{"id":5818,"date":"2025-05-15T10:57:54","date_gmt":"2025-05-15T07:57:54","guid":{"rendered":"https:\/\/neolife.innovatorspark.com\/valcea\/noutati\/diagnosticarea-cancerului-bronhopulmonar-cbp-2\/"},"modified":"2025-05-15T10:57:54","modified_gmt":"2025-05-15T07:57:54","slug":"diagnosticarea-cancerului-bronhopulmonar-cbp-2","status":"publish","type":"post","link":"https:\/\/neolife.innovatorspark.com\/valcea\/noutati\/diagnosticarea-cancerului-bronhopulmonar-cbp-2\/","title":{"rendered":"Diagnosticarea cancerului Bronhopulmonar (CBP)"},"content":{"rendered":"<p>Scopul evalu\u0103rii ini\u021biale a unui pacient cu suspiciune de cancer este de a ob\u021bine suficiente date clinice \u0219i paraclinice pentru a-l \u00eendruma, \u00eentr-un timp eficient, c\u0103tre investiga\u021bii complexe, ce au \u00een final rolul de a ob\u021bine o confirmare histopatologic\u0103 \u0219i \u00eencadrarea \u00eentr-un stadiu TNM. Accesul rapid la un tratament multidisciplinar \u00eembun\u0103t\u0103\u021be\u0219te prognosticul cancerului pulmonar.<\/p>\n<p><strong>Obiectivul evalu\u0103rii ini\u021biale este de a identifica: <\/strong><\/p>\n<ul>\n<li>afectarea clinic\u0103;<\/li>\n<li>stadializarea;<\/li>\n<li>locul \u0219i modalitatea optim\u0103 pentru a ob\u021bine proba bioptic\u0103;<\/li>\n<li>detectarea subtipului histopatologic \u0219i genotiparea cancerului;<\/li>\n<li>managementul comorbidit\u0103\u021bilor, complica\u021biilor secundare \u0219i sindroamelor paraneoplazice care ar putea influen\u021ba prognosticul;<\/li>\n<li>conduita terapeutic\u0103 corespunz\u0103toare;<\/li>\n<li>evaluarea riscului pre-operator \u00een cazul deciziei de a \u00eencadra neoplasmul \u00een categoria rezecabil\u0103.<\/li>\n<\/ul>\n<h3>\u00a0<u>INVESTIGA\u021aII PARACLINICE<\/u><\/h3>\n<p><strong>INVESTIGA\u021aII DE LABORATOR:<\/strong><\/p>\n<p>Analizele de s\u00e2nge uzuale recomandate pentru a fi recoltate sunt: hemoleucogram\u0103, coagulogram\u0103, ionogram\u0103, markerii de inflama\u021bie, afectare hepatic\u0103, afectare renal\u0103, metabolism fosfo-calcic. Se pot efectua \u0219i markeri tumorali, \u00eens\u0103 ace\u0219tia nu constituie metode de screening\/diagnostic \u00een CBP, pot s\u0103 fie utiliza\u021bi \u00een monitorizarea terapeutic\u0103 a pacien\u021bilor oncologici \u2013 CEA (antigen carcinoembrionar), NSE (enolaza neuron specific\u0103), CYFRA 21-1 \u0219i CA 125.<\/p>\n<p><strong style=\"color: initial;\">EVALUARE FUNC\u021aIONAL\u0102 \u2013 <\/strong><span style=\"color: initial;\">spirometrie cu test bronhodilatator \/ pletismografie + TLCo.<\/span><\/p>\n<p data-wp-editing=\"1\"><img loading=\"lazy\" decoding=\"async\" class=\"size-thumbnail wp-image-4761 alignleft\" src=\"https:\/\/neolife.innovatorspark.com\/valcea\/wp-content\/uploads\/sites\/9\/2025\/05\/art-3-p1-150x150.avif\" alt=\"\" width=\"150\" height=\"150\" \/><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-4763 alignleft\" src=\"https:\/\/neolife.innovatorspark.com\/valcea\/wp-content\/uploads\/sites\/9\/2025\/05\/art-3-p2-150x150.avif\" alt=\"\" width=\"150\" height=\"150\" \/><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-4762 alignleft\" src=\"https:\/\/neolife.innovatorspark.com\/valcea\/wp-content\/uploads\/sites\/9\/2025\/05\/art-3-p3-150x150.avif\" alt=\"\" width=\"150\" height=\"150\" \/><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<table>\n<tbody>\n<tr>\n<td rowspan=\"6\" width=\"140\"><strong>\u00a0<\/strong><strong>\u00a0<\/strong><strong> TESTE IMAGISTICE<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/td>\n<td colspan=\"2\" width=\"499\">C\u00e2nd exist\u0103 o suspiciune clinic\u0103 ridicat\u0103 de neoplasm pulmonar, radiografia pulmonar\u0103 reprezint\u0103 investigatia cea mai ieftin\u0103, disponibil\u0103, obligatorie \u0219i de prim\u0103 inten\u021bie.