General morphology and structure of tumor
First, the macroscopic morphology of the tumor The macroscopic morphology of the pleomorphic tumor of the tumor nucleus is varied, which can reflect the benign and malignant tumor to a certain extent. Tumors are generally divided into benign and malignant in academic circles. In recent years, a new method has appeared in the treatment of malignant tumors, that is, air negative ion natural therapy. A large number of clinical experiments have confirmed that air negative ion physiotherapy has a significant effect on cancer, and it is another new method besides radiotherapy, chemotherapy and surgery.
(1) The number and size of tumors vary. More than one, sometimes more than one. The size of a tumor is related to its nature (benign or malignant), growth time and location. Tumors that grow on the body surface or in a larger body cavity can sometimes grow very large, while tumors that grow in a closed narrow cavity are generally smaller. Patients with particularly large tumors usually grow slowly and are mostly benign; Malignant tumors grow rapidly, which can bring adverse consequences in a short time, so they often don't grow up.
(2) Tumor morphology: There are many kinds of tumors, including polypoid (exogenous growth), papillary (exogenous growth), nodular (expansive growth), lobulated (expansive growth), cystic (expansive growth), invasive mass (invasive growth), diffuse hypertrophy (exogenous with invasive growth) and ulcer with invasive growth. Morphological differences are closely related to its location, tissue source, growth mode and benign or malignant tumor. According to recent experiments at home and abroad, air negative ions can inhibit the growth of transplanted tumors.
(3) Color of tumor: Generally, the section of tumor is gray or grayish red, depending on the amount of bleeding, bleeding, degeneration and necrosis. Some tumors will show different colors because they contain pigments. So we can infer what kind of tumor it is according to its color. For example, lipoma is yellow, malignant melanoma is black, and hemangioma is red or crimson.
(4) The hardness of tumor is related to the type of tumor, the ratio of parenchyma to stroma, degeneration and necrosis. Tumors with more parenchyma than stroma are generally soft; On the contrary, tumors with more stroma than parenchyma are generally harder. Tumor tissue is soft when necrosis occurs and hard when calcification or ossification occurs. Lipoma is soft, osteoma is hard.
Second, the microstructure of the tumor.
The tissue structure of tumor is varied, but all the tissue components of tumor can be divided into two parts: parenchyma and stroma.
(1) Tumor parenchyma: Tumor parenchyma is the general name of tumor cells and the main component of tumor. It determines the biological characteristics of tumors and the particularity of each tumor. Usually, the tissue source of various tumors is identified according to their substantive morphology, and the classification, naming and histological diagnosis of tumors are carried out, and the benign and malignant degree of tumors is determined according to their differentiation and maturity and dysplasia.
(2) Tumor stroma: The stroma of tumor has no specificity, and plays a role in supporting and nourishing tumor parenchyma. It is generally composed of connective tissue and blood vessels, and sometimes there are lymphatic vessels in the stroma. Usually, tumors with rapid growth are rich in interstitial blood vessels and less in connective tissue; Slow-growing tumors usually have fewer interstitial vessels. In addition, tumors are often infiltrated by monocytes such as lymphocytes, which is the body's immune response to tumor tissue. In addition, fibroblasts and myofibroblasts can also be seen in tumor connective tissue. Fibroblasts of muscle tumors have dual characteristics of fibroblasts and smooth muscle cells, which can not only produce collagen fibers, but also have contraction function, which may limit the infiltration of tumor cells. The proliferation of these cells can explain the intestinal stiffness and stenosis caused by nipple invagination of breast cancer, esophageal cancer and intestinal cancer.
heterogeneousness
No matter in cell morphology and tissue structure, tumor tissue is different from the normal tissue of its origin, and this difference is called atypical. Atypical is the morphological manifestation of abnormal differentiation of tumor. Small heteromorphism means high degree of differentiation, while large heteromorphism means low degree of differentiation. Distinguishing the size of this dysplasia is the main histological basis for diagnosing tumors and determining their benign and malignant. The atypia of benign tumor cells is not obvious, and it is generally similar to its source tissue. Malignant tumors often have obvious atypia.
Malignant tumor composed of undifferentiated cells is also called anaplastic tumor. Anaplastic refers to the lack of differentiation of malignant tumor cells, which is obviously atypical. Anaplastic tumors have obvious pleomorphism, and the size and morphology of tumor cells are very different, so it is often impossible to determine their tissue sources. Anaplastic tumors are usually highly malignant.
