General principles and methods of treatment of cancer patients. What is radical tumor removal

Today, one can observe an increase in oncological diseases against the background of negative environmental factors and the prevalence of internal human diseases. This is what causes the development of malignant and benign tumors, while their localization can be very diverse. In this regard, new technologies are being developed, new principles are being created, and many experiments are being carried out in order to find the safest and most effective treatment for oncology.

General principles for the treatment of cancer patients

Modern methods of fighting cancer are built on the same principles, the basis of effective treatment is speed, safety and complexity. It is impossible to completely get rid of oncology, but there is a chance to significantly improve the patient's quality of life by maintaining the normal state of the body and preventing relapses.

The main objectives of the treatment of cancer patients.

• The use of combined treatment, regardless of the stage and prevalence of the pathological process.
• Combination of modern technologies with the main methods of treatment.
• Long-term treatment planning, continuity of therapeutic measures throughout the life of the patient.
• Constant monitoring of the oncological patient, correction of treatment based on the latest diagnostic tests.

In addition, the main goal of modern medicine is timely diagnosis, which is the key to effective treatment.

Medical treatment of oncology

The use of medications for the treatment of cancer patients is carried out taking into account the stage and location of the malignant process. Antitumor vaccines, hormonal and symptomatic drug therapy are used. Such treatment cannot be carried out as an independent method, and it is only an addition to the main measures in the presence of a malignant process in the body.

Let's analyze the most common types of cancer and the essence of their drug therapy.

• Breast and prostate cancer - in case of localization of cancer in the mammary gland and prostate, it is rational to use a course of hormonal therapy. Painkillers, restorative and antitumor drugs are also prescribed. The essence of hormonal treatment is to stop the synthesis of hormones that are the cause of progressive tumor growth. Be sure to prescribe cytostatic drugs that destroy atypical cells, creating all the conditions for their death.
• Cancer of the brain or bone marrow - in such diseases, drug therapy is less essential, surgical treatment should be carried out. But in order to maintain the general condition, drugs are prescribed to increase brain activity, improve memory. In patients with brain cancer, various mental disorders occur, so symptomatic therapy is carried out.
• Bone and cartilage cancer - drugs are prescribed to strengthen bones. Very often, in patients with a tumor in the bones, fractures or cracks occur even with minor loads. Therefore, it is very important to strengthen the structure of bone tissue through vitamin therapy and other drugs.

What drugs are used to treat cancer?

All medications in the fight against oncology can be divided into several groups.

• Hormonal drugs - drugs that reduce testosterone levels, these are Herceptin, Taxol, Tamoxifen, Avastin, Thyroxin, Thyreoidin.
• Toxic drugs - aimed at destroying cancer cells, by toxic effects on them, these are Celebrex, Avastin, Docetaxel. Also narcotic drugs - Morphine, Omnopon and Tramadol.
• Antiviral - the essence of the appointment of this group of drugs in maintaining immunity. In oncology, both local and internal anti-inflammatory drugs are used.
• Cytotoxins and cytostatics - under the influence of these agents, the tumor resolves and decreases in volume, which is necessary for subsequent surgical intervention.
• Antitumor universal drugs are Ftorafur, antimetabolites, Doxorubicin and others.

Radiation and chemotherapy

Radiation therapy and chemotherapy are among the main treatments for cancer. Appointed in the preoperative and postoperative period.

Radiation therapy

Radiation therapy is prescribed in case of sensitivity of cancer cells to this type of radiation. This is a small cell cancer that is most often localized in the respiratory system, uterus, in the head area, and can also affect the lungs.

Several methods of radiation therapy are used:

• remote;
• intracavitary;
• using neutrons, radioactive isotopes and protons.

It is rational to use the radiation method of oncology treatment before the operation in order to localize the main focus of the tumor. The goal of postoperative radiation therapy is to kill any remaining cancer cells.

Chemotherapy

Chemotherapy is also the main method of cancer treatment, but is used in parallel with radical measures. The drugs that are used in this case actively fight against pathological cells. Healthy tissues are also affected, but to a lesser extent. This selectivity of chemicals lies in the rate of cell growth. Cancer structures multiply rapidly and are the first to be hit by chemotherapy.

For cancer of the testicles, uterus, Ewing's sarcoma, breast cancer, chemotherapy is the main method of treatment, and can completely overcome cancer in the first and second stages.

Radical removal of the tumor

A surgical operation aimed at removing the main tumor focus and nearby tissues is used at the first, second and third stages of the disease. Late stage cancer is not amenable to surgery, and surgery is contraindicated. This is because at the 4th stage of cancer metastasis occurs, and it is impossible to remove all metastases from the body. The operation in this case will only harm the patient, weaken him (with the exception of palliative surgery).

Radical therapy in oncology occupies the first place. Complete removal of the tumor in the first stages can completely get rid of cancer. During the surgical operation, not only the focus and part of the affected organ, but also regional lymph nodes are removed. After the operation, a mandatory tissue examination is carried out, after which a course of drug treatment is prescribed.

There are two main options for the operation - organ-preserving and extended.

• An extended operation is performed mainly for cancer of the rectum, uterus, genitals. It involves the removal of the organ itself and regional lymph nodes. Another technology of extended operations has been created - super-radical, in which, in addition to the causative organ, several nearby ones are also removed. Contraindications: presence of distant metastases.
• Organ-preserving surgery is performed with a clear localization of cancer without metastatic processes. It is carried out with breast cancer, tumors in the face area. This allows you to save the body, which significantly affects the psychological state of the patient. In some cases, after a radical removal, cosmetic restoration procedures are performed, which also improves the patient's quality of life.

Palliative care

Of the entire complex of oncology treatment, it is important to single out palliative measures. They are not aimed at treatment, but at improving the quality and life expectancy of patients with stage 4 cancer. Such patients do not have a chance for a full recovery, but this does not mean that you can die in peace. Modern medicine offers such patients a set of procedures that eliminate the main symptoms of cancer. These are pain relief, cancer reduction through gentle surgery, general strengthening drugs, physiotherapy procedures.

Treatment of patients at the 4th stage is a difficult task, such patients suffer from excruciating pain, severe weight loss, and psychological disorders. Therefore, a separate treatment of each of the complications of cancer is carried out.

Symptomatic treatment includes:

• narcotic analgesics - morphine, fentanyl, buprenorphine;
• non-narcotic analgesics - paracetamol, metamizole, ibuprofen, diclofenac.

If the treatment of pain syndrome is ineffective, you can contact the Center for the treatment of oncological pain. Eliminating pain is the main task in the treatment of a cancer patient.

