Lung and pleura
What is cancer of the lung and pleura?
Lung tumors derived from cells lining the mesothelioma help respiratory tract and tumors are also called oskrzelopochodnymi. Their place of origin are the main mesothelioma help mesothelioma help bronchi, the smaller bronchial tubes leading to the lungs or small segments of bronchioles leading to mesothelioma help mesothelioma helpthe alveoli. As fmesothelioma help for the tumors from the large bronchi, we are talking about a centrally located tumors (located in the vicinity of the mesothelioma help mediastinum), and tumors derived from small bronchioles are usually position "peripheral", which is located at the periphery of the lung. For a cancer are caused by the transformation of normal epithelium cells of the respiratory disorder by (most mutations), genes important in cell growth and its divisions. These disorders are most frequently due to the action of carcinogens.
Lung cancer, which is bronchagenic malignant neoplasm of the mesothelioma help respiratory epithelium, a vast majority of lung cancers and is the most common malignancy in mesothelioma help Poland, both in terms of the number of cases (approx. 21 thousand. Per year) and the number of deaths. Less common lung tumors (approx. 1%) are epithelial tumors and lymphomas.
The most common tumor of the pleura (membrane surrounding the serosal space in which the lung is closed) is mesothelioma (mesothelioma). It is a malignant tumor of mesothelial cells and rampant in a diffuse pleural surface. The growth of mesothelioma is characterized by the formation of nodules, over time forming infiltration involving widely infiltrating the pleura and the chest wall and adjacent mediastinal structures. In the course of mesothelioma are often formation of ascites fluid, pleural accumulating and causing discomfort in the form of breathlessness. In Poland appears to be approx. 120 cases of mesothelioma per year.
lung
Risk factors
The most important risk factor for lung cancer is active smoking. Tobacco smoke contains thousands of chemical compounds, of which several dozen are substances with proven potent carcinogenic.
The risk of developing lung cancer is proportional to the length of time smoking, number of cigarettes smoked and the age of starting smoking. In smokers, the risk is higher than in non-smokers, with eg. In one pack of cigarettes a day for more than 30 years increased 20-60-fold in men and 14-20-fold in women.
There is no "safe" amount of calcined tobacco, the risk of lung cancer is even higher at the "occasional smokers" compared with those who never reach for a cigarette.
People who stopped smoking, the risk of lung cancer gradually decreases, and after many years found at approx. Twice as high than non-smokers.
Burning cigarette containing low levels of nicotine associated with similar risk of developing a smoking those with higher levels of nicotine, the use of filters also does not protect against the development of lung cancer.
Passive smoking also is associated with a higher risk of developing lung cancer compared with those not exposed to tobacco smoke. It is estimated that approx. 20-50% of "non-smoking", which sick with lung cancer, the passive smokers.
Other risk factors for lung cancer are far less important in the scale of the population. These include exposure to ionizing radiation (eg. In patients previously treated with radiotherapy to the chest or miners exposed to natural radiation) exposure to asbestos, a carcinogenic chemicals and certain heavy metals (cadmium, lead, nickel, arsenic). It has been proven also increase the risk of lung cancer with long-term exposure to the fumes of coal and liquid fuels.
The main risk factor for mesothelioma is prolonged exposure to dust containing asbestos fibers, once commonly used insulation material used in shipbuilding and electrical engineering.
The role of genetic factors is not yet quite poorly understood. The frequent occurrence of lung cancer in some families is linked with genetically prone to excessive activation of carcinogens contained in tobacco smoke, or too slow removal of these compounds from the body. Inherited is also prone to free DNA repair in respiratory epithelial cells after activation of carcinogens. We conclude that heredity is conditioned primarily special susceptibility to the carcinogenic effects of tobacco. Inheritance is the result polymorphisms (variant population), and many genes there are currently no reliable genetic test to identify the high-risk for lung cancer.
Symptoms, early detection
Tumors of the lung, trachea, pleural and in the very early stages of advancement usually do not cause symptoms, and is sometimes detected in radiological studies performed for other reasons.
The typical symptoms of chest tumors should limit their breath or shortness of breath, chest pain, hemoptysis, or frequent pneumonia. The latter symptom due to the lower permeability of the large bronchi and the tendency to residual secretion which is readily infections.
Tumors located in the upper part of the lung (lung tumors peak) characteristic symptoms are pain radiating to the shoulder of fingers on the same side. In some people the first sign of cancer is causing shortness of breath, fluid in the pleural cavity - it is the most common manifestation of patients with mesothelioma, but also occurs relatively frequently in patients with lung cancer.
A characteristic symptom of tumors located on the left can be hoarseness resulting from damage to the laryngeal nerve. The centrally located tumors may be called. superior vena cava syndrome, manifested by swelling of the head and neck, sometimes the upper limb, and a rich system of veins which indicate on the skin of the chest. All of these features are not unique to tumors of the chest, and may also occur in other diseases, including non-malignant.
Most cancers of the chest runs very aggressively and in some people the first sign of the disease may be metastases. The most common symptoms resulting from metastatic disease should supraclavicular lymphadenopathy, neurological symptoms resulting from brain metastases, bone pain or fractures due to bone metastases or problems arising from the spread to the abdominal organs. Many people are also present in tumor systemic symptoms such as weight loss, loss of appetite or anemia.
For relatively rare symptoms of lung cancer include symptoms resulting from abnormal hormonal activity of the tumor, such as coagulation disorders, neurological or peripheral nerve injury, abnormal levels of electrolytes in the blood serum, skin lesions or gynecomastia (breast enlargement in men).
stages of advancement
The basis for making decisions about the treatment of lung cancer staging, or the extent of disease in the body.
There is currently TNM prepared by the International Association for the Study of Lung Cancer (International Association for the Study of Lung Cancer). Feature T is the extent of the primary tumor (tumor), N feature - the degree of the involvement of regional lymph nodes (nodes), M feature - the presence of distant metastases (metastases). The different categories of TNM classification for lung cancer are shown in Figures 1-9. Depending on the grouping of these categories are four degrees of lung cancer, which it simply means the following clinical situations:
? I ° - tumor confined to the lung parenchyma, nienaciekajacy mediastinal structures and niezajmujacy regional lymph nodes,
? II ° - tumor confined to the lung parenchyma with metastases to lymph nodes lung cavity,
? III ° - tumor invades important mediastinal structures, spine or chest wall or forms metastases to mediastinal lymph nodes or supraclavicular lymph nodes,
? IV ° - spread to the pleural cavity, or to distant organs (usually the brain, liver, adrenal glands, bones and lungs).
In the staging of pleural mesothelioma takes into account the degree of infiltration of the pleura (pleura consists of two plaques), addressing the adjacent anatomical structures (wall of the chest, diaphragm, structure mediastinal) lymph node involvement bay lungs and mediastinal tumor and the presence of distant metastases . Below the simplification presents the classification of degrees of advancement pleural mesothelioma:
? I ° - tumor confined to one pleural plaques,
? II ° - tumor occupying the two pleural plaques within one bag pleural
? III ° - infiltration of the chest wall structures of the mediastinum, diaphragm, and / or cancerous lymph nodes not on the same side of the chest.
? IV ° - lymph node involvement on the opposite side of the chest or distant metastases.
morphological types
Lung carcinomas (epithelial tumors) the lungs divided into the following histological types:
squamous cell carcinoma
It is usually centrally located tumors, showing a strong relationship with many years of smoking. The histological type is seen in about 40-50% of lung cancer patients in our country. Its development is usually preceded by a preneoplastic conditions such as dysplasia (changes in appearance and function) respiratory epithelium.
Adenocarcinoma
This is likely to cut common form of lung cancer, characterized by microscopic examination tendency to form gland-like structures and the presence of mucus. In Poland, an approx. 30% of microscopic diagnosis of lung cancer and its incidence is increasing, likely due to the widespread use of filters in cigarettes. Adenocarcinoma may occur in non-smokers or low exposure to tobacco smoke, often in women, often at the age of 30-40 years.
large cell carcinoma
This is reminiscent of the type of tumor growth in these two types of microscopic, built of large cells and showing characteristics typical of squamous cell carcinomas or adenocarcinomas. It is approx. 5-10% of diagnoses microscopic and can be located both centrally and peripherally.
Due to the similar clinical course and the most similar treatment, these three types are recognized together as small cell lung cancer (NSCLC). Precise histological type of cancer is now a very important part of treatment in patients with lung cancer, since it determines the appropriate choice of systemic therapy.
Small cell cancer
It is a tumor made of small cells with characteristic nuclei. It is characterized by an aggressive clinical course. In Poland, it is about 15% of lung cancer diagnoses. Shows a strong association with smoking.
