03.09.2016 12738
An otolaryngologist (ENT) is a specialist with the skills of a surgeon and therapist. Treats ENT diseases of the ear, nose and larynx. In some cases, the otolaryngologist deals with.
Oncology is medical section, which studies malignant and benign neoplasms (tumors).
Tumors of the ENT organs are the growth of altered tissues, the cells of which do not have the opportunity to differentiate.
It is worth saying that all neoplasms are:
- malignant in nature
- benign in nature.
Malignant neoplasms are also divided into two types:
- sarcoma (a type of malignant tumor that comes from connective tissue).
Unfortunately, almost all malignant neoplasms are cancer.
In 55% of cases, ENT cancer is detected by doctors in a hopeless condition. But otolaryngologists just as often make mistakes. This situation occurs in 70% of situations.
Of all types of malignant tumors, ENT cancer accounts for 20%. In most cases, the larynx is affected by cancer.
This is explained by the skeptical attitude towards cancer on the part of both doctors and patients.
To prevent the occurrence of cancer of the ENT organs, it is worth taking care of taking effective measures. This number includes an active “war” with frequent consumption of strong drinks, chewing tobacco, and smoking. Care should also be taken to limit human inhalation of hazardous chemical substances in production and regular medical examinations.
If cancer of the ENT organs is detected at an early stage, the likelihood of a complete cure is quite high.
Risk factors for ENT oncology
Today, the final causes of oncology of the ENT organs are completely unknown. Large-scale studies are underway, thanks to which doctors plan to develop a scheme for preventive measures.
It is known that cancer of the nose, pharynx and ear most often affects older people (mainly men).
Of great importance is also genetic predisposition. The likelihood that a child will get cancer of the ENT organs, like his parent, is quite high. Although today there is active disagreement about this. Most doctors are confident that malignant neoplasms are in no way related to heredity.
It is worth saying that tumors of the ENT organs often occur in those who abuse alcohol or smoke. This factor can and should be influenced to reduce the likelihood of cancer.
Those who like to hold a cigarette between their teeth and connoisseurs of a tobacco pipe should remember that such a hobby greatly increases the appearance of malignant tumors on the lip, cheek and gums.
Poorly installed and incorrectly selected prostheses and implants also lead to malignant neoplasms.
Oral cancer occurs in people who do not include fresh fruits and vegetables in their diet.
As for lip cancer, here causative factor the occurrence of the disease is long exposure to the sun or exposure to ultraviolet rays.
Cancer occurs when a person is frequently exposed to “hazards” at work (inhaling chemicals).
It is worth saying that close attention is paid to the presence of the human papillomavirus, since it has been proven that it can cause nasopharyngeal cancer.
Even if you are not at risk, carefully monitor your health. If suspicious symptoms occur, consult a doctor immediately.
Diagnosis of ENT diseases
Making a diagnosis begins with interviewing the patient. During the consultation, the doctor asks about pain and medications that are this moment accepted by the patient.
This is followed by an examination of the patient, during which the doctor examines the condition of the nasal cavity, pharynx and hearing organs. Nasopharyngoscopy will help to thoroughly examine the pharynx. For more thorough examination An otolaryngologist performs an endoscopy. This procedure takes 4-5 minutes and requires you to administer an anesthetic medication. After this, the doctor prescribes other more detailed studies and analyses.
An accurate diagnosis can be made by a biopsy (a piece of tissue is taken from the area designated by the doctor).
In some cases, the doctor prescribes an ultrasound (sonography), general analysis blood and x-ray with barium suspension.
Types of ENT diseases
Just a couple of decades ago, cancer of the ENT organs sounded like a death sentence for people. Today we can say with confidence that cancer diseases can be defeated. The only condition in in this case is early production diagnosis.
So what are the types of cancer and what are they?
- Cancer of the nose and sinuses. The disease occurs most often in old age (in men). A tumor in the nose is diagnosed using endoscopic examination and rhinoscopy. Symptoms of the disease are bloody issues from the nose, painful sensations in the area of the hearing organs, heavy breathing, the appearance of a tumor on the outside.