In oncology, there are 3 main independent methods of special treatment of cancer patients:

• surgical,
• ray,
• chemotherapeutic.

Surgical method

It is the main one for the treatment of malignant tumors of most localizations. Surgical treatment should be understood not only as an intervention with a conventional scalpel. In modern surgery, a laser scalpel, electrodiathermic and ultrasonic methods of tissue destruction are used. The surgical method includes cryodestruction of tumors. Currently, there are complex technologies based on surgical treatment. These include endoscopic and radiological interventions.

The volume of the operation can be normal when a standard intervention is performed along with the removal of the lymph nodes of the first stage of metastasis. If at the same time the lymph nodes of the second or third stage of metastasis are removed, then such operations are considered to be extended. In cases where, due to the prevalence of the tumor, two (or more) organs or their parts with lymph nodes of the first stage of metastasis are removed, operations are combined. Operations with the removal of lymph nodes of the second or third stage of metastasis are combined-extended. There are cases when an oncological operation is combined with a non-oncological one. For example, during resection of the sigmoid colon for cancer, cholecystectomy is performed due to cholelithiasis. Such operations are called combined.

In essence, surgical operations are radical, palliative, symptomatic.

Under radical operation in oncology, they understand this when the entire tumor is removed within healthy tissues in a single block with regional metastasis pathways, and metastases are not detected in other places. The concept of "radical surgery" is purely clinical. It does not mean that all cancer cells have been removed from the body. For it is known that with many malignant tumors in some patients, even in the initial stages, cancer cells can circulate in the lymph and blood. Therefore, even after a radical operation, the continuation of the disease is always possible. The more common the process, the higher the chances of a recurrence of the disease.

Theoretical data and clinical observations indicate the possibility of eliminating the remnants of the tumor in the presence of only its individual cells after a radical operation by the forces of the organism itself. With common tumors, surgical treatment must be supplemented with other methods of influencing the tumor and the body (combined or complex treatment).

To palliative include operations in which not all of the tumor or metastases are removed. Palliative operations are performed mainly with the aim of improving the quality of life and its continuation. They, as a rule, do not save patients from the progression of the tumor process. Although in some cases, when using combined or complex treatment, a long-term remission is possible. Palliative operations are those that are performed with interventions reduced relative to the well-known, established volume for each localization and stage of cancer. For example, conventional gastric resection for cancer without removal of omentums or sectoral resection for infiltrative growth of breast cancer, etc.

Symptomatic operations aimed at eliminating those symptoms that directly threaten the lives of patients. These include ligation of vessels in case of bleeding from a tumor, decompression interventions for tumors of the brain and mediastinum, the imposition of various stomas on the trachea, esophagus, intestines, bladder, etc., when the tumor blocks the appropriate pathways for the passage of air, food, urine, and etc. They also include various bypass anastomoses for intestinal obstruction, denervation for the purpose of pain relief. Unlike radical and palliative operations, symptomatic operations never lead to recovery. Their positive influence is often short-term, and in some cases their expediency is doubtful.

Radiation therapy

LT occupies one of the leading places in the treatment of cancer patients and is used in at least 80% of patients. For LT, the so-called ionizing radiation is used - photon (gamma radiation, X-ray) and corpuscular (electrons, positrons, neutrons), which differ in the severity of the biological effect and the distribution of energy in the irradiated tissue. As radiation sources, radionuclides and devices that create the corresponding radiation beams are used: X-ray, electron and proton accelerators, neutron generators. Depending on the method of irradiation, remote, contact and interstitial radiation therapy are distinguished, which differ in the nature of the dose distribution in the irradiated tissue.

remote is exposure in which radiation sources are at a certain distance from the patient's body. X-ray machines, gamma-therapy machines with 60 Co sources and linear electron accelerators with the output of bremsstrahlung and electron beams are used for external beam therapy. The advantage of accelerators is the ability to select the type of radiation and control its energy. The modern design of the devices allows irradiation not only in static, but also in rotational mode.

Contact and interstitial irradiation with sealed radioactive sources are usually combined under the term brachytherapy. During contact irradiation, radioactive sources are introduced into the natural cavities of the body (intracavitary and application irradiation). This method is used in the treatment of tumors of the body and cervix, vagina, esophagus, rectum, etc. Manual introduction of sources is currently used extremely rarely due to the creation of special devices for programmable introduction of sources that enter endostats placed in the corresponding cavity. With interstitial (interstitial) irradiation, the sources enter special catheters that are placed directly in the tumor tissue in advance.

The method of treatment, when brachytherapy alternates sequentially with external beam radiation therapy, is called combined RT.

A variety of interstitial therapy can be considered "internal" irradiation, in which open (liquid) radioactive preparations are introduced into the body - intravenously or orally, then entering the corresponding organs or target tissues by biological means.

To carry out RT requires careful topometric preparation of the patient, computer planning and dosimetric control of treatment. Medical physicists and specialists in clinical dosimetry are directly involved in all stages of RT. Dosimetric planning of exposure is carried out in order to select the type of radiation, method and conditions of exposure to create the optimal distribution of the absorbed dose. A necessary condition for planning is the creation of a correct topometric map. To do this, use the data of various x-ray, less often - radioisotope, ultrasound studies.

Currently, special X-ray simulators are used that imitate the radiation beam and the irradiation mode, which makes it possible to assess the correctness of the planned treatment session, to determine the center of the tumor and the boundaries of its fields.

One of the main conditions determining the effectiveness of RT is the maximum damage to the tumor tissue with the maximum preservation of normal organs and tissues. Both the result of treatment and the further development of radiation complications that occur when the tolerable doses for normal tissues are exceeded depend on this. The tolerable dose depends both on the characteristics of the tissue itself and on the mode of irradiation and the volume of the irradiated tissue. Tolerance levels under various irradiation regimens are to a certain extent reflected by the WDF factor (time - dose - fractionation). This model was proposed to calculate the biological effect on the connective tissue and is not suitable for predicting the tolerance of a number of other organs and tissues (liver, kidneys, intestines, etc.). For these organs, a linear-quadratic model is proposed that takes into account the features of damage, repair, and repopulation of cells.

The existing and developed methods of RT are based on the principles of clinical radiobiology, the main concept being "radiosensitivity of a tumor". It is known that radiosensitivity is inversely proportional to the degree of cell differentiation. There are two types of radiation cell death: interphase, not associated with the process of division, occurring already in the first hours after irradiation, and reproductive, occurring at the time of cell division due to a violation of the DNA structure and the loss of part of the genetic information.

