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IV. Interdisciplinary integration.

Discipline

Know

Be able

1. Anatomy

Anatomy of the uterus, ovaries and lymph collectors outflow.

 

2. Pathological Anatomy

Cytological and histological features R T M, CC and OC

Describe the histological changes in the endometrium, cervical epithelium, ovarian cancer during their impressions

3. Pathophysiology

Etiology, pathogenesis R T M, CC and OC

 

 

V. The plan and organization of practical training:

 

5.1. Duration of training - 5:00 s.

 

 

5.2. Stages classes (table)

№ pp

The main stages of employment and their contents

Place to organize an occupation

Level zasvoennya knowledge

Time

min

Control methods and teaching support

1.

Preparation stage:

organization of training;

definition of educational goals and motivation;

control the output level of knowledge and skills;

a) The clinical picture of benign uterine, cervical, ovarian

b) classification, clinical manifestations, complications, diagnosis cancer of the body of the uterus, cervix, ovaries;

d) treatments.

Classrooms

II

 

15

 

 

 

 

15

 

 

15

 

 

20

Frontal poll table tests, the results of cytological and histopathological studies, history of disease

2

Main stage:

of professional skills and abilities:

a) curation and pelvic examination of patients with uterine cancer, cervical, ovarian, their survey in full according to the scheme medical history, a plan for further examination;

Specialized branch

 

III

45

4.3 inpatients, inpatients medical records, hospital records of patients. Cytological and histological conclusion. Leaves appointments maps. Clinical problem drugs.

b) diagnosis of disease based on clinical stage and the group;

c) discussion and evaluation of Supervision and specific issues of clinical features and diagnosis differential diagnosis, differential treatment, rehabilitation, medical and social assessment;

d) solve situational clinical tasks.

Classrooms

 

III

35

 

 

25

 

 

 

 

 

 

 

20

3

Final stage:

control and correction of professional abilities and skills supply totals;

homework.

Classrooms

 

III

 

25

 

5

 

5

Individual control of practical skills and the results of Supervision case patients. Addressing clinical tests. A set of tests and standards replies

5.2.1. Preparation stage:

At the beginning of class, the instructor introduces students to the basic tasks of occupation plan. To control the output level of knowledge of students each proposed to solve typical issues in diagnosis - you can use situational clinical problem.

5.2.2. Main stage:

Polls and surveys patients spend most students alternately under the control of the teacher. To evaluate the accuracy of surveys consistently attracted other students.

When patients surveyed students' attention is drawn to the medical history of the disease, the presence of chronic inflammatory percent and human rights of precancers.

RTM is ranked 1st among other sites of cancer of female genitalia. In Ukraine, the incidence is 23.8 per 100,000 of us.

RTM refers to hormone neoplasms. Estrogens are important factor proliferative endometrium, and also plays the role of a genetic factor. In other cases, RTM is caused by a virus.

Risk factors include patients with obesity, diabetes, hypertension, uterine fibroids, women who gave birth to large fruit.

Predecessors RTM: endometrial polyp, endometrial hyperplasia, atypical endometrial hyperplasia. It is considered preinvasive cancer.

Malignant neoplasms: adenocarcinoma, svitloklitynnyy cancer, squamous cell carcinoma, mixed carcinoma, undifferentiated.

Classification of cancer RTM:

T1 - tumor confined body of the uterus; T1a - uterus is up to 8 cm in length; T1b - uterus has more than 8 cm in length; T2 - the tumor extends to the cervix, T3 - tumor extends beyond Ms. uterus, vagina, does not go beyond the pelvis; T4 - tumor spreads to the bladder mucosa or rectum and extends beyond the pelvis.

Complaints of patients with CUC: spotting, bleeding, fluid uplavy - appearance chylorrhea. Pain in advanced stages of the disease.

Increased uterine determined at 2.4 cancers. The presence of vaginal walls metastases indicates Stage 3 RTM.

Diagnosis. Diagnostic curettage of the uterine cavity and cervical canal. Hysterography can determine location, size and spread of tumors in the uterine wall.

Treatment. Surgical and combined treatment method and RTM - Basic and.

Elderly patients with obesity with comorbidities perform simple hysterectomy with appendages, the tumor in the bottom of the uterus and in mature histological structure or if the tumor captures the entire uterus and passes to the cervical canal and a low degree of maturity used extended hysterectomy with appendages, removing parametrial tissue with regional lymph nodes. In order to prevent a recurrence of ablation and used before surgery radiation cryodestruction tumor.

In the presence of contraindications to surgical treatment and patient refusal of surgery is the method of choice combined-beam method of treatment - the parameters of remote exposure and intrauterine irradiation main focus in the uterus. Can be used hormones (17-alpha-hidrooksyprohesteron kapronat, Depo-Provera) at in ysokodyferentsiyo - Vano RTM.

Cervical cancer is more common in the age of 50. There is a high incidence rate of cervical cancer among women of easy virtue. Incidence in Ukraine 21.4 per 100,000 population. It is more common in women with frequently changing sexual partners, also depends on the sexual activity of carcinogenic action of smegma. It is believed that the human papilloma virus, getting in smehmu, sexually transmitted.

PatAnatomy cervical cancer.

