Tumors of bronchial tubes – various new growths in the morphological relation growing in a bronchial tube gleam (endobronkhialno) or along its wall (peribronkhialno). Can be signs of a tumor of a bronchial tube: the irritating cough, a blood spitting, short wind, the whistling breath, recurrent pneumonia. At bronchial tube cancer the called symptomatology develops against the background of the general violation of health (weakness, weight loss and so forth). For diagnostics and verification like tumor of a bronchial tube the X-ray analysis and a tomography of lungs, a bronkhoskopiya with an endoscopic biopsy and a histologic research of material is carried out. Removal of tumors of bronchial tubes (taking into account their localization and a gistotip) can be made endoscopic, by a resection of a bronchial tube or a lung.
Tumors of bronchial tubes
Tumors of bronchial tubes – new growths, various by origin, to cellular structure, the nature of growth, a current and the forecast, proceeding from fabrics of a bronchial tree. First of all, all tumors of bronchial tubes are subdivided on good-quality and malignant. The first group of new growths is more numerous though it makes only 5-10% of total number of tumoral processes in bronchial tubes. The most part of tumors of bronchial tubes is presented by various histologic options of bronkhogenny cancer. Benign tumors of lungs and bronchial tubes develop at persons of young age (30-40 years) more often, to the same extent affect men and women; malignant new growths in most cases come to light at men 50 years are more senior.
Classification of tumors of bronchial tubes
As growth of a tumor of lungs are subdivided on central (growing from large bronchial tubes - main, share, segmentary, subsegmentary) and peripheral (develop from small bronchial branches of the 5th, 6th order). The central tumors with endobronchial growth are available to visualization via the bronchoscope, often obturirut a bronchial tube gleam, causing at the same time a segment or a share of a lung. Peripheral tumors a long time do not cause clinically significant changes and proceed asymptomatically.
Benign tumors can develop from various elements of a bronchial tube on the basis of what allocate:
- tumors from an epithelium and bronchial glands (papilloma (planocellular, ferruterous, mixed), adenomas of bronchial tubes (kartsinoidny, tsilindromatozny, mukoepidermoidny, mixed)
- tumors from mesodermal fabric (a leyomioma, fibroma, a gemangioma, nevrogenny tumors)
- disembriologichesky tumors (gamartoma, gamartokhondroma)
The tumor of bronchial tubes should distinguish from endobronchial processes of not tumoral nature. In pulmonology foreign matters of bronchial tubes, an inflammatory giperplaziya of bronchial tubes, bacillar a lung, amyloid tumors, endometriosis, etc. concern to the last.
In process of development of benign tumors of bronchial tubes allocate a phase of an asymptomatic current, initial clinical manifestations and the developed clinical picture. Taking into account expressiveness of violation of bronchial passability distinguish a stage of a partial stenosis of a bronchial tube, a valvate stenosis of a bronchial tube and full occlusion of a bronchial tube. In certain cases benign tumors of bronchial tubes are exposed to a malignization and get a malignant current (for example, the bronchial tube adenoma malignization with transition to an adenocarcinoma is noted at 5–10% of patients).
Malignant tumors of bronchial tubes (cancer of bronchial tubes) differentiate depending on histologic type of a tumor (melkokletochny, krupnokletochny, planocellular cancer, an adenocarcinoma, a kartsinosarkoma, cancer of bronchial glands, kartsinoidny tumors, etc.). At the same time all forms of cancer of lung pass three periods in the development: biological (from the moment of origin of a tumor before emergence of radiological signs), preclinical (there are only radiological symptoms of a tumor; symptoms are absent) and clinical (the clinical symptomatology is expressed). Exhaustive classification of stages of cancer of lung by TNM system is presented in the review "Malignant tumors of lungs".
Reasons of tumors of bronchial tubes
In most cases tumors of bronchial tubes arise against the background of chronic inflammatory processes, toxic influences, mechanical damages of a bronchial tree. It is known that formation of malignant tumors is often preceded bronchitis of the smoker, chronic bronchitis of other etiology, a pneumoconiosis, tuberculosis. Tobacco smoke which toxic compounds promote a metaplaziya of a bronchial epithelium has the greatest carcinogenicity, and high temperature breaks processes of cellular division. The most significant factors are the smoking experience, daily "norm" of the smoked cigarettes, quality of tobacco products. It is worth to remember that both active, and passive smoking is equally dangerous.
The workers of harmful productions contacting to coal, asbestos, arsenic, chrome, nickel, aerogenic pollyutant are most subject to developing of tumors of bronchial tubes. Communication of some tumors of bronchial tubes with certain virus agents is noted (for example, association of planocellular papillomas of bronchial tubes with a virus of papilloma of the person). Papillomas of bronchial tubes are often combined with papillomatozy throats and tracheas.
Symptoms of tumors of bronchial tubes
The brightest clinical symptomatology develops with an endobronchial growth of the tumor causing violation of bronchial passability. Diameter of a gleam of a bronchial tube is almost not changed to stages of a partial bronkhostenoz, the irritating cough with a small amount of a phlegm, occasionally – a blood spitting can disturb the patient. The general health does not suffer. Radiological signs of tumoral growth are absent; identification of a new growth is possible only by means of KT of lungs or a bronkhoskopiya.
