Peripheral lung cancer, regional lymph nodes, radiation therapy. Video: Unusual signs of lung cancer. Treatment of peripheral lung cancer in Russia, Israel and Germany

Like all oncological diseases, the possibility of treatment depends on timely detection. Only taking action at the earliest stages gives a favorable prognosis for cure.

The essence of pathology

Peripheral lung cancer is a malignant formation, the development of which begins from small elements located on the periphery of the organ. At its core, it is a formation in the form of a polygonal or spherical node, originating on the mucous membrane of the bronchi, bronchial glands and pulmonary alveoli. In addition, a cavity tumor can also form.

The main difference between the pulmonary-peripheral form and central lesion- this is a slow asymptomatic development and a variety of options. The pathology is very difficult to identify until the tumor grows into large structures: pulmonary lobes, large bronchi, pleura, etc. As it progresses, the peripheral variety degenerates into the central form of oncology.

The disease begins with damage to the small bronchi. During this period, the picture of formation appears to be uneven radiance forming around the node. This manifestation is most typical for tumors of a poorly differentiated type with a fast-growing character. Cavity varieties include heterogeneous zones of decay. Peripheral cancer tends to metastasize, spreading to the central part of the organ and nearby tissues.

Specific forms of pathology

Peripheral lung cancer is diverse, but the following main forms of its development are distinguished:

1. Cortico-pleural type: an oval node located in the subpleural zone and growing into the chest. This form represents squamous cell carcinoma heterogeneous structure with an unclear contour.
2. Cavity type: the formation has a central cavity, which is formed as a result of decomposition of the central section of the node. These tumors are large in size (more than 8-9 cm).
3. Nodular form: most often originates in the terminal bronchioles. On an x-ray, clear nodes with bumps on the surface can be distinguished. At the border of the growth, a depression is recorded, indicating the entry of the bronchus (Rigler's symptom).
4. Pneumonia-like variety: a form of glandular cancer in which multiple small nodes tend to merge.

Tumors of different locations have certain specific features. So, it is divided into the following characteristic manifestations:

1. Cancer of the upper lobe of the left lung, as a rule, is detected by radiography in the form of an irregularly shaped formation with a heterogeneous structure, and the pulmonary roots have vascular dilatation, but the lymph nodes are not changed.
2. Peripheral cancer of the lower lobe of the left lung is characterized by a noticeable increase in the size of the intrathoracic, prescalene and supraclavicular lymph nodes.

Peripheral cancer of the right lung has symptoms that are in many ways similar to the development of this disease in the left lung. In particular, peripheral cancer of the upper lobe of the right lung has a heterogeneous structure and expanded pulmonary roots, while cancer of the lower lobe of the right lung is manifested by swelling of the lymph nodes. The main difference between right-sided localization is its significantly more frequent occurrence compared to left-sided formations.

Separately, another peripheral lung cancer stands out - Pankos syndrome. This form covers the pulmonary apexes, and is characterized by the germination of malignant cells into nerve fibers and blood vessels shoulder girdle.

Etiology of pathology

The causes, peripheral lung cancer, are similar to cancer of central localization. Among the main factors are the following:

• smoking: a huge amount of carcinogenic substances in tobacco smoke is recognized as one of the main causes of any type of lung cancer;
• air pollution: dust, soot, exhaust gases, etc.;
• harmful production conditions and industrial emissions into the atmosphere;
• asbestos: when its particles are inhaled, asbestosis is formed, which is an important factor in oncology;
• pulmonary pathologies of a chronic nature, repeated pneumonia;
• hereditary predisposition.

Symptoms of pathology

The following main stages are distinguished in the development of peripheral lung cancer:

• Stage 1: small tumor (1A - no more; 2Bmm);
• Stage 2: increase in the size of the formation (2A - domm, 2B - the same size, but located near the lymph nodes);
• Stage 3: tumor growth into nearby tissues (3A - size over 75 mm, spread to lymph nodes and nearby organs; 3B - growth into the chest);
• Stage 4 - metastases with spread throughout the body.

Peripheral cancer is asymptomatic for a long time, but as the tumor grows, the following symptoms appear:

• dyspnea;
• pain in the chest area;
• cough for no apparent reason, sometimes prolonged, paroxysmal;
• sputum production;
• swelling of the lymph nodes;
• signs of neuralgia are possible due to compression of the cervical nerve fibers.

The appearance of oncology helps to identify the following signs:

• slight increase in temperature in constant mode;
• general weakness and fatigue;
• weight loss;
• loss of appetite;
• joint and bone pain.

Principles of pathology treatment

The effectiveness of treatment for peripheral lung cancer depends entirely on the stage of the disease. If pathology is detected at an early stage, treatment is possible using a conservative method, but if the moment is missed, then the only real way to slow down the development of the tumor is surgical treatment in combination with intensive therapy.

Currently, the following methods are used to eliminate the disease: surgical intervention, chemotherapy, radiation therapy and radiosurgery. Surgical treatment always combined with chemotherapy or radiation to prevent relapses and destroy remaining malignant cells. The following drugs are used for intensive chemotherapy: Doxorubicin, Cisplatin, Etopizide, Bleomycin, Docetaxel, Gemcitabine and some others. Chemotherapy is sometimes prescribed in up to 4-5 courses with a break of days between courses.

Peripheral lung cancer grows from small bronchi, and therefore is very difficult to diagnose early. As it progresses, it covers the entire organ and is capable of metastasizing to other organs. The only real way to protect yourself from this terrible pathology- prevention of the causes of illness. If the pathology does arise, then it must be detected at the earliest stages.

Peripheral cancer of the left lung

Peripheral cancer of the left lung

Lung cancer occupies one of the first positions in the ranking of deadly diseases. Peripheral lung cancer develops in women after 50 years of age, and in men over 45 years of age. The male population is more susceptible to this disease. A tumor of the upper lobe occurs more often than the lower, and the right lung is affected more often than the left. But cancer of the left half is more aggressive, and there is practically no chance for a favorable prognosis.

The neoplasm represents several types of malignant processes, one of which is peripheral cancer. This form of cancer starts from the epithelial cells of the bronchi, then invades the lungs themselves. Accompanied by active metastasis to distant organs and regional lymph nodes.

Causes of peripheral cancer

Today, the main cause of the pathological process in the lungs is the influence of carcinogens, especially those inhaled from cigarette smoke. Long-term smokers are most susceptible to upper lobe lung cancer due to accumulation in the lungs large quantity tars and decreased lung function.

Carcinogens enter the lungs not only with tobacco, but also due to air pollution. In industrial areas where processing industries are active, the risk of cancer is several times higher.

Smoking has always been the main risk factor, but in addition there are other contributing factors:

1. Advanced chronic lung diseases: inflammatory and infectious processes.
2. Decreased immunity due to systemic diseases, including immunodeficiency.
3. Effect of radioactive exposure.
4. Direct inhalation or indirect contact with chemicals: arsenic, nickel, cadmium, chromium, radon.

The development of a malignant process is always based on unfavorable environmental conditions or serious systemic disorders. First of all, the name system suffers from negative factors, after which the body loses the ability to adequately fight malignant cells and the upper lobe of the right or left lung begins to grow.

The condition of the bronchi plays an important role in this case, since peripheral lung cancer begins with bronchial cells. Therefore, diseases such as chronic bacterial or toxic bronchitis play a role in the development tumor process lungs.

