{"id":36337,"date":"2026-03-11T09:25:53","date_gmt":"2026-03-11T09:25:53","guid":{"rendered":"https:\/\/be-accepted.com\/oncologie\/"},"modified":"2026-05-22T07:22:11","modified_gmt":"2026-05-22T07:22:11","slug":"oncologie","status":"publish","type":"post","link":"https:\/\/be-accepted.com\/ro\/oncologie\/","title":{"rendered":"Oncologie"},"content":{"rendered":"\t\t
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O discu\u021bie cu<\/span><\/p>

Profesor asociat Priv. Doz. Dr. Rupert Bartsch <\/span><\/strong><\/span><\/p>

Specialist \u00een Hematologie \u0219i Oncologie<\/span><\/p>

Spitalul General din Viena, Departamentul de Medicin\u0103 Intern\u0103, Divizia de Oncologie, Clinica Ambulatorie pentru S\u00e2ni<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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(c) imagine a sentimentului \/ Matern<\/figcaption>\n\t\t\t\t\t\t\t\t\t\t<\/figure>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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Domnule profesor Bartsch, c\u00e2nd anume consult\u0103 pacientele un oncolog \u00een timpul tratamentului pentru cancer mamar?<\/strong><\/p>

De obicei, noi consult\u0103m doar pacientele cu cancer mamar \u00een stadiu incipient, pentru care este planificat\u0103 terapie sistemic\u0103. Acestea sunt paciente care urmeaz\u0103 s\u0103 efectueze chimioterapie pre- sau postoperatorie, cu sau f\u0103r\u0103 imunoterapie. \u00cen plus, \u00eengrijim paciente care primesc tratament antihormonal care, \u00een cadrul centrului nostru, poate fi efectuat \u0219i la clinica de chirurgie.\u00a0<\/span><\/p>

\u00cen cazul cancerului mamar metastatic \u2013 respectiv, dac\u0103 exist\u0103 metastaze la nivelul altor organe \u2013 tratamentul este \u00een primul r\u00e2nd efectuat \u00een departamentul nostru. Astfel, \u00een cazul pacientelor care vin la departamentul nostru pentru prima consulta\u021bie diagnosticul a fost de obicei deja confirmat. \u00cen plus, de cele mai multe ori, pacientele revin pentru a solicita \u0219i doua opinie. Pe de alt\u0103 parte, o trimitere din sistemul de \u00eengrijire primar\u0103 c\u0103tre oncologie sau o clarificare solicitat\u0103 prin intermediul departamentului nostru este rar\u0103.\u00a0<\/span><\/p>

\u00cen cadrul consulta\u021biei ini\u021biale cu pacientele lor, oncologii sugereaz\u0103 planul de tratament. Este adev\u0103rat c\u0103 pacientele au un cuv\u00e2nt de spus, dac\u0103 nu chiar dreptul de a decide?\u00a0<\/strong><\/p>

Decizia final\u0103 este luat\u0103 chiar de pacient\u0103, noi, oncologii, oferim o recomandare. Dar, bine\u00een\u021beles, nu l\u0103s\u0103m singure pacientele care nu au preg\u0103tirea \u0219i cuno\u0219tin\u021bele de fond necesare, \u00een luarea acestei decizii. Chiar dac\u0103 exist\u0103 teoretic dou\u0103 op\u021biuni complet echivalente \u2013 lucru care nu se \u00eent\u00e2mpl\u0103 aproape niciodat\u0103 \u2013, medicii vor prefera \u00eentotdeauna una dintre cele dou\u0103. Acest lucru este transmis \u00eentotdeauna pacientelor, \u00een mod con\u0219tient sau subcon\u0219tient, prin limbajul corpului sau modul de comunicare.\u00a0<\/span><\/p>

\u00cen special \u00een cazul bolii \u00een stadiu incipient cu receptori hormonali pozitivi\/HER2 negativ este important ca femeile afectate s\u0103 fie implicate \u00een procesul decizional. De exemplu, se poate discuta la care dintre paciente administrarea unei chimioterapii \u00een plus fa\u021b\u0103 de terapia antihormonal\u0103 se dovede\u0219te a fi justificat\u0103, \u00eentruc\u00e2t \u00een acest cazuri, este vorba de avantaje mici \u00een intervalul de 5-10 % reducere absolut\u0103 a riscului, \u00een cazul riscului de recidiv\u0103. Unele femei nu doresc chimioterapie, cel pu\u021bin nu dac\u0103 aceasta reduce riscul de recuren\u021b\u0103 cu doar 5 % \u00een zece ani. Altele nu doresc s\u0103 \u00ee\u0219i asume niciun risc. La aceasta ne referim atunci c\u00e2nd spunem c\u0103 decizia final\u0103 este luat\u0103 chiar de paciente.<\/span><\/p>

