Cancer of the mediastinum or lung is a rather scary diagnosis, which in recent years has 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
All cases of cancer of the mediastinum and lung are divided into diseases that appeared in this area, as well as spreading here from other parts of the body. In the first case, they talk about 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 know pseudotumors, 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. Cysts are different: pericardium, bronchi, caused by infection with echinococcus. Possible proliferation of lymph nodes.
General theory
In the ICD, mediastinal cancer is encoded with the ciphers C 38.138.1-38.138.3. Among other malignant pathological processes in 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 mediastinal zone. Among other location options, cases of relatively safe flow are more often observed here.
Among the primary, neurogenic tumors are often found, especially neuromas. Among the lymphoid forms, lympho-, reticulosarcomas are distinguished. There is a risk of fibro-, angio-, liposarcoma. Cancerous processes can affect the mesenchymal tissue. Perhaps the appearance of seminoma, chorionepithelioma.
General manifestations and clarification
Signs of mediastinal cancer include the general weakness of the patient and a violation of the rhythm of heart contractions. Concerned about joint pain, the patient loses weight. Possible increased or slower heart rate. Some develop a fever. Symptoms include pleurisy.
Assuming a malignant neoplasm, it is necessary to carefully check the patient's condition. First of all, it is necessary to study the chest with an X-ray. This method allows you to determine the localization of the formation, the dimensions of the zone. Showing fluoroscopy area, computed tomography, MRI. Radiography from various positions is usually necessary. To clarify the condition do: bronchus, video, tori, mediastinoscopy. Need a biopsy: precancerous, puncture.
Timoma
Such mediastinal cancer can develop in humans, regardless of age, although the peak incidence rate falls on the age group of 30-40 years. On average, among the primary pathological malignant processes of the mediastinum, this is most often observed. There are several types, including combined flow. Malignant disease is prone to invasion, increased aggressive, spread with approximately the same frequency as a benign version of thymoma. Pathology spreads through the pleura, relatively rarely gives metastases to the lymph, through the blood. About half of those with this diagnosis have myasthenia gravis.
Dysembryogenetic pathologies
This variant of mediastinal cancer is diagnosed with a frequency close to the form described above. 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 is spreading rapidly. In some cases, the cause of the sharp increase is hemorrhage. The transformation of pathology into malignant is accompanied by the spread of secondary foci into the lungs. Perhaps regional metastasis.
Mesenchymal pathology
Such mediastinal cancer can affect any area of this area of the body, but is more often diagnosed in the anterior block. Lipoma is more likely to appear in the lower part. Distribution in different directions is possible. Lipo, fibrosarcomas are relatively rare diseases. More often, these are localized in the mediastinum behind. Because of them, internal organs located in this part of the body can shift.
If fibroma has developed, usually there are 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 fibroma. Sometimes a hemangioma develops in the area under consideration.
Relevance of the issue
Mediastinal cancer for modern medicine is considered one of the most difficult topics. Histologically, genetically, embryogenetically, such processes are extremely diverse, very different from each other in terms of the specific structure, topography, and clinical picture. Because of this, the diagnosis is complicated. It is not easy to determine the nosology of pathology. There is no clear case management tactic.
Among all malignant diseases, the share of those developing in the mediastinum accounts for 3-7%. Representatives of all genders are equally susceptible to disease. More often the disease is detected at an average young age. Every third pathology develops without symptoms, and shadows indicating a disease are accidentally detected, making a preventive picture of the sternum.
Methods and Methodologies
Suspecting cancer of the mediastinum (lymph nodes, connective tissue and other parts), it is necessary to make a full diagnosis of the condition. Given the development of technology, the best results are currently achievable by CT, MRI. To clarify the condition, ultrasound, contrast vascular examination, cytological analysis, histology of dubious areas are necessary. Do bronchoscopy. According to the results of all these works, doctors get a fairly complete picture of what the structure of the zone, area of location, relationships with other parts of the body are. Scintigraphy is often prescribed. The event requires the use of 67Ga citrate. Enough experience using immunoscintigraphy to clarify the condition of the patient. Possible intraoperative gamma radiometry.
