TUMOR

TUMOR (syn .: neoplasms, neoplasms) - abnormal growths of tissue consisting of a qualitatively altered cells that become abnormal in relation to differentiation, growth pattern, and other processes. These properties of tumor cells are transferred to the offspring.

Distinguish benign and malignant tumors. Benign tumors grow slowly, just pushing, pushing, and sometimes compressing the surrounding tissue, but not in germinating them. Malignant tumors are characterized by infiltrative (invasive) growth: they sprout into the surrounding tissues and destroy them. A related characteristic of malignant tumors the possibility of metastasis.

In economically developed countries, cancers rank second after cardiovascular diseases among the causes of death.

Swelling results from multiplication of one or more cells with altered genome. .. Violations of the genome, occurring during tumorigenesis, ie the transformation of normal cells into tumor is likely to lie in a change of normal cellular genes - proto-oncogenes. Altered protooncogenes characteristic of tumor cells, referred to as oncogenes. The appearance of oncogenes in cells leads to disruption of the regulation of cell responses to the body's signals. Tumor cells proliferate autonomously, ie, irrespective of external signals:.. Autonomy of such cells in various tumors could be expressed to varying degrees. For example, the growth of some tumors remains to some extent dependent on the hormonal stimulation (gormonalnozavisimyh tumor), while the growth of other tumors of hormone-independent.

In addition to violations of the regulation of growth for many tumor cells characterized by an impaired ability to form normal tissue and organ structure, and the ability to differentiate normal. Therefore, the structure of many tumors less streamlined than the original structure of normal tissue (tissue atypia). During the growth of each tumor are subject to change its properties, such as increase in the degree of autonomy of growth and tissue atypia.

Development of tumors from normal tissues (oncogenesis) can be induced in humans and animals to ionizing and ultraviolet radiation, certain chemicals (carcinogens) and certain viruses (tumorigenic or tumorigenic).

In the study of the etiology and pathogenesis of tumors in humans are important epidemiological studies, t. E. Comparative studies of tumor spread in different populations. For example, cancer of the skin in the south is more common than in the north, and most often it is localized on the face and exposed parts of the body that allows you to link his appearance with excessive sun exposure. It is proved that the incidence of lung cancer is closely related to the intensity and duration of smoking, carcinogens air pollution, which are a source of emissions of heating systems and industrial plants, especially exhaust gases of internal combustion engines. Some human tumors are of viral origin, such as Burkitt's lymphoma, Epstein-Barr virus is a virus.

In the nomenclature of tumors reflected their tissue origin: end - ohms (. From the Greek "onkoma" tumor) is attached to the roots of words indicating a particular tissue. A benign tumor of cartilage called chondroma, a tumor of fat tissue - lipoma of muscle - myoma .. Etc. In relation to certain tumors stored traditionally established names. For example, a malignant tumor of connective tissue called sarcoma due to the fact that the cut its cloth resembles a fish meat (from the Greek "Sarcos" meat). Malignant epithelioma is called " cancer ", probably due to the marked similarity in ancient times growths of some of these tumors with claws cancer.

Epithelial tumors are divided into originating in glandular and squamous epithelium. Benign tumors, which is dominated by glandular structures, called an adenoma , and malignant - adenocarcinoma. Benign connective tumor depending on the type of fabric are divided into fibroma, lipoma , chondroma, osteoma, and malignant respectively fibrosarcoma, liposarcoma, etc. Some tumors are called by the body or certain parts thereof, for example a tumor from liver cells -.. Hepatoma tumor of islet cells of the pancreas - insuloma et al.

Malignant tumors can develop from a number of previous benign growths them of who called precancerous or premalignant: This transformation of benign tumors called malignant malignancy. The progression of the tumor and its metastasis, loss of vital organs, anemia due to bleeding from the ulcerated tumor tissue intoxication decay products of tumor and metabolic disorders can lead to cachexia .

The frequency of tumors increases with age, and in most cases, they occur in people over 40 years. However some tumors are often in children than in adults. These include teratomas, ie tumors from embryonic tissue, tumors of nerve tissue, a kind of kidney cancer -.. Nephroblastoma and various angioma - vascular tumors.

In most cases, in the initial stages of cancer are no agonizing pain, no high temperature and other symptoms causing concern. However, there are almost always minor manifestations of the disease, for which it can be suspected. Such symptoms as severe pain, dramatic weight loss and a significant weakness, are late symptoms of the disease. Clinical manifestations of each form of cancer depends on the localization and extent of its spread (cm. Below).

There is a classification in which all clinical manifestations of tumor growth is divided into stages. Stage I - tumor limited to outside the body, there are no metastases; Stage II - tumor is within the affected organ, has metastasized to the regional lymph nodes; Stage III - tumor is large with spread to nearby organs and tissues, there are multiple metastases in regional lymph nodes; Stage IV - presence of distant metastases, regardless of the size and extent of the primary tumor.

Diagnosis of tumors conducted by the same methods as the detection of other diseases. It is based on a thorough clinical examination of the patient. Modern oncology does not have the possibility of staging the tumor diagnosis based on the results of a single laboratory test. Exceptions are neoplastic diseases of the blood, as with leukemia, blood tests can play a crucial role in the diagnosis, because she hematopoiesis system is in this case the focus of the development of cancer. The most easily recognized by the skin tumor, the lower lip, breast, cervix, available for inspection and sampling of material for morphological studies.

This article discusses some of the most common tumor sites.

SKIN CANCER

Distinguish among tumors of the skin, benign tumors, pre-malignant (pre-cancerous) skin diseases mestnodestruiruyuschim tumor growth and malignant tumor. By origin distinguish epithelial, connective tissue and pigment skin tumor.

Benign tumors. Epithelial benign skin tumors originate from the epidermis and skin appendages. Papilloma occurs in middle-aged and elderly persons. It may be localized in any part of the skin. It is a single tumor or multiple foci, towering above the skin surface, mobile, with a wide base or on the stem. Colour tumor gray or dark brown, villous surface may be covered with horny masses.

Senile verrucosum occurs, usually in elderly and senile age. Localized on exposed skin (forehead, cheeks, neck), in most cases there is a single. It represents delineated from the surrounding skin plaque with clear contours, diameter of 1-2 cm and more. The surface of the plaque covered with thin scales grayish color.

Cutaneous horn is localized on the exposed skin and on the ground, exposed to trauma. It is a sharply delineated from the surrounding skin tumor characterized by a pronounced keratinization in the form of formation of dense masses of grayish color (can be up to a few centimeters in height, with the base of the tumor does not increase). Primary cutaneous horn appears on intact skin, the development of secondary cutaneous horns preceded the pathological process in the skin (eg, tuberculosis, skin lupus erythematosus ). Cutaneous horn is usually an isolated form, projecting above the surface of the skin.

Keratoacanthoma - a relatively rare tumor of the skin. Some authors believe that its development play a role virus papilloma human. Keratoacanthoma localized in any part of the skin, usually on the face and neck, in atypical cases - on the oral mucosa, the red border of the lips, around the anus. Men have found a bit more often. Is, as a rule, a single circular formation with a diameter of 0.5-1.5 cm epithelial smooth roller and the edge portion of the depressions in the center filled horny masses. Distinguish between active tumor development (2 - 3 weeks), the process of stabilization and regression period (resolution). Their total duration is 7 - 8 weeks. Then the tumor may disappear, and in its place is a scar.

In atypical cases keratoacanthomas has a large diameter, there is about a year, it is possible to transform into squamous cell carcinoma.

Seborrheic keratosis, or seborrheic wart, is more common in the elderly; localized in closed areas of the skin such as the torso. It characterized by the appearance dramatically hyperpigmented (brown to black) plaques often multiple diameter of 0.5-4 cm and a covered easily removes greasy crusts.

Papillary gidradenoma - single mobile apocrine gland tumor. It occurs mostly in women, localized to the skin of the external genitalia and perineum. It has a soft texture and large sizes (4 - 6 cm). It grows usually slow.

Ekkrinnaya Porus - swelling of the duct ekkrinnoy intradermal sweat glands. Localized mainly on the plantar surface of the feet, the palms, the inner surface of fingers.

It is a single flattened tumor formation in the form of plaques 1-2 cm in diameter with a smooth or hyperkeratotic surface pink or dark brown. Ekkrinnaya Porus painless on palpation; It may ulcerate.

The papillary siringotsistadenoma (siringoadenoma) - adenoma sweat gland excretory duct. It occurs rarely, usually in children and youth age. Located often on the scalp, neck, groin and axillary folds. It has the form of a single or multiple tumor-like formations of dense consistency, grayish or grayish-yellow color with a papillomatous growths on the surface.

Ekkrinnaya spiradenoma - a tumor that develops from the glomerular part of the sweat glands. Rarely, more common in young men. Localized typically on the face, the front surface of the trunk. It is a bundle of dark yellow or bluish-red color, dense consistency, sometimes painful on palpation.

