5.2.2. Main stage:
Polls and physical examination performed with the patient turns the students, under the supervision of the teacher. To evaluate the accuracy of surveys consistently attracted other students.
When patients surveyed students' attention is drawn to the medical history of the disease, the presence of chronic inflammation and precancerous diseases, occupational hazard, smoking.
Dobroyakisni tumor lips: i papilloma keratoakantoma. 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 in one second molateralnomu 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. - Irradiation of the tumor i limf at nodes, and 2-3 weeks of - upper fascial-futlyarna limfade Mr. ektomiya 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 g at kiv.
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 the background of goiter attention focusing on changing growth rate and density of 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.