This chapter is devoted to a description of risk factors, general principles of diagnosis, treatment, and specialized nursing care for various oncological diseases.
SKIN CANCER
Malignant neoplasms of the skin occupy 3rd place in the structure of cancer incidence in the Russian population, second only to lung and stomach cancer in men, and only to breast cancer in women. Risk factors for developing malignant skin tumors:
- certain race: the risk of the disease is maximum in people with white skin, minimum in representatives of Asian nationalities and the Negroid race;
- age over 50 years;
- the presence of familial atypical skin lesions (nevi) and melanoma;
- chronic exposure to sunlight (sunburn);
- radioactive exposure;
- contact with chemical carcinogens;
- previous skin lesions (dermatoses, scars, trophic ulcers, osteomyelitis fistulas).
The risk of skin cancer caused by sun exposure is highest in poorly tanned people with fair skin, freckles, red hair, and blue or grey-blue eyes. Skin tumors are usually localized in open areas of the skin. One of the most malignant is squamous cell skin cancer. Stages of squamous cell skin cancer:
I. A tumor or ulcer no more than 2 cm in diameter, limited by the epidermis and the dermis itself, completely mobile along with the skin without infiltration of adjacent tissues and without metastases.
II. A tumor or ulcer more than 2 cm in diameter, growing through the entire thickness of the skin, without spreading to the underlying tissue. There may be one small mobile metastasis in the nearest regional lymph nodes.
III. A significant size, limitedly mobile tumor that has grown through the entire thickness of the skin and underlying tissues, but has not yet spread to the bone or cartilage, without certain metastases.
IV. The same tumor or a smaller tumor, but in the presence of multiple mobile metastases or one slow-moving metastasis;
a widespread tumor or ulcer, with germination into the underlying tissue with distant metastases.
The disease occurs more often in the second half of life, especially in old people, mainly on the skin of the face. Distinguish three clinical forms of skin cancer- superficial, deeply penetrating into deeper tissues and papillary.
Superficial skin cancer appears first as a small spot or plaque of gray-yellow color that rises above normal skin. Then a compacted ridge appears along the edges of the tumor, the edges become scalloped, and softening appears in the center, turning into an ulcer covered with a crust. The edges of the skin around the ulcer are red, there is no pain. In the papillary form, the formation looks like a protruding node with clear shapes.
The ulcerations are shallow, bleeding when injured, covered with crusts, pain is absent or insignificant.
Melanoma (melanoma: from Greek melas, melanos- “black”, “dark”; -ota- “tumor”) is a malignant tumor consisting of pigment-forming cells (melanocytes). It can be located on the skin, mucous membranes of the gastrointestinal tract and upper respiratory tract, in the meninges and other places. In more than 90% of cases, the tumor is found on the skin of the lower extremities, trunk and face. The majority of those sick are women.
Distinguish superficial-spreading And nodular types of skin melanoma.
Stages of malignant melanoma:
I. There is only a primary tumor of any size, thickness, characterized by any form of growth without damage to regional lymph nodes; 5-year survival rate after treatment is 80-85%.
II. There is a primary tumor and metastases in regional lymph nodes; 5-year survival rate is less than 50%.
III. There is a primary tumor, metastases in regional lymph nodes and distant metastases. All patients die within 1-2 years.
Skin melanoma looks like a papilloma, ulcer or formation of a round, oval or irregular shape, the color can range from pink to blue-black; There is non-pigmented (amelanotic) melanoma. As the primary tumor grows, radial rays appear around it, daughter pigment inclusions in the skin - satellites, and intradermal, subcutaneous and distant metastases are formed. When metastasizing to regional lymph nodes, conglomerates are formed with the involvement of surrounding tissues and skin in the pathological process. Subsequently, metastases appear in the lungs, liver, brain, bones, intestines, in any other organ or in any tissue of the body. In the later stages of the process, melanin may be detected in the patient’s urine, giving it a dark color (melanuria). Features of the clinical course of asymptomatic melanoma are extensive damage to regional lymph nodes and relatively frequent metastatic bone damage.
Principles of treatment. Treatment of malignant skin tumors involves radical removal of the tumor focus and achieving lasting clinical cure, which helps improve the quality and increase the patient's life expectancy. The choice of treatment method is determined by the doctor and depends on the nature (type), stage, localization, extent of the tumor process, the presence of metastases, general condition, and age of the patient.
Treatment options for skin cancer:
- surgical treatment - excision of the primary lesion;
- use of X-ray and laser radiation;
- cryotherapy, which promotes the death of cancer cells under the influence of cooling with liquid nitrogen;
- chemotherapy, sometimes polychemotherapy (cisplatin, bleomycin, methotrexate). To treat intraepithelial forms of cancer, applications of ointments with cytostatics (5% 5-fluorouracil, 1% bleomycin ointment, etc.) are used.
Nursing assistance. Below is list of nursing activities when providing palliative care to patients with malignant skin tumors:
- collecting anamnesis to identify hereditary predisposition to skin cancer;
- examination of the patient, palpation of the skin and lymph nodes;
- informing the patient about the disease, methods of its treatment, prevention of relapses;
- informing the patient about the need and diagnostic value of a skin biopsy followed by histological examination;
- taking smears for cytological examination;
- monitoring the use of medications prescribed by a doctor, identifying possible side effects;
- dynamic monitoring of the patient’s general condition and local (local) manifestations of tumor skin lesions;
- monitoring patient attendance at radiation therapy, laser irradiation, and cryotherapy sessions;
- organizing physical and psychological support for the patient and his relatives;
- teaching the patient self-care techniques and relatives how to care for the sick;
- involving the patient in classes at the oncology patient’s school, providing him with popular literature, booklets, reminders, etc.
1.1 Current information: symptoms, diagnosis and treatment of patients with malignant tumors of the female genital organs.
Malignant tumors can occur in any organ of the female reproductive system - the vulva (external genitalia), vagina, cervix, uterus, fallopian tubes or ovaries.
1.1.1 Uterine cancer: symptoms, diagnosis and treatment
Although this malignant tumor is commonly called uterine cancer, it is more accurately called endometrial carcinoma because the tumor initially occurs in the lining of the uterus (endometrium). In women, it is the fourth most common cancer and the most common malignant tumor of the female genital organs. Uterine cancer usually develops after menopause, usually in women between 50 and 60 years of age. Tumor cells can spread (metastasize) both to adjacent tissues and to many other organs - down to the cervix, from the uterus to the fallopian tubes and ovaries, to the tissues surrounding the uterus, to the lymphatic vessels that transport lymph to all organs, lymphatic nodes, into the blood, then through the bloodstream to distant organs.
