Lung Cancer Symptoms


Lung cancer is increasing. About the annual death rate from lung cancer per 100,000 is 40. Among all cancers, lung cancer mortality has been occupying the front rank.

Pathogenesis-smoking and other carcinogenic agents

More than 80% of lung cancer related to smoking içilmesiyle. Death rate from cancer increases with increasing number of cigarettes smoked.

Working in mines and other industrial areas of lung cancer than has been observed. Working in uranium mines and the remainder under the influence of inhalation of asbestos lung cancer are more than other professions. Especially living in the lower floors of houses may develop lung cancer, radon gas inhalasyonuyla. Radon is a radioactive element from toprakdan.

Years of age has a significant impact in the occurrence of lung cancer. After 40 years of age and 60-70 years of age is increasing gradually increases to the highest levels.

Some shimmy substances, infections, immunological and hormonal changes have the effect of the development of lung cancer. Examination of a model system in animals and humans do, or progress in immunosuppressive drugs in cancer prevention and regression of cancer in the occurrence of some carcinogenic substances do immunosuppression supports the importance of immunological factors. Lung cancer is becoming increasingly important in the relationship between some genetic problems.

Pathology and classification

More than 90% of lung cancer develops in bronchial epithelium.

Bronchial cancer radiograph can be seen to be a part of a mass-size long does it take 9 months. There is a part of this mass of 1 billion cells, it is divided into two to 30 times a cancer cell must break and twice the duration of 3-4 months. Aggregates must be a visible part of the cancer mass radiography. Until you reach this size by approximately 50% of blood and lymph vessels invaded by cancer metastases develop. This improvement in disease-related symptoms in 20% of cases but can be monitored. In some cases the size of cancer can be diagnosed in the film may take up to 30 years to reach the last period.

There are four major types of lung cancer:
1. Small cell carcinoma, 2 Adenocarcinoma, 3 Epidermoid carcinoma, 4 Large cell carcinoma. Covers 95% of all cancers in this 4-bronchial cancers.

1. Small cell anaplastic carcinoma (25%). This mmörün vascular infiltration, hilar and mediastinal intensive because of the progress and characteristics of patients with early hematogenous spread of the five year survival rate is less than 1%. Cells are small, heavily-in-one are found. Sarcoma or lymphoma cells in the small spindle-like (fusiform), polygons (polygonal), oats (lymphocyte-like), and so shaped. Andiferansiyedir These cells, the tissue cells and separated from each other is difficult. Non içilmesiyle has close relationships.

2. Epidermoid carcinoma (25%). Squamous cell carcinoma is also known as. Early diagnosis, indication for resection, and five-year survival was better than the other 3 major groups such as the low probability of distant metastases. The tumor usually develops and hilusa bronşlarından lobe segment and moving toward, 10-15% of cases of central necrosis (kovuklaşma) are observed. Local and neighboring lenfbezlerine infiltration is common. Keratinized squamous cells in the tissue cells are divided into specific, diferansiyedir, easily recognized. Non epidormoid is an important factor in the occurrence of cancer.

3. Adenocarcinoma (30%). These tumors have developed under the mucous sputum, bronchial lavage, bronchial brushing and bronchial biopsy diagnosis is not successful. Adenocarcinoma 3 / 4 found ü lung periphery. This creates an appearance of the tumor glandular cuboidal and cylindrical cells.

Female lung cancer, adenocarcinoma of the most görülenidir. Seen in smokers and nonsmokers.

4. Large cell carcinoma (i% 5). Tumor cells are large cells of the tissue do not show a specific separation. In other words, undifferentiated (anaplastic) tractor. Sinanimdir undifferentiated and anaplastic. Large-cell tumors, cell structure, primarily the formation of the second degree, or small bronchi, the nature of the spread is usually similar to adenocarcinoma. Smoking has close relationships with.

Another classification of lung cancers are divided into two.
1. Small cell lung cancers and
2. Non-small cell lung cancers. In this group, adeno carcinoma, squamous cell carcinoma and large cell cancers and the treatment periods are common similarities.

Primary tumor size and spread of cancer properties (T), regional lymph node (N) and distant metastasis (M) are evaluated according to

T-primary cancer

TX of cancer cells was seen in sputum, bronchoscopy and radiography, but unseen
TO No evidence of cancer
Collective bargaining in situ cancer
Tl cancer less than 3 sm, do not spread civara
Part of T2 cancer greater than 3, or whatever the size of the spread of the visceral pleura, atelectasis and pneumonitis hilusa has advanced cancer karenadan remote part of at least 2
T3 chest wall, mediastinum or perikarda diyafrağmaya and spread
T4 cancer, mediastinum, or heart, large arteries, trachea, esophagus or karenaya dissemination or malignant pleural effusion.

N lymph nodes (nodıarı)
NO No regional lymph node spread
NI Peribronş lymph nodes or the same side (ipsilateral) lymph nodes metastasis, or spread
Subkarena ipsilateral mediastinal lymph nodes N2 and N3, contralateral mediastinal lymph nodes metastasis in lymph nodes, contralateral lymph nodes of hi s,
ipsilateral or contralateral scalene or supraclavicular lymph nodes

M distant metastasis
MO No distant metastasis
Ml have distant metastases, determination of the place.

Three terms in the occurrence of lung cancer observed. Premalignan period in the first period. Fact that this period is months or years, is characterized by sputum cell atypia and may be reversible. Preclinical period in the second period, the development takes months or years, one or more known methods of cancer diagnosis until the cancer cells may occur and advances. The third period, clinical symptoms are diagnosed with cancer.

Diagnosis of Lung Cancer

Show the slowest growth over the other epidermoid cancers and distant, hematogenous metastastaz most scarce. However, small-cell cancers than others and need to show very rapid growth in both lenfojen way too early hematogenous metastases. Metastatic small cell cancer are diagnosed when 90% of cases. Cancer mass is greater than 1 part of 7.5 years for the last time, epidermoid carcinomas, small cell carcinoma 2.5 years.

Adenocarcinoma and large cell carcinoma and metastatic properties of growth rate among squamous and small cell carcinoma. The tumor is larger than 3 sm or approaching death. Epidermoid cancer is more chance to appear with bronchoscopy. This cancer is cough, hemoptysis good chance of being diagnosed with such symptoms, or sputum cytology is more than the others. The disease duration of symptoms associated with cancer cell type. For example, the diagnosis of squamous cell cancer, the disease symptoms started about 6 months ago, small cell cancer, this time 1.5 months.

Besides the clinical symptoms are mild or moderately severe clinical symptoms should pay attention, so early diagnosis easier. Cough, sputum, dyspnea, chest pain, hemoptysis, fatigue, pneumonitis, and lung cancers observed during both the first and the main symptoms of the disease. Lung cancer symptoms are not specific nature. The main symptoms of the disease can be examined in two groups: 1 Pulmonary symptoms, 2 Extrapulmonary symptoms.

1 - Pulmonary symptoms

Cough and phlegm often the first symptom of the disease. However, until the first few months benimsenmeyecek negligible. Many of these patients smoked cigarettes öksürüklerini bind and cough are the most before the formation of cancer. In particular the increase in cough, sputum characteristics of continuity and should be aware about it. There is little or sputum, bloody sputum, but should pay attention to come. Indicated a complication of purulent sputum is the cancer infection.

Hemoptysis is an important symptom of bronchial cancer, the disease is progressing very time shows. Hemoptysis of bronchial vessels in bronchial mucosa of cancer is dependent on or related to ü1serasyonla. Hemoptysis is seen in squamous cell carcinomas dahasık others. Bronchial cancer is approximately 50% of hemoptysis.

Close to half of the observed number of cases of chest pain. Chest pain is often blunt, is intermittent, the side of the tumor, unilateral. The pain a few minutes, sometimes it takes saatlarce. Parietal pleura in patients with severe and persistent pain should consider metastasis. Pancoast tumors in the lung apex consists of shoulder pain. Another cause of shoulder pain may be tumor invading the diaphragm, the diaphragm is the phrenic nerve in the central part of iritasyonıı

related. Pancoast or superior sulcus tumors localized in the apical region of the lung is called tömörü. The apical region of thoracic cancer, a serious and often permanent shoulder, following the nerve path, there is a pain in the arm spread. Pancoast, Homer signs of cancer is monitored frequently. Homer fallen upper eyelid syndrome (pitosis), narrowed the gap between the eyelids, pupil became smaller (myosis), eye round collapsed in (enoftalmus), and that party is the lack of sweat on his face. These symptoms are associated with tumor infiltration of pressure and sympathetic nerve. Radiograph of the upper ribs, vertebrae and posterior parts of the damage seen. Pancoast most epidermoid cancer cell type.

Bronchial pneumonia is a common complication of cancer. Antibiotic therapy may improve in a certain way or completely. A significant proportion of cases, the recovery is slow and the symptoms of the disease is not lost, however, is reduced. Chills and fever pneumonia with recurrent bronchial obstruction has many times. Particular, have delayed recovery in patients with pneumonia in the past 40 years of age should follow carefully. This delay may cause lung cancer. Tumor cells in sputum and bronchoscopy should be sought. In this case investigations aydınlanmamışsa lung biyosisi or other diagnostic methods should be applied.

Bronchus cancer is caused by obstruction of lung abscess. This is common in abscesses, necrosis and cavity formation. For suspecting the diagnosis of bronchial cancer treatment in the face of a stubborn abcess should make use of all facilities: the tumor cell must be sought in the sputum, bronchoscopy should be done. The result of this investigation is not received repeated. If necessary, other methods should be applied.

Approximately half of the first stages of the disease are dyspnea, dyspnea of lung cancers. Dyspnea emphysema, congestive heart failure, tracheal tumor progression, associated with a pneumonia, pleural effusion, atelectasis, or may be related to bronchopulmonary infection. Bronchial cancer is common in chronic lung diseases, especially chronic obstructive pulmonary disease. These diseases are caused by smoking such as cancer, by the same reasons.

Asthma symptoms are caused by narrowing of the bronchus tumor sibilan, ranflan hear crackles and wheezing in asthma patients with symptoms similar to his chest. However, these symptoms are local cancer wheezing (wheezing), and stridor niteliğindedir expiration heard much inspiration. Abnormalities, especially in this type of hilar tumors or tracheal tumors are rarely observed.

Note: cough, sputum, dyspnea, chest pain, weakness, fatigue and pneumonia-pneumonitis lung cancers observed during both the first and the main symptoms of the disease.

2 - extrapulmonary symptoms, Symptoms of Lung Cancer

Neurological symptoms of bronchial cancers without metastasis consists of some neuropathies. This is to identify the symptoms of "carcinomatous neuropathy" is used in the statement. Serious and persistent paresthesia of the extremities carcinomatous peripheral neuropathy, a significant decrease in pain and there is a sense of touch. However, Kasdan is weakness and atrophy. Kortikoserebeller carcinomatous degeneration consists of vertigo and ataxia, mental disorders are often found together. Patients with acute onset of symptoms within a few weeks of this nature and enter the period of difficulty in walking and standing. Observed signs of carcinomatous myopathies polimyosit; myasteni'yi kuşkulandıracak nature of these symptoms. Pelvic muscle strength in particular, reduction or loss of deep tendon reflexes and peripheral paresthesia is monitored. Nöromyopati incidence of small cell carcinoma more frequently observed. LO% of all bronchial cancer nöromyopati stop.

Bronchial carcinoma and hypertrophic pulmonary osteoarthropathy Drum Comag finger drum Comag 20% of the finger (clubbing) occurs. Hipertrafik clubbing and pulmonary osteoarthropathy is most-squamous cancer. In particular the long bones of the extremities of the distal parts of the symmetrical proliferation of bone, osteitis and subperiosteal have chronic joint pain related to exams.

Thrombophlebitis Thrombophlebitis consists of upper and lower extremities and other organs, sometimes the tumor before symptoms appear. Killer Repeater and nature of migration and do not respond to anticoagulation therapy in patients with bronchial cancer kuşkulanmalıdır thrombophlebitis.

Hypercalcemia in epidermoid cancer and other cancers, followed the classic symptoms of hypercalcemia anorexia, nausea, drowsiness, constipation, polyuria and polydipsia.

Ectopic ACTH syndrome, especially in small-cell cancers are observed. Various clinical and metabolic symptoms, or 50% of the cases are typical Cushingoid syndrome. The main symptoms of this syndrome, skin lines, pigmentation, obesity and osteoporosis. Hypokalemia, glucose tolerance impairment and hypertension may also occur.

Ectopic ADH syndrome many times in this syndrome of antidiuretic hormone in small cell carcinoma is a matter which relates to the proximity. Loss of appetite, nausea, vomiting, drowsiness and symptoms of hyponatremia disease.

Carcinoid syndrome This syndrome usually occurs serotonin secretion of digestive system tumors associated with karsionoid. Carcinoid syndrome in bronchial cancer are observed. In this syndrome, multiple blood supply of the face (flashing), diarrhea, asthmatic breathing (wheezing), right in your heart endocardial changes, there are signs of pulmonary stenosis and tricuspid valves.

Hematologic cancers, blood disorders, bronchial disorders, particularly anemia occurs. Anemia is associated with metastasis can develop even without such metastasis. Another factor in the occurrence of secondary infection, anemia related cancers. Bronchial cancer is increased sedimentation rate too.

3 - Symptoms of Metastasis

Continuous and penetrating chest pain (piercing), chest pain related to the spread of the tumor parietal pleura. Pleural metastases are severe pain, narcotics requires. Tumors of the brachial plexus superior suIkus enfiltre shoulder and arm so many times that the constant pain, arm weakness, and Homer's syndrome consists of symptoms. This is frequently observed in tumors of bone destruction.

Pleural fluid, pleural fluid nature oluşunca stinging chest pain passes. Pleural fluid, bronchial cancer metastases are common. For metastasis is an important symptom of the liquid immediately after Toransentezden. Bronchial cancer prognosis is worse in the pleural fluid. Fluid in the periphery of the tumor in the pleura or penetration of the tumor to be associated with pleural metastasis. Pleural metastases often bloody fluid. Liquid histopathological, biochemical, bacteriological and enzyme studies are provided with a differential diagnosis. 40 Age of bloody pleural effusion in a patient many times in the past indicated a tumor is malignant.

Superior vena cava syndrome, or metastasis of cancer by growing pressure to do deals with superior vena cava. This print collateral circulation and the expansion of the chest caused by superficial VENIERI olur.Bu patients face, neck and chest, edema and chest consists of skins, faces red (pletorik) an appearance. Increased venous pressure in the upper half of the body of headache, dizziness and feeling of suffocation occurs.

Symptoms of brachial plexus upper sulcus tumors invading the brachial plexus, and bone erosion they cause. The side of the tumor decreased upper extremity strength, atrophy, paresthesia, temperature change, and Homer syndrome.

Cervical or axillary lymph nodes metastasis in lung cancer cells to lymph bezier do. If such a finding is made ​​ganglion removed and histopathological examination. Hilar and mediastinal lymph nodes metastasis in lung cancer is often observed.

Central nervous system metastasis quite sıkdır, the most common brain tumors in the brain metastazlandır bronchial cancer. Small cell carcinoma brain metastasis is monitored more frequently. signs of intracranial metastases: hemiplegia, convulsions, personality changes, speech disorders, cerebellar disorders, severe headache, monoparalizi, isolated cranial nerve signs, or coma.

Generally, the left recurrent laryngeal nerve invasion of hoarseness associated with lung tumor. These complications in the clearance of tumor by the narrowing of the larynx and related dyspnea, stridor and inspiration jugular fossa and supraclavicular retraction distances (circulation), such symptoms may also occur. Primary or metastatic cancer of the larynx in some difficulty in swallowing (dysphagia) and pain may develop.

The above symptoms, benign tumors, acute and chronic laryngitis (eg tuberculosis), payments can be found in the larynx. Differential diagnosis should consider these diseases. Afon psikonevrozlarda hoarseness and chronic obstructive lung diseases such as bronchial asthma or monitored.

Difficulty swallowing (dysphagia), tumor invasion of mediastinum, and in particular relates to the esophagus pressure and push.
Clinical signs of liver metastasis is rare. However, liver metastases were found at autopsy in 35% of bronchial cancers. In the case of a bronchial cancer, hepatomegaly, suggesting the possibility of metastasis.
Bone metastasis sıkdır quite. Bone pain can be the first indication of bronchial cancer. Bone metastasis of many cancers is the most.
Bronchial ECG changes, such as heart arrhythmia can lead to cancer progression directly perikarda.

Physical examination

In some cases, local symptoms of bronchial obstruction is monitored, for example, the segment or lobe of the lung sounds are very light. Reinforces this belief and ronflan Railer short sibilan İnspiransyonda needed. It is preferable to a region of the lung at the end of the ration sibilan, ronflan Railer (stridor) heard bronchial narrowing doubt-assists. Sometimes the inspiration that the region does not enter the air in the first period but negative intrathoracic pressure occurs, then the air is able to pass the necessary sounds. After breathing on palpation of the region participated in other regions can be monitored. If the finding of a main bronchus tıkanmışsa more specific than the palpation. Atelectasis with bronchial cancer, pleural fluid, and the symptoms of clubbing should be investigated.

Radiological findings

Chest radiography is a useful examination in the diagnosis of cancer. The patient's chest radiograph taken in the past compared with new ones. Especially to escape from hiluslardaki reviewed and some changes in comparison with that of the old radiograph is a missed lesion.

Type of cancer there is always a relationship between radiographic abnormalities. However, many times the central region tumors or small cell cancer, squamous cell cancer. Necrosis of tumor mass (Intracavernous) is probably related to squamous cell cancer. Large mediastinal tumors adenopatisi many times in the periphery of small cell carcinoma, adenocarcinoma or large cell cancer is related izlenir.Akciğer. Apical cancer (Pancoast cancer), squamous cell cancer is monitored more.

Computer tomography (CT) provides a standard radiography and CT appearance of lesions identified. Parenkimasmda CT lung, mediastinum, and other parts of the body shows different densities in a certain way than standard radiography.

IT is used before the discovery of linear tomography, postereo-anterior, lateral or oblique positions taken radyografilerdir different sections. In the axial plane of CT tomography. Thus, taken from top to bottom axial location filimlerle lung cancer, brain, or body to another area mediasten'e metastases evaluated. In some cases, lung skaning'i, angiography, and mediastinoscopy azigografı benefit is provided. All of these inspections, each case is required.

Computer tomography in the diagnosis of lung cancers are more positive results in linear tomography. Mediastinum, nodules, lesions extending beyond the chest look better and more meaningful.
Magnetic resonance imaging (MRI) study of cardiovascular invasion of cancer, especially useful in evaluating other radiographic method. Thus, angiography is a type of investigation is done.
Almost all lung diseases, lung cancer can look similar to the radiological and being seen may be available at any radiological abnormality.

Around the isolated pulmonary nodule (coin lesion-lesion of the money) this isolated lesions of the limit of the money is not exactly certain. Granulomatous lesions of the money is less than most of the diameter of the second part. Money should be evaluated with CT lesions. These lesions are not calcified than once. Rare lesions as a notch (göbekleşme) are seen. Money sometimes Intracavernous lesions (cavity) are seen. Neoplastic cavities are found in the vicinity of the lesion center, too. The thick walls of cavities and nodüllüdür. Despite these features, for example kovuklarından tuberculosis infection neoplasma kovuklarını kovuklarından often difficult to distinguish.

Money is related to calcification of benign lesions is not authentic because of suspected lung cancer require surgical intervention. Resection of the money that 40% of malignant lesions, granulomatous, and the remaining 40% of benign tumors was 20%. To compare the patient's former radyografıleriyle new money would be very useful in assessing lesion. For this reason, care must keep radiographs taken. Currency compared to the previous filimle lesion has grown izlenmişse surgery indication. Money cytological examination of sputum or bronchoscopic lesions are not usually helpful in diagnosis. Non-malignant and malignant lesions of money separating the major symptoms:

1 - radiograph taken two years or more before a change in the size of the lesion is benign or it can be decided. Such an observation taken at least every six months should be monitored radiographically.
2 - Selina type of calcification found: the target board as in the middle or typical concentric calcification, such as corn or popcorn.
3 - whether the primary cancer should be investigated thoroughly. If such a finding is considered to be metastatic lung nodule.
4 - The above criterion in three or more than 40 of the lesion should be removed and the patient's age.

The radiological appearance of primary lung tumors

1. The bronchi of developing lung cancer can easily be confused hastalıklarınkiyle other radiographic signs. Although some symptoms such help in this regard. For example, the tumor formed "pneumonic infiltration" region, concentrated in an air-filled bronchi (air bronchogram), not seen. However, air bronchogram sign of bacterial pneumonia is almost always followed infiltrasyonlarında. The reason for this of endobronchial tumors, proximal bronchus and distal bronchi clogged air is resorbed.

2. Epidermoid cancers develop in the central regions, about 70% of perihilar. These lesions are not specific perihilar strüktürlerle mixed environments. Therefore, escape review. Tumor-related changes are considered better than the old fılimlerle hilusda compared. Cuticle-moid cancers are found in more upper lobes and primary lung tumors seen in kovuklaşmanın max.

3. Correspond to the localization of central epidermoid cancers of the lung periphery is about 70% of adenocarcinoma-sinomların. Fibrous reaction is quite good because the borders of adenocarcinomas is indefinite. These tumors are smaller than cancers epidormoid radiograph when they were diagnosed.

4. Small cell anaplastic tumors (oat cell carcinoma) is a large concentration unilateral nature of the perihilar regions and many times seen in the ipsilateral (same direction) has a specific pleurisy. Great views, very time-intensive "unilateral lymphomas" and many times similar to the periphery of the tumor interstitial infile Paren-Kima-trasyonlar monitored as a result of blockage of lymphatics. Mediastinal invasion of lung cancer often associated with small cell cancer.

5. Terminal bronkiyoler carcinoma (alveolar cell carcinoma cell or bronkiyoler) the concentration of bilateral primary lung tumors only. Concentration of these tumors are bilateral in 50%. When the tumor is first diagnosed, and usually many times the mass of an isolated mass is atelek-Tazi. Approximately 20% of infiltration of these tumors are similar to bacterial pneumonia. This is a symptom that defines types of neoplastic infiltration "lobe enlargement" is. Especially in the lateral radiograph sissürlerin changed the shape and lobe expansion is defined. Lobe ex-pension Klebsiella pneumonia and pneumonia-nekrozlaşma youth of some of the observed. However, infectious pneumonia clinic ekspansiyon'lu lobe tumor confused shows the privilege.
Consolidation (volume of a lung lobe or segment unabated homogeneous condensation) is a very rare finding in primary lung tumors. Terminal bronkiyoler infiltration in carcinomas similar to consolidation.

6. Bronchial adenoma with primary lung cancer may resemble the signs and komplikasyonlarıyle, and sometimes become aggressive and can metastasize. There is always a view that these specific radiological. Adenomalarının bronchus approximately 1 / 3 of perihilar shows a concentration. Bronkografınin share of bronchoscopy in diagnosis and importance.

There is a special radiographic appearance 7.Büyük cell anaplastic lung cancer. However, this is a very large perihilar tömörlerde observed a tendency of the lesion. Cases, 2 / 3 thirds of the tumor diameter is more than 4 sm.

8. Upper apical sulcus or Pancoast tumors strüktürle mixed reviews for the escape easily. Lordosis films, computer tomography, radiographic differentiation of the ribs and vertebrae are more chances of diagnosis increases. Posterior segments of the dorsal vertebrae, ribs and destruction of these tumors are common. Pleural lesions and progressive bone destruction adjacent tissues, the symptoms of Horner's syndrome, the symptoms are the brachialplexus. Pancoast tumors are sometimes very difficult to diagnose whether the bone damage. Asymmetric apical pleural thickening kuşkulandırmalıdır Pancoast'ı. Most Pancoast tumors are squamous cell cancer.

9. Malignant pleural mesothelioma is almost always are epanşmanı. However, benign fibrous mesothelioma pleura many times and began to advance beyond the chest wall remain unilateral direction. Quite frequently observed signs of malignant mesothelioma asbestosis. In these cases, calcification of the pleura and pericardium are intizamsız rough. Pleural calcifications are rather close to the diaphragm.

10. Alone or associated with other signs of atelectasis is an important finding for squamous cell cancer. Atelectasis in the Bronchi adenomalarında can be monitored.

11. Sometimes in cases of primary lung tumors observed in hypertrophic pulmonary osteoarthropathy. This is an interesting non-cancer diseases such as bone and joint lesions found in cases of arthritis. Bone and joint pain to complain of ill osteortropati Pulnoner hypertrophic arthritis, and many times are treated as cases. Diaphyseal periosteal new bone consists of the ends of long bones of these patients.

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