Download presentation on stomach cancer. Presentation "Stomach cancer - diagnosis and treatment" - project, report

Figure 1. X-ray for stomach cancer. With tight filling, the contour of the corner of the stomach is uneven, with a slight retraction (indicated by a black arrow). Along the lesser curvature of the antrum

– rigid platform (indicated by a white arrow).

Figure 2. X-ray for stomach cancer. With double contrasting – convergence of mucosal folds to the flattened wall of the stomach (indicated by an arrow)

Stomach cancer

Figure 1. X-ray for stomach cancer. With tight filling, the distal section is deformed like a rigid tube, its contours are uneven, its walls are rigid, and the lumen is not narrowed.

Figure 2. X-ray for stomach cancer. With double contrast, circular infiltration of the distal stomach is observed, spreading to the lesser and greater curvature of the stomach (indicated by arrows)

Stomach cancer

The symptom of atypical relief is a defect reflecting a tumor node. The shape of this node is uneven, irregular, and the outlines are blurry.

A typical sign of changes in relief in stomach cancer is a persistent stain, or barium depot, caused by ulceration of the tumor. The shape of the spot is incorrect. The contours are uneven and unclear.

In some cases, radiographs reveal powerful hyperplastic, expanded, randomly located folds with a “break-off symptom” or, conversely, the absence of folds

- “symptom of a bald area”

X-ray for stomach cancer. With tight filling, the contour of the lesser curvature of the lower third of the body is uneven (indicated by an arrow), the contour of the greater curvature is without visible changes

Small stomach cancer

Fig.1. X-ray for stomach cancer. With tight filling, the angle of the stomach is straightened, a rigid area with a notch symptom is determined on the lesser curvature (indicated by an arrow).

Fig.2. X-ray for stomach cancer. The wall of the antrum is thickened due to intramural infiltration (indicated by an arrow).

Small stomach cancer

Fig.1. X-ray for stomach cancer. With dosed compression, the contour of the lesser curvature of the lower third is uneven, undermined, and a flat ulceration is determined that does not extend to the contour (indicated by arrows).

Fig.2. X-ray for stomach cancer. Near the angle of the stomach, thickening of the gastric wall is noted, caused by intramural infiltration (marked by an arrow).

Pyloric stenosis

The main causes of pyloric stenosis:

1. Scarring in the pylorus area

2. Stricture after a chemical burn

3. Neoplasm at the outlet of the stomach

4. Tumor growth from neighboring organs. Stages of stenosis:

1. Forming stenosis: there is no clear CC, X-ray examination shows that the stomach is not dilated, peristalsis is normal or slightly increased, the stomach empties completely

2. Compensated: the stomach is of normal size or slightly dilated, on an empty stomach there is liquid, peristalsis is weakened. Evacuation of the contrast mass is delayed for 6-12 hours. Endoscopy reveals severe scar deformation of the pyloroduodenal canal with a narrowing of the lumen to 0.5 cm

3. Subcompensated stenosis: a decrease in the tone of the stomach and its moderate expansion are determined; on an empty stomach, fluid is retained in it. Peristalsis is weakened, barium remains in the stomach for 12-24 hours. With endoscopy - distension of the stomach, narrowing of the lumen of the pyloroduodenal canal to 0.3 cm

Slide 2

Epidemiology

Gastric cancer is the second most common cause of death from malignant neoplasms. The highest incidence is recorded in Japan, China, Korea, countries of South and Central America, as well as in Eastern Europe, including the former Soviet republics. In the Russian Federation, about 40 thousand primary patients with stomach cancer are registered annually, 35 thousand die. The incidence is 28.4 per 100 thousand population. Since the mid-20th century, there has been a worldwide decline in the incidence of stomach cancer due to patients with intestinal-type cancer of the distal parts of the stomach, while the proportion of cardia cancer is growing, most rapidly among people under 40 years of age.

Slide 3

Epidemiological classification according to Lauren Intestinal type: the tumor has a structure similar to colorectal cancer and is characterized by distinct glandular structures consisting of well-differentiated columnar epithelium with a developed brush border. Diffuse type: the tumor is represented by loosely organized groups or single cells with a high content of mucin (signet ring-shaped) and is characterized by diffuse infiltrative growth.

Slide 4

Epidemiology of stomach cancer

Peak incidence 50-60 years Men are 2-12 times more likely to get sick Localization: more often distal sections. However, there is a tendency towards an increase in proximal and cardio-esophageal cancer, especially in the countries of Europe and America Asia - distal cancer is much more common (better treatment results and prognosis!)

Slide 5

Epidemiology of gastric cancer in Europe

2006 - 159,900 new cases and 118,200 deaths, which ranks fourth and fifth in the structure of morbidity and mortality, respectively. Men get sick 1.5 times more often than women; the peak incidence occurs at the age of 60-70 years.

Slide 6

Increase in standardized incidence rates of malignant neoplasms (%%)

Slide 7

COMPARATIVE ASSESSMENT OF VARIOUS FACTORS AFFECTING CANCER INCIDENCE

Slide 8

Johannes Fibiger 1867- 1928

Slide 9

Biography

Genus. April 23, 1867 in Silkeborg, Denmark. He studied bacteriology under the guidance of R. Koch and E. von Behring, worked together with Karl Salomonsen at the University of Copenhagen. His doctoral dissertation on the bacteriology of diphtheria was completed in 1895, and in 1900 he became professor of pathological anatomy at the university. Introduced Behring's serum to treat diphtheria in Denmark and investigated the relationship between outbreaks of tuberculosis in cows and the spread of this disease in humans. Rat tuberculosis and gastric cancer with Spiroptera neoplastica (Gongylonema neoplasticum). In the 1920s, he conducted a comparative experimental study of cancer caused by coal tar, Spiroptera neoplastica and clinical manifestations. A combination of external influences with a genetic, not general, but organ predisposition to cancer. Nobel Prize in Medicine or Physiology for 1926. “For the first time, it has become possible to experimentally transform normal cells into malignant cancer cells. Thus, it was convincingly shown not that cancer is always caused by worms, but that it can be provoked by external influences” (W. Wernstedt). He died in Copenhagen on January 30, 1928 from rectal cancer.

Slide 10

Etiology

A. Nutritional risk factors Excessive consumption of table salt and nitrates Lack of vitamins A and C Consumption of smoked, pickled and dried foods Preserving food without using a refrigerator Quality of drinking water B. Environmental and lifestyle factors Occupational hazards (rubber, coal production) Tobacco smoking Ionizing radiation History of gastric resection Obesity B. Infectious factors Helicobacter pylori Epstein-Barrvirus

Slide 11

D. Genetic factors Blood type A (II) Pernicious anemia Familial gastric cancer Syndrome of hereditary diffuse gastric cancer (HDGC). Hereditary non-polyposis colorectal cancer Li Fraumeni syndrome (hereditary cancer syndrome) Hereditary syndromes accompanied by polyposis of the gastrointestinal tract: familial adenomatous polyposis of the colon, Gardner syndrome, Peutz-Jeghers syndrome, familial juvenile polyposis E. Precancerous diseases and changes in the gastric mucosa Adenomatous polyps of the stomach Chronic atrophic gastritis Ménétrier's disease (hyperplastic gastritis) Barrett's esophagus, gastroesophageal reflux Dysplasia of the gastric epithelium Intestinal metaplasia

Slide 12

Etiological factors of stomach cancer

Nutrition Bile reflux Helicobacter pylori Genetic disorders Risk factors - exogenous sources of nitrates and nitrites, endogenous formation of nitrates, increased salt intake, food storage, alcohol. Protective factors are antioxidants and beta-carotene.

