Методички онкология / 5 курс / САРС / 1 голова шея
.docMINISTRY OF HEALTH OF UKRAINE
Kharkiv National Medical University
Approved
the meeting Department of Oncology
Head of Department
MD, professor Starikov VI
'28"August 2011
GUIDELINES
For independent work of students
Course 5
Faculty of Medicine (specialty "General Medicine", "Pediatrics", "Prophylactic medicine")
Study Subject: Oncology
Module number 1
Content module № 1
Subject: № 1. Tumors OF lips, oral mucosa, Laryngeal cancer, thyroid cancer
Kharkiv November 2011
Topic.
Tumors of lip, oral mucosa occupy a prominent place in the structure of malignant tumors. Cancer chastishe lower lip occurs in men who suffer long-term effects of external factors, such as changes of humidity, temperature, long insolyatsiya, Smoking tobacco, chronic trauma lips. Of cancer of oral mucosa contribute to chronic traumatic acute dental fragments, poorly adapted prostheses, SUFFER FROM ANY CHRONIC burns ethyl alcohol, sharp and hot food, smoking. Awareness of these factors should lead etiolohichnyh student on the inadmissibility of bad habits i besid population. It is also knowledge of the capabilities of surgery, radiation therapy to cure cancer specified location.
Significant prevalence of carcinogenic effects as smoking tobacco, chronic inflammation in the larynx makes it relevant study themes in laryngeal cancer. Acquaintance with these topics allows you to navigate the capabilities of current treatments.
Thyroid cancer is the most common tumor of the endocrine system. Statistics show that the growth rate of thyroid cancer in the last decade in Ukraine amounted to 131-135%, significantly higher than other cancers. At present TC is about 1.5-2% of all malignant neoplasms. In recent years the world has a tendency of increase in the incidence of this disease. Although a certain percentage increase in incidence associated with the introduction into clinical practice of modern methods of examination of patients, yet there is evidence of a real increase in the incidence of thyroid cancer, which is caused by several factors, including the influence of environmental factors.
Overall objective: to be able to diagnose and treat tumors lips, oral mucosa, laryngeal cancer, cancer Thyroid
Know:
Clinical picture of benign tumors of the lips, oral mucosa, larynx, thyroid gland.
Classification, clinical manifestations, complications, diagnosis of cancer lower lip, oral mucosa, larynx, thyroid gland.
Methods of treating cancer combined lower lip, oral mucosa, larynx, thyroid gland.
Be able to:
On the basis of complaints, anamnesis, objective research, to identify the main syndromes tumor lips, oral mucosa, put a preliminary diagnosis.
Absorb the history of a patient with WG and TC and make its analysis.
Perform palpation of the thyroid gland and pidboridnyh, submandibular, cervical, supraclavicular lymph nodes.
Work plan for inspection of patient WG and thyroid cancer and, based on survey data of the patient, formulate clinical diagnosis and treatment plan Appoint additional examination methods and evaluate their data Conduct differential diagnostics, to put the final diagnosis. Appoint treatment To carry out rehabilitation and preventive measures
Contents of training
Theoretical questions to topics that must learn studentyi: 1. Clinical symptoms of cancer of the lips, mucous obolonky her mouth, larynx, thyroid gland. 2. Diagnosis of tumor lips, mucous obolonky her mouth, larynx, thyroid gland. 3. Classification of tumors lips, mucous obolonky her mouth, larynx, thyroid gland. 4. Question metastasis 5. Epidemiology tumor lips, mucous obolonky her mouth, larynx, thyroid, morbidity and mortality in these pa lips, mucous obolonky her mouth, larynx, thyroid, etiological factors and Precancer disease pathogenesis. 6. Principles and treatment in tumor lips, mucous obolonky her mouth, larynx, thyroid, and long-term results of treatment of tumors of the lips, mucous obolonky her mouth, larynx, thyroid, diagnosis and treatment of recurrences and metastases. 7. Predisposing factors and precancerous conditions, prevention. 8. Examination of disability, prognosis, rehabilitation patients
Dobroyakisni tumor lips: i keratoakantoma papilloma. Papilloma - proliferation of connective tissue covered hiperplastychnym epiteliyem with symptoms hiper-and parakeratosis. The emergence of compression, pain, suggest a malihnizatsiyu. Keratoakantoma - tumor schilnoelastychnoyi konsystentsiyi in the center of which - the crater. Treatment - surgery.
