Lung cancer in the elderly
Introduction
Introduction to lung cancer in the elderly Primary bronchial-lung cancer, ie Primary Bronchopulmonary Carcinoma, referred to as Lungcancer. Special substances related to the onset of lung cancer in industrial production are asbestos, arsenic, chromium, benzoquinone, coal tar, trichloromethyl ether, heating products of tobacco and strontium and scorpion gas produced by the decay of radioactive materials such as uranium and radium. These factors can increase the risk of lung cancer by 3 to 30 times, such as ionizing radiation and microwave radiation. The prognosis of lung cancer depends on early detection and timely treatment. Early resection of recessive lung cancer can be cured. It is generally believed that squamous cell carcinoma has a better prognosis, adenocarcinoma is second, and small cell undifferentiated carcinoma is the worst. In recent years, comprehensive treatment based on chemotherapy and radiotherapy for small cell undifferentiated cancer has improved the prognosis. basic knowledge The proportion of the disease: the disease is common in middle-aged and elderly men, and the incidence rate of people over 20 years of age is extremely high at around 2%. Susceptible people: the elderly Mode of infection: non-infectious Complications: atelectasis pneumonia
Cause
The cause of lung cancer in the elderly
Smoking (20%):
According to estimates in the United States in 1985, 80% of male lung cancer and 79% of female lung cancer are attributed to smoking, nicotine in smoke, benzopyrene, nitrosamines and a small amount of radioactive cesium are carcinogenic, especially For squamous cell carcinoma and small cell carcinoma, lung cancer can also be induced by cigarette smoke and tar in animal experiments. A rigorously designed retrospective and prospective survey showed that there is a significant dose-effect relationship between smoking and lung cancer. The younger the age, the longer the smoking time, the greater the smoking, the higher the incidence and mortality of lung cancer. Passive smoking or environmental smoking is also one of the causes of lung cancer.
Occupation (20%):
Special substances related to the onset of lung cancer in industrial production are asbestos, arsenic, chromium, benzoquinone, coal tar, trichloromethyl ether, heating products of tobacco and strontium and scorpion gas produced by the decay of radioactive materials such as uranium and radium. These factors can increase the risk of lung cancer by 3 to 30 times, such as ionizing radiation and microwave radiation.
(1) Asbestos in various asbestos industries, including miners, textiles, insulation materials, shipbuilding and other workers in lung cancer, mesothelioma and asbestosis are significantly higher, in the exposure to asbestos intensity, long time workers, lung cancer can be Accounting for 20% of all deceased, male workers working in American shipyards during World War II increased their risk of lung cancer by 60% to 70%. From exposure to asbestos to onset, it usually takes 20 years or more. Asbestos and smoking cause lung cancer. Asbestos workers who have a synergistic effect and are heavily smoked are 90 times more likely to develop lung cancer than non-smokers or non-asbestos workers.
(2) arsenic can cause skin cancer, lung cancer and liver cancer: long-term inhalation of arsenic-containing lung cancer is mainly squamous cell carcinoma, followed by undifferentiated cancer. There have been many reports on occupational cancer caused by arsenic, many of which have been reported. For multiple sites of primary cancer, the amount of inhalation sufficient to induce cancer varies greatly. The average content of oxidized ore in Yunnan tin mines in China is 1%. The arsenic content in the pit-working environment and the insoluble arsenic content in the miners' lung tissue are other. It is considered to be one of the main carcinogenic factors in the region. It is considered to be one of the main carcinogenic factors. The miners are also suffering from lung cancer and skin cancer or arsenic dermatitis. The use of arsenic-containing dust to induce lung squamous cell carcinoma in rats has been obtained. success.
(3) Chloromethyl ether Since the discovery of the production of ion exchange resins in 1973, workers exposed to dichloromethyl ether and methylol ether have a high incidence of lung cancer, which is small cell carcinoma, which is breathed by skin, or subcutaneously injected into the rodent. Animals have a strong carcinogenic effect, commercial grades of methylol ether are often contaminated with chloromethyl ether, and commercial grades of methylol ether are less carcinogenic.
Air pollution (20%):
Whether in the United States or the United Kingdom, the lung cancer mortality rate of urban residents is higher than that of rural areas, and it increases with the degree of urbanization. In the atmosphere of heavy industrial cities, there are 3,4-benzopyrene, arsenic oxide, radioactive substances. Carcinogenic substances such as non-combustible aliphatic hydrocarbons, in large cities with serious pollution, the daily intake of benzopyrene in the air can exceed 20 cigarettes, and increase the carcinogenic effect of cigarettes. 1 ~ 6.2g / 1000m3, the mortality rate of lung cancer can be increased by 1% to 15%.
Diet (10%):
Some studies have shown that people with low levels of beta-carotene in their serum have a high risk of developing lung cancer. Epidemiological survey data indicate that more green, yellow and orange vegetables containing beta-carotene are consumed. Fruit can reduce the risk of lung cancer.
