it is a malignant tumor of epithelial origin, developing from the mucous membrane of the bronchi, bronchioles, mucous membranes of the bronchial glands (bronchogenic cancer) or from the alveolar epithelium (actually pulmonary cancer).
In recent years, the incidence of lung cancer has increased in many countries. This is due to the environmental situation (increasing pollution of the inhaled air, especially in large cities), occupational hazards, and smoking. It is known that the incidence of lung cancer is more than 20 times higher in long-term and frequent smokers (two or more packs of cigarettes per day) than in non-smokers at all. It has now also been established that if a person
Etiology and pathogenesis
The etiology of lung cancer, like cancer in general, is not completely clear. Chronic inflammatory diseases of the lungs, air pollution with carcinogens, smoking contribute to its development; and especially the combined action of these three factors. There is a lot of data on the importance of burdened heredity, including immunodeficiency states.
Pathogenesis is determined, on the one hand, by the characteristics of the emergence, growth and metastasis of the tumor itself, and on the other hand, by changes in the broncho-pulmonary system, arising as a result of the appearance of a tumor and
her metastases. The emergence and growth of a tumor is largely determined by the nature of metaplastic cells. According to this principle, undifferentiated cancer, squamous cell and glandular cancers are distinguished. The greatest malignancy is characteristic of undifferentiated cancer. The pathogenic effect of a developed tumor on the body depends primarily on changes in the functions of the broncho-pulmonary apparatus.
Changes in bronchial conduction are of paramount importance. They appear first of all with endobronchial tumor growth, a gradual increase in the size of which reduces the lumen of the bronchus. The same phenomenon can occur during peribronchial growth with the formation of large nodes. Violations of bronchial conduction in the first stages lead to moderately pronounced hypoventilation of the lung area, then it increases in volume due to emerging difficulties in exit, and only with significant and complete closure of the bronchi, complete atelectasis is formed. The above-described violations of bronchial conduction often lead to infection of a portion of the lung, which can result in a purulent process in this area with the formation of a secondary abscess.
A developing tumor can undergo superficial necrosis, which is accompanied by more or less significant bleeding. Less pronounced dysfunctions of the bronchus occur with peribronchial growth of the tumor along the bronchus along its walls and with the formation of separate peripherally located foci. Their appearance for a long time does not lead to intoxication, but dysfunction the broncho-pulmonary system occurs only with metastasis to the mediastinal lymph nodes. The outcome of the tumor process is determined by the state of the body's antitumor defense, specific sanogenic mechanisms. Among them is the appearance of antitumor antibodies, which is associated with the possibility of tumor lysis. The degree of activity of phagocytosis also has a certain significance. All sanogenic mechanisms are still unknown today, but their existence is beyond doubt. In some cases, their high activity leads to the complete elimination of the tumor.
Pathological picture
Most often, cancer develops from the metaplastic epithelium of the bronchi and bronchial glands, sometimes against the background of scar tissue of the pulmonary parenchyma and in foci of pneumosclerosis. Of the three histological types of lung cancer, squamous cell carcinoma is most common - 60%, undifferentiated cancer is observed in 30%, glandular - in 10% of cases.
Regardless of the histological structure, cancer develops somewhat more often in the right lung (52%), less often in the left. More often the upper lobes are affected (60%) and less often the lower ones. Distinguish between central and peripheral lung cancer. The first one develops in large bronchi (main, lobar, segmental); peripheral - in the subsegmental bronchi and bronchioles. According to the Cancer Research Center, 40% of lung tumors are of peripheral and 60% of central origin.
lung
Stage 1. A small limited tumor of a large bronchus of endo- or peribronchial growth, as well as a small tumor of small and smallest bronchi without pleural damage and signs of metastasis.
Stage 2. The same tumor as in the 1st stage, or large, but without germination of pleural sheets in the presence of single metastases in the nearest regional lymph nodes.
Stage 3. A tumor that has gone beyond the lung, growing into one of the adjacent organs (pericardium, chest wall, diaphragm) in the presence of multiple metastases in regional lymph nodes.
Stage 4. Tumor with extensive spread to the chest, mediastinum, diaphragm, with dissemination along the pleura, with extensive or distant metastases.
T - primary tumor.
THEN - there are no signs of a primary tumor.
TIS is a non-invasive (intraepithelial) cancer.
T1 - a tumor measuring 3 cm or less in largest diameter, surrounded by lung tissue or visceral pleura and without signs of damage to the bronchial tree proximal to the lobar bronchus during bronchoscopy.
T2 - a tumor, the largest diameter of which exceeds 3 cm, or a tumor of any size, causing atelectasis, obstructive pneumonitis, or spreading to the root area. During bronchoscopy, the proximal spread of the visible tumor should not cross the border of 2 cm distal to the carina. Atelectasis or obstructive pneumonitis should not cover the entire lung; there should be no effusion.
T3 - a tumor of any size with direct spread to adjacent organs (diaphragm, chest wall, mediastinum). With bronchoscopy, the border of the tumor is determined at a distance of less than 2 cm distal to the root, or the tumor causes atelectasis or obstructive pneumonitis of the entire lung, or there is a pleural effusion.
TX - the diagnosis is confirmed by a cytological examination of sputum, but the tumor is not detected radiographically or bronchoscopically, or is not detectable (examination methods cannot be applied).
N - regional lymph nodes.
N0 - no signs of regional lymph node involvement.
N1 - signs of damage to the peribronchial and (or) homolateral lymph nodes of the root, including the direct spread of the primary tumor.
N2 - signs of damage to the mediastinal lymph nodes.
NX - a minimal set of examination methods cannot be applied to assess the state of regional lymph nodes.
M - distant metastases.
M0 - no signs of distant metastases.
M1 - signs of distant metastases.