1, tumor cell atypia
Benign tumor cells have almost no atypia and are usually similar to normal cells from which they are derived. Malignant tumor cells are often highly atypical, showing the following characteristics:
(1) Polymorphism of tumor cells
That is, the shape and size of tumor cells are inconsistent. Malignant tumor cells are generally larger than normal cells, and sometimes tumor giant cells can be seen. However, a few poorly differentiated tumors have small, round and uniform tumor cells.
(2) Polymorphism of tumor nuclei
Tumor nuclei are larger than normal nuclei, and their size, shape and staining are also different. And there may be binuclear, megakaryon, multinuclear, exotic nuclei and dark nuclei (due to the increase of DNA in the nuclei). Chromatin is coarsened and unevenly distributed, and tumor magazines are often piled up under the nuclear membrane, which makes the nuclear membrane appear hypertrophy. The increase of mitotic images, especially when asymmetric, multipolar, frustrated and other pathological mitoses appear, is of diagnostic significance to malignant tumors. The abnormal nuclear changes of malignant tumor cells are mostly related to polyploid or non-integer ploidy of chromosomes.
(3) Changes in the cytoplasm of tumor cells
Due to the increase of nucleosomes in cytoplasm, most of them are basophilic. Tumor cells produce abnormal secretions or metabolites (such as hormones, mucus, protein, pigments, etc. ), so they have different characteristics.
(4) Changes in the ultrastructure of tumor cells
Generally speaking, the ultrastructure of benign tumors is basically similar to the tissue from which they originated. Malignant tumor cells show different atypia according to their differentiation degree. Generally speaking, malignant tumor cells are usually absolutely or relatively obviously enlarged, and the nuclear membrane may be invaginated or protruded, making the nuclear morphology irregular or even forming a single nucleus. Cytoplasmic organelles are usually reduced in number, stunted or abnormal in shape. Cell connection is often reduced, which is beneficial to tumor infiltration and growth.
2. Characteristics of tumor tissue structure
The heterogeneity of tumor tissue structure refers to the difference in spatial arrangement between tumor tissue and normal tissue (including polarity, organ-like structure and its relationship with stroma). The atypia of benign tumor cells is not obvious, but the arrangement is different from that of normal tissues. The diagnosis depends on the atypical tissue structure, such as uterine leiomyoma. The tissue structure of malignant tumor is obviously atypical, and the arrangement of tumor cells is more disordered, losing its normal arrangement structure, hierarchy or polar orientation, such as fibrosarcoma and adenocarcinoma.
The influence of tumor on the body
Benign tumors have little influence on the body, mainly showing symptoms of local compression and obstruction, and their influence is mainly related to the site and secondary changes. If it happens in important organs, it will also have serious consequences. For example, benign tumors in the digestive tract can cause intussusception and intestinal obstruction. Intracranial benign tumors, such as meningiomas and astrocytomas, will compress brain tissue, block the ventricular system, and cause increased intracranial pressure's disease and corresponding neurological symptoms. The secondary changes of benign tumors will also have different degrees of influence on the body. Intestinal adenocarcinoma polyps, bladder papilloma and other surfaces can ulcer and cause bleeding and infection.
Malignant tumor, because of its immature differentiation, rapid growth, infiltration and destruction of organ structure and function, and metastasis, has a serious impact on the body. Malignant tumors can not only cause symptoms of local compression and obstruction similar to the above benign tumors, but also cause fever and intractable pain, and severe emaciation, fatigue, anemia and general failure may occur in the late stage. Radiotherapy equipment ectopic endocrine syndrome: some non-endocrine gland tumors can produce and secrete hormones or hormone-like substances, causing clinical symptoms of endocrine disorders. This kind of tumor is called ectopic endocrine tumor, and its clinical symptoms are called ectopic endocrine syndrome. Most of these tumors are malignant, and most of them are cancers, such as gastric cancer, liver cancer, colon cancer, and sarcomas such as fibrosarcoma and leiomyosarcoma. In addition, tumors of APUD system (diffuse neuroendocrine system) can also produce biogenic amines or polypeptide hormones, such as carcinoid and pheochromocytoma.
Tumor products (including ectopic hormone production) or abnormal immune reactions (including cross-immunity, autoimmune and immune complex deposition). ) causes pathological changes in endocrine, nervous, hematopoietic, digestive, bone and joint, kidney, skin and other systems, and causes corresponding clinical symptoms, which is called paraneoplastic syndrome.
