Home Lung Cancer

Lung Cancer

by admin

Cancer Definition

A large group of diseases that all have something in common is used for a wide variety of diseases: uncontrolled breakdown of cells belonging to an organ or tissue. As a result, a tumor (tumor) is formed. Malignant tumors, that is, bad types of tumors, go beyond the normal growth control of the organism. The ‘ragged’ cells multiply in an unstoppable way. They penetrate and grow in the surrounding tissues and destroy them, they can enter the blood vessels and lymph vessels, they can reach other body organs with the blood stream and the lymph flow. The cells of resistant tumors can settle in other organs and multiply again – in this way, daughter tumors (metastases) resembling resistant tumors are formed. Lung cancer is one of the cancer types defined as resistant tumors. The cells of blood cancer types spread throughout the body with the blood. In some of these types, nodes and lumps are formed, which are very similar to real resistant tumors.

 

Lung cancer types

When tumor tissue is examined under a microscope, it is determined that there are essentially four types of bronchial carcinoma (lung cancer). The most common type is plate epithelial carcinoma originating from epithelial (secretory) cells and adeno carcinoma originating from glandular cells, and they are seen with a total frequency of 70 to 75 percent. Approximately 20 percent of tumors are of the small cell carcinoma (lung cancer) type. In addition to these, large cell carcinoma (lung cancer) and other rare lung cancers are also seen at a rate of 10 percent. However, for treatment planning, a distinction is made only between non-small cell and small cell lung cancer (bronchial carcinoma) groups. In the non-small cell lung cancer group, adeno carcinomas, plate epithelial carcinomas and large cell carcinomas are collected. However, it is expected that in the future, especially with the help of increasingly improved molecular biology methods, lung cancer subtypes will be characterized and addressed separately. Based on this, there is hope that treatment options will be developed that are tailored to the biology and growth regulation of the tumor.

Akciğerde iyi huylu tümörler de oluşabilirler, örneğin lifli bağ dokusundan,kıkırdak dokusundan veya yanlış oluşmuş dokulardan. Ama bunlar pek enderdir ve yüzde 10’un altındadır. İyi huylu tümörlerin bir belirtisi, genellikle yavaş büyümeleri ve sağlıklı dokuyu bulundukları yerde basıya uğratmaları, ama onları öldürüp yok etmemeleridir.

Causes and Risk Factors

Many factors probably contribute to the development of lung cancer, but some factors that increase the individual risk of developing the disease are well known.

If a heavy smoker gives up this habit, the risk of getting sick after quitting smoking drops from 15 times to 5 times compared to a non-smoker within 10 years. 15 years after quitting smoking, this risk only drops to twice that of a non-smoker. This risk decreases even faster in women.

Environmental Factors: Contact with and inhalation of various chemical substances, especially in direct proportion to smoking, can mean an increased risk of lung cancer. Asbestos, arsenic, chromium, nickel, radon and aromatic hydrocarbons are some of these substances, and workers’ protection measures against them play an important role. The very high level of harmful substances in the air outside can slightly increase the risk of lung cancer by approximately 50%. Soot and other fine dusts created by diesel engines are among the important factors in this regard. Nutrition Nutrition is important, especially eating enough fruit clearly protects against lung cancer. However, taking vitamin tablets or other food supplements instead of fruit does not replace this protective effect. Especially smokers should be especially careful with these types of substances: In fact, in studies conducted to show the protective effect of some vitamins, an increase in risk was even detected in smokers when vitamin tablets were taken.

Genetics: It is understood that hereditary factors also play a role in the development of lung cancer. How important this is and how often it actually affects the development of lung cancer has not yet been largely clarified. In this regard, some gene changes have been identified that probably make people more sensitive to certain harmful substances and increase the risk of disease. This is especially the case for smokers.

Risk Groups: The biggest feature that distinguishes lung cancer from other cancers is that it is preventable. Approximately 90 percent of lung cancer cases are related to known causes. Approximately 85 percent of these are related to smoking. In professional life, people can take the most precautions against lung cancer by adjusting their behavior accordingly and taking precautions. The lack of a screening test for early diagnosis brings protective measures to the forefront.