- Nasopharyngeal cancer. This diagnosis is often made to men after 45 years of age. Symptoms include frequent sinusitis (at the initial stage of cancer), purulent and bloody discharge from the nose, incomplete paralysis of the facial nerve, blockage of the eustachian tube, unusual voice tone (at later). Used in treatment radiation exposure, because the surgical intervention in this case it is impossible.
- Laryngeal cancer. This condition is most often characteristic of women. Symptoms include a constant sore throat, difficulty breathing, a feeling of foreign object in the throat, hoarseness.
- Cancer of the mouth and pharynx. It occurs quite often in young people and children. Unfortunately, if cancer of the mouth and pharynx is not detected in time, there is a possibility of rapid spread to other organs.
- Cancer of the middle and outer ear. Diagnosed visually and using histological analysis. Symptoms include itching in the hearing organ, hearing loss, purulent discharge, pain, headaches, and facial paralysis.
It is worth saying that if the disease is neglected, the likelihood of a cure is very low. Therefore, if you notice any suspicious symptoms, consult a doctor.
Diseases of the ENT organs various types are diagnosed several times more often than other pathologies. They can be non-infectious or infectious in nature. But benign or malignant neoplasms that form on the tissues of the ENT organs are also identified.
What's happened
Formations of ENT organs include a large number of various tumors and growths that are localized on the nasal mucosa and oral cavity, upper respiratory tract and areas of the middle or outer ear.
They represent both various growths that are attached using a stalk or a wide base, as well as neoplasms. They can have a malignant or benign course.
Classification
In medicine, there are two main types of tumors that affect the nasopharynx and middle ear. They differ in the nature of the flow and have certain features.
Benign
They are classified according to their characteristics and appearance. Main feature formations is their slow growth and absence unpleasant symptoms.
Among such formations that have a benign course are:
- moles;
- warts;
- fibroids;
- chondromas;
- neuromas;
- polyps;
- papillomas;
- angiomas.
All of them do not have a tumor structure. Such growths represent hyperplasia of the mucous membrane of an allergic or inflammatory nature.
Clinical manifestations occur on late stages their formation, when growths and formations reach a significant size. But they also pose a danger to the life and health of the patient, since with regular injury, inflammation and bleeding, they can degenerate into malignant neoplasms.
Benign tumors form on the mucous membranes of the nasal and oral cavities, in the nasopharynx, ear canal and upper respiratory tract.
Malignant
Neoplasms that form on the mucous membrane of the ENT organs can also be malignant.
They are characterized by an aggressive course, are accompanied by many unpleasant signs and cause the development of serious complications. They are classified depending on the area of localization pathological process.
Nose cancer
The disease is diagnosed mainly in middle-aged, older and elderly men. The main way to determine the presence of formations on the nasal mucosa is rhinoscopy.
In the early stages of pathology development, certain signs are absent. As the tumor grows, bleeding, difficulty breathing, and painful sensations.
Nasopharyngeal cancer
The diagnosis is established in men over 45 years of age. The main symptom in the early stages is frequent sinusitis. Over time, pus and mucus mixed with blood are released from the nasal cavity.
For nasopharyngeal cancer use surgical removal impossible. Other methods are used for treatment.
Laryngeal cancer
Usually occurs in female patients. The disease at the initial stage is characterized by a sore throat.
The pathology proceeds aggressively, the pathological process spreads rapidly, and in short time affects healthy surrounding tissues.
Throat and mouth cancer
It is installed mainly in children and adolescents. Distinctive feature diseases is the presence visible signs presence of a pathological process.
At untimely treatment mutated cells quickly spread and infect surrounding tissues.
Outer and middle ear cancer
The disease is determined by visual examination. The main signs are a decrease in the quality of hearing, the appearance purulent discharge, headaches.
In some cases, the pathological process may spread to facial nerve, which leads to a number of other unpleasant symptoms.
Causes
Scientists have not established the true reasons for the development of tumors of the ENT organs. But even today experts are conducting a lot of research. This will allow us to identify certain preventive measures that will protect a person from the development of such diseases.
Scientists have only been able to establish a number of factors that can increase the likelihood of the formation of various types of tumors.
