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},
"code": "C44.0",
"name": "Рак кожи губы",
"icd_name": "Рак кожи губы",
"gender": 0,
"age_min": 40,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "c44.0_rak_kozhi_guby",
"lead": "злокачественная опухоль, которая произрастает из клеток эпителия, составляющих красную кайму",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Существует несколько причин, которые могут стать провоцирующими факторами для формирования злокачественного процесса в клетках эпителия.</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Проживание в районах с ярким и агрессивным солнцем, высокими температурами воздуха, например, в предгорьях, в пустынных районах. В группе риска светлокожие мужчины, работающие на открытом воздухе.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Работа в условиях, где в окружающей среде содержатся вещества, которые являются канцерогенами, то есть провоцирующими образование раковых клеток.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Состояния, из-за которых губы постоянно травмируются, а эпителий не имеет возможности для нормального обновления и восстановления. К таким привычкам относится курение, жевание табака, бетеля, насвая, употребление снюсов, а также привычка покусывать губы при нервном напряжении.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Постоянные механические раздражения внутренней части губ (слизистой): пирсинг, прикусывание зубным протезом, соседство с кариозными зубами.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наличие хронических воспалительных процессов в полости рта, в том числе хейлит (воспаление слизистой), грибковые заболевания, герпес, папилломы, лейкоплакия, гиперкератоз.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Проводятся следующие обследования:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">осмотр и пальцевое исследование губы, щечно-десневого кармана, слизистой оболочки альвеолярных отростков челюстей;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">пальпация подчелюстной области и шеи с обеих сторон;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ губы, шеи, органов брюшной полости (по показаниям);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">рентгенография нижней челюсти, ортопантомография (по показаниям);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">мазки-отпечатки для цитологического исследования (при изъязвлении) или биопсия зоны поражения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">цитологическая пункция лимфатических узлов шеи при их увеличении;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">дифференциальная диагностика с туберкулезом и сифилисом.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При подтверждении диагноза рака губы проводится рентгенологическое исследование органов грудной клетки, общеклиническое и лабораторное обследование (ЭКГ, анализы крови, мочи и пр.).</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Исследование ПЭТ-КТ назначают для:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">оценки ответа на проведенное лечение;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">выявления рецидива болезни в периоде наблюдения;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">определения стадии заболевания.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для лечения рака губы нужно учитывать множество факторов, в которые входят такие показатели, как возраст больного, вид и особенности опухоли и другое. Независимо от того, какой способ лечения будет выбран, главное воздействие оказывается на очаг поражения и зоны метастазов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Методы лечения рака губы 1 и 2 степени:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">лучевой, который представляет собой радиотерапию, как дистанционную, так и внутритканевую;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">хирургический, радикальный метод: применяется тогда, когда нет возможности использовать лучевое лечение.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Несомненно, профилактические операции на 1 и 2 стадиях заболевания проводятся в исключительных случаях, только тогда, когда динамика развития заболевания не поддаётся контролю и невозможно прогнозировать её дальнейшее распространение.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение рака губы третьей стадии (если отсутствуют метастазы), проводится комбинированным методом воздействия на очаг заражения и прилегающих к нему областей.