Ilium cancer. Chordoma comes in three forms. Proton Beam Therapy

- a group of malignant and benign neoplasms arising from bone or cartilage tissue. Most often, this group includes primary tumors, but a number of researchers also call secondary processes that develop in the bones during metastasis as bone tumors malignant neoplasms located in other organs. To clarify the diagnosis, radiography, CT, MRI, ultrasound, radionuclide methods and tissue biopsy are used. Treatment of benign and primary malignant tumors bone repair is usually surgical. For metastases, conservative methods are more often used.

ICD-10

C40 C41 D16

General information

Bone tumors are malignant or benign degeneration of bone or cartilage tissue. Primary malignant bone tumors are rare and account for about 0.2-1% of the total number of tumors. Secondary (metastatic) bone tumors are a common complication of other malignancies, such as lung cancer or breast cancer. Primary bone tumors are more often detected in children, and secondary ones in adults.

Benign bone tumors are found less often than malignant ones. Most neoplasms are localized in the area tubular bones(in 40-70% of cases). The lower extremities are affected twice as often as the upper extremities. Proximal localization is considered a prognostically unfavorable sign - such tumors are more malignant and are accompanied by frequent relapses. The first peak of incidence occurs at 10-40 years (during this period, Ewing's sarcoma and osteosarcoma develop more often), the second - after the age of 60 years (fibrosarcomas, reticulosarcomas and chondrosarcomas occur more often). Orthopedists, traumatologists and oncologists treat benign bone tumors; only oncologists treat malignant ones.

Benign bone tumors

Osteoma– one of the most favorable benign bone tumors. It is a normal spongy or compact bone with elements of restructuring. Most often, osteoma is detected in adolescence and young adulthood. It grows very slowly and can be asymptomatic for years. Usually localized in the bones of the skull (compact osteoma), humerus and femur (mixed and cancellous osteomas). The only one dangerous location– on the inner plate of the skull bones, since the tumor can compress the brain, causing an increase intracranial pressure, seizures, memory disorders and headaches.

It is a stationary, smooth, dense, painless formation. On an x-ray of the skull bones, compact osteoma appears as an oval or round dense homogeneous formation with wide base, clear boundaries and smooth contours. On radiographs of tubular bones, spongy and mixed osteomas are revealed as formations with a homogeneous structure and clear contours. Treatment is removal of the osteoma in combination with resection of the adjacent plate. In asymptomatic cases, dynamic observation is possible.

Osteoid osteoma– a bone tumor consisting of osteoid, as well as immature bone tissue. Characterized by small sizes, a clearly visible zone of reactive bone formation and clear boundaries. It is more often detected in young men and is localized in the tubular bones of the lower extremities, less often in the area of ​​the humerus, pelvis, wrist bones and phalanges of the fingers. As a rule, it manifests itself with sharp pain, in some cases it may be asymptomatic. On radiographs it appears as an oval or round defect with clear contours, surrounded by a zone of sclerotic tissue. Treatment is resection along with the focus of sclerosis. The prognosis is favorable.

Osteoblastoma– a bone tumor, similar in structure to osteoid osteoma, but different from it large sizes. Typically affects the spine, femur, tibia and pelvic bones. Manifests itself as a severe pain syndrome. In the case of a superficial location, atrophy, hyperemia and swelling of soft tissues may be detected. X-ray reveals an oval or rounded area of ​​osteolysis with unclear contours, surrounded by a zone of slight perifocal sclerosis. Treatment is resection along with the sclerotic area located around the tumor. At complete removal the prognosis is favorable.

Osteochondroma(another name for osteochondral exostosis) is a bone tumor that is localized in the cartilage zone of long tubular bones. Comprises bone base covered with cartilage. In 30% of cases, osteochondroma is detected in the knee area. May develop in the proximal part humerus, head of the fibula, spine and pelvic bones. Due to its location near the joint, it often causes reactive arthritis and impaired limb function. X-ray examination reveals a clearly defined, tuberous tumor with an inhomogeneous structure on a wide stalk. Treatment is resection; if a significant defect is formed, bone grafting is performed. In case of multiple exostoses, dynamic monitoring is carried out; surgery is indicated for rapid growth or compression of adjacent anatomical formations. The prognosis is favorable.

