Description:

Cancer of the bronchial tubes and lung is usually considered together, uniting them under the name “bronchopulmonary”. 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.

Symptoms:

Symptoms of bronchopulmonary cancer vary depending on where the primary tumor occurs - in the bronchus or in the lung tissue. With bronchial 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, 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 an exacerbation 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 takes on a persistent character: persistent, increasing weakness, increased temperature 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, which develops 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, cancer develops with the progressive accumulation of bloody effusion.

Causes:

The development of bronchial cancer can be preceded by chronic inflammatory processes: chronic bronchitis, chronic bronchitis, scars in the lung after a previous injury, etc. Smoking also plays a significant role, since, according to most statistics, lung cancer is observed much more often in smokers than in 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.

Treatment:

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 sulfanlamide therapy, as well as local administration of antibiotics through a bronchoscope (medicinal), the prescription of cardiovascular tonics and therapeutic, especially respiratory, exercises. In the postoperative period, the patient should be provided with a constant supply of oxygen. Upon exiting the patient, 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 or treatment with antitumor drugs allows for temporary improvement and prolongs the patient’s life. Metastasis of lung cancer occurs both by lymphogenous and hematogenous routes. 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. The 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.

The bronchogenic type of pathology, according to statistics, is very common and accounts for about 13 percent of the total number of identified cases of oncology. Men aged 45 to 75 are 6 times more likely to be at risk. In women, the disease is less common, mainly due to the fact that there are not so many smokers among them.

Causes

Bronchial cancer is, first of all, a consequence of addiction to tobacco. If a person consumes 40 or more cigarettes a day, his risk of getting sick increases by about 25 times. People who have been inhaling toxic smoke, which contains mainly carcinogens, for decades, provoke the development of metaplasia in the epithelium of the bronchial mucosa. Against this background, the production of sputum increases significantly, in which all harmful elements accumulate. Ultimately, the body ceases to cope with cleansing and fatal pathological changes begin.

The danger is no less high for those people who work in hazardous industries, where they have to deal with the following substances during their work:

• arsenic;
• nickel;
• chromium;
• asbestos;
• coal;
• mercury, etc.

Often, bronchial cancer is provoked by various diseases of the respiratory organs:

• bronchiectasis;
• tuberculosis;
• pneumonia;
• bronchitis.

Classification

According to histology, there are several types of disease, the most common of which are:

• squamous;
• multicellular;

Based on clinical and anatomical characteristics, the development of central cancer is more often detected - it accounts for 60 percent of cases. It is formed exclusively on large bronchi. Peripheral is diagnosed in every fourth patient.

There is also a classification based on the nature of development. In particular, a tumor growing:

• into the lumen - called exophytic;
• in the direction of the parenchyma - endophytic.

In the first case, bronchial cancer is accompanied in the patient by hypoventilation syndrome, and sometimes by valvular emphysema.

In the second, perforation of the walls of the respiratory organ often occurs, as a result of which the tumor grows to:

• esophagus;
• trachea;
• pleura;
• pericardium.

Symptoms

Signs vary depending on:

• size of the affected bronchus;
• type of tumor;
• its prevalence;
• histological structure.

When both the right and left lungs are affected, the common first symptom that appears in the initial stages is a dry cough. During attacks, the patient often:

• breathing is accompanied by whistling;
• cyanosis is detected;
• sputum with bloody inclusions is released.

The latter symptom is observed in 40 percent of patients. It accompanies the later stages and is caused by the disintegration of the neoplasm. If the disease spreads to the pleura, then there is also pain in the chest area, at the site of the tumor.

When the tumor completely blocks the bronchus, inflammation occurs in the blocked area and obstructive pneumonitis appears. This complication is accompanied by:

• more severe cough;
• secretion of mucus;
• relapsing fever;
• apathy;
• weakness;
• shortness of breath.

In the final stages, bronchial cancer leads to the formation of the so-called vena cava syndrome. This is due to poor blood circulation in the upper body. It manifests itself by swelling of blood vessels located on:

• hands;
• breasts;

The patient's face becomes bluish and swollen.