Other less common types are:
Cancer elements sarcoma
It is relatively rarely diagnosed epithelial tumor (up to 3% of diagnoses) having the characteristics of soft tissue tumors (sarcomas). It is characterized by an aggressive clinical course.
Carcinoid (Karcynoid)
It is a rare cancer, neuroendocrine tumor, typically located in large bronchi or trachea (although there are also circumferential locations), a generally mild (typical carcinoid) or having the ability to metastasize (atypical carcinoid).
Cancers of the minor salivary glands
Is a group of tumors of the minor salivary glands, most often located in the trachea and large bronchi. The clinical course of these tumors varies and depends on the individual characteristics of the construction of the tumor.
cancer indefinite
It is a cancer who do not have the characteristics of morphology and immunohistochemical staining, which would allow classification to one of the above types of microscope. It is less than 10% of microscopic diagnoses of lung cancers.
Pleural mesothelioma is divided into the following histological forms: nablonkowaty, sarcomatoid, and mixed desmoplatyczny. Form miesakowata and mixed characterized by a poor prognosis.
Diagnostics
With the suspicion of lung cancer is essential for proper conduct microscopic diagnosis confirming or excluding the diagnosis of it.
Biopsy of lung tumors usually requires careful planning because of its hard to reach location. The needle biopsy or toothbrush action determines the presence or absence of cancer cells (cytology material), while core needle biopsy or fragmentary allows you to determine a more precise diagnosis based on the image of the tissue.
The most common ways of diagnosis of microscopic lung tumor are:
? biopsy using bronchoscopy (surgery introduce tools for bronchitis, performed under local anesthesia)
? thin biopsy or core needle through the chest wall,
? biopsy of the lymph nodes through the introduction of tools to the mediastinum,
? biopsy of metastases outside the chest.
The tumors located centrally it is also possible to obtain a cytological diagnosis in the study of airway secretions. In the absence of other possibilities microscopic diagnosis is determined in biopsy after surgery to open the chest (thoracotomy).
The most common way to get recognition in cases of pleural mesothelioma is thoracoscopy, endoscopic or pleural cavity. Due to possible difficulties in contrast pleural mesothelioma cancer of the pleura invasive lung to fully recognize be taken representative of a tumor fragment.
The next step in the procedure is to determine the stage of cancer (range of cancer in the body). The basic tests to this purpose are: physical examination (physical), chest X-ray and computed tomography of the chest and abdomen. In some clinical situations, it also carries out others, such as abdominal ultrasound, computed tomography or magnetic resonance imaging of the brain and bone scan. A valuable study of some patients is also positron emission tomography (PET), which consists of imaging analysis of the accumulation of the radioisotope in the body, including in particular the tumor. Imaging studies should be completed in a number of situations, studies evaluating the state of local cancer - bronchoscopy, mediastinoscopy (mediastinal endoscopy downloading located there lymph nodes) or thoracoscopy. During all these procedures, it is possible to download pieces of tissue for microscopic examination to confirm or rule out the seizure by cancer.
Treatment
Strategy for the treatment of lung and trachea depends on three basic factors: the type of cancer, stage and capacity of the patient and his comorbidities. In brief, the choice of treatment following rules apply:
? treatment of cancer in a local or regional stage (eg. Lung cancer in the first-stage III) is carried primarily involving topical treatment (surgery or radiotherapy), sometimes supplemented with chemotherapy.
? cell lung cancer has a very high biological aggressiveness, frequent, distant metastasis, and a relatively high sensitivity to chemotherapy, which plays a leading role in the treatment of this cancer.
? Patients with tumors metastatic (stage IV) should be treated with palliative intent, whose main aim is to prolong life while maintaining its quality. Side effects of the treatment should not significantly impair the quality of life.
NSCLC
The principal method of treating small cell lung cancer in the I, II, and in selected patients with stage III is surgical resection. The scope of surgery is dictated by the size of the tumor and its relationship to critical anatomical structures (large vessels, trachea and bronchi, pericardium, spine and esophagus) and the age of the patient and its functional capacity.
The most common treatment is to remove the lobe of the lung (lobectomy), rarely performed resections to a lesser extent (a segment of lung resection or so. Wedge resection). For small peripheral lung tumors it is possible to perform treatments without wide-open chest and ribs breach of continuity. In justified cases, the extent of tumor resection is used around the lungs - pneumonectomy.
People who are not eligible for surgery because of the general condition, age or comorbidities should be considered radical radiotherapy (radiation therapy using high doses of radiation, the aim of which is to cure the patient). Patients with contraindications to surgery in the first stage it is also possible to use stereotactic radiosurgery, in which a high dose of radiation is administered on a small area in a few fractions with extremely high precision.
