Can a benign lung tumor be treated? Benign tumor of the lung. Inflammatory processes caused by infection

18.05.2017

Benign formations in lung tissue are understood as a group of tumors that differ in structure and origin.

Benign ones are detected in 10% of the total number of pathologies detected in the organ. Women and men are susceptible to the disease.

A benign tumor in the lungs is distinguished by its slow growth, absence of symptoms and destructive effect on neighboring tissues in the initial stages. That is why patients seek medical help late, not being aware of the presence of pathology.

The reason for the formation of pathologies in the lungs is not fully understood; there are only assumptions in the form of heredity, long-term exposure to toxic substances, radiation, and carcinogens.

The risk group includes people who often suffer from bronchitis, patients with asthma, tuberculosis, and emphysema. Smoking is one of the main factors, according to doctors, that causes the development of tumors.

Each smoker can assess his risk of developing the disease by calculating it using the formula - the number of cigarettes per day is multiplied by the months of smoking experience, and the result is divided by 20. If the resulting figure is more than 10, then the risk of one day discovering a lung tumor is high.

What types of tumors are there?

All pathological growths are classified according to their main characteristics. By localization:

• peripheral (formed in small bronchi, grow deep in the tissue or on its surface) are diagnosed more often than central ones, detected in each of the two respiratory organs equally often;
• central (originating in the large bronchi, growing either inside the bronchus or into the lung tissue) are more often detected in the right lung;
• mixed.

Based on the tissue from which the tumor is formed, the following are distinguished:

• those that are formed from the epithelium (polyp, papilloma, carcinoid, cylindroma, adenoma);
• tumors from neuroectodermal cells (schwannoma, neurofibroma);
• formations from mesodermal cells (fibroma, chondroma, leiomyoma, hemangioma, lymphangioma);
• formations from germ cells (hamartoma, teratoma).

Of the types of growths listed above, benign lung tumors in the form of hamartomas and adenomas are most often detected.

An adenoma is formed from the epithelium, the standard size is 2-3 cm. As it grows, the bronchial mucosa ulcerates and atrophies. Adenomas can develop into cancerous tumors.

The following adenomas are known: carcinoma, adenoid, as well as cylindroma and carcinoid. In approximately 86% of cases, a carcinoid is detected; in 10% of patients, the tumor can mutate into cancer.

Hamartoma is a tumor formed from embryonic tissues (layers of fat, cartilage, glands, connective tissues, lymph accumulations, etc.). Hamartomas grow slowly and do not show symptoms. They are a round tumor without a capsule, the surface is smooth. Rarely degenerate into hamartoblastoma (a pathology of a malignant nature).

Papilloma is a tumor with many growths, formed from connective tissue. It develops in the tissues of large bronchi, sometimes it can block the lumen of the organ and mutate into a malignant formation. Sometimes several tumors of this type are detected at once - in the bronchi, trachea and larynx. In appearance, the papilloma resembles a cauliflower inflorescence, is located on a stalk, also on the base, and has a color from pink to red.

Fibroma is a formation up to 3 cm in size, formed from the connective epithelium. The pathology can affect both lungs and grow to half of the sternum. Neoplasms are localized centrally and peripherally and are not prone to mutation.

Lipoma (also known as a wen) is a tumor of adipose tissue and is rarely detected in the respiratory system. The bronchus is formed in the central part more often than in the periphery. As the lipoma grows, it does not lose its good quality and is distinguished by the presence of a capsule, elasticity and density. More often, a tumor of this type is diagnosed in women, it can be on the base or stalk.

Vascular benign tumors of the lungs (hemangioma of the cavernous and capillary type, hemangiopericytoma, lymphangioma) are detected in 3% of pathological formations here. They are localized both in the center and on the periphery. They are characterized by a round shape, dense consistency, and the presence of a capsule. Tumors grow from 10 mm to 20 cm or more. This localization is detected by hemoptysis. Hemangiopericytoma, like hemangioendothelioma - only according to some signs - are benign lung tumors, since they can grow quickly and become malignant. In contrast, hemangiomas do not grow quickly, do not affect neighboring tissues, and do not mutate.

Teratoma is a benign tumor of the lungs, consisting of a “bouquet” of tissues - sebum, cartilage and hair, sweat glands, etc. It is detected mostly in young people and grows slowly. There are cases of tumor suppuration and mutation into teratoblastoma.

Neuroma (also known as schwannoma) is a tumor of nerve tissue, detected in 2% of all cases of blastomas in the lung. Usually located on the periphery, it can affect 2 lungs at once. The tumor is characterized by the presence of a clear capsule and the round shape of the nodes. Mutation of neuromas has not been proven.

There are other benign lung tumors, which are quite rare - histiocytoma, xanthoma, plasmacytoma, tuberculoma. The latter is a form of tuberculosis.

Clinical picture of a tumor in the lung

Symptoms vary depending on the location of the growth and the size of the pathological formation, the direction of its growth, hormonal dependence, and complications. As mentioned above, benign formations do not manifest themselves for a long time; they can gradually grow over the years without disturbing a person. There are three stages of development of neoplasms:

• asymptomatic;
• initial clinical symptoms;
• pronounced clinical symptoms, when benign lung tumors give complications in the form of atelectasis, bleeding, abscess pneumonia, pneumosclerosis, mutation into a malignant neoplasm, metastasis.

The asymptomatic stage of a peripheral tumor, as the name implies, is characterized by the absence of signs. Once the tumor progresses to the next stages, the symptoms will vary. For example, large tumors can put pressure on the chest wall and diaphragm, which causes pain in the chest and heart area, and shortness of breath. If the vessels are eroded, bleeding in the lungs and hemoptysis is detected. Large tumors, squeezing the bronchi, impair patency.

Benign tumors in the central part of the organ disrupt bronchial patency, causing partial stenosis, with more severe damage - valve stenosis, and with serious disease - occlusion. Each stage is characterized by its own symptoms.

With partial stenosis, the course of the disease does not manifest itself much; sometimes patients complain of coughing with sputum. The disease does not affect general well-being. The tumor is not visible on X-ray; for diagnosis, you need to undergo bronchoscopy and CT.

In the presence of valve stenosis (valvular), the tumor blocks most of the lumen of the organ; when exhaling in the bronchus, the lumen closes, and when air is inhaled, it opens slightly. In the part of the lung where the bronchus is damaged, emphysema is detected. Due to swelling, accumulation of sputum with blood.

Symptoms manifest as cough with sputum, sometimes with hemoptysis. The patient complains of chest pain, fever, shortness of breath and weakness. If at this moment the disease is treated with anti-inflammatory drugs, pulmonary ventilation can be restored, swelling can be relieved and the inflammatory process can be stopped temporarily.

With bronchial occlusion, irreversible changes in a fragment of lung tissue and its death are revealed. The severity of symptoms depends on the volume of tissue affected. The patient exhibits fever, shortness of breath up to attacks of suffocation, weakness, coughing up sputum with pus or blood.

What complications do tumors in the lungs cause?

The presence of a tumor in the lungs and bronchi is fraught with complications that can manifest themselves to one degree or another. The main pathological conditions are listed below:

• pneumofibrosis - due to a long inflammatory process, the lung tissue loses its elasticity, the affected area cannot perform a gas exchange function, and connective tissue begins to grow;
• atelectasis - impaired bronchial patency leads to loss of ventilation due to changes in the tissue of the organ - it becomes airless;
• bronchiectasis - stretching of the bronchi due to the proliferation and compaction of connective tissue next to them;
• abscess pneumonia is an infectious disease characterized by the formation of cavities with pus in the lung tissue;
• compression syndrome – pain due to compression of lung tissue;
• mutation into a malignant neoplasm, bleeding in the lungs.

