Modern methods of tumor diagnostics. Morphological diagnosis of neoplasms

Persons of both sexes are equally affected by tumors, occur at different ages, but sarcomas occur in younger people and crayfish- in older people. Different tumors have their own symptoms depending on:

morphological structure,

organ where the tumor develops

flow stages.

Every medical worker should have oncological vigilance and understand the general principles of diagnosis, treatment of malignant neoplasms.

The concept of oncology includes:

Knowledge of microsymptomatics - symptoms of early manifestations of malignant tumors.

Knowledge of precancerous diseases and their treatment.

Knowledge of the organization of oncological care and rapid referral of the patient to the destination.

A thorough examination of each patient who applied to a doctor (paramedic) of any specialty to identify a possible disease with a malignant tumor.

In difficult cases of diagnosis, it is necessary to think about the possibility of an atypical or complicated course of a malignant tumor and make a diagnosis as soon as possible and not start treatment without specifying the diagnosis. Why resort to a comprehensive examination of the patient with the involvement of more experienced professionals.

Early diagnosis of tumors is very important, it is based on subtle symptoms that often do not cause anxiety in the patient and are easily missed by doctors who do not have oncological alertness.

The doctor, paramedic should be able to take into account the data obtained during the collection of anamnesis:

Unmotivated depression, apathy, loss of interest in work, in others.

Change in established habits, aversion to certain types of food and smells.

The appearance of various kinds of secretions (mucus, macros, blood from the nose and rectum) and bleeding from the lungs and digestive tract.

The presence of discomfort in the gastrointestinal tract - constipation, diarrhea, bloating.

Partial or complete obstruction of the gastrointestinal tract.

The occurrence of various kinds of formations and infiltrates on skin, in the chest and abdominal cavities, an increase in visible lymph nodes.

Basic methods for diagnosing malignant tumors.

Microsymptoms (cancer alertness).

All methods of objective research (examination, palpation, percussion, auscultation).

Various methods of X-ray diagnostics.

Endoscopy (laparoscopy, thoracoscopy, duadenoscopy, sigmoidoscopy).

Histological method (aspiration, puncture, incisional biopsy with cytological examination).

CT - computed tomography.

Thermal imaging.

Echolocation. ultrasound.

Scanning is a method of obtaining images of internal organs. The method is based on the registration of gamma radiation of the RFT radiopharmaceutical preparation.

Markers (pointers, indicators) of tumors.

Study of indicators (markers) of tumor processes

Markers (pointers, indicators) of tumors- substances that are found in the blood, urine or tissues of the body of patients with some kind of tumor or different types of tumors in larger quantities than normal. Tumor markers can be different substances - hormones, enzymes, antibodies.

Research objectives.

Recognition, early diagnosis of tumor diseases by the most sparing methods for patients.

In addition, markers are also used to evaluate the effectiveness of tumor treatment by various methods. In these cases, a decrease in the content of markers in the blood with an initially increased amount before treatment is a favorable indicator.

How research is done. Blood to determine the content of tumor markers is taken from a vein.

Informativity of the method and its limits.

P.S.A. prostate-specific antigen

widely used to examine men with suspected prostate tumors. Its increase is considered the most sensitive marker for detecting prostate cancer and evaluating the effectiveness of its treatment. An increase in PSA in men after 40 years of age is a signal for a thorough examination of the prostate, including ultrasound and biopsy of the prostate. At the same time, it must be remembered that PSA may moderately increase in approximately 30-50% of patients with benign hypertrophy of the gland (adenoma) and chronic inflammation of the gland (prostatitis).

CA-125. The increase is most informative in serous ovarian cancer, but does not increase in patients with mucous ovarian cancer. Increases with sufficiently large tumors of the breast and colon. A moderate increase in the marker may be in individuals with non-tumor diseases - endometriosis, inflammatory diseases of the colon ( ulcerative colitis, Crohn's disease), cirrhosis of the liver, chronic pancreatitis.

CA-15.3. The increase is informative in breast cancer. At the same time, there may be an increase in benign breast diseases.

CA-19-9. The increase is observed mainly in cancer of the rectum and colon, as well as the pancreas. A moderate increase in CA-19-9 occurs in patients with chronic pancreatitis, ulcerative colitis.

Ca-72-4. The increase is observed mainly in gastric cancer

AFP. An increase in alpha-fetoprotein is considered a reliable marker of primary liver cancer; its content is also increased in ovarian and testicular tumors. At the same time, an increase in AFP may occur in pregnant women with liver cirrhosis, chronic active hepatitis, and toxic liver damage.

CEA. An increase in carcinoembryonic antigen is used in the recognition of colon and lung cancer. In a small percentage of cases, CEA is elevated in patients with breast and ovarian cancer. CEA also increases in such diseases as chronic pancreatitis, chronic hepatitis, pneumonia, obstructive jaundice.

FDP. An increase in fibrinogen metabolic products is observed in many tumors - lung, breast, stomach, rectum, colon, liver, ovaries, esophagus, thyroid gland, pancreas, Bladder, malignant lymphomas, leukemias.

ROM's(Fre radicals)

An increase in the number of free oxygen radicals in the blood indicates the presence of damage processes in the body. This is observed in a wide range of diseases, including those that do not manifest themselves for a long time, but are extremely dangerous. These are atherosclerosis, chronic hepatitis, kidney diseases, diabetes mellitus, chronic lung diseases, diseases of the stomach and intestines, tumors of various organs.

Usually, when examining patients, one of the markers of the tumor that is suspected in this patient is assigned. During preventive examinations, a comprehensive study of many markers is carried out. This gives the best result, as it allows searching for many types of tumors on early stages. Early recognition of tumors significantly improves the results of their treatment.

Treatment of tumors.

Radical operation aimed at eliminating the tumor and suggests the possibility of complete recovery. The operation is performed in compliance with the rules of ablastics (ablastics - wrestling). The tumor is removed within the edor tissue, and nearby and regional lymph nodes are also removed.

Palliative surgery- used when it is impossible to carry out a radical operation. Palliative surgery leads to a decrease in the suffering of the patient and to lengthening his life.

Radiation therapy- used in combination with surgical treatment. Radiation therapy is performed before the operation, which allows to reduce the volume of the operation. After operation radiation therapy performed to destroy the remaining tumor cells. Radiation therapy is not effective in deep localization of the tumor.

Complications after radiotherapy: Inhibition of leukopoiesis. Hair loss. Radiation burns. Radiation proctitis, cystitis.

Chemotherapy - the use of drugs that inhibit the growth and development of tumor cells. Chemotherapy is used in combination with surgical treatment and as an independent method of treatment in advanced cases.

Complications of chemotherapy: Inhibition of leukopoiesis. Intoxication.

Hormone therapy - It is mainly used for advanced malignant hormone-dependent tumors.

Androgens in the treatment of breast cancer.

