lung tumors can be benign or malignant and metastatic.
Benign tumors do not destroy, not infiltrate the tissue and prevent metastasis (Example - hamartomas).
Malignant tumors grow into the surrounding tissue and metastasize (example - lung cancer).In 20% of cases diagnosed local forms of malignant tumors, 25% are regional, and 55% - distant metastases.
Metastatic tumors occur primarily in other organs and metastasize to the lungs.In this article we will discuss the symptoms of lung cancer, and the main symptoms of lung cancer in humans.
symptoms of lung tumors
Symptoms and signs of lung tumors
lung tumors at early stages are asymptomatic and are usually detected incidentally during radiographic inspection or preventive examinations for other diseases.Asymptomatic period can last for years.Oncological alertness doctor should be in relation to people aged over 45 years, especially active smokers and those with industrial hazards.
lung tumor endobronchial lesions
During germination and compression of tumor or lymph nodes with metastases nerve trunks come first neurological symptoms:
- weakness in the hands, paresthesia (due to lesions of the brachial plexus);
- Horner's syndrome (miosis, narrowing of the optic fissure and enophthalmos);
- anhidrosis (as a result of the defeat of the cervical sympathetic ganglia), which is especially typical apical cancer (Pancoast cancer);
- dyspnea (as a result of the defeat of the phrenic nerve).
In malignant and especially metastatic tumors characterized by loss of body weight, up to cachexia, as well as complaints associated with lesions of distant bodies (most commonly the brain, skeleton bones).In some patients, the first symptom is itchy skin, and in the elderly has been a rapid development of ichthyosis or dermatoses.
Inspection with lung tumors
On examination, the patient in the early stages of tumor development clinical signs are not detected.With the growth of volume of education, there are signs that depend on the location of the tumor.Quite often, when lymphatic dissemination detect an increase in the left supraclavicular lymph node (Virchow metastasis).Expansion of collateral veins in the upper chest and neck, breast, edema and hyperemia of the conjunctiva characteristic of the superior vena cava syndrome.In 10-20% of cases inspection reveals a particular manifestation of dermatoses, disappearing after removal of the tumor.Late symptoms of cancer - weight loss, cachexia.For neoplastic processes typically sufficient rise in temperature, especially low-grade fever evening.
Signs of lung tumors
There are several theories of the development of lung cancer.Toxic effects may result in the accumulation of genetic abnormalities in the cells (activation of dominant oncogenes and inactivation of the recessive oncogenes (cancer suppressing genes) by mutation).This leads to uncontrolled growth of the informal with local or distant from the primary tumor lesions.The decisive factors are considered to be DNA damage, activation of cellular oncogenes and stimulation of growth factors.Primary lung cancer usually develops in the glandular epithelium of the bronchi.As the central lung cancer is a violation of bronchial patency, which leads to its obstruction and atelectasis lung downstream divisions.As the progression of the tumor grows in other parts of the body (chest wall, pericardium, esophagus, etc.), gives metastases to the liver, brain, bones and other organs.
diagnosis lung tumors
on the affected side can detect amplification of voice shake.
Percussion with lung tumors
for lung tumors is characterized by a pronounced shortening of the percussion sound over the area surround education.However, bronchial obstruction and tumor formation in the beginning of the valve mechanism may develop local emphysema, which leads to a boxed percussion sound.Subsequent atelectasis accompanied by a shortening of percussion sound.When mediastinal forms of percussion lung cancer can detect signs of a unilateral extension of the mediastinum.
Auscultation with lung tumors
When endobronchial tumor growth may appear local wheezing and local weakening of breathing.The appearance of wet wheezing along with temperature, sweating and weakness may indicate the development of obstructive pneumonia.
X-ray study of lung tumor
big role in the early detection of lung cancer plays a preventive fluorography study.That ray research methods can detect three-dimensional formation in the asymptomatic period.Suspicious symptoms: focal, spherical formation, expansion and reduction of root differentiation of its elements, extension or mediastinal shift.The first X-ray with symptom development of endobronchial lung cancer is the central hypoventilation area corresponding amazed bronchitis: a decrease in the transparency of segment or lobe, convergence and expansion of their vessels due to congestive hyperemia.In longitudinal tomograms and bronchograms possible to identify obturated bronchus stump.When peribronchial form of lung cancer in the tomograms in the root plane visible peribronchial node associated with the wall of the bronchus.Characterized by abnormal tuberosity contours shadow.Later, there is obstruction of the bronchus with a picture of the lower divisions of hypoventilation.
