Jiří Ferda, Eva Ferdová, Jan Baxa, Miloš Pešek, Petr Mukenšnabl, Hynek Mírka
Jana Zuchnická, Jana Mihályová, Jaromír Gumulec, Roman Hájek
Vladimír Červeňák, Zdeněk Chovanec, Alena Berková, Jiří Vaníček, Tomáš Hanslík, Sabina Svobodová, Robert Novák
Marián Liberko, Renata Soumarová
The aim of this article is to get a basic idea of the modern trend in the diagnosis of lung cancer. The article deals briefly with the overall view of the patient, as well as imaging methods and verification of found lesions. In the field of imaging methods, this article clarifies the concept of using PET/CT (positron emission tomography / computed tomography) of the trunk and MR (magnetic resonance) of the brain. In morphological verification, the article deals with both classical methods and modern navigation bronchoscopic systems. Pathological requirements for adequate diagnosis of lung cancer, including molecular markers, are also included.
Molecular imaging in lung carcinoma are being the basic diagnostic approaches in the confirmation of the tumorous origin of the disease, but also in staging and restaging of the disease. Positron emission tomography / computed tomography (PET/CT) with the application of 18F-fluorodeoxyglucose is the most frequent molecular imaging in lung tumors, it is used as the fundament of the clinical stage of the disease before start of the treatment. Positron emission tomography / magnetic resonance imaging (PET/MRI) enables to complete the imaging with the full valid brain magnetic resonance imaging during the own procedure, the main disadvantage of PET/MRI is the prolonged scanning, making time unacceptable for those patients, who are heavier clinical state. The alternative way of the pharmacokinetics evaluation could be the analysis of iodine content within tissues using dynamic perfusion computed tomography (CT) or dual-energy CT. The use of other radiopharmaceuticals like 18F-ftuorthymidine in tissue proliferation or 68Ga-DOTA derivate in the assessment of somatostatin receptor density could provide the supplementary information about tumor biology.
Bronchology is evolving and provides the clinic with ever better mini-invasive diagnostic options. Furthermore, a logical division into different and strict endoscopies takes place, but according to various criteria, more division is possible, as described below.
Surgical treatment is indicated for patients with lung carcinoma based on the stage of the disease and general health conditions of the patient. Surgical treatment for non-small-cell lung cancer (NSCLC) is suitable in stage I, II, and IIIA (TNM Classification), strictly individually can be considered in higher stages. Small cell lung cancer (SCLC) is suitable for surgical treatment only when T1—2(3), N0(1), M0 criteria are met. The goal of surgical intervention is to achieve a complete resection without leaving tumoral tissue, i.e. R0 resection. Surgical treatment of lung carcinoma consists also of systematic lymphadenectomy which means a complete removal of lung, hilar and ipsilateral mediastinal lymph nodes.
Lung cancers are the most commonly diagnosed cancers worldwide. Radiotherapy may be indicated in their treatment algorithm under certain circumstances at any stage of the disease with an appropriate treatment intent. It is a very dynamically developing discipline that promptly adopts the most modern imaging methods, the latest radiobiological knowledge, as well as modern technology used to accurately deliver the dose to the target volume.
Worldwide, lung cancer is the most commonly diagnosed type of cancer in both men and women (11.6% of the total number of newly diagnosed cancers) and is the most common cause of cancer deaths (1.8 million deaths, i.e. 18.4% of total number of cancer deaths). The basic treatment modalities for lung cancer include surgical treatment, radiotherapy, chemotherapy, targeted treatment and immunotherapy. Combination chemotherapy is a basic and necessary treatment modality for all patients with small cell carcinoma. Chemotherapy also plays an important role in the treatment of non-small cell lung cancer during biological treatment and immunotherapy. It is used in adjuvant, neoadjuvant treatment and it is administered concomitantly with radiotherapy or it can follow it. Palliative chemotherapy, maintenance chemotherapy and metronomic chemotherapy are also important.
A better understanding of the molecular biology of tumors and the expanding possibilities of their genotyping lead to the strengthening of precise medicine, which allows us personalized treatment. It is mainly genetic changes in the tumor that help us predict the response to molecularly targeted therapy and thus choose the most effective treatment for our patients. The introduction of targeted therapy based on molecular typing into clinical practice has succeeded in significantly prolonging the survival of patients with non-small cell lung cancer, sometimes by several years with a very good quality of life.