Most patients with stage III non-small cell lung cancer should receive combined treatment involving radiation therapy and chemotherapy (in some cases also surgery). Combination therapy involves the use of radiation therapy is administered during the two cycles of chemotherapy (treatment równoczasowe) or chemotherapy and radiotherapy (sequential therapy).
Patients with small cell lung cancer in stage IV should receive palliative treatment involving chemotherapy. The most commonly used cytostatics in the treatment of cancer include platinum agents, antimetabolites, vinca alkaloids and taxanes. The choice of treatment regimen depends on the histologic type of tumor and organ capacity of the patient. An important element of treatment is palliative radiotherapy, typically used to counter symptoms of tumor growth in the chest: hemoptysis, shortness of breath or pain.
Palliative radiotherapy is also used in cases of painful bone metastases, brain metastases or metastases to lymph nodes or invasion of the chest wall.
In cases of malignant pleural effusion in the pleural cavity causing shortness of breath are used puncture the pleura or more drainage of pleural cavity. However, often also pleurodezy treatment, comprising administering irritant agent pleural plaques and constructed to limit the pleural space where fluid could collect. There is also the opportunity to establish a catheter into the pleural cavity of the valve facilitates periodic drop of liquid.
Small cell cancer
Patients with small cell lung cancer should receive chemotherapy, as long as it allows their condition and organ performance. In patients suffering from small cell lung cancer at an early stage applied radiation to the chest area in combination with chemotherapy. After completion of chemotherapy in many apply prophylactic brain irradiation in order to reduce the risk of recurrence at this location. In a very small group of patients with stage I (no lymph node involvement by tumor) can also consider surgical resection, which precedes the treatment with cytostatics. In the event of failure of first line chemotherapy considered for re-treatment with cytostatic agents, the choice of which depends on the capacity of the patient and the time elapsed since the completion of first-line chemotherapy for relapse.
mesothelioma
Treatment of pleural mesothelioma in the I and stage II remains a subject of controversy. In some clinical situations, attempts are being made surgical treatment involving the excision of the pleura with lung (pneumonectomy), or excision of the pleura, leaving the lung parenchyma (pleurektomii / decortication). Surgery performed because of mesothelioma are very extensive and must be part of a multi-disciplinary proceedings - usually associated with chemotherapy and radiotherapy. They are in a very small group of patients and high risk of complications. Their impact on survival remains ambiguous, since there are no studies proving their efficacy well. Treatment of other patients with pleural mesothelioma is palliative in nature and mainly includes chemotherapy. An important element of the procedure is also symptomatic treatment of malignant pleural effusion or palliative radiotherapy. Results of treatment of pleural mesothelioma are unsatisfactory.
after treatment
Rehabilitation
The aim of rehabilitation after the treatment of cancer of the chest is a quick return to fitness of the patient and full independence. After surgery rehabilitation carried out already in the first day, gradually increasing the range of motor function and breathing exercises later. The early and proper rehabilitation reduced pain intensity associated with the intersection of ribs and intercostal nerves during surgery.
Proceedings during and after conservative treatment should include prevention of complications after treatment and helps reduce symptoms.
Important aspects of the after-care to be psychological counseling and early implementation of antidepressant treatment in patients who require such treatment. At cancer centers often they operate patient support group, enabling the exchange of practical experience in the fight against the disease.
Prevention
The most important etiological agent of most cancers chest is active smoking and passive exposure to tobacco smoke. Refrain from smoking or giving up this habit is the most effective way to reduce the risk of developing lung cancer. Giving up tobacco smoking is particularly important in patients being treated for cancer conditioned smoking, as the risk of developing another cancer tytoniozalezny, including lung cancer is especially high.
Neither in Poland nor in the European Union, apart from projects of a scientific nature, not currently a regular screening programs and early detection of lung cancer. Regular performance of classical X-rays of the chest does not reduce mortality from lung cancer. Some hopes are now programs low-dose computed tomography of the chest - in a clinical trial using this method of imaging has been shown to decrease mortality from lung cancer among heavy smokers of tobacco, other studies are currently in progress. Routine implementation of this research in the country, however, remains highly controversial because of the high false-positive rate (lung nodules that are not cancer), as well as the limited availability and high cost. The most important factor limiting mortality from lung cancer remains refrain from smoking or giving up the habit by smokers.