Clinical picture
The clinical picture of lung cancer is very diverse. It depends on the caliber of the affected bronchus, the stage of the disease, the anatomical type of tumor growth, histological structure, and lung diseases preceding cancer. Distinguish between local symptoms caused by changes in the lung and bronchi or metastases in organs, and general symptoms resulting from the effects of a tumor, metastases and secondary inflammatory phenomena on the body as a whole.
With central lung cancer, the very first, earliest symptom is cough. Constant coughing can intensify paroxysmal, up to severe, not relieving harsh cough with cyanosis, shortness of breath. Cough is more pronounced with endobronchial tumor growth, when, protruding into the lumen of the bronchus, it irritates the mucous membrane as a foreign body, causing bronchial spasm and a desire to cough up. With peribronchial tumor growth, cough usually appears later. Mucopurulent sputum is usually small.
Hemoptysis that occurs when a tumor breaks down is the second important symptom of central lung cancer. It manifests itself in about 40% of patients.
The third symptom of lung cancer, which occurs in 70% of patients, is chest pain. They are often caused by damage to the pleura (germination of a tumor or in connection with atelectasis and nonspecific pleurisy). Pain is not always on the side of the injury.
The fourth symptom of central lung cancer is an increase in body temperature. It is usually associated with blockage by a tumor of the bronchus and inflammation in the unventilated part of the lung. The so-called obstructive pneumonitis develops. It differs from acute pneumonia in its relative transience and persistent relapses. With peripheral lung cancer, symptoms are scanty until the tumor reaches a large size.
When a tumor invades a large bronchus, symptoms similar to central lung cancer may appear.
Atypical forms of lung cancer occur in cases where the entire clinical picture is due to metastases, and the primary focus in the lung cannot be detected by available diagnostic methods. Depending on the metastases, atypical forms are as follows: mediastinal, lung carcinomatosis, bone, cerebral, cardiovascular, gastrointestinal, hepatic.
Common symptoms - weakness, sweating, fatigue, weight loss - are found in an advanced process. External examination, palpation, percussion and auscultation in the early stages of the disease do not reveal any pathologies. When viewed in later stages of cancer in the case of atelectasis, a retraction of the chest wall and supraclavicular region can be noted.
With auscultation, you can listen to a wide variety of sound phenomena, ranging from amphoric breathing with stenosis of the bronchus and ending with the complete absence of respiratory sounds in the area of atelectasis. In the area of a massive peripheral tumor or atelectasis, the dullness of the percussion sound is determined; but sometimes with obstructive emphysema, when air enters the affected segment or lobe of the lung, and when leaving the affected bronchus is blocked by thick sputum, a characteristic box sound can be determined. On the side of atelectasis, respiratory excursions of the diaphragm usually decrease.
Changes in the hemogram in the form of leukocytosis, anemia and increased ESR most often appear with the development of perifocal pneumonia and cancer intoxication. The X-ray picture of lung cancer is very variable, therefore, the diagnosis is possible only with a comprehensive X-ray examination in comparison with clinical data, the results of endoscopic and cytological examinations.
Differential diagnosis
Differential diagnosis of lung cancer is often difficult due to the concomitant nonspecific and specific inflammatory diseases of the lung. Based on a set of diagnostic data, a correct diagnosis is made. Most often, it is necessary to differentiate lung cancer with chronic pneumonia, lung abscess, tuberculosis, echinococcosis and lung cyst.
Non-small cell carcinoma
lung: combined
Adjuvant radiation therapy (radical option) is required for stage IIIA (N2). In many hospitals, it is also used in the case of IIIA (N1). However, studies have shown that adjuvant radiation therapy only reduces the rate of relapse, but does not increase life expectancy.
Neoadjuvant radiation therapy is used for upper lobe lung cancer... This is a special variety
peripheral lung cancer... Already at an early stage, the tumor grows into the brachial plexus, which is clinically manifested Pancost's syndrome... Patients must undergo CT, mediastinoscopy and neurological examination (sometimes with a study of the speed of propagation of excitation along the nerves). Histological examination is usually not necessary, since the characteristic localization of the tumor and the irradiation of pain make it possible to make a diagnosis in 90% of cases. Radical treatment is possible only in the absence of metastases in the lymph nodes of the mediastinum. Two methods are used. The first includes irradiation of the tumor in a total focal dose of 30 Gy, divided into 10 fractions, and after 3-6 weeks - removal of the affected lobe with regional lymph nodes and part of the chest wall in a single block. The second method is radical radiation therapy in the classical fractionation mode. The three-year survival rate in both cases is approximately the same and amounts to 42% with squamous cell lung cancer and 21% - at lung adenocarcinoma and large cell lung cancer.
Chemotherapy is not the main treatment for non-small cell lung cancer. In some cases, it gives very good results, but in general, the survival rate does not increase significantly. Non-small cell lung cancer is often non-responsive to antineoplastic agents. To avoid unnecessary use of such a toxic, expensive and inconvenient method as chemotherapy, you need to know exactly when it is appropriate to use it. This can only be established on the basis of a large number of clinical observations.
For this purpose, the results of 52 controlled clinical trials (both published and unpublished) were analyzed. A total of 9387 patients participated in them. At stages I and II of lung cancer, five-year survival after combined (surgery plus chemotherapy) and surgical treatment was compared, and at stage III - two-year survival after combined treatment (radiation therapy plus chemotherapy) and radical radiation therapy (see "
Lung cancer: stages of the disease "). In both cases, the application cisplatin increased the survival rate by 13%, however, in patients with stages I and II of lung cancer, this increase was statistically insignificant, and therefore this method is not yet recommended for these categories of patients. In contrast, in stage III, the increase in survival with the use of cisplatin was statistically significant; life expectancy also increased (albeit slightly - by only a few months) at stage IV. Thus, these categories of patients can be recommended chemotherapeutic regimens, including cisplatin, having previously explained the advantages and disadvantages of the method.
Chemotherapy regimens that includealkylating agents, turned out to be ineffective: in the groups where they were used, the mortality rate was higher than in the compared ones. Currently, these drugs are not used in the treatment of non-small cell lung cancer.
