metastatic pleural tumor
Introduction
Introduction to metastatic pleural tumor Metastatic pleural tumor often causes exudative malignant pleural effusion, suggesting that the patient has a systemic metastatic disease with a very poor prognosis. Treatment of pleural metastases includes treatment of primary tumors and treatment of pleural metastases. The former should be given corresponding anti-tumor treatment according to different primary tumor properties. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: pneumonia, pleural effusion
Cause
Metastatic pleural tumor etiology
Causes:
Most of the pleural tumors are metastatic tumors, the main source is lung cancer pleural metastasis (36%), followed by breast cancer, lymphoma, ovarian cancer, gastric cancer and sarcoma, especially melanoma. Malignant pleural metastasis can cause malignant pleural effusion, 6 % of patients with malignant pleural effusion never found primary cancer, and 3 of 3 tumors metastasized to the pleura, causing malignant pleural effusion, accounting for 75% of all cases of malignant pleural effusion; 30% of lung cancer, 25% of breast cancer, 20% of lymphoma Metastatic ovarian cancer accounts for 6%, sarcoma, especially melanoma accounts for 3%, and 6% of patients with malignant pleural effusion have never found primary cancer.
Prevention
Metastatic pleural tumor prevention
We must maintain an optimistic attitude, establish a spirit of revolutionary heroism, and strengthen nutrition and physical exercise. Studies have shown that an optimistic attitude, good nutrition and proper physical exercise are conducive to keeping people's immune function in optimal condition, giving full play to anti-cancer activity, accelerating recovery and preventing recurrence. Certain foods or fruits and vegetables such as mushrooms, glutinous rice, carrots (juice), sweet potatoes, kale, kiwi, etc. may have certain anti-tumor and anti-relapse effects, and may be eaten properly.
Complication
Metastatic pleural tumor complications Complications, pneumonia, pleural effusion
Infection is the most common complication of tumor chemotherapy. It is characterized by rapid development of the disease. Once the infection occurs, it is easy to develop into sepsis. Because the infection often occurs after the leukopenia falls after chemotherapy, the chemotherapy response is not fully recovered, sometimes the primary disease. The symptoms are even more serious than general sepsis, and these clinical features cause diagnostic difficulties. At this time, you may not wait for the test results, you can start treatment, it is best to use broad-spectrum antibiotics, and the dosage should be sufficient, but the course of treatment should not be too long. Do not use sulfa drugs or chloramphenicol. Pay close attention to mixed infections or double infections during treatment.
Symptom
Metastatic pleural tumor symptoms Common symptoms Lymph node enlargement Pleural effusion Pulmonary embolism Chest pain Shortness hypoproteinemia Malignant pleural effusion Exudative pleural hemoptysis
About 50% of patients with pleural metastases have malignant pleural effusion. The most common symptom is shortness of breath. Only 25% of patients with malignant pleural effusion have chest pain, usually blunt chest pain. Some symptoms are related to the tumor itself, such as weight loss, general malaise and anorexia. About 20% of patients have no symptoms when there is pleural effusion. The amount of pleural effusion varies from a few milliliters to a few liters, making the patient's chest completely turbid and the mediastinum moving to the opposite side. If one side of the chest becomes paralyzed and the mediastinum is not displaced, the patient may There are bronchial lung cancer with main bronchial obstruction or tumor involving the mediastinum to fix it, or malignant pleural mesothelioma; if the mediastinum moves to the side of the pleural effusion, it indicates that the negative side of the affected side is higher than the healthy side, and pleurodesis is difficult to work.
In the process of disease development, about 50% of patients with bronchogenic lung cancer have pleural effusion, all cell types can cause pleural effusion, but the most common is adenocarcinoma. The pleural effusion of lung cancer patients is mostly on the same side as the primary tumor, and there are also bilateral.
Examine
Examination of metastatic pleural tumors
1. Pleural cytology
According to clinical observations, the accuracy of pleural cytology for the diagnosis of malignant pleural effusion is 40% to 87%. There are many factors that can affect cytology:
1 If the pleural effusion is not caused by the metastasis of the malignant tumor to the pleura, but secondary to other diseases such as congestive heart failure, pulmonary embolism, pneumonia or hypoproteinemia, the cytological examination of the pleural effusion will not be positive.