Zahvoryuvanist cancer lower lip - 4.8 per 100 thousand population. Obbligato Precancer - vohnyschevi dyskeratozy i papilloma. Productive form dyskeratozu - leukoplakia and cutaneous horn. Destructive form - erytroplakiya (eroziyi, cracks, sores on the red rim lip). Other disease: diffuse dyskeratoz red border, keratoakantoma, chronic indigestion, ulcers, cracks, erosion and hiperkeratotychna forms lupus planus i can turn into cancer. 90% - ploskoklitynnyy rohoviyuchyy cancer with exo-, endo-, mezofitnoyu forms of growth.
Regional lymph nodes: pidboridni, pidschelepni, deep cervical, zadnoshyyni, nadklyuchychni, peredhortanni, paratrahealni in tovschi parotid salivary gland schichni, zavushni and potylychni.
Tis - vnutrishnoepitelialnyy cancer;
T1 - up to 2 cm;
T2 - to 4 cm;
T3 - more than 4 cm;
T4 - apply to the bones, skin, neck, and others.
N1-Mt s one homolateralnomu limfovuzli to 3 cm;
N2-Mt s one homolateralnomu limfovuzli to 6 cm or multiple mt to 6 cm or bilateralni or kontralateralni metastatychni limfovuzly to 6 cm;
N3-Mt s more than 6 cm in greatest vymiri.
Diagnostics: smear-vidbytky, punktsiya tumor.
Clinic. Ekzofitni form - papilyarna i warty. Endophytic - i infiltrative ulcer.
Treatment. I,. - Resection of the lower lip or close-radiotherapy; II century. - Combined: irradiation of the primary tumor, and 2-3 weeks after the completion of the upper-futlyarno fastsialna limfadenektomiya neck. Operation Kraylya - removal of metastatic neck conglomerate with resection kyvalnoho soft muscles, internal jugular vein and additional nerve. III. - I limfovuzliv tumor irradiation, and after 2-3 weeks of - upper fascial-futlyarna limfadenektomiya neck. IV. - The plan of treatment is determined individually.
Precancer facial mouth: Bowen's disease (oblihatnyy precancerous), leukoplakia, leykokeratoz, papillomatosis, lichen planus, chronic fissures, ulcers, fibromas, lipomas, hemangiomas, and others.
Treatment: excision, kriodystruktsiya, electrocautery
Cancer mucous membranes of the oral cavity is 3.8 per 100 thousand population. Precancer: leykoplakiya, leykokeratoz, erytroplakiya, hronichni ulcers and fissures. 52% - cancer of the tongue, 20% - cancer of the floor of the mouth. Age - 60-70 years.
Ploskoklitynyy with papilyarnoho cancer, peptic ulcer and infiltratyvnoyu forms of growth. TNM Classification - as i lip cancer.
Clinic. In the initial stages - look papilomy dense, small sores or infiltratu. Germination in the tongue muscles causing pain, utrud nyuyetsya language, there drooling rapidly growing exhaustion. VF rapid transition of tumors from the tongue to the bottom of the mouth i vice versa.
Diagnostics. Smears-vidbytky, biopsiya tumor punktsiyna biopsiya limfovuzliv.
Treatment is carried out in two stages: 1 - i peredoperatsiyne irradiation after 2-3 weeks of when I-II cent. - Half-resection of the tongue), and III. - An extended transaction with the removal of mucous floor of the mouth, pidnebinnyh brackets tonsil. Stage 2 - Kraylya transaction.
Benign tumors of the larynx are 10 times more common than malignant.
Papilloma - half of the patients. There are soft (uviform formation of dark red) and solid (pale gray, fine-grained).