<\/td>\n<\/tr>\n<tr>\n<td width=\"189\"><strong>\u00a0<\/strong><strong>Low dose CT<\/strong><\/td>\n<td width=\"310\">Se recomand\u0103 screeningul imagistic prin low dose CT pentru pacien\u021bii fum\u0103tori, facilind \u00een felul acesta diagnosticul CBP \u00een stadii incipiente.<\/td>\n<\/tr>\n<tr>\n<td width=\"189\"><strong>COMPUTER TOMOGRAF (CT) cu SUBSTAN\u021a\u0102 DE CONTRAST AL SEGMENTULUI TORACIC<\/strong><\/td>\n<td width=\"310\"><strong>Indicat <\/strong>\u00een prezen\u021ba unui tablou clinic \u0219i a unei <a href=\"\/radiologie-imagistica\/\">radiografii toracice<\/a> care ridic\u0103 suspiciunea unui proces proliferativ;<strong>Aceast\u0103 investiga\u021bie este important\u0103 pentru excluderea unor diagnostice diferen\u021biale, dar \u0219i pentru stadializarea CBP. <\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"189\"><strong>\u00a0<\/strong><strong>\u00a0<\/strong><strong> TOMOGRAFIA CU EMISIE DE POZITRONI (PET \u2013 CT)<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/td>\n<td width=\"310\">Este o tehnic\u0103 imagistic\u0103 modern\u0103 care detecteaz\u0103 activitatea metabolic\u0103 intens\u0103 a celulelor de tip tumoral;Scanarea nu este doar a unui singur segment, ci a \u00eentregului organism;<strong>Este util\u0103 pentru caracterizarea nodulului pulmonar solitar &gt; 1cm la pacien\u021bii la care biopsia e neconcludent\u0103 sau contraindicat\u0103 sau pentru descrierea unor mase mediastinale greu abordabile prin mediastinoscopie;<\/strong><\/p>\n<p>Aceast\u0103 investiga\u021bie are un rol esen\u021bial \u00een stadializarea pacien\u021bilor considera\u021bi eligibili pentru interven\u021bia chirurgical\u0103 cu viz\u0103 curativ\u0103, respectiv a celor eligibili pentru radioterapie;<\/p>\n<p>Pe langa acestea, are o contribu\u021bie semnificativ\u0103 \u00een cazul suspiciunii de recidiv\u0103.<\/td>\n<\/tr>\n<tr>\n<td width=\"189\"><strong> REZONAN\u021a\u0102 MAGNETIC\u0102 NUCLEAR\u0102<\/strong><\/td>\n<td width=\"310\">Este utilizat\u0103 doar pentru evaluarea tumorilor apicale cu o posibil\u0103 invazie a plexului brahial \u0219i pentru evaluarea invaziei sistemului osos.<\/td>\n<\/tr>\n<tr>\n<td width=\"189\"><strong>ULTRASONOGRAFIA TORACIC\u0102<\/strong><\/td>\n<td width=\"310\">Se utilizeaz\u0103 pentru ghidarea toracocentezelor evacuatorii sau a biopsiilor pleurale\/ganglionare.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3>\u00a0INVESTIGA\u021aII PENTRU CONFIRMAREA DIAGNOSTICULUI \u0218I STABILIREA TIPULUI HISTOPATOLOGIC<\/h3>\n<p>Selectarea modalit\u0103\u021bii de biopsie se realizeaz\u0103 pe baza stadializ\u0103rii imagistice. Modalit\u0103\u021bile endoscopice \u0219i ghidate imagistic (bronhoscopie, EBUS \u2013 TBNA, punc\u021bie ghidat\u0103 CT) sunt preferate fa\u021b\u0103 de modalit\u0103\u021bile chirurgicale (mediastinoscopia, toracoscopia) pentru biopsia ini\u021bial\u0103.<\/p>\n<p>\u00cen mod ideal, investiga\u021biile paraclinice trebuie organizate \u00een 2 \u2013 3 zile lucr\u0103toare:<\/p>\n<ul>\n<li>ziua 1 \u2013 evaluare clinic\u0103, biologic\u0103 \u0219i func\u021bional\u0103 respiratorie;<\/li>\n<li>ziua 2 \u2013 evaluare imagistic\u0103 (CT torace, abdomen \u0219i pelvis +\/- RMN cerebral);<\/li>\n<li>ziua 3 \u2013 abord bioptic (bronhoscopie, EBUS, TBNA, punc\u021bie ghidat\u0103 CT, mijloace chirurgicale).