Immunotherapy in the form of immune checkpoint inhibitors targeting PD-1/PD-L1 or CTLA-4 has become an integral part of lung cancer treatment algorithms. The dynamics of progress in this field can undoubtedly be called unbelievable. In the conditions of the Czech Republic, there is a certain delay towards the world in the availability of individual treatments. However, there are a number of patients who intend to make the most of all available treatment options, even if they are not covered by general health insurance. The following text is therefore conceived as an overview of available and in some parts of the world registered treatment methods, not what is currently covered in the Czech Republic by health insurance.
Palliative care is provided to patients with incurable disease and focuses on quality of life of patients and their families. It is not a “victory medicine”, it does not deny the death and does not try to postpone dying, but it is neither a “nihilistic medicine” in the sense of “there is nothing more we can do”. It is an active medicine, which seeks to decrease suffering. The article is than focusing on categorization of palliative care and, in detail, on the palliative care plan. This plan is made individually, based on the patienťs clinical status and in consonance with his or her preferences. A patient with lung cancer is usually significantly symptomatic. According to the published data, it is evident, that the early palliative care in lung cancer patients does not only lead to improvement of the quality of life and lower incidence of depression but it also prolongs survival. It is important to emphasize that superior palliative care cannot be delivered in health-care departments without the adequate number of educated caregivers, who have a high professional and human quality.
Cutaneous squamous cell carcinoma (cSCC) is one of the most common skin tumors. Surgical intervention remains crucial in the treatment of cSCC. Inoperable or metastatic cSCC is one of the less common but it belongs to incurable diseases. Both systemic preparations (most often cisplatin, 5-fluorouracil) and tyrosine kinase inhibitors are used in systemic treatment. Although a relatively good therapeutic response is achieved with these drugs, their long-term efficacy remains problematic. Cemiplimab is another immunomodulatory drug that targets the PD-1 receptor. The results so far not only have a good therapeutic response, but above all, they maintain their long-term effectiveness. Due to these properties, they have become the drug of choice for inoperable/metastatic cSCC diseases.
Chronic lymphocytic leukemia is accompanied by dysfunction of the immune system. Immune dysbalances are manifested, among other things, in an increased incidence of autoimmune cytopenias. In order to choose the right therapeutic procedure, it is important to differentially diagnose other causes of anemia, thrombocytopenia or granulocytopenia. Corticoids, intravenous immunoglobulins, rituximab, or other immunosuppressants are mainly used in therapy. Inadequate response to therapy is an indication to initiate treatment for chronic lymphocytic leukemia.
Epithelial tumors are the most common tumors of the thymus. This group of tumors includes thymomas and thymic carcinoma and these tumors are very rare, although they are among the most common tumors of the anterior mediastinum in adults. The thymus is an organ of the immune system that can be routinely monitored by various chest examination methods. We encounter it more in children, but it is no exception in adults either. The problem in adults is its variable appearance, as it goes through the process of involution. Involution is support by the corticosteroids during excessive stress. Likewise, these conditions can change its shape and size. The basics of embryology, anatomy together with knowledge of imaging methods, are a necessary condition for accurate diagnosis of benign and malignant thyroid tumors. Only the correct identification of these pathologies allows you to choose the appropriate method of therapy.
In the case report described below, we will try to pass on the experience with the administration of a new modern chemotherapy in a long-term treated patient with generalized adenocarcinoma of the appendix.
Epidermal growth factor receptor (EGFR) inhibitors have become a standard part of combined treatment regimens for metastatic/advanced colorectal cancer. Their long-term use is linked to the mutational status of KRAS and NRAS genes, furthermore it is recommended rather for left-sided tumors.1,2 Following case report shows the significant benefit of EGFR inhibition with panitumumab during the treatment of a patient with a locally advanced rectosigmoid tumor, which, even after years, eventually led for a high hope for complete recovery.
Obinutuzumab with bendamustine is currently used for the treatment of follicular lymphoma in patients who are refractory to rituximab alone or to combination of chemotherapy with rituximab. This case report describes a successful treatment with obinutuzumab and bendamustine followed by obinutuzumab maintenance in a patient with multiple relapses of follicular lymphoma after several treatment lines with rituximab.
This case report describes a patient with locally advanced pancreatic cancer. By combination of chemotherapy and chemoradiotherapy, conversion of unresectable disease (locally advanced pancreatic cancer) in to resectable disease with significant pathological response was achieved.
Although both the incidence and mortality of lung cancers have tended to decline in recent years in the Czech Republic, they are still among the most common cancers in our country in both sexes. In recent years, we have been able to offer patients more and more products that use the natural properties of their own immune system to fight this insidious disease. The case documented below describes the spontaneous regression of a squamous cell lung tumor.