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},
"code": "C44",
"name": "Другие злокачественные новообразования кожи",
"icd_name": "Другие злокачественные новообразования кожи",
"gender": 0,
"age_min": 50,
"age_max": 100,
"cause": [
3,
0
],
"periodicity": 4,
"slug": "c44_drugie_zlokachestvennye_novoobrazovaniya_kozhi",
"lead": "Группа опухолей с локализацией на коже, в которую входят базальноклеточный, плоскоклеточный и метатипический виды. Среди всех злокачественных заболеваний кожи чаще встречаются базалиома и меланома.",
"description": "Базалиома отличается довольно редким метастазированием и с первого взгляда кажется не таким опасным заболеванием, но это далеко не так. Без грамотной терапии она может привести к тяжелому поражению кожного покрова. При самом худшем прогнозе последствием базалиомы является разрушение подлежащих хрящевой и костной тканей.\r\nМеланомой кожи называют злокачественную опухоль, развивающуюся из пигментных клеток родинок. Чаще всего этот вид рака кожи характеризуется агрессивностью и плохими прогнозами.\r\n",
"etiology": "<p>Факторами риска развития рака кожи могут являться:</p>\r\n<ul>\r\n<li>ультрафиолетовое и ионизирующее излучение;</li>\r\n<li>воздействие химических канцерогенов, попадающих на кожу;</li>\r\n<li>курение;</li>\r\n<li>прием препаратов, ослабляющих иммунитет (иммуносупрессоров);</li>\r\n<li>семейная предрасположенность (генетические особенности организма).</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>Диагноз рака кожи устанавливается на основании клинических и лабораторных данных с обязательным проведением морфологического исследования (цитологического и гистологического). <br /><br /><br /></p>",
"treatment": "<p class=\"bodytext\">От стадии рака кожи напрямую зависит способ лечения.</p>\r\n<p class=\"bodytext\">Лечение локальных стадий подразумевает широкое иссечение опухолей в пределах здоровых тканей. При произведении резекции нужно отступить от видимой границы меланомы кожи на 1 см при толщине опухоли 1–2 мм по Бреслоу и 2 см при толщине — 2 мм. Лимфаденэктомия в профилактических целях не применяется. Можно провести биопсию так называемого сторожевого лимфоузла.</p>\r\n<p class=\"bodytext\">Так как гормонотерапия и профилактическая химиотерапия не улучшают результаты лечения, то применять их при меланоме кожи, симптомах ее проявления не следует. Возможно осуществление профилактической иммунотерапии при помощи препарата интерферон-а при наличии неблагоприятного прогноза (в связи с молодым возрастом, изъязвленной опухолью и т. д.).</p>\r\n<p class=\"bodytext\">Не рекомендуется использовать вне клинических исследований профилактическую иммунотерапию посредствам других цитокинов с включением препарата интерлейкин 2, а также иммунохимиотерапию, вакцинотерапию.</p>\r\n<p class=\"bodytext\">Лечение рака кожи локорегиональной стадии подразумевает одномоментное иссечение первичной опухоли и лимфаденэктомию (удаление всех лимфоузлов зоны и окружающей клетчатки). Для профилактики меланомы кожи в отдельных случаях можно применять иммунотерапию, лучевую или химиотерапию в зависимости от симптомов. Назначение подобного лечения надлежит осуществлять на консилиуме, на котором должны присутствовать лучевой терапевт и химотерапевт.</p>\r\n<p class=\"bodytext\">Лечение диссеминированной стадии при наличии метастазов в головном мозге предполагает нейрохирургическое удаление и / или стереотаксическое облучение. Если единичные метастазы присутствуют в легких, то можно использовать различные лечебные комбинации оперативной, химио- и иммунотерапии. Если есть болезненные метастазы в костях, то можно назначить обезболивающую лучевую терапию.</p>\r\n<p class=\"bodytext\">При лечении меланомы кожи со множественными метастазами одного или нескольких органов проводится системная химио- и иммунотерапия.</p>",
