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Radical treatment of cancer. Oncology treatment methods

Today, one can observe an increase in cancer diseases against the backdrop of negative environmental factors and the prevalence of internal human diseases. This is what causes the development of malignant and benign tumors, and 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 of effective treatment is speed, safety and complexity. It is impossible to completely get rid of cancer, but there is a chance to significantly improve the patient’s quality of life by maintaining the normal state of the body and preventing relapses.

The main objectives of treating cancer patients.

Application combination treatment, regardless of the stage and extent of the pathological process. Combination of modern technologies with basic treatment methods. Planning of long-term treatment, 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

The use of medications for the treatment of cancer patients is carried out taking into account the stage and location of localization malignant process. Antitumor vaccines, hormonal and symptomatic therapy medicines. Such treatment cannot be carried out as an 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 – when cancer is localized in the breast and prostate, it is rational to use a course of hormonal therapy. Painkillers, restoratives and antitumor drugs are also prescribed. The essence of hormonal treatment is to stop the synthesis of hormones that cause progressive tumor growth. Cytostatic drugs are necessarily prescribed, which destroy atypical cells, creating all the conditions for their death. Brain or bone marrow- for such diseases drug therapy less significant, surgical treatment should be performed. But in order to maintain the 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 of bone tissue through vitamin therapy and other medications.

What drugs are used to treat cancer?

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

Hormonal drugs - 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; intracavity; 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 against pathological cells. Healthy tissue also receive negative impact, but to a lesser extent. This selectivity of 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. The last stage of 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: the presence of distant metastases. Organ-preserving surgery is performed when the cancer is clearly localized without metastatic processes. It is performed for breast cancer and tumors in the facial area. This allows the organ to be preserved, which significantly affects the patient’s psychological state. 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 restorative medications, and physiotherapeutic procedures.

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

Symptomatic treatment includes:

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

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

In modern medicine, three main methods are used to treat malignant tumors: chemotherapy, radiation therapy and surgical treatment. Chemotherapy involves the use medical supplies, which have the ability to destroy malignant cells. Radiation therapy consists of exposing the tumor to a narrow beam of radiation. Concerning surgical treatment , then it involves surgical removal of malignant tumors or parts thereof.

Unfortunately, even with significant advances in modern oncology, some types of cancer cannot be cured. Therefore, patients are often prescribed complex treatment, which includes a combination of several methods. The most effective method is surgical removal of the tumor. The problem is that the operation cannot be performed in all cases due to anatomical features and tumor location.

Types of oncological operations

Oncological operations are divided into two types: radical and palliative. Radical intervention implies complete removal tumors and is considered the most effective method of treating cancer. In cases where it is impossible to remove the tumor, palliative surgery is performed, which is also called symptomatic. This treatment method does not cure the patient, but it can significantly alleviate the symptoms of cancer and improve the patient's well-being.

Radical removal of cancer is usually effective at stages 1-2, while palliative operations resorted to in advanced cases in order to prolong the patient’s life.

How are cancer removal operations performed?

Since malignant cells often spread beyond the tumor, it is often removed “with a reserve”, that is, in addition to the tumor itself, the tissue surrounding it is also removed. This is done to prevent relapse of the disease. For example, with breast cancer it is often necessary to remove not only the tumor, but also the entire mammary gland, and sometimes the subclavian and axillary lymph nodes. In most cases, especially if treatment was started in the early stages, this method can prevent the development of metastases and cure the patient.

After tumor removal surgery, plastic or cosmetic surgery is often performed to remove scars and other external defects.

Cancer surgery can be carried out both using a traditional scalpel and using more modern instruments such as a laser, ultrasonic scalpel or radiofrequency knife. New equipment makes it possible to reduce the trauma of the procedure, avoid bleeding and other complications, and shorten the recovery period. For example, when laryngeal cancer is removed with a laser, the patient is often able to preserve his voice, which is not always possible with traditional operations.

Removal of malignant tumors requires special care and caution from specialists. During the procedure, it is necessary to follow the rules of ablastics to prevent the proliferation of malignant cells. Thus, the skin incision must be performed exclusively within healthy tissues, while traumatizing tumor tissues is not permissible.

Some types of cancer are difficult to cure and lead to the death of the patient. However, in many cases, cure is still possible. The successful outcome of the procedure largely depends on the characteristics of the tumor, including its type, size, stage and the presence of metastases. Another important factor determining the success of treatment is early diagnosis of the disease. The chances of cure in the early stages are very high, so you need to be careful about your own health and undergo regular medical examinations.

The human immune system serves as a kind of defense against various microbes, such as bacteria and viruses, which make the body vulnerable to infections. When the immune system sees foreign cells, it sends "invaders" to attack them. But, unfortunately, sometimes the immune system mistakes healthy cells for foreign ones, and this leads to irreversible consequences, causing autoimmune diseases.

As the incidence of autoimmune diseases increases and pharmacological treatments only alleviate symptoms, scientists from all over the world are working to study these diseases. It is suspected that environmental and external factors have a great influence on the occurrence of this type of disease.

Radical therapy, the essence of its research

Since the mid-1990s, hematologists and immunologists have been testing therapies to slow down the disease process. The essence of this therapy: when the immune system is turned off, it no longer “attacks” cells. Just a few weeks ago, the New England Journal of Medicine reported on patients who benefited from this radical treatment.

This treatment method is mainly used in scientific research when they no longer help medicines. More than 2,000 patients were studied in Europe over two decades. Almost half of them had , a quarter had , and four percent had .

One of the patients with systemic lupus erythematosus, Petra Sperling, completed the full course radical therapy and today she feels completely healthy, we can safely say that this is a medical miracle.

At the German Research Center (DRFZ) at the Charité clinic, scientist Andreas Radbruch for a long time looked for the causes of autoimmune diseases and discovered: memory cells of the immune system, which were initially programmed incorrectly, constantly produce autoantibodies. "They provoke chronic inflammation“says the scientific director of the DRFZ. “And unless you reset the immune system, the treatment will not have positive results.”

For Petra Sperling, the restart looked like this: Doctors filtered all the stem cells from her blood and placed them in the freezer. This was followed by chemotherapy: a cocktail of inhibitors cell division and antibodies obtained from experimental rabbits. The next step is an infusion with frozen stem cells, which destroys the pathogenic memory cells, and with them Sperling’s entire immune system. For four years, the patient had to stay practically in isolation, avoid public places, and always had a disinfectant with her.

