The Lung cancer: symptoms, signs, treatment of lung cancer
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Lung cancer: symptoms, signs, treatment

Content:

Despite the crazy rates of increase in the incidence 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 asked 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 whom does it strike?

Malignant tumors of this localization are found everywhere, but indeed the mass character of human injury is observed in industrially developed countries. About 1.5 million such cases are recorded annually!

And what is really scary is that these figures continue to grow ... And the mortality rate also increases. And it grows mainly at the expense of middle and young people. The most common cause is alcohol abuse and, of course, smoking.

In the USA, for example, cancer is the leader among all oncopathologies, not only in terms of frequency of occurrence, but also in mortality - about 27% of cases result in death of the patient.

According to the most conservative estimates, there are 53 patients with lung cancer per 100,000 population in Russia today. And men face this disease much more often. Approximately 28.3% of the total structure of the incidence of the male population of the country falls precisely on lung cancer. By the way, stomach cancer occurs in representatives of the stronger sex much less - about 14.8%.

In the world, more than 1 million cases of newly diagnosed lung cancer are registered annually and 60% of them are fatal. Have you imagined the scale of the problem? Now you can move on to the next, no less 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 lot of research has been done in this direction. Now there is no reason to doubt - about 88% of cases are somehow connected with smoking.

What is the secret? In the carcinogenic effect of smoking, which is due to the presence in the smoke of polycyclic aromatic hydrocarbonates (combustion products of tobacco). 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 12 times, and in men - 22 times.

It is impossible not to mention passive smoking. American scientists have found that in people who often contact a smoker, the development of cancer is observed at 32% more often. There was also a direct relationship between the occurrence of lung cancer and the increase in the number of cigarettes smoked per day (2 packs = 25 times the risk increase) and the duration of smoking. Inverse dependence is observed with the quality of tobacco.

However, not only tobacco smoke has a carcinogenic effect. Today it is proved 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 irradiation. These are the most common carcinogens, in fact there are many more ... And many of them have not been fully studied yet.

Thus, we can identify the 4 most important factors:

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



What are the types of lung cancer?

The main and recognized classification of lung tumors worldwide is histological. It was developed back in 1968 by WHO experts. Since then, it has been repeatedly reviewed - but significant amendments were introduced only in 1988.

All descriptions for various types of carcinoma are made using light microscopy. Immunohistochemistry and electron microscopy do not apply for this.

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

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

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

There is a single classification of lung cancer throughout the world, 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:

  • The lower part is (C34.3);
  • The average share is (C34.2);
  • The upper lobe is (C34.1);
  • The main bronchus is (C34.0).

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

Regional lymph nodes are the periphyre organs of the lymphatic system, which perform the function of filtering lymph from different organs and parts of the body. And "regional" they are called because they are located in close proximity to the primary focus of the tumor.

The regional lymph nodes for this tumor localization are intra-chest nodes (mediastinal, root, lobar, interlobar, segmental and subsegmental), stair 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 rather difficult to suspect such a tumor in the early stages.

Today it is common to distinguish four groups of clinical manifestations of lung cancer:

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

Symptoms in the local spread of carcinoma

They directly depend on the localization of the neoplasm and its size.

  • So, with the defeat of large bronchi (the so-called "central cancer"):
    • Cough;
    • Dyspnea;
    • Hemoptysis;
    • Obstruction (obstruction) of the bronchi (fever, cough with purulent and mucous sputum).
  • Peripheral tumors clinically manifest only when germinating into the visceral pleura or thoracic wall:
    • Dry cough;
    • Chest pain (the 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 - widening of the veins of the upper chest, jugular vein, swelling of the neck and face, sometimes cyanosis;
    • Germination in the esophagus - dysphagia.
  • Defeat of the pericardium:
    • Violation of the heart rhythm;
    • Pericarditis;
    • Heart failure: swelling of the legs, 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 metastases

About 60% of primary patients (for the first time having consulted a doctor) with small cell and 30% with non-small cell lung cancer already have symptoms that indicate the presence of distant metastases.

