Lung cancer is the most common malignant tumor in the world population. 1 million new cases are diagnosed annually (more

In 1997, 65660 patients were diagnosed with a malignant neoplasm of the trachea, bronchi, and lung.

Lung cancer risk factors

Distribution of patients by stage

Dynamics of the incidence of men and women

The gross incidence rate in Russia is 44.7% o

Clinical picture

The main reasons for neglect

Causes of neglect, depending on the quality of medical care

Lung cancer symptoms

Tactics

Symptoms of distant metastasis

Paraneoplastic syndromes

Cutaneous and musculoskeletal symptoms

Neuromuscular syndromes

Musculoskeletal Syndromes

Endocrine syndromes

Neurological syndromes

Hematological syndromes

Cardiovascular syndromes

Immunological syndromes

Other syndromes

Population survey stages

Examination of the primary patient

Three levels of diagnosis

X-ray research methods can be grouped into two diagnostic complexes

Central lung cancer

Early signs of central lung cancer

Lung root enlargement

Central lung cancer

Central lung cancer

Central cancer

Peripheral cancer

Varieties of tumor nodes in peripheral lung cancer

Retngen picture of peripheral cancer

CT picture of peripheral cancer

Peripheral cancer with centralization.

Peripheral tumor growth rate

Bronchioloalveolar cancer

Characteristics

Atypical forms

Peripheral cancer with Pancost's syndrome

Primary carcinomatosis

Primary carcinomatosis

Indications for CT of the chest

Indications for bronchoscopy

research methods

Surgical diagnosis of lung cancer

Additional research methods

PET - assessment of lymph nodes

Statistics

Epithelial tumors

The incidence of different types of lung cancer

New TNM classification

Grouping by stage

Dembo classification of respiratory failure

Respiratory failure

A simplified method for preliminary assessment of operational risk by identifying three groups of patients

Hematogenous metastasis

Lung Cancer Treatment Standards

Statistics

it is a malignant tumor of epithelial origin, developing from the mucous membrane of the bronchi, bronchioles, mucous membranes of the bronchial glands (bronchogenic cancer) or from the alveolar epithelium (actually pulmonary cancer).

In recent years, the incidence of lung cancer has increased in many countries. This is due to the environmental situation (increasing pollution of the inhaled air, especially in big cities), occupational hazards, and smoking. It is known that the incidence of lung cancer is more than 20 times higher in long-term and frequent smokers (two or more packs of cigarettes per day) than in non-smokers at all. It has now also been established that if a person

Etiology and pathogenesis

The etiology of lung cancer, like cancer in general, is not completely clear. Chronic inflammatory diseases of the lungs, air pollution with carcinogens, smoking contribute to its development; and especially the combined effect of these three factors. There is a lot of data on the importance of burdened heredity, including immunodeficiency states.

Pathogenesis is determined, on the one hand, by the characteristics of the emergence, growth and metastasis of the tumor itself, and on the other, by changes inthe broncho-pulmonary system, arising as a result of the appearance of a tumor and

her metastases. The emergence and growth of a tumor is largely determined by the nature of metaplastic cells. According to this principle, undifferentiated cancer, squamous cell and glandular cancers are distinguished. The greatest malignancy is characteristic of undifferentiated cancer. The pathogenic effect of a developed tumor on the body depends primarily on changes in the functions of the broncho-pulmonary apparatus.

Changes in bronchial conduction are of paramount importance. They appear first of all with endobronchial tumor growth, the gradual increase in the size of which reduces the lumen of the bronchus. The same phenomenon can occur during peribronchial growth with the formation of large nodes. Violations of bronchial conduction in the first stages lead to moderately pronounced hypoventilation of the lung area, then it increases in volume due to emerging difficulties in exit, and only with significant and complete closure of the bronchi, complete atelectasis is formed. The above-described violations of bronchial conduction often lead to infection of a portion of the lung, which can result in a purulent process in this area with the formation of a secondary abscess.

A developing tumor can undergo superficial necrosis, which is accompanied by more or less significant bleeding. Less pronounced dysfunctions of the bronchus occur with peribronchial growth of the tumor along the bronchus along its walls and with the formation of separate peripherally located foci. Their appearance for a long time does not lead to intoxication, but dysfunctionthe broncho-pulmonary system occurs only with metastasis to the mediastinal lymph nodes. The outcome of the tumor process is determined by the state of the body's antitumor defense, specific sanogenic mechanisms. Among them is the appearance of antitumor antibodies, which is associated with the possibility of tumor lysis. The degree of activity of phagocytosis also has a certain importance. All sanogenic mechanisms are still unknown today, but their existence is beyond doubt. In some cases, their high activity leads to the complete elimination of the tumor.

