Daim tawv nqaij carcinoma yog ib hom qog nqaij hlav qog nqaij hlav uas tsim los ntawm cov hlwb ntawm cov ntaub so ntswg ntawm ntau yam kabmob (cov qog nqaij hlav, tawv nqaij thiab ntau yam kabmob hauv nruab nrog cev).
Cov qog nqaij hlav tawv nqaij yog cov qog nqaij hlav ntawm daim tawv nqaij ntawm qhov xwm txheej phem, uas tshwm sim los ntawm kev hloov pauv ntawm nws cov hlwb, yog tus cwj pwm los ntawm kev muaj zog polymorphism. Muaj plaub yam tseem ceeb xws li mob qog noj ntshav, basal cell, squamous cell, melanoma thiab adenocarcinoma, txhua tus muaj nws cov ntaub ntawv kho mob.
tawv nqaij hlav
Nyob rau hauv tag nrho cov qog malignant, daim tawv nqaij carcinoma yog li kaum feem pua. Cov kws kho mob dermatologists tam sim no tham txog kev nce siab hauv qhov xwm txheej nrog qhov nruab nrab nce ntawm 4.4% hauv ib xyoos. Qhov mob qog noj ntshav no feem ntau tshwm sim hauv cov neeg laus, tsis hais lawv poj niam txiv neej. Cov neeg tawv nqaij tawv tshwj xeeb tshaj yog predisposed rau cov tsos mob ntawm tus kab mob, nrog rau cov neeg uasnyob rau hauv tej yam kev mob ntawm insolation muaj zog (highlands thiab kub lub teb chaws) thiab nyob nraum zoov ntev.
Ntawm tag nrho cov xwm txheej ntawm cov kab mob oncology, 11 txog 25% ntawm nws daim ntawv squamous thiab 60 txog 75% - basal cell cancer. Txij li thaum txoj kev loj hlob ntawm basal cell thiab squamous cell daim tawv nqaij cancer yog nqa tawm los ntawm cov epidermal hlwb, cov kab mob no kuj hu ua malignant epitheliomas.
Kev tshwm sim
Ntawm cov laj thawj uas ua rau muaj kev hloov pauv tsis zoo ntawm cov hlwb ntawm daim tawv nqaij, thawj qhov chaw yog ntau dhau ntawm cov hluav taws xob ultraviolet. Qhov no ua pov thawj qhov tseeb tias kwv yees li 90% ntawm cov qog nqaij hlav ntawm daim tawv nqaij tshwm sim hauv qhov chaw qhib ntawm lub cev (caj dab, ntsej muag), uas feem ntau raug hluav taws xob. Rau cov neeg uas muaj tawv nqaij ncaj ncees, cov nyhuv ntawm ultraviolet rays dhau los ua qhov txaus ntshai tshaj plaws.
Cov tsos mob ntawm daim tawv nqaij tuaj yeem tshwm sim los ntawm kev cuam tshuam rau qee yam tshuaj uas muaj cov nyhuv carcinogenic: lubricants, tar, cov pa luam yeeb thiab arsenic. Cov cua kub thiab hluav taws xob uas ua rau ntawm daim tawv nqaij tuaj yeem ua rau mob qog noj ntshav. Piv txwv li, mob qog noj ntshav ntawm daim tawv nqaij tuaj yeem dhau los ua qhov teeb meem ntawm hluav taws xob dermatitis lossis loj hlob hauv qhov chaw kub hnyiab. Kev raug mob ntau zaus rau moles lossis caws pliav tuaj yeem ua rau lawv qhov kev hloov pauv tsis zoo nrog cov tsos mob qog noj ntshav.
Genetics
Cov yam ntxwv ntawm cov kab mob hauv lub cev tuaj yeem ua rau muaj qhov tshwm sim ntawm daim tawv nqaij carcinoma,uas ua rau tsev neeg muaj tus kab mob. Tsis tas li ntawd, ntau cov kab mob ntawm daim tawv nqaij muaj peev xwm ua rau muaj kev hloov pauv mus rau cov qog nqaij hlav ntawm daim tawv nqaij thaum lub sijhawm. Xws li pathologies yog cov mob precancerous. Lawv cov npe muaj xws li Bowen's disease, erythroplasia, leukoplakia, xeroderma pigmentosum, cutaneous horn, senile keratoma, melanoma-dangerous nevi (nevus of Ota, giant nevus, blue nevus, complex pigmented nevus), Dubreuil's melanosis, chronic sphids, les inflammatory lesion (LES)., tuberculosis, trophic ulcers, thiab lwm yam).