New antineoplastic agents active against non-small cell cancer - paclitaxel, docetaxel, vinorelbine,
gemcitabine, topotecan and irinotecan are still under controlled
Small cell carcinoma
lung: combined
Combined treatment - polychemotherapy in combination with radiation therapy - is considered the method of choice for early stage small cell lung cancer. It significantly improves the results of treatment and increases life expectancy, although it gives side effects, including long-term ones. Such treatment is indicated for patients with an early stage of small cell lung cancer, with a general condition score of 0-1 points, normal lung function and no more than one distant metastasis (see "Lung cancer: stages of the disease").
Irradiation is carried out in the hyperfractionation mode through the mantle-like field, as in lymphogranulomatosis. As the tumor mass decreases, the radiation fields are narrowed.
Of the antineoplastic agents, etoposide and cisplatin are commonly used. In several large clinics, where etoposide, cisplatin and hyperfractionated radiation were administered simultaneously, a high remission rate and an acceptable risk of complications were demonstrated.
In the late stage of small cell lung cancer, chest irradiation is not advisable.
In cases where chemotherapy has proved ineffective, irrespective of the stage of the disease, a course of radiation therapy can be prescribed. According to data from various medical institutions, after combined treatment in about 15-25% of patients with an early stage of small cell lung cancer and in 1-5% of patients with a late stage, the relapse-free period lasts more than 3 years. Complete remission at an early stage can be achieved in 50% of cases, at a late stage - in 30%. In total, complete or partial remission reaches 90-95% of patients. In the absence of treatment, half of the patients die within 2-4 months.
After combined treatment in half of patients with a late stage of the disease, life expectancy increases to 10-12 months, and in half of patients with an early stage - up to 14-18 months. In addition, in most cases, the general condition improves, the symptoms caused by tumor growth disappear.
Much depends on the qualifications of the chemotherapy oncologist. He must make every effort to avoid serious complications and not worsen the general condition of the patient.
Recently, physicians' capabilities have significantly expanded: new chemotherapy regimens, high-dose polychemotherapy in combination with bone marrow autotransplantation and other combined methods of treatment have appeared.
Surgical treatment for small cell lung cancer is rarely used. Indications for surgery are the same as for lung cancer of other histological types (stage I or II of the disease without metastases to the lymph nodes of the mediastinum).
It often happens that small cell lung cancer is first diagnosed with a histological examination of a removed tumor; in such cases, adjuvant chemotherapy can achieve a cure of about 25% of patients.
Lung cancer is the most common malignant tumor in the world population. 1 million new cases are diagnosed annually (more
Cancerlung
-
most
widespread
v
world
populations
malignant
education.
1 million are diagnosed annually.
new cases (more than 12% of the
all detected malignant
neoplasms).
In Russia - 15.2%.
In 1997, 65660 patients were diagnosed with a malignant neoplasm of the trachea, bronchi, and lung.
8,6%
52.5
%
47.5
%
Diagnosis confirmed
Not confirmed
91,4
%
Stage set
Not installed
Lung cancer risk factors
Genetic risk factors:Primary multiple tumor.
Three cases of lung cancer in the family.
Modifying risk factors:
A. Exogenous: 1. Smoking; 2. Pollution
the environment; 3. Professional
harm.
B. Endogenous: 1. Over 45 years of age;
2. Chronic pulmonary diseases.
Distribution of patients by stage
19.6%
37.6
%
Stage I-II
Stage III
Dynamics of morbidity in men and women
Morbidity70
60
50
40
30
20
10
0
1945
1955
1965
Men
1975
Women
1985
1997
The gross incidence rate in Russia is 44.7% o
Saratov regionJewish Autonomous Region
Altai region
Krasnodar region
Moscow city
Ingush republic
- 56.1% about
- 56.8% about
- 54.5% about
- 40.1% about
- 28.1% about
- 14.6% about
Clinical picture
34%
In recent years, primary advanced cancer
lung (IV clinical group) in the Russian Federation
is detected in 34.2% of patients. 30
%
20
%
65
%
Completing tumor treatment
no more than 30% of identified
sick.
Operability is not
exceeds 20%.
Of the registered
65% of patients do not live for 1 year.
The main reasons for neglect
1. Insufficient oncologicalalertness and qualifications
medical personnel (43% of cases);
2. Latent, low-symptom course
diseases (33%);
3. Untimely, late appeal
patients for help (23%).
Causes of neglect depending on the quality of medical care
15%radiologist errors
31%
25%
29%
clinical errors
diagnostics
incomplete examination
sick
long-term examination
Lung cancer symptoms
Primary or local symptoms (cough,hemoptysis, chest pain, shortness of breath),
due to the growth of the primary node
tumors.
Extrapulmonary thoracic symptoms
caused by the growth of the tumor in
neighboring organs and regions
metastasis (hoarseness, aphonia,
kava syndrome, dysphagia). Extrathoracic symptoms depending on the pathogenesis
are divided into the following subgroups:
a) caused by distant metastasis (headache,
hemiplegia, bone pain, growth of secondary volume
formations);
b) associated with the interaction of a tumor - an organism (general
weakness, fatigue, weight loss, decrease
performance, loss of interest in the environment,
decreased appetite), i.e. what is defined as “syndrome
small signs ”, or rather the discomfort syndrome;
c) due to non-oncological complications of growth
swelling (fever, night sweats, chills);
d) associated with hormonal and metabolic activity
tumors (paraneoplastic syndromes): rheumatoid
polyarthritis, neuromuscular disorders, pulmonary
osteochondropathy, gynecomastia, etc.
Tactics
1. Any pulmonary complaints in a smoker over 45 years of ageshould be regarded as possible bronchial cancer.
2. Obturation
pneumonitis
fleeting,
easily
amenable to anti-inflammatory treatment, but often
re-recurs.
