Caecum - primary department colon, which is a sac-like formation located at the bottom of the ileocecal valve.
The free dome of the cecum faces the direction of the pelvis. In different people, the length can vary from 3 to 8 cm, width from 4 to 7 cm. As a rule, it is covered with peritoneum on all sides, but on the back it may not have peritoneal cover. Rarely has a mesentery, which affects its pathological mobility.
The vermiform appendix is the appendix, which extends from the dome of the cecum. Its length ranges from 2 to 13 cm, and its diameter is about 3 - 4 mm. The process is located in the right iliac fossa and connects to the cecum and the terminal section ileum through the mesentery of the appendix. However, this location is not permanent; in some people, the appendix may be located behind the cecum, being covered by the peritoneum, or in the absence of a serous membrane, it may lie extraperitoneally. The free end of the appendix is directed downward and medially to the border line, descending into the pelvis. Surrounded on all sides by bands of the colon. Its mucous membrane contains a large amount of lymphoid tissue.
In some cases, back wall the intestines can be covered after the colonic fascia, providing tight fixation with retroperitoneal tissue and parietal fascia. This anatomy creates difficulties during surgical interventions. The cecum is connected to the parietal peritoneum by cecal folds.
At the junction of the cecum and small intestine there is an ileointestinal papilla, which, together with muscle tissue, forms an anti-reflux mechanism, the main task of which is to prevent food from entering the large intestine back into the small intestine.
The intestinal wall has the same structure as the walls of the large intestine. The mucosa has minor folds that look like valves and have many muscle fibers, as well as a single fold. The mucosa contains Lieberkühn's glands, as well as goblet cells.
The organ takes part in digestion. Its main function is to absorb the liquid component of chyme. The appendix has more important functions: in its thickness there are many follicles that protect the body from foreign agents.
Despite its small size, this organ is susceptible to serious diseases.
Inflammation of the intestine or typhlitis is accompanied by similar symptoms to appendicitis. The only difference is in the occurrence of pain. Long-term stagnation contributes to the development of the disease feces, which favors the development of intestinal flora. Pathology occurs when infection multiplies during acute infectious diseases. There is also a possibility of inflammation spreading to the surface of the cecum with neighboring organs with blood. Inflammation manifests itself some time after eating with pain in the iliac region. The pain intensifies during movement, with prolonged vertical or horizontal position, localizing to the lumbar region. Patients experience symptoms such as rumbling in the abdomen, bloating, bloating, belching, nausea, diarrhea and decreased appetite. During the period of exacerbation in patients bloated belly, the anterior part of the peritoneum is not tense, the cecum is painful, compacted, mobile and swollen.
Treatment of typhlitis is of two types: symptomatic and etiological. If the patient has an infectious inflammation, then he is indicated antibacterial agents. In addition, the patient is prescribed a strict diet, intestinal massage, local thermal procedures, and in case of indigestion, enzyme preparations. At timely treatment, which is prescribed exclusively by a doctor, the prognosis is quite favorable.
TO inflammatory diseases include appendicitis. Symptoms of appendicitis are characterized by pain, which is initially localized in the epigastric region with further movement to the right iliac region. There is muscle tension in the right abdominal wall. Nausea and vomiting, changes in stool: constipation and diarrhea are also observed. Patients complain of fever and general weakness.
Appendicitis is treated surgically. The most important thing is timely hospitalization of the patient, since within a few days the appendix fills with pus and peritonitis can develop.
Cecal cancer accounts for 40% of all other intestinal tumors. The danger of this pathology is that the symptoms of the disease do not appear in the early stages. The very first symptom is usually the appearance of blood in the stool. This leads to anemia. The appearance of blood is also observed for various reasons, so patients need additional examination, allowing you to determine accurate diagnosis. A test aimed at detecting cancer should be carried out on all people with anemia if the cause of its occurrence has not been identified.
At later stages of cancer, patients complain of symptoms such as pain in the right iliac region, lack of appetite, and digestive disorders, which lead to exhaustion and weight loss. With metastases to the liver, obstructive jaundice occurs, as well as cachexia and hepatohemaly.
For malignant tumors of the cecum, surgical intervention is required. Before the operation, the cecum is carefully examined to determine the volume surgical intervention. During the operation, the affected part of the intestine is removed. In general, the operation does not require the use of a colostomy. This need arises in extreme situations, if the operation is carried out on late stages a disease accompanied by intense hemorrhages, as well as intestinal obstruction or intestinal perforation. During the operation, lymph nodes affected by the tumor process and other soft tissues are removed.
After surgery, radiation or chemotherapy is performed to reduce the recurrence of the pathology. If radical treatment cannot be carried out for certain reasons, then chemotherapy is prescribed to prolong the patient’s life and improve its quality.
Adenocarcinoma in the cavity of the cecum is the most common pathology of all malignant intestinal formations. People aged 50-60 years are at risk, but the disease can also occur at a young age. The development of adenocarcinoma is due to the following reasons:
Adenocarcinoma can develop in the presence of several factors at once.
Treatment is carried out surgical methods, chemotherapy and radiation therapy. After radical treatment The life expectancy of 70% of patients is 5 years or more. Survival depends on the stage of the process.
