Focal formations in the lungs. Benign tumors of the lungs What can be benign tumors in the lungs

The development of a malignant tumor in the lung, in most cases, begins from the cells of this organ, but there are also situations when malignant cells enter the lung through metastasis from another organ that was the primary source of the cancer.

Lung cancer is the most common type of cancer that occurs in humans. In addition, it ranks first in mortality among all possible types of cancer.

More than 90% of neoplasms in the lungs appear in the bronchi, they are also called bronchogenic carcinomas. In oncology, they are all classified into: squamous cell carcinoma, small cell, large cell and adenocarcinoma.

Another type of onset cancer is alveolar carcinoma, which appears in the alveoli (air sacs of the organ). Less common are: bronchial adenoma, chondromatous hamartoma and sarcoma.

The lungs are among the organs that most often metastasize. Metastatic lung cancer can occur against the background of advanced stages of cancer of the breast, intestines, prostate, kidney, thyroid, and many other organs.

Causes

The main reason for the mutation of normal lung cells is considered a bad habit - smoking. According to statistics, about 80% of cancer patients diagnosed with lung cancer are smokers, and most of them are long-term smokers. The more a person smokes cigarettes a day, the higher his chances of developing a malignant tumor in the lung.

Much less often, about 10-15% of all cases fall on labor activity, in conditions of work with harmful substances. The following are considered especially dangerous: work in asbestos, rubber production, contact with radiation, heavy metals, ethers, work in the mining industry, etc.

Attribute the condition to the causes of lung cancer external environment difficult, since the air in the apartment can bring more harm than street air. In some cases, cells may acquire malignant properties due to the presence of chronic diseases or inflammation.

The presence of any symptoms in a person will depend on the type of tumor, its location and stage of the course.

The main symptom is considered to be a persistent cough, but this symptom is not specific, as it is characteristic of many diseases of the respiratory system. People should be puzzled by the cough, which over time becomes more hacking and frequent, and the sputum that comes out after it is streaked with blood. If the neoplasm has damaged the blood vessels, there is a high risk that bleeding will begin.

Active development of the tumor and an increase in its size often occurs with the appearance of hoarseness, due to narrowing of the lumen respiratory tract. If the tumor covers the entire lumen of the bronchus, the patient may experience a collapse of that part of the organ that was associated with it, such a complication is called atelectasis.

No less complex consequence of cancer is the development of pneumonia. Pneumonia is always accompanied by severe hyperthermia, cough and painful sensations in the chest area. If the neoplasm damages the pleura, the patient will constantly feel pain in the chest.

A little later, they begin to show general symptoms, which consist of: loss of appetite or its decrease, rapid weight loss, constant weakness and rapid fatigue. Often, a malignant tumor in the lung causes the accumulation of fluid around itself, which certainly leads to shortness of breath, lack of oxygen in the body and problems with the heart.

If the growth of a malignant neoplasm caused damage to the nerve pathways that run in the neck, the patient may experience neuralgic symptoms: ptosis of the upper eyelid, narrowing of one pupil, eye drop, or a change in the sensitivity of one part of the face. The simultaneous manifestation of these symptoms is called Horner's syndrome in medicine. Tumors of the upper lobe of the lung have the ability to grow into the nerve pathways of the arm, which can cause pain, numbness, or muscle hypotonia.

A tumor that is located near the esophagus may grow into it over time, or it may simply grow next to it until it provokes compression. Such a complication can cause difficulty swallowing, or the formation of an anastomosis between the esophagus and the bronchi. With this course of the disease, after swallowing, the patient develops symptoms in the form of a strong cough, as food and water enter the lungs through the anastomosis.

Severe consequences can be caused by the germination of a tumor in the heart, which causes symptoms in the form of arrhythmia, cardiomegaly, or accumulation of fluid in the pericardial cavity. Often, the tumor damages the blood vessels, metastases can also get into the superior vena cava (one of the largest veins in the chest). If there is a violation of patency in it, this causes congestion in many veins of the body. Symptomatically, it is noticeable by swollen chest veins. The veins of the face, neck, chest also swell and become cyanotic. Also, the patient has headaches, shortness of breath, blurred vision, constant fatigue.

When lung cancer reaches stage 3-4, metastasis to distant organs begins. Through the bloodstream or lymph flow, malignant cells spread throughout the body, affecting organs such as the liver, brain, bones, and many others. Symptomatically, this begins to manifest itself as a dysfunction of the organ that has been affected by metastases.

A doctor may suspect the presence of lung cancer when a person (especially if he smokes) talks about complaints of a prolonged and worsening cough, which is paired with other symptoms described above. In some cases, even without bright signs, to indicate lung cancer can be a fluorographic image, which every person must undergo annually.

Chest X-ray is good method diagnosis of tumors in the lungs, but it is difficult to see small nodes on it. If an area of ​​​​blackout is noticeable on x-ray, this does not always mean the presence of education, it may be an area of ​​fibrosis that has arisen against the background of another pathology. To make sure of their guesses, the doctor may prescribe additional diagnostic procedures. Usually, the patient needs to submit materials for microscopic examination (biopsy), it can be collected using bronchoscopy. If the tumor has formed deep in the lung, the doctor may perform a puncture with a needle, under the guidance of CT. In the most severe cases, a biopsy is taken by an operation called a thoracotomy.

