Malignancy of the breast. Malignancy - what is it? Causes

Malignization is the degeneration of normal or damaged body tissues into a malignant tumor. Consequently, malignancy of gastric and duodenal ulcers is the process of the formation of cancer at the site of the ulcerative defect.

Malignancy of cells occurs due to disruption of their normal activity. According to various sources, from 2 to 15% of gastric ulcers undergo malignancy. In the duodenum, the phenomenon is extremely rare (0.1-0.3% of cases).

A malignant formation can originate at the bottom of the ulcer, at its edges, or from a healed ulcerative defect. There is an opinion that the percentage of ulcers that have undergone malignancy is overestimated due to the similarity of the initial development of a cancerous tumor and an ulcer, and in fact does not exceed 2-3%.

What is malignancy, what are its causes, signs, symptoms and treatment methods - this is what this article is about.

It is known that pathological cells, including malignant ones, constantly appear in the body. But the immune system always repels such attacks. Therefore, the effectiveness of protection largely depends on the state of immunity and the general state of human health.

Thanks to protective mechanisms, abnormal cells are recognized and destroyed. But when the immune system is weakened due to bad habits, unhealthy diet, external factors, and age, the risk of developing the disease increases.

Malignancy of cells is the initial process of the appearance of a malignant tumor in the body, its origin. Both healthy and pathological (damaged) cells of the body undergo this change. Malignancy is also called the transition of a benign tumor to a malignant one.

With this phenomenon, a genetic mutation of cells occurs and their uncontrolled growth occurs. At the initial stage, the patient himself does not feel any discomfort, unaware of the disease. Also, diagnosis is difficult during this period.

More often, tissues with various types of erosion become malignant:

ulcerative defects;
tissue inflammation;
benign tumors.

The phenomenon is not excluded in healthy tissues. Pathological changes are uncontrollable and irreversible. They can capture increasingly larger spaces with the formation of new foci - metastases.

Many factors contribute to malignancy: genetic predisposition, external and internal influences. Early detection of the disease significantly increases the chance of recovery, while late detection leads to the formation of a malignant tumor with metastases with all the ensuing consequences.

N.V. Levashov about the causes of cancer

Causes of malignancy of stomach ulcers

The impact of digestive juice on an ulcer, periods of exacerbation and relapses of the disease lead to the proliferation of connective tissue, vascular sclerosis and atrophy of the stomach wall at the site of the ulcer. All this leads to changes in the properties of cells and can cause the appearance of a cancerous tumor in the area of ulcerative lesions.

Ulcers of the pylorus, anterior and posterior walls, and the greater curvature of the stomach become malignant more often. The presence of the Helicobacter pylori bacterium contributes to the process. Malignancy of a stomach ulcer can begin regardless of the nature and duration of the peptic ulcer, but more often occurs in older people with chronic ulcers.

Malignancy of a duodenal ulcer, due to more gentle conditions for the mucous membrane compared to the stomach, is an extremely rare phenomenon.

The full picture of the mechanism of cell malignancy is still not clear. There is also no cure for cancer. The onset of the disease is preceded by unfavorable factors that trigger the pathological process. They are divided into internal and external.

Internal factors:

weakened immunity;
hormonal disorders;
improper metabolism;
genetic predisposition;
the presence of a benign tumor;
viral, fungal diseases;
chronic tissue inflammation, scars, ulcers;
prolonged stressful conditions.

External factors:

poor nutrition;
bad ecology;
solar and other types of radiation;
exceeding the X-ray dose;
harmful chemical influences.

Research indicates that the risk of malignancy is closely related to diet:

Lack or insufficient consumption of natural human food in the diet - fresh fruits, vegetables, herbs.
The predominance of fried, salted, smoked, chemical-containing and other unhealthy foods.

Thus, certain aggressive factors become the causes of cancer, as a dangerous complication of gastric ulcer, or less commonly, duodenal ulcer.

Signs and symptoms of malignancy

Signs and symptoms that raise suspicion of malignant ulcers are as follows:

Pain in the stomach loses its frequency and locality and becomes diffuse, constant, and aching in nature. They may radiate to the back and get worse at night.
Decreased appetite, weight loss.
Aversion to meat dishes.
Digestive disorders (belching, heaviness, nausea, vomiting).
Poor health (emotional exhaustion, fatigue, discomfort).

These signs may indicate that stomach cancer is already developing, which means this is a reason to immediately seek help from doctors. Also, such signs, when confirming a malignant tumor, indicate that the malignancy phase was missed.

At an early stage, the patient does not suspect the malignancy of a stomach ulcer. It is possible to detect the disease at the initial stage only in one case, if the patient with a peptic ulcer undergoes periodic medical examination.

