.Lung cancer
personal notes and reflections dr. Italiano Claudio
NB The information contained in this site are simply the scientific information
that in no case can be used for diagnosis or doctors!! The diagnosis and
treatment are likely the sole responsibility of the physician who is treating a
patient!
Why talk about lung cancer? Because it is a subtle and insidious cancer that you
stab in the back when you least expect it. In fact I remember the case of my
friend, I followed the dawn of my medical profession, when he began to
experience hoarseness and hemoptysis and had spoken to otolaryngology. The
otolaryngologist had prescribed an effective therapy with vit. B12 and
insufflation (sic). After some time the dysphonia became overt and reassessed by
another ENT that I had addressed this time of the Polyclinic of Messina, the
patient presented a clear compression of the recurrent laryngeal nerve, with
paralysis of one vocal cord. In fact, the patient could not pronounce the letter
"e", which is known to be fona with the two vocal cords that vibrate narrow
accolades between them. This patient had cough, hemoptysis and bronchitis, that
spit blood and smoking (smoking) as a turkish for reasons of work stress, in the
pauses of waiting between a customer and another (!). Another case,
unfortunately close to me, is manifested even more insidious, the patient
experienced a sudden and striking pleural effusion, which does not regress with
steroid therapy and diuretics associated with canrenoato even with repeated
thoracentesis Evacuation is the reform on a massive and sudden, with the speed
of 1-2 days.
.
.. Carried a thoracentesis, in a time of Thoracic Surgery, this document with a
right lung lobe atelectasis UnL an inflamed pleura with synechiae and fibrin
rind suspicious during thoracentesis flowed approximately 1,500 cc of pleural
fluid, yellow amber, turbid, and spoke of "the stage I empyema. In the days that
followed, however, continued to drain the lung glaringly 350, 400 cc of pleural
fluid / day, for a total of 2500-3000 cc within 7 days. CT scan with contrast
and even turned negative pleural biopsies that were performed as documented
mesothelioma or other injuries. It was only cytological examination of pleural
fluid, repeated over time to document abnormal cells, from a hypothetical
bronchogenic squamous cell carcinoma. The patient did not survive the stress of
drainage, because the clinical and cardiological problems have weakened the base
and it was not possible to go further with the treatments and the appropriate
investigations, which could include a BAL or fiberscope. Other times, however,
is a "bad ilo" pulmonary hidden in his contention that receives a packet lymph
drainage from a cancer associated image as "globose hilum. The patient, before,
again accused the Pancoast syndrome, that the tumor was interested in the costal
pleura and the brachial plexus, causing a very intense pain in my right shoulder,
which was initially mistaken for the right scapular-humeral arthritis, because
of a previous trauma of the shoulder to fall and the activity challenging work
that had been in his youth. ...
Other signs were intense dyspnea, unexplained even dall'emogas (respiratory
gases were within normal limits for both the partial pressure of oxygen and
carbon dioxide for pH), persistent cough, tiring, with great production a frothy
and purulent sputum, but not bloody, and epigastric pain simulating an ulcer,
was another sign of dysphagia el'anoressia with absolute refusal of food and
slimming inispiegabile (cf. bronchitis and systemic disease). The patient
finally had espisodi recurrent exacerbations of chronic obstructive pulmonary
disease (see Special Bronchitis Bronchitis cronica2 cronica1 Special Special
Special cronica3 Bronchitis Bronchitis cronica4 pulmonary fibrosis Allergy,
allergens! The air hunger, the patient breathless! The patient with cough ,
diagnosing and treating chronic bronchitis and exacerbations With no smoke!
Bronchitis Chronic Care How to listen to your chest and give care), with fever,
less sensitive to antibiotic treatment and insomnia explained by a probable
brain metastases and the subsequent nocturnal dyspnea with bed rest and
compression of the lung.
Other times I have taken the lymph nodes Paracaval giving compression on the
superior vena cava and cause venous stasis and the "syndrome of edema to the
mantle.
Epidemiology (ie epi demos from the greek logos, study the people, how it
impacts?)
Lung cancer is a cancer continues to rise, although from 1950 to 1980 cases of
cancer have soared 330% in women and 225% growth in men and in men of color. In
the U.S., where adenocarcinoma in the hit parade, are the leading cause of
cancer death for both males (> 100,000) and for females (> 50.000/anno). Effect
max: 55-65 years. Although we and our hinterland, if Rome does not intervene by
enforcing environmental laws and sanitation, has contributed much to the
epidemiological case! At the time of diagnosis only 20% had a localized form,
usually, however, the prognosis is always bad. The 5-year survival is only 30%
for males and 50% for females (in women the most common form is adenocarcinoma).
Over the years, have observed changes in frequency of histological type (adenocarcinoma
is currently the most common in the U.S.).
Etiopathogenesis.
This is related to changing lifestyles, the use of cigarettes and the fact that
women also work in industry as men. The lung can be divided into "primitive" and
"secondary", that is, tumors that arise from the lung or that occur as distant
metastases, those in medical jargon "repetitions." Even primitive ones, namely
those of their lungs, can be benign in 5% of cases or malignant, these are the
most frequent with 95% of cases. We must say that lung cancer is actually a
tumor arising from the bronchus and, more precisely, the epithelial lining of
the bronchus, especially for large caliber bronchi and above the hilum, that is
the point where the bronchus enters the parenchyma lung, and forms connective,
ie tissue fillers, are very rare and is mostly sarcomas. Another distinction
between "petty" and "small cell tumors" and "non-small cell tumors" and that
distinction is reason to be in the high degree of malignancy of the earliest
forms, which more often than others give rise to metastases, especially
nell'encefalo.
How to prevent lung cancer?
Risk factors:
• Cigarette smoking and the industry! Passive smoking is also risky for the
genesis of cancer as the active one; also smog and air pollution (industrial
chemicals (nickel, chromium, arsenic and cadmium, ionizing radiation) and stay
indoors as the mines where there is radon (see Risk of respiratory cancer and
industrial pollution What 'is true on radon).. Still need to think
multi-factorial genesis, ie environmental and genetic predisposing factors. The
diet with fatty foods shall, while prefer a diet of fruit and vegetables with
vitamin E deficiency and beta-carotene prevents the onset of cancer. Then the
tumor, as my late professor, "is a song that you stutter in cradle": familiarity
and RB gene mutations (patients with retinoblastoma who reach adulthood) and
First Instance of the p53 gene have a risk of another cancer of the lung or
about 2 / 3 higher).
......
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