Malignant tumors of lungs – the general concept uniting group of new growths of a trachea, the lungs and bronchial tubes which are characterized by uncontrolled division and growth of cages, an invasion in surrounding fabrics, their destruction and metastasis in lymph nodes and remotely the located bodies. Malignant tumors of lungs develop from average, is low - or the undifferentiated cages considerably differing on structure and functions from normal. The lymphoma, planocellular and ovsyanokletochny cancer, sarcoma, pleura mesothelioma, malignizirovanny belong to malignant tumors of lungs. Diagnosis of malignant tumors of lungs includes a X-ray analysis, KT or MPT of lungs, a bronchography and a bronkhoskopiya, a cytologic research of a phlegm and pleural exudate, a biopsy, PET.
Malignant tumors of lungs
Malignant tumors of lungs – the general concept uniting group of new growths of a trachea, the lungs and bronchial tubes which are characterized by uncontrolled division and growth of cages, an invasion in surrounding fabrics, their destruction and metastasis in lymph nodes and remotely the located bodies. Malignant tumors of lungs develop from average, is low - or the undifferentiated cages considerably differing on structure and functions from normal.
The most frequent malignant tumor of lungs is lung cancer. Cancer of a lung occurs at men by 5-8 times more often than at women. Lung cancer usually affects patients 40-50 years are more senior. Cancer of a lung takes the 1st place among causes of death from cancer, as among men (35%), and among women (30%). Other forms of malignant tumors of lungs are registered much less often.
Reasons of malignant tumors of a lung
Emergence of malignant tumors regardless of localization is connected with the violations of a differentiation of cages and proliferation (growth) of fabrics happening at the gene level.
The factors causing similar violations in tissues of a lung and bronchial tubes are:
- active smoking and passive inhalation of cigarette smoke. Smoking is a major factor of risk of developing of malignant tumors of lungs (in 90% at men and in 70% at women). The nicotine and pitches which are contained in cigarette smoke possess cancerogenic action. At passive smokers the probability of development of malignant tumors of lungs (especially lung cancer) increases several times.
- harmful professional factors (contact with asbestos, chrome, arsenic, nickel, radioactive dust). The people connected owing to a profession with influence of these substances are subject to risk of developing of malignant tumors of lungs, especially, if they are smokers.
- accommodation in zones with the increased radonic radiation;
- existence of cicatricial changes of pulmonary fabric, the benign tumors of a lung inclined to a malignization, inflammatory and nagnoitelny processes in lungs and bronchial tubes.
These factors influencing development of malignant tumors of lungs can cause damages of DNA and make active cellular oncogenes.
Types of malignant tumors of lungs
Malignant tumors of lungs can initially develop in pulmonary fabric or bronchial tubes (primary tumor), and also to spread from other bodies.
Lung cancer – the epitelialny malignant tumor of lungs proceeding from mucous bronchial tubes, bronchial glands or alveoluses. Cancer of a lung has property of metastasis in other fabrics and bodies. Metastasis can occur on 3 ways: limfogenny, hematogenic and implantation. The hematogenic way is observed at germination of a tumor in blood vessels, limfogenny – in lymphatic. In the first couples tumor cells with a blood-groove are transferred to other lung, kidneys, a liver, adrenal glands, bones; in the second – in lymph nodes of nadklyuchichiny area and a sredosteniye. Implantation metastasis is noted at germination of a malignant tumor of lungs in a pleura and its distribution on a pleura.
On localization of a tumor in relation to bronchial tubes distinguish peripheral cancer of a lung (develops from small bronchial tubes) and the central cancer of a lung (develops from the main thing, share or segmentary bronchial tubes). Growth of a tumor can be endobronchial (in a bronchial tube gleam) and peribronkhialny (towards pulmonary fabric).
On a morphological structure distinguish the following types of cancer of lung:
- low - and high-differentiated planocellular (epidermoidny cancer of a lung);
- low - and the high-differentiated ferruterous cancer of a lung (adenocarcinoma);
- undifferentiated (ovsyanokletochny or melkokletochny) lung cancer.
Changes of an epithelium of bronchial tubes are the cornerstone of the mechanism of development of planocellular cancer of lung: replacement of ferruterous tissue of bronchial tubes fibrous, a cylindrical epithelium flat, emergence of the centers of a dysplasia passing into cancer. In emergence of a carcinoma the hormonal factors and genetic predisposition capable to make active the carcinogens which got to an organism play a role.
