oncology

In medical practice, medical attention may attract smokers, women and men, workers in certain occupations associated with potentially carcinogenic substances (aniline dyes, radioactive radiation, asbestos, etc.). Elimination or reduction of the concentration of the etiologic factors - the real way to reduce the incidence of malignant tumors.The pathogenesis of cancer. Tumors can be benign or malignant. The first consists v.os-novnom of the same type of cells do not differ significantly in morphology from normal cells, with little potency to grow, without the capacity for invasion and metastasis-Niya. Many benign tumors retain these characteristics throughout a person's life, rarely reborn in the corresponding tumors. For example, subcutaneous lipoma, uterine fibroids are transformed into sarcoma is extremely rare. However, benign tumors can be step in the development of cancer and sarcoma. Thus, diffuse intestinal polyposis through the lives of almost 100% of the passes into cancer. In many cases, the tumor stage of the conservation features of benign tissue growths (precancer) may not be as obvious as in polyps, but somehow this stage, which occupies a different amount of time there. Maliga-governmental organizations associated with the repeated changes in the genetic apparatus of tumor cells that are prone to mutations significantly larger than normal cells. As a result, new clones of cells, characterized by rapid cellular polymorphism, atypia, germination in the adjacent organs and the ability to grow in the form of metastatic lesions in other organs and tissues.A doctor who knows the clinical patterns, especially the development of the symptomatology of benign and malignant tumors of different localization, use of the most rational methods of diagnosis and treatment of these diseases. We emphasize that the diagnosis of tumor-benign or malignant, should be immediately ichetkim. In establishing the initial diagnosis method of observation, taking into account the rate of tumor growth - the path to the error.In the pathogenesis of some tumors importance of defining importance of genetic factors. In animals, the role of genetic predisposition is evident (for example, the high-and nizkorakovyh strains of mice). In humans, the tumor may be as the only manifestation of the defect of the genome, and part of various disturbances in the genome that lead to multiple malformations and tumors. The physician must conduct a special surveillance of members of such families, discuss them with their professional activity (necessary to avoid contact with potential carcinogens) and choose a system of medical surveillance (early detection of tumors). Among the known "genetic" tumors - re-tinoblastoma, nevusnaya basal cell carcinoma, acanthoma adenoides cysticum, multiple endocrine adenomatosis, pheochromocytoma, medullary thyroid cancer, PA-raganglioma, polyposis of the colon.Development of malignant tumors becomes more frequent in violation of immunological control (immunodeficiency syndromes, agammaglobulinemia, ataxia telangiectasia, and others, prolonged use of immunosuppressive agent in the case of organ transplantation and in certain diseases). Such patients also require more frequent physician monitoring for early detection of tumors.Invasion and metastasis of malignant tumors is determined by the disease. Tumor cells grow into the surrounding tissues and organs, damage blood vessels and nerves. Invasion often, such as skin melanoma, and determines the time development of metastases. Metastasis - one of the fundamental properties of malignant tumors specifically. Although there are isolated examples of metastasis and morphologically benign tumors (eg, thyroid adenoma, pancreas, destruiruyuschy hydatidiform mole), and this - a rare exception. Benign tumors usually do not metastasize.Metastasis of malignant tumors detected in regional lymph nodes, as well as in various organs and tissues. Knowing the ways of lymph drainage is important during patient examination and treatment planning. In some cases, is a must at the same time removing the primary tumor of the operation on the regional lymph nodes. The same approach is used in radiation therapy, if it is the primary treatment modality (planned exposure and the regional lymph nodes). Different tumors have features of metastasis to distant organs and tissues. For example, breast cancer more often produces bone metastases, testicular cancer, kidney - in the lungs, colon cancer - the liver, etc. In most cases there are multiple metastases of various sizes that retain the morphological structure and biological characteristics of the primary tumor. The most commonly affects the lungs, liver, bone, brain: Peculiarities of