Tumor in the lung symptoms treatment. Lung cancer: symptoms

Benign lung tumors - a collective concept that includes big number tumors of different origin and histological structure, having different localization and clinical features.
Although benign lung tumors are much less common than cancer, they make up about 7-10% of all lung tumors.
Often the distinction between benign and malignant lung tumors is very arbitrary. Some benign tumors initially have a tendency to malignancy, with the development of infiltrative growth and metastasis. However, the vast majority of authors believe that the existence of the concept of “benign lung tumors” as a clinical and morphological group is completely justified. Despite the difference in histological structure, benign lung tumors share slow growth over many years, the absence or paucity of clinical manifestations before complications occur, and most importantly, the relative rarity of malignancy, which sharply distinguishes them from lung cancer or sarcoma and determines other approaches to the choice of tactics and methods of surgical treatment.
Classification and pathological anatomy
From the point of view of anatomical structure, everything Benign lung tumors are divided into central and peripheral. TO central include tumors from the main, lobar and segmental bronchi. The main direction of growth in relation to the bronchial wall can be different and is characterized by predominantly endobronchial, extrabronchial or mixed growth. Peripheral tumors develop from more distal bronchi or from elements of lung tissue. They can be located at different distances from the surface of the lungs. There are superficial (subpleural) and deep tumors. The latter are often called intrapulmonary. They can be localized in the hilar, middle or cortical zones of the lung.
Peripheral benign tumors are somewhat more common than central ones. Moreover, they can equally often be localized in both the right and left lungs. For central benign lung tumors, right-sided localization is more typical. Unlike cancer lung benign tumors predominantly develop from the main and lobar bronchi, rather than from segmental bronchi.
Adenomas are the most common type of histological structure of central tumors, and hamartomas- peripheral. Of all the rare benign tumors, only papilloma has a predominantly central localization, and teratoma located in the thickness of the lung tissue. The remaining tumors can be either central or peripheral, although peripheral localization is more typical for neurogenic neoplasms.

Adenoma
All adenomas are epithelial tumors, developing mainly from the glands of the bronchial mucosa. Among all benign lung tumors, adenomas account for 60-65%. In the vast majority of cases (80-90%) they are centrally localized.
Central adenomas, starting to develop in the wall of the bronchus, most often grow expansively into the lumen of the bronchus, pushing back the mucous membrane, but not growing through it. As the tumor grows, compression of the mucous membrane leads to its atrophy and sometimes to ulceration. With the endobronchial type of growth, adenomas appear quite quickly and signs of bronchial obstruction increase. With extrabronchial growth, the tumor can spread within the bronchus or outside of it. Often there is a combination of different types of tumor growth - mixed growth. Taking into account the benign nature of the course of most carcinoids, cylindrimas and mucoepidermoid tumors in clinical practice, it is advisable to consider them as benign tumors with a tendency to malignancy and on this basis conditionally retain the term “adenomas” for them, which, according to their histological structure, are divided into 4 main types: carcinoid type (carcinoids), mucoepidermoid type, cylindromatous type (cylindromas) and combined adenomas, which combine the structure of carcinoids and cylindrimas.
Carcinoids among all adenomas, they occur most often, in 81-86%. These tumors develop from poorly differentiated epithelial cells. The cells are arranged in solid islands in the form of tubes and rosettes and form mosaic structures.
There are highly differentiated (typical) carcinoid, moderately differentiated (atypical) carcinoid and poorly differentiated (anaplastic and combined) carcinoid. Tumor malignancy develops in 5-10% of cases. Malignant carcinoid has infiltrative growth and the ability to lymphogenous and hematogenous metastasis to distant organs and tissues - liver, other lung, bones, brain, skin, kidneys, adrenal glands, pancreas. It differs from cancer in its slower growth and much later metastasis, radical operations give good long-term results, local relapses are much less common.
Adenomas of other histological types are much less common than carcinoids. They also have the ability to become malignant.

Hamartoma
The term “hamartoma” (from the Greek “hamartia” - error, flaw) was originally proposed in 1904 by E. Albrecht for dysembryogenetic liver formations. It has many synonyms. In American literature, hamartomas are often called chonroadenomas.
Hamartoma is the second most common benign tumor of the lungs and the first among peripheral formations of this localization. More than half of all peripheral benign lung tumors (60-64%) are hamartomas.
Hamartoma is a tumor of congenital origin, in which various elements of germinal tissue may be present. In most hamartomas, islands of mature cartilage of atypical structure are found, surrounded by layers of fat and connective tissue. Slit-like cavities lined with glandular epithelium may occur. The tumor may include thin-walled vessels, smooth muscle fibers, and accumulations of lymphoid cells.
Hamartoma most often is a dense, round formation, with a smooth or, more often, finely lumpy surface. The tumor is completely clearly demarcated from the surrounding tissue, has no capsule and is surrounded by displaced pulmonary tissue. Hamartomas are located in the thickness of the lung - intrapulmonary or superficial - subpleural. As they grow, they can compress the vessels and bronchi of the lung, but do not grow into them.
Hamartomas are most often located in the anterior segments of the lungs. They grow slowly, and cases of rapid growth are casuistry. The possibility of their malignancy is extremely small; observations of the transformation of a hamartoma into a malignant tumor - hamartoblastoma - are only possible.

Fibroids lungs are found among other benign tumors of this location in 1-7.5% of cases. The disease occurs predominantly in men, and both the right and left lungs can be affected equally often. Typically, peripheral localization of the tumor is observed. Peripheral fibromas can sometimes be connected to the lung by a narrow stalk. Fibroids, as a rule, are small in size - 2-3 cm in diameter, but they can reach gigantic tumor sizes, occupying almost half of the chest cavity. There is no convincing data on the possibility of malignancy of pulmonary fibroids.
Macroscopically, fibroma is a dense tumor node of a whitish color with a smooth smooth surface. With central localization of fibroma during bronchoscopy, the endobronchial surface of the tumor has a whitish or reddish color due to hyperemia of the mucous membrane. Ulcerations can sometimes be seen on the mucous membrane covering the fibroma.
The tumor has a well-formed capsule that clearly demarcates it from the surrounding tissues. The consistency of the tumor is densely elastic. On the section, the tumor tissue is usually grayish in color, areas of varying density are noted, and sometimes there are foci of ossification and cystic cavities.
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Papiloma - a tumor that develops exclusively in the bronchi, mainly large ones. Another name for papilloma is fibroepithelioma. It is quite rare, occurring in 0.8-1.2% of all benign lung tumors. In most cases, bronchial papilomas are combined with papilomas of the trachea and larynx. The tumor is always covered with epithelium on the outside and grows exophytically, that is, into the lumen of the bronchus, often completely obstructing it. Over time, papillomas can become malignant.
Macroscopically, papilloma is a circumscribed formation on a stalk or broad base with an uneven lobed fine- or coarse-grained surface, color from pink to dark red. By appearance papilloma may resemble “cauliflower,” “raspberries,” or “cockscomb.” Its consistency is usually soft-elastic, less often - hard-elastic.

Oncocytoma - an epithelial tumor, most likely arising from the bronchial glands, in which specific large light cells with zosinophilic granularity of the cytoplasm and a small dark nucleus are found - oncocytes, which form the basis of the neoplasm. Oncocytomas occur in the salivary and thyroid glands, kidneys. The primary pulmonary location of the tumor is extremely a rare event, about ten similar observations are described in the literature.
Lung oncocytomas are detected in young and middle-aged people, localized in the wall of the bronchus, protruding into its lumen in the form of a polypoid formation, sometimes completely obstructing it and growing peribronchially in the form of a clearly defined node. There is also a lung tumor of peripheral localization. Oncocytomas have a thin capsule that separates them from surrounding tissue. They have a benign course.

