1. Surgical treatment
Perform the following operations:
1. Forehead is ktomiya - With small peripheral tumors or tumors are CC b (T 1 N 0 M 0) without evidence of metastasis to lymph nodes cor f ing particles or lungs.
2. Pneumonia is ktomiya - Removal of the lung along with fiber root. Carried out at the central or peripheral cancer metastasis and we in the lymph nodes of the root (T 1-3 N 1 M 0).
3. Extended pneumonia is ktomiya - removal of a lung with fiber sredostinnya from defeat. Running with tumors of any l o cal yzatsyy with metastases in lymph nodes with f and redost tion (T 1-3 N 2 M 0).
4. Combined pneumonia is ktomiya - removal of a lung together with any authority (part of it) or the structure of the chest cavity. This m at zhut be pericardium, diaphragm, trachea, chest wall with ribs and without them, the odd vein of the left atrium. Performed at T 3-4 N 2 M 0.
2. Radiation therapy may be used as an independent method (for p and dykalniy or palliative program), and as part of a combined medi tion n. After radical surgery in 3 weeks starting radiotherapy or standard fractional factions. The total focal dose of 40 Gy, focal dose of 2 Gy. 5 days a week of exposure, 2 days break. Irradiation is carried out with two opposing fields in the input field irradiation at dyat bronchial stump and seredostin tion. In a radical program of SOD at long dyat to 60 Gy. In recent years, trying to hold neoad b yuvantnu (peredop e ratsiynu) radiotherapy moderate factions OD 5.4 Gy, SOD December 20. Irradiation performed 4 - 5 days, then the next day at Lane reproduced surgery.
3. Polychemotherapy (PCT) - can be used as an independent method (palliative), and as part of combination therapy. PCTs may be applied as tysya before surgery (neoad yuvantna b) and after surgery (al b yuvantna). Commonly used few (2-4) of drugs with different mechanisms of action. Prov reproduced at 3 - 6 courses every 3 - 4 weeks. The most common modern scheme l and forging:
for non-small cell cancer
CAP (cyclophosphamide 400 mg / m 2, doxorubicin 40 mg / m 2, cisplatin 40 mg / m 2 in one day)
EP (60 mg / m 2 on day 1, etoposide 120 mg / m 2 in 4, 6, 8-day)
for small cell
ASO (doxa rubytsyn at 50 mg / m 2 on day 2, cyclophosphamide 400 mg / m 2 from 1 to 5-day, vincristine 2 mg in the 1st and 5th day).
Complications of lung cancer:
1. Pulmonary hemorrhage, compression syndrome (syndrome X of New sdavlenya September hollow vein coffee syndrome). Paresis called orotnoho nerve
In mediastinal tumors usually referred sincere tumors and cysts and tumor formation ynopodibni (100 illnesses). The structure of cancer and diseases is about 1%.
Tumors of the mediastinum
By growths used mediastinum and usually referred stynni tumors ing down with you and ling at similar formation. Clinically in new creative Power saving should be divided into four groups: 1) tumors (benign and malignant) and cysts of tissue Em b p and ord Enno inherent with e redost others nude - so-called primary tumors and cysts in August dostinnya f, 2) retrosternal and intrathoracic goiter and also (benign and zloyaki sec tion), 3) metastatic cancer of other organs, 4) psevdopuh Linney disease lesions liter mfatychnyh nodes in tuberculosis and Eh and nokokk ozi, lymph, mesenchyme and fig b n and other formation.
Terato and days and formation consisting of different fabric and x is a shout.
Pathological Anatomy. Teratomas by Diehl S BY on mature and immature. All CL and Lee teratomas usually well so kapsulyrovan and wrong th round or s and flax forms of various sizes. In the context of cysts and often prominent. Immature teratoma m a tion form sol and packing and x nodes, sometimes with small cavities. Their surface is hilly, dense fabric. Cities With such brushes - similar to fat mass viscous, brown liquid hair. Teratomas may include areas of glands, teeth, and c k ing and sometimes partially cha with the developed fetus.
Diagnosis. The clinical picture depends on the location, intensity and size of the tumor growth, maturity, complications (infection, and in the prophecy of the nearest authorities and others.).
Allocate the Bess and mptomn and uncomplicated, but manifested clinically complicated and teratomas. Located in the front s e r e acc and n or, often in the middle of his third, teratomas often accompanied kardyovaskulya p n and we disturbances (tachycardia, constricting pain in the heart). Compression of large bronchi, trachea leads to breathlessness, sometimes to the attacks of ca sh Liu, hemoptysis. Infection often causes an increase in tumors that m perature and increase symptoms. In some patients with chest wall in and walks over teratoydn and m formation, often pulsating. The most important and vy patohnomonychn j symptom - detection in sputum hair and other TC and sues.