If the ulcer has undergone malignancy, then medical examination will reveal the following signs:

Reduced stomach acidity.
Presence of lactic acid in the stomach.
Progressive anemia.
Possibly hidden blood in the stool due to bleeding in the area of the ulcer.
Failure of cell differentiation.
Enlargement of the ulcer (more than 25-30 mm) with the acquisition of an irregular shape with high, uneven, undermined edges.
The boundaries of the ulcer become blurred, and the surrounding mucosa may have a granular appearance.
Rigidity of the stomach wall, lack of peristalsis around the affected area.

Also, malignancy may be indicated by the lack of effect of antiulcer therapy.

Signs of malignancy of a gastric ulcer are determined by diagnostic methods.

Video about the causes, symptoms, treatment and timely detection of a tumor at an early stage (“Live Healthy”)

Diagnosis of malignant gastric ulcers

To identify malignancy, the same diagnostic methods are used as when examining any pathology of the stomach:

study of anamnesis (medical history);
blood, urine, stool analysis;
contrast X-ray examination;
gastroscopy with targeted biopsy;
laparoscopy.

A blood test serves as an indirect indicator of the occurrence of cancer. This is reflected in changes in such quantities as:

decreased hemoglobin levels;
decrease in the number of red blood cells;
increased leukocyte levels;
an increase in erythrocyte sedimentation rate (ESR) and other important indicators.

Detection of blood during stool analysis is a reason to find out the exact causes of its occurrence, including possible blood loss due to malignancy of a stomach ulcer.

Fluoroscopy may reflect the following signs of malignancy:

increase in ulcer size (more than 20 mm);
the ulcer takes on an atypical appearance (irregular shape);
uncharacteristic condition of the gastric mucosa around the defect, disappearance of folds;
lack of perilstatic movement of the affected area;
a symptom of a submerged niche and other signs are detected.

But here it is important to note that early signs of the disease are almost impossible to detect by X-ray examination. The listed symptoms appear later.

Therefore, the most reliable way to diagnose the malignancy of a gastric ulcer is an endoscopic examination (EGD) with the collection and subsequent histological analysis of tissue samples from the ulcer. Fragments are taken from 5-7 different places of the ulcer (bottom, edges, area around). The accuracy of this diagnostic method reaches 100%.

EGDS, in addition to the valuable opportunity to take tissue samples, also detects the described signs of atypicality of the ulcer and the area around it:

uneven, undermined edges of the ulcer, a gray coating is possible at the bottom of the defect;
wide infiltration of the ulcer, possible deformation of the stomach wall in the area of the defect;
erosion of the mucosa around the defect;
bleeding, etc.

Ultrasound and CT also help to identify atypical development of ulcerative defects.

If necessary, a laparoscopic diagnostic method is used to examine the stomach from the abdominal cavity.

Video: gastroscopy with biopsy

Treatment for malignant ulcers

The mere fact of detecting a gastrointestinal ulcer requires the active adoption of all necessary treatment measures. The patient is examined and given intensive therapy. If drug treatment is effective (the ulcer decreases, characteristic symptoms disappear), then treatment is continued with periodic monitoring, including cytological monitoring (to check the ulcer for the presence of malignancy). If the treatment does not have an effect, then surgery is used.

This statement by the prominent Soviet surgeon and scientist S.S. is often quoted. Yudin (1891-1954), who most succinctly expressed the circumstances under which surgical intervention is indicated:

“The larger the ulcer, the deeper the niche, the older the patient, the lower the acidity, the greater the risk of cancer arising from the ulcer” (S.S. Yudin, 1965).

And, therefore, the sooner the operation is indicated.

Thus, treatment when malignancy of a gastric ulcer is detected is carried out by surgery. The choice of surgical intervention depends on the location of the ulcer, its nature, size, degree and extent of tissue damage around the defect:

Distal gastrectomy is a significant removal of the lower part of the organ. An example is the removal of the antrum, during which the stomach is reduced in volume by 1/3. Subtotal resection is almost complete removal of the stomach (only a small part of it remains on top).
Proximal resection - removal of the upper part, including the cardiac part, while preserving the lower part of the organ.
Ring segmental resection - removal of the middle part of the stomach while preserving the upper and lower parts. This operation is used extremely rarely.
Total gastrectomy – complete removal of the stomach.

As noted above, if the occurrence of a cancerous tumor is detected at an early stage of malignancy and subsequent surgery, the likelihood of cure increases significantly. However, the only way to detect malignancy in time is through periodic endoscopic examination of the ulcer with a biopsy.

At the same time, if malignancy is not detected, but there is no effect of antiulcer therapy and the diameter of the ulcer exceeds 20 mm, then in this case surgery is still indicated. You should not wait for direct signs of malignancy, since earlier surgical intervention can prevent more serious, life-threatening development of the disease in the future.

Malignancy, what is this concept? Don't think that this is a disease. In medicine, this concept refers to the process of transformation of benign cells into malignant ones. Malignancy is not so difficult to recognize; the main thing is to undergo a comprehensive diagnosis.

