Lung cancer stage 5 cm. Lung cancer: signs, symptoms, stages and treatment. The Importance of Proper Staging of Lung Cancer

This is due to the asymptomatic course of the disease and inattentive attitude to one's health. But only stages 1 and 2 of lung cancer are amenable to the main methods of treatment and have a favorable prognosis. Even full recovery is possible.

Stages of lung cancer

Determining the stage of cancer, the specialist takes into account the histological characteristics of the tumor. In small cell malignancy, the degree of spread of the tumor to other organs is:

• extensive (a malignant tumor "went" beyond the lung in which it appeared, and "hit" the breast tissue or distant organs).
• latent (the tumor, as such, is not yet in the lung; cancer cells are found in sputum or in the fluid obtained during bronchoscopy);
• the first (the tumor grows in the lung, affecting deep tissues);
• the third (cancer cells are found in nearby organs, the chest wall, diaphragm, vessels or lymph nodes (including in distant parts of the body));
• fourth (cancer cells affect more than one lobe of the lung or another lung; metastasize to distant organs (liver, bones, brain)).

Stage 1 lung cancer: characteristics of the pathology

The size of a malignant tumor in the first stage of cancer is up to three to five centimeters. Cancer cells are concentrated in any one segment of the lung (peripheral cancer) or within the region of the bronchus (central cancer). There are no signs of metastasis. In addition, the malignant tumor has not yet affected the lymph nodes.

Grade 1B (the size of the tumor in the largest diameter is from three to five centimeters; lymph nodes and other parts of the body are not damaged; five-year survival at this stage for non-small cell cancer is from 45 to 60%; for small cell cancer - about 25%).

How to diagnose the first stage of cancer?

Unfortunately, only 15% of patients can recognize the disease at stage 1. Therefore, regular medical examinations should not be neglected. Since the first stage of cancer in many cases is asymptomatic, diagnostic procedures cannot be neglected.

• fluorography of the chest (a mandatory annual event that allows you to see gross pulmonary pathologies);
• bronchoscopy (doctors advise doing this procedure every year to heavy smokers and those who have a history of cancer; the study allows you to visually detect a tumor and take a piece of it for a biopsy);
• sputum analysis (the mucus secreted during coughing is examined; the detection of atypical cells makes it possible to suspect a tumor);
• computed tomography (a spiral helical section is performed to diagnose the tumor). These methods make it possible to suspect lung cancer and give the doctor a reason to prescribe additional, more informative tests.

First stage lung cancer clinic

Most often, the first stage is characterized by an asymptomatic course. The following symptoms are quite rare:

dry cough that occurs reflexively, sometimes hacking;

shortness of breath. The prognosis for stage 1 lung cancer is quite favorable. The main difficulty lies in its detection.

Lung cancer is one of the most common oncological diseases worldwide, including in our country. According to statistics, men are much more likely to suffer from lung cancer than women, especially those whose long-term bad habit is smoking.

Features of cancer of the 1st degree

To determine the stage of cancer, it is necessary to take into account its histology. In small cell carcinoma, the degree of spread of the tumor to other organs and systems can be:

• limited
• extensive. In the first case, cancer cells are localized only in one lung and adjacent tissues. In the second, a malignant tumor extends beyond the lung, in which it was originally formed, and affects distant organs or breast tissues.

Non-small cell lung cancer has six stages of development, each of which has individual characteristics.

• hidden stage. The tumor, as such, has not yet formed in the lung. Cancer cells may be found in sputum or in fluid taken for bronchoscopy.
• Zero stage. Cancer cells are found only in the lining of the lung. At this stage, the patient is diagnosed with carcinoma.
• First stage. The tumor grows throughout the lung, affecting its deep tissues.
• Second stage. The malignant neoplasm metastasizes to the lymph nodes.
• Third stage. Tumor cells are found in neighboring organs, the diaphragm, chest wall, blood vessels, lymph nodes, and in distant parts of the body.
• Fourth stage. The tumor affects more than one lobe of the lung or the second lung, metastasizes to distant organs - the head, brain, liver, bones.

A malignant tumor in the first stage of cancer has a size of 3 to 5 centimeters. If its cells are localized in one segment of the lung, then such a disease is called peripheral cancer, but if within the region of the bronchus, then central cancer. At this stage of the disease, there are no metastases, as well as tumor lesions of the lymph nodes.

Grade 1 A characterized by a maximum tumor size of up to 3 centimeters. The five-year survival rate at this stage of the disease is 60-75% for non-small cell cancer and about 40% for small cell cancer.

Grade 1 B characterized by the largest diameter of the tumor from 3 to 5 centimeters, non-damage of the lymph nodes and other parts of the patient's body. The five-year survival rate at this stage is 45 to 60% for non-small cell cancer and about 25% for small cell cancer.

As practice shows, cancer at the 1st stage is diagnosed only in 15% of patients, since it is asymptomatic. That is why we should not forget about regular medical checks and examinations, especially for those who are at risk. They are primarily smokers.

Tests that can detect lung cancer at stage 1 include:

Lung cancer, by item

- malignant tumors that originate in the mucous membranes and glands of the bronchi and lungs. Cancer cells divide rapidly, increasing the tumor. Without proper treatment, it germinates in the heart, brain, blood vessels, esophagus, spine. The bloodstream carries cancer cells throughout the body, forming new metastases. There are three phases of cancer development:

• Genetic propensity: at least three cases of a similar disease in the family or the presence of a similar diagnosis in a close relative, the presence of several different forms of cancer in one patient.
• Age after 50 years.
• Tuberculosis, bronchitis, pneumonia, scars on the lungs.
• Problems of the endocrine system. Modifiable factors (which can be influenced):
• Smoking is the main cause of lung cancer. When tobacco is burned, 4000 carcinogens are released, covering the bronchial mucosa and burning out living cells. Together with the blood, the poison enters the brain, kidneys, liver. Carcinogens settle in the lungs for the rest of life, covering them with soot. Smoking experience of 10 years or 2 packs of cigarettes a day increases the chance of getting sick by 25 times. At risk and passive smokers: 80% of exhaled smoke goes to them.
• Professional contacts: asbestos-related factories, metallurgical enterprises; cotton, linen and felting mills; contact with poisons (arsenic, nickel, cadmium, chromium) at work; mining (coal, radon); rubber production.
• Bad environment, radioactive contamination. The systematic impact of air polluted by cars and factories on the lungs of the urban population changes the respiratory mucosa.

Classification

There are several types of classification. In Russia, five forms of cancer are distinguished depending on the location of the tumor.

• Central cancer in the lumen of the bronchi. At the first degree, it is not detected on the pictures (masks the heart). The diagnosis may be indicated by indirect signs on x-rays: a decrease in the airiness of the lung or regular local inflammation. All this is combined with a hacking cough with blood, shortness of breath, later - chest pain, fever.
• Peripheral cancer invades the lung array. There is no pain, the diagnosis is determined by x-ray. Patients refuse treatment without realizing that the disease is progressing.
• Options: Cancer of the apex of the lung grows into the vessels and nerves of the shoulder. In such patients, osteochondrosis is treated for a long time, and they get to the oncologist late.
• The cavity form appears after the collapse of the central part due to lack of nutrition. Neoplasms up to 10 cm, they are confused with abscess, cysts, tuberculosis, which complicates the treatment.
• Pneumonia-like cancer is treated with antibiotics. Not getting the desired effect, they end up in oncology. The tumor is distributed diffusely (not a node), occupying most of the lung.
• Atypical forms: brain, liver, bone create metastases in lung cancer, and not the tumor itself.
• The hepatic form is characterized by jaundice, heaviness in the right hypochondrium, deterioration of tests, enlargement of the liver.
• The brain looks like a stroke: the limb does not work, speech is disturbed, the patient loses consciousness, headache, convulsions, bifurcation.
• Bone - pain symptoms in the spine, pelvic region, limbs, fractures without injury. Metastatic neoplasms originate from a tumor of another organ with the ability to grow, paralyzing the work of the organ. Metastases up to 10 cm lead to death from decay products and dysfunction of internal organs.

The primary source - the maternal tumor is not always possible to determine. According to the histological structure (cell type), lung cancer is:
Small cell tumor is the most aggressive tumor, it quickly invades and metastasizes already in the early stages. The frequency of occurrence is 20%. Forecast - 16 months. with non-spread cancer and 6 months. - with widespread. Non-small cell is more common, characterized by relatively slow growth.
There are three types:

• • • squamous cell lung cancer (from squamous lamellar cells with slow growth and low frequency of manifestation of early metastases, with areas of keratinization), prone to necrosis, ulcers, ischemia. 15% survivability.
    • adenocarcinoma develops from glandular cells. It spreads rapidly through the bloodstream. Survival is 20% with palliative care, 80% with surgery.
    • Large cell carcinoma has several varieties, asymptomatic, occurs in 18% of cases. The average survival rate is 15% (depending on the type).

stages

Lung cancer 1st degree.

• • • A tumor up to 3 cm in diameter or a bronchial tumor in one lobe, no metastases in neighboring lymph nodes. Lung cancer grade 2.
    • The tumor in the lung is 3-6 cm, blocks the bronchi, growing into the pleura, causing atelectasis (loss of air). Lung cancer grade 3.
    • A tumor of 6-7 cm passes to neighboring organs, atelectasis of the entire lung, the presence of metastases in neighboring lymph nodes (the root of the lung and mediastinum, supraclavicular zones). Lung cancer grade 4.
    • The tumor grows in the heart, large vessels, fluid appears in the pleural cavity.