Diagnostic Methods

  • Bronchoscopy

Akciğer kanseri şüphesi halinde en önemli tanısal yöntemlerden biri bronkoskopidir. Bronkoskopinin anlamı, adına bronkoskop denilen nefes borusundan bronşlara ve dallarına sokulabilen ve o yörelerin görüntülenip incelenmesini sağlayan optik bir aletin kullanımı demektir. Bunlarla birkaç milimetre çapındaki bronşiyal dalların içine girmek bile mümkündür. Hastalara sakinleştirici bir ilaç verilir ve burun, boğaz, gırtlak ve büyük bronşların sümüksel zarları bir sprey kullanarak bölgesel uyuşturulur. Bronkoskop aleti ağızdan sokulur. Bazı özel hallerde,örneğin bir tümör bronşları daraltıyorsa, rijit bronkoskop kullanılır. Bu takdir de muayene her zaman tam narkoz uygulanarak yapılır. Bronkoskop içinden geçen bir pens yardımıyla biyopsi yapılır. Bunun anlamı bronş duvarlarının şüpheli yerlerinden doku örneklerinin alınmasıdır. Asıl akciğer dokusundan doku örneği alınması, bronş duvarından sokulan bir iğne aracılığıyla gerçekleştirilir. Alınan şüpheli doku örnekleri patolojik incelemeye tabi tutulur. Eğer  kanser ise tiplendirmesi yani tümör cinsinin kesin karakteristiği tespit edilir. Adına ‘bronşiyal lavaj’ denilen bronşların yıkanması metodu veya bronş duvarından sürterek kazınarak alınan numuneler, mikroskopik incelenme amacıyla dokudan sökülmüş tek tek hücrelerin elde edilmelerini sağlar. Bu tür incelemeye sitolojik inceleme denir ve bu yöntemle dokuda mevcut kansere özgü değişiklikler tespit edilebilir. Hastaların yüzde 70’inden çoğunda alınan doku ve hücre örneklerine dayanarak bir teşhise ulaşmak mümkündür. Örneğin akciğerin dış kesimlerinde yer alan şüpheli bir bölgeye bronkoskop ile ulaşmak mümkün değilse, ince bir iğne ile göğüs duvarına dışarıdan oraya girilerek bir biyopsi yapılır.  BT kontrolü altında uzun ve ince bir iğne şüpheli bölgeye sokulur ve biraz doku emilir. Bu metod son zamanlarda sıkça uygulanmaktadır. Usulüne uygun uzmanca uygulama yapıldığı takdirde hiç komplikasyon olmamaktadır.

  • Hastalığın yaygınlığını tanımlanması

Bronşiyal karsinom olduğu şüphesi tasdik edildiyse ve tümörün cinsi histolojik veya sitolojik olarak belirlendiyse, hastalığın metastazı  (oluştuğu yerden diğer bölgelere yayılıp yayılmadığının) araştırılır. Bu amaçla akciğer kanserinin metastazlarının özellikle yerleştiği bölge ve organlar muayene edilir. Bunlar özellikle karaciğer, böbrek üstü bezleri, kemik, mediastinum bölgesindeki lenf düğümleri, ve beyindir. BT (bilgisayarlı tomografi), Kemik Sintigrafisi ve Ultrason yapılabilir. Bu metod çoğu hallerde hastalığın tespiti amacıyla uygulandığı gibi, bir akciğer kanserinin tam dağılımının tespiti için de daima kullanılır. Bu muayene, tüm göğüs bölgesini ve üst karın bölgesini kapsar ve karaciğer, böbrek üstü bezleri ve lenf düğümlerinin muayenesini sağlar.  Cihazın bilgisayarı her alanın kesit resimlerini hesaplar. Tümörler henüz 5 milimetreden küçük olsalar bile tespit edilebilirler. Bazı hallerde ek olarak ultrason muayenesi de gerekli olabilir. MR özel durumlarda kullanılması gerekmektedir (mediastinum invazyonu, büyük damar tutulumu, posterior sulcus tümörleri ve göğüs duvarı yayılımlarında). 

  • Mediastinoskopi

Lung cancer cells are often carried to other regions via lymph vessels. It is often seen that these cells are collected in the lymph nodes in the mediastinum region. If the lymph nodes are seen to be enlarged (if the axis is larger than 1 cm) especially in computer tomography and the decision on which therapy to apply and whether an operation should be performed depends on the condition of these lymph nodes, imaging of the mediastinum region (Mediastinoscopy) is appropriate. For this, the tissue is cut just above the breastbone under anesthesia and a probe called a mediastinoscope is inserted into the area between the lung wings. With this method, an opinion is reached about whether there is a tumor in that area. It is examined in a separate section on our website. Positron Emission Tomography, abbreviated as PET, provides information about the metabolic movement in the tissues. PET is more successful than CT in imaging the lymph nodes, especially in the area called mediastinum, between the heart and lungs. If the PET examination gives a negative result, it is very likely that there is no involvement of the lymph nodes. If PET is positive, tissue diagnosis is needed. The PET-CT device, which combines the positive aspects of PET and CT methods and applies them in a single process, gives more successful results, especially in terms of anatomical location. This method is currently applied in a small number of treatment centers. This method has entered the field of routine diagnostic use.