The transformation process involves a genetic failure. As a result of this disorder, a specialized phenotype is formed, after which the cells begin to actively grow and rapidly divide. It is this process that leads to tissue proliferation.

Causes

Every person should understand that at present scientists have not yet found a medicine that can finally defeat cancer. Let's look at the main reasons.

Internal reasons include:

Chronic diseases.
Decreased immunity, viral and fungal diseases.
Chronic fatigue.
Pathological crisis.
Hereditary predisposition.

In addition, the causes of occurrence include hormone imbalance, as well as endocrine disorders in the body.

External provoking factors include a polluted environment, insolation, and poor nutrition. Some scientists argue that malignancy also occurs against the background of a large dose of radiation, such as X-ray, as well as with prolonged exposure to chemical components on the human body.

Malignancy of a polyp is common in medical practice. If not treated promptly, this leads to adenocarcinoma. It should be noted that single growths can occur anywhere, but most often they are found in the colon.

Malignancy of gastric ulcers is extremely rare. The concept is based on the degeneration of ulcerative pathology into a cancerous tumor. The main reason is hereditary predisposition.

Malignancy (nevus) of a mole occurs against the background of constant friction; a common cause of degeneration of a mole into a malignant form is repeated injuries or cuts.

As for the malignancy of papillomas, with constant provoking factors, in more than 90 percent of all cases, precancerous malignant degeneration of papilloma is observed.

Malignancy of fibroids is quite rare. The risk of degeneration may include a tendency to submucous localization of the corners; in rare cases, malignancy occurs with subserous localization. Since the malignancy of uterine fibroids has an unpredictable course, a woman needs to be constantly examined by a gynecologist. If malignancy is detected early, the risk of complications can be reduced.

Malignancy of the thyroid gland occurs against the background of benign formations that are located on the thyroid gland. It is necessary to understand that if cells degenerate into a malignant form, this can put pressure on nearby organs. Therefore, the patient may experience disruption not only of the gastrointestinal tract and thyroid gland, but also of other systems.

Malignancy of the prostate occurs against the background of external and genetic factors. Most often, prostate cancer occurs in old age, as the hormonal balance in the body is disrupted.

As for hereditary predisposition, prostate cancer can occur if this pathological process was observed in close relatives. Additional causes of prostate cancer include infections in the etiology of prostate cancer.

Stages

The conversion process is quite lengthy and consists of certain stages.

Important! Each stage of malignancy has its own clinical manifestations.

The first stage is initiation. At this stage of transformation, cell mutation occurs; this process is carried out under the influence of viral antigens.

The second stage is called promotion. At this stage, defective cells multiply.

The third stage is the evasion of tumor cells directly from differentiation.

The fourth stage is called tumor progression. In this case, tumor cells begin to destroy neighboring healthy cells.

Clinical picture

Signs of malignancy primarily depend on the location of this pathology. When each organ is affected, the patient experiences certain symptoms.

But, it should be noted that in medical practice there are certain criteria that are akin to almost every pathology.

A person experiences a violation of a genetically programmed program. This program is responsible for the appearance of cells that not only have a different phenotype, but are also endowed with a certain functional load.
Against the background of this pathological process, the dividing abilities of cells are activated.
Malignancy is accompanied by changes in cell structure. As a result of malignancy of the tumor, further failure of the functioning of the affected organ occurs.

Additional signs of malignancy include a pronounced desire of the cell to continuously divide; polymorphism occurs in the patient, which is observed when metastasis is not treated in a timely manner.

The main signs of malignancy (moles) of a nevus:

The mole begins to grow rapidly.
The mole takes on an irregular shape, with an uneven edge and a jagged surface.
Hair falls out from the surface of the mole.
A person experiences an unpleasant sensation, for example: itching.

In addition, the malignancy of a nevus consists of the formation of outgrowths, and bleeding may occur on the surface of the mole.

With malignancy of the cervical epithelium, a transformation of multilayered epithelium or glandular tissue occurs. The pathological process occurs against the background of concomitant diseases, for example: cervicitis, endometriosis, leukoplakia or erosion. Therefore, the symptoms of a malignant process will depend on the disease.

Malignancy of prostate tumors, symptoms:

A person urinates more frequently.
At night, there is a constant urge that disturbs the patient’s sleep.
The pressure of the stream is weakened, so the patient must strain to go to the toilet.
Obvious signs include a feeling of incomplete emptying.

When the stomach is affected, standard symptoms occur. The first sign of malignancy is pain, especially after eating.

Additional symptoms of malignancy of the stomach and thyroid gland:

Nausea, attacks of vomiting.
There is belching, which has a foul odor.
Heaviness in the stomach.
The thyroid gland increases in size.
Weight deviation.
Arterial hypertension occurs.
The cervical lymph nodes become very inflamed.
Sleep is disturbed.

As you can see, malignancy is accompanied by various signs, because everything depends on the affected organ.

Diagnostic measures

The risk of malignancy increases under the influence of various factors, therefore, in order to promptly recognize malignancy in the affected organ, several diagnostic techniques are used.

First of all, the doctor conducts a visual examination of the patient, collects anamnesis and finds out the causes of this pathological process.

The second stage of diagnosis is to perform a biopsy. This means that the doctor needs to take biological material and then examine it for cancer cells.

The patient is required to be prescribed:

Blood analysis.
Analysis of urine.
Bacteriological analysis.

Instrumental diagnostic methods include:

Electrocardiogram.
If a duodenal ulcer or a malignant tumor in the stomach is suspected, FEGDS is performed. The main essence of the study is to examine the mucous membrane, the procedure is carried out using a special gastroscope.
Cytological examination of a smear is often prescribed for polyps.
If there is a suspicion of skin cancer, the patient is prescribed epiluminescent microscopy.

Additionally, if any organ is affected, doctors prescribe a computed tomography scan. If necessary, an X-ray or ultrasound examination of the affected organ may be performed.

It should be noted that the most informative method for malignancy of various organs is hysteroscopy.

Treatment

It is impossible to describe a specific treatment for this pathological process, because malignancy has a wide morphology. Therefore, treatment tactics will depend on the location of the lesion and the general condition of the patient.

In order to quickly get rid of the tumor, doctors perform removal. The essence of the operation is the excision of polyps and growths. If vital organs are damaged, doctors perform resection of the affected area. For example, if the tumor is located in the colon, then a gastrectomy is performed in a hospital setting.

Important! After the operation, doctors must send the removed tissue for histological examination. If the examination results reveal cancer cells, this means that the patient must be additionally prescribed anticancer therapy.

Laser therapy is often used for malignancy. With this treatment method, cancer cells can be quickly destroyed.

In rare cases, chemotherapy is used. As treatment, medications are prescribed, which are classified as cytostatics. Such drugs help suppress the growth of malignant cells.

Recently, the radiosurgical method has been actively used. The essence of the method is to influence the tumor using surgical and radiation methods. This procedure helps to effectively destroy malignant tumors.

Note that when HPV becomes malignant, radio wave removal is most often performed, and then antiviral drugs are prescribed.

Prevention

Preventive methods are necessary not only to avoid malignancy, but also to identify pathology in the early stages of its development.

Necessary:

To live an active lifestyle.
To refuse from bad habits.
Eat properly.
Undergo preventive examinations in a timely manner.
Do not stay in direct sunlight for a long time.
It is imperative to avoid contact with aggressive chemical components.
You should not take medications on your own, as serious health complications may arise.
Minimize exposure to high doses of radiation.
The main thing in prevention is timely treatment of emerging diseases.
Try to avoid stressful situations.

As you can see, there are not so many rules, the main thing is to stick to them.

Forecast

If the pathological process is identified in a timely manner and treatment of cancer is started, the prognosis is more favorable.

If a papilloma or mole degenerates: if the pathological focus is removed in time, the person will be able to live a long and happy life.

In case of malignancy of a stomach ulcer: the prognosis is less favorable. Even if measures are taken in time, the quality of life deteriorates significantly.

Important! In the absence of malignancy, the prognosis is favorable, but if it is detected and not cured in time, it can be fatal.

So, we can conclude that malignancy is serious. However, not many people know who to turn to for help. So, if the disease occurs in women, then you need to contact an oncologist-gynecologist, if in men, then to a surgical oncologist. If malignancy occurs in old age, it is better to consult an oncologist.

Malignancy of an ulcer is the degeneration of an ulcer into cancer. As a rule, gastric ulcers undergo blastotransformation (6...8%).

Characteristic signs of ulcer degeneration into cancer:

The pain syndrome becomes less pronounced, constant and does not depend on food intake.

Loss of appetite.

Aversion to meat food.

Progressive weight loss

Deterioration of general condition (decreased performance, increased fatigue, discomfort, etc.).

The size of the ulcer is more than 2.5-3 cm.

Localization of the ulcer (long-term ulcers of the greater curvature of the stomach become malignant in 90% of patients, the lower third of the stomach - in 86%, the cardiac part of the stomach - in 48%).

X-ray signs (the ulcerative defect has an irregular, trapezoidal shape, high, undermined, uneven edges, rigidity of the stomach wall, lack of peristalsis, etc.).

Endoscopic signs (ulcerative defect larger than 2.5-3 cm, blurred outline of the edges of the ulcer, granularity of the mucous membrane around it, tumor-like growths in the ulcer itself or along its edges, etc.). Particularly valuable data can be obtained by gastrobiopsy (6-7 pieces of biopsy from different areas of the ulcer) followed by morphological examination.