Slide 13

Dynamics of mortality from stomach cancer (whole population)

Prepared by Anastasia Pravko, a student of grade 11 “B”

Slide 2: STOMACH CANCER

Gastric cancer is a malignant tumor originating from the epithelium of the gastric mucosa. It is one of the most common oncological diseases. It can develop in any part of the stomach and spread to other organs, especially the esophagus, lungs and liver. Stomach cancer kills up to 800,000 people worldwide every year. This disease has a high mortality rate (more than 700,000 per year), which makes it second in the structure of cancer mortality after lung cancer. Stomach cancer occurs more often in men

Slide 3

According to incidence statistics, stomach cancer ranks first in many countries, in particular in the Scandinavian countries, Japan, Ukraine, Russia and other CIS countries. At the same time, in the USA, France, England, Spain, and Israel over the past twenty years there has been a decrease in the incidence of stomach cancer. Many experts believe that this happened due to improved food storage conditions with the widespread use of refrigeration units, which reduced the need for preservatives. In these countries, the consumption of salt, salted and smoked foods has decreased, and the consumption of dairy products, organic, fresh vegetables and fruits has increased. The high incidence of stomach cancer in the above countries, with the exception of Japan, according to many scientists, is due to the consumption of foods containing nitrites. Nitrosamines are formed from nitrites by conversion in the stomach. Currently, stomach cancer has begun to be detected more often at a young age, in the age groups of 40-50 years. The largest group of gastric cancers are adenocarcinomas and undifferentiated cancers. Cancers usually arise against the background of chronic inflammatory diseases of the stomach. It has now been proven that in a completely healthy stomach, cancer practically does not occur. It is preceded by a precancerous condition. Most often this happens with chronic gastritis with low acidity, ulcers and polyps in the stomach. On average, it takes 10 to 20 years from precancer to cancer.

Slide 4: Structure of the stomach

Slide 5: Precancerous conditions

chronic atrophic gastritis, chronic gastric ulcer, adenomatous polyps, intestinal metaplasia of the gastric mucosa, severe dysplasia of the gastric mucosa, Menetrier's disease (proliferation of the mucous membrane). anemia caused by vitamin B12 deficiency.

Slide 6: Precancerous conditions

Slide 7: First signs of stomach cancer

Firstly, stomach cancer has symptoms common to cancer. Chronic fatigue. Fast fatiguability. Unexplained weight loss.

Slide 8: Small signs of stomach cancer

Secondly, the presence of early stomach cancer can be signaled by a complex of symptoms, or the so-called minor sign syndrome. Discomfort in the stomach after eating: bloating, feeling of fullness. Frequent nausea, vomiting, mild drooling. Pain in the epigastrium: aching, pulling, dull. May occur periodically, often appearing after eating. Loss of appetite unmotivated by other factors. Frequent heartburn, difficulty swallowing food and liquids (if the tumor occurs in the upper part of the stomach). Vomiting of stagnant contents (eaten a day or two ago); vomiting “coffee grounds” or with blood, black loose stools are signs of bleeding in the stomach, requiring an urgent call for an ambulance.

Slide 9: Symptoms of stomach cancer largely depend on the location of the tumor

In case of cancer of the cardiac region (the initial part of the stomach), the symptoms of dysphagia (salivation, difficulty passing rough food) come first. Dysphagia increases as the disease progresses and the lumen of the esophagus narrows. Against this background, regurgitation of food, dull pain or a feeling of pressure behind the sternum, in the heart area or in the interscapular space appear. The cause of these symptoms may be stagnation of food in the esophagus, its expansion. When cancer is localized in the antrum (the final part of the stomach), a feeling of heaviness in the upper abdomen, vomiting of food eaten the day before, and an unpleasant rotten smell of vomit appear relatively early. In case of cancer of the body of the stomach (middle part of the stomach), even with a significant tumor size, local symptoms of the disease are absent for a long time, general symptoms predominate - weakness, anemia, weight loss, etc.

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Slide 10

3. Painful form of stomach cancer. Often there is pain in the upper abdomen, which can radiate to the lower back and be associated with eating. The pain often continues for a long period of time, sometimes all day, and may intensify with movement. With stomach cancer, pain is not natural. They do not subside after eating; there are no “hunger” pains or their seasonality. In some cases, with common forms of stomach cancer, the pain can be quite intense. When the tumor grows into the pancreas or even deeper, patients may complain of back pain. Such patients are usually treated for radiculitis and neuralgia.

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Slide 11: Stages of stomach cancer

The detection rate of cancer from one stage to another increases, and at the same time the patient’s life expectancy and the likelihood of cure decreases. Four stages of disease progression can be identified: Stage zero: Only the gastric mucosa is affected. Treatment of cancer in this case is possible without performing a strip operation, using endoscopic techniques and using anesthesia. In this case, treatment of stomach cancer has the most favorable prognosis - 90% of cases of recovery.

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Slide 12: Stage 1

The tumor penetrates deeper into the mucous membrane and also creates metastases in the lymph nodes around the stomach. The survival rate for cancer treatment at this stage is 60-80%, but such cancer is detected extremely rarely. Stage 2 The tumor does not affect only the muscle tissue of the stomach; there are metastases in the lymph nodes. The five-year survival rate when the disease is diagnosed at stage 2 is 56%.

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Slide 13: Stage 3

The cancer penetrates entirely into the walls of the stomach, and the lymph nodes are affected. Stage 3 gastric cancer is detected quite often (1 case out of seven), but the five-year survival rate in this case is 15–38%. Stage 4 The cancerous tumor penetrates not only the stomach, but also metastasizes to other organs: the pancreas, large vessels, peritoneum, liver, ovaries and even to the lungs. Cancer in this form is diagnosed in 80% of patients. Only in 5% of cases does the doctor’s prognosis for the patient’s life expectancy exceed 5 years.

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Slide 14: Stomach cancer and diagnosis

The main study for gastric cancer is considered to be FGDS, which makes it possible to conduct a detailed examination of the mucous membrane of the esophagus, duodenum and stomach, and detect a tumor and determine its boundaries. X-ray of the stomach is effective for infiltrative forms of cancer. Allows you to assess the functional capabilities of the organ, makes it possible to suspect stomach cancer or a relapse of the tumor. This diagnostic method is necessary for further effective treatment of stomach cancer. Endoscopic ultrasonography allows you to accurately study the condition of all layers of the stomach and in 80-90% of cases accurately determine the depth of the tumor. The direction of magnifying endoscopy occupies one of the leading places in the clarifying diagnosis of gastric pathology, as it allows one to identify minimal violations of the typical architectonics of the mucous membrane and distinguish between areas of intestinal metaplasia and dysplasia or the presence of neoplastic changes. Improvement of endoscopic examination is moving towards the introduction of narrow-spectrum (NBI) endoscopy. These are high-tech methods that make it possible to diagnose stomach cancer at earlier stages, and also help identify tumor foci against the background of chronic diseases. stomach diseases.

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Slide 15: Stomach cancer and diagnosis

Optical coherence tomography - designed to determine the depth of invasion into the wall of the stomach, esophagus or other hollow organ. This new generation equipment makes it possible to determine in detail the thickness of the affected tissue and, possibly, to recognize tumor growth into the submucosal and muscular layers of the stomach. Under the control of optical coherence tomography, tissue from the lymph nodes of the nearby area is collected. Diagnostic laparoscopy is a surgical procedure that is performed under intravenous anesthesia by inserting a camera into the abdominal wall to examine the abdominal organs. Such a study is used in unclear cases, to detect tumor growth into surrounding organs, metastases in the peritoneum, and to take a biopsy. This method is sometimes necessary for further effective treatment of stomach cancer. Stomach cancer and blood testing for tumor markers - proteins that are produced by the tumor and are absent in a healthy body. CEA, Ca 19.9 and Ca 72.4 are used to detect cancer. However, they all have low diagnostic value. They have found their use in patients to detect metastasis.

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Slide 16: Treatment of stomach cancer

Treatment for cancer is different from treatment for other organs. If for carcinomas in other organs surgery is performed only when conventional therapy is powerless, then for stomach cancer it is the opposite. Only surgical intervention can save the patient. This is explained by the fact that the signs of cancer are unstable and may not appear for months; as a result, the patient arrives at the moment when the phase of stenosis and metastasis has begun.