Ovsyanokletochny cancer belongs to the malignant tumors of a lung of diffusion neuroendocrine system (APUD-system) producing biologically active agents. This type of cancer of lung gives hematogenic metastasises already at an early stage.
Lymphoma – the malignant tumor of lungs proceeding from lymphatic systems. The lymphoma can initially be localized in lungs or spread in them from other bodies (mammary glands, a large intestine, a rectum, kidneys, a thyroid gland, a prostate gland, a stomach, a small egg, a neck of a uterus, skin and bones).
Sarcoma – the malignant tumor of a lung developing from intraalveolyarny or peribronkhialny connecting fabric. Sarcoma develops in left more often, but not in the right lung as cancer. Men get sick with sarcoma more often than women by 1,5-2 times.
Pleura cancer (pleura mesothelioma) - the malignant tumor proceeding from a mezoteliya – the epitelialny fabric covering a pleura cavity. Affects a pleura diffuzno more often, is more rare - locally (in the form of polipozny educations and knots). As a result the pleura is thickened to several centimeters, gets cartilaginous density, becomes rough.
Malignizirovanny gets all symptoms of a malignant tumor of a lung: unlimited infiltrative growth, ability of metastasis in the remote bodies (other lung, a liver, a brain, bones, skin, adrenal glands, kidneys, a pancreas). Unlike lung cancer grows more slowly and later gives metastasises therefore radical operation yields good results, a local recurrence arises seldom.
Classification of cancer of lung
In an onkopulmonologiya classification of cancer of lung by the international TNM system where is used:
T - primary malignant tumor of a lung, its amount and extent of germination in fabric:
- TH – radiological and bronkhologichesky data for existence of a malignant tumor of lungs are absent, however atypical cages in washouts from bronchial tubes or in a phlegm are defined
- THAT is primary tumor is not defined
- Tis — preinvazivny (vnutriepitelialny) cancer
- Tl — in an environment of pulmonary fabric or a visceral pleura is defined a tumor with a diameter up to 3 cm, at a bronkhoskopiya of signs of damage of the main bronchial tube it is not found
- T2 — is defined the tumor with a diameter more than 3 cm passing to the main bronchial tube bifurcation zones not less than on 2 cm, or with germination of a visceral pleura, or with existence of an atelektaz of a part of a lung are lower
- TZ — a tumor with germination in a chest wall, a parietal pleura, a pericardium, a diaphragm, or with distribution on the main bronchial tube, without reaching less than 2 cm bifurcation, or followed atelektazy the whole lung; tumor size any
- T4 — a tumor extends to a sredosteniye, a myocardium, large vessels (an aorta, a trunk of a pulmonary artery, the top hollow vein), a gullet, a trachea, a bifurcation zone, a backbone, and also the tumor which is followed by vypotny pleurisy.
N – involvement of regionarny lymph nodes:
- NX — is not enough data for assessment of regionarny lymph nodes
- NO — lack of metastatic damage of intra chest lymph nodes
- N1 — metastasis or spread of a malignant tumor of lungs on peribronkhialny or (and) lung root lymph nodes
- N2 — metastasis of a malignant tumor of lungs in bifurcation or lymph nodes of a sredosteniye from defeat
- N3 — metastasis of a malignant tumor of lungs in lymph nodes of a root and sredosteniye on the opposite side, supraclavicular or preskalenny lymph nodes from any party
M – absence or existence of the remote metastasises:
- MX — are not enough data for assessment of the remote metastasises
- MO — lack of the remote metastasises
- Ml — existence of the remote metastasises
G — gradation on degree of a differentiation of a malignant tumor of lungs (is defined after the histologic research):
- GX — cannot estimate degree of a cellular differentiation
- GI — high-differentiated
- G2 — umerennodifferentsirovanny
- G3 — low-differentiated
- G4 — undifferentiated
Distinguish the IV stages of cancer of lung:
- I – a tumor of a lung up to 3 cm in size with localization within one segment or a segmentary bronchial tube, metastasises are absent.
- II – a tumor of a lung up to 6 cm in size with localization within one segment or a segmentary bronchial tube, existence of single metastasises in bronkhopulmonalny lymph nodes
- III – the tumor of a lung more than 6 cm in size passing to the next share, the next or main bronchial tube, metastasises into trakheobronkhialny, bifurcation, paratrakhealny lymph nodes.
- IV \the tumor of a lung extends to other lung, the next bodies, there are extensive local and remote metastasises, cancer pleurisy.
Knowledge of classification of malignant tumors of lungs allows to predict a current and an outcome of a disease, the plan and results of treatment.
