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Samenvatting E3 Oncologie, palliatieve behandeling en levenseinde
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  • Course
  • Klinische vraagstukken
  • Institution
  • Radboud Universiteit Nijmegen (RU)
  • Book
  • Leerboek oncologie

Samenvatting van de hele module E3 met onder andere tumoren, metastasen, behandeling van symptomen bij kanker, mammacarcinoom, prostaatcarcinoom, lymfomen, leukemie, myeloproliferatieve neoplasieën, chirurgisch-oncologische behandelingsprincipes, radiotherapie bij kanker, chemotherapie bij kanker,...

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  • No
  • H7, 8, 9, 10, 11, 12, 13, 25, 27, 29, 32, 33, 35, 37, 38, 40, 41, 43
  • March 15, 2019
  • 83
  • 2018/2019
  • Summary

Subjects

  • tumoren
  • metastasen
  • hersenmetastase
  • botmetastase
  • pijn bij kanker
  • vermoeidheid bij kanker
  • mammacarcinoom
  • prostaatcarcinoom
  • lymfomen
  • hodgkin lymfoom
  • non hodgkin lymfoom
  • leukem
  • paraneoplasticshe syndromen

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  • Radboud Universiteit Nijmegen (RU)
  • Geneeskunde
  • Klinische vraagstukken
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LiekeSchonberger

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E3 Oncologie,
palliatieve behandeling
en levenseinde
SAMENVATTING




Lieke Schönberger


1

,Inhoud
Tumoren .............................................................................................................................................6
Symptomen tumoren ......................................................................................................................6
Paraneoplastische syndromen ........................................................................................................6
Endocriene paraneoplastische verschijnselen ..............................................................................6
Metabole paraneoplastische verschijnselen ................................................................................7
Metastasen .........................................................................................................................................8
Hersenmetastase ........................................................................................................................8
Botmetastasen ............................................................................................................................8
Behandeling van pijn en andere symptomen bij kanker.......................................................................9
Symptomen ....................................................................................................................................9
Pijn bij patiënten met kanker ..........................................................................................................9
Chronische pijn ......................................................................................................................... 10
Behandeling van de oorzaak van de pijn .................................................................................... 10
Opioïden ................................................................................................................................... 11
Radiotherapie ........................................................................................................................... 11
Vermoeidheid bij patiënten met kanker ........................................................................................ 12
Behandelen ............................................................................................................................... 12
Mammacarcinoom............................................................................................................................ 13
Voorkomen van mammacarcinoom in de familie .......................................................................... 13
Beeldvormende diagnostiek van de mamma ................................................................................. 13
Niet-maligne mamma-afwijkingen ................................................................................................ 15
Fibroadenoom .......................................................................................................................... 15
Fibrocysteuze afwijkingen ......................................................................................................... 15
Tepeluitvloed ............................................................................................................................ 15
Maligne afwijkingen, pathologie en stadiëring .............................................................................. 16
Chirurgie ....................................................................................................................................... 17
Radiotherapie ............................................................................................................................... 17
Systemische therapie .................................................................................................................... 17
Prostaatcarcinoom............................................................................................................................ 18
Lymfomen ........................................................................................................................................ 21
Pathologie..................................................................................................................................... 22
Kliniek en stadiëring ...................................................................................................................... 22
Hodgkinlymfoom .......................................................................................................................... 24