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Slide 17: Treatment methods

Chemotherapy, despite its capabilities, rarely helps stop the development of metastases and destroy cancer cells in adjacent organs. Radiation therapy, which is carried out for most cancers, is not carried out in cases of the stomach. Drug treatment will no longer bring any results, so the only option left is surgery. If the carcinoma is small in size, then a resection of the stomach is performed, removing most of it. But in many cases, the stomach has to be completely removed, and all affected lymph nodes are also removed. During the operation, the esophagus is sutured directly to the intestine.

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Slide 18: Relapse

Even complete cure of stomach cancer does not always have a positive prognosis: there are frequent cases of relapses, which cannot always be eliminated by repeated operations.

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Last presentation slide: STOMACH CANCER: Rules for preventing stomach cancer:

Detection of precancerous conditions and regular medical examination. Diet. Reduce consumption of fatty, salty, smoked and fried foods, hot and spicy foods, do not abuse alcohol, avoid preservatives and dyes. Be more attentive to the vegetables you eat; they can potentially contain large amounts of nitrates, nitrites, and carcinogens. Observe moderation in the use of medications (especially analgesics, antibiotics, corticoids). Reduce the negative impact of the environment and harmful chemical compounds. Eat more fresh foods rich in vitamins and microelements, as well as dairy products. Maintain a normal diet, avoiding too long breaks between meals and overeating. No smoking.

Every year there are registered

800 thousand new cases and 628

thousand deaths.

Countries that are “leaders” in

Japan, Korea, Chile, Russia,

China. They account for 40%

all cases.

Japan - 78 per 100 thousand.

Chile – 70 per 100 thousand.

24. Classification by TNM

T – tumor

TIS – intraepithelial cancer.

T1 – the tumor affects only the mucous membrane and

submucosal layer.

T2 – the tumor penetrates deeply, takes no more than

half of one anatomical region.

T3 – a tumor with deep invasion involves more than

half of one anatomical section, but not

affects neighboring anatomical sections.

T4 – the tumor affects more than one anatomical site

department and spreads to neighboring organs

1) distal subtotal resection

stomach (performed transabdominally),

2) gastrectomy (performed

transperitoneal and transpleural

3) proximal subtotal resection

stomach (performed transperitoneally and

through pleural access).

1. Polypous cancer.

2. Ulcerative (saucer-shaped) cancer

3. Infiltrative ulcerative tumor.

4. Scirrhous gastric cancer with a diffuse infiltrative type of growth.

Palliative surgical treatment of gastric cancer

The operation is aimed at improving the general condition and nutrition of the patient, not

eliminating stomach cancer. Such operations are considered to be bypass anastomosis between

stomach and small intestine - gastroenteroanastomosis, gastro- and jejunostomy.

During this operation, the primary focus or metastasis of cancer is removed.

stomach. These operations include palliative resections, removal

metastasis and palliative gastrectomy.

Gastroenterostomy - treatment of stomach cancer by creating an anastomosis between

jejunum and stomach.

Gastrostomy - involves inserting a tube into the stomach through the abdominal

wall for the purpose of feeding the patient.

Enterostomy - performed to create patency of the digestive tract

tract, if it is not possible to apply a gastrotomy, as well as for nutrition

sick.

According to Borrmann (2008) macroscopic

types of tumor growth are divided into

1) polypoid cancer - a tumor protruding into the lumen

stomach, on a wide base, with clear contours;

2) ulcerated form - a tumor that looks like an ulcer with

dense edges raised above the mucous membrane,

with infiltration of the stomach wall around it;

3) ulcerative-necrotic form - a tumor without clear

boundaries, passes to the unchanged wall of the stomach;

4) diffusely growing cancer without a noticeable tendency to

ulceration, boundaries of tumor growth

macroscopically indeterminate.

Most often, cancer affects

pyloric antrum of the stomach (60%

observations);

On the lesser curvature, carcinoma develops in

20-25% of patients;

In the proximal region - in 10-15%;

On the front and back walls - 2-5%

observations;

Total damage is recorded in 5%

patients.

N0 – no metastases

N1 – metastases in regional lymphatic

N2 – metastases in extraligamentous lymphatic

gastric apparatus

M0 – no metastases

M1 – distant metastases

To study the histological structure of cancer

stomach is currently used

International histological

WHO classification (1982)

a) papillary;

b) tubular;

c) mucinous;

d) signet ring cell.

Glandular squamous cell carcinoma (adenoacanthoma)

Squamous cell carcinoma

Undifferentiated cancer

Unclassified cancer.

T - Primary tumor

preinvasive carcinoma: intraepithelial tumor

without invasion of the own mucous membrane (carcinoma in

the tumor infiltrates the gastric wall to the submucosal layer

layer.

the tumor infiltrates the gastric wall to the subserous

shells.

the tumor grows into the serous membrane (visceral

peritoneum) without invasion into adjacent structures.

the tumor spreads to neighboring structures.

Intramural extension to the duodenum or

the esophagus is classified according to the greatest depth of invasion

in all locations, including the stomach.

N - Regional lymph nodes

insufficient data to assess regional

no signs of metastasis

regional l/nodes

N1 there are metastases in 1-5 nodes

N2 there are metastases in 6-15 nodes

N3 there are metastases in more than 16 l/nodes

M - Distant metastases

insufficient data to determine

distant metastases

M0 no evidence of distant metastases

there are distant metastases (Virchow,

Krukenberg,

Schnitzler,

carcinomatosis of the peritoneum, to the liver)

Standard (subtotal

distal gastrectomy,

proximal resection

stomach, gastrectomy)

Extended (D2, D3)

Combined

Yu.E.Berezov 1976

20. Stage 3.

For cancer of the cardia (the initial part of the stomach)

Symptoms of dysphagia (salivation, difficulty

when passing rough food). Dysphagia increases as

progression of the disease and narrowing of the lumen of the esophagus. On this background

regurgitation of food, dull pain, or a feeling of pressure behind the

sternum, in the heart area or in the interscapular space. Reason

These symptoms may be stagnation of food in the esophagus, its expansion.

When cancer is localized in the antrum (the final part of the stomach)

A feeling of heaviness in the upper abdomen appears relatively early,

vomiting food eaten the day before, unpleasant rotten smell of vomit.

For cancer of the body of the stomach (middle part of the stomach),

even with significant tumor sizes, local symptoms of the disease

absent for a long time, general symptoms predominate - weakness,

anemia, weight loss, etc.

3. Painful form of stomach cancer.

Often there is pain in the upper abdomen, which can

radiate to the lower back and be associated with eating.

The pain often continues for a long period

time, sometimes all day, may intensify with movements.

With stomach cancer, pain is not natural. They

do not subside after eating, there are no “hunger” pains or

seasonality. In some cases, with common forms

stomach cancer pain can be quite intense

character. When a tumor grows into the pancreas

or even deeper, patients may complain of back pain.

Such patients are usually treated for radiculitis,

neuralgia.

T1 - the tumor does not extend beyond the cardia;

T2 - the tumor occupies the cardiac region;

T3 - a tumor of the cardia spreads to the esophagus and

body of the stomach.

Detectability of cancer from one stage to

the other increases, and at the same time

life expectancy decreases

patient, the likelihood of cure.

Four stages can be identified

Only the gastric mucosa is affected.

Treatment of cancer in this case is possible without

carrying out a strip operation, with

using endoscopic technology and

using anesthesia.

In this case, treatment for stomach cancer has

the most favorable prognosis – 90% of cases

recovery.

The tumor penetrates deeper into the mucosa

membrane, and also creates metastases in

lymph nodes around the stomach.

Survival of cancer treatment at this stage

is 60-80%, but such cancer is detected

rarely.

The tumor does not affect only the muscle

stomach tissue, there are metastases in

lymph nodes.

Five-year survival rate

diagnosing the disease at stage 2 – 56%.

The cancer penetrates entirely into the walls of the stomach,

lymph nodes are affected.

Stage 3 stomach cancer is detected

quite often (1 case out of seven), but

five-year survival rate in this case is

The cancerous tumor penetrates not only into the stomach,

pancreas, large vessels,

peritoneum, liver, ovaries and even into the lungs.