X-ray picture of peripheral lung cancer is usually characterized by the presence of focal, localized in the upper sections (S3 segment) of the right lung, upper lobe of the left lung and the lower lobe of the right lung.The outline of the shadow of the tumor as it progresses from a clear moves to "radiant."place bronchus entry - Sometimes the "tenderloin" is clearly visible.When the peripheral lung cancer is quite common to see a track linking the focus to the root or to the parietal pleura.Approximately 2-10% of cases disintegration of the tumor site (cavernous form of cancer).In 3-10% of cases of cancer of the peripheral radiography reveals pleural effusion.When the apical localization of lung cancer in the picture can be seen in the shading of the projection apex, the lower limit of the shadows and curved bulge directed downward.Against the background shading can be detected destruction rear sections I, II, and III, and sometimes ribs.A manifestation of dissemination of the tumor in the lung is miliary carcinomatosis.
Computed tomography and other scanning lung tumors
high-resolution CT has become the standard method of examination of the patient with a tumor of the chest.CT is much more reliable conventional radiography describes the topography and the structure of the shadow, but it is not decisive in determining the malignant process.The degree of malignancy and histologic type of tumor is determined by biopsy.
Bronchoscopy with lung tumors
Bronchoscopy - a crucial bronchi research method to identify damage until subsegmental bronchi, especially if endobronchial tumor growth.If bronchoscopy is required to take samples of bronchial secretions, swabs, hold the brush or transbronchial biopsy for histological examination.Fluorescence bronchoscopy allows us to see the glow of the tumor in the early stages of it.
Radioisotope scan with lung tumors
Radioisotope Scan reveals skeletal metastatic lesions and distant metastases.However, the specificity of the detection of metastatic lesions of bones is low.
ultrasound with lung tumors
ultrasound can detect pleural effusion in the early stages of parietal and location of the tumor.liver ultrasonography can detect hematogenous metastases.
study respiratory function in lung tumors
lung ventilation capacity varies depending on the size of the tumor, stenosis of bronchus, atelectasis, or compression of the lung tissue and is characterized by mixed disorders.When pleural effusion restriction prevails.Determination of arterial blood gas analysis allows us to estimate the degree of hypoxemia (especially if extensive damage, and the elderly).
Laboratory diagnosis of lung tumors
General blood test is nonspecific, leukocytosis may occur in the event of pneumonia.Oncological alertness should cause high ESR values in the elderly.Sputum cytology (the identification of atypical or cancerous cells) in tumors of the lung generally informative in 20% of cases.At the central location of the tumor the information content of the method is increased to 74%.
biopsy at lung tumors
transthoracic and open biopsy of the tumor or lymph nodes altered using VATS allows you to take samples of altered tissue manipulation in the pleural cavity.This method allows you to remove metastases with a diameter up to 3 cm, located on the periphery of the lung.
Differential diagnosis of lung tumors
on survey radiographs of the chest shadow of peripheral lung cancer should be differentiated from other entities.All spherical formation in the lungs require removal and histological examination in order to establish an accurate diagnosis.
The list of diseases requiring differential diagnosis with malignant tumors of the lungs, also includes (in addition to those listed below) parasitic cysts, pulmonary suppuration, formation of three-dimensional nature of fungal and others.
Central lung cancer must first be differentiated from pneumonia.Violation of ventilation in tumors leads to increased pulmonary pattern, it is difficult to differentiate from pneumonic infiltration, but bronchoscopy allows you to explore the bronchi and establish the correct diagnosis.
Tuberkulёma - encapsulated tuberculous nature of education looks at the X-ray as a focus.Typical local shadow of less than 2 cm in diameter with signs of decay;lung cancer this size rarely breaks.The apparent roughness tuberkulёmy contours in a picture in direct projection may correspond to multiple or konglomerativnyh tuberkulёmam when taking pictures in the side view or conduct CT.In favor of tuberculous nature of the focus will testify, centers of screenings around or below the main shadows.Characteristically tuberkulёm location in the lung segments Si, S2, SQ.The decay period tuberkulёmy bacteriological examination of sputum can detect Mycobacterium tuberculosis.For tuberkulёm not characterized by progressive growth and pressure symptoms.A negative tuberculin test at tuberkulёmah extremely rare.