What is cancer of the lung and pleura?
Lung tumors derived from cells lining the mesothelioma help respiratory tract and tumors are also called oskrzelopochodnymi. Their place of origin are the main mesothelioma help mesothelioma help bronchi, the smaller bronchial tubes leading to the lungs or small segments of bronchioles leading to mesothelioma help mesothelioma helpthe alveoli. As fmesothelioma help for the tumors from the large bronchi, we are talking about a centrally located tumors (located in the vicinity of the mesothelioma help mediastinum), and tumors derived from small bronchioles are usually position "peripheral", which is located at the periphery of the lung. For a cancer are caused by the transformation of normal epithelium cells of the respiratory disorder by (most mutations), genes important in cell growth and its divisions. These disorders are most frequently due to the action of carcinogens.
Lung cancer, which is bronchagenic malignant neoplasm of the mesothelioma help respiratory epithelium, a vast majority of lung cancers and is the most common malignancy in mesothelioma help Poland, both in terms of the number of cases (approx. 21 thousand. Per year) and the number of deaths. Less common lung tumors (approx. 1%) are epithelial tumors and lymphomas.
The most common tumor of the pleura (membrane surrounding the serosal space in which the lung is closed) is mesothelioma (mesothelioma). It is a malignant tumor of mesothelial cells and rampant in a diffuse pleural surface. The growth of mesothelioma is characterized by the formation of nodules, over time forming infiltration involving widely infiltrating the pleura and the chest wall and adjacent mediastinal structures. In the course of mesothelioma are often formation of ascites fluid, pleural accumulating and causing discomfort in the form of breathlessness. In Poland appears to be approx. 120 cases of mesothelioma per year.
lung
Risk factors
The most important risk factor for lung cancer is active smoking. Tobacco smoke contains thousands of chemical compounds, of which several dozen are substances with proven potent carcinogenic.
The risk of developing lung cancer is proportional to the length of time smoking, number of cigarettes smoked and the age of starting smoking. In smokers, the risk is higher than in non-smokers, with eg. In one pack of cigarettes a day for more than 30 years increased 20-60-fold in men and 14-20-fold in women.
There is no "safe" amount of calcined tobacco, the risk of lung cancer is even higher at the "occasional smokers" compared with those who never reach for a cigarette.
People who stopped smoking, the risk of lung cancer gradually decreases, and after many years found at approx. Twice as high than non-smokers.
Burning cigarette containing low levels of nicotine associated with similar risk of developing a smoking those with higher levels of nicotine, the use of filters also does not protect against the development of lung cancer.
Passive smoking also is associated with a higher risk of developing lung cancer compared with those not exposed to tobacco smoke. It is estimated that approx. 20-50% of "non-smoking", which sick with lung cancer, the passive smokers.
Other risk factors for lung cancer are far less important in the scale of the population. These include exposure to ionizing radiation (eg. In patients previously treated with radiotherapy to the chest or miners exposed to natural radiation) exposure to asbestos, a carcinogenic chemicals and certain heavy metals (cadmium, lead, nickel, arsenic). It has been proven also increase the risk of lung cancer with long-term exposure to the fumes of coal and liquid fuels.
The main risk factor for mesothelioma is prolonged exposure to dust containing asbestos fibers, once commonly used insulation material used in shipbuilding and electrical engineering.
The role of genetic factors is not yet quite poorly understood. The frequent occurrence of lung cancer in some families is linked with genetically prone to excessive activation of carcinogens contained in tobacco smoke, or too slow removal of these compounds from the body. Inherited is also prone to free DNA repair in respiratory epithelial cells after activation of carcinogens. We conclude that heredity is conditioned primarily special susceptibility to the carcinogenic effects of tobacco. Inheritance is the result polymorphisms (variant population), and many genes there are currently no reliable genetic test to identify the high-risk for lung cancer.
Symptoms, early detection
Tumors of the lung, trachea, pleural and in the very early stages of advancement usually do not cause symptoms, and is sometimes detected in radiological studies performed for other reasons.
The typical symptoms of chest tumors should limit their breath or shortness of breath, chest pain, hemoptysis, or frequent pneumonia. The latter symptom due to the lower permeability of the large bronchi and the tendency to residual secretion which is readily infections.
Tumors located in the upper part of the lung (lung tumors peak) characteristic symptoms are pain radiating to the shoulder of fingers on the same side. In some people the first sign of cancer is causing shortness of breath, fluid in the pleural cavity - it is the most common manifestation of patients with mesothelioma, but also occurs relatively frequently in patients with lung cancer.