Cancer in this form is diagnosed in 80% of patients.

Only in 5% of cases does the doctor’s prognosis

The patient's life expectancy exceeds 5 years.

TxNxM1

survival rate in

depending on

Stage I – 97.8%

Stage II – 72.0%

Stage III – 44.8%

T. Kinoshita et al, 1998.

IA (early cancer limited to the mucosa

gastric lining) are performed minimally invasive

endoscopic and laparoscopic interventions –

endoscopic mucosectomy or laparoscopic

gastric resection, subtotal gastric resection.

For stages IB, II, IIIA, IIIB and IV (T4N2M0)

perform lymph node dissection in volume D2

D3 and para-aortic lymph node dissection are not

improve treatment results

(only for T4N2M0) stages –

combined treatment with

preoperative chemotherapy. Volume

lymph node dissection during subsequent surgery

does not exceed D2.

Complex treatment involves

combination of operational

interventions with neoadjuvant

(preoperative) or

adjuvant (postoperative)

polychemotherapy, or with

various options

chemoradiation treatment.

Currently, various techniques are used

combined treatment using pre-, intra- and postoperative radiation therapy. Radiation therapy in

mainly pursues the goal of prevention

locoregional relapses. In case of preoperative

exposure targets are clinical and

subclinical zones of tumor growth, with intra- and

postoperative irradiation – hypothetically

surviving viable individual tumor cells

cells or their complexes. Until now, with

combination treatment of patients with gastric cancer

mainly used two fractionation schemes

doses: classical fractionation (2 Gy 5 times per

week before a total dose of 30-40 Gy) and an intensively concentrated course of ICC (4 Gy 5 times a week until

total dose 20 Gy, which when converted to the regimen

equivalent to 30 Gy).

Another combination option

treatment – ​​intraoperative irradiation

electron beam after removal

tumors. Such an impact will

accessible to practical oncology

institutions after widespread implementation in

accelerator therapy practice

technology that generates electron beams with

energy 8-15 MeV. At the same time, the dose

single exposure can range from

15 Gy to 20 Gy.

Radiation treatment. Radiation treatment for stomach cancer was not found

wide practical application due to the danger

extensive radiation damage to the abdominal organs. IN

in a number of cases in patients with resectable tumors,

especially with localization in the cardioesophageal zone,

those who refused surgery or if there were contraindications

it is indicated for radiotherapy in radical cases

doses according to a split course. It is advisable to use

classical fractionation or dynamic schemes

fractionation.

The same therapeutic tactics may be used for cancer relapses in

stomach stump. In these cases, combinations can also be used

external irradiation with intracavitary. At large

volumes of damage and the existing danger of decay

tumors, as well as in weakened patients, irradiation is indicated

through mesh diaphragms in single doses of 3 Gy and SOD 6080 Gy under open areas.

If the unresectable process is obvious even without

surgical intervention, then in the absence

irradiation for pollutative purposes. In 1/3 of cases after

irradiation, a temporary decrease in tumor occurs and

improvement of cardia patency.

Chemotherapy. Chemotherapy is carried out for primary unresectable gastric cancer, relapses and metastases

tumors, as well as after performing palliative

surgical interventions and exploratory laparotomies. More often

5-fluorouracil (5-FU) and ftorafur are used for all treatment

both as monotherapy and as part of various regimens

polychemotherapy. 5-FU is administered intravenously every other day from

calculation 15 mg per 1 kg of patient weight (750-1000 mg).

The total dose of the drug per course of treatment is 3.5-5 g.

Another technique is to administer the drug in the same

a single dose, but with a week break. Duration

The course of treatment in these cases is 6-8 weeks. Repeated

courses are carried out at intervals of 4-6 weeks.

Ftorafur is administered (intravenously or orally) per day

dose of 30 mg/kg, divided into two doses with an interval of 12 hours

(on average 800 mg 2 times a day). The total dose in this case

is 30-40 g. This drug is very convenient for

outpatient treatment, since it can be used

In “safe” patients with unresectable tumors

classical technique in SOD 30-40 Gy and in parallel

daily intravenous administration of 250 mg 5-FU.last

can be administered every other day, then the single dose is increased to

500-700 mg. The total course dose of the cytostatic in both

cases should not exceed 3-6g.

Stage 0

Stage IA

Stage IB

Stage IIIA T2 a/b

Stage IIIB T3

Stage IV T4

Stages of gastric cancer

any N

14. Background diseases or risk groups for developing stomach cancer

Nutrition factor

Storage condition factor

food

Helicobacter pylori

There is speculation that food may

play the role of a carcinogen in various

- be a carcinogen;

- be a solvent for carcinogens;

— turn into carcinogens during processing;

carcinogens;

— it is not enough to inhibit carcinogens.

Currently, increasing attention

pay attention to the effect of Helicobacter pylori on

the occurrence of stomach cancer. This

due to reports from domestic and

foreign researchers who

note an increase in the incidence rate

in persons infected with data

microorganism.

WHO experts recognized: with morphological

point of view, there is precancer, and

it is necessary to distinguish between precancerous conditions and

precancerous changes.

Precancerous condition - concept

clinical and is characterized by those

diseases of the stomach, which are the most

often precede the development of cancer.

Precancerous changes – amount

morphological characteristics called

dysplasia, preceding and accompanying

As studies have shown, the condition

does not form acids

independent meaning. In occurrence

cancer: possible hypoacidity (20.2%),

anacidity (44.3%), normacidity (18.2%),

hyperacidity (18.2%).

In 60% of patients with initial gastric cancer

history indicates chronic

diseases; leading among them are

chronic gastritis – 76.7%, in 12.4%

patients had previously been diagnosed

duodenal ulcer, 7% gastric ulcer, 0.8% - polyps,

3.1% - previously operated stomach.

Epithelial polyps

According to their course, ES are divided into 1) non-neoplastic and 2)

neoplastic. Neoplastic – adenomas of the gastric mucosa. They

They are divided according to the macroscopic form of growth into: flat and papillary.

They occur against the background of existing metaplasia of the gastric mucosa.

The incidence of cancer associated with neoplastic adenomas ranges from

within wide limits. Malignancy of flat adenomas occurs in 621%, papillary adenomas - much more often (20-76%).

Gastric resection

Cancer develops in the remaining part. Reasons for delayed changes

in time are not entirely clear. However, the most likely factor

is

basic

parietal

responsible for the production of hydrochloric acid. Against the background of increasing pH

gastric juice, metaplasia processes begin to develop in

mucous membrane of the remaining part of the stomach, which can be considered as

precancerous changes. Time to cancer development after gastrectomy

ranges from 15 to 40 years.

Ménétrier's disease

It is a rare disease and is characterized by the presence of hypertrophic

folds

mucous membrane,

reminiscent

decrease

acid-producing function, protein-losing enteropathy. Disease

is rare, with unknown etiology and is treated symptomatically.

Pernicious anemia

With a combination of pernicious anemia and atrophic gastritis, the risk of developing gastric cancer

increases to 10%. The pathogenesis of pernicious anemia lies in the production

antibodies against proton pump cells, pepsinogen-producing cells and

Castle's internal factor.

Chronic stomach ulcer?

The question is debatable. It was recognized that cancer occurs in inflammatory

changed tissues of the edge of the ulcer (50s). However, further research

allowed us to note that only 10% of gastric cancer was combined with a chronic ulcer; in 75% it was primary gastric cancer that occurred with ulceration. That. stomach ulcer connection

and the RJ is not considered reliable.

8. Minor signs of stomach cancer

Firstly, stomach cancer has signs

common for oncological diseases.

Chronic fatigue.

Fast fatiguability.

Unexplained weight loss.

Secondly, the presence of early stomach cancer may

signal a complex of symptoms, or the so-called

small sign syndrome.

Discomfort in the stomach after eating: bloating,

feeling of fullness.

Frequent nausea, vomiting, mild drooling.

