Lung cancer: causes and risk factors. Lung Cancer - Description, Causes, Symptoms (Signs), Diagnosis, Treatment Central Lung Cancer ICD code

Clinical manifestations of benign lung tumors depend on the location of the neoplasm, its size, direction of growth, hormonal activity, degree of bronchial obstruction, and complications caused.
Benign (especially peripheral) lung tumors may not give any symptoms for a long time. In the development of benign lung tumors are distinguished:
asymptomatic (or preclinical) stage.
stage of initial clinical symptoms.
the stage of severe clinical symptoms due to complications (bleeding, atelectasis, pneumosclerosis, abscess pneumonia, malignancy and metastasis).
With peripheral localization in the asymptomatic stage, benign lung tumors do not manifest themselves. In the stage of initial and severe clinical symptoms, the picture depends on the size of the tumor, the depth of its location in the lung tissue, and the relationship to the adjacent bronchi, vessels, nerves, and organs. Large lung tumors can reach the diaphragm or chest wall, causing pain in the chest or heart area, shortness of breath. In case of vascular erosion by the tumor, hemoptysis and pulmonary hemorrhage are observed. Compression of the large bronchi by a tumor causes a violation of bronchial patency.
Clinical manifestations of benign lung tumors of central localization are determined by the severity of bronchial patency disorders, in which grade III is distinguished:
I degree - partial bronchial stenosis;
II degree - valvular or valve bronchial stenosis;
III degree - bronchial occlusion.
In accordance with each degree of violation of bronchial patency, the clinical periods of the disease differ. In the 1st clinical period, corresponding to partial bronchial stenosis, the lumen of the bronchus is narrowed slightly, so its course is often asymptomatic. Sometimes there is a cough, with a small amount of sputum, less often with an admixture of blood. General health is not affected. Radiologically, a lung tumor is not detected in this period, but can be detected by bronchography, bronchoscopy, linear or computed tomography.
In the 2nd clinical period, valvular or valve stenosis of the bronchus develops, associated with obstruction by the tumor of most of the lumen of the bronchus. With valve stenosis, the lumen of the bronchus partially opens on inspiration and closes on expiration. In the part of the lung ventilated by the narrowed bronchus, expiratory emphysema develops. There may be a complete closure of the bronchus due to edema, accumulation of blood and sputum. In the lung tissue located on the periphery of the tumor, an inflammatory reaction develops: the patient's body temperature rises, cough with sputum, shortness of breath, sometimes hemoptysis, chest pain, fatigue and weakness appear. Clinical manifestations of central lung tumors in the 2nd period are intermittent. Anti-inflammatory therapy relieves swelling and inflammation, leads to the restoration of pulmonary ventilation and the disappearance of symptoms for a certain period.
The course of the 3rd clinical period is associated with the phenomena of complete occlusion of the bronchus by the tumor, suppuration of the atelectasis zone, irreversible changes in the area of ​​the lung tissue and its death. The severity of symptoms is determined by the caliber of the bronchus obstructed by the tumor and the volume of the affected area of ​​the lung tissue. There is a persistent fever, severe chest pain, weakness, shortness of breath (sometimes asthma attacks), poor health, cough with purulent sputum and blood, and sometimes pulmonary bleeding. X-ray picture of partial or complete atelectasis of a segment, lobe or entire lung, inflammatory and destructive changes. On linear tomography, a characteristic picture is found, the so-called "bronchial stump" - a break in the bronchial pattern below the obturation zone.
The speed and severity of bronchial obstruction depends on the nature and intensity of lung tumor growth. With peribronchial growth of benign lung tumors, clinical manifestations are less pronounced, complete occlusion of the bronchus rarely develops.

Lung cancer(epidermoid lung carcinoma) is the main cause of cancer mortality in men, and in women this disease is second only to cancer mammary gland.

Frequency

Incidence

Dominant age

Code according to the international classification of diseases ICD-10:

Lung Cancer: Causes

Type 1 excludes the note - this is purely exclusive. Type 1 excludes the note for use when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition. Secondary malignant neoplasm of unspecified site. . In this context, annotation backreferences refer to codes that contain.

The additional code from chapter 4 can be used to identify functional activity associated with any neoplasm. Multiple neoplasms of the same site that are not contiguous, such as tumors in different quadrants of the same breast, should be assigned codes for each site. Myocardial neoplasms of ectopic tissue should be coded for at the mentioned site, for example, ectopic pancreatic malignancies are coded for pancreatic, indeterminate. Secondary malignant neoplasm of the ovary. Secondary malignant neoplasm of the parotid gland. Secondary malignant neoplasm of the vagina. Secondary small cell carcinoma, site unspecified. Malignant cells can also spread to other parts of the body through the circulatory and lymphatic systems. Carcinoma is a malignant tumor that starts in the skin or in the tissues that build or cover the internal organs. A sarcoma is a malignant tumor that starts in bones, cartilage, fat, muscle, blood vessels, or other connective or supportive tissues. Leukemia is a malignant tumor that starts in blood-forming tissue, such as the bone marrow, and causes large numbers of abnormal blood cells to form and enter the bloodstream. Lymphoma and multiple myeloma are malignant tumors that begin in the cells of the immune system. Cancers of the central nervous system are malignant tumors that begin in the tissues of the brain and spinal cord. Tumor consisting of atypical neoplastic, often pleomorphic cells that invade other tissues. Malignant neoplasms often metastasize to distant anatomical sites and may recur after removal. The most common malignancies are carcinomas, Hodgkin's and non-Hodgkin's lymphomas, leukemias, melanomas, and sarcomas. Cancer starts in your cells, which are the building blocks of your body. Normally, your body makes new cells as needed, replacing old cells that are dying. Sometimes this process goes wrong. New cells grow even when they don't need you, and old cells don't die when they need to. These extra cells can form a mass called a tumor. Tumors can be benign or malignant. benign tumors are not cancer, they are malignant: cells from malignant tumors can invade nearby tissues, and can also break off and spread to other parts of the body. Most cancers are named for where they begin. For example, lung cancer starts in the lungs and breast cancer starts in the chest. The spread of cancer from one part of the body to another is called metastasis. Symptoms and treatment depend on the type of cancer and how advanced it is.

• Complete neoplasm of ectopic tissue.
• Restrictive cardiomyopathy secondary to malignancy.
• Restrictive cardiomyopathy due to malignancy.
• secondary adenocarcinoma.
• Secondary malignant neoplasm of bone.
• There are several main types of malignant neoplasms.

• C34- Malignant neoplasm of bronchi and lung
• C78. 0 - Secondary malignant neoplasm of the lung
• D02. 2- Bronchus and lung

Lung Cancer: Causes

Risk factors. Smoking. There is a direct relationship between smoking and morbidity cancer lung. An increase in the number of cigarettes smoked daily leads to an increase in the disease. Passive smoking is also associated with a slight increase in the incidence. industrial carcinogens. Exposure to beryllium, radon and asbestos increases the risk of developing cancer lung, and smoking further increases this risk. Prior lung disease. It is possible to develop adenocarcinomas in scar areas with tuberculosis or other lung diseases accompanied by fibrosis; such tumors are called cancers in the scar. Certain cancers (eg, lymphoma, crayfish head, neck and esophagus) lead to increased morbidity cancer lung.
pathological anatomy
. Adenocarcinoma is the most common histological variant cancer lungs. In the group of malignant lung tumors, its share is 30-45%. Smoking addiction is not so obvious. The tumor often affects women. The usual location is the periphery of the lung. Histological examination reveals distinct acinar cell formations emanating from the distal airways. Characteristics - often the formation of adenocarcinoma is associated with scarring in the lungs resulting from chronic inflammation. Growth may be slow, but the tumor metastasizes early and spreads via the hematogenous route. In addition, its diffuse distribution in the lung tissue along the branches of the tracheobronchial tree is possible. Alveolar - cellular crayfish(a variant of adenocarcinoma) originates in the alveoli, spreads along the walls of the alveoli and causes an easily detectable x-ray thickening of the lobe. bronchoalveolar crayfish are found in three forms: a single node, multinodular and diffuse (pneumonic) forms. The prognosis is relatively favorable.
. squamous crayfish- the second most common option cancer lung (25-40% of cases). There is a clear association with smoking. Histological examination. It is believed that the tumor arises from squamous metaplasia of the epithelial cells of the tracheobronchial tree. Characteristic. squamous crayfish more often detected near the root of the lung in the form of endobronchial lesions (in 60-70% of cases) or peripheral rounded formations. The tumor is voluminous, causing bronchial obstruction. Characterized by slow growth and late metastases. Subject to necrosis of the central areas with the formation of cavities.
. small cell crayfish(oatmeal - cellular). Tumor with high malignancy. Among malignant lung tumors, its share is about 20%. Histological examination reveals nest-like clusters or layers, consisting of small round, oval or spindle-shaped cells with a round dark nucleus. The cells contain secretory cytoplasmic granules. The tumor secretes biologically active substances. Characteristic. Usually the tumor is located centrally. Early metastasis is characteristic by the hematogenous or lymphogenous route. After timely excision of small peripheral tumors of stage I in the early stages, a complete recovery is possible. Unremoved tumor cells in most cases respond to combination chemotherapy. The prognosis is bad.
. Large cell undifferentiated crayfish rarely detected (5-10% of all forms cancer lung). Histological examination reveals large tumor cells without clear signs of differentiation. Characteristic. It can develop both in the central and peripheral areas. High degree of malignancy. The prognosis is bad.

He explains the huge differences that exist here. This post is also available as an audio podcast. It is reported to the public, unfortunately very rarely, and then mostly incomplete. Those who suffered in South Africa did not accept their fate as fixed, but demanded and secured their right to effective drug treatment through public action.

Causes of lung cancer

In the end, the cell is destroyed. After infection, it usually sets in first on a long-term freedom of symptoms. Acute infection may be associated with symptoms of a transient influenza infection. This indicates an initial impairment of the immune defense. These were the most serious infections, the so-called opportunistic infections, such as non-recoverable pneumonia caused by other harmless pathogens, tuberculosis, which is not limited to mild, or severe fungal infections of the respiratory tract.

TNM classification(see also Tumor, stages). Tx - there are no signs of a primary tumor, or the tumor is confirmed by cytological examination of sputum or bronchial washings, but is not visualized by bronchoscopy and x-ray examination. Tis is carcinoma in situ. T1 - a tumor up to 3 cm in diameter, surrounded by lung tissue or pleura, without signs of germination proximal to the lobar bronchus (i.e., the main bronchus does not sprout during bronchoscopy). T2 - tumor in the presence of one of the following signs: . The tumor is more than 3 cm in diameter. The main bronchus is involved, no closer than 2 cm to the carina. Germination of the visceral pleura. Atelectasis or obstructive pneumonitis that extends into the hilar area but does not involve the entire lung. T3 - tumor of any size, which: . sprouts any of the following structures: chest wall, diaphragm, mediastinal pleura, pericardium (bag). extends to the main bronchus closer than 2 cm to the carina, but without its damage. complicated by atelectasis or obstructive pneumonitis of the entire lung. T4 - tumor of any size, if: . any of the structures sprouts: mediastinum, heart, large vessels, trachea, esophagus, vertebral body, carina. there are separate tumor nodes in the same lobe. there is malignant pleurisy (or pericarditis), confirmed morphologically. N1 - metastases in the intrapulmonary, peribronchial and / or lymph nodes of the hilum of the lung on the side of the lesion. N2 - metastases in the mediastinal and / or subcarinal lymphatic angles on the side of the lesion. N3 - metastases in the lymph nodes of the gate of the lung or mediastinum on the opposite side; ladder or supraclavicular lymph nodes.
Grouping by stages. Occult crayfish: TxN0M0 . Stage 0: TisN0M0 . Stage I: T1-2N0M0. Stage II. T1-2N1M0 . T3N0M0 . Stage III. T1-3N2M0 . T3N1M0 . T1-4N3M0. T4N0-3M0. Stage IV: T1-4N0-3M1.

