Presentation on the topic of lung cancer. Presentation on the topic "General issues in oncology"
Lung cancer is the most common malignant tumor in the world population. 1 million new cases are diagnosed annually (more than
Cancerlung
-
most
common
V
world
populations
malignant
education.
1 million are diagnosed annually.
new cases (more than 12% of the number
all detected malignant
neoplasms).
In Russia - 15.2%.
In 1997, 65,660 patients were diagnosed with a malignant neoplasm of the trachea, bronchi, and lung.
8,6%
52.5
%
47.5
%
Diagnosis confirmed
Not confirmed
91,4
%
Stage set
Not installed
Risk factors for developing lung cancer
Genetic risk factors:Primary multiple tumor.
Three cases of lung cancer in the family.
Modifying risk factors:
A. Exogenous: 1. Smoking; 2. Pollution
environment; 3. Professional
harmfulness.
B. Endogenous: 1. Age over 45 years;
2. Chronic pulmonary diseases.
Distribution of patients by stage
19.6%
37.6
%
I-II stages
Stage III
Dynamics of morbidity in men and women
Morbidity70
60
50
40
30
20
10
0
1945
1955
1965
Men
1975
Women
1985
1997
The rough incidence rate for Russia is 44.7%o
Saratov regionJewish Autonomous Region
Altai region
Krasnodar region
Moscow
Ingush Republic
- 56.1%o
- 56.8%o
- 54.5%o
- 40.1%o
- 28.1%o
- 14.6%o
Clinical picture
34%
In recent years, primary advanced cancer
lung (IV clinical group) in the Russian Federation
detected in 34.2% of patients. 30
%
20
%
65
%
Finishing tumor treatment
no more than 30% of identified
sick.
Operability is not
exceeds 20%.
Of those registered
65% of patients do not survive 1 year.
Main reasons for neglect
1. Insufficient oncologicalalertness and qualification
medical personnel (43% of cases);
2. Hidden, asymptomatic course
diseases (33%);
3. Untimely, late application
patients seeking help (23%).
Causes of neglect, depending on the quality of medical care
15%radiologists' mistakes
31%
25%
29%
clinical errors
diagnostics
incomplete examination
sick
long-term examination
Symptoms of lung cancer
Primary or local symptoms (cough,hemoptysis, chest pain, shortness of breath),
caused by the growth of the primary node
tumors.
Extrapulmonary thoracic symptoms
caused by tumor growth in
neighboring organs and regional
metastasis (hoarseness, aphonia,
cava syndrome, dysphagia). Extrathoracic symptoms depending on pathogenesis
are divided into the following subgroups:
a) caused by distant metastasis (headache,
hemiplegia, bone pain, growth of secondary volumetric
formations);
b) associated with the interaction between tumor and organism (general
weakness, fatigue, weight loss, decrease
performance loss, loss of interest in the environment,
loss of appetite), i.e. what is defined as “syndrome
small signs”, or rather discomfort syndrome;
c) caused by non-oncological complications of growth
tumors (fever, night sweats, chills);
d) associated with hormonal and metabolic activity
tumors (paraneoplastic syndromes): rheumatoid
polyarthritis, neuromuscular disorders, pulmonary
osteochondropathy, gynecomastia, etc.
Tactics
1. Any pulmonary complaints in a smoker over 45 years of ageshould be regarded as possible bronchial cancer.
2. Obstructive
pneumonitis
fleeting,
easily
amenable to anti-inflammatory treatment, but often
relapses again.
3. X-ray diagnosis of early lung cancer
difficult and unreliable. To exclude early cancer
bronchus should be prescribed whenever possible
fibrobronchoscopy.
4. Elderly patients should repeat
carry out control examinations (call
active!) 1-2 months after the transfer
“colds”, especially with incomplete cure.
Symptoms of distant metastasis
Lymph nodesNeurological symptoms
Headache
Mental disorders
Meningeal and radicular symptoms
Spinal cord lesion
Metastases in the skeleton
Liver damage
Paraneoplastic syndromes
These are symptom complexes caused byindirect (humoral, etc.)
the effect of the tumor on metabolism,
mechanisms of immunity and functional
activity of the body's regulatory systems.
With solid neoplasms they are found in
10-50% of cases. By spectrum and diversity
Such manifestations of lung cancer have no equal.
Skin and musculoskeletal symptoms
dermatomyositisacanthosis nigricans
Leser-Trélat syndrome
erythema multiforme
Hyperpigmentation
psoriatic acrokeratosis
urticarial rash
Neuromuscular syndromes
Polymyositismyasthenic syndrome (Eaton-Lambert)
Leser-Trélat syndrome
peripheral neuropathy
myelopathy
Musculoskeletal syndromes
hypertrophicosteoarthropathy
drumstick symptom
rheumatoid arthropathy
arthralgia
Endocrine syndromes
pseudo Cushing's syndromegynecomastia
galactorrhea
secretion disorder
antidiuretic hormone
carcinoid syndrome
hyper- or hypoglycemia
hypercalcemia
hypercalcitoninemia
products STG, TTG
Neurological syndromes
subacute cerebellar degenerationsensorimotor neuropathy
endefalopathy
progressive multifocal
leukoencephalopathy
transverse myelitis
dementia
psychoses
Hematological syndromes
anemiaerythrocyte aplasia
dysproteinemia
leukemoid reactions
granulocytosis
eosinophilia
plasmacytosis
leukoerythroblastosis
thrombopenia
thrombocytosis
Cardiovascular syndromes
superficial and deepthrombophlebitis
arterial thrombosis
Maranthic endocarditis
orthostatic hypotension
disseminated syndrome
intravascular coagulation
Immunological syndromes
immunodeficientstate
autoimmune reactions
Other syndromes
nephrotic syndromeamyloidosis
secretion of vasoactive polypeptide
(watery diarrhea syndrome)
amylase secretion
anorexia - cachexia
Stages of population surveys
1. Selection from the entire population of individuals,predisposed to lung cancer.
2. Identification of persons with pathological
changes in the lungs.
3. Differentiated diagnostics confirmation or exclusion
malignant lesions or
precancerous pathology.
Examination of the primary patient
Clinical or radiologicalsuspected cancer
Primary examination
(R-graphy, tomography, sputum analysis)
Bronchoscopy
Transthoracic puncture,
thoraconecthesis
Lymph node biopsy
(mediastinal, peripheral)
Histological type and TNM
Abdominal echography, bone scingraphy
Assessment of respiratory function
Three diagnostic levels
X-ray detection of suspiciouscancer of shadows in the lungs in the preclinical stage (mainly
thus, large-frame fluorography)
x-ray examination in x-ray
department of practical medical network institutions
(city, regional hospitals, clinics,
anti-tuberculosis and oncology dispensaries
etc.)
examinations in a specialized
pulmonology department. Here based on
combination of X-ray, endoscopic
research and targeted biopsy
the final detail of the diagnosis is achieved.
X-ray research methods can be grouped into two diagnostic complexes
The main set of methods with which you canobtain the optimal amount of information about
X-ray morphological features
pathological focus in the lung and about the condition
bronchial tree. This includes combined
the use of fluoroscopy, radiography and
tomography.
A set of additional methods that do not play
significant role in the early diagnosis of cancer
easy, but very helpful in clarifying
localization, prevalence of the process and
differential diagnosis.
Central lung cancer
X-ray negative phaseRecurrent pneumonitis
Hypoventilation stage
Valvular emphysema
Atelectasis stage
Early signs of central lung cancer
Ball-shaped node in the root of the lungLung root expansion
Bronchial disorder
cross-country ability:
a) increased pulmonary pattern at the root
lung
b) heaviness
c) obstructive emphysema
d) segmental atelectasis
e) paramediastinal darkening
Lung root enlargement
Central lung cancer
Central lung cancer
Central cancer
Reducing the volume of a share (segment)Lung root expansion
Prolonged course of pneumonia
Recurrent course of pneumonia
Bronchological examination / CT
Peripheral cancer
Small peripheral cancer– Tumor shadow shape
– Shadow structure
– Nature of contours
– Outlet track
– Changes in the pleura
“Giant” peripheral cancer
Types of tumor nodes of peripheral lung cancer
X-ray picture of peripheral cancer
CT picture of peripheral cancer
Peripheral cancer with centralization.