2

, Klassiek Hodgkinlymfoom.......................................................................................................... 24
Nodulair lymfocytenrijk Hodgkinlymfoom ................................................................................. 25
Non hodgkin lymfoom................................................................................................................... 26
Diffuus grootcellig B-cellymfoom (DLBCL) .................................................................................. 26
Folliculair lymfoom.................................................................................................................... 27
T-cellymfomen .......................................................................................................................... 27
Multipel myeloom (MM) ........................................................................................................... 27
Verschil Hodgkin en non-Hodgkin.................................................................................................. 28
Leukemie .......................................................................................................................................... 29
Ontstaan van leukemie ................................................................................................................. 29
Acute leukemie myeloïde leukemie (AML) .................................................................................... 29
Acute lymfatische leukemie (ALL) .................................................................................................. 31
Myelodysplastische syndromen (MDS) .......................................................................................... 31
Chronische myeloïde leukemie (CML) ........................................................................................... 32
Chronische lymfatische leukemie (CLL).......................................................................................... 33
Myeloproliferatieve neoplasieën (MPN)............................................................................................ 34
Polycythemie vera (PV) ................................................................................................................. 34
Essentiële trombocytose (ET) ........................................................................................................ 35
Myelofibrose (MF) ........................................................................................................................ 36
Chirurgisch-oncologische behandelingsprincipes............................................................................... 38
Chirurgische biopsie .................................................................................................................. 38
Curatieve of palliatieve chirurgie ............................................................................................... 38
Neoadjuvante therapie ............................................................................................................. 38
Profylactische chirurgie ............................................................................................................. 38
Radiotherapie bij kanker ................................................................................................................... 39
Effecten van ioniserende straling in de cel ................................................................................. 39
Gefractioneerde bestraling........................................................................................................ 39
Bijwerkingen ............................................................................................................................. 39
De rol van radiotherapie bij in opzet curatieve behandelingen ...................................................... 40
Bijwerkingen van bestraling en de verschillende behandelingsvormen .......................................... 40
Radiotherapie als pijnbestrijding ................................................................................................... 40
Chemotherapie bij kanker ................................................................................................................. 41
Chemotherapie en de celcyclus ..................................................................................................... 41
Wisselwerking tussen chemotherapie en tumorbiologie ............................................................... 41


3

, Resistentie tegen de behandeling ................................................................................................. 41
Cellulaire resistentie.................................................................................................................. 42
Toxiciteit van chemotherapie ........................................................................................................ 43
Indeling en werkingsmechanismen van cytostatica ....................................................................... 43
Geneesmiddelen die de cel doden door het genomische DNA te beschadigen. .......................... 43
Topo-isomerase inhibitoren ...................................................................................................... 44
Microtubulaire inhibitoren ........................................................................................................ 44
Antimetabolieten ...................................................................................................................... 44
Toepassing in de kliniek ................................................................................................................ 48
Combinatietherapie .................................................................................................................. 48
Synergie met radiotherapie ....................................................................................................... 48
Dosisintensiteit ......................................................................................................................... 48
Adjuvante en neoadjuvante behandeling .................................................................................. 49
Targeted therapy bij kanker .............................................................................................................. 50
Hormonale therapie ...................................................................................................................... 50
Receptoren voor steroïdhormonen ........................................................................................... 50
Hormonale therapie .................................................................................................................. 51
Principes van hormonale therapie ............................................................................................. 51
Aromataseremmers (anastrozol, letrozol) ................................................................................. 54
Antihormonen........................................................................................................................... 54
Totale liganddepletie................................................................................................................. 55
Regressie door endocriene therapie .......................................................................................... 55
Receptoren en effect van endocriene therapie .......................................................................... 55
Ontwikkeling van ongevoeligheid .............................................................................................. 55
Adjuvante endocriene therapie ................................................................................................. 55
Moleculaire doelgerichte behandelingen ...................................................................................... 56
Monoklonale antilichamen............................................................................................................ 57
Kleine moleculen .......................................................................................................................... 58
Immunologie van kanker................................................................................................................... 59
Tumorantigeenpresentatie........................................................................................................ 59
Inductie van een T-celrespons ................................................................................................... 59
Migratie van T-cellen naar de tumor en infiltratie in de tumor .................................................. 60
Doden van de tumorcellen door T-cellen ................................................................................... 60
Therapeutische interventies bij de cancer immunity cycle ............................................................. 60


4

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