Benign Tumors
Only 5% of all primary lung tumors are benign tumors. Half of benign tumors include bronchial adenoma.
Bronchial Adenoma
Lung cancer occurs earlier than the age (30-40 years).
Pathology
Bronchial glands, mucosa, or epitelyumlarından thrive. Adenoma in approximately 80% of the cases are found in the bronchi. These tumors are partially or completely clog bronchus. Complete blockage occurs when the relevant lobe atelectasis. In some cases, bronchial mucosa in lung tumor development in the right shows parenki-Masina. Bronchial adenoma and normal tissues show a growth of local lung parenkimasına to repel etmeyip devastated. These tumors are very rare in advanced disease, lymph nodes and metastasize to other organs.
Bronchial adenomalarının two major pathological types: (1) carcinoid type (2) Silindroma type.
Adenomalarının covers 90% of all bronchial carcinoid type. Silindroma type is 7%. Mucoepidermoid bronchial adenoma and confused the remaining 3% of the tumors. Adenomalannda bronchial tumor cell growth are similar to each other all the best diferansiye'dir nature.
This type of bronchial adenoma of carcinoid type Carcinoid tumors of the gastrointestinal tract is similar. Tumor cells are small, equal in size. Glandular arrangement of cells shows a pattern. The tumor stroma is a rich vascular structure. Sometimes increases, and the tumor vascular structure very similar to hemanjioma'ya. Because of the richness of vascular network hemoptysis is common in carcinoid tumors.
Carcinoid bronchial adenoma as a rare "carcinoid syndrome"
cause. This fast-growing tumors by sendrom'u, invasive nature and tend to spread hematogenously. External secretion of serotonin in carcinoid syndrome develop tumors has increased. This increase in hypotension, facial syanotik kızarmaları (flashing), dyspnea (bronchospasm), and causes diarrhea.
Trachea and major bronchi bronchial adenoma type Silindroma thrive in this kind. After the re-development is likely to be surgically removed. These are malignant and invade more tweaking nature of carcinoid type. Histologically, the acinar growth in the show.
Clinical symptoms
Bronchial adenomas grow slowly for years show no clinical symptoms. Tumor diagnosed with the disease several times due to a secondary infection or hemoptysis, the clinical, radiographic and bronchoscopic examination regains clarity. These tumors are rich in vascular tissue and bronchoscopy should be done cautiously. More than half of all cases of hemoptysis vardır.Hastaların other complaints of cough, sputum, fever, chest wheezing and chest ağnsıdır. Physical examination findings vary according to the localization of the disease. Regional dullness, decreased breath sounds, wet and dry Railer, similar to those seen with other clinical manifestations of bronchial cancer.
Radiological findings
Small tumors do not radiographic signs. The tumor grows, more likely seen. 80% of these tumors or a large segment of bronchial obstruction was showing bronşlarında full at a time when growth is occurring. During this period there are radiological findings of atelectasis and obstructive pnömonitisin. Repetitive nature of the distal segments of occluded the development of pneumonia, bronchial infections and bronchiectasis occurs.
Progressive bronchial obstruction has not done a full cavity, bronchial adenoma (adenoma central) radiograph around the well-defined, sometimes sliced, appear as soft tissue concentration. Computer tomography shows the tumor better. If necessary, regional and morphological features of the bronkografıyle adenomamn better determined.
Treatment
Surgery is the treatment of bronchial adenomasmın. The most commonly performed surgery lobectomy. Usually these tumors are not sensitive to radiation therapy. However, radiation therapy, surgical intervention should be attempted in cases not possible. Chemotherapy showed no particular success.
Showing posts with label Lung Cancer / Lung Tumor. Show all posts
Showing posts with label Lung Cancer / Lung Tumor. Show all posts
Hodgkin's Disease
What is Hodgkin's Disease
Lymphoid tissue lymphomas, Hodgkin's disease in the group increasingly characterized by enlargement and lymphadenopathy. Malignant lymphomas close resemblance to each other over a third of lymphomas include gösterirler.Hodgkin disease. 20-40 years of age the disease most görülür.Yılda 2/100.000 death ratio is.
Hodgkin's disease, the cause is unknown. Neoplastic in origin, however, is considered more likely.
Pathology
Lymph nodes are not given initially, the disease is spread around and proceed is combined with a specific shape. Lymph nodes are not hard too many times. However, the rapidly growing connective tissue and glands of enfıltre gerginleşir and solidify. Known appearance of the giant Reed-Sternberg cells of Hodgkin's reticular origin. The normal structure of the capsule of the gland was destroyed and the disease has been enfıltre. So many times, and increased fibrous tissue necrosis developed.
Decreases, and Reed-Sternberg cells in lymphocyte develop widespread fibrosis increases. In the cases of nodular sclerosis cases of lymphocytes and the average survival time, less lymphocytes in the cases and cases of diffuse fibrosis is longer.
Clinical symptoms
For the first time in an area (usually cervical) lymph gland, months or years and then monitored adenopathy in other regions. After spreading to other regions before the regions are adjacent. Supraclavicular, axillary, inguinal, brachial or femoral gland growth is monitored. Mediastinal gland enlargement is common. Hodge-hatred in the majority of patients with intrathoracic spread monitored. Parenkimasında other lung infiltration in mediastinal lymph nodes, metastatic-like nodules develop. The main symptoms of expansion of intrathoracic cough, dyspnea, stridor, pain, superior vena cava, especially syanoz and swallowing difficulties due to infiltration.
In most cases there is splenomegaly. Hepatomegaly is common.
The main symptoms of systemic disease with fever, chills, loss of appetite, fatigue, weight loss and night smells his sweat. Fire as a moderate increase at 40 ° C or more. Fire intizamsız or may be at the same level. In some cases, different time periods of fever, followed by periods of fever (Pel-Ebstein type fire). Hodgkin's disease, especially pulmonary and retroperitoneal fire very boring. Anemia develops in the later stages of the disease. And weakness, dyspnea and solukluğa causes an increase in symptoms. Infections are frequent and serious. Tuberculosis Hodgkin'i follows like a shadow.
After drinking alcohol, especially in the area of patients with Hodgkin's disease (eg, mediastinum, or bone) is an interesting finding in the development of a pain. This pain can also occur, and 30-60 minutes of taking a small amount of alcohol is served. Hodgkin's disease were treated with X-ray is taken to control the pain disappears içilmesiyle alcohol.
Radiological findings
Hodgkin's disease in 90% of intrathoracic spread sooner or later that is the importance of chest radiographic examination. Intrathoracic Hodgkin's, so once the expansion begins with mediastinal ganglia. Mediastinal lymph nodes in 50% of cases can be viewed at the beginning of the disease have grown. So many times, this growth of bilateral, but asymmetric nature. Para-tracheal bifurcation glands and a higher incidence of bronchopulmonary disease in some cases even up to glands are participating. Anterior mediastinum and retrosternal adenopatisi may be quite common, and sternal enfıltre. This is very visible spread sarcoidosis. Hodgkin'de posterior mediastinal adenopathy is a rare finding. The disease spread to organs komşa esophagus, superior vena cava and may be infiltrated perikard'a.