Chondroma– a benign bone tumor that develops from cartilage tissue. Can be single or multiple. Chondroma is localized in the bones of the foot and hand, less often in the ribs and tubular bones. May be located in the medullary canal (enchondroma) or along outer surface bones (ecchondroma). It becomes malignant in 5-8% of cases. Usually asymptomatic, mild pain is possible. On x-rays a round or oval focus of destruction with clear contours is determined. There is uneven expansion of the bone; in children, deformation and growth retardation of a limb segment is possible. Surgical treatment: resection (if necessary, with endoprosthetics or bone grafting); if the bones of the foot and hand are affected, amputation of the fingers is sometimes required. The prognosis is favorable.

Malignant bone tumors

Osteogenic sarcoma– bone tumor arising from bone tissue, prone to rapid progression, rapid education metastases. Develops mainly between the ages of 10 and 30, men are affected twice as often as women. Usually localized in the metaepiphyses of the bones of the lower extremities, in 50% of cases it affects the femur, followed by the tibia, fibula, humerus, ulna, bones shoulder girdle and pelvis. On initial stages manifests itself as dull, unclear pain. Then the metaepiphyseal end of the bone thickens, the tissues become pasty, a visible venous network is formed, contractures form, the pain intensifies and becomes unbearable.

Manifests intense pain, difficulty moving in the adjacent joint and swelling of the soft tissues. When located in the vertebrae, lumbosacral radiculitis develops. The flow is usually slow. Radiographs reveal a focus of destruction. The cortical layer is destroyed, the periosteal overlays are not clearly expressed, they look like spicules or a visor. To clarify the diagnosis, MRI, CT, osteoscintigraphy, open and penetrating needle biopsy may be prescribed. Treatment is often complex – chemosurgical or radiosurgical.

Ewing's sarcoma is the third most common malignant bone tumor. More often it affects the distal parts of the long tubular bones of the lower extremities, less often detected in the area of ​​​​the bones of the shoulder girdle, ribs, pelvis and spine. Described in 1921 by James Ewing. Usually diagnosed in teenagers, boys are affected one and a half times more often than girls. It is an extremely aggressive tumor - even at the stage of diagnosis, half of the patients are found to have

An important part of the human skeleton is the right and left ilium, which are located in upper sections pelvic bone. This is a pair structure, and both of its components are symmetrical - they have the same size and shape. Studying the body in detail ilium, it is important to understand that in the event of a fracture, massive internal hemorrhage occurs, and an extensive hematoma appears on the skin. Characteristic pathology More common in children, it requires immediate medical attention.

What is the ilium

If you study human anatomy, it is necessary to clarify that this is one of the largest bones of the human skeleton - the hip joint. By its design, the ilium is paired, massive, and symmetrical. The relief of this skeletal element is determined by the muscles; structurally there are several characteristic sections of various sizes and densities.

Where is

The ilium is located in the upper parts of the pelvic bone, is part of the acetabulum and is considered a pair. This so-called skeletal support is the upper border of the iliac region. The ilium forms the pelvic region of the human skeleton, and if desired, this structural element can be palpated using the commonly used palpation method.

Structure

The right and left segments on both sides are attached to the sacrum and structurally have rounded apices. Bottom part noticeably thickened and shortened, and in medicine is called the body of the iliac bone, which together with the pubic and ischial elements form top part acetabulum. The femur and sacrum bones are attached to the body.

In the upper part of the ilium there is an expansion, which precisely forms the wing of the ilium. This is a more fragile structure. Its outer curved edge is called the iliac crest, has the shape of a protrusion, and below is the sciatic notch. The concave part of the wing forms the iliac fossa, the convex part forms the surface of the buttocks, and in the posterior region inside the place of articulation of the sacrum and pelvic bone is concentrated, which is called the auricular surface.

Ilium bone hurts

Since the structure is subject to systematic compression and is open to direct blows, doctors do not deny the frequent clinical pictures of fractures in patients of different age categories. If the characteristic lumpiness begins to hurt, you need to immediately consult a specialist to promptly determine the etiology of the pathological process. There is an acute pain syndrome not only because of the fracture bone structures, doctors also focus on other pathogenic factors. Restoring the integrity of damaged tissues is a long process.

