Pathology of bronchopulmonary cancer

2021-01-28 12:00 AM

Tumours developing in the bronchial lumen cause incomplete bronchial obstruction, which disturbs the hair mucus clearance, causing stagnation, from which it is easy to get bronchitis in the corresponding lung lobe.

Outline

Primary bronchial lung cancer (UTPQPNP) is now at an alarmingly increasing frequency.

It is the leading cause of cancer death in men and 4th for women. The disease is mainly tobacco.

The detection is often late, so treatment is difficult, so the prognosis is always severe.

Causes and risk factors

Gender: Bronchopulmonary cancer is more common in men than in women with the rate of 6/1.

Age: Maximum disease in men about 65 years old and in women about 75 years old.

Environment: The disease is common in cities 3 times larger than in rural areas.

Cigarette:

Tobacco smoke has definitely been identified as the cause of bronchopulmonary cancer. 90% of bronchopulmonary cancers are caused by smoking. The rate of bronchopulmonary cancer increases with the number of cigarettes smoked per day and the number of years of addiction. If smoking more than 20 packs/year, this rate increases significantly.

Tobacco smoke slows down the purification of hair mucus, and damages phagocytic functions of the respiratory system.

The enzymes of the bronchial mucosa are not well suited to this attack: turning substances in tobacco smoke into carcinogens.

Quitting smoking reduces your risk, but doesn't lose your risk.

General air pollution:

Industrial fumes, car smoke contain benzopyrene and some toxins such as polycyclic hydrocabure, others such as metals, radioactive substances.

Occupational environmental pollution:

Asbestos dust, mine dust or industrial substances such as chrome, nickel, arsenic, printing ink of petroleum industry, radioactive substances.

Tobacco smoke is a synergistic effect that causes cancer.

Some other factors:

Lung scarring may cause adenocarcinoma more easily than other types.

Classification by disease anatomy

According to OMS bronchopulmonary cancer is classified into the following categories:

Cutaneous cancer.

Small cell carcinomas do not differentiate.

Adenocarcinoma:

Highly differentiated follicular cancer.

Bronchoalveolar alveolar cancer.

Less differentiated adenocarcinoma.

Large cell cancers do not differentiate.

Combined epidermal and glandular cancers.

Carcinoids cancer.

Bronchial cancer.

Papillary carcinoma of the superficial epidermis.

Mixed cancer carcinosarcoma.

Sarcomas.

Not rated.

Mesothelioma (pleural cancer).

Melanin.

In which the first 4 types are common.

Staging lung cancer by TNM (according to the American Association on the Cancer System)

Primary U

To: Can't see u.

Tx: U can only be detected early by cancer cells in bronchial secretions. TIS: Carcinoma in situ

T1: U has d ≤ 3cm, bronchoscopy did not spread to the lobe bronchus.

T2: Tumours are d> 3 cm or tumours regardless of size or spread to visceral pleura or atelectasis or obstructive pneumonia, spread to lobar bronchus or bronchial spines ≥ 2 cm. Atelectasis / obstructive pneumonia in only 1 lung

T3: U does not matter invasive size into chest wall or diaphragm or medial pleura or pericardium (without damage to the heart, large blood vessels, trachea, oesophagus, spine).

Or the tumour in the main bronchus less than 2 cm away from the bronchial astragalus.

T4: U cannot invade the mediastinum or heart or large blood vessels, trachea, oesophagus, spine, bronchi.

Or pleural effusion.

Lymph node damage

No: There is no metastasis to the lymph nodes.

N1: Metastasis to peri-bronchial or umbilical lymph nodes

N2: Metastasis of parietal and lateral mediastinal lymph nodes.

N3: Metastasis of different mediastinal lymph nodes, unilateral hilum, trapezoidal or superolateral lymph nodes.

Far metastasis

Mo: not far from metastasis.

M1: Far metastasis such as adrenal, liver, bone, brain.

Table: Grades by TNM.

Stage

T

N

M

Hidden carcinoma

Tx

No

Mo

Stage 0

TIS

No

Mo

Stage I

T1

T2

No

No

Mo

Mo

Stage II

T1

T2

N1

N1

Mo

Mo

Stage IIIa

T3

T1-3

N1

N2

Mo

Mo

Stage IIIb

Any T

T4

N3

Any N

Mo

Mo

Stage IV

Any T

Any N

M1

Expression in the chest

Coughs often increase in frequency and severity.

Haemoptysis

More or less amount, accounting for 50% of cases.

Bronchitis due to obstruction

Tumours developing in the bronchial lumen cause incomplete bronchial obstruction, which disturbs the hair mucus clearance, causing stagnation, from which it is easy to get bronchitis in the corresponding lung lobe.

