MD492Z - Method for determining the spread of intestinal type gastric cancer - Google Patents
Method for determining the spread of intestinal type gastric cancer Download PDFInfo
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- MD492Z MD492Z MDS20110142A MDS20110142A MD492Z MD 492 Z MD492 Z MD 492Z MD S20110142 A MDS20110142 A MD S20110142A MD S20110142 A MDS20110142 A MD S20110142A MD 492 Z MD492 Z MD 492Z
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- 206010017758 gastric cancer Diseases 0.000 title claims abstract description 33
- 201000011549 stomach cancer Diseases 0.000 title claims abstract description 33
- 238000000034 method Methods 0.000 title claims abstract description 18
- 230000000968 intestinal effect Effects 0.000 title abstract description 5
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- 108010062540 Chorionic Gonadotropin Proteins 0.000 claims abstract description 11
- 210000001151 cytotoxic T lymphocyte Anatomy 0.000 claims abstract description 11
- 229940084986 human chorionic gonadotropin Drugs 0.000 claims abstract description 11
- 239000000427 antigen Substances 0.000 claims abstract description 10
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- 108091007433 antigens Proteins 0.000 claims abstract description 10
- 239000003550 marker Substances 0.000 claims abstract description 7
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Abstract
Invenţia se referă la medicină, în special la oncologie şi poate fi utilizată pentru determinarea răspândiri cancerului gastric de tip intestinal.Conform invenţiei metoda constă în aceea că după stabilirea tipului de cancer gastric se efectuează analizele serologice şi se determină markerii CA 19-9, CA 125, antigenul carcinomului embrionar, gonadotropina corionică umană, numărul de T-limfocite citotoxice CD3 şi T-helperi CD4, în cazul, în care markerul CA 19-9 constituie 50,0…200,0 UI/ml, CA 125 - 35,0…500,0 UI/ml, antigenul carcinomului embrionar - 7,0…15,0 ng/ml, gonadotropina corionică umană - 18…287 ng/ml, T-limfocite citotoxice CD3 - 28…54%, iar T-helperi CD4 - 10…20%, se stabileşte răspândirea cancerului gastric de tip intestinal.The invention relates to medicine, in particular to oncology and can be used to determine the spread of gastric cancer of the intestinal type. According to the invention, the method consists in the fact that after establishing the type of gastric cancer serological analyzes are performed and the markers CA 19-9, CA are determined. 125, embryonic carcinoma antigen, human chorionic gonadotropin, number of cytotoxic T-lymphocytes CD3 and T-helper CD4, if the marker CA 19-9 constitutes 50.0 ... 200.0 IU / ml, CA 125-35, 0 ... 500.0 IU / ml, embryonic carcinoma antigen - 7.0 ... 15.0 ng / ml, human chorionic gonadotropin - 18 ... 287 ng / ml, CD3 cytotoxic T-lymphocytes - 28 ... 54%, and T-helper CD4 - 10 ... 20%, the spread of gastric cancer of the intestinal type is established.
Description
Invenţia se referă la medicină, în special la oncologie şi poate fi utilizată pentru determinarea răspândirii cancerului gastric de tip intestinal. The invention relates to medicine, in particular to oncology and can be used to determine the spread of intestinal-type gastric cancer.
Este cunoscută metoda de determinare a cancerului gastric de tip intestinal răspândit, care constă în efectuarea laparoscopiei diagnostice care reprezintă o tehnică chirurgicală miniinvazivă, prin care sunt vizualizate organele abdominale; printr-o incizie chirurgicală, la nivelul peretelui abdominal se introduce în abdomen laparoscopul, pentru a verifica astfel conţinutul abdominal şi a determina semnele de răspândire a procesului canceromatos, iar prin o altă incizie se introduce un tub prin care se realizează fie biopsia ghidată, fie intervenţia chirurgicală, după care se efectuează fibroesofagogastroduodenoscopia, se preia ţesut pentru efectuarea biopsiei şi se determină diagnosticul clinic [1]. The method of determining the spread of intestinal-type gastric cancer is known, which consists of performing diagnostic laparoscopy, which is a minimally invasive surgical technique, through which the abdominal organs are visualized; through a surgical incision, at the level of the abdominal wall, the laparoscope is inserted into the abdomen, in order to verify the abdominal contents and determine the signs of spread of the cancerous process, and through another incision, a tube is inserted through which either a guided biopsy or surgical intervention is performed, after which fibroesophagogastroduodenoscopy is performed, tissue is taken for biopsy and the clinical diagnosis is determined [1].
Dezavantajul acestei metode constă în aceea că este una invazivă şi nu tot timpul se poate preciza răspândirea procesului canceros gastric, în caz de metastaze în parenchimul hepatic. The disadvantage of this method is that it is invasive and it is not always possible to determine the spread of the gastric cancer process, in case of metastases in the liver parenchyma.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode neinvazive eficiente de determinare a răspândirii procesului canceromatos gastric cu scopul de a determina tactica de tratament ulterioară, a stabili volumul intervenţiei chirurgicale cu pregătirea necesară a pacientului. The problem solved by the invention consists in developing an effective non-invasive method for determining the spread of gastric cancer in order to determine the subsequent treatment tactics, establish the volume of surgical intervention with the necessary preparation of the patient.
Conform invenţiei, metoda de determinare a răspândirii cancerului gastric de tip intestinal constă în aceea că după stabilirea tipului de cancer gastric se efectuează analizele serologice şi se determină markerii CA 19-9, CA 125, antigenul carcinomului embrionar, gonadotropina corionică umană, numărul de T-limfocite citotoxice CD3 şi T-helperi CD4, în cazul, în care markerul CA 19-9 constituie 50,0…200,0 UI/ml, CA 125 - 35,0…500,0 UI/ml, antigenul carcinomului embrionar - 7,0…15,0 ng/ml, gonadotropina corionică umană - 18…287 ng/ml, T-limfocite citotoxice CD3 - 28…54%, iar T-helperi CD4 - 10…20%, se stabileşte răspândirea cancerului gastric de tip intestinal. According to the invention, the method for determining the spread of intestinal-type gastric cancer consists in that after establishing the type of gastric cancer, serological analyses are performed and the markers CA 19-9, CA 125, embryonal carcinoma antigen, human chorionic gonadotropin, the number of CD3 cytotoxic T-lymphocytes and CD4 T-helpers are determined, in the case where the CA 19-9 marker constitutes 50.0…200.0 IU/ml, CA 125 - 35.0…500.0 IU/ml, embryonal carcinoma antigen - 7.0…15.0 ng/ml, human chorionic gonadotropin - 18…287 ng/ml, CD3 cytotoxic T-lymphocytes - 28…54%, and CD4 T-helpers - 10…20%, the spread of intestinal-type gastric cancer is established.
Rezultatul invenţiei constă în determinarea rapidă şi eficientă printr-o metodă neinvazivă pentru pacient a răspândirii procesului canceromatos gastric de tip intestinal cu determinarea tacticii de tratament ulterior. The result of the invention consists in the rapid and efficient determination, by a non-invasive method for the patient, of the spread of the intestinal-type gastric cancer process with the determination of the subsequent treatment tactics.
Cancerul gastric reprezintă o afecţiune malignă, în care celulele neoplazice apar la nivelul mucoasei gastrice şi apoi se extind dincolo de peretele gastric. Cauza principală a depistării tardive este legată de prezenţa diferitor tipuri de cancer gastric, cu particularităţi clinic-patogenetice ale evoluţiei bolii. Sunt descrise 2 forme histologice de cancer gastric (Lauren-1965), tipul intestinal şi tipul difuz de cancer gastric. Gastric cancer is a malignant disease in which neoplastic cells appear in the gastric mucosa and then extend beyond the gastric wall. The main cause of late detection is related to the presence of different types of gastric cancer, with clinical-pathogenetic peculiarities of the disease evolution. Two histological forms of gastric cancer are described (Lauren-1965), the intestinal type and the diffuse type of gastric cancer.
S-a propus determinarea următorilor indici paraclinici, ce pot fi folosiţi în metoda revendicată pentru determinarea răspândirii cancerului gastric: It was proposed to determine the following paraclinical indices, which can be used in the claimed method for determining the spread of gastric cancer:
- determinarea serologică a markerilor tumorali: CA 19-9, CA 125, ACE (antigenul carcinomului embrionar), - serological determination of tumor markers: CA 19-9, CA 125, ACE (carcinoma embryonal antigen),
- GCEU (gonadotropina corionică umană) - un indicator al proliferării (în cazul tumorilor maligne), - GCEU (human chorionic gonadotropin) - an indicator of proliferation (in the case of malignant tumors),
- analiza la imunofenotipare pentru determinarea numărului de T-limfocite citotoxice CD3 şi T-helperi CD4. - immunophenotyping analysis to determine the number of CD3 cytotoxic T-lymphocytes and CD4 helper T-lymphocytes.
