JV when caring for patients with milk tumors, prostate glands. Survey of the oncological process of tumor treatment and nursing care

The date: 08.03.2020

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Introduction

oncology benign tumor

The situation around the neoplasms in general and cancer in particular remains unchanged over the past two decades. Despite the fact that cancer and other malignant oncologic meets in 5-10% of cases of all diseases, they are in second place. Giving the first only cardiovascular pathology. Most specialists are associated with two main factors:

1) an increase in the share of the elderly population of the Earth or the so-called tendency to aging.

2) deterioration of the environmental situation, which is caused by both the development of technologies and the overpopulation of the planet.

However, oncological diseases will occupy the second places in the mortality structure for an indefinitely long period of time due to a large number of issues in the causes of its occurrence. And the more perfect is the methods of diagnosis, the closer scientists approach the disclosure of the main reasons for oncological diseases, the more these issues become more.

1. Oncology

Under the concept of "malignant neoplasms", it is customary to call all kinds of malignant tumors. The mansion among malignant neoplasms is melanoma - it is formed from the pigment cells of melanocytes and is localized on the skin, mucous membranes or retina. Another type of tumor is sarcoma. Sarcomes are called malignant neoplasms resulting from stromal tissues (tendons, fat and muscles). Different types of cancer include tumors developing from epithelial tissues - light, leather, stomach.

The tumor, or neoplasm, is a cluster of similar cells, which is formed in various organs or tissues of the body. Selects benign and malignant tumors. The difference of them is that a benign tumor develops as it were in a capsule: it is limited from other organs with a dense cloth and moves other fabrics without causing it harm. Such a neoplary does not bear any danger to the patient's life.

A malignant tumor grows, embedding into other fabrics, and destroys them. If there is a nerve on the growth of a malignant tumor, then it destroys it, which causes cancerous pain, if a blood vessel is located on the way of the neoplasia, the result of its destruction becomes internal bleeding.

No matter how the type of cancer is neither the patient, the grip between the cells of such a neoplasm is very small. As a result, the cells are easily disconnected from the malignant tumor and together with the blood current apply to the body, settled in the tissues and organs. Turning to the new place, the cell gradually becomes a new tumor similar to the composition and structure with the first neoplasm. These tumors are called metastasis.

If some time after treatment, the tumor appears again, it means that it recurrences. There are no cases when different tumors appear during the life of one person. This is primary-multiple oncology. New tumors appear at an interval of less than a year - the patient has a primary multiple synchronous cancer, more than a year - primary multiple metachronous cancer.

Sometimes benign tumors reborn malignant. This process is called transformation, or outrocity.

2 . Types of benign tumors

Benign neoplasms develop from all body tissues. These tumors grow autonomously, not invasive, clearly excluded from healthy tissues, they are not metastasized, but they are able to malignant (illustrate). In the process of slow growth, they squeeze the adjacent tissues and violate the functions of the organs, which causes clinical symptoms. Benign brain neoplasms are lifeful for life.

Benign neoplasms develop from all body tissues. The most common types of benign tumors are the most common:

· Fibre. It comes from connective tissue and occurs everywhere, where its fibers are represented. Split solid noded and soft fibromes. Favorite localization of solid fibrom is a uterus, and soft - subcutaneous fiber of the perianal region and genital organs. Fibroms grow slowly, excluded from healthy fabrics, painless and movable.

· Lipoma (fat). It comes from adipose tissue. It is easily in the subcutaneous tissue and in the retroperitoneal fat space. The ratio of lime in women and men 4: 1. There are multiple wen - lipomatosis. A benign tumor of fatty tissue, soft consistency, movable. If you have in wing, the fibers of the connective tissue speak of a fibrolipome.

· Mioma (Leiio and Fibromomy). They come from muscles and localized in them. Moma grows slowly, have a solid, but elastic consistency, mobile, painless. In myoma, fibers of the connective tissue are often woven, which is observed with uterine tumors. Such a benign neoplasm is called fibromic. Multiple defeat - fibromatosis.

· Nevnoma. It comes from the shell of nerves. The tumor is dense, it happens a single or multiple, grows in the form of a node, painful when palpation. More often, a combination of a neurine with a connecting tissue is neurofibrome. A benign tumor is localized in the intercostal intervals and in the course of sedlicate nerves. Multiple neurofibromatosis according to the author is called Recklinghausen's disease.

Table 1. Classification of benign tumors

Type of fabric	Name of tumor
Irony epithelium
Cylindrical and flat epithelium	Epithelioma
Fat fabric
Smooth muscle fabric	Leiomiomoma
Cartilage fabric	Hondroma
Cross-striped muscle tissue	Rabdomioma
Lymphoid fabric
Nervous fabric	Nevnoma
Bone

3. Etiology and pathogenesis

Despite the fact that scientists cannot still give an accurate answer, which is the cause of oncological diseases, they all have a general principle of development. And he for most of his stages the same. But first it is necessary to give a little clarification regarding the vital activity of cells.

Any live cell, in addition to specific, only for it, characteristic features of metabolism and the functions performed, has the so-called chafflict limit. This is nothing more, as coded for DNA cell information about "death". Or more correctly - in the number of assigned divisions, which can perform a cell. After that, she must die. Cells of different types of tissues have a different limit. Those of those who, in the course of life, it is necessary to constantly update have a significant heiflica limit. Such fabrics include the epithelium of the skin and internal organs, bone marrow cells. The same fabrics in which cell division is provided only during the development phase have a limit for this stage. At the same time, the life expectancy of the cell is greater. The most striking example of such fabrics are neurons.

As a result of some reasons (see below), the cell loses this limit. After that, it becomes capable of an unlimited number of divisions. And since the known share of energy is due to division, its metabolism begins to gradual restructuring. All organelles guide their "forces" to the ability of the cell sharing, which negatively affects its functions - they are lost over time. After some time, the cell, deprived of the heiflica limit and its "descendants" differ very much from the rest of the tissue - formed cancer (carcinoma).

Cancer causes are not known. But numerous observations speak of a high interconnection of oncology with some factors and substances. They have a common name - carcinogens. From the Latin term "carcinogenesis", which literally translates - "Cancer Birth". To date, such substances are more than a hundred. And all of them are combined into several groups.

· Genetic factors. Associated with cell DNA defects and a high risk of cells, it has it, to lose the heiflica limit. There are no direct evidence. But observations show that persons having relatives with oncological diseases, more often than the rest are sick of cancer (carcinoma).

· Infectious causes of cancer. These include some viruses and other microorganisms. While proven is a connection with viruses for some diseases. So, cervical cancer is caused by a person's papilome virus, malignant lymphoma - herpes viruses. With regard to other types of cancer, communication with microorganisms is conditionally proven. For example, liver cancer is most often found in patients with hepatitis B and C. The basis of all the survey data is the fact that viruses carry out their development only by embedding their genes in the cell DNA. And this is the risk of developing its anomalies and loss of the heiflica 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 impact. All of them are able to destroy the shell of atoms. As a result, the structure of the molecule is disturbed and a part of the DNA is destroyed along the chain, which contains a heiflica limit.

· Chemical compounds. This group includes various substances capable of penetrating the core of the cell and enter into chemical reactions with the DNA molecule.

· Hormonal disorders. In this case, cancer is the result of a violation of the work glands of the internal secretion, which occurs under the action of excess / disadvantage of certain hormones. The most vivid examples of malignant diseases of this group are thyroid cancer and breast cancer.