Peripheral tumor growth rate
where d0 and d1 are the average tumor diametersat the first and last examination; t-
interval between studies. GGO type (ground glass opacity)
(frosted glass type)
Bronchioloalveolar carcinoma T1N0M0
Bronchioloalveolar cancer
peripheral globular tumorpseudopneumonic form
multiple nodular and nodular
education
mixed form
Features
variety of clinical and radiological symptoms,causing the identification of four forms of the disease: peripheral, pseudopneumonic, nodular,
mixed
absence of changes on tomograms and bronchograms
bronchial tree
the presence of clearing with clear contours and
“lattice” structure against a background of shadows
for peripheral bronchioloalveolar cancer
slow growth rate, subpleural localization,
heterogeneous “spongy” structure, uneven
contours, characteristic pleural reaction
in the most advanced mixed form of the disease
simultaneous manifestation of spherical,
pneumonia-like and nodular changes
with early recognition of limited forms it is possible
prevent the process from becoming widespread
lesion and start treatment in a timely manner
Atypical forms
Peripheral cancer withPancoast syndrome
Mediastinal cancer
lung
Primary carcinomatosis
Peripheral cancer with Pancoast syndrome
1) radiographically detectable shadow in the areaapex of the lung;
2) pain in the shoulder girdle;
3) impaired skin sensitivity;
4) muscle atrophy of the upper limb;
5) Horner's syndrome;
6) compaction in the supraclavicular area;
7) radiographically
determined
destruction
upper ribs;
8) destruction of the transverse processes and vertebral bodies.
Primary carcinomatosis
Primary carcinomatosis
Differentialdiagnostics
lung cancer
Indications for chest CT
dubious data of the usualx-ray examination,
need for increased sensitivity
method
detection of hidden metastases during their
high probability if it changes
therapeutic tactics
assessment of prognostic factors
need for transthoracic puncture
under CT control
radiotherapy planning and marking
radiation fields, diagnosis of relapses
tumors
Indications for bronchoscopy
if a tumor is suspectedall patients with lung cancer, including
peripheral
after radical treatment of cancer
lung lesions (endoscopic
monitoring for early detection
relapses)
when assessing the effectiveness of radiation and
drug treatment (confirmation of complete
remission)
when identifying synchronous and metachronous
foci of primary tumor multiplicity
research methods
Cytological methodsFiberoptic bronchoscopy
Computed tomography
Echography
Surgical methods
Surgical diagnosis of lung cancer
Pre-core biopsyMediastinoscopy
Anterior parasternal
mediatinotomy
Videothoracoscopy
Diagnostic thoracotomy
Additional research methods
AngiographyRadionuclide diagnostics:
Perfusion pulmonary scintigraphy,
ventilation pulmonary scintigraphy,
positive pulmonary scintigraphy,
Complex pulmonary scintigraphy,
Radioimmunoscintigraphy, Indirect
radionuclide lymphography.
Determination of humoral tumor markers PET in differential diagnosis
solitary formation in the lung
PET – lymph node assessment
CTPAT
Statistics
Stage5 year old
survival rate (%)
Ia
70-80
Ib
60-70
IIa
35
II b
25
IIIa
10
III b
5
IV
1
13% 5 year
survival
13% detection
Stage I
Mountein, Chest (1997) 111; 1701-17 Central cancer (polypoid,
endobronchial, peribronchial,
ramified).
Peripheral cancer: nodular, cavitary
(cavernous), pneumonia-like.
Atypical forms: peripheral cancer with
Pancoast syndrome (Pancoast cancer),
mediastinal form of lung cancer,
primary lung carcinomatosis.
Epithelial tumors
1. BenignPapilloma
– squamous
Adenoma
– polymorphic (mixed tumor)
– monomorphic
– other types
Dysplasia
– Pre-invasive cancer (carcinoma in situ) 2. Malignant
Squamous cell carcinoma (epidermoid)
– Highly differentiated
– Moderately differentiated
– low differentiated
Small cell cancer
– oat cell
– from intermediate type cells
– combined 3. Adenocarcinoma
acinar
papillary
bronchioloalveolar cancer
solid cancer with mucus formation
– highly differentiated
– moderately differentiated
– poorly differentiated
– bronchioloalveolar 4. Large cell cancer
giant cell variant
clear cell variant
5. Glandular - squamous cell carcinoma
6. Carcinoid tumor
7. Bronchial gland cancer
a) adenocystic
b) mucoepidermoid
c) other types
8. Other
Frequency of different types of lung cancer
SquamousSmall cell
Adenocarcinoma
Large cell
other
50%
20%
21%
7%
2%
New TNM classification
T - primary tumor.TiS - pre-invasive cancer (carcinoma in situ).
TO - the primary tumor is not determined.
T1 - tumor no more than 3 cm in greatest dimension,
surrounded by pulmonary tissue or visceral pleura,
without signs of invasion proximal to the lobar bronchus with
bronchoscopy or unusual invasive tumor of any
sizes with surface distribution within
the walls of the bronchus, including the main one.
T2 - tumor more than 3 cm in greatest dimension or
tumor of any size causing atelectasis or
obstructive pneumonitis, spreading to
root area. According to bronchoscopy, the proximal
the edge of the tumor is located 2 cm distal to the carina.
Any associated atelectasis or obstructive
Pneumonitis does not spread to the entire lung. T3 is a tumor of any size that invades the chest
wall (including cancer with Pancoast syndrome), diaphragm,
mediastinal pleura or pericardium without lesion
heart, great vessels, trachea, esophagus or bodies
vertebrae, or a tumor spreading to
the main bronchus is 2 cm proximal to the carina without it
infiltration.
T4 - tumor of any size with mediastinal involvement,
heart, large vessels, trachea, esophagus, bodies
vertebrae or carina bifurcation or presence
malignant pleural effusion (in the absence
tumor elements in punctate, hemorrhagic coloring
it or signs indicating exudate, tumor
belong to category T1-3). 1.Upper
mediastinal
2. Paratracheal
3.Pretracheal
4.Tracheobronchial
5. Subaortic
6.Para-aortic
7.Bifurcation
8. Paraesophageal
9.Pulmonary ligament
10.Lung root
11.Interlobar
12.Share
13.Segmental
14.Subsegmental N - regional lymph nodes
NO - no signs of regional damage
lymph nodes.
N1 - metastases in peribronchial and (or)
lymph nodes of the lung root on the side
lesions, including direct germination
primary tumor.
N2 - metastases in bifurcation and
mediastinal lymph nodes on
side of defeat.
N3 - metastases in lymph nodes
mediastinum or root on the opposite
side, in the precalcular or supraclavicular
zones,
Grouping by stages
Hidden cancer - TxNOMOStage O - TiS, carcinoma in situ
Stage Ia - T1NOMO
Stage Ib - T2NOMO
Stage IIa - T1N1MO
Stage IIb - T2N1MO
Stage IIIA - T3NOMO, T3N1MO, T1-3N2MO
IIIB stage - T1-4N3MO, T4NO-3MO
Stage IV - T1-4NO-3M1
Classification of respiratory failure according to Dembo
latent (no gas disturbancesblood composition at rest)
partial (hypoxemia without
hypercapnia) and global (hypoxemia, with
hypercapnia)
Degrees of respiratory failure
I degree of respiratory failure(shortness of breath with significant physical activity)
loads)
II degree (shortness of breath during normal walking)
III degree (shortness of breath when dressing and
washing) and IV degree (shortness of breath at rest).
A simplified method for preliminary assessment of operational risk by identifying three groups of patients
First group (low risk): normal size andheart function, normal blood pressure and
ECG, normal blood gases,
satisfactory pulmonary function indicators.
Group 2 (very high risk, inoperability):
congestive heart failure, refractory
arrhythmia, severe hypertension, recent myocardial infarction,
low spirometric values (FEV1 less than
35%), Pco2 more than 45 mm Hg. Art., pulmonary hypertension.
Group 3 (moderate risk): angina pectoris, heart attack
history of myocardium, arrhythmias, systemic hypertension,
heart defects, low cardiac output, hypoxia with
normal Pco2 values, moderate decrease
pulmonary function (FEV1 35-70%).
Hematogenous metastasis
To the brain - in 40% of patients, in 30%cases solitary, more often in the frontal and
occipital areas.