Pathological picture

Most often, cancer develops from the metaplastic epithelium of the bronchi and bronchial glands, sometimes against the background of scar tissue of the pulmonary parenchyma and in foci of pneumosclerosis. Of the three histological types of lung cancer, squamous cell carcinoma is most often found - 60%, undifferentiated cancer is observed in 30%, glandular - in 10% of cases.

Regardless of the histological structure, cancer develops somewhat more often in the right lung (52%), less often in the left. More often the upper lobes are affected (60%) and less often the lower ones. Distinguish between central and peripheral lung cancer. The first develops in large bronchi (main, lobar, segmental); peripheral - in the subsegmental bronchi and bronchioles. According to the Cancer Research Center, 40% of lung tumors are of peripheral and 60% of central origin.

lung

Stage 1. A small limited tumor of a large bronchus of endo- or peribronchial form of growth, as well as a small tumor of small and smallest bronchi without damage to the pleura and signs of metastasis.

Stage 2. The same tumor as in the 1st stage, or large, but without germination of pleural sheets in the presence of single metastases in the nearest regional lymph nodes.

Stage 3. A tumor that has gone beyond the lung, growing into one of the adjacent organs (pericardium, chest wall, diaphragm) in the presence of multiple metastases in regional lymph nodes.

Stage 4. Tumor with extensive spread to the chest, mediastinum, diaphragm, with dissemination along the pleura, with extensive or distant metastases.

T - primary tumor.

THEN - there are no signs of a primary tumor.

TIS is a non-invasive (intraepithelial) cancer.

T1 - a tumor measuring 3 cm or less in maximum diameter, surrounded by lung tissue or visceral pleura and without signs of damage to the bronchial tree proximal to the lobar bronchus during bronchoscopy.

T2 - a tumor, the largest diameter of which exceeds 3 cm, or a tumor of any size, causing atelectasis, obstructive pneumonitis, or spreading to the root area. During bronchoscopy, the proximal spread of the visible tumor should not cross the border of 2 cm distal to the carina. Atelectasis or obstructive pneumonitis should not cover the entire lung; there should be no effusion.

T3 - a tumor of any size with direct spread to adjacent organs (diaphragm, chest wall, mediastinum). On bronchoscopy, the tumor border is less than 2 cm distal to the root, or the tumor causes atelectasis or obstructive pneumonitis of the entire lung, or there is pleural effusion.

TX - the diagnosis is confirmed by a cytological examination of sputum, but the tumor is not detected radiographically or bronchoscopically, or is not detectable (examination methods cannot be applied).

N - regional lymph nodes.

N0 - no signs of regional lymph node involvement.

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

N2 - signs of mediastinal lymph node involvement.

NX - a minimal set of examination methods cannot be applied to assess the state of regional lymph nodes.

M - distant metastases.

M0 - no signs of distant metastases.

M1 - signs of distant metastases.

Clinical picture

The clinical picture of lung cancer is very diverse. It depends on the caliber of the affected bronchus, the stage of the disease, the anatomical type of tumor growth, histological structure, and lung diseases preceding cancer. Distinguish between local symptoms due to changes in the lung and bronchi or metastases in organs, and general symptoms that appear as a result of the impact of a tumor, metastases and secondary inflammatory phenomena on the body as a whole.

With central lung cancer, the very first, earliest symptom is cough. Constant coughing can increase paroxysmal, up to a severe, hacking cough that does not bring relief with cyanosis, shortness of breath. Cough is more pronounced with endobronchial tumor growth, when, protruding into the lumen of the bronchus, it irritates the mucous membrane as a foreign body, causing bronchial spasm and a desire to cough up. With peribronchial tumor growth, cough usually appears later.Mucopurulent sputum is usually small.

Hemoptysis that occurs when a tumor breaks down is the second important symptom of central lung cancer. It manifests itself in about 40% of patients.

The third symptom of lung cancer, which occurs in 70% of patients, is chest pain. They are often caused by damage to the pleura (germination by a tumor or in connection with atelectasis and nonspecific pleurisy). Pain is not always on the side of the injury.