As a rule, they are localized in the central neuromuscular system, adrenal gland and liver. If we talk about the clinical picture, then 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;
  • A sharp loss of body weight (more than 10 kg);
  • Radiographic unexplained fever;
  • Fast fatiguability;
  • Fatigue;
  • Anemia.

The presence of the above symptoms usually indicates the generalization of the tumor process. In connection with this, the doctor appoints additional examinations and appoints appropriate treatment.

Paraneoplastic syndromes

All paraneoplastic syndromes are divided into:

  • Hormonal (giperadrenokortitsizm, gumorolnaya hypercalcemia, etc.);
  • Neurological (Eaton-Lambert syndrome, cortical encephalopathy, etc.);
  • Musculoskeletal (symptom of tympanic sticks, osteoarthropathy);
  • Other (eg, cardiovascular).

Diagnostics

How is lung cancer diagnosed? Which surveys are most informative? What can not be done without? Such questions are always of interest to people who have encountered such a problem as lung cancer. Let's try to answer them.

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

So, what does a comprehensive examination include?

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

And much depends on its localization:

  • In peripheral cancer - a microscopic examination of smears taken from the affected areas of the bronchus and / or lung. As a rule, the fence is made with fibrobronchoscopy. Intraoperative (during the operation) for morphological confirmation by morphological examination, a puncture biopsy is performed, and if it is ineffective, a lung resection with a tumor is performed (only with small and / or superficially located tumors). In unoperable patients with poor results obtained with bronchoscopy and microscopic examination of sputum - transthoracic thin needle puncture biopsy under X-ray control;
  • In central carcinoma - a biopsy of the tumor with fibrobronchoscopy is necessary, followed by cytological and histological examination of the obtained material;
  • With distant metastases, puncture fine-needle biopsy (TIAB) is recommended under ultrasound / CT control, especially with adrenal, liver or kidney damage. Excisional or puncture biopsy of metastases - localization: peripheral lymph nodes and soft tissues.

According to international protocols, if a malignant lung tumor is suspected, a comprehensive examination is always performed, which, of course, includes laboratory tests.

They include:

  • seroreaction for syphilis ;
  • general urine analysis (OAM);
  • blood type and Rh factor;
  • the general analysis of blood (KLA);
  • Glucose, bilirubin, AsAT / AlAT, Ca, alkaline phosphatase); biochemical blood test (urea, total protein, creatinine and coagulogram (PV, APTT, fibrinogen, TV) - as an additional diagnostic.

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

  • Radiography (fluorography);
  • Determination of the function of external respiration;
  • Tracheobronchoscopy;
  • Ultrasound of the abdominal cavity;
  • Electrocardiography;
  • A standard study in assessing the operability of patients is computed tomography of the chest and upper abdominal cavity (liver, adrenal glands). In central lung cancer, CT is shown with contrast.
  • Videotorakoskopiya - in the presence of CT-signs of the spread of the tumor to the structures and organs of the mediastinum (pulmonary trunk, aorta, spine, myocardium, ERW) or pleurisy dissemination. And also to confirm the tumor's non-resectability;
  • Mediastinoscopy - with CT scans of lesion LU of the mediastinum from 2 sides. In difficult cases, it is possible to perform a composite examination - video-assisted thoracomediastinoscopy;
  • Diagnostic thoracotomy;
  • Bone scintigraphy - if there is a suspicion of having metastases (increased Ca, alkaline phosphatase in the blood serum, pain). Positive scintigraphy data for operable patients should be confirmed by X-ray examination or biopsy;
  • With neurologic 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 videotorakoskopiya (atypical resection of the lung, biopsy).  

Treatment of lung cancer

The first thing I want to say about - treatment is done only by a doctor! No self-treatment! This is a very important point. After all, the sooner you seek help from a specialist, the more chances for 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;
  • Presence of concomitant pathologies;
  • Combination of all the above-described fatkorov.

