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ONCOLOGY
Oncology (from Greek oncos — tumour) is a science which studies aetiology, pathogenesis, clinical course, diagnosis and treatment of tumours. Synonyms: blastoma, neoplasm.
Tumor is a pathological formation that spontaneously arises in different tissues and organs and is distinguished by polymorphism of structure, isolation, progressive unlimited growth. Tumours are in the group of most widespread diseases.
According to the data of WHO more than 5 million people annually die from malignant tumours, from them 1.4 million — in Europe in industrially advanced countries. The morbidity with malignant tumours in the world exceeds 6 million. Today malignant tumours occupy the second place for the death rate after cardiovascular diseases. Among all tumours cancer makes up 65%. By frequency, among cancer of different localization lung cancer (42.6%), stomach cancer (29.9%) prevail for men. Among the reasons for death from malignant tumours, breast cancer and genital cancer are the leading for women. By data of WOHP in 2,000, more than 10 mln of people needed a special treatment for malignant tumours annually. It is possible to explain the morbidity growth because the increase in life expectancy of people in economically advanced countries, influence of cancerogenic substances in the environment, increase in amount of population and improvement of diagnosis.
Aetiology and pathogenesis. Today there is no unique theory for the origin of tumours. Among the existing theories physicians draw their attention to the following:
The theory of irritation suggested by R. Virkhov. According tothis theory the reason for tumours is long action of irritating substances on tissue resulting in reorganization of cellular structures, cellular polymorphism and their progressing and unlimited growth.
The theory of embryonic origin, offered by Kongheim. According to this theory, a tumour arises from embryonic cells, which during the time of embryonic development did not take part in the construction of an organ, were not subject to differentiation, i.e. remained in germinal condition. Then as a result of the action of any chemical or mechanical stimuli they start to divide impetuously, forming a tumour.
Virus-immune-genetic theory suggested by L. A. Zilber. According to this theory, the growth of a tumour is caused by specific viruses. It is known about their existence. Experimental models of oncological diseases are created in animals. When these viruses get in cells, oncogenes are formed that break the normal regulation of cellular division. Cancerogenic factors which operate on the cell in a chemical or physical way strengthen the activity of viruses.
Recently the polyaetiologic theory of malignant tumours, whichrecognizes multiple reasons for the occurrence and development of neoplasm, received the greatest recognition: action of cancerogenic substances, long action of physical and chemical stimuli, genetic factors, influence of tumoural viruses.
Depending upon the tissue where the tumour develops epithelial, connective, muscular, vascular, nervous, bone, cartilaginous and mixed tumours are distinguished. According to the morphological features and tumoural growth in an organism the tumours are divided into benign and malignant.
Benign tumours are characterized by the presence of a capsule separating them from the surrounding tissue; they usually do not cause complaints, grow slowly, do not sprout into surrounding tissue. With localization of benign tumours in internal organs, the clinic of mechanical compression of these organs is observed. Superficially located benign tumours during palpation are mobile, not connected with surrounding tissue, painless, usually elastic consistency. The contours of tumours are easily determined, regional lymph nodes are not increased. These tumours do not recur after radical removal; they also do not give metastasises. By the histologic structure they differ little from the tissue from which they occurred. The following 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 cellular atypism is typical for malignant tumours. They completely differ from the initial tissue by structure and function. Their cells are immature with many mitosis, roughly divide. The important feature is biochemical atypism. If in healthy tissue metabolism occurs by the type of tissue respiration with end-products of CO2 and water, in malignant tumours — by the type of anaerobic or aerobic glycolysis with the accumulation of acids from the Crebs cycle in an organism. It is an uneconomical way of metabolism, which results in weight loss, intoxication and cachexia.
In the early stages of the disease patients almost never complain of pain, but there can be a feeling of heaviness, presence of a foreign object. Characteristic for the oncological anamnesis is continuous escalating of symptoms. The anamnesis of the disease with malignant tumours, as a rule, happens short, but it is necessary to remember that if the tumour arises against a background of chronic inflammatory process the anamnesis can be long-term.
