Lung neoplasms encrypted with numerous code combinations in ICD-10 are a serious oncological problem, which has recently become more common. With the timely recognition of the case and the start of adequate therapy, the patient can rely on good forecasts, but with certain forms, a high degree of malignancy of the formation and with an advanced stage, there is a risk of incurability of the condition.
About ciphers and codes
For neoplasms in the lungs, several numeric and alphabetic combinations were introduced at once in the ICD-10. For example, D38 is a code under which pathological malignant processes are hidden, whose character cannot be clarified, defined.
In the general case, when detecting malignant processes in the bronchi, neoplasms in the lungs, the ICD code is C34. But if the neoplasm is benign, it is encoded with the symbols D14. If the malignancy is secondary, the case is encrypted as C78.0. Still used for neoplasms in the lung code in the ICD D02.2. It is used if carcinoma is detected in the lungs, bronchi.
A specific code (or several) must be recorded in the client card. Responsibility for the correct choice of cipher and its fixation in the documentation lies with the attending physician of the patient.
general information
Malignant neoplasm in the bronchi and lungs is a pathological condition, the cause of which are cell development processes that are incorrectly occurring in the epithelial tissues of the respiratory system. Among other malignant pathologies that provoke a fatal outcome, lung cancer takes a confident first place. This is confirmed by world medical statics. The disease threatens people of different sex and age, with a high degree of probability it can cause death in patients of all groups. To some extent this is due to blurred symptoms, which for a long time did not allow the patient to suspect the presence of malignant areas.
A neoplasm in the right lung, left can develop in a peripheral or central form. There are massive cases of a mixed development scenario. There is a risk of malignancy of various parts of the respiratory system. Up to 95% of cases occur in the degeneration of epithelial cells, which play the role of a lining of the pathways of medium, large air. Therefore, most often the first to suffer are bronchioles, bronchi. In a number of sources for the pathological condition, the term "bronchogenic carcinoma" is used.
It is known that a tumor in the left lung, right can develop on the basis of pleural cells. Such a case is called mesothelioma. It is extremely rare that the process starts from auxiliary pulmonary tissues, including the circulatory system.
Where did the trouble come from?
The causes of neoplasms in the bronchi and lungs have been of interest to scientists and doctors for more than a decade. A link has been established with smoking, and it is the use of tobacco products that is considered the main cause of the process. About 80% of patients are heavy smokers. In the other 20%, external factors are likely to play a role: being in rooms contaminated with radon, the need to work with asbestos dust. Some heavy metals have carcinogenic qualities. The risk of getting sick is higher if you have to come in contact with chloromethyl ether.
It was found that lung neoplasms (the ICD considers this pathology in several categories) can form against the background of chronic foci of inflammation in the respiratory system. Certain risks are associated with pulmonary fibrosis.
Explaining why smoking so much affects human health, scientists have studied the properties of tobacco products. The smoke emitted during the combustion of a cigarette is rich in chemical components that play the role of carcinogens. In addition, a set of physical factors provokes the start of malignant processes, including a sharp temperature drop when inhaling hot smoke.
How to suspect?
If a person coughs for a long time, and blood turns on in the excreted sputum, one should think about the causes of the phenomenon. Really, what could it be? A neoplasm in the lungs is one of the factors that can provoke such symptoms. In general, describing the exact clinical picture is not easy, especially for the first two stages of the development of the disease. Manifestations are quite diverse, depending on the localization of the degenerate zone and the magnitude of the pathological formation. In an impressive percentage of cases in the first stages of cancer, there are no specific symptoms at all, almost always an early diagnosis of the disease is a serious complication.
The malignant neoplasms recorded in codes D02.2, D38, C34, C78.0 of the ICD more often indicate persistent coughing, respiratory failure, and soreness in the chest. Gradually, blood spitting becomes more and more frequent, and the patient loses weight for no apparent reason. Any indicated symptom should be an occasion to consult a doctor, even if others do not accompany him. It is known that an impressive percentage of deaths in pulmonary cancer is due to a too late call to a specialist. The signs are nonspecific and are manifested in various pathologies of the respiratory system, which makes clarification of the case difficult. Cancer can be suspected if, in addition to at least one of these symptoms, apathy, loss of activity, sluggish state, and temperature rises from time to time. There are cases when cancer was mistaken for pulmonary inflammation, bronchitis.
Attention to laboratory indicators!