The fourth symptom of central lung cancer is fever. It is usually associated with blockage by a tumor of the bronchus and inflammation in the unventilated part of the lung. The so-called obstructive pneumonitis develops. It differs from acute pneumonia in relative transience and persistent relapses. With peripheral lung cancer, symptoms are scanty until the tumor reaches a large size.

When a tumor invades a large bronchus, symptoms similar to central lung cancer may appear.

Atypical forms of lung cancer occur in cases where the entire clinical picture is due to metastases, and the primary focus in the lung cannot be detected by available diagnostic methods. Depending on metastases, atypical forms are as follows: mediastinal, lung carcinomatosis, bone, cerebral,cardiovascular, gastrointestinal, hepatic.

Common symptoms - weakness, sweating, fatigue, weight loss - are found in an advanced process. External examination, palpation, percussion and auscultation in the early stages of the disease do not reveal any pathologies. When viewed in later stages of cancer in the case of atelectasis, a retraction of the chest wall and supraclavicular region can be noted.

With auscultation, you can listen to a wide variety of sound phenomena, ranging from amphoric breathing with bronchial stenosis and ending with the complete absence of respiratory sounds in the atelectasis zone. In the area of \u200b\u200ba massive peripheral tumor or atelectasis, dullness of the percussion sound is determined; but sometimes with obstructive emphysema, when air enters the affected segment or lobe of the lung, and upon exiting, the affected bronchus is blocked by thick sputum, a characteristic box sound can be determined. On the side of atelectasis, respiratory excursions of the diaphragm usually decrease.

Changes in the hemogram in the form of leukocytosis, anemia and increased ESR most often appear with the development of perifocal pneumonia and cancer intoxication. The X-ray picture of lung cancer is very variable, therefore, the diagnosis is possible only with a comprehensive X-ray examination in comparison with clinical data, the results of endoscopic and cytological examinations.

Differential diagnosis

Differential diagnosis of lung cancer is often difficult due to the concomitant nonspecific and specific inflammatory diseases of the lung. Based on a set of diagnostic data, a correct diagnosis is made. Most often, it is necessary to differentiate lung cancer from chronic pneumonia, lung abscess, tuberculosis, echinococcosis and lung cyst.

Non-small cell cancer

lung: combined

Adjuvant radiation therapy (radical option) is mandatory for stage IIIA (N2). In many hospitals, it is also used for IIIA (N1). However, studies have shown that adjuvant radiation therapy only reduces relapse rates, but does not increase life expectancy.

Neoadjuvant radiation therapy is used for upper lobe lung cancer... This is a special kind

peripheral lung cancer... Already at an early stage, the tumor grows into the brachial plexus, which is clinically manifested pancost's syndrome... Patients must undergo CT, mediastinoscopy and neurological examination (sometimes with a study of the speed of propagation of excitation along the nerves). Histological examination is usually not necessary, since the characteristic localization of the tumor and irradiation of pain make it possible to make a diagnosis in 90% of cases. Radical treatment is possible only in the absence of metastases in the lymph nodes of the mediastinum. Two methods are used. The first includes irradiation of the tumor in a total focal dose of 30 Gy, divided into 10 fractions, and after 3-6 weeks - removal of the affected lobe with regional lymph nodes and part of the chest wall in a single block. The second method is radical radiation therapy in the classical fractionation mode. Three-year survival rate in both cases is approximately the same and amounts to 42% with squamous cell lung cancerand 21% - at adenocarcinoma of the lungand large cell lung cancer.

Chemotherapy is not the main treatment for non-small cell lung cancer. In some cases, it gives very good results, but overall, the survival rate does not increase significantly. Non-small cell lung cancer is often non-responsive to antineoplastic agents. To avoid unnecessary use of such a toxic, expensive and inconvenient method as chemotherapy, you need to know exactly when it is appropriate to use it. This can only be established on the basis of a large number of clinical observations.

