Inoperable tumor. Symptoms of the disintegration of a malignant tumor. Clinical classification of cancer

However, this seemingly truism is called into question by data from X-ray examinations of breast and prostate cancer, accumulated over more than twenty years and published in the latest issue of the Journal of the American Medical Association.

In addition to large tumors, which lead to death if left untreated, the images reveal many smaller formations, the growth of which at some point spontaneously stops and they begin to decrease in size. In some cases, breast cancer tumors disappear altogether.

“It was previously thought that cancer was a linear process: a mutation occurs in a cell, mutations accumulate over time, and this process cannot spontaneously occur. reverse side, says National Institutes of Health Deputy Director Barnett Kramer. “It seemed like an arrow flying only forward.”

However, in Lately It is becoming increasingly clear that cancer is not simply a process of accumulation of mutations. Neighboring cells and even the entire organism as a whole take part in the development of the disease. For example, immune and hormonal system capable of suppressing or accelerating tumor development. Therefore, Dr. Kramer argues: cancer is a dynamic process.

Not all oncologists agree with this opinion, but new data are beginning to convince even skeptics. "I can't say that I'm 100% convinced that cancer is reversible, but I wouldn't rule it out," says Robert Kaplan, chairman of the department of nursing at the University of Los Angeles School of Public Health in California. "Accumulating evidence provides ample evidence for this."

Cases of spontaneous disappearance of cancerous tumors in the testicles are well known. It has happened more than once that after removing a testicle affected by a tumor, only a large scar or a scar and a small tumor were found on it. During the time that elapsed between the discovery of cancer and the operation, the tumor spontaneously decreased or disappeared completely.

Of course, such cases are rare. Dr. Martin Gleave, professor of urology at the University of British Columbia, Canada, calls cancer remission a “rare biological phenomenon.”

Professor of pathology at the University of San Francisco, California, Thea Tlsti, says that cancerous and precancerous cells can be found in the body of almost any person who has reached middle age. This is evidenced by the results of autopsies of people who died from causes unrelated to cancer. "It turns out that the question is not so much why cancer develops, but why it does not develop," says Dr. Tlsti.

Canadian researchers are now studying small kidney cancers. There are cases where these tumors also spontaneously regress even at a severe stage of the disease.

A group led by Dr. Gleave conducted an experiment in which they gave kidney cancer patients placebo pills instead of drugs.

In at least 6% of patients, the tumors either shrank or remained unchanged. The same result was observed in the group of patients receiving conventional treatment.

As Dr. Gleave says, these days, small tumors in the kidneys are increasingly being detected by ultrasound or tomography by chance, when patients do not suspect they have cancer. In the United States, such tumors are removed, but Dr. Gleave says surgery is not always necessary.

The university where he works is participating in a nationwide study of small kidney cancers. The objective of the study is to trace the dynamics of the development of this type of cancer. The data obtained so far show that in 80% of cases, within three years the tumors either do not increase or even decrease in size.

Of course, while doctors will not advise patients to postpone treatment in the hope of a happy development of events, but perhaps further study of the development of tumors will help them determine when treatment is necessary and in which cases the tumor can be left alone.

Early diagnosis has led to the fact that, according to Dr. Gleave, “not only large fish, but also very small fish are caught in our nets. Therefore, now we need to understand which of the small fish can be released into the wild.”

/Newsland.ru/

Related news:

Cancerous tumors are like time itself: they never stand still, and always develop and always in the same direction - from bad to worse.

However, this seemingly truism is called into question by data from X-ray examinations of breast and prostate cancer, accumulated over more than twenty years and published in the latest issue of the Journal of the American Medical Association. In addition to large tumors, which can lead to death if left untreated, the images reveal many smaller formations, the growth of which at some point spontaneously stops and they begin to decrease in size. In some cases, breast cancer tumors disappear altogether.

“It was previously thought that cancer was a linear process: mutations occur in a cell, mutations accumulate over time, and the process cannot spontaneously reverse itself,” says Barnett Kramer, deputy director of the National Institutes of Health. “It seemed like an arrow flying only forward.”

However, recently it has become increasingly clear that cancer is not simply a process of accumulation of mutations. Neighboring cells and even the entire organism as a whole take part in the development of the disease. For example, the immune and hormonal systems can suppress or accelerate tumor development. Therefore, Dr. Kramer argues: cancer is a dynamic process.

Not all oncologists agree with this opinion, but new data are beginning to convince even skeptics. “I can't say I'm 100% convinced that cancer is reversible, but I wouldn't rule it out,” says Robert Kaplan, chairman of the department of nursing at the University of Los Angeles School of Public Health in California. “The accumulated data provides sufficient grounds for this.”

Cases of spontaneous disappearance of cancerous tumors in the testicles are well known. It has happened more than once that after removing a testicle affected by a tumor, only a large scar or a scar and a small tumor were found on it. During the time that elapsed between the discovery of cancer and the operation, the tumor spontaneously decreased or disappeared completely.

Of course, such cases are rare. Dr. Martin Gleave, professor of urology at the University of British Columbia, Canada, calls cancer remission a “rare biological phenomenon.”

Thea Tlsty, a professor of pathology at the University of San Francisco, California, says that cancerous and precancerous cells can be found in the body of almost anyone who has reached middle age. This is evidenced by the results of autopsies of people who died from causes unrelated to cancer. “It turns out that the question is not so much why cancer develops, but why it does not develop,” says Dr. Tlsti.

Canadian researchers are now studying small kidney cancers. There are cases where these tumors also spontaneously regress even at a severe stage of the disease.

A group led by Dr. Gleave conducted an experiment in which they gave kidney cancer patients placebo pills instead of drugs.

In at least 6% of patients, the tumors either shrank or remained unchanged. The same result was observed in the group of patients receiving conventional treatment.

As Dr. Gleave says, these days, small tumors in the kidneys are increasingly being detected by ultrasound or tomography by chance, when patients do not suspect they have cancer. In the United States, such tumors are removed, but Dr. Gleave says surgery is not always necessary.

The university where he works is participating in a nationwide study of small kidney cancers. The objective of the study is to trace the dynamics of the development of this type of cancer. The data obtained so far show that in 80% of cases within three years the tumors either do not increase or even decrease in size.

Of course, while doctors will not advise patients to postpone treatment in the hope of a happy development of events, but perhaps further study of the development of tumors will help them determine when treatment is necessary and in which cases the tumor can be left alone.

Early diagnosis has led to the fact that, according to Dr. Gleave, “not only large fish, but also very small fish are caught in our nets. Therefore, now we need to understand which of the small fish can be released into the wild.”

After the publication of my material in "Poradnitz?", I received more than 140 letters. He told many patients in detail about treatment using the mim method. Let's start with the facts. So a patient diagnosed with stage 4 ovarian cancer with a 15 cm tumor, swelling of the legs and chest after treatment with my method (today is the third year) feels good, does all the housework at home in the village. The tumor has shrunk and cannot be felt.

A patient diagnosed with breast cancer underwent surgery, but after a few months, lumps appeared in the other mammary gland. Her health condition worsened, the woman was preparing for the next operation. After treatment with my method, after half a year, my health improved significantly.

After publication in "Poradnic?" Among other letters, a letter arrived from Valentina S. from Volyn. Her mother also had ovarian cancer with metastases to other organs, fluid had already been released from the abdomen several times, her general condition was extremely unsatisfactory, there was no hope for recovery. After treatment with the method I recommended, after 2.5 months the tumor was not detected by ultrasound examination. Now the woman feels completely well and talks about how she was cured by other patients with a similar diagnosis. Many more such examples can be given.
I want to explain the meaning of the treatment I propose, so that patients will believe in this method and be cured. It is generally affordable and does not require large expenses.

I affirm that the cause of cancer is a fungus that is afraid of the clubroot environment and antifungal drugs: metronidazole (Trichopol) and tinidazole. Therefore, I suggest this treatment:
Metronidazole (Trichopol) 0.25 - 3 tablets three times a day for three days in a row, the fourth day - one tablet three times a day. A course requires 30 tablets. And at the beginning of treatment, you should complete at least 5-7 such courses with breaks between them of 2-4 days. Take the tablets with a decoction of marigolds (calendula) - 50-70 flowers per 1 liter of water, boil for 3-4 minutes and leave. It is advisable to drink this decoction during the treatment period and instead of water. Do not chew the tablets, take the decoction and immediately eat the first or second course.

After completing 7 such courses, take a break for 3-4 days and take 10 g of tinidazole according to the scheme: 1 tablet (0.5 g) in the morning and evening. Then you should take a break for a month and then take metronidazole according to the following regimen: 1 tablet in the morning, 2 tablets at lunch, 3 tablets in the evening. A course requires 30 tablets, and 3-5 such courses are required. Then take a break for a year, and then again carry out 3-5 courses of treatment with metronidazole. At the end of the second and third years from the start of treatment, these courses must be repeated. This is taken from my personal experience. Now, from time to time, when pain appears, I take 5-8 tablets of metronidazole, and the pain calms down (this has been going on for 14 years).

Since the fungus that caused the tumor dies in an acidic environment, I recommend that patients further acidify their body with warm 9% vinegar and certain foods. When warmed, the tumor begins to soften and its blood supply improves. But the blood in this case is quite saturated with metronidazole and acid and has a detrimental effect on the fungus itself, which is contained in the tumor. It's like a fisherman comes to a pond and is going to feed the fish with worms. But in fact, he has a completely different goal regarding the fish. Therefore, you should be sure to wipe your entire body, except your head, with warm vinegar 6 to 10 times every day. After wiping, you need to put a compress of warm vinegar on the sore area (not just the sore spot). For example, if cancer of the uterus, ovaries or bladder is diagnosed, then place the compress on the entire abdomen, and if breast or lung cancer - on the entire chest.

If possible, take a bath daily at the rate of 1.-2 liters. 9% vinegar per bucket of water. This acidified water can be used repeatedly, adding fresh vinegar over time. The compress must be kept until the vinegar begins to sting the skin (10-30 minutes), and lie in the bathroom until the water is warm enough. It’s good if in summer you can expose the sore spot to the sun, in winter you can sit so that the door of the stove in which the fire is burning is open opposite. The sore spot needs to be warmed up and a compress applied to it immediately.

It is advisable to consume up to two lemons or pickled apples, cabbage, cucumbers, tomatoes and pickle juice daily. You can alternate them: today - lemon, tomorrow - pickled apples, etc. Eat as many acidic foods as your stomach can handle. Drink 50-100 ml on an empty stomach. water consecrated with a silver cross.

I advise you to use the same melted pork fat from "s?tka" (we say: ?z velyon or cap) 1-2 teaspoons per day with some food or bread. It is good to eat 1-2 tablespoons of boiled red beet salad three times a day, adding salt, oil, garlic or lemon pulp for taste. It is worth consuming raw lard (a piece the size of a matchbox) with a clove of garlic from the first days of treatment, and then gradually, over the course of a week, increase the amount of garlic to 1-1.5 heads per day. Garlic can be consumed with various foods and with bread. If the body accepts this normally, then continue to do this for up to 3-4 weeks.

In cases where the pancreas, liver and kidneys are affected, it is worth consulting with a doctor and finding the best option for oxidizing the body and taking trichopolum (metronidazole) in combination with dietary nutrition in the first 2-3 months of treatment.

While intensive treatment is underway, the patient should not eat anything that contributes to the proliferation of the fungus and tumor growth - dairy products, except for well-sour milk and whey from it. You should also not eat sweets, fried foods, or drinks that contain alcohol even in small quantities.

For those recovering, severe physical labor, which can negate the effect of treatment.

An interesting fact is that the increase in radioactive contamination of soil in populated areas after Chernobyl does not coincide with an increase in the incidence of cancer. This gives rise to serious considerations.

Some patients, when they start taking medications, lose their appetite and experience nausea, and as a result they may become disillusioned with treatment. If the temperature rises or rashes appear on the body, you should take a break from taking the pills for 5-7 days and continue treatment again. I indicated dosages for adults weighing 60-80 kg.

Ovarian cancer, uterine cancer and various nodular formations in it, breast cancer, can be treated well with my method. bowel cancer, lung cancer, skin cancer.

Naturally, it is not possible to guarantee the recovery of a patient whose disease is severely advanced and the functioning of many organs is disrupted. However, I know the fact that a man was discharged from the oncology hospital to go home to die, and he still lives and works. I think that if a patient is treated with this method for at least a month or a month and a half and fate gives him another 2-3 months to live, then he already has hope for recovery.

In order to prevent cancer, I advise you to consume as much pickled apples, cucumbers, tomatoes, cabbage and their brine as possible. This is a very simple recipe, and the results are wonderful.

I hope that thanks to enthusiastic doctors, my method will be developed, supplemented, and will provide an opportunity to save cancer patients. May God bless the lives of all those who need this help.

Nikolay Klimchuk, doctor.
Those who are interested in my method can write to me at: 34705, p. New Korets, Koretsky district, Rivne region, st. Mira, 12.

Etiology of cancer. Tumor growth is caused by various etiological agents. According to experimental studies, a tumor develops under the influence of ionizing and ultraviolet radiation, various chemicals, DNA viruses of certain classes with horizontal transmission; the tumor may be due to superinfection of certain RNA viruses, etc. Diversity etiological factors is also typical for humans.

In medical practice Special attention the doctor may be attracted by smoking women and men, workers of certain professions associated with potentially carcinogenic substances (aniline dyes, radioactive radiation, asbestos, etc.). Eliminating or reducing the concentration of etiological factors is a real way to reduce the incidence of malignant tumors.

Pathogenesis of cancer. Tumors can be benign or malignant. The former consist mainly of cells of the same type, not significantly different in morphology from normal cells, with little potential for growth, without the ability to invade and metastasize. Many benign tumors retain these features throughout a person’s life, rarely degenerating into the corresponding malignant tumors. For example, subcutaneous tissue lipoma and uterine fibroids transform into sarcoma extremely rarely. However, benign tumors can be a stage in the development of cancer and sarcoma. Thus, diffuse intestinal polyposis develops into cancer throughout life in almost 100% of cases. In many cases, the stage of the tumor maintaining the characteristics of benign tissue growth (precancer) may not be as obvious as with polyposis, but one way or another such a stage, which takes a different period of time, exists. Malignization is associated with repeated changes in the genetic apparatus of tumor cells, which are prone to mutations significantly more than normal cells. As a result, new cell clones arise, characterized by sharp cellular polymorphism, atypia, germination into adjacent organs and the ability to grow in the form of metastatic foci in other organs and tissues.

A doctor who knows clinical patterns, features of the development of symptomatology of benign and malignant tumors of various locations, uses the most rational methods of diagnosis and treatment of these diseases. We emphasize that the diagnosis - whether the tumor is benign or malignant - must be immediate and clear. When establishing a primary diagnosis, an observation method that takes into account the tumor growth rate is a recipe for error.

In the pathogenesis of some tumors, genetic factors play an important determining role. In animals, the role of genetic predisposition is obvious (using the example of high- and low-cancer mouse strains). In humans, a tumor can be either the only manifestation of a genome defect or part of various disorders in the genome, leading to multiple malformations and tumors. The doctor should conduct special monitoring of members of such families, discuss with them their professional activities (it is necessary to exclude contact with potential carcinogens) and choose a medical monitoring system (early detection of the tumor). Among the known “genetic” tumors are retinoblastoma, nevus basal cell carcinoma, trichoepithelioma, multiple endocrine adenomatosis, pheochromocytoma, medullary cancer thyroid gland, pararaganglioma, colon polyposis.