The main diagnostic method - complex X-ray studies and Jenny. This is determined by a round or ovo and dne formation with distinct boundaries that are not displaced when swallowing. Sometimes you can calcareous Include n ing, teeth. Detection of inclusions contributes ichne tomographic studies, especially in terms of vo and pnevmomed and astynuma. With the rapid growth and disappearance of clear boundaries should think of m and l and flexible and Zats uw.
Treatment with surgery alone. Expectant management and dynamic spost is saving inappropriate. Choice of access depends on the localization process.
And neurogenic tumors - most often found in creative new e n ing mediastinum.
Pathological Anatomy. Honey and astynaln and neurogenic tumors and can walk in and out of different nerve trunks mediastinum and nerve elements cut one of the mediastinum. Cha stishe and neurogenic tumors localized by e it s e redost others not, at least - in the front. With sympathetic nerve cells at Volyn trunk arising hanhlyonevroma, neuroblastoma, sympatykoblast at feohromotsyto ma and ma, and the tumors of the peripheral nerves, treat neuro at ma, neurofibroma and neuromas.
Hemodektoma - tumor cells with chemoreceptors. And neurogenic sarcoma - malignant tumor membranes nerves. As neurofibromas and they found Saul and packaged or in combination with disease Reklynhhauzena. Malignant new in TV at p Power saving IU astazuyut t b l and m s mfohematohenn way.
Diagnosis. Clinical symptoms can be divided into symptoms of diabetes and typically colored or nervous tissue of the thoracic, symptoms associated with dysfunction of the chest cavity due to pressure of the tumor, symptoms of intoxication. Bowls with neurogenic tumors and x among observed at wall ball isnyy syndrome, as well as increased stomlyuv ness, weak k virtue, zone d and ne p stezyy, shortness of breath, cough, fever, sweating, with thinner Power saving, irritability, palpitations, feeling sdavlenya breasts and Noah, hoarseness, Horner's symptom, numbness of hands and others. Bol CCI and reactions are of minor sensations to the strongest neuralgia. Localization at least peo often corresponds to the location of the tumor. Tumors among at rear wall often cause bol isnyy syndrome, the tumor front is dostinnya August. Hanhlyonevrom and often occur with baa simptomno for bug and toh years and the tumor reaches a larger size. The clinical picture is immature and proc and x tumors prevalent general intoxication and ball isnyy syndrome. When feohromotsytom and patients complain of general weakness, headache, palpitations, poor appetite, sweating, feeling of inner heat, with a dyshku; leading symptom - paroxysmal hypertension, palpitations and b lems at the heart. Clinical and x neurogenic tumors can vary in conn I LCU with their ability malihnizovuvatysya or succumb to spontaneous regression when ripe and bathrooms, especially in children.
Crucial in the diagnosis belongs radiological studies and investigations, as well as diagnostic tests Minoru. To clarify the size struc k rounds teneobrazovanyya, its relationship with the mediastinum using special methods: imaging, diagnostic pneumothorax, chest, etc.. Picture of blood varies with malignant degeneration of the tumor.
Treatment. Mature and neurogenic tumors removed surgically, with immature tumor surgery coupled with radiation and p and dshe chemotherapy. Methods bypass vessels and is at kstrakorporalnoho blood circulation allow radical removal of tumors that invades the vessels, with their subsequent plasticity. When malignancy tumor that invades re b ro, to remove a tumor in the block area of the affected district is bras. If confirmed by immediate microscopy malignant nature of the new work at removing enlarged para-aortic s, e zofahealn j tracheal and limfaty h or knots. When immature neurogenic tumors and x (mostly children) neo least tern and radiotherapy. Chemotherapy has not found wide applications in the bathroom with neurogenic tumors and x.
Lymphosarcoma and Hodgkin and as a localized form of in seredostin meet together in Mr. and much less in comparison with the local defeat other groups of lymph nodes.