Markerii tumorali ACE, CA19-9 nu sunt markeri specifici pentru cancerul gastric, însă combinarea lor s-a dovedit a fi utilă în controlul pacienţilor cu o posibilă recidivă a cancerului gastric sau cu un proces canceromatos răspândit. La stabilirea diagnosticului clinic, markerul CA 19-9 este informativ în toate formele cancerului tractului gastro-intestinal. Nivelul crescut al ACE în sânge la pacienţii oncologici cu diferite localizări tumorale poate fi apreciat cu 2…5 luni până la manifestarea clinică a recidivei. Utilizarea acestui marker este destul de eficientă pentru stabilirea şi monitorizarea pacienţilor oncologici. Tumor markers ACE, CA19-9 are not specific markers for gastric cancer, but their combination has proven to be useful in monitoring patients with a possible recurrence of gastric cancer or with a widespread cancer process. When establishing a clinical diagnosis, the CA 19-9 marker is informative in all forms of gastrointestinal tract cancer. The increased level of ACE in the blood in oncological patients with different tumor localizations can be appreciated 2…5 months before the clinical manifestation of relapse. The use of this marker is quite effective for establishing and monitoring oncological patients.
Markerul tumoral CA-125 este cunoscut ca un marker ce poate indica răspândirea procesului unui cancer gastric cu metastaze regionale şi la distanţă (metastaze Krukenberg). Importanţa lui diagnostică creşte în cazul aprecierii împreună cu markerii CEA şi CA19-9. The tumor marker CA-125 is known as a marker that can indicate the spread of gastric cancer with regional and distant metastases (Krukenberg metastases). Its diagnostic importance increases when assessed together with the CEA and CA19-9 markers.
În studiul efectuat au fost incluşi 82 de pacienţi cu cancer gastric tip intestinal, cu diferite stadii ale bolii: The study included 82 patients with intestinal-type gastric cancer, with different stages of the disease:
stadiul I - 5 pacienţi, stage I - 5 patients,
stadiul II - 15 pacienţi, stage II - 15 patients,
stadiul III - 25 pacienţi, stage III - 25 patients,
stadiul IV - 38 pacienţi. stage IV - 38 patients.
Toţi aceşti pacienţi au fost investigaţi paraclinic prin imunofenotiparea limfocitelor în sângele periferic cu folosirea anticorpilor monoclonali. A fost analizat nivelul diferenţierii limfocitelor în funcţie de stadiul bolii şi tipului histologic al cancerului gastric. S-a depistat o scădere semnificativă a numărului de T-limfocite citotoxice (CD3) şi CD4 (T-hepleri) la majoritatea pacienţilor, amplificându-se odată cu răspândirea procesului canceromatos. S-a determinat că la un proces răspândit T-limfocitele citotoxice CD3 variază între 28…54%, iar T-helperii CD4 între 10…20%. All these patients were investigated paraclinically by immunophenotyping of lymphocytes in peripheral blood using monoclonal antibodies. The level of lymphocyte differentiation was analyzed depending on the stage of the disease and the histological type of gastric cancer. A significant decrease in the number of cytotoxic T-lymphocytes (CD3) and CD4 (T-helpers) was detected in most patients, increasing with the spread of the cancer process. It was determined that in a widespread process, cytotoxic T-lymphocytes CD3 vary between 28…54%, and T-helpers CD4 between 10…20%.
Metoda se efectuează în modul următor: pacientul este internat în baza tabloului clinic şi a unor indici paraclinici nespecifici, se efectuează fibrogastroduodenoscopia cu biopsia din mucoasa stomacului, în baza cărora se stabileşte diagnosticul de cancer gastric de tip intestinal, apoi se stabileşte dacă este răspândit procesul canceromatos, adică se determină prezenţa metastazelor regionale şi la distanţă pentru stabilirea tacticii de tratament ulterior şi tipului de intervenţie chirurgicală cu volumul necesar. Pentru aceasta se efectuează analizele serologice şi se determină markerii CA 19-9, CA 125, antigenul carcinomului embrionar, gonadotropina corionică umană, numărul de T-limfocite citotoxice CD3 şi T-helperi CD4, în cazul, în care markerul CA 19-9 constituie 50,0…200,0 UI/ml, CA 125 - 35,0…500,0 UI/ml, antigenul carcinomului embrionar - 7,0…15,0 ng/ml, gonadotropina corionică umană - 18…287 ng/ml, T-limfocite citotoxice CD3 - 28…54%, iar T-helperi CD4 - 10…20%, se stabileşte răspândirea cancerului gastric de tip intestinal. The method is performed as follows: the patient is admitted based on the clinical picture and non-specific paraclinical indices, fibrogastroduodenoscopy is performed with a biopsy of the stomach mucosa, based on which the diagnosis of intestinal-type gastric cancer is established, then it is determined whether the cancerous process has spread, i.e. the presence of regional and distant metastases is determined to establish the subsequent treatment tactics and the type of surgical intervention with the required volume. For this, serological analyses are performed and the markers CA 19-9, CA 125, embryonal carcinoma antigen, human chorionic gonadotropin, the number of CD3 cytotoxic T-lymphocytes and CD4 T-helpers are determined. If the CA 19-9 marker is 50.0…200.0 IU/ml, CA 125 - 35.0…500.0 IU/ml, embryonal carcinoma antigen - 7.0…15.0 ng/ml, human chorionic gonadotropin - 18…287 ng/ml, CD3 cytotoxic T-lymphocytes - 28…54%, and CD4 T-helpers - 10…20%, the spread of intestinal-type gastric cancer is established.
