Bronchial tube cancer - the malignant new growth developing from an integumentary epithelium of bronchial tubes of various caliber and bronchial glands. At development of cancer of bronchial tube of the patient cough, short wind, a blood spitting, fever of remitiruyushchy type disturbs. Diagnosis of cancer of bronchial tube assumes carrying out radiological, tomographic and bronkhologichesky inspection, cytologic or histologic confirmation of a disease. Depending on a stage, surgical cancer therapy of a bronchial tube can consist in lobectomy, a bilobektomiya or a pulmonektomiya; at inoperable processes also the chemotherapy is carried out beam.
Bronchial tube cancer
Cancer of bronchial tubes (bronkhogenny cancer) and lung cancer (alveolar cancer) in pulmonology often unite the general term "bronkhopulmonalny cancer". Primary malignant tumors of lungs and bronchial tubes make 10-13% of all oncopathology, conceding on occurrence frequency only to stomach cancer. Cancer of bronchial tubes usually develops at the age of 45-75 years; at the same time at men by 6-7 times more often than at women.
In the last decades growth of incidence of bronkhogenny cancer owing to strengthening of cancerogenic influences is noted. At the same time it should be noted progress in early diagnosis of cancer of bronchial tubes connected with broad introduction in clinical practice of endoscopic methods, expansions of opportunities of thoracic surgery in a question of radical treatment of bronkhopulmonalny cancer, increase in life expectancy of patients.
Reasons of cancer of bronchial tubes
In structure of the reasons of cancer of bronchial tubes smoking acts as the most significant etiologichesky factor. When smoking the 2nd and more packs of cigarettes in day the risk of development of bronkhopulmonalny cancer increases by 15 - 25 times. Long-term regular inhalation of the tobacco smoke containing a set of carcinogens causes a metaplaziya of an epithelium of a mucous membrane of bronchial tubes. Besides, bronchial secretion of slime in which harmful microparticles accumulate, chemically and mechanically irritating a mucous membrane amplifies. In these conditions the resnitchaty epithelium of bronchial tubes does not cope with effective clarification of airways.
The risk of developing of cancer of bronchial tubes is increased at the persons working at the harmful productions connected, first of all, with asbestos, nickel, chrome, arsenic, coal dust, yperite, mercury, etc. Often inflammatory damages of airways of chronic character act as the reasons of cancer of bronchial tubes: bronchitis, bronkhoektatichesky disease, pneumonia, tuberculosis of lungs, etc.
Pathogenesis of cancer of bronchial tubes
Decrease of the activity of the exchange and enzymatic processes directed to neutralization and removal of the harmful substances arriving from the outside formation of endogenous carcinogens in combination with violation of a trophic innervation causes development of blastomatozny process in bronchial tubes.
The complex of pathological changes at cancer of bronchial tubes is twisted from extent of violation of bronchial passability. Before all change develop with the epdobronkhialny growth of a tumor leading to narrowing of a gleam of a bronchial tube, later – with the peribronkhialny growth which is followed by a bronchial tube sdavleniye from the outside.
Bronchial obstruction or compression are followed by hypoventilation development, and at full closing of a bronchial tube - an atelektaza of the site of a lung. Similar violations can lead to infection of the site of pulmonary fabric which is switched off from gas exchange with formation of secondary abscess or gangrene of a lung. At an ulceration or a necrosis of a tumor arises less or more expressed pulmonary bleeding. Disintegration of a tumor can lead to formation of bronkhopishchevodny fistula.
Classification of cancer of bronchial tubes
From the point of view of histologic structure distinguish planocellular cancer of a bronchial tube (60%), melkokletochny and krupnokletochny cancer of a bronchial tube (30%), an adenocarcinoma (10% of cases). According to kliniko-anatomic classification, distinguish the central and peripheral bronkhogenny cancer. In 60% of observations the central cancer growing from large bronchial tubes meets (main, share, segmentary); in 40% - the peripheral cancer of bronchial tubes affecting subsegmentary bronchial tubes and bronchioles.
The central cancer of bronchial tubes can have an endobronchial nodal, peribronkhialny nodal or peribronkhialny branched (infiltrative) form. Peripheral bronkhopulmonalny cancer meets in a nodal, band and pnevmoniyepodobny form.
On the nature of growth allocate the ekzofitny cancer growing in a bronchial tube gleam; endofitny, growing in the direction of a pulmonary parenchyma; and mixed. Bronchial tube cancer with ekzofitny growth causes hypoventilation or the site of a lung ventilated by this bronchial tube; in certain cases valvate emphysema develops. The Endofitny form can lead to a perforation of a wall of a bronchial tube or growing of a tumor into the next bodies – a pericardium, a pleura, a gullet.
