Pathology of lung cancer

Outline

Lung cancer is a very common disease in chest surgery, is the leading cause of death in cancer in general. The incidence of disease is increasing due to the increasing number of risk factors for cancer. For the first time, Laennec described lung cancer in 1805. It is more common in men (eight times more common than women). Common age between 40-70. The disease is often detected late.

Whole disease

The etiologic is unknown. However, many favourable carcinogenic factors have been identified:

Occupational cancer

According to Doll: Radioactive substances, Nickel, Chromate, Amian and other substances produced by tar distillation can cause lung cancer.

Lung cancer and habitat

 More in industrial cities than in rural areas.

 In the industrial city atmosphere contains high rates of carcinogens (3-4 benzopyrene, polycyclic hydro carbides, vinyl chlorides).

Lung cancer and tobacco

There are 3-4 benzopyrene in cigarette smoke. According to cancer experts at the 1982 Geneva session, 80-90% of lung cancers are related to tobacco smoke (active or passive smoking).

Pathology

The exact term for lung cancer is bronchial cancer or lung-lung cancer.

General

The original site of the tumour originates in the bronchi

Central region: Main bronchus, lobe.

Medial zone: 3rd, 4th, and 5th grade bronchi of the segmental bronchus.

Peripheral region: Grade 6 bronchi to the bronchioles.

U is usually a solid mass, size # 2-10cm, the outer surface is rugged with many zones; Gray white cross section.

Tumours narrowing the lumen of the bronchi cause atelectasis, bronchiectasis, pneumonia, lung abscess.

The tumour is usually nourished by the branches of the bronchial artery.

Micro

According to the World Health Organization, bronchopulmonary cancer is divided into:

Type I: Carcinoma of the epidermis.

Type II: Small cell malformed cancer.

Type III: Adenocarcinoma.

Type IV: Large cell carcinoma.

Type V: Mixed (epidermal-glandular) carcinoma.

Classify

Classified by TNM:

T (# Tumour): T0, T1 (3cm), T2 (> 3cm + atelectasis of the lung), T3 (spread out of the lung into the mediastinum, pleura, chest wall).

N (# Nodule lymph nodes): N0, N1 (lobar or bronchial metastasis), N2 extrapulmonary lymph node metastasis. Mediastinal example).

  M (distant metastases # Metastases): M0, M1 extra thoracic metastasis including lymph nodes.

The stages are as follows:

Phase I:   T1 N0 M0. T1 N1 M0. T2 N0 M0.

Phase II: T2 N1 M0.

Stage III: T3 any N, N2 any T, M M1 any N, T.

Metastasis of cancer

Spread directly

Spreads through the bronchial layers to the surrounding organization.

Spread to other bronchi.

Diffused in the submucosal layer through the lymphatic tract of the bronchi.

Diffused along the bronchial lumen by the process of fibroids into small tumours.

Lan according to the mucosa.

Lymphatic spread

Lung (P): Lymph drainage is uniformly drained into the right bronchial ganglia and then into the thoracic duct.

Lungs (T): Lymph drainage from the lower lobe to the right, from the upper lobe (segments 1, 2, 3) to the left; from the 4, 5 lobes (tongue) to the left and right.

Spread by blood sugar

Organ lung cancer in left atrium metastasized liver, kidney, adrenal gland, brain and bone.

Clinical and subclinical symptoms

Clinical symptoms

Lung cancer is a generalized disease, not just localized in the lung. When the disease was detected clinically in the lung, there were a number of cancer cells scattered in many different organs. The silent illness has no specific nature. Depending on the starting point (central or peripheral), the direction of tumour growth in the vicinity, there are different signs.

Symptoms of the bronchi - lungs

 Cough: (reaction of bronchial mucosa) a dry cough at night followed by mucus, purulent mucus, blood.

 Haemoptysis.

 Chest pain.

 Fever.

Symptoms of the chest in the lungs

Hoarseness.

Upper vena cava compression: Jacket oedema.

Pancoast-Tobias syndrome.

Choking: Compression of the lymph nodes.

Haemorrhage, pleural bleeding.

Nonspecific symptoms: weight loss, thinness.

Symptoms of extra thoracic metastasis

Paralysis, epilepsy, memory disorders, headache, pain, fracture, ascites jaundice.

