The study of true tumors occupies a significant place among the problems of cognition of pathological processes and has long stood out in a special discipline - oncology(Greek. oncos- tumor, logos- the science). However, familiarity with the basic principles of diagnosis and treatment of tumors is necessary for every doctor. Oncology studies only true tumors, as opposed to false ones (an increase in tissue volume due to edema, inflammation, hyperfunction and working hypertrophy, changes in hormonal levels, limited fluid accumulation).
General Provisions
Tumor(synonym: neoplasm, neoplasm, blastoma) - a pathological formation that independently develops in organs and tissues, characterized by autonomous growth, polymorphism and atypia of cells. A characteristic feature of a tumor is the isolated development and growth within the tissues of the body.
The main properties of the tumor
There are two main differences between a tumor and other cellular structures of the body: autonomous growth, polymorphism, and cell atypia.
Autonomous growth
Acquiring tumor properties due to one reason or another, the cells convert the resulting changes into their internal properties, which are then passed on to the next direct progeny of the cells. This phenomenon is called "tumor transformation". Cells that have undergone tumor transformation begin to grow and divide without stopping, even after the elimination of the factor that initiated the process. At the same time, the growth of tumor cells is not subject to the influence of any regulatory mechanisms.
mov (nervous and endocrine regulation, immune system, etc.), i.e. not controlled by the body. A tumor, having appeared, grows as if by itself, using only nutrients and energy resources of the body. These features of tumors are called automation, and their growth is characterized as autonomous.
Cell polymorphism and atypia
The cells that have undergone tumor transformation begin to multiply faster than the cells of the tissue from which they originated, which determines the faster growth of the tumor. The proliferation rate can vary. At the same time, a violation of cell differentiation occurs to varying degrees, which leads to their atypia - a morphological difference from the cells of the tissue from which the tumor has developed, and polymorphism - the possible presence of cells of different morphological characteristics in the tumor structure. The degree of differentiation disorders and, accordingly, the severity of atypia can be different. While maintaining a sufficiently high differentiation, the structure and function of tumor cells are close to normal. In this case, the tumor usually grows slowly. Poorly differentiated and generally undifferentiated (it is impossible to determine the tissue - the source of tumor growth) tumors consist of non-specialized cells, they are distinguished by rapid, aggressive growth.
Morbidity structure, mortality
In terms of incidence, oncological diseases rank third after diseases of the cardiovascular system and injuries. According to the WHO, more than 6 million new cancer cases are registered annually. Men get sick more often than women. Distinguish between the main localization of tumors. In men, most often - cancer of the lung, stomach, prostate, colon and rectum, skin. In women, breast cancer comes first, followed by cancer of the stomach, uterus, lung, rectum and colon, and skin. Recently, the tendency of an increase in the incidence of lung cancer with a slight decrease in the incidence of stomach cancer has attracted attention. Cancer takes the second place among the causes of death in developed countries (after diseases of the cardiovascular system) - 20% of the total mortality rate. At the same time, the 5-year survival rate after
The average diagnosis of a malignant tumor is about 40%.
Etiology and pathogenesis of tumors
At the present time, it cannot be said that all questions of the etiology of tumors have been resolved. There are five main theories of their origin.
Basic theories of the origin of tumors Irritation theory R. Virkhov
More than 100 years ago, it was revealed that malignant tumors more often occur in those parts of the organs where the tissues are more subject to trauma (the area of the cardia, the outlet of the stomach, the rectum, the cervix). This allowed R. Virkhov to formulate a theory according to which constant (or frequent) tissue trauma accelerates the processes of cell division, which at a certain stage can be transformed into tumor growth.
D. Konheim's theory of embryonic rudiments
According to D. Kongheim's theory, in the early stages of embryo development, more cells may appear in different areas than are needed to build the corresponding part of the body. Some cells that remain unclaimed can form dormant rudiments, which have the potential for high growth energy inherent in all embryonic tissues. These rudiments are in a latent state, but under the influence of certain factors they can grow, acquiring tumor properties. At present, this developmental mechanism is valid for a narrow category of neoplasms called "dysembryonic" tumors.
Fisher-Wazels' regeneration-mutational theory
As a result of exposure to various factors, including chemical carcinogens, degenerative-dystrophic processes occur in the body, accompanied by regeneration. According to Fischer-Wazels, regeneration is a “sensitive” period in the life of cells, when tumor transformation can occur. The very transformation of normal regenerating cells into a tumor
Viral theory
The viral theory of the onset of tumors was developed by L.A. Zilber. The virus, penetrating into the cell, acts at the genetic level, disrupting the processes of regulation of cell division. The influence of the virus is amplified by various physical and chemical factors. Currently, the role of viruses (oncoviruses) in the development of certain tumors has been clearly proven.
Immunological theory
The youngest theory of the onset of tumors. According to this theory, various mutations constantly occur in the body, including tumor transformation of cells. But the immune system quickly identifies the “wrong” cells and destroys them. A disturbance in the immune system leads to the fact that one of the transformed cells is not destroyed and is the cause of the development of a neoplasm.
None of the presented theories reflects a single scheme of oncogenesis. The mechanisms described in them are important at a certain stage of the onset of a tumor, and their significance for each type of neoplasm can vary within very significant limits.
Modern polyetiological theory of the origin of tumors
In accordance with modern views, with the development of different types of neoplasms, the following causes of tumor cell transformation are distinguished:
Mechanical factors: frequent, repeated tissue trauma with subsequent regeneration.
Chemical carcinogens: local and general exposure to chemicals (for example, scrotal cancer in chimney sweeps when exposed to soot, squamous cell lung cancer when smoking tobacco - exposure to polycyclic aromatic hydrocarbons, pleural mesothelioma when working with asbestos, etc.).
Physical carcinogens: UV (especially for skin cancer), ionizing radiation (tumors of the bones, thyroid gland, leukemia).
Oncogenic viruses: Epstein-Barr virus (role in the development of Burkitt's lymphoma), T-cell leukemia virus (role in the genesis of the same disease).
The peculiarity of the polyetiological theory is that the very effect of external carcinogenic factors does not cause the development of a neoplasm. For the emergence of a tumor, the presence of internal causes is also necessary: a genetic predisposition and a certain state of the immune and neurohumoral systems.
Classification, clinical presentation and diagnosis
The classification of all tumors is based on their division into benign and malignant. When naming all benign tumors, the suffix -oma is added to the characteristics of the tissue from which they originated: lipoma, fibroma, myoma, chondroma, osteoma, adenoma, angioma, neurinoma, etc. If a neoplasm contains a combination of cells of different tissues, their names sound accordingly: lipofibroma, neurofibroma, etc. All malignant neoplasms are divided into two groups: tumors of epithelial origin - cancer and of connective tissue origin - sarcoma.
Differences between benign and malignant tumors
Malignant tumors are distinguished from benign ones not only by name. It is the division of tumors into malignant and benign ones that determines the prognosis and tactics of treating the disease. The main fundamental differences between benign and malignant tumors are presented in table. 16-1.
Table 16-1.Differences between benign and malignant tumors
Atypia and polymorphism
Atypia and polymorphism are characteristic of malignant tumors. In benign tumors, the cells exactly repeat the structure of the tissue cells from which they originated, or have minimal differences. The cells of malignant tumors differ significantly in structure and function from their predecessors. At the same time, the changes can be so serious that it is morphologically difficult, or even impossible, to determine from which tissue, which organ, the neoplasm has arisen (the so-called undifferentiated tumors).
Growth pattern
Benign tumors are characterized by expansive growth: the tumor grows, as it were, by itself, enlarges and pushes the surrounding organs and tissues apart. In malignant tumors, growth is infiltrating: the tumor, like the claws of cancer, captures, penetrates, infiltrates the surrounding tissues, while sprouting blood vessels, nerves, etc. The growth rate is significant; high mitotic activity is observed in the tumor.
Metastasis
As a result of tumor growth, some of its cells can break off, enter other organs and tissues and cause the growth of a secondary, daughter tumor there. This process is called metastasis, and the daughter tumor is called metastasis. Only malignant neoplasms are prone to metastasis. Moreover, in terms of their structure, metastases usually do not differ from the primary tumor. Very rarely, they have even lower differentiation, and therefore are more malignant. There are three main ways of metastasis: lymphogenous, hematogenous, implantation.
The lymphogenous pathway of metastasis is the most frequent. Depending on the ratio of metastases to the lymph outflow pathway, antegrade and retrograde lymphogenous metastases are distinguished. The most striking example of antegrade lymphogenous metastasis is metastasis to the lymph nodes of the left supraclavicular region in gastric cancer (Virchow's metastasis).
The hematogenous pathway of metastasis is associated with the entry of tumor cells into the blood capillaries and veins. With bone sarcomas, hematogenous metastases often occur in the lungs, with bowel cancer - in the liver, etc.
The implantation route of metastasis is usually associated with the ingress of malignant cells into the serous cavity (with the growth of all layers of the organ wall) and from there to neighboring organs. For example, implantation metastasis for gastric cancer in the Douglas space is the lowest region of the abdominal cavity.
The fate of a malignant cell that has entered the circulatory or lymphatic system, as well as the serous cavity, is not definitively predetermined: it can give rise to a daughter tumor, or it can be destroyed by macrophages.
Recurrence
Relapse is understood as the re-development of a tumor in the same area after surgical removal or destruction using radiation therapy and / or chemotherapy. The possibility of relapse is a characteristic feature of malignant neoplasms. Even after a seemingly macroscopically complete removal of the tumor in the area of operation, individual malignant cells can be found that can give rise to the re-growth of the neoplasm. After complete removal of benign tumors, relapses are not observed. The exceptions are intermuscular lipomas and benign retroperitoneal formations. This is due to the presence of a kind of pedicle in such tumors. When removing the neoplasm, the leg is isolated, tied up and cut off, but re-growth is possible from its remnants. The growth of a tumor after incomplete removal is not considered a relapse - this is a manifestation of the progression of the pathological process.
Influence on the general condition of the patient
In benign tumors, the entire clinical picture is associated with their local manifestations. Formations can cause inconvenience, squeeze nerves, blood vessels, disrupt the function of neighboring organs. At the same time, they have no effect on the general condition of the patient. The exception is some tumors, which, despite their "histological benign quality", cause serious changes in the patient's condition, and sometimes lead to his death. In such cases, they speak of a benign tumor with a malignant clinical course, for example:
Tumors of the endocrine organs. Their development increases the level of production of the corresponding hormone, which causes characteristic
general symptoms. Pheochromocytoma, for example, releasing large amounts of catecholamines into the bloodstream, causes arterial hypertension, tachycardia, and autonomic reactions.
Tumors of vital organs significantly disrupt the state of the body due to the disorder of their functions. For example, when a benign brain tumor grows, it compresses areas of the brain with vital centers, which poses a threat to the patient's life. A malignant tumor leads to a number of changes in the general state of the body, called cancer intoxication, up to the development of cancerous cachexia (exhaustion). This is due to the rapid growth of the tumor, its consumption of a large amount of nutrients, energy reserves, plastic material, which naturally impoverishes the supply of other organs and systems. In addition, the rapid growth of education often accompanies necrosis in its center (tissue mass increases faster than the number of vessels). Absorption of cellular decay products occurs, perifocal inflammation occurs.
Classification of benign tumors
The classification of benign tumors is simple. There are types depending on the tissue from which they originated. Fibroma is a tumor of connective tissue. Lipoma is a tumor of adipose tissue. Myoma is a tumor of muscle tissue (rhabdomyoma - striated, leiomyoma - smooth), etc. If two or more types of tissues are present in a tumor, they bear the corresponding names: fibrolipoma, fibroadenoma, fibromyoma, etc.
Classification of malignant tumors
The classification of malignant neoplasms, as well as benign ones, is primarily associated with the type of tissue from which the tumor originated. Epithelial tumors are called cancer (carcinoma, carcinoma). Depending on the origin in highly differentiated neoplasms, this name is specified: squamous cell carcinoma, adenocarcinoma, follicular and papillary cancer, etc. With poorly differentiated tumors, it is possible to specify the tumor form of cells: small cell carcinoma, signet ring cell carcinoma, etc. Connective tissue tumors are called sarcomas. With a relatively high differentiation, the name of the tumor repeats the name
tissue from which it developed: liposarcoma, myosarcoma, etc. Of great importance in the prognosis of malignant neoplasms is the degree of tumor differentiation - the lower it is, the faster its growth, the greater the frequency of metastases and relapses. Currently, the international TNM classification and the clinical classification of malignant tumors are considered generally accepted.
TNM classification
The TNM classification is accepted all over the world. In accordance with it, with a malignant tumor, the following parameters are distinguished:
T (tumor) - the size and local spread of the tumor;
N (node)- the presence and characteristics of metastases in regional lymph nodes;
M (metastasis)- the presence of distant metastases.
In addition to its original form, the classification was later expanded with two more characteristics:
G (grade) - the degree of malignancy;
R (penetration) - the degree of germination of the wall of a hollow organ (only for tumors of the gastrointestinal tract).
T (tumor) characterizes the size of the formation, the prevalence in the sections of the affected organ, the germination of the surrounding tissues.
For each organ, there are specific gradations of the indicated signs. For colon cancer, for example, the following options are possible:
T o- there are no signs of a primary tumor;
T is (in situ)- intraepithelial tumor;
T 1- the tumor occupies an insignificant part of the intestinal wall;
T 2- the tumor occupies half the circumference of the intestine;
T 3- the tumor occupies more than 2/3 or the entire circumference of the intestine, narrowing the lumen;
T 4- the tumor occupies the entire lumen of the intestine, causing intestinal obstruction and (or) grows into neighboring organs.
For a breast tumor, the grading is carried out according to the size of the tumor (in cm); for stomach cancer - according to the degree of germination of the wall and spread to its sections (cardia, body, outlet section), etc. The stage of cancer requires special reservation. "In situ"(cancer in place). At this stage, the tumor is located only in the epithelium (intraepithelial cancer), the basement membrane does not grow, and therefore does not grow into the blood and lymphatic vessels. Thus, on
At this stage, the malignant tumor is devoid of the infiltrating nature of growth and, in principle, cannot give hematogenous or lymphogenous metastasis. Listed features of cancer in situ determine more favorable results of treatment of such malignant neoplasms.
N (nodes) characterizes changes in regional lymph nodes. For stomach cancer, for example, the following types of designations are adopted:
N x- there is no data on the presence (absence) of metastases in regional lymph nodes (the patient is under-examined, not operated on);
N o - there are no metastases in the regional lymph nodes;
N 1 - metastases to the lymph nodes along the greater and lesser curvature of the stomach (1st order collector);
N 2 - metastases to prepyloric, paracardial lymph nodes, to the nodes of the greater omentum - are removed during surgery (2nd order collector);
N 3- para-aortic lymph nodes are affected by metastases - not removable during surgery (3rd order collector).
Gradation N o and N x- common to almost all tumor localizations. Specifications N 1 -N 3- different (this can mean the defeat of different groups of lymph nodes, the size and nature of metastases, their single or multiple nature).
It should be noted that at present it is possible to give a clear definition of the presence of a certain type of regional metastases only on the basis of a histological examination of postoperative (or autopsy) material.
M (metastasis) indicates the presence or absence of distant metastases:
M 0- there are no distant metastases;
M. i- there are distant metastases (at least one).
G (grade) characterizes the degree of malignancy. In this case, the determining factor is a histological indicator - the degree of cell differentiation. There are three groups of neoplasms:
G 1 - low-grade tumors (highly differentiated);
G 2 - tumors of medium malignancy (poorly differentiated);
G 3- tumors of a high degree of malignancy (undifferentiated).
R (penetration) the parameter is entered only for tumors of hollow organs and shows the degree of germination of their walls:
P 1- a tumor within the mucous membrane;
P 2 - the tumor grows into the submucosa;
R 3 - the tumor invades the muscle layer (up to the serous layer);
R 4- the tumor invades the serous membrane and goes beyond the organ.
In accordance with the presented classification, the diagnosis may sound, for example, as follows: cecum cancer - T 2 N 1 M 0 P 2. The classification is very convenient, as it characterizes in detail all aspects of the malignant process. At the same time, it does not provide generalized data on the severity of the process, the possibility of curing the disease. For this, a clinical classification of tumors is used.
Clinical classification
In the clinical classification, all the main parameters of a malignant neoplasm (the size of the primary tumor, growth into the surrounding organs, the presence of regional and distant metastases) are considered together. There are four stages of the disease:
Stage I - the tumor is localized, occupies a limited area, the organ wall does not grow, there are no metastases.
Stage II - a tumor of moderate size, does not spread beyond the organ, single metastases to regional lymph nodes are possible.
Stage III - a tumor of a large size, with decay, grows the entire wall of the organ or a tumor of a smaller size with multiple metastases to regional lymph nodes.
Stage IV - tumor invasion into surrounding organs, including those that cannot be removed (aorta, vena cava, etc.), or any tumor with distant metastases.
Clinical picture and diagnosis of tumors
The clinic and diagnosis of benign and malignant neoplasms are different, which is associated with their influence on the surrounding organs and tissues, and the patient's body as a whole.
Features of the diagnosis of benign tumors
Diagnosis of benign lesions is based on local symptoms, signs of the presence of the tumor itself. Often sick
pay attention to the appearance of some kind of education themselves. In this case, tumors usually slowly increase in size, do not cause pain, have a rounded shape, a clear border with the surrounding tissues, and a smooth surface. The main concern is the presence of education itself. Only sometimes there are signs of organ dysfunction (a colon polyp leads to obstructive intestinal obstruction; a benign brain tumor, squeezing the surrounding sections, leads to the appearance of neurological symptoms; adrenal adenoma due to the release of hormones into the bloodstream leads to arterial hypertension, etc.). It should be noted that the diagnosis of benign tumors is not particularly difficult. By themselves, they cannot threaten the patient's life. A possible danger is only a violation of the function of organs, but this, in turn, rather clearly manifests the disease.
Diagnostics of malignant tumors
The diagnosis of malignant neoplasms is rather difficult, which is associated with the various clinical manifestations of these diseases. In the clinic of malignant tumors, four main syndromes can be distinguished:
Plus-tissue syndrome;
Syndrome of pathological discharge;
Organ dysfunction syndrome;
Small Signs Syndrome.
Plus-tissue syndrome
The neoplasm can be detected directly in the area of its location as a new additional tissue - "plus tissue". This symptom is easy to identify with the superficial localization of the tumor (in the skin, subcutaneous tissue or muscles), as well as on the extremities. Sometimes a swelling in the abdomen can be felt. In addition, the sign "plus-tissue" can be determined using special research methods: endoscopy (laparoscopy, gastroscopy, colonoscopy, bronchoscopy, cystoscopy, etc.), X-ray examination or ultrasound, etc. In this case, it is possible to detect the tumor itself or to determine the symptoms characteristic of "plus-tissue" (filling defect in X-ray examination of the stomach with contrasting with barium sulfate, etc.).
Discharge Syndrome
In the presence of a malignant tumor, as a result of its invasion of blood vessels, spotting or bleeding often occurs. So, stomach cancer can cause gastric bleeding, a tumor of the uterus - uterine bleeding or spotting spotting from the vagina, for breast cancer a characteristic symptom is serous-hemorrhagic discharge from the nipple, for lung cancer hemoptysis is characteristic, and when the pleura grows, the appearance of hemorrhagic effusion in the pleural cavity, with rectal cancer, rectal bleeding is possible, with a kidney tumor - hematuria. With the development of inflammation around the tumor, as well as with the mucus-forming form of cancer, mucous or mucopurulent discharge occurs (for example, in colon cancer). Such symptoms are collectively called the syndrome of pathological discharge. In some cases, these signs help differentiate a malignant tumor from a benign one. For example, if there is bloody discharge from the nipple with a neoplasm of the mammary gland, the tumor is malignant.
Organ dysfunction syndrome
The very name of the syndrome suggests that its manifestations are very diverse and are determined by the localization of the tumor and the function of the organ in which it is located. For malignant intestinal formations, signs of intestinal obstruction are characteristic. For stomach tumors - dyspeptic disorders (nausea, heartburn, vomiting, etc.). In patients with esophageal cancer, the leading symptom is a violation of the act of swallowing food - dysphagia, etc. These symptoms are not specific, but often occur in patients with malignant neoplasms.
Small Signs Syndrome
Patients with malignant neoplasms often present seemingly incomprehensible complaints. They note: weakness, fatigue, fever, weight loss, poor appetite (aversion to meat food is characteristic, especially with stomach cancer), anemia, increased ESR. The listed symptoms are combined into a syndrome of small signs (described for the first time by A.I.Savitsky). In some cases, this syndrome occurs on a rather
early stages of the disease and may even be its only manifestation. Sometimes it can be later, being essentially a manifestation of an obvious cancer intoxication. At the same time, patients have a characteristic, "oncological" appearance: they are undernourished, tissue turgor is reduced, the skin is pale with an icteric shade, sunken eyes. Usually, such an appearance of patients indicates that they have a running oncological process.
Clinical differences between benign and malignant tumors
When determining the plus-tissue syndrome, the question arises whether this extra tissue is formed due to the development of a benign or malignant tumor. There are a number of differences in local variations (status localis), which are primarily of importance for palpable formations (tumor of the breast, thyroid gland, rectum). Differences in local manifestations of malignant and benign tumors are presented in table. 16-2.
General principles of diagnostics of malignant neoplasms
Given the pronounced dependence of the results of treatment of malignant tumors on the stage of the disease, as well as a rather high
Table 16-2.Local differences between malignant and benign tumors
the risk of relapse and progression of the process, in the diagnosis of these processes, one should pay attention to the following principles:
Early diagnosis;
Oncological pre-vigilance;
Overdiagnostics.
Early diagnosis
Elucidation of the clinical symptoms of a tumor and the use of special diagnostic methods are important for making a diagnosis of a malignant neoplasm in the shortest possible time and choosing the optimal way of treatment. In oncology, there is a concept of timely diagnosis. In this regard, the following types of it are distinguished:
Early;
Timely;
Late.
Early diagnosis is said in cases where the diagnosis of a malignant neoplasm is established at the stage of cancer in situ or at the I clinical stage of the disease. This implies that adequate treatment should lead to the patient's recovery.
A diagnosis made at stage II and in some cases at stage III of the process is considered timely. At the same time, the treatment undertaken makes it possible to completely cure the patient from cancer, but this is possible only in some patients, while others will die in the coming months or years from the progression of the process.
Late diagnosis (establishing a diagnosis at stages III-IV of cancer) indicates a low probability or fundamental impossibility of curing a patient and, in essence, predetermines his future fate.
It is clear from what has been said that one should try to diagnose a malignant tumor as soon as possible, since early diagnosis allows to achieve significantly better treatment results. Targeted treatment for cancer should be started within two weeks of diagnosis. The importance of early diagnosis is clearly shown by the following figures: five-year survival rate in the surgical treatment of gastric cancer at the stage in situ is 90-97%, and in stage III cancer - 25-30%.
Oncological alertness
When examining a patient and finding out any clinical symptoms, a doctor of any specialty should ask himself the question:
could these symptoms be a manifestation of a malignant tumor? Having asked this question, the doctor should make every effort to either confirm or eliminate the suspicions that have arisen. When examining and treating any patient, the doctor should be oncological alertness.
The principle of overdiagnosis
When diagnosing malignant neoplasms in all doubtful cases, it is customary to expose a more formidable diagnosis and to undertake more radical methods of treatment. This approach is called overdiagnosis. So, for example, if the examination reveals a large ulcer defect in the gastric mucosa and the use of all available research methods does not allow us to answer the question of whether it is a chronic ulcer or an ulcerative form of cancer, the patient is considered to have cancer and he is treated as an oncological patient.
The principle of overdiagnosis must of course be applied within reasonable limits. But if there is a possibility of error, it is always more correct to think about a more malignant tumor, a greater stage of the disease and, on the basis of this, use more radical means of treatment than to view cancer or prescribe inadequate treatment, as a result of which the process will progress and inevitably lead to death.
Precancerous diseases
For the early diagnosis of malignant diseases, it is necessary to carry out a preventive examination, since the diagnosis of cancer in situ, for example, based on clinical symptoms is extremely difficult. And at later stages, an atypical picture of the course of the disease may prevent its timely detection. People from two risk groups are subject to preventive examination:
Persons associated with the impact of carcinogenic factors (work with asbestos, ionizing radiation, etc.);
Persons with so-called precancerous diseases that require special attention.
Precancerousare called chronic diseases, against the background of which the incidence of malignant tumors increases sharply. So, for the mammary gland, a precancerous disease - dyshormonal mastopathy; for the stomach - chronic ulcer, polyps, chronic
cic atrophic gastritis; for the uterus - erosion and leukoplakia of the cervix, etc. Patients with precancerous diseases are subject to dispensary observation with an annual examination by an oncologist and special studies (mammography, fibrogastroduodenoscopy).
Special diagnostic methods
In the diagnosis of malignant neoplasms, along with conventional methods (endoscopy, radiography, ultrasound), various types of biopsy with subsequent histological and cytological examination are of particular, sometimes decisive importance. At the same time, the detection of malignant cells in the preparation reliably confirms the diagnosis, while a negative answer does not allow it to be removed - in such cases, they are guided by clinical data and the results of other research methods.
Tumor markers
As you know, at present, there are no changes in the clinical and biochemical parameters of blood specific to oncological processes. However, recently, tumor markers (OM) have become increasingly important in the diagnosis of malignant tumors. OM in most cases are complex proteins with a carbohydrate or lipid component, synthesized in tumor cells in high concentrations. These proteins can be associated with cellular structures and then they are detected in immunohistochemical studies. A large group of OM is secreted by tumor cells and accumulates in the biological fluids of cancer patients. In this case, they can be used for serological diagnostics. The concentration of OM (primarily in the blood) can, to a certain extent, correlate with the occurrence and dynamics of the malignant process. In the clinic, about 15-20 OM are widely used. The main methods for determining the level of OM in blood serum are radioimmunoassay and enzyme immunoassay. The following tumor markers are most common in clinical practice: osfetoprotein (for liver cancer), carcinoembryonic antigen (for adenocarcinoma of the stomach, colon, etc.), prostate-specific antigen (for prostate cancer), etc.
Currently known OM, with a few exceptions, are of limited use for the diagnosis or screening of tumors, since
how an increase in their level is observed in 10-30% of patients with benign and inflammatory processes. Nevertheless, OM have found wide application in dynamic monitoring of cancer patients, for early detection of subclinical relapses and control over the effectiveness of anticancer therapy. The only exception is the prostate-specific antigen used for the direct diagnosis of prostate cancer.
General principles of treatment
The therapeutic tactics of benign and malignant tumors are different, which primarily depends on the infiltrating growth, the tendency to recurrence and metastasis of the latter.
Treatment of benign tumors
The main and in the overwhelming majority of cases the only way to treat benign neoplasms is surgical. Only in the treatment of tumors of hormone-dependent organs, hormone therapy is used instead of or together with the surgical method.
Indications for surgery
When treating benign neoplasms, the question of indications for surgery is important, since these tumors, which do not pose a threat to the patient's life, do not always have to be removed. If a patient has a benign tumor for a long time that does not cause him any harm, and at the same time there are contraindications for surgical treatment (severe concomitant diseases), then it is hardly advisable to operate on the patient. In case of benign neoplasms, the operation is necessary if there are certain indications:
Constant trauma to the tumor. For example, a swelling of the scalp that is damaged by scratching; formation on the neck in the area of the collar; swelling in the waist area, especially in men (friction with a trouser belt).
Dysfunction of the organ. Leiomyoma can disrupt gastric evacuation, a benign tumor of the bronchus can completely close its lumen, pheochromocytoma due to the release of catecholamines leads to high arterial hypertension, etc.
Before the operation, there is no absolute certainty that the tumor is malignant. In these cases, the operation, in addition to the therapeutic function, also performs the role of an excisional biopsy. So, for example, with neoplasms of the thyroid or mammary gland, patients in a number of cases are operated on because with such a localization the question of the malignancy of the tumor can be resolved only after an urgent histological examination. The result of the study becomes known to surgeons while the patient is still under anesthesia on the operating table, which helps them choose the right type and amount of surgery.
Cosmetic defects. This is primarily characteristic of tumors on the face and neck, especially in women, and does not require special comments.
Surgical treatment of a benign tumor is understood to mean its complete removal within healthy tissues. In this case, the formation should be removed in its entirety, and not in parts, and together with the capsule, if any. The excised neoplasm is necessarily subject to histological examination (urgent or planned), given that after the removal of a benign tumor, relapses and metastases do not occur; after the operation, patients recover completely.
Treatment of malignant tumors
The treatment of malignant tumors is a more difficult task. There are three treatments for malignant neoplasms: surgery, radiation therapy, and chemotherapy. In this case, the main one, of course, is the surgical method.
Principles of Surgical Treatment
Removal of a malignant neoplasm is the most radical, and in some localizations, the only method of treatment. Unlike operations for benign tumors, it is not enough just to remove the formation. When removing a malignant neoplasm, it is necessary to observe the so-called oncological principles: ablastic, antiblastic, zoning, sheathing.
Ablastic
Ablasty is a set of measures to prevent the spread of tumor cells during surgery. In this case, it is necessary:
Make incisions only within known healthy tissues;
Avoid mechanical injury to the tumor tissue;
Tie up the venous vessels extending from the formation as soon as possible;
Bandage the hollow organ above and below the tumor with a ribbon (preventing cell migration along the lumen);
Remove the tumor in a single block with fiber and regional lymph nodes;
Before manipulating the tumor, limit the wound with napkins;
After tumor removal, change (treat) instruments and gloves, change limiting napkins.
Antiblastic
Antiblastic surgery is a set of measures to destroy during the operation of individual tumor cells that have torn off from its main mass (they can lie on the bottom and walls of the wound, get into the lymphatic or venous vessels and subsequently be a source of tumor recurrence or metastases). Allocate physical and chemical antiblastic.
Physical antiblastic:
Using an electric knife;
Using a laser;
Using cryodestruction;
Irradiation of the tumor before surgery and in the early postoperative period.
Chemical antiblastic:
Treatment of the wound surface after tumor removal 70? alcohol;
Intravenous administration of anticancer chemotherapy drugs on the operating table;
Regional perfusion with anticancer chemotherapeutic drugs.
Zoning
During an operation for a malignant neoplasm, it is necessary not only to remove it, but also to remove the entire area in which there may be
individual cancer cells - the principle of zoning. At the same time, it is taken into account that malignant cells can be located in the tissues near the tumor, as well as in the lymphatic vessels and regional lymph nodes extending from it. With exophytic growth (the tumor is on a narrow base, and its large mass is directed to the external environment or to the inner lumen - polypoid, mushroom-shaped), it is necessary to retreat from the visible border of formation by 5-6 cm. With endophytic growth (spread of the tumor along the wall of the organ) from the visible border should recede at least 8-10 cm.Along with the organ or part of it, it is necessary to remove all lymphatic vessels and nodes collecting lymph from this zone together with the organ or part of it (in case of stomach cancer, for example, the entire major and minor omentum should be removed). Some of these operations are called "lymphadenectomy". In accordance with the principle of zoning, in most of oncological operations, the entire organ or most of it is removed (in case of stomach cancer, for example, it is possible to perform only subtotal resection of the stomach [leaving 1 / 7-1 / 8 of its part] or extirpation of the stomach [its complete deletion]). Radical surgical interventions performed in compliance with all oncological principles are complex, large in volume and traumatic. Even with a small-sized endophytic growing tumor of the stomach body, the stomach is extirpated with the imposition of an esophagoenteroanastomosis. In this case, in a single block, together with the stomach, the small and large omentum, and in some cases the spleen, are removed. In breast cancer, the mammary gland, pectoralis major muscle and subcutaneous fatty tissue with axillary, supraclavicular and subclavian lymph nodes are removed in a single block.
The most malignant of all known tumors, melanoma requires extensive excision of the skin, subcutaneous fat and fascia, as well as the complete removal of regional lymph nodes (if melanoma is located on the lower extremity, for example, inguinal and iliac). In this case, the size of the primary tumor usually does not exceed 1-2 cm.
Casing
Lymphatic vessels and nodes through which tumor cells can spread are usually located in cellular spaces separated by fascial septa. In this regard, for greater radicalism, it is necessary to remove the fiber of the entire fascial sheath, preferably together with the fascia. A striking example of co-
observance of the principle of casing - surgery for thyroid cancer. The latter is removed extracapsularly (together with the capsule formed by the visceral leaf of the IV fascia of the neck), despite the fact that due to the risk of damage n. laryngeus recurrens and parathyroid glands, removal of thyroid tissue in case of benign lesions is usually performed intracapsularly. In case of malignant neoplasms, palliative and symptomatic surgical interventions are used along with radical ones. When they are implemented, the oncological principles are either not followed or not fully implemented. Such interventions are performed to improve the condition and prolong the patient's life in cases where radical removal of the tumor is impossible due to the neglect of the process or the serious condition of the patient. For example, with a disintegrating bleeding stomach tumor with distant metastases, palliative gastrectomy is performed, achieving an improvement in the patient's condition by stopping bleeding and reducing intoxication. In pancreatic cancer with obstructive jaundice and liver failure, a biliodigestive bypass is applied, eliminating the violation of bile outflow, etc. In some cases, after palliative operations, the remaining mass of tumor cells is treated with radiation or chemotherapy, thus achieving a cure for the patient.
Fundamentals of Radiation Therapy
The use of radiation energy for the treatment of cancer patients is based on the fact that rapidly multiplying tumor cells with a high intensity of metabolic processes are more sensitive to the effects of ionizing radiation. The task of radiation treatment is to destroy the tumor focus with the restoration of tissues in its place that have normal metabolic and growth properties. In this case, the effect of radiation energy, leading to an irreversible disruption of the viability of tumor cells, should not reach the same degree of influence on the surrounding normal tissues and the patient's body as a whole.
Radiation sensitivity of tumors
Different types of neoplasms are sensitive to radiation therapy in different ways. The most sensitive to radiation are connective tissue tumors with round cell structures: lymphosarco-
we, myeloma, endothelioma. Certain types of epithelial neoplasms are highly sensitive: seminoma, chorionepithelioma, lymphoepithelial tumors of the pharyngeal ring. Local changes in these types of tumors quickly disappear under the influence of radiation therapy, but this, however, does not mean a complete cure, since these neoplasms have a high ability to recur and metastasize.
Tumors with a histological substrate of the integumentary epithelium react sufficiently to irradiation: cancer of the skin, lips, larynx and bronchi, esophagus, squamous cell carcinoma of the cervix. If irradiation is used for small tumor sizes, then with the destruction of the primary focus, a stable cure of the patient can be achieved. Various forms of glandular cancer (adenocarcinomas of the stomach, kidneys, pancreas, intestines), highly differentiated sarcomas (fibro-, myo-, osteo-, chondrosarcomas), as well as melanoblastomas are less susceptible to radiation. In such cases, radiation can only be an adjunct treatment that complements surgery.
The main methods of radiation therapy
Depending on the location of the radiation source, there are three main types of radiation therapy: external, intracavitary and interstitial radiation.
For external irradiation, installations for X-ray therapy and telegamma therapy (special devices charged with radioactive Co 60, Cs 137) are used. Radiation therapy is applied in courses, choosing the appropriate fields and radiation dose. The method is most effective for superficially located neoplasms (a large dose of radiation to the tumor is possible with minimal damage to healthy tissues). Currently, external X-ray therapy and telegammotherapy are the most common methods of radiation treatment for malignant neoplasms.
Intracavitary irradiation allows the radiation source to be brought closer to the tumor site. The radiation source is introduced through natural openings into the bladder, uterine cavity, oral cavity, achieving the maximum dose of radiation to the tumor tissue.
For interstitial irradiation, special needles and tubes with radioisotope drugs are used, which are surgically installed in tissues. Sometimes radioactive capsules or needles are left in the wound after removal of the malignant
noisy tumor. A peculiar method of interstitial therapy is the treatment of thyroid cancer with drugs I 131: after entering the patient's body, iodine is accumulated in the thyroid gland, as well as in the metastases of its tumor (with a high degree of differentiation), thus radiation has a detrimental effect on the cells of the primary tumor and metastases.
Possible complications of radiation therapy
Radiation therapy is far from a harmless method. All its complications can be divided into local and general. Local complications
The development of local complications is associated with the unfavorable effect of radiation on healthy tissues around the neoplasm and, first of all, on the skin, which is the first barrier on the path of radiation energy. Depending on the degree of skin damage, the following complications are distinguished:
Reactive epidermis (temporary and reversible damage to epithelial structures - moderate edema, hyperemia, pruritus).
Radiation dermatitis (hyperemia, tissue edema, sometimes with blistering, hair loss, hyperpigmentation followed by skin atrophy, impaired distribution of pigment and telangiectasia - expansion of intradermal vessels).
Radiation inductive edema (specific thickening of tissues associated with damage to the skin and subcutaneous tissue, as well as with the phenomena of obliterating radiation lymphangitis and sclerosis of the lymph nodes).
Radiation necrotic ulcers (skin defects characterized by severe pain and lack of any tendency to heal).
Prevention of these complications includes, first of all, the correct choice of fields and radiation dose. Common complications
The use of radiation therapy can cause general disorders (manifestations of radiation sickness). Its clinical symptoms are weakness, loss of appetite, nausea, vomiting, sleep disturbances, tachycardia and shortness of breath. To a greater extent, the organs of hematopoiesis, primarily the bone marrow, are sensitive to radiation methods. In this case, leukopenia, thrombocytopenia and anemia occur in the peripheral blood. Therefore, against the background of radiation therapy, it is necessary to perform a clinical blood test at least 1 time per week. In some cases, uncontrollable leu-
digestion is the reason for reducing the dose of radiation or even stopping radiation therapy. To reduce these general disorders, stimulants of leukopoiesis, transfusion of blood and its components, vitamins, and high-calorie nutrition are used.
Chemotherapy basics
Chemotherapy is an effect on a tumor with various pharmacological agents. In terms of its effectiveness, it is inferior to the surgical and radiation methods. Exceptions are systemic oncological diseases (leukemia, lymphogranulomatosis) and tumors of hormone-dependent organs (breast, ovarian, prostate cancer), in which chemotherapy is highly effective. Chemotherapy is usually given in courses for a long time (sometimes for many years). There are the following groups of chemotherapeutic agents:
Cytostatics,
Antimetabolites,
Antineoplastic antibiotics,
Immunomodulators,
Hormonal drugs.
Cytostatics
Cytostatics inhibit the multiplication of tumor cells, inhibiting their mitotic activity. Basic drugs: alkylating agents (cyclophosphamide), herbal preparations (vinblastine, vincristine).
Antimetabolites
Medicinal substances affect metabolic processes in tumor cells. The main drugs are methotrexate (folic acid antagonist), fluorouracil, tegafur (pyrimidine antagonists), mercaptopurine (purine antagonist). Antimetabolites, together with cytostatics, are widely used in the treatment of leukemia and poorly differentiated tumors of connective tissue origin. In this case, special schemes are used with the use of various drugs. In particular, Cooper's scheme has become widespread in the treatment of breast cancer. Below is the Cooper's scheme as modified by the N.V. N.N. Petrov - CMFVP scheme (according to the first letters of the drugs).
On the operating table:
200 mg cyclophosphamide.
