{"id":2890,"date":"2020-03-12T12:07:53","date_gmt":"2020-03-12T12:07:53","guid":{"rendered":"http:\/\/uraloguzloc.com\/?page_id=2890"},"modified":"2021-06-28T12:30:14","modified_gmt":"2021-06-28T12:30:14","slug":"bobrek-tumorleri","status":"publish","type":"page","link":"https:\/\/uraloguz.com\/tr_TR\/bobrek-tumorleri\/","title":{"rendered":"B\u00f6brek T\u00fcm\u00f6rleri"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text]B\u00f6brek kanseri nedir ve nas\u0131l olu\u015fur?<\/strong><\/p>\n

B\u00f6brek kanseri b\u00f6brek i\u00e7inde habis (k\u00f6t\u00fc huylu) h\u00fccre b\u00fcy\u00fcmesidir. B\u00f6brekteki t\u00fcm\u00f6rler selim (iyi huylu) de olabilir.\u00a0 Kanser k\u00f6t\u00fc huylu t\u00fcm\u00f6rlere verilen isimdir. B\u00f6brekte farkl\u0131 t\u00fcm\u00f6r \u00e7e\u015fitleri ve farkl\u0131 hastal\u0131k evreleri bulunur.<\/p>\n

\u00a0<\/strong><\/p>\n

B\u00f6brek kanseri i\u00e7in risk fakt\u00f6rleri nelerdir? Geneti\u011fin rol\u00fc var m\u0131d\u0131r?<\/strong><\/p>\n

B\u00f6brek kanserinin nedenini saptamak her zaman m\u00fcmk\u00fcn olmamakla birlikte sigara ve obezite ba\u015fl\u0131ca risk fakt\u00f6rleri aras\u0131nda bildirilir.<\/p>\n

Birinci derece akrabas\u0131nda b\u00f6brek kanseri olanlar ve y\u00fcksek kan bas\u0131nc\u0131 (hipertansiyon) olanlar b\u00f6brek kanser geli\u015fimi i\u00e7in risk alt\u0131ndad\u0131rlar.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016875387{margin-top: -140px !important;}”][vc_column][vc_single_image image=”2898″ img_size=”full”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016885686{margin-top: -140px !important;}”][vc_column][vc_column_text]B\u00f6brek kanseri tan\u0131s\u0131 nas\u0131l konulur?<\/strong><\/p>\n

B\u00f6brek kanserleri t\u00fcm kanserlerin yakla\u015f\u0131k %2\u2019sini olu\u015fturur. Son y\u0131llarda b\u00f6brek kanserli hasta say\u0131s\u0131 bir miktar artm\u0131\u015f olmakla birlikte kansere ba\u011fl\u0131 \u00f6l\u00fcm oranlar\u0131 pek \u00e7ok \u00fclkede azalm\u0131\u015ft\u0131r. B\u00f6brek kanserleri s\u0131kl\u0131kla bulgu vermez yani hastal\u0131\u011f\u0131 i\u015faret eden \u00f6zg\u00fcn belirtiler bulunmaz. \u00c7o\u011fu b\u00f6brek t\u00fcm\u00f6r\u00fc rutin g\u00f6r\u00fcnt\u00fcleme i\u015flemleri s\u0131ras\u0131nda tesad\u00fcfen bulunur.<\/p>\n

Buna kar\u015f\u0131n\u00a0 10 ki\u015fiden birinde yan a\u011fr\u0131s\u0131 ve idrar kan gibi belirtiler olabilir. Bazen nadir de olsa\u00a0 paraneoplastik sendrom denilen durumlar g\u00f6r\u00fclebilir. Bunlar v\u00fccutta olu\u015fan herhangi bir kanser tipi taraf\u0131ndan olu\u015fan ve y\u00fcksek kan bas\u0131nc\u0131, kilo kayb\u0131, ate\u015f, anemi, kas kitlesi kayb\u0131 ve i\u015ftah kayb\u0131 gibi reaksiyonlard\u0131r. B\u00f6brek kanseri ile ili\u015fkili sendromlar s\u0131kl\u0131kla karaci\u011fer enzimleri ve trombosit de\u011fi\u015fiklikleri i\u00e7erir.<\/p>\n

Kemik a\u011fr\u0131s\u0131 veya inat\u00e7\u0131 \u00f6ks\u00fcr\u00fck kanserin v\u00fccudun ba\u015fka yerlerine de yay\u0131ld\u0131\u011f\u0131n\u0131n belirtisi olabilir.<\/p>\n

