Tumor of the jaw bones - osteogenic sarcoma of the jaw: symptoms and clinical manifestations, treatment methods and possible consequences. Features of the development of sarcoma of the jaw and patients’ chances of recovery

Osteogenic sarcoma is a malignant neoplasm that forms directly from bone tissue and has the ability to generate new bone itself. The above concept should not be confused with the term “osteosarcoma”, since the latter refers to a wider range of diseases - any of the possible bone sarcomas and, in this regard, confusion may arise.

A feature of osteogenic sarcoma is that, as a rule, in the case of the disease, one bone is affected. Accordingly, osteogenic sarcoma of the jaw is a disease of the bones of the upper or lower jaw. The most common case is illness upper jaw, more rare lower and there are also the rarest cases when the tumor forms in several places, on both jaws.

Symptoms of the disease

Symptoms of osteogenic sarcoma of the jaw are quite difficult to identify for a long time. If we consider specific periods, the onset of the disease can be noticed from the first days of cell damage, but there are cases when the symptoms of osteogenic sarcoma of the jaw remained undetected until 72 (!) months.

The three main signs of the disease are a pain symptom, which appears more often if the patient has osteogenic sarcoma of the jaw in the lower part of the face, on the lower jaw, and less often if on the upper. Pain, if it occurs at all, spreads closer to those teeth that are located closer to the tumor, their loosening is also possible, and irritating itching in the gum area. Further, the appearance of a tumor itself, which interferes with chewing food and closing the jaws, regardless of its location. Because of it, swelling of the face and various painful lumps. Finally, soft fabrics Individuals may experience loss of sensation and may experience short-term tingling or numbness in the chin area or under the eyes.

In general, the patient’s condition remains virtually unchanged, especially when it comes to initial stage diseases. But at the moment when osteogenic sarcoma of the jaw goes into a period of decay, the patient’s erythrocyte sedimentation rate increases significantly, in addition, the body temperature can reach 39 degrees, sometimes 40.

Sarcoma is often discovered during an examination of injuries, that is, patients come with complaints of pain from a recent bruise or other injury, and when analyzing symptoms and collecting information, doctors discover a tumor.

In children, osteogenic sarcoma develops extremely quickly and the entire course of the disease usually takes about six months. Due to such a rapid progression of the disease, the prognosis for recovery is often unfavorable.

Diagnostics

Unfortunately, the diagnosis of the disease leaves much to be desired. Approximately only half of the patients who consulted a doctor at the initial stage of the disease were given the correct diagnosis. The remaining patients were diagnosed much later.

The difficulty of making a diagnosis is due to the fact that identifying signs of sarcoma requires comprehensive examination, based on the results of which a decision can be made about the patient’s health. If any facts were missed when taking tests, collecting information about the patient, or examining photographs of the affected areas, the diagnosis may often be made incorrectly.

As for treatment, surgical method is common today. Radiation treatment and chemotherapy are recognized as not the most effective methods.

NOTE! The articles on the portal are written for information purposes and cannot in any way be a source for self-treatment. Treatment can only be prescribed by your attending physician!

When diagnosing sarcoma of the jaw, it is important to notice the symptoms at the initial stage of development of the disease. This group of tumors, which is malignant in nature, is quite common and very dangerous.

Asymptomatic onset complicates diagnosis and subsequent therapy. Therefore, it is necessary to know what signs indicate the onset of the development of the disease.

Origin of the neoplasm

Sarcoma of the jaw is a low-quality (immature) formation of non-epithelial origin from the connective or cartilage tissue. Occurs with a frequency of 15% of cases of all malignant neoplasms.

Destructive changes can begin from the periosteum, cortical layer, elements of the spongy substance bone marrow, ondogenic structures that make up vascular system, neurogenic cells. There are several types of bone tumors:

• fibrosarcoma;
• osteosarcoma;
• chondrosarcoma;
• round cell.

During the growth of the tumor, both the destruction of the bone component and the formation of new bone areas are observed. As the situation worsens, the bones become enlarged, destroyed, and the tumor grows to other organs. Osteogenic sarcoma of the jaw most often develops. It has a unique histological structure and causes difficulties in diagnosis.

How is it different from cancer?

A distinctive feature of sarcomatous tumors is that they are more likely to develop in younger patients. Cancer is more common in people over 40 years of age, sarcoma is more common in people under 40 years of age. Sarcoma differs from cancer in that it develops in connective tissues, and cancer in epithelial tissues. The spread of tumor processes occurs through blood vessels, and cancer through lymphatic vessels. Development occurs at a faster rate than cancer.

Similarities. Like cancer, sarcomas metastasize, not only to nearby lymph nodes, but can also spread to other organs. Once removed, they are likely to appear again. Connective tissues can be destroyed by infiltrating tumor growth. By analogy with cancer, a distinction is made between primary sarcoma, which develops independently, and secondary sarcoma, which grows through metastases.

Reasons for appearance, stages of development

Why the malignant process occurs is not fully known. One of the factors external environment ionizing radiation that influences the risk of tumor growth. The presence of various formations increases the possibility of its occurrence. About the likelihood of development negative processes say genetic abnormalities that are inherited. Injuries and damage can trigger the onset of the disease.

Depending on the size of the damage, the spread of metastases, and how far the tumor will develop outside the focus, 4 stages of disease formation are diagnosed:

1. The dimensions are small, about 1 cm. Localized in the original focus. Correct diagnosis, delivered at this stage, increases the likelihood of a favorable outcome of the ailment and the patient’s recovery.
2. The tumor spreads to all parts of the jaw, but does not extend beyond its limits. The functions of the jaw are impaired. Detection of the disease at this stage gives a chance of recovery, but the likelihood of relapse increases. Besides, surgery involves a large intervention area.
3. The neoplasm grows into nearby tissues, metastases spread to the lymph nodes. Forecast full recovery adverse. At this stage, the tumor is most prone to recurrence after treatment.
4. Synovial syndrome affects the entire organ, grows to very large sizes, decay occurs, bleeding appears. Metastases are extensive and have penetrated many organs, including those remote from the center of the growth. A cure is unlikely.

