A cancerous tumor, regardless of its location, poses a serious danger to human life. However, in the early stages the pathology is highly treatable. Timely therapy can prolong the patient’s life for a long time.

The problem is that it is not always possible to detect the disease at stage 1, since its symptoms are similar to those of ordinary flu. Often the clinical manifestations are very mild.

Therefore, it is important to pay attention to your health and notice even minor changes in your condition in a timely manner. After all, these warning signs often indicate the presence of a serious problem.

Symptoms of early stage bronchial cancer

Initially, the clinical picture of the disease is quite blurred; there are only minor manifestations of pathology that are not specific (that is, characteristic of this particular problem).

The first signs of the development of bronchial cancer include:

1. Appearance of dry cough, which bothers the patient at certain times, most often at night or after waking up. The cough is periodic, paroxysmal in nature.
2. Deterioration well-being, weakness, lack of performance. A person cannot perform any physical work for a long time and feels drowsy.
3. Decline appetite or its complete loss.

Symptoms of bronchogenic cancer at an early stage of development of the pathology are similar to the manifestations of other, less dangerous diseases, so during this period the patient does not rush to see a doctor, but starts taking medications (for example, for influenza, ARVI). This not only does not contribute to healing, but also significantly worsens the course of the pathological process, leading to faster and more intense tumor growth.

Further development of the clinical picture

Over time, the pathology develops, more pronounced and specific symptoms appear in women and men. First of all, this is an intensifying cough, attacks of which can occur regardless of the circumstances and time of day.

Often such a cough is accompanied by copious expectoration (that is, it takes on a wet form). Bloody elements are found in the sputum, which indicates significant damage to the organs of the respiratory system (development of metastases).

Another characteristic sign is the development of shortness of breath. Respiratory disturbances become more pronounced as the tumor grows.

A large tumor blocks the respiratory lumen, as a result of which the supply of oxygen is disrupted, which is accompanied by symptoms such as dizziness, disruption of the functioning of individual organs and systems, and the development of asthma attacks (and attacks occur not only during moments of physical activity, but also at rest).

Cancerous tumors tend to grow rapidly. Over time, the neoplasm affects not only the bronchi, but also neighboring tissues. This leads to pain in the chest. The pain syndrome intensifies at the moment of inspiration, at which a characteristic noise and whistle also appears.

Often the patient notices sudden changes in body temperature. Hyperthermia develops without any apparent reason; the elevated temperature lasts for several days, after which the readings return to normal. After some time, the temperature rises again.

The terminal stage of tumor development is characterized by the addition of such signs as rapid heartbeat, disruption of the process of digesting food (this occurs when the esophagus is compressed by an overgrown tumor), accompanied by nausea, heaviness in the abdomen immediately after eating.

The development of metastases at a late stage of cancer contributes to the appearance of various signs. These may be headaches, hearing and vision impairment, pathologies of the liver, kidneys, and other internal organs.

Bronchial cancer is a dangerous disease that has its own clinical picture. In the early stages, the pathology hardly manifests itself, and the existing symptoms are very easy to confuse with manifestations of other diseases. However, over time, the symptoms become more pronounced and significantly affect the patient’s well-being.

Bronchial cancer

What is bronchial cancer -

Cancer of the bronchial tubes and lung is usually considered together, uniting them under the name "bronchopulmonary cancer". There are two forms: central lung cancer, arising from a large or small bronchus, and peripheral cancer, developing from the lung tissue itself. There are central lung cancer, which grows predominantly intra- or peribronchially (80% of cases); peripheral cancer; The mediastinal form, miliary (nodular) carcinosis, etc. are rarely diagnosed.

What provokes / Causes of bronchial cancer:

The development of lung cancer can be preceded by chronic inflammatory processes: chronic pneumonia, bronchiectasis, chronic bronchitis, scars in the lung after previous tuberculosis, etc. Smoking also plays a significant role, since, according to most statistics, lung cancer is observed much more often in smokers than non-smokers. Thus, when smoking two or more packs of cigarettes per day, the incidence of lung cancer increases by 15-25 times. Other risk factors include working in asbestos production and exposure to radiation.

Pathogenesis (what happens?) during bronchial cancer:

According to the histological structure, lung cancers are most often squamous cell, although glandular forms (adenocarcinomas) are also observed, and sharply anaplastic ones - small cell carcinoma, oat cell carcinoma and some other variants.