Background processes: pseudo, leukoplakia, cervical polyp.

Precancerous processes: mild dysplasia, moderate dysplasia, severe dysplasia CMM degree.

Intraepithelial carcinoma.

Mikroinvazivny cancer.

Invasive cancer.

Patients with dysplasia CMM is 20 times more likely to get sick than healthy intraepithelial cancer and 10 times more likely to invasive cervical cancer.

There are:

a) cervical intraepithelial or peredinvazyvnyy (no invasion of the stroma);

b) CC mikroinvazivny. Germinating in the stroma to a depth at 0, 3 cm.

Histologically, cervical cancer is:

Squamous - 95%.

Glandular.

Poorly.

Intraepithelial cervical cancer has no clinical signs. Initial stages of cervical cancer are shaped ulcers. There are exophytic and endophytic form of cervical cancer.

Pre invasive cancer and mikroinvazivny asymptomatic. These stages are called preclinical cancer. The characteristic triad of symptoms of cervical cancer: pain, bleeding and uplavy characteristic of late, often inkurabelnoho cancer.

Pseudo at an initial invasive cancer - the touch pad and mirrors appears bleeding - an important symptom. Two-handed in intraepithelial vaginal examination and initial invasive cancer is not informative. In patients with severe clinical process - T 2 and T 3 - cervix dense or hryaschevydna available crater and infiltration. When suspected cervical cancer is mandatory research through the rectum - rektovahinalne and rektocherevne. In patients with stage II and higher cervical cancer in the parameters palpable infiltrates or sprouting in the rectum.

The method of early diagnosis of cervical cancer is cytology smear of the cervix, cervical scrapings. Material for cytology taken before bimanual examination. Cytology smears in cervical cancer is accurate in 95%.

The methods of early diagnosis of cervical cancer should colposcopy. Histological examination of tissue from the cervix is the most accurate method of diagnosis.

Doinvazyvnyy and mikroinvazivny (Tis and T1a) treated surgically (electroconization or amputation of the uterus, or a simple eksterpatsiya uterus).

Stage Cancer T 1b-2a cervical cancer treated with combined (radiation + surgery) or poyednanopromenevym method for radical program.

Poyednanopromenevyy method - is the use of two methods: contact (applique, intracavitary) and remote. The total course dose should not exceed tolerant dose of adjacent organs and constitute about 60 Gy.

Treatment of stage 2 in T -3 CC conducted combined - radiomethod the extent of the radical program.

Weather. In the first stage cervical cancer - 5-year survival rate - at 47-85%. In the second stage - 55-65%. In stage III - 20-30%.

Reese ik of OC increased twofold in patients with malignant breast tumors. Huge influence carries hereditary factor. A number of studies found that ovarian cancer can be transmitted hereditarily. In such cases, it is a family ovarian cancer. The probability of exposure to the disease is transmitted in 50% of cases from mother to daughter. Unfortunately, ovarian cancer is asymptomatic for a long time. Often she sees emerging symptoms as a manifestation adnexitis that is not uncommon in many of the fairer sex. Therefore first symptom that causes contact your doctor, there is an increase in the amount eaten. Conditional distribution of this symptom ovarian tumor in the abdomen, defeat omentum (fatty tissue located within the abdominal cavity) and accumulation in this regard, fluid (ascites). Early symptoms include the appearance of pain in the lower abdomen. Pains are often unexpressed, pulling character. Related the pain to those that occur in chronic inflammation of the uterus. Diagnosis of ovarian cancer, as well as other cancers, consisting of inspection and detection of symptoms and of instrumental methods. Gynecologist or onkohinekoloh inspect the abdomen of the patient, performed pelvic examination. In case of suspicion of ovarian cancer can be performed puncture of the abdominal cavity, followed by cytology obtained liquid. Instrumental methods include ultrasound, which can be detected ovarian tumor, and estimated prevalence of the process (of liver injury, the presence of ascites). In order to clarify the prevalence of the process may be carried out: radiography lung computed and magnetic resonance imaging of the abdomen. There laboratory techniques that can provide additional information. Thus, detection of high blood marker SA125 with persistent positive results of the study suggests that the presence of tumor. The main treatment for ovarian cancer combined - surgery and chemotherapy. The volume of surgical treatment depends on tumor spread. During the early stages of removing the affected ovary. In the case of propagation process in the uterus is performed to remove it. At tumor in the gland, performed his resection (removal). Chemotherapy is usually complements surgical treatment. Now for the medicinal treatment of ovarian cancer using combinations of these drugs as cisplatin (and next-generation drug in this group - carboplatin), cyclophosphamide, taxol, and others. Control treatment is carried out in terms of tumor markers (SA125), ultrasound and other methods used to exclude / confirm tumor spread. At the first stage of ovarian cancer 5-year survival is 80% at the initial stage (defeat one ovary that does not apply to other organs), this figure is 95%. In the case of the running of ovarian cancer - stage 3 and 4 - to 5-year survival rate is 25-30%. For other cancers, such as cancer of the stomach or pancreatic cancer, it is pretty high figure. The main cause of death in OC disease is cardiovascular failure, intoxication, breach of intestinal permeability, exhaustion. Similarly, the cause of death may become distant metastases to the lungs, liver and brain.

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