Clinical guidelines for diagnosis, treatment and monitoring of patients with ovarian cancer, Fallopian tube cancer and primary peritoneal can

Rak jajnika i jajovoda, odnosno adneksa, i primarni rak potrbušnice jest šesta po učestalosti zloćudna bolest žena i najsmrtonosniji ginekološki tumor u Hrvatskoj. Histološki je rak jajnika, jajovoda i potrbušnice najčešće epitelnog podrijetla, i to seroznog podtipa. Rjeđi su različiti neepitelni tumori jajnika kao i presadnice u jajnike. Posebnu skupinu čine karcinomi niskog zloćudnog potencijala označeni neinvazivnošću, klinički indolentnim tijekom i dobrom prognozom. Klinički su karcinomi u ranim stadijima razvoja uglavnom asimptomatski, tako da se najčešće dijagnosticiraju u kasnijim, uznapredovalim stadijima bolesti. Dijagnoza se potvrđuje patohistološkim nalazom, a iznimno nalazom citološkog bloka nakon provedene dijagnostičke obrade. O liječenju i praćenju bolesnica odlučuje multidisciplinarni tim uzimajući u obzir osobitosti bolesnice (dob, opće stanje i komorbiditete) kao i obilježja samog tumora (stadij bolesti, histološki tip i stupanj zloćudnosti tumora, status homologne rekombinacije, odnosno gena BRCA 1 i 2 kao i odgovor na prethodno liječenje i popratnu toksičnost ako se radi o povratu bolesti). Liječenje primarnog raka jajnika, jajovoda i potrbušnice temelji se na kirurškom liječenju, sistemskoj primjeni kemoterapije, imunoterapije, ciljane terapije i hormonske terapije kao i suportivno-simptomatskih mjera tijekom cijelog liječenja. Terapijski pristup se razlikuje kod rjeđih neepitelnih histoloških tipova ovih tumora jer se češće dijagnosticiraju u ranim stadijima bolesti, imaju indolentniji tijek, drugačiju biologiju bolesti kao i osjetljivost na sistemsko liječenje. U tekstu koji slijedi predstavljene su obnovljene i nadopunjene kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnica s rakom jajnika, jajovoda i potrbušnice u Hrvatskoj. Prvo izdanje smjernica za dijagnozu, liječenje i praćenje bolesnica s rakom jajnika objavljeno je 2013. godine.Ovarian and fallopian tube cancer, i.e., adnexal tumours, and primary peritoneal cancer is the sixth most common female cancer and the deadliest gynecologic tumor in Croatia. Hystologically, these tumors are most commonly of epithelial origin, a serous subtype. Less common are various non-epithelial ovarian malignancies, as well as ovarian metastases. A special group consists of epithelial carcinomas of low malignant potential characterized by non-invasiveness, clinically indolent course, and good prognosis. Clinically, these cancers are generally asymptomatic in early stages, and therefore usually diagnosed in later, advanced stages. The diagnosis is confirmed by pathological examination, or exceptionally by cell block cytology finding after the completion of diagnostic procedures. Multidisciplinary team makes treatment and follow-up decisions, taking into account patients’ (age, general condition, and comorbidities) and tumor characteristics (stage of disease, histological type and grade, homologous recombination status or BRCA gene 1 and 2 status, as well as the response and toxicity to previous treatment in case of relapse). The treatment of primary ovarian, fallopian tube, and peritoneal cancer is based on surgical procedures, systemic administration of chemotherapy, immunotherapy, targeted therapy and hormone therapy, as well as symptomatic-supportive measures throughout the whole treatment. Treatment approach differs in less frequent non-epithelial histological types of these tumors because they are commonly diagnosed in early stages of the disease, have a more indolent course, different disease biology and sensitivity to systemic treatment. The following text presents the updated and supplemented clinical guidelines in order to standardize procedures and criteria for diagnosis, management, treatment and monitoring of patients with ovarian, fallopian tube, and primary peritoneal cancer in Croatia. The first edition of the guidelines for diagnosis, treatment and monitoring of patients with ovarian cancer was published in 2013.