• Lung Cancer Symptoms

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    Lung cancer is the most common form of a tumor in men. Men are affected by this form of cancer at least 4 times more often than women. The growth of malignant cells in the lungs is one of the leading causes of death from cancer. Types of primary of lung cancer ( cancer that occurs directly in the lungs) can be grouped into two categories: small cell carcinoma and large cell carcinoma. Large cell carcinoma includes several types of cancers in the lungs and is responsible for almost 80 percent of cases of lung cancer. The prospect of developing the disease is bad for all types of lung cancer, unless the cancer is detected very early and can be surgically eliminated. Small cell carcinoma is most difficult to treat because it is often diagnosed after the disease has spread to many organs. Although small cell carcinoma is very responsive to chemotherapy and radiation, it is usually re-discovered in patients throughout the year.

    Primary lung cancer can spread substantially to any organ and cause a variety of symptoms that disable a person. Most cases of the disease are observed from 45 to 75 years, after many years of smoking or contact with other pollutants. In many cases, the disease can be prevented. More than 90 percent of diseases are associated with smoking. Non-smokers are at low risk of disease, and for those who quit smoking even after many years of smoking, the risk is greatly reduced. Lungs are also the usual place of manifestation of secondary cancer, which spreads from other organs. Such tumors are almost always incurable. How to treat cancer with folk remedies look here.

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    Initial signs of lung cancer in many cases resemble manifestations of the most common pulmonary diseases, as a result of which they do not cause serious concern of patients who are inclined to wait for their spontaneous disappearance. The most constant sign are attacks of painful, nauseous cough, at first dry, and then with scanty mucus-purulent sputum, and, most importantly, a small admixture of blood in the form of specks or veins in sputum. Blood is usually taken for the manifestation of tuberculosis, and often the patient, without going to the doctor, becomes on the false path of his own diagnosis and treatment, especially if he has had any manifestations of pulmonary tuberculosis, which does not exclude the possibility of developing cancer. That is why patients with lung cancer are usually detected in tuberculosis dispensaries.

    Together with a cough that may not be pronounced, dyspnea occurs, independent of physical stress, deep chest pains and a rise in temperature of a non-permanent character. It should be noted that all these signs can be so mild that they remain undetected for a long time and only general weakness and fatigue, for which there are apparently no obvious causes, give out the presence of an internal disease.

    Therefore, the appearance of at least one of the above signs, especially in elderly men, should raise suspicion of the possibility of developing lung cancer and serve as an excuse for immediate medical attention without resorting to home treatment for an alleged flu, bronchitis and the like.

    In recent years, due to the use of various diagnostic methods - radiologic, endoscopic, morphological, ultrasound, surgical - it was possible to develop a harmonious system of measures, the purpose of which is to establish an accurate diagnosis of lung cancer. These measures include the following diagnostic methods:

    1. Clinico-anatomical classification of lung cancer( Savitsky AI, 1957):

    I. Central Cancer:

    II.Peripheral cancer:

    III.Atypical forms associated with the characteristics of metastasis( mediastinal cancer, miliary carcinomatosis, etc.).

    The above classification does not lose its practical value even at present, although many international classifications do not provide for this division of tumors.

    The development of the problem of X-ray-negative cancer showed the inconsistency of the restriction of the central form of the tumor to segmental bronchi. Among patients with X-ray negative primary cancer, ie pre- and microinvasive, 13% of the tumor was located within the subsegmental bronchus, but in all characteristics corresponded to the central form, which allowed endoscopic treatment with good long-term results for patients of this group.

    Taking into account the difficulties of preoperative differential diagnostics of peripheral and central peribronchial cancers of the subsegmental bronchus, which cause the appearance of nodal formation in the middle zone of the lung on the X-ray patterns, A. Kh. Trakhtenberg and V. I. Chissov( 2000) consider the isolation and strict assignment of X-ray bronchial tumorsthis order to the central form and offer their classification.

    2. Clinico-anatomical classification of lung cancer( Trakhtenberg A. Kh., Chissov VI, 2000):

    I. Central form - tumor of subsegmental, segmental, lobar, main bronchus.

    II .Peripheral form - tumor of the lung parenchyma.

    III.The mediastinal form is a multiple metastatic lesion of the intrathoracic lymph nodes without the established localization of the primary tumor in the lung.

