Oncologists distinguish two main histological types of lung cancer (not counting other types that are much less common) - non-small cell (NSC) and small cell (SCLC). The latter variant of the disease is considered the most malignant and is characterized high probability formation of metastases and high metabolic activity. Treatment of the disease involves chemotherapy or radiation therapy.
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Small cell lung cancer develops from Kulchitsky cells, which are located in the bronchial epithelium. This type of LC is characterized by a highly aggressive course:
The most frequently recorded metastases of SCLC are in the brain or spinal cord, bones and red bone marrow. However, spread to the liver, kidneys, adrenal glands, opposite lung and distant lymph nodes.
The causes of this type of RL are completely unknown today, as with any cancer. Confirmed hereditary predisposition to this oncology.
Risk factors that influence the occurrence of lung cancer are the following:
SCLC is a histological type of malignant pulmonary lesion, but there is also a conditional division into clinical and anatomical forms: central, peripheral cancer and atypical forms. An X-ray picture of the lungs helps to distinguish them.
The border between the central and peripheral RL is considered to be the subsegmental bronchus.
It is important, in addition to determining the histological identity and form of lung cancer, to establish the stage of the oncological process. The latter helps the doctor choose the best treatment regimen. The stage is determined by the size of the tumor, its extent in the lymph nodes, and the presence of other tumors in the body that the doctor believes are related to the main tumor in the lungs (metastases). This process is carried out according to the TNM classification (T - tumor, N - lymph nodes, M - metastases). There are 4 stages in total, where the 4th has the worst prognosis.
To date, MRL does not have specific symptoms, All clinical manifestations that can be detected in a patient can also be observed in other diseases of the lungs and cardiovascular system.
Patients usually complain of:
Manifestations of the first group depend on the location and form of tumor growth. TO primary symptoms include:
All of the above symptoms are characteristic of central shape RL.
A feature of the peripheral form of LC is its asymptomatic course. However, there are 2 options for development dynamics:
PS is understood as a complex of symptoms that occur in a patient with cancer. It should be remembered that they large number, they do not have high specificity to suspect a particular tumor. Sometimes PS can be the only manifestation of the disease, which confuses the treating doctor.
The most common PSs encountered in patients with SCLC are:
The above syndromes do not exclude the presence of other manifestations in the patient.
All LC diagnostics consist of three types - mandatory (to detect the tumor itself), clarifying (to assess the spread of the oncological process) and functional (determining the patient’s condition).
To detect a malignant tumor in the lungs, the following mandatory tests are used: instrumental methods research:
It should be noted that the peripheral form of LC during bronchoscopy is difficult to detect for biopsy. Therefore, if there is suspicion, it is recommended to perform a blind biopsy (so-called blind biopsy). The essence of this method is scraping, which allows in 80% of cases to make a diagnosis without seeing the tumor itself.
In some rare situations, your doctor may order a lymph node biopsy armpits and neck.
In oncology, there is the following rule - any tumor must be confirmed morphologically (that is, using a biopsy). Sometimes this procedure may be performed urgently during surgery.
– histological type malignant tumor lungs with an extremely aggressive course and poor prognosis. Clinically manifested by cough, hemoptysis, shortness of breath, chest pain, weakness, weight loss; V late stages– symptoms of mediastinal compression. Instrumental methods for diagnosing small cell lung cancer (radiography, CT, bronchoscopy, etc.) must be confirmed by the results of a biopsy of the tumor or lymph nodes, and cytological analysis of pleural exudate. Surgical treatment small cell lung cancer is only advisable early stages; The main role is given to polychemotherapy and radiation therapy.
