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© Borgis - Postępy Nauk Medycznych 7/2013, s. 499-500
prof. Romuald Dębski, MD, PhD
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Oncology is one of the most dynamic developing branch of medicine. Each medical specialty is combined more or less with the cancerous problems, each of them has its own specific nature, tissue and organ characteristics. There are some medical specialties, where popularizing and improvement of chemotherapeutic guidelines or introducing the cumulating therapy led to a crucial improvement of the treatment effectiveness. The treatment efficiency of Hodgkin’s disease identified to single figures at the beginning of the XX century states nowadays to more than 90%. Almost the same effectiveness was gained in treatment of non-Hodgkin lymphomas. There was also a huge progress in the effectiveness of breast cancer treatment although the main meaning here was popularizing of the early diagnosis methods and as a consequence a higher percentage of treatment in the clinically lower-advanced changes. The main progress we observe involoves popularizing of genetic tests as a cancer risk assessment of large intestine, breast and ovary. The large amounts of capital expenditures put to basic tests led to the better understanding of cancer biology or means in clinical trials – hundreds of new chemotherapeutics, immunotherapy, introducing different combinations and schemas of treatment contributed to increased rates of the cure of many cancer diseases. Unfortunately, there are still organs and diseases which stay less cured or just uncured despite of the great progress of knowledge. The good example of such a treatment could be the gall bladder cancer, some kinds of lung cancer, central nervous system tumors, generalized melanoma and in gynecology – all tumors clinically advanced – relatively rare endometrial cancer, more often cervical cancer, vulval cancer but most of all ovarian cancer. Ovarian cancer not giving any previous clinical symptoms are diagnosed most often in a very advanced cancer process. Ovarian cancer, even in a very well defined group of the very high cancer risk who are carriers of BRCA1 or BRCA2 gene mutation, despite of performing the systematic vivid exams (transvaginal ultasonography with a Doppler blood flow assessment) and taking biochemical markers (CA125 and lately HE4), in more than 50% a cancer is diagnosed in the third stage of a clinical severity, which is in the stage of intraperitoneal dissemination. As far as chemotherapy has made a great progress in a treatment of germinal ovarian cancer, tumors which twenty years ago were a sentence for the young women, today they are permanently cured in the majority. We cannot perform such relation for the most often tumor – ovarian cancer. There were many raised hopes with completely new and modified chemotherapy and the immune system stimulating drugs. Popularizing of the most modern drugs, possibility of chemosensibility of cancer cells assessment, introducing better and more expensive non standard chemotherapy make costs of treatment higher and with the minimal influence on the long-treatment results.
As regards tumors with bad prognosis, diagnosed in the very advanced clinical stage or non sensitive to radio and chemotherapy, the base meaning is in detecting pre-cancerous changes. Removing of these changes minimize or even eliminate the risk of cancer developing. An example of these kind of movements is colonoscopy with prophylactic excision of the colon polyps or pap smear assessment which allow to recognize and treat dysplastic changes.

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Postępy Nauk Medycznych 7/2013
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