Pahidermiya - thickening of the mucous membrane of the larynx, dyskeratozy. Leukoplakia larynx - an oblong whitish spot with a rough surface.
Leykokeratoz - keratinization of the mucous membrane of white-gray color with a rough shaggy surface. Fibroma (hard and soft) - tumor size of 5 - 10 mm and with a smooth surface, gray or red-pink color.
Treatment of laryngeal cancer - surgery, electrocautery or cryolysis.
Cysts of the larynx - retention, congenital, traumatic and lymph. Treatment - surgical.
Laryngeal cancer. Incidence - 4.4 per 100 thousand people (mostly men 40-60 years).
Obligate Precancer - papilloma and papillomatosis. Optional Precancer - fibroma and cysts.
Form tumor growth: papillary, nodular and infiltrative. Depending on the tumor divided into vestibular, tumors of the vocal folds and pidskladkovi.
Regional lymph nodes - jugular, posterior cervical, supraclavicular, before - and navkolohortanni.
Clinic. Vestibular lesion of where the tumor is located in the region of the epiglottis, accompanied by foreign body sensation in the throat. The defeat of the vocal folds is hoarseness of voice, which gradually turns into aphonia. If cancer occurs in pidskladkovomu department respiratory failure, hoarseness.
In advanced stages of cancer - pain, aphonia, disintegration of the tumor, bleeding, infection accession, violation of the act of swallowing.
Diagnosis: direct and indirect laryngoscopy, x-ray, morphological study biopsy.
Treatment. Radiation and surgical techniques often - combined treatment.
In cancer, I and II,. vestibular apparatus - mainly radiotherapy, III and IV. - Combined treatment. Operation - expanded larynhektomiya.
Cancer of the larynx medium I and II century. - Radiotherapy. III and IV. -Combination therapy. I and II,. pidskladkovoho of cancer - resection of the larynx, III century. - Larynhektomiya with resection of the trachea.
Tumors of the thyroid gland. The incidence of thyroid cancer -1.5% of all malignant tumors. Etiology: hormonal disorders as inhibition of thyroid function, defined as iodine deficiency, antithyroid drugs, ionizing radiation. Differentiated cancer - follicular and papillary adenocarcinoma, and - undifferentiated carcinoma (can develop A-cells (follicular) and B cells (Bortlya - Ashkinazi)). Intermediate position occupied by tumors with C-cell (parafolikulyarnyh) - solid cancer.
Regional lymph nodes - neck and upper mediastinum.
T 1 - a tumor of 1 cm, T 2 - to 4 cm tumor, T 3 - more than 4 cm, T 4 tumor of any size with spread beyond the thyroid capsule.
M1-Mt in the regional lymph nodes.
Clinic. Papillary adenocarcinoma grows slowly metastasizing lymphogenous. Follicular adenocarcinoma develops slowly, hematogenous metastasizing.
For undifferentiated cancer inherent rapid course, rapid growth, and generalized metastasis.
In the early stages of clinical thyroid cancer is poor on symptoms:
increase in cancer occurrence dense node is sometimes the first symptom of metastatic lymph nodes of the neck. With the spread of cancer beyond the capsule of the thyroid gland appears clinic adjacent lesions of the neck (hoarseness of voice, difficulty swallowing, breathing).
Aberrant form of cancer - the virtual absence of the primary tumor, along with massive metastatic lymph nodes of the neck (25% patients).
Diagnosis. If you have a tumor on a background goiter attention focusing on changing growth and density cancer. Must guard of tumors in older people. For diagnosis using ultrasound, radionuclide examination, needle biopsy. Cytology preparation shows malignant nature of the tumor 95% of cases.
