. Concerns about unmanageable side effects (such as constipation, nausea, or confusion. Concerns about pain medication addiction. Non-adherence to prescribed pain medications. Financial barriers. Health care system concerns: Low priority for cancer pain management. Most appropriate treatment may be too expensive for patients and their families Tight regulation of controlled substances Problems with affordability or access to treatment Opiates not available over the counter to patients Unavailable medications Flexibility is key to cancer pain management Because patients vary in diagnosis, stage of the disease, response to pain and personal preferences, then it is necessary to be guided by these particular features. More details in the following articles: ">Pain in cancer 6

to cure or at least stabilize the development of cancer. Like other therapies, choice in use radiation therapy treatment for a specific cancer depends on a number of factors. These include, but are not limited to, the type of cancer, physical state patient, cancer stage, and tumor location. Radiation therapy (or radiotherapy is an important technology for shrinking tumors. High energy waves are directed at cancerous tumor. The waves cause damage to cells, disrupting cellular processes, preventing cell division, and ultimately leading to the death of malignant cells. The death of even part of the malignant cells leads to a reduction in the tumor. One significant disadvantage of radiation therapy is that the radiation is not specific (that is, it is not directed exclusively at cancer cells to cancer cells and can also harm healthy cells. Response of Normal and Cancer Tissue to Therapy The response of tumor and normal tissue to radiation depends on their growth pattern before and during treatment. Radiation kills cells through interaction with DNA and other target molecules. Death does not occur instantly, but occurs when cells try to divide, but as a result of exposure to radiation, a failure occurs in the division process, which is called abortive mitosis. For this reason, radiation damage occurs more quickly in tissues containing cells that divide quickly, and cancer cells are the ones that divide quickly. Normal tissues compensate for the cells lost during radiation therapy by speeding up the division of remaining cells. In contrast to this, tumor cells begin to divide more slowly after radiation therapy, and the tumor may shrink in size. The extent of tumor shrinkage depends on the balance between cell production and cell death. Carcinoma is an example of a type of cancer that often has a high rate of division. These types of cancer tend to respond well to radiation therapy. Depending on the dose of radiation used and the individual tumor, the tumor may begin to grow again after stopping therapy, but often more slowly than before. To prevent the tumor from growing back, radiation is often given in combination with surgery and/or chemotherapy. Goals of Radiation Therapy Curative: For curative purposes, radiation exposure is usually increased. Reaction to radiation ranges from mild to severe. Symptom relief: This procedure is aimed at relieving cancer symptoms and prolonging survival, creating a more comfortable living environment. This type of treatment is not necessarily performed with the intention of curing the patient. Often this type of treatment is prescribed to prevent or eliminate pain caused by cancer that has metastasized to the bones. Radiation instead of surgery: Radiation instead of surgery is an effective tool against a limited number of cancer diseases. Treatment is most effective if the cancer is found early, while it is still small and non-metastatic. Radiation therapy may be used instead of surgery if the location of the cancer makes surgery difficult or impossible to perform without serious risk to the patient. Surgery is the preferred treatment for lesions that are located in an area where radiation therapy may be more harmful than surgery. The time required for the two procedures is also very different. Surgery can be performed quickly after diagnosis; Radiation therapy may take weeks to be fully effective. There are pros and cons to both procedures. Radiation therapy may be used to save organs and/or avoid surgery and its risks. Radiation destroys rapidly dividing cells in the tumor while surgical procedures may miss some of the malignant cells. However, large tumor masses often contain oxygen-poor cells in the center that do not divide as quickly as cells near the surface of the tumor. Because these cells do not divide rapidly, they are not as sensitive to radiation therapy. For this reason, large tumors cannot be destroyed using radiation alone. Radiation and surgery are often combined during treatment. Useful articles for a better understanding of radiation therapy: ">Radiation Therapy 5

Skin reactions with targeted therapy Skin problems Shortness of breath Neutropenia Nervous system disorders Nausea and vomiting Mucositis Menopausal symptoms Infections Hypercalcemia Male sex hormone Headaches Hand-foot syndrome Hair loss (alopecia Lymphedema Ascites Pleurisy Edema Depression Cognitive problems Bleeding Loss of appetite Restlessness and anxiety Anemia Confusion Delirium Difficulty swallowing Dysphagia Dry mouth Xerostomia Neuropathy For specific side effects, read the following articles: "> Side effects36

cause cell death in various directions. Some of the drugs are natural compounds that have been identified in various plants, while other chemicals are created in the laboratory. Some various types chemotherapy drugs are briefly described below. Antimetabolites: Drugs that can affect the formation of key biomolecules inside the cell, including nucleotides, the building blocks of DNA. These chemotherapeutic agents ultimately interfere with the process of replication (production of the daughter DNA molecule and therefore cell division. Examples of antimetabolites include the following drugs: Fludarabine, 5-Fluorouracil, 6-Thioguanine, Ftorafur, Cytarabine. Genotoxic drugs: Drugs that can damage DNA: By causing this damage, these agents interfere with DNA replication and cell division. Examples of drugs: Busulfan, Carmustine, Epirubicin, Idarubicin. Spindle inhibitors (or mitosis inhibitors: These chemotherapy agents are aimed at preventing proper cell division , interacting with cytoskeletal components that allow one cell to divide into two parts. As an example, the drug paclitaxel, which is obtained from the bark of the Pacific Yew and semi-synthetically from the English Yew (Taxus baccata. Both drugs are prescribed as a series of intravenous injections. Others Chemotherapeutic agents: These agents inhibit (slow down cell division through mechanisms that are not covered in the three categories listed above. Normal cells are more resistant to drugs because they often stop dividing under conditions that are not favorable. However, not all normal dividing cells escape the effects of chemotherapy drugs, which is evidence of the toxicity of these drugs. Cell types that tend to rapidly those dividing, for example, in the bone marrow and in the lining of the intestines, tend to suffer the most. Death of normal cells is one of the common side effects of chemotherapy. More about the nuances of chemotherapy in the following articles: ">Chemotherapy 6