Lung expansion is usually associated with mediastinal adenopathy. Nature of local and more coarse reticulonodular radiographic changes observed. In some cases, covers an area of invasion of lung lesion, mediastinal gland. Intensive air bronchogram seen. Parankimasının lung lesions may be cavity. These are single or multiple cavities. Radiography of tuberculosis cavities show a different character, but it is many times lower lobes.
Diagnosis and differential diagnosis
Chest radiography and computer tomography in diagnosis has an important place in particular. Histopathologic examination of lymph node biopsy provides definitive diagnosis. Microscopic examination of the early period of the disease may not be summative. For this reason, the biggest one of them if you have more lymph nodes should be biopsied. Greater chance of being older than the older glands. Reed-Sternberg cells of Hodgkin's diagnosis görülmemişse questionable. In some cases, with an interval of several months for the diagnosis of the disease may have two or three biopsy.
Hodgkin's disease, signs of blood in different nature. WBC count decreased, may be normal or increased. So many times, a moderate leukocytosis observed. If done by increasing the separation of leukocyte granulocytes, lymphocytes and mono-tions were reduced tends to increase. 20% of cases, cases for there is eosinophilia. Normochromic anemia is a common finding. Erythrocyte sedimentation rate is usually accelerated. If you have impaired liver function, hepatomegaly than once. If you have increases in serum alkaline phosphatase of bone lesions. Pleural or peritoneal fluid transudate or exudate of type. Central nervous system symptoms of the disease is monitored or received block are interested punction spinal fluid protein increased, and pleositosiz (cell increase) are available.
Hodgkin's disease develop immune abnormalities, for example, there are some cases leukopenia, serum gamma-globulin and the antibody is reduced. And a significant number of patients, for example, tuberculin skin reactions in the late sensitvite reaction is reduced or negative.
The main reasons for example, tumors that enlarge the lymph glands, infeksi-tions (tuberculosis, syphilis, streptococcus, staphylococcus, etc.), sarcoidosis, and take an important place in the differential diagnosis of Hodgkin's disease Lupus Erythematosus. Suspicious cases, biopsy, mediastinoscopy and mediastinal biopsy, lenfanjiyografı, thoracotomy, laparotomy is necessary. Computer axial tomography in diagnosis has an important place.
Treatment
Radiation Therapy Radiation therapy is usually the best treatment of localized Hodgkin's disease. The disease is a common treatment of nature is done in the shimmy. For diagnostic biopsy rather than surgical intervention, and some are special cases. And now with radiation therapy is applied in some cases (adjuvant therapy).
Hodgkin's disease, drug use more than one day of the month provides a better regression. Cytostatic drugs are given together with steroids many times 3. For example, the combined drug cyclophosphamide, vincristine, methotrexate and prednisone can be used as cytostatics. Another combination therapy of nitrogen mustard, vincristine, procarbazine, and prednisone are provided with. Combination drug therapy is 2-3 weeks and a day about 6 cycles are repeated. These periods may vary according to cases.
Prognosis
Hodgkin's disease often show a chronic development. In some cases, despite the rapid progress of the treatment is monitored. The average duration of 3-4 years to live. Usually, only one region in lymphadenopathy, weight loss and fever, increased sedimentation and changes in blood in cases such as the absence of systemic symptoms and survival time is longer and slower development of disease. Prognosis for a careful assessment of history, examination, blood examination, liver function tests, X-ray examination, if necessary, should be lenfanjiyografı. Hodgkin's disease can be classified in four;
l.Hodgkin disease begins before the anatomical region. 2. Over time, the neighboring regions shows deployments. 3. The disease is more common. However, above or below the diaphragm. 4. More advanced stages of disease parenkiması lung, pleura, liver, bone, kidneys, gastrointestinal tract and spreads to other organs. Systemic spread is a chronic cases, survival time in a year.
Lymphoid tissue lymphomas, Hodgkin's disease in the group increasingly characterized by enlargement and lymphadenopathy. Malignant lymphomas close resemblance to each other over a third of lymphomas include gösterirler.Hodgkin disease. 20-40 years of age the disease most görülür.Yılda 2/100.000 death ratio is.
Hodgkin's disease, the cause is unknown. Neoplastic in origin, however, is considered more likely.
Pathology
Lymph nodes are not given initially, the disease is spread around and proceed is combined with a specific shape. Lymph nodes are not hard too many times. However, the rapidly growing connective tissue and glands of enfıltre gerginleşir and solidify. Known appearance of the giant Reed-Sternberg cells of Hodgkin's reticular origin. The normal structure of the capsule of the gland was destroyed and the disease has been enfıltre. So many times, and increased fibrous tissue necrosis developed.
Decreases, and Reed-Sternberg cells in lymphocyte develop widespread fibrosis increases. In the cases of nodular sclerosis cases of lymphocytes and the average survival time, less lymphocytes in the cases and cases of diffuse fibrosis is longer.
Clinical symptoms
For the first time in an area (usually cervical) lymph gland, months or years and then monitored adenopathy in other regions. After spreading to other regions before the regions are adjacent. Supraclavicular, axillary, inguinal, brachial or femoral gland growth is monitored. Mediastinal gland enlargement is common. Hodge-hatred in the majority of patients with intrathoracic spread monitored. Parenkimasında other lung infiltration in mediastinal lymph nodes, metastatic-like nodules develop. The main symptoms of expansion of intrathoracic cough, dyspnea, stridor, pain, superior vena cava, especially syanoz and swallowing difficulties due to infiltration.
In most cases there is splenomegaly. Hepatomegaly is common.
The main symptoms of systemic disease with fever, chills, loss of appetite, fatigue, weight loss and night smells his sweat. Fire as a moderate increase at 40 ° C or more. Fire intizamsız or may be at the same level. In some cases, different time periods of fever, followed by periods of fever (Pel-Ebstein type fire). Hodgkin's disease, especially pulmonary and retroperitoneal fire very boring. Anemia develops in the later stages of the disease. And weakness, dyspnea and solukluğa causes an increase in symptoms. Infections are frequent and serious. Tuberculosis Hodgkin'i follows like a shadow.
After drinking alcohol, especially in the area of patients with Hodgkin's disease (eg, mediastinum, or bone) is an interesting finding in the development of a pain. This pain can also occur, and 30-60 minutes of taking a small amount of alcohol is served. Hodgkin's disease were treated with X-ray is taken to control the pain disappears içilmesiyle alcohol.
