Lung cancer

Lung cancer. One of the most frequent cancer localizations in men and women over the age of 40. The risk of developing lung cancer is much higher among smokers. So, when smoking two or more packs of cigarettes per day, the incidence of lung cancer increases by 15-25 times. Other risk factors are work on asbestos production, irradiation.

Symptoms of lung cancer: cough, sputum discharge with a trace of blood, chest pain, repeated episodes of pneumonia and bronchitis; Respiratory disorders can be significant in the development of hypoventilation and atelectasis of the lobe or the entire lung. Early forms of lung cancer are low-symptomatic, and the subsequent listed symptoms are not specific for lung cancer. Meanwhile, a clinical analysis of the dynamics of such symptoms is important, as it aims at timely conducting an additional examination and establishing the correct diagnosis. Important for lung cancer diagnosis is a multiple cytological examination of sputum, lung X-ray, bronchoscopy with tumor biopsy, transthoracic tumor biopsy.

Morphological and radiographic studies provide a differential diagnosis with tuberculosis, chronic pneumonia, adenoma, carcinoid, various benign lesions, as well as metastases in the lung of tumors of other localizations.

Distinguish the central cancer of the lung, which grows mainly endo- or peribronhyapno (80% of cases); Peripheral cancer; The mediastinal form, miliary carcinosis, etc. are rarely diagnosed. Morphological structure is distinguished by squamous (epidermoid) cancer, adenocarcinoma, small and large cell carcinoma.

Lung cancer metastasizes into the lymph nodes of the root, paratracheal, paraaortal and bifurcation lymph nodes. At later stages of the disease, metastases develop into distant tissues and organs (supraclavicular lymph nodes, bones, liver, brain, lungs, etc.). Small metastatic and aggressive course is characterized by small cell carcinoma.

Treatment of non-small cell lung cancer depends on the stage of the disease. Radical surgery (pulmonectomy, lobectomy with removal of regional lymph nodes) can be carried out only in 10-20% of patients, when lung cancer is diagnosed in the early stages. In the locally advanced form of the disease, an extended pulmonectomy is performed with the removal of bifurcation, tracheobronchial, lower paratracheal and mediastinal lymph nodes, and, if necessary, with pericardial, diaphragm, and thoracic wall resection. If surgery is not possible due to the prevalence of the process or due to the presence of contraindications, radiation therapy is performed. The objective effect, accompanied by a significant symptomatic improvement, is achieved in this case in 30-40% of patients.

Chemotherapy for inoperable non-small cell lung cancer and metastases is effective in 20-30% of patients. Usually a combination of cyclophosphamide, adriamycin, vincristine or cyclophosphamide, adriamycin and cisplatin. In addition, 5-fluorouracil, methotrexate, etoposide, bleomycetin, mitomycin C, prospidin are used in various combinations.

In small-cell lung cancer, the first priority is to assess the extent of the disease, which is achieved by scintigraphy of the skeleton, bone marrow biopsy, ultrasound of the liver, computed tomography of the brain. In the localized and disseminated forms of the disease, the main method of treatment is chemotherapeutic. As an additional method, radiotherapy is used. Surgery is very rarely used.

For chemotherapy, combinations of cyclophosphamide, adriamycin, methotrexate or cyclophosphamide, adriamycin and vincristine, or cisplatin and etoposide are used.

With localized small cell lung cancer, chemotherapy courses are conducted at intervals of 3-4 weeks. For 1-1,5 years. Even at the beginning of treatment or after 3-4 courses of chemotherapy, radiotherapy (30-40 Gy) can be used additionally to the area of ​​the tumor of the lung and regional lymph nodes. When complete remission is achieved, taking into account the frequency of metastatic brain damage, radiotherapy for the brain (20-30 Gy) is prescribed to prevent the growth of metastases. As a result of complex treatment with localized disease, a significant therapeutic effect is achieved in 90% of patients, complete remission - in 30-50%. The results of treatment of disseminated small cell lung cancer are much worse.