Lung cancer is a malignant tumor, the source of which is the cells of the bronchial and alveolar epithelium. This dangerous disease is characterized by uncontrolled growth of cells in the lung tissue, a tendency to metastasis. If untreated, the tumor process can spread outside the lung to nearby or distant organs. Depending on the characteristics of the tumor-forming cells, the main types of lung cancer are small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC).
According to the WHO, this disease occupies one of the leading positions of non-communicable diseases that cause death up to 70 years.
Classification
According to the site of the primary focus, the types of lung tumors are classified.
Central cancer is localized in the proximal (central) parts of the bronchial tree. The first signs of lung cancer(symptoms), which should alert, in this case are pronounced:
- dry, prolonged cough that does not respond to treatment.
- hemoptysis begins with sputum attachment.
- blockage of the lumen of the bronchus by tumor masses leads to shortness of breath even at rest. In some cases, the temperature may rise.
Photo 1 - Central cancer of the right lower lobe bronchus (1) with obstruction and metastases (2) in the bifurcation lymph nodes
Peripheral cancer gradually forms in the lateral parts of the lungs, slowly germinating and revealing itself in nothing. This lung tumor may not give symptoms for a long time, they appear with significant local spread, the involvement of neighboring organs and structures, and bronchial sprouting. Diagnosis of lung cancer of this type of localization is most often possible with a preventive examination (X-ray or computed tomography).
Photo 2 - Peripheral cancer (1) of the upper lobe of the right lung
Causes
The cause of lung cancer, in the overwhelming majority of cases (up to 85%), becomes long-term smoking... In a 10-15 percent probability, the disease manifests itself in people who do not have this bad habit. In this case, a combination of genetic factors and exposure to radon, asbestos, second-hand tobacco smoke or other forms of air pollution can be noted.
Diagnostics
Lung cancer is usually detected by chest x-ray and computed tomography (CT) scanning. The diagnosis is confirmed by biopsy, which is usually done with tracheobronchoscopy or CT-guided.
Prophylaxis
Prevention of lung cancer is to reduce the influence of risk factors:
- quitting smoking, including "passive" (inhalation of tobacco smoke from a nearby smoking person),
- use of personal protective equipment (masks, respirators) when working with hazardous materials.
Treatment
Treatment of lung cancer and long-term results depend on the type of cancer, the degree of spread (stage), as well as the general health of the person. For non-small cell lung cancer, use:
- surgical
- chemotherapy
- radiation treatments
Small cell lung cancer has better sensitivity to drug and radiation therapy.
- the main radical method for stages 1-3 of the disease. The operations performed for this disease are classified:
- by the volume of resection (lobectomy (removal of a lung lobe), bilobectomy (removal of two lobes of a lung), pneumonectomy (removal of a whole lung)),
Photo 3 - Lobectomy
Photo 4 - Pneumonectomy
- by the volume of removal of the lymph nodes of the chest cavity (standard, dilated, super-dilated),
- by the presence of resection of adjacent organs and structures (combined operations are performed when the tumor grows into the pericardium, trachea, superior vena cava, esophagus, aorta, atrium, chest wall, spine). In addition to surgical treatment, it is possible to use an integrated approach, including radiation and chemotherapy.
In the treatment of locally advanced malignant formation with the transition to the main bronchus and pulmonary artery, in those cases where previously the only option for surgical treatment was pneumonectomy, organ-preserving operations are now possible. In this case, the affected area of the main bronchus is excised, followed by restoration of continuity (bronchoplastic and angioplastic lobectomy)
Photo 5 - Diagram of upper bronchoplastic lobectomy
Radiation therapy for lung cancer
Today, such modern methods of radiotherapy as IMRT (radiation therapy with the ability to change the dose of radiation), 3D conformal radiation therapy (three-dimensional computer planning of selective irradiation), stereotaxic (precisely focused) radiation therapy, are actively being introduced. In carrying out these manipulations, in addition to oncologists, medical physicists, radiologists, physicists-dosimetrists and other specialists are involved.
The method is shown:
- patients with a resectable lung tumor, for whom surgical treatment cannot be performed due to contraindications from the cardiovascular system or for other reasons;
- as an alternative to surgery;
- to reduce the risk of recurrence in case of damage to the lymph nodes of the mediastinum, a positive margin of resection according to the data of histological examination.
Chemotherapy
The planning of the course of treatment for non-small cell lung cancer includes the use of pharmacological agents. It is used for prophylaxis: adjuvant (auxiliary), postoperative chemotherapy at stages 2-3 of the disease and in a therapeutic course.
Depending on the histological type of the tumor, the stage of the disease and the expected sensitivity to exposure, various schemes for the use of chemotherapy have been developed.
Targeted therapy (English target - target, goal)
A separate type of pharmacological treatment, which consists in the appointment of inhibitor drugs that act only on tumor cells, in which various disorders are highlighted, which delay or even block further growth.
- tyrosine kinase inhibitors (gefitinib, erlotinib, afatinib) are used in the treatment of patients in whose tumor tissue mutations in the EGFR gene have been identified.
- With a negative EGFR mutation status, ALK inhibitors (crizotinib, alectinib).
There are targeted drugs that do not require the detection of any abnormalities in tumor cells. These include bevacizumab (a VEGF inhibitor), nivolumab, and pembrolizumab (an anti-PDL1 antibody).
Life forecast
The prognosis of lung oncology in NSCLC includes symptomatology, tumor size (> 3 cm), non-squamous histological variant, degree of spread (stage), lymph node metastasis, and vascular invasion. Inoperability of the disease, pronounced clinical picture and weight loss of more than 10% - give lower results. Prognostic factors for small cell lung cancer include condition status, sex, stage of disease, and involvement of the central nervous system or liver at the time of diagnosis.
For non-small cell lung cancer, the prognosis of life with complete surgical resection of stage IA (early stage of the disease) is 70% five-year survival.
Lung cancer is a general concept that includes various malignant tumors of the windpipe - trachea, upper respiratory tract - bronchus, alveolar sac of lungs - alveoli. They are formed in the epithelial tissue of the inner (mucous) membrane of the respiratory organs.
Features of lung cancer - many forms, courses, a tendency to early recurrence of the disease after undergoing treatment, the development of distant secondary tumor foci (metastasis). It is the most common cancer in the world. In Russia, among malignant neoplasms, lung cancer is diagnosed most often - in 14% of all cases.
In men, pulmonary oncology is observed much more often than in women. The disease is typical for elderly people; among young people under 40, it is rarely diagnosed. The key causes of oncology are external circumstances: tobacco smoking, radiation, household and chemical carcinogens.
Causes of Lung Cancer
The bulk of neoplasm episodes is formed as a result of previous degenerations of bronchial and lung tissue. The appearance of the disease is facilitated by:
- chronic obstructive;
- irreversible pathological expansion of the bronchi as a result of purulent inflammation of the bronchial wall;
- replacement of the lung tissue with connective tissue - pneumosclerosis;
- occupational diseases of the respiratory system - pneumoconiosis;
- scars on lung tissue after infection with tuberculosis;
- HIV infection;
- transfer of chemotherapy and radiotherapy in the treatment of other oncological diseases.
Malignant formations in the respiratory organs are provoked by smoking. Tobacco smoke contains about 50 carcinogens. Among smokers, the risk of contracting cancer is 17.2% in men and 11.6% in women. While the likelihood of lung cancer among nonsmokers is 1.4%. Secondhand smoke also increases the risk of cancer. If a person quit smoking, then the potential threat persists for another 10 to 12 years.
Other risk factors:
- Inhalation of radon is the next cause of illness after nicotine addiction. An increase in the concentration of radon in the air leads to an increase in the threat of oncology development from 8 to 16% for every 100 becquerels per cubic meter.
- Chronic obstructive pulmonary disease.
- Work in the following industries: coal processing into combustible gases, production of metallic aluminum, extraction of hematite, production of metal parts, production of isopropyl alcohol, production of hydrochloric acid rosanilin, production of synthetic rubbers.
- Constant interaction with the following substances: rock flax, talc, beryllium and its alloys, nickel, vinyl chloride, uranium, diesel exhaust gases, mustard gas, arsenic, cadmium and its alloys, technical grade silicon, tetrachlorobenzoparadioxin, ethers.
The combination of such unfavorable factors as work in hazardous work and nicotine addiction is especially dangerous.
The constant inhalation of dust particles in high concentrations increases the threat of oncology by 14%. The smaller the particles, the deeper they are able to penetrate into the lung.
Hereditary risk factors - the presence of close relatives (three people) with lung cancer.
Lung cancer classification
Malignant neoplasms of the lung are classified according to several parameters: the clinical and anatomical orientation of the neoplasm, its structure, the degree of prevalence of the process. A reliably defined classification of a tumor in a particular patient will make it possible to competently build a therapy tactics, and, accordingly, predict the course of the disease. The diagnostic process in patients with respiratory oncology is multicomponent and expensive.
Clinical and anatomical typology
This version of the typology involves the determination of the anatomical location of the tumor and determines the division of the neoplasm in the respiratory organs into peripheral and basal (central).
Root (central) cancer
Central cancer damages large bronchi 1 - 4 orders: the main, lobar, intermediate and segmental bronchus. These anatomical parts of the lungs are visible when examined through a broncho-fibroscope.
According to the direction of growth, central cancer has three anatomical types:
- branched cancer around the bronchi;
- deep into the lung tissue - endophytic (exobronchial) cancer;
- in the inner surface of the bronchus - exophytic (endobronchial) cancer;
There is a mixed type of malignancy.
Peripheral cancer
Peripheral cancer is formed in the epithelial layer of small bronchi, located in the lung tissue. Has the following clinical and anatomical types:
- diffuse cancer;
- apex lung cancer (Pencosta);
- cavity cancer;
- globular tumor.
Central (root) cancer is more common. The neoplasm forms in the upper segments of the bronchi and their branches. Oncology rarely manifests from the epithelium of the alveoli, is formed from the surface of the mucous membrane of the bronchi and bronchioles.
Morphological typology
Despite the fact that all forms of neoplasm in the lung originate from epithelial cells of the mucous membrane of the airways, but the histological structure (microscopic structure) includes many different variants of this disease. There are two main features of the morphological structure of oncology of the main respiratory organ: small cell and non-small cell lung cancer.
Small cell form
The most unfavorable form, requiring special treatment tactics. The tumor grows very quickly - in one month, the volume of tumor tissue doubles, and at the time of diagnosis, in most cases, it is widespread. It develops in 20% of cases.
Non-small cell form
It is diagnosed in about 80% of people. This type includes the most varied in structure forms of cancer. The most common:
- large cell carcinoma;
- squamous cell carcinoma;
- adenocarcinoma - glandular cancer;
- dimorphic cancer (mixed, adenosquamous cell);
- bronchioloalveolar cancer is a variant of adenocarcinoma.
Rare forms of lung cancer:
- adenocystic cancer - cylindroma;
- carcinoid typical and atypical;
- mucoepidermoid, growing from the cells of the bronchial glands.
The anatomical nature of various structures of tumors and the characteristic properties of their course are shown in Table 1.
Table 1
| Lung cancer form | Anatomical nature of the tumor | Features of the flow |
| Small cell carcinoma | It originates from the cellular elements of the mucous membrane (Kulchitsky cell) located in the basement membrane of bronchial epithelial cells. | The most malignant tumor. It is characterized by intensive formation of metastases, high metabolic activity. |
| Squamous cell carcinoma | It is formed from the bronchi of the 2nd - 4th order, but it can also form in the peripheral sections of the bronchial branches. | The most common structural form of the disease is 40-50% of all cases. The cause of the tumor is smoking. It tends to collapse spontaneously. |
| Adenocarcinoma (glandular cancer) | More often it originates from glandular cells of the epithelium of small bronchi or from scars on lung tissue in tuberculosis. | Metastasizes to lung tissue. Aggressive type of cancer. Vigorously forms new tumors in the regional lymph nodes, pleura, bones, in the cerebral hemispheres. It is not provoked by nicotine addiction, women are more likely to get sick. |
| Large cell carcinoma | Localized in the upper or lower lobe of the lung. | Having many structural types, the tumor is heterogeneous in its composition. The potential for malignancy is high. But according to the prognosis, it is less dangerous than small cell cancer. |
| Glandular squamous cell carcinoma (dimorphic, mixed, adenosquamous) | Formed from elements of the epidermis and glandular structures. | Has the structural characteristics of adenocarcinoma and squamous cell carcinoma. Rare. |
| Bronchioloalveolar cancer | Well-defined tumor developing in the periphery, minimally penetrating adenocarcinoma. | Tends to spread. It often grows in many separate areas of tissue, has no clear boundaries and sometimes resembles an accumulation of cellular elements. |
| Adenocystic carcinoma (cylindroma) | It originates in the windpipe (90%), grows along its wall, deepens into the submucosal layer for a long time. | It penetrates deeply, but rarely gives metastases and at a later date. Previously considered a benign neoplasm. |
| Typical carcinoid (type I) | In 80% of observations, it is distributed from the main and lobar segments. It grows into the inner surface of the organ. | It grows slowly, rarely gives metastases. The representatives of both male and female 40-50 years old are ill. A characteristic property of this oncology is the release of biologically active substances, including hormones. |
| Atypical carcinoid (type II) | More often peripheral. | Every fifth carcinoid is of this type. A fairly aggressive neoplasm, it gives metastases in 50% of cases. |
| Mucoepidermoid cancer | It is formed in the bronchi of the 2-3 order, occasionally in the trachea. | It grows into the inner surface of the organ. |
The prognosis of a successful course of the disease in mucoepidermoid cancer, adenocystic cancer and carcinoid tumors is better than in other types of respiratory cancer.
The degree of spread of the tumor process
The stage of the disease is determined by the volume of malignancy, its prevalence in the lymph nodes / glands, the presence of other neoplasms in the body (metastases) that are associated with a primary neoplasm in the lungs. The staging process is called TNM (tumor, lymph node metastasis).
General features of the course of lung cancer
The respiratory organs are densely permeated with a network of blood and lymphatic capillaries. This promotes the wide spread of cancer cells throughout all organs. Through the bronchial branches through the lymph, cancer cells reach the intrapulmonary and central lymph nodes, then into the lymph nodes of the space in the middle chest, cervical and supraclavicular, lymph nodes of the peritoneum and retroperitoneal space. When the tumor moves through the blood, vital organs are damaged: liver, brain, kidneys, adrenal glands, the opposite lung, bones.
The neoplasm captures the pulmonary pleura, malignant cells scatter through the pulmonary cavity, invade the diaphragm, and the pericardium is the sac in which the heart is located.
Lung cancer symptoms
There are no painful endings in the lung tissue, so the tumor initially proceeds without signs of organ damage. In many cases, the diagnosis is late. Symptoms of illness can occur when cancer cells invade the bronchus.
The clinic depends on the location, structure of the tumor and the degree of its prevalence. Symptoms are varied, but not a single sign is specific for lung carcinoma.
All manifestations of the disease are divided into four groups:
- Primary (local) signs of neoplasm development.
- Symptoms of damage to adjacent organs.
- Signs of the formation of distant foci of metastasis.
- Influence of biologically active compounds of malignant cells on the body.
Local symptoms manifest themselves with hilar cancer earlier (with a smaller volume of neoplasm) than with peripheral cancer.
Primary signs of central cancer
A special feature of central tumors is that they manifest themselves as external signs and are detected on an x-ray examination. This is explained by the fact that with the development of cancer cells clog the inner space of a large bronchus and cause a decrease in the lobe of the lung or insufficient ventilation of the affected lobe of the lung tissue.
The presence of a tumor in the bronchi of the 2nd - 4th order "signals" a number of external symptoms:
- chest pain;
- feeling short of breath;
- cough;
- coughing up blood;
- an increase in body temperature.
Most patients (75 - 90%) cough. The tumor irritates the mucous surface of the bronchial branches. The cough causes a concomitant disease of superficial bronchitis. At the beginning of the development of pathology, the cough is unproductive, hacking, then it becomes wet, a purulent-mucous or mucous secret is released.
Coughing up sputum with thickly colored blood or streaked with blood is observed in 30-50% of patients. The secret may be similar in color to raspberry jelly. Such symptoms indicate that the tumor has disintegrated, the inner surface of the bronchi is ulcerated, and there is a destructive degeneration in the lungs. Corrosion of the capillaries of the bronchi, vessels of the pulmonary artery can provoke severe bleeding.
Chest pain is a common symptom of pathology. Its cause is a decrease in the lobe of the lung, displacement of space in the middle sections of the chest cavity, irritation of the parietal serous membrane. The pain can be of different nature and strength:
- slight tingling in the chest;
- acute pain;
- severe aching when cancer of the peripheral segments penetrates into the chest wall.
Collapse of a part of the lung, displacement of space in the middle parts of the chest cavity, inflammation of the pleura and serous membrane of the heart, impaired blood circulation forms shortness of breath in 30-60% of patients.
Obstructive bronchitis, pneumonia, developing in the decrease of the lung lobe, increase the patient's body temperature. This symptom is not characteristic of the peripheral form of pathology.
In a third of patients with radical cancer, the onset of pathology is acute or subacute: high body temperature, pouring sweat, chills. Less often, there is a slight increase in temperature (up to 37 - 37.8 °). A debilitating fever is typical of purulent inflammation in the lungs and the onset of purulent pleurisy. Antibiotic treatment will briefly normalize body temperature. If a patient develops pneumonia twice a year, he must be thoroughly and thoroughly examined. Bronchoscopic examination with the taking of biological material for biopsy generally confirms or excludes the diagnosis of lung cancer.
With the peribronchial form of cancer, even a large tumor in the large bronchi does not close the internal space of the organ, but spreads around the bronchial wall, so there is no shortness of breath and other signs of the development of pathology.
Signs of lesion in peripheral cancer
If a small area of the lung tissue is affected and ceased to function, the pulmonary lobe does not collapse, the segment remains airy, the blockage of the small bronchi does not manifest itself as any symptomatology. The patient does not cough, he does not have shortness of breath and other signs of the development of pathology characteristic of central cancer. Cancer in the peripheral parts of the bronchi progresses, but for a long time does not make itself felt. This complicates the timely detection of the disease.
With further movement of the tumor in the direction of the peripheral parts, it penetrates into the pulmonary pleura, the chest wall, spreading throughout the organ. If the tumor moves to the main bronchus, to the root of the lung, it clogs the lumen of the large bronchi and causes symptoms characteristic of central cancer.
Damage to adjacent organs
Symptoms of damage to neighboring organs are caused by both the primary neoplasm and secondary tumors - metastases. The defeat of the adjacent organs by the initially developed tumor indicates that the oncology has progressed strongly and has reached the last stage.
When a tumor presses on large blood vessels, the superior vena cava syndrome occurs. As a result of stagnation of venous blood, the face and neck swell, the upper part of the body swells, the saphenous veins of the chest and neck expand, and there is a cyanotic color of the skin and mucous membranes. The person is dizzy, he constantly wants to sleep, fainting occurs.
The defeat of the sympathetic nerve nodes located on the sides of the spine forms signs of a disorder of the nervous system: the upper eyelid drops, the pupil narrows, the eyeball sinks.
If the larynx nerves are affected by the tumor, the voice becomes hoarse. When a tumor grows into the wall of the digestive tube, it is difficult for a person to swallow, and bronchoesophageal fistulas form.
Symptoms of the formation of secondary foci of tumor growth - metastases
Tumor damage to the lymph nodes is manifested by their compaction, an increase in size, and a change in shape. In 15 - 25% of patients, lung cancer metastases to the supraclavicular lymph nodes.
Cancer cells from the lung move through the blood and affect other organs - the kidneys, liver, brain and spinal cord, bones of the skeleton. Clinically, this is manifested by a violation of the damaged organ. Extrapulmonary symptoms of respiratory cancer can become the primary reason for referring to doctors of different directions: a neurologist, an ophthalmologist, an orthopedist (traumatologist).
Influence of biologically active tumor compounds on the body
The tumor produces toxins, biologically active substances. The body reacts to them. This is manifested by nonspecific reactions that can begin long before the onset of local characteristic symptoms. In the case of lung cancer, nonspecific (non-specific) symptoms manifest themselves as an initial clinical sign quite often - in 10-15% of patients. However, it is difficult to see an oncological disease behind them, since they are all found in non-oncological pathologies.
In medical practice, several groups of symptoms are distinguished, associated with the indirect effect of a tumor on healthy tissues. This is a violation of the functioning of the endocrine system, neurological signs, bone, associated with hematopoiesis, skin and others.
The proliferation of a tumor can provoke the development of a complication of the disease: bleeding in the lungs, the formation of broncho- and tracheoesophageal fistulas, pneumonia, accumulation of pus in the pleural region, oxygen starvation associated with compression of the airways, inability to swallow.
Diagnostics
The mandatory diagnostic set of measures for lung cancer includes:
- X-ray in direct and lateral display of the chest cavity organs;
- computed tomography of the chest cavity and mediastinum - CT scan;
- research by the method of nuclear magnetic resonance - MRI;
- a review with a bronchoscope with a sampling of bronchial secretions for bacteriological and cytological research;
- cytological examination of bronchial secretions;
- histological examination.
Five-fold cytology of bronchial secretions reveals tumors in 30-62% of patients with peripheral cancer and in 50-8% of patients with hilar lung cancer. The availability of this type of diagnostics makes it possible to use it when examining people at risk for respiratory cancer in outpatient clinics and medical institutions.
In assessing the prevalence of pathology, additional diagnostic tools are used.
Treatment
Non-small cell cancers are treated with surgical removal of the tumor. This method can be combined with radiation and chemical effects on the oncological process - combination therapy. The principles of the tactics of therapy with tumors of this group practically do not differ.
However, in practice, the percentage of patients who undergo surgery is quite low - 20%. The operation is not performed if the pathology has progressed to late stages (in 30 - 40% of cases), due to the poor general condition of the patient, old age, and sometimes because of the person's unwillingness to interfere in the pathological process.
The main method of managing patients with small cell carcinoma is exposure to drugs (chemotherapy). Treatment, as a rule, is in the nature of alleviating the course of the disease. Surgery is extremely rare. In the natural course of pathology, a person dies within a year from the moment of diagnosis.
Lung cancer is detected late. Therefore, the prognosis of this oncology, unfortunately, is not very encouraging. Among scientists, scientific developments are underway to find methods of therapy to prolong and preserve the quality of life of people with this complex oncological pathology.
Lung cancer in medicine means a whole group of malignant neoplasms arising from cells of the lung tissue and bronchi. These tumors are characterized by very rapid growth and a tendency to metastasize. In the general structure of cancers, lung cancer occupies a leading position, while men suffer from it 6-7 times more often than women, and the risk of getting sick increases with age.
Lung cancer risk factors
Carcinogens inhaled with air - substances that contribute to the development of neoplasms - have a negative effect on the lungs. Risk factors include:
- smoking - about 85% of all patients diagnosed with cancer are heavy smokers. Cigarette smoke contains about 100 different carcinogens, and smoking one pack of cigarettes a day increases the risk of cancer by 10-25 times;
- work in hazardous working conditions - work in hazardous industries where a person is constantly in contact with heavy metals (lead, mercury, chromium), toxic compounds (arsenic, asbestos and others) contributes to the occurrence of lung cancer;
- living in a polluted atmosphere - people living in industrial areas, near mining enterprises, breathe air with an increased content of toxic substances, which contributes to lung cancer;
- inflammatory lung disease, in particular, and recurrent;
Lung cancer symptoms
We recommend reading:The earlier lung cancer is suspected, the higher the likelihood of successful treatment. Therefore, it is important to know. The clinical picture of lung cancer is manifested by the following symptoms:
- cough, at first dry and then wet;
- hemoptysis - the growth of the tumor leads to the destruction of part of the blood vessels and blood enters the lumen of the bronchi, which is released with a cough;
- hoarseness of the voice - develops with damage to the nerves (recurrent and diaphragmatic);
- puffiness and swelling of the face due to compression of the superior vena cava by the growing tumor;
- respiratory failure - the lungs of a cancer patient cease to cope with respiratory function, shortness of breath, general weakness develops.
All of the above symptoms are specific to lung cancer. In addition to them, the patient may be disturbed by the general manifestations of cancer. The first symptoms include:
- general weakness;
- nausea;
- weight loss;
- prolonged low-grade fever.
Important: in advanced cases, lung cancer, the metastases of which affect other organs, is manifested by symptoms of damage to these organs.
Lung cancer stages
According to the Russian classification, 4 degrees of lung cancer are distinguished:
- 1st stage- a small tumor up to 3 centimeters in size, localized within one pulmonary segment;
- Stage 2- a tumor up to 6 cm in size, localized within one pulmonary segment, with metastases to the peri-pulmonary lymph nodes;
- Stage 3- a tumor of more than 6 cm, growing into an adjacent segment and having metastases in the parapulmonary or mediastinal (mediastinal) lymph nodes;
- Stage 4- a tumor that grows into neighboring organs and has distant metastases (to the brain, liver, etc.).
In accordance with these stages, the clinical picture of cancer develops - from mild cough up to cancerous pleurisy. A patient with grade 4 lung cancer feels worst of all. At this stage, survival is extremely low - almost 100 patients die within a few weeks. 
The international classification is more detailed and is carried out according to 3 indicators:
- T - tumor (its size),
- N - lymph nodes (number of affected lymph nodes),
- M - the presence of metastases.
The index next to the letter indicates the size of the tumor (from 1 to 4), the affected lymph nodes (from 0 to 3) and the detected metastases (0 - no, 1 - there are distant metastases). Note: thus, the most favorable diagnosis looks like this:T1 N0 M0, and the most unfavorable -T4 N3 M1
Diagnosis of lung cancer
The diagnosis of lung cancer is made on the basis of typical complaints and data from additional examination methods. Lung cancer complaints are listed above. Laboratory instrumental diagnostic methods include:
- fluorography and chest x-ray - allow you to suspect cancer;
- or MRI - allow you to establish more precisely the boundaries of the tumor, to identify metastatic lesions of the surrounding tissues;
- bronchoscopy - allows you to examine the bronchi from the inside, and if a tumor is detected, conduct a biopsy for histological examination;
- ultrasound diagnostics - carried out through the chest wall. With its help, the size of the tumor and the degree of invasion into the surrounding tissues are estimated;
- blood test for tumor markers. With this method, you can screen for lung cancer, and evaluate the quality and effectiveness of treatment.
Lung cancer: treatment
Important:Surgery, radiation therapy, and chemotherapy are used to treat lung cancer. Alternative treatment for lung cancer is quackery and leads to the progression of the disease, the growth of the tumor and the death of the patient.
Surgical treatment consists in removing the entire cancer complex - tumors, regional lymph nodes, metastases. Most often, the entire affected lung is removed with the surrounding tissues. It is best to remove peripheral lung cancer. 
X-ray treatment is performed after the tumor has been removed. Also, this method is used for inoperable forms of lung cancer. The total dose of radiation is 60-70 Gray. Chemotherapy is only prescribed if the above two treatments are ineffective. Cytostatic drugs are used that suppress the growth of tumor cells.
For more information about new effective methods of treating lung cancer and prognosis for survival, see the video review:
Lung cancer: prognosis
All patients, without exception, are interested in the question: "How long do they live with lung cancer?"
The life expectancy of such patients depends primarily on the stage at which the cancer is detected. In patients with the first and second stages, the prognosis is the most favorable - surgical removal of the lung tumor in combination with radiation therapy allows for an almost complete cure of the cancer. In this case, life expectancy is comparable to that of a healthy person. In patients with stage III, complete cure is much less common. Their life expectancy is up to several years with effective chemotherapy. At stage IV lung cancer, only palliative treatment is carried out, that is, treatment that only makes it possible to alleviate the general condition of the patient. The life expectancy of patients at this stage rarely exceeds one year.
Note: in absolute terms, untreated lung cancer leads to death in 90% of patients in the first 2 years after diagnosis. The remaining 10% die within the next 3 years. Surgical treatment can increase the survival rate by up to 30% within 5 years. The appearance of metastases of lung cancer worsens the prognosis - the cause of death in this case may not be the cancer itself, but the failure of the affected organ. People who, for one reason or another, had to deal with the problems of lung cancer treatment, will be interested in the following video review:
Gudkov Roman, resuscitator
A group of malignant tumors of the lung tissue arising from epithelial cells lining the bronchi or lungs. These tumors are characterized by rapid growth and early metastasis (the formation of distant tumor nodes).
Men suffer from lung cancer 7-10 times more often than women, and the incidence increases with age. In men aged 60-69, the incidence rate is 60 times higher than among 30-39-year-olds.
In Russia, lung cancer is the most common of all oncological diseases. However, we are still far from the first place. Today, Scotland, the Netherlands, the United Kingdom and Luxembourg have the highest rates of lung cancer deaths among men. In terms of mortality among women, Hong Kong is confidently leading, and Scotland is in second place. But it is best to live in El Salvador, Syria, Guatemala or Brazil - lung cancer practically does not occur there.
The true mechanisms of transformation of normal cells into cancerous ones have not yet been fully understood. However, thanks to many scientific studies, it became clear that there is a whole group of chemicals that have the ability to cause malignant transformation of cells. Such substances are called carcinogens.
Lung cancer risk factors
- The main reason for the development of lung cancer is the inhalation of carcinogens. About 90% of all cases of diseases are associated with smoking, more precisely, with the action of carcinogens contained in tobacco smoke. When you smoke two or more packs of cigarettes a day, the likelihood of lung cancer increases 25-125 times.
- Air pollution is directly related to lung cancer. For example, in industrial areas with mining and processing industries, people get sick 3-4 times more often than in remote villages.
- Contact with asbestos, radon, arsenic, nickel, cadmium, chromium, chloromethyl ether.
- Radiation exposure.
- Old lung diseases: pneumonia, tuberculosis.
Lung cancer types
Depending on the place of appearance ( anatomical classification) there is a central cancer (the tumor is located in the center of the lung, where large bronchi and blood vessels are located) and peripheral (the tumor grows on the periphery of the lung). They also distinguish mixed lung cancer and mediastinal, or apical - this is a variant of peripheral cancer, when the tumor is located at the apex of the lung. Cancer of the right lung or left lung is possible, or both lungs are involved.
When conducting histological analysis, establish tumor cell type.
Most often (up to 95% of cases), the tumor develops from epithelial cells that line the large and medium bronchi (therefore, sometimes they speak of bronchial cancer or bronchogenic carcinoma).
Less commonly, a tumor develops from pleural cells (then it is called mesothelioma).
There are also morphological (depending on the type of tumor cells) lung cancer classification:
small cell carcinoma:
- oatmeal
- intermediate
- combined;
non-small cell carcinoma:
- squamous
- adenocarcinoma
- large cell.
Morphological classification is important for determining the degree of tumor malignancy. Small cell lung cancer grows faster (almost three times) and metastasizes more actively.
Lung cancer symptoms
Signs of lung cancer are not always present; they are difficult to identify and distinguish from symptoms of other diseases of the respiratory system.
The appearance of such signs as persistent cough, streaks of blood in sputum, shortness of breath, chest pain, weight loss, accompanied by lethargy, increased fatigue, apathy - requires a visit to the doctor and an examination. You need to pay attention to the temperature rise, even a small one. In case of bronchitis or pneumonia, an x-ray of the lungs must be performed, including in order to clarify whether there is a tumor.
In 15% of cases, at the initial stages, a lung tumor does not appear in any way, and it can only be detected with a carefully performed X-ray or MRI.
Experienced smokers, be careful! A persistent cough, blood-streaked phlegm, chest pains, and recurrent pneumonia and bronchitis are not just unpleasant symptoms. It is possible that a serious disease-causing process is developing in your lungs: lung cancer.
Unfortunately, most of the patients go to the doctors at the advanced stages of lung cancer. Therefore, it is very important to regularly undergo preventive examinations, do fluorography and consult a pulmonologist for any symptoms of pulmonary diseases lasting more than 3 days.
Spread and metastasis of lung cancer
Cancer cells divide rapidly, and the tumor begins to grow in size. If untreated, it grows into neighboring organs - the heart, large vessels, esophagus, spine, causing damage to them.
Cancer cells travel with blood and lymph throughout the body, forming new tumors (metastases). Most often, metastases develop in the lymph nodes, another lung, liver, brain, bones, adrenal glands, and kidneys.
Lung cancer stages
The stage of lung cancer is determined depending on the size of the tumor, its morphology, the degree of growth in the surrounding tissues, as well as on the presence of lymph node involvement or distant metastases.
The stage of the tumor determines the methods of treatment for lung cancer, their expected effectiveness and prognosis.
First stage
The tumor is small (on the roentgenogram up to 3 cm), without invasion into the pleura, without affecting regional lymph nodes and distant metastases
Second stage
Tumor size from 3 to 6 cm or any other tumor size sufficient to block (obstruction) the bronchus, or induration of lung tissue within one lobe of the lung. It is possible to involve regional lymph nodes in the process on one side.
Third stage
The size is more than 6 cm, or the tumor spreads to the chest wall, affects the area of separation (bifurcation) of the main bronchi, affects the diaphragm, distant lymph nodes on the affected side or in the bifurcation area are affected, or there are signs of distant metastases.
Fourth stage
The size of the tumor is not important, it is spread to neighboring organs (heart, esophagus, stomach), many lymph nodes are affected both on the diseased side and on the opposite side, there are multiple distant metastases.
Diagnosis of lung cancer
A known way to detect lung cancer is to take an x-ray of the lungs. However, this method is not always effective in the early stages of the disease, when the tumor is very small, or with an atypical location.
Computed tomography (CT) or magnetic resonance imaging (MRI) of the lung may be required to make a diagnosis.
The most modern diagnostic methods are used early in the process to clarify the diagnosis and include:
- Multilayer spiral computed tomography, which can detect tumors up to 1-3 mm
- Positron emission tomography in combination with computed tomography (PET-CT), the minimum size of the detected tumor is 5-7 mm.
To clarify the diagnosis, endoscopic bronchography is used, which allows you to find out the location of the tumor and its size, as well as make a biopsy - take a piece of tissue for cytological examination.
Lung cancer treatment
An oncologist is involved in the treatment of patients with lung cancer. He chooses a method depending on the stage of the cancer, the type of malignant cells, the characteristics of the tumor, the presence of metastases, etc.
To do this, it is necessary to establish not only the type of cancer, its morphology, but also in some cases (for non-small cell lung cancer) to identify the genetic characteristics of the tumor (the presence or absence of certain gene mutations: for example, mutations in the EGFR gene).
Usually, to get rid of the patient from the disease, three methods are combined at once: surgical, drug and radiation.
Surgical treatment of lung cancer involves the removal of the tumor along with a part of the lung; if necessary, the damaged lymph nodes are also removed at the same time.
Chemotherapy involves the intravenous administration of drugs that suppress the growth of tumor cells. Radiation therapy - the effect of radio emission on a tumor.
For some forms of cancer (small cell), only chemotherapy is used. Chemotherapy may be given before surgery to shrink the tumor. In this case, chemotherapy has a toxic effect on the entire body, causing side effects.
That is why scientific research is constantly being carried out and new methods of treatment appear, including hormonal therapy, targeted immunotherapy. Targeted drugs are more easily tolerated by patients, since they affect only tumor cells.
The success of treatment depends on the age of the patient and the correct selection of therapy. If treatment was started in the early stages of the disease, 45-60% of patients have a chance of making a full recovery. If the disease is discovered too late, when metastases have already appeared, there are no guarantees.
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