RUSSIAN PEOPLES FRIENDSHIP UNIVERSITY

MEDICAL SCHOOL

Department of Oncology and Radiology

Russian Scientific Center for Radiology and Russian Ministry of Health

VP Kharchenko, TA Lyutfaliev, NV Kharchenko,

MA Kunda, GI Isaev, VL Baryshnikov, GM Locking

"LUNG CANCER"

IN QUESTIONS AND ANSWERS

(Training manuals)

Moscow

2004

1. How many lobes are there in the right lung?

a) Two
 b) Tree

2. How many lobes are there in the left lung?

a) Two
b) Three

3. How many segments are there in the upper lobe of right lung?

a) Tree
b) Four
c) Five

4. How many segments are there in the middle lobe of right lung?

a) Two
b) Three
c) Four

5. How many segments are there in the lower lobe of right lung?

a) Three
b) Four
c) Five

6. How many segments are there in the upper lobe of the left lung?

a) Three
b) Four
c) Five

7. How many segments are there in the lower lobe of the left lung?

a) Three
b) Four
c) Five #

8. Which cells make the lining epithelium of the bronchi?

a) Flat
b) ciliate
c) Cubic

9. Which glandular cells are most common in the bronchial mucosa?

a) Mucous secreting
b) Hormone producing

10. What are the 4 major risk factor for lung cancer?
 a) Tobacco
b) Professional Hazard
a) Errors in feeding
d) Features of the anatomical structure of the lungs
e) The impact of hazardous chemicals
g) Chronic respiratory diseases (tuberculosis, bronchitis, fungal lung)
d) ionizing radiation

11. What process is at the heart of squamous cell lung cancer?

a) Dysplasia of bronchial epithelium

b) metaplasia of the bronchial epithelium

12. What process is the basis of adenocarcinoma of the lung?

a) scarring of lung tissue in inflammatory processes

b) Restructuring of the alveoli

13. What is the central lung cancer?

a) cancer, affecting subsegmental and smaller bronchi

b) cancer, which affects large bronchi (the main, lobar, segmental)

14. What is peripheral lung cancer?

a) cancer, affecting subsegmental and smaller bronchi.

b) cancer, which affects large bronchi (the main bronchus, lobar, segmentary)

15. What is the endobronchial lung cancer?

a) Cancer, growing into the lumen of the bronchus

b) cancer growing in the bronchial wall

16. What is the central peribronchial lung cancer?

a) Cancer, growing into the lumen of the bronchus

b) cancer growing in the bronchial wall

17. What is the globular form of peripheral lung cancer?

a) The tumor has the form of spherical formations located in the pulmonary parenchyma

b) The tumor has the form of pneumonic lesion in lung

18. What is pneumonic type lung cancer?

 a) The tumor has spherical formations located in the lung parenchyma
b) The tumor has the form of pneumonic lesion in lung

19. What are the common atypical form of lung cancer?

a) globular cancer
b)Pancoast tumour
c) Pneumonic type cancer
d) mediastinal cancer
e) Primary carcinomatosis

20. What are the main histological forms of lung cancer produce?
a) Squamous
b) small-cell
a) Sarcoma
d) Adenocarcinoma

21. What is bronchoalveolar lung cancer?

a) Glandular peripheral lung cancer growing in the form of multiple nodes in the lung
parenchyma
b) A form of small cell lung cancer

22. What are the basic characteristics of lung cancer?

a) The small size of the tumor cells

b) No signs of differentiation
c) Early metastasis
g) Production of biomarkers and hormones
e) Production of mucus
g) Production of acids

23. What is meant by the symbol T1 in the classification of peripheral lung cancer in the TNM?

a) The tumor is not more than 3 cm in its greatest dimension, surrounded by lung tissue or visceral
pleura.
b) The tumor more than 3 cm in greatest dimension, surrounded by lung tissue or visceral pleura
c) The tumor of any size, germinating the chest wall, mediastinal pleura or pericardium, without lesion
of the heart, great vessels, esophagus

24. What is meant by the symbol T2 in the classification of peripheral lung cancer in the TNM?

a) The tumor is not more than 3 cm in greatest dimension, surrounded by lung tissue or visceral pleura
b) The tumor more than 3 cm in greatest dimension, surrounded by lung tissue or visceral pleura.
c) The tumor of any size, germinating the chest wall, mediastinal pleura or pericardium, without lesion
of the heart, great vessels, esophagus

