Cancer of the mediastinum or lungs are quite terrible diagnoses that in recent years have begun to occur earlier than before. Neoplasms in the mediastinum are localized in the mediastinal part of the sternum. It is customary to divide this area into three zones: top, center, bottom. Three more departments are called central and located behind and in front. Each of them can become an area of localization of the malignant process.
Theory and division into groups
All cases of mediastinal and lung cancer are divided into diseases that have appeared in this area, as well as those that have spread here from other parts of the body. In the first case, they speak of the primary form of the disease. The second is a consequence of the spread of metastases, and the initial focus is somewhere outside the designated area. This type of disease is called secondary. Doctors are aware of pseudotumors, which are relatively often detected in the mediastinal zone. They can be an aneurysm, a cyst. The first is more often detected on a large blood vessel. cystsare different: pericardium, bronchi, caused by infection with echinococcus. Possibly enlarged lymph nodes.
General theory
In the ICD, mediastinal cancer is encoded with codes C 38.138.1-38.138.3. Among other malignant pathological processes of this zone, lymphoma, thymoma, teratoma, pheochromocytoma are most often detected. The risk of a malignant process is higher if a large formation appears in the anterior mediastinum. Among other location options, cases of relatively safe current are more often observed here.
Neurogenic tumors, especially neurinomas, are not uncommon among primary tumors. Among the lymphoid forms, lympho-, reticulosarcomas are distinguished. There is a danger of fibro-, angio-, liposarcoma. Cancer processes can affect mesenchymal tissue. Perhaps the appearance of seminoma, chorionepithelioma.
General manifestations and specification
Signs of mediastinal cancer include general weakness of the patient and violation of the rhythm of heart contractions. Pain in the joints, the patient is losing weight. There may be an increase or decrease in heart rate. Some develop a fever. Symptoms include pleurisy.
Suggesting a malignant neoplasm, it is necessary to carefully check the patient's condition. First of all, it is necessary to examine the chest with an x-ray. This method allows you to determine the localization of the formation, the dimensions of the zone. Radioscopy of the area, computed tomography, MRI are shown. Usually x-rays are needed from different positions. To clarify the statusdo: broncho-, videotora-, mediastinoscopy. Need a biopsy: prescale, puncture.
Thymoma
Such mediastinal cancer can develop in a person regardless of age, although the incidence peaks in the age group of 30-40 years. On average, among the primary pathological malignant processes of the mediastinum, this is observed most often. There are several types, including combined flow. The malignant disease is prone to invasion, increased aggressiveness, is common with approximately the same frequency as the benign variant of thymoma. Pathology spreads along the pleura, relatively rarely gives metastases to the lymph, through the blood. Approximately half of those diagnosed with this disease have myasthenia gravis.
Dysembryogenetic pathologies
This variant of mediastinal cancer is diagnosed with a frequency close to the form described above. A malignant course is inherent in approximately every third patient. Teratoma is formed by different types of components. In most cases, it is diagnosed in adolescents. Approximately every second case is characterized by the presence of calcifications. The malignant process spreads rapidly. In some cases, the cause of a sharp increase is hemorrhage. The transformation of pathology into malignant is accompanied by the spread of secondary foci to the lungs. Possible regional metastasis.
Mesenchymal pathologies
This mediastinal cancer can affect any area of this area of the body, but more oftendiagnosed in the front block. The lipoma is more likely to appear in the lower part. Spread in different directions is possible. Lipo-, fibrosarcomas are relatively rare diseases. More often such are localized in a mediastinum behind. Because of them, the internal organs located in this part of the body may shift.
If a fibroma has developed, there are usually no manifestations of the disease until the pathology becomes large in size. Fibrosarcoma can be suspected if pleural exudate is observed. The same phenomenon may indicate a fibroma. Sometimes a hemangioma develops in the area under consideration.
Relevance of the issue
Mediastinal cancer is considered one of the most difficult topics for modern medicine. Histologically, genetically, embryogenetically, such processes are extremely diverse, they differ greatly from each other in terms of the specifics of the structure, topography, and clinical picture. Because of this, diagnosis is complicated. It is not easy to determine the nosology of pathology. There is no clear tactic for treating the case.
Among all malignant diseases, those developed in the mediastinum account for 3-7%. Representatives of all sexes are equally susceptible to diseases. Most of the disease is detected in middle, young age. One in three pathologies develop without symptoms, and the shadows indicating the disease are accidentally detected by taking a prophylactic chest x-ray.
