Method for prediction of synchronous multifocal colorectal carcinoma

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, and can be used for recognising synchronous multifocal colorectal carcinoma. Substance of the invention consists in measuring preoperative blood follicle-stimulating hormone both in male and female patients suffering from colorectal carcinoma. If its concentration falls within the range of 26.01 to 60.91 IU/l in the females and of 2.71 to 5.67 IU/ml in the males, a single tumour is diagnosed in the patients, and if the hormone concentration is from 2.70 to 5.50 IU/ml in the females and from 12.88 to 52.04 IU/l in the males, the presence of synchronous colorectal new growths are stated. The method can be implemented at the preoperative stage; it is easily reproducible in the oncology hospital environment.

EFFECT: stating the presence of synchronous multifocal colorectal carcinoma.

6 ex

 

The invention relates to medicine, in particular to cancer, and can be used in the treatment of colon cancer.

Colon cancer is among the most common localizations of process, which in recent years in all developed countries of the world leading position in the structure of cancer development. For this pathology is characterized by a significant incidence of metastases, recurrence and primary multiple processes, the occurrence of which is one of the difficult problems of Oncology (Zimmerman J. C. Colorectal cancer: current status of the problem. Ross. Journe. gastroenterology, Hepatology and Coloproctology. 2012, No. 4, S. 5-14).

During preoperative examination of patients diagnosis primary multiple neoplasms of the colon is associated with a certain percentage of erroneous assessment process as solitary (Chiss Century. And., Trachtenberg, A. H. Primary multiple malignant tumors. M, Medicine, 2000). Identifying a second lesion on the stages of surgical intervention can complicate the course of the operation, and therefore the development of additional predictor tests on the patient synchronous tumor growth is one of the urgent tasks of the scientific-practical laboratory research.

The peculiarity of the influence of placecast is authorized tumor on the body of the patient is the fact that its development, usually associated with the emergence of numerous failures in the functional status of the various systems of the body, the frequency and severity of paraneoplastic disorders may be aggravated as the progression of the process, including the development of new foci of malignant growth. The neuroendocrine system, which is the leading regulatory structure of the organism, along with other systems are also involved in the complex mechanism of interaction of the tumor with the body of the host. This suggests the desirability of search among the indicators of hormonal status of patients with colon cancer biochemical parameters, the dynamics of which can be associated with the number of lesions synchronous tumor growth.

There is a method of diagnosing cancer based on the determination of the content in blood of free polyamines as biochemical markers of tumor growth (balicka O. C. et al. The matters. on Oncology., 1992, T. 38, No. 6, S. 674). The authors demonstrated the possibility to use the blood levels of two factors - polyamines of spermine and putrescine, are involved in the processes of proliferation and differentiation of cells, as indicators of tumor development. It is known that the growth of malignant tumors is accompanied by a violation of the metabolism of polyamines that Pref is the CIO to their intense output of cells in biological fluids (blood, urine). The authors found that when nephroblastoma children the content of free polyamines in plasma were above normal in 63% of cases, and uniform elements of blood - 92,4% of cases. This was the basis to consider that the definition of the level of free spermine and putrescine in uniform elements of blood sufficiently informative test of the presence in the body of a malignant neoplasm. The disadvantage of this method of diagnosis of cancer is the fact its development for use in nephroblastoma that it is not possible to use these indicators in other tumor localization.

There is a method of assessing the prevalence of disease in patients with non-Hodgkin's lymphomas (Sidorenko, Y. S. et al. RF patent №2319148. Bull. No. 7, 2008). The essence of the method consists in the evaluation of patients with non-Hodgkin's lymphoma in the level of dopamine in the daily urine collected 8002000. With the development of the tumor content of dopamine in the urine is reduced in patients with stage I disease, its concentration varies in the range from 495 to 906 nmol/day, in patients with II-III stages, it ranges from 177 to 387 nmol/day, and further dissemination process is associated with a drop in dopamine levels in the urine to 43-173 nmol/day. The disadvantage of this method is the impossibility of applying it in other malignant process is x, in particular for testing the distribution process in the colon or to determine the number of colonic neoplasms.

