Cancer of the bronchi and trachea: symptoms, treatment, stages
Cancer of the bronchi, or bronchial cancer, are malignant tumors of epithelial origin, originating from the mucous membrane of the bronchi of different diameters. In the medical literature in the description of the lesions of the bronchial tree is more common, the term «lung cancer», which is identical with the «cancer of the bronchi».
Most forms of lung cancer – a tumor growing from the bronchial walls, therefore, these concepts and combined into one form – bronchopulmonary cancer.
Malignant tumor of the bronchial tree is a serious medical and social problem. As the prevalence of cancer of the bronchi is almost the first place in the world, yielding in some regions only cancer of the stomach. Among patients with this diagnosis are men who are getting sick up to 10 times more often than women and the average age of them ranged between 45-60 years, that is, the majority of patients are men of working age.
The number of patients is growing steadily, and all the world is recorded up to a million new cases of cancer of the bronchi every year. The insidiousness of the disease, especially with the defeat of the small bronchi, is a prolonged asymptomatic or oligosymptomatic course, when scarce the clinical picture of not alarming the patient in such a degree to seek the assistance of doctors. This explains the still large number of advanced forms of disease, when treatment is no longer effective.
Causes and types of cancer of the bronchi
Causes of bronchial cancer are associated mainly with effects on the respiratory system external adverse conditions. First of all it concerns Smoking, which, despite the active promotion of a healthy lifestyle continues to be widespread not only among adults but also among adolescents, particularly sensitive to the action of carcinogens.
The effect of Smoking is usually delayed in time, and the cancer may appear decades later, but to deny its role in the Genesis of tumors is meaningless. It is known that about 90% of cases of bronchial cancer were or are active smokers with great experience. Penetrating together with the tobacco smoke of harmful and hazardous substances, radioactive components, tar and soot deposited on the surface of the bronchial mucosa, cause damage to the surface epithelium, appearance of foci of metaplasia (adjustment) of the mucosa, chronic inflammation («smoker’s bronchitis»). Over time, a persistent disruption of the structure of the mucous membrane leads to dysplasia, which is considered the main «step» on the path to cancer.
Other causes of lung cancer are reduced to chronic broncho-pulmonary pathology, inflammatory changes, bronchiectasis, abscesses, scars. Contact with asbestos is very adverse vocational factor, which causes not only cancer of the pleura, but neoplasia of the bronchial tree.
Speaking of bronchial cancer, this refers to the defeat of the main (right and left bronchi), lobar, segmental and smaller bronchi. Lose the main, lobar and segmental bronchus is called the Central lung cancer, and neoplasia of the distal Airways, peripheral lung cancer.
The histological picture involves the allocation of several forms of bronchial cancer:
- Large-cell carcinoma;
- Squamous cell carcinoma.
In addition to these, there are also mixed forms that combine features of different build options.
Squamous cell carcinoma is the most frequent form of malignant lung tumors, which usually occurs in the bronchi of large calibre of the sites of squamous metaplasia of the mucosa. With highly differentiated variants of squamous cell carcinoma, the prognosis may be relatively favorable.
Small cell lung cancer is one of the most malignant forms characterized by unfavorable course and high mortality. This kind of tumor are prone to rapid growth and early metastasis.
Central cancer of the bronchus, lobar and segmental may look in the form of exophytic growing, facing the inside of the lumen of the bronchus. Such a node causes symptoms due to the closure of the lumen of the Airways. In other cases, the tumor is infiltrative growing, «enveloping» bronchus from all sides and a narrowing of its lumen.
Tumor stage is determined based on the dimensions of education, presence of metastases, and nature of changes in the surrounding structures. In the clinic there are four stages of cancer:
- At stage 1 the tumor is less than 3 cm in diameter, does not spread and does not go beyond the pulmonary segment.
- Stage 2 characterizes the neoplasia up to 6 cm with a possible metastasis to regional lymph nodes.
- Stage 3 tumor size more than 6 cm, it spreads to the surrounding tissues and metastasizes to local lymph nodes.
- 4 stage is characterized by the output of the education outside of the lung, growing it into the surrounding tissues and structures, active metastasis, including to distant organs.
Symptoms of bronchial cancer
Signs of bronchial cancer are determined not only by histological type and growth pattern of the tumor, but also its location. The main symptoms of cancer of the bronchus – cough, shortness of breath, General intoxication phenomena that used to appear in cancer of the large bronchi and quite a long time absent in peripheral tumors.
Cancer of the main bronchus before it gives symptoms in the form of cough, at first dry, then with purulent or bloody sputum. Feature in this type of tumor is the possibility of closing its lumen of the bronchus with complete violation of air entry in the lung tissue that collapses and ceases to function (atelectasis).