Tsilindroma localized on the face and scalp (called turban tumor). It is a major tumor with a smooth surface, it is characterized by progressive growth, tendency to relapse after surgical excision.

Acanthoma adenoides cysticum is multiple and single. The plural form is more common in childhood - a hereditary acanthoma adenoides cysticum. Numerous small nodules located primarily on the face, and sometimes the scalp, neck, anterior surface of the trunk. A single form occurs mainly in adults. Any localized part of the body, usually on the face.

Fibroids can appear on any part of the skin. There are hard and soft fibroma. Solid fibroma has a wide base, dense texture, smooth surface, a normal skin color or slightly pink. This limited mobility tumor, towering above the skin surface. Soft fibroma is multiple and single. Localized mainly in the neck, front surface of the chest, in the inguinal folds and armpits. It looks meshochkoobraznoy hanging various size tumor with wrinkled surface pink or brown.

Dermatofibroma can be single and multiple. It occurs usually in women, upper and lower extremities of the skin. Node consistency dense, dark brown, deep rounded shape is located in the skin, often does not protrude above its surface.

Dermatofibrosarcoma protuberans - locally invasive tumor. There is more common in men in the area of ​​the shoulder girdle, on his head. Sometimes a single and multiple. Tumor extends above the surface of the skin, has a smooth, bumpy surface, which may ulcerate. Characterized by slow growth and the trend towards the development of recurrence after excision. Hemangioma develops from blood vessels. Allocate a capillary, arterial, arteriovenous and cavernous form.

Lymphangioma - a tumor that arises from the lymph vessels. Often detected at birth. Localized in any part of the skin. Combined with hemangioma. There are capillary, cavernous and cystic forms. Against the background of cystic and cavernous lymphangiomas can develop areas palillomatoza and hyperkeratosis. Secondary lymphangioma may be a manifestation lymphostasis, sometimes it appears after infectious diseases (eg, faces ).

Leiomyoma - a tumor that occurs in the muscles, lifting the hair. Multiple leiomyoma is characterized by the appearance on the trunk and extremities tumors (3 - 5 mm in diameter) round, with a smooth surface, painful on palpation, with a tendency to grouping. Solitary leiomyoma has a size up to 2 cm in diameter; around the lesion erythema observed.

Angioleyomioma - solitary tumor is deep red, dense elastic consistency. Localized often in large joints.

Lipoma - a tumor of adipose tissue in the form of single or multiple foci (see. Lipoma ). Localized in any skin area, towering over its surface. Has, as a rule, large size (up to 10 cm in diameter) testovatoy consistency normal skin color.

For benign pigmented skin tumors include various forms of pigment nevus - spots or growths, made up of so-called nevus cells. They appear after birth or in the first years of life; sometimes appear in youth and middle age under the influence of solar radiation or during pregnancy .

Pigmented nevi - flat spots or nodules of dark gray, brown or black, udlinennnoy or round shape with a diameter of 1 cm or more. The surface of the pigment nevus usually smooth, but sometimes there are papillary warty growths. In some cases, larger nevus is a big part of the body the skin, face, neck or limbs and is a cosmetic defect (giant pigmented nevi). On its surface often grow hair. Sometimes the nevus is blue - blue nevus. It is more common in women on the face and forearms. A variety of blue nevus is a Mongolian spot. It occurs predominantly in people of Asian descent through 1 - 2 days after birth, usually in the lumbosacral region. It has a bluish or brownish color, a diameter of 10 cm or more. After 4 - 5 years old stain gradually fades and disappears.

Nevus of Ota is more common in women - representatives of Asian nations. It can be congenital or appear in the first years of life. It has the kind of pigment spots, which is placed on the face during the I and II branches of the trigeminal nerve (the forehead, malar region, wings of the nose and conjunctiva, sclera and the iris of the eye). There are also nevus Sutton (Sutton's disease) - lentigo small sizes with rim depigmented skin, localized on the trunk or extremities.

Blue nevus, nevus of Ota, nevus pigment with papillary warty growths at a trauma can be transformed into a malignant tumor of pigment - melanoma.

Precancerous skin conditions. These include xeroderma pigmentosum, radiation damage to the skin, solar keratosis, and others. A number of authors included in this group as Bowen's disease, Keira's disease and Paget's disease (when the localization is the nipple and breast areola), which are rare.

Solar keratosis is the result of excessive sun exposure. At the same time against the backdrop of foci with areas of hyperpigmentation, atrophy appear multiple foci of hyperkeratosis in the form of elongated or oval patches of up to 0.5 - 1 cm in diameter, covered with dense gray scales, crusts. In the affected areas may develop Bowen's disease or squamous cell skin cancer.

Bowen's disease is often treated as intraepidermal cancer. Observed mainly in people of middle and old age, often localized on the face, torso. Usually is a single gray-brown plaque slaboinfiltrirovanschcho, with irregular, sharp edges covered with scales or crusts. The lesion grows slowly along the periphery, its surface often ulcerate, on it there are areas of atrophy , which, together with scales and cortical layers of the tumor gives colorful look. In persons suffering from Bowen's disease, a cancer often reveal internal organs.

Keira disease - intraepidermal cancer of the genital mucosa (usually the head of the penis, the inner layer of the foreskin). The lesion has clear boundaries, shiny, velvety surface. When you join a secondary infection may experience lymphadenitis .

Paget's disease is the localization of the nipple and areola breast characterized by limited foci soak maceration and located primarily in the crotch area and the navel.

Tumors with mestiodestruiruyuschim growth. Epithelial tumors with mestiodestruiruyuschim growth is a basal cell carcinoma (basal cell carcinoma). It develops from the basal layer of the epidermis, or skin appendages (sebaceous glands and sweat glands). This is the most common epithelial tumor of the skin. Observed mainly in old age. It is characterized by invasive growth; rarely metastasizes. Clinical manifestations are diverse. There are superficial (the most favorable form), cystic, peptic ulcer, and sklerodermopodobnuyu pigment form of basal cell carcinoma.

Superficial basal cell carcinoma - a limited spot on the periphery of which has a roller consisting of individual nodules ( "pearls"). Often localized in the open areas of the body exposed to sunlight, prolonged mechanical irritation. Individuals with fair skin may occur multiple foci, which coalesce into large plaques covered with scales. Often plaques spontaneously scarring center and at the periphery - the tumor growth.

When cystic basal cell carcinoma lesion more often single, sharply demarcated from the surrounding tissue, bright pink, testovatoy consistency; on the surface often has telangiectasia. Localized mainly on the face (around the eyes, nose).

Ulcers can develop basal cell carcinoma of the surface or cystic. There is often on the chin, at the base of the nose and the inner corner of the eye. Manifested form nodules, prone to ulceration. It is characterized by tumor infiltration of underlying tissue defect with the development up to the destruction of bone and cartilage. In some cases, on the surface appear ulcerated papillomatous growths.

When sklerodermopodobnoy basal cell carcinoma on the face, upper body formed plaques of dense consistency with clear boundaries. They resemble the lesions of scleroderma , in which marked erythematous beater on the periphery of the hearth. In contrast to scleroderma at sklerodermopodobnoy basal cell carcinoma on the periphery of the lesion detected valikoobrazny edge and single knots - "pearls".

Pigmented basal cell carcinoma has a darker color (from yellow-brown or bluish-brown to dark brown or black), which is associated with the presence of melanin in the cytoplasm of tumor cells.

For skin cancers include squamous cell cancer, pigmentary tumor - precancerous melanosis Dyubreya and melanoma. Flat-cell skin cancer is an epithelial cancer. There is often in places of constant stimulation, mechanical damage, against the backdrop of nonhealing venous ulcers, fistulas, radiation damages the skin and can also develop from lesions characteristic of Bowen's disease, xeroderma pigmentosum, solar keratosis. In the clinical picture distinguish endophytic (ulcerative) and exophytic (papillary tumor or) form of squamous cell carcinoma. If a peptic ulcer crater shape is formed with a tight bottom and valikoobraznymi edges. Ulcer is slowly but steadily growing, bleeding. When papillary form of solitary solid nodules similar to a wart or keratoakantomu merge together into large lesions resembling cauliflower. Squamous keratinizing cancer differs infiltrative growth in the underlying tissues, metastasizes to the lymph nodes and lymph vessels, and in severe cases - in the blood vessels.

Precancerous melanosis Dyubreya is a slow growing tumor that usually occurs after 30 years, more frequently in women. Localized, usually on exposed skin. It looks like a single large-sized plaques (4 - 6 cm in diameter) with uneven contours and uneven pigmentation (from light brown to dark brown and black). The upward trend, changing the color of the tumor (dark), development papillomatoznyh growths on the surface or the appearance of areas of atrophy suggests its transformation into melanoma.