Radiological findings
Hodgkin's disease in 90% of intrathoracic spread sooner or later that is the importance of chest radiographic examination. Intrathoracic Hodgkin's, so once the expansion begins with mediastinal ganglia. Mediastinal lymph nodes in 50% of cases can be viewed at the beginning of the disease have grown. So many times, this growth of bilateral, but asymmetric nature. Para-tracheal bifurcation glands and a higher incidence of bronchopulmonary disease in some cases even up to glands are participating. Anterior mediastinum and retrosternal adenopatisi may be quite common, and sternal enfıltre. This is very visible spread sarcoidosis. Hodgkin'de posterior mediastinal adenopathy is a rare finding. The disease spread to organs komşa esophagus, superior vena cava and may be infiltrated perikard'a.
Lung expansion is usually associated with mediastinal adenopathy. Nature of local and more coarse reticulonodular radiographic changes observed. In some cases, covers an area of invasion of lung lesion, mediastinal gland. Intensive air bronchogram seen. Parankimasının lung lesions may be cavity. These are single or multiple cavities. Radiography of tuberculosis cavities show a different character, but it is many times lower lobes.
Diagnosis and differential diagnosis
Chest radiography and computer tomography in diagnosis has an important place in particular. Histopathologic examination of lymph node biopsy provides definitive diagnosis. Microscopic examination of the early period of the disease may not be summative. For this reason, the biggest one of them if you have more lymph nodes should be biopsied. Greater chance of being older than the older glands. Reed-Sternberg cells of Hodgkin's diagnosis görülmemişse questionable. In some cases, with an interval of several months for the diagnosis of the disease may have two or three biopsy.
Hodgkin's disease, signs of blood in different nature. WBC count decreased, may be normal or increased. So many times, a moderate leukocytosis observed. If done by increasing the separation of leukocyte granulocytes, lymphocytes and mono-tions were reduced tends to increase. 20% of cases, cases for there is eosinophilia. Normochromic anemia is a common finding. Erythrocyte sedimentation rate is usually accelerated. If you have impaired liver function, hepatomegaly than once. If you have increases in serum alkaline phosphatase of bone lesions. Pleural or peritoneal fluid transudate or exudate of type. Central nervous system symptoms of the disease is monitored or received block are interested punction spinal fluid protein increased, and pleositosiz (cell increase) are available.
Hodgkin's disease develop immune abnormalities, for example, there are some cases leukopenia, serum gamma-globulin and the antibody is reduced. And a significant number of patients, for example, tuberculin skin reactions in the late sensitvite reaction is reduced or negative.
The main reasons for example, tumors that enlarge the lymph glands, infeksi-tions (tuberculosis, syphilis, streptococcus, staphylococcus, etc.), sarcoidosis, and take an important place in the differential diagnosis of Hodgkin's disease Lupus Erythematosus. Suspicious cases, biopsy, mediastinoscopy and mediastinal biopsy, lenfanjiyografı, thoracotomy, laparotomy is necessary. Computer axial tomography in diagnosis has an important place.
Treatment
Radiation Therapy Radiation therapy is usually the best treatment of localized Hodgkin's disease. The disease is a common treatment of nature is done in the shimmy. For diagnostic biopsy rather than surgical intervention, and some are special cases. And now with radiation therapy is applied in some cases (adjuvant therapy).
Hodgkin's disease, drug use more than one day of the month provides a better regression. Cytostatic drugs are given together with steroids many times 3. For example, the combined drug cyclophosphamide, vincristine, methotrexate and prednisone can be used as cytostatics. Another combination therapy of nitrogen mustard, vincristine, procarbazine, and prednisone are provided with. Combination drug therapy is 2-3 weeks and a day about 6 cycles are repeated. These periods may vary according to cases.
Prognosis
Hodgkin's disease often show a chronic development. In some cases, despite the rapid progress of the treatment is monitored. The average duration of 3-4 years to live. Usually, only one region in lymphadenopathy, weight loss and fever, increased sedimentation and changes in blood in cases such as the absence of systemic symptoms and survival time is longer and slower development of disease. Prognosis for a careful assessment of history, examination, blood examination, liver function tests, X-ray examination, if necessary, should be lenfanjiyografı. Hodgkin's disease can be classified in four;
l.Hodgkin disease begins before the anatomical region. 2. Over time, the neighboring regions shows deployments. 3. The disease is more common. However, above or below the diaphragm. 4. More advanced stages of disease parenkiması lung, pleura, liver, bone, kidneys, gastrointestinal tract and spreads to other organs. Systemic spread is a chronic cases, survival time in a year.
Lung Cancer Chemotherapy Radiotherapy
Indications and contraindications to resection, radiation, and the amount of time, now I study of treatment efficacy and side effects are a lot of lung function tests. Lobectomy or pneumonectomy in lung cancer surgery mainly. Because the disease is progressive and propagation properties are often pneumonectomy. Therefore, pneumonectomy in respiratory function before surgery is appropriate, not evaluated. If ZVK1> 2 L or the value that should be> 80% in the pneumonectomy can be done. ZVK1 <2l zvk1 = "pre"> 800 or> 40% can be applied in the pneumonectomy. If the post for the 800 or 40% will be in the pneumonectomy. In such patients, lobectomy is needed.
Indication for resection in cases with a limited diffusion capacity, and increases the blood tests help to determine the value of P02.
Expiration of air flow and volume in a meaningful and easy to measure the relationship between the evaluation of lung function tests. Ration of maximal expiration flow and volume relationship (MEAV) curves may be beneficial in the study of obstructive and restrictive functional abnormality. In order to implement the treatment of lung cancer resection and maximal expiratory flow measured MEAV curve (V max) and the second is more than 2.5 liters of air flow in the middle of forced vital capacity (V 50) must be more than 1 liter per second. V max and V 50 is reduced in obstructive lung disease. This reduction is proportional to the degree of functional impairment. PA02 and PaC02 for the indication of resection should be measured.
Less than 65 mm Hg for surgical intervention of PA02 and PaC02 of absence must not be more than 45 mm Hg.
Another method for physical ability of the Karnofsky measure provides meaningful information about it. For an indication for surgical intervention of more than 80% of the power of his physical ability is desirable. In this case, the patient can do normal activity, there are signs of the disease. 60-80% of patients with physical strength to work, stay at home, their own personal affairs makes much of, and sometimes need help. In this case, the situation is positive, the patient's lung function tests and cardiac surgery may apply. Physical ability is an indication for surgical intervention in those with 50% or less. Patients with this condition can not look self-help and need hospital treatment, the disease is progressive.
Differential Diagnosis
Bronchus cancer followed in clinical and radiological signs can be seen in the majority of lung diseases. Due to the similarity of clinical and radiological findings in the differential diagnosis of pulmonary tuberculosis and bronchial cancer is often discussed. Differential diagnostic radiographic examination and needle biopsy-siyle bronkospi not definitive, and thoracotomy should be done if any suspicion of cancer. Torakoto-gastric cancer lesion resection were obviously applied.
