Lung cancer – the malignant tumor originating from tissues of bronchial tubes or a pulmonary parenchyma. As symptoms of lung cancer can serve subfebrilitt, cough with a phlegm or streaks of blood, short wind, thorax pains, weight loss. Development of pleurisy, a perikardit, syndrome of the top hollow vein, pulmonary bleeding is possible. Exact diagnosis demands carrying out a X-ray analysis and KT of lungs, a bronkhoskopiya, a research of a phlegm and pleural exudate, a biopsy of a tumor or lymph nodes. Rezektsionny interventions in the volume dictated by prevalence of a tumor in combination with chemotherapy and radiation therapy belong to radical methods of cancer therapy of a lung.
Lung cancer – the malignant new growth of an epitelialny origin developing from mucous membranes of a bronchial tree, bronchial glands (bronkhogenny cancer) or alveolar fabric (pulmonary or pneumogene cancer). Cancer of a lung is in the lead in structure of mortality of the population from malignant tumors. The lethality at lung cancer makes 85% of total number of the diseased, despite achievements of modern medicine.
Development of cancer of lung is unequal at tumors of different histologic structure. The slow current is characteristic of the differentiated planocellular cancer, undifferentiated cancer develops quickly and gives extensive metastasises. Melkokletochny cancer of a lung possesses the most malignant current: develops it is reserved and quickly, early spreads, has the bad forecast. More often the tumor arises in the right lung - in 52%, in the left lung – in 48% of cases.
The cancer tumor is mainly localized in the top share of a lung (60%), is more rare in lower or average (30% and 10% respectively). It is explained by more powerful air exchange in the top shares, and also features of an anatomic structure of a bronchial tree in which the main bronchial tube of the right lung directly continues a trachea, and left in a zone of bifurcation forms an acute angle with a trachea. Therefore cancerogenic substances, foreign matters, smoke particles, directing in well aerated zones it is also long being late in them, cause growth of tumors.
Metastasis of lung cancer is possible on three ways: limfogenny, hematogenic and implantation. The most frequent is limfogenny metastasis of lung cancer in bronkhopulmonalny, pulmonalny, paratrakhealny, trakheobronkhialny, bifurcation, okolopishchevodny lymph nodes. The first at limfogenny metastasis pulmonalny lymph nodes in a zone of division of a share bronchial tube into segmentary branches are surprised. Then bronkhopulmonalny lymph nodes along a share bronchial tube are involved in metastatic process.
Further there are metastasises in lymph nodes of a root of a lung and an unpaired vein, trakheobronkhialny lymph nodes. The following involves in process pericardiac, paratrakhealny and okolopishchevodny lymph nodes. The remote metastasises arise in lymph nodes of a liver, a sredosteniye, supraclavicular area. Lung cancer metastasis occurs in the hematogenic way when growing a tumor into blood vessels, at the same time other lung, kidneys, a liver, adrenal glands, a brain, a backbone most often are surprised. Implantation metastasis of lung cancer is possible on a pleura in case of germination of a tumor in it.
Factors of emergence and mechanisms of development of cancer of lung do not differ from an etiology and pathogenesis of other malignant tumors of a lung. In development of lung cancer the leading role is assigned to exogenous factors: to smoking, pollution of the air basin substances-carcinogens, to influence of radiation (especially radon).
On histologic structure allocate 4 types of cancer of lung: planocellular, krupnokletochny, melkokletochny and ferruterous (adenocarcinoma). Knowledge of a histologic form of cancer of lung is important in respect of the choice of treatment and the forecast of a disease. It is known that planocellular cancer of a lung develops rather slowly and usually does not give early metastasises. The adenocarcinoma is also characterized by rather slow development, but the early hematogenic dissemination is peculiar to it. Melkokletochny and other undifferentiated forms of cancer of lung are transient, with early extensive limfogenny and hematogenic metastasis. It is noticed that the tumor differentiation degree, the its zlokachestvenny current is lower.
On localization concerning bronchial tubes lung cancer can be central, arising in large bronchial tubes (main, share, segmentary), and peripheral, proceeding from subsegmentary bronchial tubes and their branches, and also from alveolar fabric. The central cancer of a lung meets more often (in 70%), peripheral – is much more rare (in 30%).
The form of the central cancer of lung happens endobronchial, peribronkhialny nodal and peribronkhialny branched. The peripheral cancer tumor can develop in shape "spherical" cancer (a round tumor), pnevmoniyepodobny cancer, cancer of a top of easy (Pankost). Classification of cancer of lung by the TNM system and stages of process is in detail given in the article "malignant tumors of lungs".
The clinic of cancer of lung is similar to displays of other malignant tumors of lungs. As typical symptoms serve constant cough with a phlegm of mucopurulent character, short wind, subfebrilny body temperature, thorax pains, a blood spitting. Some distinctions in clinic of lung cancer are caused by anatomic localization of a tumor.