C34 Malignant neoplasm of the bronchi and lung
The problem of the histogenesis of small cell lung cancer is currently considered from two positions - endodermal and neuroectodermal. Supporters of the first theory are inclined to the point of view that this type of tumor develops from cells of the epithelial lining of the bronchi, which in structure and biochemical properties are close to small cell carcinoma cells. Other researchers are of the opinion that the development of small cell cancer is initiated by cells of the APUD system (diffuse neuroendocrine system). This hypothesis is confirmed by the presence of neurosecretory granules in tumor cells, as well as increased secretion biologically active substances and hormones (serotonin, ACTH, vasopressin, somatostatin, calcitonin, etc.) with small cell cancer lung
Staging of small cell cancer according to the international TNM system does not differ from that for other types of lung cancer. However, to date, a classification that distinguishes localized (limited) and widespread stages of small cell lung cancer is relevant in oncology. The limited stage is characterized by unilateral tumor lesions with enlargement of the hilar, mediastinal and supraclavicular lymph nodes. In the advanced stage, the tumor moves to the other half of the chest, cancerous pleurisy, and metastases. About 60% of identified cases are of the common form (stage III–IV according to the TNM system).
Morphologically, small cell lung cancer is divided into oat cell carcinoma, cancer from intermediate type cells and mixed (combined) oat cell carcinoma. Oat cell carcinoma is microscopically represented by layers of small spindle-shaped cells (2 times larger than lymphocytes) with round or oval nuclei. Intermediate cell cancer is characterized by cells larger size(3 times more lymphocytes) round, oblong or polygonal in shape; cell nuclei have a clear structure. The combined histotype of a tumor is said to be when combined morphological features oat cell carcinoma with features of adenocarcinoma or squamous cell carcinoma.
Usually the first sign of a tumor is persistent cough, which is often regarded as smoker's bronchitis. An alarming symptom is always the appearance of blood in the sputum. Also characteristic are chest pain, shortness of breath, loss of appetite, weight loss, and progressive weakness. In some cases, small cell lung cancer clinically manifests with obstructive pneumonia caused by bronchial occlusion and atelectasis of part of the lung, or exudative pleurisy.
In the later stages, when the mediastinum is involved in the process, mediastinal compression syndrome develops, including dysphagia, hoarseness due to paralysis of the laryngeal nerve, and signs of compression of the superior vena cava. Various paraneoplastic syndromes are common: Cushing's syndrome, Lambert-Eaton myasthenic syndrome, syndrome of inappropriate antidiuretic hormone secretion.
Small cell lung cancer is characterized by early and widespread metastasis to the intrathoracic lymph nodes, adrenal glands, liver, bones and brain. In this case, the symptoms correspond to the localization of metastases (hepatomegaly, jaundice, pain in the spine, headaches, attacks of loss of consciousness, etc.).
To correctly assess the prevalence tumor process clinical examination(examination, analysis of physical data) is supplemented instrumental diagnostics, which is carried out in three stages. In the first stage, visualization of small cell lung cancer is achieved using radiation methods- chest radiography, CT scan of the lungs, positron emission tomography.
The task of the second stage is morphological confirmation of the diagnosis, for which bronchoscopy with biopsy is performed. With this patient management scenario, the 5-year survival rate within this group does not exceed 40%.
The remaining patients with a localized form of small cell lung cancer are prescribed 2 to 4 courses of treatment with cytostatics (cyclophosphamide, cisplatin, vincristine, doxorubicin, gemcitabine, etoposide, etc.) in monotherapy or combination therapy in combination with radiation primary focus in the lung, root and mediastinal lymph nodes. When remission is achieved, prophylactic irradiation of the brain is additionally prescribed to reduce the risk of metastatic damage. Combination therapy can extend the life of patients with a localized form of small cell lung cancer by an average of 1.5-2 years.
Patients with locally advanced small cell lung cancer are advised to undergo 4-6 courses of polychemotherapy. At metastatic lesion radiation therapy is used in the brain, adrenal glands, and bones. Despite the sensitivity of the tumor to chemotherapy and radiation treatment, recurrences of small cell lung cancer are very common. In some cases, relapses of lung cancer turn out to be refractory to antitumor therapy - then the average survival rate usually does not exceed 3-4 months.
