\/ROZHOVOR\/ V \u010desk\u00e9 populaci jsou nej\u010dast\u011bj\u0161\u00ed t\u0159i typy rakoviny: n\u00e1dory tlust\u00e9ho st\u0159eva, prsu u \u017een a prostaty u mu\u017e\u016f. Prim\u00e1\u0159 Onkologick\u00e9ho odd\u011blen\u00ed Nemocnice Ho\u0159ovice Martin \u0160makal p\u0159ipom\u00edn\u00e1 d\u016fle\u017eitost preventivn\u00edch vy\u0161et\u0159en\u00ed, kter\u00e1 p\u0159isp\u00edvaj\u00ed k v\u010dasn\u00e9mu zachycen\u00ed vznikaj\u00edc\u00edch n\u00e1dor\u016f. Nap\u0159\u00edklad u karcinomu prsu je p\u0159i v\u010dasn\u00e9m odhalen\u00ed mamografi\u00ed \u00fasp\u011b\u0161nost l\u00e9\u010dby kolem 92 procent.<\/p>\n\n\n\n
Va\u0161e odd\u011blen\u00ed je onkologick\u00fd stacion\u00e1\u0159, znamen\u00e1 to, \u017ee jde o klasickou ambulantn\u00ed l\u00e9\u010dbu?<\/p>\n\n\n\n
Ano, pacienti po vy\u0161et\u0159en\u00ed odch\u00e1zej\u00ed norm\u00e1ln\u011b dom\u016f. M\u00e1me tak\u00e9 l\u016f\u017eka, na kter\u00fdch je pod\u00e1v\u00e1na syst\u00e9mov\u00e1 l\u00e9\u010dba \u2013 a\u0165 u\u017e jde o chemoterapii, nebo o c\u00edlenou biologickou l\u00e9\u010dbu a dal\u0161\u00ed. Pacienti u n\u00e1s le\u017e\u00ed i n\u011bkolik hodin podle toho, jak je pot\u0159eba. Celono\u010dn\u00ed provoz ale nem\u00e1me. I tak je na\u0161e odd\u011blen\u00ed vedeno jako krajsk\u00e9, to znamen\u00e1, \u017ee m\u00e1me k dispozici takovou l\u00e9\u010dbu, kter\u00e1 je standardn\u011b vyhrazena pro fakultn\u00ed nebo krajsk\u00e9 nemocnice. Co\u017e m\u016f\u017ee n\u011bkter\u00fdm pacient\u016fm v\u00fdrazn\u011b usnadnit doj\u00ed\u017ed\u011bn\u00ed.<\/p>\n\n\n\n
Jak\u00e1 jsou nej\u010dast\u011bj\u0161\u00ed diagn\u00f3zy, kter\u00e9 stanov\u00edte?<\/p>\n\n\n\n
U n\u00e1s jsou t\u0159i \u2013 n\u00e1dory tlust\u00e9ho st\u0159eva, prsu a prostaty. Na okresn\u00ed pracovi\u0161t\u011b m\u00e1me m\u00e9n\u011b pacient\u016f s n\u00e1dory plic, proto\u017ee nem\u00e1me l\u016f\u017ekov\u00e9 plicn\u00ed odd\u011blen\u00ed. A pr\u00e1v\u011b naopak \u2013 proto\u017ee je v nemocnici velk\u00e9 urologick\u00e9 odd\u011blen\u00ed, zv\u00fd\u0161il se p\u0159\u00edliv malignit s n\u00e1dorem ledvin, mo\u010dov\u00e9ho m\u011bch\u00fd\u0159e a prostaty.<\/p>\n\n\n\n
Hodn\u011b se mluv\u00ed o rakovin\u011b tlust\u00e9ho st\u0159eva, kter\u00e1 je u n\u00e1s v \u010dele statistik. Pro\u010d je tak \u010dast\u00e1?<\/p>\n\n\n\n
