Lung Cancer Lung Cancer

Lung cancer is the most common cause of cancer deaths around the world when both men and women, with an estimated number of deaths it caused 1.2 million deaths a year, for example, is expected to hit 220,000 people in the United States, lung cancer, with the possibility of the death of 160.000 of them, while the estimated number of deaths due to cancers of the breast, prostate, colon and rectum combined 118,000 people, has increased both the proliferation of absolute and relative lung cancer dramatically, for example, the mortality rate was registered lung cancer similar to the rate resulting from pancreatic cancer before 1930 men and 1960 women. In 1953 became the lung cancer the most common cause of cancer deaths in men, in 1985 became the most common cause in women, too, began to deaths from lung cancer than men, reflecting the decrease in smoking rate they have, while the high mortality rate in women to peak until it became equal to half of deaths from lung cancer almost.


Called the name of lung cancer or cancer Bronchial a malignant tumor that originates in the respiratory tract or in the text pneumonia, P about 95% of lung cancers are classified into lung cancer, small cell SCLC and lung cancer non-small cell NSCLC, and this classification is necessary in order to determine the stage of infection and treatment and warning, while other types of lung cancer constitute the remaining 5% of malignancies arising in the lung.


Risk factors:

Play a lot of environmental factors in addition to daily habits in our lives plays an important role in the development of lung cancer, smoking is the most important and most dangerous. The following is an explanation of these factors in detail:

1 - Smoking: Smoking is the leading cause of lung cancer, where it produces 90% of lung cancers from smoking, the ratio of a person who smokes packets a day for a period of 40 years the largest twenty times the person is a smoker, and it should be noted that the more time smoking and increased exposure person smoked Kalomyant to carcinogens (asbestos) increased risk of lung cancer.
Thus, we find that the prevention of lung cancer are mainly to refrain from smoking and encouraging the smokers to quit, when the stop the person smoking reduced probability lung cancer gradually up to a minimum after 15 years;, which amounts to twice the rate of infection when the person who has never smoked.


2 - radiotherapy: a risk factor for the development of lung cancer I started another when a patient has cancer and receives treatment X-ray; where increases women's risk of lung cancer when they received the treatment radially to breast cancer Mstasal compared to other women do not receive radiation therapy with the presence of smoking as a risk factor at each of them, the study was conducted on two groups of women with breast cancer, it was observed that women who smoke and who received treatment radially increased risk overnight with lung cancer I started; and that was more pronounced in the hand, the affected breast, and radiotherapy for lymphoma and Hodgkin's associated with increased risk of cancer secondary lung, note that the use of new technologies sponsor minimizing radiation dose from radioactive which affect non-malignant tissue is expected to reduce significantly the modern equipment of the risk of secondary lung cancer.


3 - Other factors: A number of factors that affect the development of lung cancer such as:

 environmental toxins: environmental factors that lead to increased risk of lung cancer are: (passive smoking, asbestos, radon, and some metals arsenic, chromium, nickel, ionizing radiation and organic compounds, polycyclic aromatic).

 pulmonary fibrosis: Studies have shown that the incidence of pulmonary fibrosis may increase the risk of lung cancer increased by seven times, without the relationship of smoking with this danger.

 HIV infection: the incidence of lung cancer in patients with AIDS is much greater compared to patients without the disease.

 Genetic factors: The genetic factors influence the risk of disease, the impact of being warned. Although the influence of genetic factors in lung cancer is still under study but there is a risk that a family is installed and clear.

 Diet: Evidence suggests epidemic that many dietary factors (antioxidants and vegetable species Crusade and plants Alastrugenih) can decrease the risk of lung cancer, but did not confirm the role of these factors after, it has ended all attempts to prove the role of these factors in reducing risk of lung cancer in people with high rate of dangerous failure. For example, a study has shown to reduce cancer-based Torauferol alpha and beta carotene to cancer patients is increased when smokers who ate large quantities of beta carotene.

Survey Screening:

The diagnosis of lung cancer, mainly on the assessment of persons who suffer from the symptoms, but screening survey for lung cancer is widely used, on the grounds that there is no screening test as (chest, the analysis cell of the sputum or CT scan) reduces the rate of mortality lung cancer and formally recommended.
However, studies have shown that a large proportion of patients who reveal they have lung cancer screening CT imaging survey had their cancer at an early stage which helps in improving the warning.


Histopathology

World Health Organization classifies primary cancers of the lung tissue patterns of four major cellular:

 glandular carcinoma (containing the bronchial alveolar carcinoma): 38%.
 squamous cell carcinoma 20%.
 Large cell carcinoma 5%.
 small cell cancer 13%.
 non-small lung cancer cells that can not be included under any classification of 18%.
 6% other cancers.

The increased incidence relative to carcinoma glandular significantly, accompanied by this increase with a decrease in the incidence of other forms of lung cancers are small and non-small cell; where it is believed that this increase results from the introduction of filter Mnkhvs tar cigarettes in 1960, but their relationship is uncertain .


Clinical demonstrations:

Have lung cancer at an advanced stage in most patients when they pretend clinically, reflecting the aggressive behavior of this disease, and may continue the lack of symptoms until the cancer to advanced stage topically or even show metastases, where there is no check scanner effectively as mentioned earlier, and possibly produce these symptoms due to Local effects of the tumor, or because of local spread or distant or remote effects as a result of non-Banakaúl (peer tumor syndrome), where it is estimated that 3 / 4 patients had to display one or more at diagnosis.

Many influences of the tumor in the chest; most common cough, in addition to hemoptysis, and chest pain and dyspnea. To talk about these symptoms in detail:

• Cough: There are at 50-75% of patients who people have lung cancer, and occurs most commonly in cancer, squamous cell cancer, small cell, due to its tendency for growth within the lumen airways, and the beginning of modern complaint cough in smokers or former smokers carry a risk for the development of cancer, and is a Walther bronchial cough or product to large amounts of sputum thin mucous manifestations of a bronchial alveolar carcinoma and usually refers to the advanced stages of disease.

Often cause lung cancers are small and non-small-cell pneumonia after obstructive, where the bronchiectasis is rare; because the cancer usually progresses forward and quickly so as not to be allowed to appear for bronchiectasis. On the contrary, there is a greater likelihood of the development of bronchiectasis in the slow-growing tumors such as carcinoid tumors or Abah.

• jetting blood: recorded cases of jetting blood in 25-50% of patients who have lung cancer, although the bronchitis is the most common cause of this offer, where the presence of any amount of warning sign was bad and caused large quantities of asphyxiation of the patient, the presence of jetting blood When a patient means the possibility of lung cancer by between 3-34% depending on the patient's age and the presence of smoking story, where the likelihood of bronchial cancer diagnosed when a smoker has a bloody puffs with natural image was about 5% when bronchoscopic procedure.

• chest pain: chest pain present at 20% of patients with lung cancer, it may be light and variable in its qualities and is most common among young people compared to the elderly. Typically the pain is located in a primary tumor itself, may occur as a result of the silent pain continued throughout the tumor or side of the fair or the chest wall, but the presence of pain does not necessarily mean an inability to surgical excision.
In spite of the pain that may occur as a result of pleural tumor along the side, but that both obstructive pneumonia or pulmonary embolism on the situation of excessive Alkhthreyh may also cause pain Sdria.

• dyspnea: There are in 25% of cases and is one of the common symptoms of lung cancer at diagnosis, and may be the result of (obstructive external or internal to the respiratory tract, pneumonia, obstructive, atelectasis of the lung, proliferation lymphatic tumor, pulmonary embolism, pneumothorax, effusion pleurisy or pericardial effusion with heart Satam).
The occurrence of partial blockage of the respiratory tract and may cause local cicada heard by the patient or the examiner to listen, and squeaks result from blockage of the large airways.
Tests may help assess the pulmonary functions in patients who have respiratory slip caused by lung cancer, it shows a lack of volume of air flowing inspiratory or expiratory, or both resulting from the presence of tumor in the trachea, rather than the result of internal pressure or paralysis of the vocal cords.

As for the diaphragm, the one-sided paralysis may arise from the phrenic nerve injury; and here may not, patients complain of any symptoms or complain of the presence of the same palace.
The lung cancer is the most common tumors of the phrenic nerve, although the malignancies is generally responsible for only 4% of cases of paralysis of the diaphragm.

• hoarseness: enter both lung cancer and throat cancer in the differential diagnosis of persistent hoarseness when smokers, in patients with lung cancer invasion happens, and throwing the recurrent laryngeal nerve along the path under the arch of the aorta back into the throat.

• injury side: According to the TNM system to determine the clinical stage:
 2T: extension of the tumor to the visceral pleura.
 3T: extension of the tumor to the parietal pleura.
 a1M: the presence of cancer cells within the liquid side (stage IV).
Can pretend that the injury pleural thick pleura without effusion.

It may happen effusion is characterized by being:

 incurable surgical excision of the tumor (ie, malignant effusion); This treatment addresses the Tlatifia.
 accidental, and pretend to cough and respiratory Bzelh (noting that 25% of lung cancer patients with metastases to the side are not casual).
 usually Ndhya or praying, or praying bleeding or bleeding explicitly.
 occurs when 10-15% of patients with lung cancer during the course of the disease.

Must refer to the possibility of a sound-side effusion in patients with lung cancer, because of:

 blockage of lymphatic vessels.
 post-obstructive pneumonia.
 atelectasis.

And then the tumor is capable of healing of surgical excision, studies have shown that 5-14% of patients with NSCLC (Non-Small Cell Lung Cancer) with the inflow-side unilateral curable eradication of the tumor, and in order not to get lost on the patient the opportunity to cure the eradication of the tumor, must be investigated cells within the tumor mass effusion; In the case of negative tumor is curable, but in the case of tumor cells, this change of method of treatment significantly.

In general, prior to the surgery;, which is the eradication of the primary tumor should be evaluated distance pleural and by demonstrating a negative 2 or 3 tests cellular liquid side after thoracoscopy or laparoscopy side, of the sensitivity of the screening test cell for the liquid side - and that in patients who prove to have a side injury - 60%, after one puncture, but in case taking three samples, the sensitivity rises to 85%.

Be a sensitive test for the diagnosis of malignancy in a liquid side low when volume <10 ml compared Bahadjom larger; and increase the sensitivity a little bit when using Bkhozah side, closed in case of doubt Balkhbath in a patient despite a negative test, you must re-examination cell for the liquid side, with or without biopsy side.

• cava superior syndrome: occurs due to blockage of the superior vena cava SVC, and the advantage of being more common in patients with SCLC patients with NSCLC, is characterized by: the weight of the head and respiratory slip, and to a lesser pain, cough, difficulty in swallowing.


The signs seen include:

Expansion of the neck veins - venous network and clear on the chest - edema of the face.

In the chest x-ray: CXR can be seen the expansion of equitable or mass in the right pulmonary navel.

The CT scan: CT Scan is often to be able to determine the cause and the level of obstruction and venous circulation along the profile.

When the majority of patients with the lower cava syndrome secondary to lung cancer symptoms clear from caval obstruction after the eradication of the lower mediastinal tumor.

• Pancoast's syndrome (Pancoast's syndrome):

Caused by lung cancer Almtbarz within the upper groove; especially NSCLC SCC usually), and very rarely SCLC, pretends to:

 pain; usually in the shoulder and, less frequently in the shoulder blade and arm and fingers.
 Horner's syndrome Horner's Syndrome
 bone destruction.
 atrophy of the muscles of the hand.

Cancer metastases to the outside of the chest:

Lung cancer can spread to anywhere in the body, and the most common of these places: the liver, adrenal Gdta, bones, brain.
This may manifest with metastases demonstrated by the tumor, so that she is present when the patient complaint, or may occur later during the course of the disease. Here are the details:

• Liver metastases usually manifest in late liver-offs during the course of the disease and are uncommon in the beginning, but asymptomatic metastases can be detected by:

 disorder liver enzymes.
 CT scan CT.
 positron emission tomography PET.
In patients with NSCLC disposable surgical resection, demonstrated the presence of liver metastases using CT in 3% of the cases, but liver metastases were found by chance in 4% of cases, using PET or PET with the participation of CT.
Studies have demonstrated that the autopsy on the bodies of cancer metastases to the liver occurs at 50% of patients with lung cancer (either NSCLC or SCLC).

• Bone

 Matkon much bone metastases cross; Veshko patient from my back pain, or abdominal pain, or in the limbs.
 may increase the level of alkaline phosphatase in the serum due to metastases, and may increase the level of serum calcium due to a disease, bone destruction.
 plays both PET and PET-CT has an important role in the detection of metastases in a number of Members, including the bone, which is characterized by higher sensitivity of CT imaging and bone.
 in patients with NSCLC: examining bony metastases were detected at about 20% of them. The radiographic examination shows an increase in the proportion of prey of bone cells compared with cells Albanian, paragraphs and objects are the most common location for metastases to occur.
 patients: SCLC have greater incidence of metastases, as you see when 30-40% of them.

• adrenal:
 The adrenal Gdta of potential places for metastases of lung cancer but is rarely accidental.
 We expect the presence of adrenal metastases when you see the mass of a single side to CT when the patient has lung cancer or predict the presence of cancer he has.
 The detection of these metastases are not only reveal part of the adrenal mass by examination (Baltfires). In a study conducted on 330 patients with NSCLC is possible, 32 of them (10%) had an isolated adrenal mass. Found that only 8 of these 32 (25%) had malignancy, while the rest were lesion with intact (adenoma, nodular hyperplasia, cysts bleed).
 Conversely, negative imaging result does not deny the presence of adrenal metastases. In a study of patients with SCLC; found that 17% of the osteotomy showed the presence of adrenal metastases, although CT image was normal.
 The lack of quality of CT in determining the nature of adrenal masses cause a particular problem in patients with lung cancer be eradicated. In this case, the use of PET may be useful in distinguishing the cluster of malignant adrenal sound.
 the MRI test is also useful to deny the presence of metastases when there is adenoma or sound negative biopsy.
 infection adrenal glands are more common when the disease has spread widely.
 detected adrenal metastases in the context of autopsies at 40% of patients with lung cancer.

• Brain:
 include neurological manifestations of lung cancer symptoms of metastases and tumor counterpart demonstrations.
 symptoms associated with central nervous system metastases are similar to those associated with other tumors, including: (headache, vomiting, lack of visual scene, letting naughty, cranial nerve injury, epilepsy).
 in patients with NSCLC:
 The incidence of brain metastases is higher in case of glandular carcinoma and less in the case of SCC.
 increase the risk of brain metastases in the event of a large primary tumor size and the existence of the doctrine of localized accompaniment.
 careful selection of a group of patients can be cut (root) sequence (sequentially) in cases of NSCLC viable surgical resection with a single brain metastases (isolated).
 in patients with SCLC:
 see brain metastases when screening by 20-30%.
 relapse rate of 50% of patients within two years.
 studied a random sample found to decrease the rate of brain metastases when conducting preventive radiotherapy to the cranium.


Demonstrations tumor counterpart:

A result of influence or relationship of tumor invasion, tumor, or obstruction, or metastases occurrence Htaatdmn the following:

• Hyper Alcasameeh (hypercalcaemia)
 occurs either because: - bone metastases
- Less as a result of tumors to secrete parathyroid hormone-related protein (PTHrP) or Alcalsterol cytokines or other container on the factors stimulating the bone breakers.

 In a study of 1149 of lung cancer cases: a record of 6 percent have high blood calcium level and among those recorded:
SCC, glandular carcinoma, SCLC in: 51.22, 15% of cases, respectively. Most of the cases associated with hyper Alcasameeh were in advanced stages of disease (stage 3 or 4) and the average survival is a few months.
 Alksameeh hyperthyroidism symptoms (anorexia, nausea, vomiting, constipation, lethargy (age), polyuria, polydipsia, dehydration), and confusion, lethargy understanding of events late as in the case of renal failure and renal Alclas.
 Treatment
Occasional patients who have a serum calcium 12 mg \ dl (3mmol / L) or more require treatment, including rehydration and Alpefosvanat.


• syndrome of inappropriate secretion of anti-hormone-generating SIADH secretion
 often occur because of the SCLC, or as a result of lack of sodium.
 About 10% of the SCLC patients suffering from SIADH.
 SCLC constitute about 75% of the malignancies associated with the occurrence of SIADH.
 degree of severity of symptoms associated with lack of sodium or low sodium serum quickly and include: anorexia, nausea and vomiting.
 cerebral edema may occur rapidly at the beginning of low sodium and symptoms are: irritation, restlessness, agitation, personality changes, confusion, coma, epileptic seizures and stopped breathing.
 Treatment focuses on addressing malignancy.
- For most patients with SCLC, the lack of sodium back to normal within weeks of starting chemotherapy.
- Lack of sodium chronic or long-term, the unexplained can be treated with infusion of saline to reach the state or by selecting both fluids and the use of demeclocycline, or by using the Balvazobrice daad.
- Lack of acute or severe sodium hatched excessive caution (raise) the tension (3%) saline infusion to correct the 1-2 mmol \ L every hour so that does not exceed 8-10 mmol \ L in 24 hours.


• morbidity hypertrophic osteoarthritis HPO
 Tbaqrt known occurrence of the fingers and the proliferation of periosteal bone tube conjugated with lung cancer or any other lung disease.
 the pretend (HPO) clinically ill-articular painful symmetrical usually affects the ankles, knees, wrists, elbows, and may be involved metacarpal and metatarsal bones and phalanges.
 appears on the radiograph of long bones (eg tibia and fibula) in patients with the HPO placed periosteal new special.
 As shown during the filming of the irradiated bone, or PET of the Copts to spread radioactive material in the long bones.
 HPO symptoms disappear after a lumpectomy, the non-consenting patients to undergo surgery to work (they have contra-indicated for surgery), the traditional treatment used to have is either to give or NSAIDs Albeoffosvanat.