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Lung cancer: symptoms, signs, treatment

Content:

Despite the crazy growth rates of lung cancer worldwide, many people have a very vague idea of ​​this disease. In this article we will try to answer the most frequently encountered questions concerning such a serious pathology as lung cancer.

And first of all, let's talk about the statistics and epidemiology of this disease.



How often does lung cancer occur and who does it affect?

Malignant tumors of this localization are found everywhere, but the truly massive nature of the lesion of people is observed in industrialized countries. Here about one and a half million such cases are registered annually!

And what's really scary - these numbers continue to grow ... And the mortality rate is also increasing. And it grows mainly due to people of middle and young age. The most common cause is alcohol abuse and, of course, smoking.

Thus, in the USA, cancer is the leader among all oncopathologies not only in terms of frequency of occurrence, but also in mortality - about 27% of cases end in the death of a patient.

By the most conservative estimates, there are 53 patients with lung cancer per 100,000 of the population in Russia today. Moreover, men are faced with this disease more often. Approximately 28.3% of the overall morbidity structure of the male population of the country falls on lung cancer. By the way, stomach cancer is found in men more rarely - about 14.8%.

In the world, more than 1 million cases of newly diagnosed lung cancer are reported annually, and of these, 60% are fatal. Have you imagined the scale of the problem? Now you can move on to the next equally important issue.

Why does lung cancer develop? Causes and risk factors

The main and reliably proven factor in the development of lung cancer is smoking. In recent years, a huge amount of research has been conducted in this direction. Now there is no reason to doubt - about 88% of cases are somehow related to smoking.

What is the secret? In the carcinogenic effect of smoking, which is caused by the presence in the smoke of polycyclic aromatic bicarbonates (tobacco combustion products). In addition, tobacco smoke contains additional carcinogens, which include nicotine derivatives - for example, nitrosamines.

According to data recently published by WHO, smoking increases the risk of lung cancer in women by 12 times, and in men by 22 times.

Not to mention about passive smoking. American scientists have found that people who are often in contact with a smoker, the development of cancer is observed 32% more often. A direct relationship was also found between the occurrence of lung cancer and the increase in the number of cigarettes smoked per day (2 packs = an increase in risk of 25 times) and the duration of smoking. An inverse relationship is observed with the quality of tobacco.

However, not only tobacco smoke has a carcinogenic effect. Today it is proven that substances such as arsenic, beryllium, asbestos, hydrocarbons, chromium and nickel are also capable of provoking the growth of tumor cells. Do not forget about exposure. These are the most common carcinogens, in fact, they are much more ... And many of them are not yet fully understood.

Thus, 4 most important factors can be identified:

  • Tobacco smoking;
  • Genetic predisposition;
  • Environmental factors and working conditions;
  • Chronic lung disease.



What are the types of lung cancer?

The main and recognized worldwide classification of lung tumors is histological. It was developed back in 1968 by WHO experts. Since then, it has been revised several times - however, significant amendments were made only in 1988.

All descriptions for various types of carcinomas are done using light microscopy. Immunohistochemistry and electron microscopy are not used for this.

According to modern classification, 4 main types of lung carcinomas are distinguished:

  • Squamous cell carcinoma;
  • Small cell cancer;
  • Adenocarcinoma;
  • Large cell carcinoma.

These types of tumors account for about 92-95% of all malignant neoplasms of the lung. And only 5% are in combinations of the above forms (often adenocarcinoma and squamous cell carcinoma).

There is a unified classification of lung cancer worldwide, which is based on the TNM system:

The classification is fully adapted for lung cancer, including non-small cell and small cell cancer, as well as bronchopulmonary carcinoid neoplasms. It is not suitable for sarcomas and other rare tumors.

Depending on the affected anatomical parts:

  • Lower proportion - (C34.3);
  • The average proportion is (C34.2);
  • Upper lobe - (C34.1);
  • The main bronchus - (C34.0).

In order to understand this classification, it is necessary to understand what are regional lymph nodes.

Regional lymph nodes are peripheral organs of the lymphatic system, which perform the function of filtering lymph from various organs and parts of the body. And they are called “regional” because they are located in close proximity to the primary tumor site.

Regional lymph nodes with this localization of the tumor are intrasternal nodes (mediastinal, root, lobar, interlobar, segmental and subsegmental), ladder and supraclavicular lymph nodes.

Lung cancer symptoms

Unfortunately, lung cancer has no specific symptoms. Quite often, despite its prevalence, the disease is asymptomatic. That is why it is quite difficult to suspect such a tumor in the early stages.

Today it is customary to single out four groups of clinical manifestations of lung cancer:

  • Symptoms observed with local spread of the tumor;
  • Symptoms that appear in the presence of distant metastases;
  • Nonspecific systemic symptoms;
  • Paraneoplastic syndromes.  

