results. Of the 346 unaffected BRCA carriers (median age 43 years, 70% BRCA1, 30% BRCA2, median follow-up 46 months) who underwent genetic testing between October 1999 and December 2019, 25.1% had a RRM (range 35-50 years, median age at surgery 38 years). A significant difference in time to prophylactic surgery between women undergoing RRM only vs. women undergoing RRM combined with risk-reducing salpingo-oophorectomy was observed (22.6 vs 8.7 months, p=0.0009). We observed an upward trend in the annual uptake in line with the previously observed Angelina Jolie effect. In 5.7% of cases, occult breast cancer was detected. No women developed breast cancer after RRM. Women who did not opt for surgical prevention developed BRCA1/2-related cancers (9.3%). Conclusion. The uptake of RRM among unaffected BRCA carriers is 25.1% and is similar to our neighboring countries. No women developed breast cancer after RRM while women who did not opt for surgical prevention developed BRCA1/2 related cancers in 9.3% of cases. The reported data may provide meaningful aid for carriers when deciding on an optimal prevention strategy.
Keywords: risk-reducing mastectomy, breast cancer, BRCA
Published in DiRROS: 21.09.2022; Views: 428; Downloads: 145
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15. Real-world data on detection of germline and somatic pathogenic/likely pathogenic variants in BRCA1/2 and other susceptibility genes in ovarian cancer patients using next generation sequencingVida Stegel, Ana Blatnik, Erik Škof, Vita Šetrajčič Dragoš, Mateja Krajc, Brigita Gregorčič, Petra Škerl, Ksenija Strojnik, Gašper Klančar, Marta Banjac, Janez Žgajnar, Maja Ravnik-Oblak, Srdjan Novaković, 2022, original scientific article Abstract: Detection of germline and somatic pathogenic/likely pathogenic variants (PV/LPV) in BRCA genes is at the moment a prerequisite for use of PARP inhibitors in different treatment settings of different tumors. The aim of our study was to determine the most appropriate testing workflow in epithelial ovarian cancer (EOC) patients using germline and tumor genotyping of BRCA and other hereditary breast and/or ovarian cancer (HBOC) susceptibility genes. Consecutive patients with advanced non-mucinous EOC, who responded to platinum-based chemotherapy, were included in the study. DNA extracted from blood and FFPE tumor tissue were genotyped using NGS panels TruSightCancer/Hereditary and TruSight Tumor 170. Among 170 EOC patients, 21.8% had BRCA germline or somatic PV/LPV, and additionally 6.4% had PV/LPV in other HBOC genes. Sensitivity of tumor genotyping for detection of germline PV/LPV was 96.2% for BRCA genes and 93.3% for HBOC genes. With germline genotyping-only strategy, 58.8% of HBOC PV/LPV and 68.4% of BRCA PV/LPV were detected. By tumor genotyping-only strategy, 96.1% of HBOC PV/LPV and 97.4% of BRCA PV/LPV were detected. Genotyping of tumor first, followed by germline genotyping seems to be a reasonable approach for detection of PV/LPV in breast and/or ovarian cancer susceptibility genes in non-mucinous EOC patients.
Keywords: BRCA, ovarian cancer, tumor genotyping, HBOC
Published in DiRROS: 06.09.2022; Views: 503; Downloads: 274
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16. Priporočila diagnostike in zdravljenja raka dojkAna Blatnik, Andraž Perhavec, Barbara Gazić, Barbara Vidergar-Kralj, Erika Matos, Ivica Ratoša, Janez Žgajnar, Kristijana Hertl, Marko Hočevar, Mateja Krajc, Nikola Bešić, Simona Borštnar, Marija Snežna Paulin-Košir, Tanja Marinko, Ulrika Klopčič, 2021, not set Keywords: presejanje, asimptomatske bolnice, simptomatske bolnice, genetsko svetovanje, slikovna diagnostika, citopatologija, kirurško zdravljenje, sistemsko zdravljenje, algoritmi, radioterapija, elektronske knjige
Published in DiRROS: 17.03.2022; Views: 792; Downloads: 476
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17. Kaj je dedni rak? : dedno pogojeni raki - genetsko svetovanje in testiranjeAna Blatnik, Mateja Krajc, Ksenija Strojnik, Srdjan Novaković, Barbara Perić, Marta Banjac, Janez Žgajnar, 2020, not set Keywords: medicinska genetika, genetsko testiranje
Published in DiRROS: 11.03.2022; Views: 724; Downloads: 223
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18. Državni presejalni program za raka dojk - DORA : poročilo za obdobje: oktober 2007-julij 2008Maja Primic-Žakelj, Mateja Krajc, Gorazd Noč, Maksimiljan Kadivec, Kristijana Hertl, Snježana Frković-Grazio, Janez Žgajnar, Aljoša Rojec, Marija Seljak, Blanka Mikl Mežnar, Anže Drolc, Tomaž Grbec, 2008, final research report Published in DiRROS: 26.03.2021; Views: 1085; Downloads: 345
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19. 33. onkološki vikend : državni presejalni programi v onkologiji danes, jutri : zbornik : Ljubljana, 9. oktober 2020, Domus Medica2020, not set Keywords: presejalni programi, nacionalni programi, program ZORA, program DORA, program Svit, perspektivni razvoj, zborniki
Published in DiRROS: 15.03.2021; Views: 1177; Downloads: 423
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20. Rak trebušne slinavke : kaj morate vedeti o bolezni?Janja Ocvirk, Martina Reberšek, Zvezdana Hlebanja, Erik Škof, Irena Oblak, Vaneja Velenik, Franc Anderluh, 2008, dictionary, encyclopaedia, lexicon, manual, atlas, map Keywords: dejavniki tveganja, simptomi, diagnostika, zdravljenje, bolečina
Published in DiRROS: 10.08.2020; Views: 1689; Downloads: 681
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