Doctors not only saved Petra Sperling’s life, but also gave her the opportunity to continue living as a full-fledged healthy person.

This is the story of radical therapy, which gives hopeless patients a chance of recovery, but it is worth noting that the treatment is associated with high risks of side effects. But thanks to this treatment, many patients have been saved today; after therapy, they do not need to take medications.

All cancer treatment can be divided into radical and palliative.

Radical treatment

Radical (from Latin radicalis, indigenous) is a supporter of extreme, decisive actions, events, views.

Radical treatment is aimed at eliminating the tumor and implies the possibility of complete recovery or achieving remission. Remission is a state when the tumor has responded to treatment or is under control. A distinction is made between complete remission (all signs and symptoms of the disease are absent) and partial (the tumor has decreased in size, but has not completely disappeared). Remission can last from several weeks to several years. Complete remission for 5 years is considered as recovery of the patient.

Radical cancer treatment involves a range of interventions, including psychosocial support, surgery, radiation and drug therapy. According to 2010 data:

Specific gravity surgical method as an independent type of special treatment was 47.2%. High rates of use of the surgical method as an independent type of radical treatment were noted for stomach cancer (72.2%), rectal cancer (57.6%), and skin melanoma (77.5%).

Share beam method in the structure of the types of treatment used was 12.8% The frequency of use of the radiation method as an independent type of treatment prevailed in the treatment of malignant tumors of the cervix (36.4%), larynx (32.2%), oral cavity and pharynx (32.0 %), esophagus (25.0%).

Drug therapy as an independent method of antitumor treatment was used mainly for malignant neoplasms of lymphatic and hematopoietic tissue (76.8%).

Combined or complex method was used to the greatest extent in the treatment of malignant neoplasms of the ovaries (75.7%), breast (70.4%), uterine body (59.3%), larynx (39.5%), bladder (36.0%) .

Palliative care

Palliative (from French palliatif, from late Latin pallio, I cover, I protect), a measure that does not provide a complete, radical solution to the problem; half measure.

Palliative treatment aims to maintain life and relieve the symptoms caused by cancer, rather than to provide a cure. Palliative care is used for patients with advanced stages of illness and low likelihood of cure.

It is believed that palliative care can provide relief from physical, psychosocial and spiritual problems in more than 90% of patients with advanced cancer.

Alternative Treatments

One of the most pressing medical and social problems in oncology is refusal of official treatment.

In 2010, 3.3% of all newly identified patients and 4.7% of patients identified in stages I-III of the tumor process refused treatment. Moreover, among those who refused, 39.9% were patients with stage I-II tumor process, that is, with the potential complete cure.

People refuse various reasons, but one of them is trust alternative methods treatment of malignant diseases. Modern medicine has a negative attitude towards this kind of healing attempts for two main reasons:

Alternative methods do not meet the criteria of evidence-based medicine and, therefore, their effectiveness borders on quackery.
Delay in carrying out standard treatment“leads to advanced and widespread forms of the disease.

A patient suspected of having a tumor disease is included in I clinical group only after consulting an oncologist. When the diagnosis is confirmed, the patient falls into either clinical group II or IV, and after treatment - into clinical group III. If a relapse is detected, the patient will again transfer to clinical group II or IV, if treatment is not indicated due to the prevalence of the process.

In rare cases, followers of alternative treatments achieve success, which may be due to an erroneous diagnosis of cancer (especially in the case of early diagnosis). In addition, we should not forget about such a phenomenon as Peregrine syndrome.

Peregrine syndrome

Peregrine (Italian: Peregrine Laziosi, 1260-1345) was born in Italy. At the age of 30, he joined the order of Servite monks, created to glorify the Virgin Mary through ascetic deeds. Peregrine imposed a special penance on himself - to stand whenever it was not necessary to sit. This led to the development of varicose veins of the legs and at the age of 60 he developed trophic ulcer. The wound, from which blood oozed, was regarded by local doctors as cancer. Amputation of the leg was proposed as a treatment.

Before the operation, Peregrine began to pray intensely and, falling into a religious trance, saw Christ touching his leg. After the end of the trance, the wound healed and the bleeding stopped. According to Peregrine, it was prayer that helped him get rid of the disease.

After healing, Peregrine lived another 20 years and died at the age of 85. In 1726, he was canonized by Pope Benedict XIII and has since been considered the patron saint of cancer patients. And cases of spontaneous regression of cancer without any special antitumor treatment in oncology began to be called Peregrine syndrome.

It should be added that modern oncological statistics estimate the probability of spontaneous self-healing of an oncological disease as 1:200. Most often, the cause of spontaneous tumor regression is an accidental transfer at that moment. infection with high fever.

Conclusion

Fear of cancer is one of the most widespread in society. People are not afraid of high blood pressure (although death from stroke ranks high in the mortality structure), but the appearance of a tumor is stressful.

Perhaps that is why the problem of cancer has become one of the main problems that humanity is trying to solve. For those wishing to take part in reducing deaths from cancer, the following opportunities exist:

Increasing the survival rate due to early diagnosis and modern therapy.
Reducing the number of new cancer cases through primary prevention.
Participation in charity events to raise funds to help cancer patients.
Participation in scientific research (for example, using the Internet, registering in a distributed computing project and providing unused computer power to solve complex scientific problems - http://www.worldcommunitygrid.org).

Sources

Edgren G., Hjalgrim H., Reilly M. et all. Risk of cancer after blood transfusion from donors with subclinical cancer: a retrospective cohort study. // The Lancet. – 2007. – vol. 369. – p. 1724-1730.
National Cancer Institute (http://www.cancer.gov)
Rose J. Papac. Spontaneous regression of cancer // Cancer Treatment Reviews. - 1996. - vol. 22. - p. 395-423.
Schernhammer E.S., Laden F., Speizer F.E. et all. Night-shift work and risk of colorectal cancer in the Nurses" Health Study. // Journal of the National Cancer Institute. - 2003. - vol. 95. - p. 825-828.
The European Cancer Organization (http://www.ecco-org.eu/)
Internal medicine according to Tinsley R. Harrison. / Ed. E. Fauci et al. In two volumes. Per. from English - M.: Praktika, 2002.
WHO. Fact Sheet No. 297, October 2011 (http://www.who.int/mediacentre/factsheets/fs297/ru/index.html)
Prevention, early diagnosis and treatment of malignant neoplasms. / The lecture course within the framework of the subprogram “On measures to develop cancer care for the population of the Russian Federation” was developed by the team of the State Institution Russian Cancer Research Center named after N.N. Blokhin RAMS under the general editorship of Academician of the Russian Academy of Sciences and Russian Academy of Medical Sciences, Professor M.I. Davydova. - M.: Publishing group RONC, 2005. - 423 p.
The state of cancer care for the population of Russia in 2010. / Ed. IN AND. Chissova, V.V. Starinsky, G.V. Petrova. - M.: FGU “MNIOI im. P.A. Herzen" Ministry of Health and Social Development of Russia, 2011. - 188 p.

