SR | Rak Dojke: ESMO Vodic za Pacijente

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1 Breast Rak Cancer dojke Šta je rak dojke? Dozvolite nam da odgovorimo na neka od Vaših pitanja. Serija ESMO Patient ESMO vodiča Guide za Series pacijente na based osnovu on the ESMO ESMO Smernica Clinical za Practice kliničku Guidelines praksu esmo.org

2 Rak Breast dojke cancer Rak Breast dojke Cancer ESMO An ESMO Vodič guide za pacijente for patients Informacije Patient information za pacijente based na on osnovu ESMO ESMO Clinical Smernica Practice za Guidelines kliničku praksu Ovaj This vodič guide pripremljen has been prepared je kako bi to pomogao help you, Vama, as well kao as your i Vašim friends, prijateljima, family porodici and caregivers, i negovateljima better understand da bolje razumete breast cancer rak dojke and its i njegovo treatment. lečenje. It contains U njemu information se nalaze on informacije early and o advanced ranom i uznapredovalom breast cancer, including raku dojke, the uključujući causes of the uzroke disease bolesti and i how kako it se is postavlja diagnosed, dijagnoza, up-to-date najnovije guidance smernice on the o types vrstama of treatments terapije koje that mogu may biti be dostupne available and i svim any eventualnim possible side neželjenim effects of dejstvima treatment. terapije. Medicinske The medical informacije information opisane described u ovom in this dokumentu document zasnovane is based on su the na ESMO Smernicama Clinical Practice za kliničku Guidelines praksu for za rak breast dojke, cancer, a one which su izrađene are designed kako bi to pomogle help doctors lekarima with u the postavljanju diagnosis dijagnoze and management i lečenju of ranog early i uznapredovalog and advanced raka breast dojke. cancer. ESMO All ESMO Smernice Clinical za kliničku Practice praksu Guidelines pripremili are su prepared i pregledali and vodeći reviewed stručnjaci by leading koristeći experts dokaze using iz najnovijih evidence gained kliničkih from ispitivanja, the latest istraživanja clinical trials, i stručnih research mišljenja. and expert opinion. Informacije The information koje se included nalaze in u ovom this guide vodiču is nisu not intended zamena za as savete a replacement Vašeg lekara. for your Vaš doctor s lekar poznaje advice. Vašu Your kompletnu doctor medicinsku knows your istoriju full medical i usmeriće history Vas and u pravcu will help najbolje guide terapije you regarding za Vas. the best treatment for you. Reči Words istaknute highlighted bojom in colour objašnjene are defined su u rečniku in the na glossary kraju dokumenta. at the end of the document. Ovaj This vodič guide izradili has been su i developed pregledali: and reviewed by: Predstavnici Representatives European of the Society European for Society Medical for Oncology Medical (ESMO): Oncology (ESMO): Elżbieta Senkus-Konefka, Senkus-Konefka; Fatima Cardoso, Cardoso; Jean-Yves Douillard, Douillard; Claire Claire Bramley, Bramley; Francesca Francesca Longo Longo; i Svetlana Jezdić and Svetlana Jezdic Predstavnica Representative ESMO of the Radne ESMO grupe Patient zastupnika Advocates pacijenata Working (Europa Group (Europa Donna): Donna): Tanja Tanja Španić Spanic Predstavnice European Oncology Nursing Society (EONS): Deborah Fenlon i Anita Margulies Representative of the European Oncology Nursing Society (EONS): Deborah Fenlon and Anita Margulies Prevod na srpski jezik je realizovalo Udruženje žena sa rakom dojke BISER. Zahvaljujemo European Society for Medical Oncology (ESMO) na odobrenju prava na prevod, kao i odobrenju za štampu zvaničnog prevoda, distribuciju u Srbiji i postavljanje na website Udruženja medikalnih onkologa Srbije (UMOS). Ovaj vodič je nakon zvaničnog prevoda pregledan od strane bolesnice sa rakom dojke Slađane Filipović i onkologa dr Ane Cvetanović. 2

3 ŠTA SE NALAZI WHAT S INSIDE UNUTRA ESMO Patients Guide 22 ESMO An ESMO Vodič guide za pacijente for patients 44 Rak Breast dojke: cancer: Kratak A summary pregled važnih of key information informacija 77 Šta What je rak is breast dojke? cancer? Koliko How common se često is javlja breast rak cancer? dojke? Šta What izaziva causes rak breast dojke? cancer? Kako How se is breast postavlja cancer dijagnoza diagnosed? raka dojke? Kako How će will biti my određena treatment moja be determined? terapija? Koje What su are mogućnosti the treatment lečenja options raka for dojke? breast cancer? Koje What su are mogućnosti the treatment lečenja options neinvazivnog for non-invasive raka dojke (Stage(stadijum 0) breast 0) cancer (takođe (also called se naziva in situ in carcinoma situ karcinom or DCIS)? ili DCIS)? Koje What su are mogućnosti the treatment lečenja options ranog for early invazivnog invasive raka (Stage dojke I-IIA) (stadijum breast cancer? I-IIA)? Koje What su are mogućnosti the treatment lečenja options lokalno for locally-advanced uznapredovalog (Stage raka IIB dojke III) breast cancer? (stadijum IIB III)? 30 What are the treatment options for metastatic (Stage IV) breast cancer? 30 Koje su mogućnosti lečenja metastatskog raka dojke (stadijum IV)? 33 Special populations 33 Posebne populacije 35 Clinical trials 35 Klinička ispitivanja 36 Supplementary interventions 36 Dodatne intervencije 37 What are the possible side effects of treatment? 37 Koja su moguća neželjena dejstva terapije? 58 What happens after my treatment has finished? 57 Šta se dešava nakon završetka mojeg lečenja? 60 Support groups 60 Grupe za podršku 61 References 61 Reference 63 Glossary 63 Rečnik pojmova 3

4 Rak Breast dojke cancer Rak Breast dojke: cancer: Kratak A summary pregled of važnih key information informacija Uvod Introduction u priču to o raku breast dojke cancer Rak Breast dojke cancer potiče arises iz ćelija from cells u dojkama in the breast koje su that abnormalno have grown porasle abnormally i umnožile and multiplied i tako su to formirale a lump kvržicu or tumour. ili tumor. The earliest stage of breast cancer is non-invasive disease (Stage 0), which is contained within the ducts or Najraniji lobules stadijum of the breast raka and dojke has jeste not spread neinvazivna into the bolest healthy (stadijum breast tissue 0), ograničena (also called je in na situ kanale carcinoma). ili režnjeve Invasive breast dojke i cancer nije se has proširila spread u zdravo beyond tkivo the ducts dojki (takođe or lobules se naziva into healthy i in situ breast karcinom). tissue, Invazivni or beyond rak the breast dojke se to lymph nodes proširio or van distant kanala organs ili režnjeva (Stages I u IV). zdravo tkivo dojki, ili van dojki u limfne čvorove ili udaljene organe Breast (stadijumi cancer I IV). is the most common cause of cancer-related deaths in women and occurs most frequently in postmenopausal Rak dojke je najčešći women uzrok over smrti the age povezanih of 50. Breast sa rakom cancer kod also žena occurs i najčešće in men se but javlja is very kod rare, žena making koje su up u around 1% postmenopauzi of all breast cancer starijih cases. od 50 godina. Rak dojke se takođe javlja kod muškaraca, ali je veoma redak, i predstavlja oko 1% svih slučajeva raka dojke. Diagnosis of breast cancer Dijagnoza The most raka common dojke symptoms of breast cancer are changes in the breasts such as the presence of a lump, Najčešći changes simptomi the nipple, raka discharge dojke jesu from promene the nipple u dojkama or changes kao što in the je prisustvo skin of the kvržice, breast. promene na bradavici, curenje Initial investigations iz bradavice for ili promene breast cancer kože na begin dojkama. with a physical examination, mammography and ultrasound Početna scan. In some ispitivanja cases, kada breast je u magnetic pitanju rak resonance dojke počinju imaging sa fizikalnim (MRI) pregledom, will also be mamografijom performed. If a tumour i is ultrazvučnim found, a biopsy pregledom. will be taken U nekim to assess slučajevima the cancer radi before se i any snimanje treatment dojki is planned. magnetnom rezonancom (MR). Ukoliko se otkrije tumor, radi se biopsija kako bi se procenio tip tumora pre nego što se isplanira terapija. Treatment options for breast cancer Mogućnosti The treatment lečenja of breast raka cancer dojke depends on how far advanced the cancer is (Stage 0 IV) and what type of Lečenje cancer is raka present. dojke zavisi od toga koliko je rak uznapredovao (stadijum 0 IV) i koja vrsta raka je prisutna. Operacija, Surgery, radiotherapy, radioterapija, chemotherapy, hemoterapija, endocrine hormonska therapy terapija and i ciljana targeted terapija therapy koriste are used u lečenju in the raka dojke. treatment of breast cancer. Stadijum Breast cancer raka dojke is staged se određuje according prema to tumour veličini size, tumora, involvement zahvaćenosti of lymph limfnih nodes čvorova and whether i toga da it li has se spread proširio van outside dojke the i limfnih breast and čvorova lymph u nodes druge delove to other organizma, parts of the prema body, sistemu according TNM to (T the TNM tumor, system N nodusi (T tumour, (čvorovi), M N nodes, metastaze). M metastases). Ove informacije This koriste information se kao is pomoć used u to donošenju help decide najbolje the best odluke treatment. o lečenju. Prisustvo The presence biomarkera of biomarkers uključujući including hormonske hormone receptore receptors i receptor and a receptor pod nazivom called HER2 HER2 takođe also help pomažu to u određivanju determine what koji type će se of tip therapy terapije is davati. given. Neinvazivni Early stage rak non-invasive dojke u ranom breast stadijumu cancer Biological Biološko testiranje testing of tumora the tumour Pacijentima Patients with čija Stage je bolest 0 disease u stadijumu will usually 0 obično have the će tumour se tumor removed ukloniti by poštednom breast-conserving operacijom surgery dojke ili or mastektomijom. mastectomy. Radiotherapy Radioterapija is given se daje after nakon breast-conserving poštedne operacije surgery dojke but ali is obično not usually nije potrebna needed after nakon mastektomije. mastectomy. Most Većina patients pacijenata with oestrogen sa rakom sa receptor pozitivnim (ER) estrogenskim positive cancer receptorima will be given (ER) endocrine primaće endokrinu therapy after terapiju surgery nakon and radiotherapy. operacije i radioterapiju. Endocrine Hormonska therapy is given terapija to decrease daje the kako risk bi of se recurrence smanjio rizik od (the recidiva cancer (ponovne coming back), pojave as raka) well as kao prevention i da bi se of sprečio new cancers novi rak in i both u preostalom the remaining delu dojke and contralateral i u drugoj dojci. breast. 4

5 ESMO Vodič Patients za pacijente Guide Invazivni Early stage rak invasive dojke u ranom breast stadijumu cancer Pacijenti Patients with sa bolešću Stage I IIA stadijuma disease I will IIA usually obično be će treated biti hirurški with surgery lečeni kako to remove bi se the uklonio tumour tumor and i any svi affected zahvaćeni lymph limfni čvorovi. nodes. Breast-conserving Poštedna operacija surgery dojke uvek is always je praćena followed radioterapijom. by radiotherapy. Većina Most pacijenata patients will će then nakon receive toga primati adjuvantnu therapy terapiju with sa one jednim or a combination ili kombinacijom of systemic sistemskih treatments, lekova, depending u zavisnosti on the od vrste type of raka. cancer present. Neke Some pacijentkinje, patients, particularly posebno those one sa with većim larger tumorima, tumours, možda may receive će primati preoperative neoadjuvantnu neoadjuvant sistemsku systemic terapiju pre operacije therapy to kako shrink bi se the smanjio tumour tumor and improve i povećala the verovatnoća likelihood of uspešnog successful hirurškog surgical uklanjanja removal of tumora, the tumour, ili smanjio or to obim decrease operacije the extent (čime of se surgery takođe (which može postići can also i bolji achieve kozmetički a better rezultat). cosmetic result). Standardni The standard režimi chemotherapy hemoterapije regimens u slučaju in ranog early breast raka dojke cancer obično usually sadrže contain antracikline anthracyclines (npr. epirubicin (e.g. ili doksorubicin) epirubicin or doxorubicin) odnosno taksane and/or (npr. taxanes paklitaksel (e.g. paclitaxel ili docetaksel), or docetaxel), koji se daju given sekvencijalno. sequentially. Pacijenti Patients with sa ER ER pozitivnom positive disease bolešću will primaće receive endokrinu endocrine terapiju. therapy. Kod In premenopausal žena u predmenopauzi women to this je is najčešće usually tamoksifen tamoxifen alone sam or ili u in kombinaciji combination sa with lekovima drugs koji that potiskuju suppress stvaranje the ovarian estrogena production u jajnicima of oestrogen (a nazivaju (called se analozi gonadotropin-releasing gonadotropin-oslobađajućeg hormone analogues). hormona). Suppression Smanjenje funkcije of ovarian jajnika function takođe may se also može be sprovesti used with sa inhibitorima aromatase inhibitors. aromataze. In Kod postmenopausal žena u postmenopauzi women, aromatase koriste inhibitori inhibitors aromataze or tamoxifen ili tamoksifen, are used, either bilo pojedinačno alone or sequentially. ili sekvencijalno. Pacijenti Patients with sa HER2 HER2 pozitivnim positive rakom breast dojke cancer obično will usually primaju receive anti-her2 the anti-her2 lek trastuzumab drug trastuzumab hemoterapiju. as well Kod as nekih chemotherapy. pacijenata može In some se dodati patients, i pertuzumab. this may also Neratinib be combined je novi with anti-her2 pertuzumab. lek koji Neratinib takođe može is a new da se anti- koristi za HER2 lečenje agent HER2 that pozitivne may also bolesti. be used to treat HER2 positive disease. Lokalno uznapredovali i metastatski rak dojke (takođe se naziva i uznapredovali rak dojke) Locally-advanced and metastatic breast cancer (also called advanced breast cancer) Većina pacijenata čiji je rak dojke klasifikovan kao rak stadijuma IIB III primaće neoadjuvantnu terapiju pre Most patients whose breast cancer has been classed as Stage IIB III will receive neoadjuvant therapy operacije. U zavisnosti od vrste raka dojke, to može da bude jedno od ili kombinacija sledećeg: hemoterapija, before surgery is performed. Depending on the type of breast cancer, this can include one or a combination hormonska terapija, anti-her2 terapija i radioterapija. of chemotherapy, endocrine therapy, anti-her2 therapy and radiotherapy. Pacijentima sa rakom dojke stadijuma IV obično se neće raditi operacija, ali se može razmatrati u nekim Patients with Stage IV breast cancer will not usually be treated with surgery, but it may be discussed in some cases. slučajevima. ER positive advanced disease is usually treated with endocrine therapy using aromatase inhibitors, ER pozitivna uznapredovala bolest obično se leči endokrinom terapijom uz primenu inhibitora aromataze, tamoxifen or fulvestrant. In some cases, these drugs are combined with targeted therapies such tamoksifena ili fulvestranta. U nekim slučajevima, ti lekovi se kombinuju sa ciljanim terapijama kao što as cyclin-dependent kinase 4/6 (CDK4/6) inhibitors (palbociclib, ribociclib and abemaciclib) or su inhibitori ciklin-zavisnih kinaza 4/6 (CDK4/6) (palbociklib, ribociklib i abemaciklib) ili inhibitori mechanistic target of rapamycin (mtor) inhibitors (everolimus) to improve outcomes. mehanističkog cilja rapamicina (mtor) (everolimus) kako bi se unapredili ishodi lečenja. For ER negative tumours and for ER positive tumours that have stopped responding to endocrine Za ER negativne tumore i za ER pozitivne tumore koji su prestali da reaguju na endokrinu terapiju obično therapy, chemotherapy with capecitabine, vinorelbine or eribulin is usually used. A taxane or an se koristi hemoterapija sa kapecitabinom, vinorelbinom ili eribulinom. Taksan ili antraciklin se takođe anthracycline may also be used in some patients. mogu koristiti kod nekih pacijenata. HER2-positive advanced disease is usually treated with trastuzumab and pertuzumab in combination HER2-pozitivna uznapredovala bolest obično se leči trastuzumabom i pertuzumabom u kombinaciji sa with chemotherapy (docetaxel, paclitaxel, vinorelbine or capecitabine). Further-line treatments hemoterapijom (docetaksel, paklitaksel, vinorelbin ili kapecitabin). Dalje linije terapije obuhvataju include trastuzumab emtansine (T-DM1), trastuzumab in combination with lapatinib, lapatinib in trastuzumab emtanzin (T-DM1), trastuzumab u kombinaciji sa lapatinibom, lapatinib u kombinaciji sa combination with capecitabine or trastuzumab in combination with other chemotherapy agents. kapecitabinom ili trastuzumab u kombinaciji sa drugim hemoterapijskim lekovima. Bevacizumab can be combined with chemotherapy but provides only a small benefit with no impact on Bevacizumab se može kombinovati sa hemoterapijom ali ima veoma malu korist bez ikakvog uticaja na survival, and is therefore rarely used. Olaparib and talazoparib are new targeted therapies that may be preživljavanje i stoga se retko koristi. Olaparib i talazoparib su nove ciljane terapije koje se mogu koristiti za used to treat BRCA-associated advanced breast cancer (i.e. hereditary advanced breast cancer). lečenje uznapredovalog raka dojke povezanog sa BRCA (tj. naslednog uznapredovalog raka dojke). 5

6 Rak Breast dojke cancer Kontrola Follow-up ranog of early raka breast dojke cancer nakon terapije after treatment Lekar You will će usually Vas obično be seen pregledati by your svaka doctor 3-4 every meseca 3-4 months tokom for prve the dve first godine two years nakon after završetka finishing terapije, treatment, svakih every 6-8 meseci 6-8 months u periodu from years od do 5. and godine, once a year nakon thereafter. toga jednom godišnje. Takođe You will će also te raditi have a mamografiju mammography svake every godine, year, a and neki some pacijenti patients će biti will snimani also have magnetnom regular MRI rezonancom or ili ultrasound ultrazvukom. scans. Pacijentima Patients taking koji uzimaju endocrine endokrinu therapy terapiju will have radiće regular se redovne assessments kontrole to monitor u cilju praćenja the side neželjenih effects of the dejstava treatment. terapije. 6

7 ESMO Vodič Patients za pacijente Guide Šta What je is rak breast dojke? cancer? Rak Breast dojke cancer je rak is a koji cancer se stvara that forms u tkivima in the dojke tissues obično of the u breast kanalima usually (tubusima in the koji ducts prenose (tubes mleko that carry do bradavice) milk to the ili režnjevima nipple) or lobules (žlezdama (glands koje that stvaraju make mleko). milk). It Javlja occurs se in i both kod muškaraca men and women, i kod žena, although iako male je rak breast dojke cancer kod muškaraca is rare. redak. Zid Chest grudnog wall koša Rebro Rib Mišići Chest zida wall grudnog muscles koša Režnjevi Lobules (lobule) Areola Bradavica Nipple Kanal Duct (dukt) Fatty Masno tissue tkivo Koža Skin Anatomija Anatomy of ženske the female dojke. breast. Koje What su are različite the different vrste raka types dojke? of breast cancer? Rak Breast dojke cancer se može can be kategorisati categorised prema by whether tome da it li is je non-invasive neinvazivan ili or invazivan: invasive: Neinvazivni Non-invasive rak breast dojke cancer (in situ) (in situ) Duktalni Ductal carcinoma karcinom in situ (DCIS) predstavlja is a pre-malignant predmalignu lesion leziju it is to not još yet nije cancer, rak, ali but može can se progress razviti i to postati become invazivni an oblik invasive raka form dojke. of Kada breast je u cancer. pitanju In ta this vrsta type raka, of cancer, ćelije raka the nalaze cancer se cells u kanalima are in the ducts dojki, ali of se the još breast nisu but proširili have u not zdravo tkivo spread dojke. into the healthy breast tissue. Lobularna neoplasia neoplazma (previously (prethodno called lobularni lobular karcinom carcinoma situ) in situ) javlja is se when kada there postoje are promene changes in u ćelijama the cells oko lining režnjeva, što the ukazuje lobules, na which to da indicate postoji povećan that there rizik is an od increased pojave raka risk dojke of developing u budućnosti. breast Lobularna cancer neoplazma in the future. zapravo Lobular nije rak dojke, neoplasia pa iako is not će actually žene sa breast lobularnom cancer, neoplazimom and although redovno women biti with kontrolisane, lobular neoplasia kod većine will njih have se regular neće razviti check-ups, rak dojke. most will not develop breast cancer. Invazivni rak dojke Invazivni Invasive breast rak dojke cancer je naziv za rak koji se proširio van kanala (invazivni duktalni rak dojke) ili režnjeva (invazivni lobularni Invasive rak breast dojke). cancer Oni se is the dalje name mogu given klasifikovati to a cancer prema that histologiji; has spread recimo, outside tubularni, the ducts mukozni, (invasive medularni ductal i breast papilarni tumori cancer) dojke or lobules predstavljaju (invasive ređe lobular podtipove breast raka cancer). dojke. These can be further classified by their histology; for example, tubular, mucinous, medullary and papillary breast tumours are rarer subtypes of breast cancer. Rak dojke se kategorizuje i prema tome koliko je bolest uznapredovala: Breast cancer is also categorised by how advanced the disease is: 7

8 Rak Breast dojke cancer Rani Early rak breast dojke cancer Rak Breast dojke cancer se opisuje described kao rani as ukoliko early if se the tumor tumour nije has proširio not spread van dojke beyond ili pazušnih the breast limfnih or axillary čvorova lymph (poznat nodes i kao rak (also dojke known stadijuma as Stage 0 IIA). 0 Ovaj breast tip cancer). raka obično These može cancers operisati are usually i primarno operable se često and the leči primary operacijom treatment kako bi is se often uklonio, surgery iako to remove mnogi the pacijenti cancer, pre although operacije many takođe patients primaju also i neoadjuvantnu have preoperative sistemsku neoadjuvant terapiju. systemic therapy. Lokalno uznapredovali rak dojke Locally-advanced breast cancer Rak Breast dojke cancer se smatra is locally-advanced lokalno uznapredovalim if it has spread ukoliko from se proširio the breast iz dojke to nearby u okolno tissue tkivo or lymph ili limfne nodes čvorove (Stage (stadijum IIB IIB III). III). In Kod the vast velike majority većine of pacijenata patients, lečenje treatment lokalno for locally-advanced uznapredovalog raka breast dojke cancer počinje starts sistemskim with systemic lekovima. therapies. U Depending zavisnosti on od how toga far koliko the cancer se rak proširio, has spread, lokalno locally-advanced uznapredovali tumori tumours mogu may biti be either ili operabilni operable ili inoperabilni or inoperable (u tom slučaju (in which se case operacija surgery ipak may može still izvesti be performed ukoliko se if tumor the tumour smanji shrinks nakon after sistemskog systemic lečenja). treatment). Metastatski Metastatic breast rak dojke cancer Rak Breast dojke cancer se opisuje described kao metastatski metastatic kada when se proširio it has spread u druge to delove other organizma, parts of the kao body, što such kosti, as the jetra bones, ili pluća liver (stadijum or lungs (also IV). Tumori called Stage na udaljenim IV). Tumours mestima at nazivaju distant sites se metastaze. are called metastases. Metastatski rak Metastatic dojke nije breast izlečiv, cancer ali se is može not lečiti. curable but is treatable. Uznapredovali rak dojke Advanced breast cancer Uznapredovali Advanced breast rak cancer dojke je is termin a term koji used se to koristi describe za opisivanje both locally-advanced i lokalno uznapredovalog inoperable inoperabilnog breast cancer raka and dojke i metastatskog metastatic breast raka cancer. dojke. Podtipovi na osnovu statusa hormonskih receptora i HER2 ekspresije gena Subtypes based on hormone receptor status and HER2 gene expression Rast nekih tumora podstiču hormoni estrogen i progesteron. Važno je otkriti da li je tumor estrogen receptor The growth (ER) of some ili progesteron tumours is receptor stimulated (PgR) by the pozitivan hormones ili negativan oestrogen jer tumori and progesterone. sa visokim nivoom It is important hormonskih to find out whether receptora a tumour mogu da is oestrogen se leče lekovima receptor koji smanjuju (ER) or progesterone isporuku hormona receptor u tumor. (PgR) positive or negative, as tumours with a high level of hormone receptors can be treated with drugs that reduce the supply HER2 of je hormone takođe receptor to the tumour. koji učestvuje u rastu ćelija i prisutan je u oko 20% karcinoma dojke. Tumori HER2 is koji also imaju a receptor visok nivo that HER2 is involved mogu in se the lečiti growth anti-her2 of cells lekovima. and is present in about 20% of breast cancers. Tumori Tumours koji that nemaju have a ER, high PgR level ili visoke of HER2 nivoe can HER2 be treated opisani with su anti-her2 kao trostruko drugs. negativni tumori. Tumori Tumours se that mogu don t klasifikovati have ER, u PgR podtipove or high na levels osnovu of HER2 statusa are hormona described i HER2 as triple-negative receptora: luminalni tumours. A tip (ER i PgR pozitivni, Tumours HER2 can be negativni classified tumori), into subtypes luminalni based B tip on (ER hormonal odnosno and PgR HER2 pozitivni, receptor HER2 status pozitivni as ili follows: negativni luminal tumori), HER2 A-like sa (ER preteranom and PgR positive, ekspresijom HER2 (ER negative i PgR negativni, tumours), HER2 luminal pozitivni B-like tumori) (ER and/or i bazalni PgR tip positive, (trostruko HER2 negativni positive tumori). or negative tumours), HER2 overexpressing (ER and PgR negative, HER2 positive tumours) and basal-like Dodatne (triple-negative informacije tumours). o uticaju tih podtipova na lečenje raka dojke biće date kasnije u ovom vodiču u odeljku: Kako će Further biti određena information moja regarding terapija?. the impact of these subtypes on breast cancer treatment will be explained later in this guide in the section: How will my treatment be determined?. 8

9 ESMO Vodič Patients za pacijente Guide Koji What su are simptomi the symptoms raka dojke? of breast cancer? Simptomi Symptoms raka of breast dojke obuhvataju: cancer include: Kvržicu A lump in u dojci the breast Promenu Change in veličine the size ili or oblika shape dojke of the breast Udubljenja Dimpling of na the koži skin ili or zadebljanje thickening in tkiva the dojke breast tissue Uvlačenje An inverted bradavice nipple Osip Rash na on bradavici the nipple Curenje Discharge iz from bradavice the nipple Otok Swelling ili kvržica or a lump u pazuhu in the armpit Bol Pain ili or nelagodnost discomfort in u dojkama the breast koji that ne doesn t prolaze go away Crvenilo Skin redness kože Zadebljanje Skin thickening kože Ukoliko You should prepoznate see your bilo doctor koji if od you ovih experience simptoma, any trebalo of these bi symptoms. da odete na However, pregled it kod is important lekara. Ipak, to remember važno je imati that these na umu symptoms da te simptome may also be mogu caused da by izazovu other i conditions. druga stanja. Određeni Certain symptoms simptomi may mogu indicate da ukažu the na presence prisustvo of metastaza metastases na for primer, example, kvržica a lump ili otok or swelling u pazuhu, under oko grudne the armpit, kosti in ili the ključne breast kosti bone može or collar da bude bone simptom area may metastaza be a symptom u limfnim of lymph čvorovima. node metastases. Bol u kostima Pain ili kosti koje su sklone prelomima mogu da ukažu na in a bone or a bone prone to fracture might suggest metastaze u kostima, a metastaze na plućima mogu bone metastases, and lung metastases may cause da izazovu simptome infekcija u grudima, uporni kašalj symptoms of ongoing chest infections, persistent cough i gubitak daha. Važno je da ne budete uznemireni zbog and breathlessness. It s important not to be alarmed by ovih simptoma jer oni ne moraju da znače da imate metastaze; these symptoms ipak, as o they svim don t nedoumicama necessarily treba mean da that porazgovarate you have metastases; sa lekarom. however, you should discuss any concerns with your doctor. Sve Any promene changes u to dojkama your breasts treba should da be prijavite reported svom to your lekaru doctor jer as one they mogu may be da a symptom budu simptom of breast raka cancer dojke 9

10 Rak Breast dojke cancer Koliko How common se često is javlja breast rak cancer? dojke? Rak Breast dojke cancer je najčešći is most kod common žena starijih in women od 50 over godina, 50, ali but se may može also javiti occur i kod in young mlađih women žena. Rak Breast dojke cancer je vodeći is a leading uzrok smrti cause povezanih of cancer-related sa rakom deaths kod žena, in women, sa skoro with 1,7 almost miliona 1.7 novih million slučajeva cases svake diagnosed godine per i više year od and pola more miliona than half smrti a svake million godine deaths (Ferlay every et year al. 2013). (Ferlay U et razvijenim al. 2013). In zemljama developed rak countries, dojke se javlja 1 in every kod 1 8 od women 8 žena. U will Evropi develop dijagnoza breast raka cancer dojke in their se postavlja lifetime. svaka In Europe, 2 minuta, there a is do a smrti breast usled cancer raka diagnosis dojke dolazi every svakih 2 minutes 6 minuta. and Rak dojke najviše pogađa starije žene, a većina pacijenata je starija od 50 godina kada im se postavi dijagnoza, iako se a death due to breast cancer every 6 minutes. Breast cancer mostly affects older women, with the majority of oko 1 od 5 slučajeva raka dojke dijagnostikuje pre 50. godine. Rak dojke kod muškaraca je redak i predstavlja oko patients being over the age of 50 when diagnosed, although around 1 in 5 breast cancers are diagnosed before 1% svih slučajeva raka dojke. the age of 50. Breast cancer in men is rare and makes up around 1% of breast cancer cases. Stope incidence raka dojke kod žena variraju od regiona do regiona i najviše su u Zapadnoj Evropi i Sjedinjenim Female breast cancer incidence rates vary widely between regions, with the highest incidence rates in Western Američkim Državama, a najniže u Africi i Aziji. Visoka incidenca raka dojke u razvijenijim zemljama odražava prisustvo Europe and the United States, and the lowest in Africa and Asia. Higher breast cancer incidence in more većeg broja faktora rizika za rak dojke u tim zemljama (Torre et al. 2016). developed countries reflects the presence of more breast cancer risk factors in these countries (Torre et al. 2016). Ipak, incidenca raka dojke u zemljama u razvoju sve brže raste. Uprkos visokim stopama incidence, broj smrti usled However, the incidence of breast cancer in developing countries is rapidly increasing. Despite higher incidence raka dojke u većini zapadnih zemalja se smanjuje poslednjih godina zbog poboljšanog lečenja i ranijeg otkrivanja, ali se rates, znatno deaths povećava due to breast u zemljama cancer u in razvoju. most Western U razvijenim countries zemljama have oko decreased 10 15% in recent pacijenata years ima due uznapredovalu to improved bolest u treatment trenutku and postavljanja earlier detection, dijagnoze, but u have poređenju substantially sa 40 90% increased u zemljama in developing u razvoju countries. (Balogun In and developed Formenti 2015). countries, around 10 15% of patients have advanced disease at diagnosis, compared with 40 90% in developing countries (Balogun and Formenti 2015). Broj Deaths smrtnih due to slučajeva breast cancer kao posledica have decreased raka dojke u zapadnim in Western zemljama countries smanjuje due to earlier se usled detection poboljšanog lečenja and improved i ranijeg treatment otkrivanja. 10

11 ESMO Vodič Patients za pacijente Guide Na The mapi su shows prikazani estimated procenjeni numbers brojevi of new novih cases slučajeva of breast raka cancer dojke diagnosed dijagnostikovani in (the godine most (najnoviji recent statistics dostupni available) statistički per podaci) 100,000 na people of ljudi each u region s populaciji population svakog regiona (Ferlay (Ferlay et al. 2013). et al. 2013). NORTHERN SEVERNA AMERIKA AMERICA 91.6 CENTRALNA AND I ISTOČNA WESTERN ZAPADNA EUROPE EVROPA EVROPA EASTERN EUROPE EASTERN ISTOČNA AZIJA ASIA 27.0 CENTRALNA AMERICA AMERIKA 32.8 JUŽNA SOUTHERN EVROPA EUROPE 74.5 SEVERNA NORTHERN EVROPA EUROPE 89.4 MELANESIA MELANEZIJA SOUTH JUGOISTOČNA EASTERN AZIJA ASIA CARRIBEAN KARIBI 46.1 SOUTH JUŽNA AMERICA AMERIKA 52.1 WESTERN ZAPADNA AFRICA AFRIKA 38.6 MIDDLE SREDNJA AFRICA AFRIKA 26.8 SOUTHERN JUŽNA AFRIKA AFRICA 38.9 WESTERN ZAPADNA AZIJA ASIA 42.8 EASTERN ISTOČNA AFRICA AFRIKA 30.4 SEVERNA NORTHERN AFRIKA AFRICA 43.2 SOUTH JUŽNA CENTRALNA AZIJA ASIA 28.2 AUSTRALIA/ AUSTRALIJA/ NEW NOVI ZEALAND ZELAND 85.8 MICRONESIA/ MIKRONEZIJA/ POLYNESIA POLINEZIJA

12 Rak Breast dojke cancer Šta What izaziva causes rak breast dojke? cancer? Nije The poznat precise tačan cause uzrok of breast raka cancer dojke, ali is unknown, je otkriveno but nekoliko several faktora risk factors rizika for za pojavu developing bolesti. the Važno disease je zapamtiti have been da postojanje identified. faktora It is important rizika povećava to remember rizik od that pojave having raka, a risk ali factor ne znači increases da ćete the sigurno risk of dobiti cancer rak. developing Isto tako, odsustvo but it does faktora not mean rizika that ne you znači will da definitely sigurno get nećete cancer. dobiti Likewise, rak. not having a risk factor does not mean that you definitely won t get cancer. Najvažniji Most important faktori risk rizika factors Female Ženski pol gender Exposure Izloženost to ionising jonizujućem radiation zračenju Increasing Starije osobe age Having Žene fewer sa children manjim brojem dece Genetic predisposition (family history History Istorija of atypical atipične Genetska predispozicija (porodična istorija hyperplasia hiperplazije Gojaznost or ili mutacije mutations u in određenim certain genes) genima) Obesity Alkohol Exposure Izloženost to estrogenima oestrogens Alcohol Postoje There are različiti various faktori risk factors rizika povezani associated sa pojavom with developing raka dojke, breast iako cancer se većina although faktora most ne of odnosi the factors na svaku will ženu not apply kod koje to every se javi bolest. woman who develops the disease. A woman s family history of breast cancer Istorija raka dojke u porodici žene važan je faktor is an important factor that determines her risk koji određuje njen rizik za pojavu bolesti of developing the disease Porodična Family history istorija plays igra a važnu very important ulogu u tome role da in whether li će se kod or not neke a woman žene pojaviti will develop rak dojke breast ili ne. cancer. Žene Women koje u porodici, with a first-degree u prvom kolenu relative (roditelj, (parent, sestra/brat sibling or ili child) dete) imaju with breast srodnika cancer sa rakom have twice dojke, the imaju risk dva of developing puta veći rizik breast od cancer pojave compared raka dojke with od žena a woman koje nemaju with no takvu such porodičnu family history. istoriju. The Rizik risk se is increased povećava 3 3-fold puta if ukoliko that je dijagnoza raka dojke tom srodniku postavljena relative was diagnosed with breast cancer before pre menopauze (Collaborative Group on Hormonal the menopause (Collaborative Group on Hormonal Factors in Breast Cancer 2001). Factors in Breast Cancer 2001). 12