Ultrason ve Bilgisayarl\u0131 Tomografi (BT) \/ Manyetik Rezonans G\u00f6r\u00fcnt\u00fcleme (MRI) gibi g\u00f6r\u00fcnt\u00fcleme teknolojilerindeki geli\u015fmeler ve \u00e7e\u015fitli nedenlerle s\u0131k g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemlerine ba\u015fvurulmas\u0131 nedeniyle \u00a0erken d\u00f6nemde tan\u0131 konulma oranlar\u0131n\u0131n artt\u0131\u011f\u0131 g\u00f6r\u00fclmektedir. B\u00f6brekteki solid kitleler aksi ispat edilmedik\u00e7e malign (k\u00f6t\u00fc huylu, habis) kabul edilmelidir. Kitlenin kesin tan\u0131s\u0131 ve tiplemesi ise biyopsi ya da ameliyatla \u00e7\u0131kar\u0131lan kitlenin patolojik incelemesi ile konulur.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016896834{margin-top: -140px !important;}”][vc_column][vc_column_text]B\u00f6brek kanserinin tipleri nelerdir?<\/strong><\/p>\n

B\u00f6brek kanserlerinden en s\u0131k g\u00f6r\u00fcleni b\u00f6brek h\u00fccreli karsinom (BHK)\u2019 dur. B\u00f6brek h\u00fccreli karsinom kendi i\u00e7inde 3 alt tipe ayr\u0131l\u0131r.<\/p>\n

    \n
  1. Berrak h\u00fccreli BHK: En s\u0131k g\u00f6r\u00fclen ve en agresif seyirli olan\u0131d\u0131r. S\u0131kl\u0131kla 3. Kromozamdaki von Hippel-Lindau (VHL) gen mutasyonu e\u015flik eder. Bunun d\u0131\u015f\u0131nda yine VHL gen kom\u015fulu\u011funda yer alan SETD2, BAP 1 ve PBRM1 t\u00fcm\u00f6r s\u00fcpres\u00f6r genlerinin de berrak h\u00fccreli BHK lerde etkilendi\u011fi bilinmetedir.<\/li>\n
  2. Papiller BHK: 2. en s\u0131k g\u00f6r\u00fclen alt tipidir. Farkl\u0131 olarak MET gen mutasyonuyla ili\u015fkilidir. Berrak h\u00fccreli Kanser ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda daha \u00e7ok organa s\u0131n\u0131rl\u0131 olma e\u011filiminde olup s\u0131kl\u0131kla exofitik( b\u00f6bre\u011fin d\u0131\u015f\u0131na do\u011fru b\u00fcy\u00fcme) b\u00fcy\u00fcme g\u00f6sterirler.<\/li>\n
  3. Kromofob BHK: kaps\u00fcls\u00fcz kitlelerdir. Furhman grade\u2019lemesi yap\u0131lamaz. Prognozu di\u011fer ikisine nazaran daha iyidir.<\/li>\n<\/ol>\n

     <\/p>\n

     <\/p>\n

    Selim t\u00fcm\u00f6rler: <\/strong><\/p>\n

    B\u00f6brekteki baz\u0131 t\u00fcm\u00f6rler kanserojen de\u011fildir. Bunlar selim b\u00f6brek t\u00fcm\u00f6rleri olarak bilinir. B\u00f6bre\u011fin selim t\u00fcm\u00f6rlerinden en s\u0131k g\u00f6r\u00fclenleri onkositoma ve anjiolipomad\u0131r. Bu t\u00fcm\u00f6rler i\u00e7in en s\u0131k uygulanan tedavi yakla\u015f\u0131m\u0131 parsiyel nefrektomi ve aktif izlemdir.<\/p>\n

    B\u00f6brek kistleri<\/p>\n

    B\u00f6brekte en s\u0131k g\u00f6r\u00fclen benign lezyonlard\u0131r. Bu s\u0131v\u0131 dolu keseler b\u00f6bre\u011fin \u00fczerinde bulunur ve BT ile kolayca tan\u0131n\u0131r. Kistler malign (habis) olabilirler. Bu durumda cerrahi ile \u00e7\u0131kar\u0131lmalar\u0131 gerekir.<\/p>\n

    Bosniak s\u0131n\u0131flamas\u0131na g\u00f6re 1 den 4 e kadar s\u0131n\u0131flan\u0131rlar. Bosnik tip 3 kistlerin yar\u0131s\u0131, Bosniak tip 4 kistlerin %90 \u0131 malign karakterdedir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016908613{margin-top: -140px !important;}”][vc_column width=”2\/3″][vc_column_text]Prognostik (Kanserin \u0130lerlemesi) fakt\u00f6rler nelerdir?:<\/strong><\/p>\n

    Anatomik fakt\u00f6rler: B\u00fcy\u00fck t\u00fcm\u00f6r boyutu, ven\u00f6z invazyon, b\u00f6brek kaps\u00fcl\u00fcne invazyon, b\u00f6brek \u00fcst\u00fc bezlerine invazyon lenf bezlerine ve uzak organlara yay\u0131l\u0131m\u00a0 k\u00f6t\u00fc prognostik fakt\u00f6rlerdir.<\/p>\n

    Histolojik Fakt\u00f6rler: t\u00fcm\u00f6r\u00fcn Fuhrman derecesi, subtipi, sarkomatoid yap\u0131 i\u00e7ermesi, mikrovaskuler invasion, tumourde nekroz varl\u0131\u011f\u0131 ve toplay\u0131c\u0131 sistem invazyonu prognozda \u00f6nemlidir.<\/p>\n

