Presentation on lung cancer. Lung cancer From screening to biological analysis of the tumor and minimally invasive interventions

Epidemiology of lung cancer (Ukraine, 2010) Incidence - 36 per 100 thousand (male - 63.5; female - 12.5) Number of registered cases - Mortality - 28.4 per 100 thousand (male - 51.7 ; female - 8.5) Mortality throughout the year - 64% Coverage with special treatment - 42% Morphologically verified - 58% Identified during medical examinations - 22.8%

Etiology of lung cancer Smoking (active and passive). Tobacco smoke aerosol contains over 3800 chemical compounds, of which over 40 are carcinogens: nicotine, benzanthracene, nitrosamines, radioactive elements (strontium, polonium, titanium, lead, potassium); Professional factors (metallurgical, mining, gas, textile, leather, cardboard industries). Asbestos, arsenic, chromium, nickel, cobalt salts, benzopyrene, mountain gas, coal sawn, etc.; Air pollution by chemical and radioactive carcinogens; Endogenous factors– chronic lung diseases, age over 45 years

Risk factors for lung cancer Smoking persons over 45 years of age; Sick chronic diseases bronchopulmonary system; Persons in contact with asbestos, non-ferrous salts and heavy metals, sources of radioactive radiation; Persons with a family history

Precancerous diseases (frequency of malignancy %) chronic recurrent bronchitis chronic abscesses bronchiectasis cavernous cysts localized pulmonary fibrosis chronic interstitial pneumonia

3 cm or a tumor that spreads to the main bronchus at dis" title=" Classification of lung cancer by stages T N M T 0 – tumor is not determined T is – pre-invasive cancer (cancer in situ) T 1 – tumor up to 3 in size cm in greatest dimension T 2 – tumor > 3 cm in size or a tumor extending to the main bronchus at a distance" class="link_thumb"> 9 !} Classification of lung cancer by stages T N M T 0 - tumor is not determined T is - pre-invasive cancer (cancer in situ) T 1 - tumor measuring up to 3 cm in the greatest dimension T 2 - tumor measuring > 3 cm or a tumor extending to the main bronchus at a distance of 2 cm or more from the carina, or the presence of atelectasis T 3 - a tumor of any size with infiltration of the chest wall, diaphragm, pericardium, pleura, main bronchus at a distance of less than 2 cm from the carina, or total atelectasis of the lung T 4 - a tumor of any size with infiltration of the mediastinum or large great vessels, or trachea, or esophagus, or carina, or exudative pleurisy N 0 – no metastases in regional lymph nodes N 1 – metastases in the peribronchial and/or lymph nodes of the lung root on the affected side N 2 – metastases in the bifurcation lymph nodes or mediastinal lymph nodes on the affected side N 3 – metastases in the mediastinal or pulmonary root lymph nodes on the opposite side side or in the supraclavicular lymph nodes M 0 – no distant metastases M 1 – there are distant metastases 3 cm or a tumor extending to the main bronchus at a distance of > 3 cm or a tumor extending to the main bronchus at a distance of 2 cm or more from the carina, or the presence of atelectasis T 3 - a tumor of any size with infiltration of the chest wall, diaphragm, pericardium, pleura , main bronchus at a distance of less than 2 cm from the carina, or total atelectasis of the lung T 4 - tumor of any size with infiltration of the mediastinum or great great vessels, or trachea, or esophagus, or carina, or exudative pleurisy N 0 - no metastases in regional lymph nodes N 1 - metastases in the peribronchial and/or lymph nodes of the lung root on the affected side N 2 - metastases in the bifurcation lymph nodes or mediastinal lymph nodes on the affected side N 3 - metastases in the mediastinal or pulmonary root lymph nodes on the opposite side or in the supraclavicular lymph nodes M 0 - no distant metastases M 1 - there are distant metastases "> 3 cm or a tumor that spreads to the main bronchus at a distance" title=" Classification of lung cancer by stages T N M T 0 - the tumor is not determined T is - pre-invasive cancer (cancer in situ) T 1 – tumor measuring up to 3 cm in greatest dimension T 2 – tumor measuring > 3 cm or a tumor extending to the main bronchus at a distance"> title="Classification of lung cancer by stages T N M T 0 - tumor is not determined T is - pre-invasive cancer (cancer in situ) T 1 - tumor measuring up to 3 cm in the greatest dimension T 2 - tumor measuring > 3 cm or a tumor extending to the main bronchus on the race"> !}

Clinical and radiological forms of LC 1. Central (endobronchial, peribronchial, mixed) 2. Peripheral (spherical, pneumonia-like, Penkosta cancer) 3. Atypical forms (mediastinal, miliary, cerebral, hepatic, bone, Penkosta cancer)

Methods for diagnosing lung cancer Patient complaints and anamnesis Physical examination (external examination, palpation, percussion, auscultation) Radiation diagnostics (radiography, CT, MRI, PET) Endoscopic diagnostics (bronchoscopy, mediastinoscopy, thoracoscopy) Biopsy and morphological diagnostics

