Kharkiv National Medical University

Department of Oncology

guidance for students of 5th year

medical faculties

 

 

Module 1

Content Module 1

Theme 2 Gastric cancer

 

Topic

Despite significant advances theoretical and practical oncology, with a lot remains unexplained problem in gastric cancer. For example, the frequency of occurrence and biological characteristics of gastric cancer in the East and West differ. The incidence of stomach cancer is traditionally high. In this pathology up to 41 patients per 100 thousand population district in Japan - 59, Finland - 49, U.S. - 7.2. During the twentieth century, mortality from stomach cancer decreased from 20 to 5 per 100 000 population.

Stomach cancer in Ukraine ranks third in the structure of a hvoryuvanosti cancer among men and the fourth - among women. In 2002, ill th vanist was 35 per 100 thousand population.

In specific gravity main nosological forms of malignant neoplasms in Ukraine gastric cancer ranks second in men and fourth among the same and nochoho population, was 10.6% and 6.9% of the total incidence of PLN at qualitative neoplasms among female and male population respectively . The share of stomach cancer in the structure of mortality from malignant neoplasms is 13.2% for men and 10.9% for the female population. Is the second of cause of death after lung cancer for men and cancer milk h tion cancer for women.

Specific goals

Be able to:

1. On the basis of complaints, anamnesis, objective research, to identify the main 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

 

Contents of training

Theoretical questions to topics that must be learned doctors:

1. Clinical symptoms of stomach cancer (PU).

2. Diagnosis of PU.

3. Classification PU.

4. Question metastasis

5. Epidemiology of gastric cancer, the incidence and mortality of gastric cancer, etiological factors and Precancer disease pathogenesis.

6. Principles and treatment in PU, and long-term results of treatment he is stomach cancer, diagnosis and treatment of relapse and metastasis of gastric cancer.

7. Predisposing factors and precancerous conditions, prevention.

8. Examination of disability, prognosis, rehabilitation patients

Information necessary for learning training content, and you can know the following references:

1.       Selected lectures on cancer under. Ed G. .. Cooper, S. Antipov - L in Ghana, JSC "Lugansk Oblast Printing", 2009 - 560 pages

2.       Handbook of Oncology. Under editors prof. S.A.Shalymova Sci. Yu.A.Hrynevycha Sci. D.V.Myasoedova. Kiev, "Health." - 2000.

3.       Heshelin SA - TNM classification of malignant tumors and complete cure in the bathroom at tech onkol patients. - Kyiv, "Health", 1996. - 184 pages

4.       Pinchuk VG s et al. CANCER. Dictionary-Handbook. - Kiev: "Science. D in ICA, "1992.

5.       Translators NI Chemotherapy opuholevыh diseases. - Moscow. - 2000. - P. 3-85, 116-119.

6.       GV Bondar, Dumanskyy Y., Popovic A., Bondar VG Stomach cancer, 30 years Search: successes and problems. - Archive wedge. and эksperym. honey. - 2000, (4): 520-3.

7.       Zarydze DG Эpydemyolohyya and prevention of cancer. - Journal of Ross. Acad. honey. Science. - 2001, (9): 43-6.

8.       Lecture on

9.       Count on Logic and structures and themes

 

After mastering on the theme proposed move to the solution of educational problems.

 

Teaching Problem

Task 1.

Patient K., 48 years old, turned to the doctor with complaints of poor appetite, epigastric discomfort, weakness, dizziness, "flashing m in shock" before the eyes, vomiting "coffee grounds." Pain in the epigastrium notes for several months. An objective examination revealed pallor, pain on palpation in the epigastrium, rectally - traces of black stool on the glove. What syndrome is leading in this situation?

A. Pain;

B. Dyspeptic;

C. Acute hemorrhagic anemia;

D. Hemorrhagic

E. Asthenic

 

Task 2

Patient K., 73 year, complaining about the increase in the size of the stomach, Society and lnu weakness. When renthendoslidzhenni stomach tumor is the body of the stomach, which occupies 1/3 of the lumen. At a stomach palpation nodular liver in flax and fluid in the abdominal cavity. An examination of the rectum in Fig finger at th pelvic tumor determined conglomerate. Which approach to the treatment of Dr. and tion of the disease should you choose?

A. Operative treatment.

B. Chemotherapy.

C. Radiotherapy.

D. Symptomatic treatment.

E. Observations.

 

Task 3

Patient F., 68 years old, complained of pain in the area of the heart, the left half of the chest, which provoked eating, lack of appetite.

Surveys cardiologist, the ECG - age changes in clinic at least treatment for angina. Which diagnostic methods are needed in this issue and STU?

A. Ultrasonography of the abdomen.

B. Radiography stomach

C. Fibrogastroduodenoscopy with biopsy

D. Probe

E. Determination of tumor markers

 

Problem 4.

Patient I., 69. Complaints of epigastric pain, which provoked Avenue and yomom food, nausea, vomiting, weight loss. When fibrogastroduodenoscopy - antral cancer breath and Lou gastric tumor stenosis. In the right lobe of the liver 2 metastatic nodes 2,5 and 3 cm in diameter. What tactics doctor?

A. Radiotherapy;

B. Chemotherapy;

C. Symptomatic therapy;

D. Radical surgery;

E. Symptomatic operation.

 

Problem 5.

Patient A., 75 years. Complaints constant abdominal pain, overall lyrics and Biesty. Performed diagnostic laparoscopy cancer gastric body of widespread n tion on the liver, pancreas, expressed kantseromatoz. What tactics doctor?

A. Palliative surgery.

B. Symptomatic operation.

C. Himioterapevtchne treatment.

D. Radiotherapy.

E. Symptomatic therapy.

 

By giving 6

Patient E., 50 years. Complains of discomfort in the epigastrium after eating, lack of appetite, and constipation. The loss in weight of 10 kg for 1 year. 12 years dispensary on the ulcer. On examination: peripheral l / v is increased, skin turgor reduced. Abdomen soft, painful epigastric. Liver near edge of the arc. What diagnostic tactics doctor?

A. CT abdomen.

B. Abdominal ultrasound.

C. Fibrogastroduodenoscopy with biopsy.

D. FCC with biopsy.

E. Total blood.

 

Problem 7

Patient A., '50, who works as a teacher, conducted surgical medi Mr. tion for cancer of the stomach. How to evaluate the performance of the patient?

A. Not broken

B. Temporarily lost

C. Steadily lost

D. It can not work with children

E. Requires the reduction of working time

Standards of answers: 1 - D, 2 - D, 3 - C, 4 - C, 5 - E, 6 - C, 7 - B