Treatment of tumors is radical and palliative.

A. Radical treatment is aimed at eliminating the tumor and assumes the possibility of complete recovery or long-term remission.

B. Palliative treatment used when radical therapy is impossible. Treatment results in longer life and less suffering. The risk of relapse is quite high, although initially the patient may feel completely healthy.

Regular program Treatment includes a combination of surgery, radiation, chemotherapy and (in some cases) the use of biological response modifiers (immunomodulators).

Treatment should be planned taking into account the specific needs of the patient. Drawing up a treatment plan and its implementation facilitates the coordination of the efforts of the pathologist, oncologist, radiation therapist and other specialists.

Complex treatment.

Most cancer patients are treated surgically and with radiation therapy, chemotherapy and immunotherapy. The choice of treatment method depends on the nature of the disease, stage, histological type of tumor, age of the patient, and the presence of concomitant diseases.

How surgical intervention, so radiation therapy affects the primary tumor and regional The lymph nodes. Neither method affects areas of distant propagation.

Chemotherapy and immunotherapy - system methods treatments can affect areas of distant spread.

Additional treatment - systemic therapy used after local treatment(for example, resection) with a high risk of having a microscopic lesion in the lymph nodes or distant organs. A significant proportion of these patients develop a relapse; the goal of additional treatment is to destroy these distant and microscopic tumor foci.

Complex treatment. Uses the advantages of each treatment method to compensate for the disadvantages of others.

A. Mammary cancer. For local treatment, surgery (mastectomy, tylectomy) plus radiation is used. Surgery is used to determine the condition of the axillary lymph nodes; postoperative chemotherapy is necessary to reduce the likelihood of tumor metastasis in patients with affected nodes.

B. Lung tumor. Preoperative radiation in some cases reduces the size of the tumor and makes it operable.

C. Sarcoma of the extremities. For diagnosis, incisional biopsy is used; to reduce tumor size - preoperative radiation therapy; for initial local treatment - radical local resection; For further treatment postoperative radiation therapy and chemotherapy are necessary.

Surgery malignant tumors.

The principles of surgery are based on removing the tumor with the goal of cure. To prevent dissemination of tumor cells during surgery, all excisions are performed through healthy tissue. Tumors should be exposed to minimal exposure to prevent spread throughout vascular system; the vascular pedicle of the tumor is ligated as early as possible. To prevent the spread of lymphatic system apply the same measures; in addition, the area of ​​the tumor-draining lymph nodes is removed along with the tumor.

Curative resection. There are several types curative resections, varying depending on the size of the tumor and its nature.

1.Wide local resection- a method of treating low-grade tumors that do not metastasize to regional lymph nodes and do not penetrate deeply into surrounding tissues.

2.Radical local resection used for tumors that penetrate deeply into the surrounding tissue.

3.Radical resection with removal of lymphatic drainage pathwaysen bloc used for tumors that metastasize to regional lymph nodes.

4. Superradical resection . A significant part of the body is removed; it is used only for local tumors with a low probability of metastasis. For example, pelvic extirpation for locally advanced tumors of the rectum, cervix, and bladder.

Other resections

1.Removal of recurrent tumor usually feasible for localized low-grade relapses. For example, regional (in a lymph node) recurrence of colon cancer, local (in a postoperative anastomosis) recurrence of any gastrointestinal tumor and local recurrence of skin cancer.

2. Destruction of metastatic tumors feasible in several cases. The two most common are isolated liver metastases in colon cancer and pulmonary metastases (especially in chemotherapy-sensitive sarcomas).

3. Palliative surgery used to relieve or prevent a specific symptom (without the goal of cure). For example, removal of occlusive or bleeding colon cancer in a patient with liver metastases.

4. Partial excision- removal of most of the tumor while preserving its remains. Used for insurmountable tumors that grow into vital structures. The rationale for this approach is that the remaining smaller number of tumor cells are more sensitive to chemotherapy or radiation therapy.

Radiation therapy

Half of all cancer patients require radiation therapy at some stage of the disease.