Exemple concrete de realizare Concrete examples of implementation
Exemplul 1 Example 1
Pacienta T., 60 ani, internată în secţia de gastrologie cu acuze: slăbiciune generală, dureri în regiunea epigastrică, vome cu mase alimentare la câteva ore după masă, scădere ponderală aproximativ cu 10 kg, constipaţii. Din anamneză: boală ulceroasă. Ulcer gastric cronic. Patient T., 60 years old, admitted to the gastroenterology department with complaints of: general weakness, pain in the epigastric region, vomiting with food a few hours after eating, weight loss of approximately 10 kg, constipation. From the anamnesis: ulcerative disease. Chronic gastric ulcer.
S-a efectuat IFGDS cu biopsie, unde s-a depistat o tumoare circulară în regiunea antrală a stomacului, cu stenoză decompensată a regiunii pilorice. În baza rezultatelor biopsiei s-a stabilit cancer gastric de tip intestinal. La ultrasonografia cavităţii abdominale metastaze la distanţă în cavitatea abdominală şi bazinul mic nu s-au depistat. La analiza sângelui s-a depistat sindrom anemic, leucocitoză (leucocite - 10, neseg, - 2, segmentate - 57, limfocite - 34, VSH - 50 mm/oră). IFGDS with biopsy was performed, where a circular tumor was detected in the antral region of the stomach, with decompensated stenosis of the pyloric region. Based on the biopsy results, intestinal-type gastric cancer was established. Ultrasonography of the abdominal cavity did not detect distant metastases in the abdominal cavity and small pelvis. Blood analysis revealed anemic syndrome, leukocytosis (leukocytes - 10, non-segmental, - 2, segmented - 57, lymphocytes - 34, ESR - 50 mm/hour).
Analiza biochimică a sângelui: hipoproteinemie şi hipoalbuminemie. Biochemical blood analysis: hypoproteinemia and hypoalbuminemia.
Analiza privind imunofenotiparea limfocitelor din sânge periferic atestă scăderea nivelului T-limfocitelor (CD3) - 64%, CD4 - 32,1%, ACE (antigenul carcinomului embrionar) - 4,5 ng/ml, CA 19-9 - 15,8 UI/ml, CA125 - 9,2 UI/ml şi gonadotropina corionică umană - 10 ng/ml. Immunophenotyping analysis of peripheral blood lymphocytes shows a decrease in the level of T-lymphocytes (CD3) - 64%, CD4 - 32.1%, ACE (carcinoma embryonal antigen) - 4.5 ng/ml, CA 19-9 - 15.8 IU/ml, CA125 - 9.2 IU/ml and human chorionic gonadotropin - 10 ng/ml.
După investigaţiile clinice şi paraclinice şi o pregătire preoperatorie în plin volum, în conformitate cu indicaţiile vitale (luând în considerare cancerul gastric stenozat antral), pacienta a fost supusă intervenţiei chirurgicale de rezecţie gastrică subtotală Billirot-II. Perioada postopertorie a decurs relativ fără complicaţii. Plaga regenerată per prima. Externată la domiciliu sub supravegherea medicului oncolog. After clinical and paraclinical investigations and a full-scale preoperative preparation, in accordance with vital indications (taking into account antral stenosed gastric cancer), the patient underwent Billirot-II subtotal gastric resection surgery. The postoperative period was relatively without complications. The wound regenerated per prima. Discharged home under the supervision of the oncologist.
La analiza histologică postopertorie s-a depistat adenocarcinom cu infiltrarea stratului subseros. Metastaze în ganglionii limfatici nu se depistează, omentul este intact, metastaze la distanţă nu s-au depistat. Postoperative histological analysis revealed adenocarcinoma with infiltration of the subserosal layer. No lymph node metastases were detected, the omentum was intact, and no distant metastases were detected.