• and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope. Based on the established type, treatment options are selected. To understand the prognosis of the disease and survival rate, I present statistics from open US sources for 2014 on both types of lung cancer together: New cases of the disease (prognosis: 224210 Number of projected deaths: 159260 Let us consider in detail both types, specifics and treatment options.">Lung cancer 4
• in the United States in 2014: New cases: 232,670 Deaths: 40,000 Breast cancer is the most common non-skin cancer among women in the United States (open sources, an estimated 62,570 cases of pre-invasive disease (in situ, With 232,670 new cases of invasive disease and 40,000 deaths, fewer than one in six women diagnosed with breast cancer will die from the disease, compared with an estimated 72,330 American women who will die from lung cancer in 2014. Breast Cancer glands in men (yes, yes, there is such a thing, it accounts for 1% of all cases of breast cancer and mortality from this disease. Widespread screening has increased the incidence of breast cancer and changed the characteristics of detected cancer. Why has it increased? Yes, because the use of modern methods has made it possible to detect incidence of low-risk cancer, precancerous lesions and ductal carcinoma in situ (DCIS. Population-based studies in the US and UK show an increase in DCIS and the incidence of invasive breast cancer since 1970, this is associated with widespread hormone therapy in postmenopause and mammography. In the last decade, postmenopausal women have refrained from using hormones and the incidence of breast cancer has decreased, but not to the level that can be achieved with the widespread use of mammography. Risk and protective factors Increasing age is the most important risk factor for breast cancer. Other risk factors for breast cancer include the following: Family medical history o Underlying genetic susceptibility Sex mutations in the BRCA1 and BRCA2 genes, and other breast cancer susceptibility genes Alcohol consumption Breast tissue density (mammographic) Estrogen (endogenous: o Menstrual history (onset of menstruation / late menopause o No history of childbirth o Elderly age at the birth of the first child History of hormone therapy: o Estrogen and progestin combination (HRT Oral contraception Obesity Absence physical exercise Personal history of breast cancer Personal history of proliferative forms of benign breast diseases Radiation exposure breast Of all women with breast cancer, 5% to 10% may have germline mutations in the BRCA1 and BRCA2 genes. Research has shown that specific BRCA1 and BRCA2 mutations are more common among women of Jewish descent. Men who carry the BRCA2 mutation also have increased risk development of breast cancer. Mutations in both the BRCA1 and BRCA2 genes also create an increased risk of developing ovarian cancer or other primary cancers. Once BRCA1 or BRCA2 mutations have been identified, it is advisable for other family members to be tested. genetic counseling and testing. Protective factors and measures to reduce the risk of developing breast cancer include the following: Using estrogen (especially after a hysterectomy Creating an exercise habit Early pregnancy Breast-feeding Selective estrogen receptor modulators (SERMs) Aromatase inhibitors or inactivators Reducing the risks of mastectomy Reducing the risk of oophorectomy or oophorectomy Screening Clinical trials have found that screening asymptomatic women with mammography, with or without clinical breast examination, reduces mortality from breast cancer. Diagnosis If If breast cancer is suspected, the patient usually must go through the following steps: Confirmation of the diagnosis Assessing the stage of the disease Selection of therapy. Next tests and procedures used to diagnose breast cancer: Mammography. Ultrasound. Breast magnetic resonance imaging (MRI, if clinically indicated. Biopsy. Contralateral breast cancer Pathologically, breast cancer can be multicentric and bilateral. Bilateral disease is slightly more common in patients with invading focal carcinoma. Within 10 years of diagnosis, The risk of primary breast cancer in the contralateral breast ranges from 3% to 10%, although endocrine therapy may reduce this risk. Development of second breast cancer is associated with an increased risk of distant recurrence. In cases where a BRCA1/BRCA2 gene mutation has been diagnosed in Before the age of 40 years, the risk of cancer of the second breast in the next 25 years is almost 50%. Patients diagnosed with breast cancer should undergo bilateral mammography at the time of diagnosis to exclude synchronous disease. The role of MRI in contralateral breast cancer screening and monitoring of women treated with breast conservation therapy continues to develop. Because mammography's increased detection rate of possible disease has been demonstrated, selective use of MRI for adjunctive screening is occurring more frequently, despite the lack of randomized controlled data. Because only 25% of MRI-positive findings represent malignancy, pathological confirmation is recommended before treatment. Whether this increased rate of disease detection will lead to improved treatment outcomes is unknown. Prognostic Factors Breast cancer is usually treated with various combinations of surgery, radiation therapy, chemotherapy and hormonal therapy. Conclusions and selection of therapy may be influenced by the following clinical and pathological features(based on conventional histology and immunohistochemistry: Patient's climacteric status. Stage of disease. Grade of primary tumor. Tumor status depending on the status of estrogen receptors (ER and progesterone receptors (PR). Histological types. Breast cancer is classified into various histological types, some of which have prognostic value. For example, favorable histologic types include colloid, medullary, and tubular cancer. Uses of molecular profiling in breast cancer include the following: ER and PR status testing. HER2/Neu receptor status testing. Based on these results, breast cancer classified as: Hormone receptor positive. HER2 positive. Triple negative (ER, PR and HER2/Neu negative. Although some rare inherited mutations such as BRCA1 and BRCA2 predispose to the development of breast cancer in mutation carriers, however, prognostic data for mutation carriers BRCA1/BRCA2 are controversial; these women are simply at greater risk of developing second breast cancer. But it is not a fact that this can happen. Hormone replacement therapy After careful consideration, patients with severe symptoms may be treated with hormone replacement therapy. Follow-up Frequency of follow-up and advisability of screening after completion primary treatment Stage I, stage II, or stage III breast cancer remains controversial. Data from randomized trials suggest that periodic follow-up with bone scans, liver ultrasound, radiography chest and blood tests for liver function do not improve survival or quality of life at all compared with routine medical examinations. Even when these tests allow early detection of relapse of the disease, this does not affect the survival of patients. Based on these data, limited screening and annual mammography may be an acceptable continuation for asymptomatic patients who have been treated for stage I to III breast cancer. More detailed information in the articles: "> Mammary cancer5
• , ureters, and proximal urethra are lined by a specialized mucosa called transitional epithelium (also called urothelium. Most cancers that form in the bladder, renal pelvis, ureters, and proximal urethra are transitional cell carcinomas (also called urothelial carcinomas, derived from transitional epithelium Transitional cell carcinoma Bladder may be low-grade or full-grade: Low-grade bladder cancer often recurs in the bladder after treatment, but rarely invades muscle walls bladder or spreads to other parts of the body. Patients rarely die from low-grade bladder cancer. Full-blown bladder cancer usually recurs in the bladder and also has a strong tendency to invade the muscular walls of the bladder and spread to other parts of the body. High-grade bladder cancer is considered more aggressive than low-grade bladder cancer and is much more likely to cause death. Almost all deaths from bladder cancer are due to high-grade cancer. Bladder cancer is also divided into muscle-invasive and non-muscle-invasive disease, based on invasion of the muscle lining (also referred to as the detrusor muscle, which is located deep in the muscle wall of the bladder. Muscle-invasive disease is much more likely to spread to other parts of the body and is typically treated by either removing the bladder or treating the bladder with radiation and chemotherapy.As noted above, high-grade cancers are much more likely to be muscle-invasive cancers than low-grade cancers.Thus, Muscle-invasive cancer is generally considered to be more aggressive than non-muscle-invasive cancer.Non-muscle-invasive disease can often be treated by removing the tumor using a transurethral approach and sometimes chemotherapy or other procedures in which a drug is injected into the urinary cavity bladder with a catheter to help fight cancer. Cancer can arise in the bladder in the setting of chronic inflammation, such as a bladder infection caused by the parasite haematobium Schistosoma, or as a result of squamous metaplasia; The incidence of squamous cell carcinoma of the bladder is higher in the setting of chronic inflammation than otherwise. In addition to transitional carcinoma and squamous cell carcinoma, adenocarcinoma, small cell carcinoma, and sarcoma can form in the bladder. In the United States, transitional cell carcinomas account for the vast majority (more than 90% of bladder cancers. However, a significant number of transitional cell carcinomas have areas of squamous cell or other differentiation. Carcinogenesis and Risk Factors There is compelling evidence of the influence of carcinogens on the occurrence and development of bladder cancer. The most common risk factor for developing bladder cancer is cigarette smoking. It is estimated that up to half of all bladder cancer cases are caused by smoking and that smoking increases the risk of developing bladder cancer at two to four times the baseline risk. Smokers with a less functional N-acetyltransferase-2 polymorphism (known as a slow acetylator) have a higher risk of developing bladder cancer compared with other smokers, presumably due to a decreased ability to detoxify carcinogens. Some occupational hazards have also been associated with bladder cancer, and higher rates of bladder cancer have been reported due to textile dyes and rubber in the tire industry; among artists; leather workers; shoemakers; and aluminum, iron, and steel workers. Bladder carcinogens include beta-naphthylamine, 4-aminobiphenyl, and benzidine. Although these chemicals are now generally banned in Western countries, many other chemicals that are still used today are also suspected of causing bladder cancer. Exposure to the chemotherapy agent cyclophosphamide also found to be associated with an increased risk of bladder cancer. Chronic infections urinary tract infections and infections caused by the parasite S. haematobium are also associated with an increased risk of developing bladder cancer, and often squamous cell carcinoma. Chronic inflammation, is believed to play a key role in the process of carcinogenesis in these conditions. Clinical signs Bladder cancer usually presents with simple or microscopic hematuria. Less commonly, patients may complain of frequent urination, nocturia, and dysuria, symptoms that are more common in patients with carcinoma. Patients with urothelial cancer of the upper urinary tract may experience pain due to obstruction by the tumor. It is important to note that urothelial carcinoma is often multifocal, necessitating examination of the entire urothelium if a tumor is detected. In patients with bladder cancer, imaging of the upper urinary tract is essential for diagnosis and follow-up. This can be achieved using urethroscopy, retrograde pyelogram in cystoscopy, intravenous pyelogram, or computed tomography (CT urogram). In addition, patients with transitional cell carcinoma of the upper urinary tract have a high risk of developing bladder cancer; these patients require periodic cystoscopy and monitoring the opposite upper urinary tract.Diagnosis When bladder cancer is suspected, the most useful diagnostic test is cystoscopy. Radiological tests such as CT scans or ultrasound are not sensitive enough to be useful for detecting bladder cancer. Cystoscopy can be performed in a urology clinic. If cancer is detected during cystoscopy, the patient is typically scheduled for a bimanual examination under anesthesia and a repeat cystoscopy in the operating room so that transurethral tumor resection and/or biopsy can be performed. Survival Patients who die from bladder cancer almost always have metastases from the bladder to other organs. Bladder cancer with low level malignancy rarely grows into the muscle wall of the bladder and rarely metastasizes, so patients with low-grade malignancy (stage I bladder cancer) very rarely die from cancer. However, they may experience multiple recurrences that must be resected. Almost all deaths are from Bladder cancers occur among patients with disease with high level malignancy, which has a much greater potential to invade deep into the muscular walls of the bladder and spread to other organs. Approximately 70% to 80% of patients with newly diagnosed bladder cancer have superficial bladder tumors (ie, stage Ta, TIS, or T1. The prognosis of these patients depends largely on the grade of the tumor. Patients with high-grade tumors are at significant risk die from cancer, even if it is not muscle-invasive cancer. Those patients with high-grade tumors who are diagnosed with superficial, non-muscle-invasive bladder cancer in most cases have a high chance of cure, and even in the presence of muscle-invasive disease sometimes The patient can be cured. Studies have shown that in some patients with distant metastases, oncologists have achieved long-term complete responses after treatment with a combination chemotherapy regimen, although in most of these patients the metastases are limited to their lymph nodes. Secondary bladder cancer Bladder cancer tends to recur, even if it is non-invasive at the time of diagnosis. Therefore, standard practice is to monitor urinary tract after a diagnosis of bladder cancer. However, no studies have yet been conducted to evaluate whether surveillance affects progression rates, survival, or quality of life; although there are clinical trials to determine the optimal follow-up schedule. Urothelial carcinoma is believed to reflect a so-called field defect in which the cancer arises due to genetic mutations, which are widely present in the patient's bladder or throughout the urothelium. Thus, people who have had a resected bladder tumor often subsequently have ongoing tumors in the bladder, often in other locations than the primary tumor. Similarly, but less frequently, they may develop tumors in the upper urinary tract (i.e., renal pelvis or ureters. An alternative explanation for these patterns of relapse is that cancer cells that are destroyed during tumor excision may reimplant elsewhere in the urothelium. Support for this second theory is that tumors are likely to recur lower than in the opposite direction from the initial cancer. Upper tract cancer is more likely to recur in the bladder than bladder cancer to recur in the upper tract. The rest is in the following articles: "> Bladder cancer4
• , as well as an increased risk of metastatic disease. The degree of differentiation (determining the stage of tumor development has important influence on the natural history of this disease and on the choice of treatment. Increased incidence of endometrial cancer has been found to be associated with long-term, unopposed estrogen exposure (increased levels. In contrast, combination therapy(estrogen + progesterone prevents an increase in the risk of developing endometrial cancer associated with a lack of resistance to the effects of estrogen specifically. Receiving a diagnosis is not the best time. However, you should know that endometrial cancer is a curable disease. Monitor the symptoms and everything will be fine! In some patients, A previous history of complex hyperplasia with atypia may play a role as an "activator" of endometrial cancer. An increase in the incidence of endometrial cancer has also been found in association with tamoxifen treatment for breast cancer. According to researchers, this is due to the estrogenic effect of tamoxifen on the endometrium. Due to this increase, Patients prescribed therapy with tamoxifen should mandatory undergo regular pelvic examinations and should be attentive to any abnormal uterine bleeding. Histopathology The distribution pattern of malignant endometrial cancer cells depends in part on the degree of cellular differentiation. Well differentiated tumors, as a rule, limit their spread to the surface of the uterine mucosa; myometrial expansion occurs less frequently. In patients with poorly differentiated tumors, invasion of the myometrium is much more common. Invasion of the myometrium is often a precursor to lymph node involvement and distant metastases, and often depends on the grade of differentiation. Metastasis occurs in the usual way. Spread to the pelvic and para-aortic nodes is common. When distant metastases occur, it most often occurs in: Lungs. Inguinal and supraclavicular nodes. Liver. Bones. Brain. Vagina. Prognostic factors Another factor that is associated with ectopic and nodal spread of the tumor is the participation of the capillary-lymphatic space in histological examination. Three prognostic groups clinical stage I became possible thanks to careful operational planning. Patients with stage 1 tumors involving only the endometrium and no evidence of intraperitoneal disease (i.e., adnexal extension) are at low risk (">Endometrial Cancer 4

