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PLASTIC SURGERY IN TURKEY Price for plastic procedures breast augmentation Breast reduction Breast lift Gynecomastia BBL (butt lift) Liposuction Liposculpture / Lipomodeling Vaser liposuction J Plasma Rhinoplasty Simple rhinoplasty Arm lift Blepharoplasty Eyebrow lift + forehead Face lift Need help? ​ Doctors-coordinators will advise you and help you with the choice. Services Medikal & Estetik Group are free for you and do not affect the clinic bill. ​ Find a solution ​ Coordinator Medikal & Estetik Group will help find the best solution for cancer treatment ​ FIND A CLINIC ​ O Medikal & Estetik Group RHINOPLASTY 1. How many times do I need to come for an examination before nose aesthetics? Before rhinoplasty, you must undergo at least 2 examinations. The first is called a preliminary interview, it is possible to pass it online, the second or third is a final one, it is carried out in person at an in-person appointment with a doctor. The preliminary interview examines the formal or functional problems of your nose and provides general information about the process of the operation. The last interview takes place about a week before the operation, or for visiting patients, the appointment is carried out one day before the scheduled operation. The final interview examines the design patterns (3D modeling) of your nose, and explains in detail the preparation that must be done before and after the operation. 2. How many hours does the operation take, what technique is used and how is the process in Turkish clinics? Depending on the additional procedures or the condition of the nose, this takes on average 2-3 hours. The choice of technique depends on the structure of your nose and existing problems. After the operation, you need to stay in the hospital for 1 night. ​ 3. Is the postoperative process very painful and in how many days can I return to my daily life? Rhinoplasty is a completely painless process in 99% of patients. It is only on the first night after surgery that some patients develop a headache that can be relieved with pain relievers. The patch and tampon are removed 1 week after the operation, and the nose is sealed with protective tape again. The second bandage is removed after 5 days. Usually, most patients can return to their daily routine a week after surgery. ​ 4. Is there a lot of swelling and bruising after the operation? Are you using a piezo or other system? Although almost everyone has swelling in the first 3 days after surgery, it gradually diminishes after the 3rd day and your face returns to normal in 1 week on average. Although bruising is not common in all patients, your skin structure and skin response to injury are very important for bruising. In the same way, bruises completely disappear within 7-10 days. The surgery uses the Piezzo ultrasound system and the Bienair motor system. Hammer and rasp processes have not been used for more than 5 years. ​ 5. Will I have breathing problems after surgery? Although you may have nasal congestion due to crusts and stitches in your nose for 6 months postoperatively, this situation is not permanent. Your preoperative allergic situation will not go away after this surgery. This surgery is not a solution to the problem of nasal congestion during periods of allergy. ​ 6. I live outside of Turkey, what will my surgery be like? Patients arriving from outside Turkey must stay in Turkey for 7-8 days in the postoperative period. The last preoperative examination of these patients is carried out 1-2 days before the operation. ​ 7. How is our control process going and how many times do we need to come for control? On average, we have 3 controls for each patient. Check 1-3 first. Between 6 months the second control is between 6-9 months, the third control is between 12-15 months. This is done between months. 6-9 patients arrive from outside Turkey. Checks are very important. ​ 8. Will my nose be crooked again and will it sag after surgery? Curvatures of the nose are usually divided into 3 types: curvatures in the cartilage structure, curvatures in the bone structure, and cases where curvatures occur in both structures. It should be noted that in the case of a curvature of the nose in the cartilage structure, these curvatures will not improve by 100%, and a curvature of 10-20% may reappear. In the postoperative period, there is some descent (loss of rotation) of each tip of the nose. Therefore, the tip of the nose on the operating table should be raised 5-6 degrees more than the patient needs. However, in some cases (eg, weak cartilage, very thick skin), the tip of the nose may sink more than intended. Patients who may face such a situation are provided with detailed information before the operation. ​ 9. Can rhinoplasty solve my breathing problems? Before surgery, your breathing problems due to a curved middle cartilage (septum) of the nose or due to curvature of the bones can be corrected at the same time as rhinoplasty. However, this surgery is not a solution to your breathing problems caused by allergic rhinitis or the turbinates (nasal passages) that existed before the surgery. ​ 10. When and how can I schedule an examination or operation? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ You will find rhinoplasty works, as well as the best surgeons on our Instagram: рино грудь BREAST ENLARGEMENT 1. What is the difference between breast augmentation and breast lift aesthetics? How do I know which one I need? Breasts sag over time due to many reasons such as age, breastfeeding, pregnancy and genetic factors. When you come for an examination, many are assessed first. parameters such as distance from nipples to collarbones, breast circumference, shoulder width, height and weight, and it is determined which operation you need. 2. How is the operation going? According to the measurements and drawings made before the operation, the operation is planned in 4 directions: 1.the place of the incision; Deciding where the breast implant will be placed, the implant can be placed with a 1.5 cm incision under the breast, an incision from the nipple or an incision under the armpit. The site of the incision takes into account the patient's age, breastfeeding status, keloid predisposition (bad scar) and social life. 2 .. Plan where the implant will be installed; The implant can be installed in approximately 2 planes: axillary or axillary. The axillary plane is now classified as a 1-2-3 double plane. In cases where the patient's chest thickness is moderate to good, an supramuscular plan may be preferred. However, in cases where there is not enough breast tissue, the axillary (double) plan is preferred. In our daily practice, we generally prefer the axillary (dual) plan because it looks more natural and conceals the implant lines better. 3. The shape of the implant; There are 2 main forms of the implant: anatomical (drop) or round. The patient's breast structure, weight, shoulder width, desired breast shape will help us in choosing an implant. During these elections, the doctor asks his patients the following questions: 1) If you no longer want to use a supported bra and want full breasts even without a bra, choose the round implant. 2) If naturalness is paramount for you, if you dream of a slightly lowered breast shape in the nude, choose a drop implant. ​ 4. The size of the implant; The range of implant sizes can be communicated to the patient by calculating many parameters, including chest measurements, shoulder width, waist width, height-weight on a preoperative drawing. For example, a minimum of 250 and a maximum of 350 cubic implants can be installed. After that, examples of results from patients who have previously undergone surgery are shown, and together the size that is closer to the patient's request is determined. ​ 3. Does it hurt badly after surgery, when is it possible to return to daily life? After the operation, you stay in the hospital for 1 night. At the end of the operation, you will be given a new bra and you should not remove your bra for 1 week. Therefore, you cannot take a shower for 1 week. In some patients, drainage is placed. The drain is removed after 24 hours. ​ In 24 hours after the operation, the pain is almost gone, but a serious rest is required for a week. Because during this week, even during light exercise such as standing up and walking, there may be a feeling of pain and tension in the chest. In surgical procedures where an axillary plan is preferred, this pain may be slightly worse. After a week, you can return to all your daily activities except lifting weights. ​ 4. What can be done to reduce pain after surgery? In some eligible patients, intercostal block can be performed under ultrasound after surgery. Thanks to this block, patients can live this week much more comfortably. If the patient rests for 1 week after the operation, the possibility of feeling pain will be low. ​ 5. Will this surgery prevent me from breastfeeding in the future? Will the nipples be numb? Breast augmentation surgery will not prevent you from breastfeeding, this surgery has nothing to do with milk ducts or glands. If the place where the implant will be placed is chosen as the nipple, you may lose 10-20% of the nipple sensitivity, which is very unlikely. Therefore, in everyday practice, surgeons prefer the incision of the lower breast fold to all patients under the age of 40. ​ 6. When after the operation you can play sports, swim and sunbathe? After the first week after surgery, you can start doing light sports, including walking, yoga, and some Pilates exercises. After the first month, you can practice all kinds of sports, swimming and diving. Again, after 1 week, you can sunbathe in a protective bra. ​ 7. Do I need to replace my breast implant in the future? What is capsule formation? Most new generation implants are durable and may need to be replaced for two reasons: firstly, if you want to enlarge or shrink the implant, and secondly, when a capsule forms around the implant. The formation of a capsule is a shell that surrounds the implant and deforms the shape of the implant, which can occur in 1-2 patients per hundred thousand on average 5-10 years after surgery. Numerous scientific studies of the causes of capsule formation have been carried out, some of which can be attributed to the choice of an implant with a rough surface, accumulation of blood in the postoperative field (hematoma), and infection. In this case, remove the implant, clean the capsule and insert a new implant. Capsule formation is a very rare condition and the probability becomes almost zero if every precaution is taken to prevent capsule formation. ​ 8. Is it true that these implants cause breast cancer? Not true. Although lymphoma was observed around the shell of some implants, it was found to be related to the structure of the implant and these implants were discontinued. ​ 9. What brand of implant is used in Turkey? I currently use Mentor and Motiva implants. After explaining the advantages and disadvantages of both of my patients, we make a joint decision with my patient. Both brands offer a lifetime warranty. ​ 10 When can I make an appointment for an operation and examination in the near future? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Breast augmentation jobs, as well as the best surgeons, you will find on our Instagram: BREAST REDUCTION 1. What is breast reduction? Breast reduction is a surgical procedure aimed at reducing large breasts that pose problems both in terms of health and aesthetics. Disproportionately large and heavy breasts can cause a range of problems, ranging from back pain, poor posture, fatigue, diaper rash under the breast, to skeletal deformities. In addition, large breasts give an unaesthetic appearance, make it difficult to choose clothes and, at the same time, lead to a loss of self-confidence, which forces women to resort to breast reduction operations. Breast reduction surgery can be described as a practice that allows women who complain of large volume to feel comfortable in every sense. ​ 2. What is done during the operation? During breast reduction surgery, excess fat and glandular tissue, excess skin, and, if necessary, the enlarged nipple is reduced over time. 3. Breast lift and reduction In some cases, during preliminary studies of patients in our clinic, the form of the disease has changed, which has been changed. For this reason, it is possible to establish which type of operation will be most suitable for the patient only during the examination. Over-sized breasts lose their resistance to gravity over time. Breast reduction surgery improves the patient's quality of life from discomfort. ​ 4. Who can get breast reduction surgery? • Those with disproportionately large breasts • Those with other large volumes have sagging • Those who cannot pick up clothes due to large breasts • Those who experience diaper rash, back pain and poor posture • Those who have large breasts interferes with physical activity • Those who have creases in the back under the bra due to heavy breasts • Those who experience self-confidence due to an unaesthetic appearance • Those who have orthopedic problems such as hand numbness, loss of sensation, poor posture ​ All these problems to the profile of candidates, suitable for breast reduction surgery. Enlarges the breast for one or more of the above reasons, which successfully and effectively solves not only aesthetic problems, but also health problems. ​ 5. How much can breasts be reduced? Planning of the reduction surgery is performed by the procedure of functional patients, and the amount of tissue to be removed, the last amount must be calculated. 6. How is breast reduction surgery performed? The reduction surgery is performed under general anesthesia. During surgery, excess tissue and excess skin is removed from the breast. At the same time, the areola decreases to the corresponding size, increasing over time. Lift is used to solve the biggest problem of large breasts - sagging and then stitches are applied. During breast reduction surgery, the reduction is performed based on the size of the breast. The shape of the stitches can vary depending on the method used, but inverted T stitches are commonly used, which fade over time and do not affect patients with aesthetic problems. ​ 7. How long does the operation take? The reduction surgery is performed under general anesthesia and takes approximately 1 hour. уменьшение груди 8. How many scars will remain after breast reduction surgery? Increase the size of the image. The incision scar in the form of an inverted T, executed vertically under the nipple and extending longitudinally under the mammary gland, fades over time and becomes almost invisible, since the main part of it is located under the breast. Differences in size. Whichever method is used, the scar-scar theme is the one that deserves the most attention. 9. Prerequisites for performing breast reduction surgery Breast reduction surgery planning as an aesthetic look. Breast reduction should be tailored to the size of the breast, the likelihood of future motherhood and breastfeeding. The operation, which lasts approximately 1 hour, is performed with the smallest incisions, is aimed at achieving the sizes agreed before with the patient and ensuring a comfortable recovery process. A quick recovery and a problem-free postoperative period, among other things, have a positive effect on the patient's psyche. Despite the likelihood of re-growth of breast tissue as a result of weight gain. Moreover, after breast reduction surgery is not an obstacle to breastfeeding. The operation is directed ​​ to remove excess fatty tissue, not the mammary glands. During breast reduction surgery. The preservation of the former sensitivity is associated with these diseases removed from this area. Nipple sensitivity is essential for breastfeeding and channel stimulation. In addition, it is imperative to create symmetry between the mammary glands and nipples. moving the nipple to the desired area is performed with the obligatory consideration of sensitivity. 10. After aesthetic breast reduction surgery Temporal sizes, symmetry and degree of sagging breasts in women are different, the methods used will also differ. However, in Turkish clinics, first of all, we provide the most comfortable period due to the minimum number of scars. Individual breast surgery is one of the most successful practices in our partners' clinics. On average, within a few weeks, the scar marks begin to wear off. Immediately after the operation, patients feel relief; reducing the reduction of pain in the lower back and back, and even their complete disappearance, as well as solving other health problems. Patients receive aesthetic, beautifully shaped breasts. ​ 11. Can the breasts grow back? The regrowth of breast tissue can be associated with a set of previous sizes. Women emphasize the fact that after the reduction surgery, they became happier, both in personal and social life. ​ 12. Will I be able to breastfeed after surgery? You will be able to breastfeed after breast reduction surgery, however this is due to the removed mammary glands. If you are planning a pregnancy, please discuss it in advance. ​ 13 . When can I make an appointment for an operation and examination in the near future? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Breast reduction jobs, as well as the best surgeons, can be found on our Instagram: Липоскульптура LIPOSCULTURE ​ Liposculpture, i.e. painless liposuction is an operation to correct the body contour, which is constantly used with the help of liposuction, which technically differs from it in the methods used. Liposculpture, which most people take for a method of losing weight, only provides correction of problem areas. Liposuction means suction of fat, and liposculpture, by its definition, is about correcting the contour of the fatty tissue and creating an aesthetic shape. The first stage of liposculpture is the removal of vacuum in the back, waist, abdomen, on the back of the upper leg, on the thighs, above the knees, under the jaw and in other body parameters, and ends with the correction of the body shape. Liposculpture can be performed during breast augmentation and reduction surgery, tummy tuck or similar plastic surgeries. Liposculpture is not a treatment for obesity. If you want to take advantage of genetic procedures, then you should take advantage of these procedures. ​ 1. Am I suitable for liposculpture? As with all other plastic surgeries, the decision to undergo liposurgery is not made for the satisfaction of others, but for oneself. If you have fat deposits in some of your body's indicators. 2. Prices for liposculpture Liposculpture prices fluctuate a lot. But at the same time, there are more important aspects than the prices for liposculpture, namely the experience of the surgeon and the equipment of the clinic where the operation will be performed. Therefore, when choosing a clinic or a surgeon for liposculpture. 3. How is the examination for liposculpture performed? When contacting the clinics, the doctor first conducts an examination, then the medical photographer takes photographs before the operation. During the examination, you can share your medications, drug allergies and all other information. In the light of the information received, the doctor will make a complete assessment of your operation. After the examination, they share with you full information about what you need to do before the operation. During the first examination, you need to explain your wishes to the doctor in detail. In addition, you would like to share information with your doctor about the ideal weight you would like to achieve and about your plans for the future, for example, the desire to have children. Preoperative conversation with the patient for liposculpture. That is why, in this situation, the exchange of a patient with a doctor is extremely useful. In addition, the doctor will give you answers to your questions regarding liposculpture and the method used. For medical records, your images are taken and the size of the area where the liposculpture will be performed is taken. Check with your doctor about the risks or complications of surgery. 4. How is liposculpture performed? General anesthesia is performed before the operation. At the end of liposculpture, the patient, with the permission of the doctor, can go home and take a bath in a day. Liposculpture used in our clinics is carried out according to a reliable approved medical method that is used in renowned world centers. The benefits of liposculpture eliminate many of the negative side effects. High vibration removes large amounts of fat in one session and minimizes postoperative pain. ​ Liposculpture is a stable deposit using a balloon and a vacuum device and body reshaping. When using the Tumescent method, local anesthesia is applied to the area of fatty deposits on which liposculpture is used, followed by a saline water solution. This method can reduce blue discoloration and swelling after liposculpture. 5. Process after liposculpture Swelling after liposculpture completely disappears in a few weeks. Every day ​​ your body harmoniously merges with the new contour and gradually takes shape. Permanent form of life. The most important thing is to exclude weight fluctuations, engage in vigorous exercise and lifestyle. After you are discharged home, we recommend that you leave the hospital after receiving information on the necessary procedures. 6. Return to normal life after liposculpture Liposculpture gave extremely positive reviews. The wound healing time lasts from 5 to 10 days. After 1 week after surgery, the swelling begins to subside. You can return to your normal life by using cosmetics. In addition to this, a healthy lifestyle contributes to the preservation of the results of the procedures. 7. What is the difference between liposculpture and liposuction? Liposculpture is different from the liposuction technique. Liposculpture, i.e. painless liposuction is an operation to correct the body contour, which is constantly used with the help of liposuction, which technically differs from it in the methods used. Liposculpture uses microcannulas. The plastic surgeon first has small centimeter incisions in places near the problem area where liposculpture will be performed, then thin cannulas are inserted into the incisions made. These cannulas are much thinner than the cannulas used in liposuction, and as a result, the surgeon gains more control over the fat cells. In our partner clinics, NIL (Nutritional Infrasound Liposculpture), approved by the Food and Drug Administration (FDA), is performed as an equipment for correcting surgeries and body fat. NIL (Nutational Infrasonic Liposculpture) is known as Tickle Lipo. With this technique, fat is removed simultaneously. As a result of this method, the healing process is formed and is shortened. ​ 8. Why is liposculpture called painless liposuction? When performing all these actions, such disadvantages as damage to blood vessels and nerves or muscle rupture, which is observed with liposuction, are excluded. The high vibration and function ensures optimal shock while keeping the skin smooth and bruising. Thanks to the structure of the cannulas, it is possible to accurately remove adipose tissue from hard-to-reach areas. For this reason, liposculpture is painless. ​ 9. Advantages of liposculpture: • Active safety system that instantly stops the process in the absence of • adipose tissue in the treated area • Less traumatic bruising and swelling • Excellent response and smooth skin • A more gentle system for the patient and less tiring for the surgeon • Short duration of the procedure • Even less pain • Faster recovery ​ 10. When can I make an appointment for an operation and examination in the near future? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ You will find liposculpture works and the best surgeons on our Instagram подтяжка груди Breast lift ​ Breast lift surgery (mastopexy) is a plastic surgery that aims to restore the correct proportions and shape of the breasts. Partial pull from the chest. In addition, sagging breasts can be delayed at a young age. Sagging breasts make it impossible to wear the desired outfits and in most cases leads to a loss of self-confidence in women. Violation of the shape of the breast, which is an integral aesthetic decollete, manifests itself not only in sagging breasts, but also in the expansion of the areola, which we call the nipple, under the influence of hormonal decollete. A sagging breast also damages the skin structure under the breast and friction causes skin problems. Breast lift surgeries are generally recommended after the end of the breast period in order to avoid re-breaking the shape of the breast. ​ In addition, in most cases, a breast lift is performed using a breast kit. In fact, it has shrunk in size, and the skin covering it has not been able to adapt to the change in size. With the help of a breast lift operation, the excess skin thus formed can be removed. Breast lift alone will not add volume to the breast. Those. In such a situation, the operation is insufficient; another plastic operation is used to improve the appearance. To increase the size, use lipofilling or silicone implant, i.e. breast augmentation surgery. 1. Who can undergo a breast lift? • Suffering breast problems after lactation • Those suffering from delayed breast development • Suffering from sagging breasts due to frequent weight and weight loss • Sagging breasts under this set of age and gravity • Suffering from a widening of the halo, i.e. breast nipple • Lost self-confidence due to sagging breasts • Desired outfits that have lost the ability due to sagging breasts Diagonal disease is reported. Modern and innovative methods used in clinics in Turkey provide candidates for breast lift surgery with a comfortable healing process and the acquisition of the desired breast shape. ​ 2. Why are there problems with the nipple? Can you correct it? Loss of breast shape is not only a cause of sagging. At the end of this process, many women experience an enlargement of the area around the nipple of the breast, i.e. in a halo. Lift surgery corrects the shape of the breast and reduces the halo. ​ 3. Will my breasts shrink after the operation? A breast lift does not change the size of the breast, it corrects the shape, eliminates sagging and tightens the breast. ​ 4. Is it possible to use implants within one operation? Yes. If you want to increase the size of the operation, the enlargement operation is performed. ​ 5. Is it possible to reduce the breast during the operation? Yes. If you want to reduce your breast size, breast reduction surgery is performed. ​ 6. How is breast lift surgery performed? Breast lift surgery is in most cases synchronous with breast augmentation or reduction operations. During the preliminary examination, the issue of inserting the implant, the introduction of fat, i.e. lipofilling or simply performing a breast lift surgery depending on what the patient expects from the surgery. The condition of the breast tissue and excess skin is analyzed and an operation plan is drawn up. Breast lift surgery performed under general anesthesia begins with a reduction in the halo, if present. During the operation, an incision is made according to the method of a vertical central incision without a scar. The leather and the underlying tissue are then processed separately. Considering the future potential of breastfeeding, the breast tissue is leveled, tightened and the breast shaped. ​ In this case, you should pay attention to the fact that there are no changes in the size of the breast during the breast lift operation. The operation only allows the breast to return to its shape and tighten it, the breast is lifted and the operation is completed. Lift surgery involves resizing surgery. For this purpose, the breast is enlarged with breast or lipofilling. ​ 7. How long does the operation take? After the lifting operation, which lasts on average about 1-3 hours, the patient is not hospitalized, but if necessary, he can be left in the hospital for one night. ​ 8. How many marks are left during the lifting operation? In the structure of Turkish clinics, methods are preferred that ensure the formation of the most natural and minimal scar in our patients during breast lift operations. As mentioned earlier, a vertical, scarless central incision is used in Turkey. This technique is innovative, which ensures that the surgery is completed with the most optimal postoperative trace. Thanks to this technique, tissue and skin are treated and treated separately and without potential stress on the skin. Thanks to this method, in which, in addition to the aesthetic appearance, attention is paid to the elements of health during the breast lift, it also provides such advantages as nourishing the entire structure through blood circulation, eliminating problems with the sensitivity of the nipple of the breast. In addition, the vertical central central patient method is able to return home. ​ Integral elements of a breast lift operation During a breast lift operation, the degree of sagging of the breast, its plan, skin elasticity, its quality and existing excess skin are analyzed without fail, on the basis of which the operation is compiled. The incision on the chest is modeled in accordance with the analysis of the indicated indicators, the shape of the tissue is corrected and the chest is tightened. Excess skin is removed and sutures are applied. Sutures are applied according to the newly created shape. All incisions are closed with minimal suture or dermatological glue. Process after breast lift surgery Used innovative technique used in breast lift surgery. As a rule, our patients, who went home on the same day, underwent surgery, without hospitalization, for no more than 1 week. ​ 9. When can I make an appointment for an operation and examination in the near future? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Breast lift jobs as well as top surgeons you will find on our Instagram: VASER LIPOSUCTION 1. What is liposuction? Liposuction is the process of removing subcutaneous fat from the abdomen, thighs, jaw, back, waist, inner legs, and back using a variety of devices. ​ 2.How many kilograms of fat can be removed at one time? With liposuction, it is safe to take a maximum of 8000 cc at a time. See fat. If this number is exceeded, life-threatening complications can occur. It should be emphasized that liposuction is not a weight loss surgery, but a body shaping surgery. Therefore, it is not suitable for every patient. ​ 3. What kind of patient is liposuction suitable for? Liposuction is ideal for patients who are not overweight or obese, have excess fat in certain areas (such as the waist circumference) and do not have excess and loose skin. With the help of liposuction, they try to bring the body into a certain shape; this method is not used for weight loss. ​ 4. Will there be loose skin in the areas of fat removal after liposuction? This is a very important and frequently asked question. Therefore, patient selection is very important. If this method is applied to overweight and obese patients, of course, sagging skin will occur. The second important point is that some devices are used in surgery to prevent sagging that can occur on the skin. Vaser and J-Plasma are the two devices we most often use to prevent sagging skin. 5. What exactly do Vaser and J-Plasma do? This is how we explain it to our patients. When you wear an XL dress, imagine that you have lost a lot of weight and have dropped to size S, and visualize how the dress will look on you when you try to wear the same dress again. The dress will seem too loose and even wrinkled to you. This is exactly what happens with liposuction: the fat is drained, but your skin is the same width. Now take this XL dress and wash it in very hot water, you will see the dress shrink. Here is a vaser and plasma; By interacting with the layers of collagen and dermis in the skin, they cause the skin to shrink and tighten. Unfortunately, liposuction surgery in which at least one of these two devices is no longer used can be frustrating. ​ 6. Is it possible to stretch the abdominal muscles (six / four) with liposuction? Yes, we can paint the abdomen of suitable patients in the style we want, we can make some of the muscle structures more prominent. 7. What should I pay attention to after the operation and in how many days will I be able to return to my daily life? The operation must be performed under general anesthesia and in a full-fledged hospital; after the operation, you usually need to stay in the hospital for 1 night. Drainages in patients who have drainage are removed within 2-3 days. At the end of the operation, a corset is made to the patient. And we recommend using this corset for 1.5 months. After 5 days, you can take a shower. Starting from 5 days, our nutritionist prepares a special dietary recipe for them. We recommend rest for the first 5-7 days. After a week, you can start light exercises. After 2-3 weeks, you can do all kinds of sports. ​ 8. How soon can I make an appointment? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Works on Vaser liposuction, as well as the best surgeons, you will find on our Instagram vaser Gynecomastia Gynecomastia is an uncontrolled increase in breast tissue in men, and surgery to eliminate it is called gynecomastic surgery. This type of adipose tissue deposition, inherent in women and unusual for the anatomy of men, leads to problems in intimate relationships and a loss of self-confidence in the social environment. As a result of this problem, which occurs in both overweight and thin men, patients who come to our clinic complain that they cannot swim in the sea, are embarrassed to undress and cannot even dress as they would like. ​ Enlarged breasts in a man can put him in an extremely stressful and humiliating position. The number of males who avoid intimate relationships in order to hide the problem of gynecomastia, and become the subject of ridicule during adolescence, as a result of which they receive psychological trauma, is enormous. Nowadays, it is possible to solve the problem of gynecomastia in every fifth man with the help of a simple procedure. At the same time, if you think about the fact that your age and hormones "change" you, then you should not be upset. If you think you are upset and depressed due to gynecomastia, in addition to the gynecomastia surgery, we strongly recommend that you do not delay with the treatment plan. ​ 1. What is the reason for the enlargement of the mammary gland in men? The problem of gynecomastia ranks among the aesthetic problems of our time. Most of this growth in breast tissue is rooted in unhealthy diets, uncontrolled use of supplements in the food industry, and associated hormonal changes. In addition to this, in addition to this immobile lifestyle, the growth of the mammary gland is also promoted. The second factor that causes the growth of the mammary gland in men is drugs that the patient is forced to take due to health problems. Other causes of gynecomastia include alcohol and drug use, hypogonadism, aging, tumors, hyperthyroidism, renal and hepatic failure, malnutrition that disrupts hormonal balance. The risk of gynecomastia is increased, especially in adolescence or over the age of 60, when using dietary supplements to enhance athletic performance that contain steroids or androgens, and in certain chronic conditions. ​ 2. Is it possible to prevent breast enlargement in men? If breast tissue grows, exercise and diet will not be beneficial. The deposition of fat in this area in most cases has the character of a persistent and difficult to remove formation. However, exercise and a healthy diet should be considered to protect against gynecomastia and ensure hormonal balance. To protect against this problem, which has a huge impact on men psychologically and emotionally, you can turn to surgical treatment of gynecomastia. Gynecomastic surgery without incision is an extremely comfortable procedure for enlarged mammary glands. ​ 3. How is gynecomastic surgery performed? Before gynecomastic surgery, the doctor conducts a physical examination, analyzes the current state of the breast tissue. The size of the developed breast tissue and the tissue itself are carefully examined. Check for any nipple discharge or other symptoms. Then the presence of a real problem of gynecomastia and false gynecomastia is revealed, a dividing line is drawn between them. Sometimes tests may be needed to evaluate the tissue. The size and presence or absence of the nodular structure of fatty relations are specified. In addition, the presence of one of the diseases is analyzed: chronic liver disease, thyroid disease, or kidney disease. ​ In the structure of Turkish clinics, operations are performed to treat gynecomastia without an incision, with minimal swelling and blue discoloration. After examining the causes of breast growth, which is done first, other conditions that can cause similar symptoms and genicomastia are considered. For example, some men and boys have masses in the mammary gland that resemble but do not resemble gynecomastia. This growth of the mammary gland, which develops in connection with development in adolescence, stops within 1-3 years. Breast cancer in men is rare, but at the same time, the likelihood of its occurrence exists and it usually appears in one breast. In addition, during the examination, the presence of an infection in the breast tissue, the so-called inflammation of the breast (mastitis), is checked. Patients who do not have these problems are candidates for surgery to treat gynecomastia. If the decision is made to perform an operation to treat gynecomastia without an incision, an extremely practical and comfortable procedure is performed. In parallel with the development of technology, instead of removing adipose tissue in the mammary gland, as was done previously, this procedure is performed in extremely comfortable conditions through micro-holes. Earlier, after the operation, the patient's return to social life took quite a long time, and the formation in the breast tissue caused damage to the vessels and cells. Gynecological surgery without incision is performed under local anesthesia and allows you to extract the adipose tissue through pinholes. The operation is practical and does not violate the internal characteristics and structure of the mammary gland. ​ 4. What is non-incision gynecomastia surgery? This method, which allows you to solve the problem with the fatty tissue in the mammary gland and remove it through the micro-holes, does not affect the nerves and blood vessels. Due to this, complications such as blue discoloration and swelling, which are observed in classical gynecomastic operations, do not occur, and the patient returns to social life. This method, which can significantly shorten the length of the recovery period and make it extremely comfortable, has fallen into preference for many men. ​ Advantages of Gynecomastic Surgery without Incision: ​ • Execution under local or general anesthesia • Short duration of the procedure • Performing the procedure using micro-holes without incision • Instant return to social life after surgery • No damage to nerves and blood vessels • Minimal level of swelling, blue discoloration and pain • Maximum patient comfort Some of our recommendations for protecting against the risk of gynecomastia and reducing the risk of developing it are: • Try to eat a healthy diet • Avoid excessive drinking • Do not use drugs • Use supplements (such as steroids and androgens) used for bodybuilding only under the supervision of a sports nutritionist. Check the drugs you are using. If you are taking a medication that causes gynecomastia, be sure to talk to your doctor about this. ​ 5. Am I eligible for surgery? Before deciding on gynecomastic surgery, you should ask yourself the question: Do the size of breast tissue cause me physical and psychological discomfort? If the answer to this question is yes, you can ask for a solution to the problem. ​ 6. At what age is this operation performed? We generally recommend that you wait until your 18th birthday. Hormonal surges that occur in adolescence, over the course of several years, correct themselves, which actually happens with an increase in the mammary gland. ​ 7. How to choose a doctor? The most important aspect in choosing such a doctor is his experience in performing such an individual procedure. In addition, communication with the office staff and your doctor is essential. Receiving comprehensive and convincing answers to all questions will help you achieve harmony in communication with the surgeon and office staff before the operation and is extremely important for the successful result of such an operation. ​ 8. What results can be expected after the operation? In light of the upcoming results, you should discuss this issue before surgery and set absolutely realistic expectations for yourself. Our experienced surgeons will help you in this matter and inform you about the result of the procedure. ​ 9. When can I return to social life? In our clinics, gynecomastic surgeries are performed without an incision. Therefore, you will be able to return to social life 1 day after surgery. ​ 10. Do any traces remain after the operation? The operation is performed without an incision in the chest area, and the removal of adipose tissue is performed through thin microcannulas, after which pinpoint marks may remain. ​ 11. What type of anesthesia is used during the operation? The decision on the type of anesthesia is made according to the patient's medical condition and tolerance. The operation can be performed under local or general anesthesia. ​ 12. Do I need to prepare before surgery? You will be given detailed instructions before the operation. In addition, you are informed about medications and herbal supplements that should not be consumed. Instead of clothing that is tight or tight in the chest area, it is preferable to wear loose clothing with a front closure with buttons. ​ 13. When can I make an appointment for an operation and examination in the near future? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ You will find works on gynecomastia, as well as the best surgeons on our Instagram Гинекомастия J plasma J PLASMA Renuvion is a non-surgical skin tightening procedure. Also known as J Plasma or J Plasty, this procedure lifts and refreshes loose skin without the need for invasive surgery, prolonged downtime, or large surgical scars. This precise repair is unique because plastic surgeons can apply controlled heat to specific areas to tighten the skin. 1. How is RENUVION going? For the Renuvion procedure, the specialist creates a small entry point by placing the device directly under the skin. Once the device is installed, the technician releases helium gas and radio frequency (RF) to create a precise flow of energy (plasma). This energy generates enough heat to compress the skin, while excess helium gas cools the treated area. This combination of energy compresses the tissues just under the skin, which tightens it. ​ 2. When is RENUVION J-PLASMA used? Renuvion can be used to tighten skin almost anywhere on the body. Common areas include: Arm lift Tightening the skin of the abdomen and sides Breast lift Buttock lift Thigh lift Lift of the lower face and neck Tightening the skin of the legs, especially the area above the knees ​ 3. Who is this procedure suitable for? Renuvion is a treatment option for patients who want skin tightening results but do not want to undergo invasive plastic surgery. No other minimally invasive technology will tighten the skin to the same degree as J-PLASMA, which also has the following advantages: tiny cut, little or no scarring, and minimum recovery time. ​ 4. How soon can I make an appointment? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ You will find works on J-PLASMA, as well as the best surgeons on our Instagram ​ ARM LIFT / BRACHIOPLASTY (ArmLift) Upper arm lift surgery is a plastic surgery performed on the sagging and flabby skin of the upper arm, which occurs in parallel with aging and weight loss. You can strengthen the muscles of the upper arm without surgery, through exercise, but this will not help you regain elasticity and get rid of excess fat and even excess skin. In addition, the upper arm lift, the so-called Arm fit, is known in the medical literature as brachioplasty. To create a more proportional look by reducing body fat during upper arm lift surgery, the shape of the excess skin in the area between the elbow and armpits is corrected. When performing more extensive operations, a longitudinal incision mark remains on the dorsum of the upper arm. Lift surgery rejuvenates the upper arm and looks toned, and the patient's self-confidence is increased, which allows him to freely wear short-sleeved clothing. ​ 1. Am I eligible for an upper arm lift? If you have sagging skin in the upper arm due to a lot of weight loss, if the skin in the upper arm has become loose, if there is more fat in the upper arm than in the lower arm, if the shape of the skin is not restored despite exercise, then you can refer to upper arm lift surgery. ​ 2. How is the upper arm lift performed? Upper arm lift surgery first removes sagging, removes fat, excess skin and subcutaneous tissue in the inner area, and ends with reshaping and giving the upper arm a natural and rejuvenated look. Liposculpture is sometimes used as an adjunct during upper arm lift surgery. ​ Medicines are used to ensure your comfort during the surgical procedure. Having chosen the option that is best for you, the doctor proceeds to the operation after performing general anesthesia or intravenous sedation. The length and shape of the incision in the upper arm depends on the amount of skin to be removed. Incisions are made on the back or back of the upper arm at the discretion of the surgeon and only in the elbow aisles and up to the lower arm. After the incision, liposuction is performed to remove fatty deposits or lipofilling. After adjusting the shape of the muscles in the upper arm and adipose tissue, the surgeon proceeds to close the incision. Upper arm lift incisions are sutured with absorbable or removable suture material. ​ 3. Process after arm lift surgery After the upper arm lift surgery, you will have a fairly comfortable process. Swelling and blue discoloration in the upper arms and a very slight sensation of numbness in this area lasts about 2 weeks. After you are discharged home, we recommend that you leave the hospital after receiving information on the necessary procedures. ​ 4. Return to normal life after upper arm lift surgery Upper arm lift surgeries have received overwhelmingly positive reviews. The healing time of the first wound lasts from 5 to 10 days. 2 weeks after the operation, the swelling disappears and the incision lines begin to become faded. The patient at this time can return to normal life, and within 2 months after the operation, it is necessary to refrain from heavy sports. You can maintain a rejuvenated look throughout your life with exercise and weight control. In addition to this, a healthy lifestyle contributes to the preservation of the results of the procedure. ​ 5. What to choose between liposuction and an arm lift? The decision on the type of operation can be made after examination. In order to perform liposuction alone, you need sufficient skin and tissue in the upper arm. Patients who have lost a lot of weight usually suffer from excess skin, which is more than necessary for the incision when the upper arm is lifted. If you suffer from sagging skin, then liposuction is not for you. ​ 6. The recovery process After surgery, your arm will remain bandaged for several days. Thereafter, tightening clothing should be worn for 2 weeks. This will help tighten the skin around the perimeter. In addition, tightening clothing has a beneficial effect on wounds as they heal. ​ 7. When is it possible to return to exercise? It takes about 1-2 weeks to engage in daily activities, and about 4-6 weeks to continue playing sports. ​ 8. How painful is the procedure? Many patients report good pain tolerance. Most of the patients refer to a reasonably good condition a few days after the operation. ​ 9. What anesthesia is used? The operation is usually performed under general anesthesia in the operating room. In addition, a preparation for local anesthesia is additionally injected into the operated area. ​ 10. Where is the incision made? Location of the incision is determined depending on the amount of tissue removed and the place of its removal, or the back of the upper part or the lower part of the arm. The traditional vertical cut extends from the armpits to the elbow. If the excess tissue is limited to the top of the shoulder, a short crescent-shaped incision can be made in the armpit area. ​ 11. How long does it take for the suture to heal? The healing of the first suture takes about two weeks. The surgeon will then give you various guidelines to help you minimize the visibility of your incision. ​ 12. How long does the operation take? The total duration of the operation is about 2 hours. ​ 13. How soon can I make an appointment? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Hand-LIFTING jobs, as well as the best surgeons, you will find on our Instagram подтяжка рук SIMPLE RHINOPLASTY 1. What is Simple Rhinoplasty? Simple rhinoplasty, also called no-scalpel rhinoplasty, is a surgery performed without a scalpel. Simple rhinoplasty, which allowed us to achieve the most effective results in the framework of non-surgical plastic surgery, gives the nose, located in the central line of the face, a shape that harmoniously fits the overall contour. ​ 2. Why Simple Rhinoplasty? Rhinoplasty occupies the main place among the aesthetic operations that cause fear in most patients and to which they approach with some distrust due to the trauma that occurs in the postoperative process. In addition, among other factors that cause mistrust, it should be noted the length of the recovery process after rhinoplasty, the patient's separation from social life, the use of a tampon and a questionable approach to plaster. Many people with nose problems who, for aesthetic reasons, do not like their nose, postpone rhinoplasty precisely for the reasons we have listed above. That is why a simple rhinoplasty appeared, which, due to its structure, eliminates the possible problems that we listed earlier and gives our patients maximum comfort without using plaster and tampons. 3. Who can perform simple rhinoplasty? The aim of simple rhinoplasty is to lift the tip of the nose, which has dropped with age or which is congenital, in those patients who do not want to radically change the shape of the nose. With simple rhinoplasty, the tip of the nose is lifted without affecting most of the skin and the bridge of the nose, and if necessary, slight filing can be performed. 4. Application of simple rhinoplasty Simple rhinoplasty, which has a number of advantages over classical rhinoplasty, provides the patient with maximum comfort during the recovery process. Simple rhinoplasty does not use a tampon, cast, or bandage. Simple rhinoplasty is performed under local anesthesia and is completed on average within 15-20 minutes. Before performing a simple rhinoplasty, a profile and front view of the patient is taken from the patient. The picture can be taken before contacting our clinic and sent to us via our website in digital form. Our specialist doctors create the required model and develop the latest version of your nose in 3 different alternatives. ​ Simple rhinoplasty, if desired, can be performed under local anesthesia while the patient is awake, or other anesthetic techniques can be used. The problematic tip of the nose rises, and for minor problems with the bridge of the nose, filing is performed. Simple rhinoplasty, if desired, can be performed in combination with different operations, again one of the methods of non-surgical plastic. Since the face is one whole and only a general look at the face will allow you to correct each problem area and achieve the required goal. Within about 15-20 minutes, thanks to a simple procedure, you get the nose that you have dreamed of for years. ​ 5. The period after simple rhinoplasty The patient returns to social life in a fairly short time. With simple rhinoplasty, pain, swelling and blue discoloration are almost invisible or minimal. The benefits of simple rhinoplasty, which provide the patient with a fairly comfortable recovery period, are most evident during this period. 6. Benefits of Simple Rhinoplasty: • Procedure without the use of plaster, swab and scalpel • No incision, micropoint procedure • Application of local anesthesia • Sufficiently short recovery time • Instant return to social life • Simple, risk-free procedure • Alternative surgery for those who are afraid of classical rhinoplasty • Simulation in a digital environment of the patient's view after surgery and demonstration to the patient • Completion of the procedure within 15-20 minutes ​ 7. Is it possible to predict the result? Yes, thanks to digital simulation, we can show the final result after the operation. We show the patient how he will look after the operation, thus avoiding unwanted surprises. ​ 8. Which season of the year is suitable for the operation? Simple rhinoplasty can be performed any season of the year. The absence of an incision does not require protecting the nose from the sun as much as possible, as was the case with classical rhinoplasty, it is enough to protect it from the sun as required. ​ 9. When can you return to social life? Immediately after surgery. Depending on the condition, 1 day of rest after the operation is recommended. ​ 10. When can I make an appointment for an operation and examination in the near future? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ You will find works on simple rhinoplasty, as well as the best surgeons on our Instagram простая рино абдомино ABDOMINOPLASTY (tummy tuck) Tummy tuck surgery (abdominoplasty) is an auxiliary operation that allows you to solve possible aesthetic problems in the abdomen that have arisen after childbirth, with frequent weight loss, weight gain and genetic character. 1. What is an abdominoplasty? Most of the internal organs. Extensive fatty layer in the case does not respond to sports, diet and exercise. In addition, skin problems, called stretch marks on the skin, which are associated with the destruction of collagen, leads to an unaesthetic appearance, again become a problem. Deformation of the abdominal muscles, which manifests itself after the birth of overweight children, leads to the appearance of an "apron" and sagging of the abdominal skin. ​ 2. What does an abdominoplasty cover? The area that is tummy tuck surgery starts from the last rib bone and extends to the pubic eminence (pubic eminence). The pubis (Mons pubis) is a part protruding above the surrounding area, often called the Hillock of Venus. Excessive abdominal obesity is a problem not only for women, it also affects men. The food used in this area is called food. Obesity puts on the agenda for a tummy tuck due to the fact that, despite adhering to a strict diet, complete elimination of violations of the structure of the skin regime, and obesity in this area is not possible. Even in the case of belly slimming, which will achieve successful results. ​ The inability to put on the desired item of clothing and in addition to this limitation in physical mobility, such as bending forward, due to sagging skin, in some cases the emergence of bacteria as a result of sweating causes such people not only psychological problems, but also health problems. ​ 3. Who can have tummy tuck surgery? • Persons with abdominal obesity • Persons with skin deformities and skin cracks in the abdomen • Persons with damaged internal muscles of the abdominal cavity • Persons with sagging skin, apron effect, shape loss • Wanting to get rid of the unaesthetic look. If you have all of the listed problems, then you can be contacted for a tummy tuck operation. ​ 4. How is tummy tuck performed? Tummy tuck surgery is a surgical procedure performed under general anesthesia. The operation begins with an incision just below the caesarean section. Then the abdominal muscles are strengthened and tightened. Then the problematic adipose tissue is removed. If necessary, the pubis and waist are re-formed. If female patients complain of loss of shape in the chest area, then breast augmentation and plastic surgery is included in the tummy tuck operation. This combination surgery, performed at the request of the patient, does not make an incision to insert the silicone implant into the breast. The implant is inserted into the abdominal cavity through a finished incision. Then a new navel is formed in the turned away skin and sutures are applied. 5. Integral factors of abdominoplasty With abdominoplasty, you should pay attention to some aspects. In terms of its structure, a new belly created as a result of a successful tummy tuck operation must meet the following positions: ​ 1) Location of the new navel The location of the newly created navel is the most important aspect of abdominoplasty that is constantly overlooked. The new navel should be formed at the level of the two pelvic bones, taking into account the proportion of the body. If the new navel is not in the desired location, a completely new look appears that does not meet aesthetic requirements. 2) Eminence of the pubis Tummy tuck surgery allows you to achieve an aesthetically pleasing belly, and the tubercle between the clitoris and the caesarean section should support this new model. The problem of obesity in the pubic region, often called the Venus tubercle, can be resolved with similar surgery. Since the problem of obesity in this area in most cases occurs simultaneously with the obesity of the abdominal cavity, therefore, the creation of an aesthetic pubis is an essential condition. ​ 6. Where should the scar be located? The incision mark after the tummy tuck operation, which should be within the bikini line, will create the maximum aesthetic effect for the patient and help mask the seam. The scar is located as low as possible, along the line of the cesarean section. ​ 7. Waist The waist area, which is not in harmony with the new toned belly, needs plastic surgery. Waist obesity can also be eliminated. Benefits of tummy tuck surgery • In our clinics, individual plastic surgery solutions for tummy tuck are created, each surgical operation is performed individually according to the patient. • Rescue from the problem of obesity in the abdomen, not solved by sports and diets • Removal of skin with a damaged structure in the form of stretch marks, the formation of a new skin structure. • Strengthening the tone of the abdomen, eliminating the protrusion of the anterior abdominal wall. • Hiding the scar under the underwear • Formation of a toned and shaped abdomen • Correctly positioned navel and incision mark • Waist in proportion to the new belly • Extremely aesthetic body 8. Process after tummy tuck surgery All of the above problems are solved with tummy tuck surgery. Tummy tuck surgeries, which will allow you to get a toned and smooth abdomen, provide a fairly comfortable recovery process for the patient, thanks to the advantages of modern technology. Within about 1 week, you will be able to return to social life and return to life again with a renewed aesthetic body. ​ 9. Is abdominoplasty performed for men? Tummy tuck surgery, which is most often used by women to resolve deformities after childbirth, can also be performed for men. ​ 10. Who is being carried out? When they are spread apart relative to the middle fascia of the abdomen, problems arise with a strong increase in adipose tissue, weakened muscles and in particular with diastasis, which occur when the rectus abdominis muscles are separated / separated. ​ 11. Why? For various reasons, the skin in the abdomen loses its elasticity and sagging occurs. In addition, the waist lines help to increase the sagging of the skin. Cracks in the skin, causes of signs of phenomena, such as deep, red marks, on the burn. Intensive deposition of adipose tissue on the walls of the abdominal cavity, cracked and weakened tone of the abdominal region as a result of pregnancy, and weakened abdominal muscles were resolved only with the help of abdominoplasty. ​ 12. How? A tummy tuck is performed under general anesthesia and starts with an incision below the caesarean section. Excess sagging and out of shape skin is removed, the tone of the stenocot is restored. ​ 13. Is the result of tummy tuck surgery permanent? Abdominoplasty is the final and most effective treatment for abdominal problems. You will never return to your previous state, but you may return to your previous state due to factors such as weight gain or childbirth. ​ 14. Is tummy tuck painful? A mini tummy tuck is much less painful than a full tummy tuck. There may be some pain after the procedure due to your upright position. This takes a maximum of 1 week. ​ 14 . How soon can I make an appointment? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Works on ABDOMINOPLASTY, as well as the best surgeons, you will find on our Instagram bbl Brazilian Butt Lift (BBL) ​ 1. What is BBL? BBL is a buttock lift and augmentation surgery that allows you to give your buttocks a more youthful, toned, natural look and shape. Patients who are dissatisfied with the shape of their buttocks can do a similar plastic personality regardless of the size, buttocks, or the presence of saggy skin. 2. How is BBL Performed? To give the buttocks an aesthetic shape, the patient's own tissues are used during this operation. It is not possible to use other patient tissues. If there is not enough fat in the patient's body for this operation, then fillers are used. ​ This operation is called the Brazilian Butt Lift, also known as the Brazilian Butt Lift / BBL preferred by those who want a younger, distinct buttocks and a correct body profile. Your own systemic tissue components are used for this procedure. During BBL The fat is produced from the site of the patient's body fat and transported in the purest form and the best combination of fat and stem cells. This ensures the most lasting result. This procedure is called liposuction-assisted fat extraction and involves enriching the fat with stem cells after it has been removed. A centrifuge is used for enrichment with stem cells. In the last step, injections are injected into the buttocks. The procedure is designed to fill the upper quadrants of the buttocks, thus, the buttocks will appear bulging and toned. The effect of this procedure is a more attractive profile of your figure. If you describe in more detail; First, 1 mm punctures are made in the area of the body, using 3 mm cannulas, the fat is pumped out. The small openings of the cannula allow even the smallest particles of fat to be collected. Fats collected after liposuction are centrifuged and enriched with stem cells, the collected fats are processed in this way. Only a certain part of the collected donor fats is suitable for making injections and injecting into the buttock area. Basically, more than 33% of the fat cells are suitable for injection. Due to this, due to transplantation with stem cells, the duration of the effect of this procedure is increased. Only the highest quality donor fat cells are injected into the buttocks. In order to get good and injectable fat, 3. Why should you have a buttock plasty? Anyone who is dissatisfied with the appearance of their buttocks, their firmness and firmness. You don't have to live with buttocks of unwanted size and shape. Don't forget that there is a simple and effective solution to this problem that will give you a natural look! Fat transfer to the buttocks is the most advanced method. This method produces a softer natural look. At the same time, adipose tissue is extracted from the patient's body, so there is no risk of rejection 4. Preparation With buttock augmentation, fat cells are removed from the abdomen (mainly from the abdomen) and transplanted into the buttocks. The operation is performed with a certain type of anesthesia and lasts approximately 1.5-2 hours. You will be informed that you must not eat or drink 6 hours before the operation. Nothing else is required from you! 5. Combination Breast augmentation, breast lift and tummy tuck are surgeries that can be combined with berry plastics to achieve a slimmer and more toned look. Removing the fat from the waist can provide a more curved proportion. If necessary, the operation can be performed in combination with buttock plasty. ​ 6. Recovery and Results The length of time you recover from buttock surgery will depend on your age, health, physical condition, and environmental factors. No stitches are applied during the procedure. The operation is performed through micro punctures. There is no need for bandaging. You can return to social life immediately after the surgery, but you must not lift weights, run or engage in active activities for 1 week after the surgery. The more you rest, the faster you will recover. 7. Benefits • Elastic and natural result • Fresh look and healthy skin • Fast recovery • Getting rid of body fat • Beautiful curves of the waist and hips ​ 8. Factors influencing the result Age Many patients think that it takes a little aging for this procedure. However, it is not. This can be done at any age. Patient Gender Typically, in female patients, the adipose tissue is softer and less fibrous. However, if desired, men can also resort to buttocks plastic surgery. ​ 9. Is this procedure safe? Safe because only the patient's own natural fat is used ​ 10. What is the cost of the operation? The price for each procedure will differ, depending on the size of the body and the area of therapy. To find out the prices for buttock plastic surgery, it would be more correct to contact us and submit a request for a free examination. ​ 11. How is the recovery period going? After a Brazilian butt plasty, the recovery period lasts an average of 1 week. It is very important not to put pressure on the buttocks for three weeks after surgery. We recommend using a special pillow to avoid damaging the fatty tissue. After 48 hours, you will be able to take a shower. Practitioners have no pain You will also be able to exercise again within three weeks. ​ 12. Is the effect permanent? The administration of injections with donor fat-treated stem cell enrichment provides a permanent effect as the stem cells in the transplanted area continue to live and provide vascularization. ​ 13. Will cellulite disappear? Fat injections and the design of the aesthetic appearance of the buttocks of this procedure, which implies the treatment of cellulite. ​ 14. How much fat is required? This can vary from patient to patient. It is related to how bulging the buttocks the patient wants. ​ 15. When can I make an appointment for an operation and examination in the near future? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ You will find BBL works , as well as the best surgeons on our Instagram блефаро BLEPHAROPLASTY 1. What is blepharoplasty? The eyes are one of the most important organs. At the same time, the eyes themselves and the area around the eyes, in their structure, perform a protective function. A joyful state, sadness and even tiny facial movements in our daily life move the area around the eyes millions of times throughout the day, and the eyelids open and close. While this area is dynamic, it also has a very sensitive texture and is most exposed to sunlight. In addition to this, if we add signs associated with aging to all the listed features, then this background causes certain problems in the area around the eyes, on the eyelids, forehead and under the eyes. ​ 2. Why is blepharoplasty needed? In communication, the eyes and the area around the eyes most often attract the attention of the interlocutor. Therefore, in everyday life, looking at ourselves in the mirror, we most of all pay attention to this particular area. We notice signs of aging around our eyes and become frustrated by our tired, tense and sleepy reflection in the mirror. This situation, associated with the loss of the shape of the eyelids, causes changes in appearance, leads to the appearance of a tired and dull facial expression that has lost its aesthetic appearance, which can cause misunderstanding among people around us. Gender, race, and age lead to changes in the anatomy of the eye area. The area around the eyes varies significantly depending on the gender and race of the person. Moreover, the size of the eye area is different for men and women. In women, the eyebrows and eyelids are significantly higher and more arched, but the line of the eyelid fold is less pronounced compared to men. In men, the eyebrows are more pronounced, and the fold line of the eyelids is located much closer to their border. In terms of race, people with Asian and Far Eastern facial types have completely different eyes and eyelids that are expressed in shape. In light of the above, surgery in the eyelid area to shape the eye line and the area around the eyes in accordance with the anatomy should be performed by a specialist surgeon. ​ 3. What does blepharoplasty include? Blepharoplasty is treated as a whole in our clinics. Problems with the eyes and the area around the eyes should not be eliminated in a pinpoint way, but with the solution of all problems and signs of aging. It is with this decision that you will be able to acquire the much desired fresh and lively look. Most often, when blepharoplasty is faced with such problems as drooping eyelids, the appearance of crow's feet, drooping eyebrows, bags under the eyes, hollows between the area under the eyes and cheeks. With blephoplasty, all these problems are solved. All of the listed solutions are provided not only for creating an aesthetic look, but also have health benefits. Sagging or drooping eyelids with bags under the eyes can disrupt the angle of the field of view, which in turn leads to secondary health problems such as headaches. ​ 4. Who can have blepharoplasty? The weakening of the upper and lower eyelids occurs against the background of aging and is caused by the deformation of sagging skin towards fatty deposits. Therefore, due to such problems, performing blepharoplasty, especially as part of facial rejuvenation operations, allows you to eliminate fatigue and get rid of bags under the eyes. Baggy drooping upper eyelids are caused by stretching of the skin of the eyelids. The most common complaints about the lower eyelids are bags under the eyes or swelling. All problems are solved within the framework of eyelid surgery, i.e. blepharoplasty. Anyone who faces the listed problems can undergo blepharoplasty. Some patients, despite the absence of the primary problem, as well as middle and even young age, may have deficiencies over the centuries due to genetic problems. Young patients or middle-aged patients, having undergone blepharoplasty, can acquire a lively and free shape of the area around the eyes. ​ 5. How is the plastic around the eyes performed? In the framework of plastic surgery of the area around the eyes, sagging eyelids that violate the angle of the field of view are corrected using laser technology and the skin that causes vision problems is removed. At the same time, instead of a tired and sluggish facial expression, the patient acquires a youthful and fresh look. Saggy bags under the eyes not only cause vision problems, they give the face a tired look and make a person look older than his age. Eliminating bags under the eyes is one operation that is particularly difficult and requires extreme attention. This area, due to its structure, has extremely sensitive skin, so any incision made will cause a long recovery period and in addition to this leads to redness and blue discoloration. That is why in our clinics microintervention is carried out in the area of the roots of the eyelashes of the lower eyelid and using the existing fat deposits are evaporated using laser technology. Thanks to this, our patients go through a fairly comfortable recovery period without bruising and redness. ​ The second aspect of blepharoplasty is drooping of the eyelids. The drooping of the eyelids occurs due to the effort caused by the sagging of the eyelids and against the background of the loss of the shape of the forehead. As part of the eyebrow lift, a non-surgical method is again used by hanging the eyebrows on a thread, which allows you to eliminate drooping and wrinkles. In addition, depressions that form due to the drooping of the cheeks due to gravity and the separation of the lower eyelid from the cheek are solved with the help of Lipofilling. The period after blepharoplasty Within 3-4 days after the operation, the patient recovers and looks at life with a fresh look and confidence thanks to a rejuvenated look. ​ 6. Features of laser blepharoplasty All tissues around the eyes are structured to give the face a beauty and a youthful appearance. Together with new directions in plastic surgery, innovative solutions are applied in blepharoplasty. Any operation in the area around the eyes and in front of the eyes, especially in our country, causes fear and doubts in people, but thanks to new methods, we present adequate solutions to these problems, and people are starting to treat blepharoplasty more favorably than before. ​ 7. Non-surgical blepharoplasty Non-surgical blepharoplasty is performed in 3 stages using a laser. First, an intervention is performed with microinstruments in the area of \ u200b \ u200bthe hairline from the side of the forehead and the lowered eyebrow is raised up with the help of threads. Thus, the stress on the area around the eyes is eliminated and wrinkles, sagging and drooping of the eyelid are corrected. Non-surgical blepharoplasty, which lasts about 15 minutes and is performed under local anesthesia, due to its peculiarity does not require dressing, and also does not carry possible postoperative risks and complications. Thus, the patient immediately returns to social life. The threads used are a durable medical device, adapted to the tissues, and the patient begins to live with a new look. Reverting to a previous view is extremely difficult. ​ At the second stage, the second extremely important question is posed - the elimination of bags under the eyes. Such an operation, which we can call lower eyelid plastics, is particularly difficult all over the world due to the sensitivity of this area and causes many difficulties during the patient's recovery. ​ Given the presence of lymphatic tissue in this area, which stretches under the eyelashes, in the case of an operation, recovery occurs within a period of 3 weeks to 3 months. In addition, this area belongs to the category where complications arise most of all. Correction of any problem that arises is extremely difficult and includes risks that do not allow you to return to the previous view. That is why, in order to eliminate the previously listed risks and eliminate the occurrence of problems in the patient during operations to eliminate bags under the eyes or blepharoplasty, we carry out a point microintervention of 5 millimeters in size immediately under the eyelashes of the lower eyelid to eliminate fat deposits causing the formation of bags under the eyes. In laser blepharoplasty, we use a laser to remove sagging tissue, starting from the eyelashes of the lower eyelid, and in the case of plastic surgery of the upper eyelid, from the oval line that occurs when the eye is opened. In a sense, we evaporate excess skin. After this operation, which is applied without an incision, the depressions that form due to the drooping of the cheeks due to gravity and cause the lower eyelid to separate from the cheek are resolved with Lipofilling. ​ After solving all these problems, the patient gets better within 3-4 days and begins to look at the world with a young look. ​ 8. Benefits of non-surgical blepharoplasty • No incision • Using laser technology • Correction of the angle of view caused by sagging skin • Correction of the shape of the upper eyelids causing headaches • Create a fresh and rejuvenated look • fast recovery • Minimal risk of complications 9. Benefits of non-surgical eyebrow lift • No incision • Using the technique of hanging on a thread • Minimal risk of complications • Expressive eyes and elimination of the tired look • fast recovery 10. Benefits of non-surgical removal of bags under the eyes • No incision • Evaporation of fatty deposits by microinterventions • Minimal blueing and redness • fast recovery • Young and fresh look ​ 11 . How soon can I make an appointment? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Works on BLEPHAROPLASTY, as well as the best surgeons, you will find on our Instagram липосакция LIPOSUCTION ​ Liposuction ranks among the basic elements for a balanced distribution of fat, proportional contours of the figure and an attractive body. Liposuction allows you to correct body lines and shape. Many people, despite playing sports and dieting, cannot get rid of and solve the problem of local obesity. Liposuction is the most modern method of solving the problem of persistent obesity, adjusting the shape and giving the body an aesthetic appearance. 1. What is liposuction? Liposuction is a surgical procedure used to correct and shape the uneven distribution of fat on the body. As an effective solution to the problem, especially local obesity, liposuction is used as an auxiliary element in many plastic surgeries. For example, when performing gynecomastia, liposuction is used to solve the problem of breast augmentation in men. In an operation to correct the curvature of the legs, fat is taken from the patient and introduced into the problem area to mask the curvature. In short, liposuction is often used to improve and enhance the results of the performed plastic surgery. ​ When using liposuction treatments alone, without using obesity treatment methods, it has not been possible to cope with diet and exercise. The use of liposuction in the area of obesity and sagging to form a natural contour will create a sculptural form. Today in plastic surgery, there are different types of liposuction. The goal of all types of liposuction is to remove fatty deposits. The types of liposuction differ in their effectiveness and benefits. ​ Turmescent liposuction provides an anesthetic solution to the problem area to minimize bleeding and discomfort after liposuction and to increase the volume of this area. Ultrasonic liposuction uses ultrasonic energy to quickly and easily remove some of the fat. Laser liposuction uses laser technologies known by the brand name smartlipo or Slimlipo. In addition, there are liposculpture methods. 2. Areas of application of liposuction The areas of the body in men and women that can be subjected to liposuction to remove fat are different. Upper legs. The most common areas causing liposuction in men, accounting for 15-25% of such patients, are the jaw, neck, abdomen, chest and shoulder blades. ​ 3. How is liposuction performed? When using liposuction alone, without combining with any plastic surgery, it can be performed under local anesthesia. However, it is possible to use general anesthesia. The plastic surgeon decides on the form of anesthesia and marks the areas where the liposuction will be performed with a pencil. One or more small incisions are made near the area. Depending on the technique used, thin cannulas or thinnest balloons are inserted through the incisions made. The surgeon directs the vibration of the device to liquefy the fat layer under the skin and remove it. The duration of the operation depends on the size of the area and the amount of fat removed. 4. Process after liposuction After the surgery, the problems of swelling, blue discoloration or sagging of the skin are reduced to a minimum to the most modern lime technique. Many patients have a few days after liposuction, depending on their daily activities and daily life. Although pain after surgery depends on your threshold, many patients claim that they did not use pain relievers during their recovery. ​ In some cases, after liposuction, your surgeon may recommend that you wear a corset. Wearing a brace is a preventative measure that prevents contractions and swelling. The incisions made will heal in a few weeks and completely disappear within 1 year. 5. Weight gain after liposuction Liposuction almost completely removes fat deposits in case of local obesity. It could be obesity. For this reason, for a new figure, we recommend that you follow a weight maintenance program. ​ When performing the procedure by a qualified surgeon, you can get extremely positive feedback and you have no doubts about the safety of this procedure. Liposuction, which has won preference as an excellent method for correcting body shape and creating an aesthetic figure, should in no way be considered as a method of losing weight. It relieves you of localized deposits. First you need to exercise and go on a diet, and if the results are not successful, you can have liposuction. ​ 6. Results Many patients who come to our clinic for this procedure go away in a few days. As a rule, the surrounding cuts do not notice, they become invisible. Aids, such as wearing a corset after liposuction, will provide optimal results. When preserved after surgery, our patients achieved an aesthetic and effective result. Liposuction is not a weight loss method. It allows you to solve the problem of local obesity, leads to the formation of an unaesthetic appearance and loss of shape. You can turn to liposuction if you have aesthetic doubts about localized obesity despite regular exercise and a healthy and balanced diet. ​ 7. Who can get liposuction? Healthy individuals with realistic expectations for liposuction are good candidates for liposuction to maximize joy in liposuction results. Those who, despite a healthy diet, diet and exercise, have not been able to cope with local obesity, can undergo liposuction. ​ 8. What should be realistic expectations from the operation? After liposuction, the patient acquires a new body or corrected body contours, depending on the place where the liposuction is performed. After liposuction, the regrowth of fat cells in such an area is not observed, but with a strong weight gain, it can change. ​ 9. What are the possible complications and risks after liposuction? The liposuction procedure carries no serious risks and complications. According to the research done to date, the most dangerous thing about liposuction is the very large number of liposuction performed in one day and many unrelated surgeries performed on the same day the liposuction was performed. Although liposuction is extremely reliable, it carries risks such as nerve damage, skin ulcers, bleeding, and rarely infections. ​ 10. How should you choose a surgeon? Among the most frequently asked questions is the price of liposuction. The very low cost of liposuction may indicate an incomplete procedure. For this reason, we recommend that you think not about the price, but your health and ask questions in this direction. Feel free to ask your doctor questions about liposuction. Ask all important and extremely interesting questions and before making a decision, make a choice based on the answers received. ​ 11. What are the important features of reliable liposuction? Liposuction should be performed in a clinical setting in a hospital or operating room. A reliable surgical liposuction unit minimizes the risk of infection during surgery. In addition, such conditions require the maintenance of high cleanliness and maximum patient comfort. ​ 12. Do you experience pain after surgery? After that, minimal pain is possible. They decrease over time. ​ 13. Does liposuction affect the appearance of the skin? The appearance of the skin after liposuction depends on the elasticity of the skin. With good elasticity of the skin after liposuction, a smooth and natural look is created. ​ 14. Are there any visible traces of the operation? Liposuction uses tiny cannulas (microcannulas), so small incisions are made. The incisions heal completely or remain subtle. ​ 15. Does liposuction help weight loss? Liposuction is not a weight loss method. Liposuction can only solve the problem of local obesity, which could not be dealt with with the help of diets and exercise. ​ 16. When can I make an appointment for an operation and examination in the near future? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ You will find liposuction works , as well as the best surgeons on our Instagram ​ Эндо брови 1.эндо лоб 2. Эндотины 3. Подтяжка бровей 4. Специф ENDOSCOPIC EYEBROW LIFT ​ There are several methods that can be used in eyebrow lift surgeries, but the most commonly used and popular application today, the endoscope, is a procedure performed with small, thin cameras without leaving any incision marks. It is an operation that is easy to perform in the operating room under local anesthesia, supported by general or sedative therapy. ​ An endoscopic brow lift can be operated without bleeding or scarring by opening small holes in the lower parts of the scalp from several different parts. In this way, the risk of scarring is avoided, as the older methods provide less swelling, pain and a shorter healing process. ​ If pain does not occur after surgery, a regular pain reliever pill is sufficient. The stitches are removed between 8 and 12 days. Since the scars from the surgery will remain under the scalp, there are no problems with scarring. Compared to the botox process, the shape given to your eyebrows lasts much longer in this position, and this operation does not need to be repeated in certain processes, as is done with a botox brow lift. Endoscopic brow lift can provide long-lasting results compared to non-surgical use. ​ How soon can I make an appointment? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Works on ENDOSCOPIC EYEBROW LIFTING, as well as the best surgeons, you will find on our Instagram ​ подтяжка лиуа Endoscopic Facial Surgery (Midface Lift - Forehead Lift - Eyebrow Lift) ​ An endoscopic facelift is a popular technique because it is a surgical procedure with a very small and hidden incision, which gives very effective results in patients with early signs of aging who do not yet require “complete face rejuvenation”. By itself, this method is a great option for a patient who has less laxity or sagging skin and no problems in the lower face and neck. ​ In an endoscopic facelift, a small number of small, invisible incisions are made in the scalp and in the temples, and sometimes in the mouth. Sagging tissues on the cheeks are lifted with an endoscope (a small camera with a light source) and special instruments. The face is rejuvenated and rejuvenated without leaving visible scars. ​ This method can be used in combination if you have severely saggy skin and excess fat or skin on your neck. Good; The forehead, eyebrows and midface can be adjusted endoscopically, while the neck and chin line can be corrected using traditional facial rejuvenation techniques. ​ 1. Who is an endoscopic facelift suitable for? An endoscopic facelift is especially effective when the following symptoms are present: persons with a sagging area from the lower eyelid to corner of the mouth; persons with a deep crease extending from the nostrils to the corner of the mouth (nasolabial region); faces with a smile. that began to fall. ​ An endoscopic facelift can be thought of as a light touch to reduce gravity. The face, which is pulled down by gravity, rises vertically. This procedure is less invasive than other face lifts, providing a natural, more youthful look without the need for a full facelift. The most important benefit of an endoscopic facelift is that it leaves no scars on the patient or leaves very few scars. 2. What is done during an endoscopic facelift? During an endoscopic facelift, an endoscope (a very small camera) is inserted through one incision and a surgical instrument through another. Dr. Basaran controls the camera and surgical instrument through the image on the TV screen and can modify the subcutaneous tissue. While an endoscopic facelift is not as dynamic as a traditional facelift, it does provide forehead and cheek benefits that are more difficult to achieve with a traditional facelift. However, due to the nature of the procedure, it is impossible to cope with problems of the jaw line and neck. ​ 3. What is an endoscopic mid-face lift? An endoscopic mid-face lift is a surgical procedure applied to the cheekbones, around the mouth, eyelid lines and cheekbones on the 2 middle sides of the face. These areas on your face can cause bad appearance, such as sagging, wrinkling and bagging, which are mainly caused by aging and the effects of gravity. Mid-face lift surgery removes these bad facial images and makes the person who has the surgery look younger and prettier. ​ The endoscopic mid-face lift is a popular surgery performed using an endoscope and is widely known and used among women. In this operation, which is simpler and shorter than conventional facelift surgeries, the healing and recovery process is painless and faster. Endoscopic mid-face lift is not recommended for severe depression and old age. ​ How soon can I make an appointment? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Works on ENDOSCOPIC FACE LIFTING, as well as the best surgeons, you will find on our Instagram ​ ПОДТЯЖКА ЛБА FOREHEAD LIFT ​ During the natural aging process, repetitive movements such as sun exposure, environmental factors, gravity, concentration, and squinting cause wrinkles to appear on the surface of the forehead. Many patients are concerned about the negative impact these lines have on the overall aesthetic appearance and opt for forehead lift surgery to reduce discomfort. ​ Thanks to advances in modern surgery, it is now possible to offer forehead lift options where very small incisions are used and these incisions are not visible at all due to the hairline. ​ Men and women who are looking for solutions to the following problems are good candidates for a forehead lift: deep horizontal wrinkles on forehead an angry or tired look due to sagging eyebrows lines between the eyebrows and at the top of the nose. forehead lift techniques Coronal incision technique: This widely used forehead lift technique often uses an incision covered in hair. The incision begins above the ears and continues across the scalp. In some patients, the incision is made in front of the hairline to avoid elevation of the hairline. ​ Regardless of the location, the incision will be as indistinct as possible after healing. The doctor, with a successful coronal incision, can reconstruct or remove some of the wrinkle-causing muscles by removing excess skin before raising the eyebrows to a more youthful position. ​ Endoscopic forehead lift: This limited incision technique uses an endoscope (a thin tube with a light attached to a video camera) for surgical imaging. This endoscope is inserted through several incisions in the scalp rather than through a long incision, thus minimizing scar tissue and shortening the healing period. Other limited incision methods: some limited incision forehead lift techniques can be performed without the use of an endoscope. Small incisions can be made at the temple area to stretch out drooping brows, and incisions on the upper eyelid may be preferred to correct frown lines. ​ How soon can I make an appointment? ​ our mail: medikal.estetik.group@gmail.com Whats App / Viber: +90 505 479 19 17 ​ Forehead lift jobs, as well as the best surgeons, you can find on our Instagram

DIAGNOSTIC PROCEDURES Contrast-enhanced CT in Turkey Oncological screening in Turkey PET / CT in Turkey 3D Computed Tomography in Turkey Check-UP diagnostics in Turkey BRAF genetic mutation in Turkey Fusion biopsy in Turkey Endoscopic ultrasound biopsy in Turkey Genetic analysis in Turkey Endoscopy in Turkey Ultrasound-guided transrectal biopsy in Turkey AREAS OF SPECIALIZATION. DIAGNOSES Cancer treatment in Turkey Neurosurgery in Turkey Neurology in Turkey Cardiac surgery in Turkey Dentistry in Turkey Plastic surgery in Turkey Ophthalmology in Turkey Transplantology in Turkey Orthopedics and Traumatology in Turkey

TREATMENT OF KIDNEY CANCER IN TURKEY MENU PAGES: 1. Risk factors for kidney cancer 2. Renal cell carcinoma: 2.1. Signs of renal cell carcinoma 2.2. Diagnosis of renal cell carcinoma 2.3. How does cancer spread in renal cell carcinoma patients? 2.4. Treatments for patients with renal cell carcinoma 3. Transitional cell carcinoma of the renal pelvis and ureter 3.1. Signs and symptoms of transitional cell carcinoma of the renal pelvis and ureter 3.2. Factors influence prognosis (chance of recovery) and treatment options. 3.3. Tests for detecting metastases 3.4. How cancer spreads throughout the body 3.5. Types of transitional cell carcinoma of the renal pelvis and ureter 3.6. Treatment methods for patients with transitional cell carcinoma of the renal pelvis and ureter. 4. Wilms' tumors and other kidney tumors in children 4.1. Types of Wilms tumor in children 4.2. Wilms tumor risk factors 4.3. Williams Tumor Screening Tests 4.4. Signs of Williams' tumor 4.5. Tests for the diagnosis of Wilms tumor and other kidney tumors in children 4.6. Factors affecting the prognosis of recovery and treatment options 4.7. How cancer spreads throughout the body 4.8. Treatments for Williams' tumor in children 4.9. Side Effects of Treating Williams' Kidney Tumor in Children COST OF TREATMENT AND DIAGNOSIS OF KIDNEY CANCER IN TURKEY 1. Risk factors for kidney cancer ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your doctor if you think you are at risk. ​ Risk factors for renal cell carcinoma include the following: ​ Smoking. Abusing certain pain medications, including over-the-counter pain relievers, for a long time. Excess weight . High blood pressure. Has a family history of renal cell carcinoma. The presence of certain genetic diseases, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma ​ 2. Renal cell carcinoma ​ Kidney cancer can develop in adults and children. The main types of kidney cancer are renal cell carcinoma, transitional cell carcinoma, and Wilms' tumor. Certain inherited conditions increase the risk of kidney cancer. Explore the links on this page to learn more about kidney cancer treatments, statistics, research, and clinical trials. ​ Renal cell carcinoma is a disease in which malignant (cancerous) cells form in the tubules of the kidneys. ​ Renal cell carcinoma (also called kidney cancer or renal cell adenocarcinoma) is a disease in which malignant (cancerous) cells are found in the lining of the tubules (very small tubes) in the kidneys. Above the waist are 2 kidneys, one on each side of the spine. Tiny tubules in the kidneys filter and purify the blood. They excrete waste products and produce urine. Urine travels from each kidney through a long tube called the ureter into the bladder. The bladder retains urine until it passes through the urethra and leaves the body. ​ Cancer that begins in the ureters or the renal pelvis (the part of the kidney that collects urine and diverts it to the ureters) is different from renal cell carcinoma. 2.1. Signs of renal cell carcinoma ​ These and others signs and symptoms can be caused by renal cell carcinoma or other conditions. Early stages there may be no signs or symptoms. Signs and symptoms may appear as you grow tumors ... Check with your doctor if you have any of the following: ​ Blood in the urine. Bump in belly ... Side pain persists. A loss appetite ... Losing weight for an unknown reason. Anemia ... 2.2. Diagnosis of renal cell carcinoma Tests that examine the abdomen and kidneys are used to diagnose renal cell carcinoma. ​ The following tests and procedures can be used: ​ Physical examination and health history A body exam to check for general signs of health, including checking for signs of illness such as bumps or anything else that seems unusual. There will also be a history of the patient's health habits, as well as past illnesses and treatments. ​ Ultrasound examination : A procedure in which high energy sound waves (ultrasound) are reflected off internal tissues or organs and create an echo. The echo forms a picture of body tissue called a sonogram. ​ Studies of the chemical composition of blood : A procedure in which a blood sample is tested to measure the amount of certain substances that enter the bloodstream by organs and tissues of the body. An unusual (more or less than usual) amount of a substance may be a sign of illness. ​ General urine analysis : a test to check the color of urine and its contents such as sugar, protein, red blood cells and white blood cells. ​ CT (computed tomography) : A procedure in which a series of detailed pictures of areas inside the body, such as the abdomen and pelvis, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed so that organs or tissues can be seen more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (Magnetic Resonance Imaging) : A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ Biopsy : Removing cells or tissues so that a pathologist can examine them under a microscope to check for signs of cancer. To get a biopsy for renal cell carcinoma, a thin needle is inserted into the tumor and a tissue sample is taken. After renal cell cancer is diagnosed, tests are done to find out if the cancer cells have spread to the kidneys or other parts of the body. ​ The process used to determine if cancer has spread to the kidneys or to other parts of the body is called staging. The information gathered during the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. During the preparation process, the following tests and procedures can be used: ​ CT (computed tomography) : A procedure in which a series of detailed pictures of areas inside the body, such as the chest or brain, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to help organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (magnetic resonance imaging) : A procedure that uses a magnet, radio waves and a computer to create a series of detailed pictures of areas inside the body, such as the brain. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ Chest x-ray : X-ray of internal organs and bones of the chest. An X-ray is a type of energy beam that can pass through a body onto a film, creating an image of areas within the body. ​ Bone scan: a procedure to check for rapidly dividing cells such as cancer cells in the bone. A very small amount of radioactive material is injected into a vein and passed through the bloodstream. The radioactive material builds up in the bones in cancer and is detected by a scanner. ​ 2.3. How does cancer spread in renal cell carcinoma patients? ​ Cancer spreads through the body in three ways. ​ Cancer can spread through tissues, the lymphatic system, and the blood: ​ Textile. Cancer spreads from where it originated to surrounding areas. The lymphatic system. Cancer spreads from where it originated to the lymphatic system. Cancer spreads through the lymphatic vessels to other parts of the body. Blood. Cancer spreads from where it originated into the bloodstream. Cancer spreads through the blood vessels to other parts of the body. Cancer can spread from where it originated to other parts of the body. When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they originated (primary tumor) and travel through the lymphatic system or blood. ​ The lymphatic system. Cancer enters the lymphatic system, travels through the lymphatic vessels and forms tumor ( metastatic swelling) in another part of the body. Blood. Cancer enters the bloodstream, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. A metastatic tumor is the same type of cancer as the primary tumor. For example, if renal cell carcinoma spreads to the bone, the cancer cells in the bone are actually cancerous kidney cells. The disease is metastatic renal cell carcinoma, not bone cancer. ​ 2.4. Treatments for patients with renal cell carcinoma ​ There are various treatments for renal cell carcinoma patients. ​ Various treatments are available for renal cell carcinoma patients. Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. Patients may want to take part in a clinical trial. Some clinical trials are only open to patients who have not yet started treatment. ​ Five types of standard treatments are used: ​ 1.Operation ​ Surgery to remove part or all of the kidney is often used to treat renal cell carcinoma. The following types of surgical procedures can be used: ​ Partial nephrectomy : A surgical procedure to remove a tumor of the kidney and some tissue around it. Partial nephrectomy can be performed to prevent loss of kidney function when the other kidney is damaged or has already been removed. ​ Simple nephrectomy : a surgical procedure to remove only the kidney. ​ Radical nephrectomy : A surgical procedure to remove the kidney, adrenal gland, surrounding tissue and usually nearby lymph nodes. ​ A person can live with part 1 of a working kidney, but if both kidneys are removed or not working, they will need dialysis (a procedure to purify blood with an apparatus outside the body) or a kidney transplant (replacement of a healthy kidney). donor kidney). A kidney transplant can be done if only the kidney is affected and a donor kidney can be found. If the patient needs to wait for a kidney donation, another treatment is prescribed if necessary. ​ When surgery to remove the cancer is not possible, a treatment called arterial embolization can be used to shrink the tumor. A small incision is made and a catheter (thin tube) is inserted into the main blood vessel that flows to the kidney. Small pieces of a special gelatinous sponge are inserted through a catheter into a blood vessel. The sponges block blood flow to the kidneys and prevent cancer cells from receiving oxygen and other substances necessary for growth. ​ After a doctor removes any tumors that can be seen during surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer recurrence is called adjuvant therapy. ​ 2. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. External beam radiation therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. External beam radiation therapy is used to treat renal cell carcinoma and can also be used as palliative therapy to relieve symptoms and improve quality of life. ​ 3. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). ​ 4. Immunotherapy ​ Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances produced by the body or in the laboratory are used to enhance, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or biological therapy. ​ The following types of immunotherapy are used in the treatment of renal cell carcinoma: ​ Immune checkpoint inhibitor therapy: Certain types of immune cells, such as T cells and some cancer cells, have certain proteins on their surface called checkpoint proteins that control immune responses. When cancer cells contain large amounts of these proteins, they will not be attacked and killed by T cells. Inhibitors of immune checkpoints block these proteins and the ability of T cells to kill cancer cells is increased. They are used to treat some patients with advanced renal cell carcinoma that cannot be surgically removed. ​ There are two types of immune checkpoint inhibitor therapy: CTLA-4 Inhibitor: CTLA-4 is a protein on the surface of T cells that helps control the body's immune responses. When CTLA-4 attaches to another protein, called B7, on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow T cells to kill cancer cells. Ipilimumab is one of the CTLA-4 inhibitors. ​ Inhibitor PD-1 : PD-1 is a protein on the surface of T cells that helps control the body's immune responses. When PD-1 attaches to another protein, called PDL-1, on a cancer cell, it stops the T cell from killing it. PD-1 inhibitors attach to PDL-1 and allow T cells to kill cancer cells. Nivolumab , pembrolizumab and avelumab are types of PD-1 inhibitors. ​​ Interferon: Interferon affects cancer cell division and may slow tumor growth. ​​ Interleukin-2 (IL-2): IL-2 enhances the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells. ​ 5. Targeted therapy ​ Targeted therapy uses drugs or other substances to identify and attack certain cancer cells without harming normal cells. Targeted anti-angiogenic therapy is used to treat advanced renal cell carcinoma. Anti-angiogenic agents interfere with the formation of blood vessels in the tumor, causing the tumor to starve and stop growing or shrinking. ​ Monoclonal antibodies and kinase inhibitors are two types of anti-angiogenic agents used to treat renal cell carcinoma. ​ Monoclonal antibody therapy uses antibodies obtained in the laboratory from a single cell type of the immune system. These antibodies can identify substances on cancer cells or normal substances that can promote the growth of cancer cells. Antibodies attach to substances and kill cancer cells, block their growth, or prevent them from spreading. Monoclonal antibodies are given by infusion. They can be used alone or to carry drugs, toxins, or radioactive materials directly to cancer cells. Monoclonal antibodies, used to treat renal cell carcinoma, attach to and block substances that cause new blood vessels to form in tumors. Bevacizumab is a monoclonal antibody. ​ Kinase inhibitors stop cell division and can prevent the growth of new blood vessels necessary for tumor growth . Vascular endothelial growth factor (VEGF) inhibitors and mTOR inhibitors are kinase inhibitors used in the treatment of renal cell carcinoma. ​ VEGF inhibitors: Cancer cells produce a substance called VEGF, which causes new blood vessels to form (angiogenesis) and helps the cancer grow. VEGF inhibitors block VEGF and prevent new blood vessel formation. This can kill cancer cells because they need new blood vessels to grow. Sunitinib, Pazopanib, cabozantinib, axitinib, sorafenib, and lenvatinib are VEGF inhibitors. ​ MTOR inhibitors: mTOR is a protein that helps cells divide and survive. MTOR inhibitors block mTOR and can inhibit the growth of cancer cells and prevent the growth of new blood vessels necessary for tumor growth. Everolimus and temsirolimus are mTOR inhibitors. ​ 1) 2 1 2) 3) 4) 3. Transitional cell carcinoma of the renal pelvis and ureter Transitional cell carcinoma of the renal pelvis and ureter is a disease in which malignant (cancerous) cells form in the renal pelvis and ureter. ​ The renal pelvis is the upper part of the ureter. The ureter is a long tube that connects the kidney to the bladder. Above the waist are two kidneys, one on each side of the spine. The kidneys of an adult are about 5 inches long and 3 inches wide and are shaped like a bean. Tiny tubules in the kidneys filter and purify the blood. They excrete waste products and produce urine. Urine collects in the middle of each kidney in the renal pelvis. Urine passes from the renal pelvis through the ureter into the bladder. The bladder retains urine until it passes through the urethra and leaves the body. 3 Anatomy of the male urinary system (left panel) and the female urinary system (right panel), showing the kidneys, ureters, bladder and urethra. Urine is produced in the renal tubules and collected in the renal pelvis of each kidney. Urine flows from the kidneys through the ureters into the bladder. Urine is stored in the bladder until it leaves the body through the urethra. The renal pelvis and ureters are lined with transitional cells. These cells can change shape and stretch without collapsing. Transitional cell carcinoma begins in these cells. ​ Transitional cell carcinoma can form in the renal pelvis, ureter, or both. Renal cell carcinoma is the more common type of kidney cancer. ​ 3.1. Signs and symptoms of transitional cell carcinoma of the renal pelvis and ureter ​ These and other signs and symptoms can be caused by transitional cell carcinoma of the renal pelvis and ureter or other conditions. In the early stages, there may be no signs or symptoms. Signs and symptoms may appear as the tumor grows. Check with your doctor if you have any of the following: ​ Blood in the urine. Back pain that does not go away. Great fatigue. Weight loss for no known reason. Painful or frequent urination. 