Kev faib tawm
Muaj cov qauv hauv qab no ntawm hom mob qog noj ntshav:
- Squamous cell verrucous carcinoma ntawm daim tawv nqaij, los yog squamous cell hlav, uas tsim los ntawm squamous hlwb ntawm epidermal txheej txheej.
- Daim tawv nqaij adenocarcinoma yog ib hom qog nqaij hlav uas tsis tshua muaj tshwm sim los ntawm hws lossis qog sebaceous.
- Basal cell carcinoma ntawm daim tawv nqaij, lossis basalioma, - tshwm sim nrog kev hloov pauv ntawm cov kab mob epidermal basal nyob hauv qab cov hlwb thiab muaj cov kab sib npaug. Cov classic, feem ntau ntau yam yog daim ntawv nodular (micronodular), uas suav txog li 75% ntawm cov neeg mob. Nws yog tus cwj pwm los ntawm kev tsim cov qog ua haujlwm tseem ceeb - cov nodules tuab txog li 2-5 millimeters hauv txoj kab uas hla, uas, raws li qhov tshwm sim ntawm lub sijhawm ntev ntawm kev muaj sia nyob, sib cuam tshuam. Yog li, lawv tsim cov qog ua kom pom tseeb nrog txoj kab uas hla mus txog ob centimeters. Micronodular basal cell carcinoma ntawm daim tawv nqaij tej zaum yuav pigmented los yog ulcerative.
- Melanoma yog cov qog ntawm daim tawv nqaij uas tshwm sim los ntawm nws cov melanocytes, uas yog, cov xim xim. Muab rau hauv tus lej ntawm cov cim qhia ntawm melanoma, cov kws sau ntawv niaj hnub no feem ntau sib npaug lo lus "mob qog noj ntshav" nrog rau mob qog noj ntshav tsis yog melanoma.
Symptoms of skin carcinoma
Squamous cell daim tawv nqaij mob qog noj ntshav yog tus cwj pwm los ntawm kev sib kis sai thiab loj hlob ob qho tib si hauv qhov tob thiab ntawm qhov chaw ntawm daim tawv nqaij. Lub germination ntawm cov qog nyob rau hauv cov ntaub so ntswg nyob rau hauv daim tawv nqaij (cartilaginous, pob txha, cov leeg), los yog ntxiv rau ib tug inflammatory txheej txheem, yog nrog los ntawm qhov pib ntawm mob syndrome. Squamous cell daim tawv nqaij mob qog nqaij hlav zoo li nodule, plaque, los yog ulcer.
Daim ntawv rwj ntawm cov qog nqaij hlav qog nqaij hlav qog nqaij hlav zoo li lub qhov txhab zoo li lub qhov txhab, uas nyob ib puag ncig, zoo li cov menyuam yaus, los ntawm nruj tsa thiab tawg sai sai. Lub rwj muaj ib qho tsis sib xws hauv qab, nws yog them nrog crusts ntawm qhuav ntshav-serous exudate. Nws tsw tsw phem heev. Cov quav hniav ntawm cov qog nqaij hlav qog nqaij hlav qog nqaij hlav muaj lub ntsej muag liab liab, lub ntsej muag thiab lub ntsej muag tuab. Nws feem ntau los ntshav thiab loj hlob sai.
Nyob rau hauv squamous cell carcinoma ntawm daim tawv nqaij ntawm lub ntsej muag ntawm daim tawv nqaij, lub pob loj ntawm lub pob ua rau nws cov duab zoo li cov nceb lossis zaub paj. Tus cwj pwm los ntawm xim av lossis xim liab ci, muaj qhov ntom ntom ntom ntom ntawm cov qog. Nws nto yuav ulcerate los yog erode.