To the liver - in 40% of patients, more often
multiple.
In the skeleton - in 30%, thoracic and lumbar
spine, pelvic bones, ribs,
tubular bones.
In the adrenal glands – in 30%.
In the kidneys - in 20%.
Standards of treatment for lung cancer
StageConventional treatment
I
Surgical
II
Surgical
IIIa
Radiation and/or chemotherapy with
subsequent resection
IIIb
Radiation and chemotherapy
IV
Chemotherapy
Statistics
Stage5 year old
survival rate (%)
Ia
70-80
Ib
60-70
IIa
35
II b
25
IIIa
10
III b
5
IV
1
13% 5 year
survival
13% detection
Stage I
Mountein, Chest (1997) 111; 1701-17
Slide 1
Topic: BREAST CANCER Department of Oncology JSC MUA Prepared by: Anton Vadimovich Khvan, 531 group, lec. Faculty Checked by: Associate Professor of the Department of Oncology, Candidate of Medical Sciences Zhakipbaev Kasym AdilkasymovichSlide 2
Slide 3
Pathways of metastasis in breast cancer Pathways of lymph outflow from the mammary gland to the regional lymph nodes according to Nagy (scheme): 1 - lateral (anterior) axillary lymph nodes; 2 - central axillary lymph nodes; 3 - subclavian lymph nodes; 4 - supraclavicular lymph nodes; 5 - parasternal lymph nodes; 6 - retromammary lymph nodes; 7 - lymph nodes of the anterior mediastinum; 8 - interthoracic lymph nodes; 9 - submammary lymph nodes (located behind the pectoral muscles)
Slide 4
Pathways for lymph outflow from the mammary gland: 1 - paramammary lymph nodes; 2 - central axillary lymph nodes; 3 - under the clavicular lymph nodes; 4 - supraclavicular lymph nodes; 5 - deep cervical lymph nodes; 6 - parasternal lymph nodes; 7 - cross lymphatic pathways connecting the lymphatic systems of both mammary glands; 8 - lymphatic vessels going into the abdominal cavity; 9 - superficial inguinal lymph nodes
Slide 5
Lymphatic metastasis in breast cancer can go in 7-8 directions along the pectoral path - to the paramammary nodes and then to the lymph nodes of the axilla (see Fig. 2 (1)). Occurs most often (60-70% of cases); transpectoral path - to the central (upper) axillary lymph nodes (see Fig. 2 (2)). Rarely encountered; subclavian path - to the subclavian lymph nodes (see Fig. 2 (3)). Occurs in 2-30% of cases; parasternal route - to the parasternal lymph nodes (see Fig. 2 (6)). Occurs in 10% of cases; retrosternal path - to the mediastinal lymph nodes, bypassing the parasternal ones (see Fig. 2 (7,8)). Occurs in 2% of cases. cross path - to the axillary lymph nodes of the opposite side and to the mammary gland (see Fig. 2 (7)). Occurs in 5% of cases; along the lymphatic pathways of Herot - to the epigastric lymph nodes and nodes of the abdominal cavity (see Fig. 2 (8)). Rarely encountered; intradermal - along the abdominal wall to the inguinal nodes (see Fig. 2 (9)). Rarely seen.
Slide 6
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Slide 12
Classification Stage 1 T1 N0 M0 Stage 2A T0 N1 M0 T1 N1 M0 T2 N0 M0 Stage 2B T2 N1 M0 T3 N0 M0 Stage 3A T0 N2 M0 T1 N2 M0 T2 N2 M0 T3 N2 M0 Stage 3B T4 any N M0 Stage 4 any T any N M1
Slide 13
T - size of the primary tumor T0 - the primary tumor is not determined T1 - Tumor up to 2 cm in the greatest dimension T2 - Tumor up to 5 cm in the greatest dimension, limited to the gland tissue T3 - Tumor more than 5 cm in the greatest dimension, limited to the gland tissue T4 - tumor of any size, spreading beyond the gland to the chest or skin N0 - no signs of damage to the lymph nodes N1 - metastases in the displaced axillary lymph nodes on the same side as the tumor N2 - metastases in the axillary lymph nodes on the affected side, fixed with each other or with others structures on the tumor side N3 - metastases in the internal lymph nodes of the mammary gland on the affected side N - regional lymph nodes
Slide 14
M - distant metastases M0 - no signs of distant metastases M1 - there are distant metastases
Slide 15
Skin incision line for breast amputation. An ellipsoidal incision bordering the mammary gland from above (inside) and below (outside), begins at the place of attachment of the pectoralis major muscle to the humerus, arcuately outlines the mammary gland and ends in the epigastrium region.
Slide 16
After dissecting the skin, subcutaneous fat and fascia proper, the tendon of the pectoralis major muscle is bluntly isolated at the site of attachment to the humerus. The pectoralis major muscle is bluntly separated from the deltoid muscle along the deltoid-pectoral groove, where the external saphenous vein (v. cephalica) can be visible; it should be pulled to the side with a blunt hook. The lower edge of the pectoralis major muscle is identified. Place a finger under the muscle tendon and cross the tendon in the transverse direction. By pulling the cut tendon, starting from the periphery, the musculocutaneous flap containing the mammary gland is partially bluntly, partially sharply separated from the underlying tissue. In the area of the deltoid-sternal triangle, the branches of the thoraco-acromial vessels (a. thoraco-acromiali) are dissected, ligated and crossed, and the anterior thoracic nerves are also dissected. After removing the musculocutaneous glandular flap in the subclavian fossa, the fatty tissue is excised along with the lymph nodes. In this case, the lateral saphenous vein (v. cephalica) is pulled upward with a blunt hook or crossed between the ligatures. The axillary fascia is cut along the lower edge of the pectoralis minor muscle and the fatty tissue, along with the lymph nodes, is carefully removed from the armpit. Fatty tissue is removed until the neurovascular bundle is exposed. (www/who/int/countries/kaz/ru/)
Slide 17
The wound is stitched up. A rubber drainage tube surrounded by gauze is inserted into the counter-aperture.
Slide 18
It should be borne in mind that the axillary vein is located superficially and medially, the artery with the surrounding bundles of the brachial plexus is located laterally and deeper. By removing the fatty tissue in the brine, the muscles that make up the posterior and medial walls of the axilla are visible (subscapularis, vastus dorsi, serratus anterior), as well as the lateral thoracic vessels (a. et v. thoracalis laterales) and the long thoracic nerve (n. thoracalis longus). Subscapular vessels (a. et v. subscapulares) are also visible, heading into the lateral fissure (foramen trilaterum). Next, the pectoralis minor muscle is crossed at its origin on the coracoid process of the scapula and separated from the chest wall (carefully so as not to damage the intercostal muscles).
Slide 19
After this, fatty tissue and lymph nodes located along the subclavian vessels in the upper part of the axillary fossa are removed. On the posterolateral surface of the chest at the level of the III-IV ribs, a small through incision is made with a scalpel in the skin and subcutaneous fat, into which a rubber tube is inserted using a forceps, reaching the armpit (counter-aperture). The skin wound is sutured tightly. In order to facilitate tightening of the edges of the wound, the skin is slightly separated, and, if necessary, releasing incisions are made.
Slide 20
Types of surgical operations: 1) Sectoral resection of the mammary gland. Most often it is performed as a diagnostic operation with urgent histological examination of the specimen. Sectoral resection precedes radical mastectomy, or is a curative operation for benign tumors. These include fibroadenomas, cystadenopapillomas, lipomas, cysts and other rare tumors. For the treatment of breast cancer, sectoral resection is performed with the removal of axillary lymph nodes and mandatory postoperative radiation therapy.
Slide 21
Fibroadenoma of the left breast. Fibroadenoma of the right breast grew over 2 years. Grew up in 7 months
Slide 22
The best skin incision along the areola. Marking before surgery to remove a benign breast tumor After 7 days. The incision is paraareolar. There are no abnormalities in the function of the areola. (Smooth muscles contract)
Slide 23
2) Radical mastectomy (according to Halsted-Meyer). The most common surgical procedure until the late 1980s for breast cancer. The operation consists of removing the mammary gland with the pectoralis major and minor muscles, fascia, subcutaneous fatty tissue and lymph nodes of the subclavian, axillary and subscapular region.
