Primary lung cancer

 Overview
primary lung cancer (the cancer), is the most common primary lung malignancies. The world, at least 35 countries for the male lung cancer death in the first, women second only to breast cancer deaths. The disease incidence of more than 40 years of age, the peak age of onset in the 60-79 years old. male and female prevalence was 2.3:1. race, family history and smoking on lung cancer implications. cancer death in China, lung cancer accounts for common malignant tumors in men fourth, the fifth largest in the women.
cause
cause has not yet been clear. is generally believed that the incidence of lung cancer with the following factors:
I. Smoking: Smoking is recognized as an important risk factor for lung cancer.
Second, occupational carcinogen.
Third, air pollution.
four or ionizing radiation.
five, diet and nutrition.
In addition, viral infections, fungal toxins (yellow mold aspergillosis), tuberculosis of the scar, depressed immune function, endocrine disorders and family history of lung cancer and other factors may also play a comprehensive role.
The clinical manifestations of lung cancer symptoms
its location, size, type, development stage, complications or metastasis are closely related. The main symptoms include the following.
First, symptoms caused by the original tumor. < br> (a) of the cough. is a common early symptoms.
(b) hemoptysis.
(c) wheezing.
(d) chest tightness, shortness of breath.
(e) weight loss. emaciation One of the common symptoms of cancer.
(f) fever. usually due to necrosis of the tumor can cause fever, fever is due to the majority of the tumor caused by secondary pneumonia caused by poor efficacy of antibiotic therapy.
Second, the symptoms caused by local tumor extension:
(a) chest pain.
(b) difficulty in breathing.
(c) dysphagia.
(d) a hoarse voice.
check < br> A chest X-ray examination: This examination is the most important of lung cancer found a way.
Second, computer tomography (CT): CT has the advantage that ordinary X-ray examination can not be displayed CT anatomy of metastatic cancer with high fault detection rate than normal.
three magnetic resonance (MRI): MRI in the diagnosis of lung cancer similar to the basic and CT.
four consecutive days to get up early morning sputum cytology Check.
V. fiber bronchoscopy (the bronchoscopy examination.) existence of a clear and access to tumor tissue for histological diagnosis are of great significance.

lung cancer treatment is based on the patient The body condition; the pathological type, scope and development trend of violations, reasonable, planned application of existing treatments.
a treatment of the joint approach are: small cell lung cancer chemotherapy and radiotherapy and surgical use , the first choice of non-small cell lung cancer surgery, then radiation or chemotherapy. This treatment model is not monotonous, but also depends on the specific circumstances, such as small cell lung cancer a few ��, �� surgical treatment of the patient can choose, then chemotherapy and radiotherapy, and non-small cell lung cancer patients because of pulmonary function or operation or circumstances do not permit the body or �� tumor surgery of some patients lose the opportunity to radiotherapy and chemotherapy may first, then for surgery.
more effective treatment of several kinds of programs:
1.CAO P-16 program.
2.IAO program.
3.PE or PCAP program.
4.VM26DDP or VM26CAP program.
5.CMCVP16 program.
stage of lung cancer and how to guide treatment of pathological types?
pathological types of lung cancer cells is mainly based on morphological differences, in 1981 by the United Nations World Health Organization (who) released for the pathological type of lung cancer: Epidermal cancer (ie cancer), small cell carcinoma, adenocarcinoma (including bronchioloalveolar carcinoma), large cell carcinoma (including giant cell carcinoma and clear cell carcinoma), and adenosquamous carcinoma, carcinoid, bronchial cancer (including adenoid cystic carcinoma and mucoepidermoid carcinoma) and so on. According to foreign statistics, nearly 20 years, squamous cell carcinoma increased. Women are more affected by lung adenocarcinoma of the total proportion of each pathological type; male lung cancer is also an increasing trend. Shanghai Statistics also found a similar domestic situation, and even up into squamous cell carcinoma from the previous maximum. clear and lung cancer cytology or histological type, but also the range of violations of lung cancer, lymph node metastasis, with or without the transfer all the way for further examination, so you can check the results according to the initial clinical staging of lung cancer, and lung cancer according to pathological types, such as small cell lung cancer is a systemic chemotherapeutic regimens, radiotherapy or surgery. rather than small cell lung cancer will have to based on the stage at diagnosis, such as lung cancer should be taken in the early treatment programs based on surgery, but for the medium and advanced lung cancer, they have the situation under the lesion using the principles of multidisciplinary treatment of the treatment plan. Thus, the pathological type of lung cancer and staging of lung cancer treatment is very important and reasonable.