A characteristic symptom of tumors located on the left can be hoarseness resulting from damage to the laryngeal nerve. The centrally located tumors may be called. superior vena cava syndrome, manifested by swelling of the head and neck, sometimes the upper limb, and a rich system of veins which indicate on the skin of the chest. All of these features are not unique to tumors of the chest, and may also occur in other diseases, including non-malignant.
Most cancers of the chest runs very aggressively and in some people the first sign of the disease may be metastases. The most common symptoms resulting from metastatic disease should supraclavicular lymphadenopathy, neurological symptoms resulting from brain metastases, bone pain or fractures due to bone metastases or problems arising from the spread to the abdominal organs. Many people are also present in tumor systemic symptoms such as weight loss, loss of appetite or anemia.
For relatively rare symptoms of lung cancer include symptoms resulting from abnormal hormonal activity of the tumor, such as coagulation disorders, neurological or peripheral nerve injury, abnormal levels of electrolytes in the blood serum, skin lesions or gynecomastia (breast enlargement in men).
stages of advancement
The basis for making decisions about the treatment of lung cancer staging, or the extent of disease in the body.
There is currently TNM prepared by the International Association for the Study of Lung Cancer (International Association for the Study of Lung Cancer). Feature T is the extent of the primary tumor (tumor), N feature - the degree of the involvement of regional lymph nodes (nodes), M feature - the presence of distant metastases (metastases). The different categories of TNM classification for lung cancer are shown in Figures 1-9. Depending on the grouping of these categories are four degrees of lung cancer, which it simply means the following clinical situations:
? I ° - tumor confined to the lung parenchyma, nienaciekajacy mediastinal structures and niezajmujacy regional lymph nodes,
? II ° - tumor confined to the lung parenchyma with metastases to lymph nodes lung cavity,
? III ° - tumor invades important mediastinal structures, spine or chest wall or forms metastases to mediastinal lymph nodes or supraclavicular lymph nodes,
? IV ° - spread to the pleural cavity, or to distant organs (usually the brain, liver, adrenal glands, bones and lungs).
In the staging of pleural mesothelioma takes into account the degree of infiltration of the pleura (pleura consists of two plaques), addressing the adjacent anatomical structures (wall of the chest, diaphragm, structure mediastinal) lymph node involvement bay lungs and mediastinal tumor and the presence of distant metastases . Below the simplification presents the classification of degrees of advancement pleural mesothelioma:
? I ° - tumor confined to one pleural plaques,
? II ° - tumor occupying the two pleural plaques within one bag pleural
? III ° - infiltration of the chest wall structures of the mediastinum, diaphragm, and / or cancerous lymph nodes not on the same side of the chest.
? IV ° - lymph node involvement on the opposite side of the chest or distant metastases.
morphological types
Lung carcinomas (epithelial tumors) the lungs divided into the following histological types:
squamous cell carcinoma
It is usually centrally located tumors, showing a strong relationship with many years of smoking. The histological type is seen in about 40-50% of lung cancer patients in our country. Its development is usually preceded by a preneoplastic conditions such as dysplasia (changes in appearance and function) respiratory epithelium.
Adenocarcinoma
This is likely to cut common form of lung cancer, characterized by microscopic examination tendency to form gland-like structures and the presence of mucus. In Poland, an approx. 30% of microscopic diagnosis of lung cancer and its incidence is increasing, likely due to the widespread use of filters in cigarettes. Adenocarcinoma may occur in non-smokers or low exposure to tobacco smoke, often in women, often at the age of 30-40 years.
large cell carcinoma
This is reminiscent of the type of tumor growth in these two types of microscopic, built of large cells and showing characteristics typical of squamous cell carcinomas or adenocarcinomas. It is approx. 5-10% of diagnoses microscopic and can be located both centrally and peripherally.
Due to the similar clinical course and the most similar treatment, these three types are recognized together as small cell lung cancer (NSCLC). Precise histological type of cancer is now a very important part of treatment in patients with lung cancer, since it determines the appropriate choice of systemic therapy.
Small cell cancer
It is a tumor made of small cells with characteristic nuclei. It is characterized by an aggressive clinical course. In Poland, it is about 15% of lung cancer diagnoses. Shows a strong association with smoking.
Other less common types are:
Cancer elements sarcoma
It is relatively rarely diagnosed epithelial tumor (up to 3% of diagnoses) having the characteristics of soft tissue tumors (sarcomas). It is characterized by an aggressive clinical course.