Symptoms of Bronchial Cancer:

Symptoms of bronchopulmonary cancer vary depending on where the primary tumor occurs - in the bronchus or in the lung tissue. At bronchus cancer (central cancer) the disease usually begins with a dry hacking cough, and then sputum appears, often mixed with blood. Very characteristic of this form is the periodic causeless occurrence of inflammation of the lung - the so-called pneumonitis, accompanied by increased cough, high fever, general weakness, and sometimes chest pain. The cause of the development of pneumoitis is temporary blockage of the bronchus by a tumor due to associated inflammation. In this case, atelectasis (airlessness) of one or another segment or lobe of the lung occurs, which is inevitably accompanied by an outbreak of infection in the atelectasis area. When the inflammatory component around the tumor decreases or its disintegration, the bronchial lumen is partially restored again, atelectasis disappears, and all phenomena temporarily stop in order to flare up again after a few months. Very often, these “waves” of pneumonitis are mistaken for the flu, an exacerbation of bronchitis, and drug treatment is carried out without examining the patient X-ray. In other cases, the lungs are scanned after the symptoms of pneumonitis subside, when the symptom of atelectasis characteristic of cancer disappears, and the disease remains unrecognized. Subsequently, the course of the disease becomes persistent: persistent cough, increasing weakness, fever and chest pain. Respiratory disturbances can be significant with the development of hypoventilation and atelectasis of a lobe or the entire lung. For peripheral lung cancer, developing in the lung tissue itself, the onset of the disease is almost asymptomatic. In these stages, the tumor is often discovered by chance during a preventive X-ray examination of the patient. Only with an increase in size, associated inflammation, or when the tumor grows into the bronchus or pleura, vivid symptoms of severe pain, coughing and fever occur. In the advanced stage, due to the spread of the tumor into the pleural cavity, cancerous pleurisy develops with the progressive accumulation of bloody effusion.

Diagnosis of bronchial cancer:

In the early stages of the disease, an external examination of the patient does little to diagnose cancer. With a large lesion of the lung tissue or a significant area of ​​atelectasis, shortness of breath, a grayish-pale complexion, and retraction of the chest wall, corresponding to atelectasis, occur. In lung cancer, an increase in ESR, sometimes leukocytosis and anemia, is observed quite early. The main method for recognizing lung cancer is x-ray examination. Central cancer is characterized by the symptom of atelectasis, and with peripheral cancer, the images show a rounded, intense shadow with uneven contours, from which there is often a “path” to the root of the lung, resulting from cancerous lymphangitis. In the presence of metastases in the lymph nodes of the lung root, the latter are visible on the radiograph in the form of several rounded shadows merging with each other. X-rays are necessarily taken in two projections, often using tomography. Doubtful changes on the radiograph in patients over 40 years of age are highly likely to indicate lung cancer. If the X-ray picture is not clear enough, bronchography is used. The “stump” symptom revealed in this case in the form of a break in one of the bronchi confirms the presence of central cancer. The second mandatory research method is bronchoscopy, in which a tumor protruding into the lumen of the bronchus, infiltration of the bronchial wall or its compression from the outside can be seen. As a rule, they seek to confirm the diagnosis by morphological examination, for which they repeatedly (up to 6-8 times) examine sputum for atypical cancer cells, take smears from the surface of the tumor during bronchoscopy or swabs from the bronchus. It is often possible to perform a biopsy by taking a piece of tissue through a bronchoscope with a special instrument. If metastatic lesions of the mediastinal lymph nodes are suspected, mediastinoscopy is used. For small cell lung cancer, the primary task is to assess the extent of the disease, which is achieved by performing skeletal scintigraphy, bone marrow biopsy, liver ultrasound, and computed tomography of the brain.

Treatment of bronchial cancer:

The choice of treatment depends on the histological form of the cancer, its prevalence, and the presence of metastases. For non-small cell lung cancer, treatment of lung cancer can be either purely surgical or combined. The latter method gives better long-term results. In combination treatment, it begins with remote gamma therapy on the area of ​​the primary tumor and metastases. After an interval of 2-3 weeks, surgical intervention is performed: removal of the entire lung - pneumonectomy - or removal of one (two) lobes - lobectomy and bilobectomy. Surgery on the lung, especially in weakened cancer patients, is an extremely responsible and difficult intervention that requires special training of the patient, highly qualified surgeons, skillful pain management and careful postoperative care. The preparation of patients consists of general restoratives - a complete diet rich in proteins and vitamins, anti-inflammatory therapy in the form of general antibiotic and sulfonlamide therapy, as well as local administration of antibiotics through a bronchoscope (therapeutic bronchoscopy), the appointment of cardiovascular tonics and therapeutic, especially respiratory, exercises. . In the postoperative period, the patient should be provided with a constant supply of oxygen. Upon recovery from anesthesia, he is given a semi-sitting position and the state of the pulse, blood pressure, respiratory rate and the general appearance of the patient are carefully monitored. In addition, in the first 2-3 days, active aspiration is carried out from the pleural cavity through the remaining drainages using suction. Constant monitoring of active aspiration from the drains is necessary, because the retention of spilled blood and air in the pleura threatens the displacement of the mediastinum with severe disorders of the heart and the possibility of subsequent suppuration with the development of pleural empyema. Usually, after surgery, a course of antibiotics and other medications are prescribed depending on the patient’s condition, the extent of the operation and any complications that arise. The diet of patients does not change, with the exception of the first days, when the diet is somewhat limited. In the postoperative period, from the second day, breathing exercises begin to improve blood circulation and prevent congestive pneumonia in a healthy lung. Relapses of lung cancer occur after insufficiently radical operations, usually in the form of resumption of tumor growth in the abandoned bronchial stump in cases where there was significant infiltration of its wall far beyond the visible limits of the tumor. Treatment of relapses is usually purely palliative. For the disseminated form of the disease, the main treatment method is chemotherapy. Radiation therapy is used as an additional method. Surgery is used very rarely. For advanced cancer, the presence of distant metastases, damage to the supraclavicular lymph nodes or exudative pleurisy, combination chemotherapy is indicated. In the absence of effect from chemotherapy or the presence of metastases in the brain, radiation provides a palliative effect. For very common, inoperable forms of lung cancer, remote gamma therapy or courses of chemotherapy are performed for palliative purposes, sometimes combining both of these methods. Palliative radiation therapy or treatment with antitumor drugs can provide temporary improvement and prolong the patient's life. Lung cancer metastasis goes both lymphogenous and hematogenous route. The lymph nodes of the root of the lung, mediastinum, as well as more distant groups on the neck, in the supraclavicular region are affected. Hematogenously, lung cancer spreads to the liver, bones, brain and second lung. Small cell carcinoma is characterized by early metastasis and an aggressive course. Prognosis for lung cancer depends primarily on the stage of the process, as well as on the histological picture of the tumor - anaplastic forms are very malignant. For non-small cell lung cancer, survival is 40-50% in stage I and 15-30% in stage II. In advanced or inoperable cases, radiation therapy gives a 5-year survival rate of 4-8%. For localized small cell carcinoma in patients treated with combination chemotherapy and radiation, long-term survival rates range from 10 to 50%. In cases of advanced cancer, the prognosis is poor. Maximum survival is achieved after extended mediastinal lymph node removal. Radical surgical intervention (pulmonectomy, lobectomy with removal of regional lymph nodes) can be performed only in 10-20% of patients when lung cancer is diagnosed in the early stages. In case of a locally advanced form of the disease, an extended pulmonectomy is performed with the removal of bifurcation, tracheobronchiapial, lower paratracheal and mediastinal lymph nodes, as well as, if necessary, resection of the pericardium, diaphragm, and chest wall. If surgery is not possible due to the extent of the process or due to the presence of contraindications, radiation therapy is performed. An objective effect, accompanied by significant symptomatic improvement, is achieved in 30-40% of patients.

Prevention of bronchial cancer:

Preventive measures that should be widely cited include timely and correct treatment of various inflammatory processes in the bronchi and lungs in order to prevent them from becoming chronic. A very important preventive measure is to quit smoking. Those working in hazardous industries with high dust levels must use personal protection methods in the form of masks, respirators, etc.

Which doctors should you contact if you have bronchial cancer:

Interesting facts about the disease Bronchial cancer:

In the United States, the cause of every fourth death is cancer, an average of 500 thousand annually. In 2001, approximately 1,268 thousand cases of cancer were expected. In 2001, the National Institutes of Health estimated the total costs associated with the disease to be $180.2 billion. The importance of dietary factors in the etiology of most cancers is recognized by all experts, as has been repeatedly reported in various studies, including the Institute for Cancer Research in 1997. Fruit and vegetable consumption is one of the most carefully studied aspects related to risk. occurrence of cancer. The following are the results of recent research on the main forms of cancer. Lung and bronchial cancer are the leading cause of death for cancer patients, both men and women. The projected figure for 2001 could be 157.4 thousand people. Numerous previous studies show an inverse relationship between the level of consumption of fruits and vegetables and the occurrence of lung cancer, and the results of the latest ones only confirm this. The risk of American women (according to the Nurses' Health Study) consuming large quantities of individual varieties of fruits and vegetables or their combinations of developing lung cancer is 21 - 32% less than the average figure, while the role of vegetables from a statistical point of view is very significant. The chance of occurrence Lung cancer in women who consume less than two servings of fruits and vegetables per day increases significantly.The most effective preventive properties are cruciferous vegetables (CCVs) - broccoli, Brussels sprouts, cauliflower, cabbage, as well as citrus fruits and plants rich in carotenoids. Confirmation of the above are results of cohort studies conducted in the Netherlands, according to which there is a clear inverse relationship between the consumption of OSC and citrus fruits and the risk of cancer. Moreover, according to information from the Nurses' Health Study and the results of studies by the organization Health Professionals, there is an inverse relationship between the risk the occurrence of lung cancer and the consumption of carotenoids and beta-carotenes, but at the same time there was no direct relationship between the consumption of fruits and vegetables and the risk of lung cancer in men. "...Average daily consumption of cruciferous vegetables in the United States is approximately 5 to 11 grams per day, which is much lower than the research report's average. .. In summary, available evidence indicates that there is a potential breast cancer preventative effect from the consumption of certain vegetables." Studies among various ethnic groups in Hawaii have shown a significant inverse association between the risk of lung cancer and consumption of foods rich in the flavonoid quercetins , including apples and onions. Yellow grapefruit, an abundant source of the flavonoid naringenins, also provides a strong protective effect. High amounts of quercetin obtained from these foods is thought to reduce the risk of disease, but their effectiveness is small. The positive effect of consuming large amounts of fruits and vegetables may depending on whether a person smokes or not. A 25-year study in Europe found that fruits and vegetables may play a big role in preventing lung cancer, but the effect was smallest among heavy smokers. Similar findings suggest that The relationship between the level of consumption of fruits and vegetables and the occurrence of lung cancer is not in all cases indisputable, although, nevertheless, there is a definite trend in reducing the risk of lung cancer with the consumption of fruits and vegetables, and in this case careful further research is required.

