{"id":4866,"date":"2023-08-17T16:20:20","date_gmt":"2023-08-17T14:20:20","guid":{"rendered":"https:\/\/www.ptc.cz\/sto-lijecimo\/zazivaci-trakt\/jak-poznat-rakovinu-zazivaciho-traktu\/"},"modified":"2024-06-21T14:06:45","modified_gmt":"2024-06-21T12:06:45","slug":"rak-probavnog-trakta","status":"publish","type":"page","link":"https:\/\/www.ptc.cz\/hr\/sto-lijecimo\/probavni-trakt\/rak-probavnog-trakta\/","title":{"rendered":"Rak probavnog trakta"},"content":{"rendered":"<h2>N\u00e1dory j\u00edcnu<\/h2>\n<div class=\"gdc_row\">\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<p><strong>N\u00e1dory j\u00edcnu\u00a0jsou z\u00e1va\u017en\u00e9 onemocn\u011bn\u00ed,<\/strong>\u00a0kter\u00e9 vych\u00e1z\u00ed z\u00a0vnit\u0159n\u00edho povrchu j\u00edcnu a&nbsp;jeho\u017e l\u00e9\u010dba je enormn\u011b n\u00e1ro\u010dn\u00e1, ale m\u016f\u017ee b\u00fdt velmi \u00fasp\u011b\u0161n\u00e1,\u00a0<strong>tzn. m\u016f\u017ee nemocn\u00e9ho dov\u00e9st k\u00a0\u00fapln\u00e9mu vyl\u00e9\u010den\u00ed.<\/strong><\/p>\n<p><strong>V\u00a0l\u00e9\u010db\u011b se uplat\u0148uje chemoterapie,\u00a0oza\u0159ov\u00e1n\u00ed\u00a0a operace v\u00a0r\u016fzn\u00e9m po\u0159ad\u00ed<\/strong>. Obvykl\u00fd postup je v\u00a0prvn\u00ed \u0159ad\u011b sou\u010dasn\u00e1 chemoterapie a&nbsp;oza\u0159ov\u00e1n\u00ed, pak n\u00e1sleduje chirurgick\u00fd v\u00fdkon.<\/p>\n<p><strong>V\u00a0\u010cR ro\u010dn\u011b onemocn\u00ed n\u00e1dorem j\u00edcnu p\u0159es 500 osob.<\/strong>\u00a0Nej\u010dast\u011bji se onemocn\u011bn\u00ed diagnostikuje mezi 50.&nbsp;a&nbsp;70.&nbsp;rokem \u017eivota.\u00a0<strong>K\u00a0rizikov\u00fdm faktor\u016fm<\/strong>\u00a0pat\u0159\u00ed kou\u0159en\u00ed, konzumace destil\u00e1t\u016f, alkoholismus a&nbsp;bezezbytkov\u00e1 nevyv\u00e1\u017een\u00e1 strava.\u00a0<strong>P\u0159\u00edznaky n\u00e1doru j\u00edcnu<\/strong>\u00a0jsou \u010dasn\u00e9 \u2013 poruchy polyk\u00e1n\u00ed, bolestiv\u00e9 polyk\u00e1n\u00ed, rychl\u00e9 hubnut\u00ed, zvracen\u00ed, p\u0159\u00edpadn\u011b krv\u00e1cen\u00ed, resp. zvracen\u00ed natr\u00e1ven\u00e9 krve, trval\u00e9 bolesti v\u00a0hrudn\u00edku.<\/p>\n<p><strong>N\u00e1dorov\u00e1 onemocn\u011bn\u00ed j\u00edcnu se l\u00e9\u010d\u00ed r\u016fzn\u00fdmi metodami\u00a0(odborn\u011b \u201emodalitami\u201c), jejich\u017e volba a&nbsp;po\u0159ad\u00ed m\u00e1 pevn\u00e9 z\u00e1konitosti. L\u00e9\u010debn\u00fd postup se v\u017edy ur\u010duje p\u0159i spole\u010dn\u00e9m konsiliu chirurga a&nbsp;onkologa.<\/strong><\/p>\n<h3>Chirurgick\u00e1 l\u00e9\u010dba, tzn. r\u016fzn\u00e9 druhy v\u00fdkon\u016f, operac\u00ed<\/h3>\n<p><strong>N\u00e1dory se l\u00e9\u010d\u00ed operac\u00ed,<\/strong>\u00a0resekc\u00ed, bu\u010f v\u00a0prvn\u00ed dob\u011b (u&nbsp;mal\u00fdch inici\u00e1ln\u00edch n\u00e1lez\u016f), anebo po p\u0159\u00edprav\u011b oza\u0159ov\u00e1n\u00edm nebo chemoterapi\u00ed (u&nbsp;pokro\u010dilej\u0161\u00edch n\u00e1lez\u016f).\u00a0<strong>Resekce je velmi slo\u017eit\u00fd a&nbsp;n\u00e1ro\u010dn\u00fd v\u00fdkon,<\/strong>\u00a0bl\u00ed\u017ee jej pop\u00ed\u0161e chirurg. Volba mezi oza\u0159ov\u00e1n\u00edm a&nbsp;chemoterapi\u00ed se d\u011bl\u00e1 na&nbsp;z\u00e1klad\u011b lokalizace posti\u017een\u00ed. (Chemoterapie se preferuje u&nbsp;n\u00e1dor\u016f vych\u00e1zej\u00edc\u00edch z\u00a0p\u0159echodu j\u00edcnu do \u017ealudku.)<\/p>\n<p><strong>U n\u00e1dor\u016f vych\u00e1zej\u00edc\u00edch z\u00a0kr\u010dn\u00edho \u00faseku j\u00edcnu nelze operaci prov\u00e9st.