This is an undifferentiated or poorly differentiated tumor of a malignant nature of embryonic origin. Blastoma is characterized by excessive and pathological growth of tissue consisting of deformed cells that have lost their original function. Even after the influence of certain factors on them ceases, they still reproduce. Blastomas penetrate tissues, damaging blood vessels hematopoietic system, which spread pathological cells throughout the body. This is how the process of metastasis occurs.
The main cause of blastoma is considered to be disorders that affect the DNA molecule in the cell gene itself under the influence of various carcinogens that provoke genetic changes in the form of mutations. It is believed that about 75% of malignant tumors are caused by chemical exposure external environment. About 40% of blastomas arise from combustion products of tobacco products, 30% are formed from chemical agents found in food and 10% from compounds that are used in some areas of production. The most dangerous are carcinogens, which are divided into organic and inorganic chemicals. Physical carcinogens include radioactive radiation chemicals, x-rays and increased doses of ultraviolet radiation.
Cancer duodenum It is considered a rare disease of the gastrointestinal tract. This disease is equally often diagnosed in both sexes over the age of 50 years. The origin of cancer is difficult to identify at the last stage, since the germination and spread of the tumor to other organs and mucous membranes leads to the formation of a neoplasm consisting of the same tissue.
A malignant tumor of the duodenum is more often diagnosed in people over 50 years of age.
In addition, there are a number of diseases that provoke the formation of malignant pathological processes in the gastrointestinal tract. Among them:
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There are symptoms that may indicate the development of cancer at an early stage:
The above signs do not always confirm that the patient has duodenal cancer, but it is advisable to consult a specialist and, if necessary, undergo an examination. Symptoms of a cancerous tumor on late stages- This:
Cancer is a truly scary diagnosis. If you have only atrophic gastritis or an ulcer so far, do everything possible to avoid the worst.
But what about people who have already been diagnosed with a malignant tumor? Don't despair. Believe. Fight.
In the list of organs most susceptible to cancer pathologies, the stomach is mentioned in second place (more often the disease only affects the lungs).
Every year in Russia up to 50 thousand new cases of this serious disease are recorded.
The main risk group is considered to be men aged 50-70 years.
There are not only biological reasons for this. Representatives of the stronger sex very rarely monitor their health and willingly give in to bad habits.
Smoking, alcoholism, maldistribution physical activity and poor nutrition over time prepare the ground for the formation of a malignant tumor.
On early stages the oncological process practically does not make itself felt. The symptoms are approximately the same as with periodically exacerbating gastritis.
A signal for serious alarm should be anemia, a sharp loss of appetite and weight, dark stools, and characteristic frequent pain in the epigastric region.
At the first alarms you should sign up for the most complete diagnostic examination. It's better to be safe than to be late.
A diagnosis of cancer is not always a death sentence. A tumor detected at an early stage can be eliminated in 75% of patients. It can be destroyed using one of the following methods:
When malignant damage affects the submucosal layers inner shell stomach, reversing the process becomes much more difficult. The main problems begin if the cancer metastasizes to other organs - the liver, pancreas, etc. Then the operation provides only a temporary effect.
In the later stages, radiation therapy and medications that prevent the division of dangerous cells are used. IN terminal stage The essence of treatment comes down to powerful pain relief.
stomach cancer
IMPORTANT TO KNOW!
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Today, the number of people suffering from diseases of the gastrointestinal tract is constantly growing. The reason for this is, first of all, unhealthy image life and inattention to one’s own body. You can get an unpleasant diagnosis of “gastritis” regardless of age or financial situation. The disease attacks everyone who unintentionally creates favorable conditions for its development.
Among the many types of gastritis, atrophy of the gastric mucosa is the most dangerous, as it is characterized by a precancerous condition and, if not consulted in a timely manner, entails irreparable consequences. Inflammatory processes in the walls of the digestive organ and glands lead to the partial death of cells that can no longer perform their functions.
For atrophic gastritis of the stomach, it is necessary to urgently take measures to prevent further development an illness that can develop into cancer. In case chronic form disease, the number of atrophied cells is so high that the organ is unable to cope with its main function of digestion. The remaining healthy areas of the mucosa are not able to secrete gastric juice in the required volume and assimilate food.
There are quite a few provoking factors for the onset of the disease. Often, if the symptoms of superficial gastritis are ignored, processes of cellular change begin, which as a result threatens atrophy of the stomach tissue. Age category people, most at risk diseases – 35 – 60 years.
Depending on the area of damage, severity and cause of occurrence, the disease can be divided into several types:
Most often, the disease occurs against a background of low or zero acidity. The causative agent of gastritis, the microorganism Helicobacter pylori, actively multiplies in the organ cavity, and affects the level of acid secreted by the stomach. The disease is accompanied by nausea, vomiting, a feeling of heaviness after eating, and intolerance to dairy products.
Atrophic gastritis with increased acidity characterized by damage to the pancreas. Signs of a disease occurring against the background of excessive acid production are: belching with a sour taste, heartburn, pain in the abdomen and left hypochondrium.
The level of acidity is not the worst thing that atrophic gastritis conceals, because when prescribing treatment, the specialist prescribes drugs that control the pH of the stomach. A diet combined with medications relieves symptoms from the first days of use, but restoring the gastric mucosa is a difficult process and requires considerable effort. It is generally accepted that complete cure Cell atrophy cannot be cured; however, proper drug therapy along with dietary nutrition can restore partially damaged areas of the mucosa and prevent the appearance of cancer. A detailed picture of the severity and neglect of the process can be obtained after a thorough diagnosis of the disease.