First of all, it is believed that the main provocateur is genetic predisposition. Many patients had close relatives suffering from similar diseases.
Experts also believe that provoking factors may be exposure to chemicals, toxic substances or ultraviolet rays, bad habits, and poor nutrition.
Clinical picture
In the early stages, there are most often no signs of the disease. As malignant tumors of the ENT organs develop, the appearance of common features. These include headaches, weakness, fast fatiguability, loss of appetite.
At later stages, metastatic lesions appear in distant organs and tissues, pain occurs in the affected area, and breathing becomes difficult.
In some cases, shortness of breath, decreased quality of hearing, nosebleeds, and the appearance of purulent discharge from the nose, which includes blood clots, are noted. Hoarseness and sore throat are also observed.
Diagnostics
If there are complaints, the specialist first conducts a survey and examination of the patient. Also studies anamnesis. Based on the data obtained, a preliminary diagnosis is established. To clarify it, use instrumental methods research.
The main method for identifying tumors on the nasal mucosa is rhinoscopy, in which an endoscope is inserted into the nasal passage. This allows you to visualize the tumor and conduct a detailed study of it.
The patient is also prescribed an MRI or CT scan. Techniques are used to determine the extent of damage.
In order to determine the nature of the course, a biopsy is prescribed. In cases where, based on the results of the study, it is established malignancy, radiography is prescribed. The method is used to determine the presence of metastatic lesions.
An accurate diagnosis is established based on all diagnostic results.
Treatment
The main method of treating formations is surgery. Depending on the stage of development, the surgeon removes only the affected tissue or the formation along with surrounding tissue.
But removal of benign tumors is carried out if there is a risk of their degeneration into cancerous formations or they cause discomfort.
If it is impossible to remove a malignant tumor due to its localization, chemotherapy or radiation therapy is prescribed.
Complications
Cancers are not only characterized by an aggressive course, but are also capable of affecting the functioning of other organs as a result of the spread of metastatic lesions. Lack of therapy leads to death due to cardiac, renal, pulmonary or liver failure.
Benign tumors in some cases also pose dangers, as they can mutate into cancerous tumors under the influence of external and internal factors.
Prognosis and prevention
The prognosis depends on the nature of the pathology. At benign neoplasms it is most often favorable.
But upon diagnosis cancerous tumors The five-year survival rate of patients ranges from 80 to 10% in accordance with the stage of development of the pathological process.
As a preventative measure, experts recommend eating right, avoiding bad habits, eliminate exposure to chemicals and regularly undergo preventive tests. When working in hazardous industries, it is necessary to use individual means protection.
Neoplasms of the ENT organs are often diagnosed and can have a malignant course, which leads to a number of complications in the absence of therapy. That is why, if unpleasant symptoms appear, you should immediately consult a doctor for diagnosis.
To exclude the development of certain consequences, including death, allow only timely treatment.
Of all malignant neoplasms ENT organs account for 23%, in men - 40%, and laryngeal cancer predominates. 65% of all ENT tumors are detected in an advanced state. 40% of patients die without living even 1 year from the moment of diagnosis.
In patients with laryngeal cancer, 34% were misdiagnosed, and 55% were misdiagnosed with pharyngeal cancer. In patients with tumors localized in the nasal cavity and its paranasal sinuses misdiagnosis accounts for 74% of cases.
Thus, we can conclude how high the oncological alertness should be, especially in ENT practice.
Based on the 1978 classification, there are:
1. Nonepithelial tumors:
· soft tissues (connective tissue).
Neurogenic
tumors from muscle tissue
tumors from adipose tissue
neuroepithelial tumors of bones and cartilage
2. Epithelial
3. Tumors of lymphoid and hematopoietic tissue.
4. Mixed tumors
5. Secondary tumors
6. Tumor-like formations.
In each of these groups, benign and malignant tumors are distinguished. The TNM classification system is also used.
T1 - the tumor occupies one anatomical part.
T2 - the tumor occupies 2 anatomical parts, or 1 anatomical part, but grows adjacent organ, affecting no more than one anatomical part.
T3 - the tumor will occupy more than 2 anatomical parts, or 2 anatomical parts + invasion into a neighboring organ.