Diagnosticul final - Cancer gastric T2N0M0 st. II (cancer gastric tip intestinal). Final diagnosis - Gastric cancer T2N0M0 stage II (intestinal type gastric cancer).
Exemplul 2 Example 2
Pacientul R., 63 ani, internat în secţia gastrologie cu acuze la slăbiciuni generale pronunţate, dureri în regiunea epigastrică, scăderea poftei de mâncare, scădere ponderală mai mult de 10 kg, greaţă, periodic vome. Patient R., 63 years old, admitted to the gastroenterology department with complaints of pronounced general weakness, pain in the epigastric region, decreased appetite, weight loss of more than 10 kg, nausea, periodic vomiting.
Obiectiv: abdomenul suplu, sensibil în regiunea epigastrică, unde se palpează o formaţiune tumorală dură, imobilă, doloră. Objective: soft abdomen, sensitive in the epigastric region, where a hard, immobile, painful tumor formation is palpated.
La FGDS cu biopsie s-a depistat un cancer gastric cu afecţiunea corpului gastric treimea medie, pe peretele posterior gastric s-a depistat histologic un adenocarcinom. FGDS with biopsy revealed gastric cancer affecting the middle third of the gastric body, and histologically, adenocarcinoma was detected on the posterior gastric wall.
La USG cavităţii abdominale metastaze la distanţă nu s-au vizualizat. No distant metastases were visualized on abdominal ultrasound.
Din analiza generală a sângelui se evidenţiază un sindrom anemic, VSH - 45 mm/oră. The general blood test reveals an anemic syndrome, ESR - 45 mm/hour.
Din analiza biochimică a sângelui se evidenţiază o hipoproteinemie neesenţială, urea - 8,0 UI/L. The biochemical analysis of the blood revealed non-essential hypoproteinemia, urea - 8.0 IU/L.
Imunofenotiparea limfocitelor din sânge periferic atestă scăderea nivelului T-limfocitelor (CD3 - 35%, CD4 - 15%, ACE - 13 ng/ml, CA 19-9 - 100 UI/ml, CA125 - 300UI/ml şi gonadotropina corionică umană - 100 ng/ml. Immunophenotyping of peripheral blood lymphocytes shows a decrease in T-lymphocyte levels (CD3 - 35%, CD4 - 15%, ACE - 13 ng/ml, CA 19-9 - 100 IU/ml, CA125 - 300 IU/ml and human chorionic gonadotropin - 100 ng/ml.
După investigările clinice şi paraclinice şi o pregătire preoperatorie a fost efectuată operaţia de laparotomie explorativă, unde s-a depistat un proces canceros avansat, inoperabil din cauza concreşterii tumorii retroperitoneal, metastaze în ganglionii limfatici regionali. Cancer gastric T4N3M1 st. IV. Histologic s-a depistat un adenocarcinom slab diferenţiat. After clinical and paraclinical investigations and preoperative preparation, an exploratory laparotomy was performed, where an advanced cancerous process was detected, inoperable due to retroperitoneal tumor growth, metastases in regional lymph nodes. Gastric cancer T4N3M1 stage IV. Histologically, a poorly differentiated adenocarcinoma was detected.
1. WHITING J.K., SIGURDSSON A., ROWLANDS D., et al The Long term results of endoscopic surveillance of premalignant gastric lesions. Gut. 2002, 50, p.78-381 1. WHITING J.K., SIGURDSSON A., ROWLANDS D., et al The Long term results of endoscopic surveillance of premalignant gastric lesions. Gut. 2002, 50, p.78-381
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| MD3222G2 (en) * | 2006-03-22 | 2007-08-31 | Общественное Медико-Санитарное Учреждение Онкологический Институт | Method of endometrial cancer diagnosis |
| MD3717G2 (en) * | 2008-03-21 | 2009-05-31 | Государственный Медицинский И Фармацевтический Университет "Nicolae Testemitanu" Республики Молдова | Method of differential mammary tumor diagnostics |
Non-Patent Citations (1)
| Title |
|---|
| WHITING J.K., SIGURDSSON A., ROWLANDS D., et al The Long term results of endoscopic surveillance of premalignant gastric lesions. Gut. 2002, 50, p.78-381 * |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110484624A (en) * | 2019-08-28 | 2019-11-22 | 南京大学 | A gastric cancer biomarker based on peripheral blood and its detection method and application |
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| MD492Y (en) | 2012-03-31 |
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