Papillomas: why they are dangerous, how and when they need to be removed

Improper and irregular oral care means there is a high probability of getting some kind of infection, which can lead to gum disease. Gum papilloma is a form of oral disease that requires immediate treatment. It may also occur on the lips, tongue, larynx, and throat. Papillomas can be quite painful, and their development threatens inflammatory processes in the oral cavity.

Causes of papilloma

This disease is caused by papilloma, a viral infection that has a long latent, that is, hidden, period. The time during which the disease does not manifest itself after the virus enters the body takes from two months to five years. This is the main danger of such a disease, because in such cases immediate intervention by a surgeon is required, and delay can cause death. The main reason for the formation of papilloma on the gums is a decrease in human immunity.

HPV prevention

The most effective method of preventing infections and complications caused by the human papillomavirus is vaccination. It is carried out before the onset of full puberty and before the start of sexual relations. The optimal age is from 9 to 11 years.

Other preventive measures are:

• maintaining a healthy lifestyle;
• balanced healthy diet;
• timely treatment of abrasions, scratches and other skin damage;
• informing children and adolescents about the dangers of smoking, since tobacco use increases the risk of oncogenic mutations of the virus;
• regular preventive examinations.

It is very important to monitor the child’s health and support immunity in accessible ways. Active physical activity, hardening, and outdoor games are encouraged, allowing the formation of an adequate immune response to environmental factors. It is advisable to abandon home self-medication and uncontrolled use of medications, since incorrect actions can reduce the natural defenses of the child’s body and lead to the activation of HPV.

Symptoms of the development of gum papilloma

Papilloma is a benign tumor in the form of a characteristic growth. This formation can come in different sizes and shapes. Papilloma on the gum may not manifest itself in the form of pain or discomfort that bothers a person. This growth can be detected when visiting the dentist with complaints about teeth or gums, when the doctor conducts a professional examination of the entire oral cavity.

Papilloma is felt by the patient as a foreign body, which, depending on its size, creates a feeling of discomfort. It prevents the free position and movement of the tongue, which provokes distortion of the speech apparatus. With a significant increase in papilloma on the gum, it becomes difficult to chew food.

Lip tumors

Of all the anatomical parts of the oral cavity, the red border of the lower lip is most often affected. Lower lip cancer accounts for approximately 12 - 25% of the total number of tumors in this location. For reasons that are not entirely clear, tumor lesions of the red border of the upper lip are an extremely rare occurrence. The disease most often occurs in people over 60 years of age. Men are more often affected, the male/female ratio approaches 13/1. Predisposing factors are solar radiation, smoking, and alcohol abuse.

Clinically, the disease manifests itself as an exophytic (i.e., protruding) tumor or, much more often, an ulcerative bleeding surface. Since it is very difficult not to notice this lesion, the vast majority of patients seek medical help at an early stage of the disease. This circumstance (treatment of the early stages of any malignant tumors always brings better results) allows us to count on high effectiveness of treatment. In addition, lower lip cancer rarely metastasizes to regional (cervical) lymph nodes. At the time of initial treatment, involvement of the cervical lymph nodes is diagnosed in only 2–12% of patients. Damage to regional lymph nodes significantly worsens the prognosis of the disease. Thus, the 5-year survival rate in the presence of this lesion drops from 90 to 50% and forces one to resort to more aggressive methods of treatment.

Treatment for lower lip cancer is determined by the stage of the disease. Early stages can be cured with surgery or radiation treatment. There are 2 types of radiation treatment: remote and contact therapy (so-called brachytherapy).

The lip has a rather complex anatomical structure, which includes muscles with different directions of muscle fibers, skin, salivary glands, and subcutaneous tissue. Naturally, the goal of surgical treatment is not only radical removal of the tumor, but also restoration of the structure and function of the lower lip. Modern methods and techniques of plastic surgery can achieve good cosmetic and functional results. This is illustrated by the photographs below of patients who underwent surgical treatment for cancer of the lower lip.