Slide 24
3) Modified radical mastectomy: the effective surgical intervention at present is the Patey-Dysen mastectomy. In this operation, the pectoralis major muscle is preserved (but the pectoralis minor muscle is removed); according to Madden - the pectoralis major and minor muscles are not removed
Slide 25
Surgical method is the most common type of treatment for cancer patients. Most oncological operations are mutilating, which significantly reduces the quality of life of patients, increasing the number of disabled people. The current stage of development of approaches to the treatment of cancer patients includes not only the desire to increase their life expectancy, but also to improve its quality. In this regard, our goal is to help you return to the lifestyle that you led before the development of the disease. With the help of modern plastic and reconstructive surgery, which is a branch of surgery aimed at treating patients with tissue defects, deformations and dysfunctions of various parts of the body, we will try to return you to your former femininity
Slide 26
Slide 27
. A patient with stage II right breast cancer undergoing PAGE plastic surgery with gel on both sides. Markings were made before surgery. Removal of PAGE gel with one-stage reduction mammoplasty on the left. Abdominoplasty performed. After reconstruction with your own tissues - a free lower epigastric flap (microsurgical technique) Tissues are taken from the abdomen. Nipple reconstruction with a trilobal flap
Slide 28
A 28-year-old female patient was diagnosed with left breast cancer pT2N1M0. She underwent a simultaneous radical mastectomy and reconstruction (restoration) of the left breast using a thoracodorsal flap and a POLYTECH V 350 ml implant. On the right, a breast lift and breast augmentation was performed. In the postoperative period, she received radiation therapy to the left reconstructed breast and regional lymph nodes. Tattooing is the best way to hide scars.
Slide 29
Reconstruction using an expander implant. A 27-year-old female patient was diagnosed with left breast cancer pT2N0M0. Preoperative chemotherapy of 4 courses was performed with a partial response. A simultaneous mastectomy in the Madden modification was performed and a 240 ml expander was installed. On the right side, a perareolar mastopexy (skin breast lift) was performed. The nipple and areola are restored by transplanting the opposite areola and nipple plastic surgery with a three-lobed flap.
Slide 30
A 44-year-old female patient, 1 year after mastectomy and chemoradiotherapy, was diagnosed with right breast cancer pT2N0M0. 1 month after reconstruction, reconstruction of the right breast with a free revascularized DIEP-flap flap.
Slide 31
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Tissue expander, which is used to expand tissue with subsequent replacement with an endoprosthesis
Slide 33
DIEP In the DIEP technique, the flap is called a free flap because it is completely separated from the underlying tissue. Microsurgical techniques are used to restore blood supply to the free flap. Therefore, the DIEP Flap technique lasts longer (about 5 hours for reconstruction of one breast and 8 for both). With the TRAM technique, the flap is not completely separated from the abdominal tissue, thus maintaining its blood supply. As in the case of the TRAM Flap technique, the DIEP technique ends with abdominoplasty (“tummy tuck”) - plastic surgery in the area of the anterior abdominal wall.
Slide 34
The DIEP technique has been used in plastic surgery since 1990. Due to its complexity and possible complications, it is not indicated for all patients. This technique is performed by specially trained plastic surgeons experienced in microsurgical techniques. As already mentioned, the DIEP Flap technique is not indicated for all women. This is a good choice if the woman has enough tissue to transfer a free flap. It is worth saying that this technique is applicable even if you have undergone abdominal surgery in the past (hysterectomy, appendectomy, intestinal resection, liposuction).
Slide 35
Slide 36
The DIEP Flap technique is contraindicated in thin patients with a very small supply of adipose tissue, and in women who smoke, as they experience deterioration of microcirculation, which negatively affects the healing of the transplanted flap.
Slide 37
Procedure of the DIEP Flap technique In the lower abdomen, a flap containing skin with subcutaneous fat and blood vessels is excised using a horizontal incision. The flap is created in a shape resembling the mammary gland and sutured in the appropriate place. Blood vessels are reconstructed under an operating microscope. This operation takes about 5 hours. Compared to patients who underwent surgery using the TRAM Flap technique, the DIEP Flap technique has less severe postoperative pain. However, this type of plastic surgery is considered difficult and requires about 4 weeks of recovery.
Slide 38
Latissimus dorsi flap technique The latissimus dorsi muscle is one of the largest, as its name suggests. It is located under the scapula behind the axillary region, with its base attached to the processes of the vertebrae. During this operation, a flap is formed from an oval incision of the skin, fatty tissue and latissimus dorsi muscle.
Slide 39
The flap is separated and passed through a tunnel created under the skin to the area of the removed breast. If possible, the blood vessels are left intact. The flap is shaped to look like a mammary gland and is sutured. If blood vessels are damaged, they are repaired using microscopic technology. This procedure takes about two to three hours. The latissimus dorsi flap technique is a good choice for patients with small to medium-sized breasts, as there is very little fatty tissue in this part of the back. Therefore, it is almost always necessary to use an implant during surgery to give the desired shape to the breast.
Introduction
No disease causes so many fears and so many myths as malignant neoplasm or cancer. Cancer can appear in any organ and tissue as a result of the degeneration of the patient’s own cells. The older a person is, the higher the likelihood of their occurrence.
Modern cancer statistics show that this disease affects 8.2 million people worldwide every year.
Data for 2012:
Based on statistical data, I formulatedproblem project:
Every year the number of people diagnosed with cancer increases.
Every person should know the truth about this disease, since everyone, without exception, is at risk.
Purpose of the work: updating the topic of health, healthy lifestyle, responsible behavior.
Sun:
Ozone hole:
Dump:
Exhaust gases:
Chernobyl:
Wikipedia:
Appendix 1
Traces of metastases on the bones of the skeleton
Appendix 2
6 and 9 August 1945 Atomic bombings of Hiroshima and Nagasaki
According to rough estimates by experts, out of the total number of deaths in Hiroshima (140-200 thousand), approximately 70-80 thousand people died simultaneously at the moment of the bomb explosion, and of this number of deaths, several tens of thousands more directly near the fireball simply disappeared in a split second, disintegrating into molecules in the hot air: the temperature under the plasma ball reached 4000 degrees Celsius.
A few days after the explosion, doctors began to notice the first symptoms of radiation among the survivors. Soon the number of deaths among survivors began to rise again, as patients who seemed, began to suffer from this new strange disease. Deaths frompeaked 3-4 weeks after the explosion and began to decline only 7-8 weeks later. Japanese doctors considered vomiting and diarrhea to be symptoms characteristic of radiation sickness.. The increased risk of malignancy and other long-term effects of radiation plagued survivors for the rest of their lives, as did the psychological shock of the blast.
The first person in the world whose cause of death was officially listed as illness caused by the consequences of a nuclear explosion (radiation poisoning) was the actress, who survived the Hiroshima explosion, but died on August 24, 1945. No one knew about “" Until Midori's death, no one attached any importance to the mysterious deaths of people who survived the explosion and died under circumstances unknown to science at that time. Jung credits Midori's death with prompting the acceleration of nuclear medicine research, which soon saved the lives of many people from radiation exposure.
The atomic explosion over Nagasaki affected an area of approximately 110 km², of which 22 km² was water and 84 km² was only partially inhabited.
According to a report from Nagasaki Prefecture, "people and animals died almost instantly" at a distance of up to 1 km from the epicenter. Almost all houses within a 2 km radius were destroyed, and dry, flammable materials such as paper ignited up to 3 km from the epicenter. Of the 52,000 buildings in Nagasaki, 14,000 were destroyed and another 5,400 were seriously damaged. Only 12% of buildings remained undamaged. Although no firestorm occurred in the city, numerous local fires were observed.
The number of deaths by the end of 1945 ranged from 60 to 80 thousand people. After 5 years, the total number of deaths, including those who died from cancer and other long-term effects of the explosion, exceeded 140 thousand people
September 29, 1957 Kyshtym accident
The explosion occurred in a container for radioactive waste, which was built in the 1950s.
A government commission formed in November 1957 conducted surveys and found that settlements, , and the village of the Konevsky tungsten mine are located in an area of intense pollution. A decision was made to resettle the residents of the contaminated zone (4,650 people) and plow the 25 thousand hectares of arable land located in the contaminated zone.