Pain in the epigastrium: aching, pulling, dull. May occur

periodically, often appear after eating.

Loss of appetite unmotivated by other factors.

Frequent heartburn, difficulty swallowing food and liquids (if

the tumor arose in the upper part of the stomach).

Vomiting of stagnant contents (eaten a day or two ago);

vomiting “coffee grounds” or with blood,

loose black stools – signs of bleeding in the stomach,

requiring an urgent call for an ambulance.

weakness, fatigue in

over weeks and months

persistent decline and loss

appetite

stomach discomfort

progressive weight loss

persistent anemia

depression, apathy

9. The symptoms of stomach cancer largely depend on the location of the tumor.

To local manifestations

include symptoms

lack of physical satisfaction from

saturation,

dull pressing characteristic pain,

feeling of fullness and distension in

epigastric region,

decreased or lack of appetite,

aversion to meat, fish.

weakness,

weight loss,

adynamia,

rapid fatigue from usual work and decreased

interest in it (90%);

depression,

anemia associated with hidden blood loss and tumor

intoxication. Sometimes anemia is the first sign

diseases.

In advanced forms of cancer, there is an increase

body temperature from low-grade to high. Reasons

fevers serve as infection of the tumor, development

inflammatory processes outside the stomach.

neuralgia.

Clinical signs characteristic

for the initial form of stomach cancer, not

exists. It may leak

asymptomatic or manifest

signs of disease, against the background

which it develops.

Early diagnosis of cancer is possible with

mass endoscopic

population survey. Gastroscopy

allows you to detect changes in

diameter of gastric mucosa

less than 0.5 cm and take a biopsy for

verification of diagnosis.

Stomach cancer is more likely

in a group of people with increased

cancer risk. To factors

increased cancer risk

precancerous diseases of the stomach

(chronic gastritis, chronic ulcer

stomach, stomach polyps);

chronic gastritis of the gastric stump

operated on for non-cancer

stomach diseases after 5 years or more

after gastrectomy;

effects of occupational hazards

(chemical production).

Clinical manifestations of cancer

stomachs are diverse, they depend on

pathological background, against which

a tumor develops, i.e. from

precancerous diseases, localization

tumors, forms of its growth,

histological structure, stage

dissemination and development

complications.

A. Endoscopic examination

(fibrogastroduodenoscopy)

Thanks to endoscopic methods

examinations can visually identify a tumor.

At the same time, you can estimate its size, growth pattern,

presence of bleeding, ulceration, rigidity

gastric mucosa. It is also important that

during fibrogastroscopy, you can take a section

tumors for morphological examination

(biopsy). But, unfortunately, information content

single biopsy most often does not exceed 50%

and to establish the exact morphological

diagnosis requires several

Changes in blood tests appear later

stages of stomach cancer. The most common manifestation of cancer

stomach in laboratory tests is anemia. Anemia

develops mainly due to bleeding from tissues

tumors, but also a certain effect on the development

anemia is caused by impaired absorption of substances.

As anemia progresses, it will increase and

ESR.

A leukimoid reaction may develop. Wherein

the number of leukocytes in the blood will exceed 30,000,

myelocytes and myeloblasts will appear.

One of the most common manifestations in blood tests for cancer

stomach and other forms of cancer is hypoproteinemia and

dysproteinemia.

The main study for gastric cancer is FGDS, which gives

the possibility of a detailed examination of the mucous membrane of the esophagus,

duodenum and stomach, and detecting a tumor, determining it

X-ray of the stomach is effective for infiltrative forms of cancer.

Allows you to assess the functional capabilities of the organ, gives

the possibility of suspecting stomach cancer or a relapse of the tumor. Such

a diagnostic method is necessary in order to carry out effective treatment in the future

stomach cancer.

Endoscopic ultrasonography allows you to accurately study the condition

all layers of the stomach and in 80-90% of cases accurately determine the depth of the tumor.

The field of magnifying endoscopy occupies one of the leading positions in

clarifying diagnosis of gastric pathology, as it allows to identify

minimal disruption of the typical architecture of the mucous membrane and distinguish

areas of intestinal metaplasia and dysplasia or the presence of neoplastic changes.

Improvement of endoscopic examination is moving towards implementation

narrow spectrum (NBI endoscopy). These are high-tech methods that

make it possible to diagnose stomach cancer at earlier stages, and also

contribute to the identification of tumor foci against the background of hron. stomach diseases.

Optical coherence tomography – designed to determine depth

invasion of the wall of the stomach, esophagus or other hollow organ. This equipment

new generation allows you to determine in detail the thickness of the affected tissue,

it is possible to recognize tumor growth into the submucosal and muscular layers

stomach. Tissue is collected under optical coherence tomography control

lymph nodes of the nearby area.

Diagnostic laparoscopy is a surgical procedure that

performed under intravenous anesthesia by injecting a puncture into the abdominal wall

camera to examine the abdominal organs. Such research is applied

in unclear cases, to identify germination into surrounding organs

neoplasms, metastases in the peritoneum and for taking a biopsy. This method is sometimes

necessary for further effective treatment of stomach cancer.

Stomach cancer and blood testing for tumor markers - proteins that

produced by tumors and absent in a healthy body. With the aim of

CEA, Ca 19.9 and Ca 72.4 are used for cancer detection. However, they all have

low diagnostic value. They have found their application in patients for

detection of metastasis.

X-ray diagnostics. Full

the examination should include fluoroscopy and

radiography in vertical and horizontal

positions of the patient, in known and strictly

specific for each section and walls of the stomach

positions with different degrees of contrast

barium suspension and air. A necessary condition

is dosed compression of accessible sections

organ. Primary contrast technique

allows you to evaluate inaccessible palpations of the department

stomach, study their relief, identify the border

tumor infiltration. The research ends

must be under “tight filling” conditions to evaluate

wall configurations, identification of violation zones

infiltration.

Purpose: determining the location, volume of the lesion,

transition of the process to the esophagus and duodenum

intestine and the degree of stenosis, size and growth

Videogastroscopy - visual examination of the stomach with

collection of material for histological examination.

Fibrogastroscopic examination allows

determine the location, anatomical type of growth

In cases of endoscopic detection of any

changes in the gastric mucosa are necessary

perform multiple biopsies of all

suspicious areas. Moreover, with ulcerative

forms of cancer, it is necessary to take a biopsy

material both from the ulcer itself and from the surrounding

mucous membrane. When the tumor is localized in

a biopsy is indicated in the lower or upper third of the stomach

multiple areas of visually unchanged

mucous membrane in the remaining 2/3 of the organ for

determining background changes in the mucous membrane, which

can greatly influence the choice

volume of surgical intervention.

Morphological diagnosis. Research

should be subjected not only to biopsies from the stomach, but

and liver, parietal disseminates obtained from

laparoscopy, as well as as a result of targeted

Ultrasound-guided biopsy.

It should be said that in a number of cases it is not possible

obtain morphological confirmation of the diagnosis

in the presence of obvious clinical and instrumental

signs of stomach cancer, which is especially common

for infiltrative tumors with predominant

spreading throughout the submucosal layer. Such

situations, preference should be given to active

surgical tactics - diagnostic laparotomy

with intraoperative clarifying diagnostics.

Ultrasound examination (ultrasound).

Ultrasound examination of the stomach consists of 3

stages: 1) transabdominal examination;

2) polypositional polyprojection study

stomach after filling it with degassed liquid

to improve visualization of organ walls;

3) the final stage is the study of the wall

stomach with an intracavitary ultrasound sensor, with

which evaluates the depth of invasion of the stomach wall

tumor, condition of perigastric lymphatic

Laparoscopy. Laparoscopic diagnosis

carried out to clarify the depth of the lesion

tumor of the stomach wall, in particular the outlet to

serous membrane, identifying its spread to

neighboring organs and detection of ascites and parietal

disseminates. Laparoscopic comparisons

data on the germination of the serous cover of the stomach with

data from morphological research

resected stomach showed reliability

method in 95% of cases.

