Lung cancer-9.pdf

Lung cancer
https://mbbshelp.com

Lung cancer
◼ The concept of "lung cancer" is a collective
uniting various origin, histology, clinical course
and results of treatment of malignant epithelial
tumors.
They develop from the surface epithelium of the
bronchial mucosa, bronchial mucous glands of
the bronchioles and alveoli.
◼ Distinctive features of lung cancer - the variety
of clinical forms, the tendency to early
recurrence, lymphatic and hematogenous
metastasis.

Сlinical anatomy
◼ The right lung has three lobes,
which include 10 segments, left - of
2 lobes, containing 9 segments.
Bronchial tree. The trachea is
divided into right (short and wide)
and left (longer and narrower) main
bronchi.

Epidemiology
◼ Takes 1st place in the structure of
cancer incidence in developed
countries.
◼ More than 1 million diagnosed cases
of lung cancer each year worldwide ,
representing more than 12% of all
diagnosed malignancies .

Epidemiology
◼ Malignant tumors of the lung occupied 1st
place (20 - 30%) of cancer incidence in
the structure of the male population in
Western and Central Europe, the former
Soviet states , North America, South
Africa, Australia and New Zealand.
◼ In Russia, 1st place takes (12%) in the
structure incidence of malignant
neoplasms .
◼ Men suffer more often than women (ratio
8:1) .

ETIOLOGY & RISK FACTORS
◼ I. Genetic factors.
1. Primary tumor multiplicity (cure patients
of malignant tumor)
2. Three cases and more lung cancer in the
family (close relatives).
◼ II. Modifying factors.
A. Exogenous:
1. Smoking.
2. Environmental contamination by
carcinogens.
3. Professional hazard.

ETIOLOGY & RISK FACTORS
◼ B. Endogenous:
1. Age older than 50 years.
2. Chronic pulmonary diseases
(tuberculosis, pneumonia, bronchitis,
localized fibrosis)
3. Endocrine diseases.

Morphological characteristics
◼ Distinguish:
• central lung cancer arising in the
large bronchi (the main, intermediate,
equity, segmental and subsegmental)
• peripheral originating from the
epithelium of the bronchi or smaller
localized in the lung parenchyma.

Clinical - anatomical
classification:
◼ I. The central form
II. The peripheral shape
III. Mediastinal form - multiple
metastases to mediastinal lymph nodes
without fixed primary tumor in the lung.
IV. Disseminated (primary carcinomatosis)
– the plural lung without established
primary tumor to other organs.

Forms of growth
Distinguished: (with central cancer of the
direction of growth)
◼ Exophytic (endobronchial) cancer when the
tumor grows into the lumen of the bronchus
• endophyte (exo bronchial) cancer with a
primary tumor growth in the thickness of the
pulmonary parenchyma
• Branched cancer with clutch shaped
peribronchial tumor growth around the bronchi
• mixed character of tumor growth with a
predominance of one or another component.
◼

Forms of growth
Distinguished: (for peripheral
cancer)
• Hub rounded tumor
• pneumonia-like cancer
• Cancer apex syndrome Pancoast.

Histology
◼ Squamous cell carcinoma - the most common
form, predominantly male smokers older.
• Glandular cancer occurs less frequently.
Occurs more frequently in women. Often occurs
in the peripheral bronchi, progresses slowly.
• small cell lung cancer often occurs in young,
but more often in people 50 - 59 years.
Characterized by an early and rapid metastasis,
poor prognosis. Most patients die within the first
year after diagnosis.
• large cell carcinoma - is rare.