Often on the background of atelectasis occurs inflammation (pneumonitis), then the symptoms appear fever, chills, weakness, indicating an acute infectious process. The decay of the tumor, its size is somewhat reduced, and the patency of the bronchus may partially recover, with signs of atelectasis can become less noticeable. However, complacency is not necessary: after a short time, the tumor will increase again, as atelectasis and pneumonitis are likely to recur.
Cancer upper lobe bronchus arises more often than tumors of the lower respiratory system. This may be more active ventilation of the upper parts of the lungs with air containing carcinogenic substances.
Peripheral lung cancer, which may occur in small caliber bronchi and bronchioles, for a long time gives no symptoms and is often detected already at larger tumor size. The first signs are often steered to a strong cough and chest pain associated with invasion by the neoplasia of the pleura. When ingrowth of the tumor into the pleural cavity pleurisy appears, accompanied by intense pain, shortness of breath, fever.
In the case of a large volume of tumor tissue, accumulation of fluid in the chest cavity there is a shift of the mediastinum, which may manifest by arrhythmias, heart failure, puffy face. Compression of the laryngeal nerve may violate voice. With the growth of intoxication with products of tumor metabolism, the patient loses weight, increasing General weakness, fever becomes permanent.
Cancer of the trachea is the main of a rare tumor
Cancer of the trachea is considered a rare pathology, occurring no more than 0.1-0.2% of oncological patients. Primary tumors of this localization are malignant cylindroma and squamous cell carcinoma. The majority of patients – persons middle-aged and elderly, often men, as in the case of tumors of the bronchi and lung parenchyma.
Up to 90% of patients with cancer of the trachea squamous cell suffer a variety of neoplasia. The tumor usually affects the upper or lower third of the body, grows in a site facing the lumen, but infiltrative growth with significant narrowing and deformation of the wall of the trachea. Threat localization is the location of the cancer above the place of division of the trachea into the main bronchi, as in this case, the possible closure of both bronchial and choking.
The clinical picture of cancer of the trachea consist of:
Cough in cancer of the trachea painful, dry at the beginning of the disease with purulent sputum in the future. Since the tumor closes the lumen of the organ and disrupts the conduction of air during inhalation and exhalation, it is highly characterized by the appearance of shortness of breath that bothers the vast majority of patients. Dyspnea may at the moment of disintegration of the tumor tissue, then it appears again.
For some time, the patient adapts to difficulty of breathing, but with increasing neoplasia shortness of breath becomes more pronounced, threatening to escalate into choking, with full closure of the airway. This condition is very dangerous and requires emergency medical care.
The appearance of blood in sputum is associated with disintegration of the cancerous tissue and damage to feeding the tumor vessels. The spread of the disease to the larynx and recurrent nerves may violate the voice of osiplosti or even its absence. General symptoms include fever, weight loss, weakness.
Also recommend: the stuff about cancer of the larynx.
Diagnosis and treatment of cancer of the respiratory tract
To detect cancer of the trachea and bronchi are traditionally used radiographic, including CT. To clarify the nature of the spread of neoplasia performed MRI. In General, the analysis of blood can be detected increase in the level of white blood cells, ESR acceleration, and cytological examination of sputum allows it to identify malignant cancer cells.
Like any other tumor, cancer of the bronchus any caliber can be removed surgically, with radiation or receiving chemotherapy. In most patients, perhaps a combination of these methods, but in the presence of contraindications for surgery, preference will be given to conservative methods.
Surgical treatment of cancer of the bronchi
The most effective is the surgical treatment that gives the best results with small tumors detected in the early stages of development. The larger cancerous node, the more he grew into the surrounding tissue, the harder it is to get rid of the disease, and the risk of surgical complications in some cases do not allow the doctor to perform the surgery.
Intervention on the respiratory system is always a complex and traumatic, require not only a good preparation of the patient, but also high qualification of the surgeon. When cancer of the bronchi it is possible to perform:
Pneumonectomy (removal of lung)
Pneumonectomy – the most radical method to get rid of cancer of the bronchus, which is to remove the entire lung as a whole with the lymph nodes of the mediastinum and fiber. During germination of the tumor to major blood vessels or the trachea may be necessary in the resection of the area of the trachea, inferior Vena cava and aorta. Such intervention requires adequate preparation of the patient and the relatively good General condition, so not every patient, especially the elderly, may conduct a total pneumonectomy.
Contraindications to radical surgery are:
- The impossibility of removing the tumor completely because of its proliferation in lung tissues, blood vessels, etc.;
- The presence of distant metastases, making this treatment ineffective and unnecessary;
- Serious condition of the patient, eliminating the possibility of any surgery under General anesthesia;
- Internal diseases in decompensation.
Older age does not preclude surgical treatment if the General condition of the patient satisfactory, but some patients tend to refuse surgery for fear of complications or considering it useless.