Symptoms of disease development

Sarcomatous tumors can form on the lower or upper jaw. Depending on where the tumor originated, symptoms will vary. Symptoms in different patients can vary significantly; they are individual in nature. The rapidly developing process of proliferation, a confused clinical picture often leads to an incorrect diagnosis.

The main signs of the onset of the disease are: pain, deformation of the face, numbness in its areas. General symptoms represent: weakness, decreased immunity, decreased performance, irritability.

Symptoms of central sarcoma:

• painful sensations that periodically bother the patient, becoming constant over time;
• jaw deformation and loose teeth;
• reduced sensitivity of teeth at the tumor site;
• sensitivity disorder, characterized by numbness of the lips and chin (with sarcoma of the lower jaw);
• discharge from the nasal passages with blood, breathing problems (with sarcoma of the upper jaw).

Symptoms of peripheral sarcoma:

• thickening of certain areas of the jaw, its deformation;
• due to the rapid growth of the formation, speech is impaired, breathing through the nose is difficult;
• the jaw loses mobility;
• the appearance of ulcers on the mucous membrane covering the damaged area;
• pathological dental mobility due to the destruction of bone tissue and periodontium.

Signs of osteogenic sarcoma

Osteogenic sarcoma of the mandible causes severe pain. Unlike damage to the upper jaw, a neoplasm in the lower jaw already at the initial stage causes pain that intensifies at night. It is difficult for the patient to assess the location of pain. As a rule, the teeth closest to the center of the tumor hurt. There is unsteadiness of the teeth, discomfort, and itching of the gingival margin.

As damaged tissue grows, the face becomes deformed, swells, and loses proportionality. There is numbness in the lower lip, chin, and tingling in the lower part of the face. Throughout the disease, the patient's condition remains virtually unchanged. On early stages osteosarcoma gives low-grade fever 38 °C, which decreases to normal readings after a few days. At the stage of decomposition of the osteogenic structure, the temperature rises to 39 or 40 °C.

On initial stages sarcoma of the upper jaw has no manifestations and does not bother patients. After some time, patients note paresthesia (numbness) of the facial skin, headaches, sanguineous discharge from the nasal passages, and causeless unhealthy sensations in the lower and upper jaw. With this type of sarcomatous tumor, pain symptoms are late signs development of the disease.

As the size of the tumor increases, additional warning signs. Swelling, paresthesia, or painful sensations in the teeth and loosening may appear in the cheek area. Due to the curvature of the bones, the face is deformed. The pain becomes more intense and pronounced. The eyeball moves forward (exophthalmos), giving the face a characteristic appearance.

Tumor changes in the upper jaw can affect the orbit, causing the following manifestations:

• lacrimation due to compression of the nasolacrimal duct;
• headaches radiating to the temples or forehead;
• neuralgic pain;
• repeated causeless nosebleeds;
• ear pain when changes spread to the trigeminal nerve;
• inability to close or open teeth;
• the appearance of small ulcers in the mouth.

The synovial type of the disease is usually formed from atypical and mutated cells of the synovial membrane.

Osteosarcoma (video)

Symptoms of spindle-, round-, polymorphic cell sarcoma

In spindle cell sarcoma of the upper jaw, the lesion is formed from thin, narrow cells arranged in bunches. Education is characterized average degree malignancy. Metastases occur occasionally.

Round cell sarcoma is characterized by high malignancy, increased growth rate, and early metastases to the lungs. The lightning speed of such a disease contributes to the development of the disease in 7-8 weeks. A round cell form is formed from the lower anterior sections of the jaw. Rapid, progressive process of destruction bone tissue leads to pathological loosening and loss of teeth. Early signs The appearance of this type of ailment is pain of moderate intensity, which is often confused with dental pain. Removing a supposedly unhealthy tooth does not relieve pain.

Polymorphic cell sarcoma of the upper jaw has an extremely unfavorable prognosis and comes in two varieties:

• formation of low malignancy, developing gradually, occasionally metastasizing, surgical intervention brings positive results;
• a rapidly growing formation affecting neighboring areas gives numerous metastases not only to nearby nodes, but also to distant organs.

Symptoms of chondro- and fibrosarcoma

Chondrosarcoma, or chondromyxosarcoma, is characterized by an accelerated clinical course, widespread growth into areas adjacent to the affected center. Deformation changes in the jaw bones are noticed in the initial stages due to the rapid growth of tumor tissue. Palpation reveals a painless compaction that does not have a clear transition to the jaw bone.

With the central form of chondrosarcoma, the patient usually does not observe any changes. Occasionally, various minor pains are noted. As the area of ​​damage increases, the jaw bones increase in size, and then the disease proceeds similarly to the osteogenic form of the disease.

Fibrosarcoma is rarely diagnosed and grows from connective tissue. There are 2 forms of this type of disease: central and peripheral (periosteal), but in advanced cases, the distinction can be difficult. Symptoms depend on the location and volume of affected tissue.

The peripheral location is characterized by frequent complaints from patients about growing swelling of the cheek on one side. Moderate pain gradually appears. At the initial stages, the area above the affected area has slight redness and pain on palpation. If fibrosarcoma affects the maxillary sections, the patient experiences a narrowing of the palpebral fissure, flattening of the nasolabial fold, and the inability to open the mouth freely. In a short period of time (up to several months), the formation rapidly increases, which leads to noticeable deformation changes.

If fibrosarcoma affects the mandibular sections, the cheek on the affected side becomes noticeably enlarged and protrudes. The course of central fibrosarcoma is considered more severe than peripheral fibrosarcoma.

