Symptoms of precancer. Cancer in dentistry

The problem of pre-disease and early cancer is extremely relevant in oncology, as it allows one to predict the possibility of development cancer, carry out its prevention, and in the early stages of cancer development, completely cure it. The idea behind the concept of precancer is that a neoplasm almost never occurs in a healthy body, each cancer has its own precancer, and the process of transition from normal cells to a formed tumor has intermediate stages that can be diagnosed using morphological methods. Practical significance The teaching of precancer is that it allows us to identify groups at increased risk of developing cancer of a particular organ and conduct in-depth systematic observations of individuals in this group. Today, the strategy of the entire cancer control system is based on the prevention, detection and treatment of precancerous conditions and early forms malignant neoplasms.

Precancer, or precancerous disease , - a condition that is more likely to develop into cancer than in the general population. However, the presence of a precancerous background does not mean that it will inevitably turn into cancer. Malignancy in a condition called precancer occurs in 0.1-5%.

The range of precancerous conditions is unusually wide. These include almost all chronic inflammatory specific and nonspecific processes. For example, in the stomach it is chronic gastritis of various etiologies, including those resected for gastric ulcer; lungs - chronic bronchitis; in the liver - chronic hepatitis and cirrhosis, cholelithiasis in the biliary tract; dishormonal processes in the mammary gland - mastopathy; hyperplastic process in the endometrium - glandular hyperplasia; in the cervix - erosion and leukoplakia; diffuse and nodular goiter thyroid gland; dystrophic processes caused by metabolic disorders and dyskeratosis (vulvar kraurosis); radiation dermatitis and tissue damage after ultraviolet irradiation and ionizing radiation; mechanical damage accompanied by chronic irritation of the mucous membranes (dentures, pessaries, injuries; chemical agents causing occupational dermatitis, burns of the mucous membrane); viral diseases (human papillomavirus infection in the cervix); dysontogenetic - anomalies of the primary anlage of organs (teratomas, hamartomas, lateral neck cysts - derivatives of the branchial arches); benign tumors (adenomatous polyps of the stomach and colon, neurofibromas); parasitic diseases (opisthorchiasis, etc.).

Patients with precancerous conditions are under the supervision of doctors in accordance with the localization of the disease (general practitioners, gastroenterologists, gynecologists, ENT specialists, etc.), and treatment of precancerous diseases is cancer prevention. In this case, antibacterial and anti-inflammatory drugs, vitamins, microelements are prescribed, and hormonal and immunological status is corrected.

Precancer is considered precancerous conditions- optional precancer and precancerous conditions - obligate precancer. Early cancer includes pre-invasive cancer, or carcinoma in situ, and early invasive cancer - microcarcinoma. Thus, in early oncological pathology, 4 successive phases of cancer morphogenesis can be distinguished: I - precancerous conditions - facultative precancer; II - precancerous conditions - obligate precancer; III - pre-invasive cancer - carcinoma in situ and IV - early invasive cancer.

TO / precancer phase -precancerous conditions, or facultative precancer, should include various chronic diseases accompanied by dystrophic and atrophic changes in tissues with the inclusion of regenerative mechanisms, dysregenerative processes and metaplasia leading to the emergence of foci of cell proliferation, among which a foci may arise tumor growth.

II phase of precancer - precancerous conditions, or obligate precancer. This includes dysplasia (dys- violation, plasis- formation), which always occurs in the depths of the disregenerative process and is accompanied by insufficient and incomplete differentiation of tissue stem elements, impaired coordination between the processes of cell proliferation and maturation.

Dysplasia

WHO experts (1972) defined epithelial dysplasia as the following triad:

1) cellular atypia;

2) impaired cell differentiation;

3) violation of tissue architectonics.

Dysplasia is not limited to the appearance of cells with signs of cellular atypia, but is characterized by deviations from normal structure the entire tissue complex.

In most organs, the dysplastic process develops against the background of previous hyperplasia (an increase in the number of cells) associated with chronic inflammation and dysregeneration. But often hyperplasia and dysplasia of the epithelium are combined with tissue atrophy. This combination is by no means accidental, since hyperplasia and atrophy have common genetic mechanisms, which involve genes that stimulate mitotic activity and trigger cell proliferation - c-myc And bcl-2, as well as a suppressor gene p53, which blocks cell proliferation and initiates apoptosis. Therefore, in some cases, sequential activation of these genes leads to cell proliferation and dysplasia, in others - to apoptosis and cell atrophy. With dysplasia, distinct changes in the activity of all regulators of intercellular relationships are detected: adhesive molecules and their receptors, growth factors, proto-oncogenes and oncoproteins produced by them.

For some organs, the term “dysplasia” is not used to characterize transient precancerous changes. Thus, to describe the transitional stages from normal to cancer proliferation in prostate gland The concept of “prostate intraepithelial neoplasia” is used - PIN (prostatic intraepithelial neoplasia), for the lining of the vaginal portion of the cervix - CIN (cervical intraepithelial neoplasia), in the vagina - VaIN and vulva - VIN. For

endometrium instead of terms "cancer in situ" and “dysplasia” the terms “atypical glandular hyperplasia” or “adenomatosis” and “glandular hyperplasia” are used.

Most often, a three-degree gradation of dysplasia is used: mild (D I), moderately expressed (D II) and severe (D III). In this case, the determining criterion for the degree of dysplasia is the severity of cellular atypia. As the degree of dysplasia increases, the size of the nuclei increases, their polymorphism, hyperchromicity, coarsening and lumpy chromatin, an increase in the number and relative sizes of nucleoli, and increased mitotic activity differ. Over time, dysplasia can regress, be stable, or progress. The dynamics of the morphological manifestations of epithelial dysplasia largely depend on the degree of its severity and duration of existence. Mild dysplasia has virtually no relation to cancer; the reverse development of mild and moderate dysplasia is observed everywhere. The more pronounced the dysplasia, the less likely it is to develop back. The possibility of dysplasia transitioning into cancer in situ(which can be considered as an extreme degree of dysplasia) and, therefore, increases in cancer as its severity increases.