    IV.Disseminated form - multiple lung lesions without established localization of the primary tumor( lung carcinomatosis) in other organs.

    Peripheral form of cancer. Peripheral lung cancer in 70-80%.cases is spherical, located in the lung parenchyma. With such a nodular form of cancer, the tumor does not have a capsule and is often located in the dermal zone. With subpleural localization of the tumor, the pleura above it is thickened, in the center there is an entrainment. The tumor can be fixed to the chest wall and with further growth sprouts into the parietal pleura, fascia, intercostal muscles, ribs, causing their destruction.

    The cavity form of peripheral lung cancer is rare - in 2-5% of cases. Necrosis and decay in the center are usually observed with a tumor size of more than 5 cm. The walls are thickened due to the tuberosity of the inner surface. Very rarely the cavity is associated with the lumen of one of the medium-sized bronchial tubes and does not contain liquid. Insufficient blood circulation creates conditions for the disintegration of lung tissue with destruction of the vessel wall, resulting in a threat of bleeding.

    Pneumonia-like cancer occurs in 3-5% of cases. It has the form of an infiltrate in the pulmonary parenchyma without clear boundaries. The spread of the tumor occurs along the alveolar courses and bronchioles. Macroscopically, such a cancer is most often bronchioloalveolar and, according to roentgenological signs, resembles pneumonia.

    Bronchioloalveolar cancer( BAP). is classified as a highly differentiated lung adenocarcinoma, which is usually located in the peripheral parts of the lung and is characterized by intra-alveolar growth, with the alveoli serving as a stroma.

    A. X. Trachtenberg and V. I. Chissov classify this cancer as follows:

    I. Localized form:

    II.Common form:

    Central form of cancer. An important feature in the characterization of central lung cancer has a tumor growth feature.

    Exophytic( endobronchial) cancer is characterized by tumor growth in the bronchus lumen. In this case, the tumor most often has the appearance of a polyp, the tuberous surface of which is completely devoid of normal epithelium.

    Endophytic( exobronchial) cancer is characterized by predominant growth in the thickness of the pulmonary parenchyma. With this form of growth, the permeability of the bronchus is maintained for a long time.

    Branched cancer with peribronchial growth is characterized by a muff-like arrangement of the tumor around the bronchus. The tumor, as it were, repeats its shape and spreads in the direction of the bronchus, evenly narrowing its lumen.

    In practice, a mixed pattern of tumor growth with predominance of one or another component is more common. Precisely establish the nature of tumor growth is possible only during surgery or pathoanatomical research. In this regard, the nature of tumor growth, established morphologically in the study of macro preparation, should be reflected in the final morphological diagnosis.

    The mediastinal form of cancer is characterized by metastases to the lymph nodes of the mediastinum with an unexplained primary cancer focus. Usually the upper and lower( bifurcated) tracheobronchial and paratracheal lymph nodes are affected. The lesion can be one- or two-sided. The primary focus can sometimes not be detected even at the autopsy.

    Primary carcinomatosis is a bilateral lung cancer in the form of multiple nodes of different sizes.

    The most characteristic type of growth of central tumors is endobronchial - 66,6%, less often mixed - 14,8% and peribronchial - 18,4%.In a shared bronchus, cancer occurs in 52% of cases, segmental - in 33,5%, in subsegmental - in 14,8% of cases, in the main and intermediate bronchus - in 11,1%.Sprouting of the primary tumor into neighboring structures and organs is noted in 31.9% of cases. The most frequent pathological process involves parietal pleura, pericardium, major vessels of the lung root, mediastinum, diaphragm.

    An anatomical form of central cancer growth is important in characterizing the tumor and determining the prognosis. It is impossible to accurately establish the character of growth only on the basis of clinical-x-ray and bronchoscopic data without taking into account the results of studying the drug obtained during the operation and pathoanatomical research.

    The following types of carcinomas are distinguished depending on the rate of growth:

    Studies conducted by NA Karaseva and E. Ya. Drukin( 1992) showed that women are dominated by peripheral tumors with a slow growth rate( 42.1%), thenAs for men, the proportion of slowly growing carcinomas is only 25.1%.This is primarily due to the predominance of highly differentiated carcinomas in women, characterized by a slow growth( 52.1%), in men, such tumors constitute no more than 17.1%.

    3. International histological classification of lung tumors( WHO, Geneva, 1981).

    In 2004, in the next edition of the Blue Books, WHO proposed a new classification of lung tumors, edited by W. D. Travis [et al.], Based on the latest morphological developments.

    In a comparative analysis of this variant of classification with previous analogues of WHO( Olkhovskaya VM, 1993; Travis WD, 1999) and the classification of AFIP in North America, it becomes evident that there are fundamental changes in the distribution of the material among groups, its descriptive characteristics and the identification of-or new forms did not happen. There is either a regrouping, or a rearrangement of various nosological units from the heading to the heading, pleural tumors have been treated separately, but the whole "set" of certain neoplasms in a generally very extensive "kaleidoscope" called "lung tumor" is preserved. However, the following merits of the latter classification of lung cancer should be attributed to WHO: a clearer characterization of squamous cell dysplasia and cancer in situ, a description of the latest achievements of immunohistochemistry in this area, a more thorough analysis of neuroendocrine neoplasms. Currently, large-cell neuroendocrine carcinoma is perceived as a histological variant of highly differentiated non-small cell lung cancer with signs of neuroendocrine differentiation of immunohistochemical neuroendocrine markers. To the class of large cell carcinomas include several variants, including large-cell neuroendocrine and basaloid carcinomas, which are characterized by an unfavorable prognosis. And, finally, a new class of lung cancer has been identified, characterized by a wide range of cell differentiation( from epithelial to mesenchymal), called carcinomas with pleomorphic, sarcomatoid or sarcomatous elements. Immunohistochemical method and electron microscopy are valuable methods of diagnosis and subclassification of histological subtypes, however, most lung tumors can be classified using light microscopy only( Matsko DE, Zhelbunova EA, Nameinov EN, 2007).

    Preinvasive formations include squamous cell carcinoma in situ, atypical glandular hyperplasia and diffuse idiopathic hyperplasia of neuroendocrine cells.

    Squamous cell dysplasia and cancer in situ can be an independent pathology, but can act as a component of invasive cancer. It should be borne in mind that the term "preinvasive" does not mean a mandatory transition to invasive cancer. The following phases of epithelial transformation into squamous cell carcinoma are considered: normal epithelium - & gt;hyperplasia - & gt;squamous cell metaplasia - & gt;dysplasia - & gt;cancer in situ - & gt;squamous cell carcinoma.

    When considering the degree of severity of dysplasia( moderate, moderate, severe) and that it has already reached the incidence of cancer in situ, the thickness of the epithelial layer, cellular and nuclear polymorphism, cell size changes, anisocytosis, dyskaryosis( histological differentiation inthe desquamation of cells with a normal cytoplasm and hyperchromic nuclei), cell orientation, and mitotic activity. With moderately expressed dysplasia, mitoses are rare or absent altogether, mediated - the mitosis figures are localized in the lower third of the epithelial layer, in severe dysplasia - in the lower two-thirds, and in non-invasive cancer - throughout the entire epithelium.

    Diffuse idiopathic hyperplasia of neuroendocrine cells can be represented by focal congestion of neuroendocrine cells, small nodules or more spatially pronounced proliferation of these neuroendocrine cells.cells, sometimes these outgrowths are released into the lumen of bronchioles, up to the complete obturation of the latter. In cases where tumor proliferates acquire mestdo-destruiruyuschy growth with a breakthrough of the basal membrane and the formation of fibrotic stroma, they are traditionally referred to as "tumors." In cases where the neoplasm exceeds 5 mm, they are classified as carcinoids

    Squamous cell carcinoma of the lung is diagnosed in 40.8-48.0%Ploskotsletochnaya carcinoma: a tumor that arises from the bronchial epithelium and is characterized by some degree of keratinization and / or the presence of so-called intercellular bridges. Some forms of low-grade squamous cell carcinoma differ in the absence of layers of cancer parenchyma, loose growth of malignant epitheliocytes, extensive inflammatory infiltration. At the light-optical level with routine staining, it can be difficult to distinguish them from an inflammatory variant of a malignant histiocytoma or Hodgkin's disease. Cellular and nuclear polymorphism in these cases is sometimes extremely pronounced, up to the formation of giant cells.

    Approximately half the time, some squamous cell carcinomas contain an alcian-positive mucosal material. Sometimes in its cells there are neurosecretory granules.