Maxillary osteotomy (video)

The importance of timely consultation with a doctor

Considering the severity and danger of the illness, high level mortality, the issue of identifying the disease in the early stages is relevant. If you find yourself with some of the signs listed above, you should not expect that everything will resolve on its own.

Despite the fact that this disease is quite rare, do not hesitate. If you suspect any tumor changes, you should immediately consult a doctor to establish an accurate diagnosis. Timely initiation of therapy and the use of advanced technologies and methods give the patient a chance for recovery.

Limbs and spine, but also jaws.

Jaw sarcomas are not considered a particularly common pathological phenomenon; however, they are detected much more often than cancer and grow mainly from the cartilaginous and connective tissue elements of the maxillofacial zone. Such formations are more often found in 20-45 year old patients, predominantly male.

Types and causes of pathology

Jaw sarcomas can form in the form of:

1. etc.

Sarcomatous formations of similar localization are divided into mandibular and maxillary. In addition, such formations are central, soft tissue and peripheral.

The causes of jaw tumors are practically no different from similar formations of other localizations. This:

• Radiation exposure;
• Unfavorable heredity;
• Contact with carcinogenic substances such as lead, cobalt, etc.;
• Unfavorable environment such as poor ecological conditions, city air polluted with toxins, etc.;
• Unhealthy addictions like, or imply direct contact with carcinogens. Nicotine is considered especially oncotoxic;
• A history of tumor pathologies. Similar factor indicates a predisposition to malignant processes.

Symptoms of sarcomas of the lower and upper jaw

Sarcomatous formations can be located on the upper or lower jaw.

They are considered especially insidious because they are distinguished by an uncharacteristic clinical picture and rapid development.

In the process of determining an accurate diagnosis, sarcoma is confused with many diseases such as periodontitis, gingival fibromatosis, gingivitis or osteomyelitis.

The clinical picture of such tumors is individual and can clearly manifest itself not only in large-scale formations, but also in small sarcomas.

The main manifestations of sarcomatous tumors of the maxillofacial localization are:

1. Pain syndrome. It is difficult for the patient to determine the location of the pain, which tends to intensify in the area of ​​the teeth located in relative proximity to the tumor. The pain can be shooting in nature, radiating to the temporal region, or manifest as nagging discomfort;
2. For mandibular localization There is unsteadiness and loss of teeth, burning and itching of the gums.
3. Facial deformity. WITH further development Deformation disorders of bone tissue and their destruction occur (if the tumor is centrally located). A swollen lump appears in the cheek area, the face swells;
4. If the tumor is located in the upper jaw, then the symptoms are supplemented by bloody nasal discharge, problems with breathing through the nose, exophthalmos, which is associated with tumor growth into the eye sockets and nasal cavities;
5. With the growth of education there appear difficulty chewing food, the connection of the jaws occurs noticeable gain pain syndrome;
6. Numbness in some areas of the face. In case of mandibular localization, numbness of the lower lip and chin is observed, which indicates the presence of mechanical compression of the nerve endings by the tumor;
7. Submandibular and oral tissues are subject to carcinogenic infiltration. Often tumor process extends to the cervical area.

For some time, the performance and general state of the tumor remain relatively satisfactory, only occasionally local tumor signs are disturbing. On terminal stage, when the processes of tumor decay begin, persistent hyperthermia is noted, pain manifestations are observed in the mouth, on the head.

Stages of development

The stage of sarcomatous formations is determined in accordance with the size of the primary tumor focus, extension beyond the organ and into surrounding tissues, and the presence of lymphatic and distant metastases.

• Stage 1. The tumor is small in size, no more than a centimeter, and does not extend beyond the original lesion. If the tumor is detected at this stage, the treatment will be successful, and the patient has every chance of finally getting rid of the disease.
• Stage 2. The formation increases, grows into all jaw layers, and disrupts the functionality of the jaw. Such formations essentially do not extend beyond the jaw, however, their removal will require a more extensive operation. Recovery is possible, but the likelihood of relapse is high.
• Stage 3. Sarcomatous formation grows into neighboring tissues and can metastasize to regional lymph nodes. The results of treatment are usually disappointing, and relapses occur in almost all cases.
• Stage 4 is considered terminal. The tumor usually reaches gigantic sizes, disintegrates and causes bleeding. There are metastases in any lymph nodes, typically the presence of metastases in distant organs such as the lungs, brain, etc. The prognosis is negative.

Diagnosis of the disease

Sarcomatous formations of the maxillofacial localization require a comprehensive diagnostic approach, because at first they have symptoms similar to other pathologies.

The doctor collects anamnesis and conducts an examination, after which the patient is sent for examination, which involves the following procedures:

1. Laboratory examination of urine, including;
2. X-ray examination (side view, front view);
3. material obtained during biopsy;
4. Radionuclide research.

Diagnostics has vital important, because an incorrect diagnosis leads to the development of sarcoma, which is fraught with complications, including death.

Treatment of pathology

The basis of treatment for jaw sarcoma is surgical treatment, which involves removal of the affected area.

Sarcomatous formations are resistant to, therefore this type of therapy is not applied to them. used as an auxiliary technique before and after surgery.

The operation is performed in the form of resection - excision of the tumor within healthy structures. Such removal can be carried out in different ways:

• Resection without or with disruption of jaw continuity;
• Half or segmental resection with disarticulation (isolation) of the affected element;
• Wide resection including soft tissue structures.

The most optimal technique is selected by a specialist after a thorough study of the type of sarcomatous tumor, its stage, metastasis and the general well-being of the cancer patient.

Such operations are considered quite complex and highly traumatic and are performed under endotracheal anesthesia. At the same time, the patient is given a blood transfusion.