Symptoms and diagnosis: Abnormal bleeding from the uterus is the most common early symptom of uterine cancer. Bleeding may occur after menopause and may be repeated, irregular, or heavy in women who continue to menstruate. One out of every three women with uterine bleeding after menopause is diagnosed with this form of cancer. If there is abnormal uterine bleeding after menopause, you should immediately consult a doctor, as it may be caused by a malignant tumor.
To diagnose this malignant tumor, several methods are used. The Pap test can detect cervical cancer cells, but it does not detect tumor cells in about one third of cases. Therefore, the doctor also performs an endometrial biopsy or fractional curettage (separate curettage of the cervical canal and the uterine cavity), in which tissue from the lining of the uterus is removed for examination under a microscope.
If the results of a biopsy or fractional curettage confirm the presence of a cancer in the lining of the uterus, further tests must be done to determine whether the cancer has spread outside the uterus. Ultrasound (ultrasound), computed tomography (CT), cystoscopy (fiber optic examination of the bladder), barium sulfate x-ray of the intestine, chest x-ray, intravenous urography (examination of the kidneys and ureters), bone scan and liver, sigmoidoscopy (examination of the rectum using a flexible fiber-optic instrument) and lymphangiography (x-ray examination of the lymphatic system) provide the necessary information and help prescribe optimal treatment. In each case, only some of the studies listed above are carried out for specific indications.
Treatment: extirpation, that is, surgical removal of the uterus, is the basis of treatment for this type of malignant tumor. If the cancer has not metastasized beyond the uterus, then hysterectomy almost always leads to a cure. During the operation, the surgeon usually also removes the fallopian tubes, ovaries (that is, performs a salpingo-oophorectomy) and nearby (regional) lymph nodes. They are examined by a morphologist to determine the stage of cancer development and determine the need for postoperative radiation therapy.
Even when the cancer has not metastasized, your doctor may prescribe postoperative drug therapy (chemotherapy) if some cancer cells remain undetected. Usually hormones are used that suppress the growth of a malignant tumor.
If the cancer has spread beyond the uterus, higher doses of progestins are usually prescribed. In 40% of women with metastases of a malignant tumor, it decreases in size and its growth is suppressed under the influence of progestins for 2-3 years. If treatment is effective, it may continue indefinitely. Side effects of progestins include weight gain due to water retention and, in some cases, depression.
If the cancer has spread widely or if hormone therapy does not have a beneficial effect, other chemotherapy agents such as cyclophosphamide, doxorubicin and cisplatin may be added. These medications are much more toxic than progestins and cause many side effects. Before starting treatment, you must carefully weigh the risks and expected benefits of chemotherapy.
Overall, nearly two-thirds of women diagnosed with this type of cancer remain alive without relapse (recurrence) of the cancer within 5 years of diagnosis, less than a third die from the disease, and nearly 10% survive without cancer. cured If this malignancy is detected early, almost 90% of women live at least 5 years and usually recover. The chances are better for younger women, women whose cancer has not spread beyond the uterus, and women who have a slow-growing type of cancer.
1.1.2. Cervical cancer: symptoms, diagnosis and treatment
The cervix is the lower part of the uterus that extends into the vagina. Among malignant tumors of the female genital organs, cervical cancer (cervical carcinoma) is the second most common tumor among women of all ages and most common among younger women. Cervical cancer is usually found in women between 35 and 55 years of age. The development of this malignant tumor may be associated with a virus (human papillomavirus), which can be transmitted during sexual intercourse.
The younger a woman is at the time of her first sexual intercourse, and the more sexual partners she has in the future, the greater the risk of cervical cancer.
About 85% of cervical cancers are squamous cell cancer, which means they develop from stratified squamous epithelial cells, similar to skin cells, that cover the outside of the cervix. Most other types of cervical cancer develop from columnar epithelial cells of the glands in the cervical canal (adenocarcinoma) or both types of cells.
Cervical cancer cells can penetrate deep into the lining of the uterus, enter the vast network of small blood and lymphatic vessels found in the deeper layers of the cervix, and then invade other organs. In this way, a malignant tumor metastasizes both to distant organs and to tissues located near the cervix.
Symptoms and diagnosis: symptoms include bleeding between periods or after sexual intercourse. A woman may not experience pain or other symptoms until the later stages of the disease, but routine Papanicolaou tests (Pap smears) can detect cervical cancer early enough. This disease begins with slow changes in normal cells and often takes several years to develop. Changes are usually detected by examining the cells of the cervical mucosa under a microscope, which are taken for a Pap smear. Physicians have described these changes as stages ranging from normal (no pathology) to invasive cancer.
The Pap test is inexpensive and can accurately detect cervical cancer in 90% of cases, even before symptoms appear. As a result, with the introduction of this research method into practice, the number of deaths from cervical cancer decreased by more than 50%. Doctors generally recommend performing the first Pap test when a woman becomes sexually active or reaches the age of 18, and then annually thereafter. If normal results have been obtained for 3 consecutive years, such a woman can then have a Pap smear only every 2 or 3 years until her lifestyle changes. If this cytological examination were carried out regularly in all women, the mortality rate from cervical cancer could be reduced to zero. However, almost 40% of patients do not undergo regular screening.
If, during a gynecological examination, a tumor, ulcer or other suspicious area is detected on the cervix, as well as a Pap smear reveals suspicious changes in relation to a malignant tumor: two types of biopsy are used - targeted biopsy, in which a small piece of cervical tissue is taken under the control of a colposcope , and endocervical curettage, in which the mucous membrane of the cervical canal is scraped without visual control. Both types of biopsies involve some pain and some bleeding. Both methods usually provide enough tissue for a pathologist to make a diagnosis. If the diagnosis is unclear, the doctor performs a cone biopsy, which removes more tissue. Typically this type of biopsy is performed using loop electrosurgical excision (excision) techniques on an outpatient basis.
If cervical cancer is detected, the next step is to determine the exact size and location of the tumor; this process is called determining the stage of development of a malignant tumor.
Treatment: Treatment depends on the stage of development of cervical cancer. If the malignant tumor is limited to its superficial layers (carcinoma in situ), the doctor can remove the tumor completely - removing part of the cervix surgically or using a loop electrosurgical excision (excision). After such treatment, the ability to have children is preserved. However, the doctor recommends that the woman come for examinations and Pap smears every 3 months during the first year and every 6 months thereafter, since the malignant tumor may recur. If a woman is diagnosed with carcinoma in situ and she does not plan to have children, then she is recommended to have the uterus removed (extirpation).