File creation date: February 04, 2012
Document modified: February 4, 2012
Copyright Vanyukov D.A.

Target palliative care- make life easier for the patient and his loved ones.”

Most solid tumors with metastases in adults are incurable, so the goal of treatment in such cases is to eliminate the painful symptoms of the disease and, if possible, make the patient’s life easier. Upon learning of their diagnosis, many patients experience fear of suffering and what they will endure. To optimize treatment, it is necessary that it be comprehensive from the moment of diagnosis, with the participation of specialists different profiles. The degree of involvement of these specialists during treatment varies.

However, the following goals of palliative treatment can be distinguished:

ensure maximum benefit for the patient from the participation of all specialists by providing him with medical, psychological, social and spiritual assistance at all stages of cancer;
to reduce, if possible, the negative psychological impact and experiences of the patient during the transition from “active” treatment to palliative;
to help patients “come to terms with their illness” and be able to live as actively as possible for the rest of their lives;
support the patient and their caregivers during treatment, and after death, help the family cope with the loss.

"System"

Specialists providing assistance to the patient are united in a group that has a complex organization and ensures the entire process of diagnosis, clarification of the stage of the disease and treatment. However, it is precisely this circumstance that often confuses the patient and his relatives, especially if the hospital is based in several buildings or there is a need to transfer the patient to a specialized center or the diagnosis has not been definitively established. Disadvantages associated with the relative autonomy of departments, the need to make extensive notes in the medical history, etc., have decreased with the advent of multidisciplinary teams and their composition includes doctors of a new specialty - patient care. Thanks to this organization of work, continuity in work improves different specialists, patients are less likely to have to repeat themselves when questioned, have a better idea of the purpose of each doctor's visit, and know who to turn to if they feel "lost in the system."

Difficulties associated with the need to communicate sad news

The message of sad news always causes negative emotions and dissatisfaction in the patient and his family members. Many patients leave the doctor without wanting to listen to their diagnosis and prognosis in more detail, without knowing what achievements exist in the treatment of their disease, or, on the contrary, they want to receive more information than they were told. There are few free people who prefer to know less, completely trusting their doctor (perhaps less than 5%). Patients who are dissatisfied with the amount of information provided to them have a more difficult time getting used to their diagnosis, more often experience anxiety and become depressed. It is important to know how much information a patient needs at one or another stage of his illness. Information is dosed taking into account the characteristics of the patient and his disease.

Good news strengthens the patient's trust in the doctor, reduces uncertainty, and allows the patient and his family to be better prepared practically, psychologically, and emotionally for treatment. In the event of sad news, the matter is not limited to its communication. This is a process in which the news is often repeated, the diagnosis is explained, the patient and their loved ones are informed about the state of affairs in this area, and perhaps prepare them for the death of a person close to them.

Delivering sad news - ten steps

This approach can be used as a general framework and adapted to specific situations. Remember that the patient has the right, but not the obligation, to listen to sad news.

Preparation. Check out the facts. Make an appointment. Find out from the patient who he allows to be present. Make sure you are not disturbed (turn off your cell phone).
Find out what the patient already knows. Both the doctor and the patient’s relatives usually underestimate the degree of his awareness.
Find out if the patient needs additional information.
Do not prevent the patient from denying your news. Denial is a way of coping. Let the patient control the amount of information.
Warn the patient that you are about to deliver unpleasant news. This will give him time to collect his thoughts and see if he can listen to your information.
Explain the situation to the patient if he asks for it. Speak more simply and clearly. Avoid harsh statements and medical jargon. Check whether the patient understood you correctly. Be as optimistic as possible.
Listen to the concerned patient. Avoid premature encouragement.
Do not interfere with the outpouring of the patient's feelings.
Summarize what has been said and make a plan, this will avoid confusion and uncertainty.
Express your willingness to help the patient. Communicating sad news is a process. Give the patient time to ask you questions; It is advisable to give him written information indicating the care specialist to whom the patient can contact in the future. Specify the time, place and purpose of the next meeting with the patient or the next study.

Uncertainty

Uncertainty is one of the psychological states, which are especially difficult for a person to experience. This is the condition in which most patients with oncological pathology remain from the moment they develop dangerous symptoms and the start of the examination until the end of treatment. The doctor also faces a dilemma when trying to reassure an anxious patient and inform him about his illness with an uncertain prognosis. This is especially difficult when it is necessary to obtain the patient's informed consent. clinical researches or flow methods whose effectiveness is problematic.

In such cases, there are always fears of discomfort, disfigurement, disability, addiction, and death.

Most patients who are told that they have a malignant tumor have already encountered similar disease from relatives or friends. It is advisable for the doctor to know how such an experience affected the patient. You can cheer him up. Misconceptions must be corrected. If concerns are justified, they should be acknowledged and the associated anxiety should be addressed.

Psychological support in the long term

Paradoxically, patients often feel a greater need for support after completion of treatment, when they need to reassess their lives and overcome the upcoming difficulties associated with survival. They often receive psychological support through observation programs and may feel helpless when regular contact with specialists ceases. This problem is compounded by the fact that there are only a few curable cancers in adults, so patients must live with the fear of relapse.

Symptomatic treatment

Physicians and other health care professionals involved in the day-to-day care of cancer patients have a significant clinical responsibility for assessing symptoms and managing them.

Symptoms may vary:

directly related to a malignant tumor;
manifestation of side or toxic effects of palliative therapy;
affecting the physical, psychosocial, emotional and spiritual sphere of the patient;
caused by another reason not related to the underlying disease.

Therefore, the symptoms detected in the patient require careful assessment in order to create the optimal plan to eliminate them.

