Nursing care for malignant tumors. Nursing care for cancer patients. Palliative surgeries for soft tissue tumors

1.1 Current information: symptoms, diagnosis and treatment of patients with malignant tumors of the female genital organs.

Malignant tumors can occur in any organ of the female reproductive system - the vulva (external genitalia), vagina, cervix, uterus, fallopian tubes or ovaries.

1.1.1 Uterine cancer: symptoms, diagnosis and treatment

Although this malignant tumor is commonly called uterine cancer, its more accurate name is endometrial carcinoma because the tumor initially arises in the lining of the uterus (endometrium). In women, it is the fourth most common cancer and the most common malignant tumor of the female genital organs. Uterine cancer usually develops after menopause, usually in women between 50 and 60 years of age. Tumor cells can spread (metastasize) both to adjacent tissues and to many other organs - down to the cervix, from the uterus to the fallopian tubes and ovaries, to the tissues surrounding the uterus, to the lymphatic vessels that transport lymph to all organs, lymphatic nodes, into the blood, then through the bloodstream to distant organs.

Symptoms and diagnosis: abnormal bleeding from the uterus is the most common early symptom uterine cancer. Bleeding may occur after menopause and may be repeated, irregular, or heavy in women who continue to menstruate. One out of every three women with uterine bleeding after menopause is diagnosed with this form of cancer. If you experience abnormal uterine bleeding after menopause, you should immediately consult a doctor, as it may be caused by a malignant tumor.

To diagnose this malignant tumor, several methods are used. The Pap test can detect cervical cancer cells, but it does not detect tumor cells in about one third of cases. Therefore, the doctor also performs an endometrial biopsy or fractional curettage (separate curettage of the cervical canal and the uterine cavity), in which tissue from the lining of the uterus is removed for examination under a microscope.

If the results of a biopsy or fractional curettage confirm the presence of a cancer in the lining of the uterus, further tests must be done to determine whether the cancer has spread outside the uterus. Ultrasound (ultrasound), computed tomography (CT), cystoscopy (fiber optic examination of the bladder), barium sulfate x-ray of the intestine, chest x-ray, intravenous urography (examination of the kidneys and ureters), bone scan and liver, sigmoidoscopy (examination of the rectum using a flexible fiber-optic instrument) and lymphangiography (x-ray examination of the lymphatic system) provide the necessary information and help prescribe optimal treatment. In each case, only some of the studies listed above are carried out for specific indications.

Treatment: extirpation, that is, surgical removal of the uterus, is the basis of treatment for this type of malignant tumor. If the cancer has not metastasized beyond the uterus, then hysterectomy almost always leads to a cure. During the operation, the surgeon usually also removes the fallopian tubes, ovaries (that is, performs a salpingo-oophorectomy) and nearby (regional) lymph nodes. They are examined by a morphologist to determine the stage of cancer development and determine the need for postoperative radiation therapy.

Even when the cancer has not metastasized, your doctor may prescribe postoperative drug therapy (chemotherapy) if some cancer cells remain undetected. Usually hormones are used that suppress the growth of a malignant tumor.

If the cancer has spread beyond the uterus, higher doses of progestins are usually prescribed. In 40% of women with metastases of a malignant tumor, it decreases in size and its growth is suppressed under the influence of progestins for 2-3 years. If treatment is effective, it may continue indefinitely. Side effects of progestins include weight gain due to water retention and, in some cases, depression.

If the cancer has spread widely or if hormone therapy does not have a beneficial effect, other chemotherapy agents such as cyclophosphamide, doxorubicin and cisplatin may be added. These drugs are much more toxic than progestins and cause many side effects. Before starting treatment, you must carefully weigh the risks and expected benefits of chemotherapy.

Overall, nearly two-thirds of women diagnosed with this type of cancer remain alive without relapse (recurrence) of the cancer within 5 years of diagnosis, less than a third die from the disease, and nearly 10% survive without cancer. cured If this malignancy is detected early, almost 90% of women live at least 5 years and usually recover. The chances are better for younger women, women whose cancer has not spread beyond the uterus, and women who have a slow-growing type of cancer.

1.1.2. Cervical cancer: symptoms, diagnosis and treatment

The cervix is the lower part of the uterus that extends into the vagina. Among malignant tumors of the female genital organs, cervical cancer (cervical carcinoma) is the second most common tumor among women of all ages and most common among younger women. Cervical cancer is usually found in women between 35 and 55 years of age. The development of this malignant tumor may be associated with a virus (human papillomavirus), which can be transmitted during sexual intercourse.

The younger a woman is at the time of her first sexual intercourse, and the more sexual partners she has in the future, the greater the risk of cervical cancer.

About 85% of cervical cancers are squamous cell cancer, which means they develop from stratified squamous epithelial cells, similar to skin cells, that cover the outside of the cervix. Most other types of cervical cancer develop from columnar epithelial cells of the glands in the cervical canal (adenocarcinoma) or both types of cells.

Cervical cancer cells can penetrate deep into the lining of the uterus, enter the vast network of small blood and lymphatic vessels found in the deeper layers of the cervix, and then invade other organs. In this way, a malignant tumor metastasizes both to distant organs and to tissues located near the cervix.

Symptoms and diagnosis: symptoms include bleeding between periods or after sexual intercourse. A woman may not experience pain or other symptoms until the later stages of the disease, but routine Papanicolaou tests (Pap smears) can detect cervical cancer early enough. This disease begins with slow changes in normal cells and often takes several years to develop. Changes are usually detected by examining the cells of the cervical mucosa under a microscope, which are taken for a Pap smear. Physicians have described these changes as stages ranging from normal (no pathology) to invasive cancer.

The Pap test is inexpensive and can accurately detect cervical cancer in 90% of cases, even before symptoms appear. As a result, with the introduction of this research method into practice, the number of deaths from cervical cancer decreased by more than 50%. Doctors generally recommend performing the first Pap test when a woman becomes sexually active or reaches the age of 18, and then annually thereafter. If normal results were obtained over 3 consecutive years, such a woman can then have a Pap smear only every 2 or 3 years until her lifestyle changes. If this cytological examination were carried out regularly in all women, the mortality rate from cervical cancer could be reduced to zero. However, almost 40% of patients do not undergo regular screening.

If, during a gynecological examination, a tumor, ulcer or other suspicious area is detected on the cervix, as well as a Pap smear reveals suspicious changes in relation to a malignant tumor: two types of biopsy are used - targeted biopsy, in which a small piece of cervical tissue is taken under the control of a colposcope , and endocervical curettage, in which the mucous membrane of the cervical canal is scraped without visual control. Both types of biopsies involve some pain and some bleeding. Both methods usually provide enough tissue for a pathologist to make a diagnosis. If the diagnosis is unclear, the doctor performs a cone biopsy, which removes more tissue. Typically this type of biopsy is performed using loop electrosurgical excision (excision) techniques on an outpatient basis.

If cervical cancer is detected, the next step is to determine the exact size and location of the tumor; this process is called determining the stage of development of a malignant tumor.

Treatment: Treatment depends on the stage of development of cervical cancer. If the malignant tumor is limited to its superficial layers (carcinoma in situ), the doctor can remove the tumor completely - removing part of the cervix surgically or using a loop electrosurgical excision (excision). After such treatment, the ability to have children is preserved. However, the doctor recommends that the woman come for examinations and Pap smears every 3 months during the first year and every 6 months thereafter, since the malignant tumor may recur. If a woman is diagnosed with carcinoma in situ and she does not plan to have children, then she is recommended to have the uterus removed (extirpation).

If the cancer has reached a more advanced stage of development, hysterectomy in combination with removal of surrounding tissue (radical hysterectomy) and lymph nodes is necessary. However, normally functioning ovaries in young women are not removed.

