lung cancer

Lung cancer: short overview

• symptoms: at first often no or only nonspecific symptoms such as persistent cough, chest pain and fatigue. Later, symptoms such as shortness of breath, mild fever, severe weight loss and bloody sputum may be added.
• Main forms of lung cancer: Most common is non-small cell lung cancer (with adenocarcinoma, squamous cell carcinoma etc). Less common but more aggressive is small cell lung cancer.
• Causes: Especially smoking. Other risk factors include asbestos, arsenic compounds, radon, a high level of pollutants in the air and a low-vitamin diet.
• investigations: Chest X-ray (chest X-ray), computed tomography (CT), MRI (magnetic resonance imaging, MRI), examination of tissue samples (biopsies), positron emission tomography (usually in combination with CT as FDG-PET / CT), blood tests, examination the ejection, examination of the “lung water” (pleural function)
• Therapy options: Surgery, radiotherapy, chemotherapy.
• Forecast: Lung cancer is usually recognized late and is therefore rarely curable.

Lung cancer: signs

Lung cancer (lung carcinoma) causes at first often no or only nonspecific complaints, These include fatigue, to cough or Chest pain, But such complaints can also have many other causes, such as a cold or bronchitis. Therefore, lung cancer is often not recognized in early stages. That makes the therapy more difficult.

More pronounced signs cause lung cancer when it is already advanced. Then, for example Rapid weight loss, bloody sputum and shortness of breath occur.

Does the lung cancer already have daughter relatives (metastases) formed in other parts of the body come mostly other symptoms added. For example, metastases in the brain can damage the nerves. Possible consequences include headache, nausea, visual and balance disorders or even paralysis. If the cancerous cells have attacked the bones, arthrosis-like pain can occur.

Read more about the different signs of lung cancer in the article Lung Cancer: Symptoms.

Lung cancer: stages

Like any cancer, lung cancer occurs because cells degenerate. In this case, they are cells of the lung tissue. The degenerated cells multiply uncontrollably and displace healthy tissue in their environment. Later, individual cancer cells can spread through the blood and lymph vessels in the body. Often they then form a secondary tumor (metastasis) elsewhere.

A lung cancer disease can be so far advanced. For example, one speaks of an early stage or, in the worst case, of the lung cancer end stage. But these are not exactly defined terms. For this reason, physicians usually use the so-called TNM classification: it allows the individual lung cancers to be described precisely. This is important, because the treatment and life expectancy of a patient depend on the respective lung cancer stage.

Lung cancer: TNM classification and stages

The TNM scheme is an international system to describe the spread of a tumor. It says:

• “T” for the size of the Tumors

• “N” for the possible involvement of lymph nodes (Nodi lymphatici)

• “M” for the possible presence of Metastasen

For each of these three categories you assign a numerical value. It indicates how advanced the cancer of a patient is.

The exact TNM classification for lung cancer is complex. The following table gives a rough overview:

TNM	Tumor character at diagnosis	statement
TX	Occult (hidden) carcinoma	Neither radiographs nor computed tomography (CT) can detect a tumor, but the sputum of the patient has cancerous cells.
T1	The tumor is smaller than 3 cm. The main bronchus is not affected.	The main bronchi are the first branches of the trachea in the lungs.
T2	The tumor has a size of 3 to 5 cm (T2a) or 5 to 7 cm (T2b)	and or at least one of the following criteria is given: a main bronchus is affected the inner lung skin is affected part of the lung has collapsed (atelectasis) a part of the lung is inflamed
T3	The tumor is larger than 7 cm	or given at least one of the following criteria: surrounding tissue is affected (chest wall, diaphragm, etc.) a main bronchus is affected the entire lung is inflamed
T4	Tumor size no longer plays a role here, instead this stage is present when a surrounding organ is involved (e.g., heart, esophagus, trachea) Another cancer arises in another lung lobe
N0	no lymph node involvement
N1	Ipsilateral lymph node involvement around the bronchi (peribronchial) or at the site of entry of the pulmonary vessels and main bronchi into the lungs (hilar)	The term “ipsilateral” means that the affected lymph node is in the same lung or half of the body as the causative lung tumor. “Contralateral” means that lymph nodes of the other half of the body / lung are affected.
N2	Ipsilateral lymph node involvement below the branching of the main bronchi (subcarinal) or chest cavity between the two lungs (mediastinal)
N2	Ipsilateral lymph node involvement above the clavicle (supraclavicular) or the neck or infestation (at least) of a contralateral lymph node
M0	No distant metastases
M1a	Metastases in the contralateral lung and / or heavy involvement of the lung lining and / or cancer cells in the effusion fluid of the lung lining are detectable
M1b	Distant metastases	Distant metastases usually affect the liver, brain, bones and adrenal glands