Symptoms of a left lung tumor

Symptoms of a tumor in the upper lobe of the lung do not appear for a long time, which depends on the structure of the pathological cells and the characteristics of the course of the cancer. Thus, a squamous cell tumor quickly destroys the lungs; its symptoms begin as soon as the cancer reaches the third stage, when metastasis occurs. If we talk about the development of cancer from small segments of the bronchi, that is, peripheral, then its symptoms begin with the spread of the tumor to the pleura. The peripheral tumor itself has a characteristic round shape, is most often localized in the upper lobe of the lungs, then gradually affects the entire organ and structures nearby.

Peripheral cancer is also called Pencoast tumor. It is characterized by damage to the upper lobe of the organ and dysfunction nerve plexus shoulder

The main symptoms of peripheral cancer are no different from other forms; they are cough, chest pain, hemoptysis and general malaise. Depending on the growth period, symptoms either progress or subside.

Phases of the disease

1. The first phase of development is biological. It begins with the appearance of malignant cells until they are detected on an x-ray.
2. The preclinical phase or asymptomatic phase lasts from the moment the tumor is identified during diagnosis until the first symptoms appear.
3. Clinical phase of development - during this period the main symptoms of cancer appear, the course of the disease is severe, appropriate symptomatic and radical treatment is carried out. If measures are not taken in the clinical phase, the prognosis of the disease is extremely unfavorable, the patient dies within a few months.

Alternation of periods severe symptoms and asymptomatic course is due to many factors. First of all, the patient’s body is affected by tumor decay products, therapeutic treatment and structural changes in the lungs. The further the cancer progresses, the more likely it is that all lobes of the left lung are completely affected with pleural cavity.

Symptoms of metastases

Symptoms of lung cancer metastases

Metastases also affect symptoms: the passage of cancer cells through the lymphatic and circulatory system provokes changes in the function of individual organs, which complicates the treatment approach. Symptoms of intoxication, renal failure, impaired brain activity and the formation of mature blood cells are added. One violation entails subsequent diseases, and together all this leads to a serious condition for the patient.

Is it possible to suspect left lung cancer at the initial stage of development? To do this, you need to take into account the condition of your bronchi and other organs of the chest cavity. If the inflammatory process has been observed for a long time, Chronical bronchitis, chronic respiratory tract infections and at the same time there is a genetic predisposition, the possibility of oncology increases. In this case, you need to pay attention to cough, soreness, the appearance of exudate of unknown color when coughing and contact an oncologist for diagnosis.

Complication and metastasis

Peripheral cancer localized in the left lung causes irreparable harm to nearby and distant structures. First of all, breathing is impaired, then a tumor in the chest provokes inflammatory processes in the bronchi and abscesses.

Complications can also occur in the hands, the sensitivity of the fingers is impaired, pain appears in the shoulder and along the entire length of the left arm.

Metastasis in cancer occurs in almost 100% of cases, starting from the third stage. Metastases often migrate to the bone marrow, bones, kidneys and adrenal glands, as well as the brain. It follows from this that the symptoms of metastasis and complications associated with them may concern serious violations individual brain structures. This includes perception, memory, coordination and mental components. It is possible that mental disorders may develop as a result of metastasis.

Tracheal stenosis, internal bleeding, dysphagia, superior vena cava syndrome - all this can be a consequence of peripheral cancer.

Diagnosis of lung cancer

At an early stage of development in the biological phase, it is possible to detect cancer only through biochemical analysis. The disease is asymptomatic until it enters the second stage. Diagnosis in the second phase - preclinical, is possible during an X-ray examination, but the patient still has no complaints, which leads the cancer to the third period - clinical. In the clinical phase, the patient already has a set of symptoms, on the basis of which a preliminary diagnosis can be made and all the necessary diagnostic measures can be carried out.

Diagnosis of peripheral cancer includes:

• thoracotomy, pleural puncture;
• clinical tests of urine, blood and feces;
• blood chemistry;
• magnetic resonance imaging and radiography.

After the diagnosis is made and the location of the tumor process is identified, treatment begins.

Treatment of the upper lobe of the lung

The basis for surgical intervention is cancer of the left lung without signs of metastasis, limited to one lobe. The tumor focus is removed along with healthy tissue, after which the right part of the lung takes over the functions of the removed organ. Surgical treatment has a favorable prognosis, and the five-year survival rate is 55%, depending on the type of cancer and subsequent treatment.

After surgery, the patient is prescribed radiation therapy and treatment with chemotherapy drugs. Chemotherapy for lung cancer comes first among all treatment methods, since more often the lung disease is aggressive and creates many contraindications to radical treatment.

Chemotherapy

Chemotherapy for lung cancer

Chemotherapy treatment is carried out in the following cases:

• impossibility of surgery due to the proximity of the tumor to the esophagus;
• localization of cancer in the throat area;
• close location of cancer to the main blood vessels and heart.

Chemotherapy is also prescribed to prevent metastasis after cancer removal and before surgery.

Types of operations

If the patient is operable, several surgical options are performed.

1. Lobectomy – extirpation of two lobes of the lung.
2. Wedge resection is partial removal of an organ, performed only at an early stage.
3. Pulmonectomy – removal of the lung with the formation of a bronchial stump.

The possibility of surgery increases the chances of a favorable prognosis, but peripheral cancer is too aggressive, and it is extremely difficult to begin its timely treatment.

Survival prognosis for lung cancer

Chance for complete cure from peripheral cancer is practically absent, it develops at lightning speed and has low sensitivity to chemotherapy drugs. All lung cancer has a poor prognosis with survival after diagnosis of 2-6 months.

Five-year survival prognosis after surgery and conservative treatment is only 15%. Application of modern antitumor drugs can prolong the patient’s life several times, but only in the case of a limited cancer process.

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Features of peripheral lung cancer: signs, treatment and prognosis

Lung cancer can have a different character depending on the histology and localization of the tumor process. According to localization, central and peripheral cancer are distinguished.

The latter is formed from the tissues of small bronchi and bronchioles. Symptomatic manifestations of such cancer occur only after the oncological process grows in the tissue large bronchi and pleura. Therefore, peripheral cancer is usually detected in late stages, which determines the high mortality rate for such a disease.

Concept of illness

It is very difficult to detect pathology in a timely manner, because it is characterized by a meager and sometimes completely asymptomatic picture of development.

Often, a pulmonary tumor, without detecting itself, grows to very large neoplasms with a diameter of about 7 cm.

Forms of the disease

There are several specific forms of peripheral lung cancer:

• Cortico-pleural;
• Cavity;
• Nodal;
• Cancer of the upper pulmonary lobe on the right;
• Pneumonia-like cancer;
• Cancer of the lower and upper pulmonary lobe on the left;
• Pulmonary apex cancer complicated by Pancoast syndrome.

Corticopleural form

A similar oncological form was identified as a separate subtype of peripheral cancer in the middle of the last century.

It originates from the mantle of the pulmonary layer and is formed not by a nodular, but by a creeping tumor, gradually growing into the chest tissue. Typically, a corticopleural tumor is an oval formation with a wide base, which grows towards the chest wall, closely adjacent to it.

The surface that protrudes into the lung tissue is lumpy in nature. The tumor in the form of thin rays grows into the adjacent pulmonary sections. Corticopleural pulmonary tumor, according to histological and morphological characteristics, belongs to squamous cell types of cancer. It can grow into nearby vertebrae and ribs.

Cavitary

Cavity peripheral pulmonary oncology is a tumor with a cavity formation inside, which is formed as a result of processes of disintegration of the center of the node caused by insufficient nutrition.

Cavity cancerous tumors usually grow up to 10 cm in diameter, so they are often mistaken for abscesses, tuberculous or cystic processes.

Such similarity often becomes the reason misdiagnosis, as a result of which cancer processes progress, aggravating the picture of oncology. Due to the factors described above, cavitary peripheral lung cancer is diagnosed mainly in advanced, irreversible stages.

Oncology of the left upper and lower lobe

With peripheral oncology of the upper pulmonary lobe, the lymph nodes do not enlarge, and the tumor itself has an irregular shape and heterogeneous structural structure. At the same time, the pulmonary roots expand with the trunks of blood vessels.

At peripheral lesion the lower pulmonary lobe, on the contrary, there is a natural increase in lymph node centers located in the supraclavicular, intrathoracic and prescalene regions.

Peripheral cancer of the upper lobe of the right lung

With peripheral cancer of the upper lobe, a similar picture is observed as with damage to the left lung, with the only difference that the organ with right side most susceptible to cancer processes due to the anatomical features of the organ’s location.

Nodal

The nodular type of peripheral lung cancer begins from the tissues of the bronchioles, and the first symptoms manifest themselves only after germination occurs in the lung soft tissues.

On an x-ray, this form looks like a bumpy, clearly defined nodular formation.

If a bronchus or large vessel enters the tumor node, then a characteristic depression will be visible along its edge.

Pneumonia-like peripheral

This form of cancer is always distinguished by its glandular nature. This cancer usually appears in the tissues of the lower and middle pulmonary lobes.

A diagnostically significant manifestation of pneumonia-like peripheral pulmonary cancer is the “air bronchogram” sign, when an X-ray clearly shows bronchial lumens against the background of a solid dark spot.

In terms of external manifestations, this form of peripheral lung oncology is similar to prolonged inflammation. It is characterized by a hidden, slow onset with a gradual increase in symptoms.

Tops with Pancoast syndrome

In apical lung cancer with Pancoast syndrome, the penetration of abnormal cells into the vascular and nervous tissues of the shoulder girdle is typical. This form of oncology is accompanied by the following symptoms:

• Supraclavicular painful sensations of increased intensity. At first, the pain is periodic, but as the cancer progresses, it becomes permanent;
• With pressure, pain symptoms become more pronounced and can spread along the nerves that come from the plexus on the shoulder. Often, muscle tissue on the affected side of the limb atrophies, fingers go numb, and movements are impaired due to paralysis of the arm;
• The x-ray shows rib destruction and deformation of skeletal bones.

Pancoast syndrome is often accompanied by Horner's syndrome, which is characterized by constriction of the pupil, drooping eyelid, recessed eyeball, different eye shades and other disorders.

In addition, with a combination of Pancoast and Horner syndromes, hoarseness in the voice, sweating disorders, and redness of the skin on the face on the side of the affected lung are observed.

Symptoms and signs

Peripheral lung cancer does not manifest itself for a long time, and the first symptoms appear only when the tumor grows into the pleural tissues and large bronchi. Then the patient notes the appearance of symptoms like:

1. Severe shortness of breath caused by the spread of metastases to the lymph nodes;
2. Unreasonable, untreatable cough;
3. Chest pain that changes in intensity with activity;
4. Enlarged lymph nodes;
5. Copious secretion of sputum;
6. Neurological manifestations that occur when a tumor forms in the upper pulmonary lobe.

For peripheral oncology, it is typical to have signs of a general impact of formation on organic structures. They are manifested by hyperthermia, decreased ability to work, weight loss and malaise, rapid fatigue and refusal to eat, lethargy and pain in joint and bone tissues.

Reasons for development

The most common cause of peripheral and other types of lung cancer is tobacco smoking.

Tobacco smoke contains many substances that have a carcinogenic effect on organic structures, in particular on the respiratory system.

The following factors can provoke the occurrence of pulmonary peripheral oncological processes:

• Heredity;
• Aggressive environmental situation associated with air pollution from industrial emissions, dust, exhaust gases, etc.;
• Chronic lung pathologies, often leading to inflammatory processes in the pulmonary system, which increases the risk of cancer;
• Harmful production - work in dusty rooms, in mines, at construction sites (inhalation of asbestos), at chemical plants, etc.

Stages

There are four stages of development of peripheral lung oncology:

1. The initial stage is characterized by a small diameter of the tumor (up to 5 cm), which has not yet grown into the lymph nodes;
2. At the 2nd stage of development, the formation grows to 5-7 cm, cancer cells have almost reached the lymph node centers;
3. For stage 3, the large size of the formation and its growth into the lymph nodes and adjacent tissues are typical; by the end of the 3rd stage of tumor development, the tumor cells penetrate to the opposite half of the breast;
4. At stage 4, the tumor begins to spread metastases, and fluid begins to accumulate around the heart and in the pleura.

Diagnostics

Diagnostic processes are based on traditional laboratory research and radiology.

If peripheral cancer is in an advanced stage, then a single image is enough for an experienced specialist to detect it.

If the picture is unclear, then resort to additional diagnostic procedures such as computed tomography, auscultation, ultrasound, bronchoscopy, blood tests, radioisotope scanning, etc.

Treatment of patients

Treatment of peripheral lung cancer is similar to the treatment of its other types and is based on the use of polychemotherapy, radiation and surgical techniques.

Complications

If peripheral pulmonary oncology is in an advanced stage, then the main clinical manifestations are accompanied by various kinds of complications caused by metastasis to intraorganic structures.

In addition, bronchial obstruction, processes of disintegration of the original tumor focus, bleeding of the lungs, atelectasis, etc. act as complications of cancer. Often the presence of numerous metastases, pleurisy and pneumonia of cancer origin, severe exhaustion lead to the death of the cancer patient.

Forecast

In patients with the initial cancer stage of peripheral lung cancer, the probability of survival is 50%, with stage 2 only 30% survive, with stage 3 - 10%, and the final stage 4 is considered terminal and is not positively predicted.

Preventive measures

Traditional anti-cancer prevention in this situation is timely treatment of pulmonary pathologies, giving up cigarettes, using specialized protection for the pulmonary system when working in hazardous work and active life, undergoing annual fluorographic examination and excluding carcinogenic effects.

Video about endobronchial ultrasound in the diagnosis of peripheral lung cancer:

Peripheral lung cancer

Posted By: admin 10/28/2016

Neoplasms of lung tissue are a fairly progressive cancer in modern world. The occurrence of cancer in the left or right lung observed in women, men and even children. According to statistics, the male population suffers from this pathology in to a greater extent. The reason for this is a hereditary factor, as well as abuse bad habits And production influences. The development of a malignant process is most often noted in adulthood, after fifty years of life.

Etiology of lung cancer

The cause of lung tissue pathology is mainly chronic respiratory diseases, environmental pollution, smoking, alcohol abuse, radiation exposure, chemical vapor poisoning and hereditary factors. Lung abnormalities innate nature are also risk factors for cancer.

Precancerous conditions of the lungs include inflammatory processes in bronchial system which become chronic. These include: pneumosclerosis, tuberculosis, bronchiectasis, pneumonia, bronchitis, etc. The occurrence of inflammatory processes in the pulmonary and bronchial tissue can be a consequence initial stage malignant formation in the respiratory system. Currently, there are severe oncological complications after influenza, which provokes the development of an atypical process in the lungs. Therefore, after suffering from diseases of this type, the patient should be under the supervision of a pulmonologist for a year.

Pathological symptoms of the respiratory organs can occur for unknown reasons, that is, a person complains of a persistent cough, shortness of breath, increased body temperature, the presence of bloody elements in the sputum, an increase in the erythrocyte sedimentation rate in a blood test. Such a clinic should alert the doctor and identify the patient at risk for an atypical process.

Men and women who have extensive experience working in hazardous industries, as well as heavy smokers, should also undergo annual preventive examinations and chest x-rays, even in the absence of pathological symptoms.

Pathological signs of lung cancer

A malignant process in the respiratory organs develops from mucous epithelial cells of glandular and bronchial tissue. The structure of the neoplasm may consist of flat epithelial cells with varying degrees of differentiation, which is determined by the maturity of the cancer elements. To a lesser extent, undifferentiated cancer is noted and, least often, glandular cancer. The malignant process can be localized in the center of the pulmonary lobes - central cancer, which develops from the mucous layer of the bronchi (segmental, lobar and main). This localization of the tumor marks exophytic cell growth, that is, the growth of cancer in the lumen of the bronchi (endobronchial tumor) and endophytic, that is, into the lung tissue (infiltrative cancer). It is central cancer that is often detected.

Peripheral lung cancer originates from the mucous layer that lines the subsegmental bronchi and bronchioles. The occurrence of a malignant formation is more often observed in the right lung.

Varieties of lung cancer also include:

• Pneumonia-like cancer is a tumor in the form of several formations localized along the periphery of the right lung, which gradually merge with each other, affecting the entire lobe of the organ;
• Miliary cancer is a consequence of metastases of the primary tumor in the lung tissue, which can disseminate hematogenously. This form is called carcinomatosis;
• Pancoast tumor is a peripheral lung cancer that affects the upper lobe. A fast-growing form in which expansive-infiltrative growth of epithelial cells occurs, affecting the pleura, plexus of the shoulder girdle, and spine thoracic. In the presence of this form of cancer, the patient complains of limited movement in the shoulder and cervical spine, as well as a decrease in muscle tone of the arm on the affected side. If cancer is not detected in a timely manner and the symptoms of the neurological clinic are treated, the tumor gains rapid momentum and enters a late stage of development.
• The occurrence of a malignant tumor in the upper right lobe of the lung near the main bronchus or hilar part has infiltrative growth and metastasis. Early metastases rush to the mediastinum, with the corresponding clinical picture of compression of large vessels and the esophagus, which characterizes the mediastinal form of cancer.

These forms of lung cancer are atypical and rare.

Stages of a malignant tumor in the lungs

In the early, first stage, the presence of a small formation (up to three centimeters) is characteristic, which is surrounded by visceral pleura or lung tissue without visible lesions of the proximal bronchus during examination. The presence of metastases can be observed in the peribronchial, bronchial nodes on the right or left lung, as well as tumor growth in the lymphatic system.

The second stage is characterized by the presence of a tumor of more than three centimeters, in which atelectasis or inflammation of the lung tissue without pleural effusion is observed, closer to the root (obstructive pneumonia), which does not spread to both lungs. A couple of centimeters from the tracheal carina of the lung, during bronchoscopy, the proximal part of the neoplasm is observed. Metastases in the second stage affect the bronchopulmonary lymph nodes, which are located in the root area of ​​the organ.

The third stage of cancer is expressed by the presence of a tumor of significant size, which affects adjacent tissues of the thoracic region, these are: the mediastinum, the dome of the diaphragm and the chest wall. The cancer mass may not reach the pulmonary carina by a couple of centimeters, but obstructive bilateral pneumonia with effusion or atelectasis is clearly present. Lymphogenic metastasis in the third stage affects the lymph nodes of the mediastinum, which contains the paratracheal, tracheobronchial and bifurcation lymphatic systems.

Study respiratory organ at the fourth stage of cancer, notes the presence of a large tumor, with damage to the right or left lung, mediastinum, neighboring organs, with the presence of damage to regional and distant lymph nodes. Lung cancer in the fourth stage, as a rule, has the character of tissue disintegration (gangrene, abscess, pleurisy). The presence of metastases in the adrenal glands, liver, brain, bones and kidneys is often noted.

Signs and symptoms

According to observations of people who are a risk factor for the development of lung cancer, the clinical picture corresponds to the symptoms of respiratory pathology. Of these symptoms, the main one is cough. In the early stage of the disease, it is absent, but in accordance with the process of tumor infiltration, it begins to gain momentum. At the beginning, the cough may be dry, with scant sputum in the morning, then it acquires a barking character. A hysterical cough, with a voluminous amount of sputum, in which bloody streaks are noted, is a clear sign of pulmonary oncology in ninety percent of cases. Due to the proliferation of blood vessels by the tumor, hemoptysis may occur.

In second place after coughing is pain. The primary process of lung cancer is not always expressed by the presence of pain, but more than half of patients still report dull and aching pain. If the tumor is localized in the right lung, then the pain radiates to the liver, and when the left lung is affected, patients note that the heart hurts. As the tumor grows and metastasizes, the pain intensifies, especially if the patient lies on the side where the lesion is located.

An increase in body temperature is observed already at the beginning of the disease in most patients. The fever is constant, low-grade, and when accompanied by obstructive pneumonia, it becomes quite high.

During the development of an oncological process in the lungs, gas exchange in the organ is disrupted, so some patients report shortness of breath, which intensifies after physical activity.

With lung cancer, pulmonary osteopathy syndrome of a hypertrophic nature may increase, that is, patients experience night pain in the lower limbs(shins and knees).

The course of the malignant process, depending on the histological structure of the tumor and the body’s resistance, can be expressed by sluggish current or vivid symptoms for several months and even years. The development of central cancer occurs over a longer period of time than peripheral cancer. If you carry out anti-inflammatory therapy to treat pneumonia, the patient’s condition improves for a while. Constant relapses of bronchitis and pneumonia may indicate the presence of a malignant process in the lungs.

Lung cancer screening

Diagnosis of pathology in the respiratory organs, especially in people at risk, comes down to interviewing and examining the patient. The main and most informative examination is radiography, bronchoscopy and computed tomography.

When collecting anamnesis, it is necessary to pay attention to the patient’s age, work experience in hazardous work and smoking history. Also, you need to clarify the nature of the cough and pain. Diagnosis of cancer by percussion is not effective. The location and size of a tumor in the lung can be identified using X-ray images. The presence of a shadow in the right or left lung, with signs of homogeneity, blurred contours, single or multiple nodulation, polycyclicity, indicates the development of infiltrative peripheral cancer. The size of the tumor significantly increases the chances of establishing a reliable diagnosis, which is important for prescribing the correct treatment. If the formation is small, you can see a small shadow in the image, from which it is difficult to determine the nature of the pathology. The displacement of the shadow during inhalation and exhalation on an x-ray, as well as its presence in the area of ​​the root of the organ and a change in the pulmonary pattern, may indicate a sign of narrowing of the bronchus and atelectasis of the lung, which is characteristic of central cancer.

The angiography method allows you to determine the damage to the branches pulmonary artery, which confirms the presence of a malignant tumor. To do this, a contrast agent is injected intravenously.

Modern examination methods include:

• MRI to determine the exact location of the tumor. This method is harmless to the patient, but the presence of metal prostheses in the body may affect the procedure. Using magnetic resonance tomography pictures are obtained High Quality with a detailed image of the organ.
• CT is a low-dose device with the function of scanning the tissue being examined. In most cases, examination of the lungs and bronchi, spiral tomography can detect a cancerous tumor of even small size.
• PET is a diagnostic method in which a drug based on radioactive particles is injected intravenously into the body, which, when interacting with other elements, allows one to see organs in a three-dimensional image, the presence of a tumor, identification of the cellular structure and the stage of the tumor.
• Bronchoscopy is performed using equipment in the form of a probe, which is inserted into the airway with special biopsy equipment and a camera. A bronchoscope helps determine the patency of the bronchi and the presence of malignancy in the central form of cancer. The taken biomaterial is examined for histological differentiation of the tumor. To identify a peripheral oncological process in the lung, you can try the method of puncturing the lung tissue at the site of a possible focus. If pleural effusion is observed on x-rays, puncture of the pleural area may also be important. diagnostic study for cancer. A puncture biopsy procedure is very painful and therefore requires the necessary preparation of the patient.
• The collection of biopsy material can be organized through surgery, that is, by removing the affected lymph node for histological examination. Biopsy operations may be complicated by infection of the intervention site, bleeding, and other pathological reactions body.
• If there is good sputum separation, a cytological analysis can be performed. This method will help to identify and examine cancer cells, provided they are present in sputum, and therefore is not always effective in diagnosing lung cancer.
• Determining a cancerous tumor in the lungs using a tumor marker is an effective modern diagnostic method.

Treatment

The first step for lung cancer, after the final diagnosis and indications have been established, is surgery. This treatment method allows you to remove the entire or affected part of the respiratory organ. After surgery, the patient needs treatment that will complement and help avoid relapse of the disease. Such therapy includes irradiation with a radiation field and exposure to chemotherapy.

Unfortunately, less than half of patients have a favorable prognosis for life within five years after treatment.

Lung cancer is a malignant neoplasm of epithelial origin, developing from the mucous membranes of the bronchial tree, bronchial glands (bronchogenic cancer) or alveolar tissue (pulmonary or pneumogenic cancer). Lung cancer leads in the structure of mortality from malignant tumors. The mortality rate for lung cancer is 85% of the total number of cases, despite the advances of modern medicine.

The development of lung cancer is different for tumors of different histological structures. Differentiated squamous cell carcinoma is characterized by a slow course; undifferentiated carcinoma develops quickly and gives extensive metastases. The most malignant course has small cell lung cancer. develops secretly and quickly, metastasizes early, has poor prognosis. Most often, the tumor occurs in the right lung - in 52%, in the left lung - in 48% of cases.

The cancerous tumor is predominantly localized in the upper lobe of the lung (60%), less often in the lower or middle lobe (30% and 10%, respectively). This is explained by more powerful air exchange in the upper lobes, as well as by the peculiarities of the anatomical structure of the bronchial tree, in which the main bronchus of the right lung directly continues the trachea, and the left one forms an acute angle with the trachea in the bifurcation zone. Therefore, carcinogenic substances foreign bodies. smoke particles, rushing into well-aerated zones and remaining in them for a long time, cause the growth of tumors.

Metastasis of lung cancer is possible in three ways: lymphogenous, hematogenous and implantation.

The most common is lymphogenous metastasis of lung cancer to bronchopulmonary, pulmonary, paratracheal, tracheobronchial, bifurcation, and paraesophageal lymph nodes. The first to be affected by lymphogenous metastasis are the pulmonary lymph nodes in the zone of division of the lobar bronchus into segmental branches. Then the bronchopulmonary lymph nodes along the lobar bronchus are involved in the metastatic process. Subsequently, metastases occur in the lymph nodes of the root of the lung and azygos vein, and tracheobronchial lymph nodes. The next to be involved in the process are the pericardial, paratracheal and paraesophageal lymph nodes. Distant metastases occur in the lymph nodes of the liver, mediastinum, and supraclavicular region.

Metastasis of lung cancer through the hematogenous route occurs when the tumor grows into blood vessels, and the other lung, kidneys, liver, adrenal glands, brain, and spine are most often affected. Implantation metastasis of lung cancer is possible in the pleura if the tumor grows into it.

Causes of lung cancer

Factors of occurrence and mechanisms of development of lung cancer do not differ from the etiology and pathogenesis of other malignant lung tumors. In the development of lung cancer, the main role is given to exogenous factors: smoking, air pollution with carcinogenic substances, exposure to radiation (especially radon).

Classification of lung cancer

Based on the histological structure, there are 4 types of lung cancer: squamous cell, large cell, small cell and glandular (adenocarcinoma). Knowledge of the histological form of lung cancer is important in terms of choice of treatment and prognosis of the disease. It is known that squamous cell lung cancer develops relatively slowly and usually does not give early metastases. Adenocarcinoma is also characterized by relatively slow development, but it is characterized by early hematogenous dissemination. Small cell and other undifferentiated forms of lung cancer are transient, with early extensive lymphogenous and hematogenous metastasis.

It has been noted that the lower the degree of tumor differentiation, the more malignant its course.

According to localization relative to the bronchi, lung cancer can be central, arising in the large bronchi (main, lobar, segmental), and peripheral, emanating from the subsegmental bronchi and their branches, as well as from the alveolar tissue. Central lung cancer is more common (70%), peripheral lung cancer is much less common (30%).

The form of central lung cancer is endobronchial, peribronchial nodular and peribronchial branched. Peripheral cancer can develop in the form of “globular” cancer (round tumor), pneumonia-like cancer, cancer of the apex of the lung (Pancoast).

The classification of lung cancer according to the TNM system and stages of the process is given in detail in the article “Malignant lung tumors”.

Symptoms of lung cancer

The clinical picture of lung cancer is similar to the manifestations of other malignant lung tumors. Typical symptoms are a constant cough with mucopurulent sputum, shortness of breath, low-grade fever body, chest pain, hemoptysis. Some differences in the lung cancer clinic are due to anatomical localization tumors.

Central lung cancer

A cancer tumor localized in a large bronchus gives early clinical symptoms due to irritation of the bronchial mucosa, disruption of its patency and ventilation of the corresponding segment, lobe or entire lung.

The interest of the pleura and nerve trunks causes the appearance pain syndrome, cancerous pleurisy and disorders in the areas of innervation of the corresponding nerves (phrenic, vagus or recurrent). Metastasis of lung cancer to distant organs causes secondary symptoms in the affected organs.

Invasion of the bronchial tube by a tumor causes a cough with sputum and often mixed with blood. When hypoventilation occurs, and then atelectasis of a segment or lobe of the lung, cancerous pneumonia occurs. manifested by elevated body temperature, the appearance of purulent sputum and shortness of breath. Cancer pneumonia responds well to anti-inflammatory therapy, but recurs again. Cancer pneumonia is often accompanied by hemorrhagic pleurisy.

Invasion or compression by tumor vagus nerve causes paralysis of the vocal muscles and manifests itself as hoarseness. Damage to the phrenic nerve leads to paralysis of the diaphragm. The growth of a cancerous tumor into the pericardium causes pain in the heart, pericarditis. Involvement of the superior vena cava leads to disruption of venous and lymphatic drainage from the upper half of the body. The so-called superior vena cava syndrome is manifested by puffiness and swelling of the face, hyperemia with a cyanotic tint, swelling of the veins in the arms, neck, chest, shortness of breath, and in severe cases - headache, visual disturbances and impaired consciousness.

Peripheral lung cancer

Peripheral lung cancer in the early stages of its development is asymptomatic, since there are no pain receptors in the lung tissue. As the tumor node grows, the bronchi, pleura, and neighboring organs become involved in the process. TO local symptoms peripheral lung cancer include cough with sputum and streaks of blood, superior vena cava compression syndrome, hoarseness. Tumor growth into the pleura is accompanied by cancerous pleurisy and compression of the lung by pleural effusion.

The development of lung cancer is accompanied by an increase in general symptoms: intoxication, shortness of breath, weakness, weight loss, increased body temperature.

In advanced forms of lung cancer, complications from organs affected by metastases, disintegration of the primary tumor, and bronchial obstruction occur. atelectasis, profuse pulmonary hemorrhage. The causes of death in lung cancer are most often extensive metastases, cancer pneumonia and pleurisy, cachexia (severe exhaustion of the body).

Diagnosis of lung cancer

Diagnosis for suspected lung cancer includes:

Read more about methods for diagnosing lung cancer here.

Lung cancer treatment

The leading methods in the treatment of lung cancer are surgery in combination with radiation therapy and chemotherapy. The operation is performed by thoracic surgeons.

If there are contraindications or ineffectiveness of these methods, palliative care aimed at alleviating the condition of a terminally ill patient. Palliative treatment methods include pain relief, oxygen therapy, detoxification, palliative operations: tracheostomy. gastrostomies. enterostomy, nephrostomy, etc.). For cancer pneumonia, anti-inflammatory treatment is carried out, for cancer pleurisy - drainage of the pleural cavity, for pulmonary hemorrhage - hemostatic therapy.

Forecast and prevention of lung cancer

The worst prognosis is statistically observed for untreated lung cancer: almost 90% of patients die 1-2 years after diagnosis. With non-combined surgical treatment of lung cancer, the five-year survival rate is about 30%. Treatment of lung cancer at stage I gives a five-year survival rate of 80%, at stage II – 45%, at stage III – 20%.

Radiation or chemotherapy alone has a 10% five-year survival rate for lung cancer patients; with combined treatment (surgery + chemotherapy + radiation therapy), the survival rate for the same period is 40%. Metastasis of lung cancer to lymph nodes and distant organs is prognostically unfavorable.

Issues of lung cancer prevention are relevant in connection with high performance mortality from this disease. The most important elements of lung cancer prevention are active health education, prevention of the development of inflammatory and destructive lung diseases, identification and treatment of benign lung tumors, smoking cessation, elimination of occupational hazards and everyday exposure to carcinogenic factors. Having fluorography at least once every 2 years allows you to detect lung cancer in the early stages and prevent the development of complications associated with advanced forms of the tumor process.

Oncological pathology of the bronchopulmonary system is a rather serious problem. The lungs are an organ that does not have pain receptors in its structure. Therefore, pain, as a symptom of damage, appears at fairly late stages of the disease. The article discusses the main aspects of the etiology, clinical picture, diagnosis and treatment of peripheral lung cancer.

Etiological factors

It is not entirely clear what exactly causes peripheral lung cancer. However, those factors that can contribute to the appearance of this disease and its rapid progression have been precisely identified.

Any develops faster when smoking. The length of time you systematically inhale nicotine directly affects the degree of threat of developing cancer. In addition, the more cigarettes a patient uses per day, the more pronounced will be the chronic inflammatory and degenerative changes in the epithelial lining of the respiratory tract and lungs.

The peripheral form of cancer of the bronchopulmonary system arises, to a greater extent, not through the bronchogenic route (inhalation of carcinogenic compounds), like central cancer, but hematogenously. For example, inhalation of asbestos or carcinogenic metals leads to the appearance of. It affects the large bronchi. Peripheral lung cancer occurred more often in those individuals who had increased concentrations of the same carcinogenic compounds in their blood.

The environmental situation has a significant impact on the risks of oncopathology of the pulmonary-bronchial system. Residents of cities and megalopolises are susceptible to colonization of the respiratory tract by irritants and pollutants of various chemical compositions.

Chronic inflammation of the bronchi is a significant risk factor. This applies to patients with chronic broncho-obstructive disease and bronchitis.

Any inflammation that lasts for a long time can become a factor in malignancy. Especially when it comes to organs lined with epithelial cells.

Heredity, closing this list, in fact occupies far from the last place among the possible causes of oncological transformation of normal cells. Not only tumors of the lungs or bronchi are important, but also the cancer process of any location.

Symptoms of the disease

A peripheral space-occupying formation, localized in any lung, exerts volume pressure either on the bronchi, or grows into the pleura, or other adjacent structures and organs, depending on its size. Modern oncologists distinguish several groups of clinical manifestations.

The first group of symptoms are signs of intrathoracic spread of the tumor mass. However, unlike bronchogenic (central) cancer, the peripheral form of cancer does not manifest itself so clearly.

Cough appears when the size is significant. The same goes for hemoptysis. This symptom marks the destruction of the tumor conglomerate or the germination of the bronchus with a violation of the integrity of its mucosa.

Chest pain and shortness of breath are also more typical for cancer of central origin. But it is known that with large sizes, the peripheral form clinically becomes indistinguishable from the bronchogenic one.

Hoarseness occurs when the left recurrent nerve is damaged. Peripheral cancer of the left lung is quite often accompanied by this striking syndrome. But the patient complains about this even when the size of the formation is serious. Peripheral cancer of the upper lobe of the left lung is a rare finding in young patients.

It is more often localized there tuberculous lesion. But with age, the first and second segments become the site of localization of a peripheral malignant tumor. Peripheral cancer of the lower lobe of the left lung (as well as the right) is less common than pneumonia. This is the second most common disease in this area. It is difficult to imagine the clinical features of a tumor in the described localization.

More often, peripheral cancer of the right lung develops. This is due to the anatomical features of the branching of the bronchi. Peripheral cancer of the upper lobe of the right lung is more common in elderly patients. Detection of radiological changes in this area requires additional research using tomographic techniques.

Taking into account the syntopy of the lungs, in the later stages of the disease, symptoms of damage to neighboring organs develop. Dysphagia often bothers patients when the esophageal wall is involved. When the tumor spreads to the heart muscle or pericardium, functional disorders: arrhythmias, hypertension or hypotension.

Features of the apical localization of the tumor

Apical cancer does not develop as often as tumors of the above-described localizations. It should be noted that the apex of the lung is the favorite localization of the tuberculosis process. Therefore, it is necessary to exclude this chronic infectious disease first.

Cancer of the apex of the lung occurs with fairly clear symptoms, which are underestimated by doctors of related specialties.

Thus, pain in the shoulder joint, accompanied by atrophic changes in the muscles of the forearm, is regarded by rheumatologists and therapists as a manifestation of glenohumeral periarthritis or osteoarthritis.

Apical lung cancer has a different name in the literature - Pancoast cancer. The symptom complex for this localization is also called.

It includes damage to the 1st and 2nd ribs, detected on a chest x-ray. Horner's symptom is characteristic, which includes a triad of signs:

• miosis - constriction of the pupil;
• enophthalmos;
• ptosis (drooping) of the eyelid on the affected side.

These manifestations are associated with the involvement of the sympathetic trunk in the process.

Paraneoplastic syndrome

It's about violation hormonal levels and metabolic changes caused by the tumor process. Most often, the development of a clear and obvious paraneoplastic syndrome is associated with a non-small cell variant of peripheral cancer.

Typically severe muscle weakness. It may be accompanied by the appearance of convulsive syndrome. This is associated with hypomagnesemia.

Endocrine changes relate to a greater extent to Cushingoid syndrome. As part of hypercortisolism, high blood pressure develops. Darkening may be a concern skin(hyperpigmentation) first in the area of ​​folds and folds, then diffuse.

Edema may also indicate paraneoplastic syndrome. But they can also be caused by superior vena cava syndrome when this vessel is compressed by a tumor from the outside and subsequent thrombosis.

Metastasis

The occurrence of screening lesions is an inevitable part of the cancer process. Lung tumor metastases spread in three ways:

The lymphogenous route is considered the main one. Regional nodes are affected first. Contralateral metastasis is possible. Depending on which lymphatic collectors are affected by cancer cells, oncologists classify the disease.

Hematogenous metastases spread throughout various bodies. The adrenal glands are quite often affected. At the same time, symptoms of insufficiency of the function of this organ are revealed: weakness, drop in blood pressure, arrhythmias (feelings of interruptions in the functioning of the heart), electrolyte shifts in laboratory tests.

And examination of the skull using X-rays or computed tomography reveals bone damage. In about a fifth of patients, metastases can be found there.

Detection of metastatic foci in the brain and liver occurs with equal frequency. Therefore, the second stage of diagnosis includes ultrasound examination of the abdominal organs and tomography of the skull.

Diagnostic measures

The screening method for detecting the disease is fluorography. Today the frequency of this study is once a year.

Peripheral lung cancer progresses very quickly. Therefore, doctors of any specialty should pay attention to clinical manifestations.

Usually “minor” symptoms go unnoticed. Namely, they indicate that the disease is just beginning. Unfortunately, they are very nonspecific, and patients themselves rarely seek advice regarding their occurrence. medical care. What about these symptoms?

A complete blood count may reveal an acceleration of ESR. If significantly exceeded normal indicators it is necessary to start searching for oncopathology. Anemia is also characteristic - a decrease in hemoglobin levels. A detailed study reveals its redistributive nature (sideroachrestic anemia).

A biochemical blood test reveals an increase in calcium levels and a decrease in magnesium concentrations. C-reactive protein levels may be increased.

X-ray is indicative in later stages. The signs of peripheral lung cancer are not much different from the manifestations of a bronchogenic tumor in the image, especially in the later stages.

There are special forms of peripheral lung cancer. A spherical tumor is visible on an x-ray as a round shadow. Its contours are uneven. Clinically, it is worth saying that it rarely manifests itself. This is due to the fact that globular cancer comes from bronchial cells of the 4th order.

– inflammation of the lung tissue surrounding the mass formation. During treatment with antibiotics, the size of the tumor noticeably decreases, but the radiologist should be alerted to the appearance of radiance around the focal point of the darkening. This indicates inflammation lymphatic vessels– lymphangitis.

The cavity form of peripheral lung cancer is a formation that has undergone decay in its central part. This is due to tissue ischemia. On the radiograph it will be a ring-shaped shadow with a horizontal level of liquid. The contours are uneven.

The second stage of diagnosis is clarifying. It is necessary to determine the form of the disease, the extent of the tumor, its histological structure, degree of differentiation, and hormonal activity.

It is necessary to identify the presence of metastases, because all this affects the prognosis and treatment tactics. In order to understand the size and degree of involvement of neighboring organs and structures, it is necessary to conduct tomography. Mediastinoscopy, bronchoscopy, thoracoscopy are designed to assess whether the mediastinum, heart, esophagus, pleura, and lymphatic collectors are affected.

A puncture with transthoracic access allows for the collection of biological material for cytological examination. Cellular composition, cell differentiation, histochemical features will allow us to assess the operability of the situation.

Metastases are often localized in the brain and liver. Abdominal ultrasound is necessary to visualize the liver. The brain is examined using tomography.

Often the adrenal glands involved should also be examined. MRI is an integral technique for achieving this goal. Scanning of the body's bone structures and x-rays reveal lesions in the bones. The bronchoscopic stage is important for differential diagnosis. They should not be neglected, but at the same time, patients should be referred for such a study according to indications.

Treatment approaches and prognosis

Lung cancer can be treated in two ways: surgery and radiation therapy. The first method is not always practical.

If there are no metastases, and the tumor size does not exceed 3 cm in diameter, and neighboring structures are not involved, lobectomy is indicated. This . A fairly large volume of surgery is dictated by a large number of relapses. In addition, this is required by the rules of ablastics and antiblastics, on which oncology surgery is based.

If the isolateral lymphatic collectors (on one side) of the first order are affected by metastatic foci, lobectomy may also be justified. But domestic cancer surgeons prefer removal of the entire lung - pneumonectomy.

Tumor invasion of the esophagus, metastases to contralateral lymph nodes, distant organs - brain, liver, adrenal glands - are contraindications to surgery. Also, severe concomitant pathology in the stage of decompensation will prevent surgical intervention.

For these cases, radiation therapy is used. It can be an addition to surgery. Then this treatment of emerging peripheral cancer of one or both lungs is called complex.

Radiation exposure to the tumor is advisable before surgery to reduce the size of the tumor. Many factors influence survival. They are associated both with the characteristics of the tumor process and with the general condition of the patient:

Thus, the main problems of oncology are timely diagnosis and adequate treatment. Peripheral lung cancer, with careful attention to one's own body, can be detected in time and successfully treated.

Lung cancer that originates from the small bronchi and bronchioles is called peripheral. There are nodular, cancer of the apex of the lung (Pancoast cancer) and pneumonia-like form.

In general, peripheral lung cancer clinically begins to manifest itself late - only after germination into large bronchi, pleura and other structures. Its first symptoms are shortness of breath and chest pain.

Symptoms and signs

The first symptoms of peripheral lung cancer occur after the tumor, progressing, spreads to the large bronchi, pleura and chest wall. When lymph nodes are involved in a malignant process, shortness of breath may occur. Peripheral lung cancer has a tendency to decay, and therefore it is often called “abscess,” “cavernous,” or “cavitary.” When the bronchus grows, the clinical picture of the disease changes, which is expressed in the separation of sputum, and sometimes hemoptysis. Complete closure of the bronchus by a tumor node is accompanied by the development of obstructive pneumonia and the acute course of a disease that does not manifest itself for a long time.

In later stages, you may experience:

general weakness and malaise;

decreased ability to work;

fast fatiguability;

decreased or complete loss of appetite;

pain in joints and bones

weight loss.

Due to the involvement of large bronchi in the oncological process, a transition from the peripheral form of cancer to the central occurs, which is characterized by increased cough, sputum production, shortness of breath, hemoptysis and pleural carcinomatosis along with effusion into the pleural cavity.

Penkosta - such a diagnosis may be contained in the medical history (peripheral apical lung cancer). This is a type of this disease in which malignant cells penetrate the nerves and vessels of the shoulder girdle. In such patients, therapists or neurologists often suspect plexitis, osteochondrosis and prescribe appropriate treatment. As a result, they already come to the oncologist with a late stage of cancer.

In addition, there is a cavitary form of this disease - a neoplasm with a cavity in the center. This cavity occurs due to the disintegration of the central part of the tumor node, which lacks nutrition during the growth process. Such neoplasms usually reach significant sizes (can be more than 10 cm), they are often confused with inflammatory processes (cysts, tuberculosis with decay, abscesses), which leads to an initially incorrect diagnosis, which means the progression of cancer without special treatment.

Source rak-legkix.ru

Differential diagnosis

Bronchological examination of peripheral lung formations allows for a visual examination of the bronchial tree and obtaining material for morphological analysis from the area where the pathological formation is located. Among the changes detected during bronchoscopy are signs of lung cancer (direct and indirect) and signs of inflammation of the bronchial mucosa. A direct endoscopic sign of lung cancer is a tumor visible in the lumen of the bronchus. The presence of such tumor growths indicates the so-called centralization of cancer - tumor growth into the subsegmental or segmental bronchus. Narrowing due to external compression or deformation of the lumen of the subsegmental, segmental, and rarely lobar bronchus, the presence of a limited zone of hyperemia and increased bleeding of the mucous membrane, and lack of respiratory mobility of the bronchial wall are considered indirect bronchoscopic signs of peripheral lung cancer. A symptom of inflammation of the mucous membrane is endobronchitis varying degrees severity and prevalence. In our work, when assessing the capabilities of the bronchological research method, we did not distinguish between the forms of endobronchitis, combining them into one group.

Of 1106 patients with single peripheral lung formations who underwent bronchofibroscopy, changes in the bronchial tree were detected in 531 (48%). Various bronchoscopic signs of bronchitis were found with greater or lesser frequency in all diseases defined by x-ray examination as a peripheral lung formation, while direct signs of a tumor were found in our observations only in peripheral lung cancer. A tumor in the lumen of the segmental or subsegmental bronchus was detected during bronchofibroscopy in 5.42% (60 of 1106) patients with peripheral lung formation. Among patients with a malignant tumor, the frequency of tumor growths in the bronchial lumen was 7.21% (60 out of 832 patients).

Tumor growths in the lumen of the bronchus were more often detected when the tumor was localized in the lower lobe than in the upper lobe, and in none of the cases were direct signs of cancer found when the peripheral tumor was localized in the middle lobe of the lung. Apparently, this is explained by better conditions for examining the bronchi of the lower lobe compared to the upper, while the absence of tumor growths in the middle lobe bronchus in peripheral lung cancer is associated with the structural features of the bronchi of this lobe.

Source dslib.net

First of all, it is necessary to distinguish between tuberculoma and round tuberculous infiltrate. The latter differs from tuberculoma in a number of clinical and radiological signs: often an acute onset with symptoms of intoxication, a tendency towards leukocytosis, a left shift of neutrophils and accelerated ROE, sometimes the sudden onset of hemoptysis and bacilli excretion. As the infiltrate progresses, it often undergoes disintegration, and then a pneumoniogenic decay cavity is formed with all its characteristic scialogical features that are different from tuberculoma. In contrast to the latter, the infiltrate relatively quickly decreases in size or even completely resolves when treated with tuberculostatic drugs.

Some features of its x-ray display are also noteworthy. Even with significant intensity, the shadow of the infiltrate is often inhomogeneous, and its contours are usually unclear and blurred. An inflammatory “path” (racket symptom) stretches from it to the root of the lung.

From a large group nonspecific diseases lungs, radiographically having a spherical shape, one should keep in mind primarily peripheral cancer. Thus, out of 85 patients admitted for Lately to the tuberculosis clinic of the TsOLIU doctors with an erroneous diagnosis of “tuberculoma”, 33, after a comprehensive examination or surgical intervention, turned out to have this particular form of malignant tumor. The reason for the erroneous diagnosis in these cases was some similarity in the symptomatology of these processes. Indeed, peripheral cancer, like tuberculoma, especially in the initial phase, can occur inaperceptively or with minor functional disorders and local symptoms.

As the disease progresses, some general signs: cough, hemoptysis, shortness of breath, fever, fatigue, weight loss, the same physical changes, accelerated ROE, increased level of globulins in the blood serum. But the main reason for diagnostic difficulties in these cases is the rather similar X-ray picture of tuberculoma and globular peripheral cancer.

Source meduniver.com

Treatment

The most modern methods Treatments for non-small cell lung cancer include radiosurgery (including CyberKnife), IMRT radiation therapy, and chemotherapy. Combination treatment of lung cancer has become widespread in world practice, combining these methods - extensive irradiation at a linear accelerator, targeted radiosurgical removal of metastases and tumor areas located close to critical structures of the body, as well as targeted chemotherapy. Immunotherapy is at the stage of clinical testing, especially in combination with other methods.

In world practice, surgical intervention, as well as radiation therapy, which does not allow the required dose of radiation to be delivered without danger to healthy tissue, are gradually giving way to advanced methods of treating lung cancer.

Radiation treatment of non-small cell lung cancer is carried out for radical purposes or as a palliative intervention. A distinction is made between radiosurgery and radiation therapy (radiotherapy).

Most progressive method Radiosurgery is recognized as a radical treatment for lung cancer. The technical capabilities of modern remote radiosurgery complexes (for example, CyberKnife / CyberKnife) make it possible to influence tumors in almost any part of the lungs, including those located near critical structures. Also, the bloodlessness of the radiosurgery method makes possible removal several multiple metastases in different parts of the body within one session (fraction) of treatment.

In addition to the above-mentioned advantages, the effectiveness of radiosurgical treatment of lung cancer is determined by in-depth diagnostics, which are carried out before the start (when planning) of the course of treatment and throughout the entire session. Comprehensive diagnostics - CT, MRI, PET - carried out in oncology centers equipped with CyberKnife, significantly increase not only the accuracy of treatment, but also make it possible to identify possible metastases.

With radical radiation therapy, a long-lasting and lasting effect is expected as a result of the death of all cells of the primary tumor and intrathoracic metastases located in the irradiation field. For poorly differentiated forms of cancer, the irradiation field also includes the supraclavicular zones. Significantly greater accuracy, and therefore efficiency, is provided by IMRT radiation therapy, which is characterized by the possibility of significant modification of the radiation beam contour.

Radiation therapy according to a radical program (total focal dose of at least 60-80 Gy) can be prescribed to patients with stage I-II lung cancer. Radiation therapy according to a palliative program (total focal dose no more than 45 Gy) is planned for stage III lung cancer.

Source oncoportal.net

Today the disease is treated using several methods:

Surgical intervention.

This method is recognized as the most radical, but it is the one that gives real prospects full recovery. During the operation, a block of tissue is immediately removed, including 1–2 cm of healthy tissue: the entire lung (rarely its lobe), nearby lymph nodes, and surrounding tissue. But the operation cannot be performed if metastases have spread to distant organs, the vena cava, aorta, esophagus and others.

Radiation therapy.

This type of treatment gives better results when using a radical therapy program in the early (1 – 2) stages.

Chemotherapy.

Drugs such as Doxorubicin, Vincristine, Methotrexate, Cisplatin, Etoposide and others are prescribed to cancer patients only when there are contraindications to the first two methods of treatment.

Combined.

At stages 2–3, the simultaneous use of surgery, medications or radiation therapy increases the patients' chances of survival.

Source vseprorak.ru

Prevention

Preventive measures that should be widely advocated include timely and correct treatment 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.

Source infomedia.com.ru