Internal illnesses. Lung cancer (most important)

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Internal illnesses. Lung cancer (most important)

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37. LUNG CANCER

Lung cancer is common. It mainly affects men aged 40-60 years.

Etiology. The etiology is not known.

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

Pathogenesis. Exophytic-endobronchial damage to the glandular epithelium of large bronchi occurs (1st, 2nd, less often 3rd order), then passes to the lung tissue (usually on the right, with localization in the upper lobes, less often in the lower and middle lobes), mediastinal organs , regional lymph nodes. The corresponding proportion of the lung decreases, and the mediastinal organs shift towards the lesion. A secondary inflammatory process develops in the affected area. Extrapulmonary metastasis with damage to the liver, bone marrow, and bone marrow.

Clinic. Main manifestations: cough (associated with the development of reactive bronchitis, then pulmonary atelectasis, perifocal pneumonia, collapse of lung tissue), the nature of the cough is paroxysmal, whooping cough, initially dry, later with mucopurulent sputum, mixed with blood (clots, pulmonary hemorrhage). There is pain in the chest on the damaged side, the intensity of the pain increases as the tumor grows into the chest wall, the ribs and vertebrae are affected by metastases. Dyspnea increases gradually and is noted with the development of pulmonary atelectasis, massive effusion in the pleura, and compression of the mediastinal organs. There is an increase in body temperature (inflammatory process, cancer intoxication, development of complications). Weakness, sweating, fatigue, weight loss, and retraction of the chest wall on the affected side develop.

Percussion dullness of sound over the lesion. Auscultatory weakened vesicular breathing, in the presence of pleural effusion - pleural friction rub.

Diagnostic research. A general blood test is performed (anemia, neutrophilic leukocytosis with a shift to the left, an increase in ESR).

An immunological blood test is 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), and a sputum examination (cytology).

X-ray examination: with central cancer of the upper lobe and middle lobe bronchi, 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 a shift of the mediastinum to the diseased side. With peripheral lung cancer there is a dense rounded shadow with a diameter of 1-5 cm, more often in the upper lobes.

Treatment. Early surgical treatment, radiation therapy, chemotherapy, symptomatic treatment of complications.

Flow. Rapid progression.

Forecast. Adverse.

Prevention. Reducing dust, air pollution, combating occupational hazards, combating smoking, effective treatment of pneumonia.

Author: Myshkina A.K.

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