İLERİ EVRE JİNEKOLOJİK KANSERLERDE ACİL KLİNİK DURUMLAR
Özet
İleri evre jinekolojik kanserlerde gelişen onkolojik aciller, tümör progresyonu, metastazlar veya antikanser tedavilere bağlı ortaya çıkan ve erken tanınıp yönetilmediğinde ciddi morbidite ve mortaliteye yol açabilen klinik durumlardır. Bu bölümde malign bağırsak obstrüksiyonu, malign kanama, üriner sistem obstrüksiyonu, venöz tromboembolizm, spinal kord basısı, febril nötropeni ve sepsis, metabolik aciller ile malign efüzyonlar güncel yaklaşımlar doğrultusunda ele alınmaktadır. Yönetimin temel amacı, yaşamı tehdit eden fizyolojik bozuklukların hızlı stabilizasyonunu sağlarken altta yatan nedenin eş zamanlı olarak belirlenmesi ve tedavi edilmesidir. İlk değerlendirme ABCDE yaklaşımıyla yapılmalı; laboratuvar ve görüntüleme yöntemleri klinik gereksinime göre planlanmalıdır. Tedavi kararları yalnızca komplikasyonun tipine değil, hastalığın yaygınlığına, organ fonksiyonlarına, performans durumuna, mevcut onkolojik tedavilere ve hastanın bakım hedeflerine göre bireyselleştirilmelidir. Minimal invaziv girişimler, girişimsel radyoloji uygulamaları ve endoskopik yöntemler uygun hastalarda cerrahiye alternatif veya tamamlayıcı seçenekler sunmaktadır. Venöz tromboembolizm ve spinal kord basısı gibi acillerde erken tanı ve zamanında tedavi kalıcı nörolojik hasar ile mortaliteyi azaltırken, malign bağırsak obstrüksiyonu ve masif kanamada semptom kontrolü ile yaşam kalitesinin korunması ön plandadır. Üriner obstrüksiyonda stent veya perkütan nefrostomi seçimi klinik duruma göre belirlenmelidir. Tüm bu süreçlerde jinekolojik onkoloji, medikal onkoloji, radyasyon onkolojisi, acil tıp, yoğun bakım, girişimsel radyoloji ve palyatif bakım ekiplerinin koordineli çalışması esastır. Erken multidisipliner değerlendirme ve hasta merkezli karar verme, hem acil komplikasyonların etkin yönetimini hem de hastanın yaşam kalitesinin korunmasını sağlayan temel ilkeleri oluşturmaktadır.
Anahtar Kelimeler: acil, ileri evre, jinekoloji, onkoloji
Konu Alanı: Tıp -> Tıp (diğer) -> Kadın Hastalıkları ve Doğum
[1] Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10.3322/caac.21834.
[2] Gould Rothberg BE, Quest TE, Yeung SCJ, et al. Oncologic emergencies and urgencies: a comprehensive review. CA Cancer J Clin. 2022;72(6):570-593. doi:10.3322/caac.21727.
[3] Azoulay E, Schellongowski P, Darmon M, et al. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med. 2017;43(9):1366-1382. doi:10.1007/s00134-017-4884-z.
[4] Sanders JJ, Temin S, Ghoshal A, et al. Palliative Care for Patients With Cancer: ASCO Guideline Update. J Clin Oncol. 2024;42(19):2336-2357. doi:10.1200/JCO.24.00542.
[5] Thim T, Krarup NHV, Grove EL, Rohde CV, Lofgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117-121. doi:10.2147/IJGM.S28478.
[6] O'Driscoll BR, Howard LS, Earis J, Mak V, British Thoracic Society Emergency Oxygen Guideline G, Group BTSEOGD. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72(Suppl 1):ii1-ii90. doi:10.1136/thoraxjnl-2016-209729.
[7] National Institute for Health and Care Excellence. Spinal metastases and metastatic spinal cord compression. NICE guideline NG234. London: NICE; 2023.
[8] Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.1007/s00134-021-06506-y.
[9] Expert Panel on Gastrointestinal I, Chang KJ, Marin D, et al. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol. 2020;17(5S):S305-S314. doi:10.1016/j.jacr.2020.01.025.
[10] Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3) doi:10.1183/13993003.01647-2019.
[11] Madariaga A, Lau J, Ghoshal A, et al. MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer. Support Care Cancer. 2022;30(6):4711-4728. doi:10.1007/s00520-022-06889-8.