Basal cell qog
Basal cell hlav ntawm daim tawv nqaij muaj ntau duaqeeb thiab benign chav kawm piv rau squamous. Tsuas yog nyob rau hauv cov xwm txheej zoo nws loj hlob mus rau hauv cov ntaub so ntswg hauv qab nws, ua rau mob. Raws li txoj cai, metastasis tsis tuaj. Basal cell carcinoma yog tus cwj pwm los ntawm ntau dua polymorphism, uas tuaj yeem sawv cev los ntawm turban, flat superficial, sclerodermiform, nodular, pigmented, cicatricial-atrophic, perforating, warty thiab nodular-ulcerative forms. Feem ntau ntawm cov kev kho mob hom basalioma pib nrog tsim ntawm ib tug me me nodule ntawm daim tawv nqaij. Neoplasms hauv qee kis yuav muaj ntau yam.
Qhov chaw
Carcinoma ntawm daim tawv nqaij ntawm lub ntsej muag feem ntau tshwm sim ntawm thaj chaw uas muaj cov qog sebaceous thiab hws. Cov no muaj xws li puab tais, armpits, folds nyob rau hauv lub mammary qog. Adenocarcinoma pib nrog kev tsim cov papule me me los yog cov nodule cais. Hom mob qog nqaij hlav ntawm daim tawv nqaij tsis tshua muaj qhov loj hlob qeeb. Tsuas yog qee qhov tuaj yeem loj qhov ntev (kwv yees li yim centimeters hauv txoj kab uas hla) thiab nkag mus rau hauv fascia thiab cov leeg ua tiav.
Pigmented lossis depigmented
Feem ntau, melanoma yog cov qog pigmented uas yog grey, xim av lossis xim dub. Tab sis cov xwm txheej ntawm depigmented melanomas paub. Nyob rau hauv tus txheej txheem ntawm kev loj hlob ntawm daim tawv nqaij melanoma qog, ib theem ntsug thiab kab rov tav yog txawv. Nws cov kev kho mob sib txawv yog sawv cev los ntawm nodular, superficialkis thiab lentigo melanoma.
Diagnosis
Cov neeg uas xav tias muaj kab mob ntawm daim tawv nqaij ntawm lub ntsej muag thiab lub cev yuav tsum sab laj nrog kws kho mob dermato-oncologist. Tus kws kho mob tshwj xeeb tshuaj xyuas qhov tsim thiab lwm qhov chaw ntawm daim tawv nqaij, ua dermatoscopy thiab palpation ntawm cov qog ntshav hauv cheeb tsam.
Tsim kom muaj qhov tob ntawm cov qog, nrog rau kev nthuav dav ntawm cov txheej txheem kab mob yog ua los ntawm ultrasound. Tsis tas li ntawd, siascopy yog tshuaj rau pigmented formations.
Tsuas yog cov kev tshawb fawb histological thiab cytological tuaj yeem lees paub lossis lees paub qhov kev kuaj mob ntawm "mob tawv nqaij". Kev tshuaj xyuas cytological yog ua los ntawm kev siv cov tshuaj microscopy ntawm cov xim tshwj xeeb uas ua los ntawm kev yaig lossis qhov chaw mob qog noj ntshav.
Histological kuaj mob
Histological kuaj mob ntawm daim tawv nqaij yog ua los ntawm cov khoom tau tom qab tshem tawm cov neoplasm lossis los ntawm daim tawv nqaij biopsy. Nyob rau hauv qhov tsis muaj kev ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij hla lub qog, cov khoom siv biopsy yog coj los ntawm txoj kev puncture. Yog hais tias qhia, ib qho lymph node biopsy yog ua tiav. Histology txiav txim siab qhov muaj cov hlwb atypical, lawv cov keeb kwm (glandular, melanocytes, basal, ca) thiab qib sib txawv.
Nyob rau hauv cov txheej txheem ntawm kev kuaj mob qog noj ntshav, qee zaum nws yuav tsum tsis suav nrog nws cov keeb kwm thib ob, uas yog, muaj cov qog nqaij hlav hauv nruab nrog cev. Qhov no yog tshwj xeeb tshaj yog muaj tseeb rau adenocarcinomas ntawm daim tawv nqaij. Rau qhov no, ultrasound ntawm lub cev ntawm lub plab kab noj hniav, pulmonary radiography, CT ntawm lub raum, scintigraphy yog ua.ntawm lub cev pob txha, sib piv urography, CT thiab MRI ntawm lub hlwb ntawm lub taub hau, thiab lwm yam. Cov kev ntsuam xyuas tib yam yuav tsum tau kuaj xyuas cov xwm txheej ntawm cov qog nqaij hlav sib sib zog nqus los yog nyob deb ntawm metastases.
daim tawv nqaij mob cancer kho li cas?
