| Abstract | Karcinom kolona i rektuma često se grupira i naziva kao kolorektalni karcinom koji je treća najčešća
dijagnoza i druga najsmrtonosnija zloćudna bolest u svijetu. Kao heterogena bolest za nastanak sudjeluju
okolišni i genetski čimbenici rizika. Genske promjene uključuju različite nasljedne i stečene genske promjene.
Obično počinje nekanceroznom proliferacijom epitelnih stanica sluznice što se naziva polipom. Promjena
normalnog epitela u prekanceroznu leziju i konačno u karcinom zahtijeva akumulaciju genetskih mutacija u
razdoblju od 10 do 15. godina. Danas se takav proces objašnjava teorijom „adenom-karcinom slijed“. Stopa
incidencije i mortaliteta posljednjih je godina u stalnom padu, osim kod osoba mlađih od 50 godina. Rano
otkrivanje karcinoma predstavlja ključni korak u preživljavanju. U Hrvatskoj je od 2007. godine uveden
Nacionalni program ranog otkrivanja karcinoma u dobi od 50. do 74. godine života s ciljem što ranijeg
identificiranja polipa prije nego li pređu u karcinom. Procjena stadija proširenosti bitna je u određivanju
mogućnosti liječenja koje može biti kirurška resekcija, radio i /ili kemoterapija ovisno o smještaju, veličini i
stadiju tumora. Od kirurških zahvata za karcinome smještene u aboralnom dijelu sigmoidnog kolona i distalnom
rektumu radi se low anterior resection (LAR),zvana operacija po Dixonu koja može imati otvoreni ili minimalno
invazivni, laparoskopski pristup. Radi smanjenja kirurških komplikacija, boljih ishoda za bolesnike i radi
ekonomske koristi za cijeli zdravstveni sustav uvedeni su protokoli za ubrzani oporavak bolesnika nakon
operacije (Enhanced recovery after surgery protocols - ERAS) koji uključuju preporuke specifične za određenu
vrstu kirurgije. Multidisciplinarni tim svakom bolesniku pristupa individualno, tako i od strane medicinske sestre
koja čini glavnu sponu između zdravstvenih djelatnika i bolesnika. Njena uloga je postizanje najbolje fizičke i
psihičke priprema bolesnika za zahvat te intraoperacijska i poslijeoperacijska skrb za bolesnika. Svojom
stručnošću, pozitivnim stavom i motivacijom uključuje ga u aktivno planiranje i provedbu zdravstvene njege,
pomaže mu izgraditi povjerenje u stručnjake i samopouzdanje te ga usmjerava u procesu usvajanja poželjnih
znanja i načina ponašanja. |
| Abstract (english) | Colon and rectal cancer is often grouped and referred to as colorectal cancer, which is the third most
common diagnosis and the second deadliest malignancy in the world. As a heterogeneous disease, environmental
and genetic risk factors participate in its development. Genetic changes include a variety of inherited and
acquired genetic changes. It usually begins with a non-cancerous proliferation of epithelial cells of the mucous
membrane, which is called a polyp. The change of normal epithelium into a precancerous lesion and finally into
cancer requires the accumulation of genetic mutations over a period of 10 to 15 years. Today, such a process is
explained by the "adenoma-carcinoma sequence" theory. The rate of incidence and mortality has been in
constant decline in recent years, except for people under the age of 50. Early detection of cancer is a key step in
survival. Since 2007, the National Cancer Early Detection Program has been introduced in Croatia for people
aged 50 to 74 with the aim of identifying polyps as early as possible before they turn into cancer. Assessment of
the stage of extension is important in determining the treatment options, which can be surgical resection, radio
and/or chemotherapy depending on the location, size and stage of the tumor. Of the surgical procedures for
cancers located in the aboral part of the sigmoid colon and the distal rectum, low anterior resection (LAR) is
performed, the so-called Dixon operation, which can have an open or minimally invasive, laparoscopic
approach. Enhanced recovery after surgery protocols (ERAS), which include specific recommendations for a
certain type of surgery, were introduced to reduce surgical complications, improve patient outcomes, and provide
economic benefits for the entire healthcare system. The multidisciplinary team approaches each patient
individually, as does the nurse who is the main link between health professionals and patients. Her role is to
achieve the best physical and psychological preparation of the patient for the procedure and intraoperative and
postoperative care for the patient. With his expertise, positive attitude and motivation, he involves him in the
active planning and implementation of health care, helps him build trust in experts and self-confidence, and
guides him in the process of adopting desirable knowledge and ways of behaving. |
