Classification of oncological diseases. Clinical classification of tumors

The doctrine of true tumors occupies a significant place among the problems of cognition of pathological processes and has long been singled out as a special discipline - oncology(gr. oncos- a tumor logos- the science). However, familiarity with the basic principles of diagnosis and treatment of tumors is necessary for every doctor. Oncology studies only true tumors, in contrast to false ones (an increase in tissue volume due to edema, inflammation, hyperfunction and working hypertrophy, hormonal changes, limited fluid accumulation).

General provisions

Tumor(syn.: neoplasm, neoplasm, blastoma) - a pathological formation that independently develops in organs and tissues, characterized by autonomous growth, polymorphism and atypia of cells. A characteristic feature of a tumor is the isolated development and growth within the tissues of the body.

The main properties of the tumor

There are two main differences between a tumor and other cellular structures of the body: autonomous growth, polymorphism, and cell atypia.

autonomous growth

By acquiring tumor properties due to one reason or another, cells transform the resulting changes into their internal properties, which are then passed on to the next direct progeny of cells. This phenomenon is called "tumor transformation". Cells that have undergone tumor transformation begin to grow and divide without stopping even after the elimination of the factor that initiated the process. At the same time, the growth of tumor cells is not subject to the influence of any regulatory mechanisms.

mov (nervous and endocrine regulation, immune system, etc.), i.e. not controlled by the body. The tumor, having appeared, grows as if by itself, using only nutrients and energetic resources organism. These features of tumors are called automatic, and their growth is characterized as autonomous.

Polymorphism and atypia of cells

The cells undergoing tumor transformation begin to multiply faster than the cells of the tissue from which they originated, which determines the faster growth of the tumor. The speed of proliferation can be different. At the same time, to varying degrees, there is a violation of cell differentiation, which leads to their atypia - a morphological difference from the cells of the tissue from which the tumor developed, and polymorphism - the possible presence in the structure of the tumor of heterogeneous morphological features cells. The degree of impairment of differentiation and, accordingly, the severity of atypia may be different. While maintaining a sufficiently high differentiation, the structure and function of tumor cells are close to normal. In this case, the tumor usually grows slowly. Poorly differentiated and generally undifferentiated (it is impossible to determine the tissue - the source of tumor growth) tumors consist of unspecialized cells, they are distinguished by rapid, aggressive growth.

The structure of morbidity, mortality

Cancer is the third most common disease after cancer of cardio-vascular system and injuries. According to WHO, more than 6 million newly ill with oncological diseases are registered annually. Men get sick more often than women. Distinguish the main localization of tumors. In men, the most common cancers are of the lung, stomach, prostate, colon and rectum, and skin. In women, breast cancer ranks first, followed by cancer of the stomach, uterus, lung, rectum and colon, and skin. AT recent times Attention is drawn to the upward trend in the incidence of lung cancer with a slight decrease in the incidence of gastric cancer. Among the causes of death in developed countries, oncological diseases take the second place (after diseases of the cardiovascular system) - 20% of general level mortality. At the same time, the 5-year survival rate after

The diagnosis of a malignant tumor averages about 40%.

Etiology and pathogenesis of tumors

At present, it cannot be said that all questions of the etiology of tumors have been resolved. There are five main theories of their origin.

The main theories of the origin of tumors Theory of irritation by R. Virchow

More than 100 years ago, it was found that malignant tumors often occur in those parts of organs where tissues are more susceptible to trauma (cardia, stomach outlet, rectum, cervix). This allowed R. Virchow to formulate a theory according to which constant (or frequent) traumatization of tissues accelerates the processes of cell division, which at a certain stage can transform into tumor growth.

Theory of germinal rudiments by D. Congeim

According to the theory of D. Kongeym, in the early stages of embryo development in various areas, more cells than you need to build the corresponding part of the body. Some cells that remain unclaimed can form dormant primordia, potentially possessing high growth energy, which is characteristic of all embryonic tissues. These rudiments are in a latent state, but under the influence of certain factors they can grow, acquiring tumor properties. At present, this mechanism of development is valid for a narrow category of neoplasms called "disembryonic" tumors.

Regeneration-mutation theory of Fisher-Wazels

As a result of the impact various factors, including chemical carcinogens, degenerative-dystrophic processes occur in the body, accompanied by regeneration. According to Fischer-Wazels, regeneration is a “sensitive” period in the life of cells, when tumor transformation can occur. The very transformation of normal regenerating cells into tumor-

virus theory

The viral theory of the onset of tumors was developed by L.A. Zilber. The virus, invading the cell, acts at the gene level, disrupting the regulation of cell division. The influence of the virus is enhanced by various physical and chemical factors. At present, the role of viruses (oncoviruses) in the development of certain tumors has been clearly proven.

immunological theory

The youngest theory of the origin of tumors. According to this theory, various mutations constantly occur in the body, including tumor transformation of cells. But the immune system quickly identifies the "wrong" cells and destroys them. Violation in the immune system leads to the fact that one of the transformed cells is not destroyed and is the cause of the development of neoplasms.

None of the presented theories reflects a single scheme of oncogenesis. The mechanisms described in them are important at a certain stage of tumor development, and their significance for each type of neoplasm can vary within very significant limits.

Modern polyetiological theory of the origin of tumors

In accordance with modern views, during the development of different types of neoplasms, the following causes of tumor cell transformation are distinguished:

Mechanical factors: frequent, repeated traumatization of tissues with subsequent regeneration.

Chemical carcinogens: local and overall impact chemicals (for example, scrotum cancer in chimney sweeps when exposed to soot, squamous cell lung cancer when smoking - exposure to polycyclic aromatic hydrocarbons, pleural mesothelioma when working with asbestos, etc.).

Physical carcinogens: UV (especially for skin cancer), ionizing radiation (bone tumors, thyroid gland s, leukemia).

Oncogenic viruses: Epstein-Barr virus (role in the development of Burkitt's lymphoma), T-cell leukemia virus (role in the genesis of the disease of the same name).

A feature of the polyetiological theory is that the very impact of external carcinogenic factors does not cause the development of a neoplasm. For the appearance of a tumor, the presence of internal causes is also necessary: ​​a genetic predisposition and a certain state of the immune and neurohumoral systems.

Classification, clinic and diagnostics

The classification of all tumors is based on their division into benign and malignant. When naming all benign tumors, the suffix -oma is added to the characteristic of the tissue from which they originated: lipoma, fibroma, myoma, chondroma, osteoma, adenoma, angioma, neurinoma, etc. If there is a combination of cells of different tissues in the neoplasm, their names sound accordingly: lipofibroma, neurofibroma, etc. All malignant neoplasms are divided into two groups: tumors of epithelial origin - cancer and connective tissue origin - sarcoma.

Differences between benign and malignant tumors

Malignant tumors are distinguished from benign ones not only by their names. It is the division of tumors into malignant and benign that determines the prognosis and tactics of treating the disease. The main fundamental differences between benign and malignant tumors are presented in Table. 16-1.

Table 16-1.Differences between benign and malignant tumors

Atypia and polymorphism

Atypia and polymorphism are characteristic of malignant tumors. In benign tumors, cells exactly repeat the structure of tissue cells from which they originated, or have minimal differences. Cells of malignant tumors are significantly different in structure and function from their predecessors. At the same time, the changes can be so serious that it is morphologically difficult or even impossible to determine from which tissue, which organ the neoplasm originated (the so-called undifferentiated tumors).

growth pattern

Benign tumors are characterized by expansive growth: the tumor grows as if by itself, increases and pushes the surrounding organs and tissues apart. In malignant tumors, growth is infiltrating in nature: the tumor captures, penetrates, infiltrates the surrounding tissues like claws of cancer, sprouting at the same time blood vessels, nerves, etc. The growth rate is significant, high mitotic activity is observed in the tumor.

Metastasis

As a result of tumor growth, some of its cells can break off, enter other organs and tissues and cause the growth of a secondary, daughter tumor there. This process is called metastasis, and the daughter tumor is called metastasis. Only malignant neoplasms are prone to metastasis. At the same time, metastases usually do not differ in their structure from the primary tumor. Very rarely they have even lower differentiation, and therefore are more malignant. There are three main ways of metastasis: lymphogenous, hematogenous, implantation.

The lymphogenic route of metastasis is the most common. Depending on the ratio of metastases to the lymphatic drainage pathway, antegrade and retrograde lymphogenous metastases are distinguished. The most striking example of antegrade lymphogenous metastasis is metastasis to the lymph nodes of the left supraclavicular region in gastric cancer (Virchow's metastasis).

The hematogenous pathway of metastasis is associated with the entry of tumor cells into the blood capillaries and veins. With bone sarcomas, hematogenous metastases often occur in the lungs, with intestinal cancer - in the liver, etc.

The implantation path of metastasis is usually associated with the entry of malignant cells into the serous cavity (with the germination of all layers of the organ wall) and from there to neighboring organs. For example, implantation metastasis in gastric cancer in the space of Douglas - the lowest region of the abdominal cavity.

The fate of a malignant cell that has entered the circulatory or lymphatic system, as well as the serous cavity, is not completely predetermined: it can give rise to a daughter tumor, or it can be destroyed by macrophages.

Recurrence

Recurrence refers to the re-development of a tumor in the same area after surgical removal or destruction with radiation therapy and/or chemotherapy. The possibility of recurrence is a characteristic feature of malignant neoplasms. Even after a seemingly macroscopically complete removal of the tumor, individual malignant cells can be detected in the area of ​​operation, capable of re-growth of the neoplasm. After complete removal of benign tumors, relapses are not observed. The exceptions are intermuscular lipomas and benign neoplasms of the retroperitoneal space. This is due to the presence of a kind of legs in such tumors. When the neoplasm is removed, the leg is isolated, bandaged and cut off, but re-growth is possible from its remains. Tumor growth after incomplete removal is not considered a relapse - this is a manifestation of the progression of the pathological process.

Influence on the general condition of the patient

With benign tumors, the entire clinical picture is associated with their local manifestations. Formations can cause inconvenience, compress nerves, blood vessels, disrupt the function of neighboring organs. At the same time, they do not affect the general condition of the patient. The exception is some tumors, which, despite their "histological goodness", cause serious changes in the patient's condition, and sometimes lead to his death. In such cases, they speak of a benign tumor with a malignant clinical course, for example:

Tumors of the endocrine organs. Their development increases the level of production of the corresponding hormone, which causes characteristic

general symptoms. Pheochromocytoma, for example, releasing a large amount of catecholamines into the blood, causes arterial hypertension, tachycardia, autonomic reactions.

Tumors vital important organs significantly disrupt the state of the body due to the disorder of their functions. For example, a benign brain tumor during growth compresses brain areas with vital centers, which poses a threat to the life of the patient. A malignant tumor leads to a number of changes in the general condition of the body, called cancer intoxication, up to the development of cancer cachexia (exhaustion). This is due to the rapid growth of the tumor, its consumption of a large amount of nutrients, energy reserves, plastic material, which naturally impoverishes the supply of other organs and systems. In addition, the rapid growth of the formation often accompanies necrosis in its center (tissue mass increases faster than the number of vessels). Absorption of cell decay products occurs, perifocal inflammation occurs.

Classification of benign tumors

The classification of benign tumors is simple. There are types depending on the tissue from which they originated. Fibroma is a tumor of the connective tissue. Lipoma is a tumor of adipose tissue. Myoma - a tumor of muscle tissue (rhabdomyoma - striated, leiomyoma - smooth), etc. If two types of tissues or more are present in the tumor, they bear the corresponding names: fibrolipoma, fibroadenoma, fibromyoma, etc.

Classification of malignant tumors

The classification of malignant neoplasms, as well as benign ones, is primarily related to the type of tissue from which the tumor originated. Epithelial tumors are called cancer (carcinoma, carcinoma). Depending on the origin, in highly differentiated neoplasms, this name is specified: keratinizing squamous cell carcinoma, adenocarcinoma, follicular and papillary cancer, etc. In low-differentiated tumors, it is possible to specify the tumor cell form: small cell carcinoma, cricoid cell carcinoma, etc. Connective tissue tumors are called sarcomas. With relatively high differentiation, the name of the tumor repeats the name

tissue from which it developed: liposarcoma, myosarcoma, etc. Great importance in the prognosis for malignant neoplasms, it has the degree of tumor differentiation - the lower it is, the faster its growth, the greater the frequency of metastases and relapses. Currently, the international classification of TNM and the clinical classification of malignant tumors are considered generally accepted.

TNM classification

The TNM classification is accepted worldwide. In accordance with it, in a malignant tumor, the following parameters are distinguished:

T (tumor)- the size and local spread of the tumor;

N (node)- presence and characteristics of metastases in regional lymph nodes;

M (metastasis)- the presence of distant metastases.

In addition to its original form, the classification was later expanded with two more characteristics:

G (grade)- the degree of malignancy;

R (penetration) the degree of germination of the wall of a hollow organ (only for tumors gastrointestinal tract).

T (tumor) characterizes the size of the formation, the prevalence of the departments of the affected organ, the germination of surrounding tissues.

Each organ has its own specific gradations of these features. For colon cancer, for example, the following options are possible:

T o- there are no signs of a primary tumor;

T is (in situ)- inside epithelial tumor;

T1- the tumor occupies a small part of the intestinal wall;

T 2- the tumor occupies half the circumference of the intestine;

T 3- the tumor occupies more than 2/3 or the entire circumference of the intestine, narrowing the lumen;

T 4- the tumor occupies the entire lumen of the intestine, causing intestinal obstruction and (or) grows into neighboring organs.