Objective inspection of patients with tumours is based upon usual methods of clinical study, i.e. exam, palpation, percussion and auscultation. Great value is the revealing of certain symptoms characteristic for tumoural growth during the patient’s examination. The “plus tissue” symptom is typical for proliferative through the lymphatic and blood vessels in different organs of the body. After removing malignant tumours they can recur.
Features of malignant tumours in contrast to benign ones is their property to influence the general condition of an organism, to cause cancer intoxication, appearing as anemia, weight loss, exhaustion. Malignant tumours from epithelial tissue are referred to as cancer, from connective tissue — sarcoma. Patients with cancer make up 95% of patients with malignant tumours and 5% — patients with sarcoma.
Sarcomas are more malignant than cancer, because their metastasis is hematogenous. Thus, remote metastasises appear early, resulting in the death of the patient.
Special attention should be paid to so-called pre-cancerous diseases. In general it is known that the development of malignant tumours can be preceded by chronic diseases, repeated traumas to tissue. Such diseases are trophic ulcers and fistula which do not heal for a long time, chronic stomach ulcer, anacid gastritis, polyps of the GIT, mastopathy, cervical erosion, papilloma, congenital pigmentary spots, etc. The doctor should have oncological vigilance concerning these patients. These patients should be under constant supervision, regularly, no less than once every six months be examined and surveyed by a doctor.
Endoscopes, designed with the use of glass-fiber optics, so-called fibroendoscopes (fibrotic bronchoscope, fibrogastroduodenoscope, thoracoscope, fibrocolonoscope, etc.) received wide application during early diagnosis of tumours of the hollow organs or cavities of the body. They allow not only to find tumours but also take tissue samples for histologic exam.
With the revealing of atypical polymorphic cells, the malignant character of the tumour is specified, which considerably improves early diagnosis and results in early radical treatment. Endoscopes allow the taking of tissue smears and conducting their cytologic exam. The rinsing waters, exudate from the cavities, sputum, discharge from the vagina or breast, smears from ulcers, etc.
Radiological exam, which allows to determine not only the presence of a tumour but also its localization and prevalence, tumoural deformation of hollow organs and changes in their function, occupies a leading place in diagnosis. Besides of usual radioscopy and radiography, now for diagnosis of tumours tomography and kymography (an instrument for recording the flow and varying blood pressure within the blood vessels) of organs and tissue and also contrast research of vessels (cavo- and aortography, selective angiography) are applied. For the diagnosis of tumours of parenchymatous organs, endocrine glands and blood vessels radioisotope diagnosis with the application of isotopes for registration of radiation of radioactive isotopes entered into an organism and preparations made on their basis, for example, technetium, albumine, thallium have special value.
Recently in the diagnosis of tumours special methods of examination, for example, computer tomography (CT), position emission tomography (PET), ultrasonic research, based on the account of different protective properties of tissue of different density are widely applied. These methods are especially valuable in revealing tumours in parenchymatous organs, brain and heart. Now immunological methods of diagnosis of tumours have also been developed and improved. They are directed on the definition of macromolecules of antigens connected to the tumour (alpha-fetoprotein, alpha-2.4-fetoprotein, canceroembryonic antigen), isoenzymes, ectopic hormones and monoclonal antibodies (M-protien) as endocellular, and on the surface of cells or in liquid environments of an organism.
Complex examination of patients with the application of special methods of research allows the finding of tumours at an early stage of development and thus considerably improves the results of treatment and prognosis with this pathology.
Classification of Malignant Tumours
With the revealing of oncological diseases in patients, the doctor should determine the prevalence of tumour, which predetermines the plan of treatment. With this purpose N. N. Petrov suggested to distinguish 4 stages of growth of malignant tumours:
stage — tumour is localized, diameter up to 2 cm, locates only in that layer of the organ where it occurred, does not extend into the next layers of the organ. Lymph nodes are damaged, metastasises are not present.
stage — tumour has a diameter from 2 up to 5 cm, extends into the next layers of the organ, but does not leave its borders, closely located regional lymph nodes are damaged, but metastasises in other organ systems are not present.
stage — tumour has a diameter from 5 up to 10 cm, extends in all layers of the organ, including the serous membrane, disintegration of the tumour can be observed, regional and remote lymph nodes are damaged, there are some metastasises in other organ systems.
stage — tumour has significant sizes, extends in the neighboring organs, multiple metastasises in certain organs and lymph nodes.
