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"lead": "Рак мочевого пузыря – это опухоль мочевого пузыря.",
"description": "Рак мочевого пузыря – это опухоль мочевого пузыря, которая весьма распространена в промышленных странах. Чаще всего рак мочевого пузыря поверхностный и не выходит за пределы слизистой оболочки. Однако этот вид рака может распространиться на стенку мочевого пузыря и метастазировать, например, в печень, легкие или костную ткань. Случаи рака, проникающего в мышечный слой, составляют всего 20-25% из всех злокачественных опухолей мочевого пузыря. ",
"etiology": "<p>Развитие рака мочевого пузыря зачастую связывается с курением, в частности отмечается, что курильщики сталкиваются с этим заболеванием до 6 раз чаще той категории больных, у которых этой пагубной привычки нет. Помимо этого воздействуют на рассматриваемый процесс некоторые виды биологических и химических канцерогенов. При длительном контакте с химическими веществами (анилин, красители, моющие средства, бензол и пр.), также оказывается соответствующее воздействие, приводящее к развитию рака мочевого пузыря. Именно по этой причине данный диагноз весьма актуален для работников области химической промышленности, а также для парикмахеров, косметологов, работников химчистки, стоматологов и т.д.<br />Перенесение пациентами ранее процедуры радиотерапии (или облучения) относительно другого актуального для них заболевания в области малого таза (рак яичников или рак матки), химиотерапия с использованием в ней циклофосфамида – все это также определяется в качестве предрасполагающих факторов к развитию рака мочевого пузыря и его симптомов. Рассматривая возможные предрасполагающие факторы для появления и развития этого заболевания, также можно отметить хронический цистит и такую паразитарную инфекцию, как шистосомоз, не исключающие попадания пациента в группу риска. И, в довершение добавим такой предрасполагающий фактор, как установленный у больного постоянный мочевой катетер, который также может привести к рассматриваемому результату. Что касается вопроса, уравнивающего наследственность и рак мочевого пузыря, то она, на самом деле, большой роли в развитии данного заболевания не играет а, соответственно, не повышает риска возникновения рака для тех людей, у которых кто-либо из родственников сталкивался ранее с ним.<br /><br /><br /></p>",
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"diagnostics": "<p>При подозрении на опухоль мочевого пузыря делаются основные обследования: берется анализ мочи для подтверждения наличия в ней крови, анализ мочи на цитологию и проводится внутреннее обследование мочевого пузыря (цистоскопия). Как правило, делается рентген мочевыводящих путей (урография) и УЗИ. Зачастую проводится КТ-урография (визуальное исследование на компьютере) для определения локального распространения опухоли.</p>",
"treatment": "<p>Рак мочевого пузыря лечится разными методами – либо по отдельности, либо комплексно. Из-за многоликости рака мочевого пузыря и разницы в прогнозах заболевания для выбора оптимального лечения необходимо максимально точно определить степень распространенности опухоли и правильно классифицировать вид ткани, определенный патологом (гистология).</p>\r\n<p>Если опухоль поверхностная и не распространилась за пределы слизистой мочевого пузыря в мышечную ткань, проводится трансуретральная резекция мочевого пузыря (ТУР). Во время операции, с помощью, установленного через уретру резектоскоп, проводится резекция опухоли и прижигание кровоточащих сосудов (коагуляция).</p>\r\n<p>Если рак проникает в мышечную ткань или существует риск этого, в качестве лечения может быть проведена радикальная операция (тотальная цистэктомия), т. е. полное или частичное удаление мочевого пузыря и удаление предстательной железы. В таком случае отведение мочи происходит в резервуар, который создается из участка кишечника и выполняет функцию мочевого пузыря, либо резервуар для мочи может выводиться наружу, через специальное отверстие, стому.</p>\r\n<p>В зависимости от типа опухоли, ее размера и наличия метастазов возможна также лучевая терапияи внутривенное лечение цитостатическими препаратами. Химиолучевая терапия дает такие же хорошие результаты, как и традиционная операция.