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"code": "C54",
"name": "Рак тела матки",
"icd_name": "Рак тела матки",
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"lead": "это злокачественная опухоль слизистой оболочки (эндометрия), изнутри выстилающей тело матки (со стороны полости матки).\r\n",
"description": "Рак тела матки – одно из самых распространенных онкологических заболеваний, составляющее, по разным данным 30% всех онкогинекологических заболеваний, и находящееся на 3-4 месте среди онкологических заболеваний у женщин после рака молочной железы, толстой кишки и легких. По разным данным раком тела матки заболевают до 3% всех женщин. В среднем заболевание возникает у лиц старше 60 лет.\r\n",
"etiology": "<p>К факторам риска развития рака эндометрия относят:</p>\r\n<ul>\r\n<li>эндокриннообменные нарушения (например, , сахарный диабет, гипертоническая болезнь);</li>\r\n<li>гормональнозависимые нарушения функции женских половых органов (ановуляция, гиперэстрогенизм, );</li>\r\n<li>гормональноактивные опухоли яичников (гранулёзотекаклеточная опухоль и опухоль Бреннера в 20% случаев сопровождаются раком эндометрия);</li>\r\n<li>генетическую предрасположенность;</li>\r\n<li>отсутствие половой жизни, беременностей, родов;</li>\r\n<li>позднее наступление менархе, менопаузы (в возрасте старше 55 лет);</li>\r\n</ul>",
"pathogenesis": "<p>Предлагают три гипотезы возникновения и развития рака эндометрия.</p>\r\n<p>Первую из них (эстрогенную) характеризуют проявлением гиперэстрогенизма в сочетании с эндокринными и обменными нарушениями (, сахарный диабет, гипертоническая болезнь), что наблюдают у 70% больных.</p>\r\n<p>Вторая (эстрогеннезависимая) теория подразумевает отсутствие эндокриннообменных расстройств и нарушений овуляции, что наблюдают у 30% больных.</p>\r\n<p>В свете последних открытий в генетике рака пристального внимания заслуживает третья теория развития неоплазии — генетическая.</p>",
"diagnostics": "<p>Диагностический этап — ведущий и ответственный момент, позволяющий врачу выбрать наиболее правильную тактику лечения, ориентируясь на возраст больной, распространённость (стадию) процесса (локализация неоплазии, выраженность её инвазии в миометрий), морфологическую структуру опухоли, степень дифференцировки опухолевых клеток, потенциальную чувствительность данного вида опухоли к гормональной или лучевой терапии, выраженность экстрагенитальной патологии, выступающей противопоказанием к проведению того или иного метода лечения.</p>\r\n<p>Цитологический метод широко применяют в клинической практике благодаря его доступности и возможности многократного исследования в условиях поликлиники.</p>\r\n<p>В настоящее время ведущим диагностическим скринингтестом при массовых обследованиях населения считают ультразвуковое сканирование, позволяющее визуализировать патологические изменения в эндометрии у лиц любой возрастной категории.</p>\r\n<p>Гистероскопия позволяет не только судить о выраженности и распространённости неопластического процесса, но и производить прицельную биопсию патологически изменённого эпителия, а также оценивать качество раздельного лечебно- диагностического выскабливания и целесообразность его выполнения.</p>\r\n<p>Заключительным и решающим методом диагностики рака эндометрия является гистологическое исследование, позволяющее определить характер морфологических изменений.</p>",
"treatment": "<p>В настоящее время в России при раке эндометрия проводят комплексное лечение, включающее хирургический, лучевой и лекарственный компоненты. Последовательность и интенсивность каждого из них определяют степенью распространения заболевания и биологическими особенностями опухолевого процесса. Известны преимущества хирургического, комбинированного и комплексного лечения рака тела матки, при которых достигают высоких показателей пятилетней выживаемости (80–90%), что на 20–25% выше, чем при лучевой терапии. Лечение назначают индивидуально, что зависит от прогностических факторов.</p>\r\n<p>Хирургический метод считают основным в комплексном и комбинированном лечении.</p>\r\n<p>Один из компонентов комбинированного лечения при распространённых формах рака тела матки — лучевая терапия.</p>\r\n<p>Химиотерапию проводят лишь как компонент комплексного лечения. Наиболее распространённая схема поддерживающей химиотерапии для лечения рака тела матки — САР (цисплатин, доксорубицин, циклофосфамид).</p>",