More modern diagnostic methods, such as CT or MRI, are able to fix such tumors that can be missed on a simple x-ray. In addition, on CT, you can more carefully examine the formation, twist it, enlarge it and assess the condition of the lymph nodes. CT scan of other organs allows you to determine the presence of metastases in them, which is also a very important point in the diagnosis and further treatment.

Oncologists classify malignant tumors based on their size and extent of spread. The stage of the present pathology will depend on these indicators, thanks to which doctors can make some predictions about the future life of a person.

Bronchial tumors of a benign nature are removed by doctors using surgical intervention, since they block the bronchi and can degenerate into malignant ones. Sometimes, oncologists cannot accurately determine the type of cells in a tumor until the tumor is removed and examined under a microscope.

Those formations that do not go beyond the lung (the only exception is small cell carcinoma) are amenable to surgery. But the statistics are such that about 30-40% of tumors are operable, but such treatment does not guarantee complete cure. In 30-40% of patients who have had an isolated slow-growing tumor removed, they have a good prognosis and live for about 5 years. Doctors advise such people to visit a doctor more often, as there is a chance of relapse (10-15%). This figure is much higher in those people who continue to smoke after treatment.

Choosing a treatment plan, namely the scale of the operation, doctors conduct a study of lung function in order to identify possible problems in the work of the organ after the operation. If the results of the study are negative, the operation is contraindicated. The volume of the part of the lung to be removed is chosen by surgeons already during the operation, it can vary from a small segment to the whole lung (right or left).

In some cases, a tumor that has metastasized from another organ is removed first in the main focus, and then in the lung itself. Such an operation is performed infrequently, since doctors' forecasts for life within 5 years do not exceed 10%.

There are many contraindications to surgery, it can be heart pathology, chronic lung diseases and the presence of many distant metastases, etc. AT similar cases doctors prescribe radiation to the patient.

Radiation therapy has a negative effect on malignant cells, destroys them and reduces the rate of division. In inoperable, advanced forms of lung cancer, it can relieve general state patient, relieving bone pain, obstruction in the superior vena cava and much more. The negative side of irradiation is the risk of developing an inflammatory process in healthy tissues (radiation pneumonia).

The use of chemotherapy for the treatment of lung cancer often does not have the desired effect, except for small cell cancer. Due to the fact that small cell cancer almost always diverges to distant parts of the body, surgery for its treatment is ineffective, but chemotherapy is excellent. Approximately 3 out of 10 patients, such therapy helps to prolong life.

A large number of cancer patients note a serious deterioration in their general condition, regardless of whether they are undergoing therapy or not. Some patients in whom lung cancer has already reached stage 3-4 have such forms of shortness of breath and pain syndrome that they cannot tolerate them without the use of narcotic drugs. In moderate doses narcotic drugs can significantly help a sick person to alleviate his condition.

It is difficult to say exactly how long people diagnosed with lung cancer live, but doctors can give estimates based on five-year survival statistics among patients. No less important points are: the general condition of the patient, age, the presence of concomitant pathologies and the type of cancer.

How many live at 1 stage?

If the initial stage was diagnosed in time, and the patient was prescribed necessary treatment, the chances of survival within five years are 60-70%.

How long do they live with stage 2?

During this stage, the tumor already has a decent size, and the first metastases may appear. The survival rate is even 40-55%.

How many live at 3 stages?

The tumor is already more than 7 centimeters in diameter, the pleura is affected and lymph nodes. Chances of life 20-25%;

How many live at 4 stages?

Pathology has taken its most extreme degree of development (terminal stage). Metastases have spread to many organs, and a lot of fluid accumulates around the heart and in the lungs themselves. This stage has the most disappointing forecasts of 2-12%.

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Basic information

Definition

A focal formation in the lung is called a radiologically determined single defect of a rounded shape in the projection of the lung fields (Fig. 133).

Its edges may be smooth or uneven, but they must be distinct enough to define the contour of the defect and allow its diameter to be measured in two or more projections.

Rice. 133. Chest radiograph in frontal and lateral projections of a 40-year-old patient.
Focal blackout with clear boundaries is visible. When compared with previous radiographs, it was found that over a period of more than 10 years, the formation did not increase in size. It was considered benign and no resection was performed.

The surrounding lung parenchyma should appear relatively normal. Inside the defect, calcifications are possible, as well as small cavities. If most of the defect is occupied by a cavity, then a recalcified cyst or a thin-walled cavity should be assumed; it is undesirable to include these nosological units in the type of pathology under discussion.

The size of the defect is also one of the criteria for determining focal lesions in the lung. The authors believe that the term "focal lesion in the lungs" should be limited to defects no larger than 4 cm. Lesions larger than 4 cm in diameter are more often of a malignant nature.

Therefore the process differential diagnosis and the examination tactics for these large formations are somewhat different than for typical small focal opacities. Of course, the adoption of a diameter of 4 cm as a criterion for assigning pathology to the group of focal formations in the lung is to a certain extent conditional.

Causes and Prevalence

The causes of focal blackouts in the lungs can be different, but in principle they can be divided into two main groups: benign and malignant (Table 129). Among benign causes, granulomas caused by tuberculosis, coccidioidomycosis, and histoplasmosis are most common.

Table 129

Among the malignant causes of blackouts, bronchogenic cancers and metastases of tumors of the kidneys, colon, and breast are most common. According to various authors, the percentage of blackouts, which subsequently turn out to be malignant, ranges from 20 to 40.

There are many reasons for this variability. For example, in studies conducted in surgical clinics, calcified defects are usually excluded, therefore, in such populations a higher percentage of a malignant tumor is obtained compared with groups of patients from which calcified defects are not excluded.

In studies conducted in geographical areas endemic for coccidiomycosis or histoplasmosis, a higher percentage of benign changes will, of course, also be found. An important factor age is also a factor, in persons not older than 35 years the probability of a malignant lesion is small (1% or less), and in older patients it increases significantly. A malignant nature is more likely for large opacities than for smaller ones.

Anamnesis

Most patients with focal lesions in the lungs do not have any clinical symptoms. Nevertheless, with careful questioning of the patient, you can get some information that can help in the diagnosis.

Clinical symptoms of pulmonary pathology are more common in patients with a malignant origin of blackout than in patients with benign defects.

History of present illness

It is important to collect information on recent upper respiratory tract infections, influenza and influenza-like conditions, pneumonia, as sometimes pneumococcal infiltrates are round in shape.

The presence of a chronic cough, sputum, weight loss or hemoptysis in a patient increases the likelihood of a malignant origin of the defect.

Status of individual systems

With the help of correctly posed questions, it is possible to identify the presence of non-metastatic paraneoplastic syndromes in a patient. These syndromes include clubbing fingers with hypertrophic pulmonary osteoarthropathy, ectopic hormone secretion, migratory thrombophlebitis, and a number of neurological disorders.

However, if a patient has a malignant process that manifests itself only as an isolated blackout in the lung, all these signs are rare. The main purpose of such a survey is usually to try to identify extrapulmonary symptoms that may indicate the presence of a primary malignant tumor in other organs or detect distant metastases of the primary lung tumor.

The presence of an extrapulmonary primary tumor can be suspected by symptoms such as a change in stool, the presence of blood in the stool or urine, the detection of a lump in the breast tissue, the appearance of discharge from the nipple.

Past illnesses

A possible etiology of focal opacities in the lungs can be reasonably suspected if the patient previously had malignant tumors of any organs or the presence of a granulomatous infection (tuberculosis or fungal) was confirmed.

To others systemic diseases, which may be accompanied by the appearance of isolated blackouts in the lungs, include rheumatoid arthritis and chronic infections arising against the background of immunodeficiency states.

Social and occupational history, travel

A history of prolonged smoking significantly increases the likelihood of a malignant nature of focal changes in the lungs. Alcoholism is accompanied by an increased likelihood of tuberculosis. Information about the patient's residence or travel to certain geographical areas (endemic zones for fungal infections) makes it possible to suspect that the patient has any of the common (coccidioidomycosis, histoplasmosis) or rare (echinococcosis, dirofilariasis) diseases that lead to the formation of blackouts in the lungs.

It is necessary to ask the patient in detail about his working conditions, since some types of professional activity (asbestos production, uranium and nickel mining) are accompanied by an increased risk of malignant lung tumors.

Lung tumor - combines several categories of neoplasms, namely malignant and benign. It is noteworthy that the former affect people over forty, and the latter are formed in people under 35 years of age. The reasons for the formation of tumors in both cases are almost the same. Most often, long-term addiction to bad habits, work in hazardous production and exposure to the body act as provocateurs.

The danger of the disease lies in the fact that with any variant of the course of the tumor lung symptoms, which are already of a non-specific nature, may be absent for a long time. Main clinical manifestations considered to be - malaise and weakness, fever, mild chest discomfort and stubborn moist cough. In general, lung ailments have non-specific symptoms.

Differentiate malignant and benign neoplasms lungs can only be done with the help of instrumental diagnostic procedures, the first place among which is a biopsy.

Treatment of all types of neoplasms is carried out only surgically, which consists not only in excising the tumor, but also in partial or complete removal the affected lung.

The International Classification of Diseases of the Tenth Revision allocates separate values ​​for tumors. Thus, formations of a malignant course have the ICD-10 code - C34, and benign - D36.

Etiology

The formation of malignant neoplasms is provoked by improper cell differentiation and pathological tissue growth, which occurs at the gene level. However, among the most likely predisposing factors that a lung tumor appears, there are:

• long-term addiction to nicotine - this includes both active and passive smoking. Such a source provokes the development of the disease in men in 90%, and in females in 70% of cases. It is noteworthy that passive smokers have a higher likelihood of developing a tumor of a malignant course;
• specific working conditions, namely the constant contact of a person with chemical and toxic substances. The most dangerous for humans are asbestos and nickel, arsenic and chromium, as well as radioactive dust;
• permanent exposure human body radon radiation;
• diagnosed benign lung tumors - this is due to the fact that some of them, in the absence of therapy, are prone to transformation into cancers;
• the course of inflammatory or suppurative processes directly in the lungs or in the bronchi;
• scarring of lung tissue;
• genetic predisposition.

It is the above reasons that contribute to DNA damage and the activation of cellular oncogenes.

The provocateurs of the formation of benign lung tumors are currently not known for certain, however, experts from the field of pulmonology suggest that this may be affected by:

• burdened heredity;
• gene mutations;
• pathological influence of various viruses;
• influence of chemical and radioactive substances;
• addiction to bad habits, in particular, to smoking;
• contact with contaminated soil, water or air, with formaldehyde, ultraviolet radiation, benzanthracene, radioactive isotopes and vinyl chloride being most often considered provocateurs;
• decreased local or general immunity;
• permanent influence stressful situations;
• irrational nutrition;
• drug addiction.