13 ESMO Vodič Patients za pacijente Guide Mutacija BRCA mutation BRCA Oko Around 5% 5% slučajeva of breast raka cancers dojke i and do 25% up to slučajeva 25% of familial raka dojke breast u porodici cancer izaziva cases are mutacija caused BRCA1 by a BRCA1 ili BRCA2 or BRCA2 (Skol et mutation al. 2016). Žena (Skol et koja al. 2016). je nosilac A woman mutacije carrying BRCA1 a BRCA1 ima doživotni mutation rizik has od a 65 95% za lifetime pojavu risk raka of dojke, breast a cancer, smatra se and da more se više than od 90% of slučajeva hereditary naslednog breast and raka ovarian dojke cancers i jajnika javlja are thought usled mutacije to be due u to BRCA1 a mutation ili BRCA2 in BRCA1 (Paluch- or Shimon BRCA2 et (Paluch-Shimon al. 2016). et al. 2016). Lekar A doctor će uputiti will refer ženu a woman na testiranje for BRCA1 za mutaciju and BRCA2 BRCA1 i mutation BRCA2 na testing osnovu based njene on porodične her family istorije history i etničkog and porekla. ethnic background. Ukoliko se otkrije If she da is found ona nosi to be mutaciju carrying a u mutation jednom ili in oba one BRCA or both gena, of these biće genes, joj ponuđeno she will savetovanje be offered counselling tokom koga during će joj biti which predočene her options mogućnosti for za reducing smanjenje the risk rizika of od developing pojave raka breast dojke, cancer, kao što such as su preventivna dvostruka mastektomija odnosno a preventative double mastectomy and/or salpingooophorectomy (removal of the ovaries and fallopian salpingo-ooforektomija (uklanjanje jajnika i jajovoda) (Paluch-Shimon et al. 2016). tubes), will be discussed (Paluch-Shimon et al. 2016). Žene Women koje who imaju test pozitivan positive test for BRCA1/2 mutacije mutation BRCA1/2 biće will be pažljivo monitored praćene carefully i biće im and ponuđene offered riskreduction measures mere za smanjenje rizika Ženama Women who za koje are se found otkrije to be da carrying su nosioci a mutacije BRCA mutation BRCA i and koje do se not ne opt odluče for risk-reducing za operaciju kojom surgery se should smanjuje rizik treba be offered ponuditi a clinical kliničke examination preglede svakih every meseci months od from 25. the godine age of (ukoliko 25 (or je 10 dijagnoza years before raka the dojke youngest u porodici bila pre 25.godine breast cancer onda diagnosis kontrole počinju the family, 10 godina if earlier), pre najmlađe magnetic dijagnoze resonance raka imaging dojke u porodici), (MRI) every snimanje 12 months magnetnom and rezonancom mammography (MR) every svakih months meseci from i mamografiju the age of 30 (Paluch-Shimon svakih 12 meseci et al. 2016). od 30. godine (Paluch-Shimon et al. 2016). 13

14 Rak Breast dojke cancer Kako How is se breast postavlja cancer dijagnoza diagnosed? raka dojke? Dijagnoza Breast cancer raka is dojke usually obično diagnosed postavlja by clinical kliničkim examination, pregledom, imaging snimanjem and biopsy. i biopsijom. Klinički Clinical pregled examination Vaš Your lekar doctor će will pregledati examine Vaše your dojke breasts i limfne and lymph čvorove. On nodes. će Vam He/she takođe will postaviti also ask pitanja you about o tome any da family li je u Vašoj history porodici of breast bilo cancer slučajeva and raka whether dojke you i da have li ste reached ušli u menopause menopauzu or ili not. ne. He/she Možda će may uzeti also i uzorak take a blood krvi za rutinske sample for analize routine krvi. blood Ukoliko tests. postoji If there sumnja is a suspicion da imate tumor dojke, lekar će Vam možda zakazati snimanje. that you may have a breast tumour, he/she may arrange for you to have an imaging scan. Snimanje Tehnike Imaging snimanja koje se primenjuju kod žena kod kojih postoji Imaging sumnja techniques na rak used dojke for obuhvataju women in mamografiju, whom breast ultrazvuk cancer is suspected odnosno magnetnu include mammography, rezonancu (MR) ultrasound : and/or MRI scan: Mamografija: Mammography: Mamografija Mammography predstavlja is a type vrstu rendgena of low-dose sa x-ray malim that dozama looks zračenja for early breast pomoću koga se cancers. traži rani Your rak breasts dojke. will Svaka each od be Vaših placed dojki on biće the stavljena x-ray machine na rendgen and pressed aparat between i pritisnuta two između plates dve to produce ploče kako a clear bi se image. dobio If jasan the mammography snimak. Ukoliko mamografski screening shows skrining anything pokaže suspicious nešto sumnjivo in your u tkivu breast Vaše tissue, dojke, your Vaš doctor lekar will će to investigate dalje ispitati. further. Ultrazvuk: Ultrasound Ultrazvuk scan: Ultrasound koristi zvučne uses talase highfrequency sound kako bi waves stvorio to sliku create unutrašnjosti an image of the visoke frekvencije Vašeg inside organizma. of your body. U ispitivanjima In investigations koja for se vrše breast kako bi cancer, se otkrio a hand-held rak dojke, ultrasound ručni ultrazvučni device lets uređaj the omogućava lekaru da pregleda Vaše grudi i limfne doctor examine your breasts and the lymph čvorove u Vašem pazuhu. Ultrazvuk može da nodes in your armpit. The ultrasound can show pokaže da li je kvržica čvrsta, ili se radi o cisti whether a lump is solid or is a fluid-filled cyst. ispunjenoj tečnošću. MRI scan: MRI uses magnetic fields and radio Magnetna rezonanca: Magnetna rezonanca waves to produce detailed images of the inside koristi magnetna polja i radio-talase za pravljenje of your body. An MRI scanner is usually a large slika unutrašnjosti organizma. MR skener obično je velika tube that cev contains u kojoj se powerful nalaze jaki magnets. magneti. You Vi lie ležite u toj inside cevi the tokom tube snimanja during the koje scan, traje which takes minuta. Iako ovakvi minutes. pregledi Although ne predstavljaju these are not deo used rutinskih as ispitivanja, part of routine pregled investigations, magnetnom an rezonancom MRI scan might može be used in koristiti certain u circumstances, određenim okolnostima, for example recimo in kod patients pacijenata with a sa family porodičnom history of istorijom breast cancer, raka dojke, BRCA mutacijama mutations, BRCA, breast implantima implants, lobular u grudima, cancers, lobularnim if there rakom, is a suspicion ukoliko of postoji multiple sumnja tumours, na višestruke or if the results tumore of ili other ukoliko imaging rezultati techniques drugih tehnika are inconclusive snimanja ne (Cardoso dovode et do al. zaključka 2018 [in press]). (Cardoso MRI et is al. also 2018 used [u štampi]). to see Magnetna if a tumour rezonanca has responded se može to treatment, koristiti kako and bi to se plan videlo further da li therapy. je tumor reagovao na terapiju, kao i za planiranje daljeg lečenja. 14

15 ESMO Vodič Patients za pacijente Guide Biopsija Biopsy Biopsija A tumour tumora biopsy daje gives lekaru the doctor informacije information o vrsti raka about dojke the type koja of je breast prisutna cancer i pomaže present u planiranju and lečenja helps to plan treatment Kada When se breast javi sumnja cancer na is suspected, rak dojke, uzima a biopsy se biopsija is taken iz from tumora the tumour pre nego before što se any isplanira treatment lečenje is planned (Cardoso (Cardoso et al [u et štampi]). al [in Biopsija press]). The se uzima biopsy pomoću is taken igle, with obično a needle, vođene usually ultrazvukom guided by (a ultrasound nekada se (or koristi sometimes i mamografija using ili MR, mammography ukoliko tumor or nije MRI, vidljiv if the na tumour ultrazvuku) is not kako visible bismo on ultrasound) bili sigurni da to je make biopsija sure the uzeta biopsy iz odgovarajuće is taken from oblasti u dojci. the correct Biopsija area daje in the lekarima breast. važne The biopsy informacije gives o the vrsti doctors raka dojke. important information on the type of breast cancer. Istovremeno At the same time sa biopsijom, as the biopsy, u tumor a marker se može may postaviti be placed marker into the kako tumour bi se pomoglo to help surgeons hirurzima remove da kasnije the odstrane whole ceo tumour tumor. at a later date. 15

16 Rak Breast dojke cancer Kako How will će biti my određena treatment moja be determined? terapija? Kada Once Vam diagnosed postavi with dijagnoza breast cancer, za Vas će you se will pobrinuti be looked tim after stručnjaka by a team za rak of dojke breast cancer specialists Vaše Your lečenje treatment zavisiće will depend od toga on koliko a number je uznapredovao of factors, Vaš rak, including vrstu raka how (pogledajte far advanced odeljak your cancer u nastavku) is, the i procenu type rizika. of cancer (see section below) and risk assessment. Lečenje Treatment se is najbolje best done vrši in u specijalističkom a specialist centre centru that u kome se cares zbrinjava for a high veliki number broj pacijenata of breast sa cancer rakom patients. dojke. Tim koji Vas leči obično se sastoji od hirurga, radiologa, The team treating you will typically include a surgeon, medikalnogonkologa, radioterapeita i patologa. Trebalo radiation oncologist, medical oncologist, radiologist bi da Vam bude na raspolaganju i medicinska sestra and pathologist. A nurse specialist should also be specijalizovana za tu oblast koja će Vas voditi kroz available to guide you through each stage of diagnosis svaki stadijum dijagnoze i lečenja. and treatment. Određivanje Staging stadijuma It is important for your doctor to know the stage Važno je da Vaš lekar zna stadijum bolesti kako bi of the cancer so that he/she can determine the mogao da odredi najbolji terapijski pristup best treatment approach 16 Određivanje stadijuma raka koristi se da opiše njegovu veličinu i položaj, kao i da li se proširio sa mesta na kome se Staging pojavio. of cancer is used to describe its size and position and whether it has spread from where it started. Kliničko Clinical određivanje staging involves stadijuma a physical obuhvata examination, i fizikalni pregled, blood tests analize and krvi imaging. i snimanja. In addition Osim to početne your initial mamografije, mogu mammography, biti potrebna further i dodatna scans snimanja, may also uključujući be required, i kompjuterizovanu including a computed tomografiju tomography (CT) Vašeg (CT) scan grudnog of your koša, chest, ultrazvuk, an ultrasound, CT ili CT MR or snimak MRI scan Vašeg of stomaka your abdomen i snimak and kostiju. a bone Za scan. pregled Alternatively, kompletnog a positron organizma emission može biti iskorišćena tomography i pozitronska (PET) scan may emisiona be used tomografija assess the (PET). whole body. Kompjuterizovana CT scan: This is a type tomografija: of x-ray technique To je vrsta that rendgen lets doctors tehnike see koja your omogućava internal organs lekaru in da cross-section. vidi unutrašnje organe MRI scan: u preseku. MRI uses magnetic fields and radio waves to produce detailed images of the inside of your body. Magnetna Bone scan: This rezonanca: test involves Magnetna a small rezonanca amount of radioactive koristi magnetna substance polja injected i radio-talase into a za vein pravljenje and allows slika unutrašnjosti doctors to see organizma. abnormal areas of bone across your whole body, as abnormal bone absorbs more Snimak radioactivity kostiju: than Ovaj healthy test se bone. izvodi tako što se mala količina radioaktivne materije ubrizga u venu i tako lekari mogu PET scan: da vide PET postojeće uses a radioactive promene u substance svim kostima injected tela, jer into kost a vein koja and ima can promene help identify upija više areas radioaktivnosti of cancer that od zdrave an MRI kosti. or CT scan may miss. Most PET scans are now performed along with a CT scan. Pozitronska emisiona tomografija: PET koristi radioaktivnu materiju koja se ubrizgava u venu i pomaže u otkrivanju delova raka koje MR ili CT snimci mogu da propuste. Većina PET snimanja se sada vrši zajedno sa CT snimanjem.

17 ESMO Vodič Patients za pacijente Guide Hirurško određivanje stadijuma bolesti zasniva se na analizi tkiva uklonjenog tokom operacije. Surgical staging is based on examination of the tissue removed during surgery. Određivanje stadijuma raka u cilju određivanja veličine i proširenosti tumora opisuje se primenom niza slova i Cancer staging to determine the size and spread of the tumour is described using a sequence of letters and brojeva. Za rak dojke postoji pet stadijuma obeleženih rimskim brojevima od 0 do IV. Uopšteno govoreći, što je niži numbers. For breast cancer, there are five stages designated with Roman numerals 0 to IV. Generally, the lower stadijum, to je bolja prognoza. TNM klasifikacija određivanja stadijuma uzima u obzir sledeće: the stage, the better the prognosis. The TNM staging system considers: Koliki je rak, ili veličinu tumora (T) How big the cancer is, or tumour size (T) Da Whether li se rak the proširio cancer u has limfne spread čvorove to lymph (noduse) nodes (N) (N) Da Whether li se proširio it has spread na udaljena to distant mesta, sites, ili metastaze or metastases (M) (M) Biopsija Lymph node limfnih biopsy čvorova Biopsija Lymph node limfnih biopsy čvorova is an predstavlja important part važan of deo breast određivanja cancer staging. stadijuma Fine raka needle dojke. aspiration Uzorkovanje of suspicious sumnjivih lymph limfnih čvorova nodes is tankom performed iglom to vrši confirm se kako or exclude bi se potvrdilo the presence ili isključilo of metastases prisustvo metastaza in the lymph u limfnim nodes before čvorovima start pre početka of therapy. terapije. To evaluate Kako bi lymph se procenila node involvement, zahvaćenost limfnog a process čvora called obično sentinel se lymph vrši proces node nazvan biopsy biopsija is usually limfnog čvora performed sentinela (Cardoso (Cardoso et al et al. [in 2018 press]), [u štampi]), in which tokom the sentinel koga se lymph limfni node čvor (the sentinel first lymph (prvi limfni node čvor to which na koji cancer će se ćelije cells are raka most iz tumora likely to najverovatnije spread from proširiti) a tumour) određuje, is identified, uklanja removed i proverava and checked na prisustvo for the ćelija presence raka. of cancer cells. Sistem The stage grupisanja grouping stadijuma system for za breast rak dojke cancer opisan described je u tabeli in u nastavku the table (Cardoso below (Cardoso et al et al. [u 2018 štampi]). [in press]). Tabela This Vam may može izgledati seem complicated komplikovano, but your ali Vaš doctor lekar will će moći be able da to Vam explain objasni which koji part njen of deo this se table odnosi corresponds na Vaš tip karcinoma. to your cancer. 17

18 Rak Breast dojke cancer Stage Stadijum 0. Non-invasive 0. Neinvazivni tumour tumor ograničen confined to na the dojku breast (TisN0M0) (TisN0M0) Stage Stadijum I. Tumour I. Tumor is je small mali i and ograničen confined na to tkivo breast dojke tissue ili postoje or with dokazi evidence o raku of cancer u limfnim in lymph čvorovima nodes u dojci close to the breast IA The Tumor tumour nije is veći no od bigger 20 mm than u prečniku 20 mm in i ograničen diameter and je na is dojku confined (T1N0M0) to the breast (T1N0M0) IB IB Nema dokaza o primarnom tumoru (T0) ili tumor nije veći od 20 mm u prečniku (T1), ali mikrometastaze There is no evidence of a primary tumour (T0) or the tumour is no bigger than 20 mm in diameter (T1), (ne veće od 2 mm) su prisutne na ipsilateralnom nivou I/II pazušni limfni čvorovi; limfni čvorovi su but micrometastases (no bigger than 2 mm) are present in the ipsilateral level I/II axillary lymph pokretni (N1mi); nisu prisutne udaljene metastaze (M0) node(s); lymph nodes are movable (N1mi); no distant metastases are present (M0) Stage Stadijum II. Tumour II. Tumor is se in nalazi the breast u dojci or ili in u the obližnjim nearby limfnim lymph nodes, čvorovima both ili oba IIA IIA IIB IIB Nema dokaza o primarnom tumoru (T0) ili tumor nije veći od 20 mm u prečniku (T1); metastaze su prisutne There is no evidence of a primary tumour (T0) or the tumour is no bigger than 20 mm in diameter (T1); na ipsilateralnom nivou I/II pazušni limfni čvorovi i limfni čvorovi su pokretni (N1); nisu prisutne metastases are present in the ipsilateral level I/II axillary lymph node(s) and lymph nodes are udaljene metastaze (M0) movable (N1); no distant metastases are present (M0) Tumor je veći od 20 mm ali nije veći od 50 mm u prečniku (T2) i ograničen je na dojku (N0); nisu prisutne The tumour is larger than 20 mm but no bigger than 50 mm in diameter (T2) and is confined to the udaljene metastaze (M0) breast (N0); no distant metastases are present (M0) Tumor je veći od 20 mm ali nije veći od 50 mm u prečniku (T2); metastaze su prisutne na ipsilateralnom The tumour is larger than 20 mm but no bigger than 50 mm in diameter (T2); metastases are present nivou I/II pazušni limfni čvorovi i limfni čvorovi su pokretni (N1); nisu prisutne udaljene metastaze (M0) in the ipsilateral level I/II axillary lymph node(s) and lymph nodes are movable (N1); no distant metastases Tumor je veći are od present 50 mm (M0) u prečniku (T3) i ograničen je na dojku (N0); nisu prisutne udaljene metastaze (M0) The tumour is larger than 50 mm in diameter (T3) and is confined to the breast (N0); no distant metastases are present (M0) Stage Stadijum III. III. Tumour Tumor has se spread proširio from iz dojke the na breast limfne to lymph čvorove nodes u blizini close dojke, to the na breast, kožu dojki to the ili na skin grudni of the koš breast or to the chest wall IIIA IIIA Nema dokaza o primarnom tumoru (T0), tumor nije veći od 20 mm u prečniku (T1), tumor je veći od 20 There is no evidence of a primary tumour (T0), the tumour is no bigger than 20 mm in diameter (T1), mm ali nije veći od 50 mm u prečniku (T2), tumor je veći od 50 mm u prečniku (T3); metastaze su prisutne the tumour is larger than 20 mm but no bigger than 50 mm in diameter (T2), the tumour is larger than na ipsilateralnom nivou I/II pazušni limfni čvorovi i limfni čvorovi su fiksirani ili zadebljani (N2); nisu 50 mm in diameter (T3); metastases are present in the ipsilateral level I/II axillary lymph node(s) prisutne udaljene metastaze (M0) and lymph nodes are fixed or matted (N2); no distant metastases are present (M0) Tumor je veći od 50 mm u prečniku (T3); metastaze su prisutne na ipsilateralnom nivou I/II pazušni The tumour is larger than 50 mm in diameter (T3); metastases are present in the ipsilateral level I/II limfni čvorovi i limfni čvorovi su pokretni (N1); nisu prisutne udaljene metastaze (M0) axillary lymph node(s) and lymph nodes are movable (N1); no distant metastases are present (M0) IIIB IIIB IIIC IIIC Tumor (bilo koje veličine ) proširio se na zid grudnog koša odnosno kožu (T4); limfni čvorovi nisu zahvaćeni The tumour (of any size) has extended to the chest wall and/or skin (T4); lymph nodes are not involved (N0) ili metastaze su prisutne na ipsilateralnom nivou I/II pazušni limfni čvorovi i limfni čvorovi su (N0) or metastases are present in the ipsilateral level I/II axillary lymph node(s) and lymph nodes pokretni (N1) ili su limfni čvorovi fiksirani ili zadebljali (N2); nisu prisutne udaljene metastaze (M0) are movable (N1) or lymph nodes are fixed or matted (N2); no distant metastases are present (M0) Tumor bilo kog stadijuma (bilo koji T); metastaze su prisutne na ipsilateralnom nivou III pazušni limfni Tumour of any stage (any T); metastases are present in the ipsilateral level III axillary lymph čvorovi u ipsilateralnim internim limfnim čvorovima) mlečnih žlezdi sa klinički evidentnim nivoom I/ node(s), in ipsilateral internal mammary lymph node(s) with clinically evident level I/II axillary II metastaze u pazušnim limfnim čvorovima, ili u ipsilateralnim suprakavikularnim limfnim lymph node metastases, or in ipsilateral supraclavicular lymph node(s) (N2 or N3); no distant čvorovima (N2 ili N3); nisu prisutne udaljene metastaze (M0) metastases are present (M0) Stage Stadijum IV. The IV. Tumor tumour se has proširio spread u druge to other delove areas organizma of the body (bilo (any koji T any bilo N koji M1) N M1) 18

19 ESMO Vodič Patients za pacijente Guide Drugi Other faktori factors Za The lečenje treatment raka of dojke breast se cancer uzima u takes obzir a niz number činjenica. of factors Neke into od tih account. činjenica Some mogu of these odrediti factors biopsijom, can be determined ali druge se mogu from a odrediti biopsy, tek but nakon others operacije may only kojom be determined se uklanja after tumor. surgery has taken place to remove the tumour. Histologija Histology Histologija The histology raka of dojke a breast ukazuje cancer na tells to u kojim us which tkivima tissues dojki of se the formirao breast the rak cancer (duktalni has ili lobularni formed in karcinomi) (ductal or i lobular da li je invazivan carcinomas) ili and neinvazivan. whether it Histologija invasive takođe or non-invasive. može otkriti neke Histology ređe podtipove can also reveal raka dojke, some uključujući of the rarer i subtypes sledeće: of breast Tubularni cancer, rak including dojke obično the following: je mali i sastoji se od struktura oblika cevčica koje se nazivaju tubuli. Ti tumori obično Tubular su breast niskog cancers gradusa, are usually što znači small da njihove and are ćelije made izgledaju up of tube-shaped slično normalnim, structures zdravim called ćelijama tubules. i obično These sporo tumours rastu. are usually low-grade, meaning that their cells look similar to normal, healthy cells and tend to Mukozni grow slowly. tumori dojke sastoje se od abnormalnih ćelija koje plutaju po mucinu (koji je glavni sastojak mukusa, tj. Mucinous sluzi). Ovi breast tumori tumours obično are dobro made reaguju up of na abnormal terapiju. cells that float in pools of mucin (the main ingredient of Medularni mucus). These tumori tumours dojke jesu usually mekane, respond mesnate well to mase treatment. koje obično sporo rastu i ne šire se van dojki. Papilarni Medullary tumori breast dojke tumours sastoje are se soft, od fleshy malih izbočina masses which nalik prstima tend to na grow rukama. slowly Ovi and tumori don t usually obično spread su umerenog gradusa, outside the što breast. znači da njihove ćelije ne izgledaju kao normalne ćelije i rastu i dele se malo brže nego uobičajeno. Papillary breast tumours are made up of small, finger-like projections. These tumours are usually moderate-grade, meaning that their cells don t look like normal cells and are growing and dividing a little Gradus faster than normal. Gradus se zasniva na tome koliko se izgled ćelija tumora razlikuje od izgleda normalnih ćelija dojki, i tome koliko brzo Grade rastu. Gradus Grade is će based biti vrednost on how između different jedan tumour i tri i cells odražava look from agresivnost normal ćelija breast tumora; cells, and što on je how veći quickly gradus, they to je grow. agresivniji tumor. The grade will be a value between one and three and reflects the aggressiveness of tumour cells; the higher the grade, the more aggressive the tumour. Status hormonskih receptora i HER2 ekspresije gena Estrogen Hormone i receptor progesteron status su polni and HER2 hormoni gene koji prirodno expression postoje kod žena. Neki tumori dojke zavise od isporuke estrogena odnosno progesterona kako bi rasli; ti tipovi tumora imaju visok broj receptora (ER ili PgR) za koje se Oestrogen and progesterone are sex hormones that are naturally present in women. Some breast tumours hormoni vezuju kako bi stimulisali rast tumora. Tumori sa ekspresijom ER nazivaju se ER pozitivni tumori i mogu depend on a supply of oestrogen and/or progesterone to grow; these types of tumour have a high number of se lečiti smanjenjem isporuke estrogena u tumor, obično tako što se blokira estrogenski receptor ili ograniči receptors (ER or PgR) that the hormones attach to in order to stimulate growth of the tumour. Tumours with nivo estrogena u krvi. expression of ER are called ER positive tumours and can be treated by reducing the supply of oestrogen to HER2 the tumour, receptori typically se nalaze by blocking na površini the svih ER or ćelija limiting i učestvuju the levels u normalni of oestrogen procesima in the rasta, blood. umnožavanja i popravke ćelija. U oko 20% slučajeva raka dojke javljaju se abnormalno visoki nivoi HER2 na površini ćelija tumora i stoga HER2 receptors are expressed on the surface of all cells and are involved in the normal processes of cell growth, se nazivaju HER2 pozitivni tumori. Ti tumori obično rastu brže i veća je verovatnoća da će se proširiti nego HER2 negativni multiplication rak dojke. and repair. HER2 About pozitivni 20% rak of dojke breast može cancers se lečiti have lekovima abnormally koji blokiraju high levels HER2 of HER2 receptore on the kako surface bi zaustavili of nekontrolisani the tumour cells rast and tumora. are therefore called HER2 positive tumours. These tumours tend to grow faster and are more likely to spread compared with HER2 negative breast cancers. HER2 positive breast cancer can be treated with drugs that block HER2 receptors to stop the uncontrolled growth of the tumour. 19

20 Rak Breast dojke cancer Status Hormone hormonskih receptor and receptora HER2 status i HER2 of jednog a tumour tumora are major glavni factors su faktori in determining pri određivanju which koja treatment terapija will work će best najbolje delovati Status Hormone hormonskih receptor status receptora and i HER2 ekspresija expression HER2 procenjuju are assessed se using pomoću a technique tehnike koja called se naziva imunohistohemiija, immunohistochemistry, u kojoj in se which tkivo breast raka dojke cancer boji hemijskim tissue is stained sredstvima with chemicals koja će pokazati that will da show li ćelije if raka imaju cancer hormonske cells have receptore hormone receptors ili HER2 receptore. HER2 Druga tehnika receptors. pod Another nazivom technique, in situ hibridizacija called in situ takođe se može hybridisation koristiti za can lokalizaciju also be used određenih to localise gena, specific te doktori mogu genes, da allowing vide da li doctors ćelije raka to see dojke if breast imaju cancer veći broj cells kopija HER2 gena. Ekspresija hormonskih receptora i HER2 have extra copies of the HER2 gene. Expression može biti različita u različitim delovima tumora, stoga se of hormone receptors and HER2 can vary between uzorci biopsije sa negativnim hormonskim receptorima i different parts of a tumour, therefore hormone negativnim HER2 obično ponovo testiraju na tumorskom tkivu uklonjenom prilikom operacije (Cardoso et al receptor negative and HER2 negative biopsy specimens are usually retested on the tumour tissue removed by [u štampi]). surgery (Cardoso et al [in press]). Proliferacioni Proliferation markers markeri Other biomarkers may also be evaluated in the I drugi biomarkeri se takođe mogu procenjivati na tumour biopsy/surgery specimen. For example, uzorku iz biopsije tumora/sa operacije. Na primer, Ki- 67 Ki-67 je protein is a protein koji se found nalazi in u cells ćelijama when prilikom they are njihove dividing deobe (e.g. in (npr. cancer) u karcinomu) but not when ali ne they i kada rest. nema Therefore, umnožavanja if ćelija. Ki-67 Zato, is present ukoliko in je a high Ki-67 proportion prisutan u of visokom cells, this procentu ćelija, indicates to pokazuje that the tumour da tumor is brzo growing raste. quickly. Profili Gene ekspresije expression gena, profiles, koji which pokazuju show određene distinct setove sets of gena genes koje expressed eksprimira by a tumor, tumour, mogu may se be koristiti used to za give dodatne extra information informacije and i klasifikaciju classify patients pacijenata as high kao risk onih koji su or low visokorizični risk ; however, i niskorizični ; their use varies ipak, njihova from country primena to se razlikuje country, od depending zemlje do on zemlje, resources. u zavisnosti od resursa. 20

21 ESMO Vodič Patients za pacijente Guide Podtipovi Breast cancer raka subtypes dojke Tumori Breast tumours dojke mogu can se be grupisati grouped u into podtipove subtypes na using osnovu the rezultata results prethodno from the biomarker opisanih biomarkerskih tests described testova. above. These Te grupe, groupings, čiji je summarised kratak pregled in the dat table u tabeli below, u nastavku, can give mogu an indication da ukažu of na prognosis prognozu and i mogu can da help pomognu doctors lekarima to determine da odrede which treatments koje vrste terapije should be treba considered da razmotre for each za koji type tip raka of breast dojke cancer (Cardoso (Cardoso et al et al. [u 2018 štampi]). [in press]). PODTIP SUBTYPE ZAMENSKA SURROGATE DEFINICIJA DEFINITION KARAKTERISTIKE FEATURES Luminalni A-like A tip Luminalni A-like A tip ER pozitivan positive HER2 HER2 negativan negative Ki67 nizak Ki67 low PgR visok Niskorizični PgR high molekularni potpis (ukoliko je dostupan) Low-risk molecular signature (if available) Luminalni B-like B tip Luminalni B-like B tip (HER2 negativan) negative) Luminalni B-like B tip (HER2 negativan) positive) ER pozitivan positive HER2 negativan negative Bilo Either Ki67 Ki67 visok high ili or PgR PgR nizak low Visokorizični molekularni potpis High-risk molecular signature (if (ukoliko je dostupan) available) ER pozitivan positive HER2 pozitivan positive Bilo Any koji Ki67 Ki67 Bilo Any koji PgR PgR Preterana HER 2 overexpressing ekspresija HER 2 HER2 pozitivan positive (non-luminal) (neluminalni) HER2 pozitivan positive ER i and PgR PgR odsutni absent Tip Basal-like nalik bazalnom Trostruko Triple-negative negativan (ductal) (duktalni) HER2 negativan negative ER i and PgR PgR negativan negative 21

22 Rak Breast dojke cancer Koje What su are mogućnosti the treatment lečenja options raka for dojke? breast cancer? Vaša Your terapija treatment zavisiće will depend od veličine, upon the lokacije size, i location broja tumora and number i patologije of tumours (podtip, and gradus the pathology i prisustvo (subtype, biomarkera) tumora, grade and kao presence i Vaših godina of biomarkers) i opšteg zdravstvenog of the tumour, stanja. as well Sa Vama as your će age se razgovarati and general o health. izboru i The kombinaciji choice and terapije, a Vaše combination mišljenje of će treatments se uzeti u will obzir. be discussed with you and your preferences will be taken into account. Jedna One of od the Vaših most najvažnijih important odluka decisions biće you gde will ćete have se lečiti. to make Lečenje is where uz multidisciplinarni to be treated. Treatment i specijalizovani within a tim poboljšava preživljavanje multidisciplinary i kvalitet and specialised života, u odnosu team na improves lečenje survival od strane and samo quality jednog of life, lekara. as opposed Sve odluke to being o Vašem treated lečenju by a treba da single se donesu doctor. nakon All of your razgovora treatment na konzilijumu, decisions should na kome be će taken lekari after različitih discussion specijalnosti, in a multidisciplinary medicinske sestre meeting, i ostali zdravstveni where doctors radnici from uključeni different u specialties, Vaše lečenje nurses razgovarati and other doneti health odluku professionals o najboljem involved vidu lečenja in your za Vas. care will discuss your case and decide which treatment is the best option for you. Operacija Surgery Dva The two tipa types operacije of surgery raka dojke for breast su poštedna cancer are operacija breastconserving u okviru surgery, koje hirurški in which tim uklanja the surgical tumor team ali dojke pokušava removes the da tumour zadrži što but je tries moguće to keep veći as deo much dojke, of the ili mastektomija, breast possible, tokom or mastectomy, koje se odstranjuje in which cela the dojka. whole Ukoliko breast is na removed. radiološkim If the snimcima lymph nodes izgleda in da your limfni armpit čvorovi look like u they Vašem are clear pazuhu of cancer nisu zahvaćeni in imaging rakom, tests, onda treba then a izvršiti technique tehniku called koja sentinel se naziva lymph biopsija node limfnog biopsy čvora sentinela (stražara). Na taj način se određuje should be performed. This identifies the most important najvažniji (sentinel) limfni čvor koji se ispituje; ukoliko (sentinel) lymph node and examines it; if no cancer is se ne otkrije rak, onda ni jedan drugi neće biti uklonjen detected, then no other lymph nodes will be removed, limfni čvor, ali ukoliko se otkrije rak u tom limfnom but if cancer is found in that lymph node, more nodes čvoru, možda će biti potrebno uklanjanje više limfnih čvorova may have (zahvat to be removed se naziva (called aksilarna axillary disekcija). dissection). Pacijentima Patients kojima undergoing se radi mastectomy mastektomija should može usually se ponuditi be offered istovremena immediate or ili delayed naknadna breast rekonstrukcija reconstruction, dojke, except osim in u the slučaju case zapaljenskog of inflammatory raka breast dojke. cancer. Radioterapija Radiotherapy Radioterapija Radiotherapy predstavlja is a type of vrstu treatment terapije that koja uses koristi ionising jonizujuće radiation, zračenje, which koje damages oštećuje the DNA DNK ćelija of cancerous sa rakom, cells, izazivajući causing the tako cells njihovu to die. smrt. Radiotherapy Radioterapija is usually se obično given daje after nakon breast-conserving poštedne operacije surgery dojke, and a may može also se be dati i nakon given after mastektomije. mastectomy. Radioterapija Radiotherapy se takođe may also može be given dati pacijentima to patients sa with lokalno locally-advanced uznapredovalom disease bolešću which koja se remains ne može inoperable operisati after ni nakon systemic sistemske treatment terapije and i may takođe be considered može da se in razmatra certain patients kod određenih with metastatic pacijenata disease sa metastatskim to treat the symptoms oboljenjem of the za lečenje primary simptoma tumour or primarnog distant metastases tumora ili udaljenih and improve metastaza quality i of poboljšanje life. kvaliteta života. Radiotherapy after breast-conserving surgery is usually given as whole breast radiotherapy (WBRT). In Radioterapija patients considered nakon to poštedne be at high operacije risk of recurrence dojke obično who have se daje already u vidu undergone radioterapije WBRT, cele a radiotherapy dojke (WBRT). boost Kod may pacijenata be given za this koje is an se extra, smatra lower da su dose u visokom of radiation riziku directed od ponovne specifically pojave bolesti, to the area a kojima that the je već tumour rađena was radioterapije removed from. cele This dojke, may be može done se similarly dati podsticajna to WBRT with radioterapija external radiotherapy ona predstavlja or with dodatnu, brachytherapy, nižu dozu in which zračenja a radiation koja source je konkretno is placed usmerena into the breast na mesto tissue sa koga for a short je uklonjen time to tumor. provide To internal se može radiotherapy uraditi slično kao focused i only radioterapije on a small margin cele of dojke tissue sa surrounding spoljašnjom the radioterapijom site of surgery. ili brahiterapijom, kada se izvor zračenja nakratko stavi u tkivo dojke kako bi se obezbedila unutrašnja radioterapija usmerena samo na malu marginu (rub) tkiva koje okružuje mesto na kome je izvršen hirurški zahvat. 22