    The group includes the actual squamous, papillary, light cell, small cell and basaloid variants.

    Differential diagnosis is carried out with large-cell cancer( in the latter there is no keratinization), the papillary variant is often( especially in small biopsy specimens) difficult to distinguish from papilloma( should be guided by invasive growth and cytological signs of malignancy).With a massive lesion of the anterior mediastinum, one should remember the possibility of squamous cell carcinoma of the thymus gland. In addition, squamous metaplasia with atypia can occur in the so-called diffuse alveolar damage( DAD), in this case the presence of hyaline membranes, the expressed connective tissue proliferation in the interalveolar septa and the hyperplasia of pneumocytes - changes characteristic of DAD.

    Depending on the maturity of the tumor epithelium and the production of keratin, high, moderately and low-grade cancer is distinguished.

    Ploskokletogny high-grade( keratinizing) cancer is 2.4% and is represented by large polygonal or spike-shaped cells resembling cells of the cover epithelium, located in the form of cells and strands. The cytoplasm is well expressed, the nuclei are rounded with distinct nucleoli. An important distinguishing feature of this cancer is the formation of keratin with the formation of horny "pearls".

    Ploskokletochny moderately differentiated( neorogovevayuschy) cancer is 48.8% and is characterized by a large polymorphism of cells and nuclei, a significant number of mitoses. Characteristically, the presence of intercellular bridges and keratin in some cells.

    Squamous low-grade( malodifferentiated) cancer is 28.8% and is represented by polymorphic polygonal cells, sometimes somewhat elongated. The core is fusiform or round, many mitoses. Keratin is found only in separate cells. In different parts of the tumor, cells of spindle cell carcinoma can be detected. Some forms of low-grade squamous cell carcinoma differ in the absence of layers of cancer parenchyma, loose growth of malignant epitheliocytes, extensive inflammatory infiltration. At the light-optical level with routine staining, it can be difficult to distinguish them from an inflammatory variant of a malignant histiocytoma or Hodgkin's disease. Cellular and nuclear polymorphism in these cases is sometimes extremely pronounced, up to the formation of giant cells.

    Spindle cell carcinoma is a biphasic cancer. The coeval cell variant is caused both by the presence of the squamous cell and the spindle cell component, which arises from the squamous cell. The coeval cell component is characterized by a sarcoma-like structure, often with marked polymorphism and the presence of mitoses. The prognosis of the disease with spindle cell cancer is more favorable than in other forms of squamous cell carcinoma.

    The difference in the frequency of detection of different clinico-anatomical forms of squamous cell lung cancer is clearly expressed: in 2/3 of cases squamous cell carcinoma forms the central form of lung cancer, i.e., it develops in larger bronchi, in less than 1/3 cases - peripheral. In this regard, squamous cell carcinoma is more accessible for examination with endoscopic examination and is more often diagnosed cytologically than other types of neoplasms. Tumors of this structure tend to form massive foci of necrosis and the formation of cavities, which causes a more frequent occurrence of bleeding from the tumor than with other types of lung cancer. In squamous cell carcinoma, the body can respond with lymphoid infiltration of the stroma, so even highly differentiated squamous cell carcinomas can give metastases predominantly to the inner lymph nodes, often confined to the thoracic cavity.

    Glandular cancer( adenocarcinoma) is a malignant epithelial tumor, the cellular elements of which form tubular, acinar or papillary structures that produce mucus. Determination of the degree of differentiation of adenocarcinoma can be carried out only for acinar and papillary subtypes. Adenocarcinoma is a predominantly peripheral tumor and more often than other types of lung cancer, it is combined with scar changes in the lung tissue( scar tissue).

    Glandular cancer( adenocarcinoma) is diagnosed in 12.0-35.4% of patients, including papillary adenocarcinoma in 68.5%, tubular adenocarcinoma in 31.5%.Highly differentiated adenocarcinoma is observed in 3.0% of cases, moderately differentiated - in 58.3%, low-grade - in 38.7-46.0%.

    Highly differentiated adenocarcinoma is represented by glandular structures in the form of tubules or papillary structures. Cells are usually cylindrical, sometimes cubic or prismatic, with rounded or elongated cores, many mitoses. As the degree of cell differentiation decreases, polymorphism becomes more pronounced.

    Moderately differentiated adenocarcinoma also consists of large glandular cells of a cubic or prismatic shape, with abundant cytoplasm, rounded or oval nuclei.