Carcinoid (Karcynoid)
It is a rare cancer, neuroendocrine tumor, typically located in large bronchi or trachea (although there are also circumferential locations), a generally mild (typical carcinoid) or having the ability to metastasize (atypical carcinoid).
Cancers of the minor salivary glands
Is a group of tumors of the minor salivary glands, most often located in the trachea and large bronchi. The clinical course of these tumors varies and depends on the individual characteristics of the construction of the tumor.
cancer indefinite
It is a cancer who do not have the characteristics of morphology and immunohistochemical staining, which would allow classification to one of the above types of microscope. It is less than 10% of microscopic diagnoses of lung cancers.
Pleural mesothelioma is divided into the following histological forms: nablonkowaty, sarcomatoid, and mixed desmoplatyczny. Form miesakowata and mixed characterized by a poor prognosis.
Diagnostics
With the suspicion of lung cancer is essential for proper conduct microscopic diagnosis confirming or excluding the diagnosis of it.
Biopsy of lung tumors usually requires careful planning because of its hard to reach location. The needle biopsy or toothbrush action determines the presence or absence of cancer cells (cytology material), while core needle biopsy or fragmentary allows you to determine a more precise diagnosis based on the image of the tissue.
The most common ways of diagnosis of microscopic lung tumor are:
? biopsy using bronchoscopy (surgery introduce tools for bronchitis, performed under local anesthesia)
? thin biopsy or core needle through the chest wall,
? biopsy of the lymph nodes through the introduction of tools to the mediastinum,
? biopsy of metastases outside the chest.
The tumors located centrally it is also possible to obtain a cytological diagnosis in the study of airway secretions. In the absence of other possibilities microscopic diagnosis is determined in biopsy after surgery to open the chest (thoracotomy).
The most common way to get recognition in cases of pleural mesothelioma is thoracoscopy, endoscopic or pleural cavity. Due to possible difficulties in contrast pleural mesothelioma cancer of the pleura invasive lung to fully recognize be taken representative of a tumor fragment.
The next step in the procedure is to determine the stage of cancer (range of cancer in the body). The basic tests to this purpose are: physical examination (physical), chest X-ray and computed tomography of the chest and abdomen. In some clinical situations, it also carries out others, such as abdominal ultrasound, computed tomography or magnetic resonance imaging of the brain and bone scan. A valuable study of some patients is also positron emission tomography (PET), which consists of imaging analysis of the accumulation of the radioisotope in the body, including in particular the tumor. Imaging studies should be completed in a number of situations, studies evaluating the state of local cancer - bronchoscopy, mediastinoscopy (mediastinal endoscopy downloading located there lymph nodes) or thoracoscopy. During all these procedures, it is possible to download pieces of tissue for microscopic examination to confirm or rule out the seizure by cancer.
Treatment
Strategy for the treatment of lung and trachea depends on three basic factors: the type of cancer, stage and capacity of the patient and his comorbidities. In brief, the choice of treatment following rules apply:
? treatment of cancer in a local or regional stage (eg. Lung cancer in the first-stage III) is carried primarily involving topical treatment (surgery or radiotherapy), sometimes supplemented with chemotherapy.
? cell lung cancer has a very high biological aggressiveness, frequent, distant metastasis, and a relatively high sensitivity to chemotherapy, which plays a leading role in the treatment of this cancer.
? Patients with tumors metastatic (stage IV) should be treated with palliative intent, whose main aim is to prolong life while maintaining its quality. Side effects of the treatment should not significantly impair the quality of life.
NSCLC
The principal method of treating small cell lung cancer in the I, II, and in selected patients with stage III is surgical resection. The scope of surgery is dictated by the size of the tumor and its relationship to critical anatomical structures (large vessels, trachea and bronchi, pericardium, spine and esophagus) and the age of the patient and its functional capacity.
The most common treatment is to remove the lobe of the lung (lobectomy), rarely performed resections to a lesser extent (a segment of lung resection or so. Wedge resection). For small peripheral lung tumors it is possible to perform treatments without wide-open chest and ribs breach of continuity. In justified cases, the extent of tumor resection is used around the lungs - pneumonectomy.
People who are not eligible for surgery because of the general condition, age or comorbidities should be considered radical radiotherapy (radiation therapy using high doses of radiation, the aim of which is to cure the patient). Patients with contraindications to surgery in the first stage it is also possible to use stereotactic radiosurgery, in which a high dose of radiation is administered on a small area in a few fractions with extremely high precision.
