tse malignant swell of the epithelial lining that develops from the mucous membrane of the bronchi, bronchioles, mucous bronchial ulcers (bronchogenic cancer) or the alveolar epithelium (malignant legenian cancer).

For the rest of the years, the incidence of cancer legenia grew in rich lands. Because of the ecological situation (increasingly zabrudnennya inhaled air, especially near the places), professional shyness, chickens. Apparently, the incidence of cancer is more low in 20 times higher in Kurts, which happened and often (two or more packs of cigarettes per day), lower in non-Kurts in Zovsim. At the present hour, it is also established that like a person

Etiology and pathogenesis

The etiology of cancer is legeny, as if it was a cancer, I didn’t understand the rest. Spriyayat yogo development of chronic inflammation of the disease of legenia, contamination of the atmosphere with carcinogens, chicken; especially poednane diyu tsikh three chinnikiv. There is a lot of data about the significance of a severe recession, including I will become immunodeficient.

The pathogenesis is shown, on the one hand, by the peculiarities of the vinification, growth and metastasis of the swelling itself, and on the other hand, by changes in broncho-legal system, which is blamed as a result of the appearance of swelling

її metastases. Viniknennya that growth of swelling is rich in what is due to the nature of metaplasia clitin. Behind this principle, they see non-differentiated cancer, squamous and squamous cancers. The greatest evil is characteristic of undifferentiated cancer. Pathogenic influx of swelling on the body to lie down before changing the functions of the broncho-legenous apparatus.

The first priority is to change the bronchial conduction. The stench appears to us in front of the endobronchial growth of the swelling, the progress of the increase in the expansion of the bronchus, which changes the lumen of the bronchus. Such a phenomenon can also occur in peribronchial growth with the formation of great nodes. Impairment of bronchial conduction at the first stages lead to moderately severe hypoventilation of the lung disease, then the guilt increases in the case for respiratory problems, which is blamed, and less with significant and total closure of the bronchial tubes There is a new atelectasis. The above descriptions of impaired bronchial conduction often lead to infection of the legenia, as it can end with a purulent process in this zone with a secondary abscess.

Puhlina, which develops, may be subject to superficial necrosis, which is accompanied by more and less significant bleeding. Smaller manifestations of the impaired function of the bronchus are observed in peribronchial growth of the bronchus swell along the thoracic walls and in the presence of peripherally rotted follicles. For a long time, I didn’t lead to intoxication, but impaired function Broncho-legal systems are less likely to be blamed for metastases in the mediastinal lymph nodes. The result of the puffy process is considered to be an anti-puffy infection to the body, specific sanogenic mechanisms. Before them lie down and the appearance of anti-swelling antibodies, which makes it possible for the swelling to lyse. Pevne znachennya to lie down and equal to the activity of phagocytosis. At the present time, there are no known sanogenic mechanisms, but there are no reasons for doubt. In a number of vipadkіv їhnya vysoka aktіvіnії prizvodіvі to povnoї іkvіdatsії swell.

Pathological anatomical picture

In most cases, cancer develops from metaplastic bronchial epithelium and bronchial ulcers, sometimes on aphids of scar tissue of the legenous parenchyma and in the middle of pneumosclerosis. Three three histological types cancer legend squamous cell carcinoma is most common - 60%, non-differentiated cancer is observed in 30%, scaling - in 10% of cases.

Nezalezhno vіd histological life Cancer develops more often in the right legenia (52%), and more often in the left leg. The upper parts are most often affected (60%) and the lower ones are more common. Distinguish between central and peripheral lung cancer. The first one develops in the great bronchi (head, joint, segmental); peripheral - in subsegmental bronchi and bronchioles. For the tribute of the oncological research center, 40% of the tufts of the legeni may be peripheral and 60 - central.

legends

Stage 1. The bulge of the great bronchus of the endo- or peribronchial form of growth is small, and the tuft of the other and other bronchi is also small without pleural effusion, which is a sign of metastasis.

Stage 2. The same plumpness, like in stage 1, or great roses, but without pleural leaf germination due to the presence of single metastases in the nearest regional lymph nodes

Stage 3. Puhlina, which was behind the interlegens, grows into one of the vascular organs (pericardium, chest wall, diaphragm) due to the presence of multiple metastases in regional lymph nodes.

Stage 4. Puhlin with extensions to the thoracic clitina, middostal, diaphragm, with dissemination along the pleura, with great or distant metastases.

T - primary puffer.

THAT is not a sign of primary plumpness.

TIS - non-invasive (intrinsic) cancer.

T1 - plumpness 3 cm or less behind the largest diameter, sharpened with tissue lung or visceral pleura and without signs of damage to the bronchial tree proximal to the right bronchus during bronchoscopy.

T2 - puffer, which expands beyond the largest diameter by 3 cm, otherwise the puffer will expand, which leads to atelectasis, obstructive pneumonitis, or expands to the root area. During bronchoscopy, the proximal expansion of the visible swelling is innocently moving between 2 cm distal to the carina. Atelectasis chi obturation pneumonitis is not guilty of slandering everything easily, it is not guilty of buti.

T3 - plumpness of any size with straight extensions on adjacent organs (diaphragm, chest wall, middle wall). During bronchoscopy, the swell appears at a distance less than 2 cm distal to the root, or the swell shows atelectasis, or obstructive pneumonitis of the entire leg, or pleural effusion.

