Cancer of a Highmore's bosom

Description:

Defeat of malignant character of walls of a Highmore's bosom.

Symptoms of cancer of Highmore's bosom:

The symptomatology of tumors of a Highmore's bosom substantially is defined by their localization in this or that segment of an upper jaw. It is established that tumors of anteroinferior localization differ in less malignant current, than tumors of verkhnezadny localization. The clinical picture and the course of the tumors located in internal or outside segments of a Highmore's bosom are similarly various.

Spread of a tumor of a Highmore's bosom to a nasal cavity most often happens through a natural foramen on average nasal to the course. At a rinoskopichesky research in such cases the ledge of pinkish color with an uneven surface which is easily bleeding at a research the probe is defined. The following stage is the trellised labyrinth from where through a cribriform plate the tumor can get into a head cavity, causing the corresponding symptomatology. At defeat of back cells of a trellised labyrinth there is a spread of a tumor to a nasopharynx or to the main bosoms.

Germination of a tumor in an eye-socket through an upper wall of a Highmore's bosom or from a trellised labyrinth is followed by such various ophthalmologic and neurologic symptoms as paralysis of a third cranial nerve, a full ophthalmoplegia and an atrophy of an optic nerve. Along with it protrusion of an eyeglobe is quite often observed.

The pain which is one of rather precursory symptoms of malignant tumors is especially accurately expressed at damage of Highmore's bosoms. Many patients at whom spread of a tumor towards an eye-socket is planned, complain of painful evening and night headaches.

At localization of a tumor at the bottom of a Highmore's bosom germination in a hard palate and an alveolar shoot is possible. In such cases sometimes at a palpation the pliability of a hard palate and a softening of an alveolar shoot, and also shaking of teeth of an upper jaw is defined. Destruction of a front wall of a Highmore's bosom is resulted by distribution of tumoral process on soft tissues of a cheek.

The tumor of a Highmore's bosom can get through a back wall into a pterygopalatine pole, affecting the maxillary nerve located in this area. It can serve as the reason of development of heavy neuralgic pains in the course of branches of a maxillary nerve. Along with painful pain disorder of sensitivity of skin of a cheek and upper lip is sometimes observed.

Malignant tumors of a genyantrum a long time proceed asymptomatically or mask clinic of chronic sinusitis. At further development of a tumor clinical manifestations are defined by its initial localization (perednenizhnevnutrenny, verkhnezadnevnutrenny, verkhnezadnenaruzhny, perednenizhnenaruzhny segments of a bosom) and the direction of growth.

For the new growths which are located in anteroinferiorly - an internal segment, unilateral disturbance of nasal breath, mucous, mucopurulent or bloody allocations is characteristic. The tumor extends in a nasal cavity, to an alveolar shoot, a hard palate, at destruction of a front wall of a bosom infiltrirut soft tissues of a cheek.

The clinical course of the tumor proceeding from a verkhnezadne-internal segment is characterized by a zatrudnennost of nasal breath, mucopurulent and bloody allocations from a nose. Further growth of a tumor leads to deformations in the field of a medial corner of an eye and to its shift up (at destruction of the lower wall of an orbit) and knaruzh (at destruction of an internal wall of an orbit and distribution to a trellised labyrinth).

The tumor proceeding from a verkhnezadnenaruzhny segment causes the expressed pains in the area II of a branch of a trifacial. At germination the phenomena of a contracture of masseters develop in chewing muscles and a pterygopalatine pole.
New growths of a perednenizhnenaruzhny segment cause pains, shaking of teeth, deformation of an alveolar shoot of an upper jaw in back departments. At destruction of a back wall the tumor burgeons in a temporal and mandibular joint, chewing muscles, a pterygopalatine pole and causes the expressed data of jaws.