It is carried out to make a correct diagnosis, clarify the type or subtype of cancer and the extent of the tumor process. This is the basis for prescribing treatment protocols and prognosis for the patient’s future life. However, the capabilities and quality of histology directly depend on its competent implementation - from correct, careful and professional preparation to the qualifications of the pathologist studying the specimen. Also, the risks of poor-quality histology are significantly reduced by the procedure of collegial review of histological slides, which is carried out at UNIM in each case.

Glass review procedure

In order to reduce the risk of errors in the histological report, there is a practice of reviewing slides in another laboratory. Patient picks up histological slides in the laboratory that performed the first analysis and transfers them for review to another laboratory. When contacting UNIM, it takes two business days from the moment the drugs are delivered to the laboratory. However, it must be remembered that if the slides are poorly prepared (for example, there is no tumor on the section), additional sections may be required, so it is advisable to provide original paraffin blocks along with the histological slides. In this case, the final results when carrying out additional research will be ready in 2-3 business days. The patient or attending physician will be able to receive the results on the day the report is ready by email, and the original report, glasses and blocks will be delivered later by express mail.

Transfer of histological materials for revision

Previously, in order to conduct a review or repeat histology, the patient or his relatives had to personally come to the city in which these studies are carried out. In most cases, this involves additional costs and complications during an already difficult time. The UNIM company delivers from Russian regions to Moscow: glass/blocks/biopsy in formaldehyde free of charge. Delivery is organized on a door-to-door basis. This means that the company’s courier picks up the drugs at an address convenient for the sender and delivers them directly to the pathology laboratories of our partners, specializing specifically in these types of tumors. Delivery of histological preparations is carried out within 1-3 days from any region of Russia.

Additional studies after histology

Choice of the most modern laboratory, with highly qualified specialists ensures not only the high quality of the research itself, but also provides the opportunity, if necessary, to conduct additional tests(IHC, FISH) for the fastest and most accurate diagnosis, as well as get advice the best specialists according to the profile of your disease from anywhere in the world using the system.

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Revision of histology, cytology slides

Study period 1 day

Why do we need to review histological (cytological) slides?

Oncological practice shows that a diagnosis made in one medical institution very often needs confirmation or refutation. And, although examination under a microscope is carried out by professional specialists, the possibility of error or oversight cannot be excluded. Therefore, such a study as the revision of histology slides is no longer a rarity.

When is it necessary to review existing histology results?

This procedure is carried out if:

A correct diagnosis must be made;

Specify the type or subtype of tumor;

Determine the prevalence of the oncological process;

Confirm previous results.

Repeated examination of slides in another laboratory significantly reduces
risk of error. The patient can pick up histology slides in one laboratory,
to transfer to another institution and verify the correctness of the results.
In many cases, this sequence of actions is even recommended.