The main diseases like lung cancer, clinical and radiological findings are summarized below:
Granulomatous lesions (tuberculosis, sarcoidosis, fungi, etc.).
Pneumonia
Hydatid cysts, other cysts, foreign body
Benign tumors, mesotelyoma
Lung metastases
Pulmonary infarction, aneurysm
Pnömokonyozlar (silicosis)
Adenopatiler
Lymphoma, leukemia
Pleurisy
Lung Cancer Treatment
Surgical treatment
Best surgical treatment of lung cancer resection alone can be annoying. Other treatments (radiotherapy and kemotorapi), palliative and disease retarding the course of nature.
30% of lung cancers, but resection is done. Resection of the cancer cases, five year survival rate of those accessing the duration of the type of cancer, the stage and the duration varies.
The poor prognosis of small cell lung cancer. Due to the nature of diagnosis of metastatic small cell lung cancer when yayılıcı and resection and radiation therapy generally is not indicated.
Lung cancer is not a contraindication for surgical intervention should be evaluated thoroughly. The main contraindications are shown below:
1 - near and distant metastases
2 - Lymph nodes metastasis
3 - vena cava obstruction süperiyörün
4 - Karenaya uzaklıkda cancer have less than 2 sm 2 sm or less than karenaya uzaklıkda presence of lymph node metastases.
5 - severe lung function abnormalities
6 - resection survive heart disease and other diseases.
Indication for resection, and 5-year survival time in cases of squamous cell cancer comes first. Surgical treatment is not successful in the near or distant metastasis of cancer is related. Metastases in the liver, other lung, adrenal guddesine, bone, kidney and brain are.
Lung Cancer Radiotherapy (radiation therapy)
If you have a lonely and adjacent lymph nodes hemitoraksda a regional spread of lung cancer has shown that radiation therapy is indicated in inoperable cancer. Nature palliative radiation treatment, patients are anxious amacıyle reduce the symptoms. The main symptoms of bronchial obstruction and atelektaziyle dyspnea, hemoptysis, cough, chest pain, superior vena cava syndrome, and fever. Radiotherapy also increases the patient's life expectancy.
The success of radiotherapy üyüklüğünde tumor reduction, recovery and survival duration of the symptoms of the disease is evaluated.
Radiation therapy is done for the main four objectives: 1.Cerrahi interference is contraindicated in cases of respiratory illness or a serious illness. 2. Cancer-related complications, for example, the pressure of the tumor or the spread of the esophagus, superior vena cava syndrome. 3. Istemiyen patients for surgical intervention. 4. Some cancers, for example, pancoast cancer radiotherapy and resection of the tumor volume is reduced. Furthermore, in some cases, surgical intervention has not been applied together with radiotherapy and drug therapy. This treatment, adjuvant therapy, "adjunctive therapy" (radiation + drug treatment) is called.
Lung Cancer Chemotherapy
Applicable in cases of lung cancer surgery and radiation therapy or surgery and radiotherapy in the treatment of drug is helping. The drugs used in lung cancer is usually palliative nature.
The main effect of chemotherapy drugs used to treat small cell lung kanserine'dir The main cyclophosphamide, vincristine, etopsid, doxorubicin, methotrexate and lomustin (CCNU), 'stop. Usually three or more of these drugs are used in about 6 months.
Kemopeterapiyle be a good outcome (clinical and radiographic signs of cancer is not limited to) small cell lung cancer cases, 50% of these cases are tracked and life expectancy is 15 months. Widespread in small cell lung cancer is 20% of cases and good results in these cases the life time was 7 months.
Prognosis
Lung cancer and chronic quality of life of patients because of advances in different period of time, but very careful and periodic izlenmeleriyle understandable. Sometimes the therapy prolonged life expectancy or property that is connected to the understanding of cancer güçdür.
Clinical and radiological diagnosis of lung cancer for the period (prekli-technical terms) takes months or years. Preclinical period of cancer treatment with the long life time of diagnosis is provided. Diagnosed with cancer during this period, however, is not practical qualifications.
Untreated lung cancer survival time measured in matter of months. Natural course of the disease is located in the five major factors:
1. Anatomical term at the time of diagnosis of the disease
2. Cancer cell type. Small cell lung cancer survival at least, most are squamous cell lung cancer.
3. The growth rate of cancer
4. During the period before diagnosis, the patient's condition
5. Of treatment
Untreated cases of small cell carcinoma is the least time to live. The average survival time of cancer 3 months. A complete resection of the squamous cell lung cancer is 40% 30-5-year survival ratio.
Relationship was found between the duration of life of cancer growth: Tumor size is two-fold for the last time in a short period in the life is short. For example, a tumor cell proliferation in two days time (doubling time - replication time), small cell lung cancer, 30 days, adeno carcinoma 6 months. Disease symptoms, duration of cancer progression and prognosis evaluated by the success of the treatment applied. Lung cancer resection provided the best results in cases of limited disease group.
Indication for resection in cases with a limited diffusion capacity, and increases the blood tests help to determine the value of P02.
Expiration of air flow and volume in a meaningful and easy to measure the relationship between the evaluation of lung function tests. Ration of maximal expiration flow and volume relationship (MEAV) curves may be beneficial in the study of obstructive and restrictive functional abnormality. In order to implement the treatment of lung cancer resection and maximal expiratory flow measured MEAV curve (V max) and the second is more than 2.5 liters of air flow in the middle of forced vital capacity (V 50) must be more than 1 liter per second. V max and V 50 is reduced in obstructive lung disease. This reduction is proportional to the degree of functional impairment. PA02 and PaC02 for the indication of resection should be measured.
Less than 65 mm Hg for surgical intervention of PA02 and PaC02 of absence must not be more than 45 mm Hg.
Another method for physical ability of the Karnofsky measure provides meaningful information about it. For an indication for surgical intervention of more than 80% of the power of his physical ability is desirable. In this case, the patient can do normal activity, there are signs of the disease. 60-80% of patients with physical strength to work, stay at home, their own personal affairs makes much of, and sometimes need help. In this case, the situation is positive, the patient's lung function tests and cardiac surgery may apply. Physical ability is an indication for surgical intervention in those with 50% or less. Patients with this condition can not look self-help and need hospital treatment, the disease is progressive.
Differential Diagnosis
Bronchus cancer followed in clinical and radiological signs can be seen in the majority of lung diseases. Due to the similarity of clinical and radiological findings in the differential diagnosis of pulmonary tuberculosis and bronchial cancer is often discussed. Differential diagnostic radiographic examination and needle biopsy-siyle bronkospi not definitive, and thoracotomy should be done if any suspicion of cancer. Torakoto-gastric cancer lesion resection were obviously applied.
The main diseases like lung cancer, clinical and radiological findings are summarized below:
Granulomatous lesions (tuberculosis, sarcoidosis, fungi, etc.).