The TNM classification determines the lung cancer stage: 4 stages are distinguished. The higher the stage, the more advanced the disease:

Lung cancer stage I

This stage is divided into A and B. Stage IA corresponds to a classification of T1 N0 M0. That is: The malignant lung tumor is less than three inches. The main bronchus is not affected by the cancer. In addition, no lymph nodes are affected and no distant metastases have yet formed.

At stage IB, the tumor has a classification of T2a N0 M0: it is three to five centimeters in size and confined to the lungs. The tumor has therefore neither affected lymph nodes nor scattered into other organs or tissues.

In this first stage, lung cancer has the best prognosis and is often curable.

Lung Cancer Stage II

Here too, A and B are differentiated. Stage IIA includes lung tumors of the T2b category, which have not yet affected lymph nodes (N0) or have formed metastases (M0). Also tumors of the category T1 N1 M0 belong here.

Stage IIB includes tumors of the classification T3 N0 M0 or T2b N1 M0.

Even in stage II, lung cancer is still curable in some cases. The life expectancy of patients is already lower than in stage I.

Lung cancer stage III

Stage IIIA is when the lung cancer is classified as T1 / T2 N2 M0 or T3 N1 / 2 M0 or T4 N0 M0. Stage IIIB describes every lung cancer with N3 M0 or T4 N2 M0.

In lung cancer stage III, the tumor has progressed so far that patients can only be cured in rare cases.

Lung cancer stage IV

Life expectancy and chances of recovery are very low at this stage. The patient can only receive palliative therapy: it aims to alleviate the symptoms and prolong survival. Stage IV includes every lung cancer that has already formed distant metastases (M1). Tumor size and lymph node involvement then no longer play a role – they can vary.

Small cell bronchial carcinoma: alternative classification

Physicians distinguish two major groups of lung cancer: small cell lung carcinoma and non-small cell lung cancer (see below). Both can be classified according to the above TNM classification in stadiums.

For small cell bronchial carcinoma another alternative classification can alternatively be used:

• very limited disease: maximum up to T2 and N1

• limited disease: T3 / 4 with N0 / 1 or T1 through T4 with N2 / N3

• extensive disease: M1 independent of T and N

Lung cancer: treatment

The therapy of a bronchial carcinoma is very complicated. It is individually adapted to each patient: First of all, it depends on the type and spread of lung cancer. However, the patient’s age and general health also play an important role in therapy planning.

If treatment aims to cure the lung cancer, it is called one curative therapy, Patients who are no longer able to heal receive one palliative therapy, It is intended to maximize the life of the patient and relieve his symptoms.

Doctors from different disciplines of a hospital advise each other on the final treatment strategy. These include, for example, radiologists, surgeons, internists, radiation physicians and pathologists. In regular sessions (“tumor boards”) they try to find the best lung cancer therapy for a patient.

There are three different therapeutic approaches, used individually or in combination:

• an operation to remove the tumor

• chemotherapy with special drugs against cancer cells

• the radiation of the tumor

Lung cancer: surgery

A true chance of recovery in lung cancer usually only as long as you can operate on it. The surgeon attempts to completely remove the cancerous lung tissue. He also cuts out a rim of healthy tissue. So he wants to make sure that no cancer cells are left behind. Depending on the spread of bronchial carcinoma, you can either remove it one or two lung lobes (Lobectomy, bilobectomy) or even one whole lung (Pneumonectomy).

