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ONCOLOGY
Oncology (from Greek oncos — tumour) is a science which research aetiology, pathogenesis, medical course, prognosis and remedy of tumours. Synonyms: blastoma, neoplasm.
Tumor is a pathological formation that spontaneously arises in several tissues and organs and is distinguished by polymorphism of construction, isolation, progressive limitless progress. Tumours are within the group of most widespread illnesses.
In response to the info of WHO greater than 5 million folks yearly die from malignant tumours, from them 1.4 million — in Europe in industrially superior nations. The morbidity with malignant tumours on this planet exceeds 6 million. At the moment malignant tumours occupy the second place for the dying fee after cardiovascular illnesses. Amongst all tumours most cancers makes up 65%. By frequency, amongst most cancers of various localization lung most cancers (42.6%), abdomen most cancers (29.9%) prevail for males. Among the many causes for dying from malignant tumours, breast most cancers and genital most cancers are the main for ladies. By information of WOHP in 2,000, greater than 10 mln of individuals wanted a particular remedy for malignant tumours yearly. It’s attainable to elucidate the morbidity progress as a result of the rise in life expectancy of individuals in economically superior nations, affect of cancerogenic substances within the surroundings, enhance in quantity of inhabitants and enchancment of prognosis.
Aetiology and pathogenesis. At the moment there is no such thing as a distinctive idea for the origin of tumours. Among the many present theories physicians draw their consideration to the next:
The speculation of irritation instructed by R. Virkhov. In accordance tothis idea the rationale for tumours is lengthy motion of irritating substances on tissue leading to reorganization of mobile buildings, mobile polymorphism and their progressing and limitless progress.
The speculation of embryonic origin, supplied by Kongheim. In response to this idea, a tumour arises from embryonic cells, which through the time of embryonic improvement didn’t participate within the development of an organ, weren’t topic to differentiation, i.e. remained in germinal situation. Then because of the motion of any chemical or mechanical stimuli they begin to divide impetuously, forming a tumour.
Virus-immune-genetic idea instructed by L. A. Zilber. In response to this idea, the expansion of a tumour is brought on by particular viruses. It’s identified about their existence. Experimental fashions of oncological illnesses are created in animals. When these viruses get in cells, oncogenes are shaped that break the traditional regulation of mobile division. Cancerogenic components which function on the cell in a chemical or bodily approach strengthen the exercise of viruses.
Not too long ago the polyaetiologic idea of malignant tumours, whichrecognizes a number of causes for the incidence and improvement of neoplasm, acquired the best recognition: motion of cancerogenic substances, lengthy motion of bodily and chemical stimuli, genetic components, affect of tumoural viruses.
Relying upon the tissue the place the tumour develops epithelial, connective, muscular, vascular, nervous, bone, cartilaginous and combined tumours are distinguished. In response to the morphological options and tumoural progress in an organism the tumours are divided into benign and malignant.
Benign tumours are characterised by the presence of a capsule separating them from the encircling tissue; they often don’t trigger complaints, develop slowly, don’t sprout into surrounding tissue. With localization of benign tumours in inner organs, the clinic of mechanical compression of those organs is noticed. Superficially situated benign tumours throughout palpation are cell, not linked with surrounding tissue, painless, often elastic consistency. The contours of tumours are simply decided, regional lymph nodes are usually not elevated. These tumours don’t recur after radical removing; additionally they don’t give metastasises. By the histologic construction they differ little from the tissue from which they occurred. The next tumours belong to benign: epithelial — adenoma, from muscular tissue — myoma, from connective tissue — fibroma, from nerve tissue — neurinoma, from fatty tissue — lipoma, from vascular tissue — angioma, from cartilage — chondroma, from bone tissue — osteoma.