You know the level of follicle-stimulating hormone in the blood of cancer patients as a test for the sensitivity of the tumor to chemohormonal (the Method of determining the sensitivity of individual patients with ovarian cancer III-IV degree to chemohormonal. Moiseenko, T. I. et al. Pat. Of the Russian Federation No. 1827639. Bull. No. 26 from 15.07.93). The authors found that in patients with ovarian cancer stage III-IV the value of the coefficient of correlation of blood levels of follicle-stimulating and luteinizing hormones before specific treatment determines the subsequent response of the tumor to chemohormonal. Individual values of the ratio less than one indicates that the holding of chemohormonal in such patients is highly effective in contrast to patients with its value exceeded the unit. The disadvantage of this method is the limitation of its use as an indicator of the effectiveness of anticancer therapy, but not of tumor.

The aim of the invention is the identification of patients with rectal cancer to preoperative stage primary multiple process with simultaneous foci of tumor growth is.

This goal is achieved by the fact that patients with colon cancer in both sexes in the preoperative period determine the blood levels of follicle-stimulating hormone and its concentration in women range from 26,01 to 60,91 IU/l and for men in the range from 2.71 to 5,67 IU/l establish if patients solitary tumors, and when the concentration of the hormone in women range from 2.70 to 5,50 IU/l and in men range from 12,88 to 52,04 IU/l establish a presence in the colon synchronously developing tumors.

A method for predicting the presence of primary multiple synchronous colon cancer is as follows. In patients with colon cancer in both sexes with stage III disease in the preoperative period determined in the blood content of follicle-stimulating hormone, a study conducted by radioimmunoassay method using a standard test kit company Immunotech (Czech Republic) and radiometer Arian firm Vitaco (Russia). When the concentration of the hormone in the range from 26,01 IU/l to 60,91 IU/l in women and from 2.71 to 5,67 IU/l in men ascertain the patients with a single cancer of the colon, and when the content of the hormone in the range from 2.70 to 5,50 IU/l in women and in the range from 12,88 to 52,04 IU/l in men ascertain the patients with primary multiple process with simultaneous tumor growth.

How progressive is Osinovaya the availability of primary multiple synchronous cancers of the colon allows for preoperative stage to determine whether the patient single or primary multiple lesions of colon cancer with synchronous tumor growth.

It should be noted that when using the method in the hospital identify patients with hormone concentrations, intermediate in relation to presents, must call the greater vigilance in terms of their primary multiple process, the closer will be detected indicators of concentration of the hormone that is specified in the method for patients with synchronous tumor growth.

Here are clinical examples of the use of the method for predicting the presence of primary multiple synchronous colon cancer patients, male and female.

Example No. 1. Patient P., 1949 R., history of disease-16918/I. He enrolled in the Department of General Oncology 08.11.2010 g with a diagnosis of colorectal cancer T3N0M0, st III, class gr 2. Upon receipt complained of tenesmus, blood in the stool. Considers himself sick about 2 months when it first appeared the above complaints.

11.11.2010, in the blood of the patient will determine the content of follicle-stimulating hormone concentration was 49,18 IU/L.

11.11.2010 ultrasound: diffuse changes in the liver, pancreatitis, microlites both kidneys. When the FCC - cancer of the anal canal. Histological analysis (G. A.) - adenocarcinoma.

12.11.2010, the patient performed a laparotomy. 12.11.2010, made abdomino-perineal extirpation of the rectum, resection of thin Ki is Ki, atypical liver resection. Verification process: ,and. No. 74380-388/10 - rectum - moderately differencirovannoe adenocarcinoma with invasion of all layers of the colonic wall; No. 74391-401/10 lymph nodes (L. W.), liver metastases no.

30.11.2010 patient discharged from hospital with the recommendation of holding DHT. Final diagnosis: cancer of the rectum T3N0M0, st II, class gr. 2.

Thus, the patient with a single colon cancer is found in the blood has a high concentration of the hormone.

Example No. 2. Patient P., 1949 R., history of disease-13839/A. He enrolled in the Department of General Oncology 26.08.2010 diagnosed with primary multiple synchronous colon cancer: colon cancer T3N1M0 st III, cancer of the transverse colon T3N1M0 st III, class gr. 2.

Upon receipt complained of weight loss of 9 kg in 2 months, weakness, constipation. Considers himself sick about 2 months when it first appeared the above complaints.

When the FCC - rectal cancer and cancer of the transverse colon. The verification process, and. - adenocarcinoma.

29.08.2010, carried out research into patient blood levels of follicle-stimulating hormone concentration was 4,90 IU/L.