Develops against the background of obligate (warty precancer, limited dyskeratosis, Manganotti cheilitis, Bowen's disease) and facultative (leukoplakia verrucous, keratoacanthoma, cutaneous horn, papilloma with malignancy, erosive-ulcerative and hyperkeratotic form of lupus erythematosus and lichen planus, post-radiation cheilitis) precancerous processes .

Warty precancer is characterized by the appearance on the red border of the lip of a sharply demarcated hemispherical lesion with a diameter of 4 mm to 1 cm, which protrudes above the surrounding tissues and has a dense consistency. Its color varies from an almost normal red border to a stagnant red. The nodule may be covered with thin scales and resemble a wart or keratinizing papilloma. Malignancy can occur 1-2 months after the onset of the disease.

The productive form of focal dyskeratosis is characterized by excessive keratinization of the epithelium and looks like a white spot with flat protrusions on a red border or an area of ​​hyperkeratosis with stylized horny protrusions. The destructive form (erythroplakia) is distinguished by the fact that limited defects of the epithelial cover appear on the red border of the lip - erosions, ulcers, cracks. Malignancy can occur 6 months after the onset of the disease.

Abrasive pre-cancer cheilitis Manga-Notty is characterized by the formation of an oval or irregularly shaped erosion on the lip, often with a smooth, polished surface of a deep red color. Crusts may form on the surface of the erosion, which may cause slight bleeding when removed. There is no tissue compaction at the base and around the erosion. Spontaneous epithelization with subsequent recurrence is possible. Malignancy occurs 3 months to 30 years after the onset of the disease.

Lip papilloma is a clearly circumscribed tumor from 1-2 mm to 2 cm in diameter on a wide base with a villous or rough surface. As keratinization increases, the tumor acquires a whitish tint. Lip papilloma is considered a progressive precancerous disease. Compaction of the base of the papilloma and the appearance of pain are signs of its degeneration.

Treatment of diffuse lesions of the lower lip (cheilitis, leukoplakia, etc.) is predominantly conservative. Focal lesions are treated surgically, laser and cryodestruction.

Lip cancer

The term “lip cancer” refers to malignant tumors that arise in the mucous membrane of the red border of the lip. Neoplasms that have developed on the skin near the lip or mucous membrane of the vestibule of the mouth are not included in this group of tumors.

In the structure of cancer diseases in Russia (1997), lower lip cancer accounted for 1.4% of the total number of malignant neoplasms with an incidence of 2.8 per 100,000 population. The disease is most often observed in men over 70 years of age. In rural areas, lip cancer occurs 1.5-2 times more often than in urban populations. In recent decades, there has been a gradual decline in incidence. Approximately 90% of tumors of the lower lip develop due to exposure to known carcinogens, the main of which are tobacco and tobacco-containing substances. Alcohol is comparable in action to tobacco and is part of a group of agents that can potentiate tobacco-induced carcinogenesis. Other important etiological factors are chronic injuries and inflammation of the lip, ultraviolet radiation, changes in weather conditions, and occupation (work in the oil refining, coal, textile industries).

International classification according to the TNM system

Anatomical areas and parts:

1.Upper lip, red border. 2.Lower lip, red border. 3. Angles of the lips (commissures). T - primary tumor: Tx - insufficient data to evaluate the primary tumor, T0 - primary tumor not determined, Tis - preinvasive carcinoma (carcinoma in situ), T1 - tumor up to 2 cm in greatest dimension, T2 - tumor up to 4 cm in greatest dimension , T3 - tumor more than 4 cm in greatest dimension, T4 - tumor spreads to adjacent structures - bone, tongue, facial skin.

N/pN - regional lymph nodes. Regional lymph nodes for all parts of the head and neck, with the exception of the nasopharynx and thyroid gland, are the lymph nodes of the neck, including: submental, submandibular, nodes at the base of the skull near the great vessels (deep cervical), in the bifurcation zone of the common carotid artery (deep cervical) , posterior cervical (superficial cervical), located along the accessory nerve, supraclavicular, preglottic and paratracheal, retropharyngeal, parotid, buccal, postauricular and occipital.