The most radiosensitive are, as a rule, tumors of lymphoid origin, neuroblastomas, medulloblastomas and small cell lung cancer; the most radioresistant are osteogenic sarcomas, melanomas, and nephroblastomas. The radiosensitivity of neoplasm cells of the same type varies significantly, which is the reason for the variability of radiosensitivity of tumors observed in the clinic. This is due to both the influence of the microenvironment and the peculiarities of hemocirculation. In addition, the effect of radiation therapy depends on the rate of repair of sublethal damage to tumor and normal tissues, and the rate of repopulation of the cell pool also plays a role. These indicators are very different for various normal and tumor tissues. These factors influence the solution of the issue of the irradiation mode - fractionation, the duration of the course, the feasibility of using non-standard fractionation (dynamic fractionation, hyperfractionation, multifractionation).

To increase the effect of RT, various methods are used, mainly aimed at increasing the radiotherapy interval. Along with the use of various modes of fractionation, various radiomodifying agents are widely used - radioprotectors and radiosensitizers (oxygen, nitromidazole derivatives, antimetabolites, hyperthermia).

In oncological practice, LT is used as an independent method or as a component of combined and complex treatment in combination with surgical and drug treatment. In this case, both remote and brachytherapy can be used, which leads to an increase in local cure of tumors.

Preoperative RT is prescribed to increase the ablasticity of the operation, destroy radiosensitive cell populations, and prevent implantation metastasis. Preoperative irradiation leads to a reduction in the size of the tumor, and sometimes to its delimitation from the surrounding normal tissues, which increases resectability and leads to a decrease in the number of local recurrences and distant metastases. The correct choice of the dose and regimen of irradiation is important for a sufficient tumoricidal effect and to prevent an increase in the frequency and severity of postoperative complications due to damage to normal tissues. Most often irradiated at 2 Gy to 40 - 45 Gy for 4 - 4.5 weeks or 4 - 5 Gy to 20 - 25 Gy for 4 - 5 days. Moreover, in the first case, surgery is performed 2–3 weeks after the end of irradiation, in the second case, after 1–2 days (the latter technique is recommended only for obviously operable cases).

Postoperative RT is carried out in order to devitalize possible scattered cells in the surgical field or tumor remnants after non-radical operations, as well as irradiation of regional metastasis zones, including those that did not fall into the area of ​​surgical intervention. Postoperative radiation has its advantages and disadvantages. The former include the possibility of marking the tumor bed, the availability of the results of a morphological study, which facilitates the decision on the method of irradiation. The disadvantages are the irradiation of damaged tissues with inflammatory changes, impaired blood and lymph circulation, reduced radiosensitivity of tumor tissue while increasing the radiosensitivity of normal tissues due to regeneration processes in them.

Exposure doses of postoperative RT depend on its purpose: if prophylactic irradiation is carried out, aimed at eliminating possible subclinical foci, doses may not exceed 45 - 50 Gy; if with a therapeutic purpose on an unremoved tumor, the focal dose is increased to 65-70 Gy. If RT was also used in the preoperative period, the focal dose is summed up.

Contraindications to RT can be general (weak and severe condition of patients, the presence of severe anemia, leukopenia, thrombocytopenia, significant intoxication) and local (tumor decay, the threat of bleeding, inflammatory and infectious processes).

It is customary to distinguish between radiation reactions and radiation damage (complications). Radiation reactions - zritema, epitheliitis, dermatitis, esophagitis, colitis, cystitis, stomatitis, etc. - differ in that they disappear within 2-4 days on their own, without the use of long-term special treatment. Radiation complications can be early and late. The early ones develop during RT or in the next 3 months after its completion (100 days is the maximum recovery time for sublethally damaged cells). Late radiation damage develops after a specified period, often after many years. There is practically no such organ or tissue that would not be damaged by irradiation when their tolerance is exceeded. Lesions range from mild to very severe, from mild functional disorders to complete loss of function, ulceration, fistulas, necrosis.

Chemotherapy

Antitumor chemotherapy is a method of treating patients with malignant neoplasms with drugs that can inhibit the proliferation of tumor cells (cytostatic effect) or lead to their complete death or apoptosis (cytotoxic effect). More than 60 anticancer drugs are used in clinical oncology. Since not all drugs are highly selective, they have a side (toxic) effect on normal, primarily rapidly proliferating tissues - bone marrow, intestinal mucosa, hair follicles, genitals, immune system cells.

Recently, scientists have paid much attention to the development of modifiers of biological reactions. These include cytokines that regulate the functions of the immune system (interferons, interleukins, colony-stimulating factors), recombinant a-interferons (reaferon, laferon), hyperthermia, which increases the sensitivity of tumor cells to antitumor drugs, and others. Modern antitumor chemotherapy is a combined, rather intensive treatment, which is prescribed in cycles with relatively short (3-4 weeks) intervals.

In the early stages of solid malignant tumors, chemotherapy is used as a preoperative or neoadjuvant, postoperative or adjuvant therapy.

The purpose of neoadjuvant chemotherapy is to destroy micrometastases, to improve the conditions for tumor operability and patient survival as a result of systemic chemotherapy before surgery in the amount of 3-4-6 courses, for example, in breast cancer, intestines, etc. This method helps to determine the sensitivity of the tumor to chemotherapy drugs , which can be prescribed after the operation.

Adjuvant chemotherapy prescribed after surgery is aimed at increasing the life expectancy of patients and the destruction of micrometastases.

There are systemic, regional, local chemotherapy. Systemic chemotherapy includes the administration of drugs orally, intravenously, intramuscularly, under the skin, rectally. By regional chemotherapy is meant the effect of a cytostatic agent on a tumor at elevated concentrations, for example, when administered intra-arterially. In local chemotherapy, cytostatics are used as an ointment on superficial tumor nodes (fluorouracil ointment, Miltex). Solutions are injected intrathecally into the spinal canal, into the serous cavities with effusions (ascites, pleurisy), into the bladder with cancer. A new direction in chemotherapy is the biochemical modification of the action of anticancer drugs in order to reduce their toxicity. An example is the combination of high-dose methotrexate with leucovorin. Now it is unthinkable to prescribe ifosfamide without uromitexan or mesna, etc.

Of particular importance is the concomitant, or additional, treatment of cancer as a new direction in chemotherapy to improve its tolerability. At the same time, drugs such as navoban and zofran are used to reduce nausea and vomiting; with metastatic bone pain, calcium metabolism disorders - aredia and bonefos; with leukopenia - leukomax, granocyte and blasten; for anemia - erythropoietin or its recombinant form epoetin a, as well as the Ukrainian drug a-lysine-baicalinate and many others.