· Immunity violations. The basis of these causes is to reduce the activity of T-leukocyte killers, which are designed to destroy any cell cells that have deviations from the normal structure. Some experts do not allocate this group due to the fact that violations of cellular immunity play a role in the occurrence of oncological diseases in general.

4. TOlinical picture

If you recognize cancer at an early stage of development, then it can be cured. It is important to monitor your body, to understand what condition is considered normal for it, and when deviations appear to contact the doctors. In this case, if the patient is sick oncology, doctors will notice this at an early stage.

There are various common cancer symptoms:

· Tumors.

· Dyspnea, cough, hoarseness.

The so-called breast symptoms of cancer are coughing, shortness of breath and hoarseness. Of course, they can be caused by both infections and inflammations, and other diseases and disadvantages, but in some cases such signs indicate the lung cancer. The cause of hoarseness is often laryngitis. This disease means inflammation of the larynx. However, in rare cases, hoarse is the early symptom of larynx cancer.

· Violations in the work of the digestive tract.

Sign of change in the operation of the digestive tract - the presence of blood in the chair. It is usually bright red or dark. The presence of fresh, scarlet blood is a sign of hemorrhoids.

· Bleeding.

Any bleeding without visible reasons is a sign of violation in the work of the internal organs. Bleeding from the rectum can be a sign of hemorrhoids, but also one of the symptoms of cancer internal organs. If a woman had a malignant tumor in the uterus or in the cervix, the bleeding may arise between menstruation or after sexual contact. If bleeding is observed in women after a menopacteric period, then it urgently needs to consult a doctor. Blood in the urine can be a symptom of a bladder cancer or an oncological disease of the kidneys. If at the cough of the sputum comes out with blood, then the reason for this is a serious infectious disease. Sometimes it is a sign of lung cancer. Blood in vomiting can signal the stomach cancer, however, the cause of this phenomenon can be an ulcer. Therefore, the exact answer to the question is how to identify cancer - you need to contact a specialist. Nasal bleeding and bruises - rare cancer symptoms. Sometimes these signs are a consequence of leukemia. However, people suffering from this disease, there are other, more obvious signs of oncology.

· Moles.

The doctor needs to be treated immediately, if the following signs are observed in the moles:

Asymmetry;

Uneven edges;

Atypical for moles color;

Large size (moles usually do not exceed 6 mm in diameter, melanoma - more than 7 mm);

The presence of peel, itching, bleeding: melanoma can be bleeded, covered with crusts, hide.

· Unfortunate weight loss.

5. Diagnostics

Thanks to the trends of modern medicine, the doctors of all specialties of the primary link (polyclinics), as well as the carrying out of the clinicalization, is largely directed to the 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 on the development of a person, the presence of chronic diseases, injuries, etc.

Anamnesis of the disease. That is, any information regarding the onset of the disease and its subsequent development.

2. Generally clinical analyzes.

The overall blood test allows you to identify violations of exchange processes in terms of erythrocyte sedimentation (EE), glucose level, hemoglobin. The last indicator allows you to identify anemia.

The overall analysis of urine gives data on the work of the kidneys, protein and aqueous metabolism in the body.

Biochemical blood test allows to judge the types of sharing and work of some organs in more detail. So aminotransferase (abbreviations - alosy and asat), bilirubin, characterize the work of the liver. Creatine and urea serve as markers of the kidneys. Alkaline phosphatase displays the condition of some hollow organs and pancreas. Etc. In addition, biochemical analysis allows you to explore the blood for the presence of specific proteins of cancer cells - the so-called oncomarkers.

3. Special research methods aimed at certain departments of the body.

Radiography of the chest allows you to see deviations even with small tumors. (less centimeter). The same applies to the radiography of other departments (belly, loin).

Computer and magnetoresonance tomography refer to modern diagnostic methods. They allow you to see a tumor of about a millimeter.

Endoscopic methods (laryngo and bronchoscopy, fibrogastroduodenoscopy, colonoscopy and colposcopy. Used to identify larynx cancer, esophagus and stomach, rectum, uterus and appendages. All these methods allow you to visually diagnose cancer (carcinoma). In addition, most of them allow Take a piece of fabric for histological examination.

4. Cytological methods or the study of the cell structure. Give the final diagnosis.

6. Methods of treating oncology

The treatment of cancer depends on the type of tumor, its localization, structure, the stages of the disease in accordance with the classification of TNM. Distinguish the following types of treatment.

1) Surgical tumor removal with adjacent tissues. Effective for the treatment of small-sized tumors available for surgery, and in the absence of metastases. Often, after surgical treatment, tumor relapses may occur.

2) Radiation therapy is used to treat unoccalued tumors sensitive to radiation. Also used for local destruction of metastases.

3) Chemotherapy is used to treat various, often late stages of cancer using cytotoxic tools, hormonal / anti-norons, immune drugs, enzyme preparations, antitumor antibiotics and other drugs that destroy or slow down the growth of cancer cells.

4) Generate therapy The most modern method of treatment, the essence of which consists in the impact on the Signal Transcription and Activator of Transcription and other systems, thereby adjusting the process of cell division.

5) Neutron therapy is a new method of treating a tumor similar to radiation therapy, but differing from it by the fact that neutrons are used instead of conventional irradiation. Neutrons penetrate deeply in tumor tissue, which swallowed, for example, boron, and destroy them without damaging healthy fabrics in contrast to radiotherapy. This therapy showed a very high percentage of complete recovery in the treatment of tumors, which makes up 73.3% even at the started stage.

6) immunotherapy. The immune system seeks to destroy the tumor. However, it is often not able to do this for a number of reasons. Immunotherapy helps the immune system to fight a tumor, forcing it to attack the tumor more efficiently or making a tumor more sensitive. Villama Villama Vaccine, as well as a version of this vaccine - picibanyl, are effective in the treatment of some forms of neoplasms due to the stimulation of natural killer activity and the development of a series of cytokines, such as tumor necrosis factor and interleukin-12. Epigenetic therapy may apply to activate protective immune mechanisms.

7) Photodynamic therapy is 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 come into a photochemical reaction, which leads to the formation of active forms of oxygen, which acts against tumor cells.

8) Virotherapy is one of the types of biotherapy, in which oncotropic / oncolic viruses are used. One of the directions of oncology. Virotherapy mobilizes the natural protective forces of the body's immune system against cells of genetically modified organisms and tissues, including malignant cells.

9) Targeted therapy is a new development of treatment of cancer tumors affecting "fundamental molecular mechanisms", which underlie the various kinds of diseases.

At the moment, the most good results in the treatment of cancer are observed when using combined methods of treatment (surgical, radiation and chemotherapeutic).

A promising direction in the treatment is the methods of local exposure on tumors, such as chemophymbolization.

7. Nursing care

1. A peculiarity of patients with malignant neoplasms is the need for a special psychological approach. It is impossible to allow the patient to recognize the true diagnosis. Terms "Cancer", "Sarkoma" should be avoided and replaced by them with the words "ulcer", "narrowing", "seal", etc. In all extracts and certificates issued on the hands of the patient, the diagnosis also should not be understandable to the patient. It should be especially careful in conversation not only with patients, but also with their relatives. Oncological patients have a very labile, vulnerable psyche, which must be borne in mind at all stages of servicing these patients. If you need consultation with the specialists of another medical institution, then together with the patient a doctor or a nurse who transport documents are sent. If there is no such possibility, the documents are sent by mail in the name of the chief doctor or give the patient relatives in the sealed envelope. The actual nature of the disease can be informed only to the closest relatives of the patient.