Estrogens in the treatment of prostate cancer

Hormone therapy does not exclude, but only complements the combined methods of therapy of malignant tumors - surgical and radiation. Sometimes combined treatment (hormone, chemotherapy and surgery) causes a long-term pronounced remission.

Cryotherapy– treatment with liquid nitrogen (skin cancer, hemangiomas).

Symptomatic treatment - carried out in combination with all methods of treatment and

as an independent treatment in inoperable and incurable patients (prescribe painkillers).

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

Rehabilitation of cancer patients.

medical rehabilitation - restoration of lost or weakened functions and the psychological mood of the patient, the development of compensatory mechanisms through surgical, medical, spa treatment and psychotherapy.

Vocational rehabilitation - training for new professions.

Social rehabilitation - rational employment.

Questions of self-control.

What is called a tumor?

What are the signs of benign tumors?

What are the signs of malignant tumors?

List theories of etiology and pathogenesis of tumors.

What is called precancer?

What is the classification of precancers?

What is international classification malignant tumors?

What refers to facultative precancerous conditions?

What refers to obligate precancerous conditions?

Which specialist should see and treat patients with precancerous conditions?

What is the classification of malignant tumors?

What is the classification into oncological clinical groups?

What is included in the concept of "cancer alertness"?

How is cancer care organized in RF?

How is the rehabilitation of cancer patients carried out?

TUMORS OF THE SKIN.

Classification of skin tumors:

Benign congenital and acquired.

Malignant primary and secondary.

Benign tumors:

Borderline nevus.

Blue nevus.

Melanosis Dubrey.

Nevus of Ota.

Fibroepithelial nevus.

Papillomatous nevus.

Verrucous nevus.

Intradermal nevus.

Nevus Becker, Solomon, Sotton - rare forms of nevi.

Warty nevus.

Comedonal nevus (acne-like).

Nevus of hair follicles.

Pigmented hairy nevus.

Cystic nevi.

Giant pigmented nevus.

Nevus - birthmark, mole - a specific formation on the skin, related to benign tumors that tend to degenerate into malignant.

Comedonal nevus. Papillomatous epidermal nevus.

It should be taken as a rule - any nevus protruding above the surface, discolored, weeping, bleeding or causing unpleasant subjective sensations, is suspected of melanoma.

You need to consult an oncologist!

nevuscellulares

Skin cancer.

Skin cancer- one of the frequent forms of malignant tumors, equally affecting men and women, mainly over the age of 50, usually in open areas of the body. In the structure of oncological morbidity, malignant tumors account for 9-11%.

Mostly tumors of epidermal origin:

skin cancers - 8-9%.

melanoma - 1-2%.

sarcomas - 0.5%.

Mortality is 15 times less than morbidity.

Get sick more often rural population, people living in southern latitudes.

Predisposing factors( causes of skin cancer)

excessive insolation (burns, prolonged exposure to sunlight),

external carcinogenic influences - exposure to various chemical carcinogens - soot, coal tar, fuel oil, etc.,

the presence of chronic ulcers and scars,

viral infection (for example, human papillomavirus),

intake of arsenic in everyday life and in the profession,

mechanical irritation of the skin.

exposure to x-rays and radium rays, radiation dermatitis.

Precancerous skin conditions:

Pigmented xeroderma- appears shortly after birth on exposed parts of the body, especially on the face.

That is, reddening of the skin, age spots, warty growths appear, from which cancer then develops.

Bowen's dyskeratosis- appears in the form of various spots, then flat discs, then oval formations in different parts of the skin. They are covered with scales, crusts that are difficult to remove, rise above the skin and are denser than the skin.

Paget's disease- an eczematous ulcerated surface on the skin of the body, then turns into an ulcer (dark red, moist, crusty surface).

Chronic inflammatory processes with pathological regeneration, not subject to conservative treatment are optional - precancerous conditions.

Dysplastic nevus. Often referred to as Clark's nevus, atypical birthmark or an atypical nevus. Dysplastic nevus is found in about 5% of the white population. Also, a similar nevus can be found in patients with familial melanoma and in almost half of those with sporadic melanoma. For this nevus, gender does not matter at all and it can occur on the body of both men and women. Most often, a dysplastic nevus is found shortly before puberty and continues to occur on the surface of the body throughout a person's life.

It is possible to determine a dysplastic nevus by some signs: Often, this is a spot with a raised area in the middle. Often, these nevi can even be compared with "fried eggs": they very much resemble such a dual form. The size of the neoplasm often reaches more than 5-6 mm in diameter. The shape of a dysplastic nevus is round, but it can also be oval with jagged edges. The boundaries through which the nevus passes into healthy skin are blurred and gradual. You can find a dysplastic nevus on the trunk, arms and legs, sometimes on the back of the foot, on the buttocks, and even less often on the face.

Prevention and treatment. You must be extremely careful with any moles on your own body, especially dysplastic nevi, which very quickly degenerate into melanoma that spreads over the surface of the skin.

Dystrophic skin changes characterized by the appearance of numerous yellowish-brown spots rising above the skin level, warty growths with hard-to-remove crusts can also serve as the basis for the development of skin cancer.

When designing a study, the first thing to consider is individual characteristics the patient and the characteristics of the course of the disease, as well as to know the principles, possibilities and limitations of each of the methods in order to ensure the maximum effective diagnostics and treatment. Therefore, the choice of diagnostic method and research tactics is one of the main components of the treatment of cancer patients, and the analysis of the results, in addition to answering the question of the presence of a tumor, should help obtain information about the type of tumor, the stage of the tumor process, and the involvement of anatomical structures adjacent to the affected organ in the pathological process.

For a qualified and effective study using diagnostic methods, and hence the successful treatment of cancer patients, close interaction between oncologists, radiologists, radiologists, laboratory assistants, histologists, immunologists, doctors of functional diagnostics, etc. is necessary.

The doctor's consultation.

The first essential step in the recognition malignant tumor is the consultation of a doctor who examines the patient, finds out the history of the development of the disease, changes in its manifestations over time (anamnesis).

The survey reveals the duration of the disease (appearance primary symptoms tumors), dynamics of tumor growth. These data help to recognize the visual forms of cancer: lower lip, skin, oral mucosa, soft tissue tumors, breast cancer. tumors internal organs there are usually no clear symptoms of the onset of pathological growth. Malignant growth in them often begins against the background of chronic inflammatory process without clear symptoms. An already formed malignant tumor in stages I and II of growth is most often painless, without pronounced symptoms. But a carefully collected anamnesis allows in these cases to suspect the onset malignant neoplasm. Academician A. I. Savitsky described a number of small nonspecific symptoms - the "syndrome of small signs", the simultaneous presence of which in a patient is specific for a malignant tumor. It:

1) unmotivated weakness, fatigue,
2) weight loss,
3) anemia (anemia, manifested by pallor),
4) mental depression.