distant metastases for each tumor is important to know when drawing the conclusion that the tumor is localized. This is necessary in planning surgery and radiotherapy, as well as for follow-up.Term development of metastases may be different. For example, metastatic kidney cancer is mainly manifested in the first year after diagnosis and surgery, and breast cancer - within 2-5 years, sometimes 10-15 years.Recurrence of tumor growth appears in the same area in the coming months if the operation was non-radical or radiation therapy and / or chemotherapy did not lead to a truly complete tumor regression. Relapses of morphological structure similar to the primary tumor, but may have significant differences from her on biological characteristics.Diagnosis of tumors. Interview a doctor with the patient. The doctor pays attention to changes in clinical symptoms of chronic illnesses, gives some specific questions.Medical examination may be a warning, for active detection of symptoms and examination. Considerable assistance has in some cases, regular self-examination of people (palpation of breast cancer, examination of pigmented nevi, etc.). Interview and medical examination made by the initial information in formulating a diagnosis.Cytological method. The diagnosis of a malignant tumor should always be installed using cytological and / or histological examination. Cytology material to be obtained by needle biopsy of the tumor, prints, washes, centrifuged liquid, etc. After the puncture cytological preparations immediately record and then use the appropriate color. Important role of cytological analysis of breast cancer (preoperative puncture of the tumor), lung cancer (sputum, bronchoscopy materials, transthoracic puncture), the early stages of stomach cancer, esophagus, mouth, vagina, and other tumors. Should emphasize the utmost importance of the cytological method in cancer in situ, where the possibilities of this method is higher than histological. The role of cytological examination for early diagnosis is obvious in cervical cancer. If every woman regularly smear cytology, cervical cancer can be diagnosed at an early stage and cured at 100% of patients.Histological method gives the most complete picture of the disease. Material for research obtained at biopsy and after tumor removal. Establish the morphological type and variant of the tumor, the degree of infestation, the level of differentiated, associated tissue reactions, etc. In-depth study (electron microscopy, immunomorphological, histochemical methods) makes it possible to deepen the characterization of the tumor.Endoscopic studies are important for the diagnosis of certain tumors, as well as clarifying the extent of their distribution. Used an endoscopic examination of the nasopharynx, larynx, trachea and bronchi, esophagus, stomach, duodenum, colon and rectum, bladder, pleural and abdominal cavities, etc.X-ray methods remain essential in the diagnosis of tumors of the breast, lung, kidney, gastrointestinal tract, etc. In recent years, has been successfully used computerized tomography (CT). Its large informative when it detects small tumors in the thyroid gland, kidney, liver, lung, pancreas, etc. The lower diagnostic value of CT has cancer of the stomach, intestines and some other tumors. During the CT-studies can be made sight puncture the tumor.Ultrasound imaging - highly informative method of investigation; used for diagnosis of tumors of the abdominal cavity and retroperitoneum, soft tissues of the body, etc.During the study may also be performed aiming puncture the tumor.Radionuclide techniques are very promising (I mean the creation of tumor-specific labeled antibodies). Currently used diagnostic scintigraphy, skeletal, brain, lungs, for the characterization of functional status, renal scintigraphy, and liver.Biochemical methods provide useful information for the survey of cancer patients.Specific biochemical changes in the body of cancer patients is not established. At some tumors revealed some changes: for disseminated prostate cancer high levels of acid phos-fatazy installed in 75% of patients (but with localized cancer - less than 20%) in pancreatic cancer - an increase of amylase (25%), cancer of the liver -increase in hepatic alkaline phosphatase. Great practical importance is the discovery of high levels of a-fetoprotein in cancer of the liver, eggs, and various teratogenic-carcinomas, carcinoembryonic antigen - for colon cancer, human chorionic gonadotropin-in chorio-epithelioma of the uterus and testis. Biochemical tests can detect the secretion of endocrine tumors and to explain many clinical syndromes caused by tissue-specific or paraneoplastic endocrine activity. Revealed a high level of