For this purpose, the results of 52 controlled clinical trials (both published and unpublished) were analyzed. A total of 9387 patients participated in them. In stage I and II lung cancer, five-year survival after combined (surgery plus chemotherapy) and surgical treatment was compared, and in stage III, two-year survival after combined treatment (radiation therapy plus chemotherapy) and radical radiation therapy (see "

Lung cancer: stages of the disease "). In both cases, the applicationcisplatin increased the survival rate by 13%, however, in patients with stage I and II lung cancer this increase was statistically insignificant, and therefore this method is not yet recommended for these categories of patients. In contrast, in stage III, the increase in survival with the use of cisplatin was statistically significant; life expectancy also increased (albeit slightly - by only a few months) at stage IV. Thus, these categories of patients can be recommended chemotherapy regimens, including cisplatin, having previously explained the advantages and disadvantages of the method.

Chemotherapy regimens that includealkylating agents, turned out to be ineffective: in the groups where they were used, mortality was higher than in the compared ones. Currently, these drugs are not used in the treatment of non-small cell lung cancer.

New antineoplastic agents active against non-small cell cancer -paclitaxel, docetaxel, vinorelbine,

gemcitabine, topotecan and irinotecan are still under controlled

Small cell carcinoma

lung: combined

Combined treatment - polychemotherapy in combination with radiation therapy - is considered the method of choice for early stage small cell lung cancer. It significantly improves the results of treatment and increases life expectancy, although it gives side effects, including long-term ones. Such treatment is indicated for patients with an early stage of small cell lung cancer, having a general condition score of 0-1 points, normal lung function and no more than one distant metastasis (see "Lung cancer: stages of the disease").

Irradiation is carried out in the hyperfractionation mode through the mantle-shaped field, as in lymphogranulomatosis. As the tumor mass decreases, the radiation fields are narrowed.

Etoposide and cisplatin are commonly used anticancer agents. In several large clinics, where etoposide, cisplatin and hyperfractionated radiation were administered simultaneously, a high remission rate and an acceptable risk of complications were demonstrated.

In the late stage of small cell lung cancer, chest irradiation is not advisable.

In cases where chemotherapy has been ineffective, irrespective of the stage of the disease, a course of radiation therapy can be prescribed. According to various medical institutions, after combined treatment in about 15-25% of patients with an early stage of small cell lung cancer and in 1-5% of patients with a late stage, the relapse-free period lasts more than 3 years. Complete remission at an early stage can be achieved in 50% of cases, at a late stage - in 30%. In total, 90-95% of patients reach complete or partial remission. In the absence of treatment, half of the patients die within 2-4 months.

After combined treatment in half of patients with a late stage of the disease, life expectancy increases to10-12 months, and in half of patients with an early stage - up to 14-18 months. In addition, in most cases, the general condition improves, the symptoms caused by tumor growth disappear.

Much depends on the qualifications of the chemotherapy oncologist. He must make every effort to avoid serious complications and not worsen the general condition of the patient.

In recent years, doctors' capabilities have significantly expanded: new chemotherapy regimens, high-dose polychemotherapy in combination with bone marrow autotransplantation and other combined treatment methods have appeared.

Surgical treatment for small cell lung cancer is rarely used. Indications for surgery are the same as for lung cancer of other histological types (stage I or II of the disease without metastases to the lymph nodes of the mediastinum).

It often happens that small cell lung cancer is first diagnosed with a histological examination of a removed tumor; in such cases, adjuvant chemotherapy can achieve a cure of about 25% of patients.

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

Epidemiology 1st place among other malignant tumors in men in Russia, and in 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 In Russia in 2012, 55,475 people fell ill with lung cancer (24% of all Neo), 49,908 people died (35, 1%). Every 4th patient among the total number of newly registered cancer patients and every 3rd who die from these diseases are lung cancer patients. More people die from lung cancer each year than from prostate, breast and colon cancers combined.

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

Peripheral lung cancer Nodular shape (round, spherical) Pneumonia-like (infiltrative) tumor Apex cancer with Pancost's 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 carcinoma, bronchial gland cancer, etc.)

2009 TNM classification Tx - Insufficient data to assess the primary tumor or the tumor is proven only by the presence of tumor cells in sputum or bronchial lavage, but not detected by imaging T 0 - The primary tumor is not detected Tis - Preinvasive carcinoma (carcinoma in situ); T 1 - tumor 3 cm or less in the largest dimension; surrounded by lung tissue / visceral pleura. Based on the data of bronchoscopy, there are no signs of invasion, proximal to the lobar bronchus (there is no involvement of the main bronchus). T 1 a - tumor of 2 cm or less in the largest dimension. T 1 b - tumor more than 2 cm, but

