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"code": "C56",
"name": "Рак яичника",
"icd_name": "Рак яичника",
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"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>",
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},
"code": "C62.9",
"name": "Рак яичка неуточненный",
"icd_name": "Рак яичка неуточненный",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "c62.9_rak_yaichka_neutochnennyy",
"lead": "злокачественное поражение половых желез у мужчин",
"description": "",
"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;\">Выявлено три возрастных пика, связанных с возникновением рака яичка: у мальчиков до 10 лет, молодых мужчин от 20 до 40 лет и пожилых людей старше 60 лет. У детей патология в 90% случаев развивается на фоне малигнизации эмбриональной доброкачественной тератомы. В более старшем возрасте факторами, провоцирующими развитие новообразования, могут стать травмы мошонки, эндокринные заболевания (гипогонадизм, гинекомастия, бесплодие), радиационное излучение и др. Риск возникновения неоплазии возрастает при синдроме Клайнфельтера.</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;\">Наиболее часто болезнь выявляется у пациентов с крипторхизмом – неопущением желез в мошонку. Различные формы крипторхизма увеличивают риск возникновения рака в неопустившемся яичке в 10 раз. При одностороннем поражении яичка вероятность возникновения опухоли контралатеральной железы также велика. Вероятность развития рака выше у мужчин, чьи родственники первой степени (брат, отец) имели аналогичное заболевание.</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;\">Окончательная причина возникновения рака яичка до сих пор не установлена, но прослеживается ряд факторов, наличие которых существенно повышает риск развития заболевания.</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;\">Выделяют три группы факторов риска: перинатальные (связанные с внутриутробным развитием плода), постпубертатные (относящиеся к периоду развития человека после завершения полового созревания) и генетические.</span></p>\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;\">Перинатальные факторы: установлено, что эстрогены и эстрогеноподобные вещества могут оказывать влияние на внутриутробное формирование гонад у плода. Женские половые гормоны способны индуцировать возникновение тетраплоидии герминогенных клеток (редкий вариант хромосомных аномалий, при котором увеличивается полный набор хромосом зародышевых клеток). Это является одним из признаков развития у плода carcinoma in situ (предшественницы всех раков).</span></p>\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;\">Генетические факторы риска: описана связь между генетическими изменениями (в гене-супрессоре опухоли PTEN) и риском возникновения опухолей половых клеток яичка.</span></p>\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;\">Крипторхизм (неопущение яичка) увеличивает риск развития рака яичка в 5-10 раз. В утробе матери у плода мужского пола развитие яичек происходит в брюшной полости.</span></p>\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;\">Обычно яички опускаются в полость мошонки при рождении или на первом году жизни. Если этот процесс задерживается или яички не опустились в мошонку, создаются неблагоприятные условия, способствующие развитию дегенеративных изменений. Чем глубже и дольше яичко расположено в брюшной полости, тем сильнее нарушается сперматогенная (репродуктивная) функция мужчины.</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;\">Для постановки диагноза необходимо записаться на прием к андрологу или урологу. Обследование состоит из таких составляющих:</span></p>\r\n<p> </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;\">Осмотр, пальпация проблемных зон, опрос пациента и сбор анамнеза. </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;\">УЗИ. </span><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;\">Эффективность ультразвукового исследования в этом случае очень высока. </span></li>\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;\">МРТ либо КТ. </span></li>\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;\">Остеосцинтиграфия — необходима для выявления метастазов. </span></li>\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;\">Анализы крови на онкомаркеры. </span></li>\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;\">Биопсия через паховый доступ.