Lung cancer is one of the most common cancers in the world. With a central location, the tumor affects the bronchi of the first three generations: main, lobar and segmental.
- Reasons for appearance
- Classification
- Symptoms and possible complications
- Diagnostics
- Treatment
- Forecast
- Prevention
Reasons for appearance
Factors in the development of lung cancer can be grouped into three groups: genetic, exogenous (external) and endogenous (internal). Genetic causes include:
- The familial nature of the disease is three or more cases of lung cancer in close relatives.
- The patient has a history of another malignant tumor.
External factors that influence the development of this neoplasm:
- Smoking. It is addiction to this habit that is the main reason for the development of lung cancer. Moreover, not only active but also passive smoking can lead to the appearance of a tumor.
- Exposure to carcinogens: exhaust gases; some organic substances (for example, arsenic, cadmium); tars and cokes that appear in the air as a result of coal and oil processing.
- Occupational hazards: work in uranium mines; industrial processing of steel, wood, metal. Also, the risk of lung cancer is increased among those workers who come into contact with stone dust, asbestos, aluminum and nickel. The combination of these factors with smoking further increases the likelihood of developing the disease.
Endogenous factors for the development of central lung cancer include:
- Age over 50 years.
- Chronic inflammatory processes in the bronchi.
- Presence of endocrine diseases.
- Immunodeficiency conditions (HIV infection, therapy with cytostatic drugs).
Under the influence of unfavorable factors, precancerous changes are formed in the bronchi. They play an important role in the pathogenesis of this disease.
Classification
There are several principles for classifying this type of malignant tumor. According to histological structure, central lung cancer can be:
- Squamous cell (spindle cell).
- Small cell.
- Glandular (adenocarcinoma).
- Large cell.
- Glandular-squamous (dimorphic).
- Malignant tumor of the bronchial glands.
Based on the TNM classification, common to all malignant neoplasms, there are 4 stages of development of central lung cancer:
- Stage I corresponds to a tumor without spreading to neighboring organs or metastasizing.
- The malignant process of stage II is characterized by the presence of regional metastases or the transition of the tumor to the pleura, chest wall, or diaphragm.
- Stage III is assigned to cancer with metastasis to the lymph nodes (bifurcation, tracheobronchial, paratracheal).
- Stage IV neoplasm is characterized by the presence of distant metastases and extends beyond the lung.
According to the characteristics of clinical and radiological manifestations, its anatomical growth forms were determined:
- An endobronchial tumor characterized by exophytic growth and a polyp-like appearance. A clinical feature of this form of central cancer is early disturbances in ventilation of the affected area of the lung.
- Peribronchial form. The neoplasm in this case grows inside the bronchial wall. The formation of a narrowing of the lumen is possible due to its compression from the outside.
- Branched cancer also grows endophytically (towards the surrounding tissues) and takes the form of a bronchial tree.
Cases of detection of mixed forms of the disease are not uncommon. The formation of such neoplasms occurs due to the attachment of other components to the tumor during the development process.
Book a consultation 24 hours a day
+7+7+78
Initial stages of lung cancer
It is generally accepted that lung cancer has 4 stages. However, if we consider that the initial stages of lung cancer are not one, but three, then there are six in total:
Hidden cancer . Designated as TxN0M0. This means that the primary tumor has not been identified. But bronchial washings and their cytological analysis showed the presence of atypical cells in the studied material.
Stage 0 . Designated as TisN0M0. Cancer detected. But the primary tumor is limited to the bronchial mucosa and does not spread to the lung parenchyma. This is a favorable form of the disease. Another name is compensated cancer. This means that the tumor cannot grow because the body is stopping it from growing in size. At this stage, the neoplasm can remain for 5-10 years or more. But this stage of lung cancer is diagnosed extremely rarely. The patient has no symptoms. Accordingly, there is no reason to be examined either.
Stage 1 . Stage 1 lung cancer is characterized by the absence of any metastases: both near and distant. It is divided into two substages: A and B. They differ in that at substage A there is a primary T1 tumor, while stage 1 lung cancer B is characterized by the presence of a T2 tumor.
Symptoms and possible complications
The nature and severity of the symptoms of the disease depend on the size and type of growth of the formation, its histological structure, the nature of metastasis, and the presence of inflammatory processes in the bronchial mucosa. Features of the anatomical structure of the main bronchi (the right one is shorter and wider than the left) contribute to the fact that central cancer of the right lung is more common. Manifestations of the disease are primary (local), secondary and general.
Local symptoms include:
- Cough. It occurs as a result of irritation of the bronchial mucosa by a tumor and occurs in almost all patients with central lung cancer. At the beginning of the disease, coughing is noted, and as the tumor grows, the cough becomes constant, painful and annoying. It is usually dry in nature, but mucous sputum may also be produced.
- Hemoptysis. Appears due to the disintegration of central cancer, destruction of the bronchial mucosa. It is observed in approximately half of the cases. Usually blood in sputum is contained in the form of streaks, dark clots. There may be short or long intervals between episodes of hemoptysis.
- Chest pain, which can be episodic, constant, persistent, tingling, sharp, radiating along the nerves. Also, its appearance can be provoked by involvement of the pleura in the process, and in the later stages of cancer - by damage to the intercostal nerves, the ribs themselves, and the intrathoracic fascia.
- Dyspnea, the appearance of which is caused by hypoventilation during atelectasis, mediastinal displacement. As a rule, this symptom is detected with common tumors.
Secondary symptoms of central lung cancer appear later. They are caused by the impact of the growing tumor on other organs or its metastasis. This group includes such manifestations of the disease as:
- Involvement of neighboring organs. Compression of the superior vena cava may develop with swelling of the face and neck and stagnation of venous blood. When the recurrent nerve is damaged, dysphonia is observed. Tumor growth into the wall of the esophagus leads to dysphagia and fistula formation.
- Phenomena of regional and distant metastasis. Most often, hematogenous metastases of lung cancer appear in the brain and spinal cord, kidneys, and liver.
- The development of paraneoplastic syndrome is a manifestation of a tumor, which is caused by nonspecific reactions from other organs and systems. In patients with lung cancer, such manifestations are observed more often than with any other neoplasms.
Common symptoms of the disease include increased fatigue, weakness, and weight loss. In rare cases, they may be the only manifestations for quite a long time.
The course of the central form of lung cancer can be complicated by the following conditions:
- Impaired ventilation due to decreased bronchial obstruction and the formation of atelectasis.
- Pneumonitis, which develops against the background of bronchial stenosis.
- Purulent melting of lung tissue and the formation of a cavity in atelectasis, which developed due to hypoventilation. Less commonly, in this area of the lung tissue, the formation of connective tissue and shrinkage of the lung occurs.
Another common complication of this type of cancer is pleurisy. It is usually formed due to the growth of a tumor into the pleura or blood vessels.
Lung cancer stage 2
Stage 2 lung cancer is characterized by the appearance of metastatic lesions of nearby lymph nodes. But there are no distant foci of metastasis yet.
According to the international classification, stage 2 lung cancer is divided into the same substages - A and B, as stage 1 cancer. Already at stage 2, the cancer can be quite large in size, which results in an unfavorable prognosis for the patient’s life. But if the primary tumor meets the T3 criteria, then the second degree is diagnosed only in the absence of regional foci of metastasis. If they appear, stage 3 lung cancer is diagnosed.
Diagnostics
Physical examination methods, which include inspection, palpation, percussion, and auscultation, play a secondary role in diagnosing the early stages of central cancer. At the first stage of examination of a patient with late stages, the following may be observed:
- Visible asymmetry of the chest. For example, cancer of the left lung of significant size will contribute to the lag of the chest on the left when breathing.
- Palpation enlargement of peripheral lymph nodes and liver size.
- Percussion signs of atelectasis.
- Weakened breathing, stenotic wheezing, which is detected by auscultation.
Instrumental methods used to diagnose lung cancer include:
- X-ray in two projections. If the tumor is centrally located, signs of stenosis of the lobar or segmental bronchus are revealed.
- Computed tomography in direct, lateral and oblique projections. This study allows us to study in detail the condition of the bronchi (the presence of occlusion, stenosis), the nature and extent of spread of the tumor in the tissue of the lung itself and in surrounding organs (pleura, mediastinum, diaphragm, nearby lymph nodes).