Treatment. Most skin cancer is not accompanied by noticeable subjective sensations. When the patient's skin lesions should be referred for consultation to the oncologist or dermatologist who establishes the diagnosis on the basis of history, clinical signs and results of histological and cytological studies and treats. In benign tumors of the skin surgery (removal of the tumor) is carried out in the case of the tumor in places exposed to injury, as well as the patient's request (for example, a cosmetic defect). Precancerous diseases subject to compulsory treatment. For this purpose, use surgical excision, including electrosurgical, cryosurgery, radiation therapy, laser radiation. According to the testimony as topically administered various cytotoxic drugs (5-fluorouracil, ftorafur, prospidin et al.).

Prevention is the early detection of early signs of cancer, conducting preventive examinations and identification of risk groups (persons suffering from long-term healing ulcers with scar skin changes, etc.) In the active treatment of precancerous dermatoses. Avoid excessive sun exposure and exposure to carcinogens.

BREAST CANCER

By the benign tumors include adenomas breast and nipple, papilloma duct. The most common fibroadenoma consisting of epithelial cells and connective tissue stroma. It is located in any portion of the prostate, has the form of rounded, separated from the surrounding tissue and well biased at node palpation. When papilloma breast may krovjanisto-serous discharge from the nipple. Diagnosis is based on data rezultagah palpation and mammography. Treatment of breast benign tumors operative. Produce sectoral resection of the prostate with a mandatory term histological examination of distance education.

Malignant breast tumors occupy one of the first places among malignant tumors in women. The risk of developing breast cancer is higher in women who had a first pregnancy at age 35 and older, compared with those in the first pregnancy was 20 years old. Later occurrence of menstruation (17 years and older) and late menopause (in women aged 50 years or over) increase the risk of developing breast cancer. The risk of getting sick; nulliparous women is higher than that of giving birth. The results of a large number of studies have shown that breast cancer patients have blood relatives of women with this disease occurs 6-7 times more frequently than in women without a history of heredity. The risk of breast cancer in 2 - 3 or more times higher in the presence of proliferating cystic mastitis and benign tumors of the mammary glands.

Initially, breast cancer occurs usually asymptomatic, and the tumor is detected incidentally during washing, changing clothes, and so on. D. At the same time more often identified nodes in diameter from 2 to 5 cm. At the dispensary examination using modern diagnostic techniques may detect tumors as small as 0.5 cm in diameter, which can not yet be detected by palpation.

Clinical types of breast cancer are different, but more frequently observed nodal and diffuse forms. Nodular cancer occurs most often localized in the prostate verhnenaruzhnogo quadrant or in the central zone. Palpable defined clearly delineated, rounded, dense, reduced mobility education. Above the tumor can be detected pastoznost skin, a symptom of lemon peel, skin infiltration, retraction of the nipple.

Diffuse cancer combines edematous infiltrative, crustacean, like the face and mastitopodobnuyu form. Edematous infiltrative form thickets occurs in young women, often during pregnancy and lactation. Mammary gland with increased skin pasty and swelling, hyperemic. Palpated infiltration without clear contours. Armoured cancer is characterized by tumor infiltration of gland tissue and skin. The skin becomes thick, pigmented, bad shifting. Breast reduced, tightened up, it shrinks. Tumor infiltration compresses the chest wall in the form of a shell. Rozhepodobnaya and mastitopodobnaya forms of cancer are keen for extremely malignant, rapidly relapse after radical surgery and rapidly metastasize. When rozhepodobnoy form of erythematous skin lesions resembles a face , there is a high body temperature (39-40 ° C). When mastitopodobnoy forms of breast increased significantly, tense, dense, pronounced hyperemia and skin hyperthermia, there is an increase in body temperature.

Diagnosis of breast cancer, particularly in the initial stages of its development difficult. Displaying a systematic survey of women at-risk - older than 35 years, especially those with pre-cancerous and other breast diseases. It is necessary to complete the clinical and special examinations of patients, including mammography and ultrasound breast cancer research. Ductography shown in suspected vnutriprotokonuyu papilloma and ductal cancer. Ultrasound examination can detect breast tumors over 1 cm in diameter.

Of particular importance in cancer diagnostics take cytological and histological examination of material obtained by aspiratsionpoy tumor biopsy smears of discharge from the nipple. Puncture tumor fine needle carried by syringe aspiration repeated 3 - 4 times. If necessary, carry out sectoral resection with an urgent histological examination.

Treatment. Choice of treatment depends on the stage of cancer. Only surgical treatment is used in the early stages of the disease. In all other stages of surgery must be supplemented by radiotherapy, drug or a combination of methods. Most high results achieved in the treatment of cases, when using a complex method, t. E. Combine both regional (surgery, radiotherapy) and overall (chemotherapy, hormone therapy) treatment measures.

After the treatment of breast cancer patients develop a rehabilitation program based on the general condition, age, stage of the process, the profession and working conditions. The main purpose of it is to eliminate the complications that arise primarily after surgical treatment, such as limiting the mobility of the shoulder joint, plexitis , lymphostasis upper limbs, etc. It is extremely important psychological problems in patients after diagnosis and surgery. Rehabilitation of patients with breast tumors usually carries a group of specialists (radiologist chemotherapist, psychologist, physiotherapist). Long-term results of treatment depend on the stage of the tumor lesion.

lung tumor

For benign tumors of the lung include a number of tumors developing from the bronchi. The most frequently observed adenoma , hamartoma, rarely papilloma is extremely rare vascular ( hemangioma ), neurogenic (neuroma, neurofibroma), connective tissue (fibroma, lipoma , chondroma) tumor. Kind of tumor is a carcinoid of the bronchi, which may occur as a benign or malignant neoplasm.

Adenoma arises from the mucous glands of the bronchi and closing the lumen of the bronchus, lung lobe violate ventilation and promotes it in the inflammatory process. Clinically manifested hemoptysis and fever due to the development of recurrent pneumonia . The disease runs in years. Diagnosis is based on the results of X-ray examination, bronchoscopy and biopsy of the tumor tissue. surgical treatment - removal of the tumor and the affected bronchus of the lung tissue. The prognosis for timely operations is favorable.

Malignant tumor. The main malignant lung tumor - bronchogenic cancer, other malignancies (eg, sarcoma ) are rare. Among patients with lung cancer is dominated by men; the average age of patients - about 60 years. Lung cancer usually occurs on the background of chronic bronchitis caused by the inhalation of air containing carcinogens and smoking.

Depending on the location of the tumor are distinguished central lung cancer originating from segmental, equity or main bronchus and peripheral lung cancer - from the small bronchi and the smallest bronchial branches.

By the nature of the growth of bronchial lumen endobronchial tumor can life and peribronchial. Endobronchial tumor grows into the lumen of bronchi, peribronchial - mainly in the direction of the pulmonary parenchyma. Lung cancer spreads through the lymph and blood ways, affecting the lymph nodes of the root of lung, mediastinum, supraclavicular, as well as other parts of the lung, liver, bones and brain.

Clinical manifestations of lung cancer depends on the location, size of the tumor, its relation to the bronchial lumen, complications ( atelectasis , pneumonia ), and prevalence of metastases. The most common symptoms are cough (dry or with scant amounts of sputum), hemoptysis, intermittent fever, pain in the chest. In the later stages of the disease increased body temperature it becomes persistent, growing weakness and shortness of breath, increased supraclavicular lymph nodes may occur pericardial effusion , sometimes there are swelling of the face, hoarseness.

The main diagnostic methods are x-ray of the chest, including radiography and tomography and bronchoscopy, in which can be made and a biopsy of the tumor.

Choice of treatment is determined by the prevalence of (stage) of tumor, histological structure of the tumors, the functional state of the respiratory and cardiovascular systems. The most effective radical surgery (lobectomy or pneumonectomy), which is held in the initial stages of the disease when satisfactory functional performance of the respiratory and cardiovascular systems. Approximately 30% of radically operated patients live 5 years or more. Radiation treatment is sometimes the long term delaying progression of the disease. Chemotherapy, in most cases bring temporary relief.

Prevention of lung cancer is smoking cessation, treatment of chronic inflammatory diseases of the respiratory system, recovery of the air of large cities and industrial enterprises.

tumors of the esophagus

Benign tumors are rare. Observed mainly in young age, more often in the medium and lower thoracic esophagus. Leiomyomas, up to 95% non-epithelial tumors of the esophagus, are based on the muscle membrane body. They are localized intramural and have the form of a single unit, at least a few. The current long-term benign tumors, without the expressed clinical manifestations. Significant proportions of Education cause dysphagia , which is, however, less pronounced than in cancer. Single large leiomyoma sizes can ulcerate and be the source of bleeding. The diagnosis is very important X-ray with contrast gullet. A crucial role is played by esophagoscopy and (for tumors located in the lumen of the esophagus) performed during esophagoscopy biopsy.

Treatment of benign tumors with surgery alone. Epithelial tumors on a thin stalk can be removed by esophagoscopy. Forecast favorable, relapses do not occur.

Among the malignant tumors of the esophagus principal place belongs to the cancer, which is the overall structure of malignant tumors is 5 - 6%. The highest incidence is noted in China, Iran, Switzerland, northern France, Iceland, Alaska, in northern Russia, in the Trans-Baikal region, Central Asia and Kazakhstan. Esophageal cancer develops mainly in elderly persons, slightly more men are affected. Around 60% of cases the tumor is localized in the lower chest esophagus, in 30% of cases - in the lower thoracic and abdominal, 10% - in the thoracic and cervical spine.

