Enterprise
Definition
Oncology - Science of the reasons,methods of diagnosis, treatment and
Prevention of tumors.
Oncological incidence of B.
Russia, as in all economically
developed countries tends to
Growth. Malignant
The neoplasms are the third
significance cause of mortality
population after injury and cardiovascular diseases
Definition
Pretzhol (XI.: Novogu formation,Neoplasia, neoplasm) -
pathological process
rendered newly formed
cloth in which changes
The genetic apparatus of cells
lead to violation of regulation
their growth and differentiation.
Types of tumor
All tumors are divided into twoMain groups:
benign tumors,
Malignant tumors.
Benign tumors
Benign (mature,homologous) tumors consist of
cells differentiated in such
least can determine which
They grow fabrics. For these tumors
Characterized slow expansive
growth, lack of metastases, lack
General influence on the body (lipoma).
Benign tumors can
malignant (turn into
malignant).
Malignant tumors
Malignant (immature,heterologous) tumors consist of
Moderately and low-differentiated
cells. They may lose similarity with
The cloth from which they proceed. For
Malignant tumors are characteristic
Fast, more often infiltrating growth,
Metastasation and recurrence,
Availability of general influence on the body Types of tumor growth
Depending on the nature of the interaction
growing tumor with elements of the surrounding
Fabrics:
Expansive growth - tumor grows "herself
From yourself, "spreading the surrounding fabrics, fabrics
On the border with the tumor atrophically
Collapse is stroma - formed
pseudocapsula;
infiltrating growth (invasive,
Destroing) - tumor cells grow into
surrounding tissue destroying them;
Appositioning tumor growth occurs for
Neoplastic cell transformation account
surrounding tissue in tumor.
Continued
Depending on the relationship to the clearanceHollow organ:
Exofic growth - expansive
Height of the tumor in the gloss of the hollow organ,
tumor closes part of the lumen
organ connecting with its wall
leg;
Endophyte growth -
Infiltrating Tumor Growth Gluff
Body walls.
Continued
Depending on the number of fociThe occurrence of the tumor:
Unicenric growth -
The tumor grows from one hearth;
Multicenter growth -
tumor growth of two or more
foci.
Metastasation of tumors
Metastasis - Processpropagation of tumor cells from
primary focus to other organs with
The formation of secondary (subsidiaries)
Tumor foci (metastases).
Hematogenic - Metastasation Path
With the help of tumor empoles,
propagating the bloodstream;
lymphogenic - the path of metastasis when
assistance of tumor empoles,
propagating in lymphatic
vessels;
Continued
implantation (contact) - Pathmetastasis of tumor cells by
serous shells adjacent to
tumor hearth.
Intracicular - Path
Metastasis in natural
Physiological spaces
(synovial vagina I.T.D.)
perioreural (private case
intracicular metastasis) - by
The move of the nervous beam.
Continued
For different tumors are characteristicDifferent types of metastasis.
Histological type of metastases such
like tumors in the primary focus
As a rule, metastatic foci
grow faster primary tumor,
Therefore, it can be larger.
Effect of tumor on the body
The local influence issqueezing or destruction (in
Depending on the type of tumor growth)
surrounding tissues and organs.
Overall
Characteristic for malignant
tumors, manifests itself different
metabolism disorders
Before the development of cachexia
Etiology tumors
Etiology of tumors studied notend. At the moment leading
Consider
Mutational theory of carcinogenesis
but
.
Listed below are the main
Historically established theories.
Continued
Virus-genetic theoryDecisive role in the development of tumors
Wars oncogenic viruses, to
which include: Herpezzinous
Epstein-Barra virus, herpes virus,
Papillomavirus, Retrovirus, Viruses
Hepatitis B and C.
Continued
Physico-chemical theoryThe main cause of development
Tumors consider impact
Various physical I.
Chemical factors on cells
organism (
X-ray and gamma radiation,
carcinogenic substances) that
leads to their oncotransformation.
Continued
Theory of dormriconalCarcinogenesis considers various
Violations of hormonal equilibrium in
organism (disorder estrogen
exchange of cancer female reproduction
Systems)
Dysonatogenetic theory of the cause
Tumor development considers violations
Embryogenesis of fabrics, which is under the action
provoking factors can lead
To oncotransformation of tissue cells.
Mutational theory of carcinogenesis
MalignantTransformation is developing
As a result of numerous
non-served correction
DNA changes that
lead to unrelated
Violations of the structure I.
cell functions.
Continued
Malignant tumor in hisDevelopment passes 3.
Serial Stage:
initiation, promotion and
Progression.
Malignation of cells often
Causes violation of functions
Genov-suppressors, especially gene
P53, and activation of oncogenes. The initiation is to occur
persistent disorders in genes
regulating vital activity
Cells. As a result of these violations
Structure and properties may change
cells.
Promotion is
Subsequent stage of development
New formation. It is B.
Activation of transformed cells
and acquire properties inherent
cells of malignant tumor Progression is
Final stage of development
malignant
New formation.
Molecular base of carcinogenesis
The genome of each cell containsFull hereditary
Information about this body.
It has been established that the human genome
There are about 30 years of gene and
3.5 billion nucleotides.
Genes encode and regulate
Passage of cellular cell
cycle.
Continued
Cell cycle consists of 4Serial phases
intracellular changes
Phase mitosis (m) - 1 hour
Phase Presintiz (GJ) - 10-30 hours
phase of nucleic synthesis
Acid
(S) - 20-40 hours
Phase Premothesis (GT) - 2 hours
Continued
Control of unmistakablePassage of cell cycle
carried out by genes in each
Phase cycle.
For this cell cycle on
a certain phase
suspended I.
Resumes with errorless
The passage of the stage.
Types of genes.
Oncogenes - broaching genesCell cycle cause
Education and tumor growth
Tumor suppressors (syn.
Antoncogens) - Genes, Function
which are B.
Restriction of activity
oncogenes, which leads to
suppressing tumor growth. As a result of violations of the cell genome
happens:
loss by cells properties of natural
apoptosis (death), which leads to
infinite cellular division and
progression (growth) of the tumor;
Loss of contact braking properties
(cell communication between themselves) manifests itself in
Acquisition of the ability to invasive growth
and metastasis;
Tomb of blood vessels,
Providing blood supply and nutrition
tumor cells;
Cellular exchange disruption
In the general condition of the ill. Apoptosis - genetically
Programmed death
Cells after defined
The number of divisions. Preiodine Diseases
There are diseases in which
Increased likelihood of tumor development.
They are characterized by the following signs:
Proliferation - Fabric Solution
the body by neoplasms and
Propase of cells
Dysplasia - disruption of fabric structure
with pathological proliferation and
Atipia cells.
Metaplasia - Pathological
proliferation with the acquisition of cells
Structures and properties of other fabric. According to the degree of distribution
Neof-formations in Russia approved
division of malignant tumors for 4
Stages. The higher the stage - the worse
forecast.
In parallel use international
TNM classification in which
separately evaluate the magnitude of the tumor,
Regional lymphatic condition
nodes and the presence of remote metastases.
The assessment is performed twice: first
After clinical examination, then
The results of intraoperative I.
pathoanatomic conclusion. Most often neoplasm
Arises as a consequence
Mutation of one cell, but
Sometimes the source of the tumor
is a cell group. Such
Cases develop primary
Multiple tumors.
Morphological classification of tumors
From the same tissue are formed asbenign and malignant
tumors. Depending on the type of fabric from which
There is a tumor allocate:
Epithelial tumors
Connectant
Muscular
Nervous
blood system tumors;
Pigmented
Teratomas (embryonic tumors in which
hair may be present, muscle tissue,
bone tissue, less frequently more complex organs -
Eye, torso, limbs.