The evaluation of the effectiveness of antitumor chemotherapy for solid tumors primarily includes the survival of patients, as well as the objective effect, which, according to the gradation of the WHO Expert Committee, has 4 degrees:

• 1st degree - complete regression of the tumor and its metastases.
• 2nd degree - partial regression - reduction of all or individual tumors by 50% or more. To clarify the size of the tumor, it is necessary to measure it in 2 perpendicular largest diameters or at least in one (if possible).
• Grade 3 - stabilization (no change) or reduction of the tumor by less than 50% in the absence of new lesions, or its increase by no more than 25%.
• 4th degree - progression - an increase in the tumor by 25% or more, or the appearance of new tumor lesions.

The effectiveness of the treatment of hemoblastoses is determined by the normalization of bone marrow function and peripheral blood parameters.

Toxicity of antitumor chemotherapy is evaluated according to a five-point system:

• Grade 0 - the patient is practically healthy, there are no complaints.
• Grade 1 - minor changes in well-being and laboratory parameters that do not require intervention
• Grade 2 - moderate changes in well-being that disrupt the patient's life, and changes in laboratory data that require correction.
• Grade 3 - severe disorders requiring interruption or discontinuation of chemotherapy.
• Grade 4 - life-threatening, immediate withdrawal of chemotherapy is required.

Adjuvant Methods

In addition to the three main methods, there are additional, or adjuvant, which by themselves do not cure patients of malignant tumors, but only increase the effectiveness of the main ones or eliminate (or reduce) the negative effect of the latter on the body. These methods include immunotherapy, hormone therapy, local hyperthermia, hypoxic therapy, cell division synchronization methods, barotherapy, magnetotherapy, etc.

To increase the effectiveness of the main methods of treatment, many other methods of influencing various pathogenetic mechanisms of the relationship between the tumor and the body are used. Among them, a significant place in oncology is occupied by symptomatic therapy, which consists in detoxification, anesthesia and treatment of all disorders arising from the development of a tumor and the iatrogenic effect of the presence of a tumor.

For the treatment of cancer patients, combined or complex methods of treatment with different interpretations are used. Combined treatment method- is the use of two or three main (surgical, radiation, chemotherapy) methods in any sequence or simultaneously. In the world special literature, polychemotherapy is often referred to as a combined method. Complex treatment method- this is the use along with the main methods of secondary ones - hormone therapy, immunotherapy, hyperthermia, etc.

The best results of treatment are observed in the early stages of malignant tumors. In these cases, depending on the location and histological structure of the tumor, as a rule, it is sufficient to use one of the methods of treatment, more often surgical or radiation therapy.

With common malignant tumors, combined and complex treatment is necessary, and in the terminal stages - only symptomatic.

Treatment should be comprehensive and include both conservative measures and surgical treatment. The decision on the scope of the forthcoming treatment of an oncological patient is made by a council, which includes an oncologist, a surgeon, a chemotherapist, a radiologist, and an immunologist.

Surgical treatment may precede conservative measures, follow them, but a complete cure for a malignant neoplasm without removal of the primary focus is doubtful (excluding blood tumors that are treated conservatively).

Surgery for cancer can be:

1) radical;

2) symptomatic;

3) palliative.

radical operations imply the complete removal of the pathological focus from the body. This is possible due to the implementation of the following principles:

1) ablastics. During the operation, it is necessary to strictly observe ablastics, as well as asepsis. The ablasticity of the operation is a prevention of the spread of tumor cells in healthy tissues. For this purpose, the tumor is resected within healthy tissues, without affecting the tumor. In order to check the ablasticity after resection, an emergency cytological examination of the imprint smear from the surface remaining after resection is performed. If tumor cells are found, the resection volume is increased;

2) zoning. This is the removal of nearby tissue and regional lymph nodes. The volume of lymph node dissection is determined depending on the prevalence of the process, but it must always be remembered that the radical removal of lymph nodes leads to the occurrence of lymphostasis after surgery;

3) antiblasts. This is the destruction of locally advanced tumor cells, which in any case dissipate during surgery. This is achieved by chipping the circumference of the pathological focus with antitumor drugs, regional perfusion with them.

Palliative surgery carried out in the event that it is impossible to carry out a radical operation in full. In this case, a part of the tumor tissue array is removed.

Symptomatic operations are carried out to correct emerging disorders in the activity of organs and systems associated with the presence of a tumor node, for example, the imposition of an enterostomy or a bypass anastomosis in a tumor obturating the outlet section of the stomach. Palliative and symptomatic operations cannot save the patient.

Surgical treatment of tumors is usually combined with other methods of treatment, such as radiation therapy, chemotherapy, hormonal and immunotherapy. But these types of treatment can also be used independently (in hematology, radiation treatment of skin cancer). Radiation therapy and chemotherapy can be applied in the preoperative period in order to reduce tumor volume, remove perifocal inflammation and infiltration of surrounding tissues. As a rule, the course of preoperative treatment is not long, since these methods have many side effects and can lead to complications in the postoperative period. The bulk of these therapeutic measures is carried out in the postoperative period. If the patient has stages II-III of the process, surgical treatment must necessarily be supplemented with a systemic effect on the body (chemotherapy) in order to suppress possible micrometastases. Special schemes have been developed to achieve the maximum possible removal of tumor cells from the body, without exerting a toxic effect on the body. Hormone therapy is used for some tumors of the reproductive sphere.

Existing methods of cancer treatment guarantee success only in the early stages without metastasis. Even the most effective cancer treatments do not guarantee the absence of tumor recurrence in the future. All modern methods of cancer treatment are based on eliminating the consequences of certain changes in the human body. The tumor is removed, not its cause. Radical methods of treating oncology have not yet been invented, so it is too early to talk about a complete victory over this disease. But in most cases, cancer treatment methods can prolong the life of the patient and improve its quality.

