5? ????T??????? ??????? S??????? ???O???S

1
5? ????T??????? ??????? S??????? ???O???S

• ?a?a???????s? t?? p???? s?????? ?a??????

?. ???a?
2
?d???e? pa?a???????s?? ap? t?? ESMO (European
Society for Medical Oncology)

• ?s????? ?? ?e???? a??? ?a? ??? e?at?µ??e?µ??a
• St??e???? st?? asfa?? pa?a???????s? t?? as?e???
  µe t?? a?a??a?e? µ??? e?et?se??
• ?p?te???? e??a?e?? d?aµ??f?s?? ??????????
  p???t???? ?a? ?a????sµ?? e????st?? asfa??st????
  ???????
• ?a???????ta? ?a? ?at??????p?????ta? µe ß?s? ta
  ?p?????ta ded?µ??a
• Levels of evidence I - IV
• Grades of recommendation A - D

3

• Levels of evidence I - IV
• Ia ?eta????s? t??a??p???µ???? µe?et??
• Ib ???????st? µ?a t??a??p???µ??? µe??t?
• IIa ???????st? µ?a µ? t??a??p???µ??? µe??t?
• IIb ???????st? µ?a ?a?? s?ed?asµ???
  pe??aµat??? µe??t?
• III ?? pe??aµat???? pe????af???? µe??te?
• IV ??af????/???µe?/eµpe???e? e?e?d??e?µ????
  ep?t??p?? ? a??e?t???
• Grades of recommendation A - D
• ? ?a??? p???t?ta? ?a? sta?e?? s?stas?
  (evidence levels Ia, Ib)
• ? ?as?sµ??? se d?a??s?µe? µ?
  t??a??p???µ??e? a??? ?a?? s?ed?asµ??e? µe??te?
  
• (evidence levels I?a, I?b)
• C ?as?sµ??? se pe????af???? µe??te?
  (evidence level ???)
• D ?as?sµ??? se a?af???? e?d???? ep?t??p??
  ep? ap??s?a? epa???? ????????
• ded?µ???? (evidence level ?V)

4
?a?????? (????pa??? ???s?) ??a pe??stat??? (a?? 100.000 / ?t??) T??at?? (a?? 100.000 / ?t??)
??e?µ??a ??d?e? / ???a??e? 53 83 / 24 49 77 / 22
?ast?? 110 39
?a???? e?t???? ????? 58 15-25 30 4-10
???st?t? 79 31
St?µ???? 19 15
?efa???-t?a????? 35 14
O?????? 18 12
?a????at?? 11 11
????d???? ??st?? 19 8
?e????µa 10 2,5
5
?? µ??????tta????? ?a?????? p?e?µ??a

• Ge????te?a ??a t??? as?e?e?? µe ???a??????
  ??????, ta
  ded?µ??a ??a t? ?at?????? µeta?e?ape?t??? follow
  up, s?µpe???aµßa??µ???? a??µa ?a? t??
  ape?????st???? e??????, e??a? a?t?fat???
• Se as?e?e?? p?? ????? ?p?ß???e? se ?e?ape?a µe
  s??p? t?? ?as?, ???? ?ept?µe???? ?st?????? ?a?
  ??????? e??tas? p??pe? ?a p?a?µat?p?????ta? a??
  3µ??? ta p??ta 2 ?t? ?a? µet?pe?ta a?? 6µ???

6
???????tta????? ?a?????? p?e?µ??a

• Se as?µpt?µat????? as?e?e?? de? ?p?????? ded?µ??a
  p?? ?a ?p?st??????? t?? a?a??a??t?ta ta?t????
  pa?a???????s??
• ??d???? e?et?se?? s?st????ta? s?µf??a µe t??
  ???????? e?de??e??

7
?a?????? µast??

(pa?a???????s? ?at?p?? µaste?t?µ??)

