Bronchoalveolar ntsws cancer yog ib qho kev sib raug zoo oncopathology, uas yog tus cwj pwm los ntawm kev tsim ntawm ntau cov qog zoo li cov nodules.
Lub chaw tseem ceeb ntawm hom mob qog noj ntshav no yog cov kab mob alveolar-bronchial epithelial ntawm cov qog bronchial.
Cov neeg mob uas raug mob cancer tshaj plaws yog cov txiv neej hnub nyoog nruab nrab thiab poj niam.
mob qog noj ntshav bronchialveolar tshwm sim li cas?
YPathogenesis, etiology
Thawj zaug, oncopathology tau piav qhia hauv xyoo 1876, thaum nws tau tshwm sim thaum lub sijhawm cev xeeb tub ntawm tus poj niam lub cev tuag. Nyob rau hauv Lavxias teb sab cov ntaub ntawv, hais txog tus kab mob tsuas yog tshwm sim nyob rau hauv 1903. Nyob rau hauv nruab nrab-1950s, ib tsab xov xwm tau luam tawm hais tias feem ntau hom mob qog noj ntshav bronchoalveolar yog peripheral nodular cancer.
Tam sim no, tsis muaj cov ntaub ntawv ntseeg tau ntawm qhov ua rau ntawm kev txhim kho ntawm oncopathologies. Cov kws tshawb fawb tau ua pov thawj tias muaj qhov ncaj qhaKev sib raug zoo ntawm noob caj noob ces biotransformation ntawm tib neeg DNA thiab tus kab mob no.
Exogenous thiab endogenous yam
Cov kws tshaj lij txheeb xyuas ntau yam ntawm exogenous thiab endogenous yam uas ua rau cov txheej txheem ntawm kev hloov cov khoom siv caj ces:
- hnub nyoog tshaj 40.
- Localized pulmonary fibrosis.
- Kev haus luam yeeb lossis haus luam yeeb.
- Nyob zoo ib tsoom phooj ywg.
- ib puag ncig tsis zoo.
- Systematic inhalation ntawm vapors ntawm cov tshuaj lom - mercury, soot, mustard gas, thee plua plav, radon, ammonia, arsenic.
- Kev tsis txaus ntawm cov kab kawm, cov vitamins hauv kev noj haus.
- Ntau zaus ntawm cov txheej txheem inflammatory hauv cov kab mob ua pa.
- Khoom noj khoom haus tsis txaus (saturation ntawm kev noj zaub mov nrog cov khoom noj haus luam yeeb, tshuaj tua kab mob, cov rog rog).
- Kev hloov pauv hauv cov cim cicatricial hauv cov ntaub so ntswg.
- Nyob ntev UV raug.
- Txo kev tiv thaiv ntawm lub cev.
- Genetic predisposition.
- Nyob hauv thaj chaw neeg tsim.
- Txoj kev muaj ntxhiab tsw qab rau lub sijhawm ntev.
- Lub ntsws puas los ntawm hluav taws xob.
Ua ke, cov xwm txheej saum toj no ua rau kev puas tsuaj rau cov khoom siv caj ces, cuam tshuam ntawm cov protein biosynthesis. Raws li qhov tshwm sim, peptides txawv txav tau tsim los ua kom muaj kev cuam tshuam ntawm apoptosis - biologically programmed cell tuag.
Kev txo qis hauv cov tshuaj tiv thaiv metabolic, cuam tshuam rau lub cev ntawm exogenous yamkeeb kwm, tsim ntawm endogenous carcinogens ua ke nrog kev ua txhaum ntawm trophic innervation provoke qhov tshwm sim ntawm blastomatous txheej txheem nyob rau hauv lub bronchi.
Pathological hloov pauv hauv malignant neoplasm nyob rau hauv cov qauv ntawm lub bronchus nyob ntawm seb lub ntsws txhaws. Pathological hloov feem ntau tshwm sim thaum endobronchial kev loj hlob ntawm carcinoma pib.
Yuav ua li cas tom qab, kev kho mob tshwm sim tshwm sim nrog peribronchial qog loj hlob. Kev tsim ntawm neoplasm ua rau muaj kev ua txhaum ntawm cov qauv anatomical ntawm lub ntsws thiab cov ntaub so ntswg bronchial, vim tias qhov kev ua haujlwm ntawm cov kabmob no yog qhov nyuaj heev.
Hypoventilation
Kev nthuav dav ntawm cov txheej txheem pathological ua rau qhov tseeb tias hypoventilation tsim tawm tsam keeb kwm ntawm bronchial obstruction. Yog hais tias lub bronchus kaw tag nrho, atelectasis ntawm ib feem ntawm lub ntsws raug sau tseg. Nyob rau hauv cov xwm txheej zoo li no, thaj chaw tuag tes tuag taw ntawm lub ntsws ua rau muaj kev kis kab mob ntau dua. Raws li qhov tshwm sim ntawm cov txheej txheem pathological no, mob ntsws gangrene lossis abscess feem ntau tshwm sim. Cov txheej txheem necrotic tsim nyob rau hauv neoplasm feem ntau yog ua rau pulmonary hemorrhage.
Localization ntawm pathological foci
Pathological foci hauv BAD yog nyob hauv thaj chaw peripheral ntawm lub ntsws. Nodular formations nyob rau hauv mob qog noj ntshav ntawm hom no muaj ib tug ntom zoo nkauj, ib tug greyish-dawb xim. Txoj kev loj hlob ntawm pathology ua rau tshwm sim ntawm ntau yam carcinogenic foci.