Classification in stages
1 Stage - Tumor of Smallsizes, usually up to 2 cm,
limited one or two
layers of the walls of the organ (for example,
mucous membrane I.
sublimated base), without
Metastasis in lymph nodes.
Continued
11 Stage - Tumor Somewhatlarge sizes (2-5 cm) without or with
Single metastasis B.
Regional lymphatic nodes.
111 Stage - Significant Size
tumor sprouting all layers of the organ, and
sometimes surrounding fabrics, or
Tumor with multiple
Metastasis in regional
The lymph nodes.
Continued
IV Stage - Big Tumor,Sorry on significant
length in others
organs and fabrics, fixed,
failure to surgically
or a tumor of any sizes with
Failless metastasis B.
lymphatic nodes or with
Metastasis in remote authorities.
TNM Classification
This classification usesNumerical designation of various
Categories for designation
proliferation of the tumor as well
availability or absence of local
and remote metastases.
T - Tumor tumor. Describes I.
Classifies the main focus
tumors.
Continued
TIS or T0 - the so-called carcinoma"In situ" - that is, not germinating
Basal layer of epithelium.
T1-4 is a different degree of focus.
For each of the organs exists
separate decryption of each of
indexes.
TX - practically not used.
Exhibited only for a while when
metastases were found, but not detected
The main source.
Continued
N - Nodulus - node. Describes I.characterizes the presence of regional
metastases, that is, in regional
The lymph nodes.
NX - identification of regional metastases
Not carried out, their presence is not known.
N0 - regional metastases
Detected when conducting
Research for detection
Metastasis.
N1 - Revealed regional metastases.
Continued
M - MetaStasisCharacteristic of the presence of remote
Metastasis, that is - to remote
Lymph nodes, other organs, fabrics
(excluding tumor germination).
MX - identification of remote metastases
Not carried out, their presence is unknown.
M0 - remote metastases
Detected during the study
In order to detect metastases.
M1 - remote metastases are revealed.
Differentiation degree
Tumors of the same histologicalTumors of the same histological
builds vary in degree
Differentiation of cells. Allocate 4.
Histological gradations:
G1 is a high degree of differentiation;
G2 is the average degree of differentiation;
G3 - Low degree of differentiation;
G4 - undifferentiated tumors.
The lower the degree of differentiation
Cells, the worse the forecast.
Oncological alertness
Knowledge of symptomsKnowledge of precancerous diseases
Detection of risk groups
Careful examination of each
Patient
Habit to think with atypical
The course of the disease
Oncological disease
Prerostrate states
Chronic inflammationDevelopment defects
Chronic ulcers
Cervical erosion
Nodular mastopathy
PCT PC
Preiodine Diseases
Depending on the frequencyThe emergence of precancerous cancer
Diseases are divided by
Bonds I.
Optional. Bond presets of the disease, on the basis of which
always or mostly
There is a malignant
tumor,
Optional - illness, with
which cancer is developing
relatively rarely but more often than
In healthy people.
Continued
In situ cancer - fabric plot, inwhich is normal epithelium
Removed by atypical cells, not
sprouted the basal membrane.
"Invasive cancer" - malignant
epithelial tumor
Basal membrane.
Continued
Bond prejudice are:Pigment Keroderma;
Bowen's disease;
Pedge's disease (except
Localization B.
region of the nipple of the breast);
Eritolopian Caire;
Family polyposis colon.
Bowen's disease 2. Destruction (ulceration,
bleeding, melan, hemoptia,
hematuria, bleeding from
Vagina - the most typical symptom
cervical cancer) 3. Compressions (reflects pressure
Tumors on the surrounding structures.
Doubly manifests: pain
Feelings and impairment of functions
affected and neighboring organs)
4. intoxication (violated
protein and carbohydrate exchange,
Significant changes occur
enzyme and hormone
Balance. Manifests a variety
clinical symptoms. Most
Weakness, weight loss and
loss of appetite) 5. Tumor Education
(Availability of visible or
Torn tumor-shaped
education)
Affordable palpation cancer
tumor is more often painless,
dense consistency
The surface of her bugritist.
Tumor gradually
Increases in size Research methods
X-ray, including CT
Magnetic resonance tomography
Endoscopic research
Ultrasound
Radioisotope scanning
Positron emission tomography
(PAT)
Cytological research
Biopsy
Histological examination Tumor markers
Definition. Markers
Malignant tumors are called
substances that can be detected
in blood, urine, or tissues in high
Concentration compared to the norm.
They are proteins,
Glycoproteins or enzymes.
Produced tumor or are
The response of the body for
malignant neoplasm. Continued
Alfa Fetoprotein (AFP) - Embryonic
protein. Determined during liver cancer, ovaries
Prosthatspecific antigen (PSA, PSA)
- Used for early diagnosis of cancer
Prostatic gland and control
The effectiveness of treatment.
Chorionic gonadotropin - hormone, in
dignity
spims available in healthy
of people.
The content of it is sharply increased when
Horionepithelome
mobility of tumor cells,
weakening of intercellular interactions,
actions of lithic enzymes
type of body reaction.
Metastation of malignant tumors - This is penetration into the surrounding tissues of arising and growing tumor cells. This process is the result of the interaction of the tumor and the body.
mobility of tumor cells,
weakening of intercellular interactions,
actions of lithic enzymes
type of body reaction.
Metastasation takes place in 3 stages:
Department of tumor cells from primary tumor and penetration into lymphatic and blood vessels
Movement of tumor cells and their embols by vessels
Delay, adheated and growth in lymph nodes and remote organs
Lymphogenic
Hematogenic
Implantation
For non-epithelial tumors (sarcom) is characterized by hematogen .
The name of benign tumors consists of two parts:
The first part indicates the source of the tumor (cells, fabric, organ),
The second part is the subfix "Ohm" (tumor).
lipoma - tumor of adipose tissue,
momoma - from muscle tissue,
osteoma - from bone tissue,
chondroma - from cartilage fabric.
adenoma bronchi,
thyroid adenoma,
mioma forearm.
Malignant tumors are distributed according to the main types of fabrics:
epithelial
connecting
muscular
neurogenic.
Preiodine Diseases
Based on numerous clinical observations arose the doctrine of premandomatosis (V. Dubreil, 1986; P. MENETRIER, 1908; I. ORT, 1911), various aspects of which were discussed on numerous congresses. Postulates of this teaching are
"Cancer never arises in that healthy organ" (Borrmann R, 1926)
"Every cancer has its own preference" (Shabad L. M., 1967)
Currently, various changes in organs and tissues are counted. Belight skin cancers include pigment kservoch, Bowen's disease, senile keratosis and skin horn. Eliminate backgrounds (or optional) preiodines: tuberculosis, syphilis, varicose veins, fistulas during osteomyelitis, scars after burns or mechanical injuries). Pigment nevuses are important in the origin of malignant melan. The oral membranes of the mouth include leuccoplakia, chronic ulcers, cracks, sclerosing glossy, polished and warthog, papillitis, papillomas, erythlasia, chronic inflammatory processes, cysts, lupus, syphilis, flat deck, Bowen's disease, various benign tumors, dental granulomas Both cysts, scars and fistulas.
Lower lip cancer is preceded by long-term atrophic, dystrophic and hypertrophic changes in red comb. The thyroid cancer may arise from the previously existing aden, thyroiditis, the strips of Hashimoto. Milk gland cancer is preceded by mastopathy, various forms of fiberadenomatosis, intrandutal papillomas and cystadeopapillomas. Chronic bronchitis of smokers, chronic pneumonia, chronic pumping processes, pneumosclerosis, scars of tuberculosis etiology can contribute to the occurrence of lung cancer.