Pneumonia
Hydatid cysts, other cysts, foreign body
Benign tumors, mesotelyoma
Lung metastases
Pulmonary infarction, aneurysm
Pnömokonyozlar (silicosis)
Adenopatiler
Lymphoma, leukemia
Pleurisy
Lung Cancer Treatment
Surgical treatment
Best surgical treatment of lung cancer resection alone can be annoying. Other treatments (radiotherapy and kemotorapi), palliative and disease retarding the course of nature.
30% of lung cancers, but resection is done. Resection of the cancer cases, five year survival rate of those accessing the duration of the type of cancer, the stage and the duration varies.
The poor prognosis of small cell lung cancer. Due to the nature of diagnosis of metastatic small cell lung cancer when yayılıcı and resection and radiation therapy generally is not indicated.
Lung cancer is not a contraindication for surgical intervention should be evaluated thoroughly. The main contraindications are shown below:
1 - near and distant metastases
2 - Lymph nodes metastasis
3 - vena cava obstruction süperiyörün
4 - Karenaya uzaklıkda cancer have less than 2 sm 2 sm or less than karenaya uzaklıkda presence of lymph node metastases.
5 - severe lung function abnormalities
6 - resection survive heart disease and other diseases.
Indication for resection, and 5-year survival time in cases of squamous cell cancer comes first. Surgical treatment is not successful in the near or distant metastasis of cancer is related. Metastases in the liver, other lung, adrenal guddesine, bone, kidney and brain are.
Lung Cancer Radiotherapy (radiation therapy)
If you have a lonely and adjacent lymph nodes hemitoraksda a regional spread of lung cancer has shown that radiation therapy is indicated in inoperable cancer. Nature palliative radiation treatment, patients are anxious amacıyle reduce the symptoms. The main symptoms of bronchial obstruction and atelektaziyle dyspnea, hemoptysis, cough, chest pain, superior vena cava syndrome, and fever. Radiotherapy also increases the patient's life expectancy.
The success of radiotherapy üyüklüğünde tumor reduction, recovery and survival duration of the symptoms of the disease is evaluated.
Radiation therapy is done for the main four objectives: 1.Cerrahi interference is contraindicated in cases of respiratory illness or a serious illness. 2. Cancer-related complications, for example, the pressure of the tumor or the spread of the esophagus, superior vena cava syndrome. 3. Istemiyen patients for surgical intervention. 4. Some cancers, for example, pancoast cancer radiotherapy and resection of the tumor volume is reduced. Furthermore, in some cases, surgical intervention has not been applied together with radiotherapy and drug therapy. This treatment, adjuvant therapy, "adjunctive therapy" (radiation + drug treatment) is called.
Lung Cancer Chemotherapy
Applicable in cases of lung cancer surgery and radiation therapy or surgery and radiotherapy in the treatment of drug is helping. The drugs used in lung cancer is usually palliative nature.
The main effect of chemotherapy drugs used to treat small cell lung kanserine'dir The main cyclophosphamide, vincristine, etopsid, doxorubicin, methotrexate and lomustin (CCNU), 'stop. Usually three or more of these drugs are used in about 6 months.
Kemopeterapiyle be a good outcome (clinical and radiographic signs of cancer is not limited to) small cell lung cancer cases, 50% of these cases are tracked and life expectancy is 15 months. Widespread in small cell lung cancer is 20% of cases and good results in these cases the life time was 7 months.
Prognosis
Lung cancer and chronic quality of life of patients because of advances in different period of time, but very careful and periodic izlenmeleriyle understandable. Sometimes the therapy prolonged life expectancy or property that is connected to the understanding of cancer güçdür.
Clinical and radiological diagnosis of lung cancer for the period (prekli-technical terms) takes months or years. Preclinical period of cancer treatment with the long life time of diagnosis is provided. Diagnosed with cancer during this period, however, is not practical qualifications.
Untreated lung cancer survival time measured in matter of months. Natural course of the disease is located in the five major factors:
1. Anatomical term at the time of diagnosis of the disease
2. Cancer cell type. Small cell lung cancer survival at least, most are squamous cell lung cancer.
3. The growth rate of cancer
4. During the period before diagnosis, the patient's condition
5. Of treatment
Untreated cases of small cell carcinoma is the least time to live. The average survival time of cancer 3 months. A complete resection of the squamous cell lung cancer is 40% 30-5-year survival ratio.
Relationship was found between the duration of life of cancer growth: Tumor size is two-fold for the last time in a short period in the life is short. For example, a tumor cell proliferation in two days time (doubling time - replication time), small cell lung cancer, 30 days, adeno carcinoma 6 months. Disease symptoms, duration of cancer progression and prognosis evaluated by the success of the treatment applied. Lung cancer resection provided the best results in cases of limited disease group.
Mediastinoscopy and mediastinotomy
Mediastinoscopy and mediastinotomy
Applied to evaluate the indications for mediastinoscopy in lung cancer surgery. Furthermore, other diseases such as cancer, lymphoma, tuberculosis and related lenfadanopatilerin diagnosis of sarcoidosis is useful.
An incision made between the cartilage and suprasternal notch Mediastinoscopy trioid are entering. Mediastinoskopla paratrakea, tracheo-bronchial lymph glands and peribronş visualization, biopsy is done. This method is not possible to see the hilar and aorto-pulmonary lymph nodes. PET has a complication rate of 3%. The major pneumothorax, bleeding and laryngeal nerve injury of the esophagus and trachea.
Parasternal mediastinoscopy is an incision. The main indication for anterior mediastinum and left upper lobe lung cancer, and other aorto-pulmonary lymph nodes are for appearance and biopsy. Complications of mediastinoscopy is the same.
0. Period negative radiological findings, negative bronchoscopic findings, positive sputum cytology. These findings are small in diameter, is hidden or in situ indicated a counter-nomade. Where the patient was diagnosed of cancer surgery should be closely monitored.
1. Term: (a) Radiography peripheral edge has a tumor. Signs of bronchial obstruction, no signs of metastasis or invasion. Surgical resection is the initiative, (b) do not make a large bronchus obstruction of the small but has a tumor. There is no sign of metastasis in the lymph gland. Surgical resection is the initiative.
2. Period radiography or bronchoscopy, or a segment of the tumor lobe bronchus is blocked. There is no sign of metastasis. Resection is applied.
3. Term: (a) are adenopatisi hilus. However, no signs of mediastinal and distant metastases adenopatisi, (b) are adenopatisi hilus. Adenopatisi no signs of mediastinal and distant metastases. Chest wall tumor progressed. However, resection can be done.
4. Period There is no indication for surgical intervention, because the tumor medi-Asten, has invaded the pleura and vessels, are scalene lymph gland metastasis, the operation has progressed beyond the chest wall or brachial plexus, or there are distant metastases.
Early diagnosis of cancer
Early lung cancer, surgery removed the entire duration of a recovery and normal life can be provided by cause.
Less than 20 mm in diameter, pleura, lymph nodes, tumors have no chance to live near or distant metastasis according to tumor diameter greater than 20 mm is 80%. Certainly increases the chances of early diagnosis of cancer therapy.
Early lung cancer in two groups:
Hilar early lung cancer, bronchial tumor in the wall and pleura, lymph node or distant metastases do not. Research, screening or diagnostic examination of sputum is sitoloik many times. This type of early lung cancer "hidden cancer" is the name. Localization is difficult to determine. Bronkofiberskop increased the chances of this cancer diagnosis.
Early lung cancer often does routine radiography. Sometimes the lines extending to the periphery of the tumor is seen in the hilus, pnömonitis'in similar radiographic appearance. This finding is important for the tumor, the lateral radiography, computer tomography, cytological examination of sputum and bronkofiberskopla assessed. In some cases of early hilar lung cancer-a long-term chronic cough, sputum production (especially bloody sputum), such as subjective symptoms, diagnosis, consists of the router. The age of a patient who smoked more than 40 percent in the past, and especially long-term cough and phlegm landing bronkofîberskopi If there is indicated. If you doubt this indication is even more difficult to win the bloody sputum.
2. Peripheral-type early lung cancer, the tumor is less than 20 mm in diameter. Pleura, lymph node and no distant metastases. These tumors can be seen in lung radiography. An abnormal shadow in the peripheral lung X-ray computer tomography bronkografıyle be examined and, if necessary. This investigation is supported by an abnormal radiographic findings do bronchoscopy and cytological diagnosis of the material must be obtained by brushing and küretle. In such cases, the success of diagnosis is approximately 80%. If you are negative results of cytological and control of cancer in needle biopsy of suspected rontgenoscopy continues to do, and that success should be provided, thoracotomy.
Biopsy
There are different methods of biopsy for the diagnosis of lung cancer: Bronkos-endoscopic biopsy, closed or open lung and pleural biopsy, and mediastinoscopy in mediastinal lymph node biopsy, such as scalene lymph node biopsy. The biopsy technique applied to the success of their personal experience, according to information received from reviewing the material cytological changes.
With the help of computer tomography diagnosis of tumors by needle aspiration is a useful and meaningful way that is easy to obtain material.
Laboratory investigations
Cytological examination of sputum, bronchial lavage and pleural fluid cytological examination is very important in the diagnosis of lung cancer. Solo sputum cytologic diagnosis of lung cancer by studying the rate is about 70%. Cytological examination of the material obtained from the sputum and bronkoskopiyle 95% of the applied diagnostic finds.
Paraneoplastic syndromes related to laboratory analysis and are used in current investigations. Sedimentation rate of lung cancer increases.
Morning deep, strong cough following the sputum is preferred. Saliva is not useful for this purpose be analyzed. You can not make it easier methods of sputum expectoration in patients aerasyon inhalation should be tried, for example. Postural drainage and chest percussion by sputum increases the chance. Blood and sputum should be preferred in the dark. 3 or 6 different from the homogeneous appearance of sputum examined. Mucus or bronchial lavage was aspirated from each flat is spread, and 3 after being found without delay and 90% alcohol for 30 minutes Papanicolau painted technique. Fixing and staining of sputum was collected the same day, even if possible, sputum should be subtracted. This possibility will be saved until 48 hours or degree of sputum 4. The possibility of storing heat or sputum smear should be determined after the alcohol. Some laboratories Papanicolau review negative, positive, and interpret as suspicious. Some of them re-examine whether negative or positive instead of suspicious findings make two comments.
If more than one increases the chances of success in dissemination. Given the context of sputum-positive finding only about 35%, 75% of the four lambda is judging.
Serum biochemical examination dehidrojenez total lactic (LDH) in 40% of all cancer cases will increase.
Cancer disease often have increased metabolic activity. For this reason, food is not taken sufficient time to reduce the blood proteins.
Lung and other cancers in serum karsinoembriojenik antigen (CEA) increases.
Biochemical changes related to tumor metastasis
Akciğer'den especially the liver, bone, cranium, peritoneum, pleura and other organs are metastases. Whether there is an indication for surgical intervention in patients with metastases in these organs should be examined.
Liver and bile duct in cases of metastasis oksalasetik serum glutamic transaminase (SGOT), serum glutamic pruvik transaminase (SGPT), lactic dehydrogenase (LDH) and alkaline phosphatase increased. However, these findings are not specific. . Alkaline phosphatase, bone or bowel disease and Hodgkin's disease, metastasis, or the increase.
Bone metastases, serum calcium rises. Lung cancer, bone metastasis can be monitored without hypercalcemia. Hypercalcemia occurs in cases of hypercalciuria.
Cancer or metastases, pleural and peritoneal fluid LDH in these gaps increases. Pleural or peritoneal metastasis of cancer or are suspected as well as the gaps in both the serum LDH measured in the fluid at the same time. Fluid LDH is a tumor or abnormal and to have more than serumdakinden is an important finding for metastasis.
Applied to evaluate the indications for mediastinoscopy in lung cancer surgery. Furthermore, other diseases such as cancer, lymphoma, tuberculosis and related lenfadanopatilerin diagnosis of sarcoidosis is useful.
An incision made between the cartilage and suprasternal notch Mediastinoscopy trioid are entering. Mediastinoskopla paratrakea, tracheo-bronchial lymph glands and peribronş visualization, biopsy is done. This method is not possible to see the hilar and aorto-pulmonary lymph nodes. PET has a complication rate of 3%. The major pneumothorax, bleeding and laryngeal nerve injury of the esophagus and trachea.
Parasternal mediastinoscopy is an incision. The main indication for anterior mediastinum and left upper lobe lung cancer, and other aorto-pulmonary lymph nodes are for appearance and biopsy. Complications of mediastinoscopy is the same.
0. Period negative radiological findings, negative bronchoscopic findings, positive sputum cytology. These findings are small in diameter, is hidden or in situ indicated a counter-nomade. Where the patient was diagnosed of cancer surgery should be closely monitored.
1. Term: (a) Radiography peripheral edge has a tumor. Signs of bronchial obstruction, no signs of metastasis or invasion. Surgical resection is the initiative, (b) do not make a large bronchus obstruction of the small but has a tumor. There is no sign of metastasis in the lymph gland. Surgical resection is the initiative.
2. Period radiography or bronchoscopy, or a segment of the tumor lobe bronchus is blocked. There is no sign of metastasis. Resection is applied.
3. Term: (a) are adenopatisi hilus. However, no signs of mediastinal and distant metastases adenopatisi, (b) are adenopatisi hilus. Adenopatisi no signs of mediastinal and distant metastases. Chest wall tumor progressed. However, resection can be done.
4. Period There is no indication for surgical intervention, because the tumor medi-Asten, has invaded the pleura and vessels, are scalene lymph gland metastasis, the operation has progressed beyond the chest wall or brachial plexus, or there are distant metastases.
Early diagnosis of cancer
Early lung cancer, surgery removed the entire duration of a recovery and normal life can be provided by cause.
Less than 20 mm in diameter, pleura, lymph nodes, tumors have no chance to live near or distant metastasis according to tumor diameter greater than 20 mm is 80%. Certainly increases the chances of early diagnosis of cancer therapy.
Early lung cancer in two groups:
Hilar early lung cancer, bronchial tumor in the wall and pleura, lymph node or distant metastases do not. Research, screening or diagnostic examination of sputum is sitoloik many times. This type of early lung cancer "hidden cancer" is the name. Localization is difficult to determine. Bronkofiberskop increased the chances of this cancer diagnosis.
Early lung cancer often does routine radiography. Sometimes the lines extending to the periphery of the tumor is seen in the hilus, pnömonitis'in similar radiographic appearance. This finding is important for the tumor, the lateral radiography, computer tomography, cytological examination of sputum and bronkofiberskopla assessed. In some cases of early hilar lung cancer-a long-term chronic cough, sputum production (especially bloody sputum), such as subjective symptoms, diagnosis, consists of the router. The age of a patient who smoked more than 40 percent in the past, and especially long-term cough and phlegm landing bronkofîberskopi If there is indicated. If you doubt this indication is even more difficult to win the bloody sputum.
2. Peripheral-type early lung cancer, the tumor is less than 20 mm in diameter. Pleura, lymph node and no distant metastases. These tumors can be seen in lung radiography. An abnormal shadow in the peripheral lung X-ray computer tomography bronkografıyle be examined and, if necessary. This investigation is supported by an abnormal radiographic findings do bronchoscopy and cytological diagnosis of the material must be obtained by brushing and küretle. In such cases, the success of diagnosis is approximately 80%. If you are negative results of cytological and control of cancer in needle biopsy of suspected rontgenoscopy continues to do, and that success should be provided, thoracotomy.
Biopsy
There are different methods of biopsy for the diagnosis of lung cancer: Bronkos-endoscopic biopsy, closed or open lung and pleural biopsy, and mediastinoscopy in mediastinal lymph node biopsy, such as scalene lymph node biopsy. The biopsy technique applied to the success of their personal experience, according to information received from reviewing the material cytological changes.
With the help of computer tomography diagnosis of tumors by needle aspiration is a useful and meaningful way that is easy to obtain material.
Laboratory investigations
Cytological examination of sputum, bronchial lavage and pleural fluid cytological examination is very important in the diagnosis of lung cancer. Solo sputum cytologic diagnosis of lung cancer by studying the rate is about 70%. Cytological examination of the material obtained from the sputum and bronkoskopiyle 95% of the applied diagnostic finds.
Paraneoplastic syndromes related to laboratory analysis and are used in current investigations. Sedimentation rate of lung cancer increases.
Morning deep, strong cough following the sputum is preferred. Saliva is not useful for this purpose be analyzed. You can not make it easier methods of sputum expectoration in patients aerasyon inhalation should be tried, for example. Postural drainage and chest percussion by sputum increases the chance. Blood and sputum should be preferred in the dark. 3 or 6 different from the homogeneous appearance of sputum examined. Mucus or bronchial lavage was aspirated from each flat is spread, and 3 after being found without delay and 90% alcohol for 30 minutes Papanicolau painted technique. Fixing and staining of sputum was collected the same day, even if possible, sputum should be subtracted. This possibility will be saved until 48 hours or degree of sputum 4. The possibility of storing heat or sputum smear should be determined after the alcohol. Some laboratories Papanicolau review negative, positive, and interpret as suspicious. Some of them re-examine whether negative or positive instead of suspicious findings make two comments.
If more than one increases the chances of success in dissemination. Given the context of sputum-positive finding only about 35%, 75% of the four lambda is judging.
Serum biochemical examination dehidrojenez total lactic (LDH) in 40% of all cancer cases will increase.
Cancer disease often have increased metabolic activity. For this reason, food is not taken sufficient time to reduce the blood proteins.
Lung and other cancers in serum karsinoembriojenik antigen (CEA) increases.
Biochemical changes related to tumor metastasis
Akciğer'den especially the liver, bone, cranium, peritoneum, pleura and other organs are metastases. Whether there is an indication for surgical intervention in patients with metastases in these organs should be examined.
Liver and bile duct in cases of metastasis oksalasetik serum glutamic transaminase (SGOT), serum glutamic pruvik transaminase (SGPT), lactic dehydrogenase (LDH) and alkaline phosphatase increased. However, these findings are not specific. . Alkaline phosphatase, bone or bowel disease and Hodgkin's disease, metastasis, or the increase.
Bone metastases, serum calcium rises. Lung cancer, bone metastasis can be monitored without hypercalcemia. Hypercalcemia occurs in cases of hypercalciuria.
Cancer or metastases, pleural and peritoneal fluid LDH in these gaps increases. Pleural or peritoneal metastasis of cancer or are suspected as well as the gaps in both the serum LDH measured in the fluid at the same time. Fluid LDH is a tumor or abnormal and to have more than serumdakinden is an important finding for metastasis.
Bronchoscopy
Bronchoscopy in patients with bronchial cancer is suspected.
Is done under local anesthesia flexible fiberoptic bronskoskopi. Sübsegment bronchoscope bronchial branching can be up to. Characteristic appearance and location of the lesion Bronkoskopiyle examined. Yapmağa lesional biopsy should work. Materyelinin biopsy or brushing or lavage cytological and bacteriological examination of the material is provided. Bronchoscopy is finished and go up or down the effect of anesthesia after the disappearance of this initiative consists of extraction iritasyonuyla strong cough and sputum. Collect and send the histopathologic examination of the secretion of postbronchoscopic cough. This review is very important for diagnosis.
Furthermore, bronchoscopy, clinical, radiological and laboratory review-meriyle tuberculosis, infections, granulomalar and differential diagnosis of other diseases like lung cancer can be helpful. The needle biopsy material using computer tomography in the diagnosis Bronkoskopiyle konamamışsa taken. If necessary, open biopsy for cytologic diagnosis, or lymph node, subcutaneous nodules, pleural effusion, and bone lesions are taken material.
Surgical intervention should be mediastnoskopi particular indication.
Indications for bronchoscopy
1 - The main causes of hemoptysis in chronic bronchitis, pulmonary tuberculosis, pneumonia, other infections, granulomalar, lung cancer, bronchial adenoma'sı, metastatic tumors, bronchiectasis and lung abscess. If bleeding continues, and the diagnosis of bronkofiberskopi lot of useful information is provided by the lesion.
2 - Cause of severe and chronic cough, chronic cough, chronic obstructive pulmonary understood diseases, especially chronic bronchitis, tuberculosis, bronchial foreign bodies, may be related to lung cancer or bronchial adenoma'sı.
3 - Clinical signs of obstruction (wheezing), local and permanent sibilan, ronflan heard Railer, bronchus and trachea kuşkulandırmalıdır incomplete blockage. Symptom of obstructive foreign body, neoplasm, tuberculosis, bronchitis, asthma, emphysema or scarring may be related to stenosis. Thyroid, özofa-gus tumors, thymoma, granuloma, lymphoma, or metastatic tumor in the trachea and bronchi lenfadeno-paws for signs of blockage by external pressure to cause.
4 - Atelectasis and condensation radiograph atelectasis suspected tumor-related, and other symptoms seen in the concentration.
5 - Other methods identify undiagnosed infections could not be obtained from broncho-pulmonary infections bronkofiberskop'la examination of the material culture and the other is applied. Provided so that the diagnosis of disease, especially in patients with sputum production. Controlling the effect of treatment is well tolerated and Bronkofıberskopi infections often can be repeated for tracheobronchial clearance.
Contraindications bronchoscopy
* Heart and lung function in severe decline
* Plenty of hemoptysis
* Abnormal condition of the patient due to fever
* The patient's general condition of the disease is too advanced or too corrupt to be there.
Dissemination of the material to be identified and obtained from bronchoscopy brushing or biopsy cytological examination of the material is made without delay. This is not to spread the material as soon as possible or must be determined. Because so many times from the very small piece of tissue, a bath and dries quickly konursa loses the quality of cytological diagnosis. Therefore, patients receiving tissue to a total of almost 90% of alcohol in the container and daldırmalıdır yaymalı. Thus, material would have been detected. Küretinin bronchoscope with a needle tip material is taken. Received in 10% formalin solution for large material is determined.
Lung cancer is monitored bronkoskopiyle two main views:
The major lung cancer related to the I-Results of direct tumor, necrosis, infiltration, bronchial mucous membrane disorder, bronchial obstruction-force it.
II-Results indirectly related to lung cancer The major stenosis, narrowing or signs of pressure, edema, reddening of the mucosa or blood vessels dolgunluğudur.
The relationship between bronchoscopic and histopathologic diagnosis of lung cancers and bronchial localization features formed in different reaction rate is not the same as appearing in bronchoscopy. For example, squamous cell (squamous cell) carcinoma bronkofiberskopla 70% of positive findings, adenokarsinomada 30%, 60% of large cell carcinoma. Histopathologic examination of the material increases the diagnostic rate of bronchoscopy. Whisk in the abnormal tissue, or biopsy to make a more successful outcome are curetted. Applied to the study of the material obtained by curettage or biopsy Bronkofiberskopla positive diagnostic rate of lung cancer is approximately 95%.
Is done under local anesthesia flexible fiberoptic bronskoskopi. Sübsegment bronchoscope bronchial branching can be up to. Characteristic appearance and location of the lesion Bronkoskopiyle examined. Yapmağa lesional biopsy should work. Materyelinin biopsy or brushing or lavage cytological and bacteriological examination of the material is provided. Bronchoscopy is finished and go up or down the effect of anesthesia after the disappearance of this initiative consists of extraction iritasyonuyla strong cough and sputum. Collect and send the histopathologic examination of the secretion of postbronchoscopic cough. This review is very important for diagnosis.
Furthermore, bronchoscopy, clinical, radiological and laboratory review-meriyle tuberculosis, infections, granulomalar and differential diagnosis of other diseases like lung cancer can be helpful. The needle biopsy material using computer tomography in the diagnosis Bronkoskopiyle konamamışsa taken. If necessary, open biopsy for cytologic diagnosis, or lymph node, subcutaneous nodules, pleural effusion, and bone lesions are taken material.
Surgical intervention should be mediastnoskopi particular indication.
Indications for bronchoscopy
1 - The main causes of hemoptysis in chronic bronchitis, pulmonary tuberculosis, pneumonia, other infections, granulomalar, lung cancer, bronchial adenoma'sı, metastatic tumors, bronchiectasis and lung abscess. If bleeding continues, and the diagnosis of bronkofiberskopi lot of useful information is provided by the lesion.
2 - Cause of severe and chronic cough, chronic cough, chronic obstructive pulmonary understood diseases, especially chronic bronchitis, tuberculosis, bronchial foreign bodies, may be related to lung cancer or bronchial adenoma'sı.
3 - Clinical signs of obstruction (wheezing), local and permanent sibilan, ronflan heard Railer, bronchus and trachea kuşkulandırmalıdır incomplete blockage. Symptom of obstructive foreign body, neoplasm, tuberculosis, bronchitis, asthma, emphysema or scarring may be related to stenosis. Thyroid, özofa-gus tumors, thymoma, granuloma, lymphoma, or metastatic tumor in the trachea and bronchi lenfadeno-paws for signs of blockage by external pressure to cause.
4 - Atelectasis and condensation radiograph atelectasis suspected tumor-related, and other symptoms seen in the concentration.
5 - Other methods identify undiagnosed infections could not be obtained from broncho-pulmonary infections bronkofiberskop'la examination of the material culture and the other is applied. Provided so that the diagnosis of disease, especially in patients with sputum production. Controlling the effect of treatment is well tolerated and Bronkofıberskopi infections often can be repeated for tracheobronchial clearance.
Contraindications bronchoscopy
* Heart and lung function in severe decline
* Plenty of hemoptysis
* Abnormal condition of the patient due to fever
* The patient's general condition of the disease is too advanced or too corrupt to be there.
Dissemination of the material to be identified and obtained from bronchoscopy brushing or biopsy cytological examination of the material is made without delay. This is not to spread the material as soon as possible or must be determined. Because so many times from the very small piece of tissue, a bath and dries quickly konursa loses the quality of cytological diagnosis. Therefore, patients receiving tissue to a total of almost 90% of alcohol in the container and daldırmalıdır yaymalı. Thus, material would have been detected. Küretinin bronchoscope with a needle tip material is taken. Received in 10% formalin solution for large material is determined.
Lung cancer is monitored bronkoskopiyle two main views:
The major lung cancer related to the I-Results of direct tumor, necrosis, infiltration, bronchial mucous membrane disorder, bronchial obstruction-force it.
II-Results indirectly related to lung cancer The major stenosis, narrowing or signs of pressure, edema, reddening of the mucosa or blood vessels dolgunluğudur.
The relationship between bronchoscopic and histopathologic diagnosis of lung cancers and bronchial localization features formed in different reaction rate is not the same as appearing in bronchoscopy. For example, squamous cell (squamous cell) carcinoma bronkofiberskopla 70% of positive findings, adenokarsinomada 30%, 60% of large cell carcinoma. Histopathologic examination of the material increases the diagnostic rate of bronchoscopy. Whisk in the abnormal tissue, or biopsy to make a more successful outcome are curetted. Applied to the study of the material obtained by curettage or biopsy Bronkofiberskopla positive diagnostic rate of lung cancer is approximately 95%.
Lung Cancer Symptoms
Incidence
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
metastasis
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.
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
metastasis
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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