| Abstract | Karcinom gušterače nastaje kada dođe do mutacija DNA unutar stanica gušterače, a zatim
mutacije uzrokuju nekontrolirani rast stanica i stanice počinju formulirati tumor. On čini 85%
ukupno dijagnosticiranih novotvorina gušterače. Kod većine bolesnika duže vrijeme ostaje
asimptomatski, a vodeći simptom ovisi o lokalizaciji tumora, ali se simptomi pojavljuju u
odmaklom stadiju bolesti. Karcinom je u većini slučaja smješten u glavi gušterače, čak 60-70%, a
ponekad i u području repa ili trupa. Zbog kasne prezentacije bolesti samo je manji broj bolesnika
(15-20%) kandidat za kirurško liječenje u trenutku postavljanja dijagnoze karcinoma gušterače.
Najčešći, tipični, simptomi karcinoma gušterače uključuju jake bolove u trbuhu i/ili u leđima,
opstruktivnu žuticu te gubitak tjelesne težine. Rizični čimbenici za nastanak karcinoma gušterače
su spol, dob, pušenje, smanjena aktivnost, pretilost, dugotrajni dijabetes, ciroza jetre, izloženost
pesticidima, genetska predispozicija, kronični pankreatitis te neki genetski sindromi. Najčešće se
oboljeli javljaju liječniku zbog bolova ili nastale žutice. Kod svih se bolesnika sa sumnjom na
karcinom preporučuje kompjutorizirana tomografija (CT) kojom se određuje stadij bolesti i kojim
se mogu razlučiti bolesnici kandidati za resekciju od osoba koje nisu kandidati za zahvat. Kirurška
resekcija je jedini način liječenja koji nudi potencijalni lijek za karcinom gušterače, a pokazalo se
da dodatak kemoterapije u adjuvantnom okruženju poboljšava stopu preživljavanja. Kemoterapija
označuje liječenje primjenom kemijskih sredstava koji uništavaju stanice karcinoma, a takva vrsta
sredstava nazivaju se citostatici. Palijativna kemoterapija je terapija namijenjena bolesnicima s
metastatskom bolešću. Neoadjuvantna kemoterapija je primjena kemoterapije prije operativnog
zahvata. Adjuvantna kemoterapija se primjenjuje nakon kirurškog zahvata, u pravilu unutar mjesec
dana od zahvata. Otprilike 80-85% bolesnika s karcinomom gušterače nisu kandidati za operaciju
zbog uznapredovale bolesti te se kod njih poduzima palijativna terapija. Bol pogađa većinu
bolesnika s karcinomom gušterače, a pola ih zahtijeva jaču opioidnu analgeziju. Medicinske sestre
kao osobe koje su većinu vremena uz bolesnika, orijentirane su na zbrinjavanje bolesnika putem
holističkog pristupa. Medicinska sestra treba aktivno slušati bolesnika, učinkovito komunicirati s
njime, na bolesnikova pitanja odgovarati iskreno i empatično. Ona pruža zdravstvenu njegu, pruža
osjećaj sigurnosti kod bolesnika i obitelji, pruža emocionalnu i psihološku podršku i pomoć. Na
ishod bolesti utječe i uključenost obitelji u planiranju liječenja. |
| Abstract (english) | Pancreatic cancer occurs when DNA mutations occur within the pancreatic cells, and then
mutations cause uncontrolled cell growth and cells start formulating the tumour. It accounts for
85% of all diagnosed pancreatic neoplasms. Most patients remain asymptomatic for a long time,
and the leading symptom depends on tumour localisation, but symptoms occur in an advanced
stage of the disease. The cancer is most often found in the pancreas head, as much as 60-70%, and
sometimes in the tail or hull area. Due to the late presentation of the disease, only a smaller number
of patients (15-20%) are candidates for surgical treatment at the time of diagnosis of pancreatic
cancer. The most common, typical, symptoms of pancreatic cancer include severe abdominal
and/or back pain, obstructive jaundice and weight loss. Risk factors for pancreatic cancer are
gender, age, smoking, reduced activity, obesity, long-term diabetes, liver cirrhosis, exposure to
pesticides, genetic predisposition, chronic pancreatitis and some genetic syndromes. Most often,
patients report to their doctor for pain or jaundice. In all patients with a suspicion of cancer,
computerised tomography (CT) is recommended to determine the disease stage and distinguish
patients candidates for resection from non-candidates for surgery. Surgical resection is the only
treatment that offers a potential cure for pancreatic cancer, and the addition of chemotherapy to
the adjuvant setting has been shown to improve survival rates. Chemotherapy indicates treatment
with chemical agents that destroy cancer cells, which are called cytostatics. Palliative
chemotherapy is a treatment for patients with metastatic disease. Neoadjuvant chemotherapy is
chemotherapy prior to surgery. Adjuvant chemotherapy is administered after surgery, usually
within one month of surgery. Approximately 80-85% of patients with pancreatic cancer are not
candidates for surgery due to advanced illness and are undergoing palliative therapy. Pain affects
most patients with pancreatic cancer, and half require stronger opioid analgesia. Nurses, as persons
who are with the patient most of the time, are oriented towards patient care through holistic
approach. The nurse should actively listen to the patient, communicate effectively with him,
answer the patient's questions honestly and empathically. She provides health care, provides a
sense of safety in patients and families, provides emotional and psychological support and
assistance. The outcome of the disease is also influenced by family involvement in the treatment
planning. |