Other factors (10%):
Some lung diseases are associated with the incidence of lung cancer. If there is chronic bronchitis, the incidence of lung cancer is 1 times higher than that of patients without this disease. Adenocarcinoma can occur in the wounds of healed tuberculosis. In addition, viral and fungal infections may be caused by genetic factors. It is related to the occurrence of lung cancer.
Pathogenesis
1. Pathological changes of early lung cancer After bronchial epithelial damage, first the ciliated epithelium disappears, the goblet cells hyperplasia, if the stimulation continues, the columnar mucus cells form square or flat stratified epithelial cells, metaplastic epithelial cells The surface of the 2, 3 layers of cells contains many mucus droplets, but no ciliated epithelium. As time goes on, the epithelium develops into flat and keratinized, forming a heterotypic epithelial metaplasia. In 1978, Trump was experimentally observed. The process of undifferentiated cells to cancer is proposed: under the influence of cancer-promoting factors, epithelial-like metaplasia, cell dysplasia (atypical hyperplasia), further develops into carcinoma in situ, and in situ cancer infiltration breaks through the basement membrane, becoming tiny Invasive carcinoma, epithelioid metaplasia, or normal range of cell proliferation, multi-layered hyperplasia, surface cells flat or mechanized, mostly cuboidal, neatly arranged, normal nuclear and cytoplasmic ratio, when epithelial metaplasia evolved into SARS In the case of type hyperplasia, the cells are arranged in a disorderly manner, the size of the nucleus is different, the nuclear staining is deep, and the nucleolus is seen. Atypical hyperplasia is also called precancerous change, when the mucosal epithelial cells Now sizes, disorganized, nucleus and cytoplasm proportioned nuclear chromatin deep, it is in situ, invasive carcinoma in situ, and the minute average of early pathological changes in lung cancer lines.
2. Anatomical classification of lung cancer
(1) Central type lung cancer The cancer that occurs above the segmental bronchi to the main bronchus is called the central type, accounting for about 3/4. Squamous cell carcinoma and small cell undifferentiated carcinoma are more common.
(2) Peripheral lung cancer The cancer that occurs below the segmental bronchus is called the peripheral type, accounting for about 1/4, and it is more common with adenocarcinoma.
3. Histological classification of lung cancer
At present, the histological classification of cancer is still not very uniform at home and abroad, but most of them are classified into squamous cell carcinoma, small cell undifferentiated carcinoma, large cell undifferentiated carcinoma and adenocarcinoma according to the degree of cell differentiation and morphological characteristics.
(1) Squamous cell carcinoma (epidermal carcinoma): a malignant epithelial tumor with keratinization and/or intercellular bridge, classified into 3 grades according to the degree of histological differentiation:
Highly differentiated: with histological and cytological features, such as stratification, clear cells, inter-bridge and keratinization, and angular bead formation.
Moderate differentiation: between high and low differentiation.
Poor differentiation: Tumors have keratinization and/or inter-bridge, but most are characterized by undifferentiated or refractory squamous cell carcinoma.
Squamous cell carcinoma is the most common form of lung cancer. The pathogenesis of squamous cell carcinoma is closely related to smoking. Most of them are male smokers. The age is over 50 years old. The progress is slower in various types of lung cancer, and the distant metastasis rate is lower, 5 years. The survival rate is higher, but for radiotherapy (referred to as radiotherapy), chemical drug treatment (referred to as chemotherapy) is not as sensitive as small cell undifferentiated cancer, squamous cell carcinoma invades the bronchial mucosa early, gradually proliferates into the lumen, causing bronchoconstriction in early stage, resulting in Atelectasis, pneumonia or lung abscess, cancer tissue can also infiltrate and develop around the bronchus, the invaded bronchial mucosa can also be necrotic, ulcer, hemorrhage, squamous cell carcinoma occurring in the peripheral area of the lung, 10% to 15% of the cancer center Necrosis occurs in the department and voids form.
(2) Small cell carcinoma can be divided into three subtypes:
1 Oat cell carcinoma: a malignant tumor consisting of uniform small cells, generally larger than lymphocytes, the core is densely round or oval, the chromatin is dispersed, the nucleoli are not obvious, and the cytoplasm is very rare. Biopsy specimens are often deformed by extrusion. Under electron microscopy, the cytoplasm contains dense axial particles or features poorly developed desmosomes.
2 intermediate cell type: a malignant tumor composed of small cells, the characteristics of the nucleus are similar to that of oat cell carcinoma, but the cytoplasm is rich, the cell morphology is irregular, and it can be polygonal or fusiform, histology and biology. Features are similar to oat cells.
3 composite oat cell cancer: a tumor with clear oat cell cancer components and squamous cell carcinoma and/or adenocarcinoma components.
