Bronchopulmonary cancer (CBP)

Malignant lung tumors that start in glandular bronchial epithelium with screening asymptomatic often late because of developments in therapeutic effectiveness.
Third place in women after breast and uterus
Place the male

1. Smoking
2. Air pollution (industrial smoke, aromatic hydrocarbons)
3. Industrial professional factors (asbestos, dyes industry, processing of iron)
4. Preexisting lung injury:
– Bronchiectasis
– Injury post TBC
– Pulmonary Fibrosis
May. Genetic

Classification after departure point:
1. CBP central onset (on a large Bronchitis – main or lobar)
– Initially appears as a thickening of the mucosa
– Then shows the development:
a) endobronchial – mass of irregular, brittle, prone to favoring luminal obstruction: atelectasis, infection or territory corresponding bronchi abcedarea
b) Exobronsic – to surrounding tissue or that it invades surrounding lymph pre sis (regional), hilar or mediastinal, late shows metastases in other organs at distant
2. CBP onset peripheral
– Without affecting large bronchi
– The extension to the pleura
– Late extending to regional lymph

Histopathological classification:
1. Squamous cell (epidermoid)
– Has a tendency to peel (possible diagnosis by cytological examination of bronchial secretion)
– Association with paraneoplastic syndromes
– Low tendency to disseminate
– Evolution to the cancer long (3-4 years)
2. The small cells
– Rapid progression by increasing tumor size
– Increased tendency to metastatic dissemination
– Increased tendency to relapse
3. Adenocarcinoma
– Introduce glandular structure
– Produce mucin
– Does rapid dissemination marrow metastases water way
4. Undifferentiated carcinoma with large cells
– Rapid progression to metastasis

Clinical picture:
Clinical manifestations vary depending on the pathological form, stage, histological type.
Respiratory symptoms:
– Cough, cough strength (mandatory investigated any man> 40 years with cough> 3 weeks)
– Hemoptysis in small quantities, repeated in Stade advanced layout “currant jelly”
– Shortness of breath – in late stages
Extrapulmonary manifestations:
– Fatigue unjustified
– Anorexia
– Marked decrease in weight
– Feverish
– Chest pain due to pleural damage
– Voice Biton by recurrent nerve damage
Physical exam:
– Pneumonic syndrome type condensation with the evolution of 3-4 weeks
– Axillary lymph nodes, supraclavicular
– Paraneoplastic manifestations, unusual behavior, arise through ectopic secretion of hormones from tumor:
1. By hypersecretion of ACTH Cushing syndrome associated with hyperpigmentation, metabolic alkalosis, hypokalemia
2. Hypersecretion of ADH – cause hyponatremia, headache, listlessness, vomiting
3. Hypersecretion of parathyroid hormone-like – hypercalcemia
4. Pierre-Marie pneumonic hypertrophic osteoarthropathy

5. Neuromyopathy syndromes: polymyositis, myasthenia, peripheral neuropathies

6. Migratory thrombophlebitis – Trousseau syndrome
7. Acanthosis nigricantis – by hypersecretion of melanin hyperpigmentation spots
8. Hippocratic fingers
9. Hemolytic anemia, leukemia syndromes
10. Gynecomastia (by releasing hormones estrogen – like)
– Events metastatic:
1. Dysphagia – compression on the esophagus
2. Hoarseness, voice Biton – superior laryngeal nerve compression and recurrent nerve
3. Dyspnea – phrenic nerve compression
4. Plegie brachial – shoulder, arm, shoulder blade – Pancoast-Tobias syndrome
5. In locating the apical – Claude syndrome – Bernard-Horner (miosis, enophthalmos, ptosis)
6. Cyanosis, edema in “Cloak” – compression VCS
7. Arrhythmias, cardiac tamponade – compressing the pericardium
8. Nodular hepatomegaly, liver mts
9. Pathological fractures – bone mts
10. Seizures, signs of intracranial hypertension – mts brain
11. Cutaneous nodule – mts Skin

Laboratory picture:
1. Chest radiograph
– Opaque hilarious, segmentation, lobar and bronchial lymph nodes
– Retraction mediastinum, pleura, diaphragm
– Erosion ribs, vertebral
– Pleurisy
– Pericarditis paraneoplastic
2. CT – extension and invasion of primary tumor
3. Bronhografie bronchoscopy and biopsy examination – diagnosis of certainty for endobronchial tumor development
4. Radiography bone scintigraphy – highlights bone metastases
5. MRI – highlights small mts
6. Abdominal CT, brain – highlights metastases
7. Abdominal-pelvic ultrasound – highlights liver metastases, lymph node distance (periaortice), ascites paraneoplastic
8. Sputum cytology – reveals malignant cells
9. Ex blood – ESR increased anemic and leukemic paraneoplastic syndrome, FA increased, increased gammaGT – liver metastases

TNM staging – tumor / node / metastasis

T – primary tumor
Tx – can not Evidential
Tis (in situ) – stage tumor cells – anatomical and pathological diagnosis
T0 – no highlight
T1 – diameter ❤ cm
T2 – diameter> 3cm
T3 – extension to the thoracic wall, pleura, diaphragm, pericardium
T4 – invasion of the mediastinum

N – nodal involvement
N0 – no lymph node involvement
N1 – catch peribronchial or hilar lymph
N2 – catch of the hull and mediastinal lymph
N3 – catch scalene and supraclavicular lymph

M – distant metastases
M0 – no metastases
M1 – metastasis

Occult stage – TxN0M0
Stage 0 (in situ) – TisN0M0
Stage 1 – T1-2N0M0
Stage 2 – T1-2N1M0
Stage 3 – T3N0-1M0 or T1-3N2M0
Stage 4 – Any T, Any N, M1
1. Surgical
– By histology
– After stage (stages 1 and 2)
– By overall (lung function, heart, age, pre-existing conditions,)
– By location
– After remaining functional parenchyma
Types of interventions:
– Lobectomy
– Bilobectomie
– Segmentectomie
– Pneumonectomy
2. Radiotherapy:
– In advanced stages without mts distance
– The curative – when surgery is contraindicated
– The palliative effect – lowering turmoil hilarious or mediastinal invasion in order to improve quality of life
– Preoperative – decreases tumor volume decreases invasion of neighboring
– Surgery – in the treatment of incompletely resected tumors

Side Effects:
– Esophagitis radical
– Loss of appetite, vomiting, nausea
– Dry cough
– Pneumonia radical
– Gastritis radical
3. Chemotherapy:
– CBP with contraindications to surgery or radiotherapy
– CBP expanded with mts
– After surgery
– Along with radiotherapy in locally advanced forms, unresectable

It utilizes CANINE – act on the tumor cell metabolism decreases tumor cell proliferation
2. Vinblastine
3. Mitomycin C
4. Etoposide
The scheme utilizes each patient tailored combinations of chemotherapy.

Side Effects:
1. loss of appetite, nausea, vomiting 5. neurotoxicity
2. Anam, granulocytopenia, thrombocytopenia 6. ARF
3. immunosuppression 7. alopecia
4. cardiac fibrosis



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