What can prevent a pathologist from qualitatively reviewing histological slides?

Poor-quality preparation of sections in the previous laboratory makes it almost impossible to clarify the diagnosis or clarify other important details of the disease picture.

There are two ways out of this situation:

Order an additional biopsy through Oncostandard;

Take your paraffin blocks from the previous laboratory along with the histological slides.

Even the most accurate research methods often need to be double-checked. Through the Onkostandard company, it is possible to obtain an independent result based on the opinion of one or more highly qualified specialists of our partner clinics within 2-3 business days. At the same time, you do not have to come to the laboratory yourself: our courier service will pick up the drugs for review from you and deliver them back along with the test results after the procedure.

Glass review procedure

When writing a histological report, there is a risk of making a mistake, and in order to prevent this from happening in the laboratory where the study was originally carried out, it is necessary to review the slides in another laboratory. In practice everything is simple. The patient needs to pick up histological slides from his laboratory in which the initial analysis was performed and transfer these slides for review to another laboratory that is not related to the first one. Review of drugs will take two working days from the moment the drugs are delivered to the laboratory. Paraffin blocks must be sent along with histological slides. This is necessary in case the histological preparation could have been made incorrectly in the first laboratory, and additional new sections will need to be made. This will not increase the time it takes for the result to be ready, but will also take two to a maximum of three days. You can receive your result by email immediately on the day it is ready. Blocks, slides and the original histological report will be delivered by express courier to your home at the address you specified.

Transfer of histological materials for revision

The procedure for transferring histological slides and paraffin blocks is very simple. First, you need to contact our company Onkostandart. Next, we will arrange for you free delivery of your histological slides to our laboratories, with which we have an agreement for the revision of histological slides. Delivery time takes up to three days. The delivery itself is carried out from any corner of Russia immediately to the laboratory of our clinics. We value your time and make sure that you are satisfied with the quality of the services provided.

. Concerns about unmanageable side effects (such as constipation, nausea, or confusion. Concerns about pain medication addiction. Non-adherence to prescribed pain medications. Financial barriers. Health care system concerns: Low priority for cancer pain management. Most appropriate treatment may be too expensive for patients and their families Tight regulation of controlled substances Problems with affordability or access to treatment Opiates not available over the counter to patients Unavailable medications Flexibility is key to cancer pain management Because patients vary in diagnosis, stage of the disease, response to pain and personal preferences, then it is necessary to be guided by these particular features. More details in the following articles: ">Pain in cancer 6

to cure or at least stabilize the development of cancer. Like other therapies, the choice to use radiation therapy to treat a specific cancer depends on a number of factors. These include, but are not limited to, the type of cancer, the patient's physical condition, the stage of the cancer, and the location of the tumor. Radiation therapy (or radiotherapy is an important technology for shrinking tumors. High energy waves are directed at the cancerous tumor. The waves cause damage to cells, disrupting cellular processes, preventing cell division, and ultimately lead to the death of malignant cells. The death of even part of the malignant cells leads to One significant disadvantage of radiation therapy is that the radiation is not specific (that is, it is not directed exclusively at cancer cells for cancer cells and can also harm healthy cells. The response of normal and cancer tissue to therapy The response of tumor and normal tissue to radiation depends on their growth pattern before the start of therapy and during treatment. Radiation kills cells through interaction with DNA and other target molecules. Death does not occur instantly, but occurs when cells try to divide, but as a result of exposure to radiation, a failure occurs in the division process, which is called abortive mitosis. For this reason, radiation damage occurs more quickly in tissues containing cells that divide quickly, and cancer cells are the ones that divide quickly. Normal tissues compensate for the cells lost during radiation therapy by speeding up the division of remaining cells. In contrast, tumor cells begin to divide more slowly after radiation therapy, and the tumor may shrink in size. The extent of tumor shrinkage depends on the balance between cell production and cell death. Carcinoma is an example of a type of cancer that often has a high rate of division. These types of cancer tend to respond well to radiation therapy. Depending on the dose of radiation used and the individual tumor, the tumor may begin to grow again after stopping therapy, but often more slowly than before. To prevent the tumor from growing back, radiation is often given in combination with surgery and/or chemotherapy. Goals of Radiation Therapy Curative: For curative purposes, radiation exposure is usually increased. Reaction to radiation ranges from mild to severe. Symptom relief: This procedure is aimed at relieving cancer symptoms and prolonging survival, creating a more comfortable living environment. This type of treatment is not necessarily performed with the intention of curing the patient. Often this type of treatment is prescribed to prevent or eliminate pain caused by cancer that has metastasized to the bones. Radiation instead of surgery: Radiation instead of surgery is an effective tool against a limited number of cancers. Treatment is most effective if the cancer is found early, while it is still small and non-metastatic. Radiation therapy may be used instead of surgery if the location of the cancer makes surgery difficult or impossible to perform without serious risk to the patient. Surgery is the preferred treatment for lesions that are located in an area where radiation therapy may be more harmful than surgery. The time required for the two procedures is also very different. Surgery can be performed quickly after diagnosis; Radiation therapy may take weeks to be fully effective. There are pros and cons to both procedures. Radiation therapy may be used to save organs and/or avoid surgery and its risks. Radiation destroys rapidly dividing cells in the tumor, while surgical procedures may miss some of the cancerous cells. However, large tumor masses often contain oxygen-poor cells in the center that do not divide as quickly as cells near the surface of the tumor. Because these cells do not divide rapidly, they are not as sensitive to radiation therapy. For this reason, large tumors cannot be destroyed using radiation alone. Radiation and surgery are often combined during treatment. Useful articles for a better understanding of radiation therapy: ">Radiation Therapy 5

Skin reactions with targeted therapy Skin problems Shortness of breath Neutropenia Nervous system disorders Nausea and vomiting Mucositis Menopausal symptoms Infections Hypercalcemia Male sex hormone Headaches Hand-foot syndrome Hair loss (alopecia Lymphedema Ascites Pleurisy Edema Depression Cognitive problems Bleeding Loss of appetite Restlessness and anxiety Anemia Confusion Delirium Difficulty swallowing Dysphagia Dry mouth Xerostomia Neuropathy For specific side effects, read the following articles: "> Side effects36

cause cell death in various directions. Some of the drugs are natural compounds that have been identified in various plants, while other chemicals are created in the laboratory. Several different types of chemotherapy drugs are briefly described below. Antimetabolites: Drugs that can affect the formation of key biomolecules inside the cell, including nucleotides, the building blocks of DNA. These chemotherapeutic agents ultimately interfere with the process of replication (production of the daughter DNA molecule and therefore cell division. Examples of antimetabolites include the following drugs: Fludarabine, 5-Fluorouracil, 6-Thioguanine, Ftorafur, Cytarabine. Genotoxic drugs: Drugs that can damage DNA: By causing this damage, these agents interfere with DNA replication and cell division. Examples of drugs: Busulfan, Carmustine, Epirubicin, Idarubicin. Spindle inhibitors (or mitosis inhibitors: These chemotherapy agents are aimed at preventing proper cell division , interacting with cytoskeletal components that allow one cell to divide into two parts. As an example, the drug paclitaxel, which is obtained from the bark of the Pacific Yew and semi-synthetically from the English Yew (Taxus baccata. Both drugs are prescribed as a series of intravenous injections. Others Chemotherapeutic agents: These agents inhibit (slow down cell division through mechanisms that are not covered in the three categories listed above. Normal cells are more resistant to drugs because they often stop dividing under conditions that are not favorable. However, not all normal dividing cells escape the effects of chemotherapy drugs, which is evidence of the toxicity of these drugs. Cell types that tend to rapidly those dividing, for example, in the bone marrow and in the lining of the intestines, tend to suffer the most. Death of normal cells is one of the common side effects of chemotherapy. More about the nuances of chemotherapy in the following articles: ">Chemotherapy 6

