Znalezionych wyników: 4

madziorek napisał/a:

kangur_2007 napisał/a:

PS Goncha, o ile wiem nie jest specjalista zajmujacym sie melanoma tylko pacjentem z pewna wiedza na temat tego typu raka.

Ale drogi Kangurze to gontcha, uczestniczy w renomowanych kongresach typu PO ASCO 2010 skąd przekazuje najnowsze doniesienia z dziedziny onkologii. Proszę nie podważaj jej wiedzy, doniesieniami sprzed kilkunastu lat, bo to nieuczciwe. Tu znajdziesz certyfikaty

http://www.fundacja-onkol...d=56&Itemid=132
Pozdrawiam M.

AU/NZ guidelines sa z 2009 roku

Ponizej brytyjskie guidelines z 2010 roku, ktore moga zainteresowac pacjentke z Irlandii.

Revised U.K. Guidelines for the Management of Cutaneous Melanoma 2010: Follow Up

Cytat:

[u]Follow Up

There are three main reasons for follow up after treatment of primary cutaneous melanoma. The first is to detect recurrence when further treatment can improve the prognosis, the second is to detect further primary melanomas and the third is to provide support, information and education. The proportion of patients with melanoma who have impaired health-related quality of life is comparable with other cancers, and their needs for psychosocial support are likely to be similar.[137] Provision of this is an important part of MDT management.[138] There are no RCTs which have formally evaluated follow up. Numerous follow-up regimens have been reviewed but few are evidence based.[139–141] Sixty-two per cent of all recurrences were detected by patients themselves in one review, but definition of patient or doctor detection is unclear and other series emphasize the importance of physician-detected recurrence.[134] Patient opinion was equally divided as to whether follow-up visits were reassuring or provoked further anxiety. There is little evidence of survival advantage following self-detection of metastases.[139–141] Most first relapses occur in the 5 years following diagnosis, but there is a significant risk of later first relapse; both patients and their doctors should be aware of this.

A primary melanoma follow-up clinic should be provided by an MDT of dermatologists and surgeons with clinical nurse specialist support, and there should be continuity of care. Patients should be taught to self-examine to detect locoregional recurrence and new primary melanoma. Photography can be useful for follow up of patients who also have atypical moles. Patients should routinely be examined for locoregional and distant metastases, and the whole skin should be checked for new primary melanomas. A defined rapid-access pathway must be provided to all patients and general practitioners for suspected recurrence. Suspected new primary melanoma should be referred as normal through the 2-week wait system. For Scotland this needs to be compliant with the 62-day rule. Follow up of patients with AJCC stage III and IV disease should be led by melanoma SSMDTs.

Follow-up intervals and duration should be tailored to the stage group of the primary melanoma and therefore to the risk of recurrence. The follow-up plan should be agreed between the patient and the responsible doctors.

Care can be shared with primary care, but only if the secondary care team have defined and explained to the primary care team what is required, and only if the primary care team are prepared to accept responsibility for this. In the event of suspected recurrence, even after discharge from follow up, it is recommended that the patient contact the secondary care team directly to avoid possible delay in diagnosis.

Screening asymptomatic clinically normal patients with lymph node ultrasound is sensitive and can detect nodal disease, but this has not been shown to be useful in primary melanoma follow up.[142] The same applies to CT and PET imaging. These investigations should not be used outside a clinical trial.

In situ Melanoma

Patients with a surgically treated single in situ melanoma do not require follow up, as there is no risk of metastasis. They require a return visit after complete excision to explain the diagnosis, check the whole skin for further primary melanoma/s, and to teach self-examination for a new primary melanoma. Clinical nurse specialist support may be required despite the absence of metastatic risk.

Stage IA Melanoma

Patients with invasive primary cutaneous melanoma < 1·0 mm have a 5-year disease-free survival of over 90% or better. A recent review of 430 patients with melanomas < 0·5 mm showed no recurrences at 5–15 years follow up but 4% of patients developed a second primary melanoma over this period.[143] Patients with invasive, nonulcerated primary tumours 0·5–1·0 mm thick have only slightly worse 5-year disease-free survival, and are in the same stage group. Therefore, for stage IA patients a series of two to four visits over up to 12 months is suggested to teach self-examination, and then they may be discharged from regular follow up (Level III, Grade B).

http://www.medscape.com/viewarticle/727613_13

Cytat:

Powiedzieli mi też że żadnych badań robić nie będą chyba że wyniki wyciętego marginesu będą złe.

recma napisał/a:

Witam. Niestety Polska klinika w Dublinie ani żadna inna nie wykonuje w/w badań głównie chodzi o krew,bo usg jamy brzusznej owszem ale dopiero za miesiąc a RTG w ogóle nie wykonują ,więc tu moje pytanie.Czy mógłby ktoś mi wyszukać w internecie (szukałam ale nie jestem w tym dobra) w języku oczywiście angielskim wytyczne dotyczące standardowego leczenia Czerniaka w takim stopniu jak mój na całym świecie jakie powinny być procedury itp.domyślam się że standardy dotyczące leczenia są przyjęte mniej więcej na całym świecie takie same.Pomyślałam sobie że wydrukuje sobie takie coś i pokaże mojemu GP i poproszę o takie badania jeszcze raz,mam nadzieje że poskutkuje.Z góry ślicznie dziękuję.Poza tym pozdrawiam serdecznie wszystkich walczących i pomagających.

Widze, ze nie zapoznalas sie zawartoscia linka umieszczonego w moim poprzednim poscie. A szkoda.

W stadium TI (zmiana mniejsza/rowna 1mm) follow up nie przewiduje ani badania poziomu LDH (ktore jest niemiarodajne) ani RTG, ani USG brzucha. Istotne natomiast jest dokladne badanie kliniczne - na ogol co 6 miesiecy (przez 3 lata), potem co rok.

Tutaj sa AU/NZ melanoma guidelines
Przeczytaj

Undertaking follow up page 121
http://www.cancer.org.au/...tofMelanoma.pdf

Polecam lekture (ze szczegolnym uwzglednieniem fragmentow dot. rtg oraz badania poziomu LDH):

Prospective Evaluation of a Follow-Up Schedule in Cutaneous Melanoma Patients: Recommendations for an Effective Follow-Up Strategy — JCO
http://jco.ascopubs.org/content/21/3/520.full