Radiation effects in skin cancer. Radiation therapy (radiotherapy) - contraindications, consequences and complications

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The site provides background information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. A specialist consultation is required!

Contraindications for radiation therapy

Despite the effectiveness radiotherapy ( radiation therapy) in the treatment of tumor diseases, there are a number of contraindications that limit the use of this technique.

Radiotherapy is contraindicated:

• In case of violation of the functions of vital organs. During radiation therapy, the body will be exposed to a certain dose of radiation, which can negatively affect the functions of various organs and systems. If the patient already has severe diseases of the cardiovascular, respiratory, nervous, hormonal or other body systems, performing radiotherapy can aggravate his condition and lead to the development of complications.

• With severe depletion of the body. Even with high-precision radiation therapy methods, a certain dose of radiation acts on healthy cells and damages them. Cells need energy to recover from this damage. If at the same time the patient's body is depleted ( for example, due to damage to internal organs by tumor metastases), radiation therapy can do more harm than good.
• With anemia. Anemia is a pathological condition characterized by a decrease in the concentration of red blood cells ( erythrocytes). When exposed to ionizing radiation, red blood cells can also be destroyed, which will lead to the progression of anemia and may cause complications.
• If radiotherapy has already been performed recently. In this case, we are not talking about repeated courses of radiation treatment of the same tumor, but about the treatment of another tumor. In other words, if the patient was diagnosed with cancer of any organ, and radiotherapy was prescribed for its treatment, if another cancer is detected in another organ, radiotherapy cannot be used for at least 6 months after the end of the previous course of treatment. This is explained by the fact that in this case the total radiation load on the body will be too high, which can lead to the development of formidable complications.
• In the presence of radioresistant tumors. If the first courses of radiation therapy had absolutely no positive effect ( that is, the tumor did not shrink or even continued to grow), further irradiation of the body is inappropriate.
• With the development of complications during treatment. If, during the course of radiotherapy, the patient experiences complications that pose an immediate danger to his life ( eg bleeding), treatment should be discontinued.
• In the presence of systemic inflammatory diseases (e.g. systemic lupus erythematosus). The essence of these diseases lies in the increased activity of the cells of the immune system against their own tissues, which leads to the development of chronic inflammatory processes in them. The impact of ionizing radiation on such tissues increases the risk of complications, the most dangerous of which may be the formation of a new malignant tumor.
• If the patient refuses treatment. According to current legislation, no radiation procedure can be performed until the patient gives written consent to it.

Radiation therapy and alcohol compatibility

During radiation therapy, it is recommended to refrain from drinking alcoholic beverages, as this can negatively affect the general condition of the patient.

There is a popular belief that ethanol ( ethyl alcohol, which is the active ingredient in all alcoholic beverages) is able to protect the body from the damaging effects of ionizing radiation, and therefore should be used during radiotherapy. Indeed, in a number of studies it was found that the introduction of high doses of ethanol into the body increases the resistance of tissues to radiation by about 13%. This is due to the fact that ethyl alcohol disrupts the flow of oxygen into the cell, which is accompanied by a slowdown in the processes of cell division. And the slower the cell divides, the higher its resistance to radiation.

At the same time, it is important to note that in addition to a minor positive effect, ethanol also has a number of negative effects. So, for example, an increase in its concentration in the blood leads to the destruction of many vitamins, which themselves were radioprotectors ( that is, they protected healthy cells from the damaging effects of ionizing radiation). Moreover, numerous studies have shown that chronic alcohol consumption in large quantities also increases the risk of developing malignant neoplasms ( in particular tumors of the respiratory system and gastrointestinal tract). Considering the above, it follows that the consumption of alcoholic beverages during radiation therapy causes more harm to the body than good.

Can I smoke with radiation therapy?

It is strictly forbidden to smoke while performing radiation therapy. The fact is that the composition of tobacco smoke contains many toxic substances ( ethers, alcohols, resins and so on). Many of them have a carcinogenic effect, that is, upon contact with cells of the human body, they contribute to the emergence of mutations, the outcome of which can be the development of a malignant tumor. It has been scientifically proven that smokers have a significantly increased risk of lung cancer, pancreatic cancer, esophageal cancer and bladder cancer.

Considering the above, it follows that patients undergoing radiation therapy for cancer of any organ are strictly prohibited not only from smoking, but also from being near people who smoke, since inhaled carcinogens can reduce the effectiveness of the treatment and contribute to the development of a tumor.

Is it possible to perform radiation therapy during pregnancy?

Radiation therapy during pregnancy can cause intrauterine damage to the fetus. The fact is that the effect of ionizing radiation on any tissue depends on the rate at which cell division occurs in a given tissue. The faster the cells divide, the more pronounced the damaging effect of radiation will be. During intrauterine development, the maximum intensive growth of absolutely all tissues and organs of the human body is observed, which is due to the high rate of cell division in them. Consequently, even when exposed to relatively low doses of radiation, the tissues of the growing fetus can be damaged, which will lead to disruption of the structure and functions of internal organs. The outcome depends on the gestational age at which the radiation therapy was performed.

During the first trimester of pregnancy, the laying and formation of all internal organs and tissues occurs. If at this stage the developing fetus is irradiated, this will lead to the appearance of pronounced anomalies, which often turn out to be incompatible with further existence. This triggers a natural "protective" mechanism, which leads to the termination of the fetus and spontaneous abortion ( miscarriage).

During the second trimester of pregnancy, most of the internal organs are already formed, therefore, intrauterine fetal death after irradiation is not always observed. At the same time, ionizing radiation can provoke anomalies in the development of various internal organs ( brain, bones, liver, heart, genitourinary system and so on). Such a child may die immediately after birth if the resulting anomalies are incompatible with life outside the womb.

If radiation has occurred in the third trimester of pregnancy, the baby may be born with certain developmental abnormalities that may persist throughout later life.

Given the above, it follows that performing radiation therapy during gestation is not recommended. If the patient is diagnosed with cancer in early pregnancy ( up to 24 weeks) and at the same time requires radiotherapy, the woman is offered to have an abortion ( abortion) for medical reasons, after which treatment is prescribed. If cancer is detected at a later date, further tactics are determined depending on the type and rate of development of the tumor, as well as on the mother's desire. Most often, such women undergo surgical removal of the tumor ( if possible - for example, for skin cancer). If the treatment does not give positive results, you can induce childbirth or perform delivery surgery at an earlier date ( after 30 - 32 weeks of pregnancy) and then start radiation therapy.

Can I sunbathe after radiation therapy?

It is not recommended to sunbathe in the sun or in a solarium for at least six months after the end of the course of radiotherapy, as this can lead to the development of a number of complications. The fact is that when exposed to solar radiation, many mutations occur in skin cells that can potentially lead to the development of cancer. However, as soon as a cell mutates, the body's immune system immediately notices this and destroys it, as a result of which cancer does not develop.

During radiation therapy, the number of mutations in healthy cells ( including in the skin through which ionizing radiation passes) can increase significantly, which is due to the negative effect of radiation on the genetic apparatus of the cell. At the same time, the load on the immune system increases significantly ( she has to deal with a large number of mutated cells at the same time). If at the same time a person begins to sunbathe in the sun, the number of mutations may increase so much that the immune system cannot cope with its function, as a result of which the patient may develop a new tumor ( such as skin cancer).

Why is radiation therapy dangerous ( consequences, complications and side effects)?

During radiotherapy, a number of complications can develop, which can be associated with the effect of ionizing radiation on the tumor itself or on healthy tissues of the body.

Hair loss

Hair loss in the scalp is seen in most patients who have received radiation treatment for tumors in the head or neck. Hair loss is caused by damage to the cells of the hair follicle. Under normal conditions, it is the division ( breeding) of these cells and causes hair growth in length.
When exposed to radiation therapy, cell division of the hair follicle slows down, as a result of which the hair stops growing, its root weakens and it falls out.

It should be noted that when other parts of the body are irradiated ( such as legs, chest, back and so on) hair can fall out of that area of ​​the skin through which a large dose of radiation is passed. After the end of radiation therapy, hair growth resumes on average after a few weeks or months ( if no irreversible damage to the hair follicles occurred during treatment).

Burns after radiation therapy ( radiation dermatitis, radiation ulcer)

When exposed to high doses of radiation, certain changes occur in the skin, which, in appearance, resemble a burn clinic. In fact, no thermal tissue damage ( as with a true burn) is not observed in this case. The mechanism of development of burns after radiotherapy is as follows. When the skin is irradiated, small blood vessels are damaged, as a result of which microcirculation of blood and lymph in the skin is disturbed. At the same time, oxygen delivery to the tissues decreases, which leads to the death of some cells and their replacement with scar tissue. This, in turn, further disrupts the oxygen delivery process, thereby supporting the development of the pathological process.