Central cancer of a lung
The cancer tumor which is localized in a large bronchial tube gives early clinical symptoms at the expense of irritation of a mucous membrane of a bronchial tube, violation of its passability and ventilation of the corresponding segment, a share or the whole lung.
Interest of a pleura and nervous trunks causes emergence of a pain syndrome, cancer pleurisy and violations in zones of an innervation of the corresponding nerves (diafragmalny, wandering or returnable). Lung cancer metastasis in the remote bodies causes secondary symptomatology from the struck bodies.
Germination by a tumor of a bronchial tube causes emergence of cough with a phlegm and is frequent with blood impurity. At hypoventilation emergence, and then the atelektaza of a segment or a share of a lung joins the cancer pneumonia which is shown the increased body temperature, emergence of a purulent phlegm and short wind. Cancer pneumonia well gives in to anti-inflammatory therapy, but recurs again. Cancer pneumonia often is followed by hemorrhagic pleurisy.
Germination or sdavleniye a tumor of the wandering nerve causes paralysis of voice muscles and is shown by a voice osiplost. Damage of a diafragmalny nerve leads to diaphragm paralysis. Germination of a cancer tumor in a pericardium causes emergence of heartaches, a perikardit. Interest of the top hollow vein leads to violation of venous and lymphatic outflow from the top half of a trunk. So-called, the syndrome of the top hollow vein is shown by puffiness and puffiness of the person, hyperaemia with a tsianotichny shade, swelling of veins on hands, a neck, a thorax, short wind, in hard cases - a headache, visual disorders and violation of consciousness.
Peripheral cancer of a lung
Peripheral cancer of a lung at early stages of the development since pain receptors in pulmonary fabric are absent. In process of increase in tumoral knot there is an involvement in process of bronchial tubes, pleurae, the next bodies. The syndrome of a sdavleniye of the top hollow vein, a voice osiplost belong to local symptoms of peripheral lung cancer cough with a phlegm and streaks of blood. Germination of a tumor in a pleura is followed by cancer pleurisy and a sdavleniye of a lung a pleural exudate.
Development of lung cancer is followed by increase of the general symptomatology: intoxications, short wind, weakness, loss of weight, temperature increase of a body. In the started forms of cancer of lung complications from the bodies struck with metastasises join, disintegration of primary tumor, the phenomenon of bronchial obstruction, an atelektaza, profuzny pulmonary bleedings. As causes of death at lung cancer most often serve extensive metastasises, cancer pneumonia and pleurisy, a kakheksiya (heavy exhaustion of an organism).
Diagnostics at suspicion of cancer of a lung includes:
- all-clinical blood tests and urine;
- biochemical blood test;
- cytologic researches of a phlegm, washout from bronchial tubes, pleural exudate;
- assessment of fizikalny data;
- X-ray analysis of lungs in 2 projections, a linear tomography, KT of lungs;
- bronkhoskopiya (fibrobronkhoskopiya);
- pleural puncture (in the presence of an exudate);
- diagnostic torakotomiya;
- preskalenny biopsy of lymph nodes;
- other diagnostic procedures
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
In the presence of contraindications or inefficiency of these methods the palliative treatment directed to simplification of a condition of incurably sick patient is carried out. Anesthesia, a kislorodoterapiya, a detoxication, palliative operations belong to palliative methods of treatment: imposing of a tracheostoma, gastrostoma, enterostoma, nefrostoma etc.). At cancer pneumonia anti-inflammatory treatment is carried out, at cancer pleurisy – , at pulmonary bleedings – haemo static therapy.
Forecast and prevention
The worst forecast is statistically noted at uncured lung cancer: nearly 90% of patients perish in 1-2 years after diagnosis. At not combined surgical cancer therapy of a lung five-year survival makes about 30%. Cancer therapy of lungs at the I stage gives an indicator of five-year survival in 80%, on II – 45%, on III – 20%.
Independent beam or the chemotherapy gives 10% five-year survival of patients with lung cancer; at the combined treatment (surgical + chemotherapy + radiation therapy) survival percent for same the period is equal to 40%. Predictively lung cancer metastasis in lymph nodes and the remote bodies is adverse.
Questions of prevention of lung cancer are urgent in connection with high rates of mortality of the population from this disease. The most important elements of prevention of lung cancer are the active sanprosvetrabota, the prevention of development of inflammatory and destructive diseases of lungs, identification and treatment of benign tumors of lungs, refusal of smoking, elimination of professional vrednost and daily influence of cancerogenic factors. Passing of fluorography at least once in 2 years allows to find lung cancer at early stages and not to allow development of the complications connected with the started forms of tumoral process.