Benign epithelial tumors
- Symptoms of Benign epithelial tumors
- Reasons of Benign epithelial tumors
- Treatment of Benign epithelial tumors
The absolute majority in this group of tumors is made by polyps (polyposes) of a stomach. They are two types - adenomatous (adenomas) and hyperplastic. Both that and others can be both single, and multiple, their sizes fluctuate from several millimeters to 5 cm and more. On average, according to radiological, endoscopic researches, and also opening polyps come to light by 5-8 times less than a carcinoma of the stomach, making 6-10% of all tumors of this body.
The most frequent localization of polyps - antral пилорический department of a stomach (it is observed almost at a half of patients), much less often they are found in a body and a cardial part of a stomach. Usually polyps of a stomach are observed at persons at the age of 40 - 60 years, women suffer more often.
It is well-known that polyps of a stomach can be exposed to a malignancy. Unfortunately, it is quite difficult to specify exact figures of this complication as in literature it is possible to meet as the messages disproving a possibility of malignant transformation of polyps, and data on their malignancy close to 100%. However now it is possible to consider fixed that adenomatous polyps - at 18-75% of patients while the ozlokachestvleniye of hyperplastic polyps is observed very seldom malignizirutsya most often (at 0,6-3% of patients). Now it is considered that the frequency of a malignancy of gastric adenomatous polyps is much less. This statement is based on data of an endoscopic biopsy from a polyp and endoscopic polypectomy, and also on the basis of long dispenserny observation of patients with stomach polyps. Frequency of a malignancy increases at large (over 2 cm) and multiple polyps. Polyps of a body and a cardial part of a stomach are more inclined to a malignancy. Especially often (more than at 90% of patients) development of cancer against the background of total a stomach polypose is observed. According to modern data, the frequency of a malignancy of all polyps of a stomach averages 5-10%.
Symptoms of Benign epithelial tumors:
Clinical manifestations depend on the sizes and number of polyps, their localization. At most of patients the asymptomatic course of a disease is observed. The complaints to dull aches which are available for a number of patients in epigastric area, nausea, an eructation with air, unpleasant taste in a mouth are connected not with existence of a polyp, and with the accompanying chronic gastritis. Confirmation to it are the facts of preservation of pains in an upper part of a stomach and dispepsichesky frustration after an endoscopic polypectomy.
The polyps of rather big sizes (1,5-2,5 cm) located on a long leg and which are localized in prepyloric department can prolabirovat in a duodenum gleam. At their infringement in the field of the gatekeeper there are megalgias in an upper part of a stomach, quite often skhvatkoobrazny character, nausea, an eructation air develop. In the presence of polyps in a cardial part of a stomach and their prolapse in a gleam of a gullet the dysphagy phenomena are observed, a number of patients has an irradiation of pain to the area of heart. At infringement of a polyp in the field of the gatekeeper quite often there is vomiting gastric contents.
The ulceration of the mucous membrane covering a polyp can be followed by bleeding. Usually bleeding does not happen profuse, however slow blood loss is shown by a gradual anemization of the patient, darkening of coloring of fecal masses. Massive bleeding arises seldom and is shown by vomiting liquid of color of "a coffee thick" or the low-changed scarlet blood. The tar-like chair is quite often observed, also other symptoms of internal bleeding are noted (the general weakness, dizziness, pallor of integuments, etc.). At early stages of an ozlokachestvleniye of a polyp emergence of harakteny clinical symptoms usually is not noted. The general weakness, an indisposition, a loss of appetite and working capacity, weight loss and other manifestations of a so-called syndrome of "small signs" arise at a carcinoma of the stomach enough big sizes or emergence of surgical complications (profuse bleeding, a stenosis).
Reasons of Benign epithelial tumors:
Causes of illness and the present are finally not clear. At the same time it is possible to note that at the vast majority of patients the polyp arises against the background of the previous chronic (especially often atrophic) gastritis, pernicious anemia (approximately at 5% of patients with this illness).
Treatment of Benign epithelial tumors:
The choice of a method of treatment of patients with benign tumors of a stomach depends on the size, quantity and the histologic nature of polyps. At single and multiple polyps, especially adenomatous, the endoscopic polypectomy is shown. The indication to endoscopic operation in similar situations are hopelessness of drug treatment, and also a possibility of development of heavy complications - malignancies and bleedings. In these situations the endoscopic polypectomy is diagnostic, medical and preventive operation. A contraindication to this method of treatment are diseases of vitals heavy concomitantly at which performance even of the minimum endoscopic intervention can lead to development of heavy complications. Besides, this way of treatment is not shown at disturbances of coagulant system of blood, and also at diffusion to a polypose of a stomach and large intestine, in the presence of polyps on the wide basis (more than 2,5-3 cm).
Most often for endoscopic removal of polyps use their electroscission by means of a diathermic loop. It allows to remove completely a tumor and after its extraction to execute a careful morphological research of all drug from a gastric cavity. Approximately at 10-20% of patients it is not possible to take a polyp by means of the endoscope that significantly reduces the diagnostic value of this method owing to impossibility of performance of a histologic research of all polyp.