Femeile \u00een discu\u021bie au autoritatea de a lua decizii, \u00een special \u00een cazul tumorilor cu receptori hormonali pozitivi. \u00cen cazurile individuale, se poate discuta pentru ce femei ar fi benefic\u0103 chimioterapia suplimentar\u0103. \u00cen acest cazuri, este vorba de avantaje mici \u00een intervalul de 5-10 % reducere absolut\u0103 a riscului, \u00een cazul riscului de recidiv\u0103. Pacientele trebuie s\u0103 fie implicate, acestea trebuie s\u0103 decid\u0103 \u00een mod activ \u00een favoarea chimioterapiei. Unele femei nu doresc chimioterapie, mai ales dac\u0103 aceasta reduce riscul de recuren\u021b\u0103 cu doar 5 % \u00een zece ani. Altele nu doresc s\u0103 \u00ee\u0219i asume niciun risc. La aceasta ne referim atunci c\u00e2nd spunem c\u0103 decizia final\u0103 este luat\u0103 chiar de paciente.\u00a0<\/span><\/p>

C\u00e2t de repede trebuie s\u0103 ia pacientele o decizie ?<\/strong><\/p>

De obicei avem timp. De obicei pacientele \u00ee\u0219i consult\u0103 oncologul la aproximativ dou\u0103 s\u0103pt\u0103m\u00e2ni dup\u0103 interven\u021bia chirurgical\u0103. Dac\u0103 \u00eencepem terapia \u00een decurs de 6 s\u0103pt\u0103m\u00e2ni dup\u0103 opera\u021bie, sunt mul\u021bumit. Din punct de vedere medical, de obicei nu exist\u0103 nicio presiune \u00een cazul cancerului mamar, nici chiar al cancerului mamar metastatic. Singura excep\u021bie este criza visceral\u0103, adic\u0103 atunci c\u00e2nd tumora declan\u0219eaz\u0103 o disfunc\u021bie sever\u0103 a organelor. Acest lucru este \u00eens\u0103 extrem de rar \u0219i este singura excep\u021bie de la regul\u0103. Dar nu trebuie s\u0103 uita\u021bi c\u0103 exist\u0103, bine\u00een\u021beles, o presiune psihologic\u0103 uria\u0219\u0103.\u00a0<\/span><\/p>

Ce factori sunt relevan\u021bi pentru planificarea terapiei oncologice?\u00a0<\/strong><\/p>

\u00cen esen\u021b\u0103, avem nevoie de urm\u0103toarele dou\u0103 informa\u021bii despre boal\u0103:\u00a0<\/span><\/p>

\u00cen primul r\u00e2nd, biologia tumoral\u0103, respectiv, ce form\u0103 de cancer mamar este.\u00a0<\/span><\/p>

\u00cen al doilea r\u00e2nd, stadiul clinic, \u00een care aspectul important este dac\u0103 exist\u0103 deja metastaze ale cancerului mamar c\u00e2nd este diagnosticat prima dat\u0103, caz valabil pentru mai pu\u021bin de 5 % dintre femei, sau dac\u0103 este cancer mamar \u00een stadiu incipient.\u00a0<\/span><\/p>

\u00cen plus, nu trebuie uita\u021bi factorii specifici pacientei (respectiv v\u00e2rsta, bolile concomitente, circumstan\u021bele de via\u021b\u0103 specifice, dorin\u021bele individuale ale pacientei).\u00a0<\/span><\/p>

Ce forme de cancer mamar exist\u0103 \u0219i care sunt diferen\u021bele de tratament?<\/strong><\/p>

Pentru a putea face o recomandare de terapie, trebuie stabilit care dintre urm\u0103toarele trei subtipuri de cancer mamar relevante din punct de vedere clinic este implicat:\u00a0<\/span><\/p>