Symptoms

Common Symptoms of Lung Cancer

• • • fast weight loss,
    • no appetite,
    • performance drop,
    • sweating,
    • unstable temperature. Specific features:
    • cough, debilitating, for no apparent reason - a companion of bronchial cancer. The color of sputum changes to yellow-green. In a horizontal position, physical exercises, in the cold, coughing attacks become more frequent: a tumor growing in the zone of the bronchial tree irritates the mucous membrane.
    • Blood when coughing is pinkish or scarlet, with clots, but hemoptysis is also a sign of tuberculosis.
    • Shortness of breath due to inflammation of the lungs, recession of a part of the lung due to tumor blockage of the bronchus. With tumors in the large bronchi, there may be a shutdown of the organ.
    • Pain in the chest due to the introduction of cancer into the serous tissue (pleura), sprouting into the bone. At the beginning of the disease, there are no alarms, the appearance of pain indicates an advanced stage. The pain can be given to the arm, neck, back, shoulder, aggravated by coughing.

Diagnostics

Diagnosing lung cancer is not an easy task, because oncology looks like pneumonia, abscesses, tuberculosis. More than half of the tumors are detected too late. For the purpose of prevention, it is necessary to undergo an x-ray annually. If cancer is suspected:

• • • Fluorography to determine tuberculosis, pneumonia, lung tumors. In case of deviations, an x-ray should be taken.
    • X-ray of the lungs more accurately assesses the pathology.
    • Layered x-ray tomography of the problem area - several sections with a focus of the disease in the center.
    • Computed tomography or magnetic resonance imaging with the introduction of contrast on layered sections shows in detail, clarifies the diagnosis according to explicit criteria.
    • Bronchoscopy diagnoses central cancer tumors. You can see the problem and take a biopsy - a piece of affected tissue for analysis.
    • Tumor markers examine the blood for a protein produced only by the tumor. NSE tumor marker is used for small cell carcinoma, SSC, CYFRA markers are used for squamous cell carcinoma and adenocarcinoma, CEA is a universal marker. The diagnostic level is low, it is used after treatment for early detection of metastases.
    • Sputum analysis with a low percentage of probability suggests the presence of a tumor when atypical cells are detected.
    • Thoracoscopy examination through chamber punctures into the pleural cavity. Allows you to take a biopsy and clarify the changes.
    • A biopsy with a computed tomography scanner is used when there is doubt about the diagnosis. The examination should be comprehensive, because cancer is disguised as many diseases. Sometimes they even use diagnostic surgery.

Treatment

Type (surgical, radiological, palliative, chemotherapy) is selected based on the stage of the process, the histological type of the tumor, history). The most reliable method is surgery. With lung cancer of the 1st stage, 70-80%, 2nd stage - 40%, 3rd stage - 15-20% of patients survive the control five-year period. Operation types:

• • • Removal of a lobe of the lung - meets all the principles of treatment.
    • Marginal resection removes only the tumor. Metastases are treated in other ways.
    • Removal of the lung completely (pneumoectomy) - with a tumor of 2 degrees for central cancer, 2-3 degrees - for peripheral.
    • Combined operations - with the removal of part of the neighboring affected organs. Do not recommend surgery for serious concomitant diseases (myocardial infarction, diabetes, kidney and liver failure), if the tumor affects the trachea.

Chemotherapy become more effective with new drugs. Small cell lung cancer responds well to chemotherapy. With a properly selected combination (taking into account sensitivity, 6-8 courses with an interval of 3-4 weeks), the survival time increases by 4 times. Chemotherapy for lung cancer. is carried out in courses and gives a positive result for several years. Non-small cell cancer is resistant to chemotherapy (partial resorption of the tumor - in 10-30% of patients, complete rarely), but modern polychemotherapy raises survival by 35%. Treated with platinum drugs- the most effective, but also the most toxic, and therefore are introduced with a large (up to 4 l) amount of liquid. Possible adverse reactions: nausea, intestinal disorders, cystitis, dermatitis, phlebitis, allergies. The best results are achieved with a combination of chemotherapy and radiotherapy, either simultaneously or sequentially. Radiation therapy uses gamma-ray installations of beta-trons and linear accelerators. The method is designed for inoperable patients of 3-4 degrees. The effect is achieved due to the death of all cells of the primary tumor and metastases. Good results are obtained with small cell carcinoma. With non-small cell irradiation, it is carried out according to a radical program (with contraindications or refusal of surgery) for patients of 1-2 degrees or with a palliative purpose for patients of the 3rd degree. The standard dose for radiation treatment is 60-70 Gy. In 40%, it is possible to achieve a reduction in the oncological process. Palliative care surgery to reduce the impact of the tumor on the affected organs to improve the quality of life effective pain relief, oxygenation (forced oxygenation), treatment of comorbidities, support and care.

Folk methods used exclusively for pain relief or after radiation and only in consultation with the doctor. Relying on healers and herbalists with such a serious diagnosis increases the already high risk of death.

Forecast

The prognosis for lung cancer is poor. Without special treatment, 90% of patients die within 2 years. The prognosis determines the degree and histological structure. The table presents data on the survival of cancer patients for 5 years.

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A common cause of death in cancer patients is stage 4 lung cancer. This diagnosis indicates the presence of distant metastases, invasion of large vessels, the heart and other structures by a malignant tumor. Therapeutic methods, the life span of patients depend on various factors that must be taken into account when planning a treatment regimen.

ICD-10 code

According to the international classifier of diseases, lung cancer is encrypted without taking into account the stage. Anatomical location matters:

• C34.1 - upper lobe of the lung, uvula of the left lung;
• C34.2 - average share;
• C34.3 - lower share;
• C34.8 - a lesion that extends beyond the lung.

With multiple lesions, the diagnosis is supplemented with codes indicating the localization of other formations.

Classification according to the international TNM system

According to the international TNM system, stage 4 lung cancer is classified depending on the size of the tumor and the presence of distant metastases. It could be:

• Т(1–4)N(0-3)М1. The size of the tumor and the involvement of regional lymph nodes do not matter, there are distant metastases.
• T4N(0-3)M(0-1). T4 means that the tumor has grown into the mediastinum, heart, large vessels, esophagus, trachea, spine, or multiple lung lesions. The pleural exudate contains malignant cells.

In the presence of distant metastases, the category M is supplemented with the symbols:

• pul - lungs;
• oss - bones;
• hep, liver;
• bra - brain;
• lym - lymph nodes;
• mar - bone marrow;
• ple - pleura;
• per - peritoneum;
• adr - adrenal glands;
• ski - leather;
• oth - others.

The prognosis is disappointing. Due to distant metastases, damage to the heart, large vessels, most treatments are contraindicated or ineffective.

Causes and risk group

A third of patients are initially diagnosed with stage III–IV of the disease. This is due to the rapid, aggressive growth of the tumor, the scarcity of clinical signs of early lung cancer. The number of sick people is increasing every year. Pathology occurs due to:

• smoking. This is the main reason. Not only smokers suffer, but also those who are forced to inhale tobacco smoke.
• Professional hazards. Workers in the metallurgical, aluminum, gas, mining, textile, and shoe industries get sick. High risk for miners, metallurgists, welders.
• Air pollution by radioactive and chemical carcinogens. Therefore, the incidence among residents of industrial regions is much higher.

If these factors are minimized, there will be much fewer cases. It is impossible to completely eliminate them, since the appearance of pathology is facilitated by:

• heredity;
• chronic inflammatory lung diseases;
• age over 45 years.

Unfortunately, stage 4 lung cancer is virtually untreatable. For early diagnosis, a thorough examination of patients at risk is necessary.

To detect early malignant lung damage, a chest x-ray is done every six months. Pictures in direct and lateral projection are stored in fluorotheques for comparison of past results in order to detect pathological changes in time. It is expensive and impractical to undergo a full-fledged examination for all categories of the population. Therefore, risk groups are formed. It includes:

• patients over 45 years of age with a long history of smoking;
• suffering from chronic pathologies of the lungs, bronchi;
• employees of hazardous industrial enterprises, with occupational hazards;
• patients with a family history of lung cancer, primary multiple neoplasia.

They are under constant supervision. If the necessary diagnostic procedures are carried out in a timely manner, then the disease is detected at an early stage, and not in cases where conservative treatment is ineffective, and surgical is contraindicated.

Symptoms

Patients in the last stage of the disease manifest various symptoms. They arise due to damage to the respiratory system, tumor invasion, and the development of metastases. For lung cancer (especially small cell) paraneoplastic syndromes are characteristic.

Signs of defeat:

• persistent cough (smokers should pay attention to the change in its nature);
• coughing up mucopurulent sputum (at the terminal stage it is streaked with blood or in the form of "raspberry jelly"), hemoptysis;
• dyspnea;
• chest pain;
• recurrent pneumonia (cancer patients are susceptible to infectious, contagious diseases due to weakened immunity).

Cough in the terminal stage is painful, hacking, worse at night. Its character depends on the localization of the tumor. With the germination of a large bronchus, it is loud. If, as a result of invasion, the lumen of the bronchus narrows, stenosis develops, and the cough becomes painful. It causes various complications:

• dysphonia;
• chest pain;
• rib fractures;
• pneumothorax;
• vomiting;
• involuntary urination;
• bleeding.