In some cases, it would make sense to take out a whole lung. The poor health of the patient does not allow this. Then the surgeon removes as much as necessary, but as little as possible.

In the operation, the surrounding lymph nodes cut out (mediastinal lymph node dissection). This is done even if the preliminary examinations have given no indication of cancerous involvement of the lymph nodes. Often these are the first station for a move, which can not be recognized at the beginning.

Unfortunately, there is often no chance that an operation can cure the lung cancer: the tumor is already too advanced. In other patients, the tumor would be in principle operable. However, the lung function of the patient is so bad that he would not be able to cope with removing parts of the lungs. In the run-up, the doctors therefore check with special examinations whether an operation on a patient makes sense.

Lung cancer: chemo

Like many other cancers, lung cancer can also be treated with chemotherapy. The patient receives medication that inhibits cell division and thus tumor growth. These agents are called chemotherapeutic agents or cytostatic drugs.

Chemotherapy alone is not enough to cure lung cancer. They are therefore usually used in combination with other treatments. For example, it can be done prior to surgery to shrink the tumor (Neoadjuvant chemotherapy). Then the surgeon has to cut out less tissue.

In other cases, post-operative chemotherapy is supposed to destroy any cancer cells still in the body (adjuvant chemotherapy).

Chemotherapy for lung cancer usually exists several treatment cycles, So there are certain days when the doctor administers the medication. In between, two to three-week treatment breaks are taken. Mostly, the patient receives the drugs as an infusion via a vein. Sometimes, however, the preparations are also given in tablet form (orally).

To check the effect of chemotherapy, the patient is regularly examined by computed tomography (CT). So the doctor recognizes if he has to adjust the chemotherapy. He can, for example, increase the drug dose or prescribe another cytostatic drug.

Lung cancer: radiation

Another approach to lung cancer treatment is radiation. Lung cancer patients usually receive radiotherapy in addition to another form of treatment. Like chemotherapy, radiation can be, for example before or after surgery respectively. Often they are also used in addition to chemotherapy. That’s what you call it chemoradiotherapy.

Some lung cancer patients also receive a so-called Prophylactic cranial irradiation, In other words, the skull is irradiated as a precaution to prevent the formation of brain metastases.

If the lung cancer is still at a very early stage, irradiation is sometimes sufficient as the sole therapy to cure the patient.

Other treatments for lung cancer

The mentioned therapies are aimed directly at the primary tumor and possible lung cancer metastases. In the course of the disease, however, various complaints and complications may occur, which must also be treated:

• When there is an effusion between the lungs and the lungpleural effusion), it sucks him off (Pleurapunktion). If the effusion continues again, you can insert a small tube between the lung and pleura, over which the liquid flows. He stays longer in the body (chest drainage).
• The tumor can Bleeding in the bronchi cause. These can be stopped, for example, by selectively closing the blood vessel in question, for example as part of a bronchoscopy.
• The growing tumor can Close blood vessels or airways, To make it through again, you can insert a stent, so a stabilizing tube. In other cases, the tumor tissue is removed at the relevant site, for example with a laser.
• Advanced lung cancer can cause severe pain (cancer pain). The patient then receives a suitable pain therapy, for example analgesic as a tablet or syringe. For painful bone metastases, radiation can provide relief.
• difficulty in breathing can be relieved with medication and oxygen. Helpful are also special breathing techniques and proper storage of the patient.
• at heavy weight loss you may need to feed the patient artificially.
• Side effects of chemotherapy such as nausea and anemia can be treated with appropriate medication.

In addition to the treatment of physical ailments, it is also very important that the patient mentally well looked after becomes. Psychologists, social services and self-help groups help with disease management. This increases the quality of life of the patient. The relatives can and should be included in the therapy concepts.