Radiation therapy (either alone or in combination with chemotherapy and surgery) can be radical for some forms of cancer ( For example, Hodgken's disease, some head and neck carcinomas).

Radiation therapy may be palliative(For example, for advanced breast cancer, for pain relief due to bone metastases).

Chemotherapy can be used together with or before radiation treatment to enhance the effect of the latter. For example, Pyrimidine acts as a radiation sensitizer during radiation therapy. Combination therapy may cause severe toxic reactions. Classic example - radiation reaction return effect - development of enhanced (or reactive) local reaction in a previously irradiated area with simultaneous administration of doxorubicin and/or methotrexate.

Radiation therapy can be used before surgical treatment to suppress metastases or for the purpose of tumor regression, as well as after operation to improve its effectiveness. Preoperative radiation often causes postoperative complications, including poor wound healing and fistula formation.

Side effects . Most patients suffer from general or local side effects radiation exposure, especially those who received large dose irradiation ( For example, for head and neck cancer).

Radiation reactions and damage

Acute local effects(mainly swelling and inflammation) are observed within several days or weeks from the moment of irradiation.

Chronic effects(such as fibrosis and scarring) may appear months or even years after radiation therapy.

Heaviness adverse reactions depend on the location, size of the irradiated field, type of source and dose application ( For example, total dose, dose per 1 session, dose rate). Local effects can be reduced by:

Accurate determination of the tumor field using radiological technology ( For example, CT and MRI);

Exception direct action radiation on life important organs (For example, spinal cord);

Protection normal tissue from radiation;

Reducing the area of ​​the irradiated field during the treatment course.

General effects on the body radiation therapy: malaise, fatigue, anorexia, suppression of hematopoiesis; general symptoms are especially typical for patients who received both chemotherapy and radiation treatment.

Skin reactions observed after applying high doses of irradiation to areas skin (For example, chest after mastectomy). Repeated irradiation or incorrect use of the joining field method (with the superposition of one irradiation field on another) can cause multiple reactions.

• The damaged area should be clean and dry. Additional treatments include:
• Local application of ointments with vitamins A and D, liquid oil for children
• Cleansing the affected area with a solution of hydrogen peroxide and saline (1:1 ratio)
• Local application of corticosteroids.

Radiation to the head or neck high doses causes reactions of the mouth and pharynx- inflammation of the mucous membrane, pain, anorexia, dry mouth, dental caries.

To reduce such reactions it is necessary strict adherence oral hygiene, local application anesthetics, drugs that regulate salivation, proper nutrition.

IN severe cases It may be necessary to provide nutrition through a gastric tube or gastrostomy tube.

Gastrointestinal reactions observed when using doses above 40-55 Gy.

Esophagitis usually goes away by 7 - 10 days; patients are predisposed to candidal lesions. Treatment: Antacids, liquid diet and local anesthetics.

Radiation gastritis or enteritis May cause nausea, vomiting, diarrhea, abdominal pain, loss of appetite, bleeding. Treatment: antiemetics, antidiarrheals, low fat diet.

Inflammation of the rectum accompanied by bleeding or pain. The patient's condition is alleviated by an appropriate diet and enemas with steroid drugs.

Radiation pneumonia with cough, shortness of breath, pain in chest usually develops after irradiation of a significant volume of the lung. The condition is controlled by prescribing prednisolone 4 times a day, 15 mg.

CNS lesions can be observed both during the course of therapy and after for a long time after treatment.

Acute symptoms accompanying cranial irradiation: blunt, prolonged headache, signs of increase intracranial pressure(ICP), nausea and vomiting. When dexamethasone is prescribed (4 mg 4 times a day), symptoms quickly disappear.

Delayed symptoms: violation short term memory, pathology white matter brain, dilatation of the ventricles and the appearance of foci of calcification.

Drowsiness syndrome(hypersomia and fatigue) are observed for many weeks and months after cranial irradiation (especially in patients who received injections of chemotherapy drugs under the membranes of the brain).