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Other diseases from the group Oncological diseases:

Bronchial cancer is a malignant neoplasm, the formation of which begins in the glandular tissue and integumentary epithelium, and can be peripheral or central. Central cancer is formed from small and large bronchial tubes, and peripheral cancer is formed in the lung tissues. Central cancer can be small cell, large cell, or squamous cell.

Description

The lungs are the respiratory organs, located in the chest and consist of the right and left lungs. Benign tumors of the bronchi are very diverse, although they make up less than 10% of the total number of tumors of the respiratory tract. They usually appear in young people over 30 years of age and often develop into cancerous tumors.

The tumor process begins to develop when the protective functions in the upper respiratory tract are reduced and the impact of various harmful factors increases. Epithelial cells of the bronchi and bronchial glands multiply chaotically and degenerate into malignant ones. Cancerous tumors most often appear in the bronchi, but can form in any other part of the lung.

In modern medicine, the term bronchopulmonary cancer is used, combining two diseases: bronchial cancer (bronchogenic) and (alveolar). According to statistics, about 85% of patients with such tumors are smokers with a long smoking history and age from 35 to 55 years. Similar cancer can also occur in non-smokers, but such cases are much less common. People over 60 years of age are also at risk, and this disease is diagnosed in men 8 times more often than in women. Bronchogenic carcinoma is the most common cause of death from malignant tumors. Bronchoalveolar carcinoma (BAC) is a particularly rare type of lung cancer.

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Must remember! Quitting smoking is the most important and necessary thing that anyone can do to prevent cancer in the respiratory system.

Varieties

Bronchogenic cancer is classified into three types based on its histological structure:

• small cell (oat cell) - characterized by rapid growth and gives metastases to the brain, bones, and liver. Rarely found in non-smokers, it occurs in almost 20% of cases of lung cancer;
• non-small cell - divided into three subtypes: squamous cell carcinoma, large cell carcinoma. Occurs in almost 80% of cases;
• small and large cell – the neoplasm has features of both previous types.

Based on the nature of growth and development, bronchial tumors are divided into the following types:

1. exophytic - grow into the lumen of the bronchus and cause insufficient ventilation of the lungs (hypoventilation) or collapse of the lung or its lobe (atelectasis);
2. endophytic - grow in the direction of the lung parenchyma, can lead to perforation of the bronchial wall and tumor growth into adjacent organs (pleura, pericardium, esophagus);
3. mixed - have signs of both exophytic and endophytic neoplasms.

Symptoms

The growth of a malignant bronchial tumor is a long process, most often up to several years. For this reason, a lot of time passes before the first characteristic signs of the disease appear. Manifestations of cancer in the respiratory tract depend on the form of the disease and the stage of development. If the tumor has formed in the bronchus, then the first symptom of the disease is a prolonged dry cough.

In addition, the following signs of the disease are observed in the early stages:

At the initial stage, it is very difficult to determine the disease. This is due to the fact that the lungs have almost no nerve endings that are sensitive to pain. And therefore, obvious signs of the disease occur when the pleura and other tissues where there are nerve endings are affected. Symptoms of respiratory failure appear when only a quarter of the total lung tissue remains functional. The severity of symptoms depends on the patency of the airway. Early appearance of signs of pathology is observed in patients with endobronchial tumor growth, and imperceptible and slow - in peribronchial tumors, when the tumor grows outward

As the disease progresses and the bronchus is completely blocked, obstructive pneumonitis develops - an inflammatory process accompanied by such symptoms as:

• increased body temperature;
• fever;
• increased cough;
• dyspnea;
• general weakness;
• chest pain.