In the postoperative period:
In 1-14 days, 200 mg of cyclophosphamide daily;
1, 8 and 15 days: methotrexate (25-50 mg); fluorouracil (500 mg); vincristine (1 mg);
On the 1st - 15th day - prednisolone (15-25 mg / day by mouth with a gradual cancellation by the 26th day).
The courses are repeated 3-4 times with an interval of 4-6 weeks.
Antineoplastic antibiotics
Some substances produced by microorganisms, primarily actinomycetes, have an antitumor effect. The main antitumor antibiotics: dactinomycin, sarcolysin, doxorubicin, carubicin, mitomycin. The use of cytostatics, antimetabolites and antitumor antibiotics has a toxic effect on the patient's body. First of all, the organs of hematopoiesis, liver and kidneys are affected. There are leukopenia, thrombocytopenia and anemia, toxic hepatitis, renal failure. In this regard, during the course of chemotherapy, it is necessary to monitor the general condition of the patient, as well as clinical and biochemical blood tests. Due to the high toxicity of drugs in patients over 70 years of age, chemotherapy is usually not prescribed.
Immunomodulators
Immunotherapy began to be used for the treatment of malignant neoplasms only recently. Good results have been obtained in the treatment of kidney cancer, including at the stage of metastasis, with recombinant interleukin-2 in combination with interferons.
Hormonal drugs
Hormone therapy is used to treat hormone-dependent tumors. In the treatment of prostate cancer, synthetic estrogens (hexestrol, diethylstilbestrol, fosfestrol) are successfully used. In breast cancer, especially in young women, androgens (methyltestosterone, testosterone) are used, and in the elderly, drugs with antiestrogenic activity (tamoxifen, toremifene) have recently been used.
Combined and complex treatment
In the process of treating a patient, it is possible to combine the main methods of treating malignant tumors. If two methods are used in one patient, they talk about combined treatment, if all three are about complex. Indications for one or another method of treatment or their combination are established depending on the stage of the tumor, its localization and histological structure. An example is the treatment of various stages of breast cancer:
Stage I (and cancer in situ)- Sufficiently adequate surgical treatment;
Stage II - combined treatment: it is necessary to perform a radical surgical operation (radical mastectomy with removal of axillary, supraclavicular and subclavian lymph nodes) and conduct chemotherapy;
Stage III - complex treatment: first, radiation is used, then a radical operation is performed, followed by chemotherapy;
Stage IV - powerful radiation therapy followed by surgery for specific indications.
Organization of care for cancer patients
The use of complex methods of diagnosis and treatment, as well as the need for dispensary observation and the duration of treatment led to the creation of a special oncological service. Assistance to patients with malignant neoplasms is provided in specialized medical and preventive institutions: oncological dispensaries, hospitals and institutes. In oncological dispensaries, preventive examinations, dispensary observation of patients with precancerous diseases, initial examination and examination of patients with suspected tumors are carried out, outpatient courses of radiation and chemotherapy are carried out, the condition of patients is monitored, and statistical records are kept. In oncological hospitals, all methods of treating malignant neoplasms are carried out. At the head of the oncological service in Russia is the Russian Cancer Research Center of the Russian Academy of Medical Sciences, the Oncological Institute named after V.I. P.A. Herzen in Moscow and the V.I. N.N. Petrov in St. Petersburg. Here they coordinate scientific research in oncology, organizational and methodological management of other oncological
institutions, develop problems of theoretical and practical oncology, apply the most modern methods of diagnosis and treatment.
Evaluation of the effectiveness of treatment
For many years, the only indicator of the effectiveness of the treatment of malignant neoplasms was the 5-year survival rate. It is believed that if within 5 years after treatment the patient is alive, relapse and metastasis did not occur, the progression of the process in the future is extremely unlikely. Therefore, patients who have lived 5 years or more after surgery (radiation or chemotherapy) are considered to have recovered from cancer.
Evaluation of the results by 5-year survival still remains the main one, but in recent years, due to the widespread introduction of new methods of chemotherapy, other indicators of the effectiveness of treatment have appeared. They reflect the duration of remission, the number of cases of tumor regression, improvement in the patient's quality of life and allow assessing the effect of treatment in the near future.
Irritation theory R. Virkhov
More than 100 years ago, it was revealed that malignant tumors more often occur in those parts of the organs where the tissues are more subject to trauma (the area of the cardia, the outlet of the stomach, the rectum, the cervix). This allowed R. Virkhov to formulate a theory according to which constant (or frequent) tissue trauma accelerates the processes of cell division, which at a certain stage can be transformed into tumor growth.
D. Konheim's theory of embryonic rudiments
According to D. Kongheim's theory, in the early stages of embryo development, more cells may appear in different areas than are needed to build the corresponding part of the body. Some cells that remain unclaimed can form dormant rudiments, which have the potential for high growth energy inherent in all embryonic tissues. These rudiments are in a latent state, but under the influence of certain factors they can grow, acquiring tumor properties. At present, this developmental mechanism is valid for a narrow category of neoplasms called "dysembryonic" tumors.
Fisher-Wazels' regeneration-mutational theory
As a result of exposure to various factors, including chemical carcinogens, degenerative-dystrophic processes occur in the body, accompanied by regeneration. According to Fischer-Wazels, regeneration is a "sensitive" period in the life of cells when tumor transformation can occur. The very transformation of normal regenerating cells into tumor cells occurs, according to the author's theory, due to elusive changes in metastructures, for example, as a result of mutation.
Viral theory
The viral theory of the onset of tumors was developed by L.A. Zilber. The virus, penetrating into the cell, acts at the genetic level, disrupting the processes of regulation of cell division. The influence of the virus is amplified by various physical and chemical factors. Currently, the role of viruses (oncoviruses) in the development of certain tumors has been clearly proven.
Immunological theory
The youngest theory of the onset of tumors. According to this theory, various mutations constantly occur in the body, including tumor transformation of cells. But the immune system quickly identifies the “wrong” cells and destroys them. A disturbance in the immune system leads to the fact that one of the transformed cells is not destroyed and is the cause of the development of a neoplasm.
None of the presented theories reflects a single scheme of oncogenesis. The mechanisms described in them are important at a certain stage of the onset of a tumor, and their significance for each type of neoplasm can vary within very significant limits.
Modern polyetiological theory of the origin of tumors
In accordance with modern views, with the development of different types of neoplasms, the following causes of tumor cell transformation are distinguished:
Mechanical factors: frequent, repeated tissue trauma with subsequent regeneration.
Chemical carcinogens: local and general exposure to chemicals (for example, scrotal cancer in chimney sweeps when exposed to soot, squamous cell lung cancer when smoking tobacco - exposure to polycyclic aromatic hydrocarbons, pleural mesothelioma when working with asbestos, etc.).
Physical carcinogens: UV (especially for skin cancer), ionizing radiation (tumors of the bones, thyroid gland, leukemia).
Oncogenic viruses: Epstein-Barr virus (role in the development of Burkitt's lymphoma), T-cell leukemia virus (role in the genesis of the disease of the same name).
The peculiarity of the polyetiological theory is that the very effect of external carcinogenic factors does not cause the development of a neoplasm. For the appearance of a tumor, the presence of internal causes is also necessary: a genetic predisposition and a certain state of the immune and neurohumoral systems.
To date, there is no exact theory of the onset of a cancerous tumor, and many doctors and scientists argue about this. While there is a general theory, to which everyone is inclined - that cancer occurs as a result of mutation of genes inside the cells in both men, women and young children.
With the development of technology, more and more theories appear that have a place to be, but have not yet been 100% proven. If scientists understand what the cancer is from, then they will be able to predict this disease in humans and destroy it in the embryo.
It is not yet possible to answer the question of where cancer comes from, but we will provide you with several theories, and you will already decide which one is the most plausible. We advise you to read this article in its entirety, it will completely revolutionize your understanding of cancer.
When did cancer appear
Cancer and other tumors are ill not only in humans, but in animals and some types of plants. This disease has always existed in our history. The oldest mention was in 1600 BC in Egypt. On ancient papyri, a malignant neoplasm of the mammary glands was described.
The Egyptians treated cancer with fire, burning the damaged area. Poisons and even arsenic were also used for moxibustion. They did the same in other parts of the world, for example, in the Ramayana.