AKTR, antidiuretic, Parata reoidnogo, thyroid-stimulating, follikulostimuliruyusche th, lyuteotropnogo, melanostimuliruyuschego hormone erythro-poetina, cortisol, epinephrine, noradrenapina, insulin, gastrin, serotonin, etc.Biochemical methods allow us determine the content of certain hormone receptors in tumor tissue (estradiol, progesterone, testosterone, corticosteroids). Such an analysis is carried out at biopsy or tumor removal with the rapid freezing of tissue, the result of the study is useful in formulating treatment policy (eg, breast cancer, etc.).The above methods of diagnosing malignant tumors are the most informative in that case, if applied in a rational combination. The survey set reasonable diagnosis of malignant tumors and classify the disease according to international classification TNM (T - size of primary tumor, N-status of regional lymph nodes, M-the absence or presence of distant metastases). After surgery, the classification of disease specified. For most tumors develop appropriate criteria for TNM.Treatment of malignant opuholey.Pri treatment of patients with malignant tumors arise multiple problems whose solution requires the participation not only oncologists but also qualified doctors of other specialties that need to be clear about the features of the basic treatment methods used in oncology, and the possibility of subsequent rehabilitation. The main treatments: surgery, radiotherapy, chemotherapy and biotherapy. Radical surgery is performed mainly in the early stages of disease, as well as locally advanced tumors after previous radiotherapy or chemotherapy effective. Palliative surgery aims to reduce tumor mass, which increases the therapeutic effectiveness. Such operations, simplify the condition of patients (eg, intestinal obstruction, bleeding, etc.). Option of surgical treatment can be a cryogenic destruction of the tumor, performed as a radical or palliative effect.Radiation therapy is used in sensitive to radiation exposure tumors (small cell lung cancer, breast cancer, nasopharynx, larynx and other head and neck tumors, Ewing's sarcoma, cervical cancer, etc.) alone or in combination with surgery, chemotherapy.Use different methods of radiotherapy (remote gammaterapiyu, intracavitary radiotherapy, neutrons, protons, radioactive isotopes, etc.). Chemotherapy is now an important treatment modality for malignant tumors. Chemotherapy is prescribed to reduce the tumor mass with inoperable tumors after surgery to prevent the development of metastases (adjuvant chemotherapy) or in the presence of metastases. Recently used as chemotherapy for resectable tumors, followed by continuation of treatment (taking into account the sensitivity) after surgery (neoadyuvan-tnaya chemotherapy). In some diseases modern chemotherapy, being a major component of treatment provides a cure of a significant number of patients (malignant seminomnye neseminomnye and testicular tumors, chorionepithelioma cancer, localized forms osteogen-term sarcoma, breast cancer, Ewing's sarcoma, nefrob-lastomy children, etc.) . Chemotherapy often results in complete or partial tumor regression with varying duration of remission (disseminated breast cancer, ovarian, melanoma, small cell lung cancer, etc.), which increases the life expectancy of patients and reduces the clinical manifestations of disease. Chemotherapy is also used for cancer of the stomach, colon, prostate, bladder, kidney, etc.In modern clinical chemotherapy use different anticancer drugs (antimetabolites, antibiotics, alkylating, and various others). Anticancer drugs used alone or in drug combinations that can achieve the most effective treatment. At the heart of chemotherapy is the difference in the response of normal and tumor cells to cytotoxic effects. The most significant successes of chemotherapy-sensitive tumors are marked with small dimensions, whose mass is growing rapidly and has the highest sensitivity to the drug. Later in the major tumor sites of tumor doubling time increases, decreases the fraction of growth, decreasing the effectiveness of chemotherapy. Are important and other biological characteristics of tumors, especially pharmaceutical preparations kokinetiki etc.The greatest efficiency of anticancer drugs is achieved through their application in rational combinations. Information about the synergies of drugs obtained from preclinical studies. At various malignant human tumors, there are recommendations on the most effective chemotherapy - so-called first line, as well as for further treatment with little effect (second and third line).Pressing question of rational treatment regimens. The principle of maximum therapeutic effect in a short time by most oncologists. Severely criticized the