{"id":4903,"date":"2025-05-16T15:07:12","date_gmt":"2025-05-16T12:07:12","guid":{"rendered":"https:\/\/neolife.ro\/baneasa\/?p=4903"},"modified":"2025-06-30T23:00:40","modified_gmt":"2025-06-30T20:00:40","slug":"simptomatologia-in-cancerul-bronhopulmonar-cbp","status":"publish","type":"post","link":"https:\/\/neolife.ro\/baneasa\/noutati\/simptomatologia-in-cancerul-bronhopulmonar-cbp\/","title":{"rendered":"Simptomatologia \u00een cancerul bronhopulmonar (cbp)"},"content":{"rendered":"

\u00cen Rom\u00e2nia, 75% din persoanele care sunt diagnosticate cu cancer bronhopulmonar (CBP) sunt\u00a0 \u00een stadii foarte avansate ale bolii, inoperabili \u0219i pot primi doar tratament cu viz\u0103 paliativ\u0103. Boala apare mai frecvent dup\u0103 v\u00e2rsta de 50 de ani, cu o simptomatologie discret\u0103, ini\u021bial, iar mul\u021bi fum\u0103tori o pun pe seama tabagismului sau a altor probleme mai pu\u021bin grave, ceea ce face ca vizita la medic s\u0103 fie am\u00e2nat\u0103. \u0218ansele de supravie\u021buire ale unui pacient oncologic \u00een Rom\u00e2nia sunt reduse, la circa 10%, \u00een schimb cele din Norvegia sunt de 20% ca urmare a unor programe de educare continu\u0103 a popula\u021biei.<\/p>\n

Profilul unui pacient cu CBP rom\u00e2n este urm\u0103torul:<\/strong><\/p>\n

    \n
  1. 85% sunt fum\u0103tori cronici;<\/li>\n
  2. Apare preponderent la sexul masculin, \u00eens\u0103 inciden\u021ba \u00een ceea ce prive\u0219te sexul feminin este \u00een cre\u0219tere;<\/li>\n
  3. 50% dintre pacien\u021bi au v\u00e2rste cuprinse \u00eentre 45 \u0219i 65 ani;<\/li>\n
  4. Educa\u021bia medical\u0103 precar\u0103 determin\u0103 pacien\u021bii s\u0103 solicite consultul medical \u00een stadii avansate de boal\u0103;<\/li>\n
  5. Sub 5% sunt descoperi\u021bi \u00eent\u00e2mpl\u0103tor, la controale de rutin\u0103;<\/li>\n
  6. \u00cen momentul diagnosticului numai 25% sunt operabili;<\/li>\n
  7. F\u0103r\u0103 tratament, majoritatea pacientilor ajung la deces \u00een primul an de la diagnostic.<\/li>\n<\/ol>\n

    Cancerul pulmonar nu determin\u0103 simptome u\u0219or observabile de pacien\u021bi<\/strong>, dec\u00e2t \u00een stadii avansate ca urmare a lipsei de termina\u021bii nervoase dureroase la nivelul parenchimului pulmonar.<\/p>\n\n\n\n\n
    \n

    Simptome comune<\/h3>\n<\/td>\n

    		\n

    Simptome atipice<\/h3>\n<\/td>\n<\/tr>\n

    \n
      \n
    • Tuse nou ap\u0103rut\u0103 \/ modificarea unei tuse cronice<\/li>\n
    • Hemoptizie<\/li>\n
    • Sc\u0103dere ponderal\u0103 neinten\u021bional\u0103<\/li>\n
    • Durere toracic\u0103<\/li>\n
    • Dispnee nou ap\u0103ruta sau agravat\u0103 progresiv<\/li>\n
    • Astenie fizic\u0103<\/li>\n
    • Alterarea timbrului vocal<\/li>\n
    • Infec\u021bii pulmonare recurente \u00een acela\u0219i teritoriu anatomic pulmonar<\/li>\n<\/ul>\n<\/td>\n
    		\n
      \n
    • Disfagie (dificultate la \u00eenghi\u021bire)<\/li>\n
    • Disfonie (r\u0103gu\u0219eal\u0103)<\/li>\n
    • Degete de ceasornic<\/li>\n
    • Edem facial \/ sindrom de ven\u0103 cav\u0103 superioar\u0103<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      Simptomatologia \u00een CBP se \u00eemparte \u00een 3 categorii:<\/u><\/strong><\/p>\n

        \n
      1. Simptome date de forma\u021biunea tumoral\u0103:<\/strong><\/li>\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
        TUSE \u2013 55% dintre pacien\u021bi<\/strong><\/td>\n<\/tr>\n
        O tuse nou ap\u0103rut\u0103 sau modificarea caracterului tusei la un pacient cunoscut cu boal\u0103 pulmonar\u0103 obstructiv\u0103 cronic\u0103 ridic\u0103 suspiciunea de CBP. De cele mai multe ori, pacien\u021bii fum\u0103tori ignor\u0103 acest simptom consider\u00e2nd c\u0103 este firesc s\u0103 aib\u0103 tuse cronic\u0103. De cele mai multe ori discut\u0103m despre o tuse seac\u0103, persistent\u0103 \u0219i non-resposiv\u0103 la tratament.<\/td>\n<\/tr>\n
        DISPNEEA \u2013 45% dintre pacien\u021bi<\/strong><\/td>\n<\/tr>\n
        Oboseala poate fi determinat\u0103 de prezen\u021ba unei forma\u021biuni tumorale care obstrueaz\u0103 c\u0103ile aeriene, prezen\u021ba de lichid \u00een spa\u021biul pleural (rev\u0103rsat pleural) sau \u00een pericard (foi\u021ba care acoper\u0103 inima) purt\u00e2nd denumirea de pericardit\u0103, prezen\u021ba a numero\u0219i micronoduli \u0219i noduli distribui\u021bi aleatori \u00een ambele campuri pulmonare care ar putea s\u0103 ridice suspiciunea unei carcinomatoze pulmonare \u0219i nu \u00een ultimul r\u00e2nd prezen\u021ba unei pneumonii retrostenotice sau atelectazii [c\u0103ile respiratorii sau sacule\u021bii cu aer (alveolele) nu se mai pot dilata]. Pentru evaluarea dispneei se utilizez\u0103 scala Borg \u0219i mMRC.<\/td>\n<\/tr>\n
        HEMOPTIZIE<\/strong><\/td>\n<\/tr>\n
        Eliminarea prin tuse a unei cantit\u0103\u021bi de s\u00e2nge cu originea \u00een etajul subglotic al aparatului respirator. Este vorba de s\u00e2nge proasp\u0103t, aerat, de culoare ro\u0219u aprins, gust s\u0103rat, metalic, \u00eenso\u021bit de o jen\u0103 retrosternal\u0103. Poate fi o cantitate minim\u0103, moderat\u0103 sau masiv\u0103 \/ cataclismic\u0103 cu risc de asfixie \u0219i deces. Aceasta poate s\u0103 fie persistent\u0103 sau recurent\u0103.<\/td>\n<\/tr>\n
        Hemoptizia ap\u0103rut\u0103 la un pacient fum\u0103tor, \u00een cazul unei radiografii pulmonare normale impune realizarea bronhoscopiei.<\/strong><\/td>\n15 \u2013 30% dintre pacien\u021bi se prezint\u0103 cu hemoptizii la momentul diagnostic\u0103rii CBP.<\/strong><\/td>\n<\/tr>\n
        DURERI TORACICE \u2013 20 – 40% dintre pacien\u021bi<\/strong><\/td>\n<\/tr>\n
        Este descris\u0103 de pacient ca o durere surd\u0103, care r\u0103m\u00e2ne la nivelul acelea\u0219i regiuni \u0219i persistent\u0103. Poate s\u0103 fie dat\u0103 de invazia peretelui toracic sau invazia mediastinului. De obicei apare pe aceea\u0219i parte ca \u0219i afectarea tumoral\u0103. Diagnostic diferen\u021bial obligatoriu cu embolia pulmonar\u0103. Paralizia unilateral\u0103 de diafragm este dat\u0103 de invazia nervului frenic.<\/td>\n<\/tr>\n
        WHEEZING <\/strong>\u00a0– \u0219uierat ce semnific\u0103 obstruc\u021bie la nivelul c\u0103ilor aeriene.<\/td>\n<\/tr>\n
        STRIDOR <\/strong>\u2013 sunet aspru cauzat de obstruc\u021bia par\u021bial\u0103 sau compresia traheei \u0219i\/sau a bronhiilor mari.<\/td>\n<\/tr>\n
        SC\u0102DERE \u00ceN GREUTATE<\/strong> \u2013 36% dintre pacien\u021bi, factor de prognostic negativ.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
          \n
        1. Simptome date de diseminarea intratoracic\u0103: <\/strong>rev\u0103rsat pleural, rev\u0103rsat pericardic, chilotorax (prezen\u021ba de lichid pleural ca urmare a unei obstruc\u021bii la nivelul canalului limfatic), disfonie (compresiunea\/invazia nervului laringeu recurent), disfagie (compresiunea\/invazia esofagului), sindrom de ven\u0103 cav\u0103 superioar\u0103 (cefalee, edem \u00een pelerin\u0103, venectazii \u0219i cianoz\u0103), sindromul Claude \u2013 Bernard \u2013 Horner (ptoza palpebral\u0103, enoftalmie, mioz\u0103) \u0219i tumora Pancoast \u2013 Tobias (prezen\u021ba unei forma\u021biuni tumorale care erodeaz\u0103 arcul costal \u0219i invadeaz\u0103 plexul brahial de aceea\u0219i parte \u2013 homolateral, cu apari\u021bia unui sindrom algic \u0219i atrofierea musculaturii membrului superior).<\/li>\n<\/ol>\n\n\n\n\n
          \"\"<\/td>\n\"\"<\/td>\n\"\"<\/td>\n<\/tr>\n
          Sindrom de ven\u0103 cav\u0103 superioar\u0103<\/strong><\/td>\nSindrom Claude \u2013 Bernard \u2013 Horner<\/strong><\/td>\nTumora Pancoast \u2013 Tobias (reprezentare imagistic\u0103)<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
            \n
          1. Simptome determinate de prezen\u021ba metastazelor, \u00een func\u021bie de localizare, la nivelul glandelor suprarenale, ficat, creier \u0219i sistem osos.<\/strong><\/li>\n<\/ol>\n\n\n\n\n\n\n\n\n\n\n
            METASTAZE OSOASE<\/strong><\/td>\n<\/tr>\n
            Sunt simptomatice \u2013 dureri sau apari\u021bia unor fracturi pe os patologic. Orice os poate s\u0103 fie implicat, \u00eens\u0103\u00a0 cu predilec\u021bie vertebrele, coastele \u0219i oasele centurii pelvine.<\/td>\n<\/tr>\n
            METASTAZE GLANDE SUPRARENALE<\/strong><\/td>\n<\/tr>\n
            De obicei asimptomatice, \u00eens\u0103 sunt prezente \u00een propor\u021bie de 40% dintre pacien\u021bi diagnostica\u021bi cu CBP.<\/td>\n<\/tr>\n
            METASTAZE CEREBRALE<\/strong><\/td>\n<\/tr>\n
            Se manifest\u0103 prin: cefalee, vom\u0103, hemianopsie, hemiparez\u0103, convulsii \u0219i modific\u0103ri de personalitate.<\/td>\n<\/tr>\n
            METASTAZE HEPATICE<\/strong><\/td>\n<\/tr>\n
            Se manifest\u0103 prin fatigabilitate, sc\u0103dere ponderal\u0103 \u0219i astenie. Prezen\u021ba lor denot\u0103 un stadiu avansat de boal\u0103.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

