Alveolar carcinoma
Introduction
Introduction to alveolar cancer Follicular cancer is a special subtype of lung adenocarcinoma, accounting for 3% to 30% of the total non-small cell lung cancer. Compared with other subtypes of non-small cell lung cancer, bronchioloalveolar carcinoma has unique clinical manifestations, histological behavior, epidemiological characteristics, and special treatment response and prognosis. basic knowledge Sickness ratio: 0.001 Susceptible population: patients with a history of smoking Mode of infection: non-infectious Complications: obstructive emphysema
Cause
Causes of alveolar cancer
1. Smoking: In 1922, Hampeln found that continuous smoking and inhalation of dust could stimulate the bronchial epithelium to induce cancer. In 1924, Moller applied tar to the back of the rabbit and found that the incidence of lung cancer increased slightly. Currently, smoking is considered to be the most common form of lung cancer. Basic high-risk factors, there are more than 3,000 kinds of chemicals in tobacco, and multi-chain aromatic hydrocarbons (such as benzopyrene) have strong carcinogenic activity and can act on some special kinds in human tissues (especially lung tissues). Enzymes, which produce mutations in cellular molecular structures (such as DNA), may have mutations in K-ras.
2. Occupational and environmental exposure: It is estimated that up to 15% of lung cancer patients have a history of environmental and occupational exposure. There is sufficient evidence to confirm that the following nine industrial ingredients increase the incidence of lung cancer: by-products of aluminum products, arsenic, asbestos, bis- chloromethyl ether , chromium compounds, coke ovens, mustard gas, nickel-containing impurities, vinyl chloride, long-term exposure to strontium, cadmium, silicon, formalin and other substances will also increase the incidence of lung cancer, in addition, air pollution, especially industrial waste gas is High risk factors for lung cancer.
3. Radiation: Uranium and fluorspar miners are exposed to inert gas helium, decaying uranium by-products, etc., which are significantly higher than other people's lung cancer, but people with ionizing radiation do not increase lung cancer.
4, chronic lung infections: such as tuberculosis, bronchiectasis and other patients, bronchial epithelium in the process of chronic infection may turn into squamous epithelium, eventually carcinogenic, but such cases are relatively rare.
5, intrinsic factors: family, genetic and congenital factors and immune function reduction, metabolism, endocrine dysfunction, etc. may also be a risk factor for lung cancer.
6. Air pollution: The incidence of lung cancer in industrialized countries is high, the city is higher than the rural areas, and the factory and mining areas are higher than the residential areas. The main reason is due to the industrial and transportation developed areas, oil, coal and internal combustion engines, and the burning of asphalt roads. It is related to the pollution of harmful substances such as benzopyrene-induced carcinogenic hydrocarbons. The investigation materials indicate that the incidence of lung cancer is also high in areas with high concentrations of benzopyrene in the atmosphere. The incidence of lung cancer and air-borne cigarettes may promote each other and synergistically. .
Prevention
Alveolar cancer prevention
1. Prohibit and control smoking
To ban and control smoking, we must first focus on reducing the proportion of smokers in the population. It is necessary to enact certain laws or regulations to restrict people, especially to limit youth smoking.
2. Control air pollution
Do a good job in environmental protection and effectively control air pollution to achieve the goal of preventing lung cancer.
3. Occupational protection
For mining areas where radioactive ore is to be mined, effective protective measures should be taken to minimize the amount of radiation received by workers. Workers exposed to carcinogenic compounds must take various effective and effective labor protection measures to avoid or reduce contact with carcinogenic factors. .
4, prevention and treatment of chronic bronchitis
Since the incidence of lung cancer in patients with chronic bronchitis is higher than that in patients without chronic bronchitis, active prevention and treatment of chronic bronchitis has certain significance in preventing lung cancer, especially to urge smokers with chronic bronchitis to quit because of chronic bronchitis. The incidence of lung cancer is higher in smokers.
5, early detection, early diagnosis and early treatment
The screening methods for early stage lung cancer are still unsatisfactory. The cost of screening lung cancer in the population is very expensive, and the possibility of reducing lung cancer mortality is very small.
