Peripheral formation in the lung: symptoms and treatment. All about peripheral lung cancer: how it differs from regular lung cancer

Peripheral lung cancer is a neoplasm in the respiratory tract, formed from epithelial cells, which is not difficult to distinguish from other oncology of the bronchi and lungs. The neoplasm can develop from the epithelium of the mucous membrane of the bronchi, pulmonary alveoli and glands of the bronchioles. Most often the small bronchi and bronchioles are affected, hence the name - peripheral cancer.

Symptoms

In the initial stages, this disease is very difficult to determine. Later, when the tumor grows into the pleura, into the large bronchi, when it moves from the periphery to the central lung cancer, more pronounced signs of a malignant neoplasm begin. Shortness of breath, pain in the chest area (on the side where the tumor is localized), severe cough interspersed with blood and mucus appears. Further symptoms and signs:

1. Difficulty swallowing.
2. Hoarse, hoarse voice.
3. Pancoast syndrome. It appears when the tumor grows and affects the vessels of the shoulder girdle, and is characterized as weakness in the muscles of the arms, with further atrophy.
4. Increased low-grade fever.
5. Vascular insufficiency.
6. Sputum with blood.
7. Neurological disorders. It occurs when metastatic cells enter the brain, affecting the phrenic, recurrent and other nerves of the chest cavity, causing paralysis.
8. Effusion into the pleural cavity. It is characterized by the effusion of exudate into the chest cavity. When fluid is removed, exudate appears much quickly.

Causes

1. Smoking comes first. The components of tobacco smoke contain many carcinogenic chemical compounds that can cause cancer.
2. "Chronicle" - chronic lung pathologies. Constant damage to the lung walls by viruses and bacteria causes inflammation, which increases the risk of developing atypical cells. Also, tuberculosis and pneumonia can develop into oncology.
3. Ecology. It's no secret that in Russia the environment is the precursor to all diseases; polluted air, water of disgusting quality, smoke, dust from thermal power plants released into the external environment - all this leaves an imprint on health.
4. Work illness manifests itself when people work in “harmful” enterprises; constant inhalation of dust causes the development of sclerosis of the tissues of the bronchi and lungs, which can lead to oncology.
5. Heredity. Scientists have not yet proven the fact that people are capable of transmitting this disease to their blood relatives, but such a theory exists, and statistics confirm this.
6. Pneumoconiosis (asbestosis) is a disease caused by asbestos dust.

Sometimes peripheral lung cancer can be secondary disease. This happens when a malignant tumor is already developing in the body and metastasizes to the lungs and bronchi, so to speak, “settling” on them. The metastatic cell enters the bloodstream, touches the lung, and begins to grow a new tumor.

Stages of the disease

1. Biological. From the onset of tumor development until the appearance of the first visible symptoms, which will be officially confirmed by diagnostic studies.
2. Preclinical. During this period, there are no signs of the disease, this fact reduces the likelihood of seeing a doctor, and therefore diagnosing the disease in the early stages.
3. Clinical. From the appearance of the first symptoms and the initial visit to doctors.

Also, the speed of development depends on the type of cancer itself.

Types of peripheral lung cancer

Non-small cell cancer grows slowly, if the patient does not see a doctor, then the lifespan will be approximately 5-8 years, it includes:

• Adenomaccarcinoma;
• Large cell carcinoma;
• Squamous.

Small cell cancer develops aggressively and without appropriate treatment, the patient can live for up to two years. With this form of cancer there are always clinical signs and most often a person does not pay attention to them or confuses them with other diseases.

Forms

1. Cavity form is a tumor in the central part of an organ with a cavity. During the development of a malignant formation, the central part of the tumor disintegrates, as there are not enough nutritional resources for further development. The tumor reaches at least 10 cm. Clinical symptoms of peripheral localization are practically asymptomatic. The strip form of peripheral cancer is easily confused with cysts, tuberculosis and abscesses in the lungs, since they look very similar on x-rays. This form is diagnosed late, so the survival rate is not high.
2. Corticopleural form– one of the forms of squamous cell carcinoma. A tumor of round or oval shape, located in the subpleural space and penetrating into the chest, or more precisely into adjacent ribs and thoracic vertebrae. With this form of tumor, pleurisy is observed.

Peripheral cancer of the left lung

The tumor is localized in the upper and lower lobes.

1. Peripheral cancer of the upper lobe of the right lung. Cancer of the upper lobe of the left lung on X-ray differentiation of the contours of the neoplasm is clearly expressed, the tumor itself has a varied shape and heterogeneous structure. The vascular trunks of the roots of the lungs are expanded. Lymph nodes are within the physiological norm.
2. Peripheral cancer of the lower lobeleft lung- the tumor is also clearly defined, but in this case the supraclavicular, intrathoracic and prescalene lymph nodes are enlarged.

Peripheral cancer of the right lung

The same localization as in the left lung. It occurs an order of magnitude more often than cancer of the left lung. The characteristics are exactly the same as in the left lung.

