Urushizaki I
Sapporo Medical College, East Sapporo Hospital.
Gan To Kagaku Ryoho. 1990 Jul;17(7):1383-92.
Most of the symptoms from a malignant tumor are caused by local invasion by the tumor, or obstruction, either at the site of the primary disease or by metastases. However, tumors can produce symptoms at a remote site. Patients with gastrointestinal malignancy may present with symptoms which include dysphagia, nausea, vomiting, abdominal pain, diarrhea, bleeding and ascites. Palliation gastrectomy delays or prevents these symptoms. About 30% of gastric carcinomas are inoperable at the time of presentation. Chemotherapy is rarely effective in the palliation of gastric carcinoma. Laser irradiation can be delivered to assay site accessible to fibreoptic endoscopy, which is an advantage over endocavity irradiation or diathermy fulguration. Ascites is a common and disabling implication in patients with advanced malignant disease. Spironolactone will increase urinary sodium excretion significantly and control their ascites. If spironolactone fails to control, useful control can be achieved by draining the ascites. Patients with carcinoma of the lung may present with symptoms that include cough, bloody sputum and dyspnoea. Pain in the chest wall is usually secondary to invasion of the parietal pleura, ribs or intercostal nerves. Lesions in the medial portion of the right upper lobe, or mediastinal metastases, may invade or compress the superior vena cava, causing venous hypertension with oedema of the head and arms. The patients may complain of dyspnoea, dysphagia, stridor and headaches. Radiotherapy can be expected to improve the quality of life for these patients. Successful palliation of symptoms is almost related to tumor regression. The problems of obstruction and bleeding from malignant tumor is common. Recently, laser techniques have been applied to aid in palliation of these problems. Malignant effusion may occur early and be the first signs of metastases. The aim of therapy is to evacuate the fluid and induce pleural adhesion. One of the sad situations that we have to face is the patient with recurrent cancer which complains of various symptoms. The relief of symptoms is the most important palliative therapy to them.
大多数恶性肿瘤的症状是由肿瘤局部侵犯、阻塞引起的，这种侵犯或阻塞可发生在原发疾病部位或转移部位。然而，肿瘤也可在远处部位产生症状。胃肠道恶性肿瘤患者可能出现吞咽困难、恶心、呕吐、腹痛、腹泻、出血和腹水等症状。姑息性胃切除术可延缓或预防这些症状。约30%的胃癌在初诊时无法手术切除。化疗在胃癌姑息治疗中很少有效。激光照射可用于纤维内镜可到达的检查部位，这比腔内照射或透热电灼更具优势。腹水是晚期恶性疾病患者常见且致残的并发症。螺内酯可显著增加尿钠排泄并控制腹水。如果螺内酯无法控制，通过引流腹水可有效控制。肺癌患者可能出现咳嗽、咯血和呼吸困难等症状。胸壁疼痛通常继发于壁层胸膜、肋骨或肋间神经受侵。右上叶内侧病变或纵隔转移可能侵犯或压迫上腔静脉，导致静脉高压，出现头臂水肿。患者可能主诉呼吸困难、吞咽困难、喘鸣和头痛。放疗有望改善这些患者的生活质量。症状的成功缓解几乎与肿瘤消退相关。恶性肿瘤引起的阻塞和出血问题很常见。最近，激光技术已应用于辅助缓解这些问题。恶性胸腔积液可能早期出现，是转移的首发迹象。治疗目的是排出液体并诱导胸膜粘连。我们不得不面对的一个令人难过的情况是患有复发性癌症且主诉各种症状的患者。对他们来说，缓解症状是最重要的姑息治疗。
