Disease of the parliamentary gland of the ICD 10. Inflammation caused by the ingress of infectious agents or power adhesion of the near-dry salivary gland: symptoms and features of therapy of the disease. What substances lead to a catastrophe
RCRZ (Republican Center for Health Development MD RK)
Version: Clinical Protocols MOR RK - 2015
Malignant neoplasm of other and unspecified large salivary glands (C08), malignant neoplasm of the variety of salivary gland (C07)
Oncology
general information
Short description
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Ministry of Health
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from October 30, 2015
Protocol No. 14.
Zno salivary gland- malignant tumor, affecting the tissue of salivary gland, located in the parole, submandibular, approximal regions and oral cavity. In the human body there are two groups of salivary glands: the parole, submandibular and sublard. The first are located in each cheek at one level with the ears, they saliva they allocate in purph cavity From the inside of the cheeks, at the level of the upper jaw teeth. The glands of the second group are placed under the bottom of the oral cavity, saliva falls into the sublabit space.
The etiological factors up to the present remaining not clarified. People are sick in all ages, regardless of gender. The main factor determining the choice of therapeutic tactics serve the morphological structure of the tumor. With malignant neoplasms, a combined method of treatment is predominantly used. (UD - a).
Protocol name:Malignant neoplasms of salivary glands
Protocol code:
ICB -10 code:
C 07 malignant neoplasm of the parole salivary gland;
With 08 malignant neoplasm of other and unspecified large salivary glands.
Abbreviations used in the Clinical Protection:
|
Alt.alaninotransferase ASTaspartataminotransferase Achtvactivated partial thromboplastin time v / B.intravenously v / M.intramuscular HIVaIDS virus G.gray IFAlinked immunosorbent assay Elfunits Zhkt.gastrointestinal tract Znomalignant neoplasm IGS.true voice bunch IFAlinked immunosorbent assay Kt.cT scan LT.radiation therapy N.international Normalized Attitude MRImagnetic resonance imaging Oakgeneral blood analysis OAMgeneral urine analysis pCsubcutaneous Birdprotombian index PATpositron-emission tomography Rankone-time focal dose SPPfreshly frozen plasma Sodatotal focal dose SCS.the cardiovascular system UDGultrasonic Doppler Ultrasoundultrasound procedure ECGelectrocardiogram Ehocheechocardiography per Os.orally TNM.Tumor Nodulus MetaStasis - international Classification Stages of malignant neoplasms |
Protocol revision date:2015 year.
Protocol users:oncologists, maxillofacial surgeons, otorhinolaryngologists, general practitioners, emergency doctors and emergency care.
Assessment on the degree of evidence of the recommendations given.
The scale of the level of evidence:
| BUT | High-quality meta-analysis, systematic Overview of RCA or large RCCs with a very low probability (++) systematic error, the results of which can be distributed to the corresponding population. |
| IN | High-quality (++) systematic overview of cohort or studies Case-control or high-quality (++) cohort or studies Case control with a very low risk of systematic error or RCK with not high (+) risk of systematic error, the results of which can be distributed to the appropriate Population. |
| FROM |
Cohort or study case-monitoring or controlled study without randomization with a low risk of systematic error (+). The results of which can be distributed to the appropriate population or rock with a very low or low risk of systematic error (++ or +), the results of which cannot be directly distributed to the corresponding population. |
| D. | A description of a series of cases or an uncontrolled study, or the opinion of experts. |
| GPP. | Best pharmaceutical practice. |
Classification
Classification of tumors of salivary glands. (UD - a).
System classificationTNM.:
T - Primary tumor:
· TX - not enough data to estimate the primary tumor;
· To - the primary tumor is not determined;
· T1 - tumor up to 2 cm in the greatest measurement without distribution beyond the limits of the gland;
· T2 - tumor up to 4 cm in the greatest measurement without distribution beyond the limits of the gland;
· T3 is a tumor with the distribution of parenchyma without damage to the nerve VII and / or from 4 to 6 cm in the greatest measurement;
· T4-tumor more than 6 cm in the largest measurement with the distribution of parenchyma, on the bone lower jaw, external hearing pass and / or with a damage to the VII nerve;
· T4B is a tumor applies to the base of the skull, the staple space, the inner carotid artery.
N -regional the lymph nodes (Common for head and neck tumors):
· Nx - not enough data to assess the state of regional lymph nodes;
· N0 - no signs of metastatic lesion of regional lymph nodes;
· N1 - metastases in one lymph node on the side of the lesion up to 3 cm and less in the greatest measurement;
· N2 - metastases in one or more lymph nodes on the side of the lesion to 6 cm in the greatest measurement or metastase in the lymph nodes of the neck on both sides, or from the opposite side to 6 cm in the largest measurement;
· N2A - metastases in one lymph node on the side of the lesion up to 6 cm in the largest dimension;
· N2B - metastases in several lymph nodes on the side of the lesion to 6 cm in the largest dimension;
· N2C - metastases in lymph nodes on both sides or from the opposite side to 6 cm in the largest measurement;
· N3 - metastasis in the lymph node more than 6 cm largest measurement.
M -remote metastasis.
MX - not enough data to determine remote metastases;
M0 - no signs of remote metastases;
M1 - There are distant metastases.
pTNM Pathogistological classification
Requirements for the definition of categories of RT, Pn and PM meet the requirements for the definition of categories T, N and M.
Histopathological differentiation.
Degree of malignancy (G) carcinoma:
GX - the degree of differentiation cannot be installed;
G1 is a high degree of differentiation;
G2 is a moderate degree of differentiation;
G3 - Low degree of differentiation;
G4 - undifferentiated carcinoma.
For some tumors of the salivary glands, which the above-mentioned gradation system is not applicable, use independent systems for determining the degree of malignancy.
The degree of malignancy (G) of adenocystial cancer:
G1 is a tumor mainly tubular structure, without a solid component;
G2 is a tumor predominantly a cryrridge structure, a solid component up to 30%;
G3 is a solid component in the tumor more than 30%.
Histological classification.
The most frequent morphological forms of malignant tumors of the salivary glands are: Mukoepidermoid cancer, an acid-cell cancer, adenokystous cancer and nonspecific adenocarcinoma.
The following histological classification of the tumors of the salivary glands (WHO, 2005) is recommended (Limphomas and sarcoma are not included):Malignant epithelial tumors:
· Azinelic cancer (low-grade tumor);
· Adenokistal cancer (degree of malignancy is determined by the number of solid component);
· Nonspecific adenocarcinoma (low, intermediate and high degree of malignancy);
· Basal cell adenocarcinoma (low malignancy tumor);
· Carcinoma ex-pleomorphic adenoma;
· Low degree of malignancy;
· High degree of malignancy;
· Invasive;
· Non-invasive (intrakapsular);
· Metastasive pleomorphic adenoma;
· Mukoepidermoid cancer (low, intermediate and high degree of malignancy);
· Polymorphic adenocarcinoma of a low degree of malignancy (low malignancy tumor);
· Epithelial and myoepithelial carcinoma;
· Silent carcinoma (high degree of malignancy tumor);
· Popples cystadecarcinoma;
· Cystadecarcinoma;
· Cryburiform Cystadecarcinoma of a low degree of malignancy;
· Cancer of ducts of the salivary glands (high degree of malignancy tumor);
· Oncocyte carcinoma;
· Music adenocarcinoma;
· Nonspecific lightweight carcinoma;
· Myoepithelial carcinoma (low or high degree of malignant);
· Silent lymphadenocarcinoma;
· Flake carcury cancer (low, intermediate and high degree of malignancy);
· Large cell cancer (high-quality tumor);
· Fleecellular cancer (high-quality tumor);
· Carcinosarkom (metaplastic cancer);
· Lymphoepithelial cancer;
· Untifferentiated cancer;
· Sialoblastoma.
Table 1. Grouping in the stages of cancer of the salivary glands.
| StageI. | T1. | N0. | M0. |
| StageII. | T2. | N0. | M0. |
| StageIII |
T3. T1. T2. T3. |
N0. N1 N1 N1 |
M0. M0. M0. M0. |
| StageIVBUT |
T1. T2. T3. T4A. T4B |
N2. N2. N2. N2. (N0, N1) |
M0. M0. M0. M0. M0. |
| StageIVIN | T4B | any n3 | M0. |
| StageIVFROM | any T. | any n. | M1. |
Diagnostics
List of basic and additional diagnostic measures:
Main (mandatory) diagnostic surveys conducted on an outpatient level:
· Collect complaints and anamnesis;
· General physical examination;
· Ultrasound of salivary gland and lymphic nodes of the neck;
· Tonfigue aspiration biopsy from the tumor;
· cytological research;
· Histological study.
Additional diagnostic surveys conducted on an outpatient level:
· PET + CT;
The minimum list of the survey, which must be carried out in the direction of the planned hospitalization: according to the internal regulation of the hospital, taking into account the current order of the authorized body in the field of health.
Main (mandatory) diagnostic surveys conducted at the stationary level (for emergency hospitalization, diagnostic surveys are conducted on an outpatient basis):
· OAK;
· OAM;
· Biochemical blood test (total protein, urea, creatinine, glucose, alosa, asat, general bilirubin);
· Coagulogram (PH, prothrombin time, MNA, fibrinogen, ABTV, thrombin time, ethanol test, thrombotest);
· Determination of blood type on ABO standard serum;
· Determination of blood reserves;
· ECG Study;
· Radiography of chest organs in two projections.
Additional diagnostic surveys conducted at the stationary level (for emergency hospitalization, diagnostic surveys are incredited on an outpatient level)
· KT neck (in the prevalence of the process);
· MRI (in the prevalence of the process);
· CT of chest organs with contrasting (if there are metastases in the lungs);
· Continuous aspiration biopsy of increased lymph nodes of the neck (if there are increased lymph nodes);
· Uzi organs abdominal cavity and the retroperitoneal space (to eliminate the pathology of the abdominal cavity organs and the retroperitoneal space);
· EchoCG (patients of 70 years and older);
· UDG (with vascular lesions).
Diagnostic measures carried out at the emergency stage:
· Not held.
Diagnostic criteria for diagnosis:
Complaints and history.
· For the presence of a single limited displaceable tumor in the thickness of the salivary gland;
· Increase in cervical, pressed, sublectrous, submandibular, chin lymph nodes;
· Facial nerve lesions (partial and / or full paresis);
· pain syndrome;
· Fast tumor growth;
· Georce of tumor in the skin, oral cavity and the rotoglot (at the triggering processes).
Physical examinations:
· Palpator examination of the large salivary glands (consistency and soreness of the tumor, its size and displacement, clarity of the boundaries, the nature of the surface, the attitude towards the surrounding tissues (skin, mucous membrane, ear sink, a marshide process, lower jaw, throat));
· Visual assessment of the function of the mimic muscles, configuration of the face (face of the face nerve);
· Palparatory examination of the lymph nodes of the neck on both sides (the presence of increased lymph nodes of cervical, submandibular, pressed, subclavian regions, with clinically not determined metastases into lymph nodes - ultrasound of the neck);
· Orofaringoscopy (when inspecting the oral cavity and pharynx, determine the degree of opening of the mouth, there is or not there is an oral and pharynx cavity).
Laboratory research:
· Cytological study (an increase in the cell size up to a giant, change in the shape and number of intracellular elements, an increase in the size of the kernel, its contours, a different degree of maturity of the kernel and other cell elements, a change in the number and shape of the nucleus);
· Histological study (large polygonal or spiked cells with well-pronounced cytoplasm, rounded nuclei with clear nucleolines, with the presence of mitoses, cells are located in the form of cells and chickens with or without keratin formation, the presence of tumor emboliths in vessels, the severity of lymphocytic-plasmocyte infiltration, mitotic The activity of tumor cells).
Tools:
· Ultrasound of salivary gland (determine the structures of the gland and tumor, the presence of cystic cavities, size and localization of the tumor (surface, deep));
· Ultrasound of cervical, submandibular, pressed, subclavian lymph nodes (the presence of increased lymph nodes, structure, echogenicity, sizes);
· CT neck (determined the tumor top, its relationship with the surrounding structures, its localization and prevalence in the record of the fossa, the base of the skull and the relationship of the tumor to the main vessels at the base of the skull);
· MRI of the neck (determine the top of the tumor, its relationship with the surrounding structures, its localization and prevalence in the cessability of the yam, the base of the skull and the relationship of the tumor to the main vessels at the base of the skull);
· Tone-game aspiration biopsy from the tumor (allows to determine the tumor and non-tumor processes, a benign and malignant nature of the tumor, primary and secondary (metastatic) lesions of the salivary glands, differentiate epithelial and non-epitirate tumors, lymphoprolifirate diseases);
· Continuous aspiration biopsy of increased lymph nodes of the neck (allows you to determine the metastatic lesion of lymphotic nodes).
Indications for consultation of specialists:
· Consultation of cardiologist (50 years old and older patients, as well as patients under the age of 50 in the presence of concomitant Patology of the SCC);
· Consultation of the neuropathologist (with vascular brain violations, including strokes, head injuries and spinal cord, epilepsy, myasthenia, neuroinfection diseases, and in all cases of loss of consciousness);
· Consultation of the gastroenterologist (in the presence of concomitant pathology of the gastrointestinal organs in history);
· Consultation of the neurosurgeon (in the presence of cerebral metastases, spine);
· Consultation of a thoracic surgeon (in the presence of metastases in the lungs);
· Consultation of the endocrinologist (in the presence of concomitant pathology of endocrine bodies).
Differential diagnosis
D. iperfrenial diagnosis.
Table 1. Differential diagnosis.
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Treatment
Treats of treatment:
· Elimination of tumor focus and metastases;
· Achieve full or partial regression, stabilization of the tumor process.
Tactics of treatment
General principles of treatment.
Surgical tumor removal is the leading component of radical treatment of malignant neoplasms of the salivary glands.
At the i -ii stage of low-quality tumors (low-quality mukoepidermoid carcinoma, acinqueloque carcinoma) radical surgical intervention is an independent treatment method.
In case of intermediate and high malignancy tumors (mukoepidermoid carcinoma, adenocarcinoma, adenocystarous carcinoma, malignant mixed tumor, undifferentiated carcinoma and plane carcinoma) treatment combined.
The cervical lymphodissection is shown only if there are metastases in lymph nodes.
Radiation therapy is used in an independent form solely in the treatment of non-spectable tumors or in the event of a patient's failure.
Chemotherapy and chemosis raundic treatment Can be used in separate groups of patients with primary non-conductive tumors, lower-regional recurrences, remote metastases, as well as in the presence of a residual tumor or prognostically adverse factors (intermediate and low degree of differentiation, metastases in lymph nodes, invasion in facial nerve, perineral / lymphatic / Vascular invasion).
The standard method of treating malignant tumors of small salivary glands is adequate surgical removal of the tumor, the volume of which depends on the localization and prevalence of the process. Postoperative radiation therapy in high risk patients reduces the frequency of local recurrences of 1.5-2 times. Preventive irradiation of cervical lymph nodes does not lead to improved treatment results.
Treatment depending on the stage.
· Stage I-II (low-quality tumors) - complete removal of salivary gland (subtotal resection of the near-dry salivary gland according to indications).
· I-II Stage (medium / high-aligned tumors) - radical surgical intervention on the primary focus + postoperative remote radiation therapy on the bed of the remote tumor in SOG 60-70 gr (genus 2 gr) + prophylactic irradiation of regional lymph nodes on the side of the affected gland in SOD 50 gr (genus 2 g).
With adenokystous carcinoma, the exposure zone includes the bed of the remote tumor and the nearest brain-brain nerves (regional intact lymph nodes are not irradiated).
· III - IV stages (resectable) - tumor removal (according to clause 33.1.) + Radical cervical lymphodissection on the side of the tumor (for n +) + postoperative radiation therapy on the bed of a remote tumor in Sod 60-70 gr and region of regional lymph nodes on the side of the lesion in soda 50-60 gr.
In the presence of a tumor in the edge of the cut-off, moderately and low degree of differentiation, non-ultimate / perineural invasion, metastases with extracapsular propagation, lymphatic / co-trust invasion can be carried out simultaneous chemotherapy and radiation therapy:
Cisplatin 100 mg / m 2 intravenous infusion at no more than 1 mg / min with predigation in the 1st, 22nd and 43rd days against the background of radiotherapy on the bed of the remote tumor in Soda 70 gr (genus 2 C) and region of regional lymph nodes on the side of the lesion in SOD 50-60 gr.
Criteria for the effectiveness of treatment
Full effect - The disappearance of all foci of defeat for a period of at least 4 weeks.
Partial effect - greater or equal to 50% reduction in all or individual tumors in the absence of progression of other foci.
Stabilization - (no change) decrease less than 50% or an increase in less than 25% in the absence of new lesions.
Progression - an increase in the size of one or more tumors of more than 25% or the appearance of new lesions. .
Non-drug treatment:
Patient mode when conducting conservative treatment - Common. In the early postoperative period - bed or semicessary (depending on the volume of operation and the concomitant pathology). In the postoperative period - the cessation.
Diet table - №1 with operational interventions, with a further transition to the table number15.
Medical treatment:
There are several types of chemotherapy, which differ in the purpose of destination:
· Neadaduvant chemotherapy of tumors is prescribed to surgery, in order to reduce the inoperable tumor for carrying out an operation, as well as to detect sensitivity of cancer cells to drugs for further assignment after the operation.
· Adjuvant chemotherapy is prescribed after surgical treatment to prevent metastasis and reduce the risk of relapses.
· Medical chemotherapy is prescribed to reduce metastatic cancer tumors.
Depending on the localization and type of tumor, chemotherapy is assigned by different schemes and has its own characteristics.
Indications for chemotherapy:
· Tumor recurrence;
· Satisfactory blood picture in the patient: normal hemoglobin and hemocrites, the absolute number of granulocytes - more than 200, platelets - more than 100 x 10e 9 / l;
· Preserved function of liver, kidneys, respiratory system and CCC;
· The possibility of translation of the non-refueling tumor process into operational;
· Improving remote results of treatment with adverse tumor histipses (low-differentiated, undifferentiated).
Contraindications for chemotherapy:
Contraindications to chemotherapy can be divided into two groups: absolute and relative.
Absolute contraindications:
· Hypertermia\u003e 38 degrees;
· Disease in the decompensation stage (cardiovascular system, liver, kidney respiratory system);
· The presence of acute infectious diseases;
· mental diseases;
· The ineffectiveness of this type of treatment, confirmed by one or several specialists;
· Heavy condition of the patient on the scale of Karnovsky 50% and less (see Appendix 1).
· Pregnancy;
· Incixation of the body;
· Cachexia.
Below are the schemes of the most commonly used polychimotherapy modes with flat-flossing cancer of any localizations in the head and neck. They can be used in conducting both neoadjuvant (induction) chemotherapy and adjuvant polychimotherapy, followed by surgical intervention or radiation therapy, as well as during recurrent or metastatic tumors.
The main combinations used in the conduct of induction polyhemotherapy today are cisplatin with 5-fluorouracil (PF) and a docetaxel with cisplatin and 5FTRUURCYL (DFT). To date, this combination of chemotherapy has become the "gold standard" when comparing the effectiveness of the use of various chemotherapy preparations in the treatment of head-made cancer of the head and neck for all major multicenter studies. The latter scheme is most effective, but the most toxic, however, ensures more high rates survival and locked control compared to using the traditional PF scheme as induction polychimotherapy.
From targeted drugs currently in clinical practice Joined Zetuximab.
According to the latest data, the only combination of chemotherapy products, not only increasing the number of full and partial regressors, but also the life expectancy of patients with recurrences and remote metastases of the head cell of the head and neck, is a diagram using cetuximaba, cisplatin and 5-fluorouracil.
Table # 2. Activity of drugs in monodemide with a recurrent / metastatic flat-flossing cancer of the head and neck (modified by V.A. (Murphy).
|
A drug |
Response frequency,% |
| Methotrexat | 10-50 |
| Cisplatin | 9-40 |
| Carboplatin | 22 |
| Paklitaxel | 40 |
| Docetaxel | 34 |
| Formuracyl | 17 |
| Bleomycin | 21 |
| Doxorubicin | 23 |
| Zetuximab | 12 |
| Capecitabin | 23 |
| Vinorlebin | 20 |
| Cyclophosphamide | 23 |
When conducting both neoadjuvante and adjuvant polychimotherapy in the cancer of the salivary glands, the following schemes and combinations of chemotherapy products are possible:
Schemes and combinations of chemotherapy products:
· Doxorubicin 60 mg / m 2 V / in 1 day;
· Cisplatin 100 mg / m2 V / in 1 day;
· Dakarbazine 200 mg / m2 V / in 1-3 days;
· Epirubicin 25mg / m2 V / in 1-3 days;
· Fluoruracyl 250 mg / m2 V / in 1-3 days;
Repeated course after 3 weeks.
· Bleomycin 15 mg / m2 V / in from 1 to 5 days;
Repeated course after 3 weeks.
· Vincristian 1.4 mg / m2 V / in 1 day;
· Doxorubicin 60 mg / m2 V / in 1 day;
· Cyclophosphane 1000 mg / m2 V / in 1 day;
Repeated course after 3 weeks.
Chemotherapy schemes:
Most active antitumor means In case of plane carcalet cancer, the head and neck are considered as at 1 and 2 lines of platinum derivatives (cisplatin, carboplatin) derivatives of fluoropyrimidine (fluorouracil), anthracycline, taxana - paclitaxel, docetaxel.
Active with head and neck cancer Also doxorubicin, capecitabine, bleomycin, vincristine, cyclophosphane as the second line of chemotherapy
When conducting both neoadjuvante and adjuvant polychimotherapy with head cancer and neck, it is possible to use the following schemes and combinations of chemotherapy.
PF
· Formuracyl 1000mg / m2 24-hour V / in infusion (96 hour continuous infusion)
1-4-day;
PF
· Cisplatin 75-100mg / m2 V / in, 1st day;
· Fluoruracyl 1000mg / m2 24-hour V / in infusion (120 hour continuous infusion)
1-5-day;
If necessary, on the background of primary prevention by colony positive factors.
Cpf.
· Carboplatin (AUC 5.0-6.0) in / in, 1st day;
· Formuracyl 1000mg / m2 24-hour V / in infusion (96-hour continuous infusion) 1-4th days;
Course repetition every 21 day.