"prevention": "",
"clinical_picture": "<ul>\r\n<li>изменение размера: увеличение <a href=\"/symptom/pyatno_na_kozhe/\" title=\"Перейти на страницу симптома Пятно на коже\">родинки</a> в два и более раз за 6 мес.;</li>\r\n<li>изменение цвета: потемнение (до черного), осветление, появление просветления в центре и одновременное потемнение по краям, неоднородная пигментация;</li>\r\n<li>асимметрия формы;</li>\r\n<li>нечеткие границы: в данном случае <a href=\"/symptom/hloazma/\" title=\"Перейти на страницу симптома Хлоазма\">пигмент</a> плавно сливается с окружающей кожей, так что границы становятся смазанными;</li>\r\n<li>боли;</li>\r\n<li>изъязвление <a href=\"/symptom/pyatno_na_kozhe/\" title=\"Перейти на страницу симптома Пятно на коже\">родинки</a>;</li>\r\n<li><a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a>, если таковые имелись ранее на родинке.</li>\r\n</ul>",
"image": "http://api.symptomd.ru/storage/70cdfd51867b05006ea55bb422d5c0ed_li2UqKn.jpg",
"image_alt": "Рак кожи",
"standard_type": 1,
"danger": 75,
"published": 1,
"parent": null,
"block_rubric": 25,
"standards": [
4682,
4911,
4898,
4946,
5197,
5219
]
},
{
"id": 8885,
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{
"id": 3010,
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{
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{
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"lead": "Повышенное слюноотделение хроническое или аномальное следует проверить у врача",
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},
{
"id": 2950,
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{
"name": "локальная гипертермия "
},
{
"name": "горячая на ощупь"
},
{
"name": "отек на коже"
},
{
"name": "припухлость"
},
{
"name": "уплотнение"
},
{
"name": "Локализованный отек"
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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": "C44",
"name": "Другие злокачественные новообразования кожи",
"icd_name": "Другие злокачественные новообразования кожи",
"gender": 0,
"age_min": 50,
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"cause": [
3,
0
],
"periodicity": 4,
"slug": "c44_drugie_zlokachestvennye_novoobrazovaniya_kozhi",
"lead": "Группа опухолей с локализацией на коже, в которую входят базальноклеточный, плоскоклеточный и метатипический виды. Среди всех злокачественных заболеваний кожи чаще встречаются базалиома и меланома.",
"description": "Базалиома отличается довольно редким метастазированием и с первого взгляда кажется не таким опасным заболеванием, но это далеко не так. Без грамотной терапии она может привести к тяжелому поражению кожного покрова. При самом худшем прогнозе последствием базалиомы является разрушение подлежащих хрящевой и костной тканей.\r\nМеланомой кожи называют злокачественную опухоль, развивающуюся из пигментных клеток родинок. Чаще всего этот вид рака кожи характеризуется агрессивностью и плохими прогнозами.\r\n",
"etiology": "<p>Факторами риска развития рака кожи могут являться:</p>\r\n<ul>\r\n<li>ультрафиолетовое и ионизирующее излучение;</li>\r\n<li>воздействие химических канцерогенов, попадающих на кожу;</li>\r\n<li>курение;</li>\r\n<li>прием препаратов, ослабляющих иммунитет (иммуносупрессоров);</li>\r\n<li>семейная предрасположенность (генетические особенности организма).</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>Диагноз рака кожи устанавливается на основании клинических и лабораторных данных с обязательным проведением морфологического исследования (цитологического и гистологического). <br /><br /><br /></p>",