Left

If the left segment hurts in the absence of a fracture, it is possible that the indicated area is subject to increased physical activity. Such an uneven distribution of “heaviness” over time can lead to a dislocation or fracture and cause disability for the patient. Other, no less dangerous causes of a characteristic disorder of the human skeleton may be as follows:

• malignant tumors;
• osteomyelitis;
• tuberculosis;
• metabolic bone diseases;
• congenital disorder of collagen synthesis;
• age-related changes in the body;
• Paget's disease;
• long bed rest;
• chronic diseases blood.

On right

With sharp pain on the right side of the ilium bone too we're talking about about extensive pathology, which can cause other symptoms, for example, decreased mobility of the limbs, displacement of the bone structures of the hip joint with further discomfort, and the patient’s confident progress towards disability. The reasons why the once strong right structure can hurt are the following:

• blood diseases, for example, leukemia, lesions bone marrow, multiple myeloma;
• deficit minerals, as an option – vitamin D;
• consequence of injury;
• long-term use medical supplies – synthetic hormones;
• excessive secretion of cortisol;
• advanced age of the patient;
• professional pursuits sports;
• hernia intervertebral discs;
• osteochondrosis;
• oncology.

Fracture of the ilium

One of the reasons that can cause pain in a characteristic area is a fracture. This is a consequence of abnormal compression of bone structures, the result of receiving a direct blow. In such clinical picture large-scale hemorrhage occurs, an extensive blue hematoma appears on the skin. There is a dysfunction of the musculoskeletal system, the muscles of the anterior wall of the peritoneum are pathologically tense. Other signs of a characteristic illness are presented below:

• sharp pain when trying to move your leg;
• dysfunction of the right or left leg, depending on the location of the pathology;
• severe swelling of damaged tissues, specific swelling.

If you suspect a fracture, it is not recommended to carry out any activities at home. The patient urgently needs to be taken to the hospital on his back, with a cushion placed under his knees at a height of 15-20 cm. If there is no displacement, the patient is given local anesthesia (a needle with an anesthetic is inserted into the affected area), a special fixing splint is put on the leg, it is recommended bed rest for the next 3-4 weeks. When displaced - general anesthesia and surgery.

Ilial cancer

This disease can only be determined after comprehensive research. The patient must be observed in a hospital, and doctors perform a series of procedures to make a final diagnosis. These include MRI, CT, X-ray, general and biochemical blood tests, biopsy, positron emission tomography. The patient complains of constant pain in the right or left region of the iliac bone, which only intensifies with movement. With such extensive damage requires immediate diagnosis and treatment, clinical outcome adverse.

Trephine biopsy of the iliac bone

If a person has had pain in a characteristic area for more than a month, medical help is needed, but it’s better to start with full examination. If you suspect cancer in mandatory trepanobiopsy of the ilium should be used, which confirms the presence of a malignant neoplasm. Specified invasive method diagnosis is used if, after puncture, it was not possible to obtain a sufficient amount of bone marrow for examination for the prevalence of cancer cells.

For the fence biological material A thin needle with a diameter of up to 3 mm is used, which at the end has a spiral shape, which allows you to cut bone tissue. The puncture is performed in the area of ​​the iliac crest and is pre-disinfected. alcohol composition and iodine. The procedure is performed under local anesthesia, and doctors use a 2% novocaine solution specifically for these purposes. After the collection of biological material, a void may form, which is soon restored due to the regeneration of damaged tissue.

Treatment

Knowing where the iliac region is located, doctors can guess the diagnosis, but they can finally make it after a comprehensive examination. Treatment is prescribed depending on the nature of the pathology, taking into account the individual characteristics of each organism. If the focus of the pathology is the iliopubic eminence and its fracture, the patient is indicated local anesthesia and urgent hospitalization. When damaged bone structures are displaced, the prognosis is less favorable; immediate surgical intervention is required - reposition (comparison of fragments).

Features of intensive care for fractures of the iliac bone with or without displacement include a long period rehabilitation. For the patient, this means strict bed rest for at least 45 days, a course of massage, physiotherapeutic procedures, and physical therapy. If we are not talking about a violation of the integrity of the bone and injuries, the treatment regimen depends entirely on the diagnosis made by the doctor. Therapeutic measures may be as follows:

1. For blood diseases and progressive oncology, urgent surgery is indicated, followed by a course of chemotherapy;
2. At elevated physical activity and professional athletes need to reduce excessive activity, take a course of massage, exercise therapy, physical therapy.
3. In case of damage to joints and connective tissue a course of regenerating drugs, exercise therapy, electrophoresis is required, and if intervertebral hernia surgery to remove it is indicated.
4. With a deficiency of minerals, age-related changes bones shown symptomatic treatment with mandatory use multivitamin complexes.
5. If the cause of the pathology is long-term use of hormonal drugs, immediate adjustment of the prescribed dose and replacement therapy are required.