• ?ept?µe??? ?st????? ?a? p????? ??????? e??tas?
• a?? 3-6 µ??e? ??a 3 ?t?
• a?? 6-12 µ??e? ??a ta ep?µe?a 2 ?t?
• ?a? st? s????e?a a?? ?t?? A, µe p??s???
  se ???µe?
• pa?e????e?e? ?p?? ? ?ste?p???s? ?a? ?
  ?a?????? e?d?µ?t????
• ?ast???af?a a?? 1-2 ?t? D
• Se as?µpt?µat????? as?e?e?? de? apa?t???ta? ??
  e?et?se?? ???t??a? ?,?
• ?e???? a?µat?? ?a? ?/? ??e????, a/f?a
  ???a???, sp?????????f?µa ?st??, US ?pat??, CT
  ???a??? ?a? ?????a?, ?a???????? de??te? p.?. CEA
  ? CA 15-3

8
?a?????? µast??

(pa?a???????s? t?p???? ? µetastat???? ?p?t??p??)

• ?et? t?? a?t?µet?p?s? t?? t?p???? ?p?t??p??,
  pa?a???????s? ?p?? ?at?p?? µaste?t?µ??
• St? µetastat??? ??s?, ep?s???e?? ?s? s????
  ??e?????ta? ??a t?? ?a??te?? d??at? a?a???f?s?
  t?? s?µpt?µ?t?? ?a? t? d?at???s? t?? p???t?ta?
  ????

9
?a?????? pa???? e?t???? (µete??e???t???
pa?a???????s?)

• ?p?s??pe? st?? ???a??? d?????s? ?p?t??p?? ?a?
  st?? p?????? a??pt???? de?te??? ???????????
  ?a??????
• Ge????, ?? e??ast???a??? ?a? ape?????st????
  e?et?se?? de? e??a? te?µ????µ??a ep?fe?e?? ?a?
  p??pe? ?a pe????????ta? se as?e?e?? µe ?p?pta
  s?µpt?µata ?
• S???st??ta? p??t??, p??a? t?? ?st?????? ?a? t??
  ???????? e??tas??
• ????s??µ?e?d?s??p?s? a?? 6µ??? ??a 2 ?t?
  (se as?e?e?? µe
  e?t?p?s? st? ?at?te?? s??µ?e?d??)
• ??????s??p?s? st? 1? ?t?? ?a? µet? a?? 3et?a ??a
  a?a??t?s? µet??????? ade??µ?t?? ?a? ?a?????? ?
• US ?pat?? a?? 6µ??? ??a 3 ?t? ?a? µet? st? 4? ?a?
  5? ?t??
• ?/f?a ???a??? a?? ?t?? ??a 5 ?t?
• ??t??s? CEA a?? 3-6 µ??e? ??a 3 ?t? ?a? a?? 6-12
  µ??e? t? 4? ?a? 5? ?t??, ef?s?? ?ta? a?????
  a???µ???

10
?a?????? ????? (µete??e???t??? pa?a???????s?)

• ?p?s??pe? st?? a?a?????s? as?e??? µe a?????
  ?e??????e??? d??s?s?? ? pa??????t???? a?????,
  ?a??? ?a? st?? p?????? a??pt???? de?te???
  ??????????? ?a??????
• ?e? ?p?????? ap?de??e?? ?t? t? ta?t??? follow up
  ße?t???e? t?? ??ßas?
• ?? ???????-e??ast???a??? ?a? ape?????st????
  e?et?se?? de? e??a? te?µ????µ??a ep?fe?e?? ?a?
  p??pe? ?a pe????????ta? se as?e?e?? µe ?p?pta
  s?µpt?µata ?
• ???t??, p??? t? pa???, s???st??ta?
• ?st????? ?a? ????s??µ?e?d?s??p?s? a?? 6µ??? ??a 2
  ?t? V, D
• ?st????? ?a? ??????s??p?s? µe e?t?µ? p???p?d??
  a?? 5et?a ?

11
??????????? ?a?????? (µeta?e?ape?t???
pa?a???????s? p??????µ???? ??s??)

