tumor
Introduction
Tumor introduction Tumor is a disorder in which the body of a local tissue loses its normal regulation at the gene level under the action of various carcinogenic factors, resulting in abnormal clonal hyperplasia. Academics generally divide tumors into benign and malignant categories. basic knowledge The proportion of illness: 1% (the above is the probability of illness over 50 years old) Susceptible people: no special people Mode of infection: non-infectious Complications: malignant tumor
Cause
Tumor cause
The characteristics of our Chinese medical care are both Western medicine and Chinese medicine. The incidence rate is high now, and the number of cases in China is quite large. There are data showing that it accounts for 55% of the world's cases.
A tumor is essentially a genetic disease. Various environmental and genetic carcinogenic factors cause DNA damage in a synergistic or sequential manner, thereby activating proto-oncogenes and/or inactivating tumor suppressor genes, plus changes in apoptosis-regulating genes and/or DNA repair genes , in turn, causing abnormalities in expression levels, causing transformation of target cells. The transformed cells are mostly clonal hyperplasia, and after a long multi-stage evolution process, one of the clones is relatively unrestricted, and the subclones with different characteristics are selectively formed by additional mutations (heterogeneization). ), thereby obtaining the ability to infiltrate and metastasize (malignant transformation) to form a malignant tumor.
Prevention
Cancer prevention
The following foods are strictly prohibited: oil press, pickled, cola, burger, milk, nuts, beans, leeks, snacks. Traditional Chinese medicine advocates appropriate taboos, and Western medicine generally does not advocate taboos. Western medicine attaches great importance to the relationship between diet and disease, and it is not against taboos. For example, food contaminated with aflatoxin cannot be eaten; charred foods tend to denature proteins, pyrolysis and heat accumulation are prone to polycyclic aromatic hydrocarbon compounds, Harmful and not advocate eating, smoked fish, bacon does not advocate eating more, wine can reduce the body's detoxification function and biotransformation function, so that immunity is reduced, wine increases carcinogen activity in the body, and has cytotoxicity, it should not Drinking alcohol.
Some foods can not be eaten during the medication, such as vitamin C should not eat shrimp, because vitamin C can reduce the pentad arsenic in shrimp meat to arsenic trioxide, which is very toxic to human body. Chinese medicine is not blindly indiscriminate, but rather a proper taboo for dialectical purposes. It is generally believed that in the early and middle stages of cancer, the disease is devastated by yin and yin, which is mostly yin deficiency and internal heat. Therefore, in diet conditioning, foods with temperate and hot and dry properties should be avoided, and stagnation foods should also be eaten less; in the middle and late stages of cancer, Deficiency syndrome, cold syndrome, diet advocates warming the spleen and stomach, benefiting Qi and blood, and other foods, while the cold and cold foods should be eaten or not eaten on different diseases, and the mouth is also different, such as nasopharyngeal Cancer patients should avoid spicy heat, fried barbecue food, avoid eating dog meat, lamb, pepper, fennel, etc. during the radiotherapy; gastric cancer patients do not eat spicy food, cinnamon, mustard, pepper, etc.; esophageal cancer patients avoid old pork, Old duck meat; liver cancer patients avoid female pork, eat less leek. In short, the taboo should be appropriate, blindly avoiding the mouth will lead to malnutrition, affecting the recovery of the disease.
Complication
Tumor complications Complications malignant tumor
About 80% of patients in China have found malignant tumors in the middle and late stages, and the most common cause of pain, disability and death is tumor complications. The basic content of tumor complications is: direct or indirect caused by malignant tumors during the development process; iatrogenic problems caused by surgery, radiotherapy and chemotherapy (including diagnosis). The causal relationship formed by this and the other can be described as "the fire of the city gate, the fish and the fish." Even if certain complications are found to be timely and properly handled, it will determine whether the tumor can be cured or seek further treatment and obtain long-term survival opportunities. The harm is self-evident.
Symptom
Tumor symptoms Common symptoms Amenorrhea vaginal bleeding Abdominal pain Dehydration bloating Ascites pimples
Urinary tract tumor
Skin metastases from kidney cells and excessive cell tumors either locally metastasized (often on surgical scars) or distant metastases, metastatic carcinomas from renal cell carcinoma (adrenal adenomas), common in the head and neck, transitional cells Cancer is common in the trunk and limbs.
Renal cell metastasis is a single or extensive dermal nodule, the color is flesh-colored, especially purple, with obvious vascular distribution, as seen in kaposi sarcoma or suppurative granuloma, transitional cell carcinoma, skin metastasis, usually a Or multiple flesh-colored dermal nodules, verrucous papules and inflammatory plaques are less common skin metastases.
Postmenopausal ovarian malignancy
The early stage of ovarian malignant tumors is often asymptomatic. It is accidentally discovered by gynecological examination for other reasons. Once the symptoms often manifest as abdominal distension, abdominal cramps and masses, and ascites, the severity of the symptoms depends on the following points:
(1) The size, location, and degree of invasion of adjacent organs: tumors of serous or mucinous ovarian cancer may be larger; tumors of the original ovarian benign tumors rapidly increase and ascites occur; Infiltration or compression of the surrounding tissue can cause abdominal pain, low back pain or pain in the lower extremities; if the pelvic vein is pressed, lower extremity edema can occur; in the advanced stage, it shows signs of weight loss such as weight loss and severe anemia.
(2) The histological type of tumor: such as functional tumor can produce the corresponding symptoms of estrogen or androgen excess, peri-menopausal women can have more menstrual periods, prolonged period and other abnormal vaginal bleeding, a small number of patients will also appear Continuous amenorrhea or irregular bleeding; menopausal women have postmenopausal bleeding, breast swelling, breast enlargement and so on.
Seminal vesicoma
Clinical symptoms
Blood sperm, intermittent hematuria, frequent urination, thick gelatinous substance in the urine, urinary dysfunction when the tumor is large, and even urinary retention, late in the urgency and secondary epididymitis, blood in the stool suggests that the tumor has invaded the rectum .
2. Digital rectal examination
Irregular spindle-shaped lumps can be reached above the prostate, which are cystic or solid, sometimes fused with the prostate and the boundary is unclear.
The criteria for the diagnosis of seminal vesicle tumors are:
1 the tumor must be confined to the seminal vesicle;
2 no other parts of the primary tumor;
3 pathologically a papillary adenoma, if it is an undifferentiated adenoma, mucus should be formed.
Intracranial tumor
General symptoms
Increased intracranial pressure in children can be expressed as irritability and irritability, while some are indifferent or lethargic. If there is a disturbance of consciousness, slow pulse, slow breathing, high blood pressure indicates that it has entered the early stage of cerebral palsy, need to do emergency reduction of intracranial pressure, children The intracranial pressure compensatory ability is higher than that of adults, and the increase of intracranial pressure occurs later. Once decompensation, the condition deteriorates sharply, so early diagnosis is very important.
Vomiting
About 70% to 85% of children have vomiting, which is caused by increased intracranial pressure or posterior fossa tumor directly stimulating the medullary vomiting center. In some children (about 10% to 20%) vomiting is the only early symptom. Among them, infants and young children are more common, vomiting can be accompanied by headache or dizziness, vomiting is not all jetting, more common in the morning or after breakfast, often can eat immediately after vomiting, and then quickly vomiting, a small number of children can accompany Have abdominal pain, early misdiagnosis as a gastrointestinal disorder.
3. headache
70% to 75% of children have headaches, the on-screen tumor headache is mostly in the forehead, and the under-the-slice tumor is mostly in the occipital region, mainly due to increased intracranial pressure or brain tissue displacement, causing meningeal, vascular or cranial nerve tension traction. As a result, the headache may be intermittent or persistent, and gradually increase with the prolongation of the course of the disease, but when the visual loss is more obvious, the infant can not complain of headache, and can express both hands, scratching his head or bursting into tears. It should be taken seriously for children's headaches because there are few functional headaches in this age group.
4. Visual impairment
Vision loss can cause primary optic nerve atrophy due to direct compression of the visual pathway in the sellar region. It is more due to secondary optic atrophy caused by optic disc edema due to increased intracranial pressure. Optic disc edema depends on the location, nature and duration of the tumor. The posterior fossa tumor is larger and heavier in the hemisphere. The higher the malignant degree or the longer the course of the tumor, the more obvious the optic disc edema. Children's vision loss is easily ignored by the parents. Therefore, there are less than 40% of the chief complaints. In 10% of the children, the eyes were nearly blind or blind. In this group, 2,000 patients with optic disc edema accounted for 75%, the optic nerve atrophy was 8.4%, the visual field changed less, and the larger tumor in the sellar region. There may be bilateral sacral hemianopia; in the late stage of optic disc edema, there may be a reduction in visual field centripetality, but pediatric visual field examination often fails to cooperate.
5. Head enlargement
Head enlargement and broken pot sound (McCewen sign) positive, more common in infants and younger children, due to incomplete cranial suture healing or fibrous healing, increased intracranial pressure can cause cranial suture separation head circumference increased, percussion can be Smell and broken pot sound, this group of head enlargement accounted for 48.9%, infants within 1 year old can also see anterior sacral bulging and scalp venous engorgement, but not as serious as congenital hydrocephalus, the tumor is located in the cerebral hemisphere convex is still visible The skull is locally raised and the appearance is asymmetrical.
6. Neck resistance or forced head position
Pediatric intracranial tumors are more common in this manifestation. The third ventricle tumor can be in the knee chest position, and the posterior fossa tumor is skewed to the affected side to keep the cerebrospinal fluid circulating smoothly. It is a kind of protective reflection of the body. Resistance is more common in posterior fossa tumors, due to chronic cerebellar tonsillar sacral or tumor growth and compression of the upper cervical nerve root. For such patients to prevent the occurrence of occipital foramen magnum, early ventricular puncture drainage or Dehydration drugs reduce intracranial pressure.
7. Seizures
The incidence of epilepsy in children with brain tumors is lower than that of adults. The reasons are: there are more tumors under the eyes of children; and more common malignant tumors, more symptoms of brain tissue damage than irritation, this group of epilepsy authors accounted for 10%.
8. fever
The history of fever in the course of the disease is a characteristic manifestation of pediatric brain tumors. The incidence rate of this group is 4.1%, which is related to the more malignant brain tumors in children and the instability of body temperature regulation.
9. Double vision and strabismus in the eye
Mostly caused by increased intracranial pressure caused by nerve palsy, can occur at the same time, mostly bilateral.
Benign lung tumor
The vast majority have no clinical symptoms and signs, often found on X-ray examination, benign tumors can have symptoms: cough, hoarseness, lung infection and hemoptysis, lung benign tumors vary according to their classification.
The size and location of peripheral benign tumors determine their performance, rarely cause clinical symptoms, more than 60% of asymptomatic, radiological examination by accident only when found, nearly 90% of the examination has no relevant signs, a small number of patients can be compared Large, adjacent to the bronchial or other unexplained and clinical symptoms, the most common cough and non-specific chest pain, but also chest tightness, blood stasis, fatigue and so on.
The size and activity of central benign tumors determine their performance. Most cases have obvious symptoms and signs. Smaller trachea and bronchial tumors have no symptoms. Larger tumors do not completely block the trachea. Smell and wheezing, if the tumor mostly or completely obstructs the respiratory tract, causing: 1 restricted clearance of endocrine secretions, can lead to recurrent pneumonia, bronchitis, lung abscess, etc.; 2 restricted ventilation leads to distal lungs Zhang or emphysema, manifested as cough, cough, chest pain, fever, wheezing and even hemoptysis.
Breast tumor
Breast tumor masses are most common in the upper superior quadrant, followed by the nipple, areola, and upper superior quadrant. Because of the lack of self-conscious symptoms, the mass is often found by the patient inadvertently (such as bathing, changing clothes). A small number of patients may have varying degrees of tenderness or irritation and nipple discharge. The growth rate of the mass is faster, and invasion of the surrounding tissue can cause changes in the shape of the breast, resulting in a series of signs. Such as: the surface of the tumor is sunken; the cancer adjacent to the nipple can lead the nipple to the direction of the cancer; the nipple retracts. The larger the cancer, the whole breast tissue can be contracted, and the mass is obviously protruding. The cancer continues to grow, forming a so-called "orange peel" change. These are important symptoms of breast tumors.
Bone tumor
Benign bone tumors grow slowly with little or no pain. Malignant tumors develop invasive growth, develop rapidly, and appear pain early and progressively worse. Anemia and dyscrasia occur in the later stage, and multiple metastatic lesions can occur, of which lung metastases are most common.
(A) Pain: It is a major symptom of bone tumors.
(B) lumps: often manifested in abnormal uplift of the limbs or trunk.
(3) Age distribution: There are two age peaks in the population due to malignant tumor deaths. One is 15 to 20 years old and the other is 30 to 75 years old.
(4) Location characteristics: Some bone tumors have specific specific sites.
Liver tumor
1. Children often have irregular localized hepatomegaly as the initial symptom. The mass is located in the right abdomen or right upper abdomen. It is often recorded in the history that the tumor grows rapidly, some can reach the umbilicus or beyond the midline, the surface is smooth, the edge is clear, and the hardness is medium. Slightly move left and right, no tenderness, in addition to mild anemia in the early stage, the general condition is good, in the late stage, jaundice, ascites, fever, anemia, weight loss, venous engorgement can be seen in the abdominal wall, and breathing can be caused by a huge mass in the abdomen. Difficulties, about 20% of cases of hepatoblastoma have osteoporosis, and severe cases can lead to multiple fractures.
2, many patients have anemia and thrombocytosis at the time of treatment, especially in children with hepatoblastoma, liver function of children with hepatoblastoma is often normal, but cases of hepatocellular carcinoma are complicated by hepatitis or cirrhosis, serum bilirubin Alkaline phosphatase and transaminase may increase, 60% to 90% of hepatocellular carcinoma cases and more than 90% of hepatoblastoma cases have increased alpha-fetoprotein, and hepatoblastoma urinary cystosine (Cistathionine) excretion increase.
3. Other primary liver tumors are common cavernous hemangioma and vascular endothelial cell tumor. The former can compress liver tissue due to tumor growth, degeneration of liver cells, and sometimes arteriovenous short circuit in tumor, which can cause heart failure in children. Or death due to tumor rupture, small hemangiomas grow slowly, no clinical symptoms.
4, vascular endothelial cell tumor is malignant, there is sinusoid formation in the liver, clinical pain, high fever and jaundice, slow course, but the prognosis is not good.
5, liver hamartoma, teratoma and single or multiple liver cysts are extremely rare.
Examine
Tumor examination
Tumor is one of the important culprits of death from global diseases. According to statistics, there are 173 new 100% of cancer patients worldwide, and 110 out of every 100,000 people in China. Experts point out that one-third of all tumors can be prevented, one-third of tumors can be cured, and one-third of tumors can prolong life. At present, the diagnosis and treatment of tumors in developed countries are mostly in the early stage, and some tumor markers are regarded as necessary items for some people (such as PSA, etc.). Therefore, laboratory diagnostic testing of tumors is of great significance, as summarized below:
First, tumor screening
Tumor screening is the search for suspicious people from asymptomatic people. Tumor marker detection is an effective method for primary screening of tumors. Often used for high-risk population screening.