Symptoms with local spread of carcinoma

They are directly dependent on the location of the tumor and its size.

  • So, with the defeat of the large bronchi (the so-called "central cancer") is observed:
    • Cough;
    • Dyspnea;
    • Hemoptysis;
    • Obstruction (obstruction) of the bronchi (fever, cough with purulent and mucous sputum).
  • Peripheral tumors are clinically manifested only during germination in the visceral pleura or chest wall:
    • Dry cough;
    • Pain in the chest (affected side);
  • When spreading to the mediastinum, the presence of certain symptoms depends on the affected organ. For example:
    • Compression / germination of the superior vena cava - varicose veins of the upper chest, jugular vein, swelling of the neck and face, sometimes cyanosis;
    • Germination in the esophagus - dysphagia.
  • Pericardial disease:
    • Heart rhythm disorder;
    • Pericarditis;
    • Heart failure: leg swelling, shortness of breath, etc.
  • If the tumor is localized in the apical segment and affects the branches of the brachial plexus - Penkost syndrome.

Symptoms of distant metastasis

About 60% of primary (first-time medical) patients with small cell and 30% with non-small cell lung cancer already have symptoms suggesting the presence of distant metastases.

As a rule, they are localized in the central neurotic system, adrenal glands and liver. If we talk about the clinical picture, it is completely different in each case. This is due to the size of distant metastases, their location and number.

Nonspecific systemic symptoms

Such symptoms are observed in almost half of the primary patients with lung cancer. They include:

  • Lack of appetite;
  • Sharp weight loss (over 10 kg);
  • Radiographic unexplained fever;
  • Fast fatiguability;
  • Fatigue;
  • Anemia.

The presence of the above symptoms most often indicates the generalization of the tumor process. In this regard, the doctor prescribed additional examinations and appropriate treatment prescribed.

Paraneoplastic syndromes

All paraneoplastic syndromes are divided into:

  • Hormonal (hepatrenocorticism, humoral hypercalcemia, etc);
  • Neurological (Eaton-Lambert syndrome, cortical encephalopathy, etc.);
  • Musculoskeletal (symptom of drumsticks, osteoarthropathy);
  • Others (for example, cardiovascular).

Diagnostics

How is lung cancer diagnosed? Which surveys are the most informative? What can not do without? Such questions always interest people who are faced with a problem like lung cancer. Let's try to answer them.

As mentioned earlier, the disease has no specific symptoms. Therefore, for accurate diagnosis, a comprehensive examination of the patient is necessary. By the way, more than 50% of patients go to the doctor in the later stages of the development of the tumor process.

So what does a comprehensive examination include?

The main point in the diagnosis of lung cancer is morphological verification of the tumor.

And a lot depends on its localization:

  • In peripheral cancer, a microscopic examination of smears taken from the affected areas of the bronchus and / or lung is performed. As a rule, the fence is made with fibrobronchoscopy. Intraoperatively (during the operation) for morphological confirmation by morphological research, puncture biopsy is performed, and if it is ineffective, resection (removal) of the lung with a tumor is performed (only for small and / or superficial tumors). In non-operated patients with poor results obtained with bronchoscopy and microscopic examination of sputum - transthoracic fine-needle puncture biopsy under x-ray control;
  • In case of central cancer, a biopsy of the tumor is performed during fibrobronchoscopy with subsequent cytological and histological examination of the material obtained;
  • With distant metastases - recommended puncture fine-needle biopsy (TIAB) under the control of ultrasound / CT, especially with lesions of the adrenal glands, liver or kidneys. An excisional or puncture biopsy of metastases - localization: peripheral lymph nodes and soft tissues.

According to international protocols, in cases of suspected malignant neoplasm of the lung, a comprehensive examination is always performed, which, of course, includes laboratory tests.

They include:

  • seroreaction for syphilis ;
  • urinalysis (OAM);
  • blood type and Rh factor;
  • complete blood count (KLA);
  • glucose, bilirubin, AcAT / AlAT, Ca, alkaline phosphatase); biochemical blood tests (urea, total protein, creatinine and coagulogram (PT, APTT, fibrinogen, TB) - as an additional diagnosis.

