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"name": "Карцинома in situ шейки матки",
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"lead": "Нарушение здоровья, относящееся к группе новообразования in situ",
"description": "Карцинома in situ считается самой ранней формой рака. Врачи нередко рассматривают данную опухоль как предраковое состояние. Это связано с тем, что раковые клетки при данной патологии обнаруживаются только в поверхностном слое шейки матки, и не распространяются на глубокие ткани. Рак шейки матки является одной из наиболее распространенных злокачественных опухолей у женщин, занимает второе место по частоте встречаемости после рака молочной железы.",
"etiology": "<p>Чаще всего раку шейки матки подвержены женщины в возрасте 40 – 55 лет. На развитие рака шейки матки могут влиять:</p>\r\n<p>— ранее начало половой жизни,<br /> — половые инфекции,<br /> — курение,<br /> — несоблюдение интимной гигиены,<br /> — слабый иммунитет,<br /> — хронические воспалительные процессы шейки матки и наличие заболеваний таких как: дисплазия шейки матки, эрозия шейки матки, лейкоплакия,<br /> — заражение вирусом папилломы человека (80-100% пациенток с раком шейки матки заражены ВПЧ). Существует более 100 типов вируса папилломы человека, среди которых 16 и 18 типы вызывают рак шейки матки, а также могут быть причинами плоскоклеточного рака глотки и рака ануса у женщин и у мужчин.</p>",
"pathogenesis": "<p>Факторами, способствующими запуску механизмов вирусного канцерогенеза, являются вирусного канцерогенеза, являются снижение иммунитета. Развитие рака шейки матки имеет ортодоксальный закономерный характер: в поверхностном (базальном) слое матки развивается гиперпластический процесс – дисплазия, для которого свойственна атипия эпителия с нарушением слоистости, но без вовлечения поверхностного слоя и стромы. Затем в этих участках формируется преинвазивный рак с поражением всего эпителиального пласта, затем происходит прорыв базальной мембраны и развитие инвазивного процесса. Чрезвычайно важен факт существования латентного периода (длительность которого весьма вариабельна), необходимого для перехода дисплазии в преинвазивный рак и далее в инвазивный. Этот период обеспечивает возможность активной профилактики заболеваемости инвазивным раком шейки матки путем выявления дисплазии и внутриэпителиального рака и своевременного адекватного их лечения.</p>",
"diagnostics": "<p>В современной онкогинекологии существует двухэтапная система обследования пациентки. На первом этапе производится первичное выявление — скрининг, на втором — используются методы углубленной диагностики при подозрении на предрак или рак репродуктивной системы.</p>\r\n<p>Цель скрининга:</p>\r\n<p>1) определение групп риска развития рака шейки матки;</p>\r\n<p>2) выявление контингента женщин с предраковой патологией шейки матки;</p>\r\n<p>3) направление женщин для второго этапа углубленного обследования.</p>\r\n<p>На этапе скрининга собирают анамнез, проводят общий осмотр и обследование молочных желез, осмотр наружных половых органов, влагалища и шейки матки в зеркалах, цитологическое исследование мазков, взятых с поверхности шейки матки из зоны трансформации и цервикального канала, бимануальное ректовагинальное исследование. Цитологическое залючение составляется с учетом классификации, аналогичной классификации Папаниколау, предусматривающей описание пяти типов мазков:</p>\r\n<p>I — цитограмма без особенностей;</p>\r\n<p>II — воспалительный тип мазка;</p>\r\n<p>III — морфологические изменения клеток, соответствующие дисплазии;</p>\r\n<p>IV — подозрение на рак;</p>\r\n<p>V — цитограмма рака.</p>\r\n<p>На основании клинико-цитологической информации отбираются женщины, которым показано более углубленное обследование.</p>\r\n<p>Задачи углубленной диагностики:</p>\r\n<p>1) верификация и установление стадии заболевания;</p>\r\n<p>2) определение местной распространенности опухолевого процесса;</p>\r\n<p>3) выявление отдаленных метастазов;</p>\r\n<p>4) оценка функционального состояния органов и систем.