Small cell pulmonary oncology is considered a fairly common disease among men. Similar form to initial stages It is quite difficult to determine, but if it is detected in time and treatment is started, then the patient has every chance of a favorable prognosis.
Small cell lung cancer is characterized by increased malignancy, an aggressive course and a tendency to extensive metastasis. Therefore, if you do not identify it on early stages progression and not start timely treatment, then the patient is waiting fatal outcome. This type of cancer accounts for a quarter of cases from total number pulmonary pathologies.
So, small cell lung cancer is a malignant tumor formation, prone to rapid progression and extensive.
This kind of oncology has a hidden, asymptomatic onset, so it often happens that patients end up in the hands of specialists when the disease is already in an advanced stage.
More often, pathology is found in patients of the stronger sex, although in recent years the disease began to affect the fair half, which is most likely due to its spread among women.
Small cell pulmonary oncology is divided into two pathological forms:
The main cause of pulmonary small cell oncology is. The degree of risk of developing such a pathology is largely determined by the age characteristics of the patient, the number of cigarettes smoked during the day, smoking experience, etc.
Availability nicotine addiction increases the likelihood of oncological processes occurring in lung tissues by 16-25 times. In addition to smoking, the following factors can cause cancer:
Exposure to radiation can also become a trigger for the occurrence of cancerous tumor in the lungs.
As previously reported, the pathology rarely manifests itself in the initial stages of development, therefore it is detected at the stage of active progression, accompanied by the following symptomatic manifestations:
Unusual signs of lung cancer are described in this video:
With extensive growth of the tumor, additional symptoms such as ossalgia, jaundice, neurological manifestations, swelling of the supraclavicular and cervical lymph node structures.
The large size of the formation has a depressing effect on neighboring systems, causing additional pain, puffiness of the face, problems with swallowing, difficult to eliminate hiccups, etc.
Small cell forms of lung cancer develop according to the following scenario:
The diagnostic process is based on several research procedures:
It is recommended to combine such treatment with a treatment that involves irradiation of primary tumor foci and lymph node structures. A combined approach to the treatment of small cell lung cancer helps prolong the life of a cancer patient by 2 years.
If the small cell tumor is widespread, then at least 5-6 chemotherapy courses are indicated. If metastases have penetrated the bone, brain, and adrenal structures, then treatment with radiation is resorted to.
Although small cell lung cancer is different hypersensitivity to polychemotherapy and radiation exposure, the likelihood of relapse is quite high.
Without proper treatment, lung cancer is 100% fatal.
Predicting the life expectancy of patients with small cell lung cancer depends on the development of the oncological process and the correctness of its therapy.
If small cell lung cancer is detected first by pathology, then the number of survivors over a five-year period will be about 21-38%. When detected in advanced stages 3.4, survival rate is a maximum of 9%.
If during treatment there is a tendency towards a decrease in tumor parameters, then oncologists regard this phenomenon as a favorable sign, because the patient has a good chance of long life– with a partial remission result, the survival rate will be about 50%, with a complete remission – 70-90%.
An excellent measure to prevent lung cancer is to get rid of nicotine addiction, and passive smoking should also be avoided. Equally important is the prevention of pulmonary pathologies and general infections.
It is necessary to include gymnastics in the daily routine, morning exercises, fitness or jogging. Such a measure will have a beneficial effect on the pulmonary system and help control your weight.
If you have harmful addictions such as using or it is recommended to get rid of them. If the profession is associated with high-hazard production, then you need to follow safety precautions and use personal protective equipment.
Once a year you need to undergo preventive fluorography, which will help to timely detect oncological processes in the lungs, if any.
Video scientific-practical conference about small cell lung cancer:
Lung cancer is a serious cancer that is equally common throughout the world. According to statistics, mortality from lung cancer occupies a leading position, and effective treatment is still only surgery in the early stages.