[12] Tuca A, Guell E, Martinez-Losada E, Codorniu N. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res. 2012;4:159-69. doi:10.2147/CMAR.S29297.
[13] Toth R, Toth Z, Loczi L, et al. Management of Malignant Bowel Obstruction in Patients with Gynaecological Cancer: A Systematic Review. J Clin Med. 2024;13(14):4213. doi:10.3390/jcm13144213.
[14] Gonzalez-Ochoa E, Alqaisi HA, Bhat G, Jivraj N, Lheureux S. Inoperable Bowel Obstruction in Ovarian Cancer: Prevalence, Impact and Management Challenges. Int J Womens Health. 2022;14:1849-1862. doi:10.2147/IJWH.S366680.
[15] Martinez Castro P, Vargas L, Mancheno A, et al. Malignant bowel obstruction in relapsed ovarian cancer with peritoneal carcinomatosis: an occlusive state. Int J Gynecol Cancer. 2017;27(7):1367-1372. doi:10.1097/IGC.0000000000001049.
[16] Demarest K, Lavu H, Collins E, Batra V. Comprehensive Diagnosis and Management of Malignant Bowel Obstruction: A Review. J Pain Palliat Care Pharmacother. 2023;37(1):91-105. doi:10.1080/15360288.2022.2106012.
[17] Ferguson HJ, Ferguson CI, Speakman J, Ismail T. Management of intestinal obstruction in advanced malignancy. Ann Med Surg (Lond). 2015;4(3):264-70. doi:10.1016/j.amsu.2015.07.018.
[18] Patterson M, Greenley S, Ma Y, et al. Inoperable malignant bowel obstruction: palliative interventions outcomes - mixed-methods systematic review. BMJ Support Palliat Care. 2024;13(e3):e515-e527. doi:10.1136/bmjspcare-2021-003492.
[19] Paul Olson TJ, Pinkerton C, Brasel KJ, Schwarze ML. Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg. 2014;149(4):383-392. doi:10.1001/jamasurg.2013.4059.
[20] Obita GP, Boland EG, Currow DC, Johnson MJ, Boland JW. Somatostatin analogues compared with placebo and other pharmacologic agents in the management of symptoms of inoperable malignant bowel obstruction: a systematic review. J Pain Symptom Manage. 2016;52(6):901-919.e1. doi:10.1016/j.jpainsymman.2016.07.002.
[21] Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2000;(2):CD001219. doi:10.1002/14651858.CD001219.
[22] Lodoli C, Covello R, Trodella LE, et al. Palliative venting gastrostomy in patients with malignant bowel obstruction and ascites. Support Care Cancer. 2022;30(7):6067-6075. doi:10.1007/s00520-022-06989-5.
[23] Eleje GU, Eke AC, Igberase GO, Igwegbe AO, Eleje LI. Palliative interventions for controlling vaginal bleeding in advanced cervical cancer. Cochrane Database Syst Rev. 2019;3(3):CD011000. doi:10.1002/14651858.CD011000.pub3.
[24] Verschuren P, Christiaens M, Oldenburger E. Hemostatic radiotherapy: a narrative review of the literature. Ann Palliat Med. 2024;13(4):1114-1132. doi:10.21037/apm-24-26.
[25] Spahn DR, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27(1):80. doi:10.1186/s13054-023-04327-7.
[26] Haas B, Chittams J, Trerotola SO. Transarterial embolization for pelvic malignancy-related hemorrhage: outcomes and predictors of clinical success. J Vasc Interv Radiol. 2018;29(1):65-72. doi:10.1016/j.jvir.2017.08.022.
[27] Shah M, Blest F, Blackmur J, Laird A, Dawson S, Aning J. Malignant upper urinary tract obstruction in cancer patients: a systematic review. BJUI Compass. 2024;5(5):405-416. doi:10.1002/bco2.340.
[28] Blackmur J; Scottish Malignant Ureteric Obstruction Study Group. Management of malignant ureteric obstruction with ureteric stenting or percutaneous nephrostomy. Br J Surg. 2024;111(2):znae035. doi:10.1093/bjs/znae035.
[29] Gauhar V, Pirola GM, Scarcella S, et al. Nephrostomy tube versus double J ureteral stent in patients with malignant ureteric obstruction: a systematic review and meta-analysis of comparative studies. Int Braz J Urol. 2022;48(6):903-914. doi:10.1590/S1677-5538.IBJU.2022.0225.
[30] Monsky WL, Molloy C, Jin B, et al. Quality-of-life assessment after palliative interventions to manage malignant ureteral obstruction. Cardiovasc Intervent Radiol. 2013;36(5):1355-1363. doi:10.1007/s00270-013-0570-9.
[31] Key NS, Khorana AA, Kuderer NM, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO guideline update. J Clin Oncol. 2023;41(16):3063-3071. doi:10.1200/JCO.23.00294.
[32] Falanga A, Ay C, Di Nisio M, et al. Venous thromboembolism in cancer patients: ESMO Clinical Practice Guideline. Ann Oncol. 2023;34(5):452-467. doi:10.1016/j.annonc.2022.12.014.
[33] Lavikainen LI, Guyatt GH, Luomaranta AL, et al. Risk of thrombosis and bleeding in gynecologic cancer surgery: systematic review and meta-analysis. Am J Obstet Gynecol. 2024;230(4):403-416. doi:10.1016/j.ajog.2023.10.006.
[34] Farge D, Frere C, Connors JM, et al. 2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19. Lancet Oncol. 2022;23(7):e334-e347. doi:10.1016/S1470-2045(22)00160-7.
[35] Agnelli G, Becattini C, Meyer G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382(17):1599-1607. doi:10.1056/NEJMoa1915103.
[36] Raskob GE, van Es N, Verhamme P, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378(7):615-624. doi:10.1056/NEJMoa1711948.
[37] Patchell RA, Tibbs PA, Regine WF, et al. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet. 2005;366(9486):643-648. doi:10.1016/S0140-6736(05)66954-1.
[38] Sahgal A, Myrehaug SD, Siva S, et al. Stereotactic body radiotherapy versus conventional external beam radiotherapy in patients with painful spinal metastases: an open-label, multicentre, randomised, controlled, phase 2/3 trial. Lancet Oncol. 2021;22(7):1023-1033. doi:10.1016/S1470-2045(21)00196-0.
[39] Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: ASCO and IDSA clinical practice guideline update. J Clin Oncol. 2018;36(14):1443-1453. doi:10.1200/JCO.2017.77.6211.
[40] Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-e93. doi:10.1093/cid/cir073.
[41] Sandherr M, Stemler J, Schalk E, et al. 2024 update of the AGIHO guideline on diagnosis and empirical treatment of fever of unknown origin in adult neutropenic patients with solid tumours and hematological malignancies. Lancet Reg Health Eur. 2025;51:101214. doi:10.1016/j.lanepe.2024.101214.
[42] Klastersky J, Paesmans M, Rubenstein EB, et al. The Multinational Association for Supportive Care in Cancer risk index: a multinational scoring system for identifying low-risk febrile neutropenic cancer patients. J Clin Oncol. 2000;18(16):3038-3051. doi:10.1200/JCO.2000.18.16.3038.
[43] Carmona-Bayonas A, Jimenez-Fonseca P, Virizuela Echaburu J, et al. Prediction of serious complications in patients with seemingly stable febrile neutropenia: validation of the Clinical Index of Stable Febrile Neutropenia. J Clin Oncol. 2015;33(5):465-471. doi:10.1200/JCO.2014.57.2347.
[44] Smith TJ, Bohlke K, Lyman GH, et al. Recommendations for the use of WBC growth factors: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2015;33(28):3199-3212. doi:10.1200/JCO.2015.62.3488.
[45] El-Hajj Fuleihan G, Clines GA, Hu MI, et al. Treatment of hypercalcemia of malignancy in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2023;108(3):507-528. doi:10.1210/clinem/dgac621.
[46] Perissinotti AJ, Bishop MR, Bubalo J, et al. Expert consensus guidelines for the prophylaxis and management of tumor lysis syndrome in the United States: results of a modified Delphi panel. Cancer Treat Rev. 2023;120:102603. doi:10.1016/j.ctrv.2023.102603.
[47] Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3):G1-G47. doi:10.1530/EJE-13-1020.
[48] Cairo MS, Bishop M. Tumour lysis syndrome: new therapeutic strategies and classification. Br J Haematol. 2004;127(1):3-11. doi:10.1111/j.1365-2141.2004.05094.x.
[49] Vogelbaum MA, Brown PD, Messersmith H, et al. Treatment for brain metastases: ASCO-SNO-ASTRO guideline. J Clin Oncol. 2022;40(5):492-516. doi:10.1200/JCO.21.02314.
[50] Le Rhun E, Weller M, van den Bent M, et al. Leptomeningeal metastasis from solid tumours: EANO-ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. ESMO Open. 2023;8(5):101624. doi:10.1016/j.esmoop.2023.101624.