In 1958-1959, in settlements exposed to radiation contamination, special mechanized units liquidated and buried buildings, food, fodder and property of residents. After the accident, a temporary ban on economic use of the territory was introduced throughout the EURT territory.
The social and environmental consequences of the accident turned out to be very serious. Thousands of people were forced to leave their places of residence, many others remained to live in contaminatedterritories under long-term restrictions on economic activity. The situation was significantly complicated by the fact that as a result of the accident, water bodies, pastures, forests and arable lands were exposed to radioactive contamination.
Monument to the liquidators of the accident installed in Kyshtym
On the secondstation due to a leak that was not detected in a timely mannerprimary circuitand, accordingly, cooling losses. During the accident there wasabout 50%, after which the power unit was never restored. Premisesiodine-131, through numerous leaks in the purge-make-up and gas purification systems, got into the premises of the auxiliary reactor building, where they were captured by the ventilation system and thrown out through the ventilation pipe. Since the ventilation system is equipped with special adsorbent filters, only a small amount of radioactive iodine entered the atmosphere, while practically no radioactive noble gases were filtered out. Since March 28, hundreds of samples of air, water, milk, plants and soil have been collected and traces of, damaging factor became.
Directly during the explosion at the 4th power unit, only one person died (Valery Khodemchuk), another died in the morning from his injuries (Vladimir Shashenok). Subsequently, 134 Chernobyl NPP employees and members of rescue teams who were at the station during the explosion developed28 of them died over the next few months.
The highest doses were received by approximately 1,000 people who were near the reactor at the time of the explosion and who took part in emergency work in the first days after it. These doses ranged from 2 to 20(Gr) and in some cases proved fatal.
In the first weeks after the accident, many local residents ate food (mainly milk) contaminated with radioactive iodine-131. Iodine accumulated in the thyroid gland, which led to large doses of radiation to this organ, in addition to the dose to the whole body received due to external radiation and radiation from other radionuclides that entered the body. For residentsthese doses were significantly reduced (estimated by 6 times) due to the use of iodine-containing drugs. In other areas such prevention was not carried out.
Infant mortality is very high in all countries affected by the Chernobyl accident. In January 1987, an unusually high number of cases were reported, and a high level of congenital pathologies.
Between 1990 and 1998, more than 4,500 cases of thyroid cancer were reported among those who were under 18 years of age at the time of the accident. Given the low likelihood of the disease at this age, some of these cases are considered a direct consequence of radiation exposure.
According to, introduced in 2005, a total of up to 4,000 people may have ultimately died as a result of the Chernobyl nuclear power plant accident.
And the international organization “Doctors Against Nuclear War” claims that as a result of the accident, tens of thousands of people died among the liquidators alone, 10 thousand cases of deformities in newborns were recorded in Europe, 10 thousand casesand another 50 thousand are expected.
Minsk, Belarus, 2005
Oleg Shapiro (54 years old) and Dima Bogdanovich (13 years old) are being treated for thyroid cancer at the Minsk hospital.
Oleg is a liquidator of the accident at the Chernobyl nuclear power plant; he received a very large dose of radiation. This is already his third operation.
Veronica Chechet is only five years old. She suffers from leukemia and is undergoing treatment at the Center for Radiation Medicine in Kyiv. Her mother, Elena Medvedeva (29 years old), was born four years before the Chernobyl disaster near Chernigov - after the explosion a lot of radioactive fallout fell on the city. According to doctors, the illnesses of many patients are directly related to the release of radiation as a result of the accident.
March 11, 2011 Accident at the Fukushima-1 nuclear power plant in Japan.
Near the island of Honshu, powerful earthquakes with a magnitude of 9.0 occurred, after which a series of aftershock earthquakes occurred. As a result of this natural disaster, significant destruction occurred in Japan. But one of the most severe consequences was the accident at the Fukushima-1 nuclear power plant.
As a result of the accident at the Fukushima-1 nuclear power plant, radioactive elements entered the atmosphere and ocean, in particular iodine 131 (has a very short half-life) and cesium 137 (has a half-life of 30 years), and a small amount of plutonium was discovered.
The total volume of radionuclide emissions amounted to 20% of the emissions after the Chernobyl accident. The population of the 30-kilometer zone around the nuclear power plant was evacuated. The area of contaminated land subject to decontamination is 3% of Japan's territory.
Radioactive substances were found in drinking water and food not only in Fukushima Prefecture itself, but also in other areas of the country. Many countries, including Russia, have banned the import of Japanese products and “emitting” radioactive cars.
For the first time since the Chernobyl accident, nuclear energy suffered a serious blow. The world community is once again thinking about whether nuclear energy can be safe. Many countries have frozen their projects in this industry, and Germany has even stated that by 2022 it will turn off the last nuclear power plant and will develop alternative sources of electricity.
Municipal budgetary educational institution "Secondary
secondary school No. 3"
Research work
Prevalence of oncological disease “Cancer” in the Krasnodar region
Completed by: Yankina Maria, student of 9 “B” class MBOU-secondary school No. 3 Supervisor: Kivlina G.P.
Biology teacher MBOU-secondary school No. 3
Armavir
2014
Introduction
- Oncological disease "Cancer"
1.1.What is “Cancer”?
1 ^.Varieties of the disease 1.3. Methods of treating the disease 1 History of the study of the disease
- Study
2.1.Results of the study 2.2.Ways to solve the problem under study References
Introduction
Our health is priceless, which is why it must be treated with great attention and care. Many diseases begin to appear at the age of 30 and older. And all because we often avoid meeting with a doctor and postpone a visit to a specialist.
If we talk about such serious diseases as cancer, they are always preceded by various types of pathologies and precancerous diseases, which are much easier to cure.
Yes, indeed, cancer is increasingly affecting the population of the entire globe. This topic is painful and relevant. The etiology of cancer cannot be predicted 100%. Many people are now at risk of getting sick. What is this connected with? Stress, poor nutrition, ecology? World health luminaries are trying to find out the reasons for the occurrence, and make every attempt to preserve a healthy society, I would even say, a healthy world.
The purpose of the study is to examine the oncological disease “Cancer”, identify the relevance of the problem, and also find ways to avoid the disease.
The objectives of the research work in connection with this goal are:
- Find out what “Cancer” is;
- Consider the types of disease;
- Identify treatment options;
- Study the history of disease research;
- Analyze the research conducted.
1. Oncological disease “Cancer” 1.1. What is "Cancer"?
Cancer is a very common disease these days. It affects one in three people before they reach age 75. Every year, 10 million people worldwide develop cancer and 7 million deaths are caused by this disease. And as the average life expectancy of the population increases, the annual incidence of cancer is projected to increase to 15 million people.
So what is "Cancer"? Cancer is the general name for a broad group of cancers in which body cells begin to grow and divide uncontrollably. Without treatment, these diseases become fatal.
Why does cancer appear? Ordinary cells become cancerous due to damage to DNA, which carries hereditary information. Typically, if DNA is damaged, special structures in the cell repair it, or the cell dies.
But in cancer cells, the DNA remains damaged, but the cell continues to live and becomes immortal. In addition, it actively divides and produces new immortal cells with the same damaged DNA.
The body does not need such cells, since they are not able to perform the functions originally inherent in them.
All types of cancer begin when cells in the body begin to grow out of control. Instead of dying, cancer cells continue to grow and multiply. Cancer cells, unlike normal cells, have the ability to invade other tissues, gradually increasing the size of the tumor.
Types of cancer:
Brain tumors Head and neck tumors Genital organ tumors Breast tumors Endocrine gland tumors Urinary system tumors Gastrointestinal tract tumors Blood cancer (hematoblastosis)
Lung cancer
Skin cancer
Bone cancer
Heart cancer
Sarcoma
Carcinoma
Adenocarcinoma
Squamous cell carcinoma
- Surgical treatment of cancer: This type of cancer treatment is usually the initial step in the treatment of most malignant tumors. In the case when cancer was detected at the first stage of the disease, surgical intervention makes it possible to completely remove all cancer cells from the body and achieve a complete recovery of the patient from cancer. Benign tumors are also almost always removed surgically.
- Radiation therapy: This cancer treatment can be used either in combination with surgery or drug treatment. The goal of radiation therapy is to destroy cancer cells by exposing them to large doses of X-rays.
- Chemotherapy: This is a way of treating cancer using a variety of drugs that can destroy cancer cells. Chemotherapy drugs destroy cancer cells in the dividing stage and prevent them from further dividing.