Lungs' cancer In order to determine the prevalence of the tumor and assess the functional status of the patient by the doctor, the following examinations are appointed:

  • X-ray (fluorography);
  • Determination of respiratory function;
  • Tracheobronchoscopy;
  • Ultrasound of the abdominal organs;
  • Electrocardiography;
  • A standard study in assessing the operability of patients is a computed tomography of the chest and upper abdominal cavity (liver, adrenal glands). With central lung cancer, CT scan with contrast is shown.
  • Video thoracoscopy - in the presence of CT signs of the spread of the tumor on the structures and organs of the mediastinum (pulmonary trunk, aorta, spine, myocardium, ERW) or dissemination through the pleura. And also to confirm the unresectability of the tumor;
  • Mediastinoscopy - with CT signs of lesion of the mediastinum of the LU from 2 sides. In difficult cases, it is possible to perform a comprehensive examination - video-assisted thorakomediastinoscopy;
  • Diagnostic thoracotomy;
  • Bone scintigraphy - in case of suspected presence of metastases (increased levels of Ca, alkaline phosphatase in the blood serum, pain). Positive scintigraphy data in operable patients should be confirmed by X-ray or biopsy;
  • For neurological symptoms, computed tomography / MRI;
  • Metastases in the liver or adrenal gland - CT and / or ultrasound, as well as puncture biopsy;
  • Transthoracic puncture biopsy and / or videothoracoscopy (atypical resection of the lung, biopsy).  

Lung cancer treatment

The first thing I want to say is that treatment is carried out only by a doctor! No self treatment! This is a very important point. After all, the sooner you seek help from a specialist, the greater the chance of a favorable outcome of the disease.

The choice of a specific treatment strategy depends on many factors:

  • Stage of the disease;
  • Histological structure of carcinoma;
  • The presence of concomitant pathologies;
  • The combination of all the above fatkorov.

There are several complementary treatments for lung cancer:

  • Surgical intervention;
  • Radiation therapy;
  • Chemotherapy.

However, individually, they are practically not used. Most often, an effective fight against a disease involves the use of several methods at once.

Surgery

Today, treatment with surgery is the main method of dealing with lung cancer. Especially if one of its non-small cell forms is diagnosed.

Most oncology surgeons are inclined to believe that surgical treatment is the only correct method for treating this disease in stages I (A, B) and I (A, B). If the tumor process has a significant spread, then a radiation or chemotherapeutic method joins the surgery.

In order to treat lung cancer, the following operations are performed today:

  • Pulmonectomy - complete removal of the lung;
  • Lobectomy - removal of one lobe of the lung;
  • Bilobectomy - removal of two lobes of the lung;
  • Combined operations;
  • Atypical operations (for example, segmentectomy, marginal or wedge resection - performed with small peripheral tumors).

The volume of the upcoming surgery always depends on the degree of spread of the tumor. Thus, lobectomy is indicated for lesions of the parenchyma of only one lobe of the lung or for localization of carcinoma at the level of the bronchi (segmental).

The indications for performing pulmonectomy are: the defeat of the disease of the main bronchus, lung vessels, or the spread of a tumor to a nearby lobe. Sometimes a similar operation is performed in case of massive lesion of the LN with metastatic cells.

The great advantage of the surgical method of treatment is the possibility of performing an urgent or planned histological examination of resected tissue sections.

  • In addition, in the most severe and neglected cases, palliative operations can be performed to alleviate the condition of the patient. The main indications for such an intervention are the presence of decay in a tumor or atelectasis, as well as the risk of developing pulmonary hemorrhage.

Radiation therapy

This method of treatment of lung cancer is used quite often, but only as part of complex therapy. As an independent method, radiation therapy is not recognized by doctors.

LT is shown at:

  • The impossibility of carrying out radical surgical treatment (as a rule, due to the severe general condition of the patient);
  • Refusal of the patient from an operative measure;
  • Non-radically performed operation;
  • The spread of the tumor process on those structures of the body, the removal or resection of which is not possible (spine, heart, etc).

We should not forget about the contraindications for radiotherapy:

  • The collapse of the central tumor of the bronchi more than 1 cm in diameter, which is accompanied by hemoptysis;
  • severe infectious complications (abscess formation in atelectasis, empyema, etc.) and acute infectious diseases;
  • germination of esophagus tumor;
  • active pulmonary tuberculosis;
  • anemia (Hb less than 80g / l), leukopenia (less than 2.0 × 10 9 / l), thrombocytopenia
    (less than 75 × 109 / l);
  • marked dysfunctions of vital organs and systems: cardiovascular system (insufficiency from stage IIB and more), liver (bilirubin more than 60 mmol / l), kidney (creatinine more than 165 mmol / l);
  • myocardial infarction or stroke;
  • mental disorders - aggravation;

If there are some contraindications, radiation therapy should be postponed until their elimination. Otherwise, the treatment tactics are determined by a consultation of doctors.

Typically, the dose of radiation is at least 60 Gy. However, the exact numbers are determined for each patient separately.

There are two types of RT:

  • Remote - is carried out on linear accelerators or gamma-therapeutic devices. At the same time, not only the tumor itself enters the irradiation zone, it also includes areas of regional metastasis;
  • Contact, or brachytherapy. It is a point effect on a malignant neoplasm of the bronchi, having any longitudinal dimensions, but not exceeding 2.0 cm in cross section. It is more often used after palliative surgery or when the patient refuses radical treatment.

