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"lead": "внутриэпидермальный рак кожи и слизистых, разновидность карциномы, которая поражает чешуйчатые клетки эпидермиса, но не распространяется на базалиоциты",
"description": "<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;\">Карцинома in situ кожи - это разновидность неинвазивного рака кожи. Опухоль начинается с клеток, обычно находящихся на поверхности кожи. Другое название плоскоклеточного рака кожи in situ - болезнь Боуэна.</span></p>",
"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;\">Ученые выделили ряд факторов, предрасполагающих к развитию патологии:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">гены (наследование определенных дефектов);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">влияние химических факторов (например, ароматические амины или углеводороды);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">физические влияния (ионизирующие излучения, ультрафиолет);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">биологические факторы (заражение определенными онкогенными вирусами – гепатит, папилломавирус);</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">расстройства гормонального статуса – нарушение метаболизма определенных гормонов.</span></p>\r\n</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;\">Карцинома – это тип рака, который начинается в клетках, составляющих кожу или ткани, выстилающие органы, такие как печень или почки. Как и другие виды рака, карциномы - это аномальные клетки, которые бесконтрольно делятся. Они могут распространяться на другие части тела, но не всегда. Карцинома in situ остается в тех клетках, где она возникла. Не все виды рака являются карциномами.</span></p>",
"pathogenesis": "<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;\">Развитие заболевания связано с изменением митотической активности клеток росткового слоя эпидермиса по причине мутации основного гена-супрессора опухолевого роста TP53. В месте развития патологического процесса кожа утолщается за счет быстрого увеличения численности шиповатых клеток. В течение длительного времени опухолевый рост локализован в эпидермисе, но последующие мутации способствуют перемещению раковых клеток в глубжележащие ткани, распространению их гематогенным и лимфогенным путем.</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;\">Повышение степени злокачественности новообразования может происходить постепенно или скачкообразно под воздействием провоцирующих внешних и внутренних факторов. До тех пор, пока измененные клетки располагаются выше базальной мембраны (границы между эпидермисом и дермой), болезнь Боуэна расценивается как неинвазивный рак. Как только патологический рост охватывает дерму, можно говорить об инвазивном раке.</span></p>",
"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;\">Постановкой диагноза занимаются онкологи, они помимо оценки жалоб и осмотра, назначают целый ряд обследований. К ним относят:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">полное лабораторное обследование крови и мочи, включая анализ на онкомаркеры;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">эндоскопические исследования респираторного тракта и пищеварительной трубки;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">рентгенографию предполагаемого места опухоли для выявления повреждений окружающих тканей;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">КТ и МРТ для уточнения размера опухоли, определения метастазов;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 7.5pt; font-family: Verdana; color: #212529; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">биопсию подозрительного очага для подтверждения типа рака</span></p>\r\n</li>\r\n</ul>",
"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;\">Консервативная терапия</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;\">Местное воздействие на очаги поражения позволяет снизить общую нагрузку на организм, что особенно важно для ослабленных больных, пациентов с иммунодефицитом, лекарственной непереносимостью и другими ограничивающими факторами. К числу методов терапевтического лечения относят:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Местное применение лекарственных средств. Назначаются кремы с имиквимодом или 5-фторурацилом. Длительность лечения для каждого из пациентов определяется в индивидуальном порядке, составляет от 1 недели до 2-3 месяцев. Обеспечивают более глубокое проникновение 5-фторурацила, достижение значительной его концентрации в тканях окклюзионные повязки, ионофорез или предварительное лазерное облучение патологического очага.</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;\">Фотодинамическая терапия. Метод предполагает применение средств, повышающих чувствительность тканей к световому воздействию. Активные ингредиенты лекарств накапливаются преимущественно в очагах поражения. Под воздействием света опухолевые клетки гибнут. Показано фотодинамическое лечение в первую очередь пациентам с множественными очагами значительной площади.</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\"><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;\">Хирургическое лечение</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;\">Способ удаления измененных тканей определяется техническим оснащением клиники, уровнем подготовки хирурга. Высокотехнологичные методы позволяют провести лечение с меньшим риском рецидива и рубцевания, однако они доступны далеко не везде. Более простые методики не требуют значительных затрат времени и финансов для того, чтобы получить удовлетворительный результат. Хирургическое лечение может включать:</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;\">Простое оперативное удаление. Хирург иссекает новообразование в пределах здоровых тканей. Образец кожных покровов с дискератозом отправляется в лабораторию на экспресс-диагностику. Края раны стягиваются или проводится кожная пластика. Метод подходит для устранения патологических очагов небольшой площади, расположенных на туловище и конечностях. На лице могут остаться заметные рубцы.</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;\">Микрографическую операцию Мооса. Данная хирургическая техника позволяет удалить новообразование слой за слоем, не повреждая здоровые ткани. Применяется она при рецидивах болезни Боуэна, иммунодефицитных состояниях, для удаления элементов в зонах повышенного риска: вокруг глаз и носа, в области гениталий. Более тонкая и аккуратная работа хирурга снижает вероятность развития рубцов.</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;\">Кюретаж. Выскабливание очага поражения при помощи кюретки позволяет удалить эпидермис с очагами внутриэпидермального рака. Процедура имеет небольшое количество противопоказаний, проводится под местным обезболиванием, не нарушает самочувствия пациента, поэтому ее применение оправдано у широкого круга лиц старшей возрастной группы.</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;\">Криотерапию. Метод эффективен в отношении одиночных образований небольшого диаметра. Под воздействием жидкого азота измененные ткани необратимо повреждаются и спустя некоторое время ссыхаются в плотную корочку. Заживление очагов происходит без рубцевания. Проведение криотерапии не требует предварительного обезболивания за исключением чувствительной к воздействиям области лица.</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;\">Лазерную абляцию. Процедура проводится на неодимовой или углекислотной медицинской лазерной установке. Изменяя настройки аппарата, хирург может контролировать глубину и степень повреждения тканей. При помощи лазера удаляются одиночные очаги небольшого размера. Проводится лазерное лечение под местной анестезией. После удаления новообразований, расположенных в верхних слоях кожи, риск рубцевания минимальный.</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>",
"prevention": "<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;\">Снизить вероятность развития патологии позволяет отказ от посещения соляриев, ограничение пребывания на открытом солнце в теплое время года, использование шляп, кепок с козырьками, рубашек и платьев с длинными рукавами, уходовой косметики с солнцезащитными фильтрами. Рекомендуется смена работы при наличии профессиональных вредностей, предотвращение постоянного травмирования кожи с помощью защитной одежды и перчаток.</span></p>",
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"code": "D05",
"name": "Карцинома in situ молочной железы",
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"slug": "d05_karcinoma_in_situ_molochnoy_zhelezy",
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"etiology": "",
"pathogenesis": "",
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"standard_type": 3,
"danger": 1,
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"parent": null,
"block_rubric": 36,
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}
]
}