Vascular tumors occur in 2.5-3.5% of all cases of benign lung tumors. Neither include hemangioendothelioma, hemangiopericytoma and capillary hemangioma. In addition, other vascular tumors are found in the lungs - cavernous hemangioma, glomus tumor, tumors from lymphatic vessels - lymphangiomas. All of them can have both central and peripheral localization.
All vascular tumors have a round shape, a dense or densely elastic consistency and a connective tissue capsule. The surface color varies from light pink to dark red. The size of the tumor can vary - from a few millimeters in diameter to very significant (20 cm or more). Small vascular tumors are diagnosed, as a rule, when they are localized in large bronchi and develop hemoptysis or pulmonary hemorrhage.
Hemangioendotheliomas and hemangiopericytomas have rapid, often infiltrative growth, a tendency to malignant degeneration, followed by rapid generalization of the tumor process. Many authors suggest classifying these vascular tumors as conditionally benign. In contrast, capillary and cavernous hemangiomas are not prone to malignancy, are characterized by limited growth, and grow slowly.

Neurogenic tumors can develop from nerve sheath cells (neurinomas, neurofibromas), from cells of the sympathetic nervous system (ganglioneuromas), from non-chromaffin paraganglia (chemodectomas and pheochromocytomas). Of the benign neurogenic tumors in the lungs, neuromas and neurofibromas are predominantly observed, and chemodectomas are much less common.
In general, neurogenic tumors are rarely detected in the lungs, accounting for about 2% of all cases benign neoplasms. They can occur at any age, equally often in both the right and left lungs. All neurogenic tumors in the vast majority of cases have a peripheral location. Sometimes they are connected to a lung stalk. Central tumors with endobronchial localization are very rare. Neuromas and neurofibromas are sometimes observed simultaneously in both lungs. Multiple pulmonary neurofibromas can be a manifestation of neurofibromatosis - Recklinghausen's disease.
Neurogenic tumors usually grow slowly, in rare cases reaching large sizes. Macroscopically, they are round dense nodes with pronounced capsule, when cut, have a grayish-yellow color. The question of the possibility of malignancy of neurogenic tumors is highly controversial. Along with the existing opinion about a purely benign course of the disease, a number of authors provide observations of malignancy in neurogenic lung tumors. Moreover, some authors propose to consider neuromas as potentially malignant neoplasms.

Lipoma - benign tumor of adipose tissue. It is quite rare in the lungs. Mostly lipomas develop in large bronchi (main, lobar), the wall of which contains microscopic examination adipose tissue, however, they can also occur in more distal areas bronchial tree. Lung lipomas can also have peripheral localization. Lung lipomas are somewhat more common in men; their age and location are not typical. With the endobronchial location of the tumor, the clinical manifestations of the disease increase as the drainage function of the affected parts of the lung is disrupted with characteristic symptoms. Detection of a peripheral lung lipoma is usually an incidental radiological finding. The tumor grows slowly and malignancy is not typical for it.
Macroscopically, lipomas have a round or lobular shape, a dense elastic consistency, and a clearly defined capsule. On the cut they yellowish color, lobular structure. The bronchoscopic picture of endobronchial lipoma is characteristic - a smooth-walled formation of a round shape, pale yellow in color. On microscopic examination, the lipoma consists of mature fat cells, with connective tissue septa separating the islands of adipose tissue.
Leiomyoma is a rare benign tumor of the lungs that develops from the smooth muscle fibers of the bronchial wall or blood vessels. More common in women. It can have both central and peripheral localization. Central tumors have the appearance of a polyp on a stalk or broad base. Peripheral leiomyomas can be in the form of multiple nodes. Tumors grow slowly, sometimes reaching significant sizes. Leiomyomas have a soft consistency and are surrounded by a well-defined capsule.

Teratoma - formation of dysembryonic origin, usually consisting of several types of tissues. It may be in the form of a cyst or a dense tumor. It has many synonyms - dermoid, dermoid cyst, complex tumor, embryoma, etc. It is relatively rare in the lungs - about 1.5-2.5% of all cases of benign neoplasms. It is detected mainly at a young age, although observations of teratomas in elderly and even senile people have been described. Teratoma grows slowly; in the presence of a cyst, its suppuration may develop due to secondary infection. The tumor may become malignant. Malignant teratoma (teratoblastoma) has invasive growth, invades the parietal pleura, neighboring organs. Teratomas are always located peripherally; damage to the upper lobe of the left lung is often observed. The tumor has a round shape, a lumpy surface, and a dense or densely elastic consistency. The capsule is clearly defined. The wall of the cyst consists of connective tissue, lined from the inside with single-layer or multilayer epithelium. A dermoid cyst can be unilocular or multilocular, and the cavity usually contains yellow or brownish fat-like masses, hair, teeth, bones, cartilage, sweat and sebaceous glands.

