Diagnosis and Treatment of Lungs Cancer

Lungs cancer

Diagnosis:

During a clinical examination, external symptoms of the development of lung cancer are determined:

Primary early symptoms (cough, hemoptysis, dyspnea, and chest pain)

Secondary, later symptoms due to complications in the development of the tumor (inflammatory processes, germination of neighboring organs, metastases)

General symptoms characteristic of the influence of malignant tumors on the body (general weakness, fatigue, decreased performance, etc.)

X-ray diagnostics

X-ray examination is one of the main methods for diagnosing lung tumors and makes it possible to detect them in time in 80% of patients. Fluorography is used as a screening method which is usually performed during preventive medical examinations. If changes are detected (solitary pulmonary node, atelectasis, etc.) on a fluorogram or if there are clinical indications, x-rays in two projections and computed tomography are used. In addition, computed tomography is the most informative method for diagnosing metastases in other organs.

Bronchoscopy

Bronchoscopy allows you to visually examine the trachea, main, lobar, segmental, sub-segmental bronchi, and, in some cases, bronchi of the 6th, 7th or more orders. In this case, you can directly see the tumor and carry out its biopsy. Bronchoscopy is considered mandatory for suspected lung cancer.

Transthoracic biopsy

• Transthoracic puncture biopsy is used when it is impossible to carry out other methods (bronchoscopy, bronchial catheterization, sputum analysis). Indications for its implementation are:
• Rounded formation in any area of ​​the lung
• Suspicion of metastasis in the lung of a tumor with a different localization
• Multiple intrapulmonary spherical shadows
• With a transthoracic puncture, a chest puncture is performed, a sample is taken directly from the tumor and the cells are examined under a microscope. This diagnostic method allows confirming the diagnosis in a significant number of patients (62-87% of cases, depending on the location of the tumor). The most common complication (up to 50%) of this procedure is closed pneumothorax, requiring drainage of the pleural cavity.

Ultrasound diagnostics

Ultrasound is an effective method for detecting the growth of a malignant tumor into the wall structures, large-scale darkening of the lung tissue (due to its compaction, pleural effusion, etc.), and through the tissue of an airless lung, it is possible to see directly the tumor node.

 Such diagnostics are safe, simple, and relatively inexpensive. It allows you to determine the tumor lesion of the mediastinal organs: the superior vena cava, pericardium, and heart chambers, the right and left pulmonary arteries, pulmonary veins, aorta, esophagus, left atrium, as well as the degree of applicability of surgical treatment of the tumor.

Biopsy Laboratory Research

Determination of tumor type and treatment strategy

To understand how mutations affect lung cancer therapy, it is important to consider how doctors classify the disease. Lung cancer is usually divided into two main groups: small cell (SCLC) and non-small cell (NSCLC). The latter accounts for 85 to 90% of all cases, and includes the following types of tumors:

 Adenocarcinoma - develops from cells of the glandular epithelium, for example, forming a mucous membrane in the respiratory tract;

Squamous cell carcinoma - begins in squamous cells covering the surface of the airways, usually found in the center of the lung near the bronchi;

Large cell carcinoma - can occur in any part of the lung, and spreads and grows faster than other types, under the microscope, its cancer cells appear large and round

Small cell cancer, which occurs in about 10-15% of patients, begins in the neuroendocrine cells of the lung, which produce hormones that control the flow of air and blood in the lungs. SCLC and NSCLC form, not 100%, in addition to them, carcinoid tumors, and sarcoma of lung lymphoma are extremely rare.

Surgery, chemotherapy, and radiation therapy, as well as immunotherapy, are usually used for any type of lung cancer in stage I-III disease, as well as immunotherapy, which may also be part of the treatment strategy for some patients with inoperable stage III NSCLC.

 In advanced diseases, including those with metastases (stage IV), or in case of relapse after treatment, systemic therapy is used that fights malignant cells throughout the body (as opposed to pinpoint surgery). In the case of small cell lung cancer, this may be chemotherapy or chemo immunotherapy. Systemic therapy for NSCLC may include immunotherapy and targeted drugs.

In the process of researching the biology and genetics of non-small cell lung cancer, scientists realized that this disease requires different approaches to treatment depending on the characteristics of the tumor. Driver mutations have been found - changes in the DNA sequence that because normal cells to mutate into cancer cells, grow, and spread throughout the body. According to a 2016 French study in The Lancet, such genetic changes are found in approximately 50% of all lung cancer tumors, and adenocarcinoma directly accounts for 64% of them. This discovery launched the development of targeted therapies - drugs that target specific gene mutations. This later led to the introduction personal therapy - the tumor responds better to individually selected drugs than to standard chemotherapy.