Eliminating pain

Elimination of pain - an important part both palliative and radical treatment of cancer patients. In approximately 80-90% of cases, pain can be eliminated by prescribing conventional painkillers orally in combination with drugs from other groups in accordance with WHO recommendations. Not effective pain relief may worsen other symptoms, including fatigue, anorexia and nausea, constipation, depression and feelings of hopelessness. Pain can also become an obstacle to regularly taking chemotherapy drugs and visiting a doctor on time. Relieving pain at the cost of increasing side effects is unacceptable in most cases, so there is a need to develop effective interventions.

The most common causes of intractable pain in cancer patients may be the following.

A simplified approach to examination that does not allow establishing the real reason pain and its type, identify and evaluate the general unfavorable background. lowering the pain threshold. If this background is not taken into account, the prescription of analgesics alone will not be able to eliminate pain. Correction of the psychological background is necessary.
Lack of a systematic approach to pain management, including a lack of understanding of the WHO three-step regimen for pain management in cancer patients, the role of adjuvant analgesics, and opioid dose titration. “Panic prescription” of analgesics often leads to the development of side effects.

The ideal treatment for pain involves addressing its cause. Therefore, correctly selected palliative chemotherapy, radiation or hormonal therapy comes first. In palliative treatment, the use of analgesics is a generally accepted criterion for assessing response to therapy. However, even if the patient is prescribed a course of antitumor therapy, the use of analgesics does not lose its meaning, since the analgesic effect of therapy does not occur immediately and, moreover, can be incomplete and short-lived.

Categories of pain in cancer

The role of a carefully collected anamnesis in the treatment of pain can hardly be overestimated, since it allows doctors to clarify its mechanism and, therefore, select the optimal pain therapy.

Is the pain acute or chronic?

A malignant tumor does not always cause pain in a patient. Sudden pain can be a consequence of an acute complication of both the tumor itself and antitumor therapy, and sometimes it is completely associated with other causes. Examples of such causes include a pathological bone fracture leading to the need for orthopedic treatment, acute pathology organs abdominal cavity, requiring urgent surgical examination, or mucositis that developed during or after radiation therapy.

On the other hand, chronic increasing pain may indicate tumor progression and infiltration of soft tissues and nerve roots.

What type of pain?

Somatic pain, for example with metastases in the bones, phlegmon, is localized and constant.

Visceral pain is usually vaguely localized, variable in nature, and often accompanied by nausea and other symptoms (for example, with metastases to the liver or abdominal lymph nodes).

Neuropathic pain, classically described as “shooting pain,” is usually localized to the distribution of the affected nerve (eg, nerve root compression pain).

How does the patient interpret pain?

Pain has a strong emotional component and is significantly influenced by mood and morale. Understanding how a patient interprets their pain can help create a more realistic plan to manage it. For example, does the appearance of “new” pain cause anxiety in the patient, does it reduce his general activity, does the patient consider it a harbinger terminal stage of your illness. Eliminating anger, fear or irritation helps achieve more effective pain relief.

Drug treatment of pain

The principles of the three-step pain treatment regimen are as follows.

The analgesic is selected depending on the intensity of the pain, and not on the stage of the tumor process.
Analgesics for long-term use are prescribed to prevent pain. It is also necessary to have analgesics available for quick relief pain when it intensifies.
Prescribing one pain medication is rarely sufficient.
Treatment should begin with a fast-acting analgesic, and then switch to long-acting drugs and maintain a stable dose.
Spioids are usually used in combination with non-narcotic analgesics.
Adjuvant analgesics are usually prescribed based on the cause and type of pain.

First stage. Analgesia with non-narcotic drugs

Paracetamol is a non-narcotic analgesic. It also serves as an antipyretic, but does not have an anti-inflammatory effect. Side effects when prescribed in therapeutic dose rarely occur. As an alternative, drugs from NSAID groups, for example, ibuprofen at a dose of 400 mg 3 times a day, although this leads to the need for simultaneous administration of gastroprotectors and control of renal excretory function. Paracetamol can be used in combination with NSAIDs without fear of serious complications.

Second stage. Analgesia with weak opioids

Patients should continue treatment with non-narcotic analgesics. If the analgesic effect is insufficient, a weak opioid drug is prescribed. Subtherapeutic doses of codeine, which are often found in over-the-counter medications, should be avoided.

Third stage. Analgesia with potent opioids

If the pain does not stop, basic analgesic therapy with non-narcotic analgesics should be continued, but weak opioids should be replaced with strong ones. Treatment begins with fast-acting drug, given every 4 hours, with double the dose at night. The analgesic effect occurs after approximately 30 minutes, reaches a maximum at 60 minutes and lasts 4 hours if the dose is selected correctly. The dose prescribed “on demand” when pain intensifies should be one-sixth of the daily dose of the drug. Laxatives should be prescribed at the same time and antiemetics should be available.

Morphine solution or tablets (fast-acting drug):

10 mg every 4 hours (eg, at 6 a.m., 10 a.m., 2 p.m., 6 p.m., and 20 mg at 10 p.m.);
dose “on demand” - 10 mg;
oral administration is more preferable, although the drug can also be administered subcutaneously and intravenously;
treatment with morphine is carried out while taking laxatives; if necessary, the patient is given antiemetic drugs;
basic therapy also includes taking paracetamol in combination with or without NSAIDs.

Opioid dose selection

The morphine dose is adjusted every 24 hours until the optimal dose is found. The on-demand dose received during the previous 24 hours should be included in the adjusted dose. For example, if over the past day the patient received 30 mg of morphine “on demand”, in addition to those prescribed as basic therapy 60 mg, make the following correction:

the single dose is increased to 15 mg;
the dose taken at night is adjusted to 30 mg;
The on-demand dose is set to 15 mg.

After dose stabilization (i.e., when the patient receives the drug “on demand” no more than once a day), morphine is prescribed, for example, at a dose of 10 mg every 4 hours and at a dose of 20 mg at 22 hours.

The total daily dose is 60 mg.
Extended-release morphine at a dose of 30 mg 2 times a day.
Morphine is prescribed “on demand” fast action at a dose of 10 mg. The bioavailability of morphine when taken orally is approximately 30%.

