Tumor Surgery Atlas

Author: Editor-in-Chief: Jiang Xiaoqing et al.
Publisher:
Publishing Date: 1999-06-01
Features: This book is a large-scale monograph in China that provides a detailed introduction to the specific steps of surgical procedures for malignant tumors of various systems. The book is divided into ten parts and 45 chapters, including: Part I General Principles, Part II Intracranial Tumors, Part III Neck Tumors, Part IV Breast Cancer, Part V Thoracic Tumors, Part VI Abdominal Tumors, Part VII Urogenital Tumors, Part VIII Gynecological Tumors, Part IX Orthopedic Tumors, and Part X Oral and Maxillofacial Tumors. The book also briefly introduces practical surgical anatomy of various organ systems, indications for surgery, preoperative preparation, anesthesia, common complications, and postoperative management. The book contains approximately 300,000 words and 1,500 illustrations, written by middle-aged and young clinical frontline scholars from Shanghai, Jiangsu, and Zhejiang who work in tumor surgery, and reviewed and guided by experts including Academician Wu Mengchao. The book features up-to-date content and a strong emphasis on practicality, making it an invaluable reference for young physicians practicing tumor surgery, especially those working in grassroots hospitals.
Excerpt: Activities such as movement, proliferation within the stroma, self-organized invasion, lymphatic permeation, vascular permeation, and spread along serosal or mucosal surfaces are prerequisites for the metastasis of malignant tumors, which can lead to lymphatic, hematogenous, or direct seeding metastasis. The invasion of malignant tumors is related to the biological characteristics of the tumor itself, the effects of the surrounding medium, and a decline in local immunity, often resulting from the combined action of multiple factors. The metastasis of malignant tumors refers to the detachment of tumor cells from their primary site, their transport through various pathways, and their continued proliferation and growth in discontinuous target tissues, forming a tumor of the same nature. This process typically involves tumor cells detaching from the primary tumor, invading and entering the lymphatic or bloodstream, and then exiting the lymphatic or blood vessels to form a mass in the stroma of the target tissue. This mass is called metastatic cancer, while the original tumor is referred to as the primary tumor. Approximately 60% of malignant tumors are diagnosed with metastasis at the time of initial diagnosis. The invasion and metastasis of malignant tumors constitute their spread, which is one of the biological characteristics of malignant tumors. Most treatment for malignant tumors requires surgery, and a portion of them may recur postoperatively. The reasons for recurrence include four factors: ① The continued action of carcinogenic factors, leading to the regeneration of a primary tumor after treatment of the primary cancer, such as liver cancer and bladder cancer. ② Failure to detect multifocal tumors during the first surgery, which is also common in liver cancer and bladder cancer. The first two factors are essentially cases of multiple primary cancers. ③ Poor intraoperative tumor-free technique, leading to tumor seeding at the wound site, such as postoperative recurrence of breast cancer. ④ Failure to achieve radical resection during the first surgery, such as lymph node metastasis after gastric cancer surgery. Recurrence is classified into three stages: early (within six months), mid-term (half a year to five years), and late (more than five years). The recurrence and metastasis of malignant tumors increase the difficulty of clinical treatment, but understanding the patterns of recurrence and metastasis is crucial for distinguishing between multiple primary cancers and true metastatic or recurrent cancers, identifying primary tumors in cases of metastatic cancers of unknown origin, and determining the scope of surgical treatment. Additionally, active treatment should still be pursued for true recurrent or single metastatic lesions. For example, local recurrence of breast cancer, cervical cancer, thyroid cancer, laryngeal cancer, parotid cancer after surgery can still be cured, and early detection of postoperative anastomotic recurrence of gastrointestinal tumors also offers some chances for cure. Furthermore, sarcomas typically recur locally without distant metastasis, allowing for repeated, even up to 10 or more surgeries to remove recurrent tumors. The author once performed 11 surgeries on a patient with abdominal leiomyosarcoma, and the patient survived for eight years.
3. Spontaneous Regression of Malignant Tumors
Malignant tumors can also spontaneously regress, with an incidence rate of about 1/100,000. The reasons include the disappearance of carcinogenic factors, changes in the endocrine environment, improved immune function, and sensitivity to certain drugs. This is commonly observed in renal cell carcinoma, neuroblastoma, malignant melanoma, choriocarcinoma, bladder cancer, and soft tissue sarcoma. It is particularly noteworthy that after the resection of certain primary tumors, their metastatic lesions may spontaneously disappear, especially in endocrine tumors such as primary thyroid cancer, choriocarcinoma of the uterus, and lung metastatic nodules after renal cell carcinoma surgery. Therefore, it is essential to strive to resect the primary focus of such tumors.