tumor biochemical, immunological and diagnostic imaging although a lot of development, but to determine the nature of the tumor, is still mainly dependent on pathological diagnosis. pathologic diagnosis of cancer is the most standard of the most reliable methods. It is made from the secretions of the diseased organs smear, or made directly to remove the small piece of tissue sections lesion or printed piece, placed under the microscope observe the cell morphology and structure, the nature of the tumor.
pathology and histopathology is usually divided into two parts cytopathology. pathologic diagnosis can be judged not only benign tumors, malignant and its prognosis is more important is to provide a reliable basis for treatment. but the pathological diagnosis has limitations. because of biopsy specimens, giant bodies are drawn, and biopsy sampling and, ultimately, under the light microscope to see only a very small part of the disease, sometimes can not represent the whole lesions. Another pathology is reliable and with the pathological specimens of selected relevant. Sometimes there are false negative results. for clinical diagnosis and pathological diagnosis are not consistent, timely review of pathological diagnosis, if the pathological diagnosis of the exact and correct, may be considered pathological specimens Select whether considerable. necessary to re-drawn, so again, the pathological diagnosis. in order to avoid misdiagnosis, delaying treatment time.
general classification of lung cancer based on the shape and location of lesions were divided into five types. type definition: the tube type, tumor limited to the bronchial lumen , may invade the wall, but not invading the wall outside the lung tissue, mostly central. wall infiltrative type, tumor tissue was damaged bronchial wall and invaded the surrounding lung tissue, but still in the tumor section clearly identified on the bronchi, particularly the remains of bronchial cartilage, showing bronchial tumor in the center, mostly central. spherical tumor was spherical, clear boundaries with the surrounding tissue, and bronchus relationship is not clear, the edge may be presented small lobulated, generally small spherical lesions diameter l3cm, edges smooth, mostly peripheral. block-type tumor size> 3cm, irregular in shape, boundaries and the surrounding lung tissue is not clear enough, mostly peripheral. diffuse infiltrative, diffuse infiltrates involving the lung tumor tissue, similar lobar pneumonia or confluent pneumonia, mostly peripheral. central lung cancer occurred in the above paragraph and paragraph bronchi, peripheral lung cancer occurs in the following paragraphs bronchus.
one classified by anatomical site
(a ) occurred in the central lung segmental bronchi
over to the main bronchial cancer known as central, about 3 / 4, to squamous cell carcinoma and small cell undifferentiated carcinoma were more common.
(b ) peripheral lung cancer occurred in the segmental bronchi
below is called peripheral tumor, accounting for about 1 / 4, to the more common adenocarcinoma.
Second, according to the histological classification of cancer at home and abroad
classification of yet very unified, but most by cell differentiation and morphological characteristics were divided into squamous cell carcinoma, small cell undifferentiated carcinoma, large cell undifferentiated carcinoma and adenocarcinoma.
(a) of the squamous cell carcinoma (referred to as squamous cell carcinoma)
is the most common type, accounting for 40% of primary lung cancer -50% more common in older men, a very close relationship with smoking. to central lung cancer more common, and have a tube cavity growth tendency, often caused by bronchial stenosis early, leading to atelectasis, or obstructive pneumonia. cancer volatility, necrosis, or cancer of the lung abscess cavity formation. squamous cell carcinoma of slow growth, late shift, the chance of surgical resection more than 5-year survival rate of more, but radiation therapy, chemotherapy than sensitive small cell undifferentiated carcinoma.
columnar epithelial cells of the bronchial mucosa by chronic irritation and injury, loss of cilia, basal cell squamous metaplasia, atypical hyperplasia and hypoplasia, most likely to mutate into cancer. typical squamous-like arrangement. electron microscopy: a large number of leukocytes between cancer cells and fibers connected to the tension.
sometimes there is occasionally mixed squamous cell carcinoma and adenocarcinoma said mixed lung cancer (squamous carcinoma).
(b) small cell undifferentiated carcinoma (referred to as small cell carcinoma)
is the highest level of malignant lung cancer one, primary lung cancer accounts for about 1 / 5 . were younger, more in the 40-50 years old, more than a smoking history. mainly in the vicinity of the large hilar bronchial submucosa tend to the growth of lung parenchyma often violated tube, easy and hilar and mediastinal lymph node fusion into clumps. fast growth of cancer cells, invasion and strong, early metastasis, surgery found that 60% -100% vessel subject to abuse, the autopsy proved that 80% -100% of lymph node metastasis, often transferred to the brain, liver, bone, adrenal gland and other organs. This type of radiation and chemotherapy sensitive.