2. A feature of the placement of patients in the oncological department is that it is necessary to try to separate patients with launched tumors from the rest of the patients. It is desirable that patients with initial stages of malignant tumors or precancerous diseases have not met patients who have relapses and metastases. In the oncological hospital, newly arrived patients should not be placed in those chambers where there are patients with late stages of the disease.

3. When observation of cancer patients is observed, regular weighing is of great importance, since the fall in body weight is one of the signs of progression of the disease. Regular measurement of body temperature allows you to identify the alleged breakdown of the tumor, the reaction of the body into irradiation. Data measuring body weight and temperature should be fixed in the history of the disease or an outpatient map.

With metastatic lesions of the spine, often emerging during breast cancer or lungs, a bed is prescribed and put the wooden shield under the mattress to avoid pathological fractures of bones. When caring for patients suffering from non-cultural forms of lung cancer, diverge to stay in air, tireless walks, frequent air ventilation, since patients with a limited respiratory surface of the lungs need clean air inflows.

4. In order for sanitary and hygienic activities in the oncological department, it is necessary to train the patient and relatives of hygiene measures. The sputum that patients suffer from lung cancer and larynx collectors are collected in special cavities with well-fitted lids. The cavity users need to wash hot water daily and disinfect 10- 12% chlorine lime mortar. 15-30 ml of turpidar are added to the destruction of the mall smell into the calendar. Urban and measurement for research are assembled into a faience or rubber vessel, which should be regularly washed with hot water and disinfect with chlorine lime.

5. The correct power mode is important. The patient must receive food rich in vitamins and proteins, not less than 4-6 times a day, and attention should be paid to the diversity and taste quality of dishes. You should not stick any special diets, you only need to avoid excessively hot or very cold, rough, fried or acute food.

6. Patients with launched forms of gastric cancer should be fed to more gentle food (sour cream, cottage cheese, boiled fish, meat broths, steam cutlets, fruits and vegetables in a gridden or rubbed form, etc.) During meals, a reception is required to receive 1-2 tablespoons 0 , 5-1% hydrochloric acid solution.

The pronounced obstruction of solid food in patients with the inoperable shapes of cancer of the chamber of the stomach and esophagus requires the appointment with calorie and rich vitamins of liquid food (smotan, raw eggs, broths, liquid cereals, sweet tea, liquid vegetable puree, etc.). Sometimes the following mixture contributes to improved patency: alcohol-rectifitis 96% - 50 ml, glycerin - 150 ml (one tablespoon before meal). Reception of this mixture can be combined with an appointment of 0.1% atropine solution of 4-6 drops on a tablespoon of water 15-20 minutes before meals. In the threat of complete obstruction of the esophagus, hospitalization is necessary for a palliative operation. For a patient having a malignant esophageal tumor, you should have a drink and feed it with liquid food. In this case, it is often necessary to use a subtle gastric probe conducted in the stomach through the nose.

8. Preventioncancec

Primary cancer prevention is directed, first of all, to eliminate carcinogenesis - the process of origin and development of the tumor. To avoid oncology, first of all it is necessary to eliminate carcinogens.

The most effective measures in the prevention of oncological diseases are:

Refusal to excessive alcohol and smoking;

Full-fledged healthy nutrition;

Normalization of body weight;

Physical activity.

You can often hear about a diet that helps to avoid oncology. Indeed, there are rules of food in the prevention of cancer, which should especially be observed to people in the risk group.

· Relief from overweight. 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 gland, breast, etc.

· In mandatory consumption of cereals, fruits and vegetables (fresh and cooked). Plant fiber has a beneficial effect on digestion, rich in vitamins and substances that have an anticarcinogenic effect.

· Refusal of food containing nitrites (used to tinted sausages), as well as from smoked products. Smoked to contain a large number of carcinogens.

Speaking about the secondary prevention of cancer, refers to a set of actions aimed at early detection and elimination of malignant tumors and precancerous diseases, prevention of re-emergence of neoplasms after treatment. Each of the must understand that the prevention of cancer is necessary. Preventive inspections should be visited, conduct research using oncomarkers, etc. Women must regularly pass by mammography, take Pap-strokes that ensure earlier detection of uterine cancer.

If the primary prevention of cancer allows minimizing the risk of oncological diseases, then the secondary significantly increases the chances of complete 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 changed. In recent years, clinical medicine has contacted the study of subjective and objective symptoms to identify the disease, and it can be said that not only the level of development of technology, but also direct communication with the patient is important for faithful diagnosis. Relations between patients and medical staff naturally affects the results of treatment. Personality of a medical sister, working methods with people, the ability to communicate with the patient and its other qualities themselves can have a positive effect on a patient.

There is no doubt, cancer is a severe illness and requires more attention to itself than any other. However, there are no light diseases. The main thing is to detect it at the time of occurrence in one or another body. But not less, and maybe more importantly - to warn him, protect humanity and all living on Earth from the defeat of malignant tumors. Prevent the disease for society is incomparably more profitable and in economic, and especially socially, than to treat the already far-sighted disease.

List of references

1. Chenkov V.G. Clinical oncology. 3rd ed. - M.: Medical book, 2010. - 434 p. - ISBN 978-5-91894-002-0.

2. Welsher L.Z., Polyakov B.I., Peterson S.B. Clinical oncology: Selected lectures. - M.: Goeotar Media, 2009.

3. Davydov M.I., Welsher L.Z., Polyakov B.I. and others. Oncology, modular workshop: Tutorial. - M.: Goeotar Media, 2008. - 320 p.

4. Gansev Sh.h. Oncology: tutorial. - M.: Medical Information Agency, 2006. - 516 p.

5. Trapeznikov N.N., Shain A.A. Oncology. - M.: Medicine, 1992.

6. Ed. prof. M.F. Zarivatsky: Nursing in Surgery. - Rostov N / D: Phoenix, 2006

7. Ageenko A.I. Cancer face. - M.: Medicine, 1994.

8. Gershovich M.L., Paykin MD Symptomatic treatment with malignant neoplasms. - M.: Medicine, 1986.

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SKIN CANCER

Malignant skin neoplasms occupy the 3rd place in the structure of the oncological morbidity of the population of Russia, leaving for men of lung and stomach cancer, in women - only breast cancer. Risk factors for the development of malignant skin tumors:

Certain racial affiliation: the risk of the disease is maximal in people with white skin, minimal - among representatives of Asian nationalities and a neotroid race;
age older than 50 years;
The presence of family atypical lesions of the skin (Nevi) and melanoma;
chronic exposure to sun rays (solar burns);
radioactive irradiation;
Contact with chemical carcinogens;
Preceding skin lesions (dermatoses, scars, trophic ulcers, osteomyel fistulas).

The highest risk of skin cancer under the influence of sunlights of badly sunbathe people with light skin, freckles, red hair, blue or gray-blue eyes. Leather tumors are localized, as a rule, in open areas of the skin. One of the most malignant is skin plane carcass. Stages of plane bakelifier skin cancer:

I. The tumor or ulcer is not more than 2 cm in diameter, limited by the epidermis and actually a derma, completely movable along with the skin without infiltration of adjacent tissues and without metastases.