· Cisplatin 75mg / m2 V / in 1st day;
· Capecitabine 1000mg / m2 orally twice a day, 1-14th days;
· Cisplatin 75mg / m2, in / in, 2nd day;
Repeating courses every 21 day.
· Paklitaxel 175mg / m2, in / in, 1st day;
· Carboplatin (AUC 6.0), in / in, 1st day;
Repeating courses every 21 day.
Tr.
· Docetaxel 75mg / m2, in / in, 1st day;
Cisplatin-75mg / m2, in / in, 1st day;
Repeating courses every 21 day.
TPF.
· Docetaxel 75 mg / m2, in / in, 1st day;
Cisplatin 75-100mg / 2, in / in, 1st day;
Formuracyl 1000mg / m2 24-hour intravenous infusion (96-hour continuous infusion) 1-4th days;
Repeating courses every 21 day.
· Paklitaxel 175 mg / m2, in / in, 1st day 3 hours infusion;
· Cisplatin 75mg / 2, in / in, 2nd day;
· Fluoruracyl 500mg / m2 24-hour intravenous infusion (120-hour continuous infusion) 1-5 days;
Repeating courses every 21 day.
· Zetuximab 400mg / m2 V / in (infusion within 2 h), 1st day of the 1st year of course, cetuximab 250 mg / m2, in / in (infusion for 1 h), 8,15th days and 1 , 8 and 15 days of subsequent courses;
· Cisplatin 75-100mg / m2, in / in, 1st day;
· Fluoruracyl 1000 mg / m2 24-hour intravenous infusion (96-hour continuous infusion) 1-4th days;
Repeating courses every 21 day depending on the restoration of hematological indicators.
CAP (a)
· Cisplatin 100mg / m2, in / in, 1 day;
· Cyclophosphamide 400-500mg / m2, V / in 1 day;
· Doxorubicin 40-50 mg / m2, in / in, 1 day;
Repeating courses every 21 day.
Pbf.
· Formuracyl 1000mg / m2, V / in 1,2,3,5 days;
· Bleomycin 15 mg 1,2,33 days;
· Cisplatin 120 mg 4 day;
Course repetition every 21 day.
CPP.
· Carboplatin 300mg / m2, V / B, 1 day;
· Cisplatin 100mg / m2 V / B, 3 days;
Course repetition every 21 day.
MRF.
· Methotrexate 20mg / m2, 2nd 8 day;
· Fluoruracyl 375mg / m2, 2 and 3 days;
· Cisplatin 100mg / m2, 4 day;
Course repetition every 21 day
*Note: When reacing the rectaging of the primary tumor or recurrent, surgical treatment can be performed not earlier 3 weeks after the last introduction of chemotherapy.
* Treatment of the PCR head and neck is mainly problematic due to the fact that at all stages of the development of the disease require a thorough multidisciplinary approach to select existing treatment options for patients.
Chemotherapy in monodemesis is recommended to carry out:
· In weakened patients in old age;
· With low blood formations;
· With a pronounced toxic effect after previous chemotherapy courses;
· When carrying out palliative chemotherapy courses;
· In the presence of concomitant pathology with a high risk of complications.
When carrying out monochimotherapy, the following schemes are recommended:
· Docetaxel 75 mg / m2, in \\ in, 1st day;
Course repetition every 21 day.
· Paklitaxel 175mg / m2, in / in, 1st day;
Repetition every 21 day.
· Methotrexate 40mg / m2, in / in, or in / m 1 day;
· Capecitabine 1500mg / m2, orally daily 1-14 days;
Course repetition every 21 day.
· Vinorelbine 30 mg / m2, w / in 1 day;
Course repetition every week.
· Zetuximab 400mg / m2, B / B (infusion for 2 h), 1st introduction, then zetuximab 250mg / m2, in \\ in (infusion for 1 h) weekly;
Course repetition every week.
* Methotrexate, Vinorelbine, Capecitabine in monodemim is most often used as a second treatment line.
Targeted therapy.
The main indications for conducting targeting therapy is:
· Locally common flat-cell head and neck cancer in combination with radiation therapy;
· Recurrent or metastatic flat-milking head and neck cancer in the event of the ineffectiveness of previous chemotherapy;
· Monotherapy of recurrent or metastatic plane carcalet cancer and neck with the ineffectiveness of previous chemotherapy;
Zetuximab is introduced 1 time per week Dose of 400mg / m2 (first infusion) in the form of a 120-minute infusion, then at a dose of 250 mg / m2 as a 60-minute infusion.
When applying the zetuximab in combination with radiation therapy, treatment cetuximab is recommended to start 7 days before the start of radiation treatment and continue the weekly introduction of the drug until the end of radiation therapy.
Patients S. recurrent or metastatic The flatcletical cancer of the head and neck in combination with chemotherapy based on platinum preparations (up to 6 cycles) zetuximab is used as supporting therapy before the appearance of signs of disease progression. Chemotherapy begins no earlier than 1 hour after the end of the infusion of zetuximab.
In the case of the development of skin reactions to the administration of zetuxima paper, therapy can be resumed using the drug in reduced doses (200mg / m2 after the second reaction and 150mg / m2 after the third).
Surgical intervention:
Surgical intervention rendered on an outpatient level: not.
Surgical intervention provided at the stationary level:
Types of surgical interventions:
· Paradandectomy;
· Sialdenectomy;
· Resection of the parole salivary gland;
· Fascial - case excision of cervical lymph nodes.
Indications for surgical treatment:
· Cytologically or histologically verified zno salivary glands;
· In the absence of contraindications to surgical treatment.
All surgical interventions for malignant tumors of the salivary glands are performed under general anesthesia.
The main type of operational intervention in malignant tumors of the parotid salivary glands is parmotidectomy with / or without preserving facial nerve.
With low-quality tumors of the parole salivary gland T1-T2 (low-quality mukoepidermoid carcinoma, acinox cell carcinoma) is permissible to perform subtotal resection. In this case, intraoperative control of the radicality of surgical intervention is necessary. The tumors of the submandibular and sub-speaking salivary glands are removed by a single block with the contents of the submandibular triangle.
Common tumors require resection of all involved structures (skin, muscles, nerves, mandibular and temporal bone).
In case of clinically negative lymph nodes, in the course of the execution of vaporotidectomy or removal of the submandibular salivary gland, the first lymphatic level is examined. Increased or suspicious lymph nodes are directed to an urgent histological examination. The need to perform lymphodissection and its type are determined on the basis of operating finds. With single metastases and the absence of extranodal propagation, preference is given to the modified cervical lymphodissection.
Saving facial nerve.
Before the operation, the functional state of the nerve should be clearly clarified, since partial or complete paralysis can be due to the invasion of the tumor. At a nervous operation, an urgent histological study of the edges of the tumor cut-off from the nerve or the actually crossed nerve branch should be performed. Therefore, the final decision on the preservation of the facial nerve or its branches is accepted during the operation. If the tumor does not surround the nerve circularly and there is no periserial invasion. It is possible to carry out nervous operations with the subsequent course of radiation therapy.
Contraindications K.surgical treatment with zno parotone salivary glands:
· The presence of patients with signs of inoperability and severe concomitant pathology;
· Untifferentiated tumors of the salivary glands, which can be offered as an alternative to radiation treatment;
· When the process is spreading to the base of the skull with the destruction of the bones of the skull, the intimate relationship of the neoplasm with the inner carotid artery at the base of the skull.