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

2009 TNM classification Nx - not assessed. NO - there are no signs of metastatic lesions of regional LN. N 1 - there is a lesion of the peribronchial and / or LN of the root of the lung and intrapulmonary LN on the side of the lesion, including the direct spread of the tumor to the LN. N 2 - there is a lesion of the mediastinal and / or bifurcational LU (node) on the affected side. N 3 - there is a lesion of either the mediastinum or the root of the lung on the opposite side, or the prestaginal or supraclavicular LN on the side of the lesion or on the opposite side. MX - Cannot be rated. M 0 - no signs of distant metastases. M 1 - there are distant metastases. M 1 a - separate tumor focus (s) in the opposite lung; a 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 of the chest organs with contrast, PET-CT Cytological examination of sputum Fibrobronchoscopy with biopsy Transthoracic and percutaneous puncture, transbronchial or transesophageal fine needle puncture / biopsy Mediastinoscopy, diagnostic thoracotroscopy. cavity, retroperitoneal space, supraclavicular, cervical and axillary regions Respiratory function examination ECG, Echo-KG

Tumor markers Small cell: neuron-specific enolase (NSE), cancer-embryonic 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, nature and severity of concomitant pathology, functional parameters of vital organs and systems. Surgical treatment Radiation therapy Drug treatment (chemotherapy, targeted therapy)

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

Surgical treatment Lobectomy, bilobectomy, or pulmonectomy with ipsilateral mediastinal lymphadenectomy is recommended to be the minimum oncologically justified volume of surgery. With peripheral tumors up to 1, 5 cm and low functional cardiorespiratory reserves, anatomical segmentectomy is possible. Sublobar resections (atypical resection, segmentectomy) are associated with an increase in the frequency of local recurrence and a deterioration in long-term results by 5-10%.

Lymphadenectomy The standard volume of mediastinal lymphadenectomy in operations on the right lung should be the removal of the right lower paratracheal (taracheobronchial, paratracheal, pretracheal). On the left - paraaortic, subaortic, left inferior 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 - lymphadenectomy at the root of the lung, segmental branches of the right pulmonary artery are highlighted; B - isolation of the right upper lobe bronchus in a single block with the lymph nodes of the root of the 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 - azygos vein arch, 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 2 R and 4 R groups: 1 - upper lobe of the right lung; 2 - azygos vein arch; 3 - esophagus; 4 - trachea; 5 - the right vagus nerve; 6 - superior vena cava; 7 - right phrenic nerve; B - view of the operating field after performing thoracoscopic paratracheal lymph node dissection: 8 - brachiocephalic arterial trunk; 9 - aortic arch.

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

Mediastinal lymphadenectomy Bifurcated lymphadenectomy on the left. A - the posterior surface of the root of the left lung; B - type of 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 pericardial wall, 8 - esophagus.

Mediastinal lymph node dissection Zone of the aortic window with lymph nodes of groups 5 and 6. A - intraoperative revision; B - view of the operating field after the 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 intersected 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 right lobectomy; B - lower left lobectomy. Arrows indicate port installation locations.

Radiation therapy Used as an independent treatment, as well as in combination with a surgical or chemotherapy method. Irradiation is carried out remotely or by contact (brachytherapy). Radical radiation therapy is performed in patients with early stages of NSCLC with functional inoperability and a high risk of surgical complications. Adjuvant radiation therapy for patients with NSCLC stage 0-IIB (N 0) after radical surgery is not used. Neoadjuvant radiation therapy (possibly in combination with chemotherapy) can be used in selected (apex tumor with Pancost's syndrome) patients with IIIB NSCLC (N 0 -1). Brachytherapy is considered as an alternative treatment option for NSCLC confined to the mucous and submucosa.

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

Chemotherapy treatment for NSCLC Platinum regimens: Paclitaxel 175 mg / m 2, day 1, 3 hour infusion. Cisplatin 80 mg / m 2, on the 1st day. Paclitaxel 135 -175 mg / m 2, intravenous, over 3 hours, on the 1st day. Carboplatin 300 mg / m 2 intravenously over 30 min. after paclitaxel administration, on the 1st day. Docetaxel 75 mg / m2, on the 1st day. Cisplatin 75 mg / m 2, on the 1st day. Docetaxel 75 mg / m2, on the 1st day. Carboplatin AIS-5, 1 day. Gemcitabine 1000 mg / m 2; on the 1st and 8th days. Cisplatin 80 mg / m 2 on the 1st day. Gemcitabine 1000 mg / m 2, on the 1st and 8th day. Carboplatin AIS-5, 1 day. Pemetrexed 500 mg / m2, on the 1st day. Cisplatin 75 mg / m 2 on the 1st day. Vinorelbine 25-30 mg / m 2, on the 1st and 8th day. Cisplatin 80-100 mg / m 2, on the 1st day.