Small cell bronchial carcinoma

The treatment of lung cancer is influenced by what type of tumor it is. Depending on which cells of the lung tissue to cancer cells, doctors distinguish two major groups of lung cancer: One of them is small cell lung cancer (SCLC = small cell lung cancer).

This type of lung cancer grows very fast and forms early metastases (metastases) in other parts of the body. That’s why chemotherapy is the most important therapy here. Many patients also receive radiotherapy. This should improve the chances of success of the treatment.

Surgery usually only makes sense if the tumor is still very small and no or only a few neighboring lymph nodes are affected. However, this only applies to individual patients: at the time of diagnosis, small cell lung cancer is usually more advanced.

Read more about the development, treatment and prognosis of this form of lung cancer in the article SCLC: Small Cell Lung Cancer.

Non-small cell lung carcinoma

Non-small cell lung cancer is the most common form of lung cancer. It is often abbreviated to NSCLC (“non small cell lung cancer”). Strictly speaking, the term “non-small cell bronchial carcinoma” encompasses various types of tumors. These include, for example, adenocarcinoma and squamous cell carcinoma.

For all non-small cell lung carcinomas, they grow more slowly than small cell lung cancer and later on form metastases. They do not respond so well to chemotherapy.

The treatment of choice is therefore, if possible, an operation: the surgeon tries to completely remove the tumor. If this is not possible, the patient receives additional radiation. Before or after surgery, chemotherapy may be given as support. If non-small cell lung carcinoma is detected at a very early stage, even single exposure may be sufficient.

For some time, there have been other therapeutic approaches such as treatment with antibodies. They are only suitable for certain patients.

Read more about this widespread form of lung cancer in the article NSCLC: Non-Small Cell Lung Cancer.

Lung cancer: causes and risk factors

The reason for lung cancer is one uncontrolled growth of cells in the so-called bronchial system. This refers to the large and small airways of the lungs (bronchi and bronchioles). The medical name for lung cancer is therefore bronchial carcinoma. The word part “carcinoma” stands for a malignant tumor from so-called epithelial cells. They form the cover fabric that lines the airways.

The uncontrolled growing cells multiply very fast. Debei increasingly displace healthy lung tissue. In addition, the cancer cells can spread through blood and lymph vessels and form a daughter gulrow elsewhere. Such removals are called lung cancer metastases.

Lung cancer metastases should not be confused with lung metastases: These are secondary tumors in the lungs that emanate from cancerous tumors elsewhere in the body. For example, colon cancer and renal cell carcinoma often cause lung metastases.

Smoking: The most important risk factor

The most important risk factor for uncontrolled and malignant cell growth in the lungs is Smoke, About 90 percent of all men with lung cancer have actively smoked or are still doing so. For women, this applies to at least 60 percent of the patients. The higher the risk of illness, the earlier someone started smoking and the more one smokes.

Physicians measure the previous cigarette consumption of a patient in the unit “pack years“(Pack years). If someone smokes a pack of cigarettes a day for one year, this is counted as “one pack year”. If he smokes one box a day for ten years or two boxes a day for five years, that’s 10 pack years each. The more years of packaging, the higher the risk of lung cancer.

In addition to the number of cigarettes smoked, too Kind of smoking a role: the more smoke you inhale, the worse it is for the lungs. The lung cancer risk also has an impact cigarettes places: Strong or even filterless cigarettes are particularly harmful.

For some years, one also knows that Teenagers and women more sensitive to the carcinogenic substances in tobacco smoke than adults and men.

However, not everyone who smoked for a few years in their past has to be afraid of lung cancer. Fortunately, the lungs can also recover. Just a few years after smoking cessation, the lung cancer risk has dropped noticeably. About 20 to 30 years after the last cigarette, an ex-smoker has about the same disease risk again as someone who has never quenched. So it’s never too late to quit smoking.

Passive smoking also increases the risk of lung cancer!