Small cell carcinoma is a kind of undifferentiated carcinoma, which often occurs in the main bronchus or leaf bronchus. It is the most common type of lung cancer. It grows under the mucosa in the early stage of the bronchi, and the covered mucosa epithelium rises slightly and the fold disappears. However, the epithelium is intact, and it is difficult to detect exfoliated cells in the sputum. Therefore, fiberoptic bronchoscopy is important for early detection. This cancer is poorly differentiated, grows rapidly, and spreads quickly through lymph and bloodstream. The tumor can also directly infiltrate. To the mediastinum.
(3) Large cell carcinoma is a malignant epithelial tumor with large nuclei, obvious nucleoli, abundant cytoplasm, clear cell boundaries, no squamous cell carcinoma, small cell carcinoma and adenocarcinoma. The closely arranged tumor cells are more uniform. Arranged loose, cancer cells are often polymorphic, divided into 2 types:
1 giant cell carcinoma: a subtype of large cell carcinoma: with highly anatomical megakaryocytes and multinucleated cell components, tumor cells can be highly deformed, and cytoplasm can contain polynuclear leukocytes, which does not include giant cells with tumors. Squamous cell carcinoma and adenocarcinoma.
2 clear cell carcinoma: a rare type of large cell carcinoma, the cell cytoplasm is transparent or foamy, no mucus, with or without glycogen.
This type does not include squamous cell carcinoma and adenocarcinoma with clear cells. Renal cancer metastasis should be excluded at the time of diagnosis. Large cell cancer metastasizes smaller cells without differentiated cancer, and the chance of surgical resection is greater.
(4) Adenocarcinoma is divided into the following subtypes:
1 acinar adenocarcinoma: mainly glandular structure, that is, acinar, glandular tubular with or without a nipple or physical area.
2 papillary adenocarcinoma: adenocarcinoma with papillary structure.
3 bronchiole-alveolar cell carcinoma: an adenocarcinoma in which columnar or high columnar tumor cells grow along the original alveolar wall.
4 solid cancer with mucus formation: a poorly differentiated adenocarcinoma, lacking acinar and papillary structures, but containing mucus vacuoles in many cancer cells, histological features are large nuclear, obvious nucleoli, rich in cytoplasm, Closely arranged, this type is differentiated from large cell cancer with mucus formation. Special attention should be paid to the possibility of excluding metastatic cancer when diagnosing adenocarcinoma.
Adenocarcinoma is common in women and occurs in the peripheral part of the lung. It may be related to chronic inflammation of the lungs and scars in the lungs. It has little relationship with smoking. It is easy to metastasize to the liver, brain and bone, and it is more likely to involve the pleura and cause pleural effusion.
(5) Other types:
1 Adenosquamous carcinoma is a kind of cancer with adenocarcinoma and squamous cell carcinoma. It is generally observed that its biological behavior is similar to that of adenocarcinoma. The proportion of this type in various types of lung cancer is gradually increasing, and it is receiving more and more attention.
Type 2 cancer is an endocrine system tumor derived from Kultschitzky type cells.
The tumor is often central, the cells are polygonal, the cytoplasm is translucent or eosinophilic, the size of the nucleus is elliptical, the nucleolus is obvious, the mitotic figures are rare, the cells are mosaic or trabecular, lung cancer The argyrophilic staining Fontana-Masson staining may be negative, and in most cases, the argyrophilic staining may be positive, the tumor may be multiple, the type is low-grade, the tumor is small, usually without carcinoid syndrome, and rarely extrapulmonary Transfer.
Prevention
Elderly lung cancer prevention
Third-level prevention
Primary prevention: also known as etiological prevention, is a preventive measure for the cause and risk factors. Lung cancer prevention and research research has an extremely important position in epidemiology, etiology and early diagnosis and treatment, and establishes a research institute for lung cancer prevention and control. Publicity and education on prevention and treatment of lung cancer, adopt various publicity methods, popularize prevention and treatment of lung cancer, and strengthen control over known carcinogenic factors: formulate environmental protection regulations, establish air pollution monitoring agencies, and strictly control industrial three waste pollution in order to achieve The purpose of air pollution, radiation pollution should also be strictly controlled, control smoking, vigorously promote the risk of smoking caused by smoking, prohibit the smoking of minors, prohibit smoking in public places or poorly ventilated confined rooms, the smoking index (daily Heavy smokers with a combined smoking and smoking years of more than 400 are regularly inspected to establish a three-proof (anti-cancer, anti-mite, dust-proof lung) follow-up card; various forms of propaganda can be used to reduce lung cancer after smoking cessation Incidence, encourage smoking cessation, especially for workers exposed to occupational lung cancer factors, Recognizing that smoking and occupational carcinogenic factors have additive or even multiplying effects, carry out epidemiological investigations of occupational lung cancer, reform the process, do a good job in smoke prevention, dust prevention, and antifouling, and minimize and avoid workers. Contact with engineering and technical personnel to know the known occupational carcinogens. In the food, you should always take carrots, spinach and other vegetables rich in vitamin A, vitamin C, pumpkin, fresh pepper, etc., to prevent lung cancer from having a certain effect.