29.08.2010, the patient performed a laparotomy. During inspection of the abdominal cavity revealed a tumor in/ampullares Department rectum size 3×6 cm, distant metastases not detected, circular, and safety Deposit box is aktivna tumor of the transverse colon is about 8 cm in diameter. The patient underwent an operation in the amount of: anterior resection of the rectum with the formation of the G-shaped tank, obstructive resection of the transverse colon. Verification process: ,and. No. 55785-92 - well-differentiated adenocarcinoma with invasion of all layers of the rectum. G. A. No. 55793-802 - moderately differentiated adenocarcinoma, plots slizeobrazujushchej places with the structure neuroendocrinology carcinoma, metastases in the mesentery of the transverse colon.

16.09.2011 patient discharged from hospital with the recommendation of chemotherapy. Final diagnosis: primary multiple synchronous colon cancer - colorectal cancer T3N0M0 st II and cancer of the transverse colon T3T1M0 st III, class gr. 2.

Thus, the patient with synchronous developing primary multiple process detected low concentrations of circulating hormone.

Example No. 3. Patient I., 1937, R., history of disease-18162/A. He enrolled in the Department of General Oncology 07.11.2011 g with a diagnosis of colorectal cancer T4N1M0, st III, class gr. 2. Upon receipt complained of General weakness, malaise, poor appetite, nausea, epigastric pain and mesogastric, the admixture of mucus and blood in the stool, weight loss. Considers himself sick about 5 months, when first appeared the above symptoms.

31.10.2011 was held FCC, the conclusion is that t is Mor rectum.

01.11.2011 - researched content in the blood follicle stimulating hormone, its level was 3,60 IU/L. Low FSH levels suggest the presence of the patient primary multiple simultaneous process.

01.11.2011 performed abdominal ultrasound revealed diffuse changes of a parenchyma of the liver, chronic calculous cholecystitis, hydronephrosis on the left, local calcification of the body of the uterus.

02.11.2011, implemented abdominal CT, conclusion, infiltrative tumor of the rectum for up to 8.7 cm with the transition to rectosigmoidal Department, expressed the infiltration of fiber pelvis.

Patient 10.11.2011 laparotomy was done. During inspection of the abdominal cavity in the rectum detected tumor 7×8 cm, densely welded together with the uterus, thick consistency. In the loops of intestine faeces. If further revisions are identified tumor hepatic angle of the colon up to 3 cm in diameter, dense consistency, distant metastasis was not detected. The patient underwent an operation in volume: front-upper resection of the rectum with extended lymph node dissection, right hemicolectomy with the formation of enterostomy. Verification process: Geest. analysis No. 68958-60/11 - poorly-differentiated adenocarcinoma with foci of necrosis, invasion of the entire thickness of the wall of the bowel (rectum); ,and. No. 68964-6/11 - poorly-differentiated adenocarcinoma with near endocrinology component, invasion of the entire thickness of the bowel wall (hepatic angle of the colon); No. 68968/11 in l/mesentery of mcadenville with neuroendocrinology component.

22.11.2011 patient discharged from hospital with the recommendation for chemotherapy and reconstruction of the colon. The final diagnosis of primary multiple synchronous colon cancer, rectal cancer T4N1M0 st III, cancer of the hepatic angle of the colon T4N1M0 st III, class gr. 2.

Example No. 4. Patient G., 1953 R., history of disease-11576/A. He enrolled in the Department of General Oncology 11.07.2011 diagnosed with colorectal cancer T3N0M0 st II, gr 2. Upon receipt complained of the presence of blood and mucus in the stool. From history revealed that he considered himself sick about 4 months, when first appeared the above complaints. SRCT of the chest, abdomen and pelvis from 19.07.2011, inflammatory cancer rectosigmoidal Department for up to 7 cm with infiltration of the surrounding tissue.

19.07.2011, in the blood of the patient investigated the content of follicle-stimulating hormone, its level reached 2.71 IU/L.

19.07.2011, patients received FCC, conclusion, exophytic colorectal cancer.

25.07.2011, the patient performed a laparotomy. During inspection of the abdominal cavity revealed a tumor medium ampullares division of the rectum up to 5×6 cm, distant metastases not detected. B is linoma performed surgery in the amount of: anterior resection of the rectum with the formation of the hardware anastomosis, extended lymph node dissection, preventive colostomy. Verification process: g/a 25.07.2011, No. 46868-870/11-G2 adenocarcinoma with invasion to the entire thickness of the bowel wall. 46871-876 - along the lines of resection, l/y mesenteric tumors and MTS no. 11.08.2011 the patient was discharged from hospital. Final diagnosis: cancer of the rectum T3N0M0 , gr.2.