Laboratory diagnostics. Blood test in

in the early period of the disease, any

changes. Anemia usually develops secondary

due to constant blood loss, insufficient

digestibility of nutrients, in particular iron, with

achlorhydria, as well as during intoxication. Change

composition of peripheral blood is most pronounced when

metastatic damage to several organs and

most typical with metastasis to the liver and

pancreas, less pronounced with

retroperitoneal tumor growth.

First of all, you should remember about precancerous

diseases of the stomach, which can give the same

chronic gastritis, polyposis, chronic ulcer

Carcinomas must be differentiated from

non-epithelial and lymphoid tumors of the stomach,

tumor-like processes, secondary tumors, and

also inflammatory and other changes,

simulating stomach cancer (tuberculosis, syphilis,

actinomycosis, amyloidosis, etc.).

In case of cardioesophageal cancer, it is necessary to carry out

differential diagnosis with diseases

esophagus, and primarily with achalasia.

19. PATHWAYS OF METASTASIS

Gastric cancer predominantly metastasizes

lymphogenous route. It is also possible

hematogenous, contact and

implantation route of spread.

In addition, there are combinations of all three

pathways of metastasis.

The most commonly noted is the following

regional barriers are affected first

(lymph nodes located in

gastric ligaments), then lymph nodes,

accompanying large arteries that supply

stomach, then retroperitoneal and organs

abdominal cavity.

51. Treatment of gastric cancer

Treatment is surgical.

Gastric cancer is an absolute indication for

operations. Radical

intervention is resection

stomach or gastrectomy.

1) intersection of the stomach, duodenum

and esophagus within healthy tissues;

2) removal of three groups in a single block with the stomach

lymph nodes that may be affected

metastases at a given cancer location;

3) ablastic operation i.e. usage

a set of techniques aimed at reducing

the possibilities of the so-called manipulation

dissemination.

Contraindications to surgery may

be oncological and general

character. The operation is contraindicated

in the presence of distant metastases in

liver, lungs, supraclavicular

lymph nodes, if present

large ascites. Contraindications

of a general nature is harsh

cachexia, severe concomitant

diseases.

Treatment for cancer is different from treatment for other organs.

If surgery is performed for carcinomas in other organs

is done only when the usual

therapy, the opposite is true for stomach cancer.

Only surgery can save

sick. This is explained by the fact that signs of cancer

unstable and may not appear for months, eventually

the patient arrives at the moment when the

stenosis phase and metastasis.

Chemotherapy, despite its capabilities, is rarely

helps stop the development of metastases and destroy cancerous

cells in adjacent organs.

Radiation therapy, which is used for most cancers

formations, in cases with the stomach is not carried out.

Drug treatment will no longer bring any benefit

result, so the only option is surgery.

If the carcinoma is small in size, then

resection of the stomach, removing most of it.

But in many cases the stomach has to be removed completely,

At the same time, all affected lymph nodes are removed. In progress

In operations, the esophagus is sutured directly to the intestine.

In addition to removing the stomach tumor, lymph nodes and fat are removed.

fiber. Lymph dissection makes it possible to significantly increase the 5-year

survival and reduce the number of relapses. All operations are performed

minimally invasively using laparoscopic techniques. Subtal resection

is done for a small tumor that is located at the exit of the stomach, and

Approximately 4/5 of the stomach is removed. Other cases are removal of the stomach and

all zones in which lymph nodes with metastases are located, while

The esophagus and small intestine are sutured.

Treatment with surgical radical intervention

subtotal proximal gastrectomy;

gastrectomy;

subtotal distal gastrectomy.

Subtotal distal resection

During this operation, ¾ of the distal stomach with ligamentous apparatus and

lymph nodes. The entire lesser curvature is removed.

Subtotal proximal gastrectomy

This operation involves removing the entire lesser curvature of the stomach from

paraesophageal lymph nodes and lesser omentum, as well as

part of the greater omentum.

Treatment of stomach cancer with gastrectomy

It involves complete removal of the stomach with ligamentous apparatus,

omentums and all areas of metastasis.

If stomach cancer has spread to neighboring organs, do

extended combined resections and gastrectomy, and together

with complete or partial removal of the stomach, part of the adjacent one is also resected

sick.

Therapeutic tactics are decided individually in each

specific case at the MDG with mandatory participation

surgeon, anesthesiologist, radiologist and chemotherapist.

The main treatment method for patients with stomach cancer is

surgical. In recent years, they have been developing

principles and techniques of combined complex

treatment. Radiation and drug therapy as

independent methods are used only when

contraindications to surgery in patients with

advanced cancer or severe concomitant

diseases.

There are 3 main types used for stomach cancer

gastrectomy

distal subtotal resection - removal

4/5 or more parts of the stomach.

proximal gastric resection, removal of 4/5 or more parts of the stomach.

Indications for distal subtotal resection

stomach is exophytic cancer of the lower third

stomach. According to strict indications, this operation

allowed for small endophytic or

mixed growth form of pyloroantral tumors

department. In practice, such tumors are not found

in more than 1.5% of cases, which defines low

the significance of these operations.

Proximal subtotal gastrectomy

transperitoneal access is performed only when

exophytic tumor of the upper third of the stomach, not

extending to the cardia rosette.

Gastrectomy is performed for any cancer

macroscopic growth form,

locally advanced tumor, as well as

subtotal or total lesion

organ. Moreover, before the formation

anastomosis requires urgent

morphological examination of remote

stomach, allowing you to verify

absence of tumor cells along the line

resection of the stomach and esophagus to avoid

continued tumor growth.

Today, the search for new surgical approaches continues,

allowing us to hope for improvement in long-term

results of treatment of stomach cancer. One of the solutions

This problem is the implementation of advanced and

combined surgical interventions.

Surgical approaches when lymphatics are removed

nodes only with their macroscopic changes, it should be

examination of lymph nodes after surgery

allows us to establish that “intact” lymph nodes

are affected by cancer metastases in 57.1% of cases.

Given the large number of lymph nodes,

potentially capable of metastasis,

it is impossible to establish the true lymphogenous

metastasis, and, consequently, the stage of the tumor

process without the most complete removal and study

all regional lymphatic collectors, that is, without

performing extended lymph node dissection.

does not exceed D2.

fractionation.

inside.

Operational

Combined

Complex

Possibility of complete tumor removal

Absence of distant metastases: in

liver (H1-H3), Virchow, Krukenberg,

Schnitzler, S.M. Joseph, carcinomatosis

peritoneum (P1-P3),

Functional portability

interventions

Indications for performing subtotal distal resection

Exophytic

X-ray

endoscopic

signs

infiltrative growth.

No transition to the angle of the stomach (lower third

there are no multicentric growth foci.

no metastases to paracardial lymph nodes

zones, retroperitoneal, splenic, celiac area

trunk, at the gate of the spleen.

Absence of massive exit of the process to the serous

stomach lining

Proximal subtotal gastrectomy

can be performed depending on the size of the tumor

up to 4 cm, with localization in the proximal

department without spreading to the upper

third. Moreover, it is mandatory

resection unchanged visually and

palpation of the stomach wall to 2 cm

distal to the defined tumor border

with a superficial character

growth, by 3 cm with exophytic and by 5 cm with

endophytic and mixed types of growth.

The surgical method remains the gold standard in

radical treatment of GC, allowing hope for

complete recovery.

Radical operations for gastric cancer include mandatory

monoblock removal of regional lymphatics

nodes

Preventive monobloc zone removal concept

regional metastasis together with primary

lesion of GC is associated with the name of the Japanese surgeon Jinnai

(1962), who, based on his results

considered such a volume of intervention as

radical. From this moment on, the expanded radical

lymph node dissection as a mandatory integrated stage

operation became a generally accepted doctrine

surgical treatment of gastric cancer in Japan.

Various options for lymph node dissection have found their way

reflected in the classification of the volume of intervention, on

based on the last deleted stage

metastasis.

TYPE OF SURGICAL INTERVENTION

Standard gastrectomy (SG) D1 for volume

lymph node dissection N1.