1.1.3 Ovarian cancer: symptoms, diagnosis and treatment

Ovarian cancer (ovarian carcinoma) usually develops in women between 50 and 70 years of age, affecting approximately 1 in 70 women on average. It is the third most common type of female reproductive system cancer, but more women die from ovarian cancer than from any other reproductive organ cancer.

The ovaries consist of various tissues, the cells of each of them can be the source of the development of one or another type of malignant tumor. There are at least 10 types of ovarian cancer, which accordingly have different treatment features and recovery prospects.

Ovarian cancer cells can invade directly into surrounding tissue and through the lymphatic system into other organs in the pelvis and abdomen. Cancer cells can also enter the bloodstream and be found in distant organs, mainly the liver and lungs.

Symptoms and diagnosis: h A malignant ovarian tumor can grow to a significant size before any symptoms occur. The first symptom may be vague discomfort in the lower abdomen, similar to diarrhea (dyspepsia). Uterine bleeding is not a common symptom. Enlargement of the ovaries in a postmenopausal woman may be an early sign of cancer, although it is usually associated with the development of benign tumors or the appearance of other abnormalities. Fluid sometimes accumulates in the abdomen (ascites). Gradually, the abdomen increases in volume due to enlargement of the ovaries or accumulation of fluid. At this stage of the disease, a woman often feels pain in the pelvic area, she develops anemia and loses body weight. In rare cases, ovarian cancer produces hormones that cause excessive growth of the lining of the uterus, enlarged breasts, or increased hair growth.

Diagnosis of ovarian cancer early stages Its development is often difficult because symptoms usually do not appear until the tumor has spread beyond the ovaries, and because many other, less dangerous diseases are accompanied by similar symptoms.

If ovarian cancer is suspected, it should be ultrasonography(ultrasound) or computed tomography (CT) to obtain the necessary information about the ovarian tumor. Sometimes the ovaries are viewed directly using a laparoscope, a fiber-optic system inserted into the abdominal cavity through a small incision in the abdominal wall. If the examination reveals a benign ovarian cyst, the woman should undergo periodic gynecological examinations as long as the cyst persists.

Treatment: Ovarian cancer is treated surgically. The extent of the operation depends on the type of malignant tumor and the stage of its development. If the tumor is limited to the ovary, it is possible to remove only the affected ovary and the corresponding fallopian tube. When the tumor has spread beyond the ovary, both ovaries and the uterus must be removed, as well as nearby (regional) lymph nodes and surrounding tissues to which the cancer typically metastasizes.

After surgery, radiation therapy and chemotherapy are often given to destroy any small pockets of cancer that may remain. It is difficult to cure ovarian cancer that has spread (metastasized) beyond the ovaries.

Between 15 and 85% of women with the most common types of ovarian cancer survive five years after diagnosis.

1.1.4 Vulvar cancer: symptoms, diagnosis and treatment

The vulva is the external female genitalia. Vulvar cancer (vulvar carcinoma) accounts for only 3-4% of all gynecological cancers and is usually detected after menopause. As the population ages, the incidence of this malignancy is expected to increase.

Vulvar cancer is usually cancer of the skin near the opening of the vagina. Vulvar cancers most often form the same cell types as skin cancers (epidermal cells and basal cells). Approximately 90% of vulvar cancers are squamous cell carcinomas, and 4% are basal cell carcinomas. The remaining 6% are rare malignant tumors (Paget's disease, Bartholin gland cancer, melanoma, etc.).

Symptoms and diagnosis: The development of vulvar cancer can be easily detected - unusual nodes or ulcers appear near the entrance to the vagina. Sometimes there are areas of peeling or discoloration of the skin. The surrounding tissue may have a wrinkled appearance. The discomfort is usually not severe, but itching in the vagina is disturbing. Subsequently, bleeding or watery discharge often develops. The appearance of these symptoms requires immediate medical attention.

To make a diagnosis, the doctor performs a biopsy. After numbing the suspicious area with an anesthetic, a small area of discolored skin is removed. A biopsy is needed to determine whether skin changes are cancerous or due to infectious inflammation or irritation. A biopsy also makes it possible to recognize the type of malignant tumor when it is detected and determine a treatment strategy.

Treatment: A vulvectomy is an operation that removes a large area of vulvar tissue near the vaginal opening. Vulvectomy is necessary for all types of vulvar cancer except preinvasive carcinoma to remove squamous cell malignant tumors of the vulva. This extensive removal is done because this type of vulvar cancer can quickly spread to nearby tissue and lymph nodes. Because a vulvectomy may also remove the clitoris, the doctor discusses future treatment with the woman diagnosed with vulvar cancer to develop a treatment plan. the best way suitable for her, taking into account concomitant diseases, age and aspects of sexual life. Since basal cell carcinoma of the vulva does not tend to metastasize to distant organs, surgical removal is usually sufficient. If the malignant tumor is small, then removal of the entire vulva is not necessary.

1.1.5 Vaginal cancer: symptoms, diagnosis and treatment

Only about 1% of all malignant tumors that arise in the female genital organs develop in the vagina. Vaginal cancer (carcinoma) usually appears in women between 45 and 65 years of age. In more than 95% of cases, vaginal cancer is squamous cell and is morphologically similar to cervical and vulvar cancer. Squamous cell carcinoma of the vagina can be caused by human papillomavirus, the same virus that causes genital warts and cervical cancer. Diethylstilbesterol-dependent carcinoma is a rare type of vaginal cancer that occurs almost exclusively in women whose mothers took the drug diethylstilbesterol during pregnancy.

Symptoms and diagnosis: Vaginal cancer grows into the vaginal mucosa and is accompanied by the formation of ulcers that can bleed and become infected. Watery discharge or bleeding and pain during intercourse appear.

When vaginal cancer is suspected, the doctor will scrape the vaginal lining to examine under a microscope and perform a biopsy of lumps, ulcers, and other suspicious areas noticed during a pelvic exam. A biopsy is usually performed during a colposcopy.

Treatment: l Treatment for vaginal cancer depends on the location and size of the tumor. However, all types of vaginal cancer can be treated with radiation therapy.

For cancer in the middle third of the vagina, radiation therapy is prescribed, and for cancer in the lower third, surgery or radiation therapy is prescribed.

After treatment for vaginal cancer, sexual intercourse may be difficult or impossible, although sometimes a new vagina is created using a skin graft or part of the intestine. Survival at 5 years is observed in approximately 30% of women.

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NURSING CARE FOR CANCER PATIENTS

Introduction

Conclusion

Literature

Introduction

Primary malignant tumors of the central nervous system account for about 1.5% of the total cancer incidence.

In children, tumors of the central nervous system are much more common (? 20%) and are second only to leukemia. In absolute terms, the incidence increases with age. Men get sick 1.5 times more often than women, whites - more often than representatives of other races. For every spinal cord tumor there are over 10 brain tumors. Metastatic tumors of the central nervous system (mainly the brain) develop in 10-30% of patients with malignant tumors of other organs and tissues.

They are thought to be even more common than primary CNS tumors. Most often metastasizes to the brain lung cancer, breast, skin melanoma, kidney cancer and colorectal cancer.

The vast majority (more than 95%) of primary CNS tumors occur for no apparent reason. Risk factors for the development of the disease include radiation and family history (I and II). The influence of mobile communications on the occurrence of central nervous system tumors has not yet been proven, but monitoring of the impact of this factor continues.

1. Features of caring for cancer patients

What are the characteristics of a nurse working with cancer patients? A feature of caring for patients with malignant neoplasms is the need for a special psychological approach. The patient should not be allowed to find out the true diagnosis. The terms “cancer” and “sarcoma” should be avoided and replaced with the words “ulcer”, “narrowing”, “induration”, etc.

In all extracts and certificates handed out to patients, the diagnosis should also not be clear to the patient.

You should be especially careful when talking not only with patients, but also with their relatives. Cancer patients have a very labile, vulnerable psyche, which must be kept in mind at all stages of care for these patients.

If consultation with specialists from another medical institution is needed, then a doctor or nurse is sent with the patient to transport the documents.

If this is not possible, then the documents are sent by mail to the head physician or given to the patient’s relatives in a sealed envelope. The actual nature of the disease can only be communicated to the patient’s closest relatives.

What are the features of patient placement in the oncology department? We must try to separate patients with advanced tumors from the rest of the patient population. It is advisable that patients with early stages of malignant tumors or precancerous diseases do not meet patients with relapses and metastases.

In an oncology hospital, newly arrived patients should not be placed in wards where there are patients with advanced stages of the disease.

How are cancer patients monitored and cared for? When monitoring cancer patients great importance has regular weighing, since a drop in body weight is one of the signs of disease progression. Regular measurement of body temperature allows us to identify the expected disintegration of the tumor and the body’s reaction to radiation.

Body weight and temperature measurements should be recorded in the medical history or in the outpatient card.

For metastatic lesions of the spine, which often occur with breast or lung cancer, bed rest is prescribed and a wooden shield is placed under the mattress to avoid pathological bone fractures. When caring for patients suffering from inoperable forms of lung cancer, exposure to air, non-tiring walks, and frequent ventilation of the room are of great importance, since patients with limited respiratory surface of the lungs need an influx of clean air.

How are sanitary and hygienic measures carried out in the oncology department?

It is necessary to train the patient and relatives in hygienic measures. Sputum, which is often secreted by patients suffering from cancer of the lungs and larynx, is collected in special spittoons with well-ground lids. Spittoons need to be washed daily hot water and disinfect with a 10-12% bleach solution. To destroy the foul odor, add 15-30 ml to the spittoon. turpentine. Urine and feces for examination are collected in an earthenware or rubber vessel, which should be regularly washed with hot water and disinfected with bleach.

What is the diet for cancer patients?

Proper diet is important.

The patient should receive food rich in vitamins and proteins at least 4-6 times a day, and attention should be paid to the variety and taste of the dishes. You should not adhere to any special diets, you just need to avoid excessively hot or very cold, rough, fried or spicy foods.

What are the features of feeding patients with stomach cancer? Patients with advanced forms of stomach cancer should be fed more gentle foods (sour cream, cottage cheese, boiled fish, meat broths, steamed cutlets, crushed or pureed fruits and vegetables, etc.).

During meals, it is necessary to take 1-2 tablespoons of a 0.5-1% solution of hydrochloric acid. Severe obstruction of solid food in patients with inoperable forms of cancer of the cardial part of the stomach and esophagus requires the administration of high-calorie and vitamin-rich liquid food (sour cream, raw eggs, broths, liquid porridges, sweet tea, liquid vegetable puree, etc.). Sometimes the following mixture helps improve patency: rectified alcohol 96% - 50 ml., glycerin - 150 ml. (one tablespoon before meals).

Taking this mixture can be combined with the administration of a 0.1% atropine solution, 4-6 drops per tablespoon of water, 15-20 minutes before meals. If there is a threat of complete obstruction of the esophagus, hospitalization for palliative surgery is necessary. For a patient with a malignant tumor of the esophagus, you should have a sippy cup and feed him only liquid food. In this case, it is often necessary to use a thin gastric tube passed into the stomach through the nose.

2. Features of organizing nurse care for cancer patients

2.1 Organization of medical care for the population in the field of oncology

Medical care is provided to patients in accordance with the “Procedure for providing medical care to the population”, approved by order of the Ministry of Health Russian Federation dated November 15, 2012 No. 915n. Medical assistance is provided in the form of:

Primary health care;

Ambulance, including specialized emergency medical care;

Specialized, including high-tech, medical care;

Palliative care.

Medical assistance is provided in the following conditions:

Outpatient;

In a day hospital;

Stationary.

Medical care for cancer patients includes:

Prevention;

Diagnosis of oncological diseases;

Treatment;

Rehabilitation of patients of this profile using modern special methods and complex, including unique, medical technologies.

Medical care is provided in accordance with the standards of medical care.

2.1.1 Providing primary health care to the population in the field of oncology

Primary health care includes:

Primary pre-hospital health care;

Primary medical care;

Primary specialized health care.

Primary health care includes the prevention, diagnosis, treatment of cancer and medical rehabilitation according to the recommendations of the medical organization providing medical care patients with cancer.

Primary pre-medical health care is provided by medical workers with secondary medical education in an outpatient setting.

Primary medical care is provided on an outpatient basis and in a day hospital setting by local therapists and general practitioners (family doctors) on a territorial-precinct basis.

Primary specialized health care is provided in a primary oncology office or in a primary oncology department by an oncologist.

If an oncological disease is suspected or detected in a patient, general practitioners, local therapists, general practitioners (family doctors), specialist doctors, paramedical workers in the prescribed manner refer the patient for consultation to the primary oncology office or the primary oncology department of a medical organization for providing him with primary specialized health care.

An oncologist at a primary oncology office or primary oncology department refers a patient to an oncology clinic or to medical organizations that provide medical care to patients with cancer to clarify the diagnosis and provide specialized, including high-tech, medical care.

2.1.2 Providing emergency, including specialized, medical care to the population in the field of oncology

Emergency medical care is provided in accordance with the order of the Ministry of Health and Social Development of the Russian Federation dated November 1, 2004 No. 179 “On approval of the Procedure for the provision of emergency medical care” (registered by the Ministry of Justice of the Russian Federation on November 23, 2004, registration No. 6136), as amended, introduced by orders of the Ministry of Health and Social Development of the Russian Federation dated August 2, 2010 No. 586n (registered by the Ministry of Justice of the Russian Federation on August 30, 2010, registration No. 18289), dated March 15, 2011 No. 202n (registered by the Ministry of Justice of the Russian Federation on April 4, 2011, registration No. 20390) and dated January 30, 2012 No. 65n (registered by the Ministry of Justice of the Russian Federation on March 14, 2012, registration No. 23472).

Emergency medical care is provided by paramedic visiting ambulance teams, medical visiting ambulance teams in an emergency or emergency form outside a medical organization.

Also in outpatient and inpatient settings for conditions requiring urgent medical intervention.

If an oncological disease is suspected and (or) detected in a patient during the provision of emergency medical care, such patients are transferred or referred to medical organizations providing medical care to patients with oncological diseases, to determine management tactics and the need to additionally use other methods of specialized antitumor treatment.

2.1.3 Providing specialized, including high-tech, medical care to the population in the field of oncology

Specialized, including high-tech, medical care is provided by oncologists, radiotherapists in an oncology clinic or in medical organizations that provide medical care to patients with cancer, have a license, the necessary material and technical base, certified specialists, in inpatient settings and conditions of a day hospital and includes prevention, diagnosis, treatment of oncological diseases requiring the use of special methods and complex (unique) medical technologies, as well as medical rehabilitation. The provision of specialized, including high-tech, medical care in an oncology clinic or in medical organizations providing medical care to patients with cancer is carried out in the direction of an oncologist of the primary oncology office or primary oncology department, a specialist doctor in case of suspicion and (or) detection in a patient with cancer during emergency medical care. In a medical organization providing medical care to patients with cancer, tactics medical examination and treatment is established by a council of oncologists and radiotherapists, with the involvement of other medical specialists if necessary. The decision of the council of doctors is documented in a protocol, signed by the participants of the council of doctors, and entered into the patient’s medical documentation.

2.1.4 Providing palliative medical care to the population in the field of oncology

Palliative care is provided by medical professionals trained in palliative care in outpatient, inpatient, and day hospital settings and includes a set of medical interventions aimed at relieving pain, including the use of narcotic drugs, and relief of other severe manifestations of cancer.

The provision of palliative medical care in an oncology clinic, as well as in medical organizations with palliative care departments, is carried out on the direction of a local physician or general practitioner ( family doctor), an oncologist at a primary oncology office or primary oncology department.

2.1.5 Follow-up of cancer patients

Patients with cancer are subject to lifelong dispensary observation in the primary oncology office or primary oncology department of a medical organization, oncology clinic or in medical organizations providing medical care to patients with cancer. If the course of the disease does not require a change in patient management tactics, clinical examinations after treatment are carried out:

During the first year - once every three months;

During the second year - once every six months;

In the future - once a year.

Information about a newly diagnosed case of cancer is sent by a medical specialist from the medical organization in which the corresponding diagnosis was established to the organizational and methodological department of the oncology dispensary for registering the patient with the dispensary. If the patient is confirmed to have cancer, information about the patient’s updated diagnosis is sent from the organizational and methodological department of the oncology clinic to the primary oncology office or the primary oncology department of the medical organization providing medical care to patients with cancer, for subsequent follow-up of the patient.

2.2 Organization of activities of the oncology clinic

The registry office of the dispensary's clinic is responsible for registering patients for appointments with an oncologist, a gynecologist-oncologist, an oncologist, and a hematologist-oncologist. The registry keeps records of those admitted for inpatient and outpatient examinations for the purpose of consultation.

Confirmation or clarification of the diagnosis, consultation: surgeon-oncologist, gynecologist-oncologist, endoscopist, hematologist. The treatment plan for patients with malignant neoplasms is decided by the CEC. Clinical laboratory where clinical, biochemical, cytological, hematological studies are carried out.

X-ray - diagnostic room performs examinations of patients to clarify the diagnosis and further treatment in the oncology clinic (fluoroscopy of the stomach, chest radiography, radiography of bones, skeleton, mammography), special studies for treatment (marking of the pelvis, rectum, bladder).

The endoscopic room is designed for endoscopic therapeutic and diagnostic procedures (cystoscopy, sigmoidoscopy, endoscopy).

The treatment room is used to carry out medical appointments for outpatients.

Rooms: surgical and gynecological, in which outpatients are received and consultations are carried out by oncologists.

At an outpatient appointment with patients, after their examination, the issue of confirming or clarifying this diagnosis is decided.

2.3 Features of nurse care for cancer patients

Modern treatment of cancer patients is a complex problem, in which doctors of various specialties take part: surgeons, radiation specialists, chemotherapists, psychologists. This approach to treating patients also requires the oncology nurse to solve many different problems. Main areas of work nurse in oncology are:

Introduction medicines(chemotherapy, hormone therapy, biotherapy, painkillers, etc.) according to medical prescriptions;

Participation in the diagnosis and treatment of complications arising during the treatment process;

Psychological and psychosocial assistance to patients;

Educational work with patients and their family members;

Participation in scientific research.

2.3.1 Features of the work of a nurse during chemotherapy

Currently, in the treatment of oncological diseases at the Nizhnevartovsk Oncology Dispensary, preference is given to combination polychemotherapy.

The use of all anticancer drugs is accompanied by the development of adverse reactions, since most of them have a low therapeutic index (the interval between the maximum tolerated and toxic dose). The development of adverse reactions when using anticancer drugs creates certain problems for the patient and medical personnel caring for them. One of the first side effects is a hypersensitivity reaction, which can be acute or delayed.

An acute hypersensitivity reaction is characterized by the appearance in patients of shortness of breath, wheezing, a sharp drop in blood pressure, tachycardia, a feeling of heat, hyperemia skin.

The reaction develops already in the first minutes of drug administration. Actions of the nurse: immediately stop administering the drug, immediately inform the doctor. In order not to miss the onset of these symptoms, the nurse constantly monitors the patient.

At certain intervals, she monitors blood pressure, pulse, respiratory rate, skin condition and any other changes in the patient’s well-being. Monitoring should be performed whenever anticancer drugs are administered.

A delayed hypersensitivity reaction is manifested by persistent hypotension and the appearance of a rash. Actions of the nurse: reduce the rate of drug administration, immediately inform the doctor.

Other side effects that occur in patients receiving anticancer drugs include neutropenia, myalgia, arthralgia, mucositis, gastrointestinal toxicity, peripheral neutropathy, alopecia, phlebitis, extravasation.

Neutropenia is one of the most common side effects, which is accompanied by a decrease in the number of leukocytes, platelets, neutrophils, accompanied by hyperthermia and, as a rule, the addition of some infectious disease.

It usually occurs 7-10 days after chemotherapy and lasts 5-7 days. It is necessary to measure body temperature twice a day, and perform a CBC once a week. To reduce the risk of infection, the patient should refrain from excessive activity and remain calm, avoid contact with sick people respiratory infections, do not visit places with large crowds of people.

Leukopenia is dangerous for the development of severe infectious diseases, depending on the severity of the patient’s condition, requiring the administration of hemostimulating agents, the prescription of broad-spectrum antibiotics, and placement of the patient in a hospital.

Thrombocytopenia is dangerous due to the development of bleeding from the nose, stomach, and uterus. If the number of platelets decreases, immediate blood transfusion, platelet mass, and the prescription of hemostatic drugs are necessary.

Myalgia, arthralgia (pain in muscles and joints), appear 2-3 days after chemotherapy infusion, pain can be of varying intensity, last from 3 to 5 days, often do not require treatment, but in case of severe pain, the patient is prescribed non-steroidal PVP or non-narcotic analgesics .

Mucositis and stomatitis are manifested by dry mouth, a burning sensation when eating, redness of the oral mucosa and the appearance of ulcers on it.

Symptoms appear on the 7th day and persist for 7-10 days. The nurse explains to the patient that he must examine the oral mucosa, lips, and tongue every day.

When stomatitis develops, it is necessary to drink more fluids, rinse your mouth often (necessarily after eating) with a furacillin solution, brush your teeth with a soft brush, and avoid spicy, sour, hard and very hot foods. Gastrointestinal toxicity is manifested by anorexia, nausea, vomiting, and diarrhea.

Occurs 1-3 days after treatment and can persist for 3-5 days. Almost all cytotoxic drugs cause nausea and vomiting. Patients may experience nausea just at the thought of chemotherapy or at the sight of a pill or a white coat.

When solving this problem, each patient needs an individual approach, a doctor’s prescription of antiemetic therapy, and the sympathy of not only relatives and friends, but primarily medical personnel.

The nurse provides a calm environment and, if possible, reduces the influence of factors that can provoke nausea and vomiting.

For example, does not offer the patient food that makes him sick, feeds him in small portions, but more often, does not insist on eating if the patient refuses to eat. Recommends eating slowly, avoiding overeating, resting before and after meals, not turning over in bed or lying on your stomach for 2 hours after eating.

The nurse makes sure that there is always a container for vomit next to the patient, and that he can always call for help. After vomiting, the patient should be given water so that he can rinse his mouth.

It is necessary to inform the doctor about the frequency and nature of vomiting, about the presence of signs of dehydration in the patient (dry, inelastic skin, dry mucous membranes, decreased diuresis, headache). The nurse teaches the patient the basic principles of oral care and explains why it is so important.

Peripheral nephropathy is characterized by dizziness, headache, numbness, muscle weakness, impaired motor activity, and constipation.

Symptoms appear after 3-6 courses of chemotherapy and may persist for about 1-2 months. The nurse informs the patient about the possibility of the above symptoms and recommends that they urgently contact a doctor if they occur.

Alopecia (baldness) occurs in almost all patients, starting from 2-3 weeks of treatment. The hairline is completely restored 3-6 months after completion of treatment.

The patient must be psychologically prepared for hair loss (convinced to buy a wig or hat, use a headscarf, teach some cosmetic techniques).

Phlebitis (inflammation of the vein wall) is a local toxic reaction and is a common complication that develops after multiple courses of chemotherapy. Manifestations: swelling, hyperemia along the veins, thickening of the vein wall and the appearance of nodules, pain, striations of the veins. Phlebitis can last up to several months.

The nurse regularly examines the patient, assesses venous access, selects appropriate medical instruments for administering chemotherapy (butterfly needles, peripheral catheters, central venous catheters).

It is better to use a vein with the widest diameter possible, which ensures good blood flow. If possible, alternate veins of different limbs, unless anatomical reasons prevent this (postoperative lymphostasis).

Extravasation (drug penetration under the skin) is a technical error by medical personnel.

Also, the reasons for extravasation may be the anatomical features of the patient’s venous system, fragility of blood vessels, rupture of the vein at a high rate of drug administration. Getting drugs such as adriamicide, farmorubicin, mitomycin, vincristine under the skin leads to necrosis of the tissue around the injection site.

At the slightest suspicion that the needle is outside the vein, the administration of the drug should be stopped without removing the needle, and try to aspirate the contents that have fallen under the skin medicinal substance, inject the affected area with an antidote, cover with ice.

General principles for the prevention of infections associated with peripheral venous access:

1. Follow the rules of asepsis during infusion therapy, including installation and care of the catheter;

2. Carry out hand hygiene before and after any intravenous manipulation, as well as before putting on and after taking off gloves;

3. Check the expiration dates of medications and devices before performing the procedure. Do not use expired medications or devices;

4. Treat the patient’s skin with a skin antiseptic before installing the PVC;

5. Rinse the PVC regularly to maintain patency. The catheter should be flushed before and after infusion therapy to prevent mixing of incompatible drugs. For rinsing, it is allowed to use solutions drawn into a 10 ml disposable syringe. from a disposable ampoule (NaCl 0.9% ampoule 5 ml. or 10 ml.). In the case of using a solution from large volume bottles (NaCl 0.9% 200 ml., 400 ml.), it is necessary that the bottle is used only for one patient;

6. Secure the catheter after installation with a bandage;

7. Replace the bandage immediately if its integrity is damaged;

8. In a hospital setting, inspect the catheter installation site every 8 hours.

On an outpatient basis once a day. More frequent inspection is indicated when irritating drugs are administered into a vein.

Assess the condition of the catheter insertion site using the phlebitis and infiltration scales and make appropriate notes on the palliative care observation sheet.

2.3.2 Nutritional features of an oncology patient

Dietary nutrition for an oncology patient should solve two problems:

Protecting the body from food intake of carcinogenic substances and factors that provoke the development of a malignant tumor;

Saturation of the body with nutrients that prevent the development of tumors - natural anti-carcinogenic compounds.

Based on the above tasks, the nurse gives recommendations to patients who want to adhere to an antitumor diet:

1. Avoid excess fat intake. Maximum amount free fat - 1 tbsp. a spoonful of vegetable oil per day (preferably olive). Avoid other fats, especially animal fats;

2. Do not use fats that are reused for frying or that have been overheated during cooking. When cooking foods, it is necessary to use fats that are resistant to heat: butter or olive oil. They should be added not during, but after cooking food;

3. Cook with little salt and do not add salt to food;

4. Limit sugar and other refined carbohydrates;

5. Limit your meat intake. Replace it partially with vegetable proteins (legumes), fish (small deep-sea varieties are preferred), eggs, and low-fat dairy products. When eating meat, proceed from its “value” in descending order: lean white meat, rabbit, veal, free range chicken (not broiler), lean red meat, fatty meat. Eliminate sausages, sausages, as well as charcoal-fried meat, smoked meat and fish;

6. Steam, bake or simmer foods over low heat with a minimum amount of water. Don't eat burnt food;

7. Eat whole grain cereals bakery products, enriched with dietary fiber;

8. Use spring water for drinking, settle the water or purify it in other ways. Drink herbal decoctions instead of tea, fruit juices. Try not to drink carbonated drinks with artificial additives;

9. Don't overeat, eat when you feel hungry;

10. Don't drink alcohol.

2.3.3 Carrying out pain relief in oncology

The likelihood of pain and its severity in cancer patients depends on many factors, including the location of the tumor, the stage of the disease and the location of metastases.

Each patient perceives pain differently, and this depends on factors such as age, gender, pain threshold, history of pain, and others. Psychological characteristics such as fear, anxiety and certainty of imminent death may also influence the perception of pain. Insomnia, fatigue and anxiety lower the pain threshold, while rest, sleep and distraction from the disease increase it.

Treatment methods for pain syndrome are divided into medicinal and non-medicinal.

Drug treatment of pain syndrome. In 1987, the World Health Organization determined that "analgesics are the mainstay of cancer pain treatment" and proposed a "three-step approach" for the selection of analgesic drugs.

At the first stage, a non-narcotic analgesic is used with the possible addition of an additional drug.

If the pain persists or intensifies over time, the second stage is used - a weak narcotic drug in combination with a non-narcotic and possibly an adjuvant drug (an adjuvant is a substance used in combination with another to increase the activity of the latter). If the latter is ineffective, the third stage is used - a strong narcotic drug with the possible addition of non-narcotic and adjuvant drugs.

Non-narcotic analgesics are used to treat moderate cancer pain. This category includes non-steroidal anti-inflammatory drugs - aspirin, acetaminophen, ketorolac.

Narcotic analgesics are used to treat moderate to severe cancer pain.

They are divided into agonists (completely imitating the effect of narcotic drugs) and agonist-antagonists (imitating only part of their effects - providing an analgesic effect, but without affecting the psyche). The latter include moradol, nalbuphine and pentazocine. For the effective action of analgesics, the mode of their administration is very important. In principle, two options are possible: reception at certain hours and “as needed”.

Studies have shown that the first method for chronic pain syndrome is more effective, and in many cases requires a lower dose of drugs than the second regimen.

Non-drug treatment of pain. To combat pain, a nurse can use physical and psychological methods (relaxation, behavioral therapy).

Pain can be significantly reduced by changing the patient’s lifestyle and the environment that surrounds him. Activities that provoke pain should be avoided and, if necessary, use a support collar, surgical corset, splints, walking aids, wheelchair, or lift.

When caring for a patient, the nurse takes into account that discomfort, insomnia, fatigue, anxiety, fear, anger, mental isolation and social abandonment exacerbate the patient's perception of pain. Empathy for others, relaxation, the possibility of creative activity, and good mood increase the cancer patient’s resistance to the perception of pain.

A nurse caring for a patient with pain:

Acts quickly and compassionately when patient requests for pain relief;

Observes non-verbal signs of the patient’s condition (facial expressions, forced posture, refusal to move, depressed state);

Educates and explains to patients and their caring relatives medication regimens, as well as normal and adverse reactions when taking them;

Shows flexibility in approaches to pain relief, and does not forget about non-medicinal methods;

Takes measures to prevent constipation (advice on nutrition, physical activity);

Provides psychological support to patients and their

relatives, uses measures of distraction, relaxation, shows care;

Conducts regular assessments of the effectiveness of pain relief and promptly reports to the doctor about all changes;

Encourages the patient to keep a diary of changes in his condition.

Relieving cancer patients of pain is the fundamental basis of their treatment program.

This can only be achieved through the joint actions of the patient himself, his family members, doctors and nurses.

2.3.4 Palliative care for cancer patients

Palliative care seriously ill patient- this is, first of all, the highest quality care.

The nurse must combine her knowledge, skills and experience with caring for the person.

Creating favorable conditions for an oncological patient, a delicate and tactful attitude, and a willingness to provide assistance at any moment are mandatory - prerequisites for quality nursing care.

Modern principles of nursing care:

1. Safety (prevention of patient injury);

2. Confidentiality (details of the patient’s personal life, his diagnosis should not be known to outsiders);

3. Respect for dignity (performing all procedures with the patient’s consent, ensuring privacy if necessary);

4. Independence (encouraging the patient when he becomes independent);

5. Infection safety.

The cancer patient has impaired satisfaction of the following needs: movement, normal breathing, adequate nutrition and drinking, excretion of waste products, rest, sleep, communication, overcoming pain, and the ability to maintain one’s own safety. In this regard, the following problems and complications may arise: the occurrence of bedsores, respiratory disorders (congestion in the lungs), urinary disorders (infection, formation of kidney stones), the development of joint contractures, muscle wasting, lack of self-care and personal hygiene, constipation, disorders sleep, lack of communication. The content of nursing care for a seriously ill patient includes the following points:

1. Ensuring physical and psychological peace - to create comfort, reduce the effect of irritants;

2. Monitoring compliance with bed rest - to create physical rest and prevent complications;

3. Changing the patient’s position after 2 hours - to prevent bedsores;

4. Ventilation of the ward, room - to enrich the air with oxygen;

5. Control of physiological functions - for the prevention of constipation, edema, and the formation of kidney stones;

6. Monitoring the patient’s condition (temperature measurement, blood pressure, pulse counting, respiratory rate) - for early diagnosis of complications and timely provision of emergency care;

7. Measures to maintain personal hygiene to create comfort and prevent complications;

8. Skin care - for the prevention of bedsores, diaper rash;

9. Change of bed and underwear - to create comfort and prevent complications;

10. Feeding the patient, assistance with feeding - to ensure vital important functions body;

11. Training relatives in care activities - to ensure the patient’s comfort;

12. Creating an atmosphere of optimism - to ensure the greatest possible comfort;

13. Organization of the patient’s leisure time - to create the greatest possible comfort and well-being;

14. Training in self-care techniques - for encouragement and motivation to action.

Conclusion

In this work, the features of nurse care for cancer patients were studied.

The relevance of the problem under consideration is extremely high and lies in the fact that, due to the increasing incidence of malignant neoplasms, the need for specialized care for cancer patients is growing, Special attention is given to nursing care, since a nurse is not just a doctor’s assistant, but a competent, independently working specialist.

Summarizing the work done, we can draw the following conclusions:

1) We carried out an analysis of risk factors for cancer. General clinical signs have been identified, modern methods of diagnosis and treatment of malignant neoplasms have been studied; medical oncology hospital

2) During the work, the organization of medical care was considered;

3) The activities of the nurse were analyzed;

4) A survey of patients was conducted;

5) During the study, statistical and bibliographic methods were used.

An analysis of twenty literary sources on the research topic was carried out, which showed the relevance of the topic and possible ways to solve problems in caring for cancer patients.

Literature

1. M.I. Davydov, Sh.Kh. Gantsev., Oncology: textbook, M., 2010, - 920 p.

2. Davydov M.I., Vedsher L.Z., Polyakov B.I., Gantsev Zh.Kh., Peterson S.B., Oncology: modular workshop. Textbook / 2008. - 320 p.

3. S.I. Dvoinikov, Fundamentals of Nursing: Textbook, M., 2007, p. 298.

4. Zaryanskaya V.G., Oncology for medical colleges - Rostov n/d: Phoenix / 2006.

5. Zinkovich G.A., Zinkovich S.A., If you have cancer: Psychological help. Rostov n/d: Phoenix, 1999. - 320 pp., 1999.

6. Kaprin A.D., The state of oncological care for the population of Russia / V.V. Starinsky, G.V. Petrova. - M.: Ministry of Health of Russia, 2013.

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Introduction

oncology benign tumor

The situation around neoplasms in general and cancer in particular has remained unchanged over the past two decades. Despite the fact that cancer and other malignant oncological diseases occur in 5-10% of cases of all diseases, they are in second place in terms of mortality. The first is second only to cardiovascular pathology. Most experts attribute this to two main factors:

1) An increase in the proportion of the elderly population of the Earth or the so-called trend towards aging.

2) Deterioration of the environmental situation, which is caused both by the development of technology and overpopulation of the planet.

However, cancer will occupy second place in the structure of mortality for an indefinitely long period of time due to the large number of questions about the causes of its occurrence. And the more advanced diagnostic methods become, the closer scientists come to uncovering the main causes of cancer, the more these questions become.

1. Oncology

The term “malignant neoplasms” usually refers to all types of malignant tumors. Melanoma stands apart among malignant neoplasms - it is formed from the pigment cells of melanocytes and is localized on the skin, mucous membranes or retina. Another type of tumor is sarcoma. Sarcomas are malignant neoplasms formed from stromal tissues (tendon, fat and muscle). Various types of cancer include tumors that develop from epithelial tissues - lungs, skin, stomach.

A tumor, or neoplasm, is a collection of similar cells that forms in various organs or tissues of the body. There are benign and malignant tumors. The difference between them is that a benign tumor develops, as it were, in a capsule: it is limited from other organs by dense tissue and pushes aside other tissues without causing harm to them. Such a neoplasm does not pose any danger to the patient’s life.

A malignant tumor grows, wedging into other tissues and destroying them. If a nerve gets in the way of the growth of a malignant tumor, it destroys it, which causes the cancer patient severe pain, if on the path of the neoplasm is located blood vessel, then the result of its destruction is internal bleeding.

Whatever type of cancer the patient has, the adhesion between the cells of such a tumor is very low. As a result, cells are easily detached from the malignant tumor and, along with the bloodstream, spread throughout the body, settling in tissues and organs. Once in a new location, the cell gradually becomes a new tumor, similar in composition and structure to the first neoplasm. These tumors are called metastases.

If some time after treatment the tumor appears again, this means that it recurs. It is not uncommon for one person to develop different tumors during his or her lifetime. This is primary multiple oncology. New tumors appear at intervals of less than a year - the patient has primary multiple synchronous cancer, more than a year - primary multiple metachronous cancer.

Sometimes benign tumors become malignant. This process is usually called transformation, or malignization.

2 . Types of benign tumors

Benign neoplasms develop from all tissues of the body. These tumors grow autonomously, non-invasively, are clearly demarcated from healthy tissues, do not metastasize, but can become malignant (malignant). As they grow slowly, they compress adjacent tissues and disrupt organ function, causing clinical symptoms. Benign brain tumors are life-threatening.

Benign neoplasms develop from all tissues of the body. The most common types of benign tumors are:

· Fibroma. It comes from connective tissue and is found wherever its fibers are present. There are hard nodular and soft fibromas. The favorite localization of hard fibroids is the uterus, and soft fibroids are the subcutaneous tissue of the perianal area and genital organs. Fibroids grow slowly, are separated from healthy tissue, are painless and mobile.

· Lipoma (wen). Comes from adipose tissue. It is most often located in the subcutaneous tissue and in the retroperitoneal fat space. The ratio of lipomas in women and men is 4:1. There are multiple wen - lipomatosis. A benign tumor of adipose tissue is lobulated, soft in consistency, and mobile. If there are connective tissue fibers in the wen, they speak of fibrolipoma.

· Myoma (leio- and fibromyomas). They come from the muscles and are localized in them. Myomas grow slowly, have a hard but elastic consistency, are mobile, and painless. Fibroids are often woven with connective tissue fibers, which is observed with uterine tumors. This benign neoplasm is called fibromyoma. Multiple lesions - fibromatosis.

· Neuroma. Comes from the nerve sheath. The tumor is dense, can be single or multiple, grows in the form of a node, and is painful on palpation. The most common combination of neuromas with connective tissue is neurofibroma. A benign tumor is localized in the intercostal spaces and along the sciatic nerves. According to the author, multiple neurofibromatosis is called Recklinghausen's disease.

Table 1. Classification of benign tumors

Type of fabric	Tumor name
Glandular epithelium
Columnar and flat epithelium	Epithelioma
Adipose tissue
Smooth muscle tissue	Leiomyoma
Cartilage tissue	Chondroma
Striated muscle tissue	Rhabdomyoma
Lymphoid tissue
Nervous tissue	Neuroma
Bone

3. Etiology and pathogenesis

Despite the fact that scientists still cannot give an exact answer to what causes cancer, they all have a common principle of development. And it is the same throughout most of its stages. But first it is necessary to give a little clarification regarding the life of cells.

Any living cell, in addition to specific, characteristic features of metabolism and functions performed only for it, it has the so-called Heflick limit. This is nothing more than information about “death” encoded on the cell’s DNA. Or more correctly - in the number of allotted divisions that a cell can perform. After which, she must die. Cells different types fabrics have different limits. Those of them that need constant renewal in the process of life have a significant Hayflick limit. These tissues include skin epithelium and internal organs, bone marrow cells. The same tissues in which cell division is provided only at the stage of development have a limit for this stage. At the same time, the lifespan of the cell is longer. The most striking example of such tissues are neurons.

As a result of some reasons (see below), the cell loses this limit. After which, it becomes capable of an unlimited number of divisions. And since fission takes up a certain amount of energy, its metabolism begins a gradual restructuring. All organelles direct their “forces” to the cell’s ability to divide, which negatively affects its functions - they are lost over time. After some time, a cell deprived of the Hayflick limit and its “descendants” are very different from the rest of the tissue - cancer (carcinoma) is formed.

The causes of cancer are not known. But numerous observations indicate a high relationship between oncology and certain factors and substances. They have common name- carcinogens. From the Latin term “carcinogenesis,” which literally translates as “the birth of cancer.” Today there are more than a hundred such substances. And they are all combined into several groups.

· Genetic factors. Associated with defects in cellular DNA and a high risk of the cell possessing it losing the Hayflick limit. There is no direct evidence yet. But observations show that people who have relatives with cancer are more likely than others to get cancer (carcinoma).

· Infectious causes of cancer. These include some viruses and other microorganisms. So far, there is a proven connection with viruses for some diseases. Thus, cervical cancer is caused by the human papilloma virus, malignant lymphomas - by herpes viruses. For other types of cancer, the connection with microorganisms is conditionally proven. For example, liver cancer most often occurs in patients with hepatitis B and C. All these studies are based on the fact that viruses develop only by integrating their genes into the DNA of the cell. And this is the risk of developing its anomalies and losing the Hayflick limit.

· Physical factors. These are various types of radiation, X-rays, ultraviolet. Their relationship with cancer development is based on the basic mechanisms of their action. All of them are capable of destroying the shells of atoms. As a result, the structure of the molecule is disrupted and part of the DNA, which contains the Hayflick limit, is destroyed along the chain.

· Chemical compounds. This group includes various substances that can penetrate the cell nucleus and enter into chemical reactions with the DNA molecule.

· Hormonal disorders. In this case, cancer is the result of a malfunction of the glands internal secretion, which occurs under the influence of excess/deficiency of certain hormones. The most striking examples of malignant diseases of this group are thyroid cancer and breast cancer.

· Immunity disorders. The basis of these reasons is a decrease in the activity of killer T-leukocytes, which are designed to destroy any cells of the body that have deviations from the normal structure. Some experts do not distinguish this group due to the fact that violations cellular immunity play a role in the occurrence of cancer in general.

4. TOlinear picture

If cancer is detected at an early stage of development, it can be cured. It is important to monitor your body, understand what condition is considered normal for it, and if abnormalities appear, consult a doctor. In this case, if the patient has cancer, doctors will notice it at an early stage.

There are various general symptoms cancer:

· Tumors.

· Shortness of breath, cough, hoarseness.

The so-called chest symptoms of cancer are cough, shortness of breath and hoarseness. Of course, they can be caused by infections, inflammation, and other diseases and ailments, but in some cases such signs indicate lung cancer. Hoarseness is often caused by laryngitis. This disease means inflammation of the larynx. However, in rare cases, hoarseness is an early symptom of laryngeal cancer.

· Disturbances in the digestive tract.

A sign of changes in the functioning of the digestive tract is the presence of blood in the stool. It is usually bright red or dark. The presence of fresh, scarlet blood is a sign of hemorrhoids.

· Bleeding.

Any bleeding for no apparent reason is a sign of a malfunction of the internal organs. Bleeding from the rectum can be a sign of hemorrhoids, but also one of the symptoms of cancer of the internal organs. If a woman has a malignant tumor in the uterus or cervix, bleeding may occur between menstruation or after sexual intercourse. If bleeding is observed in women after menopause, then she urgently needs to consult a doctor. Blood in the urine may be a symptom of bladder cancer or kidney cancer. If when you cough, sputum comes out with blood, then the reason for this is a serious infectious disease. Sometimes this is a sign of lung cancer. Blood in vomit can signal stomach cancer, however, the cause of this phenomenon can also be an ulcer. Therefore, the exact answer to the question of how to determine cancer is to consult a specialist. Nosebleeds and bruising are rare symptoms of cancer. Sometimes these signs are a consequence of leukemia. However, people suffering from this disease also have other, more obvious signs of cancer.

· Moles.

You should consult a doctor immediately if your moles exhibit the following signs:

Asymmetry;

Ragged edges;

Color atypical for a mole;

Large size (moles usually do not exceed 6 mm in diameter, melanomas - more than 7 mm);

Crusting, itching, bleeding: melanomas may bleed, crust, or itch.

· Unreasonable weight loss.

5. Diagnostics

Thanks to the trend modern medicine, doctors of all primary care specialties (polyclinics), as well as medical examinations are largely aimed at the early detection of cancer. But diagnostic methods have been based on several principles for more than 20 years.

1. Taking an anamnesis. It includes:

Anamnesis of life. Information about human development, the presence of chronic diseases, injuries, etc.

History of the disease. That is, any information regarding the onset of the disease and its subsequent development.

2. General clinical tests.

A general blood test reveals abnormalities metabolic processes by erythrocyte sedimentation rate (ESR), glucose level, hemoglobin. The latter indicator also allows you to identify anemia.

A general urine test provides data on kidney function, protein and water-salt metabolism in the body.

A biochemical blood test allows us to judge in more detail the types of metabolism and the functioning of certain organs. So aminotransferases (abbreviations - ALT and AST), bilirubin, characterize the functioning of the liver. Creatinine and urea serve as markers of kidney function. Alkaline phosphatase reflects the condition of some hollow organs and the pancreas. And so on. Besides, biochemical analysis allows you to examine blood for the presence of specific proteins of cancer cells - so-called tumor markers.

3. Special research methods aimed at specific parts of the body.

Chest X-ray allows you to see abnormalities even with small tumors. (less than a centimeter). The same applies to radiography of other parts (abdomen, lower back).

Computed tomography and magnetic resonance imaging are modern diagnostic methods. They allow you to see a tumor about a millimeter in size.

Endoscopic methods (laryngo- and bronchoscopy, fibrogastroduodenoscopy, colonoscopy and colposcopy. They are used to detect cancer of the larynx, esophagus and stomach, rectum, uterus and appendages. All these methods allow visual diagnosis of cancer (carcinoma). In addition, most of them allow take a piece of tissue for histological examination.

4. Cytological methods or study of cell structure. A final diagnosis is given.

6. Oncology treatment methods

Cancer treatment depends on the type of tumor, its location, structure, stage of the disease in accordance with the TNM classification. The following types of treatment are distinguished.

1) Surgical removal tumors with adjacent tissues. Effective for the treatment of small tumors accessible to surgical intervention and in the absence of metastases. Tumor recurrences may often occur after surgical treatment.

2) Radiation therapy is used to treat poorly differentiated tumors that are sensitive to radiation. Also used for local destruction of metastases.

3) Chemotherapy is used to treat various, often late stages of cancer using cytotoxic agents, hormonal/antihormonal agents, immune drugs, enzyme drugs, anti-tumor antibiotics and other drugs that destroy or slow the growth of cancer cells.

4) Gene therapy is the most modern method treatment, the essence of which is to influence the STAT (signal transduction and activator of transcription) system and other systems, thereby regulating the process of cell division.

5) Neutron therapy is a new method of treating tumors, similar to radiation therapy, but differs from it in that neutrons are used instead of conventional radiation. Neutrons penetrate deep into tumor tissues that have absorbed, for example, boron, and destroy them without damaging healthy tissue, unlike radiotherapy. This therapy has shown a very high percentage of complete recovery in the treatment of tumors, amounting to 73.3%, even at an advanced stage.

6) Immunotherapy. The immune system strives to destroy the tumor. However, for a number of reasons, she is often unable to do this. Immunotherapy helps the immune system fight a tumor by making it attack the tumor more effectively or by making the tumor more sensitive. The William Coley vaccine, as well as a variant of this vaccine, picibanil, are effective in treating some forms of neoplasms by stimulating the activity of natural killer cells and the production of a number of cytokines, such as tumor necrosis factor and interleukin-12. Epigenetic therapy can be used to activate protective immune mechanisms.

7) Photodynamic therapy - is based on the use of photosensitizers, which selectively accumulate in tumor cells and increase its sensitivity to light. Under the influence of light waves of a certain length, these substances enter into a photochemical reaction, which leads to the formation of reactive oxygen species, which acts against tumor cells.

8) Virotherapy is one of the types of biotherapy that uses oncotropic / oncolytic viruses. One of the areas of oncology. Virotherapy mobilizes the body's natural defenses against cells of genetically modified organisms and tissues, including malignant cells.

9) Targeted therapy is a new treatment development cancerous tumors, affecting the “fundamental molecular mechanisms", which underlie various kinds of diseases.

On this moment most good results in the treatment of cancer are observed when using combined treatment methods (surgical, radiation and chemotherapy).

A promising direction in treatment are methods of local impact on tumors, such as chemoembolization.

7. Nursing care

1. A feature of caring for patients with malignant neoplasms is the need for a special psychological approach. The patient should not be allowed to find out the true diagnosis. The terms “cancer” and “sarcoma” should be avoided and replaced with the words “ulcer”, “narrowing”, “induration”, etc. In all extracts and certificates handed out to patients, the diagnosis should also not be clear to the patient. You should be especially careful when talking not only with patients, but also with their relatives. Cancer patients have a very labile, vulnerable psyche, which must be kept in mind at all stages of care for these patients. If consultation with specialists from another medical institution is needed, then a doctor or nurse is sent with the patient to transport the documents. If this is not possible, then the documents are sent by mail to the head physician or given to the patient’s relatives in a sealed envelope. The actual nature of the disease can only be communicated to the patient’s closest relatives.

2. A feature of placing patients in the oncology department is that you need to try to separate patients with advanced tumors from the rest of the patient flow. It is advisable that patients with early stages of malignant tumors or precancerous diseases do not meet patients with relapses and metastases. In an oncology hospital, newly arrived patients should not be placed in wards where there are patients with advanced stages of the disease.

3. When monitoring cancer patients, regular weighing is of great importance, since a drop in body weight is one of the signs of disease progression. Regular measurement of body temperature allows us to identify the expected disintegration of the tumor and the body’s reaction to radiation. Body weight and temperature measurements should be recorded in the medical history or in the outpatient card.

4. In order for sanitary and hygienic measures to be carried out in the oncology department, it is necessary to train the patient and relatives in hygienic measures. Sputum, which is often secreted by patients suffering from cancer of the lungs and larynx, is collected in special spittoons with well-ground lids. Spittoons should be washed daily with hot water and disinfected with a 10 - 12% bleach solution. To destroy the foul odor, add 15-30 ml of turpentine to the spittoon. Urine and feces for examination are collected in an earthenware or rubber vessel, which should be regularly washed with hot water and disinfected with bleach.

5. Proper diet is important. The patient should receive food rich in vitamins and proteins at least 4-6 times a day, and attention should be paid to the variety and taste of the dishes. You should not adhere to any special diets, you just need to avoid excessively hot or very cold, rough, fried or spicy foods.

6. Patients with advanced forms of stomach cancer should be fed more gentle foods (sour cream, cottage cheese, boiled fish, meat broths, steamed cutlets, crushed or pureed fruits and vegetables, etc.) During meals, it is necessary to take 1-2 tablespoons 0 .5-1% hydrochloric acid solution.

Severe obstruction of solid food in patients with inoperable forms of cancer of the cardial part of the stomach and esophagus requires the administration of high-calorie and vitamin-rich liquid foods (sour cream, raw eggs, broths, liquid porridges, sweet tea, liquid vegetable puree, etc.). Sometimes the following mixture helps improve patency: rectified alcohol 96% - 50 ml, glycerin - 150 ml (one tablespoon before meals). Taking this mixture can be combined with the administration of a 0.1% atropine solution, 4-6 drops per tablespoon of water, 15-20 minutes before meals. If there is a threat of complete obstruction of the esophagus, hospitalization for palliative surgery is necessary. For a patient with a malignant tumor of the esophagus, you should have a sippy cup and feed him only liquid food. In this case, it is often necessary to use a thin gastric tube passed into the stomach through the nose.

8. Preventioncancer

Primary cancer prevention is aimed, first of all, at eliminating carcinogenesis - the process of tumor initiation and development. To avoid cancer, it is first necessary to eliminate carcinogens.

Most effective measures in the prevention of cancer are:

Avoiding excessive drinking and smoking;

A complete healthy diet;

Normalization of body weight;

Physical activity.

You can often hear about a diet that helps avoid cancer. Indeed, there are nutritional rules for cancer prevention that should especially be followed by people at risk.

· Getting rid of excess weight. It is he who is an indispensable companion to malignant neoplasms, including breast cancer in women.

· Reduce the amount of fat in food. Consumption of carcinogens contained in fats can lead to the development of colon cancer, prostate gland, breast, etc.

· Be sure to consume cereals, fruits and vegetables (fresh and cooked). Plant fiber has a beneficial effect on digestion, is rich in vitamins and substances that have an anti-carcinogenic effect.

· Refusal of foods containing nitrites (used for coloring sausages), as well as from smoked products. Smoked meats contain a large number of carcinogens.

Speaking about secondary cancer prevention, we mean a set of actions aimed at the early detection and elimination of malignant tumors and precancerous diseases, and the prevention of recurrence of tumors after treatment. Everyone must understand that cancer prevention is necessary. You should attend preventive examinations, conduct research using tumor markers, etc. Women should definitely undergo regular mammography and PAP smears, which provide earlier detection of uterine cancer.

If primary cancer prevention allows you to minimize the risk of cancer, then secondary prevention significantly increases the chances of a full recovery and gentle treatment.

Conclusion

The development of instrumental diagnostic methods in recent decades has significantly changed the activities of medical workers, the recognition of diseases and ideas about them have changed. IN last years clinical medicine turned to the study of subjective and objective symptoms to identify the disease, and we can say that for a correct diagnosis, not only the level of technology development is important, but also direct communication with the patient. The relationship between the patient and the medical staff naturally affects the results of treatment. The nurse’s personality, methods of working with people, ability to communicate with patients and her other qualities can themselves have a positive impact on the patient.

There is no doubt that cancer is a serious disease and requires more attention than any other. However, there are no easy diseases. The main thing is to detect it at the moment of its occurrence in a particular organ. But no less, and perhaps more important, is to warn it, to protect humanity and all life on Earth from being affected by malignant tumors. Preventing a disease is incomparably more profitable for society, both economically and especially socially, than treating an already advanced disease.

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Nursing care for malignant tumors. Nursing care for cancer patients. Palliative surgeries for soft tissue tumors

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