D s and g n o s t i c a. Hospital and medyast onal and x forms lymphosarcoma and li m fohranulematozu due first intoxication, and at a white b Shih tumor size - compression of the mediastinum. In the early centuries and actions Hodgkin's disease symptoms are mild. As the process occurs at Prospect remytyruyu Mr. and temperature, one of the most important signs of the disease are itching, sometimes occurs in patients with profuse perspiration, lyrics and Biesty, marked with thin tion. Early increases BY spleen. With the growth of tumors appearing chest pain, feeling of weight in the chest, coughing and b slow but increasing shortness of breath. In Hodgkin unlike other honey and astynaln and x tumors less severe symptoms of compression. Most hara k Terni changes in the blood picture - leukocytosis or leukopenia, increased W OЭ. It can be observed also exudative j, and later hemorrahych n th player in rhythm. A characteristic feature is the bilateral is in ra tion. Lymphosarcoma and cutting I yutsya more rapid passage of progression medyastynalnoho com p resiynoho syndrome. Overall condition is deteriorating as prohresuva n ing at the main and second process. Defeat honey astynaln and x lymph nodes can be confirmed l and m fohrafyey, honey and astynoskop iyeyu.
Treatment of Hodgkin's disease and lymphosarcoma in the localization process with e redost us and conservative (chemistry and radiation therapy).
Tim and - th thymus gland tumors. Liquid disease.
Pathological Anatomy. Size tumors thymus gland th varies from 2 - 3 cm in diameter to giant - 10 - 30 cm. Accepted distinguish caps in polar yi and yi nekapsulyarn in new creative Power saving. The latter are often ma tion and nfyltryru S h i j growth, grow into surrounding organs and tissues. Tumors fork at Howl cancer are divided into three large groups: predominantly epithelial, predominantly L and MF at days and and and and and Dr. Terato. Separation Tim on benign and malignant conditions in some extent in but because in some cases, either clinically or histologically not even vdayet b Xia ascertain this.
Diagnosis. Clinical implications of t and IOM largely depend on morphology and chnoyi structure, size of the tumor and its impact on the immediate and organs and tissues. Most patients complain of weakness, fatigue, sweating, fever, hoarseness, feeling sdavlenya breasts and Noah, weight loss, cough. The most frequent and early symptom of tumors normally h KOVO cancer - chest pain that with increasing tumor gradually increases. Malignant tumors of the thymus often metastazuyut in supraclavicular, subclavian, cervical lymph nodes are enlarged, p tion and dense, sedentary. A number of patients and combined with Tim mia with shadows.
Imaging methods research is given a leadership position. The presence of shadows in the upper or middle seredosti n no bezposere d it close to the sternum makes you think about the possible pathology fork at Howl cancer. Sometimes tumors localized in the thymus is dostiny back in August. In the benign course of the boundary between the tumor and adjacent shade at p haniv are clear. Much of the X-ray tumors fork at Howl cancer and given pnevmomed astynohraf scammed.
Treatment. Power saving thymic malignancies her cancer removed by surgery. The most commonly used lateral pleural Intro ground access.
Quiz:
Lung Cancer:
1. incidence, causes, epidemiology, precancerous ill u tion
2. symptoms, diagnosis, early detection of lung cancer,
3. Differential di and Gnostics,
4. classification
5. treatment: surgery (general principles, methods); Combined at Vanya and comprehensive treatment;
6. immediate and long-term outcomes, prevention of lung cancer. Metastatic lung tumors: diagnosis, differential diagnostics and ka, treatments.
Tumors of the mediastinum (thymoma, lymphoma, teratoma):
1. morbidity and ness, symptoms, diagnosis,
2. differential diagnosis,
3. classification
4. treatment: surgery, combined and complex treatment, immediate and Dr. Dalen ve outcomes.
Quiz:
Lung Cancer:
7. incidence, causes, epidemiology, precancerous ill u tion
8. symptoms, diagnosis, early detection of lung cancer,
9. Differential di and Gnostics,
10. classification
11. treatment: surgery (general principles, methods); Combined at Vanya and comprehensive treatment;
12. immediate and long-term outcomes, prevention of lung cancer. Metastatic lung tumors: diagnosis, differential diagnostics and ka, treatments.
Tumors of the mediastinum (thymoma, lymphoma, teratoma):
5. morbidity and ness, symptoms, diagnosis,
6. differential diagnosis,
7. classification
8. treatment: surgery, combined and complex treatment, immediate and Dr. Dalen ve outcomes.
test tasks
In lung cancer often suffer from:
- Men 60 -75 years of age *
- women 40 to 50 years of age;
- equally often men and women.
Etiological factors of lung cancer is mainly:
- consumption of protein, fat in excessive amounts;
- male;
- smoking tobacco *
- trauma lips.
T2 for peripheral lung cancer are:
- tumor 3 cm;
- Tumor more than 3 cm;
- tumor which in intended to encompass neighboring structures;
- tumors up to 4 cm *
- metastatic lymph nodes neck.
clinical case studies
The task to control the entry-level knowledge.
Teaching Problem
Test 1.