    Klinik fakt\u00f6rler: hastan\u0131n genel performans\u0131, lokal semptom varl\u0131\u011f\u0131, a\u015f\u0131r\u0131 zay\u0131fl\u0131k, anemi, platelet diye adland\u0131r\u0131lan kan p\u0131ht\u0131 h\u00fccrelerinin miktar\u0131, kandaki n\u00f6trofil\/ lenfosit h\u00fccrelerinin oran\u0131, kandaki C-reactive protein (CRP) ve alb\u00fcmin d\u00fczeylerde prognozda \u00f6nemli g\u00f6stergelerdir.<\/p>\n

    Molek\u00fcler fakt\u00f6rler:\u00a0 3p kromozomu \u00fczerindeki BAP1 ve PBRM1 gen kayb\u0131, prognozu en k\u00f6t\u00fc olan \u015feffaf h\u00fccreli b\u00f6brek t\u00fcm\u00f6rlerinin % 90 \u0131nda g\u00f6r\u00fclmektedir ve t\u00fcm\u00f6r rek\u00fcrrensi (tekrar\u0131) i\u00e7in \u00f6nemli bir risk fakt\u00f6r\u00fcd\u00fcr. \u00d6zellikli BAP1 mutasyonu olanlarda sonu\u00e7lar daha k\u00f6t\u00fc bildirilmi\u015ftir.[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2897″ img_size=”full” css=”.vc_custom_1584016262731{margin-left: 20px !important;}”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016918675{margin-top: -140px !important;}”][vc_column][vc_column_text]B\u00f6brek t\u00fcm\u00f6r biyopsisi<\/strong><\/p>\n

    Ultrason veya bilgisayarl\u0131 tomografi e\u015fli\u011finde i\u011fne ile biyopsi b\u00f6brek t\u00fcm\u00f6rlerinde yap\u0131labilir ancak\u00a0 tan\u0131da kullan\u0131lan standart bir i\u015flem de\u011fildir.<\/p>\n

    \u015eu durumlarda biyopsi gerekir:<\/p>\n

    – Tarama sonu\u00e7lar\u0131n\u0131z yeterince net de\u011filse<\/p>\n

    – Aktif izlem ile tedavi edilebilecek kadar k\u00fc\u00e7\u00fck t\u00fcm\u00f6r\u00fcn\u00fcz varsa<\/p>\n

    – Radyofrekans ablasyon veya kriyoablasyon ile tedavi edilebilecek kadar k\u00fc\u00e7\u00fck t\u00fcm\u00f6r\u00fcn\u00fcz varsa[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016939637{margin-top: -140px !important;}”][vc_column][vc_column_text]B\u00f6brek kanseri nas\u0131l evrelenir?<\/strong><\/p>\n

    B\u00f6brek kanserinin farkl\u0131 d\u00f6nemleri vard\u0131r. T\u00fcm\u00f6r b\u00f6brekte s\u0131n\u0131rl\u0131 ve yay\u0131lmam\u0131\u015fsa lokalize b\u00f6brek kanseri olarak adland\u0131r\u0131l\u0131r. Lokal ilerlemi\u015f b\u00f6brek kanserinde t\u00fcm\u00f6r b\u00f6bre\u011fin d\u0131\u015f\u0131na \u00e7evreleyen dokuya do\u011fru b\u00fcy\u00fcm\u00fc\u015f, venlere, adrenal bezi ve lenf nodlar\u0131na uzanm\u0131\u015ft\u0131r. Uzak lenf nodlar\u0131na veya di\u011fer organlara s\u0131\u00e7ram\u0131\u015fsa metastatik hastal\u0131ktan bahsedilir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016950176{margin-top: -140px !important;}”][vc_column width=”2\/3″][vc_column_text]T1a: B\u00f6brekte s\u0131n\u0131rl\u0131 (b\u00f6brek kaps\u00fcl\u00fcn\u00fc a\u015fmam\u0131\u015f) 4 cm.\u2019den k\u00fc\u00e7\u00fck t\u00fcm\u00f6r<\/p>\n

    T1b: B\u00f6brekte s\u0131n\u0131rl\u0131 (b\u00f6brek kaps\u00fcl\u00fcn\u00fc a\u015fmam\u0131\u015f) 4-7 cm aras\u0131nda ebatlar\u0131 olan t\u00fcm\u00f6r<\/p>\n

    T-2:B\u00f6bre\u011fe s\u0131n\u0131rl\u0131 > 7 cm kitleler<\/p>\n

    T2a: B\u00f6brekte s\u0131n\u0131rl\u0131 (b\u00f6brek kaps\u00fcl\u00fcn\u00fc a\u015fmam\u0131\u015f), 7 cm.den b\u00fcy\u00fck ancak 10 cm\u2019den k\u00fc\u00e7\u00fck \u00e7aptaki t\u00fcm\u00f6r<\/p>\n

    T2b: T\u00fcm\u00f6r \u00e7ap\u0131 10 cm\u2019den b\u00fcy\u00fck ve b\u00f6brek kaps\u00fcl\u00fcn\u00fc a\u015fmam\u0131\u015f<\/p>\n