Bad environment high percentage smokers and a general downward trend immune defense makes the problem of diagnosing and treating lung cancer very important.
Despite the use of the standardized oncological classification TNM for small cell lung shape adopted the use of another classification, useful for the practical assessment of cancer lesions respiratory system.
Classification by degree of damage lung tissue into limited and widespread form. The limited or localized form corresponds to initial stages oncological process, i.e. I and II. The localized or limited form of lung cancer is less common than the diffuse or widespread form.
The limited form of small cell lung cancer is expressed in damage by atypical tumor cells lung tissue with a predominantly diffuse distribution path, but in oncological process only one lung is involved.
Tumor cells are already found in the early stages in the lymph nodes located in the mediastinum and supraclavicular areas, as well as in the hilar lymph nodes.
The clinical picture and symptoms of small cell lung cancer of the localized form are somewhat different from the widespread form. Symptoms specific to the limited type provide valuable information, since the treatment approach for the two forms is different.
In the limited form, symptoms such as:
Localized inflammatory process . With pronounced progression, in more than half of the cases a secondary infectious-inflammatory process develops, most often pleurisy.
When the tumor is localized in only one lung, pleurisy is also limited in nature, and accordingly pain syndrome a cancer patient will only mark on one side.
In addition to the symptoms, when examining the patient, the lesion will be detected only on one side already at the stage of physical examination, however, it is very important to confirm the diagnosis during instrumental diagnostic studies, for example using plain radiography chest organs or computed tomography.
The advanced form of small cell lung cancer is a clinically more severe form and, unfortunately, occurs more often than localized one. The common form of this cancer is more common for a number of reasons. The most typical of them are:
The common form is the next stage of tumor development after the localized form, and damage occurs to the lung tissue on the opposite half of the chest.
The clinical picture in the widespread form becomes pronounced, as the compensatory mechanisms of the respiratory system are depleted. Cancer patients in later stages experience:
Also, when lung cancer metastasizes in the later stages, damage and symptoms appear in the organs in which small-cell metastatic foci are localized.
Damage to the mediastinal organs also plays an important clinical role. Mediastinal syndrome consists of compression damage to the esophagus, which is manifested by severe dysphagia. Deformation of the trachea leads to the development inspiratory dyspnea. Due to damage to the pathways of the recurrent and laryngeal nerves, the patient's voice becomes quiet and hoarse.
Small cell lung cancer – common name malignant oncological process localized in the tissues of the lungs.
At the histological level, several types can be distinguished, which will differ in their degree of malignancy, which has a significant impact on the activity, rate of tumor progression and sensitivity to chemotherapeutic drugs and ionizing radiation.
Among the types of small cell lung cancer, the following histological types can be distinguished:
Determining the histological variant and morphology of a malignant neoplasm of the lung is of very important clinical importance.
Oat cell lung cancer is the most common of all malignant neoplasms affecting lung tissue. When performing microscopy of a histological section, multiple layers can be seen atypical cells spindle-shaped.
Atypical cells are increased in size compared to normal ones and have approximately twice the number of lymphocytes.
The nucleus of atypical cells has a round or oval shape, increased in size as a result of active mitotic divisions. Malignant neoplasms with oat cell type often undergo necrotic changes.
A feature of oat cell carcinoma is the clinical picture with a predominance of Cushing's syndrome, pronounced violations electrolyte balance blood plasma.
Atypical cells in this type of tumor have the ability to ectopically produce adrenocorticotropic hormone, which increases the sensitivity of tissues to catecholamines and mineralcorticoids.
Malignant neoplasms of this type are more likely than other forms to undergo tumor disintegration.
A neoplasm from cells of the intermediate type has its own characteristic difference, so atypical cells of the intermediate type are 3-4 times larger normal cells. The shape of the cells is varied and can be elongated, spindle-shaped or polygonal; the cytoplasm in such cells is better expressed than in oat cell carcinoma.
