Lung cancer — etiology, pathogenesis, diagnosis, treatment, prognosis

Despite the fact that basically talk about malignant tumors or lung cancer, still it is fair to cover the whole range of neoplasms of the lungs. Oncology – study of neoplasms, including benign. So just note that lung cancer is divided into two large groups:

I. Benign tumors

II. Malignant tumors

Benign tumors

Statistics benign tumors of the lung are much less malignant and account for only 7-10% of the total number of all tumors of the lungs. But, despite the initially benign nature of the tumor, some types may in time change of histological structure, to metastasize, that is, to transform into a malignant tumor. The majority of benign tumours do not "zlokacestvennoe", grow slowly and do not manifest clinically for a long time until complications occur.

Depending on the cytological structure, benign tumours are divided into Central and peripheral.

Central:

• endobronchial;
• extracranially;
• mixed.

Peripheral:

• surface;
• deep.

Peripheral tumors are more common and affect both right and left lung. Central tumors are mostly localized in the right lung.

Types of benign tumors:

1) adenoma;

2) hamartema;

3) fibroma;

4) papilloma;

5) oncocytoma;

6) vascular tumors;

7) neurogenic tumors;

8) lipoma;

9) teratoma;

10) inflammatory psevdoopujol;

11) sclerosing hemangioma.

Clinical manifestations

Benign lung cancer is found in men and in women aged 30-35 years. Quite a long period of time, the disease occurs without any clinical manifestations. Depending on the location of the tumor, the direction of growth, the degree of impaired patency of the bronchi, complications, see various symptoms.

There are three stages of flow of benign tumors:

• I-stage (asymptomatic);
• II stage (there are initial clinical manifestations);
• III stage (bright clinical picture).

Depending on the severity of the violation of bronchial patency there are also three degrees:

• The I-th stage (partial bronchostenosis);
• II stage (valve bronchostenosis);
• III stage (occlusion).

In this regard, there are three periods of clinical manifestations.

Partial bronchostenosis

The lumen of the bronchi is not changed, no symptoms except the cough and a small amount of sputum, rarely streaked with blood. The General condition of the patient good. Radiologically, the tumor is not detected. To determine the tumor is possible only with the help of bronchoscopy computed tomography.

Valve bronchostenosis

The tumor occupied a considerable part of the lumen of the bronchus, with bronchial wall is still elastic. On the exhale tumor overlaps the pressure lumen of the bronchus, and manifested symptoms of impaired ventilation of the lungs, inflammatory manifestations. The body temperature rises, shortness of breath, cough with excretion of mucous-purulent sputum, and blood, chest pain, fatigue, weakness, clammy sweat.

X-ray revealed inflammation in one or several segments throughout the lung. More accurate diagnostics can be carry out using bronchoscopic method or linear tomography.

The clinical course of the disease in the second stage gives way to relief as a result of treatment.

Bronchial occlusion

The tumour completely closes the lumen of the bronchus(obstruction of the bronchus), followed by pulmonary abscess in the area of the collapsed lobe of the lung (atelectasis), irreversible changes in the lung tissue and death.

Clinically, there is prolonged fever, cough with purulent bloody sputum, breathlessness, possible asthma, persistent fatigue, weakness. In some forms of the disease may be pulmonary hemorrhage.

Radiological findings may be partial lungs (atelectasis), its share or segment. More accurate diagnosis can only be done with the help of computer tomography.

Complications of benign tumors:

• atelectasis;
• pnevmofibros;
• pulmonary hemorrhage;
• a compartment syndrome;
• degeneration of the tumor ("zlokacestvennoe");
• metastasis etc.

Treatment of benign lung cancer is reduced only to surgical intervention. Postoperative forecasts compared with surgery for lung cancer is more favorable. High survival rate is 80-95%, relapses occur very rarely. In General, the Outlook is positive.

Malignant tumors

Lung cancer is the most common type of cancer, one in six people gets sick of them. Due to late diagnosis of the disease has a high mortality rate (85%). As a rule, patients are treated already at the last stage, when it has spread metastasis to all organs and body systems.

Topographically distinguished:

I. Central lung cancer – carcinoma of the main bronchi.

II. Peripheral lung cancer – affects the epithelium of the alveoli and small bronchi.

Forms of cancer:

• mediastinal form (the primary tumor is not detected, and the metastatic spread to lymph nodes of the mediastinum);
• disseminated form (multiple cancer foci in the lung tissue).