Skin burns can manifest themselves:

• Erythema. This is the least dangerous manifestation of radiation damage to the skin, in which there is an expansion of superficial blood vessels and redness of the affected area.
• Dry radiation dermatitis. In this case, an inflammatory process develops in the affected skin. At the same time, many biologically active substances enter the tissues from the dilated blood vessels, which act on special nerve receptors, causing an itching sensation ( burning, irritation). In this case, scales can form on the surface of the skin.
• Wet radiation dermatitis. With this form of the disease, the skin swells and may become covered with small blisters filled with a clear or cloudy liquid. After opening the vesicles, small ulcerations form that do not heal for a long time.
• Radiation ulcer. It is characterized by necrosis ( ruin) parts of the skin and deeper tissues. The skin in the area of ​​the ulcer is extremely painful, and the ulcer itself does not heal for a long time, which is due to a violation of microcirculation in it.
• Radiation skin cancer. The most severe complication after a radiation burn. The formation of cancer is facilitated by cell mutations resulting from radiation exposure, as well as prolonged hypoxia ( lack of oxygen), developing against the background of microcirculation disorders.
• Skin atrophy. It is characterized by thinning and dryness of the skin, hair loss, impaired sweating and other changes in the affected area of ​​the skin. The protective properties of atrophied skin are sharply reduced, as a result of which the risk of developing infections increases.

Itchy skin

As mentioned earlier, exposure to radiation therapy leads to disruption of blood microcirculation in the skin area. In this case, the blood vessels expand, and the permeability of the vascular wall increases significantly. As a result of these phenomena, the liquid part of the blood passes from the bloodstream into the surrounding tissues, as well as many biologically active substances, which include histamine and serotonin. These substances irritate specific nerve endings located in the skin, as a result of which there is an itching or burning sensation.

Antihistamines can be used to relieve itchy skin, which block the effects of histamine at the tissue level.

Edema

The occurrence of edema in the leg area may be due to the effect of radiation on the tissues of the human body, especially when irradiating tumors of the abdomen. The fact is that during irradiation, damage to the lymphatic vessels can be observed, through which, under normal conditions, lymph flows from the tissues and flows into the bloodstream. Violation of lymph outflow can lead to the accumulation of fluid in the tissues of the legs, which will be the direct cause of the development of edema.

Skin swelling during radiation therapy can also be caused by exposure to ionizing radiation. In this case, there is an expansion of the blood vessels of the skin and the sweating of the liquid part of the blood into the surrounding tissue, as well as a violation of the outflow of lymph from the irradiated tissue, as a result of which edema develops.

At the same time, it should be noted that the occurrence of edema may not be associated with the effect of radiation therapy. So, for example, with advanced cases of cancer, metastases may occur ( distant tumor foci) in various organs and tissues. These metastases ( or the tumor itself) can squeeze blood and lymph vessels, thereby disrupting the outflow of blood and lymph from tissues and provoking the development of edema.

Pain

Pain with radiation therapy can occur in the case of radiation damage to the skin. At the same time, in the area of ​​the affected areas, a violation of blood microcirculation is noted, which leads to oxygen starvation of cells and damage to nerve tissues. All this is accompanied by the occurrence of a pronounced pain syndrome, which patients describe as "burning", "unbearable" pain. This pain syndrome cannot be eliminated with the help of conventional painkillers, and therefore other treatment procedures are prescribed to patients ( medication and non-medication). Their goal is to reduce the edema of the affected tissues, as well as restore the patency of blood vessels and normalize microcirculation in the skin. This will help to improve the delivery of oxygen to the tissues, which will reduce the severity or completely eliminate pain.

The defeat of the stomach and intestines ( nausea, vomiting, diarrhea, diarrhea, constipation)

The cause of dysfunction of the gastrointestinal tract ( Gastrointestinal tract) the radiation dose may be too large ( especially when irradiating tumors of internal organs). In this case, there is a lesion of the mucous membrane of the stomach and intestines, as well as a violation of the nervous regulation of intestinal peristalsis ( motor skills). In more severe cases, inflammatory processes can develop in the gastrointestinal tract ( gastritis - inflammation of the stomach, enteritis - inflammation of the small intestine, colitis - inflammation of the large intestine, and so on) or even ulceration. The process of moving intestinal contents and digestion of food will be disrupted, which can cause the development of various clinical manifestations.

The defeat of the gastrointestinal tract during radiation therapy can manifest itself:

• Nausea and vomiting- associated with delayed gastric emptying due to impaired gastrointestinal motility.
• Diarrhea ( diarrhea) - occurs due to inadequate digestion of food in the stomach and intestines.
• Constipation- can occur with severe damage to the mucous membrane of the large intestine.
• Tenesmus- frequent, painful urge to defecate, during which nothing is released from the intestines ( or a small amount of mucus is secreted without stool).
• The appearance of blood in the stool- this symptom may be associated with damage to the blood vessels of the inflamed mucous membranes.
• Stomach pain- occur due to inflammation of the mucous membrane of the stomach or intestines.

Cystitis

Cystitis is an inflammatory lesion of the mucous membrane of the bladder. The cause of the disease may be radiation therapy, carried out to treat a tumor of the bladder itself or other organs of the small pelvis. At the initial stage of the development of radiation cystitis, the mucous membrane becomes inflamed and swollen, but later ( as the dose of radiation increases) it atrophies, that is, it becomes thinner, wrinkles. At the same time, its protective properties are violated, which contributes to the development of infectious complications.

Clinically, radiation cystitis may present with frequent urge to urinate ( during which a small amount of urine is released), the appearance of a small amount of blood in the urine, a periodic increase in body temperature, and so on. In severe cases, ulceration or necrosis of the mucous membrane may occur, against which a new cancerous tumor may develop.

Treatment of radiation cystitis consists in the use of anti-inflammatory drugs ( to eliminate the symptoms of the disease) and antibiotics ( to combat infectious complications).

Fistulas

Fistulas are pathological channels through which various hollow organs can communicate with each other or with the environment. The causes of fistula formation can be inflammatory lesions of the mucous membranes of internal organs, developing against the background of radiation therapy. If such lesions are not treated, over time, deep ulcers form in the tissues, which gradually destroy the entire wall of the affected organ. In this case, the inflammatory process can spread to the tissue of a neighboring organ. Ultimately, the tissues of the two affected organs are "welded" together, and a hole is formed between them, through which their cavities can communicate.

With radiation therapy, fistulas can form:

• between the esophagus and trachea ( or large bronchi);
• between the rectum and the vagina;
• rectal and bladder honey;
• between the loops of the intestine;
• between the intestines and the skin;
• between the bladder and the skin, and so on.

Lung damage after radiation therapy ( pneumonia, fibrosis)

With prolonged exposure to ionizing radiation, inflammatory processes can develop in the lungs ( pneumonia, pneumonitis). In this case, ventilation of the affected areas of the lungs will be disrupted and fluid will begin to accumulate in them. This will manifest itself as a cough, feeling short of breath, chest pains, sometimes hemoptysis ( discharge of small amounts of blood with phlegm during coughing).

If these pathologies are not treated, over time this will lead to the development of complications, in particular to the replacement of normal lung tissue with scar or fibrous tissue ( that is, to the development of fibrosis). Fibrous tissue is impervious to oxygen, as a result of which its growth will be accompanied by the development of oxygen deficiency in the body. At the same time, the patient will begin to experience a feeling of lack of air, and the frequency and depth of his breathing will increase ( that is, shortness of breath will appear).

In the case of pneumonia, anti-inflammatory and antibacterial drugs are prescribed, as well as drugs that improve blood circulation in the lung tissue and, thereby, prevent the development of fibrosis.

Cough

Cough is a common complication of radiation therapy when the chest is exposed to radiation. In this case, ionizing radiation affects the mucous membrane of the bronchial tree, as a result of which it becomes thinner and dry. At the same time, its protective functions are significantly weakened, which increases the risk of developing infectious complications. During breathing, dust particles, which usually settle on the surface of the moist mucous membrane of the upper respiratory tract, can penetrate into the smaller bronchi and get stuck there. At the same time, they will irritate special nerve endings, which will activate the cough reflex.

To treat cough with radiation therapy, expectorant drugs ( increasing the production of mucus in the bronchi) or procedures to help moisturize the bronchial tree ( e.g. inhalation).

Bleeding

Bleeding can develop as a result of exposure to radiation therapy on a malignant tumor that grows into large blood vessels. On the background of radiation therapy, the size of the tumor may decrease, which may be accompanied by a thinning and a decrease in the strength of the wall of the affected vessel. The rupture of this wall will lead to bleeding, the localization and volume of which will depend on the location of the tumor itself.

At the same time, it is worth noting that the effect of radiation on healthy tissues can also be the cause of bleeding. As mentioned earlier, when healthy tissues are irradiated, blood microcirculation is disturbed in them. As a result, blood vessels can expand or even be damaged, and some of the blood will be released into the environment, which can cause bleeding. According to the described mechanism, bleeding can develop with radiation damage to the lungs, mucous membranes of the mouth or nose, gastrointestinal tract, urogenital organs, and so on.

Dry mouth

This symptom develops with irradiation of tumors located in the head and neck region. In this case, ionizing radiation affects the salivary glands ( parotid, sublingual and submandibular). This is accompanied by a disruption in the production and secretion of saliva into the oral cavity, as a result of which its mucous membrane becomes dry and hard.

Due to the lack of saliva, taste perception is also impaired. This is explained by the fact that in order to determine the taste of a particular product, the particles of the substance must be dissolved and delivered to the taste buds located in the depths of the papillae of the tongue. If there is no saliva in the oral cavity, the food product cannot reach the taste buds, as a result of which a person's taste perception is impaired or even perverted ( the patient may have a persistent feeling of bitterness or a metallic taste in the mouth).

Tooth damage

With radiation therapy of tumors of the oral cavity, darkening of the teeth and a violation of their strength are noted, as a result of which they begin to crumble or even break. Also due to a violation of the blood supply to the dental pulp ( the inner tissue of the tooth, made up of blood vessels and nerves) the metabolism in the teeth is disturbed, which increases their fragility. Moreover, impaired saliva production and blood supply to the mucous membrane of the oral cavity and gums leads to the development of infections of the oral cavity, which also adversely affects the dental tissue, contributing to the development and progression of caries.

Temperature increase

An increase in body temperature can be observed in many patients both during the course of radiation therapy and for several weeks after its completion, which is considered absolutely normal. At the same time, sometimes an increase in temperature may indicate the development of severe complications, as a result of which, when this symptom appears, it is recommended to consult with your doctor.

An increase in temperature during radiation therapy may be due to:

• The effectiveness of the treatment. In the process of destruction of tumor cells, various biologically active substances are released from them, which enter the bloodstream and reach the central nervous system, where they stimulate the center of thermoregulation. In this case, the temperature can rise to 37.5 - 38 degrees.
• The effect of ionizing radiation on the body. When tissues are irradiated, a large amount of energy is transferred to them, which can also be accompanied by a temporary increase in body temperature. Moreover, a local increase in the temperature of the skin may be due to the expansion of blood vessels in the area of ​​irradiation and the influx of "hot" blood into them.
• The main disease. In most malignant tumors, patients have a constant increase in temperature up to 37 - 37.5 degrees. This phenomenon can persist during the entire course of radiation therapy, as well as for several weeks after the end of treatment.
• The development of infectious complications. When the body is irradiated, its protective properties are significantly weakened, as a result of which the risk of infection increases. The development of infection in any organ or tissue may be accompanied by an increase in body temperature up to 38 - 39 degrees and higher.

Decrease in leukocytes and hemoglobin in the blood

After performing radiation therapy, there may be a decrease in the concentration of leukocytes and hemoglobin in the patient's blood, which is associated with the effect of ionizing radiation on the red bone marrow and on other organs.

Under normal conditions, leukocytes ( immune system cells that protect the body from infections) are formed in the red bone marrow and in the lymph nodes, after which they are released into the peripheral bloodstream and perform their functions there. Also in the red bone marrow erythrocytes are formed ( red blood cells), which contain the substance hemoglobin. It is hemoglobin that has the ability to bind oxygen and transport it to all tissues of the body.

With radiation therapy, the red bone marrow can be irradiated, as a result of which the processes of cell division in it slow down. In this case, the rate of formation of leukocytes and erythrocytes may be disrupted, as a result of which the concentration of these cells and the level of hemoglobin in the blood will decrease. After the termination of radiation exposure, the normalization of peripheral blood parameters can occur within several weeks or even months, depending on the received dose of radiation and the general condition of the patient's body.

Periods with radiation therapy

The regularity of the menstrual cycle can be disrupted during radiation therapy, depending on the area and intensity of the radiation.

The discharge of menstruation can be affected by:

• Irradiation of the uterus. In this case, there may be a violation of blood circulation in the area of ​​the mucous membrane of the uterus, as well as its increased bleeding. This can be accompanied by the release of a large amount of blood during menstruation, the duration of which can also be increased.
• Irradiation of the ovaries. Under normal conditions, the course of the menstrual cycle, as well as the appearance of menstruation, is controlled by female sex hormones produced in the ovaries. When these organs are irradiated, their hormone-producing function can be disrupted, as a result of which a variety of menstrual irregularities can be observed ( up to the disappearance of menstruation).
• Irradiation of the head. In the head area is the pituitary gland - a gland that controls the activity of all other glands in the body, including the ovaries. When the pituitary gland is irradiated, its hormone-producing function can be impaired, which will entail a violation of the function of the ovaries and a violation of the menstrual cycle.

Can cancer recur after radiation therapy?

Relapse ( re-development of the disease) can be observed with radiation therapy of any form of cancer. The fact is that during radiotherapy, doctors irradiate various tissues of the patient's body, trying to destroy all tumor cells that could be in them. At the same time, it is worth remembering that it is never possible to exclude the likelihood of metastasis by 100%. Even with radical radiation therapy, performed according to all the rules, 1 single tumor cell can survive, as a result of which, over time, it will again turn into a malignant tumor. That is why, after the end of the treatment course, all patients should be regularly examined by a doctor. This will allow timely identification of a possible relapse and timely treatment of it, thereby prolonging a person's life.

A high likelihood of relapse may be indicated by:

• the presence of metastases;
• germination of a tumor into adjacent tissues;
• low efficiency of radiotherapy;
• late start of treatment;
• incorrect treatment;
• depletion of the body;
• the presence of relapses after previous courses of treatment;
• non-compliance by the patient with the doctor's recommendations ( if the patient continues to smoke, drink alcohol or be exposed to direct sunlight during treatment, the risk of cancer re-development increases several times).

Is it possible to get pregnant and have babies after radiation therapy?

The effect of radiation therapy on the possibility of bearing a fetus in the future depends on the type and location of the tumor, as well as on the radiation dose received by the body.

The possibility of carrying and giving birth to a child can be affected by:

• Irradiation of the uterus. If the aim of radiotherapy was to treat a large tumor of the body or cervix, at the end of the treatment the organ itself may be deformed to such an extent that it becomes impossible to develop a pregnancy.
• Irradiation of the ovaries. As mentioned earlier, with tumor or radiation damage to the ovaries, the production of female sex hormones can be disrupted, as a result of which a woman cannot become pregnant and / or bear a fetus on her own. At the same time, hormone replacement therapy can help solve this problem.
• Irradiation of the small pelvis. Irradiation of a tumor that is not associated with the uterus or ovaries, but located in the pelvic cavity, can also create difficulties when planning a pregnancy in the future. The fact is that as a result of radiation exposure, the mucous membrane of the fallopian tubes can be affected. As a result of this, the process of fertilization of the egg ( female reproductive cell) sperm ( male reproductive cell) will become impossible. The problem will be solved by in vitro fertilization, during which the sex cells are connected in laboratory conditions outside the woman's body, and then placed in her uterus, where they continue to develop.
• Irradiation of the head. Irradiation of the head may damage the pituitary gland, which will disrupt the hormonal activity of the ovaries and other glands of the body. You can also try to solve the problem with hormone replacement therapy.
• Disruption of the work of vital organs and systems. If during the course of radiation therapy the functions of the heart were impaired or the lungs were affected ( for example, severe fibrosis has developed), a woman may have difficulty carrying a fetus. The fact is that during pregnancy ( especially in the 3rd trimester) significantly increases the load on the cardiovascular and respiratory system of the expectant mother, which in the presence of severe concomitant diseases can cause the development of dangerous complications. Such women should be constantly monitored by an obstetrician-gynecologist and take supportive therapy. They are also not recommended to give birth through the natural birth canal ( the method of choice is delivery by caesarean section at 36 - 37 weeks of gestation).

It is also worth noting that the time elapsed from the end of radiation therapy to the onset of pregnancy plays an important role. The fact is that the tumor itself, as well as the treatment being carried out, significantly depletes the female body, as a result of which it needs time to restore its energy reserves. That is why it is recommended to plan a pregnancy no earlier than six months after treatment and only in the absence of signs of metastasis or relapse ( re-development) cancer.

Is radiation therapy dangerous to others?

While performing radiation therapy, a person does not pose a danger to others. Even after irradiation of tissues with large doses of ionizing radiation, they ( fabrics) do not emit this radiation into the environment. An exception to this rule is contact interstitial radiotherapy, during which radioactive elements ( in the form of small balls, needles, staples or threads). This procedure is performed only in a specially equipped room. After the installation of radioactive elements, the patient is placed in a special ward, the walls and doors of which are covered with radiation shields. In this room, he must remain throughout the course of treatment, that is, until the radioactive substances are removed from the affected organ ( the procedure usually takes several days or weeks).

Access of medical personnel to such a patient will be strictly limited in time. Relatives can visit the patient, but before that they will need to put on special protective suits that will prevent the effects of radiation on their internal organs. At the same time, children or pregnant women, as well as patients with existing tumor diseases of any organs, will not be allowed into the ward, since even a minimal exposure to radiation can negatively affect their condition.

After removing the sources of radiation from the body, the patient can return to daily life on the same day. He will not pose any radioactive threat to those around him.

Recovery and rehabilitation after radiation therapy

During radiation therapy, a number of recommendations should be followed that will save the body's strength and ensure the maximum effectiveness of the treatment.

Diet ( nutrition) during and after radiation therapy

When compiling a menu during radiation therapy, one should take into account the peculiarities of the effect of ionizing studies on the tissues and organs of the digestive system.