Based on X-ray data, the doctor, even before the operation, thinks through the course of the intervention and methods for attaching the remaining jaw fragments. As for jaw plastic surgery, it is recommended to perform it approximately a couple of years after resection, not earlier. And only in the absence of relapses.

This waiting period is necessary not only to prevent relapses, but also for regeneration, so that in the future the graft can fully take root.

Life forecast

The prognosis for sarcomatous maxillofacial formations is unfavorable.

According to statistics, only a fifth of patients have a 5-year survival rate after resection. The remaining 80% of patients experience relapses and ultimately die.

Unfortunately, nowadays the risk is growing cancer diseases. Malignant tumors tend to form in almost all organs and systems of the human body. Bones can also be affected. Among the many pathologies, there is such a disease as osteosarcoma of the upper jaw.

The development of malignant tumors has a number of causes and is different character. In order to have an idea of ​​what osteosarcoma of the upper jaw is in humans, for what reasons it occurs and what measures should be taken, it is advisable to study the relevant amount of information.

What is osteosarcoma

Cancerous tumors are formed from different tissues of the human body. The formation of osteogenic sarcoma occurs from bone tissue. This disease is aggressive in nature and is a tumor. In most cases, the course of the disease is characterized by rapid development with the formation of metastases, not excluding the initial stage. Most often, tumor formation occurs in tubular bones.

The formation of osteosarcoma occurs directly in the bone, is not related to other tumors, and is not their metastasis. Very rare disease of this type acts as a consequence of osteomyelitis.

In medical practice, only a few such cases have been recorded, and this occurs only as a result of chronicity of the underlying disease with an independent course.

Causes of development of jaw osteosarcoma

Sarcoma of the lower jaw, as well as the upper jaw, has certain causes. Provoking factors may include:

1. injuries, varying degrees of fractures;
2. mutation of bone tissue at the cellular level;
3. effects of radiation on bones;
4. development of active inflammatory process, both independently and as a result of osteomeoitis, osteochandroma or osteitis;
5. penetration of cancer cells into bone tissue from other malignant tumors;
6. rhinoblastoma;
7. pathologies that are hereditary in nature.

In addition to the jaw region, other areas of the skeletal system may be localization sites for osteosarcoma. Most often, cancer occurs in this area hip bones, knees, shoulders and elbows. The rarest localization sites are:

• lower jaw;
• sacrum;
• foot.

The onset of the disease is characterized by pain, similar to the manifestations of rheumatism. After some time, formation occurs. The manifestations are accompanied by impaired functionality of the joint, as evidenced by increased pain.

Symptoms and course of osteosarcoma of the upper jaw

Osteosarcoma of the upper jaw is a rather dangerous disease, representing a malignant neoplasm. Manifestations of the disease are characterized by symptoms such as:

1. pain;
2. headache;
3. discharge of pus from the nose;
4. development of deformative processes on the face;
5. loosening of teeth;
6. swelling accompanied by puffiness;
7. the occurrence of noticeable discomfort and disruption of the functionality of the affected area.

The development of the disease is characterized by a sluggish process, accompanied by the occurrence of slight dull pain. At first, its appearance is detected in the morning. Over time, the pain intensifies. In this case, the bone may increase in size. On palpation, pain occurs.

Gradually, the pain not only becomes more noticeable, but also becomes permanent. It is most pronounced at night and appears as a consequence after physical activity. Osteosarcoma of the upper jaw tends to recur at an accelerated rate, involving surrounding tissues and accompanied by the rapid formation of metastases.

The patient's general condition is gradually deteriorating. The tumor can interfere with chewing movements, the face swells, and sensitivity in the affected area is lost, accompanied by tingling.

Osteosarcoma of the upper jaw, the symptoms of which are identical to the lower part, has its own classification.

Types and stages of the disease

In addition to the stages of development of osteosarcoma of the upper jaw, of which there are only four, the disease is divided according to the nature of development and comes in the following forms:

• mixed;
• osteolytic;
• osteoplastic.

According to the degree of malignancy, the tumor can be:

• low;
• intermediate;
• high.

The nature of the disease is:

• metastatic, when cells that have undergone a mutation are transported throughout the body in the bloodstream, which leads to the formation of additional inflammatory foci;
• localized.

This disease requires high-quality diagnosis and timely treatment.

Diagnosis and treatment of osteosarcoma

The whole difficulty of diagnosing jaw osteosarcoma at the initial stage lies in the absence of pronounced symptoms. High-quality diagnostics are carried out through:

• computed tomography;
• x-ray;
• magnetic resonance therapy.

This approach allows us to accurately determine the location of tumors.

As for the treatment of this disease, it consists of:

• during a course of chemotherapy;
• in surgery.

The first method is reproduced through the use of certain drugs, which include:

1. etoposide;
2. adriblastine;
3. cisplatin and a number of others.

Surgical treatment consists of resection of the affected area followed by removal of the tumor. In most cases, there is a need to replace the cut section of bone.

In the case where a large area of ​​bone is affected, the entire part has to be removed. Sometimes cancer cells affect nearby lymph nodes, which also need to be removed.

After surgical intervention a repeat course of chemotherapy is prescribed. It is carried out with the aim of completely eliminating residual cancer cells, if any.

As for survival, it directly depends on the prevalence of osteosarcoma, its form, as well as on the treatment performed and the individual characteristics of the human body.

A person has two jaws: upper and lower, the main task of which is to fix the teeth to ensure chewing and articulation functions. Osteogenic sarcoma of the jaw is a malignant disease that provokes local destructive changes in the affected tissues and spreads metastases to distant organs.

Description and statistics

Initially, the symptoms of the disease do not cause any concern in the person; outwardly, he looks quite healthy, despite the onset of development of the craniofacial neoplasm. As the pathology progresses, increased division of cancer cells occurs connective tissue periosteum, cortical bone and bone marrow substance, against which the tumor grows significantly. Painful sensations occur periodically and can be relieved with analgesic drugs.