Shortness of breath appears due to blockage of the bronchus, switching off the affected lung from the act of breathing.

Chest pain is associated with:

• intense cough (pectoral muscles hurt);
• fracture of the ribs (with their metastatic lesion);
• involvement in the malignant process of the pleura;
• reflex vasospasm;
• germination of a tumor of the nerves;
• associated pneumonitis;
• mediastinal infiltration.

In addition to local symptoms due to the collapse of the tumor, severe intoxication, general signs are added. Patients go to the doctor with complaints about:

• loss of appetite;
• lethargy;
• increased fatigue;
• weight loss.

Patients complain of an increase in body temperature associated with inflammatory processes (recurrent pneumonia, pneumonitis, pleurisy, tuberculosis), tumor decay.

Invasion of carcinoma into the nearest organs is manifested:

• hoarseness of voice;
• dysphagia;
• dysfunction of the shoulder joint;
• pain in the forearm and shoulder;
• superior vena cava syndrome;
• arrhythmia;
• Horner's syndrome (omission of the eyelid, pupillary constriction and other neurological symptoms);
• heart failure.

In lung cancer, more often than in other malignant tumors, paraneoplastic syndromes develop. Neoplasia produce hormonally active substances, which manifests itself:

• Marie-Bamberg syndrome. Osteoarthropathy develops, which is characterized by thickening, sclerosis of long tubular bones, bulb-shaped thickening of the fingers (in the form of drumsticks), joint pain.
• Skin reactions. Dermatitis, pruritus, black acanthosis, keratoderma develop.
• neurological disorders. There is dizziness not associated with metastases, impaired coordination of movement, sensory, motor disorders. Small cell lung cancer is characterized by: Lambert's myasthenia gravis, limbic encephalitis, subacute peripheral sensory neuropathy, chronic intestinal pseudo-obstruction.
• Endocrine-metabolic disorders. Gynecomastia, Itsenko-Cushing's syndrome, hypercalcemia, hypophosphatemia, hyperthyroidism develop.

Stage IV cancer is disseminated. Patients, in addition to local and general symptoms, complain of various pathologies associated with metastases in distant organs.

Signs of the appearance of metastases in distant organs.

Symptoms before death

The manifestations of the disease in patients are intensifying. Causes of death:

• myocardial infarction;
• cachexia;
• suffocation;
• pneumonia;
• failure of other internal organs due to a metastatic lesion.

Sometimes edema, ascites develop, fluid accumulates in the pleural cavity.

The terminal state lasts sequentially. The functions of various organs are gradually impaired. There are 3 degrees of the terminal state:

1. Predagonia. It is manifested by general lethargy, lethargy, lack of pulse in the peripheral arteries (it is palpable only in the carotid and femoral). Respiratory failure is accompanied by severe shortness of breath, the skin is pale or cyanotic.
2. Agony. The pulse is weak even in the central arteries. The patient is in an unconscious state. Pathological breathing, muffled heart tones are heard. This period is very short.
3. clinical death. There is no circulation and respiration. After 45-90 seconds from the onset of clinical death, the pupils dilate, stop responding to light. During this period, the process is sometimes reversible. When carrying out resuscitation within 5-6 minutes (before brain death), the patient can still be brought back to life. In the terminal stage of lung cancer, the likelihood of a reverse process is extremely low.

When the cerebral cortex dies, the process becomes irreversible and biological death occurs. The timing of its onset is purely individual. Patients with stage IV, when treatment is ineffective, die in different ways. Some fade instantly, others suffer for a long time.

Signs of impending death in most cases:

• severe exhaustion;
• loss of appetite;
• despondency;
• apathy;
• lethargy;
• the dying person does not get out of bed (he needs constant care);
• sleeps almost all the time (especially if, due to severe pain, he needs strong narcotic analgesics).

Some patients experience some improvement 1-2 days before death. They are less worried about pain, cough, shortness of breath. And then everything changes dramatically, a state of preagony arises.

The least painful death from a heart attack. The lethal outcome occurs suddenly, a cancer patient may not be bedridden, but lead an active lifestyle.

In other cases, the patient slowly fades away. For a long time he complains of a debilitating cough, constant suffocation, intense pain. Anemia, hypoxia, intoxication, cachexia increase. The patient suffocates or the body temperature rises to a critical point. Sometimes falls into a state of stupor (severe lethargy, stupor, almost sound sleep).

How fast is it developing?

The growth of education is characterized by the number of divisions of atypical cells. To achieve sizes of 1-2 mm, 20 divisions are needed. While the formation is small, it is not clinically manifested. The average period of asymptomatic course is about 7 years. The rate of progression depends on the histological type of tumors:

• Adenocarcinoma. Grows slowly. The tumor doubling period is 180 days. The size of 1 cm reaches in 8 years.
• Squamous cell carcinoma. Low aggressive. The average doubling period for neoplasia is 100 days. Increases to 1 cm in 5 years.
• Small cell. Highly aggressive. The doubling period is 30 days. The tumor reaches 1 cm in diameter in 2–3 years.

Tumor growth rates depend on individual characteristics, exposure to provoking factors, and immune status.

staging

The choice of treatment method and further prognosis depend on the stage of the disease. It is determined by conducting a series of diagnostic procedures. Conventionally, lung cancer is divided into:

• limited;
• common.

The limited stage includes stages I-III, when only one half of the chest is affected.

Advanced cancers are stages III(N3)–IV. The carcinoma extends beyond one half of the chest. N3 means that supraclavicular lymph nodes, contralateral nodes of the lung root are affected.

In the Soviet classification of lung cancer, stage IV includes a malignant process with identified metastases. The size of the tumor is not important. Neoplasia with a diameter of 1 cm (which is almost not clinically manifested) can spread hematogenously.

Some clinicians categorize stage IV as:

• IVA, it corresponds to T4N(3)M0. Although there are no distant metastases, the stage is terminal, since the tumor has grown into vital structures (heart, large vessels). Supraclavicular lymph nodes are affected.
• IVB - T (1-4) N (0-3) M1. It does not matter what size the tumor is, whether there are regional metastases, the main criterion is the secondary lesion of distant organs.

Most oncologists are of the opinion that stage IV is a tumor of any size, but with distant metastases. There is no division into subcategories A, B. No matter how you classify stage IV lung cancer, it means an extremely unfavorable prognosis and a significant limitation in the choice of effective methods of treatment. How long cancer patients live with stage 4 lung cancer depends on the location of the neoplasia, its histological type.

General classification

Choosing the optimal methods of treatment, take into account the location of the tumor, its immunohistochemical features. According to these features, it is classified.

By location:

• Central. Occurs in 75-80% of cases. The tumor develops from the main, intermediate and segmental bronchi.
• Peripheral. Detected in 15-20% of patients. It develops from subsegmental bronchi, bronchioles.
• Atypical. It includes Pancoast cancer (apex of the lung), miliary carcinomatosis, mediastinal cancer.

Malignant tumors are classified according to their histological structure.

All the variety of histological types are combined into 2 groups.

• Small cell (SCLC). This group includes all subspecies of small cell carcinoma. It is highly aggressive, metastasizes rapidly, often relapses after treatment, but it is sensitive to chemoradiotherapy.
• Non-small cell (NSCLC). The group combines various forms (squamous cell, adenocarcinoma, large cell, etc.). They are not as aggressive, but more resistant to chemotherapy.

This division is due to the fact that generally accepted effective methods of treatment are approximately the same for various forms of NSCLC.

Damage to multiple organs at once

Before establishing stage 4 with a detected lesion of distant organs, it is necessary to make sure that the second focus is metastases. Sometimes neoplasias develop in different organs independently of each other. This phenomenon is called "multiple primary malignant tumors" (PMNT).

Tumors associated with lung cancer:

• larynx (72.2%);
• digestive tract (29%);
• genitourinary system (12.9%);
• mammary gland (5.8%).

Neoplasias are found simultaneously or sequentially. They are detected in 0.8–10% of patients with lung carcinoma.

PMZO are:

• synchronous (foci are detected simultaneously or no later than 6 months later);
• metachronous (the second tumor appears six months after the first).

Clinical symptoms are the same as in lung cancer, only signs of pathology of the affected organ are added to them.

In addition to distant organs, the second lung can also be affected. Therefore, it is necessary to undergo frequent chest x-rays, even if several years have passed since the operation. This is due to the fact that patients with lung cancer often experience:

• synchronous tumors (11–45%);
• metachronous (55–89%).

The longer the life expectancy after the radical removal of the first tumor, the higher the likelihood of developing a second cancer. It develops between 6 months and 20 years after primary neoplasia has been treated. Metachronous tumors are asymptomatic. In 80% of patients, they are found incidentally on a chest x-ray.

They arise due to the complex action of various factors:

• influence of carcinogens;
• reduced immunity;
• side effect of radiation treatment;
• chronic lung diseases.

The histological structure of a secondary tumor may differ from the primary one. These are usually combinations:

• squamous cell carcinoma of different differentiation (70.6%);
• squamous and SCLC (47.8%);
• adenocarcinomas with squamous (17.4%).

The treatment regimen depends on the location of the second tumor, its sensitivity to drugs, and the possibility of surgical removal. If both lungs are affected, bilateral surgery is indicated. Tumors can be removed sequentially depending on their histological structure. Risks are carefully assessed before surgery. The probability of death is 10%.