If the cancer has reached a more advanced stage of development, hysterectomy in combination with removal of surrounding tissue (radical hysterectomy) and lymph nodes is necessary. However, normally functioning ovaries in young women are not removed.
1.1.3 Ovarian cancer: symptoms, diagnosis and treatment
Ovarian cancer (ovarian carcinoma) usually develops in women between 50 and 70 years of age, affecting approximately 1 in 70 women on average. It is the third most common type of female reproductive system cancer, but more women die from ovarian cancer than from any other reproductive organ cancer.
The ovaries consist of various tissues, the cells of each of them can be the source of the development of one or another type of malignant tumor. There are at least 10 types of ovarian cancer, which accordingly have different treatment features and recovery prospects.
Ovarian cancer cells can invade directly into surrounding tissue and through the lymphatic system into other organs in the pelvis and abdomen. Cancer cells can also enter the bloodstream and be found in distant organs, mainly the liver and lungs.
Symptoms and diagnosis: h A malignant ovarian tumor can grow to a significant size before any symptoms occur. The first symptom may be vague discomfort in the lower abdomen, similar to diarrhea (dyspepsia). Uterine bleeding is not a common symptom. Enlargement of the ovaries in a postmenopausal woman may be an early sign of cancer, although it is usually associated with the development of benign tumors or the appearance of other abnormalities. Fluid sometimes accumulates in the abdomen (ascites). Gradually, the abdomen increases in volume due to enlargement of the ovaries or accumulation of fluid. At this stage of the disease, a woman often feels pain in the pelvic area, she develops anemia and loses body weight. In rare cases, ovarian cancer produces hormones that cause excessive growth of the lining of the uterus, enlarged breasts, or increased hair growth.
Diagnosing ovarian cancer in its early stages is often difficult because symptoms usually do not appear until the cancer has spread beyond the ovaries and because many other, less dangerous diseases have similar symptoms.
If ovarian cancer is suspected, an ultrasound (US) or computed tomography (CT) scan should be performed to obtain the necessary information about the ovarian tumor. Sometimes the ovaries are viewed directly using a laparoscope, a fiber-optic system inserted into the abdominal cavity through a small incision in the abdominal wall. If the examination reveals a benign ovarian cyst, the woman should undergo periodic gynecological examinations as long as the cyst persists.
Treatment: Ovarian cancer is treated surgically. The extent of the operation depends on the type of malignant tumor and the stage of its development. If the tumor is limited to the ovary, it is possible to remove only the affected ovary and the corresponding fallopian tube. When the tumor has spread beyond the ovary, both ovaries and the uterus must be removed, as well as nearby (regional) lymph nodes and surrounding tissues to which the cancer typically metastasizes.
After surgery, radiation therapy and chemotherapy are often given to destroy any small pockets of cancer that may remain. It is difficult to cure ovarian cancer that has spread (metastasized) beyond the ovaries.
Between 15 and 85% of women with the most common types of ovarian cancer survive within five years of diagnosis.
1.1.4 Vulvar cancer: symptoms, diagnosis and treatment
The vulva is the external female genitalia. Vulvar cancer (vulvar carcinoma) accounts for only 3-4% of all gynecological cancers and is usually detected after menopause. As the population ages, the incidence of this malignancy is expected to increase.
Vulvar cancer is usually cancer of the skin near the opening of the vagina. Vulvar cancers most often form the same cell types as skin cancers (epidermal cells and basal cells). Approximately 90% of vulvar cancers are squamous cell carcinomas, and 4% are basal cell carcinomas. The remaining 6% are rare malignant tumors (Paget's disease, Bartholin gland cancer, melanoma, etc.).
Symptoms and diagnosis: The development of vulvar cancer can be easily detected - unusual nodes or ulcers appear near the entrance to the vagina. Sometimes there are areas of peeling or discoloration of the skin. The surrounding tissue may have a wrinkled appearance. The discomfort is usually not severe, but itching in the vagina is disturbing. Subsequently, bleeding or watery discharge often develops. The appearance of these symptoms requires immediate medical attention.
To make a diagnosis, the doctor performs a biopsy. After numbing the suspicious area with an anesthetic, a small area of discolored skin is removed. A biopsy is needed to determine whether skin changes are cancerous or due to infectious inflammation or irritation. A biopsy also makes it possible to recognize the type of malignant tumor when it is detected and determine a treatment strategy.
Treatment: A vulvectomy is an operation that removes a large area of vulvar tissue near the vaginal opening. Vulvectomy is necessary for all types of vulvar cancer except preinvasive carcinoma to remove squamous cell malignant tumors of the vulva. This extensive removal is done because this type of vulvar cancer can quickly spread to nearby tissue and lymph nodes. Because a vulvectomy may also remove the clitoris, the doctor discusses treatment with the woman diagnosed with vulvar cancer to develop a treatment plan that is best suited for her based on comorbidities, age, and aspects of her sex life. Since basal cell carcinoma of the vulva does not tend to metastasize to distant organs, surgical removal is usually sufficient. If the malignant tumor is small, then removal of the entire vulva is not necessary.
1.1.5 Vaginal cancer: symptoms, diagnosis and treatment
Only about 1% of all malignant tumors that arise in the female genital organs develop in the vagina. Vaginal cancer (carcinoma) usually appears in women between 45 and 65 years of age. In more than 95% of cases, vaginal cancer is squamous cell and is morphologically similar to cervical and vulvar cancer. Squamous cell carcinoma of the vagina can be caused by human papillomavirus, the same virus that causes genital warts and cervical cancer. Diethylstilbesterol-dependent carcinoma is a rare type of vaginal cancer that occurs almost exclusively in women whose mothers took the drug diethylstilbesterol during pregnancy.
Symptoms and diagnosis: Vaginal cancer grows into the vaginal mucosa and is accompanied by the formation of ulcers that can bleed and become infected. Watery discharge or bleeding and pain during intercourse appear.
When vaginal cancer is suspected, the doctor will scrape the vaginal lining to examine under a microscope and perform a biopsy of lumps, ulcers, and other suspicious areas noticed during a pelvic exam. A biopsy is usually performed during a colposcopy.
Treatment: l Treatment for vaginal cancer depends on the location and size of the tumor. However, all types of vaginal cancer can be treated with radiation therapy.
For cancer in the middle third of the vagina, radiation therapy is prescribed, and for cancer in the lower third, surgery or radiation therapy is prescribed.
After treatment for vaginal cancer, sexual intercourse may be difficult or impossible, although sometimes a new vagina is created using a skin graft or part of the intestine. Survival at 5 years is observed in approximately 30% of women.
This is a common form of malignant tumors, ranking 3rd after stomach and uterine cancer in women. Breast cancer usually occurs between the ages of 40 and 50, although approximately 4% of patients are women under 30 years of age. Breast cancer is rare in men.
Previous pathological processes in its tissues play a significant role in the development of breast cancer. Mainly………………..hyperplasia
(fibroadenomatosis). The reasons for these changes in breast tissue are a number of endocrine disorders, often caused by concomitant ovarian diseases, repeated abortions, improper feeding of the child, etc.
Anatomical and embryological abnormalities are known to play a role in the development of breast cancer - the presence of accessory mammary glands and dystonia of the lobules of glandular tissue, as well as previous benign tumors - breast fibroadenoma.
All these formations, regardless of their tendency to malignant transformation, must be immediately removed, because they are often difficult to confidently distinguish from cancer.
The localization of cancerous tumors in the mammary glands is very different. Both the right and left mammary glands are equally often affected; in 2.5% there are bilateral mammary gland cancers, either as a metastasis or as an independent tumor.
Breast cancer appearance:
1. may be a small, very sweaty cartilaginous tumor without clear boundaries
2.it’s a bit soft
3. test leathery node of a round shape with fairly clear boundaries, with a smooth or bumpy surface, sometimes reaching significant sizes (5-10 cm)
4. unclear compaction without clear boundaries
The local spread of breast cancer to the skin depends on the proximity of its location to the integument and on the infiltrating nature of growth.
One of the typical symptoms of cancer is fixation, wrinkling and retraction of the skin over the tumor with the transition of 1 later stages to…………………………….. (the “orange peel” symptom) and ulcerations.
Deeply located tumors quickly grow together with the underlying fascia and lipids.
By lymph flow, which is very developed in breast tissue, tumor cells are transported to the lymph nodes and give initial metastases. The axillary, subclavian and subscapular groups of nodes are primarily affected, and if the tumor is located in the slow quadrants of the glands, the chain of parasterial nodes is affected.
In some cases, metastases in the axillary lymph nodes appear earlier than a tumor is detected in the mammary gland.
Hematogenously, metastases occur in the lungs, pleura, liver, bones and brain. Bone metastases are characterized by damage to the spine, pelvic bones, ribs, skull, femur and humerus, which is manifested at the beginning by intermittent aching pain in the bones, which later becomes persistently painful.
A tumor-like node or compaction appears in the mammary gland with blurred boundaries. In this case, a change in the position of the gland is observed - it, together with the nipple, is pulled up, or is swollen and lowered down.
A thickening or umbilical retraction of the skin is noted above the location of the tumor, sometimes an orange peel symptom, and subsequently an ulcer appears.
Typical symptoms:
Flattening and retraction of the nipple, as well as bloody discharge from it. Pain is not a diagnostic sign; it may be absent in case of cancer and at the same time greatly bother patients with mastopathy.
Forms of cancer:
1. Mastitis-like form - characterized by a rapid course with a sharp enlargement of the mammary gland, its swelling and pain. The skin is tense, hot to the touch, and reddish. The symptoms of this form of cancer are similar to acute mastitis, which in young women, especially against the background of…………….., entails severe diagnostic errors.
2. The erysipelas-like form of cancer is characterized by the appearance of sharp redness on the skin of the glands, sometimes spreading beyond its boundaries, with uneven jagged edges, sometimes with a high rise in T0. This form can be mistaken for ordinary erysipelas, with the corresponding prescription of various physiotherapeutic procedures and medications, which leads to a delay in proper treatment.
3. …………. Cancer occurs due to cancerous infiltration through the lymphatic vessels and crevices of the skin, which leads to a lumpy thickening of the skin. A kind of dense shell is formed, wrapping half, and sometimes the entire chest. The course of this form is extremely malignant.
4. Paget's cancer - general form…………. lesions of the nipple and areola; in the initial stages, peeling and scalyness of the nipple appears, which is often mistaken for eczema. Subsequently, the cancerous tumor spreads deep into the ducts of the mammary gland, forming a typical cancerous node with metastatic lesions in the tissue.
Paget's cancer progresses relatively slowly, sometimes over several years, limited only to damage to the nipple.
The course of breast cancer depends on many factors: primarily on the hormonal status and age of the woman. In young people, especially during pregnancy and lactation, it occurs very quickly, …………., distant metastases. At the same time, in old women, breast cancer can exist for up to 8-10 years without a tendency to metastasize.
Inspection and feeling
First, the examination is performed while standing with arms lowered and then with arms raised, after which examination and palpation are continued with the patient in a horizontal position on the couch.
Typical symptoms of cancer:
Presence of a tumor
Its density, blurred boundaries
Merging with skin
Gland asymmetry
Nipple retraction
Be sure to examine the second mammary gland in order to identify an independent tumor or metastasis in it, and also palpate both axillary and supraclavicular areas. Due to the frequency, metastases in ...... are also palpable.
Interdependent interventions
R-scopy of the lungs
Mammography,
Biopsy: puncture with cytological examination (sector resection)
In the initial stages, with a small size, deep location of the tumor and the absence of certain metastases.
Surgical (no mts)
Halstead mastectomy
If the tumor exceeds 5 cm in diameter with pronounced skin-like symptoms and infiltration of the surrounding tissue, with palpable mts in the axilla
l\u - combined treatment.
Stage 1 – radiation therapy
Stage 2 – surgical treatment
Approximate standard of physiological problems in breast cancer.
(before surgery)
1. A lump or thickening in or near the mammary gland, or in the armpit area.
2.Changes in breast size or shape
3.Nipple discharge
4. Change in color or texture of the skin of the breast, areola or nipple (retraction, wrinkles, scaliness)
5. Pain, discomfort
6.violation…….
7.Decreased ability to work
8.Weakness
Psychological problems of the patient
1. Feeling of fear due to an unfavorable outcome of the disease
2. Anxiety, fear when visiting a doctor “oncologist”
3. Increased irritability
4.Lack of knowledge about upcoming procedures, manipulations, and the possibility of pain during this process.
5. Feeling of hopelessness, depression, fear for your life.
6.Feeling of fear of death
Physiological problems
1. Changes in a woman’s weight or disturbances in weight distribution during breast removal, which leads to
2.discomfort in the back and neck
3. Skin tightness in the chest area
4.Numbness of the chest and shoulder muscles
After a mastectomy, some patients lose strength in these muscles permanently, but most often the decrease in muscle strength and mobility is temporary.
5. Slowing down the flow of lymph if the axillary lymph node is removed. In some patients, lymph accumulates in the upper arm and hand, causing lymphedema.
6.Lack of appetite
Potential problems
1.Nerve Damage – A woman may experience numbness and tingling in her chest, armpit, shoulder and arm. This usually goes away within a few weeks or months, but some numbness may remain permanent.
2.Risk of developing various infectious complications. It becomes difficult for the body to cope with the infection, so a woman should protect the arm on the affected side from damage throughout her life. In case of cuts, scratches, or insect bites, be sure to treat them with antiseptics, and in case of complications, consult a doctor immediately.
3. Risk of complications from the respiratory system due to pain.
4. Limitations of self-service – the inability to do laundry and wash your hair.
Violated needs
3. work hard
4. communicate
5. have no discomfort
6. be healthy
8. be safe
These operations do not require any special preoperative preparation. It is necessary to monitor active aspiration from the wound, carried out for 3-4 days, to monitor the performance of therapeutic exercises to develop hand movements from the side of the operation.
When cancer spreads both by local manifestations and by the degree of damage to the lymphatic system, especially in young menstruating women, it is used complex method treatment, combining radiation therapy and surgery with hormonal treatment and chemotherapy. Hormone therapy includes bilateral...ectomy (...radiation ovarian suppression), andogen therapy and corticoid therapy to suppress adrenal function.
Forecast – life expectancy 2.5-3 years
Prevention - timely relief of patients from precancerous lumps in the mammary glands, as well as compliance with the normal physiological rhythm of a woman’s life (pregnancy, lactation) while reducing the number of abortions to a minimum.
Prostate cancer
This is a rare form, the incidence rate is 0.85%, most often at the age of 60-70 years.
Problems
Increased frequency of urination at night
Difficulty urinating, first at night and then during the day.
Feelings of incomplete emptying of the bladder
Increase in the amount of residual urine
These problems are similar to those in patients with prostatic hypertrophy. Later, with cancer, the following appear:
Hematuria
Pain resulting from tumor invasion of the bladder and pelvic tissue
Prostate cancer often metastasizes, showing a particular tendency to involve multiple bones (spine, pelvis, hip, ribs), in addition to the lungs and pleura.
D: Rectal examination, enlargement, density, lumpiness, biopsy
In the early stages - surgical
- ……… i.m. – relieves pain and diuretic disorders (hormone therapy)
Radiation therapy
If there is severe compression of the urethra, the bladder is released through a catheter, and if catheterization is impossible, a suprapubic fistula is applied.
The prognosis is unfavorable due to the early occurrence of metastases.
Esophageal cancer
It is one of the most common forms of malignant tumors, accounting for 16-18%, and occurs much more often in men, mainly in adulthood and old age. Most often it affects the lower and middle sections of the esophagus.
External factors that contribute to the development of esophageal cancer include poor nutrition, in particular the abuse of very hot foods, as well as alcohol.
Patient problems
Quite bright. The patient's first complaint is a feeling of difficulty passing rough food through the esophagus. This symptom, called dysphagia, is initially mildly expressed and therefore the patient and doctors do not attach due importance to it, attributing its appearance to injury to the esophagus with a lump of rough food or a bone. And unlike other diseases of the esophagus caused by its spasm, dysphagia in cancer is not intermittent in nature and, once it appears, begins to bother the patient again and again. Substernal pain occurs, sometimes of a burning nature. Less often, pain precedes dysphagia.
Having difficulty passing food through the esophagus, patients first begin to avoid particularly coarse foods (bread, meat, apples, potatoes), resort to pureed, ground food, and then are forced to limit themselves only to liquid foods - milk, cream, broth.
Progressive weight loss begins, often reaching complete cachexia.
Subsequently, complete obstruction of the esophagus occurs, and everything that the patient takes is thrown back through regurgitation.
Violated needs
Adequate nutrition, drinking
Highlight
Sleep, rest
Discomfort
Communication
Interdependent interventions
They do not play a big role in recognizing the esophagus, because anemia usually occurs late. A false increase in hemoglobin content is observed due to blood thickening due to malnutrition and dehydration of the patient.
R-examination, which reveals a narrowing of the lumen of the esophagus with uneven contours and rigid, infiltrated walls. Above the narrowing, the esophagus is usually somewhat dilated. Sometimes the degree of narrowing is so great that even liquid barium in a very thin stream has difficulty passing into the stomach.
Esophagoscopy makes it possible to visually see a bleeding tumor protruding into the lumen of the esophagus or a narrowed area with dense, inelastic, hyperemic or whitish walls, through which it is impossible to pass through the esophagoscope tube. The stability of the X-ray esophagoscopic picture makes it possible to distinguish esophageal cancer from its spasm, in which the narrowing disappears spontaneously or after the administration of antiseptics and the normal lumen and patency of the esophagus is restored.
The final stage of diagnosis is a biopsy with special forceps or taking smears from the surface of the tumor for cytological examination, carried out under the control of an esophagoscope.
Radical treatment can be carried out using 2 methods. Pure radiation treatment using the method of remote gamma therapy in a certain percentage of cases gives a satisfactory result. The same applies to purely surgical treatment.
However, observations in a number of patients …….. prompted …… ………………………… to resort to combination treatment. There are 2 types of operations.
For cancer of the lower part, the affected area is removed and resected, retreating down and up from the edges of the tumor up and down at least 5-6 cm. In this case, the upper part of the stomach is often taken away, and then the esophagogastric ………. , sewing the proximal end of the esophagus into the stump of the stomach.
The second type of operation is called the Torek operation, which is most often performed for cancer of the middle esophagus. The patient is first given a gastrostomy tube for nutrition, and then the esophagus is completely removed and its upper end is brought out to the neck.
Patients live by feeding through a tube inserted into the gastrostomy opening,
And only after 1-2 years, provided that no metastases are detected, the normal passage of food is restored, replacing the missing esophagus with the small or large intestine.
The division of these operations into several stages is necessary. Because patients with esophageal cancer are extremely weakened, they cannot tolerate single-stage complex interventions.
Particular attention is paid to the preparation and management of these patients.
From the moment the patient is admitted to the hospital, he receives intravenous
Administration of fluids (saline solutions, or Ringer's, glucose), vitamins, protein preparations, native plasma and blood. By mouth, if possible, give frequent small portions of high-calorie protein foods and various juices.
Care during the period depends on the nature of the interventions. Thus, the application of a gastrostomy is not a difficult operation, but it is necessary to receive instructions from the doctor about the timing of feeding, which until his strength is restored, is carried out by honey. sister. To do this, a thick gastric tube is inserted into the openings of the gastrostomy tube, directing it to the left, into the body of the stomach and trying to insert it deeper, but without force. Putting a funnel on the probe, slowly, in small portions, introduce mixtures prepared in advance:
From milk or cream
BROTH
butter
Sometimes diluted alcohol is added.
In the future, the diet is expanded, but the food always remains liquid and pureed.
Patients eat frequently and in small portions up to 5-6 times a day.
The postoperative period is much more difficult after such complex interventions as Thorek’s operation performed in the chest cavity and esophageal plastic surgery. In these patients, a complex of anti-shock measures is carried out - blood transfusions, blood substitutes, fluids, etc. Cardiovascular drugs, oxygen and, as after all thoracic operations, active aspiration from drains left in the chest cavity are used.
Nutrition after plastic replacement of the esophagus remains through a gastrostomy and stops only after complete fusion along the line of connection of the displaced intestine with the esophagus and stomach, when there is no fear of feeding the patient through the mouth. The gastrostomy subsequently heals on its own.
A common form of esophageal cancer with invasion of surrounding tissues or the presence of distant metastases is classified as inoperable. These patients, if their general condition allows, are subject to palliative radiation treatment and also, for palliative purposes, a gastrostomy tube for nutrition.
Esophageal cancer metastasizes both by the lymphatic route - to the lymph nodes of the mediastinum and in the left supraclavicular region, and through the bloodstream, most often affecting the liver.
Metastasis rarely plays a role in the causes of death; the main effect of tumors is progressive general exhaustion due to the spread of the primary tumor.
For esophageal cancer, radically treated patients have a poor prognosis.
Persistent cure is observed in 30-35%.
Tumor- pathological tissue proliferation, which differs from other pathological tissue proliferations in its autonomy and hereditary ability for unlimited, uncontrolled growth.
Benign - expansive growth (pushes tissue apart), less pronounced anaplasia (atypia), metastasis is not typical, less pronounced damaging effect on the body, rarely cachexia.
Malignant - infiltrative growth, pronounced anaplasia, metastasis, general damaging effect on the body and the development of cachexia.
Malignant tumors based on their histological structure are divided into:
Cancers, tumors arising from epithelial tissue;
Sarcomas are connective tissue tumors.
Benign tumors from:
Epithelial tissue – papillomas, adenomas, cysts;
Connective tissue – fibromas, lipomas;
Vascular tissue – angiomas;
Nervous tissue – neuromas, gliomas, ganglioneuromas.
Biological features of tumor cells and tissues.
1. unlimited growth - tumor cells multiply as long as the body is alive, nothing stops them except treatment.
2. autonomy - insensitivity of tumor growth to the neurohumoral effects of the whole organism.
3. infiltrative growth (main criteria for malignancy).
4. metastasis - the appearance of new foci of tumor growth in tissues remote from the primary tumor node.
5. anaplasia (atypia) - features that distinguish tumor cells from normal ones and create similarities with embryonic cells.
6. clonal growth pattern - all tumor cells originate from one transformed cell.
7. tumor progression - an increase in the malignant properties of the tumor (malignancy) - autonomy, metastasis, infiltrative growth.
Carcinogens.
Chemical
endogenous
Hormones (female sex hormones, etc.)
Cholesterol derivatives
Products of amino acid metabolism
exogenous
Products of incomplete combustion (exhaust gases, smoke products)
Initial products in the synthesis of drugs, dyes, color photography, rubber production.
Inorganic - arsenic, nickel, cobalt, chromium, lead (their extraction and production).
Physical
Ionizing radiation (causes leukemia, skin and bone tumors)
UFO (skin tumors).
Biological
Some viruses.
Origin of tumors.
Currently, the most common two points of view on the origin of tumors are:
1. Virus theory, which recognizes that tumor processes are infectious diseases caused by certain viruses, virus-like factors or agents.
2. Polyetiological theory, which does not try to reduce the diversity of tumors to any single cause: physiological, chemical or biological. This theory considers the pathogenesis of tumor transformation as the result of regeneration following damage caused by various factors and acting mostly repeatedly. Regeneration after repeated damage takes on pathological forms and leads to changes in cell properties, causing tumor growth in some cases.
Precancerous diseases and conditions.
1. Endocrine disorders.
2. Long-term chronic inflammatory diseases.
3. Chronic trauma.
Clinical manifestations.
Benign tumors most often do not cause complaints and are often discovered by chance. Their growth is slow. Benign tumors of internal organs manifest themselves only as symptoms of mechanical dysfunction of organs. The general condition of the patient, as a rule, does not suffer. When examining superficially located tumors, attention is drawn to the roundness of the shape and the lobulation of the structure. The tumor is mobile, not fused with surrounding tissues, its consistency may be different, regional lymph nodes are not enlarged, palpation of the tumor is painless.
Malignant tumors at the beginning of their development are asymptomatic, hidden from the patient himself, and yet their early diagnosis is important. In this regard, when examining people, especially over 35 years of age, regarding vague complaints, incipient weight loss, long-term continuous and increasing symptoms of the disease for no apparent reason, oncological alertness should be shown. This concept includes:
1. suspicion of cancer;
2. careful collection of anamnesis;
3. use of general and special methods of use;
4. in-depth analysis and synthesis of the data obtained.
The main complaints of a patient with a malignant neoplasm are a violation of the general condition: loss of general tone at work, apathy, loss of appetite, morning sickness, weight loss, etc. These complaints may be accompanied by more local symptoms: the presence of a chronic disease of the stomach, rectum, the appearance of a lump in the mammary gland, etc. At first, these phenomena may not be accompanied by pain, but then, when the tumor begins to grow into the nerve trunks, pain appears that becomes increasingly intense. and a more tormenting nature. A malignant tumor grows quickly. Substances to nourish cells come from the whole body, causing a lack of nutrition in other tissues and organs. In addition, despite the large number of blood vessels in a cancer tumor, their deficiency often leads to malnutrition in certain areas of the tumor and the disintegration of these areas. The products of necrosis and decay are absorbed into the body, leading to intoxication, progressive weight loss, exhaustion, and cachexia.
During the course of malignant tumors there are 4 stages:
1 tbsp. - the tumor does not extend beyond the organ, is small in size, without metastases;
2 tbsp. - the tumor is significant in size, but does not extend beyond the affected organ, there are signs of metastasis to regional lymph nodes;
3 tbsp. - the tumor extends beyond the affected organ with multiple metastases to regional lymph nodes and infiltration of surrounding tissues;
4 tbsp. - far advanced tumors with metastasis not only to regional lymph nodes, but also distant metastases to other organs.