N0 - no regional metastases
N1 - regional metastases are unilateral and displaced
N2 - regional metastases, bilaterally displaced.
N3 - regional metastases, unilateral, immobile
N4 - regional metastases, bilateral, immobile, or a unilateral conglomerate of metastases, growing into neighboring organs.
M0 - no distant metastases.
M - there are distant metastases.
Malignant tumors of the larynx.
Cancer predominates, almost always squamous cell, less often basal cell. Sarcoma of the larynx is extremely rare.
Horatine cancer ranks 4th among all malignant tumors in men, behind cancer of the gallbladder, lungs and esophagus. The incidence ratio of laryngeal carcinoma in men and women is 22:1.
Laryngeal cancer occurs in persons under 30 years of age and over 40 years of age, and in women under 20 years of age.
More likely to be affected upper section larynx - middle, even less often - lower section.
The most common form of cancer is exophytic, which grows slowly. With a tumor of the epiglottis, the process spreads upward and anteriorly; with a tumor of the middle part of the larynx, through the commissure or laryngeal ventricle, the spread goes to the upper part. The tumor of the lower part of the larynx grows down through the conical ligament and penetrates into the anterior parts of the neck.
Cancer of the vestibule of the larynx metastasizes earlier, most often on the wounded side, and slowest on the tumor side anterior section larynx.
There are 3 periods of development of laryngeal tumors:
1. Initial - soreness, discomfort when swallowing, sensation of a lump in the throat.
2. The period of full development of the disease - there is hoarseness up to aphonia, difficulty breathing up to asphyxia, impaired swallowing up to complete impossibility.
3. Period of metastasis.
Differential diagnosis is carried out with tuberculosis, scleroma, syphilis.
The final (decisive) is a histological examination or preventive therapy without a sufficiently good result.
Treatment of laryngeal cancer. Most often - extirpation of the larynx, less often - its resection, and even less often - reconstructive operations. Before starting surgical treatment, a tracheotomy must be performed to administer intubation anesthesia and to ensure breathing in the subsequent postoperative period.
Types of operations for laryngeal cancer:
1. endolaryngeal tumor removal - indicated for stage 1, middle tumor.
2. Removal of the tumor using external access: a. Thyrotomy, laryngofissure - at stage 2, middle floor; b. Sublingual pharyngotomy. For tumors of the non-fixed part of the epiglottis, extirpation of the epiglottis is performed.
3. Resection of the larynx. Performed when the tumor is localized in the anterior 2/3 of the vocal folds with spread to the anterior commissure; with damage to one vocal fold; with limited cancer of the lower larynx; for limited cancer of the upper larynx, provided that the arytenoid cartilages are intact.
Types of resections:
· lateral (sagittal).
· Anterolateral (diagonal).
· Front (front).
· Horizontal.
4. Laryngectomy - performed if resection is impossible, or in the third stage.
5. Extended laryngectomy - the larynx, hyoid bone, root of the tongue, and lateral walls of the hypopharynx are removed. The operation is disabling. As a result, a tracheostomy is formed and an esophageal feeding tube is inserted.
In addition to surgery, they use radiation treatment. It begins to be carried out before surgery in stages 1 and 2 of the process. If after half the treatment sessions there is significant regression of the tumor, then radiation therapy is continued until the full dose (60-70 Gy). In cases where, after half irradiation, tumor regression is less than 50%, radiation therapy is interrupted and the patient is operated on. Cancer of the middle floor of the larynx is the most radiosensitive, and cancer of the lower part is radioresistant. In the case of regional metastases, a Krail operation is performed - the tissue of the lateral part of the neck, deep jugular lymph nodes, sternocleidomastoid muscle, internal jugular vein, submandibular lymph nodes, submandibular salivary gland. In case of distant metastases, symptomatic and chemotherapy are carried out. The exception is metastases to the lungs; surgical treatment is acceptable here.
CHEMOTHERAPY.
Used in addition to the main method of treatment, or in advanced cases. Used: prosedil, bleomycin, methotrexate, fluorobenzotec, synstrol (2500-3500 mg, used in men).