It also includes cancerous tumors of the lymph nodes or rare skin cancers such as Kaposi's sarcoma. There were also about 450 hemophiliacs and blood transfusion recipients. There were approximately 400 infected children, adolescents and young adults who were infected by their mothers before, during and after birth.

Approximately 72 percent of infected people are taking antiretroviral drugs. A follow-up study showed that the proportion of patients with retained work skills increased from 54 percent to 70 percent, and 7 percent of patients who were assessed did not complete the activity but were still able to perform half the shift.

Lung Cancer: Signs, Symptoms

Clinical picture

Lung Cancer: Diagnosis

Laboratory research

Special Studies

Lung Cancer: Treatment Methods

Treatment

small cell crayfish lung. The basis of treatment is chemotherapy. Therapeutic regimens: etoposide and cisplatin or cyclophosphamide, doxorubicin and vincristine. Limited crayfish- tumor within one pleural cavity; neoplasm can be completely cured by irradiation of the root of the lung. The maximum survival rates (10-50%) are observed in patients who received both radiation and chemotherapy, especially combined chemotherapy and fractional irradiation. Common crayfish- the presence of distant metastases, damage to the supraclavicular lymph nodes and / or exudative pleurisy. Such patients are shown combined chemotherapy. In the absence of the effect of chemotherapy or the presence of brain metastases, radiation gives a palliative effect.
. Contraindications for thoracotomy. In about half of the patients, by the time the diagnosis is established, the disease is so advanced that thoracotomy is inappropriate. Signs of inoperability: . significant involvement of the lymph nodes of the mediastinum from the side of the tumor (N2), especially the upper paratracheal ones. involvement of any contralateral mediastinal lymph nodes (N3). distant metastases. effusion in the pleural cavity. superior vena cava syndrome. damage to the recurrent laryngeal nerve. paralysis of the phrenic nerve. severe respiratory failure (relative contraindication).

Even though antiretrovirals are among the most expensive drugs and the cost of treatment can easily be up to €000 or more per illness and year, most of our patients are financially secure through their membership in one of the established health insurance companies.

Alone, some 26 million adults and children lived in sub-Saharan Africa, the hardest hit. However, it hides significant differences. While prevalence rates in Central and East Africa are between 5 and 10 percent of the adult population, they are around 20 percent in South Africa and other neighboring southern African countries, and even higher in parts of the country.

Follow-up after surgery. First year - every 3 months. Second year - every 6 months. From the third to the fifth year - 1 r / year.

Prevention

Complications

Forecast

Click here to comment on: Lung cancer(Diseases, description, symptoms, folk recipes and treatment)

However, a big problem is related to the transfer of mother and child. With effective antiretroviral treatment, this rate can be reduced to less than 1 percent. For low-income countries in sub-Saharan Africa, the so-called poor countries, including Uganda, it is important that antiretrovirals are still very expensive, and for the health sector.

Far exceed the available resources of these countries. Therefore, most of these countries rely on donations from international organizations. This is especially true for low-income countries in sub-Saharan Africa. According to the latest reports from Uganda, it is said to have increased even more in recent years and is now over 10 percent.

Within the framework of the international classification of diseases, the ICD-10 code for lung cancer is C33-C34 and is a complex disease in nature. The primary classification distinguishes mass (mixed), central and peripheral type. Regardless of the location of the disease, the disease requires emergency medical intervention. Any delay in treatment leads to irreversible changes in the body and death.

Due to the premature death of parents, many children become orphans. Most of the family fathers I had contact with during my trip reported 1 to 2 orphans who need to be cared for in addition to their own children. Condoms are limited, too expensive, or often of poor quality and are not accepted by many men. In men, concurrent sexual contact with multiple partners is socially acceptable. Polygamy is still partially recognized.

In general, the subordinate social position of women is a consequence of the fact that women's sexual self-determination is limited. These countries with the lowest life expectancy include South Africa, Swaziland, Lesotho, Namibia, Botswana, Zambia, Zimbabwe and Malawi.

The development of a dangerous disease

Lung cancer is a serious medical and social problem in developed countries and countries where the quality of medical care leaves much to be desired. Medical statistics show that the disease occupies a leading position in terms of causes of death in the framework of oncological pathologies. An unpleasant aspect of the ICD-10 is the mortality statistics: 60% of the sick cannot be saved.

Their total number is estimated at about 10 million in sub-Saharan Africa. This is almost 20 percent of all children under the age of 15. Last but not least, there are devastating economic consequences. Based in Johannesburg, South Africa for many years, the Canadian journalist has traveled extensively in sub-Saharan Africa, reporting on 28 women, men and children, each of which represents about 1 million people in sub-Saharan Africa. who are fighting for their lives there.

This was his last surviving son. Nelson Mandela suffered only with some delay from the scale of the epidemic recognized in his country. Despite the fact that the first publication of Stephanie Nolen's sad book is ten years old, it still remains very relevant. He tells how the virus works, how it spreads and how it kills.

In this regard, timely diagnosis comes to the fore, allowing the doctor to quickly identify the onset of pathological changes in the body. Representatives of the strong half of humanity are at greater risk. Within the framework of the approved international program to combat oncological pathology, increased attention is paid to risk groups: smokers, alcoholics, employees of hazardous (from an environmental point of view) enterprises.

There can be many reasons for this disease, but there are much fewer risk factors that provoke it:

• natural radon radiation - in the crust of the planet, a half-life process is constantly taking place, which can negatively affect the state of health;
• passive or active smoking;
• long-term exposure to asbestos (asbestosis) - lung cancer occurs in those who permanently live in unsanitary conditions or old houses;
• viruses - some bacterial cultures, under adverse external factors, cause oncological processes in the body;
• dust.

At the same time, doctors are calling for sanity. Every person is at risk of getting sick. Often, lung cancer develops in a healthy person against the background of many factors. Today, doctors cannot fully determine with sufficient certainty which of them are the key catalysts for the onset of dangerous changes within the body.

Typology of the disease

If risk factors still remain in some sense a mystery to doctors, then the classification of tumors has long acquired clear outlines:

• lack of the necessary amount of information for diagnosis;
• it is impossible to determine the primary neoplasm within the framework of the ICD-10;
• oncological process of unknown etymology;
• tumor size exceeds 3 cm;
• lung cancer with neoplasm up to 3 cm;
• neoplasm of any size affecting the chest.

If the first classification of ICD-10 tumors is based on localization and size, then the second is based on the presence of possible metastases. Depending on how much primary information can be collected, WHO distinguishes: the absence of metastases or information that allows to fully assess the threat to the body, minor damage to the respiratory system, the presence of multiple metastases.

In some cases, the doctor may experience certain difficulties associated with making the correct diagnosis within the framework of the ICD-10. In this case, the following procedure must be followed. Having on hand a certain amount of collected information, it is necessary to find the appropriate code. After that, you should study the recommendations and descriptions present there. This will allow directing further diagnostic and subsequent therapeutic course in the right direction. If necessary, the oncologist may refer a patient diagnosed with lung cancer for a series of additional examinations.

As part of the main diagnosis based on the available information, ICD-10 requires an examination of the histopathological gradation of tumors. The international classification contains the following items:

• it is impossible to assess the existing cell deformation;
• increased degree of deformation;
• moderate degree of deformation;
• low degree of deformity of a malignant neoplasm;
• no deformation of the neoplasm.

Within the framework of oncological diseases, the diagnostic stage occupies one of the most important places. The effectiveness of treatment depends on the right tools. This is possible only with the correct classification of the neoplasm.

Additional classifications

The internationally approved deadly disease code allows the medical community to effectively fight cancer.

From a morphological point of view, the disease is small-celled, squamous, mixed and large-celled.

Depending on the subspecies, the doctor makes a choice between emergency surgery and radiation therapy.

From an anatomical point of view, the code distinguishes peripheral or central cancer. If in the first case it is difficult to detect it, and it is easy to cure it, then in the second it is the other way around. In a separate group, the official disease code highlights the degree of aggressiveness of the neoplasm. Each person has his own internal factors that can accelerate or slow down the development of the disease. Today it is impossible to fully describe them.

The generally accepted code of the disease completes the description of the malignant neoplasm (if we consider its stages). For this, Roman numerals from I to IV are used. If the first stage is characterized by the absence of metastases, which gives a good chance for the patient to survive, then stage No. 4 does not leave even the slightest possibility. In this case, it remains for the doctor to prescribe supportive therapy to alleviate the patient's suffering.

This video is about lung cancer:

Due to the fact that this disease is extremely dangerous, citizens should carefully monitor their health. Refusal of bad habits, a passive lifestyle and timely annual medical examinations are the key to a long and fulfilling life.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Archive - Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2012 (Orders No. 883, No. 165)

Lower lobe, bronchi or lung (C34.3)

general information

Short description

Clinical Protocol "Lung Cancer"

Lung cancer- a tumor of epithelial origin, developing in the mucous membrane of the bronchi, bronchioles and mucous bronchial glands.

Protocol code:РH-S-031 "Lung Cancer"

ICD-X code(s): From 34.0-34.3

Abbreviations used in the protocol:

NSCLC is non-small cell lung cancer.

SCLC - small cell lung cancer.

Ultrasound - ultrasonography.

IHC - immunohistochemical study.

ESR - erythrocyte sedimentation rate.

HBS antigen - Hepatits B surface Antigen.

RW - Wasserman reaction.

HIV is a human immune virus.

RL - lung cancer.

RT - radiation therapy.

ROD - single focal dose.

Gr - Grey.

SOD - total focal dose.

PCT - polychemotherapy.

CT - computed tomography.

MTS - metastasis(s).

Protocol development date: 2011

Protocol Users: oncologists, general practitioners.

Indication of no conflict of interest: there is no conflict of interest.

Classification

Clinical classification(the most common approaches, for example: by etiology, by stage, etc.).

Histological classification (WHO, 2004)

I. Squamous cell carcinoma (epidermoid) 8070/3:

1. Papillary 8052/3.

2. Clear cell 8054/3.

3. Small cell 8073/3.

4. Basalioid 8083/3.

II. Small cell carcinoma 8041/3:

1. Combined small cell carcinoma 8045/3.

III. Adenocarcinoma 8140/3:

1. Mixed cell adenocarcinoma 8255/3.

2. Acinar adenocarcinoma 8550/3.

3. Papillary adenocarcinoma 8260/3.

4. Bronchioloalveolar adenocarcinoma 8250/3:

Mucous 8253/3;

Non-mucosal 8252/3;

Mixed 8254/3.