A significant part of it is metabolized (first pass effect) and excreted along with metabolites by the kidneys. The dose of morphine is subject to significant individual variations. Over time it has to be increased somewhat. Morphine has an important feature - a proportional relationship between the total daily dose and the dose taken “on demand”. Clinical experience and clinical trial results indicate that there is no pain that cannot be controlled with opioids, the only question is the dose of the drug. However, for some types of pain, this dose is too high and therefore unacceptable due to side effects, such as sedation. In such cases, for example with neuropathic pain, especially important role adjuvant analgesics play a role.

Opioid toxicity.

Nausea and vomiting: metoclopramide 10-20 mg 4 times a day or haloperidol 1.5-3 mg at night.
Constipation: regular use of co-dantramer or co-dantrusate.
Drowsiness: usually the severity of this effect decreases by the 3rd day after the next dose increase.
Dry mouth: unlimited fluid intake, oral care.
Hallucinations: haloperidol in a dose of 1.5-3 mg orally or subcutaneously in an acute situation.
Respiratory depression occurs only in cases where the dose of the drug exceeds the dose required to achieve analgesia, or when the drug accumulates, for example due to impaired renal excretory function.
Dependence (physical and mental) and addiction.

Alternatives to potent opioids for chronic pain.

Diamorphine: Used when parenteral analgesic administration is necessary.
Fentanyl: patients with chronic constant pain a transdermal form of the drug (fentanyl patch) is prescribed, and morphine is administered if the pain increases. The sedative effect and the ability to cause constipation are less pronounced. When the first patch is applied, an alternative opioid is administered simultaneously.
Methadone: can be used instead of morphine, administered orally, the toxic effects are the same, although the analgesic is less predictable. In cases of liver dysfunction, methadone treatment is safer.

Adjuvant analgesics

The need for adjuvant analgesics may arise at any stage of pain management. For optimal choice drugs, it is important to understand the mechanism of pain, but having prescribed a drug, you need to be prepared to also stop it if it is not effective enough. Otherwise, the patient will accumulate a lot of drugs, the prescription of which will be difficult to regulate, and the effectiveness of treatment will be low. Adjuvant analgesics include the following drugs.

Other treatments

Pain relief methods

For some malignant tumors, such as pancreatic cancer, which grows into neighboring tissues, they resort to blockade of the celiac plexus. In case of tumor infiltration of the nerve trunks in the armpit, a brachial plexus block is performed to eliminate pain.

For pathological fractures, when surgical fixation of the fragments is impossible, epidural anesthesia is indicated.

For severe pain that does not respond to conventional treatments, pain management specialists should be consulted.

Palliative radiotherapy

External beam radiation therapy can help treat pain associated with local tumor infiltration, such as metastatic lesions in the bone. However, it should be remembered that the maximum analgesic effect of radiation therapy is achieved within several weeks. Additionally, radiation may make the pain worse initially. Pain management during and after radiation therapy should be given due attention.

The use of radioisotopes that accumulate in bones, such as strontium, is justified for diffuse pain associated with osteoblastic metastases, for which conventional painkillers are ineffective. Radioisotopes are especially actively absorbed in areas with intense bone turnover. There is a risk of severe myelosuppression with this treatment method.

Maintenance therapy

There are also a number of other treatments available to complement pain management.

These include the following:

transcutaneous electrical nerve stimulation;
occupational therapy;
physiotherapy;
acupuncture, aromatherapy and other reflexology methods;
relaxation therapy, including massage and hypnosis;
psychotherapy and patient education.

Elimination of nausea and vomiting

Nausea and vomiting occur in approximately 70% of patients with advanced cancer. As with treating pain, eliminating these symptoms also requires understanding their mechanisms.

Iatrogenic. Prescribing opioids may cause nausea. Chemotherapy may cause nausea and vomiting at the beginning or during treatment. Radiation therapy, especially if the brain or small intestine, may cause nausea.
Metabolic. Elevated serum calcium may be accompanied by dehydration, constipation, abdominal pain, and confusion. Some patients experience nausea and vomiting without accompanying symptoms. Uremia also causes nausea, often without any other symptoms. If a metabolic mechanism for the occurrence of nausea and vomiting is suspected, it is necessary to perform biochemical analysis blood with determination of serum calcium and kidney function.
Promotion intracranial pressure associated with metastatic damage to the brain and its membranes. Anamnesis plays a role in diagnosis (changes in the nature of the headache). It is necessary to examine the fundus to exclude papilledema.
Subacute or acute intestinal obstruction, especially if the patient is diagnosed with a malignant tumor of the abdominal organs. The presumptive level of obstruction can be established on the basis of anamnesis [time of onset of nausea and vomiting, contents of vomit (unchanged food, fecal vomit), presence of stool and passage of gas, abdominal pain]. To clarify the diagnosis and the possibility of eliminating intestinal obstruction, CT scan of the abdomen and intubation enterography are performed.
Pseudo-obstruction of the intestine. If this pathology is suspected, along with other studies, a digital rectal examination should also be performed. If a patient notices the appearance of watery stools against the background of symptoms of intestinal obstruction, then it is most likely due to the fact that the fluid in the dilated intestine flows around the feces in the area of the obstruction.
Pain. Insufficiently effective pain relief can cause nausea.

Many neurotransmitter receptors are involved in the development of nausea and vomiting. Most of them are located in various areas of the central nervous system. However, peripheral receptors and neural pathways also play a significant role. Optimal selection of an antiemetic drug requires an understanding of the mechanisms of nausea and knowledge of the point of application of the drug.

The antiemetic drug is selected taking into account the most probable cause and mean in the most acceptable way.
If vomiting makes it impossible to take the drug orally, it is prescribed sublingually, buccally, rectally, intravenously, intramuscularly or subcutaneously. Long-term subcutaneous administration of the drug using a perfusion pump is especially effective.
Patients should take antiemetic drugs regularly.
If nausea and vomiting do not disappear within 24 hours, a second-line drug is prescribed.
Elimination of nausea and vomiting includes measures aimed at correcting each of the causes of these symptoms (hypercalcemia, renal excretory function, treatment with drugs that can cause vomiting, intestinal obstruction).
Metoclopramide is classified as prokinetic. It can be prescribed with caution in cases of impaired gastric emptying or subacute intestinal obstruction, but if vomiting or colicky abdominal pain worsens, the drug should be discontinued. In case of complete intestinal obstruction, metoclopramide cannot be prescribed. Cyclizine neutralizes the effect of metoclopramide, so both drugs should not be prescribed at once.
It should be remembered that there may be several reasons that cause nausea and vomiting in a cancer patient. If they are unknown or first-line therapy is ineffective, it is advisable to prescribe levomeprazine, which acts on several types of receptors at once. Due to its wide spectrum of pharmacological activity, this drug is often effective even in cases where combination therapy with selective antiemetic drugs does not help. The anxiolytic properties of levomeprazine make it preferable for this category of patients, although when prescribed at a dose of more than 6.25 mg/day, it often has a pronounced sedative effect.