TX - diagnosis confirming cytological findings of sputum, sputum sputum is not detected radiographically or bronchoscopically or is not available (the method of obstezhennia cannot be blocked).

N - regional lymph nodes.

N0 - no sign of damage to regional lymph nodes.

N1 - signs of damage to the peribronchial and (or) homolateral lymph nodes of the root, including the direct expansion of the primary swelling.

N2 - signs of damage to the lymphatic nodes of the mediastinum.

NX - the minimum set of methods of obstezhennia can be stagnant with a method of assessment will become regional lymphatic nodes.

M – distant metastases.

M0 - no sign of distant metastases.

M1 - signs of distant metastases.

clinical picture

The clinical picture of cancer of the leg is very different. It will lie in the caliber of the affected bronchus, the stage of infection, the anatomical type of growth of the swelling, the histological future and the cancer of the cancer of the legenia. Distinguish between symptoms, signs of changes in the lung and bronchi or metastases in the organs, and general symptoms that appear as a result of swelling, metastases and secondary flare-ups on the body as a whole.

In case of central cancer of the legenia, the first, most early symptom is cough. Postiyne coughing can paroxysmally limp right up to an important, not relieved hacking cough with cyanosis, buttocks. Cough is more pronounced with endobronchial swelling, if, protruding from the lumen of the bronchus, it pierces the mucous membrane like alien body blaring bronchospasm and coughing cough. With peribronchial growth of swelling, the cough sounds worse. The mucus-purulent sputum sounds not rich.

Hemoptysis, which occurs when the swelling breaks down, is another important symptom of central cancer of the leg. Vin manifests itself in approximately 40% of patients.

The third symptom of cancer of the leg, which occurs in 70% of patients, is the pain in breast cancer. The stench is often associated with lesions of the pleurisy (spreading її chubby or in a bundle with atelectasis and nonspecific pleurisy). Pains like a zavzhdi buvayut for shocks.

The fourth symptom of the central cancer of the legenia is an increase in body temperature. Vіn zazvichay pov'yazaniy іz obstruction of the chubby bronchus and the appearance of inflammation in the unventilated part of the leg. Develops so titles of obstructive pneumonitis. In the case of acute pneumonia, the veins are characterized by high susceptibility and frequent recurrences. With peripheral cancer of the legenia, the symptoms are scanty, until the plumpness does not reach the great expansions.

If the puffer grows in the great bronchus, symptoms characteristic of central cancer of the leg may be elicited.

Atypical forms of cancer are blamed on mild depressions, if the whole clinical picture is swarmed with metastases, and the primary cavity is easily accessible diagnostic methods vyyaviti not vdaєtsya. Fallow metastases of atypical forms are as follows: mediastinal, carcinomatosis legeni, cystic, cerebral, cardiovascular, shlunkovo-intestinal, Pechinkova.

Significant symptoms - weakness, sweatiness, stupefaction, weight loss - increase during the process, which is far from common. Sound look, palpation, percussion and auscultation on early stages illnesses do not show everyday pathologies. When looking at the greater stages of cancer in different atelectasis, chest wall and supraclavicular areas can be seen to be trapped.

During auscultation it is possible to hear the most highly suggestive sound phenomena, starting from amphoric breathing in case of bronchus stenosis and ending again dichal sounds in the zone of atelectasis. In the zone of massive peripheral swelling, atelectasis shows dullness of percussion sound; but sometimes with obstructive emphysema, if the segment or part of the legensia is repeated in the lesions, and when the lesions are released, the bronchus is blocked by thick sputum, a characteristic box sound can be identified. On the boots of atelectasis, sound the changing dichal excursions of the diaphragm.

Changes in hemograms in the presence of leukocytosis, anemia and increased WOE are most often manifested in the development of perifocal pneumonia and cancerous intoxication. The radiological picture of cancer of the legenia is even more variable, and the diagnosis can only be made with a complex radiological follow-up in patients with clinical findings, the results of endoscopic and cytological obstezhennia.

Differential diagnosis

Differential diagnostics cancer legend is often twisted through concomitant cancer of nonspecific and specific flamboyant illnesses legends. Based on the complex of diagnostic data, make the correct diagnosis. It is most common to differentiate cancer of the leg from chronic pneumonia, abscess of the leg, tuberculosis, echinococosis and cyst of the leg.

Non-cellular cancer

legend: combined

Adjuvant promeneva therapy (for a radical option) - obov'yazykovoy at stage IIIA (N2). At rich likuvalnyh mortgages її zastosovuyut at times IIIA (N1). Prote, as studies have shown, adjuvant promenade therapy only lowers the frequency of relapses, but at the same time increases the life expectancy.

Neoadjuvant promenu therapy should be stopped when cancer of the upper part of the legeni. Tse special variety

peripheral cancer of the legeni. Already at an early stage, the bulge grows in the shoulder plexus, which is clinically manifested. pancoast syndrome. We are ill with obov'yazkovo to carry out CT, mediastinoscopy and neurological obstezhennya (in the case of additional dyspnea expansion of the nerves). In the histologically examined case, there is little need, the signs are characteristic of the localization of swelling and the irradiation of pain, which make it possible to make a diagnosis in 90% of the symptoms. Radical rejoicing is possible only for the presence of metastases in the lymph node of the middle wall. Stop two methods. The first one includes the treatment of swelling in a total average dose of 30 Gy, divided into 10 fractions, and after 3-6 days - removed as a single block of the affected part with regional lymph nodes and part of the chest wall. Another method is radical change therapy in the classical fractionation regimen. Triangular survival in both falls is approximately the same and becomes 42% at squamous cell carcinoma of the legeni and 21% - for adenocarcinoma legeniaі great cell carcinoma of the legeni.

