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Diagnosis of tumor.ppt

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Sekaran T

Tumor diagnosis

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Stages of the tumor
process. Classification.
Diagnosis of tumors
Stages of the tumor process.
Stage I - diffuse nonspecific hyperplasia.
Stage II - focal proliferates.
Stage III - benign tumor.
Stage IV - malignant tumor.
Clinical groups of cancer patients.
I A - patients with suspected cancer.
I B - benign tumors and precancerous
diseases.
II - hematoblastosis, subject to special
methods of treatment.
II A - malignant tumors subject to radical
treatment.
III - patients cured of malignant tumors.
IV - late stages of malignant tumors.
TNM classification
International symbols used to characterize
tumor process. The modern clinical and
morphological classification provides for the
division of patients with malignant
neoplasms, depending on the extent of the
process, into 4 stages. This classification is
based on the TNM system developed by the
committee of the International Union
Against Cancer.
T symbol (tumor, tumor) - description (characteristic) of the primary
tumor, has seven options.
T0 - the primary tumor is not verified, although there are metastases.
T - pre-invasive carcinoma (carcinoma in situ) - the tumor is
localized within the layer in which it arose.
T1 - a small tumor (no more than 2 cm in diameter), limited to the
original tissue.
T2 is a small tumor (no more than 4 cm in diameter) that does not go
beyond the affected organ.
T3 - a tumor of significant size (up to 6 cm in diameter), germinating
serous membranes and capsules.
T4 is a tumor that grows into surrounding tissues and organs.
TX is a tumor, the size and boundaries of which cannot be precisely
determined.
Displacement of the esophagus
X-ray examination: the aberrant right subclavian artery (a.
Lusoria) passes through the posterior mediastinum and forms an
impression on the esophagus in the form of a strip-like defect
running obliquely.
The right-sided aortic arch forms impressed not on the esophagus
along the posterior-right wall. Enlarged lymph nodes of the
posterior mediastinum (metastases, lymphosarcoma,
lymphogranulomatosis) form an impression on one of the walls
of the esophagus or push it back