V tomto p\u0159\u00edpad\u011b se bohu\u017eel pereme s ostatn\u00edmi st\u0159edoevropsk\u00fdmi zem\u011bmi o velmi nelichotiv\u00e9 prvn\u00ed m\u00edsto v jej\u00edm v\u00fdskytu. Mimochodem St\u0159edo\u010desk\u00fd kraj na tom v porovn\u00e1n\u00ed s ostatn\u00edmi kraji nen\u00ed nejh\u016f\u0159. Pro\u010d tento n\u00e1dor vznik\u00e1, nen\u00ed \u00fapln\u011b z\u0159ejm\u00e9. U jin\u00fdch typ\u016f m\u00e1me p\u0159edstavu, kdy se daj\u00ed ur\u010dit jasn\u00e9 vazby. Jde nap\u0159\u00edklad o n\u00e1dory v oblasti hlavy a krku, plic \u010di \u017ealudku. Ty jsou v\u00fdrazn\u011b v\u00e1z\u00e1ny na kou\u0159en\u00ed. Pak jsou takov\u00e9, u kter\u00fdch jejich p\u016fvod zcela jasn\u011b nezn\u00e1me. A to bohu\u017eel plat\u00ed tak\u00e9 o rakovin\u011b tlust\u00e9ho st\u0159eva, a\u010dkoli se spekulovalo o typu potravy a podobn\u011b. Byly provedeny studie, kter\u00e9 tuto my\u0161lenky podpo\u0159ily. Ty ale stoj\u00ed na mal\u00e9m souboru dat a u v\u011bt\u0161\u00edho po\u010dtu sledovan\u00fdch pacient\u016f se to neprok\u00e1zalo.<\/p>\n\n\n\n
Tak\u017ee zat\u00edm nev\u00edme, jak by se dalo tomuto druhu rakoviny p\u0159edej\u00edt?<\/p>\n\n\n\n
Kdybychom to jasn\u011b v\u011bd\u011bli, tak to ur\u010dit\u011b obecn\u011b doporu\u010d\u00edme. Nicm\u00e9n\u011b ale dovedeme pacienty v\u00fdborn\u011b hl\u00eddat prost\u0159ednictv\u00edm preventivn\u00edch prohl\u00eddek. A tady m\u016f\u017eeme ud\u011blat obrovsk\u00fd kus pr\u00e1ce. Poka\u017ed\u00e9 pacient\u016fm \u0159\u00edk\u00e1m, \u017ee tlust\u00e9 st\u0159evo m\u00e1 kolem 120 centimetr\u016f a jeho funkc\u00ed je zahu\u0161\u0165ovat potravu, kter\u00e1 p\u0159ich\u00e1z\u00ed z tenk\u00e9ho st\u0159eva. A jakmile na n\u00e1dor v tlust\u00e9m st\u0159ev\u011b p\u0159ijdeme v\u010das a zkr\u00e1t\u00edme jej t\u0159eba o 20 centimetr\u016f, tak se prakticky v\u016fbec nic nestane a ten \u010dlov\u011bk m\u00e1 zachr\u00e1n\u011bn\u00fd \u017eivot. Obdobn\u011b to je i u n\u00e1doru prsu. Pokud jej v\u010das mamografi\u00ed zachyt\u00edme, \u00fasp\u011b\u0161nost l\u00e9\u010dby je kolem 92 procent. Nav\u00edc mnohdy nen\u00ed n\u00e1sledn\u00fd chirurgick\u00fd v\u00fdkon v\u016fbec poznat, kdy z prsu vyjmeme mal\u00fd segment tk\u00e1n\u011b. Zhor\u0161en\u00ed kvality \u017eivota je tedy u obou p\u0159\u00edklad\u016f prakticky zanedbateln\u00e9.<\/p>\n\n\n\n
Mezi \u017eenami se \u0161\u00ed\u0159ila i informace, \u017ee mamograf dok\u00e1\u017ee karcinom prsu vyvolat \u010di jej p\u0159\u00edpadn\u011b zhor\u0161it. Jak to tedy je?<\/p>\n\n\n\n
Opakovan\u00e9, velmi zbyte\u010dn\u011b \u010dast\u00e9 mamografov\u00e1n\u00ed je samoz\u0159ejm\u011b jistou rentgenovou z\u00e1t\u011b\u017e\u00ed. Ale \u017ee by m\u011bl b\u00fdt zv\u00fd\u0161en\u00fd v\u00fdskyt n\u00e1doru prsu d\u00edky mamografii, to je nesmysl. Pokud bych na tomto vy\u0161et\u0159en\u00ed vid\u011bl n\u011bjak\u00e9 negativum, tak to je jeho pr\u016fb\u011bh, kdy doch\u00e1z\u00ed ke zm\u00e1\u010dknut\u00ed prsu. Tak\u017ee v dob\u011b, kdy je t\u0159eba n\u011bjak zan\u00edcen, m\u016f\u017ee to bolet.<\/p>\n\n\n\n