    T-3: Lokal ileri t\u00fcm\u00f6rler<\/p>\n

    T3a: Renal ven yada dallar\u0131na sirayet etmi\u015f t\u00fcm\u00f6r; ya da perirenal ya\u011f dokuya uzanan ama gerotay\u0131 a\u015fmam\u0131\u015f t\u00fcm\u00f6r<\/p>\n

    T3b: Diyafram seviyesinin alt\u0131nda vena cava inferior tutulumu<\/p>\n

    T3c: Diyafram seviyesinin \u00fczerinde vena cava inferior tutulumu, ya da vena cava duvar\u0131na invaze olmu\u015f t\u00fcm\u00f6r<\/p>\n

    T-4: B\u00f6brek etraf\u0131ndaki ya\u011f dokusunu saran zar\u0131 (Gerota fasiyas\u0131) a\u015fm\u0131\u015f<\/p>\n

    Lenf Bezleri:<\/p>\n

    Nx:\u00a0\u00a0\u00a0 B\u00f6lgesel lenf bezleri de\u011ferlendirilmemi\u015f<\/p>\n

    N0:\u00a0\u00a0\u00a0 B\u00f6lgesel lenf bezlerinde t\u00fcm\u00f6r yay\u0131l\u0131m\u0131 yani metastaz yok<\/p>\n

    N1:\u00a0\u00a0\u00a0 B\u00f6lgesel lenf bezlerinde t\u00fcm\u00f6r yay\u0131l\u0131m\u0131 yani metastaz var.<\/p>\n

    Uzak Metastaz:<\/p>\n

    M0:\u00a0\u00a0\u00a0\u00a0 Kanserin uzak organlara yay\u0131m\u0131 yok<\/p>\n

    M1.\u00a0\u00a0\u00a0 Kanserin uzak organlara yay\u0131l\u0131m\u0131 mevcut.[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2893″ img_size=”full” css=”.vc_custom_1584016514788{margin-bottom: 50px !important;}”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016971676{margin-top: -180px !important;}”][vc_column][vc_column_text]Lokal ileri b\u00f6brek kanseri nedir? <\/strong><\/p>\n

    T\u00fcm\u00f6r\u00fcn b\u00f6bre\u011fin etraf\u0131ndaki kan damarlar\u0131, ya\u011fl\u0131 doku, organ ve lenf bezlerine yay\u0131lmas\u0131 anlam\u0131na gelmektedir. Evre III ya da IV olarak adland\u0131r\u0131labilir ve t\u00fcm\u00f6r\u00fcn ne kadar uza\u011fa yay\u0131ld\u0131\u011f\u0131n\u0131 g\u00f6stermektedir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584016987426{margin-top: -140px !important;}”][vc_column width=”1\/3″][vc_single_image image=”2896″ img_size=”full”][\/vc_column][vc_column width=”2\/3″][vc_column_text]B\u00f6brek kanserinde destek ve tedavi nas\u0131ld\u0131r?<\/strong><\/p>\n

    Lokalize b\u00f6brek kanserlerinde k\u00fcr elde etmek i\u00e7in cerrahi yakla\u015f\u0131m en uygun olan\u0131d\u0131r. Boyutu ve yerle\u015fimi m\u00fcsait olan t\u00fcm\u00f6rlerde parsiyel nefrektomi (b\u00f6bre\u011fin korunarak t\u00fcm\u00f6rl\u00fc alan\u0131n \u00e7\u0131kar\u0131lmas\u0131) yap\u0131lmal\u0131d\u0131r. T2 (>7 cm) t\u00fcm\u00f6rlerde ya da lokalizasyonu parsiyel nefrektomiye uygun olmayan hastalarda ise radikal nefrektomi (b\u00f6bre\u011fin ve \u00e7evre dokular\u0131n \u00e7\u0131kar\u0131lmas\u0131) ameliyat\u0131 uygulan\u0131r. Radikal \/ Parsiyel nefrektomi laparoskopik ya da a\u00e7\u0131k y\u00f6ntemlerle yap\u0131labilir.<\/p>\n

    Lokal ileri b\u00f6brek kanserlerinde ise lenf nodu tutulumu saptanmas\u0131 halinde lenf nodlar\u0131n\u0131n da \u00e7\u0131kar\u0131lmas\u0131 \u00f6nerilir. Vena cava tromb\u00fcslerinde ise t\u00fcm\u00f6rl\u00fc b\u00f6brekle birlikte tromb\u00fcs de \u00e7\u0131kar\u0131lmal\u0131d\u0131r.<\/p>\n

    E\u011fer cerrahi imkans\u0131z ya da\u00a0 \u00e7ok riskli ise embolizasyon (t\u00fcm\u00f6re giden atar damarlar kapat\u0131larak kanser h\u00fccrelerinin beslenmesi bozulur) \u00f6nerilebilir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017000261{margin-top: -140px !important;}”][vc_column width=”2\/3″][vc_column_text]\u00d6zellikle ileri ya\u015fl\u0131 hastalarda k\u00fc\u00e7\u00fck b\u00f6brek t\u00fcm\u00f6r\u00fc varl\u0131\u011f\u0131nda (< 4 cm) aktif takip edilmesi \u00f6nerilebilir. Yap\u0131lan \u00e7al\u0131\u015fmalar g\u00f6stermi\u015f ki k\u00fc\u00e7\u00fck kitleler izlendi\u011finde hastalar\u0131n sadece %1 inde t\u00fcm\u00f6r metastaz yapmaktad\u0131r. Aktif takip d\u00f6neminde t\u00fcm\u00f6r d\u00fczenli doktor muayeneleri ile izlenir. T\u00fcm\u00f6r b\u00fcy\u00fcmeye devam ederse ek tedavi gerekebilir. Bu durumda ablasyon (radyofrekans- ya da krio- ) tedavisi iyi bir alternatif olabilir.<\/p>\n

    Ablasyon tedavisi radyofrekans ablasyon (RFA) veya kriyoterapi olabilir. Bu i\u015flemler ile \u0131s\u0131tarak (RFA) veya dondurarak (kriyoterapi) t\u00fcm\u00f6r h\u00fccrelerinin \u00f6ld\u00fcr\u00fclmesi hedeflenir.<\/p>\n

    Kanser te\u015fhisi hasta ve hasta yak\u0131nlar\u0131n\u0131n ya\u015fant\u0131s\u0131na ciddi etki yapar. Anksiyete (endi\u015feye), korku ve depresyona yol a\u00e7abilir; is ve sosyal hayat\u0131n\u0131 etkileyebilir. Hastalar destek ihtiyac\u0131 oldu\u011funda bu durumu doktoruyla payla\u015fmal\u0131d\u0131r.[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2894″ img_size=”full”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017010632{margin-top: -140px !important;}”][vc_column][vc_column_text]Cerrahi sonras\u0131 ilk g\u00fcn veya haftalarda g\u00fcnl\u00fck aktiviteler i\u00e7in yard\u0131ma ihtiya\u00e7 olabilir. Hasta refakat\u00e7isi ameliyat sonras\u0131 ilk g\u00fcnlerde \u00f6nemli olabilir.<\/p>\n

    Ameliyat sonras\u0131 kontrollerde takip protokol\u00fcn\u00fcn nas\u0131l olaca\u011f\u0131 patoloji ve evreye g\u00f6re planlanmal\u0131d\u0131r.<\/p>\n

    Tedavi s\u0131ras\u0131nda ve sonras\u0131nda ya\u015fam tarz\u0131n\u0131z\u0131 devam ettirmeniz \u00f6nemlidir. Sebze, meyve ve s\u00fctten olu\u015fan dengeli bir diyetle beslenmeye \u00e7al\u0131\u015f\u0131n. Sigaray\u0131 b\u0131rakmaya \u00e7al\u0131\u015f\u0131n. Ameliyat sonras\u0131 daha h\u0131zl\u0131 iyile\u015fmenize yard\u0131mc\u0131 olabilir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017033493{margin-top: -150px !important;}”][vc_column][vc_column_text]Tedavinin riskleri var m\u0131d\u0131r? <\/strong><\/p>\n

    Radikal nefrektomi lokal- lokal ileri b\u00f6brek kanseri tedavisinde yayg\u0131n uygulanan bir i\u015flemdir. Hasta tek b\u00f6brekle kald\u0131\u011f\u0131 i\u00e7in, \u00f6zellikle diabet (\u015feker hastal\u0131\u011f\u0131), hipertansiyon gibi ek hastal\u0131\u011f\u0131 olan hastalarda daha fazla olmak kayd\u0131yla kronik b\u00f6brek yetmezli\u011fi riski artar. Ayr\u0131ca, ameliyattan sonra olas\u0131 azalm\u0131\u015f b\u00f6brek fonksiyonlar\u0131, kalp ve damar hastal\u0131klar\u0131 a\u00e7\u0131s\u0131ndan risk olu\u015fturur.<\/p>\n

    T\u00fcm b\u00fcy\u00fck ameliyatlarda oldu\u011fu gibi anesteziye ait genel riskleri de bar\u0131nd\u0131r\u0131r.<\/p>\n

     <\/p>\n

    Takip nas\u0131l olmal\u0131 ve nelere dikkat edilmelidir?<\/strong><\/p>\n

    Ameliyat sonras\u0131 klinik ve patolojik evreye g\u00f6re bir takip protokol\u00fc olu\u015fturulmal\u0131d\u0131r. Tedavi esnas\u0131nda ve sonras\u0131nda sa\u011fl\u0131\u011f\u0131n korunmas\u0131 da \u00e7ok \u00f6nemlidir ve ama\u00e7la d\u00fczenli fiziksel egzersiz yapmak, kullan\u0131yorsa sigaray\u0131 b\u0131rakmak t\u00fcm\u00f6r geli\u015fim riskini azaltacakt\u0131r.<\/p>\n