Standard radical gastrectomy (SRG) D2 for

volume of lymph node dissection N1-2.

Extended radical gastrectomy (ERG) D3

volume of lymph node dissection N1-3.

Chemotherapy – neoadjuvant, adjuvant,

perioperative, adjuvant chemotherapy and/or

radiation therapy, hyperthermic

intraoperative intraperitoneal

chemotherapy (HII), early

postoperative intraperitoneal

chemotherapy

Self-administered chemoradiotherapy

Preoperative and intraoperative

radiation therapy

Stage 1 – 74.0% (D1), 92.4% (D2.3)

Stage 2 – 66.1% (D1), 75.9% (D2.3)

Stage 3 – 24.6% (D1), 47.7% (D2,3)

Stage 4 - 0% (D1), 16% (D2,3)

Japanese Gastric Cancer Association,

1992

43. Surgical treatment of gastric cancer

access),

When determining indications for surgical treatment, the doctor should

be guided by objective data from clinical and

physical examination of the patient, based on which

preoperative clinical staging is performed

diseases and functional operability is assessed.

Mandatory preoperative morphological

biopsy examination, which in combination with

characteristic of the type of growth allows you to plan

adequate volume of operation

All patients require X-ray and

endoscopic examination. Only a combination of both

methods allows you to assess the nature of tumor infiltration

through the stomach with possible transition to adjacent structures

Gastrointestinal tract along its length (esophagus, duodenum) and

classify the type of tumor growth, which is

an integral indicator that combines data

X-ray and endoscopic examination.

X-ray examination. Is

main in determining localization and

the extent of damage to the organ wall.

It is advisable to carry out comprehensively, using tight

filling and double contrasting. First

most informative for exophytic tumors,

the second (including the combined use of barium with

effervescent substances against the background of wall relaxation

stomach using glucagon) – allows you to evaluate

intramural infiltration of the gastric wall and

involvement of adjacent structures throughout. Should

note that all patients with identified ulcers

stomach must undergo additional

endoscopic examination with morphological

verification of changes in the mucous membrane in the area of ​​the ulcer.

Judge the nature of the ulcer only from the data

X-ray examination is not possible.

Endoscopic examination. Is one of

the most informative methods for diagnosing gastric cancer, because

it determines: the border, nature and form of growth

tumors; spread of infiltration to the esophagus;

presence of complications. In some cases it is done

chromendoscopy examination. For this purpose the mucous membrane

stained with 0.1% indigo carmine solution or

methylthioninium chloride. The method allows more

establish in detail: infiltration boundaries even

with endophytic spread through the submucosal

layer; the presence of a synchronous tumor and intramural

dust-like metastases in the stomach wall at the level

submucosal layer.

Ultrasound of the abdominal organs, retroperitoneal

space. Mandatory research method

patients with gastric cancer. Women must include

pelvic organs.

Endoscopic ultrasound examination

(EUS). A promising method of complex diagnostics

intramural and lymphogenous spread

tumor process. The method accumulates

endoscopic and ultrasound capabilities

research, which allows with high reliability

determine intramural extent

process, including: depth of invasion into the wall, presence

metastases in lymph nodes not only perigastric, but also

retroperitoneal and even para-aortic and performed

puncture for the purpose of morphological verification.

CT. Its place in the preoperative diagnosis of gastric cancer

remains uncertain. Last time

use of spiral tomographs and methods

contrasting combined with the possibility

3D image construction has improved resolution

method ability.

Extracorporeal ultrasound. Depth estimation possible

gastric wall invasion and preoperative

definition of the symbol st. High enough

sensitivity (76.3%). Better reliability with

tumors in the muco-submucosal layer (cT1 – 87.1%) and

with germination of the serous membrane and involvement

surrounding structures (cT3/T4 – 76.9%). In others

In cases, overdiagnosis is possible.

Laparoscopy. To date

laparoscopic examination is

mandatory in preoperative staging of gastric cancer and

should be performed routinely on all patients.

frequency of intraperitoneal dissemination of gastric cancer,

undiagnosed using non-invasive methods

research, as well as suspicion of the presence

subcapsular formations in the liver identified

with ultrasound and CT examinations.

Despite the significant increase

resolution of diagnostic

procedures, development and optimization of techniques

research, final conclusion about

true prevalence of the process with

the possibility of performing radical

operations can often be obtained only with

intraoperative revision.

Combined

Exophytic

X-ray

endoscopic

signs

stomach lining

nodes

metastasis.

lymph node dissection N1.

8. Risk factors for gastric cancer

High intake of unrefined fats

Dietary features (low animal protein,

fresh herbs, vitamin C, microelements,

milk and dairy products, predominance

plant products with excess starch,

eating hot food, irregular

Smoking, especially in combination with alcohol

reverse – zinc, manganese

One of the most reliable causes of cancer development

stomach are N-nitrosoamines, often

endogenous. The starting point of pathogenesis

is a decrease in gastric acidity

juice, for chronic gastritis,

promoting the development of pathogenic flora,

with an increase in the synthesis of nitro compounds.

15. Background diseases or risk groups for developing stomach cancer

Epithelial polyps

Gastric resection

is

deletion

basic

parietal

Ménétrier's disease

mucous membrane,

reminiscent

convolutions

Detection of precancerous conditions and regular medical examination.

Diet. Reduce consumption of fatty, salty, smoked and fried foods, spicy and

spicy foods, do not abuse alcohol, avoid preservatives and

dyes.

Be more attentive to the vegetables you eat, as they could potentially

Observe moderation in the use of medications (especially analgesics, antibiotics,

corticoids).

Reduce the negative impact of the environment, harmful chemicals

connections.

Eat more fresh foods rich in vitamins and

microelements, as well as dairy products.

Maintain a normal diet, avoiding too long breaks

between meals, overeating.

Primary prevention of gastric cancer in

generally repeats the same for others

malignant tumors.

The secondary has a number of features. She

is based on timely identification and

adequate treatment of precancerous

diseases and early stomach cancer.

The main task in this matter is

active identification of patients with this

pathology. Introduction of screening

programs.

Most favorable results

surgical treatment of stomach cancer

can be obtained during treatment

early forms of cancer.

When only the mucous membrane is affected

shell 5-year survival rate

reaches 96-100%,

with damage to the mucous membrane and

submucosal layer – 75%.

Description of the presentation by individual slides:

1 slide

Slide description:

2 slide

Slide description:

TUMORS OF VISUAL LOCALIZATION. In the Russian Federation, as in most developed countries of the world, there is a tendency towards an increase in the incidence of malignant diseases and mortality from them. In the structure of mortality of the population of our country, malignant diseases occupy 3rd place after diseases of the cardiovascular system and accidents. The absolute number of people registered with a first diagnosis of cancer has increased by 20% over the past 10 years. Every year, more than 550 thousand patients are identified in the Russian Federation, which corresponds to the registration of 1 patient every 1.3 minutes. For every 82 residents of the Russian Federation, there is 1 patient with cancer; the incidence rate in men is 1.6 more than in women. In the structure of overall morbidity, lung cancer is in 1st place - 12.6%, skin cancer is in 2nd place - 11.6%, breast cancer is in 3rd place - 10.2%, stomach cancer is in 4th place - 6.7% %. In women, every 5 detected tumors are breast tumors. Tumors of the stomach, skin, cervix, ovaries, and colon have a high proportion.

3 slide

Slide description:

ONCOLOGY AND DEMOGRAPHIC PROBLEMS OF THE AMUR REGION. The Amur Regional Oncology Center registered more than 17,000 patients with an established diagnosis of malignant neoplasm. The number of cancer patients was 1.4% of the total population of the region. It has been noted that over the past 5 years, the incidence of malignant diseases has been constantly increasing, and the average age of patients is 40 – 69 years. The overall indicator of neglect, reflecting the state of diagnosis of malignant neoplasms, was 25.6%. Thus, in every fourth patient the tumor is diagnosed in the presence of distant metastases. In general, 32.8% of patients with malignant neoplasms die less than a year after diagnosis.