Treatment For malignant gastric ulcers, surgery involves subtotal or total removal of the stomach (gastrectomy) as in the case of primary cancer of this organ.

General principles of treatment of gastric ulcer and 12 pcs

In accordance with the indications, conservative or surgical treatment is possible.

Upcoming tasks conservative therapies are:

decreased gastric secretion and proteolytic activity of gastric juice;

elimination of pain syndrome;

suppression of the inflammatory process in the ulcer;

restoration of the basic functions of the stomach and duodenum;

strengthening of reparative processes in the body;

normalization of the activity of the autonomic nervous system, subcortical structures and the central nervous system;

increasing the immunobiological capabilities of the body.

Antisecretory drugs

blockers of H2 histamine receptors of the 1st, 2nd and 3rd generations (cimetidine, histodil, ranitidine, famotidine, ilfanin, quamatel, etc.);

benzimidazole derivatives that block the enzyme involved in the final stage of the synthesis and excretion of hydrochloric acid (omeprazole, omez, mepral, August, Losek);

anticholinesterase drugs (atropine, platyphylline, chlorazil, etc.).

Antacids and adsorbents

soluble (sodium bicarbonate, Bourget's mixture)

insoluble (calcium carbonate, aluminum hydroxide, almagel, phospholugel)

combination drugs (Vicalin, Vikair, etc.)

Analgesics and antispasmodics (baralgin, trigan, spasmalgon, no-shpa, papaverine)

Cytoprotective agents

prostaglandins (cytotec, mesoprostol, enprostil);

preparations of local protective action (de-nol, sucrafalk, sofalcon, etc.);

mucus-forming agents (carbenoxolone, liquiriton - bind bile acids, indicated for GHD).

Reparants

drugs that restore impaired regeneration of the gastroduodenal mucosa (methyluracil, sodium nucleinate, riboxin, vitamins, sea buckthorn oil, alantone);

anabolic hormones (retabolil, nerabol, phenobolin, etc.);

drugs that improve microcirculation (solcoseryl, actovegin, etc.).

Sedatives (valerian, elenium, diazepam, eglonil, etc.)

Antiheliobacter – drugs (de-nol in combination with ampicillin, amoxicillin, trichopolum, furazolidone, etc.)

Indications for surgery for peptic ulcer disease

Absolute : perforated ulcer, pyloroduodenal stenosis of any severity, chronic ulcer with suspected malignancy, profuse bleeding that cannot be stopped by conservative measures.

Relative : chronic ulcer with penetration, chronic gastric ulcer localized in the area of the greater curvature and body of the stomach, relapse after suturing a perforated ulcer; failure of conservative treatment of duodenal ulcer for two years; peptic ulcers of the anastomosis; repeated bleeding; multiple ulcers, especially with high acid production.

Currently, the indications for surgical treatment of uncomplicated gastric ulcer have been expanded:

uncomplicated peptic ulcer of the body of the stomach along the lesser curvature (no more than 3 cm from the pylorus);

ulcer of the cardia (along the lesser curvature from the esophageal-cardiac junction up to 2 cm);

subcardial ulcer (down the lesser curvature at a distance of 2 to 3 cm);

a stomach ulcer that does not heal, despite adequate treatment (up to 3 months);

often recurrent (2-3 times a year) stomach and duodenal ulcers.

For peptic ulcers of the pyloric stomach and duodenum, the timing of surgical interventions is selected individually, depending on the effectiveness of conservative treatment, the frequency of relapses and the risk of complications. If within a year the ulcer recurs frequently and heals slowly, then within 2 years it is necessary to resolve the issue with the surgeon about further tactics.

In case of rare exacerbations, the issue of surgical intervention is decided within 4-5 years from the onset of the disease, based on the clinical picture.

Choosing the method and scope of the operation

Currently, there are two main types of surgical intervention used in peptic ulcer surgery: organ-sparing operations with vagotomy and gastrectomy in various modifications. These two types of operations should not be opposed to each other.

I. For peptic ulcer 12 pc, various types of vagotomies:

Stem (StW) – transthoracic, subdiaphragmatic

Selective vagotomy (SV) - the branches of the vagus nerve going to the stomach are divided

Combined gastric vagotomy (CGV) – posterior trunk, anterior selective.

Seromuscular proximal vagotomy is a dissection of the seromuscular layer along the lesser curvature along the anterior and posterior walls, departing from the edge of the curvature by 2...2.5 cm.

Selective proximal vagotomy (SPV) is the intersection of the branches of the vagus nerves going to the body and fundus of the stomach. This type of intervention is the operation of choice in the treatment of duodenal ulcer.

If peptic ulcer 12PC is complicated by pyloroduodenal stenosis, vagotomy is combined with draining stomach operations:

1. With the preservation of the gatekeeper

duodenoplasty (Finney, Heineke-Mikulich type, etc.);

bulboduodenostomy.

