The stage of the disease is called a precancerous condition. Classification of precancerous diseases

The term precancer refers to the precancerous condition of a person. This definition is used in situations in which an existing chronic disease enters a critical stage, and the likelihood of developing oncopathology increases.

In fairness, it should be noted that precancer does not always turn into full-fledged oncology. The danger lies in the fact that a person almost does not notice the transition process, they learn about it directly at the appointment with a specialist.

Types of precancerous conditions

precancerous condition has many types. It includes all specific as well as non-specific inflammatory lesions chronic nature. Stimulate a precancerous condition can be such deviations as nodes on thyroid gland, leukoplakia, dystrophic processes caused by metabolic disorders.

Precancer is often diagnosed in people with dermatitis caused by ultraviolet irradiation. The described condition can be caused by tissue injuries resulting from radioactive exposure. Even regular mechanical injuries that irritate the mucous membrane can lead to precancer.

The latter type of damage can be obtained by improper installation of dentures or devices that support the uterine cavity. Perceptible mucosal irritants are also burns, the habit of eating hot food.

The female representatives

Precancer can be in the form of mastopathy, because it negatively affects hormonal background. In addition, a common form of the condition under consideration is endometrial glandular hyperplasia, as well as cervical erosion.
There is one more point. Representatives of the weaker sex should not forget that papillomas on uterine cervix, intrauterine fetal defects, unhealed polyps and all kinds of infections are also considered part of the precancer.

Oncopathology goes through 4 stages of progression

Modified uneven diffuse hyperplasia;
. gradual growth from multicentric foci; there are indicators of atypicality and immaturity;
. fusion of foci with the formation of a node separated from nearby tissues (this is benign education);
. malignancy - the acquisition of the properties of a malignant tumor.

Stages of precancer pass one into another almost without distinguishable boundaries. We can say that precancer is a dynamic condition that turns into oncology due to the constant change of cells towards malignancy.
Precancer lacks signs that allow you to accurately identify oncology. biofeature cellular elements precancerous lesions is that they have hypersensitivity to factors that stimulate cell reproduction.

The described state may have different dynamics. In some cases, progression and formation of the oncocenter takes place, in others, a benign tumor is formed, in the third, regression occurs. The exact causes of such metamorphoses are still unknown. It is believed that they directly depend on the immunobiological state, as well as on the duration of exposure to oncofactors.

Information about facultative and obligate precancerous pathologies

A precancerous disease is called a disease that turns into oncology with a high probability. But a precancerous background does not mean that the deviation will necessarily degenerate into oncology. The number of precancerous ailments is quite large.

These include almost all chronic inflammations of a specific and non-specific nature:
. in the stomach chronic gastritis various etiologies;
. in the lungs - chronic bronchitis;
. in the liver - cirrhosis, hepatitis (also chronic);
. in the mammary glands - mastopathy;
. hyperplastic processes inside the endometrium we are talking about glandular hyperplasia;
. in the uterine neck - leukoplakia, erosion;
. in the thyroid gland - nodular goiter.

In addition, the basis of future oncology can be chemicals that provoke dermatitis, burn damage to the mucous membrane, viral lesions genital area (for example, the entry of papillomavirus into the uterine cervix).

The consultation discusses: - methods of innovative therapy;
- opportunities to participate in experimental therapy;
- how to get a quota for free treatment at the cancer center;
- organizational matters.
After the consultation, the patient is assigned the day and time of arrival for treatment, the therapy department, and, if possible, the attending doctor is assigned.

Precancer is an abbreviated term for precancerous disease (precancerous condition). They talk about it when the patient's chronic disease passes into a critical stage, at which the development of a malignant process is possible.

Of course, it cannot be said that precancer always turns into a malignant neoplasm, however, the risk of such a degeneration increases.

According to statistics, such a rebirth occurs in 3% of cases. Moreover, patients practically do not notice this process and learn about it, as a rule, at a doctor's appointment.

Varieties of precancerous conditions

It should be noted that precancerous disease can be expressed in many varieties and conditions. These include almost all available specific and non-specific chronic inflammatory diseases.

For example, for the stomach, a precancerous condition is chronic gastritis, peptic ulcer. Also in the same group can be attributed to the condition of the stomach after surgical reduction.

If we talk about the lungs, then any chronic inflammatory diseases can lead to this dangerous condition. For example, chronic inflammation of the lungs. Cirrhosis, the presence of chronic hepatitis of any form can be attributed to precancer of the liver.

Also, diseases such as leukoplakia, the presence of nodes on the thyroid gland and even dystrophic processes that develop due to metabolic disorders in the body can also provoke a precancerous condition.

Often, precancer is found in dermatitis caused by ultraviolet radiation, as well as in injuries to the surface and internal tissues of the body due to radiation exposure.

This dangerous state can develop as a result of regular mechanical injuries, which are accompanied by irritation of the mucosa. For example, incorrectly installed dentures, devices for maintaining the uterine cavity. It can also be included here chronic dermatitis, a mucosal burn that arose as a result of exposure to chemicals.

In women, precancerous conditions include, for example, mastopathy, since it negatively affects the overall hormonal background of the body. In addition, the most common forms of this condition include glandular hyperplasia endometrium and cervical erosion (very common).

Also, women should not forget that the presence of papillomas on the cervix, intrauterine pathologies fetus during pregnancy, the presence of untreated polyps, fibroids and fibroids, as well as the presence of parasites in the body - are also referred to as precancer.

This condition is divided into two forms - facultative and obligate. The early stage of oncological disease includes pre-invasive diseases, when the cancer has not yet invaded, and invasive conditions already with embedded cancer.

At an early stage oncological disease divided by several degrees:

Facultative precancerous condition
- obligate precancer, or precancerous conditions
- pre-invasive oncology
- invasive oncology.

To the first degree, facultative precancerous conditions, include almost all chronic diseases accompanied by dystrophy, turning into subsequent tissue atrophy with an active mechanism of their regeneration.

To the second degree, precancerous conditions, include all cases of development of dysplasia based on the process of dysregeneration.

In turn, during the course of the process of dysregeneration, tissue proliferation occurs, since due to the neoplasm of cells, an imbalance occurs in the development and maturation of these cells. This means that in the precancerous state, cells are actively produced, but they do not have time to mature and perform their normal functions. Thus, chronic inflammation degenerates into a tumor.