5. Solid adenocarcinoma with mucus formation 8230/3:

Fetal 8333/3;

Mucinous (colloidal) 8480/3;

Mucinous cystadenocarcinoma 8470/3;

Clear cell 8310/3;

Round cell 8490/3.

IV. Large cell carcinoma 8012/3:

1. Neuroendocrine 8013/3:

Mixed large cell 8013/3.

2. Basalioid carcinoma 8123/3.

3. Lymphoepithelioma-like cancer 8082/3.

4. Giant cell carcinoma with rhabdoid phenotype 8014/3.

5. Clear cell carcinoma 8310/3.

V. Glandular squamous cell carcinoma 8560/3.

VI. Sarcomatoid carcinoma 8033/3:

1. Polymorphic carcinoma 8022/3.

2. Spindle cell carcinoma 8032/3.

3. Giant cell carcinoma 8031/3.

4. Carcinosarcoma 8980/3.

5. Pulmonary blastoma 8972/3.

VII. Carcinoid tumor 8240/3:

1. Typical 8240/3.

2. Atypical 8249/3.

VIII. Cancer of the bronchial glands:

1. Adenoid cystic cancer 8200/3.

2. Mucoepidermoid carcinoma 8430/3.

3. Epithelial-myoepithelial cancer 8562/3.

IX. Squamous cell carcinoma in situ 8070/2.

X. Mesenchymal tumors:

1. Epithelial hemangioendothelioma 9133/1.

2. Angiosarcoma 9120/3.

3. Pleuropulmonary blastoma 8973/3.

4. Chondroma 9220/0.

5. Peribronchial myofibroblastic tumor 8827/1.

XI. Diffuse pulmonary lymphangiomatosis:

1. Inflammatory myofibroblastic tumor 8825/1.

2. Lymphoangleiomyommatosiomatosis (lymphangiomyomatosis) 9174/1.

3. Synovial sarcoma 9040/3:

Monophasic 9041/3;

Biphasic 9043/3.

4. Pulmonary arterial sarcoma 8800/3.

5. Pulmonary venous sarcoma 8800/3.

To classification of lung cancer by TNM (7th edition, 2011)

Anatomical areas:

1. Main bronchus (C 34.0).

2. Upper lobe (C 34.1).

3. Average share (C 34.2).

4. Lower share (C 34.3)

Regional lymph nodes

Regional lymph nodes are intrathoracic nodes (nodes of the mediastinum, hilum of the lung, lobar, interlobar, segmental and subsegmental), nodes of the scalene muscle and supraclavicular lymph nodes.

Determination of the spread of the primary tumor (T)

TX - the primary tumor cannot be assessed or the presence of the tumor is proven by the presence of malignant cells in the sputum or flushing from the bronchial tree, but the tumor is not visualized by X-ray or bronchoscopy.

T0 - no data on the primary tumor.

TIS - carcinoma in situ.

T1 - Tumor less than 3 cm in greatest dimension, surrounded by lung tissue or visceral pleura, without bronchoscopically confirmed invasion of the proximal lobar bronchi (i.e. without involvement of the main bronchi) (1).

T1a - Tumor less than 2 cm in greatest dimension(1).

T1b Tumor more than 2 cm but not more than 3 cm in greatest dimension(1).

T2 Tumor more than 3 cm but less than 7 cm, or tumor with any of the following characteristics(2):

It affects the main bronchi at least 2 cm from the carina of the trachea;

The tumor grows into the visceral pleura;

Associated with atelectasis or obstructive pneumonitis that extends into the hilar region but does not involve the entire lung.

T2a Tumor more than 3 cm but not more than 5 cm in greatest dimension.

T2b Tumor more than 5 cm but not more than 7 cm in greatest dimension.

T3 Tumor larger than 7 cm or directly invading any of the following structures: chest wall (including tumors of the superior sulcus), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or affecting the main bronchi less than 2 cm from the carina of the trachea (1), but without affecting the latter; or associated with atelectasis or obstructive pneumonitis of the entire lung, or with isolated tumor nodule(s) in the same lung lobe as the primary tumor.

T4 Tumor of any size invading any of the following structures: mediastinum, heart, great vessels, trachea, esophagus, vertebral bodies, tracheal carina; the presence of a separate tumor node (nodes) in the lung lobe opposite to the lobe with the primary tumor.

Regional lymph node involvement (N)

NX - regional lymph nodes cannot be assessed.

N0 - no metastases in regional lymph nodes.

N1 - metastasis in the peribronchial lymph node and / or in the hilar node of the lung and intrapulmonary nodes on the side of the lesion of the primary tumor, including the direct spread of the tumor.

N2 - metastases in the nodes of the mediastinum and / or lymph nodes under the carina of the trachea on the side of the lesion.

N3 - metastases in the nodes of the mediastinum, the nodes of the hilum of the lung on the side opposite to the defeat of the primary tumor, ipsilateral or contralateral nodes of the scalene muscle or supraclavicular lymph nodes (node)

Distant metastases (M)

M0 - no distant metastases.

M1 - there are distant metastases.

M1a - a separate tumor node (nodes) in the other lung; tumor with nodules on the pleura or malignant pleural or pericardial effusion (3).

M1b - distant metastases.

Note

(1) A rare, superficially spreading tumor of any size that grows proximal to the main bronchi and an invasive component that is confined to the bronchial wall is classified as T1a.

(2) Tumors with these characteristics are classified as T2a if they are less than 5 cm or if the size cannot be determined, and as T2b if the tumor is greater than 5 cm but less than 7 cm.

(3) Most pleural (pericardial) effusions in lung cancer are due to the tumor. However, in some patients, multiple microscopic examinations of the pleural (pericardial) fluid are negative for tumor elements, and the fluid is also not blood or exudate. These data, as well as the clinical course, indicate that such an effusion is not associated with a tumor and should be excluded from the staging elements, and such a case should be classified as M0.

G - histopathological differentiation.

GX - the degree of differentiation cannot be determined.

G1 - highly differentiated.

G2 - moderately differentiated.

G3 - low-differentiated.

G4 - undifferentiated.

pTNM pathological classification

PN0 - histological examination of the removed lymph nodes of the root of the lung and mediastinum should usually include 6 or more nodes. If the lymph nodes are not affected, then this is classified as pN0, even if the number of nodes examined is less than usual.

Distant metastases
The categories M1 and pM1 can be further defined according to the following notation.

R-classification

The absence or presence of residual tumor after treatment is described by the symbol R:

R X Residual tumor cannot be assessed.

R 0 - no residual tumor.

R 1 - microscopic residual tumor.

R 2 - macroscopic residual tumor.

Classification of stages of lung cancer:

1. Hidden cancer - TxN0M0.

2. Stage 0 - TisN0M0.

3. Stage IA - T1a-bN0M0.

4. Stage IB - T2aN0M0.

5. Stage IIA - T2bN0M0, T1a-bN1M0, T2aN1M0.

6. Stage IIB - T2bN1M0, T3N0M0.

7. Stage IIIA - T1a-bN2M0, T2a-bN2M0, T3N1-2M0, T4N0-1M0.

8. Stage IIIB - T4N2M0, T1-4N3M0.

9. Stage IV - T1-4N0-3M1.

Diagnostics

Diagnostic criteria: the presence of a tumor process, verified histologically and/or cytologically. Operable lung cancer (stages I-III).

Complaints and anamnesis: clinical manifestations depending on the stage and localization - cough with or without sputum, the presence or absence of streaks of blood in the sputum (hemoptysis), shortness of breath during exercise, weakness, sweating at night, subfebrile temperature, weight loss.

Physical examination: weakening of breathing on the side of the lesion.

Laboratory research: laboratory tests - the norm or minor non-pathognomonic changes (such as increased ESR, anemia, leukocytosis, hypoproteinemia, hyperglucosemia, a tendency to hypercoagulability, etc.).

Instrumental Research

Main:

5. Electrocardiography.

Additional:

1. Fibrogastroduodenoscopy.

9. IHC study.

10. PCR study.

List of basic and additional diagnostic measures

Main:

1. Standard X-ray examination (radiography in direct and lateral projection, median tomography).

2. Computed tomography of the chest.

3. Fiberoptic bronchoscopy with biopsy.

4. Spirography (determination of the function of external respiration).

5. Electrocardiography.

6. Ultrasound of supraclavicular lymph nodes.

7. Ultrasound of the abdominal cavity and retroperitoneal space.

Additional:

1. Fibrogastroduodenoscopy.

2. Angiographic study.

3. Scintigraphy of the lungs, liver.

4. Computed tomography of the chest organs with contrast.

5. Computed tomography of the brain, abdominal organs.

6. Magnetic resonance imaging.

7. Polypositional electron tomography.

8. Molecular genetic study of the tumor.

9. IHC study.

10. PCR study to detect activating mutations in EGFR.

peripheral cancer- microscopic examination of smears from the subsegmental and segmental bronchi of the affected segment of the lung, taken during fibrobronchoscopy. Intraoperatively, for morphological confirmation, a puncture biopsy of the tumor is performed; if it is ineffective, a biopsy of the tumor is performed; if the diagnosis of lung cancer is confirmed, a radical operation is performed. In inoperable patients with negative bronchoscopy and microscopic examination of sputum, the surgeon performs a transthoracic puncture biopsy with a thin needle under X-ray control.

Central cancer- tumor biopsy during fibrobronchoscopy followed by cytological and histological examination of the obtained material.

Distant metastases- puncture biopsy with a fine needle under ultrasound control or excisional biopsy of metastases in peripheral lymph nodes and soft tissues.

Laboratory research

Complete blood count, biochemical blood test (protein, creatinine, urea, bilirubin, ALT, AST, blood glucose, in small cell cancer - alkaline phosphatase), coagulogram (prothrombin index, fibrinogen, fibrinolytic activity, thrombotest), urinalysis, group determination blood and Rh factor, Wasserman reaction, blood for HIV infection, HbsAg, viral hepatitis C.

Determining the extent of the tumor and the functional status of the patient: standard x-ray examination (radiography in direct and lateral projection, median tomography), fibrobronchoscopy, spirography (determination of the function of external respiration), electrocardiography, ultrasound of the abdominal organs. Computed tomography is performed to determine the degree of prevalence of the process and / or if there is a suspicion of tumor invasion into the mediastinal structures (vessels) or damage to the mediastinal lymph nodes.

According to the indications, angiographic examination of the lungs, scintigraphy of the lungs, and liver are performed.

Endovideothoracoscopy is performed when the operability is doubtful, there are CT signs of the spread of the tumor process to the structures of the mediastinum (aorta, pulmonary trunk, myocardium, spine, superior vena cava) or dissemination along the pleura - to confirm the unresectable tumor.

In difficult-to-diagnose cases, diagnostic endovideothoracoscopy or thoracotomy may be performed.

In small cell lung cancer, computed tomography of the chest, brain and abdominal organs is performed.

Differential Diagnosis

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Treatment

Treatment goals: elimination of the tumor process.

Treatment tactics

L treatment of lung cancer depending on the stage

Non-small cell cancer

Note. Lung cancer with localization at the mouth of the lobar bronchi - resection is indicated and bronchoplasty. Lung cancer with localization of the mouth of the right main bronchus is shownresection and plastic surgery of the bifurcation of the trachea.

small cell cancer

X surgical treatment of lung cancer

Radical surgery is the method of choice in the treatment of patients with stages I-II and operable patients with stage IIIa lung cancer. Standard operations are lobectomy, bilobectomy or pneumonectomy with removal of all affected and unaffected lymph nodes of the root of the lung andmediastinum with surrounding tissue on the side of the lesion (extended operations) and combined operations are performed (removal of tumor-affected areas of neighboring organs and mediastinum). With solitary and single (up to 4 formations) metastatic formations, it is advisable to perform operations using the precision technique (precision resection).

All operations performed on the lungs must be accompanied by lymph node dissection, which includes: bronchopulmonary, bifurcation, paratracheal, paraaortic, paraesophageal and lymph nodes of the pulmonary ligament (extended lobectomy, bilobectomy and pneumonectomy).

The volume of surgical intervention is determined by the degree of spread and localization of the tumor lesion. Damage within the parenchyma of one lobe or localization of the proximal edge of the carcinoma at the level of segmental bronchi or distal parts of the lobar and main bronchus is the basis for performing lobectomy, bilobectomy and pneumonectomy.

Note. In case of a tumor lesion of the mouth of the upper lobe and intermediate bronchus of the right lung, less often the left lung, reconstructive plastic surgery should be performed. If the mouth of the main bronchi, bifurcation or lower third of the trachea on the right is involved in the process, reconstructive plastic surgery should also be performed.

adjuvant therapy

Based on data from the LACE meta-analysis, the 1995 update of the BMJ meta-analysis, and data from published randomized trials, the benefit of adjuvant platinum-containing chemotherapy was confirmed, which now provides a rational basis for the ESMO clinical guidelines in favor of prescribing adjuvant chemotherapy to patients with II- III stages after radical surgery.

Neoadjuvant chemotherapy for non-small cell lung cancer

Neoadjuvant chemotherapy is still considered an experimental treatment. However, neoadjuvant chemotherapy leads to a reduction in the clinical stage in 40-60% of patients, and to a complete pathological response in 5-10% of patients. As it turned out, neoadjuvant chemotherapy is better tolerated than adjuvant one: three full cycles of chemotherapy are able to endure more than 90% of patients, while adjuvant chemotherapy is prescribed only for 45-60% of patients.

Based on current knowledge, neoadjuvant chemotherapy should be provided with at least three cycles of a platinum-containing regimen. As with advanced non-small cell lung cancer, the most preferred chemotherapy regimen is a doublet of cisplatin and a third-generation drug. Preoperative chemotherapy should be considered in patients with stage IIIA-N2 disease.

L educational therapy for lung cancer

Radiation therapy is carried out in patients for whom radical surgical treatment is not indicated due to the functional state, if the patient refuses surgical treatment or if the process is inoperable. Can be used alone or in combination with polychemotherapy.

Contraindications for irradiation are: the presence of decay in the tumor, persistent hemoptysis, the presence of exudative pleurisy, severe infectious complications (pleural empyema, abscess formation in atelectasis, etc.), active form of pulmonary tuberculosis, stage III diabetes mellitus, concomitant diseases of vital organs in the stage decompensation (cardiovascular system, lungs, liver, kidneys), acute inflammatory diseases, fever over 38 0 C, severe general the patient's condition (on the Karnofsky scale 40% or less).

Method of radiation therapy according to the radical program of non-small cell lung cancer

All patients with non-small cell cancer receive external beam radiation therapy (convection or comfort) to the area of ​​the primary focus and the area of ​​regional metastasis. For radiation treatment, the quality of radiation, localization and size of the fields are necessarily taken into account.

The volume of irradiation is determined by the size and location of the tumor and the area of ​​regional metastasis and includes the tumor + 2 cm of tissue outside its borders and the area of ​​regional metastasis.

The upper border of the field corresponds to the jugular notch of the sternum. Lower limit: with a tumor of the upper lobe of the lung - 2 cm below the bifurcation of the trachea; with a tumor of the middle lobe of the lung and the absence of metastases in the bifurcation lymph nodes - 4 cm below the bifurcation of the trachea; with a tumor of the middle lobe of the lung and the presence of metastases in the bifurcation lymph nodes, as well as with a tumor of the lower lobe of the lung - the upper level of the diaphragm.

With a low degree of differentiation of epidermoid and glandular lung cancer, the cervical-supraclavicular zone on the side of the lesion is additionally irradiated. Treatment is carried out in 2 stages with an interval between them of 2-3 weeks. At the first stage ROD 2 Gr SOD 40 Gr. At the second stage, irradiation is carried out from the same fields (the part of the field, including the primary focus, can be reduced according to the decrease in the size of the primary tumor), ROD 2 Gy, SOD 20 Gy.

M method of chemoradiotherapy for small cell lung cancer

Special treatment of patients with small cell lung cancer begins with a course of polychemotherapy. After 1-5 days (depending on the patient's condition), remote radiation therapy is performed with the inclusion in the volume of irradiation of the primary tumor, mediastinum, roots of both lungs, cervical-supraclavicular zones on both sides. The radiation therapist determines the technical conditions for irradiation.

Remote radiation therapy is carried out in 2 stages. At the 1st stage, the treatment is ROD 2 Gy, 5 fractions, SOD 20 Gy. At the 2nd stage (without interruption) ROD 2 Gr, SOD 40 Gr.
For prophylactic purposes, both cervical-supraclavicular zones are irradiated from one anterior field with a central block along the entire length of the field to protect the cartilage of the larynx and cervical spinal cord. Radiation therapy is carried out ROD 2 Gy, SOD 40 Gy. In case of metastatic lesions of the supraclavicular lymph nodes, additional irradiation of the affected area is performed from the local field ROD 2 Gy, SOD 20 Gy.

P alliative radiotherapy

1. In the absence of severe difficulty in breathing and the width of the lumen of the trachea is more than 1 cm, treatment (in the absence of contraindications) begins with polychemotherapy. Radiation therapy is followed by: in non-small cell lung cancer ROD 2 Gy, SOD 40 Gy. After 3-4 weeks, the issue of the possibility of continuing radiation treatment (ROD 2 Gy, SOD 20 Gy) is decided.In small cell lung cancer, treatment is carried out continuously up to SOD 60 Gy.

2. With severe shortness of breath and the width of the lumen of the trachea is less than 1 cm, treatment begins with radiation therapy ROD 0.5-1 Gy. In the process of treatment, with a satisfactory condition of the patient, a single dose is increased to 2 Gy, SOD 50-60 Gy.

Distant metastases

I option. With a satisfactory condition of the patient and the presence of single metastases, radiation therapy is performed on the zones of the primary focus, regional metastasis and distant metastases + polychemotherapy.

II option. In severe condition of the patient, but not less than 50% on the Karnofsky scale and the presence of multiple distant metastases, radiation therapy is performed locally on the areas of the most pronounced lesion in order to relieve shortness of breath, pain syndrome + polychemotherapy.

L Treatment of relapses and metastases of lung cancer

Surgical

In case of postoperative recurrence of cancer or single intrapulmonary metastases (up to 4 formations), with a satisfactory general condition and laboratory parameters, a second operation is indicated.

Chemoradiation

Relapse in the mediastinum and supraclavicular lymph nodes

With relapse in the mediastinum and supraclavicular lymph nodes, palliative radiation or chemoradiotherapy is performed. The radiation therapy program depends on the previous treatment. If the radiation component was not used at the previous stages, then a course of radiation therapy is carried out according to a radical program according to one of the methods described above, depending on the morphological form of the tumor. If radiation therapy was used in one volume or another at the previous stages of treatment, we are talking about additional radiation therapy, the effect of which can be realized only when doses of at least 30-40 Gy are applied. An additional course of radiation therapy is carried out ROD 2 Gy, SOD up to 30-60 Gy, depending on the timing after the completion of the previous exposure + polychemotherapy.

Metastases in the brain

Single brain metastases can be removed with subsequent irradiation. If surgical removal is not possible, brain irradiation is performed. Radiation therapy should be started only if there are no signs of increased intracranial pressure (examination by an ophthalmologist, neurologist). Irradiation is carried out against the background of dehydration (mannitol, sarmanthol, diuretics), as well as corticosteroids. First, the entire brain is irradiated in ROD 2 Gy, SOD 20 Gy, then aiming at the metastasis area ROD 2 Gy, SOD 40 Gy + polychemotherapy.

AT Second metachronous lung cancer or lung metastases

A single tumor node in the lung that appeared after radical treatment, in the absence of other signs of progression, should be considered as a second metachronous lung cancer, subject, if possible, to surgical removal. With multiple formations, chemoradiotherapy is performed.

Metastatic bone disease

Local irradiation of the affected area is carried out. In case of damage to the spine, one adjacent healthy vertebra is additionally included in the irradiated volume. When a metastatic lesion is localized in the cervical and thoracic regions, the ROD is 2 Gy, the SOD is 40 Gy with an irradiation field length of more than 10 cm. In case of damage to other bones of the skeleton, the SOD is 60 Gy, taking into account the tolerance of the surrounding normal tissues.

X lung cancer chemotherapy

It can be used in patients with stage IIIB-IV both alone and in combination with radiation therapy with good functional status.

The most effective polychemotherapy regimens

Non-small cell cancer

P latin schemes:

Paclitaxel 135-175 mg/m 2 intravenously over 3 hours on day 1.

Carboplatin 300 mg/m 2 intravenously over 30 minutes. after the introduction of paclitaxel, on the 1st day.

Carboplatin AIS-5, in 1 day.

Gemcitabine 1000 mg/m2; on the 1st and 8th days.

Cisplatin 80 mg/m 2 on the 1st day.

Gemcitabine 1000 mg/m 2 on days 1 and 8.

Carboplatin AIS-5, in 1 day.

Cisplatin 75 mg/m 2 on the 1st day.

Cyclophosphamide 500 mg/m 2 on the 1st day.

Doxorubicin 50 mg/m 2 on the 1st day.

Vinorelbine 25 mg/m 2 on the 1st and 8th days.

Cisplatin 30 mg/m 2 on days 1-3.

Etoposide 80 mg/m 2 on days 1-3.

Irinotecan 90 mg/m 2 on days 1 and 8.

Cisplatin 60 mg/m 2 on the 1st day.

Vinblastine 5 mg/m 2 on the 1st day.

Cisplatin 50 mg/m 2 on the 1st day.

Mitomycin C 10 mg/m 2 on the 1st day.

Ifosfamide (+ uromethoxan) 2.0 g/m 2 ; on the 1st, 2nd, 3rd, 4th, 5th day.

Cisplatin 75 mg/m 2 on the 1st day.

H platinum schemes:

Gemcitabine 800-1000 mg/m 2 on days 1 and 8.

Docetaxel 75 mg/m 2 on the 1st day.

Gemcitabine 800-1000 mg/m 2 on days 1 and 8.

Pemetrexed 500 mg/m 2 on day 1.

Paclitaxel 135-175 mg/m 2 intravenously over 3 hours on the 1st day.

Vinorelbine 20-25 mg/m 2 on the 1st and 8th day.