[51] Ryken TC, Kuo JS, Prabhu RS, Sherman JH, Kalkanis SN, Olson JJ. Congress of Neurological Surgeons systematic review and evidence-based guidelines on the role of steroids in the treatment of adults with metastatic brain tumors. Neurosurgery. 2019;84(3):E189-E191. doi:10.1093/neuros/nyy546.
[52] Gondi V, Bauman G, Bradfield L, et al. Radiation therapy for brain metastases: an ASTRO clinical practice guideline. Pract Radiat Oncol. 2022;12(4):265-282. doi:10.1016/j.prro.2022.02.003.
[53] Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of malignant pleural effusions: an official ATS/STS/STR clinical practice guideline. Am J Respir Crit Care Med. 2018;198(7):839-849. doi:10.1164/rccm.201807-1415ST.
[54] Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases. Eur Heart J. 2015;36(42):2921-2964. doi:10.1093/eurheartj/ehv318.
[55] Chow R, Simone CB 2nd, Rimner A. Management of malignant superior vena cava syndrome. Ann Palliat Med. 2024;13(3):620-626. doi:10.21037/apm-23-573.
[56] Mahmood K, Frazer-Green L, Gonzalez AV, et al. Management of central airway obstruction: an American College of Chest Physicians clinical practice guideline. Chest. 2025;167(1):283-295. doi:10.1016/j.chest.2024.06.3804.
[57] Kettenbach J, Ittrich H, Gaubert JY, Gebauer B, Vos JA. CIRSE Standards of Practice on Bronchial Artery Embolisation. Cardiovasc Intervent Radiol. 2022;45(6):721-732. doi:10.1007/s00270-022-03127-w.
[58] Schneider BJ, Naidoo J, Santomasso BD, et al. Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: ASCO guideline update. J Clin Oncol. 2021;39(36):4073-4126. doi:10.1200/JCO.21.01440.
[59] Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol. 2022;33(12):1217-1238. doi:10.1016/j.annonc.2022.10.001.
[60] Brahmer JR, Abu-Sbeih H, Ascierto PA, et al. Society for Immunotherapy of Cancer clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer. 2021;9(6):e002435. doi:10.1136/jitc-2021-002435.
[61] Rosello S, Blasco I, Fabregat LG, Cervantes A, Jordan K. Management of infusion reactions to systemic anticancer therapy: ESMO clinical practice guidelines. Ann Oncol. 2017;28(Suppl 4):iv100-iv118. doi:10.1093/annonc/mdx216.
[62] Mirza MR, Coleman RL, Gonzalez-Martin A, et al. The forefront of ovarian cancer therapy: update on PARP inhibitors. Ann Oncol. 2020;31(9):1148-1159. doi:10.1016/j.annonc.2020.06.004.
[63] Coleman RL, Lorusso D, Gennigens C, et al. Efficacy and safety of tisotumab vedotin in previously treated recurrent or metastatic cervical cancer (innovaTV 204/GOG-3023/ENGOT-cx6): a multicentre, open-label, single-arm, phase 2 study. Lancet Oncol. 2021;22(5):609-619. doi:10.1016/S1470-2045(21)00056-5.
[64] Matulonis UA, Lorusso D, Oaknin A, et al. Efficacy and safety of mirvetuximab soravtansine in patients with platinum-resistant ovarian cancer with high folate receptor alpha expression: results from the SORAYA study. J Clin Oncol. 2023;41(13):2436-2445. doi:10.1200/JCO.22.01900.
[65] Meric-Bernstam F, Makker V, Oaknin A, et al. Efficacy and safety of trastuzumab deruxtecan in patients with HER2-expressing solid tumors: primary results from the DESTINY-PanTumor02 phase II trial. J Clin Oncol. 2024;42(1):47-58. doi:10.1200/JCO.23.02005.
[66] Davis M, Hui D, Davies A, et al. MASCC antiemetics in advanced cancer updated guideline. Support Care Cancer. 2021;29(12):8097-8107. doi:10.1007/s00520-021-06437-w.
[67] Touyz RM, Herrmann J. Cardiotoxicity with vascular endothelial growth factor inhibitor therapy. NPJ Precis Oncol. 2018;2:13. doi:10.1038/s41698-018-0056-z.