Tumor diagnosis

Considering the asymptomatic course of the disease in the early stages, it is not surprising that tumors are detected by chance on X-ray or fluorography. On an x-ray, the tumor looks like a rounded shadow with a clear contour; the structure can be homogeneous and with inclusions.

Detailed information can be obtained using CT, where it is possible to detect not only the tissue of dense neoplasms, but also fatty tissues (lipomas), as well as the presence of fluid (vascular tumors). The use of contrast enhancement on CT allows one to distinguish a benign tumor from peripheral cancer, etc.

Bronchoscopy as a diagnostic method allows you to examine a centrally located tumor and take a fragment for biopsy and cytological examination. For peripherally located tumors, bronchoscopy is performed to identify compression of the bronchus, narrowing of the lumen, changes in angle and displacement of the branches of the bronchial tree.

If a peripheral tumor is suspected, it is advisable to perform a transthoracic puncture or aspiration biopsy under ultrasound or X-ray control. Pulmonary angiography can detect vascular neoplasms. Already at the examination stage, the doctor may note a dullness of sound during percussion, weakening of breathing, and wheezing. The chest looks asymmetrical, and the affected part lags behind the other when breathing.

Treatment of tumors

In general, treatment for benign lung tumors consists of removing them, regardless of the risk of degeneration into malignant neoplasms. The earlier the tumor is detected and removed, the fewer complications after surgery and the risk of developing an irreversible process in the lung.

Tumors localized in the central parts are removed by resection of the bronchus. If the tumor is attached to a narrow base, complete resection is prescribed, after which the defect is sutured. If the tumor is attached to a wide base, a circular resection of the bronchus is performed and an interbronchial anastomosis is performed. If the patient has already developed complications in the form of fibrosis, abscesses, then they may prescribe the removal of 1-2 lobes of the lung, and when irreversible changes are detected, the lung is removed.

Tumors localized in the periphery are removed in several ways: enucleation, resection, and, if large, lobectomy. Depending on a number of factors, thoracoscopy or thoracotomy is performed. If the tumor is attached to the organ by a thin stalk, endoscopic surgery is prescribed. The operation is minimally invasive, but has side effects - there is a risk of bleeding, incomplete tumor removal, and bronchological control is required after the operation.

If the thoracic surgeon suspects that the tumor is malignant, urgent histology is performed during the operation - a fragment of the tumor is examined in the laboratory. If the surgeon’s suspicions are confirmed, the operation plan changes slightly, and a surgical intervention is performed, similar to the procedure for lung cancer.

If a benign tumor in the lung is identified and treated in time, the long-term results will be favorable. With radical surgery, relapses are rare. For carcinoids, the prognosis is unfavorable; for different types of tumor, the 5-year survival rate ranges from 100 to 37.9%.

Considering the above, you need to take care of your health in a timely manner and do not forget to visit doctors.

Lung tumors in many cases are not malignant, i.e. the diagnosis of lung cancer in the presence of a tumor is not always made. Often the lung tumor is benign.

Nodules and spots in the lungs can be seen on an x-ray or CT scan. They are dense, small, round or oval-shaped areas of tissue surrounded by healthy lung tissue. There may be one or several nodules.

According to statistics, Lung tumors are most often benign if:

• The patient is under 40 years old;
• He does not smoke
• Calcium content was detected in the nodule;
• Small nodule.

Benign lung tumor appears as a result of abnormal tissue growth and can develop in various parts of the lungs. Determining whether a lung tumor is benign or malignant is very important. And this needs to be done as early as possible, because early detection and treatment of lung cancer significantly increases the likelihood of a complete cure and, ultimately, the patient’s survival.

Symptoms of a benign lung tumor

Benign nodules and tumors in the lungs are usually do not cause any symptoms. That is why it is almost always are diagnosed by chance during a chest x-ray or computed tomography scan.

However, they can cause the following symptoms of the disease:

• Hoarseness;
• persistent cough or coughing up blood;
• Dyspnea;
• A febrile state, especially if the disease is accompanied by pneumonia.

2. Causes of benign tumors

The reasons why benign lung tumors appear are poorly understood. But in general they appear often after health problems such as:

Inflammatory processes caused by infection:

• Fungal infections – histoplasmosis, coccidioidomycosis, cryptococcosis, aspergillosis;
• Tuberculosis
• Lung abscess
• Pneumonia

Inflammation not associated with infection:

• Rheumatoid arthritis;
• Wegener's granulomatosis;
• Sarcoidosis.
• Congenital pathologies such as lung cyst and others.

3. Types of tumors

Here are some of the most common types of benign lung tumors:

• Hamartomas. Hamartomas are the most common type of benign lung tumor and one of the common causes of the formation of solitary pulmonary nodules. This type of lung tumor is formed from the tissues of the lining of the lungs, as well as fatty and cartilage tissue. As a rule, hamartoma is located on the periphery of the lungs.
• Bronchial adenoma. Bronchial adenoma accounts for about half of all benign lung tumors. It is a heterogeneous group of tumors that arise from the mucous glands and ducts of the trachea or large airways of the lungs. Mucous adenoma is one example of a true benign bronchial adenoma.
• Rare lung tumors may appear in the form chondroma, fibroma, lipoma– benign lung tumors consisting of connective or adipose tissue.

4. Diagnosis and treatment

Diagnosis of benign lung tumors

In addition to X-ray examination and computed tomography for diagnosing lung tumors, which we have already discussed, diagnosing the patient’s health condition may include monitoring the dynamics of tumor development over several years. This practice is usually used if the size of the nodule does not exceed 6 mm and the patient is not at risk for lung cancer. If the nodule remains the same size for at least two years, it is considered benign. This is due to the fact that benign lung tumors grow slowly, if they grow at all. Cancerous tumors, on the other hand, double in size every four months. Further annual monitoring for at least five years will help to definitively confirm that the lung tumor is benign.

Benign lung nodules usually have smooth edges and a more uniform color throughout. They are more regular in shape than cancerous nodules. In most cases, to check the growth rate, shape and other characteristics of the tumor (for example, calcification), it is enough chest x-ray or computed tomography (CT) scan.

But it is possible that your doctor will prescribe other studies, especially if the tumor has changed in size, shape, or appearance. This is done to rule out lung cancer or determine the underlying cause of benign nodules.

For diagnosis you may need:

• Blood analysis;
• Tuberculin tests to diagnose tuberculosis;
• Positron emission tomography (PET);
• Single photo-irradiation CT (SPECT);
• Magnetic resonance imaging (MRI, in rare cases);
• A biopsy is the removal of a tissue sample and further examination under a microscope to determine whether a lung tumor is benign or malignant.

A biopsy can be performed using various techniques, such as needle aspiration or bronchoscopy.

Treatment of benign lung tumors

In many cases, specific treatment for a benign lung tumor is not required. Nevertheless, removal of the tumor may be recommended in case if:

• You smoke and the nodule is large;
• Unpleasant symptoms of the disease appear;
• The examination results give reason to believe that the lung tumor is malignant;
• The nodule increases in size.

If surgery is required to treat a lung tumor, it is performed by a thoracic surgeon. Modern techniques and the qualifications of a thoracic surgeon make it possible to perform the operation with small incisions and reduce the time of hospital stay. If the removed nodule was benign, no further treatment will be required unless the presence of the tumor was complicated by other problems, such as pneumonia or obstruction.

Sometimes treatment requires more complex invasive surgery, during which the nodule or part of the lungs is removed. The doctor decides which surgery will be necessary, taking into account the location and type of tumor.

It would seem that a healthy lifestyle, that is, good nutrition, the absence of chronic diseases and bad habits, but breathing becomes difficult, an unreasonable cough appears, shortness of breath and the general condition of the body is weak.