Depending on the localization of the process, in addition to the listed signs, others appear. characteristics. For example, with bronchial cancer - dry, hacking cough, repeated atypical pneumonia; with rectal cancer - a feeling of incomplete emptying, false urges, etc.

Oncologists who see the primary patient give great importance careful history taking. Many of them explain to patients the sign of anamnesis in making a diagnosis and remember all the changes in the state of body functions in recent times. However, as with other diseases, the anamnesis provides only indicative data and may direct attention to some organ where a tumor process is suspected.

When examining a patient, the doctor examines the tumor or the area of its alleged localization; state of regional and remote lymph nodes(cervical, axillary, inguinal). With a tumor of the skin, lips, tongue, the affected area is examined using a magnifying glass. If organ cancer is suspected abdominal cavity pelvic lymph nodes are examined. In women, it is imperative to conduct an examination per vaginum (through the vagina) and per rectum (through the rectum), in men - per rectum. The oncologist can conduct these studies on his own or refer the patient to a specialist gynecologist or urologist.

X-ray methods

X-ray examination - is the main method of recognition for tumors of the lungs, stomach, colon. Therefore, this method is used in the examination of cancer patients. Modern radiology widely uses tomographic (layered) examination with contrasting of the organ. Per last years significantly expanded the use special methods studies such as angiography, bronchography, which increase the effectiveness of diagnostic studies performed mainly in a hospital. Fluorography, especially large-frame, plays an important role in preventive examinations of the population.

X-ray examination is one of the main ones carried out for preventive purposes. Every adult must pass preventive examinations and x-rays of the lungs at least once a year.

Mammography is a special x-ray examination of the breast using a small dose of x-rays. Mammography helps to detect lumps in the gland tissue that are difficult to feel by feeling, as well as other changes that may indicate the possible development of a tumor before anything can be felt at all. Pictures are taken with some compression of the mammary gland. This is done in order to reduce the radiation dose and obtain higher quality images. Usually, two images of each gland are taken. In some cases, additional images are taken.

Examination is best done on the 7th - 10th day from the first day menstrual cycle when the breast is less painful. For menopausal women, mammography is performed at any convenient time. It is generally recommended that every woman over age 45 should have a mammogram every year.

CT scan. Among the methods that allow obtaining images of various areas human body, computed tomography(CT) has a special role, namely the role of the standard. The quality of the CT image, and hence its information content, depends on physical characteristics and structural features of the organ (density, electron concentration per unit mass and other properties of biological tissues), as well as on the energy of the X-ray radiation used. The advantages of CT are higher contrast resolution compared to other imaging methods, the ability to obtain a short time a large number of transverse projections, which is especially valuable for localizing the area from which a tissue sample is subsequently taken for biopsy, as well as for planning surgical intervention and subsequent radiotherapy. A limitation of the CT method in studies of internal organs is the inability to obtain images from large areas in longitudinal and frontal projections. This drawback can be overcome by using special contrast agents during the study.

Ultrasound tomography (ultrasound, sonography)

Ultrasound tomography - highly informative method research; used to diagnose tumors of the abdominal organs (especially the liver, gallbladder, head of the pancreas) and retroperitoneal space (kidneys, adrenal glands), small pelvis (bladder, uterus and its appendages: prostate), thyroid gland, soft tissues of the body, etc. .d. During the study, a targeted puncture of the tumor can also be performed.

Recently, with the development of modern equipment, Doppler sonography has become widespread - an ultrasound study using the Doppler effect. At the same time, it became possible to observe the direction and speed of blood flow in the vessels of an organ or pathological formation, which provides additional valuable information about its structure.

Since ultrasound tomography combines high information content with simplicity and safety of research, it is widely used as a mandatory research method for suspected cancer of any localization in order to exclude the presence of metastases in internal organs and, first of all, the liver.

Endoscopic method

The endoscopic research method, thanks to the achievements of modern electronics and optics, has become crucial for the early diagnosis of cancer of internal localizations: stomach, esophagus, colon and rectum, bronchi. Endoscopic devices with fiber optics (gastroscopes, intestinoscopes, colonoscopes, bronchoscopes, etc.) make it possible to carefully examine the entire mucous membrane of internal organs, to produce cytological examination, and in case of suspicion - take a piece of tissue for histological examination.

Endoscopically, you can examine not only the abdominal organs, but also the natural cavities of our body - the chest (pleural) cavity, abdominal, joint cavities, mediastinum, etc. Examination of the pleural cavity (thoraxoscopy) and abdominal (laparoscopy) are used for external examination of the external surface of the internal organs.

Laboratory research.

Clinical tests: blood, urine, gastric juice, feces is necessary in the diagnosis of the primary patient. Availability hidden blood in urine, feces, sputum is important symptom malignant tumor. Establishing the fact of increasing anemization is essential.

Biochemical research methods provide useful information in the examination of cancer patients. Although specific biochemical changes in the body of oncological patients have not been established, some characteristic changes are detected in some tumors. With disseminated prostate cancer, a high level of acid phosphatase was found in 75% of patients (however, with localized cancer - below 20%); in pancreatic cancer - an increase in amylase (25%), in liver cancer - an increase in the hepatic fraction of alkaline phosphatase.

Of great practical importance is the detection of a high level of k-fetoprotein in cancer of the liver, testis, and various teratocarcinomas; carcinoembryonic antigen - in colon cancer; chorionic gonadotropin - with chorionepithelioma of the uterus and testicles.

Biochemical tests can detect endocrine tumor secretion and explain many clinical syndromes due to tissue-specific or paraneoplastic endocrine activity. A high level of ACTH, antidiuretic, parathyroid, thyroid-stimulating, follicle-stimulating, luteotropic, melanostimulating hormone, erythropoietin is detected; cortisol, epinephrine, norepinephrine, insulin, gastrin, serotonin, etc.

Biochemical methods make it possible to determine the content of receptors of certain hormones in the tumor tissue (estradiol, progesterone, testovron, corticosteroids). Such an analysis is performed with a biopsy or tumor removal with rapid tissue freezing; the result of the study is useful in the development of treatment tactics (for example, in breast cancer, etc.).

Achievements in genetics and molecular biology of recent decades open up fundamentally new opportunities in the diagnosis and treatment of malignant neoplasms. The influence of specific genetic disorders underlying tumor growth made it possible to detect specific molecular markers. On their basis, tests for the early diagnosis of tumors are being developed. At present, several areas of use of molecular tests in oncology have been formed. The diagnostic methods themselves still have to undergo clinical trials.