practice of "podlechivaniya" drugs with little activity or just available to the physician at this time. This inadequate treatment not only helps, but considerably reduces the therapeutic results follow a rational chemotherapy. The reason is the property of tumor cells develop resistance to cytotoxic drugs in the short term.Drug resistance of the tumor - a difficult problem soaremennoy chemotherapy and poor treatment of patients deepen it. Among the causes of resistance of the tumor - the activation of the gene of multidrug resistance, insufficient intake of the drug into the cell, the lack of its activation, increased inactivation, increased concentration of the binding of the enzyme, the emergence of alternative ways of metabolism, recovery from injury, etc.Rational chemotherapy involves the use of different modes depending on the medical problem. Curative treatment can be intense, causing significant side effects, moderately toxic, or simply non-toxic. Binding is conducting refresher courses.Intervals between courses of treatment are determined by the task and characteristics of side effects of drugs. The therapeutic effect of anticancer drugs assessed after each treatment, usually after 2-4 weeks. When measured tumors use a measuring tape or a compass to determine the largest diameter and the maximum second diameter perpendicular to the first. These data are compared before and after treatment. When there are multiple foci chosen for observation 3.5 foci, different in equal measure. Metastases in the lungs make radiographs, carefully describe the location and size of the tumor.At some tumors are important ultrasound and computed tomography, hagiography, and other radiological techniques, determination of tumor markers. Recorded as the manifestations of ill-measured and unmeasured tumors. It is important to emphasize the need for a thorough description of all signs of illness before and after treatment.Complete regression - the disappearance of all manifestations of the disease, a significant partial regression - reducing the size of tumor foci> 50%, a slight improvement in the objective-reduction in tumor size at 25-49%. Stable disease for a long-term (up to 6 months), no dynamics associated with chemotherapy.Practitioners should also be aware of the side effects of cytotoxic drugs. The introduction of maximum therapeutic doses of drugs, ie, medicinal tactic involves the development of side effects to varying degrees. They can be observed directly (such as nausea, vomiting, allergic reactions, etc.), as soon as possible (leukopenia, platelet-topeniya, diarrhea, stomatitis, etc.) or in a remote period as a result of prolonged use of drugs (nephro-, cardio- , neuro-, ototoxicity, etc.). Side effects should be carefully recorded, which is important when planning further chemotherapy.In addition to cytotoxic drugs, chemotherapy involves the use of endocrine drugs.Most often they are used for hormone-dependent tumors (breast, thyroid, endometrium, prostate, etc.). Rational therapy requires a preliminary analysis of the content of estrogen receptors, progesterone and androgens in tumor tissue.Receptors are defined in the resected tumor or biopsy. Typically, the primary tumor and multiple metastases her have similar characteristics to the levels of hormone receptors. Apply anti-estrogens, androgens, corticosteroids, prog-wafer - in breast cancer, endometrial cancer, estrogen - for prostate cancer, etc. Improving the efficiency of treatment is achieved by removing the hormonal glands (ovaries, testes), turning off pituitary function (exposure, remove , the appointment of releasing pituitary hormones). Endocrine therapy may be the main method of treatment (eg, in breast cancer and uterine body in a deep menopause at a high level of estrogen receptors and / or progesterone). Often cytotoxic and endocrine drugs are used together, which increases the effectiveness of treatment.Biotherapy involves the use of various natural biologically active agents (interferons, interleukins, etc,), an immunotherapeutic interventions with vaccines, activated lymphocytes, immune-modulating pharmacological agents, etc. This is - a new promising area of medicine, whose development is closely related to the improvement testing the immuno-logical reactions in humans, the Recombinant and innovative pharmaceuticals, as well as the achievements of Experimental Immunology. The use of biotherapy in oncology practice is just beginning. Introduced in the practice of T-activin, leakadin, reaferon. To the accumulation of scientific evidence, and a significant practical experience to determine the role of biotherapeutics effects in the general system of modern treatment of patients with malignant tumors.