Jak wygląda ścieżka pacjenta przy podejrzeniu czerniaka?
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Jak przebiega ścieżka pacjenta przy podejrzeniu czerniaka?

Ten tekst przeczytasz w 2 min.

Czerniak to nowotwór, który cechuje się wysokim stopniem złośliwości. Może dawać przerzuty do okolicznych węzłów chłonnych, a także przerzuty odległe do innych narządów. Jakie są stopnie zaawansowania czerniaka i jak przebiega rozpoznanie i diagnostyka tej choroby?

Czerniak głównie dotyczy skóry, rzadziej błony śluzowej jelit, jamy ustnej i gałki ocznej. Choroba z roku na rok dotyka coraz więcej osób w Polsce, zazwyczaj dorosłych, rzadko dzieci i młodzież.

4 główne stopnie zaawansowania klinicznego czerniaka:

0 – postać nieprzekraczająca naskórka i nienaciekająca, carcinoma in situ

I – brak zajęcia węzłów chłonnych, brak przerzutów, guz z owrzodzeniem nie grubszym niż 1 mm lub bez owrzodzenia ≤2 mm

II – brak zajęcia węzłów chłonnych, brak przerzutów, wyróżnia się 3 podstopnie (IIA, IIB, IIC), w których cechą decydującą jest grubość zmiany pierwotnej

III – przerzuty do regionalnych węzłów chłonnych (lub z obecnością tzw. przerzutu in-transit, ognisk satelitarnych i/lub mikrosatelitarnych)

IV – przerzuty w odległych narządach, np. płuc i wątroby

Jak przebiega rozpoznanie i diagnostyka czerniaka?

Rozpoznanie czerniaka polega na ocenie zmiany na skórze zgodnie z zasadą ABCDE, akronimem angielskich słów, które należy wziąć pod uwagę podczas badania i obserwacji znamion.

A (asymmetry) – asymetria

B (borders) – brzegi nierówne i postrzępione

C (color) – nierównomierne rozłożenie barwnika

D (diameter) – średnica >5mm

E (Extension) – uwypuklenie powierzchni ponad poziom otaczającego zmianę naskórka

Jak przebiega ścieżka pacjenta przy podejrzeniu czerniaka?

Przeczytaj także: Antybiotykooporność w leczeniu ran – jak z nią walczyć?

Wśród niepokojących objawów, które mogą świadczyć o nowotworze jest krwawienie, swędzenie czy pieczenie znamienia/guzka. Dlatego pacjent, u którego wystąpił któryś z objawów powinien zgłosić się do lekarza rodzinnego, dermatologa lub chirurga onkologicznego. Podczas takiej wizyty zostanie przeprowadzone badanie wideodermatoskopowe, które pokaże czy zmiana powinna zostać usunięta czy wystarczy dalsza obserwacja.

Diagnostyka zmiany skórnej polega na wykonaniu tzw. biopsji wycinającej oraz ocenie (badaniu histopatologicznemu) wyciętej zmiany pod mikroskopem. Dzięki tego rodzaju diagnostyce możliwe jest ustalenie rozpoznania, ocena grubości nacieku, występowania owrzodzenia na powierzchni oraz obecności tzw. ognisk mikrosatelitarnych z melanocytów o średnicy powyżej 0,05 mm.

Na podstawie wyniku badania histopatologicznego specjalista może podjąć decyzję o dalszym postępowaniu. W przypadku rozpoznania czerniaka pacjent jest kierowany do ośrodka na kolejne badania diagnostyczne oraz leczenie.

Co szczególnie ważne w przypadku tej choroby, czas ma tu olbrzymie znaczenie. Dlatego tak ważne jest, rozpoczęcie diagnostyki jak najszybciej, w ośrodku, który zapewni pacjentowi kompleksową i interdyscyplinarną opiekę na każdym etapie choroby.

Na czym polega leczenie czerniaka?

Podczas leczenia radykalnego czerniaka specjalista jednocześnie wycina bliznę po biopsji wycinającej z marginesem tkanek oraz wykonuje biopsję węzła wartowniczego lub limfadenektomię regionalną (radykalne wycięcie węzłów chłonnych).

W sytuacji, kiedy w pobranych węzłach znajdują się komórki nowotworowe, można podjąć decyzję o całkowitym wycięciu lub leczeniu systemowym, czyli terapii całego organizmu pacjenta. Ma ona na celu całkowitą eliminację komórek nowotworowych z organizmu pacjenta (również mikroprzerzutów).

Przed rozpoczęciem leczenia powinno się oznaczyć u pacjenta obecność mutacji genu BRAF V600, ponieważ wykrycie go decyduje o zastosowaniu tzw. leczenia ukierunkowanego na cal molekularny, czyli terapii celowanej.

Więcej informacji o postępowaniu przy podejrzeniu czerniaka przeczytasz na stronie zwrotnikraka.pl.

Źródło: zwrotnikraka.pl

Przeczytaj także: Polscy naukowcy opracowali rozpuszczalny opatrunek, który dodatkowo uwolni leki do rany

Przeczytaj bezpłatnie pokrewny artykuł w czasopiśmie „Pielęgniarstwo w Anestezjologii i Intensywnej Opiece „:

Miejsce antybiotykoterapii w leczeniu ran

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