Docetaxel 75 mg/m 2 on the 1st day.

Vinorelbine 20-25 mg/m 2 on the 1st and 8th day.

BUT Active chemotherapy regimens for NSCLC:

Cisplatin 60 mg/m 2 on the 1st day.

Etoposide 120 mg/m 2 on days 1-3.

Paclitaxel 135-175 mg/m 2 intravenously over 3 hours on the 1st day.

Carboplatin 300 mg/m 2 intravenously over 30 minutes. after the introduction of paclitaxel, on the 1st day.

Cisplatin 80 mg/m 2 on the 1st day.

Vinorelbine 25-30 mg/m 2 on the 1st and 8th day.

Cisplatin 80-100 mg/m 2 on the 1st day.

Paclitaxel 175 mg/m 2 , day 1, 3 hour infusion.

Cisplatin 80 mg/m 2 on the 1st day.

Docetaxel 75 mg/m 2 on the 1st day.

Cisplatin 75 mg/m 2 on the 1st day.

Docetaxel 75 mg/m 2 on the 1st day.

Carboplatin AIS-5, on the 1st day.

Gemcitabine 1000 mg/m 2 on days 1 and 8.

Carboplatin AIS-5, on the 1st day.

Pemetrexed 500 mg/m 2 on day 1.

Cisplatin 75 mg/m 2 on the 1st day.

The interval between courses is 21 days.

Platinum-containing regimens in combination with vinorelbine, gemcitabine, taxanes, irinotecan or pemetrexed in the non-squamous variant increase life expectancy, improve quality of life and control symptoms in patients with a satisfactory somatic status.

For adenocarcinoma and bronchoalveolar cancer, pemetrexed+cisplatin or paclitaxel+carboplatin regimens with or without bevacizumab (Avastin) are preferable.
In case of contraindications to the appointment of platinum-containing therapy, platinum-free combinations with third-generation agents are prescribed. However, most studies have shown lower response rates but similar survival rates.

For elderly patients with somatic status 2, the use of monotherapy with any of the drugs is recommended. Elderly patients in satisfactory condition or non-elderly patients with medical status 2 may be given combination chemotherapy.

Maintenance therapy is an active treatment started immediately after the first line of chemotherapy, until the moment of tumor progression. The role of maintenance therapy is shown: pemetrexed, in the presence of mutated EGFR - erlotinib.

For locally advanced or metastatic non-small cell lung cancer, erlotinib is indicated as maintenance therapy in patients who have not progressed after 4 cycles of first-line platinum therapy.

Currently, for the second line of NSCLC chemotherapy, the International Association for the Study of Lung Cancer and the US Food and Drug Administration (FDA) recommend pemetrexed, docetaxel, erlotinib.

For the second line of chemotherapy, etoposide, vinorelbine, paclitaxel, gemcitabine as monotherapy, as well as in combination with platinum and other derivatives, if they were not used in the first line of treatment, can also be used.

Third line HT. With disease progression after second-line chemotherapy, patients may be recommended treatment with erlotinib and gefitinib, EGFR tyrosine kinase inhibitors. This does not exclude the possibility of using other cytostatics for the third or fourth line that the patient has not previously received (etoposide, vinorelbine, paclitaxel, non-platinum combinations).

However, patients receiving third or fourth line chemotherapy rarely achieve objective improvement, which is usually very short-lived with significant toxicity. For these patients, symptomatic therapy is the only correct method of treatment.

Targeted therapy: in recent years, it has been actively used in the treatment of non-small cell lung cancer. Currently, gefitinib, the VEGF inhibitor bevacizumab, and the tyrosine kinase inhibitor erlotinib can be recommended in targeted therapy for EGFR Mut+ patients, which is the standard of care.

The use of tyrosine kinase inhibitors (erlotinib, gefitinib) in the first line is an option in patients with certain EGFR activity in exons 19/21. Currently, other markers should not be considered when choosing treatment.

The addition of cetuximab to cisplatin and vinorelbine contributed to an increase in overall survival in patients with tumor EGFR expression and somatic status 2, regardless of the histological variant (Minimum Clinical Recommendations of the European Society for Medical Oncology (ESMO), Moscow, 2010).

Bevacizumab 7.5 mg/kg every 3 weeks, until progression - 1st line therapy for NSCLC.

Bevacizumab 15 mg/kg every 3 weeks until progression - 1st line of therapy for NSCLC.

Erlotinib hydrochloride 150 mg/day, orally - 1 line until progression in locally advanced or metastatic EGFR Mut+ NSCLC; 2 and subsequent lines (locally advanced or metastatic NSCLC after at least one ineffective course of chemotherapy) - until progression.

Erlotinib hydrochloride significantly increases the survival of patients with NSCLC, regardless of physical condition, gender, age, previous body weight loss, smoking habits, number of previous regimens and their effectiveness, disease duration, debilitated, and elderly patients.

Gefitinib 250 mg/day in NSCLC, only in line II chemotherapy in EGFR Mut+ patients. Cetuximab is used at 400 mg/m 2 IV drip for 120 minutes, then maintenance therapy - 250 mg/m 2 once a week.

Small cell cancer (SCLC)

Cisplatin 80 mg/m 2 on the 1st day.

Etoposide 120 mg/m 2 from days 1 to 3.

1 time in 3 weeks.

Doxorubicin 45 mg/m 2 on the 1st day.

Cyclophosphamide 1000 mg/m 2 on the 1st day.

Etoposide 100 mg/m 2 ; on the 1st, 2nd, 3rd or 1st, 3rd, 5th days.

1 time in 3 weeks.

After radical surgical treatment, patients with typical and atypical carcinoid should be observed annually for 10 years in order to identify possible recurrences in the area of ​​surgical intervention.

Every 3-6 months, the level of biochemical markers, such as chromogranin-A, should be determined (in the case when they were initially elevated); CT or MRI should be repeated annually.

Patients with metastases or tumor recurrence should be examined during chemotherapy and biotherapy more often, every 3 months, with monitoring (preferably CT) and determination of the level of biological markers in order to evaluate the results of the treatment.

Addition

Lung carcinoids account for 1-2% of all lung tumors.. Carcinoid tumors of the lung and thymus may be part of the complex syndrome of multiple neuroendocrine neoplasia type I (MEN-1).

Histological classification of neuroendocrine tumors of the lung:

1. A typical carcinoid characterized by a high degree of differentiation and a low mitotic index.

2. Atypical carcinoid, characterized by a higher mitotic index, less than 10/10 HPF, and isolated areas of focal necrosis.

3. Large cell neuroendocrine carcinoma, which can be difficult to distinguish from atypical carcinoid; characterized by a high mitotic index (>10/10HPF) and more widespread necrosis.

4. Small cell lung cancer (SCLC) is the most poorly differentiated neuroendocrine lung tumor, also called the classic “oat cell carcinoma”. The mitotic index is very high (greater than 80/10 HPF) with extensive areas of necrosis. SCLC is discussed in a separate chapter of the ESMO Guidelines.

Both typical and atypical lung carcinoids can express immunohistochemically detectable neuroendocrine markers (chromogranin A, synaptophysin, and neuron-specific enolase) and somatostatin receptors. The same applies to thymic carcinoids, which express neuron-specific enolase in 73%, somatostatin in 36% and ACTH in 27% of cases. Large cell carcinoma and small cell lung cancer express little synaptophysin and neuron-specific enolase and rarely express chromogranin-A. In the last two histological variants, mutations of the p53 chromosome are also found.

Thymic neuroendocrine tumors may vary in degree of differentiation from a typical highly differentiated carcinoid to small cell carcinoma.

About 70% of all carcinoids are localized in the main bronchi and 1/3 in the peripheral parts of the lungs. Most often they develop in the right lung, mainly in the middle lobe. 92% of patients present with hemoptysis, cough, recurrent lung infection, fever, chest discomfort, and localized wheezing.

In patients with lung and thymus carcinoids, carcinoid syndrome is very rare, up to 2%. Serotonin is the most commonly identified peptide that causes carcinoid syndrome. Occasionally, a carcinoid crisis can occur in initially asymptomatic patients after bronchoscopic biopsy or surgical manipulation. Approximately 2% of patients with lung and thymic carcinoids have Cushing's syndrome due to ectopic production of adrenocorticotropic hormone (ACTH).

Diagnostics

The diagnosis is established on the basis of histological examination and the determination of neuroendocrine markers by immunohistochemical methods.

Because 80% of typical lung carcinoids express somatostatin receptors, somatostatin receptor isotope scintigraphy can be highly informative.

To identify primary lesions and metastases of thymic carcinoids, it is recommended to perform CT or MRI with intravenous contrast.Somatostatin receptor isotope scintigraphy is an additional method.

Biochemical parameters depend on the histological type of neuroendocrine lung tumor. A typical carcinoid is characterized by elevated plasma levels of chromogranin-A. In the presence of symptoms due to hormonal activity, there may be an increase in plasma ACTH, somatoliberin, insulin-like growth factor, 5-hydroxyacetic acid or histamine metabolites, as well as urinary cortisol levels.

Treatment

Localized tumors

The surgical method is the main method of treatment for all localized typical and atypical carcinoids, both lung and thymus, with a 5-year survival rate of 80 to 100%. Surgical intervention is not leading in large cell carcinoma and SCLC, with the exception of small tumors, for example, in T1-2 N0; histological verification of peripherally located tumors of small size allows them to be radically removed.

Surgical access depends on the size, location and type of tissue. Removal of parietal typical lung carcinoid can be performed by bronchoscopy (when bronchoscopy should be performed under CT guidance), which can lead to a complete cure in a significant number of patients. Tumors that do not meet the criteria for endobronchial resection can be removed by marginal lung resection, segmentectomy, lobectomy, or pneumonectomy.

With localized forms, remote irradiation of the focus is possible, especially if surgical intervention is not planned. Endobronchial laser treatment, although not pathogenetic, can be used in certain cases to treat airway obstruction.

Metastatic and recurrent tumors

The standard treatment for metastatic lung and thymic carcinoids is chemotherapy combined with surgery when possible, although existing chemotherapy regimens are much less effective. Chemotherapy for SCLC, which is chemoresponsive but not curable, is discussed in the relevant sections. In the case of symptomatic hormone-producing poorly differentiated tumors, somatostatin analogues and alpha-interferon can be used.

In hormonally inactive tumors, the feasibility of using somatostatin analogues is questionable. With a high level of expression of somatostatin receptors by tumor cells, one of the possible methods of treatment is radiation therapy.

The optimal chemotherapy regimens for typical and atypical carcinoids and large cell neuroendocrine carcinoma are a combination of fluorouracil and interferon alpha; combinations based on streptozoocin; chemotherapy including etoposide/cisplatin or chemotherapy including cyclophosphamide, doxorubicin and vincristine. In general, the results of chemotherapy treatment are questionable, and survival data should be interpreted with caution.

Symptomatic metastatic disease requires palliative therapy using treatments such as embolization of liver metastases and radiation therapy for brain and bone metastases.

Hospitalization

Indications for hospitalization, indicating the type of hospitalization: planned.

The required amount of research before planned hospitalization: cytological and histological verification of the tumor, determination of activating EGFR mutations.

