Internal illnesses. Lung cancer (lecture notes)

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Internal illnesses. Lung cancer (lecture notes)

Lecture notes, cheat sheets

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LECTURE No. 32. Lung cancer

Lung cancer is common, ranging from 20 to 150 cases per 100 population. It mainly affects men aged 000-40 years.

Etiology. The etiology is not known.

The following factors contribute to the occurrence of lung cancer: exposure to carcinogens (nickel, cobalt, iron), inhalation of dust in the mining industry, aromatic substances of products of incomplete combustion of fuel in automobile engines, exposure to tobacco smoke, its passive inhalation, chronic inflammatory processes in the lungs, aggravated heredity , immunodeficiency states.

Pathogenesis. There is an exophytic-endobronchial lesion of the glandular epithelium of large bronchi (1st, 2nd, less often 3rd order), passes to the lung tissue (more often on the right, with localization in the upper lobes, less often in the lower and middle lobes), mediastinal organs, regional lymph nodes. The lumen of the bronchus closes, there is a violation of its patency (obstruction of the bronchus). The corresponding lobe of the lung decreases, the mediastinal organs shift towards the lesion. A secondary inflammatory process develops in the affected area, there is a destruction of pulmonary blood vessels with the development of hemorrhage and extrapulmonary metastasis with damage to the liver, bone marrow, and bone marrow.

Clinic. The main manifestations of lung cancer are as follows: cough associated with the development of reactive bronchitis, then atelectasis of the lungs, perifocal pneumonia, collapse of the lung tissue, the nature of the cough is paroxysmal, pertussis-like, at first dry, later with mucopurulent sputum, mixed with blood (clots, pulmonary hemorrhage) . There is pain in the chest from the damaged side, the intensity of pain increases with the germination of the tumor in the chest wall, the defeat of the ribs, vertebrae with metastases. Shortness of breath increases gradually, is noted with the development of atelectasis of the lungs, massive effusion in the pleura, compression of the mediastinal organs. An increase in body temperature is noted, associated with the inflammatory process, cancer intoxication, and the development of complications. Weakness, sweating, fatigue, weight loss, retraction of the chest wall on the side of the lesion develop.

Percussion is determined by the dullness of the sound over the lesion. Weakened vesicular breathing is auscultated, in the presence of pleural effusion - pleural friction rub.

Additional diagnostic study. A general blood test is performed, in which anemia, neutrophilic leukocytosis with a shift to the left, and an increase in ESR are noted. An immunological blood test is also carried out (an immunodeficiency state, a decrease in the activity of all parts of the immune response), a functional study of the lungs (a decrease in volume and speed indicators), a sputum examination (cytology), an x-ray examination (variability of changes).

With central cancer of the upper lobe and middle lobe bronchi, a darkening of the entire lobe or segment develops with a decrease in the volume of the lobe of the lung. With cancer of the main bronchus, its stenosis appears with the development of hypoectasis, then atelectasis of the entire lobe of the lung with a shift of the mediastinum to the diseased side. Infiltration of the lobe of the lung with the development of perifocal pneumonia refers to a far advanced process with decay, the development of metastases, and secondary bronchiectasis.

With peripheral lung cancer there is a dense rounded shadow with a diameter of 1-5 cm, more often in the upper lobes. Computed tomography is performed (to clarify the location and size of the tumor), diagnostic bronchoscopy (morphological characteristics of the tumor: endobronchial, endophytic or exophytic growth, biopsy sampling).

Complications. Complications of lung cancer are: broncho-obstruction, cor pulmonale, bleeding, metastasis.

Differential diagnostics. Should be carried out with pneumonia, lung abscess, pulmonary tuberculosis, benign lung tumors (lipoma, bronchus chondroma, sclerosing hemangioma, hemarthroma, teratoma), echinococcosis of the lungs, lymphogranulomatosis.

Flow. Rapid progression.

Forecast. Adverse.

Treatment. Shown early surgical treatment, radiation therapy, chemotherapy, symptomatic treatment of complications.

Prevention. Prevention is aimed at reducing dustiness, air pollution, combating occupational hazards, combating smoking, and effective treatment of pneumonia.

Author: Myshkina A.A.

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