Peripheral bronchus cancer prognosis with negative dynamics. Results of laboratory and special research methods

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.

All information on the site is for informational purposes only and is NOT a guide to action!
Can give you an ACCURATE DIAGNOSIS only DOCTOR!
We kindly ask you NOT to self-medicate, but make an appointment with a specialist!
Health to you and your loved ones! Do not give up

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 (symptom of “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:

biological— from the onset of the tumor to the appearance of the first clinical symptoms confirmed by diagnostic data;
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;
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. Atelectasis
. It is formed when a tumor grows into the bronchus, which leads to disruption of pneumatization of the lung tissue. Neurological impairment syndrome
. Develops with metastasis to the brain - symptoms of paralysis of the recurrent and phrenic nerves appear. 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. Pleural effusion
. The exudate cannot be treated with pleural puncture; after removal, it quickly accumulates again and is hemorrhagic in nature. 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.. 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:

removal of a lung lobe- the most common operation;
removal of the tumor itself— performed on elderly patients or patients with concomitant pathologies that are a contraindication for extensive abdominal surgery;
lung removal. This intervention is carried out at stages 2 - 3 of the disease;
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 characteristic of 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.

Oncological pathology of the bronchopulmonary system is a rather serious problem. The lungs are an organ that does not have pain receptors in its structure. Therefore, pain, as a symptom of damage, appears at fairly late stages of the disease. The article discusses the main aspects of the etiology, clinical picture, diagnosis and treatment of peripheral lung cancer.

Etiological factors

It is not entirely clear what exactly causes peripheral lung cancer. However, those factors that can contribute to the appearance of this disease and its rapid progression have been precisely identified.

Any develops faster when smoking. The length of time you systematically inhale nicotine directly affects the degree of threat of developing cancer. In addition, the more cigarettes a patient uses per day, the more pronounced will be the chronic inflammatory and degenerative changes in the epithelial lining of the respiratory tract and lungs.

The peripheral form of cancer of the bronchopulmonary system arises, to a greater extent, not through the bronchogenic route (inhalation of carcinogenic compounds), like central cancer, but hematogenously. For example, inhalation of asbestos or carcinogenic metals leads to the appearance of. It affects the large bronchi. Peripheral lung cancer occurred more often in those individuals who had increased concentrations of the same carcinogenic compounds in their blood.

The environmental situation has a significant impact on the risks of oncopathology of the pulmonary-bronchial system. Residents of cities and megalopolises are susceptible to colonization of the respiratory tract by irritants and pollutants of various chemical compositions.

Chronic inflammation of the bronchi is a significant risk factor. This applies to patients with chronic broncho-obstructive disease and bronchitis.

Any inflammation that lasts for a long time can become a factor in malignancy. Especially when it comes to organs lined with epithelial cells.

Heredity, closing this list, in fact occupies far from the last place among the possible causes of oncological transformation of normal cells. Not only tumors of the lungs or bronchi are important, but also the cancer process of any location.

Symptoms of the disease

A peripheral space-occupying formation, localized in any lung, exerts volume pressure either on the bronchi, or grows into the pleura, or other adjacent structures and organs, depending on its size. Modern oncologists distinguish several groups of clinical manifestations.

The first group of symptoms are signs of intrathoracic spread of the tumor mass. However, unlike bronchogenic (central) cancer, the peripheral form of cancer does not manifest itself so clearly.

Cough appears when the size is significant. The same goes for hemoptysis. This symptom marks the destruction of the tumor conglomerate or the germination of the bronchus with a violation of the integrity of its mucosa.

Chest pain and shortness of breath are also more typical for cancer of central origin. But it is known that with large sizes, the peripheral form clinically becomes indistinguishable from the bronchogenic one.

Hoarseness occurs when the left recurrent nerve is damaged. Peripheral cancer of the left lung is quite often accompanied by this striking syndrome. But the patient complains about this even when the size of the formation is serious. Peripheral cancer of the upper lobe of the left lung is a rare finding in young patients.

Tuberculosis lesions are more often localized there. But with age, the first and second segments become the site of localization of a peripheral malignant tumor. Peripheral cancer of the lower lobe of the left lung (as well as the right) is less common than pneumonia. This is the second most common disease in this area. It is difficult to imagine the clinical features of a tumor in the described localization.

More often, peripheral cancer of the right lung develops. This is due to the anatomical features of the branching of the bronchi. Peripheral cancer of the upper lobe of the right lung is more common in elderly patients. Detection of radiological changes in this area requires additional research using tomographic techniques.

Taking into account the syntopy of the lungs, in the later stages of the disease, symptoms of damage to neighboring organs develop. Dysphagia often bothers patients when the esophageal wall is involved. When the tumor spreads to the heart muscle or pericardium, functional disorders occur: arrhythmias, hypertension or hypotension.