Symptoms beyond the chest are not due to metastasis

Metabolism:

Cushing's syndrome: Increased ACTH, 17 urinary corticosteroid hydroxyemia.

Increased ADH syndrome: Water intoxication, vomiting.

Parental syndrome: Increased serotonin (oedema, pruritus, arteriosclerosis).

Syndrome of hypercalcemia (cancer of the epidermis): Vomiting, abdominal pain, loss of appetite, memory disorders.

Gonadotrophin Syndrome: Breast enlargement.

Insulin-like syndrome causes hypoglycemia.

Neuromuscular:

Inflammation of many muscles.

Myasthenia.

 Subacute cerebral degeneration.

Skin, bones:

Pierre Marie syndrome (finger drumstick, periosteal thickening, osteoporosis).

Skin: Disease A canthosid Nigricans: dermatitis, darkening of the skin, rash.

Blood:

Anaemia, leukocytes increased, VSS decreased.

Subclinical

Chest radiograph (straight, inclined)

Sometimes it takes 2 or more scans about 2 weeks apart to monitor the progression of lung blurring.

Central region:

The hilum is wider than usual.

The shadow is even in the navel area, the edge is irregular.

The picture of the rising sun.

Ventilation disorder with decreased light, brightening, atelectasis.

Diaphragmatic paralysis: Diaphragm arch is high, less mobile, moves backwards while breathing.

Peripheral region:

The shadow is dark, irregular density, the edge is irregular, the lung structure around the tumour is darker than usual. If the tumour is a distance from the hilum, there are rays connected to the hilum.

Necrosis in the wall or inside the tumour.

Metastases to the mediastinal lymph nodes: bronchopulmonary (hilum ring out), trachea and trachea-bronchial distance (wide mediastinal balloon), tracheal junction (tracheal base expands).

Pleural metastasis (pleural effusion), rib metastasis (rib resorption).

Contrast bronchogram

Valuable for diagnosing central cancer: narrow, limp, amputation.

CT scan of the chest

Valuable in diagnosing the location, size, and invasiveness of the cancer.

Pulmonary angiography.

Intermediate with inflatable

Mediastinal lymph nodes, other diagnosis than mediastinum.

A scan of the oesophagus.

Bronchoscopy: Very important:

Tumour white or pink, irregular margin, easy to bleed, bronchoscopy accompanied by biopsy accurately determine the nature of the tumour.

Biopsy

A lymph node biopsy on the collarbone.

Daniel biopsy.

In the absence of biopsy can poke lung tumour as cytology for diagnosis.

Diagnose

Implementing the quadrants

History, medical history.

Physical examination.

Blood test: VSS increased.

Analysis of tumour shadow characteristics on X-rays, CT scan of the chest.

Bronchoscopy, a biopsy of tumours, lymph nodes.

Probe open chest.

Differential diagnosis

Inflammatory diseases in the lungs: pneumonia, bronchiectasis, tuberculosis, abscesses.

Mediastinal tumour.

U metastasized from elsewhere.

Benign tumours.

The principles of treatment

Surgery, radiation therapy, chemotherapy and immunotherapy, surgery make up the top.

Surgery

Contraindicated

Stage of cancer development: diffuse beyond the lung: chest wall, mediastinum, diaphragmatic palsy, inverted larynx, larynx, pleura.

Based on cell type: Small cell carcinoma (radiation, chemotherapy).

Based on the patient's status: Poor lung function, associated cardiovascular diseases, weakness and old age.

Surgical methods

Thorough resection: Extensive cut, remove dependent mediastinal lymph nodes (pulmonary resection, pulmonary lobe resection).

Limited resection: Removes one lobe and attaches suspected lymph nodes.

Economical resection: Cut one lobe or one lobe + cut a part of the bronchus and stitch the ends together.

Temporary excision: Take only the main injury

Radiation therapy

When not indicated, or when lung resection but also mediastinal metastatic lymph nodes.

Chemistry

Nitrogen Mustard.

Cytoxan.

Immunity

BCG, levamisole, LH1.

Prognosis

Life over 5 years: 10% if the tumour and lymph nodes are removed.

Lymph, blood metastasis: Living less than 6 months (especially mediastinal lymph node metastasis).