23 ESMO Vodič Patients za pacijente Guide Kod Patients pacijenata who are za considered koje se smatra to be da at su a low u niskom risk of riziku recurrence od ponovne may instead pojave receive bolesti umesto a short toga course može of radiotherapy se primeniti kratak using a ciklus technique radioterapije called accelerated pomoću tehnike partial koja breast se naziva irradiation ubrzano (APBI) parcijalno (Cardoso zračenje et al dojke [in press]). (APBI) This (Cardoso et al. treatment 2018 [u štampi]). is shorter Ta terapija than WBRT je kraće and traje reduces od radioterapije the exposure cele of healthy dojke breast i smanjuje tissue izloženost and other zdravog organs tkiva in the dojke chest i drugih (e.g. heart, organa lungs) u grudima to radiation, (npr. srca, reducing pluća) the zračenju, risk of long-term smanjujući side i rizik effects. od dugoročnih neželjenih dejstava. Nekim Some patients pacijentima also potrebna require radiotherapy je i radioterapija after nakon mastectomy, mastektomije because zbog of the prisustva presence faktora of factors koji povećavaju that increase rizik od the ponovne risk of the pojave cancer raka. coming To je slično back. This radioterapiji is done similarly nakon poštedne to radiotherapy operacije after dojke. breast-conserving surgery. Sistemska terapija Systemic therapy Postoji nekoliko vrsta sistemske terapije kojom možete biti lečeni u zavisnosti od tipa i stadijuma raka koji imate. There are several types of systemic therapy that you may be treated with, depending on the type and stage of Hemoterapija cancer you have. Hemoterapija uništava ćelije raka i koristi se za lečenje većine trostruko negativnih, HER2 pozitivnih i luminalnih Chemotherapy karcinoma dojke B tipa. Hemoterapija se obično daje svake 1 3 nedelje putem intravenske infuzije. Nekim pacijentima Chemotherapy takođe destroys može biti cancer ponuđena cells and oralna is used hemoterapija to treat most nakon triple završetka negative, standardne HER2 positive intravenske and luminal B-like hemoterapije. breast cancers. Chemotherapy is usually given every 1 3 weeks as intravenous infusions. Some patients may also be offered additional oral chemotherapy following completion of standard intravenous chemotherapy. Endokrine terapije Endokrine Endocrine terapije therapies usmerene su na smanjenje dejstava estrogena kod ER pozitivnog raka dojke. To je najvažniji tip sistemske terapije za ER pozitivne tumore, koji se takođe nazivaju hormonski zavisni tumori. Endocrine therapies aim to reduce the effects of oestrogen in ER positive breast cancers. This is the most Postoji niz tipova endokrine terapije koji se uzimaju oralno (gutaju) ili se daju u vidu injekcije: important type of systemic treatment for ER positive tumours, also called hormone-dependent tumours. There Selektivni are a number modulatori of types estrogenskih of endocrine receptora therapy (SERM) available, blokiraju which ER are na taken ćelijama orally dojki or administered kako bi sprečili as an da se injection: estrogen veže za receptore. Tamoksifen je tip SERM. Selektivni Selective oestrogen antagonisti estrogenskih receptor modulators receptora (SERMs) koji smanjuju block ER njihovu on breast aktivnost cells to (SERD), prevent kao oestrogen što je fulvestrant, funkcionišu attaching to slično the receptors. kao SERM, Tamoxifen ali takođe is smanjuju a type of broj SERM. ER. Potiskivanje Selective oestrogen funkcije receptor jajnika downregulators uz pomoć analoga (SERDs), gonadotropin-oslobađajućih such as fulvestrant, work in hormona a similar ili way hirurškog to zahvata SERMs, može but also se ponuditi reduce the ženama number u predmenopauzi of ERs. i perimenopauzi kako bi se smanjila isporuka estrogena iz jajnika u tumor. Ovarian function suppression by gonadotropin-releasing hormone analogues or by surgery may Inhibitori be offered aromataze to pre- and perimenopausal smanjuju stvaranje women estrogena to reduce u tkivima the supply i organima of oestrogen osim u jajnicima, from the ovaries i stoga su to the delotvorni tumour. samo kod žena u postmenopauzi, osim ukoliko funkcija jajnika nije potisnuta (nivoi estrogena se veštački snižavaju) kod žena u predmenopauzi. Anastrozol, letrozol i eksemeztan su inhibitori Aromatase inhibitors reduce the production of oestrogen in tissues and organs other than the ovaries, aromataze. and is therefore effective only in postmenopausal women, unless the function of the ovaries is suppressed (oestrogen levels are artificially lowered) in premenopausal women. Anastrozole, letrozole and exemestane are all aromatase inhibitors. 23

24 Rak Breast dojke cancer Ciljana Targeted terapija therapy Ciljane Targeted terapije therapies su lekovi are drugs koji blokiraju that block posebne specific signalne signalling puteve pathways kod ćelija in cancer raka koje cells ih that podstiču encourage da rastu. them Određen to broj grow. ciljanih A number terapija of targeted koristi se therapies u lečenju are raka used dojke. in the treatment of breast cancer: Anti-HER2 lekovi agents deluju act on na the receptor HER2 HER2 receptor kako to block bi blokirali signalling signale and i smanjili reduce proliferaciju cell proliferation ćelija in u slučaju HER2 HER2 positive pozitivnog breast cancers. raka dojke. Trastuzumab, lapatinib, lapatinib, pertuzumab and i trastuzumab emtansine emtanzin (TDM-1) su savremeni are all currently-used anti-her2 agensi. anti-her2 Neratinib agents. je Neratinib novi anti-her2 is a new lek anti-her2 koji takođe agent može that da se may koristi also za be lečenje used to HER2 treat pozitivne HER2 positive bolesti. disease. Inhibitori Inhibitors kinaza of cyclin-dependent koje zavise od kinases ciklina 4/6 (CDK4/6) smanjuju reduce cellular proliferaciju proliferation ćelija u in tumorima. tumours. Palbociklib, Palbociclib, ribociklib ribociclib i and abemaciklib abemaciclib su inhibitori are CDK4/6 CDK4/6 inhibitors koji se used koriste in the u lečenju treatment raka of dojke. breast cancer. Inhibitors Inhibitori mehanističkog of mechanistic cilja target rapamicina of rapamycin (mtor), (mtor), kao što such je everolimus, as smanjuju reduce rast the i growth proliferaciju and proliferation ćelija tumora of koje tumour stimulišu cells mtor stimulated signali. by mtor signalling. Inhibitors Inhibitori poli of poly ADP-riboza ADP-ribose polmeraze polymerase (PARP) (PARP) otežavaju make ćelijama it difficult raka for da cancer poprave cells oštećenu to fix damaged DNK, što DNA, može which izazvati can smrt cause ćelija cancer raka. Olaparib cells to die. i talazoparib Olaparib and su talazoparib novi inhibitori are PARP new koje PARP se inhibitors mogu koristiti that za may lečenje be used nekih pacijenata to treat some sa patients mutacijom with BRCA. a BRCA mutation. Inhibitori Vascular vaskularnog endothelial endotelnog growth factor faktora (VEGF) rasta inhibitors, (VEGF) such kao što as je bevacizumab, stop ometaju tumours tumore from da stimulišu stimulating rast blood krvnih vessel sudova growth u tumoru, within uskraćujući the tumour, im thereby na taj starving način kiseonik them of i hranljive the oxygen materije and nutrients koje su im they potrebne need to continue da nastave growing. da rastu. Ostale Other treatments vrste lečenja Pacijente Patients with sa metastazama bone metastases na kostima should treba be treated lečiti lekovima with bone-modifying koji utiču na drugs kosti kao such što as su bisphosphonates bisfosfonati ili or denozumab, denosumab, u in kombinaciji combination sa with suplementima calcium and kalcijuma vitamin i D vitamina supplements. D. Ti lekovi These takođe agents jačaju strengthen kosti, smanjuju the bone, bolove u reducing kostima bone i rizik pain od preloma. and the risk Bisfosfonati of fractures. se Bisphosphonates takođe koriste u postoperativnom are also used in lečenju the postoperative ranog raka dojke treatment jer oni of mogu early breast da smanje cancer, rizik as od they ponovne may reduce pojave the raka. risk of recurrence. 24

25 ESMO Vodič Patients za pacijente Guide Koje What su are mogućnosti the treatment lečenja options za for neinvazivni non-invasive rak (Stage dojke 0) (stadijum breast cancer 0) (takođe (also called se naziva in situ karcinom carcinoma in or situ DCIS)? ili DCIS)? Operacija Surgery Cilj The operacije aim of surgery u slučaju for ranog early non-invasive neinvazivnog breast raka dojke cancer je is da to se remove izvadi tumor the tumour i da se and potvrdi confirm da je that neinvazivan. it is noninvasive. tim The će se surgical postarati team da will rak ensure bude izvađen that the zajedno cancer sa is taken zdravom away marginom along with tkiva a healthy kako bi margin se pomoglo of tissue to Hirurški sprečavanje help stop it from njegove coming ponovne back. pojave. Neinvazivni Non-invasive rak breast dojke cancer može se may lečiti be mastektomijom treated with ili mastectomy poštednom or operacijom breast-conserving dojke (Cardoso surgery et al. (Cardoso 2018 [u štampi]). et al Ženama [in press]). kojima Immediate se izvrši breast mastektomija reconstruction trebalo bi should da bude be available na raspolaganju to women i istovremena undergoing rekonstrukcija a dojke, mastectomy, osim ukoliko unless ne there postoji is klinički a clinical razlog reason da se not to ne učini. to. Breast Rekonstrukcija reconstruction dojke can može make da it olakša easier prihvatanje to accept gubitka losing a dojke breast a and ne utiče does na not sposobnost affect the ability lekara of da otkriju ponovnu doctors to pojavu detect raka. any recurrences of your cancer. Primarna The primary terapija treatment za neinvazivni for non-invasive rak breast dojke cancer je is hirurško surgical uklanjanje removal of tumora the tumour Radioterapija Radiotherapy Nakon After breast-conserving poštedne operacije surgery, dojke, obično you will ćete typically primati receive radioterapiju WBRT to cele reduce dojke the kako risk of bi the se smanjio cancer returning. rizik da se rak If you vrati. have undergone a mastectomy with successful removal of a non-invasive cancer, you will not need to Ukoliko have radiotherapy Vam je urađena (Cardoso mastektomija et al [in press]). i uspešno je uklonjen neinvazivni rak, nećete morati da primate radioterapiju (Cardoso et al [u štampi]). Systemic therapy Sistemska If your cancer terapija is ER positive and you have had breast-conserving surgery, you will usually be treated with Ukoliko tamoxifen je Vaš or rak an aromatase ER pozitivan inhibitor i rađena to Vam reduce je poštedna the risk of operacija recurrence. dojke, If your verovatno cancer is ćete ER biti positive lečeni and you tamoksifenom have had a mastectomy, ili nekim inhibitorom you will only aromataze be treated with kako tamoxifen bi se smanjio aromatase rizik da rak inhibitor vrati. Ukoliko if your je doctor Vaš rak thinks ER pozitivan you have a i high rađena risk Vam of developing je mastektomija, new tumours bićete (Cardoso lečeni samo et al tamoksifenom [in press]). i inhibitorom aromataze ukoliko Vaš lekar smatra da postoji veliki rizik da Vam se jave novi tumori (Cardoso et al [u štampi]). 25

26 Rak Breast dojke cancer Koje What su are mogućnosti the treatment lečenja options za rani for early invazivni invasive rak dojke (stadijum (Stage I-IIA) I-IIA)? breast cancer? Operacija Surgery and i radioterapija radiotherapy Cilj The operacije aim of surgery u slučaju for ranog early invasive invazivnog breast raka cancer dojke is jeste to remove da se izvadi the tumour tumor putem by breast-conserving poštedne operacije surgery dojke ili or mastektomije. mastectomy. After Nakon breast-conserving poštedne operacije surgery, dojke you verovatno will usually ćete primati receive radioterapiju radiotherapy jer as se this tako lowers snižava the rizik risk of od the toga cancer da se returning. rak vrati. Većini Most patients pacijenata have radi WBRT, se radioterapija but some patients cele dojke, who are ali neki considered pacijenti to kod be at kojih a low se risk smatra of recurrence da postoji may nizak receive rizik APBI od ponovne (Cardoso pojave et al mogu [in press]). da primaju If you ubrzano have had parcijalno a mastectomy, zračenje you may dojke also (Cardoso receive et al. radiotherapy 2018 [u štampi]) if Ukoliko cancer cells Vam je are rađena found mastektomija, in the axillary lymph možda nodes, ćete primati or occasionally i radioterapiju if you ukoliko are considered se otkriju to ćelije be raka at a high u pazušnim risk of recurrence. limfnim čvorovima, ili povremeno ukoliko se smatra da kod Vas postoji visok rizik da se rak vrati. Adjuvant systemic therapy Adjuvantna Following surgery sistemska to remove terapija the tumour, many patients with early invasive breast cancer will receive adjuvant Nakon systemic operacije treatment. radi uklanjanja Your doctor tumora, will discuss mnogi this pacijenti decision sa ranim with you, invazivnim taking into rakom account dojke the primaće hormone adjuvantnu receptor, (pomoćnu) HER2 and Ki67 sistemsku status of terapiju. your tumour, Vaš lekar the će possible sa Vama risks porazgovarati and benefits o toj odluci, you, and uzimajući your personal u obzir preferences. hormonski receptor, Adjuvant status treatment HER2 usually i Ki67 starts Vašeg between tumora, 2 moguće and 6 weeks rizike after i prednosti surgery za and Vas, several kao i Vaš types lični of izbor. therapy may be Adjuvantno used. lečenje obično počinje između 2 i 6 nedelja nakon operacije i može se koristiti nekoliko tipova terapije. Većina Most patients pacijenata with sa early ranim invasive invazivnim breast rakom cancer dojke will receive primaće systemic sistemsku therapy terapiju after nakon surgery operacije. Neoadjuvantna systemic sistemska therapy terapija Neki Some pacijenti patients sa with invazivnim early invasive rakom breast dojke, cancer, posebno particularly oni sa većim those tumorima with larger (veći (more od 2 than cm u 2cm prečniku), in diameter) ili zahvaćenim tumours or limfnim involved čvorovima, lymph nodes, mogu may da receive primaju neoadjuvantnu systemic sistemsku therapy terapiju to shrink kako the bi tumour im se smanjio to tumor improve i tako the likelihood povećala verovatnoća of successful uspešnog surgical hirurškog removal of uklanjanja the tumour tumora with a sa clear čistom margin, marginom, or to allow ili da less bi se omogućila extensive surgery operacija that manjeg may lead obima to a što better može cosmetic da dovede and/or do boljeg functional kozmetičkog outcome. odnosno All of the funkcionalnog adjuvant treatments ishoda. Sve vrste summarised adjuvantne below terapije may also navedene be used u as kratkom neoadjuvant pregledu therapy. u nastavku mogu se koristiti za neoadjuvantnu terapiju. 26

27 ESMO Vodič Patients za pacijente Guide Hormonska Endocrine therapy terapija Svim All patients pacijentima with ER sa ER positive pozitivnim breast rakom cancer dojke will biće ponuđena be offered hormonska endocrine therapy terapija (Cardoso et et al. al [in[u štampi]). press]). In Kod premenopausal žena u predmenopauzi, women, ER ER positive pozitivan early rani rak breast dojke cancer obično is usually se leči tamoksifenom treated with tamoxifen u vremenu for od 5 do years. godina. This Ta may terapije be changed se može to zameniti an aromatase inhibitorom aromataze inhibitor if the ukoliko patient pacijentkinja becomes uđe postmenopausal u postmenopauzu tokom during prvih the first 5 godina 5 years lečenja of tamoxifen tamoksifenom. treatment. Potiskivanje Ovarian function funkcije suppression jajnika pomoću with gonadotropinreleasing hormone analogues or ovarian ablation analoga gonadotropin-oslobađajućih hormona ili ablacije jajnika može se takođe ponuditi pacijentkinjama u may also be offered to premenopausal patients predmenopauzi, u kombinaciji sa tamoksifenom ili in combination with tamoxifen or an aromatase inhibitorom aromataze. inhibitor. Kod žena u postmenopauzi, ER pozitivan rani rak dojke može se lečiti bilo inhibitorima aromataze ili In post-menopausal women, ER positive early breast cancer may be treated with either aromatase inhibitors tamoksifenom. Inhibitori aromataze mogu se primeniti odmah, ili nakon 2 do 3 godine nakon lečenja or tamoxifen. Aromatase inhibitors may be used immediately, or after 2 3 years of tamoxifen treatment, or tamoksifenom, ili kao produžena adjuvantna terapija nakon 5 godina posle terapije tamoksifenom. as an extended adjuvant therapy after 5 years of tamoxifen treatment. Hemoterapija Chemotherapy Hemoterapijski Chemotherapy regimens režimi koji used primenjuju in early breast za rani cancer rak dojke usually obično contain sadrže chemicals hemijska called sredstva anthracyclines koja se nazivaju antraciklini (e.g. epirubicin (npr. or epirubicin doxorubicin) ili doksorubicin) and/or taxanes odnosno (e.g. paclitaxel taksani or (npr. docetaxel) paklitaksel used ili sequentially docetaksel) koji se for koriste weeks sekvencijalno (Cardoso et tokom al [in press]), nedelje although (Cardoso in et some al patients [u štampi]), a combination iako se kod of nekih cyclophosphamide, pacijenata može primeniti methotrexate kombinacija and 5-fluorouracil ciklofosfamida, (CMF) metotreksata may be i used. 5-fluorouracila Dose-dense (CMF). schedules Rasporedi (given davanja every 2 leka weeks sa gustim doziranjem (svake 2 nedelje umesto standardnog instead of the standard schedule of every 3 weeks) rasporeda od svake 3 nedelje) mogu se primeniti kod may be used in patients with highly proliferative pacijenata sa visoko proliferativnim tumorima. Neantraciklinski režimi (npr. docetaksel i ciklofosfamid) tumours. Non-anthracycline regimens (e.g. docetaxel and cyclophosphamide) can be used in patients mogu se koristiti kod pacijenata koji nisu pogodni za lečenje antraciklinom, ili umesto njega. Hemoterapija who are unsuitable for anthracycline treatment, or instead of it. Chemotherapy is recommended in the vast se preporučuje u velikoj većini trostruko negativnih, HER2 pozitivnih i visokorizičnih luminalnih HER2 negativnih tumora. majority of triple-negative, HER2 positive and high-risk luminal HER2 negative tumours. Anti-HER2 terapija therapy HER2 pozitivan positive breast rak dojke cancer obično is usually se leči anti-her2 treated with lekom the anti-her2 trastuzumabom agent trastuzumab putem intravenske via intravenous infuzije ili supkutanom infusion or subcutaneous (potkožnom) injection, injekcijom, as kao well i as hemoterapijom chemotherapy (Cardoso (Cardoso et et al. al [u[in štampi]). press]). Trastuzumab je is odobren approved za for primenu use in patients kod pacijenata with HER2 sa HER2 positive pozitivnim cancer rakom following nakon surgery, operacije, neoadjuvant kao neoadjuvantna or ili adjuvantna chemotherapy hemoterapija and radiotherapy, i radioterapija, in combination u kombinaciji with adjuvant sa adjuvantnom chemotherapy, hemoterapijom, and in combination i u kombinaciji with sa neoadjuvantnom chemotherapy hemoterapijom for tumours za tumore larger prečnika than 2cm većeg in diameter od 2 cm (Sažetak (Herceptin karakteristika SPC, 2017). leka The za optimal Herceptin duration iz godine). of trastuzumab Smatra se treatment da je optimalno is considered trajanje to lečenja be 1 year. trastuzumabom Trastuzumab godinu is not dana. normally Trastuzumab administered se at obično the same ne daje 27

28 Rak Breast dojke cancer u time isto as vreme anthracyclines kad i antraciklini due to zbog the risk rizika of cardiac od neželjenih side effects dejstava (see na section srce (za What detaljne are the informacije possible pogledajte side effects odeljak of treatment? Koja su for moguća more details), neželjena but dejstva can be terapije? ), given sequentially. ali može Taxanes dati sekvencijalno. can be administered Taksani at se the mogu same time davati as trastuzumab. u isto vreme In kad some i trastuzumab. higher risk patients, Kod nekih a combination pacijenata u of većem trastuzumab riziku, može and se pertuzumab primeniti kombinacija may be used. trastuzumaba Some patients might i pertuzumaba. also be offered a year of treatment with the new anti-her2 therapy neratinib following Nekim pacijentima se takođe može ponuditi godina lečenja novom anti-her2 terapijom, neratinibom, nakon completion of trastuzumab. završetka primene trastuzumaba. Pregled Treatment terapije overview The variety of treatments available may seem confusing, but the combination of systemic treatment you receive Veći broj postojećih lekova mogu delovati zbunjujuće, ali kombinacija sistemske terapije koju ćete primati zavisiće will depend on the findings from your biopsy or samples from the tumour and/or lymph nodes after they have od nalaza Vaše biopsije ili/i uzoraka tumora odnosno limfnih čvorova nakon što budu izvađeni hirurškim putem. Na been removed by surgery. The following figure gives a general overview of the types of treatment options sledećoj slici dat je opšti pregled mogućnosti lečenja preporučenih za svaki podtip bolesti: recommended for each disease subtype: Rani Early invazivni invasive rak breast dojke cancer Operacija sa Surgery +/- radioterapijom ili bez radiotherapy radioterapije Neoadjuvantna treatment terapija Adjuvantna treatment terapija ER pozitivan positive HER2 pozitivan positive Trostruko Triple negative negativan Lower Niži rizik risk Higher Viši rizik risk ER pozitivan positive ER negativan negative Hormonska Endocrine terapija therapy Chemotherapy Hemoterapija sa + endokrinom endocrine therapy terapijom Anti-HER2 terapija therapy sa + hemoterapijom chemotherapy i endokrinom + endocrine terapijom therapy Anti-HER2 terapija therapy sa + chemotherapy hemoterapijom Chemotherapy Hemoterapija Grafički Flowchart prikaz showing pristupa systemic sistemskog treatment lečenja approaches u slučaju in ranog early invazivnog invasive breast raka cancer. dojke. 28

29 ESMO Vodič Patients za pacijente Guide Koje What su are mogućnosti the treatment lečenja options za lokalno for locally-advanced uznapredovali rak (Stage dojke IIB-III) (stadijum breast IIB-III)? cancer? U In većini most cases, slučajeva, a combination za lokalno uznapredovali of systemic therapy, rak dojke koristi surgery se and kombinacija radiotherapy sistemske used terapije, for locallyadvanced breast cancer. operacije i radioterapije. Sistemska Systemic therapy terapija Neoadjuvantna therapy terapija for za locally-advanced lokalno uznapredovalu disease bolest The initial treatment for locally-advanced breast Početna cancer is terapija usually za neoadjuvant lokalno uznapredovali systemic rak therapy dojke je obično to shrink neoadjuvantna the tumour and sistemska improve the terapija likelihood kako of bi se successful smanjio tumor surgical i povećala removal of verovatnoća the tumour uspešnog with a clear hirurškog margin. In uklanjanja general, tumora the systemic sa jasnom therapies marginom. used for Uopšte early breast uzev, sistemske cancer are also terapije used za for rani locally-advanced rak dojke takođe se breast koriste cancer, za lokalno although uznapredovali in locally-advanced rak dojke, disease, pa iako se systemic kod lokalno treatment uznapredovale is usually bolesti given obično first, patients prvo daje sistemska generally require terapija, radiotherapy, pacijentima je and obično overall, potrebna the treatment radioterapija, is more i aggressive. lečenje je generalno agresivnije. U The tabeli table u nastavku below gives dat an je overview pregled tipova of the neoadjuvantne types of neoadjuvant terapije treatment koji se mogu that razmatrati may be considered za različite in tipove different inoperabilnog types of inoperable lokalno locally-advanced uznapredovalog raka breast dojke cancer (Cardoso (Cardoso et al. et 2018 al [u štampi]). [in press]). TIP TYPE LOKALNO OF LOCALLY-ADVANCED UZNAPREDOVALOG RAKA BREAST DOJKE CANCER ER ER pozitivan positive breast rak dojke cancer HER2 HER2 pozitivan positive breast rak dojke cancer Trostrukonegativan Triple-negative breast rak cancer dojke NEOADJUVANTNA THERAPY TERAPIJA Hormonska Endocrine therapy terapija or ili anthracyclinehemoterapija and na bazi antraciklina i taksana taxane-based chemotherapy Hemoterapija Anthracycline-based na bazi chemotherapy antraciklina sekvencijalno sa taksanima sequentially i anti-her2 with taxanes terapijom and anti-her2 therapy Hemoterapija Anthracyclinena and bazi taxane-based taksana i antraciklina chemotherapy Pacijenti Patients sa with lokalno locally-advanced uznapredovalim breast rakom cancer dojke may mogu also da receive primaju radiotherapy i radioterapiju as a kao neoadjuvantnu treatment. terapiju. Nakon Following delotvorne effective neoadjuvantne systemic sistemske therapy, terapije, surgical često je resection moguća hirurška of the tumour resekcija is often (odstranjivanje) possible. In tumora. most U cases, većini surgery slučajeva, will biće involve urađena a mastectomy mastektomija and removal i uklanjanje of the pazušnih axillary limfnih lymph čvorova, nodes, but ali breast-conserving kod nekih pacijenata može surgery biti might moguća be i possible poštedna in operacija some patients dojke (Cardoso (Cardoso et al. et 2018 al [in press]). [u štampi]). Lokalno Locally-advanced uznapredovali breast rak cancer dojke obično is usually se leči treated sistemskom with systemic terapijom, therapy, nakon after which koje može surgery biti moguća may operacija be possible kako to remove bi se uklonio the tumour tumor 29

30 Rak Breast dojke cancer Koje What su are mogućnosti the treatment lečenja options za metastatski for metastatic rak dojke (stadijum (Stage IV) IV)? breast cancer? Ukoliko If you have Vam been je postavljena diagnosed dijagnoza with metastatic metastatskog breast raka cancer, dojke, a new nova biopsy biopsija will će often verovatno be taken biti to urađena confirm kako the bi se potvrdila histology histologija and re-assess i kako bi the se expression ponovo procenila of biomarkers ekspresija (e.g. biomarkera hormone (npr. receptors hormonskih and HER2). receptora i HER2). Cilj The sistemske aim of systemic terapije therapy u slučaju for uznapredovale advanced disease bolesti is to je prolong da se produži life and život to maximise i unapredi quality kvalitet of života life. This što je is više moguće. most effectively To se najbolje achieved postiže with ciljanim targeted terapijama therapies (including (uključujući endocrine endokrinu therapy), terapiju), which koje are se obično typically koriste used kao primarno as the primary lečenje treatment kod većine the pacijenata. majority Osim of patients. sistemskih In addition terapija, to systemic pacijenti mogu treatments, da primaju patients i radioterapiju may receive (npr. radiotherapy kako bi se (e.g. smanjili to reduce bolovi bone u kostima pain koji associated se javljaju with zbog bone metastaza, metastases, kod for metastaza brain metastases u mozgu i and kako to reduce bi bleeding se smanjilo caused krvarenje by tumours koje izazivaju in soft tissue) tumori or u surgery mekom (e.g. tkivu) to ili relieve da budu the operisani pressure (npr. of a kako tumour bi se pressing smanjio on pritisak the spinal tumora cord, or na to kičmenu remove moždinu brain metastases). ili uklonile metastaze Patients with na mozgu). liver or lung Pacijentima metastases koji imaju may metastaze also be offered u jetri ili na plućima takođe se mogu primeniti nove ablativne terapije kao što su stereotaktična radioterapija, novel ablative therapies such as stereotactic radiotherapy, radioembolism and radiofrequency ablation, radioembolizacija i radiofrekventna ablacija, ali te vrste lečenja možda neće odgovarati svim pacijentima, a however these treatments may not be suitable for all patients and their benefits have not yet been proven. njihove koristi još nisu potvrđene. Bone modifying agents such as bisphosphonates and denosumab can help to reduce the occurrence of Lekovi koji utiču na kosti, kao što su bisfosfonati i denozumab mogu da pomognu da se smanje bolovi i broj fractures commonly associated with the presence of bone metastases as well as pain. preloma koji se obično povezuju sa prisustvom metastaza na kostima. Chemotherapy for advanced disease Hemoterapija za uznapredovalu bolest Chemotherapy is the standard treatment for triple-negative breast cancer and for ER-positive, HER2-negative Hemoterapija patients who have predstavlja stopped standardnu responding terapiju to endocrine za trostruko therapy. negativni Occasionally, rak dojke ER-positive i za pozitivne, patients HER2 may negativne require pacijente chemotherapy koji su prestali because da the reaguju cancer na is endokrinu particularly terapiju. aggressive. ER Chemotherapies pozitivnim pacijentima are usually može given biti potrebna sequentially hemoterapija for metastatic disease zbog toga but što may je be taj given tip raka in posebno combination agresivan. if the cancer Hemoterapije is progressing se obično quickly. daju Patients sekvencijalno are usually za metastatsku treated with capecitabine, bolest, ali se mogu vinorelbine davati i u or kombinaciji eribulin. ukoliko Taxanes rak or brzo anthracyclines napreduje. Pacijenti may be obično used again primaju if they terapiju kapecitabinom, have been given before vinorelbinom as neoadjuvant ili eribulinom. or adjuvant Taksani therapy, ili antraciklini if the patient se has mogu been ponovo considered primeniti to ukoliko be diseasefree for ranije at least kao 1 neoadjuvantna year and the doctor ili adjuvantna considers it terapija safe. There ukoliko are je also pacijent several u periodu other chemotherapy bez bolesti najmanje choices godinu su davani dana which i your ukoliko doctor lekar may smatra discuss da je with to bezbedno. you (Cardoso Postoje et al još neki [in press]). izbori A hemoterapije platinum-containing o kojima chemotherapy Vaš lekar može sa such Vama as carboplatin da porazgovara (Cardoso et al [u or cisplatin might also be štampi]). used in Hemoterapija patients with koja triple-negative sadrži platinu disease kao who što su have karboplatin been treated ili with cisplatin anthracyclines takođe se previously. može primeniti kod pacijenata sa trostruko negativnom bolešću koji su prethodno lečeni antracklinima. Endocrine therapy for advanced disease Hormonska terapija za uznapredovalu bolest ER positive, HER2 negative advanced disease ER should pozitivnu, almost HER2 always negativnu be initially uznapredovala treated with bolest skoro endocrine uvek treba therapy: lečiti an endokrinom aromatase terapijom: inhibitor, inhibitorom tamoxifen or aromataze, fulvestrant tamoksifenom (Cardoso et al ili [in press]). fulvestrantom In pre- and perimenopausal (Cardoso et al patients, [u štampi]). ovarian Kod function pacijentkinja suppression koje su or u ablation predmenopauzi (surgical removal) i is perimenopauzi recommended preporučuje in combination se supresija with endocrine (potiskivanje) therapy. Where funkcije available, jajnika endocrine ili ablacija therapy (hirurško is uklanjanje), usually combined u kombinaciji with targeted sa endokrinom therapies terapijom. such as Kada je moguće, hormonska terapija se obično kombinuje sa ciljanim terapijama kao što su 30

31 ESMO Vodič Patients za pacijente Guide palbociklib, palbociclib, ribociklib, ribociclib, abemaciklib abemaciclib ili or everolimus kako to improve bi se poboljšali outcomes. ishodi. Megestrol Megestrol acetate acetat and i estradiol (vrsta (a type estrogena) of oestrogen) predstavljaju are options mogućnosti for further za lines dalje of linije treatment. terapije. Patients Pacijenti with sa ER ER pozitivnim, positive, HER2 HER2 positive pozitivnim metastatskim metastatic disease oboljenjem will typically obično će be biti treated lečeni with anti-her2 anti-her2 terapijom therapy i and hemoterapijom chemotherapy kao as terapijom first-line prve treatment, linije, onda then may mogu receive da primaju endocrine endokrinu therapy terapiju in combination u kombinaciji with sa further daljom anti-her2 anti-her2 therapy terapijom as kao maintenance terapija održavanja treatment nakon što završe sa primanjem hemoterapije. after completing chemotherapy. Hormonska Endocrine resistance rezistencija is a (otpornost) term used when je termin a patient koji se experiences koristi kada a se relapse kod pacijenta (or progression javi relaps of metastatic (ili progresija metastatske bolesti) dok uzima endokrinu terapiju, ili u periodu od 12 meseci nakon završetka endokrine disease) while taking endocrine therapy, or within 12 months of completing endocrine therapy (Cardoso et al. terapije (Cardoso et al [in press]). Patients showing signs of endocrine resistance will usually have their treatment switched to a 2018 [u štampi]). Pacijenti kod kojih postoje znaci endokrine rezistencije obično prelaze na drugu endokrinu different endocrine therapy, or to chemotherapy. terapiju, ili na hemoterapiju. Anti-HER2 therapy for advanced disease Anti-HER2 terapija za uznapredovalu bolest The first-line treatment for HER2 positive advanced disease is likely to be trastuzumab and pertuzumab Terapija in combination prve linije with za chemotherapy HER2 pozitivnu (usually uznapredovalu docetaxel bolest or paclitaxel) verovatno će (Cardoso biti trastuzumab et al [in press]). i pertuzumab Secondline treatment sa in hemoterapijom these patients is typically (obično docetaksel T-DM1. Some ili paklitaksel) patients may also (Cardoso receive et al. second-line 2018 [u štampi]). treatment Terapija with druge u kombinaciji linije trastuzumab kod tih pacijenata in combination obično with je T-DM1. lapatinib. Neki Further pacijenti treatment takođe lines mogu may da include primaju combinations drugu liniju lečenja of trastuzumab koja se sastoji od with trastuzumaba other chemotherapy u kombinaciji drugs, sa or lapatinibom. a combination of Dalje lapatinib linije terapije and capecitabine. mogu da budu kombinacije trastuzumaba sa drugim hemoterapijskim lekovima, ili kombinacija lapatiniba i kapecitabina. Metastatski Metastatic rak breast dojke cancer nije izlečiv, is not curable ali se može but can lečiti velikim be treated izborom with lekova an increasing koji se povećava choice of therapies Ostale Other targeted ciljane terapije therapies CDK4/6 inhibitori inhibitors (palbociklib, (palbociclib, ribociklib ribociclib i abemaciklib) and abemaciclib) su izbor are an za lečenje option for ER the pozitivnog treatment uznapredovalog of ER positive raka advanced dojke breast u kombinaciji cancer sa in combination inhibitorom with aromataze an aromatase ili fulvestrantom inhibitor or (Ibrance fulvestrant SPC, 2017; (Ibrance Kisqali SPC, 2017; Kisqali Cardoso SPC, et al. 2017; 2018 Cardoso [u štampi]). et al [in press]). Everolimus u in kombinaciji combination sa with eksemestanom, exemestane, tamoksifenom tamoxifen or ili fulvestrantom is a treatment predstavlja option mogućnost for some lečenja za postmenopausal neke pacijentkinje patients u postmenopauzi with ER positive sa ER advanced pozitivnim breast uznapredovalim cancer which rakom has progressed dojke koji je after napredovao treatment posle with a lečenja non-steroidal nesteroidnim aromatase inhibitorom aromataze (Cardoso et al. (Cardoso 2018 [in et press]). al [u štampi]). Novi The new lekovi agents olaparib olaparib i talazoparib and talazoparib su inhibitori are PARP koji inhibitors se mogu that upotrebiti may be used kao zamena as an alternative za hemoterapiju to kod pacijenata chemotherapy sa mutacijama in patients with BRCA1/2. mutations. Bevacizumab u in kombinaciji combination sa with paklitakselom paclitaxel or ili capecitabine kapecitabinom is approved odobren in je Europe u Evropi for the za lečenje first-line prve treatment linije of metastatskog metastatic breast raka cancer dojke (Avastin (Sažetak SPC, karakteristika 2017); however, leka Avastin, this treatment 2017.); ipak, is not ta terapija currently trenutno recommended nije preporučena in European u treatment evropskim guidelines for smernicama routine use za as lečenje it only provides u rutinskoj moderate upotrebi benefits jer neki to pacijenti some patients od nje (Cardoso imaju samo et al umerenu [in press]). korist (Cardoso et al [u štampi]). 31