            \u00a0Sindroamele paraneoplazice<\/h3>\n

            Sunt determin\u0103ri nonmetastatice ale cancerului. Se caracterizeaz\u0103 prin secre\u021bia de c\u0103tre tumor\u0103 a unor hormoni, peptide \u0219i pot precede cu c\u00e2teva luni decelarea tumorii. Dispar dup\u0103 tratament \u0219i reapar \u00een caz de recidiv\u0103. Acestea au o anumit\u0103 frecven\u021b\u0103 \u00een func\u021bie de tipul histopatologic al foma\u021biunii tumorale.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
            ENDOCRINE<\/strong><\/td>\n<\/tr>\n
            Ginecomastie, hipercalcemie \u2013 se manifest\u0103 prin grea\u021b\u0103, v\u0103rs\u0103turi, poliurie, polidipsie, anorexie \u0219i astenie, sindrom Cushing \u2013 secre\u021bie inadecvat\u0103 de ACTH, SIADH \u2013 secre\u021bie inadecvat\u0103 de ADH cu hiponatriemie sever\u0103.<\/td>\n<\/tr>\n
            HEMATOLOGIE<\/strong><\/td>\n<\/tr>\n
            Tromboflebit\u0103 migratorie, tulbur\u0103ri de coagulare (tromboflebit\u0103 superficial\u0103, tromboz\u0103 venoas\u0103 profund\u0103, trombembolism, coagulare intravascular\u0103 diseminat\u0103), anemie, leucocitoz\u0103, trombocitoz\u0103, eozinofilie.<\/td>\n<\/tr>\n
            CUTANATE \u0219i MUSCULOSCHELETALE<\/strong><\/td>\n<\/tr>\n
            Osteoartropatie hipertrofic\u0103, acanthosis nigricans, dermatomiozit\u0103 asociat\u0103 cu sl\u0103biciune muscular\u0103 \u00een centur\u0103.<\/td>\n<\/tr>\n
            NEUROLOGICE<\/strong><\/td>\n<\/tr>\n
            Neuropatie senzitiv\u0103 subacut\u0103, retinopatie, sindrom cerebelos, miopatie proximal\u0103, polimiozit\u0103, sindrom Eaton \u2013 Lambert care se manifest\u0103 prin astenie muscular\u0103 la nivelul centurilor membrelor.<\/td>\n<\/tr>\n
            RENALE<\/strong><\/td>\n<\/tr>\n
            Glomerulonefrit\u0103, sindrom nefrotic.<\/td>\n<\/tr>\n
            Altele: anorexie, sc\u0103dere ponderal\u0103, ca\u0219exie.<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