Primary symptoms are similar to those of a cold and chronic fatigue. A person can be unsuccessfully treated for sinusitis, inflammation of the gums, and swelling of the upper eyelids for a long time, trying to relieve them with the help of folk remedies and medications. As a result, diagnosis and treatment of jaw sarcoma is carried out too late, when the chances of a favorable outcome are significantly reduced.

The disease is more common in children and young people under 40 years of age.

ICD-10 code: C41.0 Malignant neoplasm of the bones of the skull and face and C41.1 Malignant lesion of the lower jaw.

Causes

Factors provoking the development of the disease are:

• deforming osteosis and exostosis of bone tissue, fibrous dystrophic changes in the jaw;
• Paget's disease;
• radiation exposure;
• traumatic factors;
• bad habits- smoking and alcohol addiction;
• systematic contact with carcinogenic substances such as lead, cobalt, etc.;
• unfavorable environmental conditions;
• negative heredity for malignant diseases.

Who is at risk?

According to statistics, sarcoma of the lower and upper jaw most often occurs in children and people in the age range of 20-40 years. Moreover, the disease has no geographical, racial or ethnic characteristics.

Symptoms

As mentioned above, sarcoma can affect the upper or lower jaw. The disease is truly insidious, since during its development there is a predominance of a nonspecific clinical picture and rapid tumor growth.

From the very beginning, sarcoma of the jaw is often confused with pathologies such as periodontitis, gingivitis and other infectious and inflammatory conditions of the gums.

The nature of the disease often has individual characteristics and manifests itself in a pronounced form only under the condition of large-scale growth malignant neoplasm.

The main symptoms of jaw sarcoma:

• pain. It is difficult for a person to independently determine the true location discomfort. The pain is diffuse and intensifies in the growth zone of the teeth, which are located close to the cancer site. It can be shooting, as a rule, with recoil to the temples, or simply manifest itself as a nagging uncomfortable sensation;
• facial deformation. With the development of the malignant process, defects and destructive changes in the bone tissue of the skull occur, especially when central location neoplasms. A lump appears in the facial area, which grows, and along with it, the patient’s appearance changes for the worse;
• when sarcoma is localized in the lower jaw, loosening and loss of teeth, burning, and itching sensation in the gums are noted;
• when sarcoma is localized in the upper jaw Clinical signs the diseases are complemented by nasal discharge of an irritating nature, exophthalmos and breathing disorders, which is caused by the spread of the malignant process into the orbits and the nasal cavity.

As the cancer process progresses, difficulties arise with normal eating, chewing functions, and increased pain. Sometimes there is numbness in certain areas of the face. If the malignant neoplasm is located in the lower jaw, loss of sensitivity occurs in the chin and lower lip, which indicates pathological compression of the nerve endings by the growing tumor.

At the terminal stage, the clinical picture of the disease worsens. Man complains about chronic fatigue, general weakness, hyperthermic syndrome, etc.

Types, types, forms

Sarcoma is most often located in the area of ​​the alveolar papilla. The upper and lower jaws are affected with equal frequency.

Sarcoma of the lower jaw. Causes more severe symptoms. The pain appears early, it is constant and radiates to the teeth, which are located next to the tumor.

Sarcoma of the upper jaw. Against, long time may be asymptomatic. Before the onset of pain, patients complain of itching in the gum area, loose teeth and swelling of the mucous membrane.

Sarcoma of the lower or upper jaw develops as a result of mutation of various structural elements of the face: bone-forming and connective tissues. Most often, the following differential forms of malignant tumors are identified with this disease:

• osteosarcoma;
• fibrosarcoma;
• chondrosarcoma;
• angiosarcoma;
• Ewing's sarcoma.

Taking into account the localization of the primary focus, sarcoma of the jaw is divided into central and peripheral.

Central neoplasm. Begins development in the internal structural elements of the bone or bone marrow. Osteosarcoma of the jaw has this origin. Its formation can proceed according to the osteolytic type, that is, with the predominance of the process of destruction of bone tissue, or according to the osteoblastic type, with a predominance of cell proliferation, but more often these methods are mixed with each other. External clinical phenomena in the form of deformation of the jaw and face are noted later, but the tumor quickly affects the nerve trunks, against which literally from the first stages of the pathology a person begins to complain of acute unbearable pain that is not relieved by pharmaceutical analgesics.

Peripheral sarcoma of the jaw. It begins to develop from the tissues of the periosteum and periosteal layer - the surface structures of the bone. Its first symptoms appear early. These include facial deformation resulting from protrusion of tumor nodes or massive swelling of the oral mucosa. Peripheral sarcoma is represented by such forms of the disease as fibrosarcoma, angiosarcoma, etc.

Depending on the morphological structure, sarcoma of the jaw can be:

• fusiform;
• round cell;
• polymorphocellular.

The tumor is also divided into primary and secondary, that is, its formation can be preceded by any benign neoplasm in the gum or damage, or it becomes the result of metastasis of cancer cells from other cancer sites in the body.

Classification of the international TNM system

Let us consider in the following table the stages of sarcoma of the jaw, corresponding in gradation to the TNM system.

Let's look at the resume to the criteria listed in the table.

T - primary tumor:

• T1 - neoplasm is located in the mucous membrane and submucosal layer of the upper or lower jaw;
• T2 - the tumor grows, causing local erosion and bone destruction;
• T3 - the oncological process goes beyond the affected organ and rushes to other anatomical structures;
• T4 - the neoplasm affects neighboring tissues and organs, causing various complications, including intoxication of the body.

