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},
"code": "C38",
"name": "Рак сердца, средостения и плевры",
"icd_name": "Рак сердца, средостения и плевры",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "c38_rak_serdca_sredosteniya_i_plevry",
"lead": "Нарушение здоровья, относящееся к группе злокачественные новообразования органов дыхания и грудной клетки",
"description": "Среди всех опухолей средостения на долю злокачественных новообразований различной гистологической структуры приходится 20-40%. Кроме этого, в средостении могут выявляться метастазы первичного рака различной локализации, саркомы, меланомы.\r\nРак плевры - злокачественная опухоль париетального или висцерального листка серозной оболочки легких.\r\nРаковые заболевания сердца встречаются очень редко.\r\n",
"etiology": "<p> </p>\r\n<p>Причины рака средостения</p>\r\n<p>Ведущая роль в этиологии злокачественных новообразований медиастинальной локализации принадлежит ионизирующему излучению, контакту с канцерогенными веществами в быту, сельском хозяйстве и на производстве, вирусным агентам (вирусу Эпштейна-Барр, ВИЧ-инфекции).</p>\r\n<p>Возможен переход первично доброкачественных опухолей в злокачественные под действием неблагоприятных факторов. Метастатический рак средостения может являться «отголоском» опухолей других органов и тканей. Метастазирование из первичных очагов происходит путем контактного распространения, с током лимфы или крови.</p>\r\n<p>Причины рака плевры</p>\r\n<p>Установлено, что более 70% случаев заболевания раком плевры связано с вдыханием асбестовой пыли. Рак плевры может развиваться через 30-40 лет после контакта с асбестом. К группе риска относятся лица, занятые в горнодобывающей, строительной, текстильной промышленности, судостроении.</p>\r\n<p>Кроме экспозиции асбеста, среди причин возникновения рака плевры рассматривается значение других вредных факторов, в особенности курения.</p>\r\n<p> К причинам развития рака сердца относятся:</p>\r\n<ul>\r\n<li>нарушения иммунной системы, которая становится не способной обнаруживать отклонения и клеточные мутации;</li>\r\n<li>аберрантные наросты;</li>\r\n<li>радиационное, ультрафиолетовое и химическое влияние;</li>\r\n<li>воздействие некоторых вирусов;</li>\r\n<li>генетическая предрасположенность.</li>\r\n</ul>",
"pathogenesis": "<p>Рак плевры</p>\r\n<p>Диффузный рост опухоли обусловливает ее обширное распространение по плевре и лимфатическим путям последней, что сопровождается образованием узлов. Нередко опухоль прорастает по междолевым щелям, вовлекает в процесс внутригрудную фасцию, прорастает иногда ребра и мышцы. Для диффузных мезотелиом характерно раннее поражение обращенных друг к другу висцерального и париетального листков, вследствие чего происходит их срастание и облитерация участка плевральной полости. При отсутствии облитерации в ней рано скапливается экссудат - вначале серозный, затем вследствие десквамации опухоли и повреждения мелких сосудов геморрагический.</p>\r\n<p>Рак средостения</p>\r\n<p>Злокачественные новообразования средостения происходят из разнородных тканей и объединяются лишь одними анатомическими границами. К ним относятся не только истинные опухоли, но и различные по локализации, происхождению и течению кисты и опухолевидные образования. Все новообразования средостения по источнику их происхождения можно разделить на следующие группы: 1. Первичные злокачественные новообразования средостения. 2. Вторичные злокачественные опухоли средостения (метастазы злокачественных опухолей органов, расположенных вне средостения, в лимфатические узлы средостения). 3. Злокачественные опухоли органов средостения (пищевод, трахея, перикард, грудной лимфатический проток). 4. Злокачественные опухоли из тканей, ограничивающих средостение (плевры, грудины, диафрагмы).</p>\r\n<p>Рак сердца</p>\r\n<p>Из первичных злокачественных опухолей сердца наиболее часто встречается саркома сердца, изредка встречаются лимфомы. Первичные злокачественные опухоли составляют 25% от общего количества первичных опухолевых поражений сердца. Наиболее частой их разновидностью является саркома, которая происходит из мезенхимы и поэтому может проявляться многообразием морфологических типов и обусловливать сложность гистологической верификации. Саркома может возникнуть в любом возрасте, но наиболее часто в 30 - 50 лет, одинаково часто у мужчин и женщин. Опухоль поражает преимущественно правые отделы сердца, исходя, как правило, из эндокарда или перикарда. Первичная саркома сердца может вызвать окклюзию клапанных отверстий и выходных отделов желудочков, сдавливать и прорастать коронарные сосуды, крупные артерии и вены. Она отличается быстрым инвазивным ростом, прорастает все слои сердца и близлежащие органы, а также быстро и обширно метастазирует в легкие, средостение, трахеобронхиальные и ретроперитонеальные лимфатические узлы, надпочечники, мозг.</p>\r\n<p>Вторичными опухолями сердца чаще бывают метастазы рака молочной железы, легких, желудка, а иногда почек и щитовидной железы. Вторичные опухоли сердца встречаются в 25 раз чаще первичных.</p>",