cancer cells mostly round or prismatic, less cytoplasm, similar to lymphocytes, oat cell type and intermediate type might be derived from neural ectoderm Kulchitiky cells or argyrophil cells. cytoplasm of nerve cells secretory granules, endocrine and chemical receptor function, can secrete 5 - serotonin, catecholamine, histamine, bradykinin and other peptides, which can cause paraneoplastic syndrome. < br> (c) large cell undifferentiated carcinoma (large cell carcinoma)
can occur in the vicinity or pulmonary hilar edge of the bronchi, the larger cells, but different sizes, often has polygonal or irregular in shape, in solid of nests, large areas of hemorrhagic necrosis common; cell nuclear large, prominent nucleoli, mitotic common and abundant cytoplasm, can be divided into giant cell and clear cell type. giant cell carcinoma groups often multinucleated giant cells and surrounding inflammatory cell infiltration. clear cell type easily mistaken for metastatic renal adenocarcinoma. Large cell carcinoma small cell undifferentiated carcinoma late, a greater chance of surgical resection.
(IV) adenocarcinoma
more common in women, and Smoking has little, little more than marginal growth in the lung bronchial mucous glands, therefore, in the peripheral lung adenocarcinoma is the most common. Adenocarcinoma accounts for about 25% of primary lung cancer. adenocarcinomas tend to tube growth , but also to follow the spread of the alveolar walls, often in the lung edge of the Department of 2-4cm in diameter mass. Adenocarcinoma rich blood vessels, so the local invasion and early hematogenous metastasis than squamous cell carcinoma. easy to transfer to the liver, brain and bone, more involvement of the pleura caused by pleural effusion.
typical cancer cells, showing gland-like or papillary structures, a more consistent cell size, round or oval, abundant cytoplasm, often with mucus, and a large, deeply stained, often a nucleolus, nuclear membrane more clearly.
bronchiolar - alveolar carcinoma (referred to as lung cancer) is a subtype of adenocarcinoma, the incidence of younger, male and female incidence rates of approximation, accounting for 2% of primary lung cancer - 5%, the cause is not clear. Some people think that the occurrence of chronic inflammation and scarring caused by pulmonary interstitial fibrosis, but not with smoking. the manifestations of nodular and diffuse type of points. The former lung isolated circular lesions, which spread as diffuse inflammation of the small or large nodules like infiltration, probably due to lung cancer cells through the hole (Kohn holes), or spread directly caused by bronchial also considered the occurrence of multiple sources. It Most organizations believe that the origin of epithelial cells from the bronchial end. electron microscope examination showed the cytoplasm of cancer cells with similar type �� alveolar cells lamellar inclusion bodies. typical of this type was high columnar cells, nuclear size, uniform, no deformity, were located in the basal cells. cytoplasm abundant eosinophilic staining showed the cancer cells grow along the bronchial and alveolar walls. alveolar structure remained intact, often mucus in the alveolar deposition. solitary nodular lung cancer, longer course, the transfer slow, surgical removal of opportunities, a higher survival rate after 5 years. However, poor cell differentiation, their prognosis is no different from ordinary adenocarcinoma.
with: World Health Organization (who) in 1999 to lung cancer is divided into the following nine categories:
1, small cell carcinoma
2, squamous cell carcinoma
3, adenocarcinoma
4, large cell carcinoma
5, adenosquamous carcinoma
6, pleomorphic (sarcomatoid) carcinoma 7, carcinoid tumor (�� �� Typical carcinoid atypical carcinoid)
8, salivary gland-type carcinoma (�� �� mucoepidermoid carcinoma adenoid cystic carcinoma)
9, unclassified carcinoma clinical
generally divided into small cell lung cancer and non-small cell carcinoma, non-small cell lung cancer include squamous cell carcinoma, adenocarcinoma, large cell carcinoma, adenosquamous carcinoma and pleomorphic (sarcomatoid) carcinoma. If the small cell carcinoma contain non-small cell carcinoma, is known as small cell carcinoma of the compound.
stages:
be used in clinical work, two types of staging: 1.TNM stage 2. clinical stage .
1, TNM staging of patients with malignant disease
more comprehensive assessment, including the three links,
first need to understand the status of the primary tumor, the T, including the primary tumor of these conditions are, No, large and small, to the extent of expansion of the surrounding tissue and other violations.
need to understand the second part is the lymph node metastasis, or N. These conditions include, no, far and near.
third links need to understand whether the primary tumor metastasis has been, that M.
TNM staging for lung cancer specifically as follows:
(1) primary tumor (T) stage
Tx sputum to find cancer cells, but the X ray or bronchoscopy no lesions;
T0 No evidence of primary tumor.