<\/strong><\/p>\n<\/div>\n<\/div>\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<h3>Radioterapie\u00a0n\u00e1dor\u016f j\u00edcnu se uplat\u0148uje jako:<\/h3>\n<ul>\n<li><strong>P\u0159edopera\u010dn\u00ed,<\/strong>\u00a0tzn. oza\u0159uje se s\u00a0v\u00fdhledem n\u00e1sleduj\u00edc\u00edho chirurgick\u00e9ho v\u00fdkonu v\u00a0p\u0159esn\u00e9 \u010dasov\u00e9 n\u00e1vaznosti.<\/li>\n<li><strong>Samostatn\u00e1,<\/strong>\u00a0oza\u0159uje se bez v\u00fdhledu chirurgick\u00e9ho v\u00fdkonu a&nbsp;to v&nbsp;p\u0159\u00edpad\u011b v\u00fdskytu n\u00e1doru v&nbsp;kr\u010dn\u00edm \u00faseku j\u00edcnu, nebo pokud z&nbsp;jak\u00fdchkoli d\u016fvod\u016f\u00a0 nelze uva\u017eovat o&nbsp;operaci.<\/li>\n<li><strong>Ojedin\u011ble je indikov\u00e1na radioterapie poopera\u010dn\u00ed,<\/strong>\u00a0obvykle kdy\u017e byla provedena resekce n\u00e1doru, kter\u00fd byl v\u00a0opera\u010dn\u00edm n\u00e1lezu rozs\u00e1hlej\u0161\u00ed, ne\u017e se p\u016fvodn\u011b p\u0159edpokl\u00e1dalo.<br \/>\nAnatomick\u00e9 ulo\u017een\u00ed j\u00edcnu \u2013 mezi ob\u011bma pl\u00edcemi a&nbsp;v\u00a0bl\u00edzkosti srdce vy\u017eaduje aplikaci do geometricky slo\u017eit\u00e9ho prostoru mezi org\u00e1ny, jejich\u017e oz\u00e1\u0159en\u00ed mus\u00ed b\u00fdt minim\u00e1ln\u00ed. Proto se s\u00a0v\u00fdhodou vyu\u017e\u00edv\u00e1 protonov\u00e1 radioterapie.<\/li>\n<\/ul>\n<h3>Chemoterapie<\/h3>\n<p><strong>Chemoterapie se u&nbsp;n\u00e1dor\u016f j\u00edcnu uplat\u0148uje p\u0159ev\u00e1\u017en\u011b sou\u010dasn\u011b s\u00a0oza\u0159ov\u00e1n\u00edm.<\/strong>\u00a0Jej\u00edm c\u00edlem je zv\u00fd\u0161it senzitivitu n\u00e1doru na&nbsp;oza\u0159ov\u00e1n\u00ed.\u00a0<strong>Tato chemoterapie m\u00e1 ni\u017e\u0161\u00ed d\u00e1vky<\/strong>\u00a0a u\u017e\u00edv\u00e1 se m\u00e9n\u011b l\u00e1tek sou\u010dasn\u011b, maxim\u00e1ln\u011b 2.\u00a0<strong>Je proto dob\u0159e tolerov\u00e1na.<\/strong>\u00a0Samostatn\u00e1 chemoterapie se uplat\u0148uje u&nbsp;n\u00e1dor\u016f vych\u00e1zej\u00edc\u00edch z\u00a0p\u0159echodu j\u00edcnu a&nbsp;\u017ealudku.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-1104818837-1200x1200-1.jpg\" data-rel=\"lightbox-image-0\" data-rl_title=\"\" data-rl_caption=\"\" title=\"\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-880\" src=\"https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-1104818837-1200x1200-1.jpg\" alt=\"\" width=\"1200\" height=\"786\" srcset=\"https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-1104818837-1200x1200-1.jpg 1200w, https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-1104818837-1200x1200-1-300x197.jpg 300w, https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-1104818837-1200x1200-1-768x503.jpg 768w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><\/p>\n<h2><\/h2>\n<p>&nbsp;<\/p>\n<h2>N\u00e1dory slinivky b\u0159i\u0161n\u00ed<\/h2>\n<div class=\"gdc_row\">\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<p><strong>N\u00e1dory slinivky b\u0159i\u0161n\u00ed (pankreatu)<\/strong> vznikaj\u00ed p\u0159ev\u00e1\u017en\u011b z\u00a0v\u00fdvodn\u00e9ho syst\u00e9mu \u017el\u00e1zy. Z\u0159\u00eddka vznikaj\u00ed z\u00a0endokrinn\u00ed \u010d\u00e1sti slinivky (kter\u00e1 produkuje \u0159adu hormon\u016f, vedle dal\u0161\u00edch tak\u00e9 kup\u0159. insulin), pak se ozna\u010duj\u00ed \u201eP-NET\u201c, <strong>maj\u00ed lep\u0161\u00ed progn\u00f3zu a&nbsp;jejich l\u00e9\u010dba m\u00e1 zvl\u00e1\u0161tn\u00ed pravidla a&nbsp;postupy.