There are several mutually complementary methods of treating lung cancer:

  • Surgical intervention;
  • Radiation therapy;
  • Chemotherapy.

However, they are not used in isolation. Most often, effective control of the disease involves the use of several methods at once.

Surgery

To date, treatment with surgical intervention is the main method of combating lung cancer. Especially if one of the non-small cell forms is diagnosed.

Most oncologists 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 the surgery is joined by a radiotherapy or chemotherapeutic method.

With the purpose of treatment of lung cancer today the following operations are performed:

  • 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 - are performed with peripheral tumors of small size).

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

Indication for the performance of pulmonectomy is: defeat of the disease of the main bronchus, lung vessels or spread of the tumor to a nearby share. Sometimes such an operation is performed with a massive lesion of LU with metastatic cells.

A huge advantage of the surgical method of treatment is the possibility of performing an urgent or planned histological examination of the resected tissue sites.

  • In addition, in the most severe and neglected cases, to facilitate the patient's condition, palliative operations can be carried out. The main indications for such intervention are the presence of decay in the tumor or atelectasis, as well as the risk of pulmonary hemorrhage.

Radiation therapy

This method of treating lung cancer is used quite often, but only within the framework of complex therapy. Doctors do not recognize radiotherapy as an independent method.

LT is shown for:

  • Impossibility of carrying out radical surgical treatment (as a rule, because of the severe general condition of the patient);
  • Failure of the patient for surgical intervention;
  • A non-radical operation;
  • Spread of the tumor process on those structures of the body, removal or resection of which is not possible (spine, heart, etc.).

Do not forget about the contraindications for radiation therapy:

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

If there are some contraindications, radiation therapy should be postponed until they are eliminated. Otherwise, the tactics of treatment are determined by a doctor's consultation.

Usually the radiation dose is not less than 60 Gy. However, the exact figures are determined for each patient separately.

There are two types of LT:

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

Chemotherapy

The least effective method of treatment of lung cancer.

According to international protocols, chemotherapy is prescribed for:

  • small-cell lung cancer I-IIIA stage;
  • palliative treatment of patients with IIIB-IV stage of lung cancer;
  • single metastases of the non-small cell form of the disease.

To date, several antineoplastic agents are almost always used for chemotherapy. That is why doctors often hear a term such as "polychemotherapy".

With a view to acquaintance, we list some of the most popular and effective drugs that are part of the chemotherapy regimens for lung cancer:

  • Vinorelbine;
  • Cisplatin;
  • Paclitaxel;
  • Carboplatin;
  • Etoposide;

The interval between courses varies from 3 to 4 weeks. The dose, method and speed of administration of chemotherapy is determined only by an oncologist.

Attention! Chemotherapy is often very difficult to tolerate by patients, because it affects not only cancer cells, but also the entire human body as a whole. Sometimes this method of treatment causes far greater harm to health than the tumor itself.

The general principles that guide physicians in most countries are listed in the tables below:

With non-small cell carcinoma:

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

In small cell carcinoma:

I-IIIA Stage
(initially operable patients)
  • Radical operation (with adjuvant polychemotherapy) + preventive irradiation of the brain;
IIIA-B Step
(initially inoperable patients)
  • Chemoradiotherapy;
  • Chemotherapy;
  • PGBM (with complete regression of the tumor);
IV Stage
  • Chemoradiotherapy (palliative treatment);
  • Chemotherapy.

Forecast

Do not make accurate predictions for lung cancer, perhaps, no experienced doctor. This disease can behave unpredictably, which is largely due to the variety of histological variants of the structure of tumors.

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

According to statistical data, the 5-year survival rate 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 all of the above, it is clear that it is possible and necessary to fight lung cancer. And you have to start taking care of your health right now. Start small - go through a fluorography.

We wish you and your family good health! Be happy!


| 19 September 2014 | | 229 | Oncology
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