Severe dysplasia, or intraepithelial neoplasia, is regarded as an obligate (threatening) precancer - a stage of early oncological pathology, which sooner or later transforms into cancer. The morphological manifestations of severe dysplasia are very similar to cancer, which does not have invasive properties, which mainly corresponds to molecular genetic changes in the cells. Therefore, for obligate precancer, a set of preventive measures and even radical treatment are necessary, and patients with obligate precancer must be registered with an oncologist. The main stages of the dynamics of dysplasia of stratified squamous epithelium and its transition to cancer are presented in Fig. 4.1:

A) normal epithelium. Clear stratification of layers. The germinal zone of the epithelium is a basal layer of dark cells of insignificant width. Its cells always have a fairly high mitotic activity; BM - membrane;

b) mild dysplasia of the cervical epithelium. The germinal zone is expanded to approximately 1/3 of the epithelial layer and is replaced by proliferating basal epithelial cells;

Rice. 4.1. The main stages of the dynamics of dysplasia of stratified squamous epithelium and its transition to cancer:

a - normal epithelium; b - mild epithelial dysplasia; c - moderately severe dysplasia; d - severe dysplasia; G - cancer in situ

V) moderately severe dysplasia of the stratified squamous epithelium of the cervix. From U 2 to 2/3 of the height of the epithelial layer is replaced by cells of the germinal zone. Along with high mitotic activity, pathological mitoses occur. Cellular atypia is pronounced;

G) severe dysplasia. More than 2/3 of the height of the epithelial layer is replaced by cells of the basal layer. Cellular atypia and pathological mitoses are observed. A layer of mature cells remains in the top row. BM preserved;

d) cancer in situ. The entire thickness of the epithelial layer is replaced by immature proliferating cells of the basal type with cellular atypia and pathological mitoses. BM saved.

If in relation to the epithelium the concept of “precancer” is a clear definition, then in other tissues it is impossible to distinguish obligate premalignant conditions. Thus, the concept of “preleukemia” is currently widely discussed. This and related terms (myelodysplastic syndrome, hematopoietic dysplasia, dyshemopoiesis) combine various types of hematopoietic disorders, often preceding the development of leukemia. These include cytopenia, refractory anemia, including without blastosis or with slight blastosis bone marrow, signs of ineffective erythropoiesis, long-term unclear monocytosis, transient leukocytosis, etc. Bone marrow myelodysplasia, which can develop after massive chemotherapy of non-bone marrow, malignant tumors with subsequent bone marrow aplasia, is considered today as preleukemia. Any tumor is formed from the so-called tumor germ. Such tumor primordia are observed only under experimental conditions; they cannot be detected in clinical practice.

Who is the author of the term “precancer” is still unknown. Different authors name different names of the inventor of this term. According to T. Venkei and J. Sugar (1962), it was first found in the work of dermatologist V. Dubreuil (1896).

It is still unclear what precancer is. In terms of meaning and significance, precancer must meet two criteria: it always precedes cancer and inevitably turns into cancer, i.e. in all cases. Otherwise it's not precancer.

If precancer meets these two criteria, then its meaning is clear to everyone: diagnosing precancer and eliminating it should prevent cancer. This is the only way to reduce the number of cancer patients. Currently, this is extremely necessary, because... standard methods cancer treatments - surgical, radiation and drugs - allow you to remove and destroy only part of cancer cells, but not all, i.e. prolong the patient's life.

According to the theory of R. Virchow, the basis of any disease is the pathology of the cell or cells. The cell is the smallest unit of life and is susceptible to disease. Hence it would not be a mistake to use the expression “sick cell”.

Cancer in in a broad sense is a population of malignant cells from any tissue, the cells of which have ominous properties - invasion and metastasis. The process of cancer formation can be represented in the form of a diagram as follows1:

1 The same pattern is used to form a non-malignant tumor.

Normal

"target cell"1

> Cancer cell

> Cancer (clone or population of cancer cells)

The diagram shows that cancer is the end result of a disease of the target cell. But cancer itself arises from a cancer cell due to its unlimited division. It also follows from the diagram that if there is a precancer, then its place should be between the target cell and the cancer cell. What may be in this place should be precancer. Let’s call it “something” for now, which we learn about from the subsequent presentation.

Aristotle also wrote: “To know any thing, you need to know its origin and development.” For us, this means figuring out how a normal target cell turns into a cancer cell, i.e. we need to address carcinogenesis. However, first we should provide some information about the cell and its properties.

The life of a cell and its properties are determined by the genotype. Each gene, through its product - protein, creates some property of the cell. All properties of a cell are its phenotype. The genotype of a cell is disrupted by exposure of the cell to a carcinogen - chemical, physical or biological - a virus. In this case, the phenotype of the cell also changes: the previous properties change or disappear, and new ones appear. Properties of cancer cells: the ability to invade and metastasize are the main reasons for the difficulties in curing cancer. Thus, a target cell can become tumorous only after exposure to its genotype of a carcinogen.

It has now been found that genetic disorders, as a result of which the target cell turns into a cancer cell, there can be: 1) derepression of a number of fetal genes in it - epimutations and 2) changes in suppressor genes, DNA repair, in genes cell cycle, apoptosis and immune response in the cell - epimutations and mutations.

Although the picture genetic causes is still incomplete, but the existing knowledge can already be used in practice.

1 A “target cell” is a tissue cell that has been exposed to a carcinogen.

The main method for identifying epimutations in a cell is the methyl-specific polymerase chain reaction (MS-PCR); for identifying mutations, the polymerase chain reaction is the molecular colony method (PCR-MMK). Such methods make it possible to identify cancer cells by changes in their genes in biopsy material, as well as in samples from biological fluids from the patient - blood plasma, etc.

Carcinogenesis is the process of transforming a normal cell into a tumor cell. Only immature tissue cells can be involved in it, and more often when they are in the stage of division. There are two ways of carcinogenesis: 1) “de novo”

– from the target cell normal tissue and 2) “on the ground” (“on the background”) – from a target cell changed by one or another tissue influence; the altered tissue has a larger pool of dividing cells than normal tissue.

The experiment proved that carcinogenesis in the tissue of any organ consists of two stages: 1st – initiation and 2nd – promotion. These stages were first discovered by I. Birnbloom (1947, 1956), G.P. Roush, B.E. Kline (1950) and others on the skin of mice, and then confirmed in various tissues of other organs and other animals.

