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אונקולוגיה

אונקולוגיה

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Published by sanshine

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Published by: sanshine on May 29, 2008
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ילוח יבצמב ןחבמל םוכיס -היגולוקנוא 
1
 
:ןטרסו היגולוימדיפא
!ןטרס עונמל :הרטמה
תודרשיה 
ןמז תופוקת ךות תוומל תוריבסה בושיחו ןמז ךרואל תולכתסה .תוומו )תורקיה( תועראיה ינותנ ןיב רשקה :.ךוניחו העינמ לע העיפשהלו התומתה יזוחא לע "המל" תולאש תולעהל ,התומתב תומגמ תוהזל הרטמב תודחא
תועראיה 
.תרדגומ היסולכואב תיפיצפס ןמז תפוקתב םינחבואמה םישדחה םירקמה רפסמ :
:תוחיכש 
.םיוסמ ןמזב ןטרסה ירקמ לכ רפסמ
התומת רועיש 
.תרדגומ היסולכואב תמיוסמ ןמז תפוקתב ןטרסמ םירטפנה רפסמ :
:ןטרס לש תויגולויטא
םיקדייח-
Helicobacter Pyloric
.הביקבםיסוריו-
Burkittt's lymphoma- BV- Nasopharingial Carcinoma-CERVIX-CMV, HPV
םילקימיכןושיעו לוהוכלא --תרוסנ-טסבסא-ןזנב-םוימדקםיילקיזיפשמשל הפישח --)תיביטקאוידר וא תנניימ( הנירקל הפישח-תקלד וא ינורכ יוריג-.קבטב שומישםייתנוזת םימרוגןמוש --לוהוכלא-ןשועמ רשב-רתי תנמשהםיילנומרוה-.םחרו תינומרע ,דש ינטרס -ןגורטסאםייטנג-תויצקולסנרט -תוינטנופס תויצטומ-השרות
Carcinogen
-ב ךיפה יתלבו רישי ,עובק יונישל םרוג .ל"נה םימרוגה יגוסמ דחא לכ תויהל לוכי .חתופה םרוגה -
DNA
.
Carcinogenesis
-
.ןטרס יאתל היצמרופסנרט םירבוע םיילמרונ םיאת וב ךילהתה
Oncogen
.רוצייב טולשל ידכ םילבקמו םיחלוש םיאתש הקספהו הלעפה תותואכ לעפומש יטנג דוק -
Transformation
.אתה תקולח לע הטילשה תוסיוו קספומו תיביסרגורפל תכפוה תוניימתהה וב יבלש בר ךילהת -:תיטסלפואנ אל החימצ לש םימגד-,)אתה לדוג תלדגה ( היפורטרפיה-,)הלוע םיאת רפסמ -הלדג תיתמקר הסמ( היזלפרפיה-רסוח ,תקלד -המקרל ךייש אלש רחא גוסמ אתב ףלחומה את( היזלפטמ.)היצלומיטסה הקיספמשכ ךיפה.םינימטיוולפכשמו רדס לע רמוש ,ליעפ ,ימניד אוה ילמרונה אתה .ןדבואה וא קזנה ןקות רשאכ רצועה הטילש ןונגנמ ילמרונ אתל.ומצע תא
 