Most often, patients mistake this condition for simple bronchitis, do not go to the doctor to get an x-ray done, and treat themselves. But my health is not improving, on the contrary, it is getting worse. The chest pain intensifies, the cough becomes stronger, the temperature is higher and does not go down.

At the last stage of bronchogenic cancer, superior vena cava syndrome is observed, in which the outflow of blood in the upper part of the body is disrupted. Patients experience swelling of the veins in the neck and upper extremities, swelling of the face and neck, the voice may become hoarse and pain in the heart may occur (if it spreads to the heart sac). With advanced bronchial cancer, metastases develop to regional lymph nodes, brain, liver, adrenal glands, and bones.

Bronchial cancer is classified into four stages according to the level of progression:

• I – the size of the neoplasm does not exceed 3 centimeters, is located in the segmental bronchus, there are no metastases;
• II – the size of the neoplasm is up to 6 centimeters, located in the segmental bronchus, there are metastases to the regional lymph nodes;
• III – the size of the tumor is more than 6 centimeters, the cancer has spread to the adjacent or main bronchus, there are metastases in the lymph nodes;
• IV – the most advanced and aggressive stage, the spread of distant metastases to organs important for life, cancerous pleurisy develops.

Diagnostics

Diagnosing bronchial cancer is often difficult, since a malignant neoplasm is often mistaken for other lung diseases (bronchitis, pleurisy, pneumonia, etc.). To check the bronchi and lungs for the presence of a tumor, an X-ray examination of the chest organs is first prescribed. What does an x-ray show for bronchial cancer? X-rays may show spots and shadows, indicating the possibility of a tumor. X-ray can detect a neoplasm of at least 4 mm in diameter; tumors of smaller sizes are not detected. X-ray is considered the most effective way to determine a tumor in the respiratory tract at an early stage of its development. in case of bronchogenic cancer, it determines the presence of a neoplasm if it grows into the bronchial cavity, and also helps to obtain a sample of lavage water and tumor cells for biopsy.

In addition, a complex of diagnostic studies is carried out, including:

• histological and cytological examination is the most informative, since the genesis of neoplasm cells is accurately determined;
• MRI of the lungs;
• Ultrasound of the pleural cavity, mediastinum, pericardium - reveals signs of cancer spreading to nearby organs;
• PET-CT – used to determine the stage of a small cell type of neoplasm;
• mediastinoscopy - used to determine the extent of metastasis of the mediastinal lymph nodes;
• Skeletal scintigraphy - prescribed to assess the extent of cancer spread to the bones.

Examinations of other organs are also carried out to determine distant metastases.

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Treatment

Treatment of bronchogenic cancer is usually carried out with a combination of surgery, radiation therapy and chemotherapy.

Treatment methods are divided into three types:

• radical - removal of the tumor, affected lymph nodes and metastases;
• conditionally radical - the main method is supplemented by drug treatment and radiation therapy;
• palliative – used when it is no longer possible to cure the patient. They alleviate the symptoms of the disease (pain and other manifestations) and provide psychological support to the patient.

For non-small cell cancer of the respiratory tract, the best effect is achieved by combined treatment, which begins with radiation therapy to the area of ​​the primary tumor and metastases.

After 15-20 days, one of the surgical operations is performed:

• pneumonectomy (removal of the entire lung);
• pneumonectomy with mediastinal lymphadenectomy (removal of the lung and regional lymph nodes);
• lobectomy - resection of one lobe of the lung;
• bilobectomy - resection of two lobes of the lung;
• circular resection of the tracheal bifurcation;
• circular resection of the thoracic aorta or vena cava.

When diagnosing bronchial oncology early, in very rare cases, fenestrated or circular resection of the bronchial tube is used. In cases of bronchial cancer, sparing surgery, that is, preserving at least some part of the lung, is most often unacceptable. Malignant cells may remain in the lung tissue, and the tumor will begin to develop again. And relapses of such cancer usually have serious consequences and are treated only with a palliative method.

For small cell bronchial cancer, which is more aggressive, surgery is most often impossible or pointless. In this case, the patient is recommended chemotherapy, sometimes combined with radiation therapy. In addition, painkillers and supportive medications are prescribed.

Radiation therapy is used when there are contraindications to surgery or the patient refuses surgery. Both the focus of the malignant tumor and the mediastinum are irradiated. Chemotherapy is also used to treat respiratory cancer. But there are no big positive results from its use. Chemotherapy only reduces the size of the tumor and stops the spread of metastases. Used in palliative treatment.