Cyto-histological methods

cytological method research has received well-deserved recognition and dissemination. The simplicity and accessibility of its use in polyclinic institutions, and most importantly, its reliability make it possible in many cases to recognize early forms of a malignant process. It was first used in the diagnosis of cervical cancer. Cancer cells were found in smears from the walls of the vagina. Currently, the cytological method is widely used in the study of sputum of patients with suspected cancer of the bronchi, lungs, discharge from the nipple of the breast and punctate from the tumor, which make it possible to diagnose breast cancer earlier. The study of gastric lavage, urine helps in establishing a more accurate diagnosis. If cancer of the tongue, lower lip, skin is suspected, the diagnosis can be made at the earliest stage using a cytological examination of the prints of the ulcerated area.

Biopsy - excision or biting of a piece of a tumor or tissue suspicious of a tumor for histological examination. It is total, when the entire tumor node or a lymph node suspected of metastasis is removed entirely. If for research, only a portion of the tumor or tissue suspicious of a tumor is excised, this is an incisional biopsy. A biopsy was made for the first time in the world in 1875 by the founder pathological anatomy in Russia M. M. Rudnev. Biopsy has found wide application in oncological institutions as one of the reliable diagnostic methods. Biopsy is widely used in polyclinics for endoscopic examinations of the rectum and colon, cervix and other organs. The resulting material is transferred to the pathoanatomical department or used (for urgent histological examination), or immersed in fixative fluid if the biopsy material is sent after some time. If material for histological examination is obtained using a special or conventional injection needle, a biopsy is called a puncture biopsy. In oncology rooms and departments of polyclinics, a puncture biopsy is usually performed with a thin injection needle. At the same time, 1-2 or more cytological smears are prepared from the material obtained by aspiration, which are sent to the clinical laboratory to see a cytologist.

If melanoma is suspected, malignancy age spots or pigmented wart biopsy is usually contraindicated.

The latest diagnostic methods using modern scientific achievements in the field of radiation, magnetic and nuclear physics

Radioisotope diagnostics. In oncological practice, the method of scanning organs is used if they are suspected of a tumor lesion (primary or metastatic). The method of contact beta-radiometry is used in the diagnosis of melanomas of the skin, with superficially located tumors of the mammary gland, with Paget's disease.

radionuclide methods. Radionuclide methods are very promising (meaning the creation of tumor-specific labeled antibodies). Currently, scintigraphy of the bones of the skeleton, brain, and lungs is used for diagnosis; to characterize the functional state - scintigraphy of the kidneys, liver.

Radioimmunological study based on the analysis of the content of monoclonal antibodies in the tissues under study, it allows to detect many types of tumors at the early stages of the development of the process, when the size of the tumors is small. Tests for the detection of antibodies specific to a certain type of tumor, most effectively solve the problem of low contrast resolution between tissues of similar density, which is typical for conventional X-ray studies.

Magnetic resonance imaging (MRI) is a method for obtaining images induced by a nuclear magnetic resonance signal. The fundamental difference between MRI and CT is that in MRI the measured value is the magnetization of nuclei of a certain type located in a selected volume element, while in CT it is the coefficient of X-ray absorption by various biological tissues. The clinical application of the MRI method is to study the spatial distribution of nuclei of hydrogen, phosphorus and some other elements in the human body. The main value recorded in the MRI study is the response of magnetic nuclei to the impact of an alternating magnetic field, which depends on the density of the nuclei and other parameters specific to each area of the body.

Advantages of MRI: the method allows to achieve exceptionally high tissue contrast, to obtain an image in all anatomical projections during one study, to study the dynamic processes associated with the movement of biological fluids (blood, cerebrospinal fluid, urine, bile), and also, thanks to the use of contrast agents, with high accuracy to distinguish between peritumoral edema and the actual tumor. The disadvantages of MRI include a rather high (not only in Ukraine, but throughout the world) cost of the study, as well as the impossibility of conducting it if the patient has ferromagnetic implants.

NMR spectroscopy in vivo. The history of nuclear magnetic resonance (NMR) began with the discovery in the early 1940s of a fundamental physical phenomenon - magnetic resonance. For decades, many aspects of its development have been associated with the study of the properties and structure of various chemical substances. Improvement in research techniques expanded the range of problems solved using NMR and made it possible to study more and more complex objects, in particular, the structure of biomolecules and their functions in the body at the cell level.
The biochemical information obtained in vivo, which characterizes the level of energy supply of cells and the characteristics of metabolism in a selected area of any biological tissue, allows the oncologist to obtain very valuable information (supplementing MRI data) about the presence and type of tumor, its degree of malignancy and the safety of organs and systems. Particularly significant is the metabolic information obtained from the dynamic study of patients with oncopathology: it makes it possible to gradually evaluate the effectiveness of treatment by selecting the dose of the drug or radiation exposure, fixing instant or long-term responses to ongoing therapy.
Among the many clinical applications of the MRS method, the largest number relates to the study of patients with brain tumors.

Positron emission tomography (PET) is exclusively effective method clinical research patients with oncopathology; its wide distribution in the last decade is associated primarily with the development and technical improvement of instruments intended for the study of the whole body. PET provides unique information about the metabolic activity of tumors and metabolic changes associated with the therapy. According to the rate and intensity of accumulation of iso-labeled metabolites or special medicines one can judge the biological characteristics of the tumor tissue in comparison with the intact tissue, and also - which is especially valuable for oncology - evaluate the effectiveness of treatment and predict the further course of the process.

Thermography. This is the creation, using a special apparatus sensitive to infrared (thermal) radiation, of an image of the human body, where different colors areas with different skin temperatures are displayed. Thermographic examination of the mammary glands makes it possible to diagnose a cancerous lesion in 80-87% of those examined. The combination of thermographic examination with X-ray increases the accuracy of diagnosing this localization up to 99%. Thermographic examination is effective in the diagnosis of thyroid cancer, skin melanoma.

Conclusion.

Development of fast methods laboratory diagnostics, including immunological, the creation of new contrast agents for CG and MRI and new drugs and methods for PET, single photon emission tomography and in vivo, MRS is a new stage in the development of methods for diagnosing and treating cancer. Thanks to the improvement of diagnostic methods aimed at detecting a tumor and studying changes in metabolic processes in the body under the influence of a tumor, the time of examination is reduced and diagnostic procedures that can be performed on an outpatient basis are simplified. Application modern methods diagnosis does not reduce the value of histological studies. Only the analysis of the totality of data obtained using a variety of diagnostic methods contributes to the correct interpretation of research results and effective treatment.

Cancer diagnosis is an urgent problem modern world despite the rapid development of medicine. With the help of timely detection of the focus of the problem, further medical treatment can be selected, which will affect the prognosis of recovery and the patient's life expectancy. In order for the treatment to guarantee maximum results, one should be aware of the methods of early detection of cancer.

It is almost impossible to detect a problem in oncological diseases at a basic examination, so you need to undergo preventive examinations annually. Detection of a tumor during oncological examination at the initial stage greatly increases the likelihood of recovery.

body scan

With help the latest technologies early stages of cancer can be diagnosed. These technologies are - tomographs, endoultrasound, ultrasonic devices. The presence of a tumor is determined by differences in cells and tissue, as well as the presence of gaps in the seals.

