LUNG CANCER

Definition

The lung takes the oxygen we need to live from the air and releases the harmful carbon dioxide gas formed in our body into the air; It is our main respiratory organ that does the work of breathing.

Like every organ, our lungs consist of many cells. Cells are renewed in all systems in our body except the nervous system. Lung cells also divide and multiply according to need so that the lung can function normally.

Lung cancer is the unnecessary and uncontrolled proliferation of lung cells, forming a mass (tumor) in the lung. The mass formed here first grows in its environment, and in later stages, it spreads to surrounding tissues or distant organs through circulation (such as liver, bone, brain, etc.), causing damage.

Every year, newly diagnosed cancer patients all over the world. 12.8% are patients with lung cancer and it is increasing by 3% every year. 17.8% of people who die due to cancer in a year worldwide are lung cancer. The annual number of new cases of lung cancer, which is the most common type of cancer in the world today, is more than one million.

Lung cancer is the most common type of cancer in men, and with the increase in smoking among women in recent years, the incidence of lung cancer in women is gradually increasing. .

Lung cancer is the type of cancer that kills the most in men worldwide today. It ranks second among the causes of death after cardiovascular diseases. It has been the leading killer in women in the USA since 1987.

When we look at the world average, it ranks first in men and second in women after breast cancer. The World Health Organization estimated that 300,000 women in developing countries died from smoking-related diseases in 1985. ü reported that 21.1% of this was due to lung cancer. The number of new patients appearing every year continues to increase all over the world.

Primary lung cancer is the most common type of cancer in our country, as well as all over the world. An incidence of 11.5 / 100,000 has been reported in our country.

Risk factors for the development of lung cancer

80-9% of all lung cancers 0 It develops due to smoking. So the most important risk factor for the development of lung cancer is smoking. The risk of developing lung cancer increases as the duration of smoking and the total number of cigarettes smoked increase.

After active smoking, the second most important risk factor for lung cancer is passive smoking or smoking. It is reported that passive smoking alone increases the risk of lung cancer by an average of 1.2-1.3 times.

Some genetic factors other than smoking, such as having lung cancer in the family (first-degree relatives), increase the risk of lung cancer by 2.4 times. . Individuals with a family history of lung cancer are more likely to develop lung cancer. Smoking, especially with a family history of lung cancer, further increases the risk.

While the lung cancer risk of a woman who has a family history of lung cancer and has never smoked increases by 2.8 times; In a woman who has no family history of lung cancer and smokes, this risk increases 11.3 times; It has been shown that this risk increases 30 times in a woman who has a family history of lung cancer and smokes.

In addition, a carcinogenic mineral called asbestos, which has a fibrous structure and is very resistant to chemicals; It is effective in the formation of lung cancer, especially lung cancer (Mesothelioma). It is popularly known as white soil, barren soil, sky soil, çelpek, höllük or c. It is known by names such as the land of Eren. Asbestos is found in many regions of Anatolia and is used unconsciously by our people. Villagers use asbestos to spread the roofs of their houses, to whitewash their houses, and as a powder substitute for young children. In the Amasya region and Kayılar nomads, babies are wrapped in heated asbestos, known as höllük soil. Asbestos fibers mixed into the air during these applications are heavily inhaled. Apart from the villagers who extract and use it from the soil, asbestos is also very harmful to workers working in industrial areas where asbestos is used (ships, aircraft, automobile industries).

Occupational factors such as asbestos, cadmium, nickel, chromium and radiation lung cancer. increases the risk. While this risk is 5 in asbestos exposure, the risk increases 50-100 times when combined with smoking. The risk increases 20-fold in occupational radon exposure. This increase is greater with tobacco use. Occupational exposure to some metals and chemicals,

• Radon gas,

• Radiation,

• Some previous lung diseases (scar tissue occurring in lung tuberculosis, interstitial fibrosis, bullous emphysema and some other lung diseases with tissue destruction may form a basis for the development of lung cancer.)

• Dietary habits: It is claimed that diet is 5% effective in lung cancer. A diet low in vitamin A and β-carotene increases the risk of lung cancer. Vitamin E and selenium similarly reduce the risk with antioxidant effects.

• It has been shown that the risk of lung cancer increases in smokers who eat a high-fat diet. Consumption of tea (especially green tea) also has a protective effect.

• Also, It is thought that air pollution due to factory chimneys may increase the risk of lung cancer, but the degree of risk has not been determined.

