Cancer and pulmonary tuberculosis (Transition of tuberculosis to cancer). The relationship and differences between tuberculosis and pulmonary oncology Symptomatic differences between cancer and pulmonary tuberculosis

Tuberculosis and lung cancer are serious and also very dangerous diseases. To increase the chances of a full recovery, it is important to recognize the disease in time and carry out the appropriate course of treatment. Although pulmonary tuberculosis and cancer are considered different diseases, there is much in common in their course and symptoms, so an incorrect diagnosis may be made in the first stages. That is why it is important to pay attention to the general symptoms and find out the difference between these ailments.

Similar symptoms

At first glance, there is nothing in common between tuberculosis and cancer. But if you thoroughly study each pathology, it will become obvious that not everything is as simple as it might seem.

Signs that indicate tuberculosis or lung cancer are very similar:

Development of shortness of breath
Sudden weight loss
The presence of a chronic cough with bloody sputum.

Sometimes even specialists find it difficult to distinguish the symptoms of cancer from an infectious disease caused by Koch's bacillus. In some cases, diagnosing the disease and making a diagnosis will take longer than expected. But it is better to detect the disease later than to start ineffective treatment. A serious assessment of the patient’s condition and carrying out appropriate tests will help identify the disease.

Symptoms of lung cancer

A specialist can predict the development of oncology based on the following signs:

Severe fatigue
Apathetic state
Loss of vitality
Fever and slight increase in body temperature, as with ARVI, flu or a cold
An infrequent cough that became chronic
Sputum production with blood (in the last stages of lung cancer)
Pain in the chest area (at stages 3 or 4, analgesics do not relieve pronounced pain)
Shortness of breath along with abnormal heart rhythm (observed in advanced cancer)
Swelling of the upper body (face and neck).

With advanced processes, cyanosis of the mucous membranes, as well as acrocyanosis, is diagnosed. A change in the terminal phalanges may be observed (the presence of so-called “drumsticks”).

Diagnosing lung cancer in a patient with tuberculosis or residual effects after treatment is quite a difficult task. The most effective method is considered to be X-ray examination, as well as tomography. But along with this, the results of a cytological examination after taking a biopsy of the lung and lymph nodes from the patient are of main importance.

Invasive diagnostic methods (endobronchial examination or transthoracic puncture) should be carried out only if there are serious indications, when the observed symptoms and x-rays indicate the development of cancer.

Find out more about lung cancer

Signs of tuberculosis

With the development of this disease, the following symptoms may be observed:

Lethargy
Deterioration of general condition
Low-grade fever (body temperature – 37-38C)
Enlarged lymph nodes
Development of anemia
Chronic cough accompanied by sputum
Presence of wheezing in the lungs
Rhinitis
Difficulty breathing (quite rare), as well as pain in the chest.

Thus, we can conclude that pulmonary tuberculosis differs from cancer in the nature of the pathological processes (infectious or oncological), contagiousness, as well as partial symptoms.

Detailed information about tuberculosis prevention can be found here.

The relationship between two pathologies

The problem with the occurrence of the ailments in question lies in the fact that tuberculosis can gradually develop into lung cancer. This is why cancer is often diagnosed after tuberculosis has been completely cured.

Recent studies have shown that the risk of lung cancer in the presence of tuberculosis increases significantly, which is explained by the structural changes that occur within the lung tissue.

The age factor also plays a big role in this. In patients over 45 years of age with tuberculosis, the risk of developing cancer is almost 7 times higher than in younger people. This is due to a slowdown in metabolic processes, as well as a decrease in the body’s immune defense.

When tuberculosis degenerates into oncology, central and peripheral localization of the pathological process is observed. At the moment, there are 3 stages of lung cancer that arises against the background of tuberculosis:

Asymptomatic period
Obvious manifestation of symptoms
The occurrence of metastases.

Thanks to a thorough analysis of the observed x-ray changes in the presence of a number of signs that are not characteristic of tuberculosis, it will be possible to identify oncology in a timely manner and carry out the necessary treatment.

Tuberculosis and lung cancer often develop simultaneously. They can easily be confused, because the diseases have similar symptoms.