</span></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;\">Возможность органосохраняющей операции рассматривается при двусторонней опухоли или поражении единственной железы. После резекции яичка всем пациентам показано проведение адъювантной лучевой терапии. Стандартом хирургического лечения патологии служит орхиэктомия, при необходимости с забрюшинной лимфаденэктомией. Удаление семиномных опухолей Т1-Т2 стадий дополняется лучевой терапией; при стадиях семиномы Т3-Т4, а также при несеминомном раке требуется назначение системной химиотерапии. В случае двухсторонней орхифуникулэктомии или низкого уровня тестостерона пациентам назначается гормонозаместительная терапия.</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;\">Комплексное лечение (орхиэктомия, радиотерапия, химиотерапия) могут привести к временному или длительному бесплодию и импотенции. Поэтому пациентам фертильного возраста перед началом терапии рекомендуется обследование у онкоуролога с оценкой уровня гормонов (тестостерона, ЛГ, ФСГ) и спермограммы. При намерении в дальнейшем иметь детей до начала лечения мужчина может прибегнуть к криоконсервации спермы.</span></p>",
"prevention": "<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;\">Чтобы снизить риски развития рака яичка, необходимо придерживаться следующих профилактических мер:</span></p>\r\n<p> </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;\">Регулярно (минимум раз в месяц) проводить самообследование мошонки и яичек на предмет разных уплотнений, образований, изменений размера и т. д. При появлении любых непонятных изменений обращаться за консультацией к урологу, андрологу. </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;\">Вести здоровый образ жизни: отказаться от курения, алкоголя, достаточно времени проводить в движении, питаться здоровой пищей. </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;\">Исключить перегрев мошонки, а также ношение слишком тесной натирающей одежды. </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;\">Избегать различных травм половых органов. </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;\">Если травма все же произошла, обязательно показаться андрологу.</span></li>\r\n</ul>",
"clinical_picture": "<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;\">Первые признаки рака яичка проявляются не сразу. На ранних стадиях течение болезни обычно бессимптомное, лишь иногда появляется ощущение тяжести, наблюдаются изменения размеров яичка либо мошонки. Это уже повод немедленно обратиться к урологу и пройти обследование.</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;\">По мере развития заболевания могут появляться такие симптомы и признаки рака яичек (по нарастающей):</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;\">болевые ощущения в мошонке; </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;\">возникновение уплотнения, которое можно прощупать самостоятельно; </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;\">изменение консистенции яичка (если сравнивать с другим) — пациент тоже может ощутить это сам; </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;\">болевые ощущения в спине — с этого признака и дальше говорится о симптомах, свойственных течению болезни при метастазировании; </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;\">отечность нижних конечностей; </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;\">проблемы с мочеиспусканием, в работе почек; </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;\">одышка и кашель при поражении легких; </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;\">увеличение надключичных лимфатических узлов.</span></li>\r\n</ul>\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;\">Если вовремя не начать лечение рака яичка, метастазы будут распространяться очень быстро, подрывая здоровье мужчины.