A co nap\u0159\u00edklad rakovina prostaty u mu\u017e\u016f, jak jsme na tom?<\/p>\n\n\n\n
V posledn\u00edm desetilet\u00ed l\u00e9\u010dba rakoviny prostaty zaznamenala obrovsk\u00fd rozmach. D\u0159\u00edve se to l\u00e9\u010dilo hlavn\u011b hormon\u00e1ln\u011b, \u017ee se pacientovi odstranila varlata. Dnes m\u00e1me k dispozici tucet r\u016fzn\u00fdch l\u00e9k\u016f, kter\u00e9 jsou velmi \u00fa\u010dinn\u00e9. N\u00e1dory prostaty rostou v\u00fdrazn\u011b pomaleji ne\u017e jin\u00e9 druhy rakoviny, a um\u00edme je tak velmi \u00fasp\u011b\u0161n\u011b l\u00e9\u010dit. Tady je ov\u0161em probl\u00e9m, \u017ee spousta mu\u017e\u016f v pokro\u010dil\u00e9m v\u011bku je \u010dasto st\u00e1le potentn\u00ed a hormon\u00e1ln\u00ed blok\u00e1da testosteronu s sebou p\u0159inese v\u00fdrazn\u00e9 poruchy v oblasti erekce, ejakulace a sexu\u00e1ln\u00edch funkc\u00ed v\u016fbec. Zde se tedy v\u017edy vol\u00ed metoda, kter\u00e1 co nejm\u00e9n\u011b zhor\u0161\u00ed kvalitu \u017eivota.<\/p>\n\n\n\n
V ka\u017ed\u00e9m p\u0159\u00edpad\u011b je ale prevence kl\u00ed\u010dov\u00e1.<\/p>\n\n\n\n
Velmi za n\u00ed bojuji. Stejn\u011b tak za gynekologickou prevenci t\u0159eba u d\u011blo\u017en\u00edho \u010d\u00edpku, kde se l\u00e9ka\u0159 optikou d\u00edv\u00e1, zda sliznice nen\u00ed nap\u0159\u00edklad zarudl\u00e1, jestli to nevypad\u00e1 podez\u0159ele, zda si tu \u017eenu m\u00e1 pozvat na kontrolu d\u0159\u00edve ne\u017e za rok a tak d\u00e1le. \u010cili ano, preventivn\u00ed vy\u0161et\u0159en\u00ed hodn\u011b pom\u016f\u017eou tomu, abychom zachytili \u010dasn\u00e1 st\u00e1dia a v\u00fdrazn\u011b vylep\u0161ili progn\u00f3zu. Osobn\u011b velmi apeluji na to, aby pacienti chodili na preventivn\u00ed prohl\u00eddky tak, jak maj\u00ed. Byla by to pro n\u011b obrovit\u00e1 pomoc a v kone\u010dn\u00e9m d\u016fsledku i pro zdravotnictv\u00ed. Rad\u0161i bychom ur\u010dit\u011b l\u00e9\u010dili nepokro\u010dil\u00e9 n\u00e1dory s velk\u00fdm efektem ne\u017e pacienty, kte\u0159\u00ed k n\u00e1m p\u0159ijdou a maj\u00ed posti\u017een\u00fdch n\u011bkolik syst\u00e9m\u016f najednou \u2013 po\u010d\u00ednaje pl\u00edcemi p\u0159es j\u00e1tra a\u017e po kosti.<\/p>\n\n\n\n
Kdy\u017e u\u017e se stane, \u017ee je pacient diagnostikov\u00e1n s n\u011bjak\u00fdm druhem rakoviny, jak s n\u00edm mluv\u00edte?<\/p>\n\n\n\n