Chemotherapy

The least effective treatment for lung cancer.

According to international protocols, chemotherapy is prescribed for:

  • small cell lung cancer I – IIIA stage;
  • паллиативном лечении пациентов с IIIB-IV стадией рака легкого;
  • единичных метастазах немелкоклеточной формы данного заболевания.

На сегодняшний день для проведения химиотерапии практически всегда используется сразу несколько противоопухолевых препаратов. Именно поэтому от врачей все чаще можно услышать такой термин, как «полихимиотерапия».

С целью ознакомления перечислим некоторые из наиболее популярных и эффективных препаратов, входящих в состав схем полихимиотерапии при раке легкого:

  • Винорельбин;
  • Цисплатин;
  • Паклитаксел;
  • Карбоплатин;
  • Этопозид;

Интервал между курсами варьируется от 3 до 4 недель. Дозы, метод и скорость введения химиопрепаратов определяется только врачом-онкологом.

Attention! Химиотерапия часто очень тяжело переносится пациентами, потому как воздействует не только на раковые клетки, но и на весь организм человека в целом. Иногда этот метод лечения наносит куда больший вред здоровью, чем сама опухоль.

General principles that guide the doctors of most countries are shown in the tables below:

In non-small cell carcinoma:

Stage I
  • Lobectomy;
  • Radiation (chemoradiation) therapy;
Stage II
  • Radical surgery;
  • Chemoradiation / radiation therapy;
IIIA-B Stage (operable patients)
  • Radical surgery;
  • Adjuvant chemotherapy;
  • Chemoradiation / radiation therapy;
Stage IIIA-IIIB (inoperable patients)
  • Chemoradiation therapy;
  • Chemotherapy;
  • Radiation therapy;
Stage IV
  • Chemoradiation / radiation therapy;
  • Chemotherapy;

For small cell carcinoma:

I – IIIA Stage
(initially operable patients)
  • Radical surgery (with adjuvant polychemotherapy) + prophylactic irradiation of the brain;
IIIA – B Stage
(initially inoperable patients)
  • Chemoradiation therapy;
  • Chemotherapy;
  • POGM (with complete regression of the tumor);
Stage IV
  • Chemoradiation therapy (palliative treatment);
  • Chemotherapy.

Forecast

To make accurate predictions for lung cancer, perhaps, will not undertake any experienced doctor. This disease can behave unpredictable, which is largely due to the diversity of histological variants of the structure of tumors.

However, the cure of the patient is still possible. As a rule, the use of a combination of surgery and radiation therapy leads to a successful outcome.

According to statistics, the 5-year survival of patients with lung cancer after adequate treatment is more than 40%. In many ways, the prognosis of the disease depends on the stage of tumor prevalence, its structure and degree of differentiation.

From the foregoing, it is clear that fighting lung cancer can and should be. And you need to start taking care of your health right now. Start small - undergo fluorography.

We wish you and your loved ones good health! Be happy!


| September 19, 2014 | | 229 | Oncology
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NYMArts: Odds of beating lung cancer...realistically....are near zero...... "Treatment" ? Don't Bother. Your kids need the money. Euthanasia at the correct time.

Youssef Ahmed: I know smoking the green tea would give lung cancer I am not lying it hurt my chest when I breath and I am tired all the time swimming is hard now I love swimming maybe it because I used a regular paper to much chemicals

quentin wagner: I'm glad I watched this cuz I had a lot of the situms so I when to the Doctor and for out that I have lung Cancer so thank you for save my life

TheRenard10: My oldest sister, Crystal, had lung cancer. Also, she had a short time to live. She was 55. N November 9, 2015, she would've bn 56. She was a mother of 7, 4 girls, 3 boys, and a host of grandchildren and 1 great-granddaughter. She is missed. Still very sad, but when I heard she had cancer, I was very overwhelmed.

Lance Morales: I'm having chronic cough now... more than 1 month. They say its PTB, but i have been taking medication for months and i still have this cough.

unknown user: My dad has been smoking sense he was 15 years old. And it's 2019 now so he's 39 years old, and he is still smoking and he won't stop. I'm afraid he's going to get lung cancer and die 😪😪😫😓

Raja Basumatary: Since 2 days i have been coughing and blood comes with saliva ... What shall i do 😓😓.. I m afraid now... Shall i tell it to may parents ?? .. Or it will get alright by itself..😞😞..

Schiller Memestar: My grandpa went to the hospital recently because of a heart attack, he lived and is fine, but the doctors found a spot on his lung that they believe could be a lung tumor. Him and I are really close, so I’m honestly really scared. I just found of from my uncle this morning.

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