There are scirrhous cancer of the esophagus, infiltrative body wall and turning into normal tissue without visible boundaries; Ulcerative medullary cancer, characterized by tumor growth in the lumen of the esophagus, early ulceration and considerable depth of the ulcer; mixed (the most common), in which there is an early breakdown and ulceration; rarely found papillary or papillary cancer.

Depending on the prevalence of tumors and metastases are 4 stage process. Stage I is characterized by a clear demarcation of the tumor, only applies to the mucosa and submucosa. In stage II tumor invades the muscle membrane, there are single metastases in regional lymph nodes. For stage III is characterized by the germination of the tumor throughout the esophageal wall and the surrounding tissue, its cohesion with other bodies, the presence of multiple metastases in regional lymph nodes. In stage IV tumor invades adjacent organs, there are multiple regional and distant metastases.

The clinical manifestations of cancer associated with obstruction of the passage of food through the esophagus. There have dysphagia , pain, burning sensation behind the breastbone, but thanks to significant compensatory capabilities initially, these symptoms are transient in nature. With significant amounts of tumor of the esophagus lumen above it expands. Accumulation of food eaten results in a feeling of fullness in the chest, regurgitation ( "esophageal vomiting"), the appearance of bad breath, excessive salivation. Later symptoms appear, due to the spread of the tumor outside the esophagus and infiltration of adjacent organs. There are back pain during germination trachea and bronchi - hemoptysis, with the defeat of the aorta - a massive fatal hemorrhage. The disease is accompanied by progressive emaciation and anemia . Distant metastases observed mainly in the liver, and cervical and supraclavicular lymph nodes.

Diagnosis is based on clinical and instrumental studies. X-ray examination of the esophagus with contrast, as well as on the background of pneumomediastinum tomography, X-ray computer tomography can determine the extent of the tumor, its character, relationship with neighboring authorities, the increase in mediastinal lymph nodes. With esophagoscopy set its level, specify the length, the size of ulceration, taking material for cytological and histological studies. To detect metastases in the liver ultrasound is used and in some cases, radionuclide study and laparoscopy.

Treatment. Applied surgery or radiotherapy or a combination thereof. Chemotherapy is rarely used, mainly with contraindications to surgery and radiation treatment. If contraindications to surgery (in the case of an inoperable tumor, poor general condition of the patient, when the risk of surgery is large) is carried out only radiotherapy.

gastric tumors

For benign epithelial tumors include adenomas (polyps) that make up 10% of all gastric tumors. Externally, they resemble the mushroom-shaped growths that often ulcerate. Benign non-epithelial tumors (leiomyoma, fibroma, hemangioma , glomus tumors, neuromas, etc..) Are located in the submucosa or muscular layer, making up 3% of all gastric tumors. They usually have a smooth surface and spherical shape and may reach a large size.

Benign tumors are often asymptomatic. Complaints of patients to nausea , belching , taste perversion, pain is usually caused by underlying diseases, such as gastritis . When the tumor in cardiac or pyloric parts of the stomach may experience cramping pain in the upper abdomen, vomiting after meals. Ulceration of the tumor results in hidden or massive bleeding, development of hypochromic anemia. Possible malignancy of the tumor. In the diagnosis of benign gastric tumors primary importance are radiological and endoscopic studies. Gastroscopy reveals the prevalence of tumor process, as well as signs of malignancy; biopsy gives an opportunity to clarify the morphological nature of the tumor. Treatment of benign tumors operative. Polyps to 2 cm in diameter with a narrow base, including Multiple removed through a gastroscope or by electrocoagulation with a laser. If polyps larger sizes on a wide basis, especially those located in the body and the proximal part of the body, with non-epithelial tumors is shown gastrectomy. Weather favorable.

Among malignant epithelial tumors the most common cancer of the stomach, including non-epithelial - sarcoma . The incidence of cancer in different countries connected, apparently, with the features of the power and life (character and way of cooking, smoking, alcohol consumption), occupational hazards (working in the chemical industry), genetic predisposition, and others. malignant growth often precede changes in the mucosa stomach called precancerous.

The tumor may be localized in the proximal or distal, in the stomach, there is also a total organ failure. There are exophytic, infiltrative and mixed forms. Exophytic form, in turn, includes blyashkovidnuyu, polypoid and saucer; infiltrative - ulcerative infiltrative, submucous and ploskostelyaschuyusya; mixed - a cancer of the polyp and cancer of the ulcer. According to the microscopic structure of all forms of cancer can be divided into adenocarcinoma and perstnevidnokletochny cancer; also secrete intestinal and diffuse types.

The clinical course of gastric cancer are 4 steps: I stage - tumor limited to the mucosa and submucosa; Stage II - tumor invades the muscle layer, may occur solitary metastases in regional lymph nodes; Stage III - tumor invades the entire wall of the stomach may go beyond it and infiltrate neighboring organs, multiple metastases in regional lymph nodes; Stage IV - there are distant metastases.

The clinical picture of gastric cancer is very varied, due to the frequent occurrence of the disease on the background of gastritis , polyps, ulcers. In the early stages of stomach cancer has no specific symptoms, and therefore emit a peculiar symptom (the so-called syndrome of small signs), characterized by decreased performance, fatigue, causeless weakness, decrease in appetite, development of gastric discomfort (feeling of heaviness and fullness in the abdomen, nausea ), wanton progressive weight loss, anemia .

Symptoms of stomach cancer at the height of the disease is more pronounced and determined by the characteristics of the tumor - growth form, size, location, and the prevalence of tumor metastases, complications (infection and decay of the tumor, the violation of terrain, etc..), As well as the reactivity of the organism. All the symptoms of this can be roughly divided into several groups: general symptoms caused by intoxication (decreased appetite, general appearance unmotivated weakness, malaise, weight loss, and others.); symptoms associated with lesions of the stomach itself (pain, feeling of heaviness, burping, etc..); Symptoms caused by acceding complications ( dysphagia , vomiting , bleeding, etc.). Depending on the tumor may prevail certain symptoms. So, with the defeat of the proximal stomach develops first partial, then complete dysphagia. In patients with marked regurgitation, hiccups , weight loss, chest pain. Local symptoms are less pronounced in gastric cancer of the body. The disease is characterized mainly common symptoms - loss of appetite, general weakness, weight loss, anemia. In cancer of the distal, accompanied by pyloric stenosis, in connection with the violation of patency of a feeling of heaviness and fullness in the stomach, belching, repeated vomiting, weight loss. The spread of the tumor in the pancreas causes sharp pain in the back. Infiltration or metastasis in head of the pancreas or liver gate accompanied by jaundice mechanical origin, germination of the transverse colon leads to the development of intestinal obstruction.

Metastasis with gastric cancer is very common. Distant metastases arise as lymphogenous (current or lymph in a retrograde direction), and hematogenous route. In the advanced stage of the disease can be detected metastases in the axillary, inguinal and other distant lymph nodes. Typical for gastric cancer is a lymph node in the left supraclavicular (Virchow metastasis) in the tissue of the pelvic organs, as well as metastasis to the ovaries (metastasis Krukenberg). Metastases can also be observed in the navel, liver, pancreas, lungs, bones, skin, subcutaneous tissue.

Diagnosis in advanced stages of the disease does not pose much difficulty. Along with complaints attract the attention of the patient expressed exhaustion, sallow complexion look dull, dry and reduced skin turgor. Palpable epigastric tumor formation can be determined. With pyloric stenosis observed bloating and visible peristalsis, with ascites - a sharp increase in the abdomen.

The outcome largely depends on early detection of the disease. It is therefore important to pay special attention to patients at risk (those with a history of ahilichesky gastritis , peptic ulcer disease, gastric polyposis), as well as detection of early symptoms of the disease (for example, "small signs"). Of great importance is the timely detection of changes in the nature of pain and new symptoms in individuals with disorders of the gastrointestinal tract. A role in the diagnosis of gastric cancer plays the results of laboratory studies - moderate leukocytosis . With neutrophilia and shift to the left leukocyte, ESR increase, achlorhydria, feces positive reaction to the latent blood and other leading role in the early diagnosis of gastric cancer occupy radiological research methods and endoscopy. The main radiological signs of stomach cancer are filling defect, deformity and narrowing of the lumen of the body, the rigidity of the walls and the absence of peristalsis in the affected area, changing the structure of the mucosa relief violation of patency.

Gastroscopy makes it possible to visually determine the location, shape and nature of the tumor growth, the prevalence of the process, and get prints from, the surface of tumor cytology. To study the structure of the tumor produce sighting gastrobiopsy and histological examination of the mucous membrane surrounding the pathological focus.

Retroperitoneal metastatic disease in lymph nodes and liver were determined by ultrasound and computed tomography. Laparoscopy allows to reveal or exclude the defeat of the abdominal cavity and the transition process to adjacent organs, metastasis to the liver and other organs. In case of doubt, it is a laparotomy with biopsy.

