Central cancer of a lung
The central cancer of a lung – the malignant tumor affecting large bronchial tubes up to subsegmentary branches. Early symptoms of the central cancer of lung include cough, a blood spitting, short wind; late symptoms are connected with complications: obturatsionny pneumonia, VPV syndrome, metastasises. Verification of the diagnosis is carried out by carrying out a X-ray analysis and KT of lungs, a bronkhoskopiya with an aim biopsy, spirometry. In operable cases treatment of the central cancer of lung surgical, radical (resection volume from lobectomy to the expanded or combined pnevmonektomiya), added with postoperative radiation therapy, chemotherapy.
Central cancer of a lung
The central cancer of a lung – bronkhogenny cancer with inside - or peribronkhiapny growth, coming from proximal departments of a bronchial tree - the main, share or segmentary bronchial tubes. It is the most frequent kliniko-radiological form of a disease, a component to 70% of cancer of lung (about 30% fall to the share of peripheral cancer of lung). However if peripheral cancer is more often at comes to light at preventive fluorography, even before emergence of symptoms, then central - mainly in connection with emergence of complaints. It leads to the fact that every third patient with the central cancer of a lung, independently seen a doctor, is already inoperable.
At men cancer of a lung develops in 8 times more often than at women. At the time of detection of a tumor the age of patients usually makes from 50 to 75 years. Cancer of a lung is the most urgent problem of klinicheyosky pulmonology and oncology that is connected as with its high specific weight in structure of cancer incidence, and with the steady growth of cases of pathology.
Reasons of the central cancer of lung
All factors influencing the frequency of development of the central cancer of lung are subdivided on genetic and modifying. As criteria of genetic predisposition serve 3 and more cases of cancer of lung in a family, presence at the patient of a syndrome of a polyneoplasia - primary and multiple tumors of malignant character.
The modifying factors can be exogenous and endogenous; most of them are potentially preventable. The most influential and dangerous of them is smoking: daily smoking of one pack of cigarettes increases risk of developing of the central cancer of lung by 25 times and mortality by 10 times. As other significant exogenous factor serves impact on an epithelium of bronchial tubes of carcinogens of the environment (polyaromatic hydrocarbons, gases, pitches and so forth), production pollyutant (fertilizers, vapors of acids and alkalis, arsenic, cadmium, chrome). The ionizing radiation increasing risk of development of malignant new growths possesses system impact on an organism.
HNZL (chronic pneumonia, chronic bronchitis, pneumofibrosis, etc.), tuberculosis of lungs concern to the major endogenous to the reasons. The male and age are considered as ineradicable risk factors 45 years are more senior. Usually central cancer of a lung develops against the background of a dysplasia mucous bronchial tubes therefore it is no wonder that among the diseased over 80% are heavy smokers, and 50% have chronic bronchitis.
Classification of the central cancer of lung
According to kliniko-anatomic classification, the central cancer of a lung is subdivided on endobronchial (endofitny and ekzofitny), peribronkhialny nodal and peribronkhialny branched. On gistomorfologichesky features of a structure distinguish planocellular (epidermalny), melkokletochny, krupnokletochny cancer, an adenocarcinoma of a lung and other seldom found forms. In 80% of cases the central cancer of a lung is verified as planocellular.
In domestic classification of the central cancer of lung allocate 4 stages of an onkoprotsess:
1 stage - diameter of a tumor is up to 3 cm, localization at the level of a segmentary bronchial tube; there are no signs of metastasis.
2 stage - diameter of a tumor are up to 6 cm, localization at the level of a share bronchial tube; there are single metastasises in bronkhopulmonalny lymph nodes.
3 stage - diameter of a tumor is more than 6 cm, transition to the main or other share bronchial tube is noted; there are metastasises in trakheobronkhialny, bifurcation, paratrakhealny lymph nodes.
4 stage – spread of a tumor out of lung limits with transition to a trachea, a pericardium, a gullet, a diaphragm, large vessels, vertebras, a chest wall. Cancer pleurisy, the multiple regionarny and remote metastasis is defined.
Symptoms of the central cancer of lung
The clinic of the central cancer of lung is characterized by three groups of symptoms: primary (local), secondary and the general. Primary symptoms belong to number of the earliest; they are caused by infiltration by a tumor of a wall of a bronchial tube and partial violation of its passability. Usually in the beginning there is hoarse dry cough which intensity is more expressed at night. In process of increase of an obturation of a bronchial tube the mucous or mucopurulent phlegm appears. A half of patients has a blood spitting in a look a streak of scarlet blood; less often the central cancer of a lung demonstrates pulmonary bleeding. Expressiveness of short wind depends on caliber of the affected bronchial tube. Breast pains as on struck, and the opposite side are typical.
