Lung cancer stage 5 000000000. First stages of lung cancer: dangerous symptoms of the disease

– malignant tumors that originate in the mucous membrane and glands of the bronchi and lungs. Cancer cells divide quickly, enlarging the tumor. Without proper treatment, it grows into the heart, brain, blood vessels, esophagus, and spine. The bloodstream carries cancer cells throughout the body, forming new metastases. There are three phases of cancer development:

• The biological period is from the moment the tumor appears until its signs are recorded on x-rays (grade 1-2).
• Preclinical - asymptomatic period manifests itself only on x-rays (grade 2-3).
• Clinical shows other signs of the disease (grade 3-4).

Causes

The mechanisms of cell degeneration are not fully understood. But thanks to numerous studies, chemicals have been identified that can accelerate cell transformation. We will group all risk factors according to two criteria.

Reasons beyond a person's control:

• Genetic predisposition: at least three cases of a similar disease in the family or the presence of a similar diagnosis in a close relative, the presence of several different forms of cancer in one patient.
• Age after 50 years.
• Tuberculosis, bronchitis, pneumonia, scars on the lungs.
• Problems of the endocrine system.

Modifiable factors (what can be influenced):

• Smoking is the main cause of lung cancer. When tobacco is burned, 4,000 carcinogens are released, covering the bronchial mucosa and burning living cells. Together with the blood, the poison enters the brain, kidneys, and liver. Carcinogens settle in the lungs until the end of life, covering them with soot. Smoking experience of 10 years or 2 packs of cigarettes per day increases the chance of getting sick by 25 times. Passive smokers are also at risk: 80% of exhaled smoke comes from them.
• Professional contacts: asbestos-related factories, metallurgical enterprises; cotton, linen and felt mills; contact with poisons (arsenic, nickel, cadmium, chromium) at work; mining (coal, radon); rubber production.
• Poor ecology, radioactive contamination. The systematic influence of air polluted by cars and factories on the lungs of the urban population changes the mucous membrane of the respiratory tract.

Classification

There are several types of classification. In Russia, there are five forms of cancer depending on the location of the tumor.

1. Central cancer- in the lumen of the bronchi. In the first degree, it is not detected on photographs (masks the heart). The diagnosis may be indicated by indirect signs on X-ray: decreased airiness of the lung or regular local inflammation. All this is combined with a persistent cough with blood, shortness of breath, and later chest pain and fever.
2. Peripheral cancer penetrates into the lungs. There is no pain, the diagnosis is determined by x-ray. Patients refuse treatment, not realizing that the disease is progressing. Options:
   • Cancer of the apex of the lung grows into the vessels and nerves of the shoulder. In such patients, osteochondrosis takes a long time to be treated, and they get to the oncologist late.
   • The cavity form appears after the collapse of the central part due to lack of nutrition. Neoplasms up to 10 cm are confused with an abscess, cysts, tuberculosis, which complicates treatment.
3. Pneumonia-like cancer treated with antibiotics. Without getting the desired effect, they end up in oncology. The tumor is distributed diffusely (not in a node), occupying most of the lung.
4. Atypical forms: brain, liver, bone create metastases in lung cancer, and not the tumor itself.
   • The hepatic form is characterized by jaundice, heaviness in the right hypochondrium, deterioration of blood tests, and enlarged liver.
   • The cerebral one looks like a stroke: a limb does not work, speech is impaired, the patient loses consciousness, headache, convulsions, double vision.
   • Bone – pain symptoms in the spine, pelvic region, limbs, fractures without injury.
5. Metastatic neoplasms originate from a tumor of another organ with the ability to grow, paralyzing the functioning of the organ. Metastases up to 10 cm lead to death from decay products and dysfunction of internal organs. The primary source is the maternal tumor cannot always be determined.

According to histological structure (cell type), lung cancer can be:

1. Small cell– the most aggressive tumor, quickly occupies and metastasizes in the early stages. Frequency of occurrence – 20%. Forecast – 16 months. with non-advanced cancer and 6 months. - when widespread.
2. Non-small cell It is more common and characterized by relatively slow growth. There are three types:
   • squamous cell lung cancer (from flat lamellar cells with slow growth and a low incidence of early metastases, with areas of keratinization), prone to necrosis, ulcers, and ischemia. 15% survival rate.
   • adenocarcinoma develops from glandular cells. It spreads quickly through the bloodstream. Survival rate is 20% with palliative treatment, 80% with surgery.
   • large cell carcinoma has several varieties, is asymptomatic, and occurs in 18% of cases. Average survival rate 15% (depending on type).

Stages

• Lung cancer stage 1. A tumor up to 3 cm in diameter or a bronchial tumor in one lobe; there are no metastases in neighboring lymph nodes.
• Lung cancer stage 2. A tumor in the lung is 3-6 cm, blocks the bronchi, grows into the pleura, causing atelectasis (loss of airiness).
• Lung cancer stage 3. A tumor of 6-7 cm spreads to neighboring organs, atelectasis of the entire lung, the presence of metastases in neighboring lymph nodes (root of the lung and mediastinum, supraclavicular zones).
• Lung cancer stage 4. The tumor grows into the heart, large vessels, and fluid appears in the pleural cavity.

Symptoms

Common symptoms of lung cancer

• Fast weight loss,
• no appetite,
• decline in performance,
• sweating,
• unstable temperature.

Specific signs:

• a debilitating cough without an obvious reason is a companion to bronchial cancer. The color of the sputum changes to yellow-green. In a horizontal position, physical exercise, or in the cold, coughing attacks become more frequent: a tumor growing in the area of ​​the bronchial tree irritates the mucous membrane.
• Blood when coughing is pinkish or scarlet, with clots, but hemoptysis is also a sign.
• Shortness of breath due to inflammation of the lungs, collapse of part of the lung due to tumor blockage of the bronchial tube. With tumors in large bronchi, organ shutdown may occur.
• Chest pain due to the penetration of cancer into the serous tissue (pleura), growing into the bone. At the beginning of the disease there are no warning signs; the appearance of pain indicates an advanced stage. The pain can radiate to the arm, neck, back, shoulder, intensifying when coughing.

Diagnostics

Diagnosing lung cancer is not an easy task, because oncology looks like pneumonia, abscesses, and tuberculosis. More than half of tumors are detected too late. For the purpose of prevention, it is necessary to undergo an x-ray annually. If cancer is suspected, they undergo:

• Fluorography to determine tuberculosis, pneumonia, lung tumors. If there are deviations, you need to take an x-ray.
• X-ray of the lungs more accurately assesses the pathology.
• Layer-by-layer X-ray tomography of the problem area - several sections with the focus of the disease in the center.
• Computed tomography or magnetic resonance imaging with the introduction of contrast on layer-by-layer sections shows in detail and clarifies the diagnosis according to explicit criteria.
• Bronchoscopy diagnoses central cancer tumors. You can see the problem and take a biopsy - a piece of affected tissue for analysis.
• Tumor markers test the blood for a protein produced only by the tumor. The NSE tumor marker is used for small cell cancer, the SSC and CYFRA markers are used for squamous cell carcinoma and adenocarcinoma, and CEA is a universal marker. The diagnostic level is low; it is used after treatment for early detection of metastases.
• Sputum analysis has a low probability of suggesting the presence of a tumor if atypical cells are detected.
• Thoracoscopy - examination through camera punctures into the pleural cavity. Allows you to take a biopsy and clarify changes.
• A biopsy with a CT scan is used when there is doubt about the diagnosis.

The examination must be comprehensive, because cancer masquerades as many diseases. Sometimes they even use exploratory surgery.

Treatment

Type (radiological, palliative,) is selected based on the stage of the process, histological type of tumor, medical history). The most reliable method is surgery. For stage 1 lung cancer, 70-80%, stage 2 - 40%, stage 3 - 15-20% of patients survive the control period of five years. Types of operations:

• Removal of a lobe of the lung corresponds to all principles of treatment.
• Marginal resection removes only the tumor. Metastases are treated in other ways.
• Removal of the lung completely (pneumoectomy) - with a tumor of 2 degrees for central cancer, 2-3 degrees - for peripheral cancer.
• Combined operations - with the removal of part of the adjacent affected organs.

Chemotherapy has become more effective thanks to new drugs. Small cell lung cancer responds well to polychemotherapy. With the right combination (taking into account sensitivity, 6-8 courses with an interval of 3-4 weeks), survival times increase 4 times. Chemotherapy for lung cancer. It is carried out in courses and gives positive results for several years.

Non-small cell cancer is resistant to chemotherapy (partial tumor resorption occurs in 10-30% of patients, complete resorption is rare), but modern polychemotherapy increases survival rate by 35%.

They also treat with platinum preparations - the most effective, but also the most toxic, which is why they are administered with large (up to 4 liters) amounts of liquid. Possible adverse reactions: nausea, intestinal disorders, cystitis, dermatitis, phlebitis, allergies. The best results are achieved with a combination of chemotherapy and radiation therapy, simultaneously or sequentially.

Radiation therapy uses gamma-ray installations of beta-trons and linear accelerators. The method is designed for inoperable patients of grade 3-4. The effect is achieved due to the death of all cells of the primary tumor and metastases. Good results are obtained with small cell cancer. In case of non-small cell irradiation, irradiation is carried out according to a radical program (in case of contraindications or refusal of surgery) for patients of 1-2 degrees or for palliative purposes for patients of 3 degrees. The standard dose for radiation treatment is 60-70 gray. In 40% it is possible to achieve a reduction in the oncological process.

Palliative treatment - operations to reduce the impact of the tumor on the affected organs to improve the quality of life with effective pain relief, oxygenation (forced oxygen saturation), treatment of associated diseases, support and care.

Alternative methods are used exclusively for pain relief or after radiation and only in agreement with the doctor. Relying on healers and herbalists with such a serious diagnosis increases the already high risk of death.

Forecast

The prognosis for lung cancer is unfavorable. Without special treatment, 90% of patients die within 2 years. The prognosis is determined by the degree and histological structure. The table presents data on the survival rate of cancer patients for 5 years.

A common cause of death in cancer patients is stage 4 lung cancer. This diagnosis indicates the presence of distant metastases, invasion of large vessels, heart and other structures by a malignant tumor. Therapeutic methods and patient life expectancy depend on various factors, which must be taken into account when planning a treatment regimen.

ICD-10 code

According to the International Classification of Diseases, lung cancer is coded without taking into account the stage. Anatomical location matters:

• C34.1 – upper lobe of the lung, uvula of the left lung;
• C34.2 – middle share;
• C34.3 – lower lobe;
• C34.8 – lesion extending beyond the lung.

In case of multiple lesions, the diagnosis is supplemented with codes indicating the location of other formations.

Classification according to the international TNM system

According to the international TNM system, stage 4 lung cancer is classified depending on the size of the tumor and the presence of distant metastases. It could be:

• T(1–4)N(0-3)M1. The size of the tumor and the involvement of regional lymph nodes do not matter; there are distant metastases.
• Т4N(0-3)М(0–1). T4 means that the tumor has grown into the mediastinum, heart, large vessels, esophagus, trachea, spine, or several lung lesions have been identified. The pleural exudate contains malignant cells.

In the presence of distant metastases, the category M is supplemented with the symbols:

• pul – lungs;
• oss – bones;
• hep – liver;
• bra – brain;
• lym – lymph nodes;
• mar – bone marrow;
• ple – pleura;
• per – peritoneum;
• adr – adrenal glands;
• ski – leather;
• oth - others.

The prognosis is disappointing. Due to distant metastases, damage to the heart, and large vessels, most treatment methods are contraindicated or ineffective.

Causes and risk group

A third of patients are initially diagnosed with stage III–IV of the disease. This is due to the rapid, aggressive growth of the tumor and the paucity of clinical signs of early lung cancer. The number of sick people is increasing every year. Pathology occurs due to:

• Smoking. This is the main reason. Not only smokers suffer, but also those who are forced to inhale tobacco smoke.
• Professional hazards. Workers in the metallurgical, aluminum, gas, mining, textile, and shoe industries are getting sick. High risk for miners, metallurgists, welders.
• Air pollution by radioactive and chemical carcinogens. Therefore, the incidence among residents of industrial regions is much higher.

If these factors are minimized, there will be much fewer cases. It is impossible to completely eliminate them, since the appearance of pathology is facilitated by:

• heredity;
• chronic inflammatory lung diseases;
• age over 45 years.

Unfortunately, stage 4 lung cancer is virtually untreatable. Early diagnosis requires careful examination of patients at risk.

To detect early malignant lung damage, a chest x-ray is done every six months. Pictures in direct and lateral projection are stored in fluorotheques for comparison of past results in order to detect pathological changes in time. It is expensive and impractical to undergo a full-fledged examination for all categories of the population. Therefore, risk groups are formed. It includes:

• patients over 45 years of age with a long history of smoking;
• suffering from chronic pathologies of the lungs, bronchi;
• employees of hazardous industrial enterprises, with occupational hazards;
• patients who have a family history of lung cancer or primary multiple neoplasia.

They are under constant supervision. If you undergo the necessary diagnostic procedures in a timely manner, the disease is detected in the early stages, and not in cases where conservative treatment is ineffective and surgical treatment is contraindicated.

Symptoms

Patients in the last stage of the disease manifest various symptoms. They arise due to damage to the respiratory organs, tumor invasion, and the development of metastases. Paraneoplastic syndromes are characteristic of lung cancer (especially small cell cancer).

Signs of damage:

• constant cough (smokers need to pay attention to changes in its character);
• coughing up mucopurulent sputum (at the terminal stage it is streaked with blood or in the form of “raspberry jelly”), hemoptysis;
• dyspnea;
• chest pain;
• recurrent pneumonia (cancer patients are susceptible to infectious, contagious diseases due to weakened immunity).

Cough in the terminal stage is painful, hacking, worse at night. Its character depends on the localization of the tumor. With the germination of a large bronchus, it is loud. If, as a result of the invasion, the lumen of the bronchus narrows, stenosis develops, and the cough becomes painful. It causes various complications:

• dysphonia;
• chest pain;
• rib fractures;
• pneumothorax;
• vomiting;
• involuntary urination;
• bleeding.

Shortness of breath appears due to blockage of the bronchus, exclusion of the affected lung from the act of breathing.

Chest pain is associated with:

• intense cough (pectoral muscles hurt);
• fracture of the ribs (with their metastatic lesion);
• involvement in the malignant process of the pleura;
• reflex vasospasm;
• germination of a tumor of the nerves;
• associated pneumonitis;
• mediastinal infiltration.

In addition to local symptoms due to tumor disintegration and severe intoxication, general symptoms are added. Patients consult a doctor with complaints of:

• loss of appetite;
• lethargy;
• increased fatigue;
• weight loss.

Patients complain of increased body temperature associated with inflammatory processes (recurrent pneumonia, pneumonitis, pleurisy, tuberculosis), tumor disintegration.

Invasion of carcinoma into nearby organs manifests itself:

• hoarseness of voice;
• dysphagia;
• dysfunction of the shoulder joint;
• pain in the forearm and shoulder;
• superior vena cava syndrome;
• arrhythmia;
• Horner's syndrome (drooping eyelid, constriction of the pupil and other neurological symptoms);
• heart failure.

In lung cancer, paraneoplastic syndromes develop more often than in other malignant tumors. Neoplasia produce hormonally active substances, which manifests itself:

• Marie-Bamberg syndrome. Osteoarthropathy develops, which is characterized by thickening, sclerosis of long tubular bones, flask-shaped thickening of the fingers (in the shape of drumsticks), and pain in the joints.
• Skin reactions. Dermatitis, skin itching, acanthosis nigricans, and keratoderma develop.
• Neurological disorders. Dizziness not associated with metastases, loss of coordination of movement, sensory and motor disorders occur. Small cell lung cancer is characterized by: Lambert's myasthenia, limbic encephalitis, subacute peripheral sensory neuropathy, chronic bowel pseudo-obstruction.
• Endocrine metabolic disorders. Gynecomastia, Itsenko-Cushing syndrome, hypercalcemia, hypophosphatemia, and hyperthyroidism develop.