The study used chemoprevention, such as the use of cyclooxygenase (COX) inhibitors, fat oxygenase inhibitors, etc. to try to block the development of carcinogenic factors, some foods rich in vitamin E, carotenoids, retinal, selenium and other foods for lung cancer It also has a preventive effect.
Complication
Alveolar cancer complications Complications obstructive emphysema
Most lung cancer patients who have had intra-thoracic regional dissemination have symptoms of chest pain, followed by hoarseness, and finally lead to facial and neck edema. Finally, lung cancer patients with regional spread have almost different degrees of gas. promote.
However, some complications are often caused after lung cancer surgery. The formation of the lung cancer is closely related to the factors of the patient's body and the scope of the operation. The common postoperative complications and prevention methods are as follows:
1, respiratory complications
Such as sputum retention, atelectasis, pneumonia, respiratory insufficiency, etc., especially in the elderly and infirm, the original chronic bronchitis, emphysema, the incidence is higher, due to wound pain after surgery, patients can not do effective cough, The sputum retention causes airway obstruction, atelectasis, and respiratory insufficiency. The prevention is that the patient can fully understand and cooperate, and actively prepare for the operation. After the operation, encourage and urge the patient to take deep breath and force cough to effectively drain the sputum. If necessary, nasal catheter suction or bronchoscopy suction, pneumonia should be active anti-inflammatory treatment, when respiratory failure, mechanically assisted breathing is often required.
2, postoperative hemothorax, empyema and bronchial pleural fistula
The incidence rate is very low. Postoperative hemorrhage is a serious complication. It must be treated urgently. If necessary, the chest should be stopped again to stop bleeding. When the lung surgery is performed, the bronchus or lung secretions contaminate the chest and the empyema. In addition to the selection of effective antibiotics, timely and thorough thoracentesis is extremely important. Patients with poor results may consider closed thoracic drainage, residual bronchial stump cancer after pneumonectomy, hypoproteinemia and improper operation. After the operation, the bronchial stump is poorly healed or the fistula is formed. In recent years, the occurrence of such complications has been greatly reduced.
3, cardiovascular system complications
Old and frail, intraoperative mediastinal and hilar traction, low potassium, hypoxia and hemorrhage often become the cause, common cardiovascular complications include postoperative hypotension, arrhythmia, pericardial tamponade, heart failure, etc. For elderly patients, there are heart diseases before surgery. The indications for surgery with low cardiac function should be strictly controlled. The operator pays attention to the operation, keeps the airway open and adequate oxygen supply after surgery, closely observes blood pressure, pulse changes, and timely supplements blood volume. After the operation, the infusion rate should be slow, balanced, prevent too fast, excessively induce pulmonary edema, and at the same time, for ECG monitoring, once abnormalities are found, according to the condition, the elderly patients are often accompanied by recessive coronary heart disease, a variety of surgical trauma Stimulation can prompt an acute attack, but it can be turned safe under the strict supervision and timely treatment of the clinician.
Symptom
Alveolar cancer symptoms Common symptoms Chest pain, bloodshot fever with cough, slightly...
1. Masses: The formation of malignant proliferation of cancer cells [1] can be touched on the surface or deep in the hands, which is also a common pre-mortem symptom of alveolar cancer.
2, pain: the appearance of pain often indicates that the cancer has entered the middle and late stages. It is mostly dull or dull, and it is obvious at night. Gradually increasing in the future, it becomes difficult, staying up all night. General painkillers do not work. Pain is generally caused by cancer cells.
3, ulcer: due to the rapid growth of cancer tissue of some body surface cancer, insufficient nutrient supply, the formation of advanced necrotic cancer formed by tissue necrosis.
4, hemorrhage: cancer tissue blood vessels or cancer tissue small blood vessels rupture. Such as lung cancer patients can be hemoptysis, blood in the sputum; stomach, colon, esophageal cancer can be blood in the stool.
Examine
Examination of alveolar cancer
Laboratory inspection
1, sputum exfoliative cytology
It is simple and easy to perform, but the positive detection rate is only 50% to 80%, and there is a false positive of 1% to 2%. This method is suitable for censuses in high-risk groups, as well as isolated images in the lungs or diagnosed with unexplained hemoptysis.