For a breast tumor, gradation is carried out according to the size of the tumor (in cm); for stomach cancer - according to the degree of germination of the wall and spread to its sections (cardia, body, output section), etc. Cancer stage requires a special reservation "in situ"(cancer in situ). At this stage, the tumor is located only in the epithelium (intraepithelial cancer), does not grow into the basement membrane, and therefore does not grow into the blood and lymphatic vessels. Thus, on

At this stage, the malignant tumor is devoid of the infiltrating nature of growth and, in principle, cannot give hematogenous or lymphogenous metastasis. Listed features of cancer in situ determine more favorable results of treatment of such malignant neoplasms.

N (nodes) characterizes changes in regional lymph nodes. For gastric cancer, for example, the following types of designations are accepted:

N x- there is no data on the presence (absence) of metastases in regional lymph nodes (the patient was underexamined, not operated on);

No- there are no metastases in regional lymph nodes;

N 1 - metastases to the lymph nodes along the greater and lesser curvature of the stomach (collector of the 1st order);

N 2 - metastases in prepyloric, paracardial lymph nodes, in the nodes of the greater omentum - removed during surgery (collector of the 2nd order);

N 3- para-aortic lymph nodes are affected by metastases - they cannot be removed during surgery (collector of the 3rd order).

Gradations No and N x- common to almost all tumor localizations. Characteristics N 1 -N 3- different (so they can indicate the defeat of different groups of lymph nodes, the size and nature of metastases, their single or multiple nature).

It should be noted that at present it is possible to give a clear definition of the presence of a certain type of regional metastases only on the basis of a histological examination of postoperative (or autopsy) material.

M (metastasis) indicates the presence or absence of distant metastases:

M 0- there are no distant metastases;

M. i- there are distant metastases (at least one).

G (grade) characterizes the degree of malignancy. In this case, the determining factor is a histological indicator - the degree of cell differentiation. There are three groups of neoplasms:

G1- tumors of a low degree of malignancy (highly differentiated);

G2- tumors medium degree malignancy (poorly differentiated);

G3- tumors of a high degree of malignancy (undifferentiated).

R (penetration) the parameter is introduced only for tumors of hollow organs and shows the degree of germination of their walls:

P1- tumor within the mucous membrane;

R 2 - the tumor grows into the submucosa;

R 3 - the tumor grows into the muscle layer (to the serous layer);

R 4 The tumor invades the serous membrane and extends beyond the organ.

In accordance with the presented classification, the diagnosis may sound, for example, as follows: cancer of the caecum - T 2 N 1 M 0 P 2 The classification is very convenient, since it characterizes in detail all aspects of the malignant process. At the same time, it does not provide generalized data on the severity of the process, the possibility of curing the disease. To do this, apply the clinical classification of tumors.

Clinical classification

In clinical classification, all the main parameters of a malignant neoplasm (the size of the primary tumor, germination into surrounding organs, the presence of regional and distant metastases) are considered together. There are four stages of the disease:

Stage I - the tumor is localized, occupies a limited area, does not germinate the wall of the organ, there are no metastases.

Stage II - a tumor of moderate size, does not spread outside the organ, single metastases to regional lymph nodes are possible.

III stage - tumor large sizes, with decay, sprouts the entire wall of the organ or a smaller tumor with multiple metastases to regional lymph nodes.

Stage IV - tumor growth into surrounding organs, including non-removable ones (aorta, vena cava, etc.), or any tumor with distant metastases.

Clinic and diagnosis of tumors

The clinic and diagnosis of benign and malignant neoplasms are different, which is associated with their effect on the surrounding organs and tissues, and the patient's body as a whole.

Features of the diagnosis of benign tumors

Diagnosis of benign formations is based on local symptoms, signs of the presence of the tumor itself. Often sick

pay attention to the appearance of some kind of education themselves. In this case, tumors usually slowly increase in size, do not cause pain, have a rounded shape, a clear border with surrounding tissues, and a smooth surface. The main concern is the education itself. Only sometimes there are signs of dysfunction of the organ (intestinal polyp leads to obstructive intestinal obstruction; a benign brain tumor, squeezing the surrounding departments, leads to the appearance of neurological symptoms; adrenal adenoma due to the release of hormones into the blood leads to arterial hypertension, etc.). It should be noted that the diagnosis of benign tumors is not particularly difficult. By themselves, they cannot threaten the life of the patient. A possible danger is only a violation of the function of organs, but this, in turn, quite clearly manifests the disease.

Diagnosis of malignant tumors

Diagnosis of malignant neoplasms is quite difficult, which is associated with a variety of clinical manifestations of these diseases. In the clinic of malignant tumors, four main syndromes can be distinguished:

Syndrome "plus-tissue";

Syndrome pathological discharge;

Organ dysfunction syndrome;

Syndrome of small signs.

Plus tissue syndrome

A neoplasm can be detected directly in the location area as a new additional tissue - "plus-tissue". This symptom is easy to identify with superficial localization of the tumor (in the skin, subcutaneous tissue or muscles), as well as on the extremities. Sometimes you can feel the tumor in the abdominal cavity. In addition, the “plus-tissue” sign can be determined using special research methods: endoscopy (laparoscopy, gastroscopy, colonoscopy, bronchoscopy, cystoscopy, etc.), X-ray examination or ultrasound, etc. In this case, it is possible to detect the tumor itself or to determine the symptoms characteristic of the “plus-tissue” (filling defect in an X-ray examination of the stomach with barium sulfate contrast, etc.).

Syndrome of pathological discharge

In the presence of a malignant tumor due to the germination of blood vessels by it, spotting or bleeding often occurs. So, stomach cancer can cause gastric bleeding, uterine tumor - uterine bleeding or spotting from the vagina, for breast cancer, a characteristic symptom is serous-hemorrhagic discharge from the nipple, for lung cancer, hemoptysis is characteristic, and with pleura germination - the appearance of hemorrhagic effusion in the pleural cavity, with rectal cancer, rectal bleeding is possible, with a kidney tumor - hematuria. With the development of inflammation around the tumor, as well as with a mucus-forming form of cancer, mucous or mucopurulent discharge occurs (for example, with cancer colon). These symptoms are collectively referred to as the pathological discharge syndrome. In some cases, these signs help to differentiate a malignant tumor from a benign one. For example, if there is bloody discharge from the nipple during a neoplasm of the mammary gland, the tumor is malignant.

Organ dysfunction syndrome

The very name of the syndrome suggests that its manifestations are very diverse and are determined by the localization of the tumor and the function of the organ in which it is located. For malignant tumors of the intestine, signs of intestinal obstruction are characteristic. For a tumor of the stomach - dyspeptic disorders (nausea, heartburn, vomiting, etc.). In patients with esophageal cancer, the leading symptom is a violation of the act of swallowing food - dysphagia, etc. These symptoms are not specific, but often occur in patients with malignant neoplasms.

Syndrome of small signs

Patients with malignant neoplasms often present seemingly inexplicable complaints. They note: weakness, fatigue, fever, weight loss, poor appetite(characterized by aversion to meat food, especially in gastric cancer), anemia, increased ESR. The listed symptoms are combined into a syndrome of small signs (described for the first time by A.I. Savitsky). In some cases, this syndrome occurs on quite

early stages of the disease and may even be its only manifestation. Sometimes it can be later, being essentially a manifestation of a clear cancerous intoxication. At the same time, patients have a characteristic, "oncological" appearance: they reduced nutrition, tissue turgor is reduced, the skin is pale with an icteric tinge, sunken eyes. Usually, this appearance of patients indicates that they have a running oncological process.

Clinical differences between benign and malignant tumors

When defining plus-tissue syndrome, the question arises whether this extra tissue is formed due to the development of a benign or malignant tumor. There are a number of differences in local variations (status localis), which are primarily important for palpable formations (tumor of the breast, thyroid gland, rectum). Differences in local manifestations of malignant and benign tumors are presented in Table. 16-2.

General principles for diagnosing malignant neoplasms

Considering the pronounced dependence of the results of treatment of malignant tumors on the stage of the disease, as well as the rather high

Table 16-2.Local differences between malignant and benign tumors

the risk of recurrence and progression of the process, in the diagnosis of these processes, attention should be paid to the following principles:

Early diagnosis;

Oncological predisposition;

Hyperdiagnosis.

Early diagnosis

Clarification of the clinical symptoms of the tumor and the use of special diagnostic methods are important for staging as soon as possible the diagnosis of a malignant neoplasm and the choice of the optimal path of treatment. In oncology, there is a concept of the timeliness of diagnosis. In this regard, the following types of it are distinguished:

early;

timely;

Late.

Early diagnosis is said in cases where the diagnosis of a malignant neoplasm is established at the stage of cancer. in situ or at the first clinical stage of the disease. This implies that adequate treatment should lead to recovery of the patient.

The diagnosis made at the II and in some cases at the III stages of the process is considered timely. At the same time, the treatment undertaken allows the patient to be completely cured of cancer, but this is possible only in some patients, while others will die from the progression of the process in the coming months or years.

Late diagnosis (establishment of a diagnosis at stage III-IV of an oncological disease) indicates a low probability or fundamental impossibility of curing a patient and essentially predetermines his future fate.

From what has been said, it is clear that one should try to diagnose a malignant tumor as quickly as possible, since early diagnosis makes it possible to achieve much better treatment results. Targeted cancer treatment should be started within two weeks of diagnosis. The importance of early diagnosis is clearly shown by the following figures: the five-year survival rate in the surgical treatment of gastric cancer at the stage in situ is 90-97%, and in stage III cancer - 25-30%.

Cancer alertness

When examining a patient and finding out any clinical symptoms, a doctor of any specialty should ask himself the question:

Could these symptoms be a manifestation of a malignant tumor? Having asked this question, the doctor should make every effort to either confirm or exclude the suspicions that have arisen. When examining and treating any patient, the doctor should have oncological alertness.

The principle of overdiagnosis

When diagnosing malignant neoplasms, in all doubtful cases, it is customary to make a more formidable diagnosis and take more radical methods of treatment. This approach is called overdiagnosis. So, for example, if the examination revealed a large ulcerative defect in the gastric mucosa and the use of all available research methods does not allow answering the question of whether it is a chronic ulcer or an ulcerative form of cancer, the patient is considered to have cancer and is treated as an oncological patient.

The principle of overdiagnosis, of course, must be applied within reasonable limits. But if there is a possibility of error, it is always more correct to think about a more malignant tumor, a greater stage of the disease and, on the basis of this, use more radical means of treatment than to look at the cancer or prescribe inadequate treatment, as a result of which the process will progress and inevitably lead to death.

Precancerous diseases

For early diagnosis of malignant diseases, it is necessary to conduct a preventive examination, since the diagnosis of cancer in situ for example, on the basis of clinical symptoms is extremely difficult. And at later stages, an atypical picture of the course of the disease can prevent its timely detection. Preventive examinations are subject to people from two risk groups:

Persons who, by occupation, are associated with exposure to carcinogenic factors (work with asbestos, ionizing radiation, etc.);

Persons with so-called precancerous diseases that require special attention.

Precancerouscalled chronic diseases, against the background of which the frequency of development of malignant tumors increases sharply. So, for the mammary gland, a precancerous disease is dishormonal mastopathy; for the stomach - chronic ulcers, polyps, chronic

chesky atrophic gastritis; for the uterus - erosion and leukoplakia of the cervix, etc. Patients with precancerous diseases are subject to dispensary observation with an annual examination by an oncologist and special studies (mammography, fibrogastroduodenoscopy).

Special diagnostic methods

In the diagnosis of malignant neoplasms, along with the generally accepted methods (endoscopy, radiography, ultrasound), special, sometimes decisive, are different kinds biopsy followed by histological and cytological examination. At the same time, the detection of malignant cells in the preparation reliably confirms the diagnosis, while a negative answer does not allow it to be removed - in such cases, they are guided by clinical data and the results of other research methods.

Tumor markers

As is known, at present there are no changes in clinical and biochemical blood parameters specific for oncological processes. Recently, however, tumor markers (TM) have become increasingly important in the diagnosis of malignant tumors. OM in most cases are complex proteins with a carbohydrate or lipid component synthesized in tumor cells in high concentrations. These proteins can be associated with cellular structures and then they are found in immunohistochemical studies. A large group of OM is secreted by tumor cells and accumulates in the biological fluids of cancer patients. In this case, they can be used for serological diagnosis. The concentration of OM (primarily in the blood) can, to a certain extent, correlate with the onset and dynamics of the malignant process. In the clinic, about 15-20 OM are widely used. The main methods for determining the level of OM in the blood serum are radioimmunological and enzyme immunoassay. The following tumor markers are most common in clinical practice: osphetoprotein (for liver cancer), carcinoembryonic antigen (for adenocarcinoma of the stomach, colon, etc.), prostate-specific antigen (for prostate cancer), etc.

Currently known OMs, with a few exceptions, are of limited use for the diagnosis or screening of tumors, since

as an increase in their level is observed in 10-30% of patients with benign and inflammatory processes. Nevertheless, OM have found wide application in the dynamic monitoring of cancer patients, for the early detection of subclinical relapses and monitoring the effectiveness of antitumor therapy. The only exception is the prostate-specific antigen used for direct diagnosis of prostate cancer.