Distinguish the following stages of cancer of Highmore's bosoms
in situ cancer (cancer 0 stages sometimes is called) – at the same time cancer cells are found only on the limited site of a mucous membrane, without getting more deeply than own plate mucous.
Cancer of the I stage. The tumor is found in only a mucous membrane of a nasal cavity or okolonosovy bosoms. Cancer at the same time does not pass to other departments.
Cancer of the II stage. At the same time the tumor passes to the bones surrounding okolonosovy bosoms or on a bone of a nose and the sky, but does not affect a bone of a back wall of a bosom or a base of skull.
Cancer of the III stage. At cancer at this stage the tumor is found in any of the listed places:
• Back bone wall of a bosom
• Fabrics under skin
• Eye-socket
• Base of skull
• Trellised bosoms.
At the same time on the party of defeat the increased lymph node in a neck can be noted up to 3 cm.
Cancer of the IV stage. This stage of cancer is divided in turn into 3 substages:
• A. Otmechayetsya's stage the increased lymph node in a neck from 3 to 6 cm, or several lymph nodes of a neck in any its area are affected. At the same time the tumor is found in the following areas:
o Back bone wall of a bosom
Fabric o under skin
o Eye-socket
o Base of skull
o Trellised bosoms.
• The stage V. Opukhol burgeons to the following areas:
o Behind an eye
o In a brain
o In a middle part of a skull
o In the nerves leaving a skull
o the Upper part of a throat behind a nose
o In a base of skull.
o Or on a neck is noted a lymph node more than 6 cm.
• The stage S. Opukhol can be in any area of a bosom or about it, at the same time there are metastasises in the remote bodies, for example, in lungs.

Diagnosis:

Diagnosis of malignant new growths of a Highmore's bosom includes: careful collecting the anamnesis, external survey and a palpation, an oroskopiya, a front and back rinoskopiya, a faringoskopiya, a manual research of a nasopharynx, a nasopharynx fibroskopiya, X-ray inspection, a morphological research of punctate from a bosom or a piece of fabric from a nose tumor.

In specification of the diagnosis X-ray inspection is of great importance (a X-ray analysis of bones of a facial skull in semi-axial, nosopodborodochny and slanting projections, including with use of contrast agents, a tomography, a computer tomography). In some cases the diagnostic maxillary sinusotomy with a biopsy as the radiological method in the absence of clinical signs of a malignant tumor has no crucial importance can be the final stage of diagnosis. It is necessary to include a X-ray analysis of bodies of a thorax and ultrasound examination of abdominal organs in a clinical minimum of inspection.

Cancer therapy of a Highmore's bosom:

Treatment of malignant tumors of Highmore's bosoms combined. Surgical and beam methods can be used at limited exophytic tumors of a nasal cavity with a clear boundary.

At the first stage of the combined treatment the remote gamma therapy in a total focal dose of 40-45 Gr is carried out. Radiation is carried out preferential from two fields - front and side which sizes are defined depending on distribution and the direction of growth of a tumor. At radiation of a trellised labyrinth use three fields (front and two side). The volume of the irradiated fabrics join retropharyngeal lymph nodes. Submaxillary and cervical lymph nodes irradiate at the confirmed metastatic defeat. In 3-4 weeks after completion of radiation therapy operation is carried out.

Cancer of a genyantrum is the indication to full removal of a jaw (preferably electrosurgical) or to expanded operations with access according to Moore. The electrosurgical method consists in a step-by-step provarivaniye of the deleted fabrics by means of bipolar electrodes. Delete the welded fragments of the affected upper jaw together with a medial wall of a genyantrum, nasal sinks, and then front, average and back cells of a trellised labyrinth. At destruction of bone walls of an orbit carry out an ekzenteration. Limited germination of a tumor in a head cavity is the indication to a kraniofatsialny resection. Due to the spoiling effects of surgical interventions it is necessary to include an ekzoprotezirovaniye or plastic substitution of postoperative defects in treatment planning.

Postoperative radiation (remote gamma therapy, contact, interstitial radiation therapy) is shown in the absence of confidence in radicalism of an operative measure or existence of a residual tumor.

Surgical interventions on the regional lymphatic device (cervical fascial футлярная a limfadenektomiya, Krayl's operation) carry out at clinically defined metastasises within the combined treatment. The preventive limfadenektomiya is not made.

To patients at whom it is impossible to execute the radical combined treatment because of prevalence of process or because of the general contraindications carry out himioluchevy treatment or a remote beam gamma therapy but the radical program in a dose of 70 Gr with obligatory reduction of volume of radiation after leading of a dose of 40-50 Gr. Himioluchevy treatment is also method of the choice of therapy of nizkodifferentsiro-bathing tumors of a nasal cavity and adnexal bosoms.

Medicinal treatment is applied as neoadjuvant chemotherapy or with the palliative purposes within himioluchevy treatment. The following drugs and their combinations can be used: 5-ftoruratsit, adriamycin, a methotrexate, Cisplatinum, Bleomycinum, including in the form of regional arterial chemotherapy.

Recurrence of tumors of Highmore's bosoms arises usually within the first year after operation. Their treatment comes down to radiation (taking into account earlier brought dose) or a combination therapy in various options.

Prevention:

Prevention consists in timely treatment of precancerous diseases, refusal of smoking, improvement of working conditions on harmful productions.