The most modern and effective basic cancer treatments

Currently, the following main methods of cancer treatment are used in official medicine, which are:

• Removal of the tumor. Since tumor cells can also be found outside the tumor, it is removed with a margin. For example, in breast cancer, the entire breast is usually removed, as well as the axillary and subclavian lymph nodes. If, nevertheless, there are tumor cells outside the removed organ or part of it, the operation does not prevent them from forming metastases. Moreover, after removal of the primary tumor, the growth of metastases is accelerated. However, this method often cures malignant tumors (such as breast cancer) if the operation is done early enough. Modern methods of cancer treatment are such that surgical removal of a tumor can be carried out both with the help of traditional cold instruments and with the use of new instruments (radio frequency knife, ultrasonic or laser scalpel, etc.). For example, the most modern methods of treating laryngeal cancer (stages I-II) using a laser with direct laryngoscopy allows the patient to maintain an acceptable voice and avoid tracheostomy, which is far from always possible with traditional open surgeries (not endoscopic). The laser beam, compared to a conventional scalpel, reduces bleeding during surgery, destroys tumor cells in the wound, and provides better wound healing in the postoperative period.
• Chemotherapy. Drugs are used that target rapidly dividing cells. Drugs are effective methods of cancer treatment, since they can suppress DNA duplication, interfere with the division of the cell membrane into two, etc. However, in addition to tumor cells in the body, many healthy ones, for example, stomach epithelial cells, are intensively and rapidly dividing. They are also damaged by chemotherapy. Therefore, chemotherapy leads to severe side effects. When chemotherapy is stopped, healthy cells regenerate. In the late 1990s, new drugs came on the market that attacked the proteins of tumor cells with little or no damage to normal dividing cells. Currently, these drugs are used only for certain types of malignant tumors.
• Radiotherapy. Radiation kills malignant cells by damaging their genetic material, while healthy cells suffer less damage. For irradiation, X-rays and gamma radiation are used (short-wavelength photons, they penetrate to any depth), neutrons (have no charge, therefore they penetrate to any depth, but are more efficient with respect to photon radiation; their use is semi-experimental), electrons (charged particles penetrate to a conventionally shallow depth, up to 7 cm, using modern medical accelerators; are used to treat malignant tumors of the skin and subcutaneous cells) and heavy charged particles (protons, alpha particles, carbon nuclei, etc., in most cases semi-experimentally ).
• Photodynamic drug therapy- these are the most effective methods of cancer treatment, since they can destroy the cells of a malignant tumor under the influence of a light flux of a certain wavelength (photohem, photoditazin, radachlorin, photosens, alasens, photolon, etc.).
• hormone therapy. Cells of malignant tumors of some organs react to hormones, which is used. So, for prostate cancer, the female hormone estrogen is used, for breast cancer - drugs that suppress the action of estrogen, glucocorticoids - for lymphomas. Hormone therapy is a palliative treatment: it cannot destroy the tumor on its own, but it can prolong life or improve the chances of a cure when combined with other methods. As a palliative treatment, it is effective: in some types of malignant tumors, it prolongs life by 3-5 years.
• Immunotherapy. The immune system seeks to destroy the tumor. However, due to a number of reasons, it is often unable to do so. Immunotherapy helps the immune system fight the tumor by making it attack the tumor more effectively or by making the tumor more susceptible. Sometimes interferon is used for this. The vaccine of the American oncologist William Coley, as well as a variant of this vaccine - picibanil, are effective in the treatment of certain forms of neoplasms.
• Combined treatment. Each of the methods of treatment separately (except palliative) can destroy a malignant tumor, but not in all cases. To improve the effectiveness of treatment, a combination of two or more methods is often used.
• Cryotherapy. Cryotherapy is a technique for using deep cold, obtained through liquid nitrogen or argon, to destroy abnormal tissue. Cryotherapy is otherwise called cryosurgery or cryodestruction, since these terms are of foreign origin. In Greek, "cryo" means "cold" and "therapy" means "treatment." Cryotherapy refers to conventional cancer treatments. With the help of deep cold, some types of malignant as well as benign tumors are destroyed. When cells are frozen, the ice crystals that form in and around the cell cause them to become dehydrated. At this point, there is a sharp change in the pH value and the restriction of blood flow in such a way that the frozen cells can no longer receive nutrients. Cryotherapy can be used to treat various malignant tumors and precancerous conditions. It is especially effective in removing abnormal cells in cervical cancer and basal skin cancer cells. However, many studies have shown that cryosurgery can be successfully used to treat other types of cancer, such as localized prostate and liver cancer, retinoblastoma, and squamous cell skin cancer. Research is underway on the use of cryotherapy for other types of cancer.
• To alleviate the suffering of terminal patients (hopeless, dying), drugs are used (to combat pain) and psychiatric drugs (to combat depression and fear of death).

Surgical treatment: surgery to remove cancer and therapy after it

Surgical treatment of cancer continues to occupy the first place, since it is not only a therapeutic method, but also a diagnostic method. In the early stages of the development of malignant tumors, it gives certain chances for a cure. So, according to different authors, the five-year survival rate among radically operated patients with stage I lung cancer is 48-61%, stomach - 25-42%, while in the group of patients with stage III it reaches only 9-18%.

However, in practice, due to the difficulties of early diagnosis of oncology of internal organs, an operation to remove cancer is most often performed at the later stages of tumor development, when metastatic nodes already exist in the body. In this case, there is a danger of increased growth of metastases. The manifestation of the so-called explosive ability of cancer is mentioned in many literary sources. Cases of intensification of the metastasis process as a result of surgical interventions performed both with the removal of the primary tumor and after palliative operations are described. This phenomenon was also reproduced in the experiment (in particular, in our studies).

The considered serious complication of surgical treatment of patients with malignant tumors was initially explained by the massive influx of tumor cells into the bloodstream during the operation. Based on these ideas, N. N. Petrov in the 1950s developed the principles of ablastic and antiblastic - a system of measures that includes the most gentle attitude towards the tumor during surgery (minimal trauma), as well as the maximum possible radicalism of operations. After surgery to remove cancer, serious therapy with other methods is required to prevent recurrence.

The results of studies on the detection of tumor cells in the blood showed that, if the rules of ablastic and antiblastic are observed, the number of tumor cells in the blood and the activity of metastasis are lower.

The current concept is: if a diagnosis of "malignant tumor" is made, it is necessary to proceed with complex treatment. First of all, the problem associated with the removal of the bulk of the tumor is solved. Removal of the tumor is to a certain extent beneficial for the body, since the source of intoxication and inhibition of the body's defense systems by the products of tumor decay is removed. The main role in this task is played by the surgical method. However, it must be remembered that the body should be prepared for surgical treatment.

Currently, there are opportunities to help the body: for this purpose, adaptogens are used, which have a stress-regulating effect, reducing the likelihood of an outbreak of metastasis. This was proved by us in the experiment, as well as in the course of a study involving patients with malignant tumors of the larynx and pharynx. Some patients (50 people) constituted the control group; they received the entire modern complex of surgical treatment (radical removal of the tumor). Patients from another group (50 people) 7-10 days before surgery and at least a month after it received golden root extract (started with 10 drops in the morning, and then the dose was determined by the blood picture). In these patients, the number of postoperative complications was significantly less. There were practically no severe complications associated with a violation of the regenerative properties of tissues, altered immunological parameters normalized 3-4 days faster. The long-term results were also better: a smaller number of patients had metastases and tumor recurrences.