What to do if a diagnosis of precancer is made?

Patients who have been diagnosed with such a diagnosis must be under the constant supervision of an oncologist in a medical institution. Depending on which organ or system of the body has a pathology, the patient is referred to the appropriate specialist for monitoring and treatment.

For example, in the case of women's diseases, the condition of the patient is monitored by a gynecologist. In other cases, control is carried out by other specialists, for example, gastroenterologists, otolaryngologists, etc.

Therapy of precancerous diseases consists in preventive measures for the development of oncology, so treatment usually consists of taking anti-inflammatory, antibacterial drugs. Recommend mineral, vitamin complexes who will support immune system and general condition. Also, funds are usually prescribed to maintain normal state hormonal system, enhance immunity.

Prevention measures

In the event that you have a chronic inflammatory disease, be sure to visit your doctor, go through medical examination Take the medicines recommended by your doctor and follow his instructions.

In addition, quit smoking, give up alcoholic beverages, especially strong ones. Avoid direct sun exposure on exposed skin, try to stay in the shade. Avoid stress and depression, fight excess weight.

All this will allow you to prevent the development of cancer, or to detect and cure it in time. Be healthy!

Uterine dysplasia severe symptoms does not have, therefore, it can be recognized only if there is a concomitant disease or when a woman undergoes a routine examination by a gynecologist. In the initial stages, the disease can be cured, while it does not turn into oncology.

Causes

The epithelial layer of the uterus consists of several layers, where each performs its function. When certain disturbances occur in the structure of the layers, their normal functioning is disrupted. Against this background, the state of precancer of the uterus appears. The following degrees of the disease are distinguished:

• Weak. This is a mild form of this pathology. The changes here are minor, they affect only a third of the thickness of the epithelium.
• Moderate. The layers of the epithelium are already damaged in depth by two-thirds.
• non-invasive cancer. Changes affect all layers of the epithelial layer. But the tissues around and the vessels are not yet affected. Precancer (latent condition) of the cervix can be in women for twenty years, then it often turns into cancer.

The main reason why a woman develops a precancerous condition of the cervix, experts call the human papillomavirus. It is diagnosed in 90% of patients with this pathology. When this virus stays in the female body for a long time, the risk of cancer is very high.

But not all HPV subtypes lead to oncology or a precancerous condition of the uterus. Experts identify oncogenic types 16 and 18, which provoke the bulk of diseases. The rest, less oncogenic types, lead cancer only in the presence of predisposing factors.

The appearance of precancer of the uterus can cause the following factors:

• use of hormonal contraceptives for long period time (more than five years);
• use of intrauterine contraception;
• abuse of bad habits (smoking, alcohol);
• hereditary predisposition;
• the partner has a cancerous tumor on the head of the penis;
• HIV infection;
• sexually transmitted diseases;
• childbirth before 18 years of age and childbirth in large numbers;
• abortions;
• frequent change of partner;
• malnutrition;
• diseases of the pelvic organs that have developed into chronic ones;
• lack of vitamins A and C, beta-carotene in the body;
• poor living conditions.

These factors can contribute to the development of a precancerous condition of the uterus.

Symptoms

At first, the disease is very difficult to detect, as it proceeds without visible manifestations. Symptoms only appear on late stage when it develops into a severe form. At this stage, other infections are added, the symptoms of which make it possible to detect pathology.

Signs of inflammation are as follows:

• A woman experiences pain during intercourse.
• Appear copious discharge white color without pronounced odor.
• After examination by a gynecologist or after sexual intercourse, the discharge often contains streaks of blood.
• IN intimate area itching and discomfort appear.
• Pain in the lower abdomen, which is aching in nature.

All these symptoms can be signs of other gynecological diseases. But when they appear, a woman should be examined as soon as possible.

The most important condition for curing a woman from pathology is the timely detection of the disease and its correct treatment.

To successfully diagnose background and precancerous diseases of the cervix, doctors use modern techniques:

• Gynecological examination of a woman with a mirror. This helps to consider and evaluate external changes in the mucous membrane, determine the width of the growth of the epithelium, or detect pathological changes around the external os.
• PCR diagnostics. It helps to determine the presence / absence of the virus in the blood, mucus or urine of a woman.
• Moderate and severe dysplasia is usually detected by colposcopy. This method involves applying a special solution to the mucous membrane, which helps to reveal hidden defects.
• Cytological examination of a smear using a microscope. This study is aimed at identifying HPV markers.
• The method of targeted biopsy, it helps to obtain the most reliable information. To do this, take the excised area of ​​tissue that aroused suspicion.

According to the results of the research, specialists can put accurate diagnosis, determine the stage of the disease and choose an acceptable course of treatment.

Treatment

Cervical dysplasia is classified as a progressive disease. It usually drags on for a long time. But with early detection and proper treatment, the disease can gradually subside.

The choice of the direction of treatment of dysplasia depends on:

• the stage at which the development of the disease is currently located;
• woman's age;
• availability concomitant diseases;
• depth of the mucosal lesion;
• the importance for a woman to preserve the function of childbearing.

Treatment of a mild form of pathology is carried out by conservative methods. A woman must undergo an examination for two years; once a year she is given a colposcopy and a smear for cytology. At the same time, concomitant diseases are treated, and a contraceptive method is selected.

At a moderate stage of the disease, antiviral therapy is prescribed, a laser or radio waves, freezing or electrocoagulation can be used.

Women with severe dysplasia are given more radical treatment. Young patients, in order to preserve childbearing function, undergo conization of the cervix. This involves removing the damaged area with a special device. Elderly women undergo an operation to amputate the cervix.

Recovery from surgery usually takes 4 to 6 weeks. At this time, a woman should not lift weights, visit crowded places (baths, saunas, swimming pools). It is also not recommended to have sex and use hygienic tampons.

After the operation, a woman may experience complications:

• chronic diseases in terms of gynecology go into the stage of exacerbation;
• inability to have children;
• the cycle of menstruation is disturbed;
• recurrence of the disease occurs.