:תיטסלפואנ החימצ לש םימגד
-היזלפאנאתיביטימירפ רתוי הגרדל םיגוסנ םירגוב םיאת -הנבמ אלל -.םהלש תוחמתהב דקפתל םתלוכי םידבאמו-היזלפואנימוחתל רבעמ תבחרתמה תיתמקר הסמ -השדח החימצ -תלידג ,הליגר אל תוקלחתה ,תטלשנ אל תוליעפ .םיילמרונה המקרה.םיינויח םיניזמ םירמוח לע הרחתמו םוקמ ספות .המקירה-היזלפסידתוחפ אתב ףלחומ /ונוגרא /ותרוצ /ולדוגב הנתשמ אתה -וא יסקוט רמוח ,תקלד ,הנירק -כ"דב ינוציח אוה טנלומיטסה .לשב.טנלומיטסה רסומ וב עגרב ךיפה בצמ והז .ינורכ יוריג
:ינטרס לודיג את לש תונוכת
1
..לשב היהי אל -היצאיצנרפיד-הד -ןיימתהל תלוכיה ןדבוא
2
.וא םינומרוה רציימ .לשב וניאש ןוויכ תושדח תונוכת שכור וא דבאמ -תוימיכויבה תונוכתב יוניש
Hormon like
.יטסלפואנ-הרפ םורדניס והזש
3
..םיריבש םירתא ,םיעטקמ לש תפסות/ןדבוא ,תויצקולסנרט -ילמוזומורכה רודיסב יוניש
4
..תולפכה לשצ יפוסניא רפסמ דע -אתה יוביר לע הטילש ןדבוא
5
.-יתרורג רוזיפ
1
.)ישיבכע תת( ילדיאונכראבוס ,הרואלפ ,םואנוטירפ-ףוגה יללח
2
..היזלפרפיה -תונוש תוירשקלו תונושה תונחתל -הפמיל ילכ
3
..רתוי קוחרה רןזיפה -םדה תכרעמ
6
..תורחא תומקרל רודחל תלוכיה -תונשלופ/תולובג רסוח
7
.תוריאממה תגרד ןיב רשק שי .םיינשמ םירתאל רוקמה רתאמ ןטרסה רוזיפ -תוזאטסאטמ חולשל תלוכי.תורורג חולשל תלוכיהו
-הגרד
GRADE
G1- Well differentiated
G2- Moderately Well differentiated
G3- Poorly differentiated
G4 very Poorly differentiated- Undifferentiated
.חטשה תוזאטסאטמה רפסמו רוקמה אתל ןוימדה תדימ יפל תעבקנ תוריאממה תגרד
:םימוטפמיסו םינמיס
)םיירפירפ םירוזאב כ"דב( תוריאממ לש תורשפאל ןווכל םילוכיה םישוג ונמיס םיתיעל
.לקשמב תינוציק הדירי
.תואיר תקלד וא תעפש ומכ "תוליגר" תולחמ םיריכזמו םייפיצפס אל םינמיסה םירקמה בורביפל ,)גוס( לודיגה לש היגולופרומה יפל תעבקנ -הזונגורפ
Stage
יפלו
Grade
.
:ןוחביא
.תיגולוטסיה הנחבא תויהל תבייח-ה תרדגהל תוצוחנ היימדה תוקידב ללוכ תונוש תוקידב
Stage
.לופיטה לע תוטלחה תלבק ךרוצלו.רידנל חיכשהמ תררבמ האופרה יכ רוכזל בושח
:םינוש םינטרסל םירקרמ
Prostate Acicid Phosphatases- PAP - <3ng/ml
ליג ינפל
50
.תינומרעה ןטרסל -
CA125- Cancer Antigen 125- < 35u/ml
.תולחשה ןטרסל
CA15-3- Cancer Antigen 15-3- < 30u/ml
.דשה ןטרסל
 NSE- Neuron Specific Enolase - < 12.5 ng/ml
-ל -
Small cell carcinoma
.המוטסלבוריונלו
AFP- Alpha-Feto Protein- > 10ng/ml
.םיכשאה ןטרסו דבכה לש המוניצרק -
CT- Calcitonin- 10 pg/ml
.סירתה תטולב לש הלודמב ןטרס ->
PSA-Prostat Sspecific Antigem-< 2.5ng/mg
ליג ינפל
50
,
5ng/mg
ליג ירחא
50
.תינומרעה ןטרס -
:םידלי תיגולוקנואב תידועיסה םלועה תפקשה לע
1%
-כ הנש לכ םינחבואמ לארשיב .םידלי םה םלועב ןטרסה ילוח ללכמ
350
.םירגבתמו םידליב םישדח םירקמ:תורגבתהה ליגבו תודליה ליגב תוריאממל היגולויטא
1
.ומצע הלוחל םירושקה םימרוג-
 
