Central lung cancer according to mcb. Lung cancer - description, causes, symptoms (signs), diagnosis, treatment

Lung cancer, depending on the location, is divided into peripheral and central. Gradation according to the type of location systematizes, first of all, the immediate place of the appearance and development of cancer cells. CRL occurs in the large bronchi, and the origin of PRL is the cells of the small bronchi or alveoli located on the periphery of the respiratory organs.

The cancerous process away from the root of the lung has its own specific features, but in terms of histological forms it has the same indicators as large bronchial cancer.

Peripheral lung cancer code for mcb 10 C33-C34 is formed from cells of small bronchi, bronchioles and alveolar epithelium. The main distinguishing feature from central cancer is its weak clinical indicators or their complete absence at the initial stage of pathology.

Cancer distant from the root of the lung is often discovered by chance, during the next physical examination. The pathology manifests itself relatively late, when the tumor reaches a large size (up to 7 cm), and begins to germinate the pleura or compress the large bronchi.

Only at this stage there is a cough, shortness of breath, hemoptysis, pleural carcinomatosis. The degeneration of normal cells into cancer cells can begin at the site of the scar tissue that was formed as a result of pneumonia,.

The structure of the shadow of the cancer node is characterized by heterogeneity, which is expressed in the form of separate round shadows merged with each other. In the case of visualization of a distinct tumor, it may be difficult to differentiate it from benign formations.

The aggressiveness of the spread of atypical education is expressed not only by its size, but also by its growth rate.

Important! The rate of tumor growth is influenced by the histology of cells and the age of patients. The younger the patient, the more aggressive the rate of tumor growth. Slower growth is seen in elderly patients.

The course of the disease against the background of small bronchi appears to be inhomogeneous radiance, bordering the primary tumor. The rays depart from the focus, while their tips point towards the tissues of the lung. The presence of radiant spines is associated with blood and lymphatic vessels passing near the walls of the bronchi.

Small bronchial cancer is prone to metastasis and germination in the central lobes. Centralization of the PR causes obstruction of the large bronchi, which subsequently leads to atelectasis. The histological variant is most often, less often or undifferentiated forms.

Classification

For peripheral cancer, a number of features reflecting its clinical and anatomical manifestations are distinguished. Each anatomical form has its own characteristic differences, so they should be considered separately. Some species have, only for them, characteristic symptomatic manifestations.

Clinical forms of BPD:

• nodular;
• cavity;
• pneumonia-like;
• cortico-pleural.

The nodular form of development is the most common variant of peripheral cancer. It originates in the terminal bronchioles, on the radiograph appears as a uniform shadow with even contours and a bumpy surface.

Abdominal cancer is a rarer variant than nodular cancer. Its origin is associated with the disintegration of the nodular form into fractions of various histological structures, and the formation of a pseudo-cavernous cavity in the thickness of the node. The cavity has a central location and reaches various sizes and shapes.

Pneumonia-like form of growth is even rarer and develops not in the form of a node, but as an infiltrate without correct form and without clear boundaries. It tends to rapidly infiltrate, while it can cover an entire lobe. Histologically, it is always represented by glandular cancer, clinical indicators are similar to sluggish pneumonia.

Corticopleural cancer is classified as peripheral, although this term is not always recognized in oncology. It originates in the mantle layer of the lung tissue from the side of the spine.

Spreading along the pleura along the spine (it does not develop in the form of a knot), it envelops the processes and the body of the spine. In some cases, the tumor fuses with the spine for a considerable length.

The main symptomatology is due to pain in the thoracic spine, with the further development of the clinic of the affected spinal cord.

The clinical parameters of the tumor depend not only on its shape, but also on the location in the lung lobes.

Lung cancer peripheral code according to microbial 10, localization in lobes and relative frequency of fixations:

• upper - C34.1 (70%);
• lower - C34.3 (23%);
• medium - C34.2 (7%).

Peripheral cancer of the upper lobe of the left lung at the initial stage of the disease has weak indicators on the radiograph. Only a slight decrease in transparency or a flat shadow is visible without a clear outline of its borders. In the future, the intensity of the darkening increases, but without a clear outline.

Peripheral cancer of the lower lobe of the left lung is due to an increase in intrathoracic, supraclavicular, prescaleneal lymph nodes.

Peripheral cancer of the upper lobe of the right lung, as well as the lower lobe, is identical in its clinical and anatomical manifestations with the left-sided development of the tumor pathology. By virtue of anatomical structure the right-sided location of the disease is fixed more often than the left-sided one.

Important! Cancer of the apex of the lung, under certain conditions, is classified as a Pancoast tumor.

A characteristic symptomatology appears when the neoplasm spreads along the I segment, sprouting at the same time nearby tissues, leading to the destruction of 1-3 ribs and thoracic vertebrae. Fix increasing pain in the chest and upper limbs.