25. What is meant by the symbol of T3 in the classification of peripheral lung cancer in the TNM?
 a) The tumor is not more than 3 cm in greatest dimension, surrounded by lung tissue or visceral pleura
b) The tumor more than 3 cm in greatest dimension, surrounded by lung tissue or visceral pleura
c) The tumor of any size, germinating the chest wall, mediastinal pleura or pericardium, without lesion
of the heart, great vessels, esophagus

26. What is meant by the symbol of T4 in the classification of peripheral lung cancer in the TNM?

a) The tumor of any size, germinating the chest wall, mediastinal pleura or pericardium, without damage
of the heart, great vessels, esophagus
b) The tumor of any size with a lesion of the mediastinum, heart, great vessels, esophagus

29. What is meant by the symbol T1 in the classification of central lung cancer in the TNM?

a) The tumor, located in the bronchial wall and affects the segmental or lobar bronchus, but not
affecting the mouth lobe bronchus, atelectasis radiologically can be segment #
b) The tumor bronchial wall of any size, passing the mouth of the equity or the main bronchus, but not
reaching 2 cm to the carina, X-ray may be atelectasis share.
c) The tumor that affects the wall of the main bronchus is closer than 2 cm from carina, rentgenolgicheski may occur
atelectasis
30. What is meant by the symbol T2 in the classification of central lung cancer in the TNM?

a) The tumor, located in the bronchial wall and affects the segmental or lobar bronchus, but not
affecting the mouth lobe bronchus, radiologically atelectasis of segments can be seen.
b) The tumor is on the bronchial wall of any size, passing the mouth of the main bronchus, but not
reaching by 2 cm to the bifurcation of trachea, X-ray may show atelectasis of the lobe.
c) The tumor that affects the wall of the main bronchus is closer than 2 cm from carina, radiologically
atelectasis maybe seen.

31. What is meant by the symbol of T3 in the classification of central lung cancer in the TNM?

a) The tumor, located in the bronchial wall and affects the segmental or lobar bronchus, but not
affecting the mouth lobe bronchus, radiologically atelectasis of segment can be seen.
b) The tumor in the bronchial wall of any size, passing the mouth of the equity or the main bronchus,
but not reaching by 2 cm to the bifurcation of the trachea, X-ray may show atelectasis.
c) The tumor that affects the wall of the main bronchus and is closer than 2 cm from the bifurcation of
trachea, radiologically atelectasis maybe seen.

33. What are the regional lymph nodes that constitute the group of N1 in lung cancer?

a) The peribronchial lymph nodes, lung lymph nodes of the base of lungs
b) bifurcation, mediastinal lymph nodes
c) mediastinal or base of the lung with opposite sides

34. What are the regional lymph nodes that constitute the group of N2 lung cancer?
 a) The peribronchial lymph nodes, lymph nodes of the base of lung
b) bifurcation, mediastinal lymph node
c) mediastinal or base of the lung with opposite sides

35. What are the regional lymph nodes that constitute the group of N3 for lung cancer?

a) The peribronchial lymph nodes, lymph nodes of the base of lung

b) bifurcation, mediastinal lymph nodes
c) mediastinal or base of the lung with opposite sides

36. What remote lymphogenous metastasis of lung cancer occur most frequently?

a) Metastases to the ovaries

b) Metastases to axillary lymph nodes
c) Metastases to lymph nodes of the neck.

37. What distant hematogenous metastases occur most frequently?

a) liver metastases
b) Metastases in bones of the skeleton
c) Metastases in the adrenal glands and kidneys
d) brain metastases
g) Metastases to the skin
g) Metastases to the spleen