Clinic and diagnostics
Benign lung tumors are observed equally often in men and women. Most often they are recognized in young people under 30-35 years of age. The symptoms of benign lung tumors are varied. They depend on the location of the tumor, the direction of its growth, the degree of bronchial obstruction, and the presence of complications.
To complications The course of benign lung tumors includes: atelectasis, pneumofibrosis, bronchiectasis, abscess pneumonia, bleeding, compression syndrome, tumor malignancy, metastasis.
Benign lung tumors may not have any clinical manifestations of the disease for quite a long time. This is especially true for peripheral tumors. Therefore, in accordance with the characteristics of the clinical course, several stages are distinguished:
Stage I - asymptomatic;
Stage II - with initial and
Stage III- with pronounced clinical manifestations.
With central tumors, the speed and severity of the development of clinical manifestations of the disease and complications are largely determined by the degree of bronchial obstruction. There are 3 degrees of bronchial obstruction:
I - partial bronchoconstriction;
II - valvular or valve bronchostenosis;
III - bronchial occlusion.
In accordance with the three degrees of bronchial obstruction, three clinical periods of the disease are distinguished.
First clinical period corresponds to partial bronchostenosis, when the lumen of the bronchus is not yet significantly narrowed. It is most often asymptomatic. Patients sometimes note a cough, the appearance of a small amount of sputum, and rarely hemoptysis. General state remains good. X-ray picture more often it turns out to be normal. Only sometimes there are signs of hypoventilation of the lung area. The intrabronchial tumor itself can be detected by linear tomography, bronchography, and CT.
Second clinical period associated with the occurrence of so-called valvular or valve bronchial stenosis. It occurs when the tumor already occupies most of the lumen of the bronchus, but the elasticity of its walls is still preserved. With valvular stenosis, the lumen of the bronchus partially opens at the height of inspiration and is closed by the tumor during exhalation. In the area of ​​the lung ventilated by the affected bronchus, expiratory emphysema occurs. During this period, complete obstruction of the bronchus may occur due to swelling of the mucous membrane and blood sputum. In this case, in the lung tissue located to the periphery of the tumor, ventilation disturbances occur and inflammatory phenomena. Clinical symptoms of the second period are already clearly expressed: body temperature rises, cough appears with mucous membranes or mucopurulent sputum, shortness of breath, there may be hemoptysis, chest pain, weakness, fatigue.
An X-ray examination, depending on the location and size of the tumor, the degree of bronchial obstruction, reveals ventilation disturbances and inflammatory changes in a segment, several segments, a lobe of the lung or in the entire lung. The phenomena of hypoventilation and even atelectasis of the lung area, during this period, can be replaced by a picture of the development of its emphysema and vice versa. The supposed diagnosis, as in the first period, can be clarified with linear tomography, bronchography, CT.
In general, the second period is characterized by an intermittent course of the disease. Under the influence of treatment, swelling and inflammation in the tumor area decrease, lung ventilation is restored and the symptoms of the disease may disappear for some period.
Third clinical period and its clinical manifestations are associated with complete and persistent obstruction of the bronchus by the tumor, with the development of pulmonary suppuration in the area of ​​atelectasis, irreversible changes in the lung tissue and its death. The severity of the clinical picture largely depends on the caliber of the obstructed bronchus and the volume of affected lung tissue. Characteristic are long promotions body temperature, chest pain, shortness of breath, sometimes suffocation, weakness, excessive sweating, general malaise. A cough occurs with purulent or mucopurulent sputum, often mixed with blood. With some types of tumors, pulmonary hemorrhage may develop.
During this period, partial or complete atelectasis of the lung, lobe, segment with the possible presence of inflammatory purulent-destructive changes, bronchiectasis is determined radiologically. Linear tomography reveals a “bronchus stump”. The most accurate assessment of the intrabronchial tumor itself and the condition of the lung tissue is possible using computed tomography data.
The motley, uncharacteristic picture of physical symptoms in central lung tumors is dominated by dry and moist rales, weakening or complete absence respiratory sounds, local dullness of percussion sound. In patients with long-term obstruction of the main bronchus, asymmetry is detected chest, narrowing of the intercostal spaces, deepening of the supraclavicular and subclavian fossae, lag of the corresponding half of the chest during respiratory movements.
The severity and rate of development of bronchial obstruction depends on the intensity and nature of tumor growth. For tumors growing peribronchially, clinical symptoms develops slowly, complete obstruction of the bronchus rarely occurs.
Peripheral benign lung tumors do not manifest themselves in the first, asymptomatic period. In the second and third, i.e. During the initial period and the period of pronounced clinical manifestations, the symptoms and clinical picture of peripheral benign tumors are determined by the size of the tumor, the depth of its position in the lung tissue and the relationship with the adjacent bronchi, vessels, and organs. The tumor is large, reaching chest wall or diaphragm, may cause chest pain, difficulty breathing; when localized in the medial parts of the lung - pain in the heart area. If the tumor causes arrosion of the vessel, hemoptysis or pulmonary hemorrhage occurs. When a large bronchus is compressed, the so-called “centralization” of the peripheral tumor occurs. The clinical picture in this case is due to the phenomena of impaired bronchial patency of a large bronchus and is similar to the clinical picture of the central tumor.
Peripheral benign lung tumors are usually detected without difficulty through the usual x-ray examination. At the same time, they are displayed in the form of rounded shadows of various sizes with clear, but not entirely even contours. Their structure is often homogeneous, but there may be dense inclusions: lumpy calcifications characteristic of hamartomas, bone fragments in teratomas. A detailed assessment of the structure of benign tumors is possible using CT data. This method allows you to reliably determine, in addition to dense inclusions, the presence of fat, characteristic of lipomas, hamartomas, fibromas, and fluid - in vascular tumors, dermoid cysts. CT scan using the contrast bolus amplification technique also allows for the degree of densitometric indicators pathological formations It is sufficiently reliable to carry out differential diagnosis of benign tumors with peripheral cancer and metastases, tuberculomas, and vascular tumors.

Bronchoscopy is the most important method for diagnosing central tumors. When it is performed, a tumor biopsy is performed, which makes it possible to make an accurate morphological diagnosis. Obtaining material for cytological and histological studies It is also possible with peripheral lung tumors. For these purposes, transthoracic aspiration or puncture biopsy and transbronchial deep catheterization are performed. Biopsies are performed under x-ray guidance.
A peculiar clinical picture, the so-called “carcinoid syndrome,” in some cases may be accompanied by the course of lung carcinoids. Characteristic properties These tumors are the secretion of hormones and other biologically active substances.
The clinical picture of carcinoid syndrome is characterized by periodically occurring sensations of heat in the head, neck and upper extremities, diarrhea, bronchospasm attacks, dermatosis, mental disorders. In women with bronchial adenomas during hormonal changes associated with ovarian-menstrual cycles, hemoptysis may occur. Carcinoid syndrome does not occur frequently with bronchial carcinoids, only in 2-4% of cases, which is 4-5 times less common than with carcinoid tumors digestive tract. In case of malignancy of adenoma of the carcinoid type, the frequency of development and severity clinical manifestation carcinoid syndrome increases significantly.

Head of
"Oncogenetics"

Zhusina
Yulia Gennadievna

Graduated from the Pediatric Faculty of Voronezh State Medical University. N.N. Burdenko in 2014.

2015 - internship in therapy at the Department of Faculty Therapy of VSMU named after. N.N. Burdenko.

2015 - certification course in the specialty “Hematology” at the Hematology Research Center in Moscow.

2015-2016 – therapist at VGKBSMP No. 1.

2016 - the topic of the dissertation for the degree of Candidate of Medical Sciences “study of the clinical course of the disease and prognosis in patients with chronic obstructive pulmonary disease with anemic syndrome” was approved. Co-author of more than 10 published works. Participant of scientific and practical conferences on genetics and oncology.

2017 - advanced training course on the topic: “interpretation of the results of genetic studies in patients with hereditary diseases.”

Since 2017, residency in the specialty “Genetics” on the basis of RMANPO.

Head of
"Genetics"

Kanivets
Ilya Vyacheslavovich

Kanivets Ilya Vyacheslavovich, geneticist, candidate of medical sciences, head of the genetics department of the medical genetic center Genomed. Assistant, Department of Medical Genetics, Russian medical academy continuous professional education.

He graduated from the Faculty of Medicine of the Moscow State Medical and Dental University in 2009, and in 2011 – a residency in the specialty “Genetics” at the Department of Medical Genetics of the same university. In 2017, he defended his dissertation for the degree of Candidate of Medical Sciences on the topic: Molecular diagnostics DNA copy number variations (CNVs) in children with congenital malformations, phenotypic anomalies and/or mental retardation using high-density SNP oligonucleotide microarrays"

From 2011-2017 he worked as a geneticist at Children's clinical hospital them. N.F. Filatov, scientific advisory department of the Federal State Budgetary Institution “Medical Genetic Research Center”. From 2014 to the present, he has been heading the genetics department of the Genomed Medical Center.

Main areas of activity: diagnosis and management of patients with hereditary diseases and congenital malformations, epilepsy, medical and genetic counseling of families in which a child was born with hereditary pathology or developmental defects, prenatal diagnosis. During the consultation, clinical data and genealogy are analyzed to determine the clinical hypothesis and the required volume genetic testing. Based on the results of the survey, the data are interpreted and the information received is explained to the consultants.

He is one of the founders of the “School of Genetics” project. Regularly gives presentations at conferences. Gives lectures for geneticists, neurologists and obstetricians-gynecologists, as well as for parents of patients with hereditary diseases. He is the author and co-author of more than 20 articles and reviews in Russian and foreign journals.

Area of ​​professional interests is the implementation of modern genome-wide research into clinical practice and interpretation of their results.

Reception time: Wed, Fri 16-19

Head of
"Neurology"

Sharkov
Artem Alekseevich

Sharkov Artyom Alekseevich – neurologist, epileptologist

In 2012, he studied under the international program “Oriental medicine” at Daegu Haanu University in South Korea.

Since 2012 - participation in organizing the database and algorithm for interpreting genetic tests xGenCloud (http://www.xgencloud.com/, Project Manager - Igor Ugarov)

In 2013 he graduated from the Pediatric Faculty of the Russian National Research Medical University named after N.I. Pirogov.

From 2013 to 2015, he studied at a clinical residency in neurology at the Federal State Budgetary Institution "Scientific Center of Neurology".

