5.3. Quiz:

Esophageal cancer:

1.                  case rate, causes, epidemiology,

2.                  with precancerous and hvoryuvannya,

3.                  symptoms, diagnosis, early detection,

4.                  differential diagnosis, diagnosis of Barrett's esophagus, the classification of the stages and TNM

5.                  treatments, surgery (radical, palliative and sim p tomatic operation);

6.                  general principles of the combined and complex treatment;

7.                  immediate and long-term outcomes, methods of medical R E habilitation;

8.       preventive and ca esophageal cancer.              

Stomach cancer:

1.                  incidence, causes, epidemiology, precancerous ill th ing stomach;

2.                  symptoms, diagnosis, early detection, differential diagnosis with teak;

3.                  instrumental methods of diagnosis;

4.                  methods of screening for cancer aneu n ka;

5.                  classification by stages and TNM;

6.                  treatment: surgery (history, the role of domestic HF is their common principles);

7.                  radical surgery, the role of lymphadenectomy, palliative care and symptom at tematic operations;

8.                  combined and integrated L and forging;

9.                  immediate and long-term outcomes;

10.              methods of medical rehabilitation and mutation, the primary and secondary prevention of gastric cancer.

5.4. Final stage:

Control and correction of professional skills and knowledge at Lane reproduced by solving situational and clinical tasks, tests for females at ntrolyu. Assesses knowledge and skills students study each est. and nky.

The teacher has homework, recommended literature on the subject Mr. and feet at the first class basic and additional.

VI. Materials for the methodological support of a concept

6.1.Materialy control baseline (rising levels) of students: test questions, test items (pravilni answer Unmark as admission to "*")

Esophageal cancer:

case rate, causes, epidemiology,

with precancerous and hvoryuvannya,

symptoms, diagnosis, early detection,

differential diagnosis, diagnosis of Barrett's esophagus, and class certification for the stages and TNM

treatments, surgery (radical, palliative and sim p tical volume and transactions);

general principles of the combined and complex treatment;

immediate and long-term outcomes, methods of medical rehabilitation and mutation;

preventive and ca esophageal cancer.              

Stomach cancer:

incidence, causes, epidemiology, precancerous stomach;

symptoms, diagnosis, early detection, differential dia g nostyka;

instrumental methods of diagnosis;

methods of screening for cancer aneu n ka;

classification by stages and TNM;

treatment: surgery (history, the role of local scientists with a eral principles);

radical surgery, the role of lymphadenectomy, palliative and symptomatic op is wrong;

combined and integrated L and forging;

immediate and long-term outcomes;

methods of rehabilitation, the primary and secondary prevention of cancer aneu n ca.

The task to control the entry-level knowledge.

 

Teaching Problem

Task 1.

Patient N., 58 years old, complained of pain in the epigastric area, lowering ing up Mr. Titus is weakly k virtue, raising the temperature to 39.40 C. Sick for 3 days. With careful questioning found that prior disease eat chicken and swallowed a small bone, said nasty t cha exclusion zone in the abdomen, after which came a temporary relief. What additional research is needed to confirm the diagnosis?

A. Fibrogastroduodenoscopy;

B.Ultrasound;

C. Reset existence and liver;

D. Sigmoidoscopy;

E. Fibrokolonoskopiyu.

 

Task 2.

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

A. Pain;

B. Dyspeptic;

C. Acute hemorrhagic anemia;

D. Hemorrhagic

E. Asthenic

 

Task 3

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, and flax p and dynamics in the abdominal cavity. An examination of the rectum with your finger in the pelvis is defined tumor conglomerate. Which approach to the treatment of this disease should you choose?

A. Operative treatment.

B. Chemotherapy.

C. Radiotherapy.

D. Symptomatic treatment.

E. Observations.

 

Problem 4

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 5.

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 part yni 2 metastatic liver passage of ly 2.5 and 3 cm in diameter. What tactics doctor?

A. Radiotherapy;

B. Chemotherapy;

C. Symptomatic therapy;

D. Radical surgery;

E. Symptomatic operation.

 

Problem 6.