Suppression of bone marrow hematopoiesis occurs during irradiation using the method wide field, used in the treatment of lymphogranulomatosis (Hodgken's disease) and cancerous tumors of the pelvic area, which is especially pronounced in patients simultaneously receiving chemotherapy. For leukopenia or thrombocytopenia, blood transfusion therapy is often necessary. The development of anemia is rare. When the Hb level decreases below 9 g%, blood transfusion is performed.

Chemotherapy

Over the past 30 years, cancer therapy has been characterized by the increasing use of cytotoxic pharmacological agents. The combination of chemotherapy with surgery or radiation treatment increases life expectancy and the rate of complete remission in many malignant neoplasms.

Chemotherapy effects. Chemotherapy alone is not able to provide complete recovery in most cases of malignant tumors in adults. Effect of use pharmacological drugs almost always incomplete, short-term, with minimal magnification survival (or even without a change in life expectancy). Chemotherapeutic effects are defined as complete, partial, causing stabilization of the disease or its progression.

Full effect implies complete destruction of the tumor.

Partial effect determines a reduction in tumor size by 50% or more.

Stabilization of the disease means either a decrease in tumor size by less than 50% or an increase of less than 25% of the total mass of tumor tissue.

Disease progression involves an increase of 25% or more in the size of all tumor foci or the appearance of a new foci, considered as metastasis.

Combination chemotherapy uses drugs that are very effective against certain types of tumors. The combination of chemotherapy drugs involves the effects of a variety of cytotoxic mechanisms, which leads to various side effects. If drugs have the same side effects, then the dose of each drug is reduced accordingly. Compared with monotherapy with any one drug, combination chemotherapy increases healing effect. Simultaneously with the destruction cancer cells Through several cytotoxic mechanisms, combination chemotherapy can prevent or slow the development of drug resistance.

Literature

1.2 ed., M.I. Kuzin ed., M.: Medicine, 1995

1. Surgery / Ed. Academician RAMS Yu.M. Lopukhina M.: GEOTAR 1997

Treatment should be comprehensive and include both conservative measures and surgical treatment. The decision on the scope of future treatment for a cancer patient is made by a council consisting of an oncologist, a surgeon, a chemotherapist, a radiologist, and an immunologist.

Surgical treatment may precede conservative measures, follow them, but complete recovery from malignant neoplasm without removal of the primary lesion is doubtful (excluding tumor diseases of the blood, which are treated conservatively).

Surgery for cancer can be:

1) radical;

2) symptomatic;

3) palliative.

Radical operations imply the complete removal of the pathological focus from the body. This is possible by following the following principles:

1) ablastics. During the operation, it is necessary to strictly observe ablastics, as well as asepsis. Ablasticity of the operation is to prevent the spread of tumor cells to healthy tissues. For this purpose, the tumor is resected within healthy tissue without affecting the tumor. In order to check ablasticity after resection, an emergency examination is performed. cytological examination smear-imprint from the surface remaining after resection. If tumor cells are detected, the extent of resection is increased;

2) zonality. This is the removal of nearby tissue and regional lymph nodes. The volume of lymph node dissection is determined depending on the extent of the process, but one must always remember that radical removal of lymph nodes leads to lymphostasis after surgery;

3) antiblastics. This is the destruction of locally spread tumor cells, which in any case are dispersed during surgery. This is achieved by cutting around the circumference of the pathological focus antitumor drugs, regional perfusion by them.

Palliative surgery is carried out if it is impossible to carry out radical surgery in full. In this case, part of the tumor tissue is removed.

Symptomatic operations are carried out to correct emerging disturbances in the functioning of organs and systems associated with the presence of a tumor node, for example, the application of an enterostomy or bypass anastomosis for a tumor obstructing the gastric outlet. Palliative and symptomatic operations cannot save the patient.