Cu receptori hormonali pozitivi\u00a0<\/span><\/p>

HER2 pozitiv\u00a0<\/span><\/p>

sau\u00a0<\/span><\/p>

Triplu negativ\u00a0<\/span><\/p>

\u00cen cazul tumorilor cu receptori hormonali pozitivi, ne ax\u0103m pe terapia endocrin\u0103 (antihormonal\u0103). De obicei, aceast\u0103 terapie se administreaz\u0103 dup\u0103 interven\u021bia chirurgical\u0103 primar\u0103. Chimioterapia poate fi administrat\u0103 \u00een prealabil, dar doar dac\u0103 exist\u0103 factori de risc suplimentari. Dac\u0103 tumora este de subtip HER2 pozitiv, este tratat\u0103 cu chimioterapie \u0219i terapie cu anticorpi, \u0219i anume anticorpi specifici HER2.\u00a0<\/span><\/p>

Tumorile triplu negative sunt \u00een continuare tratate \u00een mod clasic cu chimioterapie pur\u0103; \u00een viitor, imunoterapia cu a\u0219a-numi\u021bii inhibitori ai punctului de control va juca \u0219i ea un rol aici.\u00a0<\/span><\/p>

Ce reac\u021bii adverse poate cauza chimioterapia \u0219i ce m\u0103suri pot lua femeile pentru a le ameliora?\u00a0<\/strong><\/p>

\u00cen chimioterapie, \u00een prezent, principalele reac\u021bii adverse sunt oboseala \u0219i c\u0103derea p\u0103rului, ultima cauzat\u0103 de deteriorarea r\u0103d\u0103cinilor p\u0103rului. Grea\u021ba, pe de alt\u0103 parte, poate fi evitat\u0103 prin terapii moderne concomitente. Dup\u0103 \u00eencheierea chimioterapiei, se recomand\u0103 reabilitarea oncologic\u0103 pentru redob\u00e2ndirea mai rapid\u0103 a capacit\u0103\u021bii func\u021bionale normale. \u00cen general, dup\u0103 cancerul mamar se recomand\u0103 un regim alimentar cu con\u021binut redus de gr\u0103simi \u0219i activitate fizic\u0103, deoarece ambele pot reduce riscul de recidiv\u0103.\u00a0<\/span><\/p>

Ce determin\u0103 tipul \u0219i durata terapiei antihormonale?\u00a0<\/strong><\/p>

Terapia antihormonal\u0103 depinde de riscul ini\u021bial. Dac\u0103 pacienta este t\u00e2n\u0103r\u0103 \u0219i are un risc ridicat, este indus\u0103 artificial menopauza \u0219i apoi se efectueaz\u0103 tratamentul, la fel ca \u00een cazul femeilor care au trecut de menopauz\u0103, prin a\u0219a-numitul inhibitor de aromataz\u0103, care blocheaz\u0103 produc\u021bia de hormoni \u00een afara ovarelor.<\/span><\/p>

\u00cen cazul unui risc sc\u0103zut, este inhibat doar receptorul hormonal, nu \u0219i produc\u021bia de hormoni. Aceasta \u00eenseamn\u0103 c\u0103 nu este indus\u0103 menopauza. De regul\u0103, terapia antihormonal\u0103 este administrat\u0103 \u00eentre 5 \u0219i 7 ani, \u00een cazuri rare chiar \u0219i 10 ani.\u00a0<\/span><\/p>

\u00cen cazul \u00een care riscul ini\u021bial este crescut, \u00een majoritatea cazurilor se recomand\u0103 de asemenea administrarea pentru o perioad\u0103 de 2\u20133 ani a unui inhibitor CDK4\/6, adic\u0103 a unor medicamente care sporesc eficacitatea tratamentului endocrin, prin accea c\u0103\u00a0 blocheaz\u0103 \u021bintit diviziunea celular\u0103.<\/span><\/p>

C\u00e2nd testa\u021bi femeile pentru a vedea dac\u0103 au un risc crescut de cancer mamar din cauza condi\u021biilor genetice?\u00a0<\/strong><\/p>

Exist\u0103 istorice familiale care sus\u021bin testarea pentru riscul de cancer mamar. Acest lucru are leg\u0103tur\u0103 cu existen\u021ba unui num\u0103r mare de cancere mamare \u0219i\/sau ovariene \u00een cadrul familiei \u0219i a cancerului mamar la b\u0103rba\u021bi. \u00cen plus, tindem s\u0103 test\u0103m toate pacientele cu cancer mamar metastatic HER2 negativ, deoarece \u00een cazul unei a\u0219a-numite muta\u021bii BRCA, \u00een prezent sunt disponibile tratamente \u021bintite specifice.\u00a0<\/span><\/p>

De ce conteaz\u0103 dac\u0103 cineva are cancer mamar sau cancer mamar ereditar?\u00a0<\/strong><\/p>