Stage IV disseminated cancer. In addition to local and general symptoms, patients complain of various pathologies associated with metastases in distant organs.

Signs of metastases in distant organs.

Symptoms before death

Manifestations of the disease in patients are intensifying. Causes of death:

• myocardial infarction;
• cachexia;
• suffocation;
• pneumonia;
• failure of other internal organs due to metastatic lesions.

Sometimes edema and ascites develop, and fluid accumulates in the pleural cavity.

The terminal state lasts sequentially. The functions of various organs are gradually impaired. There are 3 degrees of terminal condition:

1. Predagonia. It manifests itself as general lethargy, lethargy, and absence of pulse in the peripheral arteries (it is palpated only in the carotid and femoral arteries). Respiratory failure is accompanied by severe shortness of breath, the skin is pale or cyanotic.
2. Agony. The pulse is weak even in the central arteries. The patient is unconscious. Pathological breathing and muffled heart sounds can be heard. This period is very short.
3. Clinical death. There is no blood circulation or breathing. After 45–90 seconds from the onset of clinical death, the pupils dilate and stop responding to light. During this period, the process is sometimes reversible. If resuscitation measures are carried out within 5–6 minutes (until brain death), the patient can still be brought back to life. With terminal stage lung cancer, the likelihood of a reverse process is extremely low.

When the cerebral cortex dies, the process becomes irreversible and biological death occurs. The time of its onset is purely individual. Patients with stage IV, when treatment is ineffective, die differently. Some die instantly, others suffer for a long time.

Signs of impending death in most cases:

• severe exhaustion;
• loss of appetite;
• despondency;
• apathy;
• lethargy;
• the dying person does not get out of bed (he needs constant care);
• sleeps almost all the time (especially if due to severe pain he needs strong narcotic analgesics).

Some patients experience some improvement 1–2 days before death. They are less bothered by pain, coughing, and shortness of breath. And then everything changes dramatically, a state of pre-agony arises.

The least painful death is a heart attack. Death occurs suddenly; a cancer patient may not be bedridden, but lead an active lifestyle.

In other cases, the patient slowly fades away. For a long time he complains of a debilitating cough, constant suffocation, and intense pain. Anemia, hypoxia, intoxication, and cachexia increase. The patient suffocates or the body temperature rises to a critical point. Sometimes he falls into a state of stupor (severe lethargy, numbness, almost continuous sleep).

How fast is it developing?

The growth of the formation is characterized by the number of divisions of atypical cells. To achieve dimensions of 1–2 mm, 20 divisions are required. While the formation is small, it is not clinically manifested. The average asymptomatic period is about 7 years. The rate of progression depends on the histological type of tumors:

• Adenocarcinoma. It grows slowly. The tumor doubling period is 180 days. It reaches a size of 1 cm in 8 years.
• Squamous cell carcinoma. Low-aggressive. The average doubling period for neoplasia is 100 days. Increases to 1 cm in 5 years.
• Small cell. Highly aggressive. The doubling period is 30 days. The tumor reaches 1 cm in diameter in 2–3 years.

The rate of tumor growth depends on individual characteristics, exposure to provoking factors, and immune status.

Staging

The choice of treatment method and further prognosis depend on the stage of the disease. It is determined by carrying out a series of diagnostic procedures. Conventionally, lung cancer is divided into:

• limited;
• common.

Stages I–III are considered limited, when only one half of the chest is affected.

Advanced cancer is stages III(N3)–IV. The carcinoma extends beyond one half of the chest. N3 means that the supraclavicular lymph nodes, contralateral nodes of the lung root, are affected.

In the Soviet classification of lung cancer, stage IV refers to a malignant process with identified metastases. The size of the tumor is not important. Neoplasia with a diameter of 1 cm (which is clinically almost undetectable) can spread hematogenously.

Some clinicians divide stage IV into:

• IVA, it corresponds to T4N(3)M0. Although there are no distant metastases, the stage is terminal, since the tumor has grown into vital structures (heart, large vessels). The supraclavicular lymph nodes are affected.
• IVB – T(1-4)N(0-3)M1. It doesn’t matter what size the tumor is or whether there are regional metastases, the main criterion is secondary damage to distant organs.

Most oncologists are of the opinion that stage IV is a tumor of any size, but with distant metastases. There is no division into subcategories A, B. No matter how you classify stage IV lung cancer, it means an extremely unfavorable prognosis and a significant limitation in the choice of effective treatment methods. How long cancer patients live with stage 4 lung cancer depends on the location of neoplasia and its histological type.

General classification

When choosing optimal treatment methods, the location of the tumor and its immunohistochemical features are taken into account. It is classified according to these characteristics.

By location:

• Central. Occurs in 75–80% of cases. The tumor develops from the main, intermediate and segmental bronchi.
• Peripheral. Detected in 15–20% of patients. Develops from subsegmental bronchi and bronchioles.
• Atypical. It includes Pancoast cancer (apex of the lung), miliary carcinomatosis, mediastinal cancer.

Malignant tumors are classified according to their histological structure.

All the variety of histological types are combined into 2 groups.

• Small cell (SCLC). This group includes all subtypes of small cell cancer. It is highly aggressive, metastasizes quickly, and often relapses after treatment, but is sensitive to chemoradiotherapy.
• Non-small cell (NSCLC). The group includes various forms (squamous cell, adenocarcinoma, large cell, etc.). They are not as aggressive, but are more resistant to chemotherapy.

This division is due to the fact that generally accepted effective treatment methods are approximately the same for various forms of NSCLC.

Damage to several organs at once

Before establishing stage 4 when damage to distant organs is detected, it is necessary to make sure that the second focus is metastases. Sometimes neoplasia develops in different organs independently of each other. This phenomenon is called “primary multiple malignant tumors” (PMMT).

Tumors associated with lung cancer are:

• larynx (72.2%);
• digestive tract (29%);
• genitourinary system (12.9%);
• mammary gland (5.8%).

Neoplasias are detected simultaneously or sequentially. They are detected in 0.8–10% of patients with lung carcinoma.

PMZO are:

• synchronous (foci are detected simultaneously or no later than 6 months);
• metachronous (the second tumor appears six months after the first).

Clinical symptoms are the same as for lung cancer, only signs of pathology of the affected organ are added to them.

In addition to distant organs, the second lung may also be affected. Therefore, it is necessary to undergo frequent chest x-rays, even if several years have passed since the operation. This is due to the fact that patients with lung cancer often experience:

• synchronous tumors (11–45%);
• metachronous (55–89%).

The longer the life expectancy after radical removal of the first tumor, the higher the likelihood of developing a second cancer. It develops between 6 months and 20 years after treatment of primary neoplasia. Metachronous tumors are asymptomatic. In 80% of patients they are discovered incidentally during a chest x-ray.

They arise due to the complex action of various factors:

• influence of carcinogens;
• reduced immunity;
• side effect of radiation treatment;
• chronic lung diseases.

A secondary tumor may differ in its histological structure from the primary one. These are usually combinations:

• squamous cell carcinoma of various differentiation (70.6%);
• squamous cell and SCLC (47.8%);
• adenocarcinoma with squamous cell (17.4%).

The treatment regimen depends on the location of the second tumor, its sensitivity to drugs, and the possibility of surgical removal. If both lungs are affected, bilateral surgery is indicated. Tumors can be removed sequentially depending on their histological structure. Before surgery, the risks are carefully assessed. Chance of death is 10%.

Chemoradiation treatment is carried out. The prognosis depends on the immunohistochemical properties of the formations and the individual characteristics of the patient.

Most often, with PMZO the prognosis is more favorable than with metastases in distant organs.

Metastasis

The main reason for the high mortality rate in lung cancer is intensive metastasis. Metastases spread in the following ways:

• lymphogenous;
• hematogenous;
• implantation.

With lymphogenous spread, the bronchopulmonary and tracheobronchial paratracheal nodes are successively affected. The supraclavicular, axillary and lymph nodes of the abdominal cavity are remotely affected.

Lung cancer disseminates to distant organs hematogenously (through blood vessels). Affected:

• liver (40–45%);
• bones (30%);
• kidneys (15–20%);
• adrenal glands (13-15%);
• pancreas (4–6%);
• brain (8–10%);
• thyroid gland (6–8%)
• spleen (5%).

During implantation spread, the tumor grows into the pleura, and contact transfer of atypical cells occurs. Pleural carcinomatosis and cancerous pleurisy develop.

How long cancer patients live with stage 4 lung cancer with metastases depends on the location of the lesions. With secondary lesions in the bones, the prognosis is more favorable. Metastases to the liver do not manifest themselves clinically for a long time, but cause complications leading to death. Small cell cancer and undifferentiated tumors spread especially quickly. Therefore, for these histological variants of neoplasia, examination of bone marrow, bones and other diagnostic procedures are mandatory.

Diagnostics

Terminal stage lung disease is detected in patients by performing an X-ray examination. It is done during a medical examination or when the patient consults a doctor with complaints characteristic of lung pathology. It is impossible to tell from the image whether it is definitely cancer and what stage it is. The diagnosis is made based on the results of various studies. Carry out:

• Visual inspection. IV degree of the disease is visually manifested by pallor of the skin, cyanosis of the skin, swelling of the soft tissues of the torso, head (cava syndrome), change in voice, Horner's symptom, osteoarthropathy, lag in the act of breathing of one half of the chest.
• Palpation. Enlarged peripheral lymph nodes, liver, and pain in various parts of the chest are detected.
• Percussion. Lung atelectasis and the presence of fluid in the chest cavity are determined.
• auscultation. Stenotic wheezing and decreased breathing are heard.
• Cytological examination of sputum. 5-6 studies are carried out to identify atypical cells.
• X-ray examination in anterior and lateral projections. More accurate results are obtained by CT scanning. The procedure is necessary to determine the size of the tumor and the depth of invasion into nearby structures.
• Bronchological examination. The condition of the bronchi, larynx, and trachea is assessed, and material is collected for histological analysis.
• Angiopulmonography. Studying the vascular bed.
• Videothoracoscopy, thoracotomy. Necessary for histological verification of the diagnosis and determination of the immunohistochemical properties of the tumor.

The main disadvantage of X-ray examination is the late diagnosis of the disease. Tumors are defined as more than 1.5 cm in diameter. In lung cancer, even such small neoplasia may already have metastases. To identify them, the following is prescribed:

• Ultrasound of the liver, adrenal glands, pancreas, kidneys, lymph nodes;
• osteoscintigraphy;
• CT, MRI of the brain and spinal cord, abdominal organs;
• single-photon emission CT.

For pleurisy, thoracoscopy with puncture examination is indicated.

To monitor the effectiveness of treatment and predict the further course of the disease, patients are tested for tumor markers. They are prescribed depending on the histological structure of the tumor.

Tumor markers for different forms of lung cancer

Based on the results of all studies, the histological type of the tumor and the extent of the process are determined. This data is necessary for prognosis and choice of treatment methods.

Treatment

Unfortunately, stage 4 lung cancer is an extremely advanced form of the disease, difficult to respond to specific treatment. Often, intensive complex therapy simply prolongs the patient’s suffering for several months. If the prognosis is unfavorable or the patient’s condition is serious, palliative care is limited.

In isolated cases, it is possible to achieve a positive result. If the patient tolerates intensive treatment well and has a positive response to chemotherapy, then remission is possible. The patient is prescribed:

• symptomatic treatment;
• intensive courses of chemotherapy;
• radiation treatment.

All these methods are combined to select the most effective drugs. Since chemotherapy causes many side effects, accompanying treatment is prescribed.

Symptomatic treatment. To alleviate the patient’s condition and reduce clinical manifestations, the following are prescribed:

• antitussives;
• oxygen therapy (for severe shortness of breath);
• painkillers;
• antibiotics (if cancer is complicated by pneumonia and other infectious diseases).

The last stage of the disease is accompanied by exhaustion; patients are recommended to take general strengthening drugs and medications that stimulate appetite.

For anemia, iron supplements are prescribed, and for severe symptoms, blood transfusions and blood substitutes are prescribed.

Severe pain is the main complaint of patients with advanced disease. Which medications relieve it depends on many factors. To relieve pain use:

• NSAIDs (non-steroidal anti-inflammatory drugs);
• weak opioids (Tramal);
• hard drugs (Morphine).

Special analgesics are prescribed by the doctor. The drugs and dose are selected strictly individually.

A patient with stage 4 lung cancer with symptoms before death is best placed in hospice. This will not be a refusal of a loved one. There are always medical personnel nearby who will provide assistance in a timely manner. You can visit the patient. Some hospices are open for visits 24 hours a day.

Chemotherapy. The effectiveness of the method depends on many factors. Objective improvement after courses of chemotherapy is observed in 6–30% of patients. Worse to treat:

• non-small cell cancer;
• well-differentiated tumors;
• metastases in bones, brain, liver.

Chemotherapy is prescribed depending on the general condition of the patient. The drugs are administered mainly intravenously. The method of chemoembolization is used (at the terminal stage it may be contraindicated). For metastatic pleurisy, the medicine is administered intrapleurally after pumping out the fluid.

Prescribed:

• cytostatics (Vinblastine, Docetaxel, Cisplatin, Irinotecan, Gemcitabine);
• colony-stimulating factors, immunomodulators (Neupogen, Oprelvekin);
• targeted drugs (Erlotinib, Gefitinib, Trametinib, Crizotinib);
• monoclonal antibodies (Pembrolizumab).

Regimens are selected depending on the tumor’s resistance to various groups of medications. Thanks to the combined use of drugs, remission can be achieved. Unfortunately, in most cases it is temporary. A recurrent tumor is more resistant to the drugs that were used previously.

Radiation treatment. Radiotherapy is used as palliative treatment (to relieve pain and temporarily reduce tumor size). If there is a positive effect, patients are given a radical program.

A tumor in the lungs and metastases are irradiated using:

• remote gamma installations;
• linear accelerators;
• brachytherapy (endobronchial irradiation).

To increase efficiency, radiomodifiers (hyperbaric oxygenation, hyperthermia) are used.

Subtotal body irradiation is effective (especially for single metastases in the brain).

Symptomatic radiotherapy is needed when secondary lesions occur in the bones and liver. It does not remove metastases, but significantly reduces pain and reduces their size. Contraindicated for:

• profuse hemoptysis;
• bleeding;
• tumor pleurisy;
• multiple distant metastases;
• myocardial infarction;
• severe angina;
• decompensated pathology of the kidneys, respiratory system, liver, heart.

Radiation therapy is used as an addition to medication.

Surgery. In the terminal phase of the disease, surgical removal of the tumor is contraindicated. In isolated cases, with small sizes of neoplasia, non-small cell cancer, removable solitary metastasis, absence of complications, low risk, resection of the affected lung and secondary lesion can be performed. Treatment is supplemented with chemoradiotherapy. This is a very rare case of a favorable prognosis for metastatic lung cancer.

Surgery is acceptable as part of palliative treatment. It is not aimed at removing the tumor, but at improving the quality of life. In case of bronchial obstruction, the following is carried out:

• photodynamic laser therapy;
• laser bronchoscopic photocoagulation of the tumor;
• endoscopic bronchial stenting;
• argon plasma recanalization of the bronchial tree.

Appropriate palliative operations are performed for complications caused by metastases in distant organs.

Traditional methods. In most cases, with lung cancer at the final stage, doctors only make the patient’s life easier. Patients use all kinds of traditional methods for healing. After completing a course of chemoradiotherapy, they drink tinctures and decoctions, the effectiveness of which is questionable. They are made from:

• Artemisia annua;
• hemlock;
• fly agarics;
• ASD fraction 2.

Alternative methods can help reduce symptoms. Before using them, it is better to consult with your doctor so as not to harm yourself further. For example, it is undesirable to combine hemlock tincture for stage 4 lung cancer with chemotherapy. It will significantly enhance the toxic effect.

There are medications that oncologists recommend. Tea made from medicinal herbs will not cure cancer, especially in the terminal phase, but it will have a general strengthening effect. Recommended:

• wormwood (increases appetite);
• chamomile (anti-inflammatory);
• rosehip (diuretic, helps with swelling);
• birch sap (it contains essential microelements);
• Echinacea (strengthens the immune system);
• lemon balm, mint, valerian, motherwort (sedatives);
• raspberry leaves, cherry twigs (reduce symptoms of intoxication).