Remember! Bronchial cancer is a very serious disease that changes the patient’s entire subsequent life. Even if the operation was successful and the disease was overcome, the patient’s life will no longer be as fulfilling as before the illness.

Measures to prevent bronchial cancer include:

• healthy lifestyle;
• regular examination with fluorography;
• treatment of respiratory diseases to prevent them from becoming chronic;
• to give up smoking;
• Those working in hazardous industries must observe safety measures and use personal protective equipment (masks and respirators).

Forecast

The prognosis of bronchogenic cancer primarily depends on the stage of the disease and histological features of the tumor. Radical surgical intervention in the early stages gives high positive results in almost 80% of patients. With a non-small cell type of tumor at the initial stage, the five-year survival rate of patients is about 50%, in the second stage - up to 25%. In inoperable or advanced cases, survival rate is less than 10%. With small cell cancer, after undergoing courses of chemotherapy and radiation, the life expectancy of patients ranges from 15 to 55%. At stage 4 of the disease, the prognosis is unfavorable.

Oncological diseases of the bronchi and lung are usually combined and considered together, hence the name bronchopulmonary cancer. Bronchial cancer comes in two forms - central and peripheral. Central cancer develops from large or small bronchus, and peripheral cancer from cells of the lung itself. This type of cancer is the most studied; a doctor can easily determine its cause. In the vast majority of cases, bronchial cancer is a disease of smokers aged 30-50 years, with a significant smoking history. Each cigarette smoked greatly increases the risk of developing cancer. They talk about it on television, they write about it in periodicals, they even write about it in large letters on cigarette packs, but it all seems to be in vain. The number of smokers is not decreasing, nor is the number of bronchial cancer diagnoses. Even with such information, people continue to tempt fate and their health. Of course, this disease sometimes affects people who have never smoked, but this happens very rarely. Also provoking factors for the development of tumors in the lung are chronic inflammatory processes - bronchitis, pneumonia, tuberculosis, which leaves scars on the lung.

Types of bronchial cancer

Bronchial cancer is divided into two groups: non-small cell carcinoma and small cell carcinoma. The first group is represented by two subtypes - glandular and squamous cell carcinoma of the bronchi. Glandular cancer develops from mucus-producing cells and is called adenocarcinoma. Cancer that develops from the cells lining the airways is the most common. It accounts for half of all cases and is bronchial squamous cell carcinoma. Small cell carcinoma is also called oat cell carcinoma because its cells resemble oat grains. It accounts for about 20% of all lung cancer cases. Depending on what the histological examination shows - glandular, small cell or squamous cell bronchial cancer in the patient, appropriate treatment is prescribed.

Symptoms of bronchial cancer

When a person develops bronchial cancer, symptoms greatly depend on its form, central or peripheral. If the cancer begins in the bronchus (central form of cancer), then the first symptom is a cough. Dry, annoying, irritating, it lasts for some time, after which phlegm appears. It is often pink or streaked with blood. When central bronchial cancer progresses, symptoms may also include a phenomenon such as pneumonitis. These are periodic inflammations, which are characterized by an increasing cough, increased body temperature, weakness and chest pain. Such conditions occur periodically, and patients mistake them for symptoms of acute respiratory disease or flu. Rarely does anyone think of taking an X-ray of the lungs, so people take some kind of medication and think that they are treating ordinary bronchitis. However, the condition does not improve further. All the symptoms are only getting worse. The cough causes more and more discomfort, chest pain becomes more intense, body temperature rises and does not fall. Late manifestations of bronchial cancer are swelling of the face and neck, difficulty breathing, and the inability to sleep lying down.

Peripheral lung cancer develops asymptomatically in most cases. Most often, such tumors are discovered accidentally during a routine X-ray examination. Only when the tumor reaches a large size or grows into the bronchial tissue does pain, severe coughing and inflammation begin.

As you can see, when bronchial cancer develops, the symptoms do not specifically indicate oncology. It is difficult for both the patient and the doctor to suspect cancer in a cough and fever. Of course, most often a person does not go to the hospital with such symptoms at all, preferring to buy antipyretics and expectorants and “cure” himself. This is the whole insidiousness of bronchial cancer - when a person understands what he is faced with, time has already been lost and the disease has acquired deep and dangerous forms.