2. With the destruction of the gatekeeper:

Pyloroplasty according to Heineke-Mikulich;

Finney pyloroplasty;

Gastroduodenostomy according to Dzhabulei;

Gastroenterostomy.

When a 12PC peptic ulcer is combined with severe duodenogastric reflux (DGR) due to insufficiency (dilatation) of the pyloric sphincter, PPV is performed with plastic surgery of the pyloric sphincter using the seromuscular membrane of the anterior wall of the stomach (according to the method developed in the clinic of general surgery of the State Medical University) (Fig. 5.11 ).

II. Gastric resection indicated for chronic ulcers of any location, decompensated pyloric stenosis with significant loss of contractility of the gastric wall.

Depending on the type of gastric secretion, the nature and location of the ulcer, resection can be subtotal (malignization), in the volume of 2/3 of the stomach (with high gastric secretion), 1/2 - if the ulcer is located in the distal stomach against the background of normal or hyposecretion . In these patients, anthrumectomy supplemented with PPV is possible.

The most common methods of gastric resection and their modifications:

Billroth I (according to Haberer-Finney, pilus-preserving, etc.)

Billroth II (according to Billroth II with anastomosis according to Brown, according to Hofmeister-Finsterer, etc.).

According to Ru and its modifications.

Proximal gastrectomy.

For patients in whom, before surgery, a combination of complicated peptic ulcer with GHD, reflux gastritis (RG), intestinal epithelial metaplasia, gastric polyposis, duodenostasis was identified, primary reconstructive gastrectomy with Roux-en-Y anastomosis and the formation of an artificial functional sphincter on the efferent colon is indicated, providing slow portioned evacuation from the stomach stump and warning RG. If patients have a congenital predisposition to dumping syndrome before surgery, and especially in combination with DGR, RG, then in this case primary reconstructive resection of the stomach with a Y-shaped anastomosis and the formation of an artificial functional sphincter, ensuring rhythmic portioned evacuation of food, is also indicated , as well as a spiral-shaped intussusception valve on the efferent colon, which slows down the passage of food chyme through the jejunum (Fig. 5.6, 5.7, 5.8), developed by the authors at the General Surgery Clinic of the State Medical University.

If the pyloric sphincter is not involved in the cicatricial-ulcerative process and is not subject to dystrophic changes, pyloric-preserving gastric resections are used (according to Maki - A.A. Shalimov, A.I. Gorbashko).

In case of perforation or bleeding from an ulcer of the anterior wall of the duodenum, it is sutured or excised, followed by pyloroplasty or duodenoplasty according to Judd or G.P. Rychagova and vagotomy.

Suturing or excision of a duodenal ulcer in case of perforation, suturing or excision in case of bleeding (with possible drainage surgery and truncal vagotomy) is performed in cases of high risk of the operation itself. In similar situations, in cases of gastric ulcer, economical resection (sectoral, anthrumectomy) is justified.

Gastroenterostomy is justified in seriously ill patients with pyloroduodenal stenosis in combination with truncal vagotomy

Postoperative abdominal complications

Disorders of the motor-evacuation function of the gastrointestinal tract (GIT).

Dehiscence of anastomotic sutures.

Bleeding: intra-abdominal, gastrointestinal.

Postoperative pancreatitis.

Postoperative peritonitis.

Malignization is an irreversible process in the human body when cells or a group of cells degenerate into malignant cells. That is, their DNA is modified. This phenomenon can be observed both in malignant tumors and in healthy cells.

The human body is endowed with a certain number of cancer cells. As long as a person is healthy, the immune system works smoothly, their presence does not in any way interfere with living a full life. But, due to certain circumstances that can become an impetus for this process, the number of malignant cells can grow rapidly. Such circumstances may include old age, concomitant diseases that reduce the body’s immunity, an unfavorable external environment, etc.

What is malignancy, what is its cause and how can we combat this phenomenon, we will consider further.

Causes of malignancy

Experts are inclined to believe that malignancy will in the near future affect more and more of the population, not only the elderly, but also children and young people. Scientists associate this process with certain factors, such as an increase in life expectancy, a deteriorating environment, bad habits that plague the majority of the world's population, a huge amount of chemicals used in food production, household chemicals, etc. These disappointing forecasts force us to pay a huge role in the study of malignancy in order to understand and, if possible, prevent the process.

Leading clinics in Israel

Despite the huge amount of research in the field of cancer, the true and unambiguous cause of cell malignancy has not been established. But, some statistics suggest that there are several factors due to which healthy cells become malignant. Let's look at them:

All these factors, individually or in combination, to one degree or another influence the degeneration of cells into malignant ones.

