Disorders of the nervous system in lung cancer
Of 36 patients with brain cancer under our supervision, 4 had metastases from the stomach, 2 - from the genitourinary sphere, one - from the esophagus, 4 - from the breast, 2 - from the thyroid gland, the rest23 - from the bronchi and lungs. Our material reflects not only the frequency of lung cancer metastases in the brain, but also its frequent asymptomatic at the site of primary development. The phenomena from the nervous system come to the fore, mask the pulmonary symptoms, and often prompt the diagnosis of suffering as a primary brain tumor, apoplexy of the brain, meningoencephalitis, etc. Solitary metastases are much less common than multiple metastases. Of the 23 our patients, solitary metastasis was detected only in 8.
Depending on the localization of metastases, corresponding focal brain lesions appear. Of the features characteristic of metastatic cancers, it should be noted the frequent absence of signs of increased intracranial pressure and very late appearance of stagnant nipples. Focal symptoms can be little expressed or have no specific localization, which is due to the presence of several or many cancer nodes in the brain. Sometimes the clinical syndrome develops sharply, and neither stagnant nipples of optic nerves nor other signs of increased intracranial pressure are detected.
Much less frequently than in the brain substance, lung cancer metastasizes into the membranes. At the same time, along with lesions of the cranial nerves, severe headaches are observed. Such metastases can be taken for syphilitic basal meningitis. Against syphilis in these cases speaks exceptionally sharp headache, steady progression of suffering, the intensity of lesions of cranial nerves, the lack of biological reactions to syphilis.
Sometimes multiple cancer metastases into the soft meninges cause a clinical picture that mimics infectious meningitis. This so-called carcinomatous leptomeningitis can also be viewed on the section, for it is only detected by microscopic examination. Clinically, in addition to meningeal symptoms, characteristic psychological changes are often observed, manifested in the fact that in the patient periods of psychomotor agitation are replaced by apathy and a sharp lethargy.
In a pathoanatomical study, the metastatic nodes of the tumor appear to be sharply delimited and relatively easy to remove. As you grow in the cancerous nodes, degeneration and decay of the tissue may occur with the formation of a cyst. In the surrounding cancerous metastasis of the tissue there is a sharp edema and many phagocytes.
The incidence of metastatic brain tumors with primary localization in the lungs prompts the conclusion that when a brain tumor is detected in individuals over the age of 40, radiographic examination of the lungs is mandatory.
The disease can develop acute and give rise to a diagnosis of cerebral stroke. Sometimes it is necessary to observe even gradual improvement of clinical symptoms. An accurate diagnosis is not always easy to establish and on autopsy, if there is a softening in the pool area of a certain vessel. The cause of this softening, however, is not an ordinary vascular thrombosis, but embolism by cancer cells. In this case, softening occurs earlier than the cancer node will have time to develop. The disappearance of perifocal edema in this type of cancer embolism explains some regression of clinical symptoms.
For the diagnosis, somatic symptoms are also important: subfebrile temperature, shift to the left of the blood formula, increased ROE, cachexia. EK Ezerova notes with latent lung cancer the phenomenon of intoxication in the form of headaches, persistent pain in the chest, pain along the nerve trunks, hyporeflexia. All these signs are far from permanent.
Cancer of the upper lobe of the lung often sprouts directly into the vertebrae;while other bones of the skeleton are rarely affected. A small node of primary lung cancer is sometimes difficult to detect, but multiple metastases are seen in the bone system. Especially often the lower thoracic and lumbar vertebrae are affected.
In this case, hematogenous metastasis usually occurs in the spine with secondary compression of the spinal cord and its roots. EM Polonskaya in 70 cases of cancer metastasis to the spine found primary localization in the lungs in 11 cases. Cancer of the spine affects the body of the vertebra and often captures several nearby lying vertebrae. The compression of the roots of the spinal cord causes pain characterized by exceptional intensity. The dura mater is a stable barrier through which the spinal cord rarely sprouts into the spinal cord. The phenomena from the spinal cord are caused by compression and give a picture of compression myelitis. During the cancer of the spine, three phases are distinguished: neuralgic, spinal deformities and compression. Often the rapid development of the disease erases the boundaries between these phases. The clinical picture depends on the level of the lesion of the spine. Age, the presence of intense pain, faster flow allow in most cases to distinguish the cancer of the spine from spondylitis. However, in some cases, if it is impossible to find the primary localization of cancer, these symptoms can lead to erroneous diagnosis, as tuberculous spondylitis in older people can be acute and quickly lead to death. The question in these cases is solved by roentgenographic research.
Neuritis .Symptoms from the peripheral nerves can be observed with direct compression of the roots and nerves with a tumor. The girdling character of pain in the chest indicates the involvement of the intercostals of the intercostal nerves in the process, and the pain in the arm - the first thoracic root of the brachial plexus.
The compression of the recurrent nerve causes aphonia, attacks of suffocation, coughing. Paralysis of the recurrent nerve usually indicates the penetration of a cancerous tumor into the mediastinum. The compression of the vagus nerve is manifested by slowing or accelerating the pulse, paroxysms of convulsive coughing. The compression of the medullary nerve causes a painful hiccup and paralysis of the diaphragm.
Syndrome Pankosta .Lung cancer, located in the area of the upper pulmonary furrow, causes a peculiar combination of symptoms, known as Pancost syndrome. In this case, there are pains in the shoulder joint in the hand, Horner's syndrome, sometimes atrophy of the small muscles of the hand. As a result of involvement of the cervical sympathetic knot in the process, sweating on the corresponding arm, half of the face and neck disappears. Radiography reveals usuras at the base of the I-II cervical rib. Sometimes the puffiness of the hand, which testifies to compression of the subclavian vein, joins this syndrome.
Polyneurite .In lung cancer, as in malignant tumors of other localization, typical polyneuritis is observed, the cause of which is considered to be toxic factors, in particular, the increased disintegration of proteins and the release of other toxic products of metabolism by the tumor. According to V. V. Mikheev, cancer polyneuritis is similar to polyneuritis in case of alimentary dystrophy and beriberi. The author connects their pathogenesis with cancerous cachexia. The development and severity of polyneuritis may not proceed in parallel with the severity of cachexia, therefore, when symptoms of polyneuritis appear in the elderly, among other reasons, one should recall the possibility of a malignant tumor.
Sometimes the syndrome of simultaneous destruction of several peripheral nerves is caused by metastases, especially if the latter are located in the spine or skull. Enlarged lymph nodes can cause compression of the cervical or lumbar plexus.