• and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope. Based on the established type, treatment options are selected. To understand the prognosis of the disease and survival rate, I present statistics from open US sources for 2014 on both types of lung cancer together: New cases of the disease (prognosis: 224210 Number of projected deaths: 159260 Let us consider in detail both types, specifics and treatment options.">Lung cancer 4
• in the United States in 2014: New cases: 232,670 Deaths: 40,000 Breast cancer is the most common non-skin cancer among women in the United States (open sources, an estimated 62,570 cases of pre-invasive disease (in situ, With 232,670 new cases of invasive disease and 40,000 deaths, fewer than one in six women diagnosed with breast cancer will die from the disease, compared with an estimated 72,330 American women who will die from lung cancer in 2014. Breast Cancer glands in men (yes, yes, there is such a thing, it accounts for 1% of all cases of breast cancer and mortality from this disease. Widespread screening has increased the incidence of breast cancer and changed the characteristics of detected cancer. Why has it increased? Yes, because the use of modern methods has made it possible to detect incidence of low-risk cancers, premalignant lesions and ductal cancer in situ (DCIS). Population-based studies in the US and UK show an increase in DCIS and the incidence of invasive breast cancer since 1970, this is associated with the widespread use of postmenopausal hormone therapy and mammography. In the last decade, postmenopausal women have refrained from using hormones and the incidence of breast cancer has decreased, but not to the level that can be achieved with the widespread use of mammography. Risk and protective factors Increasing age is the most important risk factor for breast cancer. Other risk factors for breast cancer include the following: Family medical history o Underlying genetic susceptibility Sex mutations in the BRCA1 and BRCA2 genes, and other breast cancer susceptibility genes Alcohol consumption Breast tissue density (mammographic) Estrogen (endogenous: o Menstrual history (onset of menstruation / late menopause o No history of childbirth o Older age at first birth History of hormone therapy: o Combination of estrogen and progestin (HRT Oral contraception) Obesity Lack of exercise Personal history of breast cancer Personal history of proliferative forms of benign breast diseases Radiation exposure to the breast Of all Of women with breast cancer, 5% to 10% may have germline mutations in the BRCA1 and BRCA2 genes.Studies have found that specific BRCA1 and BRCA2 mutations are more common among women of Jewish descent. Men who carry a BRCA2 mutation also have an increased risk of developing breast cancer. Mutations in both the BRCA1 and BRCA2 genes also create an increased risk of developing ovarian cancer or other primary cancers. Once BRCA1 or BRCA2 mutations have been identified, it is advisable for other family members to undergo genetic counseling and testing. Protective factors and measures to reduce the risk of developing breast cancer include the following: Estrogen use (especially after a hysterectomy Establishing an exercise habit Early pregnancy Breastfeeding Selective estrogen receptor modulators (SERMs) Aromatase inhibitors or inactivators Reducing the risks of mastectomy Reducing the risk of oophorectomy or removal ovarian Screening Clinical trials have found that screening asymptomatic women with mammography, with or without clinical breast examination, reduces mortality from breast cancer.Diagnosis If breast cancer is suspected, the patient usually undergoes the following steps: Confirmation of the diagnosis Evaluation Stage of disease Choice of therapy The following tests and procedures are used to diagnose breast cancer: Mammography Ultrasound Breast magnetic resonance imaging (MRI, when clinically indicated Biopsy Contralateral breast cancer Pathologically, breast cancer can be multicentric and bilateral defeat. Bilateral disease is somewhat more common in patients with invading focal carcinoma. Over 10 years after diagnosis, the risk of primary breast cancer in the contralateral breast ranges from 3% to 10%, although endocrine therapy may reduce this risk. Development of second breast cancer is associated with an increased risk of distant recurrence. If the BRCA1/BRCA2 gene mutation was diagnosed before the age of 40, the risk of cancer of the second breast in the next 25 years reaches almost 50%. Patients diagnosed with breast cancer should undergo bilateral mammography at the time of diagnosis to rule out synchronous disease. The role of MRI in screening for contralateral breast cancer and monitoring women treated with breast conservation therapy continues to evolve. Because mammography's increased detection rate of possible disease has been demonstrated, selective use of MRI for adjunctive screening is occurring more frequently, despite the lack of randomized controlled data. Because only 25% of MRI-positive findings represent malignancy, pathological confirmation is recommended before treatment. Whether this increased rate of disease detection will lead to improved treatment outcomes is unknown. Prognostic Factors Breast cancer is usually treated with various combinations of surgery, radiation therapy, chemotherapy and hormonal therapy. Conclusions and selection of therapy may be influenced by the following clinical and pathological features (based on conventional histology and immunohistochemistry: Menopausal status of the patient. Stage of disease. Grade of primary tumor. Tumor status depending on the status of estrogen receptors (ER and progesterone receptors (PR). Histological types Breast cancer is classified into different histological types, some of which have prognostic significance. For example, favorable histological types include colloid, medullary and tubular cancer. Uses of molecular profiling in breast cancer include the following: ER and PR status testing. Receptor testing HER2/Neu status. Based on these results, breast cancer is classified as: Hormone receptor positive. HER2 positive. Triple negative (ER, PR, and HER2/Neu negative. Although some rare inherited mutations, such as BRCA1 and BRCA2, predispose to the development of breast cancer in carriers of the mutation, however, prognostic data on carriers of the BRCA1 / BRCA2 mutation are contradictory; these women are simply at greater risk of developing second breast cancer. But it is not a fact that this can happen. Hormone replacement therapy After careful consideration, patients with severe symptoms may be treated with hormone replacement therapy. Follow-up The frequency of surveillance and the appropriateness of screening after completion of primary treatment for stage I, stage II, or stage III breast cancer remain controversial. Data from randomized trials show that periodic follow-up with bone scans, liver ultrasound, chest x-rays and blood tests for liver function does not improve survival or quality of life at all compared with routine health checks. Even when these tests allow early detection of relapse of the disease, this does not affect the survival of patients. Based on these data, limited screening and annual mammography may be an acceptable continuation for asymptomatic patients who have been treated for stage I to III breast cancer. More detailed information in the articles: "> Mammary cancer5
• , ureters, and proximal urethra are lined by a specialized mucosa called transitional epithelium (also called urothelium. Most cancers that form in the bladder, renal pelvis, ureters, and proximal urethra are transitional cell carcinomas (also called urothelial carcinomas, derived from transitional epithelium Transitional cell bladder cancer can be low-grade or full-grade: Low-grade bladder cancer often recurs in the bladder after treatment, but rarely invades the muscle walls of the bladder or spreads to other parts of the body.Patients rarely die from bladder cancer low grade. Full grade bladder cancer usually recurs in the bladder and also has a strong tendency to invade the muscle walls of the bladder and spread to other parts of the body. High grade bladder cancer is considered more aggressive than low grade bladder cancer and much more more likely to result in death. Almost all deaths from bladder cancer are due to high-grade cancer. Bladder cancer is also divided into muscle-invasive and non-muscle-invasive disease, based on invasion of the muscle lining (also referred to as the detrusor muscle, which is located deep in the muscle wall of the bladder. Muscle-invasive disease is much more likely to spread to other parts of the body and is typically treated by either removing the bladder or treating the bladder with radiation and chemotherapy.As noted above, high-grade cancers are much more likely to be muscle-invasive cancers than low-grade cancers.Thus, Muscle-invasive cancer is generally considered to be more aggressive than non-muscle-invasive cancer.Non-muscle-invasive disease can often be treated by removing the tumor using a transurethral approach and