3.1. Ureteroscopy. A ureteroscope (a thin, tube-like instrument with a light and viewing lens) is inserted through the urethra into the ureter. The doctor looks at an image of the inside of the ureter on a computer monitor. Urine cytology : A laboratory test in which a urine sample is checked under a microscope for abnormal cells. Cancer of the kidney, bladder, or ureter can shed cancer cells into the urine. ​ CT (computed tomography) : A procedure in which a series of detailed pictures of areas inside the body are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to help organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ Ultrasound : A procedure in which high energy sound waves (ultrasound) are reflected from internal tissues or organs and create an echo. The echo forms a picture of body tissue called a sonogram. An abdominal ultrasound can help diagnose cancers of the renal pelvis and ureter. ​ MRI (magnetic resonance imaging) : A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body, such as the pelvis. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ Biopsy : Removing cells or tissues so that a pathologist can examine them under a microscope to check for signs of cancer. This can be done during ureteroscopy or surgery. ​ 3.2. Factors influence prognosis (chance of recovery) and treatment options. Forecast depends on the stage and degree tumors. Treatment options depend on the following: ​ Stage and grade of the tumor. Where is the tumor. Whether the patient's other kidney is healthy. Does the cancer have a relapse. Most transitional cell cancers of the renal pelvis and ureter can be cured if detected early. ​ 3.3. Tests for detecting metastases ​ The process used to determine if cancer has spread to the renal pelvis and ureter or to other parts of the body is called staging. The information gathered during the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The doctor, based on the results of diagnostic tests, will help determine the stage of the disease. ​ The following tests and procedures can also be used in the preparation process: ​ Chest x-ray : X-ray of organs and bones inside the chest. An X-ray is a type of energy beam that can pass through a body onto a film, creating an image of areas within the body. ​ PET scan (positron emission tomography) : a procedure to search for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumor cells appear brighter in the image because they are more active and consume more glucose than normal cells. ​ Bone scan : A procedure to check for rapidly dividing cells such as cancer cells in the bone. A very small amount of radioactive material is injected into a vein and passed through the bloodstream. The radioactive material builds up in the bones in cancer and is detected by a scanner. ​ 3.4. How cancer spreads throughout the body ​ Cancer can spread through tissues, the lymphatic system, and the blood: ​ Textile. Cancer spreads from where it originated to surrounding areas. The lymphatic system . Cancer spreads from where it originated to the lymphatic system. Cancer spreads through the lymphatic vessels to other parts of the body. Blood. Cancer spreads from where it originated into the bloodstream. Cancer spreads through the blood vessels to other parts of the body. ​ Cancer can spread from where it originated to other parts of the body. ​ When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they originated (primary tumor) and travel through the lymphatic system or blood. ​ The lymphatic system. Cancer enters the lymphatic system, travels through the lymphatic vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. Cancer enters the bloodstream, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. ​ A metastatic tumor is the same type of cancer as the primary tumor. For example, if transitional cell carcinoma of the ureter has spread to the lungs, the lung cancer cells are actually ureteral cancer cells. The disease is metastatic cancer of the ureter, not lung cancer. ​ 3.5. Types of transitional cell carcinoma of the renal pelvis and ureter Transitional cell carcinoma of the renal pelvis and ureter is also described as localized, regional, metastatic, or recurrent: ​ 1. Localized Cancer is found only in the kidneys. ​ 2. Regional The cancer has spread to tissues around the kidney and nearby lymph nodes and blood vessels in the pelvic region. ​ 3. Metastatic The cancer has spread to other parts of the body. 4. Recurrent The cancer was recurred (come back) after it was treated. Cancer can return to the renal pelvis, ureter, or other parts of the body such as the lungs, liver, or bone. ​ 3.6. Treatment methods for patients with transitional cell carcinoma of the renal pelvis and ureter. Various treatments are available for patients with transitional cell carcinoma of the renal pelvis and ureter. Some treatments are standard (currently used) and some are in clinical trials. A clinical trial of treatment is a scientific study designed to help improve current treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than standard treatment, the new treatment may become the standard treatment. Patients may want to take part in a clinical trial. Some clinical trials are only open to patients who have not yet started treatment. ​ One type of standard treatment is used: 1. Operation ​ One of the following surgical procedures can be used to treat transitional cell carcinoma of the renal pelvis and ureter: ​ Nephroureterectomy : Surgery to remove the entire kidney, ureter, and bladder cuff (the tissue that connects the ureter to the bladder). ​ Segmental ureteral resection: A surgical procedure to remove a portion of the ureter with cancer and a portion of the healthy tissue around it. Then the ends of the ureter are reattached. This procedure is used when the cancer is superficial and only near the bladder in the lower third of the ureter. ​ 2. Fulguration is a surgical procedure in which tissue is destroyed by an electric current. An instrument with a small wire loop at the end is used to remove a tumor or to burn off a tumor with electricity. 3. Segmental resection of the renal pelvis It is a surgical procedure to remove localized cancer from the renal pelvis without removing the entire kidney. Segmental resection can be done to preserve renal function when the other kidney is damaged or has already been removed. 4. Laser surgery A laser beam (a narrow beam of intense light) is used like a knife to remove cancer. The laser beam can also be used to kill cancer cells. This procedure can also be called laser fulguration. ​ 5. Regional chemotherapy and regional biological therapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. Biological therapy is a treatment that uses the patient's immune system to fight cancer; substances produced by the body or made in a laboratory are used to enhance, direct or restore the body's natural defenses against cancer. Local treatment means that anticancer drugs or biological agents are injected directly into an organ or body cavity, such as the abdominal cavity, so the drugs will affect cancer cells in that area. Clinical trials are looking at chemotherapy or biologic therapy using drugs that are injected directly into the renal pelvis or ureter. ​ 4. Wilms' tumors and other kidney tumors in children Kidney tumors in children are diseases in which malignant (cancerous) cells form in the tissues of the kidneys. ​ Above the waist are two kidneys, one on each side of the spine. Tiny tubules in the kidneys filter and purify the blood. They excrete waste products and produce urine. Urine travels from each kidney through a long tube called the ureter into the bladder. The bladder retains urine until it passes through the urethra and leaves the body. ​ 3.2. 3.3. 3.4. 3.5. 3.6. 4 Anatomy of the female urinary system: kidneys, adrenal glands, ureters, bladder and urethra. Urine is produced in the renal tubules and collected in the renal pelvis of each kidney. Urine flows from the kidneys through the ureters into the bladder. Urine is stored in the bladder until it leaves the body through the urethra. 4.1. Types of Wilms tumor in children There are many types of kidney tumors in children. 1. Wilms' tumor With Wilms' tumor, one or more tumors may be found in one or both kidneys. Wilms' tumor can spread to the lungs, liver, bones, brain, or nearby lymph nodes. In children and adolescents under the age of 15, the majority of kidney cancers are Wilms' tumors. 2. Renal cell carcinoma (RCC) Renal cell carcinoma is rare in children and adolescents under 15 years of age. It is much more common in adolescents from 15 to 19 years old. Children and adolescents are more likely to be diagnosed with a large renal cell tumor or cancer that has spread. Renal cell carcinoma can spread to the lungs, liver, bones, or lymph nodes. Renal cell carcinoma can also be called renal cell carcinoma. 3. Rhabdoid tumor of the kidney Rhabdoid kidney tumor is a type of kidney cancer that is more common in infants and young children. At the time of diagnosis, the disease is often progressing. A renal rhabdoid tumor grows rapidly and spreads, often to the lungs or brain. ​ Children with a specific SMARCB1 gene change can also grow tumors in the kidney, brain, or soft tissue. These children are regularly checked for a rhabdoid tumor in the kidney or brain: Children from birth or diagnosis under 5 years old MRI head and dorsal brain and Abdominal ultrasound every 3 months. 4. Clear cell sarcoma of the kidney Clear cell renal sarcoma is an uncommon kidney cancer that can spread to the bones, lungs, brain, liver, or soft tissue. Most often occurs before the age of 3 years. It can recur (come back) up to 14 years after treatment, often in the brain or lungs. ​ 5. Congenital mesoblastic nephroma Congenital mesoblastic nephroma is a tumor of the kidney that is often diagnosed during the first year of life or before birth. It is the most common kidney tumor found in children under 6 months of age and is more common in men than women. It can usually be cured. 6. Ewing's sarcoma of the kidneys Ewing's sarcoma (formerly called neuroepithelial tumor) of the kidney is rare and usually occurs in young adults. This cancer grows rapidly and spreads to other parts of the body. 7. Primary myoepithelial carcinoma of the kidney Primary myoepithelial carcinoma of the kidney is a rare type of cancer that usually affects soft tissue but sometimes forms in internal organs (such as the kidneys). This cancer grows and spreads rapidly. 8. Cystic partially differentiated nephroblastoma Cystic partially differentiated nephroblastoma is a very rare type of Wilms tumor, consisting of cysts. ​ 9. Multilocular cystic nephroma ​ Multilocular cystic nephroma is a benign tumor of cysts that is most common in infants, young children, and adult women. These tumors can occur in one or both kidneys. Children with this type of tumor may also have pleuropulmonary blastoma, so imaging tests are done to check the lungs for cysts or solid tumors. Since multilocular cystic nephroma can be hereditary, genetic counseling and genetic testing may be considered. For more information, see the PDQ Summary of Pediatric Pleuropulmonary Blastoma Management. ​ 10. Primary renal synovial sarcoma Primary synovial renal sarcoma is a cystic tumor of the kidney that is most common in young adults. These tumors grow and spread rapidly. ​ 11. Anaplastic renal sarcoma Anaplastic renal sarcoma is a rare tumor that most often occurs in children or adolescents under 15 years of age. Anaplastic renal sarcoma often spreads to the lungs, liver, or bones. Imaging tests may be performed that check the lungs for cysts or solid tumors. Since anaplastic sarcoma can be hereditary, genetic counseling and genetic testing may be considered. ​ Nephroblastomatosis is not cancer, but it can develop into Wilms tumor. ​ Sometimes, after the kidneys form in the fetus, abnormal groups of kidney cells remain in one or both of the kidneys. In nephroblastomatosis (diffuse hyperplastic perilobar nephroblastomatosis), these abnormal groups of cells can grow in many places within the kidney or form a thick layer around the kidney. When these groups of abnormal cells are found in a kidney after removal for a Wilms tumor, the child is at increased risk of a Wilms tumor in the other kidney. Regular follow-up is important at least every 3 months for at least 7 years after the child is diagnosed or treated. ​ 4.2. Wilms tumor risk factors ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your child's doctor if you think your child may be at risk. ​ Wilms' tumor may be part of a genetic syndrome that affects growth or development. A genetic syndrome is a collection of signs and symptoms or conditions that occur together and are caused by certain changes in genes. Certain conditions or environmental influences can also increase a child's risk of developing Wilms tumor. The following has been associated with Wilms' tumor: ​ WAGR syndrome (Wilms tumor, aniridia, anomaly of the genitourinary system and mental retardation). Denis-Drash syndrome (anomaly of the genitourinary system). Fraser's syndrome (an anomaly of the genitourinary system). Beckwith-Wiedemann syndrome (abnormally large growth of one or more body parts, large tongue, umbilical hernia at birth and abnormalities of the genitourinary system). Family history of Wilms tumor. Aniridia (part or all of the iris, the colored part of the eye is missing). Isolated hemihyperplasia (abnormally large growth of one or more parts of the body). Urinary tract problems such as cryptorchidism or hypospadias. The baby's mother was exposed to pesticides during pregnancy. ​ Having certain conditions can increase your risk of renal cell cancer. Renal cell carcinoma can be associated with the following conditions: ​ Von Hippel-Lindau disease (an inherited disorder that causes abnormal growth of blood vessels). Children with von Hippel-Lindau disease should be screened annually for kidney cancer by abdominal ultrasound or MRI (magnetic resonance imaging), starting at 8-11 years of age. Tuberous sclerosis (an inherited disorder characterized by benign fatty cysts in the kidneys). Familial renal cell carcinoma (an inherited disorder that occurs when certain changes in the genes that cause kidney cancer are passed from parent to child). Medullary kidney cancer (rare kidney cancer that grows and spreads rapidly). Hereditary leiomyomatosis (an inherited disorder that increases the risk of cancers of the kidney, skin, and uterus). Chemotherapy or radiation therapy for childhood cancers such as neuroblastoma, soft tissue sarcomas, leukemia, or Wilms' tumor may also increase the risk of kidney cancer. ​ 4.3. Williams Tumor Screening Tests ​ Screening tests are performed on children at increased risk of Wilms' tumor. These tests can help detect cancer early and reduce the chances of dying from cancer. ​ In general, children with an increased risk of Wilms tumor should be screened for Wilms tumor every 3 months until they are 8 years old. Abdominal ultrasound is usually used for screening. Small Wilms tumors can be detected and removed before symptoms appear. ​ Children with Beckwith-Wiedemann syndrome or hemihyperplasia are also screened for liver and adrenal tumors that are associated with these genetic syndromes. A test to check the level of alpha-fetoprotein (AFP) in the blood and an ultrasound of the abdominal cavity are performed up to 4 years of age. An ultrasound of the kidneys is done at the age of 4 to 7 years. A medical examination by a specialist (geneticist or pediatric oncologist) is done twice a year. In children with certain gene changes, a different abdominal ultrasound schedule may be used. ​ Children with aniridia and a certain gene change are tested for Wilms tumor every 3 months until they are 8 years old. An abdominal ultrasound is used for screening. ​ Some children develop Wilms' tumor in both kidneys. They often appear when a Wilms tumor is first diagnosed, but a Wilms tumor can also occur in a second kidney after successfully treating a child for a Wilms tumor in one kidney. Children with an increased risk of a second Wilms tumor in another kidney should be screened for Wilms tumor every 3 months for up to 8 years. Abdominal ultrasound can be used for screening. ​ 4.4. Signs of Williams' tumor ​ Sometimes childhood kidney tumors do not cause signs and symptoms, and the parent finds the mass in the abdomen by accident or the mass is in the process of a good child health check. These and other signs and symptoms can be caused by kidney tumors or other conditions. Check with your child's doctor if your child has any of the following: ​ A lump, swelling, or pain in the abdomen. Blood in the urine. High blood pressure (headache, feeling very tired, chest pain, or problems with vision or breathing). Hypercalcemia (loss of appetite, nausea and vomiting, weakness or feeling very tired). Fever for no known reason. Loss of appetite. Losing weight for an unknown reason. A Wilms tumor that has spread to the lungs or liver can cause the following signs and symptoms: ​ Cough. Blood in sputum. Labored breathing. Abdominal pain. ​ 4.5. Tests for the diagnosis of Wilms tumor and other kidney tumors in children ​ The following tests and procedures can be used: ​ Physical examination and health history A body exam to check for general signs of health, including checking for signs of illness such as bumps or anything else that seems unusual. There will also be a history of the patient's health habits, as well as past illnesses and treatments. ​ Complete blood count (CBC) : a procedure in which a blood sample is taken and checked for the following: The number of erythrocytes, leukocytes and platelets. The amount of hemoglobin (oxygen-carrying protein) in red blood cells. The portion of a blood sample made up of red blood cells. ​ Studies of the chemical composition of blood : A procedure in which a blood sample is tested to measure the amount of certain substances that enter the bloodstream by organs and tissues of the body. An unusual (more or less than usual) amount of a substance may be a sign of illness. This test is done to check how well the liver and kidneys are working. ​ Kidney function test: A procedure in which blood or urine samples are analyzed to measure the amount of certain substances excreted by the kidneys into the blood or urine. An increased or less than normal amount of a substance may be a sign that the kidneys are not working properly. ​ Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria. ​ Ultrasound procedure : A procedure in which high energy sound waves (ultrasound) are reflected from internal tissues or organs and create an echo. The echo forms a picture of body tissue called a sonogram. To diagnose a kidney tumor, an ultrasound of the abdominal cavity is done. 4.1. 4.2. 4.3. 4.4 4.5. Abdominal ultrasound. An ultrasound probe connected to the computer is pressed against the abdominal skin. The transducer reflects sound waves from internal organs and tissues, creating an echo that forms a sonogram (computer image). CT (computed tomography) : A procedure in which a series of detailed images of areas inside the body, such as the chest, abdomen and pelvis, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye will be injected into a vein or swallowed to make organs and tissues more visible. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (magnetic resonance imaging) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to create a series of detailed images of areas inside the body, such as the abdomen. A substance called gadolinium is injected into a vein. Gadolinium gathers around cancer cells, so they appear brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ X-ray : An X-ray is a type of energy beam that can pass through the body onto a film, creating an image of areas inside the body, such as the chest and abdomen. ​ PET-CT : A procedure that combines positron emission tomography (PET) and computed tomography (CT) images. PET and CT scans are performed simultaneously on the same machine. Images from both scans are combined to create a more detailed picture than any test could do on its own. A PET scan is a procedure to look for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Cancer cells appear brighter because they are more active and consume more glucose than normal cells. ​ Biopsy : Removing cells or tissues so that a pathologist can examine them under a microscope to check for signs of cancer. The decision to have a biopsy is based on the following: The size of the tumor. Stage of cancer. If the tumor appears to be resectable or Wilms' tumor is stage I or II, biopsy is not performed to avoid proliferation of tumor cells during the procedure. Whether there is cancer in one or both kidneys. Whether cancer is clearly shown on imaging. Whether the patient is in a clinical trial. A biopsy can be done before starting treatment, after chemotherapy to shrink a tumor, or after surgery to remove a tumor. ​ 4.6. Factors influencing the forecast convalescence and treatment options ​ The prognosis and treatment options for Wilms' tumor depend on the following conditions: ​ How tumor cells differ from normal kidney cells under a microscope. Stage of cancer. The type of tumor. Child's age. Is it possible to completely remove the tumor with surgery? Are there any changes in chromosomes or genes. Whether the cancer has just been diagnosed or has recurred (returned). The prognosis for renal cell carcinoma depends on the following: ​ Stage of cancer. Whether the cancer has spread to the lymph nodes. The prognosis for rhabdoid kidney tumors depends on the following: ​ The age of the child at the time of diagnosis. Stage of cancer. Whether the cancer has spread to the head or spinal cord ... The prognosis for clear cell sarcoma of the kidney depends on the following: ​ The age of the child at the time of diagnosis. Stage of cancer. ​ 4.7. How cancer spreads throughout the body ​ Cancer spreads through the body in three ways. ​ Cancer can spread through tissues, the lymphatic system, and the blood: ​ Textile. Cancer spreads from where it originated to surrounding areas. The lymphatic system. Cancer spreads from where it originated to the lymphatic system. Cancer spreads through the lymphatic vessels to other parts of the body. Blood. Cancer spreads from where it originated into the bloodstream. Cancer spreads through the blood vessels to other parts of the body. Cancer can spread from where it originated to other parts of the body. ​ When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they originated (primary tumor) and travel through the lymphatic system or blood. ​ The lymphatic system. Cancer enters the lymphatic system, travels through the lymphatic vessels, and forms a tumor (metastatic tumor) in another part of the body. Blood. Cancer enters the bloodstream, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body. A metastatic tumor is the same type of cancer as the primary tumor. For example, if a Wilms tumor spreads to the lungs, the cancer cells in the lungs are actually Wilms tumor cells. The disease is Wilms' metastatic tumor, not lung cancer. ​ 4.8. Treatments for Williams' tumor in children ​ There are various treatments for patients with Wilms' tumor and other kidney tumors in children. ​ Various treatments are available for children with Wilms kidney tumors and other childhood kidney tumors. Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. ​ Because cancer is rare in children, clinical trials should be considered. Some clinical trials are only open to patients who have not yet started treatment. ​ Children with Wilms' tumor or other kidney tumors in children should plan for treatment with a team of healthcare professionals who are experts in treating childhood cancer. ​ Your child's treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric providers who are experts in treating children with Wilms' tumor or other kidney tumors in children and who specialize in specific areas of medicine. This may include the following specialists: ​ Pediatrician. Pediatric surgeon or urologist. Radiologist oncologist. Rehabilitation specialist. Specialist Pediatric Nurse. Social worker . Six types of treatments are used: 1. Operation Two types of surgeries are used to treat kidney tumors: ​ Nephrectomy : Wilms tumor and other kidney tumors in children are usually treated with nephrectomy (surgery to remove the entire kidney). You can also remove nearby lymph nodes and check them for signs of cancer. Sometimes a kidney transplant (surgery to remove a kidney and replace it with a kidney from a donor) is done when the cancer affects both kidneys and the kidneys are not working properly. ​ Partial nephrectomy : If cancer is found in both kidneys or may have spread to both kidneys, surgery may include partial nephrectomy (removal of a tumor in the kidney and a small amount of normal tissue around it). A partial nephrectomy is done to keep the kidneys working. Partial nephrectomy is also called renal sparing surgery. After a doctor removes any tumors that can be seen during surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer recurrence is called adjuvant therapy. Sometimes surgery is done again to see if the cancer remains after chemotherapy or radiation therapy. ​ Sometimes the tumor cannot be removed with surgery for one of the following reasons: ​ The tumor is too close to important organs or blood vessels. The tumor is too large to be removed. Cancer affects both kidneys if the tumors are not very small. There is a blood clot in the vessels near the liver. The patient has trouble breathing because the cancer has spread to the lungs. In this case, a biopsy is done first. Chemotherapy is then given to reduce the size of the tumor before surgery, to preserve as much healthy tissue as possible and reduce problems after surgery. This is called neoadjuvant chemotherapy. Radiation therapy is given after surgery. 2. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. External beam radiation therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. ​ External beam radiation therapy is used to treat Wilms' tumor and other kidney tumors in children. ​ 3. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Combination chemotherapy is treatment with two or more anticancer drugs. ​ Systemic chemotherapy is used to treat Wilms' tumor and other kidney tumors in children. ​ Chemotherapy is sometimes given before surgery to reduce the size of the tumor, to preserve as much healthy tissue as possible and to reduce problems after surgery. This is called neoadjuvant chemotherapy. ​ 4. Immunotherapy ​ Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances produced by the body or in the laboratory are used to enhance, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy. ​ Interferon and interleukin-2 (IL-2) are types of immunotherapy used to treat renal cell carcinoma in children. Interferon can slow tumor growth and help kill cancer cells. IL-2 enhances the growth and activity of many immune cells, especially lymphocytes (a type of white blood cell). Lymphocytes can attack and kill cancer cells. ​ 5. High-dose stem cell rescue chemotherapy ​ High doses of chemotherapy are prescribed to kill cancer cells. Healthy cells, including hematopoietic cells, are also destroyed in cancer treatments. Stem cell rescue is a treatment to replace hematopoietic cells. Stem cells (immature blood cells) are removed from the patient's blood or bone marrow, frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and returned to the patient as an infusion. These stem cells turn into (and repair) blood cells. ​ High-dose stem cell rescue chemotherapy can be used to treat rhabdoid kidney tumor or recurrent Wilms tumor. 6. Targeted therapy ​ Targeted therapy is a type of treatment that uses drugs or other substances to identify and destroy certain cancer cells. Targeted therapy usually does less damage to normal cells than chemotherapy or radiation therapy. Targeted therapies used to treat kidney tumors in children may include the following: ​ Tyrosine kinase inhibitors: This targeted therapy blocks the signals that cancer cells need to grow and divide. Larotrectinib and entrectinib can be used to treat congenital mesoblastic nephroma with a specific gene change that cannot be removed with surgery, has spread to other parts of the body, or has continued to grow during treatment. This combination is also being studied for the treatment of congenital mesoblastic nephroma that has returned after treatment. Sunitinib or cabozantinib can be used to treat renal cell carcinoma. Axitinib is being studied in combination with a monoclonal antibody (nivolumab) to treat renal cell carcinoma that cannot be surgically removed or has spread to other parts of the body. Histone methyltransferase inhibitors: This targeted therapy can inhibit the growth and division of cancer cells. Tasemetostat is being studied for the treatment of a rhabdoid kidney tumor that does not respond or has returned after treatment. Monoclonal Antibody Therapy: Monoclonal antibodies of the immune system are proteins made in the laboratory for the treatment of many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that can promote cancer cell growth. The antibodies are then able to kill cancer cells, block their growth, or prevent them from spreading. Monoclonal antibodies are given by infusion. They can be used alone or to carry drugs, toxins, or radioactive materials directly to cancer cells. Nivolumab, or a combination of nivolumab and a tyrosine kinase inhibitor (axitinib), is being studied for renal cell carcinoma that cannot be removed with surgery or has spread to other parts of the body. ​ 4.9. Side Effects of Treating Williams' Kidney Tumor in Children ​ Treating Wilms' tumor and other kidney tumors in children can cause side effects. ​ Side effects from cancer treatments that start after treatment and last for months or years are called late effects. Late effects of cancer treatments may include the following: ​ Physical problems such as heart, kidney, or pregnancy problems. Infertility. Changes in mood, feelings, thinking, learning, or memory. A second cancer (newer cancers), such as leukemia, gastrointestinal cancer, or breast cancer. Some late effects can be treated or controlled. It is important to talk with your child's healthcare providers about the impact cancer treatment can have on your child. Clinical trials are being done to find out if lower doses from chemotherapy and radiation can be used to reduce the late effects of treatment without changing how well the treatment works. ​ Monitoring for late kidney-related effects in patients with Wilms tumor and related conditions includes the following: ​ Children with WAGR syndrome are monitored throughout their lives as they are at increased risk of developing hypertension and kidney disease. Children with Wilms' tumor and genitourinary abnormalities are monitored because they are at increased risk of late renal failure. Patients with Wilms tumor and aniridia without genitourinary pathology are at lower risk but are monitored for kidney disease or renal failure. 4.6. 4.7. 4.8. 4.9. 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DETAILS ABOUT THE ORGANIZATION "MEDIKAL & ESTETIK GROUP" Medikal & Estetik Group understands that the strength of our organization lies not in words, but in the implementation of our mission to help you find the best medical solutions for you. Since 2018, we have been of the opinion that much more can be achieved through the joint efforts of a caring team. This is how the organization "Medikal & Estetik Group" appeared. Contact MEET MEDIKAL & ESTETIK GROUP Free international platform for the selection of a medical solution. You don't pay us anything Medikal & Estetik Group is a Russian-Turkish international platform for free selection of medical solutions in Turkey. We know everything and even more about this country, the nuances of Turkish medicine, its laws, insurance systems, its culture and language, because we live directly in this country! Even knowing English, there is often a distortion in the perception of information in the process of dialogue between two non-native speakers of this language. Medikal & Estetik Group consists of Turkish and Russian coordinator-translators with medical education, which guarantees the provision of 100% correct information about treatment, accommodation and tourism in Turkey. Contact HOW WE HELP As your coordinators among the huge information flow about clinics and doctors in Turkey, our task is to help you make the best medical decision. For this we are ready to provide: selection of a clinic according to your budget; making an appointment with specialists without queuing and intermediaries; getting much quicker feedback than self-referral; obtaining a medical visa if you need to stay in Turkey for a long time; free translation of medical documents; organization of transfer and language support at all stages; representing your side and defending your interests; selection of the most comfortable and favorable conditions and opportunities for you, about which many are silent or do not know; guarantee that you will not face any hidden commissions, volunteer fees or "thanks" to doctors. Everything is as transparent as possible. All payments are made at the clinic's cash desks; payment is made at the clinic's cash desks; organization of a consultation with a doctor you need; feedback with us 24/7. QUESTION-ANSWER ABOUT TREATMENT IN TURKEY Step by step BEST CLINICS IN TURKEY Commitment to principles THE MAIN ABOUT TREATMENT AND DIAGNOSTICS IN TURKEY Helping the community "Every person is guilty of everything good that he has not done in his life." Voltaire MEDIKAL & ESTETIK GROUP: CONTACT medikal.estetik.group@gmail.com +905054791917 Name Email post office Telephone Address Subject Message Send message Submitted. Thank you! Все видео Play Video Search video... All Categories All Categories Cuidar de você encabeça a sua lista de prioridades ⠀Caso não, deveria. ⠀Aproveite toda a energia de renovação que circula nesse período para colocar em prática a retomada da sua autoestima! ⠀E começar pelo Play Video A_responsabilidade_é_enorme_Atingir_e_superar_as_expectativas_do Play Video ✔Possibilidades são o que as lentes de contato dental podem te dar em um curto espaço de tempo, mudando cor e forma de maneira definitivas! Quer ter aquele sorriso dos sonhos.⠀.⠀⠀.⠀Agende sua avaliação-. (31) Play Video Бесплатная организация лечения в Турции Play Video Play Video 07:49 Grup Florence Nightingale Türkçe Florence Nichtingale стали первыми в области молекулярно-генетической диагностики. Подобные обследования уникальны, они предоставляют возможность подобрать оптимальную программу лечения различных болезней в каждом конкретном случае. Диагностики проводятся в специализированных лабораториях сети, оснащенных инновационным оборудованием. Поддерживает связи и партнерские отношения с некоторыми из самых престижных медицинских учреждений в США и других странах. Play Video Play Video 01:38 Kolan International Hospital Tanıtım Filmi Уникальные услуги: 1. лечение ретинопатии недоношенных детей — с помощью наиболее безопасной экстренной лазерной терапии или методом замораживания части сетчатки; 2. увеличение груди без операции — с помощью специально подготовленной гиалуроновой кислоты. Процедура проводится под местной анестезией, поэтому пациент находится в полном сознании и может определятся с желаемым размером прямо во время процедуры. 3. лечение гинекомастии (патологического увеличения молочных желез у мужчин) Проводиться безопасное хирургическое устранение патологии с пожизненным эффектом. Play Video Play Video 06:29 Koç Üniversitesi Hastanesi Качество предоставляемых услуг соответствует мировым стандартам ISO 9001 Quality Management System. Клиника Коч имеет сертификат аккредитационной комиссии JCI, что подтверждает высокое качество предоставляемых услуг и безопасность для пациента. В госпитале Коч работают над проблемами и усовершенствованием лечения онкологических, гематологических, сердечно-сосудистых заболеваний, эндокринологии и метаболизма, ожирения, сахарного диабета, адреналовой дисфункции. Play Video Play Video 02:08 Özel Sağlık Hastanesi Yüksek Sağlık Teknolojileri ve Tecrübeli Hekimleriyle Alsancak'ta Hizmetinizde Один из современных многопрофильных центров Турции с международным уровнем находится в Измире. Özel Sağlık Hastanesi оборудован инновационным технологиями, которые применяются в урологическом отделении (оно является лучшим в Турции) : роботизированной хирургии Da Vinci, аппарату HIFU, диагностике Uronav Prostate Fusion Biopsy, системе HoLEP и процедуре REZUM

Cancer recurrence. METASTATIC CANCER, MENU PAGES: ​ 1. RELEASE OF CANCER 1.1. Why does cancer return? 1.2. Recurrent cancer types 1.3. Cancer recurrence stage 1.4. Recurrent cancer treatment 2. METASTATIC CANCER 2.1. How cancer spreads 2.2. Where does cancer spread 2.3. Symptoms of metastatic cancer 2.4. Metastatic cancer treatment 2.5. When metastatic cancer can no longer be controlled. Palliative care 2.6. Hospice care for cancer patients 2.7. Questions about advanced cancer to ask your doctor When cancer comes back after treatment, doctors call it a relapse or recurrent cancer. ​ Finding a cancer recurrence can cause feelings of shock, anger, sadness, and fear. But now you have something that was not there before - experience. You are already a cancer survivor and you know what to expect. Also remember that treatment may have improved since you were first diagnosed. New medications or methods can help you heal or treat side effects. In some cases, improved treatments have helped turn cancer into a chronic disease that people can cope with and live with for years. 1. RELEASE OF CANCER Якорь 1 1.1. Why does cancer return? ​ Cancer recurrence begins with cancer cells that were not completely removed or destroyed in the first treatment. This does not mean that you received the wrong treatment. It simply means that a small number of cancer cells survived the treatment and were too small to be detected in subsequent tests. Over time, these cells have developed into tumors or cancers that your doctor can now detect. ​ Sometimes a new type of cancer occurs in people who have had cancer. When this happens, the new cancer is called the second primary cancer. The second primary cancer is different from recurrent cancer. ​ 1.2. Recurrent cancer types Doctors describe cancer recurrence by where it develops and how far it has spread. Different types of relapses: ​ Local recurrence means that the cancer is in the same place as or very close to the original cancer. ​ Regional recurrence means that the tumor has grown into lymph nodes or tissues near the original cancer. ​ Distant relapse means that the cancer has spread to organs or tissues that are far from the original cancer. When cancer spreads to distant parts of the body, it is called metastasis. or metastatic cancer . When cancer spreads, it is still the same type of cancer. For example, if you have had colon cancer, it may return to your liver. But cancer is still called colon cancer. ​ 1.3. Cancer recurrence stage ​ To find out what kind of relapse you have, you will need to go through many of the same tests you did when you first diagnosed your cancer, such as laboratory tests and imaging procedures. These tests help determine where the cancer has returned to your body, whether it has spread, and how far. Your doctor may refer to this new assessment of your cancer as "restyling." ​ After these tests, the doctor may prescribe a new stage for the cancer. The letter "r" will be added ​​ to the beginning of a new stage to reflect the re-staging. The initial stage in the diagnosis does not change. ​ Check out our diagnostic information. to learn more about tests that can be used to assess recurrent cancer. ​ 1.4. Recurrent cancer treatment ​ The type of treatment for recurrent cancer will depend on your type of cancer and how far it has spread. To find out about the methods of treatment that can be used to treat your recurrent cancer, you can order a consultation / second opinion from the best international oncologists in Turkey on our website. 1.1. 1.2. 1.3. 1.4 SECOND OPINION Cancer that spreads from where it originated to a distant part of the body is called metastatic cancer. Many cancers are also called stage IV cancers (4). The process by which cancer cells spread to other parts of the body is called metastasis. ​ When observed under microscope and other studies, metastatic cancer cells have features similar to those of the primary cancer and are not similar to the cells where metastatic cancer is found. This way, doctors can determine that it is cancer that has spread from another part of the body. ​ Metastatic cancer has the same name as primary cancer. For example, breast cancer that spreads to the lungs is called metastatic breast cancer, not lung cancer. It is treated as stage IV breast cancer, not lung cancer. ​ Sometimes when people are diagnosed with metastatic cancer, doctors cannot tell where it started. This type of cancer is called cancer of unknown primary origin or CUP. 2. METASTATIC CANCER Якорь 2 During metastasis, cancer cells break away from where they first formed (primary cancer), travel through the circulatory or lymphatic system, and form new tumors (metastatic tumors) elsewhere in the body. A metastatic tumor is the same type of cancer as the primary tumor. 2.1. How cancer spreads ​ Cancer cells spread throughout the body in several stages. These steps include: ​ grows into or invades adjacent normal tissue movement through the walls of nearby lymph nodes or blood vessels travel through the lymphatic system and bloodstream to other parts of the body stopping in small blood vessels at a distant location, invading blood vessel walls and moving into surrounding tissues grows in this tissue until a tiny tumor forms causes the growth of new blood vessels, which creates a blood supply that allows the metastatic tumor to continue to grow In most cases, cancer cells die at some point. But as long as conditions are favorable for cancer cells at each stage, some of them can form new tumors in other parts of the body. Metastatic cancer cells can also remain inactive in a distant location for years before they start growing again, if ever. ​ 2.2. Where does cancer spread? ​ Cancer can spread to almost any part of the body, although different types of cancer are more likely to spread to certain areas than others. The most common sites for cancer to spread are bones, liver and lungs. The following list shows the most common metastatic sites, excluding lymph nodes, for some common cancers: ​ Bladder: Bone, liver, lung Chest: Bone, brain, liver, lung Large intestine: Liver, lung, peritoneum Kidney: Adrenal gland, bone, brain, liver, lung Lung: Adrenal gland, bone, brain, liver, other lung Melanoma: Bone, brain, liver, lungs, skin, muscles Ovary: Liver, lung, peritoneum Pancreas: Liver, lung, peritoneum Prostate: Adrenal gland, bone, liver, lung Rectal: Liver, lung, peritoneum Stomach: Liver, lung, peritoneum Thyroid: Bone, liver, lung Uterus: Bone, liver, lung, peritoneum, vagina ​ 2.3. Symptoms of metastatic cancer ​ Metastatic cancer does not always cause symptoms. When symptoms do occur, what they are and how often they occur will depend on the size and location of the metastatic tumors. Some common signs of metastatic cancer include: ​ pain and fractures when the cancer has spread to the bones headache, cramps, or dizziness when cancer has spread to the brain shortness of breath when the cancer has spread to the lungs jaundice or swelling in the abdomen when cancer has spread to the liver 2.4. Metastatic cancer treatment ​ There are treatments for most types of metastatic cancer. Often, the goal of treatment for metastatic cancer is to control it by stopping or slowing its growth. Some people can live for years with metastatic cancer that is well controlled. Other treatments can improve quality of life by relieving symptoms. This type of care is called palliative care. It can be administered at any stage of cancer treatment. ​ The treatment you can get depends on your type of primary cancer, where it has spread, treatment you have received in the past, and your overall health. 2.5. When metastatic cancer can no longer be controlled. Palliative care ​ If you've been told that your cancer is no longer controllable, you and your loved ones may want to discuss end-of-life patient care. Regardless of whether you decide to continue treatment to reduce cancer or control its growth, you can always get palliative care to control cancer symptoms and side effects treatment. ​ Palliative care is care that helps patients feel better, but does not cure the disease itself. Palliative care should be started when cancer is diagnosed. This continues during and after treatment. Research shows that palliative care improves the quality of life for patients and their families. All patients are entitled to comfort and quality of life throughout the entire treatment period. ​ Palliative care is especially important if you decide to stop cancer treatment. It includes: ​ treating or preventing symptoms and side effects caused by cancer treatments ​ receiving emotional and spiritual support ​ solving practical problems of patients and their families ​ Palliative care: many of the same methods that are used to treat cancer, such as medications and certain therapies, can also be used to reduce pain or other symptoms and help the patient feel more comfortable. For advanced cancer, palliative treatment may be prescribed to help the person feel better, even if it is not intended to treat cancer. For example, doctors may prescribe chemotherapy or radiation therapy to slow the growth of a tumor that is causing pain. Or, surgery may be done to remove a mass that is pressing on certain nerves and causing pain. Your healthcare team can help you to get palliative care. However, sometimes a palliative care professional may be the best person to treat the problem. Ask your doctor or nurse if you have access to a specialist. ​ 2.6. Hospice care for cancer patients ​ Hospice is a special type of care that provides medical, psychological and spiritual support to cancer patients and their loved ones when treatment no longer helps control the disease. At the hospice, a team of healthcare professionals works with patients and their families to provide the comfort and care they need towards the end of their lives. ​ Hospice care is not the same as palliative care. Although both hospice and palliative care provide patients with comfort and support, palliative care is available throughout the patient's experience with cancer. Cancer treatment continues while the person is receiving palliative care, but hospice care shifts the focus to symptom relief and end-of-life support. Hospice care is care, not treatment. The goal of hospice is to help you live every day to the fullest by controlling pain and other symptoms and making you as comfortable as possible. It is neither designed to hasten nor to delay death. Choosing a hospice does not mean that you have given up hope. Instead, hospice care means changing what you hope for. It can be the hope for a good quality of the rest of your life, including more time with family and friends. Hospice care is available in various locations. Hospice care is most often provided at home, but it can also be provided in specialized inpatient facilities, hospitals and nursing homes. It can also be done in conjunction with professional home care if needed. Hospice services will differ depending on where you live and the hospice's philosophy, but will generally include: ​ medical and nursing services medical supplies and equipment medicines to treat cancer-related symptoms and pain short term inpatient treatment volunteers to give caregivers a break counseling and spiritual assistance social work services prompt consultation and support Hospice specialists and volunteers undergo special training. They are committed to supporting the emotional needs of both patients and their families and are trained to cope with medical symptoms. A hospice team typically includes doctors, nurses, home care aides, social workers, clergy or other counselors, and trained volunteers. The team may also include speech therapists, physical therapists and therapists, if needed. The hospice team will focus on your end-of-life care goals, creating a treatment plan tailored to your needs and desires. ​ Hospice can provide support for several months. Although many people unfortunately believe that hospice is only available in the last days or weeks of life, it can provide support for several months. Many people said they would like hospice care to start earlier. They were surprised by the attentiveness and understanding of the hospice specialists. ​ Your doctor must confirm that you are eligible for hospice care. Most insurance plans cover hospice care after receiving a statement from your PCP and hospice medical director that your life expectancy is 6 months or less. You must also sign a statement that you are choosing a hospice. Hospice care can be continued if you live longer than 6 months if the hospice doctor re-confirms your condition. ​ You always have the option to discontinue hospice treatment if you want. Sometimes patients change their minds, decide to switch to another hospice provider, or their situation changes in some way. Less often, but not uncommon, patients may be discharged from hospice if their condition improves or if they resume cancer treatment. Although hospice care focuses on end-of-life care, it can be difficult to predict with certainty what will happen to a person, and sometimes unforeseen circumstances occur or the person's situation improves. ​ For information on the types of costs covered by private health policies, contact your hospital office, your hospice social worker, or your insurance company. ​ Local community, charitable or faith-based organizations can also help patients and their families with hospice costs. ​ Choosing a hospice. If you decide to use hospice services, talk to the organizations as soon as possible. The choice of hospice will depend on what services are available in your area. Not all hospices provide the same services. It will also depend on which one you like. Talk to family and friends who have used hospice services. Ask your healthcare team for advice. ​ 2.7. Questions about advanced cancer to ask your doctor ​ Communication is important when providing cancer care. If you find out that you have advanced cancer, you will have a choice of treatment and steps to take. Many people find it difficult to ask questions about what these steps should be. Some people with advanced cancer benefit from new treatments, while others do not. ​ Whether you've just been diagnosed or the standard treatment isn't working, it's important to ask your healthcare team what to expect in the future. Research shows that patients who discuss these issues with their doctor have a better quality of life than those who do not. ​ You can hope for the best while still being informed of your choice. The more information you have, the better decisions you and your loved ones can make about how you want to move forward with your concern. When you meet with your doctor, consider asking some of the following questions: ​ Questions about your cancer: ​ What does advanced cancer mean to me? How Long Can I Live With Advanced Cancer? Are there any tests I need to take now to better understand the extent of my cancer? Questions about treatment options: ​ What can we hope for by trying another treatment? What is the purpose? What are my treatment options? What do you recommend me and why? Is this treatment plan for treating side effects, slowing cancer growth, or both? Is there a chance that a new treatment will be found while we try the old one? Is a clinical trial right for me? What help will I get to feel comfortable if I choose not to actively get treatment for my cancer? Questions about symptoms and side effects: ​ What are the possible side effects and other disadvantages of this treatment? How likely are they? How can I manage the symptoms of advanced cancer or the side effects of cancer treatment? Can you refer me to a palliative care specialist to help me manage my side effects? Questions about moving from cancer treatment to hospice: ​ ​ How do I decide whether to continue or stop my cancer treatment? When should I consider hospice treatment? How can I be sure that I have the best quality of life - that I am comfortable and that I am not in pain? Can I get help with hospice at home or do I have to go to a special institution? How can I get help with financial and legal issues (such as paying for hospice care or preparing a will or advance directive)? How can I get help for my spiritual needs? Discussing these issues can help you decide whether to continue or begin active treatment. Tell your healthcare team exactly what you want to know and how much you can take. If possible, it is best to involve your loved ones in this process. This will help you understand your needs and the needs of those close to you. 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. Need help? ​ Doctors-coordinators will advise you and help you with the choice. Services Medikal & Estetik Group are free for you and do not affect the clinic bill. ​ Find a solution ​ Coordinator Medikal & Estetik Group help you find the best solution for cancer treatment ​ CHOOSE CLINIC ​ O Medikal & Estetik Group ​ Second opinion ​ Before traveling, you can get an opinion from a Turkish doctor on your diagnosis and prescribed treatment. For the patient, this is an opportunity to receive advice from the world's best specialists.