Patient, 48 years old, complained of cough, shortness of breath, swelling of the face and neck. On chest expanded subcutaneous vessels. At the root of the right lung stalemate at logical entity. Liver not enlarged. The abdomen was soft on palpation.
What is the expected diagnosis?
A. Lung cancer, cirrhosis of the liver.
B. Lung cancer metastasized to the liver.
C. Lung cancer syndrome, empty veins.
D. Lung cancer metastasis to the kidney.
E. Pulmonary tuberculosis.
Test 2.
Patient G., 52 year miner smokes. Complaints of cough, increased temp and tours, small dyspnea on exertion. When radiography - reducing the transparency of lung tissue in the lower right. Over the past four months, three times ill nyzhnyedolevoyu pneumonia.
What tactics examination to confirm the diagnosis?
A. Clinical blood tests.
B. Clinical urine.
C. Bronchoscopy.
D. Esophagoscopy.
E. Tomography.
Test 3
Patient N., 59 years old, do not smoke. Complains of cough, shortness of breath, pain in the game e it right chest, fever. Ill for two weeks. X-rays at the root of the right lung rounded shadow to 3cm. in diameter. P O breath right not prosluhuyetsya, percussion - lung sounds.
What tactics?
A. Repeated courses of antibiotics.
B. Specific antituberculosis therapy.
C. Radiotherapy.
D. Obsleduvannya in onkodispanseri
E. Chemotherapy.
Test 4
The patient in '53 set atelectasis syndrome. As he clinically proya in lyayetsya?
A. Hard bronchial breathing with dry wheezing;
V. Amforychnym breath and tympanitis;
C. The emergence of different-sized dry and moist rales;
D. Weakening or absence of breathing and voice trembling;
E. Rough dry wheezing and shortening percussion.
Test 5
Patient S., 55 years. Smokes, complaining of cough, hoarseness However, I deposited week. At the root of the left lung volume education to 3 cm. Pathological With ultrasound at BIR internal organs were found.
What is the most informative method of diagnosis in this case?
A. Total blood.
B. Bronchoscopy.
C. Laryngoscopy.
D. Tomography mediastinum.
E. Эzofahoskopiya with biopsy.
Test 6
The company conducted routine inspection. What recommendation ve d relatively healthy lifestyle in the prevention of primary lung cancer?
A. Stop Smoking
B. Do not drink alcohol
C. Watch for body weight
D. Engage in physical activity
E. Perform mode of labor and labor
Test 7
A patient with suspected central lung cancer. What is the most informative method of investigation for verifikatsiyi and localization of the primary node for a given n and tolohiyi?
A Broncho g raffia
B Computing Volume at graphy.
C Bronchoscopy with bi at psiyeyu.
D Survey roentgen g raffia.
E polipozitsionnoe radiographs and raphy.
Test 8
In patient 62, who smokes and often sick 'pneum at Niyama "by Plain radiographs of the chest in the right lung showing trick t tion form eclipse with the apex directed to the root of the lungs and heart and shifting shadows among the wall at the side damage
A central cancer gene l e
Abscess B l E gene
C l e brush gene
D Periyerychnyy cancer LEG is no
E l e atelectasis gene
Test 9
When rake Penkosta which studies the most appropriate?
A Transtor and locally puncture.
B Com of printed t at mohrafiya.
C bronchus at graphy.
D bronchus at oxidized.
E Ultrasound.
Test 10
Man '72 complains of pain in the joints on flyuorohramme revealed rounded peripheral shade diameter of 2 cm in the upper right-LEG is not. Clinically, the patient has deformity phalanges as "finger drum and Chalk." What disease most likely?
A Pak lungs
B pulmonary tuberculosis with symptoms of intoxication
C Rheumatoid arthritis petryfykat in lung
D metastatic defeat lungs and joints
E tuberkulomah
Materials for the final stage of the study: clinical case studies
Final Test
Test 1
The patient, 53 years old, a month ago suddenly, overnight, developed edema of the upper half of the body, face, head, flushing of the skin, enlarged veins and Rennie neck and subcutaneous veins of the chest. Desensitization therapy d and la little effect. What is needed for diagnosis?
A. Bronchoscopy;
V. Immunological studies;
The research to identify potential allergen;
D. Radiography of the chest to exclude tumors among at wall;
E. Echocardiography.
Test 2
A man 50 years old, a month ago developed hoarseness of voice, and a week Mr. and ass - edema of the soft tissues of the head and her congestion. What disease should be excluded in the first place?