Endoscopic RL syndromes Syndrome of direct anatomical changes - plus tissue - destruction of the mucosa - cone-shaped narrowing of the lumen - narrowing of the bronchus in a limited area Syndrome of indirect anatomical changes - infiltration without destruction of the mucosa - unclear pattern of bronchial rings - displacement of the walls or mouth of the bronchus - wall rigidity during instrumental palpation – bulging of the wall – absence of passive displacement of the bronchus Syndrome of functional changes – immobility of the bronchus wall during breathing – absence of transmitting pulsation from the heart and great vessels – presence of hemorrhagic discharge from the bronchus

Treatment of lung cancer SMALL CELL Cannot be treated surgically; Sensitive to chemoradiotherapy NON-SMALL CELL The main method of treatment is surgery; Chemotherapy and radiation therapy used in conjunction with surgery or in inoperable cases

Prevention of lung cancer; Smoking cessation; Worker protection hazardous industries from the influence of professional factors; Purification of the air environment by eliminating harmful industries and production processes (closed production cycles, etc.); Installation of catalysts on all vehicles, transition to electric vehicles

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Statistics of morbidity and mortality of the population of Russian territories with malignant neoplasms of the trachea, bronchi, and lung. Risk factors. Classification of types of lung cancer, their description and diagnosis. Treatment of the disease and endoscopy.

Lung cancer is a collective concept that unites different origins, histological structure, clinical course and the results of treatment of malignant tumors from the integumentary epithelium of the bronchial mucosa, mucous glands of the bronchioles and alveoli.

Epidemiology 1st place among other malignant tumors in men in Russia, and in terms of mortality - 1st place among men and women both in Russia and in the world Incidence - 40.2 per 100,000 population Average age– 65 years old In Russia in 2012, 55,475 people (24% of all Neo) fell ill with lung cancer, 49,908 people (35.1%) died. Every 4th patient among the total number of newly registered cancer patients and every 3rd person dying from these diseases are patients with lung cancer. Lung cancer kills more people each year than prostate, breast and colon cancers combined.

Src="https://present5.com/presentation/3/689156_437545905.pdf-img/689156_437545905.pdf-4.jpg" alt=" Etiology. Risk factors Modifiable: Smoking, environmental pollution, occupational hazards , age > 50 years,"> Этиология. Факторы риска Модифицируемые: Курение, загрязнение окружающей среды, профессиональные вредности, возраст > 50 лет, хронические легочные и !} endocrine diseases Non-modifiable: Primary multiplicity of tumors, hereditary predisposition (>=3 cases in close relatives)

Clinical and anatomical classification Peripheral - comes from the epithelium of smaller bronchi and is localized in the lung parenchyma

Peripheral lung cancer Nodular shape (round, spherical) Pneumonia-like (infiltrative) tumor Cancer of the apex of the lung with Pancoast syndrome

International histological classification squamous cell carcinoma (40% of patients) adenocarcinoma (40–50%) small cell carcinoma (SCLC) (15–20%) large cell carcinoma (5–10%) others (glandular squamous cell, bronchial gland cancer, etc.)

TNM Classification 2009 Tx – There is insufficient data to evaluate the primary tumor or the tumor is proven only by the presence of tumor cells in sputum or bronchial lavage, but is not detected by imaging methods T 0 – The primary tumor is not determined Tis – Preinvasive carcinoma (carcinoma in situ); T 1 - tumor 3 cm or less in greatest dimension; surrounded by lung tissue/visceral pleura. Based on bronchoscopy, there is no evidence of invasion more proximate to the lobar bronchus (no involvement of the main bronchus). T 1 a - tumor 2 cm or less in greatest dimension. T 1 b - tumor more than 2 cm, but

TNM classification 2009 T 3 - tumor more than 7 cm or any size, directly extending to chest wall, phrenic nerve, mediastinal pleura, parietal pericardium; or a tumor involving the main bronchus (less than 2 cm distal to the carina), but without involvement of the carina; or a tumor that led to the development of atelectasis or obstructive pneumonia of the entire lung, or separate tumor focus(es) in the same lobe as primary tumor. T 4 - tumor of any size that spreads to the mediastinum, heart, large vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral bodies, carina; or discrete tumor lesion(s) in the ipsilateral lung outside the lobe affected by the primary tumor.

2009 TNM Classification Nx - cannot be assessed. NO - there are no signs of metastatic lesions of regional lymph nodes. N 1 - there is damage to the peribronchial and/or lymph nodes of the root of the lung and intrapulmonary lymph nodes on the affected side, including direct spread of the tumor to the lymph nodes. N 2 - there is damage to the mediastinal and/or bifurcation lymph nodes (node) on the affected side. N 3 - there is a lesion either in the mediastinal lymph nodes or the root of the lung on the opposite side, or in the prescalene or supraclavicular lymph nodes on the affected side or on the opposite side. MX - cannot be assessed. M 0 - no signs of distant metastases. M 1 - there are distant metastases. M 1 a - individual tumor focus(es) in the opposite lung; tumor with pleural foci or accompanied by malignant pleural or pericardial effusion. M 1 b - distant metastases.

Clinical manifestations Primary (local): cough, hemoptysis, shortness of breath, chest pain Secondary - the result of regional and distant metastasis, involvement of neighboring organs and inflammatory complications (Horner's syndrome) General: weakness, fatigue, weight loss, decreased performance, etc.