The development of malignant tumors increases with violations of immunological control (immunodeficiency syndromes - agammaglobulinemia, ataxia-telangiectasia, etc.; long-term use of immunosuppressive drugs in the case of organ transplantation and in certain diseases). Such patients also need more frequent medical monitoring for timely detection of the tumor.

Invasion and metastasis malignant tumor determine the course of the disease. Tumor cells grow into neighboring organs and tissues, damaging blood vessels and nerves. Invasion often, for example in skin melanoma, determines the time of development of metastases. Metastasis is one of the main properties of malignant tumors. Although there are isolated examples of metastasis and morphologically benign tumors (for example, adenomas of the thyroid, pancreas, destructive hydatidiform mole); this is a rare exception. Benign tumors, as a rule, do not metastasize.

Metastases of malignant tumors are found in regional lymph nodes, as well as in the most various organs and fabrics. Knowledge of lymph drainage pathways is important when examining patients and planning treatment. In some cases, it is considered mandatory to perform surgery on regional lymph nodes simultaneously with removal of the primary tumor. The same approach is used for radiation therapy, if it is the main method of treatment (irradiation of regional lymph nodes is also planned). Various tumors have features of metastasis to distant organs and tissues. For example, breast cancer more often metastasizes to the bones, testicular cancer, kidney cancer to the lungs, colon cancer to the liver, etc. In most cases, multiple metastases of various sizes occur, preserving the morphological structures and biological characteristics of the primary tumor. The lungs, liver, bones, and brain are most often affected: It is important to know the features of distant metastasis of each tumor when drawing a conclusion that the tumor is localized. This is necessary when planning surgery and radiation therapy, as well as for dynamic monitoring.

The period of development of metastases may vary. For example, metastases of kidney cancer mainly appear within the first year after diagnosis and surgery, and for breast cancer - within 2-5 years, sometimes after 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 truly complete regression of the tumor. Relapses are similar in morphological structure to the primary tumor, but may have significant differences from it in biological characteristics.

Diagnosis of tumors. Doctor's conversation with the patient. The doctor pays attention to changes in clinical symptoms in chronic diseases and asks some specific questions. A doctor's examination can also be preventive - for active identification of symptoms and examination. In some cases, regular self-examination of people (palpation of the breast, examination of pigmented nevi, etc.) provides significant assistance. A conversation and examination by a doctor provides initial information in formulating a diagnosis.

Cytological method. The diagnosis of a malignant tumor should always be made using cytological and/or histological examination. Materials obtained during tumor puncture, prints, swabs, fluid centrifugates, etc. are subject to cytological examination. After puncture, cytological preparations are immediately fixed and then the necessary stains are used. The role of cytological analysis is important for breast cancer (preoperative tumor puncture), lung cancer (sputum, bronchoscopy materials, transthoracic puncture), early stages of stomach, esophageal, oral cavity, vaginal and other tumors. It is necessary to emphasize the extremely important importance of the cytological method for cancer in situ, when the capabilities of this method are higher than the histological one. The role of cytology for early diagnosis is obvious in cervical cancer. If every woman undergoes regular cytological examination of smears, cervical cancer can be diagnosed at an early stage and cured in 100% of patients.

Histological method gives the most complete picture of the disease. Material for research is obtained from a biopsy and after removal of the tumor. Install morphological type and type of tumor, degree of invasion, differentiated level, concomitant tissue reactions, etc. In-depth study (electron microscopy, immunomorphological, histochemical methods) makes it possible to deepen the characteristics of the tumor.

Endoscopic methods studies are important for diagnosing some tumors, as well as for determining the extent of their spread. Endoscopic examination of the nasopharynx, larynx, trachea and bronchi, esophagus, stomach, duodenum, colon and rectum, bladder, pleural and abdominal cavity, etc. is used.

X-ray methods remain important in diagnosis tumor diseases mammary gland, lung, kidney, gastrointestinal tract, etc. last years Computed tomography (CT) has been used successfully. Its information content is great when detecting a small tumor size in thyroid gland, kidney, liver, lung, pancreas, etc. CT has less diagnostic value for stomach, intestinal cancer and some other tumors. During a CG study, targeted puncture of the tumor can be performed.

Ultrasound tomography - highly informative research method; used for diagnosing tumors of the abdominal cavity and retroperitoneal space, soft tissues of the body, etc. During the study, targeted puncture of the tumor can also be performed.

Radionuclide methods very promising (meaning the creation of tumor-specific labeled antibodies). Currently, scintigraphy is used for diagnosis.

skeletal bones, brain, lungs; to characterize the functional state - scintigraphy of the kidneys and liver.

Biochemical methods studies provide useful information when examining cancer patients. Specific biochemical changes in the body of cancer patients have not been established. With some tumors, some changes are detected: with disseminated prostate cancer, a high level of acid phosphatase is found in 75% of patients (however, with localized cancer - below 20%); for pancreatic cancer - an increase in amylase (25%), for liver cancer - an increase in the liver fraction of alkaline phosphatase. Of great practical importance is the detection of high levels of a-fetoprotein in liver cancer, testicular cancer, and various teratocarcinomas; carcinoembryonic antigen - for colon cancer; chorionic gonadotropin - for chorionic epithelioma of the uterus and testicle. Biochemical tests can detect tumor endocrine secretions and explain many clinical syndromes due to tissue-specific or paraneoplastic endocrine activity. A high level of ACTP, antidiuretic, parathyroid, thyroid-stimulating, follicle-stimulating, luteotropic, melanostimulating hormone, erythropoietin is detected; cortisol, adrenaline, norepinephrine, insulin, gastrin, serotonin, etc.

Biochemical methods make it possible to determine the content of receptors of certain hormones in tumor tissue (estradiol, progesterone, testosterone, corticosteroids). This analysis is performed during a biopsy or tumor removal with rapid tissue freezing; the result of the study is useful in developing treatment tactics (for example, for breast cancer, etc.).

The listed methods for diagnosing malignant tumors are most informative if used in rational combination. As a result of the examination, a substantiated diagnosis of a malignant tumor is established and the disease is classified according to the international TNM classification (T - the size of the primary tumor, N - the state of regional lymph nodes, M - the absence or presence of distant metastases). After the operation, the classification of the disease is clarified. For most tumors, appropriate TNM criteria have been developed.

Treatment of malignant tumors. When treating patients with malignant tumors, various problems arise, the solution of which requires the participation of not only oncologists, but also qualified doctors of other specialties, who must clearly understand the features of the main therapeutic methods, used in oncology, and the possibility of subsequent rehabilitation of patients. Main treatment methods: surgery, radiation therapy, chemotherapy, biotherapy. Radical operation performed mainly in the early stages of the disease, as well as for locally advanced tumors after previous effective radiation or chemotherapy. Palliative surgery is aimed at reducing the tumor mass, which increases the effectiveness of therapeutic interventions. Such operations significantly alleviate the condition of patients (for example, with intestinal obstruction, bleeding, etc.). Option surgical treatment may be cryogenic destruction of the tumor, performed as a radical or palliative effect.

Radiation therapy is used for radiation-sensitive tumors (small cell lung cancer, breast cancer, nasopharynx, larynx, other head and neck tumors, Ewing's sarcoma, cervical cancer, etc.) alone or in combination with surgery and chemotherapy. Various methods of radiation therapy are used (external gamma therapy, intracavitary radiation therapy, neutrons, protons, radioactive isotopes, etc.). Chemotherapy is now becoming the most important treatment method for malignant tumors. Chemotherapy is prescribed to reduce tumor mass if the tumor is inoperable, after surgery to prevent the development of metastases (adjuvant chemotherapy), or if metastases are present. Recently, chemotherapy has also been used for resectable tumors, followed by continuation of treatment (taking into account sensitivity) after surgery (neoadjuvant chemotherapy). For some diseases modern chemotherapy, being the main component of treatment, provides cure for a significant number of patients (malignant seminoma and non-seminoma testicular tumors, uterine chorionepithelioma, localized forms of osteogenic sarcoma, breast cancer, Ewing’s sarcoma, nephroblastomas in children, etc.). More often, chemotherapy leads to complete or partial regression of the tumor with varying durations of remission (disseminated breast cancer, ovarian cancer, melanoma, small cell lung cancer, etc.), which increases the life expectancy of patients and reduces the clinical manifestations of the disease. Chemotherapy is also used for cancer of the stomach, colon, prostate, bladder, kidney, etc.

In modern clinical chemotherapy, various antitumor drugs are used (antimetabolites, antibiotics, alkylating agents and various others). Antitumor drugs are used alone or as part of drug combinations, which makes it possible to achieve the greatest effectiveness of treatment. Chemotherapy is based on the difference in the response of normal and tumor cells to cytostatic effects. The most significant successes of chemotherapy are observed with sensitive tumors of small size, the mass of which increases rapidly and is most sensitive to the drug. Subsequently, in large tumor nodes, the tumor doubling time increases, the growth fraction decreases, and the effectiveness of chemotherapy decreases. Other biological characteristics of the tumor, features of the pharmacokinetics of drugs, etc. are also important.

Greatest efficiency antitumor drugs achieved through their use in rational combinations. Information about the synergism of drugs is obtained as a result of preclinical studies. For various human malignant tumors, there are recommendations for the most effective chemotherapy - the so-called first line, as well as for further treatment if the effect is insufficient (second and third lines).

The issue of rational treatment regimens is relevant. The principle of achieving maximum therapeutic effect in a short time is shared by most oncologists. The practice of “treating” with drugs with little activity or simply available to the doctor at a given time is seriously criticized. Such inadequate treatment not only does not help, but significantly reduces the therapeutic outcome of subsequent rational chemotherapy. This is explained by the property of tumor cells to develop resistance to cytostatic drugs in a short time.

Lecasp/grenene tumor resistance is the most difficult problem of painful chemotherapy, and irrational treatment of patients deepens it. Among the reasons for tumor resistance are activation of the multidrug resistance gene, insufficient supply of the drug into the cell, insufficient activation, increased inactivation, increased concentration of the binding enzyme, the emergence of alternative metabolic pathways, rapid recovery after damage, etc.

Rational chemotherapy involves the use of different regimens depending on the treatment goal. The treatment regimen may be intense, cause significant side effects, mildly toxic, or simply nontoxic. Repeated courses are considered mandatory. The intervals between courses are determined by the purpose of treatment and the characteristics of the side effects of the drugs. The therapeutic effect of anticancer drugs is assessed after each course of treatment, usually after 2-4 weeks. When measuring tumors, a centimeter or compass is used to determine the largest diameter and the maximum second diameter perpendicular to the first. These data are compared before and after treatment. In the presence of multiple foci, 3-5 foci of equal size are selected for observation. For metastases to the lungs, radiographs are taken and the location and size of the tumor are carefully described.

For some tumors, ultrasound and computed tomography, hagiography, other radiological methods, and determination of tumor markers are important. Manifestations of poorly measurable and unmeasurable tumors are also recorded. It is important to emphasize the need to carefully describe all identified signs of the disease before and after treatment. Complete regression - disappearance of all manifestations of the disease; significant partial regression - reduction in the size of tumor foci > 50%; slight objective improvement - reduction in tumor size by 25-49%. Stabilization of the disease is a long-term (for up to 6 months) absence of dynamics associated with chemotherapy.

Practitioners should also be aware of the side effects of cytotoxic drugs. The introduction of maximum therapeutic doses of drugs, i.e. therapeutic tactics, involves the development of side effects of varying degrees. They can be observed directly (nausea, vomiting, allergic reactions, etc.), in the near future (leukopenia, thrombocytopenia, diarrhea, stomatitis, etc.) or in long term as a result long-term use 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 includes the use of endocrine medicines. They are most often used for hormone-dependent tumors (breast cancer, thyroid cancer, endometrial cancer, prostate cancer, etc.). Rational therapy involves a preliminary analysis of the content of estrogen, progesterone, and androgen receptors in tumor tissue. Receptors are determined in a removed tumor or during a biopsy. Typically, the primary tumor and its multiple metastases have similar characteristics in terms of hormone receptor levels. Antiestrogens, androgens, corticosteroids, progestins are used for breast cancer, endometrial cancer, estrogens for prostate cancer, etc. An increase in the effectiveness of treatment is achieved by removing the hormonal glands (ovaries, testes), turning off the function of the pituitary gland (irradiation, removal , administration of pituitary releasing hormones). Endocrine therapy may be the main treatment method (for example, for breast and uterine cancer in advanced menopause with high levels of estrogen receptors and/or progesterone). Often cytostatic and endocrine drugs are used together, which increases the effectiveness of treatment.

Biotherapy includes the use of various natural biologically active agents (interferons, interleukins, etc.), immunotherapeutic measures using vaccines, activated lymphocytes, immunomodulating pharmacological drugs, etc. This is a new promising area of ​​medicine, the development of which is closely related to improving testing of immunological reactions in humans, obtaining recombinant and fundamentally new pharmaceuticals, as well as with the achievements of experimental immunology. The use of biotherapy in oncological practice is just beginning. T-activin, leakadine, and reaferon were introduced into practice. There is a need to accumulate scientific information and more significant practical experience to clarify the role of biotherapeutic influences in the overall system of modern treatment of patients with malignant tumors.

CANCER OF THE VAGINA AND EXTERNAL GENITALS occurs in women aged 60 to 70 years and older. The development of cancer in this localization is often preceded by pre-cancerous diseases - leukoplakia and kraurosis. With leukoplakia, white spots are visible on the mucous membrane of the labia, around the clitoris, which later turn into plaques that merge with each other, with a tendency to ulceration. With kraurosis, atrophy and wrinkling of the mucous membrane and skin are observed. Among the clinical symptoms of leukoplakia and kraurosis, the most common are itching and burning in the external genital area.

Cancer of the external genitalia manifests itself as a dense nodule or ulceration that bleeds easily. The tumor is located in the area of ​​the labia majora or minora, the clitoris, and later the vagina, urethra and perineum are involved in the process. Metastases to regional inguinal, femoral and iliac lymph nodes occur quickly, and metastases to the lungs and other organs may occur.

Clinical symptoms of cancer include itching, burning, serous discharge mixed with blood, and pain.

The diagnosis is clarified by cytological and histological examination. Squamous cell carcinoma of varying degrees of differentiation is more often detected.

Treatment is radical vulvectomy with removal of inguinal lymph nodes. 75% of patients live more than 5 years after such an operation. Radiation therapy is used as independent method or in the preoperative period. Chemotherapy is used in combination with radiation therapy or alone for advanced disease (bleomycetin, methotrexate, cisplatin, etc.).

Vaginal cancer manifests itself as ulceration, tuberous papillary growths or submucosal infiltrate. The tumor bleeds easily. Metastasizes to the iliac and inguinal lymph nodes. With progressive growth, it grows into the bladder, urethra, and rectum.

Clinical symptoms: bleeding, pain.

Diagnosis is made by biopsy (squamous cell carcinoma). Differential diagnosis is carried out with cervical cancer with transition to the vagina, metastases of uterine cancer.

The main treatment method for vaginal cancer is radiation therapy (a combination of external and intracavitary irradiation).

LARYNX CANCER accounts for about 2% of all malignant tumors. It occurs 8-9 times more often in men than in women. Localized tumors are observed in 60% of patients; in 30% of cases, regional metastases are detected, and in 10% - distant metastases during the initial examination. The predominant histological form is squamous cell carcinoma. The supraglottic upper part of the larynx is most often affected (70%), then the folded (26%) and subglottic (2%).