1. Nodal form— at the beginning of formation, the site of localization is the terminal bronchioles. Symptoms appear when the tumor invades the lungs and soft tissues themselves. An x-ray shows a clearly differentiated neoplasm with a lumpy surface. If an indentation is visible on the x-ray, this indicates a vessel has grown into the tumor.
2. Pneumonia-like peripheral (glandular cancer) - the neoplasm originates from the bronchus, spreading throughout the entire lobe. The primary symptoms are subtle: dry cough, sputum is released, but not in large quantities, then it becomes liquid, thick and foamy. When bacteria or viruses enter the lungs, symptoms are characteristic of recurrent pneumonia. For an accurate diagnosis, it is necessary to donate sputum to examine the exudate.
3. Pancoast syndrome- localized in the apex of the lung, with this form of cancer the nerves and blood vessels are affected.
4. Horner's syndrome- this is a triad of symptoms, most often observed together with Pancoast syndrome, characterized by drooping or recessed upper eyelid, recession of the eyeball and atypical constriction of the pupil.

Stages

First of all, what the doctor needs to find out is the stage of cancer in order to specifically decide on the treatment of the patient. The earlier cancer was diagnosed, the better the prognosis for therapy.

Stage 1

• 1A- formation no more than 30 mm in diameter.
• 1B- cancer does not reach more than 50 mm.

At this stage, the malignant tumor does not metastasize and does not affect the lymphatic system. The first stage is more favorable, since the tumor can be removed and there is a chance of a complete recovery. Clinical signs have not yet appeared, which means the patient is unlikely to see a specialist, and the chances of recovery are reduced. There may be symptoms such as a sore throat and a mild cough.

Stage 2

• 2A- size is about 50 mm, the neoplasm approaches the lymph nodes, but without affecting them.
• 2B— The cancer reaches 70 mm, the lymph nodes are not affected. Metastases are possible to nearby tissues.

Clinical symptoms have already appeared, such as fever, cough with sputum, pain, and rapid weight loss. Survival at the second stage is lower, but it is possible to surgically remove the formation. With proper treatment, the patient's life can be extended up to five years.

Stage 3

• 3A— Size more than 70 mm. Malignant formation affects regional lymph nodes. Metastases affect the chest organs and blood vessels leading to the heart.
• 3B— The size is also more than 70 mm. Cancer is already beginning to penetrate the lung parenchyma and affects the lymphatic system as a whole. Metastases reach the heart.

At the third stage, treatment practically does not help. Clinical signs are pronounced: sputum with blood, severe pain in the chest area, continuous cough. Doctors prescribe narcotic drugs to alleviate the patient's suffering. The survival rate is critically low - approximately 9%.

Stage 4

Cancer cannot be cured. Metastases have reached all organs and tissues through the bloodstream, and concomitant oncological processes are already appearing in other parts of the body. The exudate is constantly pumped out, but it quickly reappears. Life expectancy is reduced to zero; no one knows how long a person with stage 4 lung cancer will live; it all depends on the resistance of the organism and, of course, on the treatment method.

Treatment

The treatment method depends on the type, form and stage of the disease.

Modern methods of treatment:

1. Radiation therapy. At the first and second stages it gives positive results; it is also used in combination with chemotherapy at stages 3 and 4 and achieves the best results.
2. Chemotherapy. When using this treatment method, complete resorption is rarely observed. 5-7 courses of chemotherapy are used with an interval of 1 month, at the discretion of the pulmonologist. The interval may vary.
3. Surgical removal - More often, the operation is performed at stages 1 and 2, when the tumor can be completely removed with a prognosis for full recovery. At stages 3 and 4, when metastasis occurs, removing the tumor is useless and dangerous for the patient’s life.
4. Radiosurgery - a fairly recent method, which is also called “Cyber ​​Knife”. Without incisions, the tumor is burned out by radiation exposure.

There may be complications after any treatment: impaired swallowing, tumor growth further into neighboring organs, bleeding, tracheal stenosis.

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Peripheral lung cancer is a form of lung cancer that begins in the “periphery” of the organ (hence the name) - in the cells of the bronchi, gradually moving to the lungs themselves. This is a common and dangerous disease that occurs in women after 50 years of age, and in men after 45 years of age. It appears more often in males.

It can occur in both lobes, but the right lower lobe is most often affected. Cancer on the left side is aggressive, so a favorable prognosis is extremely rare. A malignant neoplasm is accompanied by metastasis to distant organs and lymph nodes.

A person voluntarily triggers the development of cancer. Due to the presence of bad habits, as well as other factors, unwanted complications are observed. Main causes of cancer:

1. Smoking leads to oncology. The essence of what is happening is the dangerous effect on the body of toxic substances contained in tobacco. The majority (80%) of existing lung cancers are caused by smoking. And it doesn’t matter how frequent the puffs are, because any amount can cause irreparable harm to the body.
2. Working with harmful chemicals, inhaling heavy metals and being near them is undesirable. Professional activities (scientists, chemists, miners) require the use of special clothing. In ordinary life, you should beware of arsenic, nickel, radon, mercury, and coal tar.
3. Environmental pollution. It is possible to see a similar phenomenon near large cities, roads, and on the outskirts. Urban and rural residents suffer from this if there are industrial, processing, and chemical enterprises in their area of ​​residence.
4. Air poisoning occurs due to frequent smoking and the influence of radon. Present in building materials and water.
5. The impact of viruses on human DNA.
6. Hereditary factor. Peripheral formation occurs extremely rarely.