The tumor reaching the subclavian vessels causes swelling of the extremities. Growing into the sympathetic trunk leads to the appearance of Horner's syndrome - retraction of the eyeball, pupil constriction, drooping of the eyelid, and others.

Diagnostics

The most common method of early diagnosis is a preventive x-ray examination. If a suspicious darkening is detected, it is necessary to conduct an additional tomographic examination, as well as take sputum for cytological analyses.

Important! The main task for any diagnostic method is to identify cancer pathology at the stage of development, at which the tumor has not reached a large size and metastasis has not occurred.

Small ones include pathological formations up to 3 cm, and the smaller the focus, the less likely the lymphatic spread of metastases. The first signs of the disease on the x-ray can vary, so there is no certainty in this matter.

The following early forms of blackouts are distinguished:

• spherical - in 30% of cases;
• irregular, with fuzzy boundaries;
• elongated, similar to tissue fibrosis;
• shadows in the form of rough strands;

Peripheral lung cancer with subsequent progression on the radiograph is manifested by damage to the vertebrae of their processes. Intensification of the shadow, and outlining it with a correct contour, can lead to an erroneous diagnosis, confusing cancerous pathology with pleurisy.

The radiograph may not be completely informative, oncopathology may not be displayed at all in the picture, and the occurrence of pain syndrome will be linked to atypical changes in the spine. Therefore, in modern medicine A decisive role in diagnosing, in the presence of certain markers indicating the peripherization of a pathological formation, is assigned to computed tomography.

It is CT that allows you to achieve the greatest detail of the pathological picture. It should be borne in mind that the price of diagnosing, on devices latest generation, will be relatively high. However, the effectiveness and informativeness of this diagnosis is undeniable.

CT gives a clearer cut of the oncoprocess (pictured), and allows you to distinguish between a tumor lesion of the pleura from fibrous pathology. Such differences are not displayed on radiography.

CT scan well defines the following indicators:

• structure and contours of shading;
• the presence of infiltration of surrounding tissues;
• migration of metastases to the lymph nodes;
• the exact location of the tumor;
• the growth of the focus into the following lobes and the germination of the pleura.

Thanks to its informative this method allows you to identify small metastases, germination of nearby organs and tissues.

The instruction for diagnosing BPD involves the collection of biomaterial for further cytological examination. A biopsy specimen from the small bronchi is taken using the catheterization method. It consists in the fact that a radiopaque catheter is brought through the subsegmental bronchus and the necessary cellular material is removed.

Important! Collection of biomaterial is not the main method of early diagnosis. It is carried out with suspicion of oncology, and with early pathological blackout detected.

In some cases, a puncture is performed - the selection of tissue through the chest. This minimally invasive method is done through a small puncture with a special needle, under local anesthesia. The extracted biopsy is examined.

Due to the fact that the peripheral form of cancer, especially in the early stages, has a very blurred picture, its diagnosis can be difficult. Cancer foci are mistaken for other pulmonary pathologies, therefore, at the slightest suspicion of cancer, the patient must be sent for additional examination.

Important! The primary task of competent diagnosis is not to state the fact of the disease, but to detect it before the onset of metastasis.

Treatment and prognosis

The most effective treatment for BPD is surgery. radical method avoids many side effects associated directly with the treatment. When performing a surgical operation, the lesion is completely removed, and the recurrence of the disease is minimized as much as possible.

The most significant indicator for the operation is the absence of metastasis and the small size of the tumor. In this case, it is advisable to perform a lobectomy - removal of a lung lobe within its anatomical boundaries, or a biloctectomy - scalping of two lobes.

If a more developed form is registered, with metastases in the lymph nodes of the first order, then a complete resection of one of the lungs is recommended - pulmonectomy.

There are a number of restrictions on the path to partial or complete resection of one of the paired respiratory organs. This is, first of all, the neglect of the oncological process, the appearance of regional and separated metastases, the germination of the tumor near the underlying tissues and organs. If the operation is refused, the attending physician may refer to old age patient, diseases of the cardiovascular system, other indicators leading to a decrease in the vital capabilities of the body.

After the ban on the operation, the patient will be asked to undergo chemotherapy and radiation exposure. To undergo a course of drug treatment for a patient, a thorough examination will be required.

Modern drug therapy affects the disease pointwise and selectively. Although the patient will not be able to avoid many negative consequences, it is still one of the most basic methods of cancer treatment.

Radiation therapy affects several areas at the same time. Irradiation is exposed not only to the primary affected area, but also to the sites of regional metastasis. The principle of the process is presented in the video in this article.

Radiation and chemotherapeutic effects are used not only as independent methods of treatment, they can also complement each other, or be recommended in addition to surgical method. In this case, the type of treatment used is called combined.

The prognosis of survival is influenced by the stage at which the treatment of the disease began, the histological parameters of the tumor and its degree of differentiation. The most acceptable result in predicting is associated with operations to remove a malignant tumor.

However, only 10-12% of patients undergo surgery. Such low rate linked to the diagnosis of the disease in the later stages, and the impossibility of resection of the tumor.

