How to decipher the disease. Oncological diagnosis and treatment of cancer

Every patient wants to know what happened to him, and therefore, first of all, he wants to hear from the doctor the name of his illness, the diagnosis. However, to understand the tricky medical terms it can be difficult. In this case, certain information about what a particular disease is can be obtained directly from its name.

SO, there are many diseases whose names are derived from some anatomical term, usually Latin or Greek origin, and a word-forming element indicating a particular dysfunction of an organ or system. For example, the presence in the name of the Greek prefix “a” (before the vowels - “an”) means negation, the absence of some quality. These are diseases such as anemia("hema" - blood) - literally translated means "bloodlessness" (practically - "anemia"); asthenia("stenos" - strength) - literally "powerlessness", " general weakness"; atrophy("trophe" - nutrition) - lack of nutrition; arrhythmia- literally “no rhythm”, that is, any violation heart rate; anuria("urina" - urine) - "no urine", cessation of urination, etc.

If the name of the disease contains the Greek prefix “dis”, this means a disorder, difficulty in the function of one or another organ. The names of diseases such as dystrophy- eating disorders; dyskinesia(“kinesis” - movement) - violation contractile function digestive organs; dystonia("tonos" - tension) - violation nervous regulation vascular tone; dysbacteriosis("bacterion" - rod) - a violation of the biological balance between pathogenic and beneficial bacteria in the intestines; dysentery(“enteron” - intestine) - literally means “intestinal disorder”, etc.

When the name ends in "-itis", the disease usually has inflammatory nature. For example, arthritis("arthron" - joint) - inflammatory disease of the joint; gastritis(“gaster” - stomach) - inflammatory disease of the gastric mucosa; dermatitis("dermis" - skin) - inflammation of the skin; mastitis(“mastos” - breast) - inflammation of the mammary gland; nephritis(“nephros” - kidney) - inflammatory disease of the kidneys; phlebitis(“phlebos” - vein) - inflammation of the veins, etc.

Many oncological diseases can be identified by the presence in the name of the word-forming element “-oma”, meaning “tumor”. For example, angioma("angion" - vessel) - vascular tumor; myoma(“mios” - muscle) - tumor of muscle tissue; nephroma- malignant kidney tumor, etc.

The ending "-patiya" ("pathos" - illness, suffering) means common name diseases of any organ or system. For example, arthropathy- general name for joint diseases; nephropathy- kidney diseases; psychopathy("psyche" - soul, consciousness) - pathologies of character; cardiopathy("cardia" - heart) - heart disease, etc.

Often the name of the disease indicates its underlying cause. clinical symptom. For example, the presence of the word-forming element "-alg-" ("algos" - pain): neuralgia(“neoron” - nerve) - pain along the nerve; gastralgia- stomach ache; myalgia- muscle pain, etc. The names of diseases such as hemophilia(“hema” - blood and “philia” - tendency) - predisposition to bleeding; schizophrenia(“schizo” - splitting, splitting and “fren” - soul, mind, reason) - split personality; haemorrhoids("hema" - blood and "roa" - outflow) - discharge of blood, bleeding; hypertension(“hyper” - over, higher and “tonos” - tension) - increased tension blood vessels; angina(“ango” - soul) - suffocation; scarlet fever(“scarlatum” - bright red tissue) - redness of the mucous membrane of the oropharynx; stroke(“stroke” - blow) - characterizes the sudden onset of the disease, etc.

The name of the disease may indicate the underlying cause pathological process. For example, atherosclerosis("atere" - gruel and "skleros" - dense, hard) - a combination of thickening (sclerosis) of the inner lining of the artery and the accumulation of fatty substances in it, which over time acquire the appearance of gruel. Cardiac ischemia(“ischemia” - to delay, stop blood) - damage to the heart muscle caused by a disorder of coronary circulation; caries(“rotting”) - destruction of tooth tissue.

From some names you can also find out the direct cause of the disease. For example, title "hay fever"(“pollen” - pollen) indicates the connection of this disease with plant pollen; brucellosis- disease caused by various types of Brucella; leptospirosis- disease caused by Leptospira, etc.

There are also more complex names. For example, myocardial dystrophy(“myos” - muscle, “cardia” - heart, “dystrophe” - nutritional disorder) - non-inflammatory damage to the heart muscle in the form of a violation of its nutrition. In the name of the disease "Tick-borne Lyme borreliosis" the carrier (tick), pathogen (Borrelia) and the place where this disease was first described (Lyme in the USA) are indicated. And from the title "tick-borne encephalitis" you can learn that the main pathological process of this disease is inflammation of the brain (“encephalon” means brain, and the ending “-itis” means inflammation) and that the causative agent of the disease is carried by ticks.