<\/strong><\/p>\n<p><strong>N\u00e1dor pankreatu je velmi z\u00e1va\u017en\u00e9 onemocn\u011bn\u00ed,<\/strong> kter\u00e9 m\u00e1 obvykle t\u011b\u017ek\u00fd pr\u016fb\u011bh. M\u00e1 velkou tendenci k\u00a0\u010dasn\u00e9mu zakl\u00e1d\u00e1n\u00ed dal\u0161\u00edch lo\u017eisek \u2013 metast\u00e1z, zejm. v\u00a0j\u00e1trech a&nbsp;na&nbsp;pob\u0159i\u0161nici. L\u00e9\u010dba n\u00e1dor\u016f pankreatu je velmi n\u00e1ro\u010dn\u00e1 a&nbsp;\u010dasto nen\u00ed \u00fasp\u011b\u0161n\u00e1.<\/p>\n<p><strong>V\u00a0\u010cR onemocn\u00ed n\u00e1dorem pankreatu ro\u010dn\u011b p\u0159es 2000 osob.<\/strong> V\u00fdskyt stoup\u00e1 po 50.&nbsp;roce v\u011bku. <strong>Rizikov\u00e9 faktory<\/strong> pro vznik n\u00e1doru pankreatu nejsou jednozna\u010dn\u011b ur\u010den\u00e9. Ur\u010dit\u011b k\u00a0nim pat\u0159\u00ed kou\u0159en\u00ed, alkoholismus a&nbsp;opakovan\u00e9 z\u00e1n\u011bty pankreatu (\u201epankreatitida\u201c).\u00a0<strong>Onemocn\u011bn\u00ed nem\u00e1 \u010dasn\u00e9 p\u0159\u00edznaky.<\/strong> Obvykle je proto diagnostikov\u00e1no v\u00a0pokro\u010dil\u00e9m st\u00e1diu. \u010casto je za prvn\u00ed p\u0159\u00edznak pova\u017eov\u00e1no ze\u017eloutnut\u00ed (\u201e\u017eloutenka\u201c \u2013 ve smyslu p\u0159\u00edznaku, nelze zam\u011b\u0148ovat s&nbsp;\u201einfek\u010dn\u00ed \u017eloutenkou\u201c &#8211; hepatitidou ve smyslu virov\u00e9ho z\u00e1n\u011btu jater). Dal\u0161\u00ed p\u0159\u00edznaky jsou \u00faporn\u00e9 bolesti v\u00a0horn\u00ed \u010d\u00e1sti b\u0159icha, nechutenstv\u00ed (\u010dast\u00fd je odpor k\u00a0masu) a&nbsp;v\u00fdrazn\u00e9 hubnut\u00ed. K\u00a0p\u0159\u00edznak\u016fm pokro\u010dil\u00e9ho onemocn\u011bn\u00ed pat\u0159\u00ed i&nbsp;dlouhodob\u00e1 nevolnost a&nbsp;opakovan\u00e9 zvracen\u00ed.<\/p>\n<p><strong>N\u00e1dorov\u00e1 onemocn\u011bn\u00ed pankreatu se l\u00e9\u010d\u00ed r\u016fzn\u00fdmi metodami (odborn\u011b \u201emodalitami\u201c), jejich\u017e volba a&nbsp;po\u0159ad\u00ed m\u00e1 pevn\u00e9 z\u00e1konitosti. V\u00a0l\u00e9\u010db\u011b n\u00e1dor\u016f pankreatu je prvo\u0159ad\u00e1 operace<\/strong> \u2013 resekce pankreatu (cel\u00e9ho nebo poloviny) v\u010detn\u011b resekce dvan\u00e1ctern\u00edku a&nbsp;\u00fapravy pr\u016fb\u011bhu tenk\u00e9ho st\u0159eva. <strong>Pokud nelze prov\u00e9st<\/strong> (z&nbsp;jak\u00fdchkoliv p\u0159\u00ed\u010din), <strong>\u0159e\u0161\u00ed se onemocn\u011bn\u00ed z\u00e1sadn\u011b chemoterapi\u00ed, po n\u00ed\u017e m\u016f\u017ee n\u00e1sledovat oza\u0159ov\u00e1n\u00ed \u2013 radioterapie.<\/strong> Oza\u0159ov\u00e1n\u00ed m\u00e1 v\u00fdznam pouze v\u00a0kontextu chemoterapie, tzn. v\u00a0n\u00e1vaznosti na&nbsp;chemoterapii. Po \u00fasp\u011b\u0161n\u00e9 resekci n\u00e1sleduje poopera\u010dn\u00ed chemoterapie, tak\u00e9 dopln\u011bn\u00e1 oz\u00e1\u0159en\u00edm. Poopera\u010dn\u00ed oz\u00e1\u0159en\u00ed m\u00e1 speci\u00e1ln\u00ed z\u00e1konitosti.<\/p>\n<h3>Chirurgick\u00e1 l\u00e9\u010dba, tzn. r\u016fzn\u00e9 druhy v\u00fdkon\u016f, operac\u00ed<\/h3>\n<p>U&nbsp;n\u00e1dor\u016f pankreatu plat\u00ed, \u017ee <strong>chirurgick\u00e1 radik\u00e1ln\u00ed l\u00e9\u010dba je v\u017edy prvo\u0159ad\u00e1, pokud lze prov\u00e9st.<\/strong> Jin\u00fdmi slovy \u2013 pokud m\u00e1 chirurg mo\u017enost prov\u00e9st radik\u00e1ln\u00ed v\u00fdkon, je optim\u00e1ln\u00ed jej prov\u00e9st, a&nbsp;to co nejd\u0159\u00edve. (Mo\u017enosti jsou d\u00e1ny rozsahem posti\u017een\u00ed a&nbsp;stavem nemocn\u00e9ho. <strong>Radik\u00e1ln\u00ed v\u00fdkon znamen\u00e1<\/strong> kompletn\u00ed odstran\u011bn\u00ed v\u00a0ur\u010dit\u00e9m dan\u00e9m rozsahu.). Pokud chirurg nem\u016f\u017ee realizovat radik\u00e1ln\u00ed v\u00fdkon, m\u016f\u017ee ud\u011blat v\u00fdkon \u201eodleh\u010dovac\u00ed\u201c podle situace (kup\u0159. propojen\u00ed \u017ealudku a&nbsp;tenk\u00e9ho st\u0159eva, kter\u00fdm dos\u00e1hne \u00falevu v\u00a0za\u017e\u00edvac\u00edch pot\u00ed\u017e\u00edch).