State Establishment “N.N. Alexandrov National Cancer Centre of Belarus”


The Presentation inside:

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Minsk, Belarus 2009 State Establishment “N.N. Alexandrov National Cancer Centre of Belarus”


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THE COUNCIL OF MINISTERS OF THE BYELORUSSIAN SSR Resolution On Intensifying Cancer from May 23, 1959 № 364 Research Investigations The Council of Ministers of the Byelorussian SSR states that the level of researches on malignant neoplasm diseases is absolutely insufficient in medical and research institutes and establishments of the Byelorussian SSR. There is no material and technical basis for experimental studying the most important problem in the republic. Some oncological dispensaries (Mogilev, Gomel and others) are located in premises, inadequate in area, Vitebsk and Grodno dispensaries have no in-patient departments; there are no hostels-hotels for oncological patients undergoing out-patient treatment. With the aim to create necessary conditions for organizing and conducting broad experimental and clinical researches on cancer problem at an up-to-date level, training highly qualified specialists-oncologists as well as improving prophylactic and medical help to patients with malignant diseases, the BSSR Council of Ministers D e c i d e s: 1. To take into consideration that in the seven-year plan, the BSSR Public Health Ministry forsees constructing a 200-bedded research institute of oncology and medical radiology in a zone out of Minsk; 5 oncological dispensaries with radiological and in-patient departments.


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1960 y. N.N. Alexandrov – the founder and first director near a model of the future institute .


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Administration building


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Modernized building for oncological mammalogical department


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Laboratory building


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Recreational pavilions in pedestrian zones on the Centre territory


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With the Decree of President of the Republic of Belarus Alexandr Grigoryevich Lukashenko from July 6, 2005 oncology is included into the structure of main trends of scientific and technical activities in the Republic of Belarus in 2006 – 2010


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SE N.N.Alexandrov NCCB SE COH NCCB 5 regional ODs 6 interdistrict ODs and MCOD Specialized Medical Help to Oncological Patients 3 910 special beds for oncological patients


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Centre Structure At the base of the Centre, the BelMAPO Oncology Department (2 Doctors of Sciences and 2 Candidates of Sciences) functions as well as the Council for dissertation defense Д 03.12.01 on specialties 14.00.14 – oncology 14.00.19 – radiodiagnosis, radiotherapy


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Research Trends organizing anticancer struggle, studying cancer epidemiology and prophylaxis developing new technologies for diagnosing malignant tumours developing new technologies for managing patients with malignant neoplasms developing new technologies for rehabilitation and bettering quality of oncological patients’ life carrying out clinical trials of new drugs improving medical and technical basis of the oncological service of the republic


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Center Bedding 820 beds 12 beds— the Resuscitation Department


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Hospitalized Patients 19343 Annually more than 200 foreign patients from the USA, France, Russia, India, Iraq, Poland, Azerbaijan, Armenia, Georgia, Kazakhstan, Latvia, Lithuania, Moldova, Uzbekistan, the Ukraine and other countries undergo medical treatment in the Centre.


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Diagnostic Base of the Centre


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Practically, the whole specter of biochemical, clinical, immunohistological, radioisotopic, molecular and genetic investigations is performed. Laboratory Diagnosis


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Laboratory of Molecular Oncogenomics Specter of Performed Investigations Detecting mutations in genes of hemodialysis system Detecting mutations in genes hereditarily associated with breast and ovarian cancer (BRCA1 and BRCA2) development Identifying mutations in genes hereditarily associated with colon cancer (APC, K-ras, MLH1, MSH2, BCL2) development Assessing a residual minimal disease under malignant neoplasms of breast, lung and prostate


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Translocation t(11,14) under lymphoma from mantle zone cells Fluorescent microscope Axioskop 40 FISH-Laboratory FISH - fluorescent in situ hybridization identifying amplifications of HER-2/neu gene at breast cancer for performing a target (using monoclonal antibodies) therapy; detecting translocations, deletions, inversions in non-Hodgkin’s lymphomas; detecting chromosomal aberrations in solid tumours (breast and bladder cancer, some soft tissue tumours, brain tumours)


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Laboratory of Molecular Cytogenetics


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Morphological Methods of Investigation


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Distribution of protein ER in tumour cell nuclei at BC, x40. Immunohistochemical staining MKAT (clone 1D5, DAKO) Distribution of protein PR in tumour cell nuclei at BC, x40. Immunohistochemical staining MKAT (clone PgR636, DAKO) Receptor status: ER, PR Up-to-date immunohistological investigation methods using more than 60 poly- and monoclonal antibodies are introduced and widely used in practical work at present .