Since 2015, he has been working as a neurologist and researcher at the Scientific Research Clinical Institute of Pediatrics named after Academician Yu.E. Veltishchev GBOU VPO RNIMU im. N.I. Pirogov. He also works as a neurologist and a doctor in the video-EEG monitoring laboratory at the clinics of the Center for Epileptology and Neurology named after. A.A. Kazaryan" and "Epilepsy Center".

In 2015, he completed training in Italy at the school “2nd International Residential Course on Drug Resistant Epilepsies, ILAE, 2015”.

In 2015, advanced training - “Clinical and molecular genetics for medical practitioners”, RDKB, RUSNANO.

In 2016, advanced training - “Fundamentals of molecular genetics” under the guidance of a bioinformatician, Ph.D. Konovalova F.A.

Since 2016 - head of the neurological direction of the Genomed laboratory.

In 2016, he completed training in Italy at the school “San Servolo international advanced course: Brain Exploration and Epilepsy Surger, ILAE, 2016”.

In 2016, advanced training - “Innovative genetic technologies for doctors”, “Institute of Laboratory Medicine”.

In 2017 – school “NGS in Medical Genetics 2017”, Moscow State Research Center

Currently conducting scientific research in the field of genetics of epilepsy under the guidance of Professor, Doctor of Medical Sciences. Belousova E.D. and professor, doctor of medical sciences. Dadali E.L.

The topic of the dissertation for the degree of Candidate of Medical Sciences “Clinical and genetic characteristics of monogenic variants of early epileptic encephalopathies” has been approved.

The main areas of activity are the diagnosis and treatment of epilepsy in children and adults. Narrow specialization– surgical treatment of epilepsy, genetics of epilepsy. Neurogenetics.

Scientific publications

Sharkov A., Sharkova I., Golovteev A., Ugarov I. “Optimization of differential diagnosis and interpretation of genetic testing results using the XGenCloud expert system for some forms of epilepsy.” Medical Genetics, No. 4, 2015, p. 41.
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Sharkov A.A., Vorobyov A.N., Troitsky A.A., Savkina I.S., Dorofeeva M.Yu., Melikyan A.G., Golovteev A.L. "Epilepsy surgery for multifocal brain lesions in children with tuberous sclerosis." Theses XIV Russian Congress"INNOVATIVE TECHNOLOGIES IN PEDIATRICS AND CHILDREN'S SURGERY." Russian Bulletin of Perinatology and Pediatrics, 4, 2015. - p.226-227.
*
Dadali E.L., Belousova E.D., Sharkov A.A. "Molecular genetic approaches to the diagnosis of monogenic idiopathic and symptomatic epilepsies." Thesis of the XIV Russian Congress "INNOVATIVE TECHNOLOGIES IN PEDIATRICS AND CHILDREN'S SURGERY." Russian Bulletin of Perinatology and Pediatrics, 4, 2015. - p.221.
*
Sharkov A.A., Dadali E.L., Sharkova I.V. “A rare variant of early epileptic encephalopathy type 2 caused by mutations in the CDKL5 gene in a male patient.” Conference "Epileptology in the system of neurosciences". Collection of conference materials: / Edited by: prof. Neznanova N.G., prof. Mikhailova V.A. St. Petersburg: 2015. – p. 210-212.
*
Dadali E.L., Sharkov A.A., Kanivets I.V., Gundorova P., Fominykh V.V., Sharkova I.V. Troitsky A.A., Golovteev A.L., Polyakov A.V. A new allelic variant of myoclonus epilepsy type 3, caused by mutations in the KCTD7 gene // Medical Genetics.-2015.- Vol.14.-No.9.- p.44-47
*
Dadali E.L., Sharkova I.V., Sharkov A.A., Akimova I.A. "Clinical and genetic features and modern methods diagnosis of hereditary epilepsies". Collection of materials “Molecular biological technologies in medical practice” / Ed. Corresponding member RAIN A.B. Maslennikova.- Issue. 24.- Novosibirsk: Akademizdat, 2016.- 262: p. 52-63
*
Belousova E.D., Dorofeeva M.Yu., Sharkov A.A. Epilepsy in tuberous sclerosis. In "Brain diseases, medical and social aspects" edited by Gusev E.I., Gekht A.B., Moscow; 2016; pp.391-399
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Dadali E.L., Sharkov A.A., Sharkova I.V., Kanivets I.V., Konovalov F.A., Akimova I.A. Hereditary diseases and syndromes accompanied by febrile seizures: clinical and genetic characteristics and diagnostic methods. //Russian Journal of Child Neurology.- T. 11.- No. 2, p. 33- 41. doi: 10.17650/ 2073-8803-2016-11-2-33-41
*
Sharkov A.A., Konovalov F.A., Sharkova I.V., Belousova E.D., Dadali E.L. Molecular genetic approaches to the diagnosis of epileptic encephalopathies. Collection of abstracts “VI BALTIC CONGRESS ON CHILD NEUROLOGY” / Edited by Professor Guzeva V.I. St. Petersburg, 2016, p. 391
*
Hemispherotomy for drug-resistant epilepsy in children with bilateral brain damage Zubkova N.S., Altunina G.E., Zemlyansky M.Yu., Troitsky A.A., Sharkov A.A., Golovteev A.L. Collection of abstracts “VI BALTIC CONGRESS ON CHILD NEUROLOGY” / Edited by Professor Guzeva V.I. St. Petersburg, 2016, p. 157.
*
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Article: Genetics and differentiated treatment of early epileptic encephalopathies. A.A. Sharkov*, I.V. Sharkova, E.D. Belousova, E.L. Yes they did. Journal of Neurology and Psychiatry, 9, 2016; Vol. 2doi: 10.17116/jnevro 20161169267-73
*
Golovteev A.L., Sharkov A.A., Troitsky A.A., Altunina G.E., Zemlyansky M.Yu., Kopachev D.N., Dorofeeva M.Yu. " Surgery epilepsy in tuberous sclerosis" edited by Dorofeeva M.Yu., Moscow; 2017; p.274
*
New international classifications epilepsy and epileptic seizures of the International League Against Epilepsy. Journal of Neurology and Psychiatry. C.C. Korsakov. 2017. T. 117. No. 7. P. 99-106

Head of Department
"Genetics of predispositions"
biologist, genetic consultant

Dudurich
Vasilisa Valerievna

– head of the department “Genetics of predispositions”, biologist, genetic consultant

In 2010 – PR specialist, Far Eastern Institute of International Relations

In 2011 – Biologist, Far Eastern Federal University

In 2012 – Federal State Budgetary Institution Research Institute of Physics and Chemistry, FMBF of Russia “Gene diagnostics in modern medicine”

In 2012 – Study “Introduction of genetic testing into a general clinic”

In 2012 – Professional training “Prenatal diagnosis and genetic passport - the basis of preventive medicine in the age of nanotechnology” at the D.I. Ott Research Institute of AG, Northwestern Branch of the Russian Academy of Medical Sciences

In 2013 – Professional training “Genetics in clinical hemostasiology and hemorheology” at the Bakulev Scientific Center for Cardiovascular Surgery

In 2015 – Professional training within the framework of the VII Congress of the Russian Society of Medical Genetics

In 2016 – School of Data Analysis “NGS in Medical Practice” of the Federal State Budgetary Institution “MGSC”

In 2016 – Internship “Genetic counseling” at the Federal State Budgetary Institution “MGNC”

In 2016 – Took part in International Congress in Human Genetics, Kyoto, Japan

From 2013-2016 – Head of the Medical Genetics Center in Khabarovsk

From 2015-2016 – teacher at the Department of Biology at the Far Eastern State Medical University

From 2016-2018 – Secretary of the Khabarovsk branch of the Russian Society of Medical Genetics

In 2018 – Participated in the seminar “Reproductive Potential of Russia: Versions and Counterversions” Sochi, Russia

Organizer of the school-seminar “The Age of Genetics and Bioinformatics: Interdisciplinary Approach in Science and Practice” - 2013, 2014, 2015, 2016.