However, there are a number of diseases whose names do not reflect their true essence. The fact is that these names appeared at a time when the true causes of many diseases were not yet known. But despite this, some of these names are still used to refer to a number of diseases. For example, glaucoma("glaukos" - bluish) literally means "bluish clouding of the lens", although, as is known, the basis of this disease is an increase in intraocular pressure.

The name of such a disease as "gonorrhea", characteristic symptom which are purulent discharge. But when the Roman physician Galen in the 2nd century AD. e. proposed this name, they believed that the essence of the disease lies in the leakage of seminal fluid: translated from Greek, “gonorrhea” means “ejaculation” (“gonos” - seed and “roe” - discharge). And although it was later found that pus is released in this case, the original name remained.

The occurrence of a disease such as "hysteria", Ancient Greek doctors associated it with disorders of the uterus. Hence the name "hysteria", derived from the Greek. "hystera" - uterus. But even after it was proven that the symptoms characteristic of this disease depend on a disorder of the nervous system, the term “hysteria” continues to be used to designate a neuropsychic disease related to neuroses.

For more than two millennia, it was believed that prolonged inhalation of heavy swamp fumes causes a disease, which in connection with this received the name "malaria"(from the Italian “malya aria” - bad air). And although it later became clear the real reason its origin, the old name has been preserved to this day.

18.03.2016 10:34:45

Staging tumors into groups depending on their prevalence is necessary to take into account data on tumors of a particular location, treatment planning, taking into account prognostic factors, assessing treatment results and monitoring malignant neoplasms. In other words, determining the stage of cancer is necessary in order to plan the most effective treatment tactics, as well as for the work of statisticians.

TNM classification

The TNM classification for describing the prevalence of neoplasms is based on 3 components:

• First - T(lat. Tumor- tumor). This indicator determines the extent of the tumor, its size, and growth into surrounding tissues. Each location has its own gradation from the smallest tumor size ( T0), to the largest ( T4).
• Second component - N(lat. Nodus- node), it indicates the presence or absence of metastases in the lymph nodes. Just as in the case of the T component, each tumor location has its own rules for determining this component. The gradation comes from N0(absence of affected lymph nodes), up to N3(widespread lesion lymph nodes).
• Third - M(Greek Metastasis- movement) – indicates the presence or absence of distant metastases to various organs. The number next to the component indicates the degree of prevalence of the malignant neoplasm. So, M0 confirms the absence of distant metastases, and M1- their presence. After the designation M, the name of the organ in which distant metastasis was detected is usually written in parentheses. For example M1 (oss) means that there are distant metastases in the bones, and M1 (bra)- that metastases were found in the brain. For other organs, use the designations given in the table below.

Also, in special situations, an additional letter is placed before the TNM designation. These are additional criteria indicated by the symbols “c“, “р”, “m”, “y”, “r” And "a".

- Symbol "c" means that the stage is established according to non-invasive examination methods.

- Symbol "p" says that the stage of the tumor was established after surgery.

- "m" symbol used to refer to cases where several primary tumors are located in the same area.

- Symbol "y" used in cases where the tumor is assessed during or immediately after antitumor treatment. The prefix "y" takes into account the extent of the tumor before complex treatment. Values ycTNM or ypTNM characterize the extent of the tumor at the time of diagnosis using non-invasive methods or after surgery.

- "r" symbol used in the assessment of recurrent tumors after a relapse-free period.

- Character "a", used as a prefix, indicates that the tumor is classified after autopsy (autopsy after death).

Histological classification of cancer stages

• GX- the degree of tumor differentiation cannot be determined (little data);
• G1- highly differentiated tumor (non-aggressive);
• G2- moderately differentiated tumor (moderately aggressive);
• G3- low-grade tumor (highly aggressive);
• G4- undifferentiated tumor (highly aggressive);

Only after the tumor has been classified according to the TNM system can grouping by stages be performed. Determining the extent of spread of the tumor process according to the TNM system or stages is very important for the selection and assessment of the necessary treatment methods, while histological classification allows us to obtain the most exact specifications tumors and predict the prognosis of the disease and possible response to treatment.

Determination of cancer stage: 0 - 4

Traditionally Stages of cancer are usually designated from 0 to 4. Each stage, in turn, can have the letter designations A and B, which divides it into two more substages, depending on the prevalence of the process. Below we will look at the most common stages of cancer.