</p>\r\n<p>При поверхностном раке мочевого пузыря с хорошим прогнозом опухоль удаляется через уретру с помощью резетоскопа. Для снижения риска рецидива во время процедуры или сразу после нее проводится разовое промывание мочевого пузыря цитостатиками. После медикаментозного лечения поверхностных видов рака, имеющих большой риск рецидива, проводят многократное промывание мочевого пузыря цитостатиками.</p>\r\n<p>Как правило, во время операции мужчинам удаляется также предстательная железа, однако уретру на сегодняшний день обычно сохраняют. Женщинам чаще всего удаляется уретра, матка и включая сопутствующие органы. Если по причине плохого общего состояния или затруднительной локализации опухоли операция невозможна, прибегают к лучевой терапии.</p>\r\n<p>На момент диагностирования болезни метастазы обнаруживаются лишь примерно у 5% пациентов. В этих случаях вместо удаления мочевого пузыря применяют лучевую или химиотерапию. Если опухоль метастазировала, то лучевую терапию используют для облегчения симптомов, например, боли, недержания, вызванных большим размером опухоли и блокированием мочевыводящих путей. Для лечения метастазов применяют химиотерапию, с помощью которой они уменьшаются, и симптомы болезни становятся не столь выраженными.</p>",
"prevention": "<p>Риск рецидива болезни высок, поэтому пациенту следует регулярно проходить осмотры на протяжении всей жизни.</p>",
"clinical_picture": "<p>Типичными симптомами рака мочевого пузыря являются появление крови в моче и боль при мочеиспускании. Если опухоль препятствует прохождению мочи из почек в мочевой пузырь, это может привести к дисфункции почек, которая, в свою очередь, выражается болью в области почек. Если же опухоль блокирует уретру, то процесс мочеиспускания может проходить весьма затруднительно.</p>",
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"etiology": "<p>Рак мочеточника составляет в среднем 4% от всех опухолей верхних мочевых путей. Переходно-клеточный рак мочеточника составляет приблизительно 7% всех почечных опухолей. Факторы риска те же, что и для рака мочевого пузыря. Самый распространенный – это курение. Также доказано увеличение риска заболевания при злоупотреблении обезболивающими лекарственными препаратами (например, фенацетин), хроническом раздражении слизистой оболочки (при мочекаменной болезни, шистосомозе), при длительном контакте химическими веществами, используемыми в промышленности. Кроме того, жители Балкан с эндемической семейной нефропатией имеют необъяснимую предрасположенность развития рака мочеточников.</p>",
"pathogenesis": "<p>По мнению большинства патоморфологов, все папиллярные опухоли лоханки и мочеточника, являются разными стадиями единого процесса. Опухоли мочеточника бывают эпителиального (папиллома, сосочковый и плоскоклеточный рак) и соединительнотканного (фиброма, лейомиома, саркома) происхождения. Чаще наблюдаются эпителиальные опухоли. Первичные новообразования склонны к раннему метастазированию. Метастазы распространяются гематогенным и лимфогенным путем.</p>",
"diagnostics": "<p>Во время исследования крови и мочи обнаруживают такие же изменения, и при опухолях почечной лоханки.</p>\r\n<p>При цистоскопии в момент гематурии удается уточнить источник кровотечения. Кроме того, в случае локализации папиллярного новообразования в нижнем отрезке мочеточника, при цистоскопи, иногда можно наблюдать, как в момент сокращения его отверстия, ворсинки опухоли появляются в просвете мочевого пузыря. Расположение папиллярных опухолей вокруг отверстия одного из мочеточников может свидетельствовать о первичной опухоли в мочеточнике или почечной лоханке.</p>\r\n<p>Катетеризация мочеточника позволяет выявить характерный признак его опухоли - выделение крови из мочеточникового катетера в момент чистой мочи после проведения его выше (симптом Шевассю).</p>\r\n<p>С помощью экскреторной урографии определяют нарушения секреторной и экскреторной функции почек, проявляют уретерогидронефроз на стороне поражения и дефект наполнения мочеточника. На уретеропиелограмме по обе стороны от дефекта наполнения мочеточника определяют затёки рентгенконтрастного вещества (симптом жала змеи).</p>\r\n<p>Если диагноз сомнителен, выполняют уретероскопию, которая позволяет осмотреть мочеточник, установить размеры поражения и характер распространения опухоли, инфильтрацию стенки, изменения мочевых путей выше опухоли. Выполнение биопсии опухолевой ткани с последующим гистологическим ее исследованием, помогает определить до операции правильный диагноз и даже установить стадию заболевания.</p>",