- Hormone therapy: This is a way of treating cancer by blocking hormone receptors in cancer cells, so that they do not receive hormonal influences and are not stimulated to grow.
- Specific cancer inhibitors: This is a relatively new way to treat cancer; drugs in this group act on specific proteins inside the cancer cell and thus block the growth and division of malignant cells.
- Antibodies: These are cancer treatments that rely on the use of antibodies against cancer cells. Antibodies are a natural reaction and mechanism for protecting the body from everything foreign; scientists have managed to create artificial antibodies that attack malignant cells and are adapted for use in the form of medicine. There are different mechanisms of action of antibodies
- they can deprive the cancer cell of communication with the environment and can directly cause its death. Antibodies are highly specific and do not affect healthy cells.
- Biological response modifiers are cancer treatments using natural proteins and other substances that stimulate the body's own defenses to fight cancer.
- Cancer vaccines: This is a way of treating cancer by stimulating the body's immune system, which, for various reasons, cannot destroy the cancerous tumor. Vaccines typically consist of proteins that are found in or produced by cancer cells. The use of such vaccines enhances the immune response against cancer.
Some archaeological studies indicate that Neanderthals suffered from various types of cancer. The disease was first described in an Egyptian papyrus around 1600 BC. e. The papyrus talks about several forms of breast cancer and reports that there is no cure for the disease. The name “cancer” comes from the term “carcinoma” introduced by Hippocrates (460-370 BC), which denoted a malignant tumor with perifocal inflammation. (Hippocrates called the tumor carcinoma because it looks like a crab.) He described several types of cancer and also coined the term buko
TRENDS IN THE PREVALENCE OF MALIGNANT NEOPLASMS IN THE KRASNODAR REGION IN 2007-2011.
Kazantseva M.V.
GBUZ "Clinical Oncology Dispensary No. 1" DZ KK
Malignant neoplasms have traditionally been the object of increased attention from health care organizers due to the constant and widespread increase in morbidity, high mortality and disability of patients.
Every year in Russia more than 500 thousand newly identified cases of malignant neoplasms and more than 290 thousand deaths from them are registered. The leading localizations in the general structure of cancer incidence in the Russian population are: skin (12.4%), mammary gland (11.1%), trachea, bronchi, lung (11.0%), stomach (7.7%), colon ( 6.4%), prostate gland (5.1%), rectum (5.0%), lymphatic and hematopoietic tissue (4.7%), uterine body (3.8%). In the structure of mortality of the Russian population from malignant neoplasms, the largest share is made up of tumors of the trachea, bronchi, lung (17.7%), stomach (11.9%), colon (7.4%) and rectum (5.7%).
In recent years, about 20 thousand newly diagnosed patients with malignant neoplasms are registered annually in the Krasnodar Territory; 2.7% of the region's population at the end of 2011 are under dispensary observation by oncologists with a diagnosis of malignant neoplasms. The annual steady increase in the number of cases of malignant neoplasms is due to improved quality of diagnosis, statistical recording, as well as an increase in the number of older people who are at greatest risk of contracting malignant tumors. In the Krasnodar Territory over the past 5 years, the share of people aged 60 years and older has increased by 2.6% and amounted to 19.5%. Over this period of time, the average age of those living in the region increased from 38.5 to 39.5 years, an increase of 1 year (in the Russian Federation - 38.9).
An integral indicator characterizing the level and quality of life is life expectancy at birth, which in the region is almost 2 years higher than the Russian average. This figure increased by 4.7% compared to 2006 and amounted to 71.5 years in 2010 (in the Russian Federation - 69.4).
Thus, the increasing proportion of elderly and senile people, the increase in average life expectancy in the near future will contribute to a further increase in the cancer incidence of the population.
The intensive incidence rate of malignant neoplasms in the region is significantly higher than the Russian average. In 2010, the Krasnodar region ranked 5th in terms of the incidence of malignant neoplasms among 80 regions of the Russian Federation. For the period from 2007 to 2011. cancer incidence in the region increased from 380.9 to 412.2 per 100 thousand population or by 8.2%, but decreased compared to 2010 by 4.7%, which is associated with increased preventive work in the municipalities of the region and increased detection precancerous diseases and their timely treatment.
□Krasnodar region ShRF1
Rice. 1. Morbidity rate of the population of the Krasnodar Territory and the Russian Federation with malignant neoplasms in 2007-2011. (per 100 thousand population).
Over the past 5 years, the number of cancer patients registered at the dispensary in the region has increased by 18,130 people or 14.9%. The prevalence rate of malignant neoplasms increased by 12.1% compared to 2007 and amounted to 2669.8 per 100 thousand population. It should be noted that in terms of the prevalence of malignant neoplasms in 2010, the Krasnodar Territory ranked 1st among 80 regions of the Russian Federation.
The patient populations are formed mainly from persons with the most common nosological forms of malignant neoplasms: 19.7% are patients with skin cancer, 14.3% with breast cancer, 8.2% with thyroid cancer, 6.7% with body cancer and 5.4% - cervix.
Among the causes of death of the population of the Krasnodar Territory, malignant neoplasms consistently occupy 2nd place after cardiovascular diseases and account for 15.2% in the mortality structure.
220,3
225 210
In Krasnodar region and the Russian Federation
Rice. 3. Dynamics of mortality of the population of the Krasnodar Territory and the Russian Federation from malignant neoplasms in 2007-2011. (per 100 thousand population).
Mortality from malignant neoplasms in the Krasnodar region for the analyzed period 2007-2011. decreased by 4.2% from 214.8 to 205.7 per 100 thousand population and approached the all-Russian indicator (in the Russian Federation in 2010 - 204.4 per 100 thousand population). In 2010, the Krasnodar region ranked 31st in terms of mortality from malignant neoplasms among 80 regions of the Russian Federation.
In the structure of mortality, 1st place is occupied by malignant tumors of the trachea, bronchi, lung - 17.2%, 2nd - stomach - 9.5%, 3rd - breast - 8.6%, 4th - colon - 7.7% and 5th - rectum - 5.5%.
Since 2007, there has been an increase in mortality from malignant neoplasms of the liver, mesothelial and soft tissues, prostate, melanoma, cervix, lip, oral cavity and pharynx, kidney, and breast. Over the past 5 years, there has been a decrease in the mortality rate for malignant neoplasms of the thyroid gland, stomach, bladder, pancreas, bones and articular cartilage, malignant lymphomas, trachea, bronchi, lung, larynx, skin, ovaries, leukemia, uterine body, colon, esophagus, rectum.
Early diagnosis of malignant neoplasms depends mainly on the oncological alertness of both the patients themselves and general practitioners and their knowledge, and further tactics in relation to the patient. In 2010, on average in Russia, only 13.2% of patients with malignant neoplasms were identified as active.
Unfortunately, in our region, according to district and city oncologists, during preventive examinations, patients with malignant neoplasms were identified in only 10.0% of cases in 2011, which is 28.2% higher than the level in 2007 (7.8 %), but lower than the Russian average for 2010 (13.2%). The largest percentage of cases of malignant neoplasms identified during preventive examinations in 2011 were tumors of the cervix (23.9%), mammary glands (17.4%), thyroid gland (16.4%), uterine body (16.2%), skin (15.7%), lungs (14.7%), ovaries (11.4%), lips (10.1%).
At the same time, the proportion of patients actively identified, compared to 2007, decreased by 13.4% for cervical cancer, by 7.3% for ovarian cancer, and by 3% for uterine cancer, which indicates the weak performance of municipal health care institutions general profile on active detection of tumors in women.
Morphological verification is the main criterion for the reliability and validity of the diagnosis, since only by knowing its value can one judge to what extent the analyzed data actually reflect information about cancer patients. For all locations of malignant tumors, the proportion of morphologically confirmed diagnoses increased from 85.0% in 2007 to 88.4% in 2011, which is higher than the Russian average (85.3%, 2010). This is evidence of the improving quality of specialized care for cancer patients.
However, the level of this indicator for tumors of some localizations cannot be considered optimal. For example, for malignant neoplasms of the liver, the diagnosis was confirmed only in 32.4%, of the pancreas - in 39.7%, of the trachea, bronchi, lung - in 67.7%, of the kidney - in 72.1%, of the esophagus - in 88 .5%, stomach - in 88.7%.