Treatment results.
With combined treatment for stage 2 laryngeal cancer, the five-year survival rate reaches 71-75%, for the third stage 60-73%, for stage 4 25-35%, and for the first stage - 90% of cases.
The main reason for adverse outcomes is relapses.
NEOPHARYNX NEOPHARYNX.
Benign tumors - papillomas, are localized, as a rule, on the posterior surface of the soft palate, less often on the lateral and posterior walls of the nasopharynx. Treatment is surgical.
Juvenile angiofibroma. Localized in the vault of the nasopharynx. It often penetrates into the nasal cavity through the choanae. Consists of connective tissue and blood vessels. Possesses rapid growth. Clinic: impaired nasal breathing and decreased hearing as it closes auditory tube, as well as nosebleeds. The formation quickly fills the nasal cavity and paranasal sinuses, primarily the sphenoid sinus. It can destroy the structure of the skull and penetrate into its cavity. With posterior rhinoscopy, a bluish, burgundy formation can be seen. Treatment is surgical (according to Moore).
Malignant tumors. Most often occur in men over 40 years of age. It is accompanied by sinusitis, so the diagnosis is very often a mistake. Bloody discharge from the nose appears, a closed nasal character, the process is usually one-sided. There is practically no access for surgical treatment, therefore radiation therapy is used.
NEOPHORAHYNASICS.
Benign. Includes papilloma and hemangioma.
Malignant. Cancer predominates. Differentiated radioresistant tumors are identified and are found in at a young age and in children.
Initial localization (by frequency).
· Palatine tonsils 58% of cases
posterior wall of the pharynx 16% of cases
· soft sky 10% of cases
Growth is rapid, they ulcerate quickly, and often metastasize. The clinical picture depends on the initial location of the tumor. Cachexia is associated with symptoms as swallowing is impaired.
Treatment: with benign processes- an operation that can be performed through the mouth or with a sublingual pharyngotomy. In the case of malignant tumors - radiation therapy + surgery. Before the operation, tracheotomy and external ligation are required. carotid artery on the losing side.
NEW TUMORS OF THE LYRPHYNAH.
Cancer of the laryngopharynx usually develops in the pyriform sinus, a few less often in back wall and in the retrocricoid region. The most typical form of growth is exophytic.
Complaints: in early stage dysphagia if the tumor is localized at the entrance to the esophagus and difficulty breathing if localized at the entrance to the larynx. Later pain, hoarseness, hemoptysis, bad smell. Treatment, both surgical and radiation, is ineffective.
Operation - laryngectomy with circular resection cervical region esophagus + tracheal resection. A farnigostomy, orostoma, esophagostomy, and tracheostomy are formed. If possible, gastrointestinal tract plastic surgery is performed in the future.
OPERATIONS USED FOR TUMORS OF THE NOSE AND ARRANGE SINUSES.
Operations with access through the mouth (according to Denker). Indications - localization of the tumor in the anterior-lower part of the nose, tumor in the elderly - malignant, benign tumors. The operation is gentle.
An incision under the lip on the affected side continues to the opposite side. The facial wall is exposed upper jaw, pear-shaped foramen, inferior internal angle of the orbit. Soft fabrics are separated and lifted up. Possible ways approach: anterior and medial walls of the maxillary sinus, lower and lateral walls of the nasal cavity. From these approaches one can approach the main one, frontal sinuses, cells of the ethmoid labyrinth.
Moore's operation (external access). Indications: tumors of the ethmoidal labyrinth, main sinus.
The incision is made along the eyebrow, along the side wall of the nose, going around the wing of the nose. Soft tissues are separated.
Malignant tumors of the ENT organs can develop from a number of relatively benign growths (malignancy) that precede them, which are called pretumors. In addition to the direct effect of the tumor on the surrounding tissues and organs in which it arose, tumors are also characterized by so-called paraneoplastic syndromes, which are nonspecific in nature and accompany not only malignant growth, but also some benign tumors, for example, neuroma of the vestibulocochlear nerve, which develops in the internal ear canal, compressing the nerve trunks corresponding to their localization.