    Sebze, meyve ve s\u00fct \u00fcr\u00fcnlerini i\u00e7eren dengeli bir diyetle beslenilmesi \u00f6nerilir. Ekmek, patates, pirin\u00e7 ve makarna gibi ni\u015fastal\u0131 yemekler ve et, bal\u0131k ve yumurta gibi proteini zengin besinler t\u00fcketilmelidir. Buna kar\u015f\u0131n \u015fekerli, tuzlu ve ya\u011fl\u0131 yemeklerden m\u00fcmk\u00fcn oldu\u011funca sak\u0131n\u0131lmal\u0131d\u0131r.<\/p>\n

    Tedavi sonras\u0131, hastal\u0131\u011f\u0131n prognozu (gidi\u015fat\u0131) endi\u015fe yaratabilir. Kanserin tekrarlamas\u0131 korkusunu hastalarda s\u0131kl\u0131kla g\u00f6r\u00fcr\u00fcz. E\u011fer bu durum sizde de endi\u015fe ve korku yarat\u0131yorsa psikolojik destek ihtiyac\u0131 olabilir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017045918{margin-top: -150px !important;}”][vc_column][vc_single_image image=”2901″ img_size=”full” alignment=”center”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017056565{margin-top: -200px !important;}”][vc_column][vc_column_text]Metastatik B\u00f6brek Kanseri <\/strong><\/p>\n

    B\u00f6brek t\u00fcm\u00f6rleri di\u011fer organlara veya lenf bezlerine yay\u0131labilir. Buna metastatik hastal\u0131k denir. Metastatik hastal\u0131kta, b\u00f6brek t\u00fcm\u00f6r\u00fc primer t\u00fcm\u00f6r olarak adland\u0131r\u0131l\u0131r ve di\u011fer organlardaki t\u00fcm\u00f6rlere metastaz denir. B\u00f6brek kanseri metastaz\u0131 genellikle akci\u011fer, kemik, uzak lenf d\u00fc\u011f\u00fcmleri ya da beyne yay\u0131l\u0131r. Metastatik hastal\u0131k asemptomatik olup bulgu vermeyebilir ya da kanserin yay\u0131ld\u0131\u011f\u0131 yere g\u00f6re farkl\u0131 belirtilere neden olabilir. Akci\u011fer metastaz\u0131nda s\u0131kl\u0131kla kal\u0131c\u0131 kronik bir \u00f6ks\u00fcr\u00fck veya kemik metastaz\u0131 durumunda kemik a\u011fr\u0131s\u0131 olabilir.<\/p>\n

    Metastatik hastal\u0131\u011f\u0131n tedavisinde cerrahi ile birlikte hedef tedavisi olarak bilinen antianjiogenik tedavi kombinasyonu \u00f6nerebilir. Nadir durumlarda immunoterapi kullan\u0131labilir.<\/p>\n

    \u00a0<\/strong><\/p>\n

    Metastatik B\u00f6brek Kanserinde risk s\u0131n\u0131flamas\u0131<\/strong><\/p>\n

    Burada risk s\u0131n\u0131flar\u0131n\u0131 olu\u015fturmak i\u00e7in MSKCC (Memorial Sloan Kettering Cancer Center) prognostik sistemi kullan\u0131lmaktad\u0131r. Hastan\u0131n performans durumu (Karnofsky performans statusu<80), tan\u0131 ve tedavi aras\u0131nda ge\u00e7en s\u00fcre(<12 ay), kandaki laktat dehidrogenaz (LDH) ve kandaki kalsiyum d\u00fczeyleri (>10 mg\/dl), kan hemoglobin (anemi) ve n\u00f6trofil d\u00fczeyi ile belirlenir. Hastalar iyi, orta ve k\u00f6t\u00fc prognostik risk s\u0131n\u0131flar\u0131na ayr\u0131l\u0131rlar.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017182368{margin-top: -140px !important;}”][vc_column width=”1\/3″][vc_single_image image=”2895″ img_size=”full” alignment=”right” css=”.vc_custom_1584017169390{margin-right: 10px !important;}”][\/vc_column][vc_column width=”2\/3″][vc_column_text]Metastatik B\u00f6brek Kanserinde Tedavi se\u00e7enekleri<\/strong><\/p>\n

    E\u011fer metastatik hastal\u0131k varsa b\u00f6bre\u011fin cerrahi olarak \u00e7\u0131kar\u0131lmas\u0131 (sitored\u00fcktif nefrektomi), t\u00fcm\u00f6r y\u00fck\u00fcn\u00fc azaltmak ve semptomlar\u0131 hafifletmek i\u00e7in tavsiye edilir. CARMENA \u00e7al\u0131\u015fmas\u0131n\u0131n sonu\u00e7lar\u0131 g\u00f6sterdi ki iyi risk grubundaki hastalarda sitored\u00fcktif nefrektomi sa\u011f kal\u0131m\u0131 belirgin uzat\u0131rken, orta ve k\u00f6t\u00fc risk grubundaki hastalarda sa\u011f kal\u0131ma yarar\u0131 olmamaktad\u0131r.<\/p>\n