The neglect indicator, which characterizes the state of the diagnostic component of care for cancer patients in general medical institutions, has remained relatively low for 5 years and does not exceed the Russian average (Fig. 4). High rates of advanced forms of cancer are largely due to the late presentation of patients, the lack of oncological alertness of primary care physicians, the characteristics of the tumor process and objective diagnostic difficulties. However, the introduction of modern informative diagnostic methods, and, of course, actively carried out preventive measures in the Krasnodar Territory made it possible to reduce the number of advanced stages in 2011 compared to previous years. Compared to 2007 (20.2%), the rate of detection of cancer patients in an advanced stage of the disease decreased by 3.5% and amounted to 19.5%. However, in almost every fifth patient the tumor was detected in the presence of distant metastases.
2007 a. 2008 2009 2010 2011
11 Krasnodar region ■ Russian Federation
Rice. 4. Dynamics of the proportion of patients registered with stage IV of the disease in 2007-2011. in the Krasnodar Territory and the Russian Federation (%).
Alarming is the significant increase in the neglect rate compared to 2007 for skin melanoma - from 8.9% to 14.4%, for cancer of the oral cavity and pharynx - from 34.4% to 46.1%, ovarian cancer - from 19.2 % to 23.0%, thyroid gland - from 3.9% to 4.4%, esophagus - from 42.1% to 46.9%, cervix
- from 12.9% to 14.0%, colon - from 25.9% to 27.9%, bladder - from 12.1% to 12.9%,
lungs - from 51.6% to 54.8%.
However, if we take into account patients with tumors of visually visible localizations diagnosed in stage III of the disease, then the neglect rate is higher (2011 - 25.5%), but it also does not exceed the Russian average (in 2010 - 29.4%) . In this regard, noteworthy is the significant increase over the past 5 years in the proportion of patients with malignant neoplasms of the thyroid gland identified in stages III-IV of the disease, skin melanoma, cancer of the lip, oral cavity and pharynx, cervix, and breast.
One of the most objective indicators reflecting the state of diagnosis and treatment of cancer patients is the mortality rate during the first year after diagnosis.
On the territory of the Russian Federation in recent years there has been a tendency towards a decrease in the one-year mortality rate - by 5.3% over the last 5 years. In our region in 2007-2011. the proportion of cancer patients who died during the first year from the moment of diagnosis is in the range of 20-26% and, although it is below the Russian average, however, compared to 2007, its level increased by 18.8% and is equal to 2011. 24.0%.
Mortality remains high within a year in patients with malignant tumors of the liver (91.1%), pancreas (63.7%), esophagus (58.9%), lungs (54.4%), stomach (51.5%). ). It is also significant in malignant neoplasms with a relatively favorable prognosis (breast cancer - 11.3%, cervical cancer - 20.3%), which indicates late diagnosis and, accordingly, does not allow for full radical treatment of tumors of these localizations.
In conclusion, it should be noted that actively carried out cancer prevention measures among the population of Kuban have made it possible to reduce the number of newly diagnosed patients in advanced stages of the tumor process and, consequently, reduce mortality from cancer. This is eloquently evidenced by the gap between morbidity rates (Krasnodar Territory ranked 5th among 80 regions of the Russian Federation in 2010) and mortality (31st place) due to malignant neoplasms and the sharply positive dynamics of reducing the mortality rate from cancer pathology over the past 5 years ( 25th place in 2007). These facts undoubtedly indicate the correctness of the chosen path along which the development of the oncological service in the Krasnodar region is taking place.
Literature
- Malignant neoplasms in Russia in 2010 (morbidity and mortality) / Ed. V.I. Chissova, V.V. Starinsky, G.V. Petrova. - M.: FSBI “MNIOI im. P.A. Herzen" Ministry of Health and Social Development of Russia, 2012 - 260 p.
- Kazantseva M.V., Teslenko L.G., Tsokur I.V., Bondareva I.S. Prevalence of malignant neoplasms in the Krasnodar region (2006-2010). - Krasnodar, 2011. - 274 p.
- On the state of health of the population of the Krasnodar Territory in 2010: state report / Administration of the Krasnodar Territory, Department of Health of the Krasnodar Territory; under the general editorship of E.N. Redko. - Krasnodar: GUZ MIAC, 2011. - 271 p.: ill.
- The state of cancer care for the population of Russia in 2010 / Ed. V.I. Chissova, V.V. Starinsky, G.V. Petrova. - M.: FSBI “MNIOI im. P.A. Herzen" Ministry of Health and Social Development of Russia, 2011 - 188 p.
WAYS TO PREVENT MALIGNANT NEOPLOGMS
Karipidi R.K.
GBOU HPE "Kuban State Medical University" M3 and SR RF
Widespread study of the prevalence of neoplasms began relatively recently. Many researchers associate this with the idea of the place of epidemiology in the system of medical knowledge that changed in the 20th century.
The widespread occurrence of malignancies, cardiovascular diseases, injuries and other non-communicable diseases has required a reinterpretation of epidemiology as a branch that deals with the totality of diseases.
The modern definition of this subject talks about the patterns of occurrence and spread of all diseases in society and methods of their public prevention. Some modern epidemiologists argue that epidemiology should deal not only with the prevalence of diseases, but also analyze the activities of health care institutions that treat patients of the relevant profile.
Prevention measures related only to nutrition and physical activity can reduce the risk of cancer by 30-40%; other measures (quitting smoking, protection from excess solar radiation, protection from harmful substances with carcinogenic effects) can further reduce the risk of the disease.
According to experts, contained in the “European Guidelines for the Control of Malignant Tumors”, 80 or even 90% of cases of tumors are associated with causes due to lifestyle - dietary habits, social and cultural activities. European experts believe that today more than half of cancer cases have identifiable causes and are preventable.
According to research from the World Cancer Research Fund, healthy eating, physical activity and avoiding excess body weight can reduce the incidence of cancer by 30-40%. For tumors of different organs, different preventive measures have an effect, because Some tumor sites are associated and others are not associated with a specific risk factor. For example, obesity is strongly associated with the risk of breast and uterine cancer, colon and pancreatic cancer.. http://www.43.rospotrebnadzor.ru/news/detail.php?ID=l 741
Slide 1
Slide 2
How common is lung cancer? Lung cancer is one of the leading causes of death on earth. According to statistics, every 14th person has encountered or will encounter this disease in their life. Lung cancer most often affects older people. Approximately 70% of all cancer cases occur in people over 65 years of age. People under 45 years of age rarely suffer from this disease; their share of the total mass of cancer patients is only 3%.
Slide 3
What are the types of lung cancer? Lung cancer is divided into two main types: small cell lung cancer (SCLC) and large cell lung cancer (NSCLC), which in turn is divided into:
Slide 4
- Adenocarcinoma is the most common type of cancer, accounting for about 50% of cases. This type is most common in non-smokers. Most adenocarcinomas arise in the outer or peripheral region of the lungs. - Squamous cell carcinoma. This cancer accounts for about 20% of all lung cancer cases. This type of cancer most often develops in the central part of the chest or bronchial tubes. -Undifferentiated cancer, the most rare type of cancer.
Slide 5
What are the signs and symptoms of lung cancer? Symptoms of lung cancer depend on the location of the cancer and the size of the lesion in the lungs. In addition, sometimes lung cancer develops asymptomatically. In the photo, lung cancer looks like a coin stuck in the lungs. As the cancerous tissue grows, patients experience breathing problems, chest pain, and coughing up blood. If cancer cells have invaded the nerves, it can cause pain in the shoulder that radiates into the arm. When the vocal cords are damaged, hoarseness occurs. Damage to the esophagus can lead to difficulty swallowing. The spread of metastases to the bones causes excruciating pain in them. Metastases in the brain usually cause decreased vision, headaches, and loss of sensation in certain parts of the body. Another sign of cancer is the production of hormone-like substances by tumor cells, which increase calcium levels in the body. In addition to the symptoms listed above, with lung cancer, as with other types of cancer, the patient loses weight, feels weak and constantly tired. Depression and sudden mood swings are also quite common.
