Bronchopulmonary cancer (CBP)

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

Causes:
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
Pathogenesis:

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
Treatment:
1. Surgical
Criteria:
– 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:
Directions:
– 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
1. CISPLATIN
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