32 Rak Breast dojke cancer Pregled Treatment terapije overview Veliki The number broj mogućnosti of potential za treatments lečenje može can biti be veoma very confusing, zbunjujući, but ali your Vaš lekar doctor ili or specijalizovana nurse specialist medicinska will guide you sestra će through Vas provesti the options kroz one available koje su for namenjene you. The following Vama. Na figure sledećoj gives slici a broad dat je overview širi pregled of the različitih types mogućnosti of treatment lečenja preporučenih recommended za for svaki each podtip disease bolesti: subtype: Systemic Sistemska treatment terapija za for advanced uznapredovali breast rak cancer dojke ER pozitivan, positive, HER2 negativan negative ER positive, pozitivan, HER2 pozitivan positive HER2 HER2 pozitivan positive Trostruko Triple negativan negative BRCA1/2 Mutacija mutation BRCA1/2 Rezistentan Endocrine na endokrinu resistant terapiju Premenopausal Premenopauza Postmenopausal Postmenopauza Chemotherapy Hemoterapija Ablacija/potiskivanje Ovarian suppression/ablation funkcije jajnika sa endokrinom + endocrine terapijom therapy Hormonska Enodcrine therapy terapija Trastuzumab sa + pertuzumabom + i hemoterapijom chemotherapy Chemotherapy Hemoterapija Treatment Lečenje prema according to podtipu ili subtype +/ - olaparib olaparib Hormonska Endocrine therapy terapija + sa anti-her2 T-DM1 Trastuzumab sa + T-DM1 lapatinibom Trastuzumab sa + hemoterapijom chemotherapy Lapatinib sa + kapecitabinom capecitabine Grafički Flowchart prikaz showing pristupa systemic sistemskog treatment lečenja approaches u slučaju in uznapredovalog advanced breast raka cancer. dojke. 32

33 ESMO Vodič Patients za pacijente Guide Posebne Special populations grupe pacijenata Pacijenti sa mutacijama BRCA Patients with BRCA mutations Zbog povišenog rizika od pojave raka dojke, ženama koje imaju mutaciju BRCA1 ili BRCA2 može da se ponudi Due to their increased risk of developing breast cancer, women carrying a BRCA1 or BRCA2 mutation may be preventivna obostrana mastektomija uz rekonstrukciju dojke i obostranu salpingo-ooforektomiju. offered preventative bilateral mastectomy with breast reconstruction and bilateral salpingo-oophorectomy. Nakon obostrane mastektomije, rizik od pojave raka dojke kod tih pacijenata smanjuje se za 90 95% (Cardoso et After a bilateral mastectomy, the risk of breast cancer in these patients is reduced by 90 95% (Cardoso et al al [u štampi]). Uopšte uzev, tipovi ranog raka dojke povezane sa BRCA leče se na sličan način kao i drugi tipovi [in press]). In general, BRCA-associated early breast cancers are treated in a similar way to other breast cancers, raka dojke, a adjuvantnu terapiju treba davati shodno kliničkoj potrebi (Paluch-Shimon et al. 2016). Kao i za ne-brca and adjuvant therapies should be given according to clinical need (Paluch-Shimon et al. trostruko negativan rak dojke, karboplatin se preporučuje za uznapredovalu trostruko 2016). negativnu As with bolest non-brca koja je povezana triple-negative sa BRCA breast (Cardoso cancer, et al. carboplatin 2018 [u štampi]). is recommended U slučaju trostruko for BRCA-associated negativnih tumora advanced povezanih triple-negative sa BRCA ili ER pozitivnih disease (Cardoso tumora et al. otpornih 2018 [in press]). na endokrine In BRCA-associated terapije, olaparib triple-negative ili talazoparib or ER-positive mogu da tumours predstavljaju resistant alternativu to za endocrine hemoterapiju. therapies, olaparib or talazoparib might be an alternative to chemotherapy. Rak Breast dojke cancer i trudnoća and pregnancy There is no contraindication to becoming pregnant Ne postoji kontraindikacija za trudnoću nakon raka after having breast cancer. There are, however, several dojke. Ipak, postoji nekoliko važnih stvari koje treba important points to consider, especially in the case of uzeti u obzir, posebno u slučaju ER pozitivnog raka ER positive breast cancer, due to the long duration dojke, zbog dugog trajanja endokrine terapije. Endokrinu of endocrine terapiju therapy. neophodno Endocrine je prekinuti therapy pre must pokušaja be stopped da before se ostane trying u drugom to get pregnant stanju, i and sa njom should treba nastaviti be resumed nakon after porođaja delivery i dojenja. and breastfeeding. Ukoliko želite If you da ostanete wish to get u drugom pregnant, stanju, please detaljno discuss porazgovarajte all of the issues o svim carefully pitanjima with your sa svojim doctor. lekarom. Ozbiljna Treating situacija, breast cancer kao što that je occurs pojava during raka dojke pregnancy u toku trudnoće, iziskuje uključenje iskusnog tima u njegovom lečenju is a very U difficult velikoj većini situation slučajeva that should nema potrebe handled za prekidom by an experienced trudnoće (tj. team. nema In the potrebe vast majority za abortusom). of cases, Prekid there trudnoće is need ne to poboljšava terminate prognozu the pregnancy lečenja (i.e. majke there is Ipak, no need to je delikatna to have an odluka abortion). koju moraju Terminating da donesu the pregnancy žena i njen partner does not nakon improve što budu the prognosis dobro obavešteni of the mother. o svim However, mogućnostima this is koje a delicate su im na decision raspolaganju. that must Tokom be taken trudnoće by the moguće woman and je nekoliko her partner, tipova after lečenja, being u well zavisnosti informed od trimestra of all available (Peccatori options. et al. 2013). Several Operacija types of je treatment obično bezbedna are possible u toku during cele pregnancy, trudnoće. depending on the trimester (Peccatori et al. 2013). Surgery is usually safe in any trimester. Hemoterapija Chemotherapy je is bezbedna safe during tokom the drugog second i and trećeg third trimestra; trimesters; hemoterapija anthracycline-based na bazi antraciklina chemotherapy obično is usually predstavlja prvi izbor terapije u trudnoći, a mogu se koristiti i taksani. Endokrine i anti-her2 terapije mogu se the first choice of treatment in pregnancy and taxanes may also be used. Endocrine and anti-her2 therapies davati tek nakon što se beba rodi. Radioterapija se obično odlaže za period nakon porođaja. Za bebu je najvažnije can only be given after the baby is born. Radiotherapy is usually postponed until after the baby is born. The da se izbegne prevremeni porođaj. most important factor for the baby is to avoid premature birth. Mlade Young žene women Kod In younger, mlađih pacijentkinja, premenopausal koje patients, su u predmenopauzi, treatment for breast terapija cancer raka dojke can reduce može da fertility umanji and plodnost can cause i da an izazove early ranu or ili temporary privremenu menopause. menopauzu. Before Pre početka starting lečenja, treatment, Vaš your lekar doctor će sa will Vama discuss porazgovarati all possible o svim fertility mogućim issues pitanjima with you koja and will se odnose give you na information plodnost i daće about Vam any informacije suitable fertility-preservation o svim odgovarajućim options opcijama available za očuvanje to you (Peccatori plodnosti et koje al. 2013, su Vam Cardoso na et raspolaganju al [in press]). (Peccatori et al. 2013, Cardoso et al [u štampi]). 33

34 Rak Breast dojke cancer Pošto As some neki forms pristupi of cancer lečenju treatment raka mogu can biti be štetni harmful za nerođene to unborn bebe, babies, posebno especially u prvom in the trimestru, first trimester, trebalo you bi da should izbegavate avoid pregnancy trudnoću during u toku breast trajanja cancer lečenja therapy. raka It dojke. is important Važno je to razumeti understand da izostanak that a lack menstruacije of menstruation ne znači does da ste not u mean postmenopauzi, you are postmenopausal, stoga ćete i dalje therefore morati you da koristite will still mere need kontracepcije. to take contraceptive measures. Lečenje Breast cancer raka dojke treatment može da can utiče affect na fertility plodnost kod in young mladih women, žena, ali but postoje fertility-preservation mere za očuvanje plodnosti measures are available Starije žene Older women Kada donose odluku o najboljoj terapiji za Vas, lekari će uzeti u obzir Vašu biološku starost, pre nego vašu Doctors will use your biological age rather than your chronological age when deciding on the best treatment hronološku starost to znači da ukoliko ste zdrava starija pacijentkinja u dobroj kondiciji, verovatno ćete primati for you identičnu this means terapiju that kao if you i mlađe are a fit pacijentkinje, and healthy sa elderly punim patient, dozama you lekova are likely to receive identical treatments (Cardoso et al [u štampi]). Ukoliko ste to younger krhki, može patients, biti neophodno with full doses podešavanje of drugs standardne (Cardoso et al. terapije 2018 [in kako press]). bi If se you uravnotežile are frail, it prednosti may be necessary terapije i rizici to koju adjust ona standard za Vas predstavlja. treatments to balance the benefits of the treatment against the risks for you. Muškarci Men Skoro Almost svi all slučajevi cases of raka breast imaju cancer pozitivne in men hormonske are hormone receptore, receptor-positive i i estrogene for both oestrogen i androgene and hormonske androgen receptore. hormone receptors. Stoga ukoliko Therefore, Vam se if saopšti you are da told imate you trostruko have a triple-negative negativan ili HER2 or HER2 pozitivan positive rak breast dojke, treba da cancer, zatražite you mišljenje should ask i drugog for a second patologa. pathology Pristupi operaciji opinion. i Approaches radioterapiji to surgery slični and onima radiotherapy koji se koriste kod are similar žena sa to rakom those dojke. used in female breast cancer. Iako Although je mastektomija mastectomy češća is more od common poštedne than operacije breastconserving ovaj drugi surgery, zahvat the je latter takođe is moguć, also possible, kao i as dojke, neki well as oblici some manje forms invazivne of less mastektomije invasive mastectomy poput mastektomije such as nipple-sparing uz poštedu mastectomy bradavice (uklanjanje (removal of tkiva breast dojke tissue bez without uklanjanja removal kože, of bradavice the skin, ili nipple areole). or Tamoksifen predstavlja standardnu adjuvantnu endokrinu terapiju (Cardoso et al [u štampi]). U slučaju areola). Tamoxifen is the standard adjuvant endocrine therapy (Cardoso et al [in press]). For male metastatic metastatskog raka dojke kod muškaraca, hormonska terapija tamoksifenom je standard, ali se takođe mogu breast cancer, endocrine therapy with tamoxifen is standard, but an aromatase inhibitor in combination razmotriti i inhibitor aromatazeu kombinaciji sa analozi gonadotropin-oslobađajućeg hormona ili hirurško with gonadotropin-releasing hormone analogues or surgical removal of the testicles to reduce androgen uklanjanje testisa kako bi se smanjili nivoi androgena (orhiektomija) (Cardoso et al [u štampi]). Postojeće levels (orchiectomy), may also be considered (Cardoso et al [in press]). The current recommendations for preporuke za hemoterapiju i anti-her2 terapiju iste su kao i za rak dojke kod žena (Cardoso et al [u štampi]). chemotherapy and anti-her2 therapy are the same as for breast cancer in females (Cardoso et al [in press]). 34

35 ESMO Vodič Patients za pacijente Guide Klinička Clinical trials ispitivanja Vaš Your lekar doctor će Vas may moda ask you pitati whether da li biste you would želeli da like učestvujete to take part u kliničkom a clinical ispitivanju. trial. This is To a je research istraživačka study studija koja conducted se izvodi with sa patients pacijentima in order kako to bi se (ClinicalTrials.gov 2017): 2017): Ispitali Test new novi treatments lekovi; Razmotrile Look at new nove combinations kombinacije of postojećih existing treatments, lekova ili promenio or change način the way na koji they se are oni given daju kako to make bi se them učinili more delotvornijima effective or reduce ili kako side bi effects se smanjila neželjena dejstva; Uporedila Compare the delotvornost effectiveness lekova of koji drugs se used koriste to kako control bi se symptoms simptomi stavili pod kontrolu; Saznalo Find out kako how deluje cancer terapija treatments za lečenje work. raka. Klinička Clinical trials ispitivanja help to pomažu improve da knowledge se poboljša about znanje cancer o raku and i develop razviju nove new terapije, treatments, a koristi and there od učešća can be mogu many biti mnogobrojne. benefits to taking Tokom part. i nakon You would studije be bili carefully biste pažljivo monitored praćeni, during a and novi after lekovi the mogu study, da and imaju the prednosti new treatment u odnosu may offer na benefits postojeće. over existing Ipak, važno therapies. je imati It s u vidu important da neke to bear nove in terapije mind, however, nisu tako that dobre some kao new postojeće, treatments kao are i da found izazivaju not to neželjena be as good dejstva as existing koja nadmašuju treatments koristi to have (ClinicalTrials.gov side effects 2017). that outweigh the benefits (ClinicalTrials.gov 2017). Klinička Clinical trials ispitivanja help to pomažu improve da knowledge se poboljša about znanje o bolestima diseases and i razviju develop nove new terapije treatments koristi there od učešća can mogu be many biti benefits mnogobrojne to taking part Imate You have pravo the da right prihvatite to accept ili da or odbijete refuse participation učešće u kliničkom a clinical ispitivanju trial without bez posledica any consequences po kvalitet for Vašeg the lečenja. quality Ukoliko of your Vas treatment. lekar ne If pita your da doctor učestvujete does not u kliničkom ask you about ispitivanju, taking part a Vi in želite a clinical da saznate trial and više you o toj want mogućnosti, to find out možete more about pitati this svog option, lekara you da li can se ask u blizini your odvija doctor ispitivanje if there is za a trial Vaš tip for raka your (ClinicalTrials.gov type of cancer 2017). taking place nearby (ClinicalTrials.gov 2017). 35

36 Rak Breast dojke cancer Dodatne Supplementary intervencije interventions Tokom Over the čitavog entire trajanja course of bolesti, disease terapije the anticancer protiv raka treatments treba dopuniti should intervencijama be supplemented usmerenim with interventions na sprečavanje aimed komplikacija at preventing bolesti complications i lečenja, of i disease najvećim and mogućim treatment, poboljšanjem and maximization kvaliteta of života, quality kao of life, što such suportivna as supportive, nega, palijativna palliative, survivorship, nega, podrška and pacijentima end-of-life lečenim care that od should raka i nega be coordinated kraju života by a multidisciplinary kojom treba da koordiniše team (Jordan et al. 2018). multidisciplinarni tim (Jordan et al. 2018). Supportive care Suportivna nega Supportive care involves the management of cancer symptoms and the side effects of therapy. Suportivna nega obuhvata lečenje simptoma raka i neželjenih dejstava terapije. Palliative care Palijativna nega Palliative care is a term used to describe care interventions in the setting of advanced disease, including the management of symptoms and support for coping with prognosis, making difficult decisions and preparation for Palijativna end-of-life nega care. je termin koji se koristi da opiše intervencije koje se odnose na negu tokom uznapredovale bolesti, uključujući rešavanje simptoma i podršku za to kako se treba nositi sa prognozom, donošenje teških odluka i pripremu za negu na kraju života. Survivorship care Podrška Support for pacijentima patients surviving koji žive cancer sa rakom includes social support, education about the disease and rehabilitation. Survivor care plans can help patients to recover wellbeing in their personal, professional and social lives. For Podrška further information za pacijente and koji advice žive sa on rakom survivorship, (lečeni su see od ESMO s raka) obuhvata patient socijalnu guide on podršku, survivorship edukaciju (ESMO o bolesti 2017) ( i rehabilitaciji. Planovi podrške takođe mogu pomoći pacijentima da povrate blagostanje u ličnom, profesionalnom i socijalnom životu. Za dalje informacije i savete o pacijentima lečenim od raka, pogledajte ESMO smernice za pacijente o životu sa End-of-life rakom (ESMO care2017) ( End-of-life care for patients with incurable cancer primarily focusses on making the patient comfortable and Nega providing na kraju adequate života relief of physical and psychological symptoms, for example palliative sedation to induce unconsciousness can relieve intolerable pain, dyspnoea, delirium or convulsions (Cherny 2014). Discussions Nega about na end-of-life kraju života care za can pacijente be very sa distressing, rakom koji se but ne support može izlečiti should prvenstveno always be available je usmerena to patients na to da and učini their život pacijenata families at udobnijim this time. i da im pruži adekvatnu pomoć za fizičke i psihološke probleme, recimo palijativnu sedaciju kojom se izaziva nesvesno stanje što pomaže u olakšanju nepodnošljivih bolova, dispneje, delirijuma ili grčeva (Cherny 2014). Razgovori o nezi na kraju života mogu biti veoma uznemirujući, ali pacijentima i njihovim porodicama u tim trenucima pomoć uvek treba da bude na raspolaganju. 36

37 ESMO Vodič Patients za pacijente Guide Koja What su are moguća the possible neželjena side dejstva effects terapije? of treatment? Kao As with i u slučaju any medical svake treatment, medicinske you terapije, may experience možete primetiti neželjena side effects dejstva from terapije your anti-cancer u toku lečenja treatment. raka dojke. The most Sažet pregled common uobičajenih side effects neželjenih for each type dejstava of treatment za svaku are vrstu terapije summarised naveden below, je u along nastavku, with zajedno some information sa određenim on informacijama how they can be o tome managed. kako se You ona may mogu experience rešavati. side Možete effects other doživeti than i neželjene those discussed reakcije koje here. nisu It is navedene important ovde. to talk Važno to your je doctor da porazgovarate or nurse specialist sa svojim lekarom about any ili specijalizovanom medicinskom sestrom o svim potential side effects that are worrying you. potencijalnim neželjenim dejstvima koja Vas brinu. Doctors classify side effects from any cancer therapy Lekari by assigning klasifikuju each neželjena event a Grade, dejstva bilo on a koje scale terapije of protiv raka pripisujući svakom dejstvu gradus na skali 1 4, by increasing severity. Grade 1 side effects are od 1 do 4, a veći broj označava i veću težinu neželjenog dejstva. Neželjena dejstva gradusa 1 smatraju se blagim, considered to be mild, Grade 2 moderate, Grade 3 severe, and Grade 4 very severe. However, the precise criteria gradusa 2 umerenim, gradusa 3 teškim i gradusa 4 veoma teškim. Ipak, precizni kriterijumi za određivanje gradusa used to assign a grade to a specific side effect varies depending on which side effect is being considered. The za konkretno neželjeno dejstvo razlikuju se u zavisnosti od toga koje neželjeno dejstvo se razmatra. Cilj je da se aim is always to identify and address any side effect before it becomes severe, so you should always report any uvek odredi i reši svako neželjeno dejstvo pre nego što postane teško, te bi uvek trebalo da obavestite lekara ili specijalizovanu worrying symptoms medicinsku to your doctor sestru or nurse o svakom specialist simptomu as soon koji Vas as brine. possible. Važno It is important je da porazgovarate to talk to your sa svojim doctor lekarom or nurse ili specijalizovanom specialist about any medicinskom treatment-related sestrom side o svim neželjenim dejstvima koja Vas brinu a povezani su effects that are worrying you sa Vašom terapijom Zamor Fatigue je is veoma very common često prisutan in patients kod pacijenata undergoing koji cancer se leče treatment od raka and i javlja can se result ili zbog from same either bolesti the cancer ili zbog itself terapije. or Vaš the treatments. lekar ili specijalizovana Your doctor or medicinska nurse specialist sestra can mogu provide Vam you predložiti with strategies korake kojima to limit ćete the smanjiti impact uticaj of fatigue, zamora, including uključujući getting enough dovoljno sleep, sna, eating zdravu healthily ishranu and i fizičku staying aktivnost (Cancer.Net active 2016). (Cancer.Net 2016). 37

38 Rak Breast dojke cancer Operacija Surgery Limfedem Lymphoedema u rukama in the i dojkama arm and je breast veoma area često is a neželjeno fairly common dejstvo side koje effect se javlja following nakon surgery operacije to remove u kojoj su lymph uklonjeni limfni nodes čvorovi in patients kod with pacijenata breast cancer. sa rakom It affects dojke. Javlja up to 25% se kod of najviše patients 25% after pacijenata axillary lymph nakon uklanjanja node removal, aksilarnog but is limfnog less common čvora, after a ređe sentinel javlja lymph nakon node biopsije biopsy, limfnog affecting čvora less sentinela, than 10% of i to patients kod manje (Cardoso od 10% et al pacijenata [in press]). (Cardoso You can et reduce al your [u štampi]). risk of lymphoedema in several ways: Rizik Maintain od pojave a limfedema healthy body možete weight smanjiti to reduce na the nekoliko strain načina: on your lymphatic system Održavajte Use the arm zdravu on the telesnu operated težinu side kako normally biste to smanjili encourage pritisak lymphatic na Vaš limfni drainage, sistem; and exercise regularly Koristite Protect your ruku skin na strani to avoid na kojoj infection je rađena operacija normalno kako biste podstakli limfnu drenažu, i redovno vežbajte; - Moisturise the skin in the area to prevent cracked skin Zaštitite - Use kožu sunscreen kako biste to prevent izbegli sunburn infekcije; - Apply Hidrirajte insect kožu repellent kako to biste prevent sprečili bites pojavu ispucale kože; - Wear Koristite oven sredstvo gloves when za zaštitu cooking od sunca kako biste sprečili opekotine; - Wear Nanosite protective sredstva gloves koja when odbijaju gardening insekte kako biste sprečili ujede; - Nosite kuhinjske rukavice kada kuvate; If you notice any signs of swelling or infection, tell your doctor or nurse specialist as soon as possible. - Nosite zaštitne rukavice kada radite u bašti. Following surgery, your arm and shoulder on the operated side may feel stiff and sore for several weeks. Your Obavestite svog lekara ili specijalizovanu medicinsku sestru odmah ukoliko primetite znake otoka ili infekcije. nurse specialist or a physiotherapist can give you some gentle exercises to help you regain the movement you Ruka had before i rame the na operation. strani na kojoj je izvršena operacija mogu biti ukočeni i bolni nekoliko nedelja nakon operacije. Vaša specijalizovana medicinska sestra ili fizioterapeut mogu Vam odrediti neke blage vežbe koje će Vam pomoći da povratite Radiotherapy pokretljivost koju ste imali pre operacije. There are several common side effects of radiotherapy, including fatigue and skin irritation, aches and Radioterapija swelling in the treated breast. Let your doctor know of any symptoms as he/she may be able to help; for example, Postoji creams nekoliko or dressings neželjenih can help dejstava with skin radioterapije, irritation. You kao should što su zamor also avoid i iritacija exposing kože, the bolovi treated i otoci area u to tretiranoj sun for dojci. at Obavestite least a year svog after lekara treatment. o svim As simptomima radiotherapy jer će for on breast moći cancer da Vam will pomogne. also result Recimo, in some kreme irradiation ili zavoji to mogu the heart pomoći u and slučaju lungs, iritacije the risk kože. of heart Takođe disease bi trebalo and lung da izbegavate cancer (particularly izlaganje zračenog in people dela who tela smoke) suncu may najmanje be slightly godinu higher dana nakon in patients lečenja. who Pošto have radioterapija undergone radiotherapy u slučaju raka (Henson dojke et takođe al. 2013). dovodi However, do određenog modern radiotherapy zračenja srca techniques i pluća, rizik od minimise srčanih this oboljenja risk. i raka pluća (posebno kod ljudi koji puše) može biti nešto viši kod pacijenata kojima je rađena radioterapija (Henson et al. 2013). Ipak, moderne tehnike radioterapije svode taj rizik na najmanju moguću meru. Chemotherapy Hemoterapija Side effects from chemotherapy vary depending upon the drugs and doses used you may experience some Neželjena dejstva hemoterapije variraju u zavisnosti od primenjenih lekova i doza kod Vas se mogu javiti neka od of the side effects listed below but you are very unlikely to get all of them. Patients who receive a combination neželjenih dejstava navedenih u nastavku, ali je veoma mala verovatnoća da će se javiti sva. Pacijenti koji primaju of different chemotherapy drugs are likely to experience more side effects than those who receive a single hemoterapiju kao kombinacija više lekova verovatno će osetiti više neželjenih dejstava od onih koji primaju samo chemotherapy drug. The main areas of the body affected by chemotherapy are those where new cells are jedan hemoterapijski lek. Glavni delovi organizma na koje utiče hemoterapija jesu oni u kojima se ćelije brzo being quickly made and replaced (i.e. bone marrow, hair follicles, the digestive system and the lining of your razmnožavaju i zamenjuju (tj. koštana srž, folikuli dlake, sistem za organa za varenje i sluznica u usnoj šupljini). Smanjenje mouth). Reductions nivoa neutrofila in your levels (tip belih of neutrophils krvnih zrnaca) (a može type of dovesti white do blood neutropenije, cell) can lead zbog to neutropenia, koje možete postati which podložniji can make infekcijama. you more susceptible Povremeno to se infections. može desiti An slučajno accidental curenje leak of hemoterapijskog chemotherapy drug leka from iz vene the u vein okolna into tkiva (ekstravazacija), the surrounding tissues što može (extravasation) izazvati plikove can ili čireve; occasionally da bi ublažili occur and nastalu may reakciju cause blisters i bolove or možete ulcerations; primeniti these masti na effects may be counteracted using anti-histamines and steroid-based ointments, as well as warm soaks for to 38

39 ESMO Vodič Patients za pacijente Guide bazi ease antihistaminika skin pain. Some i kortikosteroida, chemotherapy kao drugs i tope can kupke affect Neki fertility hemoterapijski if you are worried lekovi mogu about da this, utiču speak na plodnost to your ukoliko doctor before Vas to brine, treatment porazgovarajte starts. Nausea sa svojim and vomiting lekarom are pre common početka and lečenja. may Mučnina be distressing i povraćanje in patients su uobičajeni receiving i chemotherapy, mogu biti neprijatni but za your pacijente doctor koji will primaju be able to hemoterapiju, use a variety of pa approaches će Vaš lekar to uz manage različite and pristupe prevent pomoći these ublažavanju symptoms ili sprečavanju (Roila et al. 2016). Most nastanka side ovih effects simptoma (Roila et al. of chemotherapy 2016). are temporary Većina neželjenih and can dejstava be controlled hemoterapije with drugs jeste or lifestyle privremena changes i može your se staviti doctor pod or nurse kontrolu will pomoću help you lekova to manage ili promene them životnih navika (Macmillan 2016). Vaš lekar ili medicinska sestra pomoći će Vam da ih rešite (Macmillan 2016). HEMOTERAPIJSKI CHEMOTHERAPY MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT LEK DRUG DEJSTVO Kapecitabin Capecitabine Bol Abdominal u trbuhupain (Sažetak (Xeloda SPC, 2017) Anoreksija Anorexia karakteristika leka Astenija Asthenia Kseloda, 2017.) Proliv Diarrhoea Zamor Fatigue Sindrom Hand-foot šaka-stopalo syndrome Mučnina Nausea Stomatitis Povraćanje Vomiting Carboplatin Karboplatin (Macmillan 2015) (Macmillan 2015.) Anaemia Anemija Constipation Zatvor Fatigue Zamor Hepatic (liver) toxicity Hepatična Increased risk (jetrena) of infection toksičnost Nausea Povećani Neutropenia rizik od infekcija Mučnina Renal (kidney) toxicity Neutropenija Thrombocytopenia Renalna Vomiting (bubrežna) toksičnost Trombocitopenija Povraćanje KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Dejstva Effects na on gastrointestinalni the gastrointestinal sistem system (mučnina, (nausea, povraćanje, vomiting, proliv, diarrhoea, bolovi abdominal u trbuhu) i pain) stomatitis and stomatitis mogu da dovedu may result do gubitka in loss of apetita appetite (anoreksije) (anorexia) ili or osećaja feelings slabosti of weakness (astenije). (asthenia). Vaš lekar Your će moći doctor da will Vam be pomogne able to help u sprečavanju you to prevent ili or rešavanju manage ovih these neželjenih side effects. dejstava. Diarrhoea Proliv may be može a temporary, da bude privremeno, mild side effect, blago but neželjeno if it is severe dejstvo then ali your ukoliko doctor je may ozbiljno, be able onda to prescribe će Vam lekar anti-diarrhoea možda propisati medicine. lek protiv proliva. To prevent and treat stomatitis, you can maintain good oral Kako biste sprečili i tretirali stomatitis, možete da održavate hygiene using a steroid mouthwash and mild toothpaste. Steroid dobru oralnu higijenu pomoću steroidne tečnost za ispiranje dental paste can be used to treat developing ulcerations. For more usta i blage paste. Steroidna dentalna pasta može se koristiti za severe (grade 2 and above) stomatitis, your doctor may suggest tretman ulceracija (ranica, čireva) koje se javljaju. U slučaju težeg lowering the dose of treatment, or delaying therapy until the stomatitisa (gradus 2 i viši), Vaš lekar može predložiti smanjenje stomatitis resolves, but in most cases, symptoms will be mild and doze terapije, ili odlaganje terapije dok stomatitis ne prođe, ali will subside once you have finished treatment. će simptomi biti blagi u većini slučajeva i proći će kada završite sa primanjem To prevent terapije. and treat hand-foot syndrome, you can try keeping hands and feet cool by exposing them to cool water (soaks, baths Radi sprečavanja i lečenja sindroma šaka-stopalo, možete da or swimming), avoiding excessive heat/hot water and keeping pokušate da rashlađujete šake i stopala u hladnoj vodi (potapanje, them unrestricted (no socks, gloves or shoes that are tight fitting). kupke ili plivanje), izbegavanjem pregrevanja/tople vode i tako što Your treatment schedule may need to be adjusted if you experience ćete se truditi da ih ne stiskate (uske čarape, rukavice i cipele). severe hand-foot syndrome but in most cases, symptoms will be Vaš raspored primanja terapije možda će morati da bude korigovan mild and treatable with creams and ointments and will subside once ukoliko se kod Vas pojavi teži oblik sindroma šaka-stopalo, ali you have finished treatment. u većini slučajeva simptomi su blagi i mogu se lečiti kremama i mastima Your blood i povući cell counts će se kada will be završite monitored sa primanjem frequently terapije. throughout Vaša your krvna treatment slika in biće order često detect proveravana any neutropenia, tokom čitavog anaemia trajanja or thrombocytopenia terapije kako bi se your otkrila doctor neutropenija, may adjust anemija your treatment ili trombocitopenija according to test results Vaš and lekar will može advise da prilagodi you on how terapiju to prevent na osnovu infections. rezultata analiza i pruži savete o tome kako da sprečite infekcije. Your doctor will be able to help you prevent or manage any nausea, Vaš vomiting lekar će or constipation. moći da Vam pomogne u sprečavanju ili rešavanju mučnine, You will have povraćanja tests before ili zatvora. and during treatment to check how well Pre your i tokom kidneys lečenja and liver biće are Vam functioning, rađene analize and you kako will bi be se asked proverila to drink funkcija plenty of Vaših fluids bubrega to prevent i jetre, your a kidneys bićete zamoljeni from becoming da pijete damaged. dosta tečnosti kako biste sprečili oštećenje bubrega. nastavak continued na sledećoj overleaf strani 39

40 Rak Breast dojke cancer HEMOTERAPIJSKI CHEMOTHERAPY DRUG LEK Cisplatin (Macmillan Cisplatin 2016.) (Macmillan, 2016) Ciklofosfamid (Sažetak Cyclophosphamide karakteristika leka (Cyclophosphamide Ciklofosfamid, 2017.) SPC, 2017) MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT DEJSTVO Anemija Anaemia Anoreksija Anorexia Promene u funkciji Changes in kidney bubrega function Smanjena plodnost Decreased fertility Proliv Diarrhoea Zamor Fatigue Povećani rizik od infekcija Increased risk of infection Povećani rizik od Increased risk of tromboze thrombosis Mučnina/povraćanje Nausea/vomiting Neutropenija Neutropenia Periferna neuropatija Peripheral neuropathy Promene čula ukusa Taste changes Trombocitopenija Thrombocytopenia Tinitus/promene Tinnitus/changes in čula sluha hearing Alopecija Alopecia Povišena temperatura Fever Mučnina Nausea Neutropenija Neutropenia Renalna toksičnost Renal and urinary tract i toksičnost urinarnog toxicity trakta Vomiting Povraćanje KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Vaša krvna slika biće često proveravana tokom čitavog Your blood cell counts will be monitored frequently throughout trajanja terapije kako bi se otkrila neutropenija, anemija ili your treatment in order to detect any neutropenia, anaemia trombocitopenija Vaš lekar može da prilagodi terapiju na or thrombocytopenia your doctor may adjust your treatment osnovu rezultata analiza i pruži savete o tome kako da sprečite according to test results and will advise you on how to prevent infekcije. infections. Uticaj na gastrointestinalni sistem (mučnina, povraćanje, proliv, Effects promena on the gastrointestinal ukusa) mogu da system dovedu do (nausea, gubitka vomiting, apetita (anoreksije). diarrhoea, taste Vaš changes) lekar će may moći result da in Vam loss pomogne of appetite u sprečavanju (anorexia). ili Your rešavanju doctor will ovih be neželjenih able to help dejstava. you to prevent or manage these side effects. Prijavite sve znake periferne neuropatije (peckanje ili utrnulost Report any u šakama signs of ili peripheral stopalima) neuropathy svom lekaru koji (tingling će Vam or pomoći numbness u sprečavanju in your hands ili rešavanju or feet) to ovih your neželjenh doctor, who dejstava. will help you to manage this side effect. Pre i tokom lečenja biće Vam rađene analize kako bi se proverila You will have funkcija tests Vaših before bubrega. and during Bićete treatment zamoljeni to da check pijete dosta how well tečnosti your kako kidneys bi se are sprečilo functioning. oštećenje You bubrega. will be asked to Obavestite drink plenty svog of fluids lekara to ako prevent primetite your bilo kidneys kakve from promene becoming sluha ili damaged. Vam se javi tinitus. Promene sluha obično su privremenog karaktera, Tell your doctor ali ponekad if you mogu notice biti any i trajne. changes in your hearing or experience tinnitus. Changes in hearing are usually temporary but can occasionally be permanent. Vaša krvna slika biće često praćena tokom čitavog trajanja Your blood cell counts will be monitored frequently throughout lečenja kako bi se otkrila neutropenija Vaš lekar može da your treatment in order to detect any neutropenia your doctor prilagodi terapiju na osnovu rezultata analiza i da Vam savete o may adjust your treatment according to test results and will tome kako da sprečite infekcije. Obavestite svog lekara o svakoj advise you on how to prevent infections. Report any fever to your povišenoj temperaturi jer to može biti znak infekcije. doctor, as this may be a sign of infection. Pre i tokom lečenja biće Vam rađene analize kako bi se proverila funkcija You will Vaših have tests bubrega, before i bićete and during zamoljeni treatment da pijete to check dosta how tečnosti kako well your biste kidneys sprečili are oštećenje functioning, bubrega. and you will be asked to drink plenty of fluids to prevent your kidneys from becoming damaged. Vaš lekar će moći da Vam pomogne u sprečavanju ili rešavanju Your doctor mučnine will be able ili povraćanja. to help you prevent or manage any nausea or vomiting. Alopecija može da uznemiri mnoge pacijente; Vaš lekar će Vam pružiti Alopecia informacije can be upsetting o tome kako for many da se patients; nosite sa your ovim doctor neželjenim will dejstvom. provide you U nekim with information bolnicama on možete how to da cope dobijete with hladne this side kape effect. kako Some bi hospitals se smanjilo can opadanje provide cold kose. caps to reduce hair loss. 40 nastavak continued na sledećoj overleaf strani