Provide to the occurrence of cancer of esophageal esophagitis, scar strictures, peptic ulcers, papillomas, benign tumors, diverticulus, cardiospasm, hernia esophagus, diaphragms and congenital short esophagus. The prejudice diseases of the stomach include chronic atrophic gastritis, chronic ulcers, polyps, pernicious anemia, intestinal metaplasia, meal disease, condition after stomach resection. Cancer and rectal cancer can occur against chronic ulcerative colitis, anorectal fistula, diverticulus and polyposis.
Patients with the above diseases should be under dispensary observation. If the development of malignant tumor is suspected, the biopsy of pathologically modified tissues is shown.Prevention of malignant tumor in these cases is timely treatment with the inclusion of surgical operation.
Classification of tumors for stages in the TNM system
The classification of tumors in stages is an attempt to combine primary patients with malignant neoplasms of the same localization in homogeneous groups on the clinical course of the disease, a forecast and approach to therapeutic tactics.
Clinical experience has shown that the most important factor affecting the course of the disease is the degree of prevalence of the neoplasm by the time of the diagnosis.
Currently adopted by the Special Committee of the International Anti-Discharge Union, the US Joint Committee on Oncological Diseases and the Federation of Gynecologists and Obstener systemTNM.. This classification is applicable to tumors of different localizations, regardless of the planned treatment and can be supplemented with surgery and pathohydropological examination.
Three symbols are used in the classification:
T. - distribution of the primary tumor,
N. - the state of regional and YUCSTAREGIONARY LIMFATICAL NODS,
M. - The presence or absence of remote metastases.
Numbers added to each of the characters (T 0, T 1, T 2, T 3, T 4; N 0, N 1, N 2, N 3, M 0, M 1) are denoted for T - dimensions and (or ) Local propagation of the primary tumor, for n a different degree of damage to regional or YUCSTAREGIONAR lymph nodes (N 4).
Symbol H. means the inability to determine the size and local tumor propagation (T H.), state of regional lymph nodes (n H.), the presence or absence of remote metastases (m H.).
For each localization there are two parallel classifications: clinical TNM and post-gurgical or pathogustological PTNM.
Clinical classification is based on data clinical, radiological, endoscopic, radionuclide, ultrasound and other types of research conducted before the start of treatment.
Posthurgical or pathochistological PTNM takes into account the results of the study of the postoperative preparation. The use of morphological data, the degree of differentiation of the tumor, the invasion of lymphatic vessels and veins, lymph nodes is provided.
Symbol " FROM"Carries information about the degree of reliability of the classification:
C 1 - only a clinical study,
C 2 - special diagnostic procedures,
C 3 - trial surgery,
With 4 - data obtained by the study of the operational preparation obtained after the radical operation,
C 5 - sectional research data.
The reliability symbol is put in the last in each category (T 2 C 2 N 2 C 2 M 0 C 1)
The degree of prevalence of the tumor By the time of the diagnosis is divided into 4 stages.
Stage I Stage
Tumor not more than 3 cm in the source fabric
No regional metastases
There are no remote metastasis
Tumor from 3 to 5 cm without exiting the body
The presence of single displaced regional metastases
There are no remote metastasis
Tumor more than 5 cm, leaving the limits of the organ
Multiple shifted regional metastases
There are no remote metastasis
Tumor applies to neighboring organs
The presence of remote lymphogenic or hematogenous metastases
Histological diagnostic methods
Only early detection of malignant tumor can lead to successful treatment of the patient. It has great importance oncological alertness"The doctor examining the patient. This concept was formulated by the founders of Oncology P. A. Herzen, N. N. Petrov, A. I. Savitsky, B. E. Peterson.
“Oncological alertness"Includes:
knowledge Symptoms of malignant tumors in the early stages;
knowledge precancerous diseases and their treatment;
knowledge Organizations of oncological assistance, network of medical institutions and the rapid direction of the patient with a detected or suspected tumor for its intended purpose;
careful examination of each patient who applied to the doctor of any specialty in order to identify possible oncological disease;
habit In difficult cases, diagnosis to think about the possibility of an atypical or complicated flow of a malignant tumor.
The patient's survey should be kept systematically, according to a certain plan, moving from the organ to the organ. The identification of pathological symptoms makes the doctor to change and deepen the survey towards the affected organs.
The identified symptoms may be manifestations of recurrence or metastases of a previously remote tumor, which must be considered when collecting anamnesis.
If there is a visible tumor, it is necessary to find out the peculiarities of its growth. Malignant tumors are characterized by rapid growth, progressive increase in dimensions, sometimes a jump-shaped character. The lack of changes in the size of the tumor during the long period does not exclude malignant.
Suspicion of the possible presence of a malignant tumor may occur when the nature of the sensations occurred over the past period. In most cases, a scrupulous analysis of symptoms makes it possible to detect non-intensive pain in the projection of the affected organ, carrying a constant or periodic character.
The absence of pain in the initial period of development of the tumor significantly increases the period before the treatment of the patient to the doctor. The pronounced pain syndrome in most cases is evidence of a far-closed tumor with germination of nerve trunks.
The growth of tumors in the lumen of hollow and tubular organs is accompanied by an inflammatory response, which in turn leads to the strengthened work out of the secret or excreta. Patients appear pathological discharge
sowing
cough with mocroid
mucus in wheel masses.
Many doctors believe that a malignant tumor is necessarily accompanied by cachexia. In fact, significant weight loss is characteristic only for the tumors of the digestive system. In case of sarcoma and tumors of other localization, patients in appearance are not different from healthy.
The inflammatory process, combined with many tumors, combined with the collapse of tumor tissue, often causes fever. The temperature curve may be permanent, interspersed, subfebrile or uncertain.
When collecting anamnesis, it is necessary to pay attention to paranoplastic syndromesseparating on:
skin
neurological
vascular
bone
kidney
homological.
Neurological symptoms may occur with paranoplastic hypercalcemia. Patients have Meionereopathy, polyneurite, Miasthenia symptoms, Parakes.
Objective study of the patient comprises inspection, palpation, auscultation and endoscopy.
In case of inspection Pay attention to the general view of the patient, the color of the skin, the finescence of the neck and face, asymmetry of the face, gait, the position of individual parts of the body, the defects of the face and limbs.
The doctor must inspect the entire area of \u200b\u200bthe patient's skin and oral mucosa. At the same time, palpation of zones of tumors of visual localizations are carried out: neck, thyroid gland, mammary glands. When inspecting the trunk, breastplate is found, protruding the kidney projection, visible peristalistic of the stomach or intestines.
Huge importance in the diagnosis of tumors have a finger study of the rectum, prostate gland and female genitals (parallel inspection of the gynecologist).
For tumors characterized " syndrome plus a fabric". The size of the neoplasms are determined in millimeters and centimeters. When describing the tumor, it is necessary to indicate form, consistency, mobility.
All zones of available palpation of lymph nodes must be investigated. Metastatic nodes are usually enlarged, dense, more often, burglar, laughing with surrounding tissues and painless.
It is necessary to remember the possibility of detecting the lesion of regional or remote lymph nodes without a determined primary tumor.
Percussion and auscultation complement the above research methods.
In the diagnosis of tumors, you need to answer the following questions:
Localization of the primary tumor
determination of the affected organ
localization and borders of the tumor
Anatomical tumor growth type
exofithic
endophyte
mixed
Histological structure of the tumor
histological belonging of the tumor
the degree of differentiation of cell elements
Stage of the disease
dimensions of the primary tumor
characteristics of regional lymph nodes
characteristics of remote lymph nodes and organs (elimination of remote metastases).
Radiological studies (Mammography, Parioshiography, Tomography, Laterography, Angiography, Irrigoscopy, Pneumaticviography, Hysterosalpingography, Lymphography, Infusion and Retrograde Pyelography, Cistography, Pneumo-DeviceFalography, Myelography, Phlebography, Pneumoniography, CT, NMR, etc.).