- Cytological analysis of sputum, which is the most informative after bronchoscopy (detection of cancer cells is observed in this case in 90% of patients).
- A bronchoscopic examination, during which a direct biopsy is performed or material is obtained for histological examination using an imprint of the tumor. In addition, during this procedure it is possible to perform transtracheobronchial puncture of the lymph nodes.
- Endoscopic transbronchial ultrasound with the ability to obtain biological material is one of the latest developments in the diagnosis of central lung cancer.
The nature of tumor metastasis is assessed using studies such as MRI of the brain and spinal cord, ultrasound examination of the retroperitoneal organs and abdominal cavity. Metastases in bone tissue are detected using scintigraphy.
Book a consultation 24 hours a day
+7+7+78
Fourth
At the fourth stage of oncology development, processes are no longer controllable. A malignant tumor rapidly spreads to all organs of the body and penetrates all cells of the body. Metastases increase in number, and new cancers form. The liver, brain, bones and other vital organs may be affected.
Manifestation of pathology:
• cough becomes paroxysmal; • a large amount of blood and pus in the sputum; • pain in the sternum; • increased shortness of breath.
In a terminal condition, the functioning of the lungs becomes difficult. Consequently, oxygen enters the organs in smaller quantities, and, as you know, it is extremely necessary for the normal functioning of the body and life in general. This is where all the above violations arise. Digestive problems often appear, because... tumor formation can push back the esophagus and impede its food passage.
Treatment
The main treatment for central lung cancer is surgical removal. Oncologists also use radiation treatment, chemotherapy and photodynamic therapy.
Surgical method
When excision of central cancer, a section of lung tissue in a volume of at least a fraction is removed with a minimum indentation of 2 cm from the border of the tumor towards healthy tissue. Regional lymph nodes are also removed.
Surgical options for this disease include:
- Lobectomy (removal of a lobe of the lung).
- Bilobectomy (excision of two lobes).
- Pneumonectomy (complete removal of the lung).
If the tumor spreads to neighboring organs, their resection may be performed. For example, if the cancer is located near the trachea, its partial removal is possible.
Other therapies
Radiation therapy can be used as a radical method or as part of palliative care for the patient. As an independent method of treatment, it is used for tumors of stages I-II in case of contraindications to surgical treatment.
The administration of chemotherapy drugs is considered as an auxiliary method for lung cancer. The best result is provided by a combination of radiotherapy and chemotherapy (when used sequentially or simultaneously).
Preparing for chemotherapy
The use of targeted and immunotherapy does not require a special regimen or diet - adequate sleep, regular healthy eating, and sometimes taking multivitamins are recommended.
When chemotherapy is carried out, healthy cells are also affected; “building material” is needed to replenish protein losses. Therefore, the diet should actively include legumes, lean meat and fish, and poultry. It is also advisable to take additional vitamins of group B. Any types of raw and boiled vegetables, salads and fruits are useful, and especially those with a high content of vitamin C - citrus fruits, apples, currants. It is also advisable to increase the amount of fluid by consuming vegetable, fruit and berry juices. The feasibility of this increases significantly when treated with platinum drugs. Carrot, beet, tomato, raspberry and lingonberry juices are especially useful.
Prevention
There are primary and secondary prevention of lung cancer. Primary measures include the development and implementation of government and medical measures that are aimed at reducing the impact of carcinogenic substances on the body. The main goals of primary prevention are the fight against smoking, air pollution from industrial enterprises and exhaust gases, and the negative effects of occupational factors.
Secondary prevention includes routine medical examination of the population in order to identify groups of patients at “high risk”. These include patients with chronic bronchitis, men who smoke for a long time, as well as people cured of another malignant tumor. Periodic examination of these groups of individuals contributes to the early diagnosis of lung cancer.
| More information about lung cancer treatment at Euroonco: | |
| Lung cancer treatment | |
| Oncologist consultation | from 5100 rub. |
| Chemotherapy appointment | 6900 rub. |
Book a consultation 24 hours a day
+7+7+78