</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;\">Иногда случается, что симптомы рака яичка сопровождаются дополнительными изменениями на фоне сильных гормональных нарушений. В таком случае выделяют еще ряд признаков:</span></p>\r\n<p> </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;\">гинекомастия — то есть увеличение молочных желез у мужчины; </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;\">эректильная дисфункция и снижение либидо у взрослых; </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;\">частые и долгие эрекции у мальчиков — симптомом является именно длительность и частота, а не сам факт эрекции, что для мальчиков нормально; </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;\">преждевременное увеличение полового члена, а также раннее появление волос на лобке; </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;\">развитие костей и мышц, которое опережает возраст.</span></li>\r\n</ul>",
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"code": "C62",
"name": "Рак яичка",
"icd_name": "Рак яичка",
"gender": 1,
"age_min": 15,
"age_max": 40,
"cause": [
"0",
"3"
],
"periodicity": 0,
"slug": "c62_rak_yaichka",
"lead": "злокачественное поражение тестикул – половых желез у мужчин.",
"description": "<p>Рак яичка — это злокачественная опухоль, развивающаяся из тканей яичек (мужских половых желез, расположенных в мошонке). Чаще встречается в возрасте от 15 до 40 лет, хотя возникновение опухоли возможно в любом возрасте, включая младенцев и пожилых людей. Выявлено три возрастных пика, связанных с возникновением рака яичка: у мальчиков до 10 лет, молодых мужчин от 20 до 40 лет и пожилых людей старше 60 лет.</p>",
"etiology": "<p align=\"justify\">Выявлено три возрастных пика, связанных с возникновением рака яичка: у мальчиков до 10 лет, молодых мужчин от 20 до 40 лет и пожилых людей старше 60 лет.</p>\r\n<p align=\"justify\">У детей рак яичка в 90% случаев развивается на фоне малигнизации эмбриональной доброкачественной тератомы. В более старшем возрасте факторами, провоцирующими развитие рака яичка, могут стать травмы мошонки, эндокринные заболевания (гипогонадизм, гинекомастия, бесплодие), радиационное излучение и др. Риск возникновения рака яичка возрастает при синдроме Клайнфельтера.</p>\r\n<p align=\"justify\">Наиболее часто рак яичка выявляется у пациентов с крипторхизмом – неопущением желез в мошонку. Различные формы крипторхизма увеличивают риск возникновения рака в неопустившемся яичке в 10 раз. При одностороннем поражении яичка вероятность возникновения опухоли контралатеральной железы также велика.</p>\r\n<p align=\"justify\">Шансы на развитие рака яичка выше у мужчин, чьи родственники первой степени (брат, отец) имели аналогичное заболевание. Рак яичка в 5 раз чаще встречается у европейцев, особенно жителей Германии и Скандинавии; реже – в азиатских и африканских странах.</p>",
"pathogenesis": "",
"diagnostics": "<ul class=\"list list-description\">\r\n<li>Анализ анамнеза заболевания и жалоб (когда появились боли, чувство тяжести в мошонке, обнаружились образования в яичке при прощупывании, увеличилось ли оно в размерах и т.д.).</li>\r\n<li>Анализ анамнеза жизни (перенесенные заболевания, оперативные вмешательства, травмы).</li>\r\n<li>Выявление наследственного фактора (были ли случаи рака яичка у близких родственников и т.д.).</li>\r\n<li>Осмотр, пальпация (прощупывание) мошонки, живота, лимфоузлов.</li>\r\n<li>УЗИ (ультразвуковое исследование) мошонки – позволяет получать изображение внутренних органов и оценивать наличие каких-либо изменений).</li>\r\n<li>Диафаноскопия — просвечивание мошонки светоисточником</li>\r\n<li>Определение в крови уровня b-ХГЧ (бета-ХГЧ, хорионический гонадотропин человека, у мужчин синтезируется опухолями), АФП (альфа-фетопротеин, значительное его повышение у мужчин указывает на наличие опухоли) и ЛДГ (лактатдегидрогеназа, фермент, участвующий в процессе окисления глюкозы и образовании молочной кислоты, накапливается в тканях организма при развитии опухоли).</li>\r\n<li>Рентгенологические исследования грудной клетки.</li>\r\n<li>МРТ (магнитно-резонансная томография, метод получения диагностических изображений, основанный на использовании физического явления ядерно-магнитного резонанса, он безопасен для организма).</li>\r\n<li> КТ (компьютерная томография, вид рентгеновского обследования, позволяющий получить на компьютере послойное изображение органов) проводятся для выявления метастазов (вторичные очаги роста опухоли, возникающие в близлежащих и удаленных органах, лимфоузлах).</li>\r\n<li>Биопсия (исследование кусочка тканей под микроскопом) тканей яичка (после операции по его удалению) – подтверждение диагноза.</li>\r\n</ul>",