In localized forms of cancer are sufficient resection of section of the bronchus or a lobectomy – lobectomy, bilobectomy (two shares, only with the defeat of the right lung). The best results are achieved in the treatment of differentiated variants of the tumor, but small cell lung cancer, detected early, may be subjected to surgical treatment.
If you remove the tumor and lymph nodes is completely impossible because of the risk of complications (bleeding, for example), then a so-called semi-radical surgery, when excised the affected tissue, and the remaining foci of cancer growth is exposed.
Increasing prevalence acquire bronhospasticescoe operations to enable more cost-effective to remove the affected tissue due to the wedge-shaped or circular resection of the bronchus. Bronhospasticescoe intervention is also indicated in cases of, when producing radical pneumonectomy is technically impossible.
Because cancer of the bronchi actively and metastasizes early to the regional lymph nodes, in all cases, removal of the tumor is accompanied by the excision of the lymph nodes that collect lymph from the affected bronchus. This approach allows to avoid possible relapses, disease progression, and increases life expectancy of operated patients.
Preparation for surgery includes a balanced diet, the appointment of broad-spectrum antibiotics to prevent infectious complications, correction of the cardiovascular system, respiratory gymnastics.
In the postoperative period patient give a semi-sitting position and provide oxygen. For the prevention of infectious complications antibiotic treatment is carried out, and from the pleural cavity and remove the blood and air in order to avoid displacement of the structures of the mediastinum.
Radiation therapy and chemotherapy
Radiation treatment is usually performed in conjunction with surgical operation, but in some cases it becomes the main and only possible way to help the patient. So, in inoperable cancer, refusal of surgery, the patient, excluding the possibility of removal of the tumor, irradiate to a total dose of 70 gray for 6-7 weeks. Most sensitive to radiation squamous cell and undifferentiated cancer of the bronchi and exposure you need to expose not only the tumor but also the mediastinum with lymph nodes. In the terminal stages of cancer radiation allows to reduce some pain, wearing palliative.
A new approach in radiation therapy is the use of cyber knife (stereotactic radiosurgery), with which it is possible to remove the tumor of the bronchus without surgery and anesthesia. In addition, the directional beam of radiation capable of removing an isolated metastasis in the lung tissue.
Chemotherapy is usually used as a palliative method in non-small cell lung cancer when surgery is not possible, and small cell varieties are sensitive to conservative treatment. Non-small cell lung cancer responds poorly to the effects of chemotherapy, so they are used mainly with palliative purpose to reduce the tumor size, pain and respiratory disorders. The most effective are cisplatin, vincristine, cyclophosphamide, methotrexate, docetaxel, etc.
Small cell lung cancer sensitive to cytotoxic agents, especially in combination with irradiation. For the treatment assigned to some of the most effective drugs in high doses that are selected individually taking into account the shape of the cancer and its sensitivity.
To increase the duration of life of patients with cancer of the bronchial tubes allows the combined treatment using a combination of radiation, surgery and drug therapy. Thus, preoperative irradiation, and the appointment of cytotoxic drugs can reduce tumor volume and, consequently, to facilitate the operation. In the postoperative period of conservative therapy aimed at prevention of recurrence and metastasis of cancer.
Radiation and chemotherapy are often accompanied by unpleasant side effects associated with the disintegration of cancer cells, therefore, symptomatic therapy is required. Appointment pain medication helps reduce pain, antibiotics to fight infection in the affected tissues. For the correction of violations of electrolyte balance shown infusion therapy.
In addition to the traditional ways of dealing with the tumor, attempts were made to introduce new methods – photodynamic therapy, brachytherapy, cryotherapy, laser treatment, treatment with targeted agents. Local treatment is justified by the small size of the cancer beyond the mucosa and in the absence of metastases.
Treatment of cancer of the trachea
Treatment of cancer of the trachea usually combined. When the accessibility of tumors for a surgeon’s scalpel, making his removal by excision of a fragment of the tracheal (resection). If you remove the tumor is impossible, it shows a palliative treatment aimed at improving the patency of the body.
In addition to surgery radiation. For inoperable patients, radiation therapy becomes the primary method of treatment to reduce pain and to improve respiratory function. The chemotherapy of tumors of the trachea a little sensitive, and chemotherapy were not used in cancer of this organ.
Video: seminar on cancer of the trachea
The prognosis of malignant tumors, outgoing, and bronchial wall, defined by histological type and incidence of tumors. If at the first stage of the disease, timely treatment gives 5-year survival rate at 80%, in the third stage, survives only a fifth of patients. The presence of metastases in distant organs significantly aggravates prognosis.
Prevention of cancer of the bronchi consists primarily of Smoking cessation, which is considered a major risk factor for the tumor. When working in hazardous conditions should be monitored closely for respiratory and to use the means of protection from dust and dangerous contaminants in the air. In the presence of inflammatory processes in the respiratory tract, must be timely to engage in their treatment and regularly visit the doctor.