2, percutaneous lung puncture cytology
Adapted to peripheral lesions and not suitable for thoracotomy for various reasons, other methods failed to establish a histological diagnosis. At present, it is preferred to use a fine needle in combination with CT, which is safer to operate and has fewer complications. The positive rate was 74% to 96% in malignant tumors and 50% to 74% in benign tumors. Complications include pneumothorax 20% to 35% (about 1/4 of which need to be treated), a small amount of hemoptysis 3%, fever 1.3%, air embolism 0.5%, and needle implant 0.02%. Thoracic surgery has fewer applications because of thoracoscopic examination and thoracotomy.
3, thoracic puncture cytology
Patients suspected or diagnosed with lung cancer may have pleural effusion or pleural dissemination, and cell analysis of pleural effusion by thoracentesis may be clearly staging, and in some cases, a diagnosis basis may be provided. For lung cancer with pleural effusion, bronchoalic adenocarcinoma has the highest detection rate, and its positive rate of cytological diagnosis is 40% to 75%. If the cytological analysis of the pleural effusion obtained by puncture cannot be diagnosed, consider further examinations such as thoracoscopic surgery.
4, scalene and supraclavicular lymph node biopsy
For patients with lung cancer, routine biopsy can not be affected by the scalene or supraclavicular lymph nodes, rarely found metastases, patients with spastic bone lymph nodes, the diagnosis rate is nearly 90%. Biopsy occasionally sees complications such as pneumothorax and major bleeding. Even if there are few complications, FNAB (fine needle aspiration biopsy) is recommended for cases of lymph nodes that can be touched on the scalene or clavicle. Surgical biopsy. Routine histology and appropriate immunohistochemistry are helpful in the diagnosis of cell typing.
5, serum tumor markers
A number of serum tumor markers associated with lung cancer have been identified, which may indicate an increase in carcinogenic factors or a degree of "detoxification" of certain carcinogens. Serum tumor markers of lung cancer may be valuable indicators for tumor staging and prognosis analysis and can be used to evaluate treatment outcomes. Tumor marker test results must be combined with other test results and cannot be used alone to diagnose cancer.
6, monoclonal antibody scanning
The use of monoclonal antibody screening, diagnosis and staging is currently an experimental field. Immunofluorescence images of anti-carcinoembryonic antigen MoAb labeled with radioactive substances have been reported. Currently, 111In or 99Tc are commonly used for labeling, respectively 73%. Primary tumors and 90% of secondary tumors absorb radiolabeled antibodies, and antibody uptake is also imaged by tumor size and location.
Film degree exam
1, X-ray diagnosis
For the most common means of diagnosing lung cancer, the positive detection rate can reach more than 90%. The earlier X-ray findings of lung cancer were: 1 isolated spherical shadow or irregular small infiltration. 2 The unilateral ventilation was poor when deep inhalation under fluoroscopy, and the mediastinum moved slightly to the affected side. 3 Localized emphysema occurred in the expiratory phase. 4 The mediastinum swing occurs during deep breathing. 5 If the lung cancer progresses in the blocked segment or the leaf bronchus, the gas at the distal end of the blockage gradually absorbs the segmental atelectasis. Such a defect such as concurrent infection forms pneumonia or lung abscess. More advanced lung cancer can be seen: lung field or hilar mass tumor nodules, no calcification, lobulated, uniform density, burr at the edges, peripheral vascular texture distortion, sometimes central liquefaction, thick wall, eccentricity, uneven inner wall Empty. The doubling time is short. When the tumor obstructs the leaf or the total bronchi, the lobes or total atelectasis appear. When the pleura is involved, a large amount of pleural fluid can be seen. When the chest wall is invaded, rib damage can be seen.
2, CT examination
In the diagnosis and staging of lung cancer, CT examination is the most valuable non-invasive examination. CT can find the location and cumulative range of the tumor, and can also roughly distinguish its benign and malignant.
Diagnosis
Diagnosis and diagnosis of alveolar carcinoma
According to the results of laboratory tests can be diagnosed.