From the foregoing, it follows that absolutely every person is predisposed to the appearance of a tumor.

Classification

Specialists from the field of pulmonology usually distinguish several types of malignant neoplasms, but the leading place among them is occupied by cancer, diagnosed in every 3 people who have a tumor in this area. In addition, the following are also considered malignant:

• - originates in the lymphatic system. Often such a formation is the result of metastasis of a similar tumor from the breast or colon, kidneys or rectum, stomach or cervix, testicle or thyroid gland, skeletal system or prostate, and skin;
• - includes intraalveolar or peribronchial connective tissue. It is most often localized in the left lung and is typical for males;
• malignant carcinoid - has the ability to form distant metastases, for example, to the liver or kidneys, brain or skin, adrenal glands or pancreas;
• squamous cell carcinoma;
• pleural mesothelioma - histologically consists of epithelial tissues that line the pleural cavity. Very often diffuse in nature;
• oat cell carcinoma - characterized by the presence of metastases on initial stages disease progression.

In addition, malignant lung tumor it happens:

• highly differentiated;
• medium differentiated;
• poorly differentiated;
• undifferentiated.

It goes through several stages of progression:

• initial - the tumor does not exceed 3 centimeters in size, affects only one segment of this organ and does not metastasize;
• moderate - the formation reaches 6 centimeters and gives single metastases to regional lymph nodes;
• severe - a neoplasm in volume of more than 6 centimeters, extends to the neighboring lobe of the lung and bronchi;
• complicated - cancer gives extensive and distant metastases.

Classification of benign tumors according to the type of tissues that make up their composition:

• epithelial;
• neuroectodermal;
• mesodermal;
• germinal.

Benign lung tumors also include:

• adenoma is a glandular formation, which in turn is divided into carcinoids and carcinomas, cylindromas and adenoids. It should be noted that in 10% of cases malignancy is observed;
• hamartoma or - an embryonic tumor that includes the constituent parts of the germinal tissue. These are the most frequently diagnosed formations in this category;
• or fibroepithelioma - consists of a connective tissue stroma and has a large number of papillary outgrowths;
• - in volume does not exceed 3 centimeters, but can grow to gigantic sizes. It occurs in 7% of cases and is not prone to malignancy;
• - This is a fatty tumor, which is extremely rarely localized in the lungs;
• leiomyoma - a rare formation that includes smooth muscle fibers and looks like a polyp;
• a group of vascular tumors - this should include hemangioendothelioma, hemangiopericytoma, capillary and cavernous, as well. The first 2 types are conditionally benign lung tumors, since they are prone to degeneration into cancer;
• or dermoid - acts as an embryonic tumor or cyst. The frequency of occurrence reaches 2%;
• neurinoma or shvannomu;
• chemodectoma;
• tuberculoma;
• fibrous histiocytoma;
• plasmacytoma.

The last 3 varieties are considered the most rare.

In addition, a benign lung tumor, according to the focus, is divided into:

• central;
• peripheral;
• segmental;
• home;
• share.

Classification in the direction of growth implies the existence of the following formations:

• endobronchial - in such a situation, the tumor grows deep into the lumen of the bronchus;
• extrabronchtal - growth is directed outward;
• intramural - germination occurs in the thickness of the lung.

In addition, neoplasms of any variant of the course can be single and multiple.

Symptoms

Several factors influence the severity of clinical signs:

• localization of education;
• tumor size;
• nature of germination;
• the presence of concomitant diseases;
• the number and extent of metastases.

Signs of malignant tumors are nonspecific and are presented:

• causeless weakness;
• fast fatigue;
• periodic increase in temperature;
• general malaise;
• symptoms , and ;
• hemoptysis;
• persistent cough with mucus or purulent sputum;
• shortness of breath that occurs at rest;
• soreness of varying severity in the chest area;
• a sharp decrease in body weight.

A benign lung tumor has the following symptoms:

• cough with the release of a small amount of sputum with impurities of blood or pus;
• whistling and noise during breathing;
• decrease in working capacity;
• dyspnea;
• persistent increase in temperature indicators;
• asthma attacks;
• tides to the upper half of the body;
• disorder of the act of defecation;
• mental disorders.

It is noteworthy that most often there are no signs of benign formations at all, which is why the disease is a diagnostic surprise. As for malignant neoplasms of the lung, symptoms are expressed only if the tumor grows to a gigantic size, extensive metastases and late stages.

Diagnostics

A correct diagnosis can only be made by a wide range instrumental examinations, which are necessarily preceded by manipulations carried out directly by the attending physician. They should include:

• study of the medical history - to identify ailments leading to the occurrence of a particular tumor;
• familiarization with the life history of a person - to clarify the working conditions, living and lifestyle;
• listening to the patient with a phonendoscope;
• a detailed survey of the patient - to compile a complete clinical picture of the course of the disease and determine the severity of symptoms.

Among the instrumental procedures it is worth highlighting:

• survey radiography of the left and right lung;
• CT and MRI;
• pleural puncture;
• endoscopic biopsy;
• bronchoscopy;
• thoracoscopy;
• Ultrasound and PET;
• angiopulmonography.

In addition, the following laboratory tests are required:

• general and biochemical analysis blood;
• tests for tumor markers;
• microscopic examination of sputum;
• histological analysis of the biopsy;
• cytological study of effusion.