<\/li>\n<\/ul>\n<h3>BRONHOSCOPIA<\/h3>\n<ul>\n<li>Confirmarea diagnosticului de CBP se face strict prin examen histopatologic astfel \u00eenc\u00e2t bronhoscopia este indispensabila \u00een aceast\u0103 patologie;<\/li>\n<li>Este de asemenea util\u0103 \u00een stadializarea bolii;<\/li>\n<li>Alte metode de prelevare a probelor biologice \u00een caz de leziuni de vecin\u0103tate sunt: biopsia cu forceps, brosajul bron\u0219ic (periaj), aspiratul bron\u0219ic \u0219i lavajul bronho-alveolar (\u00eendeosebi \u00een caz de leziuni pulmonare periferice);<\/li>\n<li>\u00cen cazul carcinoamelor in situ se poate folosii <strong>BRONHOSCOPIA CU AUTOFLUORESCEN\u021a\u0102<\/strong>;<\/li>\n<li><strong>Tehnicile bronhoscopice moderne permit recoltarea \u021besutului dincolo de limita vizual\u0103, prin intermediul biopsiilor transbron\u0219ice, al punc\u021biilor ganglionare transbron\u0219ice sub control fluoroscopic, respectiv a ecoendoscopiei bron\u0219ice (EBUS);<\/strong><\/li>\n<li><strong>BRONHOSCOPIA INTERVEN\u021aIONAL\u0102 &#8211; <\/strong>permite \u0219i manevre terapeutice minim invazive cu viz\u0103 paliativ\u0103, precum \u0219i dezobstruc\u021bia bron\u0219ic\u0103 sau stentarea bron\u0219ic\u0103.<\/li>\n<\/ul>\n<h3>PUNC\u021aIA \u2013 BIOPSIE TRANSTORACIC\u0102<\/h3>\n<p><strong>Se practic\u0103 de obicei sub ghidaj ecografic sau CT. <\/strong>Este o modalitate rapid\u0103 \u0219i relativ\u0103 sigur\u0103 de confirmare a diagnosticului de cancer pulmonar pentru formele periferice, inabordabile prin alte tehnici mai putin invazive.<\/p>\n<h3>TORACOCENTEZA<\/h3>\n<p>Are sensibilitate de 70% pentru detec\u021bia celulelor neoplazice prin analiza citologic\u0103 \u00eenalt\u0103. Aceast\u0103 procedur\u0103 poate fi completat\u0103 de <strong>punc\u021bia biopsie pleural\u0103 transtoracic\u0103.<\/strong><\/p>\n<h3>MEDIASTINOSCOPIA \u0218I TORACOSCOPIA<\/h3>\n<p>Permit vizualizarea direct\u0103 a hemitoracelui afectat, prelevarea de probe bioptice, respectiv stadializarea CBP prin evaluarea sta\u021biilor ganglionare.<\/p>\n<p><strong>\u0218i ALTE solu\u021bii (\u00een cazul \u00een care sunt posibile): <\/strong>Biopsie lichid\u0103, examen citologic al sputei.<\/p>\n<h3>TESTE IMUNOHISTOCHIMICE<\/h3>\n<ul>\n<li>Adesea fragmentele tisulare recoltate \u00een timpul biopsiei au dimensiuni foarte mici \u0219i sunt dificil de apreciat din punct de vedere histopatologic, necesit\u00e2nd investiga\u021bii imunohistochimice;<\/li>\n<li><strong>Acestea sunt recomandate \u00een diagnosticul diferen\u021biat dintre tipuri histopatologice de CBP, totodat\u0103, permit \u0219i diferen\u021bierea dintre tumora primar\u0103 \u0219i metastaz\u0103.<\/strong><\/li>\n<\/ul>\n<p><strong>Mesaje pentru ACAS\u0102:<\/strong><\/p>\n<ol>\n<li>Pacientul cu suspiciune clinic\u0103 sau imagistic\u0103 de CBP ar trebui s\u0103 fie referit c\u00e2t mai repede la medicul pneumolog pentru investiga\u021bii, iar accesul s\u0103 fie prioritizat.<\/li>\n<li>Evaluarea clinic\u0103 a pacientului cu CBP trebuie s\u0103 cuprind\u0103 istoricul medical, examenul fizic, determinarea comorbidit\u0103\u021bilor, statusul func\u021bional (indicele de performan\u021b\u0103 ECOG \u0219i indexul Karnovsky), sc\u0103derea ponderal\u0103, sindroamele paraneoplazice \u0219i semnele de invazie loco \u2013 regional\u0103 sau la distan\u021b\u0103.<\/li>\n<li>P\u00e2n\u0103 \u00een prezent, nu exist\u0103 un marker tumoral specific \u0219i sensibil pentru detec\u021bia seric\u0103 a neoplasmului pulmonar, motiv pentru care nu este recomandat ca metod\u0103 de diagnostic.