Eliminate constipation

Causes of constipation

There are many causes of constipation in cancer patients.

Drugs, especially opioid analgesics and some antiemetics, such as 5-HT3 receptor blockers.
Dehydration associated with insufficient fluid intake frequent vomiting or diuretic therapy.
Anorexia: insufficient food intake and changes in its quality composition.
Reduced motor activity and general weakness.
Hypercalcemia, especially if it is combined with dehydration, nausea, abdominal pain, confusion, although those listed associated symptoms may be absent.
Spinal cord compression: Constipation is usually a late manifestation.
Intestinal obstruction associated with adhesive process due to tumor infiltration, surgical intervention or radiation therapy, as well as obstruction by a tumor of the intestine or compression of the pelvic organs by a tumor.

Clinical manifestations

Retention of stool or absence of stool.
Nausea and vomiting.
Abdominal pain, usually colicky.
“Paradoxical diarrhea” (the appearance of watery stools against the background of constipation).
Urinary retention.
Acute psychosis.

Diagnostics

History: Questioning the patient is especially important to identify contributing factors and preventable causes of constipation, such as those related to difficulties caring for the patient at home.

Digital rectal examination.

X-ray of the abdomen is indicated only in cases where it is necessary to differentiate intestinal obstruction from pseudo-obstruction.

Blood test: serum calcium level.

Treatment

Non-medicinal.

Use more liquids and foods rich in fiber.
Increased physical activity.
Possibility of privacy. Respect for the patient's self-esteem.

Medication.

Treatment of cachexia and anorexia

Cachexia

Cachexia is understood as an increase in energy consumption independent of will, leading to a sharp decrease in the mass of both muscle and fat tissue.

Occurs in more than 85% of patients with advanced stage cancer.
Often associated with anorexia, cachexia is different from fasting because weight loss cannot be prevented by increasing nutrient intake alone.
Cachexia most often develops in patients with advanced solid tumors, especially when lung cancer and gastrointestinal organs.
The mechanisms of development of cachexia are unclear, although the role of cytokines circulating in the blood is obvious, such as tumor necrosis factor, which causes metabolic disorders, in particular protein breakdown, lipolysis, and enhancing gluconeogenesis.
Cachexia is the main cause of symptoms that appear at the end of the disease and lead to physical impotence, psychological and social maladjustment. It is painful both for the patient and for his family.

Anorexia

Decreased or lack of appetite.

Can be combined with increased fatigue and cachexia with advanced tumor process and have no other specific reason.

However, when examining you should be aware of possible preventable causes of anorexia:

nausea;
constipation;
depression;
metabolic disorders, such as increased calcium levels in the blood, uremia;
infection, such as oral candidiasis;
intestinal obstruction, ascites.

Treatment

The cause should be eliminated if possible. The measures taken usually do not affect cachexia.

General measures

Nutrition optimization. It is recommended to eat often, in small portions, and eat when you feel hungry. Food should be high in calories and have a relatively small volume. To stimulate appetite, you can drink a small amount of alcohol.

It is necessary to ensure that food brings pleasure to the patient and does not cause negative emotions. Caregivers should not be overly persistent.

It is necessary to stimulate the patient's activity whenever possible.

Drug treatment

Nutritional supplements. High-calorie protein mixtures (for example, Ensure). Glucocorticoids (eg, prednisolone 25 mg once daily) may improve appetite and general state, reduce nausea, but do not increase muscle mass.

Progesterone improves appetite, although there is no convincing evidence that it causes weight gain.

Sometimes, against the background of active antitumor therapy, enteral and parenteral nutrition is advisable, but with tumor progression it is not justified.

Elimination of symptoms of respiratory damage

Causes of shortness of breath in cancer patients

There are many reasons for shortness of breath in patients with a malignant tumor with metastases. They may be treatable, so patients should be carefully examined.

Pulmonary causes.

Lung tumor.
Pneumonia.
Effusion in pleural cavity(if fluid accumulates again, the advisability of pleurodesis should be discussed).
Carcinomatous lymphangitis.
Obstruction of a large airway with collapse of the lung distal to the obstruction.
Concomitant chronic obstructive pulmonary disease.

Cardiovascular causes.

Effusion into the pericardial cavity.
Congestive heart failure.
Pulmonary embolism.
Obstruction of the superior vena cava.
Anemia.
Heart rhythm disturbances. Neuromuscular disorders.
Muscle weakness and rapid fatigue.
Armored breast cancer (cancer en cuirasse) manifested by tumor infiltration of the chest wall.
Respiratory depression, such as that associated with opioids.
Damage to peripheral nerves, such as the phrenic nerve.
Tumor infiltration vagus nerve: hoarse voice, sometimes "bull" cough. An examination by an ENT specialist is indicated: palliative injection of a soft tissue filler into the vocal fold may help eliminate this symptom.

Psychological state of the patient.

Fear, anxiety.

Treatment

If possible, eliminate the cause of shortness of breath

Required A complex approach using non-drug treatment methods, such as breathing exercises, physiotherapy, relaxation therapy, massage. We need to help patients so that their expectations are realistic.

A number of medications can be tried as a palliative measure to reduce shortness of breath.

Opioids. Morphine at a dose of 2.5 mg 4 times a day orally reduces respiratory drive and weakens the response to hypoxia and hypercapnia. It reduces the discomfort associated with shortness of breath and also suppresses cough.
Benzodiazepines reduce anxiety, cause sedation, and may also relax muscles. Concerns regarding the possibility of respiratory depression are usually unfounded, particularly when treated with lorazepam 1-2 mg orally on demand.

Oxygen therapy can eliminate or reduce hypoxia. It may also reduce shortness of breath, which appears to be due to a facial refreshing effect or a placebo effect. Caution should be exercised in patients with chronic obstructive pulmonary disease.