3. X-ray diagnosis of early lung cancer
difficult and unreliable. To rule out early cancer
bronchus should be prescribed whenever possible
fibrobronchoscopy.
4. Elderly patients should be repeated
carry out control examinations (call
active!) 1-2 months after the transferred
"Colds", especially with incomplete cure.
Symptoms of distant metastasis
The lymph nodesNeurological symptoms
Headache
Mental disorders
Membrane and radicular symptoms
Spinal cord injury
Skeletal metastases
Liver damage
Paraneoplastic syndromes
These are symptom complexes due tomediated (humoral, etc.)
the influence of the tumor on the metabolism,
mechanisms of immunity and functional
activity of the body's regulatory systems.
With solid neoplasms, they are found in
10-50% of cases. By spectrum and variety
such manifestations of lung cancer are unmatched.
Cutaneous and musculoskeletal symptoms
dermatomyositisacanthosis black
Leser-Trel syndrome
erythema multiforme
Hyperpigmentation
psoriatic acrokeratosis
urticarial rash
Neuromuscular syndromes
Polymyositismyasthenic syndrome (Eaton-Lambert)
Leser-Trel syndrome
peripheral neuropathy
myelopathy
Musculoskeletal Syndromes
hypertrophicosteoarthropathy
drumstick symptom
rheumatoid arthropathy
arthralgia
Endocrine syndromes
pseudo Cushing's syndromegynecomastia
galactorrhea
impaired secretion
antidiuretic hormone
carcinoid syndrome
hyper- or hypoglycemia
hypercalcemia
hypercalcitoninemia
products of STG, TTG
Neurological syndromes
subacute cerebellar degenerationsensory motor neuropathy
endephalopathy
progressive multifocal
leukoencephalopathy
transverse myelitis
dementia
psychosis
Hematological syndromes
anemiaerythrocyte aplasia
dysproteinemia
leukemoid reactions
granulocytosis
eosinophilia
plasmacytosis
leukoerythroblastosis
thrombopenia
thrombocytosis
Cardiovascular syndromes
superficial and deepthrombophlebitis
arterial thrombosis
marantic endocarditis
orthostatic hypotension
disseminated syndrome
intravascular coagulation
Immunological syndromes
immunodeficientfortunes
autoimmune reactions
Other syndromes
nephrotic syndromeamyloidosis
secretion of vasoactive polypeptide
(watery diarrhea syndrome)
amylase secretion
anorexia - cachexia
Population survey stages
1. Selection from the entire population of personspredisposed to lung cancer.
2. Identification of persons with pathological
changes in the lungs.
3. Differentiated diagnosis confirmation or exclusion
malignant lesions or
precancerous pathology.
Examination of the primary patient
Clinical or radiologicalsuspected cancer
Initial examination
(R-graphy, tomography, sputum analysis)
Bronchoscopy
Transthoracic puncture,
thoraconethesis
Lymph node biopsy
(mediastinal, peripheral)
Histological type and TNM
Abdominal echography, bone scan
Respiratory function assessment
Three levels of diagnostics
X-ray detection of suspiciouscancer of the shadows in the lungs in the preclinical stage (mainly
image of large-frame fluorography)
x-ray examination in x-ray
department of institutions of practical medical network
(city, regional hospitals, clinics,
anti-tuberculosis and oncological dispensaries
etc.)
examinations in specialized
pulmonary department. Here based on
a combination of X-ray, endoscopic
research and targeted biopsy
the final specification of the diagnosis is achieved.
X-ray research methods can be grouped into two diagnostic complexes
The main set of methods with which you canget the optimal amount of information about
X-ray morphological features
pathological focus in the lung and on the condition
bronchial tree. This includes the combined
the use of fluoroscopy, radiography and
tomography.
A complex of additional methods that do not play
essential role in the initial diagnosis of cancer
easy, but very helpful in clarifying
localization, prevalence of the process and
differential diagnosis.
Central lung cancer
X-ray negative phaseRecurrent pneumonitis
Hypoventilation stage
Valvular emphysema
Stage of atelectasis
Early signs of central lung cancer
Ball node at the root of the lungDilation of the root of the lung
Violation of the bronchial
cross-country ability:
a) strengthening of the pulmonary pattern at the root
lung
b) severity
c) obstructive emphysema
d) segmental atelectasis
e) paramediastinal darkening
Lung root enlargement
Central lung cancer
Central lung cancer
Central cancer
Decrease in the volume of a share (segment)Dilation of the root of the lung
Prolonged course of pneumonia
Recurrent pneumonia
Bronchological examination / CT
Peripheral cancer
Small peripheral cancer- Tumor shadow shape
- Shadow structure
- The nature of the contours
- Discharge path
- Pleural changes
"Giant" peripheral cancer
Varieties of tumor nodes in peripheral lung cancer
Retngen-picture of peripheral cancer
CT picture of peripheral cancer
Peripheral cancer with centralization.
Peripheral tumor growth rate
where d0 and d1 are the average values of the tumor diameterat the first and last research; t -
interval between studies. Hearth type GGO (ground glass opacity)
(like frosted glass)
Bronchioloalveolar cancer T1N0M0
Bronchioloalveolar cancer
peripheral globular tumorpseudopneumonic form
multiple nodular and nodular
education
mixed form
Characteristics
variety of clinical and radiological symptoms,determining the allocation of four forms of the disease, peripheral, pseudopneumonic, nodular,
mixed
absence of changes on tomograms and bronchograms
bronchial tree
the presence of enlightenment with clear contours and
"Lattice" structure against the background of darkening
with peripheral bronchioloalveolar cancer
slow growth rates, subpleural localization,
heterogeneous "spongy" structure, uneven
contours, characteristic pleural reaction
with the most advanced mixed form of the disease
simultaneous manifestation of spherical,
pneumonia-like and nodular changes
with early recognition of limited forms, you can
prevent the process from becoming widespread
defeat and timely start treatment
Atypical forms
Peripheral cancer withPancost's syndrome
Mediastinal cancer
lung
Primary carcinomatosis
Peripheral cancer with Pancost's syndrome
1) radiographically defined shadow in the areaapex of the lung;
2) pain in the shoulder girdle;
3) violation of skin sensitivity;
4) muscle atrophy of the upper limb;
5) Horner's syndrome;
6) seal in the supraclavicular zone;
7) radiographically
determined
destruction
upper ribs;
8) destruction of the transverse processes and vertebral bodies.