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Diagnosis of tumor.ppt

  • 1. Stages of the tumor process. Classification. Diagnosis of tumors
  • 2. Stages of the tumor process. Stage I - diffuse nonspecific hyperplasia. Stage II - focal proliferates. Stage III - benign tumor. Stage IV - malignant tumor.
  • 3. Clinical groups of cancer patients. I A - patients with suspected cancer. I B - benign tumors and precancerous diseases. II - hematoblastosis, subject to special methods of treatment. II A - malignant tumors subject to radical treatment. III - patients cured of malignant tumors. IV - late stages of malignant tumors.
  • 4. TNM classification International symbols used to characterize tumor process. The modern clinical and morphological classification provides for the division of patients with malignant neoplasms, depending on the extent of the process, into 4 stages. This classification is based on the TNM system developed by the committee of the International Union Against Cancer.
  • 5. T symbol (tumor, tumor) - description (characteristic) of the primary tumor, has seven options. T0 - the primary tumor is not verified, although there are metastases. T - pre-invasive carcinoma (carcinoma in situ) - the tumor is localized within the layer in which it arose. T1 - a small tumor (no more than 2 cm in diameter), limited to the original tissue. T2 is a small tumor (no more than 4 cm in diameter) that does not go beyond the affected organ. T3 - a tumor of significant size (up to 6 cm in diameter), germinating serous membranes and capsules. T4 is a tumor that grows into surrounding tissues and organs. TX is a tumor, the size and boundaries of which cannot be precisely determined.
  • 6. Displacement of the esophagus X-ray examination: the aberrant right subclavian artery (a. Lusoria) passes through the posterior mediastinum and forms an impression on the esophagus in the form of a strip-like defect running obliquely. The right-sided aortic arch forms impressed not on the esophagus along the posterior-right wall. Enlarged lymph nodes of the posterior mediastinum (metastases, lymphosarcoma, lymphogranulomatosis) form an impression on one of the walls of the esophagus or push it back
  • 7. Symbol N (nodulus, node) - reflects the degree of damage to the lymph nodes, has five options. NX - insufficient data to determine the nature of the lesion of the lymph nodes. N0 - no signs of lymph node involvement. N1 - lesion of one lymph node located at a distance of up to 3 cm from the primary focus, the diameter of the affected node is less than 3 cm. N2 - lesion of one node, the diameter of which is 3-6 cm, or several lymph nodes, the diameter of which is less than 3 cm, but they are located at a distance of more than 3 cm from the primary tumor. N3 - lesion of one lymph node, the diameter of which is 6 cm, or several nodes, the diameter of which is 3-6 cm, but they are located at a distance of more than 3 cm from the primary tumor.
  • 8. Symbol M (metastases) - reflects the presence of individual metastases due to hematogenous or lymphogenous dissemination. The M symbol has three variants. MX - insufficient data to determine prevalence. M0 - there are no signs of distant metastasis. M1 - there are (single, multiple) distant metastases.
  • 9. Cardiospasm (esophageal achalasia) X-ray examination: on the plain chest X-ray - expansion of the shadow of the mediastinum to the right; when contrasting - a relatively uniform expansion of the esophagus along its entire length, conical narrowing of the abdominal esophagus, food in the esophagus, impaired contractile function of the esophagus, absence of a gas bubble in the stomach, thickening of the folds of the esophageal mucosa
  • 10. The principle of determining the stage of the disease in malignant neoplasms can be formulated only in a general form, since there is an individual feature for each localization of cancer. Grouping by stages depending on various combinations of the indicated symbols makes it possible to simplify and unify the quantitative and qualitative description of the tumor.
  • 11. The degree of morphological differentiation of tumor tissue. 1 - highly differentiated. 2 - the average degree of differentiation. 3 - low degree of differentiation. 4 - undifferentiated.
  • 12. DIAGNOSTICS OF MALIGNANT TUMORS The key to success in the treatment of malignant tumors is their early diagnosis. It is known that at the stage of tumor development, cancer in situ can be cured in 100% of cases. When treating cancer in stage I, a complete cure is achieved in 80-90%, in stage III - only in 30% of patients. The relevance of the issue of timely diagnosis of malignant tumors is associated with the high prevalence and wide variety of their clinical course.
  • 13. When collecting anamnesis, you should pay attention to the following data: 1) unmotivated change in well-being, increased fatigue, loss of appetite and weight; 2) change in habits, the appearance of aversion to any type of food or food smells; 3) the appearance of pathological secretions (sputum with blood, blood or mucus in the feces); 4) violation of patency of hollow organs (dysphagia, vomiting, persistent constipation, bloating); 5) the appearance of previously non-existent visible or palpable formations or ulcerations, for example, on the skin, mucous membranes of the lips and oral cavity.
  • 14. In visual forms of cancer (skin, lip, oral cavity, mammary gland, rectum, external genitalia), the most important symptom is the presence of a visible or palpable tumor. If the patient has a long-term chronic disease, it is possible to change his pre-existing symptoms, which should also alert the doctor. Besides Moreover, it is necessary to pay attention to the lack of effect from the treatment of a chronic disease, which previously brought success. It is necessary to ask the patient about his bad habits (smoking, chewing tobacco, eating hot food).
  • 15. An important role is played by an oncological anamnesis, in particular, the treatment of a patient in the past for tumors of other localizations or the presence of malignant tumors in blood relatives.If you suspect a certain oncological pathology, for example, the lungs, it is necessary to question the patient purposefully, asking leading questions, as he often cannot highlight the main complaints, focusing on minor ones, which makes it difficult to establish a true diagnosis.
  • 16. Clinical examination of the patient plays an important role, especially in the presence of visual forms of cancer. Particular attention during examination and palpation should be paid to the regional lymph nodes. When examining cancer patients, palpation of the abdominal cavity is mandatory. A digital examination of the rectum gives a lot of information about the presence of the tumor and its extent. Some metastases can be found on examination through the rectum. Information can also be obtained from auscultation and percussion, especially if there is free fluid in the pleural and abdominal cavities.
  • 17. INSTRUMENTAL METHODS FOR DIAGNOSING TUMORS The most commonly used for examining the population with suspected oncological pathology are radiation diagnostic methods. The most common of them is radiological. Not a single patient with a suspected tumor can currently do without an X-ray examination. This method is especially widely used in mass screening of the population during prophylactic examinations to identify pathology of the lungs and mammary gland.