Signs and treatment regimen may differ depending on the form of the disease. For a moment acute attack The symptoms of erosive atrophic gastritis are pronounced, and in this case it is impossible not to notice the problem. The chronic form of the disease develops over years and is characterized by periods of remissions and exacerbations. If you show inattention to your own body, the disease progresses over time and develops into a more severe stage. An exacerbation occurs against the background of factors contributing to the disease.
Symptoms of atrophic gastritis may not be very pronounced initial stage, and during endoscopy, cell modification is not always noticeable. This is due to the fact that atrophy does not occur instantly, first the glands cease to function normally, producing mucus instead of enzyme, and since the inner surface of the stomach walls is abundantly lined with it, an imitation of a healthy organ is created.
The disease is diagnosed using several procedures, such as:
If you do not delay contacting a specialist, you can prevent the development of this serious disease by early stages without unnecessary suffering and unnecessary consequences, because it is very difficult to restore the gastric mucosa with atrophic gastritis. For this you need integrated approach to treatment, the duration of which will depend on the degree of neglect of the disease. Therapy consists of a course of medication and adjustment of the patient’s diet.
After identifying the cause of the disease, work is carried out to eliminate it. If the culprit of gastritis is the microorganism Helicobacter pylori, a specialist will prescribe antibacterial agents that must be taken for up to two weeks. If the bacterium has not been destroyed during this time, and it is extremely tenacious, then the patient will be prescribed an enhanced course of antibiotics. At the same time, it is recommended to drink probiotics to normalize the microflora of the stomach. Antacids that have an enveloping effect (for example, Maalox, Almagel), anticholinergic drugs that relieve pain, prokinetics that improve organ motility (Motilium, etc.), agents for activating the production of enzymes (Plantaglucid, Limontar), and vitamins can also be prescribed.
Gastritis needs to be treated not only with medication. If the nutritional conditions recommended by a specialist are not followed, the effect of the drugs will not be achieved. The diet for focal atrophic gastritis consists of taking food that is gentle on the stomach walls and following a diet. All products must be fresh, boiled or steamed. You need to eat warm food in small portions 4 to 5 times a day. Smoked, salted, fatty and any unnatural foods, carbonated drinks, and alcohol should be excluded from the diet. Quitting smoking is also necessary for recovery. The patient will receive detailed recommendations on nutrition from a specialist after diagnosing the disease, since the list of permitted and prohibited foods may vary depending on the form of the disease. During the period of exacerbation it is possible to use therapeutic fasting. The diet is usually meager for a while, but will be replenished as improvements are observed.
In consultation with your doctor, you can use folk remedies, helping to restore the mucous membrane. St. John's wort infusion, juice of white cabbage, potatoes, beets, and rosehip decoction help increase the acidity level.
Treatment of gastritis with the help of leeches is also practiced. At the same time, they are placed on biologically active points in three zones of the human body. For the hirudotherapy procedure, you will need two to three leeches, and the course of such unconventional treatment is designed for seven sessions.
In some particularly severe cases of chronic atrophic gastritis, you can officially become disabled. If the patient experiences frequent exacerbations, severe pain, significant weight loss, and a number of other severe consequences disease, the attending physician refers the patient for a medical and social examination, as a result of which a decision is made regarding the need to register the person as disabled.
Start taking medications on your own or use traditional methods getting rid of gastritis is extremely dangerous. Correct diagnosis and complex therapy under the supervision of a specialist. Atrophic gastritis is very serious illness, so it’s worth taking its treatment seriously.
Can be used in the treatment of esophageal cancer various means to get rid of this terrible diagnosis. Besides traditional methods For treatment, recipes taken from traditional medicine can be used. One such remedy is soda, but doctors deny the effectiveness of soda in treating esophageal cancer.
Baking soda has many beneficial properties, which is why it is so useful in folk remedies.
Sprawl malignant cells progresses in an acidic environment, soda in this case performs the function of alkalization, which is necessary to maintain a slightly alkaline state in the human body. The pH value of the environment should be 7.41; a value below 5.41 is observed at death, this indicates that cancer is progressing in the human body. Lymph cells, produced naturally in the body, are able to fight cancer cells, if the pH value in the body is equal to 7.4. Lymphatic cells are prevented from performing their function anymore acidic environment, which surrounds cancer cells.
STOMACH CANCER
Stomach cancer has been the most common malignant tumor for many years. Over the past 2 decades, a clear trend towards a decrease in the incidence and mortality from gastric cancer has emerged worldwide. In our country, among men, stomach cancer ranks third among other malignant tumors (after lung cancer and colon), and in women - the fifth. In the United States, statistics on stomach cancer are so favorable that optimistic publications have appeared about the disappearing tumor. However, there are countries where stomach cancer still ranks first among other malignant tumors (Chile).
Etiology. To date, the etiology of stomach cancer has not been established. Factors that play a role in the occurrence of this tumor are usually divided into endogenous and exogenous. Endogenous factors include genetic predisposition, hormonal-metabolic imbalance, enterogastric reflux, endogenous nitroso compounds. Exogenous factors include: environmental (nitrofertilizers, water with a high content of nitrogenous compounds; smoking), nutritional (consumption of a large number of hot, smoked, spicy dishes and products with improper storage of food; reduction in vitamins C and E in the diet; excess table salt; consumption strong alcoholic drinks), bacterial (due to the synthesis of nitroso compounds by microorganisms).