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TREATMENT OF SOFT TISSUE SARCOMA IN TURKEY MENU PAGES 1. SOFT TISSUE SARCOMA IN AN ADULT 1.1. General information about soft tissue sarcoma 1.2. Risks of developing sarcoma in adults 1.3. Sarcoma Symptoms 1.4. Diagnosis of Sarcoma 1.5. Factors affecting the chance of recovery 1.6. Stages of soft tissue sarcoma in adults 1.7. Overview of treatment options 2. TREATMENT OF STROMAL TUMORS OF THE GASTROINTESTINAL TRACT (adults) 2.1. Risks of developing a stromal tumor of the gastrointestinal tract 2.2. Symptoms of the development of a stromal tumor of the gastrointestinal tract 2.3. Diagnostics of the stromal tumor of the gastrointestinal tract 2.4. Recovery prognosis 2.5. Overview of treatment options 3. TREATMENT OF STROMAL TUMORS OF THE GASTROINTESTINAL TRACT IN CHILDREN 3.1. Symptoms 3.2 Diagnostics 3.3. Overview of treatment options 4. TREATMENT OF KAPOSHA'S SARCOMA 4.1. Diagnostics 4.2. Factors affecting the prognosis of recovery 4.3. Classic Kaposi's sarcoma 4.4. Epidemic Kaposi's sarcoma (HIV-associated Kaposi's sarcoma) 4.5. Overview of treatment options 5. TREATMENT WITH RABDOMOISARCOM IN CHILDHOOD 5.1. Risks of developing rhabdomyosarcoma in children 5.2. Symptoms 5.3. Diagnostics 5.4. Factors influencing the forecast 5.5. Stages of childhood rhabdomyosarcoma 5.6. Overview of treatment options 5.7. Side Effects of Treatment 5.8. Treatment of childhood rhabdomyosarcoma 5.9. Treatment of progressive or recurrent childhood rhabdomyosarcoma 6. TREATMENT OF SOFT TISSUE SARCOMA CHILDREN 6.1. Risks of developing sarcoma of myanic tissues in children 6.2. Symptoms 6.3. Diagnostics 6.4. Types of soft tissue sarcoma tumors in children 6.5. Factors affecting the prognosis of recovery 6.6. Overview of treatment options infantile soft tissue sarcoma 6.7. Treatment for soft tissue sarcoma in children can cause side effects. 6.8. Treatment options for soft tissue sarcoma in children 7. TREATMENT OF VASCULAR TUMORS IN CHILDREN 7.1. Tests are used to detect (search) and diagnose vascular tumors in children. 7.2. Groups of vascular tumors in children 7.3. Overview of treatment options 7.4. Benign tumors 7.5. Intermediate tumors that spread locally 7.6. Intermediate tumors that rarely spread 7.7. Malignant tumors 1. SOFT TISSUE SARCOMA IN AN ADULT Soft tissue sarcoma is a broad term for cancers that begin in soft tissues (muscles, tendons, fat, lymphatic and blood vessels, and nerves). These cancers can develop anywhere in the body, but are more common in the arms, legs, chest, and abdomen. Explore the links on this page to learn more about the different types of soft tissue sarcomas and how to treat them. We also have information on research and clinical trials. ​ 1.1. General information about soft tissue sarcoma ​ Adult soft tissue sarcoma is a disease in which malignant (cancerous) cells form in the soft tissues of the body. ​ The soft tissues of the body include muscles, tendons (bands of fibers that connect muscles to bones), fat, blood vessels, lymphatic vessels, nerves, and tissues around joints. Soft tissue sarcomas in adults can form almost anywhere in the body, but are most common in the head, neck, arms, legs, trunk, abdomen, and retroperitoneal space. 1.1. Якорь 1 Soft tissue sarcoma forms in the soft tissues of the body, including muscles, tendons, fat, blood vessels, lymph vessels, nerves, and tissues around joints. There are many types of soft tissue sarcomas. In each type of cell, sarcomas look different under a microscope, based on the type of soft tissue in which the cancer started. ​ 1.2. Risks of developing sarcoma in adults ​ Having certain inherited conditions can increase the risk of soft tissue sarcoma in adults. ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your doctor if you think you are at risk. Risk factors for soft tissue sarcoma include the following inherited conditions: ​ Retinoblastoma. Neurofibromatosis type 1 (NF1; von Recklinghausen's disease). Tuberous sclerosis (Bourneville disease). Familial adenomatous polyposis (FAP; Gardner's syndrome). Li-Fraumeni syndrome. Werner's syndrome (progeria in adults). Nevoid basal cell carcinoma syndrome (Gorlin's syndrome). Other risk factors for soft tissue sarcoma include the following: ​ Past radiation therapy for certain cancers. Exposure to certain chemicals such as thorotrast (thorium dioxide), vinyl chloride, or arsenic. Swelling (lymphedema) of the hands or feet for a long time. ​ 1.3. Sarcoma Symptoms ​ A sign of adult soft tissue sarcoma is a lump or swelling in the soft tissues of the body. ​ A sarcoma can present as a painless mass under the skin, often on an arm or leg. Sarcomas that start in the abdomen may not cause signs or symptoms until very large. As the sarcoma grows larger and puts pressure on nearby organs, nerves, muscles, or blood vessels, signs and symptoms may include: ​ Pain. Labored breathing. Other conditions can cause the same signs and symptoms. Check with your doctor if you have any of these problems. ​ 1.4. Diagnosis of Sarcoma ​ Adult soft tissue sarcoma is diagnosed by biopsy. ​ If your doctor thinks you may have soft tissue sarcoma, a biopsy will be done. The type of biopsy depends on the size of the tumor and its location in the body. Three types of biopsies can be used: ​ Postoperative biopsy: Removal of part of a tumor or tissue sample. Primary biopsy: Removal of tissue with a wide needle. Excisional biopsy: Removal of an entire tumor or area of tissue that does not appear normal. Samples will be taken from the primary tumor, lymph nodes, and other suspicious areas. The pathologist examines the tissue under a microscope for the presence of cancer cells and finds out the grade of the tumor. The extent of the tumor depends on how abnormal the cancer cells look under the microscope and how quickly the cells divide. High-grade tumors usually grow and spread faster than low-grade tumors. ​ Because soft tissue sarcoma is difficult to diagnose, patients should ask that tissue samples be screened by a pathologist experienced in diagnosing soft tissue sarcoma. ​ The following tests can be performed on the removed tissue: ​ Immunohistochemistry: a laboratory test that uses antibodies to check for specific antigens (markers) in a tissue sample from a patient. Antibodies are usually associated with an enzyme or fluorescent dye. After antibodies bind to a specific antigen in a tissue sample, the enzyme or dye is activated and the antigen can be seen under a microscope. This type of test is used to help diagnose cancer and to help distinguish one type of cancer from another. ​ Light and electron microscopy: A laboratory test in which cells in a tissue sample are viewed under a conventional and high-power microscope to detect specific changes in the cells. ​ Cytogenetic analysis: A laboratory test in which the chromosomes of cells in a tissue sample are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in some chromosomes can be a sign of cancer. Cytogenetic analysis is used to diagnose cancer, plan treatment, or determine the effectiveness of a treatment. ​ FISH (Fluorescence In Situ Hybridization): A laboratory test used to study and count genes or chromosomes in cells and tissues. Pieces of DNA containing fluorescent dyes are made in the laboratory and added to a sample of the patient's cells or tissues. When these stained DNA fragments attach to specific genes or regions of chromosomes in a sample, they light up when viewed under a fluorescent microscope. The FISH test is used to diagnose cancer and plan treatment. ​ Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of living cells in the sample, and certain characteristics of cells such as size, shape, and the presence of tumor (or other) markers on the cell surface. Cells from a sample of blood, bone marrow, or other tissue from a patient are stained with a fluorescent dye, placed in a liquid, and then passed one at a time through a beam of light. The test results are based on how cells stained with a fluorescent dye respond to a beam of light. ​ After a soft tissue sarcoma in an adult is diagnosed, tests are done to find out if the cancer cells have spread to the soft tissue or to other parts of the body. ​ The process used to determine if cancer has spread to soft tissue or to other parts of the body is called staging. The stage of soft tissue sarcoma also depends on the extent and size of the tumor and whether it has spread to the lymph nodes or other parts of the body. The information gathered during the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. ​ During the preparation process, the following tests and procedures can be used: ​ Physical examination and health history: Examining the body to check for general signs of health, including checking for signs of illness, such as tumors or anything else that seems unusual. A history of the patient's health-related habits as well as past illnesses and treatments will also be recorded. ​ Chest X-ray: An X-ray of organs and bones inside the chest. X-rays are a type of energy beam that can pass through the body onto film, creating an image of areas within the body. ​ Blood chemistry tests: A procedure in which a blood sample is tested to measure the amount of certain substances that enter the bloodstream by organs and tissues of the body. An unusual (more or less than usual) amount of a substance may be a sign of illness. ​ Complete blood count (CBC): A procedure in which a blood sample is taken and checked for the following: The number of erythrocytes, leukocytes and platelets. The amount of hemoglobin (oxygen-carrying protein) in red blood cells. The portion of a blood sample made up of red blood cells. ​ CT (computed tomography): A procedure in which a series of detailed pictures of the internal parts of the body, such as the lungs and the abdomen, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to help organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ PET scan (positron emission tomography): a procedure to look for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumor cells appear brighter in the image because they are more active and consume more glucose than normal cells. The results of these tests are reviewed along with the results of the tumor biopsy to determine the stage of the soft tissue sarcoma prior to treatment. Sometimes chemotherapy or radiation therapy is prescribed as the initial treatment, and then the soft tissue sarcoma is re-inserted. ​ 1.5. Factors affecting the chance of recovery ​ Several factors influence treatment options and prognosis (chance of recovery). ​ Treatment options and prognosis depend on the following: ​ A type of soft tissue sarcoma. The size, grade and stage of the tumor. How quickly cancer cells grow and divide. Where is the tumor in the body. Has the entire tumor been removed? surgical by. Patient's age and general health. If the cancer has recurred (come back). ​ 1.6. Stages of soft tissue sarcoma in adults ​ The grade of the tumor is also used to describe the cancer and the treatment plan. ​ The grade of the tumor describes how abnormal the cancer cells look under the microscope and how quickly the tumor can grow and spread. Low, medium and high grade are used to describe soft tissue sarcoma: ​ Low grade: In low grade soft tissue sarcoma, cancer cells look more like normal cells under a microscope and grow and spread more slowly than in moderate to high grade soft tissue sarcoma. ​ Moderate: In moderate soft tissue sarcoma, the malignant cells appear more abnormal under the microscope and grow and spread faster than in low-grade soft tissue sarcoma. ​ High Grade: In high-grade soft tissue sarcoma, cancer cells appear more abnormal under the microscope and grow and spread faster than in low to moderate soft tissue sarcoma. For sarcoma of soft tissues of the trunk, arms and legs in adults, the following stages are used: ​ Stage I ​ ​ Stage I of adult soft tissue sarcoma of the trunk, arms and legs is divided into stages IA and IB: 1.2. 1.3. 1.4. 1.5. 1.6 Tumor sizes are often measured in centimeters (cm) or inches. Common foods that can be used to display tumor size in cm include: pea (1 cm), peanuts (2 cm), grapes (3 cm), walnut (4 cm), lime (5 cm or 2 cm). inches), egg (6 cm), peach (7 cm) and grapefruit (10 cm or 4 inches). In stage IA, the tumor is 5 centimeters or less and is of low grade or unknown grade. In stage IB, a tumor larger than 5 centimeters is of low grade or unknown grade. Stage II ​ In stage II adult soft tissue sarcomas of the trunk, arms and legs, the swelling is 5 centimeters or less and middle-class or high-class. ​ Stage III ​ Sarcoma of soft tissues of the trunk, arms and legs in stage III adults is divided into stages IIIA and IIIB: ​ In stage IIIA, the tumor is larger than 5 centimeters, but not more than 10 centimeters, and has a moderate to high grade. In stage IIIB, the tumor is larger than 10 centimeters and has a moderate to high grade. Stage IV ​ With sarcoma of the soft tissues of the trunk, arms and legs in a stage IV adult, one of the following is found: ​ the tumor is of any size, any grade, and has spread to nearby lymph nodes; or a tumor of any size, of any degree, and could have spread to nearby lymph nodes. The cancer has spread to other parts of the body, such as the lungs. ​ For sarcoma of the soft tissues of the retroperitoneal space in adults, the following stages are used: Stage I ​ Stage I of adult retroperitoneal soft tissue sarcoma is divided into stages IA and IB: Tumor sizes are often measured in centimeters (cm) or inches. Common foods that can be used to display tumor size in cm include: pea (1 cm), peanuts (2 cm), grapes (3 cm), walnut (4 cm), lime (5 cm or 2 cm). inches), egg (6 cm), peach (7 cm) and grapefruit (10 cm or 4 inches). In stage IA, the tumor is 5 centimeters or less and is of low grade or unknown grade. ​ In stage IB, a tumor larger than 5 centimeters is of low grade or unknown grade. ​ Stage II ​ In stage II adult retroperitoneal soft tissue sarcoma, the tumor is 5 centimeters or less and middle class or high class. ​ Stage III ​ Stage III retroperitoneal soft tissue sarcoma in adults is divided into stages IIIA and IIIB: ​ In stage IIIA, the tumor is larger than 5 centimeters, but not more than 10 centimeters, and has a moderate to high grade. ​ Stage IIIB shows one of the following: tumors larger than 10 centimeters and middle grade or high grade; or a tumor of any size, of any degree, and has spread to nearby lymph nodes. Stage IV ​ In stage IV adult retroperitoneal soft tissue sarcomas, the tumor is of any size, any grade, and can spread to nearby lymph nodes. The cancer has spread to other parts of the body, such as the lungs. ​ There is no standardized staging system for soft tissue sarcomas in the head, neck, chest, or abdomen. ​ Soft tissue sarcoma may recur (come back) after treatment. Cancer can return to the same soft tissue or to other parts of the body. ​ 1.7. Overview of treatment options 1.7. Mohs Surgery. A surgical procedure to remove a visible lesion on the skin in several stages. First, a thin layer of cancerous tissue is removed. Then a second thin layer of tissue is removed and viewed under a microscope to check for cancer cells. Several layers are removed one at a time until the remaining cancer is found on the tissue viewed under a microscope. This type of surgery is used to remove as little healthy tissue as possible. 1. Wide local excision: removal of the tumor along with the normal tissue around it. For tumors of the head, neck, abdomen and trunk, as little normal tissue as possible is removed. ​ Limb-sparing surgery: Removal of a tumor on an arm or leg without amputation, while maintaining the use and appearance of the limb. Radiation therapy or chemotherapy may be given first to shrink the tumor. Then the tumor is removed by wide local excision. The removed tissue and bone can be replaced with a graft using tissue and bone taken from another part of the patient's body, or with an implant such as artificial bone. ​ Amputation: Surgery to remove part or all of a limb or appendage, such as an arm or leg. Amputation is rarely used to treat soft tissue sarcoma of the arm or leg. ​ Lymphadenectomy: A surgical procedure in which lymph nodes are removed and a sample of tissue is checked under a microscope for signs of cancer. This procedure is also called lymphadenectomy. Radiation therapy or chemotherapy may be given before or after surgery to remove the tumor. If given before surgery, radiation therapy or chemotherapy will shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. Treatment before surgery is called neoadjuvant therapy. When given after surgery to remove all visible tumor, radiation therapy or chemotherapy kills any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer recurrence is called adjuvant therapy. ​ 2. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy: ​ External beam therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. ​ Internal beam therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are inserted directly into or near the tumor. Intensity modulated radiation therapy (IMRT) is a type of three-dimensional (3-D) radiation therapy that uses a computer to produce images of the size and shape of a tumor. Thin beams of radiation of different intensity (strength) are directed at the tumor at different angles. This type of external radiation therapy causes less damage to nearby healthy tissue and is less likely to cause dry mouth, trouble swallowing, and skin damage. ​ How radiation therapy is given depends on the type and stage of cancer treatment. External radiation therapy and internal radiation therapy can be used to treat soft tissue sarcoma in adults. ​ 3. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). ​ 4. Targeted therapy ​ Targeted therapy is a type of treatment that uses drugs or other substances to identify and target certain cancer cells. Targeted therapy can do less harm to normal cells than chemotherapy or radiation therapy. ​ Tyrosine kinase inhibitor therapy: Tyrosine kinase inhibitors are small molecule drugs that travel across the cell membrane and work inside cancer cells, blocking the signals that cancer cells need to grow and divide. Some tyrosine kinase inhibitors also have angiogenesis inhibitory effects. Pazopanib is used to treat advanced soft tissue sarcoma. ​ 2. TREATMENT OF STROMAL TUMORS OF THE GASTROINTESTINAL TRACT (adults) A stromal tumor of the gastrointestinal tract is a disease in which abnormal cells form in the tissues of the gastrointestinal tract. ​ The gastrointestinal (GI) tract is part of the body's digestive system. It helps digest food and removes nutrients from food ( vitamins, minerals, carbohydrates, fats, proteins and water) so that they can be used by the body. The gastrointestinal tract consists of the following organs: ​ Stomach . Small intestine . Colon ( colon ). Some gastrointestinal stromal tumors (GIST) grow slowly over time and may never cause problems for the patient, while others can grow and spread very quickly. They are most commonly found in the stomach and small intestine, but can be found anywhere in or near the gastrointestinal tract. Some scientists believe that GIST begins in cells called interstitial Cajal cells (ICCs) in the wall of the gastrointestinal tract. Якорь 2 Gastrointestinal stromal tumors (GIST) can be found anywhere or near the gastrointestinal tract. 2.1. Development risks stromal tumor of the gastrointestinal tract ​ Genetic factors can increase the risk of developing gastrointestinal stromal tumors. ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your doctor if you think you are at risk. ​ These genes in cells carry hereditary information received from a person's parents. The risk of GIST is increased in people who are inherited with a mutation (change) in a particular gene. In rare cases, GIST can be found in several members of the same family. ​ GIST can be part of a genetic syndrome, but this is rare. A genetic syndrome is a collection of symptoms or conditions that occur together and are usually caused by abnormal genes. The following genetic syndromes are associated with GIST: ​ Neurofibromatosis type 1 (NF1) A rare genetic disorder that causes brown spots and tumors on the skin, freckles on areas of the skin not exposed to the sun, nerve tumors, and changes in the development of the nervous system, muscles, bones, and skin. Also called NF1. Carney's triad. A very rare disease characterized by tumors of the gastrointestinal tract (usually the stomach), tumors that form in the nervous tissue of the embryo in the head, neck and trunk, and tumors that form in the cartilage of the lungs. Sometimes tumors also form in the adrenal glands and esophagus. The Carney triad is most common in young women. ​ 2.2. Symptoms of the development of a stromal tumor of the gastrointestinal tract ​ Signs of gastrointestinal stromal tumors include blood in the stool or vomiting. ​ These and other signs and symptoms can be caused by GIST or other causes. Check with your doctor if you have any of the following: ​ Blood (bright red or very dark) in stool or vomit. Abdominal pain, which can be very severe. Feeling very tired. Problems or pain when swallowing. Feeling full after eating very little food. ​ 2.3. Diagnostics stromal tumor of the gastrointestinal tract ​ Tests that examine the gastrointestinal tract are used to diagnose tumors of the gastrointestinal stroma. ​ The following tests and procedures can be used: ​ Physical examination and health history: Examining the body to check for general signs of health, including checking for signs of illness such as bumps or anything else that seems out of the ordinary. There will also be a history of the patient's health habits, as well as past illnesses and treatments. ​ CT (computed tomography): a procedure in which a series of detailed pictures of areas inside the body are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to make organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ Endoscopic ultrasound and biopsy: Endoscopy and ultrasound are used to take an image of the upper gastrointestinal tract and a biopsy is performed. An endoscope (a thin, tubular instrument with light and viewing lenses) is inserted through the mouth and into the esophagus, stomach, and first part of the small intestine. A probe at the end of an endoscope is used to reflect high-energy sound waves (ultrasound) from internal tissues or organs and create an echo. The echo forms a picture of body tissue called a sonogram. This procedure is also called endosonography. Based on the sonogram, the doctor removes the tissue with a thin hollow needle. A pathologist examines the tissue under a microscope for cancer cells. ​ When cancer is found, the following tests can be performed to look at cancer cells: ​ Immunohistochemistry: a laboratory test that uses antibodies to check for specific antigens (markers) in a tissue sample from a patient. Antibodies are usually associated with an enzyme or fluorescent dye. After antibodies bind to a specific antigen in a tissue sample, the enzyme or dye is activated and the antigen can be seen under a microscope. This type of test is used to diagnose cancer and help distinguish one type of cancer from another. ​ Mitosis rate: A measure of how quickly cancer cells divide and grow. The rate of mitosis is determined by counting the number of cells dividing in a given amount of cancer tissue. ​ Very small GISTs are common. ​ Sometimes GIST is less than a pencil eraser. Tumors can be found during a procedure that is done for another reason, such as an X-ray or surgery. Some of these small tumors will not grow and cause signs or symptoms or spread to the abdomen or other parts of the body. Doctors disagree on whether these small tumors should be removed or monitored to see if they begin to grow. ​ After a gastrointestinal stromal tumor has been diagnosed, tests are done to find out if cancer cells have spread through the gastrointestinal tract or other parts of the body. ​ The process used to determine if a cancer has spread in the gastrointestinal (GI) tract or to other parts of the body is called staging. The information gathered during the staging process determines the stage of the disease. During the preparation process, the following tests and procedures can be used: ​ PET scan (positron emission tomography): a procedure to look for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumor cells appear brighter in the image because they are more active and consume more glucose than normal cells. ​ CT (computed tomography): a procedure in which a series of detailed pictures of areas inside the body are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed so that organs or tissues can be seen more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ Chest X-ray: An X-ray of the internal organs and bones of the chest. An X-ray is a type of energy beam that can pass through a body onto a film, creating an image of areas within the body. ​ Bone scan: A procedure to check for rapidly dividing cells such as cancer cells in the bone. A very small amount of radioactive material is injected into a vein and passed through the bloodstream. The radioactive material builds up in the bones in cancer and is detected by a scanner. ​ Additional tests may be required. ​ Some tests that have been done to diagnose cancer or to determine the stage of cancer may be repeated. Some tests will be repeated to see how effective the treatment is. Decisions to continue, change, or stop treatment may be based on the results of these tests. ​ Some tests will continue from time to time after treatment ends. The results of these tests can show if your condition has changed or if the cancer has recurred (returned). These tests are sometimes called follow-up or follow-up examinations. ​ Follow-up for GST that have been surgically removed may include CT of the liver and pelvis or wait-and-see. For GISTs that are treated with tyrosine kinase inhibitors, follow-up tests such as CT, MRI, or PET scans may be done to check how well targeted therapy is working. ​ 2.4. Recovery prognosis ​ Several factors affect prognosis (chance of recovery) and treatment options. ​ The prognosis and treatment option depends on the following conditions: ​ How quickly cancer cells grow and divide. The size of the tumor. Where is the tumor in the body. Is it possible to completely remove the tumor with surgery? Whether the tumor has spread to other parts of the body. ​ 2.5. Overview of treatment options ​ The results of diagnostic and staging tests are used to plan treatment. ​ For many cancers, it is important to know the stage of the cancer in order to plan treatment. However, GIST treatment is independent of the stage of the cancer. Treatment is based on whether the tumor can be surgically removed and whether the tumor has spread to other parts of the abdomen or distant parts of the body. ​ Treatment is based on whether the tumor is: ​ Resectable: These tumors can be removed with surgery. Inoperable: These tumors cannot be completely removed with surgery. Metastatic and recurrent: Metastatic tumors have spread to other parts of the body. Recurrent tumors recurred (returned) after treatment. Recurrent GISTs may return to the gastrointestinal tract or to other parts of the body. They are usually found in the abdomen, peritoneum, and / or liver. Refractory: These tumors did not improve after treatment. ​ There are various treatments for patients with gastrointestinal stromal tumors. ​ Various treatments are available for patients with gastrointestinal stromal tumors (GIST). Some treatments are standard (currently used) and some are in clinical trials. A clinical trial of treatment is a scientific study designed to help improve current treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than standard treatment, the new treatment may become the standard treatment. Patients may want to take part in a clinical trial. Some clinical trials are only open to patients who have not yet started treatment. ​ Four types of standard treatments are used: ​ 1. Operation If the GIST has not spread and is in a safe place for surgery, the tumor and some tissue around it may be removed. Sometimes surgery is done using a laparoscope (a thin, illuminated tube) to look inside the body. Small incisions (incisions) are made in the abdominal wall, into one of which a laparoscope is inserted. Instruments can be inserted through the same incision or through other incisions to remove organs or tissues. ​ 2. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to identify and target certain cancer cells. Targeted therapy usually does less damage to normal cells than chemotherapy or radiation therapy. ​ Tyrosine kinase inhibitors (TKIs) are targeted therapies that block signals required for tumor growth. TKIs can be used to treat GISTs that cannot be surgically removed, or to shrink the GISTs so that they are small enough to be surgically removed. Imatinib mesylate and sunitinib are two BCIs used to treat GIST. TKI is sometimes prescribed until the tumor grows and serious side effects occur. 3. Watchful waiting Expectant closely monitor the patient's condition without giving any treatment until signs or symptoms appear or change. 4. Supportive therapy If GIST worsens during treatment or side effects occur, supportive care is usually given. The goal of supportive care is to prevent or treat the symptoms of the disease, the side effects caused by the treatment, and the psychological, social and spiritual problems associated with the disease or its treatment. Supportive care helps improve the quality of life for patients with serious or life-threatening medical conditions. Radiation therapy is sometimes prescribed as supportive therapy to relieve pain in patients with large, spreading tumors. ​ Treatment of resectable stromal tumors of the gastrointestinal tract Resectable gastrointestinal stromal tumors (GIST) can be completely or almost completely removed by surgery. Treatment may include the following: ​ Surgery to remove tumors measuring 2 centimeters or more. Laparoscopic surgery can be done if the tumor is 5 cm or less. If there are cancer cells remaining at the edges of the area where the tumor was removed, careful waiting or targeted therapy with imatinib mesylate may follow. Clinical study on targeted therapy with imatinib mesylate after surgery to reduce the chance of tumor recurrence (return). ​ Treatment of inoperable stromal tumors of the gastrointestinal tract Inoperable FSW cannot be completely removed by surgery because they are too large, or in a location where there would not be too much damage to nearby organs if the tumor is removed. Treatment is usually a clinical study of targeted therapy with imatinib mesylate to shrink the tumor, followed by surgery to remove as much of the tumor as possible. ​ Treatment of metastatic and recurrent stromal tumors of the gastrointestinal tract Treatments for GISTs that are metastatic (spread to other parts of the body) or recur (come back after treatment) may include the following: ​ Targeted therapy with imatinib mesylate. Targeted sunitinib therapy if tumor begins to grow during imatinib mesylate therapy or if side effects are too severe. Surgery to remove tumors that have been treated with targeted therapy and that are shrinking, stable (not changing), or slightly increased in size. Targeted therapy can be continued after surgery. Surgery to remove tumors for serious complications such as bleeding, a hole in the gastrointestinal tract, a blockage in the gastrointestinal tract, or an infection. Clinical study of a new treatment method. ​ Treatment of refractory stromal tumors of the gastrointestinal tract Many GISTs treated with a tyrosine kinase inhibitor (TKI) become unresponsive (stop responding) to the drug over time. Treatment is usually a clinical trial with a different TKI or a clinical trial of a new drug. 2.1. 2.2 2.3. 2.4 2.5. 3. TREATMENT OF STOMAL TUMORS OF THE GASTROINTESTINAL TRACT IN CHILDREN Stromal tumors of the gastrointestinal tract are diseases in which malignant (cancerous) cells form in the tissues of the wall of the stomach or intestines. ​ Gastrointestinal stromal tumors (GIST) usually begin in cells in tissues in the wall of the stomach or intestines. These cells, called Cajal interstitial cells, help food move through the digestive tract. ​ During childhood, GIST usually occurs in the stomach. It is more common in girls and usually appears during adolescence. ​ GIST in children is different from GIST in adults. Patients should be visited at centers that specialize in GIST treatment. Якорь 3 Gastrointestinal stromal tumors (GIST) are most common in the stomach and small intestine, but can be found anywhere in or near the gastrointestinal tract. GIST can develop as part of the syndrome. ​ GIST can occur as part of the following syndromes: ​ Carney triad (GIST, lung chondroma and paraganglioma). A very rare disease characterized by tumors of the gastrointestinal tract (usually the stomach), tumors that form in the nervous tissue of the embryo in the head, neck and trunk, and tumors that form in the cartilage of the lungs. Sometimes tumors also form in the adrenal glands and esophagus. The Carney triad is most common in young women. ​ Carney-Stratakis syndrome (GIST and paraganglioma). A rare hereditary disease characterized by tumors of the gastrointestinal tract and tumors that form in the nervous tissue of the embryo in the head, neck and trunk. Also called the Karni dyad and the Karni-Stratakis dyad. ​ 3.1. Symptoms ​ Signs and symptoms of GIST include anemia and abdominal induration. ​ These and other signs and symptoms can be caused by GIST or other conditions. ​ Check with your child's doctor if your child has any of the following: ​ Anemia (tiredness, dizziness, fast or irregular heartbeat, shortness of breath, or pale skin). Lump in the abdomen. Intestinal blockage (cramping abdominal pain, nausea, vomiting, diarrhea, constipation, and bloating). ​ 3.2 Diagnostics ​ Tests that examine the digestive tract are used to diagnose GIST. ​ The following tests and procedures can be used: ​ Physical examination and health history: Examining the body to check for general signs of health, including checking for signs of illness such as bumps or anything else that seems out of the ordinary. There will also be a history of the patient's health habits, as well as past illnesses and treatments. ​ Gene testing: A laboratory test in which cells or tissues are analyzed to look for changes in the KIT, PDGFA, and SDH genes. It is important to know if there are changes in these genes in order to diagnose GIST and plan treatment. ​ MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ CT (computed tomography): A procedure in which a series of detailed images of areas inside the body are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to help organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ PET scan (positron emission tomography): a procedure to look for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumor cells appear brighter in the image because they are more active and consume more glucose than normal cells. 3.1. 3.2. Positron Emission Tomography (PET). The baby lies on a table that goes through a PET scanner. The headrest and white strap help the baby to lie quietly. A small amount of radioactive glucose (sugar) is injected into the baby's vein and the scanner takes a picture of where the glucose is being used in the body. Cancer cells appear brighter in the image because they consume more glucose than normal cells. X-ray: An X-ray is a type of energy beam that can pass through the body and onto the film, creating an image of areas inside the body, such as the abdomen or the area where a tumor has formed. ​ Biopsy: Removal of cells or tissues so that a pathologist can examine them under a microscope to check for signs of cancer. Fine needle aspiration: Removal of tissue with a fine needle. Endoscopy: A procedure to examine organs and tissues inside the body for abnormal areas. The endoscope is inserted through an incision (incision) in the skin or holes in the body, such as the mouth or anus. An endoscope is a thin tubular instrument with a light and a viewing lens. He may also have an instrument to remove tissue samples or lymph nodes that are checked under a microscope for signs of disease. The following laboratory test can be done to examine tissue samples: ​ Immunohistochemistry: A laboratory test that uses antibodies to check for specific antigens (markers) in a tissue sample from a patient. Antibodies are usually associated with an enzyme or fluorescent dye. After antibodies bind to a specific antigen in a tissue sample, the enzyme or dye is activated and the antigen can be seen under a microscope. This type of test looks for the SDH enzyme in a tissue sample from a patient. When SDH is missing, it is called SDH deficient GIST. To plan treatment, it is important to know if the cancer is insufficient for SDH. After GIST has been diagnosed, tests are done to find out if cancer cells have spread to nearby areas or to other parts of the body. ​ The process used to determine if GIST has spread to nearby areas or other parts of the body is called staging. GIST can spread to the lymph nodes, liver, and peritoneum. There is no standard GIST staging system in children. The results of tests and procedures performed to diagnose GIST are used to make treatment decisions. ​ Sometimes GIST in childhood relapses (comes back) after treatment. ​ 3.3. Overview of treatment options ​ There are various types of treatment for children with GIST. ​ Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. ​ Because cancer is rare in children, clinical trials should be considered. Some clinical trials are only open to patients who have not yet started treatment. ​ Treatment for children with GIST should be planned by a team of doctors who are experts in the treatment of childhood cancers. ​ The treatment will be supervised by a pediatric oncologist, a doctor specializing in the treatment of oncological children. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and specialize in specific areas of medicine. This may include the following professionals and others: ​ Pediatrician. Children's surgeon. Pathologist. Specialist Pediatric Nurse. Social worker . Rehabilitation specialist. Psychologist . Child life specialist. ​ The following types of standard treatments are used: ​ 1. Operation Cancer removal surgery is an SDH deficient GIST treatment. 2. Targeted therapy Targeted therapy is a type of treatment that uses drugs or other substances to target cancer cells. Targeted therapy usually does less damage to normal cells than chemotherapy or radiation therapy. Tyrosine kinase inhibitor therapy: These drugs block signals required for tumor growth. Imatinib and sunitinib are used to treat GIST and GIST with SDH deficiency with KIT or PDGFR gene changes. ​ 3. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). ​ GIST treatment in children can cause side effects. Side effects from cancer treatments that start after treatment and last for months or years are called late effects. Late effects of cancer treatments may include: ​ Physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancer (new cancers) or other conditions. Some late effects can be treated or controlled. It is important to talk to your child's doctors about the possible late effects of some treatments. ​ GIST treatment Treatment for children newly diagnosed with tumors with changes in the KIT or PDGFR gene include the following: ​ Targeted therapy with a tyrosine kinase inhibitor (imatinib or sunitinib). Treatment for children newly diagnosed with an SDH-deficient tumor may include the following: ​ Surgery to remove the tumor. If intestinal obstruction or bleeding occurs, additional surgery may be required. ​ Targeted therapy with a tyrosine kinase inhibitor (sunitinib). ​ Treatment of recurrent GIST Treatment for recurrent GIST in children may include the following: ​ A clinical trial that tests a patient's sample of a tumor for some gene changes. The type of targeted therapy that will be given to a patient depends on the type of gene change. Clinical trials of a new chemotherapy drug. 3.3. 4. TREATMENT OF KAPOSHA'S SARCOMA Якорь 4 Kaposi's sarcoma is a disease in which malignant neoplasms (cancer) can form on the skin, mucous membranes, lymph nodes, and other organs. ​ Kaposi's sarcoma is cancer that causes lesions (abnormal tissue) to grow on the skin; on the mucous membranes lining the mouth, nose and throat; The lymph nodes ; or other bodies. The lesions are usually purple in color and consist of cancer cells, new blood vessels, red blood cells, and white blood cells. Kaposi's sarcoma differs from other cancers in that lesions can start in more than one place in the body at the same time. ​ Human herpes virus-8 (HHV-8) is found in lesions in all patients with Kaposi's sarcoma. This virus is also called Kaposi's sarcoma herpes simplex virus (KSHV). Most people with HHV-8 do not develop Kaposi's sarcoma. People with HHV-8 are more likely to develop Kaposi's sarcoma if their immune systems are weakened by a disease such as human immunodeficiency virus (HIV) or medications taken after organ transplants. ​ There are several types of Kaposi's sarcoma. This summary discusses two types: ​ Classic Kaposi's sarcoma. Epidemic Kaposi's sarcoma (HIV-associated Kaposi's sarcoma). ​ 4.1. Diagnostics ​ Tests that examine the skin, lungs, and gastrointestinal tract are used to diagnose Kaposi's sarcoma. ​ The following tests and procedures can be used: ​ Physical examination and health history: A body exam to check for general signs of health, including checking the skin and lymph nodes for signs of disease, such as lumps or anything else that seems unusual. There will also be a history of the patient's health habits, as well as past illnesses and treatments. ​ Chest X-ray: X-ray of internal organs and bones of the chest. An X-ray is a type of energy beam that can pass through a body onto a film, creating an image of areas within the body. It is used to detect Kaposi's sarcoma in the lungs. ​ Biopsy: Removal of cells or tissues so that a pathologist can examine them under a microscope to check for signs of cancer. ​​ One of the following types of biopsies can be done to check for Kaposi's sarcoma on the skin: Endoscopy or bronchoscopy can be done to check for Kaposi's sarcoma lesions in the gastrointestinal tract or lungs. ​ Excisional biopsy: A scalpel is used to remove all skin growth. Postoperative biopsy: A scalpel is used to remove part of the skin growth. Primary biopsy: A wide needle is used to remove part of the skin lesion. Fine needle aspiration (FNA) biopsy: A fine needle is used to remove part of the skin growth. Endoscopy for biopsy: A procedure to examine organs and tissues inside the body for abnormal areas. The endoscope is inserted through an incision (incision) in the skin or holes in the body, such as the mouth. An endoscope is a thin tubular instrument with a light and a viewing lens. He may also have an instrument to remove tissue samples or lymph nodes that are checked under a microscope for signs of disease. It is used to detect lesions of Kaposi's sarcoma in the gastrointestinal tract. Bronchoscopy for biopsy: A procedure to examine the trachea and large airways in the lungs for abnormal areas. A bronchoscope is inserted through the nose or mouth into the trachea and lungs. A bronchoscope is a thin, tubular instrument with a light and a viewing lens. He may also have an instrument for taking tissue samples, which are checked under a microscope for signs of disease. It is used to detect lesions of Kaposi's sarcoma in the lungs. After Kaposi's sarcoma has been diagnosed, tests are done to find out if the cancer cells have spread to other parts of the body. ​ The following tests and procedures can be used to find out if cancer has spread to other parts of the body: ​ Blood chemistry tests: A procedure in which a blood sample is tested to measure the amount of certain substances that enter the bloodstream by organs and tissues of the body. An unusual (more or less than usual) amount of a substance may be a sign of illness. ​ CT (computed tomography): A procedure in which a series of detailed pictures of areas inside the body, such as the lungs, liver, and spleen, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to make organs and tissues more visible. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ PET scan (positron emission tomography): a procedure to detect malignant growths in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant growths appear brighter in the image because they are more active and consume more glucose than normal cells. This imaging test checks for signs of lung, liver, and spleen cancer. ​ CD34 lymphocyte count: A procedure in which a blood sample is tested to measure the number of CD34 cells (a type of white blood cell). A lower than normal CD34 cell count may be a sign that the immune system is not working properly. ​ 4.2. Factors affecting the prognosis of recovery ​ The prognosis and treatment option depends on the following conditions: ​ Type of Kaposi's sarcoma. The patient's general health, especially his immune system. Whether the cancer has just been diagnosed or has recurred (returned). ​ 4.3. Classic Kaposi's sarcoma ​ Classic Kaposi's sarcoma is most common in older men of Italian or Eastern European Jewish descent. ​ Classic Kaposi's sarcoma is a rare disease that progresses slowly over many years. ​ Signs of classic Kaposi's sarcoma may include slow-growing lesions on the legs and feet. ​ Patients may have one or more red, purple, or brown skin lesions on the legs and feet, most often on the ankles or soles of the feet. Over time, lesions can form in other parts of the body, such as the stomach, intestines, or lymph nodes. The lesions usually do not cause any symptoms, but may increase in size and number over a period of 10 years or more. The pressure from the lesions can block the flow of lymph and blood in the legs and cause painful swelling. Digestive tract lesions can cause gastrointestinal bleeding. ​ Another cancer may develop. ​ Some patients with classic Kaposi's sarcoma may develop a different type of cancer before the appearance of foci of Kaposi's sarcoma or at a later age. Most often, this second cancer is non-Hodgkin's lymphoma. Frequent follow-up is necessary to keep track of these second forms of cancer. ​ 4.4. Epidemic Kaposi's sarcoma (HIV-associated Kaposi's sarcoma) ​ Patients with human immunodeficiency virus (HIV) are at risk of developing epidemic Kaposi's sarcoma (HIV-associated Kaposi's sarcoma). ​ Acquired Immunodeficiency Syndrome (AIDS) is caused by HIV, which attacks and weakens the body's immune system. A weakened immune system is unable to fight off infections and diseases. People with HIV have an increased risk of infection and cancer. ​ A person with HIV and certain types of infection or cancer, such as Kaposi's sarcoma, is diagnosed with AIDS. Sometimes a person is diagnosed with AIDS and Kaposi's sarcoma at the same time. ​ The use of a drug therapy called highly active antiretroviral therapy (HAART) reduces the risk of epidemic Kaposi's sarcoma in people with HIV. ​ HAART is a combination of several drugs used to reduce the damage to the immune system caused by HIV infection. Treatment with HAART reduces the risk of epidemic Kaposi's sarcoma, although a person can develop epidemic Kaposi's sarcoma while on HAART. ​ For information on AIDS and its treatment, visit the AIDSinfo website. ​ Signs of epidemic Kaposi's sarcoma can include lesions that form in many parts of the body. ​ The signs of epidemic Kaposi's sarcoma can include lesions in various parts of the body, including one of the following: ​ Leather. Mouth lining. The lymph nodes . Stomach and intestines. Lightweight and chest lining. Liver . Spleen. Kaposi's sarcoma is sometimes found on the lining of the mouth during a regular dental check-up. ​ In most patients with epidemic Kaposi's sarcoma, the disease spreads over time to other parts of the body. ​ 4.5. Overview of treatment options ​ There are different treatments for patients with Kaposi's sarcoma. ​ Various treatments are available for Kaposi's sarcoma patients. Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. Patients may want to take part in a clinical trial. Some clinical trials are only open to patients who have not yet started treatment. ​ Six standard treatments are used to treat Kaposi's sarcoma: ​ Treatment for Epidemic Kaposi's sarcoma combines treatment for Kaposi's sarcoma with treatment for acquired immunodeficiency syndrome (AIDS). The six types of standard treatments used to treat Kaposi's sarcoma include: ​ 1. HAART ​ Highly active antiretroviral therapy (HAART) is a combination of several drugs used to reduce damage to the immune system caused by human immunodeficiency virus (HIV) infection. For many patients, HAART alone may be sufficient to treat epidemic Kaposi's sarcoma. For other patients, HAART may be combined with other standard treatments for epidemic Kaposi's sarcoma. ​ 2. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy: ​ External beam therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. Internal beam therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are inserted directly into or near the tumor. How radiation therapy is given depends on the type of cancer being treated. Several types of external beam radiation therapy are used to treat lesions of Kaposi's sarcoma. Photon radiation therapy treats injuries with high energy light. Electron beam therapy uses tiny, negatively charged particles called electrons. ​ 3. Operation ​ The following surgical procedures can be used for Kaposi's sarcoma to treat small, superficial lesions: ​ Local excision: The tumor is excised from the skin along with some normal tissue around it. Electrodesification and scraping: the tumor is excised from the skin with a curette (a sharp, spoon-shaped instrument). A needle electrode is then used to shock the area with an electric current, which stops the bleeding and destroys the cancer cells remaining at the edge of the wound. This process can be repeated one to three times during surgery to remove the entire tumor. 4. Cryosurgery ​ Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy. 5. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body ( systemic chemotherapy ). When chemotherapy is injected directly into the cerebrospinal fluid, organ, tissue, or body cavity, such ​​ like the abdomen, drugs mainly target cancer cells in these areas (regional chemotherapy). ​ With electrochemotherapy , intravenous chemotherapy is given and a probe is used to send electrical impulses to the tumor. The pulses make a hole in the membrane around the tumor cell and allow the chemotherapist to enter. How chemotherapy is administered depends on where the foci of Kaposi's sarcoma occur in the body. For Kaposi's sarcoma, chemotherapy can be performed in the following ways: ​ For local lesions of Kaposi's sarcoma, such as in the mouth, anticancer drugs can be injected directly into the lesion (intralesional chemotherapy). For localized skin lesions, a topical gel can be applied to the skin. Electrochemotherapy can also be used. For extensive skin lesions, intravenous chemotherapy may be prescribed. Liposomal chemotherapy uses liposomes (very tiny particles of fat) to carry anticancer drugs. Liposomal doxorubicin is used to treat Kaposi's sarcoma. Liposomes accumulate in the tissue of Kaposi's sarcoma more than in healthy tissue, and doxorubicin is released slowly. This enhances the action of doxorubicin and causes less damage to healthy tissue. ​ 5. Immunotherapy ​ Immunotherapy is a treatment that uses a patient's immune system to fight cancer. Substances produced by the body or in the laboratory are used to enhance, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy. Interferon alpha and interleukin-12 are biological agents used to treat Kaposi's sarcoma. ​ 6. Targeted therapy ​ Targeted therapy is a type of treatment that uses drugs or other substances to identify and target certain cancer cells. Targeted therapy usually does less damage to normal cells than chemotherapy or radiation therapy. Monoclonal antibody therapy and tyrosine kinase inhibitors (TKIs) are types of targeted therapies that are being studied in the treatment of Kaposi's sarcoma. ​ Monoclonal antibodies are proteins of the immune system created in the laboratory for the treatment of many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that can promote cancer cell growth. The antibodies are then able to kill cancer cells, block their growth, or prevent them from spreading. Monoclonal antibodies are given by infusion. They can be used alone or to carry drugs, toxins, or radioactive materials directly to cancer cells. Bevacizumab is a monoclonal antibody that can be used to treat Kaposi's sarcoma. TKIs block signals required for tumor growth. Imatinib mesylate is a TKI that can be used to treat Kaposi's sarcoma. ​ Treatment of classic Kaposi's sarcoma Treatment for isolated skin lesions may include the following: ​ Radiation therapy . Surgery. Treatments for skin lesions throughout the body may include the following: ​ Radiation therapy. Chemotherapy. Electrochemotherapy. Treatment for Kaposi's sarcoma, which affects the lymph nodes or the gastrointestinal tract, usually includes chemotherapy with or without radiation therapy. ​ Treatment of epidemic Kaposi's sarcoma Treatment for epidemic Kaposi's sarcoma may include the following: ​ Surgery, including local excision or electrodesiccation and curettage. Cryosurgery. Radiation therapy . Chemotherapy using one or more anticancer drugs. Biological therapy using interferon alpha or interleukin-12. Targeted therapy using imatinib or bevacizumab. 4.1. 4.2. 4.3. 4.4. 4.5. 5. TREATMENT WITH RABDOMOISARCOM IN CHILDHOOD Якорь 5 Infantile rhabdomyosarcoma is a condition in which malignant (cancerous) cells form in muscle tissue. ​ Rhabdomyosarcoma is a type of sarcoma. Sarcoma is cancer of soft tissue (such as muscle), connective tissue (such as tendons or cartilage), or bone. Rhabdomyosarcoma usually starts in the muscles that are attached to the bones and help the body move, but it can start in many parts of the body. Rhabdomyosarcoma is the most common type of soft tissue sarcoma in children. ​ There are four main types of rhabdomyosarcoma: ​ Fetal: This type is most commonly found in the head and neck area, as well as in the genitals or urinary tract, but can occur anywhere on the body. This is the most common type of rhabdomyosarcoma. ​ Alveolar: This type is most commonly found in the arms or legs, chest, abdomen, genitals, or anal area. ​ Spindle cell / sclerosis: The spindle cell type is most commonly found in the paratesticular region (testis or spermatic cord). There are two other subtypes of spindle / sclerosis cells. One is more common in babies and is found in the trunk region. The other can affect children, adolescents, and adults. It is often found in the head and neck area and is more aggressive. ​ Pleomorphic: This is the least common type of rhabdomyosarcoma in children. ​ 5.1. Development risks rhabdomyosarcoma in children ​ Certain genetic conditions increase the risk of developing rhabdomyosarcoma in children. ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your child's doctor if you think your child may be at risk. ​ Risk factors for rhabdomyosarcoma include the following inherited conditions: ​ Li-Fraumeni syndrome. Dicer syndrome 1. Neurofibromatosis type 1 (NF1). Costello's Syndrome. Beckwith-Wiedemann syndrome. Noonan's syndrome. Babies who were high birth weight or were larger than expected at birth may have an increased risk of fetal rhabdomyosarcoma. ​ In most cases, the cause of rhabdomyosarcoma is unknown. ​ 5.2. Symptoms ​ The hallmark of rhabdomyosarcoma in childhood is a swelling or lump that continues to grow. ​ Signs and symptoms can be caused by rhabdomyosarcoma in children or other medical conditions. The signs and symptoms that occur depend on where the cancer starts. Check with your child's doctor if your child has any of the following: ​ A lump or lump that keeps getting bigger or doesn't go away. It can be painful. Crossed eyes or bulging eye. Headache. Problems with urination or bowel movements. Blood in the urine. Bleeding from the nose, throat, vagina, or rectum. ​ 5.3. Diagnostics ​ Diagnostic tests and biopsies are used to diagnose rhabdomyosarcoma in children. ​ The diagnostic tests that are done depends in part on where the cancer is. The following tests and procedures can be used: ​ Physical examination and health history: Examining the body to check for general signs of health, including checking for signs of illness such as bumps or anything else that seems out of the ordinary. There will also be a history of the patient's health habits, as well as past illnesses and treatments. ​ X-rays: X-rays of organs and bones inside the body, such as the chest. An X-ray is a type of energy beam that can pass through a body onto a film, creating an image of areas within the body. ​ CT (computed tomography): A procedure in which a series of detailed pictures of areas inside the body, such as the chest, abdomen, pelvis, or lymph nodes, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to make organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas of the body, such as the skull, brain, and lymph nodes. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ PET scan (positron emission tomography): a procedure to look for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Malignant tumor cells appear brighter in the image because they are more active and consume more glucose than normal cells. ​ Bone scan: A procedure to check for rapidly dividing cells such as cancer cells in the bone. A very small amount of radioactive material is injected into a vein and passed through the bloodstream. The radioactive material builds up in the bones in cancer and is detected by a scanner. ​ Bone marrow aspiration and biopsy: Removal of bone marrow, blood, and a small piece of bone by inserting a cannula into the hip bone. Samples are removed from both hip bones. A pathologist examines the bone marrow, blood, and bones under a microscope to look for signs of cancer. ​ Lumbar puncture: A procedure used to collect cerebrospinal fluid (CSF) from the spine. This is done by inserting a needle between two bones in the spine and into the cerebrospinal fluid and taking a sample of the fluid. A sample of cerebrospinal fluid is checked under a microscope for signs of cancer cells. This procedure is also called LP or lumbar puncture. If these tests show that there may be rhabdomyosarcoma, a biopsy is done. A biopsy is the removal of cells or tissues so that a pathologist can examine them under a microscope to check for signs of cancer. Because treatment depends on the type of rhabdomyosarcoma, biopsy specimens should be screened by a pathologist experienced in diagnosing rhabdomyosarcoma. ​ It may use one of the following types of biopsies: ​ Fine needle aspiration (FNA) biopsy: Removal of tissue or fluid with a fine needle. ​ Shaft biopsy: Removal of tissue with a wide needle. This procedure can be guided by ultrasound, computed tomography, or MRI. ​ Open biopsy: Removal of tissue through an incision (incision) in the skin. ​ Sentinel lymph node biopsy: Removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node in a group of lymph nodes to receive lymphatic drainage from the primary tumor. This is the first lymph node to which cancer can spread from the primary tumor. A radioactive substance and / or blue dye is injected near the tumor. The substance or dye flows through the lymphatic tract. To the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist examines tissue under a microscope for cancer cells. If no cancer cells are found, it may not be necessary to remove additional lymph nodes. Sometimes a sentinel lymph node is found in more than one group of nodes. Sentinel lymph node biopsy may be used in patients with rhabdomyosarcoma of the extremities or trunk when enlarged lymph nodes are not found on imaging or physical examination. ​ The following tests can be performed on a sample of tissue removed: ​ Light microscopy: a laboratory test in which cells in a tissue sample are viewed under a normal, high-power microscope to detect certain changes in the cells. ​ Immunohistochemistry: A laboratory test that uses antibodies to check for specific antigens (markers) in a tissue sample from a patient. Antibodies are usually associated with an enzyme or fluorescent dye. After antibodies bind to a specific antigen in a tissue sample, the enzyme or dye is activated and the antigen can be seen under a microscope. This type of test is used to diagnose cancer and help distinguish one type of cancer from another. ​ FISH (Fluorescence In Situ Hybridization): A laboratory test used to study and count genes or chromosomes in cells and tissues. Pieces of DNA containing fluorescent dyes are made in the laboratory and added to a sample of the patient's cells or tissues. When these stained DNA fragments attach to specific genes or regions of chromosomes in a sample, they light up when viewed under a fluorescent microscope. The FISH test is used to diagnose cancer and plan treatment. ​ Reverse transcription polymerase chain reaction (RT-PCR) test: A laboratory test that measures the amount of a genetic substance called mRNA created by a particular gene. An enzyme called reverse transcriptase is used to convert a specific piece of RNA into a corresponding piece of DNA that can be amplified (produced in large quantities) by another enzyme called DNA polymerase. Amplified copies of DNA help determine if a particular mRNA is being made by the genome. RT-PCR can be used to check for the activation of certain genes that may indicate the presence of cancer cells. This test can be used to look for specific changes in a gene or chromosome that can help diagnose cancer. ​ Cytogenetic analysis: A laboratory test in which the chromosomes of cells in a tissue sample are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in some chromosomes can be a sign of cancer. Cytogenetic analysis is used to diagnose cancer, plan treatment, or determine the effectiveness of a treatment. ​ Once children are diagnosed with rhabdomyosarcoma, treatment depends in part on the stage of the cancer and sometimes on whether the cancer has been completely removed by surgery. ​ The process used to determine if cancer has spread to tissue or to other parts of the body is called staging. It is important to know the stage in order to plan treatment. The doctor, based on the results of diagnostic tests, will help determine the stage of the disease. ​ Treatment for rhabdomyosarcoma in children is based in part on the stage and sometimes on the size of the cancer that remains after surgery to remove the tumor. The pathologist will use a microscope to check tissue removed during surgery, including tissue samples from the edges of areas where cancer was removed and lymph nodes. This is done to see if all of the cancer cells have been removed during surgery. ​ 5.4. Factors influencing the forecast ​ Several factors affect prognosis (chance of recovery) and treatment options. ​ The prognosis and treatment option depends on the following conditions: ​ The age of the patient. Where the tumor started in the body. The size of the tumor at the time of diagnosis. Whether the tumor has been completely removed by surgery. Type of rhabdomyosarcoma (embryonic, alveolar, spindle cell / sclerosing, or pleomorphic). Are there any changes in the genes. Whether the tumor has spread to other parts of the body at the time of diagnosis. Whether there was a tumor in the lymph nodes at the time of diagnosis. Whether the tumor is responding to chemotherapy and / or radiation therapy. For patients with recurrent cancer, prognosis and treatment also depend on the following: ​ Where in the body the tumor has recurred (returned). How much time elapsed between the end of cancer treatment and its relapse. Has the cancer been previously treated with radiation therapy? ​ Additional tests may be required. ​ Some tests that have been done to diagnose cancer or to determine the stage of cancer may be repeated. Some tests will be repeated to see how effective the treatment is. Decisions to continue, change, or stop treatment may be based on the results of these tests. ​ Some tests will continue from time to time after treatment ends. The results of these tests can show if your child's condition has changed or if the cancer has recurred (returned). These tests are sometimes called control or control tests. ​ 5.5. Stages of childhood rhabdomyosarcoma ​ The stage of rhabdomyosarcoma in children has three parts. ​ Childhood rhabdomyosarcoma is assessed using three different ways to describe cancer: ​ System setting. Grouping system. Risk group. The staging system is based on the size of the tumor, its location in the body, and its spread to other parts of the body: ​ Stage 1 ​ In stage 1, a tumor of any size may have spread to the lymph nodes and is found only in one of the following “favorable” sites: ​ The eye or the area around the eye. Head and neck (but not in tissues around the ear, nose, sinuses, base of the skull, brain, or spinal cord). Gallbladder and bile ducts. Ureters or urethra. Testes, ovary, vagina, or uterus. Rhabdomyosarcoma, which develops in a “favorable” location, has a better prognosis. If the site where the cancer occurs is not among the favorable sites listed above, it is considered an “unfavorable” site. 5.1. 5.2. 5.3. 5.4. 5.5. Tumor sizes are often measured in centimeters (cm) or inches. Common foods that can be used to display tumor size in cm include: pea (1 cm), peanuts (2 cm), grapes (3 cm), walnut (4 cm), lime (5 cm or 2 cm). inches), egg (6 cm), peach (7 cm) and grapefruit (10 cm or 4 inches). Stage 2 ​ In stage 2, cancer is found in an “unfavorable” location (in any area not described as “favorable” in stage 1). The tumor is no more than 5 centimeters long and has not spread to the lymph nodes. ​ Stage 3 ​ In stage 3, cancer is found in an “unfavorable” location (in any area not described as “favorable” in stage 1) and one of the following conditions is met: ​ The tumor is no more than 5 centimeters long and the cancer has spread to nearby lymph nodes. The tumor is larger than 5 centimeters, and the cancer could have spread to nearby lymph nodes. Stage 4 ​ ​ In stage 4, the tumor can be of any size and the cancer can spread to nearby lymph nodes. The cancer has spread to distant parts of the body, such as the lungs, bone marrow, or bones. ​ The grouping system is based on whether the cancer has spread and whether all of the cancer has been surgically removed: Group I ​ The cancer was only found where it started and was completely removed by surgery. The tissue was taken from the edges where the tumor was removed. This tissue was examined under a microscope by a pathologist and no cancer cells were found. ​ II group ​ Group II is divided into groups IIA, IIB and IIC. IIA: Cancer is removed by surgery, but cancer cells were seen when tissue taken from the edges where the tumor was removed was examined under a microscope by a pathologist. IIB: The cancer has spread to nearby lymph nodes, and the cancer and lymph nodes have been surgically removed. IIC: Cancer has spread to nearby lymph nodes, cancer and lymph nodes have been surgically removed, and at least one of the following is true: Tissue taken from the edges of where the tumor was removed was examined under a microscope by a pathologist and cancer cells were found. The lymph node farthest from the removed tumor was examined under a microscope by a pathologist and cancer cells were found. III group ​ The cancer was partially removed by biopsy or surgery, but a tumor remains that can be seen with the naked eye. IV group ​ When the diagnosis was made, the cancer had spread to distant parts of the body. ​ Cancer cells are detected by imaging; or Cancer cells are found in fluid around the brain, spinal cord, or lungs, or in abdominal fluid; or tumors are found in these areas. ​ The risk group is built on the basis of a stepwise ​​ systems and systems of grouping. ​ The risk group describes the likelihood that rhabdomyosarcoma will recur (come back). Every child treated for rhabdomyosarcoma should receive chemotherapy to reduce the likelihood of cancer recurrence. The type of cancer drug, dose, and number of treatments prescribed will depend on whether the child has low, medium, or high risk rhabdomyosarcoma. ​ The following risk groups are used: ​ 1. Low-risk childhood rhabdomyosarcoma ​ Low-risk childhood rhabdomyosarcoma is one of the following: ​ An embryonic tumor of any size, which is located in a “favorable” place. After the operation, a tumor may remain, which can be seen with or without a microscope. Cancer can spread to nearby lymph nodes. The following areas are "favorable" sites: The eye or the area around the eye. Head or neck (but not in tissue around the ear, nose, sinuses, base of the skull, brain, or spinal cord). Gallbladder and bile ducts. Ureter or urethra. Testes, ovary, vagina, or uterus. An embryonic tumor of any size that is not in a “favorable” location. After the operation, a tumor may remain that can only be seen under a microscope. The cancer could have spread to nearby lymph nodes. ​ 2. Pediatric rhabdomyosarcoma of medium risk ​ Mid-risk childhood rhabdomyosarcoma is one of the following: ​ An embryonic tumor of any size that does not occur at one of the “favorable” sites listed above. After the operation, a tumor remains that can be seen with or without a microscope. Cancer can spread to nearby lymph nodes. ​ An alveolar tumor of any size at a “favorable” or “unfavorable” site. After the operation, a tumor may remain, which can be seen with or without a microscope. The cancer could have spread to nearby lymph nodes. ​ 3. High-risk childhood rhabdomyosarcoma ​ A high risk of childhood rhabdomyosarcoma can be of the embryonic type or the alveolar type. It may have spread to nearby lymph nodes and has spread to one or more of the following: ​ Other parts of the body not located near the site where the tumor first formed. ​ Fluid around the brain or spinal cord. ​ Fluid in the lungs or abdomen. ​ Sometimes rhabdomyosarcoma in children continues to grow or returns after treatment. ​ Progressive rhabdomyosarcoma is cancer that keeps growing, spreading, or getting worse. Progressive illness may be a sign that the cancer has become refractory to treatment. ​ Recurrent rhabdomyosarcoma in children is cancer that has recurred (returned) after treatment. Cancer may reappear in the same place or in other parts of the body, such as the lungs, bone, or bone marrow. Less commonly, rhabdomyosarcoma can recur in the breasts of adolescent girls or in the liver. ​ 5.6. Overview of treatment options ​ There are various treatments for rhabdomyosarcoma patients in children. ​ Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. ​ Because cancer is rare in children, clinical trials should be considered. Some clinical trials are only open to patients who have not yet started treatment. ​ Children with rhabdomyosarcoma should plan for treatment by a team of healthcare professionals who are experts in treating childhood cancer. ​ Because rhabdomyosarcoma can form in many different parts of the body, many different treatments are used. The treatment will be supervised by a pediatric oncologist, a doctor specializing in the treatment of oncological children. The pediatric oncologist works with other health care providers who are experts in treating children with rhabdomyosarcoma and specialize in specific areas of medicine. This may include the following specialists: ​ Pediatrician. Children's surgeon. Radiologist oncologist. Children's hematologist. Children's radiologist. Specialist Pediatric Nurse. Geneticist or cancer genetics consultant. Social worker . Rehabilitation specialist. ​ Three types of standard treatments are used: ​ 1. Operation ​ Surgery (removal of cancer during surgery) is used to treat rhabdomyosarcoma in children. An operation called a wide local excision is often performed. A wide local excision is the removal of the tumor and part of the tissue around it, including the lymph nodes. A second surgery may be required to remove all of the cancer. Whether the operation will be performed and its type depends on the following: ​ Where the tumor started in the body. Influence of the operation on the appearance of the child. Influence of the operation on important functions of the child's body. How did the tumor respond to chemotherapy or radiation therapy, which may have been prescribed in the first place. In most children with rhabdomyosarcoma, it is not possible to remove the entire tumor with surgery. ​ Rhabdomyosarcoma can form in different parts of the body, and the operation will be different for each one. Surgery to treat rhabdomyosarcoma of the eye or genital area is usually a biopsy. Chemotherapy, and sometimes radiation therapy, may be given before surgery to shrink large tumors. ​ After the doctor removes any tumors that can be seen during surgery, patients will be given chemotherapy after surgery to kill any remaining cancer cells. Radiation therapy may also be prescribed. Treatment given after surgery to reduce the risk of cancer recurrence is called adjuvant therapy. ​ 2. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill or stop cancer cells from growing. There are two types of radiation therapy: ​ External beam therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. Certain treatments for radiation therapy can help prevent radiation from damaging nearby healthy tissue. These types of external radiation therapy include: Conformal radiation therapy: Conformal radiation therapy is a type of external radiation therapy in which a computer creates a three-dimensional (3-D) image of the tumor and generates beams of radiation that match the tumor. This allows a high dose of radiation to reach the tumor and cause less damage to nearby healthy tissue. Intensity Modulated Radiation Therapy (IMRT): I MRT is a type of three-dimensional (3-D) radiation therapy that uses a computer to produce images of the size and shape of a tumor. Thin beams of radiation of different intensity (strength) are directed at the tumor at different angles. Volumetric Modulated Arc Therapy (VMAT): VMAT is a type of three-dimensional radiation therapy in which a computer takes pictures of the size and shape of the tumor. During treatment, the radiation machine goes around the patient once in a circle and directs thin beams of radiation of different intensities to the tumor. Treatment with VMAT is faster than treatment with IMRT. Stereotactic body radiation therapy: Stereotactic body radiation therapy is a type of external radiation therapy. Special equipment is used to position the patient in the same position for every radiation therapy session. Once a day for several days, a radiation unit directs a higher than usual dose of radiation directly to the tumor. If the patient is in the same position during each treatment session, there is less damage to nearby healthy tissue. This procedure is also called stereotaxic external beam radiation therapy and stereotaxic radiation therapy. Proton beam therapy: Proton beam therapy is a type of high-energy external beam therapy. A radiation therapy machine directs beams of protons (tiny, invisible, positively charged particles) to cancer cells to kill them. This type of treatment can cause less damage to nearby healthy tissue. Internal beam therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are inserted directly into or near the tumor. It is used to treat cancer in areas such as the vagina, vulva, uterus, bladder, prostate, head, or neck. Internal radiation therapy is also called brachytherapy, internal radiation, implant radiation, or interstitial radiation therapy. This approach requires specialized technical skills and is offered in only a few health centers. The type and amount of radiation therapy, as well as when it is given, depends on the child's age, the type of rhabdomyosarcoma, the site of the tumor, the amount of tumor left after surgery, and the presence of a tumor in nearby lymph nodes. ... ​ External radiation therapy is commonly used to treat rhabdomyosarcoma in children, but internal radiation therapy is sometimes used. ​ 3. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). ​ Chemotherapy may also be prescribed to shrink the tumor before surgery to preserve as much healthy tissue as possible. This is called neoadjuvant chemotherapy. ​ Every child receiving treatment for rhabdomyosarcoma should receive systemic chemotherapy to reduce the likelihood of cancer recurrence. The type of anticancer drug, dose and number of treatments prescribed will depend on the child's age and whether the child has low, medium, or high risk rhabdomyosarcoma. ​ In addition to the standard treatment, the following treatments are used: 1. Immunotherapy ​ Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances produced by the body or in the laboratory are used to enhance, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy. There are different types of immunotherapy: ​ Vaccine therapy is a cancer treatment that uses a substance or group of substances to stimulate the immune system to find a tumor and kill it. Vaccine therapy is being studied for the treatment of metastatic rhabdomyosarcoma. ​ Immune Checkpoint Inhibitor Therapy uses the body's immune system to destroy cancer cells. Two types of immune checkpoint inhibitors are being studied in the treatment of childhood rhabdomyosarcoma that has returned from treatment: CTLA-4 is a protein on the surface of T cells that helps control the body's immune responses. When CTLA-4 attaches to another protein, called B7, on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow T cells to kill cancer cells. Ipilimumab is being studied for the treatment of childhood rhabdomyosarcoma that has returned or progressed during treatment. Therapy with PD-1 and PD-L1 inhibitors: PD-1 is a protein on the surface of T cells that helps control the body's immune responses. PD-L1 is a protein found on some types of cancer cells. When PD-1 binds to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors prevent the PD-1 and PD-L1 proteins from attaching to each other. This allows T cells to kill cancer cells. Nivolumab and pembrolizumab are types of PD-1 inhibitors that are being studied in the treatment of rhabdomyosarcoma in children that recurs or progresses during treatment. 2. Targeted therapy ​ Targeted therapy is a type of treatment that uses drugs or other substances to identify and destroy certain cancer cells. Targeted therapy usually does less damage to normal cells than chemotherapy or radiation therapy. There are different types of targeted therapy: ​ MTOR inhibitors stop a protein that helps cells divide and survive. Sirolimus is a type of mTOR inhibitor therapy being studied in the treatment of recurrent rhabdomyosarcoma. Tyrosine kinase inhibitors block signals that cancer cells should grow and divide. MK-1775, cabozantinib-s-malate, and palbociclib are tyrosine kinase inhibitors that are being studied in the treatment of newly diagnosed or recurrent rhabdomyosarcoma. ​ 5.7. Side Effects of Treatment ​ Treatment for rhabdomyosarcoma in children can cause side effects. Side effects from cancer treatments that start after treatment and last for months or years are called late effects. Late effects of rhabdomyosarcoma cancer treatments may include: ​ Physical issues affecting the following: Teeth, eyes, or gastrointestinal tract. Fertility (the ability to have children). Changes in mood, feelings, thinking, learning, or memory. Second cancer (newer cancers). Some late effects can be treated or controlled. It is important to talk with your child's doctors about the impact cancer treatment can have on your child and the types of symptoms to expect after completing cancer treatment. ​ 5.8. Treatment of childhood rhabdomyosarcoma ​ Treatment for newly diagnosed rhabdomyosarcoma in children often includes surgery, radiation therapy, and chemotherapy. The order in which these procedures are performed depends on where the tumor started in the body, the size of the tumor, the type of tumor, and whether the tumor has spread to lymph nodes or other parts of the body. See the Treatment Options Overview section of this summary for more information on surgery, radiation therapy, and chemotherapy used to treat children with rhabdomyosarcoma. ​ Rhabdomyosarcoma of the brain, head and neck ​ For tumors in the brain: Treatment may include surgery to remove the tumor, radiation therapy, and chemotherapy. ​ For head and neck tumors in or near the eye: Treatment may include chemotherapy and radiation therapy. If the tumor remains or returns after chemotherapy and radiation therapy, surgery may be required to remove the eye and some tissue around the eye. ​ For head and neck tumors that are near the ear, nose, sinuses, or base of the skull, but not in or near the eye: Treatment may include radiation therapy and chemotherapy. ​ For head and neck tumors that are not in or near the eye, or near the ear, nose, sinuses, or base of the skull: Treatment may include chemotherapy, radiation therapy, and surgery to remove the tumor. ​ For head and neck tumors that cannot be removed with surgery: Treatment may include chemotherapy and radiation therapy, including stereotactic radiation therapy. ​ For tumors of the larynx (voice box): Treatment may include chemotherapy and radiation therapy. Surgery to remove the larynx is usually not done to avoid damaging the voice. Rhabdomyosarcoma of the arms or legs ​ Chemotherapy followed by surgery to remove the tumor. If the tumor has not been removed completely, a second surgery may be performed to remove the tumor. Radiation therapy may also be prescribed. ​ For tumors of the hand or foot, radiation therapy and chemotherapy may be prescribed. The tumor cannot be removed because it will affect the function of the hand or foot. ​ Dissection of the lymph nodes (one or more lymph nodes are removed and a tissue sample is checked under a microscope for signs of cancer). For arm tumors, the lymph nodes near the tumor and in the armpits are removed. For leg tumors, lymph nodes near the tumor and in the groin area are removed. Rhabdomyosarcoma of the chest, abdomen, or pelvis ​ For tumors of the chest or abdomen (including the chest wall or abdominal wall): Surgery (wide local excision) may be performed. If the tumor is large, chemotherapy and radiation therapy are given before surgery to shrink the tumor. ​ For pelvic tumors: surgical intervention is possible (wide local excision). If the tumor is large, chemotherapy is given before surgery to shrink the tumor. Radiation therapy may be prescribed after surgery. ​ For tumors of the diaphragm: Tumor biopsy is followed by chemotherapy and radiation therapy to shrink the tumor. Later, surgery may be done to remove the remaining cancer cells. ​ For tumors of the gallbladder or bile ducts: Tumor biopsy is followed by chemotherapy and radiation therapy. Later, surgery may be done to remove the remaining cancer cells. ​ For muscle or tissue tumors around the anus, between the vulva and the anus, or between the scrotum and anus: surgery may be performed to remove as much of the tumor and some nearby lymph nodes as possible, followed by chemotherapy and radiation therapy. Rhabdomyosarcoma of the kidney ​ For kidney tumors: surgery to remove as much of the tumor as possible. Chemotherapy and radiation therapy may also be prescribed. Rhabdomyosarcoma of the bladder or prostate ​ For tumors that are only in the upper part of the bladder: Surgery (wide local excision) is performed. ​ For tumors of the prostate or bladder (other than the upper part of the bladder): Chemotherapy and radiation therapy are given first to shrink the swelling. If cancer cells remain after chemotherapy and radiation therapy, the tumor is surgically removed. Surgery may involve removal of the prostate, part of the bladder, or pelvic exenteration without removing the rectum. (This may include removing the lower colon and bladder. In girls, the cervix, vagina, ovaries, and nearby lymph nodes may be removed.) Chemotherapy is given first to shrink the tumor. Surgery is performed to remove the tumor, but not the bladder or prostate. After surgery, internal or external radiation therapy may be prescribed. Surgery to remove the tumor, but not the bladder or prostate. After the operation, internal radiation therapy is prescribed. Rhabdomyosarcoma of the testicular area ​ Surgery to remove the testicle and spermatic cord. The lymph nodes in the back of the abdomen can be checked for cancer, especially if the lymph nodes are large. Nerve-sparing retroperitoneal lymph node dissection should be performed in patients over 10 years of age without evidence of lymph node enlargement in the posterior abdomen. ​ Radiation therapy may be prescribed if the tumor cannot be completely removed with surgery. Rhabdomyosarcoma of the vulva, vagina, uterus, or ovary ​ For tumors in the vulva and vagina: Treatment may include chemotherapy followed by surgery to remove the tumor. After surgery, internal or external radiation therapy may be prescribed. ​ For tumors of the uterus: Treatment may include chemotherapy with or without radiation therapy. Surgery may sometimes be required to remove any remaining cancer cells. ​ For ovarian tumors: Treatment may include chemotherapy followed by surgery to remove the remaining tumor. ​ Metastatic rhabdomyosarcoma ​ Treatment, such as chemotherapy followed by radiation therapy or surgery to remove the tumor, is done at the site where the tumor first formed. If the cancer has spread to the brain, spinal cord, or lungs, radiation therapy may also be given where the cancer has spread. ​ The following treatments are being investigated for metastatic rhabdomyosarcoma: ​ Clinical study on immunotherapy (vaccine therapy). ​ 5.9. Treatment of progressive or recurrent childhood rhabdomyosarcoma Treatment options for progressive or recurrent rhabdomyosarcoma in children are based on many factors, including where the cancer has returned in the body, what type of treatment the child has received before, and the child's needs. ​ Treatment for progressive or recurrent rhabdomyosarcoma may include one or more of the following: ​ Surgery. Radiation therapy . Chemotherapy. Clinical trial in combination chemotherapy with or without Temsirolimus. Clinical study for targeted therapy or immunotherapy (sirolimus, Ipilimumab, nivolumab, or pembrolizumab). Clinical trial of targeted therapy with a tyrosine kinase inhibitor (MK-1775, cabozantinib-s-malate or palbociclib) and chemotherapy. A clinical trial that tests a sample of a patient's tumor for certain gene changes. The type of targeted therapy that will be given to a patient depends on the type of gene change. New therapies being investigated in the early stages of clinical trials should be considered for patients with recurrent rhabdomyosarcoma. 5.6. 5.7. 5.8. 5.9. 6. TREATMENT OF SOFT TISSUE SARCOMA CHILDREN Якорь 6 Soft tissue sarcoma in childhood is a disease in which malignant (cancer) cells form in the soft tissues of the body. ​ General information about soft tissue sarcoma (clickhere ) ​ 6.1. Risks of developing soft tissue sarcoma in children ​ The presence of certain diseases and hereditary disorders can increase the risk of developing soft tissue sarcoma in children. ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your child's doctor if you think your child may be at risk. ​ Risk factors for soft tissue sarcoma in children include the presence of the following inherited conditions: ​ Li-Fraumeni syndrome. Familial adenomatous polyposis (FAP). Changes in the RB1 gene. Changes in the SMARCB1 (INI1) gene. Neurofibromatosis type 1 (NF1). Werner syndrome. Tuberous sclerosis. Severe combined immunodeficiency with adenosine deaminase deficiency. Other risk factors include the following: ​ Past treatment with radiation therapy. Sick of AIDS (acquired immunodeficiency syndrome) and Epstein-Barr virus infection at the same time. ​ 6.2. Symptoms ​ The most common symptom of childhood soft tissue sarcoma is a painless swelling or swelling in the soft tissues of the body. ​ Sarcomas may appear as a painless lump under the skin, often on the arm, leg, chest, or abdomen. At first, there may be no other signs or symptoms. As the sarcoma gets larger and presses on nearby organs, nerves, muscles, or blood vessels, it may cause signs or symptoms, such as pain or weakness. ​ Other conditions may cause the same signs and symptoms. Check with your child's doctor if your child has any of these concerns. ​ 6.3. Diagnosis ​ The following tests and procedures may be used: ​ Medical examination and health history: examining the body to check for general signs of health, including checking for signs of disease such as tumors or anything else that seems unusual. An anamnesis of the patient's health habits as well as past illnesses and treatments will also be taken. ​ X-rays : X-rays are a type of energy beam that can pass through the body onto film, taking pictures of areas inside the body. ​ MRI (magnetic resonance imaging) : a procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas of the body, such as the chest, abdomen, arms, or legs. This procedure is also called nuclear magnetic resonance imaging (NMRI). ​ CT (computed tomography) : a procedure in which a series of detailed pictures of areas inside the body, such as the chest or abdomen, are taken from different angles. The pictures were taken by a computer connected to an x-ray machine. The dye may be injected into a vein or swallowed to make organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ Ultrasound procedure : a procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and create an echo. The echo forms a picture of body tissues called a sonogram. The picture can be printed to view later. ​ If tests show that there may be a soft tissue sarcoma, a biopsy is performed. ​ The type of biopsy depends in part on the size of the growth and whether it is close to the surface of the skin or deeper in the tissue. One of the following types of biopsy is usually used: ​ Core needle biopsy: removal of tissue with a wide needle. Several tissue samples are taken. This procedure can be guided by ultrasound, computed tomography, or MRI. ​ Postoperative biopsy: removal of part of the tumor or tissue sample. ​ Excision biopsy : removal of the entire tumor or an area of tissue that does not look normal. A pathologist examines tissue under a microscope for the presence of cancer cells. An excisional biopsy can be used to completely remove smaller tumors near the surface of the skin. This type of biopsy is rarely used because cancer cells may remain after the biopsy. If cancer cells remain, the cancer may return or spread to other parts of the body. An MRI of the tumor is performed before the excisional biopsy. This is done to show where the original tumor formed and can be used to guide future surgery or radiation therapy. ​ Whenever possible, the surgeon who removes any tumor found should be involved in planning the biopsy. The placement of biopsy needles or incisions may affect the ability to remove the entire tumor during later surgery. ​ To plan the best treatment, the tissue sample taken during the biopsy must be large enough to determine the type of soft tissue sarcoma and perform other laboratory tests. Tissue samples will be taken from the primary tumor, lymph nodes, and other areas that may have cancer cells. The pathologist examines the tissue under a microscope to look for cancer cells and determine the type and grade of the tumor. The extent of the tumor depends on how abnormal the cancer cells look under the microscope and how quickly the cells divide. High- and intermediate-grade tumors usually grow and spread faster than low-grade tumors. ​ Because soft tissue sarcoma is difficult to diagnose, the tissue sample should be reviewed by a pathologist experienced in diagnosing soft tissue sarcoma. ​ One or more of the following laboratory tests may be performed to study tissue samples: ​ Molecular test : a laboratory test to check for certain genes, proteins, or other molecules in a sample of tissue, blood, or other body fluid. A molecular test may be done with other procedures, such as a biopsy, to help diagnose some types of cancer. Molecular tests check for certain gene or chromosomal changes that occur in some soft tissue sarcomas. ​ Reverse transcription polymerase chain reaction (RT-PCR) test : a laboratory test that measures the amount of a genetic substance called mRNA made by a particular gene. An enzyme called reverse transcriptase is used to convert a specific piece of RNA into a matching piece of DNA that can be amplified (done in large quantities) by another enzyme called DNA polymerase. Amplified DNA copies help determine if a particular mRNA is being created by a genome. RT-PCR can be used to check for the activation of certain genes that may indicate the presence of cancer cells. This test can be used to look for specific changes in a gene or chromosome that can help diagnose cancer. ​ Cytogenetic analysis: a laboratory test in which the chromosomes of cells in a sample of tumor tissue are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in some chromosomes can be a sign of cancer. Cytogenetic analysis is used to diagnose cancer, plan treatment, or determine the effectiveness of a treatment. Fluorescence in situ hybridization (FISH) is a type of cytogenetic analysis. ​ Immunocytochemistry: a laboratory test that uses antibodies to test for specific antigens (markers) in a sample of a patient's cells. The antibodies are usually associated with an enzyme or fluorescent dye. After the antibodies bind to the antigen in the patient's cell sample, the enzyme or dye is activated and the antigen can be seen under a microscope. This type of test can be used to tell the difference between different types of soft tissue sarcoma. ​ Light and electron microscopy: a laboratory test in which the cells in a tissue sample are looked at under a conventional and powerful microscope to look for specific changes in the cells. ​ After being diagnosed with soft tissue sarcoma in childhood, tests are done to see if the cancer cells have spread to other parts of the body. ​ The process used to determine if cancer has spread to soft tissues or to other parts of the body is called staging. There is no standard staging system for soft tissue sarcoma in children. ​ To plan treatment, it is important to know the type of soft tissue sarcoma, whether the tumor can be surgically removed, and whether the cancer has spread to other parts of the body. ​ To find out if the cancer has spread, the following procedures can be used: ​ Sentinel lymph node biopsy: removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node in the lymph node group to receive lymphatic drainage from the primary tumor. This is the first lymph node to which cancer can spread from the primary tumor. A radioactive substance and/or a blue dye is injected near the tumor. The substance or dye flows through the lymphatic pathways to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist examines tissue under a microscope to look for cancer cells. If no cancer cells are found, it may not be necessary to remove additional lymph nodes. Sometimes a sentinel lymph node is found in more than one group of nodes. This procedure is used for epithelioid and clear cell sarcomas. ​ CT (computed tomography) : a procedure that takes a series of detailed pictures of areas inside the body, such as the chest, taken from different angles. The pictures were taken by a computer connected to an x-ray machine. The dye can be injected into a vein or swallowed to make organs or tissues more clearly visible. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ PET scan : A PET scan is a procedure to detect malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. The cells of malignant tumors appear brighter in the picture because they are more active and consume more glucose than normal cells. This procedure is also called a positron emission tomography (PET) scan. ​ PET-CT scan : a procedure that combines PET scan and computed tomography (CT) images. PET and CT scans are performed simultaneously on the same machine. The images from both scans are combined to give a more detailed picture than either test could do on its own. ​ 6.4. Types of soft tissue sarcoma tumors in children ​ There are many different types of soft tissue sarcomas. ​ Cells of each type of sarcoma look different under a microscope. Soft tissue tumors are grouped according to the type of soft tissue cells in which they first formed. ​ This summary is about the following types of soft tissue sarcomas: ​ Tumors of adipose tissue ​ Liposarcoma. This is a cancer of the fat cells. Liposarcoma usually forms in the fatty layer just under the skin. In children and adolescents, liposarcoma is often of low severity (it is likely to grow and spread slowly). There are several different types of liposarcomas, including: ​ Myxoid liposarcoma . It is usually a low-grade cancer that responds well to treatment. ​ Pleomorphic liposarcoma . It is usually a high-grade cancer that is less likely to be cured. Tumors of bones and cartilage ​ Bone and cartilage tumors are a mixture of bone and cartilage cells. Tumors of bones and cartilage are of the following types: ​ Extraskeletal mesenchymal chondrosarcoma. This type of bone and cartilage tumor often affects young people and occurs in the head and neck. It is usually highly malignant (can grow rapidly) and can spread to other parts of the body. It may also return many years after treatment. ​ Extraskeletal osteosarcoma . This type of bone and cartilage tumor is very rare in children and adolescents. It will likely return after treatment and may spread to the lungs. Tumors of fibrous (connective) tissue ​ Fibrous (connective tissue) tumors include the following types: ​ Desmoid fibromatosis (also called desmoid tumor or aggressive fibromatosis). This is a low grade fibrous tissue tumor (likely to grow slowly). It may return to nearby tissues but does not usually spread to distant parts of the body. Sometimes fibromatosis of the desmoid type can stop growing for a long time. In rare cases, the tumor may disappear without treatment. ​ ​ Children sometimes develop desmoid tumors with a change in the APC gene. Changes in this gene can also cause familial adenomatous polyposis (FAP). FAP is a hereditary disease (passed from parents to offspring) in which many polyps (growths on mucous membranes) form on the inner walls of the colon and rectum. Genetic counseling may be required (discussing hereditary diseases and genetic testing options with a trained specialist). ​ Protuberan dermatofibrosarcoma . This is a tumor of the deep layers of the skin, which most often forms in the trunk, arms or legs. The cells of this tumor have a specific genetic change called a translocation (part of the COL1A1 gene switches places with part of the PDGFRB gene). To diagnose protuberans dermatofibrosarcoma, tumor cells are tested for this genetic change. Dermatofibrosarcoma protuberance usually does not spread to the lymph nodes or other parts of the body. ​ Inflammatory myofibroblastic tumor . This cancer is made up of muscle cells, connective tissue cells, and certain immune cells. It occurs in children and adolescents. It forms most commonly in the soft tissues, lungs, spleen, and breasts. It often returns after treatment but rarely spreads to distant parts of the body. Some genetic variation has been found in about half of these tumors. ​ Fibrosarcoma. Pediatric fibrosarcoma (also called congenital fibrosarcoma). This type of fibrosarcoma usually occurs in children 1 year of age and younger and can be detected on prenatal ultrasound. This tumor grows rapidly and is often large at diagnosis. It rarely spreads to distant parts of the body. The cells of this tumor usually have some kind of genetic change called a translocation (part of one chromosome switches places with part of another chromosome). To diagnose childhood fibrosarcoma, tumor cells are tested for this genetic change. A similar tumor has been observed in older children, but it does not have the translocation that is often seen in younger children. Fibrosarcoma in adults. This is the same type of fibrosarcoma that occurs in adults. The cells of this tumor do not have genetic changes characteristic of childhood fibrosarcoma. There are two types of fibrosarcoma in children and adolescents: ​ Myxofibrosarcoma . It is a rare fibrous tissue tumor that is less common in children than in adults. ​ Low grade fibromyxoid sarcoma . It is a slow-growing tumor that forms deep in the arms or legs and mostly affects young and middle-aged people. The tumor may return many years after treatment and spread to the lungs and chest lining. Lifelong monitoring is required. ​ Sclerosing epithelioid fibrosarcoma. This is a rare tumor of fibrous tissue that grows rapidly. It may return and spread to other parts of the body years after treatment. Long-term follow-up is required. Skeletal muscle tumors ​ Skeletal muscles attach to bones and help the body move. ​ Rhabdomyosarcoma . Rhabdomyosarcoma is the most common soft tissue sarcoma in children 14 years of age and younger. (For more information, see PDQ summary for treatment of pediatric rhabdomyosarcoma.) Smooth muscle tumors ​ Smooth muscles line the interior of blood vessels and hollow internal organs such as the stomach, intestines, bladder, and uterus. ​ Leiomyosarcoma . This smooth muscle tumor has been linked to the Epstein-Barr virus in children who also have HIV or AIDS. Leiomyosarcoma may also form as a second cancer in survivors of hereditary retinoblastoma, sometimes many years after initial treatment for retinoblastoma. So-called fibrohistiocytic tumors ​ Plexiform fibrohistiocytic tumor . It is a rare tumor that usually affects children and young adults. The tumor usually starts as a painless growth on or just below the skin of the arm, hand, or wrist. Rarely, it can spread to nearby lymph nodes or the lungs. Tumors of the nerve sheaths ​ The nerve sheath consists of protective layers of myelin that cover nerve cells that are not part of the brain or spinal cord. Nerve sheath tumors are of the following types: ​ ​ Malignant tumor of the peripheral nerve sheath. Some children with peripheral nerve sheath cancer have a rare genetic disorder called neurofibromatosis type 1 (NF1). This tumor can be low grade or high grade. ​ Malignant newt tumor. These are very fast growing tumors that most often occur in children with NF1. ​ Ectomesenchymoma . It is a fast growing tumor that occurs mainly in children. Ectomesenchymomas can form in the eye socket, abdomen, arms, or legs. Pericytic (perivascular) tumors ​ Pericytic tumors form in cells that surround blood vessels. Pericytic tumors are of the following types: ​ Myopericytoma . Pediatric hemangiopericytoma is a type of myopericytoma. Children younger than 1 year of age at diagnosis may have a better prognosis. In patients older than 1 year, infantile hemangiopericytoma is more likely to spread to other parts of the body, including the lymph nodes and lungs. ​ Childhood myofibromatosis. Children's myofibromatosis is another type of myopericytoma. This is a fibrous tumor that often forms in the first 2 years of life. There may be a single nodule under the skin, usually in the head and neck (myofibroma), or multiple nodules in the skin, muscles, or bones (myofibromatosis). In patients with infantile myofibromatosis, the cancer can also spread to organs. These tumors may disappear without treatment. Tumors of unknown cellular origin ​ Tumors of unknown cellular origin (the type of cell in which the tumor first formed is unknown) include the following types: ​ Synovial sarcoma . Synovial sarcoma is a common type of soft tissue sarcoma in children and adolescents. It usually forms in the tissues around the joints of the arms or legs, but it can also form in the trunk, head, or neck. The cells of this tumor usually have some kind of genetic change called a translocation (part of one chromosome switches places with part of another chromosome). Larger tumors have a greater risk of spreading to other parts of the body, including the lungs. Children younger than 10 years of age who have a tumor that is 5 centimeters or smaller in the arms or legs have a better prognosis. ​ Epithelioid sarcoma . This is a rare sarcoma that usually starts deep in the soft tissues as a slowly growing hard lump and may spread to the lymph nodes. If cancer has formed in the arms, legs, or buttocks, a sentinel lymph node biopsy may be done to check for cancer in the lymph nodes. ​ Soft alveolar sarcoma parts . This is a rare tumor of soft, supportive tissue that connects and surrounds organs and other tissues. It most commonly occurs in the arms and legs, but can occur in the tissues of the mouth, jaws, and face. It can grow slowly and often spreads to other parts of the body. Soft alveolar sarcoma may have a better prognosis when the tumor is 5 centimeters or smaller, or when the tumor is completely removed by surgery. The cells of this tumor usually have a certain genetic change called a translocation (part of the ASSPL gene switches places with part of the TFE3 gene). To diagnose soft alveolar sarcoma, tumor cells are tested for this genetic change. ​ Soft tissue clear cell sarcoma . It is a slow-growing soft tissue tumor that starts in a tendon (tough, fibrous, umbilical cord tissue that connects a muscle to a bone or to another part of the body). Clear cell sarcoma most commonly occurs in the deep tissues of the foot, heel, and ankle. It can spread to nearby lymph nodes. The cells of this tumor usually have some kind of genetic change called a translocation (part of the EWSR1 gene switches places with part of the ATF1 or CREB1 gene). To diagnose clear cell soft tissue sarcoma, tumor cells are tested for this genetic change. ​ Extraskeletal myxoid chondrosarcoma. This type of soft tissue sarcoma can occur in children and adolescents. Over time, it tends to spread to other parts of the body, including the lymph nodes and lungs. The tumor may return many years after treatment. ​ Extraskeletal Ewing's sarcoma ​ Desmoplastic small cell tumor . This tumor most commonly forms in the peritoneum of the abdomen, pelvis, and/or peritoneum in the scrotum, but may form in the kidneys or other solid organs. Dozens of small tumors can form in the peritoneum. Desmoplastic small cell tumor can also spread to the lungs and other parts of the body. The cells of this tumor usually have some kind of genetic change called a translocation (part of one chromosome switches places with part of another chromosome). To diagnose a desmoplastic small cell tumor, tumor cells are tested for this genetic change. ​ Extrarenal (extracranial) rhabdoid tumor . This rapidly growing tumor forms in soft tissues such as the liver and bladder. It usually occurs in young children, including newborns, but may occur in older children and adults. Rhabdoid tumors may be associated with a change in a tumor suppressor gene called SMARCB1. This type of gene makes a protein that helps control cell growth. Changes in the SMARCB1 gene can be inherited. Genetic counseling may be required (discussion with a qualified specialist of hereditary diseases and the possible need for genetic testing). ​ Perivascular epithelioid cell tumors (PEComas). Benign PEComas can occur in children with an inherited condition called tuberous sclerosis. They occur in the stomach, intestines, lungs and urinary organs. PEComas grow slowly and most of them are unlikely. ​ Undifferentiated/unclassified sarcoma. These tumors usually occur in the bones or muscles that are attached to the bones and help the body move. Undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma (high grade). This type of soft tissue tumor can form in parts of the body where patients have previously received radiation therapy, or as a second cancer in children with retinoblastoma. The tumor usually forms in the arms or legs and may spread to other parts of the body. Tumors of blood vessels ​ Blood vessel tumors include the following types: ​ Epithelioid hemangioendothelioma . Epithelioid hemangioendotheliomas can occur in children but are most common in adults between the ages of 30 and 50. They usually originate in the liver, lungs, or bones. They can be either fast growing or slow growing. In about a third of cases, the tumor spreads very quickly to other parts of the body. ​ Angiosarcoma of soft tissues. Soft tissue angiosarcoma is a rapidly growing tumor that forms in the blood or lymph vessels anywhere in the body. Most angiosarcomas are in or under the skin. Those found in deeper soft tissues may form in the liver, spleen, or lungs. They are very rare in children, who sometimes have more than one tumor in the skin or liver. In rare cases, childhood hemangioma can become soft tissue angiosarcoma. ​ Sometimes soft tissue sarcoma in children continues to grow or comes back after treatment. ​ Progressive soft tissue sarcoma in children is a cancer that continues to grow, spread, or get worse. Progressive disease may be a sign that the cancer has become refractory to treatment. ​ Recurrent soft tissue sarcoma in children is cancer that has recurred (come back) after treatment. The cancer could reappear in the same place or in other parts of the body. ​ 6.5. Factors affecting the prognosis of recovery ​ Prognosis and treatment options depend on the following: ​ The part of the body where the tumor first formed. Size and grade of the tumor. type of soft tissue sarcoma. How deep is the tumor under the skin. Whether the tumor has spread to other parts of the body and where it has spread. The amount of tumor left after surgery to remove it. Whether radiation therapy was used to treat the tumor. Whether the cancer was just diagnosed or recurred (came back). ​ ​ 6.6. Overview of treatment options for children's soft tissue sarcoma ​ There are various methods of treatment for patients with soft tissue sarcoma in childhood. ​ A variety of treatments are available to patients with childhood soft tissue sarcoma. Some treatments are standard (currently used) and some are in clinical trials. A clinical trial of a treatment is a scientific study designed to help improve existing treatments or provide information about new treatments for cancer patients. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. ​ Since childhood cancer is rare, participation in clinical trials should be considered. Some clinical trials are only open to patients who have not yet started treatment. ​ Children with soft tissue sarcoma in childhood should be planned for treatment by a team of healthcare professionals who are experts in treating childhood cancer. ​ Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. A pediatric oncologist works with other health care providers who are experts in treating children with soft tissue sarcoma and specialize in specific areas of medicine. This may be a pediatric surgeon who has special training in the removal of soft tissue sarcomas. The following specialists may also be included: ​ Pediatrician. Radiation Oncologist. Pediatric hematologist. Pediatric Nurse Specialist. Rehabilitation Specialist. Psychologist . Social worker . Children's Life Specialist. Seven types of standard treatment are used: ​ 1. Operation ​ If possible, an operation is performed to completely remove the soft tissue sarcoma. If the tumor is very large, radiation therapy or chemotherapy may be given first in order to shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. This is called neoadjuvant (preoperative) therapy. ​ The following types of surgical interventions can be used: ​ Wide local excision : removal of the tumor along with the normal tissue around it. Amputation : surgery to remove all or part of an arm or leg with cancer. Lymphadenectomy : removal of lymph nodes for cancer. Mohs surgery: a surgical procedure used to treat skin cancer. Individual layers of cancerous tissue are removed and examined under a microscope one at a time until all of the cancerous tissue has been removed. This type of surgery is used to treat protuberance dermatofibrosarcoma. It is also called Mohs micrographic surgery. Hepatectomy : surgery to remove all or part of the liver. A second operation may be required for: ​ Removal of all remaining cancer cells. Check the area around where the tumor was removed for cancer cells and then remove more tissue if necessary. If the cancer is in the liver, a hepatectomy and liver transplant (the liver is removed and replaced with a healthy one from a donor) may be done. ​ After the doctor removes any tumors that can be seen during surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer coming back is called adjuvant therapy. 2. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy: ​ External Beam Therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. Certain ways of delivering radiation therapy can help prevent radiation damage to nearby healthy tissue. This type of radiation therapy may include the following: Stereotactic Body Radiation Therapy : Stereotactic Body Radiation Therapy is a type of external beam radiation therapy. Special equipment is used to position the patient in the same position for each radiation therapy session. Once a day for several days, the radiation machine delivers a larger than usual dose of radiation directly to the tumor. If the patient is in the same position for each treatment session, there is less damage to nearby healthy tissue. This procedure is also called stereotactic external beam radiation therapy and stereotactic radiation therapy. Conformal radiotherapy: conformal radiation therapy is a type of external beam radiation therapy in which a computer creates a three-dimensional (3-D) image of the tumor and generates radiation beams that match the tumor. This allows a high dose of radiation to reach the tumor and cause less damage to nearby healthy tissue. Intensity Modulated Radiation Therapy (IMRT): IMRT is a type of three-dimensional (3-D) radiation therapy that uses a computer to produce images of the size and shape of a tumor. Thin beams of radiation of different intensity (strength) are directed to the tumor at different angles. This type of external beam radiation therapy does less damage to nearby healthy tissue. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are injected directly into or near the tumor. Whether radiation therapy is given before or after cancer surgery depends on the type and stage of cancer being treated, the presence of any cancer cells after surgery, and the expected side effects of the treatment. External and internal radiation therapy is used to treat soft tissue sarcoma in children. 3. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is injected directly into the cerebrospinal fluid, organ, or body cavity, such as the abdominal cavity, the drugs mainly target cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug. ​ Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is a type of treatment used during surgery that is being studied for desmoplastic small cell tumor. After the surgeon has removed as much of the tumor tissue as possible, warm chemotherapy is directed directly into the abdomen. ​ Method of conducting chemotherapy depends on the type of soft tissue sarcoma being treated. Most types of soft tissue sarcomas do not respond to chemotherapy. 4. Surveillance ​ Observation is closely monitoring the patient's condition without giving any treatment until signs or symptoms appear or change. Observation may be carried out when: ​ Complete removal of the tumor is not possible. There are no other treatments available. The tumor is unlikely to damage any vital organs. Observation may be used to treat desmoid-type fibromatosis, childhood fibrosarcoma, PEComa, or epithelioid hemangioendothelioma. 5. Targeted therapy ​ Targeted therapy is a type of treatment that uses drugs or other substances to target and target specific cancer cells. Targeted therapy usually causes less damage to normal cells than chemotherapy or radiation therapy. ​ Kinase inhibitors block an enzyme called a kinase (a type of protein). There are different types of kinases in the body that have different actions. ALK inhibitors can stop the growth and spread of cancer. Crizotinib may be used to treat inflammatory myofibroblastic tumor, childhood fibrosarcoma, and soft tissue clear cell sarcoma. Tyrosine kinase inhibitors (TKIs) block the signals necessary for tumor growth. Imatinib is used to treat protuberance dermatofibrosarcoma. Pazopanib may be used to treat desmoid-type fibromatosis, epithelioid hemangioendothelioma, and some types of recurrent and progressive soft tissue sarcoma. Sorafenib can be used to treat desmoid-type fibromatosis and epithelioid hemangioendothelioma. Sunitinib can be used to treat soft alveolar sarcoma. Larotrectinib is used to treat childhood fibrosarcoma. Ceritinib is used to treat inflammatory myofibroblastic tumor. Axitinib may be used to treat some types of advanced soft tissue sarcoma, including alveolar soft tissue sarcoma. mTOR inhibitors are a type of targeted therapy that stops a protein that helps cells divide and survive. mTOR inhibitors are used to treat recurrent desmoplastic small cell tumors, PEComas, and epithelioid hemangioendothelioma and are also being studied to treat malignant peripheral nerve sheath tumors. Sirolimus and temsirolimus are mTOR inhibitor therapies New types of tyrosine kinase inhibitors are being studied, such as: ​ Entrectinib and selitrectinib in childhood fibrosarcoma. Trametinib for epithelioid hemangioendothelioma. ​ 6. Immunotherapy ​ Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances produced by the body or produced in a laboratory are used to enhance, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy. ​ Interferon and immune checkpoint inhibitor therapy are types of immunotherapy. ​ Interferon prevents tumor cells from dividing and can slow tumor growth. It is used to treat epithelioid hemangioendothelioma. ​ Immune checkpoint inhibitor therapy: Some types of immune cells, such as T cells and some cancer cells, have certain proteins on their surface, called checkpoint proteins, that control immune responses. When cancer cells contain large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins, and the ability of T cells to kill cancer cells is increased. There are two types of immune checkpoint inhibitor therapy: CTLA-4 inhibitor therapy: CTLA-4 is a protein on the surface of T cells that helps control the body's immune responses. When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow T cells to kill cancer cells. Ipilimumab is a type of CTLA-4 inhibitor that is being studied for the treatment of angiosarcoma. PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps control the body's immune responses. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors prevent the PD-1 and PD-L1 proteins from attaching to each other. This allows T cells to kill cancer cells. Pembrolizumab is a type of PD-1 inhibitor that is used to treat progressive and recurrent soft tissue sarcoma. Nivolumab is a type of PD-1 inhibitor that is being studied for the treatment of angiosarcoma. Atezolizumab is a type of PD-L1 inhibitor that is being studied for the treatment of soft alveolar sarcoma. 7. Other drug therapy ​ Steroid therapy has an antitumor effect in inflammatory myofibroblastic tumors. ​ hormone therapy is a cancer treatment that removes or blocks hormones and stops the growth of cancer cells. Hormones are substances produced by glands in the body and circulate in the bloodstream. Certain hormones can cause certain types of cancer to grow. If tests show that cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. Antiestrogens (drugs that block estrogen), such as tamoxifen, may be used to treat desmoid-type fibromatosis. Prasterone is being studied for the treatment of synovial sarcoma. ​ Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs (such as aspirin, ibuprofen, and naproxen) commonly used to reduce fever, swelling, pain, and redness. When treating desmoid-type fibromatosis, an NSAID called sulindac can be used to help block the growth of cancer cells. 6.7. Treatment for soft tissue sarcoma in children can cause side effects. Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include: ​ physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancer (new types of cancer). ​ 6.8. Treatment options soft tissue sarcomas in children ​ Tumors of adipose tissue Liposarcoma ​ Treatment for newly diagnosed liposarcoma may include the following: ​ Surgery to completely remove the tumor. If the cancer is not completely removed, a second operation may be done. Chemotherapy to shrink the tumor followed by surgery. Radiation therapy before or after surgery. Tumors of bones and cartilage ​ Extraskeletal mesenchymal chondrosarcoma ​ Treatment for newly diagnosed extraskeletal mesenchymal chondrosarcoma may include the following: ​ Surgery to completely remove the tumor. Radiation therapy may be given before and/or after surgery. Chemotherapy followed by surgery. After surgery, chemotherapy is prescribed with or without radiation therapy. Extraskeletal osteosarcoma ​ Treatment for newly diagnosed extraskeletal osteosarcoma may include the following: ​ Surgery to completely remove the tumor followed by chemotherapy. Fibrous (connective) tissue tumors ​ Fibromatosis desmoid type ​ Treatment for newly diagnosed desmoid-type fibromatosis may include the following: ​ Surveillance for asymptomatic tumors, tumors that cannot damage any vital organs, and tumors that cannot be completely removed by surgery. Chemotherapy for tumors that have not been completely removed by surgery or that have recurred. Targeted therapy (sorafenib or pazopanib). Non-steroidal anti-inflammatory drugs (NSAIDs) therapy. Antiestrogenic drug therapy. Surgery to completely remove the tumor. Radiation therapy . Clinical study on targeted therapy with an inhibitor of the NOTCH pathway. Protuberan dermatofibrosarcoma ​ Treatment for newly diagnosed protuberance dermatofibrosarcoma may include the following: ​ Surgery to completely remove the tumor, if possible. This may include the Mohs operation. Radiation therapy before or after surgery. Radiation therapy and targeted therapy (imatinib) if the tumor cannot be removed or has returned. Inflammatory myofibroblastic tumor Treatment for a newly diagnosed inflammatory myofibroblastic tumor may include the following: ​ Surgery to completely remove the tumor, if possible. Chemotherapy. Steroid therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) therapy. Targeted therapy (crizotinib and ceritinib). fibrosarcoma ​ Pediatric fibrosarcoma ​ Treatment for newly diagnosed childhood fibrosarcoma may include the following: ​ Surgery to remove the tumor, if possible, followed by follow-up. Surgery followed by chemotherapy. Chemotherapy to shrink the tumor followed by surgery. Targeted therapy (crizotinib and larotrectinib). A clinical trial that tests a sample of a patient's tumor for certain gene changes. The type of targeted therapy that will be administered to a patient depends on the type of gene change. Clinical trials of targeted therapies (larotrectinib, entrectinib, or selitrectinib). Fibrosarcoma in adults ​ Treatment for newly diagnosed fibrosarcoma in adults may include the following: ​ Surgery to completely remove the tumor, if possible. Myxofibrosarcoma Treatment for newly diagnosed myxofibrosarcoma may include the following: Surgery to completely remove the tumor. Fibromyxoid sarcoma, low grade Treatment for newly diagnosed low-grade fibromyxoid sarcoma may include the following: ​ Surgery to completely remove the tumor. Sclerosing epithelioid fibrosarcoma ​ Treatment for newly diagnosed sclerosing epithelioid fibrosarcoma may include the following: ​ Surgery to completely remove the tumor. Skeletal muscle tumors Rhabdomyosarcoma Smooth muscle tumors ​ Leiomyosarcoma ​ Treatment for newly diagnosed leiomyosarcoma may include the following: ​ Chemotherapy. So-called fibrohistiocytic tumors ​ Plexiform fibrohistiocytic tumor ​ Treatment for a newly diagnosed plexiform fibrohistiocytic tumor may include the following: ​ Surgery to completely remove the tumor. Tumors of the nerve sheath ​ Malignant tumor of the peripheral nerve sheath ​ Treatment for a newly diagnosed malignant peripheral nerve sheath tumor may include the following: ​ Surgery to completely remove the tumor, if possible. Radiation therapy before or after surgery. Chemotherapy for tumors that cannot be removed surgically. A clinical trial that tests a sample of a patient's tumor for certain gene changes. The type of targeted therapy that will be administered to a patient depends on the type of gene change. Clinical trials of targeted therapy (ganetespib or sirolimus) for tumors that cannot be surgically removed. Clinical trials of targeted therapy (tazemetostat). It is unclear whether radiation therapy or chemotherapy after surgery improves tumor response to treatment. ​ Malignant triton tumor ​ Newly diagnosed malignant newt tumors can be treated in the same way as rhabdomyosarcomas and include surgery, chemotherapy, or radiation therapy. It is unclear whether radiation therapy or chemotherapy improves tumor response to treatment. ​ Ectomesenchymoma ​ Treatment for a newly diagnosed ectomesenchymoma may include the following: ​ Surgery. Chemotherapy. Radiation therapy . Pericytic (perivascular) tumors ​ Pediatric hemangiopericytoma ​ Treatment for newly diagnosed childhood hemangiopericytoma may include the following: ​ Chemotherapy. Childhood myofibromatosis ​ Treatment for newly diagnosed infantile myofibromatosis may include the following: ​ Combined chemotherapy. Tumors of unknown cell origin (the place where the tumor first formed is unknown) ​ synovial sarcoma ​ Treatment for newly diagnosed synovial sarcoma may include the following: ​ Surgery. Radiation therapy and/or chemotherapy may be given before or after surgery. Chemotherapy. Stereotactic radiotherapy for tumors that have spread to the lungs. Clinical Research on Gene Therapy. Clinical Trials of Hormone Therapy. Epithelioid sarcoma ​ Treatment for newly diagnosed epithelioid sarcoma may include the following: ​ If possible, surgery to remove the tumor. Chemotherapy. Radiation therapy before or after surgery. Clinical study on targeted therapy (tazemetostat). Sarcoma of the alveolar soft part ​ Treatment for newly diagnosed soft alveolar sarcoma may include the following: ​ Surgery to completely remove the tumor, if possible. Radiation therapy before or after surgery if the tumor cannot be completely removed by surgery. Targeted therapy (sunitinib). Clinical study on targeted therapy (cediranib or sunitinib). Clinical trials of immunotherapy (atezolizumab). Clear cell soft tissue sarcoma ​ Treatment for newly diagnosed clear cell soft tissue sarcoma may include the following: ​ If possible, surgery to remove the tumor. Radiation therapy before or after surgery. Targeted therapy (crizotinib). Extraskeletal myxoid chondrosarcoma Treatment for newly diagnosed extraskeletal myxoid chondrosarcoma may include the following: ​ If possible, surgery to remove the tumor. Radiation therapy . Clinical study on targeted therapy (tazemetostat). Extraskeletal Ewing's sarcoma ​ Four types of standard treatment are used: Chemotherapy Radiation therapy Operation High-dose chemotherapy with stem cell rescue New treatments are undergoing clinical trials. Targeted Therapy Immunotherapy Desmoplastic small cell tumor ​ There is no standard treatment for a newly diagnosed desmoplastic small round cell tumor. Treatment may include the following: ​ Surgery to completely remove the tumor, if possible. Surgery and Hyperthermic Intraperitoneal Chemotherapy. Chemotherapy followed by surgery. Radiation therapy . Chemotherapy and targeted therapy (temsirolimus) for recurrent tumors. Extrarenal (extracranial) rhabdoid tumor ​ Treatment for a newly diagnosed extrarenal (extracranial) rhabdoid tumor may include the following: ​ If possible, surgery to remove the tumor. Chemotherapy. Radiation therapy . A clinical trial that tests a sample of a patient's tumor for certain gene changes. The type of targeted therapy that will be administered to a patient depends on the type of gene change. Clinical trials of targeted therapy (tazemetostat). Perivascular epithelioid cell tumors (PEComas) Treatment for newly diagnosed perivascular epithelioid cell tumors may include the following: ​ Surgery to remove the tumor. Observation followed by surgery. Targeted therapy (sirolimus) for tumors that have certain genetic changes and cannot be removed by surgery. Undifferentiated / unclassified sarcoma ​ Undifferentiated pleomorphic sarcoma/malignant fibrous histiocytoma (high grade) ​ There is no standard treatment for these tumors. Tumors of blood vessels ​ Epithelioid hemangioendothelioma ​ Treatment for newly diagnosed epithelioid hemangioendothelioma may include the following: Observation. If possible, surgery to remove the tumor. Immunotherapy (interferon) and targeted therapy (thalidomide, sorafenib, pazopanib, sirolimus) for tumors that can spread. Chemotherapy. Total hepatectomy and liver transplantation for liver tumors. Clinical study on targeted therapy ( trametinib ). Soft tissue angiosarcoma ​ Treatment for newly diagnosed angiosarcoma may include the following: ​ Surgery to completely remove the tumor. Combination of surgery, chemotherapy and radiotherapy for advanced angiosarcoma. Targeted therapy (bevacizumab) and chemotherapy for angiosarcomas that started as infantile hemangiomas. Clinical trial of chemotherapy with or without targeted therapy (Pazopanib). Clinical trials for immunotherapy (nivolumab and ipilimumab). Metastatic soft tissue sarcoma in children ​ Treatment for childhood soft tissue sarcoma that has spread to other parts of the body at diagnosis may include the following: ​ Chemotherapy and Radiation Therapy. Surgery may be done to remove tumors that have spread to the lung. Stereotactic radiotherapy for tumors that have spread to the lungs. ​ Treatment of progressive or recurrent soft tissue sarcoma in children Treatment for advanced or recurrent soft tissue sarcoma in children may include the following: ​ Surgery to remove cancer that has returned to where it first formed or has spread to the lungs. Surgery followed by external or internal radiation therapy, if radiation therapy has not yet been performed. Surgery to remove the cancerous arm or leg if radiation therapy has already been given. Surgical treatment of recurrent synovial sarcoma with or without chemotherapy. Chemotherapy. Targeted therapy (Pazopanib or axitinib). Immunotherapy (pembrolizumab). Stereotactic radiation therapy to treat cancer that has spread to other parts of the body, especially the lungs. Clinical trial of a new chemotherapy regimen with or without targeted therapy (Pazopanib). A clinical trial that tests a sample of a patient's tumor for certain gene changes. The type of targeted therapy that will be administered to a patient depends on the type of gene change. 6.1. 6.2. 6.3 6.4. 6.5. 6.6 6.7. 6.8. Vascular tumors in children are formed from cells that form blood or lymphatic vessels. ​ Vascular tumors can form from abnormal cells in the blood or lymph vessels anywhere in the body. They can be benign (not cancer) or malignant (cancer). There are many types of vascular tumors. The most common type of vascular tumor in children is childhood hemangioma, a benign tumor that usually resolves on its own. ​ Since malignant vascular tumors are rare in children, there is not much information about what is the best treatment. 7.1. The tests are used to detect (search for) and diagnose vascular tumors in children. ​ The following tests and procedures may be used: ​ Medical examination and history: examining the body to check for general signs of health, including checking for signs of disease such as lumps, lesions, or anything else that seems unusual. The patient's history, health habits, past illnesses, and treatments will also be recorded. ​ Ultrasound procedure : a procedure in which high-energy sound waves (ultrasound) bounce off internal tissues or organs and create an echo. The echo forms a picture of body tissues called a sonogram. The picture can be printed to view later. CT (computed tomography) : a procedure in which a series of detailed photographs of areas within the body taken from different angles are taken. The pictures were taken by a computer connected to an x-ray machine. The dye may be injected into a vein or swallowed to make organs and tissues more visible. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (magnetic resonance imaging) : a procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI) ​ 7.2. Groups of vascular tumors in children Vascular tumors in children can be divided into four groups. 1. Benign tumors Benign tumors are not cancer. This summary contains information about the following benign vascular tumors : ​ Children's hemangioma. congenital hemangioma. Benign vascular tumors of the liver. Hemangioma spindle cell. Epithelioid hemangioma. Pyogenic granuloma (lobular capillary hemangioma). Angiofibroma. Juvenile angiofibroma of the nasopharynx. 2. Intermediate (locally aggressive) tumors ​ Interstitial tumors that are locally aggressive often spread to the area around the tumor. This review provides information on the following locally aggressive vascular tumors: ​ Kaposiform hemangioendothelioma and bundle angioma. 3. Intermediate (rarely metastasizing) tumors ​ Intermediate (rarely metastatic) tumors sometimes spread to other parts of the body. This summary provides information on the following vascular tumors that rarely metastasize: ​ Pseudomyogenic hemangioendothelioma. Retiform hemangioendothelioma. Papillary intralymphatic angioendothelioma. Composite hemangioendothelioma. Kaposi's sarcoma. 4. Malignant tumors ​ Malignant tumors are cancer. This summary provides information on the following vascular malignancies: ​ Epithelioid hemangioendothelioma. Soft tissue angiosarcoma. ​ 7.3. Overview of treatment options ​ There are various treatments for vascular tumors in children. ​ A variety of treatments are available for children with vascular tumors. Some treatments are standard (currently used) and some are in clinical trials. A clinical trial of a treatment is a scientific study designed to help improve existing treatments or provide information about new treatments. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. ​ Since vascular tumors are rare in children, participation in clinical trials should be considered. Some clinical trials are only open to patients who have not yet started treatment. ​ Treatment of children with childhood vascular tumors should be planned by a team of healthcare professionals who are experts in the treatment of childhood cancer. ​ Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. A pediatric oncologist works with other pediatric providers who are experts in treating children with cancer and specialize in specific areas of medicine. This may include the following professionals: ​ Pediatric specialist in vascular anomalies (specialist in the treatment of vascular tumors in children). Pediatric surgeon. Orthopedic surgeon. Radiation Oncologist. Pediatric Nurse Specialist. Rehabilitation Specialist. Psychologist . Social worker . Treatment of vascular tumors in children may cause side effects. Some treatments, such as chemotherapy and radiation therapy, cause side effects that continue or appear months or years after treatment ends. These are the so-called late effects. Late effects of treatment may include the following: ​ physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancer (new types of cancer). Some late effects can be treated or controlled. It is important to talk to your child's doctors about possible late effects of certain treatments. ​ Eleven types of standard treatment are used: ​ 1. Beta-blocker therapy ​ Beta blockers are drugs that lower blood pressure and heart rate. When used in patients with vascular tumors, beta-blockers may help shrink the tumor. Beta-blocker therapy may be given by vein (IV), by mouth, or placed on the skin (topical). The method of application of beta-blockers depends on the type of vascular tumors and where the tumor first formed. ​ The beta-blocker propranolol is usually the first drug to treat hemangiomas. Infants receiving intravenous propranolol may need to start treatment in the hospital. Propranolol is also used to treat benign vascular tumors in the liver and kaposiform hemangioendothelioma. ​ Other beta-blockers used to treat vascular tumors include atenolol, nadolol, and timolol. ​ Pediatric hemangioma can also be treated with propranolol and steroid therapy, or propranolol and topical beta-blocker therapy. 2. Operation ​ The following types of surgery can be used to remove many types of vascular tumors: ​ Excision : an operation to remove the entire tumor and part of the healthy tissue around it. Laser surgery : a surgical procedure in which a laser beam (a narrow beam of intense light) is used as a knife to make bloodless cuts in tissue or remove skin lesions such as a tumor. For some hemangiomas, a pulsed dye laser can be used. This type of laser uses a beam of light that affects the blood vessels in the skin. The light is converted to heat and the blood vessels are destroyed without damaging the adjacent skin. Curettage : a procedure in which abnormal tissue is removed using a small, spoon-shaped instrument called a curette. Total hepatectomy and liver transplant: a surgical procedure to remove the entire liver, followed by transplantation of a healthy liver from a donor. The type of surgery used depends on the type of vascular tumor and its location in the body. ​ For malignant tumors, after the doctor has removed all tumors that can be seen during surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer coming back is called adjuvant therapy. ​ 3. Photocoagulation ​ Photocoagulation is the use of an intense beam of light, such as a laser, to close blood vessels or destroy tissue. Used to treat pyogenic granuloma. ​ 4. Embolization ​ Embolization is a procedure in which particles, such as tiny gelatin sponges or beads, block blood vessels in the liver. It can be used to treat certain benign vascular tumors of the liver and kaposiform hemangioendothelioma. ​ 5. Chemotherapy ​ Chemotherapy is a treatment that uses drugs to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. There are different ways of giving chemotherapy: ​ Systemic chemotherapy: when chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach tumor cells throughout the body. Sometimes more than one anticancer drug is prescribed. This is called combination chemotherapy. Local chemotherapy: when chemotherapy is applied to the skin in the form of a cream or lotion, the drugs primarily target the tumor cells in the treated area. Regional chemotherapy: when chemotherapy is injected directly into the cerebrospinal fluid, organ, or body cavity, such as the abdominal cavity, the drugs mainly target tumor cells in those areas. How chemotherapy is given depends on the type of vascular tumor being treated. Systemic and local chemotherapy are used to treat some vascular tumors. ​ 6. Sclerotherapy ​ Sclerotherapy is a treatment used to destroy a blood vessel leading to swelling and swelling. Fluid is injected into the blood vessel, causing it to become scarred and destroyed. Over time, the destroyed blood vessel is absorbed into normal tissues. Instead, blood flows through nearby healthy veins. Sclerotherapy is used in the treatment of epithelioid hemangioma. ​ 7. Radiation therapy ​ Radiation therapy is a treatment that uses high-energy x-rays or other types of radiation to kill tumor cells or prevent their growth. There are two types of radiation therapy: ​ External Beam Therapy uses a device located outside the body to direct radiation at a tumor. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are injected directly into or near the tumor. The way radiation therapy is given depends on the type of vascular tumor being treated. External radiation is used to treat some vascular tumors. ​ 8. Targeted therapy ​ Targeted Therapy is a type of treatment that uses drugs or other substances to attack specific tumor cells. Targeted therapy usually causes less damage to normal cells than chemotherapy or radiation therapy. Various types of targeted therapies are being used or are being studied to treat vascular tumors in children: ​ Angiogenesis inhibitors : angiogenesis inhibitors are drugs that stop cell division and prevent the growth of new blood vessels needed for tumor growth. The targeted therapy drugs thalidomide, sorafenib, pazopanib, and sirolimus are angiogenesis inhibitors used to treat vascular tumors in children. Mammalian target for rapamycin (mTOR) inhibitors: mTOR inhibitors block a protein called mTOR, which can inhibit the growth of cancer cells and prevent the growth of new blood vessels needed for tumor growth. Kinase inhibitors: kinase inhibitors block the signals necessary for tumor growth. Trametinib is being studied for the treatment of epithelioid hemangioendothelioma. 9. Immunotherapy ​ Immunotherapy is a treatment that uses the patient's immune system to fight disease. Substances produced by the body or produced in a laboratory are used to enhance, direct, or restore the body's natural defenses against disease. ​ In the treatment of vascular tumors in children, the following types of immunotherapy are used: ​ Interferon is a type of immunotherapy used to treat vascular tumors in children. It prevents tumor cells from dividing and can slow tumor growth. It is used in the treatment of juvenile angiofibroma of the nasopharynx, kaposiform hemangioendothelioma, and epithelioid hemangioendothelioma. Therapy with immune checkpoint inhibitors: some types of immune cells, such as T cells and some cancer cells, have certain proteins on their surface called checkpoint proteins that control immune responses. When cancer cells contain large amounts of these proteins, they will not be attacked and killed by T cells. Immune checkpoint inhibitors block these proteins, and the ability of T cells to kill cancer cells is increased. There are two types of immune checkpoint inhibitor therapy: CTLA-4 inhibitor: CTLA-4 is a protein on the surface of T cells that helps control the body's immune responses. When CTLA-4 attaches to another protein called B7 on a cancer cell, it stops the T cell from killing the cancer cell. CTLA-4 inhibitors attach to CTLA-4 and allow T cells to kill cancer cells. Ipilimumab is a type of CTLA-4 inhibitor being studied in the treatment angiosarcomas of soft tissue . 10. Other drug therapy ​ Other medicines used to treat or reverse the effects of vascular tumors in children include the following: ​ Steroid Therapy: Steroids are hormones produced naturally by the body. They can also be made in a laboratory and used as medicines. Steroid drugs help reduce vascular tumors. Corticosteroids such as prednisone and methylprednisolone are used to treat childhood hemangioma. Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs are commonly used to reduce fever, swelling, pain, and redness. Examples of NSAIDs are aspirin, ibuprofen and naproxen. In the treatment of vascular tumors, NSAIDs can increase blood flow through tumors and reduce the chance of unwanted thrombus formation. Antifibrinolytic therapy: these drugs aid blood clotting in patients with Kasabach-Merritt syndrome. Fibrin is the main protein in a blood clot that helps stop bleeding and heal wounds. Some vascular tumors cause fibrin to break down and the patient's blood does not clot normally, causing uncontrolled bleeding. Antifibrinolytics help prevent the breakdown of fibrin. 11. Surveillance ​ Observation is closely monitoring the patient's condition without giving any treatment until signs or symptoms appear or change. 7.4. benign tumors ​ In this section ​ Pediatric hemangioma congenital hemangioma Benign vascular tumors of the liver Hemangioma spindle cell Epithelioid hemangioma Pyogenic granuloma Angiofibroma Juvenile angiofibroma of the nasopharynx 1. Pediatric hemangioma ​ Infantile hemangiomas - the most common type of benign vascular tumor in children. Baby hemangiomas form when immature cells that should form blood vessels form a tumor instead. An infantile hemangioma can also be called a "strawberry mark". ​ These tumors do not usually appear at birth, but appear between 3 and 6 weeks of age. Most hemangiomas enlarge for about 5 months and then stop growing. Hemangiomas gradually disappear over the next few years, but a red mark or loose or wrinkled skin may remain. Infantile hemangioma rarely comes back. ​ Childhood hemangiomas can be on the skin, in tissues under the skin, and/or in an organ. They are usually found on the head and neck, but can be anywhere on the body or anywhere. Hemangiomas may present as a single lesion, one or more lesions spreading over a large area of the body, or multiple lesions in more than one part of the body. Lesions that spread over a large area of the body or multiple lesions are more likely to cause problems. ​ Infantile hemangioma with minimal or delayed growth (IH-MAG) is a specific type of infantile hemangioma that occurs at birth and does not tend to increase. The lesion appears as light and dark patches of redness on the skin. The lesions are usually found on the lower body, but may be on the head and neck. This type of hemangiomas resolves over time without treatment. Risk factors ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean you will get sick; the absence of risk factors does not mean that you will not get sick. Talk to your child's doctor if you think your child may be at risk. ​ Infantile hemangiomas are more common in the following cases: ​ Girls. White. Premature babies. Twins, triplets or other multiple births. Babies from mothers who are older at the time of pregnancy or who have problems with the placenta during pregnancy. Other risk factors for infantile hemangiomas include the following: ​ A family history of childhood hemangioma, usually in the mother, father, sister, or brother. Presence of certain syndromes: ​ ​ PHACE Syndrome: a syndrome in which the hemangioma spreads to most of the body (usually the head or face). Other health problems may also occur that affect large blood vessels, the heart, eyes, and/or brain. LUMBAR/Pelvic/CUT Syndrome : a syndrome in which the hemangioma extends over much of the lower back. Other health problems may also occur that affect the urinary system, reproductive organs, rectum, anus, brain and spinal cord, and nerve function. Having more than one hemangioma, respiratory hemangioma, or ophthalmic hemangioma increases the risk of other health problems. ​ Multiple hemangiomas: the presence of more than five hemangiomas on the skin is a sign that there may be hemangiomas in the organ. Liver dependent most often. Heart, muscle, and thyroid problems may also occur. ​ Airway hemangiomas: airway hemangiomas usually occur along with a large beard-shaped hemangioma on the face (from the ears, around the mouth, lower chin, and front of the neck). It is important to treat airway hemangiomas before the child has breathing problems. ​ Ophthalmic hemangiomas: hemangiomas that affect the eye can cause vision problems or blindness. Infantile hemangiomas can occur in the conjunctiva (the membrane that lines the inside of the eyelid and covers the front of the eye). These hemangiomas may be associated with other abnormal eye conditions. It is important that children with ophthalmic hemangioma be evaluated by an ophthalmologist. Signs and symptoms ​ Childhood hemangiomas can cause any of the following signs and symptoms. Check with your child's doctor if your child has any of the following: ​ Skin lesions: an area of spider veins, as well as clarified or discolored skin, may appear earlier than a hemangioma. Hemangiomas are hard, warm, bright red or crimson skin lesions or may look like a bruise. Lesions that form ulcers are also painful. Later, as the hemangiomas pass, they begin to pale in the center, then become flatter and lose color. ​ Skin lesions: lesions that grow under the skin in fatty tissue may appear blue or purple. If the lesions are deep enough under the surface of the skin, they may not be noticed. ​ Lesions in the body: signs of hemangioma formation in the organ may be absent. While most childhood hemangiomas are nothing to worry about, if your child develops bumps or red or blue spots on their skin, check with your child's doctor. If necessary, he can refer the child to a specialist. Diagnostic tests ​ Medical examination and history is usually all that is needed to diagnose infantile hemangiomas. If there is anything unusual in the tumor, a biopsy may be done. If the hemangioma is deeper inside the body with no skin changes, or the lesions spread over a large area of the body, an ultrasound may be performed. ​ If hemangiomas are part of the syndrome, additional tests may be performed such as an echocardiogram, MRI, magnetic resonance angiogram, and an eye exam. ​ Treatment ​ Most hemangiomas disappear and shrink without treatment. If the hemangioma is large or causing other health problems, treatment may include the following: ​ Propranolol or other beta-blocker therapy. Steroid therapy before starting beta-blocker therapy or when beta-blockers cannot be used. Pulsed dye laser surgery for hemangiomas that have ulcers or have not completely disappeared. Surgical intervention (excision) of hemangiomas that have ulcers, have vision problems, or have not completely disappeared. Surgery may also be used for facial lesions that do not respond to other treatments. Local therapy with beta-blockers for hemangiomas in one area of the skin. Combination therapy such as propranolol and steroid therapy or propranolol and topical beta-blocker therapy. Clinical trial with beta-blockers (Nadolol and propranolol). Clinical trials of local therapy with beta-blockers (timolol). 2. Congenital hemangioma ​ congenital hemangioma is a benign vascular tumor that begins to form even before birth and is fully formed at the birth of a child. They are usually found on the skin, but may be elsewhere. Congenital hemangioma may appear as a rash of purple patches, with the skin around the patch may be lighter in color. ​ There are three types of congenital hemangiomas: ​ Rapidly invasive congenital hemangioma: these tumors go away on their own 12 to 15 months after birth. They can ulcerate, bleed, and cause temporary problems with blood and heart clotting. The skin may look slightly different even after the hemangiomas are gone. ​ Partial involutional congenital hemangioma: these tumors do not disappear completely. ​ Non-involutional congenital hemangioma: these tumors never go away on their own. ​ Treatment ​ Treatment for rapidly involuting congenital hemangioma and partial involutive congenital hemangioma may include the following: Only observation. Treatment for non-involutional congenital hemangioma may include the following: Surgery to remove the tumor, depending on where it is located and whether it is causing symptoms. 