38. Which combinations of symbols means TNM stage I lung cancer?

a) T1N0M0, T2N0M0
b) T1N1M0, T2N1M0
a) T3N0M0, T3N1M0, T1-3N2M0, N1-4N3M0, T4N0M0
d) T1-4N0-3M1

39. Which combinations of symbols mean TNM stage II lung cancer?

a) T1N0M0, T2N0M0
b) T1N1M0, T2N1M0
a) T3N0M0, T3N1M0, T1-3N2M0, N1-4N3M0, T4N0M0
d) T1-4N0-3M1

40. Which combinations of symbols mean TNM stage III lung cancer?

a) T1N0M0, T2N0M0
b) T1N1M0, T2N1M0
a) T3N0M0, T3N1M0, T1-3N2M0, N1-4N3M0, T4N0M0
 d) T1-4N0-3M1

41. Which combinations of symbols mean TNM stage IV lung cancer?

a) T1N0M0, T2N0M0
b) T1N1M0, T2N1M0
a) T3N0M0, T3N1M0, T1-3N2M0, N1-4N3M0, T4N0M0
d) T1-4N0-3M1

42. Which secrete the major symptoms of central lung cancer?

a) Cough
b) Hemoptysis
c) chest pain
d) Shortness of breath
e) Trouble in swallowing

43. The primary cause of atelectasis in lung cancer is?

a) Hemoptysis
b) Obturation of the lumen of the bronchus by the tumor
c) Swelling of the bronchial mucosa due to inflammation

44. What is pneumonia?

a) Inflammation of the affected bronchus

b) Inflammation of the lymph nodes of the lung
c) The inflammatory process in atelectasis

45. Which course has pneumonitis in lung cancer?

a) Chronic
b) Residual

46. Which syndrome often occurs in metastatic lesions of paratracheal lymph node on the right?

a) The syndrome of compression of the superior vena cava

b) Horner's Syndrome
c) The syndrome of compression of lymphatic duct of the breast

47. What's syndrome often occurs in lesions of the left paratracheal lymph nodes in lung cancer?

a) The syndrome of dysfunction of the diaphragm

b) The syndrome of recurrent nerve lesions
 a) Syndrome lesions in mediastinal vessels

48. What syndrome occurs in metastatic lesions

bifurcation lymph nodes in lung cancer?

a) The syndrome of compression of the aorta

b) The syndrome of compression of the esophagus

49. What syndrome occurs in metastatic lesions of the pleura in lung cancer?

a) metastatic pleurisy
b) pain syndrome
c) Hemoptysis

50. What a paraneoplastic syndrome often occurs in lung cancer?

a) The syndrome of hypertrophic osteoarthropathy

b) Horners syndrome
c) Neurological syndromes

51. What is the primary symptom of hypertrophic osteo-arthropathy?

a) severe pain in joints, often ankle and wrist

b) Headache
c) Pain in the hips

52. What are the main clinical manifestations of peripheral lung cancer?

a) asymptomatic for a long time

b) Symptoms remind of clinical picture of central lung cancer
c) The clinical picture resembles focal pneumonia

53. What are the main clinical manifestations of Pancoast tumour?

a) radiologically, defined shadow in the apex of lung

b) Pain in the shoulder girdle
c) Violations of the sensitivity of the skin
d) Atrophy of muscles of the upper extremity
d) Horner's Syndrome
e) Cough and hemoptysis
g) The destruction of the upper ribs
h) The destruction of the transverse processes of vertebrae

54. What is the centralization of peripheral lung cancer?

a) The location of the tumor near the root of the lung

b) Germination of peripheral tumors in the large bronchus
 55. What are the main methods of diagnosis of lung cancer?

a) Ultrasonic
b) Endoscopic
c) X-ray
d) Radioisotope

56. What are the radiological diagnostic methods used for lung cancer?

a) Computed tomography
b) Survey radiography of the lungs
c) Flurography
g) X-ray tomography
e) Pneumoscintigraphy

57. What are the main radiological signs of central lung cancer?

a) Reduce the transparency of the field of pulmonary

b) The presence of atelectasis
a) Reduced lung field
d) Displacement of ateleactic lobe
d) amputation of the bronchus
e) bronchoconstriction

58. What are the main radiological signs of peripheral lung cancer?

a) The presence of spherical shadows in the lung tissue

b) The heterogeneous structure of the shadow
a) hilly and radiance contoured shadows
g) Availability of abductor track
d) Changes of the pleura in the places of pathological shadows.