<\/p>\n<\/div>\n<\/div>\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<h3>Radioterapie n\u00e1dor\u016f pankreatu se uplat\u0148uje jako:<\/h3>\n<ul>\n<li>Poopera\u010dn\u00ed, n\u00e1sleduj\u00edc\u00ed po radik\u00e1ln\u00edm v\u00fdkonu. C\u00edl je likvidace mo\u017en\u00fdch mikroskopick\u00fdch zbytk\u016f n\u00e1doru.<\/li>\n<li>Samostatn\u00e1. V\u00a0p\u0159\u00edpad\u011b, \u017ee nelze prov\u00e9st chirurgick\u00fd v\u00fdkon. C\u00edl je maxim\u00e1ln\u011b likvidovat n\u00e1dor.<\/li>\n<li>P\u0159edopera\u010dn\u00ed. Pokud chirurg p\u0159ipou\u0161t\u00ed mo\u017enost radik\u00e1ln\u00edho v\u00fdkonu po zmen\u0161en\u00ed n\u00e1lezu.<\/li>\n<li>Zvl\u00e1\u0161tn\u00ed uplatn\u011bn\u00ed je oza\u0159ov\u00e1n\u00ed recidivy po ji\u017e proveden\u00e9 radik\u00e1ln\u00ed operaci.<\/li>\n<\/ul>\n<h3>Oza\u0159ov\u00e1n\u00ed m\u00e1 n\u011bkolik pevn\u00fdch pravidel<\/h3>\n<ul>\n<li><strong>Spr\u00e1vn\u00e9 \u00fa\u010dinnosti se dosahuje<\/strong>, pouze pokud je oza\u0159ov\u00e1n\u00ed aplikov\u00e1no \u201ev kontextu\u201c chemoterapie. Tzn. aplikuje se nap\u0159ed chemoterapie, po ur\u010dit\u00e9 dob\u011b chemoterapie se realizuje oz\u00e1\u0159en\u00ed.<\/li>\n<li><strong>Oza\u0159ov\u00e1n\u00ed pankreatu<\/strong> p\u0159edstavuje po technick\u00e9 a&nbsp;biologick\u00e9 str\u00e1nce <strong>dost obt\u00ed\u017enou \u201e\u00falohu\u201c.<\/strong> Pankreas je toti\u017e obklopen \u0159adou org\u00e1n\u016f, kter\u00e9 lze oz\u00e1\u0159en\u00edm po\u0161kodit (j\u00e1tra, dvan\u00e1ctern\u00edk, ledviny, \u017ealudek a&nbsp;dal\u0161\u00ed). <strong>P<\/strong><strong>roto se uplat\u0148uje oza\u0159ov\u00e1n\u00ed protonov\u00e9, s\u00a0jeho\u017e pomoc\u00ed dan\u00e1 \u00faloha \u0159e\u0161it lze.<\/strong><\/li>\n<\/ul>\n<h3>Chemoterapie p\u0159edstavuje z\u00e1kladn\u00ed metodu l\u00e9\u010dby n\u00e1dor\u016f pankreatu. M\u00e1 indikace:<\/h3>\n<ul>\n<li><strong>Poopera\u010dn\u00ed<\/strong> \u2013 po radik\u00e1ln\u00edm v\u00fdkonu (s&nbsp;c\u00edlem likvidace mikroskopick\u00fdch zbytk\u016f posti\u017een\u00ed).<\/li>\n<li><strong>P\u0159edopera\u010dn\u00ed<\/strong> \u2013 stejn\u011b jako u&nbsp;radioterapie s\u00a0c\u00edlem dos\u00e1hnout mo\u017enost radik\u00e1ln\u00edho v\u00fdkonu.<\/li>\n<li><strong>Samostatn\u00e1<\/strong> \u2013 pokud nelze realizovat radik\u00e1ln\u00ed chirurgick\u00fd v\u00fdkon a&nbsp;nen\u00ed v\u00fdhled, \u017ee by tak mo\u017en\u00e9 bylo.<\/li>\n<li>V\u00a0t\u011bchto indikac\u00edch po ur\u010dit\u00e9m po\u010dtu cykl\u016f chemoterapie navazuje oza\u0159ov\u00e1n\u00ed.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<h3><a href=\"https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-583668982-1200x1200-1.jpg\" data-rel=\"lightbox-image-1\" data-rl_title=\"\" data-rl_caption=\"\" title=\"\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-881 size-full\" src=\"https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-583668982-1200x1200-1.jpg\" alt=\"\" width=\"1200\" height=\"799\" srcset=\"https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-583668982-1200x1200-1.jpg 1200w, https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-583668982-1200x1200-1-300x200.jpg 300w, https:\/\/www.ptc.cz\/wp-content\/uploads\/2023\/08\/shutterstock-583668982-1200x1200-1-768x511.jpg 768w\" sizes=\"auto, (max-width: 1200px) 100vw, 1200px\" \/><\/a><\/h3>\n<h2><\/h2>\n<p>&nbsp;<\/p>\n<h2>Rakovina jater<\/h2>\n<div class=\"gdc_row\">\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<p><strong>Prim\u00e1rn\u00ed n\u00e1dory jater\u00a0(tzn. nikoliv druhotn\u00e1 lo\u017eiska jin\u00fdch n\u00e1dor\u016f v\u00a0j\u00e1trech) jsou v\u00a0oblasti Evropy pom\u011brn\u011b vz\u00e1cn\u00e1 onemocn\u011bn\u00ed.