Work experience as a genetic counselor – 7 years

Founder Charitable Foundation named after Queen Alexandra to help children with genetic pathology alixfond.ru

Areas of professional interests: myrobiome, multifactorial pathology, pharmacogenetics, nutrigenetics, reproductive genetics, epigenetics.

Head of
"Prenatal diagnosis"

Kyiv
Yulia Kirillovna

In 2011 she graduated from the Moscow State Medical and Dental University. A.I. Evdokimova with a degree in General Medicine. She studied residency at the Department of Medical Genetics of the same university with a degree in Genetics.

In 2015, she completed an internship in Obstetrics and Gynecology at the Medical Institute for Advanced Training of Physicians of the Federal State Budgetary Educational Institution of Higher Professional Education "MSUPP"

Since 2013, he has been conducting consultations at the State Budgetary Institution "Center for Family Planning and Reproduction" of the Department of Health.

Since 2017, he has been the head of the “Prenatal Diagnostics” direction of the Genomed laboratory

Regularly makes presentations at conferences and seminars. Gives lectures for various specialist doctors in the field of reproduction and prenatal diagnostics

Provides medical and genetic counseling to pregnant women on prenatal diagnostics in order to prevent the birth of children with congenital defects development, as well as families with presumably hereditary or congenital pathology. Interprets the obtained DNA diagnostic results.

SPECIALISTS

Latypov
Arthur Shamilevich

Latypov Artur Shamilevich is a geneticist doctor of the highest qualification category.

After graduating from the Kazan State Medical Faculty in 1976 medical institute for many years he worked first as a doctor in the office of medical genetics, then as the head of the medical genetic center of the Republican Hospital of Tatarstan, the chief specialist of the Ministry of Health of the Republic of Tatarstan, and as a teacher at the departments of Kazan Medical University.

Author over 20 scientific works on problems of reproductive and biochemical genetics, participant of many domestic and international congresses and conferences on problems of medical genetics. He introduced methods of mass screening of pregnant women and newborns for hereditary diseases into the practical work of the center, and performed thousands of invasive procedures for suspected hereditary diseases of the fetus at different stages of pregnancy.

Since 2012 he has been working at the Department of Medical Genetics with a course in prenatal diagnostics of the Russian Academy postgraduate education.

Area of ​​scientific interests: metabolic diseases in children, prenatal diagnostics.

Doctors are seen by appointment.

Geneticist

Gabelko
Denis Igorevich

In 2009 he graduated from the Faculty of Medicine of KSMU named after. S. V. Kurashova (specialty “General Medicine”).

Internship at the St. Petersburg Medical Academy of Postgraduate Education Federal agency in Health and Social Development (specialty “Genetics”).

Internship in Therapy. Primary retraining in the specialty " Ultrasound diagnostics" Since 2016, he has been an employee of the department of the Department of Fundamental Principles of Clinical Medicine of the Institute of Fundamental Medicine and Biology.

Area of ​​professional interests: prenatal diagnosis, the use of modern screening and diagnostic methods to identify genetic pathology fetus Determining the risk of recurrence of hereditary diseases in the family.

Participant of scientific and practical conferences on genetics and obstetrics and gynecology.

Work experience 5 years.

Doctors are seen by appointment.

Geneticist

Grishina
Kristina Alexandrovna

She graduated from the Moscow State Medical and Dental University in 2015 with a degree in General Medicine. In the same year, she entered residency in the specialty 08/30/30 “Genetics” at the Federal State Budgetary Institution “Medical Genetic Research Center”.
She was hired at the Laboratory of Molecular Genetics of Complexly Inherited Diseases (headed by Dr. A.V. Karpukhin) in March 2015 as a research assistant. Since September 2015, she has been transferred to the position research fellow. He is the author and co-author of more than 10 articles and abstracts on clinical genetics, oncogenetics and molecular oncology in Russian and foreign journals. Regular participant in conferences on medical genetics.

Area of ​​scientific and practical interests: medical and genetic counseling of patients with hereditary syndromic and multifactorial pathology.

A consultation with a geneticist allows you to answer the following questions:

Are the child’s symptoms signs of a hereditary disease? what research is needed to identify the cause determining an accurate forecast recommendations for conducting and evaluating the results of prenatal diagnostics everything you need to know when planning a family consultation when planning IVF visiting and online consultations

Geneticist

Gorgisheli
Ketevan Vazhaevna

She is a graduate of the medical and biological faculty of the Russian National Research Institute Medical University named after N.I. Pirogov 2015, defended thesis on the topic “Clinical and morphological correlation of vital indicators of the body’s condition and morphofunctional characteristics of blood mononuclear cells in severe poisoning.” She completed clinical residency in the specialty “Genetics” at the Department of Molecular and Cellular Genetics of the above-mentioned university.

took part in the scientific and practical school "Innovative genetic technologies for doctors: application in clinical practice", the conference of the European Society of Human Genetics (ESHG) and other conferences dedicated to human genetics.

Conducts medical and genetic counseling for families with suspected hereditary or congenital pathologies, including monogenic diseases and chromosomal abnormalities, determines indications for laboratory genetic studies, and interprets the results of DNA diagnostics. Consults pregnant women on prenatal diagnostics to prevent the birth of children with congenital malformations.

Geneticist, obstetrician-gynecologist, candidate of medical sciences

Kudryavtseva
Elena Vladimirovna

Geneticist, obstetrician-gynecologist, candidate of medical sciences.

Specialist in the field of reproductive counseling and hereditary pathology.

Graduated from the Ural State Medical Academy in 2005.

Residency in Obstetrics and Gynecology

Internship in the specialty "Genetics"

Professional retraining in the specialty “Ultrasound diagnostics”

Activities:

• Infertility and miscarriage
Vasilisa Yurievna



She is a graduate of the Nizhny Novgorod State Medical Academy, Faculty of Medicine (specialty “General Medicine”). She graduated from clinical residency at FBGNU "MGNC" with a degree in Genetics. In 2014, she completed an internship at the Maternity and Childhood Clinic (IRCCS materno infantile Burlo Garofolo, Trieste, Italy).

Since 2016, he has been working as a consultant physician at Genomed LLC.

Regularly participates in scientific and practical conferences on genetics.

Main activities: Consulting on clinical and laboratory diagnostics of genetic diseases and interpretation of results. Management of patients and their families with suspected hereditary pathology. Consulting when planning pregnancy, as well as during pregnancy, on prenatal diagnostics in order to prevent the birth of children with congenital pathologies.

From 2013 to 2014, she worked as a junior researcher at the Laboratory of Molecular Oncology at the Rostov Cancer Research Institute.

In 2013 - advanced training “Current issues of clinical genetics”, State Budgetary Educational Institution of Higher Professional Education Rost State Medical University of the Ministry of Health of Russia.

In 2014 - advanced training “Application PCR method in real time for gene diagnostics of somatic mutations", Federal Budgetary Institution "Central Research Institute of Epidemiology of Rospotrebnadzor".

Since 2014 – geneticist at the laboratory of medical genetics at Rostov State Medical University.

In 2015, she successfully confirmed her qualification as a Medical Laboratory Scientist. He is a current member of the Australian Institute of Medical Scientist.