(J. Berenblum, P. Shubik, 1947)

Notes:

1) to induce a tumor, it is necessary to follow the sequence of influences - carcinogen, then promoter;

1 These stages occur in any type of carcinogenesis. A non-malignant tumor cell also arises from them.

2) initiation is reversible and can be accomplished in a matter of hours or days;

3) promotion is reversible, but requires prolonged and repeated exposure to the agent;

4) later, when studying at the genetic level, the inclusion of various genes at the stages of carcinogenesis was shown (H. Land, I.F. Parada, R.A. Weinberg, 1983).

The concept of carcinogenesis will be more clear from the example of animal experiments.

Experiment on mouse skin. Apply once to a subthreshold area of skin, i.e. minimum dose carcinogen, which in itself does not lead to the formation of a tumor. After some time - from a week to several months, the same place on the skin begins to be lubricated with a non-carcinogenic substance

– croton oil, which also does not cause cancer in itself. This lubrication is carried out for a certain minimum period equal to several weeks. As a result, multiple papillomas and cancer form on the skin.

Notes:

1) in the experiment, croton oil was used as a promoter - a nonspecific irritant, causing tissue irritation, leads to pronounced proliferation of cells of this tissue;

2) if a carcinogen is used as a promoter, then tumors arise earlier than from a nonspecific stimulus.

The initiation stage is caused only by a specific stimulus, i.e. a carcinogen, which is why it is called an initiator. The period of time from the first exposure of the tissue to a carcinogen until the appearance of a tumor visible to the eye is called latent. The promotion stage can be caused either by a carcinogen - its nonspecific part of its properties, or by various nonspecific irritants. The stimulus that causes the promotion stage is called a promoter. The role of the promoter is twofold: enhancing the proliferation of “dormant” tumor cells or increased proliferation of immature cells of the original tissue.

In the 1st stage, exposure to a carcinogen causes genotype disorders in the target cell, i.e. tumor genotype, and then tumor phenotype, i.e. the cell becomes tumorous. It carries out at least one division cycle, and these cells remain in the tissue in this state - as if “dormant”; their activation requires the action of a promoter. This is where carcinogenesis ends. This is the stage of “dormant” tumor cells.

In the 2nd stage, only under the influence of the promoter, not even carcinogenic, for example, croton oil, “dormant” tumor cells are activated and proliferate, leading to the formation of a tumor visible to the eye. From these data, I. Birnbloom concluded that “dormant” tumor cells are precancer.

However, later a number of authors (V.V. Khudoley, 1985; Ya.G. Erenpreis, 1986-1987; I.F. Seits, 1986) added to the essence of the stages: the target cell does not immediately become a tumor cell. In the 1st stage, epigenetic changes occur in the cell under the influence of a carcinogen - tumor genotype. This state persists after the cessation of the action of the carcinogen, but a change in the signs of initiation is possible; the cell still retains a normal phenotype, i.e. this is a precancerous cell. It divides at least once, and the resulting cells remain until the promoter acts on them. This is the stage of initiated cells (Ya.G. Erenpreis, 1986).

In the 2nd stage, under the influence of the promoter, initiated cells, i.e. precancerous, acquire a tumor phenotype, i.e. turn into cancer cells. This is where carcinogenesis ends. After this, the cancer cells divide indefinitely, forming a tumor. With a number of cells of 108-109 in the tumor, it can be distinguished by the naked eye.

From the analysis of the essence of the stages, it follows that in the 1st stage, the target cell first becomes precancerous, and in the 2nd stage, the promotion stage, acquiring a tumor phenotype, it turns into a cancerous one. So, the “something” is the initiated cell or cells in the tissue, i.e. precancer (stage 1 – stage of initiated cells). In this regard, it is necessary to add the missing stage to the cancer formation scheme between the “target cell” and the cancer cell -

Precancerous cell stage:

Normal target cell

> Precancerous cell(s)

> Cancer >

Cell(s)

Cancer (clone or population of cancer

The evaluation of experiments on mice by I. Birnbloom (1947, 1956) was carried out according to the final result, i.e. on cancer formation. This led to a logical conclusion: precancer is a “dormant” tumor cell.

However, in experiments:

1) the state of the cells was not studied in the interval between a single lubrication of the skin with a carcinogen and the action of the promoter. This is the reason why the precancerous cell stage was undetected;

2) a precancerous cell has a tumor genotype, but a normal phenotype. Therefore, by morphological methods it cannot be distinguished from a normal tissue cell. This requires PCR, a method that was developed only in 1983.

It follows that precancer today is a precancerous cell, and the definition: precancer is a “dormant” tumor cell is now not precise.

Thus, for so much a long period time - from the proposal of the term “precancer” to the present, many scientists have tried to figure out what precancer is, but they have never been able to achieve this goal. The main reason is that precancer was sought in isolation from carcinogenesis. This approach was based on the principle: if cancer occurs in any local tissue change, for example, leukoplakia, then such a change is precancer. Based on this and taking into account the degree of atypia of tissue cells - A, B, C (T. Venkei and Y. Sugar, 1962), classifications of “precancerous diseases” were created - skin, mucous membrane and red border of the lips by Prof. A.L. Mashkilleyson (1970) and the Head and Neck Tumor Committee (1977), as well as other authors. But this is a wrong approach.

Currently everything local change tissue is not considered a precancerous disease and is designated as a “background process.”

In oncology, there are still two criteria for precancer: a focus of grade III dysplasia that occurs in some part of the background process and is detected by morphological methods, and a precancerous cell. But grade III dysplasia, for some reasons, does not meet the criteria for precancer. This is clear from the characteristics of dysplasia:

It is interpreted differently - a focus of immature cells or a focus of immature cells with atypia of cells and tissue structure;

In terms of morphology, this is the closest cell change to cancer and often grade III dysplasia turns into cancer;

It is detected in tissue by morphological methods, but they cannot determine the genotype of its cells;

In each specific case, its fate is unknown: transformation into cancer or regression;

It is recommended to use a lesion of grade III dysplasia as a precancer for any tissue. The question arises: if the focus of grade III dysplasia is precancerous, then why does no one say that its cells are precancerous?