If, for various reasons, a person passes tests, some results oblige to consider the possibility of a malignant, benign neoplasm in the lungs and conduct diagnostic measures to confirm or refute the hypothesis. In particular, an increased calcium content in the circulatory system may indicate a squamous type of the disease, and an unreasonable increase in the percentage of sodium - small cell. Oat-cell form can be suspected if laboratory tests confirm hypertrophic osteoarthropathy. The phenomenon was called paraneoplastic syndrome. A successful therapeutic course against the main pathology allows its disappearance.
Diagnostic nuances
In approximately 15% of cases, a malignant neoplasm in the lung at the initial stage does not provoke any symptoms at all, even non-specific ones. The only way to detect pathology at this step is an instrumental examination. In practice, most often in time to make a diagnosis helps fluorography, which the citizens of our country must undergo annually. The examination is free, it takes only a few minutes, therefore it is available to everyone. If the result is a picture with a darkened area, the patient is sent for additional studies until it is possible to identify the nature of the stain and confirm or deny the presence of a malignant process.
If a malignant neoplasm in the lung caused metastases, the symptoms of this step of the process can be severe pain. The syndrome is especially pronounced if atypical cells encompass the skeletal system. With damage to the brain, there is a possibility of impaired vision, convulsions. Patients have a headache and dizzy, the condition resembles a stroke, certain parts of the body lose their sensitivity, muscle tissue weakens.
Symptoms: summarizing
To suspect a neoplasm in the lungs and consult a doctor for diagnosis is necessary if you are concerned about a constant cough, while the discharge contains blood inclusions. If the cough is chronic, not associated with malignant processes, complication, aggravation of this phenomenon may indicate pathology. There is a chance of cancer if infection of the respiratory organs is prone to relapse, a person often suffers from bronchitis or suffers from discomfort, soreness in the chest. Sudden weight loss, fatigue, breathing problems, the appearance of whistles are reasons to make an appointment with the doctor, as such symptoms can also indicate cancer.
All check out!
Assuming cancer, the doctor directs the patient to instrumental research. One of the first to carry out CT, MRI. These methods can identify the size, prevalence, accurately localize the affected area. The difference between these two methods from the x-ray in high sensitivity, the ability to detect cancer at an early stage, even if there are no symptoms of the disease. But the x-ray usually shows a fairly large neoplasm. This image allows you to quickly identify metastases.
If it is necessary to clarify the patient's condition, bronchoscopy is prescribed. The study is carried out using an endoscope, in real time receiving through the fiber optic tube an image of the internal pulmonary structures. The doctor can examine the patient’s respiratory system from the inside, see with his own eyes the location of the neoplasm and its level of growth, as well as obtain cell samples for histological analysis.
Types and stages
There are peripheral neoplasms in the lung, central. The region can be flat, large, small cell. There are mixed forms and adenocarcinoma. To clarify the stage, it is necessary to identify the exact dimensions of the formation, assess the degree of penetration into nearby structures, tissues, check the lymphatic system and other organs for metastases. Determining the exact stage is necessary to select an adequate therapeutic program. For each step of the development of the disease, unique treatment strategies have been developed. Clarification of the stage allows you to correctly predict the future of a person. The deeper and more advanced the process, the less likely it will be completely cured.
The first stage is called such a neoplasm in the lungs, whose dimensions are up to 3 cm, the process does not affect pleural tissues, regional lymph nodes, metastases cannot be detected. With the same dimensions, but the presence of metastases in the lymphatic system of the bronchi, the second stage of the disease is diagnosed.
Continuing the topic
The third stage is usually divided into A and B. The first is a neoplasm in the lungs in which the degeneration of the cells affects the visceral pleural tissue, the wall of the chest, and pleural mediastinal cells. The dimensions of the neoplasm do not play a role. Invasion can be observed against the background of metastases in the lymph nodes of the mediastinum, bronchi from the side opposite to the original focus. The third stage, subtype A, is diagnosed if only the described metastases are observed without tissue infiltration.
Type B of the third stage is also diagnosed regardless of the size of the lung tumor. Important factors will be infiltration into the mediastinum - esophageal, vascular, cardiac, vertebral tissues. Perhaps the appearance of metastases in the lymphatic system of the bronchi, lungs from the side opposite to the original focus. Metastases can be found in the lymphatic system of the supraclavicular region, the mediastinum.