Other risk factors for lung cancer

Apart from smoking, there are other factors that can increase the risk of lung cancer:

• Materials like Asbestos, arsenic compounds or quartz and nickel dusts
• High pollution of air: The most important factor is diesel soot. Particulate matter also appears to have a negative impact on lung cancer risk.
• Radon: Natural, radioactive gas is concentrated in certain areas. It is found mainly in the lower floors of buildings.
• Gene: To a certain extent, lung cancer seems to be hereditary. Especially in very young patients experts suspect a genetic predisposition. This could make the people more susceptible to lung-damaging influences (such as smoking).
• Lung scarring: They arise, for example, as a result of tuberculosis or after surgery.
• viruses: Viral diseases can also be involved in the development of bronchial cancer. HIV and human papillomaviruses (HPV) are suspected.
• Low-vitamin diet: If you eat little fruit and vegetables, the lung cancer risk appears to increase. This is especially true for smokers. However, the intake of vitamin supplements is not an alternative: Especially with smokers, such preparations seem to increase the risk of bronchial cancer even further.

If several of these factors are present at the same time, the probabilities for lung cancer do not just add up: Rather, the risk of disease increases many times over. For example, a high pollutant load in the air increases the lung cancer risk in smokers much more than in non-smokers.

Sometimes you can no cause for lung cancer Find. This is called an idiopathic disease. Of all types of lung cancer, this most commonly applies to the so-called adenocarcinoma. This is a form of non-small cell lung carcinoma.

Lung cancer: examinations and diagnosis

The lung cancer diagnosis is often made late. Symptoms such as persistent cough, chest pain and shortness of breath are often not recognized by smokers as possible signs of lung cancer. Most patients simply blame smoking. Others suspect a severe cold, bronchitis or pneumonia behind the discomfort. Only medical examinations then give the suspicion of a bronchial carcinoma.

The first point of contact for possible symptoms of lung cancer is the family doctor. If necessary, he will refer the patient to specialists, for example to an X-ray specialist (radiologist), pulmonologist (pulmonologist) or cancer specialist (oncologist). In order to diagnose lung cancer, an examination of the medical history, a physical and various apparatus examinations are necessary.

Medical history and physical examination

First, the doctor compiles the patient’s medical history (anamnesis) in conversation with the patient:

He describes the symptoms such as respiratory distress or chest pain exactly. He also asks about risk factors for lung cancer. For example, he asks whether the patient smokes or works on materials such as asbestos or arsenic compounds.

Information on possible pre-existing or underlying diseases such as COPD or chronic bronchitis is also important for lung cancer diagnosis. Patients should also tell the doctor if there were already cases of lung cancer in their family.

After the anamnesis interview, the doctor will carefully examine the patient physically. For example, he taps and hears the lungs of the patient and measures the blood pressure and the pulse. The investigation may give possible clues to the cause of the complaints. In addition, the doctor can thus better assess the general health of the patient.

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Using an X-ray of the chest (chest X-ray), the doctor can already detect certain changes in the lung tissue. If this leads to the suspicion of lung cancer, the next step is computerized tomography (CT).

Incidentally, the doctor examines the patient in two levels, ie from the front and from the side.

Computed tomography (CT)

Computed tomography provides detailed sectional images of the lungs in high resolution. This is possible with the help of X-rays, which are significantly higher dose than with a normal X-ray. In addition, the patient is given a contrast agent in advance. So the different tissue structures are better represented.

The doctor can use the CT to assess suspicious lung changes better than the X-ray images. This can corroborate the suspicion of lung cancer.

Examination of tissue samples (biopsy)

To be sure that a prominent site in the lung tissue is actually a bronchial carcinoma, one must take a small piece of tissue and examine it microscopically. Depending on the location of the suspicious area, different methods are used:

In the lung reflection (bronchoscopy) introduces a tube with a tiny camera (endoscope) over the mouth or nose into the trachea of ​​the patient and further into the bronchi. When looking inside, a tumor can often already be visually recognized. In addition, the doctor can in the context of bronchoscopy with fine instruments under visual control tissue samples and secretions from the lungs.