The secondary symptomatology reflects the complications accompanying the central cancer of a lung. Obturatsionny pneumonia, a sdavleniye or germination of the next bodies, the regionarny and remote metastasis can be such complications. At a full obturation of a gleam of a bronchial tube a tumor pneumonia which quite often has abstsediruyushchy character develops. At the same time cough becomes damp, a phlegm – plentiful and purulent. Body temperature increases, there are oznoba, symptoms of intoxication amplify. Short wind is aggravated, jet pleurisy can develop.
In case of germination of intra chest structures pains in a thorax accrue, syndromes of a mediastinalny compression and a syndrome of the top hollow vein can develop. The voice osiplost, a dysphagy, puffiness of the person and neck, swelling of cervical veins, dizziness can indicate the widespread nature of the central cancer of lung. In the presence of the remote metastasises in a bone tissue bone and backbone pains, pathological changes develop. Metastasis in a brain is followed by intensive headaches, motor and mental disorders.
The general symptoms at the central cancer of a lung are connected with cancer intoxication and the accompanying inflammatory changes. They include an indisposition, fatigue, a loss of appetite, weight loss, subfebrilitt, etc. Usually they join already in widespread stages. At 2-4% of patients paraneoplastic syndromes come to light: koagulopatiya, artralgiya, a hypertrophic osteoartropatiya, the migrating thrombophlebitis, etc.
Diagnosis of the central cancer of lung
The central cancer of a lung often proceeds behind a mask of recurrent pneumonia therefore in all suspicious cases inspection of the patient is required from the pulmonologist with carrying out a complex of radiological, bronkhologichesky, cytomorphological researches profoundly. At the general survey the attention is paid to a condition of peripheral lymph nodes, perkutorny and auskultativny signs of violation of ventilation.
Without fail all patient carries out a two-projective X-ray analysis of lungs. Of the central cancer of a lung are presented to Rentgenpriznaki by existence of spherical knot in a root of a lung and expansion of its shadow, atelektazy, obturatsionny emphysema, strengthening of the pulmonary drawing in a root zone. The linear tomography of a root of a lung helps to specify the size and localization of a tumor. KT of lungs informatively for assessment of relationship of a tumor with vessels of lungs and structures of a sredosteniye.
For the purpose of visual detection of a tumor, specification of its borders and an intake of tumoral fabric the bronkhoskopiya with a biopsy is made. In 70-80% cases informative is an analysis of a phlegm on atypical cages, a cytologic research of washout from bronchial tubes. On the basis of data of spirometry it is obviously possible to judge degree of a bronkhoobstruktion and respiratory reserves.
At the central form of cancer of lung differential diagnostics is performed with infiltrative and fibrous tuberculosis, pneumonia, abscess of a lung, BEB, foreign matters of bronchial tubes, adenomas of bronchial tubes, sredosteniye cysts, etc.
Treatment of the central cancer of lung
The choice of a way of treatment of the central cancer of lung depends on its stage, a histologic form, associated diseases. For this purpose in oncology use surgical, beam and chemotherapeutic methods, and also their combinations.
As contraindications to carrying out operation considerable prevalence of an onkoprotsess (not operability), low functional indicators of activity of cardiovascular and respiratory systems, a decompensation of the accompanying pathology can serve. Radical operations at the central cancer of a lung are resections of lungs in volume of not less than one share (lobectomy, a bilobektomiya), an expanded pnevmonektomiya. In surgery of the central cancer of lung the wedge-shaped or circular resections of bronchial tubes supplementing lobectomy are widely used. Germination by a tumor of a pericardium, diaphragm, a gullet, hollow vein, aorta, a costal wall forms the basis for the combined penvmonektomiya.
In the post-operational period to patients the chemotherapy is usually appointed; the combination of operation with the subsequent radiation therapy is possible. It is known that such combination increases 5-year survival of the operated patients for 10%. At inoperable forms of the central cancer of lung beam or medicinal treatment, symptomatic therapy (analgetics, protivokashlevy, styptic means, an endoscopic rekanalization of a gleam of a bronchial tube) is carried out.
Forecast and prevention of the central cancer of lung
The forecast of survival depends on a stage of cancer and radicalism of the carried-out treatment. Among the patients operated on 1 stages, the 5-year postoperative boundary is overcome by 70%, on 2 stages - 45%, 3 stages - 20%. However the situation is complicated by the fact that the number of operable patients among independently addressed makes no more than 30%. From them 40% patients need performance of various modifications of a pnevmonektomiya and 60% - a forehead - and bilobektomiya. The postoperative lethality fluctuates in the range of 3-7%. Without operation patients perish within the next 2 years after establishment of the diagnosis.
As the most important directions of prevention of cancer of lung serve mass preventive inspection of the population, the prevention of development of background diseases, formation of healthy habits, an exception of contact with carcinogens. These questions are priority and are supported at the state level.