The system of health service in the world today is characterized by the ever-present attention to the problems of early diagnosis and prevention of oncologic diseases among women. The prevalence rates of breast cancer have skyrocketed by 30.3 % in Russia only for the past 10 years and amounted to 439 cases per 100,000 people. The trend of «rejuvenation» of breast cancer and its increasing occurrence among women aged 19-39 by 42.2 % is of particular concern. The screening mammography was introduced in 2006 to solve the problem. The mortality rate per year and general mortality rate decreased by 26-28 %o, the age-standardized death rate decreased by 14.9 % and the detection of breast cancer in the stages 1-2 increased up to 70.4 % due to systematic screening of 42 % of women in Russia over the past 10 years. A more active role of digital non-invasive and invasive diagnostic technologies instead of hospitalization is becoming more prevalent, also the using of high energy-treatment, including targeted therapy, and oncoplastic breast surgery are necessary to enhance the effectiveness of screening. Interdisciplinary integration in the system of continuing medical education, timely adjustment of normative documents according to rapid re-equipment, solving drug shortage situation, attracting attention of public organizations, social movements, foundations, voluntary clubs for outreach activity set up a whole new level of cancer care.

The breast cancer ranks first among all cancer types diagnosed during pregnancy or up to 1 year after delivery. Most notable practicing obstetricians should remember about possibility breast cancer during pregnancy and lactation. In case of suspicious lesion standard diagnostic algorithm for pregnant women should be fulfilled completely. The delay of diagnostic procedures until after delivery is unacceptable. The strategy of treatment is individual and should be worked out at a multidisciplinary consilium. The individual treatment planning is provided by breast unit team including oncosurgeon, clinic oncologist, radiation oncologist, anesthesiologist, obstetrician and certainly clinic psychologist. The optimal option is accumulation of pregnancy-associated breast cancer patients in a specialized oncologic clinic including obstetrics outpatient and inpatient units. A majority of studies report that survival is worse of pregnancy-associated breast cancer patients than of their non-pregnant counterparts.

Management of pregnant women with ITP is important for hematologists and obstetrician-gynecologists. The article presents a review of the literature on diagnostic methods and strategies for treating pregnant women with immune thrombocytopenia. The reasons for limiting the use of the main pathogenetic drugs in a cohort in pregnant women are described in detail. The author described study with a novel approach to immune thrombocytopenia (ITP) in pregnancy (RhTPO).

Renal cell carcinoma is highly refractory to conventional chemotherapy. The survival of tumor cell in several cases is assisted by overexpression of immune checkpoint molecules such as PD-L1 to avoid being attacked by the immune system. One of directions of contemporary immunotherapy is the blocking of checkpoint of immunity by antibodies. This part of review describes the recent data on PD-1 pathway, tumor biomarker of PD-1 pathway, medications are PD-1/PD-L1 inhibitors and clinical perspectives of immunotherapy of renal cell carcinoma. We provide a discription of proteins and genes of PD-1 and PD-L1. The analysis of literature data on mechanism of action of PD-1 signaling pathway, its interaction with other pathways, and the role in regulation of the immune response is presented. The biological significance of soluble PD-1/PD-L1 in human cancers and evaluate whether they are potential diagnostic, therapeutic and prognostic biomarkers is described.

Goal. To improve results of surgical treatment of patients with Papilla Vateri cancer. Materials and methods. 253 patients with Papilla Vateri cancer were identified between years 1976 and 2017 at the Surgical Department of Pancreas and Liver Cancer of National Medical Research Centre of Oncology n.a. N. N. Blokhin in Moscow, Russia. Results. Multivariate analysis with Cox regression model revealed that 7 factors were independently associated to a longer overall survival, which included intestinal pathomorphological type of the tumor, tumor size ≤ 2 cm, no lymph node involvement, time of operation ≤ 270 min., no pancreatic stump complications, pancreaticogastrostomy vs. pancreaticojejunostomy, method of treatment (combined treatment vs. surgery alone). The increase of amount of prognostic factors leads to a shorter overall survival. The combined treatment of patients with pancreato-biliary type of Papilla Vateri cancer results in better survival comparing to surgery alone (3-year survival 65 ± 15 % vs. 49 ± 8 %, median 37 vs. 35 months respectively; p = 0.006), while patients with intestinal type of cancer showed no difference in these groups. Conclusions. Pancreato-biliary type of cancer is associated with poorer survival comparing to intestinal type. The combined treatment with adjuvant chemotherapy in patient with pancreato-biliary type of cancer improves overall survival.

The trend of modern healthcare is developing of home care strategy, including home enteral nutrition. The number of patients including oncological patients who have already be involved in this program and who need, it is progressively increasing. The multidisciplinary team, including a physician, a nutrition nurse and others should decide all medical and social issues in the feeding context after discharge. The urgent issue for Russian Federation is creation of unified program for home enteral nutrition for adult and pediatric patients.

Contemporary combined therapy in breast cancer patients includes breast reconstruction more and more often nowadays because this approach improves patients’ quality of life. But still reconstructive surgery may lead to significant amount of complications. One of the approaches which can decrease complication rate while keeping overall survival and relapse-free survival the same is neoadjuvant chemotherapy and neoadjuvant radiotherapy. In this article is presented a case of advanced breast cancer which was treated consequentially with chemotherapy, radiotherapy and mastectomy with immediate breast reconstruction.

Stereotactic radiotherapy is a relatively new development in the field of radiation therapy. Dosimetric planning of this type of radiation treatment has its own specifics. Specialized three-dimensional planning of RT allows achieving a high dose inside the target and a high dose gradient outside the target. The results of a comparison of two methods for physico-dosimetric planning of radiotherapy sessions with modulation of the intensity of the photon beam of patients with pancreatic cancer are presented.

The purpose of research. The purpose of the study was to create and test the performance of the model of individual risk assessment of cancer of different localization based on the Bayes theorem for the organization of primary prevention of the disease. Materials and methods. Epidemiological studies of the prevalence and significance of known risk factors in the development of cancer of different locations among residents of the Omsk region. The sensitivity and specificity of the proposed diagnostic approach (test) were determined. The study used epidemiological, sociological, statistical methods. Results. The paper shows the possibility of using an algorithm based on the Bayes theorem to estimate the individual risk of developing cancer of different localization. Based on the results of the epidemiological study, conditional probability of detection of risk factors in the presence / absence of cancer was calculated. At the second stage, the algorithm for calculating the likelihood of developing cancer under the certain combination of risk factors was justified. The received results allow to estimate and predict a level of individual risk at change of a combination of factors at the concrete woman. This technique can be implemented as a computer program. The conclusion. The use of probabilistic approaches to the evaluation of a complex of risk factors for the development of cancer of different localizations on the one hand will facilitate the process of making the right decision by the doctor, and on the other, will increase its objectivity. The program for calculating the risk of developing cancer can be used in the practice of an oncologist, therapist, general practitioner to assess the personified individual risk of developing this pathology and give recommendations on primary prevention. Calculation of the risk value when working with the patient can be carried out repeatedly, changing the parameters of the corrected factors.

No standard of care has been established for patients with progressive glioblastoma (rGB). Previous studies suggested that bevacizumab (BEV) is safe and produces responses that result in a decreased use of glucocorticoids and increased progression-free survival (PFS) with an unclear effect on overall survival (OS). Crossover to BEV in the control arm is the possible reason why the advantage of BEV has not been proven in Phase III trials. We present our own retrospective data on the effectiveness of the use of BEV in the rGB. Special attention was paid to the analysis of the consequences of BEV discontinuation in the absence of tumor progression and the benefit of continuing or resuming BEV at relapse.