Information

Sources and literature

1. Periodic protocols for the diagnosis and treatment of malignant neoplasms in adults of the Ministry of Health of the Republic of Kazakhstan (Order No. 883 of December 25, 2012)
   1. 1. Standards for the treatment of malignant tumors (Russia), Chelyabinsk, 2003. 2. Trakhtenberg A. Kh. Clinical onco-pulmonology. Geomretar, 2000. 3. Peterson B. E. Oncology. Moscow, "Medicina", 1980. 4. Neuroendocrine tumors. Guide for doctors. Edited by Martin Caplin, Larry Kvols/ Moscow 2010 5. Minimum clinical guidelines of the European Society for Medical Oncology (ESMO) 6. Guidelines for chemotherapy of tumor diseases edited by N.I. Perevodchikova, Moscow 2011 7. The chemotherapy Source Book, Fourth Edition, Michael C. Perry 2008 by Lippincot Williams 8. TNM Classification of malignant tumors. Sobin L.Kh., Gospordarovich M.K., Moscow 2011 9. Journal of Clinical Oncology Vol. 2, No. 3, p. 235, “Carcinoid” 100 years later: epidemiology and prognostic factors of neuroendocrine tumors. 10. Ardill JE. Circulating markers for endocrine tumors of the gastroenteropancreatic tract. Ann Clin Biochem. 2008; 539-59 11. Arnold R, Wilke A, Rinke A, et al. Plasma chromogranin A as a marker for survival in patients with metastatic endocrine gastroenteropancreatic tumors. Clin Gastroenterol Hepatol. 2008, pp. 820-7

Information

Organizational aspects of protocol implementation

Evaluation criteria for monitoring and auditing the effectiveness of protocol implementation:
1. Percentage of newly diagnosed lung cancer patients receiving initial treatment within two months of disease onset = (Number of patients diagnosed with lung cancer receiving initial treatment within two months of disease onset/All patients newly diagnosed with cancer lungs) x 100%.

2. Percentage of cancer patients receiving chemotherapy within two months after surgery = (Number of cancer patients receiving chemotherapy within two months after surgery / Number of all lung cancer patients after surgery who require chemotherapy) x 100 %.

3. Percentage of recurrence of lung cancer in patients within two years = (All patients with recurrence of lung cancer within two years / All operated patients diagnosed with lung cancer) x 100%.

Reviewers:
1. Kozhakhmetov B.Sh. - head. cafe oncology of the Almaty State Institute of Postgraduate Medical Education, MD, prof.
2. Abisatov G.Kh. - head. cafe oncology, mammology of the Kazakh-Russian Medical University, MD, prof.

Results of external review: positive decision.

List of protocol developers with indication of qualification data in KazNIIOiR:

1. Senior researcher thoraco-abdominal department Ph.D. Karasaev M.I.

2. N.s. thoraco-abdominal department Ph.D. Baymukhmetov E. T.

3. Head. Department of Radiation Oncology, MD Kim W. B.

4. Physician of the Department of Chemotherapy Musakhanov Zh.S.

Indication of the terms of the revision: revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

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Lung cancer, depending on the location, is divided into peripheral and central. Gradation according to the type of location systematizes, first of all, the immediate place of the appearance and development of cancer cells. CRL occurs in the large bronchi, and the origin of PRL is the cells of the small bronchi or alveoli located on the periphery of the respiratory organs.

The cancerous process away from the root of the lung has its own specific features, but in terms of histological forms it has the same indicators as large bronchial cancer.

Peripheral lung cancer code for mcb 10 C33-C34 is formed from cells of small bronchi, bronchioles and alveolar epithelium. The main distinguishing feature from central cancer is its weak clinical indicators or their complete absence at the initial stage of pathology.

Cancer distant from the root of the lung is often discovered by chance, during the next physical examination. The pathology manifests itself relatively late, when the tumor reaches a large size (up to 7 cm), and begins to germinate the pleura or compress the large bronchi.

Only at this stage there is a cough, shortness of breath, hemoptysis, pleural carcinomatosis. The degeneration of normal cells into cancer cells can begin at the site of the scar tissue that was formed as a result of pneumonia,.

The structure of the shadow of the cancer node is characterized by heterogeneity, which is expressed in the form of separate round shadows merged with each other. In the case of visualization of a distinct tumor, it may be difficult to differentiate it from benign formations.

The aggressiveness of the spread of atypical education is expressed not only by its size, but also by its growth rate.

Important! The rate of tumor growth is influenced by the histology of cells and the age of patients. The younger the patient, the more aggressive the rate of tumor growth. Slower growth is seen in elderly patients.

The course of the disease against the background of small bronchi appears to be inhomogeneous radiance, bordering the primary tumor. The rays depart from the focus, while their tips point towards the tissues of the lung. The presence of radiant spines is associated with blood and lymphatic vessels passing near the walls of the bronchi.

Small bronchial cancer is prone to metastasis and germination in the central lobes. Centralization of the PR causes obstruction of the large bronchi, which subsequently leads to atelectasis. The histological variant is most often, less often or undifferentiated forms.

Classification

For peripheral cancer, a number of features reflecting its clinical and anatomical manifestations are distinguished. Each anatomical form has its own characteristic differences, so they should be considered separately. Some species have, only for them, characteristic symptomatic manifestations.

Clinical forms of BPD:

• nodular;
• cavity;
• pneumonia-like;
• cortico-pleural.

The nodular form of development is the most common variant of peripheral cancer. It originates in the terminal bronchioles, on the radiograph appears as a uniform shadow with even contours and a bumpy surface.

Abdominal cancer is a rarer variant than nodular cancer. Its origin is associated with the disintegration of the nodular form into fractions of various histological structures, and the formation of a pseudo-cavernous cavity in the thickness of the node. The cavity has a central location and reaches various sizes and shapes.

Pneumonia-like form of growth is even rarer and develops not in the form of a node, but as an infiltrate without a regular shape and without clear boundaries. It tends to rapidly infiltrate, while it can cover an entire lobe. Histologically, it is always represented by glandular cancer, clinical indicators are similar to sluggish pneumonia.

Corticopleural cancer is classified as peripheral, although this term is not always recognized in oncology. It originates in the mantle layer of the lung tissue from the side of the spine.

Spreading along the pleura along the spine (it does not develop in the form of a knot), it envelops the processes and the body of the spine. In some cases, the tumor fuses with the spine for a considerable length.

The main symptomatology is due to pain in the thoracic spine, with further development of the clinic of the affected spinal cord.

The clinical parameters of the tumor depend not only on its shape, but also on the location in the lung lobes.

Peripheral lung cancer code for mcb 10, localization in lobes and relative frequency of fixations:

• upper - C34.1 (70%);
• lower - C34.3 (23%);
• medium - C34.2 (7%).

Peripheral cancer of the upper lobe of the left lung at the initial stage of the disease has weak indicators on the radiograph. Only a slight decrease in transparency or a flat shadow is visible without a clear outline of its borders. In the future, the intensity of the darkening increases, but without a clear outline.

Peripheral cancer of the lower lobe of the left lung is due to an increase in intrathoracic, supraclavicular, prescaleneal lymph nodes.

Peripheral cancer of the upper lobe of the right lung, as well as the lower lobe, is identical in its clinical and anatomical manifestations with the left-sided development of the tumor pathology. Due to the anatomical structure, the right-sided location of the disease is recorded more often than the left-sided one.

Important! Cancer of the apex of the lung, under certain conditions, is classified as a Pancoast tumor.

A characteristic symptomatology appears when the neoplasm spreads along the I segment, sprouting at the same time nearby tissues, leading to the destruction of 1-3 ribs and thoracic vertebrae. Fix increasing pain in the chest and upper limbs.

The tumor reaching the subclavian vessels causes swelling of the extremities. Growing into the sympathetic trunk leads to the appearance of Horner's syndrome - retraction of the eyeball, pupil constriction, drooping of the eyelid, and others.

Diagnostics

The most common method of early diagnosis is a preventive x-ray examination. If a suspicious darkening is detected, it is necessary to conduct an additional tomographic examination, as well as take sputum for cytological analyses.

Important! The main task for any diagnostic method is to identify cancer pathology at the stage of development, at which the tumor has not reached a large size and metastasis has not occurred.

Small ones include pathological formations up to 3 cm, and the smaller the focus, the less likely the lymphatic spread of metastases. The first signs of the disease on the x-ray can vary, so there is no certainty in this matter.

The following early forms of blackouts are distinguished:

• spherical - in 30% of cases;
• irregular, with fuzzy boundaries;
• elongated, similar to tissue fibrosis;
• shadows in the form of rough strands;

Peripheral lung cancer with subsequent progression on the radiograph is manifested by damage to the vertebrae of their processes. Intensification of the shadow, and outlining it with a correct contour, can lead to an erroneous diagnosis, confusing cancerous pathology with pleurisy.

The radiograph may turn out to be completely non-informative, oncopathology may not be displayed at all in the picture, and the occurrence of pain syndrome will be linked to atypical changes in the spine. Therefore, in modern medicine, a decisive role in diagnosing, in the presence of certain markers indicating the peripherization of a pathological formation, is assigned to computed tomography.

It is CT that allows you to achieve the greatest detail of the pathological picture. It should be borne in mind that the cost of diagnosing, on the latest generation devices, will be relatively high. However, the effectiveness and informativeness of this diagnosis is undeniable.

CT gives a clearer cut of the oncoprocess (pictured), and allows you to distinguish between a tumor lesion of the pleura from fibrous pathology. Such differences are not displayed on radiography.

Computed tomography well determines the following indicators:

• structure and contours of shading;
• the presence of infiltration of surrounding tissues;
• migration of metastases to the lymph nodes;
• the exact location of the tumor;
• the growth of the focus into the following lobes and the germination of the pleura.

Due to its informativeness, this method allows to identify small metastases, germination of adjacent organs and tissues.

The instruction for diagnosing BPD involves the collection of biomaterial for further cytological examination. A biopsy specimen from the small bronchi is taken using the catheterization method. It consists in the fact that a radiopaque catheter is brought through the subsegmental bronchus and the necessary cellular material is removed.

Important! Collection of biomaterial is not the main method of early diagnosis. It is carried out with suspicion of oncology, and with early pathological blackout detected.

In some cases, a puncture is performed - the selection of tissue through the chest. This minimally invasive method is done through a small puncture with a special needle, under local anesthesia. The extracted biopsy is examined.

Due to the fact that the peripheral form of cancer, especially in the early stages, has a very blurred picture, its diagnosis can be difficult. Cancer foci are mistaken for other pulmonary pathologies, therefore, at the slightest suspicion of cancer, the patient must be sent for additional examination.

Important! The primary task of competent diagnosis is not to state the fact of the disease, but to detect it before the onset of metastasis.

Treatment and prognosis

The most effective treatment for BPD is surgery. The radical method avoids many side effects associated directly with the treatment. When performing a surgical operation, the lesion is completely removed, and the recurrence of the disease is minimized as much as possible.

The most significant indicator for the operation is the absence of metastasis and the small size of the tumor. In this case, it is advisable to perform a lobectomy - removal of a lung lobe within its anatomical boundaries, or a biloctectomy - scalping of two lobes.

If a more developed form is registered, with metastases in the lymph nodes of the first order, then a complete resection of one of the lungs is recommended - pulmonectomy.

