Ce este cancerul pulmonar?
Cancerul pulmonar isi are originea in tesuturile plamanilor sau in celulele care acopera caile respiratorii, bronhiile. Boala incepe cu mutatii ale celulelor normale, pe care le transforma in celule canceroase.
Aceste celule se impart si se inmultesc intr-un ritm de control si, in cele din urma, pot forma tumori care impiedica respiratia si oxigenarea in tot corpul. Celulele canceroase pulmonare se pot raspandi si in alte regiuni ale corpului, care de fapt, este cauza finala a majoritatii deceselor din cauza cancerului.
In timp ce fumatul este o cauza semnificativa a bolii, nu este singurul factor care duce la aparitia cancerului pulmonar.
Concentrarea pe renuntarea la fumat ca o modalitate de prevenire a cancerului pulmonar a umbrit, in unele moduri, alte cauze, cum ar fi expunerea la radon. Din acest motiv, este vital ca toata lumea sa cunoasca simptomele si cauzele cancerului pulmonar, precum si modul in care este diagnosticat si tratat.
Raspandire
Cancerul pulmonar este principala cauza a deceselor prin cancer la nivel mondial, cu 1,8 milioane de cazuri noi fiind diagnosticate in fiecare an. In general, 27% din decesele cauzate de cancer in Statele Unite se datoreaza cancerului pulmonar.
In Statele Unite, cancerul pulmonar a depasit cancerul de san ca fiind cel mai fatal cancer la femei. La fel se intampla si la barbati, boala fiind responsabila pentru mai multe decese decat cancerul de prostata, cancerul de pancreas si cancerul de colon combinat.
Cancerul pulmonar la persoanele care nu au fumat niciodata este a sasea principala cauza de deces prin cancer in Statele Unite. Daca va intrebati de ce aducem in discutie SUA, ei bine, pentru ca acolo s-au realizat aceste studii, care scot la iveala datele respective.
Tipuri de cancer pulmonar
Exista doua tipuri principale de cancer pulmonar:
- Cancerul pulmonar cu celule mici nu este cel mai frecvent, fiind responsabil pentru 80 pana la 85 la suta dintre cancere. Acesta este tipul de cancer pulmonar mai frecvent intalnit la nefumatori, femei si adulti tineri.
- Cancerul pulmonar cu celule mici este responsabil pentru aproximativ 15 la suta din cancerul pulmonar. Aceste cancere pulmonare tind sa fie agresive si s-ar putea sa nu fie gasite pana cand nu s-au raspandit (in special la creier). De obicei raspund destul de bine la chimioterapie, dar au un prognostic slab.
Cancerul pulmonar cu celule non-mici este in continuare divizat in trei tipuri:
- Adenocarcinomul pulmonar: Adenocarcinomul pulmonar este responsabil pentru jumatate din cancerul pulmonar cu celule mici si este in prezent cel mai frecvent tip de cancer pulmonar. Adenocarcinoamele pulmonare sunt de obicei gasite adanc in plamani, unde s-ar instala fumul dintr-o tigara filtrata.
- Carcinomul cu celule scuamoase ale plamanilor: Cancerul pulmonar cu celule scuamoase a fost candva cel mai frecvent tip de cancer pulmonar, insa incidenta acestuia a scazut in ultimii ani, posibil din cauza adaugarii de filtre la tigari. Cancerul cu celule scuamoase tinde sa apara in apropierea cailor aeriene mari sau in apropiere – primul loc expus fumului de tigara.
- Cancerul pulmonar cu celule mari: carcinoamele cu celule mari ale plamanilor tind sa creasca in regiunile exterioare ale plamanilor. Acestea sunt de obicei tumori cu crestere rapida, care se raspandesc rapid.
Alte tipuri de cancer pulmonar mai putin frecvente includ tumorile carcinoide si tumorile neuroendocrine.
