Lung cancer diagnosis!

Lung cancer and other malignancies also like to produce some of hormones, antigens, proteins and other biological child sexual material, but these tumor markers for lung cancer detection there is no value to clinicians on the middle-aged or above Chronic Cough Buyu, and there Xuetan Lung X-ray examination found that nature did not block the video or inflammation of the cases changed, should heighten their vigilance and a high degree of doubt the possibility of lung cancer, a detailed inspection in time.
(1) X-X-ray inspection diagnosis of lung cancer is the most commonly used means important. Through X-ray examination of lung cancer can learn the location and size. Early lung cancer cases although the X-ray examination have not been able to show mass, but may see as bronchial obstruction caused by local emphysema, lung lesions or not the neighbouring parts of invasive disease or lung inflammation changed. Chang revealed that central lung cancer or the side of the whole lobe atelectasis (Figure: Figure 67-14 (1)), near the edge of Bu Zhengqi hilar or sub-district phyllodes tumor and lymph node swelling image. Tumor necrosis lesions central part of a hollow show that while there are mass eccentric lucent, empty wall, the wall rugged, showed less liquid plane (Figure: Figure 67-14 (2)). The most common type of lung cancer around the X-ray showed lung field position edge of the circle formed isolated Oval block video in diameter from 1 ~ 2 cm ~ 5 ~ 6cm or greater. Block shadow outline of irregular, often show little or notch-leaf, fuzzy edges, Mao Cao, a regular small burr short video (below: Figure 67-14 (3)). Disease can still progress after a mass around atelectasis, pneumonia, pleural effusion, and other features. High-voltage radiography help determine the nature of disease. Hilar area around the tumor for the most part squamous cell carcinoma and small cell undifferentiated carcinoma, which frequently have obstructive pneumonia, lung or lung is not changed, and hilar and / or lymph node enlargement. Most large cell carcinoma and adenocarcinoma and squamous cell carcinoma of small cell carcinoma and lung field at the edge site, the Ministry of cancer Feijian mostly squamous cell carcinoma. Mass greater than 4 cm in diameter, often as squamous cell carcinoma, and the formation of cancer more often empty. Bronchioloalveolar carcinoma of the X-ray findings for the most part isolated peripheral nodular lesions, the wider scope of nodular invasion, similar to bronchial or Lobar Pneumonia, sometimes show empty.
Perspective on chest X-ray observation of the diaphragm movement, will help determine whether the phrenic nerve tumor was violated. Standard fault radiography shows central lung cancer bronchial obstruction, the difference between cancer and inflammation change the image, clearly shows that lung cancer and sub-block video phyllodes shape, and hilar lymph node swelling, and video pieces in the show whether calcification Lesions. In recent years computer tomography (CT) has been in widespread clinical use. This method can display three-dimensional structure of thin cross-sectional images, to avoid disease and normal tissue images overlap, the early detection of X-ray examination generally hidden areas (such as Feijian, diaphragm, spinal side, near the chest wall pleura, the heart of the rear , Mediastinum, etc.) of lung cancer lesions, lymph node clear whether the increase, and so on, are diagnostic value. CT scans can show that less than 5 mm in diameter nodular lesions in the lungs, thus early detection of primary or secondary lung cancer. CT of the various pulmonary diseases has a good ability to distinguish between density and can help identify the nature and the lesions clear whether calcified lesions. Bronchial tumor imaging can show that due to the brink of deterioration bronchial cavity, filling defect, a narrow cavity or irregular interruption of the bronchoscopy failed to arrive at the origin of the lung or bronchial sub-paragraph of the peripheral lung cancer or adenomas with diagnosis of bronchial (Graphic: Figure 67-15). Barium X-ray examination of the meals help to understand mediastinal lung cancer and esophagus were violations of the situation. Pulmonary angiography to determine whether the tumor of the left and right, and pulmonary artery near the left and right atrium, will help determine the type of lung cancer with the possibility, but has fewer applications.
(B) cytology majority of primary lung cancer patients in the sputum may be available in the shedding of cancer cells, cancer cells and determine the types of organizations. Therefore sputum cytology survey and diagnosis of lung cancer is a simple and effective way. Gargle with water after getting up from the deep lung Kechu fresh sputum or bronchial washing the aspiration of the bronchial secretions can serve as a check samples. Repeatedly sputum cytology can enhance the positive rate. Central lung cancer sputum cytology, the positive rate of 70 to 90 percent, peripheral lung cancer smear-positive rate is only about 50 percent, negative sputum cytology can not rule out the possibility of lung cancer. Squamous cell carcinoma, mostly in the larger bronchial tumor growth to the lumen, the cancer cell surface shedding so easy to smear-positive rate is high and determine the type of organization is also more accurate. Undifferentiated small cell carcinoma smear-positive rate is high, but difficult to determine the type of organization.
Lung cancer transferred to the pleural cavity or pericardial cavity, a pleural effusion, or cardiac cases, taking part effusion, the centrifugal treatment for precipitation for smears, to find cancer cells, can be diagnosed.