41 ESMO Vodič Patients za pacijente Guide HEMOTERAPIJSKI CHEMOTHERAPY LEK DRUG Docetaksel Docetaxel (Sažetak karakteristika (Taxotere SPC, 2005) leka za Taksoter, 2005.) Pegilisani lipozomalni Pegylated liposomal doksorubicin doxorubicin (Sažetak (Caelyx SPC, 2016) karakteristika leka Caelyx, 2016.) MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT DEJSTVO Alopecija Alopecia Anemija Anaemia Anoreksija Anorexia Astenija Asthenia Proliv Diarrhoea Oštećenje Extravasation-related tkiva izazvano tissue damage ekstravazacijom Increased infections Učestale infekcije Nail disorders Poremećaji noktiju Nausea Mučnina Neutropenia Neutropenija Oedema Edem Peripheral neuropathy Periferna neuropatija Skin reaction Reakcije na koži Stomatitis Stomatitis Thrombocytopenia Trombocitopenija Vomiting Povraćanje Sindrom šaka-stopalo Neutropenija Hand-foot syndrome Stomatitis Neutropenia Trombocitopenija Stomatitis Thrombocytopenia KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Vaša krvna slika biće često proveravana tokom čitavog Your blood cell counts will be monitored frequently throughout trajanja terapije kako bi se otkrila neutropenija, anemija ili your treatment in order to detect any neutropenia, anaemia trombocitopenija Vaš lekar može da prilagodi terapiju na or thrombocytopenia your doctor may adjust your treatment osnovu rezultata analiza i pruži savete o tome kako da sprečite according to test results and will advise you on how to prevent infekcije. infections. Prijavite sve znake periferne neuropatije svom lekaru koji će Report any signs of peripheral neuropathy to your doctor, Vam pomoći u rešavanju problema sa tim neželjenim dejstvom. who will help you to manage this side effect. Dejstva na gastrointestinalni sistem (mučnina, povraćanje i Effects proliv) i on stomatitis the gastrointestinal mogu da dovedu system do gubitka (nausea, apetita vomiting, (anoreksije) diarrhoea) and ili stomatitis osećaja slabosti may (astenije). result in loss Vaš of lekar appetite će moći da (anorexia) Vam pomogne or feelings u sprečavanju of weakness ili rešavanju (asthenia). ovih Your neželjenih doctor dejstava. will be able to help you to prevent or manage these side effects. Obavestite Let your doctor svog know lekara if ukoliko you experience Vam se jave any bilo nail kakve changes, promene skin na reactions noktima, or reakcije fluid retention/swelling na koži ili zadržavanje (oedema) tečnosti/otok they will (edem) help - on you će to Vam manage pomoći these u rešavanju side effects. tih neželjenih dejstava. Alopecija Alopecia can može be upsetting da uznemiri for mnoge many patients; pacijente; your Vaš doctor lekar will će Vam pružiti provide informacije you with information o tome kako on how da se to nosite cope with sa ovim this side neželjenim effect. dejstvom. Some hospitals U nekim can bolnicama provide cold možete caps da to dobijete reduce hair hladne loss. kape kako Let your bi se doctor smanjilo know opadanje if you experience kose. any burning or skin Obavestite changes at svog the injection lekara ukoliko site, so osetite that they pečenje can ili decide promene how na to koži manage mestu these. uboda Many igle extravasations za injekciju, kako cause bi on very mogao little damage, odluči šta but da you preduzme.mnoge may need to be treated ekstravazacije with an antidote izazivaju and samo apply malo oštećenje, compresses ali to možda the area će biti for potrebno a few days da (Perez primate Fidalgo antidot et al. i stavljate 2012). zavoje na zahvaćeni deo nekoliko dana (Perez Fidalgo et al. 2012). Vaša krvna slika biće često analizirana tokom čitavog trajanja Your blood terapije cell counts kako bi will se otkrila be monitored neutropenija frequently ili throughout trombocitopenija your treatment in order Vaš to detect lekar može any neutropenia da prilagodi terapiju or na thrombocytopenia osnovu rezultata analiza your i doctor da Vam may savete adjust o tome your kako treatment da sprečite according infekcije. to test results and will advise you on how to prevent Radi infections. sprečavanja i lečenja sindroma šaka-stopalo, možete da To pokušate prevent and da treat rashlađujete hand-foot šake syndrome, i stopala u you hladnoj can try vodi keeping (potapanje, hands and feet kupke cool ili by plivanje), exposing izbegavanjem them to cool pregrevanja/tople water (soaks, vode baths i or tako swimming), što ćete se avoiding truditi da excessive ih ne stiskate heat/hot (uske water čarape, and rukavice keeping them i cipele). unrestricted Vaš raspored (no socks, primanja gloves terapije or shoes možda that će are morati tight fitting). da bude Your korigovan treatment ukoliko schedule se kod may Vas need javi to težak be adjusted oblik if sindroma you experience šaka-stopalo, severe hand-foot ali u većini syndrome slučajeva but simptomi in most će cases, biti symptoms blagi i moći will be ćete mild da and ih lečite treatable kremama with creams i mastima, and te ointments će se povući and will kada subside završite once sa you primanjem have finished terapije. treatment. Kako To prevent biste sprečili and treat i lečili stomatitis, stomatitis, you can možete maintain da održavate good oral dobru hygiene oralnu using higijenu a steroid pomoću mouthwash tečnosti and za mild ispiranje toothpaste. usta sa Steroid kortikosteriodima dental paste can be i blage used paste to treat za developing zube. Pasta ulcerations. za zube sa For kortikosteroidima more severe (grade može 2 and se above) koristiti stomatitis, za lečenje ulceracija your doctor (ranica, may čireva) suggest koje lowering se javljaju. the dose U slučaju of treatment, težeg stomatitisa or delaying therapy (gradus until 2 the i viši), stomatitis Vaš lekar resolves, može predložiti but in most smanjenje cases, symptoms doze terapije, will ili be odlaganje mild and will terapije subside dok once stomatitis you have ne finished prođe, a treatment. simptomi su blagi u većini slučajeva i prolaze kada se završi primanje terapije. nastavak continued na sledećoj overleaf strani 41

42 Rak Breast dojke cancer HEMOTERAPIJSKI CHEMOTHERAPY LEK DRUG Nelipozomalni Non-liposomal doksorubicin doxorubicin (Sažetak karakteristika (Doxorubicin SPC, leka 2016) Doksorubicin, 2016.) MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT DEJSTVO Abnormalni hepatic hepatični enzimi enzymes Alopecia Alopecija Anaemia Anemija Anorexia Anoreksija Asthenia Astenija Cardiac Oštećenja effects srca Chills Drhtavica Diarrhoea Proliv Extravasation-related Oštećenje tkiva tissue izazvano damage ekstravazacijom Fever Hand-foot Povišena temperatura syndrome Increased Sindrom šaka-stopalo infections Increased Učestale infekcije weight Leukopenia Povećana težina Mucositis Leukopenija Nausea Mukozitis Neutropenia Mučnina Stomatitis Neutropenija Thrombocytopenia Stomatitis Vomiting Trombocitopenija Povraćanje KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Vaša Your blood krvna cell slika counts će redovno will be biti monitored praćena frequently tokom lečenja throughout kako your treatment bi se otkrila in order anemija, to detect leukopenija, any anaemia, neutropenija leukopenia, ili trombocitopenija neutropenia or thrombocytopenia Vaš lekar će prilagoditi your terapiju doctor may na osnovu adjust rezultata your treatment analiza according i dati savete to test o tome results kako and da will sprečite advise you infekcije. on how Obavestite to prevent infections. svog lekara Report o svakoj any povišenoj fever to your temperaturi doctor, as jer this to may može be a sign biti of znak infection. infekcije. Rad Your Vašeg cardiac srca function biće praćen will be pre monitored i tokom terapije before and nelipozomalnim during doksorubicinom treatment with non-liposomal kako bi se na doxorubicin najmanju moguću to minimise meru sveo the risk rizik of cardiac od oštećenja impairment. srca. Radi To prevent sprečavanja and treat i lečenja hand-foot sindroma syndrome, šaka-stopalo, you can try možete keeping da hands pokušate and feet da cool rashlađujete by exposing šake them i stopala to cool u water hladnoj (soaks, vodi baths (potapanje, or swimming), kupke avoiding ili plivanje), excessive izbegavanjem heat/hot water pregrevanja/tople and keeping vode them i unrestricted tako što ćete (no se socks, truditi gloves da ih ne or shoes stiskate that (uske are tight čarape, fitting). rukavice Your treatment i cipele). schedule Vaš raspored may need primanja to be adjusted terapije if možda you experience će morati severe da hand-foot bude korigovan syndrome ukoliko but se in most kod Vas cases, javi symptoms težak oblik will sindroma be mild and šaka-stopalo, treatable with creams ali u većini and ointments slučajeva and simptomi will subside će biti blagi once you i moći have ćete finished da ih lečite treatment. kremama i mastima, te će se povući kada završite sa primanjem terapije. Effects on the gastrointestinal system (nausea, vomiting, Dejstva na gastrointestinalni sistem (mučnina, povraćanje diarrhoea) and stomatitis may result in loss of appetite i proliv) i stomatitis mogu da dovedu do gubitka apetita (anorexia) or feelings of weakness (asthenia). Your doctor will (anoreksije) ili osećaja slabosti (astenije). Vaš lekar će moći be able to help you to prevent or manage these side effects. da Vam pomogne u sprečavanju ili rešavanju ovih neželjenih dejstava. To prevent and treat stomatitis/mucositis, you can maintain good oral hygiene using a steroid mouthwash and mild Kako biste sprečili i tretirali stomatitis/mukozitis, možete da toothpaste. Steroid dental paste can be used to treat developing održavate dobru oralnu higijenu pomoću tečnosti za ispiranje ulcerations. For more severe (grade 2 and above) stomatitis, usta sa kortikosteroidima i blage paste za zube. Steroidna your doctor may suggest lowering the dose of treatment, or dentalna pasta može se koristiti za tretman ulceracija (ranica, delaying therapy until the stomatitis resolves, but in most čireva) koje se javljaju. U slučaju težeg stomatitisa (gradus cases, symptoms will be mild and will subside once you have 2 i viši), Vaš lekar može predložiti smanjenje doze terapije, ili finished treatment. odlaganje terapije dok stomatitis ne prođe, ali će simptomi biti blagi Alopecia u većini can slučajeva be upsetting i proći for će many kada patients; završite your sa primanjem doctor will terapije. provide you with information on how to cope with this side effect. Alopecija Some hospitals može can da provide uznemiri cold mnoge caps pacijente; to reduce Vaš hair lekar loss. će Vam pružiti Let your informacije doctor know o tome if you kako experience da se any nosite burning sa ovim or skin neželjenim changes dejstvom. at the injection U nekim site, so bolnicama that they možete can decide da how dobijete to manage hladne these. kape kako Extravasations bi se smanjilo can opadanje cause necrosis kose. and you may need to have Obavestite treatment for svog the tissue lekara damage ukoliko (Perez osetite Fidalgo pečenje et al. ili 2012). promene na koži na mestu uboda igle za injekciju, kako bi on mogao da odluči šta da preduzme. Ekstravazacije mogu da izazovu nekrozu i možda će biti potrebno da se tretira oštećeno tkivo (Perez Fidalgo et al. 2012). 42 nastavak continued na sledećoj overleaf strani

43 ESMO Vodič Patients za pacijente Guide HEMOTERAPIJSKI CHEMOTHERAPY LEK DRUG Epirubicin (Sažetak (Epirubicin karakteristika hydrochloride leka SPC, Epirubicin 2017) hidrohlorid, 2017.) MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT DEJSTVO Abnormalni hepatic hepatični enzimi enzymes Alopecija Alopecia Anemija Anaemia Anoreksija Anorexia Astenija Asthenia Oštećenja Cardiac effects srca Drhtavica Chills Proliv Diarrhoea Oštećenje Extravasation-related tkiva tissue izazvano damage ekstravazacijom Fever Povišena Hand-foot temperatura syndrome Sindrom Increased šaka-stopalo infections Učestale Increased infekcije weight Povećana Leukopenia težina Leukopenija Mucositis Mukozitis Nausea Mučnina Neutropenia Neutropenija Stomatitis Stomatitis Thrombocytopenia Trombocitopenija Vomiting Povraćanje KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Vaša Your blood krvna slika cell counts će redovno will be biti monitored praćena tokom frequently lečenja throughout kako your treatment bi se otkrila in anemija, order to detect leukopenija, any anaemia, neutropenija leukopenia, ili trombocitopenija neutropenia or thrombocytopenia Vaš lekar će prilagoditi your terapiju doctor may na osnovu adjust rezultata your treatment analiza according i dati savete to test o tome results kako and da will sprečite advise infekcije. you on Obavestite how to prevent svog infections. lekara o svakoj Report povišenoj any fever temperaturi to your doctor, jer to as this može may be biti a znak sign of infekcije. infection. Rad Your Vašeg cardiac srca function biće praćen will be monitored pre i tokom before terapije and epirubicinom during treatment kako with epirubicin se na najmanju to minimise moguću the meru risk of sveo cardiac rizik impairment. od oštećenja srca. To prevent and treat hand-foot syndrome, you can try keeping Radi hands sprečavanja and feet cool i lečenja by exposing sindroma them šaka-stopalo, to cool water (soaks, možete da baths pokušate or swimming), da rashlađujete avoiding šake excessive i stopala heat/hot u hladnoj water vodi and (potapanje, keeping them kupke unrestricted ili plivanje), (no izbegavanjem socks, gloves pregrevanja/tople or shoes that are vode tight fitting). i tako što Your ćete treatment se truditi schedule da ih ne may stiskate need (uske to be čarape, adjusted if rukavice you experience i cipele). severe Vaš raspored hand-foot primanja syndrome terapije but možda in most će cases, morati symptoms da bude will be korigovan mild and ukoliko treatable se kod with Vas creams javi težak and ointments oblik sindroma and will subside šaka-stopalo, once you have ali u finished većini slučajeva treatment. simptomi će biti blagi i moći ćete da ih lečite kremama i mastima, te će se povući Effects kada on the završite gastrointestinal sa primanjem system terapije. (nausea, vomiting, diarrhoea) and stomatitis may result in loss of appetite Dejstva na gastrointestinalni sistem (mučnina, povraćanje (anorexia) or feelings of weakness (asthenia). Your doctor will i proliv) i stomatitis mogu da dovedu do gubitka apetita be able to help you to prevent or manage these side effects. (anoreksije) ili osećaja slabosti (astenije). Vaš lekar će moći da To Vam prevent pomogne and treat u sprečavanju stomatitis/mucositis, ili rešavanju ovih you can neželjenih maintain dejstava. good oral hygiene using a steroid mouthwash and mild toothpaste. Steroid dental paste can be used to treat developing Kako biste sprečili i tretirali stomatitis/mukozitis, možete da ulcerations. For more severe (grade 2 and above) stomatitis, održavate dobru oralnu higijenu pomoću tečnosti za ispiranje your doctor may suggest lowering the dose of treatment, or usta sa kortikosteroidima i blage paste za zube. Steroidna delaying therapy until the stomatitis resolves, but in most dentalna pasta može se koristiti za tretman ulceracija (ranica, cases, symptoms will be mild and will subside once you have čireva) koje se javljaju. U slučaju težeg stomatitisa (gradus finished treatment. 2 i viši), Vaš lekar može predložiti smanjenje doze terapije, ili odlaganje Alopecia terapije can be upsetting dok stomatitis for many ne patients; prođe, ali your će simptomi doctor will biti provide blagi you u većini with information slučajeva i proći on how će kada to cope završite with this sa side effect. primanjem Some hospitals terapije. can provide cold caps to reduce hair loss. Alopecija Let your doctor može know da uznemiri if you experience mnoge pacijente; any burning Vaš or lekar skin će Vam pružiti changes informacije at the injection o tome site, kako so da that se they nosite can sa decide ovim neželjenim how to dejstvom. manage these. U nekim Extravasations bolnicama možete can cause da dobijete necrosis hladne and you kape kako may need bi se to smanjilo have treatment opadanje for kose. the tissue damage (Perez Fidalgo Obavestite et al. 2012). svog lekara ukoliko osetite pečenje ili promene na koži na mestu uboda igle za injekciju, kako bi on mogao da odluči šta da preduzme. Ekstravazacije mogu da izazovu nekrozu i možda će biti potrebno da Vam se tretira oštećeno tkivo (Perez Fidalgo et al. 2012). nastavak continued na sledećoj overleaf strani 43

44 Rak Breast dojke cancer HEMOTERAPIJSKI CHEMOTHERAPY LEK DRUG Eribulin (Sažetak (Halaven karakteristika SPC, 2017) leka Halaven, 2017.) MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT DEJSTVO Alopecia Alopecija Anaemia Anemija Anorexia Anoreksija Arthralgia/myalgia Artralgija/mijalgija Back Bolovi pain u leđima and pain i in bolovi extremity u udovima Constipation Zatvor Cough Kašalj Diarrhoea Proliv Dyspnoea Dispneja Fatigue Zamor Fever Povišena temperatura Headache Glavobolja Nausea Mučnina Neutropenia Neutropenija Peripheral Periferna neuropatija neuropathy Vomiting Povraćanje Gemcitabine Alopecia (Gemcitabine SPC, 2017) Anaemia Gemcitabin Alopecija Dyspnoea (Sažetak karakteristika Anemija Flu-like symptoms leka za Gemcitabin, Dispneja Increased hepatic 2017.) Simptomi slični gripu enzymes Povišen nivo hepatičnih Leukopenia enzima Nausea Leukopenija Oedema Mučnina Rash Edem Renal effects Osip Thrombocytopenia Oštećenja bubrega Vomiting Trombocitopenija Povraćanje KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Vaša Your blood krvna cell slika counts biće često will be praćena monitored tokom frequently čitavog throughout trajanja terapije your treatment kako bi in se order otkrila to detect neutropenija any neutropenia ili anemija or anaemia Vaš lekar your doctor može da may prilagodi adjust your terapiju treatment na osnovu according rezultata to test analiza results i and pruži will advise Vam savete you on o how tome prevent kako da infections. sprečite infekcije. Report any Obavestite fever to svog your doctor, lekara o as svakoj this may povišenoj be a sign temperaturi of infection. jer to može biti znak infekcije. Report any signs of peripheral neuropathy to your doctor, who Prijavite will help sve you znake to manage periferne this side neuropatije effect. svom lekaru koji će Vam pomoći u rešavanju problema sa tim neželjenim dejstvom. Effects on the gastrointestinal system (nausea, vomiting, Dejstva diarrhoea, na constipation) gastrointestinalni may result sistem in loss (mučnina, of appetite povraćanje, (anorexia). proliv, Your doctor zatvor) will mogu be able da dovedu to help you do gubitka to prevent apetita or manage (anoreksije). these Vaš side lekar effects. će moći da Vam pomogne u sprečavanju ili rešavanju ovih neželjenih dejstava. Let your doctor know if you experience a persistent cough. Obavestite svog lekara ako imate uporan kašalj. Neprijatna Troublesome dyspnoea can be treated with drugs called opioids dispneja može se lečiti lekovima koji se nazivaju opioidi or benzodiazepines, and in some cases steroids are used (Kloke ili benzodiazepini, a u nekim slučajevima se koriste i and Cherny 2015). kortikosteroidi (Kloke and Cherny 2015). Alopecia can be upsetting for many patients; your doctor will Alopecija može da uznemiri mnoge pacijente; Vaš lekar će provide you with information on how to cope with this side effect. Vam pružiti informacije o tome kako da se nosite sa ovim Some hospitals can provide cold caps to reduce hair loss. neželjenim dejstvom. U nekim bolnicama možete da dobijete hladne Let your kape doctor kako know bi if se you smanjilo experience opadanje arthralgia, kose. myalgia, Obavestite headache or svog pain lekara and they ukoliko will help Vam you se to pojave manage artralgija, these side mijalgija, effects. glavobolja ili bolovi u mišićima i on će Vam pomoći u rešavanju tih neželjenih dejstava. Your blood cell counts will be monitored frequently throughout your treatment in order to detect any leukopenia, anaemia or Vaša krvna slika biće često proveravana u toku lečenja kako bi thrombocytopenia your doctor may adjust your treatment se otkrila leukopenija, anemija ili trombocitopenija Vaš according to test results and will advise you on how to prevent lekar može da prilagodi terapiju na osnovu rezultata analiza i infections. pruži Vam savete o tome kako da sprečite infekcije. Obavestite Let your doctor svog know lekara if ako you imate experience uporan a kašalj. persistent Neprijatna cough. dispneja Troublesome može dyspnoea se lečiti lekovima can be treated koji se with nazivaju drugs opioidi called ili benzodijazepini, opioids or benzodiazepines, a u nekim slučajevima and in some se koriste cases steroids i steroidi are used (Kloke and Cherny 2015). However, this is usually mild and (Kloke and Cherny 2015). Ipak, ona je obično blaga i prolazi brzo i passes bez lečenja. rapidly without treatment. Obavestite Let your doctor svog know lekara if ukoliko you experience Vam se any jave skin bilo reactions, kakve reakcije flulike koži, symptoms simptomi or fluid nalik retention/swelling gripu ili zadržavanje (oedema) tečnosti /oticanje they will na (edem) help you to on manage će Vam these pomoći side u rešavanju effects. tih neželjenih dejstava. Funkcija Your renal Vaših and bubrega hepatic i jetre function pažljivo will će be biti closely praćena monitored pre, tokom before, i during nakon terapije. and after treatment. Alopecija Alopecia can može be da upsetting uznemiri for mnoge many patients; pacijente; your Vaš doctor lekar će will Vam pružiti provide informacije you with information o tome kako on da how se to nosite cope sa with ovim this neželjenim side effect. dejstvom. Some hospitals U nekim can bolnicama provide cold možete caps da to dobijete reduce hladne hair loss. kape kako bi se smanjilo opadanje kose. nastavak continued na sledećoj overleaf strani 44

45 ESMO Vodič Patients za pacijente Guide HEMOTERAPIJSKI CHEMOTHERAPY LEK DRUG Metotreksat Methotrexate (Sažetak karakteristika (Methotrexate leka SPC, za Metotreksat, 2017) 2017.) Paklitaksel (Sažetak Paclitaxel karakteristika leka (Paclitaxel za Paklitaksel, SPC, 2017) 2017.) MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT DEJSTVO Bol Abdominal u trbuhupain Alergijske Allergic reactions reakcije Anoreksija Anorexia Povišena Fever temperatura Učestale Increased infekcije infections Leukopenija Leukopenia Mučnina Nausea Oštećenja Renal effects bubrega Stomatitis Trombocitopenija Thrombocytopenia Povraćanje Vomiting Alopecija Anemija Alopecia Artralgija Anaemia Krvarenje Arthralgia Proliv Bleeding Reakcije Diarrhoea preosetljivosti Hypersensitivity Učestale reactionsinfekcije Leukopenija Increased infections Nizak Leukopenia krvni pritisak Mukozitis Low blood pressure Mijalgija Mucositis Poremećaji Myalgia noktiju Mučnina Nail disorders Neutropenija Nausea Periferna Neutropenia neuropatija Trombocitopenija Peripheral neuropathy Povraćanje Thrombocytopenia Vomiting KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Vaša Your krvna blood slika cell counts biće često will praćena be monitored u toku frequently lečenja kako throughout bi se otkrila your treatment leukopenija in order ili trombocitopenija to detect any leukopenia Vaš lekar or može da prilagodi thrombocytopenia terapiju na osnovu your rezultata doctor may analiza adjust i pruži your Vam treatment savete o according tome kako to da test sprečite results infekcije. and will advise Obavestite you svog on how lekara to prevent o svakoj infections. povišenoj Report temperaturi any fever to jer your to može doctor, biti as znak this infekcije. may be a Dejstva sign of infection. na gastrointestinalni sistem (mučnina, povraćanje, stomatitis) Effects on the mogu gastrointestinal da dovedu do gubitka system apetita (nausea, (anoreksije). vomiting, Vaš stomatitis) lekar će moći may result da Vam in pomogne loss of appetite u sprečavanju (anorexia). ili rešavanju Your ovih doctor neželjenih will be able dejstava. to help you to prevent or manage these side Funkcija effects. Vaših bubrega pažljivo će biti praćena pre, tokom i nakon Your renal terapije. function will be closely monitored before, during and after treatment. Vaša krvna slika biće često analizirana tokom čitavog trajanja terapije Your blood kako cell bi counts se otkrila will neutropenija, be monitored frequently leukopenija, throughout anemija your treatment ili trombocitopenija in order to detect any Vaš neutropenia, lekar može da leukopenia, prilagodi terapiju anaemia na or osnovu thrombocytopenia rezultata analiza i your da Vam doctor savete may o adjust tome kako your da treatment sprečite according infekcije. to test results and will advise you on how to Obavestite prevent infections. svog lekara o svim dejstvima na gastrointestinalni sistem (mučnina, povraćanje, proliv) jer n može da Vam Report any effects on the gastrointestinal system (nausea, pomogne u sprečavanju ili rešavanju ovih neželjenih dejstava. vomiting, diarrhoea) to your doctor as they may be able to help Prijavite you to prevent sve znake or manage periferne these neuropatije side effects. svom lekaru koji će Vam pomoći u rešavanju problema sa tim neželjenim dejstvom. Report any signs of peripheral neuropathy to your doctor, who Kako will help biste you sprečili to manage i tretirali this stomatitis/mukozitis, side effect. možete da održavate dobru oralnu higijenu pomoću tečnosti za ispiranje To prevent and treat stomatitis/mucositis, you can maintain usta sa kortikosteroidima i blage paste za zube. Steroidna good oral hygiene using a steroid mouthwash and mild dentalna pasta može se koristiti za tretman ulceracija (ranica, toothpaste. Steroid dental paste can be used to treat developing čireva) koje se javljaju. U slučaju težeg stomatitisa (gradus ulcerations. For more severe (grade 2 and above) stomatitis, 2 i viši), Vaš lekar može predložiti smanjenje doze terapije, ili your doctor may suggest lowering the dose of treatment, or odlaganje terapije dok stomatitis ne prođe, ali će simptomi biti delaying therapy until the stomatitis resolves, but in most blagi u većini slučajeva i proći će kada završite sa primanjem cases, symptoms will be mild and will subside once you have terapije. finished treatment. Obavestite svog lekara ako Vam se jave promene na noktima, artralgija Let your doctor ili mijalgija, know if you kako experience bi on mogao nail changes, da odluči arthralgia šta da preduzme. or myalgia, so that they can decide how to manage these. Alopecija Alopecia can može be da upsetting uznemiri for mnoge many patients; pacijente; your Vaš doctor lekar će will Vam pružiti provide informacije you with information o tome kako on da how se to nosite cope sa with ovim this neželjenim side effect. dejstvom. Some hospitals U nekim can bolnicama provide cold možete caps da to dobijete reduce hladne hair loss. kape kako bi se smanjilo opadanje kose. nastavak continued na sledećoj overleaf strani 45

46 Rak Breast dojke cancer HEMOTERAPIJSKI CHEMOTHERAPY LEK DRUG Vinorelbin (Sažetak (Navelbine karakteristika SPC, 2017) leka za Navelbin, 2017.) 5-fluorouracil 5-fluorouracil (Sažetak karakteristika (Fluorouracil SPC, 2017) leka Fluorouracil, 2017.) MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT DEJSTVO Abdominal Bol u trbuhupain Alopecia Alopecija Anaemia Anemija Anorexia Anoreksija Zatvor Constipation Proliv Diarrhoea Oštećenje tkiva izazvano Extravasation-related ekstravazacijom tissue Zamordamage Fatigue Povišena temperatura Fever Gastrointestinalni poremećaji Gastric disorders Increased Učestale infekcije infections Leukopenia Leukopenija Nausea Mučnina Neurological Neurološki poremećaji disorders Neutropenia Neutropenija Skin Reakcije reactions na koži Stomatitis Stomatitis Trombocitopenija Thrombocytopenia Povraćanje Vomiting Agranulocitoza Agranulocytosis Alopecija Anemija Alopecia Anoreksija Anaemia Bronhospazam Anorexia Oštećenja Bronchospasm srca Smanjena Cardiac effects funkcija koštane Decreased srži bone marrow function Sporije Delayed zarastanje wound healing rana Proliv Diarrhoea Preterana Excess uric količina acid mokraćne Fatigue kiseline Zamor Hand-foot syndrome Sindrom šaka-stopalo Increased infections Učestale infekcije Leukopenija Leukopenia Mukozitis Mucositis Mučnina Nausea Neutropenija Neutropenia Krvarenje Nose bleeds iz nosa Pancitopenija Pancytopenia Trombocitopenija Thrombocytopenia Povraćanje Vomiting Slabost Weakness KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Vaša Your blood krvna slika cell counts biće često will praćena be monitored u toku frequently lečenja kako bi se otkrila neutropenija, throughout your leukopenija, treatment in order anemija to detect ili trombocitopenija any neutropenia, Vaš lekar leukopenia, može da anaemia prilagodi terapiju or thrombocytopenia na osnovu rezultata your analiza doctor i pruži Vam savete may adjust o tome your kako treatment da sprečite according infekcije. to test Obavestite results svog and will lekara o svakoj povišenoj advise you temperaturi on how to jer prevent to može infections. biti znak Report infekcije. any fever to Dejstva your doctor, na gastrointestinalni this may be a sign sistem of infection. (mučnina, povraćanje, proliv, Effects bolovi on the u gastrointestinal trbuhu, zatvor) i stomatitis system (nausea, mogu da vomiting, dovedu do gubitka apetita diarrhoea, (anoreksije). abdominal Vaš pain, lekar constipation) će moći da and Vam stomatitis pomogne u may sprečavanju ili result rešavanju in loss ovih of appetite neželjenih (anorexia). dejstava. Your doctor will be able to Obavestite help you to svog prevent lekara or manage o svim znacima these side neuroloških effects. poremećaja (npr. slabost Report any u nogama signs of i stopalima) neurological jer će disorders on odlučiti (e.g. šta weakness da preduzme u pogledu of the tih legs neželjenih and feet) dejstava. to your doctor, who will decide how to Obavestite manage these svog side lekara effects. ukoliko osetite pečenje ili primetite promene na koži Let your na mestu doctor uboda know igle if you za injekciju, experience kako any bi burning on mogao or skin da odluči šta da preduzme. changes at the injection site, so that they can decide how to Alopecija manage these. može da uznemiri mnoge pacijente; Vaš lekar će Vam pružiti informacije Alopecia can o tome be upsetting kako da se for nosite many sa patients; ovim neželjenim your doctor dejstvom. will U nekim provide bolnicama you with information možete da dobijete on how to hladne cope with kape this kako side bi effect. se smanjilo opadanje Some hospitals kose. can provide cold caps to reduce hair loss. Obavestite Let your doctor svog lekara know if ukoliko you experience osetite pečenje any burning ili primetite or skin promene na koži. na changes mestu at uboda the injection igle za injekciju, site, so that kako they bi on can mogao decide da how odluči to šta da preduzme. manage Mnoge these. ekstravazacije Many extravasations izazivaju cause samo very malo little oštećenje, damage, ali možda će but biti you potrebno may need da to primate be treated antidot with i stavljate an antidote zavoje and na apply zahvaćeni deo nekoliko compresses dana to (Perez the area Fidalgo for a et few al. 2012). days (Perez Fidalgo et al. 2012). Vaša krvna slika biće često praćena u toku lečenja kako bi se otkrila Your blood cell counts will be monitored frequently throughout neutropenija, leukopenija, anemija, trombocitopenija ili pancitopenija Vaš lekar može da prilagodi terapiju na osnovu rezultata anal- your treatment in order to detect any neutropenia, leukopenia, anaemia, thrombocytopenia or pancytopenia your doctor iza i pruži Vam savete o tome kako da sprečite infekcije. Obavestite svog may adjust your treatment according to test results and will advise lekara o svakoj povišenoj temperaturi jer to može biti znak infekcije. you on how to prevent infections. Report any fever to your doctor, Dejstva as this may na gastrointestinalni be a sign of infection. sistem (mučnina, povraćanje, proliv) mogu Effects da on dovedu the gastrointestinal do gubitka apetita system (anoreksije). (nausea, Vaš vomiting, lekar će moći da Vam diarrhoea) pomogne may u result sprečavanju in loss of ili appetite rešavanju (anorexia). ovih neželjenih Your dejstava. doctor Radi will be sprečavanja able to help i lečenja you to prevent sindrom or manage šaka-stopalo, these side možete effects. da pokušate da To prevent rashlađujete and treat šake hand-foot i stopala u syndrome, hladnoj vodi you (potapanje, can try keeping kupke ili plivanje), hands and izbegavate feet cool by pregrevanje exposing them /toplu to vodu cool i water tako što (soaks, ćete se truditi da baths ih ne or stiskate swimming), (previše avoiding tesne excessive čarape, rukavice heat/hot i water cipele). and Vaš raspored primanja keeping them terapije unrestricted možda će (no morati socks, da gloves bude korigovan shoes ukoliko that are se kod Vas javi tight težak fitting). oblik Your sindroma treatment šaka-stopalo, schedule may ali need u većini to be adjusted slučajeva if simptomi će you biti experience blagi i moći severe ćete hand-foot da ih lečite syndrome kremama i but mastima, in most te cases, će povući kada symptoms završite will sa be primanjem mild and treatable terapije.. with creams and ointments Kako and will biste subside sprečili once i tretirali you have stomatitis/mukozitis, finished treatment. možete da održavate dobru To prevent oralnu and higijenu treat stomatitis/mucositis, pomoću tečnosti za ispiranje you can usta maintain sa kortikosteroidima good i oral blage hygiene paste using za zube. a steroid Steroidna mouthwash dentalna and pasta mild može toothpaste. se koristiti za tretman Steroid dental ulceracija paste (ranica, can be čireva) used to koje treat se developing javljaju U ulcerations. slučaju težeg stomatitisa For more (gradus severe 2 (grade i viši), Vaš 2 and lekar above) može stomatitis, predložiti smanjenje your doctor doze may terapije, ili suggest odlaganje lowering terapije the dok dose stomatitis of treatment, ne or prođe, delaying ali će therapy simptomi until biti blagi u većini the stomatitis slučajeva resolves, i proći će but kada in most završite cases, sa primanjem symptoms terapije. will be mild Alopecija and will subside može once da uznemiri you have mnoge finished pacijente; treatment. Vaš lekar će Vam pružiti informacije Alopecia can o tome be upsetting kako da se for nosite many patients; sa ovim neželjenim your doctor dejstvom. will U nekim provide bolnicama you with information možete da dobijete on how to hladne cope with kape this kako side bi effect. se smanjilo opadanje Some hospitals kose. can provide cold caps to reduce hair loss. Važna Important neželjena side effects dejstva associated pojedinačnih with hemoterapijskih individual chemotherapy lekova koji drugs se koriste used u in lečenju the treatment raka dojke. of breast cancer. Najnovije The most verzije recent Summary sažetka karakteristika of Product Characteristics leka za pojedinačne (SPCs) lekove for individual mogu se drugs naći can na: be located at: 46

47 ESMO Vodič Patients za pacijente Guide Endokrine Endocrine therapies terapije Najčešća The common neželjena side effects dejstva in koja patients se javljaju treated kod with pacijenata endocrine lečenih therapies endokrinim often relate lekovima to the često reduced se odnose action na of smanjenu oestrogen aktivnost (e.g. hot estrogena flushes, increased (npr. naleti sweating). vrućine, pojačano Many of the znojenje). side effects Mnoga from neželjena endocrine dejstva therapies endokrinih can be terapija mogu se sprečiti ili delotvorno rešiti. Uvek obavestite svog lekara ili medicinsku sestru odmah ukoliko prevented or managed effectively. Always tell your doctor or nurse as soon as possible if you notice any side primetite bilo koje neželjeno dejstvo endokrine terapije. Potiskivanje (supresija) funkcije jajnika može da effects from taking an endocrine therapy. Ovarian function suppression can cause menopausal symptoms izazove simptome menopauze kao što su naleti vrućine, pojačano znojenje, suvoća vagine i gubitak interesovanja za such polne as hot odnose. flushes, Vaš increased lekar ili specijalizovana sweating, vaginal medicinska dryness and sestra a loss moći of interest će da Vam in sex. pomognu Your doctor u rešavanju or specialist ovih simptoma. nurse will be able to help you manage these symptoms. TERAPIJA THERAPY MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI DEJSTVO Anastrozole Arthralgia/joint stiffness If you are at risk of osteoporosis, which is more common with Anastrozol (Arimidex SPC, 2014) Artralgija/ukočenost Asthenia u Ukoliko advancing ste age, u riziku you od will osteoporoze, have your bone koja mineral se češće density u starijem tested (Sažetak karakteristika zglobovima Headache životnom at the start dobu, of treatment biće Vam and merena at regular mineralna intervals gustina from kostiju then on. na leka Arimideks, 2014.) Astenija Hot flushes početku You will lečenja be advised i u redovnim to have adequate intervalima calcium nakon and toga. vitamin Dobićete Glavobolja Hypercholesterolaemia savete D3 intake o unošenju and may dovoljne be given količine a treatment kalcijuma to stop i vitamina further D3, bone a Naleti Increased vrućine sweating možete mineral dobiti loss. i lekove za sprečavanje daljeg gubitka mineralne Hiperholesterolemija Nausea gustine kostiju. Hypercholesterolaemia of grade 2 and 3 might be treated Pojačano Osteoporosis znojenje Hipeholesterolemija with drugs called statins gradusa and fibrates. 2 i 3 može Your se doctor lečiti may lekovima also Mučnina Rash koji need se to zovu pause statini or reduce i fibrati. the dose Vaš lekar of your će cancer možda treatment. morati da Osteoporoza pauzira ili smanji dozu terapije protiv raka koju primate. Osip Let your doctor know if you experience any skin reactions, Obavestite arthralgia svog or joint lekara stiffness ukoliko Vam they se will jave help bilo you kakve to manage reakcije these side na effects. koži, artralgija ili ukočenost zglobova on će Vam pomoći u rešavanju tih neželjenih dejstava. Your doctor may be able to help you to manage hot flushes, Vaš lekar može biti u mogućnosti da Vam pomogne u headaches, increased sweating and nausea. rešavanju naleta vrućine, glavobolje, pojačanog znojenja i Exemestane Abdominal pain mučnine. It is important that you tell your doctor if you are suffering from Eksemestan (Aromasin SPC, 2015) Bol Depression u trbuhu Važno depression je da kažete they will svom make lekaru sure ukoliko you get patite the help od depresije you need. (Sažetak karakteristika Depresija Dizziness Let on your će se doctor postarati know za if to you da experience dobijete pomoć insomnia, koja Vam dizziness je or leka Aromazin, 2015.) Vrtoglavica Fatigue potrebna. pain they will help you to manage these side effects. Zamor Headache Obavestite Your doctor svog may lekara be able ukoliko to help se you kod to Vas manage jave nesanica, hot flushes, Glavobolja Hot flushes vrtoglavica increased sweating, ili bolovi headache on će Vam and pomoći nausea. u rešavanju tih Naleti Increased vrućine hepatic neželjenih dejstava. Povišen enzymes nivo hepatičnih enzima Increased sweating Vaš lekar može biti u mogućnosti da Vam pomogne u Pojačano Insomnia rešavanju naleta vrućine, glavobolje, pojačanog znojenja znojenje Nesanica Joint and musculoskeletal i mučnine. Bolovi pain u zglobovima i mišićima Leukopenia Leukopenija Nausea Mučnina Pain Bol nastavak continued na sledećoj overleaf strani 47

48 Rak Breast dojke cancer 48 TERAPIJA MOGUĆE NEŽELJENO KAKO SE NEŽELJENA DEJSTVA MOGU REŠAVATI THERAPY DEJSTVO POSSIBLE SIDE EFFECT HOW THE SIDE EFFECTS MAY BE MANAGED Fulvestrant (Sažetak (Faslodex karakteristika SPC, 2017) leka Fazlodeks, 2017.) Asthenia Astenija Hot Naleti flushes vrućine Hypersensitivity Reakcije Obavestite Let your doctor svog know lekara if ukoliko you experience Vam se jave any bilo skin kakve reactions, reakcije na hypersensitivity koži, preosetljivost or joint/musculoskeletal ili bolovi u zglobovima/mišićima pain they will on help će Vam you to pomoći manage u rešavanju these side tih effects. neželjenih dejstava. preosetljivosti reactions Vaš Your lekar doctor može may biti be u able situaciji to help da Vam you to pomogne manage u hot rešavanju flushes, Increased Povišen nivo hepatic hepatičnih naleta increased vrućine, sweating pojačanog and nausea. znojenja i mučnine. enzima enzymes Increased Pojačano znojenje sweating Injection Reakcije na site mestu reactions uboda Joint Bolovi and u zglobovima musculoskeletal i mišićima pain Nausea Mučnina Rash Osip Analozi Gonadotropinreleasing hormone gonadotropinoslobađajućih analogues hormona (e.g. goserelin) (npr. (Zoladex goserelin) SPC, 2017) (Sažetak karakteristika leka Zoladex, 2017.) Letrozole Letrozol (Femara SPC, 2015) (Sažetak karakteristika leka Femara, 2015.) Megestrol acetate (Megace SPC, 2015) Megestrol acetat (Sažetak karakteristika leka Megace, 2015.) Akne Acne Obavestite Let your doctor svog know lekara if ukoliko you experience Vam se jave any bilo skin kakve reactions Povećanje Breast enlargement dojki reakcije they will na help koži, you to on manage će Vam these pomoći side u rešavanju effects. tih Smanjena Decreased želja sex drive za polnim neželjenih Your doctor dejstava. may be able to help you to manage hot flushes, odnosima Hot flushes Vaš vaginal lekar dryness može biti and u increased mogućnosti sweating. da Vam pomogne u Naleti Increased vrućine sweating rešavanju naleta vrućine, vaginalne suvoće i pojačanog Pojačano Injection site znojenje reactions znojenja. Reakcije Vaginal dryness na mestu uboda Suvoća vagine Arthralgia/joint stiffness If you are at risk of osteoporosis, which is more common with Artralgija/ukočenost Asthenia u Ukoliko advancing ste age, u riziku you od will osteoporoze, have your bone koja mineral se češće density u starijem tested at zglobovima Headache životnom the start of dobu, treatment biće Vam and merena at regular mineralna intervals gustina from then kostiju on. You na Astenija Hot flushes početku will be advised lečenja to i u have redovnim adequate intervalima calcium nakon and vitamin toga. Dobićete D3 intake Glavobolja Hypercholesterolaemia savete and may o unošenju be given a dovoljne treatment količine to stop kalcijuma further bone i vitamina mineral D3, loss. a Naleti Increased vrućine sweating možete dobiti i lekove za sprečavanje daljeg gubitka mineralne Hypercholesterolaemia of grade 2 and 3 might be treated with Hiperholesterolemija Nausea gustine kostiju. drugs called statins and fibrates. Your doctor may also need to Pojačano Osteoporosis znojenje Hipeholesterolemija pause or reduce the dose gradusa of your 2 cancer i 3 može treatment. se lečiti lekovima Mučnina Rash koji se zovu statini i fibrati. Vaš lekar će možda morati da pauzira Osteoporoza ili Let smanji your doctor dozu terapije know if protiv you experience raka koju primate. any skin reactions, Osip arthralgia or joint stiffness they will help you to manage these Obavestite svog lekara ukoliko Vam se jave bilo kakve reakcije side effects. na koži, artralgija ili ukočenost zglobova on će Vam pomoći u rešavanju Your doctor tih may neželjenih be able dejstava. to help you to manage hot flushes, headaches, increased sweating and nausea. Vaš lekar može biti u mogućnosti da Vam pomogne u Adrenal insufficiency rešavanju Your doctor naleta will monitor vrućine, glavobolje, you for signs pojačanog of diabetes, znojenja Cushing s Constipation i syndrome mučnine. and adrenal insufficiency. Hyperglycaemia is Adrenalna Cushing s syndrome Vaš usually lekar treated će with pratiti antidiabetic Vaše zdravstveno drugs stanje radi pojave insuficijencija Diabetes mellitus znaka Let your dijabetesa, doctor know Kušingovog if you experience sindroma a persistent i adrenalne cough. Zatvor Dyspnoea insuficijencije. Troublesome dyspnoea Hiperglikemija can be treated se with obično drugs leči called lekovima Kušingov Hot flushessindrom protiv opioids dijabetesa or benzodiazepines, and in some cases steroids are Dijabetes Hyperglycaemia melitus Obavestite used (Kloke svog and Cherny lekara 2015). ako imate uporan kašalj.. Neprijatna Dispneja Hypertension dispneja Your doctor može will se monitor lečiti lekovima you for signs koji se of nazivaju thrombosis. opioidi ili Naleti Increased vrućine appetite benzodijazepini, a u nekim slučajevima se koriste i steroidi Hiperglikemija Increased weight (Kloke Your doctor and Cherny may 2015). be able to help you to manage hot flushes. Hipertenzija Pulmonary embolism Vaš lekar će pratiti Vaše zdravstveno stanje radi pojave znaka Pojačan Thrombophlebitis apetit tromboze. Povećana težina Vaš lekar može biti u situaciji da Vam pomogne u rešavanju naleta Plućna embolija vrućine. Tromboflebitis nastavak continued na sledećoj overleaf strani

49 ESMO Vodič Patients za pacijente Guide TERAPIJA THERAPY MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI DEJSTVO Tamoxifen Endometrial thickening Let your doctor know if you experience any skin reactions or Tamoksifen (Tamoxifen SPC, 2017) Zadebljanje Fatigue endometrijuma Obavestite fluid retention/swelling svog lekara ukoliko they will Vam help you se jave to manage bilo kakve these (Sažetak karakteristika Zamor Fluid retention reakcije side effects. na koži, simptomi nalik gripu ili zadržavanje tečnosti leka Tamoksifen, 2017.) Zadržavanje Hot flushes tečnosti /otok on će Vam pomoći u otklanjanju tih neželjenih Your doctor will monitor you for signs of thrombosis. Naleti Increased vrućine sweating dejstava. Pojačano Vaginal bleeding/discharge and visual disorders should be Nausea znojenje Vaš lekar će pratiti Vaše zdravstveno stanje radi pojave znaka reported to your doctor. Mučnina Skin rash tromboze. Osip Thromboembolic na koži Treba Your doctor da obavestite may be able svog to lekara help you o vaginalnom to manage hot krvarenju/ flushes, Tromboembolijske Vaginal komplikacije bleeding/discharge complications sekretu increased i poremećajima sweating and vida. nausea. Vaš lekar može biti u situaciji da Vam pomogne u rešavanju Vaginalno Visual disorders krvarenje/sekret naleta vrućine, pojačanog znojenja i mučnine. Poremećaji vida Important side effects associated with endocrine therapies in the treatment of breast cancer. The most recent Summary of Product Characteristics (SPCs) for individual drugs can be located at: Važna neželjena dejstva koja se povezuju sa endokrinim terapijama u lečenju raka dojke. Najnovije verzije sažetka karakteristika leka za pojedinačne lekove mogu se naći na: 49

50 Rak Breast dojke cancer Anti-HER2 therapies terapije Česta The common neželjena side dejstva effects zabeležena seen in patients kod pacijenata treated with lečenih some nekim anti-her2 therapies terapijama are effects jesu dejstva on the na gastrointestinalni system sistem (e.g. (npr. diarrhoea, proliv, povraćanje, vomiting, mučnina) nausea) i and neka more opšta general kao što effects je zamor. like fatigue Mogu se and javiti i hypersensitivity neka potencijalno reactions. ozbiljna neželjena There can dejstva also be kao some što potentially su problemi serious sa srcem, side iako effects su ti such rizici as znatno cardiac smanjeni disorders, izbegavanjem although these istovremene risks are vastly terapije reduced kardiotoksičnim by avoiding hemoterapijskim concurrent treatment režimima, with cardiotoxic kao što su chemotherapy antraciklini (Florido et regimens, al. 2017). Mnoga such as neželjena anthracyclines dejstva anti-her2 (Florido et al. terapija 2017). Many mogu of se the sprečiti side effects ili delotvorno from anti-her2 rešiti. Uvek therapies obavestite can svog be lekara prevented ili medicinsku or managed sestru effectively. odmah Always ukoliko tell primetite your doctor bilo koje or neželjeno nurse as soon dejstvo as anti-her2 possible if terapije. you notice any side effects from taking an anti-her2 therapy. TERAPIJA* THERAPY* MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Lapatinib Lapatinib (Tyverb SPC, 2017) (Sažetak karakteristika leka Tyverb, 2017.) DEJSTVO Anorexia Arthralgia Anoreksija Cardiac Artralgija effects Cough Oštećenja srca Effects on the gastrointestinal system (nausea, vomiting, Dejstva diarrhoea, na gastrointestinalni stomatitis) may result sistem in loss (mučnina, of appetite povraćanje, proliv, (anorexia). stomatitis) Your doctor mogu da will dovedu be able do to gubitka help you apetita to prevent or (anoreksije). manage these Vaš side lekar effects. će moći da Vam pomogne u Diarrhoea Kašalj sprečavanju To prevent and ili rešavanju treat stomatitis, ovih neželjenih you can dejstava. maintain good oral Dyspnoea Proliv Kako hygiene biste using sprečili a steroid i tretirali mouthwash stomatitis, and možete mild toothpaste. da održavate Fatigue Dispneja dobru Steroid oralnu dental higijenu paste can pomoću be used steroidne to treat tečnost developing za ispiranje Headache Zamor usta ulcerations. i blage paste. For more Steroidna severe dentalna (grade 2 pasta and above) može se stomatitis, koristiti Hepatic Glavoboljatoxicity za your tretman doctor ulceracija may suggest (ranica, lowering čireva) the koje dose javljaju of treatment, U slučaju or Hot Hepatična flushes toksičnost težeg delaying stomatitisa therapy until (gradus the stomatitis 2 i viši), Vaš resolves, lekar može but predložiti in most Insomnia Naleti vrućine smanjenje cases symptoms doze terapije, will be ili mild odlaganje and will terapije subside dok once stomatitis you have Nausea Nesanica ne finished prođe, treatment. ali će simptomi biti blagi u većini slučajeva i proći će Nose Mučnina bleeds kada završite sa primanjem terapije. Let your doctor know if you experience a persistent cough. Pain Krvarenje iz nosa Obavestite Troublesome svog dyspnoea lekara ako can imate be treated uporan with kašalj. drugs Neprijatna called Rash Bol dispneja opioids or može benzodiazepines, se lečiti lekovima and in koji some se nazivaju cases steroids opioidi ili are Stomatitis Osip benzodijazepini, used (Kloke and Cherny a u nekim 2015). slučajevima se koriste i steroidi Vomiting Stomatitis (Kloke and Cherny 2015). Povraćanje Your hepatic and cardiac function will be monitored during Tokom treatment. terapije biće praćena funkcija Vaše jetre i srca. Obavestite svog lekara ukoliko se kod Vas jave artralgija ili Let your doctor know if you experience arthralgia or pain they bolovi on će Vam pomoći u rešavanju tih neželjenih dejstava. will help you to manage these side effects. They can also give Takođe Vam može dati savete o reakcijama kože, simptomima you advice on skin reactions, nasal symptoms and insomnia. koji se odnose na nos i nesanici. Your doctor may also be able to you to manage hot flushes and Vaš lekar može biti u situaciji da Vam pomogne u rešavanju headaches. naleta vrućine i glavobolja. 50 nastavak continued na sledećoj overleaf strani

51 ESMO Vodič Patients za pacijente Guide TERAPIJA* THERAPY* MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI Neratinib Neratinib (Nerlynx PI, 2017) DEJSTVO Abdominal pain Bol Abdominal u trbuhuswelling Effects on the gastrointestinal system (nausea, vomiting, Dejstva diarrhoea, na abdominal gastrointestinalni pain/swelling, sistem dyspepsia (mučnina, and povraćanje, (Uputstvo za pacijenta za Oticanje Anorexia trbuha proliv, stomatitis) bolovi u may trbuhu, result dispepsija in loss of appetite i stomatitis) (anorexia). mogu da Your Nerlynx, 2017.) Anoreksija Diarrhoea Proliv Dry skin dovedu doctor will do gubitka be able apetita to help you (anoreksije). to prevent Vaš or manage lekar će these moći side da effects. Vam pomogne u sprečavanju ili rešavanju ovih neželjenih Suva Dyspepsia koža dejstava. To prevent and treat stomatitis, you can maintain good oral Dispepsija Fatigue Kako hygiene biste using sprečili a steroid i tretirali mouthwash stomatitis, and možete mild toothpaste. da održavate Steroid Zamor Increased hepatic dobru dental oralnu paste can higijenu be used pomoću to treat steroidne developing tečnost ulcerations. za ispiranje For Povišen enzymesnivo hepatičnih usta more i severe blage paste. (grade Steroidna 2 and above) dentalna stomatitis, pasta može your se doctor koristiti may enzima Muscle spasms za suggest tretman lowering ulceracija the (ranica, dose of čireva) treatment, koje or se delaying javljaju U therapy slučaju until Grčevi Nail disorders u mišićima težeg the stomatitisa resolves, (gradus but 2 in i viši), most Vaš cases, lekar symptoms može predložiti will be Poremećaji Nausea noktiju smanjenje mild and will doze subside terapije, once ili odlaganje you have finished terapije treatment. dok stomatitis Mučnina Rash ne prođe, ali će simptomi biti blagi u većini slučajeva i proći će Osip Stomatitis Your hepatic function will be closely monitored before, during kada završite sa primanjem terapije. Stomatitis Urinary tract infection and after treatment. Funkcija Vaše jetre pažljivo će biti praćena pre, tokom i nakon Infekcija Vomitingurinarnog trakta Let your doctor know if you experience skin reactions or muscle terapije. Povraćanje Weight loss spasms they will help you to manage these side effects. They can Obavestite also give you svog advice lekara on ukoliko preventing Vam infections se jave bilo and kakve weight reakcije Gubitak težine loss. na koži ili grčevi u mišićima on će Vam pomoći u rešavanju tih Pertuzumab (Perjeta SPC, 2017) Anaemia Anorexia neželjenih Effects on dejstava. the gastrointestinal Takođe Vam može system dati (nausea, savete o vomiting, sprečavanju infekcija diarrhoea, i gubitka stomatitis, težine. constipation, dyspepsia, dysgeusia) Arthralgia may result in loss of appetite (anorexia). Your doctor will be Pertuzumab Anemija Dejstva na gastrointestinalni sistem (mučnina, povraćanje, Cough able to help you to prevent or manage these side effects. (Sažetak karakteristika Anoreksija proliv stomatitis, zatvor, dispepsija, disgeuzija) mogu da Dysgeusia leka Perjeta, 2017.) Artralgija dovedu To prevent do gubitka and treat apetita stomatitis/mucositis, (anoreksije). Vaš lekar you can će moći maintain Fatigue Kašalj da good Vam oral pomogne hygiene u using sprečavanju a steroid ili rešavanju mouthwash ovih and neželjenih mild Fever Disgeuzija dejstava. toothpaste. Steroid dental paste can be used to treat developing Gastrointestinal effects Zamor ulcerations. For more severe (grade 2 and above) stomatitis, Headache Kako biste sprečili i tretirali stomatitis/mukozitis, možete da Povišena temperatura your doctor may suggest lowering the dose of treatment, or Hypersensitivity reaction održavate dobru oralnu higijenu pomoću tečnosti za ispiranje Gastrointestinalna delaying therapy until the stomatitis resolves, but in most Infusion reaction usta sa kortikosteroidima i blage paste za zube. Steroidna dejstva cases, symptoms will be mild and will subside once you have Insomnia dentalna pasta može se koristiti za tretman ulceracija (ranica, Glavobolja finished treatment. Mucositis/mucosal čireva) koje se javljaju. U slučaju težeg stomatitisa (gradus Reakcija preosetljivosti Let your doctor know if you experience any insomnia, myalgia, inflammation 2 i viši), Vaš lekar može predložiti smanjenje doze terapije, ili Reakcije na infuziju arthralgia, pain, skin reactions, inflammation or fluid retention/ Myalgia odlaganje terapije dok stomatitis ne prođe, ali će simptomi biti Nesanica swelling they will help you to manage these side effects. Nail disorder blagi u većini slučajeva i proći će kada završite sa primanjem Mukozitis/upala Nasopharyngitis terapije. sluzokože Oedema Obavestite svog lekara ukoliko se kod Vas jave nesanica Mijalgija Pain mijalgija, artralgija, bolovi, reakcije kože, upala ili zadržavanje Poremećaji noktiju Rash tečnosti/otok on će Vam pomoći u rešavanju tih neželjenih Nazofaringitis Upper respiratory tract dejstava. Edem infection Bol Osip Infekcija gornjeg respiratornog trakta nastavak continued na sledećoj overleaf strani 51

52 Rak Breast dojke cancer TERAPIJA* THERAPY* MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI DEJSTVO T-DM1 Abdominal pain Effects on the gastrointestinal system (nausea, vomiting, T-DM1 (Kadcyla SPC, 2013) Anaemia Bol u trbuhu Dejstva diarrhoea, na gastrointestinalni constipation, stomatitis) sistem may (mučnina, result feelings povraćanje, of (Sažetak karakteristika Arthralgia Anemija proliv, weakness zatvor, (asthenia). stomatitis) Your mogu doctor da dovedu will be do able osećaja to help slabosti you to leka Kadcyla, 2013.) Asthenia Artralgija (astenije). prevent or manage Vaš lekar these će moći side da effects. Vam pomogne u sprečavanju ili Bleeding Astenija rešavanju Let your doctor ovih neželjenih know if you dejstava. experience respiratory problems. Chills Krvarenje Obavestite Troublesome svog dyspnoea lekara ako can osetite be treated bilo kakve with drugs probleme called sa opioids Constipation Drhtavica disanjem. or benzodiazepines, Neprijatna and dispneja in some može cases steroids lečiti lekovima are used koji (Kloke se Diarrhoea Zatvor nazivaju and Cherny opioidi 2015). ili benzodijazepini, a u nekim slučajevima se Dry Proliv mouth Dyspnoea koriste To prevent i steroidi and treat (Kloke stomatitis, and Cherny you 2015). Suva usta can maintain good oral Fatigue Dispneja Kako hygiene biste using sprečili a steroid i tretirali mouthwash stomatitis, and mild možete toothpaste. da održavate Steroid Fever Zamor dobru dental oralnu paste can higijenu be used pomoću to treat steroidne developing tečnost ulcerations. za ispiranje For Headache Povišena temperatura usta more i severe blage paste. (grade Steroidna 2 and above) dentalna stomatitis, pasta može your se doctor koristiti may Increased Glavoboljahepatic za suggest tretman lowering ulceracija the (ranica, dose of treatment, čireva) koje or se delaying javljaju. therapy U slučaju until enzymes Povišen nivo hepatičnih težeg the stomatitisa resolves, (gradus but 2 i in viši), most Vaš cases, lekar symptoms može predložiti will be enzima Insomnia smanjenje mild and will doze subside terapije, once ili odlaganje you have finished terapije treatment. dok stomatitis ne Low Nesanica potassium prođe, Report ali any će signs simptomi of peripheral biti blagi u neuropathy većini slučajeva to your i proći doctor, će kada Musculoskeletal Nizak nivo kalijuma pain u krvi završite who will sa help primanjem you to manage terapije. this side effect. Myalgia Bolovi u mišićima Prijavite Let your doctor sve znake know periferne you experience neuropatije arthralgia, svom lekaru myalgia, koji pain će Nausea Mijalgija Vam or insomnia pomoći u they rešavanju will help problema you to manage sa tim neželjenim these side effects. dejstvom. Nose Mučnina bleeds Obavestite svog lekara ukoliko se kod Vas jave artralgija, Peripheral Krvarenje iz nosa neuropathy mijalgija, bolovi ili nesanica on će Vam pomoći u rešavanju tih Rash Periferna neuropatija neželjenih dejstava. Stomatitis Osip Thrombocytopenia Stomatitis Urinary Trombocitopenija tract infection Vomiting Infekcija urinarnog trakta Povraćanje Trastuzumab Anorexia Your cardiac function will be assessed before starting treatment Trastuzumab (Herceptin SPC, 2017) Anoreksija Arthralgia Funkcija with trastuzumab Vašeg srca and biće will proverena be monitored pre početka every 3 lečenja 4 months (Sažetak karakteristika Artralgija Cardiac disorders trastuzumabom during treatment. If i biće your praćena cardiac function svaka 3-4 is affected, meseca tokom your leka Herceptin, 2017.) Srčane Conjunctivitis smetnje lečenja. doctor may Ukoliko decide lečenje to reduce utiče or na pause funkciju trastuzumab Vašeg srca, treatment Vaš lekar Konjuktivitis Dizziness može or prescribe da odluči you da another smanji drug ili pauzira to treat lečenje the cardiac to trastuzumabom side effects Vrtoglavica Gastrointestinal effects ili (Curigliano da Vam propiše et al. 2012). drugi lek za lečenje efekata koji su se javili u Gastrointestinalna Headache radu Effects srca on (Curigliano the gastrointestinal et al. 2012). system (nausea, vomiting, dejstva Hot flushes Dejstva diarrhoea, na constipation, gastrointestinalni dyspepsia, sistem lip (mučnina, swelling, abdominal povraćanje, Glavobolja Insomnia proliv, pain, stomatitis, zatvor, dispepsija, disguesia) oticanje may usana, result bolovi in loss u of trbuhu, appetite Naleti Myalgia vrućine stomatitis, (anorexia). disgeuzija) Your doctor will mogu be da able dovedu to help do you gubitka to prevent apetita or Nesanica Nasopharyngitis (anoreksije). manage these Vaš side lekar effects. će moći da Vam pomogne u sprečavanju Mijalgija Nose bleeds or mucusfilled nose Obavestite Troublesome svog dyspnoea lekara ako can osetite be treated bilo kakve with drugs probleme called sa opioids ili Let rešavanju your doctor ovih know neželjenih if you dejstava. experience respiratory problems. Nazofaringitis Krvarenje Paraesthesia iz nosa ili disanjem. or benzodiazepines, Neprijatna and dispneja in some može cases se steroids lečiti lekovima are used koji (Kloke se nos Rash pun and sluzi other mukus skin nazivaju and Cherny opioidi 2015). ili benzodijazepini, a u nekim slučajevima se Parestezija effects koriste It important i steroidi that (Kloke you and tell your Cherny doctor 2015). if you suffer from Osip Respiratory i druge effects pojave Važno paraesthesia, je da kažete tremor, svom dizziness lekaru ukoliko or insomnia. patite od na including koži dyspnoea parestezije, tremora, vrtoglavice ili nesanice. Let your doctor know if you experience arthralgia, myalgia Problemi Tremor sa disanjem Obavestite svog lekara ukoliko se kod Vas jave artralgija, or pain they will help you to manage these side effects. They uključujući Watery eyes dispneju mijalgija ili bolovi on će Vam pomoći u rešavanju tih can also give you advice on skin reactions, eye problems and Tremor Weight loss (drhtanje) neželjenih dejstava. Takođe Vam može dati savete o reakcijama Suzne oči nasal symptoms. kože, simptomima koji se odnose na nos i problemima sa očima. Gubitak težine Important side effects associated with anti-her-2 therapies in the treatment of breast cancer. The most recent Važna Summary neželjena of Product dejstva Characteristics koja se (SPCs) povezuju for individual sa anti-her-2 drugs can terapijama be located at: u lečenju raka dojke. Najnovije verzije sažetka karakteristika *Some of the agents leka za listed pojedinačne in this table lekove may not mogu be available se naći in na: your country. Please consult your doctor and/or local product prescribing *Neki information lekovi for iz ove further tabele details. možda nisu dostupni u Vašoj zemlji. Obratite se svom lekaru ili pogledajte lokalne informacije o propisivanju leka za više informacija. 52

53 ESMO Vodič Patients za pacijente Guide Ostale Other targeted ciljane terapije therapies Neželjena The commonly dejstva reported koja se side obično effects beleže in patients kod pacijenata treated lečenih with other ostalim targeted ciljanim therapies terapijama are generally generalno similar su slična to prethodno the side effects pomenutim from the neželjenim other treatments dejstvima listed ostalih above. vrsta Many terapije. of these Mnoga side od effects tih neželjenih can be dejstava prevented moguće or managed je sprečiti effectively, ili delotvorno and you should rešiti, i always uvek treba tell your da kažete doctor svom or nurse lekaru as ili soon medicinskoj as possible sestri if you čim notice primetite any neko side neželjeno effects dejstvo from treatment. terapije. THERAPY* TERAPIJA* POSSIBLE MOGUĆE NEŽELJENO SIDE EFFECT HOW KAKO THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI DEJSTVO Abemaciclib Abdominal pain Your blood cell counts will be monitored frequently Abemaciklib (Verzenio PI, 2017) Anaemia Bol u trbuhu throughout Vaša krvna slika your biće treatment često in analizirana order to detect tokom any čitavog neutropenia, trajanja (Uputstvo za pacijenta za Anorexia Anemija terapije leukopenia, kako bi anaemia se otkrila or neutropenija, thrombocytopenia leukopenija, your doctor Verzenio, 2017.) Diarrhoea Anoreksija Fatigue Proliv anemija may adjust ili your trombocitopenija treatment according Vaš to lekar test može results da and prilagodi will terapiju advise you na osnovu on how rezultata to prevent analiza infections. i da Vam savete o tome Headache Zamor kako Effects da on sprečite the gastrointestinal infekcije. system (diarrhoea, nausea, Increased Glavoboljainfections vomiting, Dejstva na abdominal gastrointestinalni pain) may sistem result in (proliv, loss of mučnina, appetite Leukopenia Učestale infekcije povraćanje, (anorexia). bolovi Your doctor u trbuhu) will mogu be able da to dovedu help you do gubitka to prevent or Nausea Leukopenija apetita manage (anoreksije). these side effects. Vaš lekar će moći da Vam pomogne u Neutropenia Mučnina sprečavanju ili rešavanju ovih neželjenih dejstava. Report any other side effects, including headache and fatigue Thrombocytopenia Neutropenija to Prijavite your doctor, sva druga who neželjena will help dejstva, you to manage uključujući these i glavobolju side effects. i Vomiting Trombocitopenija zamor svom lekaru koji će Vam pomoći u rešavanju problema sa Povraćanje tim neželjenim dejstvom. Bevacizumab (Sažetak (Avastin SPC, karakteristika 2017) leka Avastin, 2017.) Anorexia Anoreksija Arthralgia Artralgija Bleeding Poremećaji disorders koji se odnose na Constipation krvarenje Diarrhoea Zatvor Dysarthria Proliv Dysgeusia Dizartrija Dyspnoea Disgeuzija Fatigue Dispneja Headache Zamor Hypertension Glavobolja Leukopenia Hipertenzija Nausea Leukopenija Neutropenia Mučnina Peripheral Neutropenija neuropathy Proteinuria Periferna neuropatija Rhinitis Proteinurija Skin Rinitis reactions Stomatitis Reakcije na koži Thrombocytopenia Stomatitis Wound Trombocitopenija healing complications Komplikacije pri Vomiting zarastanju rana Watery eyes Povraćanje Suzne oči Prijavite Report any sve signs znake of periferne peripheral neuropatije neuropathy svom to your lekaru doctor, koji who će Vam will help pomoći you u to rešavanju manage this problema side effect. sa tim neželjenim dejstvom. Svaki Any treatment vid lečenja will biće be delayed odložen until sve wounds dok rane have ne healed zacele satisfactorily. na zadovoljavajući način. Vaše Your blood zdravstveno pressure stanje will biće be monitored praćeno toko throughout čitavog treatment perioda and lečenja any hypertension i svaka pojava will hipertenzije be managed appropriately. biće rešena na odgovarajući način. Your renal function will be monitored during treatment. Tokom terapije biće praćena funkcija Vaših bubrega. Effects on the gastrointestinal system (stomatitis, Dejstva na gastrointestinalni sistem (mučnina, povraćanje, constipation, diarrhoea, nausea, vomiting) and dysgeusia may proliv, stomatitis, zatvor) i disgeuzija mogu da dovedu result in loss of appetite (anorexia). Your doctor will be able to do gubitka apetita (anoreksije). Vaš lekar će moći da Vam help you to prevent or manage these side effects. pomogne u sprečavanju ili rešavanju ovih neželjenih dejstava. Let your doctor know if you experience respiratory problems. Obavestite svog lekara ako osetite bilo kakve probleme sa Troublesome dyspnoea can be treated with drugs called opioids disanjem. Neprijatna dispneja može se lečiti lekovima koji se or benzodiazepines, and in some cases steroids are used (Kloke nazivaju opioidi ili benzodijazepini, a u nekim slučajevima se and Cherny 2015). koriste i steroidi (Kloke and Cherny 2015). Obavestite Let your doctor svog know lekara if ukoliko you develop Vam se any jave skin bilo reactions kakve reakcije (e.g. rash, na dry koži, skin, (npr. discolouration) osip, suva koža, they diskoloracija, will help you tj. to promena manage boje these delova side effects. na koži) on će Vam pomoći u rešavanju tih neželjenih dejstava. Report any other side effects, including changes in vision, Prijavite dysarthria, sva druga arthralgia neželjena or headache dejstva, uključujući to your doctor, i promene who will vida, help you dizartriju, to manage artralgiju these side ili glavobolju effects. svom lekaru koji će Vam pomoći u rešavanju problema sa tim neželjenim dejstvom. nastavak continued na sledećoj overleaf strani 53