The only radical method of treatment of gastric cancer is timely surgical intervention. When exophytic cancer located in the distal or proximal part of the stomach without going to his body used subtotal resection. If it affects the body of the stomach, as well as infiltrative tumors of any localization shows gastrectomy. Upon germination of the tumor in adjacent organs (transverse colon, pancreas, liver, spleen) combined operations can be performed.

In the presence of contraindications to radical surgery shows palliative intervention (with dysphagia caused by a tumor of the proximal stomach - gastrostomy, with stenosing cancer of the output of the stomach - gastrojejunostomy, during germination or metastasis of gastric cancer in the colon or small intestine with development of obstruction - the imposition of bypass intestinal anastomosis ).

Chemotherapy is also used only for palliation. Of the chemotherapeutic agents most widely fluorine derivatives antimetabolites (5-fluorouracil and ftorafur), which is prescribed alone or in combination with other drugs (eg, vincristine, adriamycin). The use of different circuits chemotherapy process allows for partial regression of 30 - 40% of patients. Applied also radiation therapy, the possibility of which, however, limited to gastric cancer. It is usually administered in the preoperative period, or in combination with chemotherapy.

The prognosis of gastric cancer is dependent on tumor growth form, histological structure, process steps, and other factors. When exophytic tumor in the form of I -II stage of the process the forecast is quite favorable; with infiltrative form, especially in III -IV tumor stage, - unfavorable. In general, after a radical intervention to survive 5 years 20 - 30% of the operated patients. It is necessary to more early detection of the disease. This can be achieved under dynamic observation and regular examination of the patients, especially at-risk groups.

Sarcoma of the stomach, is 3 - 5% of all malignant tumors of the stomach, are more common in young adults. Depending on their histogenesis divided into lymphosarcoma, reticulosarcoma, mesenchymal and neuroectodermal sarcoma. The peculiarity of this type of tumors, in contrast to stomach cancer is the fact that, even reaching a large size, they are a long time remain a local process and metastasize less often. At the same time there is often ekzogastralnoe location of the tumor, when the main part of it is out of the stomach and the tumor grows into adjacent organs. The growth of sarcomas can be exophytic and infiltrating.

Clinically, the disease is manifested dyspeptic disorders, fever , sometimes (in the decay of the tumor), gastric bleeding. The leading method in the diagnosis of sarcoma is an X-ray. Gastroscopy with biopsies is of less importance in sarcomas of the stomach, which in some cases due to the absence of mucosal lesions. Certain diagnostic value, particularly at the tumor site in the front wall of the stomach and dissemination process have laparoscopy with biopsy.

The main method of treatment is subtotal gastrectomy and gastric resection. When certain types of sarcomas effective chemotherapy. The most commonly used cyclophosphamide, methotrexate, vincristine, adriamycin. When localized lymph and retikulosarkome in inoperable cases, radiation therapy is prescribed. Prognosis is generally unfavorable.

BOWEL CANCER

Tumors of the small intestine are rare, more often they are localized in the distal ileum, and sometimes there is a multiple lesions. Benign tumors of the small intestine in the structure is divided into epithelial (adenomas) and non-epithelial. Often observed adenoma and leiomyoma, less hemangioma , lipoma , fibroma, neurofibroma, lymphangioma. In the early stages of benign tumors of the small intestine are usually not clinically manifested. As the growth of the tumor may develop partial or complete intestinal obstruction, intestinal bleeding observed with ulceration. Adenomatous polyps of the small intestine are prone to malignancy.

Diagnosis is based on the results of X-ray or endoscopy.

Treatment operative, is resected bowel segment affected. A special place among the small intestine carcinoid tumor takes, which can be both benign and malignant course.

Malignant tumors of the small intestine are more common than benign and predominantly in men. Cancer of the small intestine, according to some authors, 0.5% of all cancers of the gastrointestinal tract. Metastasis mainly lymphogenous - in mesenteric lymph nodes and retroperitoneal space. Metastasis occurs hematogenous through the liver, lungs and other organs.

Gematosarkomy (lymphosarcoma, reticulosarcoma) occur usually at a younger age. Unlike other tumors of the small intestine are often localized in the proximal jejunum. There is a risk of a few small intestine.

In the initial stages of malignant small bowel tumors are usually asymptomatic. There may be a feeling of discomfort, pain in the abdomen. As the tumor develops clinical picture of partial or complete intestinal obstruction , with ulceration of the tumor - symptoms of intestinal bleeding at the perforation - peritonitis.

Diagnosis is based on clinical data and instrumental studies, among which the leading role belongs to the X-ray examination. It is also important gastroduodenoscopy. To clarify the diagnosis, including tumor localization, use irrigoscopy, excretory urography, ultrasonography, computed tomography of the abdomen and retroperitoneal space. Verification of the diagnosis is carried out only by histological examination of biopsy or surgical specimens.

The only radical method of treatment is surgery: wide resection of the affected portion of the intestine with the mandatory removal of regional lymph nodes of the mesentery. In inoperable cases to eliminate intestinal obstruction performed palliative interventions - imposing gastrojejunostomy, or enteroenteroanastomosis ileotransverzoanastomoza. When gematosarkomah radiation therapy and chemotherapy.

Tumors of the colon. Benign non-epithelial tumors are rare, have the structure of a lipoma , leiomyoma, fibroma, neurofibroma, angioma , lymphangioma. In the early stages they are asymptomatic, grow slowly; in later stages, obturiruya lumen, leading to intestinal obstruction . When ulceration is a picture of intestinal bleeding. Benign epithelial tumors originate from glandular epithelium and often take the form of polyps. Polyps are located on a broad basis, or leg, their size ranges from barely noticeable bumps up to 3-4 cm or more in diameter, are solitary or multiple, often localized in the left half of the colon. Meets diffuse polyposis, in some cases, having a hereditary character.

Polyps may be asymptomatic. Sometimes there presence in the stool blood and mucus, diarrhea or constipation , their alternation, abdominal pain, with diffuse polyposis - weakness and weight loss. Polyps tend to malignancy. The main methods of diagnosing colon polyps are barium enema and colonoscopy with biopsy.

All colon polyps to be removed. For small polyps in the leg can be endoscopic polypectomy. Polyps are excised on a broad base at laparotomy through an incision in the intestinal wall. In those cases where the excision of polyps impossible segment shown colon resection. In diffuse polyposis conduct more extensive surgery: right-sided and left-sided hemicolectomy, subtotal and total colectomy.

Among the malignant tumors of the colon epithelial origin is most common adenocarcinoma. Malignant non-epithelial tumor - sarcoma (mostly cell lymphoma and leiomyosarcoma) represent only 1-2% of all malignant tumors of this localization. The highest incidence of colon cancer in developed countries, due to the nature of public power (increase in animal fat and protein intake and a decrease in consumption of fiber). The disease is more common in older than 50 years. Cancer is localized mainly in the sigmoid and cecum. Macroscopically, the tumor can be polypoid, saucer, ulcerative infiltrative, diffuse (infiltrative) form.

The initial manifestation of malignant tumors are mild, so it is necessary to identify the so-called minor symptoms (fatigue, abdominal discomfort, manifested by nausea , loss of appetite, belching , discomfort in the mouth, etc..). In the expanded stage of the disease the cancer of the right half of the colon (the blind and ascending colon, hepatic flexure) is characterized by impaired general condition of the patient (fatigue, weight loss, fatigue, malaise), fever, anemia, abdominal pain, abdominal discomfort. For cancer of the left colon (splenic flexure, descending colon and sigmoid colon) are more common intestinal disorders such as constipation or diarrhea, bloating, and rumbling. When the tumor in the distal sigmoid colon marked tenesmus, in some cases, may develop partial and then full of low intestinal obstruction. The stool has blood impurity (dark color), mucus. The process can be complicated by an abscess of the abdominal cavity, or cellulitis , a perforation of the intestinal wall and the subsequent development of peritonitis, tumor invasion into adjacent organs and tissue, intestinal bleeding. Metastasis of epithelial tumors of the colon occurs in lymphogenous by parakishechnye and retroperitoneal lymph nodes, hematogenous route to the liver, lungs and other organs. Sarcomas metastasize often hematogenically.

Diagnosis of colon cancer based on carefully collected history, data inspection and palpation of the abdomen. The decisive diagnostic methods include barium enema, colonoscopy with histological examination of biopsy material. The tumors of the distal sigmoid sigmoidoscopy reveals. With the help of X-ray examination of lungs, excretory urography, ultrasound, computed tomography determine the extent of metastasis of cancer. For the detection of tumors at an early stage in asymptomatic or process used techniques based on the determination of occult blood in the stool.

The only radical method of treatment - surgery. In inoperable tumors impose bypass and create unnatural anus. Chemotherapy is not effective. Radiation therapy is used only in respect of the combined treatment, usually before surgery.