sometimes chemotherapy or other procedures in which a drug is injected into the urinary cavity bladder with a catheter to help fight cancer. Cancer can arise in the bladder in the setting of chronic inflammation, such as a bladder infection caused by the parasite haematobium Schistosoma, or as a result of squamous metaplasia; The incidence of squamous cell carcinoma of the bladder is higher in the setting of chronic inflammation than otherwise. In addition to transitional carcinoma and squamous cell carcinoma, adenocarcinoma, small cell carcinoma, and sarcoma can form in the bladder. In the United States, transitional cell carcinomas account for the vast majority (more than 90% of bladder cancers. However, a significant number of transitional cell carcinomas have areas of squamous cell or other differentiation. Carcinogenesis and Risk Factors There is compelling evidence of the influence of carcinogens on the occurrence and development of bladder cancer. The most common risk factor for developing bladder cancer is cigarette smoking. It is estimated that up to half of all bladder cancer cases are caused by smoking and that smoking increases the risk of developing bladder cancer at two to four times the baseline risk. Smokers with less functional polymorphisms N-acetyltransferase-2 (known as a slow acetylator) has a higher risk of developing bladder cancer compared to other smokers, apparently due to a decreased ability to detoxify carcinogens. Certain occupational hazards have also been linked to bladder cancer, and higher rates of bladder cancer have been reported due to textile dyes and rubber in the tire industry; among artists; leather processing industry workers; from shoemakers; and aluminum, iron and steel workers. Specific chemicals associated with bladder carcinogenesis include beta-naphthylamine, 4-aminobiphenyl, and benzidine. Although these chemicals are now generally banned in Western countries, many other chemicals that are still used today are also suspected of causing bladder cancer. Exposure to the chemotherapy agent cyclophosphamide has also been associated with an increased risk of bladder cancer. Chronic urinary tract infections and infections caused by the parasite S. haematobium are also associated with an increased risk of developing bladder cancer, and often squamous cell carcinoma. Chronic inflammation is believed to play a key role in the process of carcinogenesis in these conditions. Clinical features Bladder cancer usually presents with simple or microscopic hematuria. Less commonly, patients may complain of frequent urination, nocturia, and dysuria, symptoms that are more common in patients with carcinoma. Patients with urothelial cancer of the upper urinary tract may experience pain due to obstruction by the tumor. It is important to note that urothelial carcinoma is often multifocal, necessitating examination of the entire urothelium if a tumor is detected. In patients with bladder cancer, imaging of the upper urinary tract is essential for diagnosis and follow-up. This can be achieved using urethroscopy, retrograde pyelogram in cystoscopy, intravenous pyelogram, or computed tomography (CT urogram). In addition, patients with transitional cell carcinoma of the upper urinary tract have a high risk of developing bladder cancer; these patients require periodic cystoscopy and observation of the contralateral upper urinary tract. Diagnosis When bladder cancer is suspected, the most useful diagnostic test is cystoscopy. Radiological studies such as computed tomography or ultrasound do not have sufficient sensitivity to be useful in detecting bladder cancer. Cystoscopy may be performed in a urology department clinic. If cancer is detected during cystoscopy, the patient is usually scheduled for a bimanual examination under anesthesia and a repeat cystoscopy in the operating room so that transurethral tumor resection and/or biopsy can be performed. Survival In patients who die of bladder cancer , there are almost always metastases from the bladder to other organs. Low-grade bladder cancer rarely grows into the muscle wall of the bladder and rarely metastasizes, so low-grade (stage I) bladder cancer patients very rarely die from the cancer. However, they may experience multiple recurrences that should be treated resection. Almost all deaths from bladder cancer occur among patients with high-grade disease, which has a much greater potential to invade deep into the muscular walls of the bladder and spread to other organs. Approximately 70% to 80% of patients with newly diagnosed bladder cancer bladder have superficial bladder tumors (i.e., stage Ta, TIS, or T1. The prognosis of these patients depends largely on the grade of the tumor. Patients with high-grade tumors have a significant risk of dying from the cancer, even if it is not muscle-invasive cancer Those patients with high-grade tumors who are diagnosed with superficial, non-muscle-invasive bladder cancer in most cases have a high chance of cure, and even in the presence of muscle-invasive disease, sometimes the patient can be cured. Studies have shown that in some patients with distant metastases, oncologists achieved long-term complete responses after treatment with a combination chemotherapy regimen, although most of these patients have metastases limited to their lymph nodes. Secondary Bladder Cancer Bladder cancer tends to recur, even if it is non-invasive at the time of diagnosis. Therefore, standard practice is to perform urinary tract surveillance after a diagnosis of bladder cancer. However, no studies have yet been conducted to evaluate whether surveillance affects progression rates, survival, or quality of life; although there are clinical trials to determine the optimal follow-up schedule. Urothelial carcinoma is thought to reflect a so-called field defect, in which the cancer arises due to genetic mutations that are widely present in the patient's bladder or throughout the urothelium. Thus, people who have had a resected bladder tumor often subsequently have ongoing tumors in the bladder, often in other locations than the primary tumor. Similarly, but less frequently, they may develop tumors in the upper urinary tract (i.e., renal pelvis or ureter). An alternative explanation for these patterns of recurrence is that cancer cells that are destroyed when the tumor is excised may reimplant in another site in the urothelium. Support for this second theory is that tumors are more likely to recur lower than in the opposite direction from the initial cancer.Upper tract cancer is more likely to recur in the bladder than bladder cancer is to reproduce in the upper urinary tract. The rest is in the following articles: "> Bladder cancer4
• , as well as an increased risk of metastatic disease. The degree of differentiation (staging) of a tumor has an important influence on the natural history of the disease and on the choice of treatment. An increase in the incidence of endometrial cancer has been found in association with long-term, unopposed estrogen exposure (increased levels. In contrast, combination therapy (estrogen + progesterone prevents an increase in the risk of developing endometrial cancer associated with a lack of resistance to the effects of estrogen specifically. Receiving a diagnosis is not the best time. However, you should know - endometrial cancer is a treatable disease. Monitor the symptoms and everything will be fine! In some patients, it may play a role "activator" of endometrial cancer is a prior history of complex hyperplasia with atypia. An increase in the incidence of endometrial cancer has also been found in association with treatment of breast cancer with tamoxifen. According to researchers, this is due to the estrogenic effect of tamoxifen on the endometrium. Because of this increase, patients who Patients prescribed therapy with tamoxifen must undergo regular examinations of the pelvic region and must be attentive to any abnormal uterine bleeding. Histopathology The distribution pattern of malignant endometrial cancer cells depends in part on the degree of cellular differentiation. Well differentiated tumors, as a rule, limit their spread to the surface of the uterine mucosa; myometrial expansion occurs less frequently. In patients with poorly differentiated tumors, invasion of the myometrium is much more common. Invasion of the myometrium is often a precursor to lymph node involvement and distant metastases, and often depends on the grade of differentiation. Metastasis occurs in the usual way. Spread to the pelvic and para-aortic nodes is common. When distant metastases occur, it most often occurs in: Lungs. Inguinal and supraclavicular nodes. Liver. Bones. Brain. Vagina. Prognostic factors Another factor that is associated with ectopic and nodal spread of the tumor is the participation of the capillary-lymphatic space in histological examination. The three prognostic groupings of clinical stage I were made possible by careful operative staging. Patients with stage 1 tumors involving only the endometrium and no evidence of intraperitoneal disease (i.e., adnexal extension) are at low risk (">Endometrial Cancer 4