ON THE. Kraevsky et al. (1993) write: “The pathologist sees under a microscope either a normal cell or a tumor cell, but with a picture that is considered precancer, he does not have four morphological data to clarify its true essence.” What is the genotype of grade III dysplasia cells is not yet clear. To do this, dysplasia cells must be examined using PCR-MMK and MS- PCR method ami. It is clear that without the tumor genotype of the cells in the focus of grade III dysplasia, it cannot be considered a precancer.

A new approach to answering the question of what precancer is arose with the discovery of the stages of carcinogenesis. From stage analysis, precancer is an initiated cell

In one fabric or another. Its characteristics meet the two criteria for precancer that we mentioned at the beginning of this section.

It is not the tissue that participates in the stages of carcinogenesis, but only the cell of this tissue. If it has a tumor genotype but a normal phenotype, it is a precancerous cell. It is also important that in any tissue, a precancerous cell is a precancerous cell of a given cell type. Hence: there is precancer, but there are no precancerous diseases. (A.I. Rukavishnikov, 1994, 1999).

Prof. told us earlier about the connection between precancer and the 1st stage - the initiation stage. V.M. Dilman (1986). He emphasized: 1) “the presence of the initiation stage can be interpreted as a state of biological precancer, since during this period the cell is already genetically different from normal, but is not yet cancerous”;

2) “...after the action of the initiating agent on the cell, it is no longer normal, since the initiation phase is, for the most part, irreversible. But this cell is not malignant, since it is out of promotion tumor process does not appear. Consequently, a cell that has undergone changes under the influence of an initiating agent is already precancerous” (cited from: I.F. Seits, 1986).

So, a precancerous cell has a defective genotype, but a normal phenotype. Normally, in the body, such a cell should be destroyed by apoptosis, i.e. suicide, as defective, and cells of the immune system, as foreign.

Academician V.P. Skulachev (2002) writes about this: “Precancerous cells destroy themselves through apoptosis. In half of the cases, cancer appears when? the wt53 gene, encoding the p53 protein, which? monitors? for DNA damage. When they are detected, it sends a signal to the precancerous cell with altered genetic material to “commit suicide?”

The body's immune cells, cytotoxic T lymphocytes, “recognize and destroy foreign precancerous cells.” “But if suddenly changes in the genetic apparatus of the cell go too far and

Crash in immune system, a precancerous “cell degenerates into a cancer cell.”

The focus of precancerous cells in the tissue under experimental conditions (1st stage of initiation) is similar to the focus of grade III dysplasia detected by morphological methods in tissue from the patient. Both of them, at the very beginning of the process, represent a small group or nodule of cells in tissue measuring 1-2 mm in diameter. It is tempting to find out whether they will be identical in the genotype and phenotype of their cells. This assumption can be verified using PCR-MMK and MS-PCR in such cells of biopsy material from suspicious places in the area of the background process. If the genotypes and phenotypes of their cells coincide, we can conclude: precancer in an experiment is the same as a focus of grade III dysplasia from precancerous cells, but in the conditions of a macroorganism. So far we have not come across any work in which grade III dysplasia cells from a background process from a patient were tested by PCR-MMK and MS-PCR.

A.V. Lichtenstein, G.I. Potapova (2005) write that “the currently established practice of identifying and destroying existing cancer– this is the moment when the ?battle? V to a large extent lost. From this point of view, a much more rewarding target for therapeutic interventions is the array of mutant cells that precede cancer and do not yet possess all the properties of malignancy.” Such mutant cells are nothing more than precancerous cells, - Approx. – A.R.

In oncology, the terms are still used: obligate and facultative precancer. They are included in monographs and all textbooks that have an oncology section.

In this case, precancer is understood as altered tissue as a whole, and not a focus of grade III dysplasia and not a precancerous cell in the tissue. The term “obligate” means that this altered tissue in all cases turns into cancer, but “facultative” does not always mean. These ideas about precancer, as well as the terms denoting it, do not correspond to the level of knowledge about precancer and therefore should be excluded from the medical literature.

The search for precancerous cells and cancer in suspicious places in the area of the background process is carried out on the material of a tissue fragment from these places taken during a biopsy. Any background process on the skin or mucous membrane, or in other places of the body and a precancerous cell in the tissue is oncopathology, and such a patient belongs to 1b clinical group dispensary observation by an oncologist.

In our opinion, for patients with a background process and precancer in each big city a pre-cancer center should be organized. In such a center, the following should be organized: a PCR laboratory, a cell culture laboratory, a stem cell laboratory, etc.

If there is a pre-cancer center, the contribution of a dentist or a doctor of another profile in polyclinics in relation to patients with a background process and pre-cancer will be reduced to solving two tasks: 1) diagnose clinical methods background process in the patient and refer him to the pre-cancer center. In the absence of a pre-cancer center, the patient should be referred to a specialist in Oncology Center. In it, an oncologist will take a biopsy from suspicious places in the area of the background process and the material will be examined by morphological methods, and in the future by PCR-MMK and MS-PCR methods.

To treat a patient with a background process and precancer on the mucous membrane and skin, two methods are used: cryodestruction liquid nitrogen and excision. The excised material is sent for examination to the pathohistology laboratory. Such treatment must be performed in an oncology facility. This is already enshrined in the diagnostic and treatment tactics of a graduate dentist in the “Program for surgical dentistry for students of dental medical faculties educational institutions. M., 1996":

Treatment and diagnostic tactics of a graduate dentist

Today we will talk about precancerous conditions of the cervix. The processes that precede the development of a cancerous tumor are called dysplasia. A characteristic feature for them is atypia of the mucous membranes of the cervix. Please note that a precancerous condition of the cervix is not yet oncology, but the disease requires immediate medical intervention. After all, if therapy is completely absent, there is a high probability of the disease transforming into cancer.

To understand this issue in more detail, we suggest discussing a little the issues of oncology, dysplasia, erosion, and so on. How does this threaten a woman, how to treat her and who to contact with problems?

Oncology

So, what is a precancerous condition of the cervix called? It was already mentioned earlier that to designate this pathology there is a special medical term- dysplasia. What awaits the patient if there is no action? Of course, cancer. What is it and what are the consequences? This will be discussed in this section of the article.

Oncology in our time is one of the most terrible and common diseases. Despite the fact that it is the 21st century, a cure has still not been found. Malignant neoplasms ( cancerous tumors) can form in absolutely any tissues and organs, therefore, the manifestations can be very different. Pledge effective therapy- this is a diagnosis for early stages and purpose necessary treatment. Depends on these two points future life patient.