Thus, the low content in the patient's blood follicle stimulating hormone combined with the development of a single colon cancer.

Example No. 5. Patient A., 28.01.1941, R.., history-8854/a. He enrolled in the Department of General Oncology 07.06.2011 diagnosed with primary multiple synchronous colon cancer: cancer of the sigmoid colon T3N0M0, st II, cancer of the descending colon T3N0M0, st II, CL gr 2.

At admission the patient complained of frequent loose stools, pain in the lower abdomen. From history revealed that he considered himself sick about 10 months when he first came to the above complaints.

07.06.2011, in the blood of the patient determined the content of FSH concentration was 47,0 IU/L.

07.06.2011, patients received FCC, conclusion - synchronous cancer of the sigmoid colon and descending colon.

10.07.2011, the patient underwent laparotomy. During inspection of the abdominal cavity revealed 2 tumors: exophytic tumor 4×5 in the sigmoid and saucer-like tumor 5×6 cm in the descending colon, distant metastasis was not detected. B is linoma performed surgery in the amount of: resection of the sigmoid colon, resection of the descending colon with extended lymph node dissection. The verification process, and no 37086-087/11 saucer-like formation of the descending colon - usernotification adenocarcinoma, invasion entire thickness of the bowel wall. Verification process - g/a No. 37088-090/11 - exophytic cancer of the sigmoid colon - well-differentiated adenocarcinoma with invasion of the muscular layer.

23.06.2011 the patient was discharged from hospital. The final diagnosis of primary multiple synchronous colon cancer: cancer of the descending colon T3N0M0, st II, and cancer of the sigmoid colon T2N0M0 st II, CL gr 2.

Thus, the development of the patient primary multiple synchronous cancers combined with a high level of circulating hormone.

Example No. 6. Patient A., 1959 R. c-10274/a. He enrolled in the Department of General Oncology 27.06.2011 diagnosed with cancer of the rectum st III, class gr. 2, T3N1M0. Upon receipt complained of frequent false urge to defecate, the admixture of mucus and blood in the stool, weight loss, weakness, from history revealed that he considered himself sick about 6 months when it first appeared the above complaints. When the FCC identified colorectal cancer, ,and. No. 9672-73 - adenocarcinoma.

29.06.2011 the blood of the patient will determine the content of follicle-stimulating hormone, its level was 52,04 IU/L. High levels of the hormone allowed before ologit the patient has primary multiple simultaneous tumor growth.

01.07.2011 the patient underwent laparotomy. During inspection of the abdominal cavity revealed a tumor medium ampullares Department rectum sizes up to 12×15 cm, germinating serosa and second (synchronous) tumor rectosigmoidal Department 5×6 cm with invasion of serosa, distant metastasis was not detected. The patient underwent surgery in the amount of: low anterior resection of the rectum with the formation of the hardware anastomosis preventive ileostomy, mesorectal excision and extended aorta-iliac lymph node dissection. Verification process: ,and. No. 41781-94 - adenocarcinoma in places with the structure mucinous cancer with invasion of all layers of the colonic wall, metastases in lymph nodes.

05.08.2011 the patient was discharged from hospital with the recommendation of an ileostomy removal after 2 months. Final diagnosis: primary multiple synchronous colon cancer: colon cancer T3N1M0 st. III, cancer rectosigmoidal Department T3N1M0 st III, class gr. 2.

A method for predicting the presence of primary multiple synchronous colon cancer was used in 19 patients (10 women and 9 men). The method is easily reproducible in the hospital medical institution with cancer.

The way to establish the presence of primary multiple synchronous colon cancer, including biochemical, characterized in that cancer patients tol is the guts of both sexes in the preoperative period determine the blood levels of follicle-stimulating hormone and its concentration in women range from 26,01 to 60,91 IU/l, and men - in the range from 2.71 to 5,67 IU/l establish if patients solitary tumors, and when the concentration of the hormone in women range from 2.70 to 5,50 IU/l and in men range from 12,88 to 52,04 IU/l establish a presence in the colon synchronously developing tumors.



 

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SUBSTANCE: method comprises preliminary conditioning of rubber specimens in paraffin hydrocarbon with 12-16 atoms of carbon in the atmosphere of neutral gas and in the fuel to be tested at a temperature of 130-150°C for 3-5 hours.

EFFECT: enhanced reliability.

1 dwg, 2 tbl, 1 ex

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