Radionuclide diagnosis (static and dynamic scintiography;
Ultrasound diagnostics
Endoscopic research (Ezophagogastroduodenoscopy, RectorOnoscopy, Fibrocolonoscopy, FibrolaringoBranchoscopy, Calposcopy, Hysteroscopy, Cystoscopy, Media Stopping, Thoracoscopy, Laparoscopy)
Diagnostic operations
Biopsy tumor
Biopsy allows you to determine:
The nature of the pathological process
Histological belonging of the tumor and its degree of differentiation
Benignness or malignant tumor
The borders of the propagation of the tumor process (the radicality of the antitumor treatment)
Incision biopsy is the most common. Performed with a scalpel or a special pass. Material is obtained on the boundary of normal and pathological tissue.
Excision biopsy It is performed in the presence of small tumors, by their complete removal in a single unit within healthy tissues.
Aspiration biopsydivided into two methods. At the first, thin needles are used and strokes for cytological research are prepared from aspirated material. With the second method, the needles of a large diameter are used and the fabric column is obtained for a conventional biopsy.
Treating tumor
In oncology, the following types of treatment distinguish: radical, palliative and symptomatic.
Radical treatment It is aimed at the complete elimination of all foci of tumor growth.
Palliative treatment It lies in direct or indirect effects on the foci of tumor growth to change their mass and growth delay.
Symptomatic therapy It is aimed at eliminating or attenuating for patient manifestations of the underlying disease and its complications (or complications of antitumor treatment).
Currently, the combination of methods is usually used to treat malignant tumors and simultaneously. For the designation of treatment options, special terms are used - combined, complex and combined treatment.
Combined treatment It provides for the use of two or more different methods having the same orientation (surgical treatment, radiation therapy, cryodestruction, laser therapy, local chemotherapy, regional chemotherapy, local microwave therapy).
Comprehensive treatmentnie Includes the methods of a local and regional and general type of impact (systemic chemotherapy, hormone therapy, immunotherapy, general hyperthermia).
Combined treatment - This is an application within the framework of one method of various methods of its conduct or the use of differing in the mechanism of antitumor drugs in the process of chemotherapy (polychimotherapy, remote y-therapy, intramanese therapy, etc.).
The development of therapeutic tactics and its practical implementation in patients requires an association of specialists in various types of antitumor treatment - surgeons, radiologists, chemotherapists, morphologists, gynecologists, etc.
Surgical method It is the main method of treating oncological patients.
The presence of a patient tumor is an indication for operational treatment.
Benign tumors are removed within healthy tissues.
In the surgical treatment of malignant tumors, the rules have been adhered to the rules over the years.
When performing operational interventions, it is necessary to strictly observe ablastics and antiblastic.
Ablastics - This is the removal of a tumor within the limits of healthy tissues in accordance with the principles of anatomical zonality and composition. Anatomical zone in oncology is a biologically integral area of \u200b\u200btissues formed by the organ or part of it and related to it by regional lymph nodes and anatomical structures located on the way of spreading the tumor process.
Case Limited in places of abnurbation and fascial leaflets, layers of fatty fiber.
Tumor removal is produced by a single block within anatomical zone in a holistic case with ligation and exiting vessels outside the case.
Antiblastics - This is a set of events that prevents solidification and leaving in a wound of viable tumor elements.
Antiblasticity belongs to:
Preoperative radiation therapy.
Bringing the main vessels before the mobilization of the organ.
The use of electrosurgery for the dissection of tissues and hemostasis.
Linking tubular organs distal than and proximal than tumor.
Multiple hand washing through the operation.
Multiple shift of linen.
Disposable use of clamps, napkins and balls
Cryogenic exposure is the destruction of the tumor focus of freezing.
Using laser scalpels.
Absolute Indications:
The absence of tumor germination into non-resection organs and lack of metastases outside the regional lymphatic barrier.
The presence of complications threatening the patient's life:
bleeding
asphyxia.
obstruction.
other complications, the elimination of which makes it easy to facilitate the state of the patient and extend its life
Before the operation is established operalness - Ability to operate this patient.
Rectachableness - This is the ability to remove the tumor, which is installed during the operation.
Operational interventions in oncology are divided into diagnostic and therapeutic .
The diagnostic operation can go to therapeutic after the diagnosis or its clarification.
Therapeutic operations can be radical, conditionally radical and palliative.
A radical operation with biological positions can be estimated after 5-10 years. With clinical positions, radicality is determined by the removal of the primary tumor within the limits of healthy tissues together with regional lymph nodes. These operations are often performed at the I-II stage of the tumor disease.
Conditional radical operations Perform at the III stage of the disease, when, with a significant distribution of the tumor, it seems that all detected tumor foci are removed.
Radical and conditional radical operations are divided into typical, extended and combined.
Typical operations - Contribute to the removal of the affected organ or its part in the block with regional lymph nodes.
Extended operations - Provide additional to a typical removal of non-administrative stages of lymphogenic metastasis.
Palliative operations Perform with remote metastases. These operational interventions are divided into two types:
operations, eliminating complications, but not providing for the removal of a tumor (gastrostomy, gastroenterostomy, colostomy, etc.)
palliative resection provides for the volume of typical intervention in the presence of remote metastases and the possibility of conducting in subsequent effective chemotherapy.
Organization of oncological assistance.
Oncological service - The state system of institutions whose activities are aimed at timely identification, prevention and treatment of cancer.
The organization of the activity of the oncological service is based on a dispensary principle.
The main structural division of the oncological network is the oncological dispensary, which provides:
qualified specialized assistance
dispensary observation of oncological patients in the region,
organizational and methodological guidance of medical and prophylactic institutions on oncology issues,
specialization and improvement of the qualifications of doctors and medium medical staff on the diagnosis and treatment of patients with malignant tumors.
Oncological branches and cabinets are organized as part of a clinic and polyclinic departments of urban and central district hospitals. The tasks of these structural divisions are:
organization of anti-cancer activities
ensuring timely treatment, accounting and dispensary observation of oncological patients.
There are practically no malignant tumors, the progression of which could not begin many years after the end of antitumor treatment. However, practical doctors need to adhere to any periods of time to assess the results of the treatment.
The most common period is considered to be 5 years. For slow tumors (breast cancer, cervical cancer and body cancer), the period can be increased to 10 years, and for rapid (pancreatic cancer, esophageal cancer), on the contrary, reduced to 3 years.
Clinical groups with dispensary observation.
Group 1A. - Patients with a disease suspicious of malignant neoplasm. These patients are subject to in-depth study and as the diagnosis is established - deregistration or translation into another group.
Group 1B - Patients with prematubic diseases.
Group II. - Patients with malignant neoplasms, having as a result of the use of modern methods of treatment, real perspectives of complete cure or long remission. A subgroup is distinguished.
II.but - to be radical treatment aimed at full cure.
Group III - practically healthy as a result of radical treatment (surgical, radial, combined, complex) malignant tumor in the absence of relapses and metastases.
Group IV. - Patients with common forms of malignant neoplasm, which is impossible to carry out radical treatment, but at the same time, a surgical combined, complex, chemical treatment and other palliative or symptomatic treatment is shown or scheduled.
Lecture 37.
Plastic and Reconstructive Surgery
Introduction
In medicine there are situations where those affected by the pathological process or damaged organs and tissues lose their function. In this case the only way of treatment
The patient is replacing the affected organs or tissues on healthy
.
Reconstructive or Plastic Surgery - The section of surgery engaged in the correction and restoration of the shape and function of tissues and organs with congenital or acquired defects.
The main method of plastic surgery are plastic surgery which provide for the movement (transplantation, transplantation) of organs and tissues or implantation of their substitute materials.
Topic: "Neof-formation" syndrome.
Bodrov Yu.I. Lecture. Lecture number 30.
