Professora Associada. Pathology and genetics of tumours of the lung, pleura, thymus, and heart. An assessment of the World Health Organization classification of the histologic typing of lung tumors applied to biopsy and resected material. Anelli A. In: Younes RN, editor. Rio de Janeiro: Medsi.
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Back to Summary. Early diagnosis of lung cancer: the great challenge. Epidemiological variables, clinical variables, staging and treatment. J Bras Pneumol. The number of lung cancer deaths predicted for in Brazil was 11, for men and for women. The absolute number of deaths predicted for corresponds to gross mortality rates of In industrialized countries, lung cancer was initially an epidemic disease among men.
However, it has become increasingly more common among women. The principal risk factor is smoking, which confers a to times greater risk of developing a lung neoplasm. Other traditionally accepted factors are as follows: preexisting pulmonary disease; occupational exposure asbestos, uranium, chromium, alkylating agents, etc. This indicates that early detection measures are particularly important, since surgical resection, which constitutes the only therapeutic approach that offers a potential cure, is effective only in early clinical stages.
Information was obtained from the charts by filling out a previously defined study protocol. All of the variables analyzed were static. All cases of primary lung cancer other than bronchogenic carcinoma, cases that presented neoplasm in adjacent pulmonary tissues or pulmonary metastasis of primary neoplasms of other tissues, and cases whose medical charts contained insufficient clinical information, were excluded.
The descriptive analysis of the data was performed using the Epi Info program, and the results were compared with information from the medical literature and with data from national epidemiological surveys. Individuals who had smoked less than cigarettes during their lifetime were defined as nonsmokers. Those patients who had stopped smoking for at least one year prior to being diagnosed with lung cancer were defined as former smokers, and habitual tobacco users or former users who had stopped smoking for less than a year prior to diagnosis were defined as smokers.
The mean age was The most frequent initial symptoms were cough and chest pain Figure 1. In 22 cases, both methods were required in order to confirm the diagnosis. The patients submitted to radiotherapy and chemotherapy were those who presented SCLC, as well as those with NSCLC of a histology that was susceptible to these treatments. It has surpassed breast cancer in the USA and is the leading cause of death by neoplasm among women.
The lowest rates Smoking has an additive or multiplicative effect on some of these agents. For all age brackets, the percentage of smokers in rural zones is greater than that of smokers in urban zones. The relative risk of developing lung cancer is to fold greater among smokers than among people who have never smoked. This fact is corroborated by the results of the present study Table 1.
Passive exposure to cigarette smoke also plays an important role, since passive smoke contains a complex mixture of various mutagenic and carcinogenic agents. There is a predominance of women and a greater incidence of adenocarcinoma among young individuals who develop lung cancer. It has been postulated that endogenous and exogenous estrogens play a role in the development of adenocarcinoma.
Other predisposing factors for lung cancer are preexisting pulmonary diseases and a family history of lung cancer. There is evidence of a 2- to 5-fold increase in the prevalence of the disease among close relatives of patients with lung cancer. Cough is the most common symptom.
Although hemoptysis is common, it is rarely severe. These suggestive signs call for a more elaborate investigation. Squamous cell carcinoma SCC, also known as epidermoid carcinoma and SCLC, the most frequent histological subtypes, present as central expansive lesions of endobronchial growth.
Since the SCC starts in the central bronchi, it is more likely to be detected early through sputum cytopathologic tests than are other types of carcinoma. However, SCLC, which presents a pattern of rapid growth and almost exclusively affects smokers, tends to cause extrinsic bronchial compression.
Early metastatic dissemination is common in the SCLCs. Their early detection through sputum testing is not possible, and they typically produce metastases in distant organs.
However, in the past decade, it was surpassed by adenocarcinomas, which are more common among nonsmokers than in smokers, regardless of gender. The tumor-node-metastasis staging was applied to the histopathological variables: SCC, adenocarcinoma, and large cell carcinoma.
The SCLC was classified as limited disease disease limited to the thorax, including pleural effusion or advanced disease extrathoracic. Of the 34 cases of SCLC, Radiotherapy and chemotherapy are the treatments of choice in cases of SCLC.
However, for the other histological subtypes, these treatments are palliative and constitute the first choice only in more advanced stages of the disease. Most of the patients in our study presented the advanced stages. Due to the restricted possibility of cure through the treatment used, survival is determined by age, morphology, and staging of the disease.
Useful in staging, computed axial tomography of the chest presents sensitivity and specificity that are greater than those of the simple chest X-rays and should be ordered in the cases in which the chest X-ray results are inconclusive. This method is very useful since it makes it possible to perform both endobronchial and transbronchial biopsies, bronchoalveolar lavage, and bronchial brush.
Of those patients who were not diagnosed within one year, the majority presented adenocarcinoma The evolutive characteristics of the lung neoplasm and factors associated with the doctor, health system, or patient, can be held responsible for the delayed diagnosis and inefficacy in increasing the survival of these patients.
Due to cultural factors, habitual smoking, and fear of a possible diagnosis, patients usually postpone seeking treatment. When they do, they are submitted to evaluation by a general practitioner, and are confronted with a saturated health system, resulting in a significant delay before they are referred to a pulmonologist.
For lack of effective and economically feasible tracking programs to detect the initial disease in its asymptomatic phase, as well as because the first symptoms generally reflect an advanced stage of the disease, lung cancer is still a great challenge in the medical area, since the therapeutic initiatives to improve the five-year survival of patients have failed. Wolpaw DR. Early detection in lung cancer.
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Carcinoma de pulmão de células não pequenas
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