The periphery of the lung can manifest itself for any reason. Most cancers develop for a specific reason. There are cases when several reasons are combined at the same time. Prevention requires annual screening to combat cancer at an early stage.

Classification

Peripheral cancer is a transient and widespread disease. It differs in its special classification, degree of development, and symptoms. There are 6 forms of peripheral lung formation, which suggests that the cancer spreads to the right or left lung. The main forms of the disease include carcinoma and tuberculosis.

Corticopleural variant of the disease

The corticopleural form of lung cancer is a neoplasm characterized by an oval shape and an expanded base. Gradually it increases in size and grows into the surrounding tissues. This kind of cancer is called squamous cell cancer; cancer cells can reach the thoracic vertebrae and ribs.

Cavity option

The neoplasm has a certain cavity in the center. A characteristic change in the lung is observed through the decomposition of the tumor node, because there are not enough nutrients during development.

The formations rarely exceed 10 cm, so they are often confused with the onset of inflammation (cyst, abscess). The result is that it is not possible to make an accurate diagnosis, which leads to the progression of oncology. This is possible, because the cavitary variant of the disease does not have pronounced symptoms.

Cancer of the lower and upper organs

Oncology of the upper lobe of the right lung is indicated by contours in the image, but the structure and shape are not clear. Vessels and lymph nodes are also enlarged.

By peripheral cancer of the lower lobe we mean the reverse course of events than in the upper lobe of the lung. Changes in the intrathoracic, prescalene, and supraclavicular lymph nodes of the lower lobe of the right lung were recorded.

Nodal option

Develops from terminal bronchioles. Only the field of soft tissue growth into the lungs begins to appear. The neoplasm looks like nodules with a bumpy surface. There may be slight depressions along the edges, which suggests penetration of a large vessel or bronchus into the node.

Pneumonia-like variant

Represents glandular cancer. It begins to manifest itself in the bronchi, turning into many neoplasms - this unites the tumor infiltrate.

This form of the disease does not have any characteristic symptoms. First there is a cough that turns into sputum. As it develops, the symptoms intensify. If there is an infection, pneumonia appears, the reason for this is serious poisoning.

Apical cancer

A form of the disease due to which malignant neoplasms spread to the nerves and vessels of the shoulder.

Affected areas:

• left and right lung;
• Horner's syndrome;
• soreness above the collarbone, which has a progressive nature of development. If at first the sensations are weak, they are gradually replaced by intense, long-lasting ones. Such changes are concentrated in the supraclavicular fossa. The slightest movement intensifies the pain. Sometimes the symptom begins to arise from the nerve trunks of the brachial plexus. A common occurrence is muscle numbness or atrophy. As a result: it is difficult to make any movements with the upper limbs, since paralysis is possible.

An x-ray can reveal destruction of 1-3 ribs, lower or upper thoracic vertebrae, and changes in the condition of the skeleton. In the final stages of pathology, a specialist has the right to detect a unilateral form of varicose veins. There is also a cough.

The combination of all symptoms often manifests itself in one person. As a result of the development of problems in the lower cervical regions, the following is revealed:

• hoarseness when speaking,
• drooping eyelid,
• constriction of the pupil,
• vasodilatation,
• sunken eyeball,
• increased sweating,
• rashes on the facial skin.

Stages of pathology

Peripheral cancer is distinguished by the existence of several stages, which suggest certain symptoms and characteristic features.

• Stage 1 – the tumor is small in size. In this case, there is no possibility of cancer penetrating into the sternum or lymph nodes. Acceptable values ​​of the tumor are 3-5 cm;
• second stage - cancer cells begin to actively increase up to 7 cm. Over time, the clinical picture does not change, but the tumor approaches the lymph nodes;
• third stage - the neoplasm interferes with the normal activity of nearby organs, which is overshadowed by the rapid growth of cancer cells (more than 7 cm). As they grow, they penetrate the diaphragm, lymph nodes on the opposite side of the sternum;
• fourth stage – metastasis develops (cancer affects most of the internal organs).

Each stage has a specific clinical picture. At an early stage of tumor development, there is a high probability of a positive outcome for a person, but advanced disease is rarely cured.

Symptoms

Peripheral cancer is asymptomatic for a long time, this is influenced by the structure of pathological cells and the characteristic processes of tumor development. The main symptoms of the disease have no distinctive features from other forms. But at certain stages of development, progression or remission of the pathology is observed.

Symptoms:

• shortness of breath – the cause is considered to be metastases in the lymph nodes;
• severe pain in the sternum - the sensation may intensify as you move;
• cough is an integral part of the disease. Has a protracted nature, without a compelling reason for its manifestation;
• sputum;
• change in the size of the lymph nodes - upward.

When the tumor spreads to the upper part of the lung, compression of the veins and a negative impact on the structure of the cervical plexus are common. At the same time, neurological symptoms intensify.

Distinctive signs of pathology:

• heat;
• apathy;
• lethargy, drowsiness;
• weight loss;
• poor appetite;
• rapid fatigue;
• decreased ability for physical and mental activity;
• pain in bones and joints (rare).