A. acute cardiovascular failure;
B. Acute laryngitis that complicated allergic swelling;
S. allergic reaction to an unknown allergen;
D. Cerebrovascular accident;
E. Tumor chest with metastases in mediastinal lymph nodes.
Test 3
The man in '70 dry cough, hemoptysis, hoarseness of voice, ptosis and enoftalm left. What disease can think of?
A. Lung cancer has spread to the lymph nodes of the mediastinum;
B. Lung cancer has spread to the brain,
S. Cardiovascular insufficiency of cerebral circulation;
D. Acute laryngotracheitis;
E. larynx tumor with metastases to the brain.
Test4
Male, 47 years old, the presumptive diagnosis of central lung cancer.
What tactics doctor?
A. Control radiography in a month;
B. Bronchoscopy with biopsy;
C. Tomography of the lungs;
D. Sputum on BC;
E. Tuberculin test.
Test 5
Patient A. '57 Instal diagnosed with lung cancer. What is often the first symptom of the disease?
A. Pain in the chest
B. Dry cough, resistant to medical treatment
C. Wet cough
D. Hemoptysis
E. Dyspnea
Test 6
Patient appointed radical surgery for cancer of the LEG is not. Which among these signs are not contraindications for this method of treatment?
A. superior vena cava syndrome
B. The presence of malignant pleural effusion
C. Histological diagnosis of small cell
D. The value of tumor more than 10 cm
E. Metastases in contralateral mediastinal lymph nodes
Test 7
On the chest radiograph in the parenchyma of both lungs multiple spherical soft shadows to 3 cm. In diameter. Surveyed in Oncology Center, pervychne fireplace is not found at transbronhialniy biopsy cytology ment in mined glandular cancer cells. What tactics
a diagnostic laparotomy
b Rate of chemotherapy
c diagnostic thoracotomy
d Symptomatic therapy in the community
e Nothing decrees chynaty
Test 8
A patient with small-cell lung cancer. Determine method of treatment.
A chemoradiotherapy followed by radical op is right.
Operation B + polychemotherapy.
Operation C + telehamat e rapiya.
Operation D + polihimio and telehamat e rapiya.
One is E op tional treatment.
Test 9
When imaging the lungs in the middle of the fate of the right lung revealed peripheries and chne eclipse politsyklychnoyi shape, size 2x3 cm tumor, increased basal nodes are right. Sputum and effusion in the pleural cavity is n e. Diagnosis?
A Tuberculosis right l f gene
B Right-hand pneumonia
C peripheral cancer of the right lung with metastases in the lymph nodes prick p Neuve
D e l Lymphoma right gene
E Sarcoma right l f gene
Test 10
Patient '60 suffers chronic pneumonia with frequent exacerbations. At the next address in the precinct clinic therapist sent wet at that patient tsitolohichne study, during which in sputum were not locate e cancer cells. Simultaneously, the patient's body temperature was increased to 37,6-37,8 º C over which he received antibiotics. After 7-8 days the patient's condition improved: the body temperature returned to normal, decreased cough. The next examination of sputum cancer cells in it not znaydno.Diahnoz?
A Chronic n e specific pneumonia.
B chronic bronchitis.
C Lung Cancer.
D Pulmonary Tuberculosis.
E Bronhoe k tatychna disease.
Standards of answers control the entry-level knowledge:
1. C
2. C
3. D
4. D
5. B
6. A
7. C
8. A
9. A
10. A
Standards of answers control the final level of knowledge:
1.D
2. E
3. A
4. B
5. B
6. D
7. B
8. A
9. C
10. C
Literature
Summary:
Algorithms Modern Oncology. / Schepotyn IB, GV Bondar, Ganul VL Dumanskyy Y. et al / Kiev. The book is a plus. -2006. -304p. Bilynsky BT Oncology. Lviv, 1998.
Bilynsky BT Oncology. Lviv, 1992.
GV Bondar, O. Popovych, Dumansky Y., Y. Yakovets Lectures on clinical onkolohiyi. - Donetsk. - 2006. - 255 p.
Peterson BE CANCER. Moscow: Medicine, 1980.
Slynchak SM CANCER. Kiev, 1989.
Trapeznikov NN CANCER. Moscow: Medicine, 1981 .. - S. 278-304.
Schepotyn IB Oncology. Kiev, plus book. -2006. - 250.
Lecture material.
Further Reading:
Pinchuk VG s et al. CANCER. Dictionary-Handbook. - Kiev: "Science. Thought ", 1992
VI Starikov, Trunov GV Lung cancer. - Kharkov, "OOO Katran PDA" - 2002.-212s.
Methodological development was by Assoc. IA Sennikov