Diagnostics General clinical examination X-ray in 2 projections CT scan of the chest with contrast, PET-CT Cytological examination of sputum Fibrobronchoscopy with biopsy Transthoracic and percutaneous puncture, transbronchial or transesophageal fine-needle puncture/biopsy Mediastinoscopy, diagnostic thoracoscopy, thoracotomy Tumor markers Ultrasound br. cavity, retroperitoneal space, supraclavicular, cervical and axillary areas Study of respiratory function ECG, Echo-CG

Tumor markers Small cell: neuron-specific enolase (NSE), carcinoembryonic antigen (CEA), progastrin-releasing peptide (Pro. GRP); Squamous: cytokeratin fragment (CYFRA 21 -1), squamous cell carcinoma (SCC) marker, CEA; Adenocarcinoma: CEA, CYFRA 21 -1, CA-125; Large cell: CYFRA 21 -1, SCC, CEA.

Treatment Tactics depend on the stage of the disease in accordance with TNM, histological structure, the nature and severity of concomitant pathology, functional indicators of vital organs and systems. Surgical treatment Radiation therapy Drug treatment(chemotherapy, targeted therapy)

Surgical treatment Involves removal of an organ (pneumonectomy) or its anatomical (bilobectomy, segmentectomy) and non-anatomical (sublobar) resection of the disease focus, intrapulmonary, root and mediastinal lymph nodes. Mediastinal lymphadenectomy (removal of tissue from regional lymph nodes) is a mandatory stage of the operation, regardless of the volume of lung tissue removed.

Surgical treatment It is recommended to consider lobectomy, bilobectomy or pneumonectomy with ipsilateral mediastinal lymphadenectomy as the minimum oncologically justified volume of surgery. For peripheral tumors up to 1.5 cm and low functional cardiorespiratory reserves, anatomical segmentectomy can be performed. Sublobar resections (atypical resection, segmentectomy) are associated with an increase in the incidence of local relapse and a deterioration in long-term results by 5-10%.

Lymphadenectomy The standard volume of mediastinal lymphadenectomy during operations on the right lung should be considered the removal of the right lower paratracheal (taracheobronchial, paratracheal, pretracheal). On the left - paraaortic, subaortic, left lower paratracheal, and regardless of the side of the operation - bifurcation, paraesophageal and pulmonary ligament nodes of the corresponding sides

Segmentectomy A – isolation of the upper lobe branch of the superior pulmonary vein; B – lymph node dissection in the root of the lung, segmental branches of the right are identified pulmonary artery; B – isolation of the right upper lobe bronchus in a single block with the lymph nodes of the root lobe; D – removal of the resected part of the lung in a container. 1 – upper lobe of the right lung, 2 – upper lobe vein, 3 – projection of the superior vena cava, 4 – arch of the azygos vein, 5 – right main bronchus, 6 – left main bronchus, 7 – intermediate bronchus, 8 – upper lobe bronchus with lymph nodes, 9 – lower lobe of the right lung, 10 – container.

Mediastinal lymph node dissection A - right paratracheal space with lymph nodes of groups 2 R and 4 R: 1 - upper lobe of the right lung; 2 – arch of the azygos vein; 3 – esophagus; 4 – trachea; 5 – right vagus nerve; 6 – superior vena cava; 7 – right phrenic nerve; B – view of the surgical field after performing thoracoscopic paratracheal lymph node dissection: 8 – brachiocephalic arterial trunk; 9 – aortic arch.

Mediastinal lymph node dissection Lymph node dissection in the tracheal bifurcation zone during upper lobectomy on the right A – projection of the tracheal bifurcation with lymph nodes of group 7: 1 – azygos vein, 2 – esophagus, 3 – arch of the azygos vein, 4 – right lung, 5 – mediastinal pleura covering the posterior surface of the root of the right lung, 6 – intercostal vein; B – view of the surgical field after removal of tissue and lymph nodes: 7 – left main bronchus, 8 – right main bronchus, 9 – intermediate bronchus, 10 – upper lobe bronchus, 11 – back wall pericardium.

Mediastinal lymph node dissection Bifurcation lymph node dissection on the left. A – posterior surface of the root of the left lung; B – view of the tracheal bifurcation after lymph node dissection. 1 – lower lobe of the left lung, 2 – mediastinal pleura covering the esophagus and the tracheal bifurcation zone, 3 – thoracic aorta, 4 – left main bronchus, 5 – right main bronchus, 6 – tracheal bifurcation, posterior wall of the pericardium, 8 – esophagus.

Mediastinal lymph node dissection Area of ​​the aortic window with lymph nodes of groups 5 and 6. A – intraoperative revision; B - view of the surgical field after completion of lymph node dissection. 1 – upper lobe of the left lung, 2 – lower lobe of the left lung, 3 – left phrenic nerve, 4 – anterior surface of the root of the left lung, 5 – projection of the aortic window, 6 – aortic arch, 7 – trunk of the left pulmonary artery with crossed segmental branches, 8 – left vagus nerve, 9 – left recurrent laryngeal nerve, 10 – projection of the arterial ligament.

Cosmetic effect 3 months after thoracoscopic surgery. A - upper lobectomy on the right; B - lower lobectomy on the left. The arrows indicate the locations of the ports.

Radiation therapy Used as self-treatment, as well as in combination with surgery or chemotherapy. Irradiation is carried out remotely or through contact (brachytherapy). Radical radiation therapy is carried out for patients with early stages of NSCLC with functional inoperability, high risk surgical complications. Adjuvant radiation therapy for patients with stage 0 -IIB (N 0) NSCLC after radical surgery is not used. Neoadjuvant radiotherapy (possibly in combination with chemotherapy) can be used in selected (apex tumor with Pancoast syndrome) patients with IIIB NSCLC (N 0 -1). Brachytherapy is considered as an alternative treatment option for NSCLC limited to the mucosal and submucosal layer.

Radiation therapy Radiation therapy during non-radical surgery (R 1) reduces the risk of relapse. Chemoradiation (simultaneous) therapy increases the life expectancy of patients with inoperable lung cancer (N 2/N 3). Palliative radiotherapy is recommended to prevent or control disease symptoms (pain, bleeding, obstruction). Radiation therapy to isolated or limited metastases (eg, brain, adrenal glands, lungs) may prolong survival in a limited, well-selected group of patients (fair condition, oligometastatic process).

Chemotherapy treatment of NSCLC Platinum regimens: Paclitaxel 175 mg/m2, on day 1, 3-hour infusion. Cisplatin 80 mg/m2, on the 1st day. Paclitaxel 135 -175 mg/m2, intravenously, over 3 hours, on the 1st day. Carboplatin 300 mg/m2, intravenously over 30 minutes. after administration of paclitaxel, on the 1st day. Docetaxel 75 mg/m2, on day 1. Cisplatin 75 mg/m2, on the 1st day. Docetaxel 75 mg/m2, on day 1. Carboplatin AIS-5, 1 day. Gemcitabine 1000 mg/m2; on days 1 and 8. Cisplatin 80 mg/m2, on the 1st day. Gemcitabine 1000 mg/m2, on days 1 and 8. Carboplatin AIS-5, 1 day. Pemetrexed 500 mg/m2, on the 1st day. Cisplatin 75 mg/m2, on the 1st day. Vinorelbine 25 -30 mg/m2, on the 1st and 8th days. Cisplatin 80 -100 mg/m2, on the 1st day.

Chemotherapy treatment of NSCLC Platinum regimens: Cisplatin 60 mg/m2, on the 1st day. Etoposide 120 mg/m2, on days 1-3. Cyclophosphamide 500 mg/m2, on the 1st day. Doxorubicin 50 mg/m2, on the 1st day. Cisplatin 50 mg/m2, on the 1st day. Vinorelbine 25 mg/m2, on days 1 and 8. Cisplatin 30 mg/m2, on days 1-3. Etoposide 80 mg/m2, on days 1-3. Irinotecan 90 mg/m2, on days 1 and 8. Cisplatin 60 mg/m2, on the 1st day. The interval between courses is 3 weeks. Mitomycin C 10 mg/m2, on the 1st day. Vinblastine 5 mg/m2, on the 1st day. Cisplatin 50 mg/m2, on the 1st day. Mitomycin C 10 mg/m2, on the 1st day. Ifosfamide (+ uromethoxane) 2.0 g/m2; on the 1st, 2nd, 3rd, 4th, 5th day. Cisplatin 75 mg/m2, on the 1st day.

Chemotherapy treatment of NSCLC Non-platinum regimens: Gemcitabine 800-1000 mg/m2, on days 1 and 8. Vinorelbine 20 -25 mg/m2, on the 1st and 8th days. Gemcitabine 800-1000 mg/m2, on days 1 and 8. Paclitaxel 135 -175 mg/m2 intravenously, over 3 hours, on the 1st day. Gemcitabine 800-1000 mg/m2, on days 1 and 8. Docetaxel 75 mg/m2, on day 1. Gemcitabine 800-1000 mg/m2, on days 1 and 8. Pemetrexed 500 mg/m2, on the 1st day. Paclitaxel 135 -175 mg/m2 intravenously, over 3 hours, on the 1st day. Vinorelbine 20 -25 mg/m2, on the 1st and 8th days. Docetaxel 75 mg/m2, on day 1. Vinorelbine 20 -25 mg/m2, on the 1st and 8th days. The interval between courses is 2-3 weeks.

Chemotherapy treatment of NSCLC Active chemotherapy regimens for NSCLC: Cisplatin 60 mg/m2, on day 1. Etoposide 120 mg/m2, on days 1-3. The interval between courses is 21 days. Paclitaxel 135 -175 mg/m2 intravenously, over 3 hours, on the 1st day. Carboplatin 300 mg/m2 intravenously over 30 minutes. after administration of paclitaxel, on the 1st day. The interval between courses is 21 days. Gemcitabine 1000 mg/m2, on days 1 and 8. Cisplatin 80 mg/m2, on the 1st day. The interval between courses is 21 days. Vinorelbine 25 -30 mg/m2, on the 1st and 8th days. Cisplatin 80 -100 mg/m2, on the 1st day. The interval between courses is 21-28 days. Paclitaxel 175 mg/m2, on day 1, 3-hour infusion. Cisplatin 80 mg/m2, on the 1st day. The interval between courses is 21 days.

Chemotherapy treatment for SCLC ER: Cisplatin 80 mg/m2, on the 1st day. Etoposide 120 mg/m2, from days 1 to 3. 1 time every 3 weeks. SOE: Doxorubicin 45 mg/m2 on the 1st day. Cyclophosphamide 1000 mg/m2, on the 1st day. Etoposide 100 mg/m2; on the 1st, 2nd, 3rd or 1st, 3rd, 5th days. 1 time every 3 weeks. CAV: Cyclophosphamide 1000 mg/m2, on the 1st day. Doxorubicin 50 mg/m2, on the 1st day. Vincristine 1.4 mg/m2, on the 1st day. 1 time every 3 weeks.

Chemotherapy treatment of SCLC AVP: Nimustine 2 -3 mg/kg, IV, on the 1st day. Etoposide 100 mg/m2, from days 4 to 6. Cisplatin 40 mg/m2, on days 2 and 8. Once every 4-6 weeks. CODE: Cisplatin 25 mg/m2, on the 1st day. Vincristine 1 mg/m2, on the 1st day. Doxorubicin 40 mg/m2, on the 1st day. Etoposide 80 mg/m2, from days 1 to 3. 1 time every 3 weeks. Paclitaxel 135 mg/m2, on day 1, 3-hour infusion. Carboplatin AIS-5, on the 1st day. Once every 3-4 weeks. Irinotecan 60 mg/m2; on days 1, 8 and 15. Cisplatin 60 mg/m2, on the 1st day. 1 time every 3 weeks.

Chemotherapy treatment of SCLC Docetaxel 75 mg/m2 on day 1. Cisplatin 75 mg/m2, on the 1st day. 1 time every 3 weeks. Gemcitabine 1000 mg/m2, on days 1 and 8. Cisplatin 70 mg/m2, on the 1st day. 1 time every 3 weeks. Doxorubicin 60 mg/m2, on the 1st day. Cyclophosphamide 1 g/m2, on the 1st day. Vincristine 1.4 mg/m2, on the 1st day. Methotrexate 30 mg/m2, on the 1st day.

Chemotherapy treatment for SCLC Vincristine 1.4 mg/m2 on day 1. Ifosfamide 5000 mg/m2, on the 1st day. Carboplatin 300 mg/m2, on the 1st day. Etoposide 180 mg/m2, on day 1 and day 2. Cyclophosphamide 1000 mg/m2, on the 1st day. Doxorubicin 60 mg/m2, on the 1st day. Methotrexate 30 mg/m2, on the 1st day. CCNU (lomustine) 80 mg/m2, on day 1. Etoposide 100 mg/m2, on the 4th, 5th, 6th day. Cisplatin 40 mg/m2, on the 2nd and 8th days. Temozolomide 200 mg/m2, on days 1-5. Cisplatin 100 mg/m2, on the 1st day. Topotecan 2 mg/m2, on days 1-5 and for MTS brain SCLC.

Targeted therapy Drugs recommended for use: docetaxel, pemetrexed (for non-squamous NSCLC), gemcitabine, erlotinib (for EGFR mutation, if not previously used), gefitinib (for EGFR mutation, if not previously used) afatinib (for EGFR mutation, if not previously used) not used) crizotinib (for ALK translocation, if not previously used)

Treatment of NSCLC Disease stage Treatment methods Stage I A (T 1 a-b. N 0 M 0) Stage I B (T 2 a. N 0 M 0) Radical surgery - lobectomy (extended surgery). Stage II A (T 2 b. N 0 M 0, T 1 a-b. N 1 M 0, T 2 a. N 1 M 0) Stage II B (T 2 b. N 1 M 0, T 3 N 0 M 0 ) Radical surgery - lobectomy, bilobectomy, pneumonectomy combined with lymph node dissection Reconstructive plastic surgery with lymph node dissection Radiation therapy Chemotherapy Stage III A (T 1 a-b. N 2 M 0, T 2 a-b. N 2 M 0, T 3 N 12 M 0, T 4 N 0 -1 M 0) Radical surgery - lobectomy, bilobectomy, pneumonectomy combined with lymph node dissection. Pre- and postoperative radiation and chemotherapy Reconstructive plastic surgery with lymph node dissection, adjuvant chemoimmunotherapy. Stage III B (T 4 N 2 M 0, T 1 -4 N 3 M 0) Chemoradiation therapy Stage IV (T 1 -4 N 0 -3 M 1) Chemoradiation therapy for palliative purposes + symptomatic treatment

Treatment of SCLC Stage of the disease Treatment methods Stage I A (T 1 a-b. N 0 M 0) Stage I B (T 2 a. N 0 M 0) Preoperative polychemotherapy Radical surgery - lobectomy with lymph node dissection Chemoradiation therapy Stage II A (T 2 b. N 0 M 0, T 1 a-b. N 1 M 0, T 2 a. N 1 M 0) Stage II B T 2 b. N 1 M 0, T 3 N 0 M 0) Preoperative polychemotherapy Radical surgery - lobectomy, bilobectomy combined with lymph node dissection Reconstructive plastic surgery Chemoradiation therapy Stage III A (T 1 a-b. N 2 M 0, T 2 a-b. N 2 M 0 , T 3 N 1 -2 M 0, T 4 N 0 -1 M 0) Stage III B (T 4 N 2 M 0, T 1 -4 N 3 M 0) Chemoradiation therapy Stage IV (T 1 -4 N 0 -3 M 1) Palliative chemoradiotherapy

Prognosis ■ After radical surgical treatment, the 5-year survival rate, depending on the final stage of the disease, is: ✧ IA – 63 -81%; ✧ IB – 44 -60%; ✧ IIA – 32 -59%; ✧ IIB – 32 -50%; ✧ III – 13.5%; ✧ IV – 5%;

Resident of the Republican Oncology Dispensary, surgical department No. 2, Podolyak Maxim Aleksandrovich

GBUZ Republican Oncology Dispensary

Petrozavodsk

Lososinskoe highway, 11

DEFINITION

Epidemiology

Lung cancer ranks first in morbidity and mortality from malignant tumors in the world and in Russia.
83.6% of cases occur in men.
Every year, about 1.2 million lung cancer patients die worldwide, more than 60,000 people die in Russia.
Lung cancer is very rarely diagnosed before age 40. The average age at which lung cancer is diagnosed is 60 years.
The highest prevalence is observed in people over 75 years of age.
The risk of developing lung cancer largely depends on the age at which smoking begins, the duration of smoking and the number of cigarettes smoked per day. The risk is significantly higher for those who begin to smoke regularly in adolescence (13-19 years of age).

Epidemiology

Cigarette smoking is associated with 87 to 91% of lung cancer in men and 57 to 86% of lung cancer in women.
Due to the significant increase in the prevalence of smoking among women, a significant increase in incidence in this population is projected starting in 2010.
Passive smoking also increases the risk of lung cancer in people who have never smoked by 17-20%.

Relevance

In approximately 70% of cases, lung cancer is diagnosed when symptoms of the disease appear, when there are already mediastinal or distant metastases.
For lung cancer diagnosed clinically, the five-year survival rate of patients is only 10-16%.

Relevance

Lung cancer is the most common cancer in the world population malignancy, which occupies a leading place in the structure of cancer incidence among the male population of the CIS countries, its share is 18-22%*.

Peripheral cancer accounts for 20-30% of the total number of lung cancer cases, and non-small cell lung cancer accounts for up to 70-80%.

screening

Chest X-ray. Large-frame fluorography (the most widely used screening method) makes it possible to detect many cases of lung cancer in the early stages, but does not reduce morbidity and mortality. Not effective for screening purposes.
Spiral computed tomography. Low-dose helical computed tomography scan can detect lung cancer at early stage with very small tumor sizes. The operability of tumors detected in high-risk individuals using this method increases significantly.
Cytological examination of sputum is not used for screening purposes!!!

Clinical and anatomical classification

Central cancer:
Endobronchial
Peribronchial
Ramified
Peripheral cancer
Round tumor
Pneumonia-like cancer
Pancoast cancer
Atypical forms associated with the characteristics of metastasis:
Mediastinal form
Miliary carcinomatosis

Classification by localization

Hilar (central) lung cancer emanating from the stem, lobar and initial part of the segmental bronchus

Peripheral(including apical), emanating from the peripheral part of the segmental bronchus and its smaller branches, as well as from the alveolar epithelium.

classification

Morphological (histological)

Squamous cell (epidermoid) cancer;
highly differentiated
moderately differentiated
low differentiated
Adenocarcinoma:
highly differentiated (acinar, papillary)
moderately differentiated (glandular - solid)
poorly differentiated (solid cancer with mucus formation)
bronchioloalveolar cancer;
Carcinoid tumor (carcinoid)
Small cell
oat cell, spindle cell carcinoma
pleomorphic
Large cell
giant cell
clear cell

Clinic

Symptoms

Primary(cough, hemoptysis, shortness of breath, chest pain)
Secondary(hoarseness, SVC syndrome)
Are common(increase in body temperature, loss of body weight, decreased performance)

Clinic

Pancoast cancer
Mediastinal form or Claude-Barnard-Horner syndrome
Carcinomatosis of the thoracic cavity

Pancoast tumor

Central cancer

Peripheral cancer

Milliary cancer

Survey

Central lung cancer

General clinical study
Cytological examination of sputum (at least 3 samples)
FBS

Survey

Peripheral lung cancer

General clinical study
Polypositional X-ray examination UCP
VATS - biopsy

Surgery

Scope of intervention

Pulmonectomy
Lung resection

1) Anatomical

lobectomy and its variants segmentectomy

2) Non-anatomical

wedge-shaped planar
Resection of the trachea and large bronchi
Endoscopic interventions (recanalization of the trachea of ​​large bronchi)

Intervention option

Typical operation
Extended surgery (mediastinal lymph node dissection)
Combined surgery (resection of adjacent organs)

Contraindications to radical surgery

unresectable - spread of the tumor to adjacent tissues and organs, in which it is technically impossible to radically remove the tumor.
inappropriate due to the presence of distant metastases.
insufficiency of functions of the cardiovascular and respiratory systems, decompensated diseases of internal organs

Molecular Tumor Biology

EGFR (epidermal growth factor receptor)
ALK
Prescription of targeted therapy (Dasatinib, Crizotinib)

Evaluation of epidermal growth factor receptor (EGFR) mutational status

In the case of metastatic non-small cell lung cancer, when an EGFR mutation is detected, the effectiveness of targeted therapy based on EGFR inhibitors increases significantly. Before prescribing drugs (gefitinib, erlotinib), molecular genetic diagnostics are performed to identify receptor mutations. In 2012-2013, the Molecular Genetic Diagnostics Program of the Russian Society of Chemotherapeutic Oncologists operated in Russia, within the framework of which mutation tests were performed for all patients free of charge

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How common is lung cancer? Lung cancer is one of the leading causes of death on earth. According to statistics, every 14th person has encountered or will encounter this disease in their life. Lung cancer most often affects older people. Approximately 70% of all cancer cases occur in people over 65 years of age. People under 45 years of age rarely suffer from this disease; their share of the total mass of cancer patients is only 3%.

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What are the types of lung cancer? Lung cancer is divided into two main types: small cell lung cancer (SCLC) and large cell lung cancer (NSCLC), which in turn is divided into:

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- Adenocarcinoma is the most common type of cancer, accounting for about 50% of cases. This type is most often found in smoking people. Most adenocarcinomas arise in the outer or peripheral region of the lungs. - Squamous cell carcinoma. This cancer accounts for about 20% of all lung cancer cases. This type of cancer most often develops in the central part of the chest or bronchial tubes. -Undifferentiated cancer, the most rare type of cancer.

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What are the signs and symptoms of lung cancer? Symptoms of lung cancer depend on the location of the cancer and the size of the lesion in the lungs. In addition, sometimes lung cancer develops asymptomatically. In the photo, lung cancer looks like a coin stuck in the lungs. As the cancerous tissue grows, patients experience breathing problems, chest pain, and coughing up blood. If cancer cells have invaded the nerves, it can cause pain in the shoulder that radiates into the arm. When the vocal cords are damaged, hoarseness occurs. Damage to the esophagus can lead to difficulty swallowing. The spread of metastases to the bones causes excruciating pain in them. Metastases in the brain usually cause decreased vision, headaches, and loss of sensation in certain parts of the body. Another sign of cancer is the production of hormone-like substances by tumor cells, which increase calcium levels in the body. In addition to the symptoms listed above, with lung cancer, as with other types of cancer, the patient loses weight, feels weak and constantly tired. Depression and sudden mood swings are also quite common.

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How is lung cancer diagnosed? Chest X-ray. This is the first thing done if lung cancer is suspected. In this case, a photo is taken not only from the front, but also from the side. X-rays can help identify problem areas in the lungs, but they cannot accurately show whether it is cancer or something else. A chest x-ray is a fairly safe procedure as the patient is exposed to a small amount of radiation.

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Computed tomography A CT scanner takes pictures of not only the chest, but also the abdomen and brain. All this is done to determine whether there are metastases in other organs. The CT scanner is more sensitive to pulmonary nodules. Sometimes, to more accurately detect problem areas, contrast agents are injected into the patient’s blood. The CT scan itself usually goes through without any side effects, but the injection of contrast agents sometimes causes itching, rashes and hives. Just like a chest x-ray, computed tomography only finds local problems, but does not allow you to accurately say whether it is cancer or something else. Additional tests are required to confirm a cancer diagnosis.

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Magnetic resonance imaging. This type research is used when more accurate location data is needed cancerous tumor. Using this method, it is possible to obtain images of very high quality, which makes it possible to determine the slightest changes in tissues. Magnetic resonance imaging uses magnetism and radio waves and therefore has no side effects. Magnetic resonance imaging is not used if a person has a pacemaker, metal implants, artificial heart valves and other implanted structures, as there is a risk of their displacement under the influence of magnetism.

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Cytological examination of sputum The diagnosis of lung cancer should always be confirmed cytological examination. The sputum is examined under a microscope. This method the safest, simplest and inexpensive, however, the accuracy of this method is limited, since cancer cells are not always present in sputum. In addition, some cells can sometimes undergo changes in response to inflammation or injury, making them similar to cancer cells. Sputum preparation

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Bronchoscopy The essence of the method is water in Airways thin fiber optic probe. The probe is inserted through the nose or mouth. The method allows you to take tissue for testing for the presence cancer cells. Bronchoscopy gives good results when the tumor is located in the central regions of the lungs. The procedure is very painful and is performed under anesthesia. Bronchoscopy is considered a relatively safe research method. After bronchoscopy, coughing with blood is usually observed for 1-2 days. More serious complications such as heavy bleeding, cardiac arrhythmia and decreased oxygen levels are rare. After the procedure, side effects caused by the use of anesthesia are also possible.

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Biopsy This method used when it is impossible to reach the affected area of ​​the lungs using bronchoscopy. The procedure is performed under the control of a computed tomograph or ultrasound. The procedure gives good results when the affected area is on upper layers lungs. The essence of the method is to insert a needle through the chest and suck out liver tissue, which is subsequently examined under a microscope. The biopsy is performed under local anesthesia. A biopsy can accurately determine lung cancer, but only if it is possible to accurately take cells from the affected area.

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Surgical removal of tissue Pleurocentosis (puncture biopsy) The essence of the method is to take fluid from pleural cavity. Sometimes cancer cells accumulate there. This method is also carried out using a needle and local anesthesia. If none of the above methods can be applied, then in this case resort to surgery. There are two types of surgery: mediastinoscopy and thoracoscopy. For mediastinoscopy, a mirror with a built-in LED is used. Using this method, a biopsy of the lymph nodes is taken and the organs and tissues are examined. During thoracoscopy, the chest is opened and tissue is removed for examination.