With radiation therapy, you should:

• Eat well-processed foods. During radiation therapy ( especially when irradiating the organs of the gastrointestinal tract) damage occurs to the mucous membranes of the gastrointestinal tract - the oral cavity, esophagus, stomach, intestines. They can become thinner, inflamed, and extremely sensitive to damage. That is why one of the main conditions for food preparation is its high-quality mechanical processing. It is recommended to refuse solid, coarse or tough food, which could damage the oral mucosa during chewing, as well as the esophagus or stomach mucosa when swallowing a food bolus. Instead, it is recommended to consume all foods in the form of cereals, mashed potatoes, and so on. Also, the food consumed should not be too hot, as this can easily develop a burn of the mucous membrane.
• Eat high-calorie foods. During radiation therapy, many patients complain of nausea, vomiting, which occurs immediately after eating. That is why such patients are advised to consume a small amount of food at a time. At the same time, the products themselves must contain all the necessary nutrients to provide the body with energy.
• Eat 5 - 7 times a day. As mentioned earlier, patients are advised to eat small meals every 3 to 4 hours to reduce the likelihood of vomiting.
• Drink plenty of water. In the absence of contraindications ( for example, severe heart disease or edema caused by a tumor or radiation therapy) the patient is recommended to consume at least 2.5 - 3 liters of water per day. This will help cleanse the body and remove the byproducts of tumor breakdown from the tissues.
• Exclude carcinogens from the diet. Carcinogens are substances that can increase the risk of cancer. With radiation therapy, they should be excluded from the diet, which will increase the effectiveness of the treatment.

Radiation therapy nutrition

What can you consume?
cooked meat; wheat porridge; oatmeal; rice porridge; buckwheat porridge; mashed potatoes; boiled chicken eggs ( 1 - 2 per day); cottage cheese; fresh milk ; butter ( about 50 grams per day); baked apples ; walnuts ( 3 - 4 per day); natural honey; mineral water ( without gases); jelly.	fried food ( carcinogen); fatty foods ( carcinogen); smoked food ( carcinogen); spicy food ( carcinogen); salty food; strong coffee ; alcoholic drinks ( carcinogen); carbonated drinks; fast food ( including porridge and instant noodles); vegetables and fruits containing a large amount of dietary fiber ( mushrooms, dried fruits, beans and so on).

Radiation therapy vitamins

Under the influence of ionizing radiation in the cells of healthy tissues, certain changes can also occur ( their genetic apparatus can be destroyed). Also, the mechanism of cell damage is due to the formation of so-called free oxygen radicals, which aggressively affect all intracellular structures, leading to their destruction. In this case, the cell dies.

In the course of many years of research, it was found that some vitamins have so-called antioxidant properties. This means that they can bind free radicals inside cells, thereby blocking their destructive action. The use of such vitamins during radiation therapy ( in moderate doses) increases the body's resistance to radiation, at the same time, without reducing the quality of the treatment.

Antioxidant properties are possessed by:

• some trace elements ( eg selenium).

Can red wine be drunk with radiation therapy?

Red wine contains a variety of vitamins, minerals and trace elements necessary for the normal functioning of many body systems. Scientifically proven that consuming 1 cup ( 200 ml) red wine per day helps to normalize metabolism, and also improves the elimination of toxic products from the body. All this undoubtedly has a positive effect on the condition of the patient undergoing radiation therapy.

At the same time, it is worth remembering that abuse of this drink can negatively affect the cardiovascular system and many internal organs, increasing the risk of complications during and after radiation therapy.

Why are antibiotics prescribed for radiation therapy?

When the radiation is carried out, the cells of the immune system are affected, as a result of which the body's defenses weaken. Along with damage to the mucous membranes of the gastrointestinal tract, as well as the respiratory and genitourinary systems, this can contribute to the emergence and development of many bacterial infections. Antibiotic therapy may be needed to treat them. At the same time, it is worth remembering that antibiotics destroy not only pathogenic, but also normal microorganisms that live, for example, in the intestines of a healthy person and take an active part in the digestion process. That is why, after completing the course of radiotherapy and antibiotic therapy, it is recommended to take drugs that restore the intestinal microflora.

Why is CT and MRI prescribed after radiation therapy?

CT ( CT scan) and MRI ( Magnetic resonance imaging) Are diagnostic procedures that allow you to examine in detail certain parts of the human body. With the help of these techniques, it is possible not only to identify the tumor, to determine its size and shape, but also to control the process of the treatment being carried out, weekly noting certain changes in the tumor tissue. So, for example, using CT and MRI, it is possible to reveal an increase or decrease in the size of a tumor, its growth into neighboring organs and tissues, the appearance or disappearance of distant metastases, and so on.

It should be borne in mind that during the CT scan, the human body is exposed to a small amount of X-ray irradiation. This introduces certain restrictions on the use of this technique, especially during radiation therapy, when the radiation exposure to the body must be strictly dosed. At the same time, MRI is not accompanied by irradiation of tissues and does not cause any changes in them, as a result of which it can be performed daily ( or even more often), posing absolutely no danger to the patient's health.

Before use, you must consult a specialist.

When is basalioma irradiation used?

Radiation therapy is an effective independent treatment for basal cell carcinoma. Irradiation of basal cell carcinoma is also used as an auxiliary method after surgical treatment in case of incomplete removal of the tumor. Or, if the basal cell carcinoma has grown into the skin so deeply that the doctor assumes the development of a relapse (re-emergence) in the future, despite the operation. Radiation therapy is used mainly for basal cell carcinoma on the head and neck, since treatment on other areas (in particular, legs) is associated with slower healing, poor cosmetic results and an increased likelihood of radiation dermatitis and necrosis in the future (see photo).
Radiation to basal cell carcinoma is the main treatment option for patients over 65 years of age. This is due to the fact that many years after radiation therapy there is a risk of new foci of basal cell carcinoma or squamous cell carcinoma. Patients under the age of 65 have a longer life expectancy, and therefore a greater risk of developing radiation-induced cancer.
Irradiation is primarily indicated for very large basal cell carcinomas, tumors located on the eyelids, corners of the eyes, nose, ears and lips, where surgical treatment can lead to an unacceptable cosmetic result or organ dysfunction. Irradiation of basal cell carcinoma is also prescribed for patients with severe concomitant diseases, in old age, who have contraindications for surgical treatment. If the tumor is less than 2 cm, the risk of recurrence within 5 years after basalioma irradiation is 8.7%.

Massive basal cell carcinoma before irradiation in a 90-year-old woman who was refused surgical treatment.

The same basalioma a few weeks after exposure. The tumor is eliminated, the remaining wound will turn into a white scar within six months.

How does the radiation affect the basal cell carcinoma?

Irradiation of basal cell carcinoma is detrimental to its cells and cells of surrounding tissues. This is due to the fact that radiation therapy acts on DNA, causing breakdowns in it, leading to the impossibility of reading information and cell death. First of all, cells that are in the process of reproduction are damaged. Due to the fact that basalioma cells multiply more intensively, and the process of repairing breakdowns in them is disturbed due to mutations, they die first. On the other hand, such a destructive effect on DNA does not go unnoticed for the surrounding tissues. Many years after irradiation of the basal cell carcinoma, due to mutations in the cells of the surrounding tissues, new, newly developed foci of cancer may appear, the processes of nutrition and blood supply are disrupted.

Basalioma irradiation methods.

Basal cell carcinoma is irradiated with either surface X-rays (abbreviated as BFRT) or (beta rays).

Close-focus radiation therapy (radiotherapy, X-ray therapy) as a method of irradiating basalioma.

Irradiation of basal cell carcinoma with BPST is much cheaper and is used in the overwhelming majority of cases. The total radiation dose in the case of BPST is calculated in grays (abbreviated as Gy), divided into several portions, which are delivered over a number of days. Basaliomas in the head and neck area, on the skin around the eyes are primarily treated with close-focus radiation therapy. Typical basalioma irradiation regimen includes treatment 3 times a week
within 1 month. This mode is changed at the discretion of the doctor onco-radiologist. Radiation therapy is a relatively painless method of treatment; each radiation session takes 10-20 minutes. The X-ray tube is flexible enough to allow the patient to sit comfortably on the couch with the applicator installed. In the case of rounded basal cell carcinoma, the borders of the irradiated tissue are marked. If the basalioma has an irregular shape, a 1.5 mm lead plate with a cut out hole in the shape of the irradiated tumor can be applied. The visible basal cell and 0.5-1.0 cm of the surrounding skin are irradiated if the tumor is less than 1 cm. If the basal cell carcinoma is large or its edge is indistinct and uneven, up to 2 cm of the surrounding skin is irradiated. The radiologist calculates the radiation dose of the basal cell carcinoma, the time required for the session. Once the applicator is in place, the radiologist leaves the treatment room. The treatment lasts for a few minutes. During this period, the patient is monitored through a special window or cameras.

Basalioma exposed to radiation is outlined with a pencil for more accurate focusing of the rays.

Special mask made of 1.5 mm thick lead sheet. It is applied to protect the eye from the effects of basalioma irradiation, up to the opacity of the cornea and lens.

Radiation therapy apparatus. It is used not only to irradiate basal cell carcinoma, but also to treat squamous cell skin cancer.