59. What are the main radiological signs of broncho-alveolar lung cancer?

a) The tumor is located in parts of the subpleura of the lung

b) Configuration of the shadow is polygonal
a) The contours of the rough with the strands on the periphery
d) The presence of large clear path with defined contour, and the presence of intense internal
partitions separating the intensity to multiple cell

60. With which diseases, radiological differential diagnosis of peripheral lung cancer carried out?

a) Hamartoma
b) Tuberculoma
 c) Metastasis of cancer of other sites
d) neurenomas
e) Cyst of lung
e) carcinoid tumor
g) Parasitic cyst

61. What is hamartoma of lung?

a) The tumor of the vessel wall

b) The tumor of cartilage tissue
c) The tumor of glandular tissue

62. What are the main differences between X-ray-parameter of peripheral lung cancer and benign
nodules?

a) The precise boundaries of the tumor

b) Smooth contours
c) Uniformity of structure

63. What are the main objectives of bronchoscopy for central lung cancer?

a) Identification of direct signs of tumors - imaging of tumor lesions in the bronchial mucosa
b) Identification of indirect signs of tumor - strain with the narrowing of the bronchi, the rigidity of
the walls, restricting the mobility of the respiratory bronchial walls
a) Restoring patency of the affected bronchus
d) Morphological confirmation of the diagnosis

64. What are the main objectives of bronchoscopy in peripheral lung cancer?

a) Establishment of signs of small lesions (subsegmentary) and large (centralization process)

bronchial
b) Morphological verification of the tumor
c) Washing of bronchi

65. What are the main methods of morphological verification of peripheral lung cancer?

a) transthoracic needle biopsy

b) Bronchoalveolar wash
a) brush biopsy
d) tracheobronchial biopsy
d) sputum cytology

66. What are the main methods of morphological verification of central lung cancer?

a) transthoracic needle biopsy

b) Bronchoalveolar wash
a) brush biopsy
d) tracheobronchial biopsy
 d) sputum cytology

67. What are the main methods of diagnosis of metastatic regional lymph nodes for lung cancer?

a) radiography
b) Tomography
c) X-ray computed tomography
d) Magnetic Resonance Imaging
e) Thoracoscopy
g) Scintigraphy with gallium

68. What methodology is used to assess the status of functional lung tissue in lung cancer?

a) Radiography
b) Tomography
c) X-ray computed tomography
d) Magnetic resonance imaging
e) Thoracoscopy
e) Perfusion pneumoscintigraphy

69. What is the most informative method to detect early distant hematogenous metastasis in the
bones of the skeleton in lung cancer?

a) Computed tomography
b) Bone scan
c) X-ray examination of bones of the skeleton
d) Study of tumor markers

70. Which radioisotope technique allows visualizing tumor metastasis in lung cancer?

a) Perfusion pneumoscintigraphy
b) Ventilation pneumoscintigraphy
c) Positive pneumoscintigraphy

71. What methodologies are used to assess the prevalence of the tumor process in lung cancer in the
large vessels of the mediastinum?

a) Pneumoscintigraphy
b) Angiography
c) CT
d) Magnetic resonance imaging
e) Ultrasound imaging

72. What methods are used to detect distant haematogenic metastases for lung cancer in the adrenal
glands and kidneys?

a) Pneumoscintigraphy
 b) Angiography
c) CT
d) Magnetic Resonance Imaging
e) Ultrasonic tomography

73. . What methods are used to detect distant haematogenic metastases for lung cancer in the brain?

a) Pneumoscintigraphy
b) Angiography
c) CT
d) Magnetic Resonance Imaging
e) Ultrasound imaging

74. What are the 2 most commonly used method of treatment of lung cancer?

a) Surgical
b) Drug
c) Radiotherapy
g) Radio immune

75. What are the standard surgical procedures performed for lung cancer?

a) segmentectomy
b) Pneumonectomy
c) Lobectomy
d) wedge resection
e) Boundary resection

76. Which organ preserving surgical intervention is used for lung cancer?

a) segmentectomy
b) Pneumonectomy
c) Lobectomy
d) wedge resection
e) Boundary resection

77. What is bronhoplastic surgery for lung cancer ?

a) The operations of removing lung tumors

b) Reconstructive surgery for bronchus with preservation of lung tissue
c) Organ preserving operations with suturing of lung tissue after tumor removal

78. What is an extended resection for lung cancer?

 a) The operations by removal of more than two lobes
b) Resection of the tumor with part of the lung and body in which the tumor has invaded
a) Removeal of one lung

79. What is combination therapy for lung cancer?

a) The use of radical surgery and radiotherapy

b) Application of advanced lung resection
c) Application of radiation and drug therapy

80. What radical treatment is most often used in stage I lung cancer?

a) Combined
b) Radiation
a) Surgical
d) Complex

81. What radical treatment is most often used in II-III stages of lung cancer?

a) Combined
b) Radiation
c) Surgical
d) Complex

82. What dose of radiation therapy is used in radical radiotherapy treatment of lung cancer?

a) 36-40 Gy.
b) 56-66 Gy.

83. What dose of radiation therapy is used in the palliative treatment of lung cancer?

a) 30-36 Gy.
b) 36-40 Gy.
b) 56-66 Gy.

84. What type of radiation therapy is most often used in the combined treatment of lung cancer

a) Preoperative radiotherapy
b) Intraoperative radiotherapy
c) Postoperative radiotherapy

85. What dose of postoperative radiation therapy is used in the combined treatment of lung cancer?

a) 30-36 Gy.
b) 46-50 Gy.
b) 56-66 Gy.

86. For the treatment of which type of lung cancer is systemic chemotherapy most often used?
 a) Squamous
b) small-cell
c) glandular

87. What kind of treatment is used in small cell carcinoma of lungs?

a) Surgical
b) Combined
c) Complex treatment

88. What drugs are used in systemic chemotherapy for lung cancer?

a) Lomustin
b) Platinum compound
c) Adriomysin, bleomycin
d) Etoposide
d) 5-Fluorouracil

89. What is X-Ray negative lung cancer?

a) Lung cancer is not detected by X-ray

b) Lung cancer is not detected in X-ray light
c) Lung cancer is detected only at the onset of clinical signs of disease

90. What method is most frequently used to detect X-ray-negative lung cancer?

a) Computed tomography
b) Magnetic resonance imaging
a) Radioisotope studies
d) Endoscopic methods

91. What is a synchronous multiple primary lung cancer?

a) pathogenetically independent occurrence in lungs with two or more tumors within 6

months
b) Pategenetically independent appearance in lungs with more than two tumors after 6
months

92. What is metachronous multiple primary lung cancer?

a) pathogenetically independent occurrence in lungs with two or more tumors within 6

months
b) Patthogenetically independent appearance in lungs with more than two tumors after 6
months
LUNG CANCER

Demographic factors of lung cancer:

1. Men suffer 9 times more often.

2. Age - most often after 50 years of age. Upto 30 years of age
only 0.2 /100,000. 30.2 years - 30.2, 60 years - 48.1, -69.9 70.
3. The highest incidence is in Scotland -109.7, USA - 71.8,
Poland - 68.0. Lowest - Thailand - 2,8, Syria, El Salvador - 2,2
4. Racial characteristics - people with black skin are twice as
vulnerable
5. City dwellers are more often affected by 2-2,5 times

Risk factors for lung cancer:

1. Tobacco smoking - by burning tobacco two distinct factions

are produced: the volatile substances - nitrosoamines and
pyrimidines; suspended particles - benzpyrene and
dietylacrydine. The higher the combustion temperature, the
more harmful substances are produced. The highest
temperature of combustion is in cigarettes, lower in cigars, and
even lower in smoking pipe.
2. Professional and household factors;
A) - Cancer in professional miners common miners,miners of
uranium ore. (4 times more likely)
B) - chemical plants and laboratories (1,5 times more often)
C) - Air pollution
D) - Ionizing radiation (2-4 times more)
3. Infectious respiratory diseases: chronic bronchitis and
pneumonia, tuberculosis, fungal lung disease.
4. Genetic factor: in relatives,cancer occurs in 10%,and in
distant relatives by- 3%.

Classification of lung cancer:

Central cancer - arises from the large bronchi (the main, lobar,
segmental) There are three forms of central lung cancer:
a) polypous cancer - a cancer growing in the bronchi as a
polyp on a stalk
b) endobronchial - a cancer growing in the bronchus as a
node of irregular shape
c) peribronchial - a cancer growing along the bronchial wall
and outward

Peripheral cancer - a cancer arising from the small ,terminal

bronchi.
Also divided into three forms of peripheral lung cancer:
a) Nodular - located in the lung tissue in the form of round
shadows.
 b) Pneumonic type - pneumonic focus in the lung
tissue,most often it is bronchoalveolar carcinoma.
c) abdominal or cavernous cancer - the lung tissue is
determined by the node with the cavity decay.