Supraglottic, or vestibular, cancer of the larynx has a malignant course. The tumor usually extends superiorly and anteriorly to the lingual vallecula, root of the tongue, and preepiglottis. At first it is asymptomatic. Then you feel awkwardness and choking when swallowing, and later pain.

On examination, lumpy growths or infiltration are determined. With cancer of the vocal cords, the process spreads to the opposite fold and anterior commissure. The main symptom is hoarseness of the voice, turning into aphonia. Fibrolaryngoscopy reveals a neoplasm infiltrating the vocal cord and protruding into the lumen of the larynx.

With subglottic cancer, the main symptom is difficulty breathing and hoarseness. With advanced cancer - cough with sputum, putrid odor from the mouth.

Treatment of vestibular cancer stages I and II is radiation therapy, for stages III and IV - combined treatment (radiation therapy + laryngectomy), sometimes resection or extended laryngectomy. For stage I and II vocal cord cancer, radiation therapy or surgery can be used (long-term results are the same). For stage III and IV cancer, combination treatment is indicated. Subglottic cancer of stages I and II is treated surgically; in stages III and IV, radiation therapy is performed after surgery. For advanced stages of the disease, chemotherapy drugs can be prescribed: adriablastin, cyclophosphamide, prospidine, methotrexate, bleomycin, fluorouracil, spirobromine, etc.

LIP CANCER. 90% of all tumors occur in the central part lower lip; in 90% of cases the histological form is squamous cell carcinoma with keratinization. Predisposing factors are chronic trauma to the mucous membrane of the lip, smoking. Precancerous diseases are cheilitis, hyperkeratosis, warty precancer, keratoacanthoma, cutaneous horn.

Clinical picture: At the beginning of the disease, lip cancer manifests itself in the form of a rough compaction covered with a scab. A roll-shaped rim is formed along the edges of the compaction. As the tumor grows, decay processes occur in it, accompanied by ulceration; secondary infection occurs. Metastasis to the lymph nodes is observed in 10% of cases. The first metastases when the primary tumor is localized in the central part of the lip appear in the mental lymph nodes, and when the primary tumor is located laterally - in the submandibular lymph nodes. Distant metastases are rare. Possible growth of the lower jaw.

Treatment of stage 1 lip cancer (tumor no more than 2 cm) is radiation (intrastitial injection of radioactive needles or short-focus radiotherapy) or cryogenic. Surgical excision of the tumor is rarely used. At stage II (tumor more than 2, but less than 4 cm without metastases), radiation therapy, cryodestruction of the tumor is possible. At Stage III(a tumor within the lip is more than 4 cm or smaller in size, but the lymph nodes on the affected side are palpable) the primary lesion is treated with a combined radiation method, after regression of the tumor a fascia-sheath excision of the cervical tissue is performed on both sides. At stage IV (tumor spread to the bones, tongue, neck, bilateral metastases to the lymph nodes, distant metastases), palliative radiation or chemotherapy is indicated (possibly the use of methotrexate, fluoropropylene, bleomycin, cisplatin).

STOMACH CANCER. Early diagnosis provides the most favorable prognosis. Clinical symptoms of the disease are nonspecific: nausea, vomiting, belching, dysphagia, general weakness, weight loss, anemia, etc. It is important to pay attention to the appearance of these symptoms in previously healthy people and changes in their character with chronic gastritis or peptic ulcer disease. Gastroscopy (with biopsy) and X-ray examination stomach.

Gastric cancer is localized in the upper third (cardinal part and fundus of the stomach), middle third (body of the stomach) or lower third (pyloric part of the stomach). Metastases of stomach cancer often affect regional lymph nodes and the liver. Possible metastasis to the peritoneum (with the development of ascites), to the ovaries (Krukenberg metastases), fatty tissue pelvis (Schnitzler metastases), rarely to the lungs, skin, bones, etc.

There are 4 stages of the disease: stage 1 - tumor diameter no more than 2 cm, germination of only the mucous membrane without visible metastases to the lymph nodes; Stage II - tumor diameter 4-5 cm, germination of the submucosal and muscular layers, there may be regional metastases; Stage III - large tumor size, germination serous membrane, neighboring organs; there are distant metastases. After surgery, the tumor is usually classified using the TNM system.

Treatment. The main method of treatment is surgical, which can be used for localized forms of the disease. Proximal gastrectomy, gastrectomy, subtotal resection, and, in some circumstances, resection of 2/3 of the stomach and combined resection are used. Reduction of clinical symptoms is achieved with palliative operations (gastroenteroanastomosis, esophago-gastroanastomosis, gastrostomy, recanalization with laser).

Clinical improvement in inoperable tumors and metastases can be achieved in 20-40% of patients as a result of chemotherapy. 5-fluorouracil (5-FU) is prescribed alone or as part of drug combinations (5-FU, adriamycin, mitomycin C; 5-FU, cisplatin, adriamycin). Postoperative chemotherapy is not advisable. Radiation therapy is rarely used; as a rule, it is ineffective.

CANCER OF THE GALL TRACT (gallbladder, extrahepatic bile ducts) and MAJOR DUODENAL PAPILLA. Gallbladder cancer usually occurs over the age of 50, more often in women. According to the morphological structure, it is an adenocarcinoma of various differentiation with an infiltrative type of growth, rarely (no more than 15%) - squamous cell carcinoma. The tumor gradually affects the entire bladder, spreading to the liver, cystic and common bile duct, adjacent organs (stomach, duodenum, colon). Metastases of gallbladder cancer are found in the liver, regional lymph nodes, peritoneum, ovaries, and pleura. The disease is diagnosed late (70-90% are inoperable at the time of diagnosis). Early gallbladder cancer is an incidental finding during cholecystectomy for cholelithiasis or cholecystitis. A careful analysis of clinical symptoms, supplemented by examination, contributes to the timely diagnosis of this disease.

The earliest symptom is pain in the right hypochondrium, epigastric region with radiation to the back. Nighttime intensification of pain is typical. Compared to the previous period, in patients with cholecystitis and cholelithiasis, it is possible to detect a change in the nature of pain (constant, intense). Nausea, vomiting, and weight loss are noted. When blockage of the bile ducts occurs, dropsy and empyema of the gallbladder, jaundice, dilatation of the proximal ducts and cholangitis, secondary liver cirrhosis, develop. Bilirubin reaches high levels, the level of alkaline phosphatase and transaminases increases. On palpation, an enlarged dense liver is determined, and sometimes an enlarged gallbladder is palpated. In the absence of blockade of the common bile duct, during intravenous cholegraphy, the so-called disconnected gallbladder is detected. The diagnosis is confirmed by ultrasound and computed x-ray tomography.

Radical surgery, which can rarely be performed, includes, in addition to cholecystectomy, resection of the right lobe of the liver, and sometimes pancreaticoduodenectomy.

Extrahepatic bile duct cancer is most often observed at the age of 60-70 years. In half of the cases, the common bile duct is affected. The tumor is an adenocarcinoma of various differentiated types with an infiltrative type of growth. The tumor grows along the ducts, involving the hepatic vein and artery, portal vein, pancreas, and duodenum. Metastases form in regional lymph nodes and liver. Clinical symptoms and diagnostic methods are the same as for gallbladder cancer. In this case, percutaneous transhepatic cholangiography is very informative, helping to identify the level of tumor location. The diagnosis is confirmed during surgery, but biopsy is often difficult. Radical surgery can rarely be performed, mainly for cancer of the distal common bile duct. At the same time, pancreatoduodenectomy is performed.

Cancer of the major duodenal papilla is represented by a primary tumor (40%) or other tumors growing into this area (bile ducts, duodenum, pancreas). It is difficult to distinguish these tumors, given the similarity of histological structure. Clinical symptoms of cancer of the major duodenal papilla occur early, when the size of the tumor is still small. Rapid ulceration of the tumor is observed. Among the clinical symptoms that distinguish this disease are transient obstructive jaundice, loss of blood in feces, and anemia. The remaining symptoms are characteristic of obstructive jaundice (cholangitis, etc.). Main diagnostic methods are duodenoscopy with biopsy, relaxation duodenography. The prospects for surgical treatment are relatively favorable, given the possibility of early detection of papillary cancer and its slow development. After pancreatoduodenectomy, 30-40% of patients live 5 years without signs of disease.

Various biliodigestive anastomoses or external drainage of the biliary tract to eliminate jaundice have palliative value for inoperable cancer of the gallbladder, biliary tract and major duodenal papilla. Chemotherapy can lead to temporary remission (20-30% of cases). They use 5-fluorouracil, ftorafur, mitomycin C, adriamycin, and sometimes combinations of these drugs.

SKIN CANCER. One of the most common forms of cancer in humans. More common in people over 50 years of age, usually open areas bodies. There are basal cell and squamous cell carcinomas. Rarely is cancer diagnosed from skin appendages (sebaceous, sweat glands, hair follicles). Excessive sun exposure and radiation damage predispose to the development of skin cancer. Precancerous diseases should be considered hyperkeratoses - age-related and resulting from intense ultraviolet radiation, CVD, radiation dermatitis, xeroderma pigmentosum, albinism, chronic ulcers and scars, etc.

Basal cell carcinoma is a round, dense formation that gradually ulcerates and infiltrates the surrounding and underlying tissues. The current is slow. Metastases are extremely rare. Cure occurs in more than 90% of cases.

Squamous cell skin cancer can occur in the form of nodular, ulcerative, infiltrative forms, etc. When benign diseases transform into cancer, an obvious acceleration of the infiltrative process and ulceration occurs. Sometimes the pretumor formation does not change at all, but metastases appear in the lymph nodes. Squamous cell carcinoma progresses slowly, but in late stages regional and distant metastases usually occur. In rare cases, skin cancer develops aggressively (relapses with rapid growth, early metastasis to the lungs, bones and other tissues). Treatment of pre-tumor processes, especially with growth clinical manifestations, significantly reduces the incidence of skin cancer.

Localized skin cancer is treated with surgery or radiation therapy. It is also possible to use tumor cryodestruction. For small superficial skin cancer, ointments with cytostatic drugs (prospidin, colhamine, 5-fluorouracil) are effective. For large tumors and metastases, chemotherapy (bleomycetin, cisplatin, methotrexate) is used. Cure for squamous cell skin cancer is 80-90%. Treatment of skin appendage cancer is only surgical; other methods are ineffective.

SKIN LYMPHOMAS are a group of tumors that develop primarily or predominantly in the skin from T- and B-lymphocytes. In this regard, a distinction is made between cutaneous T-cell lymphomas (T-CCL) and cutaneous B-cell lymphoma (B-CCL).

The clinical picture is characterized by diffuse infiltration of the dermis or the appearance of spots, plaques with blurred boundaries, nodules, and erythroderma.

The diagnosis is made on the basis of histological examination.

Treatment. Depending on the form and stage of the disease, polychemotherapy (SOR, MOR, etc.) is used, less often - monochemotherapy (small doses of chlorobutin) or radiation therapy, which in generalized forms should cover the entire surface of the body.

Kaposi's sarcoma usually affects the skin of the extremities and trunk, less often the lymph nodes, visceral organs, and bones. Can be combined with immunodeficiency states. The current is slow. It manifests itself as the development of multiple exophytic formations on the skin with a tendency to ulceration. Gradually, such tumor nodules merge and form ulcerative surfaces of various sizes that are prone to infection. The underlying structures (soft tissue, bones) are also involved. Treatment uses surgery, radiation therapy, and cytostatic ointments. In advanced cases of the disease, chemotherapy is used (a combination of dactinomycin, vincristine, adriamycin). Combinations including prospidin, cyclophosphamide and some other drugs are also effective. Complete remission is achieved in 70% of cases, but relapses of the disease are not uncommon.

MALIGNANT BONE TUMORS. Among primary malignant tumors, tumors from bone tissue(osteogenic sarcoma, growth sarcoma, chondrosarcoma, malignant giant cell tumor) and non-osseous origin (Ewing's sarcoma, fibrosarcoma, chordoma, angiosarcoma, adamantinoma).

Osteogenic sarcoma occurs more often during the period of bone growth, before the age of 15 years, less often at a later age. There are osteoblastic, chondroblastic and fibroblastic sarcoma. Clinical symptoms develop quickly: pain, difficulty moving, anemia. A characteristic laboratory sign is an increase in alkaline phosphatase. X-rays reveal damage to the metaphysis of the long tubular bones and pelvic bones (97% of cases), less often the tumor is localized in other parts. Precancerous diseases (Paget's disease, osteomyelitis, etc.) precede osteogenic sarcoma in 5% of patients

The diagnosis of osteogenic sarcoma, established by bone x-ray, should be confirmed by tumor biopsy.

Osteogenic sarcoma has a significant tendency to metastasize to the lungs (70-90% of cases); metastases develop rapidly during the first year after diagnosis. Early detection of metastases is facilitated by X-ray tomography and computed tomography of the lungs. Early diagnosis of the disease leads to a reduction in the scope of surgery and, with additional chemotherapy, provides a high chance of cure.

Treatment should be carried out in specialized centers. For osteogenic sarcoma without metastases to the lungs, depending on the size and location of the tumor, limb amputation or bone resection is performed, and if the tumor is located in the pelvic bones or spine, radiation therapy is used. However surgical treatment leads to a cure in only 20% of patients. The main problem is the development of pulmonary metastases. Therefore, postoperative chemotherapy is a mandatory component of complex treatment of osteogenic sarcoma, with a 5-year survival rate reaching 70%. If by the time of diagnosis metastases in the lungs have already developed, in some cases they are removed before chemotherapy begins. This approach significantly increases the effectiveness of chemotherapy, since micrometastases have the greatest sensitivity to cytostatic drugs. An important principle in the treatment of osteogenic sarcoma is the preoperative use of regional or systemic chemotherapy, which aims to reduce tumor size, reduce the risk of additional dissemination during surgery, and have a cytostatic effect on possible existing distant metastases. A modern comprehensive treatment plan for osteogenic sarcoma may have several options. Preoperative chemotherapy is carried out with adriamycin and/or cisplatin (regional or systemic). Additionally, local radiation therapy may be prescribed. 2 weeks after radical surgery, chemotherapy is started with a combination of Adriamycin with cyclophosphamide, vincristine, sarcolysine or high doses of methotrexate with leucovorin, Adriamycin.

Parosteal sarcoma is characterized by slow growth, metastases occur rarely. They get sick at the age of 30-40 years. The distal metaphysis of the femur is most often affected. After surgery, 70-80% of patients recover. If the operation is not radical enough, a relapse of the disease is possible.

Chondrosarcoma occurs at the age of 30-50 years in the pelvic bones, proximal femur, ribs, and humerus. It grows slowly and reaches large sizes. In this case, pain is not always noted, as well as limitation of movements. Metastases to the lungs occur on later stages diseases. Relapses are more common. After radical surgery, 50% of patients recover.

Malignant giant cell tumor arises from a benign one (frequency 10-20%). Affects the epiphyses of long tubular bones. Surgical treatment is highly effective. Metastases to the lungs are rare, and surgery may also be used. When the tumor is localized in the sacrum and pelvic bones, radiation therapy is performed, but cure is achieved less frequently.