Secondary prevention: Because lung cancer has a long pre-clinical period and atypical symptoms and signs, it is necessary to conduct lung cancer screening for high-risk groups such as long-term smokers over 40 years old and occupational exposure to carcinogens. The census method can be divided into three types. : Imaging examination, that is, chest X-ray or chest X-ray examination, seeking to check once a year; cytological examination, that is, sputum exfoliative cytology, more than three series of sputum specimens can improve the diagnosis rate of central lung cancer to 80%; serological tests, such as hormones, enzymes, antigens and carcinoembryonic antigen (CEA) levels, CEA positive rate in lung adenocarcinoma of 60% to 80%, can be considered as a serum marker for small cell carcinoma.
Tertiary prevention: Chronic inflammation of the respiratory tract and other chronic respiratory diseases can cause squamous metaplasia of the tracheal epithelium. Therefore, active prevention and treatment of precancerous conditions and precancerous lesions have certain significance in preventing lung cancer.
2. Risk factors and interventions
Through extensive research work on the epidemiology and etiology of lung cancer, it fully reflects that the occurrence of lung cancer is closely related to environmental factors. Therefore, it is possible to reduce lung cancer by controlling and eliminating various carcinogenic factors known in the human body and in the environment. Incidence and mortality, vigorously train and train lung cancer prevention and treatment research professionals, establish a lung cancer prevention and treatment network, manage lung cancer factors in high-incidence areas, high-risk populations, and conduct regular comprehensive inspections of high-incidence populations.
Strengthen the legal system, formulate environmental protection laws and regulations, and uniformly plan and rationalize the newly-built industrial and mining enterprises, and strictly review the design plans. It is necessary to have perfect measures to eliminate the pollution of the three wastes before permitting construction and construction, and minimizing pollution. Carry out technological transformation of existing enterprises, comprehensively manage the three wastes, turn harm into profits, set standards, and strictly control the concentration of harmful substances in the production environment.
Vigorously promote the harm of smoking, encourage smoking cessation, strengthen the labor protection of occupational exposure to carcinogens, and reduce the risk of lung cancer.
3. Community intervention
Using bulletin boards and other forms to promote smoking has the risk of causing lung cancer, prompting citizens to ban smoking or quitting smoking, promoting the harm of smoking to the fetus, and vigorously promoting pregnant women to quit smoking; eating more vitamin A, C, -carotene, etc. Fresh fruits and vegetables have a certain effect on the prevention of lung cancer.
Enhance the people's awareness of environmental protection, plant flowers and trees, beautify and improve the environment, reduce air pollution, develop electric vehicles, electrify civilian fuels, develop solar energy, and apply harmless energy.
Complication
Elderly lung cancer complications Complications of atelectasis
The main complications were atelectasis, obstructive pneumonia, superior vena cava syndrome and tumor accompanying syndrome.
Symptom
Older lung cancer symptoms Common symptoms Loss of appetite, cancerous fever, hoarseness, dullness, weakness, chronic cough, nausea, chest tightness, chest pain, dizziness
The clinical manifestations of 88% of lung cancer patients are related to the development of the primary tumor and the location of the tumor, the size of the tumor, the impact on the bronchus, whether the adjacent trachea is invaded or oppressed, whether the distant organ has metastasis, whether there is Different factors such as ectopic endocrine characteristics occur, and various clinical manifestations appear.
Symptom
(1) Cough: mainly caused by tumor or its secretions stimulating the bronchial mucosa, usually the first symptom of lung cancer, the central type of lung cancer is more prominent, and the tumor has paroxysmal stimulation when the bronchial wall is invasively growing. Sexual cough, also known as dry cough, no sputum or a small amount of white foamy sticky sputum, sputum can be purulent after mixed infection, sputum can also increase, if the tumor is located on the small bronchial mucosa, often no cough or Cough is not obvious, so peripheral lung cancer with cough as the first cause is less than central lung cancer.
(2) hemoptysis and blood stasis: hemoptysis is one of the first symptoms of lung cancer. Among the patients, hemoptysis is the first symptom, accounting for 35.9%. It is characterized by intermittent small amount of blood stasis, often more blood than sputum, bright red color, occasionally large hemoptysis. The duration is different, generally shorter, only a few days, but also for several months. In the pathogenesis of central lung cancer, because the tumor grows on the bronchial mucosa, its surface is rich in blood vessels, and when the cough is broken, the blood vessels collapse. Therefore, hemoptysis often occurs in the early stage of central lung cancer. Peripheral lung cancer is rare when the tumor is small. When the tumor is enlarged to a certain extent, the tumor center is necrotic and accompanied by hemorrhage.