Introduction
Surgery refers to a discipline having a fundamental importance in the preparation of students in medical schools and colleges. Obtaining knowledge of surgery and mastering practical skills, students start with studying the theoretical course of lectures.
Theoretical provisions, and subsequent practical skills learned by students when studying this course, are needed not only to the future sisters of the surgical profile, but also the sisters of another profession. The goal of these lectures is to facilitate independent training of students to practical surgery and help them in mastering practical skills.
Therefore, the focus on the preparation of a lecture course is paid not only to an understanding of sections related to the practical work of nurses, but also a clear understanding of the role of the regional component in the development and course of some surgical diseases. A modern medical sister should not only fulfill the appointment of a doctor, but also be able to independently identify and solve the problems of the patient in the surgical department within its competence.
Therefore, the proposed training material is a course of lectures on surgery, medical school students are needed, colleges, for a more successful development of the specialty.
Oncology(from Grech . Oncos. - Tumor , Loqos. - Word, science) - Science, which studies the causes of the occurrence of tumors, their clinical manifestations, diagnosis, treatment and prevention.
Tumor, blastoma, neoplasm, tumor, neoplasm - based on which there is limitless and unregulated reproduction (immortality "immortality") cells that do not reach maturation.
Like many diseases, human tumors are known for a long time. When studying the ancient manuscripts, researchers discover the descriptions of various neoplasms, methods of their treatment. The current state of oncology as an independent scientific and practical discipline suggests that there are real opportunities to achieve persistent cure or remission in the majority of patients with malignant diseases of tumors under the condition of their timely detection, as well as the use of proper diagnostic and therapeutic tactics. The oncological service in our country is closely related to other services, the functions and tasks of which are to diagnose and treat oncological diseases, as well as in the rehabilitation of patients and dispensary observation after treatment.
Clinical oncology is highlighted as an independent section of medicine, but its close ties have been preserved with other scientific and practical disciplines, as well as the general patterns of diagnosis and treatment. Meanwhile, the identification and treatment of oncological diseases has a number of features. The ignorance of them generates errors, which, as a rule, create a mediocre threat to the patient's life.
The investigator of experimental oncology is a veterinary doctor MA Novinsky, who B1876. For the first time in the world, carried out the vaccination of malignant tumors from dogs to puppies.
An important stage in the development of oncology was the discovery of a raus (1910-1911) of viral nature by some sarcom chickens. The first oncological institution in Russia is founded in 1903 the institute for the treatment of tumors them. Morozov in Moscow. In 1922, the Institute was created at Moscow State University, which was headed by Professor Herzen P.A. And officially, the oncological service in Russia was organized in 1945 on the basis of the decision of the SNK. RF. "On the organization of the state oncological service in the USSR. The tasks of the oncological service include:
1. Accounting oncological patients and diseases.
2. Analysis of incidence and mortality from malignant neoplasms.
3. Security Highly qualified and specialized (stationary and polyclinic) medical help oncological patients.
4. Implementation e dispensary observation of oncological patients.
5. Functional analysis activities of oncological institutions.
6. Development territorial anti-cancer programs.
7. Exercise Methodical on the organization of activities for early detection of malignant neoplasms.
8. Organizationsanitary and educational work on the prevention of malignant neoplasms. The functioning of the oncological service is determined by the directive documents of the federal and territorial levels:
1. Order of the Ministry of Health of the USSR No. 500 of 04.04.1987 G. "On full-time regulations of medical, pharmaceutical personnel and workers of cooking oncological dispensaries, dispensary departments and cabinets.
2. Order of the Ministry of Health. RF № 420 dated 23.12.1996 . "On the creation of a state cancer register", etc.
Modern problems of oncology .
The main statistical indicators indicating the reasons for the prevalence of malignant neoplasms are indicators of morbidity and mortality.
The incidence of the male population of the Russian Federation, on (2002 is 272.7 per 100,000).
The incidence of the female population of the Russian Federation, (162.0 per 100,000 population.).
The incidence of the children's population of the Russian Federation reaches (10, 4 per 100,000).
Malignant neoplasms are found in all age groups without exception. The structure of morbidity and mortality is different for each floor and age, which, first of all, is determined by the physiological characteristics of the body and exposure to modifying factors.
In the life of a person, the most dangerous for health critical periods are noted in age (7, 14, 21, 29, 30, 36, 42, 59-60, 63, 68.).
Regional The peculiarities of the spread of malignant neoplasms are the natural conditions of the habitat, genetic features of ethnic groups, religious traditions, eating habits. It is observed that people living in warm climatic conditions are more commonly observed systemic diseases (leukemia, lymphosarcoma, lymphogranulomatosis, nasopharynx cancer, liver cancer, bladder cancer). In areas with a cold climate, it is more common (stomach tumors, lungs, chest, uterus, esophagus).
Factors contributing to the occurrence of tumors .
Heredity . Genetic predisposition is proven only for some diseases in which the probability of getting sick is 80-90%. These are rare forms of neoplasms (melanoma, sarcoma of the vascular shell, tumors of carotid taurus, intestinal polyposis, neurofibromatosis).
Currently, 38 gene mutations (BRCAL) were revealed, closely related to the development of breast tumors. Modern views on this problem, they speak more about the increased risk of disease and, accordingly, control over this group of patients.
Endocrine violations. In accordance with modern views, the development of tumors in the organ or in tissues is determined by the following triad factors (K.P. Balitsky et al., 1982):
· Reducing the immunological reactivity of the body;
· The action of a carcinogenic agent of exogenous or endogenous nature;
· Violation of the function of the organ or tissue.
According to the Burnet theory (1970), the constancy of the body's genetic composition is controlled by the immune system
Ultraviolet radiation. For the first time, the carcinogenic effect of the rays was proved in 1928 G. M. Findlau. Currently, it is known that up to 95% of cases of skin cancer occurs in open areas of the body exposed to the long-term effects of ultraviolet rays.
Radioactive radiation. The radiation causes ionization in the cells, splitting the cell molecules per ions, as a result of which one atoms lose electrons, while others attach them. In this case, changes in DNA and RNA structures are, especially sensitive to this, tissue of a growing organism.
Viral carcinogenesis. This is a complex process of interaction of the cell and oncogenic virus (the theory of viral-hycentic L.A. Zilbera)
Chemical compounds. All living and not living consists of chemical elements and compounds with different properties, depending on the structure of their atom and the structure of molecules. Currently registered about 5,000,000 chemicals from which a person consists.
In nature, there are from 5,000 to 50,000 carcinogens, which actively interact with human chemicals, forming compounds causing tumor processes.
Environmental aspects. Human habitat is represented by countless chemicals. The main sources of the distribution of chemical (carcinogens) are the prerequisites of non-ferrous metallurgy, chemical, petrochemical, petroleum, gas, coal, meat and agricultural industries.
The concept of primary and secondary prophylaxis . A complex of social and hygienic measures aimed at the maximum decrease in the impact of carcinogenic factors of the external environment on the cells of a living organism, as well as the stabilization of the immunological status of the body, through the propaganda of a healthy lifestyle (proper nutrition, rejection of bad habits, etc.) it is called primary prevention of neoplasms.
A complex of medical measures aimed at identifying patients with precancerous diseases with their subsequent improvement, dispensarization called secondary prevention.
Oncology Oncology is a science of tumors. Its main tasks in our time is the study of etiology and pathogenesis of malignant tumors, the prevention of oncological diseases, the organization and development of methods for early and timely diagnosis, the improvement of surgical, radiation, medicinal, combined and complex methods of treatment and rehabilitation.
The biological properties of tumors A. Benign - a favorable course, consist of mature cells, grow slowly, have a capsule, clear boundaries, push the tissue without destroying, do not recur, do not metastasize. But ... may be overgrown! B. Malignant - unfavorable flow, tumor cells have a number of features that distinguish them from normal cells.