"treatment": "<p align=\"justify\">Возможность органосохраняющей операции при раке яичка рассматривается при двусторонней опухоли или поражении единственной железы. После резекции яичка всем пациентам показано проведение адъювантной лучевой терапии.</p>\r\n<p align=\"justify\">Стандартом хирургического лечения рака яичка служит орхиэктомия, при необходимости с забрюшинной лимфаденэктомией. Удаление семиномных опухолей Т1-Т2 стадий дополняется лучевой терапией; при стадиях семиномы Т3-Т4, а также при несеминомном раке яичка требуется назначение системной химиотерапии. В случае двухсторонней орхфуникулэктомии или низкого уровня тестостерона пациентам назначается гормонозаместительная терапия.</p>\r\n<p align=\"justify\">Комплексное лечение рака яичка (орхиэктомия, радиотерапия, химиотерапия) могут привести к временному или длительному бесплодию и импотенции. Поэтому пациентам фертильного возраста перед лечением рака яичка рекомендуется обследование у андролога с оценкой уровня гормонов (тестостерона, ЛГ, ФСГ) и спермограммы. При намерении в дальнейшем иметь детей до начала лечения мужчина может прибегнуть к криоконсервации спермы.</p>",
"prevention": "<p>Профилактика рака яичка заключается в своевременном устранении крипторхизма, предупреждении травм мошонки, исключении облучения гениталий. Своевременному выявлению рака яичка способствует регулярное самообследование и раннее обращение к урологу-андрологу при обнаружении каких-либо изменений.</p>",
"clinical_picture": "<p>Чистая семинома протекает менее злокачественно по сравнению с другими формами опухолей яичка. Метастазы дает несколько позже, по лимфатической системе. Опухоль гормонально не активная.<br />Эмбриональный рак и тератоидная опухоль яичка отличаются более злокачественным течением, метастазы появляются рано, распространяясь как по лимфатической, так и по кровеносной системам. Опухоль гормонально активна.<br />Хорионэпителиома — наиболее злокачественная форма опухолей яичка. Метастазирует рано по кровеносной системе в легкие, печень, мозг и другие органы; метастазы могут образоваться при пальпаторно неопределяемой первичной опухоли. Опухолевая ткань вырабатывает гонадотропный гормон.<br />Интерстициальноклеточные опухоли яичка у взрослых вызывают гинекомастию и другие признаки феминизации, у детей — раннее половое развитие.<br />Для опухолей яичка характерна скудная симптоматика или начальное бессимптомное течение, вследствие чего почти в половине случаев больные обращаются к врачу с выраженными метастазами. Вначале отмечается незначительное увеличение яичка или <a title=\"Перейти на страницу симптома Отек тканей\" href=\"/symptom/otek_tkaney/\">уплотнение</a> в нем, появляется чувство тяжести или легкая болезненность в яичке. По мере увеличения яичка болезненные ощущения могут увеличиваться. Сильные боли в яичке могут зависеть от кровоизлияния, некроза или инфаркта опухоли. При поражении неопустившегося яичка прощупывается опухоль в подвздошной области или в паху. С развитием метастазов в забрюшинных лимфатических узлах появляются боли в пояснице, запоры, динамическая непроходимость, отеки нижних конечностей и др. В дальнейшем метастазы появляются в лимфатических узлах подвздошных, левой надключичной области, средостения, в печени, легких.</p>",
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"code": "C73",
"name": "Рак щитовидной железы",
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"lead": "злокачественная опухоль щитовидной железы, развивающаяся из фолликулярных или из С-клеток.",
"description": "<p>Самый распространенный тип онкологических заболеваний – это папиллярный рак щитовидной железы, встречающийся более чем в 75% случаях. Как правило, такая опухоль возникает из здоровой ткани щитовидной железы и показывает себя, как новообразование в виде кисты или неравномерной, солидной опухоли. Папиллярный рак можно считать одним из самых поддающихся лечению видов злокачественных опухолей. В 85% случаях онкобольные излечиваются полностью от данного вида рака.</p>",