II. The tumor or ulcer is more than 2 cm in diameter, germinating the entire leather, without spreading to the subjectable fabric. In the nearest regional lymph nodes there may be one small moving metastasis.

III. Significant sizes, limitedly movable tumor, sprouting the whole leather thickness and subject to fabric, but not transferred to the bone or cartilage, without certain metastases.

IV. The same tumor or a tumor of smaller sizes, but in the presence of multiple moving metastases or one low-pass metastase;

a common tumor or ulcer, with germination to the subjectable tissues with remote metastases.

The disease occurs more often in the second half of life, especially in old people, mainly on the skin of the face. Distinguish three clinical skin cancer forms - Surface, deeply penetrating into deeper fabrics and papillary.

Skin surface cancer is first manifested in the form of a small spack or a plaque of gray-yellow color, towering over normal skin. Then, along the edges of the tumor, a compacted roller appears, the edges become festral, and the center appears softening, turning into an ulcer coated with a crust. The edges of the skin around ulcers are red, pain is missing. In papillary form, the formation has a view of a protruding node with clear forms.

The ulceration of shallow, bleeding during injury, covered with crusts, there are no pains or minor.

Melanoma: from Greek. melas., melanos. - "Black", "Dark"; -Yo - "Tumor") - a malignant tumor consisting of pigment-forming cells (melanocytes). It can be located on the skin, mucous membranes of the gastrointestinal tract and the upper respiratory tract, in brain shears and other places. More than 90% of cases, the tumor is detected on the skin of the lower extremities, the body and face. Most of the commemorated women.

Distinguish surface-propagating and nodular species of melanoma skin.

Stages of malignant melanoma:

I. There is only a primary tumor of any size, thickness characterized by any form of growth without damage to regional lymph nodes; 5-year survival after treatment - 80-85%.

II. There are primary tumors and metastases in regional lymph nodes; 5-year survival - less than 50%.

III. There are primary tumors, metastases in regional lymph nodes and remote metastases. All patients dying for 1-2 years.

The melanoma of the skin has the form of papilloma, ulcers or the formation of a rounded, oval or irregular shape, color can be from pink to isc. black; It happens an unmanned (amolanotic) melanoma. As the primary tumor grows around it, radial rays appear, the daughter pigment inclusions in the skin - satellites, are formed intradermal, subcutaneous and remote metastases. When metastializing into regional lymph nodes, conglomerates are formed with the involvement of surrounding tissues and skin in the pathological process. In the future, metastases appear in the lungs, liver, brain, bones, intestines, in any other organ or in any body fabric. In the later stages of the process in the urine of the patient, a melanin can be detected, giving it a dark color (melanuria). The peculiarities of the clinical course of asymptomatic melanoma are the extensive lesion of regional lymph nodes and relatively frequent metastatic bone damage.

Principles of treatment. Treatment of malignant neoplasms of the skin provides for a radical removal of the tumor focus and the achievement of persistent clinical cure, which helps to improve the quality and increase the life expectancy of the patient. The choice of the treatment method is determined by the doctor and depends on the nature (species), stage, localization, prevalence of the tumor process, the presence of metastases, the overall state, the age of the patient.

Methods for the treatment of skin cancer:

Surgical treatment - excision of the primary hearth;
the use of X-ray and laser radiation;
Cryotherapy that contributes to the death of cancer cells under the influence of cooling with liquid nitrogen;
Chemotherapy, sometimes polychimotherapy (cisplatin, blemisin, methotrexate). For the treatment of intraepithelial forms of cancer, appliques of ointments with cytostatics are used (5% 5-fluororation, 1% blemic acid ointment, etc.).

Nursing care. Below are given list of nursing measures when providing palliative care for patients with malignant skin neoplasms:

Collecting anamnesis with identifying hereditary predisposition to the occurrence of skin cancer;
examination of the patient, palpation of the skin and lymph nodes;
informing a patient about the disease, methods of its treatment, prevention of relapses;
Message to the patient about the need and diagnostic value of skin biopsy, followed by histological examination;
Taking print-firprints for cytological research;
control of the use of prescribed medicines, identifying possible side effects;
Dynamic observation of the common state of the patient and local (local) manifestations of tumor lesion of the skin;
monitoring by patients with radiation therapy sessions, laser irradiation, cryotherapy;
Organization of physical and psychological support of the patient and his relatives;
Patient training with self-temperature, relatives - patient care;
Attracting the patient to classes at the school of an oncological patient, ensuring its popular literature, booklets, memos, etc.

The problem of combating malignant neoplasms is one of the most relevant in medicine and affects many aspects of social life.

Malignant neoplasms, in contrast to other cells and tissues of the body, are characterized by the irrepressible increase in cells with germination into neighboring tissues, metastasis (transfer of tumor cells with a current of lymph or blood to other organs and tissues), recurrence (appearance of a tumor in the same place after its removal ). As a result of metabolic changes occurring in the patient's body, the tumor process most often leads to general depletion (cachexia). Malignant tumors from epithelial tissue are called cancer, and from the connecting - sarcoma.

Among the causes causing malignant tumors, the influence of the factors of the external environment can be distinguished: chemical, physical, biological agents and the influence of the inner environment of the body. Indirect signs are of great importance: lifestyle, hereditary predisposition, defeat and diseases of various organs and organ systems.

The severity of the malignant tumor process is made to be denoted by stages.

Stage I. - small sizes Surface ulcers or a tumor that does not germinating into deep-haul fabrics and not accompanied by the defeat of nearby regional lymph nodes. Treatment conducted in this stage is most successful.

In Stage II The tumor is already sprouting into the surrounding tissues, it has small sizes and gives metastases to the nearest lymph nodes.

Small mobility and large size of the tumor along with the lesion of regional lymph nodes are characteristic of III Stages Diseases. In this stage, it is still possible to carry out treatment, especially with the help of combined methods, but its results are worse than in the I and II stages.

IN IV Stage There is an extensive spread of a tumor with deep germination into the surrounding tissues, with metastases not only in regional lymph nodes, but also to remote organs, pronounced cachexia. In this stage, only a small number of patients with chemotherapeutic and radiation methods of treatment make it possible to achieve a long clinical effect. In other cases, it is necessary to be limited to symptomatic or palliative treatment. Only with timely recognition of malignant tumors, you can count on the success of treatment, otherwise the forecast becomes extremely unfavorable.

There is a group of diseases, against the background of which malignant tumors occur most often. These are the so-called precancerous states. Language or lip cancer is developing most often in places of white spots or long non-healing fractures of the mucous membrane; Lung cancer - on the site of chronic inflammatory processes, and cervical cancer - on the spot of its erosion.

In the initial stages, some forms of cancer proceed almost asymptomaticly, and patients often do not seek medical care.

Treatment of malignant tumors

The treatment of malignant tumors of soft tissues includes three basic methods (surgical, radiation and chemotherapeutic) used independently or in combination. Among these methods, the proportion of surgical interventions is up to 40-50%. TO surgical Fashion treatments include knife or electrosurgical excision of soft tissue tumors, methods of freezing tumor tissue (cryosurgery or cryodestruction) and the destruction of the tumor with the help of a laser beam. There is a comprehensive method when all three types of treatment are used.

For radiation treatment Patients (outdoor use) skin damage arise. A redness (erythema) may occur, which corresponds to burn I burn. In the case of obtaining a very large dose of irradiation, the detachment of the outer layers of the skin comes and finally its first-samples, corresponding to the income burn.