Conduct chemoradiation treatment. The prognosis depends on the immunohistochemical properties of the formations, the individual characteristics of the patient.

Most often, with PMZO, the prognosis is more favorable than with metastases in distant organs.

Metastasis

The main cause of high mortality in lung cancer is intensive metastasis. Metastases spread in the following ways:

• lymphogenous;
• hematogenous;
• implantation.

With lymphogenous spread, bronchopulmonary, tracheobronchial paratracheal nodes are successively affected. The supraclavicular, axillary and lymph nodes of the abdominal cavity are remotely affected.

In distant organs, lung cancer disseminates hematogenously (through the blood vessels). Are affected:

• liver (40-45%);
• bones (30%);
• kidneys (15–20%);
• adrenal glands (13-15%);
• pancreas (4–6%);
• brain (8–10%);
• thyroid gland (6–8%)
• spleen (5%).

With implantation spread, the tumor grows into the pleura, contact transfer of atypical cells occurs. Develops carcinomatosis of the pleura, cancerous pleurisy.

How long cancer patients live with stage 4 lung cancer with metastases depends on the location of the lesions. With secondary foci in the bones, the prognosis is more favorable. Liver metastases do not manifest clinically for a long time, but cause complications leading to death. Small cell carcinoma and undifferentiated tumors spread especially rapidly. Therefore, with these histological variants of neoplasia, examination of the bone marrow, bones, and other diagnostic procedures are mandatory.

Diagnostics

The terminal stage of lung damage is detected in patients by conducting an X-ray examination. It is done during a medical examination or when the patient went to the doctor with complaints characteristic of lung pathology. It is impossible to tell from the picture whether it is cancer and what stage it is. The diagnosis is based on the results of various studies. Spend:

• Visual inspection. IV degree of the disease is visually manifested by pallor of the skin, cyanosis of the skin, swelling of the soft tissues of the trunk, head (kava syndrome), voice change, Horner's symptom, osteoarthropathy, lagging in the act of breathing of one half of the chest.
• Palpation. They reveal an increase in peripheral lymph nodes, liver, pain in various parts of the chest.
• percussion. Determine the atelectasis of the lung, the presence of fluid in the chest cavity.
• auscultation. Wheezing of a stenotic nature, weakened breathing are heard.
• Cytological examination of sputum. Conduct 5-6 studies, identify atypical cells.
• X-ray examination in the anterior and lateral projections. More accurate results are obtained with a CT scan. The procedure is necessary to determine the size of the tumor, the depth of invasion into the nearest structures.
• Bronchological research. The condition of the bronchi, larynx, trachea is assessed, material is taken for histological analysis.
• Angiopulmonography. Studying the vascular bed.
• Videothoracoscopy, thoracotomy. Necessary for histological verification of the diagnosis, determination of the immunohistochemical properties of the tumor.

The main disadvantage of X-ray examination is the late diagnosis of the disease. Tumors define more than 1.5 cm in diameter. In lung cancer, even with such small neoplasias, there may already be metastases. To identify them, appoint:

• Ultrasound of the liver, adrenal glands, pancreas, kidneys, lymph nodes;
• osteoscintigraphy;
• CT, MRI of the brain and spinal cord, abdominal organs;
• single-photon emission CT.

When pleurisy shows thoracoscopy with the study of punctate.

To control the effectiveness of treatment, predict the further course of the disease, patients are tested for tumor markers. They are prescribed depending on the histological structure of the tumor.

Tumor markers in different forms of lung cancer

According to the results of all studies, the histological type of the tumor, the prevalence of the process are determined. These data are necessary for prognosis, choice of treatment methods.

Treatment

Unfortunately, stage 4 lung cancer is an extremely advanced form of the disease that is difficult to respond to specific treatment. Often, intensive complex therapy simply prolongs the patient's suffering for several months. With an unfavorable prognosis, a serious condition of the patient is limited to palliative care.

In isolated cases, it is possible to achieve a positive result. If the patient tolerates intensive treatment well, there is a positive response to chemotherapy, then remission is possible. The patient is prescribed:

• symptomatic treatment;
• intensive courses of chemotherapy;
• radiation treatment.

All these methods are combined, selecting the most effective drugs. Since chemotherapy causes many side effects, an accompanying treatment is prescribed.

symptomatic treatment. To alleviate the patient's condition, reduce clinical manifestations appoint:

• antitussive drugs;
• oxygen therapy (with severe shortness of breath);
• painkillers;
• antibiotics (if the cancer is complicated by pneumonia and other infectious diseases).

The last stage of the disease is accompanied by exhaustion, patients are recommended fortifying drugs, drugs that stimulate appetite.

With anemia, iron preparations are prescribed, and with a pronounced symptom, blood transfusion, blood substitutes.

Severe pain is the main complaint of patients with an advanced form of the disease. What drugs relieve it depends on many factors. For pain relief use:

• NSAIDs (non-steroidal anti-inflammatory drugs);
• weak opioids (Tramal);
• hard drugs (Morphine).

Special analgesics are prescribed by a doctor. Drugs and doses are selected strictly individually.

A patient with stage 4 lung cancer with symptoms before death is best placed in a hospice. This will not be a rejection of a loved one. There is always a medical staff nearby who will provide assistance in a timely manner. The patient can be visited. Some hospices are open for visits around the clock.

Chemotherapy. The effectiveness of the method depends on many factors. Objective improvement after chemotherapy courses is observed in 6-30% of patients. Worse treatable:

• non-small cell cancer;
• highly differentiated tumors;
• metastases in the bones, brain, liver.

Chemotherapy is prescribed depending on the general condition of the patient. The drugs are administered mainly intravenously-drip. The method of chemoembolization is used (at the terminal stage it may be contraindicated). In metastatic pleurisy, the drug is administered intrapleurally after pumping out the fluid.

Appoint:

• cytostatics (Vinblastine, Docetaxel, Cisplatin, Irinotecan, Gemcitabine);
• colony-stimulating factors, immunomodulators (Neupogen, Oprelvekin);
• targeted drugs (Erlotinib, Gefitinib, Trametinib, Crizotinib);
• monoclonal antibodies (pembrolizumab).

Schemes are selected depending on the resistance of the tumor to various groups of drugs. Thanks to the combined use of drugs, it is possible to achieve remission. Unfortunately, in most cases it is temporary. A recurrent tumor is more resistant to those drugs that were previously used.

Radiation treatment. Radiotherapy is used as a palliative treatment (to relieve pain, temporarily reduce the size of the tumor). If there is a positive effect, patients undergo it according to a radical program.

Irradiate a tumor in the lungs, metastases with:

• remote gamma installations;
• linear accelerators;
• brachytherapy (endobronchial radiation).

To increase efficiency, radiomodifiers are used (hyperbaric oxygenation, hyperthermia).

Subtotal irradiation of the body is effective (especially with single metastases in the brain).

Symptomatic radiotherapy is needed when secondary lesions occur in the bones, liver. It does not remove metastases, but significantly reduces pain and reduces their size. Contraindicated in:

• profuse hemoptysis;
• bleeding;
• tumor pleurisy;
• multiple distant metastases;
• myocardial infarction;
• severe angina;
• decompensated pathology of the kidneys, respiratory system, liver, heart.

Radiation therapy is used as an adjunct to drug therapy.

Surgery. In the terminal phase of the disease, surgical removal of the tumor is contraindicated. In isolated cases, with small sizes of neoplasia, non-small cell cancer, removable solitary metastasis, no complications, low risk, resection of the affected lung and secondary lesion can be performed. Treatment is complemented by chemoradiotherapy. This is a very rare case of a favorable prognosis in metastatic lung cancer.

Surgery is acceptable as part of palliative care. It is not aimed at removing the tumor, but at improving the quality of life. When obstructing the bronchus is carried out:

• photodynamic laser therapy;
• laser bronchoscopic photocoagulation of the tumor;
• endoscopic stenting of the bronchi;
• argon plasma recanalization of the bronchial tree.

Appropriate palliative operations are performed for complications caused by metastases in distant organs.

folk methods. In most cases, with lung cancer at the final stage, doctors only make life easier for the patient. Patients use all sorts of folk methods for healing. After undergoing a course of chemoradiotherapy, they drink tinctures, decoctions, the effectiveness of which is doubtful. They are made from:

• wormwood annual;
• hemlock;
• fly agaric;
• ASD fraction 2.

Alternative methods help reduce symptoms. Before using them, it is better to consult with your doctor so as not to harm yourself more. For example, it is undesirable to combine hemlock tincture for stage 4 lung cancer with chemotherapy. It will greatly enhance the toxic effect.

There are medicines recommended by oncologists. Herbal tea will not cure cancer, especially in the terminal phase, but it will have a general strengthening effect. Recommended:

• wormwood bitter (increases appetite);
• chamomile (anti-inflammatory);
• rosehip (diuretic, helps with swelling);
• birch sap (it contains the necessary trace elements);
• echinacea (strengthens the immune system);
• lemon balm, mint, valerian, motherwort (sedatives);
• raspberry leaves, cherry sprigs (reduce symptoms of intoxication).

Nuts, almonds are acceptable (it is sometimes replaced with apricot kernels). They need to be consumed in small quantities (3-4 cores per day), you should not get carried away too much. This food is heavy for the stomach, and in addition to useful substances, almonds and apricot kernels contain harmful ones.

Harmless herbs can worsen a patient's severe condition. Therefore, they can be used only on the recommendation of the attending physician.

Recovery process after treatment

End-stage remission is a rare and happy exception. The patient will take a long time to recover. During this period you need:

• support of relatives and friends;
• balanced diet;
• restorative procedures;
• compliance with the regime of work and rest;
• minimum physical activity.

And most importantly - do not despair and lead a healthy lifestyle. Mandatory follow-up. If necessary, the doctor will refer to spa treatment, physiotherapy. The passage of studies will help to identify a relapse in a timely manner.

relapse

Stage 4 lung cancer often returns after a period of remission. Then the patient needs a new complex treatment. Those schemes that were used earlier lose their effectiveness. To select a therapeutic course, consultations are necessary:

• surgeon
• chemotherapist;
• radiologist.

Treatment is based on the fact that recurrent tumors are often more aggressive.

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

Children. Primary lung cancer is extremely rare in childhood. It manifests itself with typical symptoms of damage to the lungs and distant organs (depending on the location of the metastasis). This tumor is very aggressive, rapidly progressing, and at stage IV, the prognosis is extremely unfavorable.

For treatment, all available methods are used:

• immunotherapy;
• targeted drugs;
• irradiation of lung and solitary metastases.

In children, metastatic lesions of the lungs, sarcomas are more often found. Treatment depends on the type of primary tumor, its sensitivity to various therapeutic effects.

Pregnancy and lactation. The combination of lung cancer and pregnancy is very rare. Nevertheless, 78% of cancer patients are diagnosed with the disease in an advanced stage. In this case, the patient is warned that the prognosis is unfavorable, they are offered a difficult choice between abortion and the start of treatment. When deciding what to do, you need to remember:

• IV stage - lethal disease;
• lung tumors are very aggressive, they spread rapidly;
• there is a risk of placental metastasis;
• in most cases, children are born healthy;
• radiation treatment, chemotherapy can provoke a miscarriage;
• for the fetus, chemoradiotherapy is least harmful at 3–9 months of pregnancy.

The individual characteristics of the patient, the type of tumor, which organs are affected by metastases, how quickly the disease progresses, and many other factors are taken into account.

If lung cancer is detected after childbirth, then complex treatment is immediately started. During this period, the child is weaned. There are many artificial milk mixtures. The baby will not remain hungry, and he always needs his mother.

Advanced age. Lung cancer is a disease of the elderly. In young people, this disease also occurs, but not so often, and lung tumors in this case are much more aggressive. In old age, cancer spreads slowly, but treatment is significantly complicated by concomitant diseases. Many drugs are contraindicated. In extremely neglected forms, they are limited to symptomatic treatment.

Treatment of stage 4 lung cancer in Russia and abroad

Lung cancer of the 4th degree is treated in onco-pulmonological centers. With a common form of the disease, most patients are offered symptomatic treatment, participation in clinical trials of the latest anticancer drugs, and methods of therapy.

Palliative care is provided in hospices, in district medical institutions. Specialized therapy is carried out in large cancer centers. Depending on the prevalence of the process, various methods are combined:

• The primary focus is small, a single metastasis was detected. Carry out complex chemoradiotherapy. If it is effective, it is supplemented with operations. Remove the tumor and solitary metastasis.
• The tumor has grown into large vessels, chest, heart. Distant metastases are either absent or easily removed. Chemoradiation treatment is carried out, then - resection of the tumor. If the chest is damaged, it is removed, alloplasty is done. On large vessels, the heart is operated on if the patient survives it. It is done jointly by vascular, thoracic surgeons, a cardiac surgeon. All identified metastases are removed as soon as possible. The courses of chemoradiotherapy are being carried out again.
• Large tumor, multiple lesions. If the patient is not in extremely serious condition, the disease is fought with aggressive chemotherapy. Prescribe strong drugs with a high toxic effect. Not all patients can tolerate treatment. With a high probability of developing severe complications, they are limited to symptomatic treatment.
• Multiple metastatic lesions, severe condition of the patient. Only palliative care. The patient needs appropriate care. The patient and his relatives need to come to terms with the situation. An oncopsychologist, communication with volunteers will help to rethink what is happening.

The decision on how and where to be treated is made individually. With the rapid progression of cancer, the ineffectiveness of chemoradiation treatment, the patient's serious condition, palliative therapy is sufficient. It will help the patient not so painfully live the last days.

If there is a chance that education is sensitive to pharmaceuticals, radiotherapy, then you need to fight. The main thing is to choose the right clinic. The advanced form of the disease is treated in large cancer centers with a research base (there are tests of treatment methods), with experienced surgeons, chemotherapists, and radiologists.

Treatment in Russia

In district clinics, small towns, there are few opportunities to cure the terminal stage of lung cancer. Seriously ill patients with a poor prognosis receive only palliative care.

In large cancer centers, a thorough diagnosis is carried out, biopsy results are reviewed, secondary foci are re-examined (after all, it can be PMZO, then the treatment is significantly different). Based on the results of the study, a council is assembled, and a treatment strategy is determined. To combat stage IV cancer, apply:

• multicomponent chemotherapy (combines cytotoxins);
• immunotherapy;
• treatment with targeted drugs;
• radiotherapy;
• palliative operations;
• combined surgery.

You can get to a large oncology center in the direction from the district oncology dispensary. For treatment choose clinics with oncothoracic department:

• One of the leading Russian oncology clinics, equipped with modern equipment. Based on the results of a thorough examination, a complex treatment scheme is selected. Depending on the type of tumor, appropriate pharmaceuticals are prescribed. According to indications, operations are performed, palliative care is provided, and various methods of radiotherapy are used.
• City clinical oncological dispensary, St. Petersburg. Individually targeted drugs are selected for treatment, combined with cytostatics and cytotoxins, and appropriate immunotherapy is selected. With the development of drug resistance, a new generation of polytarget drugs is prescribed for the treatment of relapse. They perform palliative and radical operations of varying complexity (from video-assisted minimally invasive interventions to removal of the lung and affected nearby organs).
• State Healthcare Institution "Altai Regional Clinical Oncological Dispensary" (branch of N.N. Blokhin Russian Cancer Research Center of the Russian Academy of Medical Sciences), Barnaul. The department of thoracic surgery performs various types of surgical interventions, palliative and combined resections (surgery on the lung, heart, large vessels, chest). In chemotherapy, antitumor drugs are individually selected, complex treatment regimens are prescribed. According to indications, radiotherapy is additionally recommended.

All hospitals prescribe symptomatic treatment.

In most cases, for residents of Russia, treatment is based on a quota. There are also paid services.

Approximate cost of treatment

Reviews

Evgenia. “I express my deep gratitude to my attending surgeon of the thoracic department of the Altai Regional Clinical Oncology Center and all the medical staff for their attentiveness, care, and individual approach to each patient. Many thanks to the doctor for his hands, sympathetic kind heart. His work is difficult, we are special patients who need constant moral and psychological support. Our doctor comes to the ward several times a day and always takes care of our condition with a smile. After meeting with him, there is hope for recovery.”

Vladimir. “You can live with cancer. I have been living with him for 4 years now. I have 3 primary lesions in the larynx, skin, right lung and metastases. The treatment took place at the Moscow Research Institute of Oncology. Herzen. They performed operations on the lung and larynx. On the skin, the formation was removed with a laser. Had 4 courses of chemotherapy. I lead a normal life. The only thing is to spare no time and money to undergo CT scans of the chest and abdominal organs 2 times a year, so as not to miss a relapse. Be treated only by doctors and follow all their recommendations. Think less about the disease, do not feel sorry for yourself. Life goes on".

Treatment in Germany

In German oncology clinics, patients with end-stage lung cancer are provided with palliative care. There is an opportunity to participate in clinical trials of the latest drugs. With solitary metastases and a small tumor, surgical operations are performed:

• video-assisted endobronchial operations;
• laser removal or cryoablation of metastases;
• radical lung surgery.

Before surgery, a course of chemotherapy is prescribed individually. After conducting studies, the sensitivity of the tumor to drugs is determined and, depending on the results obtained, various drugs are combined. Apply modern methods of radiation therapy with radiomodifications.

If it is not possible to perform an operation without risk for the patient (with multiple metastatic lesions, an unfavorable course of the disease), palliative and psychological care is provided, easing the patient's suffering as much as possible.

Some of the largest clinics in Germany:

• Palliative care is provided to critically ill patients. Painkillers are selected individually. According to the indications, oxygen therapy and other symptomatic treatment are carried out. With a more favorable prognosis, the disease is fought using complex treatment with targeted drugs and immunotherapy.
• University Hospital, Essen. With advanced lung cancer, a comprehensive diagnosis is carried out, then adequate treatment is prescribed. Perform palliative surgery. Assign complex chemotherapy. Complementary to radiotherapy. With a positive result, operations are performed to remove the tumor and solitary metastases. If multiple lesions are detected, chemotherapy is ineffective, targeted and immune drugs are prescribed. Carry out symptomatic treatment.

Many German clinics are recruiting for clinical drug trials. For most patients, this is a good chance, because treatment abroad is expensive.

Approximate cost of treatment

Review

Michael. “Oncology is a terrible test for the patient and his family. Only in such a difficult moment do you realize how much you are loved and appreciated by your loved ones. I am grateful to my son for the fact that, having learned my diagnosis, he did not give up, but insisted on treatment abroad. I went to Essen. The treatment was long and difficult. Repeatedly wanted to give up and stop, but remembered his son and continued to be treated. Now everything is fine with me, I am nursing my granddaughter, and I am glad that I went to Germany.”

Treatment of stage 4 lung cancer in Israel

The clinics have modern diagnostic equipment. Patients with advanced cancer are diagnosed immediately. Then prescribe complex treatment:

• chemotherapy (targeted, immune drugs, cytotoxins);
• radiation treatment;
• various types of surgical interventions.

Since anticancer drugs are highly toxic, with many side effects, they are additionally prescribed accompanying treatment.

In case of damage to large vessels, heart, chest with solitary metastasis, the patient feels well, an appropriate combined operation is recommended. Minimally invasive methods of surgical intervention are used for symptomatic treatment.

Many clinics are testing new medicines and treatment methods. Appropriate departments for the treatment of advanced cancer are available in centers such as:

• Medical Center. Chaim Shiba, Ramat Gan. The center has a lung cancer laboratory. For the treatment of the terminal stage, the latest developments are used. Conducting clinical trials of targeted drugs, drugs for immunotherapy. Complementary to radiotherapy. Operations are carried out according to indications. There is a palliative care center.
• Herzliya Medical Center, Herzliya. The clinic is private. One of the main areas of activity is cardiac surgery. Here, surgeries are performed for advanced lung cancer, when the tumor has invaded large vessels, the heart. In the oncology department, they are treated with targeted drugs. Carry out palliative and radical irradiation. Assign symptomatic therapy.
• Medical Center "Migdal Medical", Tel Aviv. It was created on the basis of the Assuta clinic and is equipped with modern diagnostic technologies. Combined treatments for advanced cancer are used. They provide palliative care, conduct accompanying and symptomatic treatment.

Lung cancer is the most common localization of the oncological process, characterized by a rather latent course and early appearance of metastases. The incidence of lung cancer depends on the area of ​​residence, the degree of industrialization, climatic and production conditions, gender, age, genetic predisposition and other factors.

What is lung cancer?

Lung cancer is a malignant neoplasm that develops from the glands and mucous membranes of the lung tissue and bronchi. In today's world, lung cancer occupies the top line among all oncological diseases. According to statistics, this oncology affects men eight times more often than women, and it has been noted that the older the age, the higher the incidence rate.

The development of lung cancer varies with tumors of different histological structures. Differentiated squamous cell carcinoma is characterized by a slow course, undifferentiated cancer develops rapidly and gives extensive metastases.

The most malignant course is small cell lung cancer:

• develops secretly and quickly,
• metastasizes early.
• has a poor prognosis.

More often the tumor occurs in the right lung - in 52%, in the left lung - in 48% of cases.

The main group of patients are long-term smokers aged 50 to 80 years, this category accounts for 60-70% of all cases of lung cancer, and mortality is 70-90%.

According to some researchers, the structure of the incidence of various forms of this pathology, depending on age, is as follows:

• up to 45 - 10% of all cases;
• from 46 to 60 years - 52% of cases;
• from 61 to 75 years -38% of cases.

Until recently, lung cancer was considered a predominantly male disease. Currently, there is an increase in the incidence of women and a decrease in the age of initial detection of the disease.

Kinds

Depending on the location of the primary tumor, there are:

• central cancer. It is located in the main and lobar bronchi.
• Aeripheric. This tumor develops from the small bronchi and bronchioles.

Allocate:

1. Small cell carcinoma (less common) is a very aggressive neoplasm, as it can spread throughout the body very quickly, metastasizing to other organs. Typically, small cell cancer occurs in smokers, and by the time of diagnosis, 60% of patients have widespread metastasis.
2. Non-small cell (80-85% of cases) - has a negative prognosis, combines several forms of morphologically similar types of cancer with a similar cell structure.

Anatomical classification:

• central - affects the main, lobar and segmental bronchi;
• peripheral - damage to the epithelium of smaller bronchi, bronchioles and alveolus;
• massive (mixed).

The progression of a neoplasm goes through three stages:

• Biological - the period between the appearance of a neoplasm and the manifestation of the first symptoms.
• Asymptomatic - external signs of the pathological process do not appear at all, they become noticeable only on the x-ray.
• Clinical - the period when noticeable symptoms appear in cancer, which becomes an incentive to rush to the doctor.

Causes

The main causes of lung cancer:

• smoking, including passive smoking (about 90% of all cases);
• contact with carcinogens;
• inhalation of radon and asbestos fibers;
• hereditary predisposition;
• age category over 50 years;
• influence of harmful production factors;
• radioactive exposure;
• the presence of chronic respiratory diseases and endocrine pathologies;
• cicatricial changes in the lungs;
• viral infections;
• air pollution.

The disease develops latently for a long time. The tumor begins to form in the glands, mucosa, but metastases grow very quickly throughout the body. The risk factors for the occurrence of a malignant neoplasm are:

• air pollution;
• smoking;
• viral infections;
• hereditary causes;
• harmful production conditions.

Please note that cancer cells that affect the lungs divide very quickly, spreading the tumor throughout the body and destroying other organs. Therefore, timely diagnosis of the disease is important. The earlier lung cancer is detected and treated, the higher the chance of prolonging the life of the patient.

The earliest signs of lung cancer

The first symptoms of lung cancer often do not have a direct connection with the respiratory system. Patients turn to various specialists of a different profile for a long time, are examined for a long time and, accordingly, receive the wrong treatment.

Signs and symptoms of early lung cancer:

• subfebrile temperature, which is not knocked down by drugs and extremely exhausting the patient (during this period, the body undergoes internal intoxication);
• weakness and fatigue already in the morning;
• skin itching with the development of dermatitis, and, possibly, the appearance of growths on the skin (caused by the allergic action of malignant cells);
• muscle weakness and increased swelling;
• disorders of the central nervous system, in particular, dizziness (up to fainting), impaired coordination of movements or loss of sensitivity.

If these signs appear, be sure to contact a pulmonologist for diagnosis and clarification of the diagnosis.

stages

Faced with lung cancer, many do not know how to determine the stage of the disease. In oncology, when assessing the nature and extent of lung cancer, 4 stages of the development of the disease are classified.

However, the duration of any stage is purely individual for each patient. It depends on the size of the neoplasm and the presence of metastases, as well as on the rate of the course of the disease.

Allocate:

• Stage 1 - the tumor is less than 3 cm. It is located within the boundaries of a segment of the lung or one bronchus. There are no metastases. Symptoms are difficult to discern or none at all.
• 2 - tumor up to 6 cm, located within the boundaries of the segment of the lung or bronchus. Solitary metastases in individual lymph nodes. Symptoms are more pronounced, there is hemoptysis, pain, weakness, loss of appetite.
• 3 - the tumor exceeds 6 cm, penetrates into other parts of the lung or neighboring bronchi. Numerous metastases. Blood in mucopurulent sputum, shortness of breath are added to the symptoms.

How does the last 4 stage of lung cancer manifest itself?

At this stage of lung cancer, the tumor metastasizes to other organs. The five-year survival rate is 1% for small cell cancers and 2 to 15% for non-small cell cancers.

The patient has the following symptoms:

• Constant pain when breathing, which is difficult to live with.
• Chest pain
• Decrease in body weight and appetite
• Blood coagulates slowly, fractures (metastases in the bones) often occur.
• The appearance of bouts of severe coughing, often with sputum, sometimes with blood and pus.
• The appearance of severe pain in the chest, which directly indicates damage to nearby tissues, since there are no pain receptors in the lungs themselves.
• Symptoms of cancer also include heavy breathing and shortness of breath, if the cervical lymph nodes are affected, difficulty in speech is felt.

For small cell lung cancer, which develops rapidly and affects the body in a short time, only 2 stages of development are characteristic:

• limited stage, when cancer cells are localized in one lung and tissues located in close proximity.
• an extensive or extensive stage, when the tumor has metastasized to an area outside the lung and to distant organs.

Symptoms of lung cancer

Clinical manifestations of lung cancer depend on the primary location of the neoplasm. At the initial stage, most often the disease is asymptomatic. In later stages, general and specific signs of cancer may appear.

The early, first symptoms of lung cancer are non-specific and usually not alarming, and include:

• unmotivated fatigue
• loss of appetite
• slight weight loss may occur
• cough
• specific symptoms cough with "rusty" sputum, shortness of breath, hemoptysis join in later stages
• pain syndrome indicates the inclusion in the process of nearby organs and tissues

Specific symptoms of lung cancer:

• Cough - causeless, paroxysmal, debilitating, but not dependent on physical activity, sometimes with greenish sputum, which may indicate the central location of the tumor.
• Dyspnea. Shortness of breath and shortness of breath first appear in case of tension, and with the development of a tumor they disturb the patient even in a supine position.
• Pain in the chest. When the tumor process affects the pleura (the lining of the lung), where the nerve fibers and endings are located, the patient develops excruciating pain in the chest. They are sharp and aching, disturb constantly or depend on breathing and physical exertion, but most often they are located on the side of the affected lung.
• Hemoptysis. Usually, the meeting between the doctor and the patient occurs after blood begins to come out of the mouth and nose with sputum. This symptom suggests that the tumor began to affect the vessels.

Signs of lung cancer in men

• Exhausting, frequent cough is one of the first signs of lung cancer. Subsequently, sputum appears, its color may become greenish-yellow. With physical labor or hypothermia, coughing attacks intensify.
• When breathing, whistling, shortness of breath appears;
• Pain appears in the chest area. It can be considered a sign of oncology in the presence of the first two symptoms.
• When coughing, in addition to sputum, discharge in the form of blood clots may appear.
• Attacks of apathy, increased loss of strength, increased fatigue;
• With normal nutrition, the patient loses weight sharply;
• In the absence of inflammatory processes, colds, body temperature is elevated;
• The voice becomes hoarse, this is due to damage to the nerve of the larynx;
• On the part of the neoplasm, pain in the shoulder may appear;
• Swallowing problems. This is due to tumor damage to the walls of the esophagus and respiratory tract;
• Muscle weakness. Patients, as a rule, do not pay attention to this symptom;
• Dizziness;
• Violation of the heart rhythm.

lung cancer in women

Important signs of lung cancer in women are discomfort in the chest area. They manifest themselves in different intensity depending on the form of the disease. Discomfort becomes especially severe if the intercostal nerves are involved in the pathological process. It is practically intractable and does not leave the patient.

Unpleasant sensations are of the following types:

• stabbing;
• cutting;
• shingles.

Along with common symptoms, there are signs of lung cancer in women:

• changes in voice timbre (hoarseness);
• enlarged lymph nodes;
• swallowing disorders;
• pain in the bones;
• frequent fractures;
• jaundice - with metastasis to the liver.

The presence of one or more signs characteristic of a single category of diseases of the respiratory organs should cause an immediate appeal to a specialist.

A person noticing the above symptoms should report them to the doctor or supplement the information he collects with the following information:

• attitudes towards smoking with pulmonary symptoms;
• the presence of cancer in blood relatives;
• a gradual increase in one of the above symptoms (it is a valuable addition, as it indicates the slow development of the disease, characteristic of oncology);
• an acute increase in symptoms against a background of chronic previous malaise, general weakness, loss of appetite and body weight is also a variant of carcinogenesis.

Diagnostics

How is lung cancer diagnosed? Up to 60% of oncological lesions of the lungs are detected during preventive fluorography, at different stages of development.

• Only 5-15% of patients with lung cancer are registered at stage 1
• For 2 — 20-35%
• At 3 stages -50-75%
• 4 - more than 10%

Diagnosis for suspected lung cancer includes:

• general clinical blood and urine tests;
• biochemical blood test;
• cytological studies of sputum, bronchial lavage, pleural exudate;
• assessment of physical data;
• radiography of the lungs in 2 projections, linear tomography, CT of the lungs;
• bronchoscopy (fibrobronchoscopy);
• pleural puncture (in the presence of effusion);
• diagnostic thoracotomy;
• scaling biopsy of lymph nodes.

Early diagnosis gives hope for a cure. The most reliable way in this case is an x-ray of the lungs. The diagnosis is confirmed by endoscopic bronchography. With its help, you can determine the size and location of the tumor. In addition, a cytological examination - a biopsy - is mandatory.

Treatment of lung cancer

The first thing I want to say is that treatment is carried out only by a doctor! No self-treatment! This is a very important point. After all, the sooner you seek help from a specialist, the more chances for a favorable outcome of the disease.

The choice of a specific treatment strategy depends on many factors:

• Stage of the disease;
• Histological structure of carcinoma;
• The presence of concomitant pathologies;
• A combination of all the above fatcores.

There are several complementary treatments for lung cancer:

• Surgical intervention;
• Radiation therapy;
• Chemotherapy.

Surgery

Surgical intervention is the most effective method, which is shown only at stages 1 and 2. They are divided into the following types:

• Radical - the primary focus of the tumor and regional lymph nodes are subject to removal;
• Palliative - aimed at maintaining the patient's condition.

Chemotherapy

When small cell cancer is detected, the leading method of treatment is chemotherapy, since this form of tumor is most sensitive to conservative methods of treatment. The effectiveness of chemotherapy is quite high and allows you to achieve a good effect for several years.

Chemotherapy is of the following types:

• therapeutic - to reduce metastases;
• adjuvant - used as a preventive measure to prevent relapse;
• inadequate - immediately before surgery to reduce tumors. It also helps to identify the level of sensitivity of cells to drug treatment, and to establish its effectiveness.

Radiation therapy

Another method of treatment is radiation therapy: it is used for non-removable lung tumors of stage 3-4, it allows to achieve good results in small cell cancer, especially in combination with chemotherapy. The standard dosage for radiation treatment is 60-70 Gy.

The use of radiation therapy for lung cancer is considered as a separate method if the patient refuses chemotherapy, and resection is not possible.

Forecast

To make accurate predictions for lung cancer, perhaps, no experienced doctor will undertake. This disease can behave unpredictably, which is largely due to the variety of histological variants of the structure of tumors.

However, the cure of the patient is still possible. Usually, leads to a happy outcome using a combination of surgery and radiation therapy.

How long do people live with lung cancer?

• In the absence of treatment almost 90% of patients after the detection of the disease do not live more than 2-5 years;
• in surgical treatment 30% of patients have a chance to live more than 5 years;
• with a combination of surgery, radiation and chemotherapy the chance to live more than 5 years appears in 40% of patients.

Do not forget about prevention, these include:

• healthy lifestyle: proper nutrition and exercise
• giving up bad habits, especially smoking

Prevention

Prevention of lung cancer includes the following recommendations:

• Giving up bad habits, especially smoking;
• Compliance with a healthy lifestyle: proper nutrition rich in vitamins and daily physical activity, walks in the fresh air.
• Treat bronchial diseases in time so that there is no transition to a chronic form.
• Airing the room, daily wet cleaning of the apartment;
• Contact with harmful chemicals and heavy metals should be kept to a minimum. During work, be sure to use protective equipment: respirators, masks.

If you have the symptoms described in this article, be sure to see a doctor for an accurate diagnosis.

Lung cancer is the most common malignancy in the world, as well as the most common cause of death among oncological pathologies. The International Cancer Agency cites data that each year one million cases of lung cancer are recorded on the planet. At the same time, the statistics of this particular disease are deplorable: six out of ten patients die due to this pathology.

To match the global and Russian statistics of cancer: 12 percent of Russian patients with oncological pathologies suffer from lung cancer. Among fatal cases due to malignant tumors, lung cancer in Russia accounts for 15 percent of cases. The situation, according to experts, is close to critical.
It is also necessary to indicate the fact that lung cancer is more of a male pathology. Among all malignant neoplasms in men, lung cancer accounts for every fourth case, while in women only every twelfth.

The reason for this prevalence of lung cancer lies in the prerequisites for its occurrence. The main one is. According to studies, men and women who smoke are 20 times more likely to develop lung cancer than non-smokers. The smoke of cigarettes contains more than fifty carcinogens, and one of the effects of nicotine is the suppression of the protective functions of the body. Together, this "efficiency" of cigarettes leads to the fact that in several countries, nine out of ten cases of lung cancer in men are provoked by smoking.

In addition, the environmental situation has a huge impact on the risk of this pathology. The presence of radon, asbestos, dust particles in the air increases the risk of developing this cancer at times. These two factors alone indicate that almost everyone is at risk of lung cancer.

Classifications of lung cancer

Modern medicine classifies lung cancer according to many parameters. The most common among them are classifications according to the place of manifestation of the pathology and the stage of development.

Classification of lung cancer by site of manifestation

According to this classification, there are three types of lung cancer:

• central - the main influence of the oncological process falls on large bronchi. A malignant neoplasm over time blocks the lumen of the bronchus, which leads to the collapse of part of the lung;
• peripheral - oncology develops on small peripheral bronchi, and the neoplasm grows outward of the lungs. Because of this, peripheral lung cancer is often referred to as pneumonia-like. This type of pathology is characterized by a long absence of external manifestations - up to five years, because of which its diagnosis occurs already in the later stages;
• the mixed type is quite rare - in five percent of cases. Its development is characterized by the formation of a soft whitish tissue of a malignant nature, which fills the lobe of the lung, and sometimes the entire organ.

Classification of lung cancer by stage of development

This classification is based on the degree of development of the tumor or tumors. There are mainly four stages of pathology, but there are also more detailed schemes in which the development of lung cancer is divided into six stages:

• Zero stage. The earliest, in most cases, asymptomatic form of the disease. Carcinoma due to its small size is poorly visible even on fluorography, there is no damage to the lymph nodes.
• First stage. The tumor at this stage of pathology development does not exceed three centimeters in size. The pleura and lymph nodes at the first stage are not yet involved in the pathological process. Diagnosis of lung cancer at this stage is considered early and allows for favorable treatment prognosis. At the same time, the disease is diagnosed at this stage in only ten percent of patients.
• Second stage. The diameter of the tumor is in the range of three to five centimeters, metastases are fixed in the bronchial lymph nodes. Obvious symptoms of pathology begin to appear in most patients. A third of lung cancer cases are detected at this stage.
• Stage 3a. The tumor is more than five centimeters in diameter. The pleura and chest wall are involved in the pathological process. The presence of metastases is fixed in the bronchial and lymph nodes. The manifestation of symptoms of pathology is obvious, more than half of the cases of pathology are detected at this stage. The frequency of a favorable forecast does not exceed 30 percent.
• Stage 3b. A characteristic difference is the involvement in the pathological process of the vessels, esophagus, spine and heart. The size of the tumor is not a clear sign.
• Fourth stage. Metastases spread throughout the body. In the vast majority of cases, the prognosis is poor. The chances of a remission, let alone a full recovery, are virtually nil.

Symptoms of lung cancer

Having dealt with the main classifications of lung cancer, let's move on to the signs of this pathology. The main feature of this disease is its fairly frequent asymptomatic course, especially in the early stages. If this oncology manifests itself, then the symptoms are mostly non-specific and, without a proper clinical examination, they can be mistaken for manifestations of other diseases.

The visual symptoms of pathology, if present, are somewhat different in the early and late stages.

Manifestations of lung cancer in the early stages

Since lung cancer is a disease of the respiratory system, it is manifested by problems with respiratory function. First of all, attention should be attracted by an outwardly causeless dry cough of a chronic nature, which does not stop for several weeks. In combination with them, the disease is often manifested by hoarseness of voice, whistling sounds during breathing, non-systemic pain in the chest. All this leads to a tumor that has arisen, which, with its volume, puts pressure on the recurrent laryngeal nerve.
In addition, at the initial stages of development, lung cancer can manifest itself as a slight, but constant increase in body temperature up to 37.5 °, which leads to chronic fatigue and unreasonable weight loss.
The absence of bright specific symptoms of lung cancer in the early stages is due to the fact that there are no painful nerve endings in the human lungs. And the body practically does not react to the development of neoplasms in this area.

As for the symptoms that can still appear at this stage, even one of them is a reason to see a doctor and do an unscheduled fluorography. It will allow to exclude the presence of a cancerous tumor in the lungs, or to detect it at the stage when the treatment in the vast majority of cases has a positive effect.

Manifestations of lung cancer in the later stages

In the third and fourth stages of development, lung cancer is already manifested by quite vivid symptoms:

• Systemic chest pain. Despite the fact that there are no painful nerve endings in the lungs, pain during pathology at these stages is formed in the pleura - the membrane of the lungs and the walls of the chest cavity. That is, the cancer has already touched this area. In addition, pain can radiate to the shoulder or the outer side of the arm, as the pathology affects the nerve fibers.
• Cough in the late stages of lung cancer from systemic dry, but not causing serious discomfort, turns into excruciating, characteristic attacks and sputum. It is often possible to observe blotches of blood or pus in it. It is the blood in the sputum that is the most dangerous symptom, and with this manifestation, lung cancer of the third and fourth stages is recorded in most cases.
• Quite often, the pathology is manifested by an increase in lymph nodes located in the supraclavicular region. It is they who are among the first to respond to the serious development of lung cancer, although this manifestation is far from typical for all cases.
• In addition to the above three symptoms, in this pathology, in the later stages, signs of early-stage lung cancer also appear: subfebrile temperature, hoarseness, and a constant feeling of fatigue.

Any of the symptoms of the early and late stages, and even more so a complex of two or more manifestations, is a reason for an immediate examination for the presence of malignant neoplasms. Only such an approach will make it possible to detect the pathology as quickly as possible, which will significantly increase the chances of its effective treatment.

Clinical trials for suspected lung cancer

In the material on the manifestations of this oncological pathology, it is impossible not to touch on the topic of a clinical examination for suspected lung cancer. It is prescribed at the slightest probability of the presence of malignant neoplasms and is divided into two stages:

• The first step is to confirm the diagnosis. First of all, it includes fluorography of the chest in two projections, which allows you to determine the presence of a tumor and its location. This research method is the most popular in the diagnosis of lung cancer.
  In addition to radiography, the diagnosis of the disease is carried out using bronchoscopy and transthoracic puncture biopsy. The first method allows you to thoroughly examine the bronchi for the presence of neoplasms, and the second is used in cases where primary diagnosis is not possible, or does not confirm the alleged diagnosis. Puncture biopsy consists in examining the contents of the tumor for its malignancy or benignity. After taking material for research from the tumor, it is sent for cytological analysis.
• The diagnostic stage is carried out when the presence of a cancerous tumor in the lungs is confirmed and it is necessary to determine the stage of the disease. For these purposes, computer and positron emission tomography are used. In addition to being able to determine the stage and type of cancer, these studies are also used to monitor the tumor during therapy. This allows timely adjustment of treatment tactics depending on the results, which is extremely important in the fight against such a complex pathology.

As you know, a malignant tumor develops by rapid cell division. In other words, it grows out of itself. That is why for a long time education is strictly localized and does not give any symptoms. If it is identified and removed immediately, this disease can be completely defeated. Only at a certain stage of its development, lung cancer begins to affect and destroy nearby organs, vessels and systems, to give metastases. In this case, it is already very difficult to defeat the disease, and often it is simply impossible. At each stage of lung cancer, the doctor develops an individual treatment plan for the disease, on which the probability of a complete cure of the patient depends not least. Therefore, it is so important to correctly, and most importantly, timely diagnose and determine the degree of pulmonary oncology. From the article you will find out how many stages of cancer there are and the features of the development of a malignant neoplasm in each of them.

Classification of malignant tumors by stages of growth

Before making a diagnosis of lung cancer and determining its severity, the doctor must conduct an examination that will help determine the exact location of the neoplasm and the degree of its growth (indicated by the numbers I, II, III, IV). Since 1956, doctors began to use the following classification to determine the stage of cancer (relevant only for non-small cell oncology):

• Stage I - a tumor no larger than 3 cm. The nearest lymph nodes are not affected;
• II - a neoplasm with a diameter of 3 cm or more. There are no metastases at all, or there are single ones in the lymph nodes closest to the affected organ;
• III - the size of the neoplasm is 6 cm or more. There are metastases in nearby lymph nodes. Also, the neoplasm left the borders of the lung and sprouted into the organs closest to it;
• IV - a large tumor, there is a significant number of multiple metastases throughout the body.

Over time, they came to the conclusion that it is not very convenient to classify malignant neoplasms in this way. The fact is that the data contained in the above classification are very generalized and are not enough to prescribe effective treatment to the patient.
The classification was finalized and each degree of lung cancer (except the fourth) was divided into subparagraphs - "A" and "B". The letter "A" meant that there were no metastases, "B" that there were. As a result, the classification took the following form:

1 stage:

• 1A - malignant formation does not exceed 3 cm in size. The process of introducing the neoplasm into the tissues of the organ begins. Lymph nodes and bronchi, not yet affected;
• 1B - the cancer grows (3-5 cm). The lymph nodes remain unaffected.

2 stage:

• 2A - the size of the tumor is 5-7 cm, the lymph nodes are not affected. Or the size of the tumor is 5 cm and there are single metastases in the nearest lymph nodes;
• 2B - the tumor is not more than 7 cm in size, is not very far from the lymph nodes. The size is 5 cm, but the damage to the pleura and the membrane of the heart muscle begins.

3 stage:

• 3A - education in size is more than 7 cm, metastases are formed in the lymph nodes of the mediastinum, pleura, diaphragm;
• 3B - the tumor affects the mediastinum, the heart muscle.

4 stage:

With oncology of the 4th degree of severity, irreversible changes occur in the body. Metastases affect almost all organs. This stage of cancer is incurable.

Stages of small cell cancer

The above stages of lung cancer development are relevant only for non-small cell malignant tumors. A small cell malignant tumor is classified differently (this is due to the fact that the cells are much smaller in size and the process of their division, and, accordingly, its growth is much faster):

1. Limited.
2. Extensive.

At a limited stage of development, the neoplasm is located in the zone of the lung in which it was “born”. It is also possible for it to grow into the surrounding space and nearby lymph nodes. On an extensive one, a malignant formation metastasizes to neighboring organs and lymph nodes.

The Importance of Proper Staging of Lung Cancer

Why is it important to correctly stage lung cancer?

The fact is that, thanks to the information provided by the classification of the lungs according to severity, the doctor can predict the course of the development of the disease (knowing the type of tumor, its structure, growth characteristics, the presence or absence of metastasis) and, depending on this, select the correct and effective treatment.

On which, in turn, the prognosis of the outcome of the disease will depend.

Forecast

What is the prognosis for pulmonary oncology? The answer to this question depends on:

• the stage at which cancer treatment was started;
• on the type of tumor;
• from the place of its localization in the body;
• from the physical condition of the patient;
• on the quality of treatment.

People diagnosed with small cell lung cancer have the most disappointing prognosis. The fact is that cancer cells of this type divide very quickly. If the patient is not given proper treatment, he will die approximately 3 months after the detection of a malignant tumor. But it should be borne in mind that it is small cell carcinoma that is most sensitive to chemotherapy and radiation therapy. The surgical method usually does not give the proper result, since at the time of diagnosis, there are already metastases in the body. On average, 5 years after the detection of the disease, only 10% of patients remain alive.

Prognosis for non-small cell cancer (after treatment):

1. At stage 1 lung cancer - 50-60% of people survived for 5 years.
2. At 2, 30-40% of patients survived.
3. At 3 - survival rate is: 10-20%.
4. At the 4th stage of lung cancer, only 5% of patients overcome the 5-year milestone.

If no measures are taken to treat pulmonary oncology, then death will occur in 85-90% of cases within 2 years.