(3) fever: lung cancer with fever as the first symptom accounted for 21.2%, fever is divided into two types, one is due to bronchial obstruction or inflammatory fever caused by luminal compression, central lung cancer is often due to larger bronchi Tumor obstruction or stenosis causes distal bronchial endocrine retention to cause infection and fever; in some lung cancer patients, the cause of fever is difficult to explain with the above reasons, even if anti-inflammatory treatment, fever does not retreat, this is called cancerous fever, clinically often seen lung cancer The patient starts from fever or so-called infection. After X-ray fluoroscopy, he is treated with the diagnosis of intrapulmonary infection and can obtain temporary effects. However, when X-ray is reviewed, the intrapulmonary shadow will not completely disappear. If the patient has pneumonia repeatedly in the same site, the possibility of bronchial lung cancer should be highly suspected.
(4) Chest pain: early stage of lung cancer, usually with occasional chest tightness, pressure or dull pain, which may be due to the tissue invaded by the tumor, bronchial obstruction, atelectasis, wall pleural traction, may cause reflex Chest pain, peripheral lung cancer patients with chest pain, back pain, shoulder pain, upper limb pain, intercostal neuralgia, etc. as the first symptom of the patient accounted for 24%, so it must not be easy to press "shoulder joint inflammation", "cervical spondylosis", If you are treating "neurological chest pain", be sure to be alert to any lung lesions.
(5) Chest tightness, shortness of breath: When the tumor is in the leaf bronchus or the main bronchus, the big bronchi is suddenly blocked. Although the disease is not advanced, there are symptoms such as chest tightness, shortness of breath, diffuse bronchioles and alveolar carcinoma and bronchial disseminated adenocarcinoma. Frequent anxious, the former is even worse, because the alveolar epithelium has become cancer cells, ventilation / blood flow ratio is severely abnormal and diffuse dysfunction.
(6) supraclavicular lymph node enlargement and hoarseness: ipsilateral or contralateral supraclavicular lymph node metastasis means that there is extensive metastasis of mediastinal lymph nodes, which is undoubtedly advanced, vocal cord paralysis and hoarseness in the affected side due to mediastinal lymphatic metastasis or cancer of lung cancer The tumor directly invades the recurrent laryngeal nerve. In the past, this type of patient was considered to be a stage III lung cancer, which is not suitable for surgery. Many scholars today still have surgery.
(7) superior vena cava syndrome: When the tumor directly invades the superior vena cava, or the metastatic lymph node compresses the superior vena cava and the azygous vein, the venous return is blocked, which may cause dizziness, vertigo, chest tightness, head and neck edema and other symptoms. Body can be seen swelling of the head and face and neck, conjunctival congestion, edema, lip blemishes, neck and chest wall venous engorgement.
(8) Invasion of the cervical sympathetic plexus and brachial plexus: more common in the lung cancer, when the tumor invades the sympathetic ganglia near the 7th cervical vertebra and the lateral side of the first thoracic vertebrae, it can cause Horner's disease, manifested as the affected side The eyeball is sunken, the upper eyelid is drooping, the pupil is narrowed, and the cleft palate is narrow. At the same time, the compression symptoms of the brachial plexus can be generated. The upper limb has a burning pain, and it radiates from the medial side of the ankle to the distal end, and the local skin feels abnormal.
(9) pleural metastasis: more common in undifferentiated carcinoma and adenocarcinoma, less squamous cell carcinoma, as a result of direct invasion or planting of lung cancer, the diagnostic measure is puncture and drainage cytology, clinically often manifested as pleural fluid growth is extremely fast, After pumping for 2 to 3 days, it will increase again. Blood cells can often be found in bloody pleural fluid. Non-blood pleural fluid can not exclude cancer. It may be due to less pleural cancer.
(10) Hematogenous metastasis: common sites of hematogenous metastasis are bone, liver, brain, followed by kidney, adrenal gland, subcutaneous tissue and so on.
1 Bone metastasis: the common bones are ribs, vertebrae, skull, humerus, humerus, etc. Among them, ribs have the most metastasis, local pain first appeared, often before the bone destruction 1 to 2 months, turned into local severe intractability Pain, spinal metastases can oppress or invade the spinal cord causing paraplegia.
2 liver metastasis: manifested as loss of appetite, nausea, weight loss, liver pain, sometimes jaundice, the main feature of the diagnosis is that the liver is progressively increased in a short period of time, the normal contour disappears, the flexibility is inconsistent, and there are nodules. When the metastases are larger than 2cm, ultrasound and CT can be detected, serum alkaline phosphatase can be progressively increased, often more than 20 gold units, -glutamyltranspeptidase (-GT) may be positive, Transaminase and other liver function changes are not obvious, and patients often die in a short period of time.