Due to cancer, characteristic signs and symptoms may indicate the onset of an inflammatory process in the bronchi and pleura. Therefore, it is necessary to undergo an annual examination of the whole body, if possible more often. This way you can quickly detect the development of the disease.

Diagnostics

Determining the presence of cancer cells on the lung is quite difficult, since the existing changes may relate to a completely different disease. But there are several diagnostic methods for prescribing effective treatment for lung cancer.

1. An X-ray of the lung is required for various reasons, but it is the one that informs about the development of cancer. On an x-ray, you can see a slight darkening in the lung area, which characterizes cancer cells.
2. Computed tomography and magnetic resonance imaging are the most accurate research methods. Thanks to it, it is possible to print a clear image of the organ of a cancer patient in order to study in detail the existing formations. Using special programs, the clinic’s doctors are able to examine the image from any angle, extracting maximum information from it.
3. Biopsy is the removal of a piece of tissue for histological examination. It is expected to view biological material under a microscope to determine the nature of the neoplasm.
4. Bronchoscopy is an examination of the bronchi and respiratory organs from the inside using special instruments and technical equipment. But due to the remoteness of the tumor, it is extremely rare to obtain all the necessary information. The method is indispensable if available.
5. Cytological examination of sputum provides a chance to identify atypical cells and other elements for making a preliminary diagnosis.

The variety of existing diagnostic measures makes it possible to identify a tumor at the initial stage of development. The main thing is to go to a medical institution in time (annual examination), and not to aggravate the situation by having bad habits.

Treatment

To prevent the progression of the disease, comprehensive treatment is necessary. For positive dynamics, it is advisable to undertake some treatment methods without citing the loss of time or the patient’s inoperability.

On a note! Modern methods of combating oncology involve the use of radiation therapy and chemotherapy. Surgical intervention is practiced for special indications.

Irradiation is also an effective treatment method that can eliminate tumors in the initial stages of the disease. It is better to use it at stages 1-2 of cancer.

During chemotherapy, the patient is prescribed a number of drugs. A mandatory procedure if there are contraindications to radiation therapy or surgery.

If a benign form of a tumor is detected, it is permissible to use certain types of surgical intervention:

• Lobectomy is an operation on 2 lobes of the lung.
• Wedge resection is the removal of part of the lung, used in the initial stages of pathology development.
• Pulmonectomy – removal of an organ with the formation of a bronchial stump.

The possibility of surgery gives hope for a favorable outcome of the disease. Peripheral cancer develops too quickly, which makes it difficult to detect the problem and provide timely assistance.

Complications

If the tumor disappears after treatment and the body works as usual, then consequences affecting the internal organs follow.

Important! After therapeutic measures for peripheral lung cancer, the following occurs: failure of the kidneys, liver, and other organs. To improve the condition, you should resort to prevention, following the instructions. After some time, your health improves and your metabolic processes improve.

Prognosis and prevention

Peripheral cancer is practically untreatable because it develops rapidly, and the use of supportive medications rarely helps. Cancer has an unfavorable prognosis for patients - after detection of characteristic tumors, survival is 2-6 months.

Important! The progression of the disease is associated with the location and type of cancer. In non-small cell lung cancer, development is slow. There are several forms: large cell, adenocarcinoma, squamous cell. Lack of treatment is fraught with a decrease in the patient’s standard of living, not exceeding 8 years.

Important! Small cell lung cancer involves a decrease in the level of vital activity; it is rarely possible to survive for 2 years. The 5-year survival rate, with timely diagnosis and treatment, is 15%. The use of medications is effective on an individual basis, and a person’s life is prolonged.

Taking into account people who have overcome cancer, it is advisable to follow preventive measures (this will prevent the recurrence of the disease).

• fluorography;
• annual inspection;
• complete nutrition. A nutritionist who will take into account the nuances of the patient’s health should help;
• quit smoking, drugs, alcohol.

Do not forget about personal hygiene, exercise and cleanliness of the premises. It is advisable not to come into contact with harmful substances to prevent lung blockage.

Lung cancer is one of the most common types of cancer. About 1 million new cases are diagnosed every year, if we take global statistics. In this case, the disease is divided into several types depending on the location of the tumor and the characteristics of its development.

Peripheral lung cancer is considered one of the most serious and dangerous types of cancer pathology. It is dangerous because in the initial stages it practically does not manifest itself at all; it can remain in this stage for quite a long period of time.

The neoplasm usually originates in the epithelial tissue of small bronchi, bronchioles or alveoli. Experiments carried out on animals have shown that carcinogenic agents enter the lungs predominantly by hematogenous or lymphogenous route.

Clinical picture of the disease

In any case, when the tumor increases in size and grows into deeper layers of tissue, the cancerous pathology moves to a more serious stage, characteristic symptoms will appear that will help to suspect health problems as early as possible and seek medical help from specialists.

Symptoms of peripheral lung cancer are mostly similar to other types of this disease. They will appear as follows:

Important! In the later stages, general symptoms characteristic of any type of cancer pathology are observed: malaise, weakness, chronic fatigue, loss of appetite, weight loss.