Surgical treatment of tumors is usually combined with other treatment methods, such as radiation therapy, chemotherapy, hormone therapy and immunotherapy. But these types of treatments can also be used independently (in hematology, radiation treatment of skin cancer). Radiation treatment and chemotherapy can be used in the preoperative period in order to reduce the volume of the tumor, relieve perifocal inflammation and infiltration of surrounding tissues. As a rule, the course of preoperative treatment is not long, since these methods have many side effects and can lead to complications in postoperative period. The bulk of these therapeutic measures carried out in the postoperative period. If a patient has stages II-III of the process, surgical treatment must necessarily be supplemented by a systemic effect on the body (chemotherapy) in order to suppress possible micrometastases. Special schemes have been developed to achieve maximum possible removal tumor cells from the body without causing toxic effect on the body. Hormone therapy is used for some tumors of the reproductive system.

Today we can see an increase oncological diseases on the background negative factors external environment and the prevalence of human internal diseases. This is what causes the development of malignant and benign tumors, while their localization can be very diverse. In this regard, new technologies are being developed, new principles are being created, and many experiments are being conducted in order to find the safest and most effective treatment for oncology.

General principles of treating cancer patients

Modern methods of fighting cancer are built on the same principles, the basis effective treatment is speed, security and complexity. It is impossible to completely get rid of oncology, but there is a chance to significantly improve the patient’s quality of life by maintaining normal condition body and prevent relapses.

The main objectives of treating cancer patients.

• Application combination treatment, regardless of the stage and extent of the pathological process.
• Combination modern technologies with basic treatment methods.
• Long-term treatment planning, continuity of therapeutic measures throughout the patient’s life.
• Constant monitoring of the cancer patient, correction of treatment based on the latest diagnostic tests.

In addition, the main goal of modern medicine is timely diagnosis, which is the key to effective treatment.

Drug treatment of oncology

Application medications for the purpose of treating cancer patients, it is carried out taking into account the stage and location of the malignant process. Antitumor vaccines, hormonal and symptomatic therapy medicines. Such treatment cannot be carried out as independent method, and it is only an addition to the main measures in the presence of a malignant process in the body.

Let's look at the most common types cancer and the essence of their drug therapy.

• Breast and prostate cancer - if cancer is localized in the breast and prostate, it is rational to use the course hormone therapy. Painkillers, restoratives and antitumor drugs are also prescribed. The essence hormonal treatment is to stop the synthesis of hormones that cause progressive tumor growth. Must be appointed cytostatic drugs, which destroy atypical cells, creating all the conditions for their death.
• Brain cancer or bone marrow- for such diseases drug therapy less significant, surgical treatment should be performed. But in order to maintain general condition drugs are prescribed to increase brain activity, memory improvement. Patients with brain cancer experience various mental disorders Therefore, symptomatic therapy is carried out.
• Bone cancer and cartilage tissue– Medicines are prescribed to strengthen bones. Very often, in patients with a tumor, fractures or cracks occur in the bones even with minor loads. Therefore, it is very important to strengthen the structure bone tissue, through vitamin therapy and other medications.

What drugs are used to treat cancer?

All medications in the fight against cancer can be divided into several groups.

• Hormonal drugs are drugs that reduce testosterone levels, these are Herceptin, Taxol, tamoxifen, Avastin, Thyroxin, Thyroidin.
• Toxic drugs - aimed at destroying cancer cells by toxic effects on them, these are Celebrex, Avastin, Docetaxel. Also narcotic drugs - Morphine, Omnopon and Tramadol.
• Antiviral - the essence of the purpose of this group of drugs is to maintain immunity. In oncology, both local and internal anti-inflammatory drugs are used.
• Cytotoxins and cytostatics - under the influence of these drugs, the tumor resolves and decreases in volume, which is necessary for subsequent surgical intervention.
• Antitumor universal drugs are Ftorafur, antimetabolites, Doxorubicin and others.

Radiation and chemotherapy

Radiation therapy and chemotherapy are the main treatments for cancer. Prescribed in the preoperative and postoperative period.

Radiation therapy

Radiation therapy is prescribed if cancer cells are sensitive to this type of radiation. This is a small cell cancer, which is most often localized in the respiratory organs, uterus, in the head area, and can also affect the lungs.

Several radiation therapy techniques are used:

• remote;
• intracavitary;
• using neutrons, radioactive isotopes and protons.

It is rational to use the radiation method of oncology treatment before surgery in order to localize the main focus of the tumor. The goal of postoperative radiation therapy is to destroy any remaining cancer cells.