Symptoms of malignant tumors of lungs
Displays of malignant tumors of lungs are defined by localization, the tumor sizes, its relation to a bronchial tube gleam, complications (atelektazy, pneumonia), prevalence of metastasises. Early symptoms of malignant tumors of lungs of a malospetsifichna. Patients are disturbed by the increasing weakness, increased fatigue, periodic temperature increase of a body, an indisposition. The beginning of development of a tumor often masks under clinic of bronchitis, pneumonia, frequent SARS. Increase and a recurrence of these manifestations force the patient to see a doctor.
Further development of malignant tumors of lungs of endobronchial localization is characterized by persistent cough with a mucopurulent phlegm and is frequent a blood spitting. Pulmonary bleeding speaks about germination of a tumor in large vessels. With increase in the sizes of a malignant tumor of lungs the phenomena of violation of bronchial passability accrue - short wind develops.
Peripheral tumors of lungs proceed asymptomatically until germination in a chest wall or a pleura when there are severe pains in a breast. Late displays of malignant tumors of lungs – weakness, weight loss, a kakheksiya. In late stages cancer of a lung is followed by massive, recurrent hemorrhagic pleurisy.
Diagnosis of malignant tumors of lungs
The expressed fizikalny manifestations at early stages of an onkoprotsess in lungs are uncharacteristic. The main source of detection of malignant tumors of lungs at a stage of absence of clinic is the X-ray analysis. Malignant tumors of lungs can be incidentally revealed when carrying out preventive fluorography. At a X-ray analysis of lungs tumors with a diameter more than 5-6 mm, sites of narrowing and roughnesses of contours of bronchial tubes, an atelektaza and infiltrations are defined. In difficult diagnostic cases carry in addition out MPT or KT of lungs.
At peripheral localization of a tumor of a lung the pleural exudate is defined. The diagnosis of such malignant tumor of lungs is confirmed by a cytologic research of the exudate received by a pleural puncture or a pleura biopsy. Existence of primary tumor or metastasises in lungs can be established at a cytologic research of a phlegm. Bronkhoskopiya allows to examine bronchial tubes up to subsegmentary, to find a tumor, to carry out a fence of bronchial washouts and a transbronchial biopsy.
Deeply located tumors are diagnosed by means of a punktsionny biopsy of an easy and histologic research. By means of a diagnostic torakoskopiya or a torakotomiya operability of a malignant tumor of lungs is defined. At metastasis of a malignant tumor of lungs carry out their biopsy with the subsequent definition of histologic structure of a tumor to preskalenny lymph nodes. The remote metastasises of primary tumor of lungs come to light at ultrasonography echolocation, KT or radio isotope scanning (PET).
Treatment of malignant tumors of lungs
Radical method of treatment of malignant tumors of lungs is their expeditious removal which is carried out by thoracic surgeons. Considering a stage and extensiveness of defeat, make removal of one or two shares of a lung (lobectomy or a bilobektomiya); at prevalence of process – removal of a lung and regionarny lymph nodes (pnevmonektomiya). The torakotomiya or a videotorakoskopiya can be method of performing surgery. Single or multiple metastasises in a lung operate if removal of primary center is made.
Expeditious treatment at malignant tumors of lungs is not carried out in cases:
- impossibility of radical removal of a tumor
- existence of the remote metastasises
- heavy violations of functions of lungs, heart, kidneys, liver
Relative contraindication to expeditious treatment is the age of the patient 75 years are more senior.
In the postoperative period or in the presence of contraindications to operation it is carried out beam and/or chemotherapy. Often different types of treatment of malignant tumors of lungs combine: chemotherapy - operation – radiation therapy.
Forecast and prevention of malignant tumors of lungs
Without treatment life expectancy of patients with the diagnosed malignant tumors of lungs makes about 1 year.
The forecast at considerably performed operation is defined by a stage of a disease and a histologic type of a tumor. The most adverse results are yielded by the melkokletochny low-differentiated cancer. After operations for the differentiated forms of cancer of the I stage five-year survival of patients makes 85-90%, at the II stage - 60%, after removal of the metastatic centers - from 10 to 30%. The lethality in the postoperative period makes: at lobectomy - 3-5%, at a pnevmonektomiya - to 10%.
Prevention of malignant tumors of lungs dictates need of active fight against smoking (both active, and passive). The major measures are decrease in level of influence of carcinogens on production and in the environment. In the prevention of malignant tumors of lungs preventive radiological inspection of faces of risk group plays a role (smokers, patients with chronic pneumonia, workers of harmful productions, etc.).