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

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

Chemotherapy treatment of NSCLC Active regimens of chemotherapy for NSCLC: Cisplatin 60 mg / m 2, on the 1st day. Etoposide 120 mg / m 2, on days 1-3. The interval between courses is 21 days. Paclitaxel 135 -175 mg / m 2 intravenously, over 3 hours, on the 1st day. Carboplatin 300 mg / m 2 intravenously for 30 minutes. after paclitaxel administration, on the 1st day. The interval between courses is 21 days. Gemcitabine 1000 mg / m 2, on the 1st and 8th day. Cisplatin 80 mg / m 2, on the 1st day. The interval between courses is 21 days. Vinorelbine 25-30 mg / m 2, on the 1st and 8th day. Cisplatin 80-100 mg / m 2, on the 1st day. The interval between courses is 21-28 days. Paclitaxel 175 mg / m 2 on day 1, 3 hour infusion. Cisplatin 80 mg / m 2, on the 1st day. The interval between courses is 21 days.

Chemotherapy treatment for SCLC EP: Cisplatin 80 mg / m 2, on the 1st day. Etoposide 120 mg / m 2, from the 1st to the 3rd day. 1 time in 3 weeks. SOE: Doxorubicin 45 mg / m 2 on the 1st day. Cyclophosphamide 1000 mg / m 2, on the 1st day. Etoposide 100 mg / m 2; on the 1st, 2nd, 3rd or 1st, 3rd, 5th days. 1 time in 3 weeks. CAV: Cyclophosphamide 1000 mg / m 2 on the 1st day. Doxorubicin 50 mg / m 2, on the 1st day. Vincristine 1, 4 mg / m 2, on the 1st day. 1 time in 3 weeks.

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

Chemotherapy treatment of SCLC Docetaxel 75 mg / m 2 on the 1st day. Cisplatin 75 mg / m 2 on the 1st day. 1 time in 3 weeks. Gemcitabine 1000 mg / m 2, on the 1st and 8th day. Cisplatin 70 mg / m 2, on the 1st day. 1 time in 3 weeks. Doxorubicin 60 mg / m 2, on the 1st day. Cyclophosphamide 1 g / m 2, on the 1st day. Vincristine 1, 4 mg / m 2, on the 1st day. Methotrexate 30 mg / m 2 on the 1st day.

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

Targeted therapy Recommended drugs: docetaxel, pemetrexel (for non-squamous NSCLC), gemcitabine, erlotinib (for EGFR mutation, if not previously used), gefitinib (if EGFR mutation, if not previously used) afatinib (if EGFR mutation previously 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 ab. 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 lymphadenectomy Reconstructive plastic surgery with lymph node dissection Radiation therapy Chemotherapy Stage III A (T 1 ab. N 2 M 0, T 2 ab. 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 lymphadenectomy, adjuvant chemoimmunotherapy. Stage III B (T 4 N 2 M 0, T 1 -4 N 3 M 0) Chemoradiotherapy Stage IV (T 1 -4 N 0 -3 M 1) Palliative chemoradiation + symptomatic treatment

SCLC treatment Stage of the disease Treatment methods Stage IA (T 1 ab. N 0 M 0) Stage IB (T 2 a. N 0 M 0) Preoperative polychemotherapy Radical surgery - lobectomy with lymphadenectomy Chemoradiation therapy Stage II A (T 2 b. N 0 M 0, T 1 ab. N 1 M 0, T 2 a. N 1 M 0) Stage II BT 2 b. N 1 M 0, T 3 N 0 M 0) Preoperative polychemotherapy Radical surgery - lobectomy, combined bilobectomy with lymph node dissection Reconstructive plastic surgery Chemoradiation therapy Stage III A (T 1 ab. N 2 M 0, T 2 ab. 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) Chemoradiotherapy Stage IV (T 1 -4 N 0 -3 M 1) Palliative chemoradiation therapy

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%;