Tissue and mobile atypism is typical for malignant tumours. They utterly differ from the preliminary tissue by construction and performance. Their cells are immature with many mitosis, roughly divide. The vital function is biochemical atypism. If in wholesome tissue metabolism happens by the kind of tissue respiration with end-products of CO2 and water, in malignant tumours — by the kind of anaerobic or cardio glycolysis with the buildup of acids from the Crebs cycle in an organism. It’s an uneconomical approach of metabolism, which ends up in weight reduction, intoxication and cachexia.
Within the early phases of the illness sufferers nearly by no means complain of ache, however there generally is a feeling of heaviness, presence of a international object. Attribute for the oncological anamnesis is steady escalating of signs. The anamnesis of the illness with malignant tumours, as a rule, occurs brief, however it’s essential to do not forget that if the tumour arises towards a background of persistent inflammatory course of the anamnesis will be long-term.
Goal inspection of sufferers with tumours relies upon normal strategies of medical research, i.e. examination, palpation, percussion and auscultation. Nice worth is the revealing of sure signs attribute for tumoural progress through the affected person’s examination. The “plus tissue” symptom is typical for proliferative via the lymphatic and blood vessels in several organs of the physique. After eradicating malignant tumours they will recur.
Options of malignant tumours in distinction to benign ones is their property to affect the overall situation of an organism, to trigger most cancers intoxication, showing as anemia, weight reduction, exhaustion. Malignant tumours from epithelial tissue are known as most cancers, from connective tissue — sarcoma. Sufferers with most cancers make up 95% of sufferers with malignant tumours and 5% — sufferers with sarcoma.
Sarcomas are extra malignant than most cancers, as a result of their metastasis is hematogenous. Thus, distant metastasises seem early, ensuing within the dying of the affected person.
Particular consideration must be paid to so-called pre-cancerous illnesses. Usually it’s identified that the event of malignant tumours will be preceded by persistent illnesses, repeated traumas to tissue. Such illnesses are trophic ulcers and fistula which don’t heal for a very long time, persistent abdomen ulcer, anacid gastritis, polyps of the GIT, mastopathy, cervical erosion, papilloma, congenital pigmentary spots, and many others. The physician ought to have oncological vigilance regarding these sufferers. These sufferers must be below fixed supervision, frequently, a minimum of as soon as each six months be examined and surveyed by a physician.
Endoscopes, designed with the usage of glass-fiber optics, so-called fibroendoscopes (fibrotic bronchoscope, fibrogastroduodenoscope, thoracoscope, fibrocolonoscope, and many others.) acquired large utility throughout early prognosis of tumours of the hole organs or cavities of the physique. They permit not solely to seek out tumours but additionally take tissue samples for histologic examination.
With the revealing of atypical polymorphic cells, the malignant character of the tumour is specified, which significantly improves early prognosis and leads to early radical remedy. Endoscopes permit the taking of tissue smears and conducting their cytologic examination. The rinsing waters, exudate from the cavities, sputum, discharge from the vagina or breast, smears from ulcers, and many others.
Radiological examination, which permits to find out not solely the presence of a tumour but additionally its localization and prevalence, tumoural deformation of hole organs and modifications of their perform, occupies a number one place in prognosis. Moreover of normal radioscopy and radiography, now for prognosis of tumours tomography and kymography (an instrument for recording the circulate and ranging blood stress inside the blood vessels) of organs and tissue and likewise distinction analysis of vessels (cavo- and aortography, selective angiography) are utilized. For the prognosis of tumours of parenchymatous organs, endocrine glands and blood vessels radioisotope prognosis with the applying of isotopes for registration of radiation of radioactive isotopes entered into an organism and preparations made on their foundation, for instance, technetium, albumine, thallium have particular worth.
Not too long ago within the prognosis of tumours particular strategies of examination, for instance, pc tomography (CT), place emission tomography (PET), ultrasonic analysis, primarily based on the account of various protecting properties of tissue of various density are broadly utilized. These strategies are particularly worthwhile in revealing tumours in parenchymatous organs, mind and coronary heart. Now immunological strategies of prognosis of tumours have additionally been developed and improved. They’re directed on the definition of macromolecules of antigens linked to the tumour (alpha-fetoprotein, alpha-2.4-fetoprotein, canceroembryonic antigen), isoenzymes, ectopic hormones and monoclonal antibodies (M-protien) as endocellular, and on the floor of cells or in liquid environments of an organism.
Advanced examination of sufferers with the applying of particular strategies of analysis permits the discovering of tumours at an early stage of improvement and thus significantly improves the outcomes of remedy and prognosis with this pathology.
Classification of Malignant Tumours
With the revealing of oncological illnesses in sufferers, the physician ought to decide the prevalence of tumour, which predetermines the plan of remedy. With this objective N. N. Petrov instructed to differentiate 4 phases of progress of malignant tumours:
stage — tumour is localized, diameter as much as 2 cm, locates solely in that layer of the organ the place it occurred, doesn’t lengthen into the following layers of the organ. Lymph nodes are broken, metastasises are usually not current.
stage — tumour has a diameter from 2 as much as 5 cm, extends into the following layers of the organ, however doesn’t go away its borders, intently situated regional lymph nodes are broken, however metastasises in different organ techniques are usually not current.
stage — tumour has a diameter from 5 as much as 10 cm, extends in all layers of the organ, together with the serous membrane, disintegration of the tumour will be noticed, regional and distant lymph nodes are broken, there are some metastasises in different organ techniques.
stage — tumour has vital sizes, extends within the neighboring organs, a number of metastasises in sure organs and lymph nodes.
This classification takes under consideration the diploma of tumoural spreading in accordance with three fundamental attributes: sizes of tumour (Ttumour), presence of affected lymph nodes (N-modules, lymph nodes) and presence of metastasises (M-metastasises). In reference to this, it’s referred to as the classification in accordance with the TNM system.
The image T characterizes the presence and sizes of a tumour and has the next phases: Т0 — the first tumour shouldn’t be decided; T1 and T2 — a tumour of small sizes, diameter as much as 5 cm, attainable radical operation; T3 — tumour with a diameter from 5 as much as 10 cm, seldom an prolonged operation is feasible; T4 — the tumour envades the neighboring organs and damages their perform, symptomatic remedy, if essential — palliative operation is barely attainable.
The image N characterizes harm to regional lymph nodes:
N0 — lymph nodes are usually not palpated; NX — there aren’t any genuine information on lymph nodes; N1 — there are metastasises in regional lymph nodes; N2 — metastasises in lymph nodes of the second technology; N3 — harm to distant lymph nodes.
The image M means the presence of distant metastasises in different organ techniques: M0 — absence of attributes of distant metastasises; MX — there aren’t any information on the presence of distant metastasises; M1 — there are distant metastasises.
Criterion T for a tumour has its options. For instance, for intestinal most cancers T1 implies that the tumour occupies solely part of the intestinal wall; T2 — the tumour occupies half of the intestinal loop; T3 — the tumour damages all of the gut, narrows its opening and causes the phenomena of intestinal impassability; T4 — the tumour round narrows or obstructs the intestinal opening, inflicting whole intestinal impassability.
For breast tumour: T1 — tumour with a diameter as much as 2 cm, not linked with surrounding tissue; T2 — tumour with a diameter from 2 as much as 5 cm, linked with the pores and skin, provides a “lemon peal” symptom, predetermines retraction of the nipple; T3 — tumour with the scale from 5 as much as 10 cm, linked with the pores and skin and glued to the chest wall; T4 — tumour with a dimension of 10 cm, with harm to tissue of the chest wall or its disintegration.
The identical is typical for harm to regional lymph nodes: for breast most cancers the axillary and subclavical lymph nodes, for tongue most cancers — submaxillary, for abdomen most cancers — lymph nodes of the small and huge omentum, for uterine most cancers — the lymph nodes of the parametrium and pelvic tissue.
Histologic classification which characterizes the diploma of the hole organ’s wall invasion is utilized for malignant tumours to the hole organs and marked by the criterion “P”.
P1 — most cancers infiltrates solely the mucous membrane; P2 — the most cancers damages each the mucous and submucous membrane; P3 —most cancers spreads to the subserous layer; P4 — the tumour infiltrates the serous layer and goes past the borders of the organ’s wall.
Individually the classification in accordance with the diploma of malignancy is marked by the criterion “D”: D0 — nonmalignant tumour; D1 — tumour is half-malignant or probably malignant (basalioma, adenomas of the bronchial tubes, cranyopharyngioma, chondroma, hemangiotelioma); D2 — carcinoma in situ, pre-invasive tumour going via the noninfiltrating phases of improvement; D3 — a malignant tumour characterised by penetrating invasion, infiltration with infringement to the adjoining tissue, dissemination of tumoural cells and metastasises.
The reliability of a sure prognosis of malignant tumour with the assistance of the utilized strategies is pronounced by criterion “C”. The next levels are distinguished: C1 — prognosis is set solely on the premise of medical strategies of analysis; C2 — particular strategies of prognosis had been utilized, for instance fibrogastroscopy; C3 — prognosis is set after diagnostic surgical intervention; C4 — after radical removing of a tumour with following histologic analysis; C5 — after pathoanatomical examination.
After establishing the prognosis and stage of malignant course of, the physician ought to decide the medical group the given affected person belongs to.
The next medical teams of oncological sufferers are distinguished:
Group 1a — suspicion of most cancers. Sufferers of this group must be hospitalized; they’re topic to cautious examination with the aim of excluding or confirming the given prognosis.
Group 1b — sufferers with pre-cancerous illnesses. Sufferers of the given group must be topic to energetic prophylactic medical examination. Systematic management with particular strategies of examination (radiological, endoscopic, cytologic, and many others.) is utilized.
Group 2 — sufferers who’re topic to particular strategies of remedy (surgical, radiation, chemotherapy).
Group 3 — virtually wholesome individuals who acquired a full course of radical remedy. They’re on dispensary watch, they’re given a course of preventive antirecurring remedy. Throughout the first 12 months management examination of such sufferers are carried out 4 occasions, for the second 12 months — twice, the following years — 1 time. If through the management examination there are relapses or metastasises of the tumour, the sufferers are transferred to the two group.
Group 4 — sufferers with widespread course of during which particular remedy is unattainable to conduct, they’re given symptomatic remedy.
Remedy for benign tumours is barely surgical. The tumour is eliminated surgically along with the capsule. It’s inadmissible to depart the capsule, as a result of it could possibly trigger a relapse of the tumour. Surgical remedy of benign tumours is a radical approach of remedy, doesn’t give relapses and offers full restoration for the sufferers. The removing of benign tumours is performed in circumstances if the tumour breaks the organ perform, causes beauty defects, is a pre-cancerous illness or suspicious of turning into a malignant tumour.
Sufferers with malignant tumours require pressing remedy. There are such strategies of remedy for malignant tumours as surgical, radiation, chemotherapy and hormonal-therapeutic.
The fundamental methodology of remedy of malignant tumours is surgical, mixed with radiation or chemotherapy. Such sorts of complicated remedy are referred to as mixed. The mixture of surgical remedy with radiation will be carried out as pre- or postoperative irradiation, for instance, with breast, cervical, ovarian most cancers. Mixture of irradiation with chemotherapy is feasible, for instance, for sufferers with myeloma and lymphogranulomatosis. Surgical remedy shouldn’t be performed solely in these circumstances if the illness will be reliably cured with radiation or medical strategies, for instance, lip most cancers. Contraindications for surgical remedy of a malignant tumour are its nonresectablity that’s the situation which excludes the chance of radical surgical intervention in reference to metastasises.
Operations that are utilized within the remedy of malignant tumours are divided into radical and palliative.
When performing a radical operation the surgeon ought to adhere to such necessities:
Ablastic operations — a malignant tumour must be eliminated inside the limits of wholesome tissue, as a lot as attainable receding from seen borders of the tumour, in uniform block with regional lymph nodes. It’s inadmissible to injure a tumour to stop attainable implantation of tumoural cells in wholesome tissue. With this objective throughout an operation it’s essential to vary gloves and surgical toolkit. The ablastic operation must be carried out within the sure sequence. The operation is began at far from the tumour and without delay blood and lymph vessels are ligated so as to interrupt methods by which tumoural cells can unfold to different tissues and organs.
Antiblastic actions:
bodily antiblastics — through the operation they use an electroknife, apply diathermy, cryogenic remedy, laser, ultrasound;
actinic antiblastics — irradiation with X-rays of the tumour website earlier than an operation and through the postoperative interval;
chemical antiblastics is disorganization and destruction of tumoural cells throughout an operation with 96% ethyl spirit, an answer of formaldehyde, regional perfusion and intra-arterial introduction of antiblastic preparations.
With uncared for tumours of the III and IV phases with distant metastasises and pronounced intoxication radical operations are unattainable. In these circumstances palliative operations will be executed, that are directed on the elimination of issues brought on by tumours, with out motion on the tumour.
Radiation remedy within the remedy of malignant tumours is utilized isolatedly or together with surgical, chemo-therapeutic and hormone remedy. Radiation remedy relies on selectively excessive sensitivity to radiation of little differentiated tumoural cells, which intensively divide. Ionizing radiation causes radiolysis of water leading to metabolism infringement in tumoural cells. Because of radiation remedy HO–, H+, H2O2 ions which destroy chromosomes of tumoural cells, their mobile membranes and energy techniques are shaped. Malignant lymphomas (lymphosarcomas), tumours or the haemopoietic techniques (myelomas), in addition to sure types of epithelial tumours are particularly delicate to radiation remedy. Nonetheless, the pronounced formation of metastasises and relapses of tumours cut back the impact of radiation remedy within the talked about malignant tumours. Radiation remedy is ceaselessly mixed with surgical remedy; it’s utilized for breast most cancers, most cancers of the uterus, lung, and intestinal most cancers. Radiation remedy is performed with Xray irradiation, gamma irradiation with isotopes of cobalt, caesium, iridium, beta-irradiation with radioactive gold, phosphorus, directed streams of elementary particles (electrons, protons). The effectivity of radiation remedy shouldn’t be an identical for various tumours, and the course of irradiation ceaselessly must be repeated a number of occasions. The dose of irradiation is set by the oncologist along with radiologist. Radiation remedy may cause unintended effects and issues. They’re linked to a lower within the affected person’s organism reactivity and his immunity, with suppression of haemopoietic organ perform, nausea, unhealthy urge for food, sleep issues, palpitation and leukopenia. On the later interval modifications of the pores and skin (irritation and erythema) with the formation of trophic ulcers and necrosis will be noticed. Within the focus of irradiation cautious care of the pores and skin, utility of dermaprotectors (pores and skin defending means) are essential. Throughout the course of irradiation it’s essential to continuously supervise the blood image for revealing and correction of anemia and leukopenia.
Chemotherapy of malignant tumours is ceaselessly mixed with radiation remedy, particularly in circumstances of recurring tumours, in addition to on the late medical phases. The medical remedy, utilized with the aim of making antineoplastic impact is split into chemo- and hormone remedy in accordance with the kind of motion. Chemotherapy offers primarily direct cytotoxic affect on tumoural cells. Hormonal remedy is directed, primarily, for the regression of a tumour that has reached via synthetic inductive shift within the organism’s hormonal stability.
Antineoplastic preparations used now are categorised as follows:
1. Alkaloid compounds
iprite-like substances (ethylamine chloride). Embihin, novembihin, dopan belong to them. These preparations are utilized for lymphogranulomatosis, lymphoid leukosis, lymphosarcoma and reticulosarcoma. Sarcolysine is utilized for seminoma, particularly for the presence of metastasises, reticulosarcoma, Ewing’s sarcoma, myeloma, malignant angioendotelioma.
Cyclophosphanum is utilized for breast, ovarian and lung most cancers, lymphogranulomatosis and lymphosarcoma. Cyclophosphanum has a large antineoplastic impact, has softer motion on thrombocytopoiesis as in contrast with different analogues;
ethylene imine: thiophosphamidum, thioTEF, benzoTEF are used for breast, ovarian and lung most cancers.
Dipinum, thiodipinum are used for leukosis, lymphogranulomatosis and hypernephroma.
Ethers of disulphonate acids
Myelosan has a pronounced motion for leukemic types of persistent myeloleukemia, however rapidly turns into unable to perform.
Myelobromol is much like myelosan, however in reference to totally different motion mechanism it’s extra successfully and succesful than myelosan.
Antimetabolites
Mercaptopurin is used for acute and subacute leukosis, energetic persistent myeloleukemia, reticulosis, chorionepythelioma of the uterus.
Methotrexate is utilized for lymphogranulomatosis, lung, breast most cancers.
Flurourasil, phthorafur are utilized within the remedy of sufferers with most cancers of the rectum, sigmoid and huge intestines, for abdomen most cancers, together with inoperable and recurrent breast most cancers, most cancers of the pancreas and ovaries.
Antineoplastic antibiotics
Dactinomycin is utilized for acute and subacute leukosis, energetic persistent myeloleukemia, reticulosis, chorionepythelioma of the uterus, retinoblastoma, rhabdomyosarcoma.
Mytomycin is utilized for breast, abdomen most cancers and most cancers of the massive intestines.
Olivomycin is utilized for testicle tumours (seminoma, teratoblastoma, embryonic most cancers), reticulosarcoma, tonsillar and different tumours.
Rubomycin hydrochloride is utilized for chorionepythelioma, lymphogranulomatosis, acute leukosis, reticulosarcoma and neuroblastoma.
Bruneomycin is utilized for lymphogranulomatosis, persistent lymphoid leukosis, Wilms tumour, neuroblastoma, reticulosarcoma, lymphosarcoma.
Adriamycin is utilized for squamous most cancers of the mucous membrane of the oral cavity, nasopharynx, throat and esophagus, most cancers of the penis, ovarian and testicle teratoblastoma, lympho- and reticulosarcoma, lymphogranulomatosis, acute leukosis, breast, lung most cancers, neuroblastoma, Wilms tumour, most cancers of the thyroid gland and bladder.
5. Alkaloids
Vinblastin is utilized for lymphogranulomatosis, lymphosarcoma, reticulosarcoma, myeloma.
Vincristin is utilized for acute leukosis, reticulosarcoma, neuroblastoma, Wilms tumour, and likewise in complicated remedy of lymphogranulomatosis, myeloma, breast most cancers.
Colchamin is utilized for pores and skin most cancers (together with as 0.5% ointments) and in mixed remedy of esophagus most cancers.
The above-stated chemotherapeutic means are utilized internally and externally, however ceaselessly as injections — intramuscular, intravenous and intra-arterial. They’re additionally entered in cavities, in tumoural tissue: on the extremities — by regional perfusion, and for tumours of inner organs — by long-term intravenous perfusion.
Chemotherapy of malignant tumours is split into systematic and regional. Systematic chemotherapy permits the introduction of antineoplastic preparations by any of the talked about methods, contemplating their common motion on the tumour, its metabolism, thus taking into consideration options of pharmacokinetics.
Regional chemotherapy relies upon the introduction of preparation options with excessive focus straight within the tumoural tissue by perfusion or partially (intra-arterial or endolymphatic infusion).
Chemotherapy is often utilized as a way of remedy of primarily widespread kinds, relapses and metastasises of malignant tumours. It may be used additionally for preventive measures of progressive latent subclinical tumoural cells, which stay after radical surgical remedy. Such chemotherapy, a part of complicated mixed remedy, is known as extra, or adjuvant.
Within the medical observe remedy will be carried out by one preparation — monochemotherapy or a mix of a number of preparations — polychemotherapy.
Hormonal remedy is utilized for tumours of the hormone-dependant organs, for instance, breast or prostate most cancers extra typically. The sexual hormones decelerate the expansion of a malignant tumour.
Immunotherapy is utilized to activate immune mechanisms of an organism through the postoperative interval, in addition to after radiation and chemotherapy. As a way to enhance the particular immunity they apply levamisol, zymosan, prodigiosan, interferon. Passive immunization is carried out with antilymphocytic serum, immunoglobulin, remoted antibodies, complement.
Tumours of the Connective Tissue
Fibroma is a mature tumour of the connective tissue, consists of separate bunches of fibers, between which connective-tissue cells are positioned. The extra connective cells, the softer the consistence of the fibroma. Combined kinds are ceaselessly noticed, which type with the participation of different tissues, for instance, neurofibroma, fibromyoma, fibrolipoma. Fibromas will be remoted or a number of (fibromatosis). Remedy is barely surgical.
Lipoma consists of fatty tissue, bunches of connective tissue are positioned right here and there. Lipomas have a pronounced connective-tissue capsule. If they’re a number of, this phenomenon is known as lipomatosis. Remedy is sirgical — the lipoma is eliminated along with the connective-tissue capsule.
Chondroma consists of mature cartilage cells, often linked with the bone, shaped in cartilaginous elements of fingers and toes extra typically. Remedy consists in radical removing of the tumour.
Osteoma encompass cells of mature bone tissue, develops in metaphyseal a part of lengthy tubular bones and within the ribs. Massive osteomas can entail useful infringements and ache syndromes. Remedy is surgical.
Sarcoma (from Latin sarcos — meat) is a malignant tumour consisting of immature connective tissue cells. The part is pale and appears like fish tissue, grows rapidly, infiltrates and damages surrounding tissue. It metastize early, and relapses after operative removing. Metastasises are unfold within the hematogenous approach due to this fact they seem in several tissues and organs. Histologic examination reveals totally different sorts of sarcoma: spherical cell, spindle cell, malignant big cell tumour, and many others. Sarcomas are principally noticed on the younger age; the youthful affected person, the more severe the prognosis. Osteosarcomas develop in lengthy tubular bones, in pelvic bones and cranium. They will develop within the bone marrow (central or myelogenetic) or in periostis (peripheral or periosteal). Osteosarcoma progresses in a short time and in brief time provides quite a few metastasises.
Muscular, Blood Vessel, and Nerve Tumours
Myoma is a benign tumour which consists of muscular cells. tumours which encompass clean muscle tissues are referred to as leiomyomas, and from transverse-striped muscle tissues — rhabdomyomas. Often myomas are restricted from surrounding tissue by a properly superior capsule. A number of myomas are very often noticed. Remedy is surgical.
Angioma is ceaselessly noticed and rapidly grows at youngsters’s age. Hemangioma is a benign tumour of blood vessels; lymphangioma is a tumour of lymphatic vessels. After the construction hemangioma is split into capillary, cavernous (with the cavity) and cirsoid. Remedy is surgical, for giant hemangiomas: stage-by-stage. Irradiation, cryotherapy, suturing or insertion of the main vessels are utilized for remedy. These tumours ceaselessly recur. Lymphangiomas are noticed much less typically, situated on the lips, cheeks, neck, joints of the fingers. After the construction: cystic and cavernous. Remedy is surgical, radiation remedy and electrocoagulation are additionally used.
Glioma is a tumour of the mind or spinal twine which develops from neuroglia cells. Relying upon the mobile parts and extent of their maturity, totally different sorts of glioma are distinguished: medula-, ganglio-, spongio-, astro-, oligodendroglioma. Even when the tumour is benign by construction, its localization may cause very critical and life-threatening infringements, irritation and compression of the mind or spinal twine. It may end up in the affected person’s dying.
Remedy: solely operative and must be supplied as quickly as attainable.
Neurinoma (synonyms: lemoma, lemoblastoma, neurilemoma) is a tumour of the peripheral nerves. It may be shaped within the radix of the spinal twine, develops from Schvann membrane. In contrast to to different benign tumours it’s clinically accompanied by sharp ache. Remedy is surgical.
Ganglioneuroma (synonyms: ganglioma, cympaticocytoma) is a benign tumour which develops from parts of the sympathetic nervous ganglia, extra typically the belly and chest elements. Remedy is surgical.
Benign Epithelial Tumours
Papilloma (synonym: papillar tumour) origins out of pavement and transitional epithelium and acts above its floor as a papilla. It locates on the pinnacle, again, axillary space, close to the anus, however it may be shaped additionally within the bladder and intestines. Remedy is surgical — eradicating the tumours inside the limits of wholesome tissue with compulsory histologic examination, as a result of malignancy is feasible. Papilloma of the mucous membrane is cauterized by electrocoagulation.
Adenoma is a tumour which consists of fibroepithelial tissue and has a glandular construction. Relying upon the type of gland papillary, cystic, tubular and alveolar adenomas are distinguished. Extra typically these tumours are shaped within the breast, testicles, kidneys, much less typically on the pores and skin or mucous membrane. Remedy is surgical. It might probably develop into malignant.
Dermoid (synonyms: dermoid cyst, cystic teratoma) is a tumour which consists of the rest of the embryon ectoderm. Often it kinds a cavity crammed with fatty plenty and different epidermal formations. Extra typically dermoids settle within the coccyx, however it could possibly find above eyebrows, close to the nostril, on the neck and within the anterior mediastinum. Dermoid cysts ceaselessly suppurate, forming abscesses and fistula, which don’t heal. Remedy is surgical — eradicating inside the limits of wholesome tissue.
Malignant Epithelial Tumours
Most cancers (synonym: malignant epithelioma) — develops from germinal or glandular epithelium, consists of connective-tissue stroma during which blood and lymphatic vessels find, and parenchyma, shaped from epithelial cells. If the tumour consists of huge epithelial cells, it’s referred to as medullary most cancers. If the connective-tissue stroma prevails, the tumour is known as scirrhous carcinoma, and if glandular cells prevail — adenocarcinoma. Most cancers can develop in all tissues and organs the place there are epithelial formations, however extra typically it’s noticed within the abdomen, uterus, breast, on the pores and skin and within the lungs.
The formation of most cancers begins with the incidence of atypical epithelial cells, after that the connective-tissue parts of the stroma multiply. Most cancers rapidly invades the encircling tissue and metastazes in to the lymph nodes. Metastasises are often unfold lymphogenously. The medical image of most cancers relies upon upon the localization and stage of the method. Remedy of most cancers is principally operative, however on the similar time very often different strategies of remedy are additionally utilized, for instance: radiation remedy, chemotherapy and hormonal remedy.
Radical operation with retaining to ablastics and antiblastics is carried out solely within the I and II medical phases of most cancers, within the III medical stage it’s hardly performed, and within the IV medical stage — usually unattainable. In these circumstances they perform symptomatic remedy, which is supplemented with radiation and chemotherapy and likewise palliative operations.
For rendering oncological assist to the inhabitants particular oncological companies, construction which incorporates scientific analysis institutes, republican, regional and metropolis oncological clinics, in addition to oncological cupboards in every district clinic are organized. The duty of oncological clinics is certified remedy of sufferers with tumours and pre-cancerous illnesses, preventive medical examination of the inhabitants, work with the statistical information and organizational-methodical administration of oncological companies, in addition to bettering the skilled talent of the medical personnel and anticarcinogenic propagation among the many inhabitants. A rise within the oncological vigilance of common practitioners, which first meet this pathology, must be given particular consideration.