Obstructive pulmonary bronchitis is characterized by focal pneumonia, slow or incomplete response to appropriate antibiotics, repeated pneumonia at the same site.

Local screeching

Ran wheezing suggested incomplete focal blockage.

Lung collapse

When there is atelectasis syndrome, the bronchi are completely narrow.

Pleural effusion

It can be serous effusion or haemorrhage, it can be caused by a direct spread of tumour or metastasis, sometimes due to atelectasis reaction.

Chest pain

Pain is constant and persistent indicates that the cancer has spread to the chest wall, pleura, or mediastinum.

Big groove

Nodules can be in the hilum, mediastinum, trapezoidal muscle, and can develop deep sound or cause compression and erosion of the bronchi, blood vessels or neighbouring nerve clusters.

Expression of compression, tumour obstruction, metastasis, regional lymphadenopathy

The aortic vein in the mediastinum is compressed, causing the neck to enlarge, then coat oedema, purple face, and varicose veins under the skin in the shoulders and chest.

The opposing nerve is pinched, causing hoarseness, paralysis of the left vocal cord (the right vocal cord has a high ring around the inferior artery so it is less pinched).

Diaphragmatic nerve: These nerves travel along the anterior mediastinum on each side, one of the two can be pinched, causing the diaphragm to paralysis respectively, detected only by lung imaging, seeing the diaphragm moving in the opposite direction.

Pancoast Tobias syndrome

Peak lung cancer invades the parietal pleura and squeezes the lower roots of the brachial plexus, the cervical sympathetic nerve. The syndrome includes shoulder pain, arm pain with CLAUDE BERNARD HORNER syndrome on the same side (shrinking pupils, drooping eyelids, narrowing of the eyes) sometimes eroding the collarbone.

Extra-thoracic manifestations (metastases)

The 3 most commonly metastatic organs are:

The skeletal system causes bone pain, dominant pain at rest, and recurs with common pain relievers.

Central nervous system: the rate of lung tumour metastasis to the brain is very high, causing paralysis of the cranial nerves, hemiplegia.

Liver

Other metastases such as peritoneal, adrenal, kidney, and gastrointestinal tract.

Systemic syndrome

These syndromes go away when the cancer is removed and recur when metastasis develops.

Hypercalcemia

Hypercalcemia due to an abnormal parathormone and another bone-dissolving substance parathormone.

Hypercalcemia causes nausea, vomiting, excessive urination, confusion, lethargy, and stupor.

Abnormal ADH secretion syndrome

Causes hyponatremia, reduces colloid pressure, increases the proportion of urine, urine contains more sodium.

CUSHING syndrome

Bronchial lung cancer secretes the same quality as ACTH, usually less active than real ACTH.

Carcinoids syndrome

Skin congestion, facial oedema, increased tear production, increased salivation, diarrheal, vomiting, hypotension caused by 5 hydroxy tryptamine (serotonin) and 5 hydroxytryptophan are secreted in carcinoids tumour or undifferentiated small cell cancer.

Big breasts

Lymphoma secretes sex hormones that cause large breasts. 

Neuromuscular disorders

The mechanism is unknown, this syndrome does not go away when the cancer is removed.

Common are: Myasthenia gravis, cerebellar degeneration, sometimes brain and spinal cord, peripheral neurological syndrome.

Finger drumstick

PIERRE MARIE syndrome (hypertrophic osteoarthritis syndrome caused by the lungs)

The bones and joints of the extremities are painful, persistent swelling. Radiographs show inflammation and periosteal proliferation, common at the tip of the tibia and fibula, with the finger and toe drumstick. Disappears when the cancer is removed.

Nonspecific cellular immunity reduction

Dermal tuberculosis (+) is a good prognostic factor for postoperative survival twice the tuberculosis (-).

Subclinical symptoms

X-ray

Cutaneous cancers and non-differentiated small cell cancers usually occur in the umbilical cord or near the navel, adenocarcinomas and large cell cancers are often far from the navel in the host tissue.

Epidermal cancer is usually in the form of an irregular, heterogeneous fuzzy round, on one side, the goods, crickets can cause pneumonia due to obstruction or atelectasis.

Small cell carcinomas do not differentiate often in the form of fuzzy masses, less homogeneous, irregular edges, tend to spread around.

Adenocarcinoma is usually in the form of round, regular, dark, well-marked masses.

Bronchoalveolar bronchial cancer is often in the form of a single round mass or infiltrative nodule spreading one or two lungs.

Large cell cancers are usually in the form of round, dark, well-marked masses.

Cancer lesions are usually never calcified.

