Ministry of health of ukraine
Kharkiv National Medical University
Approved
on the methodical meeting Department of Oncology
Head of Department
MD, professor of Starikov VI
'28"August 2011
A methodical DEVELOPMENT
Guidelines 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: № 5. Lung cancer, tumors of the mediastinum.
number of training hours -5
Kharkiv November 2011
I. Background.
One of the most pressing problems of clinical oncology today is the problem of diagnosis and treatment of lung cancer. With rare meeting is at my dis ing the early twentieth century, lung cancer has become most widespread in human tumors to the XXI century.
Today in the structure of cancer incidence, lung cancer ranks first. Over the past 20 years, lung cancer incidence in Ukraine grew weakly at more than 2 times. Our country is put to the states with the highest incidence lung cancer, it accounts for 15.3% of all cancer patients. The highest incidence recorded in the industrialized regions of Donetsk, Mykolayiv, Kharkiv.
Male and tion in patients 7-8 times more often than women.
The most tragic aspect that characterizes cancer LEG problem is not, there is a constant increase in mortality. According to O in C, with 4.5 million deaths, and challenge them in creative new malignant ennyamy, recorded worldwide every year, more than 1 million accounts for patients who die from lung cancer.
Ongoing steady incidence can speak about the epidemic nature of the disease. In connection with this problem of cancer gene l is long gone beyond clinical oncology and become social problems is mine. This disease has all the most unfavorable characteristics of malignant tumors, including long baa from the village and mptomnyy period flow, elimination t ness pathognomonic symptoms is rapid lymphogenous and hematogenous met and stazuvannya.
Awareness of these factors should lead etiolohichnyh stud e NTA on the impermissibility of bad habits i interviews among the population. Required knowledge of possibilities of surgery, radiation therapy to cure cancer specified location.
Study objective: To raise the level of theoretical and practical knowledge Mr ing studies on prevention, pathologic anatomy, clinical, class features and nighttime course, complications, diagnosis, differential diagnostics and modern ch f tslikuvannya lung cancer and mediastinal tumors.
Know:
Clinical picture of precancer lung cancer and mediastinal tumors.
Classification, clinical manifestations, complications, diagnosis of lung cancer and pu's lin mediastinum.
Methods for combined treatment of lung cancer and mediastinal tumors.
Be able to:
1. On the basis of complaints, anamnesis, objective research, to identify the main syndromes of lung cancer tumors and tumors of the mediastinum, put a preliminary diagnosis. 2. Appoint additional examination methods and evaluate their data 3. Conduct differential diagnostics, to put the final diagnosis. 4. Appoint treatment 5. To carry out rehabilitation and preventive measures
Educational objective: to promote the education of students the principles of cancer where at ntolohiyi on specific clinical examples.
Duration of training - 5:00 s.
Contents of training
Brief guidelines for the work of students on practical zanya t ones.
In classrooms called theme, the general and specific objectives classes. In kladach and conducts test control entry-level knowledge.
More students in the Department of Thoracic HOKOD or surgical breath and Lenny HIMR conduct independent curation of patients with lung cancer and mediastinal tumor and us, alternatively, under the supervision of a teacher. To evaluate correctly at STI test constantly engaged other students., Pay attention to an mnez and patients familiar with the methods and results of laboratory studies and researches and findings are entered in workbooks.
Curator, based on the data, making the sick. I considered giving the question of etiology, pathogenesis, classification TNM lung cancer and tumor and mediastinal us, stops on the role of factors that contribute to the development of the disease is given at first.
More students together with the teacher to discuss the findings, clinical manifestations, stage of disease, differential diagnosis and modern methods l and forging and prevention of lung cancer and mediastinal tumors.
At the end of class, the instructor controls the final level of knowledge, and more confused est. knowledge and skills of students through tasks, tests, leads pi d bag sessions.
Incidence in Ukraine 44.6 in Kharkiv region - 37.1 per 100 thousand people (2001). In the structure of morbidity takes first place in the men (23.07%) and eighth place in the women (4.95%).
Risk groups
1. Malicious smokers.
2. Patients X O ZL (chronic bronchitis, fibrosis, asthma).
3. Patients with tuberculosis (lung cancer grows scar tissue).
4. Hazardous industries (refining, paint manufacturing, smelting and metal processing, manufacture of asbestos cement, welders).
5. Genetic predisposition - persons who have or have tumors other home network and Zats and machinery.
Clinical and anatomic classification by AI Savitsky:
1. Central (80%) - the main growing epithelium partially ce d mentarnyh bronchi, while there is atelectasis of part or all l f gene:
- Perybronhy cial and (seemingly bronchus) - f ndobronhyaln j (эkzof and TNA fo r ma) - branched (creeping along the wall of the bronchus).
2. Peripheral (about 20%) - rising from the epithelium of the bronchioles, atelectasis no: pnevmonyepodobna form; abdominal form; Penkosta cancer (cancer of the lung apex).
3. Al and pychn and forms 2-3% (manifested clinic hematogenic metastases):
bone, brain, liver, honey and astynalna, miliary kartsynoz.
Histological forms:
1. Ploskokl and hospitable cancer (VC and dermoydnyy) - 40 - 45% 2. Adenocarcinoma (with a lizystyy cancer) - 20% 3. Small cell - 25 - 30% .4. Krupnokl and Tina cancer 5 - 10% 5. Carcinomas and Dr.
Central Clinic cancer caused tumor growth in the lumen of the bronchus is lykoho and atelectasis:
1. Chest pain - caused by tumor growth in the lumen of the bronchus and germination of nerve endings in the bronchial tubes.
2. Cough - due to the growth of the tumor into the lumen of the bronchus and irritation of nerve endings (in the type of th a foreign object).
3. Hemoptysis - the collapse of the tumor and the allocation of sputum streaks of blood.
4. Shortness of breath - obstruction of the bronchus tumor off the act of breathing and gas exchange at major areas of pulmonary parenchyma.
5. Hyperthermia - obstruction of bronchial tumor, g and poventylyatsyya, development and p rakankroznoy pneumonia (pneumonia that accompanies cancer).
Clinic peripheral cancer very poorly, the tumor is often found in Prospect at fohlyadah by fluorography, possible symptoms:
1. Pain in the chest only during germination pleura or bronchi, as in the lung parenchyma are no nerve endings.
2. Cough - germination bronchus.
3. Hemoptysis - germination bronchus.
Metastasis of cancer lung:
1. L and mfohenne: bronchopulmonary and l and IFI UZL s, lymph nodes root of the lung - N 1, mediastinal lymph nodes of the lesion (paratrahealn and would Furko and HH nd c and f couple zofahealn etc.), N 2 lymph in UZL and seredostynnya from the opposite side, over-and subclavian l and IFI UZL s - N 3.
2. Hematogenous: liver, brain, bones, pleura - lung parenchyma, and retroperitoneal l IFI UZL s.
TNM Classification 7 edition, 2007