AFP: Screening for primary liver cancer.
PSA: Men over the age of 50 are screened for prostate cancer.
High-risk HPV: screening for cervical cancer.
CA125+ ultrasound: Women over the age of 50 screen for ovarian cancer.
Tumor markers were abnormally elevated, no obvious symptoms and signs, and need to be reviewed and followed up. If it continues to increase, it should be confirmed in time.
Second, diagnosis
Auxiliary diagnosis: The specificity of tumor markers is not strong enough to diagnose tumors based solely on tumor markers, but can provide further diagnostic clues.
Differential diagnosis: Ben-Chou protein, AFP, HCG, PSA, etc. have characteristic cancer profiles.
Unable to locate diagnosis: tumor markers lack tissue organ specificity.
Dynamic observation: progressive elevation of tumor markers has a clear diagnostic significance; markers of benign disease are elevated; transient markers of malignant tumors are persistent.
Third, monitoring the condition and efficacy
Monitoring efficacy, recurrence and metastasis are the most important clinical applications of tumor markers. After surgery, chemotherapy or radiotherapy, the specific tumor marker content rise and fall has a good correlation with the curative effect. Dynamic observation can reflect the tumor recurrence and metastasis.
Diagnosis
Tumor diagnosis
The difference between benign tumors and malignant tumors: the biological characteristics of benign tumors and malignant tumors are significantly different, and thus the impact on the body is also different. Differentiating between benign and malignant tumors is of great significance for the diagnosis and treatment of tumors.
(1) Degree of tissue differentiation: Benign tumors have good differentiation and small atypia, which are similar to the morphology of the original tissues; malignant tumors have poor differentiation and large atypicality, which is different from the original tissue.
(2) mitotic figures: benign tumors have no or few mitotic figures, no pathological mitotic figures; mitotic figures of malignant tumors are more common, and pathological mitotic figures can be seen.
(3) Growth rate: benign tumors are slow; malignant tumors are faster.
(4) Growth mode: benign tumors are often expansive and exogenous. The former often has an envelope formed, and the surrounding tissue is generally well demarcated, so it can usually be promoted; malignant tumors are invasive and exogenous, and the former has no envelope. Forming, the general boundary with the surrounding tissue is unclear, so it is usually not promoted, and the latter is accompanied by invasive growth.
(5) Secondary changes: necrosis and hemorrhage rarely occur in benign tumors; necrosis, hemorrhage and ulcer formation often occur in malignant tumors.
(6) metastasis: benign tumors do not metastasize; malignant tumors often have metastasis.
(7) Recurrence: benign tumors rarely recur after surgery; malignant tumors often recur after treatment.
(8) Impact on the body: Benign tumors are small, mainly causing local compression or obstruction. If it occurs in important organs, it can also cause serious consequences. Malignant tumors are large. In addition to oppression and obstruction, the primary and metastatic sites can be destroyed. The tissue causes necrotic hemorrhage combined with infection and even causes cachexia.
There is sometimes no absolute boundary between benign tumors and malignant tumors. The morphology of some tumors is somewhere in between, called borderline tumors. Such as ovarian borderline serous papillary cystadenoma and mucinous cystadenoma. Even malignant tumors have varying degrees of malignancy. Some benign tumors can undergo malignant changes, and individual malignant tumors can also stop growing or even subsiding. For example, polypoid adenocarcinoma of the colon can become adenocarcinoma, and individual malignant tumors such as malignant melanoma can also stop growing or even completely disappear due to the increase of immunity of the body. For example, the tumor cells of neuroblastoma seen in children and young children can sometimes develop into mature nerve cells, and sometimes even the metastatic tumor cells can mature, so that the tumor stops growing and heals itself. But this situation is very rare.