General principles of treatment

The therapeutic tactics of benign and malignant tumors is different, which primarily depends on the infiltrating growth, the tendency to recurrence and metastasis of the latter.

Treatment of benign tumors

The main and in the vast majority of cases the only way treatment of benign neoplasms - surgical. Only in the treatment of tumors of hormone-dependent organs, instead of or together with the surgical method, hormone therapy is used.

Indications for surgery

In the treatment of benign neoplasms, the question of indications for surgery is important, since these tumors do not threatening for the life of the patient, do not always have to be necessarily removed. If a patient has a benign tumor that does not cause him any harm for a long time, and at the same time there are contraindications for surgical treatment (severe concomitant diseases), then it is hardly advisable to operate on the patient. At benign neoplasms surgery is necessary if there are certain indications:

Permanent traumatization of the tumor. For example, a tumor of the scalp, damaged by scratching; formation on the neck in the area of ​​the collar; swelling in the waist area, especially in men (rubbing with a trouser belt).

Organ dysfunction. Leiomyoma can interfere with evacuation from the stomach, a benign tumor of the bronchus can completely close its lumen, pheochromocytoma leads to high arterial hypertension due to the release of catecholamines, etc.

Before surgery, there is no absolute certainty that the tumor is malignant. In these cases, the operation, in addition to the therapeutic function, also performs the role of an excisional biopsy. So, for example, with neoplasms of the thyroid or mammary gland, patients in some cases are operated on because with such localization the question of the malignancy of the tumor can be resolved only after an urgent histological examination. The result of the study becomes known to surgeons at a time when the patient is still under anesthesia on the operating table, which helps them choose the right type and volume of surgery.

cosmetic defects. This is primarily characteristic of tumors on the face and neck, especially in women, and does not require special comments.

Surgical treatment of a benign tumor is understood as its complete removal within healthy tissues. In this case, the formation should be removed in its entirety, and not in parts, and together with the capsule, if any. An excised neoplasm is necessarily subject to histological examination (urgent or planned), given that after removal of a benign tumor, relapses and metastases do not occur; after surgery, patients recover completely.

Treatment of malignant tumors

Treatment of malignant tumors is a more difficult task. There are three ways to treat malignant neoplasms: surgery, radiation therapy and chemotherapy. In this case, the main method, of course, is the surgical method.

Principles of surgical treatment

Removal of a malignant neoplasm is the most radical, and in some localizations, the only method of treatment. Unlike operations for benign tumors, it is not enough to simply remove the formation. When removing a malignant neoplasm, it is necessary to observe the so-called oncological principles: ablastic, antiblastic, zoning, sheathing.

Ablastic

Ablasty is a set of measures to prevent the spread of tumor cells during surgery. In this case, it is necessary:

Perform incisions only within known healthy tissues;

Avoid mechanical trauma to the tumor tissue;

As soon as possible, tie up the venous vessels extending from the formation;

Bandage the hollow organ above and below the tumor with a ribbon (prevention of cell migration through the lumen);

Remove the tumor as a single block with fiber and regional lymph nodes;

Before manipulating the tumor, limit the wound with napkins;

After removal of the tumor, change (process) the instruments and gloves, change the restrictive napkins.

antiblast

Antiblastics is a set of measures for the destruction during the operation of individual tumor cells that have broken away from its main mass (they can lie on the bottom and walls of the wound, enter the lymphatic or venous vessels and in the future be a source of tumor recurrence or metastases). Distinguish between physical and chemical antiblast.

Physical antiblast:

The use of an electric knife;

Use of a laser;

The use of cryodestruction;

Irradiation of the tumor before surgery and in the early postoperative period.

Chemical antiblast:

Treatment wound surface after tumor removal 70? alcohol;

Intravenous administration of antitumor chemotherapy drugs on the operating table;

Regional perfusion with anticancer chemotherapeutic drugs.

Zoning

During surgery for a malignant neoplasm, it is necessary not only to remove it, but also to remove the entire area in which there may be

individual cancer cells - the principle of zoning. At the same time, it is taken into account that malignant cells can be located in tissues near the tumor, as well as in the lymphatic vessels and regional lymph nodes extending from it. With exophytic growth (the tumor is on a narrow base, and its large mass is facing the external environment or the internal lumen - a polypoid, mushroom-shaped form), it is necessary to deviate from the visible border of the formation by 5-6 cm. With endophytic growth (spread of the tumor along the wall of the organ) from the visible border should recede at least 8-10 cm. Together with the organ or part of it as a single block, it is necessary to remove all lymphatic vessels and nodes that collect lymph from this zone (for stomach cancer, for example, the entire greater and lesser omentum should be removed). Some of these operations are called "lymphodisection". In accordance with the principle of zoning, in most oncological operations, the entire organ or a large part of it is removed (for gastric cancer, for example, it is possible to perform only subtotal resection of the stomach [leaving 1/7-1/8 of its part] or extirpation of the stomach [complete delete]). Radical surgical interventions performed in compliance with all oncological principles are complex, large in volume and traumatic. Even with a small-sized endophytically growing tumor of the body of the stomach, the stomach is extirpated with the imposition of an esophagoenteroanastomosis. At the same time, the small and large omentum, and in some cases the spleen, are removed as a single block along with the stomach. In breast cancer, the mammary gland, pectoralis major muscle and subcutaneous tissue are removed in a single block. adipose tissue with axillary, supraclavicular and subclavian lymph nodes.

The most malignant of all known tumors, melanoma, requires a wide excision of the skin, subcutaneous fat and fascia, as well as the complete removal of regional lymph nodes (if melanoma is localized on the lower extremity, for example, inguinal and iliac). In this case, the size of the primary tumor usually does not exceed 1-2 cm.

Case

Lymphatic vessels and nodes, through which tumor cells can spread, are usually located in cellular spaces separated by fascial septa. In this regard, for greater radicalism, it is necessary to remove the fiber of the entire fascial sheath, preferably together with the fascia. A striking example of

observing the principle of sheathing - surgery for thyroid cancer. The latter is removed extracapsularly (together with the capsule formed by the visceral sheet IV of the fascia of the neck), despite the fact that due to the risk of damage n. laryngeus recurrens and parathyroid glands, removal of thyroid tissue in case of benign lesions is usually performed intracapsularly. In malignant neoplasms, along with radical ones, palliative and symptomatic surgical interventions are used. When they are implemented, oncological principles are either not observed, or they are not performed in full. Such interventions are performed to improve the condition and prolong the life of the patient in cases where radical removal of the tumor is impossible due to the neglect of the process or the serious condition of the patient. For example, in a decaying bleeding tumor of the stomach with distant metastases, a palliative resection of the stomach is performed, achieving an improvement in the patient's condition by stopping bleeding and reducing intoxication. In case of pancreatic cancer with obstructive jaundice and liver failure, a bypass biliodigestive anastomosis is applied, eliminating the violation of the outflow of bile, etc. In some cases, after palliative operations, the remaining mass of tumor cells is treated with radiation or chemotherapy, achieving a cure for the patient.

Fundamentals of Radiation Therapy

The use of radiation energy for the treatment of cancer patients is based on the fact that rapidly multiplying tumor cells with a high intensity of metabolic processes are more sensitive to the effects of ionizing radiation. The task of radiation treatment is the destruction of the tumor focus with the restoration of tissues in its place that have normal properties of metabolism and growth. In this case, the action of radiation energy, leading to an irreversible violation of the viability of tumor cells, should not reach the same degree of influence on the surrounding normal tissues and the patient's body as a whole.

The sensitivity of tumors to radiation

Different types of neoplasms are differently sensitive to radiation therapy. The most sensitive to radiation are connective tissue tumors with round cell structures: lymphosarco-

we, myeloma, endothelioma. Certain types of epithelial neoplasms are highly sensitive: seminoma, chorionepithelioma, lymphoepithelial tumors of the pharyngeal ring. Local changes in these types of tumors disappear quite quickly under the influence of radiation therapy, but this, however, does not mean a complete cure, since these neoplasms have a high ability to recur and metastasize.

Tumors with a histological substrate of the integumentary epithelium respond sufficiently to irradiation: cancer of the skin, lips, larynx and bronchi, esophagus, squamous cell carcinoma of the cervix. If irradiation is used for small tumor sizes, then with the destruction primary focus permanent cure of the patient can be achieved. To a lesser extent, various forms of glandular cancer (adenocarcinomas of the stomach, kidneys, pancreas, intestines), highly differentiated sarcomas (fibro-, myo-, osteo-, chondrosarcomas), as well as melanoblastomas are less susceptible to radiation exposure. In such cases, irradiation can only be an auxiliary treatment that complements surgery.

The main methods of radiation therapy

Depending on the location of the radiation source, there are three main types of radiation therapy: external, intracavitary and interstitial irradiation.

With external irradiation, installations for X-ray therapy and telegamma therapy are used (special devices charged with radioactive Co 60, Cs 137). Radiation therapy is applied in courses, choosing the appropriate fields and radiation dose. The method is most effective for superficially located neoplasms (a large dose of tumor irradiation is possible with minimal damage to healthy tissues). Currently, external radiotherapy and telegammatherapy are the most common methods of radiation treatment of malignant neoplasms.

Intracavitary irradiation allows you to bring the radiation source closer to the location of the tumor. The radiation source is injected through natural openings into the bladder, uterine cavity, oral cavity, achieving the maximum dose of irradiation of the tumor tissue.

For interstitial irradiation, special needles and tubes with radioisotope preparations are used, which are surgically installed in the tissues. Sometimes radioactive capsules or needles are left in the surgical wound after removal of the malignant

noah tumor. A peculiar method of interstitial therapy is the treatment of thyroid cancer with drugs I 131: after entering the patient's body, iodine accumulates in the thyroid gland, as well as in the metastases of its tumor (with a high degree of differentiation), thus radiation has a detrimental effect on the cells of the primary tumor and metastases.

Possible Complications of Radiation Therapy

Radiation therapy is far from a harmless method. All its complications can be divided into local and general. Local complications

The development of local complications is associated with the adverse effect of irradiation on healthy tissues around the neoplasm and, above all, on the skin, which is the first barrier to the path of radiation energy. Depending on the degree of skin damage, the following complications are distinguished:

Reactive epidermitis (temporary and reversible damage to epithelial structures - moderate edema, hyperemia, pruritus).

Radiation dermatitis (hyperemia, tissue edema, sometimes with the formation of blisters, hair loss, hyperpigmentation followed by skin atrophy, impaired pigment distribution and telangiectasia - expansion of intradermal vessels).

Radiation indurative edema (specific thickening of tissues associated with damage to the skin and subcutaneous tissue, as well as with the phenomena of obliterating radiation lymphangitis and sclerosis of the lymph nodes).

Radiation necrotic ulcers (skin defects characterized by severe soreness and the absence of any tendency to heal).

Prevention of these complications includes, first of all, the correct choice of fields and doses of radiation. General complications

The use of radiation treatment can cause general disorders (manifestations of radiation sickness). Its clinical symptoms are weakness, loss of appetite, nausea, vomiting, sleep disturbances, tachycardia and shortness of breath. To a greater extent beam methods hematopoietic organs, especially the bone marrow, are sensitive. In this case, leukopenia, thrombocytopenia and anemia occur in the peripheral blood. Therefore, against the background of radiation therapy, it is necessary to perform at least 1 time per week clinical analysis blood. In some cases, uncontrolled leu-

accumulation causes a reduction in the dose of radiation or the cessation of radiation therapy altogether. To reduce these general disorders, leukopoiesis stimulants, blood transfusion and its components, vitamins, and high-calorie nutrition are used.

Fundamentals of Chemotherapy

Chemotherapy - the impact on the tumor by various pharmacological agents. In terms of its effectiveness, it is inferior to the surgical and radiation methods. The exceptions are systemic oncological diseases (leukemia, lymphogranulomatosis) and tumors of hormone-dependent organs (breast, ovary, prostate cancer), in which chemotherapy is highly effective. Chemotherapy is usually given in courses over a long period of time (sometimes for many years). There are the following groups of chemotherapeutic agents:

cytostatics,

antimetabolites,

anticancer antibiotics,

Immunomodulators,

Hormonal preparations.

Cytostatics

Cytostatics inhibit the reproduction of tumor cells, inhibiting their mitotic activity. Main drugs: alkylating agents (cyclophosphamide), herbal preparations (vinblastine, vincristine).

Antimetabolites

Medicinal substances act on metabolic processes in tumor cells. Main drugs: methotrexate (folic acid antagonist), fluorouracil, tegafur (pyrimidine antagonists), mercaptopurine (purine antagonist). Antimetabolites together with cytostatics are widely used in the treatment of leukemia and poorly differentiated tumors of connective tissue origin. In this case, special schemes are used with the use of various drugs. In particular, the Cooper scheme has become widespread in the treatment of breast cancer. Below is the Cooper scheme in the modification of the Research Institute of Oncology. N.N. Petrov - scheme CMFVP (by the first letters of drugs).

On the operating table:

200 mg cyclophosphamide.

In the postoperative period:

On days 1-14, 200 mg of cyclophosphamide daily;

1, 8 and 15 days: methotrexate (25-50 mg); fluorouracil (500 mg); vincristine (1 mg);

On the 1st - 15th day - prednisolone (15-25 mg / day orally with gradual withdrawal by the 26th day).

Courses are repeated 3-4 times with an interval of 4-6 weeks.