Leading clinics in Israel

Radiation diagnostics is a way to detect cancer at any stage of development superficially. If this is the initial stage, then the sites of the lesion are recognized, and in the later stages, metastases are recognized that have spread to the surrounding tissues and organs.

How to diagnose cancer? Diagnostic methods

Oncology is classified as a disease that does not show symptoms at the stage of initial development. In hospitals and oncology centers, you can undergo additional examinations that can diagnose cancer:

tumor markers;
X-ray diagnostics;
Histology.

tumor markers

Tumor markers are This method is the introduction of a special substance into the blood in order to detect a malignant tumor or to control and monitor the treatment process. This method also helps to distinguish benign tumor from malignant.

For this diagnostic procedure, the patient's blood is used, which is donated after the administration of the drug. The most famous is the DR-70 blood test. Affected tissues differ in the accumulation of fibrinogen products that appear under the influence of cancer cells.

The advantage of this method is that it helps to detect the lesion before obvious manifestations. This method is still used for preventive purposes, when the patient has a hereditary predisposition to this disease.

Exist as, CA 19-9, CA 15-3, AFP, etc.

An elevated level of the CA 12-5 tumor marker may indicate:

ovarian cancer;
uterine cancer;
breast cancer.

An elevated level may indicate:

colon cancer;
rectal cancer;

An elevated level of the CA 15-3 tumor marker may indicate:

breast cancer;
Cancer of the stomach;
liver cancer;
Cancer of the uterus and ovaries;
Pancreatic cancer.

BUT elevated level AFP tumor marker may indicate an early stage of liver cancer.

A mammogram is an image of the mammary glands made with a small dose of x-rays. This method suitable for women of all ages, is considered painless and will help solve the problem without leading to surgery. Even without the presence of symptoms, mammography is performed in patients with a hereditary predisposition to this disease and a suspected manifestation.

Mammography detects modifications in breast tissue and helps assess size and variety. This method can detect breast cancer up to two years before it can be detected during a doctor's examination.

In many countries, mammography is a mandatory screening for women over 40, which has helped reduce breast cancer deaths.

This method is used when there are any pathological changes in chest:

swelling;
redness;
Seals in the chest area;
Nipple modification;
The presence of this disease in close relatives of the patient;
The presence of chronic gynecological diseases.

Diagnostics. Endoscopy

Endoscopy is a time-tested method for diagnosing precancerous conditions and treating them. This method is used with the help of an endoscope, which is introduced into the human body in natural ways. With the help of the data, the stages of cancer development are determined and the location of the cancer cells is revealed. Also, this procedure may be accompanied by obtaining cancer tissue samples to determine its type.

Don't waste time searching uselessly for inaccurate cancer treatment prices

* Only on condition of obtaining data on the patient's disease, the clinic representative will be able to calculate the exact price for the treatment.

Endoscopy is considered one of the safest and most proven methods of diagnosing cancer.

The survey will help you find:

The initial stage of cancer of the larynx;
Lungs' cancer;
Stomach cancer;
Early stage of bowel cancer.

Diagnostics. MRI

MRI - magnetic resonance imaging, harmless and painless method. One of the disadvantages of this method is its inaccessibility, that is, not all hospitals are equipped with this device and the procedure itself can be expensive. And also this method is not suitable for those who have claustrophobia - the fear of closed spaces and people who are overweight. MRI can detect neoplasms ranging in size from 0.1-0.3 mm.

It is possible not only to detect a neoplasm, but also to observe changes in the tumor during the treatment period and to recognize the size, shape, and also to identify the spread to other tissues and organs.

The harmlessness of MRI will allow you to carry out the procedure repeatedly, without fear of radiation and aggravation. MRI will detect cancer:

Diagnostics. ultrasound

Ultrasound is an ultrasound examination based on the reflection of ultrasonic waves from tissues. This technique can be used at any stage of the examination of the patient. Then the patient will need to be examined more carefully to confirm the presence of a tumor and clarify its variety. Ultrasound can also be used to check the progress of treatment outcomes and effectiveness.

Modern ultrasound equipment is equipped with elastography function . Elastogapia helps to study the structure of an atypical tissue area and improves the outcome of the study.

Even at the end of this safe technique, you can use it to detect recurrence of a malignant tumor. The quality of the scanner and the skill level of the doctor affect the results of the ultrasound.

Ultrasound detects cancer:

Thyroid gland;
hearts;
Mothers and others

X-ray diagnostics

X-ray diagnostics is a method of computed tomography, with which you can contour the tumor. Unlike MRI, this method is also suitable for overweight people. The development of this diagnostic method helps to use this method more extensively in the study of cancer patients and not cause significant radiation exposure to the body.

Radioisotope diagnostics can also be included in this type of diagnosis. The essence of this method is the use of radioactive isotopes to determine the disease and prescribe the appropriate treatment.

Histology

Histology - pathomorphological study, obtaining pieces of the affected area or tissue. This method finally determines the diagnosis. The difference between histology and other diagnostic methods is that the results will be of increased accuracy. This method helps to study cells and tissues, to detect the focus of the formation of the disease. In particular, this method is used in gynecology.

Results of cytological and histological analyzes, which establish the type of neoplasm, affect the nature of the diagnosis assigned to patients with oncopathology. Further treatment of the patient, the appointment of chemotherapy and other procedures directly depends on the outcome of these indicators. If the result is erroneously detected, the doctor may prescribe the wrong procedures or start treatment untimely, which can lead to the death of the patient.

Some hospitals use molecular or genetic testing of blood and tumor tissue to detect cancer. They help to detect the patient's tendency to form a malignant tumor, and when a tumor is detected, they help to recognize the level of malignancy of the tumor and prescribe a treatment with high efficiency.

Molecular analysis can detect:

Is one surgical intervention enough to remove the tumor and get rid of the cancer;
Is it possible to block the development of cancer with antibodies;
Whether chemotherapy or other variations of this procedure are appropriate for the patient.

The patient is more likely to be completely cured if the oncological disease is diagnosed at the initial stages and appropriate treatment is prescribed.

If cancer is detected at an early stage of formation, then there are several types of treatment that do not greatly affect the body. There are vaccines used in such cases, they affect cancer cells or improve immune system to fight cancer. In the advanced stages of cancer, it will already be necessary surgical intervention.