· Synchronously existing tumor process in salivary gland and a common non-refaming tumor process of another localization, such as lung cancer, breast cancer;
· Chronic decompensated and / or acute functional impaired respiratory disorders, cardiovascular, urinary system, gastrointestinal tract;
· Allergies to preparations used with general anesthesia.
Contraindications K.surgical treatment with dignity of subband lifterness glands:
· Tumor infiltration of the tissue of the bottom of the oral cavity, the presidential region, the upper third of the neck
· Infiltration of main vessels held here (internal carotid artery);
· In the presence of metastatic regional lymph nodes of an infiltrative nature, germinating the inner jugular vein, a common carotid artery;
· Extensive hematogenous metastasis, disseminated tumor process;
Other types of treatment:
Other types of treatment rendered on the outpatient level: not.
Other types of treatment rendered at the stationary level:
· radiation therapy;
· Chemical therapy.
Radiation therapy - This is one of the most effective and sought-after treatment methods.
Types of radiation therapy:
· Remote radiation therapy;
· 3D conformal irradiation;
· Modulated intensity radiation therapy (IMRT).
Indications for radiation therapy:
·
low-differentiated tumors with prevalence T1 - T3;
· In the treatment of non-spectable tumors;
· Patient failure from the operation;
· The presence of a residual tumor;
· Periineural or perilimphhatic invasion;
· Extracapsular tumor propagation;
· Metastases in the gland or regional lymph nodes;
· Recurney tumor.
Contraindications for radiation therapy:
Absolute contraindications:
· Psychic inadequacy of the patient;
· radiation sickness;
· Hypertermia\u003e 38 degrees;
· The difficult state of the patient on the scale of Karnovsky is 50% and less (see Appendix 1).
Relative contraindications:
· Pregnancy;
· Disease in the decompensation stage (cardiovascular system, liver, kidneys);
· Septis;
· Active pulmonary tuberculosis;
· Tumor disintegration (threat of bleeding);
· Resistant pathological changes in blood composition (anemia, leukopenia, thrombocytopenia);
· Cachexia;
· The presence of a history of previously conducted radiation treatment.
Chemorative therapy.
With the forested forms of scalp and neck cancer, one of the ways to improve the effectiveness of treatment is the use of methods of sequential or combined chemical therapy. With consistent chemical radiation therapy at the first stage, several induction chemotherapy courses are being carried out with the subsequent conduct of radiation therapy, which ensures improvement in the location of the patients with the preservation of the body, as well as improving the quality of life, and the survival of patients.
With simultaneous chemical treatment, platinum preparations are commonly used with the ability to potentiate the effect of radiation therapy (cisplatin or carboplatin), as well as the Targeted drug Zetuximab. (UD - B).
When performing simultaneous chemical treatment, the following schemes of chemotherapy courses are recommended.
· Cisplatin 20-40mg / m2 V / in weekly, when conducting radiation therapy;
· Carboplatin (AUC1,5-2,0) in / in weekly, when conducting radiation therapy;
Radiation therapy in a total focal dose of 66-70gr. One-time focal dose - 2 grams x 5 fractions per week.
· Zetuximab 400mg / m2 V / in CAP (infusion for 2 h) a week before the start of radiation therapy, then Zetuximab 250mg / m2 V / in (infusion for 1 h) weekly during radiation therapy.
Palliative care:
· With pronounced pain syndrome, treatment is carried out in accordance with the recommendations of the Protocol «
Palliative care for patients with chronic progressive diseases in the incorrect stage accompanied by chronic pain syndrome, "approved by the minutes of the meeting of the Expert Commission on Health Development of the Ministry of Health of Kazakhstan No. 23 from December 12, 2013.
· In the presence of bleeding, treatment is carried out in accordance with the recommendations of the Protocol "Palliative care for patients with chronic progressive diseases in the incorrect stage accompanying bleeding", approved by the minutes of the meeting of the Expert Commission on Health Development Mort RK No. 23 from December 12, 2013.
Other types of treatment rendered at the ambulance phase:not
Treatment Efficiency Indicators:
· "Tumor response" - the regression of the tumor after treatment;
· Without recurrent survival (three and five year old);
· "Quality of life" includes other than the psychological, emotional and social functioning of a person, the physical condition of the organism of the patient.
Further maintenance.
Dispensary observation of cured patients:
During the first year after the completion of treatment - 1 time every 3 months;
During the second year after the completion of treatment - 1 time every 6 months;
From the third year after the completion of treatment - 1 time per year for 3 years.
Survey methods:
· Palpation of saliva -
with each examination;
-
with each examination;
· Ultrasound of the parotone or submandibular region and regional metastasis zone - twice a year;
-
once a year;
Preparations (active substances) used in the treatment
Hospitalization
Indications for hospitalization
Indications for emergency hospitalization:
· Bleeding from the tumor;
· Expressed pain syndrome.
Indications for planned hospitalization:
The presence in the patient of the morphologically verified zno salivary glands to be specialized.
Prevention
Preventive actions
· Palpation of saliva -
with each examination;
· Palpation of regional lymph nodes -
with each examination;
· Ultrasound of the parole or submandibular area and regional metastasis zone - twice a year;
· Radiographic study of the chest organs -
once a year;
· Ultrasound examination of the abdominal organs - once every 6 months (with primary and common and metastatic tumors).
Information
Sources and literature
- Protocols of the meetings of the Expert Council RCRs MZSR RK, 2015