About40% ntawm cov neeg mob uas muaj kev puas siab puas ntsws bipolar muaj sia nyob tau 5 xyoos. BAD yog ib qho kev sib txawv ntawm adenocarcinoma. Lub parenchyma ntawm malignant neoplasm yog tsim los ntawm atypical epithelial hlwb.
Kev kho mob tshwm sim
Nyob rau theem pib, mob qog noj ntshav bronchoalveolar tsis tshwm sim hauv kev kho mob. Qee zaum, tsis muaj laj thawj dab tsi, tus neeg mob yuav hnoos, nrog rau cov hnoos qeev hauv cov ntim loj (txog li 4 litres ib hnub), lossis cov kua dej foamy. Nrog rau cov txheej txheem ntawm tus kab mob, ua tsis taus pa luv tshwm sim, uas tsis zoo rau kev kho mob. Cov cim tseem ceeb ntawm oncopathology yog:
- Qhov tshwm sim ntawm kev qaug cawv ntawm lub cev.
- Kev txhim kho pneumothorax.
- Nyob heev.
- Kev qab los noj mov.
- Kev tsis xis nyob hauv siab.
- Txhob Cia Siab.
- Kev ua haujlwm tsis zoo ntawm cov dej- ntsev metabolism.
- Nyob rau hauv subfebrile kub.
Yog tias tus neeg mob tau kuaj pom tias muaj kab mob qog nqaij hlav hauv lub ntsws lossis kis mob qog noj ntshav, ces qhov kev cia siab yuav poob siab.
Stages
Muaj 4 theem ntawm tus kab mob:
- Thawj. Qhov loj ntawm cov qog nce mus txog 5 cm, tsis muaj metastases nyob deb thiab cov kab mob ntawm cov qog ntshav hauv cheeb tsam.
- Second. Qhov loj ntawm cov qog yog 5-7 cm, peribronchial thiab hilar lymph nodes cuam tshuam, neoplasm loj hlob mus rau hauv lub pleura, diaphragm, thiab pericardium.
- theem peb ntawm kev mob qog noj ntshav bronchial. Cov qog nce mus txog qhov loj ntawm ntau dua 7 cm, nyob deb thiab cov qog ntshav hauv cheeb tsam raug cuam tshuam, neoplasm loj hlob mus rau hauv cov qog mammary, lub plawv, txoj hlab pas, trachea.
- Plaub. Nws tsis tuaj yeem txiav txim siab qhov loj ntawm cov qog. Secondary oncofoci muaj nyob rau hauv lub hlwb, nyob deb ntawm lub cev. Qhov kev tshwm sim hauv qhov no yog kev poob siab.
Diagnosis
Kev kuaj pom ntawm tus neeg mob tso cai rau tus kws kho mob kom kuaj pom cyanosis ntawm daim tawv nqaij thiab pom cov mucous daim nyias nyias, uas ua rau lub cev hnyav dua. Percussion soj ntsuam qhia ib tug luv luv lub suab nyob rau hauv pathological cheeb tsam. Qee zaum, crepitus tau hnov. Kev kuaj ntshav rau lub sijhawm ntev qhia tau hais tias lub cev zoo li qub. Nrog rau txoj kev loj hlob ntawm pathology, nce ESR, leukocytosis, thiab ntshav ntshav tau kuaj pom.
Bronchoalveolar cancer yog kuaj tau zoo heev ntawm CT. Tus neeg mob kuj tau sau ntawv MRI, kuaj ultrasound, radiography. Nrog kev pab los ntawm bronchoscopy, nws muaj peev xwm pom qhov pom ntawm qhov mob neoplasm, sau cov hnoos qeev, thiab ua kev kuaj cytological.
CT kev kuaj mob ntawm bronchoalveolar ntsws cancer yog cov txheej txheem qhia tshaj plaws.
Nrog kev pab ntawm endoscopic biopsy, cov kws tshaj lij tau txais cov khoom siv lom neeg rau kev kawm ntxiv ntawm nws cov keeb kwm. Yog hais tias tus neeg mob tsim carcinomatous pleurisy, nws raug muab tshuaj thoracocentesis, tom qab uas ib tug cytological kuaj ntawm lub pleural effusion yog ua.
Kev kho mob
Kev kho mobbronchoalveolar cancer muaj qee yam nta. Txhawm rau tshem tawm cov mob qog noj ntshav, kev phais yog siv, tom qab ntawd tshuaj kho hluav taws xob tau sau tseg. Tam sim no tsis muaj cov tshuaj khomob zoo rau kev puas siab puas ntsws bipolar.
BAR feem ntau suav hais tias yog chemo-resistant cancer. Cov kab ke thiab kev sib xyaw ntawm cov kev kho mob yog txiav txim los ntawm oncologist. Nws txhim kho kev kho mob ib leeg rau txhua tus neeg mob.
Yog hais tias qhia, lobectomy thiab bilobectomy (ib nrab ntawm lub ntsws), nrog rau kev tshem tawm tag nrho (pneumoectomy) ua tau. Cov txheej txheem kawg yog qhia yog tias cov txheej txheem pathological yog dav dav, muaj cov metastases nyob rau hauv cov qog ntshav nyob ib sab.
Txoj kev tseem ceeb ntawm kev tiv thaiv BAD yog kev tiv thaiv fluorography, kev siv PPE hauv kev lag luam phom sij, kev kho mob raws sij hawm ntawm kev mob ntsws, kev tsis lees paub tus cwj pwm phem.
Kev pom zoo rau cov kab mob ntsws xws li mob qog noj ntshav bronchoalveolar tuaj yeem ua tau nrog kev kuaj mob raws sij hawm, kev tshem tawm cov foci thaum ntxov ntawm kev tsim carcinogenesis.