Features of malignant tumors 1. Autonomy - irrelevance of growth, relative independence from regulatory mechanisms. Hormone-dependent tumors are subordinate to the control influence of hormones. 2. Anaplasia (or rather cataplasia) or resistant dedifferentiation of tumor cells - loss of ability to form specific structures and produce specific substances.
Anaplasia of tumor cells with anaplasia is connected by) ATIPISM Cells: variability of sizes and forms of cells, sizes and numbers of organoids, nuclei, DNA content, chromosome - forms and numbers. B) Atypism of structures - tissue atipism. C) Functional anaplasia - complete or partial loss of tumor cells of the ability to produce specific products (for example: hormones, secrets, fibers). A) biochemical anaplasia is associated with functional anaplasia - the loss of biochemical components. b) Immunological anaplasia - the loss of antigenic components. In different tumors, the degree of anaplasia is different.
Features of malignant tumors 3. Infiltrative, or invasive, growth is the ability of tumor cells to grow and destroy surrounding healthy fabrics. a) tumors with mainly infiltrative type of growth (endophyte), b) tumors with minimal infiltration - expansive growth (exophytic) and c) with a mixed type of growth.
Features of malignant tumors 4. Metasicization is a method for the propagation of cancer cells by separating from the main focus and transferred along the blood, lymphatic paths, as well as mechanically. Reason: loss of cancer's ability to adhesion (sticking). 5. Recurring. 6. Progression of tumors - as signs of tumors grow (invasiveness, metastasis, etc.) - grow up!
The etiopathogenesis of malignant tumors The Embryon theory of Confaima - Ribbert. Virchov's annoying theory. The theory of "organizers" Spemen. Theory of biological evasion. "Mutation and transformation of cells." Fisher-Vasels theory. "Development of a tumor on a footpaded place." The theory of chemical carcinogenesis. Viratogenetic theory of origin of tumors. Polyethological theory.
Polyethological theory N.A.Veljaminov, N.N. Petrov - the occurrence of malignant tumors can be caused by several etiological factors: chemical agents, physical factors (radiation, UFO) and viruses. N.N.Petrov: "Tumor - dystrophic proliferative reaction of the body for various harmful factors, external and internal, persistently disturbed composition and structure of tissues and cells and changed their exchange."
Polyethological theory N.N. Blokhin: "So, a malignant growth is a multistage process, including at least three stages - initiation, promotion and progression. At the base - one cell with exogenous viral or cell oncogenes. Carcinogenic influences lead to large expression of various genes, the second one comes Phase - Promotion, followed by the progression of tumor growth.
Classification of tumors 1. Benign tumors. 2. Malignant tumors. 3. Tumor-like diseases (dormriconal hyperplasia (mastopathy) and foci of excessive regeneration, malformations; cysts - cavity having a wall and liquid contents, hyperrhegenerator polyps, condyloma.
Epithelial tumors of benign locally dzing papilloma bazaloma adenoma malignant (cancer) 1. Differentiated flat-milking cancer adenocarcinoma differentiation by educated structures: alveolar, tubular, cribroid, solid, etc. By the ratio of parenchyma and stroma: medullar cancer, simple, SKIRR. 2. Untifferentiated oat-milking, round-chill, large cell, polymorphnes, etc.
II. Connectual tumors of benign plane fibroma a) DESMOYID MIFOM B) Dermatofibrome Lipoma C) Some species of Lee Pom Chondrom Osteoma Malignant Leiomioma (sarcoma) Rabdomioma Fibrosarcoma, whether in-, Chondro-Osteo Leiomiosarcoma, Sarkoma Yinga
U1. Tumors from the ard-system (apoths) 1. Adenoma of endocrine glands (pituitary gland, epiphyse, pancreas - insulsome). 2. Carcinoids: a) hormonally active, b) hormonally inactive. 3. Paragangloma: a) chromaffine (feochromocytoma) b) non-chromaffine (chemodect). 4. Small flower lung cancer, medullar thyroid cancer. 5. Timoma. 6. Melanoma.
The tumors of the maxillofacial region of the lip tumor 1. benign (a) epithelial (papilloma, keratoacanta). b) Nepphelial (Fibre, whether Poma, Angoma). 2. Malignant lips cancer (flat-mellular oroging, non-illuminating, rarely basal cell, undifferentiated).
Tumors of the mucous membrane of the mouth of the tumor tumor, the bottom of the oral cavity, alveolar edges of the jaws, solid and soft nose, tongue and chicken mead. 1. B benign (papillomas). 2. Malignant cancer tumors (a flat-mellular oroging, non-illuminating, undifferentiated, iron, mucoepidermoid, cylindrocycle).
Tumors of the parole and other salivary glands 1. Benign a) epithelial: adenoma, adenolimphomes, mixed tumors, mucoepidermoid. b) Nepphelial (angioma, if Pomão, Nevnomes). 2. Malignant tumors a) cancer (cylindrome, adenocarcinoma). b) Mukoepidermoid cancer. c) flat-cell carcass. d) low-differentiated cancer.
Lower jaw tumors 1. Benignant tumors a) odontogenic (epulis (protesnevik), adamantine, ododema, cement). b) Uncommon (osteoblastoclastoma, osteoma, osteoid-suitoma, chondroma, fibroma, hemangioma). 2. Malignant tumors a) Primary lower jaw cancer (flat-stitch) (developing rarely from the epithelial islands of the Geutrian membrane, located in the depths of the bone substance of the lower jaw). b) secondary tumors of the lower jaw (when the oral mucosa cancer is spreading to the lower jaw). c) sarcoma (osteogenic sarcoma, chondrosarcomes).
Epidemiology of malignant diseases is studying the peculiarities of the propagation and causes of human diseases by malignant tumors, geographical and mineralogical features of habitat, household traditions, bad habits, professional factors, hygienic conditions of human life. The tendency to increase the specific weight of mortality from malignant tumors is noted. An increase in morbidity and mortality from malignant tumors depends: - from increasing the average life expectancy; - more often produce autopsy; - True increase in the incidence - lung cancer, colon, breast, leukemia.
Epidemiology of malignant diseases The incidence of lung cancer is growing everywhere. Zastrek cancer is often found in Japan, China, Russia, Iceland, Chile; Much less often - in the United States, Baltic States, Indonesia, Thailand. Esophageal cancer - increased morbidity on the coast of the Northern Ocean, in the republics of Central Asia and Kazakhstan, Buryatia. Cancer cavity - in Asia, India. Skin cancer - in southern countries. Breast cancer is reduced in Japan, elevated in European countries.
Preoperative states (precancerous). 1. Preoperative states, or disease, optional prepro (chronic inflammatory diseases). 2. Preoperative changes - a bond prediction, this is a morphological concept - dysplasia, prejudices as disease. A bond preference: family poly intestinal poses, pigment ceroderm skin, bowen dermatosis, adenomatous polyp stomach, some types of mastopathy. Preiodine gastric diseases - poly poses, ulcers, atrophic hyperplastic gastritis; esophagus - esophagitis, polyps, leukoplakia; Uterus - Erosion of the cervix, ecredopion.
Prevention of cancer Primary prevention - prevention of the occurrence of precancerous changes. Conducting health events: a) of a nationwide scale: the fight against soil pollution, air, water, conducting hygienic measures to eliminate pollution; b) Compliance with personal hygiene, food regime, food quality, normal lifestyle, rejection of bad habits.
Prevention of cancer. Secondary prevention Prevention of cancer in the presence of precancerous changes in chronic, prematubic, benign diseases. Tertiary prevention Warning growth and tumor propagation; Prevention of relapses and metastasis after treatment, phytotherapy, chemo-, radiation treatment, surgical, etc.