Video on the topic: Diagnosis of cancer

Introduction

The use of various diagnostic methods is necessary to identify the tumor process, determine its stage and choose the tactics of treating patients suffering from cancer. In many cases, for differential diagnosis, it is necessary to conduct several studies using various methods. When planning a study, first of all, it is necessary to take into account the individual characteristics of the patient and the characteristics of the course of the disease, as well as to know the principles, possibilities and limitations of each of the methods in order to ensure the most effective diagnosis and treatment. Therefore, the choice of diagnostic method and research tactics is one of the main components of the treatment of cancer patients, and the analysis of the results, in addition to answering the question of the presence of a tumor, should help obtain information about the type of tumor, the stage of the tumor process, and the involvement of anatomical structures adjacent to the affected organ in the pathological process. For a qualified and effective study using diagnostic methods, and hence the successful treatment of cancer patients, close interaction between oncologists, radiologists, radiologists, laboratory assistants, histologists, immunologists, doctors of functional diagnostics, etc. is necessary.

The doctor's consultation

The first essential step in recognizing a malignant tumor is a consultation with a doctor who examines the patient, finds out the history of the development of the disease, changes in its manifestations over time (anamnesis).

The survey reveals the duration of the disease (the appearance of primary symptoms of the tumor), the dynamics of tumor growth. These data help to recognize the visual forms of cancer: lower lip, skin, oral mucosa, soft tissue tumors, breast cancer. Tumors of the internal organs usually do not have clear symptoms of the onset of pathological growth. Malignant growth in them often begins against the background of a chronic inflammatory process, without clear symptoms. An already formed malignant tumor in stages I and II of growth is most often painless, without pronounced symptoms. But a carefully collected anamnesis allows in these cases to suspect the onset of a malignant neoplasm. Academician A. I. Savitsky described a number of small nonspecific symptoms - the "syndrome of small signs", the simultaneous presence of which in a patient is specific for a malignant tumor. It:

1) unmotivated weakness, fatigue,

2) weight loss,

3) anemia (anemia, manifested by pallor),

4) mental depression.

Depending on the localization of the process, in addition to the listed signs, other characteristic signs appear. For example, with bronchial cancer - dry, hacking cough, repeated atypical pneumonia; with rectal cancer - a feeling of incomplete emptying, false urges, etc.

Oncologists taking the primary patient attach great importance to the thoroughness of the history taking. Many of them explain to patients the sign of anamnesis in making a diagnosis and remember all the changes in the state of body functions in recent times. However, as with other diseases, the anamnesis provides only indicative data and may direct attention to some organ where a tumor process is suspected.

When examining a patient, the doctor examines the tumor or the area of its alleged localization; condition of regional and distant lymph nodes (cervical, axillary, inguinal). With a tumor of the skin, lips, tongue, the affected area is examined using a magnifying glass. If a tumor of the abdominal organs is suspected, the lymph nodes of the small pelvis are examined. In women, it is imperative to conduct an examination per vaginum (through the vagina) and per rectum (through the rectum), in men - per rectum. The oncologist can conduct these studies on his own or refer the patient to a specialist gynecologist or urologist.

X-ray methods

X-ray examination - is the main method of recognition for tumors of the lungs, stomach, colon. Therefore, this method is used in the examination of cancer patients. Modern radiology widely uses tomographic (layered) examination with contrasting of the organ. In recent years, the use of special research methods, such as angiography, bronchography, has significantly expanded, increasing the effectiveness of diagnostic studies performed mainly in a hospital. Fluorography, especially large-frame, plays an important role in preventive examinations of the population.

X-ray examination is one of the main ones carried out for preventive purposes. Every adult should have preventive examinations and x-rays of the lungs at least once a year.

Mammography is a special x-ray examination of the breast using a small dose of x-rays. Mammography helps to detect lumps in the gland tissue that are difficult to feel by feeling, as well as other changes that may indicate the possible development of a tumor before anything can be felt at all. Pictures are taken with some compression of the mammary gland. This is done in order to reduce the radiation dose and obtain higher quality images. Usually, two images of each gland are taken. In some cases, additional images are taken.

The examination is best done on the 7th - 10th day from the first day of the menstrual cycle, when the breast is less painful. For menopausal women, mammography is performed at any convenient time. It is generally recommended that every woman over age 45 should have a mammogram every year.

CT scan. Among the methods that allow obtaining images of various parts of the human body, computed tomography (CT) has a special role, namely the role of the standard. The quality of a CT image, and hence its information content, depends on the physical characteristics and structural features of the organ (density, electron concentration per unit mass and other properties of biological tissues), as well as on the energy of the X-ray radiation used. The advantages of CT are higher contrast resolution compared to other imaging methods, the ability to obtain a large number of transverse projections in a short time, which is especially valuable for localizing the area from which a tissue sample is taken for a biopsy, as well as for planning surgical intervention and subsequent radiotherapy. A limitation of the CT method in studies of internal organs is the inability to obtain images from large areas in longitudinal and frontal projections. This drawback can be overcome by using special contrast agents during the study.

Ultrasound tomography (ultrasound, sonography)

Ultrasonic tomography is a highly informative research method; used to diagnose tumors of the abdominal organs (especially the liver, gallbladder, head of the pancreas) and retroperitoneal space (kidneys, adrenal glands), small pelvis (bladder, uterus and its appendages: prostate), thyroid gland, soft tissues of the body, etc. .d. During the study, a targeted puncture of the tumor can also be performed.

Endoscopic method

The endoscopic research method, thanks to the achievements of modern electronics and optics, has become crucial for the early diagnosis of cancer of internal localizations: stomach, esophagus, colon and rectum, bronchi. Endoscopic devices with fiber optics (gastroscopes, intestinoscopes, colonoscopes, bronchoscopes, etc.) make it possible to carefully examine the entire mucous membrane of internal organs, perform a cytological examination, and, if suspected, take a piece of tissue for histological examination.

Laboratory research

Clinical tests: analysis of blood, urine, gastric juice, feces is necessary in the diagnosis of the primary patient. The presence of occult blood in the urine, feces, sputum is an important symptom of a malignant tumor. Establishing the fact of increasing anemization is essential.

Diagnosis, differential diagnosis and treatment of tumors is a difficult task. Each tumor must be accurately diagnosed

The success of the treatment of a malignant tumor largely depends on accurate diagnosis, the basis of which is the determination of the nature of the malignant process, detected morphologically, immunologically and genetically, and the establishment of the degree of prevalence of the process, i.e. stages.

All diagnostic measures should be clearly systematized, carried out methodically, consistently,
in accordance with the diagnostic search program.

Subject to examination:

1. Patients with carcinophobia - the fear of getting cancer.

2. Patients belonging to risk groups (hereditary predisposition, the presence of harmful factors at work, precancerous diseases).

3. Patients with benign tumors of various localizations.

4. Patients with suspected cancer.

5. Patients treated for malignancy.

Already at the first contact with the patient, it is often possible to suspect the nature of the pathological process, and to determine the algorithm for a detailed examination. When taking an anamnesis, it is often possible to immediately identify the main complaints and leading symptoms that can immediately target a specific disease.