Therefore, the appointment of adaptogens during the period of surgical intervention is necessary, as it helps to increase the real chances for a practical cure. During the operation, preparations of the golden root (rhodiola), eleutherococcus, ginseng, leuzea, etc. are successfully used.

Cancer treatment with cytostatics and chemotherapy: video, complications, recovery and consequences in oncology, how it is done

Treatment with cytostatics is used everywhere, as it gives a visible result in a short time. Modern methods of treating malignant tumors include the so-called cytostatic therapy, which includes the use of chemotherapy and antitumor antibiotics, as well as radiation therapy. With all the difference in methods in both cases, along with tumor, normal tissues are affected to one degree or another, which is the main obstacle to a complete cure. Therefore, the treatment of cancer with cytostatics is a complex and dangerous process for the body.

The first results of treatment with the use of chemotherapy in oncology, both in the experiment and in the clinic, gave encouraging results: the tumors quickly decreased, and sometimes completely resolved. However, it soon became clear that such treatment of cancer with chemotherapy has very limited possibilities, and in addition, it causes a number of complications. The fact is that the principle of action of cytostatic methods is to disrupt cell division. With increasing doses of cytostatics, not only tumor cells are damaged, but also normally dividing cells, which leads to impaired hematopoiesis, a decrease in the number of white blood cells, impaired immune cell function and natural defense (phagocytosis). At a certain stage, this becomes an insurmountable obstacle to completing the course of chemotherapy necessary for the final destruction of the entire mass of tumor cells. As a result, temporary inhibition of tumor growth after the forced termination of the course of treatment is sometimes replaced by its very rapid development.

A terrible complication of treatment with cytostatics, in addition, is the emergence of tumor cells that are resistant to the treatment, which subsequently become the foci of a new process. The most serious consequences of chemotherapy in oncology are a pathological change in the immunological status of the body, associated with dysfunction, primarily of the hematopoietic and endocrine systems. Nevertheless, certain successes are also evident in the use of these drugs in the clinic, up to the achievement of a complete cure for such tumor diseases as Burkitt's lymphoma, seminoma, nonseminoma testicular tumors, and choriocarcinoma. Chemotherapy has become the main method in the treatment of leukemia and lymphoproliferative diseases and a necessary component in the treatment of solid tumors, along with surgical and radiation treatment. You need to know about the consequences of chemotherapy in oncology and recovery of the body in accordance with the recommendations of the attending physician.

Unfortunately, the invention of new powerful sources of radiation energy, the synthesis of new cytostatics did not lead to significant progress in the treatment of cancer. Now the need is already obvious, on the one hand, to find ways to enhance the effectiveness of cytostatic therapy, to reduce its undesirable effects, and on the other hand, to find fundamentally new ways of influencing the tumor process. Depending on how chemotherapy is administered for oncology, the risk of adverse effects may decrease or increase. Look at the video of chemotherapy for oncology and its negative consequences for the patient's body:

In recent years, the hyperthermia method has come into practice: heating the patient under anesthesia to 43 ° C, while introducing small doses of cytostatics, the effect of which on the tumor under these conditions is greatly enhanced.

In search of new avenues, researchers have turned to natural remedies, prioritizing those that have been most popular in traditional medicine for cancer treatment.

The researchers found another important fact. It turned out that if a center of regeneration (that is, restoration) of normal tissues is caused in the body, then substances that inhibit the growth of tumors will be released into the blood. If adaptogens or, in general, substances that stimulate the regeneration of normal tissues are used, the formation of these substances in the body increases, and the inhibition of tumor growth also increases.

It is necessary to learn the basics of interaction with Nature and the use of natural remedies. We have even developed a program for natural therapy, a project for an oncological rehabilitation center, but all undertakings and attempts to somehow educate doctors run into a wall of misunderstanding on the part of medical officials. We acknowledge that so far, naturopathy interferes with the well-functioning flywheel of the pharmaceutical industry, which often pursues commercial goals. From a human perspective, naturopathy should interact with the pharmaceutical industry.

Radiation treatment of cancer with chemotherapy and radiation

Canadian scientists have proven that radiation chemotherapy in oncology causes irreversible changes in the brain. However, cancer treatment with radiation is the most effective and is used in the vast majority of patients.

Chemotherapy is considered one of the most effective methods of cancer treatment, despite the fact that the side effects of its use have long been known. However, Canadian scientists have found another factor worth thinking about.

The experiment involved volunteers, former cancer patients who underwent cancer treatment with chemotherapy and radiation, and they managed to get rid of a serious illness. Under the control of special equipment, the study participants performed certain tasks to check the activity of their brain. Todd Handy, professor of psychology at the University, noted that these people took several minutes to focus on the purpose of the example. While the female subjects thought they were focused on a task, in fact, most of their brains were "off". At the same time, the activity of their brain at rest was practically no different from the work of the brain of those who were not exposed to chemotherapy. The cognitive abilities of people who survive chemotherapy become unstable and lose focus, the scientists conclude; cognition - the ability to absorb and remember material.

The radiation method of cancer treatment leads to metastases: Michigan State University researchers have found that chemotherapy drugs actually allow cancer cells to take root in the bones. Once in the bone marrow, cancer cells begin to multiply very quickly, promptly restoring their pool after any losses. Scientists suggest the existence of mechanisms that lead to the spread of cancer in the bones during chemotherapy. Many types of cancer, such as prostate cancer and breast cancer, often spread by metastasizing to the bones. Principal investigator Laurie McCauley believes their results provide insight into why some cancers metastasize to the bone. The researchers eliminated one of the cellular mechanisms that drive spread for the drug cyclophosphamide. After blocking one of the cellular proteins - CCL2, they managed to prevent the appearance of tumors in the bone tissue. This study is a pilot study (undertaken to assess feasibility, time required, cost, presence or absence of side effects and evaluation), and in the future, scientists plan to further study the mechanisms that lead to the spread of cancer cells after chemotherapy.

At the same time, it is no secret that most chemotherapy drugs are cell poisons. Their cytotoxicity is based on a violation of the process of cell reproduction. By acting on actively multiplying tumor cells, chemotherapy simultaneously destroys healthy, fast-growing cells of the body. For example, cells of the hair, digestive system and bone marrow. Every year more than 1 million cancer patients receive chemotherapy, radiation therapy, or both. Despite this, the overall effectiveness of chemotherapy remains too low.