Chemotherapy is not included in the main methods of treatment of non-cellular cancer of the legenia. In a number of vipadkіv won't give even good results, but on the whole the viviance is not much better. Non-cell carcinoma of the legenia often appears to be insensitive to anti-tumor diseases. In order to escape the unrealistic zastosuvannya of such a toxic, expensive and unhandy method, like chemotherapy, it is necessary to know exactly how much it is. It is possible to install only on the base of a large number of clinical guards.

In this way, the results of 52 controlled clinical trials (both published and unpublished) were analyzed. Zagalom they took the fate of 9387 ailments. In stages I and II, cancer of the legenia was replaced five times after combined surgery (surgery plus chemotherapy) and surgical treatment, and at the III stage - yard survival after combined rejuvenation (promeneva therapy plus chemotherapy) and radical promenova therapy (div. "

Cancer of the legend: stages of illness "). cisplatin increased survival by 13%, the proteo in patients with stage I and II cancer of the disease was statistically insignificant, and for this category of patients the method is not yet recommended. Navpaki, at stage III, the improvement in survival against the background of cisplatin ingestion was statistically significant; the trivality of life also increased (albeit vaguely - less than a few months) at stage IV. Thus, for these categories of ailments it is possible to recommend chemotherapeutic regimens that include cisplatin, first explaining the shortcomings of the method.

Chemotherapy regimens that includealkylated substances, turned out to be ineffective: in groups, de stinks were stagnant, mortality was higher, lower in minors. In this hour of the day, preparations in the treatment of non-clantic cancer of the legenia do not vicorist.

New antitumor diseases, active against non-cellular cancer, - paclitaxel, docetaxel, vinorelbine,

gemcitabine, topotecan and irinotecan are still under control

Dribnoklitinny cancer

legend: combined

Combined exuberance- polychemotherapy in common with promenotherapy - is used by the method of choice in the early stage of cancer of the legenia. It will significantly improve the results of merriment and increase the trivality of life, even if side effects, zokrema in the distance. Such a treat is indicated for ailments with an early stage of cancerous cancer of the legenia, which may show an indicator of a deadly state of 0-1 points, a normal function of the leg and no more than one distant metastasis (div. "Cancer of the leg: stages of illness").

Testing is carried out in the regimen of hyperfractionation through a mantle-like field, as in case of lymphogranulomatosis. In the world of change, the masses of the plump fields of the revolution are sounding.

From the anti-swelling benefits of vicorist etoposide and cisplatin. In a number of great clinics, deetoposide, cisplatin and prescription in hyperfractionation regimens were prescribed overnight, were demonstrated high frequency remіsіy and priyatny rizik is comfy.

At the late stage of dribnocellular carcinoma of the lung chest nedocіlno.

In cases of illness, if chemotherapy proved to be ineffective, a course of interchange therapy can be considered regardless of the stage of illness. For the tribute of the people likuvalnyh mortgages, after a combined treatment, approximately 15-25% of patients with early stage dribnoclitin cancer have a legend, and 1-5% of patients with a late stage have a relapse-free period of three years. New remissions at an early stage can reach 50% of depressions, at a late stage - 30%. Most often, 90-95% of ailments reach private remissions. Half of the ill people die in 2-4 months for the presence of lunacy.

After the combined exultation in half of the ailments at the stage of illness, the trivality of life increases to 10-12 months, and in half of the sick with an early stage - up to 14-18 months. In addition, in more vipadkіv pokrashuєєє hot mill, symptomatology is known, zoomed in on the swelling

It is rich to lay down the qualifications of an oncologist, who can conduct chemotherapy. Vіn is guilty of reporting all the susils, so that he could get away from the heavy burdens and not perish the ailing camp of the ailing.

In the rest of the hour, the possibilities of doctors expanded significantly: new chemotherapeutic regimens appeared, high-dose polychemotherapy in the future with autologous transplantation of the cystic brain and other combinations of treatment methods.

Surgical treatment for cellular cancer of the legenia rarely occurs. It is also indicated before surgery, as well as in case of cancer of the legenia of other histological types (I or II stage of disease without metastases in the lymph node of the middle intestine).

It is not uncommon to trap in such a way that dribnocellular carcinoma of the legenia is first diagnosed with histologically diagnosed distant swelling; in such cases, adjuvant polychemotherapy allows about 25% of patients to reach treatment.

“Walking sights” - Two forms - methodical and unseen. Laws of unity to the type that minds are based on the theory of natural choice. Mutual sporeness of organisms; morphology; embryology; rudimentary organs. Pokhodzhennya vidiv… About the inconsistency of the geological record. instinct. About the denudation of the granite regions.