Genetic predisposition is determined by hereditary instability of the genome. Hormonal-metabolic imbalance is manifested by changes in the amount and reception of hormones and other biologically active substances. It is believed that they may play a role in the development of stomach cancer steroid hormones, gastrin, triiodothyronine, somatostatin. Enterogastric reflux leads to the reflux of duodenal contents into the stomach with bile acids and lysolecithin, which are toxic to the gastric epithelium. Nitroso compounds (N-nitrosamines, N-guanidines, N-nitrosindoles) are direct and indirect genotoxic carcinogens that can enter the stomach from the outside or be formed endogenously under the influence of bacteria. A large number of nitroso compounds are found in seafood, beans, Chinese cabbage, and soy sauce. Smoking stimulates gastric carcinogenesis due to its content in tobacco smoke polycyclic aromatic hydrocarbons and nicotine. Nutritional factors either directly damage the epithelium of the stomach (alcohol, excess table salt, spices), or reduce its reparative properties (lack of vitamins C and E), or contribute to the formation of nitroso compounds in the stomach under the influence of bacteria (improperly stored food).
There is numerous experimental data on the importance of carcinogenic substances (benzopyrene, methylcholanthrene, cholesterol, etc.) in the development of stomach cancer. The occurrence of gastric cancer of the “intestinal” type under the influence of exogenous carcinogens has been shown, and the development of gastric cancer of the “diffuse” type is more associated with the individual genetic characteristics of the body.
Pathogenesis. In the development of stomach cancer, it is necessary to take into account the background against which it appears. It is extremely rare that a tumor occurs in a practically healthy stomach, against an unchanged background (de novo). Much more often, cancer is preceded by various processes that are designated as precancerous. It is customary to distinguish between precancerous conditions and precancerous changes.
Precancerous conditions (clinical concept) are diseases in which the risk of developing cancer is increased.
Precancerous changes (morphological concept) are a histological “abnormality” in which cancer is more likely to develop than in a similar unchanged area.
There is a whole group of stomach diseases that are classified as precancerous. Their malignant potential is different, but in total they significantly increase the likelihood of cancer by 20-100% compared to the general population. This includes primarily gastric adenoma(adenomatous polyp), its malignant potential is 31%. This means that approximately every third adenomatous polyp undergoes malignancy. Second place chronic atrophic gastritis, which occupies 3/4 in the structure of all precancerous diseases due to its extreme prevalence - the likelihood of developing stomach cancer with it increases 10 times compared to the general population. Stomach cancer develops 3-5 times more often when pernicious anemia(a disease in which rapidly progressing chronic atrophic gastritis usually develops in the body of the stomach). A completely revised view of chronic stomach ulcer. For a long time it was believed that cancer very often develops with it. Thanks to modern advanced endoscopic research methods (using a Japanese gastrofibroscope), it was possible to monitor these processes in dynamics. It turned out that chronic gastric ulcers do not become malignant so often - in 0.6-2.8% of cases.
The risk of developing stomach cancer was high in patients who had various operations on the stomach (for polyposis, ulcers, etc., but not cancer). Stomach stump characterized by the fact that it creates conditions for disruption of evacuation processes and prolonged reflux of bile along with pancreatic contents, which leads to a persistent and irreversible decrease in the acidity of gastric juice. Against the background of hypo- and achlorhydria, all conditions are created for the proliferation of bacterial flora, which contributes to the restoration and long-term residence of nitrates and/or nitrites in the stomach, which have a mutagenic effect. That is why the stump of the stomach is classified as a precancerous condition. However, it turned out that all precancerous changes in the stump do not occur immediately, but at least 10 years after surgery: if 10 years after gastrectomy, cancer in the stump develops in 5-8.2% of patients, then after 20 years this figure will increase by 6-8 times.
Rare stomach diseases include Ménétrier's disease in which the folds of the mucous membrane acquire enormous dimensions - “hypertrophic gastropathy”. The malignant potential of this disease is 10 %. In last place is hyperplastic polyp, whose malignant potential is zero. However, it should not be discounted, since a hyperplastic polyp can eventually transform into an adenomatous one; In addition, the background against which a hyperplastic polyp appears is usually unusual, which is where cancer can arise.
Patients with the listed precancerous conditions or diseases are registered and they are at increased risk of developing stomach cancer only if, in the presence of a precancerous condition (disease), their histologically precancerous changes are detected, which are classified as, according to the regulations of the Coordination Committee WHO experts, only one thing - severe dysplasia of the gastric epithelium. Many authors include precancerous changes as intestinal epithelial metaplasia. However, this process is ambiguous, primarily because it occurs quite often, especially in the elderly, and in people over 70 years old - in 100 %. But intestinal metaplasia can be complete and incomplete, or small intestinal and large intestinal.
a Only incomplete, or colonic, metaplasia of the epithelium is microscopically characterized by signs of cellular and structural atypia, i.e. signs of epithelial dysplasia, therefore it would be more correct to say that precancerous changes include dysplasia of the gastric epithelium and epithelium rearranged according to the intestinal type, i.e. metaplastic.