• It has been shown that improper heating of homes by burning wood and coal causes the formation of cancer-causing substances. .

SYMPTOMS

• Persistent cough

• Chest pain, shoulder pain, arm or back pain

• Wheezing, wheezing

• Shortness of breath,

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• Coughing blood from the mouth or producing bloody sputum

• Loss of appetite, weight loss

• Weakness

• Fever

DIAGNOSIS

In patients who consult a physician with these signs and symptoms, a detailed history should be taken and a physical examination of the patient followed by a standard chest radiography should be taken first for diagnosis. Tumor on chest radiography in many patients; or lack of ventilation due to bronchial obstruction caused by the tumor, pneumonia, or the appearance of tumor-related fluid collection between the lung membranes may be detected. The next step is to take a computed lung tomography. (Except when a large amount of fluid accumulates between the lung membranes; in this case, the fluid must first be drained and then a tomography should be taken.) Computed tomography not only provides detailed information about the mass or the condition it causes, but also allows the visualization of other lesions that are too small to be seen on a chest radiography. . After examination of standard chest radiography and computed tomography, the existence of the disease, its location in the lung, and its spread are revealed.

The patient has lung cancer. At this point, the physician who believes this should attempt to determine the type of the tumor, which we call typing. The procedure to be performed here varies depending on the location of the tumor.

1.Bronchoscopy: In case of a central mass located in the bronchus, a bronchoscope is entered through the nose or mouth, reaching the tumor visually and performing a biopsy. It is the process of purchasing (parts). A bronchoscope is a long, flexible, pencil-thin tube with a bright light at the end. Since this tube is bendable, it can be easily inserted through the nose or mouth; It passes through the vocal cords and is transmitted to the larynx, from there to the trachea and then to the bronchi. The mass is reached, the liquid sent to the place where the mass is located through the bronchoscope is collected in a container with the help of an aspirator, that is, the tumor area is washed and the tumor cells spilled there are removed for examination.

2.Trans Thoracic Fine Needle Aspiration. (TTIA):In the presence of a mass close to the chest wall, since it is not possible to reach the end of the lungs by entering through the trachea with a bronchoscope, the location of the mass is marked under computed tomography and the mass is reached from outside the chest wall with a very thin needle. and by attaching a syringe to the tip of the needle, the cells are aspirated from the mass (removed by vacuuming), spread on special glasses called slides, kept in alcohol, dried and then sent to the pathologist for examination.

3. Pleura biopsy: When fluid is collected between the lung membranes, it is the removal of a piece of the lung membrane by entering the space between the lung membranes (pleural space) from the chest wall with a special needle.

4. Thoracoscopy:Under general anesthesia, a small hole is made in the chest wall. By entering the space between the lung membranes (pleural space) with the endoscope and adding a camera to the device, the entire space is made visible. Thanks to this imaging method, a definitive diagnosis is reached in the majority of cases by taking a biopsy from the diseased area.

LUNG CANCER TYPES (According to Cell Type)
 

NON-SMALL CELL LUNG CANCER

A) FLAMMA EPITHELIAL CELL LUNG CANCER = EPIDERMOID LUNG CANCER

• It is the most common lung cancer. (40-60%)

• It increases with smoking.

   B) ADENOCANCER

• It is 10-20% of lung cancers.

• It originates from the secretory cells of the airways.

• Lung cancer is the least associated with smoking. In other words, it is also seen in non-smokers.

   C) LARGE CELL LUNG CANCER

• % of lung cancers It is 5-10.

• It is located in the peripheral (end-edge) parts of the lung

SMALL CELL LUNG CANCER

• It is 15-25% of lung cancers.

• It is often caused by lung cancer. It is located in the central parts. In other words, it is mostly located in the main bronchi and lobe bronchi.

• It is directly related to smoking. Its incidence is higher in smokers than in non-smokers.

• Among lung cancers, it is the fastest progressing and earliest metastasized (spreading) lung cancer.

STAGING

Staging in non-small cell lung cancer, TNM It is done according to the (Tumor, Lymph node, Metastasis) system. In general, a tumor that is small and has not metastasized is low-stage, while a tumor that is large and has metastases is advanced stage. In low-stage cases, there is a chance of full recovery with appropriate treatment. However, very few patients are detected at these stages. . The rules regarding staging are briefly as follows:

Stage I: There is no metastasis. All�

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