Tis carcinoma in situ.
T1 tumors = <3cm, confined to the lung or visceral pleura within the bronchoscopy the tumor not involving the proximal lobe bronchus;
T2 tumors> = 3cm; or tumor invasion lobe bronchus, but other than 2cm from the carina; or visceral pleural invasion; lobe pneumonia or pulmonary congestion atelectasis, hilar involvement and the whole lung but not invasion.
T3 tumor of any size, directly involving the chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura or pericardium, but not involving the heart, great vessels, trachea, esophagus or vertebral body; or tumor in the trachea from the carina less than 2cm, but not involving the carina; whole lung obstructive pneumonia or atelectasis.
T4 tumors involving the mediastinum or any size heart, great vessels, trachea , vertebral, tracheal carina or malignant pleural effusion.
(2) lymph node metastasis (N) staging
Nx did not detect lymph node metastasis.
N0 lymph node metastasis was not found.
N1 bronchial side or ipsilateral hilar lymph node.
N2 ipsilateral mediastinal lymph nodes and subcarinal lymph node.
N3 contralateral mediastinal lymph nodes, contralateral hilar lymph node metastasis; ipsilateral or contralateral scalene or supraclavicular lymph node metastasis.
(3) distant metastasis (M) stages
Mx distant metastasis can not be determined or found
M0 no distant metastasis.
M1 distant metastasis or cervical lymph node metastasis.
2, the TNM staging clinical stage
more accurate reflection of the status of cancer patients, the clinical TNM staging was enacted under the guidance of clinical treatment to facilitate the clinical stage are as follows:
occult cancer Tx N 0M0
0 �� TisN0M0
I of T1 N0 M0; T2 N0 M0
�� of T1 N1 M0; T2 N1 M0
�� a period of T3 N0-2M0; T1- 3N2M0
�� b of any T, N3M0; T4 any N, M0
�� of any T or N, M1
which I, ��, period, �� a period, is a lung cancer early and middle to surgical treatment . �� b phase, �� of an advanced lung cancer, surgical treatment is basically lost the opportunity.
3, clinical stage small cell lung cancer staging
above for non-small cell lung cancer staging, for the natural survival short, easy to transfer, poor treatment of small cell lung cancer, TNM stage is still wrong, is added in small cell lung cancer, a clinical staging criteria, will be divided into two types: localized (cancer confined to side of the chest, including the bones have been sold and the former scalene lymph node metastases of patients) and broad (the development has been beyond the confines of the tumor type).
Second, the prognosis of patients with lung cancer diagnosed as
about 70-80% is already late, lost opportunities for surgical treatment, so all patients with lung cancer overall 5-year survival rate is still low.
(a) non-small cell lung cancer
I, II of the operative treatment mainly after surgery I was on the 3-year survival of 80-90%, 5-year survival rate of about 60-80%,
II 3-year survival rate of 60-80%, 5-year survival rate of about 40 - 60%,
III to surgery or not surgery on radiotherapy combined with treatment of 5-year survival rate of 15-30%, while radiotherapy was 5-10%.
IV treatment of patients with the purpose to improve the quality of life and prolong survival, Both methods are based, integrated treatment of chemotherapy-based, first-line cisplatin-based chemotherapy for 1 year survival rate of about 40%, a few with survival for several years, the general 5-year survival rate was 1 -2%.
(b) small-cell lung cancer small cell lung cancer
dangerous,
without treatment in 1-year survival rate of only about 4%; as have distant metastasis, mean survival time was 2 months; if no distant metastases, disease limited to, the average survival time was 4 months.
undergoing treatment survival is 4 times higher than untreated. small number of patients long-term survival.
limited small cell lung cancer with combination chemotherapy, median survival period of 12-16 months, and 2 year survival rate of 10-25%, 5 year survival rate was 6-12%.
extensive small cell lung cancer with combination chemotherapy, patients on average survival period of 7-11 months, 2 year survival of less than 5%, 5 year survival rate of 0-1%.
resectable early stage small cell lung cancer as the first principle of systemic chemotherapy (neoadjuvant chemotherapy), followed by surgery and postoperative adjuvant radiotherapy;
Phase III unresectable lesions (ie, with limited) chemotherapy radiation treatment at the same time improve the survival tendency.
diagnosis of lung cancer patients have two aspects. The first is the disease Science or cytologically confirmed cancer or cancer exists, and determine its type. The second aspect is the clear diagnosis of lung lesions, which is the clinical stage. determine the extent of disease on to treatment, prognosis is extremely valuable to determine information. So do not be too eager to lung cancer surgery, radiation therapy or chemotherapy, clinical stage to do a good job, so as to clear the situation, determined to a large, good effect.