Most patients with stage III non-small cell lung cancer should receive combined treatment involving radiation therapy and chemotherapy (in some cases also surgery). Combination therapy involves the use of radiation therapy is administered during the two cycles of chemotherapy (treatment równoczasowe) or chemotherapy and radiotherapy (sequential therapy).
Patients with small cell lung cancer in stage IV should receive palliative treatment involving chemotherapy. The most commonly used cytostatics in the treatment of cancer include platinum agents, antimetabolites, vinca alkaloids and taxanes. The choice of treatment regimen depends on the histologic type of tumor and organ capacity of the patient. An important element of treatment is palliative radiotherapy, typically used to counter symptoms of tumor growth in the chest: hemoptysis, shortness of breath or pain.
Palliative radiotherapy is also used in cases of painful bone metastases, brain metastases or metastases to lymph nodes or invasion of the chest wall.
In cases of malignant pleural effusion in the pleural cavity causing shortness of breath are used puncture the pleura or more drainage of pleural cavity. However, often also pleurodezy treatment, comprising administering irritant agent pleural plaques and constructed to limit the pleural space where fluid could collect. There is also the opportunity to establish a catheter into the pleural cavity of the valve facilitates periodic drop of liquid.
Small cell cancer
Patients with small cell lung cancer should receive chemotherapy, as long as it allows their condition and organ performance. In patients suffering from small cell lung cancer at an early stage applied radiation to the chest area in combination with chemotherapy. After completion of chemotherapy in many apply prophylactic brain irradiation in order to reduce the risk of recurrence at this location. In a very small group of patients with stage I (no lymph node involvement by tumor) can also consider surgical resection, which precedes the treatment with cytostatics. In the event of failure of first line chemotherapy considered for re-treatment with cytostatic agents, the choice of which depends on the capacity of the patient and the time elapsed since the completion of first-line chemotherapy for relapse.
mesothelioma
Treatment of pleural mesothelioma in the I and stage II remains a subject of controversy. In some clinical situations, attempts are being made surgical treatment involving the excision of the pleura with lung (pneumonectomy), or excision of the pleura, leaving the lung parenchyma (pleurektomii / decortication). Surgery performed because of mesothelioma are very extensive and must be part of a multi-disciplinary proceedings - usually associated with chemotherapy and radiotherapy. They are in a very small group of patients and high risk of complications. Their impact on survival remains ambiguous, since there are no studies proving their efficacy well. Treatment of other patients with pleural mesothelioma is palliative in nature and mainly includes chemotherapy. An important element of the procedure is also symptomatic treatment of malignant pleural effusion or palliative radiotherapy. Results of treatment of pleural mesothelioma are unsatisfactory.
after treatment
Rehabilitation
The aim of rehabilitation after the treatment of cancer of the chest is a quick return to fitness of the patient and full independence. After surgery rehabilitation carried out already in the first day, gradually increasing the range of motor function and breathing exercises later. The early and proper rehabilitation reduced pain intensity associated with the intersection of ribs and intercostal nerves during surgery.
Proceedings during and after conservative treatment should include prevention of complications after treatment and helps reduce symptoms.
Important aspects of the after-care to be psychological counseling and early implementation of antidepressant treatment in patients who require such treatment. At cancer centers often they operate patient support group, enabling the exchange of practical experience in the fight against the disease.
Prevention
The most important etiological agent of most cancers chest is active smoking and passive exposure to tobacco smoke. Refrain from smoking or giving up this habit is the most effective way to reduce the risk of developing lung cancer. Giving up tobacco smoking is particularly important in patients being treated for cancer conditioned smoking, as the risk of developing another cancer tytoniozalezny, including lung cancer is especially high.
Neither in Poland nor in the European Union, apart from projects of a scientific nature, not currently a regular screening programs and early detection of lung cancer. Regular performance of classical X-rays of the chest does not reduce mortality from lung cancer. Some hopes are now programs low-dose computed tomography of the chest - in a clinical trial using this method of imaging has been shown to decrease mortality from lung cancer among heavy smokers of tobacco, other studies are currently in progress. Routine implementation of this research in the country, however, remains highly controversial because of the high false-positive rate (lung nodules that are not cancer), as well as the limited availability and high cost. The most important factor limiting mortality from lung cancer remains refrain from smoking or giving up the habit by smokers.
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