Histological variants
1. Ploskokl and m and n j cancer - 98-99%
2. Adenocarcinoma - 1-2%
Diagnosis
1. Fluoroscopy of the esophagus with barium suspension - stenosis at stravoh do, uzuratsyya contours suprastenotychoe expansion and Rennes
2. F and f zofahoskop bro and I with biopsy
3. More research:
a) X-rays (graphy) lung
b) D D abdomen (liver, kidney, pancreas, and with Ocher is guilty l / c)
c) rectal examination (metastasis Shnytslera)
Treatment:
1. Cervical cancer - remote gamma-therapy fractional Fra c tions (ED December 2, dose of 40 - 60 Gy)
2. Cancer verhnehrudnoho Department - remote gamma-therapy (modes tizh)
3. Cancer c e rednehrudnoho Department - Operation Good and words - Toreka (eq c tyrpatsyya esophagus) - 3 stages:
a) cervical эzofahostom and I (left), gastrostomy and I
b) right-sided torakotom and I f kstyrpatsyya esophagus
c) thin section of plastic esophagus or colon (in front or behind the breastbone)
4. Cancer nyzhnehrudnoho esophagus - Operation Lewis - pravob-old and torakotomyya and verhnes e redynnaya laparatom and I resection and lower tert us esophagus and cardiac part of the stomach, esophageal-gastric Anastacia at the Ministry of Health in the right pleural cavity
5. Cardio is zofahealn j cancer - surgery Osawa-Garlock - left-spit torakofrenolaparatomyya, subtotal resection of the proximal stomach with resection of the distal esophagus, the stomach stravoshidno anastomosis in the left pleural cavity
Complication
1. Stavohi bottom-tracheal j (bronchial) fistula - the emergence coughing when eating or water, postgraduate and rac and Inna pneumonia
2. Perforation of esophagus tumors in the village is redost innya, medyastyn and t
3. Perforation of the tumor into the pleural cavity is mpyema pleura
Stomach
Epidemiology Among all human cancers with gastric cancer have 15%, and among gastrointestinal tumors 50%.
Etiology
No clear эtiolohichnyh factors have been identified. Known role nutrition. Starts transpire and the role of genetic factors in the pathogenesis of cancer in grinding NCA. Although globalized e tion of this is uneven incidence in different ethnic groups and neck cancer in the family attitude.
Precancer
Local precancerous diseases include:
Anatsydnыy gastritis (with epithelial dysplasia). Dysheneratorni (metapl and amplitude) gastritis. Folded hyperplastic gastritis (illness I t Rie). Adenomatous polyps: poodynochni - 60%, multiple - 100% probability po of cancer development. Pernicious anemia. Resected stomach (anastomosis at the border at tkiy loop). Chronic gastric ulcer.
Morphologically precancerous condition characterized by proliferative changes in the epithelium in violation of mature cells called dysplasia and eyu.
Pathologic anatomy and morphology of gastric cancer.
There are three main types of gastric cancer by type of growth.
I. Эkzofitna form (expansive)
a) blyashkopodibnyy,
b) polipopodibnyy,
c) saucer, chashepodibnyy.
II. Infiltrative form (эndofitnyy)
1. Ulcer-infiltrative form;
2. Diffuse-infiltrative form (skir, submucous, ploskoi Mr. filtratyvnyy).
III. Mixed form
B. Cancer of the polyp.
V. Cancer of ulcers.
Эkzofitna form is observed in 50-60%.
Эndofitna form - 40-50%.
The most common tumor extends into the proximal direction p and dshe the distal blockade ways lymph.
When distal cancers tumor extends to 12-typalu colon in 13.6% of cases.
Metastasis of gastric cancer is: lymphogenous, hematogenous, and m and Plant tional mixed.
Spread by lymphatic most frequent common path and is found in 45-55% of operated patients.
Hematogenous metastases: liver, bone, adrenal glands, ovaries, lungs.
Implantatsinni metastases.
Peritoneal carcinomatosis (miliary or prosovydnыy kartsynoz)
Metastasis in Douglas space (Shnytslera)
Metastasis to umbilicus (path Herota) Sister Joseph
In the ovary (Krukenberg)
Lymphogenous Virhovskyy
Classification of Gastric Cancer
T 0 - primary tumor is not defined.
T is - preinvazyvyy cancer (early cancer).
T1 - tumor ynfyltryruye stomach wall to the submucosa.
T 2 - muscular layer to the subserous layer.
T 3 - Germination in all layers.
T 4 - Tumor extends to adjacent organs.
T's - little data to estimate the size of the primary tumor.
N o - no lesion of regional lymph nodes.
N 1 - struck from 1 to 6 lymph nodes.
N 2 - struck from 7 to 15 lymph nodes.
N 3 - affected more than 15 knots.
N's - assess the state of nodes is impossible.
M o - no distant metastases.
