Geriatrik Mesane (Lokal-Metastatik) ve Üst Üriner Sistem Kanseri Hastalarına Yaklaşım
Özet
Bu bölümde, geriatrik hastalarda lokal, metastatik mesane kanseri ve üst üriner sistem kanserlerine yaklaşım ele alınmaktadır. Geriatrik popülasyonda yaş, bilişsel durum, komorbiditeler ve fonksiyonel kapasite tedavi planlamasında kritik öneme sahiptir. Kas invaze olmayan mesane kanserinde (KİOMK) düşük riskli olgularda konservatif yaklaşımlar, intravezikal tedaviler ve aktif izlem öne çıkarken; yüksek riskli hastalarda BCG, hipertermik kemoterapi ve gerekirse erken radikal sistektomi uygulanabilir. Kas invaze mesane kanserinde (KİMK) radikal sistektomi standart tedavidir; ancak yaşlı hastalarda komorbiditeler ve böbrek fonksiyonları neoadjuvan kemoterapi uygulanabilirliğini kısıtlar. Metastatik hastalıkta platin bazlı kemoterapiler, immünoterapiler ve yeni kombinasyon tedaviler önerilmektedir. Üst üriner sistem ürotelyal kanserlerinde düşük riskli olgularda böbrek koruyucu cerrahiler, yüksek riskli olgularda ise radikal nefroüreterektomi temel yaklaşımdır. Geriatrik hastalarda multidisipliner değerlendirme ve bireyselleştirilmiş tedavi onkolojik sonuçların iyileştirilmesinde kilit rol oynamaktadır.
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