Cancer is lung

Zdorovye - - NEWS - Skordumov Yuriy Alekseevich

Lung cancer is a tumor of epithelial origin that develops in the mucous membrane of the bronchi, bronchioles and mucous bronchial glands. The incidence of lung cancer in many countries over the past 50 years has increased dramatically.

Lung cancer is a tumor of epithelial origin that develops in the mucous membrane of the bronchi, bronchioles and mucous bronchial glands. The incidence of lung cancer in many countries over the past 50 years has increased dramatically.

Currently, in most developed countries, this tumor is most common in men and is one of the most important medical and socio-economic problems. Every year in the world more than 1 million new cases of lung cancer are recorded, of which 58% are in developed countries and 60% of cancer patients die as a result of this disease. The highest incidence rates are noted in North America and Europe (especially in the East), slightly lower in South America, Australia and in some regions of East Asia. In 2017

In Ukraine, 12462 people were ill with cancer, died in 10235. In the structure of the deaths from malignant neoplasms, the proportion of lung cancer was 30.8% for men and 6.6% for women. Kirovograd region is the region that occupies a leading place in terms of incidence rate per 100 thousand population (regional index - 44, 8, republican - 35,8). At the same time, mortality per 100 thousand population was 36.7 (Ukraine - 28.2). For the first time, 64.1% of lung cancer patients died in the Kirovograd oblast until one year after the diagnosis (61.8% of the Republican figure). According to WHO, in general, the 5-year survival rate for lung cancer patients in the United States is 14%, in Europe only 8%, and the same is true in developing countries. Surge is the most important factor in chemically induced lung cancer. It has been established that tobacco smoke contains over 3800 chemicals, many of which are carcinogenic to humans.

Duration of smoking is an essential factor. According to the International Agency for Research on Cancer, smoking is associated with 70-95% of cases of lung cancer, and the risk of its development among smokers is on average 10 times higher than in non-smokers. Among smoker men, the lifetime risk of developing lung cancer is 17.2%, among smokers - 11.6%. This risk is significantly lower in non-smokers: 1.3% in men and 1.4% in women. With the experience of smoking tobacco increases the likelihood of developing lung cancer in humans. Reliably established the etiological link of lung cancer with a number of substances (asbestos, arsenic, chromium, nickel and its compounds, radon and products of its decay, mustard gas, coal tar) and production processes. The proportion of lung cancer associated with professional factors ranges from 4 to 40%.

Lung cancer to a greater extent than other forms of malignant tumors, is associated with air pollution by carcinogens. In recent years, there has been a great interest in studying the role of light airborne etiology in indoor air pollution by tobacco smoke and a-particles studying radioactive radon and its derivatives. It is shown that the chemical

composition of tobacco smoke that enters the air (by-pass) is somewhat different from the composition of inhaled smoke under active smoking (main stream). Particularly, in the secondary stream higher content of ammonia, amines, including aromatic amines, and gaseous N nitro compounds than in the main stream. Studies in the United States, Europe, the UK, and Australia have shown a significant increase in relative risk among passive smokers. Recent studies have shown that smoker's exhaled smoke is more dangerous than inhaling it directly from the cigarette. 10-15% of patients with lung cancer have never smoked. Radon intake in residential areas is affected by a number of factors: the content and allocation of it from underlying rocks, from building materials that often contain high concentrations of radon and its derivatives; consumption of drinking water and gas containing radon, ventilation of premises, etc.

The effect of radon is the second cause of lung cancer in the general population after smoking with an increase in risk from 8% to 16% for every 100 Bq / m3 increase in radon concentration. This problem exists also in the Kropyvnitsky River, taking into account its location on granite layers and the development of uranium fossils under the city. Clinical manifestations of lung cancer essentially depend on localization of the primary tumor node. The first signs of lung cancer are: cough (dry or sputum); sputum secretion with the presence of blood; dyspnea; painful feelings of a different nature in breathing and coughing; fatigue; weight loss Some types of tumors (Pancost's tumor) can cause specific symptoms - pain in the shoulder girdle that extends down the arm. At later stages (with the spread of the tumor) to the above symptoms are joined: wheezing of the voice; difficulty swallowing; swelling of the face (occurs when blocking the blood vessels); increase of cervical lymph nodes. Common symptoms include general deterioration of the body, characterized by the development of malignant tumors: intoxication, shortness of breath, weakness, weight loss, body temperature rise. Also, lung cancer is accompanied by disturbances in calcium metabolism, dermatitis and deformity of the fingers by the type of "drum sticks". In the untapped stages, symptoms of metastatic defeat of vital organs are joined, and tumor and pulmonary processes, bronchial obstruction, atelectasis, and severe are joined to tumor growth. pulmonary haemorrhage.