54 Rak Breast dojke cancer 54 TERAPIJA* THERAPY* MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI DEJSTVO Everolimus Anaemia Your blood cell counts will be monitored frequently throughout Everolimus (Afinitor SPC, 2017) Anorexia Anemija Vaša your treatment krvna slika in biće order često detect analizirana any anaemia tokom čitavog your trajanja doctor (Sažetak karakteristika Cough Anoreksija terapije may adjust kako your bi se treatment otkrila anemija according Vaš to test lekar results može and da will leka Afinitor, 2017.) Diarrhoea Kašalj prilagodi advise you terapiju on how na to osnovu prevent rezultata infections. analiza i da Vam savete o Disgeusia Proliv tome kako da sprečite infekcije. Effects on the gastrointestinal system (nausea, diarrhoea, Dyspnoea Disgeuzija Dejstva na gastrointestinalni sistem (mučnina, proliv, Dispneja stomatitis) and dysgeusia may result in loss of appetite Fatigue stomatitis) mogu da dovedu do gubitka apetita (anoreksije). Zamor (anorexia). Your doctor will be able to help you to prevent or Headache Vaš lekar će moći da Vam pomogne u sprečavanju ili Glavobolja manage these side effects. Hypercholesterolaemia rešavanju ovih neželjenih dejstava. Hiperholesterolemija To prevent and treat stomatitis, you can maintain good oral Hyperglycaemia Kako biste sprečili i tretirali stomatitis, možete da održavate Hiperglikemija hygiene using a steroid mouthwash and mild toothpaste. Infections dobru oralnu higijenu pomoću steroidne tečnost za ispiranje Infekcije Steroid dental paste can be used to treat developing Nausea usta i blage paste. Steroidna dentalna pasta može se koristiti Mučnina ulcerations. For more severe (grade 2 and above) stomatitis, Nose bleed za tretman ulceracija (ranica, čireva) koje se javljaju. U slučaju Krvarenje iz nosa težeg your doctor stomatitisa may suggest (gradus lowering 2 i viši), the Vaš dose lekar of može treatment, predložiti or Oedema Edem smanjenje delaying therapy doze terapije, until the ili stomatitis odlaganje terapije resolves, dok but stomatitis in most Pneumonitis ne cases, prođe, symptoms ali će simptomi will be mild biti blagi and u will većini subside slučajeva once i you proći have će Pruritus kada finished završite treatment. sa primanjem terapije. Rash Osip Stomatitis Važno It is important je da obavestite that you svog report lekara any respiratory o bilo kakvim problems problemima to your Weight Gubitak loss težine sa doctor. disanjem. Troublesome Neprijatna dyspnoea dispneja can može be se treated lečiti with lekovima drugs koji se nazivaju opioidi ili benzodijazepini, a u nekim slučajevima se called opioids or benzodiazepines, and in some cases steroids koriste i steroidi (Kloke and Cherny 2015). Ukoliko se kod Vas javi are used (Kloke and Cherny 2015). If you develop non-infectious neinfektivno zapaljenje pluća (pneumonitis) gradusa 2, Vaš inflammation of the lungs (pneumonitis) of grade 2, your lekar može pauzirati ili čak smanjiti dozu everolimusa. Ako dobijete doctor might 3 neinfektivni pause or pneumonitis reduce the dose gradusa of everolimus. 3 ili višeg, If onda you će primena suffer from everolimusa grade 3 or higher najverovatnije non-infectious biti prekinuta. pneumonitis then everolimus will probably be stopped. Nivoi šećera i lipida u Vašoj krvi biće praćeni dok primate terapiju. Your blood Hiperglikemija sugar and lipid gradusa levels 1 will i 2 be se monitored obično leči during lekovima protiv therapy. dijabetesa. Grade 1 Hipeholesterolemija and 2 hyperglycaemia gradusa is usually 2 i treated 3 može with se antidiabetic lečiti lekovima drugs. koji Hypercholesterolaemia se zovu statini i fibrati. Vaš of lekar grade će 2 možda and morati 3 might i da be pauzira, treated with smanji drugs ili prekine called primenu statins and everolimusa. fibrates. Your Obavestite doctor may also svog need lekara to pause, ukoliko reduce Vam or se stop jave everolimus. bilo kakve glavobolje, Let your doctor reakcije know na if you koži, experience krvarenje any iz headaches, nosa gripu skin ili zadržavanje reactions, nose tečnosti bleeds /otok or fluid on retention/swelling će Vam pomoći u rešavanju they will tih help neželjenih you to manage dejstava. these side effects. Olaparib Anemija Dejstva na gastrointestinalni sistem (mučnina, proliv, Olaparib Anaemia Effects on the gastrointestinal system (nausea, diarrhoea, (Uputstvo za pacijenta Anoreksija povraćanje, zatvor, dispepsija, stomatitis) i disgeuzija mogu (Lynparza PI, 2017) Anorexia vomiting, constipation, dyspepsia, stomatitis) and dysgeusia Lynparza, 2017.) Artralgija da dovedu do gubitka apetita (anoreksije). Vaš lekar će moći Arthralgia may result in loss of appetite (anorexia). Your doctor will be able Zatvor da Vam pomogne u sprečavanju ili rešavanju ovih neželjenih Constipation to help you to prevent or manage these side effects. Proliv dejstava. Diarrhoea Disgeuzija To prevent and treat stomatitis, you can maintain good oral Dysgeusia Kako biste sprečili i tretirali stomatitis, možete da održavate Dispepsija hygiene using a steroid mouthwash and mild toothpaste. Steroid Dyspepsia dobru oralnu higijenu pomoću steroidne tečnost za ispiranje Zamor dental paste can be used to treat developing ulcerations. For Fatigue usta i blage paste. Steroidna dentalna pasta može se koristiti Glavobolja more severe (grade 2 and above) stomatitis, your doctor may Headache za tretman ulceracija (ranica, čireva) koje se javljaju. U slučaju Mijalgija suggest lowering the dose of treatment, or delaying therapy until Myalgia težeg stomatitisa (gradus 2 i viši), Vaš lekar može predložiti Nazofaringitis the stomatitis resolves, but in most cases, symptoms will be Nasopharyngitis smanjenje doze terapije, ili odlaganje terapije dok stomatitis Mučnina mild and will subside once you have finished treatment. Nausea ne prođe, ali će simptomi biti blagi u većini slučajeva i proći će Stomatitis Let your doctor know if you experience arthralgia, myalgia or Stomatitis kada završite sa primanjem terapije. Infekcija gornjeg headache and they will help you to manage these side effects. Upper respiratory tract Obavestite svog lekara ukoliko se kod Vas jave artralgija, respiratornog trakta infection mijalgija ili glavobolja on će Vam pomoći u rešavanju tih Povraćanje Vomiting neželjenih dejstava. nastavak continued na sledećoj overleaf strani

55 ESMO Vodič Patients za pacijente Guide TERAPIJA* THERAPY* MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT KAKO HOW SE THE NEŽELJENA SIDE EFFECTS DEJSTVA MAY MOGU BE MANAGED REŠAVATI DEJSTVO Palbociclib Alopecia Your blood cell counts will be monitored frequently throughout Palbociklib (Ibrance SPC, 2017) Alopecija Anaemia Vaša your krvna treatment slika biće in order često to proveravana detect any neutropenia, tokom čitavog anaemia trajanja (Sažetak karakteristika Anemija Anorexia terapije or thrombocytopenia kako bi se otkrila neutropenija, your doctor may anemija adjust ili your trombocitopenija according Vaš to test lekar results može and da prilagodi will advise terapiju you on na how osnovu to prevent rezulta- treatment leka Ibrance, 2017.) Anoreksija Diarrhoea Proliv Fatigue ta analiza infections. i pruži savete o tome kako da sprečite infekcije. Zamor Nausea Dejstva na gastrointestinalni sistem (mučnina, povraćanje, Mučnina Effects on the gastrointestinal system (stomatitis, diarrhoea, Neutropenia proliv, stomatitis) i disgeuzija mogu da dovedu do gubitka apetita Neutropenija nausea, vomiting) and dysgeusia may result in loss of appetite Rash (anoreksije). Vaš lekar će moći da Vam pomogne u sprečavanju ili Osip (anorexia). Your doctor will be able to help you to prevent or Stomatitis rešavanju ovih neželjenih dejstava. Stomatitis manage these side effects. Thrombocytopenia Kako biste sprečili i tretirali stomatitis, možete da održavate Trombocitopenija To prevent and treat stomatitis, you can maintain good oral Vomiting dobru oralnu higijenu pomoću steroidne tečnost za ispiranje Povraćanje usta hygiene i blage using paste. a Steroidna steroid mouthwash dentalna pasta and mild može toothpaste. se koristiti Steroid za tretman dental ulceracija paste can (ranica, be used čireva) to treat koje developing se javljaju. ulcerations. U slučaju težeg For stomatitisa more severe (gradus (grade 22 i viši), and above) Vaš lekar stomatitis, može predložiti your doctor smanjenje may doze suggest terapije, lowering ili odlaganje the dose terapije of treatment, dok stomatitis or delaying ne prođe, therapy ali until će simptomi the stomatitis biti blagi resolves, u većini but slučajeva in most i cases, proći će symptoms kada završite will be sa primanjem mild and terapije. will subside once you have finished treatment. Obavestite Let your svog doctor lekara know ukoliko if you Vam develop se jave any skin bilo kakve reactions reakcije they na will koži, help on you će to Vam manage pomoći these u otklanjanju side effects. tih neželjenih dejstava. Alopecija može da uznemiri mnoge pacijente; Vaš lekar će Vam Alopecia can be upsetting for many patients; your doctor will pružiti informacije o tome kako da se nosite sa ovim neželjenim provide you with information on how to cope with this side effect. dejstvom. Ribociklib Ribociclib (Sažetak (Kisqali SPC, karakteristika 2017) leka Kisqali, 2017.) Bol Abdominal u trbuhupain Vaša Your krvna blood slika cell biće counts često will analizirana be monitored tokom frequently čitavog trajanja throughout terapije your kako treatment bi se otkrila in order anemija, to detect neutropenija any anaemia, ili limfopenija neutropenia Vaš Abnormalna hepatic hepatična funkcija function lekar or može lymphopenia da prilagodi your terapiju doctor na osnovu may adjust rezultata your analiza treatment i da Alopecija Alopecia Vam according savete o tome test kako results da sprečite and will infekcije. advise you Obavestite on how to svog prevent lekara infections. o svakoj povišenoj Report any temperaturi, fever to your jer doctor, može as biti this znak may infekcije. be a Anemija Anaemia Anoreksija Anorexia Funkcija sign of Vašeg infection. srca biće proverena pre početka lečenja. Astenija Asthenia Dejstva Your na cardiac gastrointestinalni function will be sistem assessed (stomatitis, before treatment bolovi u begins. Bol Back u pain leđima trbuhu, Effects proliv, on the zatvor, gastrointestinal mučnina, povraćanje) system mogu (stomatitis, da dovedu do Oštećenja Cardiac effects srca gubitka apetita (anoreksije) ili osećaja slabosti (astenije). Vaš abdominal pain, diarrhoea, constipation, nausea, vomiting) Zatvor Constipation lekar će moći da Vam pomogne u sprečavanju ili rešavanju ovih may result in loss of appetite (anorexia) or feelings of Proliv Diarrhoea neželjenih dejstava. weakness (asthenia). Your doctor will be able to help you to Dispneja Dyspnoea Zamor Kako prevent biste sprečili or manage i tretirali these stomatitis, side effects. možete da održavate Fatigue Povišena temperatura dobru oralnu higijenu pomoću steroidne tečnost za ispiranje Fever To prevent and treat stomatitis, you can maintain good oral Glavobolja usta i blage paste. Steroidna dentalna pasta može se koristiti za Headache hygiene using a steroid mouthwash and mild toothpaste. Steroid Nesanica tretman ulceracija (ranica, čireva) koje se javljaju. U slučaju težeg Insomnia dental paste can be used to treat developing ulcerations. For Limfopenija stomatitisa (gradus 2 i viši), Vaš lekar može predložiti smanjenje Lymphopenia more severe (grade 2 and above) stomatitis, your doctor may Mučnina doze terapije, ili odlaganje terapije dok ne prođe, ali Neutropenija Nausea će simptomi suggest lowering biti blagi the u većini dose of slučajeva treatment, i proći or delaying će kada therapy završite until sa Edem Neutropenia primanjem the stomatitis terapije. resolves, but in most cases, symptoms will be Pruritus Oedema Obavestite mild and svog will lekara subside ukoliko once you se kod have Vas finished jave dispneja, treatment. nesanica, Let glavobolja, your doctor reakcije know na if koži you ili experience zadržavanje any tečnosti/otok dyspnoea, Osip Pruritus Stomatitis Rash on insomnia, će Vam pomoći headache, u rešavanju skin reactions tih neželjenih or fluid dejstava. retention/swelling Povraćanje Stomatitis Vaš lekar they će will redovno help you pratiti to manage nivoe Vaših these hepatičnih side effects. enzima i Vomiting možda će obaviti dodatne analize funkcije jetre ukoliko smatra da Your doctor will regularly monitor your hepatic enzyme levels su potrebne. and might do additional liver function tests if they are concerned. Alopecija može da uznemiri mnoge pacijente; Vaš lekar će Vam pružiti Alopecia informacije can be o tome upsetting kako for da many se nosite patients; sa ovim your neželjenim doctor will dejstvom. provide you with information on how to cope with this side effect. nastavak continued na sledećoj overleaf strani 55

56 Rak Breast dojke cancer TERAPIJA* THERAPY* MOGUĆE POSSIBLE NEŽELJENO SIDE EFFECT KAKO HOW THE SE NEŽELJENA SIDE EFFECTS DEJSTVA MAY BE MOGU MANAGED REŠAVATI DEJSTVO Talazoparib Alopecia Your blood cell counts will be monitored frequently throughout Talazoparib Anaemia Alopecija Vaša your treatment krvna slika in biće order često detect analizirana any anaemia, tokom čitavog neutropenia, Anorexia Anemija trajanja thrombocytopenia terapije kako or bi se lymphopenia otkrila anemija, your neutropenija, doctor may adjust Back Anoreksija pain trombocitopenija your treatment according ili limfopenija to test results Vaš and lekar will može advise da you on Constipation Bol u leđima prilagodi how to prevent terapiju infections. na osnovu rezultata analiza i da Vam savete o Diarrhoea Zatvor tome kako da sprečite infekcije. Effects on the gastrointestinal system (nausea, diarrhoea, Dyspnoea Proliv Dejstva vomiting, na constipation) gastrointestinalni may result sistem in loss (mučnina, of appetite povraćanje, (anorexia). Fatigue Dispneja proliv, Your doctor zatvor) will mogu be able da dovedu to help do you gubitka to prevent apetita or manage (anoreksije). these Lymphopenia Zamor Vaš side lekar effects. će moći da Vam pomogne u sprečavanju ili rešavanju Nausea Limfopenija ovih neželjenih dejstava. Let your doctor know if you experience a persistent cough. Neutropenia Mučnina Obavestite Troublesome svog dyspnoea lekara ako can imate be treated uporan with kašalj. drugs Neprijatna called opioids Thrombocytopenia Neutropenija dispneja or benzodiazepines, može se lečiti and lekovima in some cases koji se steroids nazivaju are opioidi used ili (Kloke Vomiting Trombocitopenija benzodijazepini, Povraćanje and Cherny 2015). a u nekim slučajevima se koriste i steroidi (Kloke and Cherny 2015). Alopecia can be upsetting for many patients; your doctor will Alopecija može da uznemiri mnoge pacijente; Vaš lekar će Vam provide you with information on how to cope with this side effect. pružiti informacije o tome kako da se nosite sa ovim neželjenim Important side effects associated with targeted therapies dejstvom. in the treatment of breast cancer. The most recent Summary of Product Characteristics (SPCs) for individual drugs can be located at: Važna *Some of neželjena the agents listed dejstva in this koja table se may povezuju not be available sa ciljanim in your terapijama country. Please u consult lečenju your raka doctor dojke. and/or Najnovije local product verzije prescribing sažetka karakteristika information for leka further za details. pojedinačne lekove mogu se naći na: *Neki lekovi iz ove tabele možda nisu dostupni u Vašoj zemlji. Obratite se svom lekaru ili pogledajte lokalne informacije o propisivanju leka za više informacija. Ostale vrste lečenja Suportivna terapija bisfosfonatima može da ima neželjena dejstva uključujući simptome nalik gripu, renalnu toksičnost i niske nivoe kalcijuma. Bisfosfonati povremeno mogu da dovedu do osteonekroze (smrti koštanog tkiva) u vilici. Iako je to vrlo retka pojava, važno je da redovno perete zube i da prijavite svaki problem koji Vam se javi u ustima lekaru i stomatologu. Lečenje denozumabom takođe potencijalno može da dovede do osteonekroze vilice, kao i niskih nivoa kalcijuma i infekcija kože. Veoma je važno da obavestite svog lekara ili medicinsku sestru unapred o svim planiranim stomatološkim zahvatima jer će možda biti potreban privremeni prekid terapije bisfosfonatima i denozumabom. 56

57 ESMO Vodič Patients za pacijente Guide Šta Other se treatments dešava nakon završetka moje terapije? Supportive therapy with bisphosphonates can result in side effects including flu-like symptoms, renal toxicity Kontrolni pregledi and low calcium levels. Bisphosphonates can also occasionally lead to osteonecrosis (death of bone tissues) in the jaw. Although this is very rare, it is important that you clean your teeth regularly and carefully and report any oral problems to your doctor and dentist. Denosumab therapy can also potentially lead to osteonecrosis of the jaw, Moći as well as low calcium levels and skin infections. It is crucial that you inform your doctor or nurse You will ćete be da able razgovarate to discuss o svim any concerns nedoumicama you have koje well in imate advance of any planned dental treatments, as bisphosphonates and denosumab therapy will have to be your prilikom follow-up kontrolnih appointments pregleda temporarily stopped. Nakon završetka Vaše terapije, Vaš lekar će Vam zakazati kontrolne preglede. Obično će to biti na svaka 3-4 meseca u prve 2 godine, svakih 6-8 meseci između 3. i 5. godine i jednom godišnje nakon toga (Cardoso et al [u štampi]). Tokom tih pregleda Vaš lekar će pregledati Vašu zdravstvenu istoriju sa Vama, zabeležiti sva neželjena dejstva koja se odnose na terapiju i obaviti klinički pregled. Takođe će Vam biti rađena mamografija svake godine, a neki pacijenti će biti snimani magnetnom rezonancom ili ultrazvukom. Ukoliko uzimate inhibitore aromataze, redovno će Vam biti merena gustina kostiju. Na osnovu Vaših rezultata lekar će Vam reći koliko često treba da dolazite na naredne kontrolne preglede. Šta ako mi treba dalje lečenje? Rak koji se vrati naziva se recidiv. Lečenje koje će Vam biti ponuđeno zavisi od obima recidiva i prethodnih terapija koje ste primali. Kada se tumor vrati kao recidiv u dojci ili okolnim limfnim čvorovima, može Vam biti ponuđena dalja operacija, a nakon nje i radioterapija odnosno sistemska terapija. Recidivi tumora u udaljenim organima smatraju se metastatskim rakom, i obično možete da primate dalju sistemsku terapiju to mogu da budu lekovi različiti od onih kojima ste lečeni kada Vam je prvi put postavljena dijagnoza, iako neki pacijenti mogu ponovo da primaju istu terapiju, posebno ako u dužem vremenskom periodu nisu imali rak dojke. 57

58 In collaboration with Rak Breast dojke cancer Vodite računa o svom zdravlju What happens after my treatment has finished? Nakon što završite sa lečenjem raka dojke, možete se osećati veoma umorno i vrlo emotivno. Dajte Follow-up svom telu appointments dovoljno vremena da se oporavi i dovoljno se odmarajte, ali nema razloga da ograničavate aktivnosti ukoliko se dobro osećate. Važno je da vodite računa o sebi i da dobijete potrebnu You podršku will be za nastavak able to normalnog discuss any concerns you have života, uključujući at your follow-up porodične aktivnosti appointments i rad ili profesionalne obaveze. Zdrava ishrana i fizička aktivnost mogu poboljšati Vaše generalno zdravlje, fizičke kondicije i raspoloženja. After your treatment Ako vežbate has finished, i održavate your svoju doctor will telesnu arrange težinu follow-up u zdravom appointments. rasponu, Typically, takođe možete these smanjiti rizik od recidiva (Cardoso et al [u štampi]). Važno je will da be počnete every 3 polako, 4 months laganom in the šetnjom, first 2 years, i da pojačavate every 6 aktivnosti kako budete počeli da se osećate bolje. 8 months from years 3 5 and once a year thereafter (Cardoso et al [in press]). During these appointments, your doctor will review your medical history with you, note Održavanje Maintaining any treatment-related zdravog a healthy stila side lifestyle effects, života and kroz through zdravu a healthy ishranu conduct i redovno diet a clinical and examination. vežbanje regular exercise pomoći You will će also will Vam have help da a to ostanete keep you mamography zdravi healthy i every može and year, smanjiti may and reduce some rizik patients the od risk recidiva will of also recurrence have regular MRI or ultrasound scans. If you are taking aromatase inhibitors, you will have your bone density measured regularly. Based on your results, your doctor will let you know how often you need to return for further follow-up appointments. Dugotrajna dejstva Nakon što završite sa lečenjem zbog raka dojke, kod Vas se mogu javiti neka dugotrajna neželjena dejstva, u What if I need more treatment? zavisnosti od terapije koju ste primili na primer, radioterapija može da poveća rizik od bolesti srca i raka pluća, a Cancer hemoterapija that comes može back da is izazove called a perifernu recurrence. neuropatiju. The treatment Ta dugotrajna that you will dejstva be offered mogu depends se lečiti, on te the je važno extent da of obavestite the recurrence svog and lekara the ili previous specijalizovanu treatment(s) medicinsku you have received. sestru o When svim upornim the tumour ili novim comes simptomima. back as a recurrence in the breast or surrounding lymph nodes, you may be offered further surgery followed by radiotherapy and/or Posebno systemic treba therapy. imati Recurrent u vidu da tumours terapija za in rak distant dojke organs može da are izazove regarded ranu as metastatic cancers and you can usually Survivorship menopauzu have further systemic zajedno sa therapy svim simptomima this may include koji se povezuju different sa drugs promenama to those u you were treated with when you were nivoima first diagnosed, hormona, although kao što some su naleti patients vrućine, may pojačano receive znojenje, the same suvoća treatments vagine again, i especially if they have been free gubitak from breast interesovanja cancer for za an polne extended odnose. period Menopauza of time. takođe može da doprinese What does survivorship mean? osteoporozi. Ukoliko ste zabrinuti zbog rane menopauze, trebalo bi da porazgovarate sa svojim lekarom ili specijalizovanom medicinskom sestrom. Let us explain Looking after your health it to you. Hormonska zamenska terapija se obično ne preporučuje nakon raka dojke jer se smatra After you da have bi mogla had treatment da poveća for šanse breast za cancer, povratak you raka. may feel very tired and emotional. Give your body time to recover and make sure you get enough rest, but there is no reason to limit activities if you are feeling well. It is Za important dalje informacije to take good i savete care o of tome yourself kako and da get se što the uspešnije support that vratite you u need život to resume your normal life, including pogledajte family activities ESMO and smernice work or za professional pacijente o životu roles. sa rakom (ESMO 2017) ( ESMO Patient Guide Series based on the ESMO Clinical Practice Guidelines esmo.org Eating a healthy diet and keeping active can help improve your overall health, fitness and mood. Exercising and maintaining your body weight in a healthy range may also reduce your risk of recurrence (Cardoso et al [in press]). It is important to start slowly, with gentle walking, and build up as you start to feel better. 58

59 In collaboration with ESMO Vodič Patients za pacijente Guide Emocionalna podrška Najnormalnije Maintaining je da Vas a preplave healthy osećanja lifestyle kada through Vam a healthy se postavi dijagnoza raka i kada prođete kroz terapiju. diet and regular exercise will help to keep you Ukoliko osećate teskobu ili ste depresivni, porazgovarajte healthy and may reduce the risk of recurrence sa svojim lekarom ili medicinskom sestrom oni Vas mogu uputiti specijalisti savetniku ili psihologu koji ima iskustvo sa emocionalnim problemima osoba koje se nose sa rakom. Može Vam značiti i da se pridružite grupi Long-term effects za podršku kako biste mogli da porazgovarate sa drugim ljudima After completing koji tačno treatment razumeju for kroz breast šta prolazite. cancer, you may experience some long-term side effects, depending on the treatment you have received for example radiotherapy can increase the risk of heart disease and lung cancer and chemotherapy can cause peripheral neuropathy. These long-term effects can be managed so it is important that you tell your doctor or specialist nurse about any persistent or new symptoms. Notably, treatments for breast cancer can cause an early menopause along with all of the symptoms that are associated with the change in hormone levels, including hot flushes, increased sweating, vaginal dryness and a loss of interest in sex. The menopause can also contribute to osteoporosis. If you have concerns about early menopause then you should talk to your doctor or specialist nurse. Hormone replacement therapy is not normally recommended after breast cancer as it is thought that it could increase the chances of the cancer coming back. For further information and advice regarding how to regain your life as far as possible after treatment for cancer, see ESMO s patient guide on survivorship (ESMO 2017) ( Emotional support It is common to be overwhelmed by your feelings when you have been diagnosed with cancer and when you have been through treatment. If you feel anxious or depressed, talk to your doctor or nurse they can refer you to a specialist counsellor or psychologist who has experience of dealing with emotional problems of people dealing with cancer. It may also help to join a support group so that you can talk to other people who understand exactly what you are going through. esmo.org What does survivorship mean? ESMO Patient Guide Series based on the ESMO Clinical Practice Guidelines Let us explain it to you. Survivorship 59

60 Rak Breast dojke cancer Grupe Support za groups podršku Grupe Breast za cancer pomoć patient pacijentima advocacy sa rakom groups pomažu help patients pacijentima and their families i njihovim to navigate porodicama the breast da se cancer snalaze u okruženju landscape. raka. They One can mogu be local, biti lokalne, national nacionalne or international, ili međunarodne, and they work to i one ensure se staraju patients za receive to da pacijenti appropriate dobiju odgovarajuću and timely care i blagovremenu and education. negu These i edukaciju. groups can Te grupe Vam provide mogu you obezbediti with the tools alate you koji may Vam need mogu to biti help potrebni you da better bolje understand razumete svoju your disease, bolest, i da and naučite to learn kako how da to se nosite cope with sa njom, it, living vodeći the najkvalitetniji best quality of mogući life that život. you can. ABC Global Alliance: Advanced BC: After Breast Cancer Diagnosis: Breast Cancer Alliance: Breast Cancer Care: Breast Cancer Network Australia: EUROPA DONNA: Male Breast Cancer Coalition: Metastatic Breast Breast Cancer Cancer Network: Network: Metavivor: Metavivor: National Breast Cancer Coalition: National Breast Cancer Coalition: Susan G. Komen Breast Cancer Foundation: ww5.komen.org Susan G. Komen Breast Cancer Foundation: ww5.komen.org Unión Latinoamericana Contra al Cáncer de la Mujer: Unión Latinoamericana Contra al Cáncer de la Mujer: 60

61 ESMO Vodič Patients za pacijente Guide References Balogun, O. D. and S. C. Formenti (2015). Locally advanced breast cancer - strategies - for for developing nations. Frontiers in oncology 5: 89. Cancer.Net. (2016). Fatigue. Retrieved 12 Oct, 2017, from fatigue. sideeffects/ Cardoso, F., et et al. (2018 [in press]). Primary breast cancer: ESMO Clinical Practice Guidelines for for diagnosis, treatment and follow-up. Annals of oncology: official : journal of of the the European Society for for Medical Oncology. Cardoso, F., et et al. (2018 [in press]). 4th ESO-ESMO International Consensus Guidelines for for Advanced Breast Breast Cancer (ABC Cancer 4). (ABC Annals 4). of Annals oncology: of oncology official journal : official journal the European of the European Society for Society Medical for Oncology. Medical Oncology. Cherny, N. N. I. I. (2014). ESMO Clinical Practice Guidelines for for the the management of of refractory symptoms at at the the end end of life and the use of palliative sedation. Annals of of oncology: official : journal of of the the European Society for for Medical Oncology 25 Suppl 3: iii ClinicalTrials.gov. (2017). Learn about about clinical studies. Retrieved Retrieved 30 Nov, 30 Nov, 2017, 2017, from from ct2/about-studies/learn. Collaborative Group on on Hormonal Factors in in Breast Breast Cancer Cancer (2001). (2001). Familial Familial breast breast cancer: cancer: collaborative reanalysis of reanalysis individual of data individual from 52 data epidemiological from 52 epidemiological studies including studies 58,209 including women 58,209 with women breast cancer with breast and 101,986 cancer and women without 101,986 the women disease. without Lancet the (London, disease. England) Lancet (London, 358(9291): England) (9291): Curigliano, G., G., et et al. al. (2012). Cardiovascular toxicity induced induced by by chemotherapy, targeted targeted agents agents and and radiotherapy: ESMO radiotherapy: Clinical ESMO Practice Clinical Guidelines. Practice Annals Guidelines. of oncology: Annals official oncology journal of : official the European journal Society of the European for Medical Society Oncology for 23 Medical Suppl Oncology 7: iii Suppl 7: vii ESMO. (2017). Patient Guide on on Survivorship. Retrieved Retrieved Oct, Oct, 2017, 2017, from from Patient-Guides/Patient-Guide-on-Survivorship. Ferlay, J., et et al. (2013). GLOBOCAN 2012 v1.0, Cancer Incidence and and Mortality Worldwide: IARC IARC CancerBase No. 11 [Internet]. No. 11 [Internet]. Lyon, France: Lyon, International France: International Agency for Agency Research for Research on Cancer. on Cancer. Retrieved 10 Retrieved Oct, 2017, 10 Oct, from 2017, from Florido, R., R., et et al. al. (2017). Cardiotoxicity From From Human Human Epidermal Growth Growth Factor Factor Receptor-2 Receptor-2 (HER2) (HER2) Targeted Targeted Therapies. Journal of the American Heart Association 6(9). Henson, K. K. E., E., et et al. al. (2013). Radiation-related mortality from from heart heart disease disease and and lung lung cancer cancer more more than than years years after radiotherapy for breast cancer. British journal of of cancer 108(1): Klastersky, J., J., et et al. al. (2016). Management of of febrile febrile neutropaenia: ESMO ESMO Clinical Clinical Practice Practice Guidelines. Guidelines. Annals Annals of of oncology: official : official journal journal of of the the European Society Society for for Medical Medical Oncology Oncology 27(suppl 27(suppl 5): 5): v111-v

62 Rak Breast dojke cancer Kloke, M. and N. Cherny (2015). Treatment of of dyspnoea in in advanced cancer patients: ESMO Clinical Practice Guidelines. Annals of oncology: : official journal of the European Society for for Medical Oncology Suppl Suppl 5: 5: v Loibl, S. S. and B. B. Lederer (2014). The importance of of supportive care care in in breast breast cancer cancer patients. Breast Breast care care (Basel, Switzerland) (Basel, Switzerland) 9(4): (4): Macmillan (2015). Carboplatin. Carboplatin. Retrieved Retrieved 12 Oct, 12 Oct, 2017, 2017, from from cancertreatment/treatmenttypes/chemotherapy/individualdrugs/carboplatin.aspx. cancerinformation/cancertreatment/treatmenttypes/chemotherapy/individualdrugs/carboplatin.aspx. Macmillan. Macmillan. (2016). (2016). Possible Possible side side effects effects of of chemotherapy. chemotherapy. Retrieved Retrieved 12 Oct, 12 Oct, 2017, 2017, from from org.uk/information-and-support/lung-cancer/non-small-cell-lung-cancer/treating/chemotherapy/side-effects-ofchemotherapy/possible-side-effects.html. macmillan.org.uk/information-and-support/lung-cancer/non-small-cell-lung-cancer/treating/chemotherapy/ side-effects-of-chemotherapy/possible-side-effects.html. Paluch-Shimon, S., et al. (2016). Prevention and screening in BRCA mutation carriers and other breast/ovarian Paluch-Shimon, S., et al. (2016). Prevention and screening in BRCA mutation carriers and other breast/ovarian hereditary cancer syndromes: ESMO Clinical Practice Guidelines for cancer prevention and screening. Annals of hereditary cancer syndromes: ESMO Clinical Practice Guidelines for cancer prevention and screening. Annals oncology: official journal of the European Society for Medical Oncology 27(suppl 5): v103-v110. of oncology : official journal of the European Society for Medical Oncology 27(suppl 5): v103-v110. Peccatori, F. A., et al. (2013). Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment Peccatori, and F. A., follow-up. et al. (2013). Annals Cancer, of oncology: pregnancy official and journal fertility: of ESMO the European Clinical Society Practice for Guidelines Medical Oncology for diagnosis, 24 Suppl 6: vi treatment and follow-up. Annals of oncology : official journal of the European Society for Medical Oncology 24 Suppl 6: vi Perez Fidalgo, J. A., et al. (2012). Management of chemotherapy extravasation: ESMO-EONS Clinical Practice Guidelines. Perez Fidalgo, Annals J. A., of et al. oncology: (2012). official Management journal of chemotherapy European Society extravasation: for Medical ESMO-EONS Oncology Clinical 23 Suppl Practice 7: vii Guidelines. Annals of oncology : official journal of the European Society for Medical Oncology 23 Suppl 7: vii Roila, F., et al. (2016) MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced Roila, F., et al. (2016). nausea 2016 MASCC and vomiting and ESMO and of guideline nausea and update vomiting for the in advanced prevention cancer of chemotherapy- patients. Annals and of oncology: radiotherapy-induced official journal nausea of the and European vomiting Society and of for nausea Medical and Oncology vomiting 27(suppl in advanced 5): v119-v133. cancer patients. Annals of oncology : official journal of the European Society for Medical Oncology 27(suppl 5): v119-v133. Skol, A. D., et al. (2016). The genetics of breast cancer risk in the post-genome era: thoughts on study design to move past Skol, BRCA A. D., and et al. towards (2016). clinical The genetics relevance. of breast Breast cancer risk research: in the post-genome BCR 18(1): 99. era: thoughts on study design to move past BRCA and towards clinical relevance. Breast cancer research : BCR 18(1): 99. Torre, L. A., et al. (2016). Global Cancer Incidence and Mortality Rates and Trends--An Update. Cancer epidemiology, biomarkers Torre, L. A., & et prevention: al. (2016). a Global publication Cancer of the Incidence American and Association Mortality Rates for Cancer and Trends--An Research, cosponsored Update. Cancer by the American Society epidemiology, of Preventive biomarkers Oncology & prevention 25(1): : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 25(1):

63 ESMO Vodič Patients za pacijente Guide GLOSSARY REČNIK POJMOVA 5-FLUOROURACIL A Vrsta type hemoterapije of chemotherapy koja se that daje is kao administered infuzija u venu through u Vašoj a drip ruci ili into grudima a vein in your arm or chest ABEMACICLIB ABEMACIKLIB A Novi new tip type ciljane of targeted terapije koji therapy inhibira which CDK4/6 inhibits kako bi CDK4/6 se to smanjila reduce proliferacija the proliferation ćelija tumora of tumour cells ACCELERATED ADJUVANTNA TERAPIJA PARTIAL BREAST IRRADIATION (APBI) Dodatna terapija koja se daje nakon primarne terapije kako Radiotherapy bi se smanjila šansa focused da se only rak vrati; on a small obično margin se odnosi of na tissue surrounding radioterapiju the odnosno site of sistemsku resection terapiju of the nakon breast operacije tumour ADJUVANT ADRENALNA (TREATMENT) INSUFICIJENCIJA Additional Poremećaj u treatment okviru kog given nadbubrežne after the (adrenalne) primary treatment žlezde ne to proizvode reduce dovoljno the chance određenih of the hormona cancer coming back; usually refers to radiotherapy and/or systemic therapy after surgery AGRANULOCITOZA Izražen nedostatak belih krvnih zrnaca, obično neutrofila ADRENAL INSUFFICIENCY A ALOPECIJA disorder in which the adrenal glands do not make enough Gubitak kose of certain hormones AGRANULOCYTOSIS ANALOZI GONADOTROPIN-OSLOBAĐAJUĆIH HORMONA Severe Vrste terapije deficiency koje zaustavljaju of white blood stvaranje cells, polnih usually hormona neutrophils u testisima i jajnicima. Oni kod žena izazivaju prestanak stvaranja ALOPECIA estrogena i progesterona u jajnicima Hair loss ANASTROZOL ANAEMIA Tip inhibitora aromataze A condition characterised by the shortage of red blood cells ANDROGEN or haemoglobin (a protein in red blood cells that carries Hormon oxygen koji pomaže throughout da se razviju the body) i zadrže muške polne ANASTROZOLE karakteristike A ANEMIJA type of aromatase inhibitor ANDROGEN Stanje koje karakteriše nedostatak hemoglobina (protein u Hormone crvenim krvnim that helps zrncima to koji develop prenosi and kiseonik maintain po organizmu) the male sex characteristics ANOREKSIJA ANOREXIA Nedostatak ili gubitak apetita A lack or loss of appetite ANTRACIKLIN ANTHRACYCLINE Klasa hemoterapije koja obuhvata epirubicin i doksorubicin A class of chemotherapy that includes epirubicin and doxorubicin ARTRALGIJA Bol u zglobovima AROMATASE INHIBITOR A ASTENIJA type of endocrine therapy that prevents the formation Nenormalni of osećaj oestrogen slabosti ili nedostatak energije ARTHRALGIA Joint pain ASTHENIA Abnormal feeling of weakness or lack of energy BEVACIZUMAB AXILLARY LYMPH NODES Vrsta Lymph ciljane nodes terapije in the koja armpit se koristi za lečenje nekih vrsta raka, uključujući uznapredovali rak dojke. To je monoklonsko antitelo BEVACIZUMAB koje cilja vaskularni endotelni faktor rasta (VEGF) i sprečava A type of da targeted ćelije raka therapy razviju used sopstveno to treat snabdevanje some cancers, krvlju, na including taj način advanced pomažući breast da se uspori cancer. rast It tumora is a monoclonal antibody that targets vascular endothelial growth BIOMARKERI factor (VEGF) and prevents the cancer cells from Biološki developing molekuli their koji own se blood nalaze supply, u tkivima, thus krvi helping ili drugim to slow telesnim down tumour tečnostima growth i koji su znaci stanja ili bolesti, ili opisuju ponašanje bolesti BIOMARKERS BIOPSIJA Biological molecules found in tissues, blood or other Medicinski body fluids postupak that are tokom a sign koga of a se condition mali uzorak disease, ćelija ili krvi or uzima describe za pregled the behaviour pod mikroskopom of the disease BISFOSFONATI BIOPSY Lekovi A medical koji pomažu procedure da se in spreči which ili a uspori small osteoporoza, sample of cells kao or i da tissue se spreče is taken prelomi for examination kostiju i drugi under problemi a microscope sa kostima koje izazivaju metastaze na kostima; takođe se koriste u okviru adjuvantne BISPHOSPHONATES terapije Drugs that help prevent, or slow down, osteoporosis, BRCA1 and prevent broken bones and other bone problems Gen caused koji by se, bone kada mutira metastases; (ne funkcioniše also used kako in treba), adjuvant povezuje sa treatment veoma visokim rizikom od raka dojke i jajnika BRCA2 BONE MARROW Gen A spongy koji se, tissue kada mutira found (ne inside funkcioniše some bones kako treba), (e.g. hip povezuje and sa thigh veoma bones). visokim It contains rizikom od stem raka cells, dojke which i jajnikaare cells that can develop into the red blood cells, white blood cells BRONHOSPAZAM or platelets Zatezanje mišića koji povezuju disajne puteve u plućima BRCA1 CIKLOFOSFAMID A gene which, when mutated (not functioning properly), Vrsta is associated hemoterapije with koja a very se high daje kao risk infuzija of breast u venu and u ovarian Vašoj ruci cancer ili grudima, ili oralnim putem CILJANA BRCA2 TERAPIJA Noviji A gene tip which, leka koji when funkcioniše mutated tako (not što functioning blokira signale properly), koji podstiču is associated ćelije raka with da a very rastu high ili ometa risk njihovu of breast sposobnost and ovarian da uzmu cancer hranljive materije koje su im potrebne za rast CISPLATIN BREAST-CONSERVING SURGERY Vrsta Surgery hemoterapije to remove koja a tumour se daje and kao the infuzija surrounding u venu u Vašoj breast ruci tissue ili grudima while retaining as much of the breast as possible CMF BRONCHOSPASM Vrsta Tightening hemoterapije of the muscles (kombinacija that ciklofosfamida, line the airways in the metotreksata lungs i 5 fluorouracila) koja se daje kao infuzija u venu u Vašoj ruci ili grudima, a nekada i oralno CAPECITABINE DENOZUMAB A type of chemotherapy that is administered orally Lekovi koji pomažu da se spreči ili uspori osteoporoza, kao i CARBOPLATIN da se spreče prelomi kostiju i drugi problemi sa kostima koje izazivaju A type of metastaze chemotherapy na kostima that is administered through a drip into a vein in your arm or chest 63