Immunohistochemistry makes it possible to describe the tumor at the cellular level, determine the prognosis, and help in choosing treatment tactics.

Using this method, the growth rate of the tumor is assessed, so there is such a possibility of prediction. Immunohistochemistry provides clear data on which chemotherapy the tumor is resistant to, so it is possible to choose rational treatment tactics.

The method is very valuable in breast cancer as immunohistochemistry easily evaluates such tumor-dependent hormones (estrogen and progesterone). Immunohistochemistry identifies pathological genes. Patients with the presence of these genes (proto-oncogene) have a high likelihood of developing lymphoma. Immunohistochemistry also helps in cases where two tumors are detected in a patient at once ( primary tumor with metastasis (secondary tumor)). In this situation, oncologists need to figure out what is primary and what is secondary. Importance accurate diagnosis costs the patient’s life, so it is better to order a second opinion from professionals.

Immunohistochemistry is a poorly developed research method in Russia, so the frequency of incorrect diagnoses is high. The analysis equipment that was recently purchased from Russia is very complex. Until recently, no one worked on these devices, so we have to train our specialists abroad, but oncology centers always face the problem of financing.

Sent for glass review.

The number of errors even in the most accurate research methods is high, so it is better when your histological analyzes professionals are watching. It is important that the material for the assessment is taken with high quality, but here errors are less common than when making a diagnosis. Today, many pathologies are classified, described, and making a diagnosis is not difficult for a pathologist. Often patients without an identified tumor are diagnosed with a malignant bone tumor. Let’s say that in case of damage to the collarbone, the pathologist did not describe the tissue component of the tumor and other important information the way the doctor encountered it for the first time. Bone tumors should not be biopsied frequently because this may cause accelerated tumor growth. Now it is possible to take and send your histological glass using special equipment and software to a competent pathologist via telemedicine.

A pathologist at the Institute of Histology and Pathology in the USA will decipher your slide with a histological smear in the shortest possible time.

Could the revision of slide histology be different?

In complex and rare oncological diseases, the pathologist faces difficulties in describing and making a diagnosis, therefore the best way To confirm or refute the diagnosis is to order a second opinion, or, in other words, to simply have your glasses reviewed by a more competent specialist. Let me present one case where exactly this situation occurred.

The patient underwent a histological examination of the humerus. Initially, the patient complained of bone spur in the area of ​​the upper third of the shoulders. The growth was small in size, but gradually increased in size, and pain also appeared. The patient turned to a traumatologist, who suspected oncology based on radiographs of the humerus and wrote a referral to an oncologist. The oncologist and radiologists at the center could not come to a common diagnosis, so they prescribed a biopsy. The biopsy results were as follows: malignant bone tumor of unknown origin. The patient came to a specialized center, where they helped send slides with histological material from the patient’s tumor to the American Pathological Center using telemedicine. In this center the diagnosis was formulated differently, namely benign tumor from mucoid substance. The diagnosis changed from unknown malignant to rare benign. Also, the nerves of the patient, her family, and endless trips are a thing of the past thanks to modern technologies.

American pathomorphologists examine your histological material on high-resolution monitors, which allows you to enlarge your histological slide at once.

How much does a glass inspection cost?

Revision of histological preparations in Moscow ranges from 3,500 rubles to 6,000 rubles. The turnaround time is up to two to three days. There is also an opportunity in Moscow to order glass inspections abroad. The price for glass revision in the US ranges from $100 to $250. The price depends on the qualifications of the doctor (professor, doctor of medical sciences, candidate of medical sciences).

Revision of histological slides.

Revision of slides with histological contents reduces the risk of misdiagnosis by up to 90%. The treatment and subsequent prognosis of your health depend on the diagnosis made by the pathologist. Most clinics in Israel, Germany, and the USA do not accept descriptions from Russian doctors, so it is better and cheaper for the patient to have histological slides described and given an opinion in the clinics of the countries listed above. On this moment It’s not a problem for your histological material to be described abroad remotely.

Revision of histological preparations.

The revision of histological preparations is carried out by doctors from other countries. They receive your histological specimen by email completely electronically. Histological preparations are converted into electronic form using a device similar to a scanner. After this, the digitized histological preparations are sent to doctors of the telemedicine network, where doctors analyze the histological preparation on special screens.

You also have the opportunity to choose a pathologist with a narrow specialization to further reduce the risk of misdiagnosis. Doctors of Medical Sciences or Candidates of Medical Sciences, when choosing their scientific work, choose a narrow specialty in which they are most oriented. You can choose a doctor based on the topic he has written on. scientific works. Let's say you have a histology of breast formation and you need to confirm or refute the diagnosis of breast cancer, then you should choose for you a doctor who wrote a dissertation on the pathomorphology of breast cancer. To do this, just look at the doctor's profile.

Revision of glass in Moscow.

Revision of glass in Moscow is carried out in many centers. average price in Moscow is 5,000 rubles. Completion time is from one to three days. Review of histological slides is usually ordered by patients with neoplasms who wish to refute or confirm their diagnosis.

In Moscow, you can also order a glass review service by a doctor from clinics in the USA, Israel, and Germany. A second opinion on cancer reduces the risk of misdiagnosis.

Revision of glass in St. Petersburg

Revision of glass in St. Petersburg costs on average less than in Moscow. The average price in St. Petersburg is 3,500 rubles. Average turnaround time is 2 days.

Revision of glass in Blokhina

The Moscow Blokhin Oncology Center is reviewing histological slides. This service is performed qualified doctors pathologists.

Revision of glass on Kashirka.

Russian Oncology Research Center named after. N.N. Blokhina is located in Moscow at Kashirskoye Shosse, building 23. In this center you can order the service of reviewing histological slides. Also in Moscow, you can perform this service at the following government institution - the Herzen Moscow Research Institute, which is located at 2nd Botkinsky Proezd, building 3.

Revision of histology slides on Kashirka cost.

The price for revision is 12 thousand rubles, and the price for immunochemistry is 20 thousand rubles. The average service completion time is two days.

Revision of histology slides on Kashirka.

In the Russian Oncological scientific center named after N. N. Blokhin there are academicians, professors, doctors of medical sciences, who, in addition to practical work, also conduct theoretical work at the departments, and also engage in scientific activities in a narrow specialty, which is why assessment by these specialists is so valuable.

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What are paraffin blocks, slides and smears? Why are they re-looked at for cancer?

We often have to repeat the same standard phrase for patients who are going to go to a clinic for treatment abroad or an oncology clinic in Russia:

“Remember to bring paraffin blocks and slides, both are important for diagnosis and treatment.”

We decided to talk about this in more detail, since not all patients know what it is.

Paraffin blocks

Pieces of tissue obtained from the patient’s body are sealed in them. They look like this, similar to a piece of a candle in which the contents are sealed:

Tissue obtained during biopsy can be stored in paraffin blocks for a very long time, if proper care is taken. temperature regime. The blocks can be used to conduct repeated immunological, cellular, and genetic studies of the tumor. This can be very important in choosing the right treatment method.

It should be understood that there are a lot of research methods and the opportunities for conducting research are not the same in different clinics and different countries of the world. Moreover, new drugs are emerging to treat tumors. So repeated tissue analysis several years after the initial diagnosis may be necessary and influence the selection of treatment.

How long are paraffin blocks stored and how to get them?

In Russia at least 3 years, in Finland 25 years, in Australia at least 10 years, so it’s different in different countries. They can be obtained by written request addressed to the head physician at the hospital where the biopsy was performed.

Glass

"Glass" is medical slang. These are histological and cytological preparations prepared on a special piece of glass for examination under a microscope. They are stained with different dyes to diagnose a particular disease.

The paraffin block is cut into thin sections to prepare glasses.

Histological slides stained for examination under a microscope.

Slides are also used in the preparation of smears, such as blood smears or tissue impressions, these slides are called cytological slides and are also examined under a microscope, they give an idea of ​​the cellular composition of the tissue or fluid with which they are made.

Why is this important and why can’t we just use glass?

The glasses are already painted with a certain dye and can only be viewed under a microscope; they cannot be painted differently or a genetic or immunological analysis of the tissue can be done on their basis. Unlike glass, a paraffin block makes it possible to re-examine all the characteristics of the fabric and make everything necessary tests, and not just studies under a microscope - we explained above why this is important.

Histological glasses and preparations

Revision of histological preparations in the Federal Centers of Moscow

Any tumor consists of altered cells. Initially, it is very important to understand which cancer cells and their varieties make up a particular tumor. Everything depends on it further treatment patient. For example, the concept of “lung cancer” includes more than twenty types of cancer, depending on the type of cells that form this tumor.