To estimate the prevalence of lung cancer, the International Classification by TNM system 7, 2009 edition and the histological classification (WHO, 3rd edition, 1999) are used .1. Non-small cell carcinoma1.1. Squamous cell carcinoma (epidermoid): papillary, light-cell, small-cell, basaloid.1 .2. Adenocarcinoma: acinar, papillary, bronchioalveolar cancer, solid with mucus formation, with mixed subtypes.1.3. Large cell carcinoma: neuroendocrine, combined endocrine, basaloid, lymphoepithelial, cell line, with rhabdoid phenotype. 1.4. Glandular-squamous cell carcinoma.1.5. Cancer with polymorphic, sarcomatous elements. 1.6. Carcinoid-type, atypical.1.7. Cancer of bronchial glands: adenocystised, mucoepidermoid, other types.1.8. Unclassified cancer.2. Small cell carcinoma: small cell, combined. Regional lymph nodes: intracranial nodes (mediastinal, root, partial, interdolateral, segmental and subsegmental), staging and supraclavicular lymph nodes. I stage - tumor up to 3 cm in the largest dimension, located in one segment of the lung or within the segmental bronchus. No metastases. II stage - tumor up to 7 cm in the largest dimension, located in one segment of the lung or within the segmental bronchus. There are isolated metastases in the pulmonary and bronchopulmonary lymph nodes. The third stage - a tumor greater than 7 cm with the transition to the adjacent lung or germination of the adjacent bronchus or the head bronchus. Metastases are found in bifurcation, tracheobronchial, paraphracheal lymph nodes. The IV stage - the tumor extends beyond the lungs with the spread of adjacent organs and large local and distant metastases, joining the cancerous pleurisy. N - regional lymph nodes: Nx -3. M - distant metastases: M0 - 1b The pathogistological classification of pTNM and histopathological differentiation G: Gx - G4 are also used.

It is not easy to detect cancer in the early stages, since the symptoms of the disease are quite common and may resemble other diseases (eg, inflammation of the lungs). Kirovohrad Regional Oncology Center is a third-level accreditation institution that meets European standards for the quality of medical care for patients with lung cancer. Taking into account the socioeconomic significance of lung cancer problems, unsatisfactory results of treatment in the region, a decision was made to reorganize and open the Torgago abdominal department on the basis of the dispensary from January 2011. This led to an increase in the percentage of morphological verification (63% - oblast, Ukraine - 59%), coverage of special treatment (oblast - 59%, Ukraine - 41.1%), including surgical (oblast - 10.5%, Ukraine -7.3%), five-year survival rate to 27.7%. Thanks to the efforts of the administration of the institution and with the support

of the regional state administration and people's deputy of Ukraine, the candidate of mn., Honored Doctor of Ukraine, Yarinich KV, for the equipment and repair of the dispensary in recent years was more than 60 million. The main methods of diagnosis of lung cancer, used in our clinic, are as follows: digital X-ray examination (timely detects the tumor in 80% of patients); low-dose spiral computed tomography (or spiral CT) with contrast enhancement (allows more detailed and high resolution to study the size and location of the tumor, its germination in the surrounding organs, the presence of metastases in the surrounding tissue of the lungs, in the lymph nodes of the mediastinum, in the bones of the thoracic department of the spine, ribs and sternum); Magnetic resonance imaging (MRI) is used when necessary to determine the exact location of the tumor; With the aid of videoobronhoscopy, the trachea bronchial tree is studied for bronchi of the 6th, 7th and more orders. such a study of bronchial lung cancer is more effective (up to 95-98 percent) in the central forms, with peripheral cancer, lung efficiency is about 60-70 percent, which is also a lot; ultrasound (an effective method for evaluating the spread of the process and taking a biopsy); blood test for cancer markers; transthoracic biopsy (puncture of the chest, sample of the sample directly from the tumor and examination of the material under a microscope).

With negative results of bronchoscopy with biopsy, transthoracic puncture can confirm the diagnosis in 76-88% of patients with peripheral localization of tumors. Transthoracic biopsy can cause complications in the form of pneumothorax - penetration of air into the pleural cavity - in 3-5% of cases; Mediastinoscopy is an operative endoscopic procedure that is performed for the study of parapracheal, rectum and bifurcation lymph nodes. conducted under intubation anesthesia under the operating conditions, can confirm the diagnosis in a significant number of patients (62-87% of cases, depending on the localization of the tumor). If the totality of the performed research does not allow to completely eliminate lung cancer, then it is quite justified the implementation of diagnostic videotoracoscopy as the final stage of the search. This is an operative endoscopic study performed for the study of peripheral neoplasms, diffuse lesion of the lungs, mediastinal lymph nodes, is performed under mechanical ventilation with one-pulmonary ventilation under operating conditions; the operation is shown in some cases where the diagnosis can not be established by the above methods and can not be eliminated lung cancer .. Most often (8-12%) the planned operation ends with diagnostic thoracotomy through the detection of non-resection of the tumor; cytological study of sputum); pleural puncture (thoracentesis).

Determining the prevalence of lung cancer is the most important diagnostic task that is solved at all stages of the diagnosis, ranging from physical examination of the patient. The use of modern methods (bronchoscopy, ultrasound, CT, MRI, radionuclide studies, PET), which allows choosing the optimal therapeutic gaectic in the vast majority of patients. The surgical intervention is divided into: radical, conditionally radical, and palliative. In a radical operation, the entire tumor complex is exposed: the primary cell, the regional lymph nodes, the fiber with the pathways of metastasis. Due to the availability of modern electrosurgery technology, bioclay technology, dual-light intubation tubes, plasma scalpels, disposable cross-linking devices, suture material, modern 12 bedside intensive care units, we carry out bronchopulmonary operations, which allow saving most of the lungs without worsening survival and avoiding patient disability. Radiation and drug therapy are added to the conditional-radical operation. It should also be taken into account that part of the primary tumor tissue and metastases can sometimes not be surgically removed due to the threat of bleeding or decomposition processes in atelectasis. Contraindications to a radical operation are: inoperability - the spread of tumor to adjacent tissues and organs, inappropriate because of distant metastases in the liver, bone and brain, insufficiency of the functions of the cardiovascular and respiratory systems, severe diseases of the internal organs. Surgical removal of the tumor is often accompanied by extensive removal of the root, tracheobronchial lymph nodes, fiber and lymph nodes of the mediastinum, resection of the chest wall, pericardium, diaphragm, bifurcation of the trachea, atrium, major vessels (aorta, upper vena cava), muscular wall of the esophagus and other tissues sprouted tumor. Proneuma treatment of lung cancer is carried out in inoperable forms, in case of refusal of the patient from operative treatment, and also presence of serious contraindications to operative intervention. The greatest effect is observed with the influence of radiation on the squamous cell and non-differentiated

forms of lung cancer. Projective intervention is used for both radical and palliative treatment. In radical radiation therapy, both the tumor itself and the regional metastasis, ie, mediastinum, with a total dose of 60-70 Gy, are exposed to irradiation. On the basis of the Kirovohrad Regional Oncology Center the Ukrainian Center for Volume Therapy was opened, which is the only one in Ukraine for radiation treatment and diagnostics of cancer patients. The diagnostic department is represented by the following equipment: 16 slice computer tomograph, 1,5 Ms (tesla) magnetic resonance imaging, ultrasound apparatus. The treatment room is equipped with two devices. System of tomotherapy with computer tomography and modern linear accelerator of firm "Elekta".

With non-small cell lung cancer, chemotherapy is performed in the presence of contraindications for surgical and radiotherapy. In this case, the following drugs are prescribed: doxorubicin, cisplatin, vincristine, etoposide, cyclophosphamide, methotrexate, bleomycin, nitrosylurea, vinorelbine, paclitaxel, docetaxel, gemcetabine, etc., used in courses, at intervals of 3-4 weeks (up to 6 courses). This allows you to increase the average life expectancy and improve its quality.

Palliative treatment of lung cancer is used when antitumor treatment options are limited or exhausted. Such treatment is aimed at improving the quality of life of incurable patients and includes: anesthesia, psychological help, detoxification, palliative surgical intervention (tracheostomy, gastrostomy, enterodynia, nephrostomy, etc.) . Palative care for lung cancer is used to combat shortness of breath, cough, hemoptysis, pain sensations. The treatment is attached to the tumor process of pneumonia and pneumonitis, which occurs in radiation and chemotherapy. In Kirovograd Oblast Oncology Dispensary for the first time in Ukraine a rehabilitation department was established, equipped with modern instruments and exercise equipment, there are rooms for aromatherapy and relaxation. His staff includes psychologists, physicians - rehabilitants, allowing patients to quickly return to the usual way of life. To reduce the risk of such a formidable disease, you must adhere to the following rules of conduct: 1. Getting rid of bad habits (active and passive smoking, alcoholism, drug addiction that reduces immunity) .2. Weight control. Obesity in several times increases the likelihood of developing lung cancer. From the diet should exclude products with fast carbohydrates - pastry from wheat flour, sweets, carbonated drinks, fast food, etc. 3. Reducing contact with harmful substances. Asbestos, petroleum products, rhodonium, a pair of heavy metals, chemicals - strong carcinogens. People who are in contact with these substances should use personal protective equipment, masks and respirators, which will help protect the respiratory system. Thanks to the efforts of the people's deputy of Ukraine Yarinich KV in Kropivnitsky developed and adopted a program to combat the influence on the body of the rhodonum 4. Regular ventilation of the room.