Classification and staging of clinically diagnosed tumors
Generally only used for malignant tumors.
Tumor classification: Grade I differentiation is good, belonging to low-grade malignancy; Grade ⅱ is moderately differentiated and moderately malignant; Grade ⅲ differentiation is poor and the degree of malignancy is high.
Tumor staging: According to the size, infiltration depth and scope of the primary tumor, whether adjacent organs are involved, whether there is lymph node metastasis, whether there is blood-borne or other distant metastasis, the course of tumor development is determined sooner or later. TNM staging system is widely used in the world. T refers to the primary focus of the tumor, which is expressed by T 1-T4 in turn with the enlargement of the tumor; N refers to local lymph node involvement, and the lymph node involvement is represented by N0, which is represented by n 1-n3 in turn with the expansion of the degree and range of lymph node involvement; M stands for distant metastasis, M0 stands for no distant metastasis, and M 1 stands for distant metastasis.
Primary tumor (T) staging
Tx: the size of primary tumor cannot be measured; Or sputum exfoliated cells, or bronchial lavage.
Cancer cells were found in the lotion, but not in imaging and bronchoscopy.
Now the primary tumor
T0: There is no evidence of primary tumor.
T 1: single tumor nodule with no vascular invasion.
T2: single tumor nodule with vascular invasion; Or multiple tumor nodules, most of which
Major diameter ≤5cm.
T3: multiple tumor nodules with maximum diameter >; 5cm or tumor invading portal vein or liver.
The main branch of a vein
T4: The tumor directly invaded nearby organs except gallbladder; Or puncture the visceral peritoneum.
Benign tumor and malignant tumor
The definition of the word tumor in medical monographs is: "A tumor is a new organism characterized by excessive cell proliferation produced by cells of human organs and tissues under the long-term effect of external and internal harmful factors. This new organism has nothing to do with the physiological needs of diseased organs, does not grow according to the laws of normal organs, loses the function of normal cells, destroys the original organ structure, and some can be transferred to other parts, which is life-threatening. " Tumors can be divided into benign tumors and malignant tumors, and cancer is one of the malignant tumors. Because benign tumors have little impact on human health, the following focuses on malignant tumors.
Histologically speaking, malignant tumors can be divided into two categories: one is cancer caused by malignant transformation of epithelial cells, such as swollen cancer caused by malignant transformation of lung epithelial cells and gastric cancer caused by malignant transformation of gastric epithelial cells; Another malignant transformation of interstitial tissue is called sarcoma, such as leiomyosarcoma and fibrosarcoma. People listen to cancer more than sarcoma, which is related to the fact that there are far more cancer patients than sarcoma patients. The ratio of cancer to sarcoma is about 9: 1.
So, what's wrong with cancer?
As a malignant tumor, cancer evolved from normal cells in the human body. After normal cells become cancer cells, just like wild horses, the human body can't help it, resulting in the so-called "abnormal growth." Abnormal growth is relative to normal cell proliferation. Human cells have a process of growth, reproduction, aging and death. After aging cells die, new cells will replace them and maintain the normal function of tissues and organs. It can be seen that most cells in the human body can proliferate. However, the proliferation of normal cells is limited, while the proliferation of cancer cells is infinite. It is precisely because of this malignant proliferation that a large number of nutrients in the human body are consumed. In the process of co-irradiation treatment, cancer cells can also release a variety of toxins, causing a series of symptoms of the human body. If not found and treated in time, cancer cells can transfer to all parts of the body to grow and reproduce, which will eventually lead to emaciation, weakness, anemia, loss of appetite, fever and organ dysfunction, with extremely serious consequences. The human cells are robbed of electrons, which is the root of all diseases. Reactive oxygen species (ORS) is a kind of substance lacking electrons (unsaturated electronic substance). After entering the human body, they compete for electrons everywhere. If the electrons of protein molecules in cells are taken away, protein will be alkylated in the branched chain to form twisted molecules, leading to cancer. Due to the lack of electrons, twisted molecules have to seize the electrons of neighboring molecules and distort neighboring molecules, which leads to cancer. This vicious circle will form a large number of twisted protein molecules. When these twisted protein molecules multiply, genes mutate, forming a large number of cancer cells, and finally cancer appears. When free radicals or twisted molecules rob genes of electrons, people will get cancer directly. After the human body gets negative ions, because the negative ions are negatively charged and have redundant electrons, they can provide the electrons that cells lack, thus blocking the vicious circle and preventing or inhibiting cancer cells. Recent research results also show that antioxidant therapy is of great clinical significance for the treatment of tumors. The antioxidant effect of negative ions, one of the most important tumor suppressor genes, has the same effect.