Signs of malignancy

Whether the process of malignancy has occurred in the body or not can be judged by the results of histological analysis, which is carried out by taking a piece of tissue from the suspected location of cancer cells, as well as other research methods, such as ultrasound, CT, etc. At later stages of the process, the presence of malignant degeneration of cells is indicated by a deterioration in the person’s well-being.

If the tumor was initially benign, during malignancy it begins to grow rapidly, thereby compressing the surrounding tissues;
The neoplasm in which malignancy has begun begins to grow into nearby tissues;
Tumor metastasis is a clear sign of malignancy. Malignant cells spread to healthy organ tissue through the blood;
is a sign of tumor malignancy;
During histological examination, the cells susceptible to malignancy are atypical; they grow differently than healthy cells; the immune system is not able to influence them;
Malignant cells stimulate the growth of blood vessels, and therefore the patient is often accompanied by hemorrhages.

Let's consider under what specific human conditions malignancy is most often expected:

The presence of benign neoplasms, for example adenoma with epithelial dysplasia;
When there are dysplastic processes in the body, such as, for example, the human papillomavirus found in the cervix. Cytological analysis excludes the absence of intraepithelial lesions and the uterus;
Stomach ulcer caused by Helicobacter pylori bacteria;
The presence of polyps in the colon;
Nevi on the surface of human skin.
Ovarian cyst. This is especially dangerous if the diagnosis is aggravated by a genetic factor.

This list is not final. The last point should be especially noted. Persons who have suffered from breast or ovarian cancer in their family should be periodically examined, since the risk of malignancy in this category of people is high.

Let's take a closer look at some of the items from the list that are most often found in medicine.

Malignancy of polyps

Polyps, most often, do not cause any concern in people. It seems that this is a normal growth that does not threaten anything. But, unfortunately, if not treated in a timely manner, polyps can increase in number and grow. If the condition is aggravated by heredity, then malignancy is likely to occur. In addition to the genetic factor, the malignancy of polyps can be affected by hormonal changes, previous chronic diseases, and a person’s age. Polyps larger than three centimeters are most likely to develop into a malignant tumor. Experts most often recommend removing polyps surgically, if possible.

Malignancy of stomach and intestinal ulcers

In medical practice, a fifth of diagnosed stomach ulcers turn into cancer. The wall of the stomach affected by an ulcer is affected by stomach acids; inflammatory processes are common, which lead to growths on the wall of the stomach. Malignant degeneration of an ulcer is stomach cancer. If a person is diagnosed with a stomach ulcer, it is imperative to treat the disease, otherwise the consequences are irreversible.

According to statistics, malignancy of the duodenum occurs less frequently than with a stomach ulcer, although ulcers in this organ are not uncommon. This is due to the fact that the conditions in the intestinal cavity (fewer enzymes and acids) are more favorable than in the stomach.

Nevi

Nevi or moles are present on every person’s body and in most cases do not bother them at all. Sometimes they are found in the retina of the eyes. In the presence of unfavorable factors affecting them (excess sun rays, mechanical injuries), these harmless formations can malignize into the so-called melanoma.

People with fair skin, as well as people with a large number of moles on their body, are most often at risk. They need to be careful and use sun protection, and it is advisable to stay in direct sunlight for a short time. If you notice the slightest change on the surface of the nevi, you should consult a doctor.

It should be noted that not all neoplasms that a person has are susceptible to malignancy. This type of tumor is a lipoma. While adenomatous polyps are most often prone to degeneration into a malignant tumor.

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Prevention

Patients are most often concerned with the question of whether it is possible to prevent the process of malignancy and how to do it.

Scientists are conducting many tests and studies on this issue, studying human immunity, its ability to destroy cancer cells, using a person’s own cells, such as. The latest methods of fighting cancer have been developed, such as,.

As we found out, malignancy of cells occurs due to unfavorable external factors, poor lifestyle, and poor nutrition. Therefore, doctors around the world are increasingly calling for a healthy lifestyle, giving up bad habits, and watching your diet.

Malignization is not a death sentence. A timely visit to specialists and a timely examination gives a chance for a good prognosis for life with modern medicine.

Malignization of a gastric ulcer is a process in which an ulcerative defect of the mucous membrane gradually acquires the properties of a malignant tumor. This is not a one-time phenomenon: malignancy, as a process, can last for years.

Peptic ulcer disease is considered a precancerous condition - environmental conditions under which the likelihood of a tumor increases.

The mechanism of the pathology is a violation of cell maturation: the regeneration and repair mechanisms are damaged. The normal cell cycle involves the division and distribution of cellular material across tissues. Malignization is a failure of this process; the tissue gradually turns into a tumor. Some authors believe that cancer is caused not by the ulcer itself, but by antral gastritis.

The danger of the disease lies in the fact that the cancerous degeneration of cells in the initial stages does not manifest itself with clear symptoms, but is disguised as an ordinary ulcer. In addition, malignancy can develop at the scar site of a healed ulcer.