Histological preparations and glasses. What it is?

Histological preparations are very thin sections of tumor tissue. During the manufacturing process, each section is stained with special dyes and placed on a so-called glass slide. This section is then covered with a special coverslip and examined under a microscope. This is how specialists find out exactly what cells the tumor consists of. Only after this can effective and reasonable treatment be prescribed.

These are “histological glasses”. After the initial diagnosis has been made, it is very important to always have these glasses with you - at home, and not in the hospital where the diagnosis was first made. Using these glasses you can always clarify the diagnosis in Federal Oncology Clinics and abroad.

Revision of histological slides in Russia and abroad

It is important to understand that the primary histological diagnosis may not be entirely correct. There are many reasons for this. Insufficient experience of a specialist, bad dyes, low-quality glass... In general, in Russia good specialists They don’t even let me retire. Having vast experience behind them, such professionals can very accurately determine this or that type of tumor. But the main research tool is the microscope. By the way, most cancer diagnoses are made, as they say, “under a microscope,” which is why such studies are so important.

We are ready to examine glasses remotely in leading centers and best laboratories in Moscow. More detailed information can be obtained by watching a video or calling.

In the West, special programs are used. Something like checking fingerprints for compatibility. The tissue section is run through a common international database and identical tumor variants are obtained. There is also such a thing as “paraffin blocks”. They are made and stored together with the glasses. And they represent some kind of blanks for cutting. If for one reason or another the glasses do not give unambiguous answers, you can always get new preparations from ready-made blocks.

Histological blocks and glasses

What is a histological block?

To conduct morphological studies it is required biological material patient. It is obtained by biopsy - pieces of tissue are taken from the pathological lesion (from the center of the lesion and from the border with normal tissues). These pieces are placed in containers with a solution of 10% formalin (each piece in a separate piece) and delivered to the pathology laboratory. There, these samples are subjected to wiring - specially processed to ensure the safety of tissues and cellular structures. After preparation, the samples are embedded in paraffin - this allows the material to be stored in the block forever and, if necessary, used again for analysis. Paraffin-embedded samples are histological blocks. Histological glasses are subsequently made from them.

What is histological glass?

The material preserved in the histological block is not yet ready for study under a microscope. To do this, histological blocks are microtomized - very thin plates (thickness - 1 micron) are cut out of them using a special device (microtome). These plates are then stained with certain dyes on another device - an immunohistainer. These thin colored plates, protected by glass on both sides, are histological glasses. In the form of histological slides, the material is ready for examination under a microscope.

Storage of histological blocks and slides

After a morphological examination, histological materials are not thrown away. They are deposited in the archives of the oncology clinic. The blocks on the basis of which an oncological diagnosis was made are stored for life (previously, blocks taken before 1999 and during the USSR were stored for 25 years). Blocks based on which a benign diagnosis was made are stored for 5 years. They are stored at a temperature of +10 to +25°C outside the refrigerator in a dry place, in a dark place (box, case). Glasses in laboratories are preserved only if there is oncological pathology, also for life.

Glass reconsidered

In case of oncological diseases, tumor material is taken for histological or cytological examination. This is necessary to confirm the diagnosis and determine the tactics for further management of the patient.

A tissue sample (or cellular material) obtained during surgery or a biopsy is specially fixed and stained to be examined under a microscope and immunohistochemical methods. The latter even make it possible to determine the degree of malignancy of a tumor and predict its response to chemotherapy.

When and why is glass review necessary?

If the morphological conclusion does not correspond clinical picture tumors, as well as MRI or CT images, then the glasses are sent for review to another medical institution. Typically, glass reviews are carried out by specialists with many years of experience and unique experience in diagnosing rare tumors. Additional manual review eliminates the possibility of error associated with the use of automatic analyzers.

Why can errors occur during the initial viewing of glass?

• incorrect sampling of material (for example, not the entire epithelial layer is captured, and it is impossible to judge the depth of the lesion);
• a biopsy of a section of healthy tissue was performed;
• poor quality of material processing in the laboratory;
• small number of sections studied;
• insufficient qualifications of the pathologist.

High-quality microscopic and immunohistochemical examination allows us to begin justified and timely treatment of the tumor, and therefore increases the chances of cure and survival of the patient with cancer. It is optimal if the morphological diagnosis is confirmed by two specialists.

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    Histological slides and paraffin blocks

    If you are diagnosed with cancer (the type will be important to the oncologist), you must obtain and keep with you (and not in the clinic) histological slides and paraffin blocks. Let's figure out what it is.

    As you already understand, a malignant tumor consists of many cells with a damaged program. The division period of such a cell is from 50 to 70 days. A simple calculation shows that one diseased cell will produce from 30 to 100 similar “bad” cells in a year. In 6–8 years, a malignant tumor of 1 cm in size develops, which can already be noticed. This is exactly what oncologist Alexey Mikhailovich Karachun talks about in his lecture.

    It is important to note here that establishing the fact of cancer and accurately diagnosing the type (form) of cancer occurring in each specific case is carried out using a microscope. How? Physicians have at their disposal a common international tumor database in electronic form.

    Accurate diagnosis of the type of cancer makes it possible to determine the appropriate treatment strategy. For example, for general concept“lung cancer” is worth more than twenty types of cancer, determined by the type of cells that formed malignant tumor. That is, there is a sort of “fine” tuning to the desired type of treatment. Without such a setting, you may not get a positive result.

    Histological diagnosis is based on a science called histology. When people far from medicine ask the question of histology, what is it, then what they mean is the science of the structure of TISSUE of the human body.

    To implement the search procedure, the section is stained with a special dye and placed on a special microscope glass (called a slide glass) and covered with a coverslip on top.

    This “sandwich” is placed under a microscope and examined. It should be borne in mind that the accuracy of the diagnosis is highly dependent on the experience of the specialist. Therefore, the primary diagnosis may not be established entirely accurately. Since the main tools for making a diagnosis are a microscope and the experience of a specialist, experienced specialists are protected and are not allowed to retire for as long as possible.

    So, at the slightest suspicion that the diagnosis is inaccurate or simply for clarification (for example, when traveling for cancer treatment abroad), paraffin blocks are used, from which sections are again prepared and histological slides are prepared for a new diagnosis.

    The success of cancer diagnosis and treatment is in your hands. Be sure to have on hand an extract from the hospital (clinic) where cancer was first diagnosed, ensure that you receive histological slides and paraffin blocks, and store them in the best place. Get a referral to the oncology center for a consultation.

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    Why didn’t you write that it is the pathologist who carries out the diagnosis? Why?

    Let people know who diagnoses them!

    Alexander! First of all, you shouldn’t “shout” like that. in capital letters. Secondly, do you know the situation from the inside? I know. There is a part of oncology that has actually been commercialized, but not all of it, just part of it. The name of the specialization of the physician who can conduct diagnostics (may...) has nothing to do with the essence of the work being carried out. Therefore, you should not mislead people.

    And, most importantly! I run this site with only one goal - to provide maximum information on treatment methods and alternative methods that everyone should know. Prevention is the simplest thing a person can do until a cancer diagnosis is made. And then the struggle begins (if you couldn’t resist...) and I also give as much information as possible about this. I really hope to create a community to fight cancer, where we can support each other with advice, optimism... What is needed is optimism. Then psychologically you can win the battle with the disease.

    Tell me please, are they allowed to board the plane with glass and blocks? I didn’t find anything like that anywhere in the flight rules. Domestic flight (intercity)…

    Interesting question, Alena. I haven't encountered it. Why wouldn't they let me in? To reassure yourself, get some kind of certificate signed and sealed from the head of the laboratory where the blocks were taken.

    Hello! Please tell me what to do if the analysis of histological slides did not work out?

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