Treatment. Basically - surgery (thyroidectomy). In rare moving metastatic nodes performed futlyarno - fascial limfadenoektomiya at multiple Mt s-operation Kraylya. At a local process and unfavorable histological form - preoperative irradiation. Papillary and follicular adenocarcinoma sensitive to radiation therapy. In the postoperative period with papillary and follicular carcinomas showed treatment with radioactive iodine to total ablation of thyroid tissue. Later - suppressive therapy with thyroxine. Differentiated When generalized forms - hormone (thyroid hormones). Medullary carcinoma When - postoperative irradiation and chemotherapy, hormone replacement therapy in the future. With nondifferentiable carcinoma hold conservative treatment (chemoradiotherapy) with palliative aim.
Literature
Summary:
Bilynsky BT Oncology. Lviv, 1998.
Bilynsky BT Oncology. Lviv, 1992.
Peterson BE CANCER. Moscow: Medicine, 1980.
Slynchak SM CANCER. Kiev, 1989.
Trapeznikov NN CANCER. Moscow: Medicine, 1981.
Lecture material.
Further Reading:
Borowski E., NF Danylevskyy Atlas diseases slyzystoy shell PTA. Moscow: Medicine, 1981. - 214 p.
Mashkyleyson DL Predrak kaymы a red lip and slyzystoy shell PTA. M: Medicine, 1970. - 178 p.
PABSEC AI Thyroid cancer. Moscow: Medicine, 1984.
Quiz:
1. Benign lips.
2. Etiology, pathogenesis, patAnatomy lower lip cancer
3. Classification of lower lip cancer in stages
4. Clinic and treatment of cancer lower lip
5. Benign tumors of the oral mucosa, tongue.
6. Epidemiology, etiology, precancerous, patAnatomy cancer of the oral mucosa, tongue.
7. Classification, clinical cancer of the oral mucosa, tongue.
6. Benign tumors of the larynx;
9. Epidemiology, etiology, precancerous, abnormal anatomy, ways metastasis in WP;
10. Classification WP in stages;
11. Clinic WG;
12. WP Diagnosis;
13. Treatment and Rehabilitation treatment WG;
14. Pathologic characteristics of thyroid cancer;
15. The incidence of thyroid cancer. Medical management of thyroid nodular formations;
16. Ways metastatic thyroid cancer;
17. The clinical picture of thyroid cancer;
18. Methods of diagnosis and cytological role radioisotope method;
19. General principles of treatment of thyroid cancer, the results of treatment.
test tasks (Correct answers are marked *)
At the lower lip cancer often suffer from:
- men 40-60-years old *
- women 40 to 50 years of age;
- equally often men and women.
- men 60 to 80 years old
- women 60 to 80 years old
Etiologic factors of lower lip cancer is mainly:
- consumption of protein, fat in excessive amounts;
- womankind
- male;
- smoking tobacco *
- trauma lips.
T2 for cancer of the lower lip is:
- tumor 3 cm;
- Tumor more than 3 cm;
- tumor spreads to neighboring structures;
- tumors up to 4 cm *
- metastatic lymph nodes neck.
N3 for cancer of the lower lip is:
- metastasis in 1 homolateralnomu l / in 3 cm;
- metastasis in 2 homolateraln and l / in 3 cm
- metastasis in 3 or more homolateraln and l / in 3 cm
- bilateral metastatic lymph nodes to 6 cm;
- metastasis to lymph nodes larger than 6 cm. *
Treatment and art. cancer of the lower lip is:
- operation;
- Distance hamaterapiya;
- close-radiotherapy *
- immunotherapy
- combined.
Treatment of stage II and III are:
- operation removal of the primary tumor;
- chemoradiation therapy
- close-radiotherapy;
- Kraylya operation;
- Combined: radiation + excision of the primary tumor and surgery Kraylya. *
Cancer lateral surface of the tongue found in:
- 60% of cases;
- 20%;
- 40%
- 80% *
- Of 10%.
Treatment of cancer of the tongue in stages I-III:
- Irradiation of the primary tumor;
- Half-resection of the tongue;
- Combined: radiation + surgery + chemotherapy, surgery, surgery + chemotherapy. *
- removal of the tumor followed by radiation therapy
- Remove the tongue and Chemotherapy
Obligate Precancer larynx is:
- Chronic farinhit;
- Papillomatosis *
- Fibroma;
- Pahidermiya;
-Dyskeratozy larynx.