    On the site of a solid structure of the cell polygonal shape. There are many mitoses. Fields of small rounded cells with hyperchromic nuclei are found.

    The low-differentiated( .mallodifferentiated) adenocarcinoma consists of large polymorphic cells with ugly light nuclei, a well visible nucleolus and abundant cytoplasm. The iron-like structures are guessed at individual sites of the tumor.

    Adenocarcinomas are predominantly peripheral tumors and, more often than other lung cancers, are combined with scar changes in lung tissue( scarring).

    Bronchioloalveolar cancer is the primary highly differentiated malignant epithelial tumor, which is usually localized in the peripheral parts of the lung and is characterized by intra-alveolar growth. Bronchioloalveolar cancer is about 3% and is associated with previous inflammatory and proliferative changes in the lungs, leading to the formation of fibrosis - scar. Depending on the degree of differentiation, two main types are distinguished: a highly differentiated mucus and a highly differentiated non-lysing.

    In practice, in a number of cases, a third type of tumor is also isolated: a little differentiated, in which tumor cells show signs of anaplasia.

    There is also a mixed type of this cancer, when it can not be attributed to the first two types by histological structure.

    Slime-forming bronchioloalveolar cancer is diagnosed in 41-60% of cases, non-mucosal - in 21-45% and mixed - in 12-14% of cases.

    Small cell carcinoma is a special form of lung cancer, characterized by high biological aggressiveness, unique morphological structure and the response arising in response to various antitumour effects. Small cell lung cancer accounts for 20-25% of patients with lung cancer. In the United States, about 28,000 new cases are diagnosed each year. Among the variants of undifferentiated lung cancer, which are characterized by a particularly malignant course, small cell carcinoma is isolated into a separate clinico-morphological unit.

    Ovarian cancer of the lung. It is represented by homogeneous small cells of various forms, which are usually larger than lymphocytes, with hyperchromic dense rounded or oval nuclei and extremely sparse cytoplasm, which gives the impression of naked nuclei. The nucleoli are not detected, the chromatin is diffuse. Usually, in ovarian cancer, lymphoid infiltration is not defined or expressed weakly.

    Intermediate-cell lung cancer. It is represented by small cells whose nuclei are similar to those of ovarian cancer, but their cytoplasm is more pronounced( enriched).Tumor cells of large size, can be polygonal or spindle-shaped, less monomorphic. When the cells in both components are detected in the tumor, it is regarded as ovarian cancer. Tumors in which a combination of cells of an intermediate type with the cellular elements of large cell carcinoma are found, are regarded as an intermediate-cellular cancer.

    Combined small cell carcinoma. It is a tumor in which there is a component represented by elements of oat cell carcinoma in combination with elements of squamous cell carcinoma and / or adenocarcinoma. This subtype is found in 1-3% of patients with small cell lung cancer, and with this subtype there are components of spindle cell carcinoma, giant cell carcinoma and carcinosarcoma. In patients with combined small cell lung cancer, there is a different clinical course of the disease, a response to treatment and prognosis than other forms of small cell lung cancer.

    A wide study of various aspects of small cell lung cancer allowed to obtain data on the basis of which promising directions of improvement of treatment results of this severe rapid disease were determined. Discussion about whether this form of lung cancer was originally a locoregional or primary-generalized tumor continues to this day. However, most researchers believe that small cell lung cancer should be divided into a local and common stage of the disease. In this regard, at present approaches to its treatment are changing.

    This histological type is characterized by rapid development of the disease, early and widespread metastasis. By the time the diagnosis is established, metastases to distant organs and bone marrow are often determined.

    Morphological diagnosis of small cell lung cancer before treatment is possible in 93-98% of patients, diagnostic errors are noted in 3-7% of cases. It should be noted that there are difficulties in differential diagnosis with carcinoid tumors, malodifferentiated non-small cell lung cancer, small cell lymphocytic lymphoma and even with chronic inflammation. A definite value in this situation is a cytological study of the material obtained from bronchoscopy, immunohistochemical examination of the material, and electron microscopy.

    Large cell carcinoma is a malignant epithelial tumor whose cellular elements are characterized by large nuclei, expressed by nucleoli, abundant cytoplasm and marked boundaries, but without the typical signs of squamous cell carcinoma, adenocarcinoma or small cell cancer.

