MINISTRY OF HEALTH OF UKRAINE
Kharkiv National Medical University
Approved
on the methodical meeting Department of Oncology
Head of Department
MD, professor Starikov VI
'28"August 2011
A methodical DEVELOPMENT
For independent work of students
Course 5
Faculty of Medicine (specialty "General Medicine", "Pediatrics", "Prophylactic medicine")
Study Subject: Oncology
Module number 1
Content module № 1
Subject: № 3. Liver Cancer. Pancreatic Cancer
number of training hours -5
Kharkiv November 2011
Topic.
Malignant tumors of the liver and pancreas - one of the difficult problems of oncology. Among all malignancies liver cancer is 1-2%. Men suffer more than women (3:1), aged 50-70 years. The most common tumor of head of Pancreas cancer is 60%, the body of cancer - 10% tail - 5% total defeat - about 25%.
An important problem is the extremely low efficiency of treatment. Weather is often poor. Onkonastoroha, correct assessment of clinical manifestations, use of modern methods of diagnosis and timely referral to specialized hospitals will significantly improve treatment outcomes.
Overall objective: to be able to diagnose and treat liver tumors (RP) and pancreatic cancer (prostate cancer).
Know:
1. Etiology and pathological anatomy RP and RPG.
2. Classification of RP and prostate cancer in stages.
3. Clinical picture of RP and RPG.
4. The current diagnosis of RP and RPG.
5. Treatments RP and RPG
Be able to:
1. Absorb the history of a patient with RP and RPG and make its analysis.
2. Run superficial and deep palpation of the abdomen.
3. Work plan and examination of the patient, based on a survey of the patient, formulate clinical diagnosis and treatment plan.
Contents of training
Theoretical questions to topics that must learn studentyi: Primary and metastatic liver cancer. Case rate and mortality.
Company growth and histological structure. Etiopathogenesis and holanhiotselyulyarnoho hepatocellular cancer. Prevention.
Symptoms of liver cancer. Periods of development and clinical forms.
Diagnostic methods: reaction Abelyeva-Tatarinov, radioisotope scanning. Sonography, CT, puncture liver laparoscopy.
Principles of treatment.
Case rate and mortality from prostate cancer. Prevention.
Pathomorphology: localization, macroscopic forms, histological structure, metastasis.
Symptoms of prostate cancer. The clinical picture depending on the tumor.
Diagnosis. The value of history, objective and laboratory studies.
Differential diagnosis of jaundice on the basis of tumor of pancreatic head.
Modern methods of examination: relaxation duodenohrafiya, endoscopic retrograde Cholangiopancreatography, CT.
Principles of surgical treatment. Results.
There are primary and secondary (metastatic) liver cancer. Metastatic cancer occurs 50 times more often than the original. In the development of liver cancer aflatoxins play a significant role - the waste products of plesenevoho fungus that affects food (grain, flour). A direct correlation between the incidence of liver cancer and liver spread of opisthorchiasis.
Distinguish: anchor, solid as a single node and diffuse form of liver cancer. Histologically distinguish cancer that develops from cells pechinkovyz - hepatocellular (malignant hepatoma) and holanhiotselyulyarnyy - hepatic bile ducts.
Patients with liver cancer complain of pain in the right upper quadrant, loss of appetite, weight loss. OBJECTIVE: most common symptom is hepatomegaly, sometimes - tuberosity of the liver, increasing temperatuty, ascites, jaundice. This late symptoms.
Diagnosis: Ultrasound can detect focal changes in 85% of patients with liver cancer. Determination of alpha-fetoprotein (AFT) in serum of patients. In hepatocellular liver cancer AFP determined in 70% of patients.
Treatment. Hepatectomy with liver allotransplantatsiyeyu. Chemotherapy of 5-fluorouracil and ftorafurom - improvement in 20-25% of patients.
In recent years, a growing incidence of pancreatic cancer (prostate cancer). In Ukraine, it takes 7 among all malignant tumors (7-10 cases per 100,000 of us.). Fatty foods, alcohol, smoking, cancer genes in foods, nitrates, nitrites prone prostate cancer.
Most affected head cancer. body and tail are affected less. Histologically differentiated adenocarcinoma, including lining and nedeferentsiyovanyy cancer. RPZ quickly metastasizes to lymph nodes in the area of cancer, target the liver and liver. When obturation choledochal appears jaundice - in 90% of cases positive symptom Courvoisier. In cancer, the body and tail of the pancreas no jaundice. Patients complain of epigastric pain, anorexia, weight loss, pain radiating to the back. Sometimes a tumor palpable. Dyfdiahnoz conducted with stomach cancer.
Diagnosis: radiography of the stomach and duodenum. In cancer, head cancer is unfolded horseshoe duodenum, narrowing bowel tumor and cancer in the body of cancer - a shift back wall of the stomach doperedu.
When laparoscopy is advanced gallbladder, dissemination to the peritoneum and liver metastases. Liver ultrasound detects density cancer foci and density cancer. CT detects tumors and their sizes in the gland.
Treatment. In cancer of the head - pancreatic-duodenal resection. Often impose bilidyhestyvni anastomoses. Assign 5-acyl ftorur, mitomycin C adriablastyn.
Literature
Summary:
Bilynsky BT Oncology. Lviv, 1998.
Bilynsky BT Oncology. Lviv, 1992.
Peterson BE CANCER. Moscow: Medicine, 1980.
Slynchak SM CANCER. Kiev, 1989.
Trapeznikov NN CANCER. Moscow: Medicine, 1981.
Lecture material.
Further Reading: