Chemistry after lung removal. Effectiveness of lung cancer treatment with chemotherapy. Drugs and nutrition. When and how is chemotherapy prescribed?

Asthenic syndrome belongs to the group of psychopathological disorders and is characterized by gradual development. Mental illness develops against the background of many chronic diseases. Asthenic disorder is characterized by frequent headaches and dizziness, decreased performance, increased irritability, and drowsiness.

What is asthenic syndrome?

Asthenic condition is a psychopathological disorder in which the patient complains of fatigue, weakness, irritability and other disorders in the functioning of the nervous system. This condition is considered one of the most common, as it develops against the background of many pathologies of internal organs and systems, it develops both in adults and.

Symptoms caused by asthenic syndrome are permanent. Increased fatigue, which is the main symptom of this psychopathological disorder, does not disappear after a long rest, therefore, it requires therapeutic intervention.

This syndrome differs from ordinary fatigue, which is of a short-term nature and occurs against the background of physical and mental overload, malnutrition and other reasons.

Asthenia is diagnosed when its symptoms bother the patient for several months or years.

Reasons for the development of asthenia

In about 45% of patients with asthenia, the causes of its development are due to organic damage to internal organs and systems. The risk group includes people with diseases of the cardiovascular system:

• hypertension of various etiologies;
• ischemic heart disease;
• myocardial infarction;
• carditis;
• arrhythmia.

Asthenic disorder can also be provoked by: deficiency of nutrients supplied to the central nervous system, excessive energy expenditure, metabolic disorders.

Asthenic manifestations are diagnosed against the background of pathologies of the digestive tract:

• dyspeptic disorders;
• pancreaduodenitis;
• peptic ulcer;
• gastroenterocolitis.

The appearance of asthenia is promoted by diseases of the genitourinary system: cystitis, chronic kidney pathologies, glomerulonephritis, pyelonephritis.

Possible causes of asthenia include disorders in the endocrine system caused by hypo- and hyperthyroidism, diabetes mellitus, and diseases of the adrenal glands.

Asthenic depression often develops after childbirth or due to hormonal changes in the body.

Organic reasons also include:

• systemic pathologies;
• allergic reaction;
• oncological diseases;
• congenital diseases of the kidneys, heart, lungs;
• hepatitis of various types;
• tuberculosis;
• meningitis;
• encephalitis;
• SARS;
• autoimmune diseases.

In addition, vegetovascular asthenia is distinguished, which occurs against the background of VVD.

In addition to organic causes, asthenia leads to the cessation of taking a number of drugs (withdrawal syndrome), the refusal of alcohol or cigarettes, severe stress, prolonged and excessive physical exertion.

Asthenic disorder affects people with low intelligence, living in remote settlements or with dementia. In this case, the cause of the psychopathological condition lies in irreversible changes affecting the brain. Vascular diseases (atherosclerosis) also lead to such disorders.

Classification of asthenic syndrome

Depending on the causes of occurrence, functional and somatogenic (somatic) asthenia are distinguished. Both forms of violation occur with approximately the same frequency.

Functional asthenia is temporary and reversible. This form of disorder develops due to psycho-emotional or physical overload, stress, acute infectious diseases.

Somatogenic asthenia occurs as a result of a prolonged course of chronic diseases.

Depending on the characteristics of the asthenic syndrome, its course is divided into:

1. Acute. In fact, this is another name for functional asthenia. It develops under the influence of severe stress or an infectious disease.
2. Chronic. This type of disease is characterized by a long course.

Asthenic disorder is also divided into two types, taking into account both causative factors and features of the clinical picture:

1. Senile. This type of disorder is mainly diagnosed in the elderly. Senile asthenia usually develops as a result of vascular pathologies that cause brain damage and provoke the appearance of dementia.
2. Neurocirculatory. The cause of asthenia is vegetovascular dystonia.

In addition to these types of classifications, asthenia is divided into 2 forms depending on the characteristics of clinical manifestations:

1. Hypersthenic. Characterized by increased irritability. Patients with this form of impairment cannot tolerate strong odors, strong sounds, or bright lights.
2. Hyposthenic. The development of this form of asthenic syndrome is accompanied by a decrease in the body's response to external stimuli. As a result, patients experience drowsiness, lethargy, and a state of apathy.

Severe brain pathologies caused by infection or other causes often cause the development of an organic emotionally labile asthenic disorder. This form of the disorder is characterized by sudden mood swings and emotional incontinence.

Organic brain damage provokes the development of such a form of disorder as encephalosthenic syndrome. This type of disorder is characterized by the following symptoms:

• inability to remember information;
• decrease in working capacity;
• weakening of the will;
• decreased intelligence;
• inability to adapt.

With encephalosthenic syndrome, total dementia is often diagnosed.

To determine how to treat asthenia, it is necessary to establish the cause of its occurrence and it is often possible to identify it by the characteristics of the clinical picture.

Symptoms of asthenia

The symptoms of asthenia are varied. The first signs of asthenia occur during the day. Moreover, the symptoms that develop in the late afternoon are more pronounced.

The main symptom of functional asthenia is severe fatigue. Patients quickly get tired when doing any business, and the previous performance is not restored even after a long rest. People with asthenic disorder note in themselves:

To solve problems, patients have to constantly take short breaks. As a result, against the background of such disorders, asthenic depression develops, which is characterized by the following symptoms:

• decrease in self-esteem;
• constant anxiety;
• anxiety state.

As the asthenic syndrome develops, the symptoms are supplemented by signs of psychoemotional disorders. Their appearance is explained by problems that arise due to a decrease in performance. This leads to patients becoming irritable and tense. Psycho-emotional disorders are characterized by a sharp change in mood, the predominance of optimistic or pessimistic views. The progression of asthenia causes depressive neurosis.

Associated symptoms

The development of a psychopathological disorder in most patients is accompanied by dysfunction of the autonomic system, which manifests itself in the form of the following symptoms:

Asthenia is often accompanied by:

• prolonged headaches;
• decreased libido in men;
• sleep disturbance.

Patients with asthenic syndrome are disturbed by bad dreams. Patients often wake up during the night. After waking up, patients have weakness, which increases in the evening.

With asthenia, an increase in body temperature up to 38 degrees and an increase in peripheral (cervical, axillary and other) lymph nodes is possible.

Neurocirculatory disorder

A neurocirculatory disorder that occurs against the background of dysfunction of the autonomic system is characterized by multiple symptoms. Each sign of a pathological disorder is combined into several syndromes:

1. Cardiac. It is diagnosed on average in 90% of patients with this disease. The development of cardiac syndrome is accompanied by pain sensations that are localized in the chest. At the same time, the appearance of a symptom is not associated with dysfunction of the heart muscle.
2. Sympathicotonic. This syndrome is characterized by the presence of tachycardia, jumps in blood pressure, blanching of the skin and motor excitation.
3. Vagotonic. Has a weak heartbeat. With vagotonic syndrome, low blood pressure is observed, which provokes headaches, dizziness, hyperhidrosis, and intestinal upset.
4. Mental. The syndrome manifests itself in the form of unreasonable bouts of fear and mood swings.
5. Asthenic. Patients with this syndrome react sharply to changing weather conditions and quickly get tired.
6. Respiratory. Patients experience difficulty breathing (feeling short of breath).

For neurocircular asthenia, the appearance of several syndromes at the same time is characteristic.

Symptoms depending on the causative factor

Neurotic disorders that cause asthenic syndrome manifest themselves in the form of increased muscle tone, which is why patients complain of constant weakness.

In vascular pathologies, the brain experiences an acute need for nutrients. Such violations provoke a decrease in muscle tone and slow thinking.

Oncological diseases of the brain and organic damage to its tissues cause:

With organic lesions of the brain, the symptoms are persistent and prolonged.

Similar clinical phenomena occur after CNS injuries. In this case, it is possible to attach clinical manifestations of vegetative disorders. Moreover, the symptoms of VVD become more pronounced during the course of respiratory and other diseases.

The asthenic syndrome that occurs against the background of ARVI manifests itself as a hypersthenic disorder, in which there is increased irritability and nervousness. If the respiratory disease becomes severe, the disorder takes on a hyposthenic form. With this development, there is a gradual decrease in cognitive functions and performance.

Diagnosis of asthenic manifestations

Due to the fact that with asthenic syndrome there are multiple symptoms characteristic of various mental disorders, this nervous pathology is difficult to diagnose.

To accurately determine the disease, the patient is tested, during which it is necessary to answer more than 10 questions. The results of the survey show the presence or absence of symptoms characteristic of asthenia.

Psychopathological disorder must be differentiated from other similar disorders:

• hypochondriacal neurosis;
• hypersomnia;
• depressive neurosis.

In this case, additional research helps to identify the cause. Asthenic syndrome is diagnosed by a series of laboratory tests:

If CNS or VSD is suspected, an MRI of the brain is prescribed. Additional examinations are also carried out to identify violations in the work of other organs.

How to treat asthenia?

Treatment of asthenia is carried out under the condition that other forms of disorders characterized by similar clinical manifestations are excluded. The treatment regimen is selected taking into account the disease that caused the asthenic disorder.

To cure asthenia, the patient must make significant lifestyle adjustments. It is important to avoid stressful situations until full recovery. For this, patients are often prescribed treatment in a sanatorium.

Medications help to get rid of asthenia, the action of which is aimed at eliminating the disease that caused this disorder. Treatment with medicines, depending on the nature of the pathology, is carried out under the supervision of a physician, and it is mandatory if therapy for asthenia is prescribed for VVD.

Medicines are prescribed according to the prescription of a specialist and for treatment at home.

Medical therapy

Drugs are selected taking into account the cause and the nature of the symptoms of the disease. At the initial stage of treatment, drugs are used in the minimum dosage.

Functional asthenia is treated with nootropics:

Nootropics are used for severe cognitive impairment. These medicines are recommended to be supplemented with adaptogens, which include extracts:

• ginseng;
• Rhodiola rosea;
• lemongrass;
• eleutherococcus.

A good result is demonstrated by anti-asthenic drugs with a sedative effect: Novo-Passit, Sedasen.

Asthenic depression, depending on the complexity, is treated with antidepressants or tranquilizers. The first group of drugs includes:

Of the tranquilizers for asthenia, Phenibut, Atarax, and Clonazepam are used. Antidepressants and tranquilizers are allowed to be used only after consulting a doctor.

In case of organic asthenic disorder and other forms of psychopathological condition, antipsychotics (Teralen, Eglonil) and B vitamins are also prescribed.

Regardless of the form of asthenia, symptoms and treatment, a set of measures must be applied for the successful recovery of the patient. Pills do not help if the patient does not make lifestyle adjustments.

Psychotherapeutic treatment

Asthenic disorders are successfully treated through psychotherapeutic therapy. In this case, various methods are used:

1. Influencing the general condition of the patient and eliminating individual manifestations of anxiety-asthenic syndrome. To achieve the desired result, methods of self-hypnosis, hypnosis, auto-training and others are used. Such treatment of asthenic syndrome in adults reduces anxiety and improves the patient's condition.
2. Methods affecting the mechanisms of development of the disorder. Asthenic syndrome is treated with the help of cognitive-behavioral therapy, neuro-linguistic programming.

If necessary, psychotherapeutic techniques are used, through which the factor of the appearance of the disorder is eliminated. This approach allows you to identify the relationship between certain events (for example, conflicts within the family) and the development of asthenia.

Non-drug treatments

With asthenia, treatment should be comprehensive. Already at the initial stage, patients need:

• get rid of bad habits;
• normalize rest and work schedules;
• avoid conflict situations;
• do physical exercise daily.

By following the rules above, you can get rid of such a disorder as asthenic depression.

In addition to the above methods of treatment, physiotherapeutic measures are used:

• sharko shower;
• phototherapy;
• acupuncture;
• massage and others.

Non-drug methods of treatment are unable to fully combat organic asthenic disorder. However, this approach helps to reduce the intensity of symptoms characteristic of this type of psychopathological disorder.

Prevention of asthenic phenomena

Understanding the features of asthenia, what kind of disease it is, helps to independently choose measures to prevent this mental disorder. To avoid its development, it is necessary to treat any diseases in a timely manner.

Asthenic conditions often occur against the background of physical and mental overwork, therefore, for the purpose of prevention, it is recommended to fully rest and sleep at least 7-8 hours a day. If necessary, you can take drugs that strengthen the immune system and tone the nervous system.

Asthenic reactions respond well to treatment with timely seeking help from a doctor. The prolonged development of asthenic syndrome gives complications in the form of neurosis, schizophrenia and chronic depression.

2738

The course of chemotherapy lasts cyclically, for several days. Usually it is prescribed in tablets, administered intravenously, but sometimes it is done on an outpatient basis. After that, doctors give a few days for the patient's body to recover from side effects. At this time, doctors are actively studying the effects of chemotherapy in lung cancer, and then decide whether and how to continue.

In the world there are more than 60 types of drugs for the treatment of cancer. Here are the most used ones, as well as their combinations:

• Carboplantin and paclitaxel;
• Vinoreobin and cyplastin/carboplantin;
• gemcitabine and cyplastin/carboplatin;
• mitomycin, ifosfamide and cisplatin;
• Etopoposit and carboplatin.

The course of chemotherapy for each is selected for each individual, depending on the characteristics of the body and based on the characteristics of the type of cancer.

As soon as the patient has gone all the way to recovery, he is prescribed a fairly strict diet, which is vital to follow. Although in fact, in the vast majority of cases, limited nutrition during chemotherapy is present throughout the entire process. Small meals are also important.

Here is the main list of foods strictly prohibited when eating after chemotherapy:

• Food containing a large amount of sugar or its substitute (sweets, pastries);
• Food with preservatives/additives;
• Alcohol and strong drinks (coffee, cocoa);
• Fatty, fried food;
• Smoked foods (sausage, fish), any marinades are poorly digested.

As for what is possible with nutrition after chemotherapy, the list is very small:

• Chicken eggs;
• Dairy products;
• Peanut butter, almonds, soy and beans;
• Fruits/boiled vegetables: from tomatoes to apricots;
• Various greens;
• Of meat, only poultry and rabbit meat;
• Green tea, herbal tinctures, carefully purified water.

Eating like this during or after chemotherapy for lung cancer certainly has a huge impact on weight. The body is rapidly losing the substances it needs, the person is losing weight. In order to recover and restore body weight to the optimal value at an accelerated pace, doctors recommend focusing on foods containing a large amount of protein. It is also mandatory to add seasonings such as curry, oregano, cinnamon to them, so the patient will return the sensation of taste.

Chemotherapy is used extremely intensively, since in this case metastases quickly spread throughout the body. In the last phase of the disease, a person begins to have difficulty speaking and the ability to swallow, move, puffiness of the neck, chest, head, limbs (superior vena cava syndrome) is formed.

In this case, chemotherapy is the main expensive way to recover from non-small cell cancer, which can also be combined with radiation or radiotherapy.

Two drug lines for stage 4 lung cancer

1. The first line is distinguished by the following feature - treatment is started with a mixture of platinoids, gemcitabine, vinorelbine and several other drugs. Experience has shown that it is in this way, and not by using one drug at a time, that the maximum effect is achieved.
2. The second line is used if oncology is completely indifferent to the above methods of treatment. Then specialists prescribe to patients the same platenoids, but with the addition of Docetaxel or targeted mixtures. These drugs do not have any side effects, since they provide for the absence of toxic effects on the body.

As for the special diet for lung cancer at the last 4th stage , then it does not change.

The dietary menu is strictly observed at any stage, both during treatment and for an individually set time after recovery.

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Malignant neoplasm of bronchi and lung (C34)

Oncology

general information

Short description

Recommended
Expert Council
RSE on REM "Republican Center
health development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 30, 2015
Protocol #14

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

Protocol name: Lung cancer.

Classification

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

HISTOLOGICAL CLASSIFICATION (UD-A):

TNM CLASSIFICATION OF LUNG CANCER (UD-A)

Determination of the spread of the primary tumor (T)

Regional lymph node involvement (N)

Distant metastases (M)

Diagnostics

The list of basic and additional diagnostic measures:
The main (mandatory) diagnostic examinations carried out at the outpatient level:
Collection of complaints and anamnesis;
General physical examination;

Additional diagnostic examinations performed at the outpatient level:


Fibroesophagoscopy;



Computed tomography of the brain;
· Positron emission tomography (PET) + computed tomography of the whole body.

The minimum list of examinations that must be carried out upon referral for planned hospitalization: in accordance with the internal regulations of the hospital, taking into account the current order of the authorized body in the field of healthcare.

The main (mandatory) diagnostic examinations carried out at the inpatient level (in case of emergency hospitalization, diagnostic examinations are carried out that were not performed at the outpatient level):
· General blood analysis;
Biochemical blood test (protein, creatinine, urea, bilirubin, ALT, AST, blood glucose);
· Coagulogram (prothrombin index, fibrinogen, fibrinolytic activity, thrombotest);
· General urine analysis;
X-ray of the chest organs (2 projections);
Computed tomography of the chest and mediastinum;
Fibrobronchoscopy diagnostic;
Ultrasound of supraclavicular, axillary lymph nodes;
· Spirography;
· Electrocardiographic study;
ECHO cardiography (after consultation with a cardiologist for patients aged 50 years and older, as well as patients younger than 50 years with concomitant pathology of the cardiovascular system).

Additional diagnostic examinations performed at the inpatient level (in case of emergency hospitalization, diagnostic examinations not performed at the outpatient level are performed):
· Magnetic resonance imaging of the chest with contrast;
Ultrasound of supraclavicular and cervical lymph nodes;
Complex ultrasound diagnostics (liver, gallbladder, pancreas, spleen, kidneys);
Puncture / aspiration biopsy under ultrasound control;
Fibroesophagoscopy;
Open biopsy of enlarged supraclavicular and cervical lymph nodes (in the presence of enlarged lymph nodes);
· Cytological examination;
· Histological examination.

Diagnostic measures taken at the stage of emergency care: No.

Diagnostic Criteria for Making a Diagnosis
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 on exertion
· weakness
night sweats
subfebrile temperature
weight loss.
Anamnesis: symptoms lung cancer are nonspecific, therefore characteristic of many diseases of the respiratory system. That is why the diagnosis in many cases is not timely. The tumor in the initial stage is asymptomatic due to the absence of pain endings in the lung tissue. When the tumor grows into the bronchus, a cough appears, initially dry, then with light sputum, sometimes with an admixture of blood. There is hypoventilation of the lung segment and then its atelectasis. Sputum becomes purulent, which is accompanied by fever, general malaise, shortness of breath. Cancer pneumonia joins. Cancerous pleurisy, accompanied by pain syndrome, can join cancerous pneumonia. If the tumor sprouts the vagus nerve, hoarseness joins due to paralysis of the vocal muscles. Damage to the phrenic nerve causes paralysis of the diaphragm. Germination of the pericardium is manifested by pain in the region of the heart. The defeat of the tumor or its metastases of the superior vena cava causes a violation of the outflow of blood and lymph from the upper half of the trunk, upper limbs, head and neck. The patient's face becomes puffy, with a cyanotic tinge, veins swell on the neck, arms, and chest.

Physical examination
Decreased breathing on affected side
hoarseness of voice (during the germination of the tumor of the vagus nerve)
puffiness of the face, with a cyanotic tinge, swollen veins on the neck, arms, chest (with tumor invasion of the superior vena cava)

Laboratory research
· Cytological examination(an increase in the size of the cell up to gigantic, a change in the shape and number of intracellular elements, an increase in the size of the nucleus, its contours, a different degree of maturity of the nucleus and other elements of the cell, a change in the number and shape of the nucleoli);
· Histological examination(large polygonal or spike-shaped cells with well-defined cytoplasm, rounded nuclei with clear nucleoli, with mitoses, cells are arranged in the form of cells and strands with or without keratin formation, the presence of tumor emboli in the vessels, the severity of lymphocytic-plasmacytic infiltration, mitotic activity of tumor cells ).

Instrumental Research
X-ray examination
Peripheral cancer is characterized by fuzziness, blurring of the contours of the shadow. Tumor infiltration of the lung tissue leads to the formation of a kind of radiance around the node, which can be detected only in one of the edges of the neoplasm.
In the presence of peripheral lung cancer, a path can be detected that connects the tumor tissue with the shadow of the root, due to either lymphogenous spread of the tumor, or its peribronchial, perivascular growth.
X-ray picture in central cancer - the presence of tumor masses in the region of the root of the lung; hypoventilation of one or more segments of the lung; signs of valvular emphysema of one or more segments of the lung; atelectasis of one or more segments of the lung.
X-ray picture in apical cancer is accompanied by Pancoast's syndrome. It is characterized by the presence of a rounded formation of the lung apex, pleural changes, destruction of the upper ribs and corresponding vertebrae.
Fibrobronchoscopy
The presence of a tumor in the lumen of the bronchus completely or partially obstructing the lumen of the bronchus.

Pproviding for expert advice:
· Consultation with a cardiologist (for patients aged 50 years and older, as well as patients under 50 years of age in the presence of concomitant pathology of the cardiovascular system);
· Consultation of a neuropathologist (for cerebrovascular disorders, including strokes, brain and spinal cord injuries, epilepsy, myasthenia gravis, neuroinfectious diseases, as well as in all cases of loss of consciousness);
· Consultation of a gastroenterologist (in the presence of concomitant pathology of the gastrointestinal tract in history);
· Consultation of a neurosurgeon (in the presence of metastases in the brain, spine);
· Consultation of an endocrinologist (if there is a concomitant pathology of the endocrine organs).
· Consultation of a nephrologist - in the presence of pathology from the urinary system.
· Consultation of a phthisiatrician - in case of suspected pulmonary tuberculosis.

Differential Diagnosis

Treatment abroad

Get treatment in Korea, Israel, Germany, USA

Get advice on medical tourism

Treatment

Treatment Goals:
Elimination of the tumor process;
Achieving stabilization or regression of the tumor process;
Prolongation of the patient's life.

Treatment tactics:

Non-small cell cancer

small cell cancer

III. Second metachronous lung cancer or lung metastases

Method of chemoradiotherapy for small cell lung cancer:

Syndrome of compression of the superior vena cava

Drugs (active substances) used in the treatment

Hospitalization

Indications for hospitalization, indicating the type of hospitalization:

Indications for planned hospitalization:
The presence of a tumor process, verified histologically and/or cytologically. Operable lung cancer (stages I-III).

Indications for emergency hospitalization: No.

Prevention

Preventive actions
The use of drugs that allow you to restore the immune system after antitumor treatment (antioxidants, multivitamin complexes), a complete diet rich in vitamins, proteins, giving up bad habits (smoking, drinking alcohol), preventing viral infections and concomitant diseases, regular preventive examinations by an oncologist, regular diagnostic procedures (radiography of the lungs, ultrasound of the liver, kidneys, lymph nodes of the neck)

Information

Sources and literature

1. Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
   1. References 1. Standards for the treatment of malignant tumors (Russia), Chelyabinsk, 2003. 2. Trakhtenberg A.Kh. Clinical onco-pulmonology. Geomretar, 2000. 3. TNM Classification of malignant tumors. Sobin L.Kh., Gospordarovich M.K., Moscow 2011 4. Neuroendocrine tumors. Guide for doctors. Edited by Martin Caplin, Larry Kvols/ Moscow 2010 5. European Society for Medical Oncology (ESMO) minimum clinical guidelines 6. American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 7th ed. Edge S.B., Byrd D.R., Carducci M.A. et al., eds. New York: Springer; 2009; 7. Guidelines for chemotherapy of neoplastic diseases, edited by N.I. Perevodchikova, V.A. Gorbunova. Moscow 2015 8. The chemotherapy Source Book, Fourth Edition, Michael C. Perry 2008 by Lip-pincot Williams 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

List of protocol developers with qualification data:

1. Karasaev Makhsot Ismagulovich - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", head of the Center for Thoracic Oncology.
2. Baimukhametov Emil Targynovich - Doctor of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", doctor of the Center for Thoracic Oncology.
3. Kim Viktor Borisovich - Doctor of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", head of the Center for Neurooncology.
4. Abdrakhmanov Ramil Zufarovich - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", head of the chemotherapy day hospital.
5. Tabarov Adlet Berikbolovich - clinical pharmacologist, RSE on REM "Hospital of the Medical Center Administration of the President of the Republic of Kazakhstan", head of the department of innovation management.

Statement of conflict of interest: No

Reviewers: Kaydarov Bakhyt Kasenovich - Doctor of Medical Sciences, Professor, Head of the Department of Oncology of the Republican State Enterprise on the REM “S.D. Asfendiyarov";

Indication of the conditions for revising the protocol: 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.

Annex 1
Assessment of the general condition of the patient using the Karnofsky index

Attached files

Attention!

• By self-medicating, you can cause irreparable harm to your health.
• The information posted on the MedElement website and in the mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" cannot and should not replace a face-to-face consultation with a doctor. Be sure to contact medical facilities if you have any diseases or symptoms that bother you.
• The choice of drugs and their dosage should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
• The MedElement website and mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" are exclusively information and reference resources. The information posted on this site should not be used to arbitrarily change the doctor's prescriptions.
• The editors of MedElement are not responsible for any damage to health or material damage resulting from the use of this site.

Today, lung cancer is considered the most common oncological pathology with a high degree of mortality. Previously, this disease was the prerogative of people of the older age group, but now cancer is “younger”. Modern diagnostic methods make it possible to detect the disease at an early stage, which greatly facilitates the treatment process. In lung cancer, an integrated approach is used, which includes chemotherapy, radiation therapy and surgery. Chemotherapy for lung cancer is highly effective and significantly increases the chances of recovery.

What is lung cancer

Every year, up to a million cases of lung cancer are diagnosed worldwide. The statistics regarding a positive prognosis are disappointing - 6 fatal episodes per 10 cases. On the territory of the Russian Federation, this figure is 12% of the total morbidity, while mortality is 15% of all detected cases.

Lung cancer is prevalent predominantly among the male population. Oncologists explain this distribution by the causes that led to the pathological process - smoking.

The classification is based on the localization of the pathological focus:

• central - located in the lumen of the large bronchi in the roots of the lung. As it develops, it leads to complete overlap, as a result, the lung cannot function normally;
• peripheral - an extremely dangerous option, since it occupies the area along the edge of the lung fields, remains “dumb” for a very long time, makes itself felt only with a significant increase in size;
• massive - a combined lesion with both options.

Stages of cancer development

There are 4 main stages in the development of the lung cancer process, while the third is divided into 2 subtypes:

1. Zero. At an early stage, the formation of pathological cells occurs, which are not determined by instrumental methods. Clinical manifestations in the zero stage are not detected.
2. First. The most favorable for the appointment of therapy, since treatment during this period can bring the maximum positive effect. The size of the focus does not exceed three centimeters in maximum length. Reactions of regional lymph nodes are not noted. Cancer is detected at the first stage in only 10%, which determines the importance of annual fluorographic examinations.
3. Second. The size of the tumor node varies in the range from 3 to 5 centimeters, which allows them to be visualized on x-rays. Accompanied by specific complaints - cough, hemoptysis, syndromes from the cardiovascular system, weight loss, increased fatigue.
4. Stage 3a. The size of the tumor increases, which leads to an increase in symptoms. Involvement of lymph nodes of a mediastinum is noted. The favorable prognosis is about 30%.
5. Stage 3b. Metastases appear both in the lung itself and in the vertebrae of the thoracic region, ribs, and sternum. May be accompanied by pathological fractures.
6. Fourth. Multiple foci of dropouts that spread hematogenously. The chances of recovery are minimal, so chemotherapy may often not be prescribed for stage 4 lung cancer. In such a situation resort to symptomatic treatment (palliative).

Based on this division, oncologists select the type of therapy.

Therapeutic measures for lung cancer

Early diagnosis provides a favorable prognosis for cure. For this purpose, a screening method is used - fluorography. If a pathological focus is detected, they are sent for an additional examination - computed tomography. If the fact of cancer according to CT data is confirmed, then the next step is histology in order to determine the type of cells.

Based on the results of all studies, a complex of therapeutic measures is being created. The main methods for lung cancer are surgery, chemotherapy and radiation therapy. It is an integrated approach with the use of all techniques that can give a positive effect.

Surgical treatment of lung cancer

The purpose of the operation is to remove the maximum volume of the tumor node in order to reduce compression on adjacent tissues. To achieve a significant effect, it is always combined with chemotherapy and radiation therapy.

There are several approaches to surgical intervention (laparoscopically, transthoracically), which depend on the type, size and location of the tumor.

Chemotherapy

It is the main treatment for cancer. The mechanism of action of drugs is based on a massive effect on the cellular apparatus of the tumor with its destruction. Depending on the combination with the surgical approach, chemotherapy for lung cancer is of three types:

1. Neoadjuvant, which is prescribed before surgery. Designed to destroy tumor cells, stop metastasis.
2. Adjuvant, used after surgery or radiation therapy for the final elimination of the remaining elements of cancer.
3. Targeted - a high-precision technique based on a targeted effect on the node with inhibition of growth and division. There is also a restriction of the blood supply to the cancer. The technique can be used both as an independent therapy and in combination with other options.

Indications and contraindications for chemotherapy

The conditions for choosing such an approach are:

• localization of the node and the degree of impact on the surrounding tissues;
• the types of cells that formed the tumor;
• the presence of intraorgan and distant metastases;
• lymph node response.

Leukemia, rhabdomyosarcoma, hemoblastosis, chorioncarcinoma allow for a course of chemo for lung cancer.

Before starting treatment, the doctor assesses the risks, expected side effects. A well-designed course of chemotherapy increases the likelihood of a successful cure.

Contraindications for chemotherapy:

• thrombocytopenia;
• infectious diseases in the acute period;
• pregnancy, especially in the first trimester;
• renal, hepatic, heart failure;
• marked exhaustion.

The peculiarity of these contraindications is the possibility of correction. Therefore, the attending physician will initially remove the restrictions, and then begin specific chemotherapy treatment.

Drug Options During Chemotherapy

There are more than 60 options for drugs that are used during chemotherapy. The most common are Cisplatin, Carboplatin, Gemcitabine, Vinorelbine, Paclitaxel and Docetaxel. Most often create combinations of them.

The development of the science of oncology does not stand still; new cytostatic drugs are being created. It is possible that during the course of treatment you may be offered participation in clinical trials. Of course, you have the right to refuse.

Conditions for chemotherapy

Chemistry (cytostatics) for lung cancer is most often administered intravenously in a hospital setting. The doctor selects the regimen and dose, based on the histological appearance of the tumor, the stage of the disease and the individual characteristics of the patient.

Upon completion of the course of chemotherapy, the patient is given a break for recovery for 2 weeks. Then the next course will follow, their number is determined by the protocol of therapy and effectiveness. Repeated conduct is due to the adaptive characteristics of cancer cells to the toxic effects of drugs. To smooth side effects, symptomatic therapy is prescribed.

There is also a tablet option for taking chemotherapy drugs. The advantage is that you can drink them on an outpatient basis.

Side effects

The effectiveness of this method is very high, especially with early detection. A feature of the drugs of the standard scheme is an indiscriminate effect on the cells of the body. Therefore, the consequences of chemotherapy for lung cancer are reflected in all systems:

• hematopoiesis (blood formation);
• violations of the functioning of the gastrointestinal tract in the form of dyspeptic manifestations;
• a massive effect of drugs on all rapidly dividing cells (not just cancer cells) is accompanied by hair loss (alopecia);
• psycho-emotional disorders (depression);
• the addition of secondary infections due to a decrease in the protective functions of the body is not excluded.

It is important to understand that these manifestations are inevitable, they must be taken for granted. On the other hand, they are temporary. Quite often, after completing the courses, all physiological processes return to normal. This period in life must be experienced and in no case should the treatment be stopped.

palliative care

A new direction in the management of patients is palliative chemotherapy for lung cancer. This approach is used for a group of patients to whom all possible methods have been provided, but the process is constantly progressing. It is intended to improve the quality of life of inoperable patients by leveling pain syndromes, correcting the psycho-emotional background.

Radiotherapy

Based on the effect of a beam of gamma rays on the tumor process. At the same time, the death of cancer cells is noted due to cessation of growth and division. The rays affect not only the tumor itself, but also adjacent metastases, which gives a complex effect. The use of radiotherapy is also possible for small cell lung cancer. Recent medical advances in radiotherapy include:

• remote technique, when the impact is carried out using an external (outside the body) source of x-rays;
• high-dose technology, which is based on the introduction into the patient's body of a special source that generates rays.

The latest advancement is the RAPID Arc therapy. The peculiarity is the point impact exclusively on the cancer node, while healthy tissues are not damaged.. It is accompanied by visual control of the manipulation with the ability to adjust the flow intensity and direction angle. The application is limited by the prevalence of the process.

If the cancer goes beyond the lungs, then this technique is not carried out.

conclusions

Lung cancer is a terrible disease with a high mortality rate. It is impossible to cure this disease on your own. Expectant tactics are fraught with an increase in the tumor to the point where the methods of modern medicine cannot help.

Chemotherapy is a recognized and effective method of preventing the further development of oncology. Of course, it has a number of side effects, but the effectiveness successfully covers them.