"prevention": "<p>Специфической профилактики не существует.</p>",
"clinical_picture": "<p>На ранних стадиях заболевание протекает бессимптомно. Основными клиническими симптомами рака тела матки бывают кровянистые выделения из половых путей, водянистые и боли.</p>\r\n<p>Наиболее часто наблюдаемый симптом — атипичное маточное — непатогномоничен для рака эндометрия, поскольку характерен для многих гинекологических заболеваний (например, миома матки, аденомиоз), особенно у женщин репродуктивного и перименопаузального периодов. Больные детородного возраста чаще обращаются за помощью в женскую консультацию, где длительное время наблюдаются и лечатся у гинекологов по поводу дисфункциональных нарушений.</p>\r\n<p>Однако бывает «классическим» симптомом только в постменопаузе.</p>\r\n<p>Появление обильных серозных белей у женщин пожилого возраста без сопутствующих воспалительных заболеваний матки, влагалища, шейки матки характерно для рака тела матки. Развитие заболевания может сопровождаться обильными водянистыми выделениями (лейкореей), характерными для РМТ.</p>\r\n<p>Боли — поздний симптом заболевания. Чаще локализуются внизу живота и поясничнокрестцовой области, носят схваткообразный или постоянный характер. Значительная часть больных обращаются к врачу с опозданием, т.е. когда уже есть признаки распространения опухолевого процесса (нарушение функции мочевого пузыря, кишечника). Это связано с низким уровнем медикопросветительной работы и отсутствием профилактических осмотров, проводимых среди населения.</p>",
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},
"code": "C56",
"name": "Рак яичника",
"icd_name": "Рак яичника",
"gender": 2,
"age_min": 30,
"age_max": 85,
"cause": [
0
],
"periodicity": 4,
"slug": "c56_rak_yaichnika",
"lead": "злокачественная опухоль, поражающая яичники.\r\n\r\n",
"description": "Рак яичника может носить как первичный характер, когда основной очаг расположен в тканях яичника, так и вторичный (метастатический), с первичным очагом практически в любой части тела. К первичным поражениям относятся карцинома (70% всех злокачественных опухолей яичника), герминогенные и стромальные опухоли полового тракта, а также более редкие варианты. Метастатические поражения яичника встречаются достаточно часто.",
"etiology": "<p>1. Возраст. Рак яичников и некоторые другие опухоли, например, стромы полового тяжа — болезнь пожилых, а герминогенные новообразования поражают молодых женщин и подростков.</p>\r\n<p>2. Генетические (наследственные) факторы. В 95% случаев рак яичников возникает спорадически и лишь в 5% носит наследственный характер. Риск заболеть выше у женщин, у которых родственницы 1-й степени родства (мать, дочь, родная сестра) или 2-й степени родства (бабушка, внучка, двоюродная сестра, тетя или племянница) болели раком яичников. </p>\r\n<p>3. Гормональные факторы. Беременность снижает риск возникновения рака яичников. С увеличением числа беременностей повышается защитный эффект от рака яичников. Обратите внимание, что чем больше беременностей, тем меньше число овуляторных менструальных циклов в течение репродуктивного периода женщины. увеличивает риск рака яичников. </p>\r\n<p>4. Тальк. В некоторых работах говорится о повышенном риске рака яичников при использовании талька женщинами в гигиенических целях (на область промежности). Полагают, что это связано с асбестом, содержащимся в тальке, который обладает канцерогенным действием. </p>",