Ewing's sarcoma accounts for 15-20% of malignant skeletal tumors. Occurs before the age of 25 years. It primarily affects the diaphyses of long tubular bones and metastasizes to other bones and lungs. Clinical symptoms are pronounced: acute pain, fever, weight loss, leukocytosis, anemia. Radiographs show lytic destruction and reactive bone formation. Radiation therapy is of primary importance in the treatment of the primary tumor; surgery is used in case of contraindications to radiation therapy, incomplete effect and relapse. Meanwhile, radiation therapy, even in combination with surgery, and even more so without it, cures no more than 20% of patients, since the main problem is the formation of distant metastases. Therefore, treatment should always include chemotherapy, which increases patient survival by up to 70%. Chemotherapy regimens include adriamycin, dactinomycin, vinc-ristine and cyclophosphamide. For metastases to the lungs, additional radiation therapy can be used.

Fibrosarcoma is a rare variant of bone sarcoma. After surgery, the 5-year survival rate is 15-40% (depending on the anaplasia of the tumor).

Chordoma is a bone sarcoma of embryonic origin. Occurs at the age of 40-60 years, mainly in the final parts of the spine. It grows slowly, compresses the nerve roots and spinal cord. Metastasizes late and rarely. After surgery, tumor recurrence is possible.

Adamantinoma usually appears in the tibia (90%) in patients over 30 years of age and grows slowly. The operation often leads to the cure of patients.

Primary malignant bone tumors must be differentiated from benign ones (osteoidosteoma, giant cell tumor, osteoma, chondroblastoma, hemangioma, etc.), non-tumor processes (hyperparathyroidism, Paget's disease, fibrous dysplasia, bone cysts, histiocytosis, etc.), metastases of others tumors. Careful analysis of bone radiographs and biopsy are of key importance in diagnosis.

LUNG CANCER. One of the most common localizations of cancer in men and women over the age of 40 years. The risk of developing lung cancer is significantly higher among smokers. Thus, when smoking two or more packs of cigarettes per day, the incidence of lung cancer increases by 15-25 times. Other risk factors include working in asbestos production and exposure to radiation.

Symptoms of lung cancer: cough, bloody sputum, chest pain, repeated episodes of pneumonia and bronchitis; breathing disturbances can be significant with the development of hypoventilation and atelectasis of a lobe or the entire lung. Early forms of lung cancer are asymptomatic, and those that appear later listed symptoms nonspecific for lung cancer. Meanwhile, a clinical analysis of the dynamics of such symptoms is important, since it aims at timely additional examination and identification correct diagnosis. Repeated cytological examination of sputum, radiography of the lungs, bronchoscopy with tumor biopsy, and transthoracic tumor biopsy are important for the diagnosis of lung cancer.

Morphological and radiographic studies provide a differential diagnosis with tuberculosis, chronic pneumonia, adenoma, carcinoid, various benign formations, as well as metastases in lung tumors other localizations.

There are central lung cancer, growing predominantly endo- or peribronchiapically (80% of cases); peripheral cancer; the mediastinal form, miliary carcinosis, etc. are rarely diagnosed. Based on the morphological structure, squamous cell (epidermoid) cancer, adenocarcinoma, small and large cell cancer are distinguished.

Lung cancer metastasizes to the hilar lymph nodes, paratracheal, para-aortic and bifurcation lymph nodes. At later stages of the disease, metastases develop to distant tissues and organs (supraclavicular lymph nodes, bones, liver, brain, lungs, etc.). Small cell cancer is characterized by early metastasis and an aggressive course.

Treatment for non-small cell lung cancer depends on the stage of the disease. Radical surgical intervention (pulmonectomy, lobectomy with removal of regional lymph nodes) can be performed only in 10-20% of patients when lung cancer is diagnosed in the early stages. In locally advanced forms of the disease, an extended pneumonectomy is performed with removal of the bifurcation, tracheobronchial, lower paratracheap and mediastinal lymph nodes, as well as, if necessary, resection of the pericardium, diaphragm, and chest wall. If surgery is not possible due to the extent of the process or due to the presence of contraindications, radiation therapy is performed. An objective effect, accompanied by significant symptomatic improvement, is achieved in 30-40% of patients.

Chemotherapy for inoperable non-small cell lung cancer and metastases is effective in 20-30% of patients. A combination of cyclophosphamide, adriamycin, vincristine or cyclophosphamide, adriamycin and cisplatin is usually used. In addition, 5-fluoro-racil, methotrexate, etoposide, bleomycetin, mitomycin C, and prospidin are used in various combinations.

For small cell lung cancer, the primary task is to assess the extent of the disease, which is achieved by performing skeletal scintigraphy, bone marrow biopsy, liver ultrasound, and computed tomography of the brain. For localized and disseminated forms of the disease, the main treatment method is chemotherapy. Radiation therapy is used as an additional method. Surgery is used very rarely.

For chemotherapy, combinations of cyclophosphamide, Adriamycin, methotrexate or cyclophosphamide, Adriamycin and vincristine, or cisplatin and etopozd are used.

For localized small cell lung cancer, chemotherapy courses are carried out at intervals of 3-4 weeks for 1-1.5 years. Already at the beginning of treatment or after 3-4 courses of chemotherapy, additional radiation therapy (30-40 Gy) can be used on the area where the lung tumor and regional lymph nodes are located. When complete remission is achieved, taking into account the frequency of metastatic lesions of the brain, radiation therapy to the brain (20-30 Gy) is prescribed to prevent the growth of metastases. As a result of complex treatment for localized disease, a significant therapeutic effect is achieved in 90% of patients, complete remission - in 30-50%. Treatment outcomes for disseminated small cell lung cancer are much worse.

TUMORS OF THE UTERUS. Cancer of the uterus. In 75% of cases it is diagnosed in women in menopause, another 18% during pre-menopause, and in 7% under the age of 40 years. Risk factors are obesity, diabetes, hypertension.

The main symptom of uterine cancer is abnormal vaginal bleeding (either during menopause or not during menstruation). Pelvic pain and foul-smelling discharge are signs of late stages of the disease. The main diagnostic method is separate curettage cervical canal and uterine cavity and subsequent histological examination. The cytological diagnostic method is less reliable, as well as hysterography and hysteroscopic examination; denocarcinoma is the main morphological variant (up to 70%; adenoacanthomas and glandular squamous cell carcinomas are also found.

There are three degrees of tumor differentiation (well differentiated, moderately differentiated and

undifferentiated) and 4 stages of its development: Stage I - location of the tumor in the body of the uterus, Stage II - damage to the body and cervix, II! stage - spread to parametric tissue or metastases in the vagina, stage IV - spread beyond the pelvis, invasion of the bladder or rectum.

Treatment is mainly surgical (extirpation of the uterus and appendages and sometimes removal of pelvic lymph nodes). Combined treatment is possible - surgery, and then external irradiation to the area of ​​the vaginal stump, intracavitary gamma therapy. Preoperative radiation therapy is also carried out mainly for stage III. Radiation therapy as an independent method is used for local spread of the tumor process and when surgery is contraindicated. Progestins (oxyprogesterone capronate, Provera, Depot Provera, medroxyprogesterone acetate) are effective for well-differentiated tumors in stages III and IV of the disease. Among the antitumor drugs in the metastatic phases, adriablastin, fluorouracil, methotrexate, ThioTZP can be used.

Prevention - timely treatment of chronic endometrial diseases.

Cervical cancer often arises from the squamous epithelium, less often from the glandular epithelium of the cervical canal. The development of cancer is preceded by three degrees of epidermoid dysplasia (mild, moderate and deep) and carcinoma in situ, in which cancer cells are located between squamous epithelial cells and do not penetrate the basement membrane.

Regular examinations and cytological examination (once every 2 years) help identify precancerous diseases, and their treatment-prevention cancer.

Symptoms of cervical cancer are complaints of watery leucorrhoea, contact or intermenstrual bleeding from the genital tract, pain. When examining the cervix in a speculum or during a bimanual examination, an exophytic tumor is detected (bleeding may occur when touched) or an endophytic form of the disease with ulceration in the area of ​​the external pharynx. A biopsy is of decisive diagnostic importance. In stage III and IV cancer, discharge from the genital tract is putrid in nature.

Treatment depends on the stage of the disease. At stage IA (microinvasive cancer), the uterus and appendages are removed. At stage 1B (cancer is limited to the cervix), remote or intracavitary irradiation is indicated, followed by extended extirpation of the uterus with appendages, or, conversely, surgery is performed first, and then remote gamma therapy. In stage II (involvement of the upper part of the vagina, possible transition to the body of the uterus and infiltration of the parametrium without transition to the pelvic walls), the main method of treatment is radiation. Surgery is rarely used. At stage III (transition to the lower part of the vagina, infiltration of the parametrium with transition to the pelvic bones) it is indicated radiation treatment. Finally, in stage IV (transition to the bladder, rectum or distant metastasis), only palliative radiation is used.

In later stages, it is possible to use chemotherapy treatment (cisplatin, fluorouracil, mitomycin C, bleomycin, spirobromine).

Uterine chorionepithelioma is a malignant trophoblast tumor that occurs during pregnancy or after an abortion. Given the widespread prevalence of abortion, uterine chorionic epithelioma is a common disease. In 50% of cases, uterine chorionepithelioma is preceded by pregnancy, in 25% by spontaneous abortion, and in 25% of cases by induced abortion. Differential diagnosis is made with pelvic mole, which is much more common.

Hydatidiform mole in 5-7% of cases transforms into invasive hydatidiform mole, in 3-5% - into chorionepithelioma. If, after removal of a hydatidiform mole, the level of β-chorionic gonadotropin (R-CG) does not return to normal within 2 months, the presence of a recurrent hydatidiform mole is established, and the risk of developing chorionepithelioma increases to 50%.

Clinical signs of uterine chorionepithelioma: vaginal or uterine bleeding, very high levels of r-CG. Characteristics of clinical symptoms, cytological tests, and ultrasound tomography are important in diagnosis. The course of the disease is aggressive. Fast-growing metastases are detected in the lungs, vagina, liver and other organs.

Early diagnosis is important for treatment prognosis. With favorable prognostic characteristics, it is possible to achieve complete cure and maintain the opportunity to have pregnancy and childbirth in the future. A morphological analysis of the removed trophoblast tissue and mandatory control r-CG until it normalizes in cases of detected hydatidiform mole or when signs of bleeding appear after an abortion or pregnancy in the coming months.

Non-metastatic uterine chorionepithelioma is characterized by the absence of metastases and tumor spread beyond the uterus. Cure occurs in more than 90% of patients without hysterectomy. Regarding the prognosis of treatment, metastatic chorionepithelioma can have favorable characteristics (metastases only to the pelvis and/or lungs; hCG titer in urine less than 100,000 IU/day; treatment started within 4 months from the onset of the disease) and unfavorable (metastases are localized in the pelvis , lungs, as well as in the liver, bones, brain; CG more than 100,000 IU/day; treatment started later than 4 months after diagnosis).

For localized uterine chorionepithelioma, chemotherapy is used (methotrexate -15-20 mg IM or IV daily for 5 days at intervals of 2-4 weeks until complete remission, which is confirmed by 3 normal weekly R-CG tests). If the content of r-CG remains at a high level or increases, combined chemotherapy is performed; if there is no complete effect, hysterectomy is indicated. Similar tactics are used for metastatic chorionepithelioma with favorable prognostic signs. In addition to methotrexate, dactinomycin (10 mg/kg IV daily for 5 days at intervals of 2-3 weeks) has its own therapeutic value. More difficult is the treatment of patients with advanced manifestations of uterine chorionepithelioma. Combinations of methotrexate with dactinomycin, rubomycin or adriamycin are used; in resistant cases, a combination of cisplatin with vinblastine and bleomycetin. The use of one drug, low doses of drugs, long intervals between their administrations contribute to the emergence of resistant cases of the disease. For brain metastases, radiation therapy is used. Chemotherapy with methotrexate is also used for hydatidiform mole in the event of an increase in hCG titer 8 weeks after removal of the uterus.

MESOTHELIOMA. A malignant tumor arising in the pleura or peritoneum. It is observed relatively rarely in medical practice. The risk of the disease is higher in patients with asbestosis. Clinical symptoms are nonspecific. With pleural mesothelioma - chest pain, shortness of breath, cough, accumulation of exudate in the pleural cavity, with peritoneal mosothelioma - abdominal pain, weight loss, swelling determined by palpation of the abdomen, ascites. In addition to various non-tumor diseases, the differential diagnosis is carried out with metastases to the pleura and peritoneum of tumors of various localizations. In the exudate obtained from the pleural or abdominal cavity, malignant mesothelial cells are found (in 50% of cases). However, the diagnosis of mesothelioma is established only with a biopsy performed during thoracic - and laparoscopy, or percutaneous puncture biopsy. Endoscopic examination allows you to see multiple small tumor formations on the pleura and peritoneum. In some cases, a large tumor node is detected (diffuse or diffuse nodular form).

Mesothelioma metastasizes locally; metastases to the liver, lungs, and other organs are rarely found.

Treatment. Surgical treatment is useful only in the presence of large tumor nodes and is aimed at reducing the tumor mass. For small tumor metastases, intracavitary administration of radioactive colloidal gold is used. Radiation therapy to areas of unremovable tumor formations and chemotherapy, in which thiophosphamide (30-40 mg once a week) and adriamycin (50 mg/m2 IV once every 3 weeks) are also administered into the cavities ), cisplatin (100 mg/m2 IV once every 3 weeks) or both drugs at the same time.

MELANOMA. Arises from melanocytes. Most often localized in the skin (90%), rarely in the conjunctiva, choroidal membrane of the eye, mucous membrane of the nose, oral cavity, vagina, rectum.

Melanoma of the skin appears more often between the ages of 30 and 50 years. Risk factors include significant doses of ultraviolet radiation, nevus injuries, family predisposition to melanoma, xeroderma pigmentosum, Dubreuil's melanosis. In 50-70% of cases, skin melanoma arises from pigmented nevi. The most dangerous is borderline (epidermal) nevus. More often found on the skin of the scrotum, palms, soles, it is a flat spot or pigmented nodule about 1 cm in size, not rising above the skin. Less commonly, melanoma develops from intradermal, blue nevi. In large nevi, inclusions of a border nevus are not uncommon.

In 2/3 of cases, the nevus that preceded melanoma developed in adulthood; in 1/3 of cases it was congenital.

The prognosis depends on the timely diagnosis of melanoma. Any changes in the nevus - enlargement, change in color, ulceration, bleeding - require immediate surgical intervention. Similar tactics are recommended for growing new pigmented lesions on previously normal skin. Skin melanoma most often occurs on the scalp, neck, and extremities.

After removal of cutaneous melanoma, factors influencing prognosis can be assessed. A special role is played by the degree of tumor invasion of various layers of the skin, which correlates with the development of metastases. Invasion levels I (in situ), II (involvement of the papillary layer) and partially III (penetration to the reticular layer) characterize the early diagnosis of the disease. Degree IV (penetration into the reticular layer) and V (into the subcutaneous fatty tissue) indicate a late diagnosis. In the early stages of infection, the 5-year survival rate is 60-80%. In addition to the degree of skin invasion, the prognosis of the disease is influenced by the localization of the tumor, the presence of metastases to regional lymph nodes and other factors.

Melanoma metastasizes to the skin, subcutaneous tissue, lungs, liver, brain and other organs and tissues.

The main treatment for localized melanoma is surgery. Regional lymph nodes are removed in cases where they are enlarged. Adjuvant chemotherapy does not improve outcomes.

