Lung cancer - Causes, symptoms and treatment. MF.
Causes of lung cancer
Symptoms of
Diagnosis
Treatment of lung cancer
Prognosis and prevention
Consultation of a doctor
Case histories
Lung cancer is a malignant tumor that develops from the mucous membrane and glands of bronchi and lung tissue.
Causes of lung cancer
The causes of lung cancer are manifold, they can all be divided into dependent and independent of a person.
Unchanged, independent factors include: genetic predisposition - the presence of lung cancer in immediate relatives, three or more cases of lung cancer in the family, as well as the presence of several cancerous diseases of other organs( multiple forms of cancer) in this patient. In addition, the general status of the patient includes the general status of the patient: age over 50 years, the presence of chronic lung diseases( chronic bronchitis, tuberculosis, pneumonia - pneumonia, scar changes in lung tissue);as well as endocrine disorders in the body, especially in women.
Modifiable factors, that is, those that a person is able to change, include: smoking is the main and authentically confirmed cause of lung cancer. Poisonous carcinogenic( cancer-causing) substances released during the combustion of tobacco are more than 4000 species, the most known and dangerous of them are: benzpyrene, toluidine, naphthalamine, heavy metals( nickel, polonium), nitroso compounds. The above compounds, falling with inhaled cigarette smoke into the lungs, settle on the tender mucous membrane of the bronchi, as if burning it, destroying living cells, lead to death of the ciliated epithelium - the mucous layer, absorbed through the blood vessels into the blood and carried throughout the body, falling into the internalorgans, liver, kidneys, brain, causing similar changes in them.
All harmful compounds inhaled with cigarette smoke are permanently deposited in the lungs, they do not dissolve and are not discharged outside, but form aggregations, slowly covering the lungs with black soot. The lungs of a healthy person have a gently pink color, a soft porous structure, the lungs of a smoker is a rough, inelastic fabric that acquires black or blue-black color.
The most dangerous benzpyren, it has a direct damaging effect on the bronchial mucosa, already in small doses causing the degeneration of normal cells. No less dangerous and passive smoking: the smoker takes only a small part of the smoke, exhaling all the remaining 80% of the smoke in the air. For the risk of developing lung cancer, a considerable role is played by smoking experience: more than 10 years, the number of cigarettes smoked. When smoking more than 2 packs per day, the risk of lung cancer rises by 25 times.
The next factor that increases the risk of developing lung cancer is occupational exposure:
- work in factories related to asbestos production, metal grinding and forging( iron and steel smelting),
- felting, cotton and linen production,
-professional contact with heavy metals, pesticides( arsenic, chromium, nickel, aluminum);
- work in the mining industry: coal mining, radon mines, coal tar;
- the rubber industry.
Another factor is air pollution. Daily in large cities, residents inhale thousands of carcinogens, thrown into the air by plants and the combustion of automotive fuel. The inhalation of such substances invariably leads to the rebirth of the mucous membrane of the respiratory tract.
Symptoms of lung cancer
Symptoms that allow suspected lung cancer are divided into general and specific.
Common symptoms: weakness, weight loss, loss of appetite, sweating, unreasonable body temperature rises.
Specific symptoms of lung cancer can be the following:
- cough - the occurrence of an unjustified, nauseating, debilitating cough accompanies the cancer of the bronchi( central cancer).The patient, carefully observing his health, can independently notice changes in the nature of the cough: it becomes more frequent, unguarded, the character of sputum changes. Cough can be paroxysmal, without cause or associated with the inhalation of cold air, physical exertion or lying down. Such a cough occurs when irritating the mucous bronchial tree growing in the lumen of its tumor. With central lung cancer, sputum appears, usually a yellowish-greenish color, caused by concomitant inflammatory phenomena in the lung tissue.
- One of the most characteristic symptoms of lung cancer is hemoptysis( discharge of blood with sputum): the blood can be frothy, mixed with sputum, giving it a pinkish shade and bright - scarlet, intense, in the form of veins( active bleeding) or in the form of dark clots(coagulated old blood).Bleeding from the respiratory tract can be quite intense and prolonged, sometimes leading to the death of patients. But, hemoptysis can be a symptom of other lung diseases: pulmonary tuberculosis, bronchiectasis( air cavities in the lung).
- dyspnoea is associated with changes in lung tissue: concomitant tumor pneumonia, the collapse of a part of the lung due to bronchial obstruction of the tumor( atelectasis), disrupting gas exchange in the lung tissue and impairing the conditions of the ventilation of the lungs, reducing the respiratory surface. With tumors growing in large bronchi, atelectasis of the entire lung can come and complete shutting it out of work.
Left atelectaelectasis caused by central cancer
Segmental atelectasis of the upper lobe of the left lung caused by a tumor of segmental bronchi
- chest pains - is associated with the germination of a tumor of the serous lung lining( pleura) that has many painful ends, concomitant inflammatory changes in the lungs and tumor germinationin the bones, large nerve plexus of the thorax.