In 2017 - advanced training “Interpretation of the results of genetic studies in patients with hereditary diseases”, NOCHUDPO “ The educational center on continuing medical and pharmaceutical education"; “Current issues of clinical laboratory diagnostics and laboratory genetics”, Rostov State Medical University of the Ministry of Health of Russia; advanced training "BRCA Liverpool Genetic Counseling Course", Liverpool University.

Regularly participates in scientific conferences, is the author and co-author of more than 20 scientific publications in domestic and foreign publications.

Main activity: clinical and laboratory interpretation of DNA diagnostic results, chromosomal microarray analysis, NGS.

Areas of interest: application of the latest genome-wide diagnostic methods in clinical practice, oncogenetics.

– general concept, uniting a group of neoplasms of the trachea, lungs and bronchi, characterized by uncontrolled division and proliferation of cells, invasion into surrounding tissues, their destruction and metastasis to lymph nodes and distantly located organs. Malignant lung tumors develop from moderately, poorly or undifferentiated cells that differ significantly in structure and function from normal ones. Malignant lung tumors include lymphoma, squamous cell and oat cell carcinoma, sarcoma, pleural mesothelioma, and malignant carcinoid. Diagnosis of malignant tumors of the lungs includes radiography, CT or MRI of the lungs, bronchography and bronchoscopy, cytological examination of sputum and pleural effusion, biopsy, PET.

ICD-10

C34 Malignant neoplasm of the bronchi and lung

General information

– a general concept that unites a group of neoplasms of the trachea, lungs and bronchi, characterized by uncontrolled division and proliferation of cells, invasion into surrounding tissues, their destruction and metastasis to lymph nodes and distantly located organs. Malignant lung tumors develop from moderately, poorly or undifferentiated cells that differ significantly in structure and function from normal ones.

The most common malignant tumor of the lungs is lung cancer. Lung cancer occurs 5-8 times more often in men than in women. Lung cancer usually affects patients over 40-50 years of age. Lung cancer ranks first among the causes of death from cancer, both among men (35%) and women (30%). Other forms of malignant lung tumors are reported much less frequently.

Causes of malignant lung tumors

The appearance of malignant tumors, regardless of location, is associated with disorders of cell differentiation and tissue proliferation (proliferation) that occur at the gene level.

Factors that cause such disorders in the tissues of the lung and bronchi are:

• active smoking and passive inhalation of cigarette smoke. Smoking is the main risk factor for lung cancer (90% in men and 70% in women). Nicotine and tars contained in cigarette smoke, have a carcinogenic effect. In passive smokers, the likelihood of developing malignant lung tumors (especially lung cancer) increases several times.
• harmful occupational factors (contact with asbestos, chromium, arsenic, nickel, radioactive dust). People who are occupationally exposed to these substances are at risk of developing lung cancer, especially if they are smokers.
• living in areas with increased radon radiation;
• the presence of scar changes in lung tissue, benign lung tumors prone to malignancy, inflammatory and suppurative processes in the lungs and bronchi.

These factors influencing the development of malignant lung tumors can cause DNA damage and activate cellular oncogenes.

Types of malignant lung tumors

Malignant lung tumors can initially develop in the lung tissue or bronchi (primary tumor), and also metastasize from other organs.

Lung cancer is an epithelial malignant tumor of the lungs arising from the mucosa of the bronchi, bronchial glands or alveoli. Lung cancer has the property of metastasizing to other tissues and organs. Metastasis can occur in 3 ways: lymphogenous, hematogenous and implantation. The hematogenous route is observed when the tumor grows in blood vessels, lymphogenous - into lymphatic. In the first case, tumor cells are transported through the bloodstream to another lung, kidneys, liver, adrenal glands, bones; in the second - to the lymph nodes of the supraclavicular region and mediastinum. Implantation metastasis is observed when a malignant lung tumor grows into the pleura and spreads throughout the pleura.

Based on the location of the tumor in relation to the bronchi, peripheral lung cancer (develops from small bronchi) and central lung cancer (develops from the main, lobar or segmental bronchi) are distinguished. Tumor growth can be endobronchial (into the lumen of the bronchus) and peribronchial (towards the lung tissue).

Based on their morphological structure, the following types of lung cancer are distinguished:

• low- and high-grade squamous cell (epidermoid lung cancer);
• low- and high-grade glandular lung cancer (adenocarcinoma);
• undifferentiated (oat cell or small cell) lung cancer.

The mechanism of development of squamous cell lung cancer is based on changes in the bronchial epithelium: replacement of the glandular tissue of the bronchi with fibrous tissue, cylindrical epithelium with squamous epithelium, the emergence of foci of dysplasia that develop into cancer. Hormonal factors play a role in the occurrence of carcinoma. genetic predisposition, capable of activating carcinogens that have entered the body.

Oat cell carcinoma refers to malignant lung tumors of the diffuse neuroendocrine system (APUD-system), producing biologically active substances. This type of lung cancer gives hematogenous metastases at an early stage.

For peripheral localization lung tumors pleural effusion is determined. The diagnosis of such a malignant lung tumor is confirmed by a cytological examination of the effusion obtained by pleural puncture, or a pleural biopsy. The presence of a primary tumor or metastases in the lungs can be determined by cytological examination of sputum. Bronchoscopy allows you to examine the bronchi down to the subsegmental ones, detect a tumor, collect bronchial lavages and thoracic surgeons. Taking into account the stage and extent of the lesion, one or two lobes of the lung are removed (lobectomy or bilobectomy); if the process is widespread, removal of the lung and regional lymph nodes (pneumonectomy). Method of carrying out surgical intervention may be thoracotomy or videothoracoscopy. Single or multiple metastases in the lung are operated on if the primary lesion is removed.

Surgical treatment for malignant lung tumors is not carried out in the following cases:

• impossibility radical removal tumors
• presence of distant metastases
• severe dysfunction of the lungs, heart, kidneys, liver

A relative contraindication to surgical treatment is the patient’s age over 75 years.

IN postoperative period or if there are contraindications to surgery, radiation and/or chemotherapy is performed. Often, various types of treatment for malignant lung tumors are combined: chemotherapy - surgery - radiation therapy.

Prognosis and prevention

Without treatment, the life expectancy of patients diagnosed with malignant lung tumors is about 1 year.

The prognosis for radical surgery is determined by the stage of the disease and the histological appearance of the tumor. The most unfavorable results are produced by small cell, poorly differentiated cancer. After operations for differentiated forms of stage I cancer, the five-year survival rate of patients is 85-90%, for stage II - 60%, after removal of metastatic foci - from 10 to 30%. Mortality in the postoperative period is: with lobectomy - 3-5%, with pneumonectomy - up to 10%.

Prevention of malignant lung tumors dictates the need to actively combat smoking (both active and passive). The most important measures are to reduce exposure to carcinogens at work and in the environment. Preventive X-ray examination of people at risk (smokers, patients with chronic pneumonia, workers in hazardous industries, etc.) plays a role in the prevention of malignant lung tumors.

Tumors form a large group of diverse neoplasms in the human lungs. In this case, they grow significantly lung tissue, pulmonary pleura or bronchi, which consist of physically changed cells that are no longer able to perform their functions.

Benign and malignant formations differ in the degree of differentiation of the affected cells.

In addition, tumor-like tissue from other organs may enter the lungs; these tumors are considered malignant by default.

Causes, development factors and differentiation of the disease

Among the reasons that lead to tumors in the lungs, many different factors can be identified:

It is especially worth noting that the risk of developing a neoplasm increases in the case of a chronic disease with decreased immunity, for example:

1. Bronchial asthma.
2. COPD
3. Chronic bronchitis.
4. Tuberculosis, pneumonia, and some other diseases.

In order to differentiate the neoplasm, additional examinations are necessary: ​​the tumor can be a benign granuloma, which are quite harmless in nature, but there is also a possibility that the neoplasm will turn out to be a malignant tumor, which urgently needs to be cured.