For the first time the word "cancer" was introduced into the designation by Hippocrates (460-377 BC). The name itself is taken from the Greek "karkinos", which means "Cancer" or "Tumor". So he denoted any malignant neoplasm with inflammation of nearby tissues.
There was another name "Onkos", which also means tumor formation. A physician known to the whole world already at that time first described carcinoma of the gastrointestinal tract, uterus, intestines, nasopharynx, tongue and mammary glands.
In ancient times, external tumors were simply removed, and the remaining metastases were treated with ointments and oils with admixtures of poison. On the territory of Russia, moxibustion from tincture and ointment of hemlock and celandine was often used. And in other countries where these plants did not grow, they burned with arsenic.
Unfortunately, the internal tumors were not treated in any way and the patients simply died. The famous Roman healer Galen in 164, already in our era, described tumors with the word "tymbos", which means "tombstone".
Even then, he realized that early diagnosis and detection of the disease at an early stage gives a positive prognosis. Later he tried to pay attention to the description of the disease. He, like Hippocrates, used the word onkos, which later became the root of the word "Oncology".
Aulus Cornelius Celsus in the 1st century BC tried to treat cancer only in the early stages, and in the latter, therapy no longer gave any result. The disease itself has been described in few places. There is no mention of it even in honey. the book of China "Classics of Internal Medicine of the Yellow Emperor". And there are two reasons:
- Most doctors did not describe the disease, but tried to treat it.
- The incidence of cancerous tumors was quite low. And at this time, the peak has come due to a technical breakthrough in the century, factories, industry, etc.
For the first time, a more accurate description began in the middle of the nineteenth century by the physician Rudolf Vircherov. He described the mechanism for the spread and growth of cancer cells. But oncology as a branch of medicine was founded only in the middle of the twentieth century, when new diagnostic methods appeared.
The problem of the XXI century
Yes, cancer has always existed, but it was not on the same scale as it is now. The number of diseases is growing every decade, and the problem can affect every family, literally in 50-70 years.
Another problem is that the cause of the occurrence has not yet been clarified. Many scientists and oncologists argue about the occurrence of the disease. There are quite a few theories, and each provides some aspect and reveals the mystery of the curtain of the origin of the disease. But there are those who contradict each other, and the general answer to the question - where does oncology come from? - not yet.
Hepathogenic theory
In the late 1930s, a group of German scientists investigated cancer on the basis of the so-called "cancer houses". The people living there were constantly sick with cancer, and the doctors came to the conclusion that a hepatogenous factor may indicate this. Later, they even began to release some protection against this radiation, although they themselves did not know how to fix it.
The International Congress of Oncology later refuted this theory. But later she returned. Hepathogenic zones: faults in the ground, voids, intersections of water streams, subway tunnels, etc. These zones draw energy out of a person during a long stay.
Hepathogenic rays have a diameter of up to 35 cm and can grow up to 12 floors. Getting into the area during sleep, rest or work, organs under the influence are at risk of any disease, including cancer. These zones were first described in the 50s of the last century by Ernst Hartman, he called them “Hartmann's grid”.
The doctor described the occurrence of cancer on six hundred pages. His theory was that it is the immune system that is suppressed. And as we know, it is she who first of all begins to fight the mutated cells and destroys them in the first stages. If anyone is interested, you can always find and read his book published in the 60s of the XX century - "Diseases as a problem of location."
One of the famous doctors at the time, Dieter Aschof, told his patients to check their places of work and housing with the help of biolocation specialists. Three doctors from Vienna Hohengt, Sauerbuch and Notanagel advised cancer patients to immediately move from their homes to another location.
Statistics
- 1977 — window doctor Kasyanov examined more than four hundred people who lived in the hepatogenic zone. The study showed that these people were sick with various diseases more often than others.
- 1986 - The Polish doctor examined more than a thousand patients who slept and lived in geopathogenic zones. Those who slept at the intersection of the beams got sick for 4 years. 50% - mild diseases, 30% - moderate, 20% - fatal.
- 1995 - English oncologist Ralph Gordon found that breast and lung cancer are more common in people living in hellish zones. Recall that according to statistics, these are the two most common diseases in men and women.
- 2006 - Ilya Lubensky introduced the concept of "hepatogenic syndrome". He even came up with a rehabilitation technique for people who fell under the influence of abnormal rays.
Virus theory
In 2008, Harold Zurhausen received the Nobel Prize for proving that viruses can cause cancerous tumors. He proved this with the example of cervical cancer. At the same time, many Soviet and Russian scientists and doctors of the last century also put forward this theory, but could not prove it due to the scarcity of technology and diagnostic equipment.
For the first time, the Soviet scientist Leah Zilber wrote about this theory. He was in a concentration camp and wrote his theory on a piece of tissue paper. Later, his son Fyodor Kiselev continued his father's idea and developed, together with Zurhausen, a work in which the main enemy was the human papillomavirus (HPV), which could cause cancer. Later, in large countries, almost all women began to be vaccinated against HPV.
Genetic theory
The essence of the theory is that there is an influence, both external and internal, on genes in the process of cell division and in ordinary life. As a result, the genetics of cells breaks down, and they mutate, becoming cancerous. After that, such tissues begin to endlessly divide and grow, absorbing and damaging nearby organs.
As a result, scientists have found the so-called oncogenes - these are genes that, under certain conditions and external factors, begin to degenerate any cell in the body into a cancerous one. Prior to this state, such genes are in a dormant state.
That is, a gene is that part of the program code in the body that starts working only at a certain moment and under certain conditions. That is why the risk of getting sick in people whose parents had cancer is higher than in others.
But we must remember that our immune system fights against all mutated or broken cells, which constantly scans the body for breakdowns and destroys negligent cells.
And if the immunity is lowered, then the chance in this case to get sick is greater. This is especially dangerous in a child at an early age, when he has already stopped receiving mother's milk as food. And also when dividing the remaining stem cells - they are more vulnerable to changes in the DNA molecules of tissues in babies.
Today, this theory is the main and most widespread, which is used by almost all oncologists and doctors. Since all other theories are more simply a risk factor, be it viruses or hepatogenic in nature.
Plus, he noticed that cancer cells do not form tissues as living ones, and the tumor looks more like a large colony. Nevyadomsky believed that tumor cells are foreign organisms like chlamydia.
O.I. Eliseeva, Candidate of Medical Sciences, oncologist, who has been studying cancerous tumors for 40 years, deduced the theory that a tumor is a structure of interaction between fungi, microbes and viruses, as well as protozoa. Initially, a fungus appears on the spot, on which viruses and microorganisms with protozoa develop further.
H. Clark suggested and wrote in his work that a cancerous tumor appears at the place of life of a fluke, it is a flat worm. And if you kill him, then the spread of cancer will stop. His other theory is chemical - when exposed to benzene and propylene. At the same time, in order for cancer to begin to arise, it is necessary to accumulate a sufficient amount of these substances.
And now an interesting fact - ALL the patients examined by Dr. Clark had propylene and trematodes in their bodies. He studied the factors in everyday life that affect everyone where propylene is located:
- Dentures, crowns.
- Freon from refrigerators.
- Bottled water.
- Deodorants.
- Tooth pastes.
- Refined oils.
Added to this was another theory of radiation, which originated in 1927 and was invented by Hermann Müller. He saw that as a result of exposure to radiation and all kinds of rays, cells begin to mutate and cancer can occur. True, the irradiation was carried out on animals, and not in the laboratory directly on the tissue.
Scientists have noticed that mainly cancer cells arise in an acidic environment. In such an environment, at the same time, there is a weakening of immunity and all nearby tissues of the body. And if the environment is made alkaline, then everything will be the other way around and cancer cells simply cannot survive in it, and immunity will be normal. Because of this, there is a rather old and good method to heal and restore the alkaline balance with calcium and.
Biochemistry and cancer
In our age, chemicals, substances, pesticides and other harmful substances are quite common. The basis of the theory is that all of these substances affect every cell in the body. As a result, immunity drops dramatically, and a favorable environment for the emergence of cancer cells appears in the body.