3 brain metastasis: the prognosis is very poor, generally more common in the increase of intracranial pressure, often have severe headache, jet vomiting or inner ear vertigo, after metastasis to the cerebellum, there may be ataxia, finger nose, eye test The knee sputum test is positive, sometimes there are hemiplegia, convulsions, nystagmus, diplopia and other symptoms. Even a few cases may have hallucinations, delusions, personality changes and other symptoms, sometimes the first symptoms are convulsions and sudden fainting, CT, MRI Helps to confirm the diagnosis.
4 kidney, adrenal gland and subcutaneous metastasis: Addison syndrome can occur when the adrenal gland metastasis, subcutaneous nodules can occur when subcutaneous metastasis.
2. Extrapulmonary symptoms
Ectopic hormones and similar substances secreted by lung cancer have been found, mainly adrenocorticotropic hormone (ACTH), antidiuretic hormone (ADH), gonadotropin (GTH), calcitonin (CT), serotonin (-HT). ), insulin analogs, renin-like substances, etc., can cause corresponding clinical manifestations.
(1) Carcinoid syndrome: serotonin (serotonin) caused by skin flushing, diarrhea, edema, wheezing and paroxysmal tachycardia, as well as black acanthosis and dermatomyositis, excessive skin toe Keratosis, scleroderma, and embolic phlebitis, non-bacterial embolic endocarditis, thrombocytopenic purpura, capillary oozing anemia, and other extrapulmonary manifestations.
(2) Cushing's syndrome: it is the result of the secretion of adrenergic corticosteroids from undifferentiated cell carcinoma. The clinical manifestations are centripetal obesity, purple streak, multi-blood, osteoporosis, etc. The activity of large molecular weight ACTH due to cancer cell differentiation is only 1/10 of that of pituitary ACTH. In order to identify, it is necessary to pay attention to other metabolic abnormalities, such as hypokalemia accompanied by hypochlorine alkalosis and elevated blood glucose. And diabetes.
(3) Undifferentiated cell carcinoma: especially oat cell cancer can still secrete antidiuretic hormone (ADH), causing inappropriate "antidiuretic hormone secretion syndrome", which is characterized by hypoosmolar hyponatremia. Clinical manifestations of excessive water and water poisoning symptoms, severe cases of cerebral edema, persistent sodium excretion in the urine, without kidney, adrenal failure, treatment only for sodium deficiency, must limit water intake, and supplement With a strong diuretic to get results.
(4) Some lung cancers produce ectopic prostaglandins, which may have hypercalcemia, which is common in squamous cell carcinoma. Patients present with drowsiness, anorexia, nausea, vomiting, weight loss and mental changes.
(5) ectopic gonadotropin syndrome: mainly manifested in male breast development and precocious puberty, female menstrual disorders, multiple ovarian cysts, plasma luteinizing hormone (LH) and follicle stimulating hormone (FSH) increased.
(6) ectopic growth hormone syndrome: mainly manifested as pulmonary primary hypertrophic osteoarthrosis, joint swelling of the limbs, pain, periosteal hyperplasia, clubbing (toe) and acromegaly, plasma growth hormone up to 20mg /ml, normal is 5-9 g/ml.
(7) In addition to this there are some special performances, such as neuromuscular system: cerebellar cortical degeneration, movement disorders, encephalopathy, dementia, nystagmus, myasthenia gravis, polyneuritis.
3. Signs
Early lung cancer chest examination can be characterized by partial airway obstruction and signs of pulmonary infection. At the time of auscultation, localized or unilateral wheezing sounds and dry, wet snoring sounds, lung breath sounds weakened or disappeared, and percussion was voiced or real. When the sound is considered, it is considered to be caused by partial or complete atelectasis and involvement of the pleura. When the tumor infiltrates into the extrapulmonary tissues, the body can be swollen and the supraclavicular or axillary lymph nodes are swollen; when the mediastinal lymph nodes enlarge the superior vena cava It is characterized by head and face, upper limbs and chest congestion and edema, neck swelling, jugular vein engorgement, lung tip lung cancer, compression of the cervical sympathetic nerve caused by ipsilateral pupil dilation, upper eyelid ptosis, frontal sweat and other signs, advanced lung cancer Forming intracranial, bone, abdominal organ metastasis occurs when strong, hemiplegia, cerebellar orientation and dysfunction, neuromuscular disease, disturbance of consciousness, fractures and jaundice, ascites and other systemic symptoms, chronic consumption can cause anemia, edema and cachexia status.
Be alert to lung cancer when the following symptoms occur.
1 irritating cough lasts for 2 to 3 weeks, the treatment is ineffective; or the original chronic cough, cough properties change.