We would like to draw your attention to the fact that in our country many people like to say “grade of cancer” instead of “stage of cancer.” Various websites contain questions about: “grade 4 cancer”, “survival rate for stage 4 cancer”, “grade 3 cancer”. Remember - there are no degrees of cancer, there are only stages of cancer, which we will discuss below.

Stages of cancer using the example of an intestinal tumor

Stage 0 cancer

At stage 0 cancer, the boundaries of the tumor do not extend beyond the epithelium that gave rise to the tumor. With early detection and timely initiation of treatment, the prognosis for stage 0 cancer is almost always favorable, that is Stage 0 cancer is completely curable in the vast majority of cases.

Stage 1 cancer

Stage 2 cancer

Stage 2 cancer is considered the most common stage of cancer at which cancer is diagnosed. The prognosis for stage 2 cancer depends on many factors, including the location and histological features of the tumor. In general, stage 2 cancer can be successfully treated.

Stage 3 cancer

The third stage of cancer does not involve distant metastases to various organs, which is positive thing and determines a favorable prognosis.

Stage 4 cancer

There are rare cases when stage 4 cancer can be diagnosed in the absence of distant metastases. Large, poorly differentiated, fast-growing tumors are also often classified as stage 4 cancer. There is no cure for stage 4 cancer, as well as for stage 3 cancer. At the fourth stage of cancer, the disease takes on a chronic course, and it is only possible to put the disease into remission.

cancer, c-r, Blastoma, Bl., NEO, neoplasma (neoplasm), Disease...., Tumor (tumor)
All of the above terms refer to a malignant tumor, usually cancer. They are all used to avoid writing the word “cancer” in plain text. To refer to sarcoma, another abbreviation is more often used - SA (Sa).

Trial laparotomy, Laparotomia explorativa, Petrov's operation, Explorative resection (of something)
All terms denote a situation when the “opening” of the abdomen reveals inoperability, advanced tumor, stage 4 cancer, in which it is pointless to perform any intervention. After this, the stomach is sutured without performing any surgery. Among doctors, slang expressions such as “test”, “to hammer” are often used.

Palliative surgery, palliative resection (of something)
Palliative surgery (not radical) is an operation in which the neglect and inoperability of the tumor is also established, but some kind of intervention is performed - either in order to eliminate some complication (bleeding, stenosis, etc.), or in the hope of achieving temporary remission , especially if subsequent chemotherapy or radiation treatment(also palliative, that is, not radical).

Symptomatic treatment at the place of residence
A phrase that encodes that the patient has an inoperable, advanced tumor, usually stage 4, and that such a patient, therefore, is not subject to special types radical treatment from a specialist - oncologist. Involves prescribing medicines, only alleviating the condition of an incurable patient, and, first of all, narcotic analgesics as needed. Among doctors, the slang expressions “symptoms” and “symptomatic patient” are often used. Can be considered synonymous with clinical group 4 of dispensary registration.

Generalization (dissemination)
A term denoting an advanced tumor in which there are many regional and/or distant metastases. As a rule, we are talking about stage 4 of the tumor process and clinical group 4 of dispensary registration.

Progression
The term denotes the continuation of tumor aggression, the continued growth of cancer. Common progression of untreated cancer. However, progression can also occur after treatment special treatment according to a radical program. In such a situation, it is the antonym of the word “remission”. Moreover, the timing of progression can be very variable - continued growth of cancer cells after treatment can occur after 1 - 2 months, and after 10 - 20 - 30 years. (The longest period of occurrence of progression from the end of treatment that I found in the literature was 27 years).

Secondary hepatitis (pulmonitis, lymphadenitis, etc.), secondary hepatitis (pulmonitis, lymphadenitis, etc.)
All terms indicate the presence of distant metastases (liver, lungs, lymph nodes, etc.). Indicates an advanced tumor, stage 4 cancer.

Virchow's lymphadenitis
Virchow's metastasis (cancer metastasis to the supraclavicular lymph node on the left - after the name of the author who first described it) Indicates the advanced stage of the tumor, stage 4 cancer.

mts
Metastasis (short for Latin - metastasis). It can indicate both regional and distant metastases.

prima, secunda, tercia, qarta (prima, second, third, quart)
Latin words are numerals. They indicate the stage of development of cancer, the tumor process - first, second, third and fourth. Among physicians, incurable patients are often referred to by the slang term “quart.”