Methods and methodologies
Suspecting mediastinal cancer (lymph nodes, connective tissue and other parts), it is necessary to make a fullcondition diagnostics. Given the development of technology, the best results are currently achievable through CT, MRI. To clarify the condition, ultrasound, a contrast vascular study, cytological analysis, and a histology study of questionable areas are needed. They do a bronchoscopy. As a result of all these works, doctors get a fairly complete picture of the structure of the zone, the area of location, and the relationship with other parts of the body. Often a scintigraphy is prescribed. The event requires the use of 67Ga-citrate. The experience of using immunoscintigraphy to clarify the patient's condition is quite large. Intraoperative gamma radiometry available.
Topical diagnostics gets more and more opportunities. Making a correct and accurate diagnosis is the basis for the correct selection of treatment. Invasive diagnostic methodologies are indispensable - punctures, videothoraco-, mediastinoscopy, mediastino-, thoracotomy. Through such activities, it is possible to confirm the morphological features of the area, to finally verify the correctness of the formulated diagnosis, to identify all the specific qualities of the affected area.
Problems of treatment
In the case of benign neoplasms in the mediastinum, the treatment for most cases is relatively simple. The same cannot be said about the treatment of mediastinal cancer. So far, doctors' success has been rather limited. Methods known to modern specialists have a wide range of limitations, and malignant processes in this area are characterized by a tendency to quickly affect nearby vital parts of the body. The patient's condition quickly and dramatically worsens, and a differentiated therapeutic approach can be implemented only at a stretch. The histological features of the process strongly influence the prognosis.
The classic approach in the treatment of lung cancer with mediastinal metastases, a malignant process that is primary in the thoracic region, is surgery. The possibilities of resection are severely limited even if the process is relatively uncommon. If the areas near the original source are affected, it is almost impossible to observe the ablastics. As a result, the forecasts for the occasion deteriorate sharply. It is known that numerous relapses in the treatment of cancer in such a localization area are not at all associated with remote lymphatic zones, but with the inability to completely remove the tissues affected by the process.
Surgery and outcomes
If there is no metastasis yet, mediastinal cancer has a better prognosis. The optimal treatment option is available to those who managed to go to the clinic on time, the disease was identified and correctly specified. In addition, combined treatment is indicated to improve prognosis. Quite aggressive mixed surgical interventions are often recommended. The average five-year survival rate for malignant pathologies in this area of the body is estimated at 35%.
So far, there are no exact recommendations regarding the use of surgical measures in the case of a particular form of the disease. There is no complete and reliable information about the effectiveness of surgery in different variants of the course. No and reliableevidence that survival is better in people who received radiation, chemical treatment as an addition to the main program.
Options and approaches
If there are symptoms of mediastinal cancer, if the diagnosis is confirmed, sometimes they can prescribe treatment with radiation, the use of drugs without surgery. There are cases when such approaches gave the most reliable and pronounced results. Treatment with hormonal drugs, chemical agents is almost always combined with radiation. This method is most effective for lymphoma. Radical cytoreductive surgery is indicated in the case of a germ cell tumor process. It is noted that after induction chemical treatment, surgery gives results that are 10% better than when using only the cytoreductive method.
Irradiation is indicated for mediastinal lymphoma, thymoma. The five-year survival rate was estimated at 54.6%. True, there are still no principles according to which it would be chosen which of the patients needs radiation. According to many scientists, it is necessary to introduce a system based on the nosology of diseases, histological features. The lack of such structured information and instructions for action causes an increased risk of choosing the wrong therapeutic method.
Step by step
In medicine, there are several stages of mediastinal cancer. Zero is the stage at which it is almost impossible to determine the disease due to the absence of any manifestations. Firsta step is called an encapsulated pathological process. At this stage, the pathology has not yet spread to the fiber. The second stage is characterized by infiltration of the fat layer. In the third stage, the pathology spreads to several organs of this zone, covers the lymph nodes. The fourth, terminal stage is the stage at which metastases are detected in individual organs. To determine what stage of the disease, you need to examine the patient's body through CT, MRI. Pictures must accompany the conclusion of the diagnostician.
Causes and factors
Malignant pathologies of the mediastinum are formed due to various reasons. At the moment, scientists are at a loss in identifying methods, methods that would make it possible to determine what exactly causes the pathology in the mediastinal region. The psychosomatic medical direction believes that the root cause of oncological diseases is the psycho-emotional state of the person. Another possible explanation for the cases is genetic. Presumably, heredity involves the transfer to a new generation of specific genes, due to which atypical processes begin. The predisposition is formed during the development of the embryo and may be due to the incorrect genesis of the new organism.
Another theory proposes to look for the cause of a malignant neoplasm in infection with viruses. It is assumed that the pathological agent initiates the gene mutation.
Among the factors provoking pathology, there are irradiation, background radiation, carcinogens with which a personcontacts due to the working environment, poor ecology, food. Over the years, protective mechanisms weaken, therefore, in general, the risk of cancer is higher for middle-aged and elderly people, although much depends on the form. Among other factors, chronic diseases, improper pregnancy are noted.