2 Continued sputum with blood for other reasons can not explain.
3 localized wheezing, no change after coughing.
4 repeated pneumonia in the same part.
5 unexplained lung abscess, anti-inflammatory effect is not good, no foreign body inhalation incentives, no symptoms of poisoning, a large number of purulent.
6 Unexplained joint pain and clubbing (toe).
Local emphysema on the 7X line, segment, lobe atelectasis, isolated round lesions and unilateral hilar shadow thickening, increased.
8 The original stable tuberculosis lesions, while the treatment, the shadows are enlarged, or eccentric cavities are formed, or new lesions appear, and those with negative sputum examinations.
9 unexplained migration, embolic lower extremity phlebitis.
Examine
Examination of lung cancer in the elderly
Cytological examination
It is generally believed that the positive rate of central lung cancer sputum detection is higher than that of peripheral type. If sputum specimens are collected properly, more than 3 times of sputum samples can increase the diagnosis rate of central lung cancer by 80%, cytological diagnosis and pathological histology of small cell lung cancer. The diagnostic rate was the highest, followed by squamous cell carcinoma, and the adenocarcinoma had the lowest coincidence rate. The main reason was that some poorly differentiated adenocarcinoma, squamous cell carcinoma and large cell undifferentiated carcinoma had certain difficulties in identification, and sometimes it was difficult to determine the positive rate. The level of the specimen depends on the quality of the specimen and the number of inspections. It is generally considered that the inspection is carried out 4 to 6 times.
2. Bronchoscopy
Fiber endoscopy has developed rapidly and has become one of the indispensable examination methods for many visceral diseases. Fiberoptic bronchoscopy can be performed under local anesthesia, easy to operate, less painful for patients, large visual range, main bronchus, leaf bronchus, Segmental and sub-bronchial lesions can be seen and can be taken biopsy, brush, photos, not only can diagnose lung cancer, but also determine the nature and extent of precancerous lesions, has become a routine method in the diagnosis and treatment of lung cancer, trachea The tumor inside is diagnosed by biopsy, brushing or rinsing to obtain cytological examination. Peripheral tumor can also be diagnosed by fluorescence-guided transbronchial aspiration. In recent years, it can be developed by microscopic injection or laser treatment. The main complications of biopsy are bleeding, throat, hypoxemia, pneumothorax and infection.
3. Thoracic needle biopsy
Transthoracic needle biopsy diagnosis is more reliable than suspected peripheral lesions than bronchoscopy, usually under fluoroscopy, if the lesion is close to the chest wall under ultrasound guidance, if the lesion is not under fluoroscopy It is easy to see or close to the large blood vessels of the deadly organs. Acupuncture biopsy is better under CT guidance. The common complication of transthoracic needle biopsy is pneumothorax.
4. Open chest biopsy
Open-chest biopsy is the most invasive method of examination, but open-chest biopsy is sometimes necessary when other methods cannot make a positive diagnosis. For an isolated nodule with pulmonary parenchyma, unless radiation or clinical can be positive, " The attitude of observing waiting is not advisable for lung cancer. If the patient is generally in good condition, open chest biopsy, lung cancer can be transferred to regional lymph nodes and systemic spread even if the tumor diameter is less than 2cm.
5. Serological examination
Serum and excised tumor tissues of some lung cancer patients contain one or more biologically active substances such as hormones, enzymes, antigens and carcinoembryonic antigens, among which neuron specific enolase (NEC) is positive in small cell carcinoma. The rate can reach 100% and the sensitivity is 70%. It is closely related to the stage of disease and tumor burden. It can be considered as a serum marker of small cell carcinoma. The positive rate of carcinoembryonic antigen (CEA) in lung adenocarcinoma is 60%-80. %, reflecting changes in the condition, but the above tests are lack of specificity and only have reference significance.
6. Video room inspection
In the imaging diagnosis of lung cancer, the most basic is chest X-ray film, and tomography is a supplementary examination method for chest radiograph, but we also have to admit that with CT, MRI on the basis of traditional chest X-ray diagnosis, lung cancer The diagnosis of characterization, positioning, and staging has been greatly improved.
(1) X-ray findings of lung cancer:
1 Central type lung cancer:
A. Tumor signs: The stenosis of the bronchial lumen and the surrounding wall lumps of the lesion can be displayed on the body layer, and the soft tissue mass shadow that can not be clearly displayed on the chest radiograph can be displayed on the chest slice. The bronchial layer can be expressed on the slice. The bronchial lumen is a rat tail, or the bronchial lumen is limited to a circular stenosis; it can also be seen that the bronchial cavity is suddenly cup-shaped; or the bronchial lumen is occluded, gradually becoming thinner, funnel-shaped, often centered on one side .