Density large cut capture

Helps to accurately determine the properties of abnormal fuzzy mass in the pulmonary parenchyma, and in the mediastinum, helps in biopsy under CT SCANNER's guidance for histological diagnosis.

Bronchoscopy

Flexible bronchoscopy helps to directly diagnose and probe cancer spread by cleaning the bronchi and biopsy or systematic biopsy of bronchi.

Cytology

Examination of sputum cells showed positive results over 70%, false positive results, detecting cancer cells as soon as the x-ray image was normal. Sputum cytology is therefore a screening test in the at-risk group.

Lymph node biopsy

Peripheral lymph nodes are easily biopsied, mediastinal lymph node biopsy is conducted in the operating room by a specialist.

Poke through the wall with a small needle

Applies to cancer in peripheral, difficult bronchoscopy. May be poked under monitoring on the fluorescence membrane. Easy to cause overflow when the pleura.

Pleural biopsy

Pleural biopsy must be performed in a surgical setting. Pleural fluid cytology can be investigated.

Exploration

In patients with surgery indication. Immediate biopsy and surgical examination and the decision to continue surgery or not.

Exploring metastasis

Having to do ultrasound and density tomography to conclusively conclude.

Explore respiratory function

Mainly consider the indications for surgery and explore the ability of the lung to heal.

If VEMS ≥1 / 2 is normal and paCO2 is normal 40 ± 3 mmHg then no further investigation is required.

Cancer marker

Only identifiable as tumour, helps monitor the progress after treatment.

 

Differential diagnosis

Pulmonary tuberculosis

Diagnosis is difficult in the following cases: NCD is negative and cancer cells are not found in the sputum for 3 consecutive days, on X-ray with round fuzzy mass, 2 to 3 cm in diameter, or one cloudiness. In these cases, it is recommended to actively test TB, and find ways to detect cancer cells. After one month, the latest is two months if the picture on the film is clearer than cancer.

Pneumonia

After a period of treatment for pneumonia, if the health does not return to normal, the lesions on the X-ray film are not erased, blood sedimentation is still high ... to think of bronchopulmonary cancer.

Treatment

In terms of treatment, people divide bronchopulmonary cancer into 2 main groups.

Non-small cell cancers are not differentiated

Has a doubling time of 100-200 days, including 3 types: carcinoma, adenocarcinoma, and large cell cancer?

Surgery is the most effective method, applied to the hidden cancer stages, stage 1 and stage 2 and selective cases such as T3, No, Mo or T1, N2, Mo.

Result:

Hidden cancer: 60% survived after 5 years. Follow up carefully because it is easy to relapse about 5% / year / person.

Single nodular cancer: Surgery to remove the lobe of the lung. The prognosis depends on tumour size, regional lymph nodes and k-cell differentiation.

Survival after 5 years is about 40-60% if the size is <3cm and there are no regional lymph nodes. Survival after 5 years is about 20% to <40% if the size> 3cm and has regional lymph nodes.

Without surgery, you can use chemotherapy and radiation therapy without contraindications.

The results of radiation therapy are not very good, sometimes no better than patients who have not received radiation therapy.

Chemotherapy:

Table: Results of some chemotherapy.

Characteristics

Paclitaxel
/carboplatin

Gemcitabine
/carboplatin

Paclitaxel
/Gemcitabine

Number of patients

308

309

312

Average survival time

7.9 months

7.6 months

8.4 months

Survive for 1 year

33%

31%

33%

Table: 5-year survival rate.

Author and year of publication

Number of patients

Treatment group

5 years survival%

Arriagada et al-2004

1867

Cisplatin and/ or
Etoposide
Vinorelbine Vindesine Vinblastine

44,5

Winton et al-2004

482

Cisplatin- Vinorelbine

69

Strauss et al-2004

344

Carboplatin- Paclitaxel

71 (4 years)

Rosell et al- 2005

840

Cisplatin -Vinorelbine

51

Small cell carcinomas do not differentiate

This type of cancer grows rapidly, metastasizes early and many as soon as the disease seems localized, so all attempts to remove are ineffective, so chemotherapy and radiation therapy are key.

Chemotherapy:

Topoisomerase I inhibitors include irinotecan and topotecan. The combination of irinotecan or topotecan with ciplastin has shown good results, but some authors combine etoposide with cisplatin or with carboplatin.

Radiotherapy:

Radiation therapy is given before or after chemotherapy by a specialist.

Symptomatic treatment and supportive treatment for both types:

Anti-pain, anti-infection, cough relief.

Anti-pinched nerve: dexamethasone 20-80 mg / day.

Aspiration pleural fluid.

Anti-marrow failure, anaemia.

Prevention

Propagating the harmful effects of tobacco in the mass media to encourage people to quit

Anti-pollution in the indoor and professional environments.