"etiology": "<p>Современная медицина не имеет точных и доказанных причин возникновения опухолей на щитовидной железе, в частности папиллярного рака. Наиболее вероятной причиной считается мутация клеток на уровне ДНК. Причины возникновения мутаций также не известны. Клеточная структура щитовидной железы образует опухоли после мутаций клеток, которые начинают активно расти. Рост злокачественных клеток происходит постепенно, поражая здоровые ткани органа. По мнению медиков, папиллярный рак щитовидной железы может возникать по следующим причинам:</p>\r\n<ul>\r\n<li>Дефицит йода в организме человека;</li>\r\n<li>Врожденный фактор;</li>\r\n<li>Влияние окружающей среды, плохой экологии;</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>Первичное диагностирование злокачественной опухоли в щитовидной железе может проводиться врачом путем пальпирования шейной области. При наличии уплотнений и узлов пациента направляют на ультразвуковое исследование. Однако окончательный и точный диагноз может быть поставлен только после проведения гистологического анализа узла, отсеченного из железы или удаленного лимфаузла. Выявление метастазов в костной ткани и легких осуществляется при помощи рентген-исследования.</p>\r\n<p>При возникновении небольших опухолей, которые не прощупываются, могут возникнуть затруднения в диагностировании заболевания, так как увеличение лимфатических узлов в шейном отделе указывает еще на ряд других заболеваний. Чтобы подтвердить или опровергнуть папиллярный рак щитовидной железы проводится гистологический анализ отсеченного лимфатического узла.</p>",
"treatment": "<p>Современная медицина имеет в своем арсенале эффективный метод лечения рака щитовидной железы, который состоит из двух этапов:</p>\r\n<ol type=\"1\" start=\"1\">\r\n<li>Оперативное вмешательство хирургов;</li>\r\n<li>Проведение процедур с радиоактивным йодом.</li>\r\n</ol>\r\n<p>На первом этапе лечения проводится хирургическая операция по отсечению больных клеток органы или полное отсечение щитовидной железы. При поражении рядом находящихся лимфатических узлов выполняется полное или частичное удаление лимфаузлов в шейном отделе. Статистика указывает, что папиллярный рак чаще всего поражает лимфатические узлы, расположенные рядом с гортанью и трахеей.</p>\r\n<p>На втором этапе лечения проводятся процедуры с радиоактивным йодом. Такое лечение показано больным со злокачественной опухолью и наличием метастазов в лимфатических узлах, а так же при прорастании злокачественных образований через оболочку органа. Клетки, вырвавшиеся из железы, являются очень опасными. Терапия с радиоактивным йодом убивает оставшиеся после оперативного вмешательства раковые клетки. Обычно опухолевые клетки могут оставаться в самой щитовидной железе. Кроме этого, радиоактивный йод эффективно борется с метастазами, расположенными в легких, лимфатический системе.</p>",
"prevention": "",
"clinical_picture": "<p>Первый признак – появление на щитовидной железе небольшого узелка. Он заметен под кожей и имеет вид небольшого возвышения с одной стороны. На начальных этапах узелок может быть эластичный и безболезненный, его подвижность ограничена. Он не врос в кожу, а перекатывается под ней. Со временем узел становится более плотным и увеличивается в размерах.</p>\r\n<p>Еще один ранний симптом рака щитовидной железы – увеличение лимфатического узла на шее. Иногда это единственный признак болезни.<br /><br />На поздних этапах, когда опухоль становится более крупная, появляются и другие симптомы:<br /><br /></p>\r\n<ul>\r\n<li>боль в области шеи, которая может отдавать в ухо;</li>\r\n<li>затруднение глотания;</li>\r\n<li>ощущение комка в горле;</li>\r\n<li>осиплость голоса;</li>\r\n<li>кашель, который не связан с простудой или аллергией;</li>\r\n<li>одышка и затрудненное дыхание;</li>\r\n<li>набухание шейных вен.</li>\r\n</ul>\r\n<p><br />Эти симптомы вызваны тем, что опухоль достигла крупных размеров и начала сдавливать окружающие органы: пищевод, трахею. Метастазы в голосовых связках и возвратном гортанном нерве, который проходит рядом с железой – причина изменения <a title=\"Перейти на страницу симптома Слуховые галлюцинации\" href=\"/symptom/sluhovye_gallyucinacii/\">голоса</a>.</p>",
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