B. Signs of bronchial obstruction:
a. Localized emphysema: It is an early sign of central lung cancer, which is characterized by an increase in lung volume in the affected area, an increase in the brightness of the lung field, and a rare lung texture.
b. Obstructive pneumonia: 60% to 80% of central lung cancer occurs in the segmental bronchus, part of which involves leaf bronchus, and the chest radiograph shows a thin shadow of segment or leaf distribution with deeper lung texture.
c. Atelectasis: tumor enlargement, combined with inflammatory secretions and edema caused by complete bronchial obstruction, the direct signs of atelectasis are: interlobular displacement, obstructed lung lobe, increased lung density, blood vessels And the bronchial shadows are gathered, the indirect signs have mediastinum and the hilar is pulled to the affected side, the diaphragm is elevated, the intercostal space is narrow, and the thoracic region is narrowed. If the atelectasis is accompanied by a hilar mass, the atelectasis of the atelectasis can be seen. Horizontal "S" shaped edge.
2 Peripheral lung cancer: irregular irregular infiltration of uneven density, the tumor can be smooth edged non-lobed sphere, but in most cases, the edge of the tumor is lobulated, that is, the "leaf sign "The incidence of lobulation signs of lung cancer is as high as 80%, so it has a certain significance for differential diagnosis. The edge of the shadow of the tumor is often blurred and not sharp on the X-ray film. The typical is a short-short burr shadow, such as occurs. Carcinogenic cavities can be divided into thick-walled cavities, thin-walled cavities and multiple small cavities. The thickness of each part of the cavity wall is uneven, the inner wall is not uniform, and sometimes the wall nodules are visible. The cavities are more common in squamous cell carcinoma.
3 bronchioles - alveolar carcinoma: There are two types of manifestations: nodular and round lung cancer lesions are not easy to distinguish, diffuse type is a nodular disseminated lesion of different sizes of two lungs, the boundary is clear, the density is deep, With the development of the disease gradually increase and increase, often accompanied by a deep woven shadow, the performance is similar to blood-borne disseminated tuberculosis, should be identified.
4 X-ray signs of lung cancer metastasis:
A. Lymph node enlargement: usually can be displayed on the X-ray film, mainly manifested as increased hilar shadow and hilar mass.
B. Hematogenous metastasis: can occur in the ipsilateral or contralateral lung, or both sides of the lung, X-ray manifested as multiple nodular or small patchy shadows in the lung, varying in size, uniform density and lighter, less Partial metastases may have cavities, and a single isolated metastase may have lobes.
C. Thoracic invasion: lung cancer invades the pleura, which can produce pleural effusion, most of which is bloody. The amount of fluid is often large and develops rapidly. Sometimes, pleural effusion can be limited to interlobular fissure due to parcel, but also in the lung. The bottom accumulates.
D. Chest wall invasion: Lung cancer directly invades the chest wall, ribs, spine, soft tissue mass and ribs, and spinal bone destruction.
E. Pericardial invasion: mainly manifested as pericardial effusion, increased heart shadow, flask-like, and weakened heart beat.
(2) CT findings of lung cancer: chest CT is a hidden part of the lung that is difficult to display on conventional chest radiographs, such as the posterior sternum, posterior sacral region, paraspinal, azygous esophageal fossa, posterior sacral hilar, posterior rib sac, etc. Tumors were significantly better than X-ray films. Spiral CT (spiral CT) was found to be more than 3 mm in lesions, and its rate of metastatic cancer was higher than that of normal segments.
Diagnosis
Diagnosis and diagnosis of lung cancer in the elderly
Tuberculosis
(1) tuberculosis ball: often located in the site of tuberculosis, the boundary is clear, there may be a capsule, the calcification point may be high when the density is high, and the fibrous nodular satellite lesion is visible around.
(2) hilar lymph node tuberculosis: more symptoms of fever and other poisoning, tuberculin test strong positive, anti-tuberculosis treatment is effective.
(3) Miliary tuberculosis: systemic symptoms such as fever, X-ray showed double-lung lesions with equal size, uniform distribution, and lighter miliary nodules.
2. Pneumonia is an acute onset, with symptoms of poisoning, antibiotic treatment of lesions is fast; inflammatory pseudotumor tends to be irregular in shape, uneven edges, deep density core, often accompanied by pleural thickening, long-term changes in lesions, but need Note that tumor-induced obstructive pneumonia may be.
3. Acute onset of lung abscess, systemic poisoning symptoms associated with a large number of purulent sputum, X-ray see a uniform large inflammatory shadow, visible thin-walled cavities and liquid level, blood levels increased significantly, neutrophil classification increased, antibiotic treatment effective.
4. Tuberculous pleurisy cancerous pleural effusion should be differentiated from tuberculous pleurisy, cancerous symptoms are more than poisoning, pleural effusion is mostly bloody, rapid growth, persistent progressive aggravation when chest pain, pleural effusion repeatedly find cancer cells Help with identification.
