Let’s look at one of the most common oncological diseases – lung cancer. I believe that the most frequent occurrence is due to the fact that basically all the airways are essentially the entrance gate for infection, various carcinogenic gases that I mentioned above. Currently, lung cancer occupies a leading place in the structure of cancer incidence in the population of our country. Men develop lung cancer 7-10 times more often than women. The incidence increases in proportion to age. In men aged 60-69, the incidence rate is 60 times higher than in people aged 30-39. The most important factor contributing to the occurrence of lung cancer is smoking. Tobacco smoke contains a large amount of carcinogenic substances. Long-term exposure to carcinogens during long-term smoking leads to a violation of the structure and function of the bronchial epithelium, metaplasia of the cylindrical epithelium into a multilayered flat one, and contributes to the appearance of a malignant tumor. Smoking causes lung cancer in about 90% of cases. The mortality rate of smokers from lung cancer is significantly higher than that of non-smokers. The probability of cancer increases in proportion to the length of smoking and the number of cigarettes smoked. The nature of the tobacco products used is important. Smokers of cigarettes made from cheap varieties of tobacco without a filter are most at risk. Tobacco smoke is dangerous not only for the smoker, but also for others. In the family of a smoker, lung cancer occurs 1.5-2 times more often than in non-smoking families.
An important factor contributing to the occurrence of lung cancer is the smoke in the air of large cities. Occupational hazards are important: arsenic, asbestos dust, chromium and nickel. People who work with these substances for a long time get lung cancer more often than the rest of the population. The condition of the bronchi and lungs plays a significant role in the occurrence of a tumor. Predispose to lung cancer are chronic inflammatory processes in the bronchi and pulmonary parenchyma, scarring after childhood tuberculosis, foci of pneumosclerosis.
The most important preventive measure is the fight against smoking. People who are unable to give up smoking are advised not to finish smoking cigarettes until the end, since the last third accumulates the largest amount of carcinogenic substances.
Health disorders and concomitant lung cancer clinical signs of the disease are very variable, and their manifestation depends on the stage of development of the tumor.
The most typical is the prolonged absence of any alarming, disturbing sensations during the initial period of the disease, which fully corresponds to the idea of a long, long-term growth of the tumor.
There are three periods in the development of lung cancer. The first period is called the biological period. It covers the time from the onset of the tumor to the appearance of its first radiological signs. The second, or asymptomatic period, is characterized only by radiological manifestations of cancer. The third period is clinical. It is manifested by the fact that along with radiological symptoms, clinical signs of the disease are also noted.
The initial manifestations of lung cancer in stages I-II of the disease, as a rule, refer to the biological or asymptomatic period of tumor development. The complete absence of signs of a health disorder at this time in the vast majority of cases excludes not only the independent treatment of patients for medical help, but also early recognition of the disease. The vast majority of patients go to medical institutions (or are sent for a targeted examination) only with the occurrence of disturbing disorders. But, as a rule, this corresponds to the second or third phase of lung cancer development. Even at this time, the clinical manifestations of lung cancer are very ambiguous, often diverse and uncharacteristic. At the very beginning of the disease, lung cancer is most often hidden under the” mask ” of loss of vitality, which is characterized by a slight decrease in performance, increased fatigue, a weakening of interest and apathy to the events taking place. Subsequently, in most patients, lung cancer manifests itself under the” mask ” of various respiratory diseases: “catarrh” of the respiratory tract, repeated episodes of “flu”, bronchitis, pneumonia, etc. Most often, this is the third period of the development of the disease, and at this time it is possible to establish the phenomena of concomitant pneumonia. At this time, patients periodically increase their body temperature, there is, then passes and can again repeat a slight malaise.
As a rule, taking antipyretics and anti-inflammatory drugs, as well as the so-called “home methods” that you like to use, quickly eliminate (for a while) these phenomena. Only repeated attacks of malaise, repeated for 1-2 months, lead patients to the idea of the need to seek medical help. Cough – at first rare, dry, and later nadsadny, disturbing constantly-is often indicated among the leading symptoms of lung cancer, but this is not always the case. As a rule, it is absent in patients with peripheral lung cancer. In central cancer, it is the result of involvement in the process of the bronchial wall of a large caliber – lobar or main. Hemoptysis in the form of the appearance of blood veins in the sputum is also associated with the defeat of the bronchial wall, the destruction of its mucous membrane and the blood vessels passing here. This symptom, as a rule, makes you immediately consult a doctor. However, this sign, often defined as early, most often indicates a far-advanced stage of stage III or IV lung cancer. Chest pain is a symptom that usually occurs on the side of the lung affected by the tumor. Often it is regarded as “intercostal neuralgia” and under this “mask” the whole set of manifestations of the disease is considered. The nature of pain in lung cancer may vary in intensity. Most often, this is due to the involvement of the parietal pleura in the process, and later – the intra-thoracic fascia, intercostal nerves, and ribs (up to their destruction). In the latter case, the pain is particularly painful, permanent and almost impossible to eliminate with the help of analgesic drugs. Shortness of breath, increasing respiratory discomfort, palpitations and chest pains of the angina type, sometimes accompanied by heart rhythm disorders-all this is associated with both the “shutdown” of significant parts of the lung from breathing and the contraction of the vascular bed of the small circle of blood circulation, and with possible compression of the anatomical structures of the mediastinum. The appearance of such symptoms most often indicates a far-reaching lung cancer. Sometimes observed disorders in the form of a violation of the passage of food through the esophagus also indicate a far-advanced stage of lung cancer. Hematogenous metastases of lung cancer to the brain, liver, kidneys, skeletal bones and other organs as they grow lead to the appearance and progression of clinical symptoms inherent in the violation of the activity of the corresponding organ. Such disorders suggest that patients with lung cancer have a terminal (IV) stage of the disease. It should be noted that often these extrapulmonary manifestations of lung cancer can be the first reason for the treatment of some patients to doctors of various specialties: neurologist, ophthalmologist, orthopedist-traumatologist or other specialists.
Without treatment, the further natural development of the disease always ends in death. It was found that 48 % of patients who did not receive treatment for various reasons (since the correct diagnosis was established) die within the first year, 3.4% live up to three years, and less than 1% live up to five years. The life expectancy of untreated patients with undifferentiated lung cancer is four times shorter than in patients with highly differentiated histological tumor types: from 3 to 9 months. Even at the first stage of the disease, most of them live no more than 10 months, at the second stage-up to 5 months, and at the third stage, this figure is about 2.5 months. Therefore, only timely recognition and treatment of the disease can have a significant beneficial effect on the fate and life of patients with lung cancer.
Until recently, the diagnosis of lung cancer is a complex, not completely solved problem. An analysis of the ratio of patients with a newly established diagnosis of the disease and those sent for treatment, when they are distributed by stage, shows that over the past decades there has been a certain stabilization in the general unfavorable state of affairs. Among the patients hospitalized in specialized clinics, stage I lung cancer is detected only in 6-16%, stage II-from 20 to 35 %, and stage III – in 50-75 %. More than 10 % of patients by this time have stage IV disease.
The long-term absence of clinical manifestations of lung cancer in the early (I—II) stages of its development required the development of a set of diagnostic measures for large populations in the form of large-scale, systematic dispensary examinations. The leading place here is occupied by large-frame fluorography of the thoracic cavity in two projections. Many years of experience gained in this regard suggests that such an approach is not very effective. With such an organization of diagnostic work, lung cancer can be established on average in 2-3 people out of every 10 thousand examined prophylactically. A way out of this situation can be considered a targeted survey of sample populations: people who are allocated to the” risk group ” for the development of lung cancer, and all those who go to the polyclinics of the city network with various respiratory diseases. Performing a fluorographic study in this case makes it possible to establish lung cancer in 39-40 people out of 10 thousand examined.
The traditional physical examination, which can be quite informative, and the results largely determine the direction and content of instrumental studies, retains its enduring importance. Of the instrumental methods of examination, the leading place in the diagnosis of lung cancer and its accompanying changes is occupied by X-ray. It includes performing survey radiographs, tomograms, and, if indicated (mainly to determine the relationship of the tumor or its metastases with various anatomical structures) – computed tomography.
Bronchography in the recognition of lung cancer is rarely used – only in diagnostically unclear cases, when conducting differential diagnosis with other, similar changes in the lungs.
If the totality of the conducted studies does not allow to exclude lung cancer with complete certainty, then it is quite justified to perform a diagnostic thoracoscopy or thoracotomy as the final stage. During a thoracotomy, an urgent biopsy is performed from the main lesion of the lung and regional lymph nodes. In diagnostically unclear cases, it is quite legitimate to take the removal of a section of the lung with a suspected tumor, or even the removal of an entire lobe of the lung with an urgent histological examination. The detection of lung cancer in this case makes the diagnosis reliable, makes it possible to judge the prevalence of tumor changes, the stage of the disease and, taking this into account, to take the most optimal option of surgical treatment.
Diagnostic thoracotomy is transferred to a therapeutic one. The implementation of the entire complex of necessary studies allows most patients to make an accurate diagnosis, determine the stage of development of diseases and choose the optimal treatment tactics.
Another form of cancer is sarcoma. In relation to lung cancer, the frequency of primary sarcoma of this organ ranges from 1 in 100 cases of lung cancer to 1 in 20. In most cases, lung sarcoma has the form of a massive tumor node that occupies part or all of the lung, and in some cases affects the entire lung. The tumor can be separated from the surrounding lung tissue by a capsule, but it can also infiltrate the pulmonary parenchyma, sprouting into large bronchi.
The clinical picture of primary lung sarcoma has almost no specific signs and is similar to the clinical manifestations of lung cancer. It is largely determined by the size, nature and rate of growth of the tumor, the nature of metastasis. Peripheral sarcomas in the first stage of the disease are usually asymptomatic and are detected by accident. As the disease progresses, clinical manifestations appear due to mechanical pressure and tumor growth. In these stages, the tumor often grows into the adjacent organs and anatomical formations (esophagus, trachea, large blood vessels, chest wall, mediastinal fiber, pericardium, etc.). As a rule, changes in the lungs in primary sarcoma are detected accidentally during preventive examinations, during routine X-ray examinations or during examinations for other diseases, or the true nature of the pathological changes is found out in the process of long-term unsuccessful treatment of suspected pneumonia. These lesions are not specific to primary lung sarcoma and are observed in a number of other diseases. The causes of such systemic disorders are not fully understood. Currently, it is believed that tumor intoxication, endocrine disorders, hypoxemia, and some other factors play a significant role in their origin. Changes in the peripheral blood may be absent or non-specific. Such patients may have minor leukocytosis, increased ESR, and anemia. The leading place in the diagnosis of primary lung sarcoma is occupied by radiation methods of investigation (radiography, computed tomography). New opportunities for the diagnosis of primary lung sarcomas were opened with the use of videothoracoscopy. The use of new technical means allows not only to clarify the nature and prevalence of the pathological process, but also to obtain material for histological and cytological studies.