- List of references: 1. NCCN CLINICAL PRACTICE GUIDELINES IN ONCOLOGY: HEAD AND NECK. Available at ACCESSED MARCH 2011; 2. A.I. Pach. Tumors of head and neck. Clinical manual. Fifth edition. Moscow, 2013 244- 274st. 3. A.I. Parechy., Tabolinovskaya etc. Tumors of the salivary glands. M.: Practical Medicine, 2009. 4. Lastovka A.S. Organized microsurgery of large salivary glands. Minsk, 2007. 5. American Joint Committee On Cancer (AJCC). AJCC Cancer Staging Manual, 7th Ed. EDGE S.B., BYRD D.R., CARDUCCI M.A. et al., EDS. NEW YORK: SPRINGER; 2009. 6. Murphy B.a Carcinoma of the Head and Neck. In: Handbook of Cancer Chemotherapy. Skeel R.T., Khleif S.N. (EDS). 8 th Edition. Lippincott Williams & Wilkins.2011: 69-63. 7. Guidelines for chemotherapy of tumor diseases. Edited by N.I. Translator, V.A. Gorbunova. 4th publication, expanded and complemented. Practical medicine. Moscow 2015 8. ForaStiere A.A., GoEpfert H., Maor M. et al. Concurrent Chemotherapy and Radiotherapy for Organ Prezervationin Advanced Laryngeal Cancer. N ENGL J MED.2003; 349: 2091-2098 9. Posner M.R., Hershor D.M., Blajman C.R. et al. Cisplatin and Fluorouracil Alone or with Docetaxel in Head and Neck Cancer. N engl j med. 2007; 357 (17): 1705-1715. 10. Blanchard P., Bourhis J., Lacas B. et al. Taxan-FluoroCil AS Induction Chemotherapy in Locally Advanced Head And Neck Cancers: An Individual Patient Data Meta-Analysis of the Meta-Analysis of Chemotherapy in Head and Neck Cancer Group. J clin oncol. 2013; 31 (23): 2854-2860. 11. Vermorken J.B., Mesia., Rivera F. et al. Platinum-Based Chemotherapy Plus Cetuximab in Head and Neck Cancer. N engl j med. 2008; 359 (11): 1116-1127. 12. Forstiere A.A., GoEpferi H., Maor M. et al. Concurrent Chemotherapy and Radiotherapy for Organ Preservationin Advanced Laryngeal Cancer. N engl j med. 2003; 349: 2091-2098. 13. Bonner J.A., Harari P.M., Giralt J. et al. Radiotherapy Plus Cetuximab for Squamous-Cell Carcinoma of the Head and Neck. N. engl. J. Med. 2006; 354 (6): 567-578. 14. Radiation therapy. Textbook. G.E. Trufanova "Goeotar-Medicine" 2012 15. Basics of radiation therapy. Russia, Ronts them N. Blokhin, Moscow 2012. 16. Clinical recommendations of the European Society of Radiation Therapists // Estro. - 2012, 2013 (http://www.estro.org) 17. The clinical recommendations of the American Society of Radiation Therapists // Astro. - 2011, 2012. (https://www.astro.org) 18. Radiation safety standards (NRB-99) // Ensuring radiation safety in medical radiological institutions. - December 9, 1999 No. 10. (Paragraphs 2, 6, 11, 15). 19. Guidance Document ON Delivery, Treatment Planning and Clinical Implementation of Imret: Report of the Imrt Subcommittee of Aapm Radiation Therapy Committee. 20. Nurgaziev K.Sh., Sitakezina G.D., et al. Indicators of the oncological service of the Republic of Kazakhstan for 2014, (statistical materials). - Almaty, 2015. 21. Matyakin E.G. Clinical aspects of recurrent tumors of salivary glands. Vest. RONTS RAMN, 2009, T.20 № 2, (AF.1), p.37 22. Matyakin EG, Azizyan R.I., Mattyakin G.GG Diagnostics and treatment of recurrences of mixed tumors Axis. Kremlin Medicine, 2009, No. 4, p.37-41 23. Drobyshev A. Yu., Shipkova T. P., Bykov A. A., Mattyakin E., Diagnosis and treatment of benign tumors of the salivary glands. In Sat Actual issues of diagnosis and treatment of salivary glands. M., 2009. p. 55-56. 24. Avdeenko M. The Combined Treatment with Postoperative Neutron Therapy for Patients [Text] / E. Choinzonov, L. Musabaeva, O. Gribova, M. Avdeenko // Otorinolaryngologie a Foniatrie. -Prague. - ISSN 1210-7867, 2006. - Volume 55 sup. 1 to n iune. - P. 117. 25. Avdeenko M. V. Evaluation functional disorders And the quality of life in patients with malignant neoplasms of the parotid salivary gland after combined treatment [Text] / M. V. Avdeenko, E. L. Choinsonov, L. N. Balatskaya, etc. // Siberian Oncology Magazine: scientific and practical publication. - Tomsk. - ISSN 1814 - 4861, 2007. - N 2. - P. 32 - 36. 26. Medical clinical recommendations of the European Society of Medical Oncologists (ESMO. Moscow 2014) 27. DE GRAEFF A, DE LEEUW JR, ROS WJ, ET AL. Pretreatment Factors Predicting Quality Of Life After Treatment for Head and Neck Cancer. Head Neck 2000; 22: 398-407 28. Horiot JC. . Bull ACAD NATL MED 1998; 182: 1247-1260; Discussion 1261.]. 29. TEH BS, MAI WY, GRANT WH 3RD, ET AL. INTENSITY MODULATED RADIOTHERAPY (IMRT) DECREASES TREATMENT-RELATED MORBIDYOLY AND POTENTIALLY ENHANCES TUMOR CONTROL. CANCER INVEST 2002; 20: 437-451. 30. DE NEVE W, DUTHOY W, BOTERBERG T, ET AL. INTENSITY MODULATED RADIATION THERAPY: Results in Head and Neck Cancer and Improvements ahead of us. INT J Radiat Oncol Biol Phys 2003; 55: 460. 31. BERNIER J, DOMENGE C, OZSAHIN M, ET AL. Postoperative IRRADIATION WITH OR WITHOUT CONCOMITANT CHEMOTHERAPY FOR LOCALLY ADVANCED HEAD AND NECK CANCER. N ENGL J MED 2004; 350: 1945-1952. 32. Cooper JS, Pajak TF, ForaStiere AA, et al. Postoperative Concurrent Radiotherapy and Chemotherapy for High-Risk Squamous-Cell Carcinoma of The Head and Neck. N ENGL J MED 2004; 350: 1937-1944. 33. BERNIER J, COOPER JS, PAJAK TF, ET AL. Defining Risk Levels In Locally Advanced Head And Neck Cancers: A Comparative Analysis of Concurrent Postoperative Radiation Plus Chemotherapy Trials of the Eourtc (# 22931) and RTOG (# 9501). HEAD NECK 2005; 27: 843-850. 34. Vokes Ee, Stenson K, Rosen FR, et al. Weekly Carboplatin and PaclitaXEL FOLLOWED by Concomitant PaclitaXEL, Fluorouracil, and Hydroxyurea ChemoRadiotherapy: CURATIVE AND ORGAN-PRESERVING THERAPY FOR ADVANCED HEAD AND NECK CANCER. J Clin Oncol 2003; 21: 320-326. 35. Hitt R, Grau J, Lopez-Pousa A, et al. Phase II / III Trial Of Induction Chemotherapy (ICT) with Cisplatin / 5-Fluorouracil (PF) VS. DOCETAXEL (T) PLUS PF (TPF) FOLLOWED by ChemoRadiotherapy (CRT) VS. CRT for Unresectable Locally Advanced Head and Neck Cancer (Lahnc). ASCO Annual Meeting Proceedings (Post-Meeting Edition) .j Clin OnCol 2005; 23: 5578. 36. Schrijvers D, Van Herpen C, Kerger J, et al. DOCETAXEL, CISPLATIN AND 5-FLUOROURACIL IN PATIENTS WITH LOCALLY ADVANCIL UNRESECTABLEOR HEAD AND NECK CANCER: A PHASE I-II FEASIBILITY STUDY. ANN ONCOL 2004; 15: 638-645. 37. Podolsky V.N., Shinkarev S.A., Pripaccina A.P. Clinic Diagnostics, Treatment of Owl Salum Tumors. // Methodical guide for doctors // Lipetsk. - 2005. - 32 s. 38. Scott A. Laurie, Lisa Licitra. Therapy In The Palliative Management of Advanced Salivary Gland Cancers / Oncology. 2000. 39. Sebastien J. Hotte, Eric W. Winquist, Elizabeth Lamont. Imatinib Mesylate in Patients with Adenoid Cysstic Cancers of the Salivary Glands.
Information
List of developers:
1.
Adilbaev Galym Bashenovich - Doctor Medical Sciences, Professor, "RSA on the PVV Kazakh scientific - research institute Oncology and radiology, "head of the center.
2.
Appazov Sattar Adilovich - RGP on PFV "Kazakh Scientific Research Institute of Oncology and Radiology", oncologist doctor.
3.
Tumanova Assel Kadyrbeckovna - Candidate of Medical Sciences, RGP on the PCB "Kazakh Scientific Research Institute of Oncology and Radiology", head of the department of day hospital Chemotherapy -1.
4.
Savhatova Akmaral Dospail - RGP on the PKV "Kazakh Scientific Research Institute of Oncology and Radiology", head of the day hospital department.
5.
Kydyrbayeva Gulzhan Zhanuzakne is kiddate of medical sciences, RGP on PVV "Kazakh Scientific Research Institute of Oncology and Radiology", Researcher.
6.