Symptoms of cancer of bronchial tubes
Clinical displays of cancer are defined by caliber of the affected bronchial tube, anatomic type of growth of a tumor, its histologic structure and prevalence. At the central cancer of bronchial tubes as the earliest symptom serves constant dry hoarse cough. Pristupoobrazny strengthening of cough can be followed by the whistling, stridorozny breath, cyanosis, office of a phlegm with blood impurity. The blood spitting and bleeding caused by disintegration of a tumor arises at 40% of patients. At damage of a pleura (its germination by a tumor, development of cancer pleurisy), thorax pains develop.
Full obstruction of a bronchial tube a tumor leads to an inflammation of not ventilated part of a lung with developing of an obturatsionny pneumonitis. It is characterized by strengthening of cough, emergence of a phlegm, accession of fever of remitiruyushchy character, short wind, the general weakness, apathy.
In late stages of cancer of bronchial tubes the syndrome of the top hollow vein caused by violation of outflow of blood from the top departments of a trunk develops. Swelling of veins of a neck, the top extremities and a thorax is typical for a syndrome of VPV; puffiness and cyanosis of the person. At development of an osiplost of a voice it is necessary to think of damage of the wandering nerve; when developing heartaches, a perikardit – about spread of cancer of bronchial tubes on a warm bag.
At the started cancer of bronchial tubes metastasises in regionarny (bifurcation, peribronkhialny, paratrakhealny) lymph nodes are found; hematogenic and limfogenny metastasis occurs in a liver, adrenal glands, a brain, bones.
Diagnosis of cancer of bronchial tubes
At an early stage fizikalny inspection of patients with cancer of bronchial tubes maloinformativno. At development of an atelektaz there is a zapadeniye of supraclavicular area and compliant sites of a chest wall. The Auskultativny picture of cancer of bronchial tubes is characterized by various sound phenomena up to total absence of respiratory noise in a zone of an atelektaz. The Perkutorny sound is dulled, easing or lack of a bronkhofoniya and voice trembling is noted.
At cancer of bronchial tubes full radiological examination (a X-ray analysis of lungs in 2 projections, a x-ray and computer tomography), is conducted by MRT of lungs that allows to visualize accurately in pictures all interesting structures. By means of a bronkhoskopiya it is ekzofitno possible to find visually the growing bronchial tube cancer, to take washing waters for the cytologic analysis, and also an endoscopic biopsy for carrying out a histologic research.
Ultrasonography of a pleural cavity, pericardium, sredosteniye allows to find signs of germination of cancer of bronchial tubes in the next bodies. At development of kantseromatozny pleurisy it is carried out with cytology of a pleural exudate. For assessment of prevalence of cancer process if necessary the preskalenny biopsy, a skeleton stsintigrafiya, a biopsy of marrow, ultrasonography of a liver and adrenal glands, brain KT is carried out. At a diagnostic stage cancer of bronchial tubes is differentiated with adenoma of bronchial tubes, foreign matters of bronchial tubes, bronchitis.
Cancer therapy of bronchial tubes
In cancer therapy of bronchial tubes methods of operational surgery, chemotherapy, radiation therapy are applied. The combination and sequence of methods is defined with type and prevalence of tumoral process. Taking into account indications in surgery of cancer of bronchial tubes performance of a partial resection of a lung (lobectomy and a bilobektomiya) or removals of all lung is possible (pnevmonektomiya, pnevmonektomiya with a mediastinalny limfadenektomiya, a circular resection of bifurcation of a trachea or a circular resection of the top hollow vein / a chest aorta). In rare instances at early detection of cancer of bronchial tubes are limited to a circular or okonchaty resection of a bronchial tube.
At a common form of cancer of bronchial tubes the chemotherapeutic method and radiation therapy in addition to surgery or as the main treatment are used. In case of inoperable cancer of bronchial tubes symptomatic treatment by the protivokashlevy and anesthetizing medicines, oxygen therapy is carried out.
Forecast and prevention of cancer of bronchial tubes
The forecast at cancer of bronchial tubes depends on a stage of detection of a disease. Radical surgical treatment allows to achieve good results at 80% of patients. At bronchial tube cancer metastasis in lymph nodes long-term survival among the operated patients equals 30%. For lack of surgical cancer therapy of bronchial tubes survival within 5 years makes less than 8%.
Carrying out mass screenings of the population (fluorography), timely treatment of inflammatory processes of bronchial tubes, refusal of smoking, use of means of personal protection (masks, respirators) on productions with high degree of dust content belongs to measures of prevention of bronkhoalveolyarny cancer.