Among neoplasms there are two categories:

• Benign tumors;
• Malignant.

Benign formations appear from ordinary, healthy-looking cells. A pseudocapsule forms in them, and the surrounding tissues atrophy.

Metastases this type does not form tumors. Benign tumors appear for the most part in men and women under 45 years of age, and in general percentage they make up about 7-10% of the totality of all possible tumors in the lungs.

Benign ones come from cells that are similar in structure to healthy cells. These formations grow slowly, do not destroy neighboring cells and do not infiltrate.

The following types of benign formations are distinguished:

Symptoms of benign formations

The manifestations of benign tumors are quite varied and are divided into categories depending on the stage of the disease. There are three stages of the disease:

Diagnosis of the disease

In order to make a correct diagnosis, it is necessary to carry out several additional procedures. It should be noted that single nodules in the lungs are especially dangerous for people over 35 years of age and can occur in smokers, including those who have recently quit smoking.

In people who do not smoke and are under 35 years of age, the chance that a single tumor will be malignant and form lung cancer is less than one percent.

This observation allows us to draw a conclusion about the good quality of education. The next sign will be the physical size of the tumor: tumors measuring less than a centimeter in size in the rarest cases are malignant.

Calcium inclusions also reduce the likelihood that it is malignant - this can be determined using the same x-ray observation. And another sign of a benign tumor is the absence of tumor growth for two years. This observation should be carried out under the supervision of doctors, who should carefully monitor the tumor and make adjustments taking into account changes in its size.

X-ray is used to identify a variety of pathological diseases lungs, it can be used to identify various tumors in the lungs. On an x-ray, the neoplasm is visible as a fuzzy shadow with defined boundaries; the structure of such formations is quite clear and homogeneous, however, you can also notice some especially prominent elements: similar to blocks small size decalcifications – hamartomas and tuberculomas – and hard, structurally bone-like fragments – teratomas.

Neoplasms of a benign or malignant nature are often asymptomatic - the patient does not make any complaints, and these pathologies can only be detected by X-ray studies.

But you still need to know that the above information does not provide a 100% guarantee that the tumor is benign and, of course, cannot serve as a sufficient basis for making a diagnosis. Only a specialist who has been observing the patient for a long time and knows his medical history can make an expert opinion based on data analysis and radiographs, as well as endoscopic observations. The decisive moment is a biopsy, the study of the materials of which will become the basis for the doctor’s verdict.

An important point will be the preservation of old x-rays, which are needed in order to compare with the newest images. This will make it possible to more accurately identify the location of the tumor and determine its nature. This operation will help save time and avoid unnecessary actions and begin treatment sooner.

If the patient does not have the opportunity to find images taken in the recent past, then people under 35 years of age who do not smoke should undergo this procedure once every three months, and then once a year - and this is in the absence of data indicating malignancy. education. In addition, it is recommended to do fluorography, which should be carried out by clinics at the place of residence.

A computed tomogram will be an invaluable assistant in identifying a benign tumor, because it can detect not only tumors, but also find traces of adipose tissue, which is characteristic of lipomas, it will help find fluid in the lungs.

Fluid is present in cysts and tumors of vascular origin. Computed tomography makes it possible to distinguish benign formations from tuberculomas, various options cancer and peripheral cancer.

Doctors should also determine the presence or absence of voice tremors and breathing, and determine wheezing in the chest. An asymmetrical chest can become a sign of obstruction of the main bronchus of the lung; other signs of this disease are smoothed intercostal spaces and a lag in the dynamics of the corresponding half of the cell. If the amount of data obtained from these studies is not enough, then doctors use other methods: thoracoscopy or thoracoscopy with biopsy.

Treatment of a benign tumor

In this case drug therapy useless, benign formation is subject to complete removal by surgical intervention. Only timely diagnosis can avoid irreversible consequences for the health of the patient and his lungs.

Tumors are determined by thoracoscopy or thoracomy.

Early diagnosis of the tumor is especially important, which allows you to save the maximum amount of tissue during surgery, and this in turn makes it possible to avoid numerous complications. Dealing with recovery after surgery pulmonology department. The vast majority of operations are completed quite successfully, and the recurrence of tumors is practically excluded.

To remove the central lung tumor, a bronchial resection method is used. In this method, the lung tissue is not affected, but a small incision is made, which allows for the preservation of most of the functional lung tissue. Fenestrated resection is used to remove a bronchus at the so-called narrow base, which is subsequently sutured or a bronchotomy is performed at this site.

For a more serious and massive tumor, one or two lobes of the lung are removed - this method is called a lobectomy or bilobectomy. Sometimes - especially severe cases resort to pneumonectomy - removal of the entire lung. This operation is indicated for patients who have suffered serious lung damage due to the occurrence of a benign tumor. Peripheral tumors are amputated using enucleation, segmental resection is also possible, and especially massive tumors are amputated using lobectomy.

Patients over thirty-five years of age and smokers, in addition to the above examinations, are also required to undergo a biopsy. The biopsy is performed by an experienced surgeon, and depending on its location and size, the sampling technique differs. It is imperative to note that quitting smoking reduces the risk of developing various diseases lungs, including neoplasms.

– malignant tumors, originating in the mucous membrane and glands of the bronchi and lungs. Cancer cells divide quickly, enlarging the tumor. Without proper treatment it grows into the heart, brain, blood vessels, esophagus, spine. The bloodstream spreads cancer cells throughout the body, forming new metastases. There are three phases of cancer development:

• The biological period is from the moment the tumor appears until its signs are recorded on x-rays (grade 1-2).
• Preclinical - asymptomatic period manifests itself only on x-rays (grade 2-3).
• Clinical shows other signs of the disease (grade 3-4).

Causes

The mechanisms of cell degeneration are not fully understood. But thanks to numerous studies, chemical substances, capable of accelerating cell transformation. We will group all risk factors according to two criteria.

Reasons beyond a person's control:

• Genetic predisposition: at least three cases of a similar disease in the family or the presence of a similar diagnosis in a close relative, the presence of several different forms of cancer in one patient.
• Age after 50 years.
• Tuberculosis, bronchitis, pneumonia, scars on the lungs.
• Problems of the endocrine system.

Modifiable factors (what can be influenced):

• Smoking is the main cause of lung cancer. When tobacco is burned, 4,000 carcinogens are released, covering the bronchial mucosa and burning living cells. Together with the blood, the poison enters the brain, kidneys, and liver. Carcinogens settle in the lungs until the end of life, covering them with soot. Smoking experience of 10 years or 2 packs of cigarettes per day increases the chance of getting sick by 25 times. Passive smokers are also at risk: 80% of exhaled smoke comes from them.
• Professional contacts: asbestos-related factories, metallurgical enterprises; cotton, linen and felt mills; contact with poisons (arsenic, nickel, cadmium, chromium) at work; mining (coal, radon); rubber production.
• Poor ecology, radioactive contamination. The systematic influence of air polluted by cars and factories on the lungs of the urban population changes the mucous membrane of the respiratory tract.

Classification

There are several types of classification. In Russia, there are five forms of cancer depending on the location of the tumor.

