Lung cancer is roughly divided into two different types.
The distinction is made at the histological (cellular) level: there are small cell and non-small cell lung carcinomas (lung cancer).
For example, 30% of the group of non-small cell tumors consists of so-called squamous cell carcinomas, 30% of adenocarcinomas and many other subforms.
Lung cancer is the # 1 deadliest cancer among men. In women, bronchial carcinoma ranks second behind breast cancer.
Smoking continues to be the biggest risk factor. As a result of the gender-specific change in the group of smokers, more and more women are affected by lung cancer.
The diagnosis of lung cancer is often complicated.
A malignant tumor disease is usually discovered late, when clinical signs already occur. The symptoms are non-specific in many cases, so they may indicate multiple illnesses, but usually worsen significantly as the disease progresses.
Especially in the context of small cell bronchial carcinomas so-called paraneoplastic syndromes can occur.
These are comorbidities caused by the release of tumor or hormone-like substances by the cancer. The symptoms are varied and can lure the doctor on the wrong track.
As a result, the diagnosis is delayed and the chances of recovery are gradually getting worse.
Probably the largest role in the diagnosis of lung cancer play imaging techniques. In the X-ray, the tumor centers can usually be seen as shading. However, the cancer has to be big enough for that. In part, a tumor can be x-rayed before the first symptoms appear.
For further diagnostics computed tomography (CT) is the drug of choice. The CT determines the exact size and location of the tumor tissue. Otherwise, ultrasound and scintigraphy are used to search for metastases.
The laboratory values are more of a minor factor in the detection of lung cancer. Since in bronchial carcinoma no conventional blood values are changed characteristically, so-called tumor markers have to be resorted to. The markers to be examined are assigned to specific types of tumors, but also occur in other forms of cancer or illnesses. For example, neuronal-specific enolase ( NSE ) in small cell lung cancer, carcinoembryonic antigen ( CEA ) in adenocarcinoma, and cytokeratin fragment 21-1 ( CYFRA 21-1 ) in a squamous cell tumor may be elevated.
The initial symptoms of lung cancer, if they occur at all, are very nonspecific.
Although coughing with or without sputum is a sign of lung disease, it is not primarily thought of as a lung tumor.
However, if the symptoms persist for an extended period of time, if additional serious infections such as pneumonia occur or if blood is coughed several times, a malignant disease must absolutely be ruled out.
The growth in size of an existing bronchial carcinoma can lead to pressure and occlusion of various organs. The bloodstream can be obstructed, there may be difficulty in swallowing and shortness of breath may occur during exercise.
If the tumor infiltrates muscle or bone tissue, this is not only a sign of its advanced stage, but also associated with considerable pain.
The symptoms may be very diverse in a so-called paraneoplastic syndrome, which is more common in small cell lung cancers.
The hormone-like substances secreted by the tumor can lead to excessive production of other hormones, inflammation, fluctuations in the electrolyte balance, thrombosis and psychiatric disorders with extensive clinical pictures.
The X-ray shows tumors in the lungs above a certain size of certain characteristics. Tumors smaller than 1 cm are often overlooked, making early diagnosis and promising therapy difficult.
The tumor tissue has a higher density than the lung tissue. The latter consists of air-filled alveoli and turns dark in the X-ray. This means that few X-rays are absorbed, which also makes sense in view of the low-strength tissue.
The tumor tissue consists of many, densely stored cells. Consequently, the tissue resorbs many X-rays and in the image the tumor is brighter than the surrounding tissue. Only X-rays that have passed through the body are recorded in the X-ray image as the smallest dark point. The interplay of the dots gives the picture in the end.
Tumors usually grow like heartworms in a round shape. If other lightened spots appear in the lungs with their otherwise regular structure in addition to the large bronchi, the examining physician should become aware. Malignant masses do not adhere to the anatomical limits of the lungs. You can exceed the supply areas of the individual bronchi and even the individual lung lobes. Some advanced lung tumors even grow beyond the organ boundaries and invade bone and muscle tissue or the pleura ( pleura ).
The form of benign and malignant tumors differs significantly.
While benign tumors have smooth edges, lung cancer grows infiltrating, so penetrating. The cancer cells radiate from a center radially into the surrounding tissue. This is therefore not displaced, as is the case for benign tumors or cysts, for example, but infiltrated.
In degenerated cell tissue, it often comes to the storage of lime. This shows up in radiograph as radiopaque grain (white). So-called microcalcium is a classic sign of a benign tumor, but there is still no all-clear - even though lung cancer is very rarely calcified, it is still possible. However, since lime can be seen well in the x-ray, this gives an indication of an existing change in the tissue. Now, a targeted biopsy can be carried out, in which tissue is removed and then examined in the laboratory. Radiodiagnostics is the mainstay of lung cancer detection and is often assisted by CTs, as this is the only way to pinpoint tumor borders.
In the final stage of lung cancer, the symptoms are usually already pronounced. At least now have respiratory distress and chest pain trained and increase the suffering of the patient massive. Due to the increased work of breathing and the usually large tumor, much more energy is consumed than in a normal person - the patient loses extreme weight. Also fever and hoarseness can be symptoms of a serious cancer.
Due to the transfer of the bronchi, the inflammations behind the tumor, so-called retention pneumonia, develop in the lung sections. They are usually very difficult and do not respond well to conventional therapies. The prognosis is thereby further worsened.