On histological structure of the tumor are divided into:

• small-cell;
• non-small cell lung:

1) squamous cell carcinoma of lung;

2) adenocarcinoma of the lung.

Stage lung cancer:

I. Biological, the period from the inception of the tumor before its manifestation on the radiographic images.

II. Preclinical period asymptomatic period in which a tumor is determined only radiographically.

III. Clinical period, in which along with the radiographic manifestations are already present and clinical signs.

The causes of the disease

Risk factors include:

• Smoking, including passive;
• harmful production (contact with radon, Nickel, asbestos, arsenic, chromium, cadmium);
• radiation;
• chronic forms of tuberculosis, pneumonia, bronchitis;
• heredity.

The symptoms of lung cancer

On the I St and II-nd stages of the disease symptoms of malignant lung cancer show no symptoms. And even at the third stage, patients blurry enough to describe my feelings and pain.

Clinical manifestations of lung cancer can be divided into three groups of symptoms:

• first
• second
• third

The first group of symptoms

• cough;
• sputum streaked with blood;
• shortness of breath;
• chest pain.

Cough – for endobronchial cancer is an early symptom. First, a dry cough, sometimes paroxysmal, painful, mostly at night.

Sputum – over time, the cough increases, and is allocated first thick mucous sputum, and then purulent-mucous with no odor. Appear streaks of blood, mucus becomes a crimson color.

Shortness of breath – at the beginning of the disease occurs in 10-15% of patients in the later period in 40-60% of patients. Due to shortness of breath the development of a tumor in the lumen of bronchi with atelectasislung, in the mediastinum, squeezing them.

Chest pain is the most common and severe symptom of lung cancer (40-65% of patients). Pain is usually on the affected side and rarely are subjected to the action of anesthetic drugs. Persistent, painful, rarely paroxysmal pain, often radiating to the neck, the head, the same shoulder, the stomach. The pain in the patient on the side, with a deep breath, coughing, movements of the same hand. Pain the type of pain relief should serve as a hint for metastases in the thoracic vertebrae. The fact of the appearance of pain in the early stages of the disease suggests that the size of the tumor is large enough or that the tumor touched the area of the pleura.

The second group of symptoms

Due to the fact that the tumor continues to grow rapidly, germinating in the neighboring organs, the characteristic syndromes of the superior Vena cava, Horner, compression of vessels and organs of the mediastinum, etc.

Thus, the syndrome of the superior Vena cava are observed:

• paroxysmal cough, often at night;
• shortness of breath of mixed character;
• violation of the patency of the upper airway due to compression by the tumor;
• chest pain;
• swelling of the face;
• edema of the upper half of the trunk.

For Horner's syndrome is characterized by:

• narrowing of palpebral fissure;
• constriction of the pupil;

These clinical manifestations are due to the fact that the tumor compresses the cervical sympathetic ganglion.

Syndrome of compression of the vessels and the mediastinum:

• increasing shortness of breath;
• cyanotic face;
• swelling of the neck;
• enlarged supraclavicular lymph nodes;
• swelling of the corresponding side of the chest;
• in severe cases, edema of the upper limb from the affected side;
• the change in the pulse.

The third group of symptoms

Symptoms of the third group due to multiple metastases outside the chest (in the abdominal cavity), with the corresponding symptoms. Symptoms of General intoxication and metabolic disorders:

• weakness;
• nausea;
• dizziness;
• loss of vitality;
• recurrent thrombophlebitis;
• sudden weight loss, up to exhaustion (cachexia);
• pain in bones and joints;
• psychosis.

Methods of diagnosis:

• fluorography;
• chest x-ray;
• bronchoscopy of the lungs;
• transthoracic needle biopsy of lung;
• diagnostic thoracotomy.

Treatment of lung cancer

Due to the fact that in most cases the patient seeks medical help in the last stages of the disease, treatment is complicated. But if during screening or regular medical examinations failed to detect the tumor in the preclinical period, the chances of a positive result of treatment increase significantly.

In the treatment of lung cancer, and other cancers using the combined method.

• radiation therapy;
• chemotherapy;
• surgery;
• combination therapy.

Forecasts

Due to the late diagnosis and consequently, treatment already at the last stage, when metastases have spread throughout the body or in many organs, the five-year survival rate is 10-15%.