Liver tumors

Among the benign tumors of the greatest clinical significance are adenomas , hemangiomas and teratomas. Adenomas can grow from liver cells (hepatoma) and of the bile ducts (cholangioma). Adenomas have reached high value enough manifested moderate dull pain, feeling of heaviness in the right upper quadrant. In the liver palpable tumor tugoelasticheskoy or solid consistency, sometimes plotnobugristaya shifts in breathing along with the liver. Hemangioma has a smooth or hummocky surface, sometimes mobile. The characteristic symptoms of hemangiomas are the decrease in the size of tumor and compression of its "top noise" on auscultation. The tumor is characterized by slow growth, however dangerous its complications, of which the most important are bleeding in the spontaneous rupture of the tumor and liver failure teratoma is rare. It contains derivatives of different germ layers (skin, cartilage, brain tissue, and others.); often combined with other malformations of the digestive system, lungs and skin. Detected by X-ray or ultrasound of the abdominal cavity. Treatment of benign tumors operative. P r o g n o s in most cases favorable.

Additional malignancies largest value (1 - 2% of all malignancies) has a primary liver cancer, which often develops on the background of chronic hepatitis B (in the role of hepatitis B virus) and especially (presumably in 4% of patients), liver cirrhosis .

The clinical picture consists of general and local symptoms. The former include fatigue, progressive weakness, anorexia , perversion of taste, weight loss up to cachexia. A number of patients have vomiting , fever , tachycardia , often marked anemia . Local symptoms: pressure and feeling of heaviness, dull pain in the right upper quadrant and epigastric liver enlargement. In the later stages appear jaundice and ascites . When the hub is determined by the growth of palpation hard and lumpy edge of the liver, increase in diffuse or deep location of the tumor can be marked only increase or increased body density. Of great importance, especially in the early stages, results have liver ultrasound, computed tomography, and identification of serum alpha-fetoprotein.

The liver tumors often metastasize to other organs (gastrointestinal, breast, lung, kidney, prostate, and others.). The nature of malignant liver lesions (primary or metastatic) set at morphological research material obtained during laparoscopy.

Treatment operative. In inoperable tumors used palliative interventions: cryodestruction tumor, regional or systemic administration of chemotherapy.

TUMOR GALLBLADDER

In benign tumors (adenomas, uterine fibroids, papilloma, etc.) The clinical manifestations are absent or have symptoms that are typical of chronic cholecystitis . Diagnosis is based on holetsistografii results ultrazvukonogo research. Treatment of benign tumors operative, and the majority of cases produce cholecystectomy. Weather favorable.

Additional malignancies prevails gallbladder cancer, which is about 2 to 8% of all malignancies and is the fifth malignant tumors of the gastrointestinal tract. This disease is more common in people older than 40 years, women have 4-5 times more often than men. Often, gallbladder cancer occurs against a background of gallstone disease.

In the initial stage of gallbladder cancer are asymptomatic. In that case, when the cancer develops on the background of gallstone disease and its clinical manifestations are usually camouflage the signs of cancer. Intense persistent pain and palpable nodular tumor in the right upper quadrant, jaundice , body weight loss, increasing fatigue, anemia, ascites can be suspected gall bladder cancer, however, as a rule, these symptoms indicate that already far come defeat - germination or compression of the tumor or its metastases adjacent organs and tissues.

Paroxysmal pain, a significant increase in body temperature, chills, heavy sweats occur when joining a secondary infection and the development of cholangitis or a combination of cancer with acute cholecystitis .

Because of the long asymptomatic gallbladder his diagnosis of cancer, especially early, is very difficult. The final diagnosis was based on clinical data and the results of laboratory, radiological and instrumental methods of investigation, and sometimes a biopsy of the tumor.

Treatment only operative. Cholecystectomy is a radical operation only in the early stages of the disease. In more advanced cases it is combined with liver resection and removal of regional lymph nodes.

Forecast of gallbladder cancer in most cases, even after an unfavorable radical surgery.

renal tumors

Benign tumors of the kidney are less common malignancies. Among them the most frequent are adenomas . There are also fibroma, lipoma , hemangioma , leiomyoma, papilloma of the renal pelvis, and so on. D. It's rare benign tumors and the possibility of malignancy of some of them require in each case clinically suspected kidney tumors malignant tumor and to conduct a comprehensive survey.

The most common malignant tumor of the kidney - renal cell carcinoma (renal adenocarcinoma). A characteristic feature of renal cell carcinoma is the variety of clinical manifestations. Renal symptoms include hematuria , palpable tumor in the upper quadrant on the side of destruction and pain. Extrarenal symptoms are fever, hypertension, polycythemia, increased erythrocyte sedimentation rate, anemia, varicocele , amyloidosis , enteropathy, weakness, cachexia .

Diagnosis is based on clinical signs of the disease, laboratory data, X-ray, radionuclide, ultrasound methods of investigation, and sometimes these histological studies of tissue obtained by biopsy of the tumor or its metastases. The main methods of diagnosing kidney cancer are ultrasound computed X-ray tomography, angiography. For diagnosis use as excretory urography, radionuclide techniques and sometimes retrograde pyelography.

The main treatment - nephrectomy. In addition to surgical treatment are used radiation therapy, anticancer and hormones, as well as tools that increase the reactivity of the organism These techniques are complementary, and used mainly in combination therapy. Sometimes, to facilitate the operation, and in some cases as a standalone treatment for renal artery embolization is used, in which during angiography renal artery occlusive any material (metal spiral, blood clots, etc. glue. D.).

Patients who have had surgery for kidney cancer, subject to dispensary observation, comprising a control cystoscopy every 3 months during the first 2 years, every 6 months for the next 3 years and once a year, 5 years after surgery.

testicular tumors

Tumors of the testes in most cases are malignant in nature. Most often they occur in aged 15 - 35 years. Od testicle is affected generally, often right. Factors predisposing to the development of testicular tumors are cryptorchidism , scrotum injury, hormonal disorders, atrophy of the testicles.

Tumors of the testes and germ cell divided into negerminogennye (leydigoma, sertolioma, gonadoblastoma et al.). Germ cell tumors (developing of the seminiferous epithelium) are 90 - 95%. Among them are homogeneous tumor histological type (seminoma, embryonal carcinoma, mature and immature teratoma, yolk sac tumor, horionepitelioma) and mixed tumors (teratocarcinoma et al.).

Seminoma usually occurs in the undescended testicle. The tumor is made up of one or more nodes on the cut surface is shiny, white, lobed. Other germ cell (so-called neseminomnyh) tumors are similar to each other on the clinical picture, different from seminoma more malignant course and resistance to radiation therapy and to chemotherapy drugs. Yolk sac tumor built of primitive undifferentiated cells occurs mainly in children under 3 years. There are mixed tumors (mainly teratocarcinoma - combination teratoma and embryonic cancer).

The most common clinical manifestation of testicular cancer is the appearance of assembly, seal and painless increase in testicular seminoma is when can reach large sizes. Patients report feeling of heaviness in the testicle, sometimes moderate pain that increases as the tumor growth. Approximately 10% of patients with early symptoms of disease associated with the presence of metastases. It may be back pain, palpable tumor in the epigastric (massive retroperitoneal metastases in the lymph nodes), cough and respiratory insufficiency (lung metastases). Gynecomastia is detected in approximately 5% of patients; more often it is associated with the presence or chorionepithelioma sertoliomy (a tumor that produces estrogens). Leydigoma (tumor producing androgens) may cause the early puberty.

Metastasis of malignant testicular tumors occur lymphatic and hematogenous routes, and seminoma often metastasize. The regional for eggs are retroperitoneal lymph nodes - paraortalnye (left testicle) and parakavalnye (right testicle). Hematogenous tumor metastasis eggs often occur in the lung, liver, at least in the brain, bones and kidneys.

Diagnosis is based on clinical presentation and the results of specific methods of research (laboratory, X-ray, ultrasound, thermography, radionuclide, and others.), Confirmed by testicular puncture and subsequent cytology. To determine the prevalence of the process used intravenous urography, lymphography, ultrasound, nuclear magnetic resonance and computer tomography, lower venacavography and other radiological methods. It is important immunological determination methods fetoprotsina alpha content in the blood and urine of human chorionic gonadotropin. The differential diagnosis is carried out with orchitis, tuberculosis and other diseases based on data from clinical and instrumental studies and biopsy.

Therapeutic strategy depends on the stage of disease, histological form of tumor, its sensitivity to the different methods of treatment, the patient's general condition. Treatment always begins with orhifunikulektomii (removal of the spermatic cord with testicular cancer is a must) and histological study of the removed tumor. When seminoma without metastases conduct preventive radiation therapy to radiation zones of regional metastasis or chemotherapy. In the presence of metastases is used polychemotherapy. Patients neseminomnyh germ cell tumors after orhifunikulektomii in the absence of distant metastases and massive retroperitoneal retroperitoneal lymphadenectomy is performed. If the remote lymph node metastases detected cancer, conduct additional preventive polychemotherapy. All patients underwent testicular germ cell tumors of stage IV administered chemotherapy. The most common scheme involving cisplatin and bleomycin (eg, cisplatin, bleomycin + rozevin, cisplatin, bleomycin, cyclophosphamide + + + rozevin dactinomycin, etoposide + cisplatin, bleomycin, and others.).