Features of the apical localization of the tumor

Apical cancer does not develop as often as tumors of the above-described localizations. It should be noted that the apex of the lung is the favorite localization of the tuberculosis process. Therefore, it is necessary to exclude this chronic infectious disease first.

Cancer of the apex of the lung occurs with fairly clear symptoms, which are underestimated by doctors of related specialties.

Thus, pain in the shoulder joint, accompanied by atrophic changes in the muscles of the forearm, is regarded by rheumatologists and therapists as a manifestation of glenohumeral periarthritis or osteoarthritis.

Apical lung cancer has a different name in the literature - Pancoast cancer. The symptom complex for this localization is also called.

It includes damage to the 1st and 2nd ribs, detected on a chest x-ray. Horner's symptom is characteristic, which includes a triad of signs:

miosis – constriction of the pupil;
enophthalmos;
ptosis (drooping) of the eyelid on the affected side.

These manifestations are associated with the involvement of the sympathetic trunk in the process.

Paraneoplastic syndrome

We are talking about hormonal imbalances and metabolic changes caused by the tumor process. Most often, the development of a clear and obvious paraneoplastic syndrome is associated with a non-small cell variant of peripheral cancer.

Typically severe muscle weakness. It may be accompanied by the appearance of convulsive syndrome. This is associated with hypomagnesemia.

Endocrine changes relate to a greater extent to Cushingoid syndrome. As part of hypercortisolism, high blood pressure develops. Darkening of the skin (hyperpigmentation), first in the area of folds and folds, then diffuse, may be disturbing.

Edema may also indicate paraneoplastic syndrome. But they can also be caused by superior vena cava syndrome when this vessel is compressed by a tumor from the outside and subsequent thrombosis.

Metastasis

The occurrence of screening lesions is an inevitable part of the cancer process. Lung tumor metastases spread in three ways:

The lymphogenous route is considered the main one. Regional nodes are affected first. Contralateral metastasis is possible. Depending on which lymphatic collectors are affected by cancer cells, oncologists classify the disease.

Hematogenously, metastases spread to various organs. The adrenal glands are quite often affected. At the same time, symptoms of insufficiency of the function of this organ are revealed: weakness, drop in blood pressure, arrhythmias (feelings of interruptions in the functioning of the heart), electrolyte shifts in laboratory tests.

And examination of the skull using X-rays or computed tomography reveals bone damage. In about a fifth of patients, metastases can be found there.

Detection of metastatic foci in the brain and liver occurs with equal frequency. Therefore, the second stage of diagnosis includes ultrasound examination of the abdominal organs and tomography of the skull.

Diagnostic measures

The screening method for detecting the disease is fluorography. Today the frequency of this study is once a year.

Peripheral lung cancer progresses very quickly. Therefore, doctors of any specialty should pay attention to clinical manifestations.

Usually “minor” symptoms go unnoticed. Namely, they indicate that the disease is just beginning. Unfortunately, they are very nonspecific, and patients themselves rarely seek medical advice regarding their occurrence. What about these symptoms?

A complete blood count may reveal an acceleration of ESR. If the normal values are significantly exceeded, it is necessary to begin a search for oncopathology. Anemia is also characteristic - a decrease in hemoglobin levels. A detailed study reveals its redistributive nature (sideroachrestic anemia).

A biochemical blood test reveals an increase in calcium levels and a decrease in magnesium concentrations. C-reactive protein levels may be increased.

X-ray is indicative in later stages. The signs of peripheral lung cancer are not much different from the manifestations of a bronchogenic tumor in the image, especially in the later stages.

There are special forms of peripheral lung cancer. A spherical tumor is visible on an x-ray as a round shadow. Its contours are uneven. Clinically, it is worth saying that it rarely manifests itself. This is due to the fact that globular cancer comes from bronchial cells of the 4th order.

– inflammation of the lung tissue surrounding the mass formation. During treatment with antibiotics, the size of the tumor noticeably decreases, but the radiologist should be alerted by the appearance of radiance around the focal point of the darkening. This indicates inflammation of the lymphatic vessels - lymphangitis.

The cavity form of peripheral lung cancer is a formation that has undergone decay in its central part. This is due to tissue ischemia. On the radiograph it will be a ring-shaped shadow with a horizontal level of fluid. The contours are uneven.

The second stage of diagnosis is clarifying. It is necessary to determine the form of the disease, the extent of the tumor, its histological structure, degree of differentiation, and hormonal activity.