This classification takes into account the degree of tumoural spreading according to three basic attributes: sizes of tumour (Ttumour), presence of affected lymph nodes (N-modules, lymph nodes) and presence of metastasises (M-metastasises). In connection with this, it is called the classification according to the TNM system.
The symbol T characterizes the presence and sizes of a tumour and has the following stages: Т0 — the primary tumour is not determined; T1 and T2 — a tumour of small sizes, diameter up to 5 cm, possible radical operation; T3 — tumour with a diameter from 5 up to 10 cm, seldom an extended operation is possible; T4 — the tumour envades the neighboring organs and damages their function, symptomatic treatment, if necessary — palliative operation is only possible.
The symbol N characterizes damage to regional lymph nodes:
N0 — lymph nodes are not palpated; NX — there are no authentic data on lymph nodes; N1 — there are metastasises in regional lymph nodes; N2 — metastasises in lymph nodes of the second generation; N3 — damage to remote lymph nodes.
The symbol M means the presence of remote metastasises in other organ systems: M0 — absence of attributes of remote metastasises; MX — there are no data on the presence of remote metastasises; M1 — there are remote metastasises.
Criterion T for a tumour has its features. For example, for intestinal cancer T1 means that the tumour occupies only a part of the intestinal wall; T2 — the tumour occupies half of the intestinal loop; T3 — the tumour damages all the intestine, narrows its opening and causes the phenomena of intestinal impassability; T4 — the tumour circular narrows or obstructs the intestinal opening, causing total intestinal impassability.
For breast tumour: T1 — tumour with a diameter up to 2 cm, not connected with surrounding tissue; T2 — tumour with a diameter from 2 up to 5 cm, connected with the skin, gives a “lemon peal” symptom, predetermines retraction of the nipple; T3 — tumour with the size from 5 up to 10 cm, connected with the skin and fixed to the chest wall; T4 — tumour with a size of 10 cm, with damage to tissue of the chest wall or its disintegration.
The same is typical for damage to regional lymph nodes: for breast cancer the axillary and subclavical lymph nodes, for tongue cancer — submaxillary, for stomach cancer — lymph nodes of the small and large omentum, for uterine cancer — the lymph nodes of the parametrium and pelvic tissue.
Histologic classification which characterizes the degree of the hollow organ’s wall invasion is applied for malignant tumours to the hollow organs and marked by the criterion “P”.
P1 — cancer infiltrates only the mucous membrane; P2 — the cancer damages both the mucous and submucous membrane; P3 —cancer spreads to the subserous layer; P4 — the tumour infiltrates the serous layer and goes beyond the borders of the organ’s wall.
Separately the classification according to the degree of malignancy is marked by the criterion “D”: D0 — nonmalignant tumour; D1 — tumour is half-malignant or potentially malignant (basalioma, adenomas of the bronchial tubes, cranyopharyngioma, chondroma, hemangiotelioma); D2 — carcinoma in situ, pre-invasive tumour going through the noninfiltrating phases of development; D3 — a malignant tumour characterized by penetrating invasion, infiltration with infringement to the adjacent tissue, dissemination of tumoural cells and metastasises.
The reliability of a certain diagnosis of malignant tumour with the help of the applied techniques is pronounced by criterion “C”. The following degrees are distinguished: C1 — diagnosis is determined exclusively on the basis of clinical methods of research; C2 — special methods of diagnosis were applied, for example fibrogastroscopy; C3 — diagnosis is determined after diagnostic surgical intervention; C4 — after radical removal of a tumour with following histologic research; C5 — after pathoanatomical examination.
After establishing the diagnosis and stage of malignant process, the doctor should determine the clinical group the given patient belongs to.
The following clinical groups of oncological patients are distinguished:
Group 1a — suspicion of cancer. Patients of this group should be hospitalized; they are subject to careful examination with the purpose of excluding or confirming the given diagnosis.