N – damage to regional lymph nodes:

• N0 - absent;
• N1 - single metastases up to 3 cm in size;
• N2 - single metastases with foci up to 6 cm or multiple, but with a volume of less than 6 cm;
• N3 - numerous lesions of regional lymph nodes with foci larger than 6 cm.

M - distant metastases:

• M0 - absent;
• M1 - determined.

Stages

Let's look at the stages of development of jaw sarcoma in the following table.

Difference between jaw sarcoma and carcinoma

The main distinguishing feature of sarcoma is the fact that this tumor develops mainly in young people - no older than 40 years. Cancer or carcinoma, on the contrary, is more often diagnosed in older people.

Another important difference is the origin of these malignant neoplasms. Sarcoma begins to develop from connective tissue, cancer - from epithelial tissue. It has also been noted that sarcomatous lesions progress faster compared to carcinomas.

There are also similarities between them. Both tumors spread metastases to regional lymph nodes and distant organs. After surgical intervention neoplasms are highly likely to recur. Both sarcoma and carcinoma can be primary or secondary tumors, that is, they develop independently or become the result of metastasis from other malignant neoplasms.

Diagnostics

Determination of sarcomatous lesions of the jaw is carried out using the following research methods:

• Inspection and palpation. In most cases, the primary diagnosis of pathology is performed by a dentist. If he identifies signs indicating the development of a malignant tumor in the jaw or oral cavity, the specialist will refer the patient to an oncologist.

• Radiography. The method gives full information about the location and size of the neoplasm. Optimal X-ray method The study in this case becomes an orthopantomogram.
• CT and MRI. Computed tomography and magnetic resonance imaging help to evaluate not only the characteristics of sarcomatous lesions of the jaw, but also its distribution in the body.
• Blood test for tumor markers. There are no specific antigens for the diagnosis of sarcomatous lesions. A test for the enzyme TRAСP 5b, tartrate-resistant acid phosphatase, may be prescribed, which helps to suspect malignant bone lesions.
• Biopsy with histological analysis. With this method, a puncture is taken of biological material from the suspected focus of cancer, and then it is performed microscopic examination, confirming or refuting the malignancy of the disease.

Treatment

The fight against jaw sarcoma is based on three basic therapeutic actions. Let's take a closer look at them.

Surgery. Radical removal tissue of a malignant neoplasm is recommended in the first stages - the prognosis for recovery at this stage will be the most favorable, since atypical cells have not yet penetrated the regional lymph nodes.

If the sarcoma is advanced, an aggressive treatment protocol is selected for the patient. Surgery in later stages is performed under general anesthesia with complete resection of the tumor along with adjacent soft and hard tissues. It is highly traumatic in nature. At the same time, a blood transfusion is performed.

Based on X-ray images, the doctor, even before the operation, thinks through the tactics of surgical intervention and methods of attaching the remaining fragments of the jaw. As for performing maxillofacial plastic surgery, it is recommended to do it no earlier than 2 years after the main treatment, provided there are no relapses of the oncological process. Waiting is necessary for the regeneration of the operated area, which will subsequently have a positive effect on the engraftment of the graft.

Radiation therapy. Targeted exposure to high-dose ionizing rays provokes the destruction and decay of malignant elements and leads to stabilization of the oncological process. Radiation for jaw sarcoma is carried out remotely.

Chemotherapy. The disease has a tendency to early spread of metastases, despite the fact that, according to statistics, they are diagnosed from the third stage of pathology. Once in the bloodstream, cancer cells are able to penetrate all organs and systems of the human body. To destroy them and prevent metastasis and relapses of jaw sarcoma, after surgery, doctors select a course of cytostatics - medicines with a specific effect. The chemotherapy regimen is completely individual for each patient.

Traditional treatment. This trend has evolved over hundreds of years, so many people tend to trust recipes alternative medicine. On the Internet you can find a lot of compositions based on medicinal herbs and animal products intended to combat cancer. But, unfortunately, all of them have no scientific evidence base and their use, according to experts, can not only be useless, but also harm an already weakened body that is fighting a malignant disease. Therefore, regardless of the attitude towards folk medicine and the experience accumulated by our ancestors, it is better to refuse such experiments without a doctor’s permission.

Recovery process

After the main course of treatment and severe prosthetics, patients are assigned a second disability group. If necessary, new surgical interventions are performed, articulation classes are conducted with a speech therapist, and vouchers to rest homes and various sanatoriums are offered.

When replacing the upper jaw, a three-stage approach is used:

1. Immediately after surgery and resection tumor formation A protective plate is specially manufactured and installed.
2. Replace after 15 days protective structure on the prepared forming prosthesis.
3. After 30 days, the final prosthesis is installed.

After excision of a malignant neoplasm on the lower jaw with simultaneous removal of the muscle tissue of the cheeks, a nasal feeding tube is used to feed patients. Prosthetics and plastic surgery of existing bone defects can be carried out no earlier than 2 years after radiation therapy and the absence of relapses of the disease.

It is important to take into account the fact that radical operations in oral cavity not only complex from a surgical point of view, but also highly traumatic for the human psyche. For this reason, even before surgery, the doctor must warn the patient about functional disorders that are inevitable during treatment of this kind. Even before the operating room, he should know what a tracheostomy and tube are, how to care for them and how long they are installed.

After surgery, communication with the patient is organized using paper and pen prepared by relatives in advance. It is worth noting that after the rehabilitation period, many patients speak clearly, so there is no need to worry that speech will not return. Competent preoperative preparation, including from a psychological point of view, if necessary supplemented with tranquilizers, helps painless adaptation of a person.

The rehabilitation period lasts on average 24 months. During this time, the patient is constantly monitored to exclude possible relapses of the tumor. During this period, any plastic surgery. Within 2 years, the body’s regenerative abilities are restored and the condition improves. immune system- all this increases the chances of successful plastic surgery.