Primary carcinomatosis
Primary carcinomatosis
Differentialdiagnostics
lung cancer
Indications for CT of the chest
questionable data of the usualX-ray examination,
the need to increase sensitivity
method
identification of hidden metastases in their
high probability if it changes
treatment tactics
assessment of prognostic factors
the need for transthoracic puncture
under CT control
radiation therapy planning and marking
fields of irradiation, diagnostics of relapses
tumors
Indications for bronchoscopy
if a tumor is suspectedall lung cancer patients, including
peripheral
after radical treatment of oncological
lung lesions (endoscopic
monitoring for early detection
relapses)
in assessing the effectiveness of radiation and
drug treatment (confirmation of complete
remission)
when identifying synchronous and metachronous
foci of primary tumor multiplicity
research methods
Cytological methodsFibrobronchoscopy
CT scan
Echography
Surgical methods
Surgical diagnosis of lung cancer
Prescaled biopsyMediastinoscopy
Anterior parasternal
mediatinotomy
Videothoracoscopy
Diagnostic thoracotomy
Additional research methods
AngiographyRadionucleide diagnostics:
Perfusion pulmonary scintigraphy,
ventilation pulmonary scintigraphy,
positive pulmonary scintigraphy,
Complex pulmonary scintigraphy,
Radioimmunoscintigraphy, Indirect
radionucleide lymphography.
Determination of humoral tumor markers PET in differential diagnosis
solitary lung formation
PET - assessment of lymph nodes
CT scanPAT
Statistics
Stage5 year old
survival rate (%)
Ia
70-80
Ib
60-70
II a
35
II b
25
III a
10
III b
5
IV
1
13% 5 year old
survival
13% detection
Stage I
Mountein, Chest (1997) 111; 1701-17 Central cancer (polypoid,
endobronchial, peribronchial,
ramified).
Peripheral cancer: nodular, cavity
(cavernous), pneumonia-like.
Atypical forms: peripheral cancer with
Pancoast syndrome (Pancoast cancer),
mediastinal lung cancer,
primary lung cancer.
Epithelial tumors
1. BenignPapilloma
- squamous
Adenoma
- polymorphic (mixed tumor)
- monomorphic
- other types
Dysplasia
- Preinvasive carcinoma (carcinoma in situ) 2. Malignant
Squamous cell carcinoma (epidermoid)
- Highly differentiated
- Moderately differentiated
- low differentiated
Small cell carcinoma
- oatmeal
- from cells of the intermediate type
- combined 3. Adenocarcinoma
acinar
papillary
bronchioloalveolar cancer
solid crayfish mucus production
- highly differentiated
- moderately differentiated
- poorly differentiated
- bronchioloalveolar 4. Large cell carcinoma
giant cell variant
clear cell variant
5. Glandular squamous cell carcinoma
6. Carcinoid tumor
7. Cancer of the bronchial glands
a) adenocystic
b) mucoepidermoid
c) other types
8. Others
Frequency of different types of lung cancer
SquamousSmall cell
Adenocarcinoma
Crocapocellular
others
50%
20%
21%
7%
2%
New TNM classification
T - primary tumor.TiS - pre-invasive cancer (carcinoma in situ).
THAT - the primary tumor is not detected.
T1 - tumor no more than 3 cm in greatest dimension,
surrounded by lung tissue or visceral pleura,
without signs of invasion proximal to the lobar bronchus with
bronchoscopy or unusual invasive tumor of any
sizes with surface spread within
the walls of the bronchus, including the main one.
T2 - tumor more than 3 cm in greatest dimension or
a tumor of any size causing atelectasis or
obstructive pneumonitis extending to
root area. According to bronchoscopy, proximal
the edge of the tumor is located 2 cm distal to the carina.
Any concomitant atelectasis or obstructive
pneumonitis does not spread to the entire lung. TK - a tumor of any size, invading the breast
wall (including cancer with Pancost's syndrome), diaphragm,
mediastinal pleura or pericardium without lesion
heart, large vessels, trachea, esophagus or bodies
vertebrae, or a tumor that spreads to
the main bronchus is 2 cm proximal to the carina without it
infiltration.
T4 - a tumor of any size with damage to the mediastinum,
heart, large vessels, trachea, esophagus, bodies
vertebrae or carina bifurcation or presence
malignant pleural effusion (in the absence
tumor elements in punctate, hemorrhagic coloration
him or signs indicating exudate, swelling
referred to category T1-3). 1.Top
mediastinal
2.Paratracheal
3.Pretracheal
4.Tracheobronchial
5.Subaortic
6 para-aortic
7 bifurcation
8.Paraesophageal
9.Pulmonary ligament
10 the root of the lung
11.Interlobar
12.Equity
13. Segmental
14.Subsegmental N - regional lymph nodes
NO - there are no signs of damage to regional
lymph nodes.
N1 - metastases in the peribronchial and (or)
lymph nodes of the root of the lung on the side
lesions including direct germination
primary tumor.
N2 - metastases in bifurcation and
mediastinal lymph nodes on
side of defeat.