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При запущенной стадии заболевания (4 стадия) и при имеющихся метастазах в лимфоузлах, предполагается комбинированное лечение рак губы и проведение операции, пластики и хирургической коррекции губ. При четвёртой стадии болезни применяется паллиативная химиолучевая терапия.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Своевременно начатое лечение рака губы 1-2 стадий дает положительную динамику в 97%-100% случаев. Третья стадия предполагает излечение на 67%-80%. Четвёртая стадия и повторные рецидивы - 55%.</span></p>",
"prevention": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чтобы риск возникновения опухоли был минимальным, необходимо:</span></p>\r\n<p> </p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">отказаться от курения и свести к минимуму употребление алкоголя; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">не допускать обветривания губ и повреждений кожи; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">своевременно лечить трещины и травмы губ; </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">следить за состоянием полости рта, оперативно лечить кариес, правильно подбирать зубные протезы.</span></li>\r\n</ul>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Среди первых признаков онкологического процесса следует выделить появление незаметного уплотнения, которое имеет округлую форму. На данном этапе прогрессирования заболевание еще подлежит полному излечению. Но как показывает практика, больные не обращаются к врачу при появлении незначительных признаков.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основные симптомы рака губы, которые являются поводом для обращения к врачу:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">боли, зуд и жжение в области губ;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">шероховатость поверхности;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">чрезмерное слюноотделение;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">наличие язвочек или трещин небольших размеров.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Характерный признак рака губы – увеличение ее размеров и болезненность во время приема пищи. С течением времени появляется отек и синюшность с внутренней стороны. Далее наблюдается беспричинное уменьшение массы тела, постоянная усталость и снижение подвижности челюсти.</span></p>",
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"code": "C21",
"name": "Рак заднего прохода и анального канала",
"icd_name": "Рак заднего прохода и анального канала",
"gender": 0,
"age_min": 30,
"age_max": 100,
"cause": [
3,
0
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"periodicity": 4,
"slug": "c21_rak_zadnego_prohoda_i_analnogo_kanala",
"lead": "раковое заболевание, при котором раковые клетки развиваются в тканях заднего отверстия. ",
"description": "Опухоль редкая, поражает одного-двух из 100 тысяч населения, составляет не более 2–6% от всех раков толстой кишки. \r\n\r\n",
"etiology": "<p>На возможность возникновения злокачественного процесса влияют:</p>\r\n<ul>\r\n<li>вирус папилломы человека;</li>\r\n<li>снижение иммунитета, а также прием лекарственных препаратов, подавляющих иммунную систему. Это не позволяет организму выполнять защитные функции;</li>\r\n<li>возраст старше 50 лет;</li>\r\n<li>наличие свищей, а также частые покраснения, отек и болезненность;</li>\r\n<li>вредные привычки, что также связано с подавлением иммунитета.</li>\r\n</ul>",
"pathogenesis": "<p>Наиболее распространенный тип данного вида рака представлен плоскоклеточным формированием. Другие редкие виды включают базально-клеточную карциному, аденокарциному и меланому.</p>",
"diagnostics": "<p>При выявлении симптомов пациенту следует обратиться к специалисту за установлением точного диагноза. С этой целью используются такие диагностические процедуры:</p>\r\n<ol>\r\n<li>Внешний осмотр и сбор анамнеза.</li>\r\n<li>Пальцевое ректальное обследование, в ходе которого врач может определить рак заднего прохода и признаки, связанные с этим онкозаболеванием, в том числе необычные образования в области отверстия и прямой кишки.</li>\r\n<li>Аноскопия или проктоскопия ‒ использование при осмотре специальных инструментов, с помощью которых часто проводится биопсия.</li>\r\n<li>Эндоректальное ультразвуковое исследование отверстия или прямой кишки.</li>\r\n<li>Компьютерное или магнитно-резонансное томографические сканирования, которые создают детальную картину нужных областей тела.</li>\r\n<li>Сочетание позитронно-эмиссионной и компьютерной томографий, что позволяет измерить активность клеток в конкретном участке тела. Однако, этот вид обследования не всегда уместен.</li>\r\n</ol>",