Course and treatment of the disease in children, pregnant and lactating women, the elderly

Children. Sarcomas of the jaw in childhood develop for several reasons: unfavorable heredity due to oncology, previous injuries, previous viral infections and weakened immunity. Diagnosis of the disease in young patients is carried out in the same way as in adults: using MRI, CT and biopsy, followed by histological analysis. Treatment of sarcoma of the jaw in a child depends on the location of the malignant process, its stage and size, the presence of metastatic changes and general condition body. The surgical approach is usually used as therapy, since tumors in children are less sensitive to chemotherapy and radiation, so these treatment options can be considered solely as auxiliary.

Pregnancy and lactation. Sarcomatous lesions of the upper or lower jaw are not excluded during pregnancy and lactation of a woman. If found this disease, treatment tactics are selected individually, taking into account the trimester of gestation and the patient’s desire to keep the child. If the tumor is in an operable condition, the operation is performed in the same way as in the absence of pregnancy, taking the necessary precautions. Chemotherapy and radiation are not indicated for expectant mothers, so these techniques are postponed until postpartum period. If a woman is breastfeeding, she will have to stop lactation and start treatment immediately. With positive dynamics and recovery of the patient next pregnancy permitted no earlier than after 3 years of stable remission.

Advanced age. Sarcomas are rare among older people. At this age, most often a malignant tumor affects the uterus, esophagus and stomach of a person. Sarcoma of the jaw in such situations often becomes a secondary neoplasm, that is, the result of metastasis of other cancer foci in the body. The principles of diagnosis and treatment generally do not differ from the generally accepted ones, while the prognosis for recovery may worsen depending on the tumor’s response to therapeutic methods, the presence of contraindications to surgery, the state of immunity and concomitant diseases of the elderly person.

Treatment of jaw sarcoma in Russia and abroad

Sarcoma of the jaw is dangerous condition, which begins to quickly metastasize and without proper medical care within a short time leads to fatal outcome. We invite you to find out how this pathology is treated in different countries.

Treatment in Russia

Domestic medicine recommends an integrated approach in the fight against sarcoma of the jaw: surgery and radiation therapy. Specialists from different fields take part in the treatment and rehabilitation of the patient: oncologist surgeon, dental surgeon, rehabilitation specialist, etc.

Main methods of therapy in Russia:

1. The first step in the fight against malignant lesions of the jaw is external irradiation. A course of radiotherapy is carried out using a total dose of up to 40 Gy. The goal is to reduce the size of the tumor, prepare for surgery and reduce the risk of metastasis.
2. The second stage of treatment is surgical resection of the tumor. It is carried out 4 weeks after the end of irradiation. The operation is performed on the basis of diagnostic research methods - radiography, computed tomography, etc. The tumor itself is removed, and, if necessary, regional lymph nodes, soft tissues, periosteum of the orbit, etc.
3. Third, the final stage treatment is rehabilitation. Even before the surgical intervention, an impression of the jaw is made to make a prosthesis, which will be installed after the operation. After 2 years, plastic surgery is possible.

Also, in Russian oncologic dispensaries, the method of V. S. Protsik can be used to treat sarcomatous lesions of the jaw. It also consists of several stages, such as chemotherapy, external beam radiation therapy, and only after this is surgery performed with the introduction of Co60 radionuclide into the surgical cavity to perform brachytherapy.

The cost of treatment for jaw sarcoma in Russia depends on the status of the chosen medical institution (it can be private or public) and on the characteristics of the patient’s disease. On average, a comprehensive course of therapy along with rehabilitation period is from 250 thousand rubles.

Which clinics in Russia can I go to?

• The center is equipped with modern diagnostic equipment from leading manufacturers such as GE, Philips, Siemens. When solving surgical problems, doctors use only all modern technologies.
• Russian oncological science Center named after N. N. Blokhin, Moscow. It is an independent medical scientific organization with the status of a state institution.
• Research Institute of Oncology named after. Professor N.N. Petrov, St. Petersburg. On the day of application, each person can receive free consultation oncologist and referral for appropriate diagnostics.

Madina, 27 years old. “At the N.N. Petrov Research Institute, my father was treated for sarcoma of the jaw in 2016. The impressions from the medical care provided are positive, despite the disappointing diagnosis.”

Varvara, 45 years old. “My sister underwent treatment at the N.N. Burdenko Research Institute. She was diagnosed with a tumor of the lower jaw. Everything was done well, then plastic surgery was done there. I recommend".

Treatment in Germany

Treatment of jaw sarcoma in German clinics is different high efficiency. The country's oncology centers have all possible diagnostic methods, the accuracy of which guarantees the success of subsequent treatment. In the fight against jaw sarcomas, doctors resort to combined techniques.

Advantages of treatment in Germany:

• use of high-tech equipment and effective medicines;
• work of qualified medical personnel;
• close cooperation of German clinics with leading oncology centers around the world.

Treatment of jaw sarcoma in Germany is based on integrated approach. Tactics therapeutic actions is jointly developed by a team of professional specialists such as morphologists, surgeons, chemotherapists and others. Main principle, which German oncology clinics adhere to, is the desire for reliable results and the use of organ-preserving techniques.

The cost of treatment for jaw sarcoma in Germany starts from 40 thousand euros. It depends on the characteristics of the disease, the scale surgical care etc.

Which clinics can I go to?

• Academic Clinic "Diakoni", Freiburg. Leading internal medicine center for the treatment of cancerous tumors in the southern part of Germany.
• University Hospital "Black Forest-Baar", Villingen-Schwenningen. In 2012, according to the medical magazine Focus, it entered the TOP three best oncology centers in Germany.
• The center's specialists are pioneers in the field of oncology and the general development of medicine. They annually participate in international conferences and research programs.

Let's consider reviews about the listed medical institutions.