Chemotherapy

Chemotherapy is also the main method of treating cancer, but is used in parallel with radical measures. The drugs that are used actively fight pathological cells. Healthy tissue also receive negative impact, but to a lesser extent. Such selectivity chemicals lies in the rate of cell growth. Cancerous structures multiply quickly, and they are the first to be hit by chemotherapy.

For testicular cancer, uterine cancer, Ewing's sarcoma, and breast cancer, chemotherapy is the main treatment method and can completely overcome cancer in the first and second stages.

Radical tumor removal

A surgical operation aimed at removing the main focus of the tumor and nearby tissues is used in the first, second and third stages of the disease. Last stage cancer does not respond to surgery, and surgery is contraindicated. This is because at stage 4 cancer metastasis occurs, and it is impossible to remove all metastases from the body. The operation in this case will only harm the patient and weaken him (with the exception of palliative surgery).

Radical therapy in oncology takes first place. Complete removal of the tumor in the early stages can completely eliminate cancer. In progress surgery Not only the focus and part of the affected organ is removed, but also regional lymph nodes. After the operation, a mandatory tissue examination is carried out, after which a course of drug treatment is prescribed.

There are two main options for surgery – organ-preserving and extended.

• Extended surgery is performed mainly for cancer of the rectum, uterus, and genitals. It involves the removal of the organ itself and regional lymph nodes. Another technology for extended operations has been created - super-radical, in which, in addition to the causative organ, several nearby ones are also removed. Contraindications: presence of distant metastases.
• Organ-conserving surgery is performed when cancer is clearly localized without metastatic processes. It is performed for breast cancer and tumors in the facial area. This allows you to save the organ, which significantly affects psychological condition patient. In some cases, after radical removal, cosmetic procedures for recovery, which also improves the patient’s quality of life.

Palliative treatment

Of the entire complex of oncology treatment, it is important to highlight palliative measures. They are aimed not at treatment, but at improving the quality and life expectancy of patients with stage 4 cancer. Such patients do not have a chance for a full recovery, but this does not mean that they can die peacefully. Modern medicine offers such patients a set of procedures that eliminate the main symptoms of cancer. This includes pain relief, cancer reduction through gentle surgery, taking general tonic drugs, and physiotherapeutic procedures.

Treatment of patients at stage 4 is a difficult task, such patients suffer from excruciating pain, strong weight loss, psychological disorders. Therefore it is carried out separate treatment each of the complications of cancer.

Symptomatic treatment includes:

• narcotic analgesics – morphine, fentanyl, buprenorphine;
• non-narcotic analgesics - paracetamol, metamizole, ibuprofen, diclofenac.

If treatment is ineffective pain syndrome You can contact the Cancer Pain Treatment Center. Eliminating pain is the main goal in treating a cancer patient.

For head cancer, the generally accepted radical operation is pancreatoduodenal resection, first successfully performed by W. Kausch in 1909. Domestic and foreign surgeons (V.N. Shamov, 1955; A.

N. Velikoretsky, 1959; V. V. Vinogradov, 1959; A. A. Shalimov, 1970; N. S. Makokha, 1964; V. I, Rshchiashvili, 1970; A. V. Smirnov, 1969; Child, 1966; Brunschwig, 1942; Cattel, 1953; Salmon, 1966;

Smith, 1965, and others) made major contributions to the development of this intervention. Of the domestic surgeons, A. A. Shalimov currently has the greatest experience in pancreaticoduodenal resections, who reported 103 operations at the XXIV Congress of the International Society of Surgeons (1971), N. S. Makokha performed 85 operations (1969), A. V. Smirnov - 70 (1969), E. S. Futoryan and B. M. Shubin (1977) -39. According to foreign authors (Warren et al., 1962), 218 pancreatoduodenal resections were performed at the Lehi clinic over 20 years. Monge et al. (1964) reported 239 operations at the Mayo Clinic over 22 years.