"Trees chagarnika herb" - Trees chagarnika Travi. How do trees breathe in other trees? How do you get roslini on your health? The trees are bubbling: leaves and conifers. Why do chagars grow in trees and herbs? Roslins live everywhere: on bows, forests, steppes, mountains, seas and oceans. Follow-up plan: Riznomanіtnіst roslyn.

"Forms of stateless reproduction" - Conjugation Parthenogenesis Isogamy. Article process depends on the type of isogamy. 1. Rozpodіl. Reproduction by a path of rozpodіlu clitin is more typical for single-cliten organisms. With litter of gametes, a chotiriggutic zygote is established. Class Viiskovi infusoria. The conjugation of that state of reproduction of infusoria shoes is considered for unfriendly minds.

"Dynamics of the number of populations" - Dynamics of populations. Methods of regulation of the number of populations. apply populations. Numbering of individuals. Growing population. Let's repeat the earlier twisted material. Population dynamics as a biological phenomenon. Biology and informatics. The value of the wide angle Knowledge of population dynamics. Informational models for the development of populations.

“Lesson of the Bird” - Female birds, yak and mosquitoes, make one ovary. Tokuvannya drohvi. Ritual behavior. Magpie Snigur Lastivka Crow Jackdaw Nightingale Gorobets Teteriv. Vіdkladannya yєts. Find out the evidence. Cranes - love dances. The sound of bird eggs is protected by a furry shell. Tokuvannya birds. Signs of a high organization and rice similarity to plazuny.

"Roslinnitstvo" - Є sche hliborobi ovochіvniki gardeners bavovni. Navkolishnіy svіt. What is silsk state. Roslinnitstvo. Take a look at the cultural growth and describe it. For example, on our table, plant bread, dewdrops grow grain crops, wheat, zhito and others.

Since 1985, the cancer of the legend has become the leading oncological killer! According to MAIR data, in 2002, 1,350,000 new types of cancer were registered in the world, that is 12.4% of cases of common forms of cancer. Indices of light sickness on RL since 1985 increased by 51% for men and by 75% for women. of them deaths in both articles. Spivvіdnennia died in the cancer of the legeni before new registration of ailments to become 0. 87 Epidemiology

Epidemiology on the cob of the XXIXXI century cancer of the legend one of the main causes of death of oncological ailments in the world.

Epidemiology In the United States in 2005, 172,570 ailments were registered for RL, making 12.6% of all oncological illnesses dead 163,510 ills, totaling 29.1% of all ailments nnya for a stretch of 25 years is left on a equal footing 15% Only 16 % of illnesses are registered in the early stage. Illness on RL in humans in the Northern regions - 65.7 per 100,000, in Northern Europe - 56.9, in Western Europe - 50.9, in Pivnichniy Europe - 44.3 per 100,000 on RL in Europe variant in people 95, 4 in Ukraine up to 21, 4 in Sweden, in women 27, 7 in Denmark up to 4, 0 per 100,000 in Spain In Ukraine, Pivnichnaya and Western Europe illness on RL in people decreased in s 'Language with a mass-like type of chicken. It is especially noteworthy in Great Britain, Finland, Norway. Sweden. For women in the RL in the first city of Denmark

Epidemiology For death in RL, people are on the list of Ukraine and Poland, and for women - Denmark. Behind the data of 20 European registers in 1990-1994. In the first year after the diagnosis of LC was established, 31.4% of the living lost their lives, after 5 years - 9.7% (humans). In Russia, RL cost 1 month of the middle of the uhlin in both articles. In 2003, 58812 ailments were registered. In men, the incidence of RL is 22.8% in the case of new malignant neoplasms, in women - 4%. For signs of illness on the RL in 2002. among the European lands Russia took the 3rd place among the people, and 17 among the women

Etiology I. I. Genetic factorization: 1. Primary multiplicity of downy evil swell). 2. Three and more warning signs of cancer in family (nearest relatives). II. Modifying risk factors A. Exogenous: 1. Chicken. 2. Contamination of the superfluous medium with carcinogens. 3. Professional hazards. 4. Ionizuyuche viprominyuvannya. B. Endogenous: 1. Older than 45 years old. 2. Chronic diseases of the disease (pneumonia, tuberculosis, bronchitis, localization of pneumofibrosis and others).

Etiology. Kurinnya Tilki 15 % of the RL is not to be in the exposure of Tyutyun on Slyzov Bronkhiv in non -Turkey, it is practical not to blame Pokroklinniy I DRIBLITINNINIS RAC RIZIK RIZIK NUD SIGARENTS, ShO KLODYA VIKURYUNE, TRIVALOSTIS KURINE, VID POLUTIONAL, SIDE IS STIP IS SIL Gareth. The cumulative risk of death in RL is 22 times higher in males, 12 times higher in females, lower in non-curses Risk of death in RL is 30% higher in females, who live with chickens IR RL u change by 50% Smoking cigars or pipes - 2 times increased risk of developing RL 85% RL in men and 47% RL in women - traces of smoking

Etiology. Other factors Exposure to asbestos in 1 to 5% of RL, in non-skilled workers, the risk of RL is 3 times lower in non-producing chickens, and in chickens, associated with asbestos, the risk of growth is 90 times higher speeches RL called radon, chromium, nickel, beryllium

Pathogenesis Influx of factors into the epithelium of the bronchi and disruption of mucociliary clearance Influx of carcinogens into the tissue of the respiratory tract Desquamation of the epithelium Pathological regeneration

Clinical and anatomical classification Central carcinoma of the legenia (originated in the great bronchi - smut, paio, intermediate, segmental)

Classification of cancer of the legend for Savitsky A. I. (1957) 1. Central cancer: a) endobronchial (endophytic and exophytic) b) perebronchial nodules; c) peribronchial expansion. 2. Peripheral cancer: a) round puffy; b) pneumonia-like; c) upper legenia (Penkost); 3. Atypical forms associated with specific features of metastasis: a) mediastinal; b) miliary carcinomatosis; ; c) brain; ; d) kistkova; ; e) pechinkova.