"treatment": "<p>Терапия зависит от стадии распространенности онкологического процесса и конкретной выгоды для каждого пациента. Однако следует учитывать и возможные осложнения после некоторых терапевтических мер.Наиболее эффективными методами считаются:</p>\r\n<full></full>\r\n<p>Лучевая терапия</p>\r\n<p>Применение специального оборудования, которое использует высокую энергетику излучения. Воздействие лучей на онкологические формирования проводится в течении нескольких минут каждый день на протяжении 4-6 недель.</p>\r\n<p>Побочные эффекты:</p>\r\n<ul>\r\n<li>сильная диарея и непроизвольное отхождение газов;</li>\r\n<li>воздействие на кожу, что сопровождается болью через 2-3 недели после лечения;</li>\r\n<li>выпадение волос и экстремальная усталость.</li>\r\n</ul>\r\n<p>Химиотерапия</p>\r\n<p>Предвидит использование цитотоксических препаратов для уничтожения раковых тканей. Лечение рака заднего прохода обычно включает введение таких средств, как «Митомицин» и «Фторурацил» (5-ФУ) или «Капецитабин».</p>\r\n<p>Химиотерапия может снизить количество здоровых клеток в крови, что чревато инфицированием организма. Поэтому пациенту следует тщательно следить за здоровьем.</p>\r\n<p>Побочные эффекты:</p>\r\n<ul>\r\n<li>быстрая утомляемость, связанная с анемией;</li>\r\n<li>плохое состояние организма в целом, что сопровождается тошнотой, выпадением волос и рвотой;</li>\r\n<li>боль во рту, вызванная язвами от препаратов.</li>\r\n</ul>\r\n<p>Хирургическое вмешательство</p>\r\n<p>Возможно только при небольших опухолях заднего прохода. Иногда метод представляет замену лучевой терапии или альтернативное лечение (в случае, когда иные терапевтические способы не являются возможными). Также, может использоваться для облегчения симптомов перед химиолучевой терапией.</p>\r\n<p>Виды резекции:</p>\r\n<ol>\r\n<li>Местное иссечение подходит для опухолей на внешней поверхности заднего прохода. Во время операции удаляется только участок, содержащий раковые изменения. Сфинктер обычно не затрагивается, поэтому работа кишечника остается прежней. Иногда в дополнение врачи рекомендуют лучевую или химиотерапию.</li>\r\n<li>Удаление отверстия и прямой кишки. Такая операция требует использования колостомы ‒ перенаправления прямой кишки в область брюшной стенки для возможности отхождения фекалий. Эта процедура зачастую пугает пациентов. Однако, многие люди, перенесшие операцию, отмечают постепенное адаптирование и возврат к обычной физиологической деятельности через некоторое время.</li>\r\n</ol>\r\n<p>Специалисты часто рекомендуют комбинированное лечение, при котором применяются две или три процедуры одновременно. Это позволяет достичь наилучшего результата.</p>",
"prevention": "",
"clinical_picture": "<p>Следует обратить внимание и обратиться к врачу при наличии нижеуказанных патологических состояний:</p>\r\n<ul>\r\n<li>кровотечение из отверстия или прямой кишки;</li>\r\n<li>боль, дискомфорт и зуд в области заднего прохода;</li>\r\n<li>наличие видоизмененной ткани вокруг отверстия, которую часто путают с геморроем;</li>\r\n<li>трудности с контролированием кала или изменения в работе кишечника;</li>\r\n<li>выделения при раке желеобразной субстанции (слизи) из отверстия;</li>\r\n<li>язвы вокруг заднего прохода, что распространяются на кожу ягодиц.</li>\r\n</ul>",
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"code": "C48.8",
"name": "Рак забрюшинного пространства и брюшины, выходящий за пределы одной и более локализаций",
"icd_name": "Рак забрюшинного пространства и брюшины, выходящий за пределы одной и более локализаций",
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"age_max": 100,
"cause": [],
"periodicity": 1,
"slug": "c48.8_rak_zabryushinnogo_prostranstva_i_bryushiny_vyhodyaschiy_za_predely_odnoy_i_bolee_lokalizaciy",
"lead": "",
"description": "",
"etiology": "",
"pathogenesis": "",
"diagnostics": "",
"treatment": "",
"prevention": "",
"clinical_picture": "",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 1,
"published": 1,
"parent": 7948,
"block_rubric": 26,
"standards": []
}
]
}