Considerable difficulties arise at endoscopic electroscission of the polyps located on the wide basis (over 2,5 cm). In these cases use of a technique of removal of a polyp in parts in order to avoid formation of extensive zones of a necrosis in its basis is reasonable that can lead to development of bleeding after rejection of a scab or even to perforation of a wall of a stomach.
Removal of polyps of the small sizes (to 1,5-2 cm) located on the narrow basis or a well-marked leg at the vast majority of patients can be executed in out-patient conditions. The exception is made by the patients of old age having various accompanying get sick a vaniye, and also those patients to whom removal of several polyps one session of endoscopic intervention is planned. In these cases performance of the endoscopic one-radio set in the conditions of a hospital is reasonable.
For one session it is possible to delete up to 4-7 polyps of a stomach. Removal of bigger number occupies them rather long time, is badly transferred by patients, increases risk of development of bleeding from the basis of remote polyps. At high qualification of the endoscopist total number of remote polyps reaches 50-70 and even more.
At the small polyps (less than 0,5 cm) which do not have the expressed leg, electroscission by means of a diathermic loop is, as a rule, impracticable for technical reasons. In these cases use of diathermocoagulation of all polyp is reasonable. This technique can be applied only in the presence of a morphological research of the bioptat executed before electrothermic coagulation of a tumor. At electrothermic coagulation of adenomatous polyps of the small sizes careful dynamic endoscopic observation at least 1 time a year is necessary.
The complication of endoscopic electroscission of a polyp (is much more rare - its electrothermic coagulations) is the most frequent bleeding from the basis of a remote polyp. This complication occurs rather seldom (no more than at 3-5% of patients) and can be usually liquidated by means of conservative actions or endoscopic diathermocoagulation. Only in isolated cases bleeding has the profuse character demanding the emergency surgical intervention. Perforation of a wall of a stomach after an endoscopic polypectomy is observed extremely seldom (less than 1% of patients). Treatment of this complication operational.
Frequency of a recurrence of polyps of a stomach after their endoscopic removal averages about 10%. However in most cases it is necessary to speak not about a true recurrence, and about formation of new polyps of a mucous membrane of a stomach out of the place of its endoscopic excision that is manifestation of features of a clinical course of this disease. A true recurrence of polyps on site of their endoscopic removal meets extremely seldom and is usually caused by defects of the equipment of electroscission or electrothermic coagulation.
At the small hyperplastic polyps (which are seldom exposed to a malignancy) and existence of serious associated diseases dynamic observation of patients is admissible. Annual endoscopic control is obligatory. In cases of detection of adenomatous polyps it is necessary to aim at their endoscopic removal.
At the big sizes of a polyp (more than 3 cm) that interferes with its removal via the endoscope (and as a result - uncertainty in its high-quality nature), it is necessary to give preference to a surgical method of treatment - a gastrotomy with excision on -
linden within healthy fabrics with the subsequent urgent and its planned morphological research. Now the chrezzheludochny polypectomy is applied very seldom as at high qualification of the endoscopist it is possible to delete in not operational way (in parts) polyps more than 3 cm in the diameter.
The stomach resection in treatment of multiple polyps which had earlier quite wide circulation is applied rather seldom now. The main indication to this type of operation - the proved polyp malignancy. In these cases surgical intervention is carried out according to the oncological principles, as at a carcinoma of the stomach. Existence of focuses of a malignancy in the field of a top of a polyp is not the indication to a stomach resection, especially if there are relative contraindications to operational treatment. In this situation the endoscopic polypectomy with the subsequent dynamic (endoscopic) observation is quite proved. Only at detection of elements of malignant growth in the basis of a polyp surgical intervention is shown. The resection of a stomach is carried out also at impossibility (for one reason or another) to execute an endoscopic polypectomy. It is necessary to remember that removal of a lasta of a stomach is rather difficult and traumatic intervention which is followed at 10-25% of patients with development of various complications in the early postoperative period. At the same time the postoperative lethality reaches 2-5% of total number of operated. Therefore this way of treatment has to be applied according to very strict indications. Besides, at a number of patients after a resection of a stomach various postgastrorezektsionny syndromes develop (a dumping syndrome, a syndrome of the bringing loop, a hypoglycemic syndrome, malabsorption, etc.) that significantly worsens quality of life of patients.
Especially big difficulties arise at treatment total a polypose of a stomach at which malignancy degree is high. In these cases long dynamic observation with endoscopy use at least 1 time a year is shown. Only at confirmation (morphological) operational treatment is shown to a malignancy of one of polyps. Choice operation in this situation is the gastrectomy. Earlier in treatment of patients with a total polipoz of a stomach this operation was applied quite widely. However in connection with the high postoperative lethality reaching 10-15% and with a considerable frequency of development of postgastrectomy frustration of the alimentary system now the gastrectomy is applied seldom.