Irradiation of basal cell carcinoma with beta rays (electrons) as a method of radiation therapy.

Beta rays are electrons produced by a linear accelerator or from radioactive isotopes such as strontium 90. X-ray energy is lost in tissues with increasing depth. The energy of the electron beam rises to a peak at a certain depth, and then drops sharply, this is a very useful property. The effective treatment depth in centimeters is about one third of the beam energy, so a 4.5 MeV electron beam will be effective at a depth of up to 1.5 cm, and a 12 MeV ha beam at a depth of 4 cm.
Electrons are absorbed by tissues equally well, regardless of density, X-rays are absorbed more by dense tissues. Where bones are close to the surface of the skin, X-rays can damage bones, and electron irradiation is recommended. With basalioma of the auricle,
the scalp, dorsum of the hand, and lower leg, electron beam therapy is currently preferred. It is also possible to irradiate the entire surface of the skin with electrons, which is extremely useful for multiple lesions with basaliomas.
Unfortunately, the possibility of using electron beams is limited, first of all, by the high cost of equipment. The minimum size of basalioma exposed to electron irradiation should be 4 cm2, since it is difficult to adjust the device to a smaller area. In general, tuning and focusing with electron radiation therapy is a rather laborious process. When treating basal cell carcinoma located around the eye, there is no way to protect the tissues of the eye; therefore, electron irradiation is not applicable here.

Short term side effects of basal cell carcinoma radiation. Prevention methods.

Even the modern way to irradiate basalioma can cause side effects. During each session, redness and slight soreness may develop, the severity of which increases by the 3rd week. They usually go away 4-6 weeks after the completion of the irradiation of the basal cell carcinoma and can be mitigated by the use of glucocorticoid-based ointments (prednisolone, hydrocortisone, sinaflan). During the entire course of irradiation, ulcers and crusts may form in the area of ​​the basalioma and on the skin around them - signs of radiation dermatitis, which disappear upon completion of the course of treatment. The skin is treated with petroleum jelly, argosulfan, bandages based on silver are applied to soften radiation reactions. With severe ulceration and infection, the skin is usually recommended to also be treated with dioxidine. The skin must be protected from additional damage during the course of irradiation and beyond. It is necessary to protect yourself from sunlight, heat, cold and friction. The patient must use sunscreen on the irradiated skin with a protection factor of at least 15. For basal cell carcinomas of the neck and head skin, it is necessary to wear a headdress with brim. This protection must last throughout life.

Radiation dermatitis with scarring, vasodilation (telangiectasia), crusting. Developed after irradiation of basal cell carcinoma.

Local side effects of basalioma irradiation, treatment of complications.

Other side effects depend on the region of the skin to be irradiated.
These include mucositis - inflammation of the mucous membranes of the mouth and nose during irradiation, accompanied by burning, mucus, or vice versa dryness, the appearance of superficial ulcers. For the prevention of mucositis, you must use a soft toothbrush, rinse your mouth with broths of sage, chamomile, chlorhexidine. When basalioma is irradiated near the eye, conjunctivitis may develop. Conjunctivitis should be treated with collargol or protargol (also based on silver), and taufon will help. During radiation therapy for basal cell carcinoma, baldness may occur on the scalp.

Long-term complications of basalioma radiation therapy.

After the redness disappears, most patients rate the cosmetic result of radiation therapy as good or excellent. Irradiated skin tends to become pale and thin over the course of a year. Within a few years, there may appear
telangiectasia (vasodilation), hypopigmentation (blanching) or hyperpigmentation (darkening) of the skin. Radiation scars of basal cell carcinoma get worse in appearance over time, unlike scars after surgery. The likelihood of long-term consequences increases with an increase in the total radiation dose, dose size per session, and the volume of irradiated tissues. After irradiation of basal cell carcinoma for 45 years or more, there is an increased risk of the formation of new foci of squamous cell carcinoma and, to a greater extent, basal cell carcinoma of the skin. This side effect of radiation therapy is most prevalent in younger patients. The long-term consequences of irradiation of basal cell carcinoma can also include scarring of the skin and underlying tissues, leading to limited mobility. Active and passive exercises of the irradiated areas help to maintain mobility and prevent contractures (immobility due to scarring). Due to vascular changes, the once irradiated skin recovers worse from surgical interventions. Hair loss that begins during irradiation of basal cell carcinoma is for the most part persistent for life. Additional long-term effects also depend on the location of the irradiated area. For example, irradiation of basal cell carcinoma near the eyes can cause ectropion (eyelid volvulus), cataracts (lens opacity), but these effects are extremely rare.

Of all the existing treatments for skin cancer, radiation therapy is the best. This primarily applies to facial skin tumors. Considering that there are basal cell cancers on the skin of the face, radiation therapy provides a high percentage of cures with good cosmetic effect.

Indications for radiation therapy for skin cancer

1) with primary skin cancers;

2) with metastatic skin cancers;

3) for prophylactic purposes after surgery;

4) with relapses.

Radiation therapy methods for skin cancer

Fractionated irradiation method. Its essence is. that within 10-12 days, treatment is carried out in relatively fractional doses, and the total dose is brought to 4000 glad.

The fractional irradiation method has the advantage that tumor tissues are damaged more and healthy tissues are spared more than with the old methods; on the other hand, the reactivity of the tissues surrounding the tumor is preserved, which largely determines the therapeutic effect.

The positive features of the fractionated irradiation method include the influence of the time factor. Extending treatment to 12-15 days ensures that all cancer cells are exposed to X-rays, since during this period all cells undergo the mitosis phase and, therefore, are exposed to radiation.

In the literature we have collected on the treatment of skin cancer, the idea is that all efforts should be directed towards achieving a cure after one course of X-ray therapy.

The currently accepted principle of treating malignant neoplasms is to give during one course the maximum dose compatible with the need to sparing healthy tissues. Due to the cumulative effect of X-rays, repeated exposures are dangerous - they entail a change in vascularization, damage to the surrounding healthy tissue, and cause necrotic changes.

On this basis, fractionated irradiation with a high total dose is recognized as the most effective method that guarantees the elimination of the cancer focus in one course of treatment.

Concentrated short-focus method of irradiation according to Schaul. The method of short-focus irradiation is based on the principle of creating conditions for the distribution of X-ray energy, similar to those that exist when using radium, despite the fact that the wavelength of these two types of radiation is not the same. From the point of view of modern X-ray biology, the therapeutic and biological effect depends only on the amount of absorbed energy, be it the energy of y-rays or the energy of X-rays. The qualitative side of the radiation is not given significant importance.

Based on the equivalence of y - and X-rays, Shaul believes that the greater effectiveness of radium therapy is due only to a more expedient distribution of 7-rays. It is appropriate to note here that the issue of the spatial distribution of the dose during radiation therapy is extremely relevant, especially in the treatment of malignant neoplasms. The relationship between the energy absorbed by the tumor and the adjacent tissues becomes extremely important.

A difficulty with radiation therapy for skin cancer is that the sensitivity differences between tumor cells and those of the surrounding tissue are often insufficient. That is why the currently accepted principle of using radiation therapy for malignant neoplasms is based on the desire not only to destroy the tumor as much as possible, but also to spare the surrounding tissues as much as possible.

When radium is brought directly to the affected focus, the greatest effect of the rays on the site of application of radium and the minimum effect on the surrounding tissues is achieved, since the intensity of the effect of radiation on the depth and to the periphery decreases sharply.

In this respect, the concentrated close-focus irradiation method aims to create the same conditions.

According to Schaul, the method he proposed should be an imitation of radium therapy; and indeed it began to be successfully used instead of radium therapy in some localizations of skin cancer, cancer of the lower lip, oral cavity, as well as malignant melanomas and hemangiomas. Treatment is carried out using a special X-ray tube, in which the anode in the form of a hollow cylinder is brought out.

Radiation therapy for skin cancer by this method is carried out at a single dose of 400 - 800 glad, and the total dose is 6000 - 8000 glad.

Radiation therapy results for skin cancer

Results depend on:

1) morphological picture;

2) localization and soil on which cancer develops;

3) methods of treatment.

Basal cell carcinoma is most successfully treated with X-ray therapy. The mixed form is more resistant than purely basocellular. Squamous cell carcinoma is the most dangerous form of skin cancer. The success of treatment with this form depends on the timeliness of the diagnosis.

At some localizations (corner of the eye, auricle), the effectiveness of radiation therapy for skin cancer decreases.

The prognosis sharply worsens in case of damage to bone and cartilage tissue. This is explained by the fact that bone and cartilage tissues, due to their anatomical and physiological properties, cannot respond to X-ray irradiation with an appropriate reaction.

The soil on which the neoplasm has developed is also important. The reason for the worst treatment results for cancer caused by lupus and scars is that the surrounding tissue, being weakened under the influence of the underlying disease, is not able to respond with the desired response to X-ray irradiation.

The reason for the failure of radiation therapy for skin cancer is that sometimes the proliferation of epithelial tissue in the deeper parts of the tumor stops for a very short time, and then starts again. This can be the result of inappropriate selection of beam quality, inadequate filtration and dose. To select a carcinocidal dose in relation to deeply located cells, it is necessary to use filtered beams, appropriate voltage and cross-radiation. It should be used as large a dose as possible without damaging normal tissue.