It is necessary to identify the presence of metastases, because all this affects the prognosis and treatment tactics. In order to understand the size and degree of involvement of neighboring organs and structures, it is necessary to conduct tomography. Mediastinoscopy, bronchoscopy, thoracoscopy are designed to assess whether the mediastinum, heart, esophagus, pleura, and lymphatic collectors are affected.

A puncture with transthoracic access allows for the collection of biological material for cytological examination. Cellular composition, cell differentiation, histochemical features will allow us to assess the operability of the situation.

Metastases are often localized in the brain and liver. Abdominal ultrasound is necessary to visualize the liver. The brain is examined using tomography.

Often the adrenal glands involved should also be examined. MRI is an integral technique for achieving this goal. Scanning of the body's bone structures and x-rays reveal lesions in the bones. The bronchoscopic stage is important for differential diagnosis. They should not be neglected, but at the same time, patients should be referred for such a study according to indications.

Treatment approaches and prognosis

Lung cancer can be treated in two ways: surgery and radiation therapy. The first method is not always practical.

If there are no metastases, and the tumor size does not exceed 3 cm in diameter, and neighboring structures are not involved, lobectomy is indicated. This . A fairly large volume of surgery is dictated by a large number of relapses. In addition, this is required by the rules of ablastics and antiblastics, on which oncology surgery is based.

If the isolateral lymphatic collectors (on one side) of the first order are affected by metastatic foci, lobectomy may also be justified. But domestic cancer surgeons prefer removal of the entire lung - pneumonectomy.

Tumor invasion of the esophagus, metastases to contralateral lymph nodes, distant organs - brain, liver, adrenal glands - are contraindications to surgery. Also, severe concomitant pathology in the stage of decompensation will prevent surgical intervention.

For these cases, radiation therapy is used. It can be an addition to surgery. Then this treatment of emerging peripheral cancer of one or both lungs is called complex.

Radiation exposure to the tumor is advisable before surgery to reduce the size of the tumor. Many factors influence survival. They are associated both with the characteristics of the tumor process and with the general condition of the patient:

Thus, the main problems of oncology are timely diagnosis and adequate treatment. Peripheral lung cancer, with careful attention to one's own body, can be detected in time and successfully treated.

Peripheral affects smaller bronchi, therefore, there is usually uneven radiance around the node, which is more typical for fast-growing low-grade tumors. Also, there are cavitary forms of peripheral lung cancer with heterogeneous areas of decay.

The disease begins to manifest itself when the tumor rapidly develops and progresses, involving the large bronchi, pleura and chest. At this stage, peripheral, turns into central. Characterized by increased cough with sputum discharge, hemoptysis, pleural carcinomatosis with effusion into the pleural cavity.

How to detect peripheral lung cancer?

Forms of peripheral lung cancer

One of the main differences between the tumor process in the lungs is the variety of their forms:

The cortico-pleural form is an oval-shaped neoplasm that grows into the chest and is located in the subpleural space. This form applies to . The structure of the tumor is most often homogeneous with a lumpy inner surface and unclear contours. It tends to grow both into adjacent ribs and into the bodies of nearby thoracic vertebrae.
The cavity form is a neoplasm with a cavity in the center. The manifestation occurs due to the disintegration of the central part of the tumor node, which lacks nutrition during the growth process. Such neoplasms usually reach sizes of more than 10 cm; they are often confused with inflammatory processes (cysts, tuberculosis, abscesses), which lead to an initially incorrect diagnosis, which in turn contributes to the progression. This form of neoplasm is often asymptomatic.

Important! The cavitary form of peripheral lung cancer is diagnosed mainly in the later stages, when the process has already become irreversible.

In the lungs, flat, round-shaped formations with a lumpy outer surface are localized. As the tumor grows, the cavity formations also increase in diameter, while the walls thicken and the visceral pleura is pulled towards the tumor.

Peripheral cancer of the left lung

For cancer of the upper lobe of the left lung The tumor process on an x-ray image clearly visualizes the contours of the tumor, which are of a heterogeneous structure and irregularly shaped. In this case, the roots of the lungs are expanded by vascular trunks, the lymph nodes are not enlarged.

For cancer of the lower lobe of the left lung, all it happens quite the opposite, in relation to the upper lobe of the left lung. There is an increase in the intrathoracic, prescalene and supraclavicular lymph nodes.

Peripheral cancer of the right lung

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

The nodular form of lung cancer originates from the terminal bronchioles. It appears after soft tissue has grown into the lungs. An X-ray examination can show a nodular formation with clear contours and a bumpy surface. A small depression (Rigler's sign) may be visible along the edge of the tumor; this indicates the entry of a large vessel or bronchus into the node.

Important! Particular attention should be paid to a correct and healthy diet; you need to eat only healthy and high-quality foods enriched with vitamins, microelements and calcium.