"treatment": "<p>Радикальным методом лечения может быть только оперативное вмешательство. При тотальном поражении мочеточника опухолью показана нефроуретерэктомия с резекцией мочевого пузыря, при условии хорошо функционирующей противоположной почки. При низком расположении допустимы резекция мочеточника вместе с прилегающей к устью стенкой мочевого пузыря и уретероцистоанастомоз (прямой или по Боари). Помимо хирургического лечения применяют химио- и радиотерапию, однако чувствительность опухолевых клеток к ним мала.</p>\r\n<p>После проведённого лечения пациентам рекомендуют выполнение контрольных цистоскопий через определённые промежутки времени, т.к. рак мочеточника имеет тенденцию распространяться в мочевой пузырь. В случае выявления такого процесса в ранней стадии может потребоваться выполнение трансуретральной резекции мочевого пузыря или внутрипузырных инстилляций противоопухолевых препаратов. Контрольное обследование, направленное на выявление метастазов такое же, как для рака мочевого пузыря.</p>",
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"lead": "Рак мочевого пузыря – это опухоль мочевого пузыря.",
"description": "Рак мочевого пузыря – это опухоль мочевого пузыря, которая весьма распространена в промышленных странах. Чаще всего рак мочевого пузыря поверхностный и не выходит за пределы слизистой оболочки. Однако этот вид рака может распространиться на стенку мочевого пузыря и метастазировать, например, в печень, легкие или костную ткань. Случаи рака, проникающего в мышечный слой, составляют всего 20-25% из всех злокачественных опухолей мочевого пузыря. ",
"etiology": "<p>Развитие рака мочевого пузыря зачастую связывается с курением, в частности отмечается, что курильщики сталкиваются с этим заболеванием до 6 раз чаще той категории больных, у которых этой пагубной привычки нет. Помимо этого воздействуют на рассматриваемый процесс некоторые виды биологических и химических канцерогенов. При длительном контакте с химическими веществами (анилин, красители, моющие средства, бензол и пр.), также оказывается соответствующее воздействие, приводящее к развитию рака мочевого пузыря. Именно по этой причине данный диагноз весьма актуален для работников области химической промышленности, а также для парикмахеров, косметологов, работников химчистки, стоматологов и т.д.<br />Перенесение пациентами ранее процедуры радиотерапии (или облучения) относительно другого актуального для них заболевания в области малого таза (рак яичников или рак матки), химиотерапия с использованием в ней циклофосфамида – все это также определяется в качестве предрасполагающих факторов к развитию рака мочевого пузыря и его симптомов. Рассматривая возможные предрасполагающие факторы для появления и развития этого заболевания, также можно отметить хронический цистит и такую паразитарную инфекцию, как шистосомоз, не исключающие попадания пациента в группу риска. И, в довершение добавим такой предрасполагающий фактор, как установленный у больного постоянный мочевой катетер, который также может привести к рассматриваемому результату. Что касается вопроса, уравнивающего наследственность и рак мочевого пузыря, то она, на самом деле, большой роли в развитии данного заболевания не играет а, соответственно, не повышает риска возникновения рака для тех людей, у которых кто-либо из родственников сталкивался ранее с ним.<br /><br /><br /></p>",
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"diagnostics": "<p>При подозрении на опухоль мочевого пузыря делаются основные обследования: берется анализ мочи для подтверждения наличия в ней крови, анализ мочи на цитологию и проводится внутреннее обследование мочевого пузыря (цистоскопия). Как правило, делается рентген мочевыводящих путей (урография) и УЗИ. Зачастую проводится КТ-урография (визуальное исследование на компьютере) для определения локального распространения опухоли.</p>",