Topical diagnostics is gaining more and more opportunities. A correct and accurate diagnosis is the basis for the correct selection of treatment. Invasive diagnostic methodologies are indispensable - puncture, videothoracic, mediastinoscopy, mediastino-, thoracotomy. Through such measures, it is possible to confirm the morphological features of the region, to finally verify the correctness of the formulated diagnosis, to reveal all the specific qualities of the affected area.
The issue of treatment
In the case of benign neoplasms in the mediastinal region, the treatment for most cases is relatively simple. This is not to say about the treatment of mediastinal cancer. So far, the success of doctors is quite limited. Methods known to modern specialists have a wide range of limitations, and malignant processes in this area are prone to rapidly affect nearby vital parts of the body. The patient's condition quickly and dramatically worsens, and a differentiated therapeutic approach can be implemented only with a big stretch. Histological features of the process strongly influence forecasts.
A classic approach to the treatment of lung cancer with metastases to the mediastinum, a malignant process that is primary for the chest area, is surgery. Resection options are very limited even if the process is relatively small. If areas near the source focus are affected, ablasticity is almost impossible to maintain. As a result, forecasts for the occasion are sharply deteriorating. It is known that numerous relapses in the treatment of cancer of such a localization area are not associated at all with the removed lymphatic zones, but with the inability to completely remove the tissues affected by the process.
Surgery and results
If there are no metastases yet, mediastinal cancer is associated with better predictions. The optimal treatment option is available to those who managed to contact the clinic on time, the disease was identified and correctly specified. In addition, combination treatment is indicated to improve prognosis. Quite aggressive mixed surgical interventions are often recommended. On average, five-year survival in malignant pathologies of this area of the body is estimated at 35%.
While 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 the operation for different variants of the course. There is no reliable evidence that survival is better in people who received, as a complement to the main program, radiation and chemical treatment.
Options and Approaches
If there are symptoms of mediastinal cancer, if the diagnosis is confirmed, treatment with radiation and the use of drugs without surgical intervention can sometimes be prescribed. Cases are known when exactly such approaches gave the most reliable and pronounced result. Treatment with hormonal drugs, chemicals is almost always combined with radiation. This method is most effective for lymphoma. Radical cytoreductive surgery is indicated in the case of a germinogenic tumor process. It is noted that after induction chemical treatment, surgery gives results that are 10% better than using only the cytoreductive method.
Irradiation is indicated for mediastinal lymphoma, thymoma. Five-year survival is estimated at 54.6%. True, there are as yet 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 absence of such structured information and instructions for action leads to an increased risk of the wrong choice of therapeutic method.
Step by step
In medicine, several stages of mediastinal cancer are distinguished. Zero - this is the stage at which it is almost impossible to determine the disease due to the absence of any manifestations. The first step is called the encapsulated pathological process. At this stage, the pathology has not yet spread to fiber. The second stage is characterized by the 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 in individual organs are detected. To determine what stage of the disease, it is necessary to examine the patient’s body through CT, MRI. Pictures necessarily accompany the conclusion of the diagnostician.
Reasons and factors
Malignant pathologies of the mediastinum are formed due to a variety of reasons. At the moment, scientists are finding it difficult to identify methods, methods that would allow us to determine what exactly causes the pathology in the mediastinum. The psychosomatic medical field believes that the primary cause of cancer is the psycho-emotional state of the person. Another option for explaining 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 can be explained by the incorrect genesis of the new organism.
Another theory suggests looking for the cause of a malignant neoplasm in a virus infection. The pathological agent is believed to initiate a gene mutation.
Among the factors that provoke pathology, there are radiation, radiation background, carcinogens with which a person comes into contact due to the working environment, poor ecology, and food. Over the years, the protective mechanisms weaken, therefore, in general, the risk of cancer is higher for people of middle and old age, although much depends on the form. Among other factors, chronic diseases, abnormal pregnancy are noted.