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"code": "C13",
"name": "Рак нижней части глотки",
"icd_name": "Рак нижней части глотки",
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"age_min": 35,
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"slug": "c13_rak_nizhney_chasti_glotki",
"lead": "это злокачественная опухоль, развивающаяся из клеток эпителия слизистой оболочки глотки.",
"description": "Болезнь эта, среди других онкологических недугов, распространена в степени выше среднего и входит в 20 самых частых обнаруживаемых раковых опухолей.",
"etiology": "<p>В настоящее время медицина не выяснила точную причину развития рака глотки. Однако существуют факторы риска, которые повышают вероятность возникновения опухоли глотки. К одним из таких факторов относятся курение табака, а также жевательный табак. Определенную роль играет и чрезмерное употребление алкоголя.</p>\r\n<full></full>\r\n<p><br /><br />Факторы риска рака глотки <br />Перечислим наиболее частые факторы риска, способствующие возникновению рака глотки: <br />1. Табак. Табачный дым оказывает раздражающее действие на клетки слизистой оболочки рта и глотки. Курящие люди намного больше подвержены риску рака глотки, чем не курящие. Примерно 90 % страдающих раком глотки, употребляют табак в той или иной форме. У лиц, использующих жевательный табак, кроме того, повышен риск развития рака десен, щек и губы. <br />2. Чрезмерное употребление алкоголя. Алкоголь так же оказывает раздражающее воздействие на слизистую глотки. Около ¾ пациентов с раком глотки или ротовой полости злоупотребляют алкоголем. Сочетание курения с чрезмерным употреблением алкоголя значительно повышает риск рака глотки или ротовой полости. <br />3. Длительное раздражение зубными протезами. Само по себе раздражение зубными протезами не является фактором риска развития рака глотки или ротовой полости. Однако плохо подходящие зубные протезы могут поглощать табак или алкоголь, которые и оказывают воздействие на слизистую оболочку. <br />4. Лейкоплакия. Лейкоплакия – при осмотре имеет вид ограниченного пятна белесоватого цвета, размером до 1 сантиметра. Они практически не возвышаются над поверхностью слизистой оболочки. Эти образования чаще бывают одиночными, хотя изредка бывают и множественными, встречаются на языке или слизистой оболочке щек. Лейкоплакия считается предраковым состоянием. <br />5. Эритроплакия – это красноватого цвета образования, которые, как и лейкоплакия встречаются на слизистой оболочке ротовой полости. Это так же одна из форм предрака. <br />6. Вирус папилломы человека – вирус, который ответственен за такие образования, как папиллома. Они могут быть как генитальные, так и кожные.</p>\r\n<p> </p>",
"pathogenesis": "",
"diagnostics": "<p align=\"justify\">Благодаря малосимптомному начальному периоду рак глотки может стать случайной диагностической находкой при осмотре на приеме у терапевта, отоларинголога или стоматолога. Подтвердить рак глотки может проведение гистологического исследования образца опухоли, взятого во время биопсии. Исследование мазков-отпечатков с поверхности опухоли малоинформативно и имеет значение только тогда, когда обнаруживает наличие атипичных клеток.</p>\r\n<p align=\"justify\">При подозрении на рак глотки биопсия должна проводиться под контролем фарингоскопии. Если опухоль находится в толще небной миндалины и не сопровождается изъязвлением, то биопсия может дать ложноотрицательный результат в связи с тем, что опухолевый участок не попал во взятый с поверхности миндалины биопсийный образец. Поэтому при одностороннем увеличении миндалины, предполагая рак глотки, желательно провести одностороннюю тонзиллэктомию с последующим тщательным изучением тканей различных участков удаленной миндалины.</p>\r\n<p align=\"justify\">Определить распространенность злокачественного процесса при раке глотки помогает риноскопия, ларингоскопия, исследование проходимости евстахиевой трубы, отоскопия, рентгенография черепа и околоносовых пазух, КТ черепа и глотки, МРТ головного мозга, биопсия лимфоузлов и др.</p>",
"treatment": "<p align=\"justify\">В основе лечения рака глотки лежит хирургический метод. Операция проводится под общим наркозом. Предварительно под местной анестезией выполняется трахеостомия и интубационная трубка вводится через трахеостому. Для избежания интраоперационного кровотечения проводится перевязка наружной сонной артерии. В зависимости от распространенности опухоли применяется наружный или чрезротовой доступ. В ходе операции опухоль должна быть удалена вместе с расположенными на 1 см по ее периметру визуально неизмененными тканями. Если рак глотки локализуется в небной миндалине, то операция заключается в удалении пораженной миндалины, прилегающей к ней области корня языка, небных дужек и парафарингеальной клетчатки. Если рак глотки прорастает в гортань, то проводят циркулярную резекцию глотки и удаление гортани. Операция заканчивается формированием трахеостомы, ортостомы и эзофагостомы. Спустя 3 месяца после ее проведения возможно выполнение пластики глотки и пищевода для восстановления естественного пути прохождения пищи.</p>\r\n<p align=\"justify\">Рак глотки I-II стадии подлежит только хирургическому лечению. Рак глотки III стадии является показанием к комбинированному лечению: операция в сочетании с лучевой терапией. Облучение как самостоятельный способ лечения применяется, когда операция противопоказана или пациент отказывается от нее, а также при послеоперационном рецидиве. Лечение может проводиться контактным или дистанционным способом.</p>\r\n<p align=\"justify\">В комбинации с хирургическим вмешательством или в качестве паллиативного лечения рака глотки возможно применение химиотерапии.</p>",
"prevention": "<p>Предупредить рак глотки поможет отказ от курения, жевания табака и злоупотребления спиртными напитками. Также необходимо следить за состоянием зубных протезов, своевременно лечить заболевания носоглотки и доброкачественные опухоли глотки. Своевременное обращение к отоларингологу позволяет врачу диагностировать рак глотки на I-II стадии заболевания, что значительно улучшает прогноз лечения.</p>",
"clinical_picture": "<p>К симптомам рака глотки и ротовой полости относятся: <br />- Язвочка в полости рта, которая не заживает длительное время или увеличивается в размере. <br />- Постоянная боль во рту. <br />- Образования или пятна на слизистой оболочке рта белого или красного цвета. <br />- Истончение слизистой щек. <br />- Затруднение жевания, глотания, а также движений языка. <br />- Затруднение движений нижней челюсти или боли при движениях ею. <br />- Ощущение комка в горле или язвочка на стенке глотки. <br />- Боль в области зубов либо выпадение зубов. <br />- Онемение во рту. <br />- Изменения голоса. <br />- Опухолевидное образование на шее. <br />- Неприятный запах изо рта</p>",
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