Metastases
◼ Lung cancer spreads by direct sprouting into
the surrounding tissue, as well as by lymphatic
and hematogenous metastasis. Metastases often
found in small cell, at least - with
adenocarcinoma, squamous cell carcinoma even
rarer metastasizes.
• First metastases affect thoracic lymph nodes:
bronchopulmonary, tracheobronchial and
tracheal about. Distant lymph node metastases -
supraclavicular, subclavian, abdominal lymph
nodes

Metastases
◼ Metastases to distant organs mainly
by hematogenous. Metastases to the
liver, brain, bone lesions of
(metastases in the spine, ribs, skull,
limbs and pelvis), at least - in the
adrenal glands, kidneys, pancreas.

Stage lung cancer
◼ Stage I - The tumor equity, segmental
bronchi or peripheral, up to 3 cm in
diameter, not germinating pleura, without
metastases in lymph nodes.
◼ Stage II - tumor of the same bronchus,
pleura not germinating, diameter of 3 to 5
cm without (II a) or with single
metastases (II b) in the
bronchopulmonary lymph nodes.

Stage lung cancer
◼ Stage III - tumor is larger than 5 cm
or smaller, but with pleural invasion
or spread to the main bronchus, or
with multiple metastases to regional
lymph nodes.
◼ Stage IV - The tumor has spread to
the chest, mediastinum, or with
distant metastases.

Symptoms
◼ Cough initially dry and rare in the future
becomes painful hoarse. Sometimes it is
accompanied by phlegm.
◼ Hemoptysis is manifested in small streaks of
blood in the sputum. The presence of blood
indicates the decay of the tumor.
Hemoptysis - inconstant symptom, it occurs
in 40 - 50% of patients.

Symptoms
◼ Shortness of breath. Dyspnea bronchus can be expressed
to a greater or lesser extent depending on the size of the
lesion and the degree of stenosis.
◼ Chest pain - localized on the side of the lesion , usually dull
, not sharp . Associated with tumor invasion of the nerve
trunks and therefore is not an early sign of cancer.
◼ Fever associated with concomitant pneumonitis or collapse
of the tumor. Temperature curve varies.
◼ Weakness , fatigue , weight loss , loss of appetite .
◼ Cutaneous manifestations of cancer lunge as dermatitis ,
accompanied by pruritus in any area of the body .

Diagnostics
◼ Interviews with patients
◼ Objective study (external examination,
palpation of the chest, abdomen and
lymph nodes, percussion and auscultation)
◼ 1. External inspection - dry skin, puffy
face, the backlog of the chest when
breathing, changes in nails as "time
windows" and fingers type of drumsticks.
◼ 2. Palpation of the chest - on the affected
side weakened voice trembling.

Diagnostics
◼ 3. percussion
◼ 4. Auscultation - wheezing, decreased
breath, crepitus.
◼ Laboratory tests (complete blood count)
◼ Sputum cytology
◼ fljurografiju
◼ Computed tomography
◼ Bronhografiya
◼ Bronchoscopy

Diagnostics
◼ Transthoracic puncture and catheterization
of the bronchi
◼ Isotope scanning
◼ Pnevmomediastinografiya
◼ Mediastinoscopy.

Treatment
◼ Radical treatment of lung cancer is surgery.
◼ Radiation and chemotherapy have conspicuous
palliative effect , but radical treatment of lung
cancer usually are not.
◼ Surgical treatment . Removes all of the affected
lung ( pneumonectomy ) , one ( lobectomy ) or
two ( bilobektomiya ) shares.
◼ • Lobectomy performed at the peripheral cancer
and cancer of the segmental bronchi 1 and 2
stage without metastases in lymph nodes radical

Treatment
◼ Pneumonectomy indicated for central lung
cancer, as well as peripheral tumor metastases
or bronchopulmonary tracheobronchial lymph
nodes.
◼ Chemotherapy as an independent method of
treatment used in advanced forms of lung
cancer, as well as contraindications to surgery
and radiation therapy. Drugs are used:
Methotrexate,Cyclophosphamide, Adriamycin.

Lung cancer-9.pdf

More Related Content

Similar to Lung cancer-9.pdf

More from ishanjainmj

Recently uploaded

Lung cancer-9.pdf