Perhaps chemotherapy is not the way to go. There are many studies confirming the powerful anti-cancer potential of nature's gifts. For example, oriental mushrooms, cruciferous vegetables and the sunshine vitamin (vitamin D). Maybe you should take a closer look at the alternatives? The problem is that natural remedies don't make money for the pharmaceutical lobby, so studying them isn't profitable.

Among all methods of fighting cancer, chemotherapy occupies one of the most important places. Many people pay tens of thousands of dollars for a chance to prolong their lives or be cured of this disease. Meanwhile, these expensive and highly toxic drugs often give only a few months of life, or even bring death closer, only increasing the growth of metastases. The biggest disadvantage of this procedure is that, along with infected cells, chemotherapy destroys healthy cells. These toxic substances of therapy are especially detrimental to the bone marrow that produces blood, to the reproductive, and also to the digestive system.

If you are undergoing chemotherapy and you no longer have immunity because chemotherapy destroys it (even doctors admit this), any common infection can kill you. The common flu could be the end for you. For example, a staph infection from processing raw chicken can be the beginning of the end for a cancer patient who continues to receive chemotherapy. Catch E. coli or salmonella and it will kill you. A simple food poisoning from fast food will turn out to be fatal for you.

During chemotherapy and radiation therapy, a simple cold or flu can cause death because you no longer have white blood cells to fight infections. Of course, one cannot calculate all the deaths caused by chemotherapy, because hospitals and oncologists can always say that "the cancer has spread" and this is the cause of death.

It is fairly easy to catch a supermicrobe in a hospital, i.e. a virus and/or bacteria that are resistant to antibiotics, and it is not uncommon these days. So your hospital room could very well be a breeding ground for infectious pathogens, and that's where you can pick up something life-threatening. Often this is exactly what happens.

More than 20 years ago, the question of the effectiveness of cytotoxic chemotherapy was first thoroughly asked by an oncologist-epidemiologist and medical statistician, Dr. Ulrich Abel from the Cancer Center of the German city of Heidelberg. After analyzing thousands of publications in oncological journals and collections, talking personally with hundreds of specialists from different institutes, he summarized the results in a fundamental article. Here are his findings:

• Chemotherapy does not increase patient survival or improve their quality of life for most of the most common cancers (breast, prostate, stomach, colon, lung, brain, etc.), where it is nonetheless heavily used.
• About 80% of all cases of chemotherapy use have no scientific justification.
• Only in about 3% of cases of some rather rare forms of cancer (lymphogranulomatosis, childhood leukemia, testicular cancer in men, and one form of ovarian cancer in women) can chemotherapy contribute to a complete cure.

Particularly tragic is the well-known fact that patients initially subjected to several sessions of chemotherapy often lose the opportunity to benefit from non-toxic, immunostimulating, biotherapeutic methods. And since chemotherapy still doesn't cure 96-98% of all cancers, those who receive it have few chances of recovery.

Characteristically, the citation index of this fundamental publication is very low. Not because of her lack of information; on the contrary, because of its absolute indisputability by specialists to this day.

According to the leading oncologist and chief physician of the Health Center for Space Technologies, Professor Neumyvakin (Germany), Elena Seewald, without the use of chemotherapy, it is possible to get rid of the tumor in up to 100% of patients by alternative methods that are used in the said center. But even one chemotherapy will cause an irreversible oncological process.

Best New Ways: Alternative Innovative Cancer Treatments

These are new ways of treating cancer, not fully tested types of therapies that are at the stage of scientific, clinical research and experiments that have not been included in the therapeutic standards adopted in WHO oncology. The effectiveness and safety of any experimental technique requires further study, since there is no complete information about the effect of new cancer treatments on cancer cells and the body. However, it is assumed that there is a scientific hypothesis that explains what effects are expected and why. Experimental treatments require sufficient scientific evidence and clinical trials. Applying alternative cancer treatments to patients is difficult and requires a different legal framework than standard therapy. Innovative cancer treatments can be effective, but their implementation in healthcare practice depends on the implementation of complex administrative procedures that are now standardized in all countries.

Experimental best cancer treatments are an important part of medicine, without which development is impossible. The standard types of modern therapy were also experimental in their time. Until the middle of the 20th century, experimental methods of treatment were not regulated in any way. Often, experiments were carried out on people without their consent or without full awareness of the treatment. This has necessitated the creation of international regulations that protect the health of people involved in therapy (GCP guidelines). These rules regulate the use of experimental treatments. Currently, the use of experimental methods of treatment can only be carried out on volunteers with their written consent to treatment and full awareness.

Types of experimental treatment

High Intensity Focused Ultrasound (HIFU) - to destroy the tumor.

• Gene therapy- for people genetically predisposed to malignant tumors. Gene therapy is the introduction of genes into a tumor that cause cells to die (spontaneously or under the influence of chemotherapy) or prevent them from multiplying.
• cryoablation- the process of local freezing and devitalization of tissues, which makes it possible to create a zone of necrosis of the required shape and size for the destruction of the affected tissue and adjacent healthy cells along the edge.
• local hyperthermia. A session of heating tumor tissues to a temperature that causes their death. Hyperthermia sessions require special equipment. Not to be confused with hot tub physiotherapy, sometimes referred to as a "hyperthermia session".
• Angiostatic drugs- drugs that interfere with the formation of capillaries in the tumor, after which the tumor cells die, deprived of access to nutrients. Some angiogenesis blockers are already used in oncology, but the study of new pharmacological substances continues.
• Laser therapy- a method based on the transformation of the light energy of the laser beam into heat: the temperature inside the gland reaches 60 ° C for several seconds. Against the background of this temperature, cell death rapidly develops.
• Use of anaerobic bacteria to destroy the central part of the tumor, where drugs do not penetrate well. The periphery of the tumor is well destroyed by chemotherapy.
• Vaccination against malignant cells.
• Multi-component systems in which several drugs are simultaneously prescribed that have a synergistic effect. This allows you to get a therapeutic effect with lower doses of drugs than with standard chemotherapy. Multicomponent systems are attempts to combine the principles of classical and holistic medicine.
• Nanotherapy- the introduction of nanorobots into the human body, which either deliver the drug to the desired point, or attack the malignant tumor and its metastases themselves (can be combined), can also be used to monitor the state of the human body for a long time. A promising technology for the future, currently under development.
• Neutron capture therapy. The introduction into the body of special non-radioactive medicines that selectively accumulate in a cancerous tumor. After that, the tumor is irradiated with a stream of weak neutron radiation. Medicines actively react to this radiation and amplify it many times inside the tumor itself. As a result, the cancer cells die. At the same time, the total radiation doses that a person receives are much lower than when using conventional radiotherapy. Promising high-precision and safe therapy. Currently, research is underway related to the creation of nanotechnologies designed to improve the delivery of such drugs to the tumor.

