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Lip cancer

Lip cancer this malignant new growth. It develops from cells of the cover epithelium located on a red border of an upper and under lip.

 Epidemiology

 The cancer of a lip makes about 3% of all malignancies and takes among them the 8th place. The disease from an upper lip develops seldom (4-5%). It is caused by its anatomo-physiological differences and different exposure to carcinogens.
Men have this disease more often, than women (on ten sick men only one sick woman). Elderly people (70 years are more senior) are most of all subject to this pathology, persons of middle and young age are much more rare. Villagers suffer from cancer lips more.

 Etiology and pathogeny

 Treat the factors causing malignant new growths of a lip: long influence of natural agents (wind, solar radiation, sharp fluctuations of air temperature); influence of various carcinogenic substances (bismuth, products of distillation of oil, compound of arsenic, mercury); addictions (smoking, chewing of various mixes (nasvay), alcohol intake); the frequent microtraumas of a red border of lips (caused by the carious teeth, keen edges of teeth which are incorrectly made prostheses, a dental calculus, biting of a lip, hot food, cigarettes). In development of tumoral process viral infections (shingles), inflammatory, fungus diseases of a red border of lips, diseases of a digestive tract, a liver, deficit of beta carotene, A, E, S vitamins also play a role.

 The focal dyskeratosis and papillomas which are shown giperkeratoza and a lekoplakiya belong to a pretumor state. Diffusion dyskeratoses, eritroplakiya and keratoacanthomas possess the expressed tendency to an ozlokachestvleniye.
Optional pretumor states are chronic ulcers, cracks of a lip and a cheilitis.

 Allocate three clinical forms of cancer of lip: papillary, warty and ulcer in which distinguish also ulcer and infiltrative. On a structure it is planocellular keratosic (95%) and planocellular not keratosic (5%) cancer. Planocellular not keratosic cancer is characterized by more malignant current: early innidiation in regional lymph nodes and infiltrative growth. On extent of distribution of tumoral process allocate new growth stages: I, II, III, IVa, IVb and IVc. Thanks to this classification, the attending physician estimates the forecast (outcome) of a disease and tactics of treatment of the patient.

 Clinical picture

 Symptoms of cancer of lip are various and caused by the previous precancerous diseases and morphological type of a new growth. Patients usually complain of existence of an ulcer or the condensed education in the field of an under lip, defect of an under lip, an itch, the spontaneous expiration of saliva and difficulty during meal. Increase of negative dynamics of clinical displays of a disease is noted. The number of complaints accrues, the amount of consolidation or an ulcer increase, there is their distribution on a mandible and a cheek. The rendered medical actions are not effective.

 At an early stage around consolidation or a small erosion there is a valikoobrazny nimbus that speaks about a process ozlokachestvleniya. The skin horn, papilloma, the center of a verrukozny leukoplakia, a nodular or warty precancer develop in onkoprotsess with exophytic growth. The tumor develops long, the infiltration of underlying fabrics gradually increases. Mangannoti's cheilitis, destructive forms of a dyskeratosis, other ulcer processes are transformed to cancer with endophytic growth.

 At late stages of an onkoprotsess the difference between clinical forms of cancer is erased. At far come stage, the bottom of ulcer destruction reaches a muscular layer of a lip, the tumoral infiltration covers all lip, a mouth floor, tissues of a chin, cheeks and a mandible. Destruction of fabrics amplifies, there is their secondary infection. Further food is broken and severe exhaustion develops.

 The lip cancer usually metastasizes in the lymphogenous way. Metastasises can develop on both sides in 25% of cases. Innidiation of a malignant tumor of an under lip is observed at the I stage of a disease in 2-8% of cases, at the II stage, approximately, in 15-20% of cases, at the III stage of an illness - in 35% of cases and at the IV stage - in 70%. The remote metastasises of a tumor of an under lip are observed rather seldom, only in 2%, and generally in lungs. The cancer of an upper lip behaves more aggressively that is connected with features of a lymphokinesis and innidiation.

 Diagnosis

 Begins with poll of the patient during which his complaints, the anamnesis of a disease, existence of contacts with carcinogenic substances, the labor anamnesis gather. Diagnosing of cancer of lip is based on data of visual survey of the struck area and a stomatoskopiya (heyloskopiya). These methods allow to define character and depth of ulcer process, to distinguish the infiltration roller around an ulcer form of a tumor, to find out a condition of a surrounding mucous membrane of a mouth against which there was a new growth center. And use of coloring of fabrics of 1% aqueous solution of toluidine blue helps to see the zones which underwent an ozlokachestvleniye (zones of precancerous educations remain uncolored, and onkokletka are painted in blue color).

