The activities of a nurse working with oncological patients are built according to the stages of the nursing process.
I stage. Initial assessment of the patient's condition. At the first contact with an oncological patient, the nurse gets to know him and his relatives, and introduces herself. Conducts a survey and examination of the patient, determining the degree of his physical activity, the possibility of independent physiological functions, evaluates the functional capabilities of vision, hearing, speech, determines the prevailing mood of the patient and his relatives at the time of admission, guided by facial expressions, gestures, desire to make contact. The nurse also assesses the patient's condition by the nature of breathing, color skin, measuring blood pressure, counting the pulse rate, laboratory data and instrumental methods research.
All data from the initial examination are analyzed by the nurse and documented.
II stage. Diagnosing or identifying patient problems.
When working with cancer patients, the following nursing diagnoses can be made:
Pain of various localization associated with the tumor process;
Reduced nutrition associated with a decrease in appetite;
fear, anxiety, anxiety associated with the suspicion of an unfavorable outcome of the disease;
Sleep disturbance associated with pain
unwillingness to communicate, take medications, refusal of the procedure associated with a change in the emotional state;
inability of relatives to care for the patient, associated with a lack of knowledge;
weakness, drowsiness due to intoxication;
pallor of the skin due to a decrease in hemoglobin;
Decreased physical activity due to pain and intoxication.
Stage III Stage IV
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PLANNING YOUR PATIENT CARE |
IMPLEMENTATION OF THE NURSING INTERVENTION PLAN |
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Fulfillment of doctor's orders |
1. Control over timely reception medicines. 2. Teaching the patient to take various dosage forms enterally. 3. Diagnosed complications arising from the parenteral route of drug administration. 4. Orientation of the patient to timely seeking help in case of side effects of drugs. 5. Monitoring the patient's condition during dressings, medical manipulations. |
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Exclusion of drug overdose |
Information of the patient about the exact name of the drug and its synonyms, about the time of the onset of the effect. |
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Helping the patient with hygiene measures |
1. Train the patient (patient's relatives) in hygiene procedures. 2. Obtain the patient's consent to carry out personal hygiene manipulations. 3. Help the patient clean the mouth after each meal. 4. Wash the vulnerable parts of the patient's body as it gets dirty. |
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Ensuring a comfortable microclimate in the ward that promotes sleep |
1. Create comfortable conditions for the patient in bed and in the ward: optimal bed height, high-quality mattress, optimal number of pillows and blankets, ventilation of the ward. 2. Reduce the patient's anxiety associated with unfamiliar surroundings. |
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Ensuring rational nutrition of the patient |
1. Organize diet food. 2. Create a favorable environment while eating. 3. Help the patient while eating or drinking. 4. Ask the patient in what order he prefers to eat. |
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Reducing patient pain |
1. Determine the localization of pain, time, cause of pain, duration of pain. 2. Analyze together with the patient the effectiveness of previously used pain medications. 3. Distract attention with communication. 4. Teach the patient relaxation techniques. 5. Reception of analgesics by the hour, not on demand. |
V stage. Evaluation of nursing interventions. The time and date of the evaluation of the effectiveness of nursing interventions should be indicated for each problem identified. The results of nursing actions are measured by change in nursing diagnoses. When determining the effectiveness of nursing interventions, the opinion of the patient and his relatives is also taken into account, and their contribution to achieving the goals is noted. The plan for caring for a seriously ill patient has to be constantly adjusted, taking into account the change in his condition.
Chapter 22
Nursing process in caring for patients with precancerous, benign
And malignant tumors.
In general, the Russian Federation continues to grow in cancer incidence and mortality. Cancer incidence is 95% represented by cancer of the cervix, endometrium, and ovaries. The main problem remains the late diagnosis of malignant neoplasms in outpatient clinics and the growth of advanced forms, which is due to the insufficient use of modern methods of early diagnosis, the lack of systematic medical examinations, dispensary observation of patients with chronic, background and precancerous diseases, insufficient onco-alertness of the medical staff.
The nurse should be able to identify the patient's disturbed needs associated with cancer, identify real problems in connection with existing complaints, potential problems associated with the progression of the disease and possible complications of cancer, and outline a plan for the nursing process, for the solution of which she must carry out independent and dependent interventions.
A nurse should be a competent, sensitive, attentive and caring specialist who provides assistance to women, who can talk about her condition, methods of examination, treatment, and inspire confidence in a favorable outcome of treatment. The nurse should be a real assistant to the doctor when performing appointments, additional methods research.
Tumors of the external genital organs.
Benign tumors of the vulva.
Fibroma(Fig. 147) - a tumor of a connective tissue nature of a rounded or oval shape, usually single, on a wide base or on a stalk. It is localized more often in the thickness of the labia majora or under the mucous membrane of the vestibule of the vagina. It grows slowly, only desmoid fibroma is honored.
Rice. 147 Fibroma of the vulva in the form of an extensive polypoid growth.
Myoma l localizes in the thickness of the labia majora, has a densely elastic consistency, is mobile, grows slowly.
Lipoma develops from adipose or connective tissue (fibrolipoma), localized in the pubis or labia majora, soft texture, rounded, has a capsule, not soldered to the skin, grows slowly.
Hemangioma arises on the basis of a congenital malformation of the vessels of the skin and mucous membranes of the external genital organs. More often it develops in the region of the labia majora in the form of a knot, a cyanotic or purple spot, rising above the level of the skin or mucous membrane. The tumor grows rapidly and reaches a large size, spreading to the vagina and cervix.
Lymphangioma develops from the lymphatic vessels of the skin, has cavities of various sizes and shapes containing a protein liquid. The tumor consists of small tuberous nodes with a bluish tinge, merging with each other.
Diagnostics. An examination of the external genitalia, colposcopy is carried out, and a biopsy of the tumor is performed to make a final diagnosis.
Surgical treatment of patients with benign tumors of the external genital organs. Sometimes electrocoagulation, cryo-destruction and CO 2 laser are used.
Background and precancerous diseases
Treatment.
1. When combined with inflammatory processes vulva and vagina - etiotropic anti-inflammatory treatment (antitrichomonas, antifungal, antiviral, antichlamydial).
2. Do not use products such as sea buckthorn oil, rosehip oil, aloe ointment and other biostimulants. They can contribute to the strengthening of proliferative processes and the occurrence of cervical dysplasia.
3. The most effective treatments for cervical leukoplakia include: cryodestruction and CO 2 - laser vaporization, radio wave surgery in coagulation mode.
4. When leukoplakia is combined with deformity and hypertrophy of the cervix, it is advisable to use surgical methods of treatment in a hospital: knife, laser, radio wave or electroconization; wedge-shaped or cone-shaped amputation of the cervix.
erythroplakia- this is a flattening and thinning of the layer of stratified squamous epithelium due to atrophy of the functional and intermediate layers (reduced cornification).
When viewed in mirrors areas of hyperemia are determined irregular shape, bleed easily.
Colposcopic and red areas of sharply thinned epithelium are visible, through which the underlying tissue shines through.
Histologically thinning of the squamous epithelium is observed, atypical hyperplasia of basal and parabasal cells is observed.
Treatment the same as in leukoplakia.
Polyp of the cervical canal (photo 77.78) - focal proliferation of the endocervix, in which the arborescent outgrowths of the connective tissue protrude into the lumen of the cervical canal or beyond it, are covered with a cylindrical epithelium, can be single or multiple, occur in women after 40 years of age against the background of hyperestrogenism.
When viewed in mirrors in the lumen of the cervical canal, round formations of red or pink color are visible. According to histological
the structure is distinguished by glandular, glandular - fibrous, fibrous polyps. The polyp has a thick or thin stalk, may hang down into the vagina.
Photo 77. Large polyp of the cervix, emanating from the endocervix,
dug by squamous immature epithelium, before and after treatment with Lu-gol's solution.
Photo 78. Multiple polyps on the background of ectopia, covered with CE.
Colposcopically the epithelial cover of the polyp is revealed: cylindrical epithelium or squamous epithelium.
Histologically the structure of polyps is characterized by the presence of a connective tissue stalk covered with epithelium, in the thickness of which glandular or glandular-fibrous structures are formed.
I. Epithelial tumors.
A. Serous tumors.
1. Benign: cystadenoma and papillary cystadenoma; superficial papilloma; adenofibroma and cystadenofibroma.
2. Borderline (potentially low grade): cystadenoma and papillary cystadenoma; superficial papilloma; adenofibroma and cystadenofibroma.
3. Malignant: adenocarcinoma, papillary adenocarcinoma and papillary cystadenocarcinoma; superficial papillary carcinoma; malignant adenofibroma and cystadenofibroma.
B. Mucinous tumors.
1. Benign: cystadenoma; adenofibroma and cystadenofibroma.
2. Borderline (potentially low grade): cystadenoma; adenofibroma and cystadenofibroma.
3. Malignant: adenocarcinoma and cystadenocarcinoma; malignant adenofibroma and cystadenofibroma.
B. Endometrial tumors.
1. Benign: adenoma and cystadenoma; adenofibroma and cyst denofibroma.
2. Borderline (potentially low degree of malignancy): adenoma and cystadenoma; adenofibroma and cystadenofibroma.
3. Malignant:
a) carcinoma, adenocarcinoma, adenoacanthoma, malignant adenofibroma and cystadenofibroma; endometrioid stromal sarcoma; mesodermal (Mullerian) mixed tumors.
D. Clear cell (mesonephroid) tumors: benign: adenofibroma; borderline (potentially low degree of malignancy); malignant: carcinoma and adenocarcinoma.