Pneumonia-like peripheral lung cancer – it's always . Its form develops as a result of spread along the lobe of peripheral cancer growing from the bronchus, or with the simultaneous manifestation of a large number of primary tumors in the pulmonary parenchyma and their merging into a single tumor infiltrate.

This disease does not have any specific clinical manifestations. At first, it is characterized as a dry cough, then sputum appears, initially scanty, then abundant, liquid, foamy. With the addition of infection, the clinical course resembles recurrent pneumonia with severe general intoxication.

Apical lung cancer with Pancoast syndrome - This is a type of disease in which malignant cells penetrate the nerves and vessels of the shoulder girdle.

The Pancoast syndrome (triad) is:

apical localization of lung cancer;
Horner's syndrome;
pain in the supraclavicular region, usually intense, initially paroxysmal, then constant and prolonged. They are localized in the supraclavicular fossa on the affected side. The pain intensifies with pressure, sometimes spreading along the nerve trunks emanating from the brachial plexus, accompanied by numbness of the fingers and muscle atrophy. In this case, hand movements can be disrupted to the point of paralysis.

X-ray examination of Pancoast syndrome reveals: destruction of 1-3 ribs, and often the transverse processes of the lower cervical and upper thoracic vertebrae, deformation of the bone skeleton. In far advanced cases, a doctor's examination reveals unilateral dilatation of the saphenous veins. Another symptom is a dry cough.

Horner and Pancoast syndromes are often combined in one patient. With this syndrome, due to the tumor affecting the lower cervical sympathetic nerve ganglia, hoarseness of the voice, unilateral drooping of the upper eyelid, narrowing of the pupil, sunken eyeball, injection (vasodilatation) of the conjunctiva, dyshidrosis (impaired sweating) and hyperemia of the facial skin are quite often observed. the affected side.

In addition to primary peripheral and metastatic lung cancer, Pancoast syndrome (triad) can also occur in a number of other diseases:

hydatid cyst in the lung;
mediastinal tumor;
tuberculosis.

What all these processes have in common is their apical localization. With a thorough X-ray examination of the lungs, the true nature of Pancoast syndrome can be recognized.

How long does it take for lung cancer to develop?

There are three courses of development of lung cancer:

biological - from the onset of the tumor until the appearance of the first clinical signs, which will be confirmed by the data of the diagnostic procedures performed;
preclinical - a period in which there are completely no signs of the disease, which is the exception of visiting a doctor, which means that the chances of early diagnosis of the disease are reduced to a minimum;
clinical - the period of manifestation of the first symptoms and initial visits of patients to a specialist.

Tumor development depends on the type and location of cancer cells. develops more slowly. It includes: squamous cell and large cell lung cancer. The prognosis for this type of cancer is up to 5 years without appropriate treatment. Patients rarely survive more than two years. The tumor develops rapidly and clinical symptoms of the disease appear. 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 of peripheral lung cancer

In the later stages of the disease, when the tumor spreads to a large bronchus and narrows its lumen, the clinical picture of peripheral cancer becomes similar to the central form. At this stage of the disease, the results of physical examination are the same in both forms of lung cancer. At the same time, in contrast to X-ray examination, against the background of atelectasis, a shadow of the peripheral tumor itself is revealed. In peripheral cancer, the tumor often spreads throughout the pleura with the formation of pleural effusion.
The transition of the peripheral form to the central form of lung cancer occurs due to the involvement of large bronchi in the process, while remaining invisible for a long time. Manifestations of a growing tumor may include increased cough, sputum production, hemoptysis, shortness of breath, pleural carcinomatosis with effusion into the pleural cavity.

With bronchial cancer, similar first symptoms appear with the addition of inflammatory complications from the lungs and pleura. That is why it is important to regularly conduct fluorography, which shows lung cancer.

Symptoms of peripheral lung cancer:

shortness of breath - may be due to tumor metastasis to the lymph nodes;
pain in the chest, which can change its character along with movement;
cough, prolonged, without any reason;
sputum separation;
swollen lymph nodes;
if the tumor develops in the area of the apex of the lung, then compression of the superior vena cava may occur and the neoplasm may impact the structures of the cervical plexus, with the development of corresponding neurological symptoms.

Signs of peripheral lung cancer:

temperature increase;
malaise;
weakness, lethargy;
rapid fatigue;
decreased ability to work;
loss of appetite;
weight loss;
in some cases, pain in the bones and joints is even felt.