(C) bronchoscopy bronchoscopy diagnosis of lung cancer is an important measure. Bronchoscopy through direct Kuicha of endobronchial and the pathological changes in the lumen. Insight into cancer or cancer of the invasion, organizations can be taken for pathology biopsy, or bronchial secretions lessons for cytology, a clear diagnosis and determine the type of organization. However, due to bronchial vascular rich adenoma, it is not appropriate for bronchoscopic biopsy, so as not to cause massive bleeding. Bronchoscopy and bronchial eminence can still observe the location, shape, width and activities, organizations need to take a pathological examination was helpful for understanding the scope of diseases, resection of the possibilities and scope of the lung resection. The use of the hard-bronchoscopy can only glimpse the larger bronchial, the central lung cancer diagnosis of the larger. Over the past 20 years fiber-guided bronchoscopy is widely used, such bronchoscopy smaller diameter, soft flexible, able to Shenru each lobe, lung and the majority of sub-paragraph of the bronchial, and brush or in the application of X-ray positioning of the television lens Add to the lung tissue of living within the organization clamp, taken for pathological examination of samples, increasing the bronchoscopy, the positive rate for peripheral lung cancer early diagnosis was very helpful.
(D) mediastinal examination mainly used to identify the type of mediastinal the scope of lung cancer. The sternal notch on the edge of the short-transverse incision, along the midline incision vertical banded neck muscles and trachea before the fascia, a finger in the innominate artery and aortic arch blunt the rear compartment of separation before the trachea, carina arrived trachea, Add to mediastinoscopy Kuicha and swelling of the lymph nodes. Through the puncture or cut to attract pathological lymph nodes for biopsy. Lymph node-positive, especially the opposite mediastinal lymph nodes have been transferred or differentiation of lung cancer is lung resection of the contraindications.
(5) percutaneous lung biopsy and around the chest wall or mass infiltration of suspected peripheral lung cancer lesions or diffuse alveolar carcinoma of the fine applied to other diagnostic methods, failed to clear the nature of disease, the patient's physical condition is not suitable for post-mortem Chest exploration of the cases, lung biopsy may be percutaneous. Perspective on television in the X-ray to determine the lesion site, in the testator under local anesthesia patients breath when the needle will be inserted into the lesion site, pull out the needle core, linking 30 ~ 50 ml syringes, with works in the suction of the rotating needle And then quickly pull out the needle, the collection of specimens sent for pathological examination. Percutaneous after lung puncture should pay close attention to whether with pneumothorax, chest and blood hemoptysis. Inspection of lung cancer cases around the positive rate of 80%, rate of complications is not high. Transferred to the pleural disease can also be taken through the skin puncture pleural Organization for pathological examination.
(6) radionuclide check 67 Ga-citrate and other radioactive substances and transfer of lung cancer lesions have affinity, after the intravenous injection of concentration in cancer, lung cancer can be used for the position that the scope of cancer, the positive rate Up to 90 percent. However, lung inflammation and tuberculosis, and other non-cancerous lesions can also show concentration phenomenon. Must therefore be combined with clinical examination and other performance data analysis. 133 Xe used for lung ventilation and perfusion scan of lung cancer lesions on both sides of the impact of lung function, which helps determine the treatment indications.
(7) lesion biopsy transfer of advanced lung cancer cases have been on the collarbone, neck, armpits, etc. superficial metastasis or metastatic nodules in the skin, can cut the transfer organization for pathological lesions or puncture biopsy taken from the Organization for Tu - Checks to clear diagnosis.
(8) mediastinal incision of mediastinal Kuicha difficult examination in the left aortic arch below the level before the mediastinal lesions situation. A small number of central lung cancer cases in order to avoid unnecessary thoracotomy of the adverse consequences of the purposes of the body could be considered less traumatic incision of the mediastinum. The left front sternum No. 2 intercostal incision, or removal of clothing under a short paragraph or 2 / 3 and costal cartilage, blood vessels in the thorax ligation, will open the pleura to be shown outside of mediastinal and hilar lymph nodes, easy to take Organization for a pathological examination. Such methods are not yet widely used, but for some cases in the development of treatment programmes have a certain value.
(9) thoracotomy exploration of lung tumors by various methods of inspection and test the short-term treatment failed to clear the nature of disease and lung cancer, also can not rule out the possibility, if the patient systemic conditions permit, should be exploration of thoracotomy. Of disease and in accordance with the pathological findings, the corresponding treatment. This would avoid delays caused illness early treatment of lung cancer cases lost time.
In short, these middle-aged patients, especially men have a long habit of smoking, showing irritation cough or respiratory symptoms such as bloody sputum or bone and joint swelling and pain, pestle-like that (toe), neck lymph nodes, and so on, should be Guard against the possibility of lung cancer, immediately chest X-ray and sputum for sending repeat cytology. Pulmonary tuberculosis or inflammatory disease and failed to identify who can give the appropriate short-term anti-inflammatory or anti-tuberculosis medication, to review chest film, such as lesions or it has not dissipated the increase in the diagnosis of cancer and has not yet been determined, would A bronchoscopy, with lesions and other parts of the examination. Various checks were not received positive conclusion, lung cancer can not rule out the possibility, if the patient systemic conditions permit, which should be implemented as soon as possible exploration of thoracotomy.