"pathogenesis": "<p>Эпителиальные злокачественные опухоли яичников (рак) составляют около 80% всех опухолей яичников и происходят из эпителия яичников. Остальные опухоли возникают из зародышевых и стромальных клеток. Источником почти всех эпителиальных опухолей яичников считают кисты. Клетки в этих кистах могут дифференцироваться как в трубный, так и в эндоцервикальный эпителий. </p>\r\n<p>В последнее время вопросы этиологии, патогенеза и ранней диагностики во многом связывают с медикогенетическими исследованиями, направленными на изучение роли наследственной предрасположенности к развитию рака яичников, их генетической гетерогенности и выявление лиц среди родственников с потенциально высоким риском заболеть этой формой рака.</p>",
"diagnostics": "<p>Ранняя диагностика рака яичников трудна, поскольку до настоящего времени не существует специфических диагностических тестов, позволяющих выявить опухоль на начальных этапах её развития.</p>\r\n<p>Одним из наиболее интересных и перспективных направлений в диагностике злокачественных опухолей считают определение опухолевых маркёров. Несмотря на кажущееся обилие опухолевых маркёров, единственно надёжным тестом при раке яичников, причём в основном при серозной его форме, служит определение СА 125.</p>\r\n<p>Достоинством ультразвукового метода в диагностике опухолей яичников считают его высокую информативность (чувствительность, специфичность и точность достигают 80–90%), простоту, быстроту, безвредность, безболезненность, возможность многократного проведения. УЗИ малого таза стало рутинным методом в обследовании женщины при подозрении опухоли яичника. Для более углублённой диагностики при наличии опухолей яичников в настоящее время применяют такие высокоинформативные методы, как КТ и МРТ.</p>\r\n<p>Рентгенография грудной клетки — обязательный компонент обследования при подозрении на опухоль яичников, так как позволяет диагностировать возможное метастазирование в лёгкие и плеврит. Это даёт основание с большей или меньшей долей вероятности заподозрить опухоль яичников. Однако только гистологическая верификация диагноза может дать точный и окончательный ответ.</p>\r\n<p>Иногда для постановки диагноза необходимо выполнение лапароскопии или лапаротомии и получение материала для гистологического исследования.</p>",
"treatment": "<p>Оперативному вмешательству в настоящее время придают первостепенное значение как самостоятельному методу и как важнейшему этапу в комплексе лечебных мероприятий.</p>\r\n<p>При злокачественных опухолях яичников операцией выбора считают экстирпацию матки с придатками, удаление большого сальника. В некоторых клиниках призывают дополнительно производить аппендэктомию, спленэктомию, резекцию поражённых отделов кишки, а также забрюшинную лимфаденэктомию.</p>\r\n<p>Значительно больше проблем возникает при лечении больных с распространёнными стадиями заболевания. В настоящее время нет сомнений в необходимости при первичном лечении этих больных проведения комбинированных или комплексных мероприятий.</p>\r\n<p>Изучая значение последовательности лечебных воздействий при III–IV стадиях рака яичников, пришли к выводу, что вариант «операция+химиотерапия» улучшает выживаемость больных при сравнении с вариантом, когда на первом этапе было проведено лекарственное лечение.</p>\r\n<p>Системную химиотерапию считают стандартным методом лечения больных распространённым раком яичника. С учётом того, что при II–IV стадиях рака яичников циторедуктивную операцию не считают радикальной, проведение химиотерапии следует начать как можно быстрее после операции (в ближайшие 2–4 нед).</p>",
"prevention": "<p>Профилактики рака яичников не существует в связи с отсутствием полноценного понимания этиологии и патогенеза этой патологии. К сожалению, единственное, что могут предложить онкологи в настоящее время, это регулярное наблюдение гинекологом с целью раннего выявления яичниковых образований, профилактика и лечение воспалительных заболеваний, приводящих к бесплодию. Последнее повышает риск заболевания, в то время как большое количество беременностей и родов обладает значительным защитным действием.</p>",