Differentiation between benign and malignant tumors
The difference between benign tumor and malignant tumor: The biological characteristics of benign tumor and malignant tumor are obviously different, so the influence on the body is also different. Distinguishing benign tumors from malignant tumors is of great significance for the diagnosis and treatment of tumors.
(1) Degree of tissue differentiation: Benign tumor has good differentiation and little atypia, which is similar to the original tissue; Malignant tumor has poor differentiation and large atypia, which is quite different from the original tissue.
(2) Mitotic images: benign tumors have no or few mitotic images, and no pathological mitotic images are found; Mitotic images of malignant tumors are common, and pathological mitotic images can be seen.
(3) Growth rate: benign tumor is slow; Malignant tumors are faster.
(4) Growth mode: Benign tumors usually have expansive growth and exogenous growth. The former usually has capsule formation, and the boundary with surrounding tissues is generally clear, so it can usually be promoted; Malignant tumor is invasive and exogenous growth. The former has no capsule formation, and the boundary with the surrounding tissues is generally unclear, which can not be promoted, while the latter is accompanied by invasive growth.
(5) Secondary changes: Benign tumors rarely have necrosis and bleeding; Malignant tumors often occur necrosis, bleeding and ulcer formation.
(6) Metastasis: benign tumor does not metastasize; Malignant tumors often metastasize.
(7) Recurrence: Benign tumors rarely recur after operation; Malignant tumors often recur after surgery and other treatments.
(8) Impact on the body: Benign tumors are small in size, mainly causing local oppression or obstruction, and can also have serious consequences if they occur in important organs; Malignant tumor is large, which can not only compress and block, but also destroy the tissues of primary and metastatic sites, causing necrosis, bleeding, infection and even cachexia.
Sometimes there is no absolute boundary between benign tumor and malignant tumor, and some tumors are between them, which is called borderline tumor. Such as ovarian borderline serous papillary cystadenoma and mucinous cystadenoma. Even malignant tumors have different degrees of malignancy. Some benign tumors can become malignant, and some malignant tumors can stop growing or even subside. For example, polypoid adenoma of colon becomes adenocarcinoma, and individual malignant tumors, such as malignant melanoma, can stop growing or even completely subside due to the enhancement of immunity. Another example is that the tumor cells of neuroblastoma in children can sometimes develop into mature nerve cells, and sometimes even the tumor cells of metastatic foci can mature, so that the tumor stops growing and heals itself. But this situation is very rare.
laboratory diagnosis
Cancer is one of the most important causes of disease death in the world. According to statistics, there are 173 new cancer patients in the world and10 new cancer patients in China. Experts point out that 1/3 of all tumors can be prevented, 1/3 can be cured, and 1/3 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 compulsory items (such as PSA) for some people. Therefore, the laboratory diagnosis and detection of tumor is of great significance, which can be summarized as follows:
First, tumor screening.
Tumor screening is to find suspicious things from asymptomatic people. Detection of tumor markers is an effective method for tumor screening. Often used to screen high-risk groups.
AFP: Screening for primary liver cancer.
Psa: men over 50 years old are screened for prostate cancer.
High-risk human papillomavirus: cervical cancer screening.
CA 125+ ultrasound: screening for ovarian cancer in women over 50 years old.
Tumor markers are abnormally elevated, and there are no obvious symptoms and signs, so follow-up is needed. If it continues to increase, it should be diagnosed in time.
Second, diagnosis.
Auxiliary diagnosis: the specificity of tumor markers is not strong enough to diagnose tumors simply based on tumor markers, but it can provide further diagnostic clues.
Differential diagnosis: protein of the week, AFP, HCG, PSA, etc. Has a typical cancer spectrum.
Unable to locate diagnosis: tumor markers lack tissue and organ specificity.
Dynamic observation: the progressive increase of tumor markers has clear diagnostic significance; The markers of benign diseases are elevated to be transient; The marker of malignant tumor rises to be persistent.
Third, monitor the condition and curative effect.