N/pNx - there is insufficient data to assess the condition of the regional lymph nodes, N/pN0 - there are no signs of metastatic lesions of the regional lymph nodes. pN0 - histological examination of material from a selected area of ​​neck tissue includes 6 or more lymph nodes; histological examination of the material obtained using cervical lymphadenectomy includes 10 or more lymph nodes, N/pN1 - metastases in one lymph node on the affected side, up to 3 cm or less in the greatest dimension, N/pN2 - metastases in one or more lymph nodes on the affected side, up to 6 cm in greatest dimension; or metastases in the lymph nodes of the neck on both sides or the opposite side, up to 6 cm in greatest dimension, N/pN2a - metastases in one lymph node on the affected side, up to 6 cm in greatest dimension, N/pN2b - metastases in several lymph nodes on the affected side, up to 6 cm in the greatest dimension, N/pN2c - metastases in the lymph nodes on both sides or on the opposite side, up to 6 cm in the greatest dimension, N/pN3 - metastasis in the lymph node more than 6 cm in the greatest dimension.

Note. The lymph nodes on the affected side include the lymph nodes located in the midline.

M - distant metastases: Mx - the presence of distant metastases cannot be assessed, M0 - no distant metastases, M1 - distant metastases.

The requirements for determining the рТ category correspond to those for determining the T category.

Grouping by stages

Stage 0 TisN0М0 Stage I Т1N0М0 Stage II Т2 N0М0 Stage III Т3N0М0 Т1-3N1М0 Stage IVA Т4N0-1М0 Any ТN2М0 Stage IVB Any ТN3М0 Stage IVC Any Т Any NM1

Clinic . Cancer most often affects the lower lip midway between the midline and the commissure. The main morphological form is squamous cell carcinoma (80-95%). Metastasis later, mainly to regional lymph nodes (5-9.2%). In the clinical course of cancer of the lower lip, two groups are distinguished - exophytic and endophytic. There are transitional forms between them. Exophytic cancers of the lower lip include papillary and warty forms. The papillary form develops from papilloma or against the background of focal productive dyskeratosis. Exophytic cancer visually represents a tumor of irregular shape (round, lumpy, flat), rising above the surface of the red border. There is infiltration of the underlying tissues without clear boundaries. The warty (fungous) form develops against the background of productive dyskeratosis and is characterized by the fusion of multiple small growths on the lip (“cauliflower appearance”), a gradual increase in infiltration of the underlying tissues and tumor disintegration. Endophytic cancer of the lower lip is represented by ulcerative and ulcerative-infiltrative forms. The ulcerative form is characterized by the formation of an ulcerative defect on the lip with a gradual deepening of the ulcerative surface, its bottom becomes uneven, its shape is irregular, the edges rise above the level of the red border, everted. The ulcerative-infiltrative form is characterized by infiltrative growth, which makes it difficult to determine the boundaries of the tumor. Endophytic forms of cancer are more malignant.

Diagnosis is based on anamnesis, examination, palpation of regional lymph nodes (submental and submandibular lymph nodes are examined bimanually), cytological and/or histological examination data. When making a differential diagnosis, it is necessary to keep in mind tuberculosis and syphilitic lesions.

Treatment . In stages I and II, the standard treatment method is radiation therapy (short-focus radiotherapy, electron therapy, contact radiation, interstitial or combined radiation therapy) with a total focal dose of 60 Gy.

The treatment of choice for stage I lip cancer is cryodestruction. Block resection of the lip with simultaneous plastic surgery according to Bruns is rarely used due to the poor cosmetic effect. Surgery is more indicated in the presence of residual tumor after completion of a radical course of radiation therapy; it is performed within 3-6 weeks after the end of irradiation.

For stage II tumors, 2-3 weeks after completion of treatment of the primary lesion, prophylactic upper fascial-sheath excision of the neck tissue on both sides is performed. The block of tissue removed includes the tissue of the submental and submandibular region and the lymph nodes of the fork of the common carotid artery, the lower pole of the parotid salivary gland.