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Blood tests. Routine blood tests cannot alone diagnose cancer, but they can detect biochemical or metabolic abnormalities in the body that accompany cancer. For example, increased level calcium, alkaline phosphatase enzymes.

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What are the stages of lung cancer? Stages of cancer: stage 1. One is affected by cancer lung segment. The size of the affected area is no more than 3 cm. Stage 2. The spread of cancer is limited chest. The size of the affected area is no more than 6 cm. Stage 3. The size of the affected area is more than 6 cm. The spread of cancer is limited to the chest. Extensive damage to the lymph nodes is observed. Stage 4. Metastases have spread to other organs. Small cell cancer is also sometimes divided into only two stages. Localized tumor process. The spread of cancer is limited to the chest. Common form tumor process. Metastases have spread to other organs.

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How is lung cancer treated? Treatment for lung cancer may include surgical removal cancer, chemotherapy and radiation. As a rule, all three types of treatment are combined. The decision about which treatment to use depends on the location and size of the cancer, as well as general condition sick. As with the treatment of other types of cancer, treatment is aimed at either complete removal cancerous areas or in cases where this is not possible to relieve pain and suffering.

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Surgery. Surgery is mainly used only during the first or second stage of cancer. Surgery is acceptable in approximately 10-35% of cases. Unfortunately, surgical intervention doesn't always give positive result, very often cancer cells have already spread to other organs. After surgery, approximately 25-45% of people live more than 5 years. Surgery is not possible if the affected tissue is located near the trachea or the patient has serious heart disease. Surgery is very rarely prescribed for small cell cancer, because in extremely rare cases such cancer is localized only in the lungs. The type of surgery depends on the size and location of the tumor. This way, part of a lung lobe, one lobe of a lung, or an entire lung can be removed. Along with the removal of lung tissue, the affected lymph nodes are removed. After lung surgery, patients require care for several weeks or months. People who have surgery typically experience difficulty breathing, shortness of breath, pain, and weakness. In addition, complications due to bleeding are possible after surgery.

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Radiation therapy The essence of this method is the use of radiation to destroy cancer cells. Radiation therapy is used when a person refuses surgery, if the tumor has spread to the lymph nodes or surgery is not possible. Radiation therapy usually only shrinks the tumor or limits its growth, but in 10-15% of cases it leads to long-term remission. People who have lung diseases other than cancer usually do not receive radiation therapy because radiation can reduce lung function. Radiation therapy does not have the risks of major surgery, but can have unpleasant side effects, including fatigue, lack of energy, decreased white blood cell counts (a person is more susceptible to infection), and low level platelets in the blood (blood clotting is impaired). In addition, there may be problems from digestive organs exposed to radiation.

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Chemotherapy. This method, like radiation therapy, is applicable for any type of cancer. Chemotherapy refers to treatment that stops the growth of cancer cells, killing them and preventing them from dividing. Chemotherapy is the main treatment method for small cell lung cancer, as it affects all organs. Without chemotherapy, only half of people with small cell cancer lives more than 4 months. Chemotherapy is usually given in outpatient setting. Chemotherapy is given in cycles of several weeks or months, with breaks between cycles. Unfortunately, the drugs used in chemotherapy tend to disrupt the process of cell division in the body, which leads to unpleasant side effects (increased susceptibility to infections, bleeding, etc.). Other side effects include fatigue, weight loss, hair loss, nausea, vomiting, diarrhea and mouth ulcers. Side effects usually disappear after treatment ends.

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What are the causes of lung cancer? Cigarettes. The main cause of lung cancer is smoking. People who smoke are 25 times more likely to develop lung cancer than non-smokers. People who smoke 1 or more packs of cigarettes per day for more than 30 years are especially likely to develop lung cancer. Tobacco smoke contains more than 4 thousand chemical components, many of which are carcinogenic. Cigar smoking is also a cause of lung cancer. People who quit smoking have a reduced risk of cancer because, over time, cells damaged by smoking are replaced by healthy cells. However, the restoration of lung cells is a rather long process. Usually their complete recovery is former smokers happens in 15 years.

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Other causes include: Asbestos fibers. Asbestos fibers are not removed from the lung tissue throughout life. In the past, asbestos was widely used as an insulating material. Today its use is limited and banned in many countries. The risk of developing lung cancer due to asbestos fibers is especially high in people who smoke; more than half of these people develop lung cancer. Radon gas. Radon is a chemically inert gas that is natural product uranium decay. Approximately 12% of all lung cancer deaths are attributed to this gas. Radon gas easily passes through the soil and enters homes through cracks in the foundation, pipes, drains and other openings. According to some experts, in approximately every 15 residential buildings the level of radon exceeds the maximum permissible standards. Radon is an invisible gas, but can be detected using simple instruments. Hereditary predisposition. Hereditary predisposition is also one of the causes of lung cancer. People whose parents or relatives of their parents died of lung cancer have big chance get this disease. Lung diseases. Any lung diseases (pneumonia, pulmonary tuberculosis, etc.) increase the likelihood of lung cancer. The more severe the illness, the higher the risk of developing lung cancer.

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