Tabarov Adlet Berikbolovich - Clinical Pharmacologist, RGP on PVV "Hospital of the Medical Center Management of the Office of the President of the Republic of Kazakhstan", Head of the Innovation Management Department.
Indication of conflict of interest:not.
Reviewers:Yesentaeva Suri Yertugyrovna - Doctor of Medical Sciences, Head of Course Oncology, Mammology Nuo "Kazakhstan - Russian Medical University"
Specifying the conditions for revising the clinical protocol:The revision of the Protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with the level of evidence.
Attached files
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Thanks to the process of salivation, the body is easier to cope with the digestion of food due to the pretreatment of its saliva. Also saliva helps protect against viruses and bacteria into the body through the oral cavity, thus performing a protective function. Synthesize with saliva 3 pairs of salivary glands: subnocels, sublard, sloping.
SalyaDenate of the near-dry glands - inflammation caused by the ingress of infectious agents (usually viruses, bacteria), as a result of which the process of salivation is disturbed. Code of the disease according to the ICD 10 - K11.2. According to statistics, the share of SalyaDenit accounts for about 50% of all cases of lesions of the salivary glands. The most common form of the siadenate of the parotid glands is epidemic vapotitis, which is more often diagnosed in children. To properly assign treatment of inflammation, it is necessary to find out the reasons for determining the pathogen. Unimaginary diagnosis and union medical care Can lead to the development of complications and infection of the whole organism.
Classification
The inflammation of the near-dry salivary glands is classified, based on the characteristics of the pathological process, the reasons, the mechanism of infection.
Allocate acute and chronic shapes of sialogenite. Acute siadenate proceeds in several stages:
- serous form;
- purulent;
- necrosis.
Depending on the nature of the pathogen, sharp power adornment happens:
- viral (caused by influenza viruses, cokes, epidemic vapotitis);
- bacterial (due to infected infections, after surgery, due to the obstruction of the salivary gland).
Chronic inflammation can be:
- parenchymal;
- intersequential;
- protokovy (Siiaodohit).
Causes of occurrence
Inflammation of the near-dry salivary glands may be epidemic and non-epidemic, based on its cause. Epidemic power adornitis develops a consequence of the spread of infection from one person to another. An example of this is an epidemic vapotitis (pig).
Neepidemic inflammation may occur under the influence of predisposing factors:
- mechanical damage and injuries of the paroles;
- the presence of stones in the glands;
- non-compliance with the hygiene of the oral cavity;
- ingress of foreign bodies;
- postoperative infection;
- encephalitis, tit and other primary infections.
Peel into the pathoral organisms into the paroles can be several ways:
- hematogenic (through blood);
- lymphogenic (lymphotoku);
- contact (from the nearest organs);
- ascending (from the oral cavity).:
Clinical picture
For acute form of pathology, characteristic:
- heat;
- soreness of the affected gland;
- redness of the skin around the patient site;
- eveny.
With a detailed inspection, in front of the ear shell, you can reveal swelling, which is constantly increasing. Pain syndrome can be irradized in the temporal area, under the lower jaw.
The function of the parotid gland is violated during inflammation, which leads to the appearance of additional features:
- difficulties in eating and swallowing food;
- bite disruption;
- dryness in the oral cavity;
- the appearance in the saliva mucus, pus.
On a note! The manifestations of the disease depends on its shape and the type of pathogen. Acute sial adornitis is characterized by a sudden and pronounced start. For chronic sialogenite, periodic exacerbations are characterized, the symptoms of which are similar to acute inflammation. The temperature is kept at the level of subfebrile. The patient feels difficult when opening the mouth, when chewing.
Diagnostics
Inflammation of the parole glands, based on the age of the patient, the presence of concomitant diseases, the etiology of the process, requires consultation of various specialists (pediatrician, dentist, surgeon, infectious examiner). The doctor examines the patient, according to characteristic external signs Can put a preliminary diagnosis.
To differentiate various forms Salyagenit, it is necessary to conduct additional diagnosiswhich may include:
- analysis of the secret to cytology, biochemistry, microbiology.
The anatomy and the functionality of the near-dry glands are examined with:
- sialography;
- sialotomography;
- thermography;
- sieliaometry.
During the diagnosis, it is necessary to eliminate the presence of sialodenosis, tumors of glands, lymphadenitis, infectious mononucleosis.
On the page, find out what epithelial ovarian cancer in women and how to treat oncopathology.
Medical events
Inflammation in salivary glands must begin to be treated as soon as possible. The effects of the disease can be very dangerous to patient health. The disease may be complicated by meningitis, orchite, rheumatism and other pathologies. The tactics of treatment of sialogenite is selected individually taking into account the form of inflammation, the nature of infection, the presence of concomitant diseases.
For 1-2 weeks, the patient must observe the bed regime. When viral power generate, the rinse of the oral cavity is recommended, to strengthen the immune system with the help of vitaminotherapy, intake of immunostimulants.
In bacterial forms of the disease, the introduction of antibiotics and proteolytic enzymes in the damaged gland duct is used. In the presence of infiltrates make blockages with Novocaina in Vishnevsky, compresses of dimethyl sulfoxide solution on the patient area.
Effectively in chronic inflammation, in addition to medication, resort to special massage and physiotherapists:
- electrophoresis;
- galvanization;
To accelerate recovery, a saliva diet should stick. Do not eat fatty dishes, increase vegetables, fruits, dairy products in the diet.
If purulent foci is formed during the development of the disease, resort to surgical intervention. The doctor makes an incision in the field of accumulation of pus, gives him the possibility of outflow. In the presence of concrections in the gland you need to remove them surgically. The most common ways to remove stones are lithotripsy, sialonoscopy.
Prediction and prevention
In most cases, the outcome of the siadenate of the parole salted glands is favorable. The sharp form of the disease can be cured within 2 weeks. Raised cases of inflammation can lead to the formation of scars in gland ducts, to necrosis and chronic violation salivation.
To avoid the development of Salyagenit, it is recommended:
- carefully monitor the hygiene of the mouth;
- strengthen immunity;
- in a timely manner to stop the foci of infection in the body;
- regularly conduct inspections from the dentist;
- make vaccination from epidemic parotitis.
Salyagoenitis of the near-dry glands can be warned if you fulfill all the prevention recommendations. If infection has already happened, it is necessary to find out the reasons for the inflammatory process as soon as possible and begin treatment. This will allow you to quickly restore health and avoid unwanted consequences.
The treatment of salivary cancer typically includes surgery, with radiation therapy or without it. Your treatment plan should be compiled definitely for you by a group of doctors, including surgeons, cancer (oncologists) and doctors who specialize in the treatment of cancer with irradiation (radiation oncologists).
Surgery.
If the cancer did not spread outside the salivary gland, and if the tumor is a small and "low variety", only surgery will be required to get rid of the tumor.
The removal of the tumor from the glands can be complicated, because several important nerves are located around these glands. For example, the nerve that controls the facial movement (VII of the cranial nerve) passes through the parole. Complications of the removal of the tumor from the parole can include nerve damage, which can affect the facial facial. The nerves near the subband and the lifting glands include the movement and control of the language, sensitivity and taste. If cancer spread out of the salivary gland, some of these nerves may need to be removed.
The surgeon may remove the lymph nodes in the neck ("Opening of the neck") to see whether cancer spread. In addition to the removal of lymph nodes, the "opening of the neck" may include the removal of other muscles and nerves in the neck. Complications After opening the neck may include the lack of the ear sensitivity, weakness in the lower lip and weakness when the head is lifted above the head.
Physiotherapy.
