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Lung cancer

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  • Morbidity.

  Lung cancer - the most common cancer (excluding skin cancer), he makes about a third of all deaths from cancer (first place in both men and women).  

  • Etiology  
    • Cigarette smoking is the cause of 85-90% of cases of lung cancer, smokers fall ill is 30 times more non-smokers. Smoking cigars and pipes doubles the risk of lung cancer.
    • Asbestos - a risk factor for mesothelioma, but it increases the risk of lung cancer and, especially in smokers - in addition to 3 times (thus, smokers, asbestos workers, the risk increases 90 times.)
    • Radioactive radiation increases the risk of small cell lung cancer as smokers and nonsmokers. Up to 6% of cases of lung cancer associated with radon.
    • Other substances - arsenic, nickel, chromium, chloromethyl ether, air pollutants - also contribute to the development of lung cancer.
    • Pulmonary disease (pneumosclerosis, X03L) also increase the risk of cancer.

Pathologic anatomy and flow

  • Small cell lung cancer (15% of lung cancer cases).  
    • Localization. In 95% of the tumor is located centrally  
    • The natural course. Characterized by dissemination by the time of diagnosis. The rapid deterioration in the formation of the bulk of the chest is often caused by melkokchetochnym lung cancer.
      • Distant metastases usually occur in the brain, bone marrow, liver, and often pleural effusion.
      • Relapse after chemotherapy and radiation therapy is possible in place of the original lesion, as well as new homes.
  • Nonsmall cell carcinoma (85% of cases of lung cancer). In this bottom view of the similarity of the clinical picture and treatment of combined adenocarcinoma, squamous and large cell carcinoma.
  • Squamous cell carcinoma (20-25% of non-small cell)
  • Localization. It was believed that squamous cancer characterized by a central location, and adenocarcinoma - peripheral. More recent studies show, now in the radiological picture of these tumors similar.
  • The flow. In comparison with other histological types of squamous cell lung cancer longer remains localized and the cup gives local recurrence after surgery or radiotherapy.
  • Adenocarcinoma (50-60% of non-small cell cancer), the main type of lung cancer in nonsmokers, especially in young women. Nevertheless, the majority of cases caused by smoking. In recent years, the incidence of adenocarcinoma of the lung increased.
    1. Localization. Adenocarcinoma often than squamous cell carcinoma, revealed in the form of a circular peripheral shadows in the lung.
    2. The flow. More than half of patients with a clinical picture found metastases in regional lymph nodes. Adenocarcinoma and large cell carcinoma have a similar course: typically extensive hematogenous metastasis to the bone, liver, brain.
  • Large cell carcinoma and nonsmall cell carcinoma without further specification are other cases. In recent years, the diagnosis is increasingly resorting to puncture, making it difficult to determine the histological type of tumor.
  • Rare tumors of the lungs
    • Carcinoid may show airway obstruction or ectopic ACTH secretion syndrome kariinoidnym (Ch. 15, p. 11).
    • Adenokietozny cancer (tsilindroma) differs local invasive growth. Characterized by local recurrence, although there may also metastasize to the lungs and other organs (Chapter 19, Section VI).
    • Carcinosarcoma - a tumor is usually large, prone to local growth. It is a bowl of other lung tumors is operable.
    • Mesothelioma can develop in the pleura, peritoneum and the tunica vaginalis testis. The pathogenesis of asbestos associated with the action, and if the patient has ever worked with him, there is every reason to believe that this was the cause of the disease.
  • The clinical picture
    • Medical history. About lung cancer occurrence may indicate a smoker cough (or change its nature), shortness of breath, hoarseness, hemoptysis, a prolonged pneumonia, chest pain, and loss of appetite, weight loss, the manifestations of paraneoplastic syndromes. These symptoms often prompt patients to stop smoking just before diagnosis.
      • Peripheral upper lobe of the lung cancer can cause symptoms pancoast (paresthesia and weakness in the hand), and Horners syndrome (ptosis, miosis and anhidrosis due to lesions of the cervical sympathetic fibers).
      • Symptoms of metastasis include bone pain, neurological disorders, jaundice, gastrointestinal symptoms, rapid enlargement of the liver, subcutaneous education, enlarged lymph nodes.

Prevention and early diagnosis

  • Prevention - the best way to reduce mortality from lung cancer. Up to 90% of patients with lung cancer would be avoided if it had not smoked.
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