Treatment:

Surgery:

Surgical intervention is divided into:

1.  Radical
2. Conditionally radical
3. Palliative

In a radical operation, the entire tumor complex is removed: the primary focus, regional lymph nodes, and cellular tissue with metastasis pathways. The most frequently performed operations are lobectomy (removal of one lobe of the lung), lobectomy only for the right lung (resection of two lobes of the lung), and pneumonectomy - removal of the entire lung. Extended and combined pneumonectomy - complete removal of the lung with resection of lymph nodes of different groups and removal of neighboring organs that have grown through the tumor, respectively. At stages 1 and 2, a lobectomy is performed. At stage 3A, a pneumonectomy is usually performed. Radiation and drug therapy are added to the conditionally radical operation. It should also be taken into account that

Contraindications for radical surgery are:

1. Unrespectable - the spread of the tumor to neighboring tissues and organs, in which it is technically impossible to radically remove the tumor.
2. Inappropriate due to the presence of distant metastases.
3. Insufficiency of the functions of the cardiovascular and respiratory systems
4. Decompensated diseases of the internal organs
5. Surgical removal of the tumor is often accompanied by a wide removal of the root, tracheobronchial lymph nodes, tissue and lymph nodes of the mediastinum, resection of the chest wall, pericardium, diaphragm, bifurcation of the trachea, atrium, main vessels (aorta, superior vena cava), the muscular wall of the esophagus and other tissues that have germinated by the tumor.
6. Radiation treatment of lung cancer is carried out in the postoperative period on the tumor bed and the path of regional lymph flow. In the case of inoperable forms of cancer, if the patient refuses surgical treatment or if there are serious contraindications to surgical intervention, radiation therapy can be performed as an independent method of treatment.

Radiation therapy:

Radiation therapy is used for both radical and palliative treatment. With radical radiation treatment, both the tumor itself and the zones of regional metastasis, that is, the root of the lung, mediastinum, and regional lymph flow zones, are exposed to radiation with a total dose of 50-70 Gy.

Recently, the possibilities of radiation therapy have expanded with the use of stereotactic radiation therapy of the body with synchronization with the patient's breathing. Some modern medical accelerators and CyberKnife have such capabilities. With this approach, the achieved accuracy of irradiation is about one to three millimeters, which makes it possible to deliver ablation doses of radiation to the focus, but does not require surgical access and anesthesia. This method of irradiation is most in demand for single metastases in the lung and for inoperable primary lung cancer.

Chemotherapy:

In non-small cell lung cancer, chemotherapy is performed if there are contraindications to surgical and radiation treatment. In this case, the following drugs are prescribed: doxorubicin, cisplatin, vincristine, topside, cyclophosphamide, methotrexate, bleomycin, nitrosourea, vinorelbine, paclitaxel, docetaxel, gemcitabine, carboplatin, vinorelbine, irinotecan, etc., used in courses at intervals of 3-4 weeks (up to 6-7 courses).

In small cell lung cancer, chemotherapy in combination with radiation therapy is the most effective treatment. The drugs are the same as for non-small cell lung cancer.

Contraindication to RL chemotherapy: serious condition of the patient.

A partial decrease in the size of the primary tumor and metastases is not observed in all patients; the complete disappearance of a malignant neoplasm is rare. Chemotherapy for distant metastases does not lead to a cure (palliative chemotherapy), it only reduces the severity of the manifestations of the disease, and slightly increases life expectancy.

Lung cancer treatments also include:

1. Photodynamic therapy
2. Chemoembolization
3. Radio embolization
4. Brachytherapy
5. Cryodestruction
6. Laser coagulation
7. RF ablation
8. Biotherapy
9. Immunotherapy

Palliative care:

Palliative treatment of lung cancer is used when the possibilities of anticancer treatment are limited or exhausted. Such treatment is aimed at improving the quality of life (reducing the severity of symptoms) and increasing the life expectancy of terminally ill patients and includes:

1. Anesthesia
2. Oxygen therapy
3. Symptomatic therapy
4. Psychological help
5. Blood transfusion
6. Fight against anemia
7. Detoxification
8. Palliative radiotherapy
9. Palliative chemotherapy
10. Palliative surgery (tracheostomy, gastrostomy, enterectomy, nephrostomy, etc.)

Palliative care for lung cancer is used to combat shortness of breath, cough, hemoptysis, and pain. Pneumonia and pneumonitis associated with the tumor process, which occur during radiation and chemotherapy, are treated.

Methods of palliative treatment are largely individual and depend on the patient's condition.