These complications are rare, but the risk of their occurrence is still present. After three months have passed after the operation, the woman must be re-diagnosed. If the results are negative, the woman is removed from the register after a year.

Prevention

Women who have had this disease must follow further preventive measures:

• to include in daily diet food products rich in vitamins A and C;
• quit smoking forever
• timely treat infectious diseases;
• regularly visit a gynecologist;
• use barrier methods as contraception.

Compliance with preventive measures, early detection of the disease and timely treatment give a positive prognosis of cervical dysplasia and help to avoid recurrence and development of this type of disease into cancer.

Precancers- pathological processes that necessarily precede a malignant tumor, but not always passing into it.

The term " precancer"Proposed at the International Congress of Dermatologists (London, 1896) by M.V. Dubreuil. He raised the question of keratoses as precursors (precancers) of malignant skin tumors. Since then, this term has been widely used in clinical practice for diseases that serve as a background for the development of malignant tumors of all localizations.However, long before that, there were known cases of cancer at the site of various pathological processes. So, even M.M. Rudnev (1870) said that cancer develops on a prearranged various diseases soil. However, there is still no single opinion on the role of pathological processes in the development of malignant tumors. Some believe that the concept of "precancer" should be narrowed down to include some rare diseases, not counting it as an obligatory phase in the development of tumors. Others expand this concept and believe that every cancer has its own precancer, but not every precancer turns into cancer.

Experimental data and clinical observations indicate that the development of a tumor is preceded by well-defined pathological processes.

Sabad L.M. distinguishes 4 stages in the development of cancer:

• Uneven diffuse hyperplasia, perverted morphologically and functionally.
• Focal growths against the background of diffuse hyperplasia from multicentric rudiments. Signs of immaturity, atypia.
• Merging, focal proliferates form a node delimited from surrounding tissues (benign tumor).
• Malignancy. A number of specialists consider stages 2 and 3 to be precancerous, i.e. focal proliferates and benign tumors. They propose to distinguish between precancers and underlying diseases.

Practically listed stages flow from one to the other without clear boundaries. Perhaps the formation of a malignant tumor without the 3rd stage.

Thus, precancer is a dynamic condition that turns into cancer as a result of progression, i.e. permanent change in cell properties towards malignancy. Precancer it turns into cancer not so much as a result of quantitative changes (time, mass), but as a result of a change in the biological essence of cells, the accumulation in them of the properties inherent in malignant cells.

Precancerous processes lack one or more of the hallmarks to diagnose cancer. biological feature cells of precancerous foci - in their great sensitivity to the action of factors that cause cell reproduction.

The dynamics of the precancerous condition can be different. In one case, the progression and development of cancer are noted, in the other - the formation of a benign tumor, in the third - regression. The reasons for these changes are still not clear. It is believed that they depend on the immunobiological state of the body, the duration and intensity of the action of oncogenic factors.

Morphological and clinical diagnostics precancerous conditions are very difficult, because A wide range of diseases of various origins is classified as precancerous.

From a clinical point of view, precancerous conditions include any chronic diseases accompanied by the formation of foci of excessive cell proliferation in the tissues, against which cancer can develop. It is clear that it is impossible to judge the presence of cell proliferation without a morphological study. Until now, the concept of precancerous conditions has not been clearly defined.

What provokes Precancerous conditions (precancerous)

The cause of precancers can be adverse effects of the external environment (exogenous factors), as well as a violation of the state of the whole organism (endogenous factors).

• Exogenous factors

Mechanical stimuli: coarse food, different kinds prostheses, fillings with manufacturing defects, bite anomalies and incorrect position of individual teeth, defects in dentition, uneven abrasion of teeth, bad habits(holding a pencil, pen, nails, etc. in the mouth). To the mechanical factors N.F. Danilevsky (1966) attributes some occupational hazards. It has been established that iron ore, lead, silicate dust contributes to the appearance of hyperkeratosis of the oral mucosa in workers in the relevant industries. Aluminum tires contribute to irritation of the mucous membrane due to the occurrence of galvanic currents (Penev, Todorov, 1970). therefore, steel tires should be used.

The nature of the response of the mucous membrane depends on the strength of the mechanical action. A strong mechanical stimulus causes acute injury, often accompanied by a violation of the integrity of the tissue. In most patients, the traumatic factor is eliminated and the wound heals. Otherwise, the acute wound process turns into a chronic one, as a result of which the development of the epithelium in this area is disrupted.

To a greater extent, the processes of keratinization are disturbed by micro-(trauma (chronic injury).

Chemical irritants are divided into two large groups: domestic and industrial. The first group includes chemicals that are part of food products. The second group includes substances that a person encounters in the production process.

Household chemical irritants include spices, highly concentrated solutions of ethyl alcohol, tobacco (smoking, chewing), quicklime (betel). spicy food with big amount spices is widespread among the inhabitants of the south, which explains the high incidence of leukoplakia and oral cancer in them.

Tobacco has a gross irritating effect on the oral mucosa. Nicotine in tobacco is from 2 to 9%. Approximately 20% of tobacco smoke, which contains whole line products of extremely strong irritant action: pyridine bases (the transition of nicotine to pyridine is the most harmful side of the action), hydrocyanic acid, cyanide compounds, fatty acid, phenol and tar sediment. IN tobacco smoke, in addition to polycyclic hydrocarbons, contains 3-4 benzpyrene and arsenic. Hydrocarbons are produced during the combustion of tobacco, and arsenic enters the tobacco as a result of the use chemicals protection in tobacco cultivation. With increasing consumption of tobacco products, the number of patients with leukoplakia and oral cancer is growing. Among patients with oral cancer, 80-90% were smokers.

One of the annoying aspects of smoking is the heat factor. More often, keratosis develops in those who smoke a pipe, a cigarette to the end, so that it burns the lip. Among the peoples of the countries of the Indian subcontinent, betel and nas chewing is common. According to statistics, 70% of these individuals develop cancer of the floor of the mouth.

Production stimuli(alkalis, acids in the form of vapors, aerosols, other chemicals). Depending on concentration and time, exposures can lead to acute or chronic chemical injury.

Temperature irritants(hot food, cauterization of lips with a cigarette, hot air when working in some enterprises). With prolonged exposure, they contribute to the development of precancerous diseases.