Nuts and almonds are acceptable (they are sometimes replaced with apricot kernels). They should be consumed in small quantities (3-4 kernels per day); you should not get carried away too much. This food is hard on the stomach, and almonds and apricot kernels contain harmful substances in addition to beneficial substances.

Harmless herbs can worsen the patient's serious condition. Therefore, they can only be used on the recommendation of the attending physician.

Recovery process after treatment

Remission in the terminal stage is a rare and happy exception. It will take a long time for the patient to recover. During this period you need:

• support from family and friends;
• balanced diet;
• general strengthening procedures;
• compliance with the work and rest regime;
• minimum physical activity.

And the main thing is not to despair and lead a healthy lifestyle. Medical observation is required. If necessary, the doctor will refer you for spa treatment and physiotherapy. Completion of research will help to detect relapse in a timely manner.

Relapse

Stage 4 lung cancer often returns after a period of remission. Then the patient requires a new complex treatment. Those schemes that were used previously lose their effectiveness. To select a therapeutic course, consultations are required:

• surgeon;
• chemotherapist;
• radiologist

Treatment is based on the fact that recurrent tumors are often more aggressive.

Course and treatment of the disease in children, pregnant and lactating women, the elderly

Children. Primary lung cancer is extremely rare in childhood. Manifests itself with typical symptoms of damage to the lungs and distant organs (depending on the location of the metastasis). This tumor is very aggressive, progresses quickly, and at stage IV the prognosis is extremely unfavorable.

All available methods are used for treatment:

• immunotherapy;
• targeted drugs;
• irradiation of lungs and solitary metastases.

In children, metastatic lesions of the lungs and sarcomas are more often found. Treatment depends on the type of primary tumor and its sensitivity to various therapeutic interventions.

Pregnancy and lactation. The combination of lung cancer and pregnancy is very rare. However, 78% of cancer patients are diagnosed with the disease in an advanced stage. In this case, the patient is warned that the prognosis is unfavorable and is offered a difficult choice between abortion and initiation of treatment. When deciding what to do, you need to remember:

• Stage IV – fatal disease;
• Lung tumors are very aggressive and spread quickly;
• there is a risk of placental metastasis;
• in most cases, children are born healthy;
• radiation treatment, chemotherapy can cause miscarriage;
• Chemoradiation treatment is least harmful for the fetus at 3–9 months of pregnancy.

The individual characteristics of the patient, the type of tumor, which organs are affected by metastases, how quickly the disease progresses and many other factors are taken into account.

If lung cancer is detected after childbirth, comprehensive treatment is started immediately. During this period, the child is weaned. There are many artificial milk formulas. The baby will not go hungry, and he always needs his mother.

Advanced age. Lung cancer is a disease of the elderly. This disease also occurs in young people, but not as often, and lung tumors in this case are much more aggressive. In old age, cancer spreads slowly, but treatment is significantly complicated by concomitant diseases. Many drugs are contraindicated. In extremely advanced forms, symptomatic treatment is limited.

Treatment of stage 4 lung cancer in Russia and abroad

Stage 4 lung cancer is treated in oncopulmonology centers. With a common form of the disease, most patients are offered symptomatic treatment and participation in clinical trials of the latest anticancer drugs and methods of therapy.

Palliative care is provided in hospices and district medical institutions. Specialized therapy is carried out in large cancer centers. Depending on the prevalence of the process, various methods are combined:

• The primary lesion is small in size; a single metastasis was identified. Complex chemoradiation treatment is carried out. If it is effective, it is supplemented with operations. The tumor and solitary metastasis are removed.
• The tumor has grown into large vessels, the chest, and the heart. Distant metastases are either absent or easily removed. Chemoradiation treatment is carried out, followed by tumor resection. If the chest is damaged, it is removed and alloplasty is performed. On large vessels, the heart, surgery is performed if the patient tolerates it. It is performed jointly by vascular, thoracic and cardiac surgeons. All identified metastases are removed as soon as possible. Courses of chemoradiation treatment are repeated.
• Large tumor, multiple lesions. Unless the patient is in critical condition, the disease is treated with aggressive chemotherapy. Strong drugs with a high toxic effect are prescribed. Not all patients can tolerate treatment. If there is a high probability of developing severe complications, symptomatic treatment is limited.
• Multiple metastatic lesions, serious condition of the patient. Palliative care only. The patient requires appropriate care. The patient and his relatives need to come to terms with the situation. An oncologist and communication with volunteers will help you rethink what is happening.

The decision on how and where to be treated is made individually. When the cancer progresses rapidly, chemoradiotherapy is ineffective, or the patient is in a serious condition, palliative therapy is sufficient. It will help the patient live his last days less painfully.

If there is a chance that the formation is sensitive to pharmaceuticals or radiotherapy, then we need to fight. The main thing is to choose the right clinic. The advanced form of the disease is treated in large oncology centers with a research base (testing of treatment methods is carried out there), with experienced surgeons, chemotherapists, and radiologists.

Treatment in Russia

In district clinics and small towns there are few opportunities to treat terminal stage lung cancer. Seriously ill patients with a poor prognosis are provided with only palliative care.

In large oncology centers, they conduct a thorough diagnosis, review the biopsy results, and re-examine secondary lesions (after all, this could be PMZO, then the treatment is significantly different). Based on the results of the study, a consultation is convened and a treatment strategy is determined. To combat stage IV cancer, use:

• multicomponent chemotherapy (combining cytotoxins);
• immunotherapy;
• treatment with targeted drugs;
• radiotherapy;
• palliative operations;
• combined surgical intervention.

You can get to a large oncology center by referral from the regional oncology clinic. Clinics with oncothoracic departments are chosen for treatment:

• One of the leading Russian oncology clinics, equipped with modern equipment. Based on the results of a thorough examination, a comprehensive treatment regimen is selected. Depending on the type of tumor, appropriate pharmaceuticals are prescribed. According to indications, operations are performed, palliative care is provided, and various methods of radiotherapy are used.
• City Clinical Oncology Dispensary, St. Petersburg. For treatment, targeted drugs are selected individually, combined with cytostatics and cytotoxins, and appropriate immunotherapy is selected. When drug resistance develops, new generation multitarget drugs are prescribed to treat relapse. They perform palliative and radical operations of varying complexity (from video-assisted minimally invasive interventions to removal of a lung and affected nearby organs).
• State Healthcare Institution "Altai Regional Clinical Oncology Dispensary" (branch of the N.N. Blokhin Russian Cancer Research Center of the Russian Academy of Medical Sciences), Barnaul. The Department of Thoracic Surgery performs various types of surgical interventions, palliative and combined resections (surgery on the lung, heart, large vessels, chest). In chemotherapy, antitumor drugs are selected individually and complex treatment regimens are prescribed. According to indications, radiotherapy is additionally recommended.

All hospitals prescribe symptomatic treatment.

In most cases, for residents of Russia, treatment is based on a quota. There are also paid services.

Approximate cost of treatment

Reviews

Evgenia. “I express my deep gratitude to my attending surgeon of the thoracic department of the Altai Regional Clinical Oncology Center and all the medical staff for their attentiveness, care, and individual approach to each patient. Thank you very much to the doctor for his hands and kind heart. His work is difficult, we are special patients who need constant moral and psychological support. Our doctor comes into the room several times a day and always takes care of our condition with a smile. After meeting him, there is hope for recovery.”

Vladimir. “You can live with cancer. I've been living with him for 4 years now. I have 3 primary lesions in the larynx, skin, right lung and metastases. Treatment took place at the Moscow Research Institute of Oncology. Herzen. Surgeries were performed on the lung and larynx. The lesion on the skin was removed with a laser. We carried out 4 courses of chemotherapy. I lead a normal life. The only thing is to spare no time and money to undergo a CT scan of the chest and abdominal organs twice a year, so as not to miss a relapse. Be treated only by doctors and follow all their recommendations. Think less about the disease, do not feel sorry for yourself. Life goes on".

Treatment in Germany

In German oncology clinics, patients with terminal stage lung cancer are provided with palliative care. There is an opportunity to participate in clinical trials of new drugs. For solitary metastases and a small tumor, surgical operations are performed:

• video-assisted endobronchial operations;
• laser removal or cryoablation of metastases;
• radical lung surgery.

Before surgery, a course of chemotherapy is prescribed individually. After conducting studies, the sensitivity of the tumor to medications is determined and, depending on the results obtained, various drugs are combined. Modern methods of radiation therapy with radio modifications are used.

If it is not possible to perform an operation without risk for the patient (in case of multiple metastatic lesions, unfavorable course of the disease), palliative and psychological care is provided, maximally alleviating the patient’s suffering.

Some of the largest clinics in Germany:

• Patients in serious condition are provided with palliative care. Painkillers are selected individually. Oxygen therapy and other symptomatic treatment are carried out according to indications. With a more favorable prognosis, the disease is fought using complex treatment with targeted drugs and immunotherapy.
• University Hospital, Essen. With advanced lung cancer, a comprehensive diagnosis is carried out, then adequate treatment is prescribed. Palliative operations are performed. Complex chemotherapy is prescribed. Treatment is supplemented with radiotherapy. With a positive result, operations are performed to remove the tumor and solitary metastases. If multiple lesions are detected, chemotherapy is ineffective, targeted and immune drugs are prescribed. Symptomatic treatment is carried out.

Many German clinics are recruiting for clinical drug trials. For most patients, this is a good chance, because treatment abroad is expensive.

Approximate cost of treatment

Review

Michael. “Oncology is a terrible ordeal for the patient and his family. Only at such a difficult moment do you realize how much your loved ones love and appreciate you. I am grateful to my son for the fact that, having learned my diagnosis, he did not give up, but insisted on treatment abroad. I went to Essen. The treatment was long and difficult. Repeatedly wanted to give up and stop, but remembered his son and continued to be treated. Now everything is fine with me, I am nursing my granddaughter, and I am glad that I went to Germany.”

Treatment of stage 4 lung cancer in Israel

The clinics have modern diagnostic equipment. Patients with advanced cancer are diagnosed immediately. Then complex treatment is prescribed:

• chemotherapy (targeted, immune drugs, cytotoxins);
• radiation treatment;
• various types of surgical interventions.

Since antitumor drugs are highly toxic, with many side effects, accompanying treatment is prescribed in addition to them.

If large vessels, the heart, or the chest are affected with solitary metastases, and the patient is in good health, an appropriate combined operation is recommended. Minimally invasive surgical methods are used for symptomatic treatment.

Many clinics are testing new medications and treatment methods. There are appropriate departments for the treatment of advanced cancer in such centers as:

• Medical Center named after. Chaim Shiba, Ramat Gan. The center has a laboratory to combat lung cancer. The latest developments are used to treat the terminal stage. Conducting clinical trials of targeted drugs and immunotherapy drugs. Treatment is supplemented with radiotherapy. Operations are performed according to indications. There is a palliative care center.
• Medical Center "Herzliya", Herzliya. The clinic is private. One of the main areas of activity is cardiac surgery. Surgeries are performed here for advanced lung cancer, when the tumor has invaded large vessels and the heart. In the oncology department, he is treated with targeted drugs. Palliative and radical irradiation is performed. Symptomatic therapy is prescribed.
• Medical Center "Migdal Medical", Tel Aviv. It was created on the basis of the Assuta clinic and is equipped with modern diagnostic technologies. Combination methods are used to treat advanced cancer. Provide palliative care, accompanying and symptomatic treatment.

It is possible to detect a tumor in the lungs and determine what it may be with a detailed examination. People of different ages are susceptible to this disease. Formations arise due to disruption of the process of cell differentiation, which can be caused by internal and external factors.

Neoplasms in the lungs are a large group of different formations in the lung area, which have a characteristic structure, location and nature of origin.

Neoplasms in the lungs can be benign or malignant.

Benign tumors have different genesis, structure, location and different clinical manifestations. Benign tumors are less common than malignant tumors and make up about 10% of the total. They tend to develop slowly, do not destroy tissues, since they are not characterized by infiltrating growth. Some benign tumors tend to transform into malignant ones.

Depending on the location there are:

1. Central - tumors from the main, segmental, lobar bronchi. They can grow inside the bronchus and surrounding lung tissue.
2. Peripheral - tumors from surrounding tissues and walls of small bronchi. They grow superficially or intrapulmonarily.

Types of benign tumors

There are the following benign lung tumors:

Briefly about malignant tumors

Lung cancer (bronchogenic carcinoma) is a tumor consisting of epithelial tissue. The disease tends to metastasize to other organs. It can be located in the periphery, the main bronchi, it can grow in the lumen of the bronchus, the tissues of the organ.

Malignant neoplasms include:

1. Lung cancer has the following types: epidermoid, adenocarcinoma, small cell tumor.
2. Lymphoma is a tumor that affects the lower respiratory tract. It may occur primarily in the lungs or as a result of metastases.
3. Sarcoma is a malignant formation consisting of connective tissue. Symptoms are similar to those of cancer, but develop more quickly.
4. Pleural cancer is a tumor that develops in the epithelial tissue of the pleura. It can occur primarily, and as a result of metastases from other organs.

Risk factors

The causes of malignant and benign tumors are largely similar. Factors that provoke tissue proliferation:

• Smoking active and passive. 90% of men and 70% of women who have been diagnosed with malignant neoplasms in the lungs are smokers.
• Contact with hazardous chemical and radioactive substances due to professional activities and due to environmental pollution in the area of ​​​​residence. Such substances include radon, asbestos, vinyl chloride, formaldehyde, chromium, arsenic, and radioactive dust.
• Chronic respiratory diseases. The development of benign tumors is associated with the following diseases: chronic bronchitis, chronic obstructive pulmonary disease, pneumonia, tuberculosis. The risk of malignant neoplasms increases if there is a history of chronic tuberculosis and fibrosis.

The peculiarity is that benign formations can be caused not by external factors, but by gene mutations and genetic predisposition. Malignancy and transformation of the tumor into malignant also often occur.

Any lung formations can be caused by viruses. Cell division can be caused by cytomegalovirus, human papillomavirus, multifocal leukoencephalopathy, simian virus SV-40, and human polyomavirus.

Symptoms of a tumor in the lung

Benign lung formations have various signs that depend on the location of the tumor, its size, existing complications, hormonal activity, the direction of tumor growth, and impaired bronchial obstruction.

Complications include:

• abscess pneumonia;
• malignancy;
• bronchiectasis;
• atelectasis;
• bleeding;
• metastases;
• pneumofibrosis;
• compression syndrome.

Bronchial patency has three degrees of impairment:

• 1st degree – partial narrowing of the bronchus.
• 2nd degree – valvular narrowing of the bronchus.
• 3rd degree – occlusion (impaired patency) of the bronchus.

Symptoms of the tumor may not be observed for a long time. The absence of symptoms is most likely with peripheral tumors. Depending on the severity of the symptoms, several stages of the pathology are distinguished.

Stages of formations

Stage 1. It is asymptomatic. At this stage, there is a partial narrowing of the bronchus. Patients may cough with a small amount of sputum. Hemoptysis is rare. On examination, the x-ray shows no abnormalities. Tests such as bronchography, bronchoscopy, and computed tomography can show the tumor.

Stage 2. Observed valve (valve) narrowing of the bronchus. At this point, the lumen of the bronchus is practically closed by the formation, but the elasticity of the walls is not impaired. When inhaling, the lumen partially opens, and when exhaled, it closes with a tumor. In the area of ​​the lung that is ventilated by the bronchus, expiratory emphysema develops. As a result of the presence of bloody impurities in the sputum and swelling of the mucous membrane, complete obstruction (impaired patency) of the lung can occur. In the tissues of the lung, there may be the development of inflammatory processes. The second stage is characterized by a cough with the release of mucous sputum (pus is often present), hemoptysis, shortness of breath, increased fatigue, weakness, chest pain, fever (due to the inflammatory process). The second stage is characterized by alternation of symptoms and their temporary disappearance (with treatment). An X-ray image shows impaired ventilation, the presence of an inflammatory process in a segment, lobe of the lung, or an entire organ.

To be able to make an accurate diagnosis, bronchography, computed tomography, and linear tomography are required.

Stage 3. Complete obstruction of the bronchial tube occurs, suppuration develops, and irreversible changes in lung tissue and their death occur. At this stage, the disease has such manifestations as impaired breathing (shortness of breath, suffocation), general weakness, excessive sweating, chest pain, elevated body temperature, cough with purulent sputum (often with bloody particles). Occasionally, pulmonary bleeding may occur. During examination, an x-ray may show atelectasis (partial or complete), inflammatory processes with purulent-destructive changes, bronchiectasis, and a space-occupying lesion in the lungs. To clarify the diagnosis, a more detailed study is necessary.

Symptoms

Symptoms of low-quality tumors also vary depending on the size, location of the tumor, the size of the bronchial lumen, the presence of various complications, and metastases. The most common complications include atelectasis and pneumonia.

At the initial stages of development, malignant cavity formations that have arisen in the lungs show few signs. The patient may experience the following symptoms:

• general weakness, which intensifies as the disease progresses;
• increased body temperature;
• fast fatiguability;
• general malaise.

Symptoms of the initial stage of neoplasm development are similar to those of pneumonia, acute respiratory viral infections, and bronchitis.

The progression of a malignant formation is accompanied by symptoms such as cough with sputum consisting of mucus and pus, hemoptysis, shortness of breath, and suffocation. When the tumor grows into the vessels, pulmonary hemorrhage occurs.

A peripheral lung mass may not show signs until it invades the pleura or chest wall. After this, the main symptom is pain in the lungs that occurs when inhaling.

In the later stages of malignant tumors are manifested:

• increased constant weakness;
• weight loss;
• cachexia (exhaustion of the body);
• occurrence of hemorrhagic pleurisy.

Diagnostics

To detect neoplasms, the following examination methods are used:

1. Fluorography. Preventive diagnostic method of X-ray diagnostics, which allows you to identify many pathological formations in the lungs. read this article.
2. Plain radiography of the lungs. Allows you to identify spherical formations in the lungs, which have a round contour. On the x-ray, changes in the parenchyma of the examined lungs are determined on the right, left, or both sides.
3. CT scan. Using this diagnostic method, the lung parenchyma, pathological changes in the lungs, and each intrathoracic lymph node are examined. This study is prescribed when differential diagnosis of rounded formations with metastases, vascular tumors, and peripheral cancer is necessary. Computed tomography allows a more accurate diagnosis to be made than x-ray examination.
4. Bronchoscopy. This method allows you to examine the tumor and perform a biopsy for further cytological examination.
5. Angiopulmonography. It involves performing invasive radiography of blood vessels using a contrast agent to detect vascular tumors of the lung.
6. Magnetic resonance imaging. This diagnostic method is used in severe cases for additional diagnostics.
7. Pleural puncture. A study in the pleural cavity with a peripheral location of the tumor.
8. Cytological examination of sputum. Helps determine the presence of a primary tumor, as well as the appearance of metastases in the lungs.
9. Thoracoscopy. It is carried out to determine the operability of a malignant tumor.

Fluorography.

Bronchoscopy.

Angiopulmonography.

Magnetic resonance imaging.

Pleural puncture.

Cytological examination of sputum.

Thoracoscopy.

It is believed that benign focal lesions of the lungs are no more than 4 cm in size, larger focal changes indicate malignancy.

Treatment

All neoplasms are subject to surgical treatment. Benign tumors are subject to immediate removal after diagnosis in order to avoid an increase in the area of ​​affected tissues, trauma from surgery, the development of complications, metastases and malignancy. For malignant tumors and for benign complications, a lobectomy or bilobectomy may be required to remove a lobe of the lung. With the progression of irreversible processes, pneumonectomy is performed - removal of the lung and surrounding lymph nodes.

Central cavity formations localized in the lungs are removed by resection of the bronchus without affecting the lung tissue. With such localization, removal can be done endoscopically. To remove neoplasms with a narrow base, a fenestrated resection of the bronchus wall is performed, and for tumors with a wide base, a circular resection of the bronchus is performed.

In peripheral tumors, such methods of surgical treatment as enucleation, marginal or segmental resection are used. For large tumors, lobectomy is used.

Lung masses are removed by thoracoscopy, thoracotomy and videothoracoscopy. During the operation, a biopsy is performed, and the resulting material is sent for histological examination.

For malignant tumors, surgery is not performed in such cases:

• when it is not possible to completely remove the tumor;
• metastases are located at a distance;
• impaired functioning of the liver, kidneys, heart, lungs;
• The patient's age is more than 75 years.

After removal of the malignant tumor, the patient undergoes chemotherapy or radiation therapy. In many cases, these methods are combined.

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

How long do people live with lung cancer?

The development of oncology without treatment always ends in death. 48% of patients who did not receive treatment for any reason die in the first year after diagnosis, only 1% survive to 5 years, only 3% of untreated patients live 3 years.

In Russia, according to lung cancer statistics, the incidence is relatively stable, with a slight decrease in the rate. Pathology occupies a leading position among the male population, its share is 25% among all malignant neoplasms. Among women, the disease is less common: in 4.3%.

Dynamics of incidence of lung cancer for 2004-2014 in Russia:

Lung Cancer Treatment at Hadassah

In Israel, various types of oncological diseases are successfully treated, including lung cancer, which is considered one of the most aggressive types of oncological diseases. This type of cancer is more than others associated with smoking (including passive), although 10 to 20% of all cases are non-smokers.
One of the reasons for the poor prognosis of the development of the disease is the late stage of detection of a malignant tumor. In the early stages, when treatment is most successful, no more than a third of all cases of lung cancer are diagnosed. In Israel, modern methods and drugs are used to diagnose and treat lung cancer, which contributes to a more favorable outcome of the disease.

In 2009, a modern medical center "Assuta" was built in the Ramat ha-Chayal district of Tel Aviv. The hospital immediately won the title of the leading surgical center, not only in Israel, but also in the world. The Assuta clinic is equipped with the most modern world-class equipment, which allows for a highly accurate diagnostic process and excellent results in the treatment of completely different diseases.

For several decades now, the latest methods for diagnosing and treating various types of cancer have been used here. Of course, the earlier a malignant disease is detected, the greater the patient’s chances of a complete recovery. As world practice shows, up to 90% of patients who were diagnosed with cancer at the primary stage were able to overcome the disease.

Symptoms of lung cancer

Symptoms that allow one to suspect lung cancer are divided into general and specific.

General symptoms:

1. weakness
2. weight loss
3. loss of appetite
4. sweating
5. causeless rises in body temperature.

Specific symptoms of lung cancer may include:

cough- the occurrence of an unreasonable, annoying, debilitating cough accompanies bronchial cancer (central cancer). The patient, carefully monitoring his health, can independently notice changes in the nature of the cough: it becomes more frequent, annoying, and the nature of the sputum changes. The cough may be paroxysmal, without cause, or associated with inhaling cold air, physical activity, or lying down. This cough occurs when the mucous membrane of the bronchial tree is irritated by a tumor growing into its lumen. With central lung cancer, sputum appears, usually yellowish-greenish in color, due to concomitant inflammatory phenomena in the lung tissue.

One of the most characteristic symptoms of lung cancer is hemoptysis(blood discharge with sputum): the blood can be foamy, mixed with sputum, giving it a pinkish tint and bright scarlet, intense, in the form of streaks (active bleeding) or in the form of dark clots (clotted old blood). Bleeding from the respiratory tract can be quite intense and prolonged, sometimes leading to the death of patients. But, hemoptysis can be a symptom of other pulmonary diseases: pulmonary tuberculosis, bronchiectasis (air cavities in the lung).

dyspnea associated with changes in the lung tissue: inflammation of the lungs accompanying the tumor, collapse of part of the lung due to blockage of the bronchial tube by the tumor (atelectasis), disrupting gas exchange in the lung tissue and worsening the conditions of ventilation of the lungs, reducing the respiratory surface. With tumors growing in large bronchi, atelectasis of the entire lung and its complete shutdown can occur.

pain in the chest - associated with tumor germination of the serous lining of the lungs (pleura), which has many pain endings, concomitant inflammatory changes in the lungs and tumor germination into the bones, large nerve plexuses of the chest.

ManifestationssyndromeItsenko- Cushing(obesity, increased hair growth, pink stripes on the skin). This is due to the fact that some types of cancer cells can synthesize ACTH (adrenocorticotropic hormone). Excessive synthesis of this hormone causes similar symptoms.

Anorexia(loss of body weight), vomiting, problems with the functioning of the nervous system - such signs may bother the patient if the tumor synthesizes antidiuretic hormone.

Violationexchangecalcium(vomiting, lethargy, vision problems, osteoporosis). These symptoms appear if cancer cells synthesize substances similar to the hormones of the parathyroid gland, which regulates calcium metabolism.

Syndromecompressiontophollowveins(subcutaneous veins protrude, the neck and shoulder girdle swell, problems with swallowing appear). This symptom complex develops with the rapid development of the tumor process.

When nerve fibers are damaged, paralysis and paresis of the muscles of the shoulder girdle and phrenic nerves develop, and swallowing processes are disrupted. If lung cancer metastasizes to the brain, any neurological disorders and death of the patient can occur.

At the early stage of the disease there is no pain; persistent intense pain is typical for late, advanced stages of the tumor. The pain may be in one place or radiate to the neck, shoulder, arm, back or abdominal cavity, and may worsen when coughing.

Cough

Cough with lung cancer is one of the most recognizable symptoms of malignant oncology. In almost all types and forms of lung cancer, the course of the disease is significantly aggravated by cough. This means that people who suffer from this disease must not only be able to alleviate their condition, but also know effective treatment both for such processes and for other pulmonary pathologies.

Cough in lung cancer can be characterized as a kind of protective reaction of the body to a specific receptor irritation. This reaction occurs when external or internal mediators act on receptors located in all parts of the respiratory system.

The pathological process, that is, chronic cough, can be characterized as:

rare/frequent;

strong/weak;

short/long;

raucous/loud;

jerky/rolling;

painless/painful;

wet/dry.

For a cancerous tumor, which is based in the body of the lung, the following types of cough are not characteristic - strong, short and loud. Patients who make such sounds when coughing are most likely not carriers of lung cancer, their larynx and trachea are susceptible to infectious diseases, in rare cases, the tumor is localized in these organs, and not in the lungs. If you do not recognize such changes in time and prescribe treatment in accordance with oncological protocols, you can skip the intensive cycle of the development of the disease and allow it to pass into the subacute stage, which will certainly end in death.

Characteristic cough intonations during irritation of receptors located in lung tissues:

Lengthy, muffled, weak and deep - indicates a sharp decrease in the elasticity of the lung tissue, as well as the presence of one or more pathological foci in this organ. Treatment should be symptomatic.

Pain in lung cancer, characteristic of constant coughing, tells the specialist that the tumor has affected the pleura around the lungs or is localized in the bronchi, which are sensitive to pain impulses. The pain may intensify with intense movement of the sternum. In the case when auscultation gives the result in the form of a painful cough and bursting noises, this means only one thing, fluid begins to accumulate between the pleura and the lung.

There are two types of wet cough: with regular release of liquid contents and with expectoration of a viscous substance. In the first case, we can talk about it as an acute course of a pathological process in the lungs, in the second - about a chronic form of the disease.

The cough may be dry and make breathing difficult. In some cases, it precedes the occurrence of a wet cough or, conversely, is its consequence. A dry cough itself is a sign of chronic receptor irritation, but fluid does not accumulate in the lungs. It can act as a sign of a progressive tumor, at the stage when inflammation and tissue necrosis are not yet noted around the localized focus. Treatment is prescribed according to the results of a microbiological study.

If coughing and hemoptysis stop abruptly, you should immediately contact your doctor, as this is a very dangerous situation. Suppression of the cough reflex indicates the development of intoxication of the body with tumor decay products.

Self-diagnosis and treatment at home can only worsen the situation. It is best to most expressively describe the sensations associated with the disease to your oncologist. The final result is drawn up after a whole range of necessary analyzes and studies have been carried out.

Hemoptysis and sputum as nonspecific symptoms of cancer

Most patients are frankly frightened when sputum begins to come out of the lungs with blood clots. Hemoptysis is the name of this process in modern medicine. But hemoptysis is not always a direct sign of a tumor. Blood contained in sputum as exudate is not a typical symptom of lung cancer.

Bleeding when blowing your nose during a coughing attack characterizes damage to the small blood vessels of the respiratory system. Hemoptysis implies the release of blood as part of accumulated mucus, when sputum is expelled in the process, and with pulmonary hemorrhages, the blood is scarlet and has a foamy structure.

Signs of lung cancer

There are 3 phases of lung cancer development:

Biological period - the time from the appearance of a neoplasm to the first signs during an x-ray examination

Asymptomatic period - no symptoms, only radiological signs of cancer

Clinical period - the appearance of symptoms of the disease

With stage 1-2 of the oncological process, this is a biological or asymptomatic period of cancer, when a person does not feel any health problems. A small number of patients seek medical help during this period, so timely early diagnosis of the first stages is extremely difficult.

In stages 2-3 of lung cancer, certain syndromes may appear, that is, “masks” of other ailments.

At first, the oncological process is manifested by a simple decrease in a person’s vitality, he begins to quickly get tired of simple daily everyday activities, loses interest in current events, performance decreases, weakness appears, a person may say “how tired I am of everything,” “I’m tired of everything.”

Then, as the disease progresses, cancer can disguise itself as frequent bronchitis, acute respiratory viral infections, catarrh of the respiratory tract, and pneumonia.

The patient may periodically simply have an increase in body temperature, then recover and rise again to low-grade levels. Taking antipyretics, NSAIDs or alternative methods of treatment for some time stop the malaise, but the repetition of such a condition for several months makes people who monitor their health consult a doctor.

Main causes of lung cancer:

smoking, including passive smoking (about 90% of all cases);

contact with carcinogenic substances;

inhalation of radon and asbestos fibers;

hereditary predisposition;

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.

Hazardous types of production:

steelmaking;

wood processing;

metallurgy;

mining;

asbestos-cement;

ceramic;

phosphate;

fulling;

Cancer cells have the ability to rapidly divide. The tumor can reach a significant size and, in the absence of timely treatment, penetrate into neighboring organs. Later, by lymphogenous and hematogenous way, malignant cells are spread throughout the body - this process is called metastasis.

Cigarette smoking, including passive smoking, is the most important cause of lung cancer. The risk depends on the age and intensity of smoking, as well as its duration; the risk decreases after smoking cessation, but probably never returns to baseline.

For non-smokers, the most important environmental risk factor is exposure to radon, a degradation product of natural radium and uranium. Occupational hazards associated with exposure to radon (miners of uranium mines); asbestos (from builders and workers who destroy buildings, plumbers, shipbuilders and auto mechanics); quartz (for miners and sandblasters); arsenic (in workers associated with copper smelting, pesticide production and plant protection products); chromium derivatives (at stainless steel plants and pigment factories); nickel (at battery and stainless steel plants); chloromethyl ethers; beryllium and emissions from coke ovens (from steel workers) lead to the development of a small number of cases each year.

The risk of malignant neoplasms of the respiratory organs is higher with a combination of two factors - occupational hazards and cigarette smoking than with only one of them. COPD and pulmonary fibrosis may increase the risk of developing the disease; medications containing beta-carotene may increase the risk of developing the disease in smokers. Polluted air and cigar smoke contain carcinogens, but their role in the development of lung cancer has not been proven.

Classification

There are several clinical and radiological forms of lung cancer:

1. central cancer - cancer of the bronchi, grows in the lumen of the large bronchi (central, lobar, segmental). The tumor grows both in the lumen of the bronchus (appears earlier) and in the lung tissue surrounding the bronchus. In the initial stages, it does not manifest itself in any way, it is often not visible on fluorography and x-rays, since the shadow of the tumor merges with the heart and blood vessels. The presence of a tumor can be suspected by indirect signs on the radiograph: a decrease in the airiness of the lung area or inflammation in the same place repeatedly (recurrent pneumonia). Characterized by cough, shortness of breath, hemoptysis, in advanced cases - chest pain, high body temperature

Central tumor right lung large sizes

2. Peripheral cancer - grows in the thickness of the lung tissue. There are no symptoms, it is detected by chance during examination or with the development of complications. The tumor can reach a large size without manifesting itself, such patients often refuse treatment, referring to the absence of symptoms.