    Metastaz \u00e7ok fazla a\u011fr\u0131 veya di\u011fer belirtilere neden olursa, bu metastatik t\u00fcm\u00f6rleri \u00e7\u0131karmak i\u00e7in ek ameliyat gerekebilir. Primer t\u00fcm\u00f6r\u00fcn \u00e7ok b\u00fcy\u00fck olmad\u0131\u011f\u0131 ve \u00a0di\u011fer b\u00f6bre\u011fin \u00e7al\u0131\u015fmad\u0131\u011f\u0131 ya da tek b\u00f6brekli hastalarda sitored\u00fcktif parsiyel nefrektomi uygulanabilir. Metastatik hastal\u0131kta, cerrahi ila\u00e7 tedavisi ile kombine edilir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017233344{margin-top: -150px !important;}”][vc_column][vc_column_text]Metastaz\u0131n tedavisi i\u00e7in radyoterapi de \u00f6nerilebilir. Ancak b\u00f6brek t\u00fcm\u00f6rleri genelde radyoterapiye cevap vermezler. Bu nedenle sadece cerrahi ile \u00e7\u0131kar\u0131lamayacak primer t\u00fcm\u00f6r\u00fcn veya metastaz\u0131n neden oldu\u011fu semptomlar\u0131 hafifletmek i\u00e7in \u00f6nerilebilir. T\u00fcm bunlara ra\u011fmen oligometastatik hastal\u0131kta ya da primer t\u00fcm\u00f6r\u00fcn tedavisinde fraksiyon ba\u015f\u0131na y\u00fcksek dozlar kullan\u0131larak, birka\u00e7 fraksiyonda verilebilen stereotaktik v\u00fccud radyoterapileri ile renal h\u00fccreli karsinomda radyoterapinin rol\u00fc \u00f6nem kazanmaya ba\u015flam\u0131\u015ft\u0131r.<\/p>\n

    Genellikle, metastatik hastal\u0131k tedavi edilemez. Metastatik hastal\u0131\u011f\u0131n tedavisi primer t\u00fcm\u00f6r\u00fcn boyutunu ve metastazlar\u0131 azaltmay\u0131 ama\u00e7lamaktad\u0131r. Bu hastaya daha uzun ya\u015fam ve daha az semptom \u015fans\u0131n\u0131 verecektir. Burada bahsi ge\u00e7enler genel bilgilerdir ve her hastada tedavi farkl\u0131l\u0131klar\u0131 olabilir.<\/p>\n

    Kemoterapi de b\u00f6brek kanserine \u00e7ok etkili bir tedavi se\u00e7ene\u011fi de\u011fildir. Metastatik t\u00fcm\u00f6rlerde 5-florourasil ile kombine imm\u00fcnoterapi primer t\u00fcm\u00f6r\u00fcn komplet rezeksiyonu (tamamen \u00e7\u0131kart\u0131lmas\u0131) sonras\u0131 etkili olabilir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017277215{margin-top: -150px !important;}”][vc_column][vc_column_text]Metastatik b\u00f6brek kanserlerinde \u0130mm\u00fcnoterapi kullan\u0131lmakta olan ila\u00e7 tedavilerindendir. \u0130mm\u00fcnoterapi t\u00fcm\u00f6r h\u00fccreleriyle m\u00fccadele etmesi i\u00e7in ba\u011f\u0131\u015f\u0131kl\u0131k sisteminin g\u00fc\u00e7lendirildi\u011fi bir tedavi t\u00fcr\u00fcd\u00fcr. 2 farkl\u0131 imm\u00fcnoterapi metastatik b\u00f6brek t\u00fcm\u00f6rlerinde kullan\u0131labilir.<\/p>\n

    – Interferon-alfa (INF-\u03b1)<\/p>\n

    –\u00a0 Interlokin-2 (IL-2)<\/p>\n

    Antianjiogenik tedaviler ise metastatik b\u00f6brek kanserlerinde en \u00e7ok kullan\u0131lan ila\u00e7 tedavileridir.<\/p>\n

    T\u00fcm\u00f6r\u00fc k\u00fc\u00e7\u00fcltmek i\u00e7in ameliyat \u00f6ncesi ila\u00e7 tedavisi \u00f6nerebilir. Baz\u0131 durumlarda, antianjiogenik tedavi kanserin buna nas\u0131l tepki verece\u011fini g\u00f6rmek i\u00e7in ameliyattan \u00f6nce kullan\u0131l\u0131r. \u0130yi yan\u0131t al\u0131n\u0131rsa cerrahi sonras\u0131 tedaviye devam edilir. Cerrahi tedavi m\u00fcmk\u00fcn de\u011filse, ila\u00e7 tedavilerine ba\u015flan\u0131r. Genellikle kan damarlar\u0131n\u0131n olu\u015fumunu \u00f6nleyerek t\u00fcm\u00f6r b\u00fcy\u00fcmesi \u00fczerinden etki eden antianjiojenik tedavi tercih edilir.[\/vc_column_text][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017516094{margin-top: -140px !important;}”][vc_column width=”2\/3″][vc_column_text]Antianjiogenik Tedavi<\/strong><\/p>\n