Diagnosis of bronchial cancer

A routine doctor's visit and examination may not detect lung cancer at an early stage. If the lung lesions are already quite serious, the specialist will suspect oncology based on the patient’s complaints, grayish complexion, shortness of breath and sinking of the chest wall. The main method that allows you to detect bronchial cancer is an x-ray examination. That is why clinics encourage everyone to undergo chest x-rays regularly, at least once a year. The imaginary harm from radiation is incomparable with the ability to detect the disease at an early stage. After all, it is of vital importance. If bronchial cancer is suspected, the doctor will prescribe an x-ray in two projections, as well as a computed tomography scan. Bronchoscopy is also mandatory - examination of the bronchi using an endoscope. This method is the most informative and allows, during the procedure, to take a sample of the altered tissue for histological examination, which should confirm the presence of a malignant formation and its type. In addition to bronchial studies, if cancer is confirmed, it is necessary to undergo many other procedures to find out whether neighboring organs and tissues are affected, or whether there are metastases.

Treatment of bronchial cancer

The treatment tactics for bronchial cancer fully depend on its form and the results of histological examination, as well as on the degree of the disease and the presence of metastases in other organs and tissues. Non-small cell bronchial cancer is best treated with a combination of surgery and radiation therapy. Irradiation is carried out some time before surgery, directing the radiation source to the original tumor and metastases. This is done in order to reduce their size. After a course of radiation therapy, surgery is performed. The lung is not an organ from which a tumor or metastases can be removed. They can only be removed together with the lung or its lobes. Of course, this is a very dangerous and responsible operation that requires high skill of the surgeon, extensive practice and careful care of the patient during recovery. A common mistake made by surgeons is a “gentle” approach to surgery and the desire to leave at least one lobe of the lung. This is unacceptable in such situations. If cancer cells remain in the tissues, a relapse will certainly develop, and relapses of bronchial cancer are treated only with a palliative method.

Small cell bronchial cancer is more aggressive and develops faster. It metastasizes earlier, making surgical treatment impossible or pointless. In such cases, the patient is prescribed chemotherapy, sometimes combining it with radiation. Various supportive and pain medications are also prescribed.

The five-year survival prognosis for patients with bronchial cancer varies depending on the form, stage of the disease and histological picture. The highest rates, up to 50%, are for stage 1 non-small cell cancer. Small cell cancer provides 10 to 50% of patients with a five-year survival rate, but only if the disease has not spread to other organs. With advanced small cell bronchial cancer, the prognosis is unfavorable.

Bronchial cancer is a terrible disease with painful symptoms, difficult treatment and little chance of success. Even if the operation is successful, the picture is disappointing - the person loses a lung, which means that he will never return to his previous life. Quitting smoking is the first and most important thing a person can do to prevent bronchial cancer. A correct lifestyle, timely and competent treatment of respiratory infections, the absence of chronic diseases of the lungs and bronchi - these points are very important for the prevention of cancer.

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A malignant neoplasm that develops from the integumentary epithelium of bronchi of various sizes and bronchial glands. With the development of bronchial cancer, the patient is bothered by cough, shortness of breath, hemoptysis, and remitting fever. Diagnosis of bronchial cancer involves X-ray, tomographic and bronchological examination, cytological or histological confirmation of the disease. Depending on the stage, surgical treatment of bronchial cancer may consist of lobectomy, bilobectomy or pneumonectomy; For inoperable processes, radiation and chemotherapy are performed.

General information

Bronchial cancer (bronchogenic cancer) and lung cancer (alveolar cancer) in pulmonology are often combined under the general term “bronchopulmonary cancer”. Primary malignant tumors of the lungs and bronchi account for 10-13% of all oncopathology, second in frequency only to stomach cancer. Bronchial cancer usually develops between the ages of 45 and 75; Moreover, in men it is 6-7 times more common than in women.

In recent decades, there has been an increase in the incidence of bronchogenic cancer due to increased carcinogenic influences. At the same time, one cannot fail to note the progress in the early diagnosis of bronchial cancer associated with the widespread introduction of endoscopic methods into clinical practice, expanding the capabilities of thoracic surgery in the matter of radical treatment of bronchopulmonary cancer, and increasing the life expectancy of patients.

Causes

In the structure of the causes of bronchial cancer, the most significant etiological factor is smoking. When smoking 2 or more packs of cigarettes per day, the risk of developing bronchopulmonary cancer increases by 15 to 25 times. Long-term regular inhalation of tobacco smoke, which contains many carcinogens, causes metaplasia of the epithelium of the bronchial mucosa. In addition, bronchial mucus secretion increases, in which harmful microparticles accumulate, chemically and mechanically irritating the mucous membrane. Under these conditions, the ciliated epithelium of the bronchi cannot effectively cleanse the airways.

The risk of bronchial cancer is increased in people working in hazardous industries associated primarily with asbestos, nickel, chromium, arsenic, coal dust, mustard gas, mercury, etc. Often the causes of bronchial cancer are inflammatory lesions of the respiratory tract of a chronic nature: bronchitis, bronchiectasis, pneumonia, pulmonary tuberculosis, etc.