Treatment of lymphedema

Impaired lymphatic drainage leads to excessive accumulation of interstitial fluid called lymphedema. Lymphedema most often occurs on the extremities. It is a dense swelling, in which, after pressing with a finger, a hole does not form on the tissue, limits the patient’s activity and is difficult to treat. The causes of lymphedema are:

tumor infiltration of lymphatic vessels;
violation of the integrity of the lymphatic system associated with excision of lymph nodes, and changes in it caused by radiation therapy.

Lymphedema of the limb should be differentiated from edema associated with thrombotic or tumor occlusion of the deep veins. It is very important to distinguish between these conditions, since their treatment is different.

Prevention of lymphedema

Prevention of lymphedema is more rational and effective than treatment. It is important to give the patient a correct understanding of this complication. If necessary, you can contact a lymphedema specialist. Massage and physical exercise.

It is important to avoid injury and infection of the affected limb by wearing protective gloves when working on garden plot, defence from sun rays performing venipuncture on a healthy limb). Vigorous treatment for skin infections.

Treatment

Daily skin care. Self-massage and exercise. Wearing elastic stockings.

For refractory edema, elastic bandaging of the limb may be necessary before fitting elastic stockings. There are no drugs to treat lymphedema.

Psychological support and correction of mental disorders

Assessing the mental state, providing psychological support and correcting mental disorders should be an integral part of the treatment of a cancer patient. Psychological problems may be associated with such emotions and conditions as:

denial and confusion;
anger;
anxiety;
sadness and depression;
feeling of loss;
alienation;
insufficient management of one's condition.

Clinicians should be aware that a patient's psychological problems are often unaddressed and take the time to examine mental status. It is always necessary to be attentive to the problems of the patient and those caring for him. The patient's mental state can be assessed using various rating scales and systems.

Hospital Anxiety and Depression Scale.
Functional assessment of the effectiveness of cancer treatment.
Functional vital indicator in cancer patients.
European Quality of Life Questionnaire.

Treatment

Self-help. Patients should be involved in monitoring treatment, helping them set realistic goals and formulate coping strategies.

Formal support. Patients have the opportunity to seek help from an experienced consultant at a clinic or hospital information center. Specialists providing palliative treatment have the opportunity, if necessary, to seek help from a psychologist and psychiatrist.

Psychotherapy. If the patient has severe anxiety and depression, it is advisable to conduct behavioral and short-term psychotherapy.

Psychiatric treatment. The attending physician of a cancer patient must recognize in time mental disorders requiring consultation with a psychiatrist and medicinal correction(for example, antidepressants or anxiolytics). Psychotropic medications help approximately 25% of cancer patients with anxiety and depression.

Help with terminal excitation

Assessment of the patient's condition

Even with death approaching mental state The patient should be given due attention, since in some cases it is possible to alleviate suffering and reduce pre-death excitement.

The following factors may cause additional suffering to the patient:

However, the scope of examination of a dying patient should be limited so as not to cause him additional suffering. It is important to achieve an optimal state of physical and psychological comfort to ensure a dignified and peaceful end to life.

Treatment for terminal cancer

All drugs that do not have significant for the patient. In practice, this means that only analgesics, anxiolytics and antiemetics are left. If a dying patient unconscious, glucocorticoids are usually discontinued.

Oral administration of drugs should be avoided. Subcutaneous administration using an infusion pump is often preferred. This does not require hospitalization, although significant efforts may be required from health care workers and relatives caring for the patient.

Intravenous administration of drugs is also undesirable (sometimes it is simply impossible). Cannulating a vein is painful and may cause additional suffering.

Drugs should be administered as required. Subcutaneous infusion is optimal, allowing relief of painful symptoms without the need for additional doses. It is important that caregivers have ready access to the drug to administer it as needed.

Opioids. Treatment with these drugs, if previously administered, should be continued, but the dose of the drug should be reconsidered for subcutaneous administration. The dose on demand is 1/6 of the daily dose. If opioids have not been previously administered to the patient, but need to be eliminated intense pain, a small dose of diamorphine is administered, for example 5-10 mg subcutaneously for 24 hours, and if the pain intensifies, an additional 2.5 mg subcutaneously. Observe the effect and increase the dose if necessary.

Anxiolytics, such as midazolam, are administered at a dose of 10 mg/day subcutaneously and 2.5-5 mg on demand. The effect of the drug should be carefully monitored, as there is often a need to significantly increase the dose. The drug also has antiemetic properties. Sometimes, despite increasing the dose of midazolam, agitation increases. In such cases, levomeprazine is additionally prescribed, which has a sedative property. First, 25 mg is administered subcutaneously, then an additional 50 mg over 24 hours. Depending on the effect, the dose can be increased. Haloperidol is also effective, prescribed in a dose of 5 mg subcutaneously on demand.

Antiemetics are added to treatment at the same time as opioids.

Increased bronchial secretion is often more burdensome for the patient’s relatives than for him. A conscious patient is more concerned about dry mouth - an inevitable side effect drug suppression bronchial secretion. If the patient is unconscious, then it is usually sufficient to change the position of his body or carefully evacuate the mucus using suction. Usually, hyoscine hydrobromide is administered subcutaneously at a dose of 400 mcg or the drug is added to the syringe of the perfusion pump. Instead of hyoscine hydrobromide, glycopyrronium can also be prescribed. The side effects of these drugs are the same as those of M-anticholinergic drugs.

Explanatory work. It is necessary that the patient’s relatives (and the patient himself, if he is conscious) know what purpose this or that doctor’s prescription serves. It should be explained how important it is to achieve adequate pain relief while avoiding significant sedation. Caregivers should know what drugs are contained in the subcutaneous infusion solution, monitor their effect and adjust the dose if necessary. Time spent at the bedside of a dying patient will allow relatives to experience the loss with greater understanding and without anger or suspicion and will leave them with fewer questions regarding the last hours of his life.

Referring to an outpatient or inpatient palliative care service for advice or assistance for refractory symptoms or other care before or after death.

Complex symptomatic treatment

Care for a dying patient in a hospital is increasingly becoming formalized with the participation of teams of different specialists. This is in line with NICE guidelines covering the physical, social, psychological and spiritual aspects of such care.