If you can not reach the suspicious tissue through the bronchi poorly or not at all, the doctor performs a so-called transthoracic needle aspiration Through: He stings with a very fine needle from the outside between the ribs. Under CT control, he leads the needle tip to the suspected lung area. He then sucks (aspirates) some tissue over the needle.

In some patients, neither bronchoscopy nor transthoracic needle aspiration is possible. In other cases, both studies give no clear result. Then one can surgical biopsy necessary: ​​either the surgeon opens the thorax with a larger incision (thoracotomy) and takes a sample of the suspicious tissue. Or he puts small cuts in the chest, over which he introduces a small camera and fine instruments for tissue removal (video-assisted thoracoscopy, VATS).

The removed tissue sample is examined under the microscope. As a rule, it is already possible to detect by means of fewer cells whether lung cancer is present and, if so, which type of tumor (cytological diagnosis). Only in special cases is it necessary to examine larger tissue sections (histological diagnosis).

Investigation of tumor spread (staging)

If the diagnosis of “lung cancer” is clear, the next step is to investigate its spread in the body. This section of the study is referred to by physicians as staging (English for “staging”). Only by such a staging can they classify the bronchial carcinoma according to the TNM classification.

Staging involves three steps:

• Examination of tumor size (T status)
• Examination of lymph node involvement (N status)
• Search for metastases (M status)

Examination of the primary tumor (T-status)

First of all, we investigate the size of the tumor from which lung cancer originates (primary tumor). For this purpose, the patient receives a contrast agent before using his chest and upper abdomen Computed tomography (CT) examined. The contrast medium accumulates for a short time mainly in the tumor tissue and causes a mark on the CT image. So the doctor can assess the extent of the primary tumor.

If the examination by CT is not meaningful enough, further procedures are used. This can be for examplee Ultrasound examination of the chest (thorax sonography) or one MRI Be (MRT).

Examination of lymph node involvement (N status)

In order to plan the therapy optimally, the doctor must know whether the lung cancer has already affected lymph nodes. Again, the examination by means of computed tomography (CT) helps. Often a special technique is used: the so-called FDG-PET / CT, This is a combination of positron emission tomography (PET) and CT:

Positron emission tomography (PET) is a nuclear medicine examination. The lying patient is first injected with a tiny amount of a radioactive substance into a vein. The FDG-PET / CT is about FDG, This is a radiolabeled simple sugar (fluorodeoxyglucose). It spreads in the body and accumulates particularly in tissues with increased metabolic activity, for example in cancerous tissue. During this time, the patient must remain as quiet as possible. After about 45 (to 90) minutes, the PET / CT scan is performed to visualize the distribution of FDG in the body:

The PET camera can very well represent the different metabolic activity in the different tissues. Particularly active areas (such as cancer cells in lymph nodes or metastases) literally “shine” on the PET image. Bones, organs and other structures of the body can not represent the PET so well. This is done by the almost simultaneous computer tomography CT (PET camera and CT are combined in one device). It allows a very accurate representation of the various anatomical structures. Combined with the precise mapping of metabolic activity, it is possible to locate cancerous lesions precisely.

Conclusion: Using FDG-PET / CT, metastases of lung cancer in lymph nodes and even more distant organs and tissues can be displayed very accurately. Um sicher zu gehen, kann der Arzt eine Gewebeprobe der verdächtigen Bereiche entnehmen und auf Krebszellen untersuchen (Biopsie).

Suche nach Metastasen (M-Status)

Das Streuen von Krebszellen in andere Organe ist ein großes Problem beim Bronchialkarzinom. Metastasen bilden sich besonders oft in Leber und Gehirn sowie in den Knochen und Nebennieren. Prinzipiell kann aber jede Körperstruktur von den Krebszellen befallen werden. Lungenkrebs, der bereits gestreut hat, gilt als nicht mehr heilbar.