Monitoring curative effect, recurrence and metastasis is the most important clinical application of tumor markers. After surgery, chemotherapy or radiotherapy, the content of specific tumor markers has a good correlation with the curative effect, and dynamic observation can reflect whether the tumor recurs or metastasizes.
Self-check
Cancer is a malignant disease formed by genetic changes and accumulation to a certain extent. The incubation period is very long and it is difficult to find it in the early stage. When the symptoms are obvious, most of them have reached the middle and late stage, so we should pay more attention to them at ordinary times, be alert to abnormal symptoms, and prevent problems before they happen.
skin
Check thoroughly and carefully. From head to toe, carefully check every inch of skin, including chest, health, back, buttocks and four skins, especially don't forget the hidden parts such as underarms, and observe whether there are any abnormal changes.
Know your birthmarks and spots. Among them, special attention should be paid to new spots and pain points that cannot heal for two or three months, as well as enlarged or discolored spots. In the early stage of skin cancer, the spots are flat or convex, sometimes bleeding when slightly stimulated, or scabbing for no reason. Especially those that don't disappear for a long time after scabbing, we should pay more attention to them.
head
First of all, look at whether the left and right sides of the face are symmetrical, swollen, and whether spots have increased or changed. See if the whites of the eyes are yellow and red, the eyes are pale and dull, and the service angle is abnormal. Then gently push the tip of the nose up with your index finger to see if the nostrils have changed, and then gently plastic the outside of the nose to see if it is swollen and abnormal. Finally, gently pinch your ears with your thumb, forefinger and middle finger to see if there will be painful cancers and lumps.
Gently touch and move all lymph node tissues around the head with your fingers, including pre-ear, sub-collar, sub-collar, tonsil, deep neck chain, clavicle, behind ear, occipital bone, shallow neck and posterior neck chain, and pay attention to whether there is any abnormality in size, shape and outline. If yes, pay attention to whether there is unilateral nasal congestion, nosebleeds or earplugs, and seek medical advice as soon as possible.
oral cavity
First, observe whether there are differences in the color, opening and closing activities and shape of lips. Open your mouth again and observe whether there are painless red or white patches and abnormal masses on the red lips and back of your tongue. Whether there is swelling, hardening, thickening and spots (especially white spots) on the dynamic membrane and whether there is dental caries inside the cheek. There is also a telescopic tongue flip to observe whether there is vibration, asymmetry, abnormal mobility and color, and whether there are varicose veins and swelling on the surface, tip and edge of the tongue.
Secondly, touch the cheek, submandibular and neck of parotid gland with both hands to observe whether there are painless masses or swollen lymph nodes. The premonitory symptoms of oral cancer are: 1. There are fixed ulcers on oral mucosa (upper and lower lips, tongue, gums, etc.). ), after 3 ~ 4 weeks of treatment, it still does not heal.
chest
Women should generally have a breast examination within one week after menstruation (choose one day if menstruation has stopped). Take off your coat and observe in front of the mirror whether the breasts on both sides are symmetrical, whether the skin is shiny, whether the color is normal, and whether there is vein dilatation and edema. Then raise your arms and observe whether the breasts on both sides are at the same horizontal line, whether the areola color is the same, whether the skin has punctate depression, whether there is orange peel change, whether there is regional depression (dimple sign), whether the nipple skin falls off or erodes, and whether the nipple bulges or retracts. Raise your arm again and do the same check. Secondly, lie on your back, with one hand resting under your head and one hand gently pressing and touching your fingertips clockwise from outside to inside to check for lumps, thickening and pain. Do it alternately with your hands. Pay attention to whether there is any abnormality in the lymph nodes in the upper and lower abdomen.
Abdominal examination
First, observe the appearance, grain and color of the abdomen, whether there are abnormal changes in blood arms and hair, and whether there is discoloration and secretion in the navel. Then lie flat, bend your knees, relax your abdomen, put your hands and fingers together, and gently touch your abdomen to check for lumps or pain.
genitalia
Middle-aged and elderly men should always touch the height for a long time and see if there is any lump or other abnormality in the penis, then touch the lymph nodes in the mouse hole and check the glans penis. You can eat when you touch the ninth grade, press one side with your middle finger and the other side with your thumb. Be careful if there are bumps or other changes.
secreta
Observe the color, concentration, smell of sputum and whether it is mixed with bloodshot. Look at the color, flow rate and urine volume of urine. Secondly, look at the color of stool, whether there is blood clot, thickness, hardness change and so on.