Causes of development of peripheral lung cancer:

- one of the most important causes of lung cancer incidence. Tobacco smoke contains hundreds of substances that can have a carcinogenic effect on the human body;
environmental conditions: air pollution that penetrates the lungs (dust, soot, fuel combustion products, etc.);
harmful working conditions - the presence of large amounts of dust can cause the development of sclerosis of the lung tissue, which has the risk of developing into a malignant form;
asbestosis – a condition caused by inhalation of asbestos particles;
hereditary predisposition;
Chronic lung diseases - cause constant inflammation, which increases the likelihood of developing cancer; viruses can invade cells and increase the likelihood of developing cancer.

Stages of peripheral lung cancer

depending on the clinical manifestation of the degree:

Stage 1 peripheral lung cancer. The tumor is quite small in size. There is no spread of the tumor to the chest organs and lymph nodes;

1A - tumor size does not exceed 3 cm;
1B - tumor size from 3 to 5 cm;

Stage 2 peripheral lung cancer. The tumor grows;

2A - tumor size 5-7 cm;
2B - the dimensions remain unchanged, but the cancer cells are located close to the lymph nodes;

Stage 3 peripheral lung cancer;

3A - the tumor affects adjacent organs and lymph nodes, the tumor size exceeds 7 cm;
3B - cancer cells penetrate the diaphragm and lymph nodes on the opposite side of the chest;

Stage 4 peripheral lung cancer. At this stage, the tumor spreads throughout the body.

Diagnosis of lung cancer

Important! Peripheral lung cancer is a malignant neoplasm that tends to grow and spread rapidly. When the first suspicious symptoms appear, you should not hesitate to visit a doctor, as you may waste precious time.

It is complex due to the similarity of its radiological symptoms with many other diseases.

How to recognize peripheral lung cancer?

X-ray examination is the main method in the diagnosis of malignant neoplasms. Most often, patients perform this study for a completely different reason, and in the end they may encounter lung cancer. The tumor appears as a small lesion on the peripheral part of the lung.
Computed tomography and MRI are the most accurate diagnostic methods that allow you to obtain a clear image of the patient’s lungs and accurately examine all of his tumors. With the help of special programs, doctors have the opportunity to examine the received images in different projections and extract maximum information for themselves.
- carried out by removing a section of tissue followed by histological examination. Only by examining the tissue under high magnification can doctors say that the neoplasm is malignant.
Bronchoscopy is an examination of the patient’s respiratory tract and bronchi from the inside using special equipment. Since the tumor is located in parts more distant from the center, this method provides less information than if the patient has central lung cancer.
Cytological examination of sputum - allows you to detect atypical cells and other elements that suggest a diagnosis.

Differential diagnosis

On a chest x-ray, the shadow of peripheral cancer must be differentiated from several diseases unrelated to the tumor in the right lung.

Pneumonia is an inflammation of the lungs, which gives a shadow on the X-ray image; the accumulation of exudate provokes a violation of ventilation in the lungs, since it is not always possible to make out the pattern accurately. An accurate diagnosis is made only after a thorough examination of the bronchi.
Tuberculosis is a chronic disease that can provoke the development of an encapsular formation - tuberculoma. The size of the shadow on the x-ray will not exceed 2 cm. The diagnosis is made only after laboratory testing of the exudate to identify mycobacteria.
Retention cyst – the image will show a formation with clear edges.
A benign tumor of the right lung - there will be no tuberosity in the image, the tumor is clearly localized and does not disintegrate. A benign tumor can be distinguished from the patient’s history and complaints - there are no symptoms of intoxication, stable health, and no hemoptysis.

Having excluded all similar diseases, the main stage begins - selection of the most effective treatment methods for a particular patient, depending on the form, stage and location of the malignant focus.

Informative video: Endobronchial ultrasound in the diagnosis of peripheral lung cancer

Peripheral lung cancer and its treatment

Today, the most modern methods are:

surgical intervention;
radiation therapy;
chemotherapy;
radiosurgery.

In world practice, surgery and radiation therapy are gradually giving way to advanced methods of treating lung cancer, but despite the advent of new treatment methods, surgical treatment of patients with resectable forms of lung cancer is still considered a radical method with prospects for a complete cure.

When chemotherapy is combined with radiation treatment (simultaneous or sequential use is possible), better results are achieved. Chemoradiation treatment is based on the possibility of both an additive effect and synergism, without the addition of toxic side effects.

Combined treatment is a type of treatment that includes, in addition to radical surgery, other types of effects on the tumor process in the local-regional affected area (external beam or other methods of radiation therapy). Consequently, the combined method involves the use of two heterogeneous effects of different nature, aimed at local-regional foci.

For example:

surgical + radiation;
radiation + surgical;
radiation + surgical + radiation, etc..

The combination of unidirectional methods makes up for the limitations of each of them separately. It must be emphasized that we can talk about combination treatment only when it is applied according to a plan developed at the very beginning of treatment.