Five-year survival prognosis table for BPD:

Life expectancy in peripheral cancer of the right lung does not differ from the left. That is, right-sided and left-sided localization do not affect the statistical data on the prognosis of survival.

Lung cancer (ICD-10 code C33-C34) is one of the most common ailments in the field of oncological diseases. The basis of the malignant process is the degeneration of lung tissue and the violation of gas exchange in paired organs. Death from lung cancer has a very high percentage, in the main risk group men after 50 years of age who abuse smoking.

Malignant lung tumor in 80% it occurs as a result of smoking tobacco, and it can also occur as a result of work in hazardous industries. Speaking of women, we can say that due to the fact that the percentage of women who smoke last years has risen sharply, the number of women with lung cancer has also increased. Thus, the growth of patients of the weaker sex increases significantly after 45 years.

There are many questions about this disease - how long do people live with lung cancer, can it be cured, is lung cancer contagious or not, etc. To answer all these questions, you need to understand the pathogenesis of the disease.

Etiology of the phenomenon

A lung tumor can have several causes, they are divided into depending on the person and independent of him. Independent reasons include the presence of a tumor of other organs that metastasize to the lungs, genetic predisposition, lung diseases - bronchitis, pneumonia, tuberculosis, scars on the lung tissue, endocrine diseases.

Dependent causes are smoking. Everyone knows that in the process of burning tobacco, toxic substances (there are about 4000 types) and heavy metals are released, getting into the lungs, they are deposited on the bronchial mucosa and burn out healthy cells, as a result, the mucous layer is destroyed. However, harmful substances are not excreted from the body, but remain in the lungs forever, causing cell regeneration. Passive smoking is no less dangerous, since 80% of cigarette smoke enters the surrounding air. The length of smoking and the number of cigarettes smoked also play a big role, for example, with an experience of 10 years and smoking two packs of cigarettes per day, the risk of the disease increases by 25%.

There is a professional activity that also leads to the risk of developing oncological processes in the lungs: work in a mine, asbestos production, work in felting, linen and cotton production, activities in which a person regularly comes into contact with heavy metals and pesticides.

The environment also contributes to the process. Residents of large metropolitan areas are forced to inhale a huge number of carcinogens every day, which are emitted into the air by factories, factories and cars.

Symptomatic manifestations

Symptoms of the disease at the initial stage most often do not cause anxiety in a person:

• loss of appetite;
• incomprehensible fatigue;
• weight loss (minor);
• cough.

More specific symptoms join much later. Hemoptysis, shortness of breath, cough with bloody sputum, pain are symptoms of advanced stages.

Doctors distinguish 3 stages of lung cancer:

• biological - from the beginning of the pathological process to the signs of the disease in the picture;
• asymptomatic - signs of pathology are clearly visible on the x-ray, but the symptoms do not yet appear;
• clinical - the appearance of symptoms.

At the first stage, a minimum number of patients consult a doctor, so the early diagnosis of the disease is very small.

At stages 2 and 3, oncology manifests itself as follows:

1. The patient's vitality decreases, he gets tired very quickly, loses interest in the events that are happening around him.
2. The progression of the disease is often disguised as pneumonia, catarrh, SARS.
3. An increase in body temperature to subfebrile indicators, when taking antipyretics, the temperature may drop to normal, but after a while rise again.

At first, the cough is rare, dry, but after a while it becomes constant and very disturbing.

Heart rhythm disturbances respiratory disorders, chest pains appear in advanced stages, this is due to the loss of a significant part of the lungs from the respiratory processes, in addition, in the pulmonary circulation, the vascular bed is reduced and the mediastinum is compressed.

Most often, the patient seeks medical help only when he has hemoptysis, but this symptom appears in the last stages of the disease. The same applies to pain symptoms.

Disease classification

According to the international classification, lung cancer is histologically divided into small cell and non-small cell. The development and course of these species occurs in different ways. Small cell oncology is a rapidly developing and more aggressive form of cancer. I must say that in non-smokers this type is practically not found.

The non-small cell form is divided into 3 subspecies:

1. Adenocarcinoma - develops on the periphery of the organ. Bronchoalveolar lung cancer is one of the types of adenocarcinoma, characterized by a large number of focal lesions and spreads along the walls of the alveoli.
2. Squamous cell carcinoma is a rare disease, divided into giant cell and clear cell.
3. Large cell cancer.

Other types of lung cancer - bronchial carcinoma, central cancer, peripheral cancer (nodular tumor, pneumonia-like, cancer of the apex). In addition, the disease is divided into cancer of the left lung and right. Both lungs are affected much less frequently, most often only if the cancer of the right lung metastasizes to the second and vice versa.