Meteorological factors. They are a complex of unfavorable environmental agents that affect the integumentary tissues of the face and lips. This includes the impact sun rays, dust, wind, salt water aerosols in conditions low temperature and high air humidity. When the red border of the lips is chilled, the phenomena of dyskeratosis are always observed.

Biological factors. These include a number of microorganisms facultatively and obligately pathogenic for humans: yeast-like fungi, causing increased keratinization of the tongue mucosa, pale spirochete, causing a temporary violation of keratinization in certain areas of the oral mucosa in the secondary period of syphilis; Koch's stick (tuberculous ulcers on the oral mucosa are prone to malignancy).

• Endogenous factors

Anatomical and physiological prerequisites. The tendency of the oral mucosa to increased keratinization is explained by its origin from the ectoderm. The tendency to keratinization increases with age due to cell dehydration. With age, the epithelial cover becomes thinner and more susceptible to injury. The processes of keratinization are influenced hormonal changes(especially in women).

A number of diseases of various etiologies ( chronic anemia, diabetes) may be accompanied by a violation of the processes of keratinization.

The listed factors, both in isolation and in combination, are constant companions of human life and have a constant impact on the processes of keratinization of the oral mucosa:

• stressful conditions. The role of acute mental trauma in the occurrence of dyskeratosis (for example, lichen planus), many researchers note;
• diseases of the gastrointestinal tract. In chronic gastritis (hyper- and normocidal), enteritis, colitis, conditions of para- or hyperkeratosis develop;
• feverish conditions;
• xerostomia of various etiologies;
• lupus erythematosus, psoriasis, ichthyosis.

Pathogenesis (what happens?) during the Premalignant state (precancerous)

Types of violation of the process of keratinization on the oral mucosa

• Keratosis- a clinical concept that unites a group of diseases of the skin and mucous membranes of a non-inflammatory nature, characterized by thickening of the keratinizing layer and the formation of the stratum corneum.

• Hyperkeratosis- a significant increase in the stratum corneum compared with its thickness in keratosis. Clinically manifested in the measurement of the color and relief of the mucous membrane. These are whitish formations (papules, plaques) that rise above the level of the normal mucous membrane. In the specialized literature, the term "leukokeratosis" is found, meaning an area of ​​white hyperkeratosis.

• Dyskeratosis- violation of the physiological process of keratinization of the epithelium, in which dyskeratinization and degeneration of the cells of the spinous layer occur. In this case, the cells fall out of the general connection, the connection between them is broken, the cells are arranged randomly. There are benign and malignant dyskeratosis. Benign dyskeratosis is clinically manifested in the form of areas of finely scaly peeling. Malignant dyskeratoses are found in Paget's and Bowen's (Boven's) diseases.

Dyskeratosis can be focal (limited) and widespread (diffuse). Focal dyskeratosis manifests itself in the form of excessive growth of the cover (productive). In other cases, it looks like a defect, a flaw in the cover (destructive). More often there is a combination of both forms (mixed).

On the red border, more often on its border with the skin, productive dyskeratosis occurs in the form of an awl-shaped growth with a horny layer (periodically falling off) at the top. Growing, it can take the form of a skin horn. Destructive dyskeratosis is manifested by a sharp thinning of the red border in a limited area in the form of superficial ulceration, cracks, cracks. Parakeratosis- a histological concept that characterizes a violation of keratinization associated with the loss of the ability of epithelial cells to produce keratohyalin. At the same time, loosening of the stratum corneum, partial or complete disappearance of the granular layer are noted. For most areas of the mucosa, this condition is normal. As a pathology, parakeratosis qualifies in those areas where complete keratinization is normally noted.

• acanthosis- a histological term characterizing the thickening of the epithelium due to increased proliferation of the basal and styloid layers with an increase in energy metabolism in them (proliferative acanthosis) or a decrease in metabolism (retention acanthosis).

Classification of precancerous diseases

In 1976, a group of scientists led by prof. N.I. Ermolaev (through the Committee for the Study of Head and Neck Tumors) developed a classification of precancerous processes of the oral mucosa, which is based on two main features of the precancerous process: the course of the disease (the likelihood and frequency of transformation into cancer) and pathomorphological changes. According to this classification, precancerous diseases are divided into 2 groups:

• With a high incidence of malignancy (obligate)
  • Bowen's disease.
• With a low incidence of malignancy (optional)
  • Leukoplakia verrucous.
  • papillomatosis.
  • Erosive-ulcerative and hyperkeratotic forms of lupus erythematosus and lichen planus.
  • Postradiation stomatitis.

N.F. Danilevsky and L.I. Urbanovich (1979) give another classification, noting that it is similar to the classification of A.L. Mashkilleison (1952) and V. Sugar (1962):

• Keratoses without a tendency to malignancy ( initial form leukoplakia, mild leukoplakia, geographic tongue).
• Facultative precancer in a broad sense (with a frequency of malignancy up to 6%): leukoplakia flat, hyperkeratotic form of lichen planus, pemphigoid form of lichen planus.
• Facultative precancer in the narrow sense (with a frequency of malignancy from b to 15%): warty, erosive forms of leukoplakia, warty form of lichen planus, erosive form of lichen planus, hyperplastic form of rhomboid glossitis).
• Obligate precancer with the possibility of malignancy of more than 16% (ulcerative form of leukoplakia, keloid form of leukoplakia, ulcerative form of lichen planus, follicular dyskeratosis, Bowen's disease, atrophic keratosis, pigment xeroderma, ichthyosis vulgaris).

Most oncologists distinguish 3 phases in the morphogenesis of precancers:

• On the basis of regeneration, diffuse proliferation and hyperplasia occur. These changes are reversible if the cause of their appearance is eliminated.
• Focal proliferation.
• The phase of a precancerous condition in the narrow sense of the word.

At the same time, hyperplasia increases, cellular atypism appears, although there are no cancerous growths yet.

Sabad L.M. in addition to these phases, it also distinguishes the 4th phase of benign tumors. Signs of malignancy of precancerous conditions:

• long, sluggish course of the process;
• failure of conservative treatment;
• an increase in the size of the pathological focus, despite adequate treatment;
• the appearance of a seal around or at the base of the pathological focus;
• bleeding.

