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 the student s to practical lessons  

 

Course 5

Faculty of Medicine (specialty "General Medicine", "pedi t Riya", "Prophylactic medicine")

Study Subject: Oncology

Module number 1

Content module № 1

Subject: № 2. Cancer of esophagus and stomach.

number of training hours -5

 

 

 

 

 

 

 

 

 

Kharkiv November 2011

Background: Stomach cancer is the 2nd place in the structure with these tumors conceding only lung cancer.

Among all human cancers with gastric cancer have 15%, and among the five in the digestive tract gush 50%. High incidence observed in Japan (56.8 x 100 thousand inhabitants), Finland (48.7), Brazil (49.5), Colombia (44.5). Low illnesses at ryuv ness and celebrated in the U.S. (10h100 thousand inhabitants), Canada 13.6, Indonesia 12.8. In Russia - 44.6, Ukraine - 30, Kharkov 29 (2003).

More than 85% of patients with stomach cancer are aged over 40.

If you are under 30 years 100,000 people have 0.5 cases of gastric cancer, in older age groups, the incidence is increasing:

30-39 - 10.7, 40-49 - 47.2, 50-59 - 121.1, 60-69 - 254, 70 and older 311.6 evaporation Dr. Kiv stomach cancer per 100 thousand population.

Every year in the world, recorded 8 million new cases of cancer and over 5.2 million deaths from them. Incidence in Ukraine 4.0, in Harkivs b oblasts - 4.8 per 100 thousand population. In the structure of morbidity in RP h at lovikiv ranks 10th (2.14%), women - 16th place (0.37%). Mortality century and restore 3.7 per 100 thousand people (1998).

No clear etiologic factors have been identified. Known for the role of nutrition, particularly affecting carbohydrate food insufficiency April vitamins in food A, C, high nitrates and herbicides in water, nitrates and amines form conne d absorption HN t rozamynu This carcinogens especially at low pH gastric c e kretsiyi. Smoking tobacco - to 4-fold increases the incidence of gastric cancer. Salty foods - increases the risk of several district and pharynx. Eating fresh fruits and vegetables reduces by 30% chance of developing cancer of the stomach. Contributes to the development of disease insufficiency April of cobalt magnesium excess - zinc, copper in the soil. Also promotes morbidity Mr. ing liquid nutrition from overeating. These factors contribute to a deep restructuring at ve structure of the gastric mucosa with her ​​metaplasia and enterizatsiyeyu.

Starts transpire and the role of genetic factors in the pathogenesis of gastric cancer and stravohydu. One example of this is the uneven rate of a in p and ofthem ethnic groups and identify the family cancer.

It is believed that in some patients (ethnic group) there is a genetic slope b activity (factor). To implement the program requires modifying effect outside w ment.

 

Study objective: To raise the level of theoretical and practical knowledge of students on prevention, Pathology, clinics, especially with Tay clinical course, complications, diagnosis, differential diagnostics and sucha s spetslikuvannya tion of cancer of the stomach and esophagus that future field n make us close and distant p e results of treatment ..

Know:

Clinical picture of precancer gastric cancer and esophagus.

Classification, clinical manifestations, complications, diagnosis of gastric cancer and the pages and vohodu.

Methods for combined treatment of cancer of the stomach and esophagus.

Be able to:

1. On the basis of complaints, anamnesis, objective research, and to reveal the major syndromes tumors of the stomach, put a preliminary diagnosis.

2. Appoint additional examination methods and evaluate their data

3. Conduct a differential diagnosis between different diseases in NCA grinding, put the final diagnosis.

4. Appoint treatment

5. To carry out rehabilitation and preventive measures

Duration of training - 5:00 s.

Theoretical questions to topics that students must master

In classrooms called theme, the general and specific objectives classes. In kladach and conducts test control entry-level knowledge.

More students in the abdominal compartment HOKOD or surgical ve d dividing HIMR conduct independent curation of patients with gastric cancer and p and vohodu alternatively, under the supervision of a teacher. To assess the accuracy of at least tracking constantly engaged other students., Pay attention to the history of patients acquainted with the methods and results of laboratory tests and the data are entered in workbooks.

Curator, based on the data, making the sick. I considered giving the question of etiology, pathogenesis, classification TNM gastric cancer, the stop and back on the role of factors that contribute to the development of the disease.

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 stomach cancer.

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.

Esophageal cancer

Predrakovыe disease and risk factors:

1.                  Benign

a) epithelial - adenomas, polyps

b) Nonepithelial - leyomyomы (with smooth muscle)

2.                  Chronic f zofahyt

3.                  Ahalazyya cardia - idiopatchnyy esophageal motility disorder characterized by increased pressure in the lower third against incomplete ro with slablennya Card and tial zhoma and muscles of the lower third of the esophagus. In these patients, the risk of developing R S increases 16-20 times. Medium term development of ro R S from the onset of symptoms is ahalazyy 15-17. Zloyak and sleep at transf rmatsiya mucosa develops dylatyrovann th plot against the ridge at night irritation not a vacuum yovannoy food.

4.                  Sliding hiatal hernia

5.                  Scars from chemical burns of esophagus

6.                  Smoking

7.                  Drinking liquor

8.                  Drinking heavily hot and cold food

9.                  Features food (in residence raw fish, marinated, p at the bosom, cons e rvovani products)

10.              Most mineralization and salinity of drinking water, nature of soil salt

11.              HPV infection, according to some authors, is the main cause of R S in Asia and South Africa. This virus of at myy as the cause of cervical cancer and oropharyngeal cancer. But this virus is not detected in low incidence R S, where a preview and lyuye adenocarcinoma.

12.              Syndrome Plummer-Vynsona characterized by chronic эzof and hytom against deficiency of iron, fibrosis of the esophageal wall, dysfah IE and. Approximately 10% of these patients develop R S. Pathogenesis of cancer while on a hvoryuvanni unclear. It is believed that the basis of its development is Zofia f and g and t that developed on the background of chronic iron deficiency and areas of the esophagus.

TNM Clinical Classification (7 Edition, 200 7)

T x	Not enough data to assess the primary tumor
T 0	The primary tumor is not defined
T is	Preynvazyvnaya carcinoma
T 1	Infiltration of a mucous membrane or submucosa
T 2	Infiltration of muscle membrane
T 3	Infiltration serosa
T 4	Germination of adjacent organs
N x	Not enough data to estimate regionarnogo l / in
N 0	No of regional metastases l / in
N 1	There are of regional metastases in l / in
M's	Not enough data to determine metastases
M 0	No evidence of distant metastases
M 1	There are distant metastases
M1a M1b	For tumors verhnehrudnoho esophagus Metastasis in cervical lymph nodes Other distant metastases
M1a M1b	For tumors srednehrudnoho esophagus Not specified Nerehyonarny lymph nodes and other distant metastases
M1a M1b	For tumors nyzhnehrudnoho esophagus Metastases in celiac lymph nodes Other distant metastases

Clinic:

Violation of the passage of food through the esophagus (originally coarse meal, then liquid) pain behind the breastbone C thin tion hypersalivation esophageal vomiting (ve d time after eating only a small amount of that food eaten) belching, heartburn symptoms of intoxication

Metaz uvannya

1.                  Lee mfohenne - l / sec units is redost etc. + ing as gastric cancer

2.                  Hematogenous - liver, lungs, k and c ki, peritoneum, brain