Without regular thorough ventilation, pathogenic microorganisms accumulate in the room, which enter the lungs and cause various inflammatory processes that can serve as a trigger for the development of malignant neoplasms.5. More to move. The sedative way of life provokes the appearance of stagnation in the lungs, which can also be the cause of cancer. To maintain health, every 30-40 minutes walk in a moderate pace - it will help improve blood circulation, strengthen immunity, lower insulin levels. 6. Timely treatment of lung diseases. Regular prospection, roentgenography of lungs every two years. Any chronic inflammatory process can be the cause of the formation of malignant tumors. In these cases, radiography is performed three times a year.

Remember, cancer is not a verdict that we will overcome with our joint efforts.

Tel./fax:+38 0522-22-28-82

E-mail: doc.skorodumov@gmail.com

Address: 25011, Kropivnitsky, street. Yalta, 1.

Honored Doctor of Ukraine,

Head of the Thoraco Abdominal

Department of the Kirovograd Regional Oncology Center, Regional Oncology Surgeon

Skordumov Yuriy Alekseevich

- Мам, а ведь док­тор де­ла­ет че­ло­ве­ку боль­но? - Да, сы­на, ра­бо­та у него та­кая.

- А ему мож­но в от­вет сде­лать боль­но?

- Ко­неч­но, нет.

- Мам, я хо­чу быть док­то­ром.

****

При­хо­дит муж­чи­на к вра­чу. У му­жи­ка в ухе ба­нан, с но­су огу­рец, а в зад­ни­це ба­тон. Му­жик го­во­рит:

- Док­тор, я се­бя пло­хо чув­ствую.

Док­тор осмот­рел его...

- ...так вы непра­виль­но пи­та­е­тесь!

****

- Док­тор, что со мной?! Каж­дое утро, ко­гда я смот­рю в зер­ка­ло, ме­ня под­таш­ни­ва­ет.

- Не знаю, го­луб­чик…

Но зре­ние у вас, по­хо­же, нор­маль­ное.

****

Фра­за док­то­ра: «До сва­дьбы за­жи­вет» — силь­но уди­ви­ла 97-лет­не­го ста­ри­ка, но при этом за­жгла блеск в его гла­зах.

****

— Ну что, шку­ру свою спа­сать при­бе­жал? — При­бе­жал, гос­по­дин дер­ма­то­лог...

****

- Я ре­ко­мен­дую ва­ше­му му­жу по­кой и ти­ши­ну, - го­во­рит врач мо­ло­дой да­ме, - вот ре­цепт на сно­твор­ное.

- И ко­гда он дол­жен его при­ни­мать?

- О, нет! Эти таб­лет­ки - для вас.

**** Ги­не­ко­ло­га очень лег­ко рас­по­знать сре­ди дру­гих вра­чей.

У него ча­сы за­стёг­ну­ты на уровне лок­тя.

****

— Док­тор, а та­поч­ки в боль­ни­цу брать?

— А ка­ко­го они у вас цве­та? …

****

Неко­то­рые хи­рур­ги не на­де­ва­ют пер­чат­ки на опе­ра­цию, по­то­му что «ощу­ще­ния не те».

****

У оф­таль­мо­ло­га:

— Ка­кую я бук­ву по­ка­зы­ваю?

— А где Вы?!

*****

Го­во­рят что вра­чей не нуж­но стес­нять­ся.Мол,они без­по­лые..Про­сто они не ви­де­ли на­шу дан­тист­ку с 5-м раз­ме­ром...

На­ги­ба­ясь над па­ци­ен­том,она да­же не про­сит его рас­крыть рот.

****

— Док­тор, ска­жи­те, у ме­ня грипп?!

— Да!

— Сви­ной?

— Да!

-Вы уве­ре­ны?!

-Аб­со­лют­но!

Толь­ко сви­нья мог­ла вы­звать "ско­рую" в 4 утра с тем­пе­ра­ту­рой 36, 7!

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Са­мый страш­ный мо­мент в жиз­ни па­ци­ен­та, ко­гда врач на­чи­на­ет гуг­лить в ин­тер­не­те.

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