Patient in '62 brought to the hospital with complaints of profuse cr and vavyy chair. At the time of hospitalization pulse of 98 bpm. per min., blood pressure 90/60 mm Hg. century. After hemostatic therapy data for demonstration no bleeding. Prov e Dona fibroezofahohastroskopiya. In cardiac part of the stomach to the small cr and deter defined exophytic upper pole formation, called circularly in chewing clearance cardia, partially covered by blood clot.

What is the diagnosis was possible on the basis of these data?

A Gastritis

B. Peptic ulcer

C. . Cardia gastric cancer

D. Syndrome Myellory-Veysc

E. Gastric polyp

 

Problem 7.

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, b o l pol in the epigastrium. Liver near edge of the arc. What Dr. agnostic and tactics doctor?

A. CT abdomen.

B. Abdominal ultrasound.

C. Fibrogastroduodenoscopy with biopsy.

D. FCC with biopsy.

E. Total blood.

 

Task 8

Patient. 56, asthenic constitution avenue to avlenyy o n koloha with complaints and we are on the pain behind the breastbone. Violation of the passage of solid food, podvyshenn e slyunovidelennya, belching rotten egg, with thin to 20 kg. What are the symptoms remitted's above is klinichnimi Avenue at yavamy esophagus cancer, except

A Disfahiyi

B Hipersalyvatsiyi

C Belching rotten egg

D Weight loss

E retrosternal pain

 

Problem 9

Patient, 44 years old, is a surgeon at the dispensary in connection with the diagnosis of Barrett's esophagus short, he felt pain in the chest, violation when passing solid food. Surveys: the FEHDS in c / s and p vohodu (26 cm from the edge of the upper incisors), defined narrowing on 1/2 and the one ray of light at c s tolohichnomu study found cell squamous cell carcinoma, the RO-graphy esophageal narrowing determined c / s p and vohodu for 4 cm. With ultrasound, chest radiograph disease is not found. Your dia g noz: Esophageal cancer T3 NX MO cells. grams. P. What histological structure of the tumor hara k thorns in this case?

A Adenocarcinoma

B Squamous cell carcinoma

C Mukoepidermoidna carcinoma

D Adenokistoznyy cancer

E undifferentiated carcinoma

 

Problem 10

Patient K., 72 years old, more than half complains of interference on the avenue at origin food through the esophagus with a sharp hudnennya. Last month the food was pr o walk freely, but there was a hoarseness of voice, and severe cough in the use of food, especially liquids. Increased body temperature. Take n tion to the hospital in serious condition. When X-ray thoracic cage yny diagnosis with a comrade but extensive nyzhnodolova pneumonia left. Your diagnosis?

A polyp dishes at run

B Left-hand pneumonia

C Cancer to / from the esophagus to the development ezofahobronhialnoyi n o trices

D esophageal foreign body

E Sting pages and vohodu

 

Problem 11

Patients over 10 years suffered ulcer during che p preferential exacerbation admitted to hospital. Recently lost. Appetite hall and remains the good. An examination of epigastric palpable sharply painful is ratified at Rennes. Blood and urine were normal. In the analysis of gastric juice found increasing total acidity. When X-rays at Dr. slidzhe district was not detected on the lesser curvature niche 2 cm in diameter. Stomach wall rigid, folds mucosa Mr. and bryakli. On palpation this area sharply painful. What diseases should be differentiated?

A Stomach Cancer

Maine B disease is triye

C Atrophic gastritis

D Chronic pancreatitis

E Peptic ulcer

6.2. Materials for the methods of the main phase of a concept D Abir radiographs, tables, owner of anticancer chemotherapy, hospital records and medical history of patients, findings of morphological Dr at slidzhennya biopsies (if possible micropreparations) medicines.

6.3. Materials for the final stage of the study: clinical case studies

Final Test

clinical case studies

 

Test number 1

Patient A., 45 years. Complaints of excessive fatigue, constant pain epih and striae, iradyyuyuchi in the back. OBJECTIVE: low power, the left nadkl th chychniy zone schilnoelastychnyy l / v to 1.5 cm in diameter. Abdomen soft, pain c tion in EP and hastriyi where determined hilly formation to 8 cm in diameter. What additional research most informative in this case?