N3 - lymph node metastases
mediastinum or root on the opposite
side, in the pre-scalded or supraclavicular
zones
Grouping by stage
Hidden cancer - TхNOMOStage - TiS, carcinoma in situ
Stage I - T1NOMO
Stage Ib - T2NOMO
Stage IIa - T1N1MO
Stage IIb - T2N1MO
IIIА stage - T3NOMO, T3N1MO, T1-3N2MO
Stage IIIВ - T1-4N3MO, T4NO-3MO
Stage IV - T1-4NO-3M1
Dembo classification of respiratory failure
latent (no violations of gascomposition of blood at rest)
partial (hypoxemia without
hypercapnia) and global (hypoxemia, with
hypercapnia)
The degree of respiratory distress
I degree of respiratory failure(shortness of breath with significant physical
loads)
II degree (shortness of breath during normal exercise walking)
III degree (shortness of breath when dressing and
washing) and IV degree (dyspnea at rest).
A simplified method for preliminary assessment of operational risk by identifying three groups of patients
First group (low risk): normal size andheart function, normal blood pressure and
ECG, normal blood gas,
satisfactory indicators of lung function.
The second group (very high risk, inoperability):
congestive heart failure, refractory
arrhythmia, severe hypertension, fresh myocardial infarction,
low spirometric parameters (FEV1 less
35%), РСО2 more than 45 mm Hg. Art., pulmonary hypertension.
The third group (moderate risk): angina pectoris, heart attack
history of myocardium, arrhythmias, systemic hypertension,
heart defects, low cardiac output, hypoxia with
normal indicators РСО2, moderate decrease
lung function (FEV1 35-70%).
Hematogenous metastasis
Into the brain - in 40% of patients, in 30%solitary cases, more often in the frontal and
occipital areas.
In the liver - in 40% of patients, more often
multiple.
In the skeleton - in 30%, thoracic and lumbar
spine, pelvic bones, ribs,
tubular bones.
In the adrenal glands - in 30%.
In the kidneys - in 20%.
Lung Cancer Treatment Standards
StageConventional treatment
I
Surgical
II
Surgical
IIIa
Radiation and / or chemotherapy with
subsequent resection
IIIb
Radiation and chemotherapy
IV
Chemotherapy
Statistics
Stage5 year old
survival rate (%)
Ia
70-80
Ib
60-70
II a
35
II b
25
III a
10
III b
5
IV
1
13% 5 year old
survival
13% detection
Stage I
Mountein, Chest (1997) 111; 1701-17
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Presentation on the topic:
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How common is lung cancer? Lung cancer is one of the leading causes of death on earth. According to statistics, every 14th person has encountered or will face this disease in his life. Lung cancer most often affects the elderly. Approximately 70% of all cancer cases are found in people over 65. People under 45 years old rarely suffer from this disease, their share in the total mass of cancer patients is only 3%.
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Adenocarcinoma is the most common type of cancer, accounting for about 50% of cases. This type is most common in non-smokers. Most adenocarcinomas occur in the outer or peripheral region of the lungs. - Squamous cell carcinoma. This cancer accounts for about 20% of all lung cancers. This type of cancer most often develops in the central part of the chest or bronchi. -Undifferentiated cancer, the most rare type of cancer.
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What are the signs and symptoms of lung cancer? The symptoms of lung cancer depend on the location of the cancer and the size of the lung lesion. In addition, sometimes lung cancer develops asymptomatically. In the picture, lung cancer looks like a coin stuck in the lungs. As the cancerous tissue grows, patients develop breathing problems, chest pain, and a bloody cough. If cancer cells have invaded the nerves, it can cause shoulder pain radiating to the arm. Hoarseness occurs when the vocal cords are affected. Injury to the esophagus can lead to difficulty swallowing. The spread of bone metastases causes excruciating pain in them. Getting metastases in the brain usually causes a decrease in vision, headaches, loss of sensitivity in certain parts of the body. Another sign of cancer is the production of hormone-like substances by tumor cells that increase the level of calcium in the body. In addition to the symptoms listed above, with lung cancer, as well as with other types of cancer, the patient loses weight, feels weak and constantly tired. Depression and mood swings are also quite common.
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How is lung cancer diagnosed? Chest X-ray. This is the first thing to do when lung cancer is suspected. In this case, they take a picture not only from the front, but also from the side. X-rays can help pinpoint problem areas in the lungs, but they cannot accurately show cancer or anything else. A chest X-ray is a fairly safe procedure, as the patient is exposed to a small fraction of the radiation.
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Computed tomography With the help of a computed tomography, images are taken not only of the chest, but also of the abdomen and brain. All this is done in order to determine if there are metastases in other organs. A CT scanner is more sensitive to nodules in the lungs. Sometimes, for a more accurate detection of problem areas, contrast agents are injected into the patient's blood. The computer scan itself usually goes without any side effects, but the injection of contrast media sometimes causes itching, rashes, and hives. Just like a chest x-ray, computed tomography only finds problems in the site, but does not accurately tell whether it is cancer or something else. Additional tests are required to confirm a cancer diagnosis.
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Magnetic resonance imaging. This type of study is used when more accurate data on the location of the cancer is needed. Using this method, it is possible to obtain images of very high quality, which allows you to determine the slightest changes in the tissues. Magnetic resonance imaging uses magnetism and radio waves, so it has no side effects. Magnetic resonance imaging is not used if a person has a pacemaker, metal implants, artificial heart valves and other implanted structures, as there is a risk of displacement under the influence of magnetism.
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Cytological examination of sputum The diagnosis of lung cancer should always be confirmed by cytological examination. The sputum is examined under a microscope. This method is the safest, simplest and most inexpensive, but the accuracy of this method is limited, since cancer cells are not always present in sputum. In addition, some cells can sometimes undergo changes in response to inflammation or injury, making them look like cancer cells. Sputum preparation
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Bronchoscopy The essence of the method is water in the airways of a thin fiber-optic probe. The probe is inserted through the nose or mouth. The method allows you to take tissue for examination for the presence of cancer cells. Bronchoscopy gives good results when a tumor is found in the central regions of the lungs. The procedure is very painful and is performed under anesthesia. Bronchoscopy is considered a relatively safe research method. After bronchoscopy, coughing up blood is usually observed for 1-2 days. More serious complications such as heavy bleeding, cardiac arrhythmias, and low oxygen levels are rare. After the procedure, there are also possible side effects caused by the use of anesthesia.