There is no pain at an early stage of the disease, persistent intense pains are characteristic of late, neglected stages of the tumor. Pain can be in one place or given in the neck, shoulder, arm, back or abdominal cavity, can be strengthened by coughing.
There are several clinical and radiologic forms of lung cancer:
1. central cancer - bronchial cancer, growing in the lumen of large bronchi( central, share, segmental).The tumor grows both in the lumen of the bronchus( manifested earlier), and in the surrounding bronchus lung tissue. In the initial stages, it does not manifest itself in any way, it is often not visible on fluorography and X-ray photographs, since the shadow of the tumor merges with the heart and blood vessels. It is possible to suspect the presence of a tumor by indirect signs on the roentgenogram: a decrease in the airiness of the lung site or inflammatory phenomena in the same place repeatedly( relapsing pneumonia).Characteristic cough, shortness of breath, hemoptysis, in advanced cases - chest pain, high body temperature
Central tumor of the right lung of large size
2. Peripheral cancer - grows in the thickness of the lung tissue. Symptoms are not present, it is revealed casually at inspection or at development of complications. The tumor can reach large sizes without showing itself, such patients often refuse treatment, referring to the absence of symptoms.
A type of peripheral cancer - lung cancer( Penkosta), is characterized by sprouting in the vessels and nerves of the shoulder girdle. Such patients are treated for a long time from a neurologist or a therapist with a diagnosis of osteochondrosis, plexitis and go to an oncologist with a tumor already started. A variety of peripheral cancer is also a cavity form of cancer - a tumor with a cavity in the center. The cavity in the tumor occurs as a result of the collapse of the central part of the tumor, which during growth lacks nutrition. These tumors can reach large sizes up to 10 cm or more, they can easily be confused with inflammatory processes - abscesses, tuberculosis with decay, lung cysts, which delays the formulation of the right diagnosis and leads to the progression of the disease without special treatment.
Cavity form of lung cancer: a tumor in the right lung is indicated by the arrow
3. Pneumonia-like cancer, as the name suggests, is similar to pneumonia, patients are treated for a long time with the therapist, when the effect of antibiotic treatment is not there, an assumption is made about cancer. The tumor is characterized by rapid growth, grows diffusely, not in the form of a node, occupies one or more lobes of the lung.
Pneumonia-like lung cancer with both
lung lesions of the lower lobe of the right lung
4. Atypical forms: hepatic, cerebral, bone and others. Associated with the symptoms are not the lung tumor itself, but its metastases. For the hepatic form is characteristic of jaundice, changes in blood tests, enlargement of the liver, heaviness in the right upper quadrant. Brain - often manifests by the clinic of a stroke - the arm and leg on the opposite side of the side stop working, speech disturbance, loss of consciousness, there may be convulsions, headaches, double vision. Bony - pain in the spine, pelvic bones or extremities, often there are spontaneous( not related to trauma) fractures.
5. Metastatic tumors are the screenings from the main tumor of another organ( for example, the breast, intestines, other lungs, ENT organs, prostate, and others) that have the structure of the original tumor and are capable of growing, disrupting the function of the organ. In some cases, metastases can reach huge sizes( more than 10 cm) and lead to the death of patients from poisoning with the products of the life of the tumor and disruption of the internal organs( liver and respiratory failure, increased intracranial pressure, etc.).Most often, metastases arise from tumors of the intestine, mammary gland, and the second lung, which is related to the specific circulation of the organ: a very small and highly developed vasculature, tumor cells settle in it from the bloodstream and begin to grow, forming colonies - metastases. In the lungs can metastasize a malignant tumor of any organ. Metastases in the lungs are common, I happen to be very similar to independent tumors.
Sometimes, with a full examination, the tumor - the primary source of metastases can not be detected.
Diagnosis of lung cancer
As can be seen from the above, lung cancer diagnosis is a rather complex task, tumors are often masked for other pulmonary diseases( pneumonia, abscesses, tuberculosis).In view of this, more than 50% of lung tumors are detected at large, neglected and inoperable stages. The initial stages of the tumor, and sometimes some types of neglected tumors, show no sign of themselves and are only detected by accident or by the development of complications.
To avoid this, it is necessary to undergo an X-ray examination of the lungs at least once a year.
Examination for suspected lung cancer includes:
- Fluorography - A mass screening conducted for preventive purposes among large groups of the population, reveals the coarsest pulmonary pathology: tuberculosis, lung tumors and mediastinum( the space between the lungs containing the heart, large vessels andadipose tissue), pneumonia. When pathologic changes are detected on the fluorogram, an X-ray examination of the lungs is carried out in 2 projections: the direct and lateral.
- lung radiography allows more accurate interpretation of changes in the lungs, it is necessary to evaluate both images.
- the next stage: a simple layer-by-layer X-ray tomography of the suspicious area of the lung: several layered "slices" are performed, in the center of which there is a pathological focus.
- computed tomography of the chest or magnetic resonance imaging with intravenous contrast( intravenous injection of intravenous radiocontrast): allows to perform stratified sections and examine the pathologically altered focus in more detail, distinguish tumors, cysts or tuberculous changes from one another according to characteristic features.
- bronchoscopy: used to detect tumors of the bronchial tree( central cancer) or germination in the bronchi of large peripheral lung tumors, this study allows you to visually detect a tumor, determine its boundaries, and, most importantly, perform a biopsy - to take a piece of the tumor for examination.
- In some cases, so-called oncomarkers are used - a study of blood on proteins produced only by a tumor and absent in a healthy body. For cancer of lung cancer markers are named: NSE- is used to detect small cell cancer, SSC marker, CYFRA- to identify squamous cell carcinoma and adenocarcinoma, CEA is a universal marker. But they all have low diagnostic value and are usually used in treated patients to detect metastases at the earliest possible time.
- sputum examination - has low diagnostic value, allows to suspect the presence of a tumor in detecting atypical cells.
- Bronchography( introduction of a contrast agent into the bronchial tree): an outdated method, now it is replaced by bronchoscopy.
- thoracoscopy( insertion into the pleural cavity through the punctures of the camera for examination of the surface of the lungs) - allows, in unclear cases, to interpret those or other changes in the lungs visually and perform a biopsy.
- tumor biopsy under the control of a computer tomograph is performed in unclear cases.
Unfortunately, there is no universal method of examination that allows one hundred percent to distinguish malignant lung tumors from other diseases, since the cancer can be masked for another pathology, taking into account this, the whole complex of examination is used. But if the diagnosis is not fully understood, resort to a diagnostic operation so as not to miss a malignant tumor.
Stage( degrees) of lung cancer:
Stage 1: a tumor in the lung no more than 3 cm in size or a bronchus tumor spreading within one lobe, there are no metastases in nearby lymph nodes;
Stage 2: a tumor in the lung more than 3 cm, sprouts the pleura, blocks the bronchus, causing atelectasis of one lobe;
Stage 3: the tumor passes to adjacent structures, atelectasis of the entire lung, the presence of metastases in the nearby lymph nodes-the root of the lung and mediastinum, supraclavicular;
Stage 4: the tumor sprouts surrounding organs-the heart, large vessels or fluid in the pleural cavity( metastatic pleurisy).
Treatment of lung cancer
In the treatment of lung cancer, like any other cancer, the leading and only method that gives hope of recovery is surgery.
There are several options for lung surgery:
- Lung removal - meets all the principles of lung cancer treatment.
- Edge resection( removal of tumors only) - used in the elderly and patients with severe concomitant pathology, for whom a large operation is dangerous.
- Removal of the entire lung( pneumonectomy) - for tumors of 2 stages for central cancers, 2-3 stages for peripheral.
- Combined operations - with the removal of part of the nearby, involved in tumor organs - the heart, vessels, ribs.
When detecting small cell cancer, chemotherapy is the leading method of treatment, since this form of the tumor is most sensitive to conservative methods of treatment. The effectiveness of chemotherapy is high enough and allows you to achieve a good effect for several years.
For the treatment of lung cancer, platinum preparations are used - the most effective at the moment, but also no less toxic than others, therefore they are introduced against the background of a large amount of liquid( up to 4 liters).
Another method of treatment is radiation therapy: it is used for non-detectable lung tumors of stage 3-4, it allows to achieve good results in small-cell carcinoma, especially in combination with chemotherapy. The standard dosage for radiation treatment is 60-70 gray.
Treatment of lung cancer with "folk remedies" is unacceptable, the use of toxic substances can lead to poisoning an already weakened tumor of the body and aggravate the patient's condition.
Prediction for lung cancer
Prediction for lung cancer depends on the stage and histological structure of the lungs:
In small-cell cancers, the prognosis is better than with other forms of cancer, as it is more sensitive to chemotherapy and radiation treatment than other forms of cancer.
A favorable outcome is possible in the treatment of cancer of the initial stages: 1-2.With tumors of the third and fourth stages, the prognosis is extremely unfavorable and the survival rate does not exceed 10%.
Prevention of lung cancer
Prevention, first of all, consists in the refusal of smoking and work in harmful conditions there, the use of respirators and protective equipment. Preventive performance of fluorography annually for the detection of lung tumors in the initial stages. For heavy smokers it is mandatory to perform bronchoscopy 1-2 times a year.
Consultation of oncologist on lung cancer:
Question: How often does lung cancer occur and who is at higher risk of getting sick?
Answer: Cancer of the lung is mainly caused by men. This is due, in the first place, to smoking, common among most men, as well as to hard working conditions, work on harm and plants. With the spread of smoking among women, the incidence of lung cancer also increases.
Question: How to identify lung cancer at an early stage?
Answer: For this, an annual examination is mandatory - fluorography or lung radiography. It is advisable to perform bronchoscopy annually for smokers.
Question: What is the alternative to the operation?
Answer: The only method of treating lung cancer is surgery. In weakened and elderly patients, with contraindications to surgery, an alternative is chemo-radiation treatment, which provides a life expectancy with a good response to treatment for 5 years or more.