Morphogenesis and histogenesis of gastric cancer. The morphogenesis of gastric cancer is understood as the morphology of successive stages, or stages, of cancer development from early precancerous lesions to advanced cancer capable of generalized metastasis. The problem of the onset of gastric cancer development and its carcinogenesis is still far from being resolved. A genetic link is suggested between epithelial dysplasia, which occurs in all of the above precancerous conditions of the stomach, and the development of cancer. This is confirmed by the common source of development of both dysplasia and gastric cancer.
So, cancer develops from foci of dysplasia of the gastric epithelium or metaplastic epithelium, i.e. rebuilt according to the intestinal type (colic metaplasia with cells secreting sulfomucins is dysplasia).
Severe dysplasia progresses and develops first non-invasive (carcinona in situ), and then invasive cancer. The development of infiltrating cancer begins with penetration of the basement membrane by tumor cells. This point can be captured using immunohistochemical research methods, in particular using antibodies to laminin and type IV collagen in microcarcinoma and intramucosal cancer.
The histogenesis of various histological types of gastric cancer is common - from a single source - cambial elements and progenitor cells in and outside the foci of dysplasia.
Classification. The clinical and anatomical classification of stomach cancer is based on the following parameters of the tumor: its localization in the stomach, growth pattern, macroscopic shape and histological type.
Depending on the location in various departments stomach cancer is isolated from: 1) pyloric region; 2) lesser curvature of the body of the stomach with transition to the posterior and anterior walls; 3) cardia of the stomach; 4) large curvature; 5) fundus of the stomach. If the tumor occupies more than one of the above sections, cancer is called subtotal, if all parts of the stomach are affected - total. The tumor may be located
in any part of the stomach, but the most common localization is the pyloric part and lesser curvature; These 2 localizations account for 3/4 of all gastric carcinomas.
Clinical and anatomical (macroscopic) forms of gastric cancer are usually divided into 3 groups, taking into account the nature of cancer growth, while taking into account the histological type of cancer.
Macroscopic forms of stomach cancer
[Serov V.V., 1970]
1. Cancer with predominantly exophytic growth: a plaque-like cancer
and polypous cancer
and fungoid (fungous) cancer
and ulcerated cancer
including:
Primary ulcerative
Saucer-shaped (cancer-ulcer)
Cancer from a chronic ulcer (ulcer-cancer)
2. Cancer with predominantly endophytic growth: a infiltrative-ulcerative
and diffuse
3. Cancer with exo-endophytic, mixed growth pattern: a transitional forms
(WHO classification)
1. Adenocarcinoma Options
by structure by degree of differentiation
▲tubular ▲highly differentiated
▲ papillary (papillary) ▲ moderately differentiated
▲ mucinous (mucinous cancer) ▲ poorly differentiated
2. Undifferentiated cancer
3. Squamous
4. Glandular-squamous
5. Unclassified cancer
Pathological anatomy. Plaque cancer is a rare form of cancer; presents as a flat, plaque-like formation, slightly raised above the gastric mucosa, usually small sizes(up to 2 cm in diameter). The tumor is located in the mucous membrane; the latter is mobile; in the section, the layers of the stomach wall are clearly visible. Usually it does not manifest itself clinically, it is never visible radiographically, therefore it is rarely diagnosed, mainly as a finding during gastroscopic examination. Histologically, the tumor most often has the structure of undifferentiated cancer or poorly differentiated adenocarcinoma and is usually located in the mucous membrane; less often it grows into the submucosa.
Polypous cancer usually has the characteristic appearance of a polyp on a thin stalk, growing into the lumen of the stomach, soft to the touch, and mobile. Often the tumor develops as a result of malignancy of an adenomatous polyp, which may be the result of further growth of plaque-like cancer if the exophytic growth pattern predominates. Histologically, the tumor most often has the structure of pipillary adenocarcinoma.
Fungal cancer differs from polypous cancer in that it grows on a broad base and looks like cauliflower. The tumor is most often located on the lesser curvature in the area of the body of the stomach and is constantly injured, and therefore erosions, hemorrhages and foci of necrosis covered with fibrinous plaque. Most often it is a stage of further growth of polypous cancer. Histologically, the tumor is of the type either adenocarcinoma or undifferentiated cancer.
Ulcerated carcinoma is the most common macroscopic form of cancer. However, its genesis is different, so there are 3 types: primary ulcerative, saucer-shaped and chronic ulcer cancer.
Primary ulcerative cancer, as the name implies, it is characterized by the fact that from the very beginning of its occurrence, i.e. from the stage of a flat plaque, undergoes ulceration. In this case, the tumor goes through 3 stages of development - the stage of cancerous erosion, acute ulcer and the stage of chronic cancerous ulcer. Typically, the tumor manifests symptoms characteristic of a peptic ulcer, mainly in the later stages, when it is practically impossible to distinguish it from a chronic gastric ulcer that has undergone malignancy. Histologically, it especially often has the structure of undifferentiated cancer.
Saucer-shaped cancer (cancer-ulcer)- the most common macroscopic form of gastric cancer. The tumor has a characteristic structure in the form of a node protruding into the lumen of the stomach with roller-like raised edges and a bottom sinking in the center. Typically, saucer cancer is formed as a result of necrosis and ulceration of fungiform or polypous cancer. Histologically, it is more often represented by adenocarcinoma, less often by undifferentiated cancer.