            \u00a0<\/strong>MESAJE PENTRU ACAS\u0102:<\/strong><\/p>\n

              \n
            • Focus pe medicina preventiv\u0103, elaborarea de programare de informare a popula\u021biei legate de efectele nocive ale fumatului, precum \u0219i m\u0103suri de preven\u021bie al CBP;<\/li>\n
            • Mortalitatea precoce \u00een cre\u0219tere.<\/li>\n<\/ul>\n

              BIBLIOGRAFIE:<\/strong><\/p>\n

                \n
              1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-249.<\/li>\n
              2. Hyde L, Hyde CI. Clinical manifestations of lung cancer. Chest. 1974 Mar;65(3):299-306.<\/li>\n
              3. Hirshberg B, Biran I, Glazer M, Kramer MR. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. Chest. 1997 Aug;112(2):440-4.<\/li>\n
              4. Athey VL, Walters SJ, Rogers TK. Symptoms at lung cancer diagnosis are associated with major differences in prognosis. Thorax. 2018 Dec;73(12):1177-1181.<\/li>\n
              5. Eren S, Karaman A, Okur A. The superior vena cava syndrome caused by malignant disease. Imaging with multi-detector row CT. Eur J Radiol. 2006 Jul;59(1):93-103.<\/li>\n
              6. Hiraki A, Ueoka H, Takata I, Gemba K, Bessho A, Segawa Y, Kiura K, Eguchi K, Yoneda T, Tanimoto M, Harada M. Hypercalcemia-leukocytosis syndrome associated with lung cancer. Lung Cancer. 2004 Mar;43(3):301-7.<\/li>\n
              7. List AF, Hainsworth JD, Davis BW, Hande KR, Greco FA, Johnson DH. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in small-cell lung cancer. J Clin Oncol. 1986 Aug;4(8):1191-8.<\/li>\n
              8. Sub redac\u021bia Cristian Oancea, Ovidiu Fira \u2013 Ml\u0103dinescu, Voicu Tudorache, Tratat de Pneumologie pentru medicii reziden\u021bi, Timi\u0219oara, editura Victor Babe\u0219, 2021.<\/li>\n
              9. Ariadna Petronela Filda, Ruxandra Ulmeanu, Florin Dumitru Mihaltan, Roxana Maria Nemes, Cancerul bronhopulmonar – recomadari de diagnostic \u0219i tratament, elaborat sub egida Socoetatii Romane de Pneumologie, Constanta, editura Muntenia, 2023.<\/li>\n
              10. Sub redac\u021bia Miron Alexandru Bogdan, Pneumologie, Bucure\u0219ti, editura universitar\u0103 Carol Davila, 2008.<\/li>\n<\/ol>\n\n\n

                <\/p>\n","protected":false},"excerpt":{"rendered":"

                \u00cen Rom\u00e2nia, 75% din persoanele care sunt diagnosticate cu cancer bronhopulmonar (CBP) sunt\u00a0 \u00een stadii foarte avansate ale bolii, inoperabili \u0219i pot primi doar tratament cu viz\u0103 paliativ\u0103. Boala apare mai frecvent dup\u0103 v\u00e2rsta de 50 de ani, cu o simptomatologie discret\u0103, ini\u021bial, iar mul\u021bi fum\u0103tori o pun pe seama tabagismului sau a altor probleme […]<\/p>\n","protected":false},"author":1,"featured_media":4912,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[29],"tags":[],"class_list":{"0":"post-4903","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-articole"},"acf":[],"_links":{"self":[{"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/posts\/4903","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/comments?post=4903"}],"version-history":[{"count":0,"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/posts\/4903\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/media\/4912"}],"wp:attachment":[{"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/media?parent=4903"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/categories?post=4903"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/neolife.ro\/baneasa\/wp-json\/wp\/v2\/tags?post=4903"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}