Malignancy of gastric and duodenal ulcers is observed in 5-6% of all cases of peptic ulcer. This process begins to develop when a person reaches 30-35 years of age, but most often malignancy is observed in elderly and senile people. It is believed that an ulcer located in the area of the greater curvature of the stomach becomes malignant and degenerates into a malignant tumor in 90% of cases.

The process of malignancy consists of several stages:

Etiology

The main cause of degeneration is the presence of an ulcerative defect on the gastric mucosa. However, malignancy is not always observed. There are a number of provoking factors that can increase the likelihood of tumor formation. They are divided into 2 groups:

External reasons. This includes:

Long-term effects on the body of toxic substances: smoking, alcohol, drug addiction, polluted air, work in a manufacturing plant.
Exceeding the permissible dose of x-ray radiation: living near a radiation source, working in unfavorable conditions.
Low standard of living: unsatisfactory housing conditions, inadequate food.
Unfavorable diet, enriched with fried, fatty foods, stabilizers and dyes. The likelihood increases if a person eats carcinogens: smoked meats, spices. Irrational regimen: no breakfast, coffee on an empty stomach, overeating before bed, lack of fruits and vitamins in the diet.

Group of internal reasons:

Heredity. This is an underestimated factor. A person can live a harmful life, but he will not have malignancy: his parents did not have such a pathology. On the other hand, you can lead a healthy lifestyle, eat right, but the ulcer still becomes malignant: neoplasms were observed in parents.
Weak immunity. Normally, the body’s protective functions recognize and eliminate pathological cells when they first appear, however, with weakened immunity, the destruction of tumor cells does not always occur.
Associated infectious diseases, fungus.
Other diseases of the digestive tract: gastroesophageal reflux disease, multiple gastric polyps, chronic gastritis, perforated ulcer.
Chronic stress, which affects the functioning of the immune system.
Disruption of hormonal systems, especially thyroid disease.

Symptoms

The clinical picture of degeneration in the initial stages is scarce: it manifests itself in the later stages of the disease. The following symptoms are characteristic:

If earlier the ulcer appeared periodically (seasonality and food intake), then the clinical picture of malignancy does not depend on certain conditions: pain, deterioration in general condition, lack of appetite, aversion to food have no prerequisites. Also, pain and discomfort in the stomach could be relieved with proton pump inhibitors and enveloping drugs, but these drugs do not help with malignancy.

Diagnostics

Diagnosis of the disease is based on medical history, data from instrumental research methods and clinical tests. From the anamnesis it should be known that the symptoms have lost their cyclicity, the patient has a number of predispositions (dieting disorders, bad habits, heredity, the presence of other infectious and gastrointestinal diseases) and he has a clinical picture of degeneration.

The main instrumental method is endoscopy. Fibrogastroscopy allows you to examine the surface of the gastric mucosa and identify a defect. During the study, a targeted biopsy is performed - intravital removal of a piece of tissue from several stomach ulcers for further laboratory testing.

Using a biopsy, the condition of the tissue and possible malignancy are assessed. Tissue is taken from all ulcers at once: one can become malignant, the other cannot.

On FGS fixed:

irregular shape of the ulcer, fuzzy and bumpy edges;
flat bottom, which is covered with a gray coating;
when taking tissue - increased bleeding;
erosion.

X-ray diagnostics assesses the parameters of the ulcer using contrast agents. On a radiograph, a malignant gastric ulcer appears as follows:

ulcer niche more than 2 cm;
the niche is deep, surrounded by infiltration (compaction of the ulcer area with blood and lymph cells) - a symptom of a submerged niche.
weakening of contractions of the muscular wall of the stomach;
disappearance of folds on the mucous membrane.

Laparoscopic examination– internal diagnostics of the stomach. The probe is inserted directly into the stomach by puncturing the anterior abdominal wall. This method allows you to assess the extent of malignancy and its transition to neighboring areas of the stomach.

Clinical and biochemical blood tests show anemia and increased lactate, and occult blood is detected in stool tests.

Additional methods: ultrasound diagnostics And CT scan. They are used when there is no effect from previous methods.

Useful video

Experienced doctors tell you in this video how to avoid developing cancer due to stomach ulcers.

Treatment

Malignancy of an ulcer is an absolute indication for emergency surgery. Surgery is performed even if no signs of a malignant tumor are detected, but there is evidence of malignancy. During the operation, the degenerated areas of the stomach and local lymph nodes are removed (preventing the spread of metastases).

Removal methods:

Prevention

To prevent cellular degeneration in a timely manner, patients with ulcers need to eat properly. Diet is not only about foods, but also about the timing of meals. Eliminate bad habits, especially smoking and alcohol. Change your place of work or place of residence if they are a source of pollution or radiation. Timely treatment of ulcers, gastritis and other diseases.