T.... N.... M....
An abbreviation of Latin words used in the international classification of malignant tumors by stage. T- Tumor - primary tumor, values ​​can be from 1 to 4 depending on size; N - Nodulus - nodes (lymphatic), values ​​can be from 1 to 2-3 depending on the level of damage to regional lymph nodes; M - Metastasis - metastases, meaning distant metastases, values ​​can be 0 or 1 (+), that is, distant metastases are present or not. For all categories (TNM) the value may be x (x) - the available data is insufficient for an estimate.

Difference between stage and clinical group
Often patients, even in long-term remission, panic when they hear the term “3 clinical group", considering this to be stage 3 of the development of the tumor process. This is incorrect. "Clinical groups" are groups dispensary observation, and their numerical designation has no correlation with the stage of tumor development.
1 clinical group - patients with underlying precancerous diseases, subject to dispensary observation;
Clinical group 2 - patients with cancer of any stage, subject to special types of treatment (surgical, radiation, chemo-hormonal);
3 clinical group - radically cured cancer patients;
Clinical group 4 - incurable patients, patients with advanced malignant tumors who are not subject to special types of treatment.
As you can see, clinical group 3 indicates a very good option.

Adequate pain relief
This phrase usually “hides” the recommendation to prescribe narcotic analgesics for relief pain syndrome. However, the problem of pain management for incurable patients is much more complex and broader than simply prescribing drugs.

Palliative radiation (chemotherapy)
Palliative chemotherapy, palliative radiation - non-radical use of these techniques. That is, a situation when specific treatment is performed on a patient who is known to be incurable with a deliberately non-radical purpose, either to relieve any complications and improve the quality of the remaining life, or in the hope of at least temporary stabilization of the tumor process. The concept of palliation corresponds to that of surgical treatment.

What does sick leave mean? With the help of a sick leave certificate, an illness, injury or other physiological problem of an employee is registered. The form is sometimes called differently - a sheet of temporary incapacity for work. It is allowed to be prescribed only by doctors who have passed a special check by the FSS. An employee can count on payments if the form was correctly filled out and submitted to the enterprise administration within the established time frame.

For a long time now, a single standardized form has been used to fill out sick leave. In 2011, a reform was carried out in this area, the forms began to look slightly different, and new rules for filling out were introduced. Disease codes have become strictly mandatory.

Is the diagnosis written in sick leave? The diagnosis and cause of disability are now indicated using two special digital designations. The first is the national designation of the reason (01,02,03), the second is international form disease records according to the ICD-10 system.

Primarily, the reform was carried out to avoid cases of fraud associated with sick leave payments. That's why there's honey in everything. Institutions forms are received directly through FSS branches. The sheets are marked with serial numbers, so it becomes much easier to track illegal fraud. In addition, new sheets of paper are protected with watermarks, micro-text and some other methods.

It is best to fill out the sheet using printed media, as well as a black pen. Entries must be placed exactly within the boundaries of the cells and frames. Such accuracy is necessary so that the form can be processed by a computer - electronic reading is quite sensitive and demanding. The physician must not cross out, sign, or otherwise change the completed form.

Sample of a completed sick leave certificate:

If you need to change information, you should take new leaf. The employer has the right to make mistakes and make corrections to the records, but this is highly undesirable. Corrections are written on the back of the sheet, incorrect data is crossed out.

Then you should sign and date it, recording the fact of the corrections. We also recommend that you read the article, from which you will learn about inaccuracies that FSS employees will not pay attention to.

The form must be filled out by two people: the doctor and the employer. The doctor is responsible for completing sections 1 and 3. The employer, in turn, is for the second. It should be taken into account that the FSS carries out quality control and conducts random checks. In the future, the Fund plans to switch completely to electronic system sick leave, which will further simplify the control task.

When registering/using sick leave, you should rely on the Tax, Labor and Administrative Code. In addition, important documents are Federal Laws N212, N125, N255. In any unclear cases, you should contact the FSS department for advice.

On the back side of the sheet you can always find instructions for filling out, as well as a decoding of all codes.

Registration procedure

There are three people involved in registration: the doctor, the employer and the employee. An employee becomes ill and goes to a medical facility. The doctor must diagnose the patient's disease and health condition. Based on this, the doctor determines the duration of sick leave and enters it into the form. To do this, use the corresponding unified codes (detailed explanation below). Then he indicates the following information about the patient:

• Date of Birth;
• Name of the enterprise - according to the patient, no special documents are required. If the employer is individual entrepreneur, then enter the full name of the individual. employer person.

The doctor must also indicate the name, address and registration number his medical institution. After this, the sheet should be signed and stamped. If the attending physician is engaged in private practice, then he similarly indicates his full name and register. number.

