Interpretation of cellular composition, features of changes in cells during various pathological processes

Tumor disintegration is a natural consequence of too active growth of a cancer node along the periphery or a complication of an excessively high response of a common malignant process to chemotherapy.

Not every patient has to face the severe problem of the disintegration of the cancer process, but with any intensity of clinical manifestations, the condition initiated by the disintegration of the malignant tumor directly threatens life and radically changes the therapeutic strategy.

Tumor decay: what is it?

Disintegration is the destruction of a malignant neoplasm; it would seem that it is precisely disintegration that must be strived for in the process of antitumor therapy. In fact, during chemotherapy, cancer cells are destroyed, only the killing is organic and not massive, but of single cells and small cell colonies - without the death of a large mass of tissue with the release of toxic contents into the blood from decaying cells.

Under the influence of chemotherapy, cancer cells do not decay, but undergo the process of apoptosis—programmed death. The remains of cancer cells are actively utilized by phagocytes and carried away from the maternal formation, and in the place of the dead, normal scar tissue appears, very often not visually detectable.

Regression of a malignant neoplasm in the form of apoptosis occurs slowly; if you observe the neoplasm at intervals of several days, you will notice how along the periphery the cancerous node is replaced by completely normal tissue and shrinks in size.

During decay, the cancerous conglomerate is not replaced by healthy connective tissue cells; dead cell layers form into a focus of necrosis, delimited from the rest of the cancer tumor by a powerful inflammatory shaft. Inside a malignant neoplasm, necrosis is not able to organize itself and be replaced by a scar; it only grows, capturing new areas of the cancer node, thereby destroying the tumor vascular network. From the dead focus, products of cellular decay enter the bloodstream, causing intoxication.

In some malignant diseases of the blood or lymphatic tissue, decay also occurs during chemotherapy, but without the formation of a necrosis zone, while massively dying cancer cells release their contents into the blood, which does not have time to be utilized by phagocytes, “clogs” the kidneys and is carried into the vessels of other organs.

The massive release of cellular substrate causes severe intoxication that can lead to death.

Types and forms of necrosis

There are 2 main forms of pathology:

1. Dry necrosis. In medicine it is also called coagulation. With it, the protein coagulates, which soon becomes like a curd mass. The skin in problem areas will turn yellow-gray. With this form, ulcers appear in the place where dead tissue is rejected, which quickly turn into ulcers. After opening them, a fistula is formed. At the initial stages of the development of the disease, the following symptoms may be noted: increased body temperature, problems with the functioning of the problem organ.
2. Wet necrosis. The medical term is liquefaction necrosis. It manifests itself as an active increase in soft tissues. In areas of dead tissue, they liquefy and a putrefactive environment is formed for the spread of harmful microorganisms. In addition, a rotten smell appears, with which nothing can be done, even if treatment is carried out. This form of the disease most often affects the skin, brain and other organs in which a lot of fluid accumulates. With the active development of the disease, complications may appear. If necrosis affects the brain, it is possible that the patient may lose memory.

In addition to forms, there are several types:

• bedsores - appear in patients with a bedridden lifestyle who are not provided with proper care;
• gangrene - appears after actively developing necrosis. Accompanied by necrosis of the skin, mucous membranes, muscle tissue;
• heart attack - detected when blood suddenly stops flowing to a certain organ;
• aseptic – appears when the head of the femur is injured. Its symptoms are unbearable pain in the affected area and the inability to move independently. Appear 2-3 days after the onset of the disease;
• fibrinoid - detected in the walls of blood vessels.

Causes of disintegration of a malignant tumor

The disintegration of a cancerous formation is initiated by only two reasons: the very activity of the cells of the malignant tumor and chemotherapy.

The first cause of spontaneous decay is characteristic of solid neoplasms, that is, cancer, sarcomas, malignant brain tumors and melanoma. The second cause of decay is typical for oncohematological diseases - leukemia and lymphomas; it is extremely rare in oncological processes.

Over time, the central part of a malignant neoplasm of any morphological origin begins to experience difficulties with the delivery of nutrients. This happens because cancer cells multiply faster than the vascular network that “feeds” them is formed. Starving cell layers die, which is manifested by disintegration with the formation of a zone of necrosis, delimited from living tumor tissue, with the gradual formation of a cavity in which slow rotting processes occur.

If the necrotic cavity is close to the skin, it can break out in the form of a disintegrating “ulcer” and the formation of a non-healing ulcer, for example, in the mammary gland. In the lung, an X-ray will reveal a dark “hole” inside a cancerous node with decay with a separately located island piece of necrotic tissue inside – a sequestrum.

The second variant of decay, typical for oncohematological diseases, can be ascertained by the clinical symptoms of severe intoxication with complications - tumor lysis syndrome (TLS) and biochemical blood tests, where the concentration of uric acid, potassium and phosphorus is sharply increased, but calcium is significantly reduced. The specific motivating factor for the development of SOL is an extensive malignant lesion with a very high sensitivity to chemotherapy.