\u00cen general, cancerul mamar ereditar r\u0103spunde chiar mai bine la chimioterapie \u0219i avem op\u021biuni de tratament suplimentare cu a\u0219a-numi\u021bii inhibitori PARP. Totu\u0219i, dac\u0103 este prezent\u0103 o muta\u021bie BRCA, exist\u0103 un risc ridicat de cancer mamar \u0219i\/sau ovarian ulterior.\u00a0<\/span><\/p>

Prin urmare, poate avea sens, chiar dac\u0103 ar fi posibil\u0103 o interven\u021bie chirurgical\u0103 de conservare a s\u00e2nului, s\u0103 se analizeze dac\u0103 ar trebui extirpat \u00eentregul \u021besut al glandei mamare, p\u0103str\u00e2nd pielea \u0219i mamelonul, urm\u00e2nd reconstruc\u021bia cu implanturi, care, de obicei, produce \u0219i rezultate foarte frumoase din punct de vedere estetic.\u00a0<\/span><\/p>

Ce sunt a\u0219a-numitele terapii neoadjuvante \u0219i c\u00e2nd sunt utilizate?\u00a0<\/strong><\/p>

Neoadjuvant este termenul utilizat pentru terapiile preoperatorii. \u00cen mod tradi\u021bional, scopul era ob\u021binerea posibilit\u0103\u021bii de a opera tumorile neoperabile avansate local \u0219i ulterior, \u00een mod secundar, conservarea s\u00e2nului. \u00cen prezent, tratamentul neoadjuvant este considerat strategia preferat\u0103 pentru subtipurile cu risc ridicat, cum ar fi tumorile HER2-pozitive \u0219i triplu negative.\u00a0<\/span><\/p>

Scopul terapiei neoadjuvante este remisiunea patologic\u0103 complet\u0103, respectiv s\u0103 nu mai fie g\u0103sit\u0103 nicio celul\u0103 tumoral\u0103 viabil\u0103 \u00een timpul interven\u021biei chirurgicale, deoarece \u0219tim c\u0103, \u00een cazul \u00een care am reu\u0219it \u00een acest sens, persoanele care \u00een principiu aveau un risc ridicat de recidiv\u0103, au \u00een final un prognostic foarte bun.\u00a0<\/span><\/p>

\u00cen plus, exist\u0103 aspectul terapiilor postoperatorii individualizate. Aceasta \u00eenseamn\u0103 c\u0103, \u00een cazul \u00een care sunt \u00een continuare g\u0103site celule canceroase viabile \u00een pofida terapiei neoadjuvante, tipul \u0219i intensitatea terapiei postoperatorii pot fi adaptate \u0219i riscul de recidiv\u0103 poate fi redus \u0219i mai mult.\u00a0<\/span><\/p>

A\u021bi men\u021bionat previzionarea, c\u00e2t de precise pot fi previziunile individuale?<\/strong><\/p>

\u00cen ceea ce prive\u0219te evaluarea prognosticului \u00een cazul cancerului mamar \u00een stadiu incipient, sunt importante trei lucruri:\u00a0<\/p>

Biologia tumoral\u0103, calitatea r\u0103spunsului la terapie \u0219i stadiul clinic.<\/span><\/p>

Esen\u021bial \u00een acest sens este faptul c\u0103 avem o foarte bun\u0103 capacitate de estimare a riscului \u0219i efectului unei terapii pentru o popula\u021bie. De exemplu, dac\u0103 am 100 de femei cu factori de risc complet identici, v\u00e2rst\u0103 complet identic\u0103, boli concomitente complet identice, atunci le-a\u0219 putea spune acestor 100 de femei c\u0103, \u00een cazul \u00een care nu administr\u0103m chimioterapie, 20 dintre ele vor suferi o recidiv\u0103. Cu chimioterapie, num\u0103rul recidivelor se reduce la 10. Dar aceste informa\u021bii nu ajut\u0103 \u00eentr-un caz individual, deoarece nu avem capacitatea de a le aplica efectiv pentru o persoan\u0103 anume.\u00a0<\/span><\/p>

\u00cen prezen\u021ba unei boli metastatice, este \u00eentotdeauna recomandat s\u0103 nu se men\u021bioneze cifre cu privire la speran\u021ba de via\u021b\u0103, deoarece cursul individual al bolii nu poate fi prev\u0103zut, dar cronicizarea este de obicei reu\u0219it\u0103. Aceasta \u00eenseamn\u0103 c\u0103, \u00een pofida unei boli metastatice, supravie\u021buirea este posibil\u0103 mul\u021bi ani.\u00a0<\/span><\/p>

