ACİL SERVİSTE İZLENEN KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞI VE AKCİĞER KANSERİ OLAN OLGULARIN ÖZELLİKLERİ

Öz

Acil servise başvuran kronik obstrüktif akciğer hastalığı (KOAH) ve akciğer kanseri birlikteliği olan olguların genel özelliklerini değerlendirmek. Hastanemiz acil servisine Ocak 2007-Haziran 2007 tarihleri arasında başvuran KOAH ve akciğer kanseri birlikteliği olan 86 olgunun kayıtları retrospektif olarak incelendi. Çalışmaya alınan 86 olgunun 6 (%6.9)'sı kadın, 80'i (%93.1) erkek olup yaş ortalaması 65.3 (37- 81) idi. Olgularn 76 (%88.3)'sı sigara içicisiydi ve ortalama 57.4 (0-150) paket/yılı sigara kullanma öyküsü vardı. Olgularımızda saptanan en sık semptomlar nefes darlığı (%100), öksürük (%88.3) ve balgam çıkarma (%40.6) idi. Daha az sıklıkta kilo kaybı (%40.6), göğüs ağrısı (%33.7) ve hemoptizi (%16.2) izlendi.Radyolojik olarak sıklıkla kitle lezyonu (%97.6), mediastinal ve/ veya hiler lenfadenopati (%83.7) ve atelektazi (%18.6) saptandı. Lezyonların en sık sağ üst lobda (%33.7) yerleştiği, bunu sağ hilus (%22.1) ve sol üst lobun (%20.9) izlediği görüldü. Patolojik tanı 43 (%36.9) olguda küçük hücreli dışı akciğer karsinomu (KHDAK), 14(%12.04) olguda squamöz hücreli akciğer karsinomu, 10 (%8.6) olguda adeno karsinomu, 1 olguda da büyük hücreli akciğer karsinomu ve 14 %16.4) olguda küçük hücreli akciğer karsinomu (KHAK) idi, 4 (%4.8) olguda patolojik tanıya ulaşılamadı. Olguların büyük çoğunluğu (63 olgu, %73.2) lokal ileri ve ileri evre hastalığa sahipti. Olguların 36'sına (%41.8) kemoterapi, 15'ine (%17.5) radyoterapi, 16Ôsına (%18.6) kemoterapi ve radyoterapi, 4'üne (%4.8) cerrahi tedavi uygulanmış olup, 15(%17.5) olgu semptomatik tedavi ile izlenmekteydi. KOAH'lı akciğer kanseri olgularının en sık acil başvuru semptomu nefes darlığı ve en sık acil başvuru nedeni solunum yetmezliği idi.

Anahtar Kelimeler

• Akciğer kanseri, KOAH, Acil servis

CHARACTERISTICS OF THE LUNG CANCER CASES WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE FOLLOWED IN EMERGENCY ROOM

Abstract

To evaluate the characteristics of the cases with chronic obstructive pulmonary disease (COPD) and lung cancer concurrently referred to emergency room. The data of 86 cases referred to emergency service with COPD and lung cancer concurrently between the dates of January and June 2007 were evaluated retrospectively. 80(93.1%) of cases were men and six (6.9%) were women, mean age was 65.3years(37-81). Seventy-six of cases (88.3%) were smokers. The most frequent symptom for referral to emergency room was dyspnea and it was present in all cases. Cough (88.3%), sputum expectoration (40.6%) and weight loss (40.6%) were other the most common symptoms. The most frequent radiological lesions were mass lesion (97.6%) and hilar and/or mediastinal lenfadenopathy (83.7%). Diagnosis of lung cancer was based on histopathology in 82 cases (95.2%) and clinic-radiologic findings dosyain 4 cases (4.8%). The most common cancer type was non small cell lung cancer (NSCLC) (n:43, 36.9%). 14(12.04%) caseses were squamöz lung cancer, 10 cases were adenocarsinoma and 14 cases were small cell lung carcinoma. When assessed in terms of organ metastasis, it was observed that the most frequent one was adrenal metastasis (8.0%). Chemotherapy was performed in 36 (41.8%) cases, radiotherapy in 15 (17.5%), surgery in 4 (4.8%) and 15 (17.5%) subjects were followed by symptomatic therapy. The most frequent symptom for referral was dyspnea and the most frequent cause for referral was respiratory insufficiency in COPD-patients with lung cancer.

Keywords

• Lung cancer, COPD, Emergency room

Kaynakça

1. 1. Pauwels RA, Buist AS, Calverley PM, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Obstructive Lung Disease (GOLD) Workshop Summary. Am J Respir Crit Care Med 2001; 163: 1256-76.
2. 2 Institute; NIH publication nr 03-5229. [NHLBI] National Heart, Lung, and Blood Institute Data Fact Sheet Chronic obstructive pulmonary disease (COPD). Bethesda, Maryland. US Dept Public Health and Human Services, National Institute of Health, National Heart, Lung, and Blood. 2003.
3. 3. Petty TL. Are COPD and Lung Cancer Two Manifestations of the Same Disease? Chest 2005; 128; 1895-7.
4. 4. Mannino DM, Aguayo SM, Petty TL, Redd SC. Low lung function and incident lung cancer in the United States: data from the First National Health and Nutrition Examination Survey follow-up. Arch Intern Med 2003; 163: 1475-80.
5. 5. Tockman MS, Anthonisen NR, Wright EC, Donithan MG. Airways obstruction and the risk for lung cancer. Ann Intern Med 1987; 106: 512–8.
6. 6. Lange P, Nyboe J, Appleyard M, Jensen G, Schohr P. Ventilatory function and chronic mucus hypersecretion as predictors of death from lung cancer. Am Rev Respir Dis 1990; 141: 613–7.
7. 7. Schwartz AG, Cote ML, Wenzlaff AS, Van Dyke A, Chen W, Ruckdeschel JC, Gadgeel S, Soubani AO. Chronic obstructive lung diseases and risk of non-small cell lung cancer in women. J Thorac Oncol 2009; 4(3): 291-9.
8. 8. Wasswa-Kintu S, Gan WQ, Man SF, Pare PD, Sin DD. Relationship between reduced forced expiratory volume in one second and the risk of lung cancer: a systematic review and meta-analysis. Thorax 2005; 60(7): 570-5.

9. 9. Wu AH, Yu MC, Thomas DC, Pike MC, Henderson BE. Personal and family history of lung disease as risk factors for adenocarcinoma of the lung. Cancer Res 1988; 48(24 Pt 1): 7279-84.
10. 10. Cohen BH, Diamond EL, Graves CG, Kreiss P, Levy DA, Menkes HA, Permutt S, Quaskey S, Tockman MS. A common familial component in lung cancer and chronic obstructive pulmonary disease. Lancet 1977; 10; 523-6.
11. 11. Demir A, Büyükflirin M, Polat G ve ark. KOAH çad›r›nda ölçülen SFT sonuçlar› ve KOAH risk faktörlerinin de¤erlendirilmesi. Türk Toraks Dergisi 2006;7: 23-8.
12. 12. Mannino DM. Chronic obstructive pulmonary disease:definition and epidemiology. Respir Care 2003; 48: 1185-91; discussion 1191-3.
13. 13. Sherman S, Guidat CE. Feasibility of thoracotomy for lung cancer in the elderly. JAMA 1987; 258: 927-30.
14. 14. Halilçolar H, Tatar D, Ertu¤rul G ve ark. Epidemiyoloji. Akkoçlu A, Öztürk C. Akci¤er kanseri multidisipliner yaklafl›m. Toraks Kitaplar› Say›: 1 Bilimsel T›p Yay›nevi; Ankara 1999: 7-14.
15. 15. Viegi G, Pedreschi M, Pistelli F, et al. Prevalance of airways obstruction in a general population: European Respiratory Society vs American Thoracic Society definition. Chest 2000; 117: 339-45.
16. 16. Mannino DM, Homa DM, Akinbami LJ, et al .Chronic obstructive pulmonary disease surveillance: United States,1971- 2000. Mor Mortal Wkly Rep CDC Surveill Summ 2002; 511-6.
17. 17. KOAH Çal›flma Grubu. Toraks Derne¤i Kronik Obstruktif Akci¤er Hastal›¤› Tan› ve Tedavi Rehberi, Toraks Dergisi 2000; 1(Ek 2).
18. 18. Beckles MA, Spiro SG, Colice GL, Rudd RM. Initial Evaluation of the patient with lung cancer. Symptoms, signs, laboratory tests, and paraneoplastic syndromes. Chest 2003; 123: 97-104.
19. 19. Bragg DG. The diagnosis and staging of primary lung cancer. Radiol Clin North Am 1994; 32(1): 1-14.
20. 20. Lisa JR, Trinidad S, Rosenblatt MB. Site of origin histogenesis and cytostructure of bronchogenic carcinoma. Am J Clin Pathol 1975; 44: 375-8.
21. 21. Sakarya ME, Özbay B, Arslan H, Uzun K, Ceylan E, Ödev K. Akci¤er Kanseri Tan›s›nda Konvansiyonel Radyografi ve Bilgisayarl› Tomografi Bulgular›. Van T›p Dergisi 1998;: 5: 161-5.
22. 22. Sider L. Radiographic manifestations of primary bronchogenic carcinoma. Radiol Clin North Am 1990; 28(3): 583-97.
23. 23. Schabath MB, Delclos GL, Martynowicz MM, Greisinger AJ, Lu C, Wu X, Spitz MR. Opposing effects of emphysema, hay fever, and select genetic variants on lung cancer risk. Am J Epidemiol 2005;16: 412-22.
24. 24. Koshiol J, Rotunno M, Consonni D, Pesatori AC, De Matteis S, Goldstein AM, et al. Chronic obstructive pulmonary disease and altered risk of lung cancer in a population-based case-control study. PLoS One 20098; 4: e7380.
25. 25. Janssen-Heijnen ML, Schipper RM, Razenberg PP, et al. Prevalence of comorbidity in lung cancer patients and its relationship with treatment: A population-based study. Lung Cancer 1998; 21: 105-13.
26. 26. Yancik R, Kessler L, Yates JW, et al. The elderly population: Opportunities for cancer prevention and detection. Cancer 1988; 62: 1823-8.
27. 27. Özgün MA, Karagöz B, Bilgi O, Kandemir EG, Türken O. Küçük Hücreli D›fl› Akci¤er Kanserinde Komorbiditenin Prognostik Önemi ve Di¤er Prognostik Faktörlerle ‹liflkisi UHOD 2009; 19: 63-8.
28. 28. Sin DD, Anthonisen NR, Soriano JB, Agusti AB. Eur Respir J 2006; 28: 1245-57.
29. 29. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009; 33: 1165-85.
30. 30. Wouters EF. Chronic obstructive pulmonary disease. 5. Systemic effects of COPD. Thorax 2002; 57: 1067-70.
31. 31. Agusti AG, Noguera A, Sauleda J, et al. Systemic effects of chronic obstructive pulmonary disease. Thorax 2004; 59: 574-80.
32. 32. Çilli A, Özdemir T, Özbulak Ö, Yak›flan A, Ö¤üfl C. Akci¤er kanserli hastalarda KOAH birlikteli¤i. Solunum 2003: 5: 20-4.
33. 33. Ernam D, Atalay F, Atikcan P. A retrospective evaluation of 571 lung carcinoma patients. Turkish Respiratory Journal 2003; 4: 67-9.
34. 34 Atikcan P, Pelit A, Bay›z H, Bapay N, Y›lmaz Turay Ü. Metastazlar›n tedavisi. In: Akkoçlu A, Öztürk C (eds). Akci¤er Kanseri Multidisipliner Yaklafl›m. Ankara. Bilimsel T›p Yay›nevi. 1999; 146-54.