    Large cell lung cancer accounts for 9% of all lung cancers and refers to undifferentiated forms of cancer. It is observed in central and peripheral lung cancer. Microscopically identify the components of malodifferentiated adenocarcinoma or squamous cell carcinoma, especially when examining the surgical material, and in such cases the diagnosis is lung cancer, non-small cell type. Finally, the morphological type of cancer is established using electron microscopy of immunohistochemistry.

    According to the International Histological Classification of Lung Tumors, five tumor variants are distinguished: giant cell, clear cell, spindle cell, lymphoepithelial-like and large-cell neuroendocrine. The prognosis for these subtypes of large cell carcinoma is poor, and only at stages the operation produces relatively satisfactory results( Rush W. [et al.], 1995).

    Iron-squamous cell carcinoma is a malignant tumor, represented by elements of squamous and glandular cancer. It is diagnosed in 0,6-2,3% of cases in all patients with lung cancer. There are three subtypes of this cancer: mainly consisting of elements of glandular type, mainly squamous cell type and mixed type.

    The tumor should contain a mixture of components of squamous cell carcinoma and adenocarcinoma, only in 5% of cases one of them prevails. The degree of malignancy and the tendency to metastasis in combined tumors are determined by cells with benign stage of differentiation. Some authors indicate a short lifespan in patients with ferruginous squamous cell carcinoma, others have not established a difference in prognosis compared to other types of non-small cell lung cancer( Sri-dhar, K.S. [et al., 1992].

    Cancer of the bronchial glands. Tumors included in this group correspond to the type of salivary gland cancer and are divided into three subtypes: adenocystic cancer( cylinder), mucoepidermoid cancer and pleomorphic mixed tumors.

    Adenokistozny cancer( cylinder) - malignant epithelial tumor of a characteristic cristiform structure. In adenokistoznom cancer can also be determined by other types of location of tumor cells. The tumor has a more pronounced tendency to metastasize and infiltrative growth than mucoepidermoid lung cancer. It is localized mainly in the trachea, the main bronchi, and rarely in the lobes.

    Mucoepidermoid cancer is represented by epidermoid, mucus-forming cells and intermediate-type cellular elements. Tumor cells are characterized by a more benign structure, and tumor growth is less aggressive. Mucoepidermoid cancer is one of the rare tumors. Localized in the proximal part of the tracheobronchial tree, the peripheral form is observed in 14% of patients.

    Carcinoid tumors. They are referred to tumors of the endocrine system, arising from cell elements such as Kulchitsky cells. Carcinoids are divided into the following groups: typical and atypical carcinoids, small cell carcinoma and large-cell neuroendocrine cancer. This cancer occurs in 1-2% of all lung neoplasms. The variants listed differ in different malignant potentials in the form of the severity of infiltrative growth, the rate of progression, the ability to metastasize.

    A highly differentiated( typical) carcinoid microscopically corresponds to a neoplasm with structures of the alveolar, tubular, trabecular, solid structure. Tumor cells are polygonal with a granular eosinophilic or light cytoplasm and regular oval nuclei. Mitosis is rare.

    Moderately differentiated( atipigous) carcinoid is histologically characterized by an increase in cellularity, the appearance of polymorphism of cells and their nuclei, the presence of mitoses, the increase in the volume of nuclei and the nuclear-cytoplasmic ratio. There are foci of discomplexation of trabecular, tubular, solid structures. Signs of cellular and structural atypia, as well as invasive growth in these tumors, are noted not only microscopically, but also macroscopically.

    Low-differentiated( anaplastic and combined) carcinoid is characterized by pronounced structural and cellular atypia, the presence of necrosis and infiltrative growth. With a combined subvariant, the structures of anaplastic carcinoid are combined with cancer structures, including squamous cell and adenocarcinoma.

    According to A. Kh. Trakhtenberg, V. I. Chissova( 2000), metastases with highly differentiated carcinoids were found in 3% of patients, moderately differentiated - in 17.5% and in low-grade - in 74%.The prognosis in patients with carcinoid tumors correlates with the variant of carcinoid, the stage of the patient's disease, the size of the tumor, the state of the intrathoracic lymph nodes, and the invasion of the vessels.

