Oncologische aandoeningen van de thorax
AANDOENING TYPE/BESCHRIJVING SYMPTOMEN DIAGNOSTIEK BEHANDELING EXTRA INFO
KLEINCELLIG Snel delende kleine Hoesten, dyspneu, Auscultatie hart + long; 1e keus: chirurgische Incidentie: 1-:100.000/jaar.
LONGCARCINOOM cellen met weinig sputumproductie, Palpatie supraclaviculaire resectie (meestal niet) Oorzaak: fijnstofophoping
(SCLC) cytoplasma, weinig of hemoptoë, klieren en lever; Chemotherapie in de longen.
geen nucleoli en een thoracale pijn. Xthorax; CTthorax+abdomen; (cisplatine+etoposide) Risico: roken, genetisch,
granulair chromatine- Bronchoscopie met cytologie Radiotherapie (altijd brain radioactiviteit, oud, COPD,
patroon. Non-metastase + histologie: CHr positief profylactische bestraling, TBC, beroepsblootstelling
Hormoonproductie extrapulmonair: E.v.t. FDG-PET evt thorax bij beperkt ziek) (e.g. arseen/asbest/radon)
Bijzonder agressief. clubbing, HPOA, Nabehandeling: 1 jaar TNM-Stadiëring:
anemie, thrombo- immunotherapie (III) Limited (LD): stadium I-IIIB
! Typisch lang gerookt cytose. Extensive (ED): IIIB-IV
Origine: APUD-cellen
NIET-KLEINCELLIG Oligometastatic Hoesten, dyspneu, Auscultatie hart + long; II-III: Chirurgische radicale Incidentie: 45-55:100.000/jr
LONGCARCINOOM NSCLC = tussen lokaal sputumproductie, Palpatie supraclaviculaire resectie (20%) + chemo; Oorzaak: fijnstofophoping
(NSCLC) en verspreide ziekte. hemoptoë, klieren en lever; >III: Chemotherapie; in de longen / mutatie
! Typisch lange bloot- thoracale pijn. Xthorax; CTthorax+abdomen; I-IV: Radiotherapie (altijd); Risico: zie LCLC
stelling aan fijnstof Clubbing, anemie, Bronchoscopie met cytologie Evt. targeted therapy; met 80% van alle long-
(m.n. roken) HPOA, trombo’s. + histologie; evt. FDG-PET. EGFR-remmer. carcinomen is NSLCLC
Plaveiselcelcarcinoom Incidentie 35% UK P63 of P40 positief Cisplatine + gemcitabine Meestal door roken.
Bronchusobstructie PD-L1 kleuring Origine: epitheelcellen.
Adenocarcinoom Incidentie 30% UK TTF-1 positief Gen: doelgericht; Geen mutatie -> eiwitkleur:
- AIS (in-situ) Gen: KRAS/EGFR/ALK EGFR: tyrosine kinase PD-L1: pembrolizumab
- MIA (min. Invasief) X/CT-thorax: perifere lesies Inhibitor PD-L1¯: pembrolizumab
- IA (invasief; >5mm) KRAS: Alectinib + chemotherapie
Geen mutatie: chemo- Origine: mucusklieren.
immunotherapie (max 2jr)
Adenosquameus carc. P40 en TTF-1 positief
Grootcellig carcinoom Incidentie 15% UK
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