Peripheral lung cancer: prognosis

It is very difficult to predict the treatment of peripheral lung cancer, since it can be expressed in different structures, be in different stages and be treated with different methods. This disease is curable with both radiosurgery and surgery. According to statistics, among patients who underwent surgery, the 5-year or more survival rate is 35%. When treating the initial forms of the disease, a more favorable outcome is possible.

Prevention of peripheral lung cancer

To minimize lung cancer you need to:

treatment and prevention of inflammatory lung diseases;
annual medical examinations and fluorography;
complete cessation of smoking;
treatment of benign tumors in the lungs;
neutralization of harmful factors in production, and in particular: contacts with nickel compounds, arsenic, radon and its decay products, resins;
avoiding exposure to carcinogenic factors in everyday life.

Informative video: Peripheral cancer of the upper lobe of the right lung

It is possible to detect a tumor in the lungs and determine what it may be with a detailed examination. People of different ages are susceptible to this disease. Formations arise due to disruption of the process of cell differentiation, which can be caused by internal and external factors.

Neoplasms in the lungs are a large group of different formations in the lung area, which have a characteristic structure, location and nature of origin.

Neoplasms in the lungs can be benign or malignant.

Benign tumors have different genesis, structure, location and different clinical manifestations. Benign tumors are less common than malignant tumors and make up about 10% of the total. They tend to develop slowly and do not destroy tissue, since they are not characterized by infiltrating growth. Some benign tumors tend to transform into malignant ones.

Depending on the location there are:

Central - tumors from the main, segmental, lobar bronchi. They can grow inside the bronchus and surrounding lung tissue.
Peripheral - tumors from surrounding tissues and walls of small bronchi. They grow superficially or intrapulmonarily.

Types of benign tumors

There are the following benign lung tumors:

Briefly about malignant tumors

Increase.

Lung cancer (bronchogenic carcinoma) is a tumor consisting of epithelial tissue. The disease tends to metastasize to other organs. It can be located in the periphery, the main bronchi, or grow into the lumen of the bronchus or organ tissue.

Malignant neoplasms include:

Lung cancer has the following types: epidermoid, adenocarcinoma, small cell tumor.
Lymphoma is a tumor that affects the lower respiratory tract. It may occur primarily in the lungs or as a result of metastases.
Sarcoma is a malignant formation consisting of connective tissue. Symptoms are similar to those of cancer, but develop more quickly.
Pleural cancer is a tumor that develops in the epithelial tissue of the pleura. It can occur primarily, and as a result of metastases from other organs.

Risk factors

The causes of malignant and benign tumors are largely similar. Factors that provoke tissue proliferation:

Smoking active and passive. 90% of men and 70% of women who have been diagnosed with malignant tumors in the lungs are smokers.
Contact with hazardous chemicals and radioactive substances due to professional activities and environmental pollution in the area of residence. Such substances include radon, asbestos, vinyl chloride, formaldehyde, chromium, arsenic, and radioactive dust.
Chronic respiratory diseases. The development of benign tumors is associated with the following diseases: chronic bronchitis, chronic obstructive pulmonary disease, pneumonia, tuberculosis. The risk of malignant neoplasms increases if there is a history of chronic tuberculosis and fibrosis.

The peculiarity is that benign formations can be caused not by external factors, but by gene mutations and genetic predisposition. Malignancy and transformation of the tumor into malignant also often occur.

Any lung growths can be caused by viruses. Cell division can be caused by cytomegalovirus, human papillomavirus, multifocal leukoencephalopathy, simian virus SV-40, and human polyomavirus.

Symptoms of a tumor in the lung

Benign lung formations have various signs that depend on the location of the tumor, its size, existing complications, hormonal activity, the direction of tumor growth, and impaired bronchial obstruction.

Complications include:

abscess pneumonia;
malignancy;
bronchiectasis;
atelectasis;
bleeding;
metastases;
pneumofibrosis;
compression syndrome.

Bronchial patency has three degrees of impairment:

1st degree – partial narrowing of the bronchus.
2nd degree – valvular narrowing of the bronchus.
3rd degree – occlusion (impaired patency) of the bronchus.

Symptoms of the tumor may not be observed for a long time. The absence of symptoms is most likely with peripheral tumors. Depending on the severity of the symptoms, several stages of the pathology are distinguished.

Stages of formations

Stage 1. It is asymptomatic. At this stage, partial narrowing of the bronchus occurs. Patients may have a cough with a small amount of sputum. Hemoptysis is rare. During examination, the x-ray does not reveal any abnormalities. Tests such as bronchography, bronchoscopy, and computed tomography can show the tumor.