D. Brenner tumors: benign; borderline (borderline malignancy); malignant.
Table 14. Treatment of glandular hyperplasia of the endometrium.
| Periods | Stage I Hemostasis | Stage II Prevention of relapse | Stage III Clinical examination in the antenatal clinic and monitoring the effectiveness of treatment |
| In the juvenile period | 1. Non-hormonal hemostasis: - (uterotonics, membrane protectors, dicinone, calcium gluconate, vikasol, iron preparations (sorbifer, etc.). 2. Hormonal: - homonal; - single-phase high-dose COCs (bisekurin, non-ovlon, rigevidon) 1 tablet in an hour until bleeding stops with a gradual (per tablet) daily decrease to 1 tablet per day, a course of 21 days; - estrogens (folliculin, sinestrol) 0.01% r.m., 1 ml / m , 1 hour to stop bleeding (6-8 injections) with a gradual dose reduction to 1 ml per day, a course of 14-15 days, followed by the appointment of gestagens - rheopolyglucin, infusion-transfusion therapy - symptomatic therapy 3. Surgical: with Hb< 75г/л, Ht – 20 %, раздельное диагностическое выскабли-вание цервикального канала и полости матки под контролем гистероскопии, с обкалыванием девственной плевы 0,25% раст-вором новокаина с 64 ЕД лида-зы с последующим гистологическим исследо-ванием соскоба. У 87% ЖКГЭ, может быть АГЭ. | - from 16 to 25 days gestagens (duphaston, norkolut) 6-12 months; or 14 and 21 days - 17-OPK 125 ml 6-12 months; - COC (logest, femoden, novinet, regulon) according to the contraceptive scheme; - Ultrasound of the small pelvis after 1,3,6,12 months. | - at least a year after stable normalization of the menstrual cycle. |
| In the reproductive period | Surgical: - separate diagnostic curettage of the cervical canal and uterine cavity with subsequent histological examination; - symptomatic therapy and physiotherapy. | - Regulation of the menstrual cycle; - COC according to the contraceptive scheme for 6 months; - gestagens 6 months; - cyclic vitamin-hormone therapy, physiotherapy for 3 months; - clostilbegit 50-150 mg per day for 5-9 days for 3-6 months, in young women in order to form an ovulatory menstrual cycle and stimulate ovulation. | - Ultrasound of the small pelvis after 3-6-12 months; - aspiration cytology after 6 months; - hysteroscopy with WFD after 6 months; - has been registered at the dispensary for at least 1 year, removed after stable normalization of the cycle. |
| In menopause | Surgical: - separate diagnostic curettage of the cervical canal and uterine cavity under the control of hysteroscopy. | - Gestagens; - gonadotropin inhibitors (danazol, nemestrane); - analogues of gonadotropin releasing hormones (zoladex); - women over 50 years old - androgens; - with contraindications to surgical treatment - electro- or laser ablation of the endometrium. | - Ultrasound of the small pelvis after 3-6-12 months; - aspiration cytology after 3 months; - hysteroscopy with WFD after 6 months; has been registered at the dispensary for at least 1 year, removed after stable normalization of the cycle. |
E. Mixed epithelial tumors: benign; borderline (borderline malignancy); malignant.
B. Gynandroblastoma.
IV. germ cell tumors.
A. Dysgerminoma.
B. Embryonic carcinoma.
G. Polyembryoma.
D. Chorionepithelioma.
E. Teratomas.
1. Immature.
2. Mature: solid; cystic (dermoid, dermoid cyst with malignancy).
3. Monodermal (highly specialized): ovarian struma; carcinoid; ovarian struma and carcinoid; other.
V. Gonadoblastoma.
Cancer of the vulva
Mostly women aged 60-69 get sick. Most often, vulvar cancer affects the labia majora, the periurethral region, and the posterior commissure, and the urethra is the last to be involved (photo 89).
Clinic. If the tumors of the vulva were not preceded by neurodystrophic processes, then in the early stages of the disease, the symptoms are slightly expressed and are manifested by the occurrence of discomfort (itching, burning), and then the development of a small ulcer.
Photo 89. Cancer of the vulva.
As the disease progresses, the severity of these symptoms increases. With infiltration of the underlying tissues, pain appears in the perineum, pain and burning during urination, especially with infiltration of the external opening of the urethra. The formation of a significant mass of the tumor leads to the appearance of profuse, fetid discharge with an admixture of blood, bleeding.
With the development of cancer against the background of dystrophic changes, the leading symptom is itching, paroxysmal, aggravated at night. Changes in the skin and mucous membrane correspond to the clinical manifestations of kraurosis and vulvar leukoplakia. The foci of leukoplakia flatten, coarsen, there is a thickening of the underlying skin layer, an ulcer with dense edges is organized on the surface of leukoplakia.
Frequent and rapid metastasis is noted, which is associated with a developed lymphatic network of the vulva. First, the inguinal lymph nodes are affected, and then the iliac and lumbar lymph nodes. Lymph nodes were affected on the opposite side, due to the abundance of anastomoses between intra- and extra-organ lymphatic vessels.
Diagnostics. When examining the external genital organs, attention should be paid to the size of the primary focus; the background against which the malignant tumor developed; localization of the process, the nature of tumor growth, the state of the underlying tissues. Vaginal-abdominal and rectovaginal examinations are carried out in order to exclude the metastatic nature of the tumor and to establish the extent of the process. Determine the state of the lymph nodes in the inguinal, femoral and iliac areas. In the diagnosis, vulvoscopy, cytological examination of prints from the tumor, histological examination of biopsy materials, ultrasound tomography of the inguinal, femoral and iliac lymph nodes are also used; according to indications - cystoscopy, excretory urography, radiography chest, cytological examination of punctates from the lymph nodes.
Treatment. In the treatment of preinvasive vulvar cancer, the treatment of choice is vulvectomy or cryosurgery in young women. In patients with microinvasive cancer - a simple vulvectomy.
At stage I (tumor up to 2 cm, limited to the vulva, regional metastases are not detected) - surgical treatment. A radical vulvectomy is performed. In the absence of contraindications, the volume of the operation is supplemented by inguinal-femoral lymphadenectomy.
If the tumor is localized in the clitoris, there are palpable lymph nodes, but not suspicious for metastases, radical vulvectomy and inguinal-femoral lymphadenectomy are performed.
If there are contraindications to surgical treatment, radiation is performed.
At stage II (the tumor is more than 2 cm in diameter, limited to the vulva, regional metastases are not detected) - radical vulvectomy and inguinal-femoral lymphadenectomy. After the operation, the vulvectomy area is treated with radiation therapy. If there are contraindications to combined treatment - combined radiation treatment according to a radical program. Remote gamma therapy is carried out on the region of regional inguinal lymph nodes.
At stage III (limited local spread and regional displaceable metastases) - radical vulvectomy, inguinal-femoral lymphadenectomy, supplemented by indications of iliac lymphadenectomy and subsequent remote irradiation of the vulvectomy zone. With contraindications to combined treatment, combined radiation therapy according to a radical program.
With a significant local or local-regional spread of the tumor, radiation treatment is performed before the operation: remote irradiation of the vulva, intracavitary gamma therapy followed by radical vulvectomy and inguinal-femoral lymphadenectomy, supplemented by indications of the iliac. After the operation, the vulvectomy zone is irradiated.
With contraindications to combined treatment - combined radiation therapy according to a radical program.
Stage IV (the tumor spreads to the upper part of the urethra and / or bladder, and / or rectum, and / or pelvic bones with or without regional metastasis) - radiation therapy according to an individual plan, supplemented by polychemotherapy (fluorouracil, vincristine, bleomycin , methotrexate).
Prevention. Vulvar cancer rarely develops in healthy tissues. It is preceded and accompanied by dysplasia and/or preinvasive cancer. Therefore, the primary prevention of vulvar cancer is the detection during preventive examinations once every six months of background dystrophic processes; clarification of the histological structure of altered tissues, adequate treatment of background processes, identification and surgery dysplasia, preinvasive cancer of the external genital organs.
Vaginal cancer
Vaginal cancer can be primary and metastatic (with localization of the primary tumor in another organ). Primary vaginal cancer is rare, accounting for 1-2%. Metastatic tumors of the vagina are more common. If squamous cell carcinoma of the cervix and vagina is found at the same time, then this observation is referred to as cervical cancer. When a cancerous tumor of the vulva and vagina is affected, the diagnosis is “vulvar cancer”. Vaginal cancer affects women of any age, but mostly in 50-60 years. The risk group includes women aged 50-60 years who have the following risk factors: chronic irritation due to wearing pessaries; chronic irritations associated with prolapse of the uterus and vagina; involutive and dystrophic processes; infection with HSV-2, PVI; taking diethylstilbestrol by the mother up to 8 weeks of pregnancy; cervical cancer and a history of radiation exposure.
Cervical cancer
Cervical cancer is the most common malignant disease, diagnosed with a frequency of 8-10 cases per 100,000 women.
Rice. 154. Exophytic form of cervical cancer.
Rice. 155 Endophytic form of cervical cancer with a transition to the body of the uterus.
Rice. 156. Endophytic form of cervical cancer with spread to parametrium and vaginal wall.
Rice. 157 Endophytic form of cervical cancer with spread to parametrium and adnexa.
Rice. 158 Endophytic form of cervical cancer with the transition to the body of the uterus and the wall of the vagina.
The highest frequency of cervical cancer is observed in the perimenopausal period - 32.9% less often in 30-39 years. The peak of the disease occurs at the age of 40-60 years, and in case of preinvasive cancer - 25-40 years.
Etiological risk factors in the development of cervical cancer:
- birth trauma, inflammation and trauma after abortion, which leads to deformation, disruption of traffic and tissue innervation, early sexual life, promiscuity, frequent change of sexual partners, smegma factor in a sexual partner (it is believed that smegma accumulates under foreskin, contains carcinogenic substances); the leading role in the occurrence of cervical cancer is assigned to viral infections (HSV (type 2), HPV) .;
- occupational hazards (tobacco production, mining and coal industries, oil refineries) also play a role in the occurrence of cervical disease;
- heredity (it is believed that the risk of the disease increases by 1.6 times in women with such a predisposition);
background and precancerous diseases of the cervix.
According to the morphological structure, cervical cancer variants are distinguished: squamous - 85-90% of cases; glandular - 10-15% of cases; mixed - 20% of cases. According to the degree of differentiation, there are: a highly differentiated form of cancer; moderately differentiated form of cancer; low-grade form of cancer.
Classification of cervical cancer by stage(Fig. 154, 155, 156, 157, 158).
O stage - preinvasive (intraepithelial) cancer, Ca in situ.
Stage Ia - the tumor is limited to the cervix, invasion into the stroma is not more than 3 mm, the diameter of the tumor is not more than 10 mm - microcarcinoma.
Stage Ib - the tumor is limited to the cervix with an invasion of more than 3 mm. invasive cancer.
Stage IIa - the cancer infiltrates the vagina without moving to its lower third (vaginal variant), or spreads to the body of the uterus (uterine variant).
Stage IIb - cancer infiltrates the parametrium on one or both sides, without moving to the pelvic wall (parametric variant).
Stage IIIa - cancer infiltrates the lower third of the vagina or there are metastases in the uterine appendages; regional metastases are absent.
Stage III6 - cancer infiltrates the parameters on one or both sides to the pelvic wall, or there are regional metastases in the lymph nodes of the pelvis, or hydronephrosis and a non-functioning kidney due to ureteral stenosis are determined.
IVa stage - cancer germinates the bladder or rectum.
