{"id":96,"date":"2017-01-10T13:19:45","date_gmt":"2017-01-10T12:19:45","guid":{"rendered":"http:\/\/www.mojidoktori.rs\/blog\/?p=96"},"modified":"2017-01-12T13:41:42","modified_gmt":"2017-01-12T12:41:42","slug":"rak-testisa","status":"publish","type":"post","link":"https:\/\/www.mojidoktori.rs\/blog\/rak-testisa\/","title":{"rendered":"Rak testisa"},"content":{"rendered":"
\n

RAK TESTISA<\/span><\/a><\/p>\n

Rak testisa nastaje u polnim \u017elezdama mu\u0161karaca u kojima se stvaraju mu\u0161ke polne \u0107elije (spermatozoidi) i mu\u0161ki polni hormon testosteron koji podsti\u010de stvaranje i sazrevanje spermatozoida u testisima koji su neophodni za oplodnju.<\/span><\/p>\n

Tumori testisa – retki tumori<\/span>
\n Simptomi i dijagnoza raka testisa<\/span>
\n Stadijumi bolesti kod raka testisa<\/span>
\n Le\u010denje tumora testisa<\/span>
\n Zna\u010daj ranog otkrivanja<\/span>
\n Tumori testisa – retki tumori<\/span><\/p>\n

Tumori testisa su retki tumori koji \u010dine 1% svih zlo\u0107udnih tumora kod mu\u0161karaca, ali su u dobi od 15. do 34. godine naj\u010de\u0161\u0107i solidni tumori. Naj\u010de\u0161\u0107e se pojavljuju u mla\u0111im starosnim grupama, re\u0111i su u detinjstvu, a najre\u0111e ih vi\u0111amo kod starijih mu\u0161karaca. Javljaju se s ve\u0107om u\u010destalo\u0161\u0107u kod belaca, a naj\u010de\u0161\u0107i su u razvijenim zemljama (skandinavske zemlje, Velika Britanija). Najni\u017ee stope pojavnosti su zabele\u017eene me\u0111u Azijcima i Afrikancima.<\/span><\/p>\n

Najpoznatiji faktori rizika za nastanak tumora testisa su tzv. kriptorhizam (nespu\u0161teni testis), rak testisa u porodici, prethodna istorija bolesti o preboljelim tumoru zametnih \u0107elija, genetski poreme\u0107aji, trauma testisa i sl.<\/span><\/p>\n

Simptomi i dijagnoza raka testisa<\/span><\/p>\n

Simptomi koji mogu upu\u0107ivati na rak testisa su postepeno ili naglo pove\u0107ani ili smanjeni testisi, njihovo otvrdnu\u0107e, ose\u0107aj te\u017eine, bol u le\u0111ima i oticanje nogu.<\/span>
\n Naj\u010de\u0161\u0107i simptomi koji mogu upu\u0107ivati na rak testisa su postepeno ili naglo pove\u0107ani ili smanjeni testisi, njihovo otvrdnu\u0107e, ose\u0107aj te\u017eine, bol u le\u0111ima i oticanje nogu. Retko se mogu pojaviti simptomi upale te klini\u010dka slika akutnog zbivanja u stomaku zbog krvarenja u testis ili torzije testisa. Znaci pro\u0161irene bolesti su nedostatak i kratak dah, krvavi ispljuvak, te retko glavobolje i bolovi u kostima.<\/span><\/p>\n

Dijagnoza raka testisa se postavlja nakon fizi\u010dkog pregleda, UZV testisa i odre\u0111ivanja vrednosti tumorskih biljega \u03b2-HCG, alfa feto proteina- AFP i laktat dehidrogenaze – LDH u krvi. Palpacija testisa je pre bilo kakvog pregleda testisa naravno nu\u017ena, ali nije tako ta\u010dna kao prethodno navedene metode pregleda, jer palpacijom ukoliko ne opipamo nikakav \u010dvor ili promenu strukture testisa nismo u potpunosti sigurni da tumor testisa nije prisutan.<\/span><\/p>\n

Radikalna ingvinalna orhidektomija (hirur\u0161ko uklanjanje testisa) je osnovni po\u010detni dijagnosti\u010dki i terapijski postupak. Izuzetno, ako se radi o vrlo uznapredovaloj bolesti s prate\u0107im plu\u0107nim ili neurolo\u0161kim tegobama preporu\u010duje se le\u010denje zapo\u010deti specifi\u010dnom onkolo\u0161kom terapijom, a tek kasnije sprovesti orhidektomiju.<\/span><\/p>\n

Ukoliko se dijagnostikom utvrdi prisutnost raka testisa koja se i potvrdi na patohistolo\u0161kom nalazu tumora, pristupa se daljoj dijagnostici eventualno prisutnih rasada (MSCT stomaka i karlice, MSCT grudnog ko\u0161a kod selekcioniranih bolesnika, postoperacijsko odre\u0111ivanje tumorskih biljega, 7. dan nakon operacije). Pet- CT i MR dijagnostika nemaju prednost pred ostalom dijagnostikom kod odre\u0111ivanja pro\u0161irenosti bolesti.<\/span><\/p>\n