• Se as?e?e?? µe µetastat??? ??s?, p??
  a?t?µet?p?s???a? ep?t???? µe ??µe???e?ape?a ?/?a?
  µetastase?t?µ?, de? ?p???e? ap?de??? ?t? t?
  ta?t??? follow up ße?t???e? t?? ??ßas? t??? V,
  D
• S???st??ta? ep?s???e?? t?? as?e??? µe ß?s? ta
  s?µpt?µat? t???
• ?? e??ast???a??? ?a? ape?????st???? e?et?se??
  p??pe? ?a pe????????ta? se as?e?e?? µe ?p?pta
  s?µpt?µata ?p?t??p?? ?a? ef?s?? ?e???????
  a?a??a?e? ??a t?? ?a??d???s? pe?a?t???
  ?e?ape?t???? ap?f?se?? V, D

12
?a?????? p??st?t?

• ?a ep?peda PSA st?? ??? ?a p??pe? ?a µ?? e??a? µ?
  a????e?s?µa µet? 2 µ??e?, ef?s?? ??e? p??????e?
  ?????? p??state?t?µ?
  ? ?a pe?????s???? se 1 µg\l e?t?? 16 µ????,
  ef?s?? ??e? efa?µ?s?e? ?????? a?t????e?ape?a ??,
  ?
• ?? p??t? follow up, ?at?p?? ??????? ?e?ape?a?,
  p??pe? ?a ???e? st??? 3 µ??e? ?a? ep?p??s?eta t??
  µ?t??s?? PSA, pe???aµß??e?
  
  da?t?????
  e??tas? ????? ?a? ?ata??af? ???? t?? s?µpt?µ?t??,
  e?d???te?a e?e???? p?? s?et????ta? µe t? ?e?ape?a
  
• ?? ep?µe?e? p????aµµat?sµ??e? ep?s???e?? e??a?
  et?s?e?
• Se as?µpt?µat????? as?e?e?? µe ???d? t?? PSA de?
  ?p???e? d?a??s?µ? ?d???a ??a t? ????? ??a????
  ?e?ape?a? 2?? ??aµµ??

13
?a?????? ?efa???-t?a?????

• ?a e??t?µata ??a t?? ?at?????? µeta?e?ape?t???
  pa?a???????s? t?? as?e??? pa?aµ????? a????t?
• ????? st??? ap?te?e? ? p???µ? d?????s?
  t?p???pe???????? ?p?t??p?? ? d???t??? ??s?µ??
  de?te??? p??t?pa???? ?a??????
• ?a e???µata t?? ep?µe???? ???????? e??tas?? e??a?
  e?e??a p?? ?a p??sd????s??? pe?a?t??? e?et?se??
  ?p??
  CT-scan, MRI, US, e?d?s??p?s? µe
  ???? ß?????? ? FNA
• Se as?e?e?? ?p?ß?????te? se a?t????e?ape?a
  apa?te?ta? ??e???? ???e?e?d??? st? 1?, 2? ?a? 5?
  ?t??

14
?a?????? st?µ????

• ?e? ?p???e? ap?de??? ?t? t? ta?t??? follow up,
  µet? t?? a????? a?t?µet?p?s?, ße?t???e? t??
  ??ßas? t?? as?e??? ?a? st?? p?e?ste? pe??pt?se??
  s???st??ta? ep?s???e?? ?a??d????µe?e? ap? ta
  s?µpt?µat? t??? D
• ?st?????, ???????? ??e???? ?a? a?µat????????
  e?et?se?? p?a?µat?p?????ta? ep? s?µpt?µ?t??
  ?p?t??p??, e??
  ape?????st??? d?e?e???s? s???st?ta? se as?e?e??
  p?? e??a? ?p???f??? ??a ???? pa??????t????
  ??µe???e?ape?a?

15
?a?????? pa????at??

• ? pa?a???????s? t?? as?e??? ?at?p?? ???????
  ?e?????????? e?a??es?? pe??????eta? st? ?st?????
  ?a? st?? ??????? e??tas?, ???? ???e????
  ap?te?esµat???? ?e?ape?t???? ep?????? ??a
  t?? a?t?µet?p?s? t?? ?p?t??p??

16
?a?????? ???????

• ?st????? ?a? ??????? e??tas? (s?µpe???aµßa??µ????
  t?? ???p????)
• a?? 3µ??? ??a 2 ?t?
• a?? 4µ??? t? 3? ?t??
• a?? 6µ??? ??a ta ep?µe?a 2 ?t? ? µ????
  te?µ????s? ?p?t??p??
• ? ?a???????? de??t?? CA 125 µp??e? ?a p??ß???e?
  t?? ?p?t??p? t?? ??s?? ?, ? ?a? p??pe? ?a
  e????eta? se ???e p????aµµat?sµ??? ep?s?e??
• CT ?????a? p?a?µat?p??e?ta? ef?s?? ?p???e?
  ??de??? p???d?? t?? ??s?? µe ß?s? t?? ???????
  e??tas? ? t?? ???d? t?? CA 125

17
?a?????? ????d???? ??st??

• ?a?a???????s? ?at?p?? ??????? a?t????e?ape?a?
• ??ste?s??p?s? ?a? ??tta????????? ????? a??
  3µ??? ta 2 p??ta ?t? ?a? µet?pe?ta a?? 6µ???
• ?a?a???????s? ?at?p?? ??ste?t?µ??
• ???????? ??e???? a?? 3µ??? ta 2 p??ta ?t? ?a?
  µet?pe?ta a?? 6µ??? ??a 5 ?t?

18
?e????µa (t?p???-pe??????? ??s??)

• ?e? ?p???e? s?µf???a ??a t? ?at?????? follow up
  ?a? ?p?????? a?epa??? ded?µ??a ??a t? s?stas?
  ta?t???? a?µat???????? ?a? ape?????st???? e??????
  (e?t?? a? p???e?ta? ??a as?e?e?? e?ta?µ????? se
  ??????? e?e???t??? p??t?????a)
• ?? pa?a??t? ?d???e? ??????ta? epa??e?? ??a t??
  p?e????f?a t?? pe??stat???? D
• ??a ß??? pa?a???????s? t?? as?e??? µe sp??ad??? ?
  ?????e??? s??d??µ? d?sp?ast???? sp???? ?a? µe
  ep????s? ?t? ta ???a?? e??a?µata st?? pa?d???
  ?????a ?a? ? ap??st?te?t? ???es? se ?pe???de??
  a?t??e? ap?te???? ep?p??s?et??? pa?????te?
  ???d????
• ?e?taet?? pa?a???????s? ??a ta µe?a??µata p?????
  1,5mm ?a? 10et?? ??a ta ?p????pa (a? ?a? sp???a
  ?p?????? p?? ?a??ste??µ??e? ?p?t??p??)
• ?st????? ?a? ??????? e??tas?, s?µpe???aµßa??µ????
  t?? ep??????? ?eµfad????, a?? 3µ??? ??a 2 ?t? ?a?
  µet?pe?ta a?? 6-12 µ??e?
• ??das?a??a t?? as?e??? ??a ta?t??? a?t?e??tas?
  ?a? ap?f??? ap??st?te?t?? ???es?? se ???a??? ?
  te???t?? ?pe???de?? a?t??e?

19
S?µpe??sµata

• ? t??p?? ?a? ? s????t?ta pa?a???????s?? t??
  ?a?????pa??? ?a???????ta? ap? t?? a?aµe??µe??
  e?????? t?? ??s?? ?a? t? d??at?t?ta a?t?µet?p?s??
  t?? ?p?t??p??
• ?? p???e? ?st????? ?a? ? ?ept?µe??? ???????
  e??tas? ap?te???? ta ????a e??a?e?a t??
  follow up ?a? ?a??d????? t?? pe?a?t??? a?a??a??
  e??ast???a?? ??e???
• ????p???e? ?a? dapa????? e?et?se??, a??µa ?a?
  s???? epa?a?aµßa??µe?e?, de? e?asfa?????? ?fe???
  ep?ß??s??