Failures are rare due to the presence of resistant cells, especially in basocellular epitheliomas. It should also be remembered that not all cells that make up a malignant neoplasm have the same degree of sensitivity; some of the cells in the same tumor may be very resistant.

Patients following radiation therapy for skin cancer should be monitored every six months for 5 years. Failure to comply with this rule is often the cause of serious consequences.

At stages 1 and 2, radiation therapy for skin cancer is carried out under the conditions of short-focus X-ray therapy. A single dose is 300 - 400 glad, the total dose is 5000 - 7000 glad. Doses of 500 - 600 rad per session significantly reduce the treatment time, but leave great changes on the skin, which gives worse cosmetic results. Cure at stage 1 is observed in 95-98%, and at stage 2 - in 85-87% of cases.

At stage 3, radiation therapy should be carried out under the conditions of deep X-ray therapy, on a cesium unit, and in some cases - on a telegamma unit. A single dose should not exceed 250 rad. The question of the total dose is decided in each individual case, depending on the size of the lesion. If only one radiation therapy raises doubts about the possibility of achieving good results, then after attenuation of the radiation response, surgical or electrosurgical methods of treatment can be recommended. At stage 4, treatment (if one can be carried out) must begin with radiation (deep X-ray therapy or telegammotherapy).

After radiation therapy, in some cases, it is possible to perform excision of the tumor with or without plastic surgery, depending on the condition and localization of the pathological process. In case of X-ray cancer, which has developed on the basis of scars, and relapses of skin cancer after radiation treatment, surgical treatment is indicated. The volume of the operation should not confuse the surgeon, since the growth of the tumor does not spare the patient and leads to severe disability.

Types and forms of squamous cell skin cancer, treatment, prognosis

Squamous cell carcinoma of the skin is a group of malignant neoplasms that develop from keratinocytes of the prickly layer of the cutaneous epidermis and are capable of producing keratin.

The prognosis of life with squamous cell skin cancer is characterized by the following statistics: during the first 5 years, 90% of people in whom the size of the formation is less than 1.5-2 cm survive, and when these sizes are exceeded and the neoplasm grows into the underlying tissues, only 50% of patients.

The reasons for the development of pathology

The main reason for the development of squamous cell skin cancer is considered a genetic predisposition. It can be hereditary or acquired and is expressed in:

Damage to cellular DNA under the influence of certain factors, resulting in a mutation of the TP53 gene, which encodes the p53 protein. The latter, as a regulator of the cell cycle, prevents tumor transformation of cells. "TP53" is one of the main genes involved in blocking the development of malignant neoplasms. Disorders of the functions of the immune system directed against tumor formations (antitumor immunity). In the human body, many cell mutations constantly occur, which are recognized and destroyed by cells of the immune system - macrophages, T - and B-lymphocytes, natural killer cells. Certain genes are also responsible for the formation and functioning of these cells, a mutation in which reduces the effectiveness of anti-tumor immunity and can be inherited. Violation of carcinogenic metabolism. Its essence lies in the mutation of genes that regulate the intensity of the function of certain systems, which are aimed at neutralizing, destroying and quickly removing carcinogenic substances from the body.

A favorable background for the development of squamous cell skin cancer are:

Age. The disease is extremely rare among children and young people. The percentage of cases increases sharply among people over 40, and after 65 years, this pathology occurs quite often. Skin type. The disease is more susceptible to people with blue eyes, red and light hair and light skin that does not lend itself well to sunburn. Male gender. Among men, squamous cell carcinoma develops almost 2 times more often than women. Skin defects. Cancer can develop on clinically healthy skin, but much more often - against the background of freckles, telangiectasias and genital warts, precancerous diseases (Bowen's disease, Paget's disease, xeroderma pigmentosa), in the area of ​​scars formed as a result of burns and radiation therapy, after which cancer can occur even after 30 or more years, post-traumatic scars, trophic changes in the skin (with varicose veins), openings of the fistulous passages in osteomyelitis of the bone (the frequency of metastasis is 20%), psoriasis, lichen planus, lesions in tuberculous and systemic lupus erythematosus, etc. e. Long-term decrease in general immunity.

Among the provoking factors, the main ones are:

Ultraviolet radiation with intense, frequent and prolonged exposure - sunbathing, PUVA therapy with psoralen, carried out in order to treat psoriasis and desensitization in case of allergy to the sun's rays. UV rays cause mutation of the TP53 gene and weaken the antitumor immunity of the body. Ionizing and electromagnetic radiation. Prolonged exposure to high temperatures, burns, prolonged mechanical irritation and damage to the skin, precancerous dermatological diseases. Local exposure for a long time (due to the specifics of professional activity) of carcinogenic substances - aromatic hydrocarbons, soot, coal tar, paraffin, insecticides, mineral oils. General therapy with glucocorticoid drugs and immunosuppressants, local therapy with drugs of arsenic, mercury, chloromethyl. HIV and human papillomavirus infection 16, 18, 31, 33, 35, 45 types. Irrational and unbalanced nutrition, chronic nicotine and alcohol intoxication of the body.

The prognosis without treatment is poor - the incidence of metastases is on average 16%. In 85% of them, metastasis occurs in regional lymph nodes and in 15% - in the skeletal system and internal organs, most often in the lungs, which always ends in death. The greatest danger are tumors of the head and skin of the face (affected in 70%), especially squamous cell carcinoma of the nasal skin (nasal dorsum) and neoplasms localized in the forehead, in the nasolabial folds, periorbital zones, in the area of ​​the external auditory canal, the red border of the lips, especially the upper one, on the auricle and behind it. Tumors that have arisen in closed areas of the body, especially in the area of ​​the external genital organs, of both women and men, are also highly aggressive in terms of metastasis.

Morphological picture

Depending on the direction and nature of growth, the following types of squamous cell carcinoma are distinguished:

Exophytic, growing on the surface. Endophytic, characteristic of infiltrating growth (grows into deeper tissues). It is dangerous in terms of rapid metastasis, destruction of bone tissue and blood vessels, and bleeding. Mixed - a combination of ulceration with tumor growth deep into the tissues.

The microscope examined under a microscope is characterized by a picture common to all forms of this disease. It consists in the presence of cells, similar to cells of the thorny layer, growing deep into the dermal layers. Characteristic features are the proliferation of cell nuclei, their polymorphism and excessive staining, the absence of connections (bridges) between cells, an increase in the number of mitoses (division), the severity of keratinization processes in individual cells, the presence of cancerous cords with the participation of cells of the thorny layer of the epidermis and the formation of the so-called , "Horn pearls". The latter are rounded foci of excessive keratosis with the simultaneous presence of signs of incomplete keratinization in the center of the foci.

In accordance with the histological picture, there are:

squamous cell keratinizing skin cancer (highly differentiated); undifferentiated form, or non-keratinizing cancer.

Common to both forms is the disorderly arrangement of groups of atypical flat epithelial cells with their proliferation into the deeper layers of the dermis and subcutaneous tissues. The severity of atypia in different cells may be different. It is manifested by a change in the shape and size of the nuclei and the cells themselves, the ratio of the volumes of the cytoplasm and the nucleus, the presence of pathological division, a double set of chromosomes, and many nuclei.

Highly differentiated squamous cell carcinoma of the skin

It is characterized by the most benign course, slow growth and gradual spread to deeper tissues. Signs of keratinization are determined both on the surface and in the thickness.

A keratinized tumor can have the appearance of multiple formations, but, as a rule, it is solitary, flesh-colored, yellowish or red in color. Its shape is round, polygonal or oval, sometimes with a depression in the center. On visual inspection, the neoplasm may look like a plaque, nodule or papule, the surface of which is covered with dense squamous scales of the stratum corneum separating with difficulty. In the central part, an ulcer or erosion is often determined with dense keratinized edges that rise above the surface of the skin. The erosive or ulcerative surface is crusty. When pressing on the tumor, horny masses are sometimes separated from its central or lateral sections.

Squamous cell non-keratinizing skin cancer

It has a more malignant course, compared with the previous form, manifested by rapid infiltrating growth into the deep dermal layers, faster and more frequent metastasis to regional lymph nodes.

With this form, cellular atypism and many mitoses of a pathological nature are sharply expressed with a slight reaction of the structural elements of the stroma. There is no keratinization at all. In the cells, either decaying or hyperchromic (excessively stained) nuclei are determined. In addition, in the case of an undifferentiated form of cancer, layers of epithelial cells that look like nests are separated from the epidermal layer, keratinization is absent or insignificant.

The main elements of the tumor are granulation "fleshy" soft formations like papules or nodes with elements of growth (vegetation). The most frequent localization is the external genital organs, much less often - the face or various parts of the trunk.

The neoplasm can be single or multiple, has an irregular shape and occasionally looks like a cauliflower. It quickly transforms into an erosion or ulcer with a necrotic bottom covered with a reddish-brown crust, easily bleeding with minor contact. The edges of the ulcer are soft, rise above the surface of the skin.