I have encountered such a patient, the right lung lower lobe a 5t6 cm lobulated mass, bronchoscopy, pathological diagnosis of adenocarcinoma, and soon the top three hospitals in a thoracic surgery for resection should be said that surgery was successful, but after two weeks, a number of metastatic liver lesions found , the largest with 4t3 cm in size. Although the intervention made after surgery and other treatment, ultimately powerless, patients spent over 60,000 yuan of medical expenses, but also by the trauma and pain of thoracotomy. The patients of the lesson is profound. If the patient in the preoperative staging a comprehensive examination, the liver can be found in the existing metastatic lesions, when the stage of disease is IV, do not need surgical treatment, chemotherapy is the right choice the first choice.
present the results of lung cancer staging the choice of treatment, there was a consensus at home and abroad oncology. For patients with early stage (IA, IB, IIA, IIB of) the preferred surgical treatment, if the patient can not undergo surgery for medical reasons or I refused surgery, radical radiotherapy option. For the terminally ill (IV period) to chemotherapy, and, radiation therapy is palliative in nature, are unsuitable for surgery. in patients with advanced (IIIA, IIIB period) is more complex, IIIA part of patients can still surgery, but IIIB of the patient not suitable for surgery, most of the current clinical use of radiation and chemotherapy to cure, or to make chemotherapy, radiotherapy, and then the condition assessment of whether surgery. this part of the patient is the most common patient groups, and early examination of patients is often found or because Other diseases found in hospital routine examination. small cell lung cancer commonly the United States Veterans Administration hospital system's staging mm wide branch of the lesion or lesions within a time limit of two, the main use of chemotherapy and radiation therapy. In recent years, surgery is also involved to a small cell lung cancer were. with non-small cell lung cancer TNM staging. according to the patient on the different effects are significantly different. I non-small cell lung cancer five-year survival rate of patients with 60% ~ 80%, II 40% of patients ~ 60%, III stage patients was 10% ~ 30%, IV five-year survival rate of patients less than 1%. With the changes late stage of disease, the survival ratio of more and more. for limited small cell lung cancer survival two years rate of more than 20% of patients a wide range of lesions less than 10%. These materials are not only the doctors know what, it should be known to the patient or family members.
stage of lung cancer there are two main steps, first, common in lung cancer check the transfer of parts, such as: fiberoptic bronchoscopy, biopsy or brush can not only films, on whether the surgical diagnosis is important, but also for the bulge is fixed, the situation of bronchial compression can also be understood that conventional lung cancer patients diagnosed Check the item (a contraindication exception). is lateral chest films and CT films, on pulmonary and mediastinal lymph nodes is important, head MRI or CT, can detect brain metastasis. by ultrasound examination, liver, retroperitoneal lymph nodes and adrenal metastases full observation, shows whether there is metastatic disease. on these organs in the abdomen, the chest CT scan examination more than a few levels down to the adrenal gland plane ultrasound can confirm each other, more reliable . bone metastasis is also common sites of metastases of lung cancer by isotope bone scan, can be found isotope uptake, suggesting the possibility of the transfer. metastasis and bone marrow are different concepts, by bone marrow aspiration or biopsy can confirm the diagnosis. Positron emission tomography (PET) examination expensive, there are false positive, the current is not yet universal, not as a routine examination. mediastinoscopy for mediastinal lymph node metastasis positive value, but is there trauma examination, the patient does not easily accept.
lung cancer The second stage of measures to assess organ case, further treatment of the patient's choice is important. The main contents include: a detailed history and physical examination, liver and kidney function, lung function, electrocardiogram, blood cell analysis, serum electrolytes , enzymology, and tumor markers and other projects. in the history of particular importance in the outer lung cancer symptoms, such as bone and joint symptoms, endocrine changes and so on. physical examination should be carefully examined whether the neck and axillary lymph nodes, whether the lower leg tibia pressure sore. on the surface metastases to the diagnosis of clinical physical examination. For small cell lung cancer, the tumor markers NSE and ProGRP have diagnostic and prognostic value of elevated, but not as a phased basis. other tumor markers such as : CEA, LDH, CYFRA21-1, TPA and other specific even worse, do not check items in phases.
measures in recent years, the development stage of lung cancer, there have been many genetic and molecular level the method of measuring the relatively The project must P53 gene, RB gene, erB-2, epidermal growth factor receptor and matrix metalloproteinase. but not as a regular item, pending confirmation of the international lung cancer staging and promotion agencies.