Despite the accumulated experience, pancreaticoduodenectomy widespread I didn't receive it. This is caused by a number of reasons. Patients are admitted to surgical departments in most cases with widespread tumor process, in connection with which the resectability rate for pancreatic cancer is low and according to A. A. Shalimov (1970) is 9.4%, V. I. Kochiashvgosh (1970) - 10.1%; S. M. Mikir-tumova (1963) - 4.9%; according to the Mayo Clinic (Monge et al., 1964), resectability for pancreatic head cancer was 10%. For some authors this figure is higher: Salembier (1970) - 13%, Doutre et al. (1970) - 25%, yElias (1969) -27%.

Pancreatoduodenal resection - severe traumatic intervention, accompanied by high postoperative mortality. Enters et al. (1961) provide materials from various researchers. According to them, the mortality rate ranges from 20 to 80%. For 169 operations performed by domestic surgeons by 1968 (excluding the observations of A. A. Shalimov), postoperative mortality amounted to 50%. Best performance only a few authors: Sinith (1965) -7.7%, and of 35 patients operated on by Warren et al. (1968), died

1 patient.

Five-year survival rate after pancreaticoduodenectomy for pancreatic cancer is very low: from 0 to 10-12%; average duration life 9-15 months (A. N. Velikoretsky, 1959; A. V. Smirnov, 1961; Fayos, Lainpe, 1967; Bowden, Pack, 1969, etc.). According to the Research Center of the USSR Academy of Medical Sciences, resectability for pancreatic cancer was 5.4%. In MNIIOI them. P. A. Herzen resectability was 7.4%, postoperative mortality - 48%; the average life expectancy was 13 months. This explains why, along with the promotion of pancreaticoduodenectomy, its supporters express restrained or negative attitude to this intervention. Radical or palliative surgery for pancreatic cancer is a question that is constantly discussed in the medical press.

Advances in anesthesiology, obtaining antibiotics wide range actions, antienzyme therapy for the prevention and treatment of postoperative pancreatitis, the use of effective detoxification agents, etc.

They provide the basis for further development of pancreatoduodenal resection.

The operation consists of two stages:

the first involves mobilization and removal of the drug,

the second is to restore patency gastrointestinal tract and bile ducts. The mobilization methodology is quite well developed, close to standardization and presented in detail in a significant number of monographs and atlases (V.V. Vinogradov, 1959; A.A. Shalimov, 1970; V.I. Kochiashvili, 1970). Resection of the head of the pancreas, common bile duct, lower part of the stomach and duodenum(Fig. 120). A. A. Shalimov (1970), depending on the degree of prevalence of the process, uses two variants of the operation:

I - with resection of the duodenum to the mesenteric vessels;

II - with complete removal of the duodenum after releasing its distal segment from under the mesenteric vessels.

The recovery phase of the operation is very variable. The proposed methods of reconstruction (more than 70) are aimed at preventing complications (cholangitis, pancreatitis, etc.).

The key point of pancreatoduodenal resection is the treatment of the gland stump. The method of blind stump suturing, developed by Whipple in 1935, is not widely used. The creation of a pancreatodigestive anastomosis is more physiological. According to E. S., Futoryan and B. M. Shubin (1975), for certain indications, the use of three options is justified (Fig. 121).

1. The most common method is pancreatojejunostomy. The reconstructive stage is carried out by sequential (from top to bottom) creation of pancreatodigestive, biliodigestive and gastrointestinal anastomosis. In MNIIOI them. P. A. Herzen uses the technique of disconnecting the first two anastomoses by suturing a loop of intestine between them using the UKL-60 apparatus. This technique prevents the reflux of bile into the pancreatic ducts and pancreatic juice into biliary tract, which serves as the prevention of postoperative cholangitis and pancreatitis.

2. Solid suturing of the stump is indicated for severe secondary pancreatitis with the formation of necrotic plaques, when the overlap of an anastomosis with the intestine is especially risky. In these cases, it is advisable to perform a subtotal resection of the gland in the hope of a small exocrine function a small stump (this reduces the risk of developing postoperative complications).