The history taking program should include:

1. Questions about factors modifying tumor growth (heredity, chronic diseases, bad habits)

2. Questions aimed at identifying complaints of a general nature, as well as symptoms characteristic of various localizations of tumors

3. Assessment of the main characteristics of the signs of the disease (severity, duration, dynamics)

The following signs should make the doctor think about cancer:

1. Changing habits, the appearance of aversion to food smells, etc.

2. Unmotivated change in well-being in the normal mode of work and life.

3. The appearance of pathological discharge from the nose, nipple of the mammary gland, rectum, etc.

4. Violation of the patency of hollow organs

5. The appearance of previously non-palpable formations on the skin, in the oral cavity, in the abdominal cavity, etc.

It should be remembered that the most important sign tumor lesions of internal organs is a violation of their functions.

The diagnostic algorithm consists of the following steps:

Stage 1 - analysis of complaints and results of a physical examination

Stage 2 - clarifying instrumental examination(X-ray, endoscopic, ultrasound, etc.)

Stage 3 - morphological confirmation of the diagnosis

Stage 4 - confirmation of the diagnosis of a malignant neoplasm

Stage 5 - assessment of the prevalence of the lesion

Stage 6 - development of treatment tactics

The diagnostic plan should include:

1. Collecting an anamnesis with the obligatory specification of the presence of symptoms of intoxication.

2. Examination of the patient with mandatory palpation of all groups of peripheral lymph nodes.

3. Complete blood count and biochemical tests.

4. Radiography chest is mandatory for all patients.

5. Ultrasound examination of the abdominal cavity, as well as peripheral lymph nodes, the defeat of which during palpation is doubtful.

6. Radioisotope diagnostics.

7. Endoscopy.

8. Computed tomography, magnetic resonance imaging, positron emission tomography.

9. Morphological study.

10. Determination of the functional state of vital organs, primarily the lungs and heart.

The following methods are used in oncology radiodiagnosis:

Radiography(direct and lateral chest radiographs, plain abdominal radiography, bone radiography, etc.)

Plain radiography of the abdominal cavity can reveal the displacement of intestinal loops in the direction opposite to the localization of the volumetric process, can reveal calcifications in the pathological formation, which is typical for neuroblastoma and can occur with germ cell tumors.

Bone radiographs are a highly informative method for the differential diagnosis of bone tumors. On the radiograph, the nature of the destruction of the bone tissue, the degree of spread inside the bone, the reaction of the periosteum, the exit of the process into soft tissues should be assessed.

Computed tomography (CT) one of the most informative research methods in oncology. He plays a leading role in establishing the spread of the tumor and in assessing the response of the tumor to treatment. With CT, you can examine any part of the body. Its resolution is much higher than conventional radiography; so, for example, CT reveals micrometastases in the lungs, invisible on radiography.

Nuclear magnetic resonance or magnetic resonance imaging (MRI). This highly sensitive method carries the same information as CT, but in a number of diseases its use is preferable. When examining the posterior fossa or base of the skull with CT, image quality usually suffers due to bony artifacts, so MRI is recommended when tumors are localized in these areas. MRI has successfully replaced invasive examination procedures in pathology spinal cord and other intravertebral processes.

MRI can defiantly detect metastases of solid tumors in the bone marrow, as well as involvement bone marrow in lymphoproliferative diseases. MRI with contrast is used to more accurately establish the local spread of the tumor, which is extremely important before surgery.

Positron emission tomography(PET) is a modern, highly sensitive method of nuclear diagnostics, which allows to give a qualitative and quantitative assessment of the biochemical processes occurring in the human body. For PET, radiopharmaceuticals labeled with ultrashort-lived isotopes are used, which are included in the metabolic processes of the cell. This is what makes it possible to identify various diseases with high accuracy, often before their clinical manifestation.

The most commonly used radioactive isotopes are carbon, nitrogen, oxygen, and fluorine. In the human body, they behave like their natural counterparts, being included in the metabolic processes of the cell.

Depending on the degree of activity of metabolic processes in different cells, the intensity of drug accumulation in them differs significantly. This principle underlies the differential diagnosis of normal and pathologically altered tissue.

After the introduction of a radiopharmaceutical to a patient, information about its accumulation in the body is recorded using highly sensitive PET scanners. The next step is the construction of a three-dimensional layered (tomographic) image.

The diagnostic image in PET is functional. In this it is fundamentally different from the structural images obtained with X-ray computed tomography, magnetic resonance imaging or ultrasound. Therefore, with PET, it is possible to assess the physiological state of various tissues, for example, to differentiate tumor tissues, which in most cases is not possible with other diagnostic imaging methods.

The use of highly sensitive scanners that allow the introduction of marker amounts of radioactive substances, as well as the use of ultrashort-lived isotopes with a very short half-life, ensures a low radiation exposure to the patient. This makes it possible to repeatedly repeat PET examinations at various stages of the examination and treatment of the patient.

Ultrasound examination (ultrasound- a harmless non-invasive method that can give enough information about the source of the tumor, the involvement of the lymph nodes and the invasion of large vessels. The advent of color Doppler ultrasound devices in clinical practice has made this method highly informative, especially when detecting vascular invasion. Chest ultrasonography is sometimes necessary to distinguish between the nature of the mass (fluid or solid), which is not always convincingly clear even on CT. Ultrasound can detect liver tumors, liver metastases.
Ultrasound of the testicles can confirm the clinical suggestion of a lesion in lymphomas and leukemias. By means of ultrasound, the nature of some soft tissue formations, such as benign cysts, can be determined.

Radioisotope research. Bone scintigraphy with 99 Technetium is an informative method for examining patients with tumors potentially metastasizing to the bones. Skeletal involvement may be seen in breast cancer, lung cancer, with lymphomas and leukemias, neuroblastoma, rhabdomyosarcoma, etc. Bone scintigraphy is a more sensitive method than radiography, it detects malignant bone lesions for 4-6 months. before x-ray.

It is clear that an accurately verified diagnosis is a cornerstone in oncology in general and in pediatric oncology in particular. Specific treatment (chemotherapy, radiation therapy) can be started only after the diagnosis of a malignant process has been established. The type of treatment and its intensity depend primarily on the biology of the malignant tumor. To clarify its nature, a sufficient amount of biological material obtained by punctures and biopsies is necessary. And if with leukemia the main diagnostic information can be obtained within a day, then with solid tumors the diagnostic process requires several days.

The following methods are used to verify the diagnosis in oncology:

1. Light-optical microscopy (cytological and histological studies after standard stains).

2. Electron microscopy.

3. Immunological studies (immunofluorescence, immunocytochemistry and immunohistochemistry).

4. Cytogenetics.

5. Molecular biology.

Biopsy. in clinical oncology different kind biopsies for the purpose of morphological verification of the tumor process are extremely important. A biopsy is a surgical procedure that diagnostic procedure to be performed by the surgeon. The surgeon, performing a biopsy, must obtain a sufficient volume of pathological tissue necessary to carry out all the required morphological and other special studies; at the same time, surgical intervention should be safe and minimally traumatic. The technique for performing a biopsy can vary. Biopsies are divided into closed and open.