Group 1b — patients with pre-cancerous diseases. Patients of the given group should be subject to active prophylactic medical examination. Systematic control with special methods of examination (radiological, endoscopic, cytologic, etc.) is applied.
Group 2 — patients who are subject to special methods of treatment (surgical, radiation, chemotherapy).
Group 3 — practically healthy people who received a full course of radical treatment. They are on dispensary watch, they are given a course of preventive antirecurring treatment. During the first year control examination of such patients are carried out 4 times, for the second year — twice, the next years — 1 time. If during the control examination there are relapses or metastasises of the tumour, the patients are transferred to the 2 group.
Group 4 — patients with widespread process in which special treatment is impossible to conduct, they are given symptomatic treatment.
Treatment for benign tumours is only surgical. The tumour is removed surgically together with the capsule. It is inadmissible to leave the capsule, because it can cause a relapse of the tumour. Surgical treatment of benign tumours is a radical way of therapy, does not give relapses and provides full recovery for the patients. The removal of benign tumours is conducted in cases if the tumour breaks the organ function, causes cosmetic defects, is a pre-cancerous disease or suspicious of becoming a malignant tumour.
Patients with malignant tumours require urgent treatment. There are such methods of treatment for malignant tumours as surgical, radiation, chemotherapy and hormonal-therapeutic.
The basic method of treatment of malignant tumours is surgical, combined with radiation or chemotherapy. Such kinds of complex treatment are called combined. The combination of surgical treatment with radiation can be carried out as pre- or postoperative irradiation, for example, with breast, cervical, ovarian cancer. Combination of irradiation with chemotherapy is possible, for example, for patients with myeloma and lymphogranulomatosis. Surgical treatment is not conducted only in those cases if the disease can be reliably cured with radiation or medical methods, for example, lip cancer. Contraindications for surgical treatment of a malignant tumour are its nonresectablity that is the condition which excludes the opportunity of radical surgical intervention in connection with metastasises.
Operations which are applied in the treatment of malignant tumours are divided into radical and palliative.
When performing a radical operation the surgeon should adhere to such requirements:
Ablastic operations — a malignant tumour should be removed within the limits of healthy tissue, as much as possible receding from visible borders of the tumour, in uniform block with regional lymph nodes. It is inadmissible to injure a tumour to prevent possible implantation of tumoural cells in healthy tissue. With this purpose during an operation it is necessary to change gloves and surgical toolkit. The ablastic operation should be carried out in the certain sequence. The operation is started at some distance from the tumour and at once blood and lymph vessels are ligated in order to interrupt ways by which tumoural cells can spread to other tissues and organs.
Antiblastic actions:
physical antiblastics — during the operation they use an electroknife, apply diathermy, cryogenic therapy, laser, ultrasound;
actinic antiblastics — irradiation with X-rays of the tumour site before an operation and during the postoperative period;
chemical antiblastics is disorganization and destruction of tumoural cells during an operation with 96% ethyl spirit, a solution of formaldehyde, regional perfusion and intra-arterial introduction of antiblastic preparations.
With neglected tumours of the III and IV stages with remote metastasises and pronounced intoxication radical operations are impossible. In these cases palliative operations can be executed, which are directed on the elimination of complications caused by tumours, without action on the tumour.
Radiation therapy in the treatment of malignant tumours is applied isolatedly or in combination with surgical, chemo-therapeutic and hormone therapy. Radiation therapy is based on selectively high sensitivity to radiation of little differentiated tumoural cells, which intensively divide. Ionizing radiation causes radiolysis of water resulting in metabolism infringement in tumoural cells. As a result of radiation therapy HO–, H+, H2O2 ions which destroy chromosomes of tumoural cells, their cellular membranes and power systems are formed. Malignant lymphomas (lymphosarcomas), tumours or the haemopoietic systems (myelomas), as well as certain forms of epithelial tumours are especially sensitive to radiation therapy. However, the pronounced formation of metastasises and relapses of tumours reduce the effect of radiation therapy in the mentioned malignant tumours. Radiation therapy is frequently combined with surgical treatment; it is applied for breast cancer, cancer of the uterus, lung, and intestinal cancer. Radiation therapy is conducted 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 efficiency of radiation therapy is not identical for different tumours, and the course of irradiation frequently should be repeated several times. The dose of irradiation is determined by the oncologist together with radiologist. Radiation therapy can cause side effects and complications. They are connected to a decrease in the patient’s organism reactivity and his immunity, with suppression of haemopoietic organ function, nausea, bad appetite, sleep disorders, palpitation and leukopenia. At the later period changes of the skin (inflammation and erythema) with the formation of trophic ulcers and necrosis can be observed. In the focus of irradiation careful care of the skin, application of dermaprotectors (skin protecting means) are necessary. During the course of irradiation it is necessary to constantly supervise the blood picture for revealing and correction of anemia and leukopenia.