Note that there are a number of signs that may indicate the onset of oncology, which people always ignore. These include:

pain in the stomach (they do not always indicate gastritis or erosion - perhaps this is how a cancerous tumor manifests itself);
causeless weight loss;
jaundice;
cough;
shortness of breath;
difficulty swallowing food;
burning in the chest;
swelling of the face;
enlarged lymph nodes;
bruises that formed for no reason;
weakness;
erection problem;
backache;
breast tenderness;
skin damage that does not heal for a long time;
fever;
changes in the oral mucosa;
poor condition of nails;
bleeding between periods;
swelling of body parts;
convulsions;
memory impairment;
coordination problems;
numbness of the limbs and so on.

If you notice these symptoms, you should immediately go to the hospital. Only with early diagnosis are the prognoses positive. In this section you learned about the signs of presence cancerous tumors in different tissues and parts of the body. Now let's take a closer look at cervical cancer.

Cervical cancer

So, let's talk about malignant tumors of the female genital organs. According to statistics, cervical cancer is in fourth place among cancers in women. This disease is quite difficult to recognize on your own; as a rule, it is discovered accidentally at an appointment with a gynecologist.

About 600 thousand cases of diseases of this type are detected annually. Please note that Hispanic women are more susceptible to developing malignant tumors in the female genital area. If we consider the frequency of cases relative to the age of the patients, then girls under 25 years of age very rarely suffer from this disease. Women aged thirty-five years and older are at risk.

Mortality from the disease is low, which is associated with frequent examination of patients and examination of cells for changes. After all, cancerous tumors do not form from healthy tissues and cells. Education malignant tumor preceded by precancerous conditions of the cervix. If you detect them in time and start treatment, then oncology can be avoided. It is also very important to note that tumors are often formed from scars and condylomas after childbirth. In this case, cancer takes up to fifteen years to develop.

Dysplasia

Precancerous condition of the cervix is the whole complex factors that predispose to the development of cancer. This requires certain conditions, then pathologies are formed that can transform into cancer. There are several such diseases:

dysplasia;
erythroplakia;
leukoplakia;
adenomatosis.

Now we will talk about one of the possible precancerous conditions - cervical dysplasia. Causes of the disease:

onset of sexual activity at 14-15 years of age;
frequent change of sexual partners;
pregnancy before 20 years of age;
pregnancy after 28 years;
abortions;
inflammatory processes(trichomoniasis);
smoking;
reception contraceptives for a long time;
decreased immunity;
hereditary predisposition.

Dysplasia in women as a form of precancerous condition is most common. This is a change in the mucous membranes of the cervix and vagina. There are three degrees of the disease in total. For ease of perception, we have placed information about them in a table.

All measures to treat the disease must be taken by the attending physician. Sometimes therapy is not carried out at all. For example, in a young nulliparous girl, the disease can go away on its own (provided that we're talking about about the first or second degree of dysplasia).

During the treatment process, it is necessary to pay attention to two aspects at once:

removal of the affected area;
restorative treatment.

Therapy depends on many factors: age, degree of disease, history of childbirth, and so on. We'll talk about all this a little later.

Cervical erosion

The precancerous condition of the uterus is accompanied by changes in the mucous membranes. Now I would like to pay attention to one of the most common diseases that can lead to the formation of a malignant tumor. We will talk about erosion, which is a benign pathological process occurring in the cervix.

Reasons may include:

diseases of the genital organs;
abortion;
early birth;
late birth;
cervical rupture during childbirth;
menstrual irregularities.

All women, especially between 25 and 40 years old, should make it a rule to visit a gynecologist at least once every six months. Why did we single out this particular age? It's simple, because it is at this time that a woman is most active in every sense of the word. The disease develops asymptomatically. The sooner the doctor notices the problem, the better prognosis for a woman, because a benign tumor can develop into a malignant one.

Risks

You have learned a little about what a precancerous condition of the cervix is and what it means for a woman. Now let's talk a little about risk factors. The first and most important thing for girls to remember: HPV is one of the most important factors. For those girls who are unfamiliar with this abbreviation, let us clarify a little. HPV is the papilloma virus. It is worth knowing that this is not one, but several dozen of all kinds of viruses, which, when they penetrate the human body, can provoke many pathologies.

However, HPV is not the only factor; others can also be included in the list:

the presence of several sexual partners (especially if men have inflammatory diseases);
bad habits (smoking, drugs, alcohol);
weak immunity;
uncontrolled use of oral contraception.

Pathogenesis

Now we will briefly talk about the pathogenesis of dysplasia. As is known, The epithelium covering the cervix consists of several layers. The formation of the disease can occur in two directions:

1) squamous metaplasia of reserve cells;

2) disruption of physiological transformations of the epithelium.

Dysplasia can have four forms:

mild (damage to the deepest layers of the epithelium);
moderate (to mild form damage to the lower half of the epithelium is added);
severe (this form is called pre-invasive cancer, cell differentiation occurs only in the upper layer);
macroscopic dysplasia (ectopia, ectropion, leukoplakia).

Symptoms

Symptoms of a precancerous condition of the cervix are almost always absent. The disease develops asymptomatically; a woman may notice the first signs only when the disease is advanced. Such symptoms of a precancerous condition of the cervix include pain in the lower abdomen, spotting after sexual intercourse, before and after menstruation. We remind you once again: to avoid cervical cancer, you need to visit a gynecologist at least once every six months. The examination should include:

survey;
instrumental research;
laboratory research;
clinical examination.

Gynecologists say that in most cases erosion is additionally detected. When detecting cervical erosion, the gynecologist is obliged to send the patient for a PAP test.

Pain

As mentioned earlier, one of the symptoms of dysplasia is pain. Where does her girl feel it? In the area of the cervix. All women should know that the health of the reproductive system depends on many factors that have a direct impact on reproductive function.

Painful sensations may have different character, degree and reason. Sometimes the pain is sharp, sometimes paroxysmal, and maybe nagging. Some experience discomfort during intimacy, others during critical days and so on. Remember, pain is a signal from the body that it is time to visit a gynecologist. Each case must be studied in detail by a doctor, because it is necessary to find out the cause of the disease and carry out the necessary therapy.