As soon as these signs are noticed, you should definitely consult a doctor. Only timely diagnosis and an accurately established diagnosis will make the prognosis for peripheral lung cancer more encouraging.

Diagnostics and its methods

Diagnostics will allow you to accurately determine where the tumor is located, what size it is, and what the nature of the tumor is. Depending on this, further therapy will differ.

Statistics show that peripheral cancer of the upper lobe of the right or left lung is most often diagnosed. This type of disease accounts for about 60% of cases. The reason is the anatomical structure of the respiratory organ, higher air exchange in its upper parts. If we talk about peripheral cancer of the lower lobe of the right or left lung, then this type of oncology occurs in 30% of cases. And only 10% falls on the middle lobe of the organ.

As for the diagnostic methods themselves, first of all it is radiography. X-rays for peripheral LC are done to determine the presence of a neoplasm and its location, to assess the approximate size and structure. But this examination method does not allow one to see the full picture of the patient’s health status, so it cannot be the only one. In the resulting X-ray photo, PRL may be completely invisible.

Biopsy - diagnostic method

Computed tomography and magnetic resonance imaging are required. These research methods allow you to obtain more accurate information about the structure, size and location of the tumor, determine whether there are metastases, and see where they are located.

One cannot do without a biopsy followed by histopathology of the obtained material. At this stage, doctors are able to determine the nature of the tumor and its type, and make a conclusion about the danger of the disease.

The patient will also be given a referral for a comprehensive laboratory blood test. It includes biochemistry, as well as research for tumor markers. Only after conducting a full examination, doctors will be able to make an accurate diagnosis and prescribe effective treatment for peripheral lung cancer, increasing the prognosis for recovery.

Treatment tactics

It is compiled individually in each case. It will depend on the results of the patient’s examination, the stage of the disease, as well as the presence of concomitant ailments.

In any case, surgery remains the main treatment method. It allows you to remove part of the organ affected by the tumor, as well as neighboring tissues, to avoid relapse. Moreover, if the size of the tumor is not large, there is no metastasis, there are one or two metastases in the regional lymph nodes, the operation promises to be successful, giving hope for a complete recovery.

Surgery is performed using an open or minimally invasive method. The latter is more popular because it is less traumatic, has few contraindications, and shortens the rehabilitation period. At the same time, the effectiveness of such an operation reaches the highest levels, because all actions of doctors are carried out under the control of special cameras that display images on the screen.

If more extensive work is required, then open surgery may be used due to the impossibility of doing otherwise.

Often, radiation therapy is performed before surgery. This is true in cases where the tumor is quite large and has begun to grow deep into the tissue of the organ. Antitumor drugs or radiation can destroy cancer cells, stopping tumor growth. In a large number of cases, this method can even reduce the size of the tumor, making it operable.

Treatment with anticancer drugs and radiation therapy will continue after surgery. The main goal is to destroy any cancer cells that might remain, preventing an early relapse.

The success of treatment depends on how long BPD has been developing and what stage the disease has reached. If we talk about, then exclusively palliative therapy will be carried out here, which will eliminate numerous symptoms and improve the patient’s quality of life.

Lung cancer is a malignant neoplasm of epithelial origin, developing from the mucous membranes of the bronchial tree, bronchial glands (bronchogenic cancer) or alveolar tissue (pulmonary or pneumogenic cancer). Lung cancer leads in the structure of mortality from malignant tumors. The mortality rate for lung cancer is 85% of the total number of cases, despite the advances of modern medicine.

The development of lung cancer is different for tumors of different histological structures. Differentiated squamous cell carcinoma is characterized by a slow course; undifferentiated carcinoma develops quickly and gives extensive metastases. Small cell lung cancer has the most malignant course. develops secretly and quickly, metastasizes early, and has a poor prognosis. Most often, the tumor occurs in the right lung - in 52%, in the left lung - in 48% of cases.

The cancerous tumor is predominantly localized in the upper lobe of the lung (60%), less often in the lower or middle lobe (30% and 10%, respectively). This is explained by more powerful air exchange in the upper lobes, as well as by the peculiarities of the anatomical structure of the bronchial tree, in which the main bronchus of the right lung directly continues the trachea, and the left one forms an acute angle with the trachea in the bifurcation zone. Therefore, carcinogenic substances, foreign bodies. smoke particles, rushing into well-aerated zones and remaining in them for a long time, cause the growth of tumors.

Metastasis of lung cancer is possible in three ways: lymphogenous, hematogenous and implantation.

The most common is lymphogenous metastasis of lung cancer to bronchopulmonary, pulmonary, paratracheal, tracheobronchial, bifurcation, and paraesophageal lymph nodes. The first to be affected by lymphogenous metastasis are the pulmonary lymph nodes in the zone of division of the lobar bronchus into segmental branches. Then the bronchopulmonary lymph nodes along the lobar bronchus are involved in the metastatic process. Subsequently, metastases occur in the lymph nodes of the root of the lung and azygos vein, and tracheobronchial lymph nodes. The next to be involved in the process are the pericardial, paratracheal and paraesophageal lymph nodes. Distant metastases occur in the lymph nodes of the liver, mediastinum, and supraclavicular region.