Atypical form of lung cancer:

Pancosta cancer - cancer of the apex of the lung - the nodal

form of lung cancer. Atypical in its clinical course - defect of skin
sensitivity in the shoulder region, pain in the shoulder girdle on
the affected side, muscle atrophy of the upper limbs, destruction
of the upper ribs, destruction of the transverse processes of
vertebrae.

Mediastenal lung cancer metastasis in the mediastinum with

undiagnosed peripheral or central lung cancer.

Pulmonary carcinomatosis - multiple nodal lesion of lung tissue

without initially identified peripheral or rarely central lung cancer.

Classification TNM:
Peripheral lung cancer

T0 - initial tumour is not detected

T1 - tumor less than 3 cm in diameter without affecting the
visceral pleura
T2 - tumor more than 3 cm in diameter without affecting the
visceral pleura
T3 - Tumor of any size with spread to the chest wall,
mediastinum, diaphragm.
T4 Growth of the tumor to heart, great vessels, esophagus

Central lung cancer

T0 - initial tumour not determined.

T1 - lobar bronchus is affected without tumor infiltration towards
its base.
T2 lesion of the main bronchus. Edge of the tumor is not
closer than 2 cm from the carina of the trachea. Atelectasis of
lobes is often seen.
T3 - Tumor affects the main bronchus, closer than 2 cm to
carina. Atelectasis of lung.
T4 - tumor lesion of large vessels, the heart (often with peri-
bronchial tumor growth)

N0 - regional metastases is absent

N1 - regional metastases to the peribronchial lymph nodes and
lymph nodes of the root of lung
N2 - The regional lymph node metastases in the bifurcation and
mediastinal lymph nodes on the affected side
N3 - regional metastases in mediastinal lymph nodes on the
opposite side, subclavian lymph nodes on the affected side.

M0 - no distant metastasis detected

M1 - distant lymphogenous or hematogenous metastasis

Distant metastases lymphogenous: axillary, cervical

Distant hematogenous metastases: liver, brain, adrenal gland

and kidney ,metastases in the skeleton.

Stage of the process

Stage I - T1N0M0, T2N0M0

Stage II - T1N1M0, T2N1M0
Stage III - T3N0M0, T3N1M0, T1-3N2M0,
T1-4N3M0, T4N0M0.
Stage IV-T1-4N0-3M1

Morphological classification of lung cancer:

1. Squamous cell carcinoma of the lung metaplasia of

bronchial epithelium mainly as a central cancer. Has three
differentiation - highly differentiated cancer, moderately
differentiated carcinoma, low-grade cancer. Metastasizes mainly
to regional lymph nodes. The frequency of metastasis depend
on the degree of differentiation. The lower the grade, the more
frequently identified regional metastases. The degree of
differentiation depends on the sensitivity to radiation and drug
therapy. The lower the sensitivity, the more effective radiation
therapy and drug therapy.
2. Adenocarcinoma - there is almost always a peripheral cancer
of the glands of bronchial tubes that produce mucus.
Lymphogenic and hematogenous metastases occurs. The
frequency of metastases depends on the degree of
differentiation. The lower the grade, the more frequently
identified regional metastases and frequently detected
hematogenous metastasis.
3. Small cell carcinoma - arises from hormone-producing cells
and is a tumor of the small cells with hyperchromic nuclei
resembling lymphocytes (lymphocytic cancer), characterized by:
a lack of signs of differentiation, early metastasis, malignant
course, production of hormones. Metastasizes often
hematogenically. In 50% of small cell carcinoma is diagnosed
primarily by its distant metastases.

CLINICAL PICTURE OF CENTRAL LUNG CANCER

Distinguish primary and secondary clinical manifestations of

lung cancer.
The primary symptoms of lung cancer - are associated with the
appearance in the lumen of the bronchus of the tumor. These
include:

1. Coughing -often dry cough.

2. Hemoptysis - the decay of the tumor
3. Pain in the chest wall - usually while running peribronchial
lung cancer

Secondary symptoms of lung cancer:

1. Development of inflammation in lung atelectasis with tumor

obstruction of the lumen in corresponding bronchus. Clinically
manifested as pneumonia (cough, fever,and x ray signs of
increased translucency) and is called pneumonitis. Its also has
residual development during which it serves as a differential
sign with normal pneumonia. In residual type of development in
pneumonia, the treating physician must send the patient for
bronchoscopy to exclude central lung cancer.