Pathological classification of RL due to multipotent Stovbur cells of the bronchial epithelium I. Squamous cell carcinoma (vindicated in the proximal segmental bronchi): a) highly differentiated cancer; b) peacefully differentiated cancer (without keratinization); c) low-differentiation cancer. II. Dribnocellular carcinoma (vinica in the central great posterior bronchi): a) vascular cancer; b) interstitial cancer. III. Adenocarcinoma (vinica in the peripheral bronchi): a) highly differentiated adenocarcinoma (acinar, papillary); b) moderately differentiated adenocarcinoma (salky-solid); c) poorly differentiated adenocarcinoma (solid mucus-forming cancer); d) bronchoalveolar adenocarcinoma ("adenomatosis"). IV. Large cell carcinoma: a) giant cell carcinoma; b) light cancer. V. Contagious Cancer

RL RL (through variances and ridges go to the liquor)

NSCLC Before adenocarcinoma falls 40% of RL. Zustrichaetsya at women, so do not burn. A special type is bronchoalveolar cancer, ailments on them are more effective than others, they are recommended for therapy with targeted drugs - gefitinib, erlotinib. Squamous cell carcinoma develops in 30% of patients. Localization - the central zone of legends

SCLCLC is affected in 15% of patients with RL, the swelling may be central or hilusne in 95%, 5% - peripherally. 98% of ailments on SCLC are curts

Anatomical areas: 1. head bronchus (Z 34.0) 2. upper part (Z 34.1) 3. middle part (Z 34.2) 4. lower part (Z 34.3)

Cancer Clinic Lung Symptoms, symptoms of intrathoracic bulge enlargement Symptoms, posterior thoracic bulge enlargement Paraneoplastic syndromes

Symptoms associated with intrathoracic enlargement of the swelling Central cancer of the cancer: Cough (80-90%) Hemoptysis (50%) Increased body temperature and buttocks (atelectasis and hypoventilation) Fever and productive cough (paracancer pneumonitis) Peripheral cancer of the cancer: 0 65%) Cough Ass (30 -40%) Clinical abscess legenia (in case of swelling swelling)

Symptoms, symptoms of posterior thoracic bulge swelling Liver lesion Injury of supra-thoracic follicles Injury of posterior thoracic lymph nodes (para-aortal, supraclavicular, anterior cervical) Intracranial metastases

Cancer diagnostic principles Legends Methods Primary diagnostics (recommended for all patients): Excessive clinical obstruction X-ray examination of organs in the chest Bronchological examination (in cases of central cancer) Transthoracic puncture of the swelling (in cases of peripheral cancer)

Principles of diagnosis of cancer of the legenia Clarifying methods of diagnosis (recommended for patients who require surgery or promenade): organization day empty stomach and thoracic cells Scanning of the bones of the skeleton X-ray of the bones of the skeleton Computer or magnetic resonance imaging of the brain Functional follow-up of the leg of the heart Mediastinoscopy, mediastinotomy, thoracoscopy, thoracotomy

Algorithm for exposing patients to cancer of the legenia Cancer of the legenia Standard chest X-ray Pdozra T 4 (proliferative of the organs of the middle cavity) All other Definitely T 4, N 3, M 1 in the adrenal N 2 hours N 3 N 0 hours N 1 Biopsy. Mediastinoscopy, transbronchial biopsy puncture Surgery. Contrast CT Indicated T 4 Not indicated T 4 Transbronchial puncture biopsy, mediastinoscopy, surgery

Surgical treatment Promeneva treatment Chemotherapy Combination treatment

Volume of surgical intervention: upper segmentectomy, upper lobectomy with circular resection of the bronchi

Operational options: typical (standard) operation expanded operation: - expanded according to the principles of merging - more expanded operation combined operation expanded-combined operations

Promeneva therapy for a radical program (total mid-range dose of 60-79 Gy.) is indicated for patients with NSCLC II - IIIIII A stages, if they were treated during surgery, or if surgical treatment is protipokzane

Promenade therapy for a palliative program (total mid-range dose not more than 40 Gy.) clinical manifestations Swelling In case of pronounced regression of swell in the process of promenade therapy and in the case of an overbearing stagnation of sickness, there may be changes and promenade therapy may be carried out after a radical program.

Contraindications before promenade therapy є: destruction of the primary tumour, or atelectasis due to empty decay heavy bleeding malignant hepatitis in pleural effusion recently (up to 6 months) transfers myocardial infarction active tuberculosis legeny severe inflammation of the patient

Treatment regimens for EBLT 5 Gy every other day, 3 times per day SOD 25-30 Gy; 7-10 Gr 1 time per day SOD 28-40 Gr. Gr Remote control is carried out in different modes up to SOD 40-60 Gr. The interval between the components of a single trade fair becomes 10-20 days.