\u00a0L\u00e9\u010debn\u00fd postup je zcela speci\u00e1ln\u00ed.\u00a0Nej\u00fa\u010dinn\u011bj\u0161\u00ed metoda l\u00e9\u010dby je transplantace jater. M\u00e9n\u011b \u00fa\u010dinn\u00e9 metody jsou \u010d\u00e1ste\u010dn\u00e1 resekce jater, radioterapie, chemoterapie pod\u00e1van\u00e1 do jatern\u00ed tepny a&nbsp;\u0159ada specifick\u00fdch metod, kup\u0159. radiofrekven\u010dn\u00ed oh\u0159ev n\u00e1dorov\u00e9ho lo\u017eiska, a&nbsp;fin\u00e1ln\u011b biologick\u00e1 l\u00e9\u010dba.<\/strong><\/p>\n<p><strong>Prim\u00e1rn\u00edm n\u00e1dorem jater onemocn\u00ed v\u00a0\u010cR ro\u010dn\u011b cca 400 osob<\/strong>, statistika nen\u00ed p\u0159esn\u00e1. K\u00a0rizikov\u00fdm faktor\u016fm pat\u0159\u00ed jednozna\u010dn\u011b prob\u011bhl\u00e1 infek\u010dn\u00ed \u017eloutenka (hepatitida), d\u00e1le jatern\u00ed cirh\u00f3za a&nbsp;alkoholismus.\u00a0<strong>P\u0159\u00edznaky prim\u00e1rn\u00edho n\u00e1doru<\/strong>\u00a0jater jsou obvykle pozdn\u00ed. \u010casn\u00e9 p\u0159\u00edznaky \u010dasto \u00fapln\u011b chyb\u00ed &#8211; proto je onemocn\u011bn\u00ed \u010dasto diagnostikov\u00e1no jako pokro\u010dil\u00e9. K\u00a0p\u0159\u00edznak\u016fm pat\u0159\u00ed neur\u010dit\u00e9 bolesti v\u00a0prav\u00e9 horn\u00ed \u010d\u00e1sti b\u0159icha, neur\u010dit\u00e9 za\u017e\u00edvac\u00ed pot\u00ed\u017ee, \u017eloutenka (jako p\u0159\u00edznak, nikoliv \u201ehepatitida\u201c), p\u0159\u00edpadn\u011b zhor\u0161en\u00e1 sr\u00e1\u017elivost krevn\u00ed.<\/p>\n<p><strong>Prim\u00e1rn\u00ed n\u00e1dory jater, tzn. nikoliv druhotn\u00e1 lo\u017eiska n\u00e1dor\u016f jin\u00fdch lokalizac\u00ed (metast\u00e1zy) se l\u00e9\u010d\u00ed pon\u011bkud odli\u0161n\u00fdmi metodami ne\u017e jin\u00e1 n\u00e1dorov\u00e1 onemocn\u011bn\u00ed.<\/strong>\u00a0Nej\u00fa\u010dinn\u011bj\u0161\u00ed metoda l\u00e9\u010dby je transplantace jater. M\u00e9n\u011b \u00fa\u010dinn\u00e9 metody jsou \u010d\u00e1ste\u010dn\u00e1 resekce jater, radioterapie, chemoterapie pod\u00e1van\u00e1 do jatern\u00ed tepny a&nbsp;\u0159ada specifick\u00fdch metod, kup\u0159. radiofrekven\u010dn\u00ed oh\u0159ev n\u00e1dorov\u00e9ho lo\u017eiska, a&nbsp;fin\u00e1ln\u011b biologick\u00e1 l\u00e9\u010dba.<\/p>\n<p><strong>Transplantace jater (podle jasn\u011b dan\u00fdch krit\u00e9ri\u00ed) a&nbsp;mo\u017enost operace (\u010d\u00e1ste\u010dn\u00e1 resekce jater)<\/strong><\/p>\n<ul>\n<li>Mo\u017enosti posuzuje jedno ze 2 transplanta\u010dn\u00edch pracovi\u0161\u0165 v\u00a0CR \u2013 IKEM Praha, FN Brno. (V&nbsp;\u010cR je jeden z\u00a0nej\u00fasp\u011b\u0161n\u011bj\u0161\u00edch transplanta\u010dn\u00edch program\u016f na&nbsp;sv\u011bt\u011b.)<\/li>\n<li>Pokud nelze transplantovat nebo resekovat \u010d\u00e1st jater, uva\u017euje se o&nbsp;mo\u017enostech oza\u0159ov\u00e1n\u00ed a&nbsp;c\u00edlen\u00e9 chemoterapie podan\u00e9 do jatern\u00ed tepny.<\/li>\n<li>Oza\u0159ov\u00e1n\u00ed je technicky n\u00e1ro\u010dn\u00e1 metoda. \u010casto nelze s\u00a0ohledem na&nbsp;lokalizaci a&nbsp;rozsah posti\u017een\u00ed \u00fa\u010dinnou d\u00e1vku aplikovat jinak ne\u017e oza\u0159ov\u00e1n\u00edm protony.