Prevention of occurrence of testicular tumors is early to downgrade detained in the abdominal cavity or inguinal canal eggs (aged 5 - 7 years), removal of undescended testicle after the end of puberty, the observation and treatment by an endocrinologist children with hypoplasia or atrophy of the testes.

ovarian tumors

Most ovarian tumors are epithelial. Among other tumors are more common germ cell and sex cord stromal tumors, which have hormonal activity. Often develop in the ovary metastatic tumors.

Benign epithelial tumors, the most common tumor of the ovary. Very often there are serous and mucinous epithelial tumors that are clinically referred cystoma. There are smooth-walled and papillary cystoma.

Rigid serous cystoma (serous cystadenoma, tsilioepitelialnaya cystoma) is a spherical single- or multi-chamber formation with thin walls, containing a light opalescent liquid inside is lined with ciliated epithelium. Typically, the tumor-sided, small, but there are tumor mass reaches several kilograms.

Papillary serous cystoma (papillary serous cystadenoma) differs from the smooth-presence of papillary growths on the inner surface, and sometimes outside. Often affects both ovaries, there are adhesions with neighboring organs, ascites . Serous cystoma often develop in pre- and postmenopausal women.

Mucinous cystoma got its name because of mucoid contents. Tumors usually multichamber are lobed surface protrudes through the individual chambers can reach large proportions. When papillary mucinous cystoma with the growth of buds on the surface of the tumor often arises ascites. Mucinous cystoma are usually observed at the age of 40 - 60 years-papillary tumors in postmenopausal women.

Brenner tumor of the ovary is composed of connective tissue and which are located in its various forms of epithelial cell sites. It develops, usually in pre- and postmenopausal women.

Other forms of epithelial benign tumors - endometrioid (morphologically similar to tumors of the endometrium), light cell (which include light cells containing glycogen), and mixed - are extremely rare.

Clinical manifestations of benign epithelial ovarian tumors depend mainly on the size and location of the tumor. Tumors induce even a small feeling of heaviness and pain in the abdomen. When compression of the bladder and intestines are broken urination and defecation. For some tumors characterized by ascites.

A frequent complication is ovarian torsion stem tumor. Feet tumors form stretched ligament (ligament, suspensory ovary own ovarian ligament of the rear leaf broad ligament), which are ovarian artery and branches connecting it to the uterine arteries, lymphatic vessels and nerves, often in leg swelling comes and stretched masterbatch trumpet. Torsion of ovarian tumor stem occurs at sharp movements, change in body posture, physical exertion, often during pregnancy , the postpartum period. Torsion can be complete or partial. At full torsion greatly disturbed blood circulation in tumors occur hemorrhage and necrosis, which is accompanied by the appearance of symptoms of acute abdomen: a sudden sharp pain in the abdomen, nausea , vomiting , muscle tension anterior abdominal wall, fever, pallor, cold sweat, tachycardia . The tumor grows in size, it can rupture, infection with peritonitis. Partial torsion leg tumor occurs with less severe symptoms, the intensity of which depends on the place in the tumor as a result of changes in blood disorders. Perifocal inflammation may lead to fusion of the tumor to the surrounding organs and tissues.

Break capsule ovarian cancer is less common, and sometimes it occurs as a result of injury, ill pelvic exam. Symptoms of ovarian tumor capsule rupture is sudden abdominal pain, shock due to intraperitoneal bleeding.

Ozlokachestvlyayutsya most serous papillary cystoma, rarely papillary mucinous.

The diagnosis of ovarian tumor established on the basis of gynecological data, ultrasound and histological studies. Gynecological study determined an enlarged ovary. A great help in the diagnosis, especially for small tumors of the ovary, providing ultrasound to accurately set the size of the tumor, the capsule thickness, the presence of cameras and papillary excrescences. Finally benign tumor confirm the results of the biopsy.

Treatment of benign epithelial ovarian tumors operative, since regardless of the size of the tumor there is a danger of its malignancy. During the operation, carried out an urgent histological examination of the tumor tissue. With smooth-walled serous cystoma volume of operation depends on the age of the patient: young women is acceptable husking tumor while leaving healthy ovarian tissue, post-menopausal need pangisterektomiya - removal of the uterus and its appendages. When serous papillary cystoma, mucinous cystoma and Brenner tumor of the ovaries in women of reproductive age is removed, remove the postmenopausal uterus and its appendages. When ovarian torsion stem tumor or tumor capsule rupture surgery is performed on an emergency basis.

Forecast determined after histological examination of the tumor, it is favorable with timely surgery. Women who had undergone surgery for papillary serous ovarian cysts should be observed gynecologist.

Malignant epithelial tumors (cancer). In economically developed countries of Europe and North America, incidence of ovarian cancer is the second place in the structure of malignant tumors of the female genital organs, and the death rate from ovarian cancer is higher than that of cervical and endometrial cancer combined. Ovarian cancer develops mainly in the late 4th and during the 5th decade of life.

The risk of developing ovarian cancer is high in women with menstrual irregularities, infertility, uterine bleeding in post-menopausal, long-existing ovarian cysts, uterine fibroids, chronic inflammatory diseases of the uterus, as well as the operated in pre- or postmenopausal for benign tumors of internal genital organs leaving one or both ovaries.

Ovarian cancer can proceed for some time malosimptomno. There may be weakness, pain in the hypogastric region. As the progression of the tumor process, there are signs of ascites (abdominal enlargement), hydrothorax ( shortness of breath ), disturbed bowel function, decreased urine output, deteriorating general condition. At gynecological examination in the early stages of tumor development can be found a small increase in one or both ovaries. In the later stages in the uterus (70% of the bilateral lesion) tumor masses are determined non-uniform consistency, dense, painless; adnexal mobility is restricted due to the fixation and adhesion; in the recto-uterine pouch palpable tumor.

Diagnosis of ovarian cancer in the early stages of its development is difficult; 70 - 75% of new cases of the disease are persons with stage III and IV disease. diagnostic difficulties associated with oligosymptomatic course of ovarian cancer, the lack of pathognomonic signs, underestimation of symptoms by patients and medical professionals. Ascites often wrongly regarded as a manifestation of cardiac or liver failure , hydrothorax - as a consequence of pleurisy , bulging in the umbilical region (metastases) is taken as an umbilical hernia . Sometimes ovarian cancer patients for a long time are under medical supervision, but their condition is erroneously regarded as associated with inflammation of the uterus or (for the fusion of the tumor with the uterus) subserous uterine myoma .

A great help in the early diagnosis of ovarian cancer has a ultrasound pelvis. If there is a small increase in ovarian (more than 4 cm in the juvenile period and postmenopausal women, more than 5 cm in the reproductive age) demonstrated a thorough examination, including a puncture recto-uterine pouch, followed by cytology punctate, laparoscopy and laparotomy. At laparotomy they carried out rapid biopsy to clarify the histological forms of cancer, a thorough audit of the pelvic and abdominal cavity, including the greater omentum, the liver and diaphragm, to determine the extent of the process. The specialized research centers for the diagnosis of ovarian cancer is also used computer and nuclear magnetic resonance imaging.

Treatment of ovarian cancer based on the use of surgical, chemotherapy, radiation, hormonal and immunotherapeutic methods. Treatment of ovarian cancer stage I or II begins with the removal of the uterus operation, its appendages and greater omentum. After surgery, chemotherapy is shown. In some hospitals and radiation therapy are used with success.

When ovarian cancer stage III and IV is considered to be adequate comprehensive treatment, including surgery, chemotherapy and (or) remote irradiation of the pelvis and abdomen. In most cases, treatment is initiated with operation at hydrothorax and ascites - with polychemotherapy. When operations seek to maximize the removal of the main tumor mass and metastasis in order to create better conditions for subsequent chemotherapy and radiation therapy. For this purpose, carry supravaginal amputation or hysterectomy with removal of its appendages, the greater omentum and certain metastatic nodes. Chemotherapy (it takes at least 1 year) often carried out using a combination of cyclophosphamide, methotrexate, and fluorouracil or cyclophosphamide, adriamycin, and cisplatin.

The prognosis for ovarian cancer depends on the biological properties of the tumor, the extent of the spread of the process and the adequacy of the treatment. 5-year survival rates for ovarian cancer stage I make up 60-70%; Stage II - 40-50%, III stage - 10-40%, IV stage - '2 - 7%. Despite the improvement of all components of the combined treatment, the figures have no tendency to increase markedly. Therefore, the key to the problem of ovarian cancer is the development of new approaches to its early diagnosis. The importance attached to the identification of women with ovarian cancer risk factors that should be monitored by a gynecologist (check-ups at least 1 time in 6 months) and, if necessary, be examined in the hospital. The real direction of ovarian cancer prevention is early detection and surgical treatment of benign tumors of the body.