These clinical signs can occur both separately and in various combinations. In any case, they should alert the doctor. Observation or conservative treatment patient (without the use of cauterizing, irritating agents, physiotherapy (in this case, it should not exceed a 3-week period in order to avoid the appearance of forms of malignant tumors launched as a result of untimely diagnosis.

Precancerous conditions have a peculiar morphological picture, which is characterized by:

• epithelial hyperplasia (excessive proliferation of cells of the integumentary or glandular epithelium);
• an increase in the number of mitoses (cells in the division phase);
• the appearance of cellular atypia (cells with a changed shape);
• hyperkeratosis (increased keratinization of the epithelium).

Symptoms of a precancerous condition (precancerous)

• Leukoplakia

The term " leukoplakia"introduced by the Hungarian dermatologist Swimmer in 1887. Clinical manifestations depend on the degree of violation of the keratinization of the epithelium of the mucous membrane. Includes clouding of the epithelium, keratosis, hyperkeratosis, destructive changes, which are the reaction of the mucous membrane to various irritations. With leukoplakia, cholesterol levels increase and the amount of vitamin A in the affected tissues decreases.

Delayed diagnosis increases the number of cases of leukoplakia turning into cancer.

Typical localization- on the front of the back of the tongue, mucous in the corners of the mouth and cheeks along the line of closing of the teeth, retromolar region. Predominantly sick people aged 41-55 years.

It is rare in young people.

A.G. Sargorodsky (1976) distinguishes 3 forms of leukoplakia:

• simple (flat);
• verrucous (warty, leukokeratosis);
• erosive.

The same classification is followed by A.I. Paches et al. (1988).

Simple form of leukoplakia occurs most often. The lesion has the appearance of clearly demarcated areas of keratinization of gray or grayish-white color that do not rise above the surface of the mucous membrane, which are not amenable to scraping. Patients may complain of a rough or burning sensation in the mouth. Many have no complaints at all. Transformation into cancer is rare (0.25-2.7-4%).

• Verrucous leukoplakia- a further stage in the development of a simple form of leukoplakia. At the same time, on the mucous membrane around the warty growths, towering above the surrounding areas of keratinization, lesions corresponding to flat leukoplakia are observed. The growths have a dense texture, grayish-white color. Patients complain of a feeling of embarrassment due to the roughness of the mucous membrane when talking, chewing. There may be a burning sensation, constant dryness in the mouth. Some patients do not complain. Transformation into cancer occurs in 20% of cases.

• erosive form- the result of complications of the two previous forms. Erosion occurs against the background of an already existing focus of leukoplakia.

In parallel, cracks may appear. Erosions and cracks usually appear in places subject to trauma. Around erosion or cracks there are foci of flat or verrucous leukoplakia. Mostly men aged 41-70 are ill. Patients complain of burning, sometimes pain, aggravated during eating from thermal, chemical, tactile stimuli. Occasionally, minor bleeding is possible. Under influence adverse factors erosions increase without showing a tendency to heal. The pain intensifies. Malignancy is possible in 20% of cases.

Some researchers identify ulcerative form leukoplakia. On the site of leukoplakia, there are 1 - 2 ulcers, round or oval shape. The bottom is filled with necrotic decay. The edges are uneven, rising. Palpation is painful, the mucosa does not fold. Bleeds easily. Complaints of pain, increased salivation. This form of leukoplakia is rare (3.5%) but is a true precancer. If the patient is not treated in a timely manner, then this form of leukoplakia will inevitably transform into cancer. Local treatment - surgical, general - according to the principle described above.

chronic ulcers and cracks are most often caused by prolonged mechanical trauma to the mucous membrane. Their treatment consists in the elimination of traumatic factors, sanitation of the oral cavity. If there is no positive effect within 2-3 weeks, you should cytological examination or a biopsy.

• Bowen's disease first described in 1912. Etiology and pathogenesis are not clear. On the oral mucosa, some researchers consider it as a further stage in the development of the Keira disease. It is localized more often in the posterior parts of the oral cavity (palatine arches, soft palate, root of the tongue). Possible damage to the retro-molar areas and the red border of the lips. The disease occurs in people from 20 to 80 years old, but more often in 45-70 years old, mainly in men. Elements of the lesion appear in the form of erythema, papules, erosions. At the beginning, there is a spotty-nodular lesion D=1.0 cm or more, which slowly increases. The surface of the site is hyperemic, smooth or velvety with small papillary growths. There may be slight peeling, itching. With prolonged existence, the lesion seems to be slightly sinking, sometimes erosion appears on its surface. Lesions irregular shape, sharply defined, stagnant red.

Histologically, this disease is referred to as "cancer in situ" - cancer in situ (cancer in citu). Under the microscope, giant ("monstrous") cells are found in the styloid layer with an accumulation of nuclei in the form of lumps. Keratinization of individual cells of the Malpighian layer is often observed. In the stroma - an infiltrate consisting of plasma cells, lymphocytes. The prognosis without treatment is poor (in 100% it turns into cancer). Currently, some oncologists refer this disease not to precarcinosis, but to intraepithelial cancer.

• Erythroplasia of Queira- described in 1921. On the mucous membrane of the lips, cheeks, sharply defined bright red foci appear with an inconspicuous seal at the base. The foci slightly rise above the surface of the mucosa. The surface of the lesions themselves is smooth, hyperemic, velvety.

The disease is characterized by a slow persistent course, not amenable to treatment. Gradually, ulcerations appear on the surface of the focus and degeneration into cancer occurs (100%). Metastases to lymph nodes are possible. Histological picture similar to Bowen's disease (fits into the concept of "cancer in situ"). Some do not see the need to separate Bowen's disease and Keyr's erythroplasia. Treatment is only surgical radical. Radiation therapy does not respond well.

• . In 1933, Manganotti isolated a form of the disease from the group of cheilitis, characterized by the manifestation of erosions (1-2), more often lower lip. The foci are round or irregular in size from 0.5 to 1.5 cm with a polished bottom of a pinkish-red color, bleeding slightly, especially after removing the crusts. The epithelium along the edges of erosions is hyperplastic.