When leaving these patients, the prophylaxis of radiation ulcer infection is of great importance. To eliminate local reactions, various ointments, emulsions and creams are used, which include aloe ehode emulsion or draft, linol, cigerol, hexerol, sea burying oil, vitamins A, E, high-quality fats. With the reaction of the rectum mucosa or vagina, the specified preparations are introduced in the form of microclism and tampons. After a few weeks, inflammation completely disappears, although the pigmentation of this skin section is preserved for a long time.

In the propagation of the cancer process throughout the body in the form of metastases, with non-melectual tumors localizing in vital organs, the only possible treatment of chemotherapy products and hormones may be.

Radiation therapy as well chemotherapy Can create conditions for further and surgical operation. Thus, when breast cancer, the course of radiation therapy causes the disappearance of metastases in the axillary lymph nodes and makes it possible to carry out a surgical operation. With severe esophagus, radiation therapy or chemotherapy helps restore the passage of food on the esophagus. When metastasis in the lymph nodes of the mediastinum, which squeeze the lungs and vessels, the course of radiation therapy reduces the compression of the vessels, which reduces the edema of tissues and improves the respiratory function.

Padical operations with soft tissue tumors

With these intervention operations, the tumor is removed within the limits of healthy tissues in a single block with a regional lymphatic device under the observance of the rules of ablastics and antiblastic.

Palliative operations in soft tissue tumors

Along with the radical produces the so-called palliative operations aimed at removing the bulk of the tumor to subsequently affect the remaining tumor cells in the new formation box or its metastase with radiation therapy or cytostatic drugs. Palliative operations are recommended if the patient's body is significantly weakened and not ready for a radical operation. In addition, palliative operations are shown when the tumor is located in a complex place for the operation or reached the inoperable stage. Another indication to the palliative operation serves as an elderly age of the patient.

Operations on emergency testimony and diagnostic operations

Perform operations on emergency testimony with the immediate threat of the patient's life due to the complicated course of the disease (in particular, during the decay of the tumor with bleeding). A special place in the surgical treatment of soft tissue tumors is occupied by diagnostic operations, which are usually the final phase of diagnostics.

Features of surgical operations in soft tissue tumors

One of the basic principles of the production of surgical operations in soft tissue tumors is the principle of zonality, which involves the removal of a tumor within the limits of healthy tissues of one organ with a single unit with a regional lymphatic device or together with the organ in which it is located, with the simultaneous removal of the entire regional lymphatic device. block. All participants in the operation, it is also necessary to carry out the principles of ablastics and antiblastics aimed at preventing proliferation in the wound of tumor cells, which are the source of recurrence and metastases.

Nurse's ignition when conducting a surgical operation about tumors

Even with the ablastically performed operation, the intersection of tissues is always associated with the possibility of entering the elements of the tumor, therefore you need to take a number of measures aimed at preventing such a hit. Just as with curricular surgical interventions, the operating sister should be aware of the need to change the napkins as often as possible, which isolate the removed preparation from the operating field. To drain the wound surface, one and the same gauze napkins, balls should not be applied. After each use, the tools must be treated with alcohol and only after that a surgeon was filed. After each stage of the operation, it is necessary not only to handle hands in an antiseptic solution with the subsequent drainage of the gauze napkin, but also wipe them with alcohol.

When skin cancer, electrosurgical treatment is widely used: electricity and electrocoagulation. The tumor is excised in wide limits, in particular, when the skin carcinoma, it is enough to retreat from the edge of the tumor by 2-3 cm, and with melanoblastomas - at least 5 cm. In the case of removal of large tumors, it may be necessary to autoplasty with a free skin flap or a philatic stem for closing the wound Defect after widespread excision.

In the treatment of tumors located on the face, the method of cryotherapy and laser therapy has been distributed. At the first method, under the influence of low temperatures, water crystallization in the tumor cells, leading to their deaths, occurs. With the second method, the tumor is necrotized under the influence of laser irradiation. In addition to direct influence on the tumor, the laser beam can be applied as a light scalpel.

Features of care for oncological patients

A peculiarity of patients with malignant neoplasms is the need for a special psychological approach. It is impossible to allow the patient to recognize the true diagnosis. The terms "Cancer", "Sarkoma" should be avoided and replaced by them with the words "ulcers", "narrowing", "seal", etc. in all extracts and certificates issued for sick hands, the diagnosis also should not be understandable for the patient. It should be especially careful in conversation not only with patients, but also with their relatives.

Oncological patients have a very labile, vulnerable psyche, which must be borne in mind at all stages of servicing these patients. If you need consultation with the specialists of another medical institution, then together with the patient a doctor or a nurse who transport documents are sent. If there is no such possibility, the documents are sent by mail in the name of the chief doctor or give the patient relatives in the sealed envelope.

The actual nature of the disease can be informed only to the closest relatives of the patient.

It is necessary to try to separate patients with launched tumors from the rest of the patients. It is desirable that patients with initial stages of malignant tumors or precancerous diseases have not met patients who have relapses and metastases. In the oncological hospital, newly arrived patients should not be placed in those chambers where there are patients with late stages of the disease.

When observing oncological patients, regular weighing is of great importance, since the drop in body weight is one of the signs of progression of the disease. Regular measurement of body temperature allows you to identify the alleged breakdown of the tumor, the reaction of the body into irradiation. Data measuring body weight and temperature should be fixed in the history of the disease or an outpatient map.

It is necessary to train the patient and relatives of hygienic measures. The sputum that patients suffer from lung cancer and larynx collectors are collected in special cavities with well-fitted lids. The cavity users need to wash hot water daily and disinfect with a 10-12% solution of chlorine lime. 15-30 ml of turpidar are added to the destruction of the mall smell into the calendar. Urban and measurement for research are assembled into a faience or rubber vessel, which should be regularly washed with hot water and disinfect with chlorine lime.

The correct power mode is important. The patient must receive food rich in vitamins and proteins, not less than 4-6 times a day, and attention should be paid to the diversity and taste quality of dishes. You should not stick any special diets, you only need to avoid excessively hot or very cold, rough, fried or acute food. In the clinically manifest stages of the development of loud malignant neoplasms, reinforced protein nutrition is shown. The reason for such a necessity is a more active breakdown of proteins in the body.

Patients with launched gastric cancer should feed more gentle food (sour cream, cottage cheese, boiled fish, meat broths, steam cutlets, fruits and vegetables in crushed or rubbed form, etc.). During meals, receiving 1-2 Article. l. 0.5-1% solution of hydrochloric acid. The pronounced obstruction of solid food in patients with non-cultural forms of cancer of the cardiac gastric and esophagus can require the appointment with calorie and rich vitamins of liquid food (sour cream, raw eggs, broths, liquid porridges, sweet tea, liquid vegetable puree, etc.). Sometimes the following mixture contributes to improving the patency: 96% alcohol - 50 ml alcohol, glycerin - 150 ml (1 tsp. L. Before eating).

The reception of this mixture can be combined with the assignment of a 0.1% atropine solution of 4-6 drops to 1 tbsp. l. Water 15-20 minutes before meals. In the threat of complete obstruction of the esophagus, hospitalization is necessary for a palliative operation.

For a patient having a malignant esophageal tumor, you should have a drink and feed it with liquid food. In this case, it is often necessary to use a subtle gastric probe conducted in the stomach through the nose. Often it is necessary to switch to parenteral administration of nutrients. Most often, glucose solutions with the addition of vitamins, amino acid solutions, protein mixtures are used.