For disseminated melanoma, chemotherapy is indicated, and regression of tumor formations is observed in 20-40% of patients. The following treatment regimens are most effective: 1) imidazolecarboxamide 200-250 mg/m2 IV daily, 5 days; 2) lomustine 100 mg/m2 orally on the first day in combination with vincristine - 1.2 mg/m2 IV on days 1, 8 and 15 and dactinomycin - 500 mcg IV 3 times a day week, V doses; 3) vinblastine 6 mg/m2 IV on the 1st day in combination with cisplatin - 120 mg/m2 IV on the first day, and bleomycetin - 10 mg IM on days 1-5. The intervals between chemotherapy courses are 4 weeks.

BRAIN TUMORS (BRAIN AND SPINAL) occur in adults and children, most often at the ages of 50-55 and 5-10 years. 70% of all malignant brain tumors in patients over the age of 15 years are glioblastoma and malignant astrocytoma; ependymoma, glioma, oligodendroglioma, and medulloblastoma are less commonly diagnosed. In children, brain tumors rank second among all malignant tumors (after leukemia). 60% of cases are medulloblastoma, astrocytoma and ependymoma, other tumors are less common.

The clinical picture of brain tumors is represented by symptoms of increased intracranial pressure(headache, vomiting, disc swelling optic nerve) and specific neurological disorders, different depending on the location of the tumor. For example, with medulloblastoma there are impaired coordination of movements and various cerebellar disorders. Brain tumors usually metastasize locally; distant metastases are very rare.

The diagnosis of a brain tumor is established by taking into account neurological and clinical symptoms as a result of the use of additional examination methods and clarification during surgery. An increase in pressure and an increase in the content of protein and cellular elements are noted in the cerebrospinal fluid. Computed tomography, echoencephalography, as well as brain scanning, cerebral angiography, etc. are of important diagnostic importance. Differential diagnosis is carried out with brain metastases of tumors of other locations (breast, lung, kidney, melanoma, etc.).

In the spinal cord, extradural tumors (usually metastatic or sarcomas) and intradural tumors are distinguished. The latter are extramedullary (neurofibroma, meningioma, etc.) and intramedullary (ependymoma, astrocytoma, vascular sarcoma).

In the treatment of brain and spinal cord tumors, surgery and radiation therapy are used. Medulloblastoma is most sensitive to radiation therapy. Among the antitumor drugs used in addition to radiation therapy and surgery, the most significant. lomustine (120 mg/m2 orally once every 6-8 weeks) has the same effect. In addition, methotrexate (10-30 mg/m2) intrathecally once a week is used, as well as vincristine, bleomycin (bleomycetin), interferon in standard regimens.

BREAST CANCER develops frequently, affecting approximately 1 in 10 women. Risk factors: menopause over 50 years of age; absence of childbirth or first birth over the age of 30 years (incidence is 3 times more common); family history indicating breast cancer in the mother, sister (2 times more often) or both of them (6 times more often); fibrocystic mastopathy(3-5 times more often). Early diagnosis of breast cancer ensures successful treatment most patients. The five-year survival rate for treatment of localized forms of stage I-II is 90%, for locally advanced cancer - 60%. Treatment results are much worse in the presence of distant metastases.

In diagnosing breast cancer, systematic self-examinations (4 times a year) and medical examinations of women over 40 years of age (once a year) are important. Mammography is recommended once every

2 years after the age of 40, 1 time per year after 50 years. If a dense tumor without clear boundaries is detected in the mammary gland, the diagnosis must be clarified immediately (puncture biopsy with cytological analysis, biopsy with histological analysis). The method of dynamic clinical observation should not be used instead of clarifying diagnostic procedures.

More often, benign formations are found in the mammary glands (diffuse and nodular mastopathy, intraductal papilloma, fibroadenoma). The development of breast cancer from benign formations is an uncommon situation (for example, from fibroadenoma - 1-1.5%), at the same time, erroneous tactics in differentiating from breast cancer are often encountered in practice. With diffuse mastopathy, diffuse thickening and tenderness of the mammary glands are detected, and sometimes there is light discharge from the nipple. With nodular mastopathy, single or multiple compactions of various sizes with unclear contours, not associated with the skin, are determined. Fibroadenomas can be represented by dense, round, lumpy single or multiple tumor nodes of various sizes. Leaf-shaped fibroadenomas are characterized by rapid growth and reach large sizes in a short time. Intraductal papillomas are manifested by bloody discharge from the nipple. The diagnosis is clarified by cytological analysis and intraductal contrast mammopraphy. Breast cysts are round in shape, have clear boundaries, and contain serous fluid.

Symptoms Breast cancer is manifested by the development of a limitedly mobile, dense tumor with slight retraction of the skin above it. In the later stages of the disease, these symptoms are more pronounced; nipple retraction, infiltration and ulceration of the skin, and swelling of the mammary gland in the area of ​​the tumor appear. In addition to the most typical advanced breast cancer, other clinical variants are observed. The edematous-infiltrative form is characterized by an enlargement of the mammary gland due to pronounced edema and infiltration, the skin is thickened and hyperemic, the tumor node may not be detected by palpation and mammography (primary edematous-infiltrative form) or be relatively small in size (secondary form). ric-edematous-infiltrative form). As a variant of this form of breast cancer, mastitis-like or erysipelas-like cancer sometimes develops, manifested by bright hyperemia of the skin, increased temperature and a rapid course of the disease. On the contrary, Paget's type cancer, which arises from the epithelium of large ducts near the nipple, is characterized by slow development. First, thickening, retraction and ulceration of the nipple appears, then a dense tumor node forms in the thickness of the mammary gland.

Breast cancer is classified according to the TNM system. The classification is based on the size of the tumor in the mammary gland and the location of metastases. Metastasizes breast cancer to regional lymph nodes and distant organs and tissues. When cancer is localized in the outer quadrants, the axillary lymph nodes are primarily involved; in the inner quadrants, the retrosternal and subclavian lymph nodes are involved. Possible involvement of supraclavicular and axillary nodes from the opposite side. Enlarged lymph nodes do not always mean they are metastatic. Their increase is possible as a manifestation of hyperplasia. Fact tumor lesion lymph nodes and the number of involved nodes are determined by morphological examination after surgery. Distant metastases of breast cancer occur in the bones, lungs, liver, skin of the chest wall, brain, etc. To clarify the extent of the spread of the disease at the time of diagnosis and during further observation, use skeletal scintigraphy (if necessary, bone radiography), ultrasound examination of the liver , chest radiography, etc.

Important for characterizing breast cancer is the determination of the content of estrogen receptors (ER) and progesterone receptors (PR) in the tumor, which is performed during tumor removal or by biopsy. The tumor is considered dependent on endocrine influences when the content of RE and/or RP-10 fmol/mg protein. The content of hormone receptors in the primary tumor and metastases does not differ significantly. Therefore, the conclusion about the endocrine dependence of the tumor, made in the first stages of the disease, can be taken into account when determining treatment tactics during the development of metastases.

Treatment. For stage I-II breast cancer, the optimal treatment method is surgical - radical mastectomy or sectoral resection with removal of regional lymph nodes. After surgery for early breast cancer, no additional treatment is prescribed. For affected axillary lymph nodes, adjuvant chemotherapy should be performed. In stage III of the disease, preoperative radiation and/or chemotherapy is prescribed, and after surgery, adjuvant drug therapy.

Adjuvant chemotherapy begins 2-3 days after surgery. The most commonly used regimen is CMF (cyclophosphamide - 100 mg/m2 orally, days 1-14 in combination with methotrexate - 40 mg/m2 IV, days 1 and 8 and 5-fluoroura- scrap - 500 mg/m2 IV, days 1 and 8; intervals between courses - 2-3 weeks, number of courses - 6). If the content of RE and/or RP is high during menopause, tamoxifen (20 mg daily for 2 years) is additionally given, and if the menstrual cycle is preserved, oophorectomy is performed, then tamorsifen (20 mg) or prednisolone (10 mg) is used for a long time. In case of menopause for more than 10 years and a high level of ER, adjuvant therapy can be carried out only with tamoxifen.

Preoperative therapy is carried out for locally advanced breast cancer. The CMF regimen or various combinations with the inclusion of Adriamycin are effective; radiation therapy can be prescribed at the same time (course dose 40 Gy). At high levels of RE and RP, tamoxifen is used to turn off ovarian function. The operation is performed 2-3 weeks after the end of radiation therapy.

With the development of distant metastases at various stages of the disease, drug therapy is of primary therapeutic importance. Chemotherapy regimens should include adriamycin: 1) adriamycin (20 mg/m2 IV, days 1, 8 and 15) in combination with methotrexate (20 mg/m2 IV, day 1 ), 5-fluorouracil (500 mg/m2 IV, day 8) and cyclophosphamide (400 mg/m2 IV, day 15); 2) adriamycin (40 mg/m2 IV, day 1) in combination with cyclophosphamide (600 mg/m2 IV, day 1); 3) adriamycin (30 mg/m 2 IV, days 1 and 8) in combination with 5-fluorouracil (500 mg/m 2, days 1 and 8) and cyclophosphamide (100 mg/m m2 orally, days 1-14); 4) adriamycin (60 mg/m2, IV, day 1) and vincristine (1.2 mg/m2, days 1 and 8). Courses of treatment are carried out every 4 weeks. There is no clear evidence of differences in the effectiveness of these regimens.

In case of resistance to CMF and Adriamycin, partial regression can be obtained using mitomycin C, cisplatin, vinblastine. The use of thiophosphamide (20 mg IM 3 times a week for 3 weeks) is of independent importance; however, such treatment significantly reduces hematopoietic reserves. More often, thiophosphamide is injected into the pleural cavity (30-50 mg) after removal of exudate.

Tamoxifon occupies a leading position in endocrine therapy for breast cancer. It is prescribed for positive or unknown receptors orally at 20 mg/day

for a long time. If the effect of tamoxifen is insufficient, it is advisable to use aminostlutetemide (orimetene) - 500 mg / day with cortisone acetate - 50 mg / day daily for a long time. Androgens retain their therapeutic value (testosterone or medrotestron propionate - 100 mg IM daily or every other day; omnadren, proloteston - 3 times a month). With a high level of ER, drug therapy can be started with endocrine drugs, and later supplemented with cytostatic drugs.

Radiation therapy is used for metastases to the bones, brain, skin, as well as for the primary tumor in cases of disseminated form of the disease.

BLADDER CANCER accounts for 3% of all cancer sites. The risk of illness is higher in people who work with aromatic amines, as well as those suffering from chronic cystitis. The most common is transitional cell carcinoma, less common is squamous cell carcinoma and adenocarcinoma. The disease can manifest as papillary growths with malignancy or a solid, ulcerated, invasive tumor. There are bladder cancer in situ, superficial cancer (T1-2) and cancer invading the muscle layer and surrounding tissues (T3-4). In papillary bladder cancer, multicentric growth is often observed. Superficial bladder cancer rarely metastasizes. At further development tumors affect the pelvic (N1-2), retroperitoneal lymph nodes (N3-4), as well as the lungs, liver, and bones.

The first symptom of the disease in 75% of cases is hematuria, the cause of which must be established in each case. Other symptoms of the disease - frequent urination, hydronephrosis, inflammatory complications (cystitis, pyelonephritis).

Diagnosis. Cystoscopy with biopsy is of primary importance among diagnostic methods. Additional diagnostic methods are excretory urography, computed tomography, ultrasound and T. d.

Treatment includes various surgical interventions, radiation and drug therapy. For bladder cancer in situ and superficial stage T1 cancer, transurethral resection of the bladder is used, and for stage T2, partial resection of the bladder. For an invasive tumor of significant size (TZ), cystectomy with or without pelvic lymphadenectomy is recommended. Sometimes chemotherapy and radiation therapy are preferred to such an operation, and then, if necessary, surgery is performed. For stage T4 bladder cancer, involvement of retroperitoneal lymph nodes (LN), and distant metastases, chemotherapy is of primary importance.

Often, intravesical chemotherapy is also advisable in the early stages of the disease in cases of multicentrically growing cancer, and it is advisable to carry out chemotherapy after surgery.

Chemotherapy includes intravesical or systemic administration of cytotoxic drugs. One of the following drugs is administered intravesically (in 100 ml of isotonic sodium chloride solution for 1 hour) (cisplatin 60 mg or adriamycin 80 mg once a month; thiophosphamide 60 mg once a week, 3 doses; mitomycin C 40 mg once a month 2 months). The therapeutic effect is achieved in 50-70% of patients. For systemic treatment, cisplatin (60-100 mg/m2 every 3 weeks) or a combination of cisplatin, adriamycin and 5-fluorouracil (cyclophosphamide) is recommended. Five-year survival rate for stages T 1-2 is 50-80%, stages T3g-4 - 20-30%.

ADRENAL TUMORS. There are benign and malignant adrenal tumors arising from the cortex and medulla. Adenomas with increased secretion of glucocortic acid are localized in the adrenal cortex.

ticoids or aldosterone, in the medulla - pheochromocytoma, producing adrenaline and norepinephrine. Malignant tumors (corticosteroma, pheochromoblastoma, neuroblastoma), as well as adenomas, can be secreting or non-secreting.

In the diagnosis of adrenal tumors, along with a thorough medical history, biochemical and endocrinological studies, ultrasound and computed tomography, angiography are important.

It is difficult to distinguish a benign tumor from a malignant one even with morphological analysis. In both variants, the tumor has a capsule. Signs of malignancy: invasion of the capsule and blood vessels, large tumor size, perverted reaction to the dexamethasone test. Malignant tumors are prone to recurrence, metastases appear in the para-aortic lymph nodes, lungs, liver, and bones.

Adenoma and cancer of the adrenal cortex cause Cushing's syndrome. There is a high level of cortisol in the blood, and significant excretion of ketosteroids in the urine. In case of cancer, the tumor is large, the secretion of cortisol is slightly suppressed after taking dexamethasone.

Apdosteroma is a small tumor (less than 2 cm), manifested by potassium loss and sodium retention, increased blood pressure, thirst, polyuria, and muscle weakness. Malignant aldosteroma is rare and is usually larger than 3-4 cm.

Pheochromocytoma is manifested by increased blood pressure with severe crises and rapidly developing complications (retinopathy, cerebral hemorrhage, etc.). The level of adrenaline, norepinephrine in the blood and their metabolites in the urine is high. In 10-15% of cases, pheochromocytoma develops on both sides.

Treatment. The main treatment method for patients with adrenal tumors is surgery. After removal of the secreting tumor, dynamic laboratory monitoring is necessary. Detection of a new increase in the level of hormones or other active substances helps in the early detection of tumor recurrence and timely reoperation. For malignant corticosteroma, objective and symptomatic improvement is achieved by using o,p-DDD 6-10 g/day, aminoglutethemide 500-1500 mg/day; Replacement therapy is carried out with cortisone acetate.

NEUROBLASTOMAS arise in the sympathetic nerves and ganglia, as well as in the medullary layer of the adrenal glands. Most often they develop in the area of ​​the adrenal glands and underlying tissues, then from the ganglia of the neck, posterior mediastinum, retroperitoneal space and abdominal cavity. This form accounts for up to 10% of all malignant tumors of childhood. 60% of tumors are diagnosed before the age of 1 year, between the 1st and 2nd years of life - 26%, in children over 2 years - 14%.

Neuroblastomas are very malignant tumors that metastasize to the skeleton or liver. Metastases to the lungs are rare. Spontaneous differentiation of this tumor into a benign neuroganglioma is possible. Markers of tumor growth - catecholamines.