A variety of peripheral cancer - cancer of the apex of the lung (Penkost), is characterized by germination in the vessels and nerves of the shoulder girdle. Such patients are treated for a long time by a neuropathologist or therapist with a diagnosis of osteochondrosis, plexitis and are sent to an oncologist with an advanced tumor. A variation of peripheral cancer is also a cavity form of cancer - a tumor with a cavity in the center. The cavity in the tumor arises as a result of the collapse of the central part of the tumor, which in the process of growth lacks nutrition. These tumors can reach large sizes up to 10 cm or more, they are easily confused with inflammatory processes - abscesses, decaying tuberculosis, lung cysts, which delays the correct diagnosis and leads to the progression of the disease without special treatment.

Cavitary form cancer lung: tumor V right lung indicated arrow

3. Pneumonia-like cancer, as the name implies, is similar to pneumonia, patients are treated for a long time by a general practitioner, when there is no effect from antibiotic treatment, cancer is suggested. The tumor is characterized by rapid growth, it grows diffusely, not in the form of a node, it occupies one or more lobes of the lung.

Pneumonia-like form cancer lung With defeat both lungs

4. Atypical forms: liver, brain, bone and others. They are associated with the symptoms not of the lung tumor itself, but of its metastases. The hepatic form is characterized by jaundice, changes in blood tests, enlarged liver, heaviness in the right hypochondrium. Brain - often manifests as a stroke clinic - the arm and leg on the side opposite to the lesion stop working, speech impairment, loss of consciousness, there may be convulsions, headaches, double vision. Bone - pain in the spine, pelvic bones or limbs, spontaneous (not associated with trauma) fractures often occur.

5. Metastatic tumors are screenings from the main tumor of another organ (for example, breast, intestines, other lung, ENT organs, prostate gland and others), having the structure of the original tumor and capable of growing, disrupting the function of the organ. In some cases, metastases can reach enormous sizes (more than 10 cm) and lead to the death of patients from poisoning by tumor waste products and disruption of internal organs (liver and respiratory failure, increased intracranial pressure, and so on). Most often, metastases arise from tumors of the intestine, mammary gland, second lung, which is associated with the specifics of the organ’s blood circulation: a very small and highly developed vascular network, tumor cells settle in it from the bloodstream and begin to grow, forming colonies - metastases. A malignant tumor of any organ can metastasize to the lungs. Metastases in the lungs are common and can be very similar to independent tumors.

Sometimes, after a complete examination, the tumor - the original source of metastases - cannot be detected.

Lung cancer is systematized according to the structure of the changed cells, their location, the shape of the tumor and the prevalence of tumors in the patient’s body.

Morphological classification:

Small cell (15-20% of cases) - extremely aggressive cell division and rapid metastasis. Most often caused by smoking, it is detected in the later stages when internal organs are damaged.

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.

Types of non-small cell cancer:

squamous;

large cell;

adenocarcinoma;

mixed.

These species have fundamental differences in their growth, spread, and treatment processes, so identifying them is a priority.

Anatomical classification:

central - affects the main, lobar and segmental bronchi;

peripheral - damage to the epithelium of smaller bronchi, bronchioles and alveloli;

massive (mixed).

Stages of development:

Stage 0 - small neoplasms, there is no damage to internal organs and lymph nodes;

Stage 1: a tumor in the lung no more than 3 cm in size or a bronchial tumor spreading within one lobe, no metastases in nearby lymph nodes;

Stage 2: tumor in the lung more than 3 cm, grows into the pleura, blocks the bronchus, causing atelectasis of one lobe;

Stage 3: the tumor spreads to neighboring structures, atelectasis of the entire lung, the presence of metastases in nearby lymph nodes - the root of the lung and mediastinum, supraclavicular;

Stage 4: the tumor grows into surrounding organs - the heart, large vessels, or fluid joins the pleural cavity (metastatic pleurisy).

stage 1 lung cancer

The size of a malignant neoplasm in the first degree of oncological pathology is estimated at 3-5 cm, and symptoms do not always appear. The cancer cells are located in one fixed segment of the lung area, called peripheral cancer. They can also be located in a person within the bronchial region - this is already a centrally located cancer in an early form.

A distinctive characteristic of the presented period should be considered that cancer cells have not yet affected the lymph nodes.

Oncologists suggest taking into account the following classification: dividing stage 1 lung cancer into two stages, which follow each other.

Grade 1A is associated with a maximum tumor size of 3 cm. Survival for 5 years at this stage for non-small cell cancer is from 60 to 75%. If we talk about the small cell variety, then these figures are at least 40%.

When a person encounters degree 1B, he develops the following changes and symptoms:

the tumor reaches a size of no more than 3-5 cm in diameter;

lymph nodes and other leading parts of the body are not damaged;

life expectancy for 5 years in the case of non-small cell cancer is from 45 to 60%, and in the small cell form - no more than 25%.

stage 2 lung cancer

Stage 2 goes through the normal stage of a cold, having all its symptoms. Because of this, most patients do not panic, but wait for the symptoms to gradually regress and everything to return to normal.

But these expectations are futile if you have cancer. The symptoms will only progress, and new, more serious ones will appear, for example, pain in the chest.

There are, of course, cases where there is a 2nd degree, but there are no manifestations. At the same time, if the patient makes a routine chest x-ray, then it will be possible to observe the primary tumor, sometimes large, metastasizing to nearby lymph nodes.

The second degree is very aggressive, the tumor grows very quickly, going beyond the lung. Tumor cells entering the bloodstream are transported over long distances. Metastases are detected in the brain and other organs and systems. Most often, patients complain of high fever, cough, very rapid fatigue, lack of desire to eat, often nausea. Very often such patients have pain in their bones, muscles, and head. Coughing up blood is very rare at this stage.

The disease often has a secretive course, only 3 out of 10 patients seek help at this stage. It is worth noting that in the beginning, the disease is much easier to achieve a cure; you just need to do an x-ray of the lungs every year. Today, medicine has made great progress; methods for early diagnosis of tumors have been developed by identifying tumor markers freely circulating in the human bloodstream.

Stage 3 lung cancer.

Stage 3 lung cancer is characterized by severe symptoms of the disease. Such differences distinguish this stage of oncology from the second, in which a person does not constantly experience painful sensations, they can be observed at certain hours or after intense physical exertion.

Sick people who have stage three cancer suffer from such problems as a strong, debilitating, hacking cough. It is observed against the background of the discharge of sputum, which may contain blood clots. In difficult cases, when a person smokes for a long time or has serious illnesses, for example, pneumonia, pulmonary hemorrhage is observed.

There are several signs that can be visually seen - sinking of the chest on the side affected by cancer, audible wheezing when taking a large breath. Breathing becomes difficult and sometimes painful. The prognosis is negative, surgery is not advisable, therapy can only be prescribed to make you feel better.

In stage three lung cancer, the tumor can vary in size. In most cases, it spreads to nearby anatomical tissues of the chest wall: mediastinal and diaphragmatic. The addition of atelectasis and pneumonia to the malignant process leads to the formation of effusion in the pleural cavity and inflammation of the entire lung tissue. The degree of differentiation of lung cancer depends on the pathomorphological structure. Squamous cell lung cancer has a high degree of differentiation, so identifying it even at the third stage of development can give hope for effective treatment and a favorable prognosis for life.

Stage 4 lung cancer

A patient diagnosed with the last stage of lung cancer experiences numerous complaints:

1. Constant pain when breathing, which is difficult to live with.
2. Decrease in body weight and appetite, in some cases, intestinal activity fails due to metastases, food stops being absorbed. Constipation - this symptom can occur very often, especially if the cancer has metastasized to the intestines. Also, constipation can occur due to lack of appetite and a sedentary lifestyle of the patient. It is difficult to treat such constipation with diet or medication, due to the fact that the patient has no appetite and does not accept medications well.
3. Blood clots slowly, and fractures (bone metastases) often occur.
4. The appearance of severe coughing attacks, often with sputum, sometimes with blood and pus. Hemoptysis - at the beginning of the disease, the patient may cough up sputum with small streaks of blood, but when the process reaches the fourth stage, the sputum contains so much blood that it begins to resemble raspberry jelly. In addition to blood, traces of pus sometimes appear in the sputum. Often, the fourth stage of lung cancer is accompanied by attacks of hacking cough, which in turn can cause ruptures of blood vessels, which will inevitably lead to heavy bleeding.
5. The appearance of severe pain in the chest, which directly indicates damage to nearby tissues, since there are no pain receptors in the lungs themselves.
6. Symptoms of cancer also include heavy breathing and shortness of breath, if the cervical lymph nodes are affected, difficulty speaking is felt.
7. Temperature is a very common occurrence during lung cancer, which is observed in 85% of all patients, and becomes evidence of an advanced phase of the disease. In some patients, the temperature occurs in the form of outbreaks, in others it is subfebrile and does not exceed 37.5 degrees.

The symptom complex is provoked by metastasis to distant organs and can be varied, depending on the area affected by the metastases. For example, if they reach the bone tissue, severe pain may be observed in the limbs, ribs, and spine.

If metastasis has reached the brain, the patient experiences seizures, loss of vision, incoordination, speech and memory disorders. A secondary liver tumor causes symptoms such as jaundice and liver failure. Secondary kidney tumors often provoke girdling pain in the lower back and hematuria.

Peripheral lung cancer

A malignant tumor developing from the alveoli, small bronchi and their branches; localized on the periphery of the lung, away from the root. Symptoms of peripheral lung cancer appear at a late stage, when the tumor invades large bronchi, pleura, and chest wall. They include shortness of breath, cough, hemoptysis, chest pain, and weakness.
Peripheral lung cancer is cancer arising from the bronchi of the 4th-6th order and their smaller branches, not associated with the lumen of the bronchus. In pulmonology, peripheral lung cancer accounts for 12-37% of all lung tumors. The ratio of the detection rate of central and peripheral lung cancer is 2:1. Most often (in 70% of cases) peripheral lung cancer is localized in the upper lobes, less often (23%) in the lower lobes and very rarely (7%) in the middle lobe of the right lung. The danger of peripheral lung cancer lies in its long-term latent, asymptomatic course and frequent detection in an advanced or inoperable stage. According to histological structure, peripheral lung cancer is most often represented by bronchoalveolar adenocarcinoma or squamous cell carcinoma.

In the origin of peripheral lung cancer, the role of endogenous factors is great - lung diseases (pneumonia, chronic bronchitis, smoker's bronchitis, tuberculosis, limited pneumosclerosis), which can be traced in the history of a significant number of patients. The majority of cases are people over 45 years of age. In the pathogenesis of peripheral tumors, dysplasia of the epithelium of small bronchi and alveolar epithelium plays a decisive role. Neoplasms develop from basal, ciliated, goblet epithelial cells of the bronchi, type II alveolocytes and Clara cells.
In addition, there are three clinical forms of peripheral lung cancer: nodular, pneumonia-like and Pancoast cancer (cancer of the apex of the lung)

Nodal form originates from the terminal bronchioles and clinically manifests itself only after germination of large bronchi and adjacent tissues.

Pneumonia-like form peripheral lung cancer develops in the pulmonary parenchyma and is characterized by infiltrating growth; histologically always represents adenocarcinoma; clinically resembles indolent pneumonia.

Localization Features apical lung cancer cause tumor infiltration of the cervical and brachial nerve plexuses, ribs, spine and corresponding clinical symptoms. Sometimes the cavitary form of lung cancer (formation of a pseudocavernous decay cavity in the thickness of the node) and cortico-pleural cancer (comes from the mantle layer, spreads along the pleura along the spine, grows into the tissue of the chest wall) are added to the above three main forms.

The forms of the disease presented deserve special attention. The first of these is corticopleural, in which an oval-shaped formation appears. It begins to grow into the chest, and therefore is located in the subpleural plane. This variety is dangerous due to the fact that it tends to grow into adjacent ribs, as well as into the bodies of the thoracic vertebrae located nearby.

The next form is cavitary, which is a tumor with an empty formation in the central part. Such neoplasms reach dimensions of more than 10 cm, and therefore they are confused with negative algorithms (cysts, tuberculosis, abscess) in the lungs. This form of peripheral lung cancer most often occurs without any symptoms.

Oncologists draw patients' attention to the fact that the cavitary type of the disease is most often identified in the later stages. In this case, the process turns out to be irreversible. Peripheral cancer of the left and right lungs is also distinguished; in order to identify it and determine the prognosis, a diagnostic examination will be required.

Small cell cancer

A malignant tumor that has the most aggressive course and widespread metastasis. This form accounts for about 20-25% of all types of lung cancer. Many scientific experts regard this type of tumor as a systemic disease, in the early stages of which there are almost always metastases in the regional lymph nodes. Men suffer from this type of tumor most often, but the percentage of women affected is growing significantly. Almost all patients have a fairly severe form of cancer, which is associated with rapid tumor growth and widespread metastasis.

Grades of small cell lung cancer

Stage 1 - the tumor size is up to 3 cm in diameter, the tumor has affected one lung. There is no metastasis.

Stage 2 - the size of the tumor in the lung is from 3 to 6 cm, blocks the bronchus and grows into the pleura, causing atelectasis;

Stage 3 - the tumor rapidly spreads to neighboring organs, its size has increased from 6 to 7 cm, and atelectasis of the entire lung occurs. Metastases in adjacent lymph nodes.

Stage 4 small cell lung cancer is characterized by the spread of malignant cells to distant organs of the human body, which in turn causes symptoms such as:

headache;

general malaise;

loss of appetite and sudden weight loss;

back pain

Squamous cell lung cancer

Squamous cell lung cancer is a histological type of bronchopulmonary cancer resulting from squamous cell metaplasia of the bronchial epithelium.

Clinical manifestations depend on the localization of the tumor (central or peripheral lung cancer). The disease can occur with cough, hemoptysis, chest pain, shortness of breath, pneumonia, pleurisy, general weakness, and metastasis.
Squamous cell lung cancer accounts for more than half (about 60%) of all histological forms of lung cancer. It predominantly affects men over 40 years of age. Up to 70% of tumors of this type are localized in the root of the lung; in a third of cases, peripheral lung cancer is detected. The relevance of squamous cell lung cancer for clinical pulmonology lies, first of all, in its high prevalence and potential reversibility of risk factors for the disease.
The diagnosis of squamous cell lung cancer combines several types of neoplasms of malignant etymology. Therefore, the course of different forms of the disease is different, and they also arise in different ways. Depending on which part of the respiratory system the tumor originates, there are two types:

1. Central squamous cell lung cancer. This type is diagnosed in 2/3 of patients. As a rule, the tumor is localized in the main, intermediate or lobar part of the bronchi. It is detected against the background of prolonged pneumonia or an abscess. Due to the unclear picture in this case, the symptoms are blurred.
2. Peripheral lung cancer. The tumor occurs in the segmental part of the bronchi or in their lobes. The picture of the disease can be blurred against the background of concomitant chronic processes. This form appears when metastases begin to appear.
3. Massive. This type combines the first two forms.
4. Depending on the type of tissue, two more types of cancer are distinguished: small cell and squamous cell keratinizing non-small cell lung cancer. The first type is diagnosed extremely rarely, in 15%. But, however, this is the most malignant course, rapid metastasis. Against a background of unclear symptoms. The process develops very rapidly and the prognosis is unfavorable.

Squamous cell lung cancer is very common. It begins with the degeneration of cells located in the respiratory tract. Therefore, the prognosis is made based on the type of cancer, rate of progression and malignancy of the tumor.