Cancer from chronic ulcers (ulcer-cancer) develops as a result of malignancy of a chronic ulcer. The tumor is located on the lesser curvature, i.e. where a chronic ulcer is usually located, and is also similar in appearance to it - it is represented by a deep defect in the wall of the stomach, the edges of which have a dense, callus-like consistency and characteristic edges - the proximal one is undermined, and the distal edge is flat. Typically, a tumor in the form of dense whitish-gray tissue grows in one of the edges. In cases of an advanced process, it is possible to distinguish an ulcer-cancer from a saucer-shaped cancer only microscopically, while in a malignant ulcer it is possible to detect among the tumor tissue vessels with sclerotic walls, amputation neuromas and massive fields of scar tissue in place of the muscular lining of the stomach wall. Histologically, this form of cancer is most often constructed as an adenocarcinoma.
Diffuse cancer is a macroscopic form of cancer characterized by pronounced endophytic growth: the tumor is represented by dense whitish-gray tissue that grows into the wall of the stomach, the latter is usually thickened to several centimeters, dense, the layers are indistinguishable; the mucous membrane above the tumor is sharply smoothed, and the lumen is evenly narrowed. The stomach is wrinkled and compacted, resembling the shape of a pistol holster. Diffuse cancers are often subtotal or total in distribution, and microscopically - undifferentiated with a scirrhosing type of growth. Sometimes they have the structure of mucinous adenocarcinoma (mucous cancer). As a rule, diffuse cancer develops as a result of the progression of plaque cancer, when the endophytic nature of tumor growth predominates from the very beginning.
Infiltrative-ulcerative cancer is distinguished by pronounced growth of the stomach wall by a tumor, on the one hand, and numerous erosions or ulcers on the surface of the mucous membrane, on the other. The tumor develops as a result of the progression of either diffuse or saucer-shaped cancer and is often extensive in size - subtotal or total. Histological examination reveals adenocarcinoma or undifferentiated cancer.
A thorough analysis of each macroscopic form of stomach cancer and comparison of these forms with each other convinces that the forms of stomach cancer are simultaneously phases of a single tumor process that the process of tumor development is staged in the form of form-phases, each of which bears the imprint of the predominance of the exophytic or endophytic nature of tumor growth. But these visible to the eye tumors are a continuation of the growth of those forms of cancer that are macroscopically poorly visible or often not visible at all, i.e. continued growth of early gastric cancer.
Early stomach cancer is not a temporary concept; it is cancer that is located in the gastric mucosa, less often in the submucosa. Thus, early cancer is superficial cancer. It is usually small in size, although sometimes it can reach several centimeters, but it does not grow deeper than the submucosa. Isolating this form is important from a clinical point of view, since it has a good prognosis - almost 100% five-year survival after surgery, and metastases are found in no more than 5% of patients.
Histological types of stomach cancer(See WHO classification on page 431).
Metastasis. Gastric cancer metastasizes through lymphogenous, hematogenous and implantation routes.
Lymphogenic route of metastasis. The first metastases usually occur in regional lymph nodes located on the lesser and greater curvature of the stomach. Subsequently, distant lymph node metastases are possible in the lymph nodes located in the area of the liver gate, in the para-aortic, inguinal and many other lymph nodes. However, in addition to orthograde, gastric cancer can metastasize through the retrograde lymphogenous route to both ovaries (Kruckenberg metastases), to the perirectal tissue (Schnitzler metastases) and to the left supraclavicular lymph node (Virchow gland).
Implantation metastases. Gastric cancer is characterized by metastases in the form of carcinomatosis of the pleura, pericardium, diaphragm, peritoneum, and omentum.
Hematogenous metastases. Stomach cancer most often metastasizes to the liver, less often to the lungs, brain, bones, kidneys, and even less often to the adrenal glands and pancreas.
Complications in gastric cancer may occur due to necrosis and inflammatory processes in the tumor itself. In these cases it is possible wall perforation, bleeding, peritumorous gastritis, gastric phlegmon. Much more often, complications arise due to tumor invasion and metastases of adjacent tissues. When the tumor grows into the head of the pancreas or the hepatoduodenal ligament, jaundice, ascites, portal hypertension. When germination of the transverse colon or mesenteric root develops mechanical intestinal obstruction. When a tumor grows in the pyloric canal, it is possible to develop pyloric stenosis. Pleural carcinomatosis is complicated hemorrhagic pleurisy or empyema of the pleura. But most often with stomach cancer, cachexia develops, caused by starvation of patients and severe intoxication.