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Epidemiology of lung cancer (Ukraine, 2010) Incidence - 36 per 100 thousand (men - 63.5; women - 12.5) The number of registered cases - Mortality - 28.4 per 100 thousand (men - 51.7 ; female -8.5) Mortality rate throughout the year - 64% Coverage of special treatment - 42% Morphologically verified - 58% Revealed during prophylactic examinations - 22.8%

Etiology of lung cancer Smoking (active and passive). Aerosol of tobacco smoke contains over 3800 chemical compounds, of which over 40 are carcinogens: nicotine, benzanthracene, nitrosamines, radioactive elements (strontium, polonium, titanium, lead, potassium); Professional factors (metallurgy, mining, gas, textile, leather, cardboard industry). Asbestos, salts of arsenic, chromium, nickel, cobalt, benzpyrene, mining gas, coal saw, etc .; Air pollution by chemical and radioactive carcinogens; Endogenous factors - chronic lung diseases, age over 45 years

Lung Cancer Risk Factors Smokers over 45; Patients with chronic diseases of the broncho-pulmonary system; Persons in contact with asbestos, salts of non-ferrous and heavy metals, sources of radioactive radiation; Persons with a history of heredity

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

3 cm or a tumor passing to the main bronchus on the race "title \u003d" (! LANG: Classification of lung cancer according to stages T N M T 0 - the tumor is not detected T is - pre-invasive cancer (cancer in situ) T 1 - a tumor up to 3 cm in the largest dimension T 2 - a tumor\u003e 3 cm in size or a tumor that passes to the main bronchus on the races" class="link_thumb"> 9 !} Classification of lung cancer by stages T N M T 0 - the tumor is not detected T is - pre-invasive cancer (cancer in situ) T 1 - a tumor up to 3 cm in size in the largest dimension T 2 - a tumor\u003e 3 cm in size or a tumor that passes to the main bronchus at a distance of 2 cm or more from the carina, or the presence of T 3 atelectasis - 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 lung atelectasis T 4 - a tumor of any size with infiltration of the mediastinum or large major 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 bifurcation lymph nodes or lymph nodes of the mediastinum on the side of the lesion N 3 - metastases in the lymph nodes of the mediastinum or the root of the lung on the opposite side or in the supraclavicular lymph nodes M 0 - n no distant metastases М 1 - there are distant metastases 3 cm or a tumor passing to the main bronchus on the rass "\u003e 3 cm or a tumor passing 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 , the 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 major vessels, or the trachea, or the esophagus, or the carina, or exudative pleurisy N 0 - there are no metastases in the regional lymph nodes N 1 - metastases in the peribronchial and / or lymph nodes of the lung root on the side of the lesion N 2 - metastases in the bifurcated lymph nodes or lymph nodes of the mediastinum on the side of the lesion N 3 - metastases in the lymph nodes of the mediastinum or the root of the lung on the opposite side or in the supraclavicular lymph nodes M 0 - no distant metastases М 1 - there are distant metastases "\u003e 3 cm or a tumor that passes to the main bronchus on the race" title \u003d "(! LANG: Kla sification of lung cancer by stages T N M T 0 - the tumor is not detected T is - pre-invasive cancer (cancer in situ) T 1 - a tumor up to 3 cm in size in the largest dimension T 2 - a tumor\u003e 3 cm in size or a tumor that passes to the main bronchus on races"> title="Classification of lung cancer by stages T N M T 0 - the tumor is not detected T is - preinvasive cancer (cancer in situ) T 1 - a tumor up to 3 cm in size in the largest dimension T 2 - a tumor\u003e 3 cm in size or a tumor that passes to the main bronchus on races"> !}

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

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

Endoscopic syndromes of RL 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 - fuzzy pattern of bronchial rings - displacement of the walls or mouth of the bronchus - rigidity of the wall during the instrument palpation - bulging of the wall - absence of passive displacement of the bronchus Syndrome of functional changes - immobility of the bronchial wall during breathing - absence of transmission pulsation from the heart and great vessels - presence of hemorrhagic discharge from the bronchus

Lung cancer treatment SMALL CELL Surgical treatment is not subject; Chemo-sensitive NON-SMALL CELL The main method of treatment is surgical; Chemotherapy and radiation therapy are used in conjunction with surgery or in inoperable cases

Lung cancer prevention; Smoking control; Protection of workers in 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 cars, transition to electric vehicles