2. Superior vena cava syndrome occurs in central lung

cancer(swelling, face edema,blueish appearance of facial skin,
bulging of vein in face and neck due to violation of venous
blood outflow from the face, neck and upper extremities due to
metastases compressing the upper paratracheal nodes ( N2) of
the superior vena cava.
4. Lesion in the paratracheal lymph nodes often leads to
extension towards the left recurrent nerve and results in
development of paresis of the vocal cords and resulting in voice
hoarseness.
5. Metastases of lung cancer in the lymph node bifurcation
leads to compression of the esophagus by the passing behind it
the left main bronchus,which leads to syndrome dysphagia.
Therefore, all patients with suspected lung cancer are given a
sip of barium and on the lateral position ,observation of the
barium passage in the area of the carina is done.
6. Metastases of lung cancer in the visceral or parietal pleura
lead to the development of specific tumor pleurisy, as evidenced
by cytology ,exudate from the pleural cavity is often
hemorrhagic in nature.
7. 5% of patients with lung cancer develop specific syndromes
manifested by pains in the joints (most commonly at the ankle,
wrist and spine) - a syndrome of osteoarthropathy-Marie-
Bamberg. The basis of this syndrome lies in the allocation of
articular cavity of a large number of histaminic substances
causing stimulation of pain receptors.

CLINIC OF PERIPHERAL LUNG CANCER

Peripheral lung cancer is clinically asymptomatic for a long

time.And diagnosed by chance during special investigations.
Clinical manifestations of peripheral lung cancer appear only in
advanced cases, when the tumor invades the chest wall,
diaphragm, large vessels and pain occurs in the chest or in the
presence of regional or distant metastasis.
Development of peripheral tumor of large bronchus leads to
symptoms of central lung cancer and called centralization of
peripheral lung cancer.

Instrumental diagnosis of lung cancer

Diagnosis of peripheral lung cancer:

Radiography-Review X-ray chest gives the basic idea of the

number and size of pathological focus in the lungs, lobar and
segmental topography of the tumor, its relationship with the root
of the lung, pleura,and lung condition in general. Diaphragm,
chest wall, cardio-vascular shadows, pleural cavity.
Survey radiographs produce a straight line and the lateral
projection.

X ray appearance of peripheral lung cancer:

Shape-for tumors upto 1.5 cm, often polygonal in
shape.Tumors more than 2 cm -ovoid configuration, pear-
shaped or bean-shaped. In 4% -regular round or oval shaped.
The structure of the shadow of the shade structure in 70% is
non-uniform, which is associated with varying thickness of
different parts of the tumor.
Character of contours - contours of the tumor is rough or
uneven. Sometimes radial or toothed in the periphery (for small
tumours). In 60% -tuberous and radial forms are combined
Changes in the surroundings of lung tissue - 1) strained lung
pattern, showing a picture of lymphangites and infiltrative tumor
growth 2) the outlet tracks is the result of peribronchial and
perivascular reaction.

Changes of the pleura - 1) indrawing of interlobar pleura 2)

reaction of costal pleura in the form of pleural thickening .

Bronchial carcinoma - a tumor located in subpleura of the lungs.

The configuration of the shadow is of a polygonal or stellate
form. The structure of the tumor is heterogeneous, has a
trabeculated nature with multiple point of radiolucency. Jagged
edge with strands on periphery.

TOMOGRAPHY

The level and depth of cuts is determined by measuring the

direct and lateral review of chest x ray.
The tomograms in direct and lateral projections is a more
accurate representation of the pathological object, allowing
more precise study 1) the configuration, structure, characteristic
shapes, the state of lung tissue and pleura 2) make a differential
diagnosis of the shadows 3) to clarify the spread of the
bronchial tree 4) to establish the presence of metastases in the
intrathoracic lymph nodes.