Closed biopsies:

Aspiration (injection) biopsy is performed with a thin needle. This biopsy may provide useful information in the initial study only in certain situations and with certain types of tumors. The main disadvantage aspiration biopsy is to obtain a small amount of material, and therefore, there are difficulties in formulating the final cytological conclusion. For morphological differential diagnosis of malignant tumors, special diagnostic studies are often required, namely: immunohistochemical studies, immunofluorescent method, typing technique using monoclonal antibodies, etc. The amount of material obtained from aspiration biopsy does not provide all of the above additional studies.

Trepan biopsy is a surgical procedure. After its implementation, complications are possible, such as bleeding, perforation, pneumothorax. A trephine biopsy is performed with a special needle, however, unlike an aspiration biopsy, during this manipulation the surgeon receives tissue material. At correct execution trepanobiopsy, the amount of material obtained should be sufficient to perform all the necessary studies.

Open biopsy can be total (excisional) or partial (incisional). For small lesions, more often soft tissue, where functionally and cosmetically we will not cause harm, it is better to perform a total biopsy within healthy (not affected) tissues. The need for careful planning of the biopsy site should be emphasized.

Endoscopic biopsy has become increasingly important in recent years. Often this is the method of choice for certain tumor localizations. Cystoscopic, thoracoscopic, laparoscopic, mediatenoscopic biopsies are quite widespread in oncology.

Stereotactic biopsy method of closed biopsy of brain tumors. This is done as follows: under anesthesia, the skull is fixed on the operating table and then a thorough preparation for the biopsy is carried out: CT and MRI with detailed intracranial measurements. After obtaining the necessary information, the neurosurgeon performs a biopsy of the tumor under computer control through a minimal burr hole in the skull.

Thus, to select the optimal biopsy technique, the following factors should be considered:

the possibility of obtaining an adequate volume of tumor tissue;

· the risk of the study;

availability of research;

cosmetic considerations

The examination should be as comfortable as possible and minimally traumatic.

Light-optical microscopy. The importance of light-optical microscopy in oncology is of great importance, primarily due to the fact that as a result of a cytological or histological examination of punctures, biopsy or surgical material, clinicians receive a diagnosis that determines further treatment tactics. The cellular or tissue composition of the tumor, the degree of malignancy, the nature of growth, the presence of metastases determine the choice of treatment and prognosis. In turn, for the formulation of a detailed histological diagnosis, the quality of material processing is of decisive importance. In addition, it is important to examine not only the tumor itself, but also the organ in which it is located, in order to identify background changes, which facilitates understanding the development of the tumor process. To prepare preparations suitable for light-optical microscopy, biopsy or surgical material must go through three main processing steps: fixation, embedding, and staining.

Fixation. The first step in processing tissue samples is fixation. For high-quality fixation of the material, it is necessary to cut out pieces of the examined tissue with a thickness of 3-5 mm. The most common and universal is fixation in 10% neutral formalin for 10-24 hours.

Fill. The fixed pieces of the examined tissue, after dehydration, are immersed in purified, homogenized paraffin. The use of paraffin is sufficient to obtain the 5 µm sections required for light microscopy. In recent years, special resins (methacrylates) have been used in histological practice. When immersed in them, there is practically no wrinkling artifact of the tissue under study.

Coloring. For the vast majority of diagnostic light-optical studies, simple stains are used: hematoxylin-eosin, azure II-eosin, Van Gieson, Sudan, impregnation with silver nitrate, PAS reaction. In cases where a complete cytological or histological diagnosis cannot be established on the basis of simple staining methods, electron microscopy, immunocytochemistry and immunohistochemistry methods are used.

Electron microscopy. Currently, the method of electron microscopy is more effectively used in scientific research on the pathogenetic and pathophysiological processes of tumor growth, however, in differential diagnosis Oncological diseases, this method has its application as an additional to light microscopy to clarify some diagnoses.

Immunohistochemistry (IHC)- this is a method for the detection and precise localization of a particular cellular or tissue component (antigen) in situ using immunological and histochemical reactions. The authors of this method are rightfully considered a group of researchers led by Albert Koons, who first obtained fluorescein-labeled antibodies and used them for diagnostic purposes. IHC became more widespread in the 70s after the publication of Taylor and Burns.

The following main areas of application of IHC in diagnostic practice can be distinguished:

1. Diagnosis of tumors of unknown origin. Normal histological examination can not always answer the question about the origin (histogenesis) of the tumor. In many of these cases, a well-chosen antibody panel can help establish the correct diagnosis.

2. Detection of a small number of cells.
A similar need arises with the exclusion of micrometastasis in the lymph nodes and bone marrow.

3. Immunophenotyping of tumors, especially tumors
lymphoid system.

Blood test tumor markers helps to detect malignant tumors at early stages. Based on the test results, the doctor can select patients for a more detailed examination. For those who have already had surgery and receive special treatment, the doctor may 4-6 months before the appearance clinical signs identify tumor recurrences and monitor the effectiveness of the treatment.

tumor markers- These are specific proteins produced by tumor cells, the content of which in the blood correlates with the presence or progressive growth of a malignant tumor. Currently, there is no “ideal” tumor marker that has 100% specificity (that is, not found in healthy people) and 100% sensitivity (that is, it is necessarily detected in all patients, even in the initial stage of cancer).

However, there are markers with sufficiently high rates of specificity and sensitivity that allow them to be used for initial diagnosis in risk groups or in patients with symptoms of cancer.

Determination of tumor markers in the blood for diagnostic purposes makes it possible to solve diagnostic problems, especially with a double study with an interval of 1.5–2 months: an increase in the level of a tumor marker in 1–2 months is doubled even with initial normal level- a sure sign of malignant growth.

The main types of tumor markers:

CA 15-3 breast cancer marker (BC).

CA 19-9 is a marker of pancreatic and biliary tract tumors, as well as colon cancer.

CA-242 is the earliest and most specific tumor marker for diagnosing suspected gastrointestinal cancer, starting from the first stage.

CA-125 is a tumor marker for ovarian, uterine, and endometrial cancer.

CEA - cancer-embryonic antigen is most effective in tumors of the colon and rectum; its level corresponds to the stage of the tumor.

PSA - (prostate-specific antigen) is used both for early detection prostate cancer.

AFP - (alpha-fetoprotein) - a normal protein produced by the embryo. In adults, it is practically not synthesized normally. Used for early diagnosis of primary liver cancer and cancer metastases to the liver from other organs, testicular tumors.

HCG - human chorionic gonadotropin - a marker with 100% sensitivity for tumors of the placenta in pregnant women (chorioepithelioma).