II. Etiology of Tumors
(1) Unhealthy Lifestyle: In daily life, smoking is associated with 20–30% of cancers, such as lung cancer, oral cancer, esophageal cancer, and bladder cancer. Alcohol consumption is linked to oral cancer, liver cancer, and esophageal cancer. A diet high in pickled vegetables is associated with digestive system cancers, while a low-fiber, high-fat diet is linked to breast cancer, colorectal cancer, and gallbladder cancer. Unprotected sexual intercourse is associated with cervical cancer.
(2) Chemical Factors: As early as the 18th century, it was discovered that chimney sweepers had a higher incidence of scrotal cancer compared to the general population, later found to be related to benzo[a]pyrene in soot. With industrial development, urban environments have deteriorated, leading to a rapid increase in tumor incidence. In recent years, it has been confirmed that nearly 30 chemical substances are associated with human carcinogenesis. Nitrosamines are linked to gastrointestinal tumors, polycyclic aromatic hydrocarbons, aromatic amines, aminoazo dyes, organic halides, and alkylating agents are associated with skin cancer, liver cancer, and bladder cancer. Aflatoxin can cause liver cancer.
(3) Physical Factors: Such as ultraviolet rays and ionizing radiation. The former, such as excessive sun exposure, can lead to skin cancer, while the latter, such as leukemia and thyroid cancer in adolescents caused by the Chernobyl nuclear accident in the Soviet Union, are examples.
(4) Viruses: Hepatitis B virus causes hepatitis, cirrhosis, and liver cancer. About 70% of liver cancer patients in China are positive for HBsAg. Epstein-Barr virus is associated with lymphoma and nasopharyngeal carcinoma. Papillomavirus is associated with cervical cancer. Human T-cell leukemia virus is associated with T-cell leukemia.
(5) Parasites: Such as schistosomiasis, which is associated with colorectal cancer.
(6) Chronic Irritation and Trauma: Long-standing sinuses, ulcers, and chronic gastritis can lead to canceration. Pigmented nevi in areas prone to friction can transform into melanomas. There is still no direct evidence to suggest whether trauma increases the risk of tumor development.
(7) Genetic and Immune Factors: Retinoblastoma, colon polyposis, liver cancer, and Wilm's tumor all exhibit familial clustering. The incidence of gastric cancer remains high among the second generation of Japanese immigrants to the United States. Individuals with primary immune deficiencies have a tumor incidence 10,000 times higher than the general population. According to the International Registry of Primary Immunodeficiency Diseases, approximately 10% of patients with various immune deficiencies develop malignant tumors. In kidney transplant recipients, 5%–6% develop tumors.
III. Epidemiology of Tumors
Humans have known about tumors for over 3,000 years, and malignant tumors have now become one of the main diseases threatening human health. According to a 1980 report by the World Health Organization, approximately 6.35 million new malignant tumors are diagnosed globally each year, with only one-third of the global population in developed countries accounting for 3.13 million cases, while developing countries account for 3.22 million. From 1973 to 1975, China conducted a retrospective survey of malignant tumor deaths among 850 million people, creating the "Atlas of Malignant Tumors in China." China diagnoses approximately 1 million new malignant tumors and 700,000 deaths annually, with more than 60% of cases involving digestive system tumors. After adjusting for world population standards, the mortality rate is 100/100,000, accounting for 10.13% of total deaths. The leading causes of death in men are second (gastric cancer, esophageal cancer, liver cancer, lung cancer, and colorectal cancer), while in women, they are third (gastric cancer, cervical cancer, esophageal cancer, liver cancer, and lung cancer). China is a populous country with a high number of cancer cases, including 53.9% of global cases of esophageal cancer, 44.7% of liver cancer, 30.1% of gastric cancer, 28% of cervical cancer, and 21.5% of leukemia. In recent years, the incidence and mortality rates of malignant tumors in China have risen rapidly. In 1991, the Ministry of Health conducted surveys in some cities and counties, finding that lung cancer had risen to the th position in cities, followed by gastric cancer and liver cancer, with a total incidence of 128.03/100,000. In rural areas, the main causes are gastric cancer, liver cancer, and esophageal cancer, with a total incidence of approximately 112.36/100,000. High-incidence and high-mortality areas for malignant tumors in China are Shanghai, Jiangsu, Fujian, Ningxia, and Zhejiang, while low-incidence areas are Yunnan, Guizhou, and Hunan. With the improvement of living standards, malignant tumors pose an even greater threat to humans, making the prevention and treatment of tumors more challenging and a long-term task.
IV. Prevention of Tumors
The World Health Organization has declared that one-third of malignant tumors can be prevented, one-third can be cured, and one-third can have their lives extended through existing treatment methods. The prevention of malignant tumors is divided into three levels.
(1) Primary Prevention: Causal prevention. Identifying, eliminating risk factors and causes, and enhancing cancer prevention capabilities to prevent cancer before it occurs.