A. Fibrogastroduodenoscopy with biopsy.

B. Radiography of the stomach.

C. Retropnevmoperytoneum.

D. Enema.

E. CT abdomen.

 

Test number 2.

Patient A., 56 years. Complaints dull epigastric pain, belching bal t ryam, and constipation. He considers himself a patient for 2 years. 1 year ago fibrogastroduodenoscopy - xp at night atrophic gastritis. Conservative treatment - without effect. Objects in but: peripheral l / in not enlarged, the abdomen is soft, painful epigastric. Stoves n ka collection and lshena by 3 cm, hilly land. What disease most likely in state and nomu case?

A. Cholecystopancreatitis.

B. Chronic gastritis.

C. Cancer of the stomach.

D. Hepatitis.

E. Disease Menetries.

 

Test number 3.

Patient 80 years. Complaints of pain in the epigastric area related Admission at IOM food aversion to meat, cutting overall weakness. On examination: low power, peripheral l / v is increased. Abdomen soft, painful in epihas t ry. Liver near edge of the arc. Kal black with rectal examination. What are the most informative methods of examination in this case?

A. Fibrogastroduodenoscopy with biopsy.

B. Radiography of the stomach.

C. Enema.

D. Fibrokolonoskopiyu with biopsy.

E. Ultrasonography of the abdomen.

 

Test number 4

Patient S.. 59 years. Complains of difficulty passing solid food through the esophagus, the loss in weight of 6 kg for 3 months. When fibrogastroduodenoscopy in cardia gastric lumen narrowing determined by exophytic co m and n Pone. OBJECTIVE: peripheral l / v is increased. Abdomen soft, painful in epih and striae. Liver not enlarged. With digital examination of the rectum pathological changes were detected. What is the most informative study district is necessary for clarifying the prevalence of process?

A. Radiography of the abdomen.

B. Radiography of the chest.

C. CT of the chest and abdomen.

D. Ultrasonography of the abdomen.

E. Scintigraphy bones.

 

Test number 5

Patient, 44 years old, turned to the surgeon with complaints of chest pain vidchuttyana, violation passage of solid food. Surveys: the FEHDS in c / s esophagus (26 cm from the edge of the upper incisors), defined narrowing on 1/2 of the lumen, the cytological study found ploskokl cells and of cellular cancer at RO-graphy esophageal narrowing determined by c / s at stravoh do for 4 cm. With ultrasound, chest radiograph disease is not found. Set and mined diagnosed esophageal cancer T3 NX MO cells. grams. P. Which medical tact and ka?

A gastrostomy Overlay

B Course hammaterapyy

C Course polhimyoterapiyi

D Operation Lyuysa

E Overlay eyunostomi

 

Test number 6

Patient 64 years old, admitted to the surgical hospital with complaints of Society and lnu weakness, vomiting food acceptable I wrong before, weight loss of 8 kg in 2 months. X-ray examination of the stomach in the pelvis, after 12 h at Din part barium sulfate is in prospect at the world of the stomach.

Diagnosis: subkompensyrovannyy stenosis output of the stomach. When life is washed rates of patients after preoperative preparation made ​​September's nosredyna laparotomy. During surgery, the tumor revealed эkzofitna pyloric stomach size 5h6h5 cm, which is almost entirely first kryvaye clearance pylorus, serosa sprouts. The tumor pro s andis in adjacent organs, lymph nodes were not enlarged, data deleted met and no stasis. The diagnosis of gastric cancer T2N0M0. Which surgery is indicated patient?

A Subtotal resection of the proximal aneu n ka

B Subtotal distal REZE c tion stomach

C Hastrekt at miya

D Hastroenteroana s tomoz

E gastrostomy

 

Test number 7

Patient M., 57 years, complaining of pain in the chest, violation Avenue at origin solid food, vomiting accepted food after 15-20 minutes, salivation. Surveys: at esophagoscopy in to / from esophageal narrowing etsya defined as that for which it is impossible to go through a biopsy found cells with plane koklitynnoho cancer at Rh-oxidized esophageal narrowing determined to / from the esophagus within 5 cm. With ultrasound, chest radiograph no pathology value and deno. Newly diagnosed with Esophageal cancer T3 NX MO cells. grams. P. What medication in the bathroom?