Diagnostics

Now we will talk about whether it is possible to cure a precancerous condition of the cervix, and we will dwell in more detail on diagnostic methods. Of course, precancer is curable. Diagnosis is carried out using several methods:

colposcopy;
biopsy;
scraping.

The first method is used for visual assessment of the site. A biopsy refers to the removal of a piece of diseased tissue for examination. The procedure is carried out during colposcopy, material is taken with a diameter of up to three millimeters. If no changes are detected during colposcopy, then it should be assumed that the pathology is localized in the cervical canal. For the study, an analysis is taken with a special curette. The procedure is painless and lasts a few minutes.

Survey

Before considering the treatment of a precancerous condition of the cervix, it is necessary to say what exactly needs to be examined and how. The doctor must interview the patient and examine her for gynecological chair vagina and its vestibule.

For diagnosis it is necessary to carry out:

bimanual examination of the vagina;
microbiological examination of secretions;
bacterioscopic examination of secretions;
cytological examination of discharge;
visual examination of the cervix.

Only with all of these methods is early diagnosis possible, which will help the patient avoid cancer.

Treatment

Now about how precancerous conditions of the cervix are treated. There are two approaches in total:

medicinal;
non-medicinal.

Drug treatment involves the use medicines such as “Solkovagina” and “Vagotila”, which are based on acids (organic and inorganic). The drugs have a selective coagulating effect on the epithelium. Remedy for correct use allows you to eliminate the source of infection without scarring.

Non-drug treatment includes:

laser exposure to the lesion;
cryodestruction;
operation.

Which doctor should I go to?

All questions regarding women's health, the gynecologist decides. You can make an appointment with him for a consultation; if necessary, the gynecologist himself can send you for examination to a more specialized specialist - a gynecologist-oncologist. This specialist deals with the treatment of diseases of the female reproductive system. A gynecologist-oncologist has everything necessary knowledge in the field of treatment and prevention of tumors of the female genital organs.

Prevention of cervical cancer

Precancerous conditions of the cervix, the symptoms and treatment of which we discuss in this article, can be avoided by adhering to certain rules. A woman must give up everything bad habits, disorderly sex life also unacceptable. Oral contraceptives must be prescribed strictly by the attending physician. In addition, it is necessary to visit a gynecologist once every six months, undergo vaccinations and screening. All this will help maintain your women's health.

The word “cancer” from the lips of a doctor sounds like a death sentence - incredibly scary and creepy. This disease is most often detected at certain stages of development, but few people know that there are so-called precancerous diseases, which are not nearly as scary as they seem, and in all cases are reversible. All that is required is to identify them before they develop into something larger and incurable.

Explanation of the term

Precancerous diseases are acquired or congenital changes in certain body tissues that contribute to the development of malignant neoplasms. After reading this, many can breathe a sigh of relief, they say, you are checked regularly by doctors, and if something happens, they detect the sore in the early stages. But in practice, it is extremely difficult to accurately determine that some minor tumor in the internal tissues is a signal of the onset of something more serious. Most often, precancerous conditions are tolerated by the patient absolutely painlessly, the person does not worry or worry about anything. Perhaps they can only be discovered certain technique under the direction of an experienced doctor.

Historical information

In 1870, the domestic professor and doctor M. M. Rudnev stated at one of his lectures that cancer is a disease that is formed on the basis of certain diseases that affect certain organs. He was sure that malignant tumors do not form out of the blue, there is something behind them. The term precancerous diseases first appeared in 1896, after an international congress of dermatologists was held in London. During this event the following was also revealed. They have established which human organs are susceptible to the formation of malignant tumors. Consequently, all precancerous diseases already had a precise localization, and identifying them was much easier than before. Behind short period Over time, the process of identifying such foci of such a serious illness has become very popular in the world of medicine and is called “cancer prevention.”

Classification of precancer

WITH clinical point In terms of vision, precancerous conditions are divided into two categories: obligate and facultative. Oddly enough, diseases belonging to both groups are congenital or hereditary in nature, they are almost impossible to acquire on your own or to become infected with them from someone (as is known, oncology is not transmitted by airborne droplets). Let us immediately emphasize that most of the ailments that will be described below are little known ordinary people and they don’t happen that often anymore. But at the first appearance of at least one of the symptoms of these diseases, immediately go to the oncologist, get tested and take a course of cancer prevention. Well, now we’ll take a closer look at exactly what ailments are included in the first and second categories, and what their future fate will be.

Obligate category

This group of diseases is caused exclusively congenital factors. In a percentage of cases from 60 to 90, such ailments serve as a good basis for further development cancer, as they stimulate the growth of malignant tumors in the body. The following diseases are worth mentioning in the obligate category:

All kinds of polyps that can form both on mucous membranes accessible to humans and in internal organs. Polyps themselves are neoplasms, and at the slightest malfunction they become harmful to humans.
Cysts that form in the glandular secretory organs are also background and precancerous diseases. These hardenings are most often found in the ovaries, pancreas, thyroid gland, salivary and mammary glands.
Xeroderma pigmentosum is the only hereditary disease in this category that serves as the basis for skin cancer.
Familial colon polyposis - slight deviation, which is found in the body of almost every person. However, in some cases, if there is a predisposition to cancer, such cell proliferation leads to the formation of a malignant tumor. Such polyps can cause the development of intestinal or stomach cancer.

Optional group

Sometimes a comprehensive answer to the question of what causes cancer is given specific diseases, which are familiar to almost every person. They are not as common as colds or flu, but can catch anyone by surprise. Among them we name the following:

Cervical erosion.
Papilloma.
Atrophic gastritis.
Cutaneous horn.
Keratoacanthoma.
Ulcerative colitis.

But what if none of the above was found in the patient, and a malignant tumor still formed? Inflammation in any organ, in any mucous membrane or even on the surface of the skin is the most important thing that causes cancer. Unnatural cellular formations can appear even against the background chronic bronchitis if inflammation is constantly occurring in the respiratory organs. The same applies to ulcers, gastritis, diabetes mellitus and so on.