In any case, the ilium needs timely rehabilitation, therefore, you should not endure the pain of a characteristic zone, even if it is dull in nature or occurs periodically. It is necessary to immediately undergo an examination, determine the nature of the predominant pathology, eliminate the provoking factor and undergo a full rehabilitation course with the obligatory participation of physiotherapeutic procedures.

Photo of the ilium

Video

The human skeleton consists of many bones and is a frame, which is the main supporting structure. However, despite all the strength of this system, bones are also susceptible to malignant formations.

In such cases there are certain symptoms types of bone cancer indicating the onset of the disease.

First of all, pain begins to appear in the affected bones. If at first there is no constant pain, then gradually the condition begins to worsen, especially at night and during exercise. As the tumor develops, the pain becomes permanent. Lameness develops and fractures become more frequent. Each bone of the skeleton has individual and general symptoms, appearing in various forms.

Symptoms of pelvic bone cancer

The initial stage of the disease is very mild. In the pelvis and buttocks, dull pain is observed, with a simultaneous slight increase in temperature for a short time. Pain intensifies when walking, which is typical for this disease.

As pelvic bone cancer increases in size, symptoms become more noticeable. Pathological processes begin to affect new organs and tissues. The pain intensifies, and the tumor grows rapidly. After some time it may protrude through the skin. As the tumor grows, compression and displacement of surrounding organs is observed. The functions of nerves and blood vessels are impaired due to their compression.

Mobility is gradually limited, and the pain becomes even stronger, especially at night. Painkillers no longer provide the desired effect. Pelvic tumors give early and extensive metastases, penetrating into vital organs along with the bloodstream.

Symptoms of hip cancer

Like other types of tumors, pelvic cancer femur causes symptoms starting with severe pain. However, final diagnosis is established only after a long time. Gradually, the pain takes on a deep local character, becoming aching and constant. They appear not only in calm state, but also during physical activity. As the tumor grows, the pain intensifies, and painkillers no longer help.

At the site of tumor formation, a swelling is clearly visible, easily detectable by touch. When the tumor compresses the sciatic nerve, pain occurs in the back and sacrum, causing radiculitis. As a result, sleep and general vital activity. The hip bone becomes brittle, causing frequent fractures.

Symptoms of hand bone cancer

Tumors can be primary or secondary. Hand bone cancer produces symptoms characteristic of this particular disease. Painful sensations are not associated with physical activity, they are aching and appear constantly. Insomnia sets in, the limbs and joints swell, and their bones become fragile. Fractures can occur even with a slight fall. Associated symptoms manifest as abdominal pain, nausea or vomiting. This is due to the entry of calcium salts into the blood, especially during the formation of secondary tumors.

Symptoms of spinal bone cancer

The clinical picture of spinal bone cancer shows symptoms in the form of pain in the lower or middle back. These discomfort intensifies at night and in the morning. The pain radiates to the arms or legs, it either intensifies or weakens. Its effect on surrounding organs depends on where the tumor forms.

When you feel suspicious areas, you can often find a lumpy lump that causes pain when you press it.

Nervous symptoms affecting the sciatic nerve are also observed. Spinal cancer can cause muscle weakness and decreased sensitivity. Movement becomes difficult, leading to frequent falls of the patient.

Symptoms of leg bone cancer

In most cases, malignant transformation affects the bones of the legs. This is especially true for tubular long bones and the area of ​​the knee joints. Therefore, leg bone cancer has symptoms with individual characteristics for this organ.

A mandatory sign of the disease is pain, which intensifies with physical activity. The mobility of the affected organ is limited. At the site of the tumor, swelling appears, protruding under skin, a visible leg deformity may gradually appear.

All this is accompanied by fever, lethargy, weakness and weight loss. Accurate diagnosis installed only after X-ray studies and biopsy of the diseased organ.