"clinical_picture": "<ul class=\"list list-description\">\r\n<li>Бессимптомное течение.</li>\r\n<li>Ноющие (тянущие) боли внизу живота и/или в поясничной области во время или после физической нагрузки.</li>\r\n<li>Боли и дискомфорт во время полового акта ().</li>\r\n<li> (нерегулярность).</li>\r\n<li>Увеличение в объеме живота.</li>\r\n<li>.</li>\r\n<li>Симптомы сдавления органов малого таза (при сдавлении мочевого пузыря – , при сдавлении прямой кишки – частые позывы к дефекации или запоры).</li>\r\n<li>, \"></a>, \">Рвота</a>\">\">рвота</a></a>.</li>\r\n<li>Быстрая потеря или набор веса.</li>\r\n<li>, быстрая \"></a>, общее .</li>\r\n<li>Кровянистые выделения из половых путей (влагалища).</li>\r\n<li>Симптомы, обусловленные метастазированием (вторичные очаги роста опухоли, возникающие в близлежащих и удаленных органах): и , боли в костях, патологические переломы, , неврологическая симптоматика (\"></a>, движений, судорожные припадки).</li>\r\n<li>Неспецифические симптомы опухолевой интоксикации (симптомы, которые могут встречаться и при других заболеваниях):\r\n<ul class=\"list list-description-2\">\r\n<li>анемия (снижение уровня гемоглобина (железосодержащий белок красного цвета, находится в красной кровяной клетке, эритроците) в крови),</li>\r\n<li>высокая СОЭ (скорость оседания эритроцитов, показывает наличие воспаления в организме),</li>\r\n<li>,</li>\r\n<li>, общее , быстрая \"></a>,</li>\r\n<li>.</li>\r\n</ul>\r\n</li>\r\n</ul>",
"image": "http://api.symptomd.ru/storage/ae8b4b5da30e34313da39cc2b250ba7c_3J1vnRc.png",
"image_alt": "Рак яичника",
"standard_type": 1,
"danger": 26,
"published": 1,
"parent": null,
"block_rubric": 28,
"standards": [
4714,
4800,
5199
]
},
{
"id": 7957,
"symptoms": [
{
"id": 3036,
"synonyms": [
{
"name": "белые выделения "
},
{
"name": "бели"
},
{
"name": "пахнущие выделения "
},
{
"name": "бели "
},
{
"name": "обильные выделения"
}
],
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{
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"y": 5129,
"r": 300
}
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},
"code": "C57",
"name": "Рак других и неуточненных женских половых органов",
"icd_name": "Рак других и неуточненных женских половых органов",
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"slug": "c57_rak_drugih_i_neutochnennyh_zhenskih_polovyh_organov",
"lead": "Злокачественные новообразования неуточненные женских половых органов- онкологические заболевания",
"description": "Рак маточной трубы наблюдают достаточно редко. По данным мировой и отечественной литературы, встречаемость рака маточной трубы составляет 0,11–1,18% среди опухолей женских половых органов.\r\n\r\n",
"etiology": "<p>Считают, что предрасполагающими факторами, способствующими возникновению рака маточной трубы, служая воспалительные заболевания органов малого таза в анамнезе, <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a>, возраст старше 40 лет. Воспалительные заболевания маточных труб отмечают более чем у 1/3 больных; большинство больных страдают бесплодием (40–71%).</p>\r\n<p>В последние годы появились сообщения, свидетельствующие о возможной вирусной этиологии рака маточных труб.</p>",
"pathogenesis": "<p>На ранних стадиях заболевания маточная труба макроскопически может быть не изменена. При запущенных стадиях она увеличивается в размерах и деформируется, приобретая колбасовидную, ретортообразную, яйцевидную и другие формы.</p>\r\n<p>При запаянном отверстии ампулы маточной трубы внешне характерна картина гидрогематопиосальпинкса. Поверхность опухоли обычно мелкобугристая, мелковорсинчатая, сероватобелого или розоватобелого цвета (напоминает цветную капусту). Большая часть поверхности поражённых маточных труб серосинюшного цвета, иногда темнобагрового, что наблюдают при перекруте трубы с резко выраженной дисциркуляцией. При открытом отверстии ампулы маточной трубы опухолевые массы чаще всего выступают в брюшную полость в виде опухолевых узлов или разрастаний бородавчатого вида.</p>",