Care for patients after abdominal and crotch operations

In the postoperative period, special attention should be paid to the care of the wound in the crotch area. Excess blood bandage bleeding in the first hours after the operation should be alarm.

If the overall condition of the patient remains satisfactory (the pulse of sufficient filling, there is no sharp drop in blood pressure) and bleeding from the wound is small, then by the appointment of the doctor, it is quite enough to change the bandage. With continuing bleeding, it is necessary to overflow blood and blood substitutes. With the ineffectiveness of measures to stop bleeding, the doctor produces a revision of the wound and dressing a bleeding vessel. Usually, the tampons are not removed immediately, but gradually pulling them down, starting with 2 and ending with 4-5 days after surgery.

After removing the tampons, the wound in the crotch area is necessary to rinse daily with a weak (pale pink) solution of potassium permanganate, 2% boric acid solution with the addition of hydrogen peroxide, a solution of rivocol through a rubber tube or a catheter, the end of which should reach the deepest sections of the wound bottom. The patient with this procedure should lie on the left side with the legs bent in the hip and knee joints, holding the right buttock with hand, facilitating this manipulation.

In the presence of a significant amount of purulent raids on a wound surface before washing, it is useful to clean it with a cloth moistened with a 3% hydrogen peroxide solution, chlorine, and after washing, leaving a tampon moistened with a fluosciline solution 1: 1000. Introduction of tampons with Vishnevsky or methyluracyl ointment Mase is less desirable, as this can lead to a delay of separated.

In women, in addition to the above processing, it is necessary to wash the vagina with any antiseptic solution (1: 500 rivolol, etc.), since the accumulated secret may turn out to be a source of infection. The bandage of wounds with the treatment of its edges with a 3-5% alcoholic solution of iodine and the imposition of T-shaped bandage is completed.

12-15 days after surgery, the patient is allowed to get up in the absence of oslo. If the wound is clean, then during this period, the patient should use baths with permanganate potassium 1-2 times a day (right before extracting from the hospital). With the extirpation of the rectum and the abdominal-anal resection in the presaxial space, rubber drainage leaves. It is removed only after complete discontinuation of the selection. In this case, it is preferable to later gradually removing the drainage tube from the presaxial space, since its early one-time removal can lead to the sticking of a narrow wound channel, which will entail the formation of an ulcer.

The first pull-up of the tube after the front resection of the rectum is 1-2 cm produced on the 3-4th day after the operation. A full tube is removed on the 10-11st day after the operation.

After the straight of the rectum, the drainage tube is removed on the 4-6th day after the operation.

Never accumulating drainage is regularly washed with furaticiline solution. It should be borne in mind that the absence of a drainage separated from the drainage can be due to its blockage of blood clots and the absence of exudate. In the absence of exudate, the drainage tube washing is impractical, as this contributes to the introduction of infection through drainage. If the body temperature of the patient is not high, the general condition is satisfactory, then in the absence of a dischargeable need for washing disappears. Otherwise, it is necessary to wash the drainage with an antiseptic solution (furaticline, etc.) through the smaller rubber tube, which is injected into the drainage, and with the help of the syringe produce washing. The edges of the skin around the drainage are lubricated with a 3-5% alcoholic solution of iodine.

The postoperative period may be complicated by the embodiment of the crotch wound. With the opening method of wound, the recognition of suppuration does not represent any particular difficulties. If it is sewn, it is tightly the formation of blind unfinished pockets, filling them by exudate, which is a good nutrient medium for microflora. For the treatment of this complication, it is necessary to widely drain the cavity of the introduction of anxiety, rinse with antiseptic solutions with antibiotics, as well as carry out general measures to increase the reactivity of the body.

Special care for the cultures of the rendered intestine during sphincter-retainer operations is not required. It is only necessary to process it with a 3% solution of hydrogen peroxide. 2-3 days after surgery, the doctor removes a tampon with the ointment of the Vishnevsky, introduced during the operation. It should be noted that preoperative irradiation reduces the resistance of the infection tissue, which leads to an early and massive intergeneration of the postoperative crotch wound with microorganisms and an increase in the frequency of purulent complications.

Looks sluggish wounds with necrotic plates for a long time emit a rented smell, sharply painful, and the pain is enhanced at night. For their treatment, antibiotics are used, which are prescribed depending on the sensitivity to them microflora wounds, proteolytic enzymes. After 2 days after the use of proteolytic enzymes, the amount of purulent separated, for 6-9 days the wounds are completely purified from necrotic masses and pus, pink granulations appear, pain decreases. After the complete purification of the crotch wound can be imposed on it secondary seams to accelerate healing.

Care for patients with colostite and double-rolled anus

First of all, it is necessary to be reliably wasolate with an embarrassment from the abdominal wound (stick the abdominal wound not only with a clean marlevary napkin, but also a cellophane film). With a flat colostrict on its area in the postoperative period, impose a bandage with a syntomicin or any other ointment. The edges of the skin during redness are lubricated with a strong solution of potassium permanganate. In further, care is reduced to the imposition of napkins with vaseline and replacing them as needed. Wearing a carriagory is subsequently considered not only optional, but also undesirable, as it leads to the creation and loss of the mucous membrane of the gut. It is preferable to wear a belt in the form of a lane with a linen section on the left, where the plastic ring is inserted, respectively, and the rubber valve is inserted on top of the ring, fastened to the belt with straps. Under this valve there is a small gauze bandage, covering the coogent. The bandage is pressed by the valve by fastening the straps. If the straps are needed, the toilet is produced and change the bandage.

Double anus doctor usually reveals on the 2nd day after surgery. The resulting bleeding is stopped by treatment with a 3% hydrogen peroxide solution. With the ineffectiveness of this method, the bleeding vessel bandages. In the future, they carry out the same care measures as with a flat colostrict.

Of great importance is the care of patients with double-barbecue A N in Som, superimposed to turn off the distal portion of the intestine. In these cases, the distal sector of the intestine is washed to exemplate it from the stagnant of the carte masses. To do this, under the patient, the rubber inflatable vessel is put under the patient, a rubber tube is introduced into the distal end of the intestine, pre-lubricated with vaseline oil, on a small depth and washed with a weak solution of potassium permanganate to clean water. The processing of a postoperative wound is reduced to daily lubrication with a 3-5% alcoholic solution of iodine. In the postoperative period, the postoperative wound may be charged (signs of inflammation appear, tissue infiltration around the wound, pain, the body temperature increases). Produces diagnostic sounding of the wound by a curved probe. With the appearance of pus, the nearby seams are removed, the wound is washed with antiseptic solution. In the future, there is a dressing daily with the imposition of sterile wipes moistened with hypertonic (10%) sodium chloride solution with antibiotics. In some cases, during the operation in the abdominal cavity, they leave drainages. It is necessary to monitor their permeability and systematically rinse. In the absence of the discharge, the doctor removes drainage on the 3-4th day after the operation.

With the appearance of complications in the postoperative period (the insolvency of the anastomosis, the formation of fine fistulas) intestinal content, causing maceration and skin damage, can fall on the skin. To prevent this, the surrounding areas of the skin are protected by a thick layer of lassary pasta. With a long-term finding of a patient in a forced position, the prolesidery can develop, piedermia. For their prevention, the skin of the rear surface of the body is systematically wiped with camphor alcohol, with starting beds, a solution of potassium permanganate, methyluracyl ointment, ointment "Iruksol" is used.