Proponents of the immune theory believe that cancer cells arise constantly during life, but the immune system periodically destroys them. With any influence inside the body and during the process of regeneration, our cells grow and clog both internal and external wounds. And the whole process is controlled by the immune system.
But with constant irritation and wound healing, mutation can occur and control can cease. This theory was first proposed by Rudolf Ludwig. Yamagaw and Ishikaw from Japan did a couple of tests. They smeared the ears of rabbits with chemical. carcinogen. As a result, after a few months, a tumor appeared. The problem was that not all substances influenced the oncology.
Trichomonas
The founder of this theory is Otto Warburg. He discovered in 1923 that cancer cells actively break down glucose. And in 1955, he put forward a theory according to which malignant cells, when mutated, begin to behave like primitive Trichomonas, can move, stop following the program laid down at the very beginning and grow and multiply very quickly.
In the process, the flagella, with the help of which they moved, disappear from them, as unnecessary. As mentioned earlier, many scientists have noticed that cancer cells can move and move like protozoa, and subsequently spread throughout the body, forming new colonies, even under the skin.
Each person has three types of Trichomonas: in the mouth, intestines and in the reproductive system. It is there that most often cancer occurs. In this case, before that there is some kind of inflammation of the cervix, prostatitis, etc. Moreover, Trichomonas themselves without flagella are indistinguishable from human epithelial tissues in the blood. And there are quite a few types of protozoa.
Few facts
- In the laboratory, under any conditions, not a single doctor and scientist in the world has succeeded in transforming a normal cell into a cancerous one. Acting on it with both chemical reagents and radiation.
- No one in the laboratory was able to initiate metastasis.
- The DNA of a cancer cell is 70% similar to the DNA of protozoa, similar to Trichomonas.
NOTE! And at the same time, no one takes the theory of Otto and Svishcheva as a basis. Everyone talks about genetic mutation as the dominant theory, and no one has found the right answer. Maybe the problem is that scientists, doctors are looking the other way ?! It is not yet clear why this theory is not being investigated.
Oncological neoplasms appear as a result of a violation of the circulation of internal energy through the jilo channels according to the Chinese theory. In this case, the energy of space, entering and leaving, must circulate according to certain rules. In case of violation of the law, failures occur in the body: a drop in immunity, the occurrence of any diseases, including neoplastic diseases.
All this came to us from oriental medicine. Each cell emits its own biofield, and in the complex there is a general radiation in the form of an egg. If there is a weakening of this field, then viruses, fungi and microorganisms begin to attack the body, which can lead to malignant formations.
Any sore, an additional disease, is the reason that the biofield begins to spin in the other direction. And the patient feels painful symptoms, his mood worsens and the biofield fades even more. But generally speaking, here the theory is based more on the effect, and not on the reason.
(1 estimates, average: 5,00 out of 5)
Basic theories of the genesis of tumor growth. Contemporary views about molecular mechanisms carcinogenesis. The value of oncogenes, the role of oncoproteins in carcinogenesis.Historically - concepts:
1. R. Virkhov - tumor - excess, the result of excessive excessive formative stimulation of the cell. According to Virchow, there are 3 types of cell irritation: intravenous (providing nutrition), functional, normative
2. Kongame - dysontogenetic concept of carcinogenesis: underutilized embryonic rudiments give rise to a tumor. Ex: Squamous cell carcinoma of the stomach, intestinal myxoma (from tissue similar to the tissue of the umbilical cord).
3. Ribbert - any fabric caught in unusual environment can give the beginning of tumor growth.
Molecular genetic mechanisms of cell tumor transformation.
Mutational concept of carcinogenesis. A normal cell turns into a tumor cell as a result of structural changes in the genetic material, i.e. mutations. Possible role of mutational mechanisms in carcinogenesis are evidenced by the following facts: Mutagenicity of the overwhelming majority (90%) of known carcinogens and carcinogenicity of most (in 85-87% of the studied samples) mutagens.
Epigenomic concept of carcinogenesis. According to this concept (Yu.M. Olenov, A.Yu. Bronovitsky, B.C. Sha-pot), the transformation of a normal cell into a malignant one is based on persistent disturbances in the regulation of gene activity, rather than changes in the structure of the genetic material. Under the influence of chemical and physical carcinogens, as well as oncogenic viruses, a shift in strictly specific for each fabric regulation of gene activity: groups of genes are derepressed, which in a given tissue must be repressed and (or) active genes are blocked. As a result, the cell largely loses its inherent specificity, becomes insensitive or insensitive to the regulatory influences of the whole organism, uncontrollable.
Virus-genetic concept of carcinogenesis. This concept was proposed by L.A. Zilber (1948). Tumor transformation of a cell occurs in as a result of introducing genetic material of new genetic information oncogenic viruses. The main property of the latter is their ability to break the DNA chain and unite with its fragments, i.e. with cellular genome. Having penetrated the cell, the virus, having freed itself from the protein membrane, under the influence of the enzymes contained in it, integrates its DNA into the genetic apparatus of the cell. The new genetic information introduced by the virus, changing the growth pattern and "behavior" of the cell, turns it into malignant.
The modern concept of an oncogene. In the 70s, irrefutable facts of participation in carcinogenesis and mutational, and epigenomic, and viral-genetic mechanisms that are consistently included in the process of tumor transformation. The idea of the multistage nature of the carcinogenesis process has become an axiom, the decisive prerequisite for which is the unregulated expression of a transforming gene - an oncogene, which is also present in the genome. For the first time, oncogenes were discovered by transfection ("gene transfer") in viruses that cause tumors in animals... Then, using this method, it was found that in the body of animals and humans, there are potential oncogenes - protooncogenes, the expression of which causes the transformation of a normal cell into tumor... According to the modern concept of an oncogene, the target for changes that cause the onset of tumor growth are proto-oncogenes, or potential oncogenes that exist in the genome of normal cells and provide conditions for the normal functioning of the organism. In the embryonic period, they provide conditions for intensive cell multiplication and normal development of the body. V postembryonic period their functional activity is significantly reduced - most of them are in a repressed state, and the rest provide only periodic cell renewal.
Products of activity of oncogenes- oncoproteins in trace amounts are synthesized and in normal cells, functioning in them as regulators of the sensitivity of their receptors to growth factors or as synergists of the latter. Many oncoproteins are homologous or related to growth factors: platelet (TGF), epidermal (EGF), insulin-like, etc. Being under the control of the regulatory mechanisms of the whole organism, the growth factor, acting intermittently, provides regeneration processes. Out of control, it "works" permanently, causing unbridled proliferation and preparing the ground for the process of malignancy (the theory of "self-tightening loop"). Thus, the addition of TGF to the culture of normal cells with appropriate receptors can cause reversible phenotypic changes similar to transformation: round cells turn into spindle-shaped cells and grow in a multilayer. Most of the oncoproteins belong to protein kinases. It is known that growth factor receptors on their internal, immersed in the cytoplasm is carried to the side the catalytic part of protein kinase or guanylate cyclase.
Mechanisms of action oncogenes and their products - oncoproteins.
Oncoproteins can mimic the action of growth factors by influencing the cells synthesizing them along the autocrine pathway (“self-tightening loop” syndrome.
Oncoproteins can modify growth factor receptors, mimicking the situation typical for the interaction of the receptor with the corresponding growth factor, without its action.
Anti-oncogenes and their role in oncogenesis
V the genome of the cell also has a second class tumor genes - suppressor genes (anti-oncogenes). Unlike oncogenes, they control the synthesis not of growth stimulants, but of its inhibitors (they suppress the activity of an oncogene and, accordingly, cell proliferation; stimulate their differentiation). The imbalance in the processes of synthesis of stimulants and growth inhibitors is the basis for the transformation of a cell into a tumor one.
Antiblastoma resistance of the body - anticarcinogenic, anti-mutational, anti-cellulary mechanisms. Paraneoplastic syndrome as an example of the interaction of a tumor and an organism. Principles of prevention and treatment of tumors. Mechanisms of tumor resistance to therapeutic effects.
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