Vol 21, No 5 (2016)

The main method of the treatment of patients with localized and locally advanced gastrointestinal stromal tumors (GIST) currently remains to be surgical, but its effectiveness is limited and determined by the degree of local expansion of the disease and radicality of the surgery. Before the era of the use of tyrosine kinase inhibitors (TKI) in the treatment of GIST patients the overall 5-year survival after radical surgery in the group of patients with size of the tumor larger than 10 cm failed to exceed 20%. For the time present with the comprehensive approach to the treatment indices of survival in these patients have significantly improved. Overall 5-year survival in patients with a high risk of disease progression reaches 93%. The most important prognostic factors in patients with primary localized GIST are: the size of the primary tumor, mitotic index, tumor location, mutation status and the morphological variant of the cellular structure of GIST.

In the structure of malignant tumors, accompanied by obstructive jaundice, there are most occurred such as the lesion of the pancreas (47%), bile duct cancer (20%) also papillary carcinoma (MDP) and gall bladder cancer (about 15%). In the case of inoperable tumor, in elderly and senile patients with severe concomitant somatic pathology, there are indicated palliative interventions as follows: percutaneous transhepatic external or external-internal drainage of the biliary tract with possible subsequent percutaneous transhepatic stenting of the common bile duct. Under our observation there was a patient of 75 years with verified major duodenal papilla cancer, complicated by obstructive jaundice, to whom as the first step there was performed percutaneous transhepatic external-internal drainage of the biliary tract, and as the second one - percutaneous transhepatic stenting of the common bile duct.

Skin melanoma is the one of the most aggressive malignant tumors with an unpredictable course. Rapid proliferation and high metastatic potential can be caused by a high neuroendocrine activity. The thyroid gland discharges a wide range of functions in the body, by regulating metabolism, participating in adaptation and anti-tumor protection and influencing proliferation, angiogenesis and migration of cells. The study of thyroid activity and local saturation of the skin, tumor and surrounding tissues with thyroid hormones in the dynamics of the growth of experimental В16/F10 melanoma in mice of both genders revealed gender differences in thyroid homeostasis. Females showed the syndrome of low thyroid hormone levels - so-called «low T3/low T4» - diagnosed by the level of fractions of free hormone with the deterioration in correlationships between the level of peripheral hormones and TSH. Over the growth of melanoma in males there was developed severe hypothyroidism, not controlled by the higher regulating structures, accompanied by the synthesis and/or capture of thyroxine into the tumor. Saturation of the tumor tissue with thyroxine correlated with the gender and survival of animals. The revealed differences in thyroid status should be taken into account during the treatment patients with melanoma.

Objective. The aim of the study is the evaluation ofpsychosocial and medico-social aspects of outpatient cancer care by patients in Russian Federation for the time present. Material and Methods. There was executed a sociological survey of consecutively included oncological patients who received chemotherapy or hormonal therapy at two medical institutions in Russia from May 2009 to May 2011. Results. A total of 350 oncological patients participated in the study. The majority of participants (79.7%) were females, the age of the majority of patients ((79.7%)) varied between 50 and 79 years. The most common primary lesion type was breast cancer (51.1%). 17.3% of patients reported that they felt fear, and this number increased to 37.5% in the aged group of from 40 to 49 years. A substantial number of patients (24.0%) felt uncertainty over outcome of their disease and 5.0% reported a feeling of hopelessness. A part of surveyed patients (21.7%) would like to get an understandable instructions in the form of the booklet as on the organization of everyday living as about their disease. 10.9% of patients noted that they had insufficient information about their disease and 18.8% of cases would like to know more about their diagnosis. Approximately the one-third ofparticipants reported about the improvement of the attitude of their spouses (31.7%) and children (32.0%) after the establishment of the oncological diagnosis. Conclusions. Diagnosis of the oncological disease was frequently associated with feelings of discomfort andfear that it might negatively impact on the quality of life in patients and their families. These feelings and the impact may be reduced by virtue of more effective communication and provision of information concerning the disease. Results of the performed two-center survey indicate to the need for elevation of the efficacy of communication between the patient and physician.

This review highlights some of the aspects of the fertility in patients with germ cell tumors. This problem appears to be the very actual problem because of the possible impact not only anticancer therapy, but the tumor itself, coming from the human gonadal germ cells on the fertility. The individual histological types have been characterized by age and gender features. In patients with germ cell tumors, infertility is more common than in patients with other malignancies. Feasibility of the germ cell sampling procedure: the sperm and possibly, ovum, before the treatment in order to preserve the reproductive function of cured patients.