</p>\r\n<p>Для верификации диагноза производится осмотр шейки в зеркалах, выполняется кольпоскопия, из патологических очагов берется прицельно биопсия конхотомом, скальпелем, электропетлей и выполняется выскабливание цервикального канала ложечкой Фолькманна, кюреткой.</p>\r\n<p>Местное распространение опухоли определяется при осмотре в зеркалах, ректовагинальном бимануальном исследовании органов малого таза, параметральной клетчатки, мочевого пузыря и прямой кишки на глубину пальца. Степень местного распространения уточняется при цистоскопии, ректороманоскопии. Ультразвуковое исследование позволяет выявить метастазы в подвздошных, парааортальных лимфоузлах, печени и других паренхиматозных органах брюшной полости. Под контролем УЗИ выполняется тонкоигольная пункция через влагалищные своды с целью верификации метастатического поражения регионарных лимфоузлов. С целью исключения отдаленных метастазов выполняется рентгенография органов грудной полости, при подозрении метастатического поражения костей проводится сканирование скелета. На основании полученных результатов клинического обследования выставляется стадия заболевания.</p>",
"treatment": "<p>При выборе метода лечения ранней онкологической патологии шейки матки необходимо стремиться к соблюдению двух основных принципов:</p>\r\n<p>1) обеспечение надежного излечения, в результате чего предупреждаются рецидивы заболевания и переход в более выраженный патологический процесс;</p>\r\n<p>2) применение органосохраняющих и щадящих методов лечения у женщин молодого возраста.</p>\r\n<p>Конизация шейки матки (процедура, при которой удаляют конусообразный кусок шейки матки) может быть выполнена скальпелем, электроножом, хирургическим лазером. Основные достоинства метода конизации заключаются в радикальном удалении патологически измененных тканей шейки матки в пределах здоровых тканей, небольшом количестве осложнений, сохранении физиологических функций, включая детородную. Предпочтительнее применять методики конизации, позволяющие исследовать удаленный препарат шейки матки. Метод лазерной конизации исключает эту возможность. Метод электроконизации возможен даже в амбулаторных условиях.</p>\r\n<p>Ампутация шейки матки является альтернативным методом лечения преинвазивного рака шейки матки. Этот метод показан при грубых деформациях шейки матки, вызванных ее разрывами в родах, при поражении цервикального канала, когда выполнение электроконизации шейки матки сопряжено с большим риском развития рецидива.</p>\r\n<p>Экстирпация (удаление) матки показана:</p>\r\n<p>пациентам в возрасте старше 50 лет; при преимущественной локализации опухоли в шеечном канале; распространенном анапластическом варианте с врастанием в железы; отсутствии в препарате участков, свободных от преинвазивного рака (особенно по линии отсечения) после произведенной ранее конизации; сочетании преинвазивного рака с миомой матки или опухолями придатков; рецидивах после крио- или лазерной деструкции.</p>\r\n<p>Методы криодеструкции, лазерной коагуляции, лазерной конизации шейки матки, фотодинамической лазерной коагуляции, электрокоагуляции применяются в онкогинекологии. </p>\r\n<p>Они менее целесообразны для лечения преинвазивного рака шейки матки, так как не позволяют исследовать инвазию патологического процесса</p>",
"prevention": "<p>Предупредительные мероприятия в отношении рака включает:</p>\r\n<ul>\r\n<li>проведение широкомасштабной просветительской работы, с целью повышения онконастороженности;</li>\r\n<li>внедрение плановых скрининговых обследований, начиная с 21-25 лет с целью выявления дисплазии стенок половых органов;</li>\r\n<li>проведение планомерной вакцинации от вируса папилломы человека, в отношении рака шейки, создание системы контроля безопасности вакцинопрофилактики;</li>\r\n<li>совершенствование образа жизни, наиболее реальная рекомендация касается внимательного отношения к нормализации белкового, углеводного обмена.</li>\r\n</ul>\r\n<p> </p>",
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