<\/li>\n<\/ol>\n<p><strong>\u00a0<\/strong><strong style=\"color: initial;\">BIBLIOGRAFIE:<\/strong><\/p>\n<ol>\n<li>Philip B, Jain A, Wojtowicz M, Khan I, Voller C, Patel RSK, Elmahdi D, Harky A. Current investigative modalities for detecting and staging lung cancers: a comprehensive summary. Indian J Thorac Cardiovasc Surg. 2023 Jan;39(1):42-52.<\/li>\n<li>Birchard KR. Transthoracic needle biopsy. Semin Intervent Radiol. 2011 Mar;28(1):87-97.<\/li>\n<li>Nooreldeen R, Bach H. Current and Future Development in Lung Cancer Diagnosis. Int J Mol Sci. 2021 Aug 12;22(16):8661.<\/li>\n<li>Horeweg N, Scholten ET, de Jong PA, van der Aalst CM, Weenink C, Lammers JW, Nackaerts K, Vliegenthart R, ten Haaf K, Yousaf-Khan UA, Heuvelmans MA, Thunnissen E, Oudkerk M, Mali W, de Koning HJ. Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers. Lancet Oncol. 2014 Nov;15(12):1342-50.<\/li>\n<li>Manser R, Lethaby A, Irving LB, Stone C, Byrnes G, Abramson MJ, Campbell D. Screening for lung cancer. Cochrane Database Syst Rev. 2013 Jun 21;2013(6).<\/li>\n<li>Kim J, Lee H, Huang BW. Lung Cancer: Diagnosis, Treatment Principles, and Screening. Am Fam Physician. 2022 May 1;105(5):487-494.<\/li>\n<li>Wong SK, Iams WT. Front Line Applications and Future Directions of Immunotherapy in Small-Cell Lung Cancer. Cancers (Basel). 2021 Jan 29;13(3):506.<\/li>\n<li>Sub redac\u021bia Cristian Oancea, Ovidiu Fira \u2013 Ml\u0103dinescu, Voicu Tudorache, Tratat de Pneumologie pentru medicii reziden\u021bi, Timi\u0219oara, editura Victor Babe\u0219, 2021.<\/li>\n<li>Ariadna Petronela Filda, Ruxandra Ulmeanu, Florin Dumitru Mihaltan, Roxana Maria Nemes, Cancerul bronhopulmonar &#8211; recomadari de diagnostic \u0219i tratament, elaborat sub egida Socoetatii Romane de Pneumologie, Constanta, editura Muntenia, 2023.<\/li>\n<li>Sub redac\u021bia Miron Alexandru Bogdan, Pneumologie, Bucure\u0219ti, editura universitar\u0103 Carol Davila, 2008.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Scopul evalu\u0103rii ini\u021biale a unui pacient cu suspiciune de cancer este de a ob\u021bine suficiente date clinice \u0219i paraclinice pentru a-l \u00eendruma, \u00eentr-un timp eficient, c\u0103tre investiga\u021bii complexe, ce au \u00een final rolul de a ob\u021bine o confirmare histopatologic\u0103 \u0219i \u00eencadrarea \u00eentr-un stadiu TNM. Accesul rapid la un tratament multidisciplinar \u00eembun\u0103t\u0103\u021be\u0219te prognosticul cancerului pulmonar. Obiectivul [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":4773,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[29],"tags":[],"class_list":["post-5818","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole"],"acf":[],"_links":{"self":[{"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/posts\/5818","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/comments?post=5818"}],"version-history":[{"count":1,"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/posts\/5818\/revisions"}],"predecessor-version":[{"id":5819,"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/posts\/5818\/revisions\/5819"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/media\/4773"}],"wp:attachment":[{"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/media?parent=5818"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/categories?post=5818"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/neolife.innovatorspark.com\/valcea\/wp-json\/wp\/v2\/tags?post=5818"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}