3. Benign vascular tumors of the liver ​ Benign vascular tumors of the liver can be focal vascular lesions (single lesion in one area of the liver), multiple hepatic lesions (multiple lesions in one area of the liver), or diffuse hepatic lesions (multiple lesions in more than one area of the liver). ​ The liver performs many functions, including filtering the blood and making proteins needed for blood clotting. Sometimes the blood that normally flows through the liver is blocked or slowed down by the tumor. This directs blood directly to the heart without passing through the liver and is called a hepatic shunt. This can cause heart failure and blood clotting problems. ​ Focal vascular lesions ​ Focal vascular lesions are usually rapidly involutional congenital hemangiomas or non-involutional congenital hemangiomas. Treatment ​ Treatment of focal vascular lesions of the liver depends on the presence of symptoms and may include the following: Observation. Medicines to treat symptoms including heart failure and bleeding problems. Embolization of the liver to treat symptoms. Surgery for lesions not amenable to other treatment. Multiple and diffuse liver lesions ​ Multifocal and diffuse liver lesions are usually infantile hemangiomas. Diffuse liver damage can cause serious consequences, including thyroid and heart problems. The liver may enlarge, press on other organs, and cause more symptoms. Treatment ​ Treatment for multifocal liver lesions may include the following: Monitor for lesions that do not cause symptoms. Therapy with beta-blockers (propranolol) for lesions that are starting to grow. Treatment for diffuse liver disease may include the following: Beta-blocker therapy (propranolol). Chemotherapy. Steroid therapy. Total hepatectomy and liver transplantation when lesions are not amenable to drug therapy. This is done only when the lesions have spread widely in the liver and more than one organ has failed. If a vascular lesion in the liver does not respond to standard treatment, a biopsy may be done to see if the tumor has become malignant. ​ 4. Hemangioma spindle cell ​ Spindle cell hemangiomas contain cells called spindle cells. Under a microscope, spindle cells look long and thin. ​ Risk factors ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean you will get sick; the absence of risk factors does not mean that you will not get sick. Talk to your child's doctor if you think your child may be at risk. Spindle cell hemangiomas are more common in children with the following syndromes: ​ Maffucci syndrome, which affects cartilage and skin. Klippel-Trenaune syndrome, which affects blood vessels, soft tissues, and bones. Signs Spindle cell hemangiomas appear on or under the skin. These are painful red-brown or bluish growths that usually appear on the arms or legs. They can start as one defeat and develop into new ones over time. Treatment There is no standard treatment for spindle cell hemangiomas. Treatment may include the following: Surgery to remove the tumor. Spindle cell hemangiomas may return after surgery. 5. Epithelioid hemangioma ​ Epithelioid hemangiomas usually form on or in the skin, especially on the head, but can also occur in other areas, such as bones. ​ Signs and symptoms ​ Epithelioid hemangiomas sometimes result from trauma. On the skin, they may look like hard pink or red bumps and may be itchy. An epithelioid hemangioma of bone can cause swelling, pain, and weakening of the bone in the affected area. Treatment ​ There is no standard treatment for epithelioid hemangiomas. Treatment may include the following: ​ Operation (curettage or resection). Sclerotherapy. Radiation therapy in rare cases. Epithelioid hemangiomas often return after treatment. 6. Pyogenic granuloma ​ Pyogenic granuloma is also called lobular capillary hemangioma. It is most common in older children and young adults, but can occur at any age. ​ These lesions sometimes result from injury or from the use of certain medications, including birth control pills and retinoids. They can also form, for no known reason, inside capillaries (tiny blood vessels), arteries, veins, or other places on the body. Usually there is only one lesion, but sometimes multiple lesions occur in the same area or lesions may spread to other areas of the body. Symptoms ​ Pyogenic granulomas are raised, bright red masses that can be small or large, smooth or bumpy. They grow rapidly over weeks or months and may bleed heavily. These lesions are usually found on the surface of the skin, but may form in the tissues under the skin and look like other vascular lesions. Treatment ​ Some pyogenic granulomas go away without treatment. Other pyogenic granulomas require treatment, which may include the following: ​ Operation (excision or curettage) to remove the lesion. Photocoagulation. Local therapy with beta-blockers. Pyogenic granulomas often return after treatment. 7. Angiofibroma ​ Angiofibromas are rare. These are benign skin lesions that usually occur in a condition called tuberous sclerosis (an inherited disorder that causes skin lesions, seizures, and mental disorders). ​ Symptoms ​ Angiofibromas look like red bumps on the face. Treatment ​ Treatment for angiofibroma may include the following: ​ Operation (excision) to remove the tumor. laser therapy. Targeted therapy (sirolimus). 8. Juvenile angiofibroma of the nasopharynx ​ Juvenile angiofibromas of the nasopharynx are benign tumors, but they can grow into nearby tissues. They begin in the nasal cavity and may spread to the nasopharynx, paranasal sinuses, bones around the eyes, and sometimes to the brain. ​ Treatment ​ Treatment for juvenile nasopharyngeal angiofibromas may include the following: ​ Surgery (excision) to remove the tumor. Radiation therapy . Chemotherapy. Immunotherapy (interferon). Targeted therapy (sirolimus). 7.5. Intermediate tumors spreading locally Kaposiform hemangioendothelioma and crested angioma ​ Kaposiform hemangioendotheliomas and tufted angiomas are blood vessel tumors that occur in infants or young children. These tumors can cause the Kasabagh-Merritt phenomenon, a condition in which blood cannot clot and severe bleeding can occur. In the Kasabah-Merritt phenomenon, the tumor traps and destroys platelets (blood clotting cells). Then there are not enough platelets in the blood to stop the bleeding. This type of vascular tumor is unrelated to Kaposi's sarcoma. ​ Signs and symptoms ​ Kaposiform hemangioendotheliomas and fascicular angiomas usually occur on the skin of the arms and legs, but can also form in deeper tissues such as muscle or bone, or in the chest or abdomen. Signs and symptoms may include the following: Dense painful areas of skin with bruises. Purple or brownish-red patches of skin. Light bruising. More severe than normal bleeding from mucous membranes, wounds, and other tissues. Patients with kaposiform hemangioendothelioma and tuft angioma may have anemia (weakness, feeling tired, or pale). If the physical examination and MRI clearly show that the tumor is a kaposiform hemangioendothelioma or tufted angioma, a biopsy may not be required. A biopsy is not always done because serious bleeding can occur. Treatment ​ ​ Treatment of kaposiform hemangioendotheliomas and tufted angiomas depends on the child's symptoms. Infection, delay in treatment, and surgery can cause life-threatening bleeding. Kaposiform hemangioendotheliomas and tufted angiomas are best treated by a specialist in vascular anomalies. ​ Treatment and supportive care to stop bleeding may include the following: ​ Steroid therapy, which may be followed by chemotherapy. Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin. Immunotherapy (interferon). Antifibrinolytic therapy to improve blood clotting. Chemotherapy with one or more anticancer drugs. Beta-blocker therapy (propranolol). Surgery ( excision ) to remove the tumor with or without embolization . Targeted therapy (sirolimus) with or without steroid therapy. Clinical trial of chemotherapy or targeted therapy (sirolimus). Even after treatment, these tumors do not completely go away and may return. Pain and inflammation may increase with age, often around puberty. Long-term effects include chronic pain, heart failure, bone problems, and lymphedema (accumulation of lymph fluid in tissues). 7.6. Interstitial tumors that rarely spread In this section ​ 1) Pseudomyogenic hemangioendothelioma 2) Retiform hemangioendothelioma 3) Papillary intralymphatic angioendothelioma 4) Composite hemangioendothelioma 5) Kaposi's sarcoma 1) Pseudomyogenic hemangioendothelioma ​ Pseudomyogenic hemangioendothelioma can occur in children but is most common in men between the ages of 20 and 50. These tumors are rare and usually occur on or under the skin or in the bone. They may spread to nearby tissues but do not usually spread to other parts of the body. In most cases, multiple tumors occur. ​ Signs and symptoms ​ Pseudomyogenic hemangioendotheliomas may present as a soft tissue lump or cause pain in the affected area. Treatment ​ Treatment for pseudomyogenic hemangioendotheliomas may include the following: If possible, surgery to remove the tumor. If there are multiple tumors in the bone, amputation may be required. Chemotherapy. Targeted therapy (mTOR inhibitors). Because pseudomyogenic hemangioendothelioma is very rare in children, treatment options are based on clinical trials in adults. 2) Retiform hemangioendothelioma ​ Reform hemangioendotheliomas are slow-growing, flat tumors that occur in young people and sometimes in children. These tumors usually occur on or under the skin of the arms, legs, and torso. These tumors usually do not spread to other parts of the body. Treatment ​ Treatment for retiform hemangioendotheliomas may include the following: Operation (excision) to remove the tumor. Follow-up will include monitoring to see if the tumor comes back. Radiation therapy and chemotherapy when surgery cannot be performed or when the tumor has returned. Retiform hemangioendothelioma may return after treatment. 3) Papillary intralymphatic angioendothelioma Papillary intralymphatic angioendotheliomas are also called Dubsky tumors. These tumors form in or under the skin anywhere on the body. Sometimes the lymph nodes are affected. Symptoms ​ Papillary intralymphatic angioendotheliomas may appear as firm, raised purplish bumps that may be small or large. Treatment ​ Treatment for papillary intralymphatic angioendotheliomas may include the following: Operation (excision) to remove the tumor. 4) Composite hemangioendothelioma ​ Compound hemangioendotheliomas have features of both benign and malignant vascular tumors. These tumors usually occur on or under the skin of the hands or feet. They can also occur on the head, neck, or chest. Composite hemangioendotheliomas are unlikely to metastasize (spread), but they may reappear in the same location. When a tumor metastasizes, it usually spreads to nearby lymph nodes. Treatment ​ Treatment for composite hemangioendotheliomas may include the following: Surgery to remove the tumor. Radiation therapy and chemotherapy for advanced tumors. 5) Kaposi's sarcoma ​ Kaposi's sarcoma is a cancer that causes lesions to grow on the skin; on the mucous membranes that line the mouth, nose and throat; The lymph nodes ; or other bodies. It is caused by the Kaposi's sarcoma herpes virus (KSHV). In the United States, it occurs most often in children who have a weak immune system caused by rare immune system diseases, HIV infection, or drugs used in organ transplants. Symptoms ​ Signs in children may include the following: Lesions of the skin, mouth or throat. Skin lesions are red, purple, or brown in color and vary from flat to raised, scaly areas called plaques, and nodules. Enlarged lymph nodes. Treatment ​ Treatment for Kaposi's sarcoma may include the following: Chemotherapy. Immunotherapy (interferon). Radiation therapy . Because Kaposi's sarcoma is very rare in children, some treatment options are based on clinical trials in adults. 7.7. Malignant tumors In this section ​ 1) Epithelioid hemangioendothelioma 2) Angiosarcoma of soft tissues 1) Epithelioid hemangioendothelioma ​ Epithelioid hemangioendotheliomas can occur in children but are most common in adults between the ages of 30 and 50. They usually originate in the liver, lungs, or bones. They may grow quickly or slowly. In about a third of cases, the tumor spreads very quickly to other parts of the body. ​ Signs and symptoms ​ Signs and symptoms depend on where the tumor is located: On the skin, the tumors may be raised, round, or flat, reddish-brown patches that feel warm. In the lungs, there may be no early symptoms. Signs and symptoms that may occur include: Chest pain. Spitting up blood. Anemia (weakness, feeling tired or pale). Breathing problems (due to scarring of the lung tissue). In bones, tumors can cause fractures. Tumors that originate in the liver or soft tissues can also cause signs and symptoms. Diagnostic tests ​ Epithelioid hemangioendotheliomas in the liver are detected using computed tomography and magnetic resonance imaging. You can also do x-rays. ​ Treatment ​ Treatment for slow-growing epithelioid hemangioendotheliomas includes the following: Observation. Treatment for rapidly growing epithelioid hemangioendotheliomas may include the following: If possible, surgery to remove the tumor. Immunotherapy (interferon) and targeted therapy (thalidomide, sorafenib, pazopanib, sirolimus) for tumors that can spread. Chemotherapy. Total hepatectomy and liver transplantation for liver tumors. Clinical study on targeted therapy ( trametinib ). Clinical trials of chemotherapy and targeted therapy (pazopanib). 2) Angiosarcoma of soft tissues ​ Angiosarcomas are fast-growing tumors that form in the blood or lymph vessels anywhere in the body, usually the soft tissues. Most angiosarcomas are on or near the skin. Those found in deeper soft tissues can form in the liver, spleen, and lungs. ​ These tumors are very rare in children. Children sometimes have more than one tumor in the skin and/or liver. Risk factors ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean you will get sick; the absence of risk factors does not mean that you will not get sick. Talk to your child's doctor if you think your child may be at risk. Risk factors for angiosarcoma include the following: Exposure to radiation. Chronic (long-term) lymphedema is a condition in which excess lymphatic fluid accumulates in the tissues, causing swelling. Having a benign vascular tumor. A benign tumor such as a hemangioma can become an angiosarcoma, but this is rare. Symptoms ​ Signs of angiosarcoma depend on where the tumor is located and may include the following: Red spots on the skin that bleed easily. Purple Tumors. ​ Treatment Treatment for angiosarcoma may include the following: Surgery to completely remove the tumor. Combination of surgery, chemotherapy and radiotherapy for advanced angiosarcoma. Targeted therapy (bevacizumab) and chemotherapy for angiosarcomas that started as infantile hemangiomas. Clinical trial of chemotherapy with or without targeted therapy (Pazopanib). Clinical trials for immunotherapy (nivolumab and ipilimumab). 7. TREATMENT OF VASCULAR TUMORS IN CHILDREN Якорь 7 7.1 7.2 7.3. 7.4. 1) 2) 3) 4) 5) 6) 7) 8) 7.5. 7.6. 76.1 76.2 76.3 76.4 76.5 7.7. 77.1 77.2 8. TREATMENT OF EUING'S SARCOMA Якорь 8 Ewing's sarcoma is a type of tumor that forms in bone or soft tissue. ​ Ewing's sarcoma is a type of tumor that forms from a specific type of cells in bone or soft tissue. Ewing's sarcoma can be found in the bones of the legs, arms, feet, hands, chest, pelvis, spine, or skull. Ewing's sarcoma can also be found in the soft tissues of the trunk, arms, legs, head, neck, and retroperitoneal space (the area in the back of the abdomen behind the tissue that lines the abdominal wall and covers most of the abdominal organs). or in other areas. ​ Ewing's sarcoma is most common in adolescents and young adults (from adolescence to 25 years). ​ Ewing's sarcoma has also been called peripheral primitive neuroectodermal tumor, Askin's tumor (Ewing's sarcoma of the chest wall), extraosseous Ewing's sarcoma (Ewing's sarcoma in tissues other than bone), and the Ewing's sarcoma family of tumors. ​ Undifferentiated round cell sarcoma can also occur in bones or soft tissues. Undifferentiated round cell sarcoma usually occurs in the bones or muscles that attach to the bones and help the body move. There are three types of undifferentiated round cell sarcoma that are treated as Ewing's sarcoma: ​ Undifferentiated round cell sarcoma with rearrangements BCOR-CCNB3. This type of bone tumor usually forms in the pelvis, arms, or legs. It can spread to other parts of the body. In this type of round cell sarcoma, the BCOR gene is linked to the CCNB3 gene. To diagnose round cell sarcoma, tumor cells are tested for this gene change. Undifferentiated round cell sarcoma with rearrangements CIC-DUX4. This type of soft tissue tumor usually forms in the trunk, arms, or legs. It is most common in men and young adults between the ages of 21 and 40. In this type of round cell sarcoma, the CIC gene is linked to the DUX4 gene. To diagnose round cell sarcoma, tumor cells are tested for this gene change. Undifferentiated round cell sarcoma with CIC-NUTM1 rearrangements. This type of soft tissue tumor usually forms in the central nervous system, but can also form in the trunk. Most often seen in young patients. ​ 8.1. Symptoms Ewing's sarcoma signs and symptoms include swelling and pain near the tumor. ​ These and other signs and symptoms can be caused by Ewing's sarcoma or other conditions. Check with your child's doctor if your child has any of the following: ​ Pain and / or swelling, usually in the arms, legs, chest, back, or pelvis. A lump (which may feel soft and warm) in the arms, legs, chest, or pelvis. Fever for no known reason. A bone that breaks for no known reason. ​ 8.2. Diagnostics ​ Tests that examine bones and soft tissue are used to diagnose and stage Ewing's sarcoma. ​ Procedures that take pictures of bones, soft tissue, and surrounding areas help diagnose Ewing's sarcoma and show how far the cancer has spread. The process used to determine if cancer cells have spread in and around bones and soft tissues or to other parts of the body is called staging. ​ To plan treatment, it is important to know if the cancer has spread to other parts of the body. Tests and procedures to detect, diagnose, and stage Ewing's sarcoma are usually done at the same time. ​ The following tests and procedures can be used to diagnose or stage Ewing's sarcoma: ​ Physical examination and health history: Examining the body to check for general signs of health, including checking for signs of illness, such as tumors or anything else that seems unusual. There will also be a history of the patient's health habits, as well as past illnesses and treatments. ​ MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body, such as an area where a tumor has formed. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ CT (computed tomography): A procedure in which a series of detailed pictures of areas inside the body, such as the area of a tumor or the chest, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to make organs and tissues more visible. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ PET scan (positron emission tomography): a procedure to look for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Cancer cells appear brighter because they are more active and consume more glucose than normal cells. PET and computed tomography are often done at the same time. If there is any cancer, it increases the chance of finding it. ​ Bone scan: A procedure to check for rapidly dividing cells such as cancer cells in the bone. A very small amount of radioactive material is injected into a vein and passed through the bloodstream. The radioactive material builds up in the bones in cancer and is detected by a scanner. ​ Bone marrow aspiration and biopsy: Removal of bone marrow and a small piece of bone by inserting a cannula into the hip bone. Samples are removed from both pelvic bones. A pathologist examines the bone marrow and bones under a microscope to see if the cancer has spread. ​ X-ray: An X-ray is a type of energy beam that can pass through the body onto a film, creating an image of areas inside the body, such as the chest or the area where a tumor has formed. ​ Complete blood count (CBC): A procedure in which a blood sample is taken and checked for the following: ​​ The number of erythrocytes, leukocytes and platelets. The amount of hemoglobin (oxygen-carrying protein) in red blood cells. The portion of a blood sample made up of red blood cells. Blood chemistry tests: A procedure in which a blood sample is tested to measure the amount of certain substances, such as lactate dehydrogenase (LDH), released into the blood by the body's organs and tissues. An unusual (more or less than usual) amount of a substance may be a sign of illness. ​ A biopsy is done to diagnose Ewing's sarcoma. ​ Tissue samples are taken during a biopsy so that a pathologist can examine them under a microscope to check for signs of cancer. It is helpful if the biopsy is done at the same center where the treatment will be given. ​ Needle biopsy: For a needle biopsy, tissue is removed with a needle. This type of biopsy can be done if it is possible to take tissue samples large enough to be used for testing. ​ Postoperative biopsy: For a postoperative biopsy, a tissue sample is removed through an incision in the skin. ​ Excisional biopsy: Removal of an entire tumor or area of tissue that does not appear normal. The specialists (pathologist, oncologist and surgeon) who will treat the patient will usually work together to select the best site to place the needle or biopsy incision. The choice of the biopsy site is very important. An incorrectly selected biopsy site can lead to more extensive surgery to remove the tumor or a larger area that is being treated with radiation therapy. ​ If there is a chance that the cancer has spread to nearby lymph nodes, one or more of the lymph nodes may be removed and checked for signs of cancer. ​ The following tests can be performed on the removed tissue: ​ Cytogenetic analysis: a laboratory test in which the chromosomes of cells in a tissue sample are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in some chromosomes can be a sign of cancer. Cytogenetic analysis is used to diagnose cancer, plan treatment, or determine the effectiveness of a treatment. ​ Immunohistochemistry: A laboratory test that uses antibodies to check for specific antigens (markers) in a tissue sample from a patient. Antibodies are usually associated with an enzyme or fluorescent dye. After antibodies bind to a specific antigen in a tissue sample, the enzyme or dye is activated and the antigen can be seen under a microscope. This type of test is used to diagnose cancer and help distinguish one type of cancer from another. ​ Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of living cells in the sample, and certain characteristics of cells such as size, shape, and the presence of tumor (or other) markers on the cell surface. Cells from a sample of blood, bone marrow, or other tissue from a patient are stained with a fluorescent dye, placed in a liquid, and then passed one at a time through a beam of light. The test results are based on how cells stained with a fluorescent dye respond to a beam of light. ​ Additional tests may be required. ​ Some of the tests that have been done to diagnose cancer or to determine the stage of cancer may be repeated. Some tests will be repeated to see how effective the treatment is. Decisions to continue, change, or stop treatment may be based on the results of these tests. ​ Some tests will continue from time to time after treatment ends. The results of these tests can show if your child's condition has changed or if the cancer has recurred (returned). These tests are sometimes called follow-up or follow-up examinations. ​ 8.3. Factors affecting the prognosis of recovery ​ Factors affecting prognosis are different before and after treatment. ​ Before any treatment is prescribed, the prognosis depends on: ​ Whether the tumor has spread to lymph nodes or distant parts of the body. Where the tumor started in the body. Whether the tumor has formed in the bone or soft tissue. How large is the tumor when a tumor is diagnosed. Whether the tumor is caused by bone fractures. The LDH level in the blood is higher than normal. Whether there are specific gene changes in the tumor. Has the tumor DNA been found in the blood. Whether the patient is younger than 15 years old. Patient gender. Whether the patient was being treated for another cancer. Whether the tumor has just been diagnosed or whether it has relapsed (come back). After treatment, the prognosis is influenced by: ​ Whether the tumor has been completely removed by surgery. If the tumor has responded to chemotherapy or radiation therapy. If cancer recurs after initial treatment, the prognosis depends on: ​ Whether cancer has returned more than two years after initial treatment. Whether the cancer originated in the place where it first formed or in other parts of the body. ​ 8.4. Stages of Ewing's sarcoma ​ The results of diagnostic and staging tests are used to find out if cancer cells have spread. ​ The process used to determine if cancer has spread to other parts of the body is called staging. There is no standard staging system for Ewing's sarcoma. The results of tests and procedures performed to diagnose and stage Ewing's sarcoma are used to describe tumors as localized or metastatic. ​ Ewing's sarcoma is described as localized, metastatic, or recurrent ... ​ Localized Ewing's sarcoma ​ Cancer is found in the bones or soft tissues where it started and can spread to nearby tissues, including nearby lymph nodes. ​ Ewing's metastatic sarcoma ​ The cancer has spread from bone or soft tissue, where it started to other parts of the body. With Ewing's bone tumor, cancer most often spreads to the lung, other bones, and bone marrow. ​ Recurrent Ewing's sarcoma ​ The cancer has recurred (returned) after treatment. Cancer can return to the bones or soft tissue where it originated or to another part of the body. ​ 8.5. Overview of treatment options ​ There are various treatments for children with Ewing's sarcoma. ​ Various treatments are available for children with Ewing's sarcoma. Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. ​ Since cancer is rare in children and adolescents, clinical trials should be considered. Some clinical trials are only open to patients who have not yet started treatment. ​ Four types of standard treatments are used: 1. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). Combination chemotherapy is treatment that uses more than one anticancer drug. ​ Systemic combination chemotherapy is part of the treatment for all patients with Ewing's tumors. This is often the first treatment that lasts 6 to 12 months. Chemotherapy is often used to shrink the tumor before surgery or radiation therapy and to kill any tumor cells that may have spread to other parts of the body. 2. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. External beam radiation therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. ​ Radiation therapy is used when the tumor cannot be removed with surgery, or when surgery to remove the tumor affects important body functions or how the baby will look. It can be used to shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. It can also be used to treat any tumors left over from surgery and tumors that have spread to other parts of the body. ​ 3. Operation ​ Surgery is usually done to remove cancer left over from chemotherapy or radiation therapy. If possible, the entire tumor is surgically removed. The removed tissue and bone can be replaced with a graft that uses tissue and bone taken from another part of the patient's or donor's body. Sometimes an implant is used, such as an artificial bone. ​ After a doctor has removed any tumors that can be seen during surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer recurrence is called adjuvant therapy. 4. High-dose stem cell rescue chemotherapy ​ High doses of chemotherapy are prescribed to kill cancer cells. Healthy cells, including hematopoietic cells, are also destroyed in cancer treatments. Stem cell transplantation is a treatment to replace hematopoietic cells. Stem cells (immature blood cells) are removed from the blood or bone marrow of a patient or donor, frozen and stored. After the patient completes chemotherapy, the stored stem cells are thawed and returned to the patient as an infusion. These re-injected stem cells germinate (and regenerate) the body's blood cells. Stem cell rescue chemotherapy is used to treat localized and recurrent diseases. Ewing's sarcoma. ​ Also used to treat Ewing's sarcoma: ​ 1. Targeted therapy ​ Targeted therapy is a type of treatment that uses drugs or other substances to identify and target certain cancer cells. Targeted therapy usually does less damage to normal cells than chemotherapy or radiation therapy. The types of targeted therapies used to treat Ewing's sarcoma include the following: ​ Monoclonal Antibody Therapy: Monoclonal antibodies of the immune system are proteins made in the laboratory for the treatment of many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that can promote cancer cell growth. The antibodies are then able to kill cancer cells, block their growth, or prevent them from spreading. Monoclonal antibodies are given by infusion. They can be used alone or to carry drugs, toxins, or radioactive materials directly to cancer cells. Ganitumab is a monoclonal antibody that is being studied for the treatment of metastatic Ewing's sarcoma. ​ Kinase inhibitor therapy: This treatment blocks a protein that is required for cancer cells to divide. Cabosantinib is a kinase inhibitor being studied for the treatment of recurrent Ewing's sarcoma. ​ NEDD8 Activating Enzyme Inhibitor (NAE) Therapy: NAE inhibitors are drugs that attach to the NAE and stop cancer cells from dividing. Pevonedistat is an NAE inhibitor being studied for the treatment of recurrent Ewing's sarcoma. 2. Immunotherapy ​ Immunotherapy is a treatment that uses a patient's immune system to fight cancer. Substances produced by the body or in the laboratory are used to enhance, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy. ​ Immune Checkpoint Inhibitor Therapy: This treatment blocks certain proteins produced by certain cells of the immune system, such as T cells and some cancer cells. These proteins help control immune responses and prevent T cells from killing cancer cells. When these proteins are blocked, the “brakes” of the immune system are released and T cells are better able to kill cancer cells. Nivolumab and ipilimumab are types of immune checkpoint inhibitors that are being studied for the treatment of recurrent Ewing's sarcoma. ​ CAR T Cell Therapy: This treatment alters the patient's T cells (a type of cells in the immune system) so they will attack certain proteins on the surface of the cancer cells. T cells are taken from the patient, and special receptors are added to their surface in the laboratory. The altered cells are called chimeric antigen receptor (CAR) T cells. CAR T cells are grown in the laboratory and infused into the patient. CAR T cells multiply in the patient's blood and attack cancer cells. CAR T-cell therapy is being investigated for the treatment of recurrent Ewing's sarcoma. 8.6. Treatment for Ewing's sarcoma can cause side effects. Side effects from cancer treatments that start after treatment and last for months or years are called late effects. Late effects of cancer treatments may include the following: ​ Physical problems. Changes in mood, feelings, thinking, learning, or memory. Second cancer (newer cancers). Patients treated for Ewing's sarcoma are at increased risk of acute myeloid leukemia and myelodysplastic syndrome. There is also an increased risk of sarcoma in the area that has undergone radiation therapy. Some late effects can be treated or controlled. It is important to talk with your child's healthcare providers about the impact cancer treatment can have on your child. ​ 8.7. Treatment options ​ Treatment of localized Ewing's sarcoma ​ Standard treatments first identified localized Ewing's sarcomas include: ​ Chemotherapy. Surgery and / or radiation therapy. High-dose stem cell rescue chemotherapy. Treatment of metastatic Ewing's sarcoma Standard treatments for newly diagnosed metastatic Ewing's sarcoma include: ​ Chemotherapy. Surgery. Radiation therapy . Treatment of recurrent Ewing's sarcoma There is no standard treatment for recurrent Ewing's sarcoma, but treatment options may include the following: ​ Combined chemotherapy. Radiation therapy for bone tumors as palliative care to relieve symptoms and improve quality of life. Radiation therapy, which may be followed by surgery to remove tumors that have spread to the lungs. High-dose chemotherapy with stem cell rescue ... Treatment options for recurrent Ewing's sarcoma that are being explored include the following: ​ Checking a sample of a patient's tumor for certain gene changes. The type of targeted therapy that will be given to a patient depends on the type of gene change. Targeted therapy with a tyrosine kinase inhibitor (cabozantinib). Immunotherapy with an immune checkpoint inhibitor (nivolumab or Ipilimumab). CAR T-cell therapy. Targeted therapy with a NEDD8-activating enzyme inhibitor (pevoneedistat) and chemotherapy. Clinical study of a new type of targeted therapy. ​ 8.1. 8.2. 8.3. 8.4. 8.5 8.6. 8.7. 9. TREATMENT OF OSTEOSARCOMA Якорь 9 Osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) of bone are diseases in which malignant (cancer) cells form in the bone. ​ Osteosarcoma usually starts with osteoblasts, which are a type of bone cell that becomes new bone. Osteosarcoma is most common in adolescents. It usually forms at the ends of the long bones of the body, including the bones of the arms and legs. In children and adolescents, it often forms in the long bones near the knee. In rare cases, osteosarcoma can be found in the soft tissues or organs of the chest or abdomen. ​ Osteosarcoma is the most common type of bone cancer. UPS (formerly called malignant fibrous histiocytoma [MFH]) is a rare type of bone cancer that usually begins in soft tissue but can form in bone. In bone, UPS cells look like osteosarcoma under the microscope. UPS is treated like osteosarcoma. ​ 9.1. Development risks ​ Undergoing treatment with chemotherapy or radiation therapy may increase the risk of osteosarcoma. ​ Anything that increases the risk of a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your child's doctor if you think your child may be at risk. Risk factors for osteosarcoma include the following: ​ Received chemotherapy or radiation therapy. Having a certain change in the RB1 gene. Having certain conditions, for example the following: Bloom's syndrome. Diamond-Blackfan anemia. Li-Fraumeni syndrome. Paget's disease. Hereditary retinoblastoma. Rothmund-Thomson syndrome. Werner's syndrome. ​ 9.2. Symptoms ​ Signs and symptoms of osteosarcoma and UPS include swelling of the bone or bone of the body and joint pain. ​ These and other signs and symptoms can be caused by osteosarcoma, UPS, or other conditions. Check with your doctor if your child has any of the following: ​ Swelling over a bone or bony part of the body. Bone or joint pain. A bone that breaks for no known reason. ​ 9.3. Diagnostics ​ Imaging tests are used to detect (detect) osteosarcoma and UPS. ​ Imaging tests are done before the biopsy. The following tests and procedures can be used: ​ Physical examination and health history: Examining the body to check for general signs of health, including checking for signs of illness, such as tumors or anything else that seems unusual. There will also be a history of the patient's health habits, as well as past illnesses and treatments. X-rays: X-rays of organs and bones inside the body. X-rays are a type of energy beam that can pass through the body onto film, creating an image of areas within the body. CT (computed tomography): a procedure in which a series of detailed pictures of areas inside the body are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to make organs and tissues more visible. This procedure is also called computed tomography, computed tomography, or computed axial tomography. MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI). A biopsy is done to diagnose osteosarcoma. ​ Cells and tissues are removed during a biopsy so that a pathologist can examine them under a microscope to check for signs of cancer. It is important that the biopsy is done by a surgeon who is an expert in the treatment of bone cancer. It is best if this surgeon removes the tumor. The biopsy and surgery to remove the tumor are planned together. The way the biopsy is taken will affect which surgery can be done later. ​ The type of biopsy depends on the size of the tumor and its location in the body. Two types of biopsies can be used: ​ Primary biopsy: Removal of tissue with a wide needle. Postoperative biopsy: Removal of a portion of a tumor or tissue sample that does not appear normal. The following test can be performed on the removed tissue: ​ Electron microscopy: a laboratory test in which cells in a tissue sample are viewed under a regular and powerful microscope to detect specific changes in the cells. ​ 9.4. Factors affecting the prognosis of recovery ​ Several factors can affect prognosis (chance of recovery) and treatment options. ​ On forecast certain factors before and after treatment may be affected. ​ The prognosis of untreated osteosarcoma and IBD may depend on the following: ​ Where is the tumor in the body and whether tumors have formed in more than one bone. The patient has two or more tumors in the same bone. The size of the tumor. Whether the cancer has spread to other parts of the body and where it has spread. The type of tumor (based on how cancer cells look under a microscope). Gender, age and weight of the patient at the time of diagnosis. Whether the patient was being treated for another cancer. Whether the patient has certain genetic diseases. After treatment for osteosarcoma or IBD, the prognosis also depends on the following: ​ How much of the cancer has been killed by chemotherapy. Whether the tumor has been completely removed by surgery. If the cancer has recurred (come back) within 2 years after diagnosis. Treatment options for osteosarcoma and IBD depend on the following: ​ Where is the tumor in the body and whether it has spread. The size of the tumor. Cancer assessment. Are the bones still growing? Patient's age and general health. The desire of the patient and his family for the patient to be able to participate in sports activities or to look a certain way. Whether the cancer was diagnosed for the first time or whether there was a relapse after treatment. ​ 9.5. Stages of osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) ​ After osteosarcoma or undifferentiated pleomorphic sarcoma (UPS) is diagnosed, tests are done to find out if cancer cells have spread to other parts of the body. ​ The process used to determine if cancer has spread to other parts of the body is called staging. Most patients with osteosarcoma and IBD are grouped according to whether the cancer is localized or metastatic. ​ Localized osteosarcoma, or UPS, has not spread from the bone where the cancer started. There may be one or more areas of cancer in the bone that can be removed during operations ... ​ Metastatic osteosarcoma, or IBD, has spread from the bone in which the cancer started to other parts of the body. Cancer most often spreads to lungs ... It can also spread to other bones. The following tests and procedures can be used to find out if the cancer has spread: ​ X-rays: X-rays of organs such as the chest and bones inside the body. X-rays are a type of energy beam that can pass through the body onto film, creating an image of areas within the body. An x-ray of the chest and area of the tumor will be taken. ​ CT (computed tomography): A procedure in which a series of detailed pictures of areas inside the body, such as the chest, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to make organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. X-rays of the chest and the area where the tumor is forming will be taken. ​ PET-CT scan: A procedure that combines positron emission tomography (PET) and computed tomography (CT) images. PET and CT scans are performed simultaneously on the same machine. Images from both scans are combined to create a more detailed picture than either test could do on its own. PET is a procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and shows where glucose is being used in the body. Cancer cells appear brighter because they are more active and consume more glucose than normal cells. ​ MRI (Magnetic Resonance Imaging): A procedure that uses a magnet, radio waves, and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ Bone scan: A procedure to check for rapidly dividing cells such as cancer cells in the bone. A very small amount of radioactive material is injected into a vein and passed through the bloodstream. The radioactive material builds up in the bones in cancer and is detected by a scanner. ​ Occasionally, osteosarcoma and bone oocytes come back after treatment. ​ Cancer can recur (return) to bones or other parts of the body. Osteosarcoma and IBD most often recur in the lung, bone, or both. When osteosarcoma recurs, it usually occurs within 18 months after treatment ends. ​ 9.6. Overview of treatment options ​ There are various treatments for patients with osteosarcoma or undifferentiated pleomorphic sarcoma (UPS). ​ Various treatments are available for children with osteosarcoma or bone disease. Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. ​ Because cancer is rare in children, clinical trials should be considered. Some clinical trials are only open to patients who have not yet started treatment. ​ Five types of standard treatments are used: 1. Operation ​ If possible, an operation will be performed to remove the entire tumor. Chemotherapy may be given before surgery to shrink the swelling. This is called neoadjuvant chemotherapy. Chemotherapy is given, so less bone needs to be removed and fewer problems after surgery. ​ The following types of surgical procedures can be performed: ​ Wide local excision: Surgery to remove the tumor and some healthy tissue around it. ​ Limb-sparing surgery: Removal of a tumor of a limb (arm or leg) without amputation, which allows you to preserve the appearance of the limb. Most patients with limb osteosarcoma can be treated with sparing surgery. The tumor is removed by wide local excision. The removed tissue and bone can be replaced with a graft using tissue and bone taken from another part of the patient's body, or with an implant such as artificial bone. If a fracture is found at the time of diagnosis or during preoperative chemotherapy, limb-sparing surgery may still be possible in some cases. If the surgeon cannot remove the entire tumor and enough healthy tissue around it, amputation may be done. ​ Amputation: Surgery to remove part or all of an arm or leg. This can be done when it is not possible to remove the entire tumor with limb-sparing surgery. A prosthesis (prosthesis) may be placed on the patient after amputation. ​ Rotational plasty: surgery to remove the tumor and the knee joint. The part of the leg that remains below the knee is then attached to the part of the leg that remains above the knee, with the foot facing back and the ankle acting as the knee. The prosthesis can then be attached to the foot. Studies have shown that survival is the same regardless of whether the first limb-sparing surgery or amputation was performed. ​ After the doctor removes any cancer that can be seen during surgery, patients are given chemotherapy to kill any cancer cells that remain in the area where the tumor was removed or that have spread to other parts of the body. Treatment given after surgery to reduce the risk of cancer recurrence is called adjuvant therapy. ​ 2. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells by either killing the cells or stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). ​ Combined chemotherapy is the use of more than one anticancer drug. ​ Chemotherapy is usually done before and after surgery to remove primary tumor ... 3. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy: ​ External beam therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. ​ Internal beam therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are inserted directly into or near the tumor. Osteosarcoma and UPS cells are not easy to kill with external radiation therapy. It can be used when there is little cancer left after surgery, or it can be used in conjunction with other treatments. 4. Samaria ​ Samarium is a radioactive drug that targets areas where bone cells grow, such as tumor cells in bone. It helps relieve pain caused by bone cancer and also kills blood cells in the bone marrow. It is used to treat osteosarcoma that has returned after treatment in another bone. ​ Samarium treatment may be accompanied by stem cell transplantation. Before samarium treatment, stem cells (immature blood cells) are removed from the patient's blood or bone marrow, frozen and stored. After completing the samarium treatment, the preserved stem cells are thawed and returned to the patient by infusion. These re-injected stem cells germinate (and regenerate) the body's blood cells. 5. Targeted therapy ​ Targeted therapy is a type of treatment that uses drugs or other substances to identify and target certain cancer cells. Targeted therapy usually does less damage to normal cells than chemotherapy or radiation therapy. There are different types of targeted therapy: ​ Kinase inhibitor therapy blocks a protein required for cancer cell division. Sorafenib is a type of kinase inhibitor therapy used to treat recurrent osteosarcoma. Regorafenib is a type of kinase inhibitor that is being studied in adults for the treatment of recurrent metastatic osteosarcoma. Lenvatinib is a type of kinase inhibitor that is being studied in combination with ifosfamide and etoposide for recurrent and refractory osteosarcoma. ​ Mammals targeting rapamycin inhibitors (mTORs) block a protein called mTOR, which can inhibit the growth of cancer cells and prevent the growth of new blood vessels necessary for tumor growth. Everolimus is an mTOR inhibitor used to treat recurrent osteosarcoma. ​ Treatment for osteosarcoma or UPS can cause side effects. ​ Side effects from cancer treatments that start after treatment and last for months or years are called late effects. Late effects of cancer treatments may include the following: ​ Physical problems such as infertility. Changes in mood, feelings, thinking, learning, or memory. A second cancer (newer cancers), such as breast cancer or acute myeloid leukemia. ​ Additional tests may be required. ​ Some of the tests that have been done to diagnose cancer or to determine the stage of cancer may be repeated. Some tests will be repeated to see how effective the treatment is. Decisions to continue, change, or stop treatment may be based on the results of these tests. ​ Some tests will continue from time to time after treatment ends. The results of these tests can show if your child's condition has changed or if the cancer has recurred (returned). These tests are sometimes called follow-up or follow-up examinations. ​ 9.7. Treatment options Treatment of localized osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) of bone Treatment for newly diagnosed localized osteosarcoma and bone disease may include the following: ​ Surgery to remove the primary tumor. Chemotherapy may be given before or after surgery to remove the primary tumor. Radiation therapy if surgery cannot be performed or the tumor has not been completely removed with surgery. Treatment of metastatic osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) of bone Lung metastases ​ When osteosarcoma or UPS spreads, it usually spreads to the lungs. Treatment for newly diagnosed osteosarcoma and IBD with lung metastases may include the following: ​ Chemotherapy followed by surgery to remove the primary cancer. This is followed by postoperative combination chemotherapy, followed by surgery to remove lung cancer, and another postoperative chemotherapy. Bone metastasis or bone with lung metastasis ​ Newly diagnosed osteosarcoma and IBD can spread to distant bones and / or lungs. Treatment may include the following: ​ Chemotherapy followed by surgery to remove the primary tumor and cancer that has spread to other parts of the body. After surgery, additional chemotherapy is prescribed. Surgery to remove the primary tumor followed by chemotherapy and surgery to remove cancer that has spread to other parts of the body, followed by combination chemotherapy. Radiation therapy of the extremities. Treatment of recurrent osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) of bone Treatment for recurrent osteosarcoma and bone disease may include the following: ​ Surgery to remove cancer in all areas where it has spread. Chemotherapy and targeted therapy (sorafenib or everolimus). Samarium and radiation therapy. Treatment depends on the area and type of relapse, for example: ​ For tumors that have recurred in the same bone where the cancer started: Operation. For tumors that have recurred in the lungs only: Operation. Chemotherapy. Targeted therapy. For tumors that have recurred in bones other than where the cancer started: Operation. Samarium with or without stem cells as a palliative treatment to relieve pain and improve quality of life. For tumors that have recurred twice: Surgery to remove cancer and / or chemotherapy. Clinical trials for the treatment of recurrent osteosarcoma and bone disease may include the following: ​ A clinical trial that tests a sample of a patient's tumor for certain gene changes. The type of targeted therapy that will be given to a patient depends on the type of gene change. ​ Clinical trials of targeted therapy (lenvatinib) in combination with chemotherapy. 9.1 9.2. 9.3. 9.4. 9.5 9.6. 9.7. COST OF TREATMENT AND DIAGNOSIS OF SARCOMA IN TURKEY ​ Biopsy for sarcoma from $ 450 PET-CT for sarcoma from $ 500 Focused ultrasound ablation (HIFU) for sarcoma from $ 11,000 Radiation therapy for sarcoma from $ 6500 Biopsy for Ewing's sarcoma from $ 450 PET-CT for Ewing's sarcoma from $ 500 Chemotherapy for breast cancer from $ 1200 Radiation therapy for sarcoma from $ 6500 ​ Oncology diagnostics (click here) ​ Oncology treatment (click here) ст Need help? ​ Doctors-coordinators will advise you and help you with the choice. Services Medikal & Estetik Group are free for you and do not affect the clinic bill. ​ Find a solution ​ Coordinator Medikal & Estetik Group help you find the best solution for cancer treatment ​ CHOOSE CLINIC ​ O Medikal & Estetik Group ​ Second opinion ​ Before traveling, you can get a Turkish doctor's opinion on your diagnosis and treatment prescribed. For the patient, this is an opportunity to receive advice from the world's best specialists.