Pathogenesis

A decrease in the activity of metabolic and enzymatic processes aimed at neutralizing and removing harmful substances coming from outside, the formation of endogenous carcinogens in combination with a violation of trophic innervation causes the development of a blastomatous process in the bronchi.

The complex of pathological changes in bronchial cancer depends on the degree of bronchial obstruction. First of all, changes develop with epdobronchial growth of the tumor, leading to a narrowing of the bronchial lumen, and later with peribronchial growth, accompanied by compression of the bronchus from the outside.

Bronchial obstruction or compression is accompanied by the development of hypoventilation, and with complete closure of the bronchus - atelectasis of the lung area. Such disorders can lead to infection of a section of lung tissue that is excluded from gas exchange with the formation of a secondary abscess or gangrene of the lung. With ulceration or necrosis of the tumor, less or more pronounced pulmonary hemorrhage occurs. The disintegration of the tumor can lead to the formation of a bronchoesophageal fistula.

Classification

From the point of view of histological structure, they distinguish between squamous cell carcinoma of the bronchus (60%), small cell and large cell carcinoma of the bronchus (30%), and adenocarcinoma (10% of cases). According to the clinical and anatomical classification, central and peripheral bronchogenic cancer are distinguished. In 60% of cases, central cancer occurs, growing from large bronchi (main, lobar, segmental); in 40% - peripheral bronchial cancer, affecting the subsegmental bronchi and bronchioles.

Central bronchial cancer can have an endobronchial nodular, peribronchial nodular or peribronchial branched (infiltrative) form. Peripheral bronchopulmonary cancer occurs in nodular, cavitary and pneumonia-like forms.

According to the nature of growth, exophytic cancer is distinguished, growing into the lumen of the bronchus; endophytic, growing towards the pulmonary parenchyma; and mixed. Bronchial cancer with exophytic growth causes hypoventilation or atelectasis of the area of ​​the lung ventilated by this bronchus; in some cases, valvular emphysema develops. The endophytic form can lead to perforation of the bronchial wall or tumor growth into neighboring organs - the pericardium, pleura, esophagus.

Symptoms of bronchogenic cancer

Clinical manifestations of cancer are determined by the caliber of the affected bronchus, the anatomical type of tumor growth, its histological structure and prevalence. With central bronchial cancer, the earliest symptom is a persistent dry hacking cough. Paroxysmal intensification of cough may be accompanied by whistling, stridor breathing, cyanosis, and sputum mixed with blood. Hemoptysis and bleeding caused by tumor disintegration occurs in 40% of patients. When the pleura is damaged (its germination by a tumor, the development of cancerous pleurisy), pain appears in the chest.

Complete blockage of the bronchus by a tumor leads to inflammation of the non-ventilated part of the lung with the occurrence of obstructive pneumonitis. It is characterized by increased cough, the appearance of sputum, the addition of remitting fever, shortness of breath, general weakness, and apathy.

In the later stages of bronchial cancer, superior vena cava syndrome develops, caused by a violation of the outflow of blood from the upper parts of the body. SVC syndrome is characterized by swelling of the veins of the neck, upper extremities and chest; puffiness and cyanosis of the face. When hoarseness develops, one should think about damage to the vagus nerve; if there is pain in the heart, pericarditis - about the spread of bronchial cancer to the heart sac.

With advanced bronchial cancer, metastases are detected in regional (bifurcation, peribronchial, paratracheal) lymph nodes; hematogenous and lymphogenous metastasis occurs in the liver, adrenal glands, brain, bones.

Diagnostics

At an early stage, physical examination of patients with bronchial cancer is not very informative. With the development of atelectasis, retraction of the supraclavicular region and compliant areas of the chest wall occurs. The auscultatory picture of bronchial cancer is characterized by a variety of sound phenomena, up to the complete absence of respiratory sounds in the area of ​​atelectasis. Percussion sound is dull, weakening or absence of bronchophony and vocal tremor is noted.

For bronchial cancer, a full X-ray examination is performed (x-ray of the lungs in 2 projections, X-ray and computed tomography), MRI of the lungs, which allows you to clearly visualize all the structures of interest in the images. With the help of bronchoscopy, it is possible to visually detect exophytically growing bronchial cancer, collect washing water for cytological analysis, as well as endoscopic biopsy for histological examination.

Prognosis and prevention

The prognosis for bronchial cancer depends on the stage of detection of the disease. Radical surgical treatment allows achieving high results in 80% of patients. When bronchial cancer metastasizes to the lymph nodes, long-term survival among operated patients is 30%. In the absence of surgical treatment for bronchial cancer, the 5-year survival rate is less than 8%.

Measures to prevent bronchoalveolar cancer include mass screening of the population (fluorography), timely treatment of bronchial inflammation, smoking cessation, and the use of personal protective equipment (masks, respirators) in industries with a high degree of dust.