Squamous cell skin cancer symptoms

Depending on the clinical manifestations, the following main types of the disease are conditionally distinguished, which can be combined or changed at different stages of development:

nodular or tumor type; erosive - or ulcerative-infiltrative; plaque; papillary.

Nodular or tumor type

Superficial, or nodular, squamous cell skin cancer is the most common type of tumor development. The initial stage is manifested by one or more painless nodules of dense consistency merging with each other, the diameter of which is about 2-3 mm. They rise slightly above the skin surface and have a dull white or yellowish color, very rarely brown or dark red, the skin pattern above them is not changed.

Quite quickly, the size of the nodule (s) increases, as a result of which the tumor becomes like a painless yellowish or whitish plaque with a gray tint, the surface of which may be slightly rough or smooth. The plaque also protrudes slightly above the skin. Its dense edges look like a roller with uneven, scalloped contours. Over time, a depression is formed in the central part of the plaque, covered with a crust or scale. When they are removed, a drop of blood appears.

In the future, there is a rapid increase in the size of the pathology, the central depression is transformed into erosion, surrounded by a roller with steep, uneven and dense edges. The erosive surface itself is crusty.

For the initial stage of the ulcerative-infiltrative type of squamous cell carcinoma, the appearance of a papule is characteristic as a primary element that has endophytic growth. Over the course of several months, the papule transforms into a knot of dense consistency, fused with the subcutaneous tissue, in the center of which an ulcer with an irregular shape appears in 4-6 months. Its edges are raised in the form of a crater, the bottom of which is dense and rough, covered with a whitish film. Ulceration often takes on a fetid odor. As the node enlarges, bleeding appears even in the case of a slight touch to it.

On the peripheral parts of the main node, "daughter" nodules can form, and when they disintegrate, ulcers are also formed, which merge with the main ulcer and increase its area.

This form of cancer is characterized by rapid progression and destruction of blood vessels, invading the underlying muscles, cartilage and bone tissue. Metastases spread both by the lymphogenous route to the regional nodes, as a result of which dense infiltrates are sometimes formed, and by the hematogenous route to the bones and lungs.

Plaque squamous cell carcinoma of the skin

It has the appearance of a sharply distinguished dense red area of ​​the skin surface, against the background of which small bumps, hardly noticeable upon visual inspection, sometimes appear. The element has a rapid peripheral and endophytic growth in adjacent tissues, often accompanied by severe soreness and bleeding.

Papillary squamous cell carcinoma of the skin

It is relatively rare and represents one of the exophytic forms. At first, it manifests itself as a primary, rising above the surface of the skin and rapidly growing, a nodule. A large number of horny masses are formed on it, as a result of which the surface of the node becomes lumpy with a central depression and a large number of small dilated blood vessels. This gives the tumor, located, as a rule, on a wide and little displaced base, the appearance of a dark red or brown "cauliflower". At the later stages of its development, papillary cancer transforms into ulcerative-infiltrative cancer.

A variety of the papillary form is verrucous, which in old age can manifest itself as a cutaneous horn. The verrucous form is characterized by very slow development and extremely rare metastasis. It has a yellowish or reddish-brownish color, a bumpy surface, covered with warty elements and a hyperkeratotic crust.

Treatment of squamous cell skin cancer

The choice of treatment method is influenced by:

The histological structure of the tumor. Its localization. The stage of the cancer process, taking into account the presence of metastases and their prevalence.

A small tumor without metastases is surgically excised within the unaffected tissues, retreating 1-2 cm from its edges. If the operation is performed correctly, the cure within 5 years is 98% on average. Particularly good results are observed when the tumor is excised in one block with the subcutaneous tissue and fascia.

With small tumor sizes at T1 and T2 stages, it is possible to use close-focus X-ray radiation as an independent method. At T3-T4 stages, the radiation method is used for preoperative preparation and postoperative therapy. It is especially effective in the treatment of deeply growing skin tumors. In addition, radiation exposure is used to suppress possible metastases after surgical excision of the main tumor and as a palliative method for inoperable cancer (to slow its spread).

The large size of a cancer tumor in the absence of metastases is an indication for the use of remote gamma therapy, and if they are available, combined therapy is carried out by means of X-ray and gamma irradiation, radical removal of the tumor itself with regional lymph nodes.

Cryodestruction and electrocoagulation

Treatment of small superficial highly differentiated squamous cell carcinoma with localization on the body is possible with cryodestruction, but with the obligatory preliminary confirmation of the nature of the tumor using a preliminary biopsy. Removal of a malignant skin formation of the same nature with a diameter of less than 10 mm in the face, lips and neck area can be carried out using the electrocoagulation technique, the advantage of which is less trauma.

Chemotherapy for squamous cell skin cancer is prescribed mainly before surgery in order to reduce the size of the neoplasm, as well as in combination with the method of radiation therapy for inoperable cancer. For this, drugs such as Fluorouracil, Bleomycin, Cisplastin, Interferon-alpha, 13-cis-retinoic acid are used.

Treatment with folk remedies for cancers is unacceptable. This can only lead to wasted time and the development of metastases. It is possible to use folk remedies as auxiliary only on the recommendation of a doctor for the treatment of radiation dermatitis.

Alternative therapies

Modern physical treatment in oncology also includes methods of photodynamic therapy using a pre-selected special sensitizing dye (PDT), as well as laser-induced light-oxygen therapy (LISKT). These methods are used mainly for the treatment of elderly patients, in cases of severe concomitant diseases, with localization of the neoplasm over the cartilage and on the face, especially in the periorbital zone, since they do not have a negative effect on the eyes, healthy soft and cartilaginous tissues.

Timely determination of the cause and background on which the malignant process develops, elimination (if possible) or reduction of the influence of provoking factors are important points in the prevention of metastasis and the prevention of recurrence of squamous cell carcinoma, which occurs on average in 30% after radical treatment.

Irradiation of basal cell carcinoma (radiation therapy, radiation treatment).

When is basalioma irradiation used?

Radiation therapy is an effective independent treatment for basal cell carcinoma. Irradiation of basal cell carcinoma is also used as an auxiliary method after surgical treatment in case of incomplete removal of the tumor. Or, if the basal cell carcinoma has grown into the skin so deeply that the doctor assumes the development of a relapse (re-emergence) in the future, despite the operation. Radiation therapy is used mainly for basal cell carcinoma on the head and neck, since treatment on other areas (in particular, legs) is associated with slower healing, poor cosmetic results and an increased likelihood of radiation dermatitis and necrosis in the future (see photo).

Radiation to basal cell carcinoma is the main treatment option for patients over 65 years of age. This is due to the fact that many years after radiation therapy there is a risk of new foci of basal cell carcinoma or squamous cell carcinoma. Patients under the age of 65 have a longer life expectancy, and therefore a greater risk of developing radiation-induced cancer.

Irradiation is primarily indicated for very large basal cell carcinomas, tumors located on the eyelids, corners of the eyes, nose, ears and lips, where surgical treatment can lead to an unacceptable cosmetic result or organ dysfunction. Irradiation of basal cell carcinoma is also prescribed for patients with severe concomitant diseases, in old age, who have contraindications for surgical treatment. If the tumor is less than 2 cm, the risk of recurrence within 5 years after basalioma irradiation is 8.7%.

How does the radiation affect the basal cell carcinoma?

Irradiation of basal cell carcinoma is detrimental to its cells and cells of surrounding tissues. This is due to the fact that radiation therapy acts on DNA, causing breakdowns in it, leading to the impossibility of reading information and cell death. First of all, cells that are in the process of reproduction are damaged. Due to the fact that basalioma cells multiply more intensively, and the process of repairing breakdowns in them is disturbed due to mutations, they die first. On the other hand, such a destructive effect on DNA does not go unnoticed for the surrounding tissues. Many years after irradiation of the basal cell carcinoma, due to mutations in the cells of the surrounding tissues, new, newly developed foci of cancer may appear, the processes of nutrition and blood supply are disrupted.

Basalioma irradiation methods.

Basal cell carcinoma is irradiated either with surface X-rays (close-focus X-ray therapy, abbreviated as BFRT), or with electrons (beta rays).

Close-focus radiation therapy (radiotherapy, X-ray therapy) as a method of irradiating basalioma.

Irradiation of basal cell carcinoma with BPST is much cheaper and is used in the overwhelming majority of cases. The total radiation dose in the case of BPST is calculated in grays (abbreviated as Gy), divided into several portions, which are delivered over a number of days. Basaliomas in the head and neck area, on the skin around the eyes are primarily treated with close-focus radiation therapy. Typical basalioma irradiation regimen includes treatment 3 times a week

Within 1 month. This mode is changed at the discretion of the doctor onco-radiologist. Radiation therapy is a relatively painless method of treatment; each radiation session takes 10-20 minutes. The X-ray tube is flexible enough to allow the patient to sit comfortably on the couch with the applicator installed. In the case of rounded basal cell carcinoma, the borders of the irradiated tissue are marked. If the basalioma has an irregular shape, a 1.5 mm lead plate with a cut out hole in the shape of the irradiated tumor can be applied. The visible basal cell and 0.5-1.0 cm of the surrounding skin are irradiated if the tumor is less than 1 cm. If the basal cell carcinoma is large or its edge is indistinct and uneven, up to 2 cm of the surrounding skin is irradiated. The radiologist calculates the radiation dose of the basal cell carcinoma, the time required for the session. Once the applicator is in place, the radiologist leaves the treatment room. The treatment lasts for a few minutes. During this period, the patient is monitored through a special window or cameras.