3. Pancreaticogastroanastomosis is indicated under favorable anatomical conditions and a wide stump of the pancreatic duct. When creating an anastomosis, the use of temporary external diversion of pancreatic juice is justified.

For cancer of the body and tail of the gland, resection of the distal part of the gland is performed, usually together with the spleen. These operations are extremely rare, since patients are usually admitted to advanced stage diseases. In MNIIOI them. P. A. Herzen metastases were detected in this location of cancer in 96% of cases.

Rice. 120. Boundaries of pancreatoduodenal resection.

Rice. 121. Options for the reconstructive stage of pancreaticoduodenectomy.

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Conditionally radical is a treatment that requires long-term rehabilitation and has sufficient high efficiency. These methods include:

Radiation therapy. Radiation exposure is used exclusively as an adjunct to surgery. During the procedure, cancer cells are destroyed directly at the tumor site. The main goal of such therapy is to eliminate relapses after surgery.

Depending on the purpose, radiation therapy for breast cancer can be

• · Radical, in which complete tumor resorption and cure of the patient are achieved.
• · Palliative is used in a common process, when to achieve complete cure impossible. Treatment can only prolong the patient's life by reducing suffering.
• · Symptomatic irradiation is used to eliminate the most severe symptoms cancer, primarily pain syndrome that cannot be relieved with narcotic painkillers.

Irradiated areas during radiotherapy

Depending on the purpose, the following areas may be irradiated:

• Breast (affected side)
• Regional lymph nodes (on the affected side)
• · Supraclavicular and subclavian lymph nodes involving the sternocleidomastoid (sternocleidomastoid) muscle

Being a genetically heterogeneous disease with many forms clinical course, breast cancer is considered one of the most difficult diseases to choose rational treatment, when you have to take into account many factors, each of which can be decisive not only in the prognosis of the disease, but also in the fate of the patient.

Radiation therapy for breast cancer - part complex treatment, and is not currently used as monotherapy. It can be combined with other methods (surgery, hormone therapy, chemotherapy). With a decrease in the volume of surgical treatment during organ-preserving operations, the role of radiation therapy increases.

The choice of a complex treatment regimen is determined by the following factors:

• The prevalence of the cancer process,
• · Histological structure neoplasms,
• · Character of tumor growth.

Chemotherapy. This involves taking chemicals that have a negative effect on cancer cells. These are poisons and toxins that have side effect and together with tumor cells, they destroy blood cells and body tissues that may be sensitive to a particular drug. Chemotherapy drugs are available in the form of tablets or solutions for intravenous transfusion. Chemotherapy is carried out periodically, in several stages. They are used both before and after surgery, sometimes replacing surgery. After chemotherapy, the body can recover within several months.

There are several types of chemotherapy for breast cancer:

• · adjuvant (non-adjuvant);
• · medicinal.

Adjuvant (preventive) chemotherapy is carried out after surgical intervention on mammary gland to influence hidden tumor foci in other organs. Non-adjuvant chemotherapy is given before surgery; it allows you to find out whether neoplasms are sensitive to the effects of drugs. Disadvantages of non-adjuvant: delay with surgical intervention, difficulties in determining the histological type of the tumor.

Curative chemotherapy for breast cancer is carried out even before surgical intervention in order to reduce the size of a localized tumor. In some cases, this measure allows instead of a mastectomy ( complete removal mammary gland) to get by with just a lumpectomy (removal of the affected part of the mammary gland and a small amount of the healthy area). This type of chemotherapy is also carried out to reduce distant metastases.

Targeted therapy. Aimed at blocking the HER2 gene if its activity causes growth cancerous tumor. The drugs can slow down tumor growth or prevent relapse after surgery.

Immunotherapy. The method uses the patient’s own defense mechanisms. By stimulating the immune system, the drugs help in eliminating cancer cells. Immunotherapy by itself is not effective enough, so it is used only in combination with other methods (for example, with chemicals.)

Breast cancer, treatment of which was carried out only conditionally radical methods, most often occurs again, even if the result was successful. On this moment These methods are used in most cases as auxiliary ones. Also, with the help of chemotherapy and radiation therapy, the growth of metastases can be delayed.