    Bu tedaviler medikal onkolog taraf\u0131ndan d\u00fczenlenir ve uygulan\u0131r. Ancak b\u00f6brek kanserinlerinde de multidisipliner yakla\u015f\u0131m ile tedavi ve takip \u00e7ok \u00f6nemlidir.<\/p>\n

    B\u00f6brek kanser tedavisindeki s\u0131k kullan\u0131lan antianjiogenik (tirozinkinaz inhibit\u00f6rleri ve monoklonal antikor) ila\u00e7lar:<\/p>\n

    -Sunitinib -Pazopanib -Axitinib -Sorafenib -Tivozanib -Bevacizumab[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_single_image image=”2906″ img_size=”full”][\/vc_column][\/vc_row][vc_row gradient_colors=”%5B%7B%7D%5D” css=”.vc_custom_1584017504577{margin-top: -140px !important;}”][vc_column][vc_column_text]mTOR inhibit\u00f6r\u00fc ila\u00e7lar ise enzime sald\u0131rarak t\u00fcm\u00f6r\u00fc k\u00fc\u00e7\u00fcltmeyi hedefler. mTOR, TOR (target of rapamycin) protein ailesinden bir serine\/ threonine kinazd\u0131r. mTOR inhibisyonu ile hem h\u00fccre sikl\u00fcs\u00fcnde g\u00f6rev yapan proteinlerin mRNA translasyonunda azalma olur hem de HIF-1\u03b1 translasyonu azal\u0131r. Bu yola\u011f\u0131 inhibe eden ajanlar 2 tanedir:<\/p>\n

    -Temsorulimus -Everolimus<\/p>\n

     <\/p>\n

    Bu tedaviler s\u0131ras\u0131nda bitkinlik, bulant\u0131 s\u0131k g\u00f6r\u00fclen yan etkilerdir. Ayr\u0131ca ishal ve kab\u0131zl\u0131k olabilir. Tedavi s\u0131ras\u0131nda y\u00fcksek tansiyonunuz olabilir. Bu ila\u00e7lar\u0131 al\u0131rken nefes darl\u0131\u011f\u0131, g\u00f6\u011f\u00fcs a\u011fr\u0131s\u0131 ve \u015fi\u015fmi\u015f ayak bilekleri ve ayaklarda \u015fi\u015fme ile kar\u015f\u0131la\u015fabilirsiniz. Ayr\u0131ca p\u0131ht\u0131 olu\u015fumuna neden olarak kalp krizi ve inme riskini artt\u0131rabilir. Cildinizde kuruluk, k\u0131zar\u0131kl\u0131k veya d\u00f6k\u00fcnt\u00fc olabilir. Baz\u0131 durumlarda cilt sar\u0131ya d\u00f6nebilir ve tedavi bittikten sonra d\u00fczelebilir. El ve ayak parmaklar\u0131nda uyu\u015fma ve kar\u0131ncalanma ile kar\u015f\u0131la\u015fabilirsiniz. Tedavi s\u0131ras\u0131nda sa\u00e7\u0131n\u0131z griye d\u00f6n\u00fc\u015febilir. Tedavi seanslar\u0131 aras\u0131nda baz\u0131 renkler geri gelebilir. Avu\u00e7 ve ayak taban\u0131nda kabarc\u0131klar ve k\u0131zar\u0131klar (el ayak sendromu) geli\u015febilir ya da a\u011f\u0131zda ac\u0131 tat hissi ortaya \u00e7\u0131kabilir.[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"

    [vc_row][vc_column][vc_column_text]B\u00f6brek kanseri nedir ve nas\u0131l olu\u015fur?<\/strong><\/p>\n

    B\u00f6brek kanseri b\u00f6brek i\u00e7inde habis (k\u00f6t\u00fc huylu) h\u00fccre b\u00fcy\u00fcmesidir. B\u00f6brekteki t\u00fcm\u00f6rler selim (iyi huylu) de olabilir.\u00a0 Kanser k\u00f6t\u00fc huylu t\u00fcm\u00f6rlere verilen is…<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-2890","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/uraloguz.com\/tr_TR\/wp-json\/wp\/v2\/pages\/2890","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uraloguz.com\/tr_TR\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/uraloguz.com\/tr_TR\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/uraloguz.com\/tr_TR\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/uraloguz.com\/tr_TR\/wp-json\/wp\/v2\/comments?post=2890"}],"version-history":[{"count":20,"href":"https:\/\/uraloguz.com\/tr_TR\/wp-json\/wp\/v2\/pages\/2890\/revisions"}],"predecessor-version":[{"id":3311,"href":"https:\/\/uraloguz.com\/tr_TR\/wp-json\/wp\/v2\/pages\/2890\/revisions\/3311"}],"wp:attachment":[{"href":"https:\/\/uraloguz.com\/tr_TR\/wp-json\/wp\/v2\/media?parent=2890"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}