IV6 stage - distant metastases outside the pelvis are determined.
clinical picture. The main symptoms are: acyclic (contact) spotting, leucorrhoea (partially streaked with blood), and pain when the tumor expands. Dull aching (usually nocturnal) pain in the lower abdomen, fatigue, irritability are characteristic of pre- and microinvasive cervical cancer. As the process progresses, life-threatening bleeding may occur. When the process spreads to the bladder and rectum, persistent cystitis, constipation, etc. appear; with compression of the ureters by a cancerous infiltrate, disturbances in the passage of urine, hydro- and pyonephrosis are possible.
Metastases of cervical cancer and their diagnosis. Metastasis of cervical cancer is carried out mainly through the lymphatic system, in the final stage of the disease, the lymphatic pathway of the spread of a cancerous tumor can be combined with the hematogenous one. Most often, cervical cancer metastasizes to the lungs, liver, bones, kidneys, and other organs.
Diagnostics. When carrying out independent interventions of the nursing process, the nurse must prepare the obstetrician-gynecologist with the necessary tools, sterile material for examining the cervix in mirrors, conducting rectovaginal, recto-abdominal examinations; with independent nursing interventions, the nurse, at the direction of the doctor, prepares everything necessary for performing a colposcopy (simple, extended), and, if necessary, a biopsy of the cervix,
At examination of the cervix in the mirrors with an exophytic form of cervical cancer, tuberous formations of a reddish color are found, with gray areas of necrosis. The tumor resembles a "cauliflower". The endophytic form is characterized by an increase and induration of the cervix, ulceration in the area of the external pharynx.
With cancer of the cervical canal, there are no special changes visible to the eye on the surface of the cervix. When the process spreads to the vagina, smoothing of the folds, whitish walls are noted.
Rectovaginal and rectoabdominal examination clarify the degree of distribution of the process to the parametric fiber, the walls of the vagina, the small pelvis.
Colposcopy reveals corkscrew-shaped vessels are determined located along the periphery of reddish prosovity growths with hemorrhages. Schiller's test establishes the boundaries of pathologically altered areas of the cervix, which remain negative to Lugol's solution. Extended colposcopy allows you to detect suspicious areas for cervical biopsy, histological examination of the resulting tissue . Biopsy should be performed widely, wedge-shaped excising with a scalpel a pathologically altered area of the cervix within healthy tissue.
Treatment of invasive cancer.
Stage I - combined treatment in two versions: remote or intracavitary irradiation followed by extended extirpation of the uterus with appendages or extended extirpation of the uterus followed by remote therapy. If there are contraindications to surgical intervention - combined radiation therapy (remote and intracavitary irradiation).
Stage II - in most cases, a combined beam method is used; surgical treatment is indicated for those patients in whom radiation therapy cannot be carried out in full, and the degree of local spread of the tumor allows for a radical surgical intervention.
Stage III - radiation therapy in combination with restorative and detoxification treatment.
IV stage - symptomatic treatment.
Forecast. Five-year survival of patients with microcarcinoma is 80-90%, stage I cervical cancer - 75-80%, stage II - 60%, stage III - 35-40%.
Treatment of patients with cervical cancer associated with pregnancy. Pregnancy stimulates the growth of malignant growth cells.
Detection of preinvasive cancer in the first trimester of pregnancy is an indication for its termination with obligatory curettage of the cervical canal and subsequent conization of the cervix; in the II and III trimesters, it is possible to maintain pregnancy until the term of delivery with dynamic colposcopic and cytological control. At Ib and II stages of cancer in the I and II trimesters, an extended extirpation of the uterus with appendages is performed, followed by radiation therapy; in the third trimester of pregnancy, treatment for cervical cancer is preceded by a caesarean section. Patients with stage III cancer in the I and II trimesters undergo abortion or amputation of the uterine body, followed by radiation therapy; in the III trimester of pregnancy - caesarean section, amputation of the body of the uterus, combined radiation therapy.
After surgical treatment without the use of adjuvant chemotherapy, it is necessary to monitor the patient at least once every 3 months with clinical, ultrasound and immunological (determination of the level of tumor markers in blood serum) research methods.
Prevention of cervical cancer.
- Carrying out by a nurse and all medical personnel, activities aimed at eliminating risk factors for developing cervical cancer.
- Medical examinations of women, starting from the onset of sexual activity, including cytological screening and colposcopy.
- Prevention of radiation injury.
- Sanitary education work on the dangers of abortion, modern methods of contraception, sexually transmitted infections (HSV, HPV, etc.).
- Vaccination of women before the onset of sexual activity with the recombinant vaccine Gardasil. Vaccination can prevent most cases of cervical cancer caused by HPV types 6,11,16 and 18.
- Compliance with sanitary standards in hazardous industries.
Cancer of the body of the uterus.
The peak incidence of uterine body cancer occurs at 50-60 years of age. In the elderly and senile age, the incidence of cancer of the uterine body remains high. The risk group for the development of uterine cancer includes women with neurometabolic disorders: diencephalic syndrome, obesity, diabetes mellitus, hypertension, and others; hormone-dependent dysfunctions of the female genital organs: anovulation, hyperestrogenism, infertility; hormonally active ovarian tumors that secrete estrogens, which in 25% of cases are accompanied by endometrial cancer; refusal of lactation, short-term lactation; lack of sexual life; no pregnancy, no childbirth; weighed down by heredity; late onset of menarche, late onset of menopause (over 50-52 years old); use for the treatment of estrogenic drugs without additional prescription of gestogens.
T - primary tumor
T is - preinvasive carcinoma (Ca in situ).
TO - the primary tumor is not determined (completely removed during curettage).
T 1 - carcinoma is limited to the body of the uterus.
T 1 a - uterine cavity up to 8 cm.
T 1 b - the uterine cavity is more than 8 cm.
T2 - Carcinoma has spread to the cervix, but not outside the uterus.
T 3 - carcinoma extends beyond the uterus, including the vagina, but remains within the small pelvis.
T 4 - carcinoma extends to the mucous membrane of the bladder or rectum and / or extends beyond the small pelvis.
T x - insufficient data to evaluate the primary tumor.
N- regional lymph nodes of the pelvis
N 0 - metastases in regional lymph nodes are not determined.
N 1 - there are metastases in the regional lymph nodes of the pelvis.
n x - insufficient data to assess the state of regional lymph nodes.
M - distant metastases
M 0 - no signs of distant metastases.
M 1 - there are distant metastases.
M x - not enough data to determine distant metastases.
In each clinical observation, the symbols T, N and M are grouped, which allows us to draw the following analogy with the clinical and anatomical classification by stages:
Stage 0 - T is ; Stage I - T 1 N 0 M 0 ; Stage II - T 2 N 0 M 0 ; Stage III -T 3 N 0 M o ; T 1-3 N 1 M 0 ; Stage IV - T 4 and / or m 1 for any values of T and N.
Ovarian cancer.
Ovarian cancer ranks third in frequency in the structure of oncogynecological morbidity. Ovarian cancer ranks first in the structure of cancer deaths. Cases of a five-year survival rate for ovarian cancer are 15-25%. The incidence begins to increase after the age of 40 and continues to increase until the age of 80. There is a high risk of developing ovarian cancer in the postmenopausal period.
clinical picture.
Ovarian cancer in the early stages asymptomatically or there are symptoms not characteristic of ovarian cancer (dyspepsia, feeling of expansion in the abdomen, nausea, diarrhea alternating with constipation), then there is a violation of menstrual function in the form of metrorrhagia. The disease proceeds aggressive, with early metastasis.
Clinical symptoms appear at advanced common stages of the process, when patients notice fatigue, weakness, sweating, weight loss, deterioration in general condition, difficulty breathing (due to the appearance of effusion in the abdominal cavity and pleura). In large tumors with necrosis, there may be an increase in ESR without leukocytosis, subfebrile temperature (sometimes febrile - up to 38 ° C). Due to the mechanical action of the tumor on the surrounding organs, dull aching pain in the lower abdomen, less often in the epigastric region or in the hypochondrium. The pains are constant, but they can also stop for a certain period, there is a feeling of distension of the abdomen. In cases of torsion of the tumor pedicle, pain occurs suddenly and is acute.
Quite often, one of the first signs of the disease is an increase in the size of the abdomen both due to tumor formation in the small pelvis, and due to ascites. In cancer, accompanied by the early appearance of ascites, as a rule, there is dissemination of implants in the peritoneum and abdominal organs. With percussion of the abdomen, dullness is noted in sloping places.
With advanced forms of ovarian cancer (III-IV stage), the upper half of the small pelvis is partially or completely filled with a conglomerate of tumor nodes, an enlarged and infiltrated greater omentum is palpated, metastases are found in the navel, supraclavicular region, along the peritoneum of the posterior uterine-rectal depression.
In a far advanced process, the menstrual cycle according to the type of dysfunctional uterine bleeding, the amount of urine excreted decreases, constipation occurs.
These features - asymptomatic course, rapid progression of the process and early metastasis lead to late diagnosis of ovarian cancer.
uterine fibroids
uterine fibroids(Fig. 159) is a benign, immuno- and hormone-dependent tumor that develops from the myometrium (muscle and connective tissue elements). The occurrence of uterine fibroids is facilitated by disturbances in endocrine homeostasis in the links of the hypothalamus-pituitary-ovary-uterus chain. There are two clinical and pathogenetic variants of the development of uterine fibroids.
1. Due to primary changes: hereditary burden, infantilism, primary endocrine infertility, hormonal imbalances in puberty and post-puberty.
2. The development of fibroids against the background of secondary changes in the myometrium, due to local secondary changes in receptor apparatus(abortions, postpartum complications, chronic inflammation of the genital organs, etc.).
Rice. 170. Multiple myoma uterus.
A rare variant of the development of fibroids in the postmenopausal age is associated with neoplasms in the mammary glands or endometrium, due to increased hypothalamic activity.
The following terms are used in the literature: "fibroma", "myo-fibroma", "myoma", "leiomyoma", "fibroma" and others. Depending on the predominance of muscle or connective tissue subserous nodes It is customary to call fibromyomas, since the ratio of the parenchyma to the stroma is 1: 3, that is, they are dominated by connective tissue. Intramural and submucosal nodes - fibroids or leiomyomas, where the ratio of parenchyma to stroma is 2:1 or 3:1.
Classification of uterine fibroids.
I. By localization: uterine body fibroids -95%; cervical fibroids (cervical) -5%.
Rice. 161 Scheme of the development of uterine myoma nodes
different localization (according to Albrecht).
Rice. 160 . Intraligamentally located myomatous nodes (Fig. Ya. S. Klenitsky).