For stage III lower lip cancer, combined radiation therapy is used (external gamma or electron therapy + interstitial or short-focus radiotherapy). The presence of clinically detectable metastases in the lymph nodes is an indication for preoperative irradiation of the cervical lymphatic collector on the affected side. Preventive or therapeutic fascial-sheath removal of cervical tissue (on both sides) is carried out after complete subsidence of radiation reactions and completion of regression of the primary tumor focus. The method of choice for treatment of stage III lower lip cancer, especially when the tumor has spread to the corner of the mouth, is a combined one. In this case, lymphadenectomy is performed simultaneously with removal of the primary tumor. To eliminate lip tissue defects formed after treatment, primary reconstruction is performed using local or regional flaps.

Treatment for stage IV lower lip cancer is combined. For multiple metastases in the lymph nodes of the neck, treatment begins with preoperative external beam radiation therapy. 2-3 weeks after completion of the first stage of treatment, surgery is performed on the primary lesion with simultaneous cervical lymphadenectomy. Fascial-sheath excision of the cervical tissue is performed for single, dislocated metastatic lymph nodes that are not fused with adjacent anatomical structures of the neck. The presence of multiple displaced metastases in regional lymph nodes or single, but limitedly displaced, fused with the internal jugular vein and the sternocleidomastoid muscle is an indication for performing the Crail operation. In case of bilateral metastatic lesions of the lymph nodes, cervical lymphadenectomy is performed simultaneously on both sides. In elderly and weakened patients, this operation can be done first on one side, and after 2-3 weeks on the other.

In case of unresectable tumors and the presence of contraindications to combined treatment, a course of palliative remote gamma therapy is carried out according to a radical program (60-70 Gy). Chemotherapy is used as part of palliative chemoradiation treatment (see Cancer of the mucous membrane of the floor of the mouth).

Recurrent lower lip cancer is treated surgically and in combination. For late limited relapses (developing 1 year or more after completion of short-focus radiotherapy), a course of radiation therapy (60-70 Gy) can be repeated.

Forecast . According to the summary data of various authors, the five-year survival rate for stage I is 91.2-96.9%, for stage II - 82.8-83.6%, for stage III - 63.5-75.4%, for stage IV - no more thirty%.

Prevention of lip cancer consists of timely treatment of precancerous diseases, quitting smoking, eliminating unfavorable external factors (increased insolation, etc.), and using protective lip creams.

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Treatment methods for papillomas of the nasal cavity and nasopharynx

It is advisable to remove papillomas found in the nasal cavity and nasopharynx. Papillomas that have caused at least some concern must be removed.

Removal of papillomas

Removal of papillomas is best done using modern high-tech methods. This is radio wave removal or laser removal. This removal is easily tolerated by the patient. The technology ensures rapid healing, the risk of re-formation of papilloma is minimal.

Removal of papillomas of the nasal cavity with a laser or radio wave scalpel with Surgitr is carried out at JSC “Family Doctor”.

Make an appointment Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

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Diagnosis: which doctor to contact

The examination is prescribed by a dermatovenerologist after a visual examination in a number of cases:

• the presence of papillomas on the skin or mucous membranes (or their presence in a sexual partner);
• pregnancy planning;
• infertility or unsuccessful pregnancies in the past.

The very fact of detecting a virus is not decisive - it is much more important to identify its type and degree of oncogenicity.

The following methods are used for diagnosis:

• colposcopic examination - examination using a special microscope of the cervix and vagina;
• cytological examination - taking a smear, has low accuracy; if the result is poor, additional analysis is carried out;
• histological examination of a biopsy specimen - sampling of a small fragment of tissue for analysis;
• PCR (polymerase chain reaction) - the material for the study is a smear, urine or blood, the accuracy is close to 100%.

PCR is most often used in specialized clinics. The accuracy of the result depends on compliance with the research technique. Such analysis is best done in laboratories with strict compliance with standards.