Symptoms of ilium cancer

The ilium is one of the largest parts of the skeleton. There are two of them, located to the right and left of the pelvic bone. This organ is also susceptible to cancer. Therefore, cancer of the ilium exhibits symptoms characteristic of other bone elements.

The main manifestation is constant pain and a significant deterioration in general well-being.

At the slightest suspicion of a disease, it is necessary to conduct an examination to begin timely treatment. In many cases, the final result and prognosis depend on this.

Sarcoma of the hip joint is one of the common variants malignant lesion bones. The disease accounts for 1% of all cancers. It affects both older people and young people, as well as average age. A separate group The patients are children and adolescents.

What is sarcoma of the hip?

A malignant neoplasm that develops from connective or bone tissue is called sarcoma. The hip joint can withstand a load of more than one and a half tons, so this section of the musculoskeletal system is very vulnerable. The tumor in this area is in most cases highly aggressive and prone to rapid growth. Crucial early diagnosis a disease that gives hope for a radical cure and survival of the patient.

Types of tumors

According to the classification of the World Health Organization, the following types of neoplasms on the leg bones are distinguished:

1. Osteosarcoma. It grows mainly from the articular head of the femur or ilium. Characterized by to varying degrees aggressiveness, often affects young men.
2. Chondrosarcoma. Formed from the cartilage tissue of the joint.
3. Fibrosarcoma. It develops with a gradual increase in symptoms and metastasizes in the first five years of the oncological process. The diagnosis is made after a biopsy.
4. Fibrous histiocytoma. It is highly malignant and often grows in soft fabrics.
5. Chordoma is an embryonic neoplasm with a low degree of activity. Often begins its development as a benign tumor. In most cases, it affects the sacrum or knees in men.
6. Ewing's sarcoma is a tumor of the pelvis or extremities, characterized by a high degree of malignancy. The manifestation of the disease can develop rapidly, metastasis is observed both in nearby and distant organs.

Stages and degree of malignancy of hip joint sarcoma

The stage of malignant tumors of the pelvic bones is determined depending on the following indicators:

• size of the neoplasm: a single sarcoma measuring less than eight centimeters is classified as the first stage of the disease, more than nine - to the second; multiple formations characterize the third and fourth stages);
• presence of damage to regional lymph nodes;
• metastasis to nearby or distant organs.

The most favorable option in terms of prognosis is the small size of the formation, the absence of damage to the lymphatic system and metastasis.

The degree of malignancy is determined after histological examination and depends on the differentiation of cancer cells. Tumors consisting of poorly differentiated or undifferentiated cellular elements are characterized by aggressiveness. The first and second degrees have low activity, and the 3rd and 4th are high.

Ewing's sarcoma belongs to the fourth - the most pronounced class of malignancy. This tumor of the hip or knee joint must be diagnosed as early as possible to avoid metastasis.

Causes

The main factors that can cause the development of pelvic cancer:

• past traumas that were not properly treated;
• genetic abnormalities of bone development;
• embryonic developmental defects;
• exposure to ionizing radiation and excessive exposure to x-rays;
• negative impact of chemical compounds of phosphorus and beryllium;
• smoking at a young age;
• bone marrow transplantation.

Often immediate cause the cancerous tumor cannot be determined.

Symptoms

It is necessary to respond to signs of cancer of the pelvic bones as early as possible, because only timely diagnosis and treatment can positively affect the prognosis.

The main symptoms of hip cancer:

• pain that gets worse when walking, doing physical exercise and do not subside at rest, but at night become unbearable;
• pain is not relieved after taking non-narcotic analgesics and anti-inflammatory drugs;
• the appearance of deformations and compactions in the projection of bones, determined by palpation;
• the skin over the tumor thins, becomes pale, with a pronounced vascular pattern;
• local temperature in the joint area increases;
• general weakness with deterioration of health;
• loss of appetite and sudden weight loss;
• nausea and abdominal pain.

The patient often experiences pathological fractures. This sign may appear as a symptom of metastases from other tumors to the hip joint.

Diagnostics

A diagnostic examination must be carried out in full when the first signs of the disease appear. To identify a tumor on the pelvic or leg bones, the following measures will be required:

• X-ray examination;
• computed tomography - allows you to determine the exact location and boundaries of the formation;
• magnetic nuclear resonance – shows the boundaries of the pathological focus with great accuracy;
• osteoscintigraphy – a method using contrast agent, with the help of which it is possible to identify metastases of the primary tumor to other parts of the skeleton.

