Prezentace aplikace PowerPoint - FN Brno

Karcinom aludku Bartuek D. Radiologick klinika FN Brno-Bohunice a Lkask fakulta Masarykovy univerzity Brno pednosta: prof. MUDr. Vlastimil Vlek, CSc., MBA Valtick kurzy abdominln radiologie 2013 Karcinom aludku: V souasnosti tvrtou nejastj pinou mrt na rakovinu v Evrop. Celosvtov je druhm

nejastjm malignm onemocnnm. Incidence m klesajc rove. Rozdln geografick distribuce Japonsko, na Severn Amerika. Vskyt u mu je 2x vy ne u en Multifaktoriln onemocnn Prognza ptiletho peit je kolem 20 %. Epidemiologick situace ZN aludku (C16) a jcnu (C15) v R v roce 2010 (NOR)

C16 C15 Mui/ eny celkem

Mui/ eny celkem Abs.poet 956/634 1590

492/101 593 Na 100000 18,5/11,8 15,1 9,5/1,9

5,6 Abs.poet 757/463 1220 382/84

466 Na 100000 14,6/8,6 11,6 7,4/1,6

4,4 Incidence Mortalita Vvoj incidence a mortality v R Snen mortality onemocnn je pedevm zpsobeno poklesem

incidence, nikoli zlepenm terapie. Problmem karcinomu aludku v R (ale i v jinch vysplch zemch) je pedevm pozdn diagnostika, kdy vce ne 50 % nemocnch je diagnostikovno ve stadiu IV, ppadn stadium nen ureno. Pzniv stadia I a II jsou zachycena v cca 20 %. WHO klasifikace ndor aludku Epiteliln ndory Mesenchymln ndory:

leiomyom, schwanom, plex. fibromyxom, GIST, Kaposiho sarkom, leiomyosarkom, glomus tumor, synoviln sarkom Lymphomy: MALT, Burkitv lymphom, Tlymphomy, Hodkinv lymphom Sekundrn ndory: lymphogenn: melanom, mamma, plce

pm en: jcen, pankreas intraperitoneln: diseminovan karcinomy ovaria WHO Classificiation of Tumors of Digestive System, Lyon WHO Press, 2010 Epiteliln tumory: Premalign lze: Karcinomy: adenomy, dysplasie

adenoCa papilrn, tubulrn, mucinosn, patn diferencovan vetn bunk peetnho prstenu, smen. adenoskvamosn Ca, karcinom s lymphoidnm stromatem, hepatoidn, dladicobunn, nediferencovan Neroendokrinn neoplasie: neuroendokrinn tumor NET G1( karcinoid) Neuroendokrinn karcinom Serotonin, gastrin NET

Karcinomy aludku Malign epitelov ndory, biologicky a geneticky heterogenn skupina ndor multifaktoriln etiologie Definujcm znakem je invaze pes basln membrnu do sliznin proprie Invazivn karcinomy: asn (sliznice a submukoza) pokroil (musc. propria a hloubji) Intraepiteln neoplasie - dysplasie Ca in situ

Makroskopick varianty adenoCa aludku: asn karcinom (limitovan na sliznici a submukzu) - polypoidn, plon se c (SUPER) a penetrujc (PEN) exofytick, polypoidn ulcerativn infiltrujc difuzn infiltrativn (linitis plastica)

Karcinom aludku: per continuitatem do okolnch orgn (pankreas, jtra, luov cesty, jcen, duodenum, kolon), pi perforaci stny se dostv do peritoneln dutiny, kde se dle implantan. lymfogenn do gastrickch a mediastinlnch uzlin (a do hlubokch krnch uzlin Virchowovy uzliny), do plic. hematogenn do jater, kost (osteolza ), ovaria Krukenbergv tumor;

Implantace po peritoneu (karcinomatza s hemorhagickm ascitem, metastzy v omentu). Etiopatogeneze karcinomu aludku Nitrity/nitrty, soli v potrav, uzen, kouen, deficit A,C Genetika: aktivace onkogen, inaktivace tumorsupresor, genov polymorfismy Correova patogeneze - Akutn gastritis - Chronick gastritis - Atrofick gastritis, Intestinln metaplasie - LG dysplasie - HG dysplasie - adenoCa, intestinln typ

- polypy, achlorhydrie, Menetrierova nemoc, resekce aludku II. typu. Helicobacter pylori je faktor vzniku zntu, atrofick gastritidy a histologickho vvoje k aludenmu adenokarcinomu. 8x vy riziko. Laurnova klasifikace adeno Ca Difusn - u mladch bez gastritidy a metaplzie, tvo jej buky typu peetnho prstenu ve vazivovm stromatu (skirhus linitis plastica)

nebo plavou v hlenu (gelatinzn karcinom), m hor prognzu. Intestinln - cylindrocelulrn, vznik na podklad chronick atrofick gastritidy s intestinln metaplzi sliznice a ve vym vku, Smen Indeterminovan TNM klasifikace

T1 ohranien na sliznici a submukzu; T2 pronik pes muscularis propria; T3 pronik serzou; T4 invaze do okolnch struktur; N1 16 regionlnch uzlin

(perigastrick, hepatoduodenln); N2 715 regionlnch uzlin; N3 vce jak 15 regionlnch uzlin; M1 ptomnost vzdlench metastz (neregionln uzliny supraklavikulrn,

jtra, plce, kosti, mozek). Prognoza v zvislosti na stadiu onemocnn Zobrazovac metody ndory aludku

Kontrastn rtg vyeten aludku Sonografie Vpoetn tomografie CT Magnetick rezonance MR Digitln subtrakn angiografie DSA

PET Intervenn radiologie Kontrastn rtg vyeten aludku Dvojkontrastn vyeten v hypotonii Kontrastn rtg vyeten aludku Transabdominln sonografie Monosti posuzovn aludku jsou omezen

Nhodn nlez pi UZ bicha Transabdominln sonografie Hodnocen loiskovch zmn jater CEUS Endosonografie Vpoetn tomografie - CT MDCT submilimetrov ezy

Kvalita vyeten distense aludku, hypotonie, aplikace k.l.i.v., postkontrastn 2 fze Multiplanrn rekonstrukce obrazu Vpoetn tomografie - CT

Hodnocen infiltrace, stny, rozsah Propagace do okol Vztah k okolnm strukturm Detekce zvtench uzlin Ptomnost mts Staging

Vpoetn tomografie - CT Pedoperan zhodnocen anatomickch pomr Resekabilita Hodnocen komplikac - perforace, fistulace, krvcen Biopsie loisek jater

Vpoetn tomografie - CT Karcinom aludku: Digitln subtrakn angiografie - DSA Aktivn krvcen Pedoperan vyeten u nejasnch cvnch zsobench embolizace Digitln subtrakn angiografie - DSA

Chemo-embolizace Perkutnn transhepatick dren - PTD Zvr: stup dvojkontrastnho vyeten Transabdominln sonografie posouzen loiskovch zmn (CEUS) Podl CT na stagingu

Vyuit metod intervenn radiologie Dkuji za pozornost:

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