On-service organization in Russia, the Office of the Ministry of Health, Oncoinst Settings, ONKODISPANSERS, Oncoteplies, Oncabinets. ONKODISPANER ORGMETTEDCABINET (department), polyclinic, hospital. X-ray service Laboratory endoscopic surgical, radiological, chemotherapeutic separation. Diagnosis, treatment, rehabilitation of patients, accounting, observation, dispensarization is carried out.
Clinical groups of cancer patients 1-A - with suspicion of the presence of a malignant tumor, examination within 10 days; 1-b - prematubological diseases - are treated in the general treatment network in terms of secondary prevention; P - patients with malignant tumors (1, p, w stages) are subject to treatment; P-A - radical treatment; W - almost healthy people healing from cancer. Subject to observation after 3, 6 months, annually -tretical prevention, rehabilitation; 1U - patients with a launched disease (stage 1). Are subject to symptomatic and palliative treatment.
General principles of tumor diagnosis Early diagnosis is an important condition for the effectiveness of the treatment of any disease. Oncological alertness: Knowledge of symptoms of malignant tumors in the early stages; - knowledge of precancerous diseases and their treatment; - knowledge of the principles of organizing oncological assistance - send to the appropriate institution; - a thorough examination of each patient in order to exclude cancer; - In difficult cases - setting on the suspicion of cancer.
Diagnostics Early, timely, late complaints and history, heredity. An objective examination is a lymphatic system, paraneoplastic states. Laboratory research methods. X-ray methods: R-Skopia, graphic, tomography, computed tomography, NMR. Ultrasound examination. Radioisotope diagnostics. Endoscopic methods. Morphological: cytology, histology. Study of sputum, liquids; Biopsy results - puncture, incision, excision, trepan biopsy; Study of operational material. Diagnostic operations. Early diagnosis - profuse.
The stage of the tumor process I is a small, limited 1-2 layers of a tumor, without metastases. II - a tumor within the organ + metastases in regional first-order lymphatic nodes. III - tumors spreading to surrounding organs and tissues + metastases I - p order. IU - a tumor with remote metastases.
International classification T - Tumor, N - metastases in regional lymph nodes, M - remote metastases, P is the depth of tumor germination, G - degree, degree of malignancy. Thus, the oncological diagnosis should sound like this: body cancer of the stomach, ulcer-infiltrative shape, W stage, histologically: moderately differentiated adenocarcinoma, t 3, n 1, m o, p 4, g 3.
General principles and methods for the treatment of malignant tumors. For each treatment method, there are testimonies and contraindications. Indications: Local - the size and prevalence of the tumor, the degree of anaplasia; General - the state of the body (associated diseases, age, physical condition of the body); The state of immunity, features of the hormonal profile of the patient, metabolic processes. Treatment can be: radical, conditionally radical, palliadive, symptomatic. Radicality is determined by clinically - after treatment, biologically - after 5 years.
Surgical treatment Surgical diseases: esophagus cancer, stomach, kidney, colon. With surgical treatment: electrosurgery, cryosurgery, laser. Principles of surgical surgery: ablastics, antiblastics, zonality, and storm. The tumor + metastases are removed by a single block. Contraindications for surgical treatment: oncological order - the prevalence of the process. General, according to related diseases. Operations, rectaging. Character operations: radical, conditionally radical, palliative, symptomatic. Operations in terms of volume: the usual (simple), combined, extended.
General principles of radiation therapy 1. Remote methods of radiation therapy. A) static and movable gamma therapy (beam, rokus, agate). B) radiation - proton, electronic, neutron; Radiation at accelerators: betatron, linear accelerators, neutron accelerators. 2. Contact irradiation methods: intra-freed, intramane, radiosurgical, appliquational, close-focus radiotherapy, method of selective accumulation of isotope, intraoperative. 3. Combined methods 4. X-ray therapy: static, movable.
Dosage of irradiation Various methods: a) Small fractions 2 grams. - 5 times a week, b) large fractions by gr. For days. General dose c. Various tumor radio sensitivity. High - hematopoietic and lymphoid tumors, small-cell lung cancer, thyroid gland. Radio sensitive - flat-cell skin cancer, esophagus, oral cavity, pharynges. Medium - vascular, connective tumors. Low - adenocarcinoma, lymphosarcoma, chondrosarcoma, osteosarcoma. Very low - Rabdomiosarcoma, Leiomiosarcoma, Melanoma.
Medicinal methods of treatment of malignant tumors Chemotherapeutic treatment can be: seminine eggs, skin cancer, ovarian, myeloma disease, lymphogranulomatosis, Wilms, Lymphosarcoma tumor. Cure: chorionepitheloma of the uterus, malignant Bakers lymphoma, acute leukemia in children (especially lymphoblastic). With other tumors - temporary effect, repeated courses, combined with hormones, other chemotherapy products - polychimotherapy.
Antitumor drugs apply about 40 antitumor drugs. Chlorohylamins and ethylenimins (alkylating drugs): Embichein, Novambichin, Dopard, Chlorobyl, cyclophosphane, Sarcolizin, Vpiden, thiophosphamide, benzoteph, etc. (active CH2 group - alkyl joined with nucleic acids and cell proteins, hitting it).
Anti-tumor preparations P. Antimetabolites: methotrexate, 5 - fluorouracil, fluorofour, cytosin-arabinoside, 6 - mercaptopurine (disturbed DNA synthesis in tumor cells and lead it to death). Sh. Antitumor antibiotics: Aurantin, Dactinomycin, Brunomycin, RUBUN, Karminomycin, Bleomycin, Mitzin-C, Adriamycin (cause a violation of DNA and RNA synthesis).
Anticancer preparations 1e. Preparations of plant origin: Kolhamin, Vinblastine, Wincristine (mitotic poisons - block mitosis of cells). W. Other antitumor drugs: Nitrosomethylmoevina, Natulan, Chloatin, Mieloshan; Platinum preparations: Cisce Platin, SSNU, SNU, Platidia and Others. U1. Hormonal preparations (androgens, estrogens, corticosteroids, progestins).
Treating tumors Combined treatment: radiation + surgical, surgical + radiation. Comprehensive: surgical + chemotherapy + hormonal, surgical + radiant + chemotherapeutic, surgical + chemotherapeutic + hormonal. Indications for the common process. With highly invasive tumors. With hormone-dependent tumors. Combined treatment: 2 or 3 types of same type of therapy: a) polychimotherapy, b) radiation: remote + contact - applied to operation or after surgery or during surgery.
VTE and the rehabilitation of the oncobole 1y clinical group - there is 1 group of disability and symptomatic treatment: painkillers, heartfall, etc.; Palliative chemotherapy and phytotherapy can be carried out. III clinical group - after treatment - hospital sheets for months depending on the disease, treatment method, the volume of operation, etc. Control examination after months.
The rehabilitation of the cancellation group of disability is, depending on the well-being, the volume of the remote organ, the presence of metastases, the nature of the work. In the absence of suspicion of metastases - rehabilitation: plastic surgery, prosthetics, spa treatment. Avoid thermal procedures, massage affected organs, etc. For this, rehabilitation branches are served; It is necessary to attract psychologists to work with these patients. Deontology in Oncology
EPIDEMIOLOGY
In the overall structure of morbidity in Russia, malignant neoplasms of skin cancer are approximately 10%. In 2007, the absolute number of patients with for the first time in the life was diagnosed in our country 57,503 people. The incidence of skin cancer in the dynamics tends to increase - in 1997 the intensive figure was equal to 30.5 per 100 thousand population, and in 2007 - 40.4. Among the regions of Russia, the maximum standardized incidence rates of non-green neo-formations were in Adygea (49.5 per 100 thousand men and 46.4 - 100 thousand women), the Jewish Autonomous Region (respectively 59.8 and 34.0), Chechnya (46 , 4 per 100 thousand men) and the Stavropol Territory (38.9 per 100 thousand women), minimal - in Karelia (7.1 per 100 thousand men and 4.9 - 100 thousand women) and Tyva (5, 8 per 100 thousand men). Skin cancer is found primarily in old age. More often sick faces with light skin living in southern countries and areas and conductive time outdoors. Skin mortality rates are among the lowest among all nosological forms of malignant neoplasms.