[68] Perez Fidalgo JA, Garcia Fabregat L, Cervantes A, et al. Management of chemotherapy extravasation: ESMO-EONS clinical practice guidelines. Ann Oncol. 2012;23(Suppl 7):vii167-vii173. doi:10.1093/annonc/mds294.
[69] Crawford GB, Dzierzanowski T, Hauser K, et al. Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines. ESMO Open. 2021;6(4):100225. doi:10.1016/j.esmoop.2021.100225.
[70] Stone P, Buckle P, Dolan R, et al. Prognostic evaluation in patients with advanced cancer in the last months of life: ESMO Clinical Practice Guideline. ESMO Open. 2023;8(2):101195. doi:10.1016/j.esmoop.2023.101195.
[71] Stiefel F, Bourquin C, Salmon P, et al. Communication and support of patients and caregivers in chronic cancer care: ESMO Clinical Practice Guideline. ESMO Open. 2024;9(7):103496. doi:10.1016/j.esmoop.2024.103496.
[72] Fallon M, Giusti R, Aielli F, et al. Management of cancer pain in adult patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29(Suppl 4):iv166-iv191. doi:10.1093/annonc/mdy152.
[73] Bush SH, Lawlor PG, Ryan K, et al. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol. 2018;29(Suppl 4):iv143-iv165. doi:10.1093/annonc/mdy147.
[74] Hui D, Maddocks M, Johnson MJ, et al. Management of breathlessness in patients with cancer: ESMO Clinical Practice Guidelines. ESMO Open. 2020;5(6):e001038. doi:10.1136/esmoopen-2020-001038.
[75] Johnson MJ, Spruyt O, Greenley S, et al. Paracentesis for cancer-related ascites in palliative care: an international, prospective cohort study. Palliat Med. 2022;36(10):1518-1527. doi:10.1177/02692163221119727.
[76] Stukan M. Drainage of malignant ascites: patient selection and perspectives. Cancer Manag Res. 2017;9:115-130. doi:10.2147/CMAR.S100210.
[77] Surges SM, Brunsch H, Jaspers B, et al. Revised European Association for Palliative Care recommended framework on palliative sedation: an international Delphi study. Palliat Med. 2024;38(2):213-228. doi:10.1177/02692163231220225.
[78] Cherny NI; ESMO Guidelines Working Group. ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation. Ann Oncol. 2014;25(Suppl 3):iii143-iii152. doi:10.1093/annonc/mdu238.
[79] van Esch HJ, van Zuylen L, Geijteman ECT, et al. Effect of prophylactic subcutaneous scopolamine butylbromide on death rattle in patients at the end of life: the SILENCE randomized clinical trial. JAMA. 2021;326(13):1268-1276. doi:10.1001/jama.2021.14785.
[80] Hodge C, Badgwell BD. Palliation of malignant ascites. J Surg Oncol. 2019;120(1):67-73. doi:10.1002/jso.25453.
[81] Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40(5):2898-2913. doi:10.1016/j.clnu.2021.02.005.
[82] Roeland EJ, Bohlke K, Baracos VE, et al. Cancer cachexia: ASCO guideline rapid recommendation update. J Clin Oncol. 2023;41(25):4178-4179. doi:10.1200/JCO.23.01280.
[83] Cohen AB, Schwamm LH. Digital health for oncological care. Cancer J. 2024;30(1):34-39. doi:10.1097/PPO.0000000000000693.
[84] Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197-198. doi:10.1001/jama.2017.7156.
[85] Basch E, Schrag D, Jansen J, et al. Symptom monitoring with electronic patient-reported outcomes during cancer treatment: final results of the PRO-TECT cluster-randomized trial. Nat Med. 2025;31(4):1225-1232. doi:10.1038/s41591-025-03507-y.
[86] Di Maio M, Basch E, Denis F, et al. The role of patient-reported outcome measures in the continuum of cancer clinical care: ESMO Clinical Practice Guideline. Ann Oncol. 2022;33(9):878-892. doi:10.1016/j.annonc.2022.04.007.
[87] Riaz IB, Khan MA, Osterman TJ. Artificial intelligence across the cancer care continuum. Cancer. 2025;131(16):e70050. doi:10.1002/cncr.70050.
doğan, o. (2026). İLERİ EVRE JİNEKOLOJİK KANSERLERDE ACİL KLİNİK DURUMLAR. In YURTCU, N. (Ed.), Obstetrik ve Jinekolojik Acillerde Multidisipliner Güncel Yaklaşım (pp. 563-599). Vizetek Yayıncılık. https://doi.org/10.54637/vizetek.9786253823962
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