Stage 2. Valve narrowing of the bronchus is observed. At this point, the lumen of the bronchus is practically closed by the formation, but the elasticity of the walls is not impaired. When you inhale, the lumen partially opens, and when you exhale, it closes with the tumor. In the area of the lung that is ventilated by the bronchus, expiratory emphysema develops. As a result of the presence of bloody impurities in the sputum and swelling of the mucous membrane, complete obstruction (impaired patency) of the lung may occur. Inflammatory processes may develop in the lung tissues. The second stage is characterized by a cough with the release of mucous sputum (pus is often present), hemoptysis, shortness of breath, increased fatigue, weakness, chest pain, fever (due to the inflammatory process). The second stage is characterized by alternation of symptoms and their temporary disappearance (with treatment). An X-ray image shows impaired ventilation, the presence of an inflammatory process in a segment, lobe of the lung, or an entire organ.

To be able to make an accurate diagnosis, bronchography, computed tomography, and linear tomography are required.

Stage 3. Complete obstruction of the bronchial tube occurs, suppuration develops, and irreversible changes in lung tissue and their death occur. At this stage, the disease has such manifestations as impaired breathing (shortness of breath, suffocation), general weakness, excessive sweating, chest pain, elevated body temperature, cough with purulent sputum (often with bloody particles). Sometimes pulmonary hemorrhage may occur. During examination, an x-ray may show atelectasis (partial or complete), inflammatory processes with purulent-destructive changes, bronchiectasis, and a space-occupying lesion in the lungs. To clarify the diagnosis, a more detailed study is necessary.

Symptoms

Symptoms of low-quality tumors also vary depending on the size, location of the tumor, the size of the bronchial lumen, the presence of various complications, and metastases. The most common complications include atelectasis and pneumonia.

At the initial stages of development, malignant cavitary formations that arise in the lungs show few signs. The patient may experience the following symptoms:

general weakness, which intensifies as the disease progresses;
increased body temperature;
fast fatiguability;
general malaise.

Symptoms of the initial stage of neoplasm development are similar to those of pneumonia, acute respiratory viral infections, and bronchitis.

The progression of a malignant formation is accompanied by symptoms such as cough with sputum consisting of mucus and pus, hemoptysis, shortness of breath, and suffocation. When the tumor grows into the vessels, pulmonary hemorrhage occurs.

A peripheral lung mass may not show signs until it invades the pleura or chest wall. After this, the main symptom is pain in the lungs that occurs when inhaling.

In later stages, malignant tumors appear:

increased constant weakness;
weight loss;
cachexia (depletion of the body);
the occurrence of hemorrhagic pleurisy.

Diagnostics

To detect tumors, the following examination methods are used:

Fluorography. A preventive diagnostic method, x-ray diagnostics, which allows you to identify many pathological formations in the lungs. read this article.
Plain radiography of the lungs. Allows you to identify spherical formations in the lungs that have a round outline. An x-ray image reveals changes in the parenchyma of the examined lungs on the right, left or both sides.
CT scan. Using this diagnostic method, the lung parenchyma, pathological changes in the lungs, and each intrathoracic lymph node are examined. This study is prescribed when differential diagnosis of round formations with metastases, vascular tumors, and peripheral cancer is necessary. Computed tomography allows a more accurate diagnosis to be made than x-ray examination.
Bronchoscopy. This method allows you to examine the tumor and perform a biopsy for further cytological examination.
Angiopulmonography. It involves performing invasive radiography of blood vessels using a contrast agent to detect vascular tumors of the lung.
Magnetic resonance imaging. This diagnostic method is used in severe cases for additional diagnostics.
Pleural puncture. Study in the pleural cavity with a peripheral tumor location.
Cytological examination of sputum. Helps determine the presence of a primary tumor, as well as the appearance of metastases in the lungs.
Thoracoscopy. It is carried out to determine the operability of a malignant tumor.

Fluorography.

Bronchoscopy.

Angiopulmonography.

Magnetic resonance imaging.

Pleural puncture.

Cytological examination of sputum.

Thoracoscopy.

It is believed that benign focal formations of the lungs are no more than 4 cm in size; larger focal changes indicate malignancy.

Treatment

All neoplasms are subject to surgical treatment. Benign tumors must be immediately removed after diagnosis in order to avoid an increase in the area of affected tissue, trauma from surgery, the development of complications, metastases and malignancy. For malignant tumors and benign complications, a lobectomy or bilobectomy may be required to remove a lobe of the lung. With the progression of irreversible processes, a pneumonectomy is performed - removal of the lung and surrounding lymph nodes.

Bronchial resection.

Central cavity formations localized in the lungs are removed by resection of the bronchus without affecting the lung tissue. With such localization, removal can be done endoscopically. To remove tumors with a narrow base, a fenestrated resection of the bronchial wall is performed, and for tumors with a wide base, a circular resection of the bronchus is performed.