תוילאמוזומורכ תוערפה
םידלומ םימומ
יגולונומיא רסח
תיטנג הרבעה
2
.-םייתביבס םימרוג
הנירק
םיסוריו
םיימיכ םימרוג.ןושארה םוקמב םירגבתמ לצאו ,ינש םוקמב תואצמנ ןטרס תולחמ םידלי לצא התומת תניחבמ,תינורכ הלחמכ ןטרסה רדגומ םויכ
75%
 םירגבתמו םידלי לצא הארבהיטירקה םוקישה ,קיפסמ אל יזיפה יופירה ..ימצעה יומידה םוקיש אוה
:תודליהו תורגבתהה ליגב ןטרסה תולחמ תוידוחי
1
.רוקמב םילדבה-םידליב .ילאילתיפא רוקממו תומוניצרק ללכ ךרדב םירגובמב -
.המוטסלבורפנ ,המוטסלבוריונ -םילאנוירבמא
.םצע ילודיג – ילאמיכנזמ
.תופירח תוימקול -תויטאפומה
2
.יפרטומיכ לופיטל הבוט הבוגת
3
.םצעה חמ לש הבוט תוששואתה.
:יפרטומכה לופיטה
-רתוי םייביסרגאו םיבכרומ םויכ םילופיטה
דחא לופיטב תופורת רתוי
םילופיטה ןתמב תופיכת
דואמ םיהובג םינונימ
רתוי תורומח ל"ת
רתוי הובג יופיר %
:רתוי תוקיודמו תושדח ןוחבאה יכרד םויכ
1
.,םימוזומורכ ( הקיטנגוטיצ -תושדח הדבעמ תוטיש
fish, sky
יוליג( תיראלוקלומ היגולויב .(.םידליב ןטרס לש יטנג-ירלוקלומה סיסבה
2
.-םיקיודמו םישדח הימדה יעצמא
CT, MRI, PET
םישדח דוגינ ירמוח םע םייופימ ,
MIBG
.תעינמו םילופיטה רחאלו ןמזב הבוט םייח תוכיא ,האלמ הארבה איה ןטרס ילוח םירגבתמו םידליב לופיטה תרטמ-ףוגב הרוק ךילהת הזיאו עגתשהל ילאמרונ אתל םרג המ םיעדוי אל ונחנא -תימטסיס הלחמ יהוז .םיינשמ םילודיג.תונרקהו 'ומיכב םילפטמ לודיגה תאצוהל ףסונב ןכל .רחא םוקמב םג וא ונאצמש םוקמב קר םאהםהילא םיכרצ שי דליל .ןטרסב קר אלו דליב אוה לופיטה -ינללוכ לופיט לבקל םיבייח ותחפשמו ןטרסב הקולה דלי.תישגרהו תילאטנמה ,תירוטומה תוחתפתהל ,הלידגל סחייתהל שי .דומללו חתפתהל ,ןוחטיב שוכרל ,סחיתהל ךירצ
:תודליב ןטרסה תלחמב םילופיטה
1
.:תומופמילו תוימיקול
יפארטומיכ לופיט
IV
הרדישה טוח ללחל לופיט
IT
תוקירז
IM, SC
תופורת
PO
הנירק
2
.:םיקצומ םילודיג
היספויב ,לודיגה תאצוה -יגרוריכ לופיט
.לודיגה לש תטלחומ הדחכהל חותינה רחאלו .חותינה ינפל לודיג תנטקהל -יטוקא -'ומיכ
הנירק: לופיטהמ תוידימ ל"ת
תלוכיו ףוגה תדוגנת תדרוי .םצעה חמ יוכיד םרוג הזל .הינפוטיצובמורט ,הינפוקיול ,הימנא -הינפוטיצנפ.םייתירטפו םיילאריוו םייקדייח םימוהיזל איבמש המ ,השירקה

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