Oncobol group wedge:

1-a – suspicion of malignancy;

1-b – swelling of the buttocks;

2 – subject to special (radical) treatment;

3 – practically healthy after radical treatment;

4 – widespread swelling (palm or symptomatology).

Complex treatment- a combination of two different methods (oper + chemo)

Combinir lech– several unidirectional methods (radiation therapy + medication)

Combined treatment– one method using several techniques (radiation ter-distant + local, intracavitary

Targeted therapy-cytostatic ter method medicinal effects The poison on the tumor has a cytostatic effect: hormone therapy and immunotherapy - on the tumor cell there is an AT for the development of tumor growth, the drugs block receptors (tropic to AT) on top of the cells.

Radical ( from lat. radicalis, radical) - aimed at eliminating the swelling and presuming a complete recovery or achieving remission. Remission is a state when the tumor has responded to treatment or control. There is a difference between complete remission (all signs and symptoms of the disease are absent) and partial (the swelling has decreased in size, but not completely disappeared). Rem can last from several weeks to several years. Complete remission for 5 years is considered as a patient's recovery.

Radical treatment is a series of interventions, including psychosocial support, surgery, radiation and drug therapy.

Lekar therapy as an independent method of anti-optional treatment is used as a basis for malignant neoplasms of lymphatic and hematopoietic tissues

Combined or complex the method is used to the greatest extent in the treatment of malignancies of the ovaries (75.7%), breast (70.4%), uterine body (59.3%), larynx (39.5%), bladder (36.0% ).

Palliative aimed at supporting life and relieving symptoms caused by cancer, and not at curing. Fell pom pri pats with launch stud pain and with low ver. It is believed that the treatment can provide relief from physical, psychosocial and spiritual problems in more than 90% of patients with advanced cancer.

Symptomatic treatment of pain syndrome

For pain relief, I used analgesics, The regimen, dosage and regimen will be prescribed by the doctor based on the pain condition and the severity of the pain syndrome. The drug can be prescribed by the hour at a determined industrial time, with the last dose taken or administered when the previous one has not yet taken effect. This is what happened when the patient did not have time to experience pain between taking medications.

WHO "pain staircase" when As the patient's pain worsens, the analgesic is towards a strong or narcotic. Usually, I start with non-narcotic analges (paracetamol, ketorol), and as the symptoms progress, switch to weak opiates (codeine, tramadol), and then to strong opiates (morphine). .

Symptomatic treatment of dyspeptic syndrome

Cure criteria:

No complaints or signs of inflammation during gynecological examination;

Normalization of blood counts;

Negative results of bacterioscopic and bacteriological studies;

Restoring normal menstrual cycle if it is violated;

Restoring fertility.

Chemotherapy of tumors. Main groups antitumor drugs. Indications and contraindications for chemotherapy.

Chem is a method of treating cancer pain using a drug that inhibits proliferation or irreversibly damages cancer cells.

Anti-tumor effect achieved : a) direct action(main mechanism )b) increasing time cell generation c) applied cancer cell damage, because of the cat she underwent metastasis d) stimulation of immune and regulate reactions

Main groups of antitumor drugs:

1. Alkylating prep: replacing a hydrogen atom with an alkylating group; active in G2 and M phase:

Chlorethylamines are a product of bis-(beta-chloroethyl) amine (nitrogen mustard analogues)

Ethyleneimines

Nitrosomethylurea derivatives

2. Antimetabolites: yavl antag veshchv, providing norms metab; asset in phase G2 and S:

Folate antagonists

Purine analogues

Pyrimidine analogues

3. Antibiotics: interacts with DNA, changes its template activity in the percentage of replication and transcription; active in M phase:

Adriamycin (doxorubicin), bleomycin, actinomycin D, bruneomycin, rubomycin, etc.

4. Substances plant origin : disrupt mitosis; active in M or G2 phase:

Alkaloids (vincristine, vinblastine, colhamine, etc.) – active in the M phase

Epipodophyllotoxins (etoposide, VP 16, VP 16-213) - active in G2 phase

5. Platinum derivatives: interaction with DNA; active in M phase:

Cisplatin, carboplatin, platidiam

Contraindications to chemotherapy: - insensitivity of the tumor - starting the process in the soch with cachexia - decompensated chronic disease - we take it - very old and less than 6 months of age - presence of metastasis in the central nervous system (relates to the opposite) - primary changes in the blood (leukocytes<3000; тромбоц <100 000) + Невозмож оценить эффект леч, выяв и устр его осло. + Медл раст бессимпт опух, не подд излеч.

Indications

1.- lymphomas, nephroblastoma, Ewing’s sarcoma, retinoblastoma, rhabdomyosarcoma in children, lymphogranulomatosis and some high-grade lymphomas in adults (the probability of cure reaches 50% or more);

Testicular germ cell tumors - seminomas, non-seminomas (probability of cure - 75% or more);

Choriocarcinoma in women (probability of cure -90% or more);

Acute leukemia in adults, ovarian cancer (probability of cure - 15-20%).

2. Extended life of creatures (with little faith to heal)

3. Reducing the severity of symptoms in disseminated forms of malignancy.

4. Treatment of asymptomatic tumors:

If an aggressive tumor is detected, it is sensitive to the doctor;

5. Reduce the volume of the surgical intervention plan (neoadjuv chemotherapy).

Chemotherapy methods:

1. According to the intended purpose: a separate method and a complementary method (adjuvant or neoadjuvant)

2. By regimen: monochemotherapy, polychemotherapy, intensive or high-dose

3. By method of application: systemic, local, regional

Polychemotherapy options:

a) cytostatic + cytostatic b) cytostatic + hormone c) cytostatic + antidote

Principles of polychemotherapy:

1. Cytotoxic (prime prep, different mechanics)

2. Toxicological (prep with different toxicity)

3. Biochemical (primarily things that cause various biological disorders)

4. Cytokinetic (necessity of cell synchronization in the cycle)

TYPES OF LECTURE

1. Primary chem local spread of inoperable and metastatic proc. There are curative and palliative chemicals. Pal When identified, he gave the metastasis with the goal of not curing, but prolonging life and improving its quality.

2. Adjuvant chemo An additional method of treatment is to prescribe radicals or cytoreductive surgery or radiation therapy after prolapse, i.e. in the absence of residual tumor and gave metastasis.

3. Neoadjuvant chemo before surgery, intervention or radiation therapy is planned in order to reduce the volume of the primary tumor and its regulation.