Two types of precancer treatment

Many doctors adhere to the so-called rule of cutting off the problem or source of the disease. In other words, an operation is performed during which a tumor or growth that has arisen in the body is simply removed using a scalpel. Long time It was believed that this method was the most effective, but it turned out that this was not entirely true. The fact is that even after liquidation malignant tumors the “roots” of the disease remain in the tissues, which in the near future will bear new “fruits”. For example, precancerous diseases of the cervix are polyps. They can be removed, and in some cases even without medical care, on one's own. However, soon the next neoplasms will grow, perhaps even larger in size and much more dangerous to health. It is necessary to undergo regular examinations, undergo preventive measures and thoroughly monitor your body.

Stomach

This organ seems to serve as a target for a wide variety of ailments. Moreover, it is he who is responsible for our appearance, for the condition of the skin and hair, even for the mood. Precancerous diseases of the stomach are almost all sores that occur in it and are accompanied by inflammatory processes. For example, against the background of seemingly harmless gastritis, something more dangerous and malignant can grow. The same applies to pancreatitis, ulcers, etc.

So, in short, precancerous diseases of the stomach are chronic ulcer, polyposis various departments intestines, hypertrophic gastritis, reduced stomach acidity. Also, malignant tumors can begin to develop against the background of previously performed operations to remove a specific part of the stomach.

Prevention

The spread and development of stomach cancer is believed to depend on geographic location. The bottom line is that in every country people eat certain products which can either stimulate excessive growth cancer cells, or slow down this process. Thus, it was revealed that pickles and smoked foods, rice in large quantities, as well as a lack of vitamins are the cause of the formation and development of malignant tumors. But consuming all dairy products reduces the risk of stomach cancer.

Gynecology

In this industry, there are two types of precancer: the external genitalia and the cervix. In the first category, two main ailments can be identified that serve as a background for the further formation of a malignant tumor.

Leukoplakia is a dystrophic disease that is accompanied by keratinization of the vaginal mucosa. Also in the process, dry white plaques appear, followed by the formation of sclerosis and tissue wrinkling.
Kaurosis of the vulva is characterized by wrinkling and atrophy of the mucous membrane, clitoris and labia minora. As a result, the skin of the external genitalia becomes hypersensitive, causing unbearable itching and burning.

Precancer in the internal genital organs

Oddly enough, this category of diseases is much more common and, of course, more dangerous. Most often, precancerous diseases of the cervix are determined in the gynecological office after an examination or after tests, and among them are the following:

Erosion.
Leukoplakia of the vagina.
Polyps.
Erythroplakia.
Ectropion.

In most cases, precancerous diseases in gynecology require surgical intervention. After the source of the disease is completely excised, the patient must undergo a long and regular course of prevention so that the disease does not flare up with renewed vigor.

Cancer in dentistry

Not only teeth and gums, but also all parts of the oral cavity should be healthy - this is what dentists say. You need to monitor the condition of the upper and lower palate, tongue, inside of the cheeks, as well as the lips and even the tonsils. After all, all these organs and parts of the body are in close proximity to each other, and all those diseases that appear on one of them quickly spread to all the others. Oddly enough, cancer is a disease that can even affect the oral cavity. Its development most often begins with completely harmless, at first glance, defects, which can hardly be called a disease. These can be permanent cracks on the lips, a coating of a certain color and structure on the tongue, small pimples and wounds on the palate. Therefore, before we move on to a detailed consideration of all the ailments associated with this mucous membrane, we warn you: watch yourself carefully, pay attention to all the flaws and points that bother you. It’s better to see a doctor in vain than to regret it later.

External changes that indicate precancer

In some cases, you yourself may detect some metamorphoses on your body, which will mean that something has gone wrong in the body. Some of these changes may include the following:

The mucous membrane loses moisture and becomes dry and wrinkled.
Areas of cloudiness appear on it.
Some of its areas may be de-epidermalized.
Microcracks become a pathology that cannot be eliminated.
Increased bleeding. This is due to the fact that the vessels and capillaries become too fragile.

List of diseases and underlying conditions

Precancerous diseases of the oral cavity are also divided into obligate and facultative. Let us immediately note that they may be identical in severity, or even an obligate illness will be more easily tolerated than an optional one. But in the first case, the formation of a malignant tumor is inevitable, and in the second, this is only one of the options for the development of events. So, the following are included in the obligate category:

Keir's erythoplasia and Bowen's disease.
Abrasive precancerous cheilitis Manganotti.
Nodular or warty precancer.
Organic hyperkeratosis of the red border.

As it turned out, there are much more facultative precancerous conditions of the oral cavity than obligate ones. Many of them later turn into cancer in an average of 15 percent of cases. But we will still list them:

Cutaneous horn.
Papillomas.
Erosive and verrucous leukoplakia.
Keratoacanthoma.
The presence of ulcers on the mucous membrane (most often they are chronic).
Constantly chapped lips.
Cheilitis of various types.
Post-X-ray stomatitis.
Lichen planus.
Lupus erythematosus.

Summarizing

IN medical theory precancerous conditions are specific diseases that can be treated and prevented. Therefore, it is believed that by detecting them, it is possible to protect the patient from death. In practice, it turns out that there are much more such states than described above. The fact is that cancer tumors can arise in the most unexpected places and organs. They form in areas where inflammatory processes regularly occur. And most importantly, the person himself may not even be aware of these processes. Therefore, you need to monitor your body with special care, undergo regular examinations by doctors and take care of yourself.