Diagnostic measures

Most often, lung cancer is diagnosed using X-ray equipment. Every person after 16 years of age should examine the lungs on fluorography every year. So, diagnostic methods:

1. If the patient went to the doctor with a cough and recurrent pneumonia, then the specialist directs him to an x-ray. The picture must be taken in two projections.
2. Bronchoscopy is the most reliable diagnostic method. The procedure consists in examining the bronchial lumen through a bronchoscope. Thus, the doctor can not only examine the area of ​​interest, but also take material for histological examination.
3. CT and MRI are also very informative diagnostic methods. The doctor can detect not only the presence of a tumor, but also see how much it has spread to nearby organs. The respiratory system can be studied in detail using positron emission tomography.
4. If the central localization of the tumor is suspected, then mediascopy is used - a small incision is made where the camera is inserted, the specialist on the monitor can also examine the condition lymph nodes including.
5. Percutaneous biopsy is indicated for lung cancer of the peripheral type, in which case a sample can be taken for histological analysis.

Principles of treatment

The doctor chooses the tactics of treatment depending on many factors: the stage of the disease, the form of oncology, the histological structure of the tumor, the existing pathologies, and so on. There are 3 types of treatment - surgery, radiation therapy, chemotherapy. But each type separately is almost never used, in most cases two or three methods are used at once.

The main form of cancer control is surgical intervention. At the same time, if the tumor is very large and has spread to neighboring organs, radiation or chemotherapy is also prescribed.

Surgical intervention may be as follows:

• pulmonectomy - the lung is completely removed;
• lobectomy - one lobe of the organ is removed;
• bilobectomy - removal of two lobes;
• combined intervention;
• an atypical operation (wedge resection, segmentectomy, and others) is performed with small lesions.

Which intervention the surgeon chooses depends on how much the tumor has spread. If only one lobe of the organ is affected, then a lobectomy is performed, and if there is a lesion of the main bronchus, then pulmonectomy is prescribed. Palliative surgery is performed in severe cases, when tumor decay is diagnosed or there is a risk of pulmonary hemorrhage.

Radiation therapy is indicated when surgical intervention is impossible or when the patient refuses surgery. It must be understood that this type of therapy has contraindications:

• swelling swelling;
• severe infections;
• the tumor has grown into the esophagus;
• tuberculosis;
• anemia;
• violations in vital systems;
• a history of heart attack or stroke;
• exacerbation of mental disorders.

Radiation therapy can be remote and contact. The choice of therapy is determined by the doctor.

Chemotherapy is prescribed for small cell cancer, palliative treatment, single metastases. This type of therapy is difficult for patients to tolerate, since the effect is not only on cancer cells, but also on healthy cells, in some cases, the harm from chemotherapy is much stronger than from the tumor itself.

Life Predictions

No doctor can give accurate predictions. A cancerous tumor often behaves unpredictably. But if we talk about healing, then it is possible. A favorable outcome can be achieved by surgery and radiation therapy in combination.

Approximately half of patients after such treatment live 5 years. However, the prognosis, of course, depends on the stage of the disease, on what form the lung cancer has, metastases, how fast the tumor grows, etc. The psychological mood of the patient and his desire to live are also very important.

Disease prevention

There are several rules, following which you can significantly reduce the occurrence of lung cancer.

1. It is necessary to get rid of bad habits, in particular from tobacco smoking.
2. Be sure to control your weight, as obesity increases the risk of developing cancer.
3. Contact with harmful substances as little as possible, and if this is not possible, then it is imperative to use protective masks, respirators, etc.
4. It is advisable to ventilate the room more often so that pathogenic microorganisms do not accumulate and do not trigger various inflammatory processes in the respiratory system.
5. To prevent stagnation in the lungs, you need to move more, take walks and exercise.
6. It is necessary to treat lung diseases in time.

Is cancer contagious?

Today, the diagnosis of oncology is the most terrible sentence for any person, so it is possible to explain people's anxiety about whether it is possible to get cancer from a sick person? On this occasion, it was a large number of studies and as a result, when asked if lung cancer is contagious, the oncologist's answer is no. If this were possible, then humanity would have been wiped off the face of the Earth long ago, it is impossible to get cancer by any means (saliva, household way, cough, sputum, etc.). No transfer cases cancer has not been noted in the world.

Through mother's milk, a baby cannot also become infected with oncology, especially since cancer cells are rather capricious and take root in the body with difficulty. If a person is healthy and his immune system is working normally, then his body will perceive the pathological cell as foreign and immediately destroy it. Cancer is also not transmitted through blood, and the fact that cancer patients do not take donor blood is explained by concern for the patient himself, since the immune system is significantly weakened during oncology.

Lungs' cancer

RCHD (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Version: Clinical Protocols of the Ministry of Health of the Republic of Kazakhstan - 2015

Malignant neoplasm of bronchi and lung (C34)

Oncology

general information

Short description

Recommended
Expert Council
RSE on REM "Republican Center
health development"
Ministry of Health
and social development
Republic of Kazakhstan
dated October 30, 2015
Protocol #14

Lung cancer - a tumor of epithelial origin, developing in the mucous membrane of the bronchi, bronchioles and mucous bronchial glands. (UD-A)

Protocol name: Lung cancer.