Treatment

Absolutely all malignant and benign lung tumors (regardless of the likelihood of malignancy) undergo surgical excision.

As a medical intervention, one of the following operations can be selected:

• circular, marginal or fenestrated resection;
• lobectomy;
• bilobectomy;
• pneumonectomy;
• husking;
• complete or partial excision of the lung;
• thoracotomy.

Operable treatment can be carried out by open or endoscopic way. To reduce the risk of complications or remission after the intervention, patients undergo chemotherapy or radiation treatment.

Possible Complications

If you ignore the symptoms and do not treat the disease, then there is a high risk of developing complications, namely:

• pulmonary bleeding;
• abscess pneumonia;
• syndrome of compression of blood vessels and internal organs;
• malignancy.

Prevention and prognosis

Reducing the likelihood of the formation of any neoplasms in the body contribute to:

• complete rejection of all bad habits;
• correct and balanced diet;
• avoidance of physical and emotional overstrain;
• usage individual funds protection when working with toxic and poisonous substances;
• prevention of irradiation of the body;
• timely diagnosis and treatment of pathologies that can lead to the formation of tumors.

Also, do not forget about regular preventive examination in medical institution which must be taken at least 2 times a year.

Benign tumor in the lungs- This is a neoplasm in the lungs in the form of a dense nodule of an oval or rounded shape, which is formed as a result of excessive pathological growth of organ tissues and is located among healthy tissue areas. The histological structure (structure) of such nodules can be very diverse, but it differs from the structure of normal lung tissue.

Due to a certain similarity of benign tumors with the difference between them is somewhat relative, but the former are characterized by very slow growth over a long period, scant external signs (or without any) before the onset of complications, and a minimal tendency to move into malignant form. Accordingly, the tactics of treatment differ in their characteristics in comparison with the treatment of malignant tumors.

The prevalence of benign formations is 10-12 times lower than malignant ones and is more typical for non-smokers under the age of 40 years. The frequency of the disease in men and women is equivalent.

Classification

Due to the extensive characteristics of the concept of "benign tumor", they are classified according to several principles: anatomical structure, histological structure and clinical manifestation.

According to the anatomical structure, it becomes clear where the tumor comes from and what is the main direction of its growth. Localization of tumors is central and peripheral. With a central placement, the tumor is formed from large bronchi. In the direction relative to the wall of the bronchus, benign formations can grow inside the lumen of the bronchus (endobronchial type), outward (extrabronchial type) and into the thickness of the bronchus (intramural type). Peripheral tumors develop on the distal (distant from the center) branches of the bronchi or from other types of lung tissue. Depending on the distance to the surface of the lungs, such tumors are divided into superficial and deep.

According to the histological structure, 4 groups of benign tumors are distinguished (based on the tissue from which the neoplasm was formed:

1. epithelial tumors (from the superficial lining): adenomas, papillomas;
2. neuroectodermal tumors (from nerve fiber sheath cells): neuromas, neurofibromas;
3. mesodermal tumors (from adipose and connective tissue): fibromas, myomas, lipomas);
4. dysembryogenetic tumors (congenital tumors with elements of germinal tissue): hamartomas, teratomas.

The most common benign lung tumors are considered to be adenomas (60-65%), most often they are centrally located and hamartomas, which are characterized by a peripheral location.

By clinical principle classification is assumed according to the severity of the manifestations of the disease. With central tumors, bronchial patency is taken into account:

• I degree: partial obstruction of the bronchus, breathing in both directions;
• II degree: inhalation is possible, exhalation is not - the tumor acts here as a valve (valvular bronchoconstriction);
• III degree: complete obstruction of the bronchus, it is completely excluded from breathing (bronchial occlusion).

Benign tumors of peripheral localization are also divided into three degrees of clinical signs. Grade I is characterized by an asymptomatic course, II - with meager manifestations, and III - with pronounced signs that appear with the growth of the tumor and its pressure on adjacent tissues and organs.

Symptoms

Benign lung tumors present themselves in different ways. Depending on the location and size of the tumor, and sometimes hormonal activity, different symptoms are expressed. Tumors of central localization are characterized by the following stages:

• asymptomatic: external manifestations no, but the tumor may be incidentally detected on x-ray;
• initial manifestations: partial valvular bronchoconstriction may be accompanied by a cough with a small amount of sputum or be asymptomatic. On an x-ray, a picture of hypoventilation of a lung area can only be detected upon careful examination. When the tumor grows to such a size that it can only pass air in one direction (during inspiration), emphysema develops, which is accompanied by shortness of breath. With complete obstruction (occlusion) of the bronchus, an inflammatory process occurs in its wall, associated with stagnation of the detachable mucous membrane. There is a fever and cough, accompanied by mucopurulent sputum. When the exacerbation subsides, the condition improves;
• pronounced manifestations: due to developed complications. At this stage, the blockage of the bronchus is permanent, and general symptoms in the form of weight loss, weakness, and sometimes hemoptysis are added to the signs of the previous stage. When listening, wheezing, weakening of breathing and voice trembling are revealed. At the same time, the quality of life is greatly reduced, and working capacity may be lost. It should be noted that it rarely comes to this stage, since due to the very slow growth of the tumor, complete blockage of the bronchus is a rare occurrence.