"diagnostics": "<p>Правильная предоперационная диагностика рака маточной трубы крайне неинформативна (всего 10%). Даже интраоперационно правильный диагноз устанавливают только в 50% случаев. Следует подчеркнуть, что ни одна деформация маточной трубы не должна быть оставлена во время операции без обследования (исследовать следует весь операционный материал).</p>\r\n<p>Учитывая отсутствие высокоинформативного метода диагностики, большинство клиник применяют комплексный подход, включающий целый ряд клинических, лабораторных и инструментальных методов исследования. Среди них наиболее часто выполняют УЗИ и рентгеновскую КТ, лапароскопию, определение опухолеассоциированных маркёров.</p>",
"treatment": "<p>Первым этапом при раке маточной трубы проводят хирургическое лечение — выполнение радикальной операции, включающей экстирпацию матки с придатками, удаление большого сальника, биопсию парааортальных и подвздошных лимфатических узлов, биопсию и взятие смывов с брюшины таза, латеральных каналов и диафрагмы. При невозможности выполнения лимфаденэктомии выполняют биопсию этих узлов.</p>\r\n<p>Выборочные исследования и широкое применение различных химиопрепаратов, их комбинации, а также сочетание химиотерапии с лучевой терапией не позволяют провести адекватное сравнение различных подходов лечения. Высокая частота неэффективности лечения даже при ранних стадиях подчеркивает необходимость адъювантного лечения на каждой стадии заболевания.</p>",
"prevention": "<p>Профилактика рака маточной трубы мало изучена и сводится к своевременному лечению воспалительных процессов.</p>",
"clinical_picture": "<p>В отличие от рака яичников, в большинстве случаев характеризующегося долгим бессимптомным течением, при раке маточных труб существует достаточное разнообразие симптомов. Наиболее частыми симптомами бывают обильные водянистые и кровянистые выделения, боли внизу живота. Однако сочетание этих трёх признаков отмечают лишь в 12,5% случаев.</p>\r\n<p>Кровянистые выделения из половых путей на фоне менопаузы или ациклические кровянистые выделения у женщин репродуктивного возраста отмечают в 50–60% случаев. Кровянистые выделения преимущественно обусловлены прорастанием слизистой оболочки маточной трубы опухолью, а также распадом опухоли. В этом случае часто ошибочно ставят диагноз рака эндометрия и более чем в половине случаев производят диагностическое выскабливание матки (иногда повторно). Даже в повторно произведённых соскобах не всегда обнаруживают опухолевую ткань. Это приводит к задержке в постановке истинного диагноза.</p>\r\n<p>Подозрение на рак маточных труб вызывают также обильные, периодически возникающие водянистые выделения (иногда с примесью крови), совпадающие с уменьшением мешотчатой опухоли придатков матки. Этим выделениям предшествуют схваткообразные боли внизу живота. Симптом «перемежающейся водянки» маточной трубы считают патогномоничным для рака маточной трубы (наблюдают в 3–14% случаев).</p>\r\n<p>Метастатическое поражение лимфатических узлов (парааортальных, надключичных, шейных) может быть первым клиническим признаком рака. Такую клиническую картину наблюдают в 8–12,5% случаев. К объективным симптомам рака маточных труб относят <a href=\"/symptom/uvelichenie_zhivota/\" title=\"Перейти на страницу симптома Увеличение живота\">увеличение живота</a> в объёме вследствие скопления свободной жидкости в брюшной полости у больных с III и IV стадией заболевания или вследствие роста опухолей.</p>",
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"name": "Рак женских половых органов, выходящий за пределы одной и более локализаций",
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"standard_type": 3,
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"parent": 7957,
"block_rubric": 28,
"standards": []
}
]
}