Classification

Clinical classification: (the most common approaches, for example: by etiology, by stage, etc.).

HISTOLOGICAL CLASSIFICATION (UD-A):

TNM CLASSIFICATION OF LUNG CANCER (UD-A)

Determination of the spread of the primary tumor (T)

Regional lymph node involvement (N)

Distant metastases (M)

Diagnostics

The list of basic and additional diagnostic measures:
Basic (mandatory) diagnostic examinations carried out at the outpatient level:
Collection of complaints and anamnesis;
General physical examination;

Additional diagnostic examinations performed at the outpatient level:


Fibroesophagoscopy;



Computed tomography of the brain;
· Positron emission tomography (PET) + computed tomography of the whole body.

The minimum list of examinations that must be carried out upon referral for planned hospitalization: in accordance with the internal regulations of the hospital, taking into account the current order of the authorized body in the field of healthcare.

The main (mandatory) diagnostic examinations carried out on stationary level(in case of emergency hospitalization, diagnostic examinations not performed at the outpatient level are carried out):
· General analysis blood;
Biochemical blood test (protein, creatinine, urea, bilirubin, ALT, AST, blood glucose);
· Coagulogram (prothrombin index, fibrinogen, fibrinolytic activity, thrombotest);
· General urine analysis;
X-ray of the chest organs (2 projections);
Computed tomography of the chest and mediastinum;
Fibrobronchoscopy diagnostic;
Ultrasound of supraclavicular, axillary lymph nodes;
· Spirography;
· Electrocardiographic study;
ECHO cardiography (after consultation with a cardiologist for patients aged 50 years and older, as well as patients younger than 50 years of age with concomitant pathology of the cardiovascular system).

Additional diagnostic examinations performed at the inpatient level (in case of emergency hospitalization, diagnostic examinations not performed at the outpatient level are performed):
· Magnetic resonance imaging of the chest with contrast;
Ultrasound of supraclavicular and cervical lymph nodes;
Complex ultrasound diagnostics (liver, gallbladder, pancreas, spleen, kidneys);
Puncture / aspiration biopsy under ultrasound control;
Fibroesophagoscopy;
Open biopsy of enlarged supraclavicular and cervical lymph nodes (in the presence of enlarged lymph nodes);
· Cytological examination;
· Histological examination.

Diagnostic measures taken at the stage of emergency care: no.

Diagnostic Criteria for Making a Diagnosis
complaints and anamnesis
clinical manifestations depending on the stage and localization:
cough with or without sputum
The presence or absence of streaks of blood in the sputum (hemoptysis)
shortness of breath when physical activity
· weakness
night sweats
· subfebrile temperature
weight loss.
Anamnesis: symptoms lung cancer are nonspecific, therefore characteristic of many diseases of the respiratory system. That is why the diagnosis in many cases is not timely. The tumor in the initial stage is asymptomatic due to the absence of pain endings in the lung tissue. When the tumor grows into the bronchus, a cough appears, initially dry, then with light sputum, sometimes with an admixture of blood. There is hypoventilation of the lung segment and then its atelectasis. Sputum becomes purulent, which is accompanied by fever, general malaise, shortness of breath. Cancer pneumonia joins. Cancerous pleurisy, accompanied by pain syndrome, can join cancerous pneumonia. If the tumor grows nervus vagus, hoarseness joins due to paralysis of the vocal muscles. Damage to the phrenic nerve causes paralysis of the diaphragm. Germination of the pericardium is manifested by pain in the region of the heart. The defeat of the tumor or its metastases of the superior vena cava causes a violation of the outflow of blood and lymph from the upper half of the body, upper limbs, head and neck. The patient's face becomes puffy, with a cyanotic tinge, veins swell on the neck, arms, and chest.

Physical examination
Decreased breathing on affected side
hoarseness of voice (during the germination of the tumor of the vagus nerve)
puffiness of the face, with a cyanotic tinge, swollen veins on the neck, arms, chest (with tumor invasion of the superior vena cava)

Laboratory research
· Cytological examination(an increase in the size of the cell up to gigantic, a change in the shape and number of intracellular elements, an increase in the size of the nucleus, its contours, a different degree of maturity of the nucleus and other elements of the cell, a change in the number and shape of the nucleoli);
· Histological examination(large polygonal or spike-shaped cells with well-defined cytoplasm, rounded nuclei with clear nucleoli, with mitoses, cells are arranged in the form of cells and strands with or without keratin formation, the presence of tumor emboli in the vessels, the severity of lymphocytic-plasmacytic infiltration, mitotic activity of tumor cells ).