The primary focus is not determined during the study.

• angiography – reveals the condition of blood vessels near the oncological process;
• biopsy of the affected bone area - allows you to make a histological diagnosis with clarification of the characteristics of the cells from which the tumor developed.

Additionally they do biochemical tests blood for the content of lactate dehydrogenase and alkaline phosphatase.

Treatment

The volume and nature of health measures depends on the cells from which the tumor of the hip joint arose, as well as its stage. Comprehensive, timely treatment improves the prognosis and can stop the development of bone destruction.

Chemotherapy

Chemotherapy drugs are prescribed before and after surgery. This tactic allows you to minimize the development of relapses. Dosages of drugs are selected individually and depend on the degree of malignancy of the process, age and general condition patient.

To suppress the proliferation of tumor cells for the treatment of bone cancer, combinations of the cytostatic Methotrexate with other chemotherapeutic drugs are most often practiced.

High doses of therapy used can cause serious side effects. When prescribing treatment, the possibility of complications must be taken into account.

Surgery

Surgery is a radical and most effective method of tumor removal. To prevent secondary disease, it is recommended to remove the damaged area of ​​bone along with the adjacent area of ​​healthy tissue.

With a high degree of aggressiveness of the pathological process, it often becomes necessary to remove the entire femur. In this case, the patient is fitted with an endoprosthesis. Children have to undergo prosthetic surgery several times due to the continued growth of bone tissue.

Some tumors (fibrosarcoma) are characterized by deep growth into soft tissues - for this reason, their excision is necessary.

Radiation therapy

The use of radioactive irradiation for oncological pathologies of the pelvic bones is limited: this method of treatment does not provide reliable results when used independently.

If possible radical surgery prefer to remove the tumor. If intervention is impossible due to widespread metastases or the tumor is supposed to be partially removed, this treatment method is used.

To achieve an antitumor effect, high doses of radioactive Samarium 153 are used.

Carrying out monitoring and follow-up

Repeated studies during treatment, before and after surgery are necessary to assess the effectiveness of therapy and the presence of metastasis.

After chemotherapy, collection of follow-up (conclusive information about the patient’s condition) also includes assessment of early and late complications this method treatment.

A month after the end of treatment, the patient must undergo a series of the following studies:

• X-ray of the affected joint;
• computed or magnetic resonance imaging;
• X-ray examination of the chest organs;
• Ultrasound of the abdominal cavity;
• osteoscintigraphy;
• laboratory parameters of a clinical blood test with a detailed interpretation of the leukocyte formula and biochemical tests (alkaline phosphatase, LDH, creatinine, urea, bilirubin, transaminase, nitrogen, trace element content).

During the first 2 years after surgery and chemotherapy, the patient must undergo studies recommended by specialists at certain intervals (from 2 to 4 months).

Life expectancy with sarcoma of the pelvic region

Forms of tumor with low aggressiveness, which are localized in the area of ​​the affected joint, with timely surgical intervention provide patient survival rates of up to 70%. Supplementing radical surgery with chemotherapy and radiation increases the chances of survival to 80-90%.

Increasing tumor mass increases the risk of metastasis.

From the group high risk, which includes patients with aggressive tumor processes, the survival rate is about 18%.

Patients with intermediate risk, whose neoplasm gives nearby local metastases, survive in 66% of cases.

If the disease relapses in the first five years after treatment, no more than 25% of patients remain alive.

Consequences and prevention

The consequences of the pathological process depend on the timeliness of the treatment measures taken and the degree of malignancy of the neoplasm.

There are no specific preventative measures to prevent this condition. To reduce the risk of developing the disease you need to:

• promptly and fully treat injuries of the hip joint and femur;
• take measures to treat precancerous destructive diseases articular surfaces and bones;
• adhere to principles healthy image life (eat rationally, maintain adequate physical activity).

Patients who have undergone surgery to remove a tumor of the hip joint must be regularly examined by a specialist and undergo a set of necessary tests.

Medicine on modern stage has effective methods treatment and diagnosis of the most complex oncological diseases. Timely appeal Seeing a doctor if complaints or discomfort occurs will help make a diagnosis in the early stages of the disease. Treatment in this case gives good results and can completely eliminate the consequences of the disease.