Combined treatment - surgery in combination with radiation and chemotherapy (cyclophosphamide, vincristine, adria-ablastine, cisplatin). The average 3-year survival rate is 30%.

TUMORS OF THE NASAL CAVITY AND PARADISE SINUSES are rare (0.5% of all tumors). Squamous cell carcinoma accounts for 80% of cases, and esthesione-roblastoma (from the olfactory neuroepithelium) also occurs.

Symptoms: impaired nasal breathing, swelling of the face, purulent discharge from the nose, displacement of the eyeball, pain. Tumors can be localized in the nasal cavity or maxillary sinuses.

Combined treatment: surgery in combination with radiation and chemotherapy (adriablastine, cisplatin, cyclophosphamide, methotrexate, fluorouracil, proel idine).

NASOPHARYNX TUMORS. Squamous cell carcinoma is the main histological variant of tumors in this zone. There are undifferentiated cancer (30%), lymphosarcoma (see) and lymphoepithepioma.

Symptoms depend on the types of invasion of neighboring organs. Nasopharyngeal cancer can spread down the wall of the pharynx, affecting the soft palate, making the act of swallowing difficult, causing hoarseness and coughing. In 30% of patients the tumor grows into nasal cavity, causing nasal discharge, nasal speech, and difficulty breathing through the nose. When a tumor occurs in the lateral sections, the patency of the auditory (Eustachian) tube is disrupted, and hearing is reduced. When the tumor spreads into the cranial cavity, headaches, diplopia, loss of vision and other symptoms occur.

Final diagnosis installed after surgical biopsy.

The main method of treatment is radiation therapy of the primary lesion and areas of regional metastasis on both sides. Chemotherapy drugs that can be used in advanced stages of the disease include adriablastin, cisplatin with storouracil, cyclophosphamide, methotrexate, prospidine and other drugs.

TUMORS OF THE PARATHYROID GLAND are rare. They are usually benign adenomas, sometimes carcinomas. They are characterized by slow development. Metastasizes to regional lymph nodes, lungs, and liver.

The clinical picture is represented by symptoms of hyperparathyroidism associated with increased release of parathyroid hormone. Laboratory studies reveal hypercalcemia, hypophosphatemia, and increased urinary excretion of calcium and phosphorus. As a result of the resulting resorption of bone tissue, bone pain, deformation, osteoporosis, and fractures occur. Nephrocalcifications are formed, and renal failure subsequently develops. Other manifestations include anorexia, vomiting, neuromuscular disorders, symptoms of pancreatitis, and gastric ulcers.

The diagnosis is established on the basis of data from a study of parathyroid hormone in the blood, ultrasound and computed tomography of the areas where the parathyroid glands are located. Treatment is surgical.

LIVER CANCER accounts for 1-1.5% of all malignant tumors. Hepatocellular cancer develops most often (90%), less often - cholangiocellular cancer (10%). The development of liver cancer can occur with or without previous cirrhosis.

Clinical symptoms vary depending on this. If, against the background of signs of liver cirrhosis, sharp deterioration general condition, rapid loss of body weight, pain in the right hypochondrium, increasing laboratory signs of liver dysfunction, the appearance of ascites, and changes in size focal formations According to ultrasound tomography, it is reasonable to assume liver cancer. In other cases, against the background of a favorable general condition, an enlarged liver is detected upon palpation, and ultrasound and computed tomograms reveal a large tumor with or without small formations (nodular form). Sometimes a large node is not detected (diffuse form). As the disease progresses, intra-abdominal bleeding, jaundice, ascites, and other symptoms may develop.

The diagnosis of liver cancer is made by tumor biopsy (percutaneous, laparoscopic). Important

has a determination of ex-fetoprotein in the blood, the level of which in hepatocellular cancer is high in 70-90% of patients. The extent of the spread of the disease is also determined by angiography. Differential diagnosis is made with metastatic cancer. Liver cancer metastases occur within the organ, less commonly (30-50%) in the periportal lymph nodes, lungs, and bones.

Treatment. For localized liver cancer, liver resection is performed. The five-year survival rate averages 15-30%, the best results are obtained with well-differentiated cancer. Temporary objective and subjective improvement is provided by ligation or embolization hepatic artery. Improvement is also observed with chemotherapy administered through the hepatic artery (5-fluorouracil, Adriamycin, mitomycin C) or systemically intravenously using combinations of Adriamycin -50 mg/m2 on day 1 and 5-fluorouracil -600 mg/m2 on days 1 and 8; carminomycin - 18 mg/m2 on the 1st day and bleomycetin - 10-15 mg every other day, 5 doses.

ESOPHAGAL CANCER is usually diagnosed at the age of 55 years and older, and is 3 times more common in men than in women. Russia is characterized by uneven incidence in different republics: the highest is in Kazakhstan, Turkmenistan, and Uzbekistan.

The main histological form is squamous cell carcinoma. Malignant tumors are preceded by chronic esophagitis, peptic ulcers, chemical and thermal burns. The systematic consumption of very hot food, microburns and microtraumas of the esophagus, the influence of aflatoxins, nitrosamines, alcohol, and lack of vitamins A and C are also of etiological significance.

Esophageal cancer can be ulcerative, warty-papillomatous and infiltrating. Most often, tumors are localized in the middle third of the esophagus (60%), then in the lower third (30%), and least often in the cervical region.

Symptoms: dysphagia (first there is difficulty swallowing solid food, then semi-liquid and liquid; dysphagia progresses continuously), pain (also during swallowing), salivation (more often with the upper cervical and upper thoracic localization of cancer), weight loss and dehydration.

X-ray and endoscopic examination can reveal the level of narrowing of the esophagus, determine the size of the tumor, and the presence of ulceration. The final diagnosis is made after a biopsy. Patients die both from complications associated with the primary tumor (perforation causing mediastinitis, exhaustion) and from distant metastases (lymph nodes, lungs, liver).

Treatment. The main method of treatment is surgical or combined (radiation therapy in combination with surgery). Palliative operations such as gastrostomy can be performed. Beam method single treatment is also possible. When carrying out chemotherapy, adriablastine, fluorouracil, methotrexate, cisplatin, bleomycin, and prospidine are used.

PANCREAS CANCER occupies one of the first places among malignant tumors in terms of frequency of occurrence. The risk of the disease is present after 30 years of age with a peak after 70 years of age. There are cancers of the head, body and tail of the pancreas. Mostly ductal cancer (adenocarcinoma) develops. The tumor is localized in the head of the gland in 75% of cases. Rapid compression or growth of the common bile duct leads to obstructive jaundice. A tumor of the head of the gland is characterized by Courvoisier's triad (an enlarged, painless gallbladder in the presence of jaundice). In this case, dilation of the bile ducts and enlargement of the liver also occur. When a tumor grows into the duodenum or stomach, bleeding or stenosis may develop.

The first symptom of the disease is pain in the epigastric region and hypochondrium, sometimes radiating to the back, with increasing intensity at night. In addition, a progressive decrease in body weight without a clear reason is characteristic. With the appearance of jaundice, nausea, vomiting, diarrhea intensify, and symptoms of cholangitis, etc. may occur.

Cancer of the gland body quickly grows into the superior mesenteric veins and arteries, and the portal vein. Jaundice occurs rarely. Sometimes (10-20%) diabetes mellitus develops due to the destruction of β-cells.

A tumor of the tail of the pancreas often invades the portal vein and splenic vessels, which leads to the development of portal hypertension with splenomegapy and other characteristic symptoms. When the tumor is localized in the tail and body of the gland, the pain syndrome is especially pronounced due to the tumor growing into numerous nerve plexuses surrounding the gland. Pancreatic cancer metastasizes early, often to regional lymph nodes and the liver. Metastasis is also possible V lungs, bones, peritoneum, pleura, adrenal glands, etc.

Early diagnosis is extremely difficult, especially for cancer of the body and tail of the pancreas. Almost 70% of patients are diagnosed late. The results of treatment of such patients are therefore very poor.

In the diagnosis of the disease, a decisive role belongs to modern methods of instrumental research: ultrasound and computed x-ray tomography, endoscopic, retrograde pancreatography, angiography, relaxation duodenography.

In some cases, despite the use of the listed diagnostic procedures, significant difficulties arise in the differential diagnosis with some forms of chronic pancreatitis. In such a situation, the final diagnosis is made on the basis of a cytological and histological examination of biopsy material obtained during a diagnostic puncture (under ultrasound and X-ray tomographic control) or during operation time.

Treatment of pancreatic cancer is surgical. For head cancer, radical surgery (pancreaticoduodenal resection) is possible only in 10-25% of patients. To eliminate jaundice, palliative operations (cholecystojejunostomy, etc.) are used. Radiation therapy is ineffective. Among the effective antitumor drugs are 5-fluorouracil (15 mg/kg IV every other day, 3-5 doses), ftorafur (1.2-2 g orally daily for 3-4 weeks), 5-fluorouracil in combination with metomycin C and adriamycin. After treatment, temporary remissions were observed in 20-40% of patients.

PANCREATIC TUMORS FROM THE ISLANDS OF LANGERHANS most often represent adenomas (up to 90%). The characterization of a tumor as malignant is based not on the data of a morphological study (tumor growths are highly differentiated), but on the fact of the occurrence of metastases, which are often localized in the liver, sometimes in the lungs, bones, and brain. 20% of islet tumors are characterized by endocrine secretion, which largely determines the clinical picture of the disease. The size of the tumor is often less than 2 cm, while the level of endocrine secretion does not depend on the size of the tumor. Thus, secreting adenomas can be diagnosed early. Islet tumors have different clinical characteristics depending on the cellular source of the tumor (a- or beta-cells, other elements). Thus, a tumor from a-cells secretes glucagon and leads to hyperglycemia and dermatitis. A tumor of β-cells (insuloma) secretes insulin and leads to severe hypoglycemic crises. In other cases, gastritis is released and the syndrome develops

Zollinger-Ellison (severe gastric hypersecretion, ulcers of the stomach, duodenum and jejunum). Tumors that secrete serotonin (carcinoid) lead to carcinoid syndrome. Tumor release of ACTH causes Cushing's syndrome.

The clinical course of islet tumors is slow.

Treatment is surgical (pancreatic resection). However, in the presence of metastases, surgery is ineffective. Antitumor drugs provide a good symptomatic effect in 30% of cases (5-fluorouracil - 500 mg IV and streptozotocin -1000 mg IV, days 1-5).

PENIS CANCER is a relatively rare disease. It can develop against the background of precancerous diseases (leukoplakia, Queyrat's erythroplasia, etc.). In almost all cases, squamous cell carcinoma develops with a high degree of differentiation. The body of the penis is usually affected; the urethra is rarely involved. Metastases form on both sides in the inguinal, pelvic and retroperitoneal lymph nodes, lungs. Tumor growths develop slowly, then ulceration, bleeding, inflammatory complications occur, and phimosis occurs.

The diagnosis is established by cytological examination of prints or punctate from the tumor, as well as by histological examination of a biopsy. The diagnosis is often made with a long delay due to late presentation of the patient, and therefore information about the possibility of curing penile cancer in the early stages and preventive examinations are extremely important.

Stage of the disease: Stage I - localized tumor without metastases. Removal of the tumor within healthy tissue or radiation therapy is highly effective. After irradiation, narrowing of the urethra, skin changes, and atrophy may develop. Relapse of the disease occurs rarely. After 5 years, 90% of patients are healthy. Stage II is characterized by the presence of metastases in the lymph nodes. The treatment is similar; in addition, radiation therapy is administered to the inguinal and pelvic lymph nodes. Subsequently, local relapse rarely occurs, but metastases can develop. Five-year survival rate is 30%. Stage III-IV - inoperable primary tumor with or without metastases to lymphatic and other organs and tissues. Removal of the penis, radiation therapy and chemotherapy are palliative (treatment regimens are similar to those used for advanced skin cancer).

CANCER OF THE KIDNEY AND URETER. Kidney cancer can originate from the renal parenchyma (renal cell carcinoma, hypernephroma) and from the epithelium of the renal pelvis (adenocarcinoma).

Renal cell kidney cancer occurs most often after the age of 50 years. The tumor can reach large sizes, grows into the kidney capsule, renal and inferior vena cava, metastasizes to the lymph nodes, lungs, bones, and liver. The first sign of the disease is often massive hematuria (in 40-70% of patients). Hematuria in the future with inoperable kidney cancer becomes a significant severe manifestation of the disease, leading to severe anemia. During the period of hematuria, pain intensifies and symptoms of renal colic appear. Another early symptom is an increase in body temperature in the afternoon to 38-39 °C. All episodes of hematuria should be carefully analyzed through a detailed examination. In every case of unexplained increase in temperature with evening rises, you should remember the possibility of developing kidney cancer. This doctor’s approach to the first episode of massive hematuria, to a temperature reaction that persists for more than 1 month, is a real way to earlier detection of kidney cancer. Other symptoms include detection of a tumor upon palpation, varicocele on the right, which is a sign of tumor invasion of venous vessels, increased ESR, and sometimes (in 2% of cases) an increase in the number of red blood cells and hemoglobin due to the secretion of erythropoietin by the tumor.

The diagnosis is made by intravenous and retrograde pyelography, ultrasound and computed tomography. However, selective renal angiography is of primary importance in diagnosis. The extent of the spread of the disease is determined by radiography and scintigraphy of the lungs and skeletal bones.

Treatment. For localized renal cell carcinoma, the kidneys undergo nephrectomy, after which the 5-year survival rate is 40-70%. Nephrectomy is also performed in the presence of metastases in the lungs and sometimes in the bones. An indication for surgery in such a situation may be the possibility of removing large tumor, relieving the patient of painful symptoms (hematuria, pain).

Drug therapy is sometimes effective. Use fluorobenzotef - 40 mg IV 3 times a week for 2-3 weeks; tamoxifen - 20 mg/day for a long time. The effectiveness of reaferon (interferon o^) (3,000,000 units intramuscularly daily, 10 days, interval 3 weeks) has been established for metastases to the lungs. Tumor regression or long-term stabilization of the disease occurs in 40% of patients with small pulmonary metastases. Therefore, after nephrectomy, patients should be closely monitored with chest radiography every 3 months for 2 years. With early detection of metastases, one can be more confident in the success of treatment.

Renal pelvic cancer accounts for 7% of all kidney tumors. Papillary adenocarcinoma of the pelvis is characterized by morphological heterogeneity, in which it is similar to bladder cancer.

The diagnosis is often difficult. The main symptoms are hematuria, minor or massive, attacks of renal colic. General signs of the disease, so often found in renal cell carcinoma, are less common in renal cell carcinoma. For diagnosis, intravenous and retrograde pyelography is used, which reveals a filling defect in the pelvis, as well as ultrasound and computed x-ray tomography. Angiography is not very informative. Differential diagnosis is carried out with tuberculosis, urolithiasis, pyelitis. Detection of a filling defect in the pelvis during X-ray examination in a patient aged 60-70 years, who had not previously suffered kidney stones and having had the first episode of hematuria, will give reason to assume cancer of the renal pelvis.

Ureteral cancer is morphologically similar to the structure of bladder cancer. More often it affects the lower third, manifested by lower back pain and hematuria. Leads to blockage of the ureter with the development of atrophy or hydronephrosis of the kidney. Infiltrates the submucosal and muscular layer, and lymphogenous and hematogenous metastases occur.