Department of Oncology and radiation therapy with a software course Topic: Stomach cancer Lecture 4 for non-oncology residents studying in the specialty - Oncology, students in the specialty - Oncology Lecturer: Doctor of Medical Sciences, Professor Dykhno Yuri Aleksandrovich Krasnoyarsk, 2012
Lecture outline: Lecture outline: 1. Relevance of the topic 2. Epidemiology of stomach cancer 3. Risk factors for stomach cancer 4. Precancerous diseases of the stomach 5. Classification and clinical picture of stomach cancer 6. Basic methods for diagnosing stomach cancer 7. Treatment methods for stomach cancer 8. Long-term results treatment of stomach cancer 9. Medical and social examination 10. Conclusions
Risk factors for stomach cancer Long-term infection Long-term infection with H. pylori Abuse of alcohol and table salt Reflux of duodenal contents into the stomach (secondary bile acids) Reflux of duodenal contents into the stomach (secondary bile acids) Carcinogens coming from water and food (nitrosamines, polycyclic Carcinogens coming from with water and food (nitrosamines, polycyclic hydrocarbons) hydrocarbons)
Environmental factors Condition of the gastric mucosa Dietary factors H. pylori (+) Smoking (+) Alcohol (+) Impaired absorption of vitamins (+) Table salt (+) Nitrates (+) -carotenes (-) Vitamin C (-) Vitamin E ( -) Se, Zn (-) Table salt (+) Nitrates (+) Vitamin C (-) Table salt (+) -carotenes (-) Normal mucosa Superficial gastritis Atrophic gastritis Metaplasia Dysplasia Cancer Scheme of the pathogenesis of gastric cancer T. Wadstorm, 1995
Classification of gastric polyps and the frequency of their transformation into cancer Group Localization Polyp size % malignancy I Antrum Up to 1 cm 2.9 II Antrum 1-2 cm 9.1 III Antrum More than 2 cm 18 Body of the stomach Regardless of size 40.5 IV Multiple
Syndrome of minor signs of stomach cancer (A.I. Savitsky, 1947) Decreased ability to work, fatigue, weakness Decreased ability to work, fatigue, weakness Mental depression, loss of interest in work and others, apathy, alienation Mental depression, loss of interest in work and others, apathy, alienation Unmotivated decrease in appetite, aversion to food Unmotivated decrease in appetite, aversion to food “Gastric discomfort” - a feeling of fullness, bloating, heaviness, soreness “Gastric discomfort” - a feeling of fullness, distension, heaviness, pain Unreasonable weight loss, pallor Unreasonable weight loss, pallor In patients with peptic ulcer and gastritis - modification and appearance of new symptoms In patients with peptic ulcer and gastritis - modification and appearance of new symptoms - bright expressed 70% - not enough 18% - not there 12%
Clinical forms of stomach cancer 1. Gastralgic (painful) 2. Dyspeptic 3. Stenotic 4. Anemic 5. Cardiac 6. Bulemic 7. Enterocolitic 8. Ascitic 9. Hepatic 10. Pulmonary 11. Metastatic 12. Febrile 13. Asymptomatic
Spread of stomach cancer Contact route ( tumor cells spread in case of infiltrative tumors by 6-8 cm, and in case of exophytic tumors - by 2-3 cm from the visible borders of the tumor) (tumor cells spread in case of infiltrative tumors by 6-8 cm, and in case of exophytic tumors - by 2-3 cm from the visible borders of the tumor ) Implantation (Schnitzler metastases) Lymphogenous (metastases to the navel, Virchow, Krukenberg, etc.) Hematogenous (more often the liver is affected, less often the lungs, pleura, pancreas, kidneys)
Treatment methods for stomach cancer Surgical - Subtotal gastrectomy - Radical gastrectomy - Gastro-, enterostomy Radiation - Preoperative (40-45 Gy) - Intraoperative (15 Gy) - Postoperative (45-60 Gy, radioactive gold) Chemotherapy - 5-fluorouracil - Ftorafur - Mimomycin C - Adriamycin - UFT, S-1 - Polychemotherapy: FAP, FAM, EAP, EFL, etc. proximal distal
Reasons for late diagnosis of stomach cancer Lack of cancer alertness among doctors general practice Lack of oncological alertness among general practitioners. The practice of making a diagnosis remains chronic gastritis without x-ray and endoscopic examination The practice of diagnosing chronic gastritis without X-ray and endoscopic examination remains. Low capacity of X-ray rooms. Low capacity of X-ray rooms. Lack of an extensive network of gastric centers. Lack of an extensive network of gastric centers.
Labor prognosis for stomach cancer Heavy physical labor is contraindicated Heavy physical labor is contraindicated Light work, including administrative and economic Light work, including administrative and economic Dietary meals every 2 - 3 hours Dietary meals every 2 - 3 hours Compliance with sanitary and hygienic regime, additional breaks Compliance with the sanitary and hygienic regime, additional breaks Exemption from business trips, travel around the city Exemption from business trips, travel around the city
MSEC for stomach cancer I disability group: I disability group: - patients with stage IV, - with relapse and distant metastases, - with severe agastric asthenia. - patients with stage IV, - with relapse and distant metastases, - with severe agastric asthenia. Disability group II: Disability group II: - after gastric extirpation and combined operations (upon re-examination after a year, it is possible to assign Group III for life based on an anatomical defect). - after gastric extirpation and combined operations (if re-examined after a year, it is possible to assign group III for life according to the anatomical defect).