<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<h3>Chirurgick\u00e1 l\u00e9\u010dba, transplantace, \u010d\u00e1ste\u010dn\u00e1 resekce<\/h3>\n<ul>\n<li>Chirurgick\u00e9 metody maj\u00ed nejlep\u0161\u00ed \u00fa\u010dinnost. Pouze pokud chirurg jednozna\u010dn\u011b zam\u00edtne transplantaci nebo resekci, jsou indikov\u00e1ny dal\u0161\u00ed l\u00e9\u010debn\u00e9 modality. (P\u0159irozen\u011b u&nbsp;velmi pokro\u010dil\u00fdch onemocn\u011bn\u00ed, kup\u0159. s\u00a0mnoho\u010detn\u00fdmi metast\u00e1zami, je stanovisko p\u0159edem jasn\u00e9 a&nbsp;nen\u00ed nutn\u00e9 zat\u011b\u017eovat \u0161pi\u010dkov\u00e1 pracovi\u0161t\u011b zbytnou konzultac\u00ed.)<\/li>\n<\/ul>\n<h3>Radioterapie<\/h3>\n<p><strong>Radioterapie prim\u00e1rn\u00edch n\u00e1dor\u016f jater je pom\u011brn\u011b nov\u00e1 metoda<\/strong>, zat\u00edm m\u00e1lo vyu\u017e\u00edvan\u00e1. Je to d\u00e1no t\u00edm, \u017ee b\u011b\u017en\u00fdmi metodikami fotonov\u00e9ho (gama) z\u00e1\u0159en\u00ed nebylo mo\u017en\u00e9 oz\u00e1\u0159en\u00ed n\u00e1doru jater do \u00fa\u010dinn\u00e9 d\u00e1vky bezpe\u010dn\u011b prov\u00e9st.<\/p>\n<p>A\u017e n\u00e1stup pokro\u010dil\u00fdch metod radioterapie, nap\u0159.\u00a0<strong>protonov\u00e9 radioterapie,\u00a0umo\u017e\u0148uje oz\u00e1\u0159it prim\u00e1rn\u00ed n\u00e1dor jater s\u00a0vysokou \u00fa\u010dinnost\u00ed.\u00a0<\/strong>Oza\u0159uje se n\u00e1dorov\u00e9 posti\u017een\u00ed, kter\u00e9 chirurg neur\u010dil jako vhodn\u00e9 k\u00a0resekci nebo transplantaci a&nbsp;kter\u00e9 nepostihuje tk\u00e1n\u011b mimo j\u00e1tra. Posti\u017een\u00ed tak\u00e9 nesm\u00ed zauj\u00edmat v\u00edce ne\u017e polovinu jater.<\/p>\n<h3>Chemoterapie, biologick\u00e1 terapie a&nbsp;ostatn\u00ed metody<\/h3>\n<p>\u00da\u010dinn\u00e1 chemoterapie prim\u00e1rn\u00edch n\u00e1dor\u016f jater nebyla vyvinuta.\u00a0<strong>\u00da\u010dinnost m\u00e1 pouze speci\u00e1ln\u00ed chemoterapie pod\u00e1van\u00e1 p\u0159\u00edmo do jatern\u00ed tepny, ozna\u010dovan\u00e1 term\u00ednem \u201eTACE\u201c.<\/strong>\u00a0N\u011bkter\u00e9 prim\u00e1rn\u00ed n\u00e1dory jater tak\u00e9 lze l\u00e9\u010dit p\u0159\u00edmou intervenc\u00ed, obvykle p\u0159es jehlu zavedenou do n\u00e1doru pod&nbsp;kontrolou CT \u2013 souhrnn\u011b \u201eabla\u010dn\u00ed metody\u201c Jedn\u00e1 se o&nbsp;metody ozna\u010dovan\u00e9 RFA (radiofrekven\u010dn\u00ed ablace), PEI (perkut\u00e1nn\u00ed alkohlov\u00e1 injekce), IRE (ireverzibiln\u00ed eletroporace) a&nbsp;dal\u0161\u00ed. U&nbsp;pokro\u010dil\u00fdch n\u00e1lez\u016f se u\u017e\u00edv\u00e1 c\u00edlen\u00e1 biologick\u00e1 l\u00e9\u010dba ve form\u011b tablet.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-1884 size-full\" src=\"https:\/\/www.ptc.cz\/wp-content\/uploads\/2024\/01\/shutterstock_1877565325-s.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/www.ptc.cz\/wp-content\/uploads\/2024\/01\/shutterstock_1877565325-s.jpg 1920w, https:\/\/www.ptc.cz\/wp-content\/uploads\/2024\/01\/shutterstock_1877565325-s-300x200.jpg 300w, https:\/\/www.ptc.cz\/wp-content\/uploads\/2024\/01\/shutterstock_1877565325-s-1400x933.jpg 1400w, https:\/\/www.ptc.cz\/wp-content\/uploads\/2024\/01\/shutterstock_1877565325-s-768x512.jpg 768w, https:\/\/www.ptc.cz\/wp-content\/uploads\/2024\/01\/shutterstock_1877565325-s-1536x1024.jpg 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<h2><\/h2>\n<p>&nbsp;<\/p>\n<h2>N\u00e1dory an\u00e1ln\u00edho otvoru<\/h2>\n<div class=\"gdc_row\">\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<p><strong>N\u00e1dory anu jsou zcela specifick\u00e9 onemocn\u011bn\u00ed, kter\u00e9 vych\u00e1z\u00ed z\u00a0oblasti sv\u011bra\u010de, p\u0159\u00edpadn\u011b a\u017e z\u00a0oblasti p\u0159echodu sv\u011bra\u010de do k\u016f\u017ee.