Simptomele cancerului pulmonar
Poate fi usor sa ignori simptomele cancerului pulmonar, mai ales daca nu esti fumator si, poate sa nu iei in considerare ca ai si risc de boala. Ba mai mult, de obicei persoanele sanatoase nu sunt examinate de cancer pulmonar, cu exceptia cazului in care au cunoscut factori de risc, cum ar fi un istoric familial de cancer pulmonar sau un fumator de multa vreme.
Scopul este de a detecta cancerul pulmonar in primele etape, cand este inca posibil sa fie tratat. Recunoasterea simptomelor sale este esentiala in acest sens. In general, cele mai frecvente simptome includ:
- Tuse persistenta.
- Raguseala.
- Scurta respiratie cu activitate.
- Etanseitatea in piept.
- Tuse cu sange..
- Pierdere in greutate inexplicabila
- Dureri in piept.
- Infectii frecvente, cum ar fi bronsita sau pneumonia.
- Un sentiment general de a fi intr-o stare de sanatate rea.
Carcinomul cu celule scuamoase si cancerul pulmonar cu celule mici tind sa provoace simptome mai devreme, care adesea includ o tuse si tusea cu sange.
Adenocarcinoamele pulmonare tind sa creasca mult timp inainte de a provoca simptome, care pot include scurta respiratie usoara, scadere subtila in greutate si un sentiment general de avea o stare de sanatate rea. Deoarece tipurile de cancer pulmonar s-au schimbat de-a lungul anilor, lista posibilelor simptome are si ea.
Cauze
Cancerul pulmonar incepe de obicei cu cativa ani inainte de a provoca simptome si cu cativa ani inainte sa fie diagnosticat. Celulele din plamani pot deveni celule canceroase dupa ce trec printr-o serie de mutatii care le transforma in celule canceroase.
Este posibil sa aveti o predispozitie ereditara la mutatii genice sau acestea pot fi rezultatul daunelor ADN cauzate de expunerea la cancerigeni in mediu. Cu siguranta, fumatul este o cauza semnificativa a cancerului pulmonar, dar exista si alte cauze importante ale cancerului pulmonar.
Expunerea la radon in casa, care pentru oricine este un pericol real, este a doua cauza principala a cancerului pulmonar si cea mai frecventa cauza la nefumatori. Alte cauze posibile includ: poluarea aerului, gatitul cu ventilatie slaba, expunerea la fum (in special fumul rezultat din arderea lemnului), expuneri profesionale.
Virusul papiloma uman (HPV) este virusul care cauzeaza cancerul de col uterin, si este asociat cu unele forme de cancer pulmonar, desi nu este deloc sigur daca acest lucru poate fi o cauza reala a bolii.
Diagnostic
O combinatie de studii imagistice, inclusiv tomografie computerizata (tomografie computerizata), imagistica prin rezonanta magnetica (RMN) si tomografie cu emisie de pozitroni (scanare PET) poate fi utilizata pentru a diagnostica cancerul pulmonar. In plus, de obicei este necesara o biopsie pulmonara pentru a determina tipul.
Pana de curand, nu a existat niciun test de screening pentru cancerul pulmonar, dar asta s-a schimbat. Este important de retinut faptul ca radiografiile toracice nu sunt un test de screening adecvat, deoarece nu reusesc sa recolteze cancerul pulmonar intr-un stadiu suficient de devreme pentru a imbunatati supravietuirea. Screeningul cancerului pulmonar este acum recomandat persoanelor care:
- Au intre 55 si 80 de ani.
- Au fumat timp de cel putin 30 de ani cel putin un pachet de tigari pe zi.
- Continua sa fumeze sau nu au renutat la fumat in ultimii 15 ani.
Pentru persoanele cu alti factori de risc, precum un istoric familial de cancer pulmonar, un istoric personal al bolii pulmonare obstructive cronice (BPOC) sau alti factori de risc pentru cancerul pulmonar, poate fi luat in considerare si screeningul.