"treatment": "<p class=\"bodytext\">От стадии рака кожи напрямую зависит способ лечения.</p>\r\n<p class=\"bodytext\">Лечение локальных стадий подразумевает широкое иссечение опухолей в пределах здоровых тканей. При произведении резекции нужно отступить от видимой границы меланомы кожи на 1 см при толщине опухоли 1–2 мм по Бреслоу и 2 см при толщине — 2 мм. Лимфаденэктомия в профилактических целях не применяется. Можно провести биопсию так называемого сторожевого лимфоузла.</p>\r\n<p class=\"bodytext\">Так как гормонотерапия и профилактическая химиотерапия не улучшают результаты лечения, то применять их при меланоме кожи, симптомах ее проявления не следует. Возможно осуществление профилактической иммунотерапии при помощи препарата интерферон-а при наличии неблагоприятного прогноза (в связи с молодым возрастом, изъязвленной опухолью и т. д.).</p>\r\n<p class=\"bodytext\">Не рекомендуется использовать вне клинических исследований профилактическую иммунотерапию посредствам других цитокинов с включением препарата интерлейкин 2, а также иммунохимиотерапию, вакцинотерапию.</p>\r\n<p class=\"bodytext\">Лечение рака кожи локорегиональной стадии подразумевает одномоментное иссечение первичной опухоли и лимфаденэктомию (удаление всех лимфоузлов зоны и окружающей клетчатки). Для профилактики меланомы кожи в отдельных случаях можно применять иммунотерапию, лучевую или химиотерапию в зависимости от симптомов. Назначение подобного лечения надлежит осуществлять на консилиуме, на котором должны присутствовать лучевой терапевт и химотерапевт.</p>\r\n<p class=\"bodytext\">Лечение диссеминированной стадии при наличии метастазов в головном мозге предполагает нейрохирургическое удаление и / или стереотаксическое облучение. Если единичные метастазы присутствуют в легких, то можно использовать различные лечебные комбинации оперативной, химио- и иммунотерапии. Если есть болезненные метастазы в костях, то можно назначить обезболивающую лучевую терапию.</p>\r\n<p class=\"bodytext\">При лечении меланомы кожи со множественными метастазами одного или нескольких органов проводится системная химио- и иммунотерапия.</p>",
"prevention": "",
"clinical_picture": "<ul>\r\n<li>изменение размера: увеличение <a href=\"/symptom/pyatno_na_kozhe/\" title=\"Перейти на страницу симптома Пятно на коже\">родинки</a> в два и более раз за 6 мес.;</li>\r\n<li>изменение цвета: потемнение (до черного), осветление, появление просветления в центре и одновременное потемнение по краям, неоднородная пигментация;</li>\r\n<li>асимметрия формы;</li>\r\n<li>нечеткие границы: в данном случае <a href=\"/symptom/hloazma/\" title=\"Перейти на страницу симптома Хлоазма\">пигмент</a> плавно сливается с окружающей кожей, так что границы становятся смазанными;</li>\r\n<li>боли;</li>\r\n<li>изъязвление <a href=\"/symptom/pyatno_na_kozhe/\" title=\"Перейти на страницу симптома Пятно на коже\">родинки</a>;</li>\r\n<li><a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a>, если таковые имелись ранее на родинке.</li>\r\n</ul>",
"image": "http://api.symptomd.ru/storage/70cdfd51867b05006ea55bb422d5c0ed_li2UqKn.jpg",
"image_alt": "Рак кожи",
"standard_type": 1,
"danger": 75,
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"parent": null,
"block_rubric": 25,
"standards": [
4682,
4911,
4898,
4946,
5197,
5219
]
},
{
"id": 8885,
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{
"id": 3010,
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{
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{
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"lead": "Повышенное слюноотделение хроническое или аномальное следует проверить у врача",
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},
{
"id": 2950,
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{
"name": "локальная гипертермия "
},
{
"name": "горячая на ощупь"
},
{
"name": "отек на коже"
},
{
"name": "припухлость"
},
{
"name": "уплотнение"
},
{
"name": "Локализованный отек"
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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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