Erosions are more often localized in the center or lateral parts of the lip. They can spontaneously epithelialize and recur at the same or another place in the red border.

Morphology is characterized by immersion of epithelial tissues, sometimes by cell atitution.

• . Refers to obligate precancers. First described by Mashkillenson A.L. in 1970. Men of young and middle age are more often ill. The lower lip is affected. The lesion is represented by densely fixed scales of a grayish-white color, slightly rising above the red border of the lip. In some patients, inflammation is noted around the focus of hyperkeratosis.

Histology: focal proliferation of the epidermis in the form of strands. Discomplexation of cells of the Malpighian layer.

The disease can last for decades, but malignancy can occur within one year and even the first months.

• Papilloma is a collective concept. It has the appearance of papillary growths. The surface is compacted, the phenomena of hyperkeratosis, acanthosis are frequent. I have a leg in color that is indistinguishable from the normal mucosa. They are more common in women aged 38-40 years and are localized mainly on the cheeks and tongue. With the histological detection of dyskeratosis, a conclusion is made about the malignancy of the papilloma. Surgical treatment.

Papillomatosis- multiple papilloma. Sprawl reminds cauliflower. The rest of the clinic is the same as with papilloma. Given the more frequent malignancy, the tumor should be removed with subsequent histological examination.

Skin horn- limited, pronounced hyperkeratosis. The horny masses formed during this disease, protruding above the surface of the skin, resemble the shape, density, and layered structure of the horn. Predisposing factors - insolation, wind.

Skin horn- facultative precancerosis. Occurs on the basis of senile atrophy, keratoacanthoma, leukoplakia, senile wart. Patients over 50 years of age. IN young age is rare. Cutaneous horn usually occurs on uncovered areas of the body: face, neck, dorsal surfaces of the hands. It has the appearance of a cone on a wide base, with a diameter of several millimeters to 10-20 mm, raised above the level of the skin by 2-3 mm. In length, the skin horn can reach 1.5-2.0 cm or more. To the touch, the formation is tight, elastic, dirty gray or brown. Signs of malignancy: the development of a sharply limited bushy surface, erasing of the skin pattern around the base, uneven growth along the edges, spreading in depth - the occurrence of inflammation.

Morphology: all layers of the epidermis, especially the granular layer, are thickened. The phenomena of parakeratosis, dyskeratosis, cellular atypism are noted. border of the epithelium connective tissue erased. Often the picture corresponds to the initial cancer.

Surgical treatment. If there morphological features malignancy, radiation therapy.

Keratoacanthoma- atypical fatty cyst, hemispherical awl-shaped keratinizing tumor up to 2.0 cm high. Assume a viral nature. Men get sick more often villager. Regular localization on the lower lip, the mucous membrane and skin of the cheeks may be affected. Single elements of the lesion are more common in the elderly, multiple (2-3) - in the young.

Development of keratoacanthoma: dense to the touch nodule oval or round shape is growing rapidly. The center is crater-like deepened and contains horny masses. The entire formation is covered with normal or hyperemic skin. Cytologically: atypical cells are rarely found (8%), mitoses are more often seen without signs of atypia.

Histologically: epidermal hyperplasia with hyperkeratosis, proliferation of cellular elements with deep infiltrative growth.

Treatment: surgical removal followed by histological examination. Close-focus X-ray therapy is possible.

Diagnosis of pretumor condition (precancerous)

Methods of examination of patients with precancerous conditions

Due to the absence of subjective sensations in the initial stages of precancers, a thorough examination of the oral mucosa should be carried out in all patients who have applied to the dentist.

Diagnosis of diseases of this group requires the dentist to have knowledge of dermatology, pathology internal organs and systems, neurology, psychiatry, etc. In difficult cases, you should seek advice from specialists of the appropriate profile.

Patients with precancerous conditions need a special examination. It should be carried out according to plan and in a certain sequence, which will allow the doctor to study the picture of the disease in detail without missing a single symptom. The survey begins with a survey. It is important to exclude cancerophobia. As a rule, there are no special complaints in patients with precancers. Complaints can be reduced to a sensation of roughness in some part of the mucous membrane, swelling, sensation of a foreign body, burning or soreness while taking hot or spicy food. Many patients have no complaints at all. Special attention given to hereditary history, the presence of bad habits, industrial hazards, transferred and concomitant diseases.

After clarifying the complaints, they proceed to the examination. It must be carried out in natural light, because. artificial changes the color of the mucous membrane and can contribute to diagnostic errors. The patient should be given a comfortable position for examination in a chair. They begin the examination with the skin of the face, because. many mucosal diseases are combined with skin lesions. On the mucous membrane of the cheeks and lips, one can notice reduced sebaceous glands, usually arranged in groups in the form of yellowish nodules. Using a spatula or mirror, inspect the vestibule of the oral cavity. Investigate the function of the parotid salivary glands, excretory ducts which open at the level of the second upper molars. Then the oral cavity is examined. Examine the function of the submandibular salivary glands, tongue, pharynx.

A very important element of the examination of the patient is palpation. Cheeks, lips, tongue are palpated with two fingers; thumb and index or bimanually. At the same time, the consistency, mobility, soreness of organs and tissues are determined; subject to mandatory palpation The lymph nodes(all groups!)

Dentistry is the most acceptable diagnostic method in dental practice. If necessary, it can be used to select a site for a biopsy. In 1959, Söhnemann reported on the first applications of the Ginselman colposcope for stomatoscopy. Currently, a photodiagnososcope is used for this purpose, which allows simultaneously photographing areas of interest to the mucosa.

Dentistry (simple) carry out in the following way. The patient sits on a chair, puts his chin on a special stand at a distance of 30-40 cm from the device. They focus and proceed to the study, starting from the red border of the lips and further, following the sequence as described above. Extended stomatoscopy is used to obtain greater clarity of the mucosal pattern. For this, one or another method of vital staining is preliminarily used (4% acetic acid, 2% Lugol's solution, 1% toluidine blue solution, hematoxylin according to A.B. Derazhnya).

Acetic acid test: apply a cotton swab moistened with 2-4% acetic acid for 20-30 seconds. Acid contributes to the rapid elimination of mucus that interferes with the examination. Swelling of the epithelium occurs, as a result, the vessels disappear from the field of view and do not interfere with studying the surface of the mucous membrane. Action acetic acid continues for 1-1.5 minutes. This test is most indicative on the buccal mucosa.

Iodine reaction (Siller's test) - use 2% aqueous solution of Lugol. The technique consists in applying an application of a cotton swab moistened with Lugol's solution for 1 minute to the area under study with a capture of 1-2 cm of a visually normal mucous membrane. Then examine the result with a stomatoscope. It should be borne in mind that with this test, the mucous membrane is stained differently.

mobile areas (lips, cheeks, transitional folds, sublingual region) dark brown staining is observed, and the red border of the lips, gums, mucous membrane of the hard palate, back of the tongue give iodine-negativity, as they are covered with epithelium, which has a small layer of keratinization. The essence of this test is as follows: active protective functions regeneration and keratinization are accompanied by high energy metabolism in the epithelium.

Synthesis and accumulation of a large amount of glycogen are characteristic of cells of stratified squamous epithelium. Most of all, it accumulates in those parts of the mucous membrane where the epithelium is not normally subjected to keratinization (moving sections of the mucous membrane). In the keratinizing epithelium (fixed areas), glycogen is normally completely absent or there are traces of it.

It is believed that glycogen plays the role of an energy source or plastic material for the synthesis of the keratin protein. There are no cells with keratin in the non-keratinized epithelium, but it contains many lumps and grains of glycogen. In those parts of the mucosa where the epithelium undergoes keratinization, glycogen is quickly consumed for protein synthesis - keratin and therefore is not detected during histochemical examination. With the development of inflammation in the tissue, the processes of keratinization sharply weaken or completely stop, and the amount of glycogen increases greatly. This can be used for differential diagnosis.

There are 3 degrees of iodine negativity:

• 1 degree - complete absence of staining,
• Grade 2 - iodine negativity in pathological conditions of the mucous membrane, accompanied by parakeratosis of the epithelium,
• Grade 3 - iodine negativity is detected in areas of the alleged (visually) normal mucous membrane and in the environment of the lesion.

Staining with hematoxylin according to A.B. Deragene is based on the ability of the dye to be intensively perceived by cell nuclei. A solution of hematoxylin lubricates the mucous membrane for 2-3 minutes. In this case, atypical epithelium is stained in dark purple, and normal - in pale purple. The color intensity in cancer is due to an increase in the amount of nuclear substance. Areas of keratinization containing cells poor in nuclei determine the effect of iodine negativity (grade 3), as in the Siller test. There is no staining in hyperkeratosis.

Stained with toluidine blue. Applying 1% solution of toluidine blue, note the difference in color. Atypical epithelium stains dark blue, while normal epithelium stains pale blue. This stain gives a clearer result than hematoxylin staining.

Luminescent research- allows you to study the picture with hyperkeratosis in its various manifestations. To do this, use the photodiagnosis of the Leningrad plant "Krasnogvardeets". The method consists in observing the secondary luminescence of tissues when irradiated with ultraviolet radiation with a wavelength of 365 microns. The research is carried out in total darkness. Healthy mucosa reflects a pale bluish-violet color; keratosis gives a medium intensity glow with a yellowish tint; hyperkeratosis - bluish-violet; inflamed! fabrics give an intense bluish-violet staining; erosions and ulcerations appear as dark brown or black spots.

cytological method- simple, secure, allows you to quickly get a response. For the first time studied and implemented in gynecology in 1941 by Papanicolaou. Material can be collected different ways: by scraping, smear-imprint, flushing, aspiration, puncture. The resulting material is immediately placed on a fat-free glass slide, marked (clearly indicate the name and initials of the patient on the glass with a special pencil) and fill out the direction for cytological examination. The material is sent to the cytology laboratory.

Histological examination- one of the most reliable methods of morphological examination, which allows making a diagnosis based on the study of a tissue section (in contrast to the morphology of cells in a cytological examination).

Keratinization index. To determine it, the total number of keratinized and non-keratinized cells is counted in the exfoliated material. The number of dead cells is multiplied by 100 and divided by the total number of cells. The keratinization index is individual. Normally, the gum keratinization index is 50%, the hard palate - from 83.5 to 94.3%.

Radioisotope research- used for early detection of malignancy of precancers. The essence of the method is reduced to intense absorption radioactive isotopes atypical cells.

In addition to the above methods for diagnosing precancerous conditions, the determination of the level of vitamin E in the blood is used (in patients with endocrine disorders, muscular dystrophies, collagenoses). Normally, the amount of this vitamin is 0.8-1.0 mg%. Bacteriological examination is used (the composition of microorganisms is established at the site of the lesion). Electron microscopic and histochemical studies are used.

The doctrine of precancer is of great practical importance. Taking it into account, one of the most important areas of oncology is being built - the prevention of malignant tumors. Clinical prevention of malignant tumors consists in the timely diagnosis, treatment and registration of precancerous conditions, since only this guarantees against the development malignant neoplasms. Among precancers there are many diseases that are difficult to cure. These are long-term non-healing ulcers, leukoplakia, etc. It should be borne in mind that the longer an untreated precancerous condition exists, the more danger transforming it into cancer.

Patients with precancerous conditions should be registered at the dispensary (clinical group 1-B).

Treatment of precancerous condition (precancerous)

• Leukoplakia

Treatment is predominantly conservative. First of all, the factors contributing to the appearance of the disease are eliminated (see above). Mandatory sanitation of the oral cavity. Medical therapy consists in prescribing large doses of vitamin A locally and orally, as well as a complex of vitamins B and C. With a tendency to spread, apply surgery(diathermocoagulation, cryodestruction, simple excision followed by histological examination).

• Verrucous leukoplakia

Treatment: a combination of local and common impacts. General treatment consists of prescribing drugs that increase the nonspecific reactivity of the body (aloe, prodigiosan, etc.), diet therapy, and treatment of organ pathology. Locally: eliminate sources of irritation in the oral cavity by sanitation, treat inflammatory diseases. Prohibit smoking, eating spicy food. In the presence of lesions on the lips, it is recommended to avoid insolation. In view of the significant tendency to malignancy, the focus of leukoplakia is subject to surgical treatment.

• erosive form

Complex treatment (general and local). The general treatment is the same as for the verrucous form. Local - after sanitation of the oral cavity and elimination of all identified adverse factors - conservative effect on the focus: combinations of proteolytic enzymes (trypsin, chymotrypsin) with antibiotics, vitamin-novocaine blockades (2% solution of novocaine + 5% solution of vit. B1) to improve tissue trophism in the lesion. Promotes epithelialization of the erosive surface of the application 30% oil solution vit. E, emulsions of a pyramidant with furacilin, metacil. If erosion does not tend to reverse development, resort to surgical treatment, as with verrucous leukoplakia. The erosive form is prone to relapse.

• Bowen's disease

Treatment: surgical. It is necessary to remove the lesion within healthy tissues, i.e. departing from the visible boundaries of the formation by 1-1.5 cm. It is necessary to work with an electric knife. If surgical treatment is not possible, close-focus X-ray therapy is used.

• Abrasive precancerous cheilitis of Manganotti

Treatment consists in the use of agents that stimulate the epithelization of erosions: vitamin A 6-8 drops 3 times a day, riboflavin. Erosions are lubricated with concentrates of vitamins A and D2, vitamin E.

• Limited precancerous hyperkeratosis of the red border of the lips

Treatment: surgical removal of the focus within healthy tissues.

Prevention of pretumor condition (precancerous)

Sanation oral cavity, prevention of injuries of the red border of the lips during work and at home, exclusion of burns when smoking, protection from adverse weather conditions, excessive insolation. Individuals who have dry skin should use moisturizing creams.

It is useful to take vitamin A concentrate by mouth 5-7 drops 3 times a day for 2 months, repeating courses 2-3 per year. Recommended also long-term use vitamins of group B. Smoking, drinking alcohol is excluded. It is necessary to treat actinic, hayandular cheilitis, eliminate the consequences of vesicular lichen and prevent its relapses. Warning chronic injury oral mucosa with teeth, prostheses, fillings, exclusion of chemical, thermal, bacteriological damage to it. Salt-free, non-alcoholic diet. Exclusion of spicy food.

Which doctors should you contact if you have Precancerous conditions (precancerous)

• Oncologist
• Dentist
• Dermatologist

Viruses not only hover in the air, but can also get on handrails, seats and other surfaces, while maintaining their activity. Therefore, when traveling or in public places, it is advisable not only to exclude communication with other people, but also to avoid ...

Return good vision and say goodbye to glasses forever and contact lenses is the dream of many people. Now it can be made a reality quickly and safely. New opportunities laser correction vision is opened by a completely non-contact Femto-LASIK technique.

Cosmetic preparations designed to care for our skin and hair may not actually be as safe as we think.

The precancerous condition is special condition organism, which certain moment can turn into cancer. There are two main categories of precancers:

1. Obligate precancerous conditions are combined into one group of diseases, the consequence of which is a cancerous tumor.
2. Facultative precancers are pathological conditions that, in the course of their development, are not necessarily accompanied by malignant degeneration of the affected tissues.

Such precancerous conditions require urgent specialist advice, because, depending on the type of precancer, the patient may require specific therapy. In some cases, patients are advised to undergo routine preventive examinations for dynamic observation for this type of pathology.

Leading clinics abroad

Precancerous condition: symptoms and signs

Manifestations, clinical picture and symptoms of precancers depend primarily on the location of the lesion.

Precancerous condition of the uterus:

A true precancer of the uterus is epithelial dysplasia, which is manifested by increased cell division of the surface layer of the mucous membrane with the presence of a small number of atypical elements. The development of dysplasia contributes to the early onset of sexual activity, frequent changes in sexual partners and pregnancy at a young age. Precancerous condition of the cervix in many cases also associated with human papillomavirus infection.

The disease is mostly asymptomatic and is detected incidentally during a planned gynecological examination. Dysplasia is diagnosed based on cytological analysis smear, colposcopy and histological examination pathological tissues.

Precancerous condition of the stomach:

In fact, chronic gastritis can be considered an optional precancer. Recently installed infectious etiology inflammation of the gastric mucosa. As it became known, after penetration into digestive tract bacteria "Helicobacter pylori", they are introduced into the mucous membrane and attached to the wall of the organ. At this point, an inflammatory reaction of the body is formed, which can ultimately lead to erosion and ulcers. As a result of such processes, the cells of the gastrointestinal tract accumulate genetic mutations, which can provoke cancerous degeneration of gastric tissues.

Precancerous skin condition:

Skin precancers can take two main forms:

1. Diseases of a tumor nature:

• Senile keratoma, which manifests itself in the form of wart rashes covered with crusts. Such a formation, as a rule, slightly rises above the surface of the skin.
• Skin horn- has the appearance of a limited proliferation of epithelial cells, which is subsequently covered with a keratinized layer of the skin. This condition in almost 90% eventually degenerates into a malignant tumor, that is.

1. Non-tumor precancers:

• Viral epidermodysplasia. This pathology It is formed as a result of infection of the body with a papilloma virus and, according to the clinical picture, resembles a wart skin lesion.
• Giant condyloma. The disease is localized skin genital organs and in the anus and has the appearance of a nodular compaction, often with areas of ulceration.
• Pigmented xeroderma. This genetically determined skin reaction to exposure to ultraviolet radiation is manifested by areas of erythematous reddening of the epidermis. Over time, a pigment spot forms in these places.
• solar keratosis. The lesion is predominantly observed in older patients in whom, under the action of ultraviolet rays formed yellow color spot. After some time, such formation is covered with scales.
• Leukoplakia. Given pathological condition characterized by atypical keratinization of the epithelium and mucous membrane as a result of chronic mechanical, chemical or thermal injury.

Precancerous condition of the lungs:

May contribute to the development of cancerous tumors the following diseases respiratory system:

1. Bronchiectasis is a precancerous mucosal condition bronchial system, in which there is an atypical proliferation of cellular elements in the form of papillomas. Such a process, in most cases, is a consequence of a chronic inflammatory process in the bronchi.
2. chronic pneumonia. lingering current inflammatory processes in the lung tissue, according to some scientists, it is considered an optional form of precancer of the entire respiratory system.