Currently, the International Union Against Cancer has proposed a classification of tumors using the TNM system. The TNM system provides classification according to three main indicators: T - tumor - tumor (its size, germination into neighboring organs), N - nodulus - state of regional lymph nodes (density, adhesion to each other, infiltration of surrounding tissues), M - metastasis - hematogenous metastases or lymphogenous to other organs and tissues.
Examination methods.
1. History. In the anamnesis, attention is paid to chronic diseases, the appearance and growth of a tumor, the patient’s profession, and bad habits.
2. Objective examination. After a general examination of the patient, the tumor is examined and palpated (if it is accessible to inspection). Its size, character, consistency and relationship to surrounding tissues are determined. The presence of lesions, distant metastases, and enlargement of regional lymph nodes are determined.
3. Laboratory research methods. In addition to a general blood and urine test, all functional studies of the organ in which the tumor is suspected must be performed.
4. X-ray research methods. To diagnose a tumor, a variety of studies are performed: radiography, tomography, kymography, angiography, etc. In some cases, these methods are the main ones for diagnosis and allow not only to identify a tumor, but also to clarify its location, extent, determine the displacement of an organ, etc. Currently Computed tomography is widely used.
5. Endoscopic examination. In the study of hollow organs and cavities, endoscopy (rectoscopy, esophagoscopy, gastroscopy, bronchoscopy, cystoscopy) is widely used. An endoscopic examination makes it possible not only to examine a suspicious area of an organ (cavity), but also to take a piece of tissue for morphological examination. A biopsy (excision) followed by microscopic examination is often crucial for making a diagnosis.
6. Cytological examination. Such a study makes it possible in some cases to detect rejected tumor cells in gastric juice, washing water, sputum, and vaginal discharge.
7. For diseases of the internal organs, when, despite all the research methods used, the diagnosis of the disease remains unclear and the suspicion of a tumor process has not yet been removed, they resort to diagnostic surgery (chnosection, thoracotomy, etc.).
General principles of tumor treatment.
Treatment of a benign tumor is surgical: excision along with the capsule followed by histological examination. For small, superficially located benign tumors that do not bother the patient, waiting is possible. The absolute indications for tumor removal are:
1. the presence of a symptom of organ compression, obstruction, caused by a tumor;
| 9 | | | | |^ Lecture No. 24. NURSING PROCESS IN NEW PLACES
Oncology is the science that studies tumors.
1/5 of cases are detected during clinical examinations.
The role of the nurse in the early diagnosis of tumors is extremely important; she communicates closely with patients and, having a certain “oncological alertness” and knowledge of the issue, she has the ability to promptly refer the patient to a doctor for examination and clarification of the diagnosis.
The nurse should help prevent cancer by recommending and explaining the positive role of a healthy lifestyle and the negative role of bad habits.
Features of the oncological process.
A tumor is a pathological process that is accompanied by the uncontrolled proliferation of atypical cells.
Tumor development in the body:
the process occurs where it is completely undesirable;
tumor tissue differs from normal tissues by its atypical cellular structure, which changes beyond recognition;
a cancer cell behaves differently from other tissues; its function does not meet the needs of the body;
being in the body, the cancer cell does not obey it, lives at the expense of it, takes away all the vitality and energy, which leads to the death of the body;
in a healthy body, there is no place for the location of a tumor; for its existence, it “conquers” a place and its growth is either expansive (pushing apart the surrounding tissues) or infiltrating (growing into the surrounding tissues);
The cancer process itself does not stop.
Viral theory (L. Zilber). According to the provisions of this theory, the cancer virus enters the body in the same way as the influenza virus does, and the person becomes ill. The theory assumes that the cancer virus is initially present in every body, and not everyone gets sick, but only the person who finds himself in unfavorable living conditions.
Irritation theory (R. Virchow). The theory suggests that the tumor occurs in those tissues that are more often irritated and injured. Indeed, cervical cancer is more common than uterine cancer, and rectal cancer is more common than other parts of the intestine.
Germ tissue theory (D. Konheim). According to this theory, during the process of embryonic development, more tissue is formed somewhere than is required to form the organism, and then a tumor grows from these tissues.
Theory of chemical carcinogens (Fischer-Wasels). The growth of cancer cells is caused by chemicals that can be exogenous (nicotine, metal poisons, asbestos compounds, etc.) and endogenous (estradiol, folliculin, etc.).
Immunological the theory says that weak immunity is not able to restrain the growth of cancer cells in the body and a person gets cancer.
^ Classification of tumors
The main clinical difference between tumors is benign and malignant.
Benign tumors: slight deviation of the cellular structure, expansive growth, has a membrane, growth is slow, large in size, does not ulcerate, does not recur, does not metastasize, self-healing is possible, does not affect the general condition, interferes with the patient's weight, size, appearance.
Malignant tumors: completely atypical, infiltrating growth, does not have a membrane, growth is rapid, rarely reaches a large size, the surface is ulcerated, recurs, metastasizes, self-healing is impossible, causes cachexia, life-threatening.
A benign tumor can also be life-threatening if it is located near a vital organ.
A tumor is considered recurrent if it occurs again after treatment. This suggests that there is a cancer cell remaining in the tissue that can give rise to new growth.
Metastasis is the spread of cancer in the body. With the flow of blood or lymph, the cell is transferred from the main focus to other tissues and organs, where it produces new growth - metastasis.
Tumors vary depending on the tissue from which they originate.
Benign tumors:
Epithelial:
papillomas" (papillary layer of skin);
adenomas (glandular);
cysts (with a cavity).
Muscular - fibroids:
rhabdomyomas (striated muscle);
leiomyomas (smooth muscle).
Fatty ones - lipomas.
Bone - osteomas.
Vascular - angiomas:
hemangioma (blood vessel);
lymphangioma (lymphatic vessel).
Connective tissue - fibromas.
From nerve cells - neuromas.
From brain tissue - gliomas.
Cartilaginous - chondromas.
Mixed - fibroids, etc.
Epithelial (glandular or integumentary epithelium) - cancer (carcinoma).
Connective tissue - sarcomas.
Mixed - liposarcoma, adenocarcinoma, etc.
Exophytic, which have exophytic growth, have a narrow base and grow away from the wall of the organ.
Endophytes, which have endophytic growth, infiltrate the wall of the organ and grow along it.
T - indicates the size and local spread of the tumor (can be from T-0 to T-4;
N - indicates the presence and nature of metastases (can be from N-X to N-3);
M - indicates the presence of distant metastases (can be M-0, i.e. absence, and M, i.e. presence).