Care for patients after mastectomy operations

A rather traumatic operation is mastectomy. As a result of the removal of the mammary gland and regional lymph nodes of the axillary, connectible and behindading regions, an extensive defect of the tissues is formed, numerous lymphatic vessels are intersect, which leads to long-term release of the wound fluid.

These operations usually end with the drainage of wounds with forced suction of separated by vacuum suction. U-shaped drainage from elastic polyethylene with a plurality of side holes through 2 contrapertures are introduced into the postoperative wound region so that one of them is located in the axillary region, which comes with a separated from behindading and plug-in areas, and the second in the flap area. With the help of a tee, both drainage are connected to a rubber tube, which is attached to the Bobrov apparatus. To seal the system in the field of drainage, skin fixing seams are imposed. Usually, with a properly applied sealed system, skin flaps are firmly adjacent to the subjectable tissues. This makes it optional overlaying the bandage dressing, it is possible to limit ourselves to the marvel sticker to the postoperative wound area. Instead of the Bobrov apparatus, it is sometimes used by a hermetic container and a richardson cylinder with a valve or other device, with which you can pump out air from the tank.

The dressing nurse must follow the tightness of the system, pump out the air from the vessel, merge the liquid from it and fix its quantity. In patients with a slightly developed subcutaneous fat layer, the amount of fluid released minimally, but the system must be kept for 3-5 days. Purchase patients have to use vacuum suction for 5 and even 7 days.

After removing drainage in most patients, limification occurs in the axillary and plug-in areas. In this case, daily punctures with complete evacuation of fluid are necessary. These puncture usually produces a attending physician, but an experienced nurse oncological institution should also fulfill them (in coordination with the doctor). The technique of these puncture is as follows. We produce skin treatment in the area of \u200b\u200bliquid accumulation with alcohol and 3% iodine alcohol solution, then determine the center of the cavity, where the needle is introduced, piercing only the skin. This manipulation must be carried out with maximum caution, since in the depths of this cavity are unprotected connectual veins and artery. Usually, on the outcome of the first week after operation, the amount of fluid is 80-100 ml (in some cases more). Then the amount of fluid gradually decreases, and usually after 3 weeks daily punctures can be stopped and just go to tight binting.

For the treatment of cancer of the rectum before or after the operation, radiation therapy in combination with chemotherapy is widely used. Nursing activities in the preoperative and postoperative period Psychological preparation of a patient positive thinking is a powerful tool for psychological preparation for operation and recovery after it. Psychological preparation of a patient for the operation is almost impossible without the help of loved ones and relatives. As far as possible, psychologists recommend not to give up the usual routine of the day on the eve of ...

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Introduction

Main part

Chapter 1 Oncology

1.5 Colon cancer. Symptoms. Diagnosis and treatment

Chapter 2. Nursing activity

2.1 Preparation for instrumental research methods.

2.2 Patient management in the preoperative and postoperative period

Conclusion

List of references

Applications

Appendix 1 (name)

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Introduction

It has long been a winged Medical Commandment "Health We must protect the Smalod". The meaning of this folk wisdom is many of us, unfortunately, comprehend only in mature, and often in the elderly years. It is no secret that healthy people often do not realize this advantage and, in the end, pay for such frivolity. The main factor in the preservation of the health, life expectancy of a person, his physical and creative performance is a healthy lifestyle in its widest interpretation.

So, today the death rate of the population in Russia is the highest in Europe. We are behind not only from Western European countries, but also from Poland, the Czech Republic, Romania and the Baltic countries. One of the main causes of deaths of the population are malignant tumors. For example, in 2005, 285 thousand people died from malignant neoplasms! The most frequent were tumors of light, trachea, stomach, breast.

Oncology (Greek. ONKOS - Weight, Tumor + Logos - Teaching) - The area of \u200b\u200bmedicine that studies the causes of the occurrence, mechanisms of development and clinical manifestations of tumors and developing methods for their diagnosis, treatment and prevention.

In essence, oncological diseases arise from the fact that a certain cell or group of cells begins to multiply and randomly grow, displacing normal cells in the human body of any age.The digestive organs are largely susceptible to the risk of oncology. The reason for this becomes changed living conditions - change of food, changing the lifestyle with active physically to passive, change of the routine of the day. For many, such changes are inevitable, many are pleasant for many. Nevertheless, the statistics of the disease cancer of the digestive system in aggressive form makes it possible to understand how important it is to eat and move to the one who wants to live normally.

Modern methods of diagnosis and treatment allow you to promptly detect malignant neoplasm and heal more than half of children and adults.

This topic I chose because it is relevant in our time, also to expand the horizons and even because it can touch any person.

The purpose of my work:

Get acquainted with the causes of the occurrence of oncological diseases;
Explore the methods of nursing interventions in the diagnosis and treatment of tumors;
And also learn how to carry out nursing activities for patients with oncological diseases of the digestive organs.

To realize the goal, I set up the following tasks:

Development of work skills with scientific literature;
The ability to choose the main thing;
Structuring text;
Literacy of the expression of their thoughts;
Expansion of the horizons of knowledge in the field of oncology;
Use the knowledge gained in your practical activity.

Object: Oncological patients.

Subject of study:

Causes of oncological diseases;
Classification of digestive tumors;
Prevention and treatment of oncological diseases;
Nursing activities.

Chapter 1 Oncology

1.1 General concepts about oncology. Types of oncological diseases of the digestive organs

Oncology (from Greek. Onros - Breakness, Logos -Nuka) - Science, which studies the causes of the occurrence, mechanisms of development and clinical manifestations of tumors and developing methods for their diagnosis, treatment and prevention.

In essence, oncological diseases arise from the fact that a certain cell or a group of cells begins to multiply and randomly grow, displacing normal cells.

By the ability to spread in the body, the tumor is divided into two groups:

Benign (not possessing the ability to grow into neighboring fabrics);
Malignant (capable of growing in certain tissues and move to other parts of the body, giving the beginning of secondary tumors metastases).

In the mortality rate of the population of Russia, cancer ranks second after cardiovascular diseases. In humans, the most studied causes of cancer are radiation, chemical carcinogens and viruses.

Biological properties of tumors

Accelerated growth;
Cell ability to constant division (lack of cell aging);
Irregularity of migration;
Loss of a malignant cell of contact braking in its growth and reproduction;
Metastasis ability;
Progression of the malignant process.

1.2 Tumors of the digestive tract in children

Schenile intestinal polyps

This is the most common type of bowel tumor in children. Usually polyps (Appendix 1.1) arise in children over 12 months. And only in rare cases in adolescents over 15 years old.

Symptoms of the disease

Metabolic disorders (associated disorders of digestion, suction and intestinal motility);
Painless rectal bleeding (blood can be on the surface of the hose masses or mixed with them);
Iron deficiency anemia (due to microscopic blood loss).

Diagnostics

The diagnosis is made on the basis of a rectal study. About 1/3 polyps are available to detect a finger, although it is quite difficult to feel them.
When reorgano-blocking, the polyps look like smooth, having a leg of formation containing gray-white cysts.
Double contrast irrigoscopy allows you to identify the polyps that are above the reach of the sigmoscope.
Currently prefer to use.

Treatment and prevention

Patients with juvenile polyposis showed operational treatment.