Na nov\u00e9 pacienty si nech\u00e1v\u00e1m dvojn\u00e1sob \u010dasu. P\u0159i prvn\u00ed n\u00e1v\u0161t\u011bv\u011b, kdy\u017e jim \u0159eknu \u201eA\u201c, tedy \u017ee maj\u00ed n\u00e1dorov\u00e9 onemocn\u011bn\u00ed, kter\u00e9 jim m\u016f\u017ee zkr\u00e1tit \u017eivot, tak jim ale \u0159eknu i \u201eB\u201c. Jestli\u017ee jde nap\u0159\u00edklad o \u017eenu, kter\u00e1 m\u00e1 v prsu osmimilimetrov\u00fd n\u00e1dor, tak je jej\u00ed \u0161ance na vyl\u00e9\u010den\u00ed dokonce 95 procent. A je to paradoxn\u011b jednodu\u0161\u0161\u00ed se vyl\u00e9\u010dit, ne\u017e kdy\u017e si t\u0159eba zlom\u00ed nohu v kotn\u00edku, kdy do \u00fapln\u00e9ho uzdraven\u00ed budou pot\u0159eba i dva roky. Osobn\u011b tak\u00e9 pacient\u016fm \u010dasto \u0159\u00edk\u00e1m, a\u0165 se pod\u00edvaj\u00ed na internetu na podobn\u00e9 p\u0159\u00edpady, aby vznikla na\u0161e vz\u00e1jemn\u00e1 d\u016fv\u011bra. A\u0165 hledaj\u00ed podle druhu onemocn\u011bn\u00ed, histologick\u00e9ho n\u00e1lezu a podobn\u011b, a pod\u00edvaj\u00ed se, co jim Google takzvan\u011b vyjede. V\u011bt\u0161inou zjist\u00ed, \u017ee maj\u00ed vysokou \u0161anci p\u0159e\u017e\u00edt. Pak je tu samoz\u0159ejm\u011b pacient v t\u00e9 hor\u0161\u00ed situaci, kdy jsme u n\u011bho zjistili pokro\u010dil\u00fd n\u00e1lez. St\u00e1le to nicm\u00e9n\u011b neznamen\u00e1, \u017ee l\u00e9\u010dba nem\u016f\u017ee dob\u0159e zas\u00e1hnout a dlouhodob\u011b pomoci. \u010casto ale mus\u00edm zcela up\u0159\u00edmn\u011b sd\u011blit, \u017ee \u0161ance na vyl\u00e9\u010den\u00ed jsou mal\u00e9. Na druhou stranu progn\u00f3za na to, \u017ee ten \u010dlov\u011bk bude m\u00edt n\u011bkolik let \u017eivota nav\u00edc, je pom\u011brn\u011b vysok\u00e1.<\/p>\n\n\n\n
D\u00e1 se obecn\u011b popsat, jak\u00e9 nej\u010dast\u011bj\u0161\u00ed chyby pacienti v procesu l\u00e9\u010dby d\u011blaj\u00ed?<\/p>\n\n\n\n
Toto nelze \u00fapln\u011b zobecnit. Ale sp\u00ed\u0161e bych \u0159ekl, \u017ee tu nejv\u011bt\u0161\u00ed chybu d\u011blaj\u00ed jejich p\u0159\u00edbuzn\u00ed. Ti maj\u00ed pocit, \u017ee ten \u010dlov\u011bk je najednou vy\u0159azen ze \u017eivota, a ud\u011blaj\u00ed z n\u011bj obrovsk\u00e9ho maroda. \u0158ekn\u011bme, \u017ee je po operaci n\u00e1doru tlust\u00e9ho st\u0159eva a \u0161ance na p\u0159e\u017eit\u00ed je t\u0159eba 60 a\u017e 70 procent, tedy pom\u011brn\u011b velk\u00e1. A hlavn\u011b v dob\u011b, kdy k n\u00e1m takov\u00ed pacienti doch\u00e1zej\u00ed na l\u00e9\u010dbu, tak jim nic moc nen\u00ed. Ale p\u0159\u00edbuzn\u00ed se k nim chovaj\u00ed, jako by m\u011bli z\u00edtra zem\u0159\u00edt \u2013 j\u00e1 ti dojdu pro noviny, necho\u010f zal\u00e9vat tu zahradu, rad\u011bji si odpo\u010di\u0148. Ti lid\u00e9 pak maj\u00ed pocit, \u017ee jsou v t\u011b\u017ek\u00e9 a bezv\u00fdchodn\u00e9 situaci. Tak to ale v\u011bt\u0161inou nen\u00ed.<\/p>\n\n\n\n
Co pacienti, kte\u0159\u00ed zva\u017euji alternativn\u00ed l\u00e9\u010dbu?<\/p>\n\n\n\n