Peripheral tumors do not show any symptoms until they reach a large size. In the first variant, they can be accidentally discovered during an X-ray examination. In the second case, the growing tumor begins to put pressure on the diaphragm or chest wall and provoke difficulty in breathing or pain in the region of the heart. When squeezing a large bronchus, the symptoms become similar to the symptoms of a central tumor. On x-ray, the tumor is visible in the form of a rounded formation with even contours.

Diagnostics

Benign formations of peripheral localization are easily detected during or. Nodules are displayed as rounded shadows, the edges of which are clear and smooth. The structure of the tissue is most often homogeneous, but there may be some inclusions. CT scan thanks to a detailed assessment of the tissue structure, it allows to distinguish benign from malignant formations with a sufficiently high accuracy.

Diagnosis of a tumor can also be made by monitoring the dynamics of its development during long period. If a nodule less than 6 mm in size does not grow in a period of two to five years, then it is classified as a benign form, since cancerous tumors grow rapidly and within 4 months a two-fold increase can be observed. If during the next x-ray examination the doctor finds that the tumor has changed in size or shape, additional appointments will be prescribed, including. In this case, a small piece of tissue will be taken and examined under a microscope to confirm its good quality and rule out lung cancer.

With a central tumor process, the main diagnostic method is, in which a piece of tissue is also taken from the tumor and its morphological (histological) analysis is carried out.

Treatment

If a benign tumor does not manifest itself in any way, does not grow and does not affect the quality of life, specific treatment is not required. In other cases, surgical removal of the neoplasm may be recommended. The operation is performed by a thoracic surgeon, who determines the scope of the intervention and the method of execution. At the moment, if central tumor grows into the lumen of the bronchus, it is possible to perform endoscopic surgery(minimal surgery).

In most cases, with a peripheral and central location of the tumor, a traditional abdominal operation is performed, during which only the tumor, the tumor and part of the lung tissue, individual segments of the lung, or even the entire lobe can be removed. The amount of intervention depends on the size of the tumor and the data of an urgent histological examination, which is performed during the operation.

The results of surgical treatment of the disease on early stage good ones. Working capacity with small volumes of surgical intervention is restored completely.

Lung cancer is the most common localization of the oncological process, characterized by a rather latent course and early appearance metastases. The incidence of lung cancer depends on the area of ​​residence, the degree of industrialization, climatic and production conditions, gender, age, genetic predisposition and other factors.

What is lung cancer?

Lung cancer is a malignant neoplasm that develops from the glands and mucous membranes of the lung tissue and bronchi. In the modern world, lung cancer among all oncological diseases occupies the top spot. According to statistics, this oncology affects men eight times more often than women, and it was noted that than older age the higher the incidence rate.

The development of lung cancer varies with tumors of different histological structures. Differentiated squamous cell carcinoma is characterized by a slow course, undifferentiated cancer develops rapidly and gives extensive metastases.

The most malignant course is small cell lung cancer:

• develops secretly and quickly,
• metastasizes early.
• has a poor prognosis.

More often the tumor occurs in the right lung - in 52%, in the left lung - in 48% of cases.

The main group of patients are long-term smokers aged 50 to 80 years, this category accounts for 60-70% of all cases of lung cancer, and mortality is 70-90%.

According to some researchers, the structure of morbidity different forms This pathology depending on age is as follows:

• up to 45 - 10% of all cases;
• from 46 to 60 years - 52% of cases;
• from 61 to 75 years -38% of cases.

Until recently, lung cancer was considered a predominantly male disease. Currently, there is an increase in the incidence of women and a decrease in age primary detection illness.

Kinds

Depending on the location of the primary tumor, there are:

• central cancer. It is located in the main and lobar bronchi.
• Aeripheric. This tumor develops from the small bronchi and bronchioles.

Allocate:

1. Small cell carcinoma (less common) is a very aggressive neoplasm, as it can spread throughout the body very quickly, metastasizing to other organs. Typically, small cell cancer occurs in smokers, and by the time of diagnosis, 60% of patients have widespread metastasis.
2. Non-small cell (80-85% of cases) - has a negative prognosis, combines several forms of morphologically similar types of cancer with a similar cell structure.

Anatomical classification:

• central - affects the main, lobar and segmental bronchi;
• peripheral - damage to the epithelium of smaller bronchi, bronchioles and alveolus;
• massive (mixed).

The progression of a neoplasm goes through three stages:

• Biological - the period between the appearance of a neoplasm and the manifestation of the first symptoms.
• Asymptomatic - external signs the pathological process does not appear at all, they become noticeable only on the x-ray.
• Clinical - the period when noticeable symptoms appear in cancer, which becomes an incentive to rush to the doctor.

Causes

The main causes of lung cancer:

• smoking, including passive smoking (about 90% of all cases);
• contact with carcinogens;
• inhalation of radon and asbestos fibers;
• hereditary predisposition;
• age category over 50 years;
• influence of harmful production factors;
• radioactive exposure;
• the presence of chronic respiratory diseases and endocrine pathologies;
• cicatricial changes in the lungs;
• viral infections;
• air pollution.

The disease develops latently for a long time. The tumor begins to form in the glands, mucosa, but metastases grow very quickly throughout the body. The risk factors for the occurrence of a malignant neoplasm are:

• air pollution;
• smoking;
• viral infections;
• hereditary causes;
• harmful production conditions.