II. Growth form: interstitial(intermuscular) - the node is located in the thickness of the myometrium; submucosal(submucosal) - growth towards the uterine cavity; subserous(subperitoneal) - growth towards the abdominal cavity; mixed(a combination of two, three forms of growth); intraligamentary(interligamentous) (Fig. 160) - the growth of the node between the anterior and posterior leaves of the broad ligament of the uterus; retroperitoneal- with exophytic growth from the lower segment of the uterus, isthmus, cervix. On fig. 161 shows a diagram of the development of myomatous nodes according to Albrecht.
Among submucosal fibroids, tumors are born when the growth of the node occurs towards the internal pharynx. The long-term development of such a node leads to the expansion of the cervical canal and is often accompanied by the release of a tumor into the vagina (the birth of a submucosal node).
Clinic of uterine fibroids. Often, uterine fibroids are asymptomatic. The main symptoms of uterine fibroids are menstrual dysfunction, pain, tumor growth and dysfunction of neighboring organs.
hypermenstrual syndrome characteristic of the submucosal or multiple interstitial form. The duration and intensity of uterine bleeding increases with the growth of fibroids. Later, acyclic bleeding may also join. As a result of menorrhagia and metrorrhagia, chronic posthemorrhagic anemia develops, hypovolemia, m
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Introduction
oncology benign tumor
The situation around neoplasms in general and cancer in particular has remained unchanged over the past two decades. Despite the fact that cancer and others, malignant oncological diseases occur in 5-10% of cases of all diseases, they are in second place in terms of mortality. Yielding the first only to cardiovascular pathology. Most experts attribute this to two main factors:
1) An increase in the proportion of the elderly population of the Earth or the so-called aging trend.
2) The deterioration of the ecological situation, which is caused by both the development of technology and the overpopulation of the planet.
Nevertheless, oncological diseases will take second place in the structure of mortality for an indefinitely long period of time due to the large number of questions in the causes of its occurrence. And the more perfect diagnostic methods become, the closer scientists approach the disclosure of the main causes of oncological diseases, the more these questions become.
1. Oncology
The term "malignant neoplasms" refers to all types of malignant tumors. Melanoma stands out among malignant neoplasms - it is formed from pigment cells of melanocytes and is localized on the skin, mucous membranes or retina of the eye. Another type of tumor is a sarcoma. Sarcomas are malignant neoplasms that form from stromal tissues (tendons, fat, and muscles). Different types of cancer include tumors that develop from epithelial tissues - lungs, skin, stomach.
A tumor, or neoplasm, is a cluster of similar cells that forms in various organs or tissues of the body. Distinguish between benign and malignant tumors. Their difference is that a benign tumor develops as if in a capsule: it is limited from other organs by a dense tissue and pushes other tissues away without harming them. Such a neoplasm does not pose any danger to the patient's life.
A malignant tumor grows, wedging into other tissues, and destroys them. If a nerve is on the path of growth of a malignant tumor, then it destroys it, which causes severe pain to the cancer patient; if a blood vessel is located on the path of the neoplasm, then internal bleeding becomes the result of its destruction.
Whatever type of cancer the patient has, the adhesion between the cells of such a neoplasm is very small. As a result, cells are easily detached from a malignant tumor and, together with the blood flow, spread throughout the body, settling in tissues and organs. Once in a new place, the cell gradually becomes a new tumor, similar in composition and structure to the first neoplasm. These tumors are called metastases.
If after some time after treatment the tumor reappears, it means that it recurs. It is not uncommon for one person to develop different tumors during their lifetime. This is primary multiple cancer. New tumors appear with an interval of less than a year - the patient has primary multiple synchronous cancer, more than a year - primary multiple metachronous cancer.
Sometimes benign tumors become malignant. This process is called transformation, or malignization.
2 . Types of benign tumors
Benign neoplasms develop from all tissues of the body. These tumors grow autonomously, non-invasively, are clearly demarcated from healthy tissues, do not metastasize, but are capable of becoming malignant (malignant). In the process of slow growth, they compress neighboring tissues and disrupt the functions of organs, which causes clinical symptoms. Benign neoplasms of the brain are life-threatening.
Benign neoplasms develop from all tissues of the body. The most common types of benign tumors are:
Fibroma. It comes from the connective tissue and is found wherever its fibers are present. There are hard nodular and soft fibromas. The favorite localization of hard fibromas is the uterus, and soft ones are the subcutaneous tissue of the perianal region and genital organs. Fibromas grow slowly, are delimited from healthy tissues, are painless and mobile.
Lipoma (wen). Comes from adipose tissue. It is located more often in the subcutaneous tissue and in the retroperitoneal fatty space. The ratio of lipomas in women and men is 4:1. There are multiple wen - lipomatosis. A benign tumor of adipose tissue is lobular, soft in consistency, mobile. If there are connective tissue fibers in the wen, they speak of a fibrolipoma.
Fibroids (leio- and fibromyomas). They come from the muscles and are localized in them. Fibroids grow slowly, have a firm but elastic consistency, are mobile, painless. Fibers of connective tissue are often woven into fibroids, which is observed with tumors of the uterus. Such a benign neoplasm is called a fibromyoma. Multiple lesion - fibromatosis.
Neurinoma. Comes from the sheath of the nerves. The tumor is dense, it can be single or multiple, it grows in the form of a node, it is painful on palpation. The most common combination of neuromas with connective tissue - neurofibroma. A benign tumor is localized in the intercostal spaces and along the sciatic nerves. Multiple neurofibromatosis is called Recklinghausen's disease by the author.
Table 1. Classification of benign tumors
|
Type of fabric |
Name of the tumor |
|
|
glandular epithelium |
||
|
Cylindrical and squamous epithelium |
epithelioma |
|
|
Adipose tissue |
||
|
Smooth muscle tissue |
Leiomyoma |
|
|
cartilage tissue |
Chondroma |
|
|
striated muscle tissue |
Rhabdomyoma |
|
|
Lymphoid tissue |
||
|
nervous tissue |
Neurinoma |
|
|
Bone |
3. Etiology and pathogenesis
Despite the fact that scientists still cannot give an exact answer to what is the cause of oncological diseases, they all have a common principle of development. And it is the same for most of its stages. But first it is necessary to give a little explanation regarding the vital activity of cells.
Any living cell, in addition to specific ones, only for her characteristic features metabolism and functions, has the so-called Heflick limit. This is nothing more than information about "death" encoded on the DNA of the cell. Or more correctly - in the number of allotted divisions that a cell can make. After that, she must die. Cells different types fabrics have a different limit. Those of them that need constant updating in the process of life have a significant Hayflick limit. These tissues include the epithelium of the skin and internal organs, bone marrow cells. The same tissues in which cell division is provided only at the stage of development have a limit for this stage. At the same time, the life span of the cell is longer. The most striking example of such tissues are neurons.
As a result of some reasons (see below), the cell loses this limit. After that, she becomes capable of unlimited number divisions. And since the fission takes a certain amount of energy, its metabolism begins a gradual restructuring. All organelles direct their "forces" to the ability of the cell to divide, which negatively affects its functions - they are lost over time. After some time, a cell deprived of the Hayflick limit and its "descendants" are very different from the rest of the tissue - cancer (carcinoma) is formed.
Causes, cancer-causing not known. But numerous observations indicate a high relationship of oncology with certain factors and substances. They have a common name - carcinogens. From the Latin term "carcinogenesis", which literally translates - "the birth of cancer." To date, there are more than a hundred such substances. And all of them are combined into several groups.
· Genetic factors. Associated with defects in cellular DNA and a high risk of the cell possessing it losing the Hayflick limit. There is no direct evidence yet. But observations show that people who have relatives with cancer are more likely to get cancer (carcinoma).
· Infectious causes of cancer. These include some viruses and other microorganisms. So far, the connection with viruses for some diseases has been proven. So, cervical cancer is caused by the human papillomavirus, malignant lymphomas - by herpes viruses. For other types of cancer, association with microorganisms is conditionally proven. For example, liver cancer most often occurs in patients with hepatitis B and C. All these studies are based on the fact that viruses carry out their development only by embedding their genes in the DNA of the cell. And this is the risk of developing its anomalies and losing the Hayflick limit.
· Physical factors. These are different types of radiation, X-ray, ultraviolet. Their relationship with the development of cancer is based on the main mechanisms of their action. All of them are capable of destroying the shells of atoms. As a result, the structure of the molecule is disrupted and a part of the DNA, which contains the Hayflick limit, is destroyed along the chain.
· Chemical compounds. This group includes various substances that can penetrate the cell nucleus and enter into chemical reactions with the DNA molecule.
· Hormonal disorders. In this case, cancer is the result of a malfunction of the endocrine glands, which occurs under the influence of an excess / deficiency of certain hormones. The most striking examples of malignant diseases of this group are cancer. thyroid gland and breast cancer.
Immunity disorders. The basis of these reasons is to reduce the activity of T-killer leukocytes, which are designed to destroy any body cells that deviate from the normal structure. Some experts do not distinguish this group due to the fact that disorders of cellular immunity play a role in the occurrence of oncological diseases in general.
4. Toline picture
If cancer is recognized at an early stage of development, it can be cured. It is important to monitor your body, understand what condition is considered normal for it, and consult a doctor if abnormalities appear. In this case, if the patient has cancer, doctors will notice it at an early stage.
There are various common symptoms of cancer:
Tumors.
Shortness of breath, cough, hoarseness.
The so-called chest cancer symptoms are coughing, shortness of breath and hoarseness. Of course, they can be caused by infections, inflammation, and other diseases and ailments, but in some cases, such signs indicate lung cancer. The cause of hoarseness is often laryngitis. This disease means inflammation of the larynx. However, in rare cases, hoarseness is an early symptom of laryngeal cancer.
Disorders in the work of the digestive tract.
A sign of a change in the functioning of the digestive tract is the presence of blood in the stool. Usually it is bright red or dark. The presence of fresh, scarlet blood is a sign of hemorrhoids.
· Bleeding.
Any bleeding for no apparent reason is a sign of a malfunction in the internal organs. Bleeding from the rectum can be a sign of hemorrhoids, but also one of the symptoms of cancer of the internal organs. If a woman has a malignant tumor in the uterus or cervix, then bleeding may occur between periods or after sexual contact. If bleeding occurs in women after menopause, then she urgently needs to see a doctor. Blood in the urine can be a symptom of bladder cancer or kidney cancer. If, when coughing, sputum comes out with blood, then the reason for this is a serious infectious disease. Sometimes this is a sign of lung cancer. Blood in vomit can signal stomach cancer, however, an ulcer can also be the cause of this phenomenon. Therefore, the exact answer to the question of how to determine cancer is to consult a specialist. Nosebleeds and bruising are rare symptoms of cancer. Sometimes these signs are a consequence of leukemia. However, people suffering from this disease have other, more obvious signs of oncology.
· Moles.
You should contact your doctor immediately if your moles show any of the following symptoms:
Asymmetry;
uneven edges;
Atypical color for a mole;
Large size (moles usually do not exceed 6 mm in diameter, melanomas - more than 7 mm);
Presence of crusting, itching, bleeding: melanomas can bleed, crust, itch.
Unexplained weight loss.
5. Diagnostics
Thanks to the trend modern medicine, doctors of all primary care specialties (polyclinics), as well as medical examinations are largely aimed at early detection of cancer. But diagnostic methods have been based on several principles for more than 20 years.
1. Collection of anamnesis. It includes:
Anamnesis of life. Information about human development, the presence of chronic diseases, injuries, etc.
Disease history. That is, any information regarding the onset of the disease and its subsequent development.
2. General clinical analysis.
A general blood test allows you to identify metabolic disorders in terms of erythrocyte sedimentation rate (ESR), glucose levels, and hemoglobin. The latter indicator also allows you to identify anemia.
A general urine test provides data on the work of the kidneys, protein and water-salt metabolism in the body.
A biochemical blood test allows you to judge in more detail the types of metabolism and the work of some organs. So aminotransferases (abbreviations - ALT and AST), bilirubin, characterize the work of the liver. Creatinine and urea are markers of kidney function. Alkaline phosphatase displays the state of some hollow organs and the pancreas. Etc. Besides, biochemical analysis allows you to examine the blood for the presence of specific proteins of cancer cells - the so-called tumor markers.
3. Special research methods aimed at certain parts of the body.
Chest x-ray allows you to see abnormalities even with small tumors. (less than a centimeter). The same applies to radiography of other departments (abdomen, lower back).
Computed and magnetic resonance imaging are modern methods of diagnostics. They allow you to see a tumor about a millimeter in size.
Endoscopic methods (laryngo- and bronchoscopy, fibrogastroduodenoscopy, colonoscopy and colposcopy. They are used to detect cancer of the larynx, esophagus and stomach, rectum, uterus and appendages. All these methods allow visually diagnosing cancer (carcinoma). In addition, most of them allow take a piece of tissue for histological examination.
4. Cytological methods or study of cell structure. Give a definitive diagnosis.
6. Methods of oncology treatment
Cancer treatment depends on the type of tumor, its location, structure, stage of the disease in accordance with the TNM classification. There are the following types of treatment.
1) Surgical removal of the tumor with adjacent tissues. Effective for the treatment of tumors of small size, accessible for surgical intervention, and in the absence of metastases. Quite often, after surgical treatment, recurrence of the tumor may occur.
2) Radiation therapy used to treat poorly differentiated tumors that are sensitive to radiation. Also used for local destruction of metastases.
3) Chemotherapy is used to treat various, often advanced, cancers using cytotoxic agents, hormonal/antihormonal agents, immune preparations, enzyme preparations, antitumor antibiotics and other drugs that destroy or slow down the growth of cancer cells.
4) Gene therapy is the most modern method of treatment, the essence of which is to influence the STAT (signal transduction and activator of transcription) system and other systems, thereby regulating the process of cell division.
5) Neutron therapy - a new method of tumor treatment, similar to radiation therapy, but differs from it in that neutrons are used instead of conventional radiation. Neutrons penetrate deep into tumor tissues that have absorbed, for example, boron, and destroy them without damaging healthy tissues, unlike radiotherapy. This therapy has shown a very high percentage of complete recovery in the treatment of tumors, amounting to 73.3% even at an advanced stage.
6) Immunotherapy. The immune system seeks to destroy the tumor. However, due to a number of reasons, it is often unable to do so. Immunotherapy helps the immune system fight the tumor by making it attack the tumor more effectively or by making the tumor more susceptible. The William Coley vaccine, as well as a variant of this vaccine, picibanil, are effective in the treatment of certain forms of neoplasms due to the stimulation of natural killer activity and the production of a number of cytokines, such as tumor necrosis factor and interleukin-12. Epigenetic therapy can be used to activate protective immune mechanisms.
7) Photodynamic therapy - based on the use of photosensitizers, which selectively accumulate in tumor cells and increase its sensitivity to light. Under the action of light waves of a certain length, these substances enter into a photochemical reaction, which leads to the formation of reactive oxygen species, which acts against tumor cells.
8) Virotherapy is one of the types of biotherapy in which oncotropic / oncolytic viruses are used. One of the branches of oncology. Virotherapy mobilizes the natural defenses of the body's immune system against cells of genetically modified organisms and tissues, including malignant cells.
9) Targeted therapy is a new treatment development cancerous tumors, affecting the "fundamental molecular mechanisms" that underlie various kinds of diseases.
On the this moment the best results in the treatment of cancer are observed when using combined methods of treatment (surgical, radiation and chemotherapy).
A promising direction in the treatment are methods of local impact on tumors, such as chemoembolization.
7. nursing care
1. A feature of caring for patients with malignant neoplasms is the need for a special psychological approach. The patient should not be allowed to know the true diagnosis. The terms "cancer", "sarcoma" should be avoided and replaced by the words "ulcer", "narrowing", "seal", etc. In all extracts and certificates issued to patients, the diagnosis should also not be clear to the patient. You should be especially careful when talking not only with patients, but also with their relatives. Cancer patients have a very labile, vulnerable psyche, which must be kept in mind at all stages of care for these patients. If consultation with specialists from another medical institution is needed, then a doctor or nurse is sent along with the patient to transport documents. If this is not possible, then the documents are sent by mail to the head physician or given to the patient's relatives in a sealed envelope. The actual nature of the disease can be reported only to the closest relatives of the patient.
2. A feature of the placement of patients in the oncology department is that you need to try to separate patients with advanced tumors from the rest of the flow of patients. It is desirable that patients with early stages of malignant tumors or precancerous diseases do not meet patients with relapses and metastases. In an oncology hospital, newly arrived patients should not be placed in those wards where there are patients with advanced stages of the disease.
3. When monitoring cancer patients great importance has regular weighing, as a drop in body weight is one of the signs of the progression of the disease. Regular measurement of body temperature allows you to identify the expected decay of the tumor, the body's response to radiation. Measurements of body weight and temperature should be recorded in the medical history or in the outpatient card.
In case of metastatic lesions of the spine, often occurring in breast or lung cancer, bed rest is prescribed and a wooden shield is placed under the mattress to avoid pathological bone fractures. When caring for patients suffering from inoperable forms of lung cancer, exposure to air, tireless walks, and frequent ventilation of the room are of great importance, since patients with a limited respiratory surface of the lungs need an influx of clean air.
4. In order to carry out sanitary and hygienic measures in the oncology department, it is necessary to train the patient and relatives in hygienic measures. Sputum, which is often secreted by patients suffering from cancer of the lungs and larynx, is collected in special spittoons with well-ground lids. Spittoons need to be washed daily hot water and disinfect with 10 - 12% bleach solution. To destroy the fetid odor, add 15-30 ml of turpentine to the spittoon. Urine and feces for examination are collected in a faience or rubber vessel, which should be washed regularly with hot water and disinfected with bleach.
5. The right diet is important. The patient should receive food rich in vitamins and proteins at least 4-6 times a day, and attention should be paid to the variety and taste of dishes. You should not follow any special diets, you just need to avoid excessively hot or very cold, rough, fried or spicy foods.
6. Patients with advanced forms of stomach cancer should be fed with more gentle food (sour cream, cottage cheese, boiled fish, meat broths, steam cutlets, crushed or pureed fruits and vegetables, etc.) During meals, 1-2 tablespoons are required 0 5-1% hydrochloric acid solution.
Severe obstruction of solid food in patients with inoperable forms of cancer of the cardia of the stomach and esophagus requires the appointment of high-calorie and vitamin-rich liquid foods (sour cream, raw eggs, broths, liquid cereals, sweet tea, liquid vegetable puree, etc.). Sometimes the following mixture contributes to the improvement of patency: rectified alcohol 96% - 50 ml, glycerin - 150 ml (one tablespoon before meals). The intake of this mixture can be combined with the appointment of a 0.1% solution of atropine, 4-6 drops per tablespoon of water 15-20 minutes before meals. With the threat of complete obstruction of the esophagus, hospitalization is necessary for palliative surgery. For a patient with a malignant tumor of the esophagus, you should have a drinker and feed him only liquid food. In this case, it is often necessary to use a thin gastric tube passed into the stomach through the nose.
8. Preventioncancer
The primary prevention of cancer is aimed primarily at eliminating carcinogenesis - the process of the inception and development of a tumor. To avoid oncology, first of all it is necessary to eliminate carcinogens.
Most effective measures in cancer prevention are:
Rejection overuse alcohol and smoking;
A complete healthy diet;
Normalization of body weight;
Physical activity.
You can often hear about a diet that helps to avoid cancer. Indeed, there are nutritional rules in the framework of cancer prevention, which should be especially observed by people who are at risk.
· Getting rid of excess weight. It is he who is an indispensable companion of malignant neoplasms, including breast cancer in women.
Reducing the amount of fat in food. The use of carcinogens contained in fats can lead to the development of colon cancer, prostate cancer, breast cancer, etc.
Be sure to consume cereals, fruits and vegetables (fresh and cooked). vegetable fiber It has a beneficial effect on digestion, is rich in vitamins and substances that have an anticarcinogenic effect.
Refusal of food containing nitrites (used to color sausages), as well as smoked products. Smoked meats contain a large amount of carcinogens.
Speaking of secondary cancer prevention, we mean a set of actions aimed at early detection and elimination of malignant tumors and precancerous diseases, prevention of recurrence of neoplasms after treatment. Everyone should understand that cancer prevention is necessary. Must visit preventive examinations, conduct research using tumor markers, etc. Women should definitely undergo regular mammography, take PAP smears, which provide early detection of uterine cancer.
If the primary prevention of cancer minimizes the risk of oncological diseases, then the secondary significantly increases the chances of a full recovery and gentle treatment.
Conclusion
The development of instrumental diagnostic methods in recent decades has significantly changed the activities of medical workers, the recognition of diseases and ideas about them have changed. AT last years clinical medicine has turned to the study of subjective and objective symptoms to identify the disease, and it can be said that for the correct diagnosis, not only the level of technology development is important, but also direct communication with the patient. The relationship between the patient and the medical staff naturally affects the results of treatment. The personality of the nurse, the methods of working with people, the ability to communicate with the patient and other qualities of a nurse can in themselves have a positive impact on the patient.