What is tuberculosis

This disease is a chronic infection caused by a specific type of bacteria (Koch bacillus). The respiratory organs are most often affected, but the disease can also affect other areas of the body:

genitals;
eyes;
bones and joints;
lymph nodes.

Treatment of the disease takes a lot of time. Therapy includes a complex of antibiotics, and in some cases surgery is required. In most cases, infection occurs through airborne droplets after contact with an infected person.

Less commonly, the disease is transmitted through contact or due to poor personal hygiene. A patient who has this disease in its open form spreads the infection by coughing (along with sputum). A patient can infect more than 10 people in 1 year.

The causative agents of the disease are resistant to environmental influences. They can live outside the human body for some time. Sunlight and ultraviolet rays are harmful to them.

What is lung cancer

The disease is the presence of a malignant tumor developing in the respiratory organs (bronchi or lungs). According to statistics, this form of oncology most often ends in death (in 85% of cases).

The undifferentiated type of the disease develops quite rapidly and is accompanied by extensive metastases. Differentiated is characterized by slow development. The small cell type is considered the most dangerous.

It is characterized by rapid development, mild symptoms, and early appearance of metastases.

The tumor most often forms in the upper part of the lung. This is explained by stronger air exchange, as well as the anatomical structure of the bronchial tree. All harmful substances that enter the body along with the air remain for a long time in the upper lobes of the lungs, causing the development of diseases.

The spread of metastases occurs in 3 ways:
Lymphogenic. The lymph nodes of the respiratory system are the first to be affected. The disease then spreads to everyone else.
Hematogenous. The tumor grows into a blood vessel. As a result, infected cells spread throughout almost the entire body.

Implantation. Spread occurs through the pleura.

Causes of the disease include smoking, air pollution and radiation.

Similarities

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shortness of breath (in both cases the respiratory organs are affected);
nausea, loss of appetite, weight loss;
cough (it cannot be treated, is present constantly or intermittently);
hemoptysis (occurs due to damage to the blood vessels in the respiratory system);
indifference, increased fatigue;
pain in the sternum;
increased erythrocyte sedimentation rate;
anemia;
visual similarity in the picture (x-ray).

The reasons for their occurrence are also common:

decreased protective functions of the body;
harmful working conditions;
environmental (air) pollution;
smoking (with many years of experience);
presence of chronic lung diseases.

If you have the listed symptoms, you should not put off visiting a doctor, since both diseases are life-threatening.

What is the difference

Difference between tuberculosis and lung cancer:

Causes of the onset of the disease. The infection is transmitted by airborne droplets. Infection most often occurs in childhood or adolescence. A tumor is formed as a result of pathological changes occurring in cells. Among the patients, the majority are middle-aged and elderly people.
The nature of the disease. In the first case, the pathology occurs in 2 stages. The first stage lasts a long time, and if you have good immunity, the disease stops spreading. In the case of oncology, the disease develops rapidly and is accompanied by irreversible consequences.
Forecast. With adequate therapy and a timely diagnosis, the life expectancy of tuberculosis patients is much higher.

One disease differs from another in terms of treatment methods. In the first case, chemotherapy is used, aimed at destroying the causative agent of the disease. If a tumor is present, the affected area of tissue is surgically removed, followed by treatment with chemotherapy.

How to distinguish

What disease the patient has - tuberculosis or lung cancer - can be distinguished if you know the signs of each of them. Symptoms of an infectious disease that are not typical for oncology:

Tachycardia, increased sweating, loss of appetite. If a tumor is present, such symptoms appear at a late stage.
The cough is worse in the morning and during sleep.
In the absence of proper therapy, insomnia, headaches, nausea and problems with stool appear.
Mycobacteria destroy bone tissue. The pathology is accompanied by pain in the joints, especially during physical work.
In rare cases, the kidneys and reproductive organs are affected. As a result, problems with urination occur and there is a possibility of infertility.
The skin is affected. Infiltrates appear under the epidermis.

Distinguishing one disease from another is vital, but in both cases you cannot do without medical help.

Can tuberculosis turn into cancer?