Slide 6
How is lung cancer diagnosed? Chest X-ray. This is the first thing done if lung cancer is suspected. In this case, a photo is taken not only from the front, but also from the side. X-rays can help identify problem areas in the lungs, but they cannot accurately show whether it is cancer or something else. A chest x-ray is a fairly safe procedure as the patient is exposed to a small amount of radiation.
Slide 7
Computed tomography A CT scanner takes pictures of not only the chest, but also the abdomen and brain. All this is done to determine whether there are metastases in other organs. The CT scanner is more sensitive to pulmonary nodules. Sometimes, to more accurately detect problem areas, contrast agents are injected into the patient’s blood. The CT scan itself usually goes through without any side effects, but the injection of contrast agents sometimes causes itching, rashes and hives. Just like a chest x-ray, computed tomography only finds local problems, but does not allow you to accurately say whether it is cancer or something else. Additional tests are required to confirm a cancer diagnosis.
Slide 8
Magnetic resonance imaging. This type of study is used when more accurate data on the location of the cancerous tumor is needed. Using this method, it is possible to obtain images of very high quality, which makes it possible to determine the slightest changes in tissues. Magnetic resonance imaging uses magnetism and radio waves and therefore has no side effects. Magnetic resonance imaging is not used if a person has a pacemaker, metal implants, artificial heart valves and other implanted structures, as there is a risk of their displacement under the influence of magnetism.
Slide 9
Cytological examination of sputum The diagnosis of lung cancer should always be confirmed by cytological examination. The sputum is examined under a microscope. This method is the safest, simplest and inexpensive, however, the accuracy of this method is limited, since cancer cells are not always present in sputum. In addition, some cells can sometimes undergo changes in response to inflammation or injury, making them similar to cancer cells. Sputum preparation
Slide 10
Bronchoscopy The essence of the method is to insert water into the respiratory tract with a thin fiber-optic probe. The probe is inserted through the nose or mouth. The method allows you to take tissue to test for the presence of cancer cells. Bronchoscopy gives good results when the tumor is located in the central regions of the lungs. The procedure is very painful and is performed under anesthesia. Bronchoscopy is considered a relatively safe research method. After bronchoscopy, coughing with blood is usually observed for 1-2 days. More serious complications such as severe bleeding, cardiac arrhythmia, and decreased oxygen levels are rare. After the procedure, side effects caused by the use of anesthesia are also possible.
Slide 11
Biopsy This method is used when it is impossible to reach the affected area of the lungs using bronchoscopy. The procedure is performed under the control of a computed tomograph or ultrasound. The procedure gives good results when the affected area is on the upper layers of the lungs. The essence of the method is to insert a needle through the chest and suck out liver tissue, which is subsequently examined under a microscope. The biopsy is performed under local anesthesia. A biopsy can accurately determine lung cancer, but only if it is possible to accurately take cells from the affected area.
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Surgical removal of tissue Pleurocentosis (puncture biopsy) The essence of the method is to take fluid from the pleural cavity for analysis. Sometimes cancer cells accumulate there. This method is also performed using a needle and local anesthesia. If none of the above methods can be applied, then in this case they resort to surgery. There are two types of surgery: mediastinoscopy and thoracoscopy. For mediastinoscopy, a mirror with a built-in LED is used. Using this method, a biopsy of the lymph nodes is taken and the organs and tissues are examined. During thoracoscopy, the chest is opened and tissue is removed for examination.
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Blood tests. Routine blood tests cannot alone diagnose cancer, but they can detect biochemical or metabolic abnormalities in the body that accompany cancer. For example, increased levels of calcium, alkaline phosphatase enzymes.
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What are the stages of lung cancer? Stages of cancer: stage 1. One segment of the lung is affected by cancer. The size of the affected area is no more than 3 cm. Stage 2. The spread of cancer is limited to the chest. The size of the affected area is no more than 6 cm. Stage 3. The size of the affected area is more than 6 cm. The spread of cancer is limited to the chest. Extensive damage to the lymph nodes is observed. Stage 4. Metastases have spread to other organs. Small cell cancer is also sometimes divided into only two stages. Localized tumor process. The spread of cancer is limited to the chest. A common form of the tumor process. Metastases have spread to other organs.
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How is lung cancer treated? Treatment for lung cancer may include surgical removal of the cancer, chemotherapy, and radiation. As a rule, all three types of treatment are combined. The decision about which treatment to use depends on the location and size of the cancer, as well as the patient's general condition. As with other types of cancer, treatment is aimed either at removing the cancerous areas completely or, in cases where this is not possible, at relieving pain and suffering.
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Surgery. Surgery is mainly used only during the first or second stage of cancer. Surgery is acceptable in approximately 10-35% of cases. Unfortunately, surgery does not always give a positive result; very often cancer cells have already spread to other organs. After surgery, approximately 25-45% of people live more than 5 years. Surgery is not possible if the affected tissue is located near the trachea or the patient has serious heart disease. Surgery is very rarely prescribed for small cell cancer, because in extremely rare cases such cancer is localized only in the lungs. The type of surgery depends on the size and location of the tumor. This way, part of a lung lobe, one lobe of a lung, or an entire lung can be removed. Along with the removal of lung tissue, the affected lymph nodes are removed. After lung surgery, patients require care for several weeks or months. People who have surgery typically experience difficulty breathing, shortness of breath, pain, and weakness. In addition, complications due to bleeding are possible after surgery.
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Radiation therapy The essence of this method is to use radiation to destroy cancer cells. Radiation therapy is used when a person refuses surgery, if the tumor has spread to the lymph nodes or surgery is not possible. Radiation therapy usually only shrinks the tumor or limits its growth, but in 10-15% of cases it leads to long-term remission. People who have lung diseases other than cancer usually do not receive radiation therapy because radiation can reduce lung function. Radiation therapy does not have the risks of major surgery, but it can have unpleasant side effects, including fatigue, lack of energy, low white blood cell counts (a person is more susceptible to infection) and low blood platelet levels (blood clotting is impaired). In addition, there may be problems with the digestive organs exposed to radiation.
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Chemotherapy. This method, like radiation therapy, is applicable for any type of cancer. Chemotherapy refers to treatment that stops the growth of cancer cells, killing them and preventing them from dividing. Chemotherapy is the main treatment method for small cell lung cancer, as it affects all organs. Without chemotherapy, only half of people with small cell cancer live more than 4 months. Chemotherapy is usually given on an outpatient basis. Chemotherapy is given in cycles of several weeks or months, with breaks between cycles. Unfortunately, the drugs used in chemotherapy tend to disrupt the process of cell division in the body, which leads to unpleasant side effects (increased susceptibility to infections, bleeding, etc.). Other side effects include fatigue, weight loss, hair loss, nausea, vomiting, diarrhea and mouth ulcers. Side effects usually disappear after treatment ends.
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What are the causes of lung cancer? Cigarettes. The main cause of lung cancer is smoking. People who smoke are 25 times more likely to develop lung cancer than non-smokers. People who smoke 1 or more packs of cigarettes a day for more than 30 years are especially likely to develop lung cancer. Tobacco smoke contains more than 4 thousand chemical components, many of which are carcinogenic. Cigar smoking is also a cause of lung cancer. People who quit smoking have a reduced risk of cancer because, over time, cells damaged by smoking are replaced by healthy cells. However, the restoration of lung cells is a rather long process. Typically, their complete recovery in former smokers occurs within 15 years.
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Other causes include: Asbestos fibers. Asbestos fibers are not removed from the lung tissue throughout life. In the past, asbestos was widely used as an insulating material. Today its use is limited and banned in many countries. The risk of developing lung cancer due to asbestos fibers is especially high in people who smoke; more than half of these people develop lung cancer. Radon gas. Radon is a chemically inert gas that is a natural product of the decay of uranium. Approximately 12% of all lung cancer deaths are attributed to this gas. Radon gas easily passes through the soil and enters homes through cracks in the foundation, pipes, drains and other openings. According to some experts, in approximately every 15 residential buildings the level of radon exceeds the maximum permissible standards. Radon is an invisible gas, but can be detected using simple instruments. Hereditary predisposition. Hereditary predisposition is also one of the causes of lung cancer. People whose parents or relatives of their parents died of lung cancer have a high chance of getting this disease. Lung diseases. Any lung disease (pneumonia, pulmonary tuberculosis, etc.) increases the likelihood of lung cancer. The more severe the illness, the higher the risk of developing lung cancer.
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