The diagnosis is made by X-ray (including computed tomography), endoscopic and ultrasound examination.

Cancerous and ureteral tumors are very aggressively metastasizing tumors (metastasizes to the liver, lymph nodes, lungs, brain, bones and other organs).

Treatment in the early stages is surgical. Removal of the kidney and ureter is mandatory. When the process is disseminated, it is possible to use broad-spectrum drugs - cisplatin, adriamycin, vincristine, bleomycin, fluorouracil.

PROSTATE CANCER is one of the first places in men in terms of incidence. Most often diagnosed over the age of 60 years. It is an adenocarcinoma of various differentiation. The tumor secretes mucin-containing sialic acid and contains acid phosphatase and (3-glucuronidase. Differential diagnosis is carried out with prostate adenoma. The adenoma has clear contours, low density, and is characterized by slow growth. Cancer is manifested by the development of a dense node infiltrating the adjacent tissue of the gland, the base of the bladder, lateral walls of the pelvis. Metastases of prostate cancer are found in the regional pelvic and retroperitoneal lymph nodes. Distant metastases are determined in the bones, and primarily damage to the pelvic bones is characteristic. Metastases are of the osteoblastic type or in combination with osteolytic ones. Metastases may appear in the lungs and other organs In the early stages, prostate cancer manifests itself only locally, metastases cannot be detected.

Clinical signs are nonspecific. There is an increased urge to urinate, especially at night; difficulty starting urination, blood in the urine, painful sensations etc.

Diagnosis is made by biopsy. However, an assumption about the diagnosis can be made based on palpation of the gland during rectal examination and ultrasound tomography.

Stage I: there are no clinical manifestations, the diagnosis is made by chance during a morphological examination of removed adenomas.

Stage II: there are no urinary problems or other signs of illness; a rectal examination reveals a dense nodule in the gland; diagnosis is made by biopsy; metastases at this stage are rare.

Stage III: frequent urination, hematuria, other symptoms; the tumor grows into the seminal vesicles, the base of the bladder and the side walls of the pelvis; a biopsy confirms the diagnosis; in half of the cases metastases are found in the pelvic and peritoneal lymph nodes,

Stage IV: often a large tumor with severe dysuric disorders; The main characteristic feature of this stage is the presence of metastases in the bones and/or other organs. In serum in 70% of cases a high level of acid phosphatase is detected.

Treatment. Cure is possible only for small, localized tumors. In other cases, modern treatment provides a reduction or elimination of clinical signs of the disease, a temporary objective effect in 60-80% of patients; The 5-year survival rate for stages I-II is 85%, stage III -50%, stage IV - 20%. This dictates the need for early detection of the disease, which is facilitated by a preventive (once a year) rectal examination, which must be performed for every man over 40 years of age. For localized tumors, radical prostatectomy is used. If stage I is detected in a removed adenoma, additional prostatectomy is usually unnecessary. Additional hormonal treatment not prescribed for stages I-II. At stages III-IV, orchiectomy is recommended in combination with or without estrogen hormone therapy. The administration of estrogens (synestrol, fosfestrol, diethylstilbestrol, chlorotrianizene, etc.), which do not increase survival and at the same time (with high doses and long-term use) cause an increase in the incidence of cardiovascular complications (cerebral stroke, myocardial infarction, thromboemboembolism). lia, circulatory failure), advisable only for severe urination disorders, intense bone pain, etc. For long-term use, diethylstilbestrol 5 mg/day (chlorotrianisene - 48-72 mg/day) is recommended, sometimes in combination with prednisolone -

10 mg/day. Radiation therapy to the prostate area, as well as to areas of metastatic bone damage with severe pain and the threat of compression, has palliative value. As a method of endocrine treatment, irradiation of the pituitary gland is used to turn off its function.

CANCER OF THE ORAL MUCOSA. This group includes malignant tumors that arise V tongue, mucous membrane of the cheek, floor of the mouth, alveolar edges of the lower and upper jaw, in the hard and soft palate, anterior palatine arches. The most common histological variant of a malignant tumor is squamous cell keratinizing carcinoma. Tumors in this area are more common in men. Pre-tumor processes - Bowen's disease, verrucous leukoplakia, papillomatosis, consequences of lupus erythematosus.

Clinical picture. The first clinical manifestations are painless nodules, superficial erosions and cracks, gradually enlarging. Then there is pain radiating to the ear, salivation, bleeding, and bad breath. Cancer of the mucous membrane of the posterior half of the oral cavity is more malignant and infiltrates faster neighboring organs and fabrics.

Tumors can have an exophytic (ulcers with a tumor ridge along the edges or mushroom-shaped growths) or an endophytic form (infiltrates, the boundaries of which are difficult to determine).

Cancer of the oral mucosa widely metastasizes to the superficial and deep lymph nodes of the neck. Distant metastases occur in 1-5% of cases. Treatment is divided into two stages: targeting the primary tumor and treating regional metastases.

Combined treatment. First, preoperative gamma therapy is performed, followed by removal of the primary tumor by fascial-sheath excision of the fatty tissue of the neck. In generalized forms of the disease, it is possible to use chemotherapy drugs (cisplatin, fluorouracil, methotrexate, bleomycin).

MALIGNANT TUMORS OF THE OROPHARYNX combine tumors of the palatine tonsils, the root of the tongue and the posterior wall of the pharynx. Squamous cell carcinoma predominates; lymphoepitheliomas and undifferentiated forms of cancer also occur.

The first symptoms of the disease are persistent pain radiating into the ear and difficulty swallowing. Sometimes the patient discovers a dense, lumpy tumor in the tonsils. The timbre of the voice may change due to damage to the soft palate.

Tumors of the oropharynx aggressively metastasize to the submandibular and mandibular lymph nodes.

The main method of treatment is radiation therapy. Surgery is warranted for small tumors as an adjunct to radiation therapy. For common forms of the disease, chemotherapy (cisplatin, adriamycin, fluorouracil, methotrexate, bleomycin, spirobromine, prospidin, etc.) is advisable.

CANCER OF SALIVARY GLANDS. Malignant tumors most often occur in the parotid gland, less often in the submandibular and sublingual glands. Cypindromas (adenocystic carcinoma), adenocarcinoma, and less commonly epidermoid carcinomas and poorly differentiated cancer predominate.

The cylinders have a dense capsule, are poorly displaced, grow slowly, cause severe pain, paralysis of facial muscles. This tumor is characterized by hematogenous metastasis (to the lungs, bones). In 10% of patients, metastases to the cervical lymph nodes are observed. Malignant tumors, which are characterized by a different histological structure, grow quickly and lack clear boundaries.

tumor, the skin and subcutaneous tissue are infiltrated. The process involves the facial and other nerves. In 50% of patients, metastasis to the cervical lymph nodes is observed.

Cancer salivary glands may also arise as a result of malignancy of a long-existing mixed tumor of this organ.

Treatment. The leading method is the surgical method. Tumors of this localization are radioresistant. Antitumor drugs that can be used are cisplatin, adriablastine, fluorouracil and methotrexate.

SOFT TISSUE SARCOMAS. Depending on the source of origin in soft tissues, fibrosarcoma, mesenchymoma, liposarcoma, histiocytoma, leiomyosarcoma, rhabdomyosarcoma, synovial sarcoma, angiosarcoma, lymphangiosarcoma, hemangiopericytoma, malignant schwannoma and neurilemma are distinguished. The tumor can be located in the soft tissues of the extremities, trunk, retroperitoneum and other areas of the body. Soft tissue sarcomas account for 1% of all malignant tumors. Early diagnosis is important for prognosis. If a soft tissue tumor is detected, the dynamic observation method should not be used. Errors in diagnosis are common, and the time to establish a diagnosis is often delayed for 6-12 months. A biopsy or tumor removal is necessary.

Soft tissue sarcomas tend to recur after surgery, especially when the size is more than 5 cm and the tumor is poorly differentiated. Distant metastases appear in the lungs, less often in other organs. Metastases in regional lymph nodes are diagnosed only in 5-20% of patients. Differential diagnosis is carried out with benign tumors, which are much more common than malignant ones, but their transformation is rare.

The diagnosis is based on morphological examination data (fibroma, lipoma, leiomyoma, rhabdomyoma, etc.).

Treatment. The main method of treatment is surgical. Wide removal of tissue adjacent to the tumor is important. To reduce the risk of tumor recurrence after surgery, radiation therapy is used; embryonal rhabdomyosarcomas are more sensitive. Chemotherapy with or without radiation therapy is used for inoperable tumors and metastases. Chemotherapy regimens: 1) cyclophosphamide-500 mg/m2 IV in combination with adriamycin - 50 mg/m2 IV on day 1, Vinc-ristine - 1 mg/m2 IV on days 1 and 5 days and imidazolecarboxami-dom - 250 mg/m2 IV on days 1-5; 2) carminomycin - 6 mg/m2 IV on days 1, 8 and 15 in combination with vincristine - 1 mg/m2 (or methotrexate - 20 mg/m2) IV on the same days and cyclophosphan - 250 mg/m2 IV 3 times a week, 6 doses; 3) cyclofoo fan - 500 mg/m2 in combination with adriamycin - 50 mg/m2 on day 1, vincristine - 1 mg/m2 IV on days 1 and 5 and dactinomycin - 0. 3 mg/m2 IV on days 3-5; 4) adriamycin - 60 mg/m2 on day 1 in combination with cyclophosphamide - 600 mg/m2 on day 2 and cisplatin - 100 mg/m2 on day 3 intravenously.

In case of single metastases in the lungs, surgical removal can be performed, the feasibility of which is more justified when there is a large interval from removal of the primary tumor to the detection of metastases in the lungs and their slow growth. Five-year survival rate for soft tissue sarcomas ranges from 20 to 80% depending on the morphological structure and differentiated tumor, its size and location.

RHABDOMYOSARCOMA IN CHILDREN. The most common form of soft tissue sarcoma in pediatric practice. There are 3 histological variants: embryonic, alveolar and polymorphic. Most often occurs between the ages of 2 and 6 years in the following order: head and neck, prostate gland, bladder and vagina. In adolescence

Those malignant tumors of this structure are found on the extremities, testicles and paratesticular tissue.

Surgical removal is performed for small tumors. Rhabdomyosarcomas, especially embryonal ones, are radiosensitive tumors, so radiation therapy is an essential component of combined treatment. Chemotherapy drugs are prescribed in combinations: vin-cristine, cyclophosphamide, dactinomycin, adriamycin, cisplatin.

As a result of complex treatment (surgery, radiation and chemotherapy), the 3-year survival rate is 60%.

CANCER OF THE COLON (COLON AND RECTAL). In recent years, there has been a significant increase in the incidence of colorectal cancer. Adenomas, diffuse polyposis and ulcerative colitis increase the risk of developing cancer and are considered pre-tumor diseases. Thus, malignancy with diffuse polyposis occurs in almost 100% of cases.

Localization of cancer colon may be different - in the ascending, transverse colon, descending, sigmoid colon. Rectal cancer is located in the anal, lower, middle, upper ampullary and rectosigmoid regions. The tumor grows predominantly exophytically (into the intestinal lumen) or endophytically (into the thickness of the intestinal wall). Adenocarcinomas are more often diagnosed; rarely the tumor has the structure of signet ring cell, undifferentiated or squamous cell carcinoma. Metastasizes colorectal cancer to regional lymph nodes, liver, lungs, and sometimes to other organs. The classification of this disease is carried out according to the TNM system, specifying the depth of tumor growth into the intestinal wall and based on data from the study of surgical material.

Clinical picture: discharge from the intestine of blood mixed with mucus and pus, defecation rhythm disorders (diarrhea and constipation, tenesmus), abdominal pain, general weakness, weight loss, fever, anemia, etc. Clinical symptoms vary depending on the location of the tumor . At initial stages disease manifestations may be insignificant (dyspeptic symptoms, anemia due to hidden blood loss, etc.). Subsequently, the signs of the disease increase, in severe cases intestinal obstruction, bleeding, inflammatory complications (abscess, phlegmon, peritonitis) are observed. In case of rectal cancer, the tumor can grow into the bladder, vagina with the development of fistulas, cause compression of the ureters, etc.

The diagnosis of colon and rectal cancer in the early stages is based on data from finger rectal examination, irrigoscopy, sigmoidoscopy and colonoscopy (with biopsy). Patients in risk groups are subject to dispensary observation. In other cases, patients are selected for examination after analyzing clinical symptoms, obtaining the results of a stool test for the presence of blood, and determining carcinoembryonic antigen in the blood. To exclude liver metastases, ultrasound tomography is performed.

Treatment. The main method of treatment for colorectal cancer is surgical. After radical operations, the 5-year survival rate is 50-60%. For colon cancer, a right or left hemicolectomy is performed. When the tumor is localized in the distal third sigmoid colon perform its resection. In case of rectal cancer, an operation is performed to remove the closure apparatus (abdominal-perineal extirpation with colostomy) or preserve it (abdominal-anal resection with or without colon reduction, anterior resection, Hartmann's operation). Palliative surgeries can

reduce the manifestations of the disease (intestinal bypass, colostomy for obstruction; palliative resection for liver metastases; ligation or embolization of the hepatic artery, etc.).

Radiation therapy can cause partial regression of the tumor. It is most often used for primary and recurrent rectal cancer. Chemotherapy is used only in cases of inoperable tumor and metastases. It is effective in 20-40% of patients. The most commonly prescribed drug is fluoride-fur. Combinations of fluorafura or 5-fluoro-uracil with other drugs (mitomycin C, lomustine, adriamycin, cisplatin) are more effective.

MALIGNANT TUMORS OF THE SMALL INTESTINE (carcinoid, cancer, leiomyosarcoma) are rare. Carcinoid is most often localized in the terminal ileum, is small in size, and develops slowly. In the absence of serotonin secretion, clinical symptoms are mild (diarrhea, weight loss). As the tumor enlarges, abdominal pain and symptoms of partial intestinal obstruction gradually appear. The period from the onset of symptoms to diagnosis can be several years. Carcinoid syndrome In addition to diarrhea, it is manifested by redness of the face and torso, high content in urine 5-hydroxyindoleacetic acid. The incidence of carcinoid syndrome is 10-30%. Metastases of malignant carcinoid occur in the abdominal cavity, regional lymph nodes and liver. Sometimes metastases appear after many years. The main method of treatment is surgical. The five-year survival rate after radical surgery is 90%, and the 10-year survival rate is 75%. In the presence of metastases in the abdominal cavity and lymph nodes, the 5-year survival rate is 57%, with metastases in the liver - 31%. Chemotherapy can be effective (steptozotocin - 500 mg/m2 IV on days 1-5 in combination with 5-fluorouracil - 325 mg/m2 intravenously on days 1-5).

Adenocarcinoma is most often localized in the duodenum and jejunum. It is manifested by intestinal bleeding, pain, weight loss, diarrhea and fever are less common. Treatment is surgical.

Leiomyosarcoma can reach large sizes and is localized in the duodenum and jejunum. Manifested by pain and intestinal bleeding. Radical surgery cures 40% of patients. When differentially diagnosing tumors of the small intestine, one must remember the possibility of developing lymphosarcoma and inflammatory diseases.