The development of a malignant tumor in the body is a process that occurs over many years, characterized by accelerated proliferation cellular elements and changes in body tissues in the form of non-inflammatory proliferation of cells of immature epithelial or other tissue, which creates conditions for their malignancy. This condition is called “precancer”. In clinical practice, the development of a tumor has invariably been associated with the existence of previous changes, and this term was proposed by V. Dubreuil back in 1896. In 1965, this term was officially adopted by the WHO Expert Committee and it was recommended to provide theoretical and morphological justifications for it. In subsequent years, oncologists formulated such ideas.
Big theoretical value had the formulation proposed by M. Shabad in 1979: “Precancer is microscopic, multicentrically occurring, partly multiple foci of non-inflammatory atypical growth of immature epithelium with a tendency to infiltrative growth, but without tissue destruction,” as well as the concept of “tumor progression.” He also identified 4 stages of blastomogenesis:
1. uneven diffuse hyperplasia,
2. focal proliferations,
3. relatively benign tumors,
4. malignant tumors.
The sequence of which he looked through in many organs. M. Shabad combined the second and third stages into precancer and argued that “every cancer has its own precancer.” Currently, this definition includes precancerous diseases and precancerous changes that, under certain conditions, can lead to the development of invasive cancer. Important modern morphological criteria for the disorder tissue differentiation There were two options according to Fischer-Wasels, proposed in 1927: metaplasia and dysplasia. In this field, the nature of the tumor germ was studied.
Metaplasia- is the replacement of one type of mature cellular elements by others due to chronic inflammation, nutritional disorders, endocrine effects. An example is the transformation of transitional epithelium Bladder in multilayer flat or ferruginous prismatic. The phenomena of metaplasia are varied and widely represented in connective tissue.
Dysplasia- a violation of tissue structure, characterized by pathological proliferation and atypia of cells. This is a morphological concept, since dysplasia is detected only after histological examination a section of tissue that makes it possible to establish increased proliferation (proles - descendant, ferre - create), that is, the formation of new cells through their reproduction by division, as well as disruption of their differentiation.

There are three degrees of dysplasia:

1. weak (small), changes are determined by 1/3 of the thickness of the epithelium;
2. moderate (average) - changes by 1/2 of the thickness of the epithelium;
3. pronounced (significant) - changes by 1/3 of the thickness of the epithelium.
A weak degree of dysplasia is easily subject to reverse development, a moderate degree is less likely to develop, and with degree III, the probability of mutations increases, and cells with signs of genetic instability appear, which in 15% of cases can transform into cancer within 10-15 years. It has been noted that the increase in the severity of dysplasia correlates with chromosomal damage. Dysplastic changes in many cases consistently occur against the background of metaplasia, but going through all stages of dysplasia for the development of cancer is not necessary.
Currently, dysplasia is recognized as the most important morphological criterion of the precancerous period, synonymous with precancer. The reasons for the transformation of dysplasia, which can exist for decades, into cancer, are not yet completely clear. Long-term exposure to carcinogenic agents plays a leading role in the occurrence of cancer. G. A. Frank believes that in practice, dysplasia should mean only controlled and reversible disorders of epithelial differentiation of a precancerous nature as a result of the proliferation of cambial elements (undifferentiated precursor cells, stem cells) with the development of their atypia, loss of polarity and disruption of the histostructure without invasion basement membrane. It is proposed to classify dysplasia I-II degrees as a facultative precancer, and grade III as an obligate one. These definitions of precancer, based on the concept of likelihood of development malignant neoplasm, are widely used in clinical practice and acquire particular significance during clinical monitoring of patients.
Optional precancer(Greek facultas - opportunity) - diseases in which the development of cancer is possible. Examples include chronic skin ulcers, leukoplakia, erythroplakia, nodular mastopathy, benign tumors, many chronic inflammatory and specific processes.
Obligate precancer(Greek obligates - oblige) - diseases in which the development of malignancy is almost inevitable (occurs more often than in 80% of cases): xeroderma pigmentosum, Dubreuil's melanosis, familial polyposis of the colon, papilloma of the bladder, etc.
Going through all stages of cancer formation is not mandatory. The inclusion of benign tumors in this scheme is quite natural, since the detection of dysplasia in them is considered as an “indicator of the risk of possible malignancy.” The likelihood of such malignancy is determined by the organ and nosological form, as well as the duration of exposure to the carcinogen. However, the full mechanism of malignancy of precancerous conditions has not yet been revealed. The process of malignancy benign tumor actively obstruct defense mechanisms body. Thus, I. N. Schwemberger and B. Ginkul found that the body’s lymphocytic reaction prevents the transformation of rapidly proliferating colorectal adenomas into invasive carcinomas, as a result of which this process can last from 10 to 20 years. Moreover, lymphocytes surrounding the tumor can prevent its metastasis, as the authors judge by the longer survival (more than 5 years) of patients with tumors surrounded by a lymphocyte barrier.
Sarcomogenesis studied in less detail. The development of sarcoma is faster than cancer, and V.S. Turusov suggests leaving the question of its stages open for now. The term “presarcoma” has been known since 1967, when it was proposed by M. Shabad, who experimentally studied the formation of connective tissue proliferations in the early stages of sarcoma formation and determined risk factors for the development of the disease.
Patients with precancer, especially obligate cancer, are monitored and treated by oncologists, which seems to be an important link in the complex of measures for the prevention and early diagnosis of cancer.

Early cancer

According to the “tumor field” theory, a tumor develops from multiple germs of neoplasms. Precancerous cell changes under certain conditions turn into invasive cancer, which is a critical moment in the formation of a malignant tumor, after which irreversible malignant tumor progression occurs. Its predecessor is non-invasive cancer (intraepithelial), which differs from invasive cancer in the preservation of the basement membrane.
Intraepithelial cancer isolated into an independent morphogenetic form of the tumor and is called carcinoma in situ (Tis). This term was proposed in 1932 by Broders and refers to the complete replacement of the epithelial layer with anaplastic elements. Intraepithelial cancer can exist in the body for a long time, reflecting a state of equilibrium between oncogenic transformations and protective forces body. This is still an avascular tumor in which metabolism is maintained by diffusion. There is no immediate threat to the body from it, since it is not capable of unlimited growth - invasion and metastasis. However, gradually the tumor becomes dangerous properties. When tumor cells invade through the basement membrane, we are talking about the formation of early cancer.
Early cancer or microcarcinoma (microinvasive cancer), is a small malignant avascular tumor that has invaded the basement membrane, but has not spread beyond the mucous membrane or other tissue from which it arose. It extends beyond the basement membrane to a depth of 0.3 cm, does not metastasize and is the most favorable option for invasive cancer, providing 100% five-year survival rate during treatment. The concept of early cancer includes morphological criteria for tumor growth, i.e. it is cancer that does not extend beyond the mucous membrane.
For tumors from the integumentary epithelium, the definitions of early cancer and carcinoma in situ are considered identical. But for tumors coming from internal organs, lined glandular epithelium(stomach, intestines, endometrium), as well as parenchymal organs These concepts do not coincide due to the organ features of the architectonics of the mucous membranes, as a result of which other definitions are used for early cancer in such cases.