"treatment": "<p>Рак мочевого пузыря лечится разными методами – либо по отдельности, либо комплексно. Из-за многоликости рака мочевого пузыря и разницы в прогнозах заболевания для выбора оптимального лечения необходимо максимально точно определить степень распространенности опухоли и правильно классифицировать вид ткани, определенный патологом (гистология).</p>\r\n<p>Если опухоль поверхностная и не распространилась за пределы слизистой мочевого пузыря в мышечную ткань, проводится трансуретральная резекция мочевого пузыря (ТУР). Во время операции, с помощью, установленного через уретру резектоскоп, проводится резекция опухоли и прижигание кровоточащих сосудов (коагуляция).</p>\r\n<p>Если рак проникает в мышечную ткань или существует риск этого, в качестве лечения может быть проведена радикальная операция (тотальная цистэктомия), т. е. полное или частичное удаление мочевого пузыря и удаление предстательной железы. В таком случае отведение мочи происходит в резервуар, который создается из участка кишечника и выполняет функцию мочевого пузыря, либо резервуар для мочи может выводиться наружу, через специальное отверстие, стому.</p>\r\n<p>В зависимости от типа опухоли, ее размера и наличия метастазов возможна также лучевая терапияи внутривенное лечение цитостатическими препаратами. Химиолучевая терапия дает такие же хорошие результаты, как и традиционная операция.</p>\r\n<p>При поверхностном раке мочевого пузыря с хорошим прогнозом опухоль удаляется через уретру с помощью резетоскопа. Для снижения риска рецидива во время процедуры или сразу после нее проводится разовое промывание мочевого пузыря цитостатиками. После медикаментозного лечения поверхностных видов рака, имеющих большой риск рецидива, проводят многократное промывание мочевого пузыря цитостатиками.</p>\r\n<p>Как правило, во время операции мужчинам удаляется также предстательная железа, однако уретру на сегодняшний день обычно сохраняют. Женщинам чаще всего удаляется уретра, матка и включая сопутствующие органы. Если по причине плохого общего состояния или затруднительной локализации опухоли операция невозможна, прибегают к лучевой терапии.</p>\r\n<p>На момент диагностирования болезни метастазы обнаруживаются лишь примерно у 5% пациентов. В этих случаях вместо удаления мочевого пузыря применяют лучевую или химиотерапию. Если опухоль метастазировала, то лучевую терапию используют для облегчения симптомов, например, боли, недержания, вызванных большим размером опухоли и блокированием мочевыводящих путей. Для лечения метастазов применяют химиотерапию, с помощью которой они уменьшаются, и симптомы болезни становятся не столь выраженными.</p>",
"prevention": "<p>Риск рецидива болезни высок, поэтому пациенту следует регулярно проходить осмотры на протяжении всей жизни.</p>",
"clinical_picture": "<p>Типичными симптомами рака мочевого пузыря являются появление крови в моче и боль при мочеиспускании. Если опухоль препятствует прохождению мочи из почек в мочевой пузырь, это может привести к дисфункции почек, которая, в свою очередь, выражается болью в области почек. Если же опухоль блокирует уретру, то процесс мочеиспускания может проходить весьма затруднительно.</p>",
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"etiology": "<p>Рак мочеточника составляет в среднем 4% от всех опухолей верхних мочевых путей. Переходно-клеточный рак мочеточника составляет приблизительно 7% всех почечных опухолей. Факторы риска те же, что и для рака мочевого пузыря. Самый распространенный – это курение. Также доказано увеличение риска заболевания при злоупотреблении обезболивающими лекарственными препаратами (например, фенацетин), хроническом раздражении слизистой оболочки (при мочекаменной болезни, шистосомозе), при длительном контакте химическими веществами, используемыми в промышленности. Кроме того, жители Балкан с эндемической семейной нефропатией имеют необъяснимую предрасположенность развития рака мочеточников.</p>",
"pathogenesis": "<p>По мнению большинства патоморфологов, все папиллярные опухоли лоханки и мочеточника, являются разными стадиями единого процесса. Опухоли мочеточника бывают эпителиального (папиллома, сосочковый и плоскоклеточный рак) и соединительнотканного (фиброма, лейомиома, саркома) происхождения. Чаще наблюдаются эпителиальные опухоли. Первичные новообразования склонны к раннему метастазированию. Метастазы распространяются гематогенным и лимфогенным путем.</p>",
"diagnostics": "<p>Во время исследования крови и мочи обнаруживают такие же изменения, и при опухолях почечной лоханки.</p>\r\n<p>При цистоскопии в момент гематурии удается уточнить источник кровотечения. Кроме того, в случае локализации папиллярного новообразования в нижнем отрезке мочеточника, при цистоскопи, иногда можно наблюдать, как в момент сокращения его отверстия, ворсинки опухоли появляются в просвете мочевого пузыря. Расположение папиллярных опухолей вокруг отверстия одного из мочеточников может свидетельствовать о первичной опухоли в мочеточнике или почечной лоханке.</p>\r\n<p>Катетеризация мочеточника позволяет выявить характерный признак его опухоли - выделение крови из мочеточникового катетера в момент чистой мочи после проведения его выше (симптом Шевассю).</p>\r\n<p>С помощью экскреторной урографии определяют нарушения секреторной и экскреторной функции почек, проявляют уретерогидронефроз на стороне поражения и дефект наполнения мочеточника. На уретеропиелограмме по обе стороны от дефекта наполнения мочеточника определяют затёки рентгенконтрастного вещества (симптом жала змеи).</p>\r\n<p>Если диагноз сомнителен, выполняют уретероскопию, которая позволяет осмотреть мочеточник, установить размеры поражения и характер распространения опухоли, инфильтрацию стенки, изменения мочевых путей выше опухоли. Выполнение биопсии опухолевой ткани с последующим гистологическим ее исследованием, помогает определить до операции правильный диагноз и даже установить стадию заболевания.</p>",
"treatment": "<p>Радикальным методом лечения может быть только оперативное вмешательство. При тотальном поражении мочеточника опухолью показана нефроуретерэктомия с резекцией мочевого пузыря, при условии хорошо функционирующей противоположной почки. При низком расположении допустимы резекция мочеточника вместе с прилегающей к устью стенкой мочевого пузыря и уретероцистоанастомоз (прямой или по Боари). Помимо хирургического лечения применяют химио- и радиотерапию, однако чувствительность опухолевых клеток к ним мала.</p>\r\n<p>После проведённого лечения пациентам рекомендуют выполнение контрольных цистоскопий через определённые промежутки времени, т.к. рак мочеточника имеет тенденцию распространяться в мочевой пузырь. В случае выявления такого процесса в ранней стадии может потребоваться выполнение трансуретральной резекции мочевого пузыря или внутрипузырных инстилляций противоопухолевых препаратов. Контрольное обследование, направленное на выявление метастазов такое же, как для рака мочевого пузыря.</p>",
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"clinical_picture": "<p>Большинство пациентов обращаются за медицинской помощью при появлении гематурии – примеси крови в моче. Болезненность и учащение мочеиспускания могут присоединяться в тех случаях, когда мочевой пузырь также вовлечен в опухолевый процесс. При обтурации просвета мочеточника может возникнуть приступ почечной колики из-за нарушения оттока мочи от почки. В некоторых случаях может развиться гидронефроз – расширение полостной системы почки.</p>\r\n<p>Обследование обычно включает УЗИ или КТ с контрастированием. Диагноз должен быть подтвержден цитологически или гистологически. Уретероскопия, нефроскопия или обе диагностические процедуры выполняются для уточнения уровня и характера поражения мочеточника, а также для выполнения биопсии с целью определения гистологической структуры опухоли и стадии процесса. Кроме того для определения распространенности опухоли и наличия метастазов выполняют КТ органов брюшной полости и малого таза и рентгенографию грудной клетки.</p>",
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