The combination of tuberculosis and lung cancer is quite common, since the first disease creates the preconditions for the development of the second. Most of the processes characteristic of an infectious disease are favorable factors for the appearance of tumors.

Conditions for the development of oncology:

Inflammatory processes that constantly occur in the body.
Weakening of the body's protective functions. The immune system actively fights infection. The body does not have enough strength to resist the development of a new disease.
The affected tissue does not have time to regenerate, causing the cells to become malignant.

Even after recovery for 2 years, the risk of tumors remains. There is also an inverse relationship: people with cancer are at risk of developing tuberculosis due to weakened immunity.

Differences in diagnosis

Differential diagnosis determines the signs of the disease with maximum accuracy. Methods for detailed study of pathologies used in medical institutions:

X-ray. When affected by mycobacteria, the lungs contain one or more homogeneous structures with clearly visible voids. In case of cancer, an expansion of the pulmonary root is observed on the radiograph.
Fiberglass bronchoscopy. The procedure helps to analyze bronchial secretions and find out the extent of damage to the mucous membranes and walls of the respiratory organs. The presented method allows you to take tissue for analysis and determine the presence of neoplasms. A biopsy is performed to help diagnose the disease and its stage.
Videothoracoscopy. It is a surgical procedure performed under general anesthesia. The obtained material allows us to make a diagnosis with great accuracy.

According to WHO statistics, the incidence of lung cancer in the population increases annually by 5-7%, while the epidemiological indicators of tuberculosis are steadily decreasing.

The average life expectancy of patients with tuberculosis has increased and is 55-60 years. Under these conditions, the preconditions are created for an increase in the incidence of lung cancer among them. According to various authors, the frequency of combined diseases of tuberculosis and lung cancer varies widely - from 6.8 to 40%. According to the observations of A.E. Rabukhin, when comparing intensive indicators, it was established that in 1967-1969. Lung cancer was observed among patients with respiratory tuberculosis 4-4.5 times more often than among the corresponding age group of the population, and in 1973, in persons 40-49 years old, primary lung cancer was observed 4.9 times more often, and at the age of 60 years and older - 6.6 times. According to S. D. Poletaev et al. (1982), the frequency of fluorographic detection of primary lung cancer in combination with tuberculous changes in the respiratory organs has increased in recent years compared to persons with only tuberculosis by 2.1 times. During the period from 1947 to 1983, according to autopsy materials, the proportion of bronchogenic cancer among patients with tuberculosis increased from 1.8 to 8.2%.

There are different points of view regarding the pathogenetic relationship between tuberculosis and lung cancer. Supporters of some points of view exclude the possibility of such a connection and emphasize the antagonism between these diseases, while supporters of others not only admit the possibility of their coexistence, but also emphasize the certain role of tuberculosis in the development of the tumor process.

The possible role in this regard of foci in the lungs and intrathoracic lymph nodes with calcified inclusions and scars on the bronchial mucosa is indicated. However, it is noted that cancer can be localized outside the area of a specific process in the lungs. Despite the contradictory nature of the above points of view, it is currently generally accepted that tuberculosis and lung cancer occur independently of each other; More often, with this combined disease, tuberculosis is the first and cancer is added to it, but it is possible for a patient with lung cancer to develop active tuberculosis. The combination of these diseases is more common in men over 50 years of age with focal pulmonary tuberculosis in the inactive phase, but is often found in fibrous-cavernous and cirrhotic forms that occur chronically, with a predominance of the productive type of reaction, pronounced sclerotic changes in the lung tissue and bronchi. Such individuals constitute a risk group for lung cancer. It is believed that tuberculosis does not significantly affect the course of lung cancer, but lung cancer can affect the state of the tuberculosis process, contributing to its exacerbation and progression.

Diagnosis of lung cancer in patients with tuberculosis is difficult due to the low-symptomatic initial manifestations, the commonality of many clinical signs of the disease, the absence of characteristic pathological signs of the early stage of cancer, and the duration of the asymptomatic period. For early diagnosis, cancer masks should be kept in mind. The combination of cancer with tuberculosis greatly increases the uniqueness of the clinical picture of the disease. The most common masks for the combination of cancer and tuberculosis are pneumonia, exudative pleurisy, especially hemorrhagic. Their development in these patients should alert us to the presence of a tumor process.

When solving differential diagnostic problems, one should take into account a number of patterns characteristic of each disease, in particular, indications in the anamnesis of contact with bacterial excretors, previous pleurisy, adenopathy in tuberculosis, and in case of cancer - a family history, chronic inflammatory processes in the lungs.

Patients with tuberculosis are characterized by moderate cough with sputum, shortness of breath and adynamia, while with lung cancer - a painful cough, chest pain, pronounced adynamia, shortness of breath, inadequate to x-ray changes in the lungs. Only some forms of cancer can remain asymptomatic for a long time.

Stetoacoustically (due to more intense tissue compaction), the dullness of percussion sound in cancer is more pronounced. A special place in the differential diagnosis of both diseases is occupied by the x-ray method. It has been established that cancerous changes are more often localized in the middle and lower parts of the lungs, closer to the root; the number and size of foci increase towards the basal parts of the lung. A blastomatous node is characterized by tuberosity and uneven contours, and the absence of areas of calcification. In contrast to tuberculous infiltrate, central cancer is accompanied by atelectasis of a lobe or segment of the lung, paracancrosis pneumonia, and enlarged intrathoracic lymph nodes. While in tuberculosis the X-ray image is characterized by polymorphism, the presence of bronchogenic seedings and adhesions, and emphysema in chronic forms, in lung cancer a single round shadow with sharp but uneven boundaries and unilateral expansion of the root are often observed with symptoms of hypoventilation. The main types of radiological manifestations of combined lung disease with tuberculosis and cancer were determined by A. E. Rabukhin. M. A. Myskin et al. The earliest sign of central lung cancer is the appearance, in close connection with the elements of the root, of a round, medium-intensity, homogeneous, ill-defined shadow measuring 3-5 mm against the background of a preserved root structure. An early sign of peripheral cancer is the appearance in the intact area of the lung of a group of nodular shadows measuring 3-5 mm. The intravital diagnosis of a cancerous tumor that has developed from the wall of the cavity is described, based on the appearance in patients of anemia, persistent hemoptysis and an additional shadow with a polycyclic contour identified on the inner surface of the cavity wall.

Bronchological examination data are important for the differential diagnosis of cancer and pulmonary tuberculosis. While in tuberculosis changes in the bronchi are in the nature of wall infiltration, erosion, proliferation of granulation tissue, scar changes, in bronchogenic cancer a tumor is detected that narrows or obstructs the bronchial lumen. Studies of biopsied material, especially by catheterization biopsy, or sputum for atypical cells help clarify the diagnosis; upon bronchography, they reveal a narrowing or “amputation” of the bronchus, the latter is rare, but can also occur with tuberculosis. From these laboratory research methods, one should keep in mind the leukocytosis, accelerated ESR, lymphopenia, hypochromic anemia, and high levels of serum α 2 - and γ-globulins characteristic of cancer patients.

As for tuberculin tests, in tuberculosis, especially in tuberculomas, sensitivity to tuberculin is high, in cancer patients it is often negative or weakly positive. Bronchogenic cancer developing against the background of tuberculosis often entails the extinction of tuberculosis allergy.

For the purposes of differential diagnosis, serological and immunological reactions have been successfully used in recent years.

The clinical picture of the combined disease - tuberculosis and lung cancer - is varied and depends on the stage, form of bronchogenic cancer (central or peripheral, endo-, exo- or peribronchial growth), localization, as well as the form and phase of the tuberculous process.

A detailed study of these features allowed D. D. Yablokov and A. I. Galibina to identify 3 periods during this combined disease: the period of asymptomatic or low-symptomatic course of the tumor, the period of pronounced symptoms of the disease, and the period of complications and metastasis.

Treatment of patients with tuberculosis and lung cancer should be comprehensive using combination antibacterial therapy and, if indicated, surgical treatment methods. The issue of radiation therapy and chemotherapy with anticancer drugs is decided individually. In the presence of a limited tuberculosis process, surgical treatment of lung cancer can be performed. In this case, both in the pre- and postoperative period, long-term therapy with anti-tuberculosis drugs is necessary.