Jde na\u0161t\u011bst\u00ed v\u011bt\u0161inou o v\u00fdjimky, kte\u0159\u00ed se rozhodnou j\u00edt touto cestou. Mrz\u00ed n\u00e1s to hlavn\u011b ve chv\u00edli, kdy v\u00edme, \u017ee by na\u0161e l\u00e9\u010dba mohla b\u00fdt velmi \u00fasp\u011b\u0161n\u00e1. Na druhou stranu v momentu, kdy tu je nap\u0159\u00edklad n\u00e1dor \u017elu\u010dov\u00fdch cest, kter\u00fd je velmi m\u00e1lo citliv\u00fd na l\u00e9\u010dbu, a ten pacient zvol\u00ed jinou metodu, tak m\u011b to nebol\u00ed tolik, proto\u017ee v\u00edm, \u017ee na\u0161e \u00fasp\u011b\u0161nost je pom\u011brn\u011b n\u00edzk\u00e1. Ale kdy\u017e s t\u00edm p\u0159ijde m\u00e1ma od dvou mal\u00fdch d\u011bt\u00ed, kter\u00e1 se rozhodne, \u017ee p\u016fjde alternativn\u00ed cestou, kde \u010dasto \u0161ance kles\u00e1 k nule, tady se u\u017e sna\u017e\u00edm na\u0161e postupy hodn\u011b vysv\u011btlovat; a tak\u00e9 to, \u017ee tady na tom sv\u011bt\u011b nen\u00ed sama.<\/p>\n\n\n\n
Jak jsme na tom jako spole\u010dnost. Jsou lid\u00e9 \u010dast\u011bji onkologicky nemocn\u00ed ne\u017e d\u0159\u00edve?<\/p>\n\n\n\n
Ano i ne. Jak se prodlu\u017euje d\u00e9lka \u017eivota v populaci, kdy to a\u017e do covidu bylo ka\u017ed\u00fd rok zhruba o t\u0159i m\u011bs\u00edce, tak r\u016fzn\u00fdch druh\u016f rakovin p\u0159irozen\u011b p\u0159ib\u00fdv\u00e1. D\u00e1 se tedy \u0159\u00edct, \u017ee obecn\u011b je k\u0159ivka \u00famrt\u00ed pom\u011brn\u011b oplo\u0161t\u011bn\u00e1, proto\u017ee neum\u00edr\u00e1me tolik a sp\u00ed\u0161e se toho karcinomu do\u017eijeme. Nap\u0159\u00edklad kdy\u017e my mu\u017ei \u017eijeme o p\u011bt nebo \u0161est let d\u00e9le ne\u017e p\u0159ed 30 lety, a t\u00edm \u017eeny trochu doh\u00e1n\u00edme, tak v t\u011bchto letech p\u0159ibude nejen infarkt\u016f nebo \u00faraz\u016f, ale pr\u00e1v\u011b tak\u00e9 n\u00e1dor\u016f.<\/p>\n\n\n\n
Radek R. Ka\u0161a<\/p>\n\n\n\n
Pra\u017esk\u00fd den\u00edk<\/p>\n\n\n\n
https:\/\/prazsky.denik.cz\/<\/a><\/p>\n","protected":false},"excerpt":{"rendered":" \/ROZHOVOR\/ V \u010desk\u00e9 populaci jsou nej\u010dast\u011bj\u0161\u00ed t\u0159i typy rakoviny: n\u00e1dory tlust\u00e9ho st\u0159eva, prsu u \u017een a prostaty u mu\u017e\u016f. Prim\u00e1\u0159 Onkologick\u00e9ho odd\u011blen\u00ed Nemocnice Ho\u0159ovice Martin \u0160makal p\u0159ipom\u00edn\u00e1 d\u016fle\u017eitost […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":17226,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-38415","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/38415","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=38415"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/38415\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/17226"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=38415"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=38415"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=38415"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}