In oncological processes - cancers, sarcomas, melanoma, the reaction to cytostatics is predominantly moderate and not so rapid, therefore SOL is fundamentally possible only in exceptional cases of small-cell, undifferentiated or anaplastic malignant process.

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Symptoms of the collapse of a malignant tumor

The clinical result of the spontaneous disintegration of a cancerous tumor is chronic intoxication, often combined with symptoms of generalized inflammation due to the formation of a purulent focus. Symptoms are varied, but the majority experience progressively increasing weakness, an increase in temperature from low-grade to fever, palpitations and even arrhythmias, changes in consciousness - stupor, loss of appetite and rapid weight loss.

Local manifestations of spontaneous destruction of a cancer tumor are determined by its location:

• breast cancer, melanoma and skin carcinoma, oral tumors - a purulent, profusely secreting open ulcer with rough, undermined edges, often emitting a putrid odor;
• disintegrating lung carcinoma - when a necrotic cavity is perforated into a large bronchus, a paroxysmal cough with purulent sputum occurs, often streaked with blood, and sometimes profuse pulmonary bleeding occurs;
• destruction of neoplasms of the gastrointestinal tract - development of local peritonitis when a cancerous conglomerate perforates into the abdominal cavity, bleeding with black stools and vomiting of coffee grounds;
• disintegrating uterine carcinoma - intense pain in the lower abdomen, difficulty urinating and defecating with the formation of purulent fistulas.

Tumor lysis syndrome in leukemia and lymphoma is a potentially fatal condition leading to:

• first of all, to the deposition of uric acid crystals in the renal tubules with disabling function and acute renal failure;
• additionally damaging the kidneys is rapid acidification of the blood - lactic acidosis;
• a decrease in calcium levels and an increase in phosphates initiates a convulsive syndrome, complemented by neurological manifestations due to the release of cytokines;
• increased potassium negatively affects cardiac activity;
• the release of biologically active substances from cells leads to increased permeability of small blood vessels, which reduces the level of proteins and sodium in the blood, reduces the volume of circulating plasma, clinically manifested by a drop in pressure and worsening kidney damage;
• extensive and profound metabolic disorders in all organ systems resulting in multiple organ failure.

What is the disease and how does it progress?

Necrosis is one of the most terrible diseases, in which the vital activity of tissues, cells and internal organs ceases. Most often, this condition is caused by the activity of harmful microorganisms, as well as chemical, mechanical and thermal agents that have a destructive effect. The disease can also manifest itself as a result of severe allergic reactions or due to problems with blood circulation and severe hypothermia in this area. With severe overheating, excessive metabolism is noted, and in case of problems with blood circulation, the likelihood of a necrotic process increases.

The first signs of pathology are numbness and a low sensitivity threshold. In this case, you should immediately seek help from a specialist. Additional symptoms include pale skin, which is associated with impaired blood circulation. Over time, the skin may become an uncharacteristic shade - yellow, gray, green or blue. If the legs are affected, the patient complains of rapid fatigue when walking, a feeling of cold and cramps. As a result, trophic ulcers are formed that will not heal and will soon lead to necrosis of tissue and skin.

All this together negatively affects the functioning of the central nervous system, respiratory organs, kidneys and liver, the general condition noticeably worsens, the immune system weakens, metabolism is disrupted, and blood diseases may appear.

Treatment of tumor decay

For effective treatment of a disintegrating tumor conglomerate, it is necessary to restore intratumoral nutrition through the rapid formation of a new vascular network, which is completely impossible. Therefore, in case of spontaneous decay, they resort to symptomatic therapy, including palliative surgical - “sanitary” interventions.

Formally, with a decaying tumor, radical surgery is impossible; the disease is often considered inoperable, but chemotherapy and radiation are excluded from the program because they can worsen necrosis. The desperate situation of the patient and the likelihood of massive bleeding from a large vessel eaten away by cancer justifies the performance of a palliative operation, the main goal of which is to remove the source of chronic inflammation and intoxication.

Tumor lysis syndrome is treated with many hours of drip infusions with increased diuresis - urine excretion, binding of uric acid with special medications. At the same time, the functioning of the cardiovascular system is supported, intoxication and inflammation are stopped. When acute renal failure develops, hemodialysis is performed.

Tumor lysis syndrome is difficult to treat, but its symptoms can be prevented or at least reduced. Prevention begins a few days before the course of chemotherapy and continues for at least three days after the end of the cycle. In addition to special drugs that remove uric acid, long-term droppers are prescribed, missing trace elements are introduced, and excess trace elements are removed or bound with other medications.

Prevention of tumor lysis has become the standard of care for hematologic oncology patients, which cannot be said about cancer patients with disintegrating malignant processes, for whom it is very difficult to find a surgeon willing to perform palliative surgery. Intervention for sanitary reasons is refused due to the difficulty of caring for a seriously ill patient after extensive surgery. In our clinic, no one is denied help.

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