Among the ovarian germ cell tumors are more common mature teratoma (dermoid cyst) - benign tumors made up of various tissues of the body (skin, adipose tissue, hair, nerve tissue, bones, teeth), concluded in slizeobraznuyu mass and coated with a dense thick-walled capsule. The tumor is usually unilateral, grows slowly, not reaching large sizes. Found usually in young women and girls during puberty.

Clinical manifestations are due to the size of the tumor. Often there is a torsion leg tumor, accompanied by symptoms of acute abdomen. At gynecological examination dermoid cysts palpated the side and front of the uterus. Treatment operative - removal of the tumor while leaving healthy ovarian tissue. Weather favorable.

The most common malignant germ cell ovarian tumors include disgerminomu, immature teratoma and horionepiteliomu. The tumor in most cases, one-sided, its value varies widely, often tumor invades the capsule and merges with the surrounding tissues. In tumor tissue often observed hemorrhages. Metastasis occurs mainly lymphogenous way.

Dysgerminoma develops in girls and young women. Clinically, pain can occur in the abdomen, sometimes (eg, hemorrhage into the tumor) sharp. Diagnosis is based on the results of gynecological, ultrasound and histological studies.

In young patients with small tumors, not germinating capsule allowed removal of the affected ovary and omentum with subsequent chemotherapy. In the next 3 years it is recommended preventive chemotherapy.

In other cases, conduct radical surgery (removal of the uterus with appendages) and chemotherapy. The prognosis for adequate treatment relatively favorable.

Sex cord-stromal tumors are referred to as hormone producing tumors. They are divided into feminized (secreting estrogen) and virilizing (secreting androgens).

Feminizing ovarian tumors include granulosa, tekakletochnye (TECOM) and mixed (granulosa-tekakletochnye) tumor. Granulosa tumor develops from the granulosa cells of ovarian follicles atreziruyuschihsya. The tumor usually unilateral, its diameter is not more than 10 cm. Tumor dense smooth coated capsule, a soft consistency, to cut it defines cystic cavity dense structures, often colored yellowish, foci of hemorrhages.

Tekakletochnaya tekakletok formed from tumor does not reach the large sizes (its diameter is typically at most 8 cm), has a dense texture, often repeats ovary shape. In the context of tumor are determined by the structure of intense yellow color. Granulosa-tekakletochnye tumor composed of granulosa cells and tekakletok.

All three types of feminizing ovarian tumors usually develop in postmenopausal women, at least in the first decade of life before the onset of menarche. In the reproductive years, these tumors are rare. Many patients with feminizing ovarian tumors detected uterine fibroids , follicular cysts of ovaries and various hyperplastic processes in the endometrium (glandular-cystic hyperplasia, atypical hyperplasia, adenocarcinoma).

Clinical manifestations of feminizing ovarian tumors depend on the age at which they develop. In girls, the first decade of life there is a premature sexual development: increased external and internal sex organs, breasts, pubic hair appears, begin menstrualnopodobnye acyclic selection. In women of reproductive age having acyclic uterine bleeding similar to dysfunctional. In postmenopausal women appear menstrualnopodobnye allocation in connection with hyperplastic changes of the endometrium, there are signs of "rejuvenation": increases skin turgor, nagrubayut breasts disappear atrophic changes of internal and external genitals, libido appears.

Most feminizing ovarian tumors are benign. But even in the absence of histological signs of malignancy metastasis can occur in the serous cover of the abdominal cavity, parietal peritoneum, omentum and tumor recurrence in many years after its removal.

Diagnosis feminizing ovarian tumors in girls first decade of life in postmenopausal women due to the characteristic clinical symptoms not complicated. It confirms the detection of ovarian enlargement (more than 4 cm on ultrasound scans). Auxiliary diagnostic value is well above the age detection rate of blood estrogen and urine, indicating autonomous secretion of these hormones.

Treatment feminizing ovarian tumors operative. The girls and young women is permissible only removal of the ovaries, menopausal and postmenopausal require pangisterektomiya.

Given the possibility of recurrence and metastasis to distant periods after surgery, patients should be lifelong to be under the supervision of a gynecologist-oncologist.

Virilizing ovarian tumors - androblastoma - arise from the Sertoli cells and (or) the Leydig cells. Tumor Sertoli cells - a benign, consisting of highly differentiated cells. Along with androgens, estrogens secreted, leading to the appearance of mild background virilization expressed endometrial hyperplastic processes. The tumor usually does not exceed 10 cm in diameter, surrounded by a thick capsule, the cut has lobed structure, a yellowish tint. Tumor Sertoli cells and Leydig cells are usually small (no more than 5 to 6 cm in diameter), a soft consistency, the capsule does not, on the section resembles an immature or kriptorhichnye testicles. A tumor can be benign and malignant. The tumor of Leydig cells is rare. Ovary develops in a delimited gate having no capsule on node yellowish sectional diameter of not more than 10 cm. In most cases a benign.

Androblastoma observed more frequently in young women. The clinical picture is due to the ability of tumors to secrete androgens, which are broken under the influence, and then stop menstruation, increased clitoris, hirsutism acquires virility traits (hair growth in male pattern on the face, trunk, extremities), coarsens his voice, older women often observed baldness. Usually, the first symptom of the disease in women of reproductive age is oligomenorrhea, then comes amenorrhea .

Such symptoms occur and adrenoblastome (hypernephroma) - ovarian tumor of ectopic tissue of the adrenal cortex; occurring in the reproductive age, rarely before the beginning of puberty and menopause.

Virilizing tumor diagnosis confirms ultrasound revealed an increase in the ovary, as well as elevated levels of testosterone in the blood and 17-keto steroids in urine.

Treatment virilizing ovarian tumors operative - removal of the affected ovary or (at age 50), removal of the uterus and its appendages. After surgery, virilization symptoms disappear, in women of reproductive age is restored menstrual cycle.

tumor processes

The most common follicular cyst ovarian cyst and corpus luteum; parovarialnaya cyst, endometrioid ovarian cyst (. see Endometriosis ), multiple follicular ovarian cysts or polycystic ovaries oophoritis - inflammation of the ovaries, which is often associated with inflammation of the fallopian tube and is accompanied by the formation of tumor conglomerate - tubo-ovarian education.

Follicular ovarian cyst is formed as a result of accumulation in follicular fluid neovulirovavshem follicle; more common in puberty and in young women. It is a thin-walled single chamber formation, the diameter of which is rarely more than 8 cm. As the cyst cells lining the inner surface of its wall, atrophy. Small follicular cysts, lined by granulosa cells have moderate hormonal activity.

Follicular cysts with a diameter up to 4 - 6 cm often not clinically manifested. If hormonally active cysts may hyperestrogenia and caused her irregular menstrual cycle: acyclic uterine bleeding in women of reproductive age or premature sexual development in girls first decade of life. When follicular cyst diameter of 8 cm or more cysts can occur torsion legs, accompanied by blood circulation and necrosis of ovarian tissue, and (or) the cyst rupture. In these cases, the picture of acute abdomen.

The diagnosis of ovarian follicular cyst is set based on clinical manifestations, gynecological and ultrasound studies. At gynecological examination (vaginal-bryushnostenochnom, recto-bryushnostenochnom) at the front and the side of the uterus palpable tumor formation tugoelasticheskoy consistence with a smooth surface, in most cases, mobile, maloboleznennoe. On ultrasound scans follicular cyst is a single chamber rounded education with thin walls and uniform content.

Patients with follicular cysts in diameter to 8 cm are subject to dynamic observation with repeated ultrasonography. As a rule, for 1.5 - 2 months there is regression of the cyst. To accelerate its use of estrogen-progestin drugs (Ovidon, non-ovlon, bisekurin et al.) From the 5th to the 25th day of the menstrual cycle for 2 - 3 cycles. With a diameter of 8 cm follicular cyst and a cyst is shown husking and closure of its wall or resection of the ovary. These operations including during laparoscopy. When torsion of ovarian cyst legs, rupture of ovarian surgery is performed on an emergency basis, in the case of circulatory disorders in the ovary is removed.

Corpus luteum cyst is formed in situ neregressirovavshego corpus luteum, the center of which as a result of circulatory disorders hemorrhagic fluid accumulates. cyst diameter is typically less than 8.6 cm. luteum cyst, generally asymptomatic and subjected to reverse development for 2-3 months. Complications are cysts leg torsion and cyst rupture due to a hemorrhage in her chamber, accompanied by a picture of acute abdomen. At gynecological examination is determined by tumor formation in the ovary.

Patients with asymptomatic small cysts of the corpus luteum (diameter 6-8 cm) are observed gynecologist for 2-3 months. In larger cysts, as well as cysts rupture or torsion of her legs held surgical treatment. Husking cyst and suturing its walls, ovary resection within healthy tissue also perform during laparoscopy. In the case of necrotic changes of ovarian cysts with torsion legs are made laparotomy and oophorectomy.