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Distribution of protein c-erbB-2 in tumour cell nuclei at BC, x40. Immunohistochemical staining MKAT (dilution 1:300, polyclonal, DAKO) Level of Protein c-erbB-2 and Protein BRCA I Expressing Cytoplasmatic distribution of protein BRCA1 in tumour cells at BC, x40. Immunohistochemical staining MKAT (dilution 1:50,clone E30, DAKO)


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Telepathology system for giving on-line consultations on morphological preparations Modern equipment for biopsy material automated paraffin covering


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Radiodiagnosis The department is equipped with modern, mainly, digital diagnostic instruments securing the use of an advanced filmless technology of getting, transmitting, processing and keeping images. At the base of the department one realizes a big work on training specialists in radiodiagnosis for medical institutions of the oncological profile of the Republic of Belarus (at working places and conducting thematic seminars). The permanent school for advanced training of radiodiagnosticians of Minsk region has been functioning here for 5 years.


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Computer roentgen tomographs


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Magnetic resonance tomograph


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One-photon emission tomograph


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Angiographic investigations


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Ultrasound investigations USI scanners in the expert class


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Intraoperative ultrasound investigation


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Diagnosing Bladder Cancer on the Basis of Photodynamic Effect Bladder cancer manifestation after intravesicular introduction of 5-ALA (Alamin): А – white lit; B – blue lit (? = 400 nm), one can see additionally detected bladder tumours А B


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Efficacy of Clinical Use of 5-ALA (Alamin) of the Belarusian Production Additional malignant bladder tumours are detected in more than 18% of patients Obligate precancer is detected in 13% of patients


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Highly Technological Methods of Treatment


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Surgical Activities Totally, there were made 2007 — 9 323 operations 2008 — 10 628 operations. There were operated 2007 — 9 027 patients 2008 — 9 721 patients


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Highly Technological Medical Interventions Combined operations with resection and prosthetics of arch and chest aorta, vertebrae bodies as well as resection of atrium with alloplasty of its wall using an artificial circulation apparatus in lung cancer patients Bronchoplastic operations with resection and plasty of pulmonary artery and vena cava superior at lung cancer Intrapleural and intra-abdominal thermochemotherapy in patients with pleural mesothelioma and metastatic involvement of abdomen Pancreoduodenal resections at pancreas head cancer, with pylorus being saved


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Pancreatectomy under total pancreas cancer, with pylorus constrictor being saved Gastropancreatoduodenal resections under locally spread stomach carcoma (with involvement of pancreas head) Biliary stenting at pancreas head cancer complicated with mechanical jaundice Management of liver and lung metastatic lesions using radiofrequency ablation Extended operative interventions into liver with removing 6 segments Radical cystectomy with forming artificial bladder from intestine


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Multicomponent management of patients with primary liver cancer and colorectal cancer with metastases in liver using preoperative chemoembolization of hepatic artery Laparoscopic radical prostatectomy Extracorporeal nephrectomy Operations under brain and skull base tumours Reconstructive and plastic operations using a microsurgical technique Photodynamic diagnosis and therapy using original Belarusian drugs (5-aminolevulinic acid, fotolon)


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method of combined and radiation treatment of patients with supratentorial gliomas and a metastatic brain lesion ; pneumoectomy with resection and prosthetics of descending aorta; distal resection of pancreas with resection and angioplasty of celiac trunk; exenteration of pelvis at locally spread cervical cancer; monoblock hystervaginavulvectomy with lymphaden-ectomy; fluorescent diagnosis and photodynamic therapy for precancer cervical diseases; subtotal laryngectomy; High Technologies Introduced in 2008


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reconstruction of mandible using titanium implants; use of the navigation system for diagnosing and treating brain and skull base tumours; shunting operations under brain tumours; extraperitoneal videoassisted radical prostatectomy; extracorporeal nephrectomy with autotransplantation; videoassisted nephroablation; subtotal coloproctectomy with forming intestine reservoir and ileoanal anastomosis; intersphincter proctectomy; stenting esophagus and trachea.


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Radiofrequency Ablation of Tumours Perfused elecrodes Generator Integra Elektrotom HITT®106


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Radiofrequency Ablation of Hepatic Tumour Liver CT with bolus contrasting (portal phase) before (A) and after (B) radiofrequency ablation of solitary metastasis of bronchial carcinoid


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Radiofrequency Ablation of Pulmonary Neoplasm Computer tomograms during the ablation (A) and 1 month afterwards (B) of the patient with a lung cancer metastasis after lobectomy. There is an encysted cavity at the metastasis place.


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Radiofrequency Ablation of Kidney Neoplasm


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Endoscopic Operations Laparascopic: splenectomy,adrenalectomy, nephrectomy, radical prostatectomy, obstructive resection of sigmoid colon and others. Thoracoscopic: lobectomy, thymectomy, removing posterior mediastinum, parasternal lymphadenectomy at breast cancer. Videoassisted mediastinoscopy 100% of morphological verification of pathological changes of mediastinum lymphnodes. 10% of changed diagnoses after mediastinoscopy Complications – 0,32%.