Txoj kev kho mob
Txoj kev kho mob raug xaiv raws li qhov tshwm sim ntawm cov txheej txheem, nws hom, qib sib txawv ntawm cov qog nqaij hlav cancer. Lub hnub nyoog ntawm tus neeg mob thiab qhov chaw ntawm daim tawv nqaij hlav kuj raug coj mus rau hauv tus account.
Lub hom phiaj tseem ceeb hauv kev kho mob ntawm daim tawv nqaij yog kev tshem tawm radical. Nws yog tsuas yog ua phais, nrog kev pab los ntawm excision ntawm pathologically hloov ntaub so ntswg. Kev cuam tshuam yog nqa tawm nrog kev ntes ntawm 1-2 centimeters ntawm cov ntaub so ntswg zoo. Txhawm rau ua tiav kev ua haujlwm, ua kom tsawg kawg ntawm cov ntaub so ntswg noj qab haus huv thiab tshem tawm tag nrho cov hlwb ntawm cov qog nqaij hlav qog noj ntshav kom tiav, ua rau nws muaj peev xwm ua tau qhov kev kuaj mob microscopic ntawm thaj chaw marginal ntawm thaj chaw raug tshem tawm. Kev txiav tawm ntawm daim tawv nqaij tuaj yeem ua tau siv cov pa roj carbon dioxide lossis neodymium laser, uas txo cov ntshav thaum muaj kev cuam tshuam thiab muab cov txiaj ntsig zoo nkauj zoo nkauj.
Cov neoplasms me me (ib mus rau ob centimeters), nrog me ntsis ntawm cov qog loj hlob mus rau hauv cov ntaub so ntswg, curettage, electrocoagulation lossis laser tshem tawm tuaj yeem siv tau. Yog tias electrocoagulation ua tiav, nws yog qhov tsim nyog los ntes cov ntaub so ntswg noj qab haus huv los ntawm 5-10 millimeters. Superficial, minimally invasive and well-differentiated forms of skin cancer tej zaum yuav raug cryodestruction, thaum cov ntaub so ntswg noj qab haus huv raug ntes.2-2.5 cm siab. Txij li thaum cryodestruction tsis tso cai rau kev soj ntsuam histological ntawm cov khoom tshem tawm, nws tuaj yeem ua tau tsuas yog tom qab kuaj pom ua ntej, thaum muaj qhov sib txawv siab thiab qis qis ntawm cov neoplasm tau lees paub.
mob qog noj ntshav ntawm daim tawv nqaij uas cuam tshuam rau thaj chaw me tuaj yeem kho tau zoo nrog kev tsom mus ze rau X-ray kho. Txhawm rau kho cov tawv nqaij thiab tib lub sijhawm loj neoplasms, irradiation nrog lub teeb hluav taws xob yog siv. Tom qab cov qog raug tshem tawm, txoj kev kho hluav taws xob tau muab rau cov neeg uas muaj feem ntau ntawm metastasis thiab rov ua dua ntawm daim tawv nqaij. Nws kuj yog siv los txo cov metastases, nrog rau txoj kev palliative rau inoperable oncology.
Kev siv cov kev kho mob photodynamic tau tso cai, nyob rau hauv uas irradiation yog nqa tawm nrog kev taw qhia ntawm ib tug photosensitizer. Cov txiaj ntsig zoo hauv basalioma tso cai rau koj kom tau txais kev kho mob hauv zos nrog cytostatics.
Huab cua
mob qog nqaij hlav tawv nqaij muaj ib qho ntawm cov neeg tuag tsawg tshaj plaws piv rau lwm cov kab mob oncological. Qhov no feem ntau nyob ntawm qhov sib txawv ntawm cov qog hlwb thiab hom mob qog noj ntshav.
Dab tsi yog qhov tshwm sim rau basal cell carcinoma ntawm daim tawv nqaij? Daim ntawv no ntawm oncology muaj cov chav kawm zoo dua qub, tsis muaj metastasis. Yog tias squamous cell carcinoma raug kho raws sijhawm, qhov kev muaj sia nyob tsib xyoos yog 95%. Qhov kev kwv yees tsis zoo tshaj plaws hauv cov neeg uas muaj melanoma, daim duab no tsuas yog 50%