Instrumental Research
X-ray examination
Peripheral cancer is characterized by fuzziness, blurring of the contours of the shadow. Tumor infiltration of the lung tissue leads to the formation of a kind of radiance around the node, which can be detected only in one of the edges of the neoplasm.
In the presence of peripheral lung cancer, a path can be detected that connects the tumor tissue with the shadow of the root, due to either lymphogenous spread of the tumor, or its peribronchial, perivascular growth.
X-ray picture in central cancer - the presence of tumor masses in the region of the root of the lung; hypoventilation of one or more segments of the lung; signs of valvular emphysema of one or more segments of the lung; atelectasis of one or more segments of the lung.
X-ray picture in apical cancer is accompanied by Pancoast's syndrome. It is characterized by the presence of a rounded formation of the lung apex, pleural changes, destruction of the upper ribs and corresponding vertebrae.
Fibrobronchoscopy
The presence of a tumor in the lumen of the bronchus completely or partially obstructing the lumen of the bronchus.

Pproviding for expert advice:
· Consultation with a cardiologist (for patients aged 50 years and older, as well as patients under 50 years of age in the presence of concomitant CVS pathology);
Neurologist's consultation (for vascular brain disorders, including strokes, injuries of the brain and spinal cord, epilepsy, myasthenia gravis, neuroinfectious diseases, as well as in all cases of loss of consciousness);
· Consultation of a gastroenterologist (in the presence of concomitant pathology of the gastrointestinal tract in history);
· Consultation of a neurosurgeon (in the presence of metastases in the brain, spine);
· Consultation of an endocrinologist (if there is a concomitant pathology of the endocrine organs).
· Consultation of a nephrologist - in the presence of pathology from the urinary system.
· Consultation of a phthisiatrician - in case of suspected pulmonary tuberculosis.

Differential Diagnosis

Treatment abroad

Get treatment in Korea, Israel, Germany, USA

Get advice on medical tourism

Treatment

Treatment Goals:
Elimination of the tumor process;
Achieving stabilization or regression of the tumor process;
Prolongation of the patient's life.

Treatment tactics:

Non-small cell cancer

small cell cancer

III. Second metachronous lung cancer or lung metastases

Method of chemoradiotherapy for small cell lung cancer:

Syndrome of compression of the superior vena cava

Drugs ( active substances) used in the treatment

Hospitalization

Indications for hospitalization, indicating the type of hospitalization:

Indications for planned hospitalization:
The presence of a tumor process, verified histologically and/or cytologically. Operable lung cancer (stages I-III).

Indications for emergency hospitalization: no.

Prevention

Preventive actions
Application medicines allowing to restore immune system after antitumor treatment (antioxidants, multivitamin complexes), a full-fledged diet rich in vitamins, proteins, giving up bad habits (smoking, drinking alcohol), prevention viral infections and concomitant diseases, regular preventive examinations by an oncologist, regular diagnostic procedures(radiography of the lungs, ultrasound of the liver, kidneys, lymph nodes of the neck)

Information

Sources and literature

1. Minutes of the meetings of the Expert Council of the RCHD MHSD RK, 2015
   1. References 1. Standards for the treatment of malignant tumors (Russia), Chelyabinsk, 2003. 2. Trakhtenberg A.Kh. Clinical onco-pulmonology. Geomretar, 2000. 3. TNM Classification of malignant tumors. Sobin L.Kh., Gospordarovich M.K., Moscow 2011 4. Neuroendocrine tumors. Guide for doctors. Edited by Martin Caplin, Larry Kvols/ Moscow 2010 5. Minimum clinical guidelines European Society for Medical Oncology (ESMO) 6. American Joint Committee on Cancer (AJCC). AJCC Cancer Staging Manual, 7th ed. Edge S.B., Byrd D.R., Carducci M.A. et al., eds. New York: Springer; 2009; 7. Guidelines for chemotherapy of neoplastic diseases, edited by N.I. Perevodchikova, V.A. Gorbunova. Moscow 2015 8. The chemotherapy Source Book, Fourth Edition, Michael C. Perry 2008 by Lip-pincot Williams 9. Journal of Clinical Oncology Vol. 2, no. 3, p. 235, “Carcinoid” 100 years later: epidemiology and prognostic factors of neuroendocrine tumors. 10. Ardill JE. Circulating markers for endocrine tumors of the gastroenteropancreatic tract. Ann Clin Biochem. 2008; 539-59 11. Arnold R, Wilke A, Rinke A, et al. Plasma chromogranin A as a marker for survival in patients with metastatic endocrine gastroenteropancreatic tumors. Clin Gastroenterol Hepatol. 2008, pp. 820-7

Information

List of protocol developers with qualification data:

1. Karasaev Makhsot Ismagulovich - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", head of the Center for Thoracic Oncology.
2. Baimukhametov Emil Targynovich - Doctor of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", doctor of the Center for Thoracic Oncology.
3. Kim Viktor Borisovich - Doctor of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", head of the Center for Neurooncology.
4. Abdrakhmanov Ramil Zufarovich - Candidate of Medical Sciences, RSE on REM "Kazakh Research Institute of Oncology and Radiology", head of the chemotherapy day hospital.
5. Tabarov Adlet Berikbolovich - clinical pharmacologist, RSE on REM "Hospital of the Medical Center Administration of the President of the Republic of Kazakhstan", head of the department of innovation management.