There are a number of restrictions on the path to partial or complete resection of one of the paired respiratory organs. This is, first of all, the neglect of the oncological process, the appearance of regional and separated metastases, the germination of the tumor near the underlying tissues and organs. If the operation is refused, the attending physician may refer to the advanced age of the patient, diseases of the cardiovascular system, and other indicators that lead to a decrease in the vital capabilities of the body.

After the ban on the operation, the patient will be asked to undergo chemotherapy and radiation exposure. To undergo a course of drug treatment for a patient, a thorough examination will be required.

Modern drug therapy affects the disease pointwise and selectively. Although the patient will not be able to avoid many negative consequences, it is still one of the most basic methods of cancer treatment.

Radiation therapy affects several areas at the same time. Irradiation is exposed not only to the primary affected area, but also to the sites of regional metastasis. The principle of the process is presented in the video in this article.

Radiation and chemotherapeutic effects are used not only as independent methods of treatment, but they can also complement each other, or be recommended in addition to the surgical method. In this case, the type of treatment used is called combined.

The prognosis of survival is influenced by the stage at which the treatment of the disease began, the histological parameters of the tumor and its degree of differentiation. The most acceptable result in predicting is associated with operations to remove a malignant tumor.

However, only 10-12% of patients undergo surgery. Such a low rate is associated with the diagnosis of the disease in the later stages, and the impossibility of resection of the tumor.

Five-year survival prognosis table for BPD:

Life expectancy in peripheral cancer of the right lung does not differ from the left. That is, right-sided and left-sided localization do not affect the statistical data on the prognosis of survival.

Peripheral lung cancer is one of the most serious and common malignant diseases affecting the organs of the respiratory system. Pathology is insidious in that a person learns about it late, since in the early stages the tumor practically does not manifest itself. Initially, the cancer process affects medium-sized bronchi, but in the absence of medical care, it passes into the central form with a more unfavorable prognosis.

Concept and statistics

Peripheral lung cancer begins its development from the epithelium of medium-sized bronchi, gradually capturing the entire lung tissue. The pathogenesis of the disease is characterized by the latent course of the first stages of the malignant process and metastasis to the lymph nodes and distant organs.

Lung cancer, both peripheral and central, occupies a leading position in the ranking of deadly pathologies. According to statistics, the disease is usually diagnosed in men over 45 years of age. Women are less likely to suffer from this disease, which is explained by a lower percentage of smokers among them.

The tumor is usually localized in the upper lobe of the organ, while the right lung is affected more often than the left. However, the cancer of the left lung has a much more aggressive course, leaving no hope of recovery.

According to statistics, the disease code according to the ICD-10 registry: C34 Malignant neoplasm of the bronchi and lungs.

The reasons

But carcinogens get into the lungs and due to environmental pollution. In areas where chemical and other industrial production operates, the incidence of respiratory tract cancer has increased several times.

Also, the factors provoking the oncological process include:

• ionizing radiation;
• immunodeficiency that developed against the background of chronic somatic conditions;
• neglected diseases of the respiratory system - inflammatory and infectious lesions of the bronchi and lungs;
• constant exposure to chemicals such as nickel, radon, arsenic, etc.

Who is at risk?

Most often, the following groups of people are included in the number of cases:

• smokers with many years of experience;
• workers in chemical industries, for example, in the production of plastic;
• persons suffering from COPD - chronic obstructive bronchopulmonary diseases.

The condition of the bronchi and lungs plays an important role in the development of oncology. It is important not to leave problems with the respiratory organs unattended and treat them in a timely manner in order to avoid various complications, including deadly ones.

Classification

Lung cancer of the peripheral type is divided into several forms, each of which has its own characteristics. We propose to consider them in more detail.

Cortico-pleural form

The malignant process develops in the form of a tumor with a bumpy surface, which quickly spreads through the bronchi, growing into the lungs and chest with thin winding threads. It belongs to squamous cell carcinoma, therefore it gives metastases to the bones of the spine and ribs.

Nodal shape

The tumor has a nodular character and a bumpy surface, starting to develop from the tissues of the bronchioles. On the radiograph, this neoplasm is characterized by a deepening - Riegler's syndrome - it indicates the entry of the bronchus into the malignant process. The first symptoms of the disease make themselves felt when it grows into the lungs.

Pneumonia-like form

A tumor of a glandular nature, represented by multiple malignant nodes that tend to gradually merge. Basically, the middle and lower lobe parts of the lung are affected. When diagnosing this disease, the patient's radiograph clearly shows bright spots in the picture of a solid dark background, the so-called "air bronchogram".

Pathology proceeds as a protracted infectious process. The onset of the pneumonia-like form is usually latent, the symptoms increase with the progression of the tumor.

cavity form

The neoplasm has a nodular character with a cavity inside, which appears as a result of its gradual decay. The diameter of such a tumor usually does not exceed 10 cm, so quite often the differential diagnosis of the malignant process is incorrect - the disease can be confused with tuberculosis, abscess or lung cyst.

This similarity often leads to the fact that cancer, left without appropriate treatment, actively progresses, aggravating the picture of oncology. For this reason, the cavity form of the disease is detected extremely late, mainly in inoperable terminal stages.

Peripheral cancer of the left upper and lower lobe

When the upper lobe of the lung is affected by a malignant process, the lymph nodes do not increase, and the neoplasm has an irregular shape and a heterogeneous structure. The pulmonary pattern during X-ray diagnostics in the root part expands in the form of a vascular network. With the defeat of the lower lobe, on the contrary, the lymph nodes increase in size.

Peripheral cancer of the upper lobe of the left lung and right

If the upper lobe of the right lung is affected, the clinical manifestations of the oncological process will be the same as when the left lung is involved in the disease. The difference lies only in the fact that, due to the anatomical features, the organ on the right is more often exposed to cancer.

Peripheral apical carcinoma with Pancoast syndrome

Atypical cells in this form of cancer are actively introduced into the nerve tissues and vessels of the shoulder girdle. The disease is characterized by the following clinical manifestations:

• pain in the clavicle area, initially periodic, but over time, painful permanent type;
• violation of the innervation of the shoulder girdle, which leads to atrophic changes in the muscles of the hands, numbness and even paralysis of the hands and fingers;
• development of destruction of the bones of the ribs, visible on the x-ray;
• Horner's syndrome with characteristic signs of pupillary constriction, ptosis, retraction of the eyeballs, etc.

Also, the disease causes such general signs as hoarseness in the voice, increased sweating, flushing of the face from the side of the affected lung.

stages

The disease proceeds according to certain stages of the malignant process. Let's take a closer look at them in the following table.

Symptoms

Cough is considered the first and main clinical sign of pathology. At an early stage of tumor growth and development, it may be absent, but with the progression of the disease, its manifestations begin to intensify.

Initially, we are talking about a dry cough with occasional scanty sputum, mainly in the morning. Gradually, it acquires a barking, almost hysterical character, with an increased volume of sputum secreted with the presence of blood streaks. This symptom is important in diagnosing cancer in 90% of cases. Hemoptysis begins when the tumor grows into the walls of adjacent vessels.

After coughing comes pain. This is an optional symptom for lung cancer, but the vast majority of patients note its manifestations of aching or dull nature. Depending on the location of the tumor, discomfort can radiate (give) to the liver when the neoplasm is in the right lung, or to the heart area if it is a lesion of the left lung. With the progression of the malignant process and metastases, the pain intensifies, especially with physical impact on the oncological focus.

Many patients have subfebrile body temperature already at the first stage of the disease. She is usually persistent. If the situation is complicated by the development of obstructive pneumonia, the fever becomes high.

Gas exchange in the lungs is disturbed, the patient's respiratory system suffers, and therefore the appearance of shortness of breath is noted even in the absence of physical activity. Additionally, there may be signs of osteopathy - night pain in the lower extremities.

The course of the malignant process itself depends entirely on the structure of the tumor and the body's resistance. With strong immunity, pathology can develop for a long time, for several years.

Diagnostics

Identification of a malignant process begins with a survey and examination of a person. During the collection of an anamnesis, the specialist pays attention to the age and the presence of addictions in the patient, smoking experience, employment in hazardous industrial production. Then the nature of the cough, the fact of hemoptysis and the presence of pain syndrome are specified.

The main laboratory and instrumental diagnostic methods are:

• MRI. It helps to establish the localization of the malignant process, tumor growth into neighboring tissues, the presence of metastases in distant organs.
• CT. Computed tomography scans the lungs, allowing you to detect with high accuracy a neoplasm up to a small size.
• PAT. Positron emission tomography makes it possible to examine the emerging tumor in a three-dimensional image, to identify its structural structure and the stage of the oncological process.
• Bronchoscopy. Determines the patency of the respiratory tract and allows you to remove the biomaterial for histological examination in order to differentiate the neoplasm.
• Sputum analysis. The lung discharge during coughing is examined for the presence of atypical cells. Unfortunately, it does not guarantee 100% results.

Treatment

The fight against peripheral lung cancer is carried out by two main methods - surgical and radiation therapy. The first is not relevant in all cases.

In the absence of metastases and tumor sizes up to 3 cm, a lobectomy is performed - an operation to remove the neoplasm without resection of adjacent structures of the organ. That is, we are talking about the removal of a lobe of the lung. Quite often, with the intervention of a larger volume, relapses of the pathology occur, therefore, surgical treatment at the first stage of the malignant process is considered the most effective.

If regional lymph nodes are affected by metastases and tumor sizes corresponding to the second stage of cancer, pulmonectomy is performed - complete removal of the diseased lung.

If the malignant process has spread to neighboring organs and metastases have appeared in distant parts of the body, surgery is contraindicated. Serious comorbidities cannot guarantee a favorable outcome for the patient. In this case, radiation exposure is recommended, which can also be an auxiliary method for surgical intervention. It helps to reduce the volume of malignant neoplasm.

Along with these methods of treatment, chemotherapy is also used. Patients are prescribed drugs such as Vincristine, Doxorubicin, etc. Their use is justified if there are contraindications to surgical and radiation therapy.

Oncologists believe that chemotherapy for this diagnosis should be carried out for 6 cycles at intervals of 4 weeks. At the same time, 5-30% of patients show signs of an objective improvement in well-being, sometimes the tumor resolves in full, and with a combination of all methods of fighting lung cancer, a positive outcome can be achieved in many cases.

Frequently asked Questions

Is it possible to remove both affected lungs at the same time? A person cannot live without two lungs, therefore, with oncological lesions of both organs at once, surgical intervention is not carried out. As a rule, in this case we are talking about advanced cancer, when surgical treatment is contraindicated and other methods of therapy are resorted to.

Is a lung transplant/transplant done for cancer? Oncological diseases are a limitation to the transplantation of a donor organ or transplantation. This is due to the fact that a specific therapy is used in the malignant process, against which the probability of survival of the donor lung is reduced to zero.

Alternative treatment

People usually resort to informal medicine when there is no effect from traditional therapy or there is a desire to achieve better results and speed up the recovery process.

In any case, folk recipes are not a panacea in the fight against cancer and cannot act as an independent treatment. Their use in practice must necessarily be agreed with a specialist.