A Surgical.

B chemoradiation.

C Surgical and chemotherapy.

D Chemotherapy.

E Radiation.

 

Test number 8

Patient '50 at fibrogastroscopy zone angle on the lesser curvature of the stomach revealed a flat cover ulcers of the mucous membrane of the lifted and we cr and pits up to 5 cm in diameter. What additional research is needed to establish a definitive diagnosis?

A. biopsy

B. radiography of the stomach

C. Abdominal ultrasound

D. CT abdomen

E. CBC

 

Test number 9

In patients with gastric cancer after laparotomy, during the audit of h is zealous cavity detected moving body of the stomach tumor, regional lymph nodes were not enlarged at. What is the proper volume of surgical treatment?

A. gastrectomy

B. distal gastric resection

C. proximal gastric resection

D. gastrostomy

E. hastroenterostomiya

 

Test number 10

In a patient with gastric cancer performed gastrectomy, obtained histological conclusion: adenocarcinoma that invades all layers of the stomach wall with meth and stasis in 5 lymph nodes along the left gastric artery. Which plan filed b pects of the patient?

A. adjuvant chemotherapy

B. radiotherapy

C. hormone

D. immunotherapy

E. without treatment

 

Test 11

The patient in '82 found isolated gastric polyp on a stalk, with small sized ro 2h2sm with malignancies in the top section of the polyp. The patient has a number of soup in tnih diseases: hypertension, diabetes under subkompe Mr. satsiyi. What interventions are most shown?

A endoscopic polypectomy

B gastrotomy, excision pm and pa

C wedge resection grinding in NCA

D economical cut is ktsiya stomach

E subtotal resection of the stomach

 

Test 12

The patient complains of '67 general weakness, the feeling drive at mfortu, belching foul-smelling. and aching pain in the epigastric and Dr. Lyantse after taking overconsumption, sudden loss of appetite. Clinical examination revealed in s: pale skin, clean with palpation in the epigastric palpable left n in gush like formation, painless, maloruhome deeply located. F and ziolohichni mandrel: chair - the last time was dohtopodibnyy who dia g noz?

A Stomach Cancer

B Peptic min at Rob stomach

C Pancreatic hall at za

D Pancreatic Cyst hall at za

E Cancer OVEN n ki

 

Standards of answers control the entry-level knowledge:

1A

2D

3B

4C  

5E

6C

7C  

8C  

9B

10C  

11A

 

Standards of answers control the final level of knowledge:

1.                  A

2.                  C

3.                  A

4.                  C

5.                  D

6.                  B

7.                  B

8.                  A

9.                  A

10.              A

11.              A

12.              A

 

 

Literature

Summary:

Algorithms Modern Oncology. / Schepotyn IB, GV Bondar, D and nul VL Dumanskyy Y. et al / Kiev. The book is a plus. -2006. -304p. Bilynsky BT Oncology. Lviv, 1998.

Bilynsky BTOncology.Lviv, 1992.

GV Bondar, O. Popovych, Dumansky Y., Y. Yakovets Lectures on clinical onkolohiyi. - Donetsk. - 2006. - 255 p.

Peterson BE CANCER. Moscow: Medicine, 1980.

Slynchak SM CANCER. Kiev, 1989.

Trapeznikov NN CANCER. Moscow: Medicine, 1981 .. - S. 278-304.

Schepotyn IB Oncology. Kiev, plus book. -2006. - 250.

Lecture material.

 

Further Reading:

Pinchuk VG s et al. CANCER. Dictionary-Handbook. - Kiev: "Science. Thought ", 1992

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

General Oncology: A Guide for Physicians / Ed. N.P.Napalkova. - L.: M e dytsyna, 1989. - P. 568-570.

GV Bondar, Dumanskyy Y., Popovic A., Bondar VG Cancer railroad in a certificate, 30 years Search: successes and problems. - Archive wedge. and эksperym. honey. - 2000, (4): 520-3.

11. Lecture on

 

Methodological development was by PhD, Assoc. IA Sennikov