Please note that cancer cells that affect the lungs divide very quickly, spreading the tumor throughout the body and destroying other organs. Therefore, timely diagnosis of the disease is important. The earlier lung cancer is detected and treated, the higher the chance of prolonging the life of the patient.

The earliest signs of lung cancer

The first symptoms of lung cancer are often not directly related to respiratory system. Patients turn to various specialists of a different profile for a long time, are examined for a long time and, accordingly, receive the wrong treatment.

Signs and symptoms of early lung cancer:

• subfebrile temperature, which is not knocked down by drugs and extremely exhausting the patient (during this period, the body undergoes internal intoxication);
• weakness and fatigue already in the morning;
• skin itching with the development of dermatitis, and, possibly, the appearance of growths on the skin (caused by the allergic action of malignant cells);
• muscle weakness and increased swelling;
• disorders of the central nervous system, in particular, dizziness (up to fainting), impaired coordination of movements or loss of sensitivity.

If these signs appear, be sure to contact a pulmonologist for diagnosis and clarification of the diagnosis.

stages

Faced with lung cancer, many do not know how to determine the stage of the disease. In oncology, when assessing the nature and extent of lung cancer, 4 stages of the development of the disease are classified.

However, the duration of any stage is purely individual for each patient. It depends on the size of the neoplasm and the presence of metastases, as well as on the rate of the course of the disease.

Allocate:

• Stage 1 - the tumor is less than 3 cm. It is located within the borders lung segment or one bronchus. There are no metastases. Symptoms are difficult to discern or none at all.
• 2 - tumor up to 6 cm, located within the boundaries of the segment of the lung or bronchus. Solitary metastases in individual lymph nodes. Symptoms are more pronounced, there is hemoptysis, pain, weakness, loss of appetite.
• 3 - the tumor exceeds 6 cm, penetrates into other parts of the lung or neighboring bronchi. Numerous metastases. Blood in mucopurulent sputum, shortness of breath are added to the symptoms.

How does the last 4 stage of lung cancer manifest itself?

At this stage of lung cancer, the tumor metastasizes to other organs. The five-year survival rate is 1%. small cell carcinoma and 2 to 15% for non-small cell cancer

The patient has the following symptoms:

• Constant pain when breathing, which is difficult to live with.
• Chest pain
• Decrease in body weight and appetite
• Blood coagulates slowly, fractures (metastases in the bones) often occur.
• The appearance of bouts of severe coughing, often with sputum, sometimes with blood and pus.
• Appearance severe pain in the chest, which directly indicates damage to nearby tissues, since there are no pain receptors in the lungs themselves.
• Cancer symptoms also include heavy breathing and shortness of breath if affected. cervical lymph nodes, speech difficulty is felt.

For small cell lung cancer, which develops rapidly and affects the body in a short time, only 2 stages of development are characteristic:

• limited stage, when cancer cells are localized in one lung and tissues located in close proximity.
• an extensive or extensive stage, when the tumor has metastasized to an area outside the lung and to distant organs.

Symptoms of lung cancer

Clinical manifestations of lung cancer depend on the primary location of the neoplasm. On the initial stage most often the disease is asymptomatic. In later stages, general and specific signs of cancer may appear.

The early, first symptoms of lung cancer are non-specific and usually not alarming, and include:

• unmotivated fatigue
• loss of appetite
• slight weight loss may occur
• cough
• specific symptoms cough with "rusty" sputum, shortness of breath, hemoptysis join in later stages
• pain syndrome indicates the inclusion in the process of nearby organs and tissues

Specific symptoms of lung cancer:

• Cough - causeless, paroxysmal, debilitating, but not dependent on physical activity, sometimes with greenish sputum, which may indicate the central location of the tumor.
• Dyspnea. Shortness of breath and shortness of breath first appear in case of tension, and with the development of a tumor they disturb the patient even in a supine position.
• Pain in the chest. When the tumor process affects the pleura (the lining of the lung), where nerve fibers and ending, the patient develops excruciating pain in the chest. They are sharp and aching, disturb constantly or depend on breathing and physical exertion, but most often they are located on the side of the affected lung.
• Hemoptysis. Usually, the meeting between the doctor and the patient occurs after blood begins to come out of the mouth and nose with sputum. This symptom suggests that the tumor began to affect the vessels.

Stages of lung cancer	Symptoms
1	dry cough; weakness; loss of appetite; malaise; temperature increase; headache.
2	The disease manifests itself: hemoptysis; wheezing when breathing; weight loss; elevated temperature; increased cough; chest pains; weakness.
3	Symptoms of cancer appear: increased wet cough; blood, pus in sputum; breathing difficulties; dyspnea; problems with swallowing; hemoptysis; sharp weight loss; epilepsy, speech disorder, with small cell form; intense pain.
4	Symptoms get worse last stage cancer.

Signs of lung cancer in men

• Exhausting, frequent cough is one of the first signs of lung cancer. Subsequently, sputum appears, its color may become greenish-yellow. With physical labor or hypothermia, coughing attacks intensify.
• When breathing, whistling, shortness of breath appears;
• Pain appears in the chest area. It can be considered a sign of oncology in the presence of the first two symptoms.
• When coughing, in addition to sputum, discharge in the form of blood clots may appear.
• Attacks of apathy, increased loss of strength, increased fatigue;
• With normal nutrition, the patient loses weight sharply;
• With absence inflammatory processes, colds body temperature is increased;
• The voice becomes hoarse, this is due to damage to the nerve of the larynx;
• On the part of the neoplasm, pain in the shoulder may appear;
• Swallowing problems. This is due to tumor damage to the walls of the esophagus and respiratory tract;
• Muscle weakness. Patients, as a rule, do not pay attention to this symptom;
• Dizziness;
• Violation of the heart rhythm.

lung cancer in women

Important signs of lung cancer in women are discomfort in the chest area. They manifest themselves in different intensity depending on the form of the disease. Discomfort becomes especially severe if pathological process intercostal nerves are involved. It is practically intractable and does not leave the patient.