The employee takes the form completed by the doctor to the administration at the place of work. The employer fills out information regarding payment calculations and information about his company:

• Name of organization - 29 cells are allocated, one empty cell must be left between words;
• Type of work (main or part-time);
• Registration number in the Social Insurance Fund (enterprise);
• Subordination code;
• Employee number (identification);
• Fear. number;
• Payment terms;
• Fear. employee experience;
• Avg. earnings;
• Full name of the head. accountant and company manager;
• Amount of payments - indicate three amounts: from the employer, from the Fund and the final amount (due to the employee).

In addition, the data necessary for the tax authorities is recorded. Every year, tax reports (2-NDFL) must be prepared for all employees. On sick leave, the tax code is always 2300. The benefit is not taxed, although formally it is classified as income. A 2-NDFL certificate is sometimes required for an employee to get a loan; it may be necessary in a new workplace. The employee always has the opportunity to check the correctness of payments.

Explanation of the fields on the sick leave:

The employee is also a participant in the registration process, but he practically does not fill out anything. All he needs to do is consult a doctor in a timely manner and obtain a certificate of incapacity for work. Then it is necessary (within compliance with the deadlines) to provide the completed form at the place of work.

Codes

Special digital codes are used to record information describing the nature (diagnosis, disease, cause) and duration of disability. Codes can be two-digit or three-digit (starting from zero). Using such a flexible system, all reasons for incapacity/sick leave are coded. There are 15 main causes of disability(diseases), let's figure out what the codes on the sick leave mean, what disease and diagnosis is hidden behind it, and let's start deciphering them:

• “01” - disease, the most common case, especially during influenza epidemics;
• "02" — domestic injury, that is, damage to the body received outside of work/workplace;
• “03” - quarantine, indicates the need for quarantine, typical for infectious diseases, for example, tuberculosis;
• “04” is a work-related injury, but correct name there will be an “occupational accident”;
• “05” - the onset of disability due to pregnancy and childbirth;
• "06" - prosthetics, which (according to medical reasons) can only be carried out in a hospital;
• "07" - prof. disease, as well as exacerbation of prof. diseases, especially typical for industries with hazardous conditions;
• “08” - medical procedures in hospitals and sanatoriums;
• “09” - disability due to the need to care for a sick family member (for example, a disabled person);
• “10” - poisoning, as well as other conditions;
• “11” is a disease from the list of social services. significant diseases, the list was approved by Government Decree N715. These include, in particular, tuberculosis, hepatitis, HIV, diabetes, oncology;
• “12” - the reason is the illness of a child under 7 years old, the need for additional care;
• “13” - caring for a disabled child;
• “14” - cancer in a child or a post-vaccination complication;
• “15” – HIV infection in a child.

Points “14” and “15” are noted on the form only with the consent of the insured person (employee).

After the code “15”, three-digit designations begin (the first is “017”), they are indicated next to the above two-digit ones. They are incremental in nature, giving more detail if needed, and they start with the number “0.” There are five such designations in total:

• “017” - indicate if the treatment took place in a special facility. sanatoriums;
• “018” - undergoing sanatorium-resort treatment due to an industrial injury;
• “019” – treatment in a clinic at a university/institute;
• "020" - additional holiday for labor and finance;
• “021” - noted if the disease/injury was caused by alcohol and drug use.

Thus, correlating the reason with the established list, the doctor enters the reason on the form. For example, if a woman is on sick leave according to BiR and received additional leave for this reason, the form will indicate the codes “05” and “017”.

Then, in the lines “Other” and , the code again becomes two-digit. Let's figure out what some of the codes in the "Other" section mean:

• “31” - noted if the employee continues to be sick;
• “32” - the employee was assigned a disability;
• "34" - death(in this case: the reason for the end of sick leave);
• “36” - the patient arrived (at the appointment) healthy and able to work.

In addition to codes for causes of disability, there are so-called ICD codes ( international classification diseases). The latest version is ICD-10, the tenth edition of this classification. The doctor on sick leave also notes the disease according to the ICD system. There are 22 classes of diseases in total. They are designated from "A00" to "Z100". The ICD is already completely medical information.

If the doctor made a mistake when filling out the codes, then he must take a new, blank form. He is not allowed to cross out, sign or make changes.

Conclusion

A sick leave certificate is required when registering an employee’s temporary disability. In 2011, in order to optimize document flow and reduce FSS costs, a reform was carried out. Causes and diseases are recorded using digital symbols called codes.

Information is indicated using two designations - the first is the national designation of the cause of disability (for example, injury, disease), the second is the international designation of the disease according to the ICD-10 system, it provides more detailed medical information.