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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:

Materials for the methods of the main stage sessions

N Abir Mammograms, tables, owner of anticancer chemotherapy, hospital records and medical history of patients with precancerous and early breast cancer, findings of morphological studies of biopsies of breast tumors (if possible micropreparations)

Polls and physical examination performed with the patient turns the students, under the supervision 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 inflammation and precancerous oryuvan illnesses, occupational hazard.

When patients surveyed students' attention is drawn to the medical history of the disease, the study of factors that give rise to breast cancer, number of pregnancies and lactations.

Mastitis - a hormonal hyperplasia of mammary glands. Mastitis is related to the action of estrogenic hormones. Hiperstrohenemiya can be caused by several factors: violation of the regulatory impact of the cerebral cortex, hypothalamus, pituitary, thyroid, adrenal cortex.

Clinical manifestations: breast engorgement, pain before menstruation. Palpable determined diffuse (usually) or nodal consolidation in the mammary glands. Varieties of mastitis: IDSA and lhiya, fibrous and fibro-ki stozn and breast disease (Shimmelbush a) adenosyl breast disease (Rec Liu), bleeding nipple (illness Ming tsa, intraductal papilloma). Treatment of mastitis in most cases - conservative, severe nodular - sometimes surgery. Depending on the histology of mastopathy divided into simple and proliferating (requiring surgical treatment).

Conservative treatment of mastitis: sedatives (valerian, pustyrn and k), progesterone (local shape in the form of a gel), m Al Todd and non (homeopathic medicine), normalization of hormonal levels in the body (including sexual activity, pregnancy, lactation ).

Fibroadenoma of the breast - a special form of hormonal hyperplasia. This is a good quality breast tumors. Clinically, fibroadenomas are limiting seal with sharp edges, painless, with a smooth or bumpy surface. No. Fibroadenomas are single and multiple. Sizes range from microscopic to large, when the tumor occupies most of the breast. For histological distinction intrakanalikulyarni, perykanalikulyarni and foliate (filoyidni) forms fibroadenomas. Recent growing rapidly and often reach huge sizes.

Diagnosis fibroadenomas: - breast palpation and ultrasonography with puncture biopsiyey, sometimes (age over 40 years) mammography.

Treatment fibroadenomas - removal of the tumor

Among the etiologic factors of breast cancer isolated violation endocrine relationships. Among ethnic groups, who come to marriage at an early age birth to 3-4 children and lasted breastfeeding, breast tumors occur less frequently.

Allocate 4 pathogenic forms of breast cancer:

1) hipoty reoyidna form (5%);

2)               ovarian - in patients with severe ovarian function, with menstrual disorders and with a tendency to dishormonal hyperplasia of mammary glands;

3)               adrenal - infiltrative tumors grow and prone to early Ener g ation process;

4)               senile - (10% patients) developed over 60 years.

Risk factors for breast cancer;

1)               deviation in time of first menstruation;

2)               late first pregnancy

3)               absence of pregnancy;

4)               breast cancer in close relatives;

5)               presence of a history of benign breast tumors;

6)               smoking tobacco;

7)               use of hormones (especially estrogen).

8)               Surgery (radiation) menopause;

9)               Early or late onset of menopause;

10)               The presence of thyroid dysfunction (hypothyroidism);

11)               Pituitary dysfunction;

12)               Adrenal dysfunction;

13)               Ovarian dysfunction, pancreas with the development of diabetes, dishormonal breast disease;

14)               Sexual disorders (lack of sexual activity);

15)               Hypertension;

16)               Body weight over 80 kg.

17)               Growth of more than 170 cm;

18)               Weight at birth more than 5 kg.

Ways regional metastasis:

1)               axillary lymph nodes and mizhpektoralni 3 levels. Level I - lymph nodes located outward from the outer edge of the small pectoral muscles, the second - between the outer and inner edges of the small chest muscle and lymph nodes mizhpektoralni, III - lymph nodes located inward from the inner edge of a small chest muscle, including with subclavian and apical (apical) lymph nodes;

2)               internal nodes of the breast, along the edge of the sternum on the affected side.

By the common forms of breast cancer may include diffuse form, inflammatory tumors (beshyhopodibnyy, armor and mastytopodibnyy cancer).

Diffuse or edematous-infiltrative form differs increase breast cancer infiltration of the skin to form a "lemon peel". Infitrat has no clear boundaries. Metastasis to regional nodes limfotychni there often comes quite quickly.

Mastytopodibna form combines features of infiltrative symptoms of inflammation - flushing of skin, increased local temperature, rapid tumor growth and infiltration as the skin and underlying tissues. This unfortunate form of breast cancer. Quickly metastasizing.

Eeryzypeloyid form is characterized by internally ­ cutaneous tumors spread to the lymph vessels of the skin and is manifested focal hyperemia, similar to erysipelas.

Crustacean cancer - is actually late stage of local spread of infiltrative breast cancer. It dominates the infiltration of the breast, skin and underlying tissues. Gradually shrinks breast and infiltrate extends into the chest wall, zakovuyuchy sick though in armor.

It must be emphasized that needle biopsy is the main method, which allows for a morphological assessment of breast tumors. Discussion of additional examination methods, rationale and preliminary clinical diagnoses kurovanyh patients conducted in educational rooms. Consists algorithm differential diagnosis between precancerous diseases and cancer of the breast. For patients examined characteristics defined etiology and pathogenesis of the clinical course of the disease. A discussion of the treatment of patients with precancerous diseases and early breast cancer observed students. In drawing up the plan of treatment the patient to emphasize that it should be differentiated. Tactics of treatment depends on the flow of precancerous diseases and breast cancer, stage of the process, concomitant diseases and age of patients.

Choice of treatment locally common forms of breast cancer should be individualized, preferably treatment is complex.

When tumor size T1-T2 in the absence of distant metastases spend mastectomy for Peyto-Dissonom with preoperative radiotherapy middle fractions (4-5 Gy) dose of 20-25 Gy., Or without it. Later spend postoperative radiotherapy dose fractionation classic 40-60 Gy. and chemotherapy with hormonoterapiyey.

When "inflammatory" forms of breast cancer radical surgery almost never used, preferred chemo-radiation and hormone therapy. After neoadjuvant chemotherapy in locally advanced breast cancer is sometimes possible forms of radical m astektomiyi for Halstead-Meyer.

Radiotherapy conduct small fraction (1.5-2   Gy), daily irradiated breast and regional lymph nodes. The total dose to the operation 40-50   Gy, the radical program for 60-70   Gy.

Monochemotherapy hardly used, preferred combinations of drugs with different mechanisms of action (tiofosfamid, cyclophosphamide, 5-fluorouracil, methotrexate, ftorafur, adriablastyn etc.).

Hormone therapy is determined hormonozalezhnistyu breast tumors. For this purpose, use surgical Owari at ektomiyu, less radiation, or designate antyes Trogen different action (tamoxifen, fareston, deferelyn, fazlodeks, aromazyn).

 

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