Samenvatting E3 Oncologie, palliatieve behandeling en levenseinde
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Course
Klinische vraagstukken
Institution
Radboud Universiteit Nijmegen (RU)
Book
Leerboek oncologie
Samenvatting van de hele module E3 met onder andere tumoren, metastasen, behandeling van symptomen bij kanker, mammacarcinoom, prostaatcarcinoom, lymfomen, leukemie, myeloproliferatieve neoplasieën, chirurgisch-oncologische behandelingsprincipes, radiotherapie bij kanker, chemotherapie bij kanker,...
E3 Oncologie,
palliatieve behandeling
en levenseinde
SAMENVATTING
Lieke Schönberger
1
,Inhoud
Tumoren .............................................................................................................................................6
Symptomen tumoren ......................................................................................................................6
Paraneoplastische syndromen ........................................................................................................6
Endocriene paraneoplastische verschijnselen ..............................................................................6
Metabole paraneoplastische verschijnselen ................................................................................7
Metastasen .........................................................................................................................................8
Hersenmetastase ........................................................................................................................8
Botmetastasen ............................................................................................................................8
Behandeling van pijn en andere symptomen bij kanker.......................................................................9
Symptomen ....................................................................................................................................9
Pijn bij patiënten met kanker ..........................................................................................................9
Chronische pijn ......................................................................................................................... 10
Behandeling van de oorzaak van de pijn .................................................................................... 10
Opioïden ................................................................................................................................... 11
Radiotherapie ........................................................................................................................... 11
Vermoeidheid bij patiënten met kanker ........................................................................................ 12
Behandelen ............................................................................................................................... 12
Mammacarcinoom............................................................................................................................ 13
Voorkomen van mammacarcinoom in de familie .......................................................................... 13
Beeldvormende diagnostiek van de mamma ................................................................................. 13
Niet-maligne mamma-afwijkingen ................................................................................................ 15
Fibroadenoom .......................................................................................................................... 15
Fibrocysteuze afwijkingen ......................................................................................................... 15
Tepeluitvloed ............................................................................................................................ 15
Maligne afwijkingen, pathologie en stadiëring .............................................................................. 16
Chirurgie ....................................................................................................................................... 17
Radiotherapie ............................................................................................................................... 17
Systemische therapie .................................................................................................................... 17
Prostaatcarcinoom............................................................................................................................ 18
Lymfomen ........................................................................................................................................ 21
Pathologie..................................................................................................................................... 22
Kliniek en stadiëring ...................................................................................................................... 22
Hodgkinlymfoom .......................................................................................................................... 24
2
, Klassiek Hodgkinlymfoom.......................................................................................................... 24
Nodulair lymfocytenrijk Hodgkinlymfoom ................................................................................. 25
Non hodgkin lymfoom................................................................................................................... 26
Diffuus grootcellig B-cellymfoom (DLBCL) .................................................................................. 26
Folliculair lymfoom.................................................................................................................... 27
T-cellymfomen .......................................................................................................................... 27
Multipel myeloom (MM) ........................................................................................................... 27
Verschil Hodgkin en non-Hodgkin.................................................................................................. 28
Leukemie .......................................................................................................................................... 29
Ontstaan van leukemie ................................................................................................................. 29
Acute leukemie myeloïde leukemie (AML) .................................................................................... 29
Acute lymfatische leukemie (ALL) .................................................................................................. 31
Myelodysplastische syndromen (MDS) .......................................................................................... 31
Chronische myeloïde leukemie (CML) ........................................................................................... 32
Chronische lymfatische leukemie (CLL).......................................................................................... 33
Myeloproliferatieve neoplasieën (MPN)............................................................................................ 34
Polycythemie vera (PV) ................................................................................................................. 34
Essentiële trombocytose (ET) ........................................................................................................ 35
Myelofibrose (MF) ........................................................................................................................ 36
Chirurgisch-oncologische behandelingsprincipes............................................................................... 38
Chirurgische biopsie .................................................................................................................. 38
Curatieve of palliatieve chirurgie ............................................................................................... 38
Neoadjuvante therapie ............................................................................................................. 38
Profylactische chirurgie ............................................................................................................. 38
Radiotherapie bij kanker ................................................................................................................... 39
Effecten van ioniserende straling in de cel ................................................................................. 39
Gefractioneerde bestraling........................................................................................................ 39
Bijwerkingen ............................................................................................................................. 39
De rol van radiotherapie bij in opzet curatieve behandelingen ...................................................... 40
Bijwerkingen van bestraling en de verschillende behandelingsvormen .......................................... 40
Radiotherapie als pijnbestrijding ................................................................................................... 40
Chemotherapie bij kanker ................................................................................................................. 41
Chemotherapie en de celcyclus ..................................................................................................... 41
Wisselwerking tussen chemotherapie en tumorbiologie ............................................................... 41
3
, Resistentie tegen de behandeling ................................................................................................. 41
Cellulaire resistentie.................................................................................................................. 42
Toxiciteit van chemotherapie ........................................................................................................ 43
Indeling en werkingsmechanismen van cytostatica ....................................................................... 43
Geneesmiddelen die de cel doden door het genomische DNA te beschadigen. .......................... 43
Topo-isomerase inhibitoren ...................................................................................................... 44
Microtubulaire inhibitoren ........................................................................................................ 44
Antimetabolieten ...................................................................................................................... 44
Toepassing in de kliniek ................................................................................................................ 48
Combinatietherapie .................................................................................................................. 48
Synergie met radiotherapie ....................................................................................................... 48
Dosisintensiteit ......................................................................................................................... 48
Adjuvante en neoadjuvante behandeling .................................................................................. 49
Targeted therapy bij kanker .............................................................................................................. 50
Hormonale therapie ...................................................................................................................... 50
Receptoren voor steroïdhormonen ........................................................................................... 50
Hormonale therapie .................................................................................................................. 51
Principes van hormonale therapie ............................................................................................. 51
Aromataseremmers (anastrozol, letrozol) ................................................................................. 54
Antihormonen........................................................................................................................... 54
Totale liganddepletie................................................................................................................. 55
Regressie door endocriene therapie .......................................................................................... 55
Receptoren en effect van endocriene therapie .......................................................................... 55
Ontwikkeling van ongevoeligheid .............................................................................................. 55
Adjuvante endocriene therapie ................................................................................................. 55
Moleculaire doelgerichte behandelingen ...................................................................................... 56
Monoklonale antilichamen............................................................................................................ 57
Kleine moleculen .......................................................................................................................... 58
Immunologie van kanker................................................................................................................... 59
Tumorantigeenpresentatie........................................................................................................ 59
Inductie van een T-celrespons ................................................................................................... 59
Migratie van T-cellen naar de tumor en infiltratie in de tumor .................................................. 60
Doden van de tumorcellen door T-cellen ................................................................................... 60
Therapeutische interventies bij de cancer immunity cycle ............................................................. 60
4
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