Benign tumors of the lungs, as a rule, are not lumpy, do not break up.In contrast to the benign, in peripheral lung cancer small size (up to 2 cm in diameter) shade contours rarely sharp.However, in the future, as growth (2.5-3 cm) malignant tumor takes clear outline.For benign tumors not characterized by intoxication, hemoptysis, radiant circuits.
retention cysts.Their contours clear, without radiant and tuberosity, pulmonary drawing is not changed.It should be remembered that the blockage of the bronchus cancer and accumulation of secretions distal to obstruction sometimes lead to the formation of cysts.
prevalence of lung cancer
lung cancer is more than 90% of all lung tumors and 28% of all deaths resulting from tumor diseases in humans.This is the most common malignant tumor in men (35% of all tumors) and women (30%) aged 45-70 years (female lung cancer frequency is in third place after breast cancer and cervical cancer).In recent years there has been a primary lung cancer incidence increase among women, and the disease occurs in women at a younger age than men.In Russia, over the past 35 years the number of patients with lung cancer increased by almost 3 times.In the US, lung tumors occur with a frequency of 70 per 100,000 population, while African-Americans fall ill 1.5 times more likely than whites.The most common lung tumors are found in the UK and Poland, where the prevalence is more than 100 per 100,000 population, less often - in Senegal and Nigeria (less than 1 in 100,000).
classification of lung tumors
On histological types : adenocarcinoma, small cell carcinoma, large cell carcinoma, squamous cell and other forms.
Localization : central, peripheral (localization of the tumor since bronchi 4th order), apical, mediastinalnyi, miliary (millet small foci in both lungs).
Direction tumor growth : ekzobronhialny, endobronchial, peribronchial cancer.Tumor, depending on the stage, without metastases may develop, with regional and distant metastases.
At the stage of disease:
stage - small tumors limited to the large bronchi endo- or peribronchial direction of growth or tumor of small and smallest bronchi without germination and pleural metastasis.
stage - the same tumor as in stage I, or larger, no germination of the pleura, in the presence of single metastasis in the coming regio tionary lymph nodes.
stage - a tumor, which appeared beyond the lung, grows in the pericardium, chest or diaphragm, in the presence of multiple metastases to regional lymph nodes.
stage - a tumor with extensive spread to adjacent organs with dissimination on the pleura, extensive regional and distant metastases.
More than 90% of cases of lung cancer in men and 70% in women are associated with carcinogenic components of tobacco smoke during smoking.In general, lung cancer risk is increased by 13 times with the active smoking and 1.5 times the passive exposure to cigarette smoke.Occupational factors are critical in 15% of cases of lung cancer in men and 5% - for women.Perhaps, industrial poisons and tobacco smoke act as carcinogens.In the development of some forms of significance of hereditary factors of lung cancer is not excluded.
Pathology lung tumors
term "lung cancer" is used to refer to tumor arising from the epithelium of the airways (bronchi, bronchioles, alveoli).Unlike cancer, and other tumor types (mesotheliomas, lymphomas and stromal tumor (sarcoma)) have epithelial origin.Four types of tumor cells constitute 88% of all primary lung tumors: squamous (epidermoid) carcinoma (29%), small cell (ovsyanokletochnaya) carcinomas (18%), adenocarcinoma (32% including bronchioloalveolar carcinoma), and large cell carcinoma (9%).The remaining tumor (undifferentiated carcinoma, carcinoid tumors of the bronchial glands, and others.) Are less common.Because different types of cancer cells respond differently to certain types of treatment, the correct histological diagnosis - a necessary condition for the effective treatment of tumors.
lung tumors metastasize lymphogenous (in bronchopulmonary lymph nodes, the lymph nodes of the root of lung and mediastinum) and hematogenically (distant metastases in the liver, brain, bones, lung and other organs).In addition to lung cancer in the lungs can also occur multifocal lymphoma.