For peripheral tumors, surgical treatment methods such as enucleation, marginal or segmental resection are used. For large tumors, lobectomy is used.

Lung formations are removed using thoracoscopy, thoracotomy and videothoracoscopy. During the operation, a biopsy is performed, and the resulting material is sent for histological examination.

For malignant tumors, surgical intervention is not performed in the following cases:

when it is not possible to completely remove the tumor;
metastases are located at a distance;
impaired functioning of the liver, kidneys, heart, lungs;
The patient's age is more than 75 years.

After removal of the malignant tumor, the patient undergoes chemotherapy or radiation therapy. In many cases, these methods are combined.

The cancer is the uncontrolled growth of abnormal cells in one or both lungs. Mutated cells do not perform their functions. In addition, the pathological growth of the tumor damages the pulmonary structure. As a result, the lungs lose their ability to provide the body with oxygen.

Leading clinics abroad

Causes

All cells in the human body contain genetic material called DNA. Each time a mature cell divides into two new cells, its DNA is precisely duplicated. The new cells are identical in all respects to the original.

Lung cancer begins with the occurrence of mutation processes in cellular DNA, which can be caused by aging of the body or environmental factors (such as tobacco smoke, inhalation of asbestos and radon vapors).

Researchers have discovered that a cell can be in a precancerous state before it becomes cancerous. At this stage, in addition to a small number of mutations, the unhindered functioning of lung cells is observed. After several cycles of tissue division, the tissue becomes pathological.

In later stages of the disease, some mutated cells may travel through the lymphatics and blood vessels from the original tumor to other areas of the body, causing new lesions. This process is called metastasis.

Classification

Depending on the location of the malignant process, tumors are:

Right lung cancer.
Left lung cancer.

Stages of development of lung oncology:

I. The size of the neoplasm is 3 cm. It is located in one segment of the lung. There are no metastases.

II. Tumor size – 6 cm. Localization within a segment of one lung. Single metastases are observed.

III. The tumor is more than 6 cm in diameter and the process spreads into two segments. May grow to the central bronchus. Extensive metastases are detected.

IV. The pathology extends beyond the organ and is characterized by extensive distant metastases.

Clinical picture depending on the location of the malignant process

Central right lung cancer characterized by the following symptoms:

Attacks of frequent dry cough, sometimes with blood;
There is a history of regular treatment for pneumonia;
The occurrence of shortness of breath for no apparent reason;
Body temperature is maintained at 37º C for a long period;
Painful sensations in the chest area on the right side.

Peripheral cancer of the right lung in the early stages it is practically asymptomatic. This form of the disease is diagnosed accidentally (during an X-ray examination of the chest organs) or purposefully (in the later stages of the disease, when its general symptoms appear).

Leading specialists from clinics abroad

General symptoms

A sharp decrease in body weight.
Hyperthermia, which is not associated with colds or inflammatory diseases of the body.
General weakness that increases as the tumor develops.
Prolonged pain in the right half of the body.

Diagnostics

The main way to diagnose each type of lung cancer is an x-ray examination, which determines the location of the tumor, its size and extent. In some cases, magnetic resonance imaging is performed to clarify the boundaries of the area affected by the oncological process. depends on the country of treatment, as well as on the complexity of the techniques used. Finally, oncologists perform a biopsy, which is necessary to determine the cellular composition of the tumor.

Right lung cancer - treatment

There are three main methods of treating oncological lesions of the pulmonary system: surgery, exposure to ionizing radiation and chemotherapy. The treatment option depends on the location of the process and its cellular composition.

Surgical removal of a malignant neoplasm is carried out in the early stages and can be partial or complete. For example, if a diagnosis of “Cancer of the upper lobe of the right lung” is established, the oncologist decides on partial resection of the upper lobe of the lung. During the operation, lymph nodes are also removed along with the affected lung tissue to prevent the development of relapse of the disease.
The second most effective method of treating lung cancer is ionizing radiation, which can be used either independently or in combination with surgery. The complex method of exposure is recommended for use when mutated cells are located in hard-to-reach areas (cancer of the lower lobe of the right lung).
Chemotherapy is mainly used for patients who are unable to undergo surgery, or in advanced stages with extensive foci of tumor metastasis.

Complications of surgical treatment

The occurrence of extensive bleeding during surgery.
Development of recurrent lung cancer.
Formation of pulmonary failure.
Lymphostasis in the vessels of the chest.

Prevention of lung cancer

Passing a regular annual medical examination, including fluorography;
Timely and complete treatment of inflammatory processes in the chest cavity;
Rejection of bad habits;
Maintaining a healthy lifestyle;
Proper nutrition.