P location of the tumor in the upper lobe

So, when the tumor is located in the upper lobe of the right lung, as a rule, the superior vena cava and unpaired veins, the lateral wall of the trachea, and the ribs are involved in the blastomatous process. One of the options for the development of peripheral cancer in the upper lobe of the lung includes the so-called “Pancost type”. In this case, a peripheral spherical tumor, located in the apical segment of the upper lobe of the lung as it develops, extends beyond the organ, spreading to the subclavian vessels, brachial plexus nerves, and the trunk of the sympathetic nerve with a violation of their normal activity.

The progressive development of a cancerous tumor in the middle lobe of the right lung most often leads to damage to the mediastinal pleura, phrenic nerve and pericardium.

For lung cancer of the lower lobe localization at far advanced stages of the disease, depending on the type of tumor growth and its location in different segments, a lesion of the right dome of the diaphragm, esophagus, pericardium, common trunk of the upper and lower pulmonary veins, and atrium was established.

With the development of a tumor in the upper lobe of the left lung, the mediastinal pleura, diaphragmatic and vagus nerves are involved in the blastomatous process, often with impaired function of the lower laryngeal nerve departing from it, and the pericardium. Often found with such cancer localization, involvement in the process over a significant length of the left branch of the pulmonary artery. In the case of cancer of the upper lobe of the left lung, the aortic wall is most often affected in the area of ​​the “aortic window” or in the initial part of its descending section, in the places where bronchial arteries form.

The development of cancer in the lower lobe of the left lung is accompanied by damage to the left dome of the diaphragm, anatomical structures of the chest wall, mediastinal pleura, pericardium. As the lower pulmonary vein travels, the tumor can reach the left atrium. It is not very rare to engage in the malignant process of the esophagus side wall and germination of the aorta in its descending section.

As studies of surgical material have shown, the development of a tumor in the advanced stages of the disease with its transition to extrapulmonary anatomical structures of the chest cavity and mediastinum in more than half of patients — in 55% of cases was local in nature. In the remaining observations, the lesion was of a multiple nature, involving two, less often three extrapulmonary anatomical structures or organs in the blastomatous process.

A purposeful study of the spread of the boundaries of tumor growth showed the uniqueness of their extent within the bronchial tree. As a rule, the boundaries of tumor growth visually established during surgical interventions along the bronchus significantly differ from the true ones. Only a little more than in half of the observations — in 53%, the boundaries of tumor growth that were visual and established by histological examination coincided. In other cases, the range of correspondence is true, i.e. determined by microscopic examination and data of visual and palpation studies undertaken during intraoperative revision of the lung, fluctuated over a very wide range. Moreover, the true tumor growth in the bronchus in 30% of patients exceeded the expected in the range from 1 to 3 mm, in 8% to 6 mm, in 5% to 11 mm, and in 3% exceeded 16 mm.

These indicators significantly depend on the degree of differentiation of lung cancer and naturally increase with low-grade tumors. In this case, the spread of the tumor, its invasion occurs mainly along the submucosal layer of the bronchial membrane, often involving also adventitia. In the mucous membrane proper, the bronchus increases markedly with a peribronchial or mixed type of lung cancer growth or with its metastasis to mediastinal lymph nodes.

The transition of a perivasal, peribronchial growing tumor to the anatomical structures and mediastinal structures — pleura, pericardium and large vessels, atrium, esophagus, trachea, lymph nodes located here — especially with their multiple and simultaneous lesions and with a small primary tumor focus in the lung, is often distinguished as a kind , called “mediastinal,” a form of cancer.

local_offerevent_note September 21, 2019

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