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Biopsy This method is used when it is impossible to get to the affected area of the lungs using bronchoscopy. The procedure is performed under the control of a CT scanner or ultrasound. The procedure gives good results when the affected area is on the upper layers of the lungs. The essence of the method is to water the needle through the chest and suction of liver tissue, which are further examined under a microscope. The biopsy is done under local anesthesia. A biopsy allows you to fairly accurately determine lung cancer, but only if it was possible to accurately take cells from the affected area.
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Pleurocentosis (puncture biopsy) The essence of the method consists in taking fluid from the pleural cavity for analysis. Sometimes cancer cells accumulate there. This method is also performed with a needle and under local anesthesia. Surgical removal of tissue If none of the above methods can be applied, then in this case they resort to surgical operation. There are two types of surgery: mediastinoscopy and thoracoscopy. For mediastinoscopy, a mirror with a built-in LED is used. With this method, a biopsy of the lymph nodes is taken and the organs and tissues are examined. With thoracoscopy, the chest is opened and tissues are taken for examination.
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Blood tests. Routine blood tests alone cannot diagnose cancer, but they can detect biochemical or metabolic abnormalities in the body that accompany cancer. For example, increased levels of calcium, alkaline phosphatase enzymes.
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What are the stages of lung cancer? Cancer stages: stage 1. Cancer affects one segment of the lung. The size of the affected area is not more than 3 cm. Stage 2. Cancer spread is limited to the chest wall. The size of the affected area is not more than 6 cm. Stage 3. The size of the affected area is more than 6 cm. The spread of cancer is limited to the chest. There is extensive involvement of the lymph nodes. Stage 4. Metastases have spread to other organs. Small cell carcinoma also sometimes divides into only two stages. Localized tumor process. Cancer spread is limited to the chest wall. A common form of the tumor process. Metastases have spread to other organs.
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How is lung cancer treated? Lung cancer treatments may include surgical removal of the cancer, chemotherapy, and radiation. Typically, all three of these treatments are combined. The decision about which treatment to use depends on the location and size of the cancer, as well as on the general condition of the patient. As in the treatment of other types of cancer, treatment is directed either at the complete removal of cancerous areas or, in cases where this is not possible, at relieving pain and suffering.
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Surgery. Surgery is mainly used only during the first or second stage of cancer. Surgical intervention is acceptable in about 10-35% of cases. Unfortunately, surgical intervention does not always give a positive result, very often cancer cells have already entered other organs. After surgery, approximately 25-45% of people live for more than 5 years. Surgery is not possible if the affected tissue is near the trachea or if the patient has serious heart disease. Surgery is very rarely prescribed for small cell cancer, because in extremely rare cases, such cancer is localized only in the lungs. The type of surgery depends on the size and location of the tumor. This can remove part of a lung lobe, one lung lobe, or a whole lung. Together with the removal of lung tissue, the affected lymph nodes are removed. After lung surgery, patients need care for several weeks or months. People who have had surgery usually experience breathing difficulties, shortness of breath, pain, and weakness. In addition, complications due to bleeding are possible after the operation.
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Radiation therapy The essence of this method is to use radiation to destroy cancer cells. Radiation therapy is used when a person refuses to have surgery, if the tumor has spread to the lymph nodes or if surgery is not possible. Radiation therapy usually only shrinks the tumor or limits its growth, but in 10-15% of cases it leads to long-term remission. People who have lung conditions other than cancer are usually not given radiation therapy because radiation can reduce lung function. Radiation therapy does not have the risks of major surgery, but it can have unpleasant side effects, including fatigue, lack of energy, decreased white blood cells (a person is more susceptible to infection), and low platelets in the blood (blood clotting is impaired). In addition, there may be problems from the digestive organs that have been exposed to radiation.
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Chemotherapy This method, as well as radiation therapy, is applicable for any type of cancer. Chemotherapy refers to treatment that stops the growth of cancer cells, kills them, and prevents them from dividing. Chemotherapy is the main treatment for small cell lung cancer, as it covers all organs. Without chemotherapy, only half of people with small cell cancer live for more than 4 months. Chemotherapy is usually given on an outpatient basis. Chemotherapy is given in cycles of several weeks or months, with breaks between cycles. Unfortunately, the drugs used in chemotherapy tend to disrupt the process of cell division in the body, which leads to unpleasant side effects (increased susceptibility to infections, bleeding, etc.). Other side effects include fatigue, weight loss, hair loss, nausea, vomiting, diarrhea, and mouth ulcers. Side effects usually disappear after treatment ends.
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What are the causes of lung cancer? Cigarettes. Smoking is the leading cause of lung cancer. People who smoke are 25 times more likely to develop lung cancer than non-smokers. People who smoke 1 or more packs of cigarettes a day for more than 30 years are especially likely to develop lung cancer. Tobacco smoke contains over 4 thousand chemical components, many of which are carcinogenic. Cigar smoking is also a cause of lung cancer. In people who quit smoking, the risk of cancer is reduced as cells damaged by smoking are replaced with healthy cells over time. However, the restoration of lung cells is a rather long process. Usually, their complete recovery in former smokers occurs within 15 years.
