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

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.

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

Administration building

Modernized building for oncological mammalogical department

Laboratory building

Recreational pavilions in pedestrian zones on the Centre
territory

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

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

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

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

Center Bedding
820 beds
12 beds— the Resuscitation Department

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.

Diagnostic Base of
the Centre

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

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

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)

Laboratory of Molecular Cytogenetics

Morphological Methods of Investigation

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 .

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)

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

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.

Computer roentgen tomographs

Magnetic resonance tomograph

One-photon emission tomograph

Angiographic investigations

Ultrasound investigations
USI scanners in the expert class

Intraoperative ultrasound investigation

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 (λ = 400 nm),
one can see additionally detected bladder tumours
А
B

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

Highly Technological Methods of Treatment

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

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

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

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)

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

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.

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

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

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.

Radiofrequency Ablation of Kidney Neoplasm

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%.

OPERATIONS UNDER HEAD AND NECK TUMOURS

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

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

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

ONE-STAGE REPARATION OF VOCAL AND ESOPHAGEAL FUNCTIONS
PHARYNGOSTOMA
TRACHEOSTOMA

TRACHEOESOPHAGEAL ANASTOMOSIS FORMING
The trochar is inserted
via pharynx

PROSTHESIS FIXATION IN CONDUCTOR
The prosthesis is fixed
in a conductor

PHARYNX ANTERIOR WALL FORMING WITH
LOCAL TISSUES
Vocal prosthesis

THE SKIN DEFECT IS REMOVED WITH SKIN AND MUSCULAR PECTORAL GRAFT

INSERTED VOCAL PROSTHESIS

Plastic Operations in Patients with Breast Cancer

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

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

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

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

Postmastectomy Syndrome

Plasty of Soft Tissues

Rhabdomyosarcoma of Left Forearm Soft Tissues

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

Operations Preserving Organs under Bone Tumours

Modular Endoprostheses

Endoprosthetics with saddle-like prosthesis

Lung Cancer and Mediastrium Tumours

Lung Tumour Invading Left Atrium Lumen

Tumour in Left Atrium Lumen

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

MSCT before Operation

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

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

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

Macropreparation

Extracorporeal nephrectomy with autotransplantation

View of reconstructed kidney

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

Operating Block

Resuscitation Department

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

Radiotherapy

Material and Technical Basis of Remote Radiotherapy

Material and Technical Basis of Short Focus and Contact Radiotherapy

Material and Technical Basis for Preradiation Preparation

Material and Technical Basis (Auxiliary Devices and Dosimetry)

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

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

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

Hyperthermia

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

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

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

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)