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OPERATIONS UNDER HEAD AND NECK TUMOURS


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Upper maxilla cancer with growing into the orbit and spreading into the anterior cranial fossa CRANIOFACIAL RESECTION


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CRANIOFACIAL RESECTION Cranial and facial stage View of the wound after removing preparation Macropreparation


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TECHNOLOGY OF TRACHEOESOPHAGEAL SHUNTING WITH VOCAL PROSTHESIS INSERTING SET FOR INSERTING VOCAL PROSTHESES


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ONE-STAGE REPARATION OF VOCAL AND ESOPHAGEAL FUNCTIONS PHARYNGOSTOMA TRACHEOSTOMA


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TRACHEOESOPHAGEAL ANASTOMOSIS FORMING The trochar is inserted via pharynx


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PROSTHESIS FIXATION IN CONDUCTOR The prosthesis is fixed in a conductor


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PHARYNX ANTERIOR WALL FORMING WITH LOCAL TISSUES Vocal prosthesis


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THE SKIN DEFECT IS REMOVED WITH SKIN AND MUSCULAR PECTORAL GRAFT


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INSERTED VOCAL PROSTHESIS


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Plastic Operations in Patients with Breast Cancer


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Patient Z, 34 y.o. Diagnosis: left breast cancer T2N0M0G2. The condition after a complex treatment in 1996–1997. DELAYED MAMMAPLASTY


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The same patient. The condition after a delayed mammaplasty with a free TRAM-graft in 1999.


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The same patient. The condition after the reconstruction of mamillary and areolar complex in 2001.


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Right breast cancer Т2N1М0. The condition after bilateral subcutaneous mastectomy and one-stage mammaplasty through a combined method (the broadest back muscle + endoprosthesis)


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Postmastectomy Syndrome


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Plasty of Soft Tissues


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Rhabdomyosarcoma of Left Forearm Soft Tissues


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The same patient: plasty with a radial fixed vascular pedicle flap


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Operations Preserving Organs under Bone Tumours


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Modular Endoprostheses


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Endoprosthetics with saddle-like prosthesis


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Lung Cancer and Mediastrium Tumours


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Lung Tumour Invading Left Atrium Lumen


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Tumour in Left Atrium Lumen


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The lung is removed, the left atrium wall defect is substituted with xenopericardium


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MSCT before Operation


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Detecting Site of Thoracic and Abdominal Aorta with Tumour Esophagus Celiac trunk SMA Left kidney vessels Aorta tumour


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Spine Left kidney vessels Aorta The site of aorta with tumour is resected. Celia trunk


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Esophagus Left kidney vessels Aorta prosthesis The prosthesis is made to aorta. Celia trunk SMА


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Macropreparation


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Extracorporeal nephrectomy with autotransplantation


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View of reconstructed kidney


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Ileocystoplasty according to R. Hautmann (Modified) after Radical Cystectomy due to Bladder Cancer


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Operating Block


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Resuscitation Department


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The apparatus “Artificial Kidney” Procedure of extracorporeal detoxication using the apparatus «Multifiltrat»


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Radiotherapy


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Material and Technical Basis of Remote Radiotherapy


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Material and Technical Basis of Short Focus and Contact Radiotherapy


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Material and Technical Basis for Preradiation Preparation


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Material and Technical Basis (Auxiliary Devices and Dosimetry)


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Linear accelerator with 2 photon energies and 6-8 energies of electrons with a many-plane diaphragm, with a mobile system of getting tomographic images through X-ray bundle according to the procedure “Cone-beam CT” for localizing a target, verifying an irradiation plan and posing a patient (IGRT) Radiotherapeutic Complex


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High Technologies in Radiotherapy Three-dimensional conformal radiotherapy Radiotherapy with modulating dose intensity Stereotaxic radiotherapy / radiosurgery Four-dimensional conformal radiotherapy


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Brachytherapy Using an Integrated X-ray and Topometric Complex (IBU) Brachytherapy of prostate tumours with high dose power controlled through TRUZI and planning in the SWIFT- system online


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Hyperthermia


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Equipment for Photodynamic Therapy and Diagnosis «Metalaz-M» «Kamin-Video» «Lesa-6» «LD-680»


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6 months afterwards Patient C., 34 y.o., CIN III. 26.10.07. – PDT Before treatment Photodynamic Therapy under Cervical Dysplasia


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Dynamics of Malignant Neoplasm Morbidity and Mortality in the Republic of Belarus 194,3 (-3,1%) 329,1 414,1 188,2 (on 100 000 of population) (+24,8%) Data of the Cancer-Register. Data of the National Committee on Statistics of Belarus


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Europe Belarus European Union Annals of Oncology 16: 481-488, 2005 Belarusian Cancer-Register, 2008 Correlation of the Died due to Malignant Neoplasms to the Number of the Sickened (2004)


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