The prognosis of this combined disease largely depends on timely detection.

Kalyuzhnaya E.A. Omsk

According to Rabukhin A.E. 1976, lung cancer often develops with focal pulmonary tuberculosis. Moreover, in the majority of patients with a clear loss of tuberculosis activity. Cancer often develops with inactive residual changes of tuberculosis in the lungs and roots.

A combination of cancer with fibrous-cavernous and cirrhotic tuberculosis is more common. That is, those forms that occur chronically with a predominance of reactions of the productive type, as well as sclerotic changes in the lung tissue and bronchi.

The pathomorphological substrate, which plays the role of a chronic traumatic agent, and, consequently, a carcinogenic factor, is the occurrence during the chronic course of tuberculosis of trophic changes in the lung parenchyma, metaplasia of the columnar epithelium of the bronchi into multilayered squamous epithelium, fibrous walls of old cavities, and mainly scars on the mucous membranes of the bronchi after involution of inflammatory changes. Inflammatory and degenerative-dystrophic changes of various nature, including tuberculosis, can play a significant role in the development of cancer. But regardless of their origin, their pathogenic influence is usually noted only during a chronic, often long-term course.

The interval between the time of detection or subsidence of active tuberculosis and the moment of diagnosis of cancer turns out to be quite long:

23.3% – both diseases are detected simultaneously,
1.3% – tuberculosis is detected against the background of cancer,
75.4% – tuberculosis precedes cancer.

The period between the detection of tuberculosis and cancer is 8.8 – 10.8 years. The period between the subsidence of tuberculosis and the detection of cancer is about 7 years.

It has been noted that in the majority of patients with tuberculosis, when lung cancer is added, the tuberculosis process not only does not worsen, but even subsides under the influence of chemotherapy. And only in the terminal stages of the process does progression continue. Signs of exacerbation of tuberculosis (bacillus excretion, enlargement of decay cavities, formation of perifocal infiltration and fresh dissemination) are absent in most patients.

Four types of radiological manifestations of lung cancer associated with tuberculosis have been described:

A single isolated large-focal or focal shadow in the area of stationary or regressive tuberculous changes.
A single isolated large-focal shadow against the background of active changes, or outside their zone, which continues to increase against the background of specific chemotherapy and regression of tuberculous changes.
The appearance against the background of active or subsiding tuberculosis: hypoventilation, pneumonitis, atelectasis, increasing peribronchial and interstitial changes or unilateral enlargement and thickening of the root shadow.
Asymmetrical thickening of the wall of an old tuberculous cavity in the absence of perifocal inflammation and fresh bronchogenic dissemination.

In the regional anti-tuberculosis dispensary of the Omsk region for 1998 - 2000, the number of deaths with a morphologically confirmed diagnosis of tuberculosis and lung cancer amounted to a fairly significant percentage - 5.4% of the total number of deaths. When analyzing the medical history of this category, excluding patients discharged for outpatient treatment with a morphologically unconfirmed diagnosis, the following patterns are recorded.
In 100% of cases, lung cancer was detected against the background of existing pulmonary tuberculosis. The interval between the detection of tuberculosis and the diagnosis of cancer is relatively short: up to 3 years - 52.9%. The highest percentage of detection occurs in the first year after detection of pulmonary tuberculosis - 41.1%. There were no cases of tuberculosis being detected against the background of lung cancer. It was not possible to trace the beginning of the development of the tumor in the anamnesis until the appearance of clinical and radiological signs.

In all 100% of cases, the death of patients is due to lung cancer and its complications. Lung cancer was detected in any form and phase of pulmonary tuberculosis, at any time. More often, oncopathology is detected against the background of focal pulmonary tuberculosis in the consolidation phase of MBT- and fibrous-cavernous pulmonary tuberculosis in the remission phase of MBT-.
Any histological form of cancer can occur in combination with pulmonary tuberculosis. Peripheral and central cancer differ slightly in frequency. Of the histological forms, poorly differentiated and squamous cell forms are most often recorded.