MSEC after gastric resection at stages I – II Sick leave within months Sick leave within months III group disability - for those who performed light physical labor, disability group III - for those who performed light physical labor, disability group II - for those who performed heavy physical labor, disability group II - for those who performed heavy physical labor
Literature: Basic 1) Davydov, M. I. Oncology: textbook / M. I. Davydov, Sh. Kh. Gantsev, -M. GEOTAR-Media, Additional 1) Oncology: national guide / ch. ed. V. I. Chissov [etc.]; scientific ed. G. A. Frank [and others]. - M.: GEOTAR-Media,) Oncology / trans. from English A. A. Moiseev; ed. D. Casciato [et al.]. - M.: Praktika,) Oncology: modular workshop: textbook / M. I. Davydov, L. Z. Welscher, B. I. Polyakov [and others]. - M.: GEOTAR-Media,) Cherenkov, V. G. Clinical oncology: textbook / V. G. Cherenkov. - 3rd ed., rev. and additional - M.: Medical book, Electronic resources: 1) IHD KrasSMU 2) MedArt database 3) Medicine database 4) Ebsco database 5) Physician consultant. Oncology [Electronic resource]. - M.: GEOTAR-Media, (CD-ROM) Oncology Oncology: modular workshop Clinical oncology Physician consultant. Oncology
Classification of stomach tumors n Benign tumors v Benign tumors n n Gastric adenomas (adenomatous polyps) Hyperplastic polyps v Benign tumors § § § epithelial mesenchymal Leiomyomas Lipomas Fibromas Granular cell tumors (Abrikosov tumor) Neurolemmomas Neurofibromas, etc.
Classification of stomach tumors n Malignant tumors stomach v Cancer (90 -95%) v Carcinoids v Leiomyoblastomas v Leiomyosarcoma v Malignant lymphomas
Incidence of stomach cancer Countries with high Countries with low incidence of stomach cancer Japan USA Finland Mexico Russia African countries Chile New Zealand Iceland Southeast countries. Asia UK Korea
Frequency of detection of stomach cancer Country Stomach cancer stage I-II. III-IV Art. Japan 84% 16% UK 50% Russia 16% 84%
Etiology of stomach cancer Predisposing factors Unfavorable heredity Geographical factors Dietary factors Habitual intoxication (nicotine, alcohol) Exogenous carcinogens Immunodeficiency Carcinogenic viruses, etc.
Signs of genetic determination of stomach cancer n n Genetic evidence of the development of intestinal metaplasia (the presence of mutations or gene polymorphisms): p52 bcl-2 Cdx-2 Genetic evidence of the development of stomach cancer (the presence of mutations or gene polymorphisms): E-cadherin CDH-1
Precancerous conditions n n Progressive atrophy of the coolant Hyper- and dysregenerative changes in the coolant § § Metaplasia of the coolant of the colon type (incomplete metaplasia) Dysplasia (cellular atypia) of the coolant, especially severe (4th) degree
Precancerous diseases n n Chronic atrophic gastritis Chronic gastric ulcer Long-lasting non-scarring gastric ulcer n Callous gastric ulcer n Senile gastric ulcer n n n Adenomatous polyps Pernicious anemia Menetrier's disease Mesenchymal (nonepithelial) benign tumors
Precancerous conditions and diseases CONTROVERSIAL ISSUES: ü ü Intestinal dysplasia of low (1-3) degrees Helicobacteriosis Peptic ulcer stomach Condition after resection of the stomach (stomach stump)
Frequency of localization of stomach cancer LOCALIZATION OF STOMACH CANCER In young and middle age In older people Outflow tract of the stomach 50 -65% 40 -28.5% Lesser curvature of the body 25 -27% 12 -15% Cardiac and subcardial sections Body of the stomach 8 -15% 37 -39% 2 -5% 3 -7% Greater curvature 1.7 -3% 6 -8% 1.5 -2.5% 2 -2.5% Total lesion
Macroscopic forms of stomach cancer (according to V.V. Serov, 1970) 1. Cancer with predominantly exophytic expansive growth (71.8%): n n Plaque-like (including developing from a gastric polyp); Polypoid (mushroom-shaped); Saucer-shaped (primarily ulcerative form of stomach cancer, malignant ulcers, cancer, etc.); Brainy;
Macroscopic forms of stomach cancer (according to V.V. Serov, 1970) 2. Cancer with predominantly endophytic infiltrating growth (28.2%): Infiltrative-ulcerative; n Submucosal; n Flat laying. n 3. Cancer with exoendophytic, mixed growth pattern - transitional forms
Cancer triad of clinical signs of stomach cancer (according to A.V. Melnikov, 1960) 1. 2. 3. Gastric discomfort Loss of appetite Weight loss
“Small sign syndrome” of stomach cancer (A.I. Savitsky, 1947) n n n Appearance of unmotivated general weakness Rapid fatigue Decreased ability to work Decreased or loss of appetite Aversion to certain types of food “Stomach discomfort” Unmotivated weight loss Increasing anemization Appearance of a jaundiced tint of the skin Mental depression Susceptibility colds
Clinical forms of stomach cancer (according to V. Kh. Vasilenko, 1984) n n n n Dyspeptic Anemic Fever Cachectic Jaundiced Edema Pulmonary hemorrhagic
Gastric dyspepsia in stomach cancer n n n Loss of appetite Rapid satiety Gastric discomfort Feeling of heaviness in the epigastrium Belching, hiccups Heartburn, nausea, vomiting
Modern principles of treatment of stomach cancer n Combined treatment: o o o q Surgery Antitumor therapy Immunomodulation Chemotherapy (for inoperable patients) q Complex: o o o Surgery Vaccination Immunomodulation