"diagnostics": "<p>Рак плевры</p>\r\n<p>О диагнозе совершенно точно можно говорить только после проведенной биопсии плевры, а также электронной микроскопии вместе с иммуногистохимическим исследованием.</p>\r\n<p>Часто в процессе рентгенографии, проводимой в области грудной клетки, обнаруживается плевральный выпот и диффузное утолщение в плевре.</p>\r\n<p> Рак средостения</p>\r\n<p>Лабораторные методы исследования</p>\r\n<ul>\r\n<li>Общий и биохимический анализ крови – выявляется анемия, лейкоцитоз, лимфопения, повышенная СОЭ;</li>\r\n<li>Реакцию Вассермана (для исключения сифилитической природы образования);</li>\r\n<li>Реакцию с туберкулиновым антигеном.</li>\r\n</ul>\r\n<p>При подозрении на системные заболевания (лейкоз, лимфогранулематоз, ретикулосаркоматоз и др.), а также на незрелые неврогенные опухоли выполняют костномозговую пункцию с изучением миелограммы.</p>\r\n<p> Инструментальные методы диагностики:</p>\r\n<ul>\r\n<li>Рентгенологическое исследование – позволяет определить локализацию патологического образования.</li>\r\n<li>Рентгеноскопия позволяет возможность выявить \"патологическую тень\", определить ее локализацию, форму, размеры, подвижность, интенсивность, контуры, установить отсутствие или наличие пульсации ее стенок. В ряде случаев можно судить о связи выявленной тени с расположенными рядом органами (сердцем, аортой, диафрагмой). При рентгенографии уточняют структуру затемнения, его контуры, отношение новообразования к соседним органам и тканям. Контрастирование пищевода помогает оценить его состояние, определить степень смещения или прорастания новообразованием средостения.</li>\r\n<li>Бронхоскопия применяется для исключения бронхогенной локализации опухоли или кисты, а также для определения прорастания злокачественной опухолью средостения трахеи и крупных бронхов. Во время этого исследования возможно проведение пункционной биопсии образований средостения.</li>\r\n</ul>\r\n<p>Рак сердца</p>\r\n<p>Инструментальные исследования при злокачественных опухолях указывают на преимущественное поражение правых отделов органа, и среди редких случаев прижизненной диагностики у 60-70% больных обнаруживаются отдаленные метастазы.</p>\r\n<p>Эхокардиография рассматривается как метод выбора в диагностике опухолей сердца, достаточный для выработки соответствующей хирургической тактики.</p>\r\n<p>КТ, МРТ - позволяют проводить топическую диагностику опухоли и определить место ее фиксации.</p>",
"treatment": "<p>Тактика лечения рака зависит от типа опухоли, ее локализации и распространенности.</p>\r\n<p>Применяются лучевая терапия, полихимиотерапия, иммунотерапия, гормонотерапия, радикальное хирургическое удаление опухоли, паллиативное удаление образования с целью декомпрессии средостения.</p>\r\n<p>Возможна пересадка сердца при поражении его опухолью.</p>\r\n<p>При выраженном болевом синдроме выписывают наркотические анальгезирующие средства, чтобы побороть одышку применяются ингаляции кислородом. Симптоматическое лечение рака плевры включает разгрузочные пункции, дренирование плевральной полости, введение в плевральную полость цитостатических препаратов для замедления темпов экссудации и стимуляции облитерации полости</p>\r\n<p> </p>",
"prevention": "<p>К сожалению возможно говорить только о снижении риска развития рака. И происходит это потому, что устранить воздействие вредных факторов часто не представляется возможной. Первичная профилактика направления на устранение канцерогенеза - процесса возникновения опухоли. Прежде всего, это устранение контакта с канцерогенами. отказ от курения, чрезмерного употребления алкоголя соблюдение диеты регулярная физическая активность Вторичная профилактика направлена на выявление и устранение предраковых заболеваний и раннее выявление и устранение злокачественных опухолей, а также профилактику повторного возникновения опухолей после лечения. К мероприятиям, позволяющим рано выявлять опухоли относятся: маммография, PAP-мазки (для раннего выявления рака шейки матки), профилактические осмотры, определение онкомаркеров, выявление групп риска и др.</p>",