Flaws

• unpredictability of action. Less information about possible side effects compared to conventional therapy.
• Difficulty in finding an organization that provides effective treatment.
• The need to pay for therapy if the patient is not participating in clinical trials.

Found a new cancer vaccine against malignant cells

Scientists have found a vaccine against cancer: The therapy aims to teach the body to recognize the molecule found in 90% of all cancer cells.

Preliminary tests have shown that a cancer vaccine can turn on the immune response against cancer cells and suppress the disease. Scientists believe the vaccine could be effective against small tumors and also help treated patients who fear relapse against malignant cells.

Normally, cancer cells do not elicit a response from the body's immune system because they are not recognized as a threat. The cancer vaccine, developed by the pharmaceutical company Vaxil Biotheraputics in collaboration with Tel Aviv University, aims to train the immune system to respond to the MUC1 molecule found in the vast majority of cancer cells. The molecule is also part of ordinary cells, but its amount in them is too small to cause a reaction. ImMucin, after only two to four injections, elicited a specific immune response to cancer cells in all ten patients in the first tests. Tests of a new cancer vaccine were held at the Hadassah Medical Center in Jerusalem, according to their results, three subjects who suffered from blood cancer were completely cured, and seven improved.

Treatment against cancer with dendritic cells

Dendritic cells against cancer are a kind of “command cabin” of immunity within the body. Dendritic cell vaccination is a cancer treatment that uses the remarkable ability of dendritic cells to designate an antigen (the hallmark of cancer). Dendritic cells convey information about antigens to immune cells called T cells, which, with the provided identification marks (CTL: cytotoxic T lymphocytes), recognize and specifically attack cancer cells that have this antigen. It is a treatment that focuses only on cancer cells by relaying information about the cancer to dendritic cells.

Healthy cells are not attacked, so there are practically no side effects. Since there is no great burden on the body, this type of treatment is suitable for patients with advanced oncological diseases. Cancer cells are recognized and attacked at the molecular level, and as a result, an effect can be expected in the treatment of the smallest unrecognized lesions, as well as in the treatment of cancer with dendritic cells of the infiltrative type, which is difficult to remove surgically.

Perhaps outpatient treatment. Once every 2 weeks, a small amount of blood is taken from a vein (25 ml). Monocytes are isolated after cell division, which are cultivated with a large number of dendritic cells. By cultivating cells with a cancer antigen derived from the patient's tumor cell material or artificial antigens (long-chain peptides), a dendritic cell vaccine is obtained. The cancer vaccine is given by subcutaneous injection into a nearby lymph node associated with the site of the disease. Killer T-lymphocytes, supported by T-helper cells, which transmit information about target cells, attack cancer cells.

The course of treatment with dendritic cells takes about 3 months, during which the patient donates blood every 2 weeks and receives an injection of the prepared vaccine. Taking blood from a vein (each time) takes about 5 minutes. A new vaccine is prepared every 2 weeks, there is no need for freezing, which allows a fresh vaccine to be administered each time.

The Japanese are especially successful in this area. I must say that cancer cells have many types of antigen (identification marks). However, sometimes cancer cells hide these identifying marks to evade immune system oversight. Accordingly, the more information that indicates cancer cells (peptides) in a vaccine, the higher the probability of detecting cancer cells and, as the results of clinical studies show, the more effective the vaccine will be. Many Japanese medical centers have been successful in preparing high efficiency dendritic cell vaccines with long chain peptides WT1, NY-ESO-1 and others.

Thanks to the function of memory T-cells, the therapeutic effect of the vaccine lasts for a long time, so this treatment meets the criteria for evaluating the effectiveness of treatment according to the irRC system (immune response of related criteria).

Cell division is carried out in a highly sterile culture center, completely isolated from contact with the outside world. The level of sterility of laboratory equipment in the manufacture of vaccines can compete with the so-called clean room - sterile rooms used in the pharmaceutical industry. Impeccable control is carried out in order to prevent bacteria and viruses from infecting important immune cells for the patient. A system for preventing the human factor has been developed: the entire process of cell cultivation is carried out under the control of computer systems.

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Cancer treatment is carried out with the help of standard surgical interventions called radical operations. Indications for radical operations are the results of a preoperative clinical, instrumental, laboratory examination of the patient and data from the revision of the pathological process during the operation, which confirm the absence of distant metastases and germination in neighboring anatomical structures.

Cancer treatment is possible with typical, combined and extended radical operations. Surgeons often have to operate on patients whose tumor process has gone beyond the organ and moved to other anatomical structures. In such cases, in the absence of distant metastases, there is a need for additional removal or partial resection of other organs and tissues. Such radical operations are called combined. For example, removal of the stomach in combination with resection of the tail of the pancreas in gastric cancer.

Extended surgical interventions include those that are accompanied by the removal of lymph nodes. In addition, so-called super-radical operations have been developed, when, together with the organ in which the primary tumor is located, several neighboring organs (due to their tumor involvement) or a significant part of the body are completely removed. An example of such an operation can be an exenteration of the pelvis with the removal of the rectum, genitals, and bladder. Such an operation is sometimes performed for locally advanced rectal cancer or uterine cancer, again, provided there is no distant metastasis. The appropriateness of performing superradical surgeries for cancer treatment remains debatable.

The achievement of oncosurgery in recent decades is the introduction into practice of organ-preserving and reconstructive operations. This is due to advances in the early diagnosis of the tumor process.
In organ-preserving operations, the volume of surgical intervention is reduced to a relatively local removal of the primary tumor within healthy tissues with the elimination or even leaving of regional lymph nodes. Such operations include, for example, radical sectoral resection of the mammary gland.

In order to preserve the quality of life of cancer patients, eliminate significant cosmetic defects after radical surgical interventions, reconstructive operations are used - breast restoration, elimination of significant cosmetic defects in the head and neck, etc.

In some patients with certain types of cancer, in which regional lymph nodes are available for examination, it may be possible to limit the local removal of the tumor within healthy tissues. Regional lymph nodes as an immune organ are left. Such patients are monitored and only with clinical manifestations of metastases in the regional lymph nodes they are removed.