At a stage of a valvate stenosis of a bronchial tube the tumor already considerably blocks a gleam of pneumatic ways. The patient is disturbed by constant cough with allocation of a mucopurulent phlegm, a blood spitting, short wind, the whistling breath. During an exhalation under pressure the tumor can close completely a bronchial tube in this connection at this stage there are signs of violation of pulmonary ventilation, inflammatory changes. Radiological segmentary infiltrates are found, the tumor of bronchial tubes is confirmed endoscopic or by means of a linear tomography.
The full obturation of a bronchial tube a tumor leads to formation of an atelektaz, nagnoitelny processes in not ventilated site of pulmonary fabric. The clinical picture corresponds to obturatsionny pneumonia: fever, cough with a purulent phlegm, the general weakness, perspiration. At an arrosion of bronchial vessels there can be massive pulmonary bleedings.
Kartsinoidny adenomas of bronchial tubes can produce biologically active agents therefore at tumors of this type the kartsinoidny syndrome quite often develops: a bronchospasm, dizzinesses, reddening of skin, feeling of heat, allergic rashes on skin, etc.
Tumors with peribronkhialny growth, as a rule, do not cause a full obturation of a bronchial tube therefore the symptomatology is not expressed. Also malosimptomno and course of peripheral tumors. Usually clinical demonstration is connected with a vessel arrosion (blood spitting), a sdavleniye or germination of bronchial tubes (cough, short wind, temperature increase etc.). At bronchial tube cancer, except respiratory manifestations, the general violations are expressed: cancer intoxication, weakness, kakheksiya, anemia, pain syndrome.
Diagnosis of tumors of bronchial tubes
Causeless or long hoarse cough, blood spitting, short wind, the complicated exhalation and other signs of trouble from airways have to become a reason for urgent visit of the pulmonologist. After assessment of auskultativny and other fizikalny data the algorithm of diagnostic inspection is defined.
As a rule, the first step on the way of detection of a tumor of a bronchial tube is the X-ray analysis of lungs in two projections and a tomographic research. In most cases radiological hypoventilation or parts of a lung is defined; on tomograms - "amputation" obturirovanny a bronchial tube tumor. For assessment of a vaskulyarization of a tumor of a bronchial tube performance of bronchial arteriography or angiopulmonografiya is expedient.
The greatest value at endobronchial new growths the fibrobronkhoskopiya with an endoscopic biopsy has. The histologic analysis of a bioptat allows to define morphological type of a tumor finally. Bronkhoskopiya can be informative and at peripheral tumors – in this case the endoscopist fixes indirect signs of tumoral growth (narrowing and deformation of contours of a bronchial tube at the expense of an external sdavleniye, change of a corner of an otkhozhdeniye of bronchial branches and so forth). At such localization the transbronchial biopsy of a tumor is also possible. For the purpose of assessment of extent of violation of passability of bronchial tubes the spirometry is carried out.
In respect of differential diagnostics by the most important differentiation of benign and malignant tumors of bronchial tubes is represented. Definition of a gistotip, localization and degree of prevalence of a tumor of a bronchial tube allows to plan the subsequent treatment competently.
Treatment and forecast of tumors of bronchial tubes
Benign tumors of bronchial tubes with vnutriprosvetny growth can be removed in various ways. So, at single polyps on a narrow leg as a method of the choice endoscopic removal of a polyp via the bronchoscope with coagulation of a bed can be considered. In other cases the torakotomiya with a bronkhotomiya and removal of a tumor, an okonchaty or circular resection of a bronchial tube is, as a rule, made; and in the presence of irreversible changes in a lung (bronkhoektaz, a pneumosclerosis) – different types of a resection. Peribronkhialny and peripheral benign tumors, as a rule, are removed in the course of regional or segmentary lung resection, lobectomies.
Absolutely other approach is used concerning malignant tumors of bronchial tubes. Proceeding from requirements of radicalism, the volume of a resection increases to lobectomy and even an expanded pnevmonektomiya. Endobronchial removal (laser destruction, cryodestruction, radio-frequency or argonoplazmenny coagulation, FDT) as a surgery alternative, is applied only at a stage of TisN0M0 or at functional not operability of the patient in the large centers of thoracic surgery where there is corresponding hardware and experience. Surgical cancer therapy of bronchial tubes is supplemented with chemotherapy or radiation therapy; these methods serve as the unique way of extension of life of the patient in the started cases.
After removal benign tumors of bronchial tubes can recur, especially in case of the continuing influence prichinno of significant factors. Endobronchial removal of a tumor can be complicated by a cicatricial stenosis of a bronchial tube. The refusal of treatment is fraught with developing of zhizneugrozhayushchy bleeding, development of irreversible changes of pulmonary fabric, a bronchial tube tumor ozlokachestvleniye. The forecast of malignant tumors of bronchial tubes depends on a stage of an onkoprotsess, radicalism of the carried-out treatment, a histologic form of cancer, existence of metastasises at the time of establishment of the diagnosis.