Defeat vestibular tumor of the larynx accompanied by:
- Foreign body sensation in the throat *
- Hoarseness;
- Aphonia;
- breach of breath;
- Bleeding;
Treatment III and IV. laryngeal cancer:
- Larynhektomiya;
- Radiotherapy;
- Chemotherapy
- Chemoradiation therapy
- Radiotherapy followed by extended larynhektomiyeyu *
Ts for thyroid cancer is:
- Tumor more than 4 cm in greatest dimension *
- Tumor spread beyond the thyroid capsule;
- Tumors up to 4 cm
- Tumor more than 3 cm
- Tumor up to 5 cm
All cases of undifferentiated thyroid ra tion are to:
- In situ
-1 Stage;
- II stage;
- III stage;
- IV stage *
Regional lymph nodes for thyroid are:
- Jugular and paratrahealn and *
- Retrosternal;
- Vzodvzh additional nerve;
- Occipital;
- Axillary;
Percutaneous biopsy with cytology preparation shows malignant nature of the tumor:
- 95% of cases *
- 60%;
- 48%;
- 30%
- 15%
When undifferentiated thyroid cancer treatment should begin with:
- Radiotherapy + chemotherapy *
- Thyroidectomy;
- Subtotal resection of cancer chemotherapy +
- Chemotherapy, immunotherapy
- Removal of the tumor
Test case studies (Correct answers are marked *)
1. In the clinic enrolled min. S., in '45, with the presence of tumor in the region of the lower lip measuring 1 cm. Which you accept tactic examination and treatment?
Survey:
A. Review
B. Review and scraping *
C. Puntsiya tumor
D. Ultrasound and puntsiya
E. CT
Treatment:
A. dynamic monitoring
B. close-radiotherapy *
C. Distance hamaterapiya
D. remote gamma therapy and lymphadenectomy pidborodna
E. operation Kraylya
2. Patient B., '54, addressed the oncologist complaining tumor 2 cm in diameter in the area of the lower lip. The formation of a whitish color. After removing horny layers exposed pink bleeding surface. What is the diagnosis most likely be in this case?
A. chancre
B. Cancer of the lower lip *
C. Leukoplakia
D. Dyskeratoz
E. granuloma
3. In min. W., '70, was diagnosed with cancer of the lower lip needle biopsy of the tumor. Formation of size 5 x 4 cm, enlarged pidboridni, submandibular, posterior neck l / c. Size L / in more than 6 cm. Which stage of the disease?
A. II
B. III
C. V and A
D. IV V *
E. IV C
4. In min. M., '72, diagnosed tongue cancer III., T2N1M0. The tumor is localized on the lateral surface of the tongue. What treatment is indicated for this patient?
A. dynamic monitoring
B. Radiotherapy close-
C. Remote hamaterapiya
D. Remote gamma therapy and lymphadenectomy pidborodna
E. radiation + surgery *
5. Man '65're concerned about any sores on the mucous membrane of the right cheek in her traumatic prosthesis. Ulcer there about a year, medical treatment is not exposed in the last 3 months doubled. Ulcer size 2 - 2.5 cm, bottom - necrotic. Regional lymph nodes - Submandibular to 2 cm, soft elastic, limited traffic, the number 3. The most likely diagnosis: A. Dekubitylna ulcer V. thrush C. Cancer oral mucosa * D. "Aspirin" ulcer E. leukoplakia
6. Patient to a surgeon turned 46 years old, in which the lower lip is a painless ulcer size 0.5 x 0.5 cm in the last year on the lower lip scales observed that occasionally fall away. Ulcer appeared 2 months ago. The left submaxillary area revealed dense l / of 0.5 x 1.0 cm your diagnosis: A. Herpes labialis V. rodent ulcer lower lip S. chancre lower lip D. Lower lip cancer has spread to the submandibular lymph nodes * E. leukoplakia
Methodological development was MD, assistant Muzhychuk O.