Promeneva therapy following a radical program: classic SOD fractionation - 70 Gy x 35 days. dynamic fractionation of SOD - 70 Gy x 30 days. superfractionation of SOD - 46.8 Gy x 13 days. promenade therapy SOD - 60 -80 Gy x 34 days

Preoperative interchange therapy: classic fractionation - 30 Gy x 15 days dynamic fractionation - 30 Gy x 12 days enlarged fractionation - 20 Gy x 5 days daily interchange therapy - 30 -40 Gy x 1 - 46 Gy x 23 days n dynamic fractionation - 30 Gy x 12 days superfractionation - 46.8 Gy x13 days

Chemotherapy for cancer of the legenia Drugs: Vinorelbine Gemcitabine Cisplatin Carboplatin Paclitaxel Etoposide Cyclophosphamide Doxorubicin Mitomycin Ifosfamide vinblastine

At this hour, standard chemotherapy of the II line in NSCLC IIIIII - IVIV stage, combinations: taxol + carboplatin taxol + cisplatin taxotere + cisplatin navelbine + cisplatin gemzar + cisplatin 40 -60% sickness, with single survival 50% sick.

The goals of neoadjuvant chemotherapy to change the growth of the primary tumour, including micrometastasis of the promotion of the ablasticity of the operation and the resectability of the tumour

Peculiarities of neoadjuvant chemotherapy 1. 1. Treatment courses may be short, with small intervals. The optimal course is 2 courses, but not more than 3-4 surgical operations 3. 3. Spivvіdnennia effektivnostі/toxicity vikoristovuvannyh regimenіv іkuvannya may be optimal.

Targeted therapy for NSCLC Targeted preparations for: - Inhibition of enzymes that take part in the synthesis of DNA, RNA - Ways of transmission and signal transduction mechanisms - Angiogenesis - Gene expression - Apoptosis

Targeted therapy for NSCLC The target of drugs is the epidermal growth factor receptor. It is expressed in NSCLC (squamous cell 84%, occlusion - 68%) and radiation to the signal cascade leading to cellular proliferation of angiogenesis, invasion, metastasis, apoptosis. Targeted preparations in combination with chemotherapy give an objective positive effect similar to chemotherapy. Drugs: alimta, iresa, erlotinib, panitumubab

with resectable puffiness (T 1 -2 NN 1 1 M 0), surgery is possible with offensive postoperative combined chemotherapy (4 courses) continue with the next operation, prote the controversy of evidence

in case of unresectable tufts (localized form), combined chemotherapy (4-6 cycles) is indicated in the affected areas of the bulge of the leg and mediastinum. In times of reaching total clinical remission, prophylactic brain injury (25–30 Gy). for the presence of distant metastases (expanded form of SCLC) - combined chemotherapy is indicated, promeneva therapy is carried out for special indications (metastases in the brain, cysts, epidermis)

in the given hour, the possibility of healing was brought to close 30% of ailments on SCLC in the early stages of illness and 5-10% of ailments with unresectable puffiness. the situation that the group of new antitumor drugs active in SCLC turned out to be the last fates allows us to move further away from the full therapeutic regimen

Occult cancer of the legenia (Tx. N 0 M 0)) - - dynamically guarded Stage 0 (Tis. N 0 M 0):): resection (segmentectomy or wedge-like resection) with maximum savings of the legene tissue endobronchial promenade therapy (swelling less than 1 cm )

Stage II (B (T 1 N 0 M 0 , T 2 N 0 M 0):): Lobectomy Alternative: radical exchange therapy (not less than 60 Gy) endobronchial exchange therapy

Stage IIII A, B (T1N1M0, T2N1M0, T3N0M0):): lobectomy, pulmonectomy Alternative: radical change therapy

Stage IIIIII A (TT 33 NN 11 MM 00 , T, T 1 -31 -3 NN 22 MM 0): neoadjuvant chemotherapy (with platinum drugs included) + surgical treatment promeneva therapy + surgical treatment chemotherapy : radical promeneva therapy chemotherapy therapy in independent variant

Stage III (T-be-yaka N 3 M 0, T 4 N - be-yaka M 0 M 0):): You can see the connection with possible different surgical tactics: T 4 a - tracheal sprouting, carini, upper empty veins, left atrial (potentially resectable injury) T 4 b - diffuse injury of the middomain, injury of the myocardium, sprain of the ridge, stravohodus, malignant pleural effusion (surgery is not indicated)

Stage IVIV (Tube-yak NN dermal M 1): chemopromene therapy, palliative polychemotherapy symptomatically likuvannya

Prognosis for cancer of the legenia 5-line survival II stage - 65% II c stage - 40% IIIIII A stage - 19% IIIIII B U cc stage - 5% IVIV stage - 2%

Screening for RL RL is diagnosed in most patients at the late stages, only diagnostics in stage II allows 50-80% of patients to survive 5 years of life or 1 time per 4 months radiography is legen Available in 0.44% to 2.7% RL, with 74 -78% in stage II, PET and fluorescent bronchoscopy values ​​show up

Prevention of cancer of the legenia Primary, or hygienic, prevention is a system of medical and sovereign approaches, directed at the application or change in the injection of speech and factors into the body, which were recognized as carcinogenic in the present hour (). Another, abo clinical, prevention is called a specially organized system of detection and treatment of pre-swelling illnesses (shear fluorography, caution and treatment of fahivtsiv).