Mit der oben beschriebenen Spezialuntersuchung FDG-PET/CT können Metastasen überall im Körper nachgewiesen werden. Um mögliche Absiedlungen im Gehirn ausfindig zu machen, wird zudem der Schädel mittels Kernspintomografie (MRT) untersucht.

Bei manchen Patienten ist eine FDG-PET/CT nicht möglich. Die Alternative ist dann eine Computertomografie or Ultraschall-Untersuchung des Rumpfes und zusätzlich eine sogenannte Knochenszintigrafie, Also Ganzkörper-MRT-Aufnahmen sind möglich.

Blutuntersuchungen

Es gibt keine Blutwerte, mit deren Hilfe sich Lungenkrebs sicher diagnostizieren lässt. Allerdings kann man sogenannte Tumormarker im Blut bestimmen. Das sind Substanzen, deren Blutspiegel bei einer Kresberkrankung erhöht sein kann. Denn die Tumormarker werden entweder von den Krebszellen selbst oder aber vom Körper als Reaktion auf den Krebs verstärkt produziert.

Mediziner kennen zwei Tumormarker, die bei Lungenkrebs oft erhöht sind: die neuronenspezifische Enolase (NSE) und CYFRA 21-1. Anhand dieser Marker allein kann man aber keine Diagnose stellen. Sie dienen vielmehr der Verlaufsbeurteilung: Ihre Konzentration im Blut wird regelmäßig bestimmt. So kann der Arzt abschätzen, wie schnell der Tumor wächst beziehungsweise ob nach einer Behandlung erneut Krebszellen auftauchen.

Untersuchung des Auswurfs

Der Auswurf (Sputum), den ein Patient aus der Lunge hochhustet, kann ebenfalls untersucht werden. Diese Methode wird vor allem dann angewendet, wenn andere Diagnoseverfahren nicht möglich sind (etwa weil der Gesundheitszustand des Patienten zu schlecht ist).

Ist der Auswurf unauffällig, heißt das aber nicht unbedingt, dass kein Lungenkrebs vorliegt. Die Untersuchung des Auswurfs dient eher dazu, einen bereits vorhandenen Verdacht zu bestätigen.

Untersuchung von Lungenwasser

Bei Lungenkrebs-Patienten bildet sich oft “Lungenwasser”. Das heißt: Es sammelt sich vermehrt Flüssigkeit zwischen Lungenfell und Rippenfell. Ein solcher Pleuraerguss kann aber auch andere Ursachen haben. Zur Abklärung wird der Arzt über eine feine Hohlnadel eine Probe des Ergusses entnehmen (Pleurapunktion) und mikroskopisch untersuchen. So kann er feststellen, wodurch der Erguss entstanden ist.

Gibt es Vorsorgeuntersuchungen bei Lungenkrebs?

Eine allgemeine Früherkennung, wie man sie zum Beispiel bei Brustkrebs, Darmkrebs oder Hautkrebs anwendet, ist bei Lungenkrebs schwierig. Man könnte zwar regelmäßig zum Beispiel Röntgen-Aufnahmen des Brustkorbs machen, das Blut auf Tumormarker untersuchen oder den Auswurf analysieren. Solche Vorsorgeuntersuchungen sind aber entweder zu ungenau oder aber zu empfindlich. Im zweiten Fall könnte sich ein unbegründeter Krebsverdacht ergeben. Außerdem bedeuten regelmäßige Röntgen- oder auch CT-Untersuchungen eine Strahlenbelastung für den Betroffenen.

Menschen, die ein hohes Risiko für Lungenkrebs haben, könnten allerdings von Vorsorgeuntersuchungen profitieren. Es wurden zum Beispiel Studien durchgeführt, bei denen Risikopatienten regelmäßig mittels Computertomografie (CT) mit niedriger Strahlendosis untersucht wurden. Auf diese Weise konnte etwa bei starken Rauchern Bronchialkrebs früher entdeckt werden. Dies muss aber noch genauer untersucht werden. Erst dann kann man vielleicht solche Vorsorgeuntersuchungen für bestimmte Risikogruppen empfehlen.

Lungenkrebs: Krankheitsverlauf und Prognose

Für Patienten, die eine Therapie mit Heilungsabsicht (kurative Therapie) bekommen haben, gibt es einen speziellen Nachsorgeplan. Nach Abschluss der Behandlung sollten sie in regelmäßigen Abständen zu Kontrolluntersuchungen ins Krankenhaus gehen. Besonders wichtig sind regelmäßige Röntgen- und CT-Bilder. Der Arzt wird diese jeweils im Vergleich zu den letzten Aufnahmen des Patienten beurteilen.

Auch Patienten, bei denen keine Heilung mehr zu erwarten ist, werden regelmäßig vom Arzt untersucht. So lässt sich feststellen, ob die palliative Therapie die Symptome ausreichend lindert oder eventuell angepasst werden muss.

Lungenkrebs: Prognose

Insgesamt hat das Bronchialkarzinom eine schlechte Prognose: Lungenkrebs wird bei vielen Patienten erst entdeckt, wenn die Erkrankung bereits weit fortgeschritten ist. Eine Heilung ist dann oft nicht mehr möglich. Wird der Lungenkrebs in frühen Stadien entdeckt, kann man eventuell operieren. Nach einiger Zeit bildet sich aber oft ein erneuter Krebstumor (Rückfall = Rezidiv).

Gerade weil die Heilungschancen so gering sind, ist es wichtig, das Risiko für Lungenkrebs nicht unnötig zu erhöhen. Der wichtigste Faktor, den jeder selbst in der Hand hat, ist das Rauchen. Wer auf das Qualmen verzichtet oder gar nicht erst damit anfängt, senkt deutlich sein persönliches Risiko für ein Bronchialkarzinom. Prognose und Verlauf einer bereits bestehenden Lungenkrebs-Erkrankung lassen sich ebenfalls verbessern, wenn man mit dem Rauchen aufhört.

Lungenkrebs: Lebenserwartung

Wer die Diagnose Lungenkrebs bekommt, stellt sich oft die Frage: “Wie lange werde ich noch leben?” Für den Arzt ist es nicht ganz einfach, diese Frage zu beantworten. Die Lebenserwartung bei Lungenkrebs hängt nämlich von verschiedenen Faktoren ab:

Es spielt zum Beispiel eine Rolle, wie weit fortgeschritten der Tumor zum Zeitpunkt der Diagnose ist. Lungenkrebs wird oft erst spät entdeckt, was sich nachteilig auf die Lebenserwartung des Patienten auswirkt. Ebenfalls einen Einfluss auf das Überleben hat die Art des Tumors: Nicht-Kleinzellige Bronchialkarzinome wachsen langsamer als Kleinzellige. Sie haben deshalb generell eine bessere Prognose.

Der allgemeine Gesundheitszustand ist ebenfalls wichtig: Wenn zum Beispiel die Herz- und Lungenfunktion eines Patienten deutlich geschwächt sind, kann es sein, dass bestimmte Behandlungsformen nur eingeschränkt oder gar nicht durchgeführt werden können. Das kann die Lebenserwartung des Lungenkrebs-Patienten deutlich senken.

Nähere Informationen zu Lebenserwartung und Heilungschancen bei Lungenkrebs erfahren Sie im Text Lungenkrebs: Lebenserwartung.

Weiterführende Informationen:

guidelines:

• S3-Leitlinie “Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms” der Arbeitsgemeinschaft der Wissenschaftlichen MedizinischenFachgesellschaften e.V., der Deutschen Krebsgesellschaft e.V. und der Deutschen Krebshilfe (2018)

Selbsthilfegruppen:

• Bundesverband Selbsthilfe Lungenkrebs e.V.
• Selbsthilfe Lungenkrebs
• Deutsche Krebshilfe e.V.