There is no doubt that cancer is a serious disease and requires more attention than any other. However, there are no easy diseases. The main thing is to detect it at the moment of occurrence in one or another organ. But no less, and perhaps more important, is to warn him, to protect humanity and all life on Earth from being affected by malignant tumors. Preventing a disease is incomparably more profitable for society, both economically and especially socially, than treating an already advanced disease.
Bibliography
1. Cherenkov V.G. Clinical oncology. 3rd ed. - M.: medical book, 2010. - 434 p. - ISBN 978-5-91894-002-0.
2. Velsher L.Z., Polyakov B.I., Peterson S.B. Clinical oncology: selected lectures. - M.: GEOTAR-Media, 2009.
3. Davydov M.I., Velsher L.Z., Polyakov B.I. and others. Oncology, modular workshop: textbook. - M.: GEOTAR-Media, 2008. - 320 p.
4. Gantsev Sh.Kh. Oncology: textbook. - M.: Medical Information Agency, 2006. - 516 p.
5. Trapeznikov N.N., Shain A.A. Oncology. - M.: Medicine, 1992.
6. ed. prof. M.F. Zarivchatsky: Nursing in surgery. - Rostov n/a: Phoenix, 2006
7. Ageenko A.I. Cancer face. - M.: Medicine, 1994.
8. Gershanovich M.L., Paikin M.D. Symptomatic treatment for malignant neoplasms. - M.: Medicine, 1986.
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Surgical oncology - a branch of surgery that studies the pathology, clinic, diagnosis and treatment of those oncological diseases, in the recognition and treatment of which surgical methods play a leading role.
Currently, more than 60% of patients with malignant neoplasms are treated with surgical methods, and more than 90% of cancer patients use surgical methods in the diagnosis and staging of the disease. Such a widespread use of surgical methods in oncology is based primarily on modern ideas about the biology of tumor growth and the mechanisms of development of oncological diseases.
Tumors(neoplasms) of man have been known since ancient times. Hippocrates also described individual forms tumors. Bone neoplasms have been found in the mummies of ancient Egypt. Surgical methods of treating tumors were used in the medical schools of ancient Egypt, China, India, the Incas of Peru, and others.
In 1775, the English surgeon P. Pott described skin cancer of the scrotum in chimney sweeps as a result of long-term contamination with soot, smoke particles and coal distillation products.
In 1915-1916, Japanese scientists Yamagiva and Ichikawa smeared the skin of rabbit ears with coal tar and got experimental cancer.
In 1932-1933. the work of Keeneway, Heeger, Cook and their collaborators found that the active carcinogenic principle of various resins are polycyclic aromatic hydrocarbons (PAHs) and, in particular, benzopyrene.
in 1910-1911 Raus discovered the viral nature of some chicken sarcomas. These works formed the basis of the viral concept of cancer and served as the basis for many studies that discovered a number of viruses that cause tumors in animals (Showe's rabbit papilloma virus, 1933; Bitner's mouse mammary cancer virus, 1936; Gross' mouse leukemia viruses, 1951; virus " polyomas” by Stewart, 1957, etc.).
In 1910, the first guide by N.N. Petrov "General doctrine of tumors". At the beginning of the 20th century, I.I. Mechnikov and N.F. Gamaleya.
In Russia, the first oncological institution for the treatment of tumors was the Institute. Morozov, based on private funds in 1903 in Moscow. In the Soviet years, it was completely reorganized into the Moscow Oncological Institute, which has already existed for 75 years, and was named after P.A. Herzen, one of the founders of the Moscow school of oncologists.
In 1926, on the initiative of N.N. Petrov, the Leningrad Institute of Oncology was created, now bearing his name.
In 1951, the Institute of Experimental and Clinical Oncology was founded in Moscow, now the Cancer Research Center of the Russian Academy of Medical Sciences named after its first director N.N. Blokhin.
In 1954, the All-Union (now Russian) Scientific Society of Oncologists was organized. Branches of this society operate in many regions, although now, due to certain economic circumstances, many of them have gained independence and organized regional associations of oncologists. Interregional, republican conferences are held with the participation of oncological institutes. The Society of Oncologists of Russia organizes congresses and conferences, and is also a member of the International Cancer Union, which unites oncologists from most countries of the world.
The World Health Organization (WHO) has a special Cancer Department founded and for many years headed by Russian oncologists. Russian specialists actively participate in international congresses, work in permanent commissions and committees of the International Cancer Union, WHO and IARC, take an active part in symposiums on various problems oncology.
Legislative basis of the organization cancer care in our country were laid down by the Decree of the Council of People's Commissars of the USSR "On measures to improve oncological care for the population" dated April 30, 1945.
The modern oncological service is represented by a complex and harmonious system of oncological institutions dealing with all issues of practical and theoretical oncology.
The main link in the provision of oncological care to the population are oncological dispensaries: republican, regional, regional, city, interdistrict. All of them have multidisciplinary departments (surgical, gynecological, radio-radiological, laryngological, urological, chemotherapeutic and pediatric).
In addition, dispensaries have morphological and endoscopic departments, a clinical and biological laboratory, an organizational and methodological department, and polyclinic rooms.
The work of dispensaries is headed by the Head Oncological Institute of the Ministry of Health and Social Development of the Russian Federation.
In recent years, an auxiliary oncological service has begun to develop in the form of hospices, medical institutions for the care of incurable patients. Their main task is to alleviate the suffering of patients, to choose effective pain relief, to provide good care and a dignified death.
Tumor- Excessive proliferation of tissues not coordinated with the body, which continues after the cessation of the action that caused it. It consists of qualitatively changed cells that have become atypical, and these properties of the cell are passed on to their descendants.
Cancer(cancer) - an epithelial malignant tumor.
blastoma- Neoplasm, tumour.
Histological examination– study of the tissue composition of the tumor (biopsy).
Incurable patient - not subject to specific treatment due to the prevalence (neglect) of the tumor process.
Inoperable patient- not subject to surgical treatment due to the prevalence of the tumor process.
Carcinogens- Substances that cause tumor formation.
Lymphadenectomy- Surgery to remove lymph nodes.
Mastectomy- surgery to remove the mammary gland.
Metastasis- a secondary pathological focus, which occurs as a result of the transfer of tumor cells in the body.
Palliative surgery- an operation in which the surgeon does not set himself the goal of completely removing the tumor, but seeks to eliminate the complication caused by the tumor and alleviate the patient's suffering.
Radical operation - complete removal of the tumor with regional lymph nodes.
Tumorectomy- removal of the tumor.
Cytological examination- study of the cellular composition of a smear or tumor biopsy.
Extirpation- the operation of the complete removal of the organ.
Features of tumor cells in the body.
autonomy-
independence of the rate of cell reproduction and other manifestations of their vital activity from external influences that alter and regulate the activity of normal cells.
tissue anaplasia-
returning it to a more primitive type of fabric.
Atypia-
difference in structure, location, relationship of cells.
progressive growth- non-stop growth.
invasive, or infiltrative growth- the ability of tumor cells to grow into surrounding tissues and destroy, replace them (typical for malignant tumors).
Expansive growth
the ability of tumor cells to displace
surrounding tissues without destroying them (typical for benign tumors).
Metastasis-
the formation of secondary tumors in organs distant from the primary tumor (the result of tumor embolism). characteristic of malignant tumors.
Ways of metastasis
hematogenous,
lymphogenous,
implantation.
invasion by cells of the primary tumor of the wall of the blood or lymphatic vessel;
exit of single cells or groups of cells into the circulating blood or lymph from the vessel wall;
retention of circulating tumor emboli in the lumen of a small diameter vessel;
invasion by tumor cells of the vessel wall and their reproduction in a new organ.
BPH (prostate adenoma),
uterine fibroid,
thyroid adenoma, etc.
According to the nature of the clinical course of the tumor are divided into:
benign,
malignant.
expansive growth
clear boundaries of the tumor,
slow growth
no metastases,
do not grow into surrounding tissues and organs.
infiltrative growth,
no clear boundaries
fast growth,
metastasis,
recurrence.
| Fabric name | benign tumors | Malignant tumors |
| epithelial tissue | apilloma-papillary adenoma (glandular cyst with a cavity) Epithelioma Polyp | Cancer Adenocarcinoma Basilioma |
| Connective tissue | Fibroma | Sarcoma |
| Vascular tissue | Angioma, hemangioma, Lymphangioma | angiosarcoma, Hemangiosarcoma, Lymphosarcoma |
| Adipose tissue | Lipoma | Liposarcoma |
| Muscle | Myoma | Myosarcoma |
| nervous tissue | Neurinoma, Ganglioneuroma, Glioma. | Neurosarcoma |
| Bone | Osteoma | osteosarcoma |
| cartilage tissue | Chondroma | Chondrosarcoma |
| Tendon sheaths | benign synovioma | Malignant synovioma |
| epidermal tissue | Papilloma | squamous |
| pigment fabric | Nevus* | Melanoma |
| * Nevus - accumulation of pigment cells of the skin, in the strict sense does not apply to tumors, is a tumor-like formation. |
||
International TNM classification ( used to comprehensively characterize the prevalence of tumors).
T - tumor - tumor size,
N - nodulus - the presence of regional metastases in the lymph nodes,
M - metastasis - the presence of distant metastases.
In addition to the classification by stages of the process, a unified classification of patients by clinical groups has been adopted:
Group I a- Patients with suspected malignancy. The term of their examination is 10 days.
Group I b- patients with precancerous diseases.
Group II- Patients subject to special treatment. This group has a subgroup.
II a- patients subject to radical treatment (surgical, radiation, combined, including chemotherapy).
Group III- practically healthy, who underwent radical treatment and who do not reveal relapses or metastases. These patients need dynamic monitoring.
Group IV- patients in the advanced stage of the disease, whose radical treatment is not feasible, they are given palliative or symptomatic therapy.
Groups I a (suspicion of Cr), II ( special treatment) and II a (radical treatment).
Stages of development of tumors -
this is the apparent spread of the disease, established during the clinical examination of the patient.
According to the degree of distribution, there are:
Stage I - local tumor.
Stage II - the tumor increases, nearby lymph nodes are affected.
Stage III - the tumor grows into neighboring organs, regional lymph nodes are affected.
Stage IV - the tumor grows into neighboring organs.
Palliative care(from French palliatif from lat. pallium - veil, raincoat) is an approach that improves the quality of life of patients and their families who are faced with problems life threatening disease, by preventing and alleviating suffering through early detection, careful assessment and treatment of pain and other physical symptoms, and psychosocial and spiritual support for the patient and their loved ones.
Goals and objectives of palliative care:
Adequate pain relief and relief of other painful symptoms.