Besides:

• hoarseness indicates that the vagus nerve is affected;
• pain in the heart and pericarditis - about the development of a tumor in this direction.

Advanced cancer is accompanied by metastases, first in the lymph nodes, and then in:

• liver;
• brain;
• bone tissue;
• adrenal glands.

Diagnostics

In the early stages, it is almost impossible to detect cancer during a physical examination. Making a diagnosis will allow:

• X-ray;
• bronchoscopy.

Using ultrasound, tumor growth into neighboring organs is detected. It is important to differentiate oncology from bronchitis, the introduction of foreign bodies and adenoma.

Treatment

To eliminate the disease in question, the following is used:

• surgical removal of the tumor;
• radiation and chemotherapy.

The order in which the main methods are used depends on the type of tumor and the degree of its prevalence. During the operation, either the affected part of the organ or the entire lung is removed. When the disease is detected in the early stages, resection of only one bronchus is sufficient. When it comes to the common form, all methods of fighting cancer are used together. And in half the cases it gives a positive result.

Patients with inoperable tumors are prescribed symptomatic therapy based on:

• painkillers;
• antitussives;
• oxygen.

Forecast

In general, it is almost impossible to say exactly how long a particular patient has left to live. The favorable prognosis largely depends on the stage at which the pathology was detected. In particular, the survival rate after surgery is currently 80 percent.

If surgery is performed at the stage of lymph node metastasis, then life can be saved in 30% of patients.

Without radical removal of the tumor (subject to treatment only with conservative methods), the maximum life expectancy is 5 years. This prognosis is relevant, however, only for 8 percent of patients.

Bronchial cancer is a malignant neoplasm that affects the bronchi, resulting in impaired breathing processes. The risk group includes people who smoke for a long time and come into contact with vapors of harmful substances, which reduces local immunity. The prognosis is unfavorable, as the tumor grows in the lung tissue, completely affecting the organ. Only the initial stages are treatable. In other cases, a person will inevitably die.

It is not known for certain what exactly causes cancer cells to actively divide, forming a tumor. But there are prerequisites that contribute to the launch of pathological processes in the bronchi, among which the most common are:

1. Active and passive smoking - inhalation of tobacco smoke rich in nicotine and tars leads to irritation of the epithelium. This in turn makes the tissue less dense, allowing carcinogenic substances to be easily absorbed and enter the bloodstream. It has been proven that passive smokers, who intentionally or unintentionally constantly inhale cigarette smoke, are no less susceptible to the development of oncological processes in the respiratory organs.
2. Harmful working conditions in which a person is forced to inhale vapors of heavy metals and toxic substances - respirators and other personal protective equipment are not able to fully protect the respiratory system from harmful particles. This also applies to workers in mills and construction sites, where small dust particles enter the lungs along with the air, settling and accumulating in the body. Constant intoxication provokes a decrease in general immunity, which makes the lungs a vulnerable place.
3. Pathologically reduced immunity, which leads to the development of chronic inflammatory processes in the bronchi - a person suffers from constant bronchitis, the intensity of which depends on the time of year. In winter, bronchitis can be prolonged, which is accompanied by a severe cough and the need for antibacterial therapy. In the summer season, the disease progresses more easily.

Predisposition cannot be ruled out. If there are people with cancer in the family, then the risks of developing bronchial cancer in the presence of associated factors are high.

Types of cancer depending on location

Considering the location of tumor formation, bronchial cancer can be of two types:

1. Central - localized in large bronchi, accompanied by a high probability of their complete overlap, which affects the breathing process. As the tumor grows, a person feels localized pain in the sternum, which intensifies when there is a cough.
2. Peripheral - formed in small bronchioles, growing through them. It is characterized by rapid growth and the possibility of metastasis to the lymph nodes and nearby internal organs. The danger of this type of cancer is that it is almost impossible to detect it in the initial stages. The first symptoms of the disease appear closer to stages 2-3, which is the point of no return.