You probably need physiotherapy to overcome such complications after surgery, as difficulties in conversation, chewing or swallowing. Doctor - a nutritionist will help choose products that are suitable for you if you have lost some of the ability to chew and swallow. You will also get instructions on how to learn to swallow again.
Restorative therapy.
If a large amount of bone or tissue was cut during surgery, then restoration surgery is necessary. The goal of reducing surgery is to improve appearance and help you adapt to difficulties that may arise with chewing, swallowing, when conversing or with breathing. It may be necessary to transplant skin or fabric from other parts of the body to restore woven cover in the mouth, throat or jaw. You may also need a denture to replace part of the jaw removed during surgery.
Radiation therapy.
With radiation therapy used x-raysTo kill cancer cells. The irradiation of cancer cancer usually occurs with the help of a machine that is located outside the body (external radiation therapy).
If the tumor is quite large and complicated, if the cancer spread out of the salivary glands or if the doctor is concerned that other areas may be affected, then irradiation after surgery can be part of treatment. If the tumor cannot be removed by surgery, then only irradiation can be used to get rid of the cancer of the salivary gland.
Side effects From radiation of the head and neck may include changes in skin color and structure (similar to tan), dry mouth or saliva, redness, irritation and wounds in the mouth, angina, hoarse, problems when swallowing, rigidity, loss or changes in taste, Pain in the ear, pain in the bones, nausea, or fatigue.
Chemotherapy.
Chemotherapy is not used as standard treatment from salivary cancer, although scientists explore its effectiveness in the treatment of this disease.
Code of ICD-10: D11.0 is a benign tumor of the parole salivary gland.
Code on the ICD-10: D11.7 - a benign tumor of the salivary glands, except for the parole.
Localization of these tumors and their malignant potential are presented in the tables below.
Clinical manifestations Adenom different types Approximately the same. Long-term history, slow tumor growth, the absence of metastases, infiltration and ulceration and the safety of the function of the facial nerve indicate the benign nature of the tumor of the salivary gland. The final diagnosis is made after histological examination of the excreted tumor. All adenoma of salivary glands are subject to surgical removal. Read more treatment is discussed below.
- Symptoms and clinic. Pleomorphic adenomas are formed mainly in the parole (there are 80% of Pleomorphic adenomes on this localization). They are almost always unilateral. Pleomorphic adenoma grows slowly for many years. The duration of the history when handling is approximately 5-7 years, but some of the patients it reaches 20 years. Women are sick more often. The tumor has a dense consistency, an inefficient structure and painless. The function of the facial nerve is not disturbed even with significant sizes of the tumor, if it is not subjected to malignant transformation.
The difficulty of swallowing is associated with significant sizes of the tumor and the propagation of it in the throat or with the damage to the adenomas of the small salivary gland or pharynx.
Large adenomas growing deep into the direction of non-toned almonds are called the iceberg tumors.
- Causes and mechanisms of development. The epithelial origin of pleomorphic adenomes has been proven. Approximately two thirds of these tumors come from the surface fraction of the parole. The histological picture at these tumors is characterized by significant variability. The accumulation of experience made it possible to highlight the subtype with a rarefied stroma, which is inclined to malignant transformation.
Approximately 50% aden has a capsule. In cases where the capsule is absent, the borders of the adenoma with the cloth of salivary gland are fuzzy. The true cellular structure of pleomoric adenomes is rarely observed. The recurrence of "multicenter" pleomorphic adenomes usually the result of errors in the technique of operation.
Topographic analytomatic relationships of the parole and various neck and pharynx structures: 1 - penette muscle; 2 - Network Almond; 3 - chewing muscle;
4 and 10 - the branch of the lower jaw; 6 - Internal jugular vein; 7 - CN IX, X and XII;
8 - internal carotid artery; 9 - the percentage of the parcel of the parcel; 11 - facial nerve;
12 - Surface share of the parole.
- Diagnostics. Palpation played the main role in the diagnosis of pleomorphic aden. Syalography and aspiration biopsy of a thin needle allow you to diagnose the tumor before the operation only with its obscure nature. The intraoperative diagnosis can be delivered by histological examination of frozen cuts, but for the final diagnosis it is necessary to histological examination of the remote drug.
- Treatment. The tumors of the paroles are treated by removing the surface share or total vaporotidectomy (when the adenoma is localized in a deep share or distribution to a deep share), while maintaining the face nerve. In tumors of the subband treatment consists of excision glands along with tumor and adjacent tissues. The tumors of the small salivary glands are excised within the limits of the healthy tissue of the salivary gland.
- Forecast Very favorable. Malignant transformation of pleomorphic adenomes occurs in 3-5% of cases. With recurrent adenomas, incomplete excision, and with a long history, this indicator is higher.
Tumor-iceberg of the parish gland in a patient 47 years:
and the tumor is localized in the presidential yam.
b tumor is visible and can be placed in a tonsillar yam.
in a tumor after excision. Typical view of pleomorphic adenoma:
pulling in the area of \u200b\u200bthe parole having a smooth surface.
b) Cystadenolimphoma (tumor islander):
- Symptoms and clinic. Cystadeymphomas are usually one-sided, but 10% of patients have bilateral localization. The tumor is a dense or denselylastic painless and mobile surround education. In most cases, the cystadeymphoma suffers from the elderly men.
- Causes and mechanisms of development. Cystadeymphoma is a cystic tumor, which is usually developing at the bottom of the parole. It appears that it comes from the segments of the salivary ducts, which in the embryonic period are included in intra- or estraglandular lymphatic nodes, therefore the tumor is rich in lymphicscular stroma and contains lymphatic follicles between epithelial eyed gradual segments. This gave reason to call a tumor in such cases by papillary lymphoma-tousy cystadenoma.
and the tumor is depicted in the patient for 15 years. b MRI, T2-weighted image.
- Diagnostics. The diagnosis is made by the results of thorough palpation and ultrasound. With scintigraphy with 99m TC absorption of isotope tumor tissue. The diagnostic value of the aspiration biopsy in the ciladaidalimphome is not so large as with solid tumors. The final diagnosis is made after histological examination of the remote drug.
- Treatment. Depending on the localization of the tumor, resection of the parotic gland is carried out with the preservation of the facial nerve or exchauable the subband.
- Forecast Very favorable, malignant transformation is observed extremely rarely.
The most common benign tumors: Mioma of the uterus - develops from the muscular wall of the uterus: the body, the cervix. This type of tumor is developing in 15-17% of women over the age of 30. It is manifested in main uterine bleeding, an increase in the size of the uterus, pain in the lower abdomen. Papilloma's papilloma (lat. Papilloma; from Papilla - nipple + -_ma - tumor) - the type of benign epithelium of viral origin. Papilloma has a view of a tubercle or warts of various sizes. It can develop both on the skin and on the surface of the mucous membranes (nose, intestines, trachea, bronchi). Clinical picture Depends on location. When localizing the skin of the face and neck, a cosmetic defect is detected. Localization B. respiratory tract May cause respiratory disorder, the defeat of the urinary tract - to lead to the difficulty of urination. Adenoma - develops from the glandular epithelium of various organism glands (thyroid, prostate, salivary glands). Most often has a melbid shape or nodule shape. Often retains the ability to produce a secret characteristic for this body (mucus, colloid). May develop asymptomatic. Adenoma prostatic glandachieving significant sizes, causes urination disorders. Adenoma pituitary gland is a benign pituitary tumor. Tumor cells in most cases excessively distinguish the hormones of pituitary glands, due to which in addition to symptoms characteristic of tumor growth, various develop various endocrine diseases (Kushing's disease, giantism, acromegaly, etc.)
