Extrapulmonary symptoms
Introduction
Introduction Extrapulmonary symptoms are syndromes caused by the action of lung cancer on other systems, including the endocrine system, neuromuscular, connective tissue, blood system and so on. Symptoms are diverse, the etiology and mechanism are unknown, and some are related to ectopic endocrine, the incidence rate is 1% to 2%, also known as "para cancer syndrome", "non-metastatic performance outside the lungs" and "tumor adverbism".
Cause
Cause
The etiology and mechanism are unknown, and some are related to ectopic endocrine.
Examine
an examination
Related inspection
Bronchoscopy cardiopulmonary exercise test (CPET)
X-ray inspection
X-ray examination can be used to understand the location and size of lung cancer, and may see local emphysema, atelectasis or invasive lesions in the vicinity of the lesion or inflammation of the lungs due to bronchial obstruction.
2. Bronchoscopy
The bronchoscope can directly observe the lesions of the endobronchial and luminal lumens. Tumor tissue can be taken for pathological examination, or bronchial secretions can be taken for cytological examination to confirm the diagnosis and determine the histological type.
3. Cytological examination
Sputum cytology is a simple and effective method for the screening and diagnosis of lung cancer. Most patients with primary lung cancer can find shed cancer cells in sputum. The positive rate of sputum cytology in central lung cancer can reach 70% to 90%, and the positive rate of peripheral lung cancer sputum detection is only about 50%.
4. Thoracotomy
Pulmonary mass can not be confirmed by various examinations and short-term diagnostic treatment. If the possibility of lung cancer cannot be excluded, it should be used for thoracotomy. This avoids delays in the disease and causes lung cancer patients to lose the opportunity for early treatment.
5.ECT check
ECT bone imaging can detect bone metastases earlier. X-ray films and bone imaging have positive findings. For example, if the osteogenesis reaction in the lesion is static and the metabolism is inactive, the bone imaging is negative and the X-ray film is positive. The two complement each other, which can improve the diagnosis rate. It should be noted that the false positive rate of ECT bone imaging for the diagnosis of bone metastasis of lung cancer can reach 20% to 30%. Therefore, the positive ECT bone imaging needs to be the MRI scan of the bone in the positive area.
6. Mediastinoscopy
Mediastinoscopy is mainly used in patients with mediastinal lymph node metastasis, not suitable for surgical treatment, and other methods can not obtain pathological diagnosis. Mediastinoscopy should be performed under general anesthesia. A transverse incision was made in the concave part of the sternum, and the soft tissue before the neck was bluntly separated to reach the anterior space of the trachea. The anterior channel of the trachea was bluntly released, and the observation mirror was slowly passed through the innominate artery to observe the paratracheal, tracheobronchial angle and the bulge. The enlarged lymph nodes in the site were dissected by special biopsy forceps to obtain lymph node tissue for pathological examination.
The diagnosis of primary bronchogenic carcinoma includes: symptoms, signs, imaging findings, and sputum cancer screening.
Diagnosis
Differential diagnosis
Tuberculosis
In particular, tuberculoma (ball) is sometimes difficult to distinguish from peripheral lung cancer. Pulmonary tuberculoma (ball) is more common in young patients under the age of 40. The course of disease is longer, and there is less blood in the sputum. There is less change in erythrocyte sedimentation rate. Tuberculosis is found in 16% to 28% of patients. The chest radiograph is mostly round, found in the tip or posterior segment of the upper lobe, the volume is small, generally not more than 5cm in diameter, the boundary is smooth, and the density is uneven, calcification is visible. In 16% to 32% of cases, the drainage bronchus is visible to the hilar, less Pleural shrinkage occurs, and the growth is slow. For example, there is a hollow in the center liquefaction, and the middle is thin and the inner edge is smooth. There are often scattered tuberculosis lesions around the tuberculoma (ball) called satellite foci. Peripheral lung cancer is more common in patients over 40 years old, with more blood in the sputum, and 40% to 50% of cancer cells in the sputum. X-ray chest radiographs are often lobulated, with irregular edges, small burr and pleural shrinkage, and rapid growth. In some cases of chronic tuberculosis, lung cancer can occur on the basis of tuberculosis. Therefore, in adult patients with chronic tuberculosis, if abnormal lung shadows appear in the lungs, the hilar shadows increase or after regular anti-tuberculosis drugs are treated, the lesions do not increase and then increase. When you are old, you should suspect the possibility of lung cancer. Further sputum cytology and bronchoscopy should be performed and a thoracotomy should be performed if necessary.
2. Lung inflammation
Bronchial pneumonia in elderly patients is sometimes difficult to distinguish from obstructive pneumonia caused by lung cancer obstructing the bronchi. Obstructive pneumonia often has a fan-shaped distribution according to the bronchial branches, while the general bronchopneumonia has irregular flaky shadows. However, if pneumonia has multiple episodes in the same site, it should be vigilant. It should be highly suspected of tumor blockage. The patient's sputum should be taken for cytological examination and fiber light-guided vascular examination. In some cases, pulmonary inflammation Absorption, when the remaining inflammation is wrapped by fibrous tissue to form nodules or inflammatory pseudotumors, it is difficult to distinguish from peripheral lung cancer. In suspicious cases, lobectomy should be performed to avoid delay in treatment.
3. Benign lung tumors and bronchial adenomas
Benign lung tumors such as structural tumors, chondromas, fibroids, etc. are rare, but they must be differentiated from peripheral lung cancer. Generally, benign tumors have a long course of disease, slow growth, and most of them have no symptoms in clinical practice. X-rays are often used. It has a round shadow with neat edges, no burrs, and no lobes. Bronchial adenoma is a low-grade malignant tumor, often occurring in younger women, mostly originating from the larger bronchial mucosa. Therefore, there are often pulmonary infections and hemoptysis caused by bronchial obstruction in the clinic. Ventiloscopy can often make a diagnosis.
4. Mediastinal malignant lymphoma (lymphosarcoma and Hodgkin's disease)
Clinically, there are often symptoms such as cough and fever. X-ray films show a widening of the mediastinum and are lobulated, sometimes difficult to distinguish from central lung cancer. If there is swelling of the lymph nodes on the supraclavicular or axillary fossa, it is often clear that the biopsy is used for pathological sectioning. Lymphosarcoma is particularly sensitive to radiation therapy. For suspicious cases, small doses of radiation therapy can be tried. When the temperature reaches 5-7 Gy, the mass can be significantly reduced. This experimental treatment also contributes to the diagnosis of lymphosarcoma.