Additional designations: from G-1 to G-3 - this is the degree of malignancy of the tumor, the conclusion is given only by a histologist after examining the tissue; and from P-1 to P-4 - this is applicable only for hollow organs and shows the tumor has invaded the organ wall (P-4 - the tumor extends beyond the organ).
^ Stages of tumor development
There are four stages:
stage - the tumor is very small, does not grow into the wall of the organ and does not have metastases;
stage - the tumor does not extend beyond the organ, but there may be a single metastasis to the nearest lymph node;
stage - the size of the tumor is large, it grows into the wall of the organ and there are signs of decay, it has multiple metastases;
stage - either germination into neighboring organs, or multiple distant metastases.
Stage 1 – interview, observation, physical examination.
History: duration of the disease; ask what the patient discovered (the tumor is visible on the skin or in soft tissues, the patient himself discovers a certain formation), the tumor was found by chance during fluorography, during endoscopic examinations, during a clinical examination; the patient noticed the appearance of discharge (usually bloody), gastric, uterine, urological bleeding, etc.
Symptoms of cancer depend on the organ affected.
General symptoms: the onset of the process is imperceptible, there are no specific signs, increasing weakness, malaise, loss of appetite, pallor, vague low-grade fever, anemia and accelerated ESR, loss of interest in previous hobbies and activities.
It is necessary to actively identify signs of a possible disease in the patient.
History: chronic inflammatory diseases, for which he is registered. Such diseases are considered “precancer”. But not because they necessarily turn into cancer, but because a cancer cell, entering the body, is embedded in chronically altered tissue, i.e., the risk of a tumor increases. The same “risk group” includes benign tumors and all processes of impaired tissue regeneration. The presence of occupational hazards that increase the risk of cancer.
Observation: movements, gait, physique, general condition.
Physical examination: external examination, palpation, percussion, auscultation - notes deviations from the norm.
In all cases of suspected tumor, the nurse should refer the patient for examination to an oncology clinic with an oncologist.
Using the knowledge of medical psychology, the nurse must correctly present to the patient the need for such an examination by an oncologist and not cause him stress, categorically writing an oncological diagnosis or suspicion of it in the direction.
Stage 2 - nursing diagnosis, formulates the patient's problems.
Physical problems: vomiting, weakness, pain, insomnia.
Psychological and social - fear of learning about the malignant nature of the disease, fear of surgery, inability to take care of oneself, fear of death, fear of losing a job, fear of family complications, depressing state from the thought of staying forever with an “ostomy”.
Potential problems: formation of bedsores, complications of chemotherapy or radiation therapy, social isolation, disability without the right to work, inability to eat by mouth, threat to life, etc.
Stage 3 – draws up a plan to solve the priority problem.
Stage 4 – implementation of the plan. The nurse plans activities based on the nursing diagnosis. Therefore, according to the action plan, the plan for implementing the problem will change.
If the patient has an ostomy, the nurse instructs the patient and family on how to care for it.
Stage 5 - evaluate the result.
^ The role of the nurse in examining a cancer patient
Examination: to make a primary diagnosis or as an additional examination to clarify the disease or stage of the process.
The decision on examination methods is made by the doctor, and the nurse draws up a referral, conducts a conversation with the patient about the purpose of a particular method, tries to organize the examination in a short time, gives advice to relatives about psychological support for the patient, and helps the patient prepare for certain examination methods.
If this is an additional examination in order to resolve the issue of a benign or malignant tumor, then the nurse will highlight the priority from all problems (fear of detecting a malignant process) and will help the patient solve it, talk about the possibilities of diagnostic methods and the effectiveness of surgical treatment and advise giving consent to the operation in the early stages .
For early diagnosis use:
X-ray methods (fluoroscopy and radiography);
computed tomography;
ultrasound examination;
radioisotope diagnostics;
thermal imaging research;
biopsy;
endoscopic methods.
^ The role of the nurse in the treatment of cancer patients
The decision on the method of treating the patient is made by the doctor. The nurse must understand and support the doctor’s decisions to perform or refuse surgery, about the timing of surgery, etc. Treatment will largely depend on the benign or malignant nature of the tumor.
If the tumor benign, then, before giving advice about the operation, you need to find out:
Location of the tumor (if it is located in a vital or endocrine organ, then it is operated on). If it is located in other organs, then check:
b) whether it is constantly injured by the collar of clothes, glasses, a comb, etc. If it is a defect and is injured, then it is removed promptly, and if not, then only observation of the tumor is required.
Effect on the function of another organ:
b) compresses blood vessels and nerves;
c) closes the lumen;
If there is such a negative effect, then the tumor must be removed promptly, and if it does not disrupt the function of other organs, then there is no need to operate.
Is there confidence that the tumor is benign: if it is, then they do not operate; if not, then it is better to remove it.
Surgery - the most effective method of treatment.
Danger: spread of cancer cells throughout the body, danger of not removing all cancer cells.
There are concepts of “ablastic” and “antiblastic”.
Ablastika is a set of measures aimed at preventing the spread of tumor cells in the body during surgery.
This complex includes:
do not injure the tumor tissue and make an incision only along healthy tissue;
quickly apply ligatures to vessels in the wound during surgery;
bandage the hollow organ above and below the tumor, creating an obstacle to the spread of cancer cells;
delimit the wound with sterile napkins and change them during the operation;
changing gloves, instruments and surgical linen during surgery.
Such events include:
use of a laser scalpel;
irradiation of the tumor before and after surgery;
use of antitumor drugs;
treating the wound surface with alcohol after tumor removal.
If it is impossible to perform a radical operation, a palliative operation is performed; it does not require ablastics, antiblastics, or zonality.
Radiation therapy . Radiation only affects the cancer cell; the cancer cell loses its ability to divide and multiply.
RT can be both the main and additional method of treating a patient.
Irradiation can be carried out:
external (through the skin);
intracavitary (uterine cavity or bladder);
interstitial (into tumor tissue).
on the skin (in the form of dermatitis, itching, alopecia - hair loss, pigmentation);
general reaction of the body to radiation (in the form of nausea and vomiting, insomnia, weakness, heart rhythm disturbances, lung function and changes in blood tests).
Groups of drugs used to treat cancer patients:
cytostatics that stop cell division;
antimetabolites that affect metabolic processes in a cancer cell;
antitumor antibiotics;
hormonal drugs;
immunity enhancing agents;
drugs affecting metastases.
Cytokines are protein cellular regulators of the immune system: interferons , colony-stimulating factors.
monoclonal antibodies.
The disease is considered cured if: the tumor is completely removed; no metastases were detected during surgery; within 5 years after the operation the patient has no complaints.