Central lung cancer

ByhisstructureAndformscentralcancerlungsMaybehavethe mostvariousforms:

plaque-like;

polyposis;

branched (peribronchial and perivascular);

knotty;

endobronchial diffuse

Location of the tumorByratioTolumenbronchiMaybehighlighttwobasicformscentralcancer:

1. endobronchial - developing inside the bronchus;
2. peribronchial - developing outside the bronchus, in its lumen.

The difference between these forms lies in the different symptoms and course of the disease. Much more often, central cancer of the right lung is diagnosed, accounting for approximately 52% of patients. Most often, this group includes men whose age has reached 40-45 years and who are heavy smokers with experience. Central cancer of the left lung is slightly less common; its diagnosis accounts for 48% of the disease.

It has been revealed that the main cause of bronchial cancer development is irritation of the bronchial mucosa. But despite this, the most important cause of bronchial cancer development is smoking, and passive smokers are at the same risk as active smokers. Harmful substances found in tobacco smoke (nicotine) destroy the bronchial mucosa and negatively affect the endocrine glands. In addition, tobacco smoke also contains a lot of harmful substances, which in turn are harmful to the body.

Metastases

Mestases (metastasis - og Greek. Meta staseo - otherwise I stand) are secondary foci of growth of almost any malignant tumor. Most cancers lead to the appearance of secondary lesions in local and regional lymph nodes, liver, lungs, and spine.

Modern concepts of the development of metastases are based on the fact that metastases in the lung develop almost immediately as soon as the malignant tumor itself appears. Individual cells detached from it first penetrate the lumen of the blood vessel (hematogenous dissemination pathway) or lymphatic vessel (lymphogenous dissemination pathway), and then are transported with the blood or lymph flow, stop at a new location, then leave the vessel and grow, forming new metastases. At first, this process is slow and imperceptible, since cancer cells from the maternal lesion suppress the activity of secondary lesions.

Liver metastases in lung cancer

Often, with lung cancer, general cerebral or focal symptoms predominate. Paroxysmal symptoms are observed very rarely, so they are not considered standard. Anticonvulsants are prescribed as prophylactic agents.

The liver is the most favorable place for the localization of metastases, regardless of where the primary tumor is located. Lung cancer and liver metastases are observed in half of all cases of lung cancer.

Symptoms of liver metastases are similar to those of liver cancer.

To themrelate:

frequent ailments;

causeless nausea and vomiting;

sudden weight loss;

heaviness in the upper abdomen;

attacks of acute abdominal pain;

excessive sweating.

Lung cancer metastases in the spine

Bone metastases, in particular metastases to the spine, are also quite common in lung cancer. Cancer cells spread throughout the body through the bloodstream and enter bone tissue, which leads to its destruction. Such processes of bone destruction cause more harm to the body than cancer cells. When bones break down, frequent fractures can occur.

Metastases in the spine usually cause pain in the area of ​​the corresponding vertebrae and, in addition, neuralgic pain caused by the pressure of these metastases on the nerve roots of the spinal cord. Localized more often in the lumbar spine, metastases cause sciatica pain; in rare cases, even compression of the spinal cord may occur and cause paralysis of the lower extremities. Metastases in the spine often occur at the initial stage of the disease. At later stages, metastases to the ribs are noted, which can cause severe pain simulating intercostal neuralgia. Impulsive change of position or careless compression of the chest leads to a fracture of the ribs. Diagnosis of tumor metastases in the spine and ribs is facilitated by an x-ray.

WITHmanycirculatoryvesselsarisemetastasesVbones:

shoulder;

femoral;

• cranial;

• spine.

Such metastases often occur asymptomatically, which is a very big danger. The main symptom of bone metastases in lung cancer is hypercalcemia.

HerCandefineBylike thissignsHow:

dry mouth;

excessive urine production;

disturbance of consciousness.

Lung cancer metastases to the brain

Often, in patients with cancer of the left lung with metastases spread, which occurs in the brain. In order for the effect of the treatment to give the best possible results, the entire brain is exposed to radiation. Stereotactic radiosurgery is used for multifocal lesions, followed by systemic chemotherapy. This metastasis may be asymptomatic, or it may show signs of damage to the central nervous system, such as drowsiness, apathy, headaches, etc.

Metastases in lung cancer appear synchronously or within one year after the onset of the disease. Metastases often affect the parietal lobe of the brain.

There are enough methods for treating lung metastases. Each method of treatment is selected individually for each patient, taking into account the course of the disease and the location of the metastases.

Lung cancer metastases to lymph nodes

Metastases in the lymph nodes are secondary foci of growth of malignant tumors that are present in the body. The development of metastases indicates active progression of the disease.

The main reason for the spread of metastases in the body is the growth of a malignant tumor. As production increases, cells begin to move throughout the body, using the lymphatic system.

Lung cancer, laryngeal cancer, bronchial cancer are provocateurs for the appearance of metastases in the lymphatic system.

Symptoms of metastasis to lymph nodes

The first sign of metastases in the lymph nodes is their enlargement, which the patient himself can determine by touch. Pain may not be felt.

At inspection, available definition lymph nodes:

• supraclavicular;

  axillary

Alsoincreaselymph nodesMaybebe presentWith:

• general weakness;

  weight loss.

These symptoms are a warning signal that requires you to immediately consult a doctor.

Mortality and lung cancer

Despite increases in incidence and prevalence, mortality from lung cancer is declining worldwide, but survival prognoses remain extremely poor.

Lung cancer mortality per 100,000 population:

According to statistics, lung cancer accounts for 31% of the structure of cancer mortality; mortality within 1 year after an accurate diagnosis is 50%. Projections for five-year survival rate, subject to timely diagnosis and rational treatment, reach 40-50%. But in the absence of adequate therapy, 80% of patients die within 2 years, and only 10% can live 5 years or more.

Dynamics of mortality from lung cancer in Russia per 100,000 population for 2004-2014:

Lung cancer survival forecasts

The mortality rate for lung cancer has remained high for many years, so survival projections are relatively low and stable. The life expectancy of patients depends on various factors: age, concomitant pathology, stage of cancer, type of tumor, tumor size, metastases and others.

According to statistics, lung cancer most often develops in the upper lobe (40%), in the lower lobe in 30% and least often in the middle lobe - 10%. In most cases, the tumor forms in the central regions (80%). Cancer of the central part of the lungs rapidly progresses, causing the appearance of unfavorable symptoms in the early stages; the life expectancy of patients with this type of tumor is no more than 4 years. Peripheral forms of lung cancer are less aggressive and exist for a long time without clinical manifestations.

Lung cancer is divided into types according to different criteria, a classification based on the histological structure of the tumor plays an important role:

Non-small cell lung cancer: formed in 80-85%, survival forecasts depend on the stage of the disease, but are generally favorable;

Small cell lung cancer: registered in 10-15% of cases, a rather aggressive form of the tumor, it is susceptible to chemotherapy and undergoes regression in 60-80%. Mortality from lung cancer of this type is high: no more than 40% of patients can live at the 1-2 stage of the neoplasm for 5 years, the 2-year survival rate is 50%, the five-year survival rate is 10-15%.

Projections of five-year survival in different countries in%:

Mortality from lung cancer and its stages

Lung cancer, according to the classification, has 4 stages that have a strong impact on survival prognosis:

1. The neoplasm is no more than 3 cm, located in one of the segments. If a non-small cell tumor is formed, then the prognosis for five-year survival is 60-70%, with a small cell type - no more than 40%. If the size of the tumor increases to 5 cm, then the prognosis worsens by 20%;
2. The neoplasm is more than 6 cm in size, localized in one of the segments, a single lesion of regional lymph nodes cannot be excluded, the 5-year survival prognosis for non-small cell cancer is 40%, for small cell cancer - 18%;
3. Lung cancer actively grows, affecting surrounding tissues, metastases to the lymph nodes, the five-year survival rate reaches 19%, but with multiple metastases in the lymph nodes no more than 8%;
4. Lung cancer of arbitrary size, gives multiple metastases to all organs and tissues, five-year survival prognosis is no more than 13%.

According to statistics, lung cancer in Russia is most often registered at stages 3-4, although in recent years the proportion of patients in the early stages has increased.

The share of registered patients depending on the stage of lung cancer for 2007-2017 in Russia.

Diagnosis of lung cancer

Modern diagnostics of lung cancer allows doctors to detect a tumor at any of its stages of development. Of course, it is better for the patient if doctors manage to detect lung cancer in the first stages of its development, and ideally: even at the stage of the beginning of the degeneration of healthy cells into cancer cells. Symptoms of oncology of the respiratory system of the body today can be diagnosed using the following methods:

Taking an x-ray. This is a simple, and at the same time the oldest method for determining the presence or absence of cancer in the lungs. It is performed by recording the condition of the lungs on a fluorographic image. If there is a foreign tumor inside the organ, then it will be displayed in the image as a dark spot or slight shading.

It all depends on the volume of the tumor and the density of its tissue. Unfortunately, this method for detecting lung cancer is not able to completely identify the tumor. As dark spots, he can recognize inflammation, or a completely different disease unrelated to oncology. Always after fluorography, and detection of darkening of the lungs in the image, additional diagnostic measures are prescribed.

CT scan. It is a more modern method of studying the lung. The diagnostic accuracy is so high that lung cancer detected using computed tomography may go unnoticed on a fluorographic image. Thanks to this, doctors are able to identify the tumor at the stage of its initial inception, when there are still practically no symptoms, and begin timely drug therapy.

Bronchoscopy. After lung cancer has been detected using an x-ray or computed tomography, the next step in diagnosing an oncological disease begins. A special flexible tube is inserted into the respiratory tract of the subject, at the end of which a video camera is installed. The image is displayed on a special monitor of medical equipment. The doctors' task is to locate the tumor inside the lungs, visually examine it, and then use special instruments to select part of the tumor tissue. A tumor fragment is sent for biopsy to determine whether it is malignant or benign.

Needle biopsy. This type of diagnosis, like the previous one, involves penetration into the lungs, but not with the help of a bronchoscope, but with a special needle. It is so thin that it is injected through the patient’s skin and penetrates the small bronchi. These are the most distant and microscopic parts of the airways in the lungs. The selected biological material is also transferred for laboratory study.

Blood test for markers. Special drugs with a protein structure are introduced into the patient’s body and circulate throughout the body along with the blood. Their task is to signal the presence or absence of cancer cells in the lungs. If they are present there, then in the resulting analyzes the number of markers will be displayed in excess. Each individual organ studied has its own type of markers.

In addition, in case of unclear diagnostic cases and identification of signs characteristic of lung cancer, diagnostic thoracotomy can be used - material for histological examination is obtained during the surgical procedure. To detect metastases of lung cancer, a biopsy of a lymph node or organ, ultrasound, or radioisotope scanning can be performed.

A method by which the level of accumulation of radioisotopes in tissues is measured and affected areas are identified (radioisotope scanning).

Positron emission tomography, which makes it possible to make a functional assessment of oncological formation.

Ultrasound examination using a modern ultrasound machine

Pulmonary syndrome

There are several pulmonary syndromes: pulmonary compaction syndrome, pleural syndrome, cavity syndrome, broncho-obstructive syndrome, hyperairy lung syndrome, Pickwickian syndrome, sleep apnea syndrome (sleep apnea syndrome), respiratory failure syndrome. It should be borne in mind that within the same major syndrome there are a number of variants, the diagnosis of which is certainly important, since treatment methods will be different.

Main clinical (pulmonary) syndromes:

Pulmonary consolidation syndrome:

1. Infiltrate (pneumonic, tuberculous, eosinophilic).
2. Pulmonary infarction (thromboembolism, thrombosis).
3. Atelectasis (obstructive, compression, middle lobe syndrome).
4. Congestive heart failure (stagnation of fluid in the lower parts of the lungs).
5. Tumor.

Pleural syndrome:

1. Fluid in the pleural cavity (transudate, exudative pleurisy).
2. Air in the pleural cavity (pneumothorax).

Cavity syndrome(disintegrating abscess and tumor, cavity).

Broncho-obstructive syndrome:

1. Obstruction or narrowing of the bronchus.
2. Bronchospasm.

Hyperairy lung syndrome(various types of emphysema).

Pickwickian syndrome And apnea syndrome during sleep (night apnea syndrome).

Respiratory distress syndrome:

1. Acute respiratory failure (including adult distress syndrome).
2. Chronic respiratory failure.

The identification of these syndromes occurs primarily when using the basic methods of examining the patient - examination, palpation, percussion, auscultation.

Pulmonary consolidation syndrome

Pulmonary compaction syndrome is one of the most pronounced manifestations of pulmonary diseases. Its essence lies in a significant reduction or complete disappearance of the airiness of the lung tissue in a more or less widespread area (segment, lobe, several lobes at the same time). Foci of compaction differ in location (lower areas, apexes of the lungs, middle lobe, etc.), which also has differential diagnostic significance; they specifically highlight the subpleural localization of the focus of compaction with the involvement of the visceral and adjacent parietal layers of the pleura, which is accompanied by the addition of signs of pleural syndrome. The development of compaction can occur quite quickly (acute pneumonia, pulmonary infarction) or gradually (tumor, atelectasis).

There are a number of types of pulmonary compaction: infiltrate (pneumonic focus) with the release of tuberculous infiltrate, which is prone to caseous decay; pulmonary infarction due to thromboembolism or local vascular thrombosis; obstructive (segmental or lobar) and compression atelectasis (collapse, collapse of the lung) and hypoventilation; a variant of atelectasis is hypoventilation of the middle lobe due to obstruction of the middle lobe bronchus (bronchopulmonary lymph nodes, fibrous tissue), which, as is known, normally does not ventilate the lobe completely enough - middle lobe syndrome; lung tumor; congestive heart failure.

Subjective manifestations of pulmonary compaction syndrome vary depending on the nature of the compaction and are discussed when describing the corresponding diseases.

A common objective sign of a developing decrease in airiness corresponding to the compaction of a section of lung tissue is the asymmetry of the chest, revealed during examination and palpation.

Regardless of the nature of this syndrome, with large foci of compaction and their superficial location, one can detect bulging and lag in breathing of this part of the chest (and only with large obstructive atelectasis is it possible to retract it), vocal tremors are increased. Percussion determines dullness (or absolute dullness) in the area of ​​compaction, and in the presence of infiltration (pneumonia), in the initial stage and during the period of resorption, when the alveoli are partially free of exudate, and the draining bronchi retain full patency (and therefore contain air), dullness combined with a tympanic shade of percussion sound. The same dull-tympanic shade upon percussion is noted in the initial stage of development of atelectasis, when there is still air in the alveoli and communication with the afferent bronchus is preserved. Subsequently, when the air is completely absorbed, a dull percussion sound appears. A dull percussion sound is also noted above the tumor node.

Auscultation in the infiltrate zone in the initial and final stages of inflammation, when there is little exudate in the alveoli and they straighten when air enters, weakened vesicular breathing and crepitus are heard. At the height of pneumonia, due to the filling of the alveoli with exudate, vesicular breathing disappears and is replaced by bronchial breathing. The same auscultatory picture is observed with pulmonary infarction. With any atelectasis in the initial stage (hypoventilation), when slight ventilation of the alveoli still occurs in the collapse zone, a weakening of vesicular respiration is noted. Then, after resorption of air in the case of compression atelectasis (compression of the lung from the outside by liquid or gas of the pleural cavity, tumor, with a high position of the diaphragm), bronchial breathing is heard: the bronchus, which remains passable for air, conducts bronchial breathing, which spreads to the periphery by a compacted, compressed area of ​​the lung.

With obstructive atelectasis (reduction of the lumen of the afferent bronchus by an endobronchial tumor, foreign body, compression from the outside) in the stage of complete blockage of the bronchus above the airless zone, no breathing will be heard. Breath sounds will also not be heard over the tumor area. Bronchophony with all types of compactions repeats the patterns identified by determining vocal tremors.

During auscultation over subpleurally located infiltrate and tumor, as well as during pulmonary infarction, a pleural friction noise is detected.

Since the bronchi are often involved in the process in various types of compaction, it is possible to detect moist rales of different sizes. Of particular diagnostic importance is listening to fine-bubbly ringing rales, indicating the presence of an infiltration zone around the small bronchi, which enhances the sound vibrations occurring in the bronchi.