Stadiji bolesti kod raka testisa<\/span><\/p>\n

I stadijum : tumor ograni\u010den na oboleli testis<\/span>
\n II stadijum : pro\u0161irenost bolesti u tzv. retroperitonealno limfne \u010dvorove (\u010dvorovi u zadnjem delu trbu\u0161ne duplje)<\/span>
\n III stadijum : pro\u0161irenost bolesti u udaljene organe i limfne \u010dvorove van trbu\u0161ne duplje<\/span><\/p>\n

Histopathologi , 95% svih tumora testisa poti\u010de iz germinativnih \u0107elija, a oni se dele na \u010diste seminoma (40% bolesnika) i neseminome (embrionalni tumori testisa, tumori zumanjcana vre\u0107e, koriokarcinomi i Teratoma testisa). Na\u010delno mo\u017eemo re\u0107i da seminoma imaju ne\u0161to bolju prognozu.<\/span><\/p>\n

Seminomski tumori testisa uglavnom metastaziraju limfogeno, a povra\u0107aj bolesti je naj\u010de\u0161\u0107i u prve dve godine nakon orhidektomije. Neseminomskom tumori testisa se vrlo \u010desto \u0161ire krvlju, medijana povrata bolesti kod neseminomskih tumora testisa je kratak i iznosi oko 4 meseca, a 95% recidiva se javi u roku od dve godine.<\/span><\/p>\n

Ukoliko ne postoji dokaz primarnog tumora u testisu mo\u017ee se postaviti dijagnoza ekstratestikularnog tumora germinativnih \u0107elija (u oko 5-8% bolesnika). Naj\u010de\u0161\u0107e lokalizacije takvih tumora su u medijastinalni poreme\u0107aji, limfnim \u010dvorovima zadnjeg dela trbu\u0161ne duplje ili pinealnoj \u017elezdi.<\/span><\/p>\n

Le\u010denje tumora testisa<\/span><\/p>\n

Zahvaljuju\u0107i efikasnim metodama le\u010denja rak testisa je izle\u010div u 95% svih pacijenata.<\/span>
\n Zahvaljuju\u0107i efikasnim metodama hirur\u0161kog i onkolo\u0161kog le\u010denja rak testisa je izle\u010div u 95% svih bolesnika sa ovom dijagnozom, te u 80% pacijenata sa metastatskim bole\u0161\u0107u.<\/span><\/p>\n

Multidisciplinarnost je neophodna u le\u010denju onkolo\u0161kih pacijenata. Zna\u010daj timskog rada je posebno nagla\u0161ena u mladih pacijenata sa tumorom testisa koji je ako se ispravno dijagnostikuje, le\u010di i kontroli\u0161e izle\u010div u visokom procentu iu diseminiranoj bolesti.<\/span><\/p>\n

Inicijalni plan le\u010denja ovih bolesnika treba doneti multidisciplinarni tim koji se sastoji od urologa, patologa, radiologa i onkologa. Izuzetno, u hitnim situacijama kod jako uznapredovale bolesti le\u010denje se mo\u017ee zapo\u010deti i bez sastanka multidisciplinarnog tima \u010dak i bez patohistolo\u0161ke potvrde bolesti, a na osnovu samo povi\u0161enih vrednosti tumorskih biljega.<\/span><\/p>\n

Vrlo je va\u017eno savetovati bolesnika da u\u010dini skladi\u0161tenje semena . Stoga se uglavnom pre operativnog le\u010denja pohrani uzorak sperme u banku sperme, kako bi u slu\u010daju kasnijih problema sa plodnosti imali pohranjeni uzorak sperme za potomstvo. Neophodno je i detaljno razgovarati s bolesnikom kako bi mu se objasnili svi prednosti i rizici pojedinog na\u010dina le\u010denja.<\/span><\/p>\n

Rak testisa se naj\u010de\u0161\u0107e dijagnostikuje u mla\u0111oj \u017eivotnoj dobi iu I. klini\u010dkom stadijumu . S obzirom na visoku stopu izlje\u010divosti i mogu\u0107e kasne posledice onkolo\u0161kog le\u010denja jo\u0161 uvek postoje prijepori vezani uz optimalni terapijski pristup u I. stadijumu bolesti (posebno u bolesnika sa neseminomskom tumorima), sa sve \u010de\u0161\u0107om opcijom aktivnog pra\u0107enja \u010dak iu visokorizi\u010dnih bolesnika.<\/span><\/p>\n