COLOR / RECTAL CANCER TREATMENT IN TURKEY MENU PAGES: 1. What is colon cancer? 1.1. Colon cancer risk factors 1.2. Colon cancer signs 1.3. Colon Cancer Diagnostic Tests 1.4. Diagnosis of metastases 1.5. Treatments for Colon Cancer Patients 1.6. Treatment options by stage 2. What is rectal cancer? 2.1. Rectal cancer risk factors 2.2. Rectal cancer signs 2.3. Tests for the diagnosis of rectal cancer 2.4. Treatments for rectal cancer patients 3. Factors affecting prognosis (chance of recovery) and treatment options COST OF TREATMENT AND DIAGNOSIS OF RECTAL CANCER IN TURKEY COST OF TREATMENT AND DIAGNOSIS OF COLOR CANCER IN TURKEY Colorectal cancer is a disease in which malignant (cancerous) cells form in the tissues of the colon or rectum. ​ The large intestine is part of the body's digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps eliminate waste from the body. The digestive system consists of the mouth, throat, esophagus, stomach, and the small and large intestines. The colon (large intestine) is the main part of the large intestine and in an adult is about 5 feet long. Together, the rectum and anal canal makes up the last part of the large intestine and is 6 to 8 inches long. The anal canal ends at the anus (the exit of the large intestine to the outside). ​ The prognosis for recovery depends on the following: ​ Whether the tumor has been completely removed by surgery. Whether the cancer has spread to other parts of the body, such as the lymph nodes, lungs, liver, pelvis, ovaries, or bones. Whether the cancer has just been diagnosed or has recurred (returned). 1. What is colon cancer? Colon cancer is a disease in which malignant (cancerous) cells form in the tissues of the colon. ​ The large intestine is part of the body's digestive system. The digestive system removes and processes nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps eliminate waste from the body. The digestive system consists of the esophagus, stomach, small and large intestines. The colon (large intestine) is the main part of the large intestine and is about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are about 6 to 8 inches long. The anal canal ends at the anus (exit colon outward). ​ Stromal tumors of the gastrointestinal tract can occur in the colon. 1 1.1. Colon cancer risk factors ​ Anything that increases the likelihood of getting sick is called a risk factor. Having a risk factor does not mean that you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your doctor if you think you are at risk of developing colorectal cancer. ​ Risk factors for colorectal cancer include the following: ​ Having a family history of colon or rectal cancer in the first degree of relationship (parent, sibling, or child). Personal history of colon, rectal, or ovarian cancer. Personal history of high-risk adenomas (colorectal polyps 1 centimeter or larger, or cells that look abnormal under a microscope). Having inherited changes in certain genes that increase the risk of familial adenomatous polyposis (FAP) or Lynch's syndrome (hereditary non-polyposis colorectal cancer). A history of chronic ulcerative colitis or Crohn's disease for 8 years or more. Drinking three or more alcoholic beverages a day. Smoking cigarettes. Be African American. Be obese. Old age is a major risk factor for most cancers. The likelihood of developing cancer increases with age. 1.1. Colon polyps. Some polyps have a pedicle, while others do not. The inset shows a photo of a polyp with a stem. 1.2. Colon cancer signs Signs of colon cancer include blood in your stools or changes in bowel habits. ​ These and other signs and symptoms can be caused by colon cancer or other conditions. Check with your doctor if you have any of the following: ​ Change in bowel habits. Blood (bright red or very dark) in the stool. Diarrhea, constipation, or a feeling that the bowels are not emptying completely. The stool is narrower than usual. Frequent gas pains, bloating, fullness, or cramps. Losing weight for an unknown reason. Feeling very tired. Vomit . 1.2. 1.3. Colon Cancer Diagnostic Tests ​ The following tests and procedures can be used: ​ Physical examination and health history A body exam to check for general signs of health, including checking for signs of illness such as bumps or anything else that seems unusual. There will also be a history of the patient's health habits, as well as past illnesses and treatments. ​ Digital rectal examination : examination of the rectum. A doctor or nurse inserts an oiled gloved finger into the rectum to feel for lumps or anything else that seems unusual. ​ Fecal occult blood test (FOBT): A test to check stool (solid waste) for the presence of blood that can only be seen under a microscope. A small stool sample is placed on a special card or container and returned to the doctor or laboratory for analysis. Blood in your stools can be a sign of polyps, cancer, or other medical conditions. There are two types of FOBT: ​ 1. Guaiac FOBT: The stool sample shown on the special card is tested with a chemical. If there is blood in the stool, the special card changes color. ​ 2. Immunochemical FOBT: Liquid is added to the stool sample. This mixture is injected into a machine that contains antibodies that can detect blood in the stool. If there is blood in the stool, a line will appear in the car window. This test is also called the stool immunochemical test or FIT. ​ Barium enema : a series of X-rays of the lower gastrointestinal tract. A liquid containing barium (a silvery-white metallic compound) is injected directly into the intestine. Barium covers the lower part of the gastrointestinal tract, x-rays are taken. This procedure is also called the lower GI series. 1.3. Barium enema procedure. The patient lies on the X-ray table. Liquid barium is injected into the rectum and passed through the colon. X-rays are used to find abnormal areas. Rigmoidoscopy : A procedure to look at your rectum and sigmoid (lower) colon for polyps (small areas of bulging tissue), other abnormal areas, or cancer. A sigmoidoscope is inserted through the rectum into the sigmoid colon. A sigmoidoscope is a thin tubular instrument with a light and a viewing lens. He may also have an instrument to remove polyps or tissue samples that are checked under a microscope for signs of cancer. Sigmoidoscopy. A thin, illuminated tube is inserted through the anus and rectum into the lower colon to look for abnormal areas. Colonoscopy: A procedure to look at the rectum and colon for polyps, abnormal areas, or cancer. The colonoscope is inserted through the rectum into the large intestine. A colonoscope is a thin tubular instrument with a light and a viewing lens. He may also have an instrument to remove polyps or tissue samples that are checked under a microscope for signs of cancer. Colonoscopy. A thin, illuminated tube is inserted through the anus and rectum into the colon to look for abnormal areas. Virtual colonoscopy : A procedure that uses a series of X-rays, called a computed tomography, to create a series of pictures of the colon. The computer combines the images to create detailed images that can show polyps and anything else that seems unusual on the inside of the colon. This test is also called colonography or CT colonography. ​ Biopsy : Removing cells or tissues so that a pathologist can examine them under a microscope to check for signs of cancer. ​ 1.4. Diagnosis of metastases The process used to determine if cancer has spread in the colon or to other parts of the body is called staging. The information gathered during the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. ​ During the preparation process, the following tests and procedures can be used: ​ CT (computed tomography) : A procedure in which a series of detailed pictures of areas inside the body, such as the abdomen, pelvis or chest, are taken from different angles. The pictures were taken by a computer connected to an X-ray machine. The dye can be injected into a vein or swallowed to help organs or tissues show more clearly. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (magnetic resonance imaging) : A procedure that uses a magnet, radio waves, and a computer to create a series of detailed images of areas inside the colon. A substance called gadolinium is given to the patient through a vein. Gadolinium gathers around cancer cells, so they appear brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (MRI). ​ PET scan (positron emission tomography) : a procedure for finding malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into the vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. Cancer cells appear brighter because they are more active and consume more glucose than normal cells. ​ Chest X-ray: An X-ray of the internal organs and bones of the chest. X-rays are a type of energy beam that can pass through the body onto film, creating an image of areas within the body. ​ Surgery : A procedure to remove a tumor and find out how far it has spread in the colon. ​ Lymph node biopsy : Removal of all or part of the lymph node. A pathologist examines the lymph node tissue under a microscope to check for cancerous cells. This can be done during surgery or with a fine-needle aspiration biopsy under endoscopic ultrasound guidance. ​ Complete blood count (CBC) : a procedure in which a blood sample is taken and tested for the following: The number of erythrocytes, leukocytes and platelets. The amount of hemoglobin (oxygen-carrying protein) in red blood cells. The portion of a blood sample made up of red blood cells. ​ Carcinoembryonic Antigen Assay (CEA) : a test that measures the level of CEA in the blood. CEA enters the bloodstream from both cancerous and normal cells. When found in higher than normal amounts, it could be a sign of colon cancer or other conditions. ​ 1.5. The Ides of treatment of patients with colon cancer Various treatments are available for patients with colon cancer. Some treatments are standard (currently used) and some are in clinical trials. A treatment clinical trial is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment can become the standard treatment. Patients may want to take part in a clinical trial. Some clinical trials are only open to patients who have not yet started treatment. ​ Seven types of standard treatments are used: ​ 1. Operation ​ Surgery (removal of cancer through surgery) is the most common treatment for all stages of colon cancer. A doctor can remove cancer using one of the following types of surgery: ​ Local excision : If cancer is found at a very early stage, the doctor can remove it without cutting the abdominal wall. Instead, the doctor may insert a tube with a cutting instrument through the rectum into the colon and cut out the cancer. This is called a local excision. If cancer is found in a polyp (a small bulging area of tissue), the surgery is called polypectomy. ​ Colon resection with anastomosis : If the tumor is larger, the doctor will perform a partial colectomy (removal of the tumor and a small amount of healthy tissue around it). The doctor may then perform an anastomosis (stitching the healthy portions of the colon together). The doctor will also usually remove the lymph nodes near the colon and examine them under a microscope to determine if they contain cancer. ​ 1.4. 1.5. Colon resection with anastomosis. The portion of the colon containing the cancer and nearby healthy tissue is removed, and then the severed ends of the colon are reattached. Colon resection with colostomy: If the doctor is unable to stitch the two ends of the colon together, a stoma (hole) is made on the outside of the body to allow the waste to pass. This procedure is called a colostomy. A waste collection bag is placed around the stoma. Sometimes a colostomy is only needed until the lower part of the colon heals, and then it can be canceled. However, if the doctor needs to remove the entire lower part of the colon, the colostomy may be permanent. Colon cancer surgery with colostomy. The portion of the colon containing the cancer and nearby healthy tissue is removed, a stoma is created, and a colostomy bag is attached to the stoma. Colon resection with colostomy : If the doctor cannot sew the two ends of the colon together, a stoma (hole) is made on the outside of the body to allow waste to pass through. This procedure is called a colostomy. A waste collection bag is placed around the stoma. Sometimes a colostomy is needed only until the lower part of the colon has healed, and then it can be cancelled. However, if the doctor needs to remove the entire lower colon, the colostomy may be permanent. ​ After the doctor removes any tumors that can be seen during surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer coming back is called adjuvant therapy. 2. Radiofrequency ablation ​ RF ablation is the use of a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in a hospital under general anesthesia. 3. Cryosurgery ​ Cryosurgery is a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy. 4. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is injected directly into the cerebrospinal fluid, organ, or body cavity, such as the abdominal cavity, the drugs primarily target cancer cells in those areas (regional chemotherapy). ​ Chemoembolization from the hepatic artery can be used to treat cancer that has spread to the liver. This includes blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. The liver arteries then deliver the drugs to the liver. Only a small amount of the drug reaches other parts of the body. The blockage can be temporary or permanent, depending on what is being used to block the artery. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestines. How chemotherapy is given depends on the type and stage of cancer treatment. ​ 5. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy: ​ External Beam Therapy uses a device outside the body to direct radiation to an area of the body affected by cancer. ​ Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires or catheters that are injected directly into or near the tumor. How radiation therapy is given depends on the type and stage of cancer treatment. External beam radiation therapy is used as a palliative therapy to relieve symptoms and improve quality of life. ​ 6. Targeted therapy ​ Targeted Therapy is a type of treatment that uses drugs or other substances to target and target specific cancer cells. Targeted therapy usually causes less damage to normal cells than chemotherapy or radiation therapy. ​ Types of targeted therapies used in the treatment of colon cancer include the following: ​ Monoclonal antibodies : Monoclonal antibodies are immune system proteins created in a laboratory to treat many diseases, including cancer. As a treatment for cancer, these antibodies can attach to a specific target on cancer cells or other cells that can promote cancer cell growth. The antibodies are then able to kill the cancer cells, block their growth, or stop them from spreading. Monoclonal antibodies are given by infusion. They can be used alone or to carry drugs, toxins, or radioactive materials directly to cancer cells. Species:​ There are different types of monoclonal antibody therapy: Vascular endothelial growth factor (VEGF) inhibitor therapy: Cancer cells produce a substance called VEGF, which causes new blood vessels to form (angiogenesis) and promotes cancer growth. VEGF inhibitors block VEGF and prevent the formation of new blood vessels. This can kill cancer cells because they need new blood vessels to grow. Bevacizumab and ramucirumab are VEGF inhibitors and angiogenesis inhibitors. ​ Epidermal growth factor receptor (EGFR) inhibitor therapy: EGFRs are proteins found on the surface of certain cells, including cancer cells. Epidermal growth factor attaches to EGFR on the cell surface and causes cells to grow and divide. EGFR inhibitors block the receptor and prevent epidermal growth factor from attaching to the cancer cell. This stops the growth and division of the cancer cell. Cetuximab and panitumumab are EGFR inhibitors. ​ Angiogenesis Inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels needed for tumor growth. ​ Ziv-aflibercept is a vascular endothelial growth factor decoy that blocks an enzyme needed for the growth of new blood vessels in tumors. ​ Regorafenib is used to treat colorectal cancer that has spread to other parts of the body and has not improved with other treatments. It blocks the action of certain proteins, including vascular endothelial growth factor. This can help prevent cancer cells from growing and killing them. It can also prevent the growth of new blood vessels needed for tumor growth. ​ 7. Immunotherapy ​ Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances produced by the body or produced in a laboratory are used to enhance, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy. ​ Immune checkpoint inhibitor therapy is a type of immunotherapy: ​ PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps control the body's immune responses. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors prevent the PD-1 and PD-L1 proteins from attaching to each other. This allows T cells to kill cancer cells. Pembrolizumab is one of the PD-1 inhibitors. ​ 1.6. Treatment options by stage Stage 0 treatment (carcinoma in situ) ​ Treatment for stage 0 (carcinoma in situ) may include the following types of surgery: ​ Local excision or simple polypectomy. Resection and anastomosis. This is done when the tumor is too large to be removed by local excision. ​ Treatment of colon cancer stage I ​ Treatment for stage I colon cancer usually includes the following: ​ Resection and anastomosis . ​ Treatment of colon cancer stage II ​ Treatment for stage II colon cancer may include the following: ​ Resection and anastomosis. ​ Treatment for stage III colon cancer ​ Treatment for stage III colon cancer may include the following: ​ Resection and anastomosis followed by chemotherapy. Clinical trials of new chemotherapy regimens after surgery. ​ Treatment of stage IV and recurrent colon cancer ​ Treatment for stage IV and recurrent colon cancer may include the following: ​ Local excision for tumors that recur. Resection with or without anastomosis. Surgery to remove parts of other organs such as the liver, lungs, and ovaries where the cancer may have recurred or spread. Treatment for cancer that has spread to the liver may also include the following: Chemotherapy is given before surgery to shrink the tumor, after surgery, or both before and after. Radiofrequency ablation or cryosurgery for patients who cannot be operated on. Chemoembolization from the hepatic artery. For some patients, radiation therapy or chemotherapy may be offered as palliative therapy to relieve symptoms and improve quality of life. Chemotherapy and/or targeted therapy with monoclonal antibodies or an angiogenesis inhibitor. Immunotherapy. Clinical trials of chemotherapy and/or targeted therapy. ​ 2. What is rectal cancer? ​ Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum. ​ The rectum is part of the body's digestive system. The digestive system obtains nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps eliminate waste from the body. The digestive system consists of the esophagus, stomach, small intestine, and large intestine. The large intestines (large intestine) are the first part of the large intestine and are about 5 feet long. Together, the rectum and anal canal make up the last part of the large intestine and are 6 to 8 inches long. The anal canal ends at the anus (the exit of the large intestine to the outside). ​ 2.1. Factors risk of colorectal cancer ​ Anything that increases the likelihood of a disease is called a risk factor. Having a risk factor does not mean you will get cancer; the absence of risk factors does not mean that you will not get cancer. Talk to your doctor if you think you are at risk of developing colorectal cancer. ​ Risk factors for colorectal cancer include the following: ​ Having a family history of colon or rectal cancer in the first degree of relationship (parents, sibling, or child). Having a personal history of colon, rectal, or ovarian cancer. Having a personal history of high-risk adenomas (colorectal polyps 1 centimeter or larger, or cells that look abnormal under a microscope). Having inherited changes in certain genes that increase the risk of familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colorectal cancer). A history of chronic ulcerative colitis or Crohn's disease for 8 years or more. Drinking three or more alcoholic drinks per day. Smoking cigarettes. Be African American. Be obese. Old age is a major risk factor for most types of cancer. The chance of getting cancer increases with age. ​ 2.2. Signs of colorectal cancer Signs of rectal cancer include changes in the bowel or blood in the stool. These and other signs and symptoms may be caused by colon cancer or other conditions. Check with your doctor if you have any of the following: ​ Blood (bright red or very dark) in stool. Change in bowel habits. Diarrhea. Constipation. Sensation that the bowels are not emptying completely. The stool is narrower or of a different shape than usual. General abdominal discomfort (frequent gas pains, bloating, feeling of fullness or cramps). Change in appetite. Weight loss for unknown reason. Feeling very tired. ​ 2.3. Tests for diagnostics rectal cancer ​ Tests used to diagnose rectal cancer include the following: ​ Medical examination and medical history : examining the body to check for general signs of health, including checking for signs of disease such as lumps or anything else that seems unusual. An anamnesis of the patient's health habits as well as past illnesses and treatments will also be taken. ​ Digital Rectal Examination (DRE) : examination of the rectum. The doctor or nurse inserts a lubricated, gloved finger into the lower rectum to feel for lumps or anything else that seems unusual. In women, the vagina can also be examined. ​ Colonoscopy : a procedure for examining the rectum and colon for polyps (small pieces of raised tissue), abnormal areas, or cancer. The colonoscope is a thin, tube-like instrument with light and viewing lenses. It may also have a tool to remove polyps or tissue samples that are checked under a microscope for signs of cancer. ​ Biopsy : removal of cells or tissue so that they can be viewed under a microscope for signs of cancer. Tumor tissue that is removed during a biopsy can be tested to see if the patient has a gene mutation that causes HNPCC. This can help plan treatment. The following tests may be used: ​ Reverse transcription polymerase chain reaction (RT-PCR) test : A laboratory test that measures the amount of a genetic substance called mRNA made by a particular gene. An enzyme called reverse transcriptase is used to convert a specific piece of RNA into a matching piece of DNA that can be amplified (done in large quantities) by another enzyme called DNA polymerase. Amplified DNA copies help determine if a particular mRNA is being created by a genome. RT-PCR can be used to check for the activation of certain genes that may indicate the presence of cancer cells. This test can be used to look for specific changes in a gene or chromosome that can help diagnose cancer. Immunohistochemistry: a laboratory test that uses antibodies to test for specific antigens (markers) in a patient's tissue sample. The antibodies are usually associated with an enzyme or fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated and the antigen can be seen under a microscope. This type of test is used to diagnose cancer and helps distinguish one type of cancer from another. Carcinoembryonic antigen (CEA) analysis: a test that measures the level of CEA in the blood. CEA enters the bloodstream from both cancerous and normal cells. If its amount exceeds normal, it may be a sign of rectal cancer or other diseases. ​ After rectal cancer has been diagnosed, tests are done to find out if the cancer cells have spread in the rectum or to other parts of the body. ​ The process used to determine if cancer has spread to the rectum or to other parts of the body is called staging. The information gathered during the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. ​ The following tests and procedures may be used in the preparation process: ​ Chest x-ray : X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can pass through the body onto film, creating an image of areas within the body. ​ Colonoscopy : a procedure for examining the rectum and colon for polyps (small pieces of raised tissue). abnormal areas or cancer. The colonoscope is a thin, tube-like instrument with light and viewing lenses. It may also have a tool to remove polyps or tissue samples that are checked under a microscope for signs of cancer. ​ CT (computed tomography) : A procedure that takes a series of detailed pictures of areas inside the body, such as the abdomen, pelvis, or chest, taken from different angles. The pictures were taken by a computer connected to an x-ray machine. The dye may be injected into a vein or swallowed to make organs and tissues more visible. This procedure is also called computed tomography, computed tomography, or computed axial tomography. ​ MRI (magnetic resonance imaging) : A procedure that uses a magnet, radio waves and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). ​ PET scan (positron emission tomography) : procedure for searching for malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and takes a picture of where glucose is being used in the body. The cells of malignant tumors appear brighter because they are more active and consume more glucose than normal cells. ​ Endorectal Ultrasound : A procedure used to examine the rectum and nearby organs. An ultrasound transducer (transducer) is inserted into the rectum and is used to bounce high energy sound waves (ultrasound) from internal tissues or organs and make echoes. The echo forms a picture of body tissues called a sonogram. A doctor can identify a tumor by looking at a sonogram. This procedure is also called transrectal ultrasound. ​ 2.4. Types of treatment for patients with rectal cancer A variety of treatments are available for patients with rectal cancer. Some treatments are standard (currently used) and some are in clinical trials. A clinical trial of a treatment is a scientific study designed to help improve existing treatments or provide information about new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may wish to participate in a clinical trial. Some clinical trials are only open to patients who have not yet started treatment. ​ Six types of standard treatment are used: ​ 1. Operation ​ Surgery - the most common treatment for rectal cancer at all stages. The cancer is removed with one of the following types of surgery: ​ Polypectomy : If cancer is found in a polyp (a small piece of swollen tissue), the polyp is often removed during a colonoscopy. ​ Local excision : If the cancer is found on the inside of the rectum and has not spread to the rectal wall, the cancer and a small amount of surrounding healthy tissue are removed. ​ Resection : if the cancer has spread to the rectal wall, the area of the rectum with cancer and nearby healthy tissue is removed. Sometimes the tissue between the rectum and the abdominal wall is also removed. The lymph nodes near the rectum are removed and checked under a microscope for signs of cancer. ​ Radiofrequency ablation: using a special probe with tiny electrodes that kill cancer cells. Sometimes the probe is inserted directly through the skin and only local anesthesia is needed. In other cases, the probe is inserted through an incision in the abdomen. This is done in a hospital under general anesthesia. ​ Cryosurgery : a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy. ​ Pelvic exenteration : If the cancer has spread to other organs near the rectum, the lower colon, rectum, and bladder are removed. In women, the cervix, vagina, ovaries, and nearby lymph nodes may be removed. In men, the prostate may be removed. Artificial openings (stoma) are designed to drain urine and stool from the body into a collection bag. ​ After cancer removal surgeon : ​ make an anastomosis (sew healthy parts of the rectum, sew up the rest or make a stoma (hole) from the rectum to the outside of the body to allow waste to pass through. This procedure is done if the cancer is too close to the anus and is called a colostomy. A waste collection bag is placed around the stoma. Sometimes a colostomy is needed only until the rectum has healed, and then it can be cancelled. However, if the entire rectum is removed, the colostomy may be permanent. ​ Radiation therapy and/or chemotherapy may be given before surgery to shrink the tumor, make it easier to remove the cancer, and help with bowel control after surgery. Treatment before surgery is called neoadjuvant therapy. After all cancer that can be seen during surgery is removed, some patients may be given radiation therapy and/or chemotherapy after surgery to kill any remaining cancer cells. Treatment given after surgery to reduce the risk of cancer coming back is called adjuvant therapy. ​ 2. Radiation therapy ​ Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy: ​ External Beam Therapy uses a device located outside the body to target cancer with radiation. ​ Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are inserted directly into or near the tumor. ​ How radiation therapy is given depends on the type and stage of cancer treatment. External beam radiation therapy is used to treat rectal cancer. ​ Short-term preoperative radiation therapy is used for some types of rectal cancer. This treatment uses smaller and lower doses of radiation than standard treatment, followed by surgery a few days after the last dose. ​ 3. Chemotherapy ​ Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is given directly to the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs primarily target cancer cells in those areas (regional chemotherapy). ​ Chemoembolization of the hepatic artery is a type of regional chemotherapy that can be used to treat cancer that has spread to the liver. This is done by blocking the hepatic artery (the main artery that supplies blood to the liver) and injecting anticancer drugs between the blockage and the liver. The liver arteries then carry the drugs to the liver. Only a small amount of the drug reaches other parts of the body. The blockage can be temporary or permanent, depending on what is being used to block the artery. The liver continues to receive blood from the hepatic portal vein, which carries blood from the stomach and intestines. ​ How chemotherapy is given depends on the type and stage of cancer treatment. ​ 4. Active Surveillance ​ Active surveillance closely monitors the patient's condition without giving any treatment unless there is a change in test results. It is used to detect early signs of deterioration. In active surveillance, patients undergo certain examinations and tests to check if the cancer is growing. When the cancer begins to grow, treatment is given to cure the cancer. Tests include the following: Digital rectal examination. MRI. Endoscopy. Sigmoidoscopy. CT scan . Carcinoembryonic antigen (CEA) analysis 5. Targeted Therapy ​ Targeted Therapy is a type of treatment that uses drugs or other substances to target and attack specific cancer cells without harming normal cells. ​ Types of targeted therapies used in the treatment of rectal cancer include the following: ​ Monoclonal antibodies: Monoclonal antibody therapy is a type of targeted therapy that is used to treat rectal cancer. Monoclonal antibody therapy uses antibodies made in a laboratory from a single cell type of the immune system. These antibodies can identify substances on cancer cells or normal substances that can promote cancer cell growth. Antibodies attach to substances and kill cancer cells, block their growth or stop them from spreading. Monoclonal antibodies are given by infusion. They can be used alone or to carry drugs, toxins, or radioactive materials directly to cancer cells. ​ There are different types of monoclonal antibody therapy: ​ Vascular endothelial growth factor (VEGF) inhibitor therapy: Cancer cells produce a substance called VEGF, which causes new blood vessels to form (angiogenesis) and promotes cancer growth. VEGF inhibitors block VEGF and prevent the formation of new blood vessels. This can kill cancer cells because they need new blood vessels to grow. Bevacizumab and ramucirumab are VEGF inhibitors and angiogenesis inhibitors. Epidermal growth factor receptor (EGFR) inhibitor therapy: EGFRs are proteins found on the surface of certain cells, including cancer cells. Epidermal growth factor attaches to EGFR on the cell surface and causes cells to grow and divide. EGFR inhibitors block the receptor and prevent epidermal growth factor from attaching to the cancer cell. This stops the growth and division of the cancer cell. Cetuximab and panitumumab are EGFR inhibitors. Angiogenesis Inhibitors: Angiogenesis inhibitors stop the growth of new blood vessels needed for tumor growth. Ziv-aflibercept is a vascular endothelial growth factor decoy that blocks an enzyme needed for the growth of new blood vessels in tumors. Regorafenib is used to treat colorectal cancer that has spread to other parts of the body and has not improved with other treatments. It blocks the action of certain proteins, including vascular endothelial growth factor. This can help prevent cancer cells from growing and killing them. It can also prevent the growth of new blood vessels needed for tumor growth. ​ 6. Immunotherapy ​ Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances produced by the body or produced in a laboratory are used to enhance, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or biological therapy. ​ Immune checkpoint inhibitor therapy is a type of immunotherapy: ​ Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of T cells that helps control the body's immune responses. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing it. PD-1 inhibitors attach to PDL-1 and allow T cells to kill cancer cells. Pembrolizumab is one of the immune checkpoint inhibitors. ​ 3. Factors affecting prognosis (chance of recovery) and treatment options ​ The prognosis (chance of recovery) and treatment options depend on the following conditions: ​ The stage of the cancer (whether it affects the internal lining of the rectum only, involves the entire rectum, or has spread to lymph nodes, nearby organs, or to other locations in the body). Whether the tumor has spread to or through the intestinal wall. Where cancer is found in the rectum. Whether the intestines are clogged or there is a hole in it. Is it possible to remove the entire tumor surgically. The general health of the patient. Whether the cancer was just diagnosed or recurred (came back). 1.6. 2 2.1. 2.2. 2.3. 2.4. 3 COST OF TREATMENT AND DIAGNOSIS OF RECTAL CANCER IN TURKEY ​ Biopsy for rectal cancer from $ 450 CT (computed tomography) for rectal cancer from $ 50 Immunotherapy with Keytruda (Pembrolizumab) for rectal cancer from $ 3300 Chemotherapy for breast cancer from $ 1200 Cyberknife for rectal cancer from $ 4400 Da Vinci robotic system for rectal cancer from $ 16,000 Removal of polyps of the gastrointestinal tract for rectal cancer on request Intraperitoneal chemotherapy HIPEC for rectal cancer from $ 20,000 Nano Knife for Rectal Cancer from $ 12,000 Rectum resection for rectal cancer from $ 8000 ​ COST OF TREATMENT AND DIAGNOSIS OF COLOR CANCER IN TURKEY ​ Colon cancer biopsy from $ 450 CT (computed tomography) for colon cancer from $ 50 PET-CT for colon cancer from $ 500 Immunotherapy with Keytruda (Pembrolizumab) for colon cancer from $ 3300 Colectomy (colon resection) for colon cancer from $ 8650 Cyber Knife for Colon Cancer from $ 4400 Da Vinci robotic system for colon cancer from $ 16,000 Removal of polyps of the gastrointestinal tract for colon cancer on request Intraperitoneal chemotherapy HIPEC for colon cancer from $ 20,000 Nano Knife for Colon Cancer from $ 12,000 прямой толстой Need help? ​ Doctors-coordinators will advise you and help you with the choice. Services Medikal & Estetik Group are free for you and do not affect the clinic bill. ​ Find a solution ​ Coordinator Medikal & Estetik Group help you find the best solution for cancer treatment ​ CHOOSE CLINIC ​ O Medikal & Estetik Group ​ Second opinion ​ Before traveling, you can get an opinion from a Turkish doctor on your diagnosis and prescribed treatment. For the patient, this is an opportunity to receive advice from the world's best specialists.

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4 min HOW TO CHOOSE A BREAST IMPLANT BY SHAPE AND VOLUME The eternal topic of breast prosthetics is the choice of a breast implant. At first glance, it may seem that how many people, so many... 1 like. Post not marked as liked 1 2 min ПОДТЯЖКА БРОВЕЙ ИЛИ ПОДТЯЖКА ЛБА Меню страницы: 1. ЧТО ТАКОЕ ПОДТЯЖКА БРОВЕЙ? 2. КТО ОБРАЩАЕТСЯ ЗА ПОДТЯЖКОЙ? 3. КАКАЯ АНЕСТЕЗИЯ ИСПОЛЬЗУЕТСЯ? 4. ОБЩИЕ СВЕДЕНИЯ Брови... Post not marked as liked 2 min Главное об офтальмологии в Турции Меню страницы: ДИАГНОСТИКА МЕТОДЫ ЛЕЧЕНИЯ ВОССТАНОВЛЕНИЕ ЗРЕНИЯ СТОИМОСТЬ 80% случаев нарушения зрения могут быть обратимыми. В турецких... Post not marked as liked 4 min Ринопластика в Турции Меню страницы: ЧТО ТАКОЕ РИНОПЛАСТИКА? ПОКАЗАНИЯ И ПРОТИВОПОКАЗАНИЯ К РИНОПЛАСТИКЕ ДИАГНОСТИКА И КОНСУЛЬТАЦИЯ ПЕРЕД РИНОПЛАСТИКОЙ МЕТОДЫ... Post not marked as liked 5 min Главное о лечении рака в Турции Меню страницы: МЕТОДЫ ДИАГНОСТИКИ ДИАГНОСТИКА ОНКОЛОГИИ В ТУРЦИИ ЛЕЧЕНИЕ РАКА В ТУРЦИИ ИННОВАЦИОННАЯ МЕТОДИКА ЛЕЧЕНИЯ РАБОТА С БОЛЬНЫМИ... Post not marked as liked

Key points about ultrasound-guided endoscopic biopsy In the meantime, there is no need to worry about it. ” No posts published in this language yet Stay tuned...

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How it works? Medikal & Estetik Group will organize for you a trip to Turkey for diagnosis, treatment or plastic procedure. You will receive quality medical services, comfort and safety. We accompany our patients from the application on the website until they return home at the end of the treatment. All our services are free. Our services What does it mean to organize a medical trip to Turkey? Получение быстрого ответа из клиник Сравнение предложений разных клиник Бронирование визита к опытному специалисту Защита Ваших интересов Бесплатная поддержка на всех этапах Предоставление актуальной стоимости How do we organize it? ECONOMICAL FLIGHT Our coordinator assists in finding and booking the best air ticket to Turkey. If necessary, we will organize an air evacuation for patients in serious condition. HOTEL RESERVATION We select a hotel or apartment within walking distance from the clinic of interest at the best prices. We help to book a room for you and your companions. TRANSFER TO CLINIC We will arrange a meeting at the airport, as well as a transfer to the clinic immediately after arrival at the airport. Also, a transfer is possible during the period of treatment "clinic-hotel", "hotel-clinic". TRANSLATION OF DOCUMENTS We will translate your medical documents into Turkish. Perhaps before personal and online consultations. LANGUAGE SUPPORT At the clinic, you will be provided with language support to understand doctors and staff during consultations, examinations and treatment. The translator has medical training. VISA SUPPORT If you need long-term treatment, we provide assistance in obtaining a medical visa, advise on the preparation of medical documents as soon as possible. PREPARE FOR YOUR TRAVEL IN ADVANCE In the meantime, there is no need to worry about it. ” Plan your visit to the clinic before you arrive, get an estimate for treatment or an independent second medical opinion completely free of charge. To provide you with up-to-date and detailed information about treatment options, as well as to make a request to the clinic, we need your documentation (medical reports, extracts and epicrisis, test results, MRI, CT, PET CT, passport). In the meantime, there is no need to worry about it. ” Your personal coordinator will provide you with all the comprehensive information from the clinic for treatment to come to Turkey. Name Surname Email Your comments Send message Your message has been sent!

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The main thing about cancer treatment in Turkey Page menu: DIAGNOSTIC METHODS DIAGNOSTICS OF ONCOLOGY IN TURKEY CANCER TREATMENT IN TURKEY INNOVATIVE TREATMENT TECHNIQUE WORK WITH PATIENTS IN STAGE 4 CHILD ONCOLOGY TREATMENT LIST OF ONE OF THE BEST DOCTORS COST OF CANCER TREATMENT IN TURKEY RANKING OF THE BEST CLINICS IN TURKEY IN TREATMENT OF ONCOLOGY COST OF CANCER TREATMENT IN TURKEY WHAT IS INCLUDED IN THE PRICE OF CANCER TREATMENT IN TURKEY ​ Cancer treatment is a priority in the development of medicine in most clinics in Turkey. Turkey has already made impressive progress in this area, and continues to move towards becoming the world's best cancer control. Survival rates after the end of cancer treatment in Turkey have already exceeded those in Israel and Germany. ​ 1. DIAGNOSTIC METHODS ​ For the diagnosis of cancer from stage 0 to 4, clinics in Turkey are equipped with the most innovative technologies and equipment, namely: when diagnosing and treating, they follow established international protocols; diagnostic plans and therapy protocols in Turkey are fully consistent with the principles of precision medicine (personalization, participation, forecasting); 42 medical institutions of the country are accredited by JCI, their certificate is recognized as the most prestigious in the world; Turkey is one of the 5 countries with the largest amount of the latest generation of medical equipment; in private medical centers in Turkey, all the necessary methods of therapy are available for oncology, as well as for organ transplants and bone marrow transplants; world-famous medical centers cooperate with Turkish ones in the direction of cancer treatment (Johns Hopkins Clinic, Memorial Sloan-Kettering Cancer Center, Anderson Cancer Center, etc.). Turkish specialists regularly improve their knowledge at international conferences, seminars, symposia dedicated to the fight against cancer, held in the United States and Europe; in Turkish hospitals the most reasonable prices, in comparison with EU clinics, are 40% lower, but the level of medical services is on a par with leading countries. Summarizing the above, we can safely guarantee that Turkey has all the ingredients for effective cancer treatment, from experienced doctors with international practice and education to equipping clinics with the latest innovations in the field of medicine and safe equipment. ​ 2. DIAGNOSTICS OF ONCOLOGY IN TURKEY ​ CT (computed tomography) is the gold standard for recognizing the type of tumors; MRI (Magnetic Resonance Imaging) provides high-resolution 3D images. It is also used in operations to improve the accuracy of the intervention; the program of treatment and prognosis in oncology is based on the biopsy of the tumor tissue; the time for the entire examination takes 1-2 days, and the results are obtained in 3. A consultation (a group of experienced doctors of different specializations) is involved in making the diagnosis. 3. CANCER TREATMENT IN TURKEY ​ Among the oncological areas, patients often go to Turkey for treatment: breast cancer; adenocarcinoma of the stomach; prostate cancer; bladder tumors; lung cancer; melanoma; liver cancer; meningiomas; kidney cancer; astrocytomas; for a bone marrow transplant, which is required for patients with acute or chronic leukemia, lymphoma, lymphocytic leukemia and other blood disorders. Reasons for choosing Turkey for bone marrow transplant: ​ Turkish clinics have access to the Bone Marrow Donors Worldwide (BMDW). This enables the patient to find a suitable donor faster; in Turkey, autologous and allogeneic bone marrow transplants from a related or unrelated donor are practiced; the cost of transplantation in Turkey is 2-3 times cheaper than in Europe and the USA. The price of bone marrow transplant in Turkey is indicated at the end of the article; after transplantation, the patient is placed in specialized sterile boxes, protected from the penetration of any infections. The wards are equipped with special HEPA filters, which significantly reduces the risk of complications; in the first 3 months after transplantation, the patient is under medical supervision. In the event of a new bone marrow rejection, the transplant team will provide the necessary assistance. ​ The success rate of bone marrow transplant in Turkey is over 94%. ​ 4. TECHNOLOGICAL EQUIPMENT OF CLINICS ​ TrueBeam Varian / Elekta / STx Linear accelerator of the latest generation used to irradiate tumors. The use of TrueBeam cuts the treatment time in half. Radiation is directed locally to the tumor with millimeter precision. In this regard, side effects are minimized. The procedure does not require anesthesia, as the radiation is absolutely painless. ​ CyberKnife Robotic System A unique device in the world for non-invasive treatment of tumors anywhere using high doses of radiation. CyberKnife imaging software delivers ultra-precise target doses and automatically adjusts to tumor movement. ​ Da Vinci robotic system Doctors, controlling the Robot, carry out low-traumatic operations through several incisions. This system is equipped with a video camera and delicate instruments that make incisions with millimeter precision, unlike human hands. Thanks to this, the operations are carried out without complications. After robotic surgery, the patient recovers faster and, in most cases, retains the functionality of the organ. ​ Gamma Knife Elekta This radiosurgical unit is used to treat brain tumors. The irradiation accuracy with the Gamma Knife Elekta system is 0.15 mm, which is six times the standard for existing systems. The safety of using the Gamma Knife is enhanced by the Cone Beam CT imaging. Due to this, the irradiation is stopped or reduced when healthy tissue hits the target. ​ 5. INNOVATIVE TREATMENT TECHNIQUE ​ Innovative technologies and methods are applied in the treatment of cancer for any stage and type. In Turkey, special attention is paid to the use of modern methods of oncological therapy, which show high efficiency in cancer treatment and safety for patients. Namely: ​ targeted therapy, that is, the treatment of cancer with targeted drugs that have a point effect on a malignant neoplasm; tomotherapy, which destroys tumors using layer-by-layer radiation; immunotherapy is the treatment of oncology with medications that activate the patient's immunity and help the immune system to destroy cancer cells. Originals of proven and effective drugs are available (Keytrudy, Opdivo, Tukisa); HIFU therapy is a high-intensity focused ultrasound used to treat prostate cancer. It is an alternative to radiotherapy with the least side effects. 6. WORK WITH PATIENTS IN STAGE 4 ​ In Turkey, there are a huge number of cases when clinics accepted hopeless patients for treatment and helped them. The patients showed significant tumor shrinkage and improved. ​ 7. TREATMENT OF CHILD ONCOLOGY ​ For children, special, more gentle treatment protocols are being developed. Pediatric bone marrow transplant in Turkey has a 92% success rate. Turkish clinics cooperate with foundations that help raise money for the treatment of children. Children with the following oncological diagnoses are more often brought to Turkish clinics for treatment: Ewing's sarcoma; nephroblastoma; Hodgkin's lymphoma; retinoblastoma; neuroblastoma. These children need inexpensive and safe chemotherapy and radiotherapy. Turkish doctors have extensive experience in bone marrow transplantation for children. For example, in 2017 alone, more than 2,600 successful pediatric bone marrow transplants were performed across Turkey. ​ 8. LIST OF ONE OF THE BEST DOCTORS ​ Professor Fatih Ağalar is a world-renowned oncological surgeon who has been dealing with oncology and hematology oncology for over 20 years. Specializes in Da Vinci robotic surgery. Dr. Ağalar practices at the LIV HOSPITAL . Professor Derya Balbay is a renowned oncological urologist and specialist in surgery Da Vinci. Practicing at the MEMORIAL clinic. The total experience is over 32 years. Associate Professor Ahu Birol has specialized in skin cancer for over 29 years. Works as an oncodermatologist at the MEMORIAL clinic. Prior to that, she studied in the USA. Professor Nejdet Husein is an ESMO certified hematologist who participated in the first bone marrow transplant in Turkey. Professor Tunç Fışgın is an outstanding pediatric hematologist with 25 years of experience. He accepts patients at the MEDIKAL PARK clinic 9. RATING OF THE BEST CLINICS IN TURKEY IN TREATMENT OF ONCOLOGY ​ The ranking of Turkish hospitals is based on the presence of strong oncology departments and the number of good patient reviews. The survival rate of cancer patients in these hospitals is slightly higher than in other clinics in Turkey. ​ LIV HOSPITAL clinic in Istanbul; University Hospital KOÇ UNIVERSITY HOSPITAL in Istanbul; a group of MEMORIAL clinics in Antalya and Istanbul; the network of clinics MEDIKAL PARK in Istanbul, Izmir; ACIBADEM clinic in Istanbul, Ankara; ​ KENT HASTANESI clinic in Izmir; ÖZEL SAĞLIK HASTANESI clinic in Izmir. 10. COST OF CANCER TREATMENT IN TURKEY ​ Oncology treatment in Turkey is much more budgetary than in other EU countries. The same chemotherapy in Turkey will cost $ 1,000, while in Israel a patient will pay $ 2,000-2,500 for a course. The prices of oncology treatment in Turkey are from 25% to 50% lower in comparison with Germany, England, Israel and the USA. The cost of the oncological therapy program consists of the selected methods of dealing with pathology, the experience of the specialists conducting the treatment, as well as the pricing policy of the clinic. The average cost of treating malignant neoplasms in Turkish medical centers is: ​ Consultation with an oncologist from $ 115; Prostatectomy from $ 12,000; Esophagectomy (surgical removal of esophageal cancer) from $ 13,400; Chemotherapy from $ 1,000; Targeted therapy from $ 2,000; Immunotherapy from $ 1,800. 11. WHAT IS INCLUDED IN THE PRICE OF CANCER TREATMENT IN TURKEY We offer an example of a service and its price. A consultation of doctors draws up a personal program for each patient. It may include other analyzes or another type of surgery. Treatment is selected so that it does not harm healthy human organs. For this, not only the peculiarities of the course of oncology are taken into account, but also the state of health in general, the patient's medical history. Cancer Check-up from $ 3 600 Consultation with an oncologist Complete blood count and tumor marker test CT of the lungs Abdominal MRI Ultrasound of the thyroid gland Mammography / PSA test Radiosurgery at the LIV HOSPITAL clinic from $ 6 400 Consultation with a radiologist Fixing vest or mask 1 session of CyberKnife irradiation 2 places of irradiation Radical bladder resection (with reconstruction) at KOÇ UNIVERSITY HOSPITAL from $ 15,000 Consultation with an oncologist Open surgery to remove the bladder Restoration of the urinary tract 7 days in the hospital Mastectomy at MEDIKAL PARK from $ 8,000 Consultation with an oncologist and mammologist Complete breast removal 3 days in the hospital Medicines and special linen The advanced computer software, which the unit is equipped with, makes it possible to monitor the location and borders of the tumor in real time with high accuracy. At the slightest movement of the patient, the direction of radiation is automatically corrected. ​ This is especially important when malignant tumors, such as lung cancer, change their position during breathing. ​ In addition, the patient does not need rigid fixation, which significantly increases the comfort of the procedure. ​ This system has made it possible to obtain good results in the treatment of prostate cancer, liver cancer, metastases of various localization, head and neck cancer. In addition, it has shown high efficiency in brain radiosurgery. ​ The Radiotherapy Unit of Turkish Medical Centers is planning to sign an agreement with the manufacturer Accuray and become an official training center for the use of the Cyberknife device. ​ Varian Edge ™ This robotic computer system is based on TrueBeam technology. It is unique in that it combines the capabilities of stereotactic radiotherapy and radiosurgery. Thanks to this, the capabilities of the system have expanded significantly. It is able to effectively fight tumors of various sizes and localizations, which often cannot be operated on or cannot be treated with traditional methods. Varian Edge ™ quickly and accurately transmits radiation to the desired point. The radius of action is less than 1 mm, which allows for maximum precision. The system adjusts the radiation dose, adjusting to the displacement of the tumor during breathing or micromovements of the patient. ​ As a result, the beam affects only cancer cells without affecting neighboring healthy tissues. The side effects of radiation are minimized. ​ Accuray Radixact® System ​ This is the latest device for tomotherapy (TomoTherapy), which allows the treatment of a wide range of oncological diseases without size restrictions, including volumetric neoplasms in breast cancer, craniospinal tumors, bone metastases. ​ Its significant advantage over other similar devices is the ability to conduct radiation therapy to the whole body, which is especially important for cancer of the blood and bone marrow. ​ This latest generation machine is faster and easier to use. The Radixact Accuray system is equipped with a tomograph, which makes it possible to obtain a clear image of the neoplasm in real time and make corrections based on changes in the shape, size and location of the tumor. ​ Radiotherapy is a very important part of cancer treatment. The director of the radiotherapy department in one of the medical centers in Turkey, Professor Hal Bashak Chalar, says: “We chose the Radixact device because it has unique technical features that will help us deliver cancer treatments even more effectively. This robotic system is able to connect to the digital support of the CyberKnife M6, which gives us more options in the fight against cancer. If necessary, we can combine both devices or exchange one device for the other, depending on the patient's needs, thus providing a more personalized treatment. ” ​ 13. The value of modern technologies for the treatment of cancer ​ The use of modern equipment and technologies in medical centers in Turkey allows for treatment by methods of stereotactic radiotherapy and radiosurgery on an outpatient basis. ​ These techniques: do not require surgery and anesthesia; painless; are not accompanied by serious side effects (nausea, vomiting); do not imply long-term rehabilitation. In contrast to traditional methods of radiation exposure, after the procedure, only small short-term symptoms may appear, which differ from case to case. ​ Need help? ​ To organize cancer treatment in Turkey, leave a request on the website Medikal & Estetik Group . You will be contacted by a specialized doctor-coordinator who will help you choose the best medical center. Send him your medical records, he will redirect them to the hospital of your choice and request a treatment program. ​ We will help you organize your trip and stay in touch with you throughout your treatment - from the moment you contact us and even after you return home. ​ Medikal & Estetik Group is an independent medical service that does not represent the interests of any of the clinics. Patients do not pay for our services - medical centers do it. ​ Doctors-coordinators will advise you and help you with the choice. Medikal & Estetik Group services are free of charge for you and do not affect the clinic bill. 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