COMPUTER TOMOGRAPHY

1). It has a significant increased sensitivity in the diagnosis of

peripheral growths.
2) reveals the hidden metastases
3) significant sensitivity in the diagnosis of mediastinal lesions
and the root of the lung
4. Allows the sighting for transthoracic puncture
5. Paramount among the methods of radiation therapy planning
6. Reliably diagnose a recurrence of the tumor.
7. Germination of peripheral tumors in the chest wall, large
vessels and heart

Radiological differential diagnosis of peripheral lung cancer is

performed with:
a) Hamartoma
b) Tuberculoma
c) metastases at other sites
d) neuroma
e) a cyst of lung
e) carcinoid tumor
g) parasitic cyst
The main X-ray characteristics of good-quality peripheral
formations, are:

a) The precise boundaries of the tumor

b) Smooth contours
c) Uniformity of structure

Angiography

Defines the status of large vessels in lung cancer. In peripheral

lung cancer is set for large tumors, especially in tumors with
centralization for determining the narrowing and occlusion of the
lumen of large vessels, which is important in determining
resectability and operability of the tumor.

Bronchoscopy

In peripheral lung cancer bronchoscopy is applied to:

1) Examine the state of large bronchi (the presence of the
centralization of the process)
2) Conduct a bronchoalveolar wash to obtain material for
morphological (cytological) study of the small bronchi and
alveoli.
3) To reveal the undirect signs of peribronchial metastasis and
puncture.
MORPHOLOGICAL STUDIES IN PERIPHERIAL LUNG
CANCER

Transthoracic puncture - the leading method for the

morphological material for peripheral lung cancer and the
differential morphological diagnosis in the presence of
peripheral lung shadows.

Diagnosis of central lung cancer

Survey radiography of the lungs:

1) The presence of X-ray picture of atelectasis

2) Lowering the transparency of light on the affected side
3) Reduced lung field
4) The shift of root of the lung towards the affected side

Tomography:

1) allows us to identify symptoms of the bronchus: stump,

amputation, constriction, thickening of the walls.
2) detect the tumor site at the root of lung
3) Increase of intrathoracic lymph nodes

Computed Tomography:

1) diagnosis of bronchial structures, to identify the tumor and

spread to the bronchial wall
2) diagnosis of metastatic cancer in the bifurcation and
paratracheal lymphatic nodes.
3) the state of the lymph nodes of the aorto-pulmonary window
4) growth of the tumor into the large vessels and the heart
5) radiation therapy planning

Bronchoscopy:

1) renders the lesion

2) the prevalence of tumor in the bronchial mucosa
3) identification of regional metastasis
4) to obtain morphological material from a tumor biopsy, with
prints on the glass, the brush biopsy

Endoscopic signs of tumor: a tumor with a lumpy mushroom or

papillomatous surface covered by necrotic or purulent coating,
deformation and narrowing of the bronchi, narrowing of its walls,
mucosal defect,flattening of the contours of cartilaginous rings

Angiography:
Five main groups of angiographic signs of

1) No changes in blood vessels and the mediastinum

2) lesion of the segmental branches of pulmonary artery
3) loss of major branches of the pulmonary artery
4) lesions of the superior vena cava
5) growth into the pericardium

Methods to determine functional states of lungs:

1) The function of respiration

2) Analysis of blood gas composition
3) Perfusion pulmonoscintigraphy

TREATMENT OF LUNG CANCER

The main methods used for treatment:

1) Surgical treatment
2) Radiotherapy
3) Polychemotherapy

Treatment is carried out depending on the stage of the process:

Stage I - surgical treatment.

Stage II - combined treatment.
Stage III, the combined treatment
Stage IV - chemotherapy

Treatment of small cell lung cancer complex treatment

Surgical intervention for lung cancer:

Standard operation - pneumonectomy, lobectomy

Organ-preserving surgery - segmentectomy, marginal resection
Reconstructive plastic surgery - operations on bronchus to
preserve lung tissue.
Radiation therapy: radical program of radiation therapy - SOD
56-66 Gy.
Palliative radiotherapy SOD - 36-40 Gy.
Postoperative radiation therapy for combined treatment for fixed
- 30-36 Gy.
During radiation therapy, the method small fractional irradiation
2 Gy.

Chemotherapy - chemotherapy drugs used in modern systemic

chemotherapy:

a) Lomustin
b) Platinum compound
c) Adriomysin, bleomycin
d) Etoposide
 e) nitrosourea.

Synchronous lung cancer - pathogenetically independent

occurrence in lungs, two or more tumors within 6 months