Psychological support for the patient and caring relatives.
Development of an attitude towards death as a natural stage of a person's path.
Satisfaction of the spiritual needs of the patient and his relatives.
Solving social and legal, ethical issues that arise in connection with a serious illness and the approaching death of a person.
The need for a special psychological approach (since patients have a very labile, vulnerable psyche, which must be borne in mind at all stages of their care).
The patient should not be allowed to know the true diagnosis.
The terms "cancer", "sarcoma" should be avoided and replaced by the words "ulcer", "narrowing", "seal", etc.
In all extracts and certificates issued to patients, the diagnosis should not be clear to the patient.
Expressions: "neoplasm" or "neo", blastoma or "Bl", tumor or "T", and especially "cancer" or "cr" should be avoided.
Try to separate patients with advanced tumors from the rest of the flow of patients (this is especially important for x-ray examination, since usually the maximum concentration of patients selected for a deeper examination is reached here).
It is desirable that patients with early stages of malignant tumors or precancerous diseases do not meet patients with relapses and metastases.
In an oncology hospital, newly arrived patients should not be placed in those wards where there are patients with advanced stages of the disease.
If consultation with specialists from another medical institution is necessary, then a doctor or nurse is sent along with the patient, who transports the documents. If this is not possible, then the documents are sent by mail to the head physician or given to the patient's relatives in a sealed envelope.
The actual nature of the disease can be reported only to the closest relatives of the patient.
You should be especially careful when talking not only with patients, but also with their relatives.
If it was not possible to perform a radical operation, patients should not tell the truth about its results.
Relatives of the patient should be warned about the safety of a malignant disease for others.
To take measures against the attempts of the patient to be treated by medicine men, which can lead to the most unforeseen complications.
Regular weighing is of great importance, as a drop in body weight is one of the signs of disease progression.
Regular measurement of body temperature allows you to identify the expected decay of the tumor, the body's response to radiation.
Measurements of body weight and temperature should be recorded in the medical history or in the outpatient card.
It is necessary to train the patient and relatives in hygienic measures.
Sputum, which is often secreted by patients suffering from cancer of the lungs and larynx, is collected in special spittoons with well-ground lids. Spittoons should be washed daily with hot water and disinfected.
Urine and stool for examination are collected in a faience or rubber vessel, which should be regularly washed with hot water and disinfected.
In case of metastatic lesions of the spine, often occurring in breast or lung cancer, monitor bed rest and place a wooden shield under the mattress to avoid pathological bone fractures.
When caring for patients suffering from inoperable forms of lung cancer, exposure to air, tireless walks, and frequent ventilation of the room are of great importance, since patients with a limited respiratory surface of the lungs need an influx of clean air.
Proper diet is important. The patient should receive food rich in vitamins and proteins at least 4-6 times a day, and attention should be paid to the variety and taste of dishes.
You should not follow any special diets, you just need to avoid excessively hot or very cold, rough, fried or spicy foods.
Patients with advanced forms of stomach cancer should be fed more sparing food (sour cream, cottage cheese, boiled fish, meat broths, steam cutlets, fruits and vegetables in crushed or pureed form, etc.)
During meals, it is obligatory to take 1-2 tablespoons of a 0.5-1% solution of hydrochloric acid. Severe obstruction of solid food in patients with inoperable forms of cancer of the cardia of the stomach and esophagus requires the appointment of high-calorie and vitamin-rich liquid foods (sour cream, raw eggs, broths, liquid cereals, sweet tea, liquid vegetable puree, etc.).
With the threat of complete obstruction of the esophagus, hospitalization is necessary for palliative surgery.
For a patient with a malignant tumor of the esophagus, you should have a drinker and feed him only liquid food. In this case, it is often necessary to use a thin gastric tube passed into the stomach through the nose.
Provide the patient with a strict pastel regime during the first 3-5 days after the operation, in the future - dosed activation of the patient.
Observe the mind of the patient.
Monitor the functions of vital organs:
monitor BP,
pulse,
breath,
Ascultative picture in the lungs,
body temperature,
diuresis,
frequency and nature of the stool.
Celebrate regularly:
The concentration of O 2 in the inhaled mixture,
Its humidity
Temperature
Oxygen therapy technique
The operation of the ventilator;
The most important point is the elimination of pain, which in some forms of cancer is extremely strong. Pain in malignant neoplasms is a consequence of compression of the nerve endings by the tumor and therefore has a constant, gradually increasing character.
Give the patient an elevated position (raising the head end of the bed) to facilitate respiratory excursion of the chest and prevent congestion in the lungs.
Take measures to prevent pneumonia: remove from the oral cavity liquid media using napkins or electric suction; effleurage, vibration massage of the chest, teach the patient breathing exercises.
In the presence of intra-abdominal drainages - control over their condition, the amount and nature of the discharge, the condition of the skin around the drainage channel.
In the history of the disease, note the amount of discharge and its nature (ascitic fluid, pus, blood, etc.).
Once a day, change the connecting tubes to new ones or rinse and disinfect the old ones.
Record the amount and nature of discharge into the bandage, replace the bandage in a timely manner according to the general rules for bandaging surgical patients.
Monitoring the state of the gastric or nasogastric tube and their processing.
Provide psychological support to the patient.
Provide a regimen of intravascular (parenteral) nutrition with the use of protein preparations, amino acid solutions, fat emulsions, glucose solutions and electrolytes.
Ensuring a gradual transition to enteral nutrition (4-5 days after surgery), feeding patients (until self-service skills are restored), monitoring the diet (fractional, 5-6 times a day), the quality of mechanical and thermal processing of food.
Help with physiological poisoning.
Control urination and timely bowel movements. If feces or urinals are installed, replace them as they fill up.
Provide a hygienic toilet for the skin and mucous membranes.
Help to take care of the oral cavity (brush your teeth, rinse your mouth after eating), help wash your face in the morning.
Take measures to combat constipation, apply enemas.
Maintain a urinary catheter if present.
To carry out the prevention of bedsores, with a forced extension of bed rest (especially in elderly and debilitated patients).
Maintain the sanitary and epidemiological regime of the ward. Often ventilate it (the air temperature in the ward should be 23-24 ° C), irradiate with a bactericidal lamp, carry out wet cleaning more often.
The bed and linen of the patient should be clean, dry, replace them as they become dirty.
Create an atmosphere of calm in the room.
Lecture #6
Nursing care for neoplasms: « » DISCIPLINE NURSING IN SURGERY: SPECIALTY 060109 NURSING 51 State educational institution secondary vocational education of the city of Moscow Medical College No. 5 Department of Health of the city of Moscow
Objectives To introduce students to the role of a nurse in providing care to patients with neoplasms Formation of readiness to carry out nursing interventions in compliance with professional ethics
Objectives To know the basic concepts and terms of the topic. Principles of organizing oncological care in Russia. The need for constant oncological vigilance when working with patients. Principles of treatment of tumors. Nursing process in pre and postoperative period. Psychological and ethical aspects activities of a nurse in the care of cancer patients Be able to apply the knowledge gained in the care of patients with neoplasms. Distinguish between the main features of benign and malignant tumors.
TERMINOLOGICAL GLOSSARY Oncology is a branch of medicine dealing with the study, diagnosis and treatment of tumors. A tumor is a pathological process represented by a newly formed tissue in which changes in the genetic apparatus of cells lead to dysregulation of their growth and differentiation, characterized by structural polymorphism, features of development, metabolism and isolation of growth Palliative surgery is an operation in which the surgeon does not set himself the goal of completely removing the tumor , but seeks to eliminate the complication caused by the tumor and alleviate the suffering of the patient. Radical surgery - complete removal of the tumor with regional lymph nodes.
A tumor is a pathological process represented by a newly formed tissue, in which changes in the genetic apparatus of cells lead to a violation of the regulation of their growth and differentiation, characterized by structural polymorphism, development, metabolism, and isolation of growth.
Historical background Cancer was first described in an Egyptian papyrus from about 1600 BC. e. The papyrus describes several forms of breast cancer and states that there is no cure for this disease.
Historical background The name "cancer" comes from the term "carcinoma" introduced by Hippocrates (460-370 BC), which meant a malignant tumor. Hippocrates described several types of cancer.
Historical background Roman physician Cornelius Celsus in the 1st century BC. e. proposed to treat cancer at an early stage by removing the tumor, and at later stages - not to treat it in any way. Galen used the word "oncos" to describe all tumors, which gave the modern root to the word oncology.
Theories of the origin of tumors I. Theory of irritation by R. Virchow constant traumatization of tissues accelerates the processes of cell division
Theories of the origin of tumors II. The theory of germinal rudiments by D. Kongeym at the early stage of development of the embryo, more cells can be formed than necessary. Unclaimed cells have the potential for high growth energy
Theories of the origin of tumors III. Mutation theory of Fisher-Wazels as a result of the influence of various factors in the body, degenerative-dystrophic processes occur with the transformation of normal cells into tumor cells
Theories of the origin of tumors IV. Viral theory The virus, penetrating into the cell, acts at the gene level, disrupting the regulation of cell division Epstein-Barr virus Herpes virus Papillomavirus retrovirus Hepatitis B and
Theories of the origin of tumors V. Immunological theory disorders in the immune system lead to the fact that the transformed cells are not destroyed and are the cause of tumor development
Theories of the origin of tumors VI. Modern polyetiological theory Mechanical factors Chemical carcinogens Physical carcinogens Oncogenic viruses
Men Women Common forms Mortality Prostate 33% 31% Breast 32% 27% Lungs 13% 10% Lungs 12% 15% Rectum 10% Rectum 11% 10% Bladder 7% 5% Endometrium Uterus 6%
Features of tumor cells Autonomy - the independence of the rate of cell reproduction and other manifestations of their vital activity from external influences that change and regulate the vital activity of normal cells. Tissue anaplasia is a return to a more primitive type of tissue. Atypia is a difference in the structure, location, and relationship of cells.
Features of tumor cells Progressive growth - non-stop growth. Invasive growth - the ability of tumor cells to grow into surrounding tissues and destroy, replace them. Expansive growth - the ability of tumor cells to displace surrounding tissues without destroying them Metastasis - the formation of secondary tumors in organs distant from the primary tumor
Metastasis Ways of metastasis hematogenous lymphogenous implantation. Stages of metastasis: invasion by cells of the primary tumor of the wall of a blood or lymphatic vessel; exit of single cells or groups of cells into the circulating blood or lymph from the vessel wall; retention of circulating tumor emboli in the lumen of a small diameter vessel; invasion by tumor cells of the vessel wall and their reproduction in a new organ.