The nuclei of cancer from intermediate cells are well defined and structured; in some cell nuclei the nucleolus can be visualized. Pronounced cell polymorphism in the intermediate form is its characteristic feature.
When conducting a histological examination of the intermediate tissue, it can be noted that the degree of differentiation of atypical cells in different areas tumors are not the same, which makes heterogeneity during differentiation another feature of cancer from intermediate type cells.
The mixed species occurs with the same frequency as the oat cell species. The mixed variant is detected by identifying on a histological section not only spindle-shaped cells characteristic of oat cell carcinoma, but also others with completely different shapes.
Thus, we can say that in the mixed type of lung cancer, a pronounced polymorphism of atypical cells predominates, however, in the general structure, the ratio of spindle-shaped atypical cells to polymorphic ones is increased, while the spindle-shaped cells have less potential for the secretion of adrenocorticotropic hormone than in the full oat cell form.
Predicting the outcome of lung cancer is quite difficult due to its severe clinical course. The prognosis for the patient largely depends on the stage at which the malignant neoplasm is detected and how quickly treatment is started, however important There are also factors such as:
In 60-70% of cases, lung cancer is diagnosed in its advanced form, which makes the prognosis for the patient unfavorable. Mortality in diffuse common forms of small cell lung cancer reaches 75% in the first year, since damage to the respiratory system quickly leads to its decompensation and pulmonary failure.
The degree of differentiation of atypical tumor cells is of great importance in prognosis; the lower it is, the worse the prognosis for the cancer patient.
At timely detection diseases when the oncological process is still localized in one lung - surgery with pneumonectomy and extended lymph node dissection, as well as a subsequent course of polychemotherapy, increases the one- and five-year survival rate of cancer patients, but the prognosis still remains conditionally unfavorable.
The prospects for the treatment of this type of neoplasm are described in a video from a scientific conference:
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A disease characterized by strong tumor growth and enlargement malignant cells in human lungs, as a rule, implies stage 4 lung cancer and the prognosis for it, unfortunately, is unfavorable. With stage 4 cancer, extensive metastases form, which grow beyond the lungs, affect the lymph nodes, enter the liver, bone tissue, kidneys, into the human brain. As a result, the bronchial walls are affected, the mucous membrane is destroyed and blood vessels, chest pains appear more and more often. The pain that occurs in such cases is very closely related to damage to the tissues adjacent to the lungs - oddly enough, the lung tissue itself does not have pain receptors.
The picture of the disease is very pronounced: paroxysmal, hysterical cough with the presence bleeding in sputum. Shortness of breath, angina pectoris develops, and heart rhythm is disturbed.
There are several types of lung cancer, these include:
Non-small cell lung cancer is a malignant tumor formed from epithelial tissue. In 90% of affected men and 80% of women, the disease occurs due to smoking. Currently, there are 3 types of non-small cell cancer:
Symptoms of the disease:
The prognosis for stage 4 non-small cell lung cancer is disappointing, since usually the disease already affects both lungs and metastasizes to other organs. 60% of cases are detected very late, the life expectancy of patients for 5 years is no more than 17%. Squamous cell lung cancer arises from flat cells of the bronchial epithelium (which are not normally present).
As a rule, smokers and workers in hazardous industries get cancer.
In addition, a number of other reasons influence the occurrence of squamous cell carcinoma:
The disease is most often detected in people 40-50 years of age, and men are more often affected.
Signs of the disease:
The prognosis for stage 4 squamous cell lung cancer is unfavorable - it is incurable, since metastases penetrate almost all internal organs and the poisoning of the body begins. The organs necessary for human life cannot cope with their functions and the person fades away.
Small cell lung cancer stage 4 prognosis: life expectancy without therapy ranges from 6 to 18 weeks. This is the aggressor tumor. The outbreak spreads throughout the body at tremendous speed. Characteristic signs illness - the same as with other types of cancer, with the addition of speech impairment and headache attacks.
Has two forms:
