Cancer of mucous membranes of a mouth

Description:

Malignant tumors of a mucous membrane of an oral cavity and stomatopharynx make okolo1,5% of all tumors at the person. Occurs at men most often at the age of 40-60 years and by 4 times more often than at women.

Symptoms of Cancer of mucous membranes of a mouth:

The clinical course of cancer tumors of bodies of an oral cavity can conditionally be divided into three phases or the period: initial, developed and the neglect period.

Initial stage. At this time patients most often note unusual feelings in a zone of the pathological center. At survey of an oral cavity various changes can be found: consolidation of a mucous membrane, consolidation of fabrics, superficial ulcers, papillary new growths, white spots, etc. During this period it is necessary to examine carefully bodies of an oral cavity as  the analysis of observations shows that nearly 10% of cases at the first addresses to the doctor focal lesions on a mucous membrane were not revealed.

Pains which usually force to see a doctor, are noted during an initial stage of development of cancer approximately in 25% of cases. However more than in 50% of cases of pain connect with quinsy, a disease of teeth, etc. Especially often it is observed at cancer with localization in a back half of an oral cavity and alveolar edge of a jaw. Quite often the attention of doctors goes on a false way.

During an initial stage of development of cancer of bodies of an oral cavity it is reasonable to allocate three anatomic forms: a) ulcer; b) knotty; c) papillary.

The ulcer form is observed most often, approximately at 50% of patients the sizes of an ulcer increase slowly, at others quickly. Conservative treatment, as a rule, does not lead to reduction of an ulcer. It can be told also about two following forms.

The knotty form is shown by consolidation in a mucous membrane with whitish spots around or hardening in fabrics. In the latter case the mucous membrane over hardening can be not changed. Consolidations usually have a clear boundary and develop quicker, than at an ulcer form.

The papillary form is characteristic existence of dense outgrowths over a mucous membrane. They quickly develop and are often covered with an undisturbed mucous membrane.
Developed the period. At this time there are numerous symptoms. First of all almost all patients are disturbed by pains of different intensity though sometimes, even at the big sizes of tumors, pains can be absent. Pains become painful, have local character or irradiate to this or that area of the head, is more often in the corresponding ear, temporal area. At many patients the sialosis as a result of irritation of a mucous membrane tumor decomposition products amplifies. A typical symptom is the fetid smell from a mouth - the satellite of disintegration and infection of a tumor.

In the mucous membrane of an oral cavity developed the period of cancer  we allocate two anatomic formy:1) an exophytic form (papillary - a tumor of a fungoid form  with blyashkovidny or papillary outgrowths; ulcer - existence of an ulcer with the regional roller of active tumoral growth, despite increase in its sizes it nevertheless remains superficial, and the tumoral roller as if delimits process)  and 2) an endophytic form (ulcer and infiltrative - an ulcer on massive tumoral infiltrate. Ulcers often take a form of deep cracks;  the infiltrative form is characterized by diffusion defeat of body. The mucous membrane at these new growths does not ulcerate).

The division cancer of a mucous membrane of an oral cavity  on anatomic forms pursues the aim of specification of nature of growth of a tumor and identification of species of treatment. Clinical experience shows that the endophytic forms of tumors which are characterized by diffusion growth have more malignant current, than exophytic forms with the delimited growth type.

Neglect period. Cancer of a mucous membrane of an oral cavity, quickly extending, destroys surrounding fabrics and it has to be carried to those tumors which we consider exclusively aggressive and malignant.

It should be noted that in general cancer of a mucous membrane of a back half of an oral cavity proceeds more zlokachestvenno, than a lobby, to treat cancer of bodies  of a back half of an oral cavity also much more difficultly.

Language cancer - most often develops in an average third of its side surface (62-70%) and in a root. Much less often it arises on the lower surface of language, sometimes - on a dorsal surface (7%) and a language tip (3%). Cancer of a root of language  is observed according to different data in 20 - 40% of cases. More often it is planocellular cancer of various differentiation. The malignant tumors proceeding from small sialadens in language develop approximately in 1,5-3% of cases. In a back part of language sometimes there are malignant lymphoma.

Cancer of a mouth floor - makes 20% of all planocellular crayfish of an oral cavity, of them about 3% - adenocarcinomas of small sialadens. Often the mouth floor infiltrirutsya for the second time by malignant tumors of language, a gingiva, mandible, submaxillary sialadens.

The request of patients for medical assistance at early stages is observed seldom. It is necessary to face more often tumoral processes when consecutive infection joins them and pain develops. Quite often at the first address to the doctor spread of a tumor is defined on a mandible and muscles of a mouth floor. During this period approximately at one third of patients regional metastasises are noted.


Cancer of a mucous membrane of a cheek - a histologic picture in this case same, as  at cancer of language and a mouth floor. However malignant tumors of small sialadens meet less often. Often mucous membrane of a cheek infiltrirutsya by a tumor for the second time from almonds, a lip and skin. Regional metastasises at the first address of patients to the doctor are observed seldom, the exception is made by the tumors which are localized in retromolar area and with their distribution on almonds and handles.

Cancer of a mucous membrane of the sky - on a hard palate the malignant tumors proceeding from small sialadens develop more often (an adenokistozny carcinoma - a tsilindroma, an adenocarcinoma). Slightly less often here enclavomas (polymorphic adenomas) which differential diagnosis is very often difficult the doge to histologists are observed. Planocellular cancer on a hard palate develops seldom. On a soft palate of a new growth, proceeding from small sialadens, are observed seldom and the absolute majority of tumors makes planocellular cancer. Such morphological feature of tumors of a hard and soft palate considerably affects in their clinical current.

Planocellular cancer of a hard palate quickly enough ulcerates, causing unpleasant feelings or pains. Patients usually see a doctor when tumors have still the small sizes.