Prevention of lung cancer Fighting chickens with a decrease in tar in cigarettes before inserting MAIR between the fight for the purity of the atmospheric air, or the maximum change in the intake of the va- rable workloads of health improvement in patients with chronic bronchial ailments legends of rational eating for screening in the group of patients with risk of cancer

“It’s important to recognize the ailment on the cob, but it’s easy to wiggle it, if it’s running, then it’s easy to recognize it, but it’s important to wiggle it. » N. Macchiaveli, 1513 p.

Summary of the theory of cancer vindication Suppressor gene (when mutated, enter control) control Proto-oncogene (permanently mutated, which ensures adaptation) Propagation of swollen cells Neoangiogenesis and metastasis Immunological paralysis Organism gyne Organism alive , for the presence of help (likuvannya) Operatively Promeneve Chemistry

In this way, cancer is a polyetiological ailment, and the number of causes of dovkill is superimposed on a genetically determined slightness, and the result is blamed on the evil newborn. Current epidemiologists say that up to 90% of the tufts are cured external reasons 2 00 sick in Australia

Primary prevention of cancer Recommendations for eating: (35%) Cleaning of fresh vegetables, fruits and coarse fiber cells Cleaning of salt and preservatives food additives Rational grub diet for saving normal body weight

Secondary prevention of cancer Diagnosis and treatment of precancerous diseases, as well as early diagnosis 1. Rectum - hemocultest 2. Diaphragm (Japan) - fluorography 3. Lungs - fluorography 4. Milk rash - self-infection (with the help of WHO, mortality can be reduced by 20%), mammography, lower palpates ia, showing swelling up to 3-4 mm.

Screening - revealing puffs in the middle of a practically healthy population ("pro_yuvannya"). It is promising, but the road, as it will require significant penny vouchers, is often inaccessible to most of the powers. Inexpensive Safe Easy to carry out Acceptable for testing and testing Highly sensitive (few hybno-negative findings Specific (few hybno-positive findings)

Screening for good diagnosis of a fight and a far-fetched glee of yoga can potentially change illness (and zanedbanist, obviously). And reduce illness to reduce mortality. Screening is carried out: In risky groups In formally healthy people

Targeted Therapy As a result of reaching molecular oncology, which has become clear in the 21st century, there are clear indications about the pathogenesis of puffiness, vinicle and is actively developing to be promising, so the targeted therapy of puffiness is called. Previously, empirical evidence (often vaping) is replaced by scientifically-primed, molecular-directed testing of specific anti-cancer agents, directing to activation or inactivation of biochemical components in puffy transformations ii. Target drugs. It is directed to: Inhibition of enzymes that take part in the synthesis of RNA and DNA Ways of transmission and mechanisms of transduction of signals in Angiogenesis Expression of genes Apoptosis The search for new achievements instills great optimism. It seems that there are no such drugs, which are responsible for different pathogenesis. Herceptin, Mabthera, Glivec, Alimta, Iresa, monoclonal antibodies - Avastin, Sutent are already actively zastosovuyutsya.

Photodynamic therapy PDT is a promising technique for treating evil and other new creations. The essence of it lies in the fact that a photosensitizer (PS) is introduced into the body with a further improvement in tissue light in the spectral range (400 -700 nm). In this case, the activation of PS molecules and molecular energy transfers, which lead to the development of singlet acidity and other highly reactive cytotoxic speech, which cause the death of cells. Sounding FS are filled with evil and dysplastic cells. With a decrease in the number of minds (PS tropism to malignant tissue and selective delivery of light to plumpness), the effectiveness of antitumor therapy with minimal damage to healthy tissues is ensured.

Cancer of the legend is the most widespread in the world population of evil light. 1 million new cases are widely diagnosed (more

In 1997 65,660 patients were diagnosed with malignant neoplasm of the trachea, bronchi, legenia.

Chinniki risik rozvitku raku legendi

Rose sick at the stage

Dynamics of illness in people and women

Rough indicator of sickness in Russia - 44.7%

clinical picture

The main reasons for zanedbannosti

Causes of zanedbanosti, yakі to lie down as a kind of medical assistance

Symptoms of cancer of the legeni

Tactics

Symptoms of distant metastasis

Paraneoplastic syndromes

Skin and skeletal-mucosal symptoms

Nervo-m'yazovі syndromes

Skeletal and m'yazovі syndromes

Endocrine syndromes

Neurological syndromes

Hematological syndromes

Cardiovascular syndromes

Immunological syndromes

Other syndromes

Etapi settlement of the population

Obstezhennia of the primary ailment

Three equal diagnostics

X-ray methods of investigation can be grouped in two diagnostic complexes

Central cancer of the legeni

Early signs of central cancer of the legenia

Extraction of the root of the legend

Central cancer of the legeni

Central cancer of the legeni

central cancer

peripheral cancer

Varieties of swollen nodes in peripheral cancer of the legenia

X-ray picture of peripheral cancer

CT picture of peripheral cancer

Peripheral cancer from centralization.