Anna, 38 years old. “We were treated for jaw cancer at the Diakoni clinic in Germany. The feedback is positive, as the quality of service and assistance provided is at a high level.”

Maria, 47 years old. “I got rid of jaw sarcoma in a German clinic in Heidelberg. I am very grateful to the doctors for their work and help.”

Treatment of jaw sarcoma in Israel

Fight with malignant diseases in Israel - a popular practice among foreign citizens. The fact is that there is many years of successful practice here similar diagnoses, which has successfully proven itself all over the world.

How is jaw sarcoma treated in Israel?

• Surgical therapy is based exclusively on gentle techniques. Thanks to this approach, doctors have the opportunity to preserve the affected organ and subsequently restore its functional activity. Microsurgery is the most popular, with the help of which specialists are able to transplant muscle tissue and restore the aesthetics of the operated area of ​​the body to the maximum extent.
• Radiotherapy increases the effectiveness of any type of sarcoma treatment. On average, a course of irradiation procedures takes from 2 to 3 months, but options are possible when, with the help of a modified dosage of radiation exposure, the duration of therapy is reduced several times.
• Targeted therapy. This method allows you to influence the tumor focus with special conservative means and successfully eliminate it. Targeted treatment is much more effective than chemotherapy, and it causes less side effects, which is very relevant.

Success in the fight against sarcomatous lesions of the jaw in Israel is the hope of modern oncology. This country accepts for treatment not only its own, but also foreign citizens. The cost of therapy depends on the characteristics of the disease and the status of the chosen medical institution. Let's look at the approximate prices for the proposed treatment:

• amputation of the jaw with microsurgical reconstruction of removed tissues - $18.5 thousand;
• amputation of the jaw without restoration - $10 thousand;
• consultation with a maxillofacial surgeon - $550.

Which clinics in Israel can I go to?

• Sheba Hospital, Ramat Gan. State medical institution, where the most qualified specialists work and all the necessary latest generation equipment is available.
• Every year up to 700 thousand people come here to receive quality cancer care. The clinic has a prestigious international JCI accreditation, indicating the high qualifications of the medical personnel working here.
• Clinic "Ramat Aviv", Tel Aviv. A private medical institution equipped with the most modern equipment necessary for high-quality diagnostics, anesthesia and minimally invasive surgical interventions.

Let's consider reviews about the listed medical institutions.

Alice, 32 years old. “At the Kaplan clinic, my father underwent surgery to remove a tumor of the lower jaw. Everything went well, thanks to the doctors for their work. He then received further treatment in Moscow, the prognosis is good.”

Irma, 34 years old. “When my mother was diagnosed with cancer, we immediately decided to send her to Israel, because we had heard about the specialists in this country. At the Ramat Aviv clinic they removed the jaw sarcoma, immediately put on prosthetics, and then there was rehabilitation. We are happy with the help.”

Complications

The consequences that jaw sarcoma provokes depend on the location of the malignant process and its stage. The list of main complications includes:

• problems with breathing and eating. Occur as a result of obstructive changes appearing in the oral or nasal cavity;
• deterioration appearance. A growing sarcoma negatively affects a person’s appearance, reducing his self-confidence and provoking many worries. Complex, expensive plastic surgery may be required to restore the face;
• metastases. Mainly found in regional lymph nodes, liver, lungs and bone structures. Malignant cells spread by lymphogenous, hematogenous and invasive routes;
• damage to neighboring tissues and organs. During surgery or pathological tumor growth, vital anatomical structures such as nerve endings, blood vessels and much more.

Relapses

According to statistics, already in the first 3 years of sarcoma maxillofacial area give relapses in 70-80% of cases. Secondary manifestations malignant process can be diagnosed locally or in distant systems and organs. With the development of relapse, the prognosis for survival worsens significantly. When a tumor is detected early, conservative methods are used - chemotherapy and radiation, and less often - repeated operations.

Prognosis for different stages

As a result of delayed diagnosis and ineffectiveness of selected treatment methods, the prognosis for sarcoma of the jaw will be unfavorable. At the same time, there are certain criteria that influence how long a person with this disease will live. These include:

• stage of the oncological process;
• the presence of metastatic changes - damage to regional lymph nodes and distant organs;
• age over 50 years;
• size of the malignant neoplasm.

There is no definite prognosis for 5-year survival for patients with sarcoma of the jaw. But there are statistics that with such a diagnosis, regardless of the stage of tumor development, only 20% of patients survive over the next 5 years.

Diet

Nutrition for diagnosed sarcoma of the lower or upper jaw plays one of the important roles. Only a properly organized balanced menu will help reduce the symptoms of the disease, strengthen the immune system and direct all efforts to fight the tumor.

Persons with this diagnosis should eat fractionally, at least 6 times a day, in small portions. This will help maintain normal work everyone internal organs and prevent the progression of the malignant process.

With sarcoma of the jaw, a person loses the ability to eat normally. After surgical treatment, most patients are temporarily fitted with a nasal feeding tube through which they receive food. These are mainly special nutritional mixtures. As health improves, the probe is removed and the patient is transferred to a normal diet.

The principles of the diet for sarcoma of the jaw are the same as for others oncological diseases. Persons with this diagnosis are contraindicated in the abuse of fatty and protein foods, dishes with preservatives and artificial fillers, and other unhealthy foods. The basis of the diet should be dairy products, a large number of vegetable fiber - vegetables, fruits and herbs, dietary meats and fish.

Prevention

Prevention of the development of sarcoma of the jaw is based on regular examinations at the dentist's office, complete care for the oral and nasal cavity and strengthening the immune system. Risk factors for the formation of malignant tumors include frequent viral and infectious pathologies, radiation and ionizing radiation, contact with carcinogens, bad habits and poor nutrition- all this is important to exclude as much as possible from the environment and life of your children.