Antitumor antibiotics

Some substances produced by microorganisms, primarily actinomycetes, have an antitumor effect. The main antitumor antibiotics are: dactinomycin, sarcolysin, doxorubicin, carubicin, mitomycin. The use of cytostatics, antimetabolites and antitumor antibiotics has a toxic effect on the patient's body. First of all, the hematopoietic organs, liver and kidneys suffer. Leukopenia, thrombocytopenia and anemia occur, toxic hepatitis, kidney failure. In this regard, during chemotherapy courses, it is necessary to monitor the general condition of the patient, as well as clinical and biochemical blood tests. Due to the high toxicity of drugs in patients over 70 years of age, chemotherapy is usually not prescribed.

Immunomodulators

Immunotherapy began to be used for the treatment of malignant neoplasms only recently. Good results have been obtained in the treatment of kidney cancer, including at the stage of metastasis, with recombinant interleukin-2 in combination with interferons.

Hormonal drugs

Hormone therapy is used to treat hormone-dependent tumors. In the treatment of prostate cancer, synthetic estrogens (hexestrol, diethylstilbestrol, fosfestrol) are successfully used. In breast cancer, especially in young women, androgens (methyltestosterone, testosterone) are used, and in the elderly, drugs with antiestrogenic activity (tamoxifen, toremifene) have recently been used.

Combined and complex treatment

In the process of treating a patient, it is possible to combine the main methods of treating malignant tumors. If two methods are used in one patient, one speaks of combined treatment if all three are o complex. Indications for one or another method of treatment or their combination are established depending on the stage of the tumor, its localization and histological structure. An example is the treatment of different stages of breast cancer:

Stage I (and cancer in situ)- enough adequate surgical treatment;

Stage II - combined treatment: it is necessary to perform a radical surgical operation ( radical mastectomy with the removal of axillary, supraclavicular and subclavian lymph nodes) and conduct chemotherapy treatment;

Stage III - complex treatment: first, radiation is used, then a radical operation is performed, followed by chemotherapy;

Stage IV - powerful radiation therapy followed by surgery for certain indications.

Organization of care for cancer patients

The use of complex diagnostic and treatment methods, as well as the need for dispensary observation and the duration of treatment, led to the creation of a special oncological service. Assistance to patients with malignant neoplasms is provided in specialized medical institutions: oncological dispensaries, hospitals and institutes. Oncological dispensaries carry out preventive examinations, dispensary observation of patients with precancerous diseases, primary examination and examination of patients with suspected tumors, conduct outpatient courses of radiation and chemotherapy, monitor the condition of patients, and keep statistical records. In oncology hospitals, all methods of treating malignant neoplasms are carried out. The head of the oncological service of Russia is the Russian Oncological science Center RAMS, Cancer Institute. P.A. Herzen in Moscow and the Research Institute of Oncology. N.N. Petrov in St. Petersburg. Here they coordinate scientific research in oncology, provide organizational and methodological guidance to other oncological

institutions, develop problems of theoretical and practical oncology, apply the most modern methods of diagnostics and treatment.

Evaluation of the effectiveness of treatment

For many years, the only indicator of the effectiveness of the treatment of malignant neoplasms was a 5-year survival rate. It is believed that if within 5 years after treatment the patient is alive, relapse and metastasis did not occur, the progression of the process in the future is extremely unlikely. Therefore, patients who live 5 years or more after surgery (radiation or chemotherapy) are considered to have recovered from cancer.

Evaluation of results based on 5-year survival still remains the main one, but in recent years, due to the widespread introduction of new methods of chemotherapy, other indicators of treatment effectiveness have appeared. They reflect the duration of remission, the number of cases of tumor regression, the improvement in the quality of life of the patient and allow us to evaluate the effect of treatment in the near future.

Many people, when a neoplasm or seal is found, wonder about the malignancy of oncology and what stage of cancer is in this moment and whether there are metastases. Timely detection of tumors will help to adjust the treatment and choose best practices to eliminate the neoplasm. When determining the stages, a qualified specialist will be able to assess all the risks for the patient, so you should immediately consult a doctor when the first symptoms appear.

What is cancer

Neoplastic processes that occur in the body, different in their ability to metastasize, morphological characteristics, clinical course, are often combined into one definition - cancer. This general term is used for serious cancers that are characterized by uncontrolled rapid development tumor-forming cells. Neoplasms can increase in size and affect nearby organs. Doctors divide tumors into two types:

1. Malignant. It is considered dangerous to human life, tk. it is able to grow quickly and at the same time freely move around the body, destroying healthy organs. At the last stage of the disease, metastases affect all vital systems (colon cancer occurs, lung tissue, bones, uterus, etc.).
2. Benign. Such a formation, as a rule, does not form metastases and does not change its size. When removed, surgical treatment is used.

How many stages are there

Each cancer has a special staging system, which is adopted by the health committee. The most popular TNM classification was developed by Pierre Denois in 1952. With the development of the direction, it has undergone changes; the seventh edition of 2009 is considered relevant today. Traditionally, the stages of cancer are designated from 0 to 4. Each of them, taking into account the prevalence of the process, can have the letters A and B. It should be noted that many patients often say the degree of cancer instead of the stage, but this is an incorrect definition.

How to determine

The term "cancer stages" is used to choose the right treatment regimen and predict the patient's chance of recovery. As a rule, the stages of oncological diseases are determined by three factors:

• possible spread to lymph nodes located near the tumor;
• feature of the growth and size of the neoplasm;
• the presence of metastases in other organs.

Detection of cancer is possible after a complete examination of the patient. Only the presence of a disease can be determined qualified specialist. For this, the following diagnostic methods can be applied:

• history taking and physical examination (information about the patient's well-being, symptoms, recent tests, past illnesses);
• the use of diagnostic tests (endoscopy, ultrasound);
• the use of imaging procedures of malignant tumors that help to examine the organs and extent of the tumor (radionuclide scanning, magnetic resonance imaging);
• tissue sampling to determine the presence cancer cells(biopsy).

The classification of oncological diseases by stages helps the doctor describe the severity of the disease, the prevalence of the tumor process, assess all the risks for the patient and prescribe treatment. Detection of the stage of the tumor process is possible after a microscopic examination of a tissue sample, which shows how much healthy cells left, and how many have already appeared mutated.

Zero

The size of the primary tumor at the initial stage does not reach 3 cm. The boundaries of the disease do not advance further than the epithelium. It is characterized by different localization of the tumor. With adequate treatment and timely diagnosis this type of cancer is completely curable. The general symptoms of this phase are characteristic regardless of the sex and age of the patient. If they are found, you should immediately consult a doctor to prevent the development of the pathological process. Basically they are:

• loss of appetite;
• decrease in the level of hemoglobin in the blood;
• pallor of the skin;
• fast fatiguability.

1 stage

At the first stage of oncology, the disease begins to gradually expand its boundaries, although it does not go far and does not affect distant organs. An exception is stomach cancer, which already in this phase begins to metastasize to the lymph nodes. It is characterized by a large tumor node and the absence of metastases, while the patient has a favorable prognosis, so you can count on healing, the main thing is to diagnose the disease in a timely manner and take measures to eliminate the tumor. Common early symptoms that should alert a person:

• causeless anxiety;
• the presence of blood in the urine and feces;
• state change birthmarks, epidermis, moles;
• pain;
• slight malaise;
• change in the volume of lymph nodes;
• long-lasting cough;
• problems with swallowing food.

2 stage

In contrast to the first, the second clinical stage of the disease is characterized by high activity of a malignant tumor in the patient's body. The spread is fast. Tumor foci become larger and grow into the surrounding tissues. In addition, the second phase of the disease is always with metastases and involvement of the lymph nodes. This stage is considered the most common at which cancer is diagnosed. Stage II cancer can be defeated and successfully treated. General signs:

• high body temperature;
• causeless fatigue;
• fast loss weight;
• change in size, color, appearance, birthmarks;
• the oral cavity may be covered with ulcers;
• problems with urination;
• atypical bleeding.

3 stage

This phase is characterized by the progression of the disease, the spread of tumor seals to the lymph nodes, but there are no distant metastases, which is considered an encouraging factor for prolonging life. Although the survival rate for each tumor is different. The prognosis can be influenced by the type, location, degree of differentiation, the general condition of the patient and other factors that aggravate the course of the disease or, conversely, help prolong life. At the third stage, symptoms appear in the body that interfere with its normal functioning:

• sudden weight loss;
• appetite disappears;
• constant temperature is +37.5 degrees;
• Availability blood secretions(depending on localization);
• observed general malaise and frequent fatigue;
• pain in the back, sacrum, abdomen.

4 stage

The most severe is the terminal stage of cancer or the fourth. The tumor can reach a huge size, grow into other organs and tissues, metastasize to the lymph nodes. This phase often includes undifferentiated thyroid cancer and poorly differentiated tumors, regardless of the size and condition of the regional lymph nodes. Recovery at this stage is almost impossible. A cancer patient may even fall into a coma. There are common clinical signs of cancer:

• lack of appetite;
• sudden weight loss;
• lethargy, drowsiness, decreased ability to work;
• swollen lymph nodes;
• fever;
• the presence of seals in the tissues;
• acute ischemia;
• fever body;
• jaundice due to blockage of bile excretion;
• anemia.

Treatment Methods

Cancer has several stages, where only the initial ones are treatable. For this modern medicine developed special methods involving a range of procedures. Only a doctor can prescribe them, given the severity of the disease. Based on the type of disease and the stage of oncology, the following methods of cancer therapy can be used:

Forecast

early stages cancers are treated effectively. Late - can also be treated successfully. A doctor in relation to cancer patients can give a positive prognosis, basically such a conclusion is made 5 years after the main treatment, in the absence of a relapse. With timely diagnosis of the zero stage and good treatment, such cancer is completely curable. The survival prognosis for the first phase is also favorable, the patient can count on complete healing, the main thing is to diagnose the disease in time and take all necessary measures to remove the tumor.

Survival of patients with stage 2 cancer depends on the location and type of tumor. Reviews of experts indicate that if the patient lived for 5 years after the operation, then he was completely cured. The survival rate for stage 3 cancer for each tumor will depend on the degree of penetration of metastases into the body. In the last stage, life expectancy can vary from a few months to two years. Few people manage to cross the line of 5 years with oncology of the 4th stage, people with more chances lung cancer, less - the stomach and liver.

Can stage 4 cancer be cured?

Many people believe that in the last stage of cancer, the patient dies quickly. However, the right treatment will help prolong life and improve its quality for up to 6 years, depending on the degree of damage, the type of tumor of vital organs, and the presence of concomitant diseases. Complex therapy helps only to alleviate the patient's condition and give him the opportunity to extend his life for several years. It is impossible to cure cancer at this stage, so you should not believe that it is possible to eliminate the tumor with the help of folk remedies.

Video

In most people, when a neoplasm is detected, the first question arises about its malignancy. And if the answer is disappointing, then it will be natural to be interested in the spread of the oncological process, because everyone knows that the stages of cancer determine both the treatment, which can be very painful, and the prognosis, which threatens to be unfavorable.

The variety of neoplastic processes that can originate in human body cannot be viewed from the same perspective. These can be completely different tumors with characteristics inherent only to them, united by one concept - evil. In addition, malignancy is not always determined by the appearance, reproduction and journey through the body of a “bad” cell. For example, a malignant basalioma does not show a tendency to metastasize, so such cancer at the initial stage can be completely cured, that is, the concepts of "good" and "evil" in this regard are very relative. An important role in determining future bad or good prospects is played by the stages of cancer, which, as one of the main indicators, are used in the classification of oncological diseases.

Classification and forecast

Neoplastic processes that can originate in the body can vary greatly in morphological characteristics, preferences for a particular tissue, ability to metastasize, clinical course and prognosis, although all of them are often combined into one word - cancer, which is a malignant tumor from epithelial tissue. . Carrying "evil" oncological processes of a different origin have other names.

Thus, various (basic) characteristics of the neoplastic process are taken as the basis for the classification of malignant neoplasms:

• Morphological features of the tumor (its type, degree of malignancy);
• Localization of the primary focus;
• The size of the neoplasm, the rate of its growth;
• The ability of this type of neoplasia to.

TMN classification on the example of the thyroid gland

International Classification (TNM - t death, n odus, m etastasis) malignant tumors is voluminous and for the most part incomprehensible to a person who is far from the terminology of the fundamental sciences of medicine, however, forming groups of tumors, it primarily focuses on the prognosis for cancer at various stages, and stages are determined by:

1. The prevalence of the primary focus at the time of its discovery (T);
2. Reactions of regional lymph nodes (N);
3. The presence or absence of distant metastasis (M).

In addition, each tumor process (taking into account localization) can be classified according to individual parameters:

• By clinical signs(clinical classification), that is, according to data obtained using various diagnostic methods;
• Based on the pathomorphological features of the tumor, which are determined by histological examination;
• Depending on histopathological differentiation (poorly differentiated tumors are more dangerous and "meaner", they grow faster into neighboring tissues and metastasize to distant organs).

All these classification issues are very difficult for a non-specialist, while patients are more interested in what is the prognosis for cancer of a certain localization, depending on the stage of the process, because it is obvious that differently morphologically arranged tumors will behave differently in the body. In this regard, the stage of cancer is perceived, perhaps, as the most reliable prognostic criterion not only by doctors, but also by patients.

It all depends on the stage.

Without delving into the numerous classification characteristics, we will try to consider similar prognosis options for various forms of neoplasia, depending on the stage. There are five of them:

0 stage

Stage 0 includes cancerous tumors any localization. The boundaries of cancer at the zero stage do not move beyond the boundaries of the epithelium, which gave rise to the neoplasm. An example of stage 0 is carcinoma in situ, a non-invasive (for the time being) epithelial tumor. With adequate treatment, such cancer completely curable.

1 stage

At this stage, cancer slowly expands its borders in search of a place, but does not go far and does not affect distant organs. The only exception is gastric cancer, which already at the first stage metastasizes to the lymph nodes. Mostly, the prognosis for this stage is favorable, the patient can count on healing, the main thing is early diagnosis and immediate measures to eliminate the tumor.

2 stage

Stage 2 differs not only in the progression of the process in the primary focus, but also in the beginning of metastasis to the lymph nodes (regional). The prognosis for grade 2 cancer depends on the type and location of the tumor.

stage of cancer on the example of a tumor of the intestine / esophagus, at stage 4, detached metastases are formed

3 stage

Here, further progression of the disease is noted, the penetration of cancer into the lymph nodes is obvious, but there are no distant metastases yet, which is an encouraging factor for prolonging the life of the patient. Survival in stage 3 cancer is also different for each tumor. The location, type, degree of differentiation of neoplasia, the general condition of the patient and other factors that aggravate the course of the disease or, conversely, help prolong life, play a role.

When asked if stage 3 cancer is curable, the answer will be rather negative, because even in the absence of explicit distant metastases, the malignant process has already taken power over the human body, so you can’t count on a long and happy life with grade 3 cancer. The life expectancy of the patient depends entirely on the degree of evil brought by the tumor.

4 stage

Stage 4 is the terminal stage of cancer. Damage to the organ, lymph nodes, metastases to distant organs. However, it should be noted that stage 4 cancer can be diagnosed in the absence of distant metastases. Common, rapidly growing primary tumors or neoplasms of small size, in which the lymph nodes are affected, are also sometimes referred to as stage 4 of the malignant process. Some poorly differentiated tumors and undifferentiated thyroid cancer are also included here, regardless of the size of the tumor and the state of the regional lymph nodes, but when distant metastases are detected. A cure for stage 4 cancer is in great doubt, or rather, it is generally excluded, even if the primary tumor is completely destroyed, distant metastases will still “eat a person”.

Each tumor has its own prognosis

Describing the stages of all tumors is not only difficult, but also impossible. Meanwhile, it is worth trying to acquaint the reader with the initial stage for tumors that the patient himself can detect (superficial types), as well as with the course and prognosis of the most common neoplastic processes localized in the main human organs.

cancer on the surface

Cancer localized on the skin and visible mucous membranes at the initial stage can be suspected by the person himself, if he is inclined to carefully monitor his health.

At first, it manifests itself as a small speck or nodule, which is not particularly disturbing. If, for a long time, it does not disappear, does not go away from the use of various pharmaceutical and folk remedies, it is better for the patient to immediately consult a doctor for an explanation of the origin of incomprehensible and unusual skin elements.

skin tumors: 1 - mole, 2 - nevus dysplasia (moles), 3 - senile keratosis, 4 - squamous cell carcinoma, 5 - basal cell carcinoma, 6 - melanoma

The initial stage in most cases is asymptomatic, however, painful cracks, sores, erosion, seals should alert in terms of the development of the oncological process.

leukoplakia of the tongue, papillomatosis, erosive changes in the mucosa are common precancerous conditions

early stage lip cancer

It does not occur so often, smokers or people who irritate this area in another way suffer more. The symptoms of cancer (non-healing cracks, ulcers, peeling, in general, everything that should not be there) are not so painful for the patient so that he quickly runs to the doctor, but in vain, because cancer at the initial stage can be cured. In the future, this will be very difficult to do.

With symptoms of inflammation, the initial stage proceeds, so patients attribute everything to manifestations of the usual chronic illness and, as a rule, do not rush to the doctor.

Neoplastic processes that have found a place for themselves in the tongue, lips, throat, are combined into one pathology - oral cancer.

Rapid growth and high aggression - lung cancer

Fast-growing, very malignant and very common neoplasms that claim thousands of (mostly male) lives every year. That's right, this definition primarily concerns, which in growth is ahead of neoplasia of other localizations and in a short time reaches the last stage, leading a person to his deathbed.

In the first stage of lung cancer the size of the tumor usually does not reach 3 cm, the “birthplace” (segment) of the neoplasm does not leave, it practically does not give symptoms of its presence. Patients can associate any manifestations in the form of cough, shortness of breath, chest pain with the presence of another pathology, for example, chronic bronchitis. Meanwhile, early diagnosis of cancer with active treatment at the first stage gives a fairly high percentage of survival (up to 80%).

Second stage also tends to disguise itself as relative well-being, but the size of the focus is already doubled (up to 6 cm). The neoplastic process still remains within the lobe of the lung, but is already beginning to "show interest" in the nearby lymph nodes, dispersing single metastases. Cough, sputum (sometimes with blood), pain, fever, signs of intoxication again resemble an exacerbation of long-term chronic diseases bronchopulmonary system. This usually confuses the patient, so he does not go to the doctor for a long time, thereby losing precious time. But the combination with radical treatment ensures survival in stage 2 cancer up to 50%. As they say, fifty-fifty, and this is a lot.

For the third stage The malignant process in the lungs is characterized by further growth of the tumor, which exceeds 6 cm in size and, having struck the lung, metastasizes to nearby lymph nodes.

Last stage (fourth) has a large tumor that has left borders of the lung, which captured neighboring organs and settled metastases with the help of lymphatic and blood vessels throughout the body. The terminal stage of cancer leaves the patient only a few months to live. The body is destroyed by a tumor, the existing methods of treatment are useless or can only alleviate suffering, but not really improve the condition. A cure for stage 4 cancer can only be dreamed of, and people who defeated stage 4 cancer can only be found on dubious forums on the Internet ... But this has already been said before.

Focus on breast cancer

Often, cancer at the initial stage can be "caught" with lesions. The best diagnostician in this case is the woman herself or (quite often) her husband. This is explained by female breast is not only an organ that serves to feed a child. She is an object of adoration and admiration for people of the opposite sex, so the attitude towards her is especially reverent, and attention is increased. Meanwhile, not everyone and not always manages to successfully find the primary focus and cope with in situ carcinoma (non-invasive epithelial tumor), in some the disease goes through all stages of breast cancer:

characteristic cancerous and precancerous changes in the breast, which are worth paying attention to

• Zero stage - carcinoma in situ(intraductal tumor, lobular cancer, Paget's disease) - a pre-invasive form that gives every chance for complete healing.
• First stage of breast cancer: the tumor is small, its diameter does not exceed 2 cm, it has not yet sprouted anywhere and, moreover, has not given metastatic growth, the prognosis, of course, is favorable.
• Second stage: the size of the neoplasm in grade 2 cancer varies between 2-5 cm, the tumor began to capture additional territories, growing into neighboring tissues, and metastasizing to the lymph nodes.
• The severity of the third stage It consists not only in the growth of the tumor, its penetration into neighboring tissues and nearby lymph nodes, but also in the transfer of cancer cells to distant organs. After all, even with radical treatment, evil can lurk, and after 10-15 years (this can be the life expectancy for stage 3 breast cancer) remind of itself in order to have a fatal outcome, so stage 3 cancer is considered incurable.
• For stage four breast cancer the size of the primary focus no longer matters. The worst thing about grade 4 cancer is that the tumor growth completely took over the lymphatic system, “occupied” the chest and spread to the entire body in the form of metastases to distant organs. It is impossible to cure cancer of the 4th stage by any methods, because the dispersed "evil" can no longer be collected through all the tissues of the body. Radiation and chemotherapy may delay neoplastic growth for a while, but not for long - with stage 4 cancer, they live from a year to 3 years.

breast cancer stages

By the way, oncological diseases of the mammary gland are not excluded in males, however, this happens very, very rarely.

Purely female problems

The most vulnerable place of the main reproductive organ of women

In recent years, cervical tumors have significantly “rejuvenated”, which experts attribute to the spread of human papillomavirus infection (HPV). Meanwhile, there is a high probability of detecting a neoplastic process at the stage of its inception, and in other stages this type of oncology is relatively well diagnosed. Thus, before becoming real, the development of a tumor goes through several stages:

stages of cervical cancer

The prognosis for cervical cancer, as with other tumors, depends on the stage. Of considerable importance are factors such as the form of cancer and the degree of neoplasia differentiation (the higher the degree, the greater the chance of survival).

The main "killer" of oncogynecology

ovarian cancer, having a lot of forms and types, is considered the most unfavorable and uncontrollable oncological process of the female genital area. The most common variety is recognized as a tumor of the glandular tissue of the ovaries - adenocarcinoma, which is characterized by particular cruelty and aggression. The insidiousness of ovarian cancer also lies in the fact that it presents particular difficulties in diagnosis. The existing symptoms are well linked to the manifestations of chronic gynecological diseases (adnexitis, uterine fibroids, etc.). However some signs should still alert a woman:

1. causeless weight loss without diet and exercise;
2. progressive enlargement of the abdomen (accumulation of fluid in the abdominal cavity - ascites);
3. indigestion.

Ovarian cancer, like other tumors, goes through 4 stages:

1. The "birth" of a cancer cell, the development of the process within one ovary. The appearance of ascites is possible already in the first stage of cancer, which gives some hope for its early diagnosis and prolongation of life by 5 years in 80% of patients (of course, provided that surgical treatment is combined with other methods).
2. At the second stage both ovaries, peritoneum, fallopian tubes and uterus are affected. An enlarged belly (ascites) with a general weight loss tells a woman about the development of a bad disease, the prognosis, of course, worsens.
3. Third stage is no longer difficult to diagnose, problems can be noticed even during a routine gynecological examination. The survival rate for stage 3 cancer is low, only every tenth woman out of a hundred has a chance to live five years.
4. For stage 4 cancer is characterized by the spread of metastases throughout the body, but most often they can be found in the lungs and liver. There is no question of a cure for stage 4 cancer, the survival rate is reduced to zero.

The prognosis cannot be the same for everyone, it is impossible in general to talk about the stage of cancer and the prospects for life, because in each case other factors are taken into account: the histological features of the tumor, the age of the patient, the condition of other organs. Someone can fight longer, and someone gives up in the first months.

Gastrointestinal tract

Esophageal carcinoma

They are classified as malignant and aggressive neoplastic processes. It grows rapidly, metastasizes early, is difficult and painful in diagnosis and treatment, and has a very unfavorable prognosis.

This cancer at the initial stage can mislead its owner by the absence of any specific symptoms. Difficulties with swallowing, intermittent spasms, choking while eating, a person overcomes with the help of liquid. He washed down his food with water - everything seems to have passed and you can continue to live in peace, so a visit to the doctor is constantly being postponed. And, by the way, thoughts of the bad are rarely visited. However, if the disease is found at the first stage, quickly take action, then you can count on five (or even more) years of life.

Symptoms of esophageal cancer increase as the tumor develops, which goes through the same stages as other cancers (with germination and metastasis). At the same time, the prognosis worsens.

On the 3-4 stages the voice is already changing, dysphagia is increasing, esophageal vomiting appears periodically, something is constantly bothering in the chest, the patient is losing weight, losing the ability to work. Survival for stage 3 cancer is low, with active treatment, approximately 25% of patients benefit, but with distant metastasis, only half of them have some prospects.

With stage 4 cancer, patients live for hardly half a year, and this can hardly be called a full life.

Number two leader

It still holds the leading position in terms of frequency and mortality, only lung cancer, recognized throughout the world as an invincible "enemy of all times and peoples", moves it to second place. The abundance of carcinogens, bad habits, hereditary predisposition, carriage of Helicobacter pylori infection are factors contributing to the development of a tumor of this localization. Human nature is such that he hears the stomach better and more often than other organs (eat, drink, smoke ...). Satisfying his (stomach) sometimes unreasonable demands, the thrill-seeker “digs his own grave”.

The prognosis for gastric cancer largely depends on how deep the tumor has reached when immersed in the wall of the stomach. For example, early cancer, affecting only the surface layers (mucous and submucosal), responds well to treatment, so almost all patients survive. However, such bright prospects, unfortunately, cannot be expected in patients whose tumor is already at first stage spread not only to the stomach, but also gave metastases to the lymph nodes.

stages of stomach cancer

Disorder in the stomach can be quite difficult to notice, the symptoms appear late, despite the fact that the tumor can be determined by palpation. Dyspeptic disorders, weakness, aversion to food, weight loss, lack of interest in life - many people refer to these “small signs” as their usual sensations, especially if they have suffered from ulcers or gastritis for many years. Pain appears in the later stages (3-4), when the cancer, having reached a large size, has already left the digestive organ.

The terminal stage of stomach cancer is accompanied by great suffering:

• Intense pain;
• progressive anemia;
• Changes in the blood (leukocytosis, high ESR);
• Intoxication;
• Fever;
• Exhaustion.

The last stage leaves a patient with stomach cancer only a few months of life ...

Gender and age again...

All of the above stages go through and. It most often affects the large intestine of middle-aged and elderly men. The reason for its development, as well as stomach cancer, is often the addiction of the patient himself. The first symptoms (discomfort, fatigue, nervousness) do not give much reason to suspect evil. The appearance obvious signs(pain, intestinal disorders, excretion of blood with feces) is often delayed.

stage of bowel cancer, the 4th is characterized by metastasis to the liver

The stage of bowel cancer, as in the case of neoplasia of other localizations, entirely determines the prognosis.

Detection of an oncological process at the first stage provides a 5-year survival rate for almost 90% of patients, with an increase in the degree, the chances of living for many years fall sharply. With the last stage of bowel cancer, the prognosis is extremely unfavorable, especially if the tumor originated in the distal rectum.

The tasks of oncology are solved by specialists, however, according to the author, people who are far from medicine can play a big role in this if they are aware of the symptoms, stages and methods of treatment of malignant neoplasms. It is obvious that in most cases we will defeat cancer at the initial stage, the main thing is to detect it in time. And who, if not the patient himself, will be the first to know about the impending disaster, but at the same time he will not rush to try dubious medicines such as soda and hemlock, but will turn to medical institution where he will receive qualified assistance.

Video: stages of cancer and other oncological concepts in simple terms

The author selectively answers adequate questions from readers within his competence and only within the limits of the OncoLib.ru resource. Face-to-face consultations and assistance in organizing treatment, unfortunately, are not provided at the moment.

International classification of oncological diseases (ICD-O) is a special thematic extension of the International Classification of Diseases.

The first edition of the ICD-O, developed by the World Health Organization, took place in 1976, simultaneously with the publication of the Systematized Nomenclature of Medicine (SNOMED) issued by the College of American Pathologists. In 1990, WHO published the second edition of the ICD-O (eng.ICD -O-2 ). The topography section of this edition followed the structure of the Neoplasms section of ICD-10, while the morphology section was taken from SNOMED. The third revision of the ICD-O has now been published.ICD - O -3 ), the section of topography in which did not change.

The ICD-O has a biaxial structure with a coding system for the topography and morphology of tumors. The morphological code contains five characters, the first four of which describe the histological type of the tumor, and the fifth - its biological properties (/0 - benign tumor; /1 - it is not clear whether the tumor is benign or malignant; /2 non-invasive cancer; /3 - malignant neoplasm, primary focus; /6 - malignant neoplasm, metastasis; /9 - malignant neoplasm, it is not clear whether the primary focus or metastasis).

General principles of classification

Most classifications in oncology are the result of international collaborations between different oncology institutions. The statistical classification is built on a hierarchical basis and consists of mutually exclusive rubrics covering all diseases. It is designed to study the frequency and characteristics of the course of each tumor. Rubrics are usually provided to account for unclassified pathology.

The nomenclature classification is organized according to the system principle and provides a separate name for each known disease. International Classification of Diseases (ICD) - a system of headings with specific nosological units. It does not allow for the inclusion of detailed data for each specialty. The ICD is based on a three-digit code for each disease. Oncology occupies 2 sections - C (malignant tumors) and D (cancer in situ and benign tumors).

Since 1900, 10 revisions of the ICD have been carried out. In 1989, the last one was adopted at the 43rd World Health Assembly in Geneva. 10th revision of the ICD. A stable and flexible classification has been developed that allows comparison of indicators across institutions without being limited to a particular country. ICD-10 has been adopted in Russia since 1993.

In addition to the described version of the ICD in the oncology section, the 2nd edition of the International Classification of Cancer Diseases (ICD-O) was published in 1990, intended for use in databases, oncological registries and in the pathology departments of hospitals. This is a biaxial classification with a coding system according to the topography of the tumor and according to its morphology. It allows you to specify the localization of the primary focus in more detail. The morphological code has 5 characters: the first four indicate the histological type, the fifth - the biological properties of the tumor. For example, moderately differentiated squamous cell carcinoma has the code M-8070/32. Usually, this code is not indicated when formulating a diagnosis, but it is necessary in scientific research and in the preparation of international publications.

Classifications according to the prevalence of the tumor

For many years, the prevalence of the tumor was determined according to the domestic classification. The stage was designated by a Roman numeral (I-IV), reflecting the size and prevalence within the organ. The letters of the Russian alphabet a and b indicated, respectively, the absence or presence of regional metastases. In the middle of the last century, the domestic, and subsequently the international TNM classification was approved. Since January 1, 2003, the International Cancer Union has recommended the use of b-th version TNM classification. Classification of MNs according to the TNM system is the most accurate and mandatory way of coding prevalence for the formation of an oncological diagnosis. The 2002 MN staging guidelines have been approved by all TNM National Committees. The use of a unified classification by all oncological institutions - necessary condition for adequate comparison of clinical materials and evaluation of treatment outcomes. In all statistical developments, it is necessary to take into account differences in the prevalence indicated in the classifications in different years. In scientific papers, it is customary to indicate the year and version of the classification by prevalence.

In the 6th version of the classification, the X index was introduced, which is used in cases where the size of the primary focus, damage to regional lymph nodes and the presence of distant metastases cannot be determined for one reason or another; in addition, the gradation of lymph node involvement was changed in some MN localizations. For cancer of some localizations, category T has 2 subsections: a - without damage to vital organs, which determines the tumor resilience; b - tumor germination in vital organs and tissues (large vessels and parenchymal organs). Multifocal forms of cancer are denoted by the sign t. To indicate the defeat of the lymph nodes, the index N is used. If in previous versions the gradation depended only on the level (zone) of the lesion of the lymph nodes, now for a number of localizations the number of affected lymph nodes is taken into account. Additionally introduced histological gradation (G, degree of cell differentiation). The presence or absence of a residual tumor (tumor tissue) after treatment is indicated by the symbol R. This reflects the effectiveness of the treatment, influences the planning of further treatment and is an important factor forecast.

Other medical classifications(epidemiological, clinical, laboratory, morphological) have their own specific goals (preventive, diagnostic, organizational, therapeutic, scientific) and are of a subordinate (statistical) nature.

Source: Journal of Medical Statistics and Organizational Methods in Healthcare Institutions 2013/02

• Registration and record keeping of patients with malignant neoplasms
• Formulation and coding of clinical and pathoanatomical diagnoses for cardiovascular diseases in accordance with the requirements of ICD-10
• Basic requirements of the ICD-10 for the formulation of the final clinical and pathoanatomical diagnoses
• On some features of the use of the ICD-10 in practical healthcare
• International Classification of Functioning and Disabilities and Health
• Development of a new international classification of diseases of the 11th revision
• On the features of coding injuries in road traffic accidents in accordance with ICD-10
• General principles for the classification of ICD diseases
• Encryption of data on morbidity and mortality in accordance with ICD-10
• History of the adoption of the international statistical classification of diseases and related health problems, the tenth revision of the ICD

Depending on the clinical course and morphological characteristics, tumors are divided into benign and malignant.

Benign tumors are characterized by slow expansive growth, a clear demarcation from the surrounding tissues (the presence of a capsule), morphological similarity with the tissues from which they originated and, as a rule, do not threaten the patient's life.

Malignant tumors are characterized by rapid invasive growth, morphological atypism, the ability to metastasize and, as a rule, threaten the life of the patient.

Of particular importance for the practical activities of the oncological service is the histogenetic classification of tumors, which determines the tissue from which the neoplasm has developed: epithelium, connective, hematopoietic tissue, endothelium, tissues nervous system, APUD systems, embryonic islets, trophoblastic tumors, hamartomas. Each given morphological substrate can be affected by benign and malignant tumors. An exception is hematopoietic tissue, which is affected by only malignant diseases.

I. EPITHELIAL TUMORS

benign

1. Papilloma - a tumor of squamous epithelium

2. Adenoma - a tumor from the glandular epithelium

Papillomas and adenomas protruding into the lumen of a hollow organ (on a stalk or broad base) are called papillary or adenomatous polyps, respectively.

Malignant (cancer - cancer, crab)

1. Squamous cell carcinoma with or without keratinization.

2. Adenocarcinoma (glandular cancer).

II. CONNECTIVE TISSUE TUMORS

benign

1) Lipoma 2) Fibroma 3) Myxoma 4) Chondroma 5) Osteoma 6) Leiomyoma 7) Rhabdomyoma.

Malignant (sarcoma)

1) Liposarcoma 2) Fibrosarcoma 3) Myxosarcoma 4) Chondrosarcoma 5) Osteosarcoma 6) Leiomyosarcoma 7) Rhabdomyosarcoma.

III. TUMORS FROM HEMOPOETIC TISSUE (HEMOBLASTOSIS)

1. Systemic hemoblastosis (malignant)

1.1. Acute leukemia; 1.2. Chronic leukemia.

2. Tumors (sarcomas)

2.1. Lymphogranulomatosis; 2.2. Lymphosarcoma; 2.3. plasmacytoma;

2.4. reticulosarcoma; 2.5. malignant lymphomas.

IV. TUMORS FROM ENDOTHELIUM AND MESOTHELIUM

benign

1. Hemangioma;

2. Lymphangioma;

3. Benign synovioma;

4. Localized mesothelioma.

Malignant

1. Hemangiosarcoma;

2. Lymphangiosarcoma;

3. Malignant synovioma;

4. Diffuse mesothelioma.

V. TUMORS OF NERVOUS TISSUE

benign

1. Neurofibroma; 2. Neurinoma; 3. Ganglioneuroma; 4. Oligodendroglioma; 5. Astrocytoma; 6. Meningioma.

Malignant

1. Neurofibrosarcoma; 2. Malignant neuroma; 3. Ganglioneuroblastoma; 4. Sympathoganglioma; 5. Astroblastoma; 6. Medulloblastoma; 7. Spongioblastoma; 8. Epindymoblastoma; meningeal sarcoma.

VI. TUMORS FROM APUD CELLS - SYSTEMS (APUDOMS)

The APUD system is a functionally active system that includes neuroendocrine cells scattered throughout the body.

benign

1. Adenomas endocrine glands; 2. Carcinoids; 3. Paragangliomas (pheochromocytoma, chemodectoma); 4. Thymomas.

Malignant

1. Small cell lung cancer; 2. Medullary thyroid cancer; 3. Melanoma; 4. Carcinoid malignant.

VII. TUMORS FROM EMBRIONAL ISLANDS (RUDs, REMAINS)

benign

1. Teratoma - a tumor consisting of tissues characteristic of the affected organ, and also contains tissue components that are not normally found in this area and cannot arise due to metaplasia; 2. Dermoid cyst.

Malignant

1. Teratoblastoma; 2. Wilms tumor (nephroblastoma).

VIII. TROPHOBLASTIC TUMORS

benign

bubble skid

Malignant:

chorionepithelioma

IX. HEMARTOMAS (DISEMBRIOGENETIC TUMORS) - tumors consisting of tissues characteristic of the affected organ: vascular hemangiomas, vascular and pigmented skin nevi, congenital neurofibromatosis, exostoses, familial polyposis intestines, etc.

CLINICAL GROUPS OF ONCOLOGICAL PATIENTS

In order to unify the record, analyze the prevalence and frequency of oncological diseases, as well as determine the effectiveness of the oncological service, all patients are divided into 6 clinical groups.

Group Ia - patients with a suspicion of a malignant disease. Patients of this group are subject to an in-depth examination within no more than 14 days, and as the diagnosis is established, they are transferred to another group or removed from the register.

Group Ib - patients with precancerous diseases and benign tumors. Patients of this group are subject to clinical examination and rehabilitation (sanation). According to the number of patients registered and the number deregistered after treatment, the intensity and effectiveness of the work of each specialist and institution for the medical prevention of malignant neoplasms is determined.

Group II - patients with malignant diseases subject to special methods of treatment (hemoblastosis).

Group IIa - patients with malignant tumors subject to radical treatment.

Group III - practically healthy people, cured of a malignant tumor, who have been registered at the dispensary for at least 5 years.

Group IV - patients with malignant tumors in the late stages of the disease, when palliative or symptomatic treatment is indicated.

PRINCIPLES OF DIAGNOSIS

All patients with suspected cancer undergo a comprehensive examination, including laboratory and special research methods. When making a diagnosis, complaints, anamnesis and objective data are carefully analyzed.

The clinic and diagnostics of specific oncological diseases are so diverse that they are studied in each field of medicine independently, therefore, these sections are presented in the relevant manuals or oncology textbooks. However, there are general principles diagnosis, which provide a unified approach and unification of the assessment of relevant data.

1. The diagnosis of oncological disease must be confirmed by cytological or pathomorphological examination. Without histological verification, the diagnosis of a malignant tumor remains doubtful.

Only melanoma should not be biopsied, as this contributes to its dissemination. Morphological study of melanoma produced after its radical excision.

2. For all malignant tumors, two diagnoses are made:

Clinical diagnosis based on clinical, radiographic, endoscopic, biopsy and a number of additional research methods; this diagnosis determines the method of treatment for a particular patient;

Pathological (post-surgical, pathohistological) diagnosis based on data obtained before the start of treatment, but supplemented by information obtained during surgical intervention or morphological (cytological) examination of the surgical material. This diagnosis determines the prognosis and long-term results.

3. When making a diagnosis of a tumor, the localization, nature and stage of the disease are indicated.

The existing clinical and morphological classification provides for the division of patients with malignant neoplasms, depending on the degree of prevalence of the process, into 4 stages, indicated by Roman numerals I, II, III, IV.

This division is based on the TNM system, developed by a special committee of the International Cancer Union, therefore this classification is called international, it is accepted in most countries of the world.

Symbol T (tumor, tumor) - the primary tumor for most localizations has 7 options:

T0 - the primary tumor is not detected (not detected using known research methods), although there are tumor metastases;

Tis - preinvasive carcinoma (Carcinoma in situ) - the tumor is located within the layer of origin ("intraepithelial cancer", non-infiltrating intraductal carcinoma of the breast).

T1 - a small tumor (depending on the organ up to 1 cm, but not more than 2 cm in diameter), limited to the original tissue;

T2 - small tumor(depending on the organ from 2 to 5 cm in diameter), not extending beyond the affected organ;

T3 - a tumor larger than 5 cm, extending beyond the affected organ, germinating serous membranes and capsules;

T4 - a tumor of any size, growing into neighboring organs and tissues.

TX is a tumor, the size and boundaries of which cannot be accurately determined.

Symbol N (nodulus, node) - indicates the defeat of the lymph nodes, has 5 options.

NX - insufficient data to determine the extent (degree) of lymph node involvement;

N0 - no signs of damage to the lymph nodes;

N1 - defeat of one regional lymph node with a diameter in the largest dimension less than 3 cm, at a distance from the primary tumor up to 3 cm;

N2 - defeat of one or more lymph nodes, less than 3 cm in diameter, but located at a distance of more than 3 cm from the primary tumor or one node with a diameter of 3-6 cm;

N3 - defeat of one regional lymph node with a diameter of more than 6 cm or several nodes with a diameter of 3-6 cm, located at a distance of more than 3 cm from the primary tumor.

Symbol M (metastases) - indicates the presence of distant metastases, due to hematogenous or lymphogenous dissemination. Metastasis to non-regional (juxta-regional) lymph nodes is considered as distant metastasis.

The hematogenous (venous) path of metastasis from the systems of the superior and inferior vena cava most often leads to damage to the lungs, in the portal system - to the liver.

The symbol M has three meanings:

MX - insufficient data to establish the likelihood of distant metastases;

MO - there are no signs of distant metastases;

M1 - there are single or multiple distant metastases.

All combinations of T1-4 N0-3 M0-1 give 32 categories, which is completely unacceptable for practice, so the grouping of patients by stages is used. The principle of determining the stage of the disease of a malignant tumor can only be formulated in a general form.

Stage I - a small or small tumor that does not extend beyond the affected organ in the absence of regional metastases. According to the TNM system, the first stage includes: T1-2 N0 M0 (T1 N0 M0; T2 N0 M0).

Stage II - a small or small tumor that does not extend beyond the affected organ in the presence of a single regional lymphatic metastasis. According to the TNM system, the second stage includes: T1-2 N1 M0 (T1 N1 M0; T2 N1 M0).

III stage - tumor, extending beyond the affected organ, germinating serous membranes and capsules or a small tumor with the presence of multiple regional metastases. According to the TNM system, the third stage includes all combinations that include T1-3 N0-3 M0, not included in stages I and II (T1 N2 M0; T1 N3 M0; T2 N2 M0; T2 N3 M0; T3 N0 M0; T3 N1 M0 ; T3 N2 M0; T3 N3 M0).

Stage IV - a large tumor that grows into neighboring organs and tissues or a tumor of any size in the presence of distant metastases.

According to the TNM system, the fourth stage includes all combinations, including N1-4 T0-3 M0-1, not included in the previous stages (N1

N0 M1; T1 N1 M1; T1 N2 M1; T1 N3 M1; T2 N0 M1; T2 N1 M1; T2 N2 M1; T2 N3 M1; T3 N0 M1; T3 N1 M1; T3 N2 M1; T3 N3 M1; T4 N0 M0; T4 N1 M0; T4 N2 M0; T4 N3 M0; T4 N0 M1; T4 N1 M1; T4 N2 M1; T4 N3 M1).

The above classification is quite consistent with the diagnosis of cancer of the esophagus, stomach and lungs. For other localizations, the grouping of TNM by stages may differ somewhat.

It should be borne in mind that the size of the tumor, which determines, to some extent, the stage of the disease, is a relative value. So, for the stomach and eye, the size of the tumor is equal to 2 cm in diameter in the first case, a small tumor, in the second, a very large one.

4. When making a diagnosis, there is often doubt about the stage of the disease. For solitary tumors, a lower TNM value is chosen, since this most often orients towards radical treatment.

In the presence of multiple synchronous tumors, the stage is determined by the highest category T and N among all available tumors.

OUTCOMES AND HAZARDS OF MALIGNANT

NEOPLASMS

1. Destruction of tissue in the focus of localization of the primary tumor, and as a result, a decrease or loss of the corresponding function.

2. Spread (dissimilation) of the tumor and damage to vital organs (lungs, liver, adrenal glands, etc.).

3. Intoxication due to the decay of tumor tissue and infection - the formation of endotoxins.

4. Depletion due to inhibition of enzyme systems and competition in the use of plastic and energy substrates.

5. Bleeding due to vascular erosion.

6. Thromboembolism associated with impaired rheological properties

stv blood and hypercoagulability.

GENERAL PRINCIPLES AND METHODS OF TREATMENT

ONCOLOGICAL PATIENTS

Depending on the goal, treatment can be radical, palliative and symptomatic.

Radical treatment is a therapy aimed at the complete elimination of all foci of tumor growth. The evaluation of the results of radical treatment of the tumor is carried out immediately after its completion (clinical evaluation), and then according to long-term results (biological evaluation - B.E. Peterson, 1980). Conditionally long-term results are determined by a five-year life after treatment.

Palliative care is a therapy directed directly or indirectly to the tumor, which provides life extension. It is used in cases where a radical cure is unattainable.

Symptomatic treatment is the therapy of patients with stage IV of the disease, aimed at eliminating or alleviating painful or life-threatening complications for the patient.

Treatment methods for cancer patients:

1. Surgical (operational) method

2. Radiation therapy.

3. Chemotherapy.

4. Hormone therapy.

5. Supportive therapy.

6. Combined therapy.

7. Combined treatment.

8. Comprehensive treatment.

Surgical treatment of tumors

Types of surgical interventions used in the treatment of cancer patients:

1. Radical operations (typical, extended, combined).

2. Palliative operations.

3. Symptomatic operations.

4. Rehabilitation operations.

A typical radical operation involves the removal of the affected organ or part of it within obviously healthy tissues, together with the regional lymphatic apparatus and the surrounding tissue in one block.

An extended radical operation, along with a typical radical operation, involves the removal of third-order lymph nodes (N3-lymphadenectomy).

A combined radical operation is performed in cases where two or more adjacent organs are involved in the process, so the affected organs and their lymphatic apparatus are removed.

The principle of determining the volume of surgical intervention in radical operations can only be formulated taking into account the nature of growth and the degree of anaplasia:

For small exophytic, highly differentiated tumors, a major operation should be performed;

With large exophytic, highly differentiated tumors, a very large operation should be performed;

With small infiltrative undifferentiated tumors, the largest operation should be performed;

With large infiltrative undifferentiated tumors, the operation should not be performed (B.E. Peterson, 1980).

Palliative operations are performed in cases where a radical operation cannot be performed. In these cases, the primary tumor is removed in the scope of a typical radical operation, which ensures the continuation of life.

Symptomatic operations are used in advanced processes, when there is a pronounced dysfunction of the organ or complications that threaten the life of the patient, but which can be eliminated by surgery.

Rehabilitation operations are performed for medical and social rehabilitation cancer patients. They can be plastic, cosmetic and restorative.

When performing operations for oncological diseases, it is necessary to observe, along with asepsis and antisepsis, the principles of area and antiblastic.

Ablastics is a system of measures aimed at preventing implantation metastases, dispersion of tumor cells in the area of ​​the surgical wound.

Ablastics includes the following activities:

Careful delimitation of the manipulation zone from the surrounding tissues, repeated change of surgical linen;

The use of a laser or electric scalpel;

One-time use of tupfers, napkins, balls;

Repeated change or washing during the operation of gloves and surgical instruments;

Ligation and intersection of blood vessels that provide blood supply to the organ affected by the tumor, beyond its limits before the start of mobilization;

Removal of a tumor within known healthy tissues, corresponding to the boundaries of the anatomical zone, as a single block with regional lymph nodes and the surrounding tissue.

Antiblastics is a system of measures aimed at combating tumor elements that can enter the wound during surgery and creating conditions that prevent the development of implantation metastases.

Antiblastics includes the following activities:

Stimulation of body resistance (immune, non-specific);

Preoperative radiation and/or chemotherapy;

Creating conditions that prevent adhesion of cancer cells: the introduction of heparin or polyglucin into the abdominal (thoracic) cavity before the mobilization of the affected organ, treatment of the surgical wound with 96o ethyl alcohol;

Intraoperative use of cytostatics (into the cavity, infiltration of tissues to be removed);

Radiation exposure (radiation, isotopes) and chemotherapy in the early postoperative period.

Along with surgical methods, cryosurgery (destruction of affected tissues by freezing) and laser therapy ("evaporation", "incineration" of the tumor with a laser) are currently used.

RADIATION THERAPY OF TUMORS.

Radiation therapy is carried out using various sources (installations) of ionizing (electromagnetic and corpuscular) radiation.

Remote methods of radiation therapy are static or mobile irradiation using gamma units containing cobalt-60, a betatron or a linear accelerator as an emitter.

Contact methods of radiation therapy (selective isotope accumulation method) - intracavitary, radiosurgical and application irradiation, as well as close-focus X-ray therapy.

X-ray therapy can be static and mobile (rotational, pendulum, tangential).

Combined methods of radiation therapy is the use of one of the methods of remote and contact irradiation.

Irradiation modes

1. Simultaneous irradiation - the required dose is carried out in one session (rarely used).

2. Continuous - irradiation by the contact method (intracavitary, interstitial and application).

3. Fractional irradiation is performed using remote gamma therapy and X-ray therapy. The method provides for the division of the total course dose of radiation (according to the radical program - 60 Gy for the tumor and 55-60 Gy for regional metastasis zones) into small fractions (2 Gy per day), enlarged fractions (4 Gy per day) or large fractions (5- 6 Gy per day). Irradiation is carried out with an interval of 2-3 days.

4. Method of a split course of remote gamma therapy. The method provides for the division of the therapeutic course dose into 2 equal cycles of fractional irradiation with a break of 3-4 weeks. This makes it possible to increase the total course radiation dose by 10-15 Gy.

In radiation therapy, the determination of the course therapeutic dose is based in general terms on the law of Bergonier and Tribando, which states: "The sensitivity of tissues to radiation is directly proportional to mitotic activity and inversely proportional to cell differentiation."

Malignant tumors are divided into 5 groups according to their sensitivity to ionizing radiation (Mate, 1976).

Group I - highly sensitive tumors: hematosarcomas, seminomas, small cell undifferentiated and poorly differentiated cancer.

Group II - radiosensitive tumors: squamous cell carcinoma of the skin, oropharynx, esophagus and Bladder.

Group III - tumors with medium sensitivity: vascular and connective tissue tumors, astroblastomas.

Group IV - tumors with low sensitivity: adenocarcinomas of the breast, pancreas, thyroid glands, kidneys, liver, colon, lympho-, chondro-, osteosarcomas.

Group V - tumors with very low sensitivity: rhabdo- and leiomyosarcomas, ganglioneuroblastomas, melanomas.

CHEMOTHERAPY FOR MALIGNANT NEOPLASMS

All drugs that act directly on the tumor are grouped into the group of cytostatics, although in their action they can delay cell division (cytostatic effect) or destroy it (cytotoxic effect).

Currently, two mechanisms of action on the tumor are mainly used in chemotherapy: direct damage and slowing down the time of tumor cell generation.

Classification of anticancer drugs

1. Alkylating compounds - interact with other substances through an alkylation reaction, i.e. replacement of the hydrogen of a compound by an alkyl group. Micro- and macromolecules undergo alkylation, but the main thing in the antitumor effect is their interaction with DNA. This group includes: embikhin, novembikhin, cyclophosphamide, sarcolysin, thiophosfamide (ThioTEF), etc.

2. Antimetabolites - block the synthesis of substances necessary for cell function. Of greatest interest are: methotrexate, a folic acid antagonist; mercaptopurine, thioguanine - purine antagonists; fluorouracil, fluorofur, cytarabine are pyrimidine analogs.

3. Antitumor antibiotics - inhibit the synthesis of nucleic acids. This group includes: dactinomycin, adriamycin, rubomycin, carminomycin, bleomycin, olivomycin, etc.

4. Herbal preparations - cause denaturation of the tubulin protein, which leads to mitosis arrest. This group includes: kolhamin, vinblastine, vincristine, etoposide, teniposide.

5. Enzymes. This group includes - asparaginase (krasnitin), used in leukemia, whose cells do not synthesize asparagine, their needs are met by asparagine present in the blood. The introduction of asparaginase leads to the destruction of asparagine, and the cells that need it die.

6. Compounds with an alkylating and antimetabolite action component - platinum complex compounds: cisplatin, platinol.

Chemotherapy, depending on the nature and extent of the tumor process, can be the main method of treatment (hemoblastoses, disseminated forms of solid tumors) or a component of combined or complex treatment, in particular as postoperative adjuvant (additional) therapy.

Types of chemotherapy

1. Systemic - general drug exposure by administering drugs orally, intravenously, intramuscularly or subcutaneously.

2. Regional - medicinal effect on a certain area by isolated perfusion or endolymphatic infusion.

3. Local - medicinal effect by injection into the cavity (intrapleurally, intraperitoneally), intrathecally (into the cerebrospinal fluid space), intravesically (into the bladder), directly on the tumor or tumor ulcers.

Classification of tumors according to sensitivity to cytostatics

1. Tumors are highly sensitive - the frequency of stable remission after treatment is achieved in 60-90% of patients. This group includes: chorionepithelioma, acute lymphoblastic leukemia in children, Burkitt's tumor, lymphogranulomatosis, malignant testicular tumors.

2. Tumors are relatively sensitive - the frequency of remission is observed in 30-60% of patients, a real possibility of prolonging life. This group includes: acute leukemias, multiple myeloma, erythremia, Ewing's sarcoma, cancer of the breast and prostate, ovaries, lung (small cell), uterine body, Wilms' tumor, embryonic rhabdomyosarcoma in children, lymphosarcomas.

3. Tumors are relatively resistant - the frequency of remission is in the range of 20-30% of patients, an increase in life expectancy is observed in a small part of patients. This group includes: cancer of the stomach, colon and rectum, larynx, thyroid gland, bladder, squamous cell skin cancer, chronic leukemia, melanoma, neuroblastoma in children, soft tissue sarcoma, osteogenic sarcoma, glioblastoma, corticosteroma.

4. Resistant tumors - remission is possible in a small part (less than 20%) of patients, in the vast majority of cases - partial and short-lived. This group includes: cancer of the esophagus, liver, pancreas, kidney, cervix, vagina, lung (not small cell).

It should be emphasized that even effective chemotherapy most often leads only to clinical remission for a longer or shorter period, regardless of the sensitivity of the tumor to cytostatics.

Side effects of chemotherapy

Side effects cytostatics in clinical manifestations are very diverse. However, the toxic effect of their systemic use manifests itself primarily in actively proliferating tissue: bone marrow, lymphatic system, epithelium of the gastrointestinal tract, reproductive organs.

For patients with a large mass of tumor tissue, chemotherapy may do more harm than good.

Clinical classification of chemotherapy complications

1. Toxic action cytostatics.

1.1. Local irritating effects: toxic dermatitis, phlebitis, thrombophlebitis, cystitis, serositis, neuropathy, etc.

1.2. Systemic complications: myelodepression, dyspeptic syndrome (nausea, vomiting, diarrhea), alopecia (baldness), aminorrhea.

1.3. System specific complications: neuritis, polyneuritis, encephalopathy, psychosis, toxic hepatitis, liver cirrhosis, pancreatitis, myocardial dystrophy, cystitis, glomerulonephritis, etc.

II. Complications associated with immune imbalance.

2.1. Immunosuppression: various types of intercurrent infection, exacerbation of chronic infection, development of secondary tumors.

2.2. Allergic reactions: dermatitis, eczema, anaphylaxis.

III. Complications associated with cytostatic intolerance: fever, swelling of the face, larynx, shortness of breath, severe myelodepression, independent of the dose, tachycardia, syncope.

IV. Complications due to the interaction of cytostatic with other used medicinal substances- increased toxicity of cytostatics or other drugs, the emergence of new side effects.

HORMONOTHERAPY

Some malignant neoplasms are able to change their growth and development under the influence of certain hormones. These tumors are united in the "hormone-dependent" group.

Of greatest practical importance are preparations of male (androgens) and female (estrogens, progestins) sex hormones. The exception is glucocorticoids, which have a positive effect in acute and chronic lymphocytic leukemia, lymphogranulomatosis, and especially in malignant lymphomas.

Hormone therapy includes not only hormones, but also non-hormonal substances that block the action of certain hormones.

Despite the undoubted success of hormone therapy in a number of malignant neoplasms, this method (monotherapy) is still regarded as a palliative treatment for primary and disseminated forms of tumors, as well as for relapses and metastases. However, it is widely used as a component of complex therapy.

The principle of prescribing hormones is to determine the individual sensitivity of the tumor to the corresponding hormone. At the same time, hormone-dependent tumors in men (prostate cancer, breast cancer), as a rule, are sensitive to extragens; hormone-dependent tumors in women (breast cancer, cancer of the body of the uterus) - to androgens. In order to enhance the effect of hormone therapy at the beginning of treatment, indirect-acting surgical interventions- castration.

ADDITIONAL THERAPY

Under the adjuvant therapy of malignant tumors, various effects are understood that do not independently affect the course of the disease, but they can enhance the effect of radiation, chemohormonal therapy or increase the body's resistance.

Auxiliary methods include: stimulation of the natural and immunological resistance of the body, correction of metabolism, hyperthermia, hyperglycemia, stabilization of lipid peroxidation reactions, etc.

COMBINATION THERAPY

Combination therapy is understood as a combination of actions within one of the treatment methods. So, the combined effect is widely used in chemotherapy, when two or three drugs are prescribed simultaneously or sequentially. Similar treatment is used for hormone and radiation therapy.

COMBINED TREATMENT

Under combined treatment understand any combination of the two fundamentally different methods treatment (chemo-radiation, chemo-hormonal, operative radiation, etc.), which are applied simultaneously or sequentially.

COMPLEX TREATMENT

Under complex treatment understand the combination of three or more fundamentally different treatments, including various methods adjuvant therapy. This method is most often used in the treatment of malignant tumors.

PREVENTION OF TUMORS

Prevention of malignant neoplasms is based on epidemiological data. So, for most European countries, the most common factors in the development of cancer are:

1. Nutrition 35%

2. Smoking 30%

3. Violation of the function of the genital organs 10%

4. Solar radiation, ultraviolet 5%

5. Environmental pollution 4%

6. Occupational hazards 4%

7. Ionizing radiation 3.5%

8. Alcohol 2.5%

9. Hereditary factors 2.3%

10. Reasons not established 3.7%

In the conditions of the Republic of Belarus, environmental pollution, occupational hazards, as well as ionizing radiation and alcohol are undoubtedly of greater importance.

With all these factors in the development of cancer, the psycho-emotional state is of great importance, as the background against which carcinogens are realized. Of particular importance is chronic emotional stress, since negative emotions reduce the natural resistance of the body, and on the other hand, steroid hormones, the level of which rises sharply during stress, acting through receptors located in the cytoplasm, affect the degree of DNA methylation, so they can derepress silent" oncogenes.

Based on the foregoing, the real ways of cancer prevention can be represented as follows.

1. Correction of the psycho-emotional state.

2. Rational nutrition.

3. Limitation (elimination) of the action of carcinogenic factors.

4. Mode of work and rest.

5. Correction of the mechanisms of reactivity and resistance of the body.

6. Treatment of precancerous diseases.

1. Psycho-emotional factors in the pathogenesis of cancer.

According to psychologists, psychoneurologists, psychotherapists, for normal functioning central nervous system (CNS), including its regulatory mechanisms, a balanced supply of various stimuli is necessary. Determined that the best option that ensures the stable functioning of adaptive reactions, including the immune system, is the following ratio of stimuli: emotionally neutral should enter the central nervous system about 60%; emotionally positive - 35% and only 5% emotionally negative.

Stress adversely affects all organs when it is very intense or long enough.

Consequently, both acute and chronic stress can cause disorganization of the regulatory function of the CNS. However, chronic stress, despite its small amount of force, always has a more severe effect, up to and including exhaustion.

2. Nutrition plays an important role in the development of malignant neoplasms and not only in the gastrointestinal tract. At the same time, nutritional factors can have both negative and positive effects. Nutritional factors are not so much the initiators of carcinogenesis as they form a functional pre-cancer-cancrophilia in the body - the sum of metabolic disorders that increase the likelihood of malignant transformation of the cell.

Specific nutritional factors in the pathogenesis of neoplasms.

2.1. The ecological purity of consumer products is beyond doubt, since the content of PAHs, aflatoxins and other chemicals in food will undoubtedly affect the frequency of carcinogenesis.

2.2. An important role in the formation of cancrophilia is played by the regularity of nutrition, as this affects the function of the glands of the digestive tract, the features of the excretory and endocrine functions of a number of sections of the gastrointestinal tract. Of particular danger is the reception of very hot food and hasty food.

2.3. The way food is prepared has a very significant effect on the function of the gastrointestinal tract, as well as on the formation of modifying conditions for carcinogenesis. Fried food contains a number of very strong extractives, and re-fried food may contain carcinogens such as PAHs. Smoked meats always contain more or less chemical carcinogens.

2.4. Essential in carcinogenesis is the diet, which includes the following components.

2.4.1. The balance of food consumed, since it is known that an excess in the diet of any of the main ingredients of food (proteins, fats, carbohydrates) inevitably leads to cancrophilia.

2.4.2. Reasonable calorie restriction in accordance with the needs, including age. Being overweight increases the risk of developing cancer of the colon, liver, gallbladder, breast and prostate glands.

2.4.3. Fats, especially of animal origin, inhibit the detoxification function of a number of enzymes. An increase in the concentration of free fatty acids, low and very low density lipoproteins, cortisol, insulin impairs the functioning of the DNA repair system, creates conditions conducive to the onset of cancer. Therefore, it is necessary to reduce the consumption of fats, especially of animal origin, since epidemiological studies show that there is fairly strong evidence of a direct relationship between fat intake and the incidence of breast and colon cancer. A real preventive effect can be achieved by reducing dietary fat (in terms of calories) to 25-30%.

2.4.4. It is possible to change the diet more often, since a monotonous diet leads to a number of metabolic disorders.

2.4.5 Data from epidemiological and experimental studies show that there is an inverse relationship between the amount of plant foods consumed and the frequency of a number of cancers. So, cabbage and other vegetables contain indoles, which are inhibitors of carcinogens that can cause breast cancer; fruits, berries contain natural coumarins - inhibitors of various carcinogens; fruits, especially citrus fruits, vegetables rich in beta-carotene (a natural precursor of vitamin A, found in large quantities in carrots), as well as all foods containing vitamins C, E, B, reduce the likelihood of developing cancer of the esophagus, larynx, stomach, lungs, urinary bubble. Vitamins C and E seem to be able to inhibit the synthesis of endogenous nitro compounds.

3. The role of carcinogens in the development of the tumor process is known, therefore, the natural task of the entire state, the sanitary and hygienic service, environmentalists, and all medical personnel is to protect members of society from the action of carcinogens or reduce their pathogenic effect. There are no universal methods for eliminating or limiting the negative effects of carcinogens.

Thus, the mechanical factors of carcinogenesis are of particular importance for women and, in particular, traumatic injuries mammary gland. In this regard, it is necessary to categorically oppose such types of women's sports when it is created real danger repeated breast injuries: boxing, kickboxing, sambo, etc.

Of the physical carcinogens, ultraviolet radiation is of particular importance, since it is universal and radioactive radiation, since it is the most dangerous. With the exception of catastrophes associated with nuclear fission, the effect of these factors is quite manageable.

UVA poses a danger during the summer months when people tend to tan, are long time with an open body in direct sunlight.

Radioactive and x-ray radiation dangerous as occupational hazards, therefore, the development and implementation of technologies that reduce radiation exposure is the main direction in reducing pathogenic influence this carcinogen.

carcinogens of the environment and the microclimate of the premises occurs during smoking, engine operation internal combustion, adverse household factors and environmentally dirty industries. According to WHO, tobacco smoke is a powerful carcinogenic factor and poses a huge danger to human health. A causal relationship has been established between smoking and lung cancer. Moreover, smoking increases the risk of developing cancer of the lips, larynx, esophagus, gallbladder, and pancreas.

The smoke generated in the kitchen due to burning food, burning stoves, pans, etc., has a carcinogenic effect. With insufficient ventilation of the room, conditions are created for the accumulation of various toxic substances in the air.

Therefore, the fight against smoking, the elimination of adverse factors in everyday life are real ways to prevent cancer.

A very dangerous situation arises when the environment is polluted exhaust gases internal combustion engines, especially when running out of adjustment or worn motors. Control over this type of pollution lies with the sanitary service and the traffic police.

Environmentally polluted industries significantly increase the content of carcinogens in the environment, so it is the duty of the sanitary service, technologists, environmentalists to monitor the design of industries, their location, and also control their work.

4. Mode of work and rest in the pathogenesis of neoplasms.

Factors that increase the likelihood of developing a tumor:

Overload: physical, mental;

Night shifts;

Passive rest;

Excess solar radiation.

Factors that reduce the likelihood of developing a tumor:

Labor is joy;

Alternation of mental and physical labor;

Leisure;

Having a hobby.

5. Resistance of the organism in the pathogenesis of neoplasms.

Factors that increase the likelihood of developing neoplasms:

Congenital or acquired immunological deficiency;

Decreased natural resistance due to hypovitaminosis, chronic intoxication, exhaustion.

Therefore, in violation of the body's resistance, stimulation of nonspecific defense mechanisms (anabolites, vitamins, biostimulants) and the immunocompetent system (interferon, interleukin-2, thymalin, levomisole, etc.) will undoubtedly reduce the risk of developing malignant neoplasms.

6. Cancer, as a rule, does not arise on unaltered soil, this is preceded by various pathological conditions accompanied by active cell proliferation (precancer). Based on this, a medical direction for the prevention of malignant neoplasms was formulated - the improvement of patients with precancerous diseases. This function is performed by doctors of all specialties by detecting precancerous diseases in a polyclinic, hospital, and prophylactic examinations. These patients are taken into account, their purposeful treatment is carried out.

The given system of prevention allows us to state that potential opportunities prevention of the development of tumors is quite significant, but its effectiveness depends on the social conditions and lifestyle of the person himself.