Tempi growth of peripheral swelling

Bronchioloalveolar cancer

Characteristics of rice

Atypical forms

Peripheral cancer with Pancoast syndrome

Primary carcinomatosis

Primary carcinomatosis

Indications before chest CT

Indication before bronchoscopy

follow-up methods

Surgical diagnosis of cancer of the legeni

Dodatkovі methods of follow-up

PET - evaluation of lymph nodes

Statistics

Epithelial swelling

The frequency of different types of cancer of the legeni

New TNM classification

Grouped by stages

Classification of dychal insufficiency according to Dembo

Stages of dychal insufficiency

Forgiveness method of early assessment of operational risk for three groups of patients

Hematogenous metastasis

Standards for the treatment of cancer of the legeni

Statistics

slide 2

Epidemiology

Cancer of the slug is another cause of death in the case of evil newborns. The highest incidence of disease is recorded in Japan, China, Korea, the lands of Pivdennoy and Central America, as well as in Western Europe, including many of the Radian Republics. In the Russian Federation, it is reasonable to register close to 40 thousand. the first ailments for shell cancer, 35 yew. die. Illness to become 28.4 per 100 yew. Population. Starting from the middle of the 20th century, the whole world has seen a decrease in the incidence of cancer in the stomach for cancer of the intestines for cancer of the distal ducts of the intestinal type, in that hour, as a pet, the cancer of the cardio grows, and the most ib younger than 40 years old.

slide 3

Epidemiological classification according to Lauren Intestinal type: plump may be budovu, I look like colorectal cancer, and are characterized by clear slick structures that are well differentiated. cylindrical epithelium with a broken shield oblyamіvkoy. Diffuse type: the puffiness is represented by weakly organized groups or by single clitins with a large amount of mucin (pharyngeal) and is characterized by diffuse infiltrative growth.

slide 4

Epidemiology of shell cancer

Individuals are 2-12 times more likely to be ill. Localization: more often distal. However, there is a tendency to increase the incidence of proximal and cardio-esophageal cancer, especially in the regions of Europe and America, Asia - significantly more often distal cancer (better results are better prognosis!)

slide 5

Epidemiology of duct cancer in Europe

2006 - 159,900 new cases and 118,200 deaths, which take a quarter and a fifth of a month from the structure of illness and mortality rate. People get sick 1.5 times and more often for women, the peak of illness falls on the age of 60-70 years.

slide 6

Growth of standardized indicators of illness evil newcomers (%%)

Slide 7

APPROPRIATE ASSESSMENT OF THE LIFE FACTORS THAT ARE INVOLVED IN CANCER ILLNESS

Slide 8

Johannes Fibiger 1867-1928

Slide 9

Biography

Rid. April 23, 1867 in Silkeborg, Denmark. Having studied bacteriology under the supervision of R. Koch and E. von Bering, worked in partnership with Karl Salomonsen at the University of Copenhagen. Doctoral dissertation in bacteriology of diphtheria was completed in 1895, and in 1900 - professor of pathology at the university. Having put Bering's milkweed for the treatment of diphtheria in Denmark, and having continued the relationship between tuberculosis in cows, and the spread of this disease in humans. Tuberculosis of the mouth and duct cancer of Spiroptera neoplastica (Gongylonema neoplasticum). In the 20th year, it is necessary to carry out a regular experimental study of cancer treated with coal tar, Spiroptera neoplastica and clinical manifestations. Podnannya zovnіshnіh vplivіv іz genetic not zagalnuyu, but organ schilnistyu to cancer. Nobel Prize for Medicine and Physiology for 1926 “In the past, it has become possible to achieve the experimental transformation of normal cells on the evil cells of cancerous puffs. Tim himself was reconciledly shown not by those who always call cancer with chrobaks, but by those who can provoke outward spirits ”(W. Wernshtedt). He died near Copenhagen on September 30, 1928 due to rectal cancer.

Slide 10

Etiology

A. Kharchovі factori riziku Superfluous storage of kitchen salt and nitrates Nedolyk vitamins A and С Saving of smoked, marinated and dried products Preservation of zhіzhі without refrigerant whiskey Quality of drinking water B. Factors of healthy medium and way of life tya Professional shkіdlіvosti (gummies, corner vippromіnyuvannya Resection history of sloughing Obesity B. Infectious factors Helicobacter pylori Epstein-Barrvirus

slide 11

D. Genetic factors Blood group A (II) Pernicious anemia Semeyny cancer of the duct Syndrome of diffuse type of recessive duct carcinoma (HDGC). Recessive non-polyposis colorectal cancer Li Fraumeni syndrome (syndrome of relapsed cancer) Recessive syndromes that are accompanied by polyposis of the intestinal tract: familial adenomatous polyposis of the colon, Gardner's syndrome, Peutz-Jeghers syndrome, familial juvenile polyposis cancer. gastritis Pain Menetria (hyperplastic gastritis) Stravohid Barrett, gastro-esophageal reflux Dysplasia of the tubular epithelium Intestinal metaplasia

slide 12

Etiology factor cancer of the schlub

Zhivlennya Reflux Zhovchi Helicobacter pylori Genetic damage Factor risk - exogenous gerela nitrates and nitrites, endogenous nitrates, salt reduction, conservation food products alcohol. Zahisnі factori - antioxidants and beta-carotene.

slide 13

Dynamics of mortality in shell cancer (all population)