1. Central cancer- in the lumen of the bronchi. In the first degree, it is not detected on photographs (masks the heart). The diagnosis may be indicated indirect signs X-ray: decreased airiness of the lung or regular local inflammation. All this is combined with a persistent cough with blood, shortness of breath, and later chest pain and fever.
2. Peripheral cancer penetrates into the lungs. Painful sensations no, the diagnosis is determined by x-ray. Patients refuse treatment, not realizing that the disease is progressing. Options:
   • Cancer of the apex of the lung grows into the vessels and nerves of the shoulder. In such patients, osteochondrosis takes a long time to be treated, and they get to the oncologist late.
   • The cavity form appears after the collapse of the central part due to lack of nutrition. Neoplasms up to 10 cm are confused with an abscess, cysts, tuberculosis, which complicates treatment.
3. Pneumonia-like cancer treated with antibiotics. Without getting the desired effect, they end up in oncology. The tumor is distributed diffusely (not in a node), occupying most of the lung.
4. Atypical forms: brain, liver, bone create metastases in lung cancer, and not the tumor itself.
   • The hepatic form is characterized by jaundice, heaviness in the right hypochondrium, deterioration of blood tests, and enlarged liver.
   • Brain damage looks like a stroke: a limb does not work, speech is impaired, the patient loses consciousness, headache, convulsions, bifurcation.
   • Bone – pain symptoms in the spine, pelvic region, limbs, fractures without injury.
5. Metastatic neoplasms originate from a tumor of another organ with the ability to grow, paralyzing the functioning of the organ. Metastases up to 10 cm lead to death from decay products and dysfunction internal organs. The primary source is the maternal tumor cannot always be determined.

According to histological structure (cell type), lung cancer can be:

1. Small cell– the most aggressive tumor, quickly occupies and metastasizes in the early stages. Frequency of occurrence – 20%. Forecast – 16 months. with non-advanced cancer and 6 months. - when widespread.
2. Non-small cell It is more common and characterized by relatively slow growth. There are three types:
   • squamous cell carcinoma lung (from flat lamellar cells with slow growth and a low frequency of early metastases, with areas of keratinization), prone to necrosis, ulcers, ischemia. 15% survival rate.
   • adenocarcinoma develops from glandular cells. It spreads quickly through the bloodstream. Survival rate is 20% with palliative treatment, 80% with surgery.
   • large cell carcinoma has several varieties, is asymptomatic, and occurs in 18% of cases. Average survival rate 15% (depending on type).

Stages

• Lung cancer stage 1. A tumor up to 3 cm in diameter or a bronchial tumor in one lobe; there are no metastases in neighboring lymph nodes.
• Lung cancer stage 2. A tumor in the lung is 3-6 cm, blocks the bronchi, grows into the pleura, causing atelectasis (loss of airiness).
• Lung cancer stage 3. A tumor of 6-7 cm spreads to neighboring organs, atelectasis of the entire lung, the presence of metastases in neighboring lymph nodes ( lung root and mediastinum, supraclavicular areas).
• Lung cancer stage 4. The tumor grows into the heart, large vessels, and fluid appears in the pleural cavity.

Symptoms

Common symptoms of lung cancer

• Fast weight loss,
• no appetite,
• decline in performance,
• sweating,
• unstable temperature.

Specific signs:

• cough, debilitating, without obvious reason- companion of bronchial cancer. The color of the sputum changes to yellow-green. In a horizontal position, physical exercise, in the cold, coughing attacks become more frequent: a tumor growing in the area of ​​the bronchial tree irritates the mucous membrane.
• Blood when coughing is pinkish or scarlet, with clots, but hemoptysis is also a sign.
• Shortness of breath due to inflammation of the lungs, collapse of part of the lung due to tumor blockage of the bronchial tube. With tumors in large bronchi, organ shutdown may occur.
• Chest pain due to the penetration of cancer into the serous tissue (pleura), growing into the bone. At the beginning of the disease there are no alarm signals; the appearance of pain indicates advanced stage. The pain can radiate to the arm, neck, back, shoulder, intensifying when coughing.

Diagnostics

Diagnosing lung cancer is not an easy task, because oncology looks like pneumonia, abscesses, and tuberculosis. More than half of tumors are detected too late. For the purpose of prevention, it is necessary to undergo an x-ray annually. If cancer is suspected, they undergo:

• Fluorography to determine tuberculosis, pneumonia, lung tumors. If there are deviations, you need to take an x-ray.
• X-ray of the lungs more accurately assesses the pathology.
• Layered X-ray tomography problem area– several sections with the focus of the disease in the center.
• Computed tomography or magnetic resonance imaging with the introduction of contrast on layer-by-layer sections shows in detail and clarifies the diagnosis according to explicit criteria.
• Bronchoscopy diagnoses central cancer tumors. You can see the problem and take a biopsy - a piece of affected tissue for analysis.
• Tumor markers test the blood for a protein produced only by the tumor. The NSE tumor marker is used for small cell cancer, the SSC and CYFRA markers are used for squamous cell carcinoma and adenocarcinoma, and CEA is a universal marker. The diagnostic level is low; it is used after treatment for early detection of metastases.
• Sputum analysis has a low probability of suggesting the presence of a tumor if atypical cells are detected.
• Thoracoscopy - examination through camera punctures in pleural cavity. Allows you to take a biopsy and clarify changes.
• A biopsy with a CT scan is used when there is doubt about the diagnosis.

The examination must be comprehensive, because cancer masquerades as many diseases. Sometimes they even use exploratory surgery.

Treatment

Type (radiological, palliative,) is selected based on the stage of the process, histological type of tumor, medical history). The most reliable method is surgery. For stage 1 lung cancer, 70-80%, stage 2 - 40%, stage 3 - 15-20% of patients survive the control period of five years. Types of operations:

• Removal of a lobe of the lung corresponds to all principles of treatment.
• Marginal resection removes only the tumor. Metastases are treated in other ways.
• Removal of the lung completely (pneumoectomy) - with a tumor of 2 degrees for central cancer, 2-3 degrees - for peripheral cancer.
• Combined operations - with the removal of part of the adjacent affected organs.

Chemotherapy has become more effective thanks to new drugs. Small cell lung cancer responds well to polychemotherapy. With the right combination (taking into account sensitivity, 6-8 courses with an interval of 3-4 weeks), survival times increase 4 times. Chemotherapy for lung cancer. It is carried out in courses and gives positive results for several years.

Non-small cell cancer is resistant to chemotherapy (partial tumor resorption occurs in 10-30% of patients, complete resorption is rare), but modern polychemotherapy increases survival rate by 35%.

They also treat with platinum preparations - the most effective, but also the most toxic, which is why they are administered with large (up to 4 liters) amounts of liquid. Possible side effects: nausea, intestinal disorders, cystitis, dermatitis, phlebitis, allergies. top scores achieved by combining chemotherapy and radiation therapy, simultaneously or sequentially.

Radiation therapy uses gamma-ray installations of beta-trons and linear accelerators. The method is designed for inoperable patients of grade 3-4. The effect is achieved due to the death of all cells of the primary tumor and metastases. Good results receive at small cell cancer. In case of non-small cell irradiation, irradiation is carried out according to a radical program (in case of contraindications or refusal of surgery) for patients of 1-2 degrees or for palliative purposes for patients of 3 degrees. The standard dose for radiation treatment is 60-70 gray. In 40% it is possible to achieve a reduction in the oncological process.

Palliative treatment - operations to reduce the impact of the tumor on the affected organs to improve the quality of life with effective pain relief, oxygenation (forced oxygen saturation), treatment of associated diseases, support and care.

Traditional methods are used exclusively to relieve pain or after radiation and only in consultation with a doctor. Relying on healers and herbalists for such a serious diagnosis increases the already high risk of death.

Forecast

The prognosis for lung cancer is unfavorable. Without special treatment, 90% of patients die within 2 years. The prognosis is determined by the degree and histological structure. The table presents data on the survival rate of cancer patients for 5 years.