Dig up the roots of the plant after flowering, rinse, cut into pieces 3 mm thick and dry in the shade. 50 g of dry raw materials pour 0.5 liters of vodka, leave for 10-14 days. Take orally 1 tsp. 3 times a day before meals.

Means from badger fat. This product is highly effective in the first stage of lung cancer. Badger fat, honey and aloe juice are mixed in equal proportions. The drug is taken orally 1 tbsp. l. 3 times a day on an empty stomach.

Recovery process

The rehabilitation period after the therapeutic effect on the body requires a sufficient amount of time. Oncologists notice that some patients recover easier and faster, while others take months and even years to return to their former lives.

• conducting special respiratory exercises under the guidance of an exercise therapy instructor aimed at training the muscles of the chest and maintaining the respiratory system in good shape;
• constant motor activity even at rest - kneading the limbs improves blood circulation and avoids congestion in the lungs.

In addition, attention is paid to adherence to the principles of dietary nutrition - it should not only be fractional, but also sufficiently fortified and easily digestible in order to maintain the energy balance of the body.

Diet

In the system of treatment and preventive approach nutrition for lung cancer, although not the main type of care, but also plays an important role. A balanced diet allows you to provide the body of both healthy and sick people with the necessary energy support and nutrients, normalize metabolism and minimize the side effects of chemotherapy and radiation therapy.

Unfortunately, there is no specially designed and generally accepted diet for peripheral and central lung cancer. Rather, it is about the principles on which this nutrition system is built, taking into account the state of human health, the stage of the oncological process, the presence of disorders in the body (anemia, pneumonia, etc.) and the development of metastases.

First of all, we list which products with antitumor activity should be included in the diet equally for both prophylactic and therapeutic purposes in relation to peripheral lung cancer:

• foods rich in carotene (vitamin A) - carrots, parsley, dill, rose hips, etc.;
• dishes containing glucosinolates - cabbage, horseradish, radish, etc.;
• food with monoterpene substances - all kinds of citrus fruits;
• products with polyphenols - legumes;
• fortified dishes - green onions, garlic, offal, eggs, fresh fruits and vegetables, loose tea.

You need to give up obviously harmful food - fried and smoked foods, fast food, carbonated sugary drinks, alcohol, etc.

With the progression of lung cancer, many patients refuse to eat, therefore, for their life support in stationary conditions, enteral nutrition is organized - through a probe. Especially for people who are faced with such a disease, there are ready-made mixtures enriched with essential vitamins and minerals, for example, Composite, Enpit, etc.

The course and treatment of the disease in children, pregnant and lactating, the elderly

Children. Oncology in childhood, caused by damage to the bronchi and lungs, rarely develops. Usually in young patients, this disease is associated with adverse environmental conditions or a serious hereditary predisposition. For example, we can talk about the tobacco addiction of a mother who did not stop smoking while in position.

Clinical symptoms of peripheral lung cancer in a child are easy to identify - in the absence of data on bronchopulmonary disease, the pediatrician sends the baby for an additional examination to a pulmonologist or phthisiatrician for correct diagnosis. With the earliest possible detection of oncology and the treatment started, the prognosis for recovery is positive. The principles of therapy used will be the same as in adult patients.

Pregnancy and lactation. Diagnosis of peripheral lung cancer is not excluded in women during pregnancy and breastfeeding. In this case, the treatment must be completely entrusted to specialists of the appropriate profile. The issue of keeping a child is decided on an individual basis. If the stage is operable, surgery is recommended in the second trimester without termination of pregnancy. The risk of fetal death is 4%. In the presence of metastases in the case of advanced oncology, the prognosis for a woman is unfavorable - no more than 9 months from the date of diagnosis.

Advanced age. In the elderly, peripheral lung tissue cancer often occurs latently and is detected too late. Due to their state of health and the years they have lived, such patients rarely pay attention to periodic coughing, the appearance of sputum and other signs of trouble, attributing them to weakened immunity and chronic pathologies. Therefore, the disease is more often detected at the terminal inoperable stage, when help is limited only to palliative medicine.

Treatment of peripheral lung cancer in Russia, Israel and Germany

Statistics collected over the past decade indicate that lung cancer or adenocarcinoma is one of the most devastating ailments. According to the same study, more than 18.5% of all cancer patients die each year from this diagnosis. Modern medicine has a sufficient arsenal to combat this disease, with early treatment, the probability of stopping the malignant process and getting rid of it is high. We offer you to learn about the possibility of treating peripheral lung cancer in different countries.

Treatment in Russia

The fight against oncological diseases of the respiratory system is carried out here in accordance with the requirements of the World Health Organization. Assistance provided to patients is generally provided free of charge in the presence of a medical policy and citizenship of the Russian Federation.

We offer you to find out where you can go with peripheral lung cancer in Moscow and St. Petersburg.

• Cancer Center "Sofia", Moscow. He specializes in areas such as oncology, radiology and radiation therapy.
• Moscow Research Institute named after P.A. Herzen, Moscow. Leading cancer center in Russia. It provides the necessary range of medical services to patients who have applied for lung cancer.
• National Medical and Surgical Center. N.I. Pirogov, St. Petersburg Clinical Complex.

Consider what reviews are on the network about the listed medical institutions.

Natalia, 45 years old. “With a diagnosis of “peripheral cancer of the left lung of the 2nd stage,” a 37-year-old brother was sent to Moscow by the Research Institute. Herzen. We are satisfied with the result, we are very grateful to the doctors. A year and a half has passed since discharge - everything is normal.

Marina, 38 years old. “Peripheral cancer of the right lung of my father was operated on in St. Petersburg at the Pirogov Research Institute. At that time in 2014, he was 63 years old. The operation was successful, followed by chemotherapy courses. In the fall of 2017, a relapse occurred in one of the bronchi, unfortunately, it was recognized late, the process has been launched, now the doctors’ forecasts are not the best, but we do not lose hope.”

Treatment in Germany

Innovative methods of treating peripheral lung cancer are highly effective, accurate, and tolerable, but they are not carried out in domestic hospitals, but abroad. For example, in Germany. That is why the fight against cancer is so popular in this country.

So, where can you get help in the fight against peripheral lung cancer in German clinics?

• University clinic. Giessen and Marburg, Hamburg. A large medical complex in Western Europe, carrying out practical and scientific activities.
• Essen University Hospital, Essen. He specializes in the treatment of oncological diseases, including the respiratory system.
• Lung Oncology Clinic "Charite", Berlin. The Department of Pulmonary Oncology with specialization in Infectology and Pulmonology operates on the basis of the University Medical Complex.

We offer to consider reviews of some of the listed medical institutions.

Sergey, 40 years old. “5 years ago, in Germany, the Charite clinic underwent an operation and several courses of chemotherapy for my wife with peripheral lung cancer. I can say that everything went better than we expected. Thanks to the clinic staff. They did not take time with diagnosis and treatment, they helped quickly in the shortest possible time.”

Marianne, 56 years old. “Lung cancer of the peripheral type was found in my husband, he is an experienced smoker. Appealed to Germany in the clinic "Essen". The difference with domestic service is obvious. After the treatment, they immediately went home, the husband received a disability. 2 years have passed, there are no relapses, we are regularly checked by an oncologist. We recommend the Essen clinic.”

Treatment of peripheral lung cancer in Israel

This country is rightfully popular in the direction of medical tourism. It is Israel that is famous for the highest level of diagnosis and treatment of malignant neoplasms at any stage of their development. The results of the fight against cancer in this part of the world are considered the best in practice.

We offer you to find out where you can get help with oncology of the bronchopulmonary system in this country.

• Cancer Center, Herzliya Clinic, Herzliya. For more than 30 years, it has been accepting patients from all over the world for the treatment of oncological diseases.
• Medical Center "Ramat Aviv", Tel Aviv. The clinic uses all the innovative technologies in the field of surgery and radioisotope research.
• Clinic "Assuta", Tel Aviv. A private medical institution, thanks to which patients do not have to wait in line to receive and carry out the necessary medical procedures.

Consider reviews of some clinics.

Alina, 34 years old. “8 months ago my father was diagnosed with Stage 3 Peripheral Lung Cancer. In Russia, they refused to operate, citing metastases and a high risk of complications. We decided to turn to Israeli specialists and chose the Assuta clinic. The operation was carried out successfully, the doctors are just professionals in their field. Additionally, chemotherapy and radiation therapy were completed. After being discharged, the father feels fine, we are being observed by an oncologist at the place of residence.”

Irina, 45 years old. “With peripheral cancer of the right lung, stage 1, I urgently flew to Israel. The diagnosis was confirmed. Radiation therapy was carried out at the Ramat Aviv clinic, after which the tests showed the absence of an oncological process, and computed tomography did not detect a tumor. The operation was not done. Doctors are the most caring. They helped me get back to a fulfilling life."

Metastasis

The development of secondary oncofoci is an inevitable process in advanced cancer. Metastases in peripheral lung cancer spread throughout the body in the following ways:

• Lymphogenic. The lung tissue has a dense network of lymphatic vessels. When a tumor grows into their structure, atypical cells disperse through the lymphatic system.
• Hematogenous. Dissimilation of metastases occurs throughout the body. First of all, the adrenal glands are affected, then the bones of the skull and chest, the brain and liver.
• Contact. The tumor is implanted in nearby tissues - usually this process begins with the pleural cavity.

Complications

With an advanced degree of lung carcinoma of a peripheral nature, the consequences of the disease are metastases that spread to the intraorgan structures of the body. Their presence aggravates the prognosis for survival, the stage of oncology becomes inoperable, and the death of the patient is considered a further complication.

The immediate consequences of the oncoprocess in the respiratory system are bronchial obstruction, pneumonia, pulmonary hemorrhage, atelectasis, tumor decay with intoxication of the body. All this negatively affects the patient's well-being and requires comprehensive medical care.

relapse

According to statistics, approximately 75% of malignant tumors relapse within the next 5 years after the end of primary treatment. The most risky are relapses in the coming months - against their background, a person can live up to one year. If the recurrence of cancer does not occur within 5 years, the probability of secondary development of the tumor, according to oncologists, is reduced to the minimum values, the dangerous period has passed.

With peripheral lung damage, the recurrence of the malignant process is extremely aggressive and treatment is successful only at an early stage of the disease. Unfortunately, in other cases, the prognosis for how long the patient will live is extremely unfavorable, since the tumor is practically insensitive to repeated chemotherapy and radiation therapy, and surgical intervention is often contraindicated in this situation.

Forecast (how long live)

Figures regarding survival in peripheral lung cancer vary depending on the classification of the histological structure of the tumor. In the following table, we present the average prognosis criteria for all cancer patients with this diagnosis.

Prevention

It is possible to prevent the development of peripheral lung cancer with the help of timely and adequate treatment of infectious and inflammatory processes in the bronchi in order to prevent their transition to a chronic form. In addition, it is extremely important to give up tobacco addiction, use personal protective equipment (respirators, masks, etc.) when working in hazardous industries and strengthen the immune system.

The main problem of oncology today is still the late detection of malignant processes in the body. Therefore, to preserve the health and life of a person, his own attentive attitude to changes in well-being will help - only thanks to this, it is possible to detect the disease in time and successfully treat it.

Are you interested in modern treatment in Israel?