    Primary malignant non-epithelial lung tumors. The concept of "primary malignant non-epithelial lung tumors" unites various neoplasms in histogenesis. Until 1975 many other malignant non-epithelial tumors( malignant lymphomas, carcinosarcoma, etc.) were described in many publications under the term "lung sarcoma".

    In men, squamous cell carcinoma of the lung is 66%, adenocarcinoma is 20.1%( including a highly differentiated adenocarcinoma - 44.9%), bronchioloalveolar cancer is 2.9%.In women, these figures are respectively 28.8, 40.9( 70.4) and 16.7%.Thus, in the structure of lung cancer in women predominates glandular cancer, whereas in men the main histological species is squamous cell carcinoma( Karaseva NA, Drikin E. Ya., 1992).

    R. Azikbekov( 1989) studied the features of metastasis of various histological forms of lung cancer on the autopsy material of 162 patients. In squamous cell cancer, metastases were detected in 71.8% of cases, including 43.7% in the regional lymph nodes, 18.3% in the distant lymph nodes, and 29.6% in the liver.

    In lung adenocarcinoma, metastases were registered in 79.4% of cases, including 35.3% in the regional lymph nodes, 32.3% in the distant lymph nodes, and 38.2% in the liver.

    Most metastasizes small cell lung cancer( 88.2% of cases), including regional lymph nodes - 62.7%, distant lymph nodes - 27.4%, liver - 52.8%.

    In large cell cancer, metastases are noted in 83.7% of patients.

    Metastases in the adrenal glands with small cell carcinoma and adenocarcinoma are registered 2 times more often than with squamous cell carcinoma. The lung most often metastasizes adenocarcinoma. In the brain, there is an ovate cell subtype of small cell lung cancer( 46.6%), whereas in the case of an intermediate subtype, the metastasis of this localization is observed in 11.1% of patients.

    6. Clinical classification of lung cancer.

    I stage - a tumor up to 3 cm in diameter of segmental, lobar or peripheral bronchi without affection of the visceral pleura. Metastases in regional lymph nodes are absent.

    II stage is a tumor from 3 to 5 cm in diameter of the segmental, lobar or peripheral bronchus that does not extend proximally beyond the lobar bronchi and without the germination of the visceral pleura, or a tumor of the same or smaller dimensions with the germination of the visceral pleura. Metastases in regional lymph nodes are absent.

    IIbstadia - a tumor of the same or a lesser degree of local spread with single metastases in the bronchopulmonary lymph nodes.

    IIIa stage - a tumor of more than 5 cm in diameter of the lobar or peripheral bronchus that does not extend proximally beyond the lobar bronchus and does not germinate the visceral pleura, or a tumor of the same or lesser dimensions that extends beyond the lobe( extends to the neighboring lobar, intermediate or major bronchus,sprouts the visceral pleura, grows into a neighboring lobe) and / or ingrown on a limited area in the parietal pleura, pericardium, diaphragm.

    IIIb stage - a tumor of the same or a lesser degree of local spread with multiple metastases in bronchopulmonary lymph nodes and / or single or multiple removable metastases in the lymph nodes of the mediastinum.

    IVa stage is a tumor of any size and localization in the lung that grows into vital anatomical structures or organs( the superior hollow vein, aorta, esophagus), and / or with extensive spread to the chest wall, diaphragm, mediastinum. Regional metastases are absent.

    IVb stage - a tumor of the same degree of local spread with any variants of regional metastasis or a tumor of a lesser degree of local spread with unrecognizable regional metastases, pleural dissemination, specific pleurisy, or a tumor of any degree of local spread with clinically defined distant metastases.

    7. Classification of lung cancer using the TNM system( ICD-OC34).

    Classification rules

    The classification is applicable only for cancer. There should be a histological confirmation of the diagnosis, allowing to determine the morphological subtype of the tumor.

    The following methods are used to evaluate categories T, N and M:

    T-categories Physical examination, imaging techniques, endoscopy and / or N-type surgical examination Physical examination, imaging techniques, endoscopy and / or M-category surgical examination Physical examination,methods of visualization and / or surgical examination.

    Anatomical regions and parts

    Regional lymph nodes

    Regional lymph nodes are the intrathoracic, premolar and supraclavicular lymph nodes.

    TNM - clinical classification

    T - primary tumor

    N - regional lymph nodes

    M - distant metastases

    G - histopathologic differentiation

    Grouping in stages

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