In 94.1% of patients, lung cancer was localized in the area of tuberculous changes: active - 23.5%, compacted foci - 17.6%, relatively stable - 9 people (52.9%). In all 100% of cases, the existence of diffuse chronic bronchitis was morphologically confirmed. One patient was found to have active bronchial tuberculosis (a complication of infiltrative tuberculosis in the MBT+ decay phase) in an area coinciding with the location of the cancer. In all 100% of cases, the history shows long-term smoking abuse with typical changes in the bronchopulmonary system, which could serve as the basis for a violation of the protective system of the lungs. That is, there may not be a cause-and-effect relationship between tuberculosis and cancer. Both diseases arose both against the background of suppression of the bactericidal defense of the lungs and a violation of the antioxidant defense with excessive production of reactive oxygen species caused by chronic bronchitis.

The age of the patients corresponds to the usual age for the development of malignant neoplasms. All 100% of patients had metabolic disorders that had existed for a long time before the diagnosis of pulmonary tuberculosis. A weight loss of 4–10 kg was recorded in 29.4% of cases, and by 11 kg or more in 70.6% of cases. The results of the analysis of tuberculin samples indicate that the process occurred against the background of relatively reduced specific immunity. The frequency of anergic reactions was 47.0%, questionable reactions – 11.8%. Normergy occurred quite often - 41.2%. No hyperergic results of tuberculin reactions were recorded.

In 100% of cases, there was a gradual onset with an increase in symptoms of intoxication. Only in the later stages did clinical symptoms appear that did not fit into the manifestations characteristic of tuberculosis and made it possible to suspect lung cancer. The difficulty of diagnosis is associated not only with the lack of significant differences in the symptom complex, but also with the presence of previous chronic bronchitis in 100% of cases.

Clinical symptoms in the later stages did not differ significantly from the typical picture of lung cancer:

Chest pain of varying intensity – 70.6%
Hemoptysis – 29.4%
Weakness, fatigue – 100%
Cough (dry, hacking) – 82.4%
Cough with a lot of sputum – 17.6%
Fever of the wrong type in the terminal period -100%
Increasing shortness of breath in the terminal period – 88.2%
Weight loss, increasing in the terminal period – 100%

The following radiological manifestations have been recorded in the development of lung cancer against the background of existing tuberculosis:

Isolated focal shadow increasing in dynamics against the background of compacted foci or relatively stable tuberculous changes - 23.5%.
A single focal shadow increasing in dynamics against the background of active tuberculous changes – 17.6%.
The appearance of hypoventilation and atelectasis against the background of active tuberculous changes – 5.9%.
Development of hypoventilation and atelectasis against the background of relatively stable tuberculous changes – 35.3%
Unilateral root enlargement against the background of compacted lesions – 11.8%
Unilateral enlargement and thickening of the root against the background of relatively stable tuberculous changes – 5.9%.
Bilateral total large-focal dissemination (carcinomatosis) against the background of small-focal and medium-focal bilateral total dissemination (hematogenously disseminated pulmonary tuberculosis MBT+) – 1 case.
The development of cancer in the wall of old caverns has not been recorded, possibly due to the limited number of observations.

In the literature, cases of a combination of two disseminations (cancer and tuberculosis) could not be found, but since the data were confirmed morphologically, such a clinical and radiological variant is obviously possible. In other cases (94.1%), radiological manifestations correspond to the data of Rabukhin A.E. 1976
In all cases, a single focal shadow that appeared against the background of tuberculous changes had an irregular rounded shape. In 71.4%, a lumpy outer contour was noted. Lymphangitis was recorded in 28.6%. Thus, no differences from the usual x-ray picture of cancer were found.

Any form and phase of tuberculosis does not exclude the presence of concomitant lung cancer, the localization of which may or may not coincide with the location of tuberculous changes.
More often, both processes develop in the same zone of decreased protective system of the lungs, which can be caused by both a violation of the bronchopulmonary system due to smoking, and chronic bronchitis of any origin, which in 100% of cases preceded lung cancer and tuberculosis. Thus, tuberculosis and tuberculous bronchopathy are an additional factor that aggravates already existing changes.