Most often, central cancer occurs, since pathological growth of the epithelium is sufficient for its progression, which is caused by constant exposure to pathogenic substances: smoke, toxins, carcinogens, vapors of pesticides.

Classification depending on histological structure

Taking into account the peculiarities of the cellular structure, cancer can have several subtypes:

1. Adenocarcinoma is a neoplasm that remains asymptomatic for a long time and is accompanied by active growth and an increase in size, which allows it to grow into all tissues of the lung, complicating the treatment process. With the active growth of the tumor, a wet cough appears with the release of sputum, which has an unpleasant smell of rot and a grayish-green color. A person coughs almost constantly, and any movement of the chest causes pain.
2. Squamous cell carcinoma - a distinctive feature of this type of cancer is its relatively slow progression. A person may not even be aware of the presence of an oncological process, which has been asymptomatic for years. As the cancer progresses, shortness of breath and a dry, paroxysmal cough appear, accompanied by hemoptysis. The temperature may rise, and external clinical manifestations may resemble tuberculosis. Therefore, differential diagnosis is important.
3. Small cell cancer - consists of small cells that are connected to each other in the form of a garland. In almost all cases, small cell cancer gives extensive metastases localized to the lymph nodes. Typically, the cancerous tumor reaches a small size compared to other types of cancer. It is characterized by a rapid course, in which, without early diagnosis and comprehensive treatment, death occurs in the first year.
4. Large cell cancer - consists of large cells that can be connected to each other, or can be located separately. It is one of the most aggressive types of cancer, metastasizing to distant organs and bone tissue.
5. Mixed type - includes the presence of small-cell and large-cell structures, as well as glandular neoplasms. The most difficult type of cancer to treat, since individual tumors have their own treatment characteristics, and when there are many of them, in 90% of cases the therapy will be ineffective.

There are 4 stages of bronchial cancer, which affects further prognosis and survival:

1. The first stage – the tumor does not exceed 2-3 cm in diameter, there are no metastases. Clinical manifestations are mild or absent altogether. The main reason for suspecting oncological processes is the increased frequency of respiratory diseases, which are severe.
2. The second stage – the tumor diameter reaches 5-6 cm, and metastases are present in the lymph nodes. The first clinical manifestations characteristic of cancer appear.
3. The third stage - the tumor actively grows and affects large areas of the lungs, growing into the deep layers of the organ. The breathing process is disrupted, there is a constant cough and severe shortness of breath. At night, coughing attacks may appear that cannot be stopped.
4. The fourth stage is accompanied by the most unfavorable prognosis and an increased risk of death due to asphyxia. The lack of oxygen in the body, which occurs due to impaired respiratory function, is associated with severe coughing attacks. Palliative therapy is prescribed.

Early diagnosis helps detect cancer in its early stages, which can be corrected with comprehensive treatment. Advanced forms of cancer cannot be treated, so the person quickly dies. It is enough to undergo a mandatory fluorography procedure annually, the images of which show the condition of the bronchi and lungs.

Clinical manifestations

Symptoms of bronchial cancer depend primarily on the stage of tumor progression. There are three clinical stages:

1. Biological – the image shows minor foci of cell dysplasia, clinical manifestations are completely absent.
2. Asymptomatic - the tumor is well visualized, but clinical manifestations are either absent or insignificant.
3. The stage of active symptoms is accompanied by the presence of a vivid clinical picture, which indicates the rapid growth of cancer cells and an increase in tumor diameter.

The first symptoms that may indicate the presence of cancer are:

1. Periodically manifested cough, independent of respiratory disease.
2. Pathologically reduced immunity, causing frequent respiratory diseases that occur in an aggravated form.
3. Chronic fatigue, which provokes a decrease in performance.
4. Discomfort in the sternum area, which occurs when turning the body and taking a deep breath.
5. Development of shortness of breath during exercise.