Statement of conflict of interest: No

Reviewers: Kaydarov Bakhyt Kasenovich - Doctor of Medical Sciences, Professor, Head of the Department of Oncology, RSE on REM "Kazakh National medical University named after S.D. Asfendiyarov";

Indication of the conditions for revising the protocol: revision of the protocol 3 years after its publication and from the date of its entry into force or in the presence of new methods with a level of evidence.

Attachment 1
Grade general condition patient using the Karnofsky index

Attached files

Attention!

• By self-medicating, you can cause irreparable harm to your health.
• The information posted on the MedElement website and in the mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" cannot and should not replace an in-person consultation with a doctor. Be sure to contact medical facilities if you have any diseases or symptoms that bother you.
• The choice of drugs and their dosage should be discussed with a specialist. Only a doctor can prescribe the right medicine and its dosage, taking into account the disease and the condition of the patient's body.
• The MedElement website and mobile applications "MedElement (MedElement)", "Lekar Pro", "Dariger Pro", "Diseases: Therapist's Handbook" are exclusively information and reference resources. The information posted on this site should not be used to arbitrarily change the doctor's prescriptions.
• The editors of MedElement are not responsible for any damage to health or material damage resulting from the use of this site.

Not all tumors that form in the lungs indicate that approximately 10% of them do not contain malignant cells and belong to a general group called "benign lung tumors." All of their neoplasms differ in origin, localization, histological structure, clinical features, but they are united by very slow growth and the absence of a metastasis process.

General information about benign neoplasms

The development of a benign formation occurs from cells that are similar in structure to healthy ones. It is formed as a result of the onset of abnormal tissue growth, for many years it may not change in size or increase very slightly, often does not show any signs and does not cause discomfort to the patient until the process complication begins.

Neoplasms of this localization are nodular seals of an oval or round shape, they can be single or multiple and localized in any part of the organ. The tumor is surrounded by healthy tissues, over time, those that create the border atrophy, forming a kind of pseudocapsule.

The appearance of any seal in the organ requires a detailed study of the degree of malignancy. The chance of getting a positive answer to the question: "Can a tumor in the lungs be benign" is much higher in a patient:

• which leads healthy lifestyle life;
• I do not smoke;
• by age - younger than 40 years;
• timely undergoes a medical examination, in which compaction is detected in a timely manner (in the initial stage of its development).

The reasons for the formation of benign tumors in the lungs are not well understood, but in many cases they develop against the background of infectious and inflammatory processes (for example: pneumonia, tuberculosis, fungal infections, sarcoidosis, Wegener's granulomatosis), abscess formation.

Attention! Benign neoplasms of this localization are included in the ICD 10, the group is marked with the code D14.3.

Classifications of pathological neoplasms

In medical practice, they adhere to the classification of benign lung tumors, based on the localization and formation of a tumor compaction. According to this principle, there are three main types:

• central. These include tumor formations formed from the walls of the main bronchi. Their growth can occur both inside the bronchus and in adjacent surrounding tissues;
• peripheral. These include formations formed from distal small bronchi or segments of lung tissues. By location, they can be superficial and deep (intrapulmonary). This species is more common in the central;
• mixed.

Regardless of the type, tumor seals can appear both in the left and in the right lung. Some tumors are congenital in nature, others develop in the process of life under the influence of external factors. Neoplasms in the organ can be formed from epithelial tissue, mesoderm, neuroectoderm.

Overview of the most common and known species

This group includes many types of neoplasms, among them there are the most common, which are often heard by the population and are described in any essay on benign lung tumors.

1. Adenoma.

Adenomas account for more than half of all benign tumors localized in the organ. They are formed by cells of the mucous glands of the bronchial membrane, tracheal ducts and large airways.

In 90% they are characterized by central localization. Adenomas are mainly formed in the wall of the bronchus, grow into the lumen and into the thickness, sometimes extrabronchially, but do not germinate the mucosa. In most cases, the form of such adenomas is polypoid, tuberous and lobular are considered more rare. Their structures can be clearly seen on the photos of benign lung tumors presented on the Internet. The neoplasm is always covered with its own mucosa, occasionally covered with erosion. There are also fragile adenomas, with a mass of curd consistency contained inside.

Neoplasms of peripheral localization (of which about 10%) have a different structure: they are capsular, with a dense and elastic internal consistency. They are uniform in cross section, granular, yellowish-gray in color.

According to the histological structure, all adenomas are usually divided into four types:

• carcinoids;
• cylindromas;
• combined (connecting signs of carcinoids and a cylinder);
• mucoepidermoid.

Carcinoids are the most common type, accounting for about 85% of adenomas. This type of neoplasm is considered as a slow-growing, potentially malignant tumor, which is distinguished by the ability to secrete hormonally active substances. Therefore, there is a risk of malignancy, which eventually occurs in 5-10% of cases. Carcinoid, which has taken on a malignant nature, metastasizes through the lymphatic system or bloodstream, thus entering the liver, kidneys, and brain.