  • 18. The use of the X-ray method makes it possible to resolve the issue of the presence or absence of pathological changes in a particular organ. In the future, clarifying research methods are used. The X-ray method makes it possible to assess the dynamics of the pathological process with special treatment. Pulmonary tomography, angiography, pyelography and dr.
  • 19. X-ray computer tomography (CT), which allows transverse scanning and obtaining a differentiated image of tissues and organs, the radiopacity of which is distinguishable by 0.5%. Computed tomography can detect small tumors even in the brain, kidneys, pancreas, organs of the small pelvis.
  • 20. Increasingly, when examining cancer patients, it is used magnetic resonance imaging (MRI). The advantages of this method include the practical absence of radiation exposure. The MRI method is based on the phenomenon of nuclear magnetic resonance (registration of the energy emitted by hydrogen nuclei after preliminary exposure to a broad-spectrum radio frequency pulse).
  • 21. Among the advantages of MRI, it should also be noted that there is no need to use contrast agents, the ability to obtain an image in any plane (including three orthogonal anatomical projections), and a high resolution of contrasting soft tissues. MRI is used in the diagnosis of almost all types of human tumors.
  • 22. Ultrasound examination (ultrasound) has become one of the most widespread radiation research methods in recent years. The advantage of the method is its high resolution and harmlessness, which makes it possible to repeat the study many times. With the help of ultrasound, almost all organs and soft tissues can be examined.
  • 23. Tumors of the lungs, stomach, intestines, bones, brain and spinal cord are inaccessible for echography. In cases where the use of the above methods does not allow us to accurately establish the nature of the disease or the extent of tumor spread, the method of radionuclide diagnostics is used, which is based on the ability of radiopharmaceuticals (chemical compounds labeled certain radionuclides) selectively accumulate in various organs, tissues, tumors. Registration of gamma radiation emitted during the decay of a nuclide makes it possible to obtain an image (scintigraphy) of the organ under study.
  • 24. Scintigraphy allows detecting tumors or metastases at least 2 cm in size in places inaccessible for X-ray examination, or long before their X-ray imaging (sometimes up to 6 months) in the form of "cold" or "hot" foci. "Cold" lesions indicate organ tissue replacement pathologically altered tissue, which does not accumulate a radiopharmaceutical that is tropic to the tissue of the organ, "hot" - about an increased accumulation of the isotope, which is selectively fixed in the tumor.
  • 25. Emission computed tomography has greatly expanded possibilities of radionuclide diagnostics. This method provides accurate measurement of the tumor lesion and visualization of low-contrast structures that are not detected by scintigraphy. A promising method for diagnosing tumors and metastases is radionuclide immunoscintigraphy using monoclonal antibodies.
  • 26. The endoscopic method occupies one of the leading places in diagnostics, as it allows you to visually assess the nature of pathological changes in the organ. This method in the presence of a tumor (stomach, intestines, bronchi) allows you to determine its localization, size, growth boundaries and, most importantly, to take material for morphological verification of the diagnosis. The endoscopic diagnostic method allows detecting cancer at the earliest stages of development, when the tumor reaches several millimeters in size. In the diagnosis of such small tumors, endoscopic methods in complex with biopsy and cytological examination are much more effective than
  • 27. Material for cytological examination can be obtained by scraping from a tumor, flushing, puncture. The most informative is the forceps biopsy of the tumor tissue followed by histological examination. Endoscopic research methods have become practically obligatory for the corresponding pathology: bronchoscopy, esophagoscopy, gastroscopy, colonoscopy, sigmoidoscopy, laparoscopy, colposcopy, thoracoscopy.
  • 28. MORPHOLOGICAL METHOD FOR TUMOR DIAGNOSTICS A special place in oncology is occupied by morphological research methods - cytological and histological. None of the existing special methods of treatment (surgical, radiation, drug) can be carried out without morphological verification of the diagnosis. Failure to comply with this rule leads to an incorrect diagnosis, to the unreasonable conduct of special treatment, as a result, severe, sometimes crippling operations are performed, radiation therapy with severe radiation injuries or chemotherapy, which has a teratogenic and carcinogenic effect, is performed. The exclusion of the diagnosis of a malignant tumor without a morphological examination may be erroneous, which delays the timing of the start of special treatment and worsens it. long-term results
  • 29. Cytological research method. The material for research can be cells that are independently excreted from the tumor and excreted, and cells obtained by aspiration during puncture of the tumor. The material for research in the first case is sputum, urine, prostate secretions, discharge from the nipple of the breast, cervix and vagina, rectum. Material from hollow organs can be obtained by washing with isotonic sodium chloride solution, by imprints or scraping from the surface of tissues using a cotton swab or special brushes.
  • 30. Aspiration cytology involves the study of cells obtained by puncture of tumor formations from the thyroid, breast, salivary and prostate glands, lymph nodes, tumors of the lungs and mediastinum, tumors of soft tissues and bone marrow. Puncture allows you to obtain cytological material from the pleural and peritoneal cavities, spinal canal, pericardium and synovial sheaths. With the help of sternal puncture, bone marrow tissue is also obtained for cytological examination.
  • 31. The malignant transformation of cells can be judged on the basis of a set of signs that characterize the cells of the neoplasm and their relationship with other cells. The main groups include pronounced atypia compared to normal cells, which consists in the polymorphism of the size and shape of cells, an increase in the nucleus relative to the size of the cell, the formation of giant nuclei, the eccentric arrangement of the nucleus, the presence of several nuclei in one cell
  • 32. the number of mitoses, nuclear hyperchromia and vacuolization of the cytoplasm, a large number of "naked" nuclei. The size of tumor cells ranges from 4 to 60 ¬. Most often, they are larger than the cells of the original tissue and can have various shapes: oval, round, fusiform, cylindrical, triangular, stellate, polygonal, etc. The shape of the nuclei of malignant cells is also diverse and can be oval, bean, fusiform, crescent and irregular. The boundaries of malignant cells are often blurred, uneven. One of the main morphological signs of malignant tumors is the formation of multinucleated giant cells. A malignant tumor is characterized by a large number of mitoses.