64 Rak Breast dojke cancer REČNIK GLOSSARY POJMOVA DISGEUZIJA CHEMOTHERAPY Promena A type of čula cancer ukusa treatment using medicine that kills the cancer cells by damaging them, so that they cannot DIZARTRIJA reproduce and spread Teško ili nejasno artikulisan govor (npr. nerazgovetan govor, nazalni CHRONOLOGICAL prizvuk, promukao AGE ili preterano glasan ili tih glas) Age based on the actual passage of time DISPEPSIJA Medicinski CISPLATINizraz za lošu probavu A type of chemotherapy that is administered through a DISPNEJA drip into a vein in your arm or chest Gubitak daha CLINICAL TRIAL DOCETAKSEL A study that compares the effects of one treatment Vrsta with hemoterapije another koja se daje kao infuzija u venu u Vašoj ruci ili grudima CMF DOKSORUBICIN A type of chemotherapy (combination of Vrsta cyclophosphamide, hemoterapije koja methotrexate se daje kao infuzija and 5 u fluorouracil) venu u Vašoj ruci that ili is grudima administered through a drip into a vein in your arm or chest, or sometimes orally EDEM Nakupljanje COLD CAPtečnosti u organizmu koje dovodi do oticanja zahvaćenih A cap that tkiva cools the scalp before, during and after treatment to reduce the effects of the treatment on hair EKSEMESTAN follicles Tip inhibitora aromataze COMORBIDITIES EKSTRAVAZACIJA Additional diseases or disorders experienced by the Curenje tečnosti, kao što je lek protiv raka, iz krvnog suda ili patient at the same time cevčice u okolno tkivo COMPUTED TOMOGRAPHY (CT) SCAN EPIRUBICIN A scan using x-rays and a computer to create detailed Vrsta images hemoterapije of the inside koja of se your daje body kao infuzija u venu u Vašoj ruci ili grudima CONJUNCTIVITIS ERIBULIN Inflammation of the membrane that covers the eyeball Vrsta and lines hemoterapije the eyelidkoja se daje kao infuzija u venu u Vašoj ruci ili grudima CONTRACEPTIVE ESTROGEN An intervention to prevent pregnancy, e.g. Hormon contraceptive koji pomaže pill da se razviju i zadrže ženske polne odlike ESTROGENSKI CUSHING S SYNDROME RECEPTOR (ER) POZITIVNE Ćelije A condition koje imaju in which receptorski there protein is too koji much vezuje cortisol estrogen. (a Ćelijama hormone raka made koje by su the ER-pozitivne adrenal gland) za rast in je the potreban body; estrogen symptoms include a round face, thin arms and legs, severe fatigue and muscle weakness, high blood EVEROLIMUS pressure, high blood sugar, purple or pink stretch Vrsta ciljane terapije koja se koristi za lečenje uznapredovalog marks on the skin and weight gain raka dojke. On inhibira mtor kako bi smanjio rast i proliferaciju ćelija CYCLIN-DEPENDENT tumora KINASES 4/6 (CDK4/6) Enzymes that drive cell proliferation FOLIKULA DLAKE Kesica u koži iz koje raste dlaka FULVESTRANT CYCLOPHOSPHAMIDE Tip A type endokrine of chemotherapy terapije koji that blokira is administered receptore estrogena through i a smanjuje drip into njihov a vein broj in your arm or chest, or orally GASTROINTESTINALNI DENOSUMAB SISTEM Sistem A drug organa used to kroz treat koje osteoporosis hrana ulazi u telo and i prevent iz njega izlazi broken i koji bones koristi and hranu other tako bone da problems telo održi zdravim caused - by sastoji bone se od jednjaka, metastases želuca i creva GEMCITABIN DOCETAXEL Vrsta A type hemoterapije of chemotherapy koja se that daje is kao administered infuzija u venu through u Vašoj a ruci drip ili into grudima a vein in your arm or chest GEN DOXORUBICIN Geni A type su of delovi chemotherapy DNK zaduženi that za proizvodnju is administered materija through potrebnih a Vašem drip into organizmu a vein in kako your bi arm funkcionisao or chest GOJAZNOST DUCTS (BREAST) Nenormalno Tubes that carry ili preterano milk to nakupljanje the nipplemasti koje može da škodi zdravlju DYSARTHRIA GRADUS Difficult or unclear articulation of speech (e.g. slurred, Gradus nasal-sounding, raka se zasniva hoarse na or tome excessively koliko se izgled loud or ćelija quiet) tumora razlikuje od izgleda od normalnih ćelija pod mikroskopom, i na tome DYSGEUSIA koliko brzo rastu. Gradus će biti vrednost između jedan i tri A change i odražava in agresivnost the sense of ćelija taste tumora; što je veći gradus, to je agresivniji tumor. DYSPEPSIA HEMOTERAPIJA The medical term for indigestion Vrsta terapije protiv raka u kojoj se koristi lek koji ubija DYSPNOEA ćelije raka tako što ih oštećuje, tako da one ne mogu da se Shortness of breath umnožavaju i šire ENDOCRINE THERAPY HEPATIČNI A type of anticancer therapy that reduces the supply Koji of hormones se odnosi na to jetru hormone receptor-dependent breast HER2 cancers Protein ENDOCRINE uključen RESISTANCE u rast ćelija i može se naći na nekim tipovima ćelija When raka, a tumour uključujući stops rak responding dojke to endocrine therapy HIBRIDIZACIJAIN EPIRUBICIN SITU Laboratorijska A type of chemotherapy metoda za otkrivanje that is administered i lokalizovanje through određenih a gena drip into u uzorcima a vein in krvi your arm or chest HIPERGLIKEMIJA ERIBULIN Povišen A type of nivo chemotherapy glukoze (šećera) that u krvi is administered through a drip into a vein in your arm or chest HIPERHOLESTEROLEMIJA Povišen EVEROLIMUS nivo holesterola u krvi A type of targeted therapy used to treat advanced HLADNA KAPA breast cancer. It inhibits mtor to reduce the growth Kapa kojom se hladi vlasište pre, tokom i nakon terapije kako and proliferation of tumour cells bi se umanjilo dejstvo terapije na folikule dlake EXEMESTANE A type of aromatase inhibitor 64

65 ESMO Vodič Patients za pacijente Guide REČNIK GLOSSARY POJMOVA HORMONSKA EXTRAVASATION (ENDOKRINA) TERAPIJA Vrsta Leakage terapije of fluid, protiv such raka as koja an smanjuje anticancer isporuku drug, hormona from a za tipove blood raka vessel koji or zavise tube od into hormonskih the tissue receptora around it HORMONSKA FATIGUE REZISTENCIJA (OTPORNOST) Kada Overwhelming tumor prestane tiredness da reaguje na endokrinu terapiju HRONOLOŠKA FIRST-LINE (TREATMENT) STAROST Starost The initial na osnovu treatment stvarnog given protoka a patient vremena IMUNOHISTOHEMIJA FULVESTRANT Laboratorijska A type of endocrine analiza u therapy kojoj se that koriste blocks antitela oestrogen kako bi se ispitalo receptors prisustvo and reduces određenih the biomarkera number of u uzorku them tkiva INHIBITOR GASTROINTESTINAL AROMATAZESYSTEM Tip The endokrine system of terapije organs koji responsible sprečava stvaranje for getting estrogena food into and out of the body and for making use of food to keep INTRAVENSKA the body healthy includes the oesophagus, stomach Koja and intestines se daje se u venu INVAZIVNI GEMCITABINE (RAK DOJKE) Rak A type koji of se chemotherapy proširio van kanala that ili is režnjeva administered through a drip into a vein in your arm or chest IPSILATERALNO Javlja GENEse na istoj strani tela Genes are pieces of DNA responsible for making JONIZUJUĆE substances that ZRAČENJE your body needs to function Bilo koja vrsta čestice ili elektromagnetnog talasa koja prenosi dovoljnu GONADOTROPIN-RELEASING količinu energije za uklanjanje HORMONE elektrona iz atoma (npr. ANALOGUES rentgen zraci) Treatment that stop the testicles and ovaries from KANALI making (U sex DOJCI) hormones. In women, they cause the Cevčice ovaries koje to stop prenose making mleko oestrogen do bradavice and progesterone KAPECITABIN GRADE Vrsta Cancer hemoterapije grade is based koja se on daje how oralno different tumour cells look from normal cells under a microscope, and on KARBOPLATIN how quickly they grow. The grade will be a value Vrsta between hemoterapije one and three koja se and daje reflects kao infuzija the aggressiveness u venu u Vašoj ruci of tumour ili grudima cells; the higher the grade, the more KI67 aggressive the tumour Protein HAIR FOLLICLE koji se nalazi u ćelijama prilikom njihove deobe, ali ne i A kada small miruju. sac in the skin from which hair grows KINAZE HAND-FOOT KOJE ZAVISE SYNDROME OD CIKLINA 4/6 (CDK4/6) Enzimi A condition koji podstiču marked proliferaciju by pain, swelling, ćelija numbness, tingling, desquamation and formation of blisters, or KLINIČKO ISPITIVANJE redness of the hands or feet. It sometimes occurs as a Studija u kojoj se porede dejstva jedne terapije sa dejstvima side effect of certain anticancer drugs druge terapije HEPATIC KOMORBIDITETI Relating to the liver Dodatne bolesti ili poremećaji koji se istovremeno javljaju kod pacijenta HER2 A protein involved in cell growth, which is found on some types of cancer cells, including breast KOMPJUTERIZOVANA HYPERCHOLESTEROLAEMIA TOMOGRAFIJA (CT) Vrsta An increase snimanja in u the kome level se of koriste cholesterol rendgen in zraci the blood i kompjuter da se naprave detaljne slike unutrašnjosti Vašeg organizma HYPERGLYCAEMIA KONJUKTIVITIS An increase in the level of glucose (sugar) in the blood Upala membrane koja pokriva očnu jabučicu i oivičava kapke IMMUNOHISTOCHEMISTRY KONTRACEPCIJA A laboratory test that uses antibodies to test for certain Intervencija markers in kojom tissue se sample sprečava trudnoća, npr. kontraceptivna pilula IN SITU HYBRIDISATION KOŠTANA A laboratory SRŽmethod to detect and localise specific Sunđerasto genes in tissue tkivo koje samples se nalazi u nekim kostima (npr. kostima kukova i butina). Ono sadrži matične ćelije, a to su ćelije iz kojih INTRAVENOUS se mogu razviti crvena krvna zrnca, bela krvna zrnca ili trombociti Administered into a vein KUŠINGOV INVASIVE SINDROM (BREAST CANCER) Stanje Cancer u that kome has se javlja spread previše outside kortizola the ducts (hormona lobules koji stvara nadbubrežna IONISING RADIATION žlezda) u organizmu; simptomi Any type obuhvataju of particle zaobljeno or electromagnetic lice, tanke ruke wave i noge, that izražen zamor carries i slabost enough mišića, energy visok to ionise krvni pritisak, or remove visok electrons nivo šećera u from krvi, an ljubičaste atom (e.g. ili ružičaste x-rays) strije na koži i porast težine LAPATINIB IPSILATERAL Vrsta Occurring ciljane on terapije the same koja side se koristi of the za body lečenje HER2 pozitivnog raka dojke KI67 LETROZOL A protein found in cells when they are dividing but not Tip when inhibitora they rest aromataze LEUKOPENIJA LAPATINIB Smanjen A type of broj targeted leukocita therapy (vrste belih used krvnih to treat zrnaca) HER2-positive u krvi, koji dovodi breast pojedince cancer u povišen rizik od infekcije LIMFEDEM LETROZOLE Otok A type izazvan of aromatase nakupljanjem inhibitor limfne tečnosti u tkivima u organizmu. On može biti rezultat oštećenja limfnog sistema zbog LEUKOPENIA operacije ili radioterapije limfnih čvorova u pazuhu ili okolnoj A decrease oblasti in the number of leukocytes (a type of white blood cell) in the blood, which places individuals at LIMFNI increased ČVOROVI risk of infection Male strukture u čitavom limfnom sistemu koje funkcionišu kao LOBULES filteri za (BREAST) štetne materije, kao što su ćelije raka ili bakterije Glands that make milk LIMFOPENIJA Nenormalno LYMPH NODES nizak nivo limfocita (vrste belih krvnih zrnaca) u krvi, Small koji structures dovodi pojedince throughout u povišen the lymphatic rizik od infekcije system that work as filters for harmful substances, such as cancer MAGNETNA cells or bacteria REZONANCA (MR) Vrsta snimanja koja koristi jaka magnetna polja i radio talase za LYMPHOEDEMA pravljenje detaljnih slika unutrašnjosti organizma Swelling caused by a build-up of lymph fluid in the MAMOGRAFIJA tissues of the body. This may result from damage to the Metoda lymphatic u kojoj system se dobija because slika of dojki surgery pomoću or rentgen radiotherapy zraka i kojom to the se lymph može nodes otkriti rani under rak the dojke arm and surrounding area 65

66 Rak Breast dojke cancer GLOSSARY REČNIK POJMOVA LYMPHOPENIA MARGINA (RUB) An Ivica abnormally ili granica tkiva low uklonjenog level of lymphocytes prilikom operacije (a type raka. of white blood Margina cell) se in opisuje the blood, kao negativna which places ili čista individuals kada nema ćelija at increased raka na ivici risk tkiva of što infection ukazuje na to da je ceo rak uklonjen. Margina se opisuje kao pozitivna ili zahvaćena kada ima ćelija MAGNETIC raka na ivici tkiva RESONANCE što ukazuje IMAGING na to da nije (MRI) uklonjen SCANceo rak. A type of scan that uses strong magnetic fields and radio MASTEKTOMIJA waves to produce detailed images of the inside of Operacija the body kojom se uklanja dojka MAINTENANCE MEGESTROL ACETAT TREATMENT Treatment Tip endokrine given terapije after koji the umanjuje initial cycles dejstvo of estrogena chemotherapy with the aim of keeping the cancer under control MEHANISTIČKI CILJ RAMPAMICINA (MTOR) Protein MAMMOGRAPHY uključen u deobu i preživljavanje ćelija, koji može biti An x-ray aktivniji of u the nekim breasts tipovima that ćelija can detect raka nego early u normalnim breast ćelijama cancers MENOPAUZA MARGIN Menopauza The edge or je border kada žena of the izgubi tissue menstrualni removed ciklus in cancer i više ne može surgery. da zatrudnim The margin prirodnim is described putem as negative or clean when no cancer cells are found at the edge of the tissue, MENSTRUACIJA suggesting that all of the cancer has been removed. The Poznata margin i is kao described menstrualni as positive ciklus ili mesečnica, or involved predstavlja when cancer redovni cells are (obično found mesečni) at the edge odliv of krvi the i tkiva tissue, iz unutrašnjosti suggesting that materice all of the kroz cancer vaginu has not been removed METASTAZE MASTECTOMY Kancerogeni Surgery to remove tumori koji a breast potiču iz primarnog tumora/izrasline u drugom delu organizma MECHANISTIC TARGET OF RAPAMYCIN (MTOR) METOTREKSAT A protein involved in cell division and survival, which Vrsta may be hemoterapije more active koja in some se daje types kao infuzija of cancer u venu cells u Vašoj than ruci in normal ili grudima, cellsili oralnim putem MIJALGIJA MEGESTROL ACETATE Bol A type u mišićima of endocrine therapy that reduces the effects of oestrogen MUKOZITIS Upala MENOPAUSE i ulceracija sluznice gastrointestinalnog sistema The menopause is when a woman stops having periods MUTACIJA and is no longer able to get pregnant naturally Trajna promena niza DNK koji sačinjava gen, takva da se taj niz MENSTRUATION razlikuje od onoga što postoji kod većine ljudi i menja funkciju This is also povezanog known proteina as a period or monthly, and is the regular discharge (usually monthly) of blood and tissue NAZOFARINGITIS from the inner lining of the uterus through the vagina Otok i upala nosnih šupljina i zadnjeg dela grla METASTASES NEINVAZIVNI Cancerous tumours (RAK DOJKE) that have originated from a primary Rak tumour/growth koji se nije proširio in another u zdravo part tkivo of the dojke body METHOTREXATE A type of chemotherapy that is administered through a drip into a vein in your arm or chest, or orally NEOADJUVANTNA MUCOSITIS (TERAPIJA) Terapija Inflammation koja se and daje ulceration kao prvi korak of the kako membranes bi se smanjio lining tumor pre the nego gastrointestinal što se primeni system glavni vid lečenja (obično operacija). Primeri neoadjuvantne terapije obuhvataju hemoterapiju, radioterapiju MUTATION i endokrinu terapiju A permanent alteration in the DNA sequence that makes NERATINIB up a gene, such that the sequence differs from what Nova is found vrsta in ciljane most terapije people and za lečenje alters HER2 the function pozitivnog of raka the dojke related protein NEUTROFILI MYALGIA Vrsta Muscular belih krvnih pain zrnaca koja igra važnu ulogu u borbi protiv infekcije NASOPHARYNGITIS NEUTROPENIJA Swelling and inflammation of the nasal passages and Nenormalno the back of nizak the throat nivo neutrofila u krvi, koji povećava rizik od infekcije NEOADJUVANT (TREATMENT) OLAPARIB Treatment given as a first step to shrink a tumour before Novi the main tip ciljane treatment terapije (usually koji inhibira surgery) PARPis given. Examples of neoadjuvant therapy include chemotherapy, ORHIEKTOMIJA radiotherapy and endocrine therapy Operacija kojom se uklanjaju ili jedan ili oba testisa NERATINIB OSTEONEKROZA A new type of targeted therapy for HER2-positive Gubitak breast prenosa cancer krvi do koštanog tkiva zbog čega kost odumire OSTEOPOROZA NEUTROPENIA Smanjenje An abnormally količine low i gustine level of koštanog neutrophils tkiva zbog in the kojeg blood, kosti postaju which increases slabe i lakše risk se lome of infection PAKLITAKSEL NEUTROPHILS Vrsta A type hemoterapije of white blood koja cell se daje that kao play infuzija an important u venu u Vašoj role in ruci fighting ili grudima off infection PALBOCIKLIB NON-INVASIVE (BREAST CANCER) Vrsta Cancer ciljane that terapije has not koja spread se koristi into healthy za lečenje breast uznapredovalog tissue raka dojke. On inhibira CDK4/6 kako bi se smanjila proliferacija ćelija NURSE tumora SPECIALIST A nurse specialised in the care of patients with a certain PANCITOPENIJA condition (e.g. cancer) Niski nivoi crvenih i belih krvnih zrnaca i trombocita u krvi OBESITY PARESTEZIJA Abnormal or excessive fat accumulation that may Osećaj impair peckanja, health trnjenja ili utrnulosti, obično u rukama, nogama, šakama ili stopalima OEDEMA PAZUŠNI A build-up LIMFNI of fluid ČVOROVI in the body which causes the affected Limfni tissues čvorovi to become u pazuhu swollen PERIFERNA OESTROGEN NEUROPATIJA Oštećenje Hormone nerava that helps u telesnim to develop udovima. and maintain female sex Simptomi characteristics mogu biti bol, osetljivost, utrnulost ili slabost u rukama, OESTROGEN stopalima RECEPTOR ili potkolenicama (ER)-POSITIVE Cells that have a receptor protein that binds oestrogen. Cancer cells that are ER-positive need oestrogen to grow 66

67 ESMO Vodič Patients za pacijente Guide REČNIK GLOSSARY POJMOVA PERTUZUMAB OLAPARIB Vrsta A new ciljane type of terapije targeted koja therapy se koristi which za lečenje inhibits HER2 PARP pozitivnog raka dojke ORCHIECTOMY PLATINA Surgery to remove one or both testicles Metal koji predstavlja važnu komponentu nekih lekova protiv raka, OSTEONECROSIS kao što je karboplatin Loss of blood flow to bone tissue, causing the bone PNEUMONITIS to die Zapaljenje pluća OSTEOPOROSIS POLI A decrease ADP-RIBOZA in the POLIMERAZA amount and thickness (PARP) of bone tissue, Enzim which koji causes učestvuje the bones u mnogim to become ćelijskim weak funkcijama, and break uključujući more easily popravku oštećenja DNK POŠTEDNA OVARIAN FUNCTION OPERACIJA SUPPRESSION DOJKE Operacija Treatment kojom that se stops uklanja or lowers tumor i the okolno amount tkivo of dojke, a istovremeno oestrogen made ostavlja by što the je ovaries moguće veći deo dojke POZITRONSKA PACLITAXEL EMISIONA TOMOGRAFIJA (PET) Vrsta A type snimanja of chemotherapy pri kojoj se koristi that is boja administered sa radioaktivnim through a materijama drip into a vein (obeleživačima) in your arm koja or Vam chest se ubrizgava u venu u ruci PALBOCICLIB PROGESTERON A type of targeted therapy used to treat advanced Hormon breast cancer. koji igra It ulogu inhibits u menstrualnom CDK4/6 to reduce ciklusu i the trudnoći proliferation of tumour cells PROGESTERONSKI RECEPTOR (PgR) Receptorski PANCYTOPENIA protein koji vezuje protesteron Low levels of red cells, white cells and platelets in the PROGNOZA blood Verovatan ishod medicinskog stanja PARAESTHESIA PROTEINURIJA Pricking, tingling or numbing sensation usually felt in Nenormalno the arms, legs, visok hands nivo proteina or feet u mokraći; može da ukaže na loše funkcionisanje bubrega PERIPHERAL NEUROPATHY PRURITUS Damage to the nerves in the extremities of the body. Izražen Symptoms svrab may kožeinclude pain, sensitivity, numbness or weakness in the hands, feet or lower legs (TERAPIJA) PRVE LINIJE Početna PERTUZUMAB terapija koja se daje pacijentu A type of targeted therapy used to treat HER2-positive RADIOEMBOLIZACIJA breast cancer Vrsta unutrašnje radioterapije koja se koristi za lečenje metastaza na jetri. Sićušna zrnca koja sadrže radioaktivnu materiju ubrizgavaju se u glavni krvni sud koji prenosi krv POLY ADP-RIBOSE POLYMERASE (PARP) do jetre. Zrnca se nakupljaju u tumoru i u krvnom sudu blizu An enzyme involved in many cell functions, including tumora, uništavajući krvne sudove potrebne tumoru za rast i the repair of DNA damage ubijajući ćelije raka POSITRON EMISSION TOMOGRAPHY (PET) RADIOFREKVENTNA ABLACIJA An imaging test that uses a dye with radioactive Postupak tokom koga radio talasi putuju kroz elektrode kako bi tracers, which is injected into a vein in your arm zagrevale i uništavale ćelije raka RADIOTERAPIJA PLATINUM Terapija A metal koja that se is sastoji an important od zračenja component visoke energije of some koje se obično anticancer koristi drugs, za lečenje such raka as carboplatin RADIOTERAPIJA PNEUMONITIS CELE DOJKE (WBRT) Radioterapija Inflammation kojom of the se lungs tretira cela dojka RENALNI PROGESTERONE Koji Hormone se odnosi that na plays bubrege a role in the menstrual cycle and pregnancy RENTGEN ZRACI Zraci PROGESTERONE koji se primenjuju RECEPTOR za snimanje (PgR) u okviru koga se koristi vrsta A receptor zračenja protein koja može that da binds prođe progesterone kroz telo, na taj način omogućavajući Vašem lekaru da vidi slike Vašeg organizma PROGNOSIS RESEKCIJA The likely outcome of a medical condition Operacija kojom se uklanja tkivo PROTEINURIA REŽNJEVI An abnormally (LOBULE) high (U level DOJCI) of protein in the urine; may Žlezde indicate koje kidney stvaraju dysfunction mleko RINITIS PRURITUS Upala Severe sluznice itching nosa of the skin RIBOCIKLIB RADIOEMBOLISM Vrsta A type ciljane of internal terapije radiotherapy koja se koristi used za lečenje to treat liver uznapredovalog metastases. Tiny raka beads dojke. containing On inhibira CDK4/6 a radioactive kako bi se smanjila substance proliferacija are injected ćelija into tumora the main blood vessel that carries blood to the liver. The beads collect in SALPINGO-OOFOREKTOMIJA the tumour and in blood vessels near the tumour, Operacija destroying kojom the se blood uklanjaju vessels jajnici that i jajovodi the tumour needs to grow and killing the cancer cells SEKVENCIJALNO Terapije RADIOFREQUENCY koje se daju jedna ABLATION nakon druge A procedure in which radio waves travel through SINDROM electrodes ŠAKA-STOPALO to heat and destroy cancer cells Stanje obeleženo bolovima, otokom, utrnulošću, peckanjem, preljuštavanjem RADIOTHERAPY i stvaranjem plikova, ili crvenilom na rukama i nogama. Treatment Ponekad involving se javlja the use kao neželjeno of high-energy dejstvo radiation, nekih lekova protiv which raka is commonly used to treat cancer SISTEMSKA RENAL (TERAPIJA) Lekovi Relating koji to se the šire kidneys organizmom kako bi napadali ćelije raka gde god se one nalazile. Oni obuhvataju hemoterapiju, hormonsku RESECTION terapiju i ciljanu terapiju Surgery to remove tissue SPECIJALIZOVANA MEDICINSKA SESTRA RHINITIS Medicinska sestra koja je obučena za negu pacijenata sa Inflammation of the lining inside the nose određenim stanjima (npr. rakom) RIBOCICLIB STEREOTAKTIČNA RADIOTERAPIJA A type of targeted therapy used to treat advanced Tip spoljašnje radioterapije pri kojoj se koristi specijalna breast cancer. It inhibits CDK4/6 to reduce the oprema za postavljanje pacijenta u određen položaj i precizno proliferation of tumour cells zračenje tumora SALPINGO-OOPHORECTOMY Surgery to remove the ovaries and fallopian tubes 67

68 Rak Breast dojke cancer REČNIK GLOSSARY POJMOVA STOMATITIS SEQUENTIALLY Zapaljenje Treatment usne given duplje one after the other SUPKUTANA STEREOTACTIC RADIOTHERAPY Potkožna A type of external radiotherapy that uses special equipment to position the patient and precisely deliver SUPRESIJA radiation to (POTISKIVANJE) a tumour FUNKCIJE JAJNIKA Terapija kojom se zaustavlja ili snižava količina estrogena koju STOMATITIS proizvode jajnici Inflammation of the inside of the mouth TAKSAN Klasa SUBCUTANEOUS hemoterapije koja obuhvata paklitaksel i docetaksel Beneath the skin TALAZOPARIB Novi SYSTEMIC tip ciljane (TREATMENT) terapije koji inhibira PARP Drugs that spread throughout the body to treat TAMOKSIFEN cancer cells wherever they may be. They include Tip chemotherapy, endokrine terapije hormonal koji blokira therapy dejstvo and targeted estrogena therapy u dojkama TALAZOPARIB TERAPIJA A new type ODRŽAVANJA of targeted therapy which inhibits PARP Terapija koja se daje nakon početnih ciklusa hemoterapije u cilju TAMOXIFEN držanja raka pod kontrolom A type of endocrine therapy that blocks the effects of TINITUS oestrogen in the breast Pojava kada se čuje zvuk (poput zvonjave, zavijanja ili zujanja) kada TARGETED zapravo THERAPY nije prisutan spoljni zvuk A newer type of drug that works by blocking the signals TRASTUZUMAB that tell cancer cells to grow or by interfering with their Vrsta ability ciljane to obtain terapije nutrients koja se for koristi growth za lečenje HER2 pozitivnog raka dojke TAXANE TRASTUZUMAB A class of chemotherapy EMTANSIN that (T-DM1) includes paclitaxel and Kombinacija docetaxel trastuzumaba i leka za hemoterapiju koji se naziva emtansine THROMBOCYTOPENIA TROMBOCITOPENIJA A deficiency of platelets in the blood. This causes Nedostatak bleeding into trombocita the tissues, u krvi. bruising, Zbog toga and se javljaju slow blood krvarenje u tkivima, clotting modrice after injury i sporo zgrušnjavanje krvi nakon povrede TROMBOFLEBITIS THROMBOPHLEBITIS Zapaljenje Inflammation vene of kada a vein se formira when a ugrušak blood clot krvi forms TROMBOZA THROMBOSIS Formiranje The formation krvnog of ugruška a blood u clot krvnom inside sudu a blood koje ometa vessel, protok krvi obstructing kroz krvni the sistem flow of blood through the blood system TUMOR TINNITUS Kvržica The hearing ili izraslina of a sound nenormalnih (such ćelija. as ringing, Tumori whining mogu da or budu benigni buzzing) (nisu when kancerozni) no external ili maligni sound (kancerozni). is present U ovom vodiču termin tumor odnosi se na kanceroznu izraslinu, TRASTUZUMAB ukoliko nije drugačije navedeno A type of targeted therapy used to treat HER2-positive ULTRAZVUČNO breast cancer SNIMANJE Vrsta medicinskog snimanja u kojoj računar pretvara zvučne talase u slike UBRZANO TRASTUZUMAB PARCIJALNO EMTANSINE ZRAČENJE (T-DM1) DOJKE (APBI) Radioterapija Combination usmerena of trastuzumab samo na and malu a chemotherapy marginu tkiva koje drug okružuje called emtansine mesto na kome se izvodi resekcija tumora dojke VASKULARNI TUMOUR ENDOTELNI FAKTOR RASTA (VEGF) Protein A lump koji or growth proizvode of ćelije abnormal koji stimuliše cells. Tumours rast novih may krvnih be sudova benign (not cancerous) or malignant (cancerous). In this guide, the term tumour refers to a cancerous VINORELBIN growth, unless otherwise stated Vrsta hemoterapije koja se daje kao infuzija u venu u Vašoj ruci ULTRASOUND ili grudima, ili SCAN oralnim putem A type of medical scan where sound waves are ZAMOR converted into images by a computer Preveliki umor VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) A protein produced by cells that stimulates the growth of new blood vessels VINORELBINE A type of chemotherapy that is administered through a drip into a vein in your arm or chest, or orally WHOLE BREAST RADIOTHERAPY (WBRT) Radiotherapy delivered to the entire breast X-RAY An imaging test, using a type of radiation that can pass through the body, which allows your doctor to see images of inside your body 68

69 ESMO Vodič Patients za pacijente Guide Ovaj This vodič guide pripremljen has been prepared je kako bi to pomogao help you, Vama, your friends Vašim and prijateljima your family i porodici better u understand boljem razumevanju the nature prirode of breast raka dojke cancer i vrste and the lečenja treatments koje su that na raspolaganju. are available. Medicinske The medical informacije information opisane described u ovom in this dokumentu document zasnovane is based on su the na smernicama clinical practice za kliničku guidelines praksu of the European European Society Society for for Medical Medical Oncology Oncology (ESMO) (ESMO) za lečenje for the ranog management i uznapredovalog of early raka and advanced dojke. Preporučujemo breast cancer. da We se obratite recommend svom that lekaru you sa ask pitanjima your doctor o testovima about the i vrstama tests and lečenja types koje of treatments postoje u Vašoj zemlji za Vaš tip i stadijum raka dojke. available in your country for your type and stage of breast cancer. Neki lekovi iz ovog vodiča možda nisu dostupni u Vašoj zemlji. Obratite se svom lekaru ili pogledajte lokalne informacije o propisivanju lekova za više informacija. Ovaj This vodič guide sastavila has been je written agencija by Kstorfin Medical Communications Ltd Ltd u on ime behalf ESMO. of ESMO. Copyright 2018 European Society for Medical Oncology. Sva All prava rights zadržana reserved širom worldwide. sveta. European Society for Medical Oncology (ESMO) Via Ginevra Lugano Švajcarska Switzerland Tel.: Tel: +41 (0) Faks: Fax: +41 (0) Imejl: clinicalguidelines@esmo.org 69

70 Možemo We can help Vam you pomoći understand da razumete breast rak cancer dojke i postojeće mogućnosti and the available za lečenje. treatment options. ESMO The ESMO vodiči Guides za pacijente for Patients sastavljeni are designed su kako to bi assist pomogli patients, pacijentima, their relatives njihovoj and caregivers porodici to i negovateljima understand the da nature razumeju of different prirodu različitih types of vrsta cancer raka and i evaluate da procene the best najbolje available postojeće treatment mogućnosti choices. lečenja. The medical information described in the Guides for Patients Medicinske is based on informacije the ESMO Clinical opisane Practice u vodičima Guidelines, za pacijente which zasnivaju se are na designed ESMO Smernicama to guide medical za kliničku oncologists praksu in koje the diagnosis, su osmišljene kako follow-up bi pomogle and treatment medicinskim in different onkolozima cancer u types. postavljanju dijagnoze, kontroli i lečenju različitih tipova raka For more information, please visit Za više informacija posetite