Other types of adenomas also carry the risk of cell transformation into malignant ones, but they are very rare. At the same time, all neoplasms of the considered type respond well to treatment and practically do not recur.

1. Hamartoma.

Among the most common is hamartoma, a benign lung tumor formed from several tissues (organ shell, fat and cartilage), including elements of germinal tissues. Also in its composition thin-walled vessels, lymphoid cells, smooth muscle fibers can be observed. In most cases, it has a peripheral localization, most often pathological seals are located in the anterior segments of the organ, on the surface or in the thickness of the lung.

Externally, the hamartoma has a rounded shape with a diameter of up to 3 cm, can grow up to 12, but there are rare cases of detection of larger tumors. The surface is smooth, sometimes with small bumps. The internal consistency is dense. The neoplasm is gray-yellow in color, has clear boundaries, does not contain a capsule.

Hamartomas grow very slowly, while they can squeeze the vessels of the organ without sprouting them, they are distinguished by a negligible tendency to malignancy.

1. Fibroma.

Fibromas are tumors formed by connective and fibrous tissue. In the lungs, they are detected, according to various sources, from 1 to 7% of cases, but mostly in males. Outwardly, the formation looks like a dense whitish knot about 2.5-3 cm in diameter, with a smooth surface and clear boundaries that separate it from healthy tissues. Less common are reddish fibromas or stalk-connected to the organ. In most cases, seals are peripheral, but may be central. Tumor formations of this type grow slowly, there is no evidence of their tendency to malignancy yet, but they can reach too large sizes, which will seriously affect the function of the organ.

1. Papilloma.

Another well-known, but rare case for this localization is papilloma. It is formed only in large bronchi, grows exclusively into the lumen of the organ, and is characterized by a tendency to malignancy.

Outwardly, papillomas are papillary in shape, covered with epithelium, the surface can be lobed or granular, in most cases with a soft elastic consistency. The color may vary from pinkish to dark red.

Signs of the appearance of a benign neoplasm

Symptoms of a benign lung tumor will depend on its size and location. Small seals most often do not show their development, they do not cause discomfort for a long time and do not worsen the general well-being of the patient.

Over time, seemingly harmless benign neoplasm in the lung can lead to:

• cough with phlegm;
• inflammation of the lungs;
• rise in temperature;
• expectoration with blood;
• pain in the chest;
• narrowing of the lumen and difficulty breathing;
• weaknesses;
• general deterioration in well-being.

What treatment is provided

Absolutely all patients diagnosed with a neoplasm are interested in the question: what to do if a benign lung tumor is found and is surgery performed? Unfortunately, antiviral therapy no effect, so doctors still recommend surgery. But modern methods and equipment of clinics make it possible to perform the removal as safely as possible for the patient, without consequences and complications. Operations are performed through small incisions, which reduces the duration recovery period and contributes to the aesthetic component.

An exception may be only inoperable patients for whom surgery is not recommended due to other health problems. They are shown dynamic observation and radiographic control.

Is there a need for a complex invasive operation? Yes, but it depends on the size of the pathological seal and the development of concomitant diseases and complications. Therefore, the treatment option is chosen by the doctor on a strictly individual basis, guided by the results of the patient's examination.

Carefully! There is no evidence of the effectiveness of the treatment of such pathologies. folk remedies. Do not forget that everything, even benign formations, carry a potential danger in the form of malignancy, i.e., a change in character to malignant is possible, and this cancer is a deadly disease!

Brief information from the international classifier of diseases 10 for lung cancer and other malignant tumors of the pulmonary system.

ICD-10 code for lung cancer

C34.0 - all types of malignant tumors of the lung and bronchi.

• C34.0- main bronchi
• C34.1- upper lobe
• C34.2– average share
• C34.3- lower lobe
• C34.8- defeat of several localizations
• C34.9- unspecified localization

Higher classification

C00-D48– neoplasms

C00-C97– malignant

C30-C39- respiratory and thoracic organs

Add-ons

In this system, classification occurs only by localization. Many are looking into which category peripheral cancer may fall into. The answer is to any of the above, depending on the location of the carcinoma in the lung.

Another common question is where to classify metastases in the classification. The answer is that they are not included here. The presence of metastases already occurs in the same TNM classification. Where M is just the fact of the presence or absence of neoplasms.

The next one is central cancer. We refer to C34.2 by localization in the middle lobe of the lung.

Cancer of the main bronchi is already reflected - C34.0.

The classifier also does not take into account the left-right localization of the disease. Only from top to bottom.

Lungs' cancer

Let's not repeat ourselves, detailed overview malignant tumor lung has already been made by us in . Read, watch, ask questions. It is there that you can read about the factors, signs, symptoms, diagnosis, treatment, prognosis and other important information regarding the whole disease.