\u00cen ce m\u0103sur\u0103 trebuie pacientele s\u0103 \u0219tie mereu totul?\u00a0<\/strong><\/p>

Conform conceptului lui P\u00f6ltner*, medicii nu au voie s\u0103 fac\u0103 urm\u0103toarele dou\u0103 lucruri, deoarece ar pasa responsabilitatea \u00een fiecare dintre situa\u021bii:\u00a0<\/span><\/p>

Primul este s\u0103 ofere explica\u021bii f\u0103r\u0103 niciun fel de menajamente, iar al doilea este refuzul de a informa sau nefurnizarea de informa\u021bii despre boal\u0103.\u00a0<\/span><\/p>

Comunicarea trebuie s\u0103 fie sincer\u0103 \u0219i adaptat\u0103 \u00een mod individual la necesit\u0103\u021bile persoanelor implicate.<\/span><\/p>

Ce se \u00eent\u00e2mpl\u0103 dac\u0103 o pacient\u0103 nu tolereaz\u0103 terapia planificat\u0103?\u00a0<\/strong><\/p>

Terapia este ajustat\u0103. \u00cen cazul chimioterapiei, aceasta \u00eenseamn\u0103 adaptarea terapiei de sus\u021binere \u0219i\/sau reducerea dozei. \u00cen cazul terapiilor antihormonale, care sunt de obicei administrate mai mul\u021bi ani, schimb\u0103m medica\u021bia.\u00a0<\/span><\/p>

\u00cen afar\u0103 de terapiile clasice, ce recomanda\u021bi pacientelor dumneavoastr\u0103 pentru a-\u0219i \u00eent\u0103ri rezisten\u021ba organismului \u00een cel mai bun mod posibil?\u00a0<\/span><\/p>

Terapiile fizice \u0219i sprijinul psihologic au foarte mult sens. Consilierea nutri\u021bional\u0103 poate fi, de asemenea, esen\u021bial\u0103. \u00cen leg\u0103tur\u0103 cu m\u0103surile care \u021bin de medicina complementar\u0103, este important pentru mine s\u0103 fiu informat despre tipurile de m\u0103suri avute \u00een vedere, deoarece sunt posibile interac\u021biuni cu terapia oncologic\u0103. Acest lucru este valabil \u00een mod special, dar nu exclusiv, \u00een cazul sun\u0103torii.\u00a0<\/span><\/p>

Auzim deseori despre un vaccin \u2013 este un vis de viitor pentru cancerul mamar sau este ceva realizabil?\u00a0<\/span><\/p>

Un vaccin care poate preveni apari\u021bia cancerului mamar sau servi drept tratament este, bine\u00een\u021beles, un vis. Din p\u0103cate, p\u00e2n\u0103 acum, abord\u0103rile nu s-au dovedit a fi suficient de eficiente. F\u0103r\u0103 \u00eendoial\u0103 este nevoie \u00een continuare de cercet\u0103ri extinse \u00een acest sens, cu toate acestea, primele date privind vaccinurile pe baz\u0103 de ARN sunt promi\u021b\u0103toare.<\/span><\/p>

*Nota editorului: G\u00fcnther P\u00f6ltner este un filosof austriac; materialele publicate de acesta includ cartea \u201eGrundkurs Medizin \u2013 Ethik\u201d (\u201eCurs de baz\u0103 \u00een medicin\u0103 \u2013 Etica\u201d), publicat de Facultas Universit\u00e4tsverlag Vienna.<\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"

Interviu cu prof. asociat Priv. Doz. Dr. Rupert Bartsch
\n: Prof. Bartsch, c\u00e2nd, \u00een timpul cancerului de s\u00e2n, vin pacien\u021bii la un oncolog? <\/p>\n

De obicei, vin la noi doar pacien\u021bii cu cancer de s\u00e2n \u00een stadiu incipient, pentru care este planificat\u0103 terapie sistemic\u0103. <\/p>\n","protected":false},"author":14,"featured_media":36340,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[417],"tags":[],"class_list":["post-36337","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-be-medicina-conventionala"],"acf":[],"yoast_head":"\nOncologie - Be accepted<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/be-accepted.com\/ro\/oncologie\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Oncologie - Be accepted\" \/>\n<meta property=\"og:description\" content=\"Interviu cu prof. asociat Priv. Doz. Dr. Rupert Bartsch : Prof. Bartsch, c\u00e2nd, \u00een timpul cancerului de s\u00e2n, vin pacien\u021bii la un oncolog? 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