<\/strong> <strong>V\u00a0l\u00e9\u010db\u011b n\u00e1dor\u016f anu v\u00a0sou\u010dasn\u00e9 dob\u011b p\u0159evl\u00e1d\u00e1 radioterapie nad&nbsp;chirurgick\u00fdm v\u00fdkonem,<\/strong> kter\u00fd vy\u017eaduje zaveden\u00ed trval\u00e9ho (do\u017eivotn\u00edho) v\u00fdvodu st\u0159eva \u2013 kolostomie.<\/p>\n<p><strong>Radioterapie samotn\u00e1 sta\u010d\u00ed k\u00a0\u00fapln\u00e9mu vyl\u00e9\u010den\u00ed cca u&nbsp;90&nbsp;% nemocn\u00fdch <\/strong>a jde o&nbsp;l\u00e9\u010dbu velmi n\u00e1ro\u010dnou a&nbsp;rizikovou. <strong>U protonov\u00e9 radioterapie je n\u00e1ro\u010dnost men\u0161\u00ed.<\/strong><\/p>\n<p><strong>V\u00a0\u010cR ro\u010dn\u011b onemocn\u00ed n\u00e1dorem anu 170-190 osob.<\/strong> V\u00fdskyt nar\u016fst\u00e1 po 40.&nbsp;roce v\u011bku. K\u00a0<strong>rizikov\u00fdm faktor\u016fm<\/strong> n\u00e1dor\u016f anu pat\u0159\u00ed infekce virem HPV (nyn\u00ed je mo\u017enost vakcinace), kou\u0159en\u00ed a&nbsp;neobvykl\u00e9 sexu\u00e1ln\u00ed praktiky.\u00a0<strong>P\u0159\u00edznaky n\u00e1doru anu<\/strong> jsou sice \u010dasn\u00e9, ale \u010dasto jsou myln\u011b diagnostikov\u00e1ny pouze hemoroidy. <strong>Hlavn\u00ed p\u0159\u00edznak<\/strong> je krv\u00e1cen\u00ed, d\u00e1le neur\u010dit\u00e9 bolesti ve sv\u011bra\u010di, dr\u00e1\u017ed\u011bn\u00ed, bolestiv\u00e9 vyprazd\u0148ov\u00e1n\u00ed stolice, p\u0159\u00edpadn\u011b n\u00e1lez zv\u011bt\u0161en\u00fdch uzlin v\u00a0t\u0159\u00edslech.<\/p>\n<p><strong>L\u00e9\u010dba n\u00e1dorov\u00fdch onemocn\u011bn\u00ed \u0159itn\u00edho otvoru \u2013 anu se \u0159\u00edd\u00ed specifick\u00fdmi pravidly.<\/strong> Volba l\u00e9\u010debn\u00fdch modalit je zcela odli\u0161n\u00e1 od n\u00e1dor\u016f sousedn\u00ed anatomick\u00e9 lokalizace \u2013 kone\u010dn\u00edku. <strong>Je proto t\u0159eba zcela jednozna\u010dn\u011b (a&nbsp;samoz\u0159ejm\u011b spr\u00e1vn\u011b) ur\u010dit diagn\u00f3zu: n\u00e1dor \u0159itn\u00edho otvoru \u2013 anu vers. n\u00e1dor kone\u010dn\u00edku \u2013 rekta.<\/strong><\/p>\n<p><strong>L\u00e9\u010debn\u00fd postup se v\u017edy rozhoduje p\u0159i konzultaci s\u00a0nemocn\u00fdm<\/strong>, <strong>kter\u00fd m\u00e1 na&nbsp;v\u00fdb\u011br mezi chirurgick\u00fdm v\u00fdkonem a&nbsp;oza\u0159ov\u00e1n\u00edm. <\/strong>Oza\u0159ov\u00e1n\u00ed se v\u017edy dopl\u0148uje sou\u010dasnou chemoterapi\u00ed. <strong>Radioterapie je velmi n\u00e1ro\u010dn\u00e1<\/strong> a&nbsp;je prov\u00e1zena \u0159adou ne\u017e\u00e1douc\u00edch efekt\u016f v\u00a0oblasti k\u016f\u017ee a&nbsp;sliznic sv\u011bra\u010de a&nbsp;okol\u00ed, ale tak\u00e9 ne\u017e\u00e1douc\u00edmi efekty, kter\u00e9 se manifestuj\u00ed v\u00a0krevn\u00edm obraze. <strong>Proto byly vyvinuty techniky protonov\u00e9 radioterapie,<\/strong> kter\u00e9 omezuj\u00ed ne\u017e\u00e1douc\u00ed efekty a&nbsp;umo\u017e\u0148uj\u00ed obvykle aplikovat oza\u0159ov\u00e1n\u00ed bez nutnosti zav\u00e9st do\u010dasnou (odleh\u010dovac\u00ed) kolostomii.<\/p>\n<\/div>\n<\/div>\n<div class=\"gdc_column gdc_chalf\">\n<div class=\"gdc_inner\">\n<h3>Chirurgick\u00e1 l\u00e9\u010dba, tzn. r\u016fzn\u00e9 druhy v\u00fdkon\u016f, operac\u00ed<\/h3>\n<p><strong>Chirurgick\u00e1 l\u00e9\u010dba n\u00e1dor\u016f anu se od 80.&nbsp;let 20.&nbsp;stol.\u00a0 prim\u00e1rn\u011b neuplat\u0148uje.<\/strong> Byl toti\u017e objeven v\u00fdrazn\u00fd efekt z\u00e1\u0159en\u00ed, kter\u00fd vede u&nbsp;vysok\u00e9ho pod\u00edlu nemocn\u00fdch (podle st\u00e1dia onemocn\u011bn\u00ed 80% &#8211; 95%) k\u00a0\u00fapln\u00e9mu vyl\u00e9\u010den\u00ed bez chirurgick\u00e9ho v\u00fdkonu.