Metastazele
Cancerele pulmonare pot patrunde in tesuturile din apropiere si se pot raspandi prin fluxul sanguin, sistemul limfatic sau, eventual, chiar caile respiratorii catre siturile indepartate.
Cele mai comune locuri ale metastazelor cancerului pulmonar (raspandit) includ creierul, oasele, ficatul si glandele suprarenale. Unele tipuri de cancer pulmonar de exemplu, cancerul pulmonar cu celule mici, sunt adesea diagnosticate numai dupa ce cancerul s-a raspandit deja.
Un patolog poate spune ca celulele sunt celule canceroase pulmonare, si nu cele legate de un alt tip de cancer pe baza aspectului lor la microscop. Acest lucru este valabil chiar daca cancerul pulmonar se raspandeste in alte regiuni ale corpului.
De exemplu, daca cancerul pulmonar se raspandeste in creier, celulele prelevate din metastaza din creier ar fi identificate si considerate a fi celule canceroase pulmonare. Diagnosticul ar fi cancerul pulmonar cu metastaze la nivelul creierului. Cancerul pulmonar este diagnosticul primar, in timp ce metastaza este considerata diagnosticul secundar.
In schimb, cand tumorile incep in alte parti ale corpului si metastazeaza la plamani, acest lucru nu este considerat cancer pulmonar. Mai degraba, este denumit un cancer (de exemplu, cancer de san) care este metastatic la plamani.
Tratament
Optiunile de tratament pentru cancerul pulmonar s-au imbunatatit semnificativ in ultimii ani. De la chirurgie si radioterapie la imunoterapie si chimioterapie, exista o varietate de optiuni si optiuni. Iata o imagine de ansamblu a unor optiuni de tratament mai comune.
- Chirurgie: Exista mai multe tipuri de chirurgie de cancer pulmonar care pot fi efectuate, in functie de dimensiunea si locatia unei tumori.
- Radioterapie: Radioterapia poate fi administrata ca adjuvant la o interventie chirurgicala pentru a reduce durerea sau obstructia cailor respiratorii din cauza unui cancer, sau in doze mari catre o regiune localizata, in incercarea de a vindeca cancerul.
- Chimioterapie: Chimioterapia utilizeaza de obicei o combinatie de medicamente pentru a trata cancerul pulmonar.
- Terapii vizate: In prezent, medicamentele terapeutice vizate sunt disponibile pentru persoanele care poarta tumori cu mai multe mutatii genetice, inclusiv mutatii EGFR, rearanjari ALK si rearanjari ROS1.
- Imunoterapie: Patru medicamente pentru imunoterapie sunt aprobate pentru tratamentul cancerului pulmonar: Nivolumab (Opdivo), Pembrolizumab (Keytruda), Atezolizumab (Tecentriq) si Durvalumab (Imfinzi). In unele cazuri, aceste medicamente au dus la supravietuirea pe termen lung chiar si pentru cei cu stadii avansate de cancer pulmonar.
Alte tratamente
Ingrijirea paliativa, care este conceputa pentru a raspunde intregului spectru de nevoi medicale pentru persoanele cu cancer (fizice, emotionale, spirituale), poate fi, de asemenea, considerata ca adjuvant. Studii timpurii au descoperit ca, pe langa imbunatatirea calitatii vietii, ingrijirea paliativa poate imbunatati supravietuirea.
Tratamente integrative, cum ar fi acupunctura, pot fi utilizate pentru a ajuta la ameliorarea simptomelor de cancer si tratamente pentru cancer si sunt acum disponibile in multe centre de cancer.
Desi este rar acest lucru, cancerul pulmonar in unele cazuri, pur si simplu a disparut. Acest fenomen este denumit remisie spontana a cancerului. Cercetatorii apeleaza la aceasta descoperire pentru a afla cum functioneaza in mod obisnuit sistemul imunitar pentru a elimina celulele canceroase, astfel incat tratamentele bazate pe acest principiu pot fi dezvoltate.
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