4 slide

Slide description:

INCIDENCE BY NOSOLOGICAL UNITS IN THE AMUR REGION: Men Women Children 1. Lung cancer Breast cancer Hemoblastoses 2. Skin cancer Skin cancer Musculoskeletal system 3. Stomach cancer Uterine cancer Congenital tumors 4. Male tumors Cervical cancer Gastrointestinal tract tumors of the genital area

5 slide

Slide description:

Causes of cancer. STRESS ECOLOGY HEREDITIES VIOLATION OF WORK AND REST REGIME DISORDERS DIUTRITION HARMFUL WORKING CONDITIONS

6 slide

Slide description:

Tumors of visual localization Skin Peripheral lymph nodes Oral cavity (lip, tongue, oral mucosa, soft and hard palate, tonsil) Thyroid gland Breast gland External genitalia Cervix Rectum

7 slide

Slide description:

Features of malignant tumor cells. Autonomy - lack of control of growth - disobedience to those regulatory influences that limit or stop the reproduction of normal cells. Anaplasia or differentiation of tumor cells is the loss of their ability to form a specific structure and produce specific substances. Atypia of tumor cells is closely associated with anaplasia. Infiltrated or invasive growth is the ability of tumor cells to grow and destroy surrounding healthy tissue. Infiltratively growing tumors that spread throughout the organ, often ulcerate, have no visible boundaries, are also called endophytic, growing predominantly deep into the organ. Tumors that grow into the lumen of the organ, protrude significantly above the surface of the mucosa and have boundaries, are called exaphytic. A mixed type of tumor is more common. As the tumor grows, endophytic growth begins to predominate. The more pronounced the infiltrative component, the more malignant the tumor. Metastasis is the main way a malignant tumor spreads. As a result of the transfer of tumor cells or groups of cells along the lymphatic (lymphogenic route) and blood (hematogenous route), new foci of tumor growth are formed. In some cases, metastases begin so early, with a small primary tumor, that they overtake its growth. And all the symptoms of the disease are caused by metastases. More often there is a mixed - lymphohematogenous path of metastasis. The following types of metastases are distinguished: 1. Intraorgan - these are detached tumor cells that have become embedded in the tissue of the same organ. 2. Regional - they are located in the lymph nodes close to the organ in which the tumor has grown. 3. Distant - dissemination or generalization of the process.

8 slide

Slide description:

PREVENTION OF BREAST CANCER. Breast cancer is the most common form of malignant tumors in women. Every year, more than 1 million cases of breast cancer are registered worldwide, and the number of cases is growing year by year. Today, the number of women with newly diagnosed breast cancer is 1.5 times higher than 15 years ago. The risk of disease is determined by many factors. Breast cancer progresses much faster in young women than in older women. How to recognize the disease. Typical symptoms of breast cancer: Nipple retraction and bloody discharge. The skin of the breast acquires an “orange peel” appearance. Enlargement of nearby regional lymph nodes. It is necessary to regularly conduct self-examination and medical examination. It is better to consult a mammologist, but an oncologist or surgeon can also conduct an examination. In the early stages, the main method for detecting breast cancer is an X-ray examination - mammography. Additionally, the doctor may refer you for an ultrasound examination and puncture (biopsy). In addition to traditional examination methods, computer and magnetic resonance imaging and mammoscintigraphy are used for diagnosis.

Slide 9

Slide description:

The main risk factors for developing breast cancer: Family history - breast cancer in close maternal relatives Various benign breast diseases, including mastopathy Age (the incidence of breast cancer detection increases in women over 40-45 years of age) Hormonal disorders, female loneliness, absence of childbirth, late first birth and inadequate lactation Stress, difficult environmental situation, etc.

10 slide

Slide description:

Factors that reduce the likelihood of developing breast cancer: Late onset of menstruation Early end of menstruation Breastfeeding Regular mammograms and regular breast examinations Healthy lifestyle Regular breast self-examination Maintaining a normal body weight Avoiding or infrequently drinking alcohol Healthy diet

11 slide

Slide description:

Breast self-examination. This is an examination and palpation of the mammary glands by the woman herself, which makes it possible to detect a tumor in the early stages. Conduct self-examination at least once a month. When you feel the seal, do not be alarmed, because... it can also have a natural character. For example, a week before menstruation, lumps the size of an orange seed may appear, which disappear with the onset of menstruation. In addition, lumps can be caused by increased estrogen levels. Such lumps rarely degenerate into cancer, but only medical examinations can diagnose the nature of the lumps.

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How to conduct a self-examination. Inspection. Stand in front of a mirror with your arms down, then raise your arms up. When examining, look for the following signs: - Retraction or bulging of an area of ​​skin - Retraction of the nipple or shortening of the radius of the areola - Changes in the normal shape and size of one of the mammary glands - Yellowish or bloody or bloody discharge from the nipple or other changes to the nipple.

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Feeling. While lying on your back, lift your chest on the side being examined by placing a small cushion under your shoulder blade. Gently feel the mammary gland with the hand of the opposite side of the body, simultaneously grasping small areas of the breast. Feel each breast while lying down in the following positions: Hand up and behind the head Hand to the side Hand along the body Try to determine if there are any changes in the structure of the breast tissue or other changes

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Feeling technique. Using the fingers of the opposite hand, feel the outer half of the breast from the nipple, moving outward and upward towards the side of the chest. Feel all areas of the inner half of the breast, starting from the nipple and moving towards the sternum. 2. Feel the axillary and supraclavicular areas. 3. Use your fingers to squeeze the areola and nipple. Check for nipple discharge.

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SYMPTOMS OF BREAST CANCER Retraction of the skin over the tumor. Determined upon inspection. The cause of the symptom is the pulling of subcutaneous tissue towards the tumor. The “lemon peel” symptom is a change in the skin in which pores become more noticeable and swelling of the skin is noted. Breast deformation.

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SYMPTOMS OF BREAST CANCER Tumor. Most often it is determined by the woman herself. In most cases, the size of the detected tumor is more than 2 cm. The tumor has a vague outline, often the tumor is lumpy and irregular in shape. A site symptom is a violation of the contour of the mammary gland when palpating the area where the tumor is located. Instead of a round surface, a platform is formed. The cause of the symptom is the pulling of subcutaneous tissue towards the tumor.

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SYMPTOMS OF BREAST CANCER An ulcer on the skin of the breast. Indicates that a tumor has invaded the skin. It is a symptom of an advanced tumor. Nipple retraction

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SYMPTOMS OF BREAST CANCER Redness of the skin of the breast. With a malignant tumor of the mammary gland, it indicates damage to most of the mammary gland. Indicates an advanced tumor. Nipple skin irritation, peeling. Occurs in Paget's cancer.

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SYMPTOMS OF BREAST CANCER Swelling of the breast. It may occur as a result of damage to the breast tissue and a violation of the outflow of fluid in connection with this and in connection with damage to the axillary lymph nodes. Indicates an advanced tumor. Enlarged axillary lymph nodes. As a rule, it indicates damage to the lymph nodes.

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SYNDROME OF ACTIVATION OR MALIGNANT DEVELOPMENT OF PIGMENTARY NEVUS. Changes in the size, shape, thickness of the pigmented nevus, increase and/or decrease in the degree of pigmentation, its unevenness; The appearance of a corolla of hyperemia, radiant growths, uneven contours or edges, pigment satellites near or at some distance from the maternal formation; Ulceration of the surface, bleeding on contact, crusting, burning or itching.

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Most often, basal cell carcinoma is localized in the following areas of the skin: Upper or lower eyelid; Nose; Nasolabial folds; Cheeks; Auricle; Neck; The scalp.

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Causes of lip cancer: exposure to sunlight, frequent exposure to high temperatures, frequent mechanical injuries, smoking (especially pipes), chewing tobacco, chemical carcinogens: compounds of arsenic, mercury, bismuth, anthracite, liquid resins, petroleum distillates, alcohol, viral infections, chronic inflammatory processes