In addition to general screening, not only smokers but also non-smokers should have their lung function checked regularly by their doctor. In addition to any previously under-recognized conditions, a whole host of other lung diseases are being discovered, including, increasingly, lung cancer. It is now the case that more lung ulcers and lung tumors are already being found in men over the age of 40 than other lung diseases.
Causes of lung cancer
Air sacs (alveoli) affected by lung cancer identified in section. Click to enlarge. Although the causes of cancer development are not yet fully understood, we know that there are many factors that trigger lung cancer or promote its development. Only when they have all been researched and put together correctly like the building blocks of a mosaic picture will it be possible to have a detailed overview of the development of cancer. However, all the world’s medical experts agree on one factor: smoking, especially cigarette smoking, promotes the development of lung cancer. In this case, it is not nicotine that is the harmful agent that promotes the development of cancer, but the tar products that are formed by a smoldering process during the slow burning of the cigarette. From these tobacco tar products, it has been possible to isolate substances that have the ability to cause lung cancer in animal experiments. With these products, the smoker tars his bronchial tubes daily by inhaling the cigarette smoke and additionally inflames them. The chronic and repetitive inflammation and irritation of the bronchial mucosa can cause cancer after a latency period of about twenty years. Patients between the ages of 50 and 70 are most likely to develop the disease, but even younger people are not safe from lung cancer. The observation that women are not as likely to develop lung cancer is not due to gender differences, but reflects the fact that men smoke more than women, although women now smoke almost as much as men. Besides smoking, there is another factor that contributes to the development of lung cancer. This is the pollution of the air of our modern industrial cities and large industrial plants. A well-known example is the heavy pollution of the air in the Ruhr area, even though the air there has become much cleaner in recent years. Exhaust fumes from cars also contribute strongly to the pollution of the air we breathe, and these are particularly pronounced precisely in urban centers.
Symptoms and signs
A cancerous tumor always develops from the mucous membrane of the bronchi and for this reason is also called bronchial cancer. If the large bronchi are affected, we speak of a central lung cancer; if it develops in the periphery, we speak of a peripheral lung cancer. The classification into these two groups is of great importance for the early detection of lung cancer. There are no pain-conducting nerves in the lungs, so there is no alarm system to alert to changes in the lungs, for example, through pain. It is these “silent” peripheral ulcers in particular that are discovered by X-ray examination or by chance during other prophylactic examinations. It is different with lung cancer, which develops in the large bronchi. This is where cough reflex centers are located. The growing lung cancer leads to irritation of these centers, there is a persistent cough, which, for example, unlike bronchitis, cannot be influenced by cough medications. In addition, sputum, blood admixtures in the sputum, frequently occurring flu-like infections or repeated illnesses of pneumonia, can be important signs.
Examination and treatment
Now, what is the course of the examination if a man has been found to have pulmonary shadowing in the right upper lobe by X-ray examination and it has not been possible to find out which disease is causing this shadowing area by the examination methods available in an outpatient facility? Indeed, an x-ray examination cannot always provide accurate information about the nature of a shadowing. The X-ray provides only a black and white shadow image of the lung and the disease process. It can be compared with a lighted screen, behind which different coins of the same size are held.One then sees only round shadow images of the same size, but cannot see the value of the individual coins. However, to find out the cause of the shadowing, the patient must go to a hospital for a special examination. Just as there are instruments that can be used to look into the bladder or stomach, there is also one that can be used to look into the bronchial tubes, the bronchoscope. Flexible bronchoscopy is a routine examination that is no longer performed with a short anesthetic or local anesthetic and takes about ten minutes. The bronchoscope can be used to look directly at the large bronchial tubes and also to look into their branches with optics. In this way, it is possible to determine whether, for example, there are inflammatory changes in the bronchial mucosa or ulcer-like growths in the bronchi. The physician removes a small piece of tissue from the suspicious area using fine forceps. Microscopic examination of this sample then provides information as to whether lung cancer is really present. In addition to malignant tumors, benign neoplasms can also occur in the lungs and bronchi. However, it is not possible to see beyond the large bronchial tubes and their branches with the bronchoscope, because the next branches are too fine. Another examination method, bronchography, can be used to visualize the peripheral sections of the bronchial tree. This is done by taking advantage of the fact that certain chemical substances (contrast agents) do not allow X-rays to pass through, thus causing shadowing in the X-ray image. The contrast medium is filled into the bronchi of the diseased side of the lung through a rubber catheter so that the small bronchi stand out clearly on the X-ray screen. Infographic on the different lung diseases and their characteristics, anatomy and location. Click to enlarge. Now the patient can be identified by bronchography which bronchus leads into the obstruction Now the third important examination method of bronchology is used. For this purpose, a fine rubber catheter is advanced from the bronchoscope to the focus via the feeding bronchus identified by bronchography. The physician also needs the X-rays for this examination. With the help of fluoroscopy, he can determine whether the catheter is taking the right path to the focus of the disease. Once the catheter has reached the focus, it is connected to a suction pump. This allows tiny chunks of tissue to be aspirated from the focus of disease, which are stained and examined for fine tissue under a microscope. This method, which the physician calls catheter biopsy, thus allows tissue to be removed from the periphery of the lungs. The bronchial tubes are used as a natural access route and the patient is spared a diagnostic surgical procedure. Thus, in one affected patient, bronchological examinations were able to detect lung cancer. It had been detected by radiography in such a timely manner, and the patient was admitted for inpatient observation so quickly, that the ulcers could be radically removed by surgery, which was initiated immediately.
Differential Diagnosis
But not every patient who undergoes bronchologic evaluation has lung cancer. In most cases, it turns out that other lung diseases are present. Here, too, bronchologic examination has often helped to quickly find the right course of treatment. From the causes for the development of cancer, which we mentioned at the beginning,
At the same time, a number of assumptions can be derived, the continuation of which can lead to a decrease in the number of lung cancer cases. Because we know exactly which substances in polluted air promote the development of cancer, both occupational physicians and legislators are making great efforts to reduce the presence of these substances in the air to an acceptable level. These efforts mark a form of social responsibility for health protection. If society reduces the general hazard at great and ever-increasing financial expense, then individuals should also make a corresponding contribution, which may even bring them savings, and refrain from smoking, especially cigarettes. Those who believe they cannot do without their cigarettes should at least put them out when they are two-thirds smoked, because the last third is where a particularly large amount of tobacco tar products accumulate. The widespread opinion that a filter cigarette retains these tar products is wrong.Preventive measures also include that everyone participates in the preventive examinations that make sense in their own interest. If the doctor orders inpatient treatment, one should take this to heart, even if one feels completely healthy, but also not “go crazy”, because firstly, lung cancer is not hidden behind every shadow on the X-ray and secondly, it has already been pointed out that almost every type of cancer is curable if detected in time. In the case of lung cancer, this means seeing the doctor immediately if a persistent cough develops that does not subside even after the use of medication, or blood is noticed in the sputum.