A systematic dispensary observation must be organized for patients for many years after surgical treatment. At least once a year, a gastroscopy, a colonoscopy and an intestinal radioscopy is carried out.

Family polyposis

Family polyposis is more often developing during puberty (13-15 years), in the future (up to 21) the frequency of its occurrence increases. The disease is characterized by a progressive course with mandatory malignant reincarnation.

Symptoms of the disease

Unstable stool (diarrhea, admixture of mucus, sometimes blood in fees);
Anemia is gradually developing, general weakness, intoxication, developmental delay.

Diagnostics

Proctic examination of the patient, colonoscopy and irrigoscopy.

The proctic examination of the patient includes four consecutive

stage:

- inspection of the perianal area;

- finger study of the rectum;

- inspection of the rectum using a rectal mirror;

- RectorOnoscopy (inspection of direct and distal sections of the sigmoid gut using a reorganoskop, if necessary when taking biopsy).

Treatment

The only chance to save the life of the patient is timely conducting radical surgical intervention.

Family adenomatous polyposis colon

This is a precancerous disease, characterized by the presence of a large number of adenomatous polyps (Appendix 1.2) in the distal colon department. In the literature describes cases of polyps
at an early age, but usually they arise by the end of the first decade and in adolescence.

Symptoms of the disease

There are diarrhea, bleeding;
Malignation can occur in children over 10 years old.

Diagnostics

The diagnosis is made on the basis of the results of a radiological study (with double contrast irrigoscopy, multiple accumulation defects are visible);
As well as sigmoscopy and colonoscopy, at which polyps of different sizes are visible.

Treatment and prevention

Operational treatment.

After the kingctomy, patients need to conduct endoscopy of the upper sections of the tract of the tract every 6 months for 4 years.

1.3 esophagus cancer. Symptoms. Diagnosis and treatment

The esophagus joins the sip with the stomach, the food is swallowed through it. Despite the fact that swallowing lasts just a second, it is enough that when exposed to some products and beverages, including alcohol and inhaled tobacco smoke, such damage to the mucous membrane, which create a favorable ground for the development of cancer, occur.

Etiology

Environmental pollution (work in mines, in metallurgy, in asphalt pairs, carp and other harmful conditions);
Overweight;
Erosion erosion (when drinking caustic liquids, first of all, the esophagus suffers, where very large scars and deformations remain).

Symptoms of the disease

Disruptions of swallowing and moving food;
Pain behind the sternum or in the upper part of the abdomen (due to the difficult sort of food);
Weight loss.

Diagnosis and treatment

Ezophagoscopy.
It often happens that the esophagus is so narrowed due to the tumors in it that the esophagoscope does not pass. In this case, an X-ray study is used for the diagnosis (Appendix 2.1), in which the patient must drink a special mixture of barium, and then find out the obstacles and the size of the tumor.
To determine the spread of the tumor outside the esophagus, additional studies are carried out: X-ray of the lungs, ultrasound examination (sonography) of the abdominal cavity, computed tomography of the chest and abdomen, etc.

Ecophageal cancer is being treated operational, exercise of gastrostomas, as well as chemotherapy and radiation therapy.

Prevention

It is necessary to systematically undergo preventive inspections and inform the doctor about any violations of health, difficulty difficulties, the passage of coarse food.

Since the external factors contributing to the development of esophageal cancer include improper nutrition (the abuse of very hot, pickled food, the deficiency of vitamins A and C, as well as smoking and alcohol abuse), with a prophylactic purpose, it is advisable to abandon the bad habits and normalize nutrition.

1.4 stomach cancer. Symptoms. Diagnosis and treatment

Stomach cancer - ranks first among cancer tumors of other localization. On average, they are ill under the age of 60 ... 65 years. Cases of people under the age of 40 are frequent. Most often, the gastric cancer occurs in middle-aged men, over the years the probability of the disease increases.

Etiology

Special risk factors are diseases in which the stomach cancer occurs more often than in a healthy stomach. These are the so-called precancerous stomach conditions:

Chronic atrophic gastritis - inflammatory state, which causes dryness of the stomach mucosa;
Malignant anemia, which is caused by violations of the absorption of vitamin B12 in the stomach.
Microbe infection with Helicobacter Pylori, which causes special inflammation and ulcers of the gastric mucosa.
Polyps in the stomach and colon - the decisive are their size and nature of the structure.

Symptoms of the disease

Small syndrome:

A change in taste;
Feeling of gravity in the stomach with a small abundance of eaten food;
Feeling of overflow of the stomach;
Nausea in the morning, belching;
Weakness;
In the later stages - Milena.

Diagnosis and treatment

The most accurate answer about the presence of gastric cancer, like the esophagus cancer, will give gastroscopy. With the help of gastroscopy, you can observe the state of the stomach, detect changes, take a biopsy;
A radiographic study of the stomach with a barium mixture is used (Appendix 2.2);
The treatment of gastric cancer, as a rule, operational is resection of the stomach with subsequent chemotherapy and radiation therapy.

1.5 Rak rectum. Symptoms. Diagnosis and treatment

Rak rectum occurs in both sexes is about the same. Statistics show that about 90% of cancer suffering over 50 years old.

Etiology

Wrong lifestyle (alcohol, smoking, hygodymna, bad hygiene);
Excessive use of acute and fatty;
Family predisposition;
Polyps;
Ulcers;
Dims.

Symptoms of the disease

Violation of the act of defecation (alternation of constipation and diarrhea);
Bleeding (feces, mixed with blood);
False urges;
The shape of Cala is changing ("Sheep-Chair" - Small Portions, "Ribbon Chair");
Profuses of bleeding (with a large tumor).

Diagnosis and treatment

The best result in the diagnosis of rectal diseases gives rectoscopy, allowing you to take a biopsy.
In some cases, you can explore the intestine using irrigoscopy (Appendix 2.3).

As with any cancer, the best results give the operation - the imposition of colostomas.

For the treatment of cancer of the rectum before or after the operation, radiation therapy in combination with chemotherapy is widely used.

Prevention

The prevention of the rectum cancer is mainly reduced to the timely radical treatment of the intestinal polyposis, as well as the proper treatment of colitis in order to prevent its transition to a chronic form.

An important preventive measure is the normalization of nutrition, a decrease in the diet of meat products, the fight against constipation.

Chapter 2. Nursing activity

2.1 Patient preparation for research tool methods

Ezophagoscopy

Explain to the patient the purpose of the upcoming research and the essence of the preparation;
On the day before: prescribed sedatives (bromine preparations - sodium bromide and potassium Bromide, as well as drugs valerian, mother-in-law), sometimes tranquilizers (mescapes, pinezepams, sibaz), at night - sleeping pills (nitrazempam, floh-domes);
Limit drink, exclude dinner;
On the day of the procedure, eating and liquid is excluded, the procedure is carried out on an empty stomach;
30 minutes before the procedure are prescribed to introduce an adult subcutaneously 1 ml of 2% of the propulsion solution or 0.5-1.0 ml of 0.1% solution of atropine sulfate. In children under 5 years old, esophagoscopy is usually produced without anesthesia;
Removable dentures should be removed;
The patient should be warned that at the time of the introduction of Ezophagoscope, he will experience an unpleasant feeling of suffocation (it is necessary to recommend breathing calmly, even, not to strain the muscles of the abdomen and the backbone, not to fold back);

Gastroscopy