M 1 - is distant metastasis.
M's - not enough data.
In 1956 he proposed the term "early gastric cancer» R. Hess dia g nostuyetsya only эndoskopichno. Defeat only mucous layer without meth and stasis, 2 - 3 cm. In diameter. Early gastric cancer is usually during the preventive Professor and reviews of people who belong to high risk groups.
Manifest gastric cancer
This is mainly common cancer stage II-III. But even with takim distributing patohnomanichnyh no symptoms. Often the hospital depends on l at localization of cancer in the stomach. The main symptoms include:
epigastric pain (periodic or continuous).
Recurrent cancer is more often the source of and linked to by Dr. lyshkovym stretching the stomach during a meal. Linked with peristalt and Coy. P O pain independently indicates germination tumors in adjacent organs. For small tumors (up to 3 cm) ball ovyy syndrome observed in 35% evaporation Dr. Kiv, with larger sizes in 60-95% of cases. When the tumor during the grinding pain in the NCA generally can not be.
Diarrheal syndrome
Feeling of fullness in the e pihastriyi, belching, heartburn. Often the source of cancer of the stomach, with symptoms of stenosis. Feelings quickly fill Mr. ing, feeling the weight in epyhastralniy area.
Dysphagia
Violation of the passage of food in swallowing typical cardia cancer. This is sometimes the first symptom of cancer, but not early.
Decreased appetite
Depends on the defeat of glands that produce hydrochloric acid and positioned at ated in the body and the bottom of the stomach.
At the same tumor may experience anemia due to loss of ability to form antianemic factor Castle.
Weight Loss
The most common symptom of cancer of the stomach.
Causes: dysphagia, stenosis, indigestion, resulting
defeat secretory glands.
Syndrome of small signs Savitsky A.
1. Weakness, fatigue, loss of earning capacity.
2. Development of mental dypresiyi, apathy.
3. Anorexia, avert more to meat eating.
4. Losing a sense of satisfaction from the ingested food.
5. The development of gastric discomfort, fullness, feeling of weight in the epigastrium and pain.
A Triad. V. Melnikova: Weight loss, loss of appetite, epigastric pain, grinding in nkovyy discomfort.
Asymptomatic flow in 5-10% of patients
This is often neglected and inkurabelni patients when installing diagnosis.
Atypical forms
1. Anemic form (hypochromic anemia);
2. Febrile form (high or low-grade fever)
3. Heart or stenokardytychna form
Complicated forms of cancer of the stomach flow
I.Krovotecha with tumor
1. Vomiting coffee shroud.
2. Dohtepodibnyy chair.
3. Pale.
4. Reduced pressure.
II. Stenosis.
Cancer cardia of the stomach or outgoing.
In inoperable if the presence of stenosis impose gastro bypass at enteroanastomoz.
Breakthrough III tumors (perforation)
Hospital acute abdomen. Symptom Schetkin - Mr. Blumberg disappearance furnace blende stupidity. Gas under the dome of the diaphragm.
Diagnosis of cancer of the stomach.
Special methods.
The main research methods are X-ray and endoscopy h ny. RO-logically possible to detect a tumor more than 2 cm, it is difficult to identify pu's tench infiltrative form. Better diagnosed cancer output of the stomach. The main symptom - filling defect in the study of contraception with tnoyu liquid symptom niche. Precipice folds mucus vo st, stomach wall rigidity, lack of peristalsis.
Much information gives double contrast stomach. Research mo e vmorelefa with gas Fizzy.
II. The most informative method of research is fibrogastroscopy
1. Place defeat: cardio, low curvature, the output section.
2. Length tumor.
3. The presence or absence of other entities polyps, ulcers.
4. Biopsy in 4-8 parts.
III. CT
Prevalence of retroperitoneal lymph nodes and paraortalni "m" in the liver, pos e zinku.
Ultrasound (эhosonohrafiya).
Laparoscopy
Before surgery, the study indicated all patients to avoid unnecessary and bnu laparotomy. You can see the omentum peritoneum great and small,
liver, and the front part of the lower surface, spleen, and Mr. determine patency of fluids and take it.
Research per rectum
"M" Shnytslera.
Laboratory Methods
Clinical analysis of blood
Anemia
Increasing SHOЭ
Coagulogram
Fibrinosis more than 6 g / l. (Normal 2-4 g / l)
Reaction to Prix latent blood in the stool (p-tion Gregersen)
R-tion of benzidine.
Treatment.
Subtotal resection of the distal stomach
Hofmeister-Fynsteref
Balfour.
Hastrektomyya
Proximal gastric resection
Operation Osawa-Garlock
Palliative surgery
Symptomatic.
Chemotherapy.
5 Fluorouracil - therapeutic effect in 17% of patients, mitomycin, and platinum.
Regional chemotherapy (selective)
Increasing life expectancy of 16-24 months.