In heart failure, a decrease in the airiness of the lung tissue is detected, primarily in the lower parts of the lungs on both sides, which is associated with stagnation of blood in the pulmonary circulation. This is accompanied by a shortening of the percussion sound, sometimes with a tympanic tint, a decrease in the excursion of the lower edge of the lungs, a weakening of vesicular breathing, the appearance of moist fine rales, and sometimes crepitus.

Pleural syndrome

Pleural syndrome is a set of symptoms characteristic of damage to the pleural layers (inflammation, tumor) and (or) accumulation of fluid (exudate, transudate, blood, pus) or gas in the pleural cavity; sometimes inflammation of the pleura (dry pleurisy) precedes the appearance of pleural fluid; in addition, liquid and gas can be detected simultaneously in the pleural cavity.

With dry pleurisy, during breathing there is a lag in the affected half of the chest, since due to severe pain the patient spares this area. Auscultation over the affected half of the chest reveals a rough pleural friction noise, sounding equally loud throughout inhalation and exhalation, blocking vesicular breathing; sometimes the friction of the pleura is clearly noticeable upon palpation.

Accumulation of fluid in the pleural cavity (hydrothorax), which can be exudate, transudate, pus (pyothorax, pleural empyema), blood (hemothorax) or of a mixed nature, is accompanied by smoothing of the intercostal spaces and even bulging of the affected half of the chest, lag in breathing, voice no shaking is performed on this side. With comparative percussion, a sharp dullness or absolute dullness of the percussion sound is determined, above the upper border of which a poorly ventilated, compressed lung gives it a dull-tympanic hue. With topographic percussion, features of the upper border of the dullness are revealed, which, as already mentioned, can have a different direction depending on the nature of the fluid, as well as a significant limitation in the mobility of the lower edge of the compressed lung. Auscultation above the zone of dullness reveals a sharp weakening of vesicular breathing or, more often, its absence, above this zone - weakening of vesicular breathing, and in an oblique direction of the upper line of the zone of dullness (exudative pleurisy) part of a more compressed lung (closer

to the spine) is adjacent to the large bronchi, so a site is formed where bronchial breathing (Garland’s triangle) is heard against the background of a dull tympanic percussion sound. With exudative pleurisy, another small area is sometimes identified adjacent to the spine in the lower part of the dullness zone and already on the healthy side, where, as a result of some displacement of the aorta, dullness of percussion sound and absence of breathing during auscultation are determined (Rauchfuss-Grocco triangle).

The presence of gas in the pleural cavity (pneumothorax) is indicated by characteristic symptoms that make it possible to diagnose this condition even before radiography. Upon examination and palpation of the affected half of the chest, smoothness of the intercostal spaces, a lag in breathing, and a weakening of vocal tremors are revealed. The percussion sound over this zone is tympanic in nature; with large pneumothorax, the lower border of tympanitis falls below the usual border of the lungs beyond the light of the expansion of the pleural sinuses.

With the simultaneous presence of gas and liquid (hydropneumothorax, pyopneumothorax, hemopneumothorax), percussion over the affected half of the chest reveals a combination of dull (lower part) and tympanic (upper part) shades of sound.

Auscultation allows us to detect the absence of vesicular breathing (or its sharp weakening), and with the so-called valvular pneumothorax, when there is communication between the pleural cavity and the respiratory tract, and with each breath a new portion of air enters it, you can listen to bronchial breathing (also only on inspiration) .

Cavity syndrome

Cavity syndrome includes signs the appearance of which is associated with the presence of a cavity, abscesses, cysts, i.e. formations that have a dense, more or less smooth wall, often surrounded by an infiltrative or fibrous shaft. The cavity can be filled entirely with air only (empty cavity) or contain, in addition to air, this or that amount of liquid, remain closed or communicate with the draining bronchus. All this, of course, is reflected in the characteristics of the symptoms, which also depend on the size of the cavity and the depth of its location. With large, superficially located and isolated cavities, regardless of their contents, vocal tremors are weakened. If the cavity communicates with the bronchus and at least partially contains air, the percussion sound will have a tympanic tint; dullness or absolute dullness is noted above the fluid-filled cavity. When auscultating over an isolated air cavity, breathing is not heard; if the air cavity has a connection with the draining bronchus, bronchial breathing will be heard, which is easily carried out from the site of formation (glottis) along the air column and can acquire a metallic tint as a result of resonance in the smooth-walled cavity (amphoric breathing). The cavity, partially containing liquid, is the source of the formation of moist rales, which, as a rule, are loud in nature, since their conduction is enhanced by the surrounding compacted (infiltrated) tissue. In addition, auscultation can detect an independent stenotic noise that enhances bronchial breathing, occurring at the junction of the cavity (cavity) with the draining bronchus.

It should be noted that all of these symptoms characterizing cavity syndrome are often very dynamic, since there is a stage in the development of cavity formation, especially lung abscess: partial or complete emptying is replaced by the accumulation of fluid, which is reflected in the characteristics of the above symptoms of the presence of a cavity containing air or fluid .

Broncho-obstructive syndrome

Broncho-obstructive syndrome (bronchial obstruction syndrome) is manifested by a severe productive, less often non-productive cough, as well as symptoms of the naturally developing consequences of its long-term existence - signs of pulmonary emphysema. The clinical manifestations of broncho-obstructive syndrome are based on impaired bronchial obstruction, associated difficult and uneven ventilation (mainly due to limited expiratory flow) and an increase in residual lung volume. With true bronchial obstruction syndrome, we are talking about a change in the patency of the small bronchi (they are called in this regard the “Achilles heel” of the bronchi). Impaired patency of small bronchi most often occurs due to inflammation and swelling of the bronchial mucosa (chronic bronchitis, allergic component), bronchospasm, usually with swelling of the mucous membrane (bronchial asthma), and less often with diffuse peribronchial fibrosis, compressing the bronchi from the outside.

Chronic bronchitis most often leads to the development of irreversible inflammatory-scarring changes in the small bronchi and represents the basis of chronic obstructive pulmonary disease, the main clinical signs of which are the following:

1. cough with thick and sticky sputum;
2. clinical and functional signs of airway obstruction;
3. increasing shortness of breath;
4. development of “pulmonary heart” (cor pulmonale), terminal respiratory and heart failure.

Cigarette smoking is the most common etiological factor that supports the progression of the disease. Due to the incidence of cyanosis and heart failure, patients with chronic obstructive bronchitis are described as “blue edema.” In this variant of the obstructive syndrome, following inflammatory edema of the mucous membrane of the terminal bronchioles, leading to hypoventilation of the alveoli, a decrease in the partial pressure of oxygen and an increase in the partial pressure of carbon dioxide - hypoxemia and hypercapnia, spasm of the alveolar capillaries and hypertension of the pulmonary circulation occur. A pulmonary heart is formed, the decompensation of which is manifested by peripheral edema.

Hyperairy lung syndrome

Lung hyperairiness syndrome is most often a consequence of long-term difficulty in exhalation (bronchial obstruction), which leads to an increase in the residual volume of the lungs, chronic mechanical effects on the elastic apparatus of the alveoli, their stretching, and irreversible loss of the ability to collapse, increasing the value of the residual volume. A typical variant of this syndrome is pulmonary emphysema, which usually develops gradually. Acute pulmonary distension is rare.

Thus, there is a close relationship between broncho-obstructive syndrome and pulmonary emphysema, which therefore most often has an obstructive (obstructive) character. Much less common is compensatory (including vicarious) emphysema, which develops in response to a slow increase in diffuse pulmonary fibrosis. Due to the fact that broncho-obstructive syndrome often has a generalized character, pulmonary emphysema is a bilateral process. Its clinical signs are a barrel-shaped chest with reduced respiratory mobility, weak conduction of voice trembling, the presence of a widespread box percussion sound that can replace the zone of absolute cardiac dullness, a downward displacement of the lower edge of the lungs, a uniform weakening of vesicular respiration, auscultatory signs of broncho-obstructive syndrome (wheezing, prolonged exhalation).

It should be emphasized that these signs are detected in advanced emphysematous process; of course, it is important to detect earlier symptoms, which essentially include one - a decrease in the respiratory excursion of the lower pulmonary edge, which gradually increases over time, which is detected long before the appearance of signs of pronounced swelling of the lungs.

Pickwickian syndrome and sleep apnea

Of interest are Pickwickian syndrome and sleep apnea syndrome (a symptom of sleep apnea), which are usually mentioned in the section on diseases of the respiratory system (although they are not directly related to lung diseases), since their main manifestation is respiratory failure with hypoxia and hypoxemia - develops in the absence of primary lung disease.

Pickwickian syndrome is a symptom complex that includes severe alveolar hypoventilation and the resulting hypoxia and hypercapnia (PCO2 above 50 mm Hg), respiratory acidosis, as well as irresistible daytime sleepiness, polycythemia, high hemoglobin levels, and episodes of apnea. The reason for this hypoventilation is considered to be significant obesity with predominant fat deposition in the abdominal area with short stature; Genetic sensitivity to such hypoventilation appears to be important. These patients are characterized by a long period of severe (morbid) obesity with an additional sharp increase in body weight, the development of cor pulmonale, shortness of breath on exertion, cyanosis, swelling of the legs, morning headaches, but the most typical symptom is pathological drowsiness, including during conversation, while eating, reading and in other situations. It is of interest that a decrease in body weight leads in some patients to a reverse development of the main signs of the symptom complex.

Respiratory distress syndrome

Respiratory failure syndrome is one of the largest and most important pulmonary syndromes, since its occurrence indicates the appearance of changes in the main function of the respiratory organs - the gas exchange function, including, as already mentioned, pulmonary ventilation (air flow into the alveoli), diffusion (gas exchange in the alveoli) and perfusion (oxygen transport), as a result of which the maintenance of normal blood gas composition is disrupted, which in the first stages is compensated by more intense work of the external respiration system and heart. Typically, respiratory failure develops in patients suffering from chronic lung diseases, leading to the appearance of emphysema and pneumosclerosis, but it can also occur in patients with acute diseases accompanied by the exclusion of a large mass of the lungs from breathing (pneumonia, pleurisy). Recently, acute distress syndrome in adults has been specifically identified.

Adult respiratory distress syndrome is the most common cause of acute respiratory failure with severe hypoxemia, developing in a person with previously normal lungs due to the rapid accumulation of fluid in the lung tissue at normal pressure in the pulmonary capillaries and a sharply increasing permeability of the alveolar-capillary membranes. This condition is caused by the membrane-damaging influence of toxins and other agents (medicines, especially narcotics, toxic products formed during uremia), heroin, aspirated stomach contents, water (drowning), excessive formation of oxidants, trauma, sepsis caused by gram-negative bacteria, fat embolism, acute pancreatitis, inhalation of smoky or hot air, trauma to the central nervous system, and, apparently, a direct effect on the alveolar membrane of the virus. As a result, lung compliance and gas exchange are impaired.

Acute respiratory failure develops very quickly. Shortness of breath appears and quickly intensifies. Additional muscles are involved in the work, a picture of non-cardiogenic pulmonary edema develops, and a mass of moist rales of various sizes is heard. X-ray reveals a picture of interstitial and alveolar pulmonary edema (diffuse infiltrative changes in the form of “white shutdown” of the pulmonary fields). Signs of respiratory failure with hypoxemia and then hypercapnia increase, fatal heart failure intensifies, disseminated intravascular coagulation (DIC) and infection are possible, which makes the prognosis very difficult.

Systemic syndromes

Systemic paraneoplastic syndromes are manifested by large-scale damage to the body, which affects various organs and systems. The most common manifestations of lung cancer are the following:

1. Cachexia is a depletion of the body's resources. It manifests itself as a rapid decrease in body weight, which is accompanied by a weakening of the nervous and muscular systems. Cachexia is caused by metabolic disorders and a lack of oxygen and nutrients in the tissues. has a detrimental effect on the functioning of the entire organism, gradually causing disturbances in the functioning of various organs that are incompatible with life. To date, exhaustion is the cause of approximately 35% of deaths in patients with cancer of the respiratory tract. The main reason for the development of cachexia is general intoxication of the body during the breakdown of tumor products.
2. Systemic lupus erythematosus is a pathology of the immune system, causing a reaction of autoaggression of T and B lymphocytes and the formation of antibodies to the patient’s own cells. The development of lupus can be caused by exposure of the patient to a growing tumor and metastases, taking cytostatic drugs, or penetration of various bacteria and viruses into the tissue. Manifested by damage to blood vessels and connective tissue. The patient develops a rash on the nose and cheeks, peeling of the skin, trophic ulcers, and impaired blood flow in the vessels of the extremities.
3. Orthostatic hypotension is a pathological syndrome that manifests itself with a sharp decrease in blood pressure if the patient tries to assume an upright position. The decrease in indicators is more than 20 mm Hg. Art. The disease is caused by disruption of normal blood flow in the human body and oxygen deficiency in tissues and organs, including the brain.
4. Nonbacterial thrombotic endocarditis is a pathology also called cachetic endocarditis. This disorder develops in people with cancer due to the deposition of proteins and platelets on the valves of the heart and blood vessels. Such disturbances lead to thrombosis and severe disruption of the circulatory system.

Skin syndromes

Skin lesions develop for several reasons. The most common factor that provokes the appearance of various pathologies of the epidermis is the toxic effect of malignant neoplasms and cytostatic drugs on the human body. All this weakens the body’s protective functions and allows various fungi, bacteria and viruses to infect the patient’s skin and epithelium.

In patients with lung carcinoma, the following syndromes are noted:

hypertrichosis - excessive hair growth throughout the body;

dermatomyositis - inflammatory pathology of the connective tissue;

acanthosis - coarsening of the skin at the site of the lesion;

hypertrophic pulmonary osteoarthropathy - a lesion leading to deformation of bones and joints;

vasculitis is a secondary inflammation of blood vessels.

Hematological syndromes

Circulatory disorders in patients with cancer develop quite quickly and can appear already at stages I-II of the pathology. This is caused by the sharp negative impact of carcinoma on the functioning of the hematopoietic organs and disruption of the full functioning of the lungs, which causes oxygen starvation of all systems of the human body. Patients with lung cancer show a number of pathological symptoms:

thrombocytopenic purpura - increased bleeding, leading to the appearance of hemorrhages under the skin;

• myloidosis - a disorder of protein metabolism;

  hypercoagulation - increased blood clotting function;

  leukemoid reaction - various changes in the leukocyte formula.

Neurological syndromes

Neurological paraneoplastic syndromes develop due to damage to the central or peripheral nervous system. They arise due to trophic disturbances or due to the growth of metastases in the spinal cord or brain, which is quite often observed in pulmonary carcinomatosis. Patients experience the following disorders:

peripheral neuropathy - damage to the peripheral nerves leading to impaired mobility;

Lampert-Eaton myasthenic syndrome - muscle weakness and atrophy;

necrotizing myelopathy - necrosis of the spinal cord leading to paralysis;

cerebral encephalopathy - brain damage;

loss of vision.

Treatment

Before starting treatment, a diagnosis is carried out to determine the rate of development of the process and other nuances that indicate the patient’s health status. At the initial stage, since therapy involves new drugs, they are used in minimal dosages. Oncologists try to limit themselves to medications, because in this case the risk of new injuries is minimized and the disease progresses more easily.

However, in some cases, when a segment is damaged, a biopsy, radiation, and an ASD drug are used. It is recommended not to use more than 2-3 methods at the initial stage, because this can cause serious harm to the body and provoke syndromes . With a normal start of treatment, the following results will be achieved:

normalization of the respiratory process and elimination of the forced formation of shortness of breath;

relief from unpleasant and painful sensations in the bronchi and pulmonary parenchyma;

stabilization of temperature indicators, which leads to normalization at the initial stage and eliminates negative symptoms and signs.

In order for lung cancer treatment to be effective and the results to last for a long time, it is necessary to constantly consult with an oncologist and carry out diagnostic examinations. This will allow you not only to know everything about how the process develops, but also to determine the time of formation and how long this period will last. If initial treatment for lung cancer is not effective, therapy will be needed in subsequent stages.

For lung cancer, treatment methods can be of several types.

Surgical intervention

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

Radical- the primary tumor focus and regional lymph nodes must be removed;

Palliative- aimed at maintaining the patient's condition.

Consists of the following stages:

General strengthening procedures to prepare the patient for surgery - taking vitamin complexes, a protein diet, taking antibiotics to reduce the inflammatory process and performing therapeutic bronchoscopy. In case of cardiovascular failure, medications are prescribed that increase the tone of blood vessels and breathing exercises;

During the postoperative period, the patient should be provided with constant access to oxygen. For the first 2-3 days, lying down and aspiration from the pleural cavity are indicated;

When the patient recovers, he is prescribed taking medications to prevent complications.

For inoperable forms, remote gamma therapy (radiation therapy) and courses of chemotherapy are indicated.

The lesions are directly irradiated, and the doses do not exceed 50-70 Gy. The consequences of radiation therapy are hair loss, nausea, pain and skin rashes. Chemotherapy is used before and after surgery, as well as in the presence of inoperable tumors that are accompanied by damage to the lymph nodes.

Acts in the following areas:

reducing the size of metastases;

weakening of symptoms if it is impossible to remove foci of inflammation;

destruction of cells and affected tissues that were not removed during resection.

Chemotherapy is of the following types:

therapeutic - to reduce metastases;

adjuvant - used for prophylactic purposes to prevent relapse;

inadequate - immediately before surgery to reduce tumors. It also helps to identify the level of sensitivity of cells to drug treatment and establish its effectiveness.

Chemotherapy

The tactics of mass chemotherapy are determined by the form of the disease and the stage of carcinogenesis.

Common cytostatics are pharmacological drugs that have the ability to suppress the growth of cancer cells: Cisplatin, Etoposide, Cyclophosphamide, Doxorubicin, Vincristine, Nimustine, Paclitaxel, Carboplatin, Irinotecan, Gemcitabine. These drugs are used before surgery to reduce the size of the tumor. In some cases, the method has a good therapeutic effect. Side effects after using cytostatics are reversible.

Relatively recently introduced into practical use:

hormonal treatments;

immunological (cytokinetic) methods of combating lung cancer.

Their limited use is associated with the complexity of hormonal correction of certain forms of cancer. Immunotherapy and targeted therapy do not effectively fight cancer in an organism with a destroyed immune system.

Promising treatments

Treatment of lung cancer mainly involves surgery. Depending on the size and stage of development, radical or palliative operations are performed. In this case, not only the tumor is usually removed, but also regional lymph nodes and adjacent tissue. In some situations, a lobectomy, aimed at removing a lobe of the lung, or a pneumonectomy, which involves surgical removal of the entire lung, is indicated.

However, it is impossible to imagine treating lung cancer without the use of chemotherapy. Israeli specialists use not only traditional methods of administering medications, but also innovative developments to help their patients. One of them is the procedure of inhalation of cytostatic substances, which provides the most effective effect on the tumor. The new chemotherapy technology used in Israel already offers excellent prospects for improving the effectiveness of lung cancer treatment. The inhalation method of administering cytostatics makes it possible to significantly reduce the severity of side effects, which are often unbearable for patients and force them to stop treatment. That is why a recent discovery in the field of experimental nanomedicine could lead to a real breakthrough in the field of cancer treatment in Israeli clinics. Replacing the traditional intravenous route of administering cytostatics with inhalation is the key to overcoming the problem of side effects of these drugs.

The groundbreaking research used chemotherapy and interferon-based drugs to make atypical cancer cells more sensitive. The drugs were inhaled in the form of nanoparticles, the sizes of which approached the parameters of individual molecules. This administration of the drug allowed the substance to enter directly into the lungs, bypassing the liver, kidneys, and spleen. Thus, the severity of side effects became minimal. This therapy option is much safer for the patient, but at the same time shows excellent results. This can be explained by the fact that the nanoparticles of the drug attach directly to the surface of the tumor cell and increase its sensitivity to the effects of chemotherapy.

It is expected that the new method will find wide application in clinical practice, because today, despite the amazing successes of Israeli surgeons, treatment of lung cancer is impossible to imagine without chemotherapy. However, the biggest problem in its implementation continues to be the severe side effects of most drugs. Fortunately, these difficulties can now be easily resolved.

To treat lung tumors in Israel, multimodal therapy is used, which combines several effective techniques. The specialist’s goal is to completely eliminate the tumor in a given patient and control the course of the disease. Traditionally, surgery, radiation, and chemotherapy are used to treat cancer. However, Israeli doctors constantly use innovative approaches to helping patients, for example, gene, photodynamic, and immune therapy. As a result, it is possible to significantly improve the survival rate and quality of life of patients with lung tumors. Among Israeli doctors, the most effective treatment using surgery, treatment and chemotherapy is considered to be trimodal therapy.

In practice, doctors began to use a combination of different techniques when they discovered that most patients do not have very good survival rates with monotherapy. The use of a combination of techniques made it possible to enhance the positive dynamics. The best results were obtained by combining extrapleural pneumonectomy with radiation and chemotherapy. As a result, the five-year survival rate of patients increased to 45%. In addition, the frequency of detection of metastases in the lymph nodes decreased significantly. Over time, doctors became even more convinced of the effectiveness of the new method.

When developing a multimodal therapy plan, doctors take into account the stage of cancer development, its histological subtype, the degree of involvement of lymph nodes in the pathological process, the general condition of the patient, the potential toxicity of treatment and possible complications. Specific combinations of treatment methods are recommended depending on the characteristics of each clinical situation. If a patient responds poorly to treatment, doctors make the necessary adjustments and achieve improvement.

Radiation therapy

One of the main methods of combating malignant neoplasms is the treatment of lung cancer with radiation therapy. The advantages of this method are its effectiveness and safety.

Radiation therapy, also called radiotherapy, is based on the use of high-energy radiation to fight cancer. This. Currently a common technique used by radiation oncologists to completely get rid of the disease, relieve pain and symptoms caused by the tumor.

Irradiation of a cancer tumor disrupts the reproductive functions of cells, that is, they do not multiply.

Radiation therapy kills cancer cells by interfering with their DNA structure, resulting in their inability to grow and reproduce. Today, radiotherapy is an effective method of combating tumors.

The sensitivity of tumor cells to radiation is explained by:

Dividing speed (faster than healthy cells);

Inability to repair damage.

Radiotherapy for this type of disease is the most used method of combating the tumor, both as an independent method and simultaneously with chemotherapy.

In oncology clinics, this treatment is used before or after surgery. A course of radiation therapy may be prescribed after chemotherapy to prevent brain metastases.

The effects of radiotherapy in combination with other methods can overcome small cell cancer, but have side effects.

Methods of using radiation therapy

Radiation therapy for lung cancer can be used for the following purposes:

• As the main treatment method when localized lung cancer is detected.
• To reduce the size of a cancerous tumor before surgery.
• To eliminate traces of cancer after surgery.
• To destroy cancer metastases that have spread to the brain and other internal organs.

According to these criteria, radiation therapy for lung cancer is divided into two main types, depending on the degree of its effect on the body:

• Radical radiation therapy. Used to completely destroy cancer cells. Typically used in the early stages of the disease or in cases of radiosensitive cancers. For a full course of treatment, it is necessary to attend radiation therapy sessions every day for several days - usually the duration of treatment is up to two weeks.
• Non-radical radiation therapy for lung cancer is used to prevent the growth of cancer, and also, in some cases, to save the patient’s life - for example, when a tumor can block the respiratory tract or destroy the lung. For such therapy, one or several sessions are enough.

Types of radiotherapy

For radiation treatment of lung cancer, the following main types are usually used:

• Remote (external). The radiation source in this case is located at a short distance from the patient, and the rays are projected to the expected location of the tumor;
• Internal radiotherapy. The radiation source is in contact with the cancerous tumor;
• Systemic radiotherapy. It involves irradiation of the whole body and is used when there is a suspicion of associated cancerous bleeding of the blood.

Chemotherapy for lung cancer today is one of the most popular procedures. The fact is that lung cancer is the leading cause of death in the world.

Often this disease affects older people. Diagnosing the problem at an early stage can help resolve the problem. Proper use of diagnostic measures and effective treatment provide a good chance of recovery.

Indications for chemotherapy for lung cancer

Indications for chemotherapy for lung cancer directly depend on the disease itself and its stage. There are a number of factors that influence this. First of all, attention is paid to the size of the tumor, stage of development, growth rate, degree of differentiation, expression, degree of metastasis and involvement of regional lymph nodes, as well as hormonal status.

The individual characteristics of the organism also play a special role. These include age, the presence of chronic diseases, the location of the malignant cancer, as well as the condition of regional lymph nodes and general health.

The doctor always evaluates the risks and complications that treatment may cause. Based on all these factors, the main indications for chemotherapy are given. Basically, this procedure is recommended for people with cancer, leukemia, rhabdomyosarcoma, hemoblastosis, chorionic carcinoma and others. Chemotherapy for lung cancer is a chance for recovery.

The effectiveness of chemotherapy for lung cancer

The effectiveness of chemotherapy for lung cancer is quite high. But for the treatment to really give a positive result, complex combinations must be carried out. The effectiveness of modern treatment methods is in no way related to the severity of side effects. Success during treatment depends on a lot. Thus, the stage of the disease and the period when it was diagnosed play an important role.

The use of medicinal plants in the treatment of disease

In folk medicine there are a sufficient number of plants that have antitumor properties. Moreover, some plants exist in several botanical species. For example, thistle can be vegetable, field and multi-leaved. This plant contains a large amount of rubber, alkaloids, tannins, flavonoids, and essential oil. For lung cancer, a prepared infusion of bergenia is taken orally. To do this, the leaves and tops of the plant on which the flowers are located are collected, dried and crushed. For those who do not have the opportunity to collect herbs, there is an alternative option - to purchase a ready-made collection. To prepare a decoction, you need to add three tablespoons of dry herb to 500 ml of plain water and simmer over low heat for five minutes. The container with the broth should be wrapped and allowed to brew for about two hours. The infusion is consumed four times a day, half a glass thirty minutes before meals. This remedy is used to treat lung cancer and helps stop coughing up blood.

There are plants with very strong effects, so long-term use of decoctions and infusions is not recommended. This applies to creeping thyme. You should brew one tablespoon of herb in a glass of boiling water. The decoction is infused for an hour, while the container must be closed. Take one tablespoon at least four times a day

For preventive and therapeutic purposes, plantain of the large and lanceolate species is used for lung cancer. The plant grows throughout Eurasia and its healing properties have been known since ancient times. First of all, plantain helps to increase immunity, the level of hemoglobin in the blood, thinning sputum, and eliminating harmful organisms from the upper respiratory tract. The use of plantain has a huge effect during human infection with bacteria such as Pseudomonas aeruginosa. The infusion is prepared simply; for this, take a tablespoon of the dried plant and brew it with a glass of boiling water. The product should sit for three hours. Drink one tablespoon of decoction 20 minutes before meals four times a day.

Traditional medicine is rich in another antitumor and hemostatic plant. This is gray wormwood, from which decoctions are also prepared. For one glass of boiling water, you should take a dry crushed plant in the amount of one teaspoon. It takes two hours to infuse, then strain the broth and drink two tablespoons before meals at breakfast, lunch and dinner.

As you know, a malignant tumor develops by rapid cell division. In other words, it grows “out of itself.” That is why for a long time education is strictly localized and does not give any symptoms. If it is identified and removed immediately, this disease can be completely defeated. Only at a certain stage of its development, lung cancer begins to affect and destroy nearby organs, vessels and systems, to give metastases. In this case, it is already very difficult to defeat the disease, and often it is simply impossible. At each stage of lung cancer, the doctor develops an individual treatment plan for the disease, on which the probability of a complete cure of the patient depends not least. Therefore, it is so important to correctly, and most importantly, timely diagnose and determine the degree of pulmonary oncology. From the article you will find out how many stages of cancer there are and the features of the development of a malignant neoplasm in each of them.

Classification of malignant tumors by growth stages

Before making a diagnosis of lung cancer and determining its severity, the doctor must conduct an examination that will help determine the exact location of the neoplasm and the degree of its growth (indicated by the numbers I, II, III, IV). Since 1956, doctors began to use the following classification to determine the stage of cancer (relevant only for non-small cell type oncology):

• Stage I – tumor no more than 3 cm in size. Nearby lymph nodes are not affected;
• II – neoplasm with a diameter of 3 cm or more. There are no metastases at all, or there are single ones in the lymph nodes closest to the affected organ;
• III – neoplasm size 6 cm or more. There are metastases in the nearest lymph nodes. Also, the neoplasm left the boundaries of the lung and grew into the organs closest to it;
• IV - a large tumor, there is a significant number of multiple metastases throughout the body.

Over time, they came to the conclusion that it is not very convenient to classify malignant neoplasms in this way. The fact is that the data contained in the classification presented above is very generalized and is not enough to prescribe effective treatment to the patient.
The classification was finalized and each degree of lung cancer (except the fourth) was divided into subsections - “A” and “B”. The letter “A” indicated that there were no metastases, “B” that there were metastases. As a result, the classification took the following form:

Stage 1:

• 1A – the malignant formation does not exceed 3 cm in size. The process of introducing the neoplasm into the tissue of the organ begins. Lymph nodes and bronchi are not yet affected;
• 1B – the cancerous tumor is growing (3-5 cm). Lymph nodes remain unaffected.

Stage 2:

• 2A – tumor size is 5-7 cm, lymph nodes are not affected. Or the tumor size is 5 cm and there are single metastases in the nearest lymph nodes;
• 2B – the tumor is no more than 7 cm in size and is not very far from the lymph nodes. The size is 5 cm, but damage to the pleura and the membrane of the heart muscle begins.

Stage 3:

• 3A – formation is more than 7 cm in size, metastases form in the lymph nodes of the mediastinal organs, pleura, diaphragm;
• 3B – the tumor affects the mediastinum and heart muscle.

Stage 4:

With stage 4 cancer, irreversible changes occur in the body. Metastases affect almost all organs. This stage of cancer is incurable.

Stages of small cell cancer

The above stages of lung cancer development are relevant only for non-small cell malignancy. Small cell malignant tumor is classified differently (this is due to the fact that the cells are much smaller in size and the process of their division, and accordingly its growth occurs much faster):

1. Limited.
2. Extensive.

At a limited stage of development, the neoplasm is located in the zone of the lung in which it was “born”. It is also possible for it to grow into the surrounding space and nearby lymph nodes. In extensive cases, the malignant tumor metastasizes to neighboring organs and lymph nodes.

The importance of correctly staging lung cancer

Why is it so important to correctly stage lung cancer?

The fact is that, thanks to the information provided by the classification of lungs according to severity, the doctor can predict the course of development of the disease (knowing the type of tumor, its structure, growth characteristics, the presence or absence of metastasis) and, depending on this, select the correct and effective treatment.

On which, in turn, the prognosis of the outcome of the disease will depend.

Forecast

What is the prognosis for pulmonary oncology? The answer to this question depends on:

• the stage at which treatment of the malignant tumor was started;
• depending on the type of tumor;
• from the place of its localization in the organ;
• on the physical condition of the patient;
• on the quality of treatment.

The most disappointing prognosis is for people diagnosed with small cell lung cancer. The fact is that cancer cells of this type divide very quickly. If the patient is not given proper treatment, he will die approximately 3 months after the diagnosis of a malignant tumor. But it should be borne in mind that it is small cell cancer that is most sensitive to chemotherapy and radiation therapy. The surgical method usually does not give the desired result, since at the time of diagnosis there are already metastases in the body. On average, 5 years after the disease is diagnosed, only 10% of patients remain alive.

Prognosis for non-small cell cancer (after treatment):

1. At stage 1 lung cancer, 50-60% of people survived for 5 years.
2. At 2, 30-40% of patients survived.
3. At 3 - survival rate is: 10-20%.
4. At stage 4 of lung oncology, only 5% of patients overcome the 5-year mark.

If no measures are taken to treat pulmonary oncology, then death will occur in 85-90% of cases within 2 years.