As cancer progresses and the tumor rapidly increases in size, clinical manifestations develop such as:

1. An increase in temperature and its persistence for a long time, which cannot be controlled with antipyretic drugs.
2. The appearance of coughing attacks that develop without any prerequisites.
3. Sputum secretion mixed with blood and pus, which has an unpleasant odor and color. Its volume directly depends on the location of the tumor and its size.
4. Dyspnea that develops at rest.
5. Inability to sleep on your back.
6. Acute pain in the sternum and under the shoulder blades, which is caused by tumor growth and damage to nerve receptors.
7. The development of anemia, which is caused by an acute lack of oxygen in the body.

The patient's condition worsens as the tumor grows. In the absence of complex therapy, death soon develops.

Diagnostics

There are several ways to diagnose cancer, the most common of which are:

1. X-ray – a picture of the lungs shows the presence of dark spots, which are neoplasms. Using the image, you can assess the size of the tumor and its location, but not the type and form of cancer.
2. Cytology and histology of the sample - a biopsy is used to obtain a small sample of the tumor, which is examined for the presence and type of cancer cells. This allows you to determine the type of cancer, the stage of progression and predict the further course of the disease.
3. MRI of the lungs is a high-precision equipment with which it is possible to examine the tumor in the smallest detail. Helps control tumors and view dynamics.
4. Bronchoscopy is effective only when the tumor is localized inside the bronchus. A special tube, at the end of which there is a microscope, is inserted through the trachea into the bronchi, which helps to examine the tumor as accurately as possible.
5. Ultrasound of the pleural cavity helps to identify the presence of accumulated effusion, as well as prevent the development of cancer complications in the form of pleurisy.

Early diagnosis helps to identify early forms of cancer, the treatment of which is accompanied by a favorable prognosis.

Treatment methods

The main goal in cancer treatment is to destroy cancer cells, slow their growth and development, and remove the affected area of ​​the lung. Therapy must be comprehensive, since surgical removal of damaged areas of the lung does not guarantee a complete cure for cancer.

If the tumor is small and not prone to metastasis, part of the damaged bronchi is resected. Advanced forms of cancer require removal of a third or an entire lobe of the lung.

Chemotherapy using cytostatics can suppress the activity of cancer cells throughout the body, which reduces the activity of metastases and slows down the progression of cancer. In the process of remission, people live for years, leading a full life

Radiation therapy is prescribed in the presence of extensive lesions, including the lymphatic system, bone marrow and bone tissue. In some cases, the body cannot tolerate the increased load, which leads to death.

Inoperable tumors are practically impossible to treat. With the help of chemotherapy courses it is possible to prolong life, but it is impossible to get rid of cancer completely. The terminal stage involves the use of palliative treatment aimed at alleviating the person’s condition and relieving the consequences of respiratory failure.

Prevention

As a preventive measure, it is necessary to exclude all factors contributing to the development of cancer:

1. Stop smoking and inhaling toxic substances.
2. In the presence of hazardous production, use personal protective equipment to prevent toxic substances from entering the lungs.
3. Spend more time outdoors, preferring walks in the forest.
4. Visit sanatorium-resort complexes annually, giving the body the opportunity for recreation.
5. If there are inflammatory processes in the lungs, treat them correctly and in a timely manner, preventing the development of a chronic form.
6. Undergo a medical examination annually, including fluorography.
7. If you are prone to cancer and have strange symptoms such as a prolonged cough, you should immediately consult a pulmonologist.

Regular fluorography, which reflects the health status of the lungs, will help protect your life.

Forecast

The prognosis for bronchial cancer is conditionally unfavorable. Success in treatment is achieved only in the initial forms. Survival rate is 18-30%. Life expectancy depends entirely on the progression of the tumor and its aggression towards other organs and systems.

Most often, people die from respiratory failure or pulmonary hemorrhage, which develops due to severe bronchospasm. The average life expectancy, if all doctor's recommendations are followed, is 1-2 years. This form of cancer is one of the most rapidly developing and prone to metastasis.

You need to pay attention to the first signs of bronchial cancer, which in its symptoms resembles a cold. Self-monitoring and comprehensive diagnostics will help identify the ill-fated disease at an early stage, and specially selected treatment can get rid of cancer.

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 psychologically support 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.

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, 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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