"clinical_picture": "<p>Рак плевры</p>\r\n<p>Наиболее характерными симптомами являются раннее возникновение болей, не связанных вначале с дыханием, имеющих упорный ноющий характер, асимметричность дыхательных движений. Характерно быстрое накопление экссудата в плевральной полости, постепенное нарастание одышки, которая не уменьшается при удалении экссудата и усиливается при перемещении тела из горизонтального в вертикальное положение. При локализации опухоли в области купола плевры могут быть боли в надплечье, отмечают появление синдрома Горнера (опущение века, сужение зрачков, впадением глаз</p>\r\n<p>Рак средостения</p>\r\n<p>Злокачественные новообразования средостения обнаруживаются преимущественно в молодом и среднем возрасте (20 - 40 лет), одинаково часто как у мужчин, так и у женщин. В течении болезни при злокачественных новообразованиях средостения можно выделить бессимптомный период и период выраженных клинических проявлений. Длительность бессимптомного периода зависит от локализации и размеров злокачественного новообразования, скорости роста, взаимоотношений с органами и образованиями средостения. Очень часто новообразования средостения длительное время протекают бессимптомно, и их случайно обнаруживают при профилактическом рентгенологическом исследовании грудной клетки. Клинические признаки злокачественных новообразований средостения состоят из: </p>\r\n<p>- симптомов сдавления или прорастания опухоли в соседние органы и ткани;</p>\r\n<p>- общих проявлений заболевания ;</p>\r\n<p>- специфических симптомов, характерных для различных новообразований;</p>\r\n<p>Наиболее частыми симптомами являются боли, возникающие вследствие сдавления или прорастания опухоли в нервные стволы или нервные сплетения. Боли, как правило, неинтенсивные, локализующиеся на стороне поражения, и нередко иррадиируют в плечо, шею, межлопаточную область. Боли с левосторонней локализацией часто похожи на боли при стенокардии. При возникновении болей в костях следует предполагать наличие метастазов. Сдавление или прорастание опухолью пограничного симпатического ствола обуславливает возникновение синдрома, характеризующегося опущением верхнего века, расширением зрачка и западением глазного яблока на стороне поражения, нарушение потоотделения, изменение местной температуры и дермографизма. Поражение возвратного гортанного нерва проявляется осиплостью голоса, диафрагмального нерва - высоким стоянием купола диафрагмы. Сдавление спинного мозга ведет к расстройствам функции спинного мозга. Проявлением компрессионного синдрома является и сдавление крупных венозных стволов и, в первую очередь, верхней полой вены (синдром верхней полой вены). Он проявляется нарушением оттока венозной крови от головы и верхней половины туловища: у больных появляются шум и тяжесть в голове, усиливающиеся в наклонном положении, боли в груди, одышка, отечность и синюшность лица, верхней половины туловища, набухание вен шеи и грудной клетки. Центральное венозное давление повышается до 300-400 мм вод. ст. При сдавлении трахеи и крупных бронхов возникает кашель и одышка. Сдавление пищевода может вызвать дисфагию - нарушение прохождения пищи. На поздних стадиях развития новообразований возникают: общая слабость, повышение температуры тела, потливость, похудание, которые характерны для злокачественных опухолей. У некоторых больных наблюдаются проявления нарушений, связанных с интоксикацией организма продуктами, выделяемыми растущими опухолями. К ним относится боли и припухлость суставов, отеки мягких тканей конечностей, нарастание частоты сердечных сокращений, нарушение сердечного ритма. Некоторым опухолям средостения присущи специфические симптомы. Так, кожный зуд, ночная потливость характерны для злокачественных лимфом (лимфогранулематоз, лимфоретикулосаркома). Спонтанное снижение уровня сахара в крови развивается при фибросаркомах средостения. Симптомы тиреотоксикоза характерны, для внутригрудного тиреотоксического зоба.</p>\r\n<p>Рак сердца </p>\r\n<p>Клиническая картина зависит от локализации опухоли и величины обструкции полостей сердца. Типичным являются необъяснимая, быстро прогрессирующая сердечная недостаточность с увеличением размеров сердца, выпотом в перикард (геморрагическим), тампонадой, болью в области грудной клетки, аритмиями, нарушениями проводимости, обструкцией полой вены и внезапная смерть. Опухоли, ограниченные миокардом без распространения внутрь полости, могут некоторое время протекать бессимптомно или вызывать аритмии и нарушения проводимости. У больного может быть длительное небольшое повышение температуры тела, похудание, постепенно нарастающая слабость, боли в суставах, различные высыпания на туловище и конечностях, онемения пальцев рук и ног. Постепенно могут сформироваться признаки хронической сердечной недостаточности – барабанные палочки (похудание пальцев рук и утолщение их на концах), изменения ногтей по типу «часовые стекла». При распространении опухоли на перикардиальное пространство часто образуется геморрагический выпот в перикард и может возникнуть тампонада. Поскольку наиболее часто поражается правая часть сердца, саркома нередко вызывает симптомы правожелудочковой недостаточности вследствие обструкции правого предсердия, правого желудочка, трехстворчатого клапана или клапана легочной артерии. Обструкция верхней полой вены может приводить к отеку лица и верхних конечностей, тогда как обструкция нижней полой вены вызывает застой во внутренних органах.</p>",
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