Metastasis of lung cancer through the hematogenous route occurs when the tumor grows into blood vessels, and the other lung, kidneys, liver, adrenal glands, brain, and spine are most often affected. Implantation metastasis of lung cancer is possible in the pleura if the tumor grows into it.

Causes of lung cancer

Factors of occurrence and mechanisms of development of lung cancer do not differ from the etiology and pathogenesis of other malignant lung tumors. In the development of lung cancer, the main role is given to exogenous factors: smoking, air pollution with carcinogenic substances, exposure to radiation (especially radon).

Classification of lung cancer

Based on the histological structure, there are 4 types of lung cancer: squamous cell, large cell, small cell and glandular (adenocarcinoma). Knowledge of the histological form of lung cancer is important in terms of choice of treatment and prognosis of the disease. It is known that squamous cell lung cancer develops relatively slowly and usually does not give early metastases. Adenocarcinoma is also characterized by relatively slow development, but it is characterized by early hematogenous dissemination. Small cell and other undifferentiated forms of lung cancer are transient, with early extensive lymphogenous and hematogenous metastasis.

It has been noted that the lower the degree of tumor differentiation, the more malignant its course.

According to localization relative to the bronchi, lung cancer can be central, arising in the large bronchi (main, lobar, segmental), and peripheral, emanating from the subsegmental bronchi and their branches, as well as from the alveolar tissue. Central lung cancer is more common (70%), peripheral lung cancer is much less common (30%).

The form of central lung cancer is endobronchial, peribronchial nodular and peribronchial branched. Peripheral cancer can develop in the form of “globular” cancer (round tumor), pneumonia-like cancer, cancer of the apex of the lung (Pancoast).

The classification of lung cancer according to the TNM system and stages of the process is given in detail in the article “Malignant lung tumors”.

Symptoms of lung cancer

The clinical picture of lung cancer is similar to the manifestations of other malignant lung tumors. Typical symptoms are a persistent cough with mucopurulent sputum, shortness of breath, low-grade body temperature, chest pain, and hemoptysis. Some differences in the clinical picture of lung cancer are due to the anatomical location of the tumor.

Central lung cancer

A cancer tumor localized in a large bronchus produces early clinical symptoms due to irritation of the bronchial mucosa, disruption of its patency and ventilation of the corresponding segment, lobe or entire lung.

The interest of the pleura and nerve trunks causes the appearance of pain, cancerous pleurisy and disturbances in the areas of innervation of the corresponding nerves (phrenic, vagus or recurrent). Metastasis of lung cancer to distant organs causes secondary symptoms in the affected organs.

Invasion of the bronchial tube by a tumor causes a cough with sputum and often mixed with blood. When hypoventilation occurs, and then atelectasis of a segment or lobe of the lung, cancerous pneumonia occurs. manifested by elevated body temperature, the appearance of purulent sputum and shortness of breath. Cancer pneumonia responds well to anti-inflammatory therapy, but recurs again. Cancer pneumonia is often accompanied by hemorrhagic pleurisy.

Germination or compression of the vagus nerve by a tumor causes paralysis of the vocal muscles and manifests itself as hoarseness. Damage to the phrenic nerve leads to paralysis of the diaphragm. The growth of a cancerous tumor into the pericardium causes pain in the heart, pericarditis. Involvement of the superior vena cava leads to disruption of venous and lymphatic drainage from the upper half of the body. The so-called superior vena cava syndrome is manifested by puffiness and swelling of the face, hyperemia with a cyanotic tint, swelling of the veins in the arms, neck, chest, shortness of breath, and in severe cases - headache, visual disturbances and impaired consciousness.

Peripheral lung cancer

Peripheral lung cancer in the early stages of its development is asymptomatic, since there are no pain receptors in the lung tissue. As the tumor node grows, the bronchi, pleura, and neighboring organs become involved in the process. Local symptoms of peripheral lung cancer include cough with sputum and streaks of blood, compression syndrome of the superior vena cava, and hoarseness. Tumor growth into the pleura is accompanied by cancerous pleurisy and compression of the lung by pleural effusion.

The development of lung cancer is accompanied by an increase in general symptoms: intoxication, shortness of breath, weakness, weight loss, increased body temperature.

In advanced forms of lung cancer, complications from organs affected by metastases, disintegration of the primary tumor, and bronchial obstruction occur. atelectasis, profuse pulmonary hemorrhage. The causes of death in lung cancer are most often extensive metastases, cancer pneumonia and pleurisy, cachexia (severe exhaustion of the body).

Diagnosis of lung cancer

Diagnosis for suspected lung cancer includes:

Read more about methods for diagnosing lung cancer here.

Lung cancer treatment

The leading methods in the treatment of lung cancer are surgery in combination with radiation therapy and chemotherapy. The operation is performed by thoracic surgeons.

If there are contraindications or ineffectiveness of these methods, palliative treatment is carried out, aimed at alleviating the condition of a terminally ill patient. Palliative treatment methods include pain relief, oxygen therapy, detoxification, palliative operations: tracheostomy. gastrostomies. enterostomy, nephrostomy, etc.). For cancer pneumonia, anti-inflammatory treatment is carried out, for cancer pleurisy - drainage of the pleural cavity, for pulmonary hemorrhage - hemostatic therapy.