Staging

  • Search for metastases

Especially in the case of small cell lung cancer or before the planned operation of regionally advanced non-small cell lung cancer, a computer tomography of the brain with the help of contrast material or a bone scintigraphy may be appropriate. MRI is especially valuable if CT (computer tomography) does not show any findings in patients with symptoms of brain metastasis. A bone scintigraphy is performed in case of suspected bone metastasis. Technetium (a metallic element) is given to the blood vessels with a solution based on phosphate and accumulates in the diseased bones. The areas where this element accumulates can be viewed with the help of a special camera on the body, because the technetium used emits rays for a short time. However, since the bone scintigram shows increased bone metabolism, including benign changes, an X-ray examination or MRT examination is necessary for a more reliable diagnosis. PET is very valuable in bone metastases. If staging is to be done with PET, other examinations are unnecessary. Checking the general health status Before performing an operation, it is necessary to decide whether the general health status of the patient is suitable for a surgical procedure and to what extent the lung tissue will be excised or radiotherapy will be applied. The examinations to be performed for this purpose include a careful examination of the respiratory function and an electrocardiogram (ECG). In lung function tests, the one-second volume and total capacity in active exhalation are the most important data.

Disease Stage: The examinations described above take into account the spread of the tumor according to the TNM system, its size and local (regional) spread (T), recurrence to the lymph nodes (N, Nodule) and metastases (M). The numbers behind the letters provide information about the size and distribution (T1-4), the number and position of the diseased nodes (N0-3) and the presence or absence of distant metastases (M0 or M1). For example, T1 N0M0 means a small tumor that has not spread to the lymph nodes and has not formed metastases. The stage of this disease determines the treatment method. The exact determination of the TNM stage is only possible after the tumor is surgically removed. In this case, a small “p” letter will be included in the pathologist report regarding the TNM stages and it means that it is pathologically proven, for example pT1pN0pM0. Treatment planning The type of cancer, the stage of the disease and the patient’s general health score determine the treatment. It is also very important whether the lung cancer is small cell or not. In non-small cell cancer, surgery is necessary if possible, in small cell lung cancer, surgery is performed in Stage Ia. It is possible to treat with radiation, namely radiotherapy, and with substances that slow down cell growth, namely chemotherapy. These are applied either alone or in addition to the operation method, depending on the situation. Chemotherapy is given priority in small cell cancer. If the patient’s general health is not good, especially if the efficiency of the heart and lungs is weakened, some forms of therapy can only be applied to a limited extent or not at all, otherwise they will be very tiring for the patient with lung cancer. The physiological age of the patients does not actually play an important role in this regard. Chronological age does not constitute a contraindication for surgery, that is, it is not an obstacle to surgery. Lung cancer treatment should be performed by experienced clinicians and physicians.

Treatment

If local cancer is identified in staging studies, if the patient’s general condition and especially the heart and lung function are suitable for surgical intervention, surgery is always the first option in non-small cell lung cancer. In contrast, surgery is not the first option in small cell lung cancer, except in the very early stages.

The aim of the operation is to completely remove the tumor (complete resection) by taking the healthy lung tissue around the tumor. Within the scope of the operation, the diseased lung lobes, the lymph nodes in the hilar and mediastinum regions are also scraped (lymph node dissection) and examined later for tumor. In order for it to be complete, there should be no tumor in the border areas of the lymph node farthest from the tumor. The most common type of operation is to cut and remove the diseased lung lobe (Lobectomy).

If the tumor has exceeded the border between the two lobes, both lobes are cut and removed (Bilobectomy). In large tumors and tumors in the main bronchus region near the lung entrance (central, central), one of the lungs may be removed (Pneumonectomy). However, due to the higher risk of the operation and the effects of pneumonectomy surgery, this surgical procedure should only be performed in cases that have been carefully considered and planned.

Organ-preserving surgery (Sleeve Resections): Today, lung surgeons perform operations aimed at preserving as much of the lung tissue as possible. If there is healthy lung tissue behind a tumor in a central location of the lung and the supply of this tissue will be cut off as a result of the operation, the ends of the cut bronchi and possibly the large blood vessels can be reattached and stitched together (bronchoplastic operation and angioplastic operation). In this way, the remaining lung parts can be fed with air and blood again and their functions can be preserved. If the tumor has spread to the organs and tissues adjacent to the lung, these are also removed with the operation. If there is no spread to the lymph nodes, chest wall, aorta, diaphragm and caval vein resections and constructions can be performed. They are examined separately under the title of Extended Lung Surgeries on our website. How the situation really is and how wide the operation should be performed can only be seen during the surgical procedure. The ability of the remaining lung to recover A lung that has been slightly damaged before the operation, the removal of lung tissues; The decrease in the respiratory surface due to functional surface loss can be compensated to a certain degree, even if the number of cells does not increase, this is achieved by increasing the surface due to the expansion feature of the lung. The remaining lung tissue expands to compensate for the lost part and thus, severe shortness of breath usually does not occur after the operation.

Adres

Kazımdirik Mah. 184 Sk. No:63 K:1 D:1 Bornova / İZMİR/TÜRKİYE

Phone Number

LEGAL INFORMATION

This site is designed for informational purposes only. No treatment method can be applied to a patient without being examined by a doctor, without examining the tests and making a detailed evaluation.