The new growths proceeding from small sialadens a long time remain encapsulated, reaching sometimes the considerable sizes. Such patients have the first and main complaint - existence of a tumor on a hard palate. In process of increase in the sizes of a new growth its pressure upon a mucous membrane amplifies and there is a site of an ulceration, then the infection joins, and there are pains. It must be kept in mind that adenocarcinomas and enclavomas of a hard palate during an initial stage of development a long time have similarity and mainly keep a tendency to the encapsulated growth. Then the adenocarcinoma burgeons and destroys the subject bone structures.

Cancer of a mucous membrane of alveolar edge of the lower and upper jaws
These new growths almost always have a structure of planocellular cancer. They prove early enough as teeth are involved in process and there is a dentagra. Quite often concerning these pains treatment and even an odontectomy is made. The unreasonable odontectomy promotes spread of a cancer tumor to a tooth hole, and behind that in a bone. During an initial stage the tumor usually happens local and bleeds at a touch. Infiltration of the subject bone tissue (alveolar edge of the lower or upper jaw) happens several months later and has to be considered as late display of a disease. Extent of spread of a tumor is defined on a bone radiological, however it must be kept in mind that chronic diseases of teeth also cause a picture of demineralization of a bone tissue. The cancer tumor of gums depending on localization extends also to a mucous membrane of a cheek, the sky or a mouth floor. Regional innidiation is observed early and diagnosed approximately for  a third of patients. The malignant tumors proceeding from small sialadens meet seldom.

Reasons of Cancer of mucous membranes of a mouth:

In most cases they develop on patholologically the changed fabrics. Most often it is long the proceeding inflammatory processes of various etiology and dyskeratoses which belong to a so-called precancer. The significant role in development of pathological processes in an oral cavity is played by such addictions as smoking, abuse of hard alcoholic drinks, the use of NASA at the people of Central Asia, the people of India have a chewing of leaves of a betel. Also  such factors as the chronic mechanical injury caused by the destroyed tooth crown, a keen edge of a seal or poor made prosthesis. A certain value for development of pretumor states has also character of food. Insufficient contents in food of vitamin A or disturbance of its comprehensibility an organism leads to change of processes of keratinization. Undoubtedly and adverse effect of the systematic use of too hot and spicy food.

Cancer therapy of mucous membranes of a mouth:

Treatment of patients with cancer of a mucous membrane of an oral cavity can be divided into two stages conditionally: treatment of primary center and treatment of regional metastasises.

The I stage - treatment of primary center.
For treatment of primary new growth use the beam, combined and surgical methods.
Beam method. One of the most widespread methods of cancer therapy of a mucous membrane of an oral cavity and stomatopharynx. It is applied at 88,7% of patients with tumors of bodies of an oral cavity, and at 72,4% - as an independent method. It is recognized as the main thing in treatment at early stages of development of tumors.
  The remote gamma therapy is most often used, also their combination is more rare intracavitary.

As for results, according to domestic and foreign authors at primary cancer of a mobile part of language corresponding  to I and II stages (T1 and T2), use of various techniques of radiation therapy allowed to cure respectively 70-85% and 38-56% of patients within 5 years. At cancer of the I stage of a mouth floor within 5 years 53 - 66% sick, and the II stages - 43-46% recover, at cheek cancer - 81 and 61% respectively.

Results of beam cancer therapy of a mucous membrane of an oral cavity of the III stage it is much worse - 16-25%.

The combined method. Now  in our country the combined method of cancer therapy of a mucous membrane of an oral cavity which main component is operation is widely applied. Most of specialists at the first stage of treatment recommend a remote gamma therapy, and on the second - an operative measure. Doses of preirradiation make 35-45 Gr.
Favorable results of the 5 years' combined cancer therapy of language I and II of stages are comparable with results only of beam impact on a tumor and sostavlt 80-94% and 39-65% respectively. At tumors of other localizations of I and II stages long treatment is reached at 30-53% of patients with cancer of a mouth floor, at 42,8% - an alveolar shoot of a mandible and respectively at 94 and 65% of patients with cancer of a cheek.

At a disease of the III stage results of the combined cancer therapy of any localization in an oral cavity made to 37% of izlecheniye within 5 years.
This method is used as the leader at locally-spread cancer. The main component is operation, its volume has to correspond to extent of spread of primary tumor, a form of its development and its histologic structure.

Surgical method.
In surgery of language the half electroglossectomy is widely applied so far. This operation is carried out both at cancer of the I-II stages, and at big tumors as a part of the combined interventions (on 2 and more bodies). Excision borders - not less than 2-4 cm of healthy fabrics.
At locally-spread cancer of a mobile part of language and a mouth floor the combined half electroglossectomy  with a resection of a mouth floor (is carried out at indications and a mandible resection) with single-step plastics musculocutaneous rags of defects of fabrics of language and a mouth floor.

The II  stage - tactics of impact on zones of regional innidiation
Regional metastasises of cancer of mucous membrane of an oral cavity of all localizations are observed in 23-40% of cases. The greatest percent of metastasises in lymph nodes of a neck is noted at primary tumor of 4 cm in size and more. Tell the following data of domestic and foreign authors about influence of regional metastasises on destiny of patients. At primary tumor of 4 cm and more with morphologically confirmed metastasises in течениек 5 years are live without recurrence and metastasises only of 17-20% of patients. Irrespective of the sizes of primary tumor with regional metastasises 9-33% of patients are living, and at their absence - 50-70%. The leading method of treatment of regional metastasises is the surgical method.

Excision of cellulose of a neck and Krayl's operation are for this purpose carried out fascial футлярное.

For the purpose of prevention of development of regional metastasises a number of radiologists use elective radiation of zones of regional lymphatic outflow.