Benign (mature) tumors do not grow into surrounding tissues and organs expansive growth clear tumor boundaries slow growth no metastases
II. Morphological classification Benign Tissue Malignant Papilloma Polyp Epithelial Cancer Adenocarcinoma Squamous Cell Carcinoma Fibroma Chondroma Osteoma Junctional Sarcoma Fibrosarcoma Chondrosarcoma Osteosarcoma Leiomyoma Rhabdomyoma Muscular Leiomyosarcoma Rhabdomyosarcoma Neurinoma Neurofibroma Astrocytoma Nervous Neurofibrosarcoma Hemangioma Lymphangiosarcoma Melongiosarcoma Vascular Hemangiosarcoma
III. International classification according to T N M T (tumor) to describe the size and spread of the primary tumor TX - it is not possible to estimate the size and local spread of the primary tumor; T 0 - the primary tumor is not determined; T 1, T 2, T 3, T 4 - categories reflecting the increase in the size and / or local spread of the primary tumor focus
II. International classification according to T N M N (lymph nodes) to describe involvement of regional lymph nodes NX - insufficient data to evaluate regional lymph nodes; N 0 - no metastases to regional lymph nodes; N 1, N 2, N 3 - categories reflecting the varying degree of damage to regional lymph nodes by metastases.
II. International classification by T N M M (metastases) - indicates whether the tumor has distant screenings - MX metastases - there is not enough data to determine distant metastases; M 0 - no signs of distant metastases; M 1 - there are distant metastases.
Stages of malignant tumors I. Stage - the tumor is localized, occupies a limited area, does not germinate the wall of the organ, there are no metastases II. Stage - a tumor of moderate size, does not spread outside the organ, single metastases to regional lymph nodes are possible
Stages of malignant tumors III. Stage - a large tumor, with decay, germinates the entire wall of the organ or a smaller tumor with multiple metastases to regional lymph nodes. IV. Stage - tumor growth into surrounding organs, including non-removable ones (aorta, vena cava, etc.), distant metastases
Dispensary care is a system of active medical and sanitary measures aimed at constantly monitoring the state of people's health, providing medical and preventive care.
, Examinations during the patient's dispensary: examinations fluorography mammography examination by a gynecologist rectal examination examination by a urologist (male) esophagogastroduodenoscopy colonoscopy sigmoidoscopy (with chronic diseases gastrointestinal tract).
Oncological alertness knowledge of the symptoms of malignant tumors in the early stages; knowledge of precancerous diseases and their treatment; identification of risk groups; timely treatment and dispensary observation; careful examination of each patient; in difficult cases of diagnosis, think about the possibility of an atypical or complicated course of the disease.
Precancerous conditions chronic inflammation malformations long-term non-healing ulcers cervical erosion gastric polyps scars after burns
Cancer syndromes Plus-tissue syndrome Abnormal discharge syndrome Organ dysfunction syndrome Minor signs syndrome
Syndrome of small signs of discomfort fatigue, drowsiness, indifference, decreased efficiency perversion of taste or lack of appetite lack of satisfaction from food intake nausea, vomiting for no apparent reason dry, hacking cough or cough with sputum streaked bloody discharge from the vagina, hematuria, blood and mucus in the feces
Diagnostics x-ray examination CT scan(CT) magnetic resonance imaging (MRI) endoscopic examination ultrasound examination (ultrasound) biopsy of tumor material cytological examinations laboratory examinations
Malignant tumors by combined methods - the use of two different types of treatment (surgery + chemotherapy; surgery + RT); combined methods - the use of various therapeutic agents (interstitial and external irradiation); complex method - the use of all three types of treatment (surgical, chemotherapy, radiation therapy).
Surgical methods of treatment Radical surgery - complete removal of the tumor with regional lymph nodes. Contraindications generalization of the tumor process - the occurrence of distant metastases, intractable tumors with surgical intervention. the general serious condition of the patient, due to senile age and decompensated concomitant diseases.
Palliative surgery to restore lost function or alleviate patient suffering. for cancer of the esophagus - gastrostomy, for cancer of the larynx - tracheostomy, for colon cancer - colostomy.
Radiation therapy - use various kinds ionizing radiation to destroy the tumor focus.
Radiation therapy Types of radiation: Electromagnetic: x-ray, gamma radiation, beta radiation. Corpuscular: artificial radioactive isotopes
Radiation therapy Irradiation methods: remote method (external) - the radiation source is at a distance from the patient contact method (interstitial, intracavitary, application)
Drug therapy is the use of drugs that have a damaging effect on tumor tissue.
Drug therapy Types of drug therapy: Chemotherapy - the use of chemical compounds that destroy tumor tissue or inhibit the reproduction of tumor cells. Cytostatics (antimetabolites), Antitumor antibiotics, Herbal preparations. Hormone therapy: corticosteroids, estrogens, androgens.
Side effects chemotherapy hemodepression nausea, vomiting loss of appetite diarrhea gastritis cardiotoxic effect nephrotoxicity cystitis stomatitis alopecia (hair loss)
Symptomatic therapy The goal of treatment is to alleviate the suffering of patients. In order to reduce pain, they use: narcotic and non-narcotic analgesics; novocaine blockade; neurolysis is the destruction of pain nerves by surgery or exposure to x-rays.
Oncological ethics and deontology The conversation with the patient is correct, sparing the psyche, giving hope for a favorable outcome of the disease The patient has the right to full information about his disease, but this information must be sparing.
Historical reference The ancient Greek historian Herodotus (500 BC), 100 years before Hippocrates, narrates a legend about the princess Atossa, who suffered from breast cancer. She turned to the famous doctor Democedes (525 BC) for help only when the tumor reached a large size and began to bother her. Out of false modesty, the princess did not complain as long as the tumor was small.
Historical note The famous physician Galen (131-200) may have been the first to propose a surgical treatment of breast cancer while preserving the pectoralis major muscle.
in the world more than 1 million new cases of breast cancer are registered annually in the Russian Federation - over 50 thousand.
Risk factors age over 50 abortion menstrual function - onset at age 10-12, late menopause. nulliparous women first births over 35 years of age long-term breastfeeding diseases of the female genital organs heredity overweight radiation exposure, smoking, alcohol use oral contraceptives
Clinical international (classification T NM) T 1 tumor up to 2 cm T 2 tumor 2-5 cm T3 tumor more than 5 cm T 4 tumor with spread to the chest or skin N 0 axillary lymph nodes are not palpable N 1 dense displaced lymph nodes in the axillary region are palpated on the same side N 2 large axillary lymph nodes are palpated, soldered, limited mobility N 3 palpated on the same side of the sub- or supraclavicular lymph nodes, or swelling of the arm Mo no distant metastases M 1 there are distant metastases
Stages of development Stage I: tumor up to 2 cm without damage to the lymph nodes (T 1, N 0 M o)
Stages of development Stage II a: tumor no more than 5 cm without damage to the lymph nodes (T 1 -2, N o M 0) Stage II b: tumor no more than 5 cm, with damage to single axillary lymph nodes (T 1, N 1 M 0)
Stages of development Stage III: a tumor more than 5 cm with the presence of multiple metastases in the axillary lymph nodes (T 1 N 2 -3, Mo; T 2 N 2_3 Mo; T 3 N 0. 3 Mo, T 4 N 0. 3 M 0)
Stages of development Stage IV: the presence of a tumor that has spread to areas of the body located at a significant distance from the chest (any combination of T, N with M +)
Clinical forms nodular form diffuse form edematous - infiltrative form mastitis-like cancer erysipelas-like cancer shell cancer Paget's disease (cancer)
Nodular form Early clinical signs: The presence of a clearly defined node in the mammary gland. Dense consistency of the tumor. Limited mobility of the tumor in the mammary gland. Pathological wrinkling or retraction of the skin over the tumor Painlessness of the tumor node. The presence of one or more dense mobile lymph nodes in the axillary region of the same side.
Nodular form Late clinical signs: Visible retraction of the skin at the site of the detected tumor Symptom of "lemon peel" over the tumor. Ulceration or germination of the skin by a tumor. Thickening of the nipple and areola folds is a symptom of Krause. Retraction and fixation of the nipple. Big sizes tumors. Deformity of the breast Large immobile metastatic lymph nodes in the armpit Supraclavicular metastases Pain in the breast Distant metastases identified clinically or radiographically.
Principles of treatment II. Radiation therapy Remote gamma therapy, electron or proton beam is used.
Treatment principles III. Chemotherapy Cytostatics cyclophosphamide 5 - fluorouracil vincristine adriampicin, etc. Hormone therapy androgens corticosteroids estrogens
Nursing care before surgery radical mastectomy On the evening before surgery: light dinner, cleansing enema, shower, change of bed and underwear, follow the instructions of the anesthesiologist, In the morning before surgery: do not feed, do not drink, shave armpits, remind the patient to urinate, bandage her legs with elastic bandages up to the inguinal folds, premedicate for 30 minutes. Before surgery, bring to the operating room in the nude on a gurney, covered with a sheet.
Nursing care after surgery radical mastectomy Immediately after surgery: assess the patient's condition put in a warm bed horizontal position without a pillow, turn your head to one side inhale humidified oxygen put an ice pack on the operation area check the condition of the drains and the drainage bag bandage the arm on the side of the operation with an elastic bandage follow the doctor’s prescriptions: the introduction of narcotic analgesics, infusion of plasma substitutes, etc. conduct dynamic monitoring
Nursing care after surgery radical mastectomy 3 hours after surgery: give a drink; raise the head end, put a pillow under the head; change ice pack make the patient take a deep breath, cough; massage the skin of the back; check the bandages on the legs and arm; follow the doctor's orders; conduct dynamic monitoring.
Nursing care after surgery radical mastectomy 1st day after surgery: help the patient to carry out personal hygiene, sit up in bed; lowering your legs out of bed for 5-10 minutes; feed a light breakfast; perform a back massage with effleurage and cough stimulation; remove the bandages from the arms and legs, massage them and bandage them again; bandage the wound together with the doctor; change the drainage bag - an accordion, fixing the amount of discharge in the observation sheet; conduct dynamic monitoring
Nursing care after surgery Radical mastectomy Day 2-3 after surgery Help the patient get out of bed Help walk around the ward, perform personal hygiene Bandage the arm and legs with a light massage Feed according to the diet of concomitant diseases or diet No. 15 Start training in gymnastics for the arm on the side of the operation to carry out - dynamic monitoring, prevention of late postoperative complications
Nursing care after surgery radical mastectomy From day 4, the ward regime with gradual drainage is removed on days 3-5, and if lymph accumulates under the skin, it is removed by puncture. stitches from the wound are removed on the 10th - 15th day.
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