Irradiation of basal cell carcinoma with beta rays (electrons) as a method of radiation therapy.

Beta rays are electrons produced by a linear accelerator or from radioactive isotopes such as strontium 90. X-ray energy is lost in tissues with increasing depth. The energy of the electron beam rises to a peak at a certain depth, and then drops sharply, this is a very useful property. The effective treatment depth in centimeters is about one third of the beam energy, so a 4.5 MeV electron beam will be effective at a depth of up to 1.5 cm, and a 12 MeV ha beam at a depth of 4 cm.

Electrons are absorbed by tissues equally well, regardless of density, X-rays are absorbed more by dense tissues. Where bones are close to the surface of the skin, X-rays can damage bones, and electron irradiation is recommended. With basalioma of the auricle,

The scalp, dorsum of the hand, and lower leg, electron beam therapy is currently preferred. It is also possible to irradiate the entire surface of the skin with electrons, which is extremely useful for multiple lesions with basaliomas.

Unfortunately, the possibility of using electron beams is limited, first of all, by the high cost of equipment. The minimum size of basalioma exposed to electron irradiation should be 4 cm2, since it is difficult to adjust the device to a smaller area. In general, tuning and focusing with electron radiation therapy is a rather laborious process. When treating basal cell carcinoma located around the eye, there is no way to protect the tissues of the eye; therefore, electron irradiation is not applicable here.

Short term side effects of basal cell carcinoma radiation. Prevention methods.

Even the modern way to irradiate basalioma can cause side effects. During each session, redness and slight soreness may develop, the severity of which increases by the 3rd week. They usually go away 4-6 weeks after the completion of the irradiation of the basal cell carcinoma and can be mitigated by the use of glucocorticoid-based ointments (prednisolone, hydrocortisone, sinaflan). During the entire course of irradiation, ulcers and crusts may form in the area of ​​the basalioma and on the skin around them - signs of radiation dermatitis, which disappear upon completion of the course of treatment. The skin is treated with petroleum jelly, argosulfan, bandages based on silver are applied to soften radiation reactions. With severe ulceration and infection, the skin is usually recommended to also be treated with dioxidine. The skin must be protected from additional damage during the course of irradiation and beyond. It is necessary to protect yourself from sunlight, heat, cold and friction. The patient must use sunscreen on the irradiated skin with a protection factor of at least 15. For basal cell carcinomas of the neck and head skin, it is necessary to wear a headdress with brim. This protection must last throughout life.

Local side effects of basalioma irradiation, treatment of complications.

Other side effects depend on the region of the skin to be irradiated.

These include mucositis - inflammation of the mucous membranes of the mouth and nose during irradiation, accompanied by burning, mucus, or vice versa dryness, the appearance of superficial ulcers. For the prevention of mucositis, you must use a soft toothbrush, rinse your mouth with broths of sage, chamomile, chlorhexidine. When basalioma is irradiated near the eye, conjunctivitis may develop. Conjunctivitis should be treated with collargol or protargol (also based on silver), and taufon will help. During radiation therapy for basal cell carcinoma, baldness may occur on the scalp.

Long-term complications of basalioma radiation therapy.

After the redness disappears, most patients rate the cosmetic result of radiation therapy as good or excellent. Irradiated skin tends to become pale and thin over the course of a year. Within a few years, there may appear

Telangiectasia (vasodilation), hypopigmentation (blanching) or hyperpigmentation (darkening) of the skin. Radiation scars of basal cell carcinoma get worse in appearance over time, unlike scars after surgery. The likelihood of long-term consequences increases with an increase in the total radiation dose, dose size per session, and the volume of irradiated tissues. After irradiation of basal cell carcinoma for 45 years or more, there is an increased risk of the formation of new foci of squamous cell carcinoma and, to a greater extent, basal cell carcinoma of the skin. This side effect of radiation therapy is most prevalent in younger patients. The long-term consequences of irradiation of basal cell carcinoma can also include scarring of the skin and underlying tissues, leading to limited mobility. Active and passive exercises of the irradiated areas help to maintain mobility and prevent contractures (immobility due to scarring). Due to vascular changes, the once irradiated skin recovers worse from surgical interventions. Hair loss that begins during irradiation of basal cell carcinoma is for the most part persistent for life. Additional long-term effects also depend on the location of the irradiated area. For example, irradiation of basal cell carcinoma near the eyes can cause ectropion (eyelid volvulus), cataracts (lens opacity), but these effects are extremely rare.

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As shown by radiometric and morphological research, the degree of radiation damage to the skin, and, consequently, the possibility of its recovery, are directly related to the distribution of energy in depth. Therefore, the absolute value of the incident dose, measured on the surface of the skin, cannot characterize the expected effect under the action of radiation of different energies. It is known that large doses of soft radiation cause a smaller biological effect than small doses of hard radiation [Osanov DP et al., 1976; Dvornikov V.K., 1975]. At the same time, soft radiation, which has less energy, in comparable doses causes local manifestations of radiation damage to the skin faster than hard X-rays, y-rays and neutrons, which have a greater penetrating ability [Ivanovsky BD, 1958; Borzov M. V. et al., 1972].

Pathogenesis of structural changes skin changes significantly depending on where energy is mainly absorbed - in the epidermis, superficial or deep layers of the dermis, or in the underlying tissues. Therefore, the calculations of the magnitude and depth of the distribution of absorbed energy doses show that the primary changes in the epidermis become less pronounced as the hardness of the radiation energy increases and, conversely, the severity of damage to the deep layers of the dermis and underlying soft tissues increases accordingly. For example, when irradiated with an energy of 7 keV at the level of the basal layer of the epidermis, the absorbed dose is 2 times higher than when irradiated with an energy of 18 keV [Dvornikov VK, 1975; Samsonova T. V., 1975]. After external exposure to p-radiation at a dose of 5000 R, complete restoration of the epidermis is possible, while with y-irradiation with megavolt energy, damage to the epidermis may be absent, but fibrosis of the subcutaneous tissue develops in the long term [Dzhelif AM, 1963].

L. A. Afrikanova(1975) identifies 3 zones of structural abnormalities when the skin is irradiated with soft X-ray radiation: the necrosis zone itself, the reserve necrosis zone and the zone of reactive changes. At the same time, the author notes that necrotic changes in the papillary and other layers of the dermis appear (reserve zone of necrosis) only after the death of the epidermis due to the termination of the physiological regeneration of the latter under the influence of radiation. However, such a clear division into zones and such a sequence are characteristic only of lesions of the skin with soft radiation at a dose of up to 5000-10,000 R, when the main amount of energy is absorbed by the surface layers of the skin.

On action hard radiation due to the geometry of the distribution of the maximum dose of absorbed energy, morphological changes in the irradiated skin have their own characteristics. They are most clearly manifested in places of maximum direct exposure to gamma rays or fast neutrons with uneven irradiation of the body. This type of radiation injury to the skin, judging by the literature data, is possible during accidents at nuclear installations in production or laboratory conditions, which deserves special attention from the practical point of view. It should be noted that in this case, along with the early changes in the epidermis described above, significant violations of the deep layers of the dermis, subcutaneous tissue and skeletal muscles occur simultaneously.

Moreover, if the radiation does not cause immediate death epidermis, then morphological changes in the integumentary epithelium are less gross than violations of the dermis and underlying soft tissues. In the early days of the disease, a significant edema of the dermis and physicochemical changes in collagen fibers draw attention, which is especially clearly revealed by their metachromatic coloration in purple by the Mallory method. In addition, gross changes in elastic fibers are revealed, which, as you know, is not characteristic of the early stage of skin lesions by X-rays [Afrikanova L. L. 1975].

In the subcutaneous tissue and skeletal muscles are also observed signs massive edema, accumulation of acidic mucopolysaccharides (glycosaminoglycans) in the main substance of the interstitial tissue and walls of blood vessels, dystrophic changes in fibrous structures and striated muscles. In the following days, these changes increase and spread from the deep layers of the skin to the superficial. Microscopically distinguishable voids or gaps are formed between the basal layer of epidermal cells and the basement membrane due to vacuolization of cells and rejection of the epidermis due to edema of the retinal layer. Thus, the death of the epidermis and the formation of necrotizing ulcerative defects when damaged by gamma-neutron or neutron radiation are primarily due to severe circulatory disorders and dystrophic changes in the subcutaneous tissue and dermis. This corresponds to the deep distribution of the absorbed energy and the peculiarities of the interaction of fast neutrons with tissues.

As is known, 85% of the energy of a fast neutron beam is spent on education recoil protons in the interaction of neutral particles with hydrogen atoms. Therefore, the maximum exchange of energy occurs in the subcutaneous tissue, which contains 15-20% more hydrogen than other tissues [Dzhelif A., 1964; Grammatikati VS, etc., 1978].