Signs of lung and bronchial cancer. The first signs of bronchial cancer. Types of cancer depending on location

Over the past few decades, the number of cases diagnosed with bronchial cancer has increased several times. In this pathological process, neoplasms are formed from the integumentary epithelium and bronchial glands, which are malignant in nature.

Bronchial cancer - causes

There is a certain list of factors that can provoke the development of the formation of an oncological process in the bronchi.

1. Malignant tumors form when healthy tissue degenerates. Doctors have not yet found an exact explanation for why this happens.
2. A tumor in the bronchi can develop due to, since nicotine can damage the mucous membrane in the respiratory tract. In addition, temperature disrupts the process of cell division, which leads to the rapid development of neoplasms.
3. Working in poor conditions, such as in a mine, chemical plant or nuclear power plant.
4. The presence of chronic diseases, scars on the lungs after treatment, and so on.

Types of bronchial cancer

There are two main types of tumors that arise in the bronchi:

1. The situation when neoplasms concern only the lobar and segmental parts indicates central bronchial cancer. In this case, the tumor quickly grows inside the organ.
2. Peripheral bronchial cancer in women and men is accompanied by neoplasia of the distal respiratory tract. This type of disease is asymptomatic for a long time.

Bronchial squamous cell carcinoma

Epidermal cancer is the most common and in this case the formation is formed from large flat cells that are arranged in a spiral or polar manner. The tumor may be of low differentiation, with or without keratinization. Squamous cell carcinoma of the bronchus is highly malignant and often has a poor prognosis and low survival rate.

Small cell bronchial cancer

An undifferentiated type of cancer, in which the formation grows infiltratively, and in most cases the tumor originates directly in the lung. It consists of small cells, without signs of multilayered epithelium. They are arranged in the form of a garland or path. In some cases, small cell cancer produces extensive metastases and aggressively spreads to nearby tissues.

This form of the disease accounts for about 20-25% of all diagnosed types and is directly related to smoking. It is worth noting the high aggressiveness of such bronchial cancer, since the tumor metastasizes to distant organs, for example, the adrenal glands, brain and bones. The malignant formation is inoperable, so chemotherapy and radiation therapy are used in treatment.

Large cell carcinoma

In this type, the formation consists of large cells. There are two types of cancer: those with mucus secretion and those with cavities filled with atypical cells. Large cell cancer is the disease that occurs the least often, and this is for the best, since death occurs in the early stages. Oncologists note that the formation of this type is influenced by passive smoking and long-term drug addiction.

Bronchial adenocarcinoma

Glandular cell carcinoma is characterized by the appearance of a tumor with a well-formed structure. It is characterized by the production of mucus. The tumor occurs in the peripheral part of the lung, and in the first stages the symptoms of the disease do not appear. Bronchial adenocarcinoma metastasizes to the brain. If a tumor is diagnosed in the early stages, it can be removed through surgery.

Bronchial cancer - symptoms

It’s worth mentioning right away that tumor growth takes a long time, so more than one year passes before the first specific symptoms are identified from the onset of the disease. When figuring out how bronchial cancer manifests itself, it is worth noting that, according to clinical signs, the following stages are distinguished:

1. Biological. At this initial stage there are no clinical or radiological signs. When carried out, you can see changes in the pulmonary structure.
2. Asymptomatic. The development of the first signs is observed, which are determined during an x-ray.
3. Stage of clinical manifestations. The patient notices various symptoms and the disease is already actively developing.

At the second and third stages, changes in a person’s condition may be observed that are characteristic of other diseases, for example, ARVI, pneumonia, and so on. In the later stages of cancer, signs of pulmonary failure are revealed, shortness of breath, pain in the chest and problems with the heart are noted.

Bronchial cancer - symptoms, first signs

Many oncological diseases have nonspecific early signs, so patients rarely come to the doctor in the first stages of the disease, when treatment is most effective. Symptoms of bronchial cancer at an early stage: coughing, decreased performance and loss of weight and appetite. Over time, signs of respiratory failure gradually increase. The first symptoms of bronchial cancer include the appearance of pain when the tumor grows into the surrounding tissue.

Stages of cancer

There are 4 stages of development of the disease and each has its own symptoms. Doctors say that treatment will give results only in the first two stages and the earlier signs of bronchial cancer are detected, the better the prognosis.

1. Stage No. 1. The neoplasm does not reach more than 3 cm in diameter. In most cases, it is localized in the segmental bronchus, but metastasis is not observed.
2. Stage No. 2. Metastases begin to spread to regional lymph nodes. The diameter of the formations reaches 6 cm.
3. Stage No. 3. At this stage, the tumor in the bronchi becomes even larger, symptoms appear and metastasis in the lymph nodes is already observed. Another important point is that the oncological process spreads to the neighboring bronchus.
4. Stage No. 4. Symptoms of cancerous pleurisy are noted and metastases develop in other important organs. At stage 4, bronchial cancer has a poor prognosis. The formation is inoperable, and treatment will consist of radiation and.

Bronchial cancer - diagnosis

To confirm or refute the diagnosis, doctors use the following diagnostic methods: CT, MRI and X-ray. They help to identify not only the presence, but also the location and volume of the tumor. X-rays and other techniques help determine bronchial cancer, and the diagnosis also necessarily includes a general blood test to find out the level of leukocytes and ESR indicators. Cytological examination is important because it helps determine the nature of the formation.

Bronchial cancer - treatment

To help the patient, doctors use conservative and surgical treatment methods. The first group includes radiation therapy, which in the final stages is used together with surgery. Irradiation is carried out for 2 months. and the total dose is up to 70 Gray. To remove a tumor without anesthesia and complex surgery, doctors, based on individual indicators, can prescribe stereotactic radiosurgery, which uses a cyberknife. This instrument emits radiation that removes tumors and metastases.

Non-small cell bronchial cancer (stage 3 and other complex stages) is treated with chemotherapy. It is used when surgery is not possible. Chemotherapy drugs are prescribed when it is necessary to treat a small cell tumor that is sensitive to such drugs. For non-small cell types, chemotherapy is used to reduce the size of the formation and pain, and also restore respiratory function. Treatment of bronchial cancer with folk remedies is impossible and very dangerous.

Surgery cannot be performed in all cases. Bronchial cancer is treated faster if the formation is completely removed, which will ensure a quick recovery for the patient. At stage 4, surgery is not performed, since metastases affect nearby tissues, and such intervention is ineffective. Surgical treatment of cancer is carried out in several ways, and the choice of option takes into account the extensiveness of the process:

1. Lobectomy refers to the resection of a lobe of the lung. The doctor makes the final decision after the chest is opened. If indications are found, for example, the spread of the oncological process, the operation can be expanded.
2. Bilobectomy is based on removing the upper or middle, or lower and middle lobes together. The lobes that remain are sutured to the mediastinum. Immediately during surgery, nearby lymph nodes are removed.
3. During a pneumonectomy, the lung and nearby lymph nodes are completely removed. This operation is performed only if the patient is in good condition.

Bronchial cancer - prognosis

It's no secret - the earlier the problem is identified, the more likely the chance of a complete recovery. If you are interested in how long people live if they have bronchial cancer, then you should know that if the tumor is identified in the initial stages and treated in a timely manner, the five-year survival rate is up to 80%. When the disease is advanced, according to statistics, approximately 30% of operated patients survive. If a person refuses treatment, then only 8% of patients survive to five years.

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.

Thank you

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Description

Bronchogenic carcinoma is the most common type of solid malignancy in men. In some developed countries, such as the United States, it is ahead of female breast cancer, which ranks first among female cancers. The incidence among the male population of developed countries has stopped growing, while among women lung cancer has become more frequent. This trend is explained by an increase in the number of smokers among adult and young females.

This disease is known for its negative outcome due to the lack of symptoms and the ability to spread beyond the lungs before any signs begin to appear and the disease can be detected.

Kinds

Small cell lung cancer

Non-small cell lung carcinoma

• squamous cell carcinoma, which accounts for 40%-60% of all lung tumors. This subtype of non-small cell carcinoma is associated with smoking and can be removed surgically. The operation consists of removing part of the lung affected by the tumor, provided it is detected at an early stage


• adenocarcinoma, which arises in the peripheral part of the lung, is asymptomatic and metastasizes to the brain before patients report any manifestations of the disease. If detected at an early stage, this malignant tumor can be removed surgically.


• two other subtypes of tumors known as large cell and bronchoalveolar carcinomas, fortunately, are found in a small number of patients, as both are fatal.

It should be noted that the lungs are often affected by metastases of other organs, which appear on radiographs as a “cannonball” pattern.

A rational approach to the treatment of bronchogenic carcinoma can only be achieved through cytological (cellular) and tissue classification of tumors.

Methods for diagnosing the disease and its stage

Due to the dismal prognosis of this disease, patients should not be informed of the diagnosis until confirmation has been obtained based on the results of cell or tissue analysis.

After histological or cytological diagnosis, the staging process begins, during which the location and size of the tumor in the lung is determined. Signs of damage to adjacent organs, regional lymph nodes, as well as metastases to other organs are considered. This approach helps the treating physician and oncologist (cancer specialist) determine the most effective treatment strategy with the fewest side effects for patients (see treatment of bronchogenic carcinoma).

Early diagnosis of the disease in symptomatic patients, carried out by specialists such as radiologists, pulmonologists and thoracic surgeons, who in turn were notified by a physician, is the most effective way to combat this disease. Treatment of this disease at an advanced stage is often palliative (temporarily relieving), rather than curative.

Causes of the disease

Factors that increase the incidence of cancer among smokers include starting smoking at an early age and the large number of cigarettes smoked per day. In these people, the total load of carcinogens, which may include inorganic substances (arsenic and nickel), as well as other organic substances, leads to precancerous cell changes over years of constant intoxication of the respiratory tract. These mutations occur as a result of the penetration of carcinogens into the DNA of the bronchial walls. Subsequently, ordered cell division gives way to uncontrolled tumor growth in one or more parts of the bronchial walls.

Filter cigarettes and half-smoked cigarettes may prevent the early development of bronchogenic carcinoma, but they are by no means a protection against this dangerous disease. Smoking a pipe and cigars is less likely to lead to the development of lung cancer, but loses its aura of innocence due to the more frequent development of carcinoma of the lips, larynx and esophagus.

The dangers of second-hand or side-stream cigarette smoke as a cause of lung carcinoma have been established through studies of non-smoking spouses of heavy smokers, as well as non-smoking people working in places where heavy smoking occurs. Forced and passive smokers inhale particularly high concentrations of carcinogens from sidestream smoke. However, the incidence of lung cancer among those unlucky enough to be nearby is still lower than among smokers.

Among those who smoked a little and quit, the susceptibility to the disease decreases after 10 years compared with those who do not smoke but smoked a lot before, and it is only 2.5 times less than among those who still smoke.

Exposure to dust and gas at work is a powerful causative agent of bronchogenic carcinoma. The list of hazardous inhalable substances includes asbestos, which, in addition to asbestosis (asbestos pneumoconiosis), can cause mesothelioma (cancer of the lining tissue of the lung, pleura), as well as bronchogenic carcinoma. While unfortunate non-smokers develop mesothelioma due to asbestos exposure, dust lung cancer is extremely rare in non-smoking asbestos miners. Smokers exposed to asbestos dust are 9 times more likely to develop bronchochenal carcinoma than smokers who are not exposed to asbestos dust, and 92 times more likely than non-smokers without exposure to asbestos dust.

The incidence of lung cancer in the mining industry is also associated with radiation emitted from the mine environment, dust particles from uranium, fluorspar and even iron ore. Radioactive dust contains Alpha particles and radon daughter substances, which have a high ability to change the structure of DNA and over the years cause the development of bronchogenic carcinoma. It was found that smoking is a pronounced provocateur of the development of lung cancer among workers of these mines.

Other industrial substances, such as nickel, chromium and arsenic salts, which are used in metal cleaning, are also carcinogenic.

Genetic predisposition to the development of bronchogenic carcinoma, although it is difficult to give actual figures, will undoubtedly contribute to the occurrence of this dangerous disease in a small group of people with a negative family history of cancer of any kind.

Environmental pollution, although clearly implicated in the development of chronic obstructive pulmonary disease and worsening asthma, has not been shown to be a compelling factor in the development of lung cancer.

Manifestation of the disease

Incidental discovery of bronchogenic carcinoma during x-ray examination for other purposes reveals malignant neoplasms in the lung at an early stage. This dangerous disease manifests itself according to one of three mechanisms:

• local manifestations;


• metastatic manifestations;


• non-metastatic systemic manifestations.

Local manifestations are cough and sputum production due to the endobronchial (intrabronchial) localization of the tumor. This pathology can lead to the appearance of a “metallic” cough tone in patients suffering from chronic cough. Obstruction of normal mucus drainage and subsequent recurrent respiratory tract infections may result in recurrent bronchitis, pneumonia, and lung abscess. These manifestations should alert patients and force them to visit a doctor and get a chest x-ray, especially for smokers over 40 years of age.

The development of hemoptisis or hemoptysis due to the destruction of the bronchial wall by the tumor causes the patient to experience a completely expected anxiety state. Bleeding tumors are usually detected during bronchoscopy, since this examination becomes mandatory if fluorography reveals a tumor formation or destruction of a lung lobe due to bronchial blockage. Large malignant neoplasms located in the central part of the lung usually cause obstruction of the main airway with subsequent destruction of one or more lobes or the entire lung. Such patients will complain of increasing shortness of breath or wheezing that does not improve with conventional treatment with bronchodilators.

Patients report pain when metastases have spread to the chest: the bones of the thoracic (chest) wall and the nerve endings located above the top of the lung.

Damage to the pleura (the thin layer of cells lining the surface of the lung and the inside of the chest wall) can cause pain when inhaling. When a large amount of fluid accumulates in the pleural cavity, the pain is muffled, but the pressure on the lung located underneath increases, which leads to shortness of breath. Experienced doctors, when examining the chest, will be able to detect effusion in the pleural cavity, lung atelectasis (collapse of lung tissue or part of it), or even partial blockage of the main airways.

The spread of metastases from lung tumors to distant organs such as the brain, bone damage accompanied by fractures and pain, as well as frequent asymptomatic damage to peripheral organs, can only be detected through appropriate research methods.

It is essential that at-risk patients, especially those over 40 years of age, consult their GP or pulmonologist as soon as they begin to experience new symptoms for which they cannot find an obvious explanation. Subtle manifestations of the disease such as loss of weight and appetite, unexplained anemia and chronic general malaise should prompt smokers to seek professional help. However, there is no evidence that regular annual clinical examination and fluorography of healthy populations can prevent high mortality and prevalence rates by diagnosing the disease at an early stage. The costs of these procedures are also prohibitively high compared to the positive outcome.

Treatment

Surgical intervention (operation)

Preoperative assessment of patients by pulmonologists and thoracic surgeons using x-rays, bronchoscopy and cytology is carried out to classify patients according to the tumor/lymph node/metastasis system. Selecting patients with a localized form of the disease and planning their surgery, subject to general good health and normal lung function in patients of any age, can ensure survival after surgery with subsequent full life. In developing countries, lack of preoperative assessment and surgical and postoperative care results in up to 5% of those surviving 5 years after surgery.

Radiotherapy

Certain types of malignant neoplasms, such as adenocarcinoma, cannot be treated with radiotherapy, and such as small cell carcinoma show immediate but short-term results after this treatment. Extensive radiotherapy, which is designed and administered to maximize patient survival, may have immediate and delayed side effects. Palliative radiation therapy for the primary tumor and its metastases in the bones and brain usually provides rapid but short-term relief of the disease and allows patients and their families several weeks to several months to resolve all necessary matters.

Chemotherapy

Once again, we would like to draw your attention to the fact that this method of treating small cell carcinoma gives a temporary result, and chemotherapy for other types of lung malignancies usually does not bear significant fruit.

Combinatorial treatment

It is important to remember that the life expectancy of patients with bronchogenic carcinoma is short. Treatment should not be planned that severely limits the fullness of life that the patient may not enjoy for long, even if such therapy pursues good goals. The support of family, friends, home hospice and other professional organizations should not be underestimated, because the patient will be surrounded by their care throughout his last days and weeks of life. Through their efforts, temporary relief will be achieved in the health of a person suffering from lung cancer when medical science has recognized its own defeat.

Bronchogenic carcinoma stubbornly resists any research and scientific approaches to improve its terrible outcome. The positive is that it is hoped that, by being informed, the public will make informed decisions about tobacco smoking in the future, resulting in a reduction in the spread of the disease.

There is no better advice to young people than to stay away from smoking, as this habit is the cause of one of the fatal diseases that long-term smokers cannot avoid.

It has been proven that lifestyle plays a major role in the development of most pathologies. Bronchial cancer is precisely the disease for which the person himself is to blame. Everyone has heard about the effect of smoking on the condition of the lungs, but most ignore this information.

Bronchopulmonary cancer includes cancer of the bronchi and lung tissue itself. This is a malignant tumor that develops from the epithelium of the bronchi of various sizes. It is most often found in people over 45 years of age with a long history of smoking. Very quickly it metastasizes to the liver, kidneys, adrenal glands, bones, and pleura.

About the organ

Bronchi are part of the lower respiratory tract, tubular formations that start from the trachea with two main ones - right and left, branch repeatedly and form the bronchial tree. With each subsequent branch their diameter decreases.

The wall consists of three layers:

• mucous internal;
• muscular-cartilaginous, with open half-rings of hyaline cartilage;
• adventitia, which covers them from the outside.

The function of the bronchi is to conduct air. They continue to warm and moisturize it, and also trap dust particles and microbes with the help of epithelial cilia and synthesized mucus. The vibration of the cilia occurs in the direction of the upper respiratory tract, in this way mucus and harmful impurities are removed.

The bronchi are involved in immune defense and detoxification of certain dangerous substances.

Causes

1. Smoking.
2. Inhalation of radon.
3. Asbestos dust.
4. Human papillomaviruses, cytomegalovirus.
5. Dust.

Kinds

Determining the type of carcinoma is necessary to choose treatment tactics and determine the prognosis for the patient.

According to histological structure

• Squamous (epidermal) Cancer occurs in most cases, formed by large flat cells that are arranged in a spiral or polar manner, in clusters. The tumor can be of a low degree of differentiation, with or without keratinization.
• Small cell (undifferentiated) the type of tumor grows infiltratively. The cells are small, without signs of multilayer epithelium. They are arranged in the form of garlands and paths. Some subtypes give extensive metastases and aggressively grow into surrounding tissues.
• Adenocarcinoma (glandular cell cancer)– a type of tumor with a well-formed structure, located like glandular formations. Produces mucus.
• Large cell carcinoma formed by large cells. There is a solid type with and without secretion of a mucous substance; it has cavities filled with atypical cells.
• Mixed type formed by cells with different histological characteristics; the degree of differentiation is taken into account for it.

By location

Central Cancer is divided into three types:

• endobronchial nodular;
• peribronchial infiltrative;
• peribronchial nodular.

Peripheral affects small caliber bronchi and alveoli, is divided into several types:

• nodal;
• cavitary;
• pneumonia-like.

Separately allocate atypical growth forms:

• mediastinal;
• cerebral;
• miliary;
• apex of the lung.

By nature of growth

• exophytic – growing into the lumen of the bronchus;
• endophytic – spreads towards the lung tissue;
• mixed type.

Stages

Detecting a tumor at a certain stage allows us to make prognoses for further treatment.

• Stage 0– the size of the tumor is small, it does not affect the lymph nodes and mediastinum.
• 1 stage– diameter up to 3 cm, no damage to the pleura and lymph nodes.
• 2 stage– the size of the formation is 3-5 cm, metastases appear in the bronchial lymph nodes.
• 3astage– a tumor of various sizes, the lymph nodes on the opposite side, pleura, chest wall, mediastinum are involved in the process.
• 3bstage– damage to mediastinal organs – heart, blood vessels, esophagus, spine.
• 4 stage– multiple metastases throughout the body.

Main stages

Symptoms

1. Cough. Initially it is dry, but gradually the mucous membrane becomes irritated and sputum appears.
2. Blood streaks or pink sputum appear as a result of mild trauma to the surface of the tumor or its disintegration.
3. Frequent inflammatory lung diseases, especially reminiscent of pneumonia, are accompanied by a rise in temperature to 37 degrees and a little more.
4. Prolonged slight increase in temperature without other symptoms.
5. Complete blockage of the bronchial lumen leads to the development of pneumonitis, shortness of breath, weakness, slight fever, coughing attacks, which may cause cyanosis of the face.
6. Bloating of neck veins, swelling of the face, cyanosis observed in late stages during the formation of superior vena cava syndrome. This is a disturbance in the flow of blood from the upper body.
7. Hoarseness of voice appears when the vagus nerve is involved in the tumor process.
8. Chest pain worries when the tumor grows into the pleura, the formation of bloody effusion.
9. Pericarditis– a complication that develops after cancer grows to the heart sac.

Diagnostics

1. Inspection allows you to assess the general condition of the patient; during auscultation with a phonendoscope, the doctor can hear a change in the breathing pattern. If obstructive pneumonitis has developed with atelectasis of a lung segment or lobe, areas will appear over which breathing cannot be heard.
2. X-ray is the primary diagnostic method, including preventive annual fluorography. Assessing areas of darkening and clearing in the image, the doctor determines additional tissue formations that change the structure of the bronchial tree; due to a decrease in pneumotization, areas of atelectasis and an inflammatory reaction are distinguishable.
3. Bronchoscopy allows you to see from the inside and assess the condition of the bronchi. In them, a thin flexible tube with a video camera is passed through the nasal passage or mouth. A biopsy is taken from altered and suspicious areas for further examination. After performing it, expectoration of dark blood is possible for 1-2 days.
4. Histology– examination of tissue fragments taken during a biopsy. Gives a morphological characteristic of the tumor, allows you to make a prognosis on the aggressiveness of growth and spread throughout the body.
5. Sputum analysis- an easy-to-use diagnostic method; under a microscope it is possible to examine the resulting mucus and detect cancer cells in it. If the carcinoma does not grow into the lumen of the bronchus, then the study will not be informative.
6. Biochemical blood test assesses the state of nonspecific enzymes that may increase with metastases to the bones (alkaline phosphatase and calcium), liver (liver enzymes, ALT, AST). Determination of tumor markers characteristic of bronchial cancer is under development.
7. CT necessary for diagnosing the exact location of the tumor and identifying metastases, it is a more sensitive method than x-ray examination, it allows you to identify even small tumors. Sometimes this is done by injecting a contrast agent into a vein.
8. MRI an even more accurate diagnostic method, assesses the pinpoint location of tumors and metastases, and is preferable for examining soft tissues. It is not always used due to a number of contraindications and restrictions.

Treatment

Surgical treatment involves removing part of an organ with a cancerous tumor. At the initial stages, the efficiency reaches 35%. The choice of the volume of intervention depends on the prevalence of the process.

1. Lobectomy- This is a resection of a lobe of the lung. The final decision is made after opening the chest. If there are indications in the form of the prevalence of the process, the operation can be expanded.
2. Bilobectomy– surgical removal of the upper and middle lobes or the lower along with the middle. The division is carried out based on the interlobar groove and the branching of the bronchi. The remaining lobes are sutured to the mediastinum. At the same time, nearby lymph nodes are removed.

Removal of the entire lung– pneumonectomy, radical surgery. The decision about it is made after thoracotomy and revision of the chest cavity for the presence of metastases and altered lymph nodes.

Sometimes, in a widespread process, it is necessary to remove the lung along with parts of the chest, diaphragm, and pericardium. Be careful when performing the operation, because the vagus nerve and the superior vena cava are located close to the root of the lung, and the inferior vena cava is located below the diaphragm.

Chemotherapy used as an independent treatment method or in combination with surgery and radiation therapy. When carried out before surgery, it reduces the size of the carcinoma and the number of metastases; after surgical treatment, it destroys the remaining tumor cells.

Ineffective for non-small cell cancer, can be used as palliative care for inoperable tumors.

Radiation therapy carried out to curb the progression of the disease. Used for any morphological forms. Radiation is given either from the outside through the chest or from the inside.

This uses a radioactive substance sealed in a special container. External irradiation is carried out 4-5 times a week for several weeks. The dose is determined by the doctor individually. With concomitant severe lung diseases, the use of radiation therapy aggravates the condition.

Unique footage of a real operation with detailed comments from a specialist in this video:

Forecast

When a tumor is detected in the early stages and treated in a timely manner, the 5-year survival rate is up to 80%. Advanced cancer leaves only 30% of those operated on alive. If treatment is refused, only 8% of patients survive for up to 5 years.

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Bronchial cancer, or bronchogenic cancer, is a malignant formation of epithelial origin, originating from the mucous membrane of the bronchi of various diameters. In the medical literature, in describing lesions of the bronchial tree, the term “, which is identical to “bronchial cancer,” is more common.

Tracheal cancer is classified as a completely separate nosology; it is much less common. (Prevalence is tenths of a percent of the total incidence in oncology. Some details are further in the text).

Most forms of lung cancer are tumors growing from the bronchial walls, which is why these concepts are combined into one form - bronchopulmonary cancer.

example of a bronchopulmonary tumor

Malignant tumors of the bronchial tree represent a serious medical and social problem. In terms of prevalence, bronchial cancer ranks almost first in the world, second only to in some regions. Among patients with this diagnosis, men predominate, who get sick up to 10 times more often than women, and their average age ranges between 45-60 years, that is, the majority of patients are men of working age.

The number of patients is steadily growing, and up to a million new cases of bronchial cancer are registered in the world every year. The insidiousness of the disease, especially when the small bronchi are affected, consists of a long asymptomatic or low-symptomatic course, when the meager clinical picture does not alarm the patient to such an extent as to seek help from doctors. This is precisely why there is still a large number of advanced forms of pathology, when treatment is no longer effective.

Causes and types of bronchial cancer

The causes of bronchogenic cancer are mainly associated with the impact of external unfavorable conditions on the respiratory system. First of all, this concerns smoking, which, despite the active promotion of a healthy lifestyle, is still widespread not only among the adult population, but also among adolescents, who are especially sensitive to the effects of carcinogens.

Effect of smoking is usually delayed in time, and cancer can appear decades later, but it makes no sense to reject its role in tumor genesis. It is known that about 90% of patients with bronchogenic cancer were or are active smokers with a long history. Harmful and dangerous substances, radioactive components, tars and soot that penetrate along with tobacco smoke are deposited on the surface of the bronchial mucosa, leading to damage to the surface epithelium, the appearance of foci of metaplasia (restructuring) of the mucosa, and the development of chronic inflammation (“smoker’s bronchitis”). Over time, persistent disruption of the structure of the mucous membrane leads to dysplasia, which is considered the main “step” on the path to cancer.

Other causes of lung cancer come down to chronic bronchopulmonary pathology - inflammatory changes, bronchiectasis, abscesses, scars. Contact with asbestos is considered a very unfavorable occupational factor, which provokes not only pleural cancer, but also neoplasia of the bronchial tree.

structure of brochs

Speaking about bronchogenic cancer, we mean damage to the main (right and left bronchus), lobar, segmental and smaller bronchi. Damage to the main, lobar and segmental bronchus is called central lung cancer, and neoplasia of the distal airways – peripheral lung cancer.

The histological picture implies the identification of several forms of bronchogenic cancer:

• Glandular;
• Large cell;
• Small cell;
• Squamous cell carcinoma.

In addition to those listed, there are also mixed forms that combine the characteristics of different structural options.

Squamous cell carcinoma considered the most common form of malignant lung tumors, which usually arises in large-caliber bronchi from areas of squamous metaplasia of the mucosa. With well-differentiated variants of squamous cell carcinoma, the prognosis can be relatively favorable.

Small cell cancer– one of the most malignant forms, characterized by an unfavorable course and high mortality. This type of tumor is prone to rapid growth and early metastasis.

Cancer of the central bronchus, lobar and segmental may look like an exophytically growing formation facing the inside of the bronchial lumen. Such a node causes symptoms due to the closure of the airway. In other cases, the tumor grows infiltratively, “enveloping” the bronchus from all sides and narrowing its lumen.

Tumor stages determined based on the size of the formation, the presence of metastases and the nature of changes in the surrounding structures. The clinic distinguishes four stages of cancer:

• At stage 1, the tumor does not exceed 3 cm in diameter, does not metastasize and does not extend beyond the pulmonary segment.
• Stage 2 characterizes neoplasia up to 6 cm with possible metastasis to regional lymph nodes.
• At stage 3, the size of the tumor exceeds 6 cm, it spreads to surrounding tissues and metastasizes to local lymph nodes.
• Stage 4 is characterized by growth beyond the lung, its ingrowth into surrounding tissues and structures, and active metastasis, including to distant organs.

Symptoms of bronchogenic cancer

Signs of bronchogenic cancer are determined not only histological type and growth pattern of the tumor, but also its location. The main symptoms of bronchial cancer are cough, shortness of breath, and symptoms of general intoxication, which appear earlier in cancer of large bronchi and are absent for quite a long time in peripheral neoplasms.

Main bronchus cancer early gives symptoms in the form cough, initially dry, then with the release of purulent or bloody sputum. A feature of the course of this type of tumor is the possibility of its closing the lumen of the bronchus with a complete disruption of the flow of air into the lung tissue, which collapses and ceases to function (atelectasis).

Often, inflammation (pneumonitis) occurs against the background of atelectasis, then symptoms include fever, chills, and weakness, indicating an acute infectious process. As the tumor disintegrates, its size decreases somewhat, and bronchial patency may be partially restored, while the signs of atelectasis may become less noticeable. However, you should not calm down: after a short time, when the tumor increases again, the state of atelectasis and pneumonitis will most likely recur.

Upper lobe bronchus cancer occurs somewhat more often than tumors of the lower respiratory system. This may be caused by more active ventilation of the upper parts of the lungs with air containing carcinogenic substances.

Peripheral lung cancer, which can occur in small-caliber bronchi and bronchioles, does not give any symptoms for a long time, and is often detected when the tumor is large. The first signs are often limited to a severe cough and chest pain associated with the germination of pleural neoplasia. When a tumor grows into the pleural cavity, pleurisy appears, accompanied by intense pain, shortness of breath, and fever.

In the case of a large volume of tumor tissue, accumulation of exudate in the chest cavity, displacement of the mediastinal organs occurs, which can manifest itself as arrhythmias, heart failure, and puffiness of the face. Compression of the laryngeal nerve can lead to voice impairment. As intoxication with tumor metabolic products increases, the patient loses weight, general weakness increases, and the fever becomes constant.

Trachea cancer - basic information about a rare tumor

Tracheal cancer is considered a rare pathology, occurring in no more than 0.1-0.2% of oncology patients. The primary neoplasms of this localization are malignant cylindromas and squamous cell carcinoma. The bulk of patients are middle-aged and elderly people, more often men, as in the case of tumors of the bronchi and pulmonary parenchyma.

Up to 90% of tracheal cancer patients suffer from the squamous cell type of neoplasia. The tumor usually affects the upper or lower third of the organ and grows in the form of a node facing the lumen, but infiltrative growth with significant narrowing and deformation of the tracheal wall is also possible. A dangerous localization is the location of the cancer above the site of division of the trachea into the main bronchi, since in this case closure of both bronchi and suffocation is possible.

The clinical picture of tracheal cancer consists of:

1. Cough;
2. Shortness of breath;
3. Hemoptysis;
4. Vocal function disorders.

The cough in tracheal cancer is painful, dry at the beginning of the disease and with purulent sputum subsequently. Since the tumor closes the lumen of the organ and disrupts the conduction of air during inhalation and exhalation, the appearance of shortness of breath is very typical, which worries the vast majority of patients. A decrease in shortness of breath is possible when the tumor tissue disintegrates, but then it appears again.

For some time, the patient adapts to the difficulty in breathing, but as the neoplasia increases, the shortness of breath becomes more and more pronounced, threatening to develop into suffocation if the airways are completely closed. This condition is very dangerous and requires emergency medical attention.

The appearance of blood in sputum is associated with the breakdown of cancer tissue and damage to the vessels feeding the tumor. The spread of the disease to the larynx and recurrent nerves is fraught with voice impairment in the form of hoarseness or even its complete absence. Common symptoms include fever, weight loss, and weakness.

Diagnosis and treatment of respiratory tract cancer

X-ray methods, including CT, are traditionally used to detect tracheal and bronchial cancer. To clarify the nature of the spread of neoplasia, an MRI is performed. A general blood test can detect an increase in the level of leukocytes, an acceleration of ESR, and a cytological examination of sputum can reveal malignant cancer cells in it.

Like any other tumor, bronchial cancer of any size can be removed by surgery, radiation, or chemotherapy. For most patients, a combination of these methods is possible, but if there are contraindications to surgery, preference will be given to conservative methods.

Surgical treatment of bronchial cancer

Surgical treatment is considered the most effective, as it gives the best results for small tumors detected in the early stages of development. The larger the cancerous node, the more it has grown into the surrounding tissue, the more difficult it will be to get rid of the disease, and the risk of surgical complications in some cases does not allow the doctor to perform the operation at all.

Interventions on the respiratory organs are always complex and traumatic; they require not only good preparation of the patient, but also highly qualified surgeons. For bronchial cancer it is possible to perform:

1. Pulmonectomy;
2. Lung resections.

Pulmonectomy (lung removal)

Pulmonectomy– the most radical way to get rid of bronchial cancer, which involves removing the entire lung with mediastinal lymph nodes and tissue. If the tumor invades large vessels or the trachea, it may be necessary to resect a section of the trachea, inferior vena cava and aorta. Such an intervention requires adequate preparation of the patient and relatively good general condition, so not every patient, especially the elderly, can undergo a total pneumonectomy.

Contraindications to radical surgery are:

• The impossibility of removing the entire tumor due to its growth in the lung tissues, blood vessels, etc.;
• The presence of distant metastases, making such treatment ineffective and impractical;
• The patient's serious condition precludes the possibility of performing any operation under general anesthesia;
• Diseases of internal organs in the stage of decompensation.

Old age is not an obstacle to surgical treatment if the patient’s general condition is satisfactory, but some patients themselves tend to refuse surgery, fearing complications or considering it useless.

Other operations

For localized forms of cancer, it is sufficient resection section of the bronchus or removal of a lobe of the lung - lobectomy, bilobectomy(two lobes, only if the right lung is affected). The best results are achieved when treating differentiated tumors, however, small cell cancer detected at an early stage can be subjected to surgical treatment.

If it is impossible to completely remove the tumor and lymph nodes due to the risk of complications (bleeding, for example), then a so-called conditionally radical operation is performed, when, if possible, all affected tissue is excised, and the remaining foci of cancer growth are exposed to irradiation.

Becoming increasingly common bronchoplastic operations, allowing for more economical removal of affected tissue through wedge-shaped or circular resection of the bronchus. Bronchoplastic interventions are also indicated in cases where it is technically impossible to perform a radical pneumonectomy.

Since bronchial cancer actively and early metastasizes to regional lymph nodes, in all cases, removal of the tumor is accompanied by excision of the lymph nodes that collect lymph from the affected bronchus. This approach avoids possible relapses and progression of the disease, and also increases the overall life expectancy of operated patients.

Preparation for surgery includes a balanced diet, prescription of broad-spectrum antibiotics to prevent infectious complications, correction of the cardiovascular system, and breathing exercises.

In the postoperative period, the patient is placed in a semi-sitting position and oxygen is supplied. To prevent infectious complications, antibiotic therapy is administered, and blood and air are removed from the pleural cavity to avoid displacement of mediastinal structures.

Radiation and chemotherapy

Radiation treatment is usually given in combination with surgery, but in some cases it becomes the main and only possible way to help the patient. Thus, in case of inoperable cancer, refusal of surgery, or the patient’s serious condition, which excludes the possibility of tumor removal, irradiation is carried out at a total dose of up to 70 Gray for 6-7 weeks. The most sensitive to radiation are squamous cell and undifferentiated forms of bronchial cancer, and not only the tumor, but also the mediastinal area with lymph nodes must be irradiated. In the terminal stages of cancer, irradiation can somewhat reduce the pain syndrome, being palliative in nature.

A new approach in radiation therapy is the use of a cyberknife (stereotactic radiosurgery), with which it is possible to remove a bronchial tumor without surgery or anesthesia. In addition, a directed radiation beam is capable of removing single metastases in the lung tissue.

Chemotherapy is usually used as for non-small cell cancer, when surgery is no longer possible, and for small cell varieties that are sensitive to conservative treatment. Non-small cell cancer does not respond well to chemotherapy, so they are used mainly for palliative purposes to reduce tumor size, pain and respiratory distress. The most effective are cisplatin, vincristine, cyclophosphamide, methotrexate, docetaxel, etc.

Small cell cancer is sensitive to cytostatics, especially in combination with radiation. For such treatment, several of the most effective drugs are prescribed in high doses, which are selected individually, taking into account the type of cancer and its sensitivity.

Combination treatment, which combines radiation, surgery and drug therapy, can increase the life expectancy of patients with bronchial cancer. Thus, preoperative irradiation and the administration of cytostatics can reduce the volume of the tumor and, accordingly, facilitate the operation. In the postoperative period, conservative therapy is aimed at preventing relapses and metastasis of cancer.

Radiation and chemotherapy are often accompanied by unpleasant side effects associated with the breakdown of cancer cells, so symptomatic therapy is required. Prescribing painkillers helps reduce pain, antibiotic therapy is designed to fight infection of the affected tissues. Infusion therapy is indicated to correct electrolyte imbalances.

In addition to traditional methods of fighting a tumor, attempts are being made to introduce new methods - photodynamic therapy, brachytherapy, cryotherapy, laser treatment, etc. Local treatment is justified for small cancers that do not extend beyond the mucous membrane and in the absence of metastases.

Treatment of tracheal cancer

Treatment for tracheal cancer is usually combined. If the tumor is accessible to the surgeon’s scalpel, it is removed by excision of a fragment of the trachea (resection). If it is impossible to remove the tumor, then palliative treatment aimed at improving the patency of the organ is indicated.

In addition to surgery, radiation is given. For inoperable patients, radiation therapy becomes the main treatment method to reduce pain and improve respiratory function. Tracheal tumors are not very sensitive to chemotherapy, so chemotherapy has not been used for cancer of this organ.

Video: seminar on tracheal cancer

The prognosis for malignant neoplasms originating in the bronchial wall is determined by the histological type and extent of the tumor. If at the first stage of the disease, timely treatment gives a 5-year survival rate of 80%, then at the third stage only a fifth of patients survive. The presence of metastases in distant organs significantly worsens the prognosis.

Prevention of bronchial cancer primarily includes quitting smoking, which is considered a major risk factor for the tumor. When working in hazardous conditions, you should carefully monitor your respiratory system and use protective equipment against dust and hazardous impurities in the air. If there are inflammatory processes in the respiratory tract, you need to promptly treat them and regularly visit a doctor.

Video: lung/bronchus cancer – program “About the Most Important Thing”

The author selectively answers adequate questions from readers within his competence and only within the OnkoLib.ru resource. Face-to-face consultations and assistance in organizing treatment are not provided at this time.