7.6. Tuberculosis and lung cancer


It is established, that the lung cancer among tuberculosis patients and among persons with residual changes after the cured tuberculosis are more frequent than among all population. At realization dispenserary supervision oncological watch-full must be applied over the patients with tuberculosis of respiratory organs and persons with residual changes after the cured tuberculosis.

The increased risk of a lung tumor development can be among:

  1. long time smoking males;
  2. males over 40 years;
  3. persons with revealed metatuberculous syndrome, with background inflammation processes in lungs;
  4. groups of the population for a long time exposed to influence professional or natural carcinogenic factors.

Clinically the combination of tumor and tuberculosis can be divided into three periods:

  1. asymptomatic;
  2. expressed symptoms of tumor;
  3. metastasis.

The histological picture of most tumors are planocellular; adenocarcinoma (acinar carcinoma), and last place – low differentiated tumors. The preferable tumor’s localization is in III, VIII and X segments of the right lung. The signs of malignant damage of the lungs are dyspnea, hoarse cough, sometimes with sputum, hemoptysis, chest pains, common weakness, fatigue, weight loss, increase of temperature, pain in long cylindrical bones. At the far advanced processes the bluish mucous and acrocyanosis appear, “digitus Hippocraticus “.

The diagnostics of a tumor is difficult task at the tuberculosis patients and at the persons with residual changes after cured tuberculosis. An extremely valuable method of diagnostics is X-ray and computer tomography, allowing to find out changes caused by lung tumor. Nevertheless decisive diagnose has cytological examination of lung and lymphatic nodes biopsy. The methods of invasive examinations (bronchi endoscopy, transthoracic puncture) should be applied only after strict indications, when the clinical symptoms and X-ray picture allow suspecting lung tumor.

It is necessary to remember, that well known clinical symptoms of lung tumors: reduction of body weight, chestpain, cough, hemoptysis, can be caused by tuberculosis. Therefore, sometimes, their occurrence does not cause suspicion of the patient and does not serve for the doctor as a ground for realization of purposeful diagnostics of lung tumor. The careful analysis of dynamic X-ray changes at occurrence of signs which do not corresponded to clinical picture of tuberculosis requires more precise definition of the etiology of these changes.

The presence of active tuberculosis or residual changes after the cured tuberculosis representing as focuses, tuberculemas, fibrotic changes, as a rule, is not an obstacle for application of surgical treatment of lung tumors, if the disease is revealed at early stages or at least tumor could be operated.

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