THYROID CANCER accounts for about 1% of all tumors. It occurs 2 times more often in women than in men. Average age onset of the disease at 43-44 years of age. Histologically, palillary cancer is the most common (60-70%), follicular cancer accounts for up to 30%; Anaplastic and medullary cancer is rarely detected. For papillary and follicular cancer, the main symptoms are the identification of a solitary node in the thickness of the thyroid gland. With anaplastic cancer, symptoms are most often associated with compression of neighboring organs and tissues - dysphagia, shortness of breath, hoarseness, pain, enlarged gland. With papillary cancer, regional metastases more often develop, with follicular cancer, distant metastases develop, and undifferentiated cancer develops in a gaping manner with generalization of metastasis. Medullary cancer is a highly malignant form that leads to early metastasis. When making a diagnosis, importance is attached to cytological examination, radioisotope scanning, arteriography, and determination of tumor markers (calcitonin for medullary cancer).

Treatment is surgical, radiation, and the use of radioactive iodine. Chemotherapy drugs that can be used include adri-ablastine, fluorouracil, and cisplatin.

MALIGNANT TESTICAL TUMORS account for about 1% of all tumors in men. They occur with a frequency of 20-25 per 1 million men, most often at the age of 20-35 years. Factors predisposing to the occurrence of tumors are cryptorchidism, late descent of the testicle (after 6 years), and trauma. There are germ cell tumors (95%) arising from the seminiferous epithelium, and non-germ cell tumors arising from hormone-producing cells and from the stroma (5%).

Germ cell tumors - seminomas (40%) and non-seminomas (embryonic cancer, teratoma, chorionepithelioma, yolk sac tumor). Non-seminoma tumors are often mixed in nature, consisting of different components, including seminoma. Seminomas are more often found in people over 30 years of age, non-seminomas - from 20 to 36 years.

Symptoms of testicular tumors are painless, gradually increasing induration. The main symptoms are associated with metastasis to the retroperitoneal lymph nodes (patients experience excruciating pain in the lower back) and lungs, which leads to cough and hemoptysis. Gynecomastia is often observed. In a biochemical blood test, a-fetoprotein is detected in non-seminoma tumors. With testicular chorionic pitelioma, the content of human chorionic gonadotropin increases in the urine. Intravenous urography, ultrasound examination of the retroperitoneal space, computed tomography, angiography make it possible to establish metastases in the retroperitoneal space.

Treatment of patients begins with orchiofuniculectomy. After histological examination of the tumor, treatment tactics may be different. In case of seminoma without metastases, we can limit ourselves to removing the primary tumor focus. In the presence of retroperitoneal metastases, radiation therapy is carried out according to a radical program. If metastases are detected in the lungs or other organs, chemotherapy (sarcolysine, cyclophosphamide, cisplatin, vinblastine) is indicated.

In patients with non-seminoma tumors, in case of suspicion after orchiofunicupectomy for retroperitoneal metastases, they are surgically removed on both sides, after which chemotherapy is prescribed (cisplatin, bleomycin and vinblastine, dactinomycin, adriamycin, olivomycin). If it is impossible to remove retroperitoneal metastases, 5-6 courses of chemotherapy are carried out according to the above regimen. If the patient still has metastases after chemotherapy, they are removed surgically. This treatment can cure 70-80% of patients. Non-germ tumors are less malignant and are mainly treated surgically.

OVARIAN CANCER. The most common are serous, mucinous and endometrioid malignant tumors of the ovary. Serous cancer usually develops from cilioepithelial languor and is characterized by the accumulation of serous fluid inside mapped cystic formations. When the capsule grows and metastasizes, ascites is formed. Mucinous cancer is manifested by the development of tumor formations containing mucus; with a breakthrough into the abdominal cavity, pseudomyxoma peritonei develops. Endometrioid cancer is a dense tumor, which, according to its morphological structure, is glandular cancer with foci of squamous epithelium. Serous cancer occurs more often at the age of 40-60 years, mucinous - after 60 years, and endometrial cancer - up to 30 years. In 40-70% of cases, a malignant tumor affects both ovaries. Metastasis of these forms of ovarian cancer occurs in the abdominal cavity (through the peritoneum, into the omentum). Metastatic ascites and pleurisy may develop. Metastases to the liver, lungs, and other organs occur relatively rarely. Recurrence of ovarian cancer is most often localized in the pelvic area.

Diagnosis. Timely diagnosis largely determines the success of modern treatment for ovarian cancer. Unfortunately, to date, in 60-80% of patients, the diagnosis is made at the stage of tumor dissemination. Regular examinations by a gynecologist are important. With such an examination, a round, often mobile ovarian tumor with a tendency to grow can be found. The examination data can be clarified with ultrasound tomography. The question of the presence of a benign or malignant tumor usually remains unclear, but indications for surgical intervention in such cases are obvious. In later stages of the disease, there is dissemination throughout the peritoneum and pleura, ascites and pleurisy develop. Laparoscopy with biopsy for morphological analysis, as well as cytological study of exudate, are of diagnostic importance. Clinical examination in such cases involves excluding metastasis to the ovaries and abdominal cavity of tumors of other locations (from the stomach, intestines, pancreas).

Surgery and chemotherapy are used to treat ovarian cancer. In case of a localized form of the disease, the uterus with appendages is removed and the greater omentum is resected. For disseminated ovarian cancer, palliative surgery is used, the purpose of which is to reduce the tumor mass before chemotherapy. The use of chemotherapy for ovarian cancer, which improves treatment results in the localized form of the disease, takes a leading place in the disseminated nature of the tumor. Chemotherapy can also be used in the preoperative period in order to reduce the manifestations of the disease and increase the scope of subsequent surgery. The most effective combination is cispatin with cyclophosphamide and adriamycin; weakened patients are prescribed cyclophosphamide or thiophosphamide. The intervals between courses should not exceed 3-4 weeks. In the absence of clinical manifestations of the disease during postoperative chemotherapy, laparoscopy is performed (after 6-12 months) to establish the completeness of remission. Only when complete remission is achieved and chemotherapy lasts for at least 12 months can the issue of stopping treatment be decided. Radiation therapy is rarely used, mainly for tumor recurrence. For ascites and pleurisy, thiophosphamide and cisplatin are administered intraperitoneally.

Among more rare forms malignant ovarian tumors - clear cell (mesonephroid) cancer, malignant Brenner tumor; stromal tumors (granulosa cell carcinoma, androblastoma, gonadoblastoma); embryonal tumors (dysgerminoma, teratocarcinoma, embryonal cancer, chorionic carcinoma). Clinical course and treatment principles for clear cell carcinoma and Brenner malignancy are almost the same as for mucinous carcinoma. Granulosa cell carcinoma is characterized by endometrial hyperplasia, accompanied by uterine bleeding resulting from high production of estrogen. With androblastoma, signs of virilization are observed (hair growth male type, change in voice, cessation of menstruation) due to hyperproduction of androgens. Both types of tumors occur more often before the age of 30. The occurrence of metastases is characteristic V retroperitoneal lymph nodes and lungs, sometimes many years after surgery. For early detection of relapse and metastases, it is advisable to dynamically determine the level of estrogens and androgens. The main method of treatment is surgical. After radical surgery, chemotherapy is not performed. At an advanced stage of the disease, radiation and chemotherapy (thiophosphamide, adriamycin, cyclophosphamide) are used.

Gonadoblastoma is a mixed morphological variant - a combination of pranulosa cell carcinoma and adroblastoma. Embryonic malignant tumors of the ovary arise in at a young age, are characterized by an aggressive course. Dysgerminoma has a rapid growth rate and metastasizes to the retroperitoneal lymph nodes, lungs, and other organs. The development of the tumor is accompanied by disruption of the menstrual cycle. After radical surgery, thiophosphamide or cyclophosphamide is prescribed. Teratocarcinomas can have different morphological structures and include elements of dysgerminoma, embryonal cancer, and chorionic carcinoma. Metastases occur in the abdominal cavity, retroperitoneal lymph nodes, and lungs. When establishing a diagnosis and dynamic monitoring, it is useful to determine tumor markers (a-fetoprotein, chorionic gonadotropin). In case of a localized form of the disease, radical surgery is performed followed by chemotherapy. In the disseminated form, it is advisable to start treatment with chemotherapy, and when remission is achieved after 3-6 courses, remove the remaining tumor nodes. Modern chemotherapy for ovarian teratocarcinoma includes combinations of several antitumor drugs (cisplatin with vinblastine, bleomycetin, dactinomycin and cyclophosphamide or cisplatin with etoposide and bleomycetin).

Tumor disintegration is a fairly common phenomenon and can be observed in most patients with malignant neoplasms. This process leads to an even greater deterioration in the well-being of patients, poisoning of the body with harmful metabolic products, and even the occurrence of life-threatening conditions.

Tumor decay means the death of cancer cells, which are destroyed and release toxic metabolic products. Is it good or bad? It’s difficult to answer unequivocally.

On the one hand, against the background of decay, severe intoxication occurs, on the other hand, this is most often the result of treatment, which is designed to destroy cancer cells, so this process can be considered a natural manifestation of antitumor therapy.

However, it must be borne in mind that patients may require emergency care during this period, so constant monitoring in a hospital setting is necessary.

The disintegration of a malignant tumor can occur spontaneously or under the influence of specific therapy, as mentioned above. Spontaneously, that is, by itself, the tumor often disintegrates large sizes, since the vessels may simply not be able to keep up with the increase in cell mass, and then a disruption of the blood supply, hypoxia and necrosis is inevitable. Neoplasms located on the skin or in the mucous membrane of the stomach and intestines can be injured mechanically by the action of hydrochloric acid and enzymes, so the risk of their destruction is especially high. Some tumors, in particular Burkitt's lymphoma and leukemia, are themselves prone to tumor disintegration, and this must be taken into account when treating such patients.

Necrosis of cancer cells provokes the development of the so-called rapid tumor decay syndrome (tumor lysis syndrome), manifested by severe intoxication. The death of a large number of cells leads to the release of uric acid and its salts, potassium, phosphates, lactic acid derivatives, which enter the bloodstream, spread throughout the body, significantly disrupt the acid-base balance and damage internal organs. A state of acidosis is created in the blood - acidification (lactic acidosis), which, coupled with dehydration, can cause a serious blow to the functioning of the kidneys.

Metabolic changes during the breakdown of a cancerous tumor include:

• Increased levels of uric acid and its salts in the blood;
• Increased phosphate concentration and decreased calcium;
• Hyperkalemia – increased potassium concentration;
• Acidosis (acidification) of the internal environment of the body.

Typically, the described changes accompany treatment and may persist for several days after the end of chemotherapy.

Significant amounts of uric acid circulate in the blood and its salts can lead to their closing of the lumens of the renal tubules and collecting ducts, which is fraught with the development of acute renal failure (ARF). The risk of such changes is especially high in patients who had any kidney disorders before the disease or the start of antitumor therapy. In addition, acidosis and dehydration both promote and aggravate the manifestations of acute renal failure.

Phosphate yield from destroyed cancer cells provokes a decrease in calcium in the blood serum, which is accompanied by convulsions, drowsiness, and an increase in potassium coming from the site of tumor growth can lead to cardiac arrhythmias, sometimes fatal.

In addition to these metabolites, cancer cells are capable of secreting enzymes and other aggressive waste products, so the process of decay of tumor tissue can be complicated by inflammation, infection with suppuration, or damage to a large vessel with bleeding. These complications complicate treatment, worsen the well-being of patients and can cause sepsis and severe blood loss.

Symptoms of the collapse of a malignant tumor

Symptoms of tumor tissue breakdown vary, but are very similar in most patients. This:

• Severe weakness, increasing day by day;
• Fatigue;
• Fever;
• Dyspeptic disorders - nausea, vomiting, abdominal pain, decreased or lack of appetite, stool disorders;
• In case of defeat nervous system possible disturbance of consciousness up to coma, convulsions, changes in sensitivity;
• Arrhythmias, against the background of acute renal failure - often ventricular, cardiac arrest is possible;
• Progressive weight loss extreme degree which is cancer cachexia (exhaustion);
• Changes in the skin and mucous membranes - pallor, yellowness, cyanosis with impaired liver function and microcirculation.

At different types cancer, in addition to the general symptoms described, there may be other signs characteristic of a specific tumor location.

Thus, decay often serves as a reason for classifying the disease as the fourth stage. Massive cell necrosis, skin involvement, infection lead to the formation of large and long-lasting non-healing ulcers, which in most cases prevent the oncologist from starting antitumor therapy as quickly as possible, since the latter can further aggravate the cancerous decay. While the patient is undergoing antibacterial and detoxification therapy, the tumor continues to grow and progress, often leaving no chance for surgical treatment. The issue of treating disintegrating breast tumors is very acute, especially considering the high frequency of late presentations and advanced forms of the disease among women.

They are prone to decay when large in size, then there is a high probability of perforation of the organ wall and release of contents into the abdominal cavity - peritonitis. Such peritonitis is accompanied by severe inflammation, infection of the peritoneum with digestive products and can lead to death, unless the patient receives emergency care. Another manifestation of the disintegration of a stomach tumor can be massive bleeding, which is manifested by vomiting with blood like “ coffee grounds", weakness, tachycardia, drop in blood pressure, etc.

Disintegration is dangerous due to damage to the vessels of the intestinal wall and bleeding, and in the rectum it is possible not only for severe inflammation, infection and suppuration, but also for the formation of fistulous tracts in other pelvic organs (bladder, uterus in women).

Disintegration is fraught with the penetration of air into the pleural cavity (pneumothorax), massive bleeding, and the usual symptoms of cough, shortness of breath, pain are added to the discharge of a large amount of fetid sputum of a putrefactive nature.

They are prone to decay when the tumor is large in size. When cancer cells are destroyed, severe inflammation and infiltration of surrounding tissues occurs, and fistulas are formed in the bladder and rectum, through which the neoplastic process will spread to these organs. The disintegration of cancer of this localization is accompanied by severe intoxication, fever, and widespread inflammation in the pelvis.

Signs of the beginning disintegration of a malignant tumor are always an alarming “bell” that should not be ignored, so any deterioration in the patient’s well-being should be a reason to exclude this dangerous condition. It is especially important to monitor the condition of patients undergoing antitumor treatment.

Methods for correcting disorders in tumor decay syndrome

Treatment of tumor collapse syndrome should be carried out only under the supervision of a specialist and in a hospital setting. It includes:

1. Antiemetic drugs, sorbents, laxatives for constipation, if ineffective - enemas, which not only remove feces, but also help reduce intoxication by metabolic products.
2. Infusion therapy to correct acid-base balance - administration of calcium preparations, glucose solution with insulin, aluminum hydroxide with an increase in phosphates in the blood serum, sodium bicarbonate. Perhaps acidosis during tumor disintegration - the only one a justified case for the (so notoriously popular) use, but such treatment should only be carried out by a specialist and under strict control of the acid-base state of the blood.
3. Hemodialysis when signs of acute renal failure appear.
4. Antiarrhythmic therapy for cardiac arrhythmias.
5. In case of anemia, the administration of iron supplements is indicated.
6. Painkillers and anti-inflammatory drugs, which, in addition to relief pain syndrome, help reduce fever.
7. Good nutrition and adequate drinking regimen.

Before starting, in order to prevent complications, it is necessary drinking plenty of fluids and rehydration therapy for 24-48 hours.

With adequate prevention of tumor tissue decay syndrome, the prognosis is generally favorable, and hemodialysis in cases of acute renal failure promotes almost complete restoration of renal function. The key to successfully combating this dangerous phenomenon– vigilance of the patient and constant monitoring by the doctor.

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment in this moment, unfortunately, they do not turn out to be.