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Also the reasons include: Asbestos fibers. Asbestos fibers are not cleared from the lung tissue throughout life. In the past, asbestos was widely used as an insulating material. Today its use is restricted and prohibited in many countries. The risk of developing lung cancer due to asbestos fibers is especially high in people who smoke; more than half of these people develop lung cancer. Radon gas. Radon is a chemically inert gas that is a natural decay product of uranium. Approximately 12% of all lung cancer deaths are associated with this gas. Radon gas easily passes through the soil and enters residential buildings through cracks in the foundation, pipes, drains and other openings. According to some experts, in about every 15 residential buildings, the level of radon exceeds the maximum permissible standards. Radon is an invisible gas, but can be detected with simple instruments. Hereditary predisposition. Hereditary predisposition is also one of the causes of lung cancer. People whose parents or parental relatives have died of lung cancer have a high chance of getting the disease. Diseases of the lungs. Any lung disease (pneumonia, pulmonary tuberculosis, etc.) increases the likelihood of lung cancer. The more severe the illness, the higher the risk of developing lung cancer.
Slide No. 23
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ABOUT ONCOLOGICAL DISEASES Among oncological diseases are distinguished: sarcoma cancer - a malignant tumor, most often formed in bone, muscle or brain tissues. malignant diseases of the blood system - lymphomas and leukemias. With these diseases, leukocytes or, much less often, platelets and erythrocytes are reborn.
N CAUSES OF ONCOLOGICAL DISEASES Smoking, active or passive. excessive alcohol consumption. polluted habitat. exposure to the body of toxic substances. hormonal disorders. prolonged exposure to ultraviolet radiation (sunlight). trauma to skin formations.
A CUTTING SMOKING Tobacco smoking is one of the most widespread types of drug addiction, affecting a large number of people and therefore is a household drug addiction. In terms of toxicity, nicotine can be compared with hydrocyanic acid: their lethal doses for humans are the same - 0.08 mg. In the United States, smoking is responsible for one in six deaths, with more than half of these deaths from cancer.
P ASSIVE SMOKING As a result of secondhand smoke, 3,000 people die annually from lung cancer, and up to 62,000 2,700 children die of heart disease for the same reason, as a result of the so-called sudden infant death syndrome. It has been established that more than 50 components of tobacco smoke are carcinogenic, 6 have a detrimental effect on fertility and the general development of a child. In general, inhalation of tobacco smoke is much more dangerous for children. So, passive smoking annually causes asthma in 826 thousand children, bronchitis - in thousand, and from 7.5 to 15.6 thousand children are hospitalized, and from 136 to 212 of them die.
CONTAMINATED ENVIRONMENT The human habitat is a set of objects, phenomena and environmental factors that determine the conditions for human life and is capable of influencing him. Industrial enterprises, vehicles, testing of nuclear weapons, excessive use of mineral fertilizers, pesticides, etc. have a negative impact on the environment. Intensive rates of environmental degradation pose a real threat to the existence of man himself. Environmental poisoning has led to a massive degradation of public health. With a systematic or periodic intake of relatively small amounts of toxic substances in the body, chronic poisoning occurs.
POLLUTED ENVIRONMENT Doctors have established a direct link between the increase in the number of people suffering from allergies, bronchial asthma, cancer, and the deterioration of the environmental situation in the region. Over the past 4 years, the birth rate in Russia has fallen by 30%, and the death rate has increased by 15%. 23% of children remain healthy by the age of 7, and only 14% by the age of 17. Since the 70s, the incidence of cardiovascular and oncological diseases has increased by 50%.
WITH DISEASE DISEASES constant nervousness; weakness, fatigue; insomnia, sleep disturbances; lack of appetite; various pain sensations, the reasons for which are not clear to you; blood in the body's natural secretions; discomfort in the stomach after eating; lumps under the skin or on the skin.
C PREVENTION OF CANCER Quit smoking If you quit smoking, your chances of getting cancer in your lungs will be 90 percent lower. In addition, the chances of life without cancer of the lip, tongue, liver and a dozen other organs are significantly increased. Give up alcohol Even lowering the strength of alcohol consumed will reduce the risk of cancer of the liver, esophagus, mouth, throat and other parts of the digestive tract by at least half. Maintain a normal weight Being overweight leads to the development of cancerous tumors in 15–20 percent of cases. Eat vegetables and fruits These contain natural cancer-fighting bioflavonoids. Visit your doctor regularly Experts say that it is impossible to completely prevent the risk of cancer, but you can reduce it as much as possible.
"Origin of Species" - Two forms - methodical and unconscious. The laws of unity of type and conditions of existence are covered by the theory of natural selection. Mutual relationship of organisms; morphology; embryology; vestigial organs. The origin of species ... On the incompleteness of the geological record. Instinct. About denudation of granite areas.
"Trees Shrubs Grasses" - Trees Shrubs Grasses. How are trees different from other plants? How do plants affect human health? Trees are: deciduous and coniferous. How are shrubs different from trees and grasses? Plants live everywhere: in meadows, forests, steppes, mountains, seas and oceans. Research plan: Plant diversity.
"Forms of asexual reproduction" - Conjugation Parthenogenesis Heterogamy Oogamy Isogamy. The sexual process occurs according to the type of isogamy. 1. Division. Reproduction by cell division is characteristic of unicellular organisms. When gametes merge, a four-flagellate zygote is formed. Class Ciliated ciliates. Conjugation and sexual reproduction of slipper ciliates occurs under unfavorable conditions.
"Population dynamics" - Population dynamics. Methods for regulating the number of populations. Examples of populations. Fluctuations in the number of individuals. Population growth. Let's repeat the previously studied material. Population dynamics as a biological phenomenon. Biology and Informatics. The amount of the annual catch. Knowledge about population dynamics. Information models of population development.
"Bird Lesson" - Female birds, like reptiles, have one ovary. Leading bustard. Ritual behavior. Magpie Bullfinch Swallow Crow Jackdaw Nightingale Sparrow Grouse. Laying eggs. Find a match. Cranes - mating dances. Outside, the bird's egg is protected by a leathery shell. Bird mating. Mark signs of high organization and similarities with reptiles.
"Plant growing" - There are also grain growers, vegetable growers, cotton growers. The world. What is agriculture. Plant growing. Take any cultivated plant and describe it. For example, so that there is always bread on our table, plant breeders grow grain crops, wheat, rye and others.
