SUMMARY Although breast cancer (BC) occurs more often in older women, it is the most commonly diagnosed malignancy in women of childbearing age. Owing to the overall advancement of modern medicine and the growing global trend of delaying childbirth until later age, we find ever more younger women diagnosed and treated for BC who have not yet completed their family. Therefore, fertility preservation has emerged as a very important quality of life issue for young BC survivors. This paper reviews currently available options for fertility preservation in young women with early-stage BC and highlights the importance of a multidisciplinary approach to fertility preservation as a very important quality of life issue for young BC survivors. Pregnancy after BC treatment is considered not to be associated with an increased risk of BC recurrence; therefore, it should not be discouraged for those women who want to achieve pregnancy after oncologic treatment. Currently, it is recommended to delay pregnancy for at least 2 years after BC diagnosis, when the risk of recurrence is highest. However, BC patients of reproductive age should be informed about the potential negative effects of oncologic therapy on fertility, as well as on the fertility preservation options available, and if interested in fertility preservation, they should be promptly referred to a reproductive specialist. Early referral to a reproductive specialist is an important factor that increases the likelihood of successful fertility preservation. Embryo and mature oocyte cryopreservation are currently the only established fertility preservation methods but they require ovarian stimulation (OS), which delays initiation of chemotherapy for at least 2 weeks. Controlled OS does not seem to increase the risk of BC recurrence. Other fertility preservation methods (ovarian tissue cryopreservation, cryopreservation of immature oocytes and ovarian suppression with gonadotropin-releasing hormone agonists) do not require OS but are still considered to be experimental techniques for fertility preservation.
Izvorni rad | Original article Deskriptori TUMORI-komplikacije; MALNUTRICIJA-dijagnoza, epidemiologija, etiologija; NUTRITIVNI STATUS; NUTRITIVNA PROCJENA; PROCJENA RIZIKA-metode, statistički podatci; PRESJEČNA ISTRAŽIVANJA; HRVATSKA-epidemiologija SAŽETAK. Cilj istraživanja: Utvrditi trenutačnu prevalenciju znatnoga nutritivnog rizika među onkološkim bolesnicima u Republici Hrvatskoj. Ispitanici i metode: Ova presječna studija ugniježđena je u prospektivnu kohortnu studiju Sekcije mladih onkologa HDIO-a HLZ-a, koja je provedena u Hrvatskoj tijekom 2017. godine na susljednom uzorku onkoloških bolesnika biranome prema redoslijedu dolaska na liječenje. Nutritivni probir proveli smo uporabom upitnika za procjenu nutritivnog rizika NRS-2002. Prema njemu, bolesnik se smatra nutritivno ugroženim ako je rezultat ≥ 3. Rezultati: U istraživanje je uključeno 275 bolesnika, medijana (interkvartilnog raspona) dobi od 61 godine (51-68), među kojima je bila 161 žena (58,5%). Bolesnici su liječeni u jedanaest onkoloških centara u Hrvatskoj. U 60 bolesnika (21,8%; 95%-tni CI 17,1-27,2%) utvrđen je znatan nutritivni rizik (NRS-2002 ≥ 3) koji indicira potrebu za nutritivnom intervencijom. Bilo kakvu nepovoljnu promjenu tijekom 30 dana prije uključivanja, dakle, gubitak tjelesne mase ili smanjen unos hrane, primijetilo je 127 (46,2%) sudionika. Zaključak: Naše istraživanje potvrdilo je da znatan broj onkoloških bolesnika u Hrvatskoj ima neki stupanj nutritivnog rizika te da je u više od četvrtine potrebna nutritivna intervencija. Nutritivni probir prvi je korak u dugoročnoj kontroli komplikacija vezanih uz promijenjen unos hrane i nutritivni rizik, kao i pri poboljšanju kvalitete života onkoloških bolesnika te prognoze ishoda bolesti pa bi ga, s obzirom na prikazane rezultate, trebalo rutinski provoditi.
Systemic cytotoxic chemotherapeutic treatment of malignant tumors does not fully meet its goal due to the resistance of present tumor cells to the applied therapy. Chemoresistance is complex and multifactorial, caused by numerous mechanisms that alter drug concentration in the cell, by changes in expression of the epidermal growth factor and by activation of intracellular signaling pathways PI3K / Akt and MAPK. The factor of chemoresistance is also an increased level of antioxidative glutathione and glutathione transferase-S enzyme and the presence of tumor stem cells that signifi cantly improve protection of DNA from damage. Apart from cellular factors, resistance is infl uenced by extracellular hypoxia and acidosis and autophagy. Overcoming the chemoresistance is possible by using nanomechanisms for delivery of drugs to tumor cells, autophagy inhibitors like antimalarials chloroquine and hydroxychloroquine and plant polyphenols. By bett er understanding the mechanisms of chemoresistance and it's overcoming it can be possible to achieve improvement in antitumor treatment.
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