Forecast and prevention of lung cancer

The worst prognosis is statistically observed for untreated lung cancer: almost 90% of patients die 1-2 years after diagnosis. With non-combined surgical treatment of lung cancer, the five-year survival rate is about 30%. Treatment of lung cancer at stage I gives a five-year survival rate of 80%, at stage II – 45%, at stage III – 20%.

Radiation or chemotherapy alone has a 10% five-year survival rate for lung cancer patients; with combined treatment (surgery + chemotherapy + radiation therapy), the survival rate for the same period is 40%. Metastasis of lung cancer to lymph nodes and distant organs is prognostically unfavorable.

Issues of lung cancer prevention are relevant due to the high mortality rates of the population from this disease. The most important elements of lung cancer prevention are active health education, prevention of the development of inflammatory and destructive lung diseases, identification and treatment of benign lung tumors, smoking cessation, elimination of occupational hazards and everyday exposure to carcinogenic factors. Having fluorography at least once every 2 years allows you to detect lung cancer in the early stages and prevent the development of complications associated with advanced forms of the tumor process.

Lung cancer is a disease that includes epithelial tumors of different histological structure and symptoms. They develop from the pulmonary alveoli, glands of the bronchioles and the integumentary epithelium of the bronchial mucosa. The main features of lung cancer that distinguish it from other malignant neoplasms are the tendency to early relapse, the variety of clinical forms and multiple routes of metastasis.

Lung cancer that develops from bronchioles and small bronchi is called peripheral. Clinically, it begins to manifest itself only after germination into the pleura and large bronchi. It is this reason that accounts for the high mortality rate from this form of cancer.

Forms of peripheral lung cancer

As mentioned above, one of the main differences between the tumor process in the lungs is the variety of its forms. Let's take a closer look at them.

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Corticopleural form. This is an oval-shaped neoplasm that does not grow as a single node, but grows into the chest and is located in the subpleural space. According to histological composition, the tumor belongs to the squamous cell type of cancer.

The structure of the tumor is in most cases homogeneous with a lumpy inner surface and unclear contours. It can grow not only into adjacent ribs, but also into the bodies of nearby thoracic vertebrae.

Cavity form. The main difference between this cancer process is its asymptomatic nature.

It is detected already in the later stages, when the developed processes become irreversible.

In the parts of the lungs, single-chamber spherical cavity formations with a lumpy outer surface and unclear contours are localized.

As the tumor increases in size, the cavity formations also increase in diameter, at the same time their walls thicken and the visceral pleura is pulled towards the tumor.

Cancer of the upper lobe of the left lung. With this type of tumor process, the X-ray image clearly shows the fuzzy contours of a neoplasm of irregular shape and heterogeneous structure. The roots of the lungs are expanded by vascular trunks, the sinuses are free.

Lymph nodes, as a rule, do not enlarge. In case of cancer of the lower lobe of the left lung, on the contrary, there is an increase in intrathoracic, prescalene and supraclavicular lymph nodes.

Cancer of the upper lobe of the right lung. It has the same features as the previous form of cancer, but is more common, just like cancer of the lower lobe of the right lung.

Nodular form of lung cancer. It is formed from terminal bronchioles. Clinical manifestations appear after germination of the soft tissues of the lungs. An X-ray examination can show a nodular neoplasm with clear contours and a bumpy surface.

In some cases, a small depression appears along the edge of the tumor (Rigler's sign). This indicates the entry of a large vessel or bronchus into the node.

Syndrome of decay, tumor centralization

When the tumor reaches a large size, the blood supply to the lungs begins to deteriorate, which causes the tumor to disintegrate. It occurs gradually with the formation of cavities in the tumor node.

Due to the unevenness of the process, tumor masses remain in places on the walls of the cavity (the symptom of a “signet ring inward”). After the merging of small cavities into one large one, a phase of large decay begins.

The central decay phase is the last stage of tumor decay.

The examination reveals a thick-walled cavity formation with a horizontal fluid level. The clinical course of the tumor collapse and centralization syndrome resembles the picture of an abscess.

The patient's body temperature rises sharply, and the sputum that comes out when coughing becomes purulent in nature with hemoptysis. The risk of pulmonary hemorrhage increases.

Causes

This disease develops most often due to the carcinogenic effects of many chemical elements on lung tissue. This may be due to poor environment, hazardous production, nicotine addiction and many other factors.

Disputes about genetic predisposition to the development of lung cancer still rage among scientists, but so far this has not been a scientifically proven factor.

Video: Why smoking causes lung cancer

How long does it take for peripheral lung cancer to develop?

The course of the cancer process in the lungs can be divided into the following periods:

1. biological— from the onset of the tumor to the appearance of the first clinical symptoms confirmed by diagnostic data;
2. preclinical— a period of complete absence of signs of the disease, which eliminates the likelihood of the patient going to the doctor, and therefore reduces the chances of early diagnosis of the disease;
3. clinical— the period of manifestation of the first symptoms and initial visits of patients to a specialist;

The development time of the oncological process depends on the structure of the tumor and its location. Non-small cell cancer develops much more slowly. This type of cancer includes squamous cell carcinoma, adenocarcinoma and large cell carcinoma.