<\/p>\n<p>Nicm\u00e9n\u011b jako alternativa k\u00a0oza\u0159ov\u00e1n\u00ed je chirurgick\u00fd v\u00fdkon st\u00e1le v\u00a0r\u00e1mci standardn\u00edho postupu k\u00a0dispozici. Spo\u010d\u00edv\u00e1 v\u00a0odstran\u011bn\u00ed cel\u00e9ho sv\u011bra\u010de, tzn. vy\u017eaduje zaveden\u00ed trval\u00e9ho v\u00fdvodu.<\/p>\n<p>V&nbsp;sou\u010dasn\u00e9 dob\u011b jsou hlavn\u00edmi indikacemi k&nbsp;chirurgick\u00e9mu v\u00fdkonu (z\u00e1chrann\u00e9 l\u00e9\u010db\u011b) situace, kdy onemocn\u011bn\u00ed bu\u010f recidivuje, anebo nebylo oza\u0159ov\u00e1n\u00edm kompletn\u011b vyl\u00e9\u010deno (podle st\u00e1dia onemocn\u011bn\u00ed je riziko 5-15%).<\/p>\n<p>Do oblasti chirurgick\u00e9 l\u00e9\u010dby tak\u00e9 spad\u00e1 ot\u00e1zka do\u010dasn\u00e9ho zaveden\u00ed v\u00fdvodu na&nbsp;dobu radioterapie, kter\u00e9 umo\u017en\u00ed l\u00e9pe tolerovat poradia\u010dn\u00ed ko\u017en\u00ed a&nbsp;slizni\u010dn\u00ed reakce.<\/p>\n<h3>Radioterapie<\/h3>\n<p>Radioterapie n\u00e1dor\u016f anu je prioritn\u00ed l\u00e9\u010dba, pokud se nemocn\u00fd nerozhodne pro chirurgickou alternativu.\u00a0Radioterapie n\u00e1dor\u016f anu je velmi n\u00e1ro\u010dn\u00e1 l\u00e9\u010dba. <strong>Jej\u00ed ned\u00edlnou sou\u010d\u00e1st\u00ed je sou\u010dasn\u00e9 pod\u00e1n\u00ed standardn\u00ed chemoterapie<\/strong>. Je prov\u00e1zena \u0159adou ne\u017e\u00e1douc\u00edch efekt\u016f v\u00a0oblasti k\u016f\u017ee, sliznic, urogenit\u00e1ln\u00edho traktu a&nbsp;tak\u00e9 krevn\u00edho obrazu.<\/p>\n<p><strong class=\"custom-bold\">Proto se uplat\u0148uje radioterapie protonov\u00e1,<\/strong> kter\u00e1 m\u00e1 p\u0159\u00edzniv\u011bj\u0161\u00ed rozlo\u017een\u00ed d\u00e1vek ne\u017e konven\u010dn\u00ed radioterapie fotonov\u00e1, a&nbsp;ne\u017e\u00e1douc\u00ed efekty se da\u0159\u00ed sp\u00ed\u0161e zm\u00edr\u0148ovat, p\u0159irozen\u011b ne eliminovat.<\/p>\n<p>Ve v\u011bt\u0161in\u011b p\u0159\u00edpad\u016f\u00a0<strong class=\"custom-bold\">lze protonovou radioterapii aplikovat bez zaveden\u00ed do\u010dasn\u00e9ho v\u00fdvodu st\u0159eva, tzv. kolostomie.<\/strong> Protin\u00e1dorov\u00e1 \u00fa\u010dinnost protonov\u00e9 a&nbsp;fotonov\u00e9 radioterapie je stejn\u00e1.<\/p>\n<h3>Chemoterapie<\/h3>\n<p><strong>Je indikov\u00e1na u&nbsp;rozm\u011brn\u00fdch n\u00e1dor\u016f p\u0159ed radioterapi\u00ed s\u00a0c\u00edlem zmen\u0161it oza\u0159ovanou masu.<\/strong> Je t\u00e9\u017e indikov\u00e1na p\u0159i recidiv\u011b ve form\u011b vzd\u00e1len\u00fdch metast\u00e1z (lok\u00e1ln\u00ed recidiva lze \u0159e\u0161it \u201ez\u00e1chrannou\u201c operac\u00ed).<\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>N\u00e1dory j\u00edcnu &nbsp; &nbsp; N\u00e1dory slinivky b\u0159i\u0161n\u00ed &nbsp; &nbsp; Rakovina jater &nbsp; &nbsp; N\u00e1dory an\u00e1ln\u00edho otvoru<\/p>\n","protected":false},"author":1,"featured_media":4834,"parent":4855,"menu_order":247,"comment_status":"closed","ping_status":"closed","template":"template-service-detail-with-sidebar.php","meta":{"footnotes":""},"class_list":["post-4866","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/4866","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/comments?post=4866"}],"version-history":[{"count":1,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/4866\/revisions"}],"predecessor-version":[{"id":4887,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/4866\/revisions\/4887"}],"up":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/pages\/4855"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/media\/4834"}],"wp:attachment":[{"href":"https:\/\/www.ptc.cz\/hr\/wp-json\/wp\/v2\/media?parent=4866"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}