Slaid 18 THYROID CANCER

Slaid 15

Their division on benign and malignant is the cornerstone of classification of all tumors. Benign tumors it is characterized by rather slow body height, the maximum morphological similarity to tissues from which they came; an accurate delimitation from surrounding tissues a capsule; don't tend to a boundless progression; have no infiltrative body height, don't metastasize, don't influence the general state, don't recur after radical operation, lives of a sick organism don't threaten.

Malignant tumors grow, quickly taking root and sprouting in the next tissues and organs that the infiltrative form of body height is estimated as. Cells of a malignant tumor sharply differ from cells of a normal tissue in the expressed cellular atypical, a polymorphism and disturbance of a differentiation - an anaplazia. Body height of a malignant tumor is reflected in a condition of an organism, at patient?s attrition, an anorexia develops.

Malignant tumors give metastasizes and can recur after the conducted course of any kind of treatment.

Slaid 16 PATHOLOGICAL ANATOMY

THE MACROSCOPIC SHAPE OF THE TUMOR: Infiltrating growth, The expansive growth

Slaid 17 Local differences

Can be local symptoms of a malignant tumor:

1) the increased education density, in comparison with a benign tumor;

2) change of a form, for example, a lymph node from bean-shaped in spherical or transition of smooth education to the tuberous;

3) small mobility because of involvement in process of surrounding tissues ? the is less mobile a tumor, the probability of its excision is less.

Slaid 18 THYROID CANCER

Slaid 19Distinguish metastases: a) intraorganic, b) regionarny, c) the remote. Intraorganic metastases are ethnomofauna tumor cells, fixed in tissues of the same organ in which the tumor and given secondary body height grew.

There are three main ways of an innidiation:

a) The hematogenous way of spread of a tumor ? drift of cells with blood current in organs, most often ? in lungs and a liver as in a liver the blood from all unpaired abdominal organs is filtered, and in lungs becomes isolated a small circle of a circulation;

Slaid 20b) Lymphogenous, tumor cells extend on lymphatic vessels in the lymph nodes which are most close located and then ? in more distant (in so-called collectors of an innidiation);

Slaid 21c) The contact way of spread of a tumor ? a thicket on a serous cover, for example, a tumor of a stomach can have Shnitsler's metastasis; at excision of a pleural drainage there can be a metastasis in the field of the drainage channel;

Cronenbergs metastasistumor of the ovary, which is the metastasis of gastric cancer

d) Recurrence is a repeated development of a tumor after surgical excision or a radial chemotherapy.

Slaid 22Morphological classification of tumors is most widespread. It gives the chance to define initial cellular and fabric accessory of a tumor, its high quality or a malignant, details of structure, maturity degree.

Malignant tumor from an epithelium ? a cancer, from a connecting tissue - a sarcoma.

Slaid 23In recent years the international classification of malignant tumors by TNMGP system gains ground.

She allows receiving more exact decision about extent of spread of a tumor, to form comparable groups of patients, to estimate various methods of treatment.

Special significance is attached to the first three letters.

T (tumor) ? the size and local spread of the tumor;

N (node) ? the presence and characteristics of metastases in regional lymph nodes;

M (metastasis) ?the presence of distant metastases;

G (grade) ?the degree of malignancy;

P (penetration) ? the degree of germination wall of a hollow organ (only for tumors of the gastrointestinal tract)

Slaid 24The T ? tumor, is classified by the tumor sizes.

Tx ? not enough data to assess the primary tumor

T0 ? primary tumor is not determined

Tis ? preinvasive carcinoma (intraepithelial

the tumor is sprouting its own plate

mucosa)

T1 ? the tumor infiltrates the stomach wall

to the submucosa

T2 ? the tumor infiltrates the stomach wall

to subserous membranes

T3 ? tumor invades serosa without invasion

into surrounding structures

T4 ? the tumor extends to adjacent structures

Slaid 25 N-nodulus ?

Nx ? insufficient data for assessment regional

lymph nodes

N0 ? no evidence of metastatic lesion

lymph nodes

N1 ? there are metastases in 1-6 lymph nodes

N2 ? there are metastases in 7-15 lymph nodes

N3 ? there are metastases in over 15 lymph

nodes

Slaid 26The M ? metastasis is classified by absence (M0) or existence (M1) of the remote metastasizes in organs.