Unpleasant sensations are of the following types:

• stabbing;
• cutting;
• shingles.

Along with common symptoms, there are signs of lung cancer in women:

• changes in voice timbre (hoarseness);
• enlarged lymph nodes;
• swallowing disorders;
• pain in the bones;
• frequent fractures;
• jaundice - with metastasis to the liver.

The presence of one or more signs characteristic of a single category of diseases respiratory organs should be the reason immediate appeal to a specialist.

A person noticing the above symptoms should report them to the doctor or supplement the information he collects with the following information:

• attitudes towards smoking with pulmonary symptoms;
• the presence of cancer in blood relatives;
• a gradual increase in one of the above symptoms (it is a valuable addition, as it indicates the slow development of the disease, characteristic of oncology);
• an acute increase in symptoms against a background of chronic previous malaise, general weakness, loss of appetite and body weight is also a variant of carcinogenesis.

Diagnostics

How is lung cancer diagnosed? Up to 60% of oncological lung lesions are detected during prophylactic fluorography, on different stages development.

• Only 5-15% of patients with lung cancer are registered at stage 1
• For 2 — 20-35%
• At 3 stages -50-75%
• 4 - more than 10%

Diagnosis for suspected lung cancer includes:

• general clinical blood and urine tests;
• biochemical blood test;
• cytological studies of sputum, bronchial lavage, pleural exudate;
• assessment of physical data;
• radiography of the lungs in 2 projections, linear tomography, CT of the lungs;
• bronchoscopy (fibrobronchoscopy);
• pleural puncture (in the presence of effusion);
• diagnostic thoracotomy;
• scaling biopsy of lymph nodes.

Early diagnosis gives hope for a cure. The most reliable way in this case is an x-ray of the lungs. The diagnosis is confirmed by endoscopic bronchography. With its help, you can determine the size and location of the tumor. In addition, it is imperative cytological examination- biopsy.

Treatment of lung cancer

The first thing I want to say is that treatment is carried out only by a doctor! No self-treatment! This is a very important point. After all, the sooner you seek help from a specialist, the more chances for a favorable outcome of the disease.

The choice of a specific treatment strategy depends on many factors:

• Stage of the disease;
• Histological structure of carcinoma;
• The presence of concomitant pathologies;
• A combination of all the above fatcores.

There are several complementary treatments for lung cancer:

• Surgical intervention;
• Radiation therapy;
• Chemotherapy.

Surgery

Surgery is the most effective method, which is shown only in stages 1 and 2. They are divided into the following types:

• Radical - to be removed primary focus tumors and regional lymph nodes;
• Palliative - aimed at maintaining the patient's condition.

Chemotherapy

When small cell cancer is detected, chemotherapy is the leading method of treatment, since this form of tumor is most sensitive to conservative methods treatment. The effectiveness of chemotherapy is quite high and allows you to achieve good effect for several years.

Chemotherapy is of the following types:

• therapeutic - to reduce metastases;
• adjuvant - used in preventive purposes to prevent relapse;
• inadequate - just before surgical intervention to reduce tumors. It also helps to identify the level of sensitivity of cells to drug treatment, and to establish its effectiveness.

Radiation therapy

Another method of treatment is radiation therapy: it is used for non-removable lung tumors of stage 3-4, it allows to achieve good results in small cell cancer, especially in combination with chemotherapy. Standard dosage at radiation treatment is 60-70 gry.

Application radiotherapy in lung cancer, it is considered as a separate method if the patient refuses chemotherapy, and resection is not possible.

Forecast

Make accurate predictions lung cancer, perhaps, no experienced doctor will undertake. This disease can behave unpredictably, which is largely due to the variety of histological variants of the structure of tumors.

However, the cure of the patient is still possible. Usually, to happy outcome leads using a combination of surgery and radiation therapy.

How long do people live with lung cancer?

• In the absence of treatment almost 90% of patients after the detection of the disease do not live more than 2-5 years;
• at surgical treatment 30% of patients have a chance to live more than 5 years;
• with a combination of surgery, radiation and chemotherapy the chance to live more than 5 years appears in 40% of patients.

Do not forget about prevention, these include:

• healthy lifestyle: proper nutrition and exercise
• giving up bad habits, especially smoking

Prevention

Prevention of lung cancer includes the following recommendations:

• Giving up bad habits, especially smoking;
• Maintaining a healthy lifestyle: proper nutrition rich in vitamins and daily physical activity, walks in the fresh air.
• Treat bronchial diseases in time so that there is no transition to a chronic form.
• Airing the room, daily wet cleaning of the apartment;
• Contact with harmful chemicals and heavy metals should be kept to a minimum. During work, be sure to use protective equipment: respirators, masks.

If you have the symptoms described in this article, be sure to see a doctor for an accurate diagnosis.