U II. stadijumu bolesti le\u010denje se individualizira zavisno o histolo\u0161kom tipu, stepena zahva\u0107enosti retroperitonealnih limfnih \u010dvorova i vrednostima tumorskih biljega \u03b2-hCG i AFP te LDH. Standardne terapijske opcije su radioterapija (seminoma), hemoterapija po protokolu BEP te retroperitonealno limfadenektomija (RPLND), ao njihovoj primeni uglavnom postoji konsenzus svih relevantnih stru\u010dnih dru\u0161tava.<\/span><\/p>\n

U bolesnika s uznapredovalom bole\u0161\u0107u i visokim rizikom relapsa nastoje se prona\u0107i aktivniji hemoterapijski protokoli u prvoj liniji (u odnosu na standardne protokole BEP i VIP), pri \u010demu se kombinacija paklitaksela, ifosfamid i cisplatina (TIP) \u010dini obe\u0107avaju\u0107om.<\/span><\/p>\n

U terapiji povrata bolesti izazov predstavlja optimalni odabir pacijenata koji \u0107e biti le\u010deni standardnom hemoterapijom (naj\u010de\u0161\u0107e kombinacijom cisplatina i ifosfamid uz vinblastin ili paklitaksel), odnosno visokodoznom hemoterapijom uz transplantaciju mati\u010dnih \u0107elija hematopoeze, pri \u010demu poma\u017eu brojni prognosti\u010dki modeli.<\/span><\/p>\n

Zna\u010daj ranog otkrivanja<\/span><\/p>\n

Rak testisa ne mo\u017ee se prevenirati stoga su redovni pregledi neophodni za rano otkrivanje bolesti.<\/span>
\n Kako se rak testisa ne mo\u017ee prevenirati, redovni pregledi neophodni su za rano otkrivanje bolesti i uspe\u0161nije le\u010denje. \u010cesto se doga\u0111a da bolest nije na vreme dijagnostikovana jer nema sistematski odre\u0111enih pregleda aktivnog tra\u017eenja raka testisa u populaciji koju bolest zahvata. To su tumori koji brzo rastu te je stoga va\u017eno rano otkrivanje, ne samo da bi bili uspe\u0161ni u le\u010denju, nego da bi se izbegla hemoterapija i zra\u010denje koji zna\u010dajno mogu o\u0161tetiti zdrave organe te uticati na reproduktivnu sposobnost mladog mu\u0161karca.<\/span><\/p>\n

S obzirom na dugotrajno pre\u017eivljavanje pacijenata sa rakom testisa sve se vi\u0161e pa\u017enje posve\u0107uje mogu\u0107im zdravstvenim rizicima vezanim uz provedenu radioterapiju, hemoterapiju i radiolo\u0161ko pra\u0107enje, prvenstveno u smislu induciranja drugih primarnih tumora, ali i drugih patolo\u0161kih stanja. Nova istra\u017eivanja fokusiraju se na molekulskom genske mehanizme koji kod pacijenata uslovljavaju individualnu sklonost razvoju toksi\u010dnih efekata jedinjenja platine. Identifikacijom potencijalno rizi\u010dnih pacijenata na osnovu molekulskih biomarkera mogla bi se spre\u010diti kasna toksi\u010dnost i o\u010duvati kvalitet \u017eivota.<\/span><\/p>\n

\u00a0<\/span><\/div>\n<\/div>\n

 <\/p>\n

\u00a0<\/span><\/div>\n","protected":false},"excerpt":{"rendered":"

RAK TESTISA Rak testisa nastaje u polnim \u017elezdama mu\u0161karaca u kojima se stvaraju mu\u0161ke polne \u0107elije (spermatozoidi) i mu\u0161ki polni hormon testosteron koji podsti\u010de stvaranje i sazrevanje spermatozoida u testisima koji su neophodni za oplodnju. Tumori testisa – retki tumori Simptomi i dijagnoza raka testisa Stadijumi bolesti kod raka testisa…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[75,67,76,71,66,74,68,69,70],"class_list":["post-96","post","type-post","status-publish","format-standard","hentry","category-blog","tag-kriptorhizam","tag-lecenje-tumora-testisa","tag-nespusteni-testis","tag-palpacija-testisa","tag-rak-testisa","tag-rplnd","tag-stadijumi-bolesti-kod-raka-testisa","tag-tumori-testisa","tag-uzv-testisa"],"yoast_head":"\nRak testisa - Popusti i kuponi<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.mojidoktori.rs\/blog\/rak-testisa\/\" \/>\n<meta property=\"og:locale\" content=\"sr_RS\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rak testisa - Popusti i kuponi\" \/>\n<meta property=\"og:description\" content=\"RAK TESTISA Rak testisa nastaje u polnim \u017elezdama mu\u0161karaca u kojima se stvaraju mu\u0161ke polne \u0107elije (spermatozoidi) i mu\u0161ki polni hormon testosteron koji podsti\u010de stvaranje i sazrevanje spermatozoida u testisima koji su neophodni za oplodnju. 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