ETIOLOGY
Among the factors contributing to the occurrence of skin cancer, first of all, there should be a long and intensive effect on the skin of solar radiation. This circumstance can be explained by the fact that almost B90% of cases of skin cancer are localized in open areas of the skin of the head and neck, to the greatest degree of insolation. Local impact of various groups of chemical compounds with carcinogenic influence (arsenic, fuel and lubricating mat
rial, tar), ionizing radiation also relate to factors that contribute to the occurrence of skin cancer. Mechanical and thermal leather injuries leading to the formation of scars, against the background of which the malignant process is possible, it is possible to attribute to factors that increase the risk of skin neoplasms.
Optional and bond skin prediction
The occurrence of skin cancer is preceded by various prematubological diseases and pathological processes that are called the prejudice. A bond preference is almost always a malignant transformation. The following diseases include the bonde preiodine of the skin:
Pigment Keroderma;
Bowen's disease;
Pedge's disease;
Erytoplasia Caera.
Optional presets can sometimes go into cancer - during the coating of certain adverse factors of both the outer and the inner environment of the body. The optional prejudice includes:
Senile (solar, acticine) keratosis;
Skin horn;
Keratoacanta;
Senile (seborrheic) keratoma;
Late radial ulcers;
Trophic ulcers;
Arsenic keratosis;
Lesions of the skin with tuberculosis, systemic red lolly, syphilis.
Let us dwell on the characteristics of individual forms of precancerous skin diseases in more detail.
Pigment Kerodermait is a disease with an autosomal-recycable type of inheritance. The first manifestations are observed in early childhood. It is characterized by the pathological sensitivity of the skin to UV radiation. During the disease, 3 periods are distinguished:
1) erythema and pigmentation;
2) atrophy and teleangectasis;
3) neoplasms.
Open parts of the body exposed to sunlight, with pigment kservoderma are covered with freckles and red spots. Even short-term stay in the sun leads to swelling and skin hyperemia. In the future, erythematous stains increase in size, darken. Peeling and skin atrophy appear. The skin acquires a variegated view by alternating red and brown spots, scar changes, atrophic sites and teleangectasis. Subsequently detected papillomas, fibromes. Malignation of pigment kservoch in cancer, melanoma or sarcoma comes in 100% of cases. Most patients dying aged 15-20 years.
Bowen's diseasemen elderly sick. Any parts of the body are affected, but more often torso. The disease is manifested in the form of a single plaque of pale pink or violet color with a diameter of up to 10 mm. The edges of the tumor are clear, slightly rise above the skin level, the surface is covered with crust and peeling, places erosion and atrophichn. The disease is characterized by a slow growth of the lesion. Bowene's disease in 100% of cases is reborn into flat-belling cancer and can be combined with indoor cancer.
Pedgety's diseasemost often localized in the nipple area of \u200b\u200bthe breast, less often - in the region of genitals, in the perineum, axillary depressions. Macroscopically represents a plaque of red or cherry blossom, oval shape, with clear boundaries. The surface of the plaques is erosioned, mocking, places covered with crusts. Patients worried burning and itching. During the damage to the breast, one-sidedness of the lesion, the nipple retracting and serous-bleeding from it are characteristic. This is a special variety of cancer. Cancer cells (PIDING cells) are in the epidermis and in sweat or mammary glands. In the dermis, only signs of chronic inflammation are observed.
Eritopia Caerait is an option for Bowen's disease with localization on mucous membranes. Men not subjected to Circumcisia are more often sick. This is a rather rare disease. Macroscopically, it is manifested in the form of a flax of bright red with sharp boundaries and slightly raised edges. When switching to flat-belling cancer, the boundaries of the plaques become uneven, erosion appears, then an ulcer coated with fibrinous film or hemorrhagic crusts.
Senile (sunny, acticine) keratosisit is observed more often in men over 50 years and localized in open areas of the body. Changes look like a cluster of burned scales of yellow-brown color, rounded shape, with a diameter of no more than 1 cm. The removal of the scales is difficult, as they are soldered with the skin to be leather, painfully. When removing the scales, an erosive surface or an atrophic stain is exposed. On the malignant transformation into a flat-belling cancer indicates the appearance of itching, soreness, infiltration, ulceration and bleeding in the field of lesion focus.
Skin Rogconsider as an option of senile keratosis. Usually occurs in places of frequent skin injury. It is a dense cylindrical or cone-shaped formation, towering above the surface of the skin, yellow-brown or gray, tightly soldered with the subject to the skin. It is characterized by slow growth, in length can reach 4-5 cm. During malignancy in the field of the base of the skin, red, seal and soreness appear.
Senile (seborrheic) keratom- This is common in elderly and senile age epithelial tumors. Located in closed parts of the body. The foci of lesion multiple, grow slowly, reaching a diameter of 1-2 cm. The elder keratoma is a flat or a burglar bleach, oval or round shape, with clear boundaries, brown or gray-black. The surface of the plaques is covered with easily removed by bold crusts, fine-making, as it contains horny cysts (closed hair follicles). Malignation of elder kerats is rare. For malignancy, the appearance of erosion on the surface and sealing its base is characteristic.
Skin cancer prevention measures
1. Timely treatment of precancerous skin diseases.
2. Exception of long and intensive insolation.
3. Compliance with safety equipment when working with sources of ionizing radiation.
4. Compliance with safety measures in the production of chemicals (nitric acid, benzene, polyvinyl chloride, pesticides, plastics, pharmaceutical preparations).
5. Compliance with personal hygiene measures when working with household chemical products.
Histological varieties of skin cancer
Skin cancer comes from the cells of the spike layer of the epidermis. Basal cell Cancer (basaloma) is up to 75% of all cancer skin diseases. Its cells are similar to the cells of the base layer of the skin. The tumor is characterized by slow, local-dispusing growth, does not metastasis. Can germinate and destroy surrounding fabrics. In 90% of cases is located on the face. Primary multiple basalomas may be observed.
Flake carcury Cancer meets much less frequently basal cell and often develops against the background of chronic skin diseases. It consists of atypical cells resembling hipged. The tumor can be localized on any skin sections. It has infiltrative growth and is capable of metastasis. Lymphoinely metastasizes in regional lymph nodes in 5-10% of cases. Hematogenic metastases are more likely to be amazed and bones.
Even less often there are adenocarcinoma of the skin arising from sweat and sebaceous glands.
International Classification
On the TNM system (2002)
Applicable to the classification of cancer of the skin of the entire body surface, except for the eyelids, outdoor female genital organs and penis. In addition, this classification is not applicable to skin melanoma, including the skin of the eyelids.
Rules of classification
The classification below is applicable only for cancer. In each case, histological confirmation of the diagnosis and isolating the histological type of the tumor is necessary.
Anatomical regions
Lip skin, including the Red Kaima.
Eye skin.
Ear leather and outdoor auditory passage.
Leather of other and unspecified departments of the face.
The skin of the scalp and neck.
The skin of the body, including the perianal area.
The skin of the upper limb, including the area of \u200b\u200bthe shoulder belt.
Lower limb leather, including a hip area.
Skin of female outdoor genital organs.
Leather of penis.
Scrotum skin.
Regional lymphatic nodes
Localization of regional lymph nodes depends on the primary tumor.
One-sided tumor
Head, Neck: Ipsilateral proud, lifting
neulatile, cervical and pressed lymph nodes.
Chest: Ipsilateral axillary lymph
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