Slaid 27Distinguish I, II, III and IV stages of a tumor.

The I stage ? a tumor occupies a limited site, doesn't sprout an organ wall, metastasizes are absent.

The II stage ? a tumor doesn't extend out of organ limits, single metastasizes in regional lymph nodes are possible.

The III stage ? a tumor of the larger sizes, sprouts all wall of an organ with multiple metastasizes in regional lymph nodes.

The IV stage ? germination of a tumor in surrounding organs or a tumor with the remote metastasizes.

Slaid 28 G-grad ? characterizes degree. Thus the defining factor is the histological indicator: G1 ? the high-differentiated tumors, low degree of a malignant, G2 ? low-grade tumors, average degree of a malignant, G3 ? undifferentiated tumors, high degree of a malignant. Than degree of a differentiation of a tumor, subjects it malignant is lower.

Slaid 29 ?? penetration ? characterizes extent of germination of their wall (only for tumors of hollow organs): P1 ? infiltration by a tumor of a mucosa, P2 ? infiltration by a tumor of mucous and sub mucous covers, P3 ? infiltration by a tumor of mucous, sub mucous and muscular covers, P4 ? infiltration by a tumor of all layers of a wall of an organ or an exit out of its limits.

Slaid 30 Clinic of malignant tumors.

Malignant tumors at the beginning of the development flow asymptomatically, is hidden from the patient. In early stages of a disease almost never patients complain of pains, don't consider themselves patients, continue to work and lead a usual life. But note fatigability, drowsiness, loss of interest to surrounding, working capacity depression.

On the basis of appreciable experience in oncologic institute of Herzen A.N. Savitsky came to a conclusion that, for example, in a clinical picture of an initial carcinoma of the stomach it is necessary to allocate not separate suspicious symptoms, but a certain clinical syndrome:

1. Syndrome of so-called small signs. In this syndrome the major place belongs not to local gastric symptoms which usually only and draw to themselves attention of the patient and doctor, and explains to the general disorders by which, as a rule, there passes a patient and the doctor them with the reasons which aren't bound to a stomach lesion.

The syndrome of small signs includes the following symptoms:

a) the change of health of the patient which is appearing usually for some weeks or months to the address to the doctor and expressed in emergence of the general delicacy, fast fatigability, working capacity depression

b) Unmotivated permanent loss of appetite, sometimes its total loss, up to disgust for food,

c) Phenomena of "a gastric discomfort": loss of physiological feeling of satisfaction from acceptance of nutrition, unpleasant local gastric symptoms: overflow of a stomach, fullness its gases, feeling of gravity, sometimes morbidity in an anticardium, occasionally ? nausea, vomiting,

d) The causeless progressing weight loss of the patient noticed either him, or people around, paleness of integuments and other phenomena of an anemic,

e) a mental depression ? loss of pleasure of life, interest to surrounding, to work, apathy.

Slaid 31 2. A syndrome "plus a tissue" - it is possible to tap this symptom at superficial localization of a tumor (a skin, a hypodermic fat, extremities), sometimes palpate a tumor in an abdominal cavity. This syndrome can be taped at FGS, columned and bronchoscopes?, stomach X-ray scopes?.

Slaid 323. A syndrome of pathological allocations ? at germination of vessels ? bloody allocations, or bleedings.

Slaid 334. The syndrome of malfunction of an organ ? is admissible, an intestinal obstruction, disturbances of the act of a swallowing.

Slaid 34Algorithm of inspection of patients with suspicion on a tumor the following: the collecting of the anamnesis with emphasis on heredity and existence of chronic diseases; assessment of the general and local clinical implications and laboratory and tool inspection.

Early establishment of diagnosis in situ stage I and clinical stage of disease, adequate treatment leads to full recovery

Timely ? diagnosed at II, and in some cases on stage III of the process ? complete recovery is possible only in some patients, others observed the progression of the process

Late ? diagnosed on stage III-IV ? low probability or inability to cure the patient

Slaid 35At the collecting of the anamnesis the special attention is paid to identification of precancerous states, precancerous diseases.

Precancerous state ? various pathological processes which precede development of a malignant tumor, but not necessarily pass into it.

Obligate precancerous ? it surely will pass sooner or later into a cancer. In 80% - colon polyposis, bladder papilloma, a melanosis.

Development of malignant tumors requires long action of the allowing factors.

Date: 2016-06-13; view: 163