Why? Such symptoms may indicate pathological processes in the body, the examination of which should begin with the respiratory system. First of all, it is necessary to conduct a biochemical analysis of blood and urine, then take an x-ray of the lungs. The presence of unclear foci and shadows on the respiratory organs in the image requires mandatory consultation with a pulmonologist, phthisiatrician and oncologist. Pulmonary pathologies include: bronchitis, pneumonia, pleurisy, atelectasis, abscesses, gangrene, tuberculosis and lung tumors. These processes can occur with a benign course and degenerate into the malignant nature of the disease.

Development of lung cancer

A lung tumor can be considered both as a precancerous condition and as a malignant formation. This form of oncology ranks second in increasing morbidity and mortality after tumor-like formations of the digestive and reproductive systems in men and women.

The pathogenesis of precancerous conditions (benign course of pathology) develops in the presence of chronic processes in the bronchi and lung tissue. This is preceded by diseases such as:

• Chronical bronchitis;
• Pneumonia;
• Pneumosclerosis;
• Bronchiectasis;
• Chronic tuberculosis;
• Complicated influenza;
• Silicosis.

The risk group includes people who complain of a prolonged, causeless cough and the presence of bloody streaks in the sputum, as well as a prolonged increase in ESR in a blood test and a constantly observed low-grade body temperature. This list can be supplemented by chronic smokers and patients who have deformation of the respiratory organs as a result of tuberculosis pathology.

A malignant growth in the lung tissue is called lung cancer. Symptoms of this pathology are observed in people in adulthood, and especially in males. The reason for the development of oncology today is considered to be a genetic, that is, hereditary factor, as well as the weakness of the body’s immune system to overcome environmental pollution, occupational hazards, frequent diseases of the respiratory system and smoking. The last factor determines one of the main influences on the occurrence of lung cancer. Heavy smokers need about five years of abstinence for the lungs to begin to recover and about fifteen years for the organ to reach the status of being free of smoking residues.

The localization of lung cancer can be varied and it develops from the glands and epithelium lining the bronchi. The classification of the tumor depends on the symptoms of differentiation of its degree. There are squamous cell, small cell, anaplastic and glandular lung cancer. The location of the lesion of the main, initial and lobar pulmonary segments is considered to be the localization of the central tumor, and the area of ​​bronchioles and subsegmental bronchi is considered to be peripheral cancer.

Central lung cancer

Atypical cells of such a tumor grow exophytically, that is, starting from the lumen of the bronchus, they spread into the lung tissue. Metastases in this form spread through the lymphohematogenous route. This occurs by affecting the nodes and vessels of the lymphatic system near the gate and in the interlobar region of the lungs, and then the spread affects the lymph flows of the root section of the lung tissue. As the tumor develops, metastases descend to the mediastinal and tracheobronchial nodes and then can penetrate the subclavian, cervical and even axillary lymph nodes. Metastases can be transported through the bloodstream to the adrenal glands, liver, bones and brain.

The classification of oncological pathologies, as a rule, according to the symptoms of the course, is determined by four stages. Early tumor development can be attributed to the first two stages of the spread of atypical cells. The treatment and prognosis for such damage to the lung tissue is more favorable than for cancer of the respiratory organs, and these are the lobes of the lungs, bronchi and trachea.

Determination of the localization, size and distribution of metastases is classified according to the system TNM. If a malignant formation is detected by analysis of bronchial mucus or by cytological examination, but with no image on x-ray, then the designation is established Tx. When the tumor initially affects the tissues of the respiratory organs, indicate the titer T or That when the formation is invisible in the field of view. According to the classification from T1-T3, the location of the tumor and its size are observed with a clear image. The tumor can reach more than three centimeters and is located in the area of ​​the carina of the trachea, the root of the lung, the diaphragm, the mediastinum, the chest wall, affecting the entire lung tissue with pleural effusion observed. A mandatory addition to this system are captions N— condition of the lymph nodes in the regional areas of the bronchi (N1) and mediastinum (N2), as well as tumor metastasis – M, Where M1 indicates the detection of metastases and Mo, Mx - about their absence or difficult determination.

Main symptoms

The symptomatic clinical picture of respiratory cancer is usually difficult to recognize. The occurrence of cough, shortness of breath, constant increase in temperature to low-grade levels and pain in the chest area may alert about the occurrence of an atypical pathological process in the lungs. Symptoms of the presence of a tumor can be expressed in cases such as:

Presence of cough reflex and shortness of breath . A person who smokes a lot for a long time almost always notices the desire to clear his throat. This condition occurs when products from the combustion of cigarette filling substances accumulate in the bronchial mucosa. A dry, hacking cough torments at night, in the morning and at the end of the day. At the same time, a small amount of sputum and even streaks of blood may be released, which is typical for the primary oncological process. The appearance of heavy bleeding may indicate severe damage to the lung tissue. If gas exchange and ventilation of the lungs are impaired, shortness of breath appears during physical activity of the body and with increased environmental humidity;

Painful spasms in the chest . The persistence of pain in the chest wall may indicate not only the presence of pathology in the respiratory system. This sensation is also observed with abnormalities in the functioning of the heart, liver and pancreas. Mild and constant chest pain is observed in most pulmonary cancer patients;

Loss of energy, drowsiness and weakness with lung cancer , appears together with the presence of a slightly elevated body temperature. This process is determined by the protective properties of the body, which try to fight excreted tumors and decay products.

The clinical course of such symptoms can last a long time, and sometimes at an accelerated rate of tumor development. Its rapid growth is often accompanied by bronchitis, pneumonia and pleurisy. The condition of the organs, in this case, can be slightly improved with anti-inflammatory treatment. But the occurrence of recurrent pathologies indicates rapid tumor growth. At the same time, the hormonal balance in the body is disrupted, which leads to a decrease in the rate of metabolic processes with potassium, glucose and calcium in the blood. With this course of metabolism in cancer patients, pulmonary osteopathy is often observed, which is expressed by painful sensations in the legs and difficult mobility in the legs and knee joints. This is considered one of the initial symptoms of respiratory cancer.

Signs

The increase in clinical indicators of cancer is accompanied by other signs of abnormalities in the functioning of the respiratory system, and these are:

• Difficulty in moving the diaphragm;
• Disturbance of innervation and blood supply in nerve and large venous vessels;
• Vocal cord paresis and intercostal neuralgia;
• Difficult passage of the esophagus due to its compression by a tumor or enlarged lymph nodes;
• Hemoptysis, exudative pleurisy with abscess or gangrene of the lung, which is accompanied by an unbearable rotten odor when the patient breathes.

Video on the topic

Examination and treatment of a cancer patient

Recognizing the development of benign tumors and cancer in the patient's respiratory organs is a complex process. Symptoms of abnormalities in the functioning of the bronchi and lungs can be attributed to pathologies of an inflammatory nature, the occurrence of injuries during the digestive act or infection with a tuberculosis infection. To establish a reliable diagnosis, it is necessary, first of all, to collect an anamnesis of pathological abnormalities and conduct an examination using auscultation and percussion. The second and most basic step is to examine the X-ray image of the lungs. The presence of shadows, cavities and capsule-shaped foci in the respiratory organs can indicate the shape of the cancer, its location, size, contours and the cavity of its decay. The diagnosis of oncological pathology is complemented by other hardware methods:

• Angiography and bronchography;
• Tomography of the bronchi and trachea;
• Bronchoscopy and puncture of the pulmonary pleural cavity followed by cytological examination of bronchial mucus and pleural fluid.

The subsequent treatment of the patient and the prognosis for further life activities depend on a correctly established diagnosis after examination. As a rule, for cancer of the pulmonary system, the most effective treatment methods, depending on the extent of the lesion and the stage of the tumor, are a conservative approach and a radical one. Conservative treatment is provided for early forms of malignant tumors and in terminal conditions of the patient to facilitate his life. This treatment involves the use of antitumor drugs in a combination form, these are chemotherapy drugs and antibiotics (methotrexate, cyclophosphamide, Adriamycin and others).

The treatment effect is also significantly enhanced by the use of radiation therapy, which, according to the latest technologies, is aimed at removing a specific lesion through irradiation without affecting nearby organ tissue. If the malignant process is more severe and there are no contraindications to surgery, surgical intervention is resorted to. Radical treatment consists of removing the tumor and resection of lung tissue. The indication for removal of a segment of lung tissue, its lobe, and sometimes the entire affected lung is considered to be the determination of the oncological process according to the lung cancer classification system.

The prognosis for a favorable outcome for the continuation of the life of a pulmonary cancer patient depends on his timely referral to a specialist, the establishment of an accurate diagnosis and the use of effective treatment with subsequent rehabilitation.

Video on the topic

Oncological pathology of the bronchopulmonary system is a rather serious problem. The lungs are an organ that does not have pain receptors in its structure. Therefore, pain, as a symptom of damage, appears at fairly late stages of the disease. The article discusses the main aspects of the etiology, clinical picture, diagnosis and treatment of peripheral lung cancer.

It then swells and penetrates the alveoli with rich protein fluid to edema. Disorders of fluid and ion transport, as well as increased activity of neutrophils and macrophages lead to increased production of cytokines. 9 Neutrophils migrate into the vesicular space, which is most likely a consequence rather than a cause of acute lung injury. The number of these cells, as well as their activation and secretion of cytokines, determines the damage to this organ.

In some cases it is found

Activated neutrophils are isolated, in particular. free oxygen radicals, which, together with cytokines, damage the epithelial cells of the alveoli, which, in turn, reduces the formation of protective surfactant 11. All these changes at the cellular level obviously affect the course of the respiratory process, causing its disorder, known by many names of lung diseases. This extremely powerful and apparently powerful organ breaks down easily because it does not isolate it from external factors.

Etiological factors

It is not entirely clear what exactly causes peripheral lung cancer. However, those factors that can contribute to the appearance of this disease and its rapid progression have been precisely identified.

Any develops faster when smoking. The length of time you systematically inhale nicotine directly affects the degree of threat of developing cancer. In addition, the more cigarettes a patient uses per day, the more pronounced will be the chronic inflammatory and degenerative changes in the epithelial lining of the respiratory tract and lungs.

The air we breathe is only slightly filtered, warmed and humidified as it enters the lungs through the nose. However, it cannot stop all irritants. Some of them can still catch the thin layer of mucus lining the bronchi, which is removed from the lungs using special cilia or cough reflexes - the so-called. The sputum may then contain blood, oil, or pathogens 12.

Substances that overwhelm these defense mechanisms cause damage to the delicate and essentially delicate lungs. Although the number of diseases that can result from their attacks is long, in principle most of them are due to similar risk factors.

The peripheral form of cancer of the bronchopulmonary system arises, to a greater extent, not through the bronchogenic route (inhalation of carcinogenic compounds), like central cancer, but hematogenously. For example, inhalation of asbestos or metals with carcinogenic effects leads to the appearance of. It affects the large bronchi. Peripheral lung cancer occurred more often in those individuals who had increased concentrations of the same carcinogenic compounds in their blood.

Nicotine is the best documented risk factor for lung disease. The risk of its occurrence increases with the number of cigarettes. 13. Smoking and cigars also cause significant morbidity and mortality. Likewise, exposure to secondhand smoke is a major risk factor 14 .

The reason tobacco smoke has such a high impact on the development of lung diseases is that it contains highly irritating substances that lead to chronic irritation, inflammation and obstruction of the airways. 15. Smoking also worsens overall lung function, increases respiratory symptoms, and leads to cancer.

The environmental situation has a significant impact on the risks of oncopathology of the pulmonary-bronchial system. Residents of cities and megalopolises are susceptible to colonization of the respiratory tract by irritants and pollutants of various chemical compositions.

Chronic inflammation of the bronchi is a significant risk factor. This applies to patients with chronic broncho-obstructive disease and bronchitis.

Causes of benign tumors

Ambient air pollution, mainly sulfur dioxide, is associated with a significant deterioration in respiratory function. 16. This concerns primarily the long-term effects of pollution. At this year's European Respiratory Society Congress, researchers presented the latest research showing that childhood exposure to carbon dioxide doubles the risk of death from respiratory disease in adults.

Another study found that short-term exposure to air pollution also leads to an immediate and immediate decline in lung function. In: Braunwald's heart disease. . Dust particles and mites, gases evaporating from smokeless heating systems, volatile and semi-volatile organic compounds from chemicals, asbestos, mold, allergens, viruses and bacteria from ventilation systems can also cause irritation of the respiratory tract and worsen symptoms of lung disease. air conditioner.

Any inflammation that lasts for a long time can become a factor in malignancy. Especially when it comes to organs lined with epithelial cells.

Heredity, closing this list, in fact occupies far from the last place among the possible causes of oncological transformation of normal cells. Not only tumors of the lungs or bronchi are important, but also the cancer process of any location.

Genetic and congenital factors

Causes of lung disease also include genetic predisposition and birth defects. Some researchers have reported that autoimmune disease is dependent on the development of airway obstruction. A similar relationship was observed in patients with emphysema - levels of autoantibodies correlated with the severity of the disease, indicating that it is partly autoimmune.

Treatment of lung cancers

Significance may also be found in certain coding genes, poor lung development during the fetus, a weak immune system, and even gender—women are more sensitive to the effects of tobacco smoke, for example. Of course, the main principle of preventing lung disease is to avoid all of these risk factors - especially stopping smoking, as well as proper maintenance of used heating and air conditioning units, ventilation of rooms and even regular cleaning to minimize the presence of dust, mites and allergens.

Symptoms of the disease

A peripheral space-occupying formation, localized in any lung, exerts volume pressure either on the bronchi, or grows into the pleura, or other adjacent structures and organs, depending on its size. Modern oncologists distinguish several groups of clinical manifestations.

The mechanism of development of a benign lung tumor

Otherwise, we find that our respiratory system comes into contact with highly irritating substances, resulting in serious illness. Even seemingly trivial inflammation can be dangerous. Tests have also shown that some lung diseases are more severe in people who are too low in the sun vitamin. However, they have not proven that this deficiency is a direct cause of lung disease problems.

When and how to check lung efficiency?

Australian scientists conducted further experiments on mice. The motivation to control our lungs must already be exposed to risk factors such as smoking or jobs that involve inhaling toxic gases or pollutants. If you experience symptoms such as cough, shortness of breath, shortness of breath or chest pain, you should think about the main function of the respiratory system, which is spirometry.

The first group of symptoms are signs of intrathoracic spread of the tumor mass. However, unlike bronchogenic (central) cancer, the peripheral form of cancer does not manifest itself so clearly.

Cough appears when the size is significant. The same goes for hemoptysis. This symptom marks the destruction of the tumor conglomerate or the germination of the bronchus with a violation of the integrity of its mucosa.

Based on the examination, the doctor determines whether there may be obstruction, that is, a disproportion between the volume of the lungs and the volume of air flowing through individual parts of the respiratory system. It is based on the intensive release of air from the lungs into a special device. Before performing it for 4 hours. Don't smoke or drink alcohol, and don't eat heavy meals or exercise. Spirometry can be performed in a doctor's office.

Admittedly, it is used to determine the severity of shortness of breath and severity of illness 24, but may well be the first warning sign. Lung cancer is the most common malignant tumor in Poland - about 21 thousand are diagnosed every year. Lung cancer is a very broad concept that refers to different types of cancer. Due to biological characteristics and treatment used, it is divided into: small cells and non-small cells.

Chest pain and shortness of breath are also more typical for cancer of central origin. But it is known that with large sizes, the peripheral form clinically becomes indistinguishable from the bronchogenic one.

Hoarseness occurs when the left recurrent nerve is damaged. Peripheral cancer of the left lung is quite often accompanied by this striking syndrome. But the patient complains about this even when the size of the formation is serious. Peripheral cancer of the upper lobe of the left lung is a rare finding in young patients.

At a later stage, hoarseness, cough, shortness of breath, hemoptysis, or general weakness may occur. However, for some people, the first symptoms do not appear until metastases have begun. The main risk factors for developing lung cancer are cigarette smoking—multiple smokers are about 60 times more likely to develop it—passive smoking, exposure to asbestos or heavy metals, inactivity, a diet low in fruits and vegetables, and genetic predisposition. Molecular diagnostics plays a special role in the treatment of non-small cell lung cancer.

Tuberculosis lesions are more often localized there. But with age, the first and second segments become the site of localization of a peripheral malignant tumor. Peripheral cancer of the lower lobe of the left lung (as well as the right) is less common than pneumonia. This is the second most common disease in this area. It is difficult to imagine the clinical features of a tumor in the described localization.

Diagnosis and treatment

This makes it possible to detect epidermal growth factor receptor mutations in the cells of this tumor. Such changes in cells cause them to multiply rapidly, leading to rapid metastasis to other organs. The most commonly used material is cancerous lung tissue removed during surgery or tumor cells obtained by puncturing it during bronchoscopy or by puncturing it directly through the chest.

The advantage of targeted therapy for treating this disease is that, unlike radiation therapy or chemotherapy, it mainly removes the cells that have changed in the cancer. If you have the option of using targeted therapy, you should talk to your doctor. Ask him or her to interpret the results, explain problems you don't understand, explain what they are and what therapy looks like. Don't be afraid to ask a lot of questions. Remember, this concerns your health!

More often, peripheral cancer of the right lung develops. This is due to the anatomical features of the branching of the bronchi. Peripheral cancer of the upper lobe of the right lung is more common in elderly patients. Detection of radiological changes in this area requires additional research using tomographic techniques.

How to prepare for a conversation with a doctor? A cancer diagnosis comes as a shock to us. The stress associated with this makes us often unable to concentrate on the information provided to us by the doctor. Rational thinking replaces emotions: fear, panic. As a result, when we leave the office, all we know is that we have cancer. What treatment will be used, how will it be planned, what can we expect from it?

Diagnosis of benign neoplasms

The answers to these and many other questions, even if they fell out of the doctor’s mouth, are probably not in our memory. In this situation, after cooling down, we begin to search for information “on our own.” At the same time, they are not always adequate to the specifics of our disease, and they can mislead us.

Taking into account the syntopy of the lungs, in the later stages of the disease, symptoms of damage to neighboring organs develop. Dysphagia often bothers patients when the esophageal wall is involved. When the tumor spreads to the heart muscle or pericardium, functional disorders occur: arrhythmias, hypertension or hypotension.

To avoid this situation, you should prepare for every visit to the doctor's office.

• Write down questions you would like to ask your doctor.
• Take a notebook and pen with you and write down the most important information.

The first step to actively participating in your treatment is to have an open discussion with your doctor. By being prepared to talk, you leave the office with as much knowledge as possible about cancer and an understanding of how best to participate in the treatment process. How can I change my lifestyle to best support my targeted therapy? What changes in our lives should prepare my family?

• Don't be embarrassed to ask him anything that interests you or worries you.
• If you don't understand something, ask him to explain it again.
• What did my tests do and what are they waiting for?
• If not, when and how will they be implemented?
• Are molecular tests painful?
• How do you do it?

Features of the apical localization of the tumor

Apical cancer does not develop as often as tumors of the above-described localizations. It should be noted that the apex of the lung is the favorite localization of the tuberculosis process. Therefore, it is necessary to exclude this chronic infectious disease first.

Cancer of the apex of the lung occurs with fairly clear symptoms, which are underestimated by doctors of related specialties.

It has been well documented that in the context of lung cancer protection and prevention, high cross-over intake may protect against lung cancer, which is likely due to the presence of phytochemicals. The results suggest that a low intake of omega-6 fatty acids and a high intake of omega-3 fatty acids may help prevent lung cancer. Pulmonary exposure to eicosapentaenoic acid has been shown to reduce the production of prostaglandins from arachidonic acid, which may lead to decreased proliferation of cancer cells.

Regularly reduces the risk of developing lung cancer in women. Regular consumption protects women and men from this type of cancer. Studies have shown a negative correlation between boron intake and lung cancer in women. Preliminary results indicate that adequate intake of copper, zinc and iron reduces the risk of lung cancer and plays an important role in lung cancer prevention.

Thus, pain in the shoulder joint, accompanied by atrophic changes in the muscles of the forearm, is regarded by rheumatologists and therapists as a manifestation of glenohumeral periarthritis or osteoarthritis.

Apical lung cancer has a different name in the literature - Pancoast cancer. The symptom complex for this localization is also called.

It includes damage to the 1st and 2nd ribs, detected on a chest x-ray. Horner's symptom is characteristic, which includes a triad of signs:

• miosis – constriction of the pupil;
• enophthalmos;
• ptosis (drooping) of the eyelid on the affected side.

These manifestations are associated with the involvement of the sympathetic trunk in the process.

Paraneoplastic syndrome

We are talking about hormonal imbalances and metabolic changes caused by the tumor process. Most often, the development of a clear and obvious paraneoplastic syndrome is associated with a non-small cell variant of peripheral cancer.

Typically severe muscle weakness. It may be accompanied by the appearance of convulsive syndrome. This is associated with hypomagnesemia.

Endocrine changes relate to a greater extent to Cushingoid syndrome. As part of hypercortisolism, high blood pressure develops. Darkening of the skin (hyperpigmentation), first in the area of ​​folds and folds, then diffuse, may be disturbing.

Edema may also indicate paraneoplastic syndrome. But they can also be caused by superior vena cava syndrome when this vessel is compressed by a tumor from the outside and subsequent thrombosis.

Metastasis

The occurrence of screening lesions is an inevitable part of the cancer process. Lung tumor metastases spread in three ways:

The lymphogenous route is considered the main one. Regional nodes are affected first. Contralateral metastasis is possible. Depending on which lymphatic collectors are affected by cancer cells, oncologists classify the disease.

Hematogenously, metastases spread to various organs. The adrenal glands are quite often affected. At the same time, symptoms of insufficiency of the function of this organ are revealed: weakness, drop in blood pressure, arrhythmias (feelings of interruptions in the functioning of the heart), electrolyte shifts in laboratory tests.

And examination of the skull using X-rays or computed tomography reveals bone damage. In about a fifth of patients, metastases can be found there.

Detection of metastatic foci in the brain and liver occurs with equal frequency. Therefore, the second stage of diagnosis includes ultrasound examination of the abdominal organs and tomography of the skull.

Diagnostic measures

The screening method for detecting the disease is fluorography. Today the frequency of this study is once a year.

Peripheral lung cancer progresses very quickly. Therefore, doctors of any specialty should pay attention to clinical manifestations.

Usually “minor” symptoms go unnoticed. Namely, they indicate that the disease is just beginning. Unfortunately, they are very nonspecific, and patients themselves rarely seek medical advice regarding their occurrence. What about these symptoms?

A complete blood count may reveal an acceleration of ESR. If the normal values ​​are significantly exceeded, it is necessary to begin a search for oncopathology. Anemia is also characteristic - a decrease in hemoglobin levels. A detailed study reveals its redistributive nature (sideroachrestic anemia).

A biochemical blood test reveals an increase in calcium levels and a decrease in magnesium concentrations. C-reactive protein levels may be increased.

X-ray is indicative in later stages. The signs of peripheral lung cancer are not much different from the manifestations of a bronchogenic tumor in the image, especially in the later stages.

There are special forms of peripheral lung cancer. A spherical tumor is visible on an x-ray as a round shadow. Its contours are uneven. Clinically, it is worth saying that it rarely manifests itself. This is due to the fact that globular cancer comes from bronchial cells of the 4th order.

– inflammation of the lung tissue surrounding the mass formation. During treatment with antibiotics, the size of the tumor noticeably decreases, but the radiologist should be alerted to the appearance of radiance around the focal point of the darkening. This indicates inflammation of the lymphatic vessels - lymphangitis.

The cavity form of peripheral lung cancer is a formation that has undergone decay in its central part. This is due to tissue ischemia. On the radiograph it will be a ring-shaped shadow with a horizontal level of liquid. The contours are uneven.

The second stage of diagnosis is clarifying. It is necessary to determine the form of the disease, the extent of the tumor, its histological structure, degree of differentiation, and hormonal activity.

It is necessary to identify the presence of metastases, because all this affects the prognosis and treatment tactics. In order to understand the size and degree of involvement of neighboring organs and structures, it is necessary to conduct tomography. Mediastinoscopy, bronchoscopy, thoracoscopy are designed to assess whether the mediastinum, heart, esophagus, pleura, and lymphatic collectors are affected.

A puncture with transthoracic access allows for the collection of biological material for cytological examination. Cellular composition, cell differentiation, histochemical features will allow us to assess the operability of the situation.

Metastases are often localized in the brain and liver. Abdominal ultrasound is necessary to visualize the liver. The brain is examined using tomography.

Often the adrenal glands involved should also be examined. MRI is an integral technique for achieving this goal. Scanning of the body's bone structures and x-rays reveal lesions in the bones. The bronchoscopic stage is important for differential diagnosis. They should not be neglected, but at the same time, patients should be referred for such a study according to indications.

Treatment approaches and prognosis

Lung cancer can be treated in two ways: surgery and radiation therapy. The first method is not always practical.

If there are no metastases, and the tumor size does not exceed 3 cm in diameter, and neighboring structures are not involved, lobectomy is indicated. This. A fairly large volume of surgery is dictated by a large number of relapses. In addition, this is required by the rules of ablastics and antiblastics, on which oncology surgery is based.

If the isolateral lymphatic collectors (on one side) of the first order are affected by metastatic foci, lobectomy may also be justified. But domestic cancer surgeons prefer removal of the entire lung - pneumonectomy.

Tumor invasion of the esophagus, metastases to contralateral lymph nodes, distant organs - brain, liver, adrenal glands - are contraindications to surgery. Also, severe concomitant pathology in the stage of decompensation will prevent surgical intervention.

For these cases, radiation therapy is used. It can be an addition to surgery. Then this treatment of emerging peripheral cancer of one or both lungs is called complex.

Radiation exposure to the tumor is advisable before surgery to reduce the size of the tumor. Many factors influence survival. They are associated both with the characteristics of the tumor process and with the general condition of the patient:

Thus, the main problems of oncology are timely diagnosis and adequate treatment. Peripheral lung cancer, with careful attention to one's own body, can be detected in time and successfully treated.

Lung tumors can be benign or malignant, as well as metastatic.

Benign tumors do not destroy, do not infiltrate tissues and do not metastasize (for example, hamartomas).

Malignant tumors grow into surrounding tissues and metastasize (for example, lung cancer). In 20% of cases, local forms of malignant tumors are diagnosed, in 25% there are regional, and in 55% there are distant metastases.

Metastatic tumors primarily arise in other organs and metastasize to the lungs. In this article, we will look at the symptoms of a lung tumor and the main signs of a lung tumor in humans.

Lung tumor symptoms

Symptoms and signs of lung tumor

Lung tumors in the early stages are asymptomatic and, as a rule, are detected incidentally during preventive X-ray examinations or examinations for other diseases. The asymptomatic period can last for years. The doctor should exercise oncological vigilance in relation to people over 45 years of age, especially active smokers and people with occupational hazards.

Complaints from lung tumors

With endobronchial damage, patients complain of symptoms such as cough (in 75% of cases) and hemoptysis (57%). The cough is often persistent, constant, sometimes with scanty sputum. Such patients, to varying degrees, have signs of bronchial obstruction, causing shortness of breath. Inspiratory dyspnea is more reflective of atelectasis or the formation of pleural effusion. Chest pain (in 50% of cases) is characteristic of tumor growth into the pleura. When the recurrent nerve is compressed, hoarseness occurs.

When germination and compression by a tumor or lymph nodes with metastases of the nerve trunks occur, neurological symptoms come first:

• weakness in the arms, paresthesia (as a result of damage to the brachial plexus);
• Horner's syndrome (miosis, narrowing of the palpebral fissure and enophthalmos);
• anhidrosis (as a result of damage to the cervical sympathetic nodes), which is especially typical for apical cancer (Pancoast cancer);
• shortness of breath (as a result of damage to the phrenic nerve).

Malignant and especially metastatic tumors are characterized by weight loss, up to cachexia, as well as complaints associated with lesions of distant organs (most often the brain, skeletal bones). In some patients, the first symptom is itching, and in older people there is a rapid development of ichthyosis or dermatoses.

Examination for lung tumors

When examining a patient in the early stages of tumor development, no clinical signs are detected. As the tumor grows, signs appear that depend on the location of the tumor. Quite often, with lymphogenous spread, an enlargement of the supraclavicular lymph nodes on the left is detected (Virchow’s metastasis). Dilation of collateral veins on the upper chest and neck, on the mammary gland, swelling and hyperemia of the face, and conjunctiva are characteristic of superior vena cava syndrome. In 10-20% of cases, examination reveals one or another manifestation of dermatoses, which disappears after removal of the tumor. Late signs of a malignant neoplasm are weight loss, cachexia. An increase in temperature, especially evening low-grade fever, is quite typical for tumor processes.

Signs of a lung tumor

There are several theories about the development of lung cancer. Toxic effects can lead to the accumulation of genetic abnormalities in cells (activation of dominant oncogenes and inactivation of recessive oncogenes (tumor suppressor genes) as a result of mutations). This results in uncontrolled, disorganized growth with lesions localized or distant from the primary tumor. Decisive factors are considered to be DNA damage, activation of cellular oncogenes and stimulation by growth factors. Primary lung cancer usually develops from the glandular epithelium of the bronchi. As central lung cancer grows, the obstruction of the bronchial tube occurs, which leads to its obstruction and atelectasis of the lower parts of the lung. As the tumor progresses, it grows into other organs and tissues (chest wall, pericardium, esophagus, etc.), giving metastases to the liver, brain, bones and other organs.

Diagnosis of lung tumor

On the affected side, increased vocal tremors can be detected.

Percussion for lung tumors

Lung tumors are characterized by a pronounced shortening of the percussion sound over the area of ​​the space-occupying lesion. However, when the bronchus is obstructed by a tumor and the valve mechanism is formed, local emphysema may initially develop, which leads to a boxy percussion sound. Subsequent atelectasis is accompanied by shortening of the percussion sound. In mediastinal forms of lung cancer, percussion can detect signs of unilateral expansion of the mediastinum.

Auscultation for lung tumors

With endobronchial growth of the tumor, local wheezing and local weakening of breathing may appear. The appearance of moist rales along with fever, sweating and weakness may indicate the development of obstructive pneumonia.

X-ray examination of a lung tumor

Preventive fluorographic examination plays a major role in the early detection of lung tumors. It is radiation research methods that make it possible to detect a space-occupying lesion in an asymptomatic period. Suspicious symptoms: focal, spherical formations, expansion of the root and decreased differentiation of its elements, expansion or displacement of the mediastinum. The first radiological symptom of the endobronchial development of central lung cancer is hypoventilation of the area corresponding to the affected bronchus: a decrease in the transparency of a segment or lobe, the convergence of blood vessels and their dilation due to congestive hyperemia. On longitudinal tomograms and bronchograms it is possible to identify the stump of an obstructed bronchus. In the peribronchial form of lung cancer, tomograms in the root plane show a peribronchial node associated with the bronchial wall. The contours of the pathological shadow are characterized by tuberosity. Later, obstruction of the bronchus occurs with a picture of hypoventilation of the underlying sections.

The X-ray picture of peripheral lung cancer is usually characterized by the presence of a focus localized in the upper parts (segment S3) of the right lung, the upper lobe of the left lung, or the lower lobe of the right lung. The outline of the shadow of the tumor as it progresses from clear to “radiant”. Sometimes the “notch” is clearly visible - the place where the bronchus enters. With peripheral lung cancer, quite often you can see a path connecting the focus with the root or with the parietal pleura. In approximately 2-10% of cases, disintegration of the tumor node (cavernous form of cancer) is observed. In 3-10% of peripheral cancers, radiography reveals pleural effusion. With apical localization of lung cancer, the image shows shading in the projection of the apex, the lower border of the shadow is arched and convexly directed downward. Against the background of shading, one can detect destruction of the posterior segments of the 1st, 2nd, and sometimes the 3rd ribs. A manifestation of tumor dissemination in the lungs is miliary carcinomatosis.

Computed tomography and other types of scans for lung tumors

High-resolution CT has become the standard method for examining patients with chest tumors. RCT is much more reliable than conventional radiography in characterizing the topography and structure of the shadow, but is not decisive in determining the malignancy of the process. The degree of malignancy and histological type of tumor is determined by biopsy.

Bronchoscopy for lung tumors

Bronchoscopy is a decisive method for examining the bronchi, allowing one to identify lesions down to the subsegmental bronchi, especially with endobronchial tumor growth. During bronchoscopy, samples of bronchial secretions and washings are necessarily taken, and a brush or transbronchial biopsy is performed for histological examination. Fluorescence bronchoscopy allows you to see the glow of the tumor in its early stages.

Radioisotope scanning for lung tumors

Radioisotope scanning can detect metastatic lesions of the skeleton and distant metastases. However, the specificity of the method in detecting metastatic lesions of skeletal bones is low.

Ultrasound for lung tumors

Ultrasound can detect pleural effusion in the early stages and parietal tumors. Ultrasound of the liver can detect hematogenous metastases.

Study of respiratory function in lung tumors

The ventilation capacity of the lungs varies depending on the size of the tumor, the development of bronchial stenosis, atelectasis or compression of the lung tissue and is characterized by mixed disorders. When pleural effusion appears, restriction predominates. Determination of the gas composition of arterial blood allows one to assess the degree of hypoxemia (especially with extensive damage and old age).

Laboratory diagnosis of lung tumor

A general blood test is nonspecific; if pneumonia occurs, leukocytosis may develop. Oncological alertness should be caused by high ESR values ​​in elderly people. Cytological examination of sputum (detection of atypical or cancer cells) for lung tumors is generally informative in 20% of cases. When the tumor is centrally localized, the information content of the method increases to 74%.

Biopsy for lung tumor

Transthoracic and open biopsy of a tumor or altered lymph nodes using videothoracoscopy allows you to take samples of altered tissues and manipulate them in the pleural cavity. This method allows you to remove metastases with a diameter of up to 3 cm located on the periphery of the lung.

Differential diagnosis of lung tumor

On plain chest radiographs, the shadow of peripheral lung cancer should be differentiated from other formations. All spherical formations in the lungs require removal and histological examination in order to establish an accurate diagnosis.

Central lung cancer must first be differentiated from pneumonia. Impaired ventilation in tumors leads to increased pulmonary pattern, which is difficult to differentiate from pneumonic infiltrate, however, bronchoscopy allows you to examine the bronchi and establish the correct diagnosis.

Tuberculoma - an encapsulated formation of a tuberculous nature looks like a focus on an x-ray. A local shadow less than 2 cm in diameter with signs of decay is characteristic; Lung cancer this size rarely disintegrates. The apparent tuberosity of the contours of a tuberculoma in a direct projection image may correspond to multiple or conglomerate tuberculomas when taking images in a lateral projection or performing an RCT. The tuberculous nature of the focus will be indicated by screening lesions around or below the main shadow. The location of tuberculomas is characteristic in the lung segments Si, S2, SQ. During the period of tuberculoma disintegration, bacteriological examination of sputum can reveal Mycobacterium tuberculosis. Tuberculomas are not characterized by progressive growth and symptoms of compression. Negative tuberculin tests for tuberculomas are extremely rare.

Benign lung tumors, as a rule, are not lumpy and do not disintegrate. Unlike benign tumors, with peripheral lung cancer of small sizes (up to 2 cm in diameter), the contours of the shadow are rarely sharp. However, later, as it grows (2.5-3 cm), the malignant tumor takes on clear outlines. Benign tumors are not characterized by intoxication, hemoptysis, or radiant contours.

Retention cysts. Their contours are clear, without radiance or tuberosity, the pulmonary pattern is not changed. It should be remembered that blockage of the bronchus by a cancerous tumor and the accumulation of secretions distal to the obstruction sometimes lead to the formation of a cyst.

Lung cancer prevalence

Lung cancer accounts for more than 90% of all pulmonary neoplasms and 28% of all deaths resulting from tumor diseases in humans. This is the most common malignant tumor in men (35% of all tumors) and women (30%) aged 45-70 years (in women, lung cancer ranks third in frequency after breast cancer and cervical cancer). In recent years, there has been an increase in the incidence of primary lung cancer among women, with the disease occurring in women at a younger age than in men. In Russia, over the past 35 years, the number of patients with lung cancer has increased almost 3 times. In the United States, lung tumors occur with a frequency of 70 per 100,000 population, with African-Americans getting sick 1.5 times more often than the white population. The most common pulmonary neoplasms are found in the UK and Poland, where the prevalence exceeds 100 per 100,000 population, and least often in Senegal and Nigeria (less than 1 per 100,000).

Classification of lung tumor

By histological types: adenocarcinoma, small cell carcinoma, large cell carcinoma, squamous cell carcinoma and other forms.

By localization: central, peripheral (tumor localization starting from the 4th order bronchi), apical, mediastinal, miliary (small millet-like foci in both lungs).

In the direction of tumor growth: exobronchial, endobronchial, peribronchial cancer. The tumor, depending on the stage, can develop without metastases, with regional and distant metastases.

By stages of the disease:

stage - a small limited tumor of a large bronchus with an endo- or peribronchial direction of growth or a tumor of small and minute bronchi without pleural invasion and metastases.

stage - the same tumor as in stage I, or larger, without invasion of the pleura, in the presence of single metastases to the nearest regional lymph nodes.

stage - a tumor that has extended beyond the lungs, growing into the pericardium, chest or diaphragm, with multiple metastases to regional lymph nodes.

stage - a tumor with extensive spread to neighboring organs with dissemination throughout the pleura, extensive regional and distant metastases.

More than 90% of lung cancer cases in men and 70% in women are associated with the carcinogenic effects of tobacco smoke components when smoking. In general, the risk of developing lung cancer increases by 13 times with active smoking and 1.5 times with passive exposure to tobacco smoke. Occupational factors are critical in 15% of lung cancer cases in men and 5% in women. Perhaps industrial poisons and tobacco smoke act as carcinogens. In the development of some forms of lung cancer, the role of hereditary factors cannot be ruled out.

Pathomorphology of lung tumor

The term "lung cancer" is used to refer to tumors arising from the epithelium of the respiratory tract (bronchi, bronchioles, alveoli). Unlike cancer, other types of tumors (mesotheliomas, lymphomas and stromal tumors (sarcomas)) are not of epithelial origin. Four types of tumor cells account for 88% of all primary lung tumors: squamous cell (epidermoid) carcinoma (29%), small cell (oat cell) carcinoma (18%), adenocarcinoma (32%, including bronchioloalveolar carcinoma) and large cell carcinoma (9%). Other tumors (undifferentiated carcinomas, carcinoids, tumors of the bronchial glands, etc.) are less common. Because different types of malignant cells respond differently to certain types of therapy, correct histological diagnosis is a prerequisite for effective tumor treatment.

Lung tumors metastasize lymphogenously (to the bronchopulmonary lymph nodes, lymph nodes of the root of the lung and mediastinum) and hematogenously (distant metastases to the liver, brain, bones, lung and other organs). In addition to lung cancer, multifocal lymphomas can also occur in the lungs. A large group is formed by metastatic tumors originating from other organs (breast, colon, kidneys, thyroid, stomach, testicles, bones, etc.).

Benign lung tumors are a broad concept that implies a fairly large number of neoplasms that differ from each other in etymology, morphological structure, place of formation, but have several main common features, these are:

• slow growth over several years;
• no metastasis or very little spread;
• absence of clinical manifestations before complications;
• impossibility of degeneration into oncological neoplasms.

Benign lung tumors are a dense nodular formation of an oval or round shape. They develop from highly differentiated cells, which in their structure and functions are in many ways similar to healthy ones. However, the morphological structure of the neoplasm differs significantly from normal cells.

A benign tumor affects the lung much less often than a malignant one. It is mainly diagnosed in people under forty years of age, regardless of gender.

The methods and tactics of treating this pathology differ significantly from the methods of combating cancerous tumors of the organ.

The reasons for the appearance of benign tumors today are difficult to clearly identify, since research in this direction continues. However, a certain pattern of this pathology has been identified. Factors that provoke mutation of typical cells and their degeneration into atypical ones include:

• heredity;
• disorders at the gene level;
• viruses;
• smoking;
• bad ecology;
• aggressive UV radiation.

Classification of benign tumors

Benign tumors of the respiratory system are categorized according to the following criteria:

• anatomical structure;
• morphological composition.

An anatomical study of the disease provides complete information about where the tumor originated and in which direction it is growing. According to this principle, lung tumors can be central or peripheral. The central neoplasm is formed from large bronchi, the peripheral one - from distal branches and other tissues.

Histological classification designates tumors in accordance with the tissues from which this pathology was formed. There are four groups of pathological formations:

• epithelial;
• neuroectodermal;
• mesodermal;
• germinal, these are congenital tumors - teratoma and hamartoma.

Rarely occurring forms of benign lung tumors are: fibrous histiocytoma (tissues of inflammatory origin are involved), xanthoma (connective or epithelial tissue), plasmacytoma (neoplasm arising in connection with a disorder of protein metabolism), tuberculoma. Most often, the lungs are affected by adenoma of central location and hamartoma with peripheral location.

According to clinical manifestations, three degrees of disease development are distinguished. The key point in determining the stage of growth of the central tumor is bronchial patency. So:

• the first degree is marked by partial blockage;
• the second is manifested by impaired respiratory function during exhalation;
• third degree is complete dysfunction of the bronchus, it is excluded from their breathing.

Peripheral tumors in the lungs are also determined by three stages of pathology progression. At the first stage, clinical symptoms do not appear, at the second they are minimal, the third stage is characterized by acute signs of tumor pressure on nearby soft tissues and organs, painful sensations appear in the sternum and heart area, and difficulty breathing appears. When the tumor damages the blood vessels, hemoptysis and pulmonary hemorrhage occur.

Depending on the degree of tumor development, accompanying symptoms appear. At the initial stage, when the bronchial tube is slightly obstructed, there are practically no special symptoms. From time to time you may experience a cough with copious sputum, sometimes with signs of blood. General health is normal. At this stage, it is impossible to detect a tumor using x-rays; more in-depth research methods are used to diagnose it.

At the second stage of tumor development, bronchial valve stenosis is formed. With a peripheral tumor, the inflammatory process begins. At this stage, anti-inflammatory therapy is used.

Complete bronchial obstruction occurs at the third clinical stage of a benign neoplasm. The severity of the third degree is also determined by the volume of the neoplasm and the area of ​​the organ affected by it. This pathological condition is accompanied by high fever, attacks of suffocation, coughing with purulent sputum and blood, and even pulmonary hemorrhage. A third-degree benign lung tumor is diagnosed using X-rays and tomography.

Diagnosis of benign neoplasms

Benign tumors are easily identified using x-ray examination and fluorography. On x-rays, the pathological compaction is indicated as a dark round spot. The structure of the neoplasm has dense inclusions. The morphological structure of the pathological compaction is studied using CT scan of the lungs. Using this procedure, the density of atypical cells and the presence of additional inclusions in them are determined. The CT method allows you to determine the nature of the formation, the presence of metastases and other details of the disease. Bronchoscopy is also prescribed, together with which a biopsy is performed for a deep morphological examination of the neoplasm material.

Neoplasms of a peripheral location are studied using transthoracic puncture or biopsy under ultrasound guidance. Pulmonary angiography examines vascular tumors in the lungs. If all the diagnostic methods described above do not allow obtaining complete data on the nature of the tumor, then thoracoscopy or thoracomy is used.

Treatment of lung tumors

Any pathological change in the body requires due attention from medicine and, of course, a return to a normal state. The same applies to tumor neoplasms, regardless of their etymology. A benign tumor must also be removed. The degree of complexity of surgical intervention depends on early diagnosis. Removing a small tumor is less traumatic for the body. This method makes it possible to minimize risks and prevent the development of irreversible processes.

Centrally located tumors are removed using gentle bronchial resection without damaging the lung tissue.

Neoplasms on a narrow base undergo fenestrated resection of the bronchial wall, after which the lumen is sutured.

The tumor in the wide part of the base is removed by circular resection, after which an interbronchial anastomosis is performed.

In severe stages of the disease, when pathological seals in the respiratory organ grow and cause a number of complications, the doctor decides to remove its lobes. When irreversible processes begin to appear in the lungs, pneumonectomy is prescribed.

Lung neoplasms that are peripherally located and localized in the lung tissue are removed using enucleation, segmental or marginal resection.

Large tumors are removed using lobectomy.

Benign neoplasms in the lungs with a central location, which have a thin stalk, are removed endoscopically. When performing this procedure, there is a risk of bleeding, as well as incomplete removal of tumor tissue.

If there is a suspicion of a malignant tumor, then the material obtained after removal is sent for histological examination. In the case of a malignant tumor, the entire range of necessary procedures for this pathology is performed.

Benign lung tumors respond well to treatment. Once removed, their reoccurrence is quite rare.

The exception is carcinoid. The prognosis for survival with this pathology depends on its type. If it is formed from highly differentiated cells, then the result is positive and patients are 100% free from this disease, but with poorly differentiated cells the five-year survival rate does not exceed 40%.

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