If distant metastases are detected, the fourth stage is diagnosed. The same diagnosis is made if the malignant processes are small-cell cancer of a limited, widespread type.
About categories in more detail
Central malignant formation is localized in the bronchial segments, large bronchi. Squamous, non-small cell forms of oncological diseases are revealed here. The peripheral type, as the name implies, is localized on the pulmonary periphery. With it, the alveoli, small bronchial structures, branches of the bronchi are reborn. The main danger of this form is the course of almost no symptoms for a long time. As a rule, the first signs of the disease appear only at the fourth stage, when the tumor already becomes large and compresses the structures located nearby, infiltration into large bronchi, pleural tissues, and chest took place.
Pleural mesothelioma is rarely detected . This is a fairly aggressive form of the disease, originating from the pleural membranes.
Forms, stages and strategies
Based on the degree of the process, it is possible to assess the type of neoplasm, the features of its development, distribution, size, as well as the specifics of infiltration. This information is needed to make an adequate forecast. Stage, other features of the case affect the choice of therapeutic approach. A better future awaits patients who come to the clinic with a zero stage. The treatment will bring good results at the first stage of the development of pathology. In the second and third forecasts are much worse, but there are certain chances for a full recovery. At the fourth stage, it is almost impossible to achieve a cure and even prolonged stabilization of the state.
When a neoplasm is detected, special attention should be paid to metastases. If any already exist, the therapeutic course in the predominant percentage of cases is palliative. If none are found, the operation is shown. A neoplasm in the lungs with a high degree of probability following the results of a radical intervention will be eliminated without consequences and relapses in the future.
The future: what to count on?
The prognosis is determined by the nuances of localization, the size of the neoplasm, the severity of symptoms, the type of atypical cells, and the state of human health in general. With lung cancer, the average prognosis is worse than with most other malignant diseases. Survival is relatively low relative to a number of other forms of disease. So, in the analysis of five years, the average survival rate is only 16%. For comparison, with a malignant neoplasm in the large intestine for the same time period, survival is estimated at 65%, and with malignancy of breast cells - 89%.
Worst predictions if the neoplasm develops according to the scenario of small cell degeneration. Chemotherapy alone and in combination with other therapeutic approaches can extend the patient’s life by an average of five times. Nevertheless, five-year survival in the case of small cell malignant process is estimated at an average of 5-10%. The main percentage of survivors are people with a limited form of the disease.
Is it possible to warn?
The main preventive measure is the complete exclusion from your life of smoking, not only active but also passive. To abandon a bad habit, you can resort to the help of doctors - narcologists, psychologists. Many products have been developed that simplify the period of failure (inhalers, chewing gum, tablets). The first ten years after the abandonment of tobacco products are associated with an increased risk of malignant processes, but the likelihood of their development is gradually reduced.
To eliminate radon from the premises, it is necessary to constantly ventilate all habitat zones and do wet cleaning. If the frame of the building is made of reinforced concrete, surfaces should be treated in residential and working premises, painted or wallpapered. If possible, contact with heavy metals and asbestos dust should be avoided. This is especially important for people working in production areas.
It is important to eat properly. Scientists are convinced that the risk of neoplasm can be reduced if the diet is diluted with natural antioxidants. Fruits, herbs, vegetables contain ascorbic acid, retinol, tocopherol, which reduce the risk of malignant processes in the respiratory system.
The latest technology: CyberKnife
Some modern clinics offer the treatment of cancer processes using the CyberKnife method. The accuracy of the movements is estimated at 0.5 mm. The technology belongs to the category of radiosurgery, performed without direct contact. Through a special installation, a malignant neoplasm is treated with thin beam beams. In just three sessions, the pathological zone can be completely destroyed without harming the organic structures nearby, including the aorta. Such an operation does not require hospitalization, you do not need to cut anything. Not even general anesthesia is required.
It is believed that CyberKnife shows high accuracy, and its use is associated with a minimum level of danger.Special marks are placed in the tumor boundaries that are harmless to humans, but simplify the targeting of ionizing beams. Before applying the next beam, the computer evaluates the location of the tumor, its displacement, due to which the energy supply is provided as accurately as possible.
If the patient has decided in favor of the CyberKnife technology, a vest will be put on for the period of intervention, providing protection and simplifying control over breathing, involuntary body movements. Consequently, all the rays will fall exactly at those points that must be processed according to plan. Similarly, metastases located in the lungs can be destroyed.