Paraneoplastic syndromes are a variety of pathological manifestations, caused by the influence tumor process on metabolism and functional activity of the body's regulatory systems. For the most part, these syndromes aggravate the course of the tumor process, and in some cases their signs help diagnose the disease. Over 60 paraneoplastic syndromes have been described, among which are syndromes with metabolic disorders, endocrine functions, skin lesions, vascular disorders, autoimmune disorders, allergic reactions, lesions of the central nervous system, neuromuscular disorders, etc. The incidence of tumors increases with age, and in most cases they occur after 40 years. However, some tumors are more common in children than in adults. These include teratomas - neoplasms from embryonic tissue, tumors from nervous tissue, peculiar kidney tumors (nephroblastomas) and various angiomas - vascular tumors.
Symptoms of malignant tumors of the ENT organs
It is generally accepted that malignant tumors in initial stages are asymptomatic, but in most cases, with a careful and in-depth medical history, one or more minor symptoms of a general oncological disease can be identified (deterioration of health, increased fatigue, loss of appetite, weakness, etc.), if a tumor or its predecessor - a pretumor - develops in an organ whose function is obvious to both the patient and others (for example, the phonatory function of the larynx), then these minor symptoms must be taken into account while observing the principle of oncological vigilance . The symptoms of each form of malignant (benign) tumor depend on its location and degree of spread, which is usually designated according to the International System, where T is the primary tumor focus, N is the lesion lymph nodes, M - presence of hematogenous metastases in distant organs. The degree of expression of each of these signs is characterized by digital indicators. There is a classification in which everything clinical manifestations tumor growth divided into stages:
- stage I - the tumor is limited to the organ, there are no metastases;
- stage II - tumor within the affected organ, there are metastases in regional lymph nodes;
- stage III - a tumor of significant size with invasion into adjacent organs and tissues, there are multiple metastases in regional lymph nodes;
- stage IV - the presence of distant metastases, regardless of the size and extent of the primary tumor.
Diagnosis of malignant tumors of the ENT organs
Diagnosis of malignant tumors of the ENT organs is carried out using the same methods as the recognition of other diseases. Early recognition is easiest oncological diseases organs accessible to visual examination, since in this case it is possible not only to examine them, but also to take material for morphological research. Early diagnosis of tumors is most difficult internal organs. In this case, special research methods become crucial: X-ray, radionuclide, morphological, immunological, etc. clinical practice research methods using nuclides are increasingly being introduced, called radionuclide diagnostics, which is a method of recognition pathological changes human organs and systems using radiopharmaceuticals, which include compounds labeled with radionuclides. Registration of the effects of radionuclides introduced into the body is carried out using scintigraphy, scanning, radiometry, and radiography. Scintigraphy, the most common method of radionuclide diagnostics, allows you to obtain an image of an organ and use it to judge its size and shape, identify the lesion in the form of an area of increased or decreased accumulation of the injected radionuclide, evaluate functional state organ according to the rate of accumulation and release of the radiopharmaceutical. The use of radionuclide diagnostics due to the extremely low dose of the nuclide, its short half-life and rapid elimination does not pose a danger to the body. The final stage of diagnosis is a morphological examination, which is carried out using histological (biopsy) or cytological methods for studying cells in washings and scrapings from the affected area. According to the method of taking material for histological examination, they distinguish between incisional, puncture and aspiration biopsy. In this case, preliminary tissue dissection may be required to provide access to a deep-lying lesion (open biopsy). For tumors of the upper respiratory tract, incisional biopsy is most often used due to the accessibility of the study object. When examining the trachea and bronchi, aspiration biopsy of sputum and swabs is used. The biopsy is performed only in a medical institution, strictly observing the requirements of asepsis and taking into account general state sick. The resulting material is immediately placed in a freshly prepared fixative solution containing 1 part formalin and 4-5 parts water, and together with the filled doctor accompanying document delivered to the laboratory of the pathology department.
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The floor goes to the chief freelance otorhinolaryngologist of the Ministry of Health of the Russian Federation, first deputy chairman of the Commission of the Public Chamber of the Russian Federation for the protection of citizens' health and healthcare development, director of the Federal Scientific and Clinical Center of Otorhinolaryngology of the Federal Medical and Biological Agency of Russia, professor, corresponding member of the Russian Academy of Sciences Nikolai Daikhes.
There is contact!
Alexandra Tyrlova, AiF Health: Nikolai Arkadyevich, in your opinion, what is the main direction of development of otorhinolaryngology today?
Nikolay Dykhes: Today, all over the world, otorhinolaryngology is developing as an interdisciplinary specialty - head and neck surgery. And, naturally, we should not lag behind in this regard. Of course, this became possible only after the new Federal Scientific and Clinical Center for Otorhinolaryngology was opened. This is the largest center not only in Russia, but also in the world. Here on one site we provide all types of high-tech medical care related to diseases of the ear, nose and throat in both adults and children, we treat patients who need help from oncologists, maxillofacial and plastic surgeons, ophthalmologists, occupational pathologists, and much more related to head and neck pathology.
- But oncology is a separate field of medicine?
Indeed, this was the case for for long years. Unfortunately, in the late 80s - early 90s, clinicians of narrow specialties were excluded from the structure of oncological care. This led to poor results. For example, currently there is an increase in oncological diseases of the ENT organs not only in Russia, but throughout the world, which is about 15-20% in general structure cancer, and this is a fairly high percentage. For example, 60-70% of patients with laryngeal cancer who seek help for the first time already have the third or fourth stage of the disease. How can such statistics be explained? There are several reasons. Firstly, this is the low oncological alertness of doctors conducting initial appointments in clinics, when inadequate treatment is prescribed and the disease becomes advanced. It is important that, first of all, the specialist always remembers the possibility of a hidden oncological process. I always remind outpatient otorhinolaryngologists: examine the patient and make sure there is no oncological problem, then treat the inflammatory or other pathology. After all, malignant tumors, as a rule, are always preceded by background or pretumor conditions.
But this is not always only the fault of non-oncologists, since in the process of obtaining postgraduate medical education they are not properly trained in oncology. Conversely, oncology clinicians are not sufficiently trained in the skills of a particular subspecialty. As a result, it is not always possible to perform gentle oncological surgery to preserve the functionality of a vital organ.
- What should be done to establish contact between oncologists and doctors of other specialties?
Now the Russian Ministry of Health understands that such interaction is necessary - the development of joint clinical recommendations for oncologists and doctors of other specialties, educational programs postgraduate education of doctors aimed at improving their skills in oncology. Many heads of leading cancer centers are ready to cooperate with medical centers other directions. I hope that an interdisciplinary working group, which will deal with oncology problems in all areas.
Fighting for patients
- It is not possible to perform a complex operation everywhere. How to increase the availability of high-tech medical care?
One of the areas of development and accessibility of high-tech medical care is the creation of branches of leading institutes. For example, we have branches in Khabarovsk and Astrakhan. In addition, over the past year and a half, we have traveled to 50 regions of the country to sign agreements providing for the opportunity to directly refer patients for treatment to our center under the high-tech compulsory medical insurance system.
- How much effort does a patient need to make to get a referral? high-tech operation? Is there competition between medical institutions here?
High-tech medical care in Russian Federation consists of two parts - basic program High-tech compulsory medical insurance (HT compulsory medical insurance) and extra-basic, or federal, high-tech medical care (HTMC) programs.
The difference between them lies in the methods of financing, the volume of assistance and the structure of tariffs for the provision of services. VMP is de facto a direct government investment that gives a certain clinic a guaranteed volume of patients. The question is different.
For example, our federal center annually carries out more than 7 thousand complex operations, and the allocated volumes of VMP are clearly not enough for us. Therefore, we travel to the regions to invite patients for treatment under the basic high-tech compulsory medical insurance program.I believe that in order to maintain a balance, it is necessary to expand the possibility of providing high medical care within the framework of compulsory medical insurance of the basic program and unify the tariffs of the basic high medical medical insurance program and the extra-basic high medical medical insurance program.
This will create real opportunities for patients independent choice medical institution for getting high-tech assistance, will ensure competition between medical institutions, which means it will improve the quality of medical care.
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