 Palpatorny research of a lip allows to determine the actual sizes of a tumor. At suspicion of an onkoprotsess special cytologic research of smears prints of contents of an ulcer is conducted. If necessary the puncture of suspicious regional lymph nodes is carried out. According to indications ultrasonography of a lip, a neck and abdominal organs, and also a mandible X-ray analysis is carried out.

 Differential diagnosis of a malignant tumor of a lip is carried out with numerous diseases: leukoplakia, hyperkeratosis, papilloma, Manganotti's cheilitis, tubercular ulcer, syphilitic ulcer, skin horn.

 Treatment

 At treatment of a disease the set of various factors is considered: age of the patient, existence of the accompanying pathology, type of tumoral process, the sizes and features of distribution of a tumor. The cancer therapy of a lip is usually carried out by the combined method and is directed to treatment of primary tumoral process and sites of primary innidiation. Treat methods of treatment of tumoral process: cryogenic - impact on a tumor very low temperature, beam - a roentgenotherapy, surgical and photodynamic therapy.

 At the I stage of tumoral process treatment is usually begun with a cryogenic method - impact on tumoral education with liquid nitrogen. This treatment is the most effective as it functional sparing and treatment approaches 100%. Therefore the cryogene therapy is shown to elderly people and/or having the heavy accompanying pathology. Also this treatment is applied at treatment of recurrent tumors.

 By the following method of treatment is beam. At the same time the short-distance roentgenotherapy with loading at 50-65 Gr, interstitial therapy by radium at 50-70 Gr and electronic therapy is used. The surgical method is used at impossibility of use of cryogenic or radiation therapy. At the same time excision of a tumor is made, and in addition perform Vanakh or Krayl's operation, for the purpose of prevention of distribution of metastasises. One more way of a cancer therapy of a lip is photodynamic therapy. The essence of this method is that the fabrics affected with a tumor are exposed to radiation of the laser. Photosensitive drug is applied previously on pathological zones or it is entered intravenously. Such therapy is used only at limited tumoral process.

 The roentgenotherapy of primary tumoral center at first is applied to treatment of the II stage of a disease, and in 2-3 weeks an operative measure on excision upper fascial futlyarnoy cervical cellulose is carried out. It should be noted that preventive operations at I and II stages of a disease are carried out when there is no opportunity to conduct dynamic supervision over the patient, and there is an adverse forecast.

 Primary center at the III stage is cured in the beam way on gamma and therapeutic installation. Enter needles with a radioisotope into the remains of a tumor. Further the tumor is removed by means of resecting of a lip. After full regression of a malignant tumor excision becomes bilateral fascial futlyarnaya. Existence of regional metastasises is the basis for use of radiation therapy at 30-40 Gr, it precedes surgical treatment. Thus try to obtain reduction of the sizes of lymph nodes. At numerous, slow-moving or the large sizes the metastasises which arose in deep jugular or supraclavicular lymph nodes Krayl's operation is performed. Which essence consists in a resection of an internal jugular vein, an eleventh cranial nerve and grudino - a clavicular and mastoidal muscle.

 At the IV stage complex treatment is carried out: preoperative remote beam or brachytherapy, neoadjuvant polychemotherapy, broad excision of a tumor. Radiation of submaxillary area and regional lymph nodes of a neck in a dose of 40-50 Gr is also obligatory. For IVS of a stage the palliative polychemotherapy and beam treatment is shown. The polychemotherapy in view of the low performance did not get broad use. It is carried out by a methotrexate, platinum drugs, Bleomycinum and ftoruratsily and used only at therapy of the remote metastasises.

 Prevention

 Primary prevention consists in protection of face skin against direct sunshine, refusal of smoking, change of working conditions or change of the place of work, respect for hygiene of an oral cavity, refusal of hard alcoholic drinks. The persons inclined to dyskeratoses of lips, and a cheilitis have to pass dispensary surveys annually.

 Secondary prevention. Timely sanitation of an oral cavity and annual routine inspections of the stomatologist. Carrying out adequate conservative treatment of dyskeratoses and heylit, and at its inefficiency - surgical treatment. Annual dispensary detection and treatment of pretumor diseases at seamen, agricultural workers and employees of the enterprises, with harmful production.

 
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