2 The nature of the primary tumor determines the results of pleural fluid examination, such as pleural effusion caused by lung squamous cell carcinoma, usually due to bronchial obstruction or lymphatic occlusion, pleural cytology is mostly negative; cytological examination of lymphoma patients 75% were positive, while only 25% of Hodgkin's disease was positive, and the positive rate of pleural cytology was higher than that of sarcoma.
3 The more specimens are collected, the higher the percentage of positive results.
4 If the cell block and pleural effusion of the pleural effusion are sent for examination, the positive rate is higher than that of only one type.
The percentage of 5 positive diagnoses is related to the skill of the laboratory technician.
2. Pleural biopsy
It is generally believed that pleural cytology is more effective than pleural biopsy, but in some cases, pleural cytology is negative, while pleural biopsy is positive, and acupuncture pleural biopsy is diagnosed as pleural malignant lesions accounting for about 40%~ In 75% of cases, in clinical practice, the diagnosis of thoracic malignant lesions should be diagnosed first. For exudate, cytology should be performed first. When the test result is negative, the patient should be puncture pleura. Biopsy, and send a pleural effusion specimen for cytology.
3. Other diagnostic tests
In recent years, it has been proposed to measure various tumor markers in pleural fluid for the diagnosis of malignant pleural fluid, including carcinoembryonic antigen, immunosuppressive acidic protein, carbohydrate antigen IgG, tissue polypeptide antigen, alpha-fetoprotein, alpha-acidified glycoprotein and 2-2-globulin, it is generally believed that the average content of these tumor markers is higher than benign effusion in malignant pleural effusion, but the content of any of these markers is increased due to the overlap between the two groups of markers. Can not be used as a basis for the diagnosis of malignant pleural effusion. In recent years, immunohistochemical staining of pleural effusion cells with a group of monoclonal antibodies is promising for the diagnosis of malignant pleural effusion. This method needs to be developed.
Analysis of chromosomes in pleural fluid cells sometimes works. Malignant cells have more chromosomes and labeled chromosomes, ie, structurally deformed chromosomes. Chromosome analysis is more common than conventional cytology in the diagnosis of pleural effusion, lymphoma and pleural biopsy. However, chromosomal analysis of pleural fluid cells may be effective when malignant pleural effusion is still highly suspected.
4. Pleural biopsy
Many patients with exudative pleural effusion have no diagnostic results for pleural cytology, chest puncture or other laboratory tests. In some patients, malignant pleural effusion may still be present. For example, pleural effusion does not cause symptoms, tuberculosis skin test is negative, pleural effusion Gradually absorbed, it can be recommended to observe for 3 months; if the patient has shortness of breath, the symptoms are getting worse, and the weight loss has a history of cancer, the chest should be considered for pleural biopsy. The pleural surface is widely rubbed with gauze during operation to effectively make the pleura. Fixation.
Diagnosis
Diagnosis and differentiation of metastatic pleural tumor
diagnosis
Another key to diagnosis is the stage of the lesion, which is the extent to which the tumor is progressing. Unfortunately, 75% of patients with mesothelioma have been diagnosed at very late stage 3 or 4, and a detailed history of the disease is beneficial to both. The identification of diseases, such as the main cause of malignant pleural mesothelioma, is asbestos exposure. Many people engaged in transportation, mining and insulation contact with asbestos fibers through work, but not only men and women who are in direct contact with asbestos. Malignant pleural mesothelioma has also occurred in indirect contact with asbestos family members by touching the relatives' work clothes.
Differential diagnosis
Different from malignant pleural mesothelioma, malignant pleural mesothelioma is a cancer of the lung capsule or pleura. Due to its anatomical location in the body, the tumor can grow and compress the lungs and displace the anatomical structure in the middle of the chest, including In the heart and the airways, it is worth noting that the enlargement of the tumor can press the diaphragm, which limits the respiratory dynamics. The patient usually visits the pulmonary surgeon for respiratory symptoms, and can perform x-ray examination and CT scan. Provides a more accurate diagnosis than the former, typically showing a thickening of the lung capsule, which can be up to 20 times normal. It can be diagnosed as mesothelioma, and then histological examination, usually thoracoscopic or fine needle aspiration, under the microscope Careful observation of histological diagnosis is not an easy task. From the histological point of view, 10-20% of mesothelioma diagnosis is misdiagnosed. Combined with CT scan, histological diagnosis helps oncologists to diagnose mesothelioma diagnosis.