Patients with this type of cancer can live 6-8 years without treatment, without even knowing about their disease. Conversely, patients with small cell cancer of the respiratory system rarely live more than two years after the onset of the disease.

The tumor of the central type is located in the large bronchi, which causes the early manifestation of clinical symptoms of the disease. Peripheral cancer develops in the small bronchi, does not produce pronounced symptoms for a long time and often manifests itself during routine medical examinations.

Symptoms and signs

Early symptoms of peripheral lung cancer include shortness of breath, cough with hemoptysis and chest pain on the affected side. With the further development of the disease, the patient experiences an increase in body temperature, a large amount of sputum begins to be released, and symptoms of intoxication of the body appear.

The main symptoms are accompanied by secondary ones; they are caused by the tumor growing into adjacent tissues and organs.

1. Atelectasis. It is formed when a tumor grows into the bronchus, which leads to disruption of pneumatization of the lung tissue.
2. Neurological impairment syndrome. Develops with metastasis to the brain - symptoms of paralysis of the recurrent and phrenic nerves appear.
3. Perifocal inflammation. It appears when a focus of pneumonia forms around the tumor node. The main symptoms are catarrhal symptoms, cough with copious sputum, and hyperthermia.
4. Pleural effusion. The exudate cannot be treated with pleural puncture; after removal, it quickly accumulates again and is hemorrhagic in nature.
5. Pancoast syndrome. It manifests itself as atrophy of the muscles of the upper limb, pain in the shoulder girdle. Develops with apical cancer with germination into the nerves and vessels of the shoulder girdle.
6. Mediastinal compression syndrome. Characterized by difficulty swallowing, chest pain, hoarseness.

Video: Unusual signs of lung cancer

Differential diagnosis

Bronchographic and radiation diagnostics play a huge role in making an accurate diagnosis. With its help, you can not only differentiate lung cancer from tuberculosis or prolonged pneumonia, but also establish the form of cancer.

X-rays of central cancer show insufficient ventilation of the lungs, atelectasis of the lung tissue, narrowing of the central bronchi and enlargement of the lymph nodes of the mediastinum and the root of the lung.

The tumor itself has unclear contours and a heterogeneous structure. Bronchography clearly shows a narrowing or complete closure of the bronchial lumen.

An X-ray with a peripheral form of cancer shows decay cavities with unclear contours and a node against the background of lung tissue. During a bronchographic examination, multiple amputations of the bronchi in the area of ​​the node and narrowing of the small bronchi are clearly visible.

Stages of the disease

There is the following classification of lung cancer depending on its clinical manifestations and the extent of the process:

• Stage I peripheral lung cancer. This is the very initial stage of the disease, when the tumor is small, until it begins to grow into the lymph nodes. In stage 1A, the tumor does not exceed 3 cm in size; in stage 1B, the tumor size ranges from 3 to 5 cm;
• Stage II peripheral lung cancer. The size of the tumor gradually increases. In stage 2A they are 5-7 cm; in 2B, its size does not change, but the cancer cells are located close to the lymph nodes;
• Stage III peripheral lung cancer. In stage 3A, the tumor affects adjacent organs and lymph nodes, its size exceeds 7 cm. In stage 3B, cancer cells penetrate the diaphragm and lymph nodes on the opposite side of the chest;
• IV stage peripheral lung cancer. At this stage, metastasis occurs, that is, the tumor spreads throughout the body. There is a possibility of fluid formation in the pleural cavity and around the heart;

Treatment

Treatment methods for lung cancer depend on the stage of development of the process, the size of the tumor and its structure. Small cell cancer is the most sensitive to conservative therapy.

Therefore, the main treatment method for this form is chemotherapy, which helps to achieve a good result with a duration of several years.

Radiation treatment is used for stage 3 and 4 cancer. In combination with chemotherapy, it is possible to achieve a positive effect in the fight against small cell cancer. The usual dosage for radiation therapy is 60 - 70 gray. But the main treatment for lung cancer is surgery.

Depending on the stage of the disease, the following operations may be performed:

1. removal of a lung lobe- the most common operation;
2. removal of the tumor itself- performed on elderly patients or patients with concomitant pathology, which is a contraindication for extensive abdominal surgery;
3. lung removal. This intervention is carried out at stages 2 - 3 of the disease;
4. combined operation. Along with the tumor, nearby tissues and organs involved in the process are removed.

Complications

These include pulmonary hemorrhage, tracheal stenosis, and impaired swallowing associated with tumor growth into the esophagus and trachea. Complications develop in advanced cases, characterized by tumor disintegration. This is usually typical for stage 4 of the cancer process.

Prognosis (life expectancy)

Life expectancy for lung cancer depends on the stage at which the disease was discovered and its treatment began, namely:

• in stage I of the disease, the survival rate of patients is 40-50%;
• in stage II - 15 - 30%;
• when treatment is started at stage III, the five-year survival rate is 5 - 10;
• If the process is detected at stage IV, the prognosis is unfavorable.