Chemotherapy of malignant tumours is frequently combined with radiation therapy, especially in cases of recurring tumours, as well as at the late clinical stages. The medical therapy, applied with the purpose of creating antineoplastic effect is divided into chemo- and hormone therapy according to the type of action. Chemotherapy provides mainly direct cytotoxic influence on tumoural cells. Hormonal therapy is directed, mainly, for the regression of a tumour that has reached through artificial inductive shift in the organism’s hormonal balance.
Antineoplastic preparations used now are classified as follows:
1. Alkaloid compounds
iprite-like substances (ethylamine chloride). Embihin, novembihin, dopan belong to them. These preparations are applied for lymphogranulomatosis, lymphoid leukosis, lymphosarcoma and reticulosarcoma. Sarcolysine is applied for seminoma, especially for the presence of metastasises, reticulosarcoma, Ewing’s sarcoma, myeloma, malignant angioendotelioma.
Cyclophosphanum is applied for breast, ovarian and lung cancer, lymphogranulomatosis and lymphosarcoma. Cyclophosphanum has a wide antineoplastic effect, has softer action on thrombocytopoiesis as compared with other analogues;
ethylene imine: thiophosphamidum, thioTEF, benzoTEF are used for breast, ovarian and lung cancer.
Dipinum, thiodipinum are used for leukosis, lymphogranulomatosis and hypernephroma.
Ethers of disulphonate acids
Myelosan has a pronounced action for leukemic forms of chronic myeloleukemia, but quickly becomes unable to function.
Myelobromol is similar to myelosan, but in connection with different action mechanism it is more effectively and capable than myelosan.
Antimetabolites
Mercaptopurin is used for acute and subacute leukosis, active chronic myeloleukemia, reticulosis, chorionepythelioma of the uterus.
Methotrexate is applied for lymphogranulomatosis, lung, breast cancer.
Flurourasil, phthorafur are applied in the treatment of patients with cancer of the rectum, sigmoid and large intestines, for stomach cancer, including inoperable and recurrent breast cancer, cancer of the pancreas and ovaries.
Antineoplastic antibiotics
Dactinomycin is applied for acute and subacute leukosis, active chronic myeloleukemia, reticulosis, chorionepythelioma of the uterus, retinoblastoma, rhabdomyosarcoma.
Mytomycin is applied for breast, stomach cancer and cancer of the large intestines.
Olivomycin is applied for testicle tumours (seminoma, teratoblastoma, embryonic cancer), reticulosarcoma, tonsillar and other tumours.
Rubomycin hydrochloride is applied for chorionepythelioma, lymphogranulomatosis, acute leukosis, reticulosarcoma and neuroblastoma.
Bruneomycin is applied for lymphogranulomatosis, chronic lymphoid leukosis, Wilms tumour, neuroblastoma, reticulosarcoma, lymphosarcoma.
Adriamycin is applied for squamous cancer of the mucous membrane of the oral cavity, nasopharynx, throat and esophagus, cancer of the penis, ovarian and testicle teratoblastoma, lympho- and reticulosarcoma, lymphogranulomatosis, acute leukosis, breast, lung cancer, neuroblastoma, Wilms tumour, cancer of the thyroid gland and bladder.
5. Alkaloids
Vinblastin is applied for lymphogranulomatosis, lymphosarcoma, reticulosarcoma, myeloma.
Vincristin is applied for acute leukosis, reticulosarcoma, neuroblastoma, Wilms tumour, and also in complex treatment of lymphogranulomatosis, myeloma, breast cancer.
Colchamin is applied for skin cancer (including as 0.5% ointments) and in combined treatment of esophagus cancer.
The above-stated chemotherapeutic means are applied internally and externally, but frequently as injections — intramuscular, intravenous and intra-arterial. They are also entered in cavities, in tumoural tissue: on the extremities — by regional perfusion, and for tumours of internal organs — by long-term intravenous perfusion.
Chemotherapy of malignant tumours is divided into systematic and regional. Systematic chemotherapy allows the introduction of antineoplastic preparations by any of the mentioned ways, considering their general action on the tumour, its metabolism, thus taking into account features of pharmacokinetics.
Regional chemotherapy is based upon the introduction of preparation solutions with high concentration directly in the tumoural tissue by perfusion or partially (intra-arterial or endolymphatic infusion).
Chemotherapy is usually applied as a method of treatment of primarily widespread forms, relapses and metastasises of malignant tumours. It can be used also for preventive measures of progressive latent subclinical tumoural cells, which remain after radical surgical treatment. Such chemotherapy, a component of complex combined treatment, is called additional, or adjuvant.
In the clinical practice treatment can be carried out by one preparation — monochemotherapy or a combination of several preparations — polychemotherapy.
Hormonal therapy is applied for tumours of the hormone-dependant organs, for example, breast or prostate cancer more often. The sexual hormones slow down the growth of a malignant tumour.
Immunotherapy is applied to activate immune mechanisms of an organism during the postoperative period, as well as after radiation and chemotherapy. In order to increase the specific immunity they apply levamisol, zymosan, prodigiosan, interferon. Passive immunization is carried out with antilymphocytic serum, immunoglobulin, isolated 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 placed. The more connective cells, the softer the consistence of the fibroma. Mixed forms are frequently observed, which form with the participation of other tissues, for example, neurofibroma, fibromyoma, fibrolipoma. Fibromas can be isolated or multiple (fibromatosis). Treatment is only surgical.
Lipoma consists of fatty tissue, bunches of connective tissue are placed here and there. Lipomas have a pronounced connective-tissue capsule. If they are multiple, this phenomenon is called lipomatosis. Treatment is sirgical — the lipoma is removed together with the connective-tissue capsule.
Chondroma consists of mature cartilage cells, usually connected with the bone, formed in cartilaginous parts of fingers and toes more often. Treatment consists in radical removal of the tumour.
Osteoma consist of cells of mature bone tissue, develops in metaphyseal part of long tubular bones and in the ribs. Large osteomas can entail functional infringements and pain syndromes. Treatment is surgical.
Sarcoma (from Latin sarcos — meat) is a malignant tumour consisting of immature connective tissue cells. The section is pale and looks like fish tissue, grows quickly, infiltrates and damages surrounding tissue. It metastize early, and relapses after operative removal. Metastasises are spread in the hematogenous way therefore they appear in different tissues and organs. Histologic exam reveals different kinds of sarcoma: round cell, spindle cell, malignant giant cell tumour, etc. Sarcomas are mostly observed at the young age; the younger patient, the worse the prognosis. Osteosarcomas develop in long tubular bones, in pelvic bones and skull. They can develop in the bone marrow (central or myelogenetic) or in periostis (peripheral or periosteal). Osteosarcoma progresses very quickly and in short time gives numerous metastasises.
Muscular, Blood Vessel, and Nerve Tumours
Myoma is a benign tumour which consists of muscular cells. tumours which consist of smooth muscles are called leiomyomas, and from transverse-striped muscles — rhabdomyomas. Usually myomas are limited from surrounding tissue by a well advanced capsule. Multiple myomas are quite often observed. Treatment is surgical.
Angioma is frequently observed and quickly grows at children’s age. Hemangioma is a benign tumour of blood vessels; lymphangioma is a tumour of lymphatic vessels. After the structure hemangioma is divided into capillary, cavernous (with the cavity) and cirsoid. Treatment is surgical, for large hemangiomas: stage-by-stage. Irradiation, cryotherapy, suturing or insertion of the leading vessels are applied for treatment. These tumours frequently recur. Lymphangiomas are observed less often, located on the lips, cheeks, neck, joints of the hands. After the structure: cystic and cavernous. Treatment is surgical, radiation therapy and electrocoagulation are also used.
Glioma is a tumour of the brain or spinal cord which develops from neuroglia cells. Depending upon the cellular elements and extent of their maturity, different kinds of glioma are distinguished: medula-, ganglio-, spongio-, astro-, oligodendroglioma. Even if the tumour is benign by structure, its localization can cause very serious and life-threatening infringements, irritation and compression of the brain or spinal cord. It can result in the patient’s death.
Treatment: only operative and should be provided as soon as possible.
Neurinoma (synonyms: lemoma, lemoblastoma, neurilemoma) is a tumour of the peripheral nerves. It can be formed in the radix of the spinal cord, develops from Schvann membrane. Unlike to other benign tumours it is clinically accompanied by sharp pain. Treatment is surgical.
Ganglioneuroma (synonyms: ganglioma, cympaticocytoma) is a benign tumour which develops from elements of the sympathetic nervous ganglia, more often the abdominal and chest parts. Treatment is surgical.
Benign Epithelial Tumours
Papilloma (synonym: papillar tumour) origins out of pavement and transitional epithelium and acts above its surface as a papilla. It locates on the head, back, axillary area, near the anus, but it can be formed also in the bladder and intestines. Treatment is surgical — removing the tumours within the limits of healthy tissue with obligatory histologic exam, because malignancy is possible. Papilloma of the mucous membrane is cauterized by electrocoagulation.
Adenoma is a tumour which consists of fibroepithelial tissue and has a glandular structure. Depending upon the kind of gland papillary, cystic, tubular and alveolar adenomas are distinguished. More often these tumours are formed in the breast, testicles, kidneys, less often on the skin or mucous membrane. Treatment is surgical. It can become malignant.
Dermoid (synonyms: dermoid cyst, cystic teratoma) is a tumour which consists of the remainder of the embryon ectoderm. Usually it forms a cavity filled with fatty masses and other epidermal formations. More often dermoids settle in the coccyx, but it can locate above eyebrows, near the nose, on the neck and in the anterior mediastinum. Dermoid cysts frequently suppurate, forming abscesses and fistula, which do not heal. Treatment is surgical — removing within the limits of healthy tissue.
Malignant Epithelial Tumours
Cancer (synonym: malignant epithelioma) — develops from germinal or glandular epithelium, consists of connective-tissue stroma in which blood and lymphatic vessels locate, and parenchyma, formed from epithelial cells. If the tumour consists of large epithelial cells, it is called medullary cancer. If the connective-tissue stroma prevails, the tumour is called scirrhous carcinoma, and if glandular cells prevail — adenocarcinoma. Cancer can develop in all tissues and organs where there are epithelial formations, but more often it is observed in the stomach, uterus, breast, on the skin and in the lungs.
The formation of cancer begins with the occurrence of atypical epithelial cells, after that the connective-tissue elements of the stroma multiply. Cancer quickly invades the surrounding tissue and metastazes in to the lymph nodes. Metastasises are usually spread lymphogenously. The clinical picture of cancer depends upon the localization and stage of the process. Treatment of cancer is basically operative, but at the same time quite often other methods of treatment are also applied, for example: radiation therapy, chemotherapy and hormonal therapy.
Radical operation with keeping to ablastics and antiblastics is carried out only in the I and II clinical stages of cancer, in the III clinical stage it is hardly conducted, and in the IV clinical stage — generally impossible. In these cases they carry out symptomatic treatment, which is supplemented with radiation and chemotherapy and also palliative operations.
For rendering oncological help to the population special oncological services, structure which includes scientific research institutes, republican, regional and city oncological clinics, as well as oncological cabinets in each district clinic are organized. The task of oncological clinics